Pathways Mental Health
Psychiatric Patient EvaluationInstructions
Use the following case template to complete Week 2 Assignment 1. On page 5, assign
DSM-5-TR and Updated ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit altogether as one document.
Identifying Information
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957amChief Complaint
“My other provider retired. I don’t think I’m doing so well.”HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors. Diagnostic Screening Results
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32Past Psychiatric and Substance Use Treatment
Entered mental health system when she was age 19 after raped by a stranger during a house burglary.
Previous Psychiatric Hospitalizations: denied
Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015
Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)
Previous mental healt.
Student NameCollege of Nursing-PMHNP, Walden UniversityN.docxcpatriciarpatricia
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan II
Faculty Name
Assignment Due Date
Pathways Mental Health
PSYCHIATRIC PATIENT EVALUATION
INSTRUCTIONS
Use the following case template to complete Week 2 Assignment 1.
On page 5, assign
DSM-5
and ICD-10 codes to the services documented. You will
add your narrative answers to the assignment questions to the bottom of
this template
and submit altogether as one document.
IDENTIFYING INFORMATION
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957am
CHIEF COMPLAINT
“My other provider retired. I don’t think I’m doing so well.”
HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
DIAGNOSTIC SCREENING RESULTS
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32
PAST PSYCHIATRIC AND SUBSTANCE USE TREATMENT
• Entered mental health system when she was age 19 after raped by a stranger during a house burglary. • Previous Psychiatric Hospitalizations: denied• Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015• Previous psychotropic medication trials: sertraline (became suicidal), trazodone (wor.
The AssignmentAssign DSM-5 and ICD-10 codes to service.docxrtodd17
The Assignment
Assign
DSM-5
and ICD-10 codes to services based upon the patient case scenario.
Then, in 1–2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit altogether as one document.
Explain what pertinent information, generally, is required in documentation to support
DSM-5
and ICD-10 coding.
Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
Instructions
Use the following case template to complete Week 2 Assignment 1. On page 5, assign
DSM-5
and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit altogether as one document.
Identifying Information
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957am
Chief Complaint
“My other provider retired. I don’t think I’m doing so well.”
HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
Diagnostic Screening Results
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in fun.
Chief Complaint Follow upHistory of Presenting IllnessMrJinElias52
Chief Complaint: Follow up
History of Presenting Illness:
Mr. Gerald is 58-year-old AA male admitted to SBGC on 10/8/21 due to history of HTN, chronic ETOH use, tobacco use, Wernicke's encephalopathy and unspecified psychiatric history. He was seen for follow up via telemedicine. He was selectively mute and could not talk to us much. Nodded head to most questions. Patient is a poor historian and has a history of given conflicting information. Staff report that appetite and sleep varies. He is being managed with Aricept 5mg for dementia and Cogentin 0.5mg for EPS. Ativan 1mg PRN for agitation. Nursing to continue to document behavior to direct further treatment plan. Verbalized understanding. No change in status. Denies suicidal or homicidal ideation. Denies any issue or discomfort currently. Patient denies current SI/HI/AVH/Paranoia/Delusion.
Current Medication: As per Matrix medication lists for medical.
Psychiatric medication: None
Past Psychiatric History: Unknown
Past Psychiatric Hospitalization: Unknown
History of Suicide Attempts or Thoughts- Unknown
Previous Psychiatric Medications: None PTSD: Y/N- Unknown.
Family Psychiatric History: Unknown
Medical History/Review of Systems: See Matrix for medical diagnosis.
Allergies Drug: NKDA.
Food Allergies: NKFA
Surgery: Y/N- Unknown. Sleep and Appetite Varies.
Normal Developmental History: None
Exposure to Drugs/medication/Alcohol: Y/N-Unknown
Speech/Language delays: Y/N- Yes
Sexual Abuse or Physical abuse: Y/N-Unknown
Social History: Unknown
Sexually active. Are you in relationship: Unknown?
Family Structure: Unknown
Favorite/Leisure activity: Y/N: Unknown
Educational History/Career: Unknown
Work history: Unknown
Substance Use History: Unknown.
Legal History: Y/N- Unknown
Mental Status Examination:
General Appearance: Neat & clean, casually dressed in good hygiene.
Eye contact: Normal Psychomotor Activity: Normal
Memory: Long term and short-term memory not intact. Attention: Reduced
SPEECH: Decreased speech in amount, rate, and volume.
MOOD: objectively Poor.
AFFECT: Flat and anxious.
THOUGHT PROCESS: Not appropriate.
THOUGHT CONTENT: Denies SI/HI.
PERCEPTIONS: Denies AVH sensorium.
INSIGHT: Poor
JUDGMENT: Poor
COGNITION: Poor
Language. normal.
Diagnosis:
F03.20 Dementia.
Suicidal ideation/HI - Denies Suicidal or homicidal ideation.
PROTECTIVE FACTORS: Family support
RISK ASSESSMENT: Low
SAFETY PLAN RECOMMENDATIONS: Notify staff if feeling Suicidal and call 911 for suicidal attempt.
Psychosis: - Denies Paranoia and delusional.
Prescription: No medication at this time.
Medication Education: Aricept 5mg at bed time for dementia. Cogentin 0.5mg for EPS. Ativan 1mg every 6hrs PRN.
Non-Pharmacological Education Recommended: Continue to use positive coping skills as needed. Identify triggers and address them proactively.
Plan: In 90 days, there will be improvement in memory and concentration.
Fall precaution in place
Follow up in 2 to 4 weeks.
NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation ...
Initial Psychiatric Interview/SOAP Note Template
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name: Susan
DOB: not provided
Minor: NA
Accompanied by: self
Demographic: NA
Gender Identifier Note: Female
CC: “I have been feeling anxious, depresssed, high blood pressure, irregular heartbeat, elevated body temperature, crying spells for the last 2 days”
.
HPI: Susan is a midde aged woman who reports to the healthcare clinic reporting several symptoms that she has observed over the period of the last two days. She reports having high blood pressure, an irregular heartbeat, depression, anxiety, and an increase in body temperature. Susan doesn't realize that she shows signs of alcohol dependence and physiological dependence, which downplays the seriousness of her alcohol usage. This diagnosis is supported by the withdrawal symptoms that appear to be becoming more tolerable as well as by the sustained and increased alcohol consumption despite the harm it does to social interactions and job performance. She has also increased her alcohol consumption to ease withdrawal symptoms. s He has a history of drinking, which has caused him to skip work and even get arrested. She downplays her alcohol consumption and justifies how often and how much she drinks.
Pertinent history in record and from patient: Alcohol withdrawal
During assessment: Patient is cam and corparative
Patient seemed to be suffering from serious cases of both anxiety and despair judging from her crying spells.
Patient denies hallucinating. The patient has nomal thought process. .
SI/ HI/ AV: patient denies signs of suicidal ideation and violent behavior.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: NKDA
Describes stable course of illness.
Previous medication trials: not reported
Safety concerns:
History of Violence
to Self:none reported
History of Violence t
o Others: none reported
Auditory Hallucinations: not reported
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Priorsubstance abuse treatment: not reported
Trauma history: Client reveals no history of traumatic experiences (such as abuse, domestic violence, or exposure .
Initial Psychiatric SOAP Note Template There are different ways.docxLaticiaGrissomzz
Initial Psychiatric SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
o Others: none reported
Auditory Hallucinations:
Visual Hallucinations:
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Prior substance abuse treatment: not reported
Trauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing events.
.
Initial Psychiatric InterviewSOAP Note Template There are diff.docxLaticiaGrissomzz
Initial Psychiatric Interview/SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
o Others: none reported
Auditory Hallucinations:
Visual Hallucinations:
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Prior substance abuse treatment: not reported
Trauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing.
Student NameCollege of Nursing-PMHNP, Walden UniversityN.docxcpatriciarpatricia
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan II
Faculty Name
Assignment Due Date
Pathways Mental Health
PSYCHIATRIC PATIENT EVALUATION
INSTRUCTIONS
Use the following case template to complete Week 2 Assignment 1.
On page 5, assign
DSM-5
and ICD-10 codes to the services documented. You will
add your narrative answers to the assignment questions to the bottom of
this template
and submit altogether as one document.
IDENTIFYING INFORMATION
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957am
CHIEF COMPLAINT
“My other provider retired. I don’t think I’m doing so well.”
HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
DIAGNOSTIC SCREENING RESULTS
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32
PAST PSYCHIATRIC AND SUBSTANCE USE TREATMENT
• Entered mental health system when she was age 19 after raped by a stranger during a house burglary. • Previous Psychiatric Hospitalizations: denied• Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015• Previous psychotropic medication trials: sertraline (became suicidal), trazodone (wor.
The AssignmentAssign DSM-5 and ICD-10 codes to service.docxrtodd17
The Assignment
Assign
DSM-5
and ICD-10 codes to services based upon the patient case scenario.
Then, in 1–2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit altogether as one document.
Explain what pertinent information, generally, is required in documentation to support
DSM-5
and ICD-10 coding.
Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
Instructions
Use the following case template to complete Week 2 Assignment 1. On page 5, assign
DSM-5
and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit altogether as one document.
Identifying Information
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957am
Chief Complaint
“My other provider retired. I don’t think I’m doing so well.”
HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
Diagnostic Screening Results
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in fun.
Chief Complaint Follow upHistory of Presenting IllnessMrJinElias52
Chief Complaint: Follow up
History of Presenting Illness:
Mr. Gerald is 58-year-old AA male admitted to SBGC on 10/8/21 due to history of HTN, chronic ETOH use, tobacco use, Wernicke's encephalopathy and unspecified psychiatric history. He was seen for follow up via telemedicine. He was selectively mute and could not talk to us much. Nodded head to most questions. Patient is a poor historian and has a history of given conflicting information. Staff report that appetite and sleep varies. He is being managed with Aricept 5mg for dementia and Cogentin 0.5mg for EPS. Ativan 1mg PRN for agitation. Nursing to continue to document behavior to direct further treatment plan. Verbalized understanding. No change in status. Denies suicidal or homicidal ideation. Denies any issue or discomfort currently. Patient denies current SI/HI/AVH/Paranoia/Delusion.
Current Medication: As per Matrix medication lists for medical.
Psychiatric medication: None
Past Psychiatric History: Unknown
Past Psychiatric Hospitalization: Unknown
History of Suicide Attempts or Thoughts- Unknown
Previous Psychiatric Medications: None PTSD: Y/N- Unknown.
Family Psychiatric History: Unknown
Medical History/Review of Systems: See Matrix for medical diagnosis.
Allergies Drug: NKDA.
Food Allergies: NKFA
Surgery: Y/N- Unknown. Sleep and Appetite Varies.
Normal Developmental History: None
Exposure to Drugs/medication/Alcohol: Y/N-Unknown
Speech/Language delays: Y/N- Yes
Sexual Abuse or Physical abuse: Y/N-Unknown
Social History: Unknown
Sexually active. Are you in relationship: Unknown?
Family Structure: Unknown
Favorite/Leisure activity: Y/N: Unknown
Educational History/Career: Unknown
Work history: Unknown
Substance Use History: Unknown.
Legal History: Y/N- Unknown
Mental Status Examination:
General Appearance: Neat & clean, casually dressed in good hygiene.
Eye contact: Normal Psychomotor Activity: Normal
Memory: Long term and short-term memory not intact. Attention: Reduced
SPEECH: Decreased speech in amount, rate, and volume.
MOOD: objectively Poor.
AFFECT: Flat and anxious.
THOUGHT PROCESS: Not appropriate.
THOUGHT CONTENT: Denies SI/HI.
PERCEPTIONS: Denies AVH sensorium.
INSIGHT: Poor
JUDGMENT: Poor
COGNITION: Poor
Language. normal.
Diagnosis:
F03.20 Dementia.
Suicidal ideation/HI - Denies Suicidal or homicidal ideation.
PROTECTIVE FACTORS: Family support
RISK ASSESSMENT: Low
SAFETY PLAN RECOMMENDATIONS: Notify staff if feeling Suicidal and call 911 for suicidal attempt.
Psychosis: - Denies Paranoia and delusional.
Prescription: No medication at this time.
Medication Education: Aricept 5mg at bed time for dementia. Cogentin 0.5mg for EPS. Ativan 1mg every 6hrs PRN.
Non-Pharmacological Education Recommended: Continue to use positive coping skills as needed. Identify triggers and address them proactively.
Plan: In 90 days, there will be improvement in memory and concentration.
Fall precaution in place
Follow up in 2 to 4 weeks.
NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation ...
Initial Psychiatric Interview/SOAP Note Template
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name: Susan
DOB: not provided
Minor: NA
Accompanied by: self
Demographic: NA
Gender Identifier Note: Female
CC: “I have been feeling anxious, depresssed, high blood pressure, irregular heartbeat, elevated body temperature, crying spells for the last 2 days”
.
HPI: Susan is a midde aged woman who reports to the healthcare clinic reporting several symptoms that she has observed over the period of the last two days. She reports having high blood pressure, an irregular heartbeat, depression, anxiety, and an increase in body temperature. Susan doesn't realize that she shows signs of alcohol dependence and physiological dependence, which downplays the seriousness of her alcohol usage. This diagnosis is supported by the withdrawal symptoms that appear to be becoming more tolerable as well as by the sustained and increased alcohol consumption despite the harm it does to social interactions and job performance. She has also increased her alcohol consumption to ease withdrawal symptoms. s He has a history of drinking, which has caused him to skip work and even get arrested. She downplays her alcohol consumption and justifies how often and how much she drinks.
Pertinent history in record and from patient: Alcohol withdrawal
During assessment: Patient is cam and corparative
Patient seemed to be suffering from serious cases of both anxiety and despair judging from her crying spells.
Patient denies hallucinating. The patient has nomal thought process. .
SI/ HI/ AV: patient denies signs of suicidal ideation and violent behavior.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: NKDA
Describes stable course of illness.
Previous medication trials: not reported
Safety concerns:
History of Violence
to Self:none reported
History of Violence t
o Others: none reported
Auditory Hallucinations: not reported
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Priorsubstance abuse treatment: not reported
Trauma history: Client reveals no history of traumatic experiences (such as abuse, domestic violence, or exposure .
Initial Psychiatric SOAP Note Template There are different ways.docxLaticiaGrissomzz
Initial Psychiatric SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
o Others: none reported
Auditory Hallucinations:
Visual Hallucinations:
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Prior substance abuse treatment: not reported
Trauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing events.
.
Initial Psychiatric InterviewSOAP Note Template There are diff.docxLaticiaGrissomzz
Initial Psychiatric Interview/SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
o Others: none reported
Auditory Hallucinations:
Visual Hallucinations:
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Prior substance abuse treatment: not reported
Trauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing.
Meditrek NoteName J. C. Age 40yrs Purpose of Note InitialAbramMartino96
Meditrek Note
Name: J. C.
Age: 40yrs
Purpose of Note: Initial psychiatric evaluation
Chief complaint: Severe inattentiveness interfering with occupational functioning.
Diagnosis: F90.2 - Attention-deficit hyperactivity disorder, combined type.
Medical/Physical Disorders: None Psychosocial Stressors (formerly Axis IV):
Problems with: Axis I condition/mental health problem. Presenting Problem Inattentiveness hyperactivity and impulsivity MENTAL STATUS EXAMINATION & BEHAVIORAL OBSERVATIONS Appearance: Well-nourished, well-groomed, and developed and in no acute distress.
Behavior: Well-controlled with good eye contact. Psychomotor activity: Normal. Speech: The client spoke at a normal rate, rhythm, and tone. Volume: Normal.
Language: Unimpaired. Mood: Anxious, worried and slightly irritable.
Affect: Full ranging, mood congruent and appropriate. Thought Processes: Coherent, i.e., logical and goal directed.
Associations: There were no flight of ideas or ideas of reference.
