Screening for & Management of Acute and Chronic Health Problems PDF

Screening for & Management of Acute and Chronic Health, and Psychiatric, Behavioral Problems/Disorders Tamar U. Rodney, PhD, RN, PMHNP-BC, CNE, FAAN  1. Identify screening guidelines used when assessing adults and older adults with acute...

Screening for & Management of Acute and Chronic Health, and Psychiatric, Behavioral Problems/Disorders Tamar U. Rodney, PhD, RN, PMHNP-BC, CNE, FAAN  1. Identify screening guidelines used when assessing adults and older adults with acute and chronic health, psychiatric, behavioral problems/disorders 2. Discuss epidemiology, pathophysiology and clinical presentation of adult and older adults presenting with acute By the end of and chronic health, psychiatric, behavioral this module, you will be able to: problems/disorders 3. Describe the evaluation and management of adult and older adults presenting with acute and chronic health, psychiatric, behavioral problems/disorders Mental Health ► Ability to Think rationally Communicate appropriately Learn Grow emotionally Be resilient Have a healthy self-esteem Realistic goals and reasonable function within the individual’s role Source Info Mental Illness ► Disorders with definable diagnosis ► Significant dysfunction in mental functioning related to Developmental Biological Physiological disturbances ► Culturally defined Source Info DSM-5-TR ► The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ► Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders ► Based on specific criteria influenced by multiprofessional clinical field trials Source Info Disorder-Specific Severity Measures ► Measures correspond with the diagnostic criteria. ► Used to confirm a diagnostic impression, assess severity, and monitor progress ► Some clinician-rated, some patient-rated. Source Info Assessment Measures ► https://www.psychiatry.org/psychiatrists/practice/dsm/ed ucational-resources/assessment-measures Source Info The Perspectives of Psychiatry ► Diseases - Has ► Dimensions - Is ► Behaviors - Does ► Life story – Experiences McHugh and Slavney Source Info Steps to Diagnosis ► General/Other or Medical Condition ► Consider if Substance-Related or Substance/Medication-Induced ► Role of diversity/ cultural/ developmental McHugh and Slavney Source Info Steps to Diagnosis ► Differentiation between diagnostic groupings ► Discrimination of disorders within the diagnostic group ► Impairment, distress, and resilience ► Resolve diagnostic uncertainty Source Info Psychiatric Mental Health Nursing Assessment ► Gathering data Review of systems Laboratory data MSE Psychosocial assessment Source Info Psychiatric Mental Health Nursing Assessment (Cont.) ► Gathering data (Cont.) Spiritual/religious assessment Cultural and social assessment Validating the assessment Using rating scales Source Info Mental Status ► Source of data: patient and others ► Assessment of current functioning ► Used to make a judgment about diagnosis ► Can pick up immediate threats of suicide ► Can help identify delirium, dementia Source Info Mental Status Examination ► General observations ► Sensorium and intelligence ► Thought processes ► Thought content ► Affect ► Mood ► Insight Source Info General Observations ► Physical characteristics ► Manner of dress ► Personal hygiene ► Consistency of behavior ► Posture and Gait ► Facial expression Source Info Sensorium and Intelligence ► Level of consciousness ► Orientation ► Memory ► Intellectual functioning ► Judgment ► Comprehension Source Info Thought Processes ► Rate of speech ► Loose associations ► Flight of ideas ► Thought blocking ► Neologisms ► Quantity of speech ► Circumstantiality ► Tangentiality Source Info Thought Content ► Delusions ► Illusions ► Hallucinations ► Obsessions ► Compulsions ► Thought broadcasting ► Depersonalization Source Info Emotional State ► Affect ► Mood: self rated ► Assess for suicidal or homicidal thoughts ► Assess anxiety ► Assess for anger Source Info Insight ► Does patient acknowledge a problem? ► Does patient accept need for help? ► What is patient’s explanation of problem? Source Info Recording the Mental Status Exam ► Includes documentation of nonadherence ► The medical record is a legal document ► Accurately reflect the patient’s condition, treatment, tests, responses, and any untoward incidents ► Important points: Structure the findings Use verbatim examples Clarify judgments with examples Be specific, avoid global statements Record your response to the patient, the interview Source Info Recording the Mental Status Exam ► Includes documentation of nonadherence ► The medical record is a legal document ► Accurately reflect the patient’s condition, treatment, tests, responses, and any untoward incidents ► Important points: Structure the findings Use verbatim examples Clarify judgments with examples Be specific, avoid global statements Record your response to the patient, the interview Source Info References Diagnostic and Statistical Manual of Mental Disorders: DSM-5- TR. (2022). United States: American Psychiatric Association Publishing. McHugh, P. R., Slavney, P. R. (1998). The Perspectives of Psychiatry. United Kingdom: Wolters Kluwer Health, LWW. Source Info Contact Details Tamar Rodney [email protected] @TamarRodney