Question

1. Discuss mental health in the patient hospital setting.

2. Discuss functional abilities in the geriatric patient. Give specific example in your text.

3. Discuss Assessment in the geriatric patient in the hospital. Focus on 3 areas only.

Answer 1

1. Discuss mental health in the patient hospital setting.

Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.

Mental health needs' is a vague term usually mentioned as a justification for the development of a mental health service or program. The term might be referring to the needs for care that should be provided to people who have mental disorders.

How to Care for Patients With Mental Health Problems

1. Assess a patient's mental state.
2. Establish good communication with the patient.
3. Build a relationship with the patient.
4. Use language that shows consideration.
5. Provide sensitive patient-centered care.
6. Consult with knowledgeable mental health professionals.
7. Refer a patient to community services.

2. Discuss functional abilities in the geriatric patient. Give specific example in your text.

Functional status refers to a person's ability to perform tasks that are required for living. The geriatric assessment begins with a review of the two key divisions of functional ability: activities of daily living (ADL) and instrumental activities of daily living (IADL). ADL are self-care activities that a person performs daily (e.g., eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling bladder and bowel functions). IADL are activities that are needed to live independently (e.g., doing housework, preparing meals, taking medications properly, managing finances, using a telephone). Physicians can acquire useful functional information by simply observing older patients as they complete simple tasks, such as unbuttoning and buttoning a shirt, picking up a pen and writing a sentence, taking off and putting on shoes, and climbing up and down from an examination table. Two instruments for assessing ADL and IADL include the Katz ADL scale and the Lawton IADL scale.

3. Discuss Assessment in the geriatric patient in the hospital. Focus on 3 areas only.

The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually initiated when the physician identifies a potential problem. Specific elements of physical health that are evaluated include nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement. The geriatric assessment differs from a standard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, by incorporating a multidisciplinary team. It usually yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues. Well-validated tools and survey instruments for evaluating activities of daily living, hearing, fecal and urinary continence, balance, and cognition are an important part of the geriatric assessment. Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed. When multiple concerns are presented, the use of a “rolling” assessment over several visits should be considered.

Steps	Additional Information
1. General appearance: Affect/behaviour/anxiety Level of hygiene Body position Patient mobility Speech pattern and articulation	Alterations may reflect neurologic impairment, oral injury or impairment, improperly fitting dentures, differences in dialect or language, or potential mental illness. Unusual findings should be followed up with a focused neurological system assessment. Assess general appearance
This is not a specific step. Evaluating the skin, hair, and nails is an ongoing element of a full body assessment as you work through steps 3-9. 2. Skin, hair, and nails: Inspect for lesions, bruising, and rashes. Palpate skin for temperature, moisture, and texture. Inspect for pressure areas. Inspect skin for edema. Inspect scalp for lesions and hair and scalp for presence of lice and/or nits. Inspect nails for consistency, colour, and capillary refill.	Check for and follow up on the presence of lesions, bruising, and rashes.Variations in skin temperature, texture, and perspiration or dehydration may indicate underlying conditions. Redness of the skin at pressure areas such as heels, elbows, buttocks, and hips indicates the need to reassess patient’s need for position changes. Unilateral edema may indicate a local or peripheral cause, whereas bilateral-pitting edema usually indicates cardiac or kidney failure. Check hair for the presence of lice and/or nits (eggs), which are oval in shape and adhere to the hair shaft.
3. Head and neck: Inspect eyes for drainage. Inspect eyes for pupillary reaction to light. Inspect mouth, tongue, and teeth for moisture, colour, dentures. Inspect for facial symmetry.	Check eyes for drainage, pupil size, and reaction to light. Drainage may indicate infection, allergy, or injury. Slow pupillary reaction to light or unequal reactions bilaterally may indicate neurological impairment. Check pupillary reaction to light Dry mucous membranes indicate decreased hydration. Facial asymmetry may indicate neurological impairment or injury. Unusual findings should be followed up with a focused neurological system assessment.