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)


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.

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.


Management Of Diarrhoea In Adults

Management Of Diarrhoea In Adults , Disorders of intestinal absorption and bowel elimination do not only affect functional elimination status. Other functional health patterns affected include, but are not limited to, health perception– health management, nutritional–metabolic, activity–exercise, self-perception–self-concept and sexuality– reproductive. Bowel function is affected by inflammations, infections, tumours, obstructions or changes in bowel structure.
Normal bowel elimination patterns vary widely. For some people, two to three stools per day is their usual pattern, whereas for other people their usual pattern is three stools per week. It is important to evaluate each person’s bowel elimination against their normal pattern. One of disorders of intestinal absorption is Diarrhoea.
Diarrhoea is an increase in the frequency, volume and fluid content of the stool. In diarrhoea, the water content of faeces is increased, usually due to either malabsorption or water secretion in the bowel. It is a clinical manifestation, rather than the primary disorder. Diarrhoea may be acute or chronic. Acute diarrhoea (lasting less than a week) is usually due to an infectious agent. Chronic diarrhoea (persisting longer than 3 to 4 weeks) may be caused by inflammatory bowel disorders, malabsorption or endocrine disorders.

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manifestations of diarrhoea depend on the cause, duration, severity and area of bowel affected, as well as a person’s age and general health. Diarrhoea presents as several large, watery stools daily or very frequent small stools containing blood, mucus or exudates.
Complications Diarrhoea can have devastating effects. Water and electrolytes are lost in diarrhoeal stools, leading to dehydration, particularly in the very young, older adults or debilitated individuals unable to respond to thirst. With severe diarrhoea, vascular collapse and hypovolaemic shock may occur. Potassium and magnesium are lost, potentially leading to hypokalaemia and hypomagnesaemia. The loss of bicarbonate in the stool can lead to metabolic acidosis.
Management of diarrhoea focuses on identifying and treating the underlying cause. Additionally, the diarrhoea itself needs to be treated, comfort promoted and complications prevented. A health history (including the onset and associated circumstances of the diarrhoea) and physical examination often provide enough information to identify its cause. However, precise diagnosis is only achieved with laboratory investigations.
Antidiarrhoeal medications are used sparingly or not at all until the cause of diarrhoea is identified. In diarrhoea associated with botulism or bacillary dysentery, giving an antidiarrhoeal agent worsens or prolongs the infection by slowing toxin elimination from the bowel. Once the underlying cause for diarrhoea is established, specific medications, if appropriate, are ordered to treat the underlying cause. Antibiotics are used cautiously as these alter the bowel’s normal bacterial population and may actually increase diarrhoea. A balanced electrolyte solution may be required to replace fluid and electrolyte losses. Intravenous or oral potassium preparations may also be prescribed.
Opium and some of its derivatives, anticholinergics, absorbents and demulcents are commonly used as antidiarrhoeal preparations. Specific preparations, their method of action and nursing implications for these medications are outlined in the following ‘Medication administration’ box.

Fluid and electrolyte replacement is of primary importance in managing a person with diarrhoea. If the person is tolerating oral fluids (i.e. the person is not experiencing nausea and vomiting), an oral glucose/balanced electrolyte solution provides the best fluid replacement. Several commercial preparations (e.g. Gastrolyte) are available, as are paediatric solutions which can be used for adults as well as children. During acute diarrhoea, the person’s diet should be modified to rest the bowel. During the first 24 hours, solid food should be withheld. After this time, frequent, small amounts of starchy foods can be added. Milk and milk products are added last, as these contain lactose which frequently aggravates the diarrhoea. Raw fruit and vegetables, fried foods, bran, wholegrain cereals, condiments, spices, coffee and alcoholic beverages are avoided during the recovery period as the bowel has difficulty processing these complex materials. People with chronic diarrhoea may benefit by eliminating specific foods from their diet. Foods and non-food substances aggravating diarrhoea are outlined in Table 23.1. The diet should be high in kilojoules and nutritional value. Vitamin supplements may be necessary, particularly the fat- soluble vitamins (A, D, E, and K). Occasionally, people with severe chronic diarrhoea require parenteral nutrition.

