Posts Tagged ‘Forensic Nursing Mental Health Assessment’

Alzheimer’s disease

February 7, 2012

Patients diagnosed with Alzheimer’s disease usually experience symptoms in their mid to late 60s. These symptoms usually include memory loss and confusion, developing to severe dementia. Because of their confusion, Alzheimer’s patients in nursing homes sometimes wander from their rooms or beds and fall and injure themselves, accidents that can sometimes be fatal.
Forensic nursing may be required in such situations. Nursing homes are accountable for the accidents that occur in their facilities. The extent of the Alzheimer’s disease in the patient sometimes needs to be determined for legal reasons. This is accomplished by examining the brain and the presence of neuritic plaques and neurofibrillary tangles. (Lehne, Richard A. Pharmacology for Nursing Care, 6th ed.)

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Mental Health Assessment in Forensic Nursing

March 3, 2011

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 Does the client appear anxious, withdrawn, or does the client’s mood appear appropriate to the situation?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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Excited Delirium Syndrome

November 19, 2008

Excited Delirium Syndrome is a cause of sudden death on an individual who is confused, irrational, delusional and violent. They may present high risk in this manner: a. A prior episode of excited delirium b. Violent and aggressive behavior c. Use of medication that increases the release or blocks reuptake of norepinephrine d. Cardiac disease e. Asthma or any pulmonary disease involving restriction of airway f. Epilepsy g. Use of stimulants such as cocaine and methamphetamine Age is not a factor. Behavior characteristics are: a. Verbal threats of violence b. Screaming, swearing, shouting at others c. Breaking or throwing objects d. Motor agitation, rigid/taut body expressions with poor concentration e. Projecting angry emotions onto another (e.g. blaming) f. Nonverbal behavior of rejecting others g. Pacing, restlessness, inability to sleep or eat, hyperactivity, history of violent behavior with need for physical restraint h. Delusions and confusion of mental state i. Defiance j. Bullying others k. Using stimulants (e.g. cocaine, methamphetamine) l. Paranoid behavior with auditory hallucinations. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Secondary trauma

November 18, 2008

Interpreters and therapist who may be affected by continued interactions with human right atrocities may be in need of counseling themselves in order to continue their work with torture victims. Since there are only about 200 such centers around the world that provide this service, in light that there so few people who are trained to do this work? Who helps those who help the victims?

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Risk Assessment In Forensic Nursing

October 9, 2008

Forensic nurses work with mental ill patients, many with a criminal background. As nurses work with patients who have a high probability of displaying violent behavior, the need for a risk assessment increases. Risk assessment is the process of assessing the individual patient against his or her specific risk factors as well as against other general risk factors, such as substance abuse. The Royal College of Nursing (1998) suggests that the aims of risk assessment are to: identify the hazards, identify who is at risk, evaluate the risks, make a record of the findings, and review and revise the assessment. A thorough mental health and mental status assessment is also key. As a nurse we need to be aware of the many factors that influence mental health, which can aid in our risk assessment skills. Individuals have different stress management abilities, spiritual and belief systems, genetic factors and interpersonal relationships. Assessment and management of risk are necessary in mental health nursing; they protect the welfare of consumers of mental health services and the community, and also play a role in protecting nurses against potential litigation. – Health Assessment for Nursing Practice, 3rd edition, Wilson-Giddens -Violence


Postpartum Depression, comment

April 29, 2008

I agree that a postpartum psychiatric evaluation is an important part of the postpartum patient assessment. Nurses should be looking for signs in the patient of potential problems of postpartum depression as opposed to postpartum blues. As a nurse that works on L & D and postpartum, I watch for things such as: 1) inability of mother to bond with infant or not wanting to hold infant after delivery, 2) Name calling of infant, 3) Just not showing interest in feeding or holding infant. I have witnessed all of these events in my department. Mothers who have a history of postpartum depression with prior deliveries should definitely be referred for a psychiatric evaluation and perhaps follow up visits after discharge, if necessary. Although postpartum depression is a real problem for some women, it is not excuse for child abuse or murder. It can be treated. As health care providers, we need to step in and refer these women by doing a thorough assessment and involve psychiatrics and/or social services in their care.