Attention: Markedly impaired with impulsivity and inattentiveness increased distractibility
Thought Content: There were no hallucinations, delusions, phobias, or paranoia.
Orientation: Alert and oriented in all spheres, i.e., oriented to person, place, time and situation. Judgment/Insight: Adequate.
Suicidal Ideations: There were no active or passive suicidal ideations.
Homicidal Ideations: Denied.
Memory: Grossly intact without deficits.
Fund of Knowledge: Grossly average to high average.
Past Psychiatric History: [ADHD diagnosed as a child treated with Ritalin and Adderall until she became pregnant with her daughter. No history of inpatient psychiatric services or suicidal behavior].
Substance Use History: [Occasional drink of wine without any history of illicit drug use].
Family Psychiatric History: [ Sons with ADHD and other relatives with ADHD].
Past Medical History: None. Past Surgical History: [ Partial hysterectomy due to fibroids and dysfunctional uterine bleeding]. Allergies: No known drug allergies.
Medications: [ Multivitamins]. Psychosocial History: Patient was the product of a normal childbirth. Patient had no developmental delays. She was born and raised in Oxford England. She described her childhood as good but having to move around in a military family. Patient denied having any history of abuse or neglect. Patient is a high school graduate. Has a bachelor’s degree. She is currently married with 4 children 2 biological children and 2 stepchildren. She currently works in marketing however this job has been adversely affected due to her ADHD related symptoms.
History of Present Illness: This patient is self -referred reports being diagnosed with ADHDs as a child and was treated with Ritalin and Adderall until 2006, she discontinued her medications when she became pregnant with her daughter. The patient never undergone any inpatient psychiatric services and never engaged in any self-injurious or suicidal behavior. Patient continues to have dif ...
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
Initial Psychiatric SOAP Note TemplateThere are different ways i.docxpauline234567
Initial Psychiatric SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and
(Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
If Minor obtain Developmental Hx: (most often from parents), in utero, birth and delivery hx, early childhood, school hx, behavior, etc…
Nutritional status (this is an important component to gauge how well the mind and body are being nourished for full function. Ex: lack of iodine create thyroid issues, thyroid issues creates metabolism issues which affects function of cognition, mood, etc…)
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
.
2Assessing ClientsA comprehensive assessment of the patient who p.docxBHANU281672
2Assessing Clients“A comprehensive assessment of the patient who presents for psychotherapy is necessary to develop an appropriate treatment plan. This assessment is a relational process that sets the tone for subsequent sessions” (Wheeler, 2014, p. 131). As a future Psychiatric Mental Health Nurse Practitioner, it is essential to be able to accurately assess clients to determine whether yourtherapeutic approach would contribute to improved clinical outcomes. The purpose of this assignment is to select a client that was observed or counseled at my practicum site and completea comprehensive client assessment and genogram for the client selected.Comprehensive Client AssessmentDemographic information for the client chosen is as follows: The client is a 27-year-old African female who resides in Maryland. She is a single, heterosexual, mother of fraternal twins,a boy and a girl. She was referred by her psychiatrist to the current counselor for psychotherapy and is primarily followed by the psychiatrist for medication management. The client has been receiving psychotherapy for the past two years. Her presenting problem revolves around learning how to be independent while coping with her mental illness. She stated, “I need help with figuring out my finances.” History of present illness: Client has a history of bipolar and presented to the office with complaints about her “baby daddy” not wanting to help her out with their children and about how difficult it’s going to be when her cousin stops keeping her twins because daycare is expensive. She also expressed discontent towards her father interfering in herpsychiatric care because he shares the same Nigerian ethnicity as her psychiatrist and she wants to be on less medication and receives more psychotherapy. The client’s past psychiatric history includes two psychiatric hospitalizations for manic episodes with psychosis. Medical history includes a previous diagnosis of hypertension (HTN), but that diagnosis was later removed. The
3client never took any medications for HTN diagnosis, and HTN resolved through life modifiers. Currently takes Lithium and Cogentin. The client has no substance use history, and developmental milestones were reached as expected. No family psychiatric history reported. Psychosocial history: She currently lives with her father. Her youngest brother and cousin, who is married, also reside in the same house. She works a full-time minimum wage job and is recently single. She has been in contact with her ex-boyfriend who is trying to ‘hook up’ with her to have sex. She is the mother of fraternal twins, a boy and a girl. No history of abuse or trauma.Psychiatric Review of SystemsClient denies “shortness of breath, heart palpitations, panic attacks, sweating flushing, hyperventilation, sense of doom, fear of death or collapse, cold or clammy skin, and tingling sensations in extremities” (Wheeler, 2014, p. 140). Client denies feeling sad, irritable, tired, h.
Comprehensive Client Family Assessment and Genogram The client.docxmccormicknadine86
Comprehensive Client Family Assessment and Genogram
The client is a 24-year-old female, single, African America active duty, service member (SM). SM who resides in the barracks medication, SM MOS is 25U, signal support specialist (IT), SM recently completed basic training and Advanced Individual Training (AIT), before enlisting SM worked as Computer Specialist.
Presenting Problem: I do not know why I am here; I do not need to be here.”
History of Present illness: She appears slightly disheveled, tired, and generally irritable both in the lobby, with nursing staff, and once in the room. She is accompanied by an escort who remains throughout the visit.
Past Psychiatric history: Insomnia.
Medical History: None
Substance use History: denies
Developmental History: She who appears older than stated age, the client is disheveled, with noted body odor
Family Psychiatric history: no familial history
Maternal grandmother marijuana user, paternal grandmother incarcerated no further history. Father Diabetes, Mother HTN, one sister HTN, 1 Brother HTN
Psychosocial History: She states she was homeless before joining the Army National Guard, difficulty to find a job. She wants to go to college for nursing or IT.
History of abuse/Trauma: She reports two episodes of sexual harassment in 2012 in 2013 with no sexual assault but declines to provide more information: no article 15s or negative counseling statements related to her behavior.
Review of Systems:
General: She is alert and oriented x 1 self only B/P 100/60 59, 24, 97.7, 99% room air. Pain 0/10, Weight 153.
HEENT: no discharge intact, moist
Skin: warm and dry
Cardiovascular: no palpitations
Respiratory: no cough or rales or expiratory wheezing was noted neither was any adventitious sounds heard.
GI: No nausea, no vomiting, and no abdominal pain..
Genitourinary: She denies any burning upon urination and dribbling. No obstetrics or gynecology symptoms LMP states 05/01/2019
Neurological: She denies headaches, dizziness, and tingling in all her extremities.
Musculoskeletal: FULL ROM to all extremities
Psychiatric:
Allergies: No known medication/ food allergies
Mental Status Examination
Orientation: Alert and oriented to person
Appearance: in uniform, disheveled, mild body odor
Musculoskeletal: gait and station intact
Behavioral: Irritable/cooperative
Motor activity: appropriate
Speech: pressured, frenzied
Mood: euthymic
Affect: Irritated Restless
Thought content: No suicidal ideation, no homicidal ideation
Perceptions: denies auditory/visual hallucination exaggerated sense of self
Thought Process: illogical and irrational
Attention and Concentration: distracted
Remote and Recent Memory: able to recall the last 5 minutes
Judgment: delayed
Insight and Judgment: fragmented
Differential Diagnosis:
Schizophrenia: a brain disorder that affects how a person reason, feel, and perceive. The hallmark symptom of schizophrenia is psychosis, such as experiencing ...
NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the
Comprehensive Psychiatric Evaluation Template
AND the Rubric
as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
In the
Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use, social, and medical history
· Allergies
· ROS
·
Read rating descriptions to see the grading standards!
In the
Objective section, provide:
· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
·
Read rating descriptions to see the grading standards!
In the
Assessment section, provide:
· Results of the mental status examination,
presented in paragraph form.
· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
DSM-5 diagnostic criteria for each differential diagnosis and explain what
DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.
Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
·
Read rating descriptions to see the grading standards!
Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(The comprehensive evaluation is typically the
initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety sympt.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
Running head ASSIGNMENT 2 PRACTICUM – ASSESSING CLIENTS .docxhealdkathaleen
Running head: ASSIGNMENT 2: PRACTICUM – ASSESSING CLIENTS 1
10
ASSIGNMENT 2: PRACTICUM – ASSESSING CLIENTS
Assignment 2: Practicum – Assessing Clients
Part 1: Comprehensive Client Family Assessment
Demographic information: T.C is a 73 years old African American male who was admitted after being discharged from another local hospital.
Presenting problem: The patient’s present problem is increased psychosis with auditory hallucination (AH).
History or present illness: The patient has a history of multiple hospitalizations, of which he refused to give further details. He was however diagnosed with increased psychosis with auditory hallucination and reports of being capable of hurting himself and others. He was planning to harm himself with an ice pick on the neck. He claims that he has been having auditory hallucinations telling him to harm himself. He was unable to state the onset of the symptoms of the presenting illness. He was not cooperating with the clinician.
Past psychiatric history: The patient has a history of multiple hospitalizations, which he refused to discuss further.
Diagnoses: Chronic mental illness
Suicidal gestures or attempts: None
Medical history: Cerebrovascular accident (CVA), Hypertension (HTN), chronic obstructive pulmonary disease(COPD), Seizure, Congestive heart failure (CHF).
Surgical history: None
Allergies: No known drug allergies
Current Medication:
· Aspirin oral 81 mg TC, PO daily for the management of CAD
· Rivaroxaban oral 10mg tablets PO daily for the management of CAV/MI
Substance use history: The patient claims to be using cocaine as much as he can, once a month. He claims to have started using the drug when he was 19 years old. He, however, refused to give the last day that he used the drug. He also smokes marijuana once a day and started using it when he was 17 years old. He smokes cigarettes at least 3 to 4 times a day.
Developmental history: The patient is a 73-year-old African American male. He is homeless. He is a Christian. His past daily activities include playing soccer and taking an active role in community services. All his early motor, social, language in addition to emotional milestones were within normal limits before being diagnosed with a psychological disorder.
Family psychiatric history: Negative family psychiatric history. There is no known history of any of the family members suffering from any psychiatric disorder, or under psychiatric medications or hospitalization. No other family member has ever displayed suicidal behavior or substance abuse.
Psychosocial history: The patient has a history of chronic mental illness and is non-compliant to medical treatment.
History of abuse/trauma: The patient has no reported history of abuse or trauma.
Review of systems:
General: No weight change, generally appears to be confused. He presented with poor insight and unable to respond to most questions during an assessment. He does not exercise as much as he used to.
Sk ...
Brook Grove Treatment Center7433 West Embers PathRed Lea.docxhartrobert670
Brook Grove Treatment Center
7433 West Embers Path
Red Leaf Cove
Summary Record Report
Client
Jeannie Smith
Case
456789
DOB
07/08/1962
Unit
15
Summary of Findings
Interviewer summary of findings (add details where appropriate)
Clinical Summary
Clinical summary
Impressions
Recommendations
Case Manager Signature
Date
1 | Intake Assessment Form
The objective function always includes all of the decision variables, but that is not necessarily true of the constraints. Explain the difference between the objective function and the constraints. Then, explain why a constraint need not refer to all the variables.
1 | I n t a k e A s s e s s m e n t F o r m
Brook Grove Treatment Center
7433 West Embers Path
Red Leaf Cove
Intake Assessment Form
Client Jeannie Smith Case 456789
DOB 07/08/1962 Unit 15
Date of assessment 08/05/2012
Presenting problem Jeannie is a 50 year old woman who came in because she was struggling with
depression. She said her husband of 20 years was an alcoholic and a batterer.
She said her main reason for coming in was because of her marriage but when
questioned she said that she drank vodka on a daily basis but could stop
whenever she wanted too. She reported that she had used drugs on a heavy
basis when she was in college but denied use now. She said she had taken over
the counter diet pills but was not concerned about that. She denied blackouts
but said she was scared about her health because she said sometimes when
she drank she had heart palpitations. She also admitted to hiding liquor but
said she did this so her kids wouldn’t find it.
Current client
involvement with
other agencies
Agency/contact – None reported
Phone/email
Service
Date
Assessment of life circumstances
Family
She has 3 children but they were still young and not a support for her. She
denied any other support.
Social She reported that she is pretty isolated and only stays at home with her
children.
Support She denied any other support.
Legal Jeannie reported never having any legal issues.
Education
She said she had a B.S. degree and a teacher’s certification. She had started
work on a Master’s degree but did not finish. She said school was her only
outlet.
Occupation
Jeannie is a teacher who reported that she was recently laid off. She was
unable to get another job.
Finances She reported no financial difficulties.
Psychosocial and
environmental
She said the only problem was her ex abusive husband but she was not
concerned.
Current medical
conditions
Condition – Anorexia
Physician/provider – Dr. Max Jones
Treatment – Counseling
2 | I n t a k e A s s e s s m e n t F o r m
Condition – Heart palpitations
Physician/provider – Did not see a doctor
Treatment – Not currently treated
Pregnant If yes, receiving care? N/A
Primary care physician
Dr. Janey Baker
Current medications Medication ...
JW House FundraiserJourney Through the Enchanted Forest Ga.docxpauline234567
JW House Fundraiser
Journey Through the Enchanted Forest Gala
Silent Auction
Table Decor
Specialized cocktails for Event
Three Screens will be Placed for Optimum Viewing by all Attendees
New House Announcement
Happy 30th Birthday, JW!
Auction
Isle down Center Allows Fundraising Auctioneer to Engage Audience
Balloon
Drop
S’mores Sponsored by Largest Corporate Donor
Finish the Evening with Dancing & Beverages
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1. INTRODUCTION. Begin by stating what you will discuss and explain why is important.
2. CRITICAL SUMMARY. Summarize the relevant views and the arguments that you believe are important.
Usually in a critical discussion it is not sufficient to merely summarize the author’s view. Your attention should be
focused on the author's development of the view--that is, on his arguments, in the broadest sense of the word.
3. CARE IN CITATIONS. Make sure you accurately state the position of the author and always include page
references for each quotation or attribution to her/him if applicable.
4. CRITICAL EVALUATION FROM A CHRISTIAN PERSPECTIVE. At least half of your paper must be devoted
to a critical evaluation of the views of the author you are discussing from the perspective of the Christian thesis that
a Christian call in business may prop-up the role of the markets.
5. CONSIDER POSSIBLE RESPONSES TO YOUR OBJECTIONS. Whenever you offer an objection to an
author's position, explicitly consider whether the author has said anythin.
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Meditrek NoteName J. C. Age 40yrs Purpose of Note InitialAbramMartino96
Meditrek Note
Name: J. C.
Age: 40yrs
Purpose of Note: Initial psychiatric evaluation
Chief complaint: Severe inattentiveness interfering with occupational functioning.
Diagnosis: F90.2 - Attention-deficit hyperactivity disorder, combined type.
Medical/Physical Disorders: None Psychosocial Stressors (formerly Axis IV):
Problems with: Axis I condition/mental health problem. Presenting Problem Inattentiveness hyperactivity and impulsivity MENTAL STATUS EXAMINATION & BEHAVIORAL OBSERVATIONS Appearance: Well-nourished, well-groomed, and developed and in no acute distress.
Behavior: Well-controlled with good eye contact. Psychomotor activity: Normal. Speech: The client spoke at a normal rate, rhythm, and tone. Volume: Normal.
Language: Unimpaired. Mood: Anxious, worried and slightly irritable.
Affect: Full ranging, mood congruent and appropriate. Thought Processes: Coherent, i.e., logical and goal directed.
Associations: There were no flight of ideas or ideas of reference.
Attention: Markedly impaired with impulsivity and inattentiveness increased distractibility
Thought Content: There were no hallucinations, delusions, phobias, or paranoia.
Orientation: Alert and oriented in all spheres, i.e., oriented to person, place, time and situation. Judgment/Insight: Adequate.
