FOUNDATION: MENTAL HEALTH

what mental health integrate

multiple concepts

• cognition, anxiety, mood and affect, communication

Cognition

The ability to understand and process information, focus attention, solve problems, and demonstrate the ability to remember recent and remote events

anxiety

a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat

Mood

the way a person feels emotionally

affect

the observable response that person has to those emotions

communication

The active process of using words, sounds, signs or behaviors to exchange information

mental health

State of well-being—Ability to realize one’s own abilities.

what can you do with good mental health

◦ Can cope with normal stresses of life.

◦ Capacity to rationally think, communicate, learn, grow emotionally, and have self-esteem.

◦ Able to contribute to community.

what can affect mental health

Changes in people’s lives

what is required

Periodic assessment of mental health and mental status

mental status

Degree of competence that a person shows: Intellectual, Emotional, Psychological, Personality

mental health neurotransmitters

◦ Dopamine

◦ Serotonin

◦ Norepinephrine

◦ Acetylcholine

• too high or too low can lead to mental health disorders

how is data needed for mental health assessment collected

by talking with patient, nurse collects data about mental status during history

during interview what does the nurse determine

patient’s appearance, behavior, and cognitive function compared with characteristics of a healthy personality.

when does data collection begin

upon first seeing the patient

what do nurses look at in general health history

◦ Is patient dressed appropriately for weather?

◦ Does his or her mood seem appropriate? Is affect (emotional state) appropriate?

◦ What is patient’s body posture? Slumped over and looking at ground with a sad facial expression, or walking tall with a brisk step and a smiling face?

◦ What is the tone of voice? Monotone or happy, expressive tone?

◦ Does conversation flow in logical sequence?

Present Health Status Questions

◦ Are you having any medical problems?

◦ What medications are you taking?

why to ask about medication

Side effects of some medications may cause changes in mood and behavior; also, nurse needs to know if patient is taking medications for mental disorders.

Past Mental Health History: In the past, have you experienced any behaviors that could indicate a mental

health problem?

◦ If yes, how have you coped in the past?

◦ Did these strategies work for you?

past mental health question: Do you have any blood relatives who have behaviors that could indicate a mental health problem?

If yes, describe the behavior they experience.

past mental health history: Some people have witnessed violence at home

Did you have any experience with violence?

Personal and Psychosocial History:Self-Concept Questions

How have you been feeling about yourself?

• Do you consider your present feelings as being a problem in everyday life?

How would you describe yourself to others?

• What are your best characteristics?

• What do you like about yourself?

Personal and Psychosocial History: Interpersonal Relationship Questions

◦ How satisfied are you with your interpersonal relationships?

• Are there people you feel you can talk to about your feelings?

what three questions should be ask to every patient because abuse or violence has become more common

◦ Have you been physically injured by someone in your home over the last year?

◦ Are you fearful of anyone you have had a relationship with?

◦ Do you feel safe?

questions to ask about stressors

◦ Have there been any recent changes in your life?

◦ Have these affected your stress level?

◦ What are major stressors in your life? How do you deal with stress?

◦ Are those methods effective for you?

why should every adult and adolescent should be asked about alcohol and recreational drug use

to determine if it is a health problem

alcohol use question

How often do you drink alcohol, including beer, wine, or liquor?

Recreational drug use question

Do you ever use recreational drugs? If yes, tell me about your drug use.

mental health problem based history

◦ Depression

◦ Anxiety

◦ Altered Mental Status

◦ Alcohol/Drug Use

◦ Interpersonal Violence

women depression risk

Women are at risk for depression 2:1 over men.

depression age

most common between the ages of 25 and 44.

what do you pay attention to in depression assessment

◦ Facial expression.

◦ Eye contact.

◦ Body language.

◦ Tone of voice.

Depression questions

During past month, have you been feeling down, depressed, or hopeless?

• Have you had little interest or pleasure in activities?

Are you able to fall asleep and stay asleep?

• Have you lost or gained weight recently?

Describe your mood:

• Do you have crying spells?, Is it hard to concentrate?, Have you been more irritable?, How often have you had those feelings?, How long did they last?

Do you have friends you can trust and who are available when you need them?

Have you had feelings like this before?

• What did you do about depressive feelings then?

Have you ever thought of escaping by hurting yourself or ending your life?

• If yes, do you feel like this now?, Do you have a plan for hurting yourself?, Have you told anyone else about your plan?, What would happen if you were dead?, What has kept you from hurting yourself in the past?

anxiety questions

◦ Have you had difficulty in concentrating or making decisions?

• Are you able to fall asleep and stay asleep?, Have you been more irritable?, Are your muscles tense? Do you feel a tightening in your throat?

◦ Have you felt nauseated?

• Does your heart race?, Do you have to urinate more?

◦ Have you noticed a change in your feelings?

• If yes, describe., What initiated those feelings

when do changes in mental status may become evident

when there is change in patient’s orientation to time, place or person, attention span, or memory.

when orientation become a concern while nurse is taking data what does nurse do

ask addition questions to collect data

how can long term memory be assessed during interview

by asking patient where he or she was born or about previous surgeries.

orientation questions to ask for altered mental status

◦ What year is it?

◦ Where are you?

memory questions to ask for altered mental status

Ask patient to repeat three unrelated objects.

other question to ask for altered mental status

Calculation ability:

• You buy fruit that cost $2.45. You give the cashier $3.00. What should your change be?

Alcohol Abuse Questions

Many people drink, do you sometimes?

• If yes, how many times in the past year would you say you have had more than five drinks in a day (for male) or four drinks (for women)?

In the past 2 months, has your drinking caused any problems?

• Risk of harm, Relationship trouble, Role failure, Run-ins with the law

Drug Abuse Questions

Have you used recreational drugs in the past?

For each drug reported, ask:

• How often have you used it?

• Do you have a strong desire for it?

• Have you tried and failed to control or cut down use?

Recreational drug

heroin, cocaine, and marijuana and abuse of prescription drugs.

question about violence if they answered yes to violence eariler in screening

◦ Are you in a relationship in which you have been hurt or threatened?

◦Has your partner destroyed things you care about?

◦ Has your partner ever threatened or abused your children?

◦ Has your partner ever forced you to do something you did not want to do?

◦ Has your partner prevented you from leaving home, seeing friends, getting a job, or continuing your education?

◦ Do you have guns in the home?

mental health assessment physical examination

◦ General Survey

◦ Vital Signs

◦ Gait, posture, movements

◦ Assess LOC

◦ Observe for affect, facial expressions, voice tone

◦ Observe dress and hygiene

◦ More in-depth neurological assessment if indicated (altered mental status)