Chapter 5 Notes (Mental Status) ⭐..

Mental status ⇒ Cognitive + Emotional

Key Concepts

• All assessments moving forward will and must include mental status.
• Mental, emotional, cognitive function affects everything.
• Aging adults → comorbidities, grief, chronic pain can worsen mood/mental state.
• Mental disorders affect social life and appearance.

Mental Assessment (ABCT)

Appearance, Behavior, Cognition, Thought Process

1. Appearance
• Posture → relaxed, no involuntary movement.
• Dress → appropriate for setting, and person.
• Grooming & hygiene → clean, odor-free.
2. Behavior
1. Facial expression.
2. Speech → clarity, slurring, articulation, pacing, word choice.
3. Mood & affect → body language + appropriateness.

🧠 Levels of Consciousness (Glasgow Coma Scale)

1. Alert – Fully awake and oriented. Aware of self and surroundings, responds appropriately, and can hold normal conversation without extra stimulation.
2. Lethargic (Somnolent) – Drowsy, not fully alert. Arousable to voice in normal tone, but drifts back to sleep. Responds appropriately, though slow, distracted, or forgetful.
3. Obtunded – Sleeps most of the time and difficult to arouse. Requires loud voice or vigorous shake. When aroused, speech may be confused, short, or mumbled. Needs repeated stimulation to remain cooperative.
4. Stupor (Semi-Coma) – Spontaneously unconscious. Arousable only with persistent or painful stimuli. May withdraw from pain or make sounds (groans, mumbles), but shows no sustained or purposeful activity. Reflexes intact.
5. Coma – Completely unconscious, not arousable by any voice or pain.
• Light coma: some reflexes present, no purposeful movement.
• Deep coma: no reflexes or motor response.
6. Delirium (Acute Confusional State) – Clouded consciousness. Arousable but inattentive, easily distracted. Disoriented, with poor memory, incoherent speech, or hallucinations. Symptoms often worsen at night.

1. Cognition
• Orientation → Time → Place → Person.
• The order of disorientation is typically time, then place, and finally person, particularly in cases of progressive neurological conditions like Alzheimer's disease
• Attention span → ability to concentrate.
• Memory:
• Recent → 24-hour recall (only ask about things that you can verify, like questions about things that happened after admission)
• Remote → past events, presidents, anniversaries, etc. (only ask about things that you can verify)
• Four Unrelated Word Test → It test for “New Learning”. A person is given four random words, does a simple distraction task, and then must recall the words after a few minutes. It’s a quick, reliable way to see how well someone can form new memories and can help detect problems like dementia.
• Aphasia types → Broca (expressive), comprehension vs production issues.
• Broca’s area → affects speech. Commonly damaged in strokes or tumors. The person knows what they want to say, but cannot speak or express it clearly. Often, speech and writing are both impaired, and multiple communication problems occur together.
2. Thought Process
• Logical, consistent, able to complete thoughts.
• Content → logical & relevant.
• Perception → assess reality orientation.
• Can you walk to the Bahamas ?

Concepts:

• Abstract reasoning: Deep thinking. 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. Being aware of surroundings.

Mental Disorders

• Dementia, depression, anxiety → must be screen.
• Anxiety, measured with GAD-7. ≥3 minor anxiety
• Depression, PHQ-2 test.
• Suicide risk:
• Have you consider hurting yourself or others?//Avoid word “suicide,” ask about harming self or others.
• Always ask and take the answers of pt. seriously, even if they say it like joking. No-one jokes with suicide.
• If yes → suicide watch until psychologist evaluates them.
• Test : ASQ (Ask Suicide-Screening Questions)

The Mini-Cog.  The Mini-Cog is a reliable, quick, and easily available instrument to screen for cognitive impairment in otherwise healthy older adults. You make them draw a clock. A score of <3 is indicative of dementia

OPO (Maybe not on test, but she talked about it in class)

Organ Procurement Organization" (OPO). An OPO is a federally designated, non-profit organization responsible for coordinating the donation and recovery of organs and tissues from deceased donors for transplantation.

OPOs serve as the vital link between a donor and a patient in need of a life-saving transplant.

• Factors that affect assessment:
• Alcohol intoxication.
• Medications & idiosyncratic reactions → Sometimes a medication meant to calm or reduce pain causes the opposite effect. Instead of becoming calm, the patient may react unusually by becoming excited, restless, or irritable.
• Judgment → compare, evaluate alternatives, logical decision-making.
• Case studies → review from PowerPoint.