Nursing Mental Health Assessment Form
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Questions and Answers

What are some examples of limitations in performing ADL (Activities of Daily Living)?

Washing, Toileting, Dressing, Feeding, Mobility, Transferring

Which of the following are components of immediate memory assessment?

  • Ask the client to remember three words (correct)
  • Inquire about childhood or past history
  • Ask the client about your name (correct)
  • Question about recent lockdowns

    • Average hours of Sleep:______

    blank

    Match the following components with their descriptions:

    <p>Judgment = Questions about behavior in society Suicidality = Questions about feelings of self-harm or harm towards others Thought Process = Observing abundance or paucity of thoughts Thought Content = Inquiries about obsessions, phobias, fears</p> Signup and view all the answers

    What is the purpose of the Mental Health Assessment Form?

    <p>To gather demographic and psychosocial information about the individual.</p> Signup and view all the answers

    Good insight means the client has FULL awareness of their strengths, limitations, and conditions.

    <p>True</p> Signup and view all the answers

    How would you describe the individual's childhood according to the form?

    <p>Good, fair, poor, or N/A.</p> Signup and view all the answers

    Are there questions related to the individual's spiritual and cultural background in the form?

    <p>True</p> Signup and view all the answers

    Which substances are included in the Substance Use History section?

    <p>Cocaine</p> Signup and view all the answers

    In the Violence Risk Assessment section, what is asked about regarding harm to oneself?

    <p>Self-harm intentions and suicide attempts.</p> Signup and view all the answers

    What is the instruction given to assess distractibility?

    <p>Repeat the days of the week backwards</p> Signup and view all the answers

    What is the other instruction given to assess distractibility?

    <p>Spell the word 'hotdog' backwards</p> Signup and view all the answers

    What mathematical task is used to assess distractibility?

    <p>Begin from 50 then subtract 7 again and again</p> Signup and view all the answers

    Begin from 50 then subtract 7 again and again and so on is a way to test ________________.

    <p>distractibility</p> Signup and view all the answers

    What cognitive ability is being assessed with abstract thinking tasks?

    <p>Similarities</p> Signup and view all the answers

    How many cities are required to be named in Cavite?

    <p>5</p> Signup and view all the answers

    Match the following proverbs with their descriptions:

    <ol> <li>Ang hindi lumingon sa pinanggalingan, ay di makakarating sa paroroonan. = A. Always remember your roots to reach your destination.</li> <li>Kapag binato ka ng bato, batuhin mo ng tinapay. = B. Respond with kindness even in the face of hostility.</li> <li>Pag may tiyaga may nilaga. = C. Persistence leads to success.</li> </ol> Signup and view all the answers

    Have you ever been physically harmed by another person in your past?

    <p>Yes</p> Signup and view all the answers

    Have you ever been forced to engage in sexual contact against your will?

    <p>Yes</p> Signup and view all the answers

    Have you ever been abused? If yes, provide details about the abuser, timing, and type of abuse.

    <p>Yes</p> Signup and view all the answers

    How do you cope with your current situation or environment?

    <p>N/A</p> Signup and view all the answers

    Do you feel your current coping techniques are effective?

    <p>Yes</p> Signup and view all the answers

    Client spends free time with: ___ Family / ___ Friends / ___ Co-Workers / ___ Alone / Other: _________

    <p>Client's choice</p> Signup and view all the answers

    Study Notes

    Mental Health Assessment Form

    • Designed for patients to provide personal and medical information to assess their mental health
    • Divided into sections: Demographic Profile, Psychosocial Assessment, Family History and Social History, Relationships, Substance Use History, Spiritual and Cultural Assessment, Violence Risk Assessment, Coping Skills, Interests and Abilities, and Mental Status Checklist

    Demographic Profile

    • Collects personal information: full name, nickname, age, sex, date of birth, address, email, contact number, city/town, province, postal code, marital status, occupation, ethnicity, religion, health insurance/health card number, and emergency contact details

    Psychosocial Assessment

    • Evaluates the patient's chief concerns, psychiatric history, and current mood
    • Asks about previous counseling sessions, hospitalizations, and feelings
    • Inquires about the patient's mood, including feelings of anxiety, depression, or suicidal thoughts

    Family History and Social History

    • Explores the patient's family dynamics, childhood, and relationships with parents, siblings, and guardians
    • Inquires about family history of mental illness, substance abuse, and cultural or social issues that impacted childhood
    • Examines the patient's current relationships with family members and siblings

    Relationships

    • Assesses the patient's marital history, including duration and quality of marriages
    • Evaluates the patient's relationships with their spouse, children, and other family members

    Substance Use History

    • Inquires about the patient's history of substance use, including type, frequency, and last use of various substances

    Spiritual and Cultural Assessment

    • Explores the patient's religious faith, spiritual beliefs, and cultural practices
    • Evaluates the role of spirituality in the patient's life and treatment