Original Post:
February 7, 2007
In response to the article “Postpartum Depression” from 9-16-06, I feel that after delivering the baby, a new mother must have a psych assessment done before going home with her baby and maybe they should have a home health nurse or some sort of social worker check in with the new mother at 1-2 weeks postpartum. I feel that these mothers such as Andrea Yates, sometimes claim postpartum depression as a cover up for something they definitely know they did wrong. I do agree that some mothers may have some depression after giving birth because of the hormone levels changing, but I do not believe they don’t know what they are doing at the time, such as murdering their children or drowning them. They sure know enough to be able to tell the police “I was crazy at the time and depressed.” So then they go for the “not guilty by reason of insanity” plea. I believe most of it is to get attention. Most of them also have no remorse.

Original Post:
September 16, 2006
What is postpartum depression? According to American Association for Marriage and Family Therapy (2002), “Postpartum depression is a biological illness caused by changes in brain chemistry that can occur following childbirth. During pregnancy, hormonal levels increase considerably, particularly progesterone and estrogen, and fall rapidly within hours to days after childbirth. Also, the amount of endorphins, the feel-good hormones that are produced by the placenta during pregnancy, drop significantly after delivery. Even the thyroid gland can be affected by the enormous hormonal changes that are associated with pregnancy and childbirth, leaving women more at risk for depression.” Additionally, AAMFT (2002) states, that “for 10 to 15% of those women, the period following childbirth becomes a nightmare as they experience sleeplessness, confusion, memory loss, and anxiety during the already stressful adjustment to motherhood.”
American Association for Family and Marriage

What comes to mind is the Andrea Yates case in which she murdered her children. A very notable forensic case that has been in the headline in the past but has recently come to light again as the Andrea Yates murder trial begins. In which she has claimed postpartum depression as the major reason she murdered her children. World Wide Web CNN- July 12, 2006, “Yates, 42, is being retried because her 2002 conviction was overturned by an appeals court that ruled erroneous testimony might have influenced the jury. She has again pleaded innocent by reason of insanity. Her attorneys say she suffered from severe postpartum psychosis and did not know that killing the children was wrong.” ( this is a fascinating case, in the aspect that Yates had been in and out of psychiatric facilities for mental illness and depression prior to the murder of her children, so why did the psychiatrist not see this coming?

Today, with the many publicized murder trials of women who have murdered their children supposedly due to postpartum depression as the potential root cause, have encourage healthcare providers, nurses, and even new mom’s to look for the possible signs of this mental health condition. As a nurse, it is part of our nursing assessment skills in looking for potential signs that might indicate a new mom might need further assessment to rule out postpartum depression.

A great example was the other day a new mom of 4 months called the physicians office asking if there was a blood test to test if one might have postpartum depression. The woman claimed that she has noticed recently that she was having a few “sad days” and did not think she needed psychoanalysis but just wanted a blood test to check her hormone levels. When consulting with her physician, he stated that there is no specific blood test to find out if someone’s hormone levels are abnormal that would indicate postpartum depression and the only way to determine if the patient was truly having postpartum depression was an in-person evaluation, which a series of questions and lab work might be obtained. When the patient was advised of the physicians response to her questions, she agreed to a next day appointment but not before the nurse assessed if she was in any danger of hurting herself or anyone else.


