I need help with this assignment in the attached file.

Score

Points

Orientation

1. What is the:

Year?

_____

1

Season?

_____

1

Date?

_____

1

Day?

_____

1

Month?

_____

1

2. Where are we?

State?

_____

1

Country?

_____

1

Town or city?

_____

1

Hospital?

_____

1

Floor?

_____

1

Registration
3. Name three objects, taking 1 second to say each. Then ask the patient to repeat all three names after you have said them. (Give one point for each correct answer.) Repeat the answers until the patient learns all three.

_____

3

Attention and calculation
Serial sevens. Have the patient count backward from 100 by 7's. (Stop after five answers: 93, 86, 79, 72, 65. Give one point for each correct answer.) Alternatively, have the patient spell WORLD backwards.

_____

5

Recall
5. Ask for the names of the three objects learned in question 3. (Give one point for each correct answer.)

_____

3

Language
6. Point to a pencil and a watch. Have the patient name them as you point.

_____

2

7. Have the patient repeat "No ifs, ands or buts."

_____

1

8. Have the patient follow a three-stage command: "Take a paper in your hand. Fold the paper in half. Put the paper on the floor."

_____

3

9. Have the patient read and obey the following: "CLOSE YOUR EYES." (Write the words in large letters.)

_____

1

10. Have the patient write a sentence of his or her choice. (The sentence should contain a subject and an object, and it should make sense. Ignore spelling errors when scoring.)

_____

1

11. Have the patient copy the following design. (Give one point if all sides and angles are preserved and if the intersecting sides form a quadrangle.)

_____

1

Total Score

_____

Yes

I have an illness or condition that has made me change the kind and/or amount of food I eat.

2

I eat fewer than two meals a day.

3

I eat few fruits, vegetables or milk products.

2

I have three or more drinks of beer, liquor or wine almost every day.

2

I have tooth or mouth problems that make it hard for me to eat.

2

I do not always have enough money to buy the food I need.

4

I eat alone most of the time.

1

I take three or more different prescribed or over-the-counter drugs a day.

1

Without wanting to, I have lost or gained 10 pounds in the past six months.

2

I am not always physically able to shop, cook and/or feed myself.

2

1. Are you basically satisfied with your life?

Yes / NO

2. Have you dropped many of your activities and interests?

YES / No

3. Do you feel that your life is empty?

YES / No

4. Do you often get bored?

YES / No

5. Are you in good spirits most of the time?

Yes / NO

6. Are you afraid that something bad is going to happen to you?

YES / No

7. Do you feel happy most of the time?

Yes / NO

8. Do you often feel helpless?

YES / No

9. Do you prefer to stay at home, rather than going out and doing new things?

YES / No

10. Do you feel you have more problems with memory than most?

YES / No

11. Do you think it is wonderful to be alive now?

Yes / NO

12. Do you feel pretty worthless the way you are now?

YES / No

13. Do you feel full of energy?

Yes / NO

14. Do you feel that your situation is hopeless?

YES / No

15. Do you think that most people are better off than you are?

YES / No

1. Can you use the telephone?

Without help

3

With some help

2

Completely unable to use the telephone

1

2. Can you get to places that are out of walking distance?

Without help

3

With some help

2

Completely unable to travel unless special arrangements are made

1

3. Can you go shopping for groceries?

Without help

3

With some help

2

Completely unable to do any shopping

1

4. Can you prepare your own meals?

Without help

3

With some help

2

Completely unable to prepare any meals

1

5. Can you do your own housework?

Without help

3

With some help

2

Completely unable to do any housework

1

6. Can you do your own handyman work?

Without help

3

With some help

2

Completely unable to do any handyman work

1

7. Can you do your own laundry?

Without help

3

With some help

2

Completely unable to do any laundry at all

1

8a. Do you take any medicines or use any medications?

Yes (If "yes," answer question 8b.)

1

No (If "no," answer question 8c.)

2

8b. Do you take your own medicine?

Without help (in the right doses at the right time)

3

With some help (take medicine if someone prepares it for you and/or reminds you)

2

Completely unable to take own medicine

1

8c. If you had to take medicine, could you do it?

