ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam
COMPONENTS OF MENTAL STATUS EXAM INCLUDE: - answerA-B-C-T
APPEARANCE; posture, body movements, dress, grooming and hygiene
BEHAVIOR; LOC, Facial expression, speech, mood and affect
COGNITION; address, phone#, etc. date?, attention span, recent and remote memory,
new learning
THOUGHT PROCESS; perceptions, should be logical and consistent this person make
sense?
how do people treat you?, do you feel you are being watched, followed or controlled?
have you heard your name when alone?
___________________ screens for Anxiety - answerGAD- 7
questions to ask for depression or suicidal ideations: - answer Depression :
Over the past two weeks, have you fell down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Suicidal:
Have you ever felt so blue you thought of hurting yourself?
Do you have a plan to hurt yourself?
How would you do it?
***Must not ignore any talk of suicide***
When is a full mental status exam necessary? - answer* Patients whose initial
screening suggests an anxiety disorder or depression
* Behavioral changes: such as memory loss, inappropriate social interaction
* Brain lesions: trauma, tumor, cerebrovascular accident or stroke
* Aphasia: impairment of language ability secondary to brain damage
* Symptoms- of psychiatric mental illness especially with acute onset
________________ Screens for Alcoholism. - answerCAGE: Score 2 or greater highly
significant
* Have you ever felt you should CUT down on your drinking?
* Have people ANNOYED you by criticizing your drinking?
* Have you ever felt bad or GUILTY about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or get rid of
a hangover? (EYE OPENER)
Things to Consider When Assessing Older Adults mental status include: - answerAsk
about chronic illness and how they are managing?
Sensory impairments?
,Polypharmacy (med list again!)
Social isolation
Physiological issue
- Delirium vs. Dementia
- UTI
- Sundowners
Delirium VS Dementia VS Depression:
Onset
course
duration
consciousness
attention
psychomotor changes
reversibility - answerDelirium ** Dementia ** Depression:
==========================================
O: Acute insidious Acute or insidious
C: Fluctuating Progressive May be chronic
D: Hrs to wks Mos to yrs Mos to yrs
C: Altered Usually clear clear
A: Impaired Normal unless May be decreased
severe dementia
P: increased often normal may be slowed in decreased severe cases
R: usually irreversible usually
Delirium Causes: - answerD- Dementia
E- Electrolyte disorders
L - Lung, liver, heart, kidney, brain dysfunction
I- Infection
R- Rx Drugs
I- Injury, pain, stress
U- Unfamiliar environment
M- Metabolic
Adolescent: heeadsss psychosocial interview: - answer- Home
- Education & Employment
- Eating
- Activities
- Drugs
- Sexuality
- Suicide & Depression
- Safety (injury/violence)
When assessing children for mental heath disorders, things to consider: - answerDoes
the child seem sad, tired, restless?
,Does the child spend a lot of time alone?
Frequent outbursts of shouting, complaining, or crying?
Lost interest in hobbies like music/sports?
Talks about death or suicide?
Sleep too much or not enough?
Other questions...
____________________ is the test for Proprioception. - answerRomberg's Test:
- Stand with feet together
- Arms out with palms up
- Shut eyes
- If pt sways or looses balance = Positive Romberg's
Risks Related to Undiagnosed Ear Disorders: - answer- Poor language development
- Delayed learning
- Social isolation
- Hearing loss
- Risk for falls
- Missed diagnoses of respiratory and oral infections
Major symptoms of ear disease include: - answerHearing loss
Vertigo
Tinnitus
Otorrhea
Otalgia
Itching
Questions to ask if acute hearing loss occurs: - answer- Is the hearing loss in one ear?
- For how long have you been aware of the hearing loss?
- Was the loss sudden?
- Is there a family history of hearing loss?
- What type of work do you do (or have you done)?
- What types of hobbies do you have?
- Have you noticed you can hear better when it's noisy?
- What kind of medications are you currently taking?
- Do you know if you have been given an antibiotic called streptomycin or gentamicin?