Suicidal Ideations: There were no active or passive suicidal ideations.
Homicidal Ideations: Denied.
Memory: Grossly intact without deficits.
Fund of Knowledge: Grossly average to high average.
Past Psychiatric History: [ADHD diagnosed as a child treated with Ritalin and Adderall until she became pregnant with her daughter. No history of inpatient psychiatric services or suicidal behavior].
Substance Use History: [Occasional drink of wine without any history of illicit drug use].
Family Psychiatric History: [ Sons with ADHD and other relatives with ADHD].
Past Medical History: None. Past Surgical History: [ Partial hysterectomy due to fibroids and dysfunctional uterine bleeding]. Allergies: No known drug allergies.
Medications: [ Multivitamins]. Psychosocial History: Patient was the product of a normal childbirth. Patient had no developmental delays. She was born and raised in Oxford England. She described her childhood as good but having to move around in a military family. Patient denied having any history of abuse or neglect. Patient is a high school graduate. Has a bachelor’s degree. She is currently married with 4 children 2 biological children and 2 stepchildren. She currently works in marketing however this job has been adversely affected due to her ADHD related symptoms.
History of Present Illness: This patient is self -referred reports being diagnosed with ADHDs as a child and was treated with Ritalin and Adderall until 2006, she discontinued her medications when she became pregnant with her daughter. The patient never undergone any inpatient psychiatric services and never engaged in any self-injurious or suicidal behavior. Patient continues to have dif ...
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
Initial Psychiatric SOAP Note TemplateThere are different ways i.docxpauline234567
Initial Psychiatric SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and
(Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
If Minor obtain Developmental Hx: (most often from parents), in utero, birth and delivery hx, early childhood, school hx, behavior, etc…
Nutritional status (this is an important component to gauge how well the mind and body are being nourished for full function. Ex: lack of iodine create thyroid issues, thyroid issues creates metabolism issues which affects function of cognition, mood, etc…)
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
.
2Assessing ClientsA comprehensive assessment of the patient who p.docxBHANU281672
2Assessing Clients“A comprehensive assessment of the patient who presents for psychotherapy is necessary to develop an appropriate treatment plan. This assessment is a relational process that sets the tone for subsequent sessions” (Wheeler, 2014, p. 131). As a future Psychiatric Mental Health Nurse Practitioner, it is essential to be able to accurately assess clients to determine whether yourtherapeutic approach would contribute to improved clinical outcomes. The purpose of this assignment is to select a client that was observed or counseled at my practicum site and completea comprehensive client assessment and genogram for the client selected.Comprehensive Client AssessmentDemographic information for the client chosen is as follows: The client is a 27-year-old African female who resides in Maryland. She is a single, heterosexual, mother of fraternal twins,a boy and a girl. She was referred by her psychiatrist to the current counselor for psychotherapy and is primarily followed by the psychiatrist for medication management. The client has been receiving psychotherapy for the past two years. Her presenting problem revolves around learning how to be independent while coping with her mental illness. She stated, “I need help with figuring out my finances.” History of present illness: Client has a history of bipolar and presented to the office with complaints about her “baby daddy” not wanting to help her out with their children and about how difficult it’s going to be when her cousin stops keeping her twins because daycare is expensive. She also expressed discontent towards her father interfering in herpsychiatric care because he shares the same Nigerian ethnicity as her psychiatrist and she wants to be on less medication and receives more psychotherapy. The client’s past psychiatric history includes two psychiatric hospitalizations for manic episodes with psychosis. Medical history includes a previous diagnosis of hypertension (HTN), but that diagnosis was later removed. The
3client never took any medications for HTN diagnosis, and HTN resolved through life modifiers. Currently takes Lithium and Cogentin. The client has no substance use history, and developmental milestones were reached as expected. No family psychiatric history reported. Psychosocial history: She currently lives with her father. Her youngest brother and cousin, who is married, also reside in the same house. She works a full-time minimum wage job and is recently single. She has been in contact with her ex-boyfriend who is trying to ‘hook up’ with her to have sex. She is the mother of fraternal twins, a boy and a girl. No history of abuse or trauma.Psychiatric Review of SystemsClient denies “shortness of breath, heart palpitations, panic attacks, sweating flushing, hyperventilation, sense of doom, fear of death or collapse, cold or clammy skin, and tingling sensations in extremities” (Wheeler, 2014, p. 140). Client denies feeling sad, irritable, tired, h.
Comprehensive Client Family Assessment and Genogram The client.docxmccormicknadine86
Comprehensive Client Family Assessment and Genogram
The client is a 24-year-old female, single, African America active duty, service member (SM). SM who resides in the barracks medication, SM MOS is 25U, signal support specialist (IT), SM recently completed basic training and Advanced Individual Training (AIT), before enlisting SM worked as Computer Specialist.
Presenting Problem: I do not know why I am here; I do not need to be here.”
History of Present illness: She appears slightly disheveled, tired, and generally irritable both in the lobby, with nursing staff, and once in the room. She is accompanied by an escort who remains throughout the visit.
Past Psychiatric history: Insomnia.
Medical History: None
Substance use History: denies
Developmental History: She who appears older than stated age, the client is disheveled, with noted body odor
Family Psychiatric history: no familial history
Maternal grandmother marijuana user, paternal grandmother incarcerated no further history. Father Diabetes, Mother HTN, one sister HTN, 1 Brother HTN
Psychosocial History: She states she was homeless before joining the Army National Guard, difficulty to find a job. She wants to go to college for nursing or IT.
History of abuse/Trauma: She reports two episodes of sexual harassment in 2012 in 2013 with no sexual assault but declines to provide more information: no article 15s or negative counseling statements related to her behavior.
Review of Systems:
General: She is alert and oriented x 1 self only B/P 100/60 59, 24, 97.7, 99% room air. Pain 0/10, Weight 153.
HEENT: no discharge intact, moist
Skin: warm and dry
Cardiovascular: no palpitations
Respiratory: no cough or rales or expiratory wheezing was noted neither was any adventitious sounds heard.
GI: No nausea, no vomiting, and no abdominal pain..
Genitourinary: She denies any burning upon urination and dribbling. No obstetrics or gynecology symptoms LMP states 05/01/2019
Neurological: She denies headaches, dizziness, and tingling in all her extremities.
Musculoskeletal: FULL ROM to all extremities
Psychiatric:
Allergies: No known medication/ food allergies
Mental Status Examination
Orientation: Alert and oriented to person
Appearance: in uniform, disheveled, mild body odor
Musculoskeletal: gait and station intact
Behavioral: Irritable/cooperative
Motor activity: appropriate
Speech: pressured, frenzied
Mood: euthymic
Affect: Irritated Restless
Thought content: No suicidal ideation, no homicidal ideation
Perceptions: denies auditory/visual hallucination exaggerated sense of self
Thought Process: illogical and irrational
Attention and Concentration: distracted
Remote and Recent Memory: able to recall the last 5 minutes
Judgment: delayed
Insight and Judgment: fragmented
Differential Diagnosis:
Schizophrenia: a brain disorder that affects how a person reason, feel, and perceive. The hallmark symptom of schizophrenia is psychosis, such as experiencing ...
NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the
Comprehensive Psychiatric Evaluation Template
AND the Rubric
as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
In the
Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use, social, and medical history
· Allergies
· ROS
·
Read rating descriptions to see the grading standards!
In the
Objective section, provide:
· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
·
Read rating descriptions to see the grading standards!
In the
Assessment section, provide:
· Results of the mental status examination,
presented in paragraph form.
· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
DSM-5 diagnostic criteria for each differential diagnosis and explain what
DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.
Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
·
Read rating descriptions to see the grading standards!
Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(The comprehensive evaluation is typically the
initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety sympt.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
Running head ASSIGNMENT 2 PRACTICUM – ASSESSING CLIENTS .docxhealdkathaleen
Running head: ASSIGNMENT 2: PRACTICUM – ASSESSING CLIENTS 1
10
ASSIGNMENT 2: PRACTICUM – ASSESSING CLIENTS
Assignment 2: Practicum – Assessing Clients
Part 1: Comprehensive Client Family Assessment
Demographic information: T.C is a 73 years old African American male who was admitted after being discharged from another local hospital.
Presenting problem: The patient’s present problem is increased psychosis with auditory hallucination (AH).
History or present illness: The patient has a history of multiple hospitalizations, of which he refused to give further details. He was however diagnosed with increased psychosis with auditory hallucination and reports of being capable of hurting himself and others. He was planning to harm himself with an ice pick on the neck. He claims that he has been having auditory hallucinations telling him to harm himself. He was unable to state the onset of the symptoms of the presenting illness. He was not cooperating with the clinician.
Past psychiatric history: The patient has a history of multiple hospitalizations, which he refused to discuss further.
Diagnoses: Chronic mental illness
Suicidal gestures or attempts: None
Medical history: Cerebrovascular accident (CVA), Hypertension (HTN), chronic obstructive pulmonary disease(COPD), Seizure, Congestive heart failure (CHF).
Surgical history: None
Allergies: No known drug allergies
Current Medication:
· Aspirin oral 81 mg TC, PO daily for the management of CAD
· Rivaroxaban oral 10mg tablets PO daily for the management of CAV/MI
Substance use history: The patient claims to be using cocaine as much as he can, once a month. He claims to have started using the drug when he was 19 years old. He, however, refused to give the last day that he used the drug. He also smokes marijuana once a day and started using it when he was 17 years old. He smokes cigarettes at least 3 to 4 times a day.
Developmental history: The patient is a 73-year-old African American male. He is homeless. He is a Christian. His past daily activities include playing soccer and taking an active role in community services. All his early motor, social, language in addition to emotional milestones were within normal limits before being diagnosed with a psychological disorder.
Family psychiatric history: Negative family psychiatric history. There is no known history of any of the family members suffering from any psychiatric disorder, or under psychiatric medications or hospitalization. No other family member has ever displayed suicidal behavior or substance abuse.
Psychosocial history: The patient has a history of chronic mental illness and is non-compliant to medical treatment.
History of abuse/trauma: The patient has no reported history of abuse or trauma.
Review of systems:
General: No weight change, generally appears to be confused. He presented with poor insight and unable to respond to most questions during an assessment. He does not exercise as much as he used to.
Sk ...
Brook Grove Treatment Center7433 West Embers PathRed Lea.docxhartrobert670
Brook Grove Treatment Center
7433 West Embers Path
Red Leaf Cove
Summary Record Report
Client
Jeannie Smith
Case
456789
DOB
07/08/1962
Unit
15
Summary of Findings
Interviewer summary of findings (add details where appropriate)
Clinical Summary
Clinical summary
Impressions
Recommendations
Case Manager Signature
Date
1 | Intake Assessment Form
The objective function always includes all of the decision variables, but that is not necessarily true of the constraints. Explain the difference between the objective function and the constraints. Then, explain why a constraint need not refer to all the variables.
1 | I n t a k e A s s e s s m e n t F o r m
Brook Grove Treatment Center
7433 West Embers Path
Red Leaf Cove
Intake Assessment Form
Client Jeannie Smith Case 456789
DOB 07/08/1962 Unit 15
Date of assessment 08/05/2012
Presenting problem Jeannie is a 50 year old woman who came in because she was struggling with
depression. She said her husband of 20 years was an alcoholic and a batterer.
She said her main reason for coming in was because of her marriage but when
questioned she said that she drank vodka on a daily basis but could stop
whenever she wanted too. She reported that she had used drugs on a heavy
basis when she was in college but denied use now. She said she had taken over
the counter diet pills but was not concerned about that. She denied blackouts
but said she was scared about her health because she said sometimes when
she drank she had heart palpitations. She also admitted to hiding liquor but
said she did this so her kids wouldn’t find it.
Current client
involvement with
other agencies
Agency/contact – None reported
Phone/email
Service
Date
Assessment of life circumstances
Family
She has 3 children but they were still young and not a support for her. She
denied any other support.
Social She reported that she is pretty isolated and only stays at home with her
children.
Support She denied any other support.
Legal Jeannie reported never having any legal issues.
Education
She said she had a B.S. degree and a teacher’s certification. She had started
work on a Master’s degree but did not finish. She said school was her only
outlet.
Occupation
Jeannie is a teacher who reported that she was recently laid off. She was
unable to get another job.
Finances She reported no financial difficulties.
Psychosocial and
environmental
She said the only problem was her ex abusive husband but she was not
concerned.
Current medical
conditions
Condition – Anorexia
Physician/provider – Dr. Max Jones
Treatment – Counseling
2 | I n t a k e A s s e s s m e n t F o r m
Condition – Heart palpitations
Physician/provider – Did not see a doctor
Treatment – Not currently treated
Pregnant If yes, receiving care? N/A
Primary care physician
Dr. Janey Baker
Current medications Medication ...
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JW House Fundraiser
Journey Through the Enchanted Forest Gala
Silent Auction
Table Decor
Specialized cocktails for Event
Three Screens will be Placed for Optimum Viewing by all Attendees
New House Announcement
Happy 30th Birthday, JW!
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S’mores Sponsored by Largest Corporate Donor
Finish the Evening with Dancing & Beverages
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1. INTRODUCTION. Begin by stating what you will discuss and explain why is important.
2. CRITICAL SUMMARY. Summarize the relevant views and the arguments that you believe are important.
Usually in a critical discussion it is not sufficient to merely summarize the author’s view. Your attention should be
focused on the author's development of the view--that is, on his arguments, in the broadest sense of the word.
3. CARE IN CITATIONS. Make sure you accurately state the position of the author and always include page
references for each quotation or attribution to her/him if applicable.
4. CRITICAL EVALUATION FROM A CHRISTIAN PERSPECTIVE. At least half of your paper must be devoted
to a critical evaluation of the views of the author you are discussing from the perspective of the Christian thesis that
a Christian call in business may prop-up the role of the markets.
5. CONSIDER POSSIBLE RESPONSES TO YOUR OBJECTIONS. Whenever you offer an objection to an
author's position, explicitly consider whether the author has said anythin.
JP Morgan Chase The Balance Between Serving Customers and Maxim.docxpauline234567
JP Morgan Chase: The Balance Between Serving Customers and Maximizing Shareholder Wealth
Penelope Bender
William Woods University
BUS 585: Integrated Studies in Business Administration
Dr. Leathers
Abstract
This paper investigates why JP Morgan Chase and other financial institutions struggle to balance client interests over maximizing wealth.
It is an exploratory study done through literature review.
Often financial institutions, like JP Morgan, put profits ahead of the interests of those they serve.
The paper contributes to better understanding of corporate culture.
This paper investigates why JP Morgan Chase and other financial institutions struggle to balance client interests over maximizing shareholder wealth. This exploratory study is done through a literature review to answer why financial institutions, specifically JP Morgan, often put profits ahead of those they serve. The study will provide evidence of the complex nature of balancing client interests over maximizing shareholder and individual wealth and the need for tighter internal and external oversight. This paper contributes to a better understanding of why corporate culture encourages profit over stakeholders’ interests.
2
Research Question
Why does JP Morgan Chase and other financial institutions struggle to balance client interests over maximizing shareholder wealth?
Employees of JP Morgan Chase and other large banks work in their best interests to increase wealth and succeed by meeting management goals. However, because of the complex nature of large banks, an individual(s), unethical behavior can go unchecked.
3
Problem Statement
JP Morgan Chase competes globally and faces competition from other large banks in the US and abroad.
JP Morgan Chase is part of a complex system of regulation, self-interests, and wealth creation.
The interests of shareholders and investors is sometimes overshadowed by agents working in their own best interests.
Financial markets are a complex web of interests, and because of opportunities for individual profits, regulating individual’s actions without stricter regulations and internal oversight is impossible.
