COLLEGE OF NURSING

ABVIMS & DR. RML HOSPITAL DELHI

SUBJECT – MENTAL HEALTH NURSING
LESSON PLAN ON
MENTAL STATUS EXAMINATION
 IDENTIFICATION DATA

Name of the Presenter:- Ms. Vijay Laxmi Garg

Subject- Mental health Nursing
Topic- Mental Status Examination
Venue- B.Sc. Nursing 3RD Year class room
Language- English
Duration- 60 minutes
Previous Knowledge: Students have some knowledge regarding behavioral changes in mentally ill person.
Method of Teaching: Lecture-cum-Discussion, Case Discussion
Media of Instruction: Blackboard, Flashcards and power point presentation

GENERAL OBJECTIVE:-
At the end of the class, student will be able to enhance their knowledge about mental status examination and apply
this knowledge in their practices.

SPECIFIC OBJECTIVES:-
At the end of the teaching Students will be able to:-

 To define mental status examination

 To enlist steps or areas of mental status examination

 To describe the steps or areas of mental status examination

S.N TIME SPECIFIC CONTENTS A. V. AIDS TEACHING EVALUATION
. OBJECTIVES LEARNING
ACTIVITY
1. 5 min. To introduce INTRODUCTION:- White board Lecture cum What is mental
the mental Mental status examination is a technique for psychiatric and marker Discussion status
status nursing assessment. Power point examination?
examination. A patient, who is unconscious or stupors, should be sent presentation
for medical examination for any organic brain syndrome.
It is only if the patient is conscious, we proceed for
psychiatric assessment.
Mental status examination is used to identify the
person’s present mental status.

2. 5min. To define the DEFINITION:-

mental status Mental status examination is an assessment of White board Lecture cum Define the
examination general motor behavior, thought, emotional functioning and marker Discussion mental status
along with evaluation of insight and judgment of the Power point examination?
patient’s present status. presentation

3. 50 min To enlist and STEPS OF MENTAL STATUS EXAMINATION:-

describe the
steps of mental General Behavior and General Appearance: Enlist and
status IN GENERAL BEHAVIOR, White board Lecture cum describe the
examination 1. Level of consciousness is assessed. and marker Discussion steps of mental
Consciousness observation should be made Power point Case discussion status
whether the patient is conscious, withdrawn or presentation Demonstration examination?
stuporous.
2. General appearance,
a. The physique of the patient in term of
 ectomorphic, mesomorphic or endomorphic
built is noted.
b. Appearance also includes the way the patient
is dressed that is in terms of time, place,
occasion and also mentioning the use of
cosmetics.
c. Personal hygiene maintained adequately or
not maintained at all. General cleanliness,
sleep and eating pattern should be recorded.
d. Posture is the position taken by the patient at
the time of interview. For instance, posture
of the patient is to be observed whether it is
close or open. Gait should be watched in
terms of staging, small steps, or confident
walk.
e. In facial expression, note for closed eyes, sad
look or happy look on the face.
f. Gestures, grimaces, tics or mannerisms
should also be noted.
g. Record the activity of the patient. Is he
overactive? Or is activity reduced? Or is there
presence of stereotype activity?

Talk or Speech:

The characteristics or form of speech should be noted.

Observe for speech activity, unusual pattern and
unusual words.

Mood and Affect:

Describe the intensity of sadness, happiness, irritability,

anger, suspiciousness, fear, worry and restlessness.
Observe the consistency of mood and the influence
which changes it. Mood should be related to the topic
discussed. Shallowness, superficiality, or absences of
mood are as important indicator of abnormality as
where the patient shows euphoria or excessive
happiness.

Thought:

Assessment of thought refers to observation of the

patient’s attitude toward various people and things in
the environment. Questions may be asked as follows;
“Do you believe that you have been watched, laughed at
or spoken about? “Do you believe that attempt have
been made to kill you?” “Do you get any thought
repeatedly?”

Perception:

Assess for disorders of perception from your

observation and interaction with the patient such as any
illusion or hallucinations.

Orientation:
To assess whether the patient is oriented to time, place
or person. Record his answers with regard to his own
name and identity, the place where he is, the time of the
day and date.

