now moving on to objective assessment we always start with mental status examination so we always want to Simply look at the client right so we're going to be looking at everything so for example their posture their body movement their facial affect or basically how they look as well as how they're dressing with hygiene and even grooming and always note that inappropriate appearance or even poor hygiene May indicate depression or even manic disorder or even Dementia or brain disease or other behavioral disorders now in terms of behavior is the client calm and collected are they making eye contact and are they really answering questions appropriately so always pay attention if the client is answering questions appropriately for example to situation and content so just simply ask is this client acting or answering appropriately if they are then they're alert and oriented times three or times four so they're answering questions correctly like their name their date of birth where they're at or even the current president now for orientation this is to person and place as well as time now in terms of attention span this is the ability to concentrate so what is serial sevens so serial sevens is a way that you can test your patient's ability it's included in the many mental SAS exam and also the MSC or the mental status exam okay so serial sevens is where you would ask the client starting from the number 30 count backwards by seven so so 30 then 23 then 16 9 2. okay so part of that the ability to calculate as well as pay attention to that task they don't say 23 oh wait when's lunch going to get here and start to get distracted which can be a sign of ADHD flight of ideas also can be a sign of dementia hey there nursing student listen up did you know only 20 of our videos are here on YouTube you're missing out on over 900 videos not on YouTube plus 500 visual study guides that follow along every video and a massive quiz Bank to test your knowledge all neatly organized in our new app try it for free visit simplenursing.com today and so another one that we do for our mental status exam is we check their recent memory so we would do What's called the three or you could even do the forward recall test and you want to pick unrelated words so that way they don't easily relate the words to each other so for example can you repeat these three words dog train blue dog train blue wonderful do you have any issues with understanding those words no so then you would go further along in the mental status exam you'll come back to that though so he said those words now I'm going to do something else ask him about something else and then ask him a period of time later like five or ten minutes later and then you can even try 30 minutes later can you tell me those three words again yeah Doug train Luke very good so the wonderful thing about this is we can use this objectively we could test them again a year from now five years from now and see if over time does he slowly lose that ability to recall and lose that short-term memory because that's what happens in patients with dementia is they lose short-term memory because one thing that happens is an early sign of dementia is confabulation confabulation confabulation it's a fancy word for making stuff up okay so I always think like the con in the beginning of it a con artist makes things up okay so confabulation is a fancy word for making things up so we have to use three word recall or forward recall whichever one you prefer that you feel the longer ones needed because if you were to say what'd you have for breakfast today he might be able to tell me something and I can't verify that okay and it might not be what he actually had and not that he's purposely lying but think about if someone says what'd you do last weekend and you think oh wait what did I do last weekend okay you know what day is it today right and you try to work yourself through that in patients with dementia sometimes they'll say last weekend I was on vacation oh and that may or may not be true okay and it's part of sort of a coping mechanism that their brain does mentally so you want something that we can verify that we know is true and it's an objective way that we can also measure if five years from now the patient could only remember two of the three words or really struggles after that 5 10 or 30 minute mark because as you guys know dementia you can simply remember this is damage to the brain so clients are losing touch with reality and it's really hard for them to really process things now another key term that relates to dementia is judgments so this determines whether the client's actions or decisions Visions regarding the discussion during the interview are realistic so really just assessing the thought process and perceptions here so remember clients with dementia have damage to the brain and so they're not going to respond appropriately