Assessment Of Mental Status By Dr. Hanan Said Ali

Learning Objectives. Define mental status Learning Objectives * Define mental status * Identify major areas of mental status assessment - language ability. - orientation level of client. - Immediate recall, recent, and remote memory. - Attention span and calculation. - level of consciousness

Introduction Assessment of mental status reveals the client’s general cerebral function. These functions include intellectuals (cognitive) as well as emotional (affective) function. * Major areas of mental status assessment include: 1- Language. 2- Orientation. 3- Memory. 4- Attention span and calculation. 5- Level of consciousness

1- Language * any defects in or loss of the power to express oneself by speech, writing, or signs, or to comprehend spoken or written language due to disease or injury of the cerebral cortex is called aphasia. A- Motor Aphasia It involves loss of the power to express oneself by writing , making signs , or speaking.

B –Sensory Aphasia There are two types of sensory aphasia: B –Sensory Aphasia There are two types of sensory aphasia: * Auditory aphasia A client have lost the ability to understand the symbolic content associated with sounds. *Visual aphasia A clients have lost the ability to combine speech sounds into wards.

If the client displays difficulty speaking Assessment: If the client displays difficulty speaking Assessment: ** Point to common objects and ask the client the name of them. ** Ask the client to read some words and to match the printed and written words with pictures. **Ask the client to respond to simple verbal and written commands e.g. ‘point to your toes’ or raise your left arm.

2- Orientation Determine client’s orientation to person, time, and place by tactful questioning : ** Ask the client the city state of residence. ** Time of day. ** Date, day of the week. ** Duration of illness. ** Name of family members.

More direct questioning may be necessary for some people: More direct questioning may be necessary for some people: ** where are you now ? ** What day is it today ? If the client cannot answer these questions accurately. ** Asking the client to state his or her full name

3- Memory Listed for lapses in memory 3- Memory Listed for lapses in memory. Ask the client about difficulty with memory. ** If problems are apparent , three categories of memory are tested : 1- Immediate recall. 2- Recent memory. 3- Remote memory.

To assess immediate recall To assess immediate recall * Ask the client to repeat a series of three digits e.g., 7- 4- 3- , spoken slowly. * Gradually increase the number of digits, e.g.,7- 4- 3- 5-, 7- 4- 3- 5- 6,and 7- 4- 3- 5- 6- 7- 2, until the client fails to repeat the series correct.

* Start again with a series of three digits , but this time ask the client to repeat them backward. N.B. The average person can repeat a series of five to eight digits in sequence and four to six digits in reverse order.

TO Assess Recent memory TO Assess Recent memory * Ask the client to recall the recent events of the day, such as how the client got to the clinic . * Ask the client to recall information given early in the interview, e.g., the name of doctor.

Provide the client with three facts to recall, e. g * Provide the client with three facts to recall, e.g., a color , an object, and an address; or a three- digit number , and ask the client to repeat all three. * Later in the interview ,ask the client to recall all three items.

To assess remote memory To assess remote memory ** Ask the client to describe a previous illness or surgery, e.g., 5 years ago, or a birthday or anniversary.

4- Attention span and calculation Test the ability to concentrate or maintain attention span by: * Asking the client to recite the alphabet or to count backward from 100. * Test the ability to calculate by asking the client to subs tract 7 or 3 progressively from 100.i.e., 100, 93, 86, 79, or 100, 97, 94, 91.

*N.B. Normally , an adult can complete the serial sevens test in about 90 second with three or fewer errors. Because educational level, language, or cultural differences affect calculating ability.

5- Level of consciousness Level of consciousness(LOC) can lie anywhere along a continuum from a state of alertness to coma. * A fully alert client responds to questions spontaneously; a comatose client may not responds to questions spontaneously.

The Glasgow coma scale was originally developed to predict recovery from a head injury . * It tests in three major areas: 1- Eye response. 2- Motor response. 3- Verbal response. *** An assessment totalling 15 points indicate the client is alert and completely oriented. A comatose client scores 7 or less.

Glasgow coma scale When used to score the effects of a head injury, a score of 13 or 14 indicates mild head injury, 9 to 12 indicates moderate injury, and any score of 8 or below indicates severe head injury

Disorientated, converses Uses inappropriate words Faculty Measured Response Score Eye Opening Spontaneous To verbal command To pain No response 4 3 2 1 Motor response To localize pain Flexes and withdraws Flexes abnormally Extended abnormally 6 5 Verbal response Oriented, converses Disorientated, converses Uses inappropriate words Make incomprehensible sounds

Thank You