Forensic Nursing Chronicles

Chapter 7 of Health Assessment for Nursing Practice discusses mental health and mental status assessment. This chapter correlates with Forensic Nursing in that the Forensic Nurse’s assessment needs to indicate the mental status of the client he/she is subjectively and objectively assessing.

The Forensic Nurse determines the client’s mental status by examining the client’s behavior, appearance, risk factors, interpersonal relationships and cognitive function. Vital signs are indicated as well in order to ascertain whether medical treatment is required. Past medical history, family history, drug and alcohol abuse, and medications that the client is using is also added.

The nurse assesses the client’s behavior and cognitive function in order to ascertain the client’s mental status. Is the client alert and oriented to person, place and time? Does the client appear anxious, withdrawn, or does the client’s mood appear appropriate to the situation? Is the client’s emotional state appropriate to the situation? Is the client displaying signs of paranoia, delusions of grandeur, obsessive compulsive actions, or bipolar episodes?

Is the client appropriately dressed for the weather? What is the client wearing? Is the client wearing outlandish dress and makeup or does the client display a lack of hygiene. Assess the posture of the client – Is the patient slumped in a chair and looking to the ground or is the client sitting upright and smiling? Is the client fidgeting or pacing the room? Does the client’s tone of voice indicate anxiety, anger, or is the client rambling with inappropriate sentences?

Risk factors involved include the client’s age, gender, family history, psychosocial environment and personal characteristics. Has the client had a past history of trauma, sexual or physical abuse, or alcoholism? Does the client display evidence of low self esteem?

Interpersonal relationships are indicated to establish the client’s social surroundings. Is the client in an abusive relationship? Does the client have family and friends that are supportive and that the client is able to discuss with them his/her feelings and problems? Does the client have a social phobia which inhibits him/her to avoid social situations?

Elevated blood pressure and pulse may indicate severe anxiety or panic. Assess respirations for dyspnea, tachypnea, or labored breathing. Decreased respirations may indicate depression with evidence of frequent, deep sighs.

Mental Status assessment is one of many observations that the Forensic Nurse incorporates in her nursing assessment. It can give valuable evidence of victim abuse, sexual assault and mental trauma.

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