Mmse In Nursing Analysis Essay
Mmse In Nursing Analysis Essay
Functions assessed re usually arithmetic, memory and orientation (Changsu Han, 2008). I assessed Mrs.
Pandeys state of cognitive impairment using the mini mental state examination. Mrs. Pandey is a young lady suffering from multiple sclerosis. At this point we assume that she has a normal cognitive state and it was proven correct by the mini mental state examination.
After my assessment I found that the MMSE was easy to perform in a way that the type of questions to address where given to me already, concentration as nowon effective communicaion with Mrs.
Pandey and developing confidence in her to answer the questions to the best of her ability. Mmse In Nursing Analysis Essay. To some individuals it is difficult to ask some of the questions , an example was the one question were i had to ask the patient to count backwards from 100 by 7. This was because the patient could find it difficult to understand what is required by the question or interprete in a different way, which can affect the accuracy in determining the patient’s state of ognitive impairment.
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Some of the questions sounded a bit silly which could possibly annoy the patient especially when they have a normal cognitive state (McMurray, A. 2005). This I thought could cause psychological depression to the patient since they might feel they could be so silly enough not to answer some of the questions correctly. The advantage in this examination could be that no answer is wrong; it is lust a way of assessing their state of cognitive assessment. Mmse In Nursing Analysis Essay.
A mini mental state examination (MMSE) also known as the Folstein political campaign is a brief 30-point questionnaire test that is used to screen for cognitive impairment in a long-suffering. Its use I commonly in medicine to screen for the presence of dementia. In this case I used it to estimate the cruelty of cognitive impairment at a given point in time and to follow the ply of cognitive changes in an individual over time. Functions assessed are usually arithmetic, memory and orientation (Changsu Han, 2008).I assessed Mrs. Pandeys state of cognitive impairment using the mini mental state examination. Mrs. Pandey is a young peeress suffering from multiple sclerosis. At this point we assume that she has a normal cognitive state and it was proved correct by the mini mental state examination. After my assessment I found that the MMSE was smooth to perform in a way that the type of questions to address where given to me already, concentration was nowon effective communicaion w ith Mrs.Mmse In Nursing Analysis Essay. Pandey and ontogenesis confidence in her to answer the questions to the best of her ability. To some individuals it is difficult to ask some of the questions , an example was the wiz question were i had to ask the patient to count backwards from 100 by 7. This was because the patient could let on it difficult to understand what is required by the question or interprete in a different way, which asshole affect the accuracy in determining the patients state of cognitive impairment.Some of the questions sounded a bit silly which could possibly annoy the patient especially when they have a normal cognitive state (McMurray, A. 2005). This I thought could cause psychological depression to the patient since they might feel they could be so silly enough not to answer some of the questions correctly. The advantage in this examination could be that no answer is wrong it is just a way of assessing their state of cognitive assessment. Communication was not much a problem.An issue cou ld be misunderstanding the aim or the purpose of the examination I did do my best I think to explain the purpose of the exam. I really did not guide to rephrase most of the questions because Mrs. Pandey is of an English speaking background indeed I just needed to joint it as it is. I do not think, though, that my question could help me draw a definite finish because people make mistake even if their cognition is normal due to anxiety and nervousness therefore it is difficult to draw an accurate conclusion (Galea, M. Woodward, M. 2005 ) (McMurray, A. 2005). In terms of the video, i was a little thwart because i was not speaking loud enough so some of the things i said could not be heard in the video. all in all i think i did a good job in communicating with the patuent, i had a profound open posture to the patient and the patient to examiner positioning was perfect in that it gave the patient a state of superiority.Mmse In Nursing Analysis Essay.
The focus of this assignment is to show an understanding of the assessment process. A brief description of the patients profile and practice setting will be outlined. The setting’s name, location and patient’s name are not disclosed for confidentiality according to the Nursing and Midwifery Council, (NMC2008) hence the name will be fictitious. The patient has consented to the use of their personal information in this assignment. A consent form has been signed by the mentor. The patient’s name will be referred to as Jane. The assignment will discuss the importance of assessment and how the contribution of patient, family, or carer and multi professionals assist the process of assessment. The Mini Mental State Examination, (MMSE) tool will be used in the assessment of a patient and the rationale for using the tool will be discussed. The outcome of the assessment will determine the patient’s needs and future care plan and will therefore be highlighted. An analysis of the efficiency of the assessment tool, its advantages and disadvantages as well as my overall view on my experience of using the tool will conclude the assignment.
