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NUR2200 Mental Health Across Lifespan: Mental State Examination Assessment 2 Answer

    Assessment 2 – Mental State Examination

    Task overview

    Assessment nameNUR2200  Mental Health Across the Lifespan
    Mental State Examination  Assessment
    Brief task descriptionIt is expected that as a student you will develop an ability to observe consumer behaviour and accurately document those observations as findings on the Mental Status Examination (MSE) and risk screening tool in the correct assessment categories using the correct terminology. You will also develop patient-focused documentation skills in reporting the identified MSE and risk assessment findings concisely and accurately within the nursing report. From your findings, it is also expected that you will be able to identify symptoms about the client and consequently be able to develop mental health nursing-specific interventions to assist the client. 
    NOTE: This is an individual student assessment and not a group assessment. Therefore, students must submit original work. Students are required to adhere to USQ policies in the gathering and completion of this assessment.
    Rationale for assessment taskAssessment is one of the most important and fundamental skills of the mental health nurse. Through assessment, the mental health nurse develops an understanding of the consumer, formulates a plan of care and contributes to the decision making of the multidisciplinary teams.  Additionally, undertaking assessments is an important means of connecting with the consumer to commence the process of developing a therapeutic relationship.  
    Assessments performed in the mental health care setting, which can be consumer or health care centred, is the first step of the nursing process and is ongoing over the time that the consumer is engaged with mental health care(Evans et al., 2017,p. 519).  This process is systematic and organized, to ensure that the mental health nurse critically thinks and documents data, to implement and evaluate the individualized healthcare need of the consumer in their care.
    Continuity of patient care is achieved by the clear and concise transfer of patient clinical information from one health care provider to another during handover. Effective communication is a vital factor in providing safe patient care.
    Standardised assessment tools used can be formal or semi-formal, and include the mental state examination (MSE) and clinical risk assessment, however, there are numerous other tools incorporated to collect data in the clinical setting.
    LengthThere is a 7 page limit to this assessment. 
    Two pages for the MSE
    Two page completed Risk Assessment Tool
    Maximum of one page each for the Mental Health Nursing Interventions; Nursing report and Reference list.
    This will complete a seven -page assessment and must be uploaded in that order.
    Course Objectives measuredAligns to the Course Objectives 3, 4 & 5.
    LO 3- Legal and ethical issues in caring for people with a mental illness. Mental health act legislation. 
     LO 4- Diagnostic related groups and contemporary mental health nursing practices. 
     LO-5 Treatment Modalities and Medication Safety.
    Exemplar/Example providedExemplar is loaded onto the study desk
    Task detailPlease include the following consumer details on the appropriate documentation for this assignment. 
    URN : USQ77478 
    Name: Peter Goldblum
    D.O.B. 25.12.1982
    Address: 123 Smiths Rd., Smithville. 4444
    • Download and read the history related to Peter Goldblum.
    • Access and download the MSE form and risk screening tool from the study desk. “MSE Form & Risk Screening Tool.” The MSE is a word document, and you are required to type directly into the formatted document provided.
    • From the information obtained from Peter and documented on the MSE, a risk assessment is also to be completed using a Risk Screening Tool (separate from the MSE that you will complete). The risk screening tool is available via the study desk. Print both sides of the risk screening tool form and complete the assessment in your own hand writing. As this form must be handwritten, writing must be legible for marking and no other risk assessment form will be accepted.
    • Watch the video about Peter that is located on the study desk. Record your observations from the interview/assessment between Peter and the mental health consultant, on the MSE form. Refer to your text and lectures throughout the semester on the study desk for assistance, ensuring that you use the appropriate mental health terminology to communicate your findings.
    • You may record findings in dot point or in a short paragraph, however, you must support and specify the evidence that substantiates your observation, 
    e.g. paranoia  Peter believed that he was being followed as evidenced by…..
    The MSE report is to be typed as a word document, be succinct and relevant to your findings that were included in the interview content.
    • From the findings and documentation in the MSE or Risk Assessment screening for Peter, identify THREE (3) relevant symptoms or issues that Peter displayed during the interview, or is recorded on the Risk Assessment. 
    • Research TWO (2) evidenced-based nursing mental health interventions per finding / symptom to assist you in completing the management plan for Peter. 
    • Complete the symptoms / findings and intervention page. There should be THREE (3) symptoms / findings   in total identified, and TWO (2) evidenced mental health nursing based interventions per symptom (total of six interventions) and one reference per intervention to a total of six individual references.
    • The symptoms / findings that you record on your intervention page, must be from documented evidence within your MSE and or risk assessment report.
    • Nursing Report: Together with your findings from the MSE and the risk screening assessment, you are required to write a one-page nursing report ( between  400-500 words) , as if you were documenting your findings into a patient chart, by using the SHARED tool that is commonly the preferred communication tool in QLD mental health.– situation, history, assessment, risk , expectation and documentation.  
    This will require you to gather the relevant and pertinent details and combine this into your nursing report. This is not a narration of your findings; this is to be succinct, pertinent and relevant information that would be important and critical to document in a patients chart. As this is report style writing, references are not required for the nursing report as you have gathered the details from your findings.
    Writing Style This assessment piece will be written in the form of a Mental Health Assessment providing links to relevant peer reviewed articles.  


