Assessment of Speech (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 Another assessment we're going to be doing is on speech and language.

    00:07 So we want to make sure that if a person is having difficulty vocalizing, difficulty speaking to us, which is called dysarthria, that we are going to be able to say that quite often we have a person who has some disability.

    00:29 And they may speak slower, or they may have a hard time finding those words.

    00:36 And especially with older people, you're going to find that their speech slows down as they search for the words.

    00:51 Understand that this is a natural part of a person who is in the beginning stages of dementia or perhaps is 103 years old.

    01:02 Finding those words, it slows them down.

    01:06 That is different from dysarthria, which is difficulty vocalizing.

    01:14 We also might be seeing echolalia with our patients.

    01:19 So you say them, "How are you?" And they say, "How are you?" And you say, "Do you know what day today is?" And they say, "Do you know what day to day is?" Echolalia is repeating the exact same words that they are hearing.

    01:40 How about perseveration? A person might get stuck on a word or a theme.

    01:47 And as you're moving forward in your assessment, and you're saying, "So you said you came in today because you were having some intrusive thoughts." And the person says, "Hoo, thoughts.

    02:00 Thoughts, you know, those thoughts. They're bad thoughts." "Can you give me some idea of what those thoughts are?" "Oh, boy. Bad thoughts. Bad thoughts." Yeah, no bad thoughts. Oh-oh. that's really bad thoughts." So did something happen that started you thinking this way? Ho boy, boy, oh boy, oh boy, bad, bad, bad, bad, bad, bad, bad, bad thoughts? Well, that is perseveration repeating the same words or the themes over and over again.

    02:30 Even though the assessment is moving forward, the person has sort of gotten stuck on that word or those themes.

    02:39 There's also clang association.

    02:42 So that's rhyming words.

    02:44 And not necessarily rhyming words and making it sound sensible.

    02:49 We're not talking about rap.

    02:51 We're talking about a person who you say, so you're, you've been feeling sad lately.

    02:58 And they go, "Sad, bad, yada, yada, yada, bad, bad, sad. Dang, ha ha." And you realize you're not getting any information except for you can write down clang association occurring during natural speech.

    03:16 We're also going to be looking at the quantity of speech that we are hearing.

    03:21 Is the person talking it? So if you have a person who has mania, and you say, "What do you have for breakfast?" The person who has experienced a manic episode will say, "Breakfast, you're asking me about breakfast? I didn't have any breakfast? Why would I have any breakfast? I don't need to eat.

    03:38 You know, everybody thinks about food all the time in the United States. And I don't think about food.

    03:44 Why do I have to think about food? There's so many other things to think about.

    03:47 Like for instance, let's take the weather.

    03:49 The weather is important because then I know how to dress.

    03:52 If I don't know how to dress, I'm going to go out people are going to look at me.

    03:54 I hate when people are looking at me.

    03:57 Well, that is quite talkative.

    04:01 Normal speech when we are asking a question, and we say, what did you have for breakfast? We're expecting? "Oh, this morning, I had some coffee.

    04:09 I had bacon and eggs. I had some toast.

    04:11 My friend made me some grits. But I was really full.

    04:16 And so that's all I had.

    04:19 But what if a person has poverty of speech? What do you think that looks like? "So, what did you have for breakfast?" "Bread." "So, you had bread and coffee?" That's what we would see with poverty is speech.

    04:48 The person doesn't really have the words.

    04:52 They're not able to express.

    04:56 What about their volume? What does the volume tell us? It can tell us a bunch of stuff.

    05:03 If they're speaking very loudly.

    05:05 "What? You asked me what I had for breakfast? For breakfast? Ah, coffee. Had coffee, had toast, had bacon and eggs. Yeah." What would you be thinking? My first thought would be, their hard of hearing.

    05:22 And so they are compensating by shouting.

    05:26 And I want to make sure that if they have anything in their ear to help them hear that I get them some batteries because they're speaking quite loudly.

    05:37 But what about the person who's speaking so softly? You can't hear them.

    05:41 (whisper) That there are dark in lightness.

    05:45 What might this mean? Is someone talking to you like this? Well, it might mean a number of things.

    05:53 They might have laryngitis.

    05:56 I always say, before you call the TV repairman, please see if it's plugged into the wall.

    06:04 Check for any mechanical difficulties before going deeper.

    06:08 So when you're listening to volume, you document - speaking loudly, speaking softly, speaking hesitantly.

    06:15 Talkative, poverty of words. But then check out why.

    06:21 That softness may be the person is timid, they are shy.

    06:27 How about how fast they're talking? When I gave you that example of the person who might be a bit manic, what I was doing it was fast, and it was pressured.

    06:38 You could feel those words, pressurized, coming out so fast, that the person can hardly have any time to breathe, because they have to tell you everything in that detail right now, right now, right now, before the thought goes away.

    06:50 Because once thought goes away, I can never get it back.

    06:52 It's just going to be in and out. And then it's gone.

    06:57 It's really important to put that rate down fast, pressure, talkative, loud, as opposed to, yeah, I had some toast, the coffee, bacon and eggs, that's it.

    07:13 And that would be a normal rate.

    07:16 How fluent are they? Are they able to fluently tell you what they're saying? Is it clear? Is it continuous? Like that talkative person where they just don't seem to be able to stop? Is their speech slurred? And is this a difference from what you heard yesterday? If yesterday I say to you, I had coffee, bacon and eggs, and toast.

    07:45 And today I say, I had coffee, bacon and eggs, toast.

    07:53 That's a big change. What might I be thinking? If the person is in the unit with me, I know they haven't been exposed to any drugs.

    08:03 I'm going to start thinking stroke.

    08:06 I'm going to ask them to smile.

    08:07 I'm going to ask them to bring their hands up to make sure that that person is not having a cerebral vascular accident, a CVA, a stroke.

    08:18 What can slurred speech tell us? And is their slurred speech because they learned how to speak? And they had had surgery, and so they have different tongue capacity? And so because they have a different tongue capacity, if I make my tongue on the bottom of my mouth, I'm going to talk in a way as a little bit more slurred.

    08:45 But if I have a neurological condition that causes my tongue to not move correctly, it's going to affect my speech.

    08:54 And can they speak? Are they aphasia, meaning they can't speak at all? Is there no fluency? How about that rhythm? Are we looking at someone who sometimes gets caught? Almost like it's blocked. And they're really hesitant.

    09:36 Do we know the cause of the hesitancy? Remember, we're not going to assume that we know anything.

    09:45 We're just going to say hesitant speech.

    09:48 We don't know if it's because they don't want to talk to us.

    09:51 And we don't know whether is because of some neurological condition or another disability that they might have that's impacting their ability to speak in a rhythm that is ongoing with good articulation, where the words are able to be articulated and we understand them.

    About the Lecture

    The lecture Assessment of Speech (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Psychiatric Assessment (Nursing).

    Included Quiz Questions

    1. Echolalia
    2. Perseveration
    3. Clang association
    4. Dysphagia
    1. Clang association
    2. Perseveration
    3. Dysphagia
    4. Echolalia
    1. Poverty of speech
    2. Echolalia
    3. Perseveration
    4. Dysarthria
    1. Pressured speech
    2. Poverty of speech
    3. Dysarthria
    4. Dysphagia
    1. Instruct the client, "Raise your arms and smile."
    2. Perform blood testing
    3. Take the client’s blood pressure and pulse rate
    4. Check the client’s capillary refill and skin turgor

    Author of lecture Assessment of Speech (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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