Nursing Health Assessment, 2nd Edition

Approach to the Mental Health

Assessment

Nursing Health Assessment, 2nd Edition

Mental Health is a state of

successful
performance of
mental function,
resulting in
productive activities,
fulfilling
relationships with
other people, and
the ability to adapt
to change and to
cope with adversity

Characteristic of positive
mental health

Self perception
Personality integration
Autonomy & independence
Perception and reality
Growth and development
leading to self-actualization

Nursing Health Assessment, 2nd Edition

Mental Disorders
Prevention
Affect thinking,
Primary prevention
mood, or behavior
or a combination of
entails decreasing the
incidence of mental
all the three, leading
disorders by identifying
to impaired function,
those at risk, those who
disability, pain and
are vulnerable to
developing mental
even death.

Nursing Health Assessment, 2nd Edition

Secondary prevention Tertiary prevention

- involves reducing the
prevalence of mental
disorders through
screening and initiating
prompt treatment of
mental disorders.

- aims at reducing the

severity of the
illness by providing
follow-up and
rehabilitative
services.

Nursing Health Assessment, 2nd Edition

Understanding Mental Health

Biological theory
Psychological theory
Cognitive theory
Developmental theory
Social theory

Nursing Health Assessment, 2nd Edition

Developmental Considerations
Developmental considerations related to
mental health for:
Children
Adolescents
Pregnant patients
Older adults

Nursing Health Assessment, 2nd Edition

Cultural Variations
What cultural variations are seen regarding
mental health?

Nursing Health Assessment, 2nd Edition

Case Study
Hollie Baker, age 40
c/o fatigue, no energy
Feeling overwhelmed
and depressed
Recently divorced,
mother of 2
adolescents

(Continued)

Nursing Health Assessment, 2nd Edition

Case Study
History of breast
cancer, HTN,
hypothyroidism,
bipolar disorder
Tamoxifen,
Metoprolol, Synthroid,
Lithium, and Risperdal

Nursing Health Assessment, 2nd Edition

Health History
What can the health history tell you about your
patients mental health?
Biographical
Current health status
Past health history
Family history
Review of systems
Psychosocial history

Nursing Health Assessment, 2nd Edition

Physical Examination
How do your patients physical findings
reflect his/her mental status?
Head-to-Toe Assessment

Nursing Health Assessment, 2nd Edition

Mental Status Assessment

Appearance
behavior
Speech
Attitude
Mood
Perceptual
disturbances

Thought process
Thought content
Affect
Memory
Insight judgment

Nursing Health Assessment, 2nd Edition

Additional Assessments

Crises assessment
BATHE Technique
Depression assessment
Suicidal assessment
Substance abuse

Nursing Health Assessment, 2nd Edition

Pertinent Physical Findings

10-lb. weight gain over the past month

Poor eye contact
Slow to respond
Disheveled appearance
Slouched posture
Crying
Difficulty staying focused
Constipation

Nursing Health Assessment, 2nd Edition

Nursing Diagnosis
What actual or
potential problems
can you identify for
Mrs. Baker?