Ha Lab Sas 21 Magbanua Glory Mae Paciol BSN1 A18 PDF

HEALTH ASSESSMENT (Physical Examination
and History Taking) – LAB / RLE

STUDENT’S ACTIVITY SHEET BS NURSING / FIRST YEAR
Session # 21
LESSON TITLE: MENTAL STATUS Materials:

LEARNING OUTCOMES: Book, pen and notebook, index card/class list, speaker and
LCD projector
Upon completion of this lesson, the nursing student can:
1. Describe the areas assessed in the mental status. References:

2. Determine the symptoms and behaviours assess in a mental health
screening. Hogan-Quigley, B., Palm, M. L., & Bickley, L. S. (2017).
3. Obtain an accurate mental status history for a patient. Bates' nursing guide to physical examination and history
4. Perform a mental status examination taking. Philadelphia: Wolters Kluwer
5. Identify the screening and health promotion and counselling tools for
depression, suicide, and substance use disorders.
6. Apply the learnt theories and body of knowledge.
LESSON PREVIEW/REVIEW (5 minutes)

Recapitulate the previously learnt about the assessment of musculoskeletal system.
MAIN LESSON (75 minutes)
The instructor should discuss the following topics. Instruct the students to take down notes and read their book about this
lesson. For detailed explanation and illustrations, please refer to CHAPTER 19: MENTAL STATUS, page 647 – 665.
MENTAL STATUS
Patient Indicators for Mental Health Screening
 Medically unexplained physical symptoms – more  Rating as a “difficult encounter”
than half have a depression or anxiety disorder  Recent stress
 Multiple physical or somatic symptoms or “high  Low self-rating of health
symptom count”  High use of health care services
 High severity of the presenting somatic symptoms  Substance abuse
 Chronic pain
 Symptoms for more than 6 weeks
THE HEALTH HISTORY
Common or concerning symptoms:
 As with the General Survey, your assessment of mental status begins
when you first meet with the patient. Please refer to page 650 – 651.  Changes in attention, mood, or speech
 As you gather the mental history, you will quickly observe the patient’s  Changes in insight, orientation, or memory
level of alertness and orientation, mood, attention, and memory.  Delirium or dementia
 As the history unfolds, you will learn about the patient’s insight and
judgement, as well as any recurring or unusual thoughts or perceptions.
 These and other components of mood and cognition will alert you to conditions that require more detailed follow-up,
including a formal mental status examination and possible referral.
Terminology: The Mental Status Examination (Students will fill this in with necessary information)
Terms Definition Terms Definition
Level of Insight
consciousness
Attention Judgement
Memory Affect
Orientation Mood
Perceptions Language
Thought Higher cognitive

processes functions
Thought content
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PHYSICAL EXAMINATION
The mental status examination consists of 5 components (please refer to page 652 – 663)
Appearance and Speech and Mood Thoughts and Perception Cognitive functions
behaviour language
 Level of  Quantity  Thought processes  Orientation
consciousnes  Rate o Circumstantiality o person
s  Loudness o Blocking o Place
 Posture and  Articulation of o Flight of ideas o Time
motor Words o Confabulation o Situation
behaviour  Fluency o Incoherence  Attention
 Dress, o Aphasia o Derailment o Digit span
grooming, o Neologism o Serial &s
and personal o Perseveration o Spelling backward
hygiene o Echolalia o Remote memory
 Facial o clanging o Recent memory
expression  Thought content o New learning ability
 Manner,  Perceptions  Higher cognitive functions
affect, and o Illusions o Information and
relationship o Hallucinations vocabulary
to people and  Insight and judgement o Calculating ability
things o Insight o Abstract thinking
o Judgement  Proverbs
 Similarities
o Constructional ability
SPECIAL TECHNIQUES RECORDING FINDINGS

 Mini – Mental state Examination (MMSE) Please refer to page 663
Please refer to 663
HEALTH PROMOTION AND COUNSELING
Please refer to page 664 - 665
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CHECK FOR UNDERSTANDING (10 minutes)
The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.
Multiple Choice.
(For 1-10 items, please refer to the questions in the Rationalization Activity)
1. What percent of the population identified as drug abusers abuse marijuana?

a. 60%
b. 50%
c. 40%
d. 30%
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The outcome and costs of care of what dis- eases improve when depression is treated? (Mark all that apply.)
a. HIV/AIDS
b. Dementia
c. Kidney disease
d. Diabetes
e. Liver disease
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. When depression goes undiagnosed, what consequences occur eight times more frequently than in the
general population?
a. Polyhedonia
b. Comorbidity
c. Death
d. Bankruptcy
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Which patients are most at risk for depressive symptoms? (Mark all that apply.)
a. Married
b. Divorced
c. Females
d. Males
e. Chronically ill
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Nurses are urged to conduct what kind of mental health screenings?

a. General
b. Targeted
c. Focal
d. Mini
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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6. As a nurse, when do you screen for alcohol and drug use?
a. Every patient/every patient history
b. Every patient/initial assessment
c. At-risk patient/every patient history
d. At-risk patient/initial assessment
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. When assessing your patient you note that he is delusional. You would know that delusional thinking can
lead to what?
a. Major depression
b. Suicide
c. Flight of ideas
d. Comorbidity
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. Mr Gutierrez, 77 years old, is brought to the clinic by his son, who states, “My father just doesn’t seem to be
able to function as well as he used to.” When assessing this patient the nurse is aware that she will be a
what?
a. Patient advocate
b. Diagnostician
c. Part of a health care team
d. Referral source
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. You are admitting a patient to your unit for open heart surgery the next morning. You note that the patient
speaks at an accelerated pace and jumps from topic to topic, none of which progresses to sensible
conversation. What would you document about this patient?
a. Patient demonstrates confabulation
b. Patient is incoherent
c. Patient demonstrates flight of ideas
d. Patient demonstrates schizophrenia
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. You are assessing a patient with a history of Korsakoff syndrome. What would you expect this patient might
demonstrate?
a. Psychotic tendencies
b. Incoherence
c. Flight of ideas
d. Confabulation
ANSWER: ________
RATIONALE:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates.
1. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________________________________________________
2. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________________________________________________
3. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________________________________________________
4. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
__________________________________________________________________________________________
5. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________________________________________________
6. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
__________________________________________________________________________________________
7. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
__________________________________________________________________________________________
8. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________________________________________________
9. ANSWER: ________
RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
__________________________________________________________________________________________
10. ANSWER: ________

RATIONALE:___________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
You are done with the session! Let’s track your progress.
CAT: Muddiest Point
The Muddiest Point
In today’s session, what was least clear to you?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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HEALTH ASSESSMENT (Physical Examination

and History Taking) – LAB / RLE

LESSON TITLE: MENTAL STATUS Materials:

1. Describe the areas assessed in the mental status. References:

LESSON PREVIEW/REVIEW (5 minutes)

Thought Higher cognitive

SPECIAL TECHNIQUES RECORDING FINDINGS

1. What percent of the population identified as drug abusers abuse marijuana?

5. Nurses are urged to conduct what kind of mental health screenings?

10. ANSWER: ________

CAT: Muddiest Point

The Muddiest Point

In today’s session, what was least clear to you?

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