(3) Ask the patient to tell you the year, month, and time-of-day
(mid-morning, late afternoon, and so forth). Do not ask for the date. This is a poor
indication of orientation. Most people cannot tell you the exact date when questioned.
d. Affect, or mood, is evaluated by observing the patient's verbal and nonverbal
behavioral responses for appropriateness. For example:
Does the patient laugh when talking about serious or sad subjects?
Is the patient easily startled by loud noises?
Does the patient respond to stimuli in a normal manner?
Does the patient display excessive anger, fear, confusion, and so forth?
e. Long and short term memory should be evaluated by asking questions.
(1) Discussing past events or questioning the patient about his medical
history will test his ability for remote recall (long-term memory).
(2) Questions about daily events will test recent recall (short- term memory).
For example, ask the patient what he ate for breakfast that morning.
f. Cognition is tested by asking the patient to perform calculations. For
example, ask the patient to count backward from 100 by 7s.
2-14. SENSORY FUNCTION
a. Sensory function is evaluated by testing perception of pain, touch, and
(1) Pain--using a safety pin, touch the skin as lightly as possible to elicit a
(2) Touch--ask the patient to close his eyes. Use a piece of cotton or gauze
to gently brush the skin on the patient's arms, legs, and feet. Ask the patient to tell you
when and where he feels a touch.
(3) Position--ask the patient to close his eyes. Grasp one of the patient's
digits (thumb, great toe) and move it up or down. Ask the patient to tell you which
direction the digit is pointing. Do not exert any pressure with your grasp that will
indicate which direction you are moving the digit.
b. Pupillary response is another sensory function indicator. Evaluate:
Size in millimeters (do not use subjective terms such as dilated or