A person who has previously been well-groomed and now has poor personal
hygiene, lack of concern for appearance, and inappropriate clothing for the
time of year may have an emotional problem, a psychiatric disturbance, or an
organic brain syndrome.
DETAILED NEUROLOGIC EXAMINATION
A more complete and specific neurologic examination is necessary to confirm a
diagnosis in a suspected neurologic disorder. Areas to be evaluated in such an
examination include mental status, motor function, sensory function, and reflexes.
a. Mental Status.
(1) Level of consciousness. The single most valuable indicator of
neurologic function is the individual's level of consciousness. Determine the patient's
level of consciousness -- alert, lethargic, stupor, semicoma, or coma.
Legally, only physicians are authorized to make such determinations. You
can legally describe the patient's condition in the nursing notes by saying,
"appears to be" alert or lethargic or so forth.
(a) Alert. The patient is awake and verbally and motorally responsive.
(b) Lethargic. The patient is sleepy or drowsy and will awaken and
respond appropriately to command.
(c) Stupor. The patient becomes unconscious spontaneously and is
very hard to awaken.
(d) Semicoma. The patient is not awake but will respond purposefully
to deep pain.
Coma. The patient is completely unresponsive.
(2) Calculations in basic mathematics. Ask the patient to do some simple
arithmetic problems without using paper and pencil. For example, ask him to add 7s or
to subtract 3s backwards. It should take the patient of average intelligence about one
minute to complete the calculations with few errors.
(3) Affect/mood. During the physical part of the examination, note the
patient's mood and emotional expressions which you can observe by his verbal and
nonverbal behavior. Notice if he has mood swings or behaves as though he is anxious
or depressed. Notice whether or not the patient's feelings are appropriate for the
situation. Disturbances in mood, affect, and feelings may be indicated by a patient who
exhibits unresponsiveness, hopelessness, agitation, euphoria, irritability, or wide mood