NURS 360

Capstone Project Template

PMH Care Plan
SN: ___Todd Shumway____________ Date: _______________
Pt.: Sex: _F _Age: ___47 y o___

Date of Admission: _______12/04/15___

Transferred? ___No _X_Yes: (Reason/Date)_From Hawaii State Hospital on an acquit

and commit of second degree assault__
Income source: The State/ Food State/ Unemployed
Legal Status: ___704-411 (1)(d)____________Expiration Date: __01/13/16____
DSM Diagnosis:
I F29 Psychotic Disorder, Not otherwise specified.
F15.10 Amphetamine Abuse, in Early Remission
F25.9 Rule Schizoaffective disorder
F32.3 Rule out MDD with psychotic features
F19.959 Rule Out Drug Induced Depression
_________________________________________________________________
II Deferred
__________________________________________________________________
III HTN, Obesity, Chronic Degenerative Disk Disease, Chronic Back Pain
_____________________________________________________________________
IV Psychosocial and Environmental Problems, Legal Problems
______________________________________________________________________
V GAF admission 48
______________________________________________________________________
What brought patient to the hospital?
Sent from Hawaii State Hospital. Was arrested March 15 for second degree assault on
husband when attempting to cut off his hand. Patient spent 8 months in OCCC.

Patients description of illness/issues:

-Hearing voices/ command hallucinations/ auditory hallucinations
-Attempted to overdose due to severe depression
-Amphetamine use/abuse
-Depression and amphetamines make voices worse

Spirituality:
Christianity, believes in GOD and a Higher Power
Considerations r/t ethnicity or religion:
Patient is Hawaiian, and practices as a Christian and believes in GOD
Patients Strengths:
1. Coping strategies aeb talking to staff when she has a problem, walks away from situations, and
exercises when she is stressed.
2. Goal oriented aeb wanting to spend more time with family, staying off drugs, and being more
medication compliant.
3. Friendly and cooperative with staff, patients, and group activities.

Patients Limitations:
1. Poor control over substance abuse aeb only reason she is off drugs is because she has been
locked up for so long, over 20 years of amphetamine use, using marijuana since age 12 and
alcohol since age 15.
2. Poor Medication Compliance aeb frequent hospitalizations.
3. Poor family dynamic with daughters and son aeb not having had contact with them since her
incarceration.
4. Violent auditory command hallucinations aeb attempting to cut off husbands hand due to voices
command, increase in voices when not on medication, and most frequently at night.

Medications:
Order: Ziprasidone HCL ,1 dose, 40 mg, 1 cap, BID with meals (Geodon)
Drug class: Antipsychotic/neuroleptic
Pts target sx: Decreased signs/symtoms of psychosis: Used for schizophrenia, acute
agitation, acute psychosis, bipolar disorder, mania, psychotic depression
Total 24h dose: 80 mg
Recommended range: PO 20 mg BID with food
L M H Max
Current Side effects: Seizures, Neuroleptic Malignant Syndrome, Tachycardia,
Sedation

Order: Loratidine, 10 mg tabs, one dose, 1 tab, Every Day (Claritin)

Drug class: Antihistamine
Pts target sx: Decreased nasal stuffiness, itching, swollen eyes
Total 24h dose: 10mg/day
Recommended range: 10 mg/day
L M H Max
Current Side effects: Sedation, H/A, Fatigue, Restlessness
Order: Hydrochlorothiazide 25 mg tabs, one dose, 25 mg, 1 tab, Every Morning Hold if
sys <100, dib <60, HR <60
Drug class: Diuretic, Antihypertensive
Pts target sx: Decreased B/P, decreased edema in lung tissues peripherally
Total 24h dose: 25 mg
Recommended range: 12.5-25 mg/day
L M H Max
Current Side effects: Hypokalemia, Drowsiness, Dizziness, Fatigue, Polyuria
Order: Lisinopril, 20 mg tab, one dose, 20 mg, 1 tab, every morning, Hold if sys <100,
dib <60, HR <60
Drug class: Antihypertensice, ACE Inhibitor
Pts target sx: Decreased B/P in HTN
Total 24h dose: 20 mg
Recommended range: 10-40 mg/day
L M H Max
Current Side effects: Vertigo, H/A, Cough, Angioedema
Order: Metamucil S-F Org pwd packet 3.4 gm packe one dose BID
Drug class: Bulk-forming fiber laxative
Pts target sx: Relief of constipation
Total 24h dose: 6.8 g/day
Recommended range: 25 g/day
L M H Max
Current Side effects: Diarrhea
Order: Hydroxyzine pamoate 25 mg caps, One dose, 25 mg, TID
Drug class: Anti-anxiety, Sedative, Hypnotic, Antihistamine,
Antiemetic
Pts target sx: Absence of anxiety
Total 24h dose: 75 mg/day
Recommended range: PO 25-100 mg/day TID- QID
L M H Max
Current Side effects: Dizziness, drowsiness, confusion, seizures, hypotension, dry
mouth, nausea, diarrhea, weight gain
Order: Baclofen 20 mg tab, One dose, 20 mg, 4 times daily
3

