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Introduction You are working on a busy Emergency Department (ED) as a newly registered nurse. A young woman in her early adulthood presents at 0800 hours in the company of an older woman. The young woman is dressed in dirty jeans and a T-shirt and is barefoot. Her hair is dyed blue and pink but is unkempt and matted. She has a number of piercings in her nose, eyebrow and lip. She is very tense and paces up and down the ED corridor wringing her hands from time to time. She responds instantly to any sounds or movements in the ED that alert her attention and her eyes stare intensely either into the ceiling above or at staff members. Her gaze and manner alternates between being intrigued to afraid to hostile. She seems unable to sit still for any time at all and ignores the older woman’

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Issues to consider to enable one undertake Mental State exam         

During a mental situation assessment, behavior and the general appearance are evaluated together. These aspects get checked together and recording is relevant in each stage of the examination stages for purposes of comparison as time changes. The conduct and appearance both portray the actual mental situation of an individual. A patient’s behavior assessment involve his or her appearance to the professional and the nurse and his or her physical appearance is very significant in the assessment (Molitor and Dvorsky, 2018, p.1-14). When one is scared, aggressive or rude, the situation requires maximum attention. Another determinant in this case is the tone of voice an individual uses. The physiological aspects like pupil activity, signs such as blood pressure, heart rate, and sweating are also significant in this assessment since they reveal the level of anxiousness. If the size of pupils is smaller as compared to the normal state, the nurse needs to discover this since behaviors and appearance which are uncommon may be as a result of use of drugs such as opioids. The drugs may make the pupils’ size to appear as very small. Psychomotor exercises such as wringing hands, changes to the normal gait, and pacing are also assessed since they may be useful in showing numerous issues (Noftle, Gust and Fleeson, 2017, p.1066-1066). Kee

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