Without help (in the right doses at the right time)

3

With some help (take medicine if someone prepares it for you and/or reminds you)

2

Completely unable to take own medicine

1

9. Can you manage your own money?

Without help

3

With some help

2

Completely unable to handle money

1

Problem

Screening measure

Positive screen

Vision

Ask this question: "Because of your eyesight, do you have trouble driving a car, watching television, reading or doing any of your daily activities?"
If the patient answers "yes," test each eye with the Snellen eye chart while the patient wears corrective lenses (if applicable).

"Yes" to question and inability to read at greater than 20/40 on the Snellen eye chart

Hearing

Ask this question: Do you frequently ask people around you to repeat what they have said? Are your friends and family concerned about your hearing? Do you have to have the volume loud on the TV or stereo? Do you have trouble talking on the phone because you can’t hear what is being said?

"Yes" to 2 or more question

Leg mobility

Time the patient after giving these directions: "Rise from the chair. Then walk 20 feet briskly, turn, walk back to the chair and sit down."

Unable to complete task in 15 seconds

Urinary incontinence

Ask this question: "In the past year, have you ever lost your urine and gotten wet?"
If the patient answers "yes," ask this question: "Have you lost urine on at least 6 separate days?"

"Yes" to both questions

Nutrition and weight loss

Ask this question: "Have you lost 10 pounds over the past 6 months without trying to do so?"
If the patient answers "yes," weigh the patient.

"Yes" to the question or a weight of less than 45.5 kg (100 lb)

Memory

Ask to recall three-items: Such as birthday, address, phone number, family/friends names, etc)

Unable to remember all three items after 1 minute

Depression

Ask this question: "Do you often feel sad or depressed?"

"Yes" to the question

Physical disability

Ask the patient these six questions:

"Are you able to do strenuous activities, like fast walking or bicycling?"

"Are you able to do heavy work around the house, like washing windows, walls or floors?"

"Are you able to go shopping for groceries or clothes?"

"Are you able to get to places that are out of walking distance?"

"Are you able to bathe--sponge bath, tub bath or shower?"

"Are you able to dress, like put on a shirt, button and zip your clothes, or put on your shoes?"

"No" to any of the questions

Score

Points

Orientation

1. What is the:

Year?

_____

1

Season?

_____

1

Date?

_____

1

Day?

_____

1

Month?

_____

1

2. Where are we?

State?

_____

1

Country?

_____

1

Town or city?

_____

1

Hospital?

_____

1

Floor?

_____

1

Registration
3. Name three objects, taking 1 second to say each. Then ask the patient to repeat all three names after you have said them. (Give one point for each correct answer.) Repeat the answers until the patient learns all three.

_____

3

Attention and calculation
Serial sevens. Have the patient count backward from 100 by 7's. (Stop after five answers: 93, 86, 79, 72, 65. Give one point for each correct answer.) Alternatively, have the patient spell WORLD backwards.

_____

5

Recall
5. Ask for the names of the three objects learned in question 3. (Give one point for each correct answer.)

_____

3

Language
6. Point to a pencil and a watch. Have the patient name them as you point.

_____

2

7. Have the patient repeat "No ifs, ands or buts."

_____

1

8. Have the patient follow a three-stage command: "Take a paper in your hand. Fold the paper in half. Put the paper on the floor."

_____

3

9. Have the patient read and obey the following: "CLOSE YOUR EYES." (Write the words in large letters.)

_____

1

10. Have the patient write a sentence of his or her choice. (The sentence should contain a subject and an object, and it should make sense. Ignore spelling errors when scoring.)

_____

1

11. Have the patient copy the following design. (Give one point if all sides and angles are preserved and if the intersecting sides form a quadrangle.)

_____

1

Total Score

_____

Yes

I have an illness or condition that has made me change the kind and/or amount of food I eat.

2

I eat fewer than two meals a day.

3

I eat few fruits, vegetables or milk products.

2

I have three or more drinks of beer, liquor or wine almost every day.

2

I have tooth or mouth problems that make it hard for me to eat.

2

I do not always have enough money to buy the food I need.

4

I eat alone most of the time.

1

I take three or more different prescribed or over-the-counter drugs a day.

1

Without wanting to, I have lost or gained 10 pounds in the past six months.