Drug class: Skeletal Muscle Relaxant

Pts target sx: Decreased Spasticity of Muscles, Spasticity in spinal cord injury
Total 24h dose: 80 mg/day
Recommended range: Max 80 mg/day
L M H Max
Current Side effects: Dizziness, weakness, fatigues, drowsiness, seizures, CNS
depression, Nausea,
Order: Carbamide Peroxide 6-5%, two gtts in right auditory canal, BID X5 days
Drug class: Anti-infectives
Pts target sx: Cerumen Removal
Total 24h dose: Four drops per ear per day
Recommended range: 5-10 drops per day
L M H Max
Current Side effects: Rash, hives, itching, difficulty breathing, tightness in chest
Order: Diphenhydramine 25 mg caps, one dose, 1 cap, PRN every 6 hours
Drug class: Antihistamine
Pts target sx: Uticaria, antiparkinsonism
Total 24h dose: 100 mg/day
Recommended range: Max 100 mg/day
L M H Max
Current Side effects: Sedation, sleepiness, dizziness, disturbed coordination
AXIS III: List all conditions even if they are not listed in multi-axial diagnoses or
on chart. (Particularly note any unstable conditions & all non-medication
interventions.)
1. Hypertension
2. Obesity
3. Chronic Degenerative Disk Disease
4. Chronic Back Pain
BMI: 36.4

: Category: Obesity

(Height: 54

Weight: 212lb

Food & fluid intake: Regular

Bladder & bowel status: Regular
Sleep pattern: Patient reported sleeping early around 2100 and waking up around
0300 in the morning.

Total sleep/24 hrs: 6 hours

(Circle) Hypersomnia/Difficulty falling asleep/Middle insomnia/Early morning

awakening

Number of hrs of disruption: 1 hour

Naps: Yes
When: In the afternoon
Total nap time: 30-45 minutes

Lab & studies

11/11/15
Cholesterol
Tiglycerides
HDL
LDL

CBC w/Diff and

Platelets
WBC
RBC
Hemoglobin
Hematocrit
MCV
MCH
MCHC
Neutrophils
Lm.
Granulocytes
Lymphocytes
Monocytes
Eosinophils
Basophils
Platelets
RDW
Absolute
Neutrophils
Absolute
Immature
Granulocytes
CMP
Glucose
BUN
Creatinine
GFR non-af

Range

Value

Analysis

mg/dl
mg/dl
mg/dl
mg/dl

100-200
0-149
39-150
0-99

223
181
53
134

Patient is
diagnosed with
Obesity which
relates to her
high levels of
cholesterol,
triglycerides, and
LDL.

x10E3/u
L
x10E3/u
L
g/dl
%
fL
pg
g/dl
%
%

4.0-10.5

7.70

4.10-5.60

4.99

12.5-17.0
36.0-50.0
80-98
27.0-34.0
32.0-36.0
40-74
14-46

13.2
40.1
80.4
26.5
32.9
50.0
0.3

%
%
%
%
x10E3/u
L
%
x10E3/u
L
x10E3/u
L

14-46
4-13
0-7
0-3
140-415

24.2
9.6
15.6
0.3
284

11.7-15.0
1.8-7.8

14.3
3.86

0.7-4.5

0.02

mg/dl
mg/dl
mg/dl

65-115
8-25
0.8-1.4

102
18
1.0
59

GFR Afr Am
HemoA1C
NA
K
Ch
Co2
Ca
SGOT (AST)
SGPT (ALT)
Alk. Ph
Bili Total
Total Protein
Alb.
Glob
Albumin/Glob

%
mEq/L
mEq/L
mEq/L
mEq/L
mg/dl
U/L
U/L
U/L
mg/dl
g/dl
g/dl
g/dl

135-145
3.5-5.0
97-110
6-28
8.5-10.5
5-35
17-56
30-132
0.1-1.3
6.0-8.4
2.9-5.0
2.0-3.8
0.9-2.5

>60
5.7%
139
4.5
101
26
9.6
27
32
86
0.2
7.0
4.1
2.9
1.4

Date/Panels in which all values were normal: See Above Chart

Date/Any abnormal labs: See Above Chart
Labs you would expect but were not ordered: Drug Screening and LFTs for
alcohol and substance abuse history
Glucose readings x 24h for all diabetic pts.: N/A
All drug screen findings: No Lab Findings

