54500904 NCMH Case Study Gia

Chapter I

Introduction

Schizophrenia is a disorder characterized by significant disorganization of thinking

manifested by problems with communication and cognition; impaired perceptions of reality

manifested by hallucinations and delusions; and sometimes in significant decreases in

functioning.

Approximately 2.2 million people, or 1% of the world population, suffer from

schizoprenia . Statistics indicate that approximately 40% of these individual (1.8 million people)

do not receive psychiatric treatment on any given day, resulting in homelessness, incarceration,

or violence.(National Advisory Mental Health Council,2005).

The onset of schizoprhenia may occur late in adolescence or early in adulthood, usually

before the age of 30. Although the disorder has been diagnosed in children, approximately 75%

of person diagnosed as having schizoprhenia develop the clinical symptoms between ages of 16

and 25 years. Schizoprhenia usually first appears earlier in men, in their late teens or early

twenties, than in women, who are generally affected in their twenties or early thirties.

( shives,2008)

Age at onset appears to be an important factor in how the client fares: those who develop

the illness earlier show worse outcomes than those who develop it later. Younger clients display

a poorer premorbid adjustment, more prominent negative sign, and greater cognitve impairment

than do older clients. Those who experience a gradual onset of the disease (about 50%) tend to

have both poorer immediate and long term course than those who experience an acute and

sudden onset (Buchanan and Carpenter, 2005)

Schizoprenia are classified into four types: Paranoid Schizoprhenia, Disorganized

Schizophrenia, Catatonic Shizophrenia, Residual schizophrenia and Undifferentited type was

charcterized by mixed shizoprhenic symptoms along with disturbances of thought, affect and

behavior.

This was a case of a 39 years old, female client from Sorsogon City, with an early onset

of undifferentiated shizophrenia since 1990 and admitted at National Center for Mental Health in

Pavillion 2 accompanied by her father, later on she was transferred in Unit 2, Pavillion 5 because

of agitation and assultive behavior to other client.

Theoretical Framework

Different theorist in the past proposed theories to explain the possible cause and

development of schizophrenia:

Psychoanalysis theory by Sigmund freud postulated that shizophrenia resulted form

development of fixation that occurred earlier that those culminating in the development of

neuroses. These fixations produced defects in ego development and freud postulated that such

defects contributed to the symptoms of schizophrenia. Ego intergration in schizoprhenia

represent a return to the time when the ego was not yet , or had just begun to be established.

Because the ego affects the interpretation of reality and control the inner drives such as sex and

agression. These ego functions are impaired, thus , intrapsychic conflict arising from the early

fixation and the ego defects which may resulted from early object relations, full of psychotic

symptoms. (Kennedy,2007)

Genetic predisposition theory suggest that the risk in inheriting schizophrenia is 10% to

20% in those who have one immediate family member with the disease, and approximately 40%

if the disease affects both parents or an identical twins. (Shives, 2008).

Biochemical and neurostuctural theory includes the dopamine hypothesis: that an

excessive amount of neurotransmitter dopamine allows nerves impulses to bombard the

mesolimbic pathway, thye part of the brain normally involved in arousal and motivation. Normal

cell communication is disrupted, resulting in the development of hallucinations and delusions,

symptoms of schizoprhenia. The abnormalities of neurocircuitry or signals from nuerons are

being studied as well. A defective circuit can result in bombardment of infiltered information,

possibly causing negative and positive symptoms. Overwhelmed the mind makes errors in

perception and hallucinates, draws incorrect conclusion, and becomes delusionals. To

compensate for this barrage , the mind withdraws and negative symptoms develop. (Beuer,2006)

Organic or Pathophysiologic Theory suggest schizophrenia is a functional deficit

occuring in the brain caused by stressors such as viral infection, toxins, trauma or abnormal

substances.( Well-connected,2006)

Perinatal Theory suggest that the risk of schizophrenia exist if the developing fetus or

newborn is deprived of oxygen during pregnancy or if the mother suffers from malnutrition or

starvation during first trimester of pregnancy . The development of schizoprhenia may occur

during fetal life at critical points in the brain development generally the 34th or 35th week

gestation. The incidence of trauma and injury during the second trimester and birth also been

considered in the development of schizoprenia. ( Well-connected,2006)

Schisms and Skewed families by Theodore Lidz described two abnormal patterns of

family behaviors. In one family type, with a prominant schism between the parents, one parent is

overly close to a child of the opposite gender. In the other family type a skwed relationship

between a child and one parent involves a power struggle between one parent. These dynamics

stress the tenuous adaptive capacity of schizoprenic person.( Balllard 2009)

Pseudomutual and Psuedohostile families by Lyman Wynne, some families supress

emotional expression by consistently using pseudomutual or psuedohostile verbal

communication. In such families, a unique verbal communication develops and when child

leaves home and must relate to other persons, problems may arise the verbal communication may

be incomprehensive to outsider( Brien 2007).

Psychological or Experiential theory found that prefrontal lobes of the brain are

extremely responsive to stress. Individuals with schizophrenia experiences stress when family

members and acquaintances respond negatively to the individual’s emotional needs. These

negative responses already vulnerable neurologic state, possibly trigerring and excerbating

existing symptoms. Stressors that have been thought to contribute to the onset of schizophrenia

include poor mother-child relationships, deeply disturbed family intrepersonal relationships,

impaired sexual identity and body image, rigid concept of reality, and repeated exposure to

double bind situation. A double-bind stuation is a no win experience, one in which there is no

correct choice. (kolb,2005).

Double bind concept by Gregory Bateson and Donald Jackson is to described the

hypothetical family in which children receive conflicting parental messages about their behavior,

attitudes and feelings. Children withdraw into a psychotic sate to escape the unsolvable

confusion of double bind. (Ballard 2009).

Environmental or cultural Theory state that person who develops schizoprhenia has a

faulty reaction to the environment, being unable to respond selectively to numerous social

stimuli. Theorist also believe that person who come from low socioeconomic areas or single-

parent homes in deprived areas are not exposed to situations in which they can achive or become

succesful in life.

Patient Personal Data:

Name: Patient JD

Age: 39 yrs. Old

Address: Sorsogon, City

Sex: Female

Date of Birth: July 12, 1971

Place of Birth: Pasig, City

Race/Religion: Filipino/ Catholic

Marital Status: Single

Education: Highschool Graduate

Occupation: none, former plywood cutter and Garments Factory worker

Source of Refferal:

The patient was brought to Ortho by social worker at Sorsogon, City because of assultive

behavior with post inflammatory scar on both lower extremities and fever for first intervention

then finally admitted to National Center forMental Health Pavillion 2 accompanied by her father,

later on she was transferred in Unit 2, Pavillion 5 for further monitoring of behavior.

