Chapter08-Assessment.pptx

Chapter 8 Assessment Learning Objectives  1. Identify the categories used to assess the client’s mental health status.  2. Formulate questions to obtain information in each category.  3. Describe the client’s functioning in terms of self-concept, roles, and relationships.  4. Recognize key physi...

Chapter 8 Assessment Learning Objectives  1. Identify the categories used to assess the client’s mental health status.  2. Formulate questions to obtain information in each category.  3. Describe the client’s functioning in terms of self-concept, roles, and relationships.  4. Recognize key physiological functions that are frequently impaired in people with mental disorders.  5. Obtain and organize psychosocial assessment data to use as a basis for planning nursing care.  6. Examine one’s own feelings and any discomfort discussing suicide, homicide, or self-harm behaviors with a client. Copyright © 2023 Wolters Kluwer All Rights Reserved Psychosocial Assessment  Purpose o Picture of client’s current emotional state, mental capacity, behavioral function o Basis for developing plan of care o Clinical baseline to evaluate effectiveness of treatment or measure client’s progress Copyright © 2023 Wolters Kluwer All Rights Reserved Factors Influencing Assessment Client participation/feedback Client’s health status Client’s previous experiences/misconceptions about health care Client’s ability to understand Nurse’s attitude and approach Copyright © 2023 Wolters Kluwer All Rights Reserved The Interview #1 Environment o Comfortable, private, safe o Quiet with few distractions Input from family, friends o Information about their perceptions of client o Information limited by certain factors  Family do not feel safe to speak about pt  Pt needs family present in order to participate  Pt does not allow to interview family separate Copyright © 2023 Wolters Kluwer All Rights Reserved The Interview #2 Questions o Open-ended to initiate assessment  “What brings you in today” o Focused if client cannot organize thoughts or has difficulty answering open-ended questions  Clear, simple, direct “How many meal a day do you eat” Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #1 History (see Box 8.1) o Age o Developmental stage o Cultural considerations o Spiritual beliefs o Previous history Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #2 (Box 8.1 cont) General appearance/motor behavior o Hygiene/grooming o Appropriate dress o Posture o Eye contact o Unusual movements/mannerisms  Automatisms, psychomotor retardation, waxy flexibility o Speech  Neologisms Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #3 (Box 8.1 cont) Mood/affect o Assess for consistency o Common terms in assessing affect  Blunted  Broad  Flat  Inappropriate  Restricted  Labile Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #4 (Box 8.1 cont)  Thought process/content o Process (how the client thinks) and content (what the client says)  Circumstantial thinking  Delusion  Flight of ideas  Ideas of reference  Loose associations  Tangential thinking  Thought broadcasting, insertion, blocking, withdrawal Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #5 (Box 8.1 cont) Assessment of suicide or harm toward others (see Box 8.2) o Ask client directly o Anger, hostility, or threats toward another person o Specific threats or plans to harm someone  Duty to warn Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #6 (Box 8.1 cont) Sensorium/intellectual processes o Orientation o Memory o Ability to concentrate o Abstract thinking and intellectual abilities Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #7 (Box 8.1 cont) Sensory–perceptual alterations o Auditory hallucinations o Visual hallucinations Judgment and insight o Ability to interpret environment o Ability to understand true nature of one’s situation Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #8 (Box 8.1 cont)  Self-concept o Personal worth and dignity o Description of physical characteristics/body image o Emotions the client frequently experiences  Roles and relationships o Current roles o Ability to fulfill roles o Changes in roles o Satisfaction with relationships o Online activity/social media o Categories of family assessment (see Box 8.3) Copyright © 2023 Wolters Kluwer All Rights Reserved Assessment Content #9 (Box 8.1 cont) Physiological and self-care considerations o Eating habits o Sleep patterns o Major or chronic health problems o Use of drugs and/or alcohol o Noncompliance with prescribed medications Copyright © 2023 Wolters Kluwer All Rights Reserved Data Analysis Overall assessment o Not isolated bits of information o Patterns or themes in data → conclusions about clients’ strengths and needs, problems and risks Ongoing, dynamic process o Assess and reassess throughout care of pt Psychological tests (criticized for being culturally biased) o Intelligence tests-tests cognitive abilities and intellectual functioning o Personality tests(Table 8.2) Psychiatric diagnoseso Found in DSM-5 Universally used by psychiatrist and mental health practitioners Mental status examination Copyright © 2023 Wolters Kluwer All Rights Reserved Data Analysis: Psychological Tests Intelligence tests o Cognitive abilities o Intellectual functioning Personality tests o Self-concept, impulse control, reality testing, major defenses o Objective (see Table 8.1)  requires the respondent to make a particular response to a structured set of instructions (e.g., true/false, yes/no, or the correct answer). o Projective (see Table 8.2)  a personality test in which subjects are shown ambiguous images or given situations and asked to interpret them. The subjects are to project their own emotions, attitudes, and impulses onto the stimulus given; and then use these projections to explain an image, tell a story, or finish a sentence. Copyright © 2023 Wolters Kluwer All Rights Reserved Data Analysis: Psychiatric Diagnoses Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) o Classifies mental disorders into categories o Describes each disorder o Provides diagnostic criteria for each disorder Copyright © 2023 Wolters Kluwer All Rights Reserved Data Analysis: Mental Status Examination Client’s cognitive abilities o Orientation to person, time, place, date, season, day of the week o Interpretation of proverbs o Math calculations o Memorization, short-term recall o Identification of common objects o Ability to follow multistep commands o Ability to write or copy a simple drawing Copyright © 2023 Wolters Kluwer All Rights Reserved Self-Awareness Issues Gather all information needed. o Judgments are not part of assessment process. Be open, clear, direct when asking about personal or uncomfortable topics. Examine own beliefs; gain self-awareness (growthproducing experience). Do not allow personal beliefs to interfere with nurse– client relationship and assessment process. Copyright © 2023 Wolters Kluwer All Rights Reserved