MENTAL STATUS ASSESSMENT:

Appearance: Patients appearance good aeb hair neat, good hygiene, and appropriate
clothing.
Behavior and Attitude: Patient was cooperative and friendly aeb participating in group
activities, sharing and talking during therapy, and following directions and rules of the
milieu.
Speech: Patients speech was of normal volume and rate throughout conversation.
Affect: Patient had a full range affect aeb various and appropriate ranges of emotion
during conversation. Patient expressed sadness and depression during her suicidal
attempt, happiness and joy when spending time with her nephew, and guilt about not
spending enough time with her children.
Mood: Patients mood was euthymic
Thought Process: Patients thought process was congruent and linear aeb her
consistent responses.

Thought Content: Patient denied no current auditory/visual hallucinations but did

report a hx of auditory command hallucinations when not on medications and
occasionally in the middle of the night.
Cognitive Exam: Patient alert and oriented X 3, attentive and concentrated to group
activities, therapy sessions, and during conversations.
Insight: Patient showed fair insight into her condition aeb knowledge of illness, reason
for hospitalization, and treatments. Patient reported difficulty in maintaining medication
compliant when not in the hospital. Patient could identify psychosocial stressors.
Judgment: Patients judgment was good aeb being able to seek help if needed and
ability to understand components of treatment.
Drugs: Substance abuse or dependence: (Include nicotine & any alcohol &
drugs. List by drug: Last date of use/Current acute intoxication or withdrawal
signs and symptoms when SN caring for pt./Used how long/Route/Usual
amount/Negative consequences)

Drug class

Last
Use

Nicotine

02/15

Alcohol

2014

Meth
Amphetamine
s

02/15

Marijuana

02/15

Acute intox
or
withdrawal
sx?
Irritability,
Anger,
confusion,
Depressed
Headache,
Nausea,
Vomiting

Depressed,
Insomnia,
sweating,
Nausea,
Vomiting
Headache

Length of
Time Used

Route

Usual
amt.

Negative
Consequences

Since age
12

Inhaled

Half
pack a
day

Wasted a lot of
money

Since age
15

Oral

Wasted a lot of
money, memory
problems, drank to
pass the day

Over 20
years.
Consistently
since 1997

Inhaled

Till
Blackout:
Patient
reported
using
hard
Patient
reported
till I feel
high

Since age
12

Inhaled

Patient
reported
till I feel
high

Wasted a lot of
money, family
neglect, avoided
feelings,
depression
Wasted a lot of
money

Problems Identified In Hospitals Master Treatment Plan:

1. Safety: Elopement
2. Psychiatric: Thought/ Perceptual disturbance Psychosis)/ Co-occuring substance
abuse dependence
3. Medical: HTN, Obesity, Pain, Osteoarthritis and Back Pain, and Rheumatic Chorea
4. Psycho-social stressors
5. Nutritional: Obesitity
Current Discharge Plan:
Estimated Length of Stay: 3-4 months
Nursing interventions you performed this shift (Include safety and teaching!):
1.
2.
3.
4.

Stress Management (See Attachments)

TM33 (See Attachments)
TM48 (See Attachments)
Burns Depression Checklist (See Attachments)

Patient-centered Care Analysis

PRIORITIZED PATIENT NEEDS
What are the patients 3 highest needs/problems?
(Use your best nursing judgment! It will be different than the master treatment
plan.) P=Problem, E= Evidence, S= Solution.
1. P: Risk for violence directed at self or at others
E: Hx of intentional medication overdose and attempting to cut off
husbands hand d/t auditory command hallucinations
S: Maintain medication compliance, less stimulating environment
(living with 2 sisters and husband at home with 2 nephews), and attend
group therapy.
2. P: Ineffective Coping
E: Patient has over 20 years of methamphetamine use. Patient has
demonstrated poor medication compliance aeb frequent hospitalizations and
increased auditory command hallucinations leading to her reason of
admission of attempting to cut off husbands hand. Patient has verbalized
auditory hallucinations of running away. Patient has a history of intentional
overdose due to sever depression.
S: Patient can learn various coping techniques through group therapies
and activities to learn about being substance free and to manage severe
8

depression and schizoaffective symptoms. Patient can demonstrate

medication compliance through medication education and day treatment
programs.
3. P: Ineffective Health Maintenance
E: Patient has a history of medication noncompliance that lead to
frequent hospitalizations. Patient shows limited knowledge into medication
regimen. Patient shows little insight into current health conditions and little
interest into managing her conditions. Patient has poor support system in
helping her manage her health conditions.
S: Educate patient about current medication regimen, heath
conditions, and techniques to improve her health. Offer group therapies and
exercise programs to help patient express thoughts and feelings and to
participate in her care