Chief Complain:

Nagwawala, Balisa, Ayaw uminom ng Gamot, mainitin ang ulo as verbalized by the Father.

Diagnosis: Undifferentiated Schizoprenia

History of Present Illness:

Patient is on Unit 2, Pavillion 5 for further monitoring of behavior, She was on good

mood state with normoproductive speech, She had poor recent, remote and immediate memory,

she only remembers the memory when she was at the age of 16-33. She was disoriented in time

and date but know what place she was. She denied any suicidal attempts and hurting others. She

said she had good sleeping pattern and also she denied any visual hallucination but sometimes

she experience auditory and gustatory hallucination such as “binubuyo niya akong saktan ang

sarili ko pero di ko na pinapansin yun” and “walang lasa ang pagkain dito palagi”.she also said

she always complied to her medicine but complain of positive dizziness.she also had unusual

mannerism and gesture such as scratching her plam and her head.

Past Personal History:

The patient was mentally ill since 1990’s with previous admission at an ortho because of

post inflammatory scar at both lower extremities, she was discharge as improved, following

medication was initially complain. Patient was eventually loss to follow-up with the medication

given because of low financial assistance.

Few days prior to admission, patient was noted to be restless, agitated and have

perceptual disturbances. January 15, 2008 family was decided to admit her at NCMH Pavillion 2

accompanied by her Father, after three months she exhibited normal cognition and physical state

then later on she was transferred to Pavillion 5 unit 2 because of escape and suicidal attempts,

assultive behavior to co-client,flight of ideas with looseness of association, poor impulse control,

agitated, tangentially and visual and auditory hallucination.She had 2x2 cm 2x 1.5 contrusion

hematoma on left Zygomattic area after having first fight last July 10, 2008. On October 29,2008

she was brought to restrain and undergo Electroconvulsive therapy on the following day. At

Novemeber 7, 2008 another incidental report happen when the patient was on restlessness nd

accidentally bumped her head on the cemented wall 3x4 cm contrusion on mid forehead.

Family History:

Her Father was 64 years old, jobless and her mother was 59 years old manicurista both

live at Sorsogon, City and earn 2,400 a month. She had a older brother who had own his family.

There is no data about history of having schizoprhenia in the family. But because of low

financial assistant with on and off medication serves as the rooted of worse progression of

patient diagnosis.

Chapter II

General Appearance

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

Good grooming * *

Appropriate facial expression

* * *

Appropriate posture

* * *

Maintain eye contact

* * *

During student nurse- patient interaction, the patient’s grooming was not good prior to

morning care she wear dirty ward gown without slippers but on the second day and later part she

improves and shows good grooming. Most of the time she exhibited appropriate facial

expression and posture during interactions. She also displays and maintain good eye contact and

show ineterest on the topic but she was easily get distracted by environmental stimuli such as

other student nurse in the room or preparing something. As days passes by student nurse

established rapport on the patient.

Motor Behavior


AUTOMATISM

HYPERKINESTHESIA

WAXY FLEXIBILITY

CATAPLEXY

CATALEPSY

STEREOTYPE

COMPULSION

PSYCHOMOTOR RETARDATION

ECHOPRAXIA

CATATONIC STUPOR

CATATONIC EXCITEMENT

TICS AND SPASMS

IMPULSIVENESS

CHOREIFORM MOVEMENTS

Analysis: Patient doesn’t exhibit any problem in motor behavior.

C. Sensorium and Recognition


ORIENTATION

TIME

PLACE * * *

PERSON * * *

CONCENTRATION

MEMORY

REMOTE

RECENT

IMMEDIATE RETENTION

Analysis: During our NPI patient was oriented in place and people but not in time and

date, lack of orientation may indicate possibility of a medical or nuerological brain disorder.

Some patient also with schizophrenia may give incorrect or bizzare answer to the question.

(Saddock,2007). She’s also has poor remote, recent, immediate retention in memory because

she’s doesn’t recall her past past experiences it may be because of the cognitive impairment.She

also exhibited poor concentration because she was easily distracted by environmental stimuli..

Patient with schizophrenia typically exhibit cognitive impairment in the domains of attention,

working, recent, remote and immediate memory, this impairements cannot function as a

diagnostic tools but they are strongly related to the functional outcome of the illness.

(saddock,2007) .

D.Perception


HALLUCINATION

VISUAL

OLFACTORY

AUDITORY *

TACTILE

GUSTATORY

ILLUSIONS

DELUSIONS

Analysis: The patient shows auditory hallucination during day 2 of nurse patient

interaction, Any fives senses may be affected by hallucinatory experiences in patient with

schizophrenia. The mosy common hallucination was auditory with voices that are often

threatening, obscene, accussatory or insulting. That may comment on the patient’s life behavior.

( Saddock, 2007) . On my patient her auditory hallucination was ” sabunutan daw po kita” . as

patient verbalized. Auditory Hallucination was under the categories of positive symptoms

schizophrenia where in Patient with Undifferentiated schizoprenia may experience it (Videbeck

2008).

E.ATTITUDE AND BEHAVIOR


COOPERATION * * *

OUTGOING

WITHDRAWN

EVASIVE

SARCASTIC

AGGRESSIVE

PERPLEXED

APPREHENSIVE

ARROGANT

DRAMATIC

SUBMISSIVE

FEARFUL

SEDUCTIVE

UNCOOPERATIVE

IMPATIENT

RESISTANT

IMPULSIVE

Analysis: The patient is cooperative throughout the exposure she cooperates well and

interacts with us and participates in the activities.

F.DEFENSE MECHANISM

Criteria Day 1 Day 2 Day 3 Day 4

DENIAL

REPRESSION * * *

SUPPRESSION

RATIONALIZATION

PROJECTION

DISPLACEMENT

INTROJECTION

CONVERSION

SYMBOLIZATION

DISSOCIATION

UNDOING

REGRESSION

SUBSTITUTION

FANTASY

REACTION FORMATION

SUBLIMATION

COMPENSATION

Analysis: The patient show repression. Repression was excluding painful or anxiety-

provoking thoughts and feelings from contious awareness, a person use this kind of defense

mechanism to cover-up her fears (Keltner2007). She remember her memory when she was 33

years old and doesn’t recall any previous experiences, she doesn’t know why she was in NCMH.

According to Frued it is unconscious defense mechanism in which unacceptable mental contents

are banished or kept out of consciousness; important in psychological development and in

neurotic ans psychotic symptoms formation( Saddock,2007).

