Psychosocial Integrity / Topic 6

Make sure to:

  • Evaluate clients for impaired cognition.
  • Assess clients for both acute and chronic mental illness.
  • Provide care to clients experiencing acute and chronic psychosocial issues.

Since COVID-19 pandemic, there has been an increased emphasis on mental health. Nonetheless, mental health assessment has always been a fundamental part of nursing care for clients.

In this learning experience, learners will gain knowledge and insights into mental health concepts, specifically focusing on assessing clients for impaired cognition and identifying acute and chronic mental illness, as well as providing appropriate care to these clients.

6.1 Assessment of Clients for Impaired Cognition

Clients with impaired cognition experience disruptions in their cognitive and thinking abilities, operations and activities (Burke, 2023).

Nursing should assess clients for the following signs and symptoms of impaired cognition as identified by Burke (2023):

  • Egocentricity.
  • Hypervigilance.
  • Cognitive dissonance.
  • Lack of orientation and confusion.
  • Poor hygiene and grooming.
  • Impaired judgment and insight.
  • Short and/or long-term memory loss.
  • Inability to recognize familiar faces and objects.
  • Failure to carry out basic and instrumental activities of daily living.
  • Difficulty understanding and comprehending written and spoken words.

It is also important to assess clients for primary disorders that can lead to impaired cognition (Burke, 2023), including:

  • Delirium: Characterized by sudden onset of temporary cognition impairment. This can result from chronic mental illness, infections, medications, and/or substance abuse.
  • Dementia: A group of syndromes causing impaired thinking ability leading to difficulties in carrying out normal daily activities and interacting with others.
  • Closed Head Injury: Injuries to the head that can impact cognitive functions.
  • Other Neurological Events: Including conditions like cerebral tumor or a cerebrovascular accident (strokes).

It is important for assessment findings to be thoroughly documented. Nurses and other healthcare team members should work collaboratively to manage the care of clients with impaired cognition.

6.2 Assessment of Clients for Acute and Chronic Mental Illness

Nurses are tasked with assessing clients for both acute and chronic mental health disorders. For a comprehensive understanding, Table 1 offers a detailed list of mental illnesses, along with examples, and key assessment findings for some of them.

Table 1

Acute and Chronic Mental Illnesses and Assessment Findings

Adapted from Burke, A. (2023). Mental Health Concepts: NCLEX-RN. https://www.registerednursing.org/nclex/mental-health-concepts/; Kaplan Nursing. (2023). NCLEX-RN Content Review Guide: Preparation for the NCLEX-RN Examination (9th ed.). Kaplan Test Prep.

Nurses can use the following tools as recommended by Burke (2023), to assess their clients for:

  • Anxiety Disorder:
    • Modified Spielberger State Anxiety Scale.
    • National Stressful Events Survey.
    • Hoarding Scale of Self Reports.
    • Hamilton Rating Scale for Anxiety.
    • Yale-Brown Obsessive Compulsive Scale.
  • Psychotic Disorders:
    • Abnormal Involuntary Movement Scale.
    • Scale for the Assessment of Negative Symptoms.
    • Global Assessment Scale of Functioning.
    • Brief Psychiatric Rating Scale.

6.3 Providing Care to Clients with Acute and Chronic Psychosocial Issues

Nurses provide care to clients experiencing acute and chronic psychosocial issues that impact their mental health. After assessing their clients for impaired cognition and mental illness, care plans are developed. Burke (2023) outlines key aspects of nursing care for these clients, including:

  • Establishing a therapeutic milieu.
  • Ensuring a safe environment.
  • Administering medications as prescribed.
  • Providing individual and group counseling/therapy as ordered.
  • Offering nutritional support and hydration, such as for clients with delirium.
  • Conducting weight monitoring, particularly in clients with bipolar and eating disorders.Assisting with electroconvulsive therapy, especially for clients with depression.

Upon completing this learning experience, the learner will have acquired a thorough understanding of mental health concepts. The main goals are to prepare learners for successful performance on the NCLEX examination and their clinical competency in mental health care.

After reviewing the resources provided, it is important to identify areas that need further improvement. Focusing on these areas will help in improving the necessary skills for effective mental health care and professional practice.

  • Burke, A. (2023, November 4). Mental Health Concepts: NCLEX-RN. https://www.registerednursing.org/nclex/mental-health-concepts/ 
  • Kaplan Nursing. (2023). NCLEX-RN Content Review Guide: Preparation for the NCLEX-RN Examination (9th ed.). Kaplan Test Prep.

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Readings

Videos

  • Lecturio Nursing. (2021, March 3). Mental Health Concepts: Mental Health | Lecturio Nursing [Video]. YouTube. https://youtu.be/niW_-ugGegY