General Survey

General SurveyAppearancePosture

NormalAbnormalPosture is erect, and position is relaxedSitting on edge of chair or curled in bad, tense muscles, frowning, darting watchful eyes, restless pacing (anxiety and hyperthyroidism).AppearanceBody Movements

NormalAbnormalBody movements are voluntary, deliberate, coordinated, and smooth and even.Restless, fidgety movements or hyperkinetic appearance occurs with anxiety.

Apathy and psychomotor slowing occur with depression and dementia.AppearanceBody Movements

NormalAbnormalAbnormal posturing and bizarre gestures (schizophrenia).

Facial grimaces.AppearanceDress

NormalAbnormalDress is appropriate for setting, season, age, gender, and social group. Clothing fits and is put on appropriately.Inappropriate dress can occur with organic brain syndrome.

Eccentric dress combination and bizarre makeup occur with schizophrenia or manic syndrome.AppearanceGrooming and Hygiene

NormalAbnormalThe person is clean and well- groomed

Hair is neat and cleanUnilateral neglect (CVA)

Inappropriate dress, poor hygiene and lack of concern with appearance (Depression and severe AD)AppearanceGrooming and Hygiene

NormalAbnormalWomen have moderate or no makeup

Men are shaved, or beard or mustache is well groomedMeticulously dressed and groomed appearance and fastidious manner may occur with OBD.AppearanceGrooming and Hygiene

NormalAbnormalNote: disheveled appearance in a previously well- groomed person is significant.BehaviorLevel of Consciousness

NormalAbnormalThe person is awake, alert, aware of stimuli from the environment and within the self, and responds appropriately and reasonably soon to stimuli.Loses track of conversation, falls asleep.Lethargic, obtunded.BehaviorFacial expression

NormalAbnormalThe look is appropriate to the situation and changes appropriately with the topic. There is comfortable eye contact unless precluded by cultural norm (American Indian)Flat, masklike expression occurs with parkinsonism and with depression.BehaviorSpeech

NormalAbnormalJudge the quality of speech by noting that the person makes laryngeal sounds effortlessly and shares conversation appropriately.DysphoniaMonopolizes interviewSilent, secretive, or uncommunicativeBehaviorSpeech

NormalAbnormalThe pace of the conversation is moderate, and stream of talking is fluentSlow, monotonous speech (Parkinsonism and Depression)

Rapid- fire, pressured, and loud talking (manic syndrome)BehaviorSpeech

NormalAbnormalArticulation is clear and understandableDysarthria

Misuses words: omits letters, syllables, or words (aphasia)NeologismBehaviorSpeech

NormalAbnormalWord choice is effortless and appropriate to educational level. The person completes sentences, occasionally pausing to think.Unduly long word- finding or failure in word search (aphasia)BehaviorMood and Affect

NormalAbnormalJudge this by body and facial expression and by asking directly.

The mood should be appropriate to the persons place and condition and change appropriately with topics.Wide mood swings (manic syndrome)Bizarre mood (schizophrenia)BehaviorMood and Affect

NormalAbnormalThe person is willing to cooperate with you.Cognitive FunctionsOrientation

NormalAbnormalOriented to time, place, personDisorientation Cognitive FunctionsAttention Span

NormalAbnormalCheck the persons ability to concentrate by noting whether he or she completes a thought without wandering. Lack in people who are anxious, fatigued, or drug intoxicated.Digression from initial thought. Irrelevant replies to questions.Confusion, negativismCognitive FunctionsRecent Memory

NormalAbnormalNote for confabulationRecent memory deficits (dementia, amnesia, chronic alcoholism)Cognitive FunctionsRemote Memory

NormalAbnormalPast eventsNot able to recall past events (cortex)Thought ProcessesThought Process

NormalAbnormalPerson should complete a thoughtIllogical, unrealistic thought processes

Evidence of blocking

Digression from initial thoughtsThought ProcessesThought Content

NormalAbnormalConsistent and logicalObsessions and compulsionsThought ProcessesPerceptions

NormalAbnormalConsistently aware of reality

How do people treat you?Do other people talk about you?Do you feel like you are being watched, followed, or controlled?Is your imagination very active?HIDThought ProcessesPerceptions