Types and Causes of Hearing Loss: - answerConductive:
- Poor transmission of sound waves through the external and/or middle ear
- Tend to speak softer
Sensorineural
- Diseases of the cochlea and/or poor conduction of sound-generated impulses along
the eighth cranial nerve to the brain stem
- Tend to speak louder
, Mixed
- Combination of both conductive and sensorineural hearing loss in the same ear
Questions to ask if acute vertigo occurs: - answer- How long have you had this
sensation?
- Have you had repeated attacks?
- How long does an attack last? Seconds? Minutes? Hours? Days?
- Is the onset of an attack abrupt?
- Was the sensation brought on by, or worsened by, changes in position?
- Does the spinning sensation get worse during an attack?
- Are there positions that make you feel better?
During an attack have you had double vision? Loss of strength? Decreased hearing? A
disturbance of gait? Nausea? Vomiting? Ringing in your ears?
- What medications are you currently taking?
- Do you know if you have been given an antibiotic called streptomycin or gentamicin?
Tinnitus is defined as ___________________. - answerBuzzing or ringing in the ears
without environmental input
Causes of Tinnitus can include: - answer- Meniere's disease
- Noise trauma
- Ototoxic drugs
- Otosclerosis
Pulsatile tinnitus is ____________________ and can be caused by
_______________________. - answer- Beats at the same rate as the heart
- vascular tumor of head or neck
Characteristics of Tinnitus include: - answer- Originates in the central auditory system
- Affects approximately 10% of the population
- Can be transient or continuous
- Can be mild, moderate, or severe
- Can be subjective (audible only to patient) or objective (sound also audible to
examiner as a bruit)
- Incidence increases with age
Otorrhea is _________________. - answerdischarge from the ear. Usually indicates
acute or chronic infection.
Questions to ask a patient with Otorrhea include: - answer- Can you describe the
discharge?
- Have you had similar episodes?
- Do you experience dizziness?
- Do you have ear pain?
- Have you had a recent ear or throat infection?
- Have you had any change in your hearing?
Comprehensive Final Exam
COMPONENTS OF MENTAL STATUS EXAM INCLUDE: - answerA-B-C-T
APPEARANCE; posture, body movements, dress, grooming and hygiene
BEHAVIOR; LOC, Facial expression, speech, mood and affect
COGNITION; address, phone#, etc. date?, attention span, recent and remote memory,
new learning
THOUGHT PROCESS; perceptions, should be logical and consistent this person make
sense?
how do people treat you?, do you feel you are being watched, followed or controlled?
have you heard your name when alone?
___________________ screens for Anxiety - answerGAD- 7
questions to ask for depression or suicidal ideations: - answer Depression :
Over the past two weeks, have you fell down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Suicidal:
Have you ever felt so blue you thought of hurting yourself?
Do you have a plan to hurt yourself?
How would you do it?
***Must not ignore any talk of suicide***
When is a full mental status exam necessary? - answer* Patients whose initial
screening suggests an anxiety disorder or depression
* Behavioral changes: such as memory loss, inappropriate social interaction
* Brain lesions: trauma, tumor, cerebrovascular accident or stroke
* Aphasia: impairment of language ability secondary to brain damage
* Symptoms- of psychiatric mental illness especially with acute onset
________________ Screens for Alcoholism. - answerCAGE: Score 2 or greater highly
significant
* Have you ever felt you should CUT down on your drinking?
* Have people ANNOYED you by criticizing your drinking?
* Have you ever felt bad or GUILTY about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or get rid of
a hangover? (EYE OPENER)
Things to Consider When Assessing Older Adults mental status include: - answerAsk
about chronic illness and how they are managing?
Sensory impairments?
,Polypharmacy (med list again!)
