Mental status evaluation includes testing of memory, orientation, intelligence, and the other aspects of the patient's psychic state. Only the first 3 are discussed here. When overt symptoms or signs of a psychic disturbance are present, psychiatric evaluation should be considered.

1. Memory

Memory is the ability to register and recall prior sensory input. Recent and remote memory functions are differently affected depending on the disease process. Remote memory is relatively preserved in chronic dementing processes, with major disturbances in the attention span and recent memory. On the contrary, all aspects of memory are impaired in acute encephalopathies.

The nurse can test remote, or long term memory by asking clients about their birth date , schools attended, the city of birth, or any thing in the past that can be verified.

Recent or recall memory can be tested fairly well during the history taking by assessing the accuracy of the medical history, dates of clinic or physician appointments etc.

The nurse may test immediate (new) memory by giving the client two or three unrelated words, such as “apple” “street” and “chair” and asking him or her to repeat the words to make sure they were heard. After about 5 minutes, while continuing examination, the nurse asks the client to repeat the words.

2. Orientation and Level of conscious ness

Orientation is an individual's cognitive sense of his status in time, place, and person. These functions are affected in the same order as they are in organic disease. In other words, the sense of time is first to be impaired in organic dysfunction, and the sense of person is the last to be lost. However, the order may be disturbed in psychological dysfunction.

A patient who does not know who he or she is, but at the same time can tell the time and is oriented in place, is more likely to have a psychological disturbance than to have an organic etiology for the condition. Nonetheless, rare cases of isolated amnesia have been reported.

To assess level of consciousness Glasgow Coma Scale can be used

3. Attention
To assess attention the nurse may use digit span, spelling backwards and naming months of the year backward test attention and working memory which are frontal lobe functions.

4. Language

Receptive language
Asking the patient to follow commands demonstrates that they understand the meaning of what they have heard or read. It is important to test reception of both spoken and written language.

Expressive language
In assessing expressive language it is important to note fluency and correctness of content and grammar. This can be accomplished by tasks that require spontaneous speech and writing, naming objects, repetition of sentences, and reading comprehension.

5.Intelligence

Intelligence is the ability to quickly and successfully apply previous knowledge to a new situation and to use reason in solving problems. Vocabulary, fund of knowledge, calculations (eg, serial-7 calculations), abstraction (eg, use of proverbs), and judgment (eg, what to do with a found wallet) are good indicators of intelligence.

Category: Medicine Notes