NormalAbnormalHave you heard your name when alone?HIDAbnormalities of Thought ProcessTypeDefinitionBlockingSudden interruption in train of thought, unable to complete sentence, seems related to strong emotionConfabulationFabricates events to fill in memory gapsNeologismCoining a new word: invented word has no real meaning except for the person

May condense several wordsAbnormalities of Thought ProcessTypeDefinitionCircumlocutionRound- about expression, substitutions a phrase when cannot think of name of objectCircumstantialityTalks with excessive and unnecessary detail, delays reaching point

Sentences have a meaningful connection but are irrelevantAbnormalities of Thought ProcessTypeDefinitionLoosening associationsShifting from one topic to an unrelated topic;

Person seems unaware that topics are unconnectedFlight of ideasAbrupt change, rapid skipping from topic to topic, practically continuous flow of accelerated speechWord saladIncoherent mixture of words, phrases, and sentencesIllogical, disconnected, includes neologismAbnormalities of Thought ProcessTypeDefinitionPerseverationPersistent repeating of verbal or motor response, even with varied stimuliEcholaliaImitation, repeats others words or phrases, often with a mumbling, mocking, or mechanical toneClangingWord choice based on sound, not meaning, includes nonsense rhymes and punsAbnormalities of Thought ContentTypeDefinitionPhobiaStrong, persistent, irrational fear of an object or situation; feels driven to avoid itHypochondriasisMorbid worrying about his or her own health, feels sick with no actual basis for that assumptionObsessionUnwanted, persistent thought or impulses; logic will not purge them from consciousness; experienced as intrusive and senselessAbnormalities of Thought ContentTypeDefinitionCompulsionUnwanted repetitive, purposeful act; driven to do it; behavior thought to neutralize or prevent discomfort or some dreaded eventDelusionsFirm, fixed, false beliefs; irrational; person clings to delusion despite objective evidence to contraryAbnormalities of PerceptionTypeDefinitionHallucinationSensory perceptions for which there are no external stimuli; may strike any sense; visual, auditory, tactile, olfactory, gustatoryIllusionMisperception of an actual existing stimulus, by any senseObserve the patients general state of health, height, build, and sexual development. Obtain the patients weight. Note posture, motor activity, and gait; dress, grooming, and personal hygiene; and any odors of the body or breath.

Watch the patients facial expressions and note manner, affect, and reactions to persons and things in the environment. Listen to the patients manner of speaking and note the state of awareness or level of consciousness.

ASSESSING POSTUREInspect position, posture.Inspect normal curves of the spine with the patient standing.

Normal findings:Posture erect, head midline, four normal spinal curves.

ASSESSING POSTUREIf you suspect a spinal deformity, test for kyphosis and scoliosis by having patient bend at the waist and assume a dive position. Stand behind patient and inspect and palpate spinal curvature.

ASSESSING POSTURETest for lordosis: Have the patient stand against a wall and flatten her or his back against it while you attempt to slide your hand behind patients back.

ASSESSING POSTUREscoliosislordosis

ASSESSING POSTUREAssessing for knee deviation: Note position of knees, and draw an imaginary line from the anterior superior iliac crest through the knees to the feet. Imaginary line should transect patella.

Normal findings:Knees midline.

Inspect the patient as he or she walks.Note posture, head position, conformity of phases, toe position, arm swing, cadence, coordination of movements, stride length, and base of support.Assessing GaitAssessing GaitPropulsive gaitRigid, stooped posture with head leaning forward and arms, knees, and hips stiffly flexed.Rapid, short, shuffling steps.

Assessing GaitScissors gait

Bilateral spastic paresis of legs; arms not involved.Legs flexed at hip and knees.Knees adduct and meet or cross like scissors.Short steps, foot plantarflexed, walks on toes.

Assessing GaitSpastic gaitUnilaterally stiff, dragging leg from leg, muscle hypertonicity.

Assessing GaitWaddling gaitDucklike walk with wide base of support, chest thrown back, exaggerated lumbar curve (lordosis), and protruding abdomen.Normal in toddlers and late stages of pregnancy.

Assessing GaitSteppage gaitFoot drop with external rotation of hip and hip and knee flexion. Foot slaps when it hits ground.

Normal findings:Posture erect, head midline, phases conform, weight evenly distributed, both feet point straight ahead, no toeing in or out, all movements coordinated and rhythmic, arms swing in opposition, stride length appropriate.

Assessing Gait