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Health

Mental Health Assessment Tools For Young Adults

Menthal Health AssessmentAssessment of mental health and well-being is integral to the holistic care of a critically ill patient. The assessment has a twofold purpose—first, to identify the impact of physical illness or injury on the patient’s mental health, and second, to establish the effect, if any, of mental ill health on the patient’s physical health and recovery. In addition, nurses should be familiar with the principles and functions of mental capacity assessment. During the mental health assessment, it may become apparent that the patient is at risk. this should prompt immediate referral to mental health services. The physical signs and symptoms that may be attributable to mental disorders and/or medication prescribed for a mental disorder.

  1. ABC Mental Health Assessment

This involves rapid assessment of mental health status within three domains.

Affective domain

This domain focuses on observation of the patient’s emotional state and expressed feelings. It involves objective interpretation by the nurse of the patient’s non-verbal communication, and documentation of the patient’s mood, which is a subjective finding.

Behaviour domain

This domain focuses on observation of the patient’s behaviour. It involves subjective interpretation by the nurse of the patient’s behaviour and appearance. Caution is needed when interpreting the patient’s behaviour as a sign of mental disorder (e.g. inability to maintain eye contact can be a sign of depression, but this behaviour can also be due to a social or cultural convention).

Physical signs and symptoms that may be caused by mental disorders and/or medication prescribed for such disorders :

  • Sleep disturbance
  • Dizziness
  • poor memory
  • Impaired speech
  • Seizures
  • Muscle weakness
  • Sensory disturbance—vision, hearing, smell, taste, and touch
  • Hyperventilation
  • tachycardia or bradycardia
  • palpitations
  • Nausea and vomiting
  • Increased or decreased appetite
  • Weight gain or loss
  • Amenorrhoea

Cognition domain

This domain focuses on evaluation of the patient’s cognitive function. Within this domain there is overlap with neurological assessment. It involves objective interpretation by the nurse of the patient’s orientation to person, place, and time, and observation of any signs of confusion or change in alertness.

  1. Mental capacity assessment

The five key principles

  • Every adult has the right to make their own decisions (i.e. a patient is assumed to have capacity unless proven otherwise).
  • A person must be given as much help as is practicable before anyone treats them as not being able to make their own decisions.
  • If an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision.
  • Anything that is done or any decision that is made on behalf of a person who lacks capacity must be done or decided in their best interests.
  • Anything that is done for or on behalf of a person who lacks capacity should be minimally restrictive of their basic rights and freedoms.

Mental capacity assessment applies to situations where a person may be unable to make a particular decision at a particular time. It does not mean an inability to make general decisions or that a loss of capacity is permanent. Assessment of mental capacity :

  • Identify the specific decision to be made.
  • the assessment of capacity relates to a particular decision made at a particular time, and is not about a range of decisions.
  • Functional test of capacity.
  • Is there an impairment of, or disturbance in, the functioning of the person’s mind or brain (this may be either permanent or temporary)?
  • If the answer is yes, does the impairment or disturbance result in the person being unable to make the particular decision?

The person will be unable to make the particular decision if, after all appropriate help and support has been given to them, they cannot:

  • understand the information relevant to that decision, including the likely consequences of making or not making the decision
  • retain that information
  • use or weigh that information as part of the decision-making process
  • communicate their decision (either verbally or non-verbally).

Decisions about serious medical treatment

  • New treatment
  • Stopping current treatment
  • Withholding treatment
  • treatment that has potentially serious consequences

