copyright © 2013 by mosby, an imprint of elsevier inc. mental health and abusive behavior...

CHAPTER 7

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.

Mental Health and Abusive Behavior Assessment

DSN Kevin Dobi, MS, APRN

Definition of Mental Health

Mental health: State of well-being – ability to realize one’s

own abilities. Can cope with normal stresses of life. Able to contribute to community.

Changes in people’s lives may affect mental health: Periodic assessment of mental health and

mental status is required.

Copyright © 2013 by Mosby, an imprint of Elsevier Inc. 2

Definition of Mental Status

Mental status: Degree of competence that a person shows:

Intellectual Emotional Psychological Personality


Interpersonal Violence

Abusive experiences may influence a person’s mental health: Alcohol abuse Drug abuse Personal abuse

Interpersonal violence: Is not an illness, but is a crime. Is a human rights violation.

Can have negative impacts on mental health.


Anatomy and Physiology Limbic system called emotional brain because it

regulates memory and basic emotions such as fear, anger, and sex drive.

Structures of limbic system: Limbic lobe Cingulate gyrus Hippocampus Amygdala Thalamus Portions of the hypothalamus

These structures enable communications between limbic system and cerebral cortex.


Anatomy and Physiology: Neurotransmitters

Neurotransmitters have an essential role in human emotion and behavior


Neurotransmitters Affecting Mental Health

Several neurotransmitters affect mental health: Norepinephrine (excites or elevates) Serotonin (stablises) Dopamine (feel good) Histamine (numbs) Acetylcholine (tremors) Gamma-aminobutyric acid (GABA) (sedating)


General Health History

Because data needed for mental health assessment are collected by talking with patient, nurse collects data about mental status during history: This is a deviation from assessments of

specific body systems when data collection for history is performed prior to examination.

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


General Health History (contd.)

Data collection begins upon first seeing patient: 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 tone of voice? Monotone or happy, expressive tone?

Does conversation flow in logical sequence?


General Health History:Present Health Status Questions

Are you having any medical problems? What medications are you taking?

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:Questions

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?

Do you have any blood relatives who have behaviors that could indicate a mental health problem? If yes, describe the behavior they experience.

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 every day 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? Because abuse or violence have become more

common, all patients should be asked these questions: 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?Copyright © 2013 by Mosby, an imprint

of Elsevier Inc. 15

Stressors

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?


Anger

Anger: Have you been feeling angry? Do you feel angry now? How do you react when angry?

Verbally, physically, or do you keep anger inside? Can you talk about what causes your anger?

We all fight at home: What happens when you and your partner

fight?


Alcohol and Drug Use

Every adult and adolescent should be asked about alcohol and recreational drug use to determine if it is a health problem.

Alcohol use: How often do you drink alcohol, including

beer, wine, or liquor? Recreational drug use:

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


Problem-Based History

Commonly reported problems of mental health include: Depression Anxiety Altered mental status

Common problems of abusive behaviors include: Alcohol abuse Drug abuse Interpersonal violence


Problem-Based History:Depression Assessment

Note gender and age of patient: Women are at risk for depression 2:1 over

men. It is most common between the ages of 25

and 44. Pay special attention to:

Facial expression Eye contact Body language Tone of voice


Problem-Based History: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?Copyright © 2013 by Mosby, an imprint

of Elsevier Inc. 21

Problem-Based History:Depression Questions (contd.)

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?Copyright © 2013 by Mosby, an imprint

of Elsevier Inc. 22

Problem-Based History:Anxiety Questions

Have you had difficulty 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?


Problem-Based History:Altered Mental Status

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 becomes a concern while taking history, nurse asks questions to collect additional data.

Long-term memory can be assessed during history by asking patient where he or she was born or about previous surgeries.


Problem-Based History:Altered Mental Status Questions

Orientation: What year is it? Where are you?

Memory: Ask patient to repeat three unrelated objects.

Calculation ability: You buy fruit that cost $2.50. You give the cashier $3.00.

What should your change be? Communication skills:

Repetition Reading Writing Copying


Interpersonal Violence Questions

If the patient answered “yes” during earlier screening questions about interpersonal violence, follow up in private.

You are asked about violence because so many women are dealing with this in their homes: If abuse is a problem for you, you may talk to

me about it safely. Are you in a relationship in which you have

been hurt or threatened?


Interpersonal Violence Questions(contd.)

Nobody deserves to be afraid in their home: 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 form leaving

home, seeing friends, getting a job, or continuing your education?

Do you have guns in the home?


Age-Related Variations:Infants, Children, and Adolescents

Variations for neonates and infants include asking about drug and alcohol use of the mother during pregnancy.

Children are asked about experiences in school, if they like school, if they get into trouble, and fears about any aspects of their lives.

Adolescents are asked about school experiences, drug and alcohol use, and feelings of depression or anxiety; assessing the self-esteem of those in this age group is important.


Age-Related Variations:Older Adults

Indications of depression in older adults may be misinterpreted as expected manifestations of aging: Decrease in appetite or fatigue may be a

decrease in metabolism or a loss of taste buds.

Problems concentrating or sleeping may be interpreted as expected change of advanced age.

Many think depression will go away without intervention, that they are too old to get help, or that reporting sadness may be seen as a sign of weakness.


Cognitive Disorders:Delirium

Delirium is characterized by disturbance of consciousness and rapidly developing change in cognition. Manifestations are 1 or more weeks. Reversible with treatment.

Clinical findings: Altered level of consciousness. Impaired memory. Fluctuating attention span. May have hallucinations or delusions. “Sundowning” may increase. Speech may be rapid, inappropriate, or

rambling.Copyright © 2013 by Mosby, an imprint

of Elsevier Inc. 30

Cognitive Disorders:Dementia

Dementia is characterized by memory impairment: Aphasia Apraxia Agnosia Disturbance of executive function

Dementia is not reversible. Clinical findings:

Onset slow Consciousness intact but memory, judgment,

and calculation impaired Flat affect May have delusions Speech is slow and incoherent


Question 1

During the initial intake, the nurse asks the patient a series of questions. When asked how long he has been working in real estate, the patient responds by saying, “I think 5 years. My dad was in real estate, but my mom worked in an office. I like offices because they are usually organized and neat. My son is very messy, but he is good at guitar. Do you play any musical instruments?” The nurse should document that the patient:

A. Appears concerned about son.B. Suffers from manic disorder.C. Demonstrates flight of ideas.D. Is able to multitask but struggles with echolalia.


Question 2

After completing a dressing change and tidying up the room, the nurse asks the patient if she needs anything. The patient responds, “I am just tired of being tired. Ever since my husband died, I can’t seem to sleep more than 3 to 4 hours a night. I can’t find anything fun to do, and all my friends seem to have disappeared.” The nurse discloses this information to the social worker and recommends that the patient:

A. Start taking diphenhydramine at bedtime.B. Be assessed on the Beck short form.C. Undergo AUDIT assessment.D. Undergo CAGE assessment.


The End


copyright © 2013 by mosby, an imprint of elsevier inc. mental health and abusive behavior...

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