    Violence Risk Assessment

    • Assesses the patient's risk of harming themselves or others
    • Inquires about suicidal thoughts, previous suicide attempts, and harm to others

    Coping Skills

    • Evaluates the patient's coping mechanisms and strategies
    • Inquires about the patient's hobbies, interests, strengths, and weaknesses

    Interests and Abilities

    • Explores the patient's leisure activities, skills, and personal strengths and weaknesses

    Mental Status Checklist

    • Assesses the patient's appearance, behavior, speech, and thought processes
    • Evaluates the patient's level of consciousness, orientation, and cognitive function### Speech
    • Quantity: Talkative, expansive, paucity, poverty
    • Fluency: Slurred, clear, hesitant, with good articulation
    • Language: Neologisms, anomia, word salad, clang associations, echolalia, apraxia, aphasia

    Mood and Affect

    • Mood: Subjective, angry, irritable, restricted, depressed, guilty, brightly elevated, darkly elevated, other
    • Affect: Objective, appropriate, inappropriate, blunted, broad, flat, restricted, labile, constricted, apathetic, congruent

    Physiologic and Self-Care Considerations

    • Eating habits and behaviors: Normal, emotional under-eating, emotional overeating
    • Sleep: Average hours of sleep, sleep patterns (normal, difficulty falling asleep, staying asleep, waking up too early, unrefreshing/non-restorative, nightmares)
    • Limitations in performing ADL: Washing, toileting, dressing, feeding, mobility, transferring

    Memory

    • Immediate Memory: Average, below average, no data
    • Recent Memory: Average, below average, no data
    • Remote Memory: Average, below average, no data
    • Questions to assess memory:
      • Immediate memory: Ask client to remember three words and repeat them after 5 minutes
      • Recent memory: Ask client about examiner's name, medications taken, recent events
      • Remote memory: Ask client about childhood or past history, favorite childhood memory, year of finishing studies

    Insight

    • Can recognize one's strengths and limitations: Good, fair, poor
    • Can recognize illness and need for treatment: Good, fair, poor
    • Questions to assess insight:
      • Can you recognize your strengths and weaknesses?
      • Do you think you need treatment?

    Judgment

    • Good, fair, poor
    • Questions to assess judgment:
      • If you found a wallet on the floor, what would you do?
      • If you were in a situation where you had to make a decision, what would you do?

    Suicidal and Homicidal Ideation

    • Suicidality: None, ideation, plan, intent, self-harm
    • Homicidality: None, ideation, plan, intent
    • Questions to assess suicidality and homicidality:
      • Do you ever feel like life isn't worth living?
      • Have you ever thought of harming yourself or others?
      • Do you think about hurting others who have wronged you?

    Thought Process

    • Overabundance, paucity, spontaneity, goal-directed, logical, perceptive, perseveration or repetition of thoughts, tangential, loose associations, rambling

    Thought Content

    • Obsessions, compulsions, phobias, paranoia, persecution, wanting to harm self or others, somatic concerns, repetitive thoughts of worry
    • Questions to assess thought content:
      • What's been on your mind lately?
      • Have you had any recent obsessions or phobias?
      • Do you have any worries about being sick?

    Thought Disturbances

    • Delusions (false beliefs), hallucinations, ideas of reference, thought broadcasting, magical thinking, grandiosity, confabulation
    • Questions to assess thought disturbances:
      • Do you have any personal beliefs that are not shared by others?
      • Do you sometimes feel like things are unnatural or unreal?
      • Do you hear voices or see things that are not really there?

    Attention

    • Attention/distractibility: Sufficient, deficient, easily distractible, short attention span

    • Questions to assess attention:

      • Repeat the days of the week backwards
      • Spell the word "hotdog" backwards### Intellectual Abilities

    • Ability to concentrate involves sustained, selected, and divided attention

    • Intellectual abilities can be measured through information and vocabulary tests

    Information and Vocabulary

    • Information tests assess knowledge of current events, such as:
      • Naming the current president, vice president, and mayor
      • Identifying cities located in Cavite
    • Vocabulary tests evaluate language proficiency at different levels:
      • Grade school level
      • High school level
      • Fluent
      • Consistent with education

    Abstraction

    • Abstraction involves identifying similarities and understanding proverbs
    • Similarities test:
      • Identifying commonalities between objects, such as:
        • Apple and orange
        • Chair and table
    • Proverbs test:
      • Understanding the meaning of sayings, such as:
        • "Ang hindi lumingon sa pinanggalingan, ay di makakarating sa paroroonan"
        • "Kapag binato ka ng bato, batuhin mo ng tinapay"
        • "Pag may tiyaga, may nilaga"

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    Mental Health Assessment Form PDF

    Description

    This quiz is a mental health assessment form used in the nursing field to gather demographic information about patients. It includes questions about the patient's name, age, sex, and date of birth.

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