Priority # _1__
CARE PLAN
Nursing Diagnosis: Risk for violence directed at self or at others related to lack of impulse control, auditory command
hallucinations, and excalating anxiety aeb Hx of intentional overdose and attempt to cut off husbands hand d/t auditory
command hallucinations.
Create 3 plans of care one for each of your priorities identified.
P: Risk for violence directed at self or at others
E: Hx of intentional medication overdose and attempting to cut off husbands hand d/t auditory command hallucinations
S: Maintain medication compliance, less stimulating environment (living with 2 sisters and husband at home with 2 nephews),
and attend group therapy.
BehavioralTherapy

Focusontheconsequencesofdysfunctionalbehaviorsandwaystochangethem.

Teachsocialskills,activitiesofdailyliving,andcommunicationskills.

Useatokeneconomytoreinforcedesiredbehaviorsbyrewardingthemwithspecialprivileges.

GroupTherapy

Focusondailylivingskills.

Teachwaystomanageenvironmentalandinterpersonalstressors.

Helptheclientdevelopapositivesenseofself

Providetheexperienceofsupportiveanddirectiveinteractionswithothers.Theclientcanlearntolisten,askquestions,andgiveappropriatefeedback.

Provideaplacetoexpressfeelingsandtotalkaboutorresolveproblems.

Presentopportunitiestogiveandreceivesupport.

FamilyTherapy

Focusonpromotinganunderstandingofthestructureandfunctioningofthefamilysystem.

Assistthefamilytobesupportiveandcaringoftheclientwithoutbeingoverprotective.

Encouragehonestexpressionoffeelings.

Promoteeffectivewaystohandlenegativefeelingsandfamilyconflicts,andcorrectunsuitablecommunicationanddistortionsofnegativeevents.

Increaseabilitytocopewithchronicmentalillness.

Clarifyboundariesandtherolesoffamilymembers.

Discusstheneedforinvolvementinopportunitiesforsocialnetworking.

Outpatient Therapy/Day Treatment Program

Focusonlongtermsymptommanagement.

Promotemedicationmanagement.

Provideforindividualtherapy,grouptherapy,andstructuredactivitiesorvocationaltrainingasneededbytheclient.

Providecontinuingsocial,occupational,andcommunicationskilldevelopment.

Createandmaintaincontinuityofcare,asenseofhope,andafamilyconnectiontothementalhealthsystem

LT goal: The client will not harm self or others during hospitalization.
ST goal: The client will identify signs of increased violent impulses and learn effective coping skills during my shift
Intervention & Frequency

Scientific Rationale
(In complete sentences!)
(Reference in APA format, including page number)

Evaluation

Observe the client to identify daily

events or stressors that are associated
with the clients agitation.

Observation of the client in daily

activities and routines allows the nurse
to help the client identify stressors that
provoke an agitated response.

Patient reported that another patient on the unit is a

stressor in her life and that she tries her best to stay away
from her, but that it is hard to stay away when they have
group therapy and other activities together. Patient raised
voice at other patient and walked away.

Help the client identify and discuss the

negative feelings, such as anger, fear,
loss of self-control, that are evoked by
the stressors such as other patients and
auditory command hallucinations with
group therapy.

Identification of stressors and the

negative feelings associated with them is
the first step in learning to control them.

Patient reported anger and almost loosing control

when she is around the other patient. She said She
just gets to me. Patient reported that auditory
hallucinations occur when she is not on medication
or when it is late at night.

Teach the client to use the quiet room or

to take a time-out when feeling
overwhelmed.

Even if the client cant verbalize intense

feelings, the client can learn how to
identify and depart from situations that
create or potentiate agitation

Patient went in room for most of the day to avoid the other
patient who was causing her stress. Patient finds walking
and reading to be stress relieving when she feels stressed
or agitated.

Identify patients feeling about triggers

that can cause violence or self harm.

Identifying triggers related to clients

feelings about self harm or violence can
help the patient be more incontrol of
these behaviors.

Patient reported that taking her medications helps

reduce auditory command hallucinations that tell
her to act violently or to act out in self harm.
Patient reported difficulty in being med compliant
when not in the hospital.

Priority # _2__
CARE PLAN
Nursing Diagnosis: Ineffective individual coping related to inadequate skills for handling stress, poor family
support system aeb unstable physical or emotional health, noncompliance with prescribed drug regimen,
methamphetamine use, high elopement risk, and intentional overdose.
P: Ineffective Coping
E: Patient has over 20 years of methamphetamine use. Patient has demonstrated poor medication compliance
aeb frequent hospitalizations and increased auditory command hallucinations leading to her reason of admission
of attempting to cut off husbands hand. Patient has verbalized auditory hallucinations of running away. Patient
has a history of intentional overdose due to sever depression.
S: Patient can learn various coping techniques through group therapies and activities to learn about being
substance free and to manage severe depression and schizoaffective symptoms. Patient can demonstrate
medication compliance through medication education and day treatment programs.
LT goal: The client will use constructive coping strategies and function without interference from delusional thinking throughout
hospital stay.
ST goal: The client will develop adaptive coping strategies during my shift.
Scientific Rationale
Intervention & Frequency

(In complete sentences!)