The study is not meant to be a moral or ethical analysis but merely why the complex relationship exists and will continue to exist in capitalist society. This paper contributes to a better understanding of why capitalism or financialism’s (Clarke, 2014) fundamentals encourage wealth creation. Financial markets are a complex web of interests, and because of opportunities for individual profits, regulating individual’s actions without stricter regulations and internal oversight is impossible.
4
Literature Review
The literature review showed a connection between self-interests, regulators, competition, and risk, which all lead to a complex system of conflicting agendas.
5
How Self-Interests Influence Behavior
Ross (1973) explains that all employment relationships are agency relationships and moral hazards are generally .
Interpret a Current Policy of Three CountriesInstructionsAs .docxpauline234567
Interpret a Current Policy of Three Countries
Instructions
As a scholar in public administration, you are asked to present options based on three different countries' information for the next congressional meeting in your state. Be sure to include the following information:
• Perform a SWOT analysis of each immigration system presenting the strengths, weaknesses, opportunities, and threats of each system. You are required to evaluate the United States' system but may choose two other countries besides Costa Rica and Ghana as these were already covered in your weekly resources. Topics such as ethics, history, actors, budgeting can be incorporated into your SWOT analysis.
• Facilitate an immigration benefit analysis for each system to determine the best fit for your state (be sure to identify your state to provide context for your presentation).
• Prepare a plan for the implementation of your chosen immigration program.
Compare how the immigration system is treated in three countries (the U.S. and two other countries).
Length: 12 to 15 pages, not including title and reference pages
References: Include a minimum of seven scholarly references.
The completed assignment should address all the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations, and current APA standards.
Respond to
two or more of your colleagues’ posts in one or more of the following ways:
(100 words each Colleague)
· Ask a question about or provide an additional suggestion for the risks that your colleague’s organization might face if it engaged in the capital investment project.
· Provide an additional perspective on the level of risk associated with the project your colleague identified for their selected organization or on how willing/capable the organization might be in taking on and managing the risks your colleague identified.
· Offer an insight you gained from your colleague’s summary of the trade-offs between risks and returns and/or their recommendation for their selected organization to move or not move forward with the project.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you have learned or any insights you have gained as a result of the comments your colleagues made.
1st Colleague to respond to:
The risks associated with a capital investment project for medical equipment for healthcare organizations such as hospitals, as discussed in Week 7, are listed below.
· An inadequate system of budget management caused by unethical conduct.
· The lack of a clearly defined internal process management framework
· Insufficient communication channels within the organization.
The information provided by the managerial accountant assists in making crucial business decisions. Thus, if such information is fabricat.
INTRODUCTIONWhen you think of surveillance, you may picture tw.docxpauline234567
INTRODUCTION
When you think of surveillance, you may picture two police officers camped out in an unmarked car, watching the comings and goings at a suspect’s apartment building. Or you may imagine an investigator trailing a car on the highway or tapping a suspect’s phone to listen in on potentially incriminating conversations. Surveillance is all these activities, but in the 21st century, it is also much more.
Consider video surveillance of local businesses, streets, and highways; cell phone data; and the reams and reams of digital information gathered on everyday activities—from social media and computer use to credit card transactions.
This week, you analyze concerns related to this new era of surveillance, such as privacy and legal requirements.
LEARNING OBJECTIVES
Students will:
Analyze issues related to privacy and surveillance
Describe surveillance
Differentiate between legal and illegal surveillance
Analyze legal requirements for conducting surveillance
PRIVACY VERSUS PUBLIC SAFETY
The average citizen today may feel as though they are constantly being watched and their actions recorded. And perhaps rightly so. After all, social media sites market personalized products based on how you use the Internet, cell phones pinpoint your location, and fitness trackers transmit your health and fitness activities to the cloud. This sense of being “spied on,” however, does not negate the important use of surveillance techniques in solving and preventing crime.
For this Discussion, you analyze how to balance two sometimes opposing sides in surveillance work: the expectation of privacy and the goal of public safety.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
YOU WILL FIND THE READING FOR THIS ASSIGNMENT IN THE ATTACHED READING MATERIALS PLEASE GO THERE AND READ BEFORE TRYING TO COMPLETE THIS ASSIGNMENT SO YOU WILL UNDERSTAND WHAT IS NEEDED TO COMPLETE THE WORK….
Post a response to the following:
When conducting surveillance, explain how to balance an expectation of citizen privacy with legitimate investigative procedure that has public safety as its goal.
Explain whether citizens should differentiate between government intrusion and private companies who use citizens’ online data to surveil their movements and activity.
.
Interviews and Eyewitness Identifications AP PhotoMat.docxpauline234567
Interviews and
Eyewitness
Identifications
AP Photo/Matthew Apgar
OBJECTIVES
After reading this chapter you will be able to:
• Identify the evidence collected
by investigators in the BP
gas station robbery and
discuss its role in the
identification and apprehension
of the perpetrator.
• Discuss the advantages and
disadvantages of using facial
identification software and
forensic sketches to create
composite pictures of
suspects.
• Identify and discuss the
rationale of the recommended
lineup procedures.
• Discuss the research that
has been conducted on the
accuracy of hypnotically elicited
testimony. • Identify the difference between
primary and secondary
witnesses and give an example
of each.
• Discuss the value of eyewitness
identifications in establishing
proof. • Compare and contrast the
cognitive interviewing approach
with standard police interviews.
• Identify and discuss the
methods of eyewitness
identifications.
• Identify the three phases of
human memory and discuss
how factors at each phase
may affect the retrieval of
information from witnesses.
• Discuss the contributions
of cognitive interviewing in
enhancing memory recall.
From the CASE FILE
BP Gas Station Robbery
The introduction to this chapter consists of a police
report (edited for length) of the investigation of an
armed robbery of a British Petroleum (BP) gas station
that occurred on August 22, 2011, in Germantown,
Wisconsin (a suburb of Milwaukee). The report serves
as an example of a criminal investigation case report
and also highlights issues discussed in this chapter,
such as the value of eyewitness identification. Issues
discussed in other chapters, including the important
role of patrol officers in investigations, crime scene
photographs, investigation of robbery and auto theft,
and the value of DNA, are also present in this report.
Incident Report Number: 11-014277,
Report of Officer Toni Olson
On Monday, August 22, 2011, I, Officer Olson, was
assigned to investigate and respond to a robbery, which
had just occurred at the County Line BP, located at 21962
County Line Road. Officers were advised that the c I erk at
the BP gas station had called the non-emergency number
reporting that a younger wh ite male came into the store and
hit him over the head with an unknown object before taking
money out of his cash drawer and leaving in a red SUV or
truck, northbound on Bell Road. A possible registration
of 583RIB was given out for the suspect vehicle. I, along
with Lt. Huesemann, Officer Brian Ball, and Officer Daniel
Moschea of the Germantown Police Department responded.
Upon arriving on scene, officers were advised that witnesses
reported the suspect veh icle leaving the scene of the
robbery northbound on Bell Road into a subdivision. The
witnesses also stated that they had not seen the suspect
vehicle leave the subdivision, which only has two ways to get
in and.
Interview Presentation: Questions
To prepare:
· Identify an interview subject with a different cultural background than you.
· Ask your interview subject the questions below. Be sure to record the interview and/or take good notes.
During the interview, ask the individual the following interview questions:
· Have you ever lived or visited outside of the United States? If so, where? Describe the experience.
· What do you identify as your culture?
· What are the most important values and beliefs of your family and community?
· What are the important events, traditions, celebrations, and practices in your family or community?
· How does your family or community define gender roles?
· How do you identify your:
· Race
· Ethnicity
· National origin
· Color
· Sex
· Sexual orientation
· Gender identity or expression
· Age
· Marital status
· Political belief
· Religion
· Immigration status
· Disability status
· How well do you fit within your family or community based on these other identities you hold?
· How do you think others outside your community view your culture?
· Have you experienced prejudice or discrimination? Please describe.
Social Media and Ethical Considerations
Walden’s MSW Social Media Policy
A student’s presence on and use of social media reflects on the MSW program and the social
work profession; therefore, behavior on social media will be held to the same professional
standards and student code of conduct expectations. Social Work professionals, including
students, are expected to adhere to the NASW Code of Ethics related to virtual communications.
Students should use social work values and principles, as well as specific agency policy, to guide
their social media interactions.
Students need to consider the ethical consequences of their own social media use, as well as use
of social media in practice. Be aware of and follow agency policies regarding the use of social
media. Before using social media communication tools on behalf of a field agency, students
must seek agency approval of any messages or posts.
Walden MSW students are expected to adhere to the ethical standards outlined in the NASW
Code of Ethics. Common ethical issues that social workers need to understand and manage when
utilizing social media include, but are not limited to, privacy and confidentiality (Section 1.07),
conflicts of interest and dual relationships (Section 1.06), and informed consent (Section 1.03).
There is significant risk of unintentionally sharing protected information when using social
media. Be cautious when posting information about an agency. Never post confidential or
private information about clients or colleagues, even using pseudonyms.
Students need to remain aware of professional boundaries even when participating in social
media in their personal time. Managing “friend” requests and maintaining privacy settings is
critical regardless of whether a student uses social me.
INT 220 Business Brief Template Course Project.docxpauline234567
INT 220 Business Brief Template
Course Project
Section One: Drivers for Global Entry
Going global would afford the company many benefits including increased sales and revenues. Japan is a developed market and thus the purchasing power of the consumers is high, which implies that many consumers will be able to purchase our products. Expanding to Japan will enable increased profits that can be reinvested in research and development of new technology and innovation that will create a competitive advantage for both domestic and international market. In addition, entering the foreign market will help the business to tap into new market segment. According to International Data Corporation (IDC), Apple was the largest smartphone brand in 2020 in Japan with a 47.3 percent market share (Sudarshan, 2021). The data shows that Japan would be an ideal market for quality phone cell cases due to high purchase of smartphones. Therefore, the company will benefit from increased sales and profits.
Section Two: Market Profile
Cultural Profile
CategoryUnited StatesJapan
Commonly Spoken Languages
English
Japanese
Commonly Practiced Religions
Christianity
Shinto
Power Distance Index (PDI)
40
54
Individualism Versus Collectivism (IDV)
91
46
Masculinity Versus Femininity (MAS)
95
62
Uncertainty Avoidance Index (UAI)
92
46
Long-Term Orientation Versus Short-Term Normative Orientation (LTO)
88
26
Indulgence Versus Restraint (IVR)
42
68
Political and Economic Profile
CategoryUnited StatesJapan
Political System
Representative democracy
Constitutional monarchy
Current Leaders
Joseph Biden president
Fumio Kishida prime minister
Economic Classification
Developed
Developed
Economic Blocs Impacting Trade
World trade organization
World trade organization
Gross Domestic Product
23 trillion USD
4.9 trillion USD
Purchasing Power Parity
22,996.08
100.412
Gross Domestic Product Per Capita
69,287.54 USD
39,285.16 USD
Human Development Index
Very high 0.921
0.919
Human Poverty Index
$26,246 for a family of four
Poverty headcount ratio at $5.50 a day
In terms of economic development, both countries have developed economy, thus making them ideal for business. Consumers have high purchasing power which means that they are able to purchase new products. US has a higher GPD compared to Japan, however, this can be attributed to the size and population of U.S. compared to that of Japan. Furthermore, both countries are members of World Trade Organization, which means that their trade operations with other nations are regulated and subject to WTO regulations. The culture in Japan is hugely different then the culture in America. Americans are self-motivated while the Japanese culture embraces more of a group mentality and looks for approval from their superiors before making big decision. Both cultures work long hours and take very little breaks. For the most part Japanese culture is more formal in the work place then in the U.S.
Section Three: Market Consideratio.
Instructor Name Point Value 30Student NameCATEGORY .docxpauline234567
Instructor Name: Point Value: 30
Student Name:
CATEGORY Excellent (12–11 points) Good (10–9 points) Fair (8–7 points) Poor (6–1 points) Did Not Complete (0 points) # of points
Content Quality
40% of total Discussion
grade
Student participated in the
Discussion about the presented
topic with detailed, relevant,
supported initial posts and
responses. Student enhanced
points with examples and
questions that helped further
discussion. Discussion is well
organized, uses scholarly tone,
follows APA style, uses original
writing and proper paraphrasing,
contains very few or no writing
and/or spelling errors, and is fully
consistent with graduate-level
writing style. Discussion contains
multiple, appropriate and
exemplary sources
expected/required for the
assignment.
Student participated in the
Discussion about the presented
topic with detailed, relevant,
supported initial posts and
responses. Discussion is mostly
consistent with graduate level
writing style. Discussion may have
some small or infrequent
organization, scholarly tone, or
APA style issues, and/or may
contain a few writing and spelling
errors, and/or somewhat less than
the expected number of or type of
sources.
Student participated in the
Discussion about the presented
topic with adequate content but
the content lacked either detail,
relevancy, or support. Discussion
is somewhat below graduate level
writing style, with multiple smaller
or a few major problems.
Discussion may be lacking in
organization, scholarly tone, APA
style, and/or contain many writing
and/or spelling errors, or shows
moderate reliance on quoting vs.
original writing and paraphrasing.
Discussion may contain inferior
resources (number or quality).
Content of student's post and
responses was not clear, relevant,
or supported. Discussion is well
below graduate level writing style
expectations for organization,
scholarly tone, APA style, and
writing, or relies excessively on
quoting. Discussion may contain
few or no quality resources.
Student did not submit a post or
response.
CATEGORY Excellent (12–11 points) Good (10–9 points) Fair (8–7 points) Poor (6–1 points) Did Not Complete (0 points) # of points
Engagement
40% of total Discussion
grade
Student participated actively as
evidenced by strong reflective
thought in both the initial post and
in responses to classmates' posts.
Student response participation
exceeded the stated minimum
requirements.
Student participated actively as
evidenced by strong reflective
thought in both the initial post and
in responses to classmates'
posts.Student responses
contributed to classmates'
experience.
Student participated somewhat
actively as evidenced by posts
and responses that were adequate
but lacking strong reflective
thought.
Student did not participate actively
as evidenced by little reflective
thought in i.
InstructionsThere are two high-level types of distribution cha.docxpauline234567
Instructions
There are two high-level types of distribution channels, direct and indirect. In the direct distribution channel, goods are moved directly from the Producer to the Consumer. In the indirect distribution channel, the producer will meet consumer demand through third -party wholesalers and/or retailers. Direct channels produce short supply chains, indirect channels produce long chains.
Research and report on two large producers, Costco and Apple, and describe in detail which distribution approach each company uses -- direct, indirect, or mixed – for at least two products in each company.
Your APA paper should be at least 1,000 words in length.
.
InstructionsNOTE If you have already reviewed this presentation.docxpauline234567
Instructions
NOTE: If you have already reviewed this presentation in a different class please enter class number and instructor’s name in the submission text box below.
____________________________________________________________________
If you have not reviewed this presentation in a previous class, please proceed.
Please review the curated presentations below. These presentations will prepare you for writing deliverables that meet the expectations of this course. We want you to be successful in all your courses so please refer back to this tool often. This presentation is located in the library and the Student Center. To view an presentation, please click on the button below. Be sure to review all five presentations for this week!
Presentation Four: The Research Process & Choosing a Topic
Presentation Five: Types of Sources
Presentation Six: Search Strategies & Techniques
Presentation Seven: Evaluating Information
Presentation Eight: Ready to Shine!
When you have finished reviewing all five presentations, please copy and paste the following statement into the submission box below:
STATEMENT: I HAVE REVIEWED WEEK TWO INFORMATIONAL PRESENTATION. I UNDERSTAND THIS PRESENTATION IS ALSO LOCATED IN THE LIBRARY AND STUDENT CENTER FOR FUTURE REFERENCE.
.
InstructionsRead two of your colleagues’ postings from the Di.docxpauline234567
Instructions:
Read two of your colleagues’ postings from the Discussion question.
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two of your colleagues.
