202 Exam Review The Interview, General Study, and Mental Status Assessment

What are the two types on communication?

Verbal communication- the words you speak and tone you speak

Non-verbal communication- body language, unconscious messages

The interview is the __________

first point of contact

What does the interview teach us?

It is the best chance to gain an understanding of the pt concerns, beliefs, and perceptions of their individual health state.

It allows for collection of subjective data and awareness of objective data.

What is a good practice when receiving communication?

Gestures are as important as words. Be aware of the conversation and perception of the message.

What internal factors can affect communication?

Liking others and using a genuine approach

Empathy by developing an understanding and sensitivity for others feelings

Ability to listen and use active listening

Being self aware of your own bias

What external factors can affect communication?

Privacy

Interruptions

Physical Environment (Equal Status Seating)

Your apparent and comfort

Note- taking (stay focused on the conversation not the notes)

What is EHR?

The Electronic Health Record

The federal government requires use of EHR

DO NOT LET THIS BECOME A BARRIER OF COMMUNICATION

What are some techniques of the communication during the interview?

When introducing the interview- keep it short and formal

Verbal skills include questions to patient and your responses to what is said.

OPEN ENDED QUESTIONS

What is facilitation?

encouraging patients to say more

What is silence?

Directed attentiveness, silence says a lot

What is reflection?

echoes to help express meaning, putting the question in different words aimed to get more out of the patient

What is empathy?

Naming a feeling and allowing the patient to express their feelings

What is confrontation?

clarifying inconsistent information, ask about inconsistencies

What is interpretation?

makes association to identify causes or conclusions

What is explanation?

informing person by sharing factual and objective information

What is summary?

provides conclusion based on verified information which in turn identifies that the interview process is closing

10 Traps of Interviewing

1. providing false assurance

2. giving unwanted advice

3. using authority

4. using avoidance language

5. distancing

6. using professional jargon

7. using leading or biased questions

8. talking too much

9. interrupting

10. using “why” questions

What are some nonverbal modes of communication?

Physical Appearance

Posture

Gestures

Facial Expressions

Eye Contact

Voice

Touch

How should you close the interview?

Dont introduce new topics

Slowly come to close and allow for final expression

Summary as a final statement

What do you do when interviewing a child or infant?

Focus on both patient and caregiver

Obtain relevant data

Use their names

Be aware of non verbal clues

Consider the maturity level of the child

What changes should you make with a older adult?

Be respectful

Therapeutic touch to provide empathy

Cut out more time due to physical limitations, hearing loss, processing

What changes should you make when interviewing people with special needs?

Consider key elements what will address populations

Cut out distractions

What is a general survey?

The study of a whole person

Provides an overall impression

Includes objective parameters that apply to the whole body such as physical appearance, body structure, mobility, and behavior

What objective data should you note with physical apparence?

Age- do they look their age

Sex- is their development appropriate

LOC: alert and oriented x4

Skin color: even, skin intact, no lesion

Facial Features: symmetric with movement

Overall Appearance: provide general statement, presence or absence or distress

What objective data should be noted with body structure?

Stature: height appears in normal range

Nutrition: wight appears in normal range

Symmetry: body parts look equal and proportionate

Posture: stands/sits comfortably

Position: how are they during the assessment

Body, build, contour: proportions and note any deformities

What objective data should be noted with mobility?

Gait: base is shoulder width

Foot placement: accurate, walk is smooth, arm swing is symmetric

ROM: full mobility of joints, movement is deliberate, coordinated

No involuntary movements W

What objective data should be noted with behavior?

Facial Expression: person maintains eye contact, expressions are appropriate

Mood and affect: comfortable and cooperative, interacts pleasantly

Speech: articulation is clear, look at patterns and word choices

Dress: appropriate to climate, good for age group, think about culture too

Personal hygiene: clean and groomed, take culture to account

How should objective data should be noted with weight?

Use a standard balance or scale

Remove any heavy items

Wt in KG and LBS

Compare weight to previous visits

Abnormalities in Body Height and Proportion

Dwarfism- short extremities

Gigantism- too big

Anorexia nervosa- dont eat

Bulimia Nervosa- throw up

Marfan Syndrome- tall and thin with long arms, legs, fingers and toes.

Mental health is assess by the following individual behaviors:

Consciousness, language, mood, affect

AOX3… person, place, time, event/situation

memory or abstract reasoning

thought process content and perceptions

What is a mental disorder?

