Case Study - CCMH

Case Study onPresented by:Group 2: Erardo, Erguiza, Eribal, Esguerra, Esmero, Español, Española, Estacio M., Estacio, P., Estepa, Estrada & Evangelista

PRESENTED TO:Mrs. Joanie C. Andaya, RNGroup 2 Clinical Instructor

COLLEGE OF NURSING

A Case Study on

Residual Schizophrenia

Presented to the College of Nursing

University of Perpetual Help System DALTA

In Partial Fulfillment of the

Subject Requirement in

Related Learning Experience (NCM 104)

Presented by:

ERARDO, Darius Daniel Gonzales

ERGUIZA, Mianne Nicole Empalmado

ERIBAL, Charmaine delos Reyes

ESGUERRA, Jose Mari Filipinas

ESMERO, Jimmel Obejas

ESPAÑOL, Nikko Jan Tristan Respicio

ESPAÑOLA, Alberto Miguel Moscoso

ESTACIO, Mary Grace Natividad

ESTACIO, Precious Ann Sernande

ESTEPA, Kevin Marlo Alonzo

ESTRADA, Ralph Edison Clemente

EVANGELISTA, Lorna Tabudlong

BSN 4G – Group 2

Presented to:

Mrs. Joanie C. Andaya, RN

ACKNOWLEDGEMENT

This Case Study would not have been possible without the help of many

people. We, the Group 2 of BSN 4G would like to extend our warmest gratitude to the

following people who made an effort to help in different ways:

To our Family, for their continuous support and encouragement and for

being our inspiration in every task that we are doing;

We would like also to convey our thanks to the Staff of Cavite Center for

Mental Health for allowing us in borrowing the case of their patients for our case

study.

To our Clinical Instructor, Mrs. Joanie C. Andaya, we whole heartedly

thank you for your efforts and suggestions; we really appreciate your kindness and

patience to help us in many ways for us to have courage to pursue this task.

To our Patient, Mr. R.M, we really appreciate your participation in our

case study. Thank you for allowing us to have an interview with you.

And lastly, to our God Almighty for the gift of wisdom and skills for us to

accomplish this task, we offer you these for being our source if encouragement and

determination.

CHAPTER 1: Overview of the Disease

DEFINITION

Schizophrenia is an extremely complex mental disorder: in fact it is probably many

illnesses masquerading as one. A biochemical imbalance in the brain is believed to

cause symptoms. Recent research reveals that schizophrenia may be a result of faulty

neuronal development in the fetal brain, which develops into full-blown illness in late

adolescence or early adulthood.

Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions,

movement, and behavior. It cannot be defined as a single illness; rather thought as a

syndrome or disease process with many different varieties and symptoms. It is

usually diagnosed in late adolescence or early adulthood. Rarely does it manifest in

childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35

years of age for women.

TYPES

Schizophrenia, paranoid type is characterized by persecutory (feeling

victimized or spied on) or grandiose delusions, hallucinations, and occasionally,

excessively religiosity (delusional focus) or hostile and aggressive behavior.

Schizophrenia, disorganized type is characterized by grossly inappropriate or

flat affect, incoherence, loose associations, and extremely disorganized

behavior.

Schizophrenia, catatonic type is characterized by marked psychomotor

disturbance, either motionless or excessive motor activity. Motor immobility

may be manifested by catalepsy (waxy flexibility) or stupor.

Schizophrenia, undifferentiated type is characterized by mixed schizophrenic

symptoms (of other types) along with disturbances of thought, affect, and

behavior.

Schizophrenia, residual type is characterized by at least one previous, though

not a current, episode, social withdrawal, flat affect and looseness of

associations.

SYMPTOMS

The symptoms of schizophrenia are categorized into two major categories, the

positive or hard symptoms which include delusion, hallucinations, and grossly

disorganized thinking, speech, and behavior, and negative or soft symptoms as flat

affect, lack of volition, and social withdrawal or discomfort. Medication treatment can

control the positive symptoms but frequently the negative symptoms persist after

positive symptoms have abated. The persistence of these negative symptoms over

time presents a major barrier to recovery and improved the functioning of client’s

daily life.

MEDICAL MANