NSG 3160 - Health Assessment Exam 2 Review/NSG 3160 - Health Assessment Exam 2 Review. Unit 3 Neurological System Chapter 5 Mental Status Assessment Defining Mental Status Mental status is a person's emotional (feeling) and cognitive (knowing) function. – Optimal functioning aims toward simul...
Mental status is a person's emotional (feeling) and cognitive (knowing) function.
– Optimal functioning aims toward simultaneous life satisfaction in work, caring
relationships, and within the self.
– Usually, mental status strikes a balance between good and bad days, allowing person to
function socially and occupationally.
. Mental health is “a state of well-being in which every individual realizes his or her own potential, can
cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution
to her or his community.” 27 Mental health is relative and ongoing. We all have days when we feel
anxious or depressed or feel as if we cannot cope. Usually these feelings dissipate and we return to
healthy function socially and occupationally.
• Mental status cannot be scrutinized directly like the characteristics of skin or heart sounds.
• Its functioning is inferred through assessment of an individual’s behaviors:
– Consciousness, language, mood, and affect
– Orientation and attention
– Memory and abstract reasoning
– Thought process, through content, and perception
• Consciousness: Being aware of one's own existence, feelings, and thoughts and of the
environment. This is the most elementary of mental status functions.
• Language: Using the voice to communicate one's thoughts and feelings. This is a basic tool of
humans, and its loss has a heavy social impact on the individual.
• Mood and affect: Both of these elements deal with the prevailing feelings. Affect is a temporary
expression of feelings or state of mind, and mood is more durable, a prolonged display of
feelings that color the whole emotional life.
• Orientation: The awareness of the objective world in relation to the self, including person, place,
and time. Attention: The power of concentration, the ability to focus on one specific thing
without being distracted by many environmental stimuli.
• Memory: The ability to lay down and store experiences and perceptions for later recall. Recent
memory evokes day-to-day events; remote memory brings up years' worth of experiences.
• Abstract reasoning: Pondering a deeper meaning beyond the concrete and literal.
, • Thought process: The way a person thinks; the logical train of thought.
• Thought content: What the person thinks—specific ideas, beliefs, the use of words.
• Perceptions: An awareness of objects through the five senses.
• Mental disorder
– Clinically significant behavioral emotional or cognitive syndrome that is associated with
significant distress (a painful symptom) or disability (impaired functioning) involving
social, occupational, or key activities
– is apparent when a person's response is much greater than the expected reaction to a
traumatic life event
– For example, major depression is characterized by feelings that are unrelenting or
include delusional or suicidal thinking, feelings of low self-esteem or worthlessness, or
loss of ability to function. 1
• Organic disorders
– Due to brain disease of known specific organic cause (e.g., delirium, dementia, alcohol
and drug intoxication, and withdrawal)
• Psychiatric mental illnesses
– Organic etiology has not yet been established (e.g., anxiety disorder or schizophrenia)
– Mental status assessment documents a dysfunction and determines how that
dysfunction affects self-care in everyday life.
Developmental Competence
Aging adults
Age-related changes in sensory perception can affect mental status along with chronicity of
disease process (presence of comorbidity).
Grief and despair surrounding these losses can affect mental status and can result in disability,
disorientation, or depression.
Older adulthood contains more potential for losses.