Mental capacity terminology

  • Lasting power of attorney (LPA)—a legal document that allows decisions to be made by an identified person (the attorney) on behalf of a person who lacks mental capacity (the donor). the document is only considered legal if it is registered with the Office of the public Guardian.
  • Court of Protection— a specialist court that arbitrates over issues specifically related to mental capacity. the Court of protection will appoint a Deputy when decisions need to be made on behalf of a person who lacks mental capacity.
  • Deprivation of liberty safeguards (DOLS)—decision making on behalf of a person who lacks capacity can potentially deprive them of their personal freedom and choice (deprivation of liberty). Safeguards now exist to ensure that decisions are made in the best interests of the person, and that the process is legal and open to challenge.
  • Independent Mental Capacity Advocate (IMCA)—an IMCA is appointed if a person who lacks capacity has no one other than paid staff to assist them with decision making about serious medical treatment.
  • Advance decisions—an advance decision allows a person to refuse pre-specified medical treatment at a time when they may no longer be capable of consenting to or refusing treatment. the person must have capacity at the time of making the decision, and must clearly identify which treatments would be refused and under what circumstances. Until an advance decision has been identified and confirmed as valid, the healthcare professionals must continue to act in the person’s best interests.

Factors that affect the mental health and well-being of critically ill patients

  • Communication barriers:

 Endotracheal tube or tracheostomy, sedation, cognitive dysfunction and muscle weakness.

  • Confusion:

May be linked to the patient’s past medical history (e.g. mental disorder, dementia) , may be the reason for their admission (e.g. neurological injury, sepsis) , may be caused by their treatment (e.g. post-sedation delirium).

  • Environment:

Noise levels , activity levels and intensity,  privacy and dignity, unfamiliar surroundings, transfer and discharge.

References : Oxford Handbook of Critical Care Nursing (2016)

Categories
Health

Early Menopause Signs And Symptoms UK

Early Menopause Signs And Symptoms UK – Each woman responds to the ageing process in her own way. Most women have coping skills that adequately equip them to deal with the gradual changes associated with ageing. Factors that may provoke a lowered self-esteem are the loss of youth, a sense of emptiness as children leave home and the need to redefine one’s self-concept and roles as parenting becomes less important. Women who place a high value on their physical attractiveness may experience a painful psychological response to the physical changes of menopause.

As a woman progresses through the perimenopausal period, changes in her appearance and the loss of childbearing ability may combine to make her feel vulnerable to community stereotyping of the ‘older woman’ as less attractive and unproductive. Although this is far from the truth, with women living at least one-third of their lives after menopause in productive careers and activities, it nevertheless is the perception of women as well as society.
Menopause is the permanent cessation of menses. The climacteric, or perimenopausal, period denotes the time during which reproductive function gradually ceases. For most women, the perimenopausal period lasts several years. It begins with a decline in the production of the hormone oestrogen, includes the permanent cessation of menstruation due to loss of ovarian function, and extends for 1 year after the final menstrual period, at which time a woman is said to be postmenopausal. On average, women live one-third of their lives after menopause.

early menopause signs and symptoms uk

Menopause is a normal physiological process. It is not a disease or a disorder. It is included here because it does increase the risk of physical disorders, as well as affecting various aspects of women’s health. Many women welcome the freedom from monthly menstrual periods and have relatively minor physical effects from the reduction in oestrogen. However, the hormonal changes that occur can be accompanied by side effects. There is wide variation in how individual women experience these side effects. In Australia, most women cease menstruating at between 48 and 55 years of age, with the average being about 50 or 51 years. Early menopause is when a woman stops menstruating before 45 years of age. In 50% of cases of early menopause there are no known causes. However, early menopause is associated with surgical removal of the ovaries, chemotherapy and radiotherapy. After menopause certain health risks increase, including heart disease, osteoporosis, macular degeneration, cognitive changes and breast cancer.

The physiology of menopause
The menopausal period marks the natural biological end of reproductive ability. Surgical menopause occurs when the ovaries are removed in premenopausal women, dramatically reducing the production of oestrogen and progestins. Chemical menopause often occurs during cancer chemotherapy, when cytotoxic medications arrest ovarian function. As ovarian function decreases, the production of oestradiol (E2) decreases, and is ultimately replaced by oestrone as the main ovarian oestrogen. Oestrone is produced in small amounts and has only about one-tenth the biological activity of oestradiol. With decreased ovarian function, the second ovarian hormone, progesterone, is also markedly reduced.