Clinically significant behavioral emotional or cognitive syndrome that is associated with significant distress or disability involving social, occupational, or key activities

What are the two types of metal disorders?

Organic Disorders- due to brian diseases like dementia or withdraw

Psychiatric Mental Illness- causes dysfunction in daily life with no organic etiology established like anxiety

What considerations do we need to note in infants and childen?

Age and developmental stage of the child

Critical issues such as suicide in adolescents

What considerations do we need to note with aging adults?

Age related sensory changes- sight, vision…

Grief and despair

How can genetics and environment play into the genral survey?

family histories

genetic components of diseases like alzheimer’s

food insecurity

social risk factors

what are considerations for sexual and gender minorities?

stigma and rejection

higher mental health risk

need social acceptance

give them support and referrals when needed

What are the four main heading for metal status assessments

ABCT

Apparence

Behavior

Cognition

Thought Processes

When is a full mental status assessment necessary

If the initial screening suggest anxiety or depression

Major behavioral changes such as memory loss

Brain lesions from trauma, tumors…

Aphasia- impairment of language ability

Symptoms of Psychiatric mental illness

What factors could affect interpretation of findings?

Known illness or health problems (alcoholism)

Medications (side effects of confusion or depression)

Educational/ Behavioral Level (know their baseline)

Stress responses observes in sleep, social interactions

How do we collect objective data?

Address key areas such as ABCT

Additional screenings as needed

Determine normal vs abnormal findings

Document all abnormalities

Obtain baseline

What objective data would be noted with appearance?

Posture- erect and relaxed

Body Movement- voluntary, coordinated, smooth, even

Dress- appropriate for setting, seaon, age, social group

Grooming/ Hygiene- appropriate for age and culture

Pupils- note size and reaction to light

What objective data should be noted with behavior?

LOC- awake and alert, responds to stimuli (person, place, event, time)

Facial Expressions- appropriate to situation and changes with topic

Speech- noting if it is effortless and appropriate word choice

Mood and Affect- judge by body language and facial expression

Different Mood and Affects

Flat- lack of emotion

Depression- done feel anything, sadness and gloom

Depersonalization (lack of ego boundaries)- loss of identity, “i dont feel real”

Elation- joy and happiness

Euphoria- excessive well being, unusually cheerful

Anxiety- worried and uneasy, danger not known

Fear- external danger is known and identified

Irritability- annoyed, impatient

Rage- furious, very angry, loss of control

Ambivalence- opposing emotion towards object, idea or person

Lability- rapid shifts in emotions

Inappropriate affect- discordant with speech and communication

What do you need to check when assessing cognitive function?

Orientation- time, place, person, event

Attention Span- ability to concentrate, impaired by anxiety or intoxication

Recent memory- what did they have for breakfast

Remote memory- describe their first job.. far back memory

What is the 4 unrelated words test?

Highly sensitive and valid memory test, tell them four words that are unrelated and different and ask them to remember the words at 5 minutes, 10 minutes, and 30 minutes.

What is aphasia?

loss of ability to speak or write coherently or to understand speech or writing due to a cerebrovascular accident

How do you screen for anxiety disorders?

Generalized anxiety disorder scale (GAD-7)

Higher the score, greater the likelihood of anxiety

Greater or equal to 3 indicates anxiety

How do you screen for depression disorders?

Patient Health Questionnaire-2 (PHQ-2)

only ask 2 questions about depressed mood and lack of interest, if one of these is present, then move on with the next questions

PHQ-9

series of 9 questions, higher the score the greater likelihood of functional impairment

How do you screen for suicidal thoughts?

Be straight up, ask them

YOU may be the only health professional to pick up clues suicide risk

What is judgement?

the ability to compare and evaluate alternatives and reach an appropriate course of action

What is the Mini-Mental State Exam (MMSE)?

Concentrates only on cognitive function

Standard set of 11 questions

Only takes 5-10 minutes

What is the Montreal Cognitive Assessment (MoCA)?

examines more cognitive domains and is more sensitive to mild cognitive impairments

10 mins to administer

total score of 30 with a score of greater or equal to 26 considered normal

What should you check in aging adults mental assessment?

Check sensory status, vision, and hearing before any aspect of mental status.

Confusion is common and is easily misdiagnosed.

Present of delirium can have serious affects.

What special considerations should you take for aging adults?

Aging persons may be considered oriented if they know generally where they are and the present period.

In people of normal cognitive function, age-related decline occurs in performance in the Four Unrelated Words Test.