2

I am not always physically able to shop, cook and/or feed myself.

2

1. Are you basically satisfied with your life?

Yes / NO

2. Have you dropped many of your activities and interests?

YES / No

3. Do you feel that your life is empty?

YES / No

4. Do you often get bored?

YES / No

5. Are you in good spirits most of the time?

Yes / NO

6. Are you afraid that something bad is going to happen to you?

YES / No

7. Do you feel happy most of the time?

Yes / NO

8. Do you often feel helpless?

YES / No

9. Do you prefer to stay at home, rather than going out and doing new things?

YES / No

10. Do you feel you have more problems with memory than most?

YES / No

11. Do you think it is wonderful to be alive now?

Yes / NO

12. Do you feel pretty worthless the way you are now?

YES / No

13. Do you feel full of energy?

Yes / NO

14. Do you feel that your situation is hopeless?

YES / No

15. Do you think that most people are better off than you are?

YES / No

1. Can you use the telephone?

Without help

3

With some help

2

Completely unable to use the telephone

1

2. Can you get to places that are out of walking distance?

Without help

3

With some help

2

Completely unable to travel unless special arrangements are made

1

3. Can you go shopping for groceries?

Without help

3

With some help

2

Completely unable to do any shopping

1

4. Can you prepare your own meals?

Without help

3

With some help

2

Completely unable to prepare any meals

1

5. Can you do your own housework?

Without help

3

With some help

2

Completely unable to do any housework

1

6. Can you do your own handyman work?

Without help

3

With some help

2

Completely unable to do any handyman work

1

7. Can you do your own laundry?

Without help

3

With some help

2

Completely unable to do any laundry at all

1

8a. Do you take any medicines or use any medications?

Yes (If "yes," answer question 8b.)

1

No (If "no," answer question 8c.)

2

8b. Do you take your own medicine?

Without help (in the right doses at the right time)

3

With some help (take medicine if someone prepares it for you and/or reminds you)

2

Completely unable to take own medicine

1

8c. If you had to take medicine, could you do it?

Without help (in the right doses at the right time)

3

With some help (take medicine if someone prepares it for you and/or reminds you)

2

Completely unable to take own medicine

1

9. Can you manage your own money?

Without help

3

With some help

2

Completely unable to handle money

1

Problem

Screening measure

Positive screen

Vision

Ask this question: "Because of your eyesight, do you have trouble driving a car, watching television, reading or doing any of your daily activities?"
If the patient answers "yes," test each eye with the Snellen eye chart while the patient wears corrective lenses (if applicable).

"Yes" to question and inability to read at greater than 20/40 on the Snellen eye chart

Hearing

Ask this question: Do you frequently ask people around you to repeat what they have said? Are your friends and family concerned about your hearing? Do you have to have the volume loud on the TV or stereo? Do you have trouble talking on the phone because you can’t hear what is being said?

"Yes" to 2 or more question

Leg mobility

Time the patient after giving these directions: "Rise from the chair. Then walk 20 feet briskly, turn, walk back to the chair and sit down."

Unable to complete task in 15 seconds

Urinary incontinence

Ask this question: "In the past year, have you ever lost your urine and gotten wet?"
If the patient answers "yes," ask this question: "Have you lost urine on at least 6 separate days?"

"Yes" to both questions

Nutrition and weight loss

Ask this question: "Have you lost 10 pounds over the past 6 months without trying to do so?"
If the patient answers "yes," weigh the patient.

"Yes" to the question or a weight of less than 45.5 kg (100 lb)

Memory

Ask to recall three-items: Such as birthday, address, phone number, family/friends names, etc)

Unable to remember all three items after 1 minute

Depression

Ask this question: "Do you often feel sad or depressed?"

"Yes" to the question

Physical disability

Ask the patient these six questions:

"Are you able to do strenuous activities, like fast walking or bicycling?"

"Are you able to do heavy work around the house, like washing windows, walls or floors?"

"Are you able to go shopping for groceries or clothes?"

"Are you able to get to places that are out of walking distance?"

"Are you able to bathe--sponge bath, tub bath or shower?"

"Are you able to dress, like put on a shirt, button and zip your clothes, or put on your shoes?"

"No" to any of the questions