The aging process leaves the parameters of mental status mostly intact. There is no decrease in general
knowledge and little or no loss in vocabulary. Response time is slower than in youth; it takes a bit longer
for the brain to process information and to react to it. Thus performance on timed intelligence tests may
be lower for the aging person—not because intelligence has declined, but because it takes longer to
respond to the questions. The slower response time affects new learning; if a new presentation is rapidly
paced, the older person does not have time to respond to it. 20 Recent memory, which requires some
processing (e.g., medication instructions, 24-hour diet recall, names of new acquaintances), is somewhat
decreased with aging. Remote memory is not affected. Age-related changes in sensory perception can
affect mental status. For example, vision loss (as detailed in Chapter 15) may result in apathy, social
isolation, and depression. Hearing changes are common in older adults (see the discussion of
,presbycusis in Chapter 16). Age-related hearing loss involves high-frequency sounds. Consonants are
high-frequency sounds; therefore, older people who have difficulty hearing them have problems with
normal conversation. This problem produces frustration, suspicion, and social isolation and may make
the person look confused. The era of older adulthood contains more potential for loss (e.g., loss of loved
ones, job status and prestige, income, and an energetic and resilient body) than do earlier eras. In
addition, living with chronic diseases (e.g., heart failure, cancer, diabetes, osteoporosis) may increase the
fear of loss of independence or of death. The grief and despair surrounding these losses can affect
mental status. The losses can result in disorientation, disability, or depression. In a given year mental
disorders affect an estimated 18.3% of U.S. adults ages 18 years and older. A smaller group,
approximately 4.2%, suffers from a serious mental illness. 15 The global impact of mental illness is
enormous, with an estimated 14.3% of deaths worldwide being attributed to mental illness. 25 The
problem is lack of access to good-quality mental health services, both in the United States for poor,
homeless, uninsured, or underinsured people and in the rest of the world for low- and middle-income
countries. An estimated 76% to 85% of people with mental illness in lowand middle-income countries
and 35% to 50% of people with mental illness in high-income countries receive no treatment.
Components of the Mental Status Examination
• Full mental status examination is a systematic check of emotional and cognitive functioning.
• Usually, mental status can be integrated within the context of the health history interview.
• Four main headings of mental status assessment: A-B-C-T
– Appearance
– Behavior
– Cognition
– Thought processes
• It is necessary to perform a full mental status examination when any abnormality in affect or
behavior is discovered and in certain situations.
• You will collect ample data to be able to assess mental health strengths and coping skills and to
screen for any dysfunction.
When a Full Mental Status Examination is Necessary
• Initial screening
– Suggests an anxiety disorder or depression
• Behavioral changes
– Memory loss, inappropriate social interaction
• Brain lesions
– Trauma, tumor, cerebrovascular accident, or stroke
, • Aphasia
– Impairment of language ability secondary to brain damage
• Symptoms of psychiatric mental illness
– Especially with acute onset
In every mental status examination, note these factors from the health history that could affect your
interpretation of the findings:
• Any known illnesses or health problems such as alcohol use disorders or chronic renal disease.
• Current medications with side effects that may cause confusion or depression.
• The usual educational and behavioral level—note that factor as the normal baseline, and do not expect
performance on the mental status examination to exceed it.
• Responses to personal history questions indicating current stress, social interaction patterns, sleep
habits, drug and alcohol use.
In the following examination the sequence of steps forms a hierarchy in which the most basic functions
(consciousness, language) are assessed first. The first steps must be assessed accurately to ensure
validity for the steps to follow (i.e., if consciousness is clouded, the person cannot be expected to have
full attention and to cooperate with new learning). Or if language is impaired, subsequent assessment of
new learning or abstract reasoning (anything that requires language functioning) can give erroneous
conclusions.
Objective Data Normal Range of Abnormal Findings
Findings
Posture: Sitting on edge of chair or curled in bed, tense
Posture is erect, and position is muscles, frowning, darting and watchful eyes,
relaxed. and restless pacing occur with anxiety and
hyperthyroidism. Sitting slumped in chair, slow
walk, dragging feet occur with depression and
some organic brain diseases.
Body Movements: Restless, fidgety movement or hyperkinetic
Body movements are voluntary, appearance occurs with anxiety. Apathy and
deliberate, coordinated, smooth, psychomotor slowing occur with depression and
dementia. Abnormal posturing and bizarre
and even
gestures occur with schizophrenia. Facial
grimaces may occur with pain. Involuntary tics
can occur with neurologic disorders (e.g.,
Tourette syndrome, tardive dyskinesia
Dress: Inappropriate dress can occur with organic brain
Dress is appropriate for setting, syndrome. Eccentric dress combination and
season, age, gender, and social bizarre makeup occur with schizophrenia or
manic syndrome.
group. Clothing fits and is worn
appropriately.
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