(Reference in APA format, including page number)

Evaluation

Teach the client appropriate ways to

handle stress, such as journaling or
structured physical activity like taking a
walk.

Acquisition of skills, information, and options

for dealing with stress enhances the clients
coping ability.

Patient reported taking walks, and reading as good

ways for her to calm down. Patient also reported to
just walk away from stressful activities helps her
cope with problems.

Help the client identify people and

community resources to alleviate
difficulties such as depression and
schizoaffective symptoms.

Helping the client develop a personal

acquaintance with community support
people alleviates negative feeling, such
as lonliness, anhedonia, or avolition.

Patient reported that taking her medication makes

her symptoms like auditory hallucinations go away.
Patient has a hard time finding help in the
community because she is too distracted with
negative influences such as illegal substances.
Patient reports feeling confident in talking to staff if
she has a problem.

Help the client formulate plans to contact

support services such as community
mental health workers or pastoral care
personnel, to discuss the clients concerns
about self and lifestyle adaptions.

Providing a plan with specific, delineated

steps enables the client to follow them
through and achieve success

Patient reports feeling confident in talking to staff if

shee has a problem. Patient has limited family
support and community help when she is out of the
hospital. Patient reports that praying and going to
church is helpful in her staying away from negative
influences.

Help the client establish a predictable,

daily routine while incorporating
medication compliance.

Daily routines provide structure and a

sense of security and reduce the stress
that can provoke delusional thinking.

Patient reports likeing the unit schedule because it

gives her something to do and be distracted from
negative thoughts and feelings. Patient reported
benefits in taking medication in reducing auditory
hallucinations.

Priority #

_3__

CARE PLAN

Nursing Diagnosis: Impaired health maintenance, related to obesity, methamphetamine abuse, lack of exercise,
lack of knowledge, ineffective coping, and lack of support systems aeb medication noncompliance, lack of
expressed interest in improving health behaviors, failure to recognize or respond to important symptoms
reflective of changing health state, and inability to follow instruction or programs for health maintenance
P: Ineffective Health Maintenance
E: Patient has a history of medication noncompliance that lead to frequent hospitalizations. Patient shows limited
knowledge into medication regimen. Patient shows little insight into current health conditions and little interest
into managing her conditions. Patient has poor support system in helping her manage her health conditions.
S: Educate patient about current medication regimen, heath conditions, and techniques to improve her health.
Offer group therapies and exercise programs to help patient express thoughts and feelings and to participate in
her care.
LT goal: Patient demonstrates positive health maintenance behaviors aeb keeping scheduled appointments, participating in
substance abuse programs, making diet and exercise changes, improving home environment, and following treatment programs
during hospitalization.
ST goal: Patient verbalizes understanding of current health conditions and expresses insight and interest in health improvement
during my shift.
Scientific Rationale
(In complete sentences!)
(Reference in APA format, including page number)

Evaluation

Assess the patients knowledge of health

maintenance behaviors, health history,
and environmental, social, intrafamilial
disruptions or changes that have
correlated with poor health behaviors.

The health care provider needs to ensure

that the patient has all the information
needed to make good lifestyle choices.
Assessment may give some perspective
on poor health habits and on factors of
general condition.

Patient reported being obese due to the medication

she was taking. Patient reported not exercising as
much as she probably should and that she has had
chronic back pain for years. Patient reported
difficulty in taking her medications due to the
amount of medication that she needs to take.
Patient reported eating a lot of fast food with her
family because its the easiest food to get.

Discuss noncompliance with instructions

or programs with the patient, and
identify barriers to maintaining health
behaviors.

The patient may be experiencing

obstacles in compliance that can be
resolved.

Patient reported a want to get skinnier but blames

her medication for being the cause of all her weight
gain. Patient reported switching to different
antipsychotic medications but still finds trouble in
maintaining her weight. Patient reported the want
to do more exercise.

Intervention & Frequency

Involve family in health planning, and

compliment patient on positive
accomplishments

Family members need to understand that

care is planned to focus on what is most
important to the patient and positive
reinforcement enhances behavior
change. Patients with a stronger selfefficacy are more likely to engage in
positive behaviors.

