Assessment of Memory and Intellectual Functioning (Nursing)

00:01 We do want to test their memory in a mental status exam.

00:07 We want to test their recent memory. So, we might say, "Do you take any medications?" And if they say yes, you say, "What medications did you take today?" Oftentimes, a person will say, "Oh, my gosh, what medications did I take today? Let me think about it." It's fine. This is not a timestamp.

00:30 Oftentimes, especially for our patients who are anxious, these little tasks that we seem to think are fairly easy, under duress, can be very difficult.

00:45 So, the way you're speaking to someone, the tone that you're using, the fact that you are not rushing them through, if they can't remember whether or not they took their medications, you might say, "Okay, did you have breakfast?" "Oh, yes, I had breakfast." "So, what did you have for breakfast?" "I had coffee, bacon, and eggs, rye toast." And then, if you have, when you've met them, introduced yourself, this far into your mental status exam, you might say, "By the way, do you remember my name?" Now, if you're wearing your name badge, that's not a question that's very hard to answer.

01:31 But if you introduce yourself, "Hello, my name is Dr. Marshall.

01:35 Oh, my first name is Brenda," then halfway through this interview, you might say, "Do you recall my first name? I think I told you when you first came in." And just notice if their recent memory is good.

01:53 You also might want to ask them some things like, "What is your social security number?" That's a little bit more remote memorization.

02:04 Most older adults will be able to rattle off their social security number even if they were not able to remember what they had for breakfast.

02:15 In this day and age, it is very possible that a person will say to you, "I would prefer not to give you my social security number." Please don't press them. Just say, "Fine.

02:27 Do you remember the year you graduated from high school?" Now, most people do remember the year that they graduated from high school if they graduated from high school.

02:39 So, asking this question means that you have already looked at their demographics.

02:47 You know that they went to high school.

02:50 Another way to be looking at their immediate memory is to give them five words.

02:57 You can give them shoe, head, computer, telephone, light.

03:07 And then, after a few minutes, ask them if they can give you those same words.

03:14 Shoe, head, computer, they may only be able to give you three.

03:23 They may be able to give you four. They may be able to give you all five.

03:29 What we're looking at is their immediate memory, whether they are able to focus on what you're saying, if they are able to recall something that you just said.

03:42 Another aspect that we're going to be looking at is intellectual functions.

03:49 This is quite important. We're going to be looking at what we see and also what we ask them about.

03:58 Evaluating a person's intellectual functions during a mental health assessment will let us know whether or not they're going to be able to follow and be adherent to medications, to behaviors that we are going to be asking them to do as they progress in their recovery.

04:19 So, we have to assess what is their vocabulary? What level is their vocabulary at? If we are speaking to them at a very high level of vocabulary, are they understanding the words that we're using? A lot of people won't say, "I'm sorry, but I don't actually know what the word inquired means.

04:41 Can you tell me what that means?" But that's not the majority.

04:47 The majority will nod their head at you like they understand even if they don't.

04:53 They don't want to be known as not understanding what you're saying.

04:59 We might be able to then also get some information from them on what kind of intellectual functioning they have about the world they live in.

05:13 We could ask them perhaps, "Can you name five big cities?" Now, remember, if this is a person who is immigrated to this country or like my own grandparents who came from Hungary, when they got older, their minds went back to Hungary.

05:35 And although they lived in Los Angeles, if you ask them for five big cities, they're going to start with Budapest.

05:42 So, you have to be careful when you're asking that you are clear.

05:47 That you know the person who you are asking these questions.

05:51 That you know their history.

05:54 You might want to ask them who the current president is, but you also might say, "Can you recall who the last three presidents are?" Now, this might work for someone who's in their 40s, 50s, 60s.

06:09 It might not work for someone who's in their 20s or 30s because they may have not been engaged in thinking about the last three presidents.

06:20 We can also do things like looking and see if they know similarities and dissimilarities.

06:28 Being able to show them four things where three of them have something that are the same and one is not the same, and ask them, "When you look at this, can you show me what is the same and which one does not belong?" Proverb meaning is one of my favorite ones, because it gives you a great insight into the person that you're working with.

06:55 And if there is an alteration in intellectual functioning, you might be able to pick it up when you ask, "What does this proverb mean?" One time, I was working with a young man who is about 14 years old, and he was really struggling at school in a number of ways.

07:15 And it was very hard for his parents because they didn't see that he had any impact on his intellectual functioning at all.

07:24 He was brilliant in math, he was a wiz in science, but when they took him out of that mathematical class, everything else was such a struggle for him.

07:37 So, I said to him, "Can you please tell me what the following proverb means?" A stitch in time saves nine. I saw his parents become very uncomfortable as he pondered the question. As he repeated, "A stitch in time saves nine." And so, I said, "Can you tell me what that means to you?" He said, "Yeah, for example, I'm riding my bicycle.

08:12 And my bicycle has a basket in the front of it.

08:17 And in the basket, I have this bag. And in the bag, there are nine kittens.

08:25 And I'm riding the bike and I notice there's a big hole in the side of the bag.

08:34 And so, I stop, and I stitch up the whole in the bag." And I said, "Oh, so how does that work?" He said, "Because I stitched it up in time, so I saved the nine kitties." Well, that made perfect sense.

08:58 He stitched it up in time, the nine kitties made it to wherever their destination was.

09:03 But that is not the meaning of that proverb.

09:08 And we were then able to sit down with his parents and start getting him the resources at school at age 14 to help him to start first, stepping back, and then starting to relearn a lot of things that he had just not understood, just went over his head, because he was afraid to say to anyone at school that he was not that person who his family had thought he was.

09:39 So, let's take a little bit of time to review the psychiatric assessment. When does it start? It starts the moment that we meet that patient or client.

09:52 The moment they come in to meet with us.

09:57 The relationship that we are going to build is a professional relationship.

10:02 This relationship focuses only on the needs of that patient, not on our needs.

10:09 We're going to make sure we have the proper amount of time and that we are not going to be interfered with during the time that we are speaking with this patient.

10:21 We're going to start engaging in those skills of communication that are going to facilitate a level of trust and that is going to support patient recovery.

10:33 We are going to continue to utilize these skills and strategies throughout our assessment.

10:40 What we learn during these times of assessment is not just for us to know.

10:47 Guarding the information does not help us or the patient to recover.

10:53 So, anything that we learn during our assessments, which are persistent and ongoing throughout the time that the patient is with us, we share all this information with all of the team members.

11:07 We add any information that we gain even after our initial assessment so that this multidisciplinary team can help this patient achieve their goal.