Memory:

Memory of the patient is assessed by comparing the

events given by him with those of his or her relative.
Memory constitutes immediate, recent and remote.

Judgment:

Judgment is made with regard to the patient himself and

his social setting. For example, a patient may be asked
such questions. You are standing on the roadside to
cross the road, if a car comes from the opposite
direction what would you do?”

Insight:

Ask the patient questions to assess his insight into his

present state of illness that is whether he regards his
illness as physical or mental.

Attention and Concentration:

Note the patient’s attention and concentration. Is the

attention easily around? Does he concentrate? Is he
easily distracted? If he is preoccupied?
The patient may be asked to tell the day of the
week or the month in reverse order, eg. December,
November,…………… January. Subtraction of number 7
from 100. eg. 100-7=93, 93-7=86, 86-7=79, etc.

General Information:

Test the general information of the patient according to

the knowledge and place from where he/she comes.
The general questions which a patient can be asked are:
“Who is the Prime Minister of India?” “When did India
get independence?” “When do you out your rabi crop?”

Intelligence:

Intelligence should be assessed by using the patient’s

history, his performance at school, general knowledge
and general information. To be exact, the patient can be
referred to a psychologist for intelligence test.

Psychosocial Factors:

This includes stressors, coping skills, relationship,

sociocultural, spiritual and occupational adaptability.

Stressors:.

The nurse may ask the patient, “Do you feel that this
mental illness has caused a feeling of inferiority in him?
(Example of internal stress).” “Is the mental illness
causing financial burden on family? (External stress).”

Coping Skills:

The nurse may ask the patient, “How are you going to
manage the financial loss?”, “What will you do, if your
daughter/son does not get admission in the subject of
her/his choice?”

Relationship:

This includes Mother-Child Relationship, Parental

Relationship, Peer Group Relationship and Sexual-
Relationship.

Sociocultural:

The nurse may ask the patient, “Do you feel that rules of
society are strict and you feel like rebelling?” ‘Do you
feel people in your society are suffering?”

Spiritual:.

The nurse may ask the patient, “What makes you feel
comfortable during difficult situations?” “Do you pray or
go to any religious place?”

Occupational:
 The nurse may ask the patient, “What are you working
as?” “What type of job you are doing?” “Are you
satisfied with the jog you do?”

MENTAL STATUS EXAMINATION PERFORMA

M.S. Examine by Mr./Ms. : Vijay laxmi garg

Date of M.S.E. : 07/02/2017
Place of M.S.E. : De-addiction Ward
Time of M.S.E. : 11 am to 11:30 am

Patient’s Profile

I. Identification data
Client name : Mr. Prahlad
Age : 40 Years
Sex : Male
Father / Spouse name : Mr. Lallu Ram
Address : 5 No V K I,O, Jaipur
Education : No formal education
Occupation : Agriculture
Income : Rs. 2000/ month.
Marital status : Married
 Religion : Hindu
Date of admission : 25/01/2017
Provisional diagnosis : Alcohol dependence
ii. Mental status examination