G.AFFECTIVE STATE


EUPHORIA

FLAT AFFECT

BLUNTING

ELATION

EXULTATION

ECTSTASY

ANXIETY

FEAR

AMBIVALENCE

DEPERSONALIZATION

IRRITABILITY

RAGE

LABILITY

DEPRESSION *

Analysis: The patient does exhibit depresion on the first day, because when we talk about

her family, she expresses feelings of loneliness and longing to go home. Depression may be part

of the psychopathology of schizophrenia, and studies, on the average, have suggest that 25% or

more of schizophrenic patient experience depression (keck, 2007)

H. SPEECH


VERBIGERATION

RHYMING

PUNNING

MUTISM

APHASIA

UNUSUAL TONE RATES

UNUSUAL VOLUME OF SPEECH

UNUSUAL INTONATION

UNUSUAL MODULATION

Analysis: The patient does not exhibit any problem of the speech behavior above.

I. THOUGHT PROCESS AND CONTENT


BLOCKING

FLIGHT IDEAS *

WORLD SALAD

PERSEVERATION

NEOLOGISM

CIRCUMSTANTIALITY

ECHOLAGIA

CONDENSATION

DELUSION

PHOBIA

OBSESSION

HYPOCHONDRIAC

Analysis: The patient show flight of ideas during 4th day of exposure, One of the

symptoms of Schizophrenia was flight of ideas where in there is a overproductivity of talk and

verbal thinking skipping from one idea to another.Although talk is continously, the ideas are

fragmently. Connections between segment of speech often are determine between segment of

speech.( shives, 2008). On Patient she answer the question about ahow many child she had then

she answer it 3 then turn her answer about her husband eventhough she had no husband and

children. Flight of ideas was of the disorder in thought process and it concern in the way ideas

and language are formulated, thought control in which outsides forces are controlling what the

patients thinks or feels.( Saddock, 2007)

Chapter III

Book based

i

CAUSES: SCHIZOPRHENIA

Biochemical factors:

-Increase dopamine activity in the limbic system

Neurostructural factors:

-Enlarge ventricles-brain atrophy-decrease cortical blood flow in the prefrontal lobe

Genetics:

-can be inherited because schizophrenia runs in the families.

Psychodynamic:

-Developmental stage.

-family relationship

Symptoms: Disturbance in perception Disturbance in thought process Disturbance in reality testing Disturbance in feeling ,behavior, attention

Decline in psychosocial functioning

Acute Phase:

The patient experiences severe psychotic symptoms.

Stabilizing Phase:

The patient gets better.

Stable Phase:

The patient might still experiences hallucinations and delusion but the hallucination and delusion are not severe not as disabling as they were during acute phase.

Five types of schizophrenia:

Paranoid schizophrenia, disorganized schizophrenia, Catatonic schizophrenia, Residual schizophrenia and undifferentiated schizophrenia.

According to Kelther (2007) there are different factors that causes Schizophrenia first the

Biochemical factors in which there is increase dopamine activity that contibute in activating

positive symptoms of schizophrenia, second was neurostuctural in which there is large

ventricles, brain atrophy and has decrease in blood flow in prefrontal cortex of the brain, third

the genetics which it can be inherited by a person who has schizoprhenia runs in the family and

lastly the psychodynamic factors in which a person with schizophrenia has tendency that he or

she had deprive in her or his developmental stage or a person may experienced conflict with

family relationship. There are different psychotic symptoms that may be seen such as d

Disturbance in perception , thought process, reality testing, feeling ,behavior, attention which may be

result in decline of psychosocial functioning. There are three phase that the patient might be experienced

first, in acute phase the patient experiences severe psychotic symptoms followed by stabilizing phase in

which patient gets better and lastly the stable phase, in this phase the patient might experiences

hallucination and delusion but the hallucination and delusion are not as severe nor disabling as were

during acute phase.

Client based Undifferentiated Schizophrenia diagnosed since 1990’s

Patient experiences agitation, restlessness,

and perceptual disturbance

She exhibit normal cognitive and physical

state.

After three months she was been shown to be poor impulse control, agitated, tangentially with flight of ideas with looseness of association and visual and auditory hallucination, she revealed escape and suicidal attempts, assultive behavior to co-client.

The onset of patient shizophrenia was diagnosis since 1990, there’s no data of any family

members having schizophrenia except of her. The patient was brougth to ortho for her post

inflammatory scar in both lower extremities , she was discharge as improved, following

medication was initially complain. Patient was eventually loss to follow-up with on and off

rooted complain because of low financial assistance. Few days prior to admission patient

exhibited restlessness, agitation, perceptual diturbance. Then after three months she was been

shown to be poor impulse control, agitated, tangentially with flight of ideas with looseness of

association and visual and auditory hallucination, she revealed escape and suicidal attempts,

assultive behavior to co-client.

Related literature

Different studies are conducted to give possible explanation in the development of

schizoprhenia:

Gene Study Suggests New Target for Schizophrenia Tx Reviewed by Robert Jasmer,

MD; Associate Clinical Professor of Medicine, University of California, San Francisco and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner stated that defects in a pathway with

a misleading name may underlie some cases of schizophrenia, according to researchers

conducting a genetic study.

Genomic variants known as microduplications in or near the gene for the vasoactive

intestinal peptide (VIP) receptor were 14 times as common in a sample of patients with

schizophrenia relative to normal controls, reported Jonathan Sebat, PhD, of the University of

California San Diego, and colleagues, in the Feb. 24 issue of Nature.VIP is actually a

http://www.medpagetoday.com/reviewer.cfm?reviewerid=55

http://www.medpagetoday.com/reviewer.cfm?reviewerid=55

multifunctional protein that is produced throughout the body and is active in a host of body

systems. In addition to playing multiple roles in the intestinal tract and circulatory systems, VIP

helps regulate vaginal secretions, prolactin release, and circadian rhythms. This last function is

located in the brain, and previous studies have linked circadian rhythm disturbances with

schizophrenia.

They undertook the study because earlier studies had identified copy number gains

involving large DNA sequences (more than 500,000 bases) that were more common in

schizophrenic patients, and wondered if replication of shorter sequences might also be linked to

the disorder.

In the second stage, Sebat and colleagues looked more closely at these regions in samples

from 7,488 patients and 6,689 controls.They found that microduplications within a 362-kilobase

region at chromosomal location 7q36.3 -- in or near the VIP receptor gene known as VIPR2 --

were significantly more common in the patients, with an odds ratio of 14.1 (95% CI 3.5 to

123.9).

"While duplications of VIPR2 account for a small percentage of patients, the rapidly

growing list of rare copy number variants that are implicated in schizophrenia suggests that this

psychiatric disorder is, in part, a constellation of multiple rare diseases," the researchers wrote.

