Physical Examination

• The Mental Status Exam (MSE) is the psychological equivalent of a physical exam that describes the mental state and behavior of the person being seen
• Components Of Mental Health Assessment

  • APPEARANCE & BEHAVIOR
  • SPEECH & LANGUAGE
  • MOOD
  • THOUGHTS & PERCEPTION
  • COGNITIVE FUNCTIONS
• The terms “behavioral health & “mental health” are often used interchangeably
• Normal Arm Measurement Values

  • TRICEPS SKINFOLD: Men 12.5 mm, Women 16.5 mm
  • MIDARM CIRCUMFERENCE: Men 29.3 cm, Women 28.5 cm
  • MIDARM MUSCLE CIRCUMFERENCE: Men 25.3 cm, Women 23.2 cm
• Components of Mental Health Assessment - THOUGHTS & PERCEPTION

  • Thought processes
  • Thought content
  • Perception
  • Insight
  • Judgment
• Components of Mental Health Assessment - SPEECH & LANGUAGE

  • Quantity
  • Rate
  • Loudness
  • Articulation of words
  • Fluency
• Pain Scale
• Assessment of Integumentary System - SKIN, HAIR, & NAILS

  • General color
  • Texture
  • Turgor
  • Temperature
  • Moisture
  • Others: e.g. edema, lesions, vascularization
  • Nails: shape, color, blanch test of capillary refill
• Purposes of Mental Status Exam

  • APPEARANCE & BEHAVIOR
  • SPEECH & LANGUAGE
  • MOOD
  • THOUGHTS & PERCEPTION
  • COGNITION
• Components of Mental Health Assessment - APPEARANCE & BEHAVIOR

  • Level of consciousness
  • Posture & motor behavior
  • Dress, grooming, & personal hygiene
  • Facial expression
  • Manner, affect, & relationship to people & things
• A measurement that’s <90% of the standard indicates caloric deprivation; a measurement >90% indicates adequate or more than adequate energy reserves
• Behavioral health includes ways of promoting well-being by preventing or intervening in mental health issues such as depression or anxiety, and also aims at preventing or intervening in substance abuse or other addictions
• Components of Mental Health Assessment - MOOD

  • Sadness & deep melancholy
  • Contentment
  • Joy
  • Euphoria & elation
  • Anger & rage
  • Anxiety & worry
  • Detachment & indifference
• Components of Mental Health Assessment - COGNITIVE FUNCTIONS

  • Orientation
  • Attention
  • Remote memory
  • Recent memory
  • New learning ability
  • Higher cognitive functions
• Assessment of Integumentary System: Skin, Hair, and Nails
• Assessment of Skin and Appendages

  • Color
  • Moisture
  • Temperature
  • Texture
  • Lesions
• Assessment of Integumentary System

  Skin, Hair, and Nails
• General assessment
• Skin and Appendages

  1. Color

  2. Moisture

  3. Temperature

  4. Texture

  5. Lesions

  6. Mobility and turgor
• Elderly: Physical Changes of the Skin

  • Flat tan to brown-colored macules, referred to as senile lentigines or melanotic freckles
  • Warty lesions (seborrheic keratosis) with irregularly shaped borders and scaly surface often occur on the face, shoulders, and trunk
  • Telangiectasia: visible bright red, fine dilated blood vessels commonly occur as a result of the thinning of the dermis and the loss of support for the blood vessels walls
  • Actinic keratoses: dry, scaly and rough-skin colored to reddish-brown “bump” on the skin, are often sensitive or “touchy”, may appear often on the face, ears, backs of the hands, and arms
• External structures and lacrimal apparatus of the left eye
• Callus is flat and painless caused by thickening of epidermis
• Primary Skin Lesions

  • Vesicle
  • Bulla
• SKIN, HAIR, & NAILS

  • General color
  • Texture
  • Turgor
  • Temperature
  • Moisture
  • Others: e.g. edema, lesions, vascularization
  • Nails: shape, color, blanch test of capillary refill
• Calluses and corns are found on the toes or fingers
• Memory types

  • Remote memory
  • Recent memory
  • New learning ability
  • Higher cognitive functions (Information & vocabulary, calculating ability, abstract thinking, constructional ability
• Anatomic structures of the right eye, lateral view
• Corns are caused by friction and pressure from shoes
• Inspect & palpate the lacrimal gland and nasolacrimal duct

  No edema & tearing. Increased tearing. Perform corneal sensitivity test. Client blinks (trigeminal intact). One or both lids fail to respond
• Assess for each pupil direct and consensual reaction to light

  Illuminated pupil constricts (direct response). Either constricts/unequal responses. Assess each pupil reaction to accommodation. Pupils constrict when looking at near objects & dilate when looking at far objects. One/both pupils fail to constrict/dilate
• Assessing the pupil

  Partially darken the room. Look straight ahead. Using penlight on the pupil from the side, shine a light. Observe response & do on the other eye. Normally pupil constrict in the presence of light source and dilates when the light source is moved away
• Inspect the pupils for color, shape & symmetry of shape

  Black in color, equal in size, normally 3-7mm in diameter, round smooth border. Cloudiness, bulging of iris towards cornea
• Extraocular movements

  Make the patient to sit 2 feet away from the nurse. Hold a finger about 30 cm away from the patient. The client keeps the head fixed and follows the movement of the nurse's finger
• Snellen Eye Chart

  Measures VISUAL ACUITY. Normal = 20/20, means you can read at 20 ft. what the normal eye can read at 20 ft. Position client 20 feet from the chart. Shield one eye at a time, leave glasses on except for reading glasses. Read smallest line possible. Numerator = top # (distance person is standing from the chart). Denominator = bottom # (distance a normal eye can read that line)
• Auricle inspection

  Inspect the auricle's size, shape, symmetry, position, and color. Palpate the auricle for texture, tenderness, and skin lesions. Inspect the opening of the ear canal for size and discharges
• Visual field examination

  Patient sits 60cm away from the nurse at the eye level. Patient covers one eye. Nurse closes the opposite eye. Nurse moves a finger equidistant from the nurse and the client outside the field of vision and slowly brings it back to the visual field. The patient is asked to say when the finger is seen
• Pupil dilation when light source is moved away

  Pupil dilates
• Elderly experience physical changes in the eyes and vision
• Weber's Test

  Hold the base of the tuning fork at the patient's head with ears sound normal. Place the base of the fork on the middle of the client's forehead. Ask the patient what they hear
• Pupil constriction in the presence of light source

  Pupil constricts