Discuss the Process of a Psychosis Mental Health - Nursing Assessment Answers

Mental Health - Nursing Assignment Help

Topic

Describe and discuss the process of a mental health assessment for one of themental health

• Psychosis

Introduction

Psychosis is the term, which is used to describe the mental state of an individual, who experience distortion of reality, and losing control over consciousness. The mental state is distinguished with the presence of though disorder, hallucinations and delusions. The conditions may also include loss of motivation. Several other secondary features are anxiety, sleep disturbance, depression, and social withdrawal. During the psychotic events, patient could also try to commit suicide. The essay provides the detailed and well researched view towards Psychosis and will also discuss the main points related to the given case study. This disorder may include various other conditions, which will be discussed in this essay. Psychotic mental illness is a significant public health and social issue, which requires attention.

Biopsychosocial Approach: Psychosis

It is claimed that beginning and course of this disorder is determined through various vulnerabilities and the impact of various environmental stressors that may be responsible for causing the symptoms of Psychosis. The Biopsychosial approach toward the disorder includes the assessment of the patient. Biopsychosocial history of the patient is important to understand the biological, psychological and social functioning of the patient. This kind of model is often applied, on the early stage of the Psychosis intervention (Townsend 2014). It must include the major complaints associated with the patient’s condition in his own words, because due to illness the statement of patient may differ from the family’s assessment. The major or the chief complaints may provide the valuable data about patient’s illness (Townsend 2014).

The next step in the model is to determine the history of the present illness (HPI). This must include the information about the symptoms from the beginning, duration and change in symptoms over time must be noted. The stresses associated with the current psychotic episodes are negative as well as positive. Thus, for the nurse it is important to determine those factors. Changes in the somatic functions like, cognitive ability, sleep patter, sexual function and appetite should also be noted. It is important to determine the past psychiatric history is important for understanding the current episode and to do accurate diagnosis.

Objective, Subjective and Secondary Data Regarding Patient’s condition

Alcohol and Substance abuse

According to the various studies, the co-morbidity associated with mental illness often includes alcohol and substance abuse. Drug, or alcohol can precipitate the mental illness episode or it can also be presented as an attempt, which is used by the client for copping up with preexisting mental disorder (Ferris et al, 2011). Researchers have also shown that use of alcohol or drug gives adverse effects on the mental condition of client. According to the case study, Steven is involved in alcohol consumption, due to which his condition has worsened.

Medical, Developmental and Social History

Nurse should also look towards noting the medical history of the patient, which may include past medications, treatments, injuries, and side effects of any medicine if present. Family history related to mental illness is also important to be noted. In the case of mental illness, it has been noted that many of such problems are often hereditary. Client’s response towards many interventions could also inherited as well, thus family history is also important. Developmental history and social history of the patient must be noted, as the psychological adaptations of the individual are influenced by their development history. The developmental features of self-esteem, independence and self-control are developed from the childhood, and they also help in understanding the person’s ability to cope with stressors and mental illness (Jacobs 2010). Mental disorders in childhood, interpersonal relationships, and temperament help to determine that current situation of the client. In case of Steve, it is important to determine such factors, as they will assist in proper diagnosis of the problem (Coombs 2014).

Social history of the patient, involves the information about the relationships and social circle. The people with larger social networks have less chances of suffering from mental illness. It is the duty of psychiatric nurse to inquire about the family members, friends and other members associated with client (Bentall & Fernyhough 2008). The history of the sexual partners and friends is significantly vital. The life events associated with client can play a major role in proper diagnosis. According to the case study, Steven has been recently separated from his wife and two kids. This could be one of the reasons behind elevation of his mental illness. However, proper Pathophysiology is not clear in case of Steven.

Educational and Work History

This information is very significant to understand the client’s ability and present level of function at the workplace. Work related stress call increase the illness. A problematic history of work can lead to chronic, psychotic episodes, or mental illness. The client’s level of education will facilitate the nurse to choose the correct way of communication and inform the client about his health. Low level of socio-economic status is also correlated with higher rate of mental illness Bentall & Fernyhough 2008).

Coping Skills

Coping skills are the person’s ability to manage their internal and external stressors. Coping behavior can allow an individual to control a stressful situation and minimize the effect of stress from the situation. The individual, who are suffering from chronic psychiatric and life threatening mental illness, may not be able to cope up with stressful situations. Clients in such situation may use alternate ways to reduce their stress (Jackson & McGorry 2009). In the case of Steven he uses alcohol to reduce his stress. But, in this situation different approach is required. Such clients also display different behavioral signs that could be controlled with the help and support of family members, friends and healthcare professionals (Coombs 2014).

