Introduction to the Psychiatric Assessment (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:02 Let's take a moment to look at the psychiatric assessment.

    00:07 How are you going to know who your patient is? How are you going to be able to assess why your patient is in front of you? Why they've been admitted? We need to be able to do an assessment, a full assessment of this person.

    00:26 The goal of the psychiatric nursing assessment is to help define the patient's problem, while at the same time fostering the nurse-patient relationship.

    00:39 So we are collecting data.

    00:42 Where is this data coming from? Well, it comes from a variety of sources.

    00:48 It comes from the patient, it comes from the chart, it comes from the interviews that have been done with family members.

    00:56 We need to know where the information is coming from, if it is coming from reliable sources, and how old it is? Some of the information we get on our patients might be quite old.

    01:11 It is not the first time that I have looked at an admission and seeing that the patient was admitted five years ago.

    01:19 And the diagnosis is very similar.

    01:22 But I need to know, what has transpired in those five years? I need to look at their medication sheet, for example.

    01:31 What a wonderful place that I can get some information from.

    01:35 Has their medication changed? Are they new medications? Oftentimes, medications are going to indicate diagnosis.

    01:45 And so, being able to look at all of your chart, being able to pull up any blood work that was done, any X rays that were done, any information that has been gained.

    02:00 And looking at all charts, this will give us our best look at the whole patient.

    02:07 Sometimes psychiatric symptoms have metabolic bases.

    02:13 For example, a person who has thyroid disease, if it's hypothyroid, might have depression.

    02:21 If it's hyperthyroid, may present with some manic syndromes.

    02:26 So we want to be able to look not only at them psychologically, but also physiologically.

    02:34 So you start with that system review.

    02:37 You're going to look at the cardiovascular system, respiratory scan.

    02:43 You want to make sure that these things have been done.

    02:46 Usually, a full history and physical has been taken by the admitting physician or the house physician, or if you are working in a place that has residents.

    02:57 Make sure that you read over that admitting physiological systems review that is on the chart.

    03:07 Then you want to be able to do a mental status evaluation.

    03:13 The mental status evaluation covers a number of different categories.

    03:18 For example, we look at the general appearance, we look at the patient's mood and affect.

    03:26 We look at their thought processes and the content of those thoughts.

    03:33 We evaluate their cognitions, their thoughts.

    03:37 We evaluate their speech and their language capabilities.

    03:42 We assess their judgment.

    03:45 And we look to see if they have some insight into the reasons why they have been admitted.

    03:52 Also, we want to evaluate whether or not our patient is a reliable historian.

    03:59 So we're looking at reliability.

    04:02 Is the patient able to give us information and facts that are reliable? Can we trust what the patient is telling us? Assessing the psychiatric patient is one of the most critical skills that the psychiatric nurse will engage in? The psychiatric assessment has the general assessment.

    04:29 It provides a nursing diagnosis.

    04:32 It tells what the outcome identification is going to be.

    04:38 And it starts us engaging in the planning of nursing interventions, which are based upon our nursing diagnosis, which is going to come from that assessment that we do as we learn who this patient is.

    04:56 Our assessment, our psychiatric assessment is persistent, it's ongoing.

    05:02 And it is where our treatment plans are going to emanate from.

    05:08 As we know this patient better and better, our treatment plan will evolve.

    05:14 So we want to make sure that we are sharing our information and gaining our information not just from the patient alone, but also from the others on the team.

    05:29 And we want to share information that we gain from our patient.

    05:35 Because we're the people who spend the most time with the patient.

    05:39 Everyone else may come in and see them for an hour or 15 minutes.

    05:44 But we're there on the floor, working with them for eight hours, or 10 hours, or 12 hours.

    05:52 And so our information truly is focused on the patient.

    05:59 Any information that we gain must be used to increase the understanding of this patient's struggle, and to help prepare a treatment plan that will help them towards recovery.

    06:15 Any information that doesn't help us to understand the patient is not therapeutic information.

    06:23 And any information that we gain that is therapeutic that is important must be shared.

    06:29 If we learn something about this patient, we might be able to look at the environment we're in.

    06:37 For example, if a patient says to you, "Boy, you know, whenever I hear the vacuum, suddenly I go into this horrible fear and I just, I just want to like run and hide.

    06:53 And when I'm home, if my mother vacuums I have to hide in the bathroom.

    06:58 Well, that's an important thing for us to know.

    07:00 Because during the day, there are going to be a number of people who are going to be coming in and cleaning the floors, and maybe vacuuming.

    07:09 So we want to be able to know and say to maintenance, if you're coming up if you're going to be using that please let me know in advance so that I can prepare this patient.

    07:20 So that we don't have a patient who suddenly due to environmental stimuli is going to be acting in a way that is going to be misinterpreted, which might end up with having a crisis on the floor.

    07:33 Remember, we are always thinking safety.

    07:36 Safety, safety, safety.

    07:38 We want to increase our capacity to provide every, every patient with a safe environment.

    About the Lecture

    The lecture Introduction to the Psychiatric Assessment (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Psychiatric Assessment (Nursing).

    Included Quiz Questions

    1. Help identify the client’s problem or concern
    2. Developing the nurse-client relationship
    3. Diagnose the client
    4. Determine which medication the client needs
    5. Facilitate discharge planning
    1. The client’s chart from a previous psychiatric admission
    2. The client's current assessment findings
    3. The client’s parents and older sibling
    4. The client’s medication list
    5. The client’s social media pages
    1. Cognition
    2. General appearance
    3. Judgment and insight
    4. Medication side effects
    5. Cranial nerve function
    1. “Last time they were admitted, the client responded well to progressive muscle relaxation.”
    2. “The client voiced feeling more comfortable talking with female staff during their last admission.”
    3. “The client always seemed like they felt like they were smarter than the rest of us.”
    4. “I think the client complained to the manager about me last time they were in. Be careful.”
    5. “The client has difficulty hearing. I found that speaking slowly with lots of pauses really helped.”

    Author of lecture Introduction to the Psychiatric Assessment (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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