"This knowledge, along with a growing interest in the development of drugs targeting rare

The researchers conducted the scans in a two-stage study. They first searched for copy

number variants in 802 schizophrenia patients and 742 controls, which yielded positive

findings in 114 genomic "regions of interest."

disorders, provides an avenue for the development of new treatments for schizophrenia."

(http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?

utm_source=twitterfeed&utm_medium=twitter)

According to Dr. A Bassett of the university of Toronto,the first true etologic subtype of

shizoprenia, the consequence of a chromosome deletion refered to as the 22q1deletion syndrome.

Person with this syndrome have distinct facial appearance, abnormalities of the palate, heart

defects, and immunologic deficits. The risk of developing shizoprhenia in the presence of this

syndrome appears to be approximately 25%. Genetic locations of schizophrenia, believed to be

on chromosomes 13 and 8. One study found thatmothers of client with schizophrenia had a high

incidence of gene type H6A-B44 (shives,2008)

http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed&utm_medium=twitter

http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed&utm_medium=twitter

Drug study

NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION

NURSING INTERVENTION

Haloperidol Competitively blocks dopamine receptor s to cause sedation and also causes alpha-adrenergic and anticholonergic blockade. It depressescerebral cortex, hypothalamus and limbic system, which control activity and aggression but also cause significant extrapyrimidal effects

Management of Tourette disorders; control of adults; management of severe behavioral problems in children . long term antipsychotic therapy.

Severe toxic CNS depression or comotose states from any cause; parkinson disease.

Glaucoma, seizure disorder, hepatic and renal impairment

asses pt. disorder and mental status before drug therapy. Reassses affect, orientation, mood, behavior, sleep pattern.

Monitor possible adverse reaction such as CNS, severe extrapyramidal reactions.

Monitor swallowing of oral administration medication and check for hoarding or giving meds to other client.

Monitor vital signs.



Chlorpromazine

Thorazine

Blocks postsynaptics dopamine receptors in brain.

Management of manifestations pf psychotic disorders, to control nausea and vomiting, relief of restlessness and apprehension before surgery, acute intermittent porphyria, adjunct in the treatment of tetanus, to control manifestation of the manic type manic depressive illness, relief of intractable hiccups, treatment of severe behavioral problems in children marked by combativeness or hyperexcitable behavior.

Comatose states, presence of large amounts of CNS depressants, presence of bone marrow depression.hypersensitivity.

Drowsiness, jaundice, postural hypotension, extrapyrimidal effects. Persistent abnormal movement, cerebral edema, hematologic disorders, ECG changes.

asses for mental status: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms before initial therapy

Monitor swallowing of oral administration medication and check for hoarding or giving meds to other client.

Monitor input and output



Biperiden Synthetic anticholinergic drugs, block cholinergic response in the CNS.

Parkinsonian syndrome especially to counteract muscular rigidity and tremor; extrapyrimidal syndrome.

Narrow- angle glaucoma, mechanical stenoses in gastrointestinal and megacolon; prostatic adenoma and disease leading to perilous tachycardia. Hypersensitivity to biperiden.

CNS and peripheral effects, skin rashes, dyskinesia, ataxia, twitching, impaired speech, micturition difficulties.

Document indication for therapy, onset of signs and symptoms and other agent tried and outcomeof therapy.

Assess for parkinsonism, EPS: shuffling gait, muscle rigidity, involuntary movement, pill rolling, spasm and drooling during treatment.

Monitor constipation, cramping pain in abdomen and abdominal distention.Increase fluids, add fiber to diet and excercise.



Amoxicillin Prevents bacterial cell wall synthesis during replication.Bactericidal

Treatment of infections of respiratory tract, skin and skin structures, genitourinary tract, otitis media, meningitis, septicemia,sinusitis bacterial endocarditis prophylaxis.

Hypersensitivity to penicilin, cephalosphorins,or imipenem. Not used to treat severe pneumonia, empyema, bactemeria, pericarditis, meningitis and purulent or septic arthritis during acute stage.

Dizziness, fatigue, insomia, reversible hyperacidity, urticaria, maculopapular to exfoliative dermititis.

Obtain pt. history of allergy

Asses pt. for sign and symptoms of infection, wound characteristic, sputum, urine stool, fever and WBC count.

Monitor sign of nephrotoxicity: urine cast, oliguria, proteinuria, increase BUN

Monitor for bleeding, ecchymosis, bleeding gums, hematuria.



Paracetamol Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation.

Relief of mild to moderate pain; treatment of fever.

Hypersensitivity, intolerance totertazine, alcohol, table sugar, saccharin.

Stimulation, dowsiness, nausea, vomiting, abdominal pain, hepatoxicity, hepatic seizure, renal failure.

asses pt. fever or pain, location, intensity, duration, temperature, diaphoresis.

Assess allergic reaction: rash, urticaria; if these occur, drug may have to be discontinued.

Monitor liver and renal function.,

Check input and output ratio.

Asses hepatoxicity.



Vitamin C Needed for wound healing, collagen synthesis, antioxidant, carbohydrate metabolism, protein, lipid synthesis, prent infection.

Inhance body natural immune function.

asses pt. nurtitional status for inclusion of foods hign in vitamin C: citrus fruits.

Monitor input and output: polyuria

Monitor ascorbic acid levels throughout treatment..

Assess patient knowledge on drug therapy.

Chapter IV

Psychotherapies Implemented

1. Exercise Therapy

Description Goal Procedure/Activities Patient Role/Patient

Analysis

Role of the Nurse

Is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body.

. To teach the patient the some exercises.

2. To assess motor abilities of the patients.

3. To give simple instructions that the patient can follow.

4. Safety is the priority.

5. To promote wellness

Let have atleast one or two leader.

-Set a joyful and lively music with a beat.

-Let the client to follow the Steps.Caution: Remind the condition of the clients to consider

Patient follows the step and does the exercise.

I encourage her to do the exercise and assist her.

2. Dance Therapy


Analysis

Role of the Nurse

The therapeutic use of movement to further the emotional, social, cognitive, and physical integration of the individual in the treatment of a variety of social, emotional, cognitive, and physical disorders.

To teach the patient the movements of the dance.2. To assess motor abilities of the patients.3. To give simple instructions that the patient can follow.4. Safety is the priority.

-Let atleast two to three students to lead the step in the song.

-Have a good choice of music it should be lively.

-Ensure the step must be applicable to the clients.

-Assure that most of the extremities will move.

The patient follows the dance step and cooperates well.

Wemake dance steps together with my classmates and teach them the steps.

3. Music and Arts Therapy


Analysis

Role of the Nurse

It is an interpersonal process in which uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health.