Specific Assessment Tool

The specific assessment tool which can be used to diagnose the correct reasons of the mental illness is ABC APC TJR SEA.

Evaluating the mental states is also significant to examine the current state of the patient. Mental status of the patient is examined through client’s behavior, speech, mood, though process, impulse control, judgment, cognition and knowledge. Besides gathering the history, direct questioning is also required to find most pertinent information. This is done through various interview processes.

Steven has displayed the suicidal behavior, which could be due to various factors. The most important factor associated with his condition is lack of emotional support. He has been recently divorced and requires support to relieve stress. But as he could not talk to anyone ‘heart-to-heart’, his situation has become worse (O'Connor & Nock 2014). He has a feeling of hopelessness and depression, which is not allowing him to cope-up with other stressors in his life.

A: Appearance of the client is evaluated. It is the duty of the nurse to note the postures and movement disturbance in the patient. It is also important that a nurse should always examine that how the patient is reacting towards the interviewer and to the complete interview process

B: Behavior of the patient is examined, if he has suicidal behavior. In order to understand the behavior, it is important o note the activity level, gait, mannerism, and psychomotor activities. The clients with mental illness are agitated and could sit still (O'Connor & Nock 2014).

C: Conversation is very important to be noted, as it can help the nurses to determine the mental condition and level of the client. This could inform about, what is going on the mind of patient, and will he can try to commit suicide. In case of Steven, he feels guilty towards his children as he could not be a good father. He also has suicidal thoughts, as he finds himself to be useless person and calls himself a ‘failure’. Understanding the though process will help in providing counseling (Jacobs et al, 2010).

A: Affect is related to mood affect of the client, as mood of the client is considered as the persuasive subjective emotional state. The visible actions under this state are called as affects. Nurse should be able to notice the depth, range and fluctuations in the emotional expressions of the client during the interview. The mood and emotions may change rapidly from being euthymic to labile.

P: Perceptual disturbance is also called as illusion or hallucinations. This is known as the misinterpretation of the real stimuli. The client may not be able to intact reality test. The patient may not be able to accept that his perceptions are not real (O'Connor & Nock 2014).

C: Cognition stands for understanding the level of consciousness, memory and concentration. It is important to determine cognition skills in the patient that display symptoms of dementia (Townsend 2014).

I: Insight refers to the level to which client is aware of his illness and maladaptive behavior. If client states in an interview that he or she wants to live again with his or her abuser, this display little insight.

J: Judgment is the capability to identify the possible response of an action. It also stands for a person’s capability to anticipate the consequences of an action, and thus chooses appropriate behavior according to situation.

R: Rapport building is very important with the patient suffering from psychosis. The interaction between therapist and patient must be built on trust in order to get agreement over trivial matters and providing therapeutic treatment (Jackson & McGorry 2009).

S: Sleeping is very important for the patients suffering from mental illness, as sleeping helps in providing comfort and relief to mind.

E: Energy level is noticed to be reduced in the patients. Patient often suffers from lack of energy.

A: Patients suffering from Psychosis also suffer from loss of appetite. They do not feel hungry, due to which their weight is reduced (Jackson & McGorry 2009).

Role of Nurse and Care Plan

Role of nurse is very significant from the early diagnosis of Psychosis to treatment and intervention. Nurse must take the details about all such things including nicotine and caffeine intake, as over consumption of these substance can also increase depression and agitation. Nurse should also look towards noting the medical history of the patient, which may include past medications, treatments, injuries, and side effects of any medicine if present (Keller 2010). According to the assessment tool it is also significant to determine the coping skills of patient and to help the patient in developing those skills. The patient may provide unreliable information during the interview, thus nurse must be able to determine the problems such as lack of insight, lack of judgment and symptoms of delusion (Keller 2010). Care plan can be prepared according to the specific needs of the patient. If patient display suicidal tendency then care plan will first focus on keeping patient safe, by providing secure environment (as in the case of Steve). Care plan should also focus on providing proper appetite and energy through diet. Thus, assessment tool is very significant in preparing care plan.

Conclusion

Psychosis is a mental disorder, which can occur due to various reasons. According to the cases study, Steven is facing the issue of mental illness and is unable to cope-up with his condition. The subjective and objective data obtained from his condition. His case requires more detailed use of specific assessment tool, so that a care plan could be made. He has a suicidal tendency, for which it is important to provide him support and keep him safe. Assessment can be used to plan a care, as it will allow the practitioners to understand his mental state, level of illness and co-morbidities. Thus, proper care plan could only be made by detailed assessment.