    Answer

    General appearance
    		Peter is a 38-year old man and is looking older as per his age. Peter was wearing jeans and a shirt. He has grey hairs and has very few facial hairs and appearance and hairstyle were well maintained. His stature and height are average but he looked tired. His complexion is white and his skin is not dry.  
    Behaviour
    		Mr Peter is not confident while talking and continuously looks on other sides also he was not in favour of the evaluation and feels that he ready to go home. He was not making eye contact with the nurse, seems to be mumbling and not presenting clear information. He doesn't have speed in expression. 
    Speech
    		Peter is speaking very slowly and speaks in short phrases and stammers as he spoke. Also, he looks hesitant and though he is giving answers to all the questions but using a murmuring sound. He used soft volume but at times when he was distressed, he was looking as if he is hiding things and not giving complete information (limited content). 
    Mood and 
    Affect
    		Mr Leroy was looking tensed about the safety of his sister and wants to go home. Further, he had ongoing mood-swings. He was turning aggressive at one time and the next time he was calm and pleased. Also, by expression and mood, he was congruent and by effect anxious.  


    Thought process
    		His thought process is completely different from others and he has feelings that medicines are of no use and doing no benefit to him. He does not take medicines and takes pills sometimes just to have asleep. He firmly believes that his secret voices are real and they are telling him that steeve is not the right person and belives that other males in his life paedophiles.  


    Thought content

    		Peter beliefs that he should protect his sister. Earlier he even called police as he thought that his uncle is not safe for his mother. Also, he believes in his secret voices and feels good about such voices. He thinks that steeve is manipulating his sister and he is a paedophile. His thought content also shows that he is ok and does not have schizophrenia and is ready to go home and does not require medicines. The last moment he changes his mood that from few months he is ok with steeve and he is not that bad.  
    Perception

    		His perception is that he is right and other males in his life are a paedophile. He needs to protect his sister and it is the only to protect her. He keeps a knife and keeps an eye on steeve. Has disturbed image about others.  


    Cognition
    		Rather than believing in the real truth he is forming his own opinions and pursuing them. He suffers from short-term memory loss, too. He has not maintained a confident voice and speaks no more than once phrases while talking. He lacks concentration as well. He insists that he does not need medicines to be healthy and safe that reflects his limited intelligence. 
    Insight 

    		Impaired insight- Despite his mental health condition (schizophrenia) he feels ok and thinks that he does not require hospitalization. Moreover, he is very cautious about other males and indulged in being strict towards them and hence keeps a knife. 
    Judgment 

    		Impaired Judgment- restricted his judgements to the secret voices that he hears and does not use his abilities and feels good about the voices. Further, his judgement about medicines is made on his own.  
    SYMPTOM
    		INTERVENTIONS

    Delusions 


    (i). Individual psychotherapy- Individual interviews have also been found beneficial to establishing trust and rapport with the mental health patients suffering from delusions. Individual interviews are interventions to promote protection, coping effectively and increase regular interaction with people at high risk of negative thoughts or delusions (Kumar, 2020). Individual psychotherapy may help the participant understand the underlying thought that has been distorted and correct it. Literature offers increasingly strong evidence of the use of therapeutic approaches to individual psychotherapy in the treatment of persistent mental illnesses and their symptoms such as delusions (Arnold & Vakhrusheva 2016).
    (ii). Pharmacological intervention (Medicines)- The key drugs used in the treatment of the delusional condition is called anti-psychotics (Abou et al., 2019). Ever since the 1950s, traditional antipsychotics, also named neuroleptics, were used to treat psychiatric illnesses. these drugs work  By suppressing dopamine brain receptors. Dopamine is a neurotransmitter that is considered to be implicated in the growth of delusions (Lewekeet al., 2018). Chlorpromazine-fluphenazine (Prolixin ®), (Thorazine ®), thiothixene (Navane ®), haloperidol (Haldol ®), thioridazine (Mellaril ®), trifluoperazine (Stelazine ®), and perphenazine (Trilafon ®) are traditional antipsychotics (Abouet et al., 2019).

