Mental Health Assessment

Mental Status: What is it?

• A person’s emotional and cognitive functioning

• Optimal functioning aims toward simultaneous life satisfaction in work, in caring relationships, and within the self.

Mental Status...

• Cannot be scrutinized directly like the characteristics of skin or heart sounds

• Its functioning is inferred through assessment of an individual’s behaviors.

Mental Status Assessment is Used to Detect:

• Presence of neurologic disease such as dementia

• Emotional dysfunction such as depression or schizophrenia

• Intellectual functioning such as occurs with retardation or toxic effects (drugs)

Mental Status Assessment:

• Appearance

• Behavior

• Cognition

• Thought processes

Appearance

• posture

• body movements

• dress

• grooming/hygiene

Behavior

• level of consciousness

• facial expression

• speech

• mood and affect

Cognitive Functions

• orientation

• attention span

• recent memory

• remote memory

• new learning

• persons with aphasia

Example of tool:  Mini Mental State Exam (Folstein)

Thought Processes and Perceptions

• Thought process

• Thought content

• Perceptions

• Suicidal thoughts

Nutritional Assessment

Nutritional Assessment refers to the degree of balance between nutrient intake and nutrient requirements

Nutritional balance affected by many factors:

• Physiologic

• Psychosocial

• Developmental

• Cultural

• Economic

Comprehensive nutritional assessment:

• Recommended for all individuals with confirmed nutritional risk (1 or more of following risk factors)

Risk Factors

• Weight <80% or >120% of ideal wt.

• History of unintentional weight loss

• Serum albumin concentration <3.5g/dl

• Total lymphocyte count <1500

• History of illnesses, sx., or factors associated with nutritional depletion or inadequate intake or absorption

Comprehensive nutritional assessment includes:

• height/weight measurement

• dietary history and intake information

• physical examination

• anthropometric measures

• lab tests

Dietary History/Intake

• 24-hour recall

• Food frequency questionnaire

• Food diaries

• Direct observation of feeding and eating process

History Questions (Subjective Data)

• Eating patterns

• Usual weight

• Changes in appetite, taste, smell, chewing, swallowing

• Recent surgery, trauma, burns, infection

• Chronic illnesses

• Vomiting, diarrhea, constipation

• Food allergies/intolerances

• Meds/nutritional supplements

• Self-care behaviors

• ETOH/illegal drug use

• Exercise/activity patterns

• Family history

Additional Questions for Certain Groups:

For Infants and Children:

• gestational nutrition

• infant breast or bottle fed

• child willing to eat what is prepared?

For Adolescent:

• your present weight (dieting?, feeling fat?, vomit/laxatives/diuretics after eating?)

• what snacks or fat foods do you like to eat?

• age first start menstruating (late if malnourished)

For Pregnant Female:

• how many times have you been pregnant?

• what foods do you prefer when pregnant?

For Aging Adult:

• How does your diet differ from when you were in your 40s and 50s?

• Who prepares the meals (or is an outside service, such as Meals on Wheels used?)?

Physical Examination for Clinical Signs: What would be important for you to assess?

• Skin, hair

• Eyes

• Lips, tongue, gums

• Nails

• Musculoskeletal

• Neurologic

Anthropometric Measures:  The measurement and evaluation of growth, development, and body composition

Body Weight

• As a percentage of ideal body weight

• Current weight/ideal weight X 100

          80-90% = mild malnutrition

  70-80% = moderate malnutrition

  < 70% = severe malnutrition

Percent usual body weight

Current weight/usual weight X 100

                85-95% = mild malnutrition

                75-84% = moderate malnutrition

                < 75% = severe malnutrition

Recent Weight Change

Usual weight - current weight/usual weight X 100

Body Mass Index (BMI)

• Simple indicator of total body fat or obesity

25-29.9  = Overweight

              > 30 =   Obese

Skinfold Thickness

• Provides estimate of body fat stores

• Measure at posterior upper arm, midway between acromion process of scapula and the olecranon process

• Measure with calipers and compare with standards

• TSF = triceps skin fold

• MAC = mid-upper arm circumference

• Estimate skeletal muscle mass and fat stores

Waist-to-hip ratio-- relationship to Metabolic Syndrome

Laboratory Tests

• H & H

• cholesterol, triglycerides

• total lymphocyte count

• skin testing

• serum albumin

• serum transferrin

• nitrogen balance

Monitoring Nutritional Status

To monitor nutritional status in malnourished: serial measurements are made at routine intervals

At the minimum the following should be monitored weekly

• weight

• H & H

• serum albumin

• TLC

Skin fold measurements and arm muscle circumference measures change more slowly and may be collected biweekly or monthly.

Spiritual Assessment

What types of things would you assess?

Spiritual Assessment

• Presence of religious objects

• Garments

• Check greeting cards

• Prayer times

• Special dietary requests

• Religious magazines/books

• Mention God, prayer, faith, etc.?

• Expression of anxiety or fear about pain, suffering, death?

• Prefer to interact with others or to remain alone?

Cultural Assessment

Cultural competence:  having the knowledge, understanding, and skills to provide acceptable care to peoples from diverse cultures.

Cultural assessment: 

• One aspect of a comprehensive health history

• The collection of data related to culturally based beliefs and practices about health and illness

• Helps determine explicit nursing needs and intervention practices within the cultural context of the person being evaluated.

What areas should be assessed in a cultural assessment?

• brief history of the cultural group with which the person identifies

• values orientation (regarding birth, death, health, illness, health care providers)

• cultural sanctions and restrictions

• language and communication

• health-related beliefs and practices

• parenting styles and role of family

• sources of support beyond family

• nutrition (dietary practices)

• socioeconomic considerations

• organizations providing cultural support

• educational background

• religious affiliation

• spiritual considerations

Be aware of community makeup

Use interpreter

https://www.thinkculturalhealth.hhs.gov/