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Chapter 1 Introduction to Mental Health Nursing 27

■ Social history, including communication skills, social Each chapter in units 4 and 5 contains a Focused Nurs-
networks, work/school roles, economic stressors, and ing Assessment table to help students learn the types of
legal stressors questions to ask and the particular characteristics to assess.
■ Living conditions, including availability of food and Observing experienced nurses is a great way to learn basic
shelter interviewing skills, and see techniques that are more ad-
vanced. Be sure to discuss your observations with another
■ Spiritual considerations, including beliefs, values, and
nurse, and clarify anything that was unclear.
religious concerns
■ Strengths and competencies Neuropsychiatric Assessment The neuropsychiatric assess-
ment provides information about the client’s appearance, be-
The U.S. Department of Health and Human Services has
havior, speech, emotional state, and cognitive functioning.
launched a national public health campaign to encourage all
See Box 1.5 for the neuropsychiatric assessment. Box 1.6 de-
American families to learn more about their family health his-
scribes signs of disease when assessing client perceptions,
tory. Access this information and download for free the “My
forms of thought, and content of thought.
Family Health Portrait” tool at: www.hhs.gov/familyhistory.
Physical Assessment Clinical skills include conducting a
detailed physical assessment. In many community settings,
psychiatric nurses are the only mental health care providers
BOX 1.5 Neuropsychiatric Assessment
General
■ Age BOX 1.6 Signs of Pathology
■ Relationship status
■ Family composition Perception
■ Employment
■ Living situation ■ Illusions (the misinterpretation of an environmental stimulus
of sight, sound, touch, smell, or taste)
Appearance ■ Hallucination (occurrence of a sight, sound, touch, smell, or
■ General state of health taste without any external stimulus)
■ Depersonalization (feel sense of identity has been altered
■ Grooming and hygiene
■ Posture and therefore feel strange and unreal)
■ Derealization (feel the environment has changed and is
Activity unreal)
■ Motor activity (appropriate; increased/decreased) Form of Thought
■ Tremors, dystonias
■ Blocking (sudden stop in speech or train of thought)
■ Hyperactivity (activity is purposeful)
■ Circumstantiality (overly detailed, tedious; eventually reaches
■ Agitation (activity is purposeless)
goal)
Speech and Language ■ Confabulation (unconsciously filling in memory gaps with
imagined material)
■ Fluency ■ Derailment (speech is blocked and then begins again on
■ Comprehension
unrelated topic)
■ Pace (fast, slow) ■ Flight of ideas (rapid, fragmented thoughts manifested in
■ Volume
pressured speech)
■ Tone (calm, hostile) ■ Loose association (disconnected thoughts)
Emotional State ■ Neologism (making up new words; not understood by
others)
■ Mood (sustained emotional state; what client describes; ■ Tangential (thoughts veer from main idea and never get back
depression, anxiety, sadness, calmness, anger) to it)
■ Affect (immediate emotional expression; what others observe;
appropriateness, intensity, lability, range of expression) Content of Thought

Perceptions ■ Disorders range from transient preoccupations to intractable

delusions
■ Five senses: seeing, hearing, smelling, tasting, feeling ■ Ruminations (recurring mood-congruent concerns usually
Cognitive Functioning related to anxiety or depression)
■ Obsessions (unwanted, repetitive thoughts that lead to
■ Orientation (person, time, place) feelings of fear or guilt)
■ Concentration ■ Compulsions (thoughts or behaviors used to decrease the
■ Memory (recent, remote) fear or guilt associated with obsessions)
■ Intellectual functioning (general grasp of information, ■ Delusions (grandiosity, persecution, control, sin and guilt;
reasoning and judgment, insight) religious, erotomanic, somatic)
■ Form of thought ■ Experiences of influence (ideas of reference, thought broad-
■ Content of thought casting, thought withdrawal, thought insertion)

DESIGN SERVICES OF
100366 C P Ed /NJ/CHET A F i P N 2 C/M/Y/K/PMS