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Full mental health exam is needed when
- Behavioral changes: memory loss, inappropriate social behaviors
- aphasia: language impairment due to brain injury
- brain lesions: stroke/CVA, trauma, tumor
- symptoms of mental illness
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Appearance
- Posture
- - normal: straight, erected, relaxed
- -abnormal: pacing, tensed muscles= anxiety, hunched over = depressed
- Body movement
- - normal: coordinated, smooth & even
- - abnormal: restless, fidgety = anxiety, or slow= depression
- - cogwheel = parkinsons
- dress/ grooming & hygiene
- -norm: appropriate for season, clean, shaven
- -abnormal: disheveled, dirty, not shaven-
- unilateral neglect- depression/ mental status
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Behavior
- Level of Consciousness
- Speech: smooth, articulated, appropriate volume/ fast = anxiety, slow = depressed, distorted = stroke
- Affect&mood: relaxed & cooperative " how do you feel today,
- - flat, no expression = mental illness
- - schizophrenia: mood swings, bizarre moods
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Cognition
- Orientation: Person, place & time
- Recent memory:
- Remote memory:
- New learning: 4 unrelated words & repeat them back
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Mini Cog Exam
- tell them 3 random words
- ask them to draw a clock at a certain time
- then ask them to repeat the words again
- 1-2 words = possible dementia
- no words = dementia
- abnormal clock = cognitive impairment
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Thought Process
- normal: logical
- abnormal: illogical
- - obsession - repetitive thoughts
- - compulsion - repetitive behavior
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Assess suicidal thoughts if _____
- They exhibit:
- sadness, grief, despair, hopelessness
- Ask:
- have you ever thought of harming yourself?
- are you thinking about it right now?
- do you have plans?
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Major Depressive Disorder
- If pt. shows 5 or more symptoms for 2wks:
- depressed
- fatigued
- wt loss
- agitation
- worthlessness
- diminished interest
- inability to think
- insomnia/ hypersomnia
- death
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Aging
- response time = slower
- recent memory may decrease
- Same: intellect & remote memory
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Neurological Assessment Subjective Data
- headache
- headinjury
- dizziness/vertigo
- syncope (random fainting)
- seizures
- tremors
- incoordination
- stroke/ CVA
- meningitis
- dysphagia
- dysphasia
- dysarthria
- aphasia
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Cranial Nerve I & II
Olfactory: close eyes & test each nostril separately
Optic: visual acuity, snellen chart
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Cranial Nerve III IV VI
- muscles around the eye, tested together
- PERRLA = III
- Extraoccular movements/ cardinal field of gaze test
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Nystagmus & Ptosis
Nystagmus: jerking of the eye
Ptosis: droopy eyelid on one side
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Cranial Nerve V
- Trigeminal nerve: opthalmic, maxillary, mandibular
- sensory: light touch
- corneal reflex: cotton swab ( involuntary blinking)
- motor: masticatoin
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Cranial nerve VII
- Facial:
- motor: symmetry of movements & strength
- sensory: taste sweet, salt & sour (uncommon test)
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Bells Palsy
asymmetry of the face, cranial nerve VII impairment
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Cranial Nerve VIII
- Acoustic: hearing acuity
- Whisper test:
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Cranial Nerve IX, X
- Glossopharyngeal & vagus
- motor: tongue blade, test pharynx movement
- uvula, soft palate, gag reflex
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Cranial nerve XI & XII
- Spinal acessory nerve:
- sternomastoid & trapezius muscle; turn head & shrug shoulder against resistance
Hypoglossal: tongue stick out
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Cerebellar Function Coordination & Balance Tests
- Tandem walking: heel to toe(soberity)
- Romberg: stand stil, test balance (positive = fall)
- shallow knee bed/ hop in place
- rapid alternating movements
- finger to finger
- finger to nose
- heel to shin
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Deep Tendon Reflexes
- Graded 0-4: 0 = none 2= normal 4= clonus
- Reinforcement: raise hand up to relax other muscles
- clonus: short, jerking motion on stimuli
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Glascow Coma Scale
- Eyes: 4
- Verbal: 5
- Motor: 6
- max score = 15
- 7 or < = coma
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