Psychiatric Mental Health Nursing Assessment and the Electronic Medical Record

October 25, 2007

I am in agreement that the electronic medical record is not always ideal for charting a patient assessment. It takes thought to actually write down notes whereas sometimes in computer documentation you can get away with pointing and clicking. There is not always the correct symptom or description to fit what you are wanting to say. Today I assisted with a patient on my unit (in for a dislocated hip) but was apparently withdrawing from something. There was nothing in the computer to describe what this patient was exhibiting. She was screaming that someone was murdering her family, the next minute she was in church having revival. I am interested in looking tomorrow at what the nurse charted. We are also on electronic documentation. I think it is worse for nursing. The doctors at least have to write a progress note. The physical therapy notes include a lot of annotations. Computerized charting may be quicker, but I am not convinced it gives an accurate picture.


Post Partum Depression comments from 9/16/06

October 1, 2007

One of my nursing school classmates recently suffered a severe case of post partum depression after her delivery 6 months ago. Her depression was so severe she considered filing for divorce, quitting nursing school, and leaving a good job. Her Ob/Gyn’s Nurse Practitioner suggested a psych consultation and complete hormone evaluation. Lo and behold, her hormone levels were anything but normal. With professional medical intervention and psychological therapy, she is doing well. Thank God she had a great nurse who was truly a patient advocate and with her problem solving/forensic skills training, knew what to look for in post partum depression. Unfortunately, many new mothers don’t get the proper help they need.


The Amish Country Killing, comment

September 4, 2007

Wow, what a story. I do not agree with that sentence at all. Just because you are Amish does not mean you are above the law. The Amish believe in no violence so this Amish man must have extremely mentally unstable and probably should have never been let out. Then to have no regard for doing it in front of your children, he obviously has no regard or respect for human life.

The forensic nursing assessment would be to put the pieces together of what occurred. To keep your own judgments at bay. You must be aware of the culture. The children would be the living victims. They would need continued follow up after witnessing such a traumatic event. The approach to these children would need to be extremely gentle. A full psychological and mental evaluation would need to be done. The follow up would be long term for them. Forensic nurses would have to build a rapport with the children and have a lot of patience with them in order to do the assessments. Their emotional and mental health would be at stake. The children would probably be reliving this every day for the rest of their lives. One would have to decide at what point do you stop and try to move past it.

When this guy is released from prison, probably mandatory follow up should for him. He should not be let out without him checking in with a mental health facility on a regular basis for continued psychological and mental assessment.


Drug and alcohol detox

September 3, 2007

I consider myself very fortunate to be in an occupation where I am able to learn and experience a seemingly endless amount of medical specialties while still being a nurse.

The most recent “new specialty” for me is drug and alcohol detox. Working in a jail presents a great opportunity to learn this, as one might imagine. Especially a jail located in the middle of “sin city.” I did not realize how vulnerable a patient could be when a patient’s constant consumption of alcohol was abruptly ended. The vomiting, diarrhea, chills, and overall feelings of malaise and sickness are symptoms that are very hard to watch another human go through. I have learned the importance of keeping these individuals on medications like Librium that keep the CNS depressed. It made so much sense to me when the doctors on staff explained to the new nurses the importance of allowing the patients time to adjust accelerated levels of function that non-alcoholics are normally accustomed. With the reading material, and verbal instruction that my employer has provided my assessment skills and understanding of this disease process has greatly improved. I now am able to assess acutely detoxing patients of tachycardia, and tremors that require immediate intervention due to the possibility of inadequate medications.

I am still probably a little more ignorant of drug detoxification. Our facility does not currently treat patients who are merely drug addicts. The only protocols for them are assessment of vital signs and/or neuro checks, rarely with any medications prescribed. My understanding of why this is; those detoxing from drugs are less likely to die. I would like to see my facility designate housing specifically for both alcohol and drug detoxing. So, nursing staff most familiar with this process can be assigned to monitory for signs of patients becoming unstable.

I myself will continue to ask questions about this subject when at work. I find it a very intriguing subject in nursing, and would suggest the same to any nurse to understand it better. Because it dose not matter if you are an ER nurse managing the care of a teenager that has overdosed, or a psych nurse taking care of a drug induced schizophrenic, drugs and alcohol affect all of us in the medical field.


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