Assignment Example on Mental Health Assessment: Acute Confusion (Delirium)

1. After watching the video of a brief initial interview (within Module 4), document the detailed Mental State Examination findings for Mrs. B. using the headings in Chapter 13 of the text. Submit your findings

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From the video on the assessment of Mrs. B., it is evident that she presents herself as an appropriately dressed individual. At the beginning of her assessment, she is seen sloughing and maintaining limited eye contact with the doctor and this appears to be an indication of depression. Also, she generally manifests limited body movement with some hand-wringing an indication of possible motor agitation and irritation. At the start of the assessment, Mrs. B appears to be sleeping, but she is easily woken up indicating her high level of awareness of the current state and she showed no sign of being intoxicated. The shows some level of alertness and cooperation during the assessment, although at times she becomes irritated by some questions posed to her and indication of a clouded level of consciousness. She manifests hostile thought towards the questions asked a sign of her underlying irritability. She speaks clear English although sometimes during the interview she hesitates and continues to speak loudly with emotions.

Assessment of her general mood indicates levels of frustration while the tone of her voice coupled with her facial expressions portrays a blunt effect. She manifests some level of confusion as evidenced when she hallucinates exemplified by her aggressive reaction to unreal people and the perpetual abnormalities she experiences like touching unseen objects. Mrs. B shows signs of depression as she finds it hard to connect with the interviewer which implies that she has obsessional thoughts seen by her frequent pauses in her answering. Also, during the interview, the patient has poor comprehension and judgment of her current mental state as seen by her failure to remember all her medications an indicator of poor memory. Her state of confusion and impaired through processes has led to her impaired judgment (Pridmore, 2000).

2. What other assessment information can the nurse gather and how might you go about this?

There are various assessment techniques that a nurse can employ to gather more information on the patients' cognitive impairments that affect their behavioural functioning such as speech, personality, reasoning and learning among others. Delirium is an acute disorder impacting on the patient's psychomotor activity, attention and cognition particularly common among the elderly. Superimposition of delirium upon other disorders like dementia is linked to both functional and cognitive deterioration, making it difficult for the patient to be evaluated for delirium. Some of the most popular techniques that Mental Health Assessment can be done include the Confusion Assessment Tool (CAM), CAM-ICU and brief CAM (Ward, Perera & Stewart, 2015).

One vital technique is the administration of the three-minute instrument to screen the cognitive impairment of an individual, especially the aged admitted in a healthcare setting. The Mini-Cog technique entails the use of three recall tests for individual's memory and a Clock score Drawing Test (CDT). The Confusion Assessment Method-Intensive Care unit is used by physicians and nurses to gather data from ICU patients and it utilizes nonverbal techniques for non-ventilated and mechanically ventilated patients in ICUs (Byrne & Neville, 2010). Also, the confusion assessment method is aimed at improving the recognition and identification of delirium and offers a standard method to be used by clinicians who are not trained as psychiatrists in the identification of delirium. The rating scale is essential in rating symptoms of delirium and it is critical in ensuring accurate diagnosis of delirium by clinicians. Delirium symptoms Interview is used to assess the seven symptoms indicated by the DSM-III criteria for the disorder and it is administered daily to hospitalized elderly patients by non-clinicians. The method is best used in combination with various data to foster the definition of various cases of delirium and also acts as an option to the existing delirium III-R and DSM III diagnostic criteria.

3. After synthesizing this information what would be your diagnostic formulation?

Synthesis of the information presented in the video shows that Mrs. B's mental state has been linked to the high dosage of several medications which have led to the development of delirium particularly considering her old age. Presentation of other medical problems such as constipation is an indication of delirium. More so, her state has been worsening in the past five months following the demise of her husband and this has deteriorated her psychological and behavioural which signals dementia and delirium as evident by the episodic depression. Her depressive symptom is also linked to hypothyroidism, which can be an indication of Alzheimer disease in its initial stages. Also, the patient has been experiencing behavioural and psychological symptoms of dementia evidenced by her pathetic interactions, agitation, irritation, hallucinations and wandering (Re, et al., 2015).

4. What are the main goals of a care plan for her while she is in a hospital?

The main objective of her hospitalization is the treatment of her urinary tract infection and hypothyroidism in order to give way for the assessment and of the side effects caused by the many medications she has been taking leading to various psychiatric problems such as dementia and delirium. One of the major objectives of hospitalizing Mrs. B is to ensure that her current mental state is improved and that she is provided with a safe environment vital in reducing her stress levels. Also, hospitalization targets at ensuring maintenance of her fluid and diet intake to promote her physical health especially considering she is constipating. Finally minimization of her psychological and behavioural signs of Alzheimer's disease-like wandering and memory deterioration through the provision of care, support and therapeutic activities as well as the provision of memory aids such as the use of calendars and clocks (Byrne & Neville, 2010).

Finally, hospitalization is essential in ensuring that caregivers are collaborating in drafting the patient's comprehensive care plan which is critical in yielding positive outcomes. The inclusion of family, friends, and relatives among others in her care plan ensures that caregivers are well informed of the best strategies to cope and manage acute confusion and dementia which Mrs. B is diagnosed with. Caregivers play a critical role in the long-term management of many mental disorders, hence hospitalization is a platform to promote a collaborative management approach.

5. How would you collaborate with her and her family to plan her care?

A comprehensive care plan for Mrs. B can be formulated through the involvement of all parties close to her including her family, relatives, friends, and the hospital staff. Caregivers are essential in ensuring that she receives quality care and that positive outcomes are realized. For For example, her son plays a vital role in her care plan because he is a vital source of information pertaining to the patient, such as her favourite meals, medication history, and other critical information essential in ensuring she is provided with appropriate management for her conditions. The first way of collaborating her caregivers in the Mrs. B care plan is through face to face meetings where they are provided with psychoeducation regarding the patient's conditions and the best management approaches such as the pharmacological and non-pharmacological interventions. Also, in cooperation with the patient's family can be achieved by encouraging them to frequently visit the patient in order to offer her emotional support critical in the management of her psychological and behavioural conditions (Wolters, et al., 2016). Family involvement in her care plan boosts her self-esteem and provision of critical information to caregivers on her condition ensures that it is well managed and that they possess coping skills needed to manage dementia and delirium.

References

Byrne, G. J., & Neville, C. C. (2010). Community mental health for older people. Elsevier Health Sciences.

Pridmore, S. (2000). The psychiatric interview: A guide to history taking and the mental state examination. Amsterdam, The Netherlands: Harwood Academic.

Re, M. L., Di Sapio, A., Malentacchi, M., Granieri, L., & Bertolotto, A. (2015). Acute confusional state in HaNDL syndrome (transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis). Neurological Sciences, 36(3), 477.

Ward, G., Perera, G., & Stewart, R. (2015). Predictors of mortality for people aged over 65 years receiving mental health care for delirium in a South London Mental Health Trust, UK: a retrospective survival analysis. International journal of geriatric psychiatry, 30(6), 639-646.

Wolters, A. E., Peelen, L. M., Welling, M. C., Kok, L., De Lange, D. W., Cremer, O. L., ... & Veldhuijzen, D. S. (2016). Long-term mental health problems after delirium in the ICU. Critical care medicine, 44(10), 1808-1813.