Patient reported that she has a poor family support

when it comes to maintaining her health because
the house is so crowded. Patient lives with 2 sisters,
2 nephews, and husband and feels she is too busy
taking care of them. Patient reported getting most
of her points when it comes to activities and
enjoyes getting points so that she can do more
things.

Provide the patient with a rational for the

importance of proper nutrition, exercise,
hygiene, substance abuse cessation,
stress management, regular physical and
to report changes in health.

Nutrition, exercise, hygiene, substance

abuse cessation, stress management,
regular physical and reporting unusual
changes in health contribute to positive
health management and lets the patient
become involved and in control of self.

Patient reported the want to exercise more, eat

healthier, and be substance free. She reported that
the only reason she is substance free is because
she has been locked up for so long and hasnt been
around it. Patient reported liking the food at the
hospital and that she has a salad everyday. Patient
has reported the weight gain from her medication
and has interest in switching medications.

http://www.homesteadschools.com/lcsw/courses/PsychiatricMental/Chapter06.html

Burns Depression Checklist

Place a check () in the box to the right of each category to indicate how much this type of
feeling has bothered you in the past several days.
0
Not at All
1. Sadness: Do you feel sad or down in
the dumps?
2. Discouragement: Does the future look
hopeless?
3. Low self-esteem: Do you feel
worthless?
4. Inferiority: Do you feel inadequate or
inferior to others?
5. Guilt: Do you get self-critical and
blame yourself?
6. Indecisiveness: Is it hard to make
decisions?
7. Irritability: Do you frequently feel
angry or resentful?
8. Loss of interest in life: Have you lost
interest in your career, hobbies, family,
or friends?
9. Loss of motivation: Do you have ot
push yourself hard to do things?
10. Poor self-image: Do you feel old or
unattractive?
11. Appetite changes: Have you lost
your appetite? Do you overeat or
binge compulsively?
12. Sleep changes: Is it hard to get a good
nights sleep? Are you excessively
tired and sleeping too much?
13. Loss of sex drive: Have you lost your
interest in sex?
14. Concerns about health: Do you
worry excessively about your health?
15. Suicidal impulses: Do you have
thoughts that life is not worth living or
think youd be better off dead?

1
Somewhat
X

2
Moderately

3
A Lot

X
X
X
X
X
X
X
X
X
X
X
X
X
X

Total Score on items 1-15

17

Scoring Key for Burns Depression Checklist

Total Score

Degree of
Depression

0-4

Minimal or No Depression

5 - 10

Normal but Unhappy

11 - 20

Borderline to Mild
Depression

21 - 30

Moderate Depression

31 - 45

Severe Depression

Psych-Ed Leadership
Topic: Stress
I.
II.

III.

IV.

V.

What is Stress?
a. Stress can be defined as the brain's response to any demand. Many things can
trigger this response, including change.
How does stress affect the body?
a. With chronic stress your immunity is lowered and your digestive, excretory, and
reproductive systems stop working normally.
b. Problems occur if the stress response goes on too long, such as when the source of
stress is constant, or if the response continues after the danger has subsided.
How does stress affect your overall health?
a. There are at least three different types of stress, all of which carry physical and
mental health risks:
i. Routine stress
ii. Stress brought about by a sudden negative change
iii. Traumatic stress
b. Some people experience mainly digestive symptoms, while others may have
headaches, sleeplessness, depressed mood, anger and irritability. People under
chronic stress are prone to more frequent and severe viral infections, such as the
flu or common cold
c. Over time, continued strain on your body from routine stress may lead to serious
health problems, such as heart disease, high blood pressure, diabetes, depression,
anxiety disorder, and other illnesses.
How can I cope with stress?
a. The effects of stress tend to build up over time. Taking practical steps to maintain
your health and outlook can reduce or prevent these effects. The following are
some tips that may help you to cope with stress:
i. Seek help from a qualified mental health care provider if you are
overwhelmed, feel you cannot cope, or have suicidal thoughts
ii. Stay in touch with people who can provide emotional and other support.
iii. Recognize signs of your body's response to stress, such as difficulty
sleeping, being easily angered, feeling depressed, and having low energy.
iv. Set priorities
v. Note what you have accomplished at the end of the day, not what you have
been unable to do.
vi. Avoid dwelling on problems. If you can't do this on your own, seek help
from a qualified mental health professional who can guide you.
Other ways to help yourself deal with stress
a. Exercise regularly-just 30 minutes per day of gentle walking can help boost mood
and reduce stress.
i. Considered vital for maintaining mental fitness, and it can reduce stress.
Studies show that it is very effective at reducing fatigue, improving
alertness and concentration, and at enhancing overall cognitive function.
1. Meditate, Breathe deeply, Talk to others