(a) General appearance and behavior

 Appearance : Looking one’s age
 Level of grooming : No Grooming
 Level of cleanliness : Unhygienic
 Level of consciousness : Conscious
 Mode of entry : Persuaded by son
 Cooperativeness : Cooperative
 Eye-to-eye contact : Maintained
 Psychomotor activity : Decreased activity, tremors
 Rapport : Not maintained properly
 Gesturing : Exaggerated
 Posturing : Normal posture
 Other movements : Retarded
 Other catatonic phenomena : Not present
 Conversion and dissociative signs : Not present
  Compulsive acts or rituals : Not present
 Hallucinatory behavior : Auditory hallucination
(b) Speech
Student Nurse : Aapka nam kya hai?
Client : Prahlad
 Initiation : Patient responded when Pressure him
 Reaction time : Slow
 Rate : Slow
 Productivity : Pressured speech
 Volume : Decreased
 Tone : Normal variation
 Relevance : Some time off target
 Stream : Normal
 Coherence : Loosening of associations
 Others : No rhyming, punning, echolalia perseveration or neologism.
(c) Mood
 Subjective
Student nurse : Aapka man kaisa hai?
Patient : Mera man dukhi hai,mujhe pina hai.
 Objective : Irritable mood.
(d) Thought
Student Nurse : Aapke dimag me kya vichar aate hai?
Client : Mujhe daru pini hai .
 Stream :Rumination of thought.
 Form : No thought disorder is present
 Content
Student nurse : Aap aapke liye kya sochte ho?
Client : Mujhe lagata hai me sharab ke bina jinda nahi rah sakta hu
Remarks : No delusional thinking
(e) Perception
 Hallucinations
Student Nurse : Kya aapko koi aawaje sunae ya koi dikhae deta hai kya?
Client : Ha jab me sharab nahi pita hu to mujhe ek aadami ki aawaj sunae deti hai jo mujhe sharab pine ke liye
kahti hai.
Remarks : Auditory hallucinations present
(f) Cognitive Functions
 Consciousness
Student Nurse : Ram Gopal kon hai
Client : Me hu
Remarks : Patient has obeyed by calling his name
 Orientation
i. Person
Student Nurse :Aapke pas kon baitha hai?
Client : Mera baita
Remarks : Oriented to person
ii. Place
Student Nurse : Aap abhi kaha hai?
Client : Aspatal me
Remarks : Oriented to place
iii. Time
Student Nurse : Aaj konsa war hai?
Client : Mangalwar
Remarks : Oriented to time
 Attention
Student Nurse : 2, 4, 6, 8, 10 ko ulta boliye.
Client : 10, 8…4..6..2.
Remarks : Attention aroused with difficulty
 Concentration
Student Nurse : Mahine ke naam ulte boliye?
Client : December, November…September, October, June, July …August, March ….January.
 Remarks : Concentration sustained with difficulty
 Memory
i. Immediate
Student Nurse : Pankha, Gulab, Maize, Train, Paid ko wapas boliye .
Client : Mujhe yaad nahi
Remarks : Immediate memory impaired.
ii. Recent
Student Nurse : Aapne naste me kya khaya tha?
Client : Poha
Remarks : Recent memory intact
iii. Remote
Student Nurse : Aapka janam din kab aata hai?
Client : Mujhe nahi pata
Remarks : Remote memory impaired
 Intelligence
Student Nurse :Aapke gram ke sarpanch ka kya naam hai?
Client :Kalu Ram Gurjar
Remarks : Normal intelligence
Abstraction
Student Nurse :Gulap or kamal me kya samanta hai?
 Client : Dono phool hai.
Student Nurse :Car or bus me kya anter hai?
Client :Car me 4-5 sawari hi baith sakti hai or bus me 50-60.
Student Nurse :Aap ghar ja kar kya karenge
Client :Kheti karunga.
 Remarks : Abstract thinking present
(g) Insight: (grade1 to 6)
Student Nurse :Kya aapko lagata hai ke aap Bimar hai or aapko dawaeyo ki jarurat hai?
Client : Nahi, Me bimar nahi hu.
Remarks : Grade 1 Insight is present
(h) Judgment:
Student Nurse :Aap kya karenge yadi aapko koi bacha road par milega jo ki bahut bimar hai.
Client : Me kuch nahi karunga.
Remarks : Judgment impaired.

SUMMARY/CONCLUSION:-
 Mental status examination is a technique for psychiatric nursing assessment .The aspect include in this examination are general
behavior and appearance, speech or talk, mood or affect, thought, perceptual changes, orientation, memory, judgment, insight, attention and
concentration, and general information.

ASSIGNMENT:-

Write an assignment on steps of Mental Status Examination?

EVALUATION:-

One case should be taken for MSE after 5 Days.

BIBLIOGRAPHY:-

1. Kapoor, Bimla. Textbook of psychiatric nursing. Kumar publishing House (1992).

2. Townsend, Mary C. Concepts of care in evidence-based practice (Seventh Edition) F.A. Davis Company, Philadelphia(2012).
3. Keys J. and Hoffling C.K. Basic Psychiatric Concept in Nursing (Fourth Edition) J.B. Lippincott Company (1980).
4. Taylor C.M. Essential of psychiatric nursing (Eleventh Edition) The C.V. Mosby Company, London (1982).
5. www.google.co.in