Maria is an 81 years old lady who was referred by the Emergency General Hospital to an elderly acute Mental Health hospital for patients with dementia. She was in the Emergency general hospital for treatment of a chest infection following a chest drain. The referral was made after she became uncommunicative and had stopped feeding orally. Whilst she was in the General hospital she had been put on a nasogastric feeding machine and had been bed bound for four months. She was admitted on an informal basis for assessment and treatment with the hope to discharge her back home with a full package of care or into a nursing home with a continuing package of care. Jane’s past medical and non medical history confirmed that she suffered from anxiety and mild agoraphobia and has over the past few years had Cognitive Behavioral Therapy. She was reported by her son to have been forgetful over the past 3 years and had forgotten him. Mmse In Nursing Analysis Essay. She has recurrent urinary tract infections. She mobilizes by use of a hoist and needs total nursing intervention. On admission she was found to be withdrawn and uncommunicative, she was diagnosed with depression and psychomotor agitation or pseudo dementia and acute confusion due to infection.
Alongside nursing care and support, she was offered specialist expertise intervention which involved the contribution from nutritionists, Doctors, physiotherapists and other multi professionals and multi agencies.
According to Phillip Barker, (2004), page 7, “An assessment is described as the process of making a decision, based upon the collection of relevant information, using a formal set of ethical criteria that contributes to an overall estimation of a person and circumstances, while Mosby’s Medical Dictionary (2009), defines assessment as identification of needs, preferences, and abilities of a patient. Phillip Barker, (2004, p6) says that it was suggested by most psychologists that a definition relevant to psychiatric and mental health nursing should focus on estimation of character or person’s worth and what they may become.
An assessment is very important because it provides the scientific basis for a complete care plan. It is considered to be the first step towards treatment of a patient. An assessment has to be precise and accurate because it determines patient’s diagnosis and prescription of medication. An assessment involves an interview and observation of a patient by the nurse and considers the symptoms and signs of the condition, the patient’s verbal and non verbal communication, the patient’s medical and social history and any other information available. The physical aspects assessed are vital signs, skin color and condition, motor and sensory nerve function, brain function, nutrition, rest, sleep, activity, elimination, and consciousness. The social and emotional factors included in assessment are religion, occupation, attitude towards hospital and health care, mood, emotional tone, and family ties and responsibilities. Medical Dictionary, Mosby, 8th edition, (2009). Mmse In Nursing Analysis Essay.
There are two forms of assessment methods, which are informal assessment, where information is collected by less structured questions even haphazard methods and formal assessment where structure to questions is emphasized and has been planned and studied carefully through research. However different kinds of assessment tools in form of questionnaires or guidelines where designed in order to assist nurses in carrying out a formal assessment and collect information about the nature and scale of a patient’s problem. A tool is selected and used if the questions meet the individuals assessment needs.
The MMSE was first published in a Journal in 1975 as an appendix in an article written by Dr. Marshal Folstein , Dr Susan E. Folstein, and Dr.Paul R McHugh with the aim to separate individuals with cognitive functions from those without such disturbances. It was found to be highly reliable in detecting cognitive impairment and is now widely used around the world and in many clinical settings, and by General Practioners. The MMSE is a structured questionnaire that includes such categories as orientation to time and place, registration, attention, calculation, recall, language, ability to follow a three step command and visual construction. It contains standard wording and a total score of thirty points. Any score greater than or equal to 25 points (out of 30) is normal, 9 points and below indicate severity, 10-20 points indicate moderate and 21-24 points indicate mild cognitive decline.Mmse In Nursing Analysis Essay. According to Folstein, a score below twenty was found in patients with dementia, delirium, schizophrenia, or affective disorder, and not in normal elderly people. He also states that an abnormal score on the MMSE is not diagnostic of dementia or delirium but does reflect the severity of cognitive impairment. Thirty seven studies were carried out over ten years using the MMSE to show progress of patients with dementia and an average change of score was3.3 points, Tom burgh and McIntyre (1992). The MMSE has its limitations , it is found that cognitive performance as measured by the MMSE varies within population by age and education, with lower scores for oldest age groups and those with less education and it is insensitive to very mild cognitive decline particularly in highly educated individuals, Miller et al: (August 1997). The MMSE was also found to be brief and can be easily administered in ten minutes. The rationale for using this assessment tool is that it is found to be appropriate for assessing elderly people with Dementia by the practice placement. The multi professional team also found the tool reliable and considered it to meet the patient’s needs and ensured clinical effectiveness and evaluation.