    Hallucinations 


    (i). CBT- Cognitive behavioural therapy is an effective intervention to minimize the irritation and violent nature and stress among service users. The use of open-ended interrogation, interpersonal skills, empathizing listening and talking will be the major key elements to build rapport with Peter (Thomson et al., 2017). Cognitive therapy is a well-known intervention used by nurses for the treatment of schizophrenia in mental health patients (Pontillo et al., 2016). In order to provide Peter with relaxation and ensure that he sleeps properly and has proper medication, the nurses should try to reduce the environmental stimuli (Lincoln & Peters, 2019). The section ends by affirming that interpersonal relationships constitute the most positive strategy under the rules of recognition, affiliation and reciprocity, regaining the feeling of self and comprehension psychotic experiences in a biographical context. 
    (ii). Hallucination-integrated-treatment (HIT)- This includes several therapeutic modalities including antipsychotic medicine, cognitive-behavioural intervention, relaxation therapy, family counselling, rehabilitative intervention, portable crisis management and strategies of behaviour and empowerment (Kumar & Venkatasubramanian, 2018). In general, HIT affects the emotional state, decreases the psychological pressure, quality of life and social functioning. According to the therapy, in most situations, fair adherence and high engagement with HIT treatment are evident; 65% speech-free; most display a noticeable increase in mastery, fear, interfering with thought and social functioning; none exacerbated (Pontillo et al., 2016).

    Confused thoughts and disorganized speech


    		(i). Non-pharmacological interventions- Psychotherapy- psychotherapeutic approaches can be categorised into three groups: individual, collective and cognitive behavioural. Psychotherapy is a treatment process which is continually evolving. Meta-cognitive preparation, narrative interventions, and perception counselling provide new psychotherapies (Sanada et al., 2016). Non-pharmacological therapies should be used as a supplement to, not a replacement for, drugs.
    There is an elevated risk of relapse in schizophrenia patients who avoid taking their medication, that can cause health problems. It is also critical that patients are kept aware of their condition and the complications and feasibility of treatment. Any psychotherapies may help inform people about the value of their drugs being administered. Cognitive behavioural therapy ( CBT), personal therapy, and enforcement therapy are among these programmes (Tumiel et al., 2019).
    (ii). Pharmacological interventions- antipsychotics significantly reduce the severity of psychiatric symptoms. In order to optimise the advantage for the patient with schizophrenia, often health care providers recommend either of these drugs, often in conjunction with one or more other psychotropic medications. Antipsychotics can be taken as an injection or as a pill (Ganguly et al., 2018). 
    These medications function on chemicals in the brain such as serotonin and dopamine.  It is necessary to get support from the nurse and doctor once or twice a month called a long-acting injectable antipsychotic drug (LAI) as the patient thinks that those medicines are not helpful (Pandarakalam, 2016). Further, the nurses should take the responsibility to make him understand the value of conformity with drugs. It works almost as well as taking a pill every day (Pandarakalam, 2016).
                                 NURSING REPORT

    Peter has been admitted to the mental health facility after the referral through his sister. He is suffering from schizophrenia but denies his mental illness. He has symptoms of schizophrenia such as hallucinations, delusions and distorted thought and speech. Further, Peter has two older brothers and one sister. His family history shows mental health issues including depression, anxiety and many health issues that were not even diagnosed. His grandfather also suffered PTSD after the war.  

    Peter did not complete his schooling and left school grade 11. His academics shows school refusals, low grades and disengagement and he preferred being a mechanic. He lived with his parents but due to Peter/s aggressive behaviour, they left him. He has had previous mental health referrals due to issues like voicing potential voices and showing violence towards others. He also keeps a knife with him which can result in a potential hazard.  

    Despite Peter’s exceptional misery, I have felt positive about my communications with him. This affirmation is because of the solid affinity and remedial relationship that has worked in Peter’s past admissions to the inpatient unit. 

    I would make a point to offer the most critical actualities about schizophrenia in a straightforward, and a mindful way and after that give him extra assets for data and support. Contrasted with what has happened in this clinical circumstance, the method of activity under such conditions ought to be guided by the most flow, confirm based nursing research. It is, subsequently, dampening now and again to see him keep on re-introduce and not have all the earmarks of being advanced in his recuperation.  

    Peter is a 38-year old man and is looking older as per his age. During evaluation and interview with the professional, Peter was wearing jeans and a shirt. He has grey hairs and has very few facial hairs and appearance and hairstyle were well maintained. He has distorted thought content and his thought process is completely different from others and he has feelings that medicines are of no use and doing no benefit to him. He does not take medicines and takes pills sometimes just to have asleep. He firmly believes that his secret voices are real and they are telling him that steeve is not the right person and belives that other males in his life paedophiles.  He has impaired judgment as he restricts his judgements to the secret voices that he hears and does not use his abilities and feels good about the voices. Further, his judgement about medicines is made on his own. 

    Based on the evaluation Peter is not suicidal but he has violence/aggression which needs to be monitored on a regular basis as it might be harmful to other people around. Vulnerability risk is also very high and needs prompt attention. During the hospital stay, he will be kept under daily risk assessment and it will be made sure that the patient has no sharps or weapon around him to keep the surroundings safe.  

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