Timia Brown (
She/Her)
In healthcare, whether long-term or acute care, interdisciplinary communication is necessary to provide patient-centered care. The two scenarios provided both effective and ineffective communication.
Scenario 1
Assuming the leader for the interdisciplinary rounds was the case manager, she introduced the nursing student, who was not paying attention. The case manager did not present other team members, so the student was left guessing. The pharmacist and the physical therapist were laughing and talking during the discussion. There was no engagement; the MD was on her phone, and everyone was preoccupied. Each team member individually knew the patient and his shortcomings, yet there was no preparation for the actual engagement with each other. Each team member projected issues onto the next member, using terms such as "somebody" or "someone" needed to do this. There was no responsibility for care. The team spoke unprofessionally to each other, using words like "yep" and "umm." In the end, the case manager assigned responsibility; however, the disciplines accepted the responsibility grudgingly. The team's disrespect for each other was portrayed to the student, who was disengaged throughout the meeting. The patient was not ready to be discharged from the sound of this scenario. The patient's pain was not controlled, nor was his anxiety; no equipment had been ordered for discharge. The patient's safety was not a priority in this meeting, which could lead to readmission or fall risk at home.
In scenario two, the team all appeared happy to be there, with smiling faces and excellent eye contact. The leader engaged the nursing student immediately by having the team introduce themself. The team was much more prepared and engaged. Each member respected the other's role in providing care and a safe, patient-centered discharge. The team took responsibility for what was needed from each of them now and at the time of release. The communication was more two-way communication. They did a recap of what was discussed, and everyone willingly took part in making sure the patient went home safely and confidently.
Effective communication between interdisciplinary teams must be present to provide the care needed for each patient. It starts with respecting each other's role in the patient's care and remembering the patient is the priority. The
Journal of Communication in Healthcare stated the leading cause of all sentinel events from 1995 to 2004 was ineffective communication. (2019, Altabba) Therefore effective communication could decrease the number of incidents, and lead to proper care.
References
Altabbaa G, Kaba A, Beran TN. Moving from structure.
InstructionsRespond to your colleagues. Respond with a comment .docxpauline234567
Instructions:
Respond to your colleagues. Respond with a comment that asks for clarification, supports, or contributes additional information to two or more of your colleagues.
Reynaldo Guerra
As influencers in our society, that bring about social change in healthcare as all those we contact, the type of agent I would align with is a Purposeful Participant. Where "School or work are the primary motivations for involvement in positive social change." (
What kind of social change agent are you? n.d.) are what defines greatly the type of agent I am. Due to my desire to expand my education and grow, I have been allowed to not just see but know that I can contribute to various aspects of healthcare. At the hospital I currently am employed, many principles are introduced to us and help us with making a difference for our patients as all professionals alike by the way we interact and the relationship we create with everyone. Even if driven by these two motivators, they have opened my eyes and expanded my limitations in the change we can bring about.
This eye-opening experience has changed my perspective on how I can make a social change with all those around me. I now feel that a cascade effect comes from my changes as little as it might seem, it gets passed down and impact larger changes in the long run. How I speak with my patients and show the advocate I am for them in addressing their healthcare issues with importance, to the trust and relationship I have created with the primary care providers, goes to show these small social changes can in the end bring a great change for all. This has shown me that social change has a larger purpose in the end and even as small of a change we bring about, if we all come together and do the same, the results would be even more significant than what we perceived as a small change in the beginning. From our professional interactions with one another to our desire to help and better our care with all patients alike, these changes have a great purpose and impact on our future as everyone else.
Apart from that, social change has influenced my education by motivating me to seek ways to make a difference in a community project presented by my university. It has ignited a flame in me, so to speak, and piqued my interest in seeing what my university has to offer in making a social change. Whether this is by being part of projects, joining a committee, or being part of future alumni programs to help others. Also, being able to refine my nursing practice in our community as in the hospital has been a change for me. This, in turn, will be put forth in the interactions and relationships I create with my patients, colleagues, peers, and others I come in contact with, hopefully, bringing a social change in the end. This is what the principles of social change will bring about for me.
References
Walden University. (n.d.).
What kind of social change agent are you? Lin.
Instructions
Procurement Outsourcing (PO) Strategies:
PO strategies at the highest level involve either materials or traditional business processes such as HR, IT, Finance, Accounting, Travel/Entertainment services, Marketing/Print/Advertising, or Customer Relationship Management (CRM). Your task here is to choose a public business organization and report on what direct materials are being outsourced. Direct materials are categorized as strategic (high-impact), bottleneck items (low-profit impact and high-supply risk), leverage items (high-profit items and low-supply risk), or non-critical (low-profit impact and low-supply risk). Describe the outsource process in detail, who provided the outsourced services, and what direct materials were involved.
You are to prepare a PowerPoint presentation, with a minimum of twelve (12) slides, to include inline citations, a cover slide, and a slide of references. Your citations and references should be APA-compliant.
Level of writing: Exemplary
.
InstructionsPart Four of Applied Final Project,Playing with Ge.docxpauline234567
Instructions
Part Four of Applied Final Project,Playing with Gender: Understanding Our Gendered Selves:
"Understanding My Playing-with-Gender Act" (20% of course grade; due end of Week 7) Five (5) pages (1200-1500 words)
All parts of this project should be formatted in APA style (follow for both essay and citation styles):https://libguides.umgc.edu/c.php?g=1003870
Purpose: Act Analysis
In this part of the assignment, you will perform, describe, and analyze your act. After you perform your act, compose a 5-page (1200-1500 words) task specifying your experiences. The first section (one-third to one-half of your paper) should describe your act and your responses to it, and the second section should analyze your act in terms of the scholarship on gender:
Section One (minimum 500 words):
1. Describe your act:
2. What did you do?
3. Where did you do it?
4. How did you prepare for it?
5. What responses did you get while performing your act?
6. How did you feel while performing your act?
7. What would you do differently if you had to perform this same act again? Would you perform the act in the same location and at same time? Would you change your appearance during the act? Would you do anything else differently?
8. Please refer directly to the required reading on Participant Observation (Mack et al., 2005) in this section of the paper (Mack et al., 2005) (
PLEASE see attached for document):
Mack et al. (2005). "Module Two: Participant Observation," from
Qualitative Research Methods: A Data Collector's Field Guide, Family Health International. Read Module 2, pages 13-27. Retrieved from
https://www.fhi360.org/sites/default/files/media/documents/Qualitative%20Research%20Methods%20-%20A%20Data%20Collector's%20Field%20Guide.pdf
Section Two: (minimum 700 words):
(Please see attached for document listing the sources)
Referring directly to at least three academic sources for support (these may be pulled from the sources you identified and discussed in your Annotated Bibliography for Part 3
and/or the readings for this class), consider the potential impact of your act. Here are some questions to consider (you do not have to answer all of these questions; they are provided to help you to think about ways your act may have impact on society):
· Can you explain the range of reactions to your act? Did those reactions reflect any of the sociological scholarship found in the course readings or in your research? Did any of the reactions challenge that research?
· How do you think class, race, age, and sexuality came into play during the conception and performance of the act?
· Was performing this act an act of feminism? Why? and, if so, what type(s) of feminism?
· Was your act an act of activism? That is, could it help to create social change? If so, how?
Please see attached for Project 1, 2 & 3 for information and assistance.
Qualitative
Research
Methods:
A DATA CO L L E.
InstructionsClients come to MFTs because they want to change, .docxpauline234567
Instructions
Clients come to MFTs because they want to change, whether the change is in cognitions, structure, insight, or something else. Therefore, it is important for you to understanding why, when, and how people change. This week, you will continue the exploration of core concepts related to systems theory and its application to MFT field concepts. You will review several concepts associated with change including homeostasis, first-order change, second-order change, continuous change, and discontinuous change.
Complete the provided worksheet template located in this week’s resources. Note: You will use the worksheet you complete this week as part of your work in Week 4.
For each item, be sure to address the following:
· Record a direct quotation that defines the concept or describes the assumption.
· Paraphrase the definition or description by explaining the information in your own words. As you are paraphrasing, keep in mind that concepts often involve several interrelated ideas. When you are paraphrasing, be sure to not oversimplify the concept.
· Provide an original example (not one you read about in the course resources) of the concept or assumption.
· Explain how your example reflects the definition. Refer to your paraphrased definition in order to compare the example to the concept.
Should you have questions or need clarification on any items, please contact your professor to discuss it.
Length: 1-2 pages (completed template). Additional resources/reference page is not required.
Your cheat sheet should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Be sure to adhere to Northcentral University's Academic Integrity Policy.
Upload your document, and then click the
Submit to Dropbox button.
Building Blocks to Conceptualizing Family: A Family System’s Perspective Valerie Q. Glass, PhD, LMFT
Background of Systemic Thinking
Systemic thinking, for some, means trying on a new and unique lens when considering “presenting problems” that arise in therapeutic settings. Most mental and emotional health backgrounds study individual cognitive and emotional processes, systemic thinking means a shift in looking at one person to looking at a whole system. Keeney (1983) calls this change in professional theory an epistemological shift. Epistemology, most basically, is the way one understands what is in front of them, and the root with which decisions are made. Helping fields all develop from different epistemologies. Psychiatry views medicine and biology as their epistemological construct of how or why people act the way they do. Much of the epistemological focus of social work fields embraces the necessity or connecting to resources and social support as a catalyst for change. Psychology explores the make-up of the individual’s mind and develops steps for change. Family systems, and.
INST560, Internet of Things (IoT)UNIVERSITY OF NORTH AMERICA.docxpauline234567
INST560, Internet of Things (IoT)
UNIVERSITY OF NORTH AMERICA
Lecture 3: Fall 2022
Professor Aliakbar Jalali
[email protected]
1
Internet of Things Enabling Technologies
/59
UoNA-ST560-FALL-2022, Internet of Things (IoT)
Overview
Introduction
Evolution of the Technology
Some significant statistics
IoT Technology
Risks of IoT Technologies
Use Cases of IoT Technology!
What are IoT Enabling Technology
Conclusion
References
2
/59
UoNA-ST560-FALL-2022, Internet of Things (IoT)
Introduction
Because of technological changes taking place in the world, IoT is gradually taking over all the fields, and the future of the IoT applications are increasing day by day.
Technological advances are fueling the growth of IoT.
Technology improved communications and network, new sensors of various kinds; cheaper, denser, more reliable, and power efficient storage both in the cloud and locally are converging to enable new types of IoT based products that were not possible a few years ago.
IoT technology will further develop to make our day-to-day operations much easier and more remotely controlled in the days to come.
3
/59
UoNA-ST560-FALL-2022, Internet of Things (IoT)
Introduction
Businesses need to constantly explore IoT applications within their domain to stay ahead in competitiveness and implementation.
The competition will primarily define in the coming decade as how companies take advantage of innovative technology.
However, it is the dominant technology that determines the future of many businesses attached to the future of the internet of things (IoT).
4
/59
UoNA-ST560-FALL-2022, Internet of Things (IoT)
Introduction
The emerging trends in IoT are majorly driven by technologies like artificial intelligence, blockchain, 5G and edge computing.
We need to know more in detail about the elements that make up broad spectrum of technologies, we know as the Internet of Things.
Technological advances lies in the business value of IoT applications like smart wearables, smart homes and buildings, smart cities, autonomous cars, smart factories, location trackers, wireless sensors and much more.
5
/59
UoNA-ST560-FALL-2022, Internet of Things (IoT)
Introduction: Technology is changing the world!
Technology is changing the world.
It is changing the way we communicate, shop, learn, travel, play and of course the way we work.
http://www.telegraph.co.uk/technology/2017/05/06/internet-things-could-really-change-way-live/
6
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UoNA-ST560-FALL-2022, Internet of Things (IoT)
6
Introduction: Technology is changing the world!
7
Global gigabit subscriptions are expected to jump to 50 million in 2022, more than doubling from 24 million at the end of 2020, according to a new report from analyst firm Omdia.
High Speed Internet!
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UoNA-ST560-FALL-2022, Internet of Things (IoT)
Introduction: Social Media is Changing societies!
8
Are you on social media a lot? When is the last time you checked Twitter, Facebook, or Instagram? Last n.
Insert Prename, Surname of all studentsWinter Term 202223Theo.docxpauline234567
Insert Prename, Surname of all students
Winter Term 2022/23
Theory Factsheet: Insert name of theory
Level of analysis
Insert levels of analysis, e.g., organisation, individual, social
Dependent construct(s)
Please insert the dependent construct(s) of the theory
Independent construct(s)
Please insert the independent construct(s) of the theory
Short description of the theory
Please describe the theory in full sentences.
Cause-Effect Model
Please insert a visual diagram of the cause-effect relationships or factor model of the theory (if available).
Applications of the theory
Please describe for which purposes / in which fields the theory has been applied.
Which relevance does the theory have for digitalization in organizations?
Criticism
Describe alternative views, potential critique, and open discussion on the theory.
References
Insert sources and references used in this factsheet in APA 7th style.
Students will write a 2-3 pages essay analyzing one of the topics addressed during the semester under the section of Contemporary Issues: Human Rights. The student will be free to choose any of the topics discussed during class as well as his/her opinion about it.
1. Choose a topic (death penalty, assisted suicide, abortion, death by euthanasia, bioethics… etc.)
2. First page: description of the problem (is is here Fl, or national or worlwide, statistics, etc)
Second page: YOUR ETHICAL POSITION ABOUT IT (why is this an ethical issue, where your argument os coming from, etc)
3. REFERENCES (could be ppt, movie, article, web, book)
The writing will be evaluated for clarity and proper handling of terms, phrases, and concepts addressed up to this date. APA or MLA style will be required
https://owl.english.purdue.edu/owl/section/2/10/.
Reading listWinter semester 2022/23
Version 24.09.2022
Reading
Package
No.
Theories Papers
Information Systems Foundational Theories
Structuration Theory Orlikowski, W.J. (1992). The Duality of Technology: Rethinking the Concept of Technology in Organizations. Organization Science, 3 (3), 398-
427.
Structuration Theory Orlikowski, W.J. and Robey, D. (1991). Information Technology and the Structuring of Organizations. Information Systems Research, 2 (2),
143-169.
Structuration Theory Walsham, G. and Han, C.K. (1991) Structuration theory and information systems research. Journal of Applied Systems Analysis 17: 77-85.
Institutional Theory Barley, S.R and Tolbert, P.S. (1997). Institutionalization and structuration: studying the links between action and institution. Organization
Studies 18 (1): 93-118.
Institutional Theory Orlikowski, W. J., & Barley, S. R. (2001). Technology and institutions: What can research on information technology and research on
organizations learn from each other? MIS Quarterly, 25(2), 145.
Design Science Hevner, A. R., March, S. T., Park, J., & Ram, S. (2004). Design science in information systems research. MIS Quarterly, 28 (1), 75.
Informative SpeechCourse COM103 Public SpeakingCriteria.docxpauline234567
Informative Speech
Course: COM103 Public Speaking
Criteria Level 4 Level 3 Level 2 Level 1 Criterion Score
Introduction / 10
Material / 8
Transitions / 10
10 points
Introduction
contained a
strong
attention
getter,
introduction of
the topic,
credibility
statement, and
previewed the
speech.
7 points
Introduction
contained 3 of
the following:
a strong
attention
getter,
introduction of
the topic,
credibility
statement, and
previewed the
speech.
4 points
Introduction
contained 2 of
the following:
a strong
attention
getter,
introduction of
the topic,
credibility
statement, and
previewed the
speech.
0 points
Introduction
contained 1 of
the following:
a strong
attention
getter,
introduction of
the topic,
credibility
statement, and
previewed the
speech.