In order to prepare for Jane’s assessment, her medical and non medical history was accessed through Rio. Mary received specialist care of a nutritionist for diet intake, and a physiotherapist for aiding with walking since the tendons of the back of her feet have shortened from being bed bound for four months. Weekly meetings are held by the Multi professional team in order to discuss her progress and review her care. Relatives are involved because they are considered to have an important role in planning of care and helping to evaluate the service and also in consenting for the patient if they do not have an advanced directive or capacity to consent.
Jane’s history explains why she is low in mood and tired most of the time. Therefore, it was important to be very sensitive when building a rapport with her. A professional relationship was built everyday for a period of two weeks during assisting her with personal care, by initiating conversation with her during the day, by assisting her with feeding, and getting involved in her physiotherapy sessions. A lot of empathy and encouragement was demonstrated. A therapeutic relationship built on trust and respect was developed. Mmse In Nursing Analysis Essay.
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When Jane seemed relaxed and less tired, she was asked if she would mind completing an MMSE and she consented. She was taken to a quiet room where an MMSE was administered. A quiet room was selected in order to reserve her privacy and to maintain concentration. Interview skills such as sitting squarely, maintaining eye contact, active listening and having an open posture and pleasant attitude where maintained (SOLAR). The questions were spoken clearly and softly and repeated for clarity when necessary. Jane remained calm, content and pleasant during the assessment and engaged appropriately throughout. Mary’s overall score was 13 out of 30. Jane’s results reflected poor orientation in time and place with a score of 4 out of 10, in registration test she was hesitant of repeating the three objects but mentioned all 3 very quickly, on attention she could not subtract, she became very confused. On recall she could not remember any of the three objects which is a sign of short term memory. Jane was found not to be very clear in speech but could follow instructions of folding a paper, closing eyes and so on without much confidence. Her drawing and writing was much affected by shaking; she scored 6 out of 9 points.
Jane’s MMSE result is lower than 20 so it reflects poor cognitive function, memory problems, lack of insight and understanding possibly caused by dementia, urinary infections and maybe depression. Total nursing intervention is required. Her care plan requires a holistic approach based on physical, psychological, social, and spiritual needs. Mmse In Nursing Analysis Essay.
Jane was involved in preparing her care plan. Her care plan outlines,
-Regular physical activities such as walking. Exercise is known to slow down decline in mobility associated with dementia. This will be achieved with the help of a physiotherapist.
-Imply cognitive stimulation by talking to Jane and allowing her to discuss her feelings and thoughts, and introduce recreational activities such as problem solving activities that may enhance quality of life and wellbeing.
-Reality orientation, by giving regular information about times, dates, season, places, or people to keep her oriented.
– Cognitive behavioral therapy known to treat people with depression associated with dementia. This can be achieved with the help of an Occupational Therapist.
-Reminiscence therapy by initiating discussions about her past so she can use her long term memory. This is known to be good in people with mild to moderate dementia.
-Sensory stimulation by use of music, lights, massage, sounds to stimulate the brain; this is known to improve restlessness and lift moods.
-A risk assessment with regular baseline observations to monitor self neglect and poor dietary intake and poor personal hygiene caused by poor cognitive function.
-General observations to be maintained by monitoring improvement or deterioration of mental or physical state.
-Two weekly MMSE’s to be carried out to monitor progress.
-Her son to be involved in weekly care reviews and in deciding her care.
This is important because problems such as hearing, illiteracy, late onset of depression, urinary tract infections, underactive thyroid, drugs such as sedatives and pain killers can cause memory lose and confusion so they can interfere with interpretation of the MMSE, if not properly noted. Patient UK leaflet Print, page 1, Alzheimer’s society, Mmse In Nursing Analysis Essay.
