NR 548 Week 6 Exam 3 - Review

-physical appearance • distinguishable markings; scars or tattoos -facial expressions level of alertness -attitudes -Self-esteem -Personal statement MSE: Behavior how the client presents themselves during the examination -eye contact -psychomotor activity • increased or decreased -movements -mannerisms -stereotypies -posturing -how the client responds to the exam • responses appropriate to topics? • sit still through exam? -gait -movements • coordinated, slowed, excessive MSE: Speech Assess general speech qualities: -rate • fast, rapidly, slowly -rhythm • monotone or slurred -latency -volume • soft, normal, or loud -content -increased or decreased pauses between questions and answers? -General quality individual who presents with an extremely rapid and pressured speech with constant interruptions may be experiencing __________ or __________ hypomania or mania An absence of speech is seen with some diagnoses such as ___________ dementia -evaluation of a client's level of awareness, attention, concentration, and memory -Awareness: observation with emphasis on the client's eyes and speech -alertness or wakefulness provides information about cognitive function • help rule out potential substance use or intoxication -levels of awareness: alert and oriented, somnolent, drowsy, or even comatose -Attention and concentration: observation of responses during the interview • can they stay on topic? • able to focus and respond to Q's? • can use standardized tools such as the Mini-Mental State Exam (MMSE), digit span test and the SSST -Memory assessment: immediate recall, short-term, and long-term memory • particularly important when ruling out dementia or Alzheimer's disease • Stress, anxiety, and depression can also impact memory • orientation, three-object recall -Mini-Cog exam is commonly used to help rule out significant cognitive issues Two attention and concentration assessments digit span test -patient is given 5-7 numbers & asked to repeat them forward and backward SSST -pt asked to subtract 7 from 100 and to continue counting back by 7s until told to stop *research studies have not endorsed them -SSST given to 132 normal adults, only 42% with errorless performance -325 hospitalized psychiatric pts given SSST, no diff. in performance from 50 healthy control subjects -Digit span test among 60 elderly pts with memory impairment and 44 elderly who were healthy found no difference MMSE -Mini-Mental State Exam -30-point questionnaire -measures cognitive impairment in the areas of orientation, attention, memory, language, and visual-spatial skills -method of monitoring deterioration over time -age, education, and visual or hearing impairment may impact scores • Most studies have defined poorly educated as 8 or fewer years of education—that is, no high school -sensitivity of the test is high, specificity is low Interpret a mini-cog score • William Shakespeare, writer • Christopher Columbus, discovered America -Famous dates • When did World War II happen? (Any time in the 1930s or 1940s is adequate.) • When was John F. Kennedy assassinated? (Sometime in the 1960s.) -Lists of information • screening for dementia is the set test: patient to name as many items (up to ten) as he can recall in each of four categories: colors, animals, fruits, and towns; max of 40, score of 25