b. Schedule regular times for healthy and relaxing activities

c. Explore stress coping programs, which may incorporate meditation, yoga, tai chi,
or other gentle exercises.
d. Eating good
i. Water, fresh vegetables, fresh fruits, fish, soups, yogurts
1. Fresh fruit and vegetables provide an array of vitamins and
minerals that are great for reducing stress. Vegetables also have a
high fiber content, which is helpful in treating constipation
another long-term effect of stress
2. Fish such as mackerel contain omega fatty acids, which are
extremely good for the heart and can protect you from heart
diseases. Fish also contains choline a great memory booster
3. Yogurts provide minerals including calcium, essential to maintain
well functioning nerve impulses.
4. To keep stress to a minimum, design a meal plan for the day that
incorporates a big meal in the morning, something relatively light
for lunch and another light meal in the evening. Salad before your
evening meal with fruits and yogurts after is a sure way to satisfy
your appetite.
e. Sleeping
i. When you are tired, you are less patient and easily agitated which can
increase stress. Most adults need 7-8 hours of sleep per night. Practicing
good sleep hygiene along with stress-lowering tactics can help improve
your quality of slee
RESOURCES:
http://www.nimh.nih.gov/health/publications/stress/index.shtml
https://www.lawsociety.org.nz/lawtalk/lawtalk-archives/issue-813/sleep-can-reduce-stress-levels
http://www.adaa.org/understanding-anxiety/related-illnesses/other-relatedconditions/stress/physical-activity-reduces-st
http://www.webmd.com/balance/guide/blissing-out-10-relaxation-techniques-reduce-stress-spot
http://www.stress.org.uk/How-food-can-help-your-stress-levels.aspx
Agenda:
1) Talk about Stress
2) Picture Handout
3) Activity
a) Stress index assessment
b) Writing activity (Have them write down):
1. What stressors do they have?
2. How do they deal with it?
3. Three ways they will continue working on managing their stress
BornandraisedinHawaii

ThreeSisters
o Describedasfightingalotandnotgettingalong
Fatherwasarubbishmanandmotherwasabusdriver
o Father:describedasherbestie
o Mother:describedasherteacher
Duetolimitedresourcesofthefamilyandbeingsicklywithasthma,shewasmostly
raisedbyhergrandfather
FamilyMentalHealth
o Motherhasdepression
o UnclehasSchizophrenia
o SisterisBipolar
o Shekindofluckedoutwithallthreeandthensome
Describesherselfasatomboyandafunnykid,wholikedtoplayvolleyball
o Unfortunatlyatayoungage,shedescribedinsecuritiesofselfimageduetobeing
madefunofherhugetitsbychildrenwhentheywereplayingPictionary
o Tothisday,shestillfindstroubleinplayingthisgameandspeakinginfrontof
people
History
o Startedhearingvoicesaroundage11or12
o Startedmarijuanaatage12
o Heavyalcoholabuseatage15
o PregnantinhersenioryearinHighSchool
Thefatherofherchildishercurrenthusbandtoday.Theyhaveknowneachotherfor31
yearsandhavebeenhappilymarriedfor24years,withbumpsintheroad.
o Patientdescribesherhusbandasherrock
Theeventuallyhad2daughtsand1son
o PoorFamilyDynamic:Shedescribedherrelationshipaswhenshewouldstartto
gettingdeliriousandhallucinationskidswouldtellherMomgotakeyour
meds.
Longhistoryofsubstanceabuseandjustgotworseasshediscoveredmeth
o Tillthisdayshehaswellover20yearsofmethamphetamineuse
o HerBiggestGuitwasstartingherhusbandonmeth.Thetwogotsofarintoitthat
theystartedcooking
Startedhearingvoicesinthemid90saroundwhenshestartedusingmeth,whichleadto
frequenthospitalizations.
o Lostmanyjobs(Kmart,Hostess,andFisher)
o AdmittedtoKahiMohalain97d/tSchizoaffectivedisorder
Manymoremedicalissuespilledupandherhealthcontinuedtogetworse
MajorProblems
o PoorFamilyDynamicwithchildren
Haventspokentothemsincebeforeherhospitalizationandpreviousjail
time
Onlybeenincontactwithhersister

o Medicationnoncompliancedoesntlikethesideeffects
o Substanceabuse
o FrequentHospitalizations
o Harmtoherself(attemptedoverdosebymedicaction)andharmtohusband
o Ineffectivecoping
Adjustment
o Inadjustingtoherhospitalstay,sheattendsmeetings,participatesingroup
therapy,andiscooperativeandfriendly
Goals
o Beafamilyagain
o Spendmoretimewithhergrandchildren(metonce)andnieces
o Besubstancefree
o Continuetakingmedication(reportsbenefitfromthem)
o Eatinghealthysoshecanlooseweight
Whatmusthappen
o Maintainmedicationregimen
o 12step
o Substancefree
o Utilizecommunityresourcestohelpherbemedcompliant
o Learneffectivecopingtechniques

