Mental Health HA Exam #2

physical appearance, body structure, mobility, behavior
looking as soon as you walk in
high five and shaking hand can assess mobility

appearance
behavior
cognition
thought processes

appears stated age
appears older than stated age
appears younger than stated age

appears stated sex
What about transgendered?

pink regardless of ethnicity
note ethnicity
even skin tone
document piercings and tattoos, for multiple tattoos can say sleeve on left leg etc

symmetrical
note any abnormality
asymmetrical -> stroke, Bell's Palsy

tall, short, erect
tripoding ->COPD sitting with elbows on knees to gain breath
slump shoulder

gait, range of motion

a person's emotion and cognitive functioning

life satisfaction
work satisfaction
caring relationships
self satisfaction

good and bad days
social function
occupation function

2-6 months to overcome
over that it becomes unhealthy

through the assessment of behaviors:
consciousness
language
mood and affect
orientation
attention
memory
abstract reasoning
thought process
thought content
perceptions

being aware of one's own existence, feelings and thoughts and of the environment
the most elementary of mental status functions

using voice to communicate one's thoughts and feelings
this is basic tool humans and its loss has heavy social impact on the individual

mood is prolonged display of feelings
affect is temporary expression of feelings -> blunted, short, overdramatic, flat, hypervigilant (parents with baby)
both deal with prevailing feelings

awareness of the objective world in relation to the self including person, place and time

power of concentration, the ability to focus on one specific thing without being distracted by many environmental stimuli

ability to lay down and store experiences and perceptions for later recall

pondering a deeper meaning beyond the concrete and literal

the way you think
logical train of thought

what you think
specific ideas, beliefs, the use of words
maybe not in reality

awareness of objects through the 5 senses

Alert
Lethargic (somnolent)
Obtunded
Stupor or semi coma
Coma

awake, oriented, meaningful interactions
first thing documented it alert and then orientation
disorientation goes in reverse order of person, place, time

hearing
can hear even when not fully conscious

not fully alert, drifts to sleep, aroused when name is called verbally
loses train of thought

sleepy, difficult to arouse (should or vigorous shake)
confused when aroused
speech may be mumbled or incoherent

unconscious
aggressive sternal rub
only groan, mumble, move restlessly
appropriate motor response

completely unconscious, no response to pain or stimuli
light coma -> some reflex activity, no purposeful movement
deep coma -> no motor response

a systematic check of emotional cognitive functioning
can be assessed in the context of the health history interview

Appearance (A)
Behavior (B)
Cognition (C)
Thought processes (T)

posture
body movements
dress
groom and hygiene
pupils

level of consciousness
facial expressions
speech
mood and affect

orientation
attention span
recent and remote memory
new learning -- 4 unrelated words test

thought content
perceptions
screen for anxiety, depression and suicidal thoughts

into health history is usually sufficient

behavior changes
memory changes
brain lesions (trauma, tumor, stroke) -> disoriented to point where don't know where they are
aphasia (secondary to brain damage)
symptoms of psychiatric mental illness
family concerns about their family member

expressive aphasia: can understand language but cannot use language effectively

receptive aphasia: can hear sounds and words but cannot relate them to previous experiences

appropriate for setting, season, age, gender and social group

clean and well groomed
disheveled appearance in previously well groomed person is significant
some people dress disheveled all the time, address changes

clothing that is disheveled
piercings and tattoos
economic status
deliberate fashion trends

person is awake, alert, aware
responds appropriately

appropriate to situation
changes appropriately with topic

shares conversation appropriately (for age)
pace is moderate
articulation is clear and understandable
word choice is effortless, appropriate for education level
person completes sentences, pauses to think

judge by:
body language
facial expressions
"How do you feel today?"
mood should be appropriate to person's place and condition

confirm orientation through interview

day of week, date, year, season

where person lives, address, phone number, present location, type of building, name of city and state

name, age, type of worker

"Awake, Alert and Oriented to person, place and time"
oriented to time, place, person
oriented to person, not time or place
oriented to person and place, not time

completes a thought without wondering

assess 24-hour diet recall or by asking time person arrived at agency
ask questions you can answer

verify historical events
birthday/anniversary dates

ability to compare and evaluate alternative and reach an appropriate course of action
test on daily or long-term goals
note what person says about job plans, social or family obligations, and plans for the future
ask for rationale for his or her health care (compliance/decision making)
**All thoughts/plans should be logical and realistic

highly sensitive and valid memory test
pick four words with different sounds
ask person to remember the four words
be certain of understanding (ask patient to repeat)
ask for the recall 5, 10, 30 minutes

loss of ability to speak, write coherently or understand speech

point to articles and have patient name them

ask person to read available print (Can patient read)

ask person to write a sentence; note coherence, spelling

mandatory regulatory requirement
begin with more general questions-probe if needed

Have you ever felt so blue you thought of hurting yourself or do you feel like hurting yourself now?
Do you have a plan to hurt yourself? How would you do it?
What would happen if you were dead?
How would other people react if you were dead?