1. Appreciate the music and put the feeling of the drawing.

2. Discuss and show the drawing.

3. Divert attention into something more productive.

1.Prepare all the material

2. Be sure that all materials are adequate.3. Gather all clients into one area.

4. Explain the purpose and procedure of the therapy.

5. Distribute materials.

6. Play music

7. Let the client to draw.

8. Inform clients to share the work later.

9. When drawing recognized client.

10. Repeat the music when needed.

The clients draw and share her drawing to everyone.

Provide drawing materials and explain again the procedure to the patient.

Listen to the sharing of patient’s drawing.

Appreciate patient’s sharing.

4. Bibliotherapy

Description Goal Procedure/Activities Patient Role/Patient Analysis

Role of the Nurse

Bibliotherapy is rendered with the use of a story with elaborate images to be helpful for the client to imagine the story.

1.To develop an individual self-concept

2. Increase understanding.

3. Foster an individual honest self-appraisal.

-Prepare a story with elaborate images.

-Arrange the sits of the client into a good setting: theatrical setting is more advisable.

-Story telling must be in form of monologue.

-Someone should introduce the story.

-At the end of the therapy the clients must share insights and thoughts about he story.

The patient can express their learning about the story the heard. And give insight and comments on the different situation on the story.

Arrange the chairs in semi circle for the patients

Listen to the learning’s of patients

Give appreciation or recognition.

5. Remotivation TherapyDescription Goal Procedure/Activities Patient

Role/Patient Analysis

Role of the Nurse

A therapy of very simple group therapyof an objective nature used in an effortto reach the unwounded areas of thepatient’s personality & get them

1. To stimulate patient to be fellow explorer of the real world.2. To develop the ability to communicate & share ideas & experience with other.

1 .Introduction

2. Ask any body what they can say about the drawing and if anybody see a forest.

3. Poem reading “ Kalikasan ating Pagingatan”

4. Evaluation and

The patient can able to site example and give comments on the poem, also to the drawing and give their learning’s.

Listen to patient’s sharing and give recognition.

movingback into the reality.

3. To develop feeling of acceptance &Recognition.

Summary.

6. Socialization

Description Goal Procedure/Activities Patient Role/Patient Analysis

Role of the Nurse

Is the primary means by which human infants begin to acquire the skills necessary to perform as a functioning member of their society, and is the most influential learning processes one can experience.

1. To develop cooperation.

2. Safety is prioritized.

3. To develop interaction with other patients.

4. To develop camaraderie with other schools.

1. Introduction

2. National anthem

3.Prayer

4Opening remarks

1. Exercises

6.Yell/ Cheer

7.Intermission numbers

8Games

9. Closing remarks

The patient enjoyed and participated in the games and activities.

The patient increases self confidence and cooperate.

Arrange chairs and prizes.

Assist patients in the games

Join patient in dancing.

Cleaning the place.

Chapter V

Nurse Patient Interaction

Day 1

Nurse Response Analysis of Nurse Response

Patient’s Response Analysis of Patient’s Response

“Hello Ma’am” Giving recognition “hello!(smile)” The patient response

through verbal by

saying hello and non

verbal communication

which is smiling, it

seems that she’s a

little bit shy to the

student nurse during

first interaction.

“ ako po si Gia

Borlongan, galling

pos a URC sa malolos

bulacan, ako po ang

inyong student nurse.

Kayo po maari niyo

po bang ibigay ang

inyong pangalan?”

Giving information

And

seeking information

“ ako si patient JD”

The patient responds

directly in the

question by stating

her name and with

smile on her face.

The patient can able

to answer the

question.

“Ilang taon na po

kayo?”

Seeking information “33 years old.” Patient answered the

question by stating

her age with

maintained eye

contact to the student

nurse.

“Kailan po ang Seeking Information “July 12, 1971” Patient answered the

birthday niyo?” question by stating

her birthday with

maintained eye


nurse. The patient was

oriented.

“Saan po kayo

nakatira?”

Seeking Information “Pasig, City” Patient answered the

question by stating

were she live.It seems

that she only

remember the place

where she grow up

because according to

the chart, the patient

live in Sorsogon, city.

“May asawa po ba

kayo?”

Seeking Information “Wala.” Patient answered the

nurse’s question

seriously with

maintained eyecontact

to the student nurse.

The patient answer

same on the data on

the chart.

“May kapatid po ba

kayo?”

Seeking Information “oo. Isa. Kuya ko ” Patient answered the

question directly and

stating the

relationship of the

person to her. The

patient still remember

her siblings.

“Alam ninyo po ba

kung anong araw at

oras ngayon?

Seeking Information “hindi ko alam eh!”

(yumuko)

Patient answered the

question with low

tone of voice,then

bow her head, it

seems that she’s feels

shy on her answer.

“ Ngayon po ay

huwebes, ika-17 ng

febrero 2011, at 11:15

na po ng umaga

Providing

information,

orientation

“ ah, ganun ba” Patient get oriented in

time and date, and

deeply listening to the

information given by

the student nurse .

“ anu po trabaho

ninyo dati”

Seeking Information “ Nagtrarabaho ako sa

pasig Plywood cutter,

tas sa Antipolo

nagtatangal ng mga

sobrang sinulid sa

damit mula lunes

hanggang biyernes,

7:00-7:00.parehong

oras at araw

Patient answer the

question with

irrelevent information

because it is

impossible that she

works as plywood

cutter at the same time

works in the garment

in same time and

days.

“Ilang taon na po

kayo dito sa NCMH?”

Seeking Information “ tatlong taon na” Patient answered the

question while

counting with the

used of her fingers.the

patient was thinking

before answering.

“Sino po nagdala sa

inyo dito?”

Seeking Information “yung tatay ko” Patients answered the

question by stating the

person who brought

her to NCMH with

sadness on her face. It

seems that she was

depress.

“ Alam ninyo po ba

kung bakit kayo

nadala dito?”

Asking relate

question, clarifying.

“hindi ko alam”.

(umiling)

The patient answered

the question by saying

she didn’t know and

non verbal

communication by

turning his head a

gesture that means she

doesn’t know the

answer.

“May gusto po ba

kayong sabihin sa

akin?”

Encouraging patient

to express feelings

“ gusto ko na umuwi

sa amin, miss ko na

nga sila, kelan ba ako

maaring umuwi?.

Patientanswered the

questioned by

expressing her

feelings of longing to

her family members

with sadness on her

face. Also seeking for

information about the

time were she can go

home.It seems that

she has strong desire

to go home, because

since the time she was

admitted in NCMH,

no one visited her.