8 points
Material was
clear AND
well organized
5.6 points
Material was
either clear
OR well
organized
3.2 points
NA
0 points
Material was
neither clear
and well
organized
10 points
Transitions
were clear and
used after the
intro, between
each main idea
and before the
conclusion
7 points
Transitions
were clear, but
were not used
in all areas:
after the intro,
between each
main idea and
before the
conclusion
4 points
Transitions
used after the
intro, between
each main idea
and before the
conclusion,
but were not
effective
0 points
Transitions
were not used.
Rubric Assessment - COM103 Public Speaking - National University https://nationalu.brightspace.com/d2l/lms/competencies/rubric/rubrics_a...
1 of 4 12/6/22, 5:38 PM
Criteria Level 4 Level 3 Level 2 Level 1 Criterion Score
Conclusion / 8
Time limit / 8
Preparation
outline
uploaded
/ 8
8 points
The
conclusion
contained a
strong closing
AND the
speaker
signaled the
end of the
speech
5.6 points
The
conclusion
contained a
strong closing
OR the
speaker
signaled the
end of the
speech
3.2 points
The speaker
needs
improvement
signalling the
end of the
speech and a
stronger
closing.
0 points
The
conclusion
neither
contained a
strong closing
and the
speaker did
not signal the
end of the
speech
8 points
The length of
the speech
was between
5 and 6
minutes
5.6 points
NA
3.2 points
The length of
the speech
was shorter
than 5 minutes
or longer than
6 minutes
0 points
NA
8 points
The
preparation
outline was
uploaded with
the speech
5.6 points
The
preparation
outline was
uploaded after
delivering the
speech
3.2 points
The
preparation
outline was
not in a
preparation
outline format
0 points
The
preparation
outline was
not uploaded.
Rubric Assessment - COM103 Public Speaking - National University https://nationalu.brightspace.com/d2l/lms/competencies/rubric/rubrics_a...
2 of 4 12/6/22, 5:38 PM
Criteria Level 4 Level 3 Level 2 Level 1 Criterion Score
Eye Contact / 10
Delivery / 10
Non verbals / 10
Overall
preparation
/ 8
10 points
The speaker
had strong eye
contac.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Pathways Mental Health Psychiatric Patient Evaluatio.docx
1. Pathways Mental Health
Psychiatric Patient EvaluationInstructions
Use the following case template to complete Week 2
Assignment 1. On page 5, assign
DSM-5-TR and Updated ICD-10 codes to
the services documented. You will add your narrative answers
to the assignment questions to the bottom of this template and
submit altogether as one document.
Identifying Information
Identification was verified by stating of their name and date of
birth.
Time spent for evaluation: 0900am-0957amChief Complaint
“My other provider retired. I don’t think I’m doing so well.”HPI
25 yo Russian female evaluated for psychiatric evaluation
referred from her retiring practitioner for PTSD, ADHD,
Stimulant Use Disorder, in remission. She is currently
prescribed fluoxetine 20mg po daily for PTSD, atomoxetine
80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia,
anhedonia, amotivation, no anxiety, denied frequent worry,
reports feeling restlessness, no reported panic symptoms, no
reported obsessive/compulsive behaviors. Client denies active
SI/HI ideations, plans or intent. There is no evidence of
psychosis or delusional thinking. Client denied past episodes of
hypomania, hyperactivity, erratic/excessive spending,
involvement in dangerous activities, self-inflated ego,
grandiosity, or promiscuity. Client reports increased irritability
2. and easily frustrated, loses things easily, makes mistakes, hard
time focusing and concentrating, affecting her job. Has low
frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares
of previous rape, isolates, fearful to go outside, has missed
several days of work, appetite decreased. She has somatic
concerns with GI upset and headaches. Client denied any
current binging/purging behaviors, denied withholding food
from self or engaging in anorexic behaviors. No self-mutilation
behaviors. Diagnostic Screening Results
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9
Mild depression 10-14 Moderate depression 15-19 Moderately
severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ≥10 Possible diagnosis of GAD;
confirm by further evaluation 5 Mild Anxiety 10 Moderate
anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32Past Psychiatric and Substance Use Treatment
Entered mental health system when she was age 19 after raped
by a stranger during a house burglary.
Previous Psychiatric Hospitalizations: denied
Previous Detox/Residential treatments: one for abuse of
stimulants and cocaine in 2015
Previous psychotropic medication trials: sertraline (became
suicidal), trazodone (worsened nightmares), bupropion (became
suicidal), Adderall (began abusing)
3. Previous mental health diagnosis per client/medical record:
GAD, Unspecified Trauma, PTSD, Stimulant use disorder,
ADHD confirmed by school recordsSubstance Use History
Have you used/abused any of the following (include
frequency/amt/last use):
Substance Y/N Frequency/Last Use
Tobacco products Y ½
ETOH Y last drink 2 weeks ago, reports drinks 1-2 times
monthly one drink socially
Cannabis N
Cocaine Y last use 2015
Prescription stimulants Y last use 2015
Methamphetamine N
Inhalants N
Sedative/sleeping pills N
Hallucinogens N
Street Opioids N
Prescription opioids N
Other: specify (spice, K2, bath salts, etc.) Y reports one-
time ecstasy use in 2015
Any history of substance related:
Blackouts: +
Tremors: -
DUI: -
D/T's: -
Seizures: -
Longest sobriety reported since 2015—stayed sober maintaining
sponsor, sober friends, and meetingsPsychosocial History
Client was raised by adoptive parents since age 6; from Russian
orphanage. She has unknown siblings. She is single; has no
children.
4. Employed at local tanning bed salon
Education: High School Diploma
Denied current legal issues.Suicide / HOmicide Risk
Assessment
RISK FACTORS FOR SUICIDE:
Suicidal Ideas or plans - no
Suicide gestures in past - no
Psychiatric diagnosis - yes
Physical Illness (chronic, medical) - no
Childhood trauma - yes
Cognition not intact - no
Support system - yes
Unemployment - no
Stressful life events - yes
Physical abuse - yes
Sexual abuse - yes
Family history of suicide - unknown
Family history of mental illness - unknown
Hopelessness - no
Gender - female
Marital status - single
White race
Access to means
Substance abuse - in remission
PROTECTIVE FACTORS FOR SUICIDE:
Absence of psychosis - yes
Access to adequate health care - yes
Advice & help seeking - yes
Resourcefulness/Survival skills - yes
Children - no
Sense of responsibility - yes
Pregnancy - no; last menses one week ago, has Norplant
Spirituality - yes
Life satisfaction - “fair amount”
5. Positive coping skills - yes
Positive social support - yes
Positive therapeutic relationship - yes
Future oriented - yes
Suicide Inquiry: Denies active suicidal ideations, intentions, or
plans. Denies recent self-harm behavior. Talks futuristically.
Denied history of suicidal/homicidal ideation/gestures; denied
history of self-mutilation behaviors
Global Suicide Risk Assessment: The client is found to be at
low risk of suicide or violence, however, risk of lethality
increased under context of drugs/alcohol.
No required SAFETY PLAN related to low riskMental Status
Examination
She is a 25 yo Russian female who looks her stated age. She is
cooperative with examiner. She is neatly groomed and clean,
dressed appropriately. There is mild psychomotor restlessness.
Her speech is clear, coherent, normal in volume and tone, has
strong cultural accent. Her thought process is ruminative. There
is no evidence of looseness of association or flight of ideas. Her
mood is anxious, mildly irritable, and her affect appropriate to
her mood. She was smiling at times in an appropriate manner.
She denies any auditory or visual hallucinations. There is no
evidence of any delusional thinking. She denies any current
suicidal or homicidal ideation. Cognitively, She is alert and
oriented to all spheres. Her recent and remote memory is intact.
Her concentration is fair. Her insight is good. Clinical
Impression
Client is a 25 yo Russian female who presents with history of
treatment for PTSD, ADHD, Stimulant use Disorder, in
remission.
Moods are anxious and irritable. She has ongoing reported
6. symptoms of re-experiencing, avoidance, and hyperarousal of
her past trauma experiences; ongoing subsyndromal symptoms
related to her past ADHD diagnosis and exacerbated by her
PTSD diagnosis. She denied vegetative symptoms of depression,
no evident mania/hypomania, no psychosis, denied anxiety
symptoms. Denied current cravings for drugs/alcohol, exhibits
no withdrawal symptoms, has somatic concerns of GI upset and
headaches.
At the time of disposition, the client adamantly denies SI/HI
ideations, plans or intent and has the ability to determine right
from wrong, and can anticipate the potential consequences of
behaviors and actions. She is a low risk for self-harm based on
her current clinical presentation and her risk and protective
factors. Diagnostic Impression
[Student to provide DSM-5-TR and Updated ICD-10 coding]
Double click inside this text box to add/edit text. Delete
placeholder text when you add your answers.Treatment Plan
Medication:
Increase fluoxetine 40mg po daily for PTSD #30 1 RF
Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF
Instructed to call and report any adverse reactions.
Future Plan: monitor for decrease re-experiencing,
hyperarousal, and avoidance symptoms; monitor for improved
concentration, less mistakes, less forgetful
Education: Risks and benefits of medications are discussed
including non-treatment. Potential side effects of medications
discussed. Verbal informed consent obtained.
Not to drive or operate dangerous machinery if feeling sedated.
7. Not to stop medication abruptly without discussing with
providers.
Discussed risks of mixing medications with OTC drugs, herbal,
alcohol/illegal drugs. Instructed to avoid this practice. Praised
and Encouraged ongoing abstinence. Maintain support system,
sponsors, and meetings.
Discussed how drugs/ETOH affects mental health, physical
health, sleep architecture.
Patient was educated about therapy and services of the MHC
including emergent care. Referral was sent via email to therapy
team for PET treatment.
Patient has emergency numbers: Emergency Services 911, the
national Crisis Line 800-273-TALK, the MHC Crisis Clinic.
Patient was instructed to go to nearest ER or call 911 if they
become actively suicidal and/or homicidal.
Time allowed for questions and answers provided. Provided
supportive listening. Patient appeared to understand discussion
and appears to have capacity for decision making via verbal
conversation.
RTC in 30 days
Follow up with PCP for GI upset and headaches, reviewed PCP
history and physical dated one week ago and include lab results
Patient is amenable with this plan and agrees to follow
treatment regimen as discussed.
Narrative Answers
[In 1-2 pages, address the following:
8. · Explain what pertinent information, generally, is required in
documentation to support DSM-5-TR and Updated ICD-10
coding.
· Explain what pertinent documentation is missing from the case
scenario, and what other information would be helpful to narrow
your coding and billing options.
· Finally, explain how to improve documentation to support
coding and billing for maximum reimbursement.]
Add your answers here. Delete instructions and placeholder text
when you add your answers.
References
[Add APA-formatted citations for any sources you referenced
Delete instructions and placeholder text when you add your
citations.
Page | 2
Walden University, LLC rev 6.2022
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REVIEW
published: 08 May 2020
doi: 10.3389/fspor.2020.00042
Frontiers in Sports and Active Living | www.frontiersin.org 1
May 2020 | Volume 2 | Article 42
Edited by:
Sophia Nimphius,
Edith Cowan University, Australia
Reviewed by:
Chris John Bishop,
Middlesex University, United Kingdom
Claudia Reardon,
University of Wisconsin-Madison,
United States
10. *Correspondence:
J. Bryan Mann
[email protected]
Specialty section:
This article was submitted to
Elite Sports and Performance
Enhancement,
a section of the journal
Frontiers in Sports and Active Living
Received: 05 October 2019
Accepted: 30 March 2020
Published: 08 May 2020
Citation:
Lopes Dos Santos M, Uftring M,
Stahl CA, Lockie RG, Alvar B,
Mann JB and Dawes JJ (2020) Stress
in Academic and Athletic Performance
in Collegiate Athletes: A Narrative
11. Review of Sources and Monitoring
Strategies.
Front. Sports Act. Living 2:42.
doi: 10.3389/fspor.2020.00042
Stress in Academic and Athletic
Performance in Collegiate Athletes: A
Narrative Review of Sources and
Monitoring Strategies
Marcel Lopes Dos Santos 1, Melissa Uftring 1, Cody A. Stahl 1,
Robert G. Lockie 2,
Brent Alvar 3, J. Bryan Mann 4* and J. Jay Dawes 1
1 School of Kinesiology, Applied Health and Recreation,
Oklahoma State University, Stillwater, OK, United States,
2Department of Kinesiology, California State University,
Fullerton, CA, United States, 3Department of Kinesiology,
Point Loma
Nazarene University, San Diego, CA, United States,
4Department of Kinesiology and Sport Sciences, University of
Miami,
Miami, FL, United States
College students are required to manage a variety of stressors
related to academic,
social, and financial commitments. In addition to the burdens
facing most college
12. students, collegiate athletes must devote a substantial amount of
time to improving
their sporting abilities. The strength and conditioning
professional sees the athlete on
nearly a daily basis and is able to recognize the changes in
performance and behavior an
athlete may exhibit as a result of these stressors. As such, the
strength and conditioning
professional may serve an integral role in the monitoring of
these stressors and may be
able to alter training programs to improve both performance
andwellness. The purpose of
this paper is to discuss stressors experienced by collegiate
athletes, developing an early
detection system through monitoring techniques that identify
the detrimental effects of
stress, and discuss appropriate stress management strategies for
this population.
Keywords: stress, load management, academic stress, stress
management, injury
INTRODUCTION
The college years are a period of time when young adults
experience a significant amount of change
and a variety of novel challenges. Academic performance, social
demands, adjusting to life away
13. from home, and financial challenges are just a few of the
burdens college students must confront
(Humphrey et al., 2000; Paule and Gilson, 2010; Aquilina,
2013). In addition to these stressors,
collegiate athletes are required to spend a substantial amount of
time participating in activities
related to their sport, such as attending practices and training
sessions, team meetings, travel, and
competitions (Humphrey et al., 2000; López de Subijana et al.,
2015; Davis et al., 2019; Hyatt and
Kavazis, 2019). These commitments, in addition to the normal
stress associated with college life,
may increase a collegiate-athlete’s risk of experiencing both
physical and mental issues (Li et al.,
2017; Moreland et al., 2018) that may affect their overall health
and wellness. For these reasons, it is
essential that coaches understand the types of stressors
collegiate athletes face in order to help them
manage the potentially deleterious effects stress may have on
athletic and academic performance.
Strength and conditioning coaches are allied health care
professionals whose primary
job is to enhance fitness of individuals for the purpose of
improving athletic performance
(Massey et al., 2002, 2004, 2009). As such, many universities
and colleges hire strength
https://www.frontiersin.org/journals/sports-and-active-living
https://www.frontiersin.org/journals/sports-and-active-
living#editorial-board
https://www.frontiersin.org/journals/sports-and-active-
living#editorial-board
https://www.frontiersin.org/journals/sports-and-active-
living#editorial-board
https://www.frontiersin.org/journals/sports-and-active-
15. to incorporate illness and injury risk management education into
their training programs (Radcliffe et al., 2015; Ivarsson et al.,
2017).
Based on the large number of contact hours strength and
conditioning coaches spend with their athletes, they are in
an optimal position to assist athletes with developing effective
coping strategies to manage stress. By doing so, strength and
conditioning coaches may be able to help reach the overarching
goal of improving the health, wellness, fitness, and performance
of the athletes they coach. The purpose of this review article
is to provide the strength and conditioning professional with a
foundational understanding of the types of stressors collegiate
athletes may experience, and how these stressors may impact
mental health and athletic performance. Suggestions for
assisting
athletes with developing effective coping strategies to reduce
potential physiological and psychological impacts of stress will
also be provided.
