***Always verbally note what you are finding during the assessment!!!***
For this assessment you will need: cotton ball, ÃÂ½ tongue dep., tongue depressor, penlight, reflex hammer, salty/sweet & sour/bitter, smell x 2, & 2 different objects to feel with hands (quarter, paperclip, etc...)
INSPECTION IS THE BIGGEST PART OF THIS EXAM, WE DO A LOT OF OBSERVING!!!
MENTAL STATUS: Start conversation with pt. by asking "How are you doing today?" "Do you know where you are?" "Do you know what day it is?" & pt. already identified their name so they 'know who they are': and then assess:
LOC: Expected = Answers 1st 3 questions correctly (are alert & oriented x3).
Speech pattern: Expected= smooth, regular, non-slurred. Abnormal=slow, slurred, stuttering (Parkinson's)
Voice quality: Expected= smooth, regular, appropriate volume, appropriate pitch. Abnormal=dysphonia (a disorder of voice volume or qualityÃ¢ÂÂ¦monotone, harsh, loud)
Comprehension: Ask pt series of questions to assess comprehension & memory.
Expected= able to follow instructions (appropriate comprehension); immediate, recent, & remote memory intact.
"Repeat these 5 numbers: __,__,__,__,__ (you choose #'s)" (IMMEDIATE MEMORY)
"What did you eat for breakfast?" (RECENT MEMORY)
"Who was the previous president of the US?" (REMOTE MEMORY)
Superficial pain: Make sure pt. HAS SHOES OFF! Alternating the sharp & smooth edges of a broken tongue blade, touch the patient's skin in an unpredictable pattern (allow 2 sec. between each). Ask pt. to identify each sensation as sharp or dull and where it is felt. Expected= able to correctly identify sharp/dull & location (superficial pain sensation intact). Abnormal=diminished pain sensation (Peripheral Neuropathy)
Stereognosis: Place different object in each hand (you choose objects, but they should be familiar to the patient (examples=quarter, paperclip, key, eraser, etcÃ¢ÂÂ¦). Expected= able to distinguish objects. Abnormal=inability to distinguish (parietal lobe dysfunction).