Nursing Care Plan - Elderly Assessment of Mental State
Elderly Assessment of Mental State
Mental status assessment is a systematic approach to collecting data on psychosocial functioning. This assessment includes: general appearance of the client, awareness, affective function, speech characteristics, orientation, attention and concentration, judgment, memory, perception, and the content and process of thought. This study aims to determine the thoughts and mental processes that influence the achievement of an optimal level of functioning elderly. This assessment is integrated in the interview and physical examination.
Assessment of Mental Status
General Appearance
The general appearance can provide a picture of psychological functions. The general appearance include: physical appearance, coordination of movements, facial expressions and posture. Physical appearance include: how to dress, personal care and personal hygiene.
Awareness
Awareness is the ability of individuals to make contact with their environment and with themselves (through the senses). When consciousness is good (not decreased), the orientation capabilities such as time, place and people will be better and be able to process incoming information effectively (through memory and judgment). In assessing the level of consciousness should be considered:
Affective Functions
Things that need to be considered in assessing the affective function in the elderly, namely:
It is important to assess the significance of an event for the elderly to assess the depth and duration of affective that appear.
Emotional expression is influenced by cultural and personal characteristics.
In the elderly usually do not express their feelings directly / verbal. Therefore, it is important to observe the reaction of indirect / non-verbal of the elderly.
It is important to use terms that can be accepted by the elderly at the time of the interview by focusing on the feelings experienced by the elderly. Can be initiated by using an open-ended question, such as: how are you today?
Affective function impairment in the elderly is often the case is depression. The Geriatric Depression Scale (GDS) is a valid and reliable measurement is to determine the presence of depression. Use of GDS can facilitate clients express attitudes and feelings that are difficult expressed that actually associated with depression.
Attention and Concentration
Nurses must observe and record the response shown by the elderly at the time of assessment, namely when answering questions.
Assessment
Assessment is the ability to assess a situation correctly, to do according to the situation.
Memory
The memory includes a new memory, short-term memory and long term memory. Memory impairment can identify the presence of intellectual impairment / cognitive. The Short Portable Mental Status Quesionnaire (SPMQ) was used to detect the level of intellectual impairment.
Perception
Perception is the power to know things, quality, relationships and differences through the process of observing, knowing and interpreting after getting his senses stimulated.
In elderly perception disorder usually associated with dementia, depression and delirium.
Content and Thought Process
The process of thought can be assessed at the time of the interview.
References
Mental status assessment is a systematic approach to collecting data on psychosocial functioning. This assessment includes: general appearance of the client, awareness, affective function, speech characteristics, orientation, attention and concentration, judgment, memory, perception, and the content and process of thought. This study aims to determine the thoughts and mental processes that influence the achievement of an optimal level of functioning elderly. This assessment is integrated in the interview and physical examination.
General Appearance
The general appearance can provide a picture of psychological functions. The general appearance include: physical appearance, coordination of movements, facial expressions and posture. Physical appearance include: how to dress, personal care and personal hygiene.
Awareness
Awareness is the ability of individuals to make contact with their environment and with themselves (through the senses). When consciousness is good (not decreased), the orientation capabilities such as time, place and people will be better and be able to process incoming information effectively (through memory and judgment). In assessing the level of consciousness should be considered:
- The influence of medication.
- Affective disorders.
- Pathological conditions.
Affective Functions
Things that need to be considered in assessing the affective function in the elderly, namely:
It is important to assess the significance of an event for the elderly to assess the depth and duration of affective that appear.
Emotional expression is influenced by cultural and personal characteristics.
In the elderly usually do not express their feelings directly / verbal. Therefore, it is important to observe the reaction of indirect / non-verbal of the elderly.
It is important to use terms that can be accepted by the elderly at the time of the interview by focusing on the feelings experienced by the elderly. Can be initiated by using an open-ended question, such as: how are you today?
Affective function impairment in the elderly is often the case is depression. The Geriatric Depression Scale (GDS) is a valid and reliable measurement is to determine the presence of depression. Use of GDS can facilitate clients express attitudes and feelings that are difficult expressed that actually associated with depression.
Attention and Concentration
Nurses must observe and record the response shown by the elderly at the time of assessment, namely when answering questions.
Assessment
Assessment is the ability to assess a situation correctly, to do according to the situation.
Memory
The memory includes a new memory, short-term memory and long term memory. Memory impairment can identify the presence of intellectual impairment / cognitive. The Short Portable Mental Status Quesionnaire (SPMQ) was used to detect the level of intellectual impairment.
Perception
Perception is the power to know things, quality, relationships and differences through the process of observing, knowing and interpreting after getting his senses stimulated.
In elderly perception disorder usually associated with dementia, depression and delirium.
Content and Thought Process
The process of thought can be assessed at the time of the interview.
References
- Jeri B. Brown. Nancy K. Bedford, Sarah S. White. (1999). Gerontological Protocols for Nurse Practitioners. Lippincott, Philadelphia.
- Miller, C.A. (1995). Nursing care of olders adults : Theory and practice. Philadelpia : JB Lippincott. Lippincott, Philadelphia
- Staab,A.,S., & Hodges,l.,C.,(1996 ) Gerontological Nursing: Adaptation to the aging process
- Matteson, M.A. and Mc. Connel, E.S. (1988). Gerontological Nursing : Concepts and practice. Philadelpia : WB Saunders Company.
- Sheila L. Molony, Cristine M, Waszynski, Courtney H Leyder. (1999). Gerontological Nursing. Appleton & Lange. Conecticut.
- Stuart, G.W and Sundeen, S.J, 1995. principles and practice of psychiatric nursing, St. Louis, Mosby Year Book.
- Beck, CM, Rawlins and Williams, S.R, 1996, Mental health psychiatric nursing: A Holistic life-Cycle approach, St Louis, Mosby Co.
