NUR 2730 Mental Status and Neuro Assess Spr 25 - Tagged

Primary Sensory and Motor Cortex

• Primary Sensory Cortex (Postcentral Gyrus)

• Primary Motor Cortex (Precentral Gyrus)

• Somatic Motor Association Area (Premotor Cortex)

• Somatic Sensory Association Area

• Visual Cortex and Association Area

• Wernicke's Area (understands speech)

• Broca's Area (produces speech)

• Auditory Cortex and Association Area

• Prefrontal Cortex

Importance of Mental Health Assessments

• Recognizing Mental Disorders

  • Health care providers may overlook subtle indicators of mental illness.

  • Nursing staff must actively screen for signs of mental illness and risky behaviors.

  • Empathic listening and careful observation are critical to understanding the patient’s mental state.

Challenges in Nursing Assessments

• Multiple Mental Disorders

  • Many patients experience various mental disorders simultaneously; symptoms may resemble physical illnesses.

  • Failure to adequately assess can jeopardize patients' health, function, and quality of life.

Understanding Patient Symptoms

• Types of Symptoms

  • Psychological symptoms (mood or anxiety-related)

  • Physical symptoms (body sensations)

  • 30% of symptoms may be medically unexplained.

  • Functional syndromes often co-occur with similar symptoms.

Health Promotion and Screening Tools

• Key Screening Tools:

  • Depression: PHQ-2 and PHQ-9

  • Suicide Risk: ASQ (Ask Suicide-Screening Questions)

  • Alcohol Use: AUDIT (Alcohol Use Disorders Identification Test)

  • Substance Abuse: DAST-10 (Drug Abuse Screening Test-10)

  • Dementia: MMSE (Mini Mental State Exam)

Personal Identity and Orientation

• Orientation Assessment

  • Awareness of personal identity, time, and place is critical.

  • A & O × 4: assesses awareness of person, place, time, and event.

  • Level of Consciousness:

    • Alertness or response to stimuli; can be measured using the Glasgow Coma Scale (GCS).

Levels of Consciousness

• Hierarchy of States:

  • Normal

  • Confused

  • Delirious

  • Somnolent (lethargic)

  • Obtunded

  • Stuporous

  • Comatose

Health History Assessment Techniques

• General Survey

  • Initial observations of alertness and orientation should guide the assessment.

  • Engage in social conversation to evaluate mood, insight, judgment, and peculiar thoughts.

Mood Assessment

• Various emotional states to assess:

  • Sadness vs. deep melancholy

  • Contentment, joy, euphoria, elation

  • Anger or rage

  • Anxiety or worry

  • Detachment or indifference

Observational Skills in Assessment

• Appearance and Behavior:

  • Awake and alert vs. lethargic or confused.

  • Assess posture, motor function, grooming, and hygiene.

  • Observe facial expressions and affective responses regarding appropriateness.

Speech and Language Evaluation

• Components to Note:

  • Quantity of speech: talkative vs. silent.

  • Rate: speed of speech (fast/slow).

  • Articulation: clarity of words, presence of dysarthria or aphasia.

  • Fluency: smoothness and flow of speech.

Mini-Mental State Exam Components

• Exam Structure:

  • Orientation: Questions regarding time and place.

  • Registration: Name 3 objects, recalled later.

  • Attention and Calculation: Serial 7s or spelling.

  • Language: Naming objects, following commands, writing sentences, and copying designs.

Levels of Consciousness Assessment

• Monitoring Responses

  • Judging the patient's state should guide further interventions.

  • Drowsy patients who respond to questions may fall into lethargic or obtunded categories.

Neurological Assessment Strategies

• General Considerations:

  • Look for signs of neurologic impairment throughout the interview and examination.

  • Assess cranial nerves (I-XII) functionality during assessment.

  • Peruse muscle strength, coordination, and reflexes during assessment.

CNS Structure and Function

• Key Components:

  • Cranial Nerves: 1-12 with specific functions listed.

  • Techniques for understanding their functionality, utilizing tools such as mnemonics.

Problem-Based Health History Assessment

• Common Issues

  • Headaches, dizziness, neurasthenia/weakness, sensory loss, and potential CNS disorders.

  • Approach each complaint systematically (e.g., OLDCART for headaches).

Motor System Overview

• Involuntary Movements and Patterns

  • Observe for tremors and note attributes like location, amplitude, etc.

  • Coordination requires integrated functioning of motor, cerebellar, vestibular, and sensory systems.

Reflexes and Their Significance

• Grading Reflexes:

  • Scale from 0 (no response) to 4+ (hyperactive with clonus).

  • Assess reflexes to better understand neurological function.

Documentation Strategies

• Sample Final Documentation

  • Capture findings regarding alertness, cranial nerves, muscle strength, gait, and sensory integrity.

Health Promotion: Stroke Prevention

• Understanding Stroke Risks

  • Educate on 5th leading cause of death and risks associated.

  • Recognize signs (BEFAST acronym) to promote timely intervention and awareness.