Stress and the Stress Response
In its most simplistic definition, stress can be described as a
state of physical and psychological activation in response to
external demands that exceed one’s ability to cope and requires
a person to adapt or change behavior. As such, both cognitive
or environmental events that trigger stress are called stressors
(Statler and DuBois, 2016). Stressors can be acute or chronic
based on the duration of activation. Acute stressors may be
defined as a stressful situation that occurs suddenly and results
in physiological arousal (e.g., increase in hormonal levels,
blood
flow, cardiac output, blood sugar levels, pupil and airway
dilation,
etc.) (Selye, 1976). Once the situation is normalized, a cascade
of hormonal reactions occurs to help the body return to a
resting state (i.e., homeostasis). However, when acute stressors
16. become chronic in nature, they may increase an individual’s
risk of developing anxiety, depression, or metabolic disorders
(Selye, 1976). Moreover, the literature has shown that
cumulative
stress is correlated with an increased susceptibility to illness
and injury (Szivak and Kraemer, 2015; Mann et al., 2016;
Hamlin et al., 2019). The impact of stress is individualistic and
subjective by nature (Williams and Andersen, 1998; Ivarsson
et al., 2017). Additionally, the manner in which athletes respond
to a situational or environmental stressor is often determined
by their individual perception of the event (Gould and Udry,
1994; Williams and Andersen, 1998; Ivarsson et al., 2017). In
this
regard, the athlete’s perception can either be positive (eustress)
or negative (distress). Even though they both cause
physiological
arousal, eustress also generates positive mental energy whereas
distress generates anxiety (Statler and DuBois, 2016).
Therefore,
it is essential that an athlete has the tools and ability to cope
with
these stressors in order to have the capacity to manage both
acute
and chronic stress. As such, it is important to understand the
types of stressors collegiate athletes are confronted with and
how
these stressors impact an athlete’s performance, both
athletically
and academically.
METHODS
Literature Search/Data Collection
The articles included in this review were identified via online
databases PubMed, MEDLINE, and ISI Web of Knowledge
17. from October 15th 2019 through January 15th 2020. The
search strategy combined the keywords “academic stress,”
“athletic stress,” “stress,” “stressor,” “college athletes,”
“student
athletes,” “collegiate athletes,” “injury,” “training,”
“monitoring.”
Duplicated articles were then removed. After reading the titles
and abstracts, all articles that met the inclusion criteria were
considered eligible for inclusion in the review. Subsequently,
all eligible articles were read in their entirety and were either
included or removed from the present review.
Inclusion Criteria
The studies included met all the following criteria: (i) published
in English-language journals; (ii) targeted college athletes; (iii)
publication was either an original research paper or a literature
review; (iv) allowed the extraction of data for analysis.
Data Analysis
Relevant data regarding participant characteristics (i.e.,
gender, academic status, sports) and study characteristics
were extracted. Articles were analyzed and divided into two
separate sections based on their specific topics: Academic
Stress and Athletic Stress. Then, strategies for monitoring and
workload management are discussed in the final section.
ACADEMIC STRESS
Fundamentally, collegiate athletes have two major roles they
must balance as part of their commitment to a university: being
a college student and an athlete. Academic performance is a
significant source of stress for most college students (Aquilina,
2013; López de Subijana et al., 2015; de Brandt et al., 2018;
Davis et al., 2019). This stress may be further compounded
among collegiate athletes based on their need to be successful
in
18. the classroom, while simultaneously excelling in their
respective
sport (Aquilina, 2013; López de Subijana et al., 2015; Huml
et al., 2016; Hamlin et al., 2019). Davis et al. (2019) conducted
surveys on 173 elite junior alpine skiers and reported
significant
moderate to strong correlations between perceived stress and
several variables including depressed mood (r = 0.591), sleep
disturbance (r = 0.459), fatigue (r = 0.457), performance
demands (r = 0.523), and goals and development (r = 0.544).
Academic requirements were the highest scoring source of
stress
of all variables and was most strongly correlated with perceived
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May 2020 | Volume 2 | Article 42
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living#articles
Lopes Dos Santos et al. Stress in College Athletes
stress (r = 0.467). Interestingly, it was not academic rigor that
was viewed by the athletes as the largest source of direct stress;
rather, the athletes surveyed reported time management as being
their biggest challenge related to academic performance (Davis
et al., 2019). This further corroborates the findings of Hamlin
et al. (2019). The investigators reported that during periods
of the academic year in which levels of perceived academic
stress were at their highest, students had trouble managing sport
practices and studying. These stressors were also associated
with
a decrease in energy levels and overall sleep quality. These
19. factors
may significantly increase the collegiate athlete’s susceptibility
to illness and injury (Hamlin et al., 2019). For this reason,
coaches should be aware of and sensitive to the stressors
athletes
experience as part of the cyclical nature of the academic year
and
attempt to help athletes find solutions to balancing athletic and
academic demands.
According to Aquilina (2013), collegiate athletes tend to be
more committed to sports development and may view their
academic career as a contingency plan to their athletic career,
rather than a source of personal development. As a result,
collegiate athletes often, but certainly not always, prioritize
athletic participation over their academic responsibilities
(Miller
and Kerr, 2002; Cosh and Tully, 2014, 2015). Nonetheless,
scholarships are usually predicated on both athletic and
academic
performance. For instance, the National Collegiate Athletic
Association (NCAA) requires collegiate athletes to achieve and
maintain a certain grade point average (GPA). Furthermore,
they
are also often required to also uphold a certain GPA to maintain
an athletic scholarship. The pressure to maintain both high
levels
of academic and athletic performancemay increase the
likelihood
of triggeringmental health issues (i.e., anxiety and depression)
(Li
et al., 2017; Moreland et al., 2018).
Mental health issues are a significant concern among college
students. There has been an increased emphasis placed on the
mental health of collegiate athletes in recent years (Petrie et al.,
20. 2014; Li et al., 2017, 2019; Reardon et al., 2019). Based on
the 2019 National College Health Assessment survey from the
American College Health Association (ACHA) consisting of
67,972 participants, 27.8% of college students reported anxiety,
and 20.2% reported experiencing depression which negatively
affected their academic performance (American College Health
Association American College Health Association-National
College Health Assessment II, 2019). Approximately 65.7%
(50.7% males and 71.8% females) reported feeling
overwhelming
anxiety in the past 12months, and 45.1% (37.1%males and
47.6%
females) reported feeling so depressed that it was difficult for
them to function. However, only 24.3% (13% males and 28.4%
females) reported being diagnosed and treated by a professional
in the past 12 months. Collegiate athletes are not immune to
these types of issues. According to information presented by
the NCAA, many certified athletic trainers anecdotally state that
anxiety is an issue affecting the collegiate-athlete population
(NCAA, 2014). However, despite the fact that collegiate
athletes
are exposed to numerous stressors, they are less likely to
seek help at a university counseling center than non-athletes
(NCAA, 2014), which could be related to stigmas that surround
mental health services (NCAA, 2014; Kaier et al., 2015; Egan,
2019). This not only has significant implications related to their
psychological well-being, but also their physiological health,
and
consequently their performance. For instance, in a study by
Li et al. (2017) it was found that NCAA Division I athletes
who reported preseason anxiety symptoms had a 2.3 times
greater injury incidence rate compared to athletes who did
not report. This same study discovered that male athletes who
reported preseason anxiety and depression had a 2.1 times
greater
21. injury incidence, compared to male athletes who did not report
symptoms of anxiety and depression. (Lavallée and Flint, 1996)
also reported a correlation between anxiety and both injury
frequency and severity among college football players (r = 0.43
and r = 0.44, respectively). In their study, athletes reporting
high
tension/anxiety had a higher rate of injury. It has been
suggested
that the occurrence of stress and anxiety may cause
physiological
responses, such as an increase in muscle tension, physical
fatigue,
and a decrease in neurocognitive and perception processes that
can lead to physical injuries (Ivarsson et al., 2017). For this
reason, it is reasonable to consider that academic stressors may
potentiate effects of stress and result in injury and illness in
collegiate athletes.
Periods of more intense academic stress increase the
susceptibility to illness or injury (Mann et al., 2016; Hamlin
et al., 2019; Li et al., 2019). For example, Hamlin et al. (2019)
investigated levels of perceived stress, training loads, injury,
and
illness incidence in 182 collegiate athletes for the period of one
academic year. The highest levels of stress and incidence of
illness arise during the examination weeks occurring within the
competitive season. In addition, the authors also reported the
odds ratio, which is the occurrence of the outcome of interest
(i.e., injury), based off the given exposure to the variables of
interest (i.e., perceived mood, sleep duration, increased
academic
stress, and energy levels). Based on a logistic regression, they
found that each of the four variables (i.e., mood, energy, sleep
duration, and academic stress) was related to the collegiate
athletes’ likelihood to incur injuries. In summary, decreased
levels of perceived mood (odds ratio of 0.89, 0.85–0.0.94 CI)
22. and
sleep duration (odds ratio of 0.94, 0.91–0.97 CI), and increased
academic stress (odds ratio of 0.91, 0.88–0.94 CI) and energy
levels (odds ratio of 1.07, 1.01–1.14 CI), were able to predict
injury in these athletes. This corroborates Mann et al. (2016)
who
foundNCAADivision I football athletes at a Bowl Championship
Subdivision university were more likely to become ill or injured
during an academically stressful period (i.e., midterm exams
or other common test weeks) than during a non-testing week
(odds ratio of 1.78 for high academic stress). The athletes were
also less likely to get injured during training camp (odds ratio
of 3.65 for training camp). Freshmen collegiate athletes may
be especially more susceptible to mental health issues than
older students. Their transition includes not only the academic
environment with its requirements and expectations, but also
the adaptation to working with a new coach and teammates.
In this regard, Yang et al. (2007) found an increase in the
likelihood of depression that freshmen athletes experienced,
as these freshmen were 3.27 times more likely to experience
depression than their older teammates. While some stressors
are recurrent and inherent in academic life (e.g., attending
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classes, homework, etc.), others are more situational (e.g.,
exams,
23. midterms, projects) and may be anticipated by the strength and
conditioning coach.
ATHLETIC STRESS
The domain of athletics can expose collegiate athletes to
additional stressors that are specific to their cohort (e.g., sport-
specific, team vs. individual sport) (Aquilina, 2013). Time
spent training (e.g., physical conditioning and sports practice),
competition schedules (e.g., travel time, missing class), dealing
with injuries (e.g., physical therapy/rehabilitation, etc.), sport-
specific social support (e.g., teammates, coaches) and playing
status (e.g., starting, non-starter, being benched, etc.) are just a
few of the additional challenges collegiate athletes must
confront
relative to their dual role of being a student and an athlete
(Maloney and McCormick, 1993; Scott et al., 2008; Etzel, 2009;
Fogaca, 2019). Collegiate athletes who view the demands of
stressors from academics and sports as a positive challenge
(i.e.,
an individual’s self-confidence or belief in oneself to
accomplish
the task outweighs any anxiety or emotional worry that is
felt) may potentially increase learning capacity and competency
(NCAA, 2014). However, when these demands are perceived as
exceeding the athlete’s capacity, this stress can be detrimental
to the student’s mental and physical health as well as to sport
performance (Ivarsson et al., 2017; Li et al., 2017).
As previously stated, time management has been shown to
be a challenge to collegiate athletes. The NCAA rules state
that collegiate athletes may only engage in required athletic
activities for 4 h per day and 20 h/week during in-season and
8 h/week during off-season throughout the academic year.
Although these rules have been clearly outlined, the most
recent NCAA GOALS (2016) study reported alarming numbers
24. regarding time commitment to athletic-related activities. Data
from over 21,000 collegiate athletes from 600 schools across
Divisions I, II, and III were included in this study. Although a
breakdown of time commitments was not provided, collegiate
athletes reported dedicating up to 34 h per week to athletics
(e.g., practices, weight training, meetings with coaches, tactical
training, competitions, etc.), in addition to spending between
38.5 and 40 h per week working on academic-related tasks. This
report also showed a notable trend related to athletes spending
an
increase of ∼2 more athletics-related hours per week compared
to the 2010 GOALS study, along with a decrease of 2 h of
personal time (from 19.5 h per week in 2010 to 17.1 in 2015).
Furthermore, ∼66% of Division I and II and 50% of Division
III athletes reported spending as much or more time in their
practices during the off-season as during the competitive season
(DTHOMAS, 2013). These numbers show how important it
is for collegiate athletes to develop time management skills to
be successful in both academics and athletics. Overall, most
collegiate athletes have expressed a need to find time to enjoy
their college experience outside of athletic obligations (Paule
and
Gilson, 2010). Despite that, because of the increasing demand
for
excellence in academics and athletics, collegiate athletes’ free
time
with family and friends is often scarce (Paule and Gilson,
2010).
Consequently, trainers, coaches, and teammates will likely be
the
primary source of their weekly social interactivity.
Social interactions within their sport have also been found
to relate to factors that may impact an athlete’s perceived
stress. Interactions with coaches and trainers can be effective or
25. deleterious to an athlete. Effective coaching includes a coaching
style that allows for a boost of the athlete’s motivation, self-
esteem, and efficacy in addition to mitigating the effects of
anxiety. On the other hand, poor coaching (i.e., the opposite of
effective coaching) can have detrimental psychological effects
on
an athlete (Gearity and Murray, 2011). In a closer examination
of the concept of poor coaching practices, Gearity and Murray
(2011) interviewed athletes about their experiences of receiving
poor coaching. Following analysis of the interviews, the authors
identified the main themes of the “coach being uncaring and
unfair,” “practicing poor teaching inhibiting athlete’s mental
skills,” and “athlete coping.” They stated that inhibition of
an athlete’s mental skills and coping are associated with the
psychological well-being of an athlete. Also, poor coaching
may result in mental skills inhibition, distraction, insecurity,
and ultimately team division (Gearity and Murray, 2011). This
combination of factors may compound the negative impacts
of stress in athletes and might be especially important for in
injured athletes.
Injured athletes have previously been reported to have
elevated stress as a result of heightened worry about returning
to pre-competition status (Crossman, 1997), isolation from
teammates if the injury is over a long period of time
(Podlog and Eklund, 2007) and/or reduced mood or depressive
symptoms (Daly et al., 1995). In addition, athletes who
experience prolonged negative thoughts may be more likely to
have decreased rehabilitation attendance or adherence, worse
functional outcomes from rehabilitation (e.g., on measures of
proprioception, muscular endurance, and agility), and worse
post-injury performance (Brewer, 2012).
MONITORING CONSIDERATIONS
In addition to poor coaching, insufficient workload management
26. can hinder an athlete’s ability to recover and adapt to training,
leading to fatigue accumulation (Gabbett et al., 2017).
Excessive
fatigue can impair decision-making ability, coordination and
neuromuscular control, and ultimately result in overtraining
and injury (Soligard et al., 2016). For instance, central fatigue
was found to be a direct contributor to anterior cruciate
ligament injuries in soccer players (Mclean and Samorezov,
2009). Introducing monitoring tools may serve as a means to
reduce the detrimental effects of stress in collegiate athletes.
Recent research on relationships between athlete workloads,
injury, and performance has highlighted the benefits of athlete
monitoring (Drew and Finch, 2016; Jaspers et al., 2017).
Athlete monitoring is often assessed with the measuring and
management of workload associated with a combination of
sport-
related and non-sport-related stressors (Soligard et al., 2016).
An
effective workload management program should aim to detect
excessive fatigue, identify its causes, and constantly adapt rest,
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recovery, training, and competition loads respectively (Soligard
et al., 2016). The workload for each athlete is based off their
current levels of physical and psychological fatigue, wellness,
27. fitness, health, and recovery (Soligard et al., 2016).
Accumulation
of situational or physical stressors will likely result in day-
to-day fluctuations in the ability to move external loads and
strength train effectively (Fry and Kraemer, 1997). Periods of
increased academic stress may cause increased levels of fatigue,
which can be identified by using these monitoring tools, thereby
assisting the coaches with modulating the workload during these
specific periods. Coaches who plan to incorporate monitoring
and management strategies must have a clear understanding of
what they want to achieve from athletemonitoring (Gabbett et
al.,
2017; Thornton et al., 2019).