Complementary and alternative therapies
Herbal or homeopathic therapies may be used to help relieve diarrhoea. People with lactose intolerance may use lactase enzymes tablets or drops when consuming milk products. Herbal treatments include a strong tea of black pepper, chamomile, coriander, rosemary, sandalwood or thyme. Ginger tea or capsules are helpful in reducing intestinal inflammation and decreasing the effects of food poisoning. Probiotics, live microogranisms similar to those normally found in the gut, may be used to prevent or treat antibiotic- associated diarrhoea (Campbell, 2014; Reintam Blaser, Deane & Fruhwald, 2015). Probiotics are available as dietary supplements and food (e.g. yoghurt, yoghurt drinks). The person should consult a qualified medical or homeopathic practitioner when choosing to manage their diarrhoea with complementary and alternative therapies.

Health promotion
Prevention of diarrhoeal diseases essentially involves avoiding infectious agents (Lee & Bishop, 2013). Educating individuals and their families about the importance of handwashing is a primary measure to prevent and reduce the spread of infectious diseases, including those causing diarrhoea. Educating people about safe food handling techniques prevents bacterial contamination. Discuss measures to ensure safe drinking water. For people planning travel to remote areas or outside Australia, discuss the importance of avoiding the consumption of high-risk foods (especially raw foods) and beverages, and purification methods for drinking and cooking water.


Patient Centred Interview Skills Guide

Patient-centered interviewing skills; Data Gathering For Health Professional , Patient-centered interviewing skills are used at the beginning of the interaction to obtain the patient’s perspective. They elicit unique symptom, personal, and emotional information from the patient. They are also used throughout the interview to continue building and maintaining the clinician-patient relationship. Clinician-centered skills may be used sparingly during patient -centered interviewing but, mainly, are used in the middle portion of the interview to provide more control for the clinician. They elicit information the clinician needs to know that has not already arisen during the initial patient -centered portion. In this chapter, both skills are discussed with the emphasis on using the more difficult patient-centered skills.

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Patient -centered interviewing assists patients in expressing what is most important to them, recognizing the importance of personal concerns, thoughts, feelings, and emotions. A useful analogy is to view each piece of new information during the interview, as being placed on a table between the clinician and patient.

The clinician succeeds in being patient -centered when the information on the table has been placed there by the patient. When the clinician places new ideas “on the table;’ this defines clinician-centered interviewing. Regardless of effort to not introduce new topics, clinicians using patient -centered skills can still influence the type and amount of information patients disclose through gestures, comments, and selectively attending to certain topics. Used prematurely during the beginning of the interview, clinician-centered skills can contaminate the patient’s story with what is on the clinician’s mind, creating a cognitive bias. This is sometimes referred to as premature hypothesis testing by focusing only on the initial piece of information to make subsequent judgments.

This can lead to an inaccurate or skewed view of the problem(s) and therefore lead to erroneous treatment.2 Individualized care relies on an accurate patient report of symptoms and, especially, their context in the history of the illness. Contextual errors occur when elements of the patient’s environment, behavior, or emotions are not considered when making diagnosis and treatment plans.


