Mental Status Assessment nursing

Mental Status and Neurological

There are six general components of a complete neurologic examination, and you must be prepared to conduct any or all of these assessments. As is common with physical assessment, some of these techniques will become staples in your practice, and you will use them on a routine basis. Checking pupillary reaction, for example, is a neurologic test that many nurses preform frequently. Other skills are used less routinely, except in certain practice settings. Checking deep tendon reflexes (DTRs) is one such technique. Nursing students learn to check DTRs, but in many practice settings it’s rarely done. However, if you talk with nurses working on neurology units or in labor and delivery, you will find that they check DTRs quite often.

Some of the components of a neurological exam are described elsewhere in this skills module. For example, you’ll find assessment of level of consciousness in the “basic patient survey” component of this module. You’ll learn about tests of balance in the musculoskeletal section and about some cranial-nerve testing with head and neck assessment. For your convenience, you’ll find the entire neurologic assessment in this portion of the module.

Mental status

Neurologic assessment typically begins with considering your patient’s mental status from the moment you meet him. Evaluate the patient’s level of consciousness. Is he alert and responding appropriately as you greet him? If so, then assess his orientation by asking him to tell you his name, the location, and the time or date. If he is alert and answers correctly, document that he is “alert and oriented times three.” Remember, though, that hospitalized patients often have difficulty recalling the day of the week because their normal schedule has been disrupted. Do not be too quick to interpret that as a lack of orientation.

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For a patient who is not alert, assess his level of consciousness by observing his reaction as you stimulate him to respond. For example, if he appears to be asleep or unconscious, see if he will respond to your voice. If he does not, assess his response to touch. Press or gently rub his arm or shoulder. Some patients who do not respond to gentle touch will respond to pain. Test for a pain response by pressing a pen across a nailbed or rubbing a knuckle over the bony part of the patient’s sternum. Practice these techniques on yourself to learn an appropriate amount of pressure to apply. Note whether or not the patient responds to voice, touch, or pain.

In some practice settings, you will use a standardized scale to assess level of consciousness. For example, the Glasgow Coma Scale uses a point system based on the patient’s responsiveness as indicated by eye opening, as well as verbal and motor responses to stimulation. Another example, the AVPU scale, assigns points according to the patient’s degree of alertness and response to verbal and painful stimulation. The letters in “AVPU” correspond to alert, verbal stimulus response, pain stimulus response, and unresponsive.

Reporting mental status includes a statement about the patient’s mood, or affect. You will get a sense of this as you interact with him. Is his affect bright, anxious, depressed, angry, frightened, or hostile?

Tests of memory are sometimes included in a mental-status exam. Because we store information in different parts of our brains, it is important to test immediate, recent, and remote memory. A common approach to use for both immediate and recent memory is to recite for the patient a list of three words or a series of numbers and ask him to try to remember them. For example, the words could be “dog, pencil, and apple.” To test immediate memory, simply ask the patient to repeat the words back to you. About 10 minutes later, ask again to test recent memory. Test remote memory by asking about events that happened years ago. Of course, it is often difficult to confirm information patients report about remote events.

Other tests of mental status assess a variety of attributes, such as cognition, general knowledge, communication, judgment, and interpretation of proverbs. While these assessments are often important, they are beyond the scope of this skills module.

Motor function, balance, and coordination

Test motor function and balance together with gait assessment, as you learned to do in the musculoskeletal assessment. As you observe the patient walking through the various gaits, look for signs of balance problems. Many patients who have no difficulty with a normal gait might raise their arms to help with balance on heel-to-toe or tandem walking. Both toe walking and heel walking are effective tests of both motor function and balance. And, of course, tests of muscle strength and joint range of motion can reveal abnormalities with a neurologic cause, as well as primary musculoskeletal disorders.

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Q&A

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How do I schedule a mental status evaluation? | Yahoo Answers

John ... start by seeing your regular physician. They will give you a full blood workup checking for things like blood sugar disorders and glandular problems. If they don't find anything, then see a psychiatrist for diagnosis and treatment. There are very good medicines today to treat most mental disorders and well as therapy once the medication(s) take effect. Take care of yourself by eating healthy, doing cardio exercise and getting quality sleep, which are also needed for positive brain chemistry. Chip

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