Monitoring External Loads
External load refers to the physical work (e.g., number of
sprints, weight lifted, distance traveled, etc.) completed by the
athlete during competition, training, and activities of daily
living
(Soligard et al., 2016). This type of load is independent of
the athlete’s individual characteristics (Wallace et al., 2009).
Monitoring external loading can aid in the designing of training
programs which mimic the external load demands of an athlete’s
sport, guide rehabilitation programs, and aid in the detection of
spikes in external load that may increase the risk of injury
(Clubb
and McGuigan, 2018).
The means of quantifying external load can involve metrics
as simple as pitch counts in baseball and softball (Fleisig and
Andrews, 2012; Shanley et al., 2012) or quantifying lifting
session training loads (e.g., sum value of weight lifted during
an exercise x number of repetitions × the number of sets).
Neuromuscular function testing is another more common way
of analyzing external load. This is typically done using such
measures such as the counter movement jump, squat jump,
28. or drop jump. A force platform can be used to measure a
myriad of outcomes (e.g., peak power, ground contact time,
time to take-off, reactive strength index, and jump height), or
simply measure jump height in a more traditional manner.
Jumping protocols, such as the countermovement jump, have
been adopted to examine the recovery of neuromuscular
function
after athletic competition with significant decreases for up to
72 h commonly reported (Andersson et al., 2008; Magalhães
et al., 2010; Twist and Highton, 2013). (Gathercole et al., 2015)
found reductions in 18 different neuromuscular variables in
collegiate athletes following a fatiguing protocol. The variables
of eccentric duration, concentric duration, total duration, time
to peak force/power, and flight time:contraction time ratio,
derived from a countermovement jump were deemed suitable
for detecting neuromuscular fatigue with the rise in the use of
technology for monitoring, certain sports have adopted specific
software that can aid in the monitoring of stress. For example,
power output can be measured using devices such as SRMTM
or PowerTapTM in cycling (Jobson et al., 2009). This data can
be analyzed to provide information such as average power or
normalized power. The power output can then be converted into
a Training Stress ScoreTM via commercially available software
(Marino, 2011). More sophisticated measures of external load
may involve the use of wearable technology devices such
as Global Positioning System (GPS) devices, accelerometers,
magnetometer, and gyroscope inertial sensors (Akenhead and
Nassis, 2016). These devices can quantify external load in
several
ways, such as duration of movement, total distance covered,
speed of movement, acceleration, and decelerations, as well as
sport specific movement such as number and height of jumps,
number of tackles, or breakaways, etc. (Akenhead and Nassis,
2016). The expansion of marketing of wearable devices has
29. been
substantial; however, there are questions of validity and
reliability
related to external load tracking limitations related to
proprietary
metrics, as well as the overall cost that should be considered
when
considering the adoption of such devices (Aughey et al., 2016;
Torres-Ronda and Schelling, 2017).
Monitoring Internal Loads
While external load may provide information about an athlete’s
performance capacity and work completed, it does not provide
clear evidence of how athletes are coping with and adapting to
the external load (Halson, 2014). This type of information
comes
from the monitoring of internal loads. The term internal load
refers to the individual physiological and psychological
response
to the external stress or load imposed (Wallace et al., 2009).
Internal load is influenced by a number of factors such as daily
life
stressors, the environment around the athlete, and coping ability
(Soligard et al., 2016). Indirect measures, such as the use of
heart
rate (HR) monitoring, and subjective measurements, such as
perceived effort (i.e., ratings of perceived exertion), are
examples
of internal load monitoring. Using subjective measurement
systems is a simple and practical method when dealing with
large
numbers of athletes (Saw et al., 2016; Nässi et al., 2017).
Subjective
reporting of training load (Rating of Perceived Exertion—RPE)
(Coyne et al., 2018), Session Rating of Perceived Exertion—
sRPE)
30. (Coyne et al., 2018), perceived stress and recovery (Recovery
Stress Questionnaire for Athletes—RESTQ-S), and
psychological
mood states (Profile of Mood States—POMS) have all been
found
to be a reliable indicator of training load (Robson-Ansley et al.,
2009; Saw et al., 2016) and only take a few moments to
complete.
In addition, subjective measures can be more responsive to
tracking changes or training responses in athletes than objective
measures (Saw et al., 2016).
Heart rate (HR) monitoring is a common intrinsic measure
of how the body is responding to stress. With training, the
reduction of resting HR is typically a clear indication of the
heart
becoming more efficient and not having to beat as frequently.
Alternately, increases of restingHR over time with a
continuation
of training may be an indicator of too much stress. Improper
nutrition, such as regular or ongoing suboptimal intakes of
vitamins or minerals, may result in increased ventilation and/or
increased heart rate (Lukaski, 2004). It has been suggested that
the additional stress may lead to parasympathetic hyperactivity,
leading to an increase in resting HR (Statler and DuBois, 2016).
This largely stems from research examining the sensitivity of
various HR derived metrics, such as resting HR, HR variability
(HRV), and HR recovery (HRR) to fluctuations in training load
(Borresen and Ian Lambert, 2009). HRR in athlete monitoring is
the rate of HR decline after the cessation of exercise. A
common
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measure of HHR is the use of a 2min step test followed by a
60 s HR measurement. The combination of the exercise (stress)
on the cardiovascular system and then its subsequent return
toward baseline has been used as an indicator of autonomic
function and training status in athletes (Daanen et al., 2012). In
collegiate athletes it was found that hydration status impacted
HRR following moderate to hard straining sessions (Ayotte and
Corcoran, 2018). Athletes who followed a prescription
hydration
plan performed better in the standing long jump, tracked
objects faster, and showed faster HRR vs. athletes who followed
their normal self-selected hydration plan (Ayotte and Corcoran,
2018). To date, HR monitoring and the various derivatives have
mainly been successful in detecting changes in training load and
performance in endurance athletes (Borresen and Ian Lambert,
2009; Lamberts et al., 2009; Thorpe et al., 2017). Although
heart
rate monitoring can provide additional physiological insight for
aerobic sessions or events, it thus far has not been found to be
an
accurate measurement for quantifying internal load during many
explosive, short duration anaerobic activities (Bosquet et al.,
2008).
Amultitude of studies have reported the reliability and validity
of using RPE and sRPE across a range of training modalities
(Foster, 1998; Impellizzeri et al., 2004; Sweet et al., 2004).
This
measure can be used to create a number of metrics such as
32. session load (sRPE× duration in minutes), daily load (sum of all
session loads for that day), weekly training load (sum of all
daily
training loads for entire week), monotony (standard deviation
of weekly training load), and strain (daily or weekly training
load×monotony) (Foster, 1998). Qualitative questionnaires that
monitor stress and fatigue have been well-established as tools
to use with athletes (see Table 1 for examples of commonly
used questionnaires in research). Using short daily wellness
questionnaires may allow coaches to generate a wellness score
which then can be adjusted based off of the stress the athlete
may be feeling to meet the daily load target (Foster, 1998;
Robson-Ansley et al., 2009). However, strength and
conditioning
coaches need to be mindful that these questionnaires may
require
sports psychologist or other licensed professional to examine
and provide the results. An alternative that may be better
suited for strength and conditioning professionals to use could
be to incorporate some of the themes of those questionnaires
into programing.
A Multifaceted Approach
Dissociation between external and internal load units may
be indicative of the state of fatigue of an athlete. Utilizing
a monitoring system in which the athlete is able to make
adjustments to their training loads in accordance with how they
are feeling in that moment can be a useful tool for assisting
the athlete in managing stress. Auto-regulation is a method of
programming that allows for adjustments based on the results
of one or more readiness tests. When implemented properly,
auto regulation enables the coach or athlete to optimize training
based on the athlete’s given readiness for training on a
particular
day, thereby aiming to avoid potential overtraining (Kraemer
and
33. Fleck, 2018). Several studies have found that using movement
velocity to designate resistance training intensities can result
in significant improvements in maximal strength and athletic
performance (Pareja-Blanco et al., 2014, 2017; Mann et al.,
2015).
Velocity based training allows the coach and athlete to view
real time feedback for the given lifts, thereby allowing them to
observe how the athlete is performing in that moment. If the
athlete is failing to meet the prescribed velocity or the velocity
drops greater than a predetermined amount between sets, then
this should signal the coach to investigate. If there is a higher
than normal amount of stress on that athlete for the day, that
could be a potential reason. This type of combination style
program of using a quantitative or objective measurement (s)
and a subjective measure of wellness (qualitative questionnaire)
has recently been reported to be an effective tool in monitoring
individuals apart of a team (Starling et al., 2019). The
subjective
measure in this study was the readiness to train questionnaire
(RTT-Q) and the objective measures were the HRR6min test
(specifically the HRR60s = recorded as decrease in HR in the
60 s after termination of the test) to assess autonomic function
and the standing long jump (SLJ) to measure neuromuscular
function. The findings found that, based on the absolute typical
error of measurement, the HRR60s and SLJ could detect
medium
and large changes in fatigue and readiness. The test took
roughly
8min for the entire team, which included a group consisting
of 24 college-age athletes. There are many other combinations
of monitoring variables and strategies that coaches and athletes
may utilize.
Data Analysis – How to Utilize the
Measures
34. Regardless of what type of monitoring tool a coach or athlete
may incorporate, it is essential to understand how to analyze
this
data. There are excellent resources available which discuss this
topic in great detail (Gabbett et al., 2017; Clubb and McGuigan,
2018; Thornton et al., 2019). This section will highlight two
main conclusions from these sources and briefly describe two of
the main statistical practices and concepts discussed. The use of
z-scores or modified z-scores has been proposed as a method
of detecting meaningful change in athlete data (Clubb and
McGuigan, 2018; Thornton et al., 2019). For different
monitoring
tools listed in Table 1, the following formula would be an
example of how to assess changes: (Athlete daily score—
Baseline
score)/Standard deviation of baseline. The baseline would likely
be based off an appropriate period such as the scores across 2
weeks during the preseason.
In sports and sports science, the use of a magnitude-based
inference (MBI) has been suggested as more appropriate and
easier to understand when examining meaningful changes
in athletic data, than null-hypothesis significance testing
(NHST) (Buchheit, 2014). Additional methods to assess
meaningful change that are similar to MBI are using standard
deviation, typical error, effect sizes, smallest worthwhile
change (SWC), and coefficient of variation (Thornton et al.,
2019). It should be noted that all of these methods have faced
criticism from sources such as statisticians. It is important
to understand that the testing methods, measurements, and
analysis should be based on the resources and intended goals
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TABLE 1 | Overview of common tool/measures used by
researchers to monitor training load.
Category of training load Variable examined Tests or Methods
of collection References
External load: defined as
the work completed by the
athlete, measured
independently of their
individual characteristics
(Wallace et al., 2009)
Power output Various devices Pyne and Martin, 2011
Neuromuscular function Jump tests—CMJ or SJ performance
Twist and Highton, 2013
Sprint performance Twist and Highton, 2013
Time-motion analysis GPS tracking Aughey, 2011; Halson,
2014
Movement pattern analysis via digital video Taylor et al., 2012;
36. Halson (2014)
Internal load: related to
physiological and
psychological stress
imposed (Wallace et al.,
2009)
Perception of effort Rating of Perceived Exertion (RPE)
Borresen and Ian Lambert, 2009
Session Rating of Perceived Exertion (sRPE) Foster, 1998
Heart rate measures Heart rate (HR) Hopkins, 1991
HR to RPE Martin and Andersen, 2000
HR recovery (HRR) Daanen et al., 2012
HR variability (HRV) Plews et al., 2013
Training Impulse (TRIMP) Morton et al., 1990; Pyne and
Martin, 2011
Qualitative questionnaires* Profile of Mood States (ROMS)
Morgan et al., 1987
Recovery Stress Questionnaires for Athletes (REST-Q) Kallus
and Kellmann, 2016
Daily Analysis of Life Demands for Athletes (DALDA) Rushall,
1990
37. Total Recovery Scale (TQR) Kenttä and Hassmén, 1998
* indicates variable/monitoring tool that is most appropriate for
use by a sport psychologist or licensed psychologist.
from use, which will differ from every group and individual.
Once identified, it is up to the practitioner to keep this
system the same, in order to collect data that can then be
examined to understand meaningful information for each setting
(Thornton et al., 2019).
Managing and Coping Strategies
Once the collegiate-athlete has been able to identify the need to
balance their stress levels, the athlete may then need to seek out
options for managing their stress. Coaches are be able to assist
them by sharing information on health and wellness resources
available for the students, both on and off campus. Another way
a coach can potentially support their athletes is by establishing
an
open-door policy, wherein the team members feel comfortable
approaching a member of the strength and conditioning staff in
order to seek out resources for coping with challenges related
to stress.
There are some basic skills that strength and conditioning
coaches can teach (while staying within their scope of practice).
Coaches can introduce their athletes to basic lifestyle concepts,
such as practicing deep breathing techniques, positive self-talk,
and developing healthy sleep habits (i.e., turning off their
mobile
devices 1 h before bed and aiming for 8 h of sleep each night,
etc.).
A survey of strength and conditioning practitioners by Radcliffe
et al. (2015) found that strategies used by practitioners included
a mix of cognitive and behavioral strategies, which was used as
38. justification for recommending practitioners find opportunities
to guide professional development toward awareness strategies.
Practitioners reported using a wide variety of psychological
skills
and strategies, which following survey analysis, highlighted a
significant emphasis on strategies that may influence athlete
self-
confidence and goal setting. Themes identified by Radcliffe et
al.
(2015) included confidence building, arousal management, and
skill acquisition. Additionally, similar lower level themes that
are connected (i.e., goal setting, increasing, or decreasing
arousal
intensities, self-talk, mental imagery) are all discussed in the
4th
edition of the NSCA Essentials of Strength and Conditioning
book (Haff et al., 2016). When the interventions aiming to
improve mental health expand from basic concepts to mental
training beyond a coach’s scope, it would be pertinent for the
coach to refer the collegiate-athlete to a sport psychology or
other
mental health consultant (Fogaca, 2019). Moreover, strength
and conditioning coaches may find themselves in a position to
become key players in facilitating management strategies for
collegiate athletes, thereby guiding the athlete in their quest to
learn how to best manage the mental and physical energy levels
required in the quest for overall optimal performance (Statler
and
DuBois, 2016).
CONCLUSION AND FUTURE DIRECTIONS
This review article has summarized some of the ways that
strength and conditioning professionals may be able to gain
a better understanding of the types of stressors encountered
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by collegiate athletes, the impact these stressors may have on
athletic performance, and suggestions for assisting athletes with
developing effective coping strategies to reduce the potential
negative physiological and psychological impacts of stress. It
has been suggested that strategies learned in the context of
training may have a carry-over effect into other areas such as
competition. More education is needed in order for strength and
conditioning professionals to gain a greater understanding of
how to support their athletes with stress-management techniques
and resources. Some ways to disseminate further education
on stress-management tools for coaches to share with their
athletes may include professional development events, such as
conferences and clinics.
AUTHOR CONTRIBUTIONS
All of the authors have contributed to the development of the
manuscript both in writing and conceptual development.
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https://www.frontiersin.org/journals/sports-and-active-
living#articlesStress in Academic and Athletic Performance in
Collegiate Athletes: A Narrative Review of Sources and
Monitoring StrategiesIntroductionStress and the Stress
ResponseMethodsLiterature Search/Data CollectionInclusion
CriteriaData AnalysisAcademic StressAthletic StressMonitoring
ConsiderationsMonitoring External LoadsMonitoring Internal
67. LoadsA Multifaceted ApproachData Analysis – How to Utilize
the MeasuresManaging and Coping StrategiesConclusion and
Future DirectionsAuthor ContributionsReferences