  1. Open-Ended Skills
    Open-ended skills encourage the patient to freely express what is on his/her mind. There are two types of open-ended skills: (1) nonfocusing skills (silence, nonverbal encouragement, and continuers) and (2) focusing skills (echoing, open-ended requests, summaries). When the patient’s narrative becomes hard to follow, gets off-track, or overwhelming, focusing skills are used to help restore structure and balance to the interview-to focus the patient’s story
  2. Open-Ended Nonfocuslng Skills
    Nonfocusing skills encourage the patient to put more and more information “on the table”.
  3. Silence
    Remaining silent-saying nothing-while continuing to be nonverbally attentive and responsive (using appropriate eye contact and an open body posture, leaning forward with legs and arms uncrossed) prompts the patient to continue talking and signals that you are interested in what s/he is saying.
  4. Nonverbal encouragement
    Nonverbal encouragement often paired with silence, urges patients to talk freely. Typically; the clinician makes a sympathetic facial expression (expectation to continue), nods, or simply indicates by body language that the patient should continue speaking.
  5. Continuers
    Integrated with silence and nonverbal encouragement, continuers are brief, noncommittal statements such as ‘1 see;’ llh-huh,”‘ “Yes:· or “Mmm” that encourage the patient to talk without directing the conversation; they let the patient know you are following what slhe is saying.
  6. Open-Ended Focusing Skills ,Focusing skills encourage the patient to expand on specific parts of the information they have already “placed on the table”. In essence, the clinician uses these skills to pick things up “off the table” in order to learn more about them.
  7. Echoing , Echoing is a type of reflection, accomplished by repeating a word or phrase “placed on the table” by the patient; this not only lets the patient know slhe is heard, but also provides encouragement to focus, expand, and elaborate on the word or phrase.
  8. Open-ended requests, Open-ended requests are used to focus the patient on an already mentioned area that the clinician wants to expand upon, such as “Tell me more about the daughter you mentioned.Like other focusing skills, open-ended requests move the patient to deeper levels of his/her story by focusing on something that the patient has already mentioned. They should not be used to direct the patient to a topic they have not already mentioned, for example, “Tell me about your family” when the patient has not said anything about her or his family. Remember the table analogy? Family was not on the table, so the clinician should not introduce a new topic.
  9. Summarizing paraphrasing , Summarizing by paraphrasing what the patient said invites the patient to focus on and expand the material provided, but also is an accuracy check. Basically, summarizing allows the patient to know that the clinician has followed the conversation, heard the details, and is ready for more information. With open -ended focusing skills the clinician can refocus the patient on an important topic that may have slipped by too quickly. Often patients mention an emotionally loaded topic, such as death, but rapidly move away from it. You can return to the topic by saying, for example, “You mentioned death a minute ago, tell me more about that:’ Because the patient initially introduced the topic of death by “placing it on the table; the clinician can comment on it, even though it may interrupt the immediate thread of conversation. Using these open-ended skills, the clinician learns information, feelings, and thoughts important to the patient-patient-centered material-with less contamination from the clinician
  10. Closed-Ended Data-Gathering Skills (Used In the Middle Portion of Interview) , Closed-ended questions, typically answered with yes, no, or a choice among provided answers, are used primarily to confirm or refute specific issues, rather than expand the conversation in the way that open-ended questions do. Close-ended questions imply that the clinician knows what is important to the patient, and possibly that the patient’s concerns are trivial. Patients who are chronically exposed to this type of questioning during the encounter are less satisfied with the clinician and the interaction.
  11. Integrating Open-Ended and Closed-Ended Skills, Open- and closed-ended skills complement each other. During the patientcentered beginning of the interview, open-ended skills predominate and are used repeatedly, primarily for developing information about symptoms and personal and emotional concerns expressed by the patient. Closed-ended questions are used sparingly during the beginning of the interview to clarify the patient’s utterances. As you will learn in Chapter 3, at the end of the patient-centered part of the interview a clear transitional statement is made alerting the patient to a change in interview style. Then, during the cliniciancentered middle of the interview, open-ended questions are fewer and used primarily at the start of each step for brief but repeated scanning purposes. Closed-ended questions predominate and are used to pin down details and often place new information “on the table.” Thus far, we have described the fundamental communication skills used for data-gathering. Next, we will discuss how to use these and other skills to build positive, strong relationships with patients. Then, we will show how to integrate these skills into a method to conduct a patient-centered interview in a systematic manner.