Nursing process in psychiatric and mental health
1- Define nursing process.
2- Identify six steps of nursing process.
3- Describe nursing actions related to assessment step include:
- Psychiatric assessment.
- Mental health examination.
Definition of nursing process:
It is an ongoing dynamic process that continues for as long as nurse and client have interactions directed toward change in the client's physical or behavioral responses.
- Nursing process consists of six steps and uses a problem-solving approach
- It is a process of collection and organization of data which required for diagnosis of mental illness.
- It may include further assessment as:
1- Laboratory tests.
2- Hospital observation.
3- Psychological testing.
4- Home visits.
- Aims of Psychiatric assessment:
1- Discover and diagnose the mental illness.
2- Determine the severity of the diagnosed.
3- Identify the causes of mental illness.
4- Used for setting the management plan.
5- Make a good relationship with clients.
- Difference between psychiatric and medical-surgical assessment:
1- Psychiatric assessment usually takes longer time.
2- In psychiatric assessment, information from others are mostly necessary.
3- Also psychiatric patient may feel ashamed.
- Methods of psychiatric assessment:
1- Psychiatric history ( patient history).
2- Mental status examination.
3- Physical examination.
I - Psychiatric history ( psychiatric interview):
- Types of psychiatric interview:
1- Structured (Questions of interview are prepared and planed before).
2- Non-structured (Question determined by interviewer according to patient style).
3- Semi structured (Includes the structured and non structured interviews).
- Components of Psychiatric history:
1- Identifying data as (Client name, sex, age, marital status,language,interview time,date, and palce...etc).
2- Chief complain (Write patient's own words and use Open ended questions).
3- Present history: With analysis the present complain by (PQRST) method.
4- Past history: as
1- Past psychiatric and medical-surgical history.
2- Past personal history:
- Early development (Birth and pregnancy and maternal problems).
- Childhood (Early,Middle, and late).
- Occupational history.
- Marital relationship.
- Social activity.
- Current living situation.
- Family history.
II - Mental Status Examination "MSE"
Definition: "It's one of neurological examinations which needed for mental status and cerebral function testing to reach a tentative diagnosis".
Components of MSE :
1- General Appearance
Nutritional status (Malnutrition may refer to depression, or anorexia nervosa).
Hygiene and dress (Poor self hygiene refer to depression, and mismatched colorful dress refer to mania).
Eye contact (Wandering eye contact may refer to anxiety or mania)
2- Psychomotor behavior
Level of activity (Increased in mania, and decreased in depression).
Posture, sitting and walking (Pacing increased in mania).
Facial expression (Sad face in anxiety, and mask face may refer to Parkinson).
Movement (Mannerisms refer to schizophrenia, and hand tremor refer to anxiety).
3- Mood "Sustained emotion that colors the patient perception of world around"
Anxious in anxiety.
Sad in depression.
perplexed in mania.
Labile in hysterical patients.
Elated in mania.
4.Affect "External expressions of the patient emotion which observed by examiner"
Appropriate to situation in healthy clients.
Inappropriate to situation in schizophrenia.
Apathetic in depression or schizophrenia.
Amount (Increased in mania and anxiety, and decreased in depression).
Speed (Increased in mania and anxiety, and decreased in depression).
Articulation (Poor articulation may refer to schizophrenia).
Rhythm (Heterotonus in mania and anxiety, and monotonous in depression).
Thought Process "Thoughts availability and association"
- (Flat ideas in mania, and loss of association in schizophrenia).
Thought Content "Delusions, phobias, obsessions, compulsions, and hypochondria"
Hallucination "False perception without external stimulus".
Illusions "False perception with real external stimulus".
8.Sensorium and Cognition
Consciousness level .
Orientation to place, person, and time.
Concentration "Ability to keep one's attention on a certain task".
Memory "Short (5- 10 min), long (24 hr), intermediate (less than 1min), remote (years ago)" .
Abstract thinking "Ability to expalin and deal with concepts as proverbs".
Intelligence and calculation.
Insight "It's the degree of patient's awarness to that he or she is ill".
Judgment "It's the ability to choose appropriate goals to acheive them".
- It's the patient ability to control his sexual, agressive and other impulses.
- Veracity of gathered information.
- Major positive and negative data from the history and MSE are summarized to identify a tentative and differntial diagnosis, also other investigations and tests needed are listed.
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