208 Concept: Development; topics mental status exam, into to assessment of nutritional status Flashcards
Define mental health.
The capacity to feel, think, express emotions, and behave in ways that enhance personal capacity to manage challenges, adapt successfully to a range of demands and enjoy life.
Finding balance in all aspects of life; can vary over time across a continuum
Define mental disorder.
Constellations of co-occurring symptoms that may involve alterations of thought, experience, and emotion that are serious enough to cause distress and impair functioning, cause difficulty in sustaining interpersonal relationships and performing jobs, and sometimes leads to self-destructive behaviours and suicide.
What % of Canadians personally experience a diagnosed mental illness during their lifetime?
20%
What factors influence mental health?
- Internal emotional problems
- Familial and social network
- Community, including health care systems, employment, education, and housing
- Larger social issues (e.g., poverty, racism, discrimination)
What is mental status?
emotional and cognitive functioning
What are the domains of mental status?
- Appearance
- Behaviour (mood and affect, speech)
- Cognition (consciousness, orientation, memory, attention and concentration, comprehension and abstract reasoning)
- Thinking (perception, content, process, insight, judgement)
What forms the appearance domain of mental status?
Posture
Body Movements
Dress
Grooming & Hygiene
What forms the behaviour domain of mental status?
Level of consciousness
Facial expression
Mood
Affect
What forms the cognition domain of mental status?
Consciousness Orientation Memory Attention & Concentration Comprehension & Abstract Reasoning
What forms the thinking domain of mental status?
Perception Content Process Insight Judgement
When are measurements often taken and what are some associated guidelines?
- Often completed as part of a nutritional assessment
- Serial measurements over time can provide more useful information than a single, one-time measurement
- Weigh at the same time each day
What are the steps to measuring weight?
Remove shoes and heavy outer clothing Weight at same time each day Record in kilograms and/or pounds How does weight compare to pt’s height? Compare with last weight completed
What are the steps to measuring height?
Align head piece with top of head
Remove shoes
Stand straight, looking ahead
Feet, shoulders, buttocks should be in contact with hard surface
What is waist-to-hip circumference? What are the risk ranges?
Waist-to-hip ratio = Waist circumference/Hip circumference
Waist circumference >88cm (35in) in women and > 102cm (40 in) in men places them at risk for type 2 diabetes, coronary heart disease and hypertension
What is body mass index (BMI)?
Body Mass Index (BMI)
Practical marker of optimal weight for height
Indicator of obesity or protein-calorie malnutrition
BMI interpretation for adults: <18.5: Underweight 18.5–24.9: Normal weight 25.0–29.9: Overweight 30.0–34.9: Obesity (Class 1) 35–39.9: Obesity (Class 2) ≥40: Extreme obesity (Class 3) BMI interpretation for children aged 2 to 19 years: 97–99th percentile or beyond = further assessment and intervention is required.
What are some signs of malnutrition?
Stunting: people are too short for their age
Wasting: people are too thin for their height
Obesity: People are overweight
What are critical components of completing a nutritional assessment?
Positivity, build rapport, open communication ◼ Consider food/nutrition literacy ◼ Subjective & objective data: dietary intake, psych, behavioral, functional factors ◼ Developmental stage ◼ Health promotion & teaching ◼ Measurements ◼ FASTCHECK ◼ Limitations
What is the purpose of the mental status exam?
Check emotional/cognitive function.
What does ABCT stand for relative to a mental health exam?
Appearance
Behaviour
Cognition
Thought process
General presentation to others.
Appearance
Consciousness
Being aware of one’s feelings, thoughts, and environment.
Speech
Using language and the voice to communicate one’s thoughts and feelings.
Expressing the prevailing feelings through mood (a sustained emotion that the patient is experiencing) and affect (a display of feelings or state of mind).
mood and affect
Awareness of the objective world in relation to the self.
orientation
Pondering a deeper meaning beyond the concrete and literal.
abstract reasoning
The way a person thinks; the logical train of thought.
thought process
What the person thinks; specific ideas, beliefs, the use of words
thought content
An awareness of objects through the five senses.
perception
awareness of the reality of the situation
insight
Ability to choose a logical course of action.
judgement
What does the Folstein Mini-Mental State Examination (MMSE) assess for?
orientation, registration, attention, calculation, recall and language
What is the purpose of the Four Unrelated Words Test?
Tests the patient’s ability to acquire new memories. Highly sensitive and valid memory test.
What is the most common method of obtaining information about dietary intake?
24-hour recall
Which age group is most likely to experience mental illness and/or substance abuse?
15 - 24 year olds
Define optimal nutritional status.
Nutrients are consumed in amounts that support daily requirements and increase as metabolic demands increase.
Define undernutrition.
Occurs when nutritional reserves become depleted or when nutrient intake is inadequate to meet daily requirements or metabolic demands.
Define overnutrition.
Consumption of nutrients in excess of requirements.
What nutritional developmental considerations are there for infants and children?
- recommended breastfeeding until 6 months
- If breastfed, supplement with vitamin D
- Solid foods usually at 6 months of age
- Whole milk not until 9 -12 months
What nutritional developmental considerations are there for adolescents?
- increased needs for energy and protein
- due to rapid bone growth and increasing muscle mass need more calcium and iron
What nutritional developmental considerations are there for adulthood?
Often need nutritional counselling to address or prevent overweight or obesity.
What nutritional developmental considerations are there for older adults?
- after age 50, energy requirements decrease by about 5% per decade
- Poor dentition, decreased visual acuity, decreased saliva production, slowed GI motility, decreased GI absorption, and diminished olfactory and taste sensitivity can affect nutrition
- Supplement with vitamin D
- Medications can affect things
What forms for nutritional assessment are there?
1) 24 hour recall (can forget things, it may be an atypical day, may alter information, snacks and condiments may be underreported)
2) Food frequency questionnaire (also relies on memory and doesn’t measure food quantities)
3) Food diary: records everything consumed for certain periods of time; 3 days is often suggested (challenges include nonadherence, inaccurate recording, atypical intake on recording days, conscious alteration of diet on those days)
4) direct observation
What are the components of the nutritional assessment?
- Health history
- Dietary history
- Inspect skin, hair, eyes, oral cavity, nails and musckuloskeletal and neurological systems.
- Athropomorphic Measures
- Height and weight
- BMI
- Waist-Hip ratio
- Laboratory Studies
- Hemoglobin (for iron deficiency)
- Hematocrit (iron status indicator)
- Cholesterol (risk of CVD)
- Triglycerides
- Blood glucose monitoring (prediabetes or diabetes)
- total lymphocyte count
- serum proteins
- nitrogen balance
- Serial assessment
- Offer health promotion
Measurement of body composition
Anthropometry
75% to 84% of usual body weight
Moderate malnutrition
BMI greater than 30
obese
Current weight divided by ideal weight times 100
% of ideal weight
Indicator of body fat distribution
waist-to-hip ratio
A relative measure of weight and height
BMI