“ anu daw po ba ang Asking and clarifying Sabi matagal pa daw, Patient answered the

sabi ng doctor at nurse

dito?

information through

the use of questioning

kasi nasa probinsya

daw sila, dito muna

daw ako. ( with teary

eye)

question by giving

details on what she

had been heard

explanation from

other health care

provider. While

telling this to the

student nurse it seems

that she want to cry.

“siguro po pag mabuti

na ang inyong

kalagayan, papayagan

na po kayo umuwi,

kamusta na po kayo?

Giving opinion and

seeking for

information

“okey naman ako,

ayos na ako matulog,

at iniinom ko naman

ang gamut ko.

Patient give detailed

information about her

condition, and she

explained to the

student nurse what

that she doesn’t

experiences

difficulties unlike

before .

Ma’am pakibigay po

ulit ang akin

pangalan, natatandaan

ninyo pa po ba?

testing if the patient

are oriented to the

person interacted,

clarifying previous in

interaction

“ikaw si Gia, student

nurse kita


question with

smilling, and she was

able to remember the

student nurse name. It

seems that she can

recall the name of the

person she’s ineract

with.

“bukas po, may mga

therapy po tayong

gagawin,maaasahan

Giving information,

encouraging the

patient to join to the

Oo, sigeh(smile) Patient answered the

question through

smile and argees to

ko po ba ang inyong

paglahok?.

activities. cooperate in the

activities. It seems

that the patient was

interested with the

incoming activities.

“ bukas po ulit

ma’am, salamat pos a

pagbabahagi

impormasyonng

inyong sarili”

Thanking for the

information she

gathered.

(smile) Patient answeres

through non verbal

communication by

smiling and waving ,

it is a gesture saying

goodbye. The patient

also expecting the

student nurse in the

next exposure.

Day 2

Nurse Response Analysis of Nurse

Response

Patient’s Response Analysis of Patient’s

Response

“Hello Ma’am,

kamusta na po kayo?

Tanda ninyo po ba

ako?”

Giving recognition

and testing client if

she remember the

nurse

“ok naman!(smile).

Ikaw si gia”


the question with

smile and she’s also

stating the name of

the student nurse

which means that she

still remember the

student nurse. The

patient answered the

question correctly.

“ nagustuhan ninyo po seeking information “ oo, sumayaw nga The patient answered

ba ang mga activity

ngaun?

ako, tas nagdrawing

pa”

the question by sating

what sh’ve done on

the activity, It means

that there is

acceptance,

recognition and it

seems that she

enjoyed the activity.

“Ilang taon na po ulit

kayo?”

clarifying information “33 years old.” Patient answered the

nurse’s question same

as the previous

interaction in student

nurse with

maintained eye

contact.

“Kailan po ang

birthday niyo?”

clarifying Information “July 12, 1971” Patient answered the


as previous interaction

with maintained eye


nurse.

“Saan po kayo

nakatira?”

clarifying Information “Pasig, City” Patient answered the



witha maintained eye


nurse.

“May asawa po ba

kayo?”

clarifying Information “Wala.”(yumuko) Patient answered the



with maintained eye


nurse while having a

gesture of turning her

head side to side as a

sign that she doesn’t

have.


kayo?”

clarifying Information “oo. Isa.” Patient answered the



with maintained eye


nurse.

“Ano po ang

pinakagustong

activity na ginawa?

Seeking Information “yung kwento ni

maria makiling!”


nurse’s question in

interesting manner

with smile on her

face. It seems that she

really liked the story

in the activity.

“ bakit po? Asking the patient to

elaborate the answer

“ kasi iba yung pag-

iibigan nila ni gat

dula, tsaka yung

pagmamahal niya sa

magulang nya”

She answered the

question by giving the

qualities of the

character in the story

and also telling a part

of the story. It seems

that she can relate the

character of the story

to her qualities.

“anu pong paguugali

ni maria ang maaring

ihalintulad sa inyo”

Asking the patient to

relate it to herself

“ mapagmahal at

mapagalaga sa

magulang, maganda

pa


question with smile

and giving her same

qualities base on the

qualities of the

character and her. It

seems that she can

relate on the qualities

of the character.

”may gusto pa po ba

kayong tauhan sa

kwento?

Seeking Information “ si gat dula, para

siyang si cocoy”


question and giving

example of specific

person that she knows

that has the same

qualities to the

character of the story.

“Sino po si cocoy? Seeking Information “yung crush ko,

gwapo kasi un”

Patient providing

information about a

specific person that

she knows from the

past with smile on her

face .It seems that she

likes this person.

“ Nagkatuluyan po ba

kayo?

Asking information “hindi kasi pareho

kaming mahiyain,

piloto un.


question, by stating

what happen to her

and to the person

involve.

“may gusto pa po ba

kayong ibahagi?

Encouraging patient

to express feelings

“yung tatay ko

katulad ng tatay ni

maria, pinapagalitan

din ako?.

Patient answer the

question in which she

relate the qualities of

the father to the

qualities of the

character in the story.

It seems she had

childhood experiences

where she

experienced

repremmanded by her

father.

“ baka naman po kayo

napapagalitan kasi

may mali po kayong

nagawa., madalas po

ba kayo

napapagalitan?

Giving opinion and

seeking for

information

“ oo ganun na

nga(smile)


question with smile

and agreed to the

opinion of the student

nurse. It seems that

she approved to the

opinion of the student

nurse.

“nagustuhan ninyo

pop la lahat ng

activity, may gusto pa

ba kayong ibahagi?

Summarizing and

asking question.

Wala na Patient answered the

question and seems

she don’t want to

open another

conversation about the

topic.

Ako naman po ang

magtatanong, alam

ninyo po ba inyong

Seeking information “thorazine Patient answered the

question directly by

stating the name of

gamut? her drugs.this means

that she was aware on

the drugs she’s taking.

“ngayon po

nakakaranas pa po ba

kayo ng pagbulong?

Seeking information Oo, Patient

respond with the

question by stating

yes,which means she

was experienced

auditory hallucination.

Auditory

Hallucination was

under the categories

of positive symptoms

schizophrenia where

in Patient with

Undifferentiated

schizoprenia may

experience it

(Videbeck 2008).

“anu naman po ang

binubulong sa inyo”

Seeking information Sabi sabunutan ka

daw

Patient respond to the

question by stating

her auditory

hallucination. It seems

that she hallucination

symptoms are not yet

subsiding.

“ ano po ulit ang sabi? Clarifying

information

Hindi dati yun,

ngayon medyo

nawawaqla na


question by trying to

cover up what she’s

been heard. It seems

that she withrawn it.

Silence silence Napapagod na ako

pwede na ba ako

pumasok

Patient Expresses

what she feel and she

want to go back in the

ward. It seems that it

is her way to escape

reality that she had

auditory hallucination.

