Mental Health Assessment

Mental status examination: modelled from NSW HEALTH documents
(Please see original documents for detailed content, this is headings only, to be used as a template, please delete bracketed work prior to submission)- to print and use for your use in the video viewing create more space after either the heading or the green text (as a hint)
APPEARANCE ( physical description, hygiene, grooming, hair colour and length, posture, poise, body type, looking stated, notable characteristics such as tattoos, piercings)
BEHAVIOUR ( rapport, engagement, psychomotor activity both qualatitive and quantative, attitude )
AFFECT (observed emotional response – appropriate, restricted, flattened, congruence)
MOOD (reported feeling or emotion as expressed by the client, including depth, intensity , duration and fluctuations)
SPEECH (quantity, rate, volume, tone, flow,unusual characteristics)
THOUGHT FORM (the process, how they put ideas together, logical, tangential, concrete, blocked, vague, poverty, loose associations)
THOUGHT CONTENT ( what the person is actually thinking, detail themes, obsessions, delusions, ideas, plans, antisocial urges )
PERCEPTION (hallucinations – auditory, visual, somatic, gustatory, kinaesthetic, olfactory – identify type describing client experiences )
COGNITION & INTELLECTUAL FUNCTIONING ( orientation – time, place and person; memory – remote, recent, recall ; attention , concentration; ability to plan and implement; fund of knowledge; calculations; abstract reasoning )
INSIGHT & JUDGEMENT ( insight = awareness of problem – denial; judgement = understanding of consequences of their behaviours )

(15 marks)
Identify 4 risks (5 marks). Refer to risk template for various types of risks.

Care plan: Modelled on clinical modules information NSW HEALTH
(please delete all bracketed information to use as a template for submission) you will not need to print this for viewing ( 20 marks)

CLINICAL ISSUE ( HIGHEST priority mental health problem, issue, risk or concern)
RATIONALE FOR CHOSEN ISSUE ( outline the impact of this issue on the clients wellbeing if this issue is not addressed, what information from the case study identified this as an issue, use literature AND client information to support your choice)
GOAL/S (what will your ultimate outcome be for the above problem, direct relationship to the issue identified )
INTERVENTIONS – 3 ONLY (the interventions MUST be nursing interventions, be client specific, short term ,detailed –what, how, when /frequency,SUPPORT validity with literature)
1
2
3
RATIONALES -( the how / why of interventions , for each of the interventions use literature that supports the validity of this intervention and its relationship to being able to achieve your goals and what the outcome on the client should / could be )
1
2
3

ACTIVITY 3 ( 5 marks) ( remember delete all of the instructions and marks before submission – needs to be comprehensive eg what did the interviewer say or do, why and how was this good or bad with regards to communication and a therapeutic relationship and give the reason why it is good or bad – use literature to support ) 4 positive interactions and 2 negative interactions .

References and academic writing (5 marks).