Manifestations
As oestrogen decreases, various tissues are affected, and breast tissue, body hair, skin elasticity and subcutaneous fat decrease. The ovaries and uterus become smaller and the cervix and vagina also decrease in size and become pale in colour. These changes may result in problems with vaginal dryness, dyspareunia, urinary stress incontinence, urinary tract infections (UTIs) and vaginitis. Hot flushes, palpitations, dizziness and headaches are often caused by vasomotor instability. Other problems resulting from vasomotor instability include insomnia, frequent awakening and perspiration (night sweats). The woman may experience irritability, anxiety and depression as a result of these events.

Long-term oestrogen deprivation results in an imbalance in bone remodelling and osteoporosis, leading to fractures and kyphosis. The risk of cardiovascular diseases increases in response to an increase in atherosclerosis (from an increase in the LDL-toHDL cholesterol ratio). Symptoms of the perimenopausal period are listed in the following box. These symptoms vary widely. Some women experience few or no symptoms, others experience moderate symptoms and some women experience severe symptoms.

Care of the woman experiencing menopausal symptoms focuses on relieving symptoms and minimising postmenopausal health risks. Diagnosis As oestrogen secretion diminishes, levels of FSH and LH rise and remain elevated. A woman who has not menstruated for 1 full year or who has an increased FSH blood level is considered menopausal. Medications Hormone replacement therapy may be prescribed to alleviate severe symptoms of menopause, but only for a limited amount of time and only after a woman has been provided with information about known risks. HRT may include oestrogen alone for women who have had a hysterectomy, or a combination of oestrogen and progestin for women who still have their uterus. The addition of progestin stimulates monthly shedding of the interuterine lining, decreasing the risk of uterine cancer.

HRT relieves hot flushes and night sweats, and decreases problems of vaginal dryness and urogenital tissue atrophy, which can lead to painful intercourse and urinary incontinence. Long-term HRT may increase the risk of breast cancer, ovarian cancer, stroke and venous thrombosis (Mayo Foundation for Medical Education and Research, 2015). However, women who have had a menstrual cycles become unpredictable. menstrual flow varies widely in amount and duration and eventually ceases.

1. Vaginal, vulval and urethral tissues begin to atrophy.
2. Vaginal pH rises, predisposing the woman to bacterial infections.
3. Vaginal lubrication decreases and vaginal rugae decrease in number. This may result in dyspareunia, injury and fungal infections.
4. Vasomotor instability due to a decrease in oestrogen may result in hot flushes and night sweats. A hot flush starts in the chest and moves upwards towards the face, and may last from seconds to several minutes.
5. Psychological symptoms may include moodiness, nervousness, insomnia, headaches, irritability, anxiety, inability to concentrate and depression.

Manifestasioons The perimenopausal period hysterectomy and take oestrogen alone do not have an increased risk of breast cancer. Selective oestrogen receptor modulators (SERMs), such as raloxifene (Evista) and tamoxifen, bind to oestrogen receptors and exert site-specific effects in different target tissues. Tamoxifen and toremifene (a derivative of tamoxifen) have a beneficial effect on bone mineral density, and serum lipids and decrease the risk of invasive breast cancer in women at high risk. They also provide an alternative to HRT for preventing osteoporosis. Alternative and complementary therapies Non-traditional or alternative therapies have become popular as a result of the controversy surrounding the use of HRT.
The following complementary therapies are examples of those used by menopausal women to reduce associated discomfort:
a. acupuncture
b. biofeedback
c. massage
d. herbs such as Cimcifuga racemosa (black cohosh), Vitex agnus castii (chasteberry), Rehmannia, ginseng, the Chinese tonics he shou wu and dong quai, golden seal, flaxseed and evening primrose
e. supplements such as vitamin E and soy protein (soy is high in plant oestrogens)
f. meditation and yoga.

However, there is little reliable research available on the effect of soy, primrose oil, black cohosh or other herbs on decreasing hot flushes or sleep disturbances. However, exercise such as yoga or walking will assist women to maintain a healthy lifestyle and may combat some of the side effects of menopause.