O sige po respond to the patient

question

Smile Patient respond with

nonverbal

communication by

means of smiling.

Day4

Nurse Response Analysis of Nurse

Response

Patient’s Response Analysis of Patient’s

Response

“Hello Ma’am,

kamusta na po

kayo?.tanda ninyo po

ba ako?”

Giving recognition

and testing client if

she remember the

nurse

“ok naman!(smile).

Ikaw si gia”


the question with

smile and recall what

the name of her

student nurse. The

patient can still

remember the student

nurse. It seems that

the student nurse

established rapport

well.

“ may socialization po Giving information “ oo, sigeh, may Patient agrees to the

tayo ngaun, sana po

makilahok kayo sa

mga laro

and encouraging to

join to the activity.

sayaw ba dun?” suggestion and asked

information with

interesting manner by

knowing what

activities she may

cooperates and she

also smiles.It seems

that she was excited

on upcoming

activities.

“ Nagenjoy po ba

kayo sa socialization?

seeking information “oo Patient answered the n

question directly

about what she feel on

the activity. It seems

that she enjoyed the

activity well.

“Kailan po ang

birthday niyo?”

clarifying Information “July 12, 1971” Patient answered the



she had a week

before. The patient

answered it correctly

“Saan po kayo

nakatira?”

clarifying Information “Pasig, City” Patient answered the



a week before with

maintained eye

contact on the student

nurse.

“May asawa po ba

kayo?”

clarifying Information “meron.” Patient answered the

nurse’s question

different from the

previous interaction

because previously

she tells she had no

husband with smile on

her face. It seems that

she experiencing

delusion.


kayo?”

clarifying Information “oo. Isa.” Patient answered the



with maintained eye

contact on the student

nurse.

“anu po pangalan ng

asawa ninyo ?

Seeking Information “cocoy!” Patient answered the

nurse’s question with

the smile and giving

the name of the

person she talking

about.

“ Di ba po sabi ninyo

wala kayong asawa?

clarifying Information “ meron, tatlo nga

anak namin eh.

Answered question

with explanation, and

giving information

about the person. The

patient answer was

new to the student

nurse, she had

different answer on

the previous

ineraction.

“anu po mga pangalan

ng anak ninyo?”

seeking information “ joan, anna, miguel Patient aswered the

question with smile

and stating the name

of the sibling she

had.This is part of her

delusions because she

had no children.

”ilan taon na sila? Seeking Information “di ko alm eh, piloto

si cocoy,”

Patient answer the

question with light of

ideas, the answer was

not connected to each

other. Because the

question of student

nurse was focused on

the children she

answered it is

irrelevant to the

question.

“kasal nap o ba kayo

ni cocoy?

Seeking Information “hindi, di ko alm kung

nasaan sya.”

Patient answer the

question with Flight

of ideas, it is not

related to each other

with maintained eye

contact. flight of ideas

where in there is a

overproductivity of

talk and verbal

thinking skipping

from one idea to

another(shives,2008).

It is sign of disturbed

thought process.

“ Ito po ang huling

araw naming dito, ako

po’y lubos na

nagpapasalamat at

nagbahagi kayo sa

akin.

thanksgiving “salamat din sa mga

natutunan ko, alam ko

na kailanagn maglinis

ng katawan lagi at

salamat kasi

nabubusog ako

Giving thanks, and

expressing what she

learned from the

student nurse with

smile on her face and

shaking hand with her

, a gesture of thanks

giving and saying

goodbye.

Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONObjective Data:

-Patient wears dirty ward gown and without slippers

-bad breath

-patient has foul odor

Self care deficit related to poor personal hygiene.

After Nursing exposure the patient will be able to:

a. Participate in self care activities

b. Demonstrate independence

2. Explain task in short simple manner.

3. Allow patient sufficient time to complete any task.

4. Remain with the client throughout the task: do not attempt to hurry the client

5. Gradually withdraw assistant and supervision to the patient grooming and other self care skills.

-A complex task will be easier for the client it is broken down into series of steps.

-It may take longer to complete task because of lack of concentration and short attention span.

-trying to rush the patient will frustrate him/her and make completion of the task impossible.

It is important for the client to gain independence as soon as possible.

After the exposure the patient able to :

a. Participated in self care activities.

b. Can able to perform self care activities on her own

Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONSubjective Data:

“Hindi ko alm kung anung oras na o anung araw na ngayon, kanina sinabi nung nurse pero di ko na maalala ” as verbalized by the patient

“Sabi daw niya sabutan daw po kita” as verbalized by the patient

Disturbed thought process related to auditory hallucination, disoriented in time and date.

After Nursing exposure the patient will be able to:

a. Oriented in time and date.

b. Present into reality.

1. Reorienting the patient.

2. Continue therapeutic nurse-patient alliance.

3. Use short simple directions and explanation.

-help patient maintain her level of orientation; increase her ability to become more oriented.

- It promoted and strengthens trust between the patient and nurse.

-It increases patient ability to understand and follow.

After the exposure the patient able to :

a. Can state the right time and date.

b. Presented into reality

Chapter VI

Journal

Day 1: February 17, 2011

At first I feel combination of nervous and excitement because I don’t know what type of

client I will handle. I don’t know what kind of approach I will give to be able to gain rapport and

I feel also shock to the kind of environment they were staying because I’m expecting it was like

ward I was seen in the movie. I learned that in interacting them to gain rapport we should not

force to answer all our question and we need to ask them little by little, because it is not easy for

them to open up especially like us stranger or newly met, and there are lots of painful of

experience they encounter, and that their emotional coping mechanism was not that stable. I also

learned that I’m blessed because I have my family to support me in times of problem that can

help me to cope. I also feel lucky that I’m not craving for food like them and I was in good

condition. As a future nurse someday I learned that in handling patient during initial interaction

we should maintain eye contact, let the patient feel that you are not harmful to them that you can

lend your ears to hear their feelings and lastly face them with optimism appearance even though

they had poor hygiene. And it is nice to know and hear about different qualities I didn’t found to

myself that other could see it.


On the second day of the exposure I’m quite comfortable to the place, first we arrange

the table and the chairs that we’ve been using for the different therapy. At first we do the routine

of patient hygiene, exercise, dance therapy where I know I discovered my dancing talent and

think simple step in a short time, music and arts and bibliography. I’m gently listening to their

sharing about the learning and the meaning of the drawing they draw and I’ve learned that partly

the activity or the therapy they connected it to the previous experience they have. During the

patient inter action I was shocked when my patient tell me about her auditory hallucination “ sabi

daw sabunutan kita” then I stop talking but maintaining my eye contact to her then I asked

clarification question like “anu po ulit yung naririnig ninyo?” then she said “wag ka mag-alala di

ko na sila pinapansin” and I learned that it is nice to help the client express her feelings and be

calm enough to interact to them even if you are afraid about what they are saying.