Her main areas of concern are previous violence (self harm as well), substance abuse,
and major medical illnesses. In becoming substance free she will need to attend 12 step
meetings, group therapy, and have a strong support system. She needs to become med
compliant which can decrease her symptoms of her condition. Becoming more incontrol
of these conditions with lead to a better quality of life.
In sprinkling my creative side into this presentation I would like to relate her life and
condition into a form of music. Music is not only therapeutic in a physical form, but I
believe that we all have our own soundtrack to our life that explains who we are, the
vibes that we produce, and the way that we adapt to situations. Music is fluid and
changes through our day and life and that soundtrack is ultimately influenced by our life
experiences, our traditions, and choices we make. So I will try to put what I received
from this patient into this form.

Like any good psyche, we need stability and a strong support system. For this patient
her husband is her main support system that she has gained a lot of stability from. In
music, stability can be in the form of a rhythm, or a drum beat.
For our melody, this is the emotion that we produce such as our affect and mood. Her
mood was full range, with notes of happiness and joy to notes of sadness and guilt. I
feel her melody is sort of melancholic with notes of hope.
For a bass, this is like our physical health. Bass is like the background sound that adds
range to the piece. Although the bass is not usually of our main focus, just like our
health, we can neglect ot remember that it is there. Her health is poor, but with a little
insight and education she is starting to see the importance of working towards being
healthy.
Lastly for
Open relationship with her illness with the children, so if she was acting weird, the
children would be like, mom go take your medications.
Otis Redding finished recording "(Sittin' On) The Dock of the Bay" just days before the plane
crash that took his life. He was only 26 years old. The song was released just weeks after he was
buried in Georgia, so it was widely heard as his epitaph. In many ways, it is still inextricable
from his tragic death.
But listeners have always been divided on the spirit of Redding's final work. Does it tell the story
of a man at peace with the rhythms of life, or does it express a more pessimistic sadness, even
defeat? Let's delve further into the song's background to pull apart this question.
In other words, it's hard to believe that Redding looked out over the lapping waves of the San
Francisco Bay with anything other than satisfaction, the sort of contentment that comes with all
things being in their place. And that's certainly one way to hear the song that Redding's bayside
reveries produced, as a song about a man who has experienced life's trials but now, having found
peace, is content to just watch the ships come and go, blissfully wasting time.
At the same time, others have found a far different constellation of feelings in the song, like

overpowering sadness, almost unbearable regret, and the sense of time and a life wasted. For
example, the song was heavily played on US Army radio stations broadcasting in Vietnam. One
GI recalled how the song spoke to him and his friends: "We were absolutely stuck in our
situation and lyrics from 'Dock of the Bay' such as 'Looks like nothing's gonna change' evoked
the misery and homesickness we felt."
Back home in the States, many African Americans believed the song captured the sadness and
frustration that came with hopes unfulfilled. In previous years, the civil rights movement had
made huge gains. Court decisions and federal legislation seemed to be opening doors. But in the
spring of 1968, Martin Luther King, Jr. was assassinated and all of a sudden, all that progress
seemed smashed. Despite years of protest and mass action, "Looks like nothing's gonna change,
Everything still remains the same."
The combination of lyrics and music that frame these melancholy reflections is not hard to
dissect. A lone guitar slowly rises above the sound of waves breaking, and there's a simple bass
line, just enough to keep the song moving forward. Redding enters with a voice that is emotional
and knowing, but also stoic, as even and reliable as the waves that reflect his mood.
The visceral appeal of the song is just as easy to understand. We've all been there we've all sat
at the water's edge and lost ourselves in its rhythms. We've all watched the ships come in and
then watched them go away again, carrying our thoughts to some other place.
And in fact, the simple universality of the experience Redding describes may explain why people
disagree over the mood and meaning of the song. We disagree because through Redding's lyrical
and musical magic his song becomes oursand the feelings that it summons are therefore ours
as well. For some of us, the song, like the experience, may uncover feelings of contentment, for
others feelings of loss; for some, the song, like the experience, will conjure feelings of peace
with the passage of time, but for others, regret over its waste.
It may be impossible to separate Redding's death from the songin fact, this awareness adds
depth to its melancholy feel. Redding's death frames the reflective seaside space into which the
song carries us. But the song's real power lies in the fact that ultimately we do separate Redding's

death and even Redding from the song. By tapping into a universal experience, it summons
reflections on time, it raises questions both cosmic and personal, it draws us into a space that is
universally shared but ultimately private and all our own.