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What is the first question you would ask if a pt. complains of depression?
- "Are you thinking about killing yourself?"
- if so,
- "What is your plan?"
- Important to assess feasability and seriousness of plan.
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T/F Mental status is an objective assessment?
F. It's both subjective and objective because it is inferred through an individual's behavior.
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When would you want to obtain a mental status assessment?
- To obtain a baseline (family may need to help fill in gaps).
- When there is a Behavior change
- Brain lesions (trauma, tumor, brain attack)
- Aphasia (secondary to brain damage)
- Symptoms of psychiatric mental illness
- A,B,C,T abnormalities:
- Appearance
- Behavior
- Cognition
- Thought processes
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Objective Data for the Mental Health Assessment
- Appearance:
- Posture
- Body movements, are they smooth, easy, natural?
- Dress, is it appropriate for their peer group?
- Grooming and hygiene
- Behavior:
- LOC?
- Facial expression, is it appropriate to setting/questions?
- Speech, any dysphasia?
- Mood and affect. Mood=general feelings about life, affect=feelings right now.
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What are the components of the minimental exam?
- J= Judgment: What would you do if you saw someone collapse in the street?
- O=Orientation: Name, location, date, time
- M= Memory: 3 unrelated words at 1 & 5 minutes, recent & past events
- A= Appearance: Posture, body movements, dress, grooming/hygiene
- C= Calculation: Subtract serial sevens from 100
- S= Speech: Quality, Rate, Articulation, Word choice
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What are some various levels of consciousness?
- Alert and oriented: A,A,Ox4
- Lethargic (somnolent): Drowsy, but responds to name, slow response, ↓spontaneous movements
- Obtunded: Difficult to arouse, confused, needs constant stimulation
- Stupor or semi-coma: Unconscious but able to arouse with pain, language impaired, +reflex activity
- Coma: Unconscious, no response to pain
- Acute confused state (delirium): clouded consciousness, incoherent, agitated, disoriented
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Delerium vs. Dimentia...
- Delirium:
- Acute onset
- Young or old
- Causes: infection, intoxication, withdrawal, hypoxia, F&E imbalance, post head trauma, postop
- Dementia:
- Gradual onset
- More common in elderly
- Causes: Alzheimer’s, Parkinson’s, CVA, HIV, head trauma
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Developemental considerations for Mental Status in Aging Adults
- No decrease knowledge or vocabulary
- Slowed response time
- Decrease in recent memory
- No change in remote memory
- Multiple losses can affect mental status and cause disorientation, depression and disability.
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Who is most at risk for suicide?
Men over 65 yrs.
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