This was the third day of the duty; we are all excited for the Ms. Valentine pageant, we

are tasked to design the sash that been using at the pageant, I know in this simple tasked I used

again my artistic talent in designing the sash. In this duty we all witness the talent and question

and answer portion. I can say that by this type of motivation it helps the client to gain their

confidence and boost their talent. They touched my heart about the question and answer

especially when they were given the time to give thanks to the audience, I can see their hope and

their happiness in their eyes. I learned also only their mind can betray them but on the other side

of it their hope and feelings that they want to be free from their disease.


This was the last day of the exposure. The grand socialization, we are all busy preparing

in this day. And the very good thing I established camaraderie to other student nurse from the

different school. The greatest learning I’ve learned about is the talk of our C. I that socialization

is not intended only for the residents but also to the student as well, so that they know how to

mingle to others, how to give and take knowledge and strategies, it is not about completion about

other schools but learning how to interact with them. I realized from this that our group may be

together now but after we are graduated and pass the board exam we go different way and it is

better to practice camaraderie not only to our group because we did established it but to others

also, because some point in time we may cross our path and be my co- health workers in the

future. After the socialization we have is interaction to the patient, I’m glad to know that even in

a short time my patient can know my name even without looking at my name tag. And it is nice

to know that she learned something on me, me as well.

Appendices

Definition of terms

Definition of terms

Automatism - repeated purposeless behaviors often indicative of anxiety, such as

drumming fingers, twisting locks of hair, or tapping the foot.

Psychomotor Retardation - overall slowed movements.

Waxy Flexibility - maintenance of posture or position over time even when it is awkward

or uncomfortable.

Delusion - a fixed false belief not based in reality.

Hallucination - false sensory perception or perceptual experiences that do not really

exist.

Flat Affect - showing no facial expression.

Echolalia - the client’s imitation or repetition of what the nurse says.

Compulsion - ritualistic or repetitive behaviors or mental acts that a person carries out

continuously in an attempt to neutralize anxiety.

Echopraxia - imitation of the movements and gestures of someone an individual is

observing.

Cataplexy - is a sudden and transient episode of loss of muscle tone, often triggered by

emotions.

Catalepsy - is a nervous condition characterized by muscular rigidity and fixity

of posture regardless of external stimuli, as well as decreased sensitivity to pain.

Catatonic Stupor - is a motionless, apathetic state in which one is oblivious or does not

http://en.wikipedia.org/wiki/Apathy%20%5C%20Apathy

http://en.wikipedia.org/wiki/Pain

http://en.wikipedia.org/wiki/Human_position%20%5C%20Human%20position

http://en.wikipedia.org/wiki/Muscle%20%5C%20Muscle

react to external stimuli.

Catatonic excitement - is a state of constant purposeless agitation and excitation.

Individuals in this state are extremely hyperactive, although, as aforementioned, the

activity seems to lack purpose.

Choreiform movement - is characterized by repetitive and rapid, jerky, involuntary

movements that appear to be well-coordinated, but are rather performed involuntarily by

the patient afflicted with such a disorder.

Impulsiveness - is a personality trait characterized by the inclination of an individual to

initiate behavior without adequate forethought as to the consequences of their actions,

acting on the spur of the moment.

Regression - a defensive reaction to some unaccepted impulses.

Suppression - is the process of deliberately trying to stop thinking about certain thoughts.

Euphoria - is the process of deliberately trying to stop thinking about certain thoughts.

Blunting - lack of emotional reactivity on the part of an individual. It is manifest as a

failure to express feelings either verbally or non-verbally, even when talking about issues

that would normally be expected to engage the emotions.

Depersonalization - is a malfunction or anomaly of the mechanism by which an

individual has self-awareness.

Word Salad - flow of unconnected words that convey no meaning to the listener.

Neologism- invented words that have meaning only for the client.

Phobia - an illogical, intense, and persistent fear of specific object or social situation that

causes extreme distress and interferes with normal functioning.

Aphasia - deterioration of language function.

http://en.wikipedia.org/wiki/Emotion%20%5C%20Emotion

http://en.wikipedia.org/wiki/Psychomotor_agitation%20%5C%20Psychomotor%20agitation

http://en.wikipedia.org/wiki/Stimulus_(physiology)%20%5C%20Stimulus%20(physiology)

Mutism - is a speaking disorder in which a person, most often a child, who is normally

capable of speech, is unable to speak in given situations, or to specific people.

http://en.wikipedia.org/wiki/Speech_communication%20%5C%20Speech%20communication

Patient output

The patient drew a house using the color blue which indicates severe depression. Using

the blue color, she also drew a human stick that she labeled as Cinderella. Using the same color,

she drew two cats and two kids playing piko. Around and in between the pictures she had drawn,

she had shade it with the color violet which reflects depression, she also used that color to write

her name at the top of the paper. As the drawing specifies, the patient reminisces the past

especially her childhood. From all her experiences, she insisted that she was only 33 years old

but in reality she is already 39 years old.

Bibliography

Sadock M.D et. al (2007). Synopsis of Psychiatry. Lipprincott& Williams.United State of

America.

Kelther N.(2007). Psychiatric Nursing( 5th ed). Elvevier Piecta. Singapore.

Kaufman (2006). Essentials of Abnormal Psychology. John Wiley& Sons Inc. United

State of America.

Videbeck, S. L. (2008). Psychiatric Mental Health Nursing. (5th ed). Wolters Kluwer

Health.

Shives, L. R. (2008). Psychiatric Mental Health Nursing. (7th ed). Lippincott Williams &

Wilkins.

Kennedy P. (2008) Psychiatric Mental Health Nursing. Jones and Barlett Publishers, Inc.

United State of America.

Internet sources:

http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed

&utm_medium=twitter

http://www.nursingscrib.com

http://psychopathology.wikispaces.com/Schizophrenia

http://www.nursingscrib.com/

http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed%20%20&utm_medium=twitter

http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed%20%20&utm_medium=twitter

University of Regina Carmeli

Catmon, City of Malolos

College of Allied Medical Sciences

In PartialL Fulfillment in NCM 105 RLE

PSYCHIATRIC CASE STUDY

Submitted to:

Mrs. Perlita Espinoza

Submitted by:

Borlongan, Gia Pauline A.

BSN3

54500904 NCMH Case Study Gia

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Transcript of 54500904 NCMH Case Study Gia