General Survey and Mental Status Exam Review

General Survey and Mental Status Exam

Instructors

  • Brandi Peachey, DNP, FNP-BC, CNE
    Nese College of Nursing, Penn State University Nursing 251

Objectives

  • Describe the general survey of a patient encounter.

  • Describe and identify the four components of a mental status assessment.

General Survey and Measurement

  • General Survey

    • This is the FIRST PART OF PHYSICAL ASSESSMENT!

    • Focuses on the study of the whole person.

    • Serves as an introduction for the physical examination that will follow.

    • Provides an overall impression of the person.

    • Begins with direct observation of the patient.

Components of General Survey

  • Physical Appearance

    • Age: The patient should appear their stated age.

    • Level of Consciousness: Assessment is made upon first glance to determine alertness.

    • Overall Appearance: Watch for any signs of distress.

  • Body Structure

    • Stature/Height for Age: Evaluates whether the height and weight are appropriate for age, includes nutrition, posture, and position.

    • Mobility: Assess the patient's gait and ability to move independently.

  • Behavior

    • Includes facial expressions, mood, speech, and dress.

Measurements

  • Weight

    • Use a standardized balance or electronic standing scale.

    • Remove shoes before measuring.

  • Height

    • Measure height using a wall-mounted device.

Special Considerations

  • Head Circumference: Important measurement for infants.

Abnormalities in Body Weight and Proportion

  • Dwarfism

    • Hypopituitary dwarfism: Due to inadequate growth hormone.

    • Achondroplastic dwarfism: Genetic disorder affecting bone growth.

  • Gigantism vs. Acromegaly (Hyperpituitarism): Differentiating conditions due to excess growth hormone.

  • Anorexia Nervosa: Eating disorder characterized by an aversion to food and extreme weight loss.

  • Endogenous Obesity: Associated with Cushing’s syndrome, characterized by excessive cortisol.

  • Marfan Syndrome: Genetic disorder affecting connective tissue leading to tall stature and long bones.

Mental Status Examination

  • The mental status exam assesses a person’s emotional and cognitive functioning. Optimal mental functioning includes satisfaction in work, relationships, and self-perception.

Key Components of Mental Status Exam
Components to Identify

  1. Appearance

    • Posture: How the person presents themselves physically.

    • Body Movements: Smoothness and integrity of movement.

    • Dress: Appropriateness of clothing.

    • Grooming and Hygiene: Personal care and cleanliness.

    • Pupils: Check for anisocoria (unequal pupil sizes).

  2. Behavior

    • Level of Consciousness:

      • Alert: Fully awake.

      • Lethargic: Not fully alert; may drift off and appear drowsy.

      • Obtunded: Difficult to arouse.

      • Stupor: Spontaneously unconscious.

      • Coma: Unresponsive state.

    • Speech:

      • Rate, volume, and clarity of speech.

    • Mood & Affect: Observed emotional state.

  3. Cognition

    • Orientation:

      • Assess person, place, and time.

      • Example questions:

      • What is your name?

      • Where are we today?

      • What is the date today?

    • Memory:

      • Recent Memory: 24-hour recall (e.g., last meal, recent activities).

      • Remote Memory: Recollection of past significant events (e.g., childhood experiences).

      • New Learning: 4 unrelated words test that assesses immediate and delayed recall.

      • Example: Ask a person to recall 4 diverse words after intervals of 5, 10, and 30 minutes.

      • Normal response for adults younger than 60 is recalling 3 or 4 words.

  4. Thought Processes

    • Evaluate if the individual’s speech and thought patterns are consistent and logical.

    • Screen for mental health issues, such as anxiety and depression.

    • Assess judgment: Ability to compare alternatives and plan actions based on evaluations of situations.

      • Example questions to assess judgment may include inquiries about career plans or future goals.

Supplemental Mental Status Examination

  • Mini-Mental State Exam (MMSE): Focuses on cognitive function through an 11-question format, typically completed within 5 to 10 minutes.

Screening Tests for Various Age Groups

  • Infants and Children:

    • Denver II screening test: Facilitates childhood interaction to assess mental status.

    • Behavioral Checklist: For parents of school-age children (ages 7 to 11) to observe behaviors relevant to mental status and development.

  • Adolescents: Apply similar A-B-C-T guidelines used for adult assessments.

Developmental Competence in Aging Adults

  • Important to assess sensory status (vision and hearing) prior to conducting a mental status assessment as age-related changes can complicate results.

  • Conditions such as confusion are common among older adults and can often be misdiagnosed.

  • Delirium may occur during acute illnesses or infections (e.g., urinary tract infections), while dementia reflects a gradual decline in cognitive abilities.

Case Study Examples in Mental Status Assessment

  • Questions on Differentiating Symptoms:

    • Example patient profiles to analyze confusion and memory issues, emphasizing the distinction between delirium (acute) and dementia (chronic).

Practice Questions Involving Mental Assessment Scenarios

  • Communication Techniques in Assessments: Evaluate responses in terms of therapeutic and non-therapeutic communication actions during patient encounters.

  • Closed-Ended Questions: Identify examples from health history gathering that limit responses and ensure information accuracy.

  • Physical Assessment Elements: Recognize components that should be included within a general survey and mental status assessment.

Study Tips and Concluding Thoughts

  • Recommended to prioritize sleep while studying.

  • Parting words focus on the importance of collaboration and support among peers.

Ethics and Practical Implications

  • The mental status assessment offers significant insight into patients' cognitive abilities, which is crucial for providing appropriate care and ensuring effective communication.

  • Understanding the nuances of mental status and behavioral assessments enhances patient evaluations in various healthcare settings.