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
: Category: Obesity
(Height: 54
Weight: 212lb
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
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
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.
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
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.
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
Evaluation
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
http://www.homesteadschools.com/lcsw/courses/PsychiatricMental/Chapter06.html
1
Somewhat
X
2
Moderately
3
A Lot
X
X
X
X
X
X
X
X
X
X
X
X
X
X
17
Degree of
Depression
0-4
Minimal or No Depression
5 - 10
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
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.