Social isolation
Physiological issue
- Delirium vs. Dementia
- UTI
- Sundowners
Delirium VS Dementia VS Depression:
Onset
course
duration
consciousness
attention
psychomotor changes
reversibility - answerDelirium ** Dementia ** Depression:
==========================================
O: Acute insidious Acute or insidious
C: Fluctuating Progressive May be chronic
D: Hrs to wks Mos to yrs Mos to yrs
C: Altered Usually clear clear
A: Impaired Normal unless May be decreased
severe dementia
P: increased often normal may be slowed in decreased severe cases
R: usually irreversible usually
Delirium Causes: - answerD- Dementia
E- Electrolyte disorders
L - Lung, liver, heart, kidney, brain dysfunction
I- Infection
R- Rx Drugs
I- Injury, pain, stress
U- Unfamiliar environment
M- Metabolic
Adolescent: heeadsss psychosocial interview: - answer- Home
- Education & Employment
- Eating
- Activities
- Drugs
- Sexuality
- Suicide & Depression
- Safety (injury/violence)
When assessing children for mental heath disorders, things to consider: - answerDoes
the child seem sad, tired, restless?
,Does the child spend a lot of time alone?
Frequent outbursts of shouting, complaining, or crying?
Lost interest in hobbies like music/sports?
Talks about death or suicide?
Sleep too much or not enough?
Other questions...
____________________ is the test for Proprioception. - answerRomberg's Test:
- Stand with feet together
- Arms out with palms up
- Shut eyes
- If pt sways or looses balance = Positive Romberg's
Risks Related to Undiagnosed Ear Disorders: - answer- Poor language development
- Delayed learning
- Social isolation
- Hearing loss
- Risk for falls
- Missed diagnoses of respiratory and oral infections
Major symptoms of ear disease include: - answerHearing loss
Vertigo
Tinnitus
Otorrhea
Otalgia
Itching
Questions to ask if acute hearing loss occurs: - answer- Is the hearing loss in one ear?
- For how long have you been aware of the hearing loss?
- Was the loss sudden?
- Is there a family history of hearing loss?
- What type of work do you do (or have you done)?
- What types of hobbies do you have?
- Have you noticed you can hear better when it's noisy?
- What kind of medications are you currently taking?
- Do you know if you have been given an antibiotic called streptomycin or gentamicin?
Types and Causes of Hearing Loss: - answerConductive:
- Poor transmission of sound waves through the external and/or middle ear
- Tend to speak softer
Sensorineural
- Diseases of the cochlea and/or poor conduction of sound-generated impulses along
the eighth cranial nerve to the brain stem
- Tend to speak louder
, Mixed
- Combination of both conductive and sensorineural hearing loss in the same ear
Questions to ask if acute vertigo occurs: - answer- How long have you had this
sensation?
- Have you had repeated attacks?
- How long does an attack last? Seconds? Minutes? Hours? Days?
- Is the onset of an attack abrupt?
- Was the sensation brought on by, or worsened by, changes in position?
- Does the spinning sensation get worse during an attack?
- Are there positions that make you feel better?
During an attack have you had double vision? Loss of strength? Decreased hearing? A
disturbance of gait? Nausea? Vomiting? Ringing in your ears?
- What medications are you currently taking?
- Do you know if you have been given an antibiotic called streptomycin or gentamicin?
Tinnitus is defined as ___________________. - answerBuzzing or ringing in the ears
without environmental input
Causes of Tinnitus can include: - answer- Meniere's disease
- Noise trauma
- Ototoxic drugs
- Otosclerosis
Pulsatile tinnitus is ____________________ and can be caused by
_______________________. - answer- Beats at the same rate as the heart
- vascular tumor of head or neck
Characteristics of Tinnitus include: - answer- Originates in the central auditory system
- Affects approximately 10% of the population
- Can be transient or continuous
- Can be mild, moderate, or severe
- Can be subjective (audible only to patient) or objective (sound also audible to
examiner as a bruit)
- Incidence increases with age
Otorrhea is _________________. - answerdischarge from the ear. Usually indicates
acute or chronic infection.
Questions to ask a patient with Otorrhea include: - answer- Can you describe the
discharge?
- Have you had similar episodes?
- Do you experience dizziness?
- Do you have ear pain?
- Have you had a recent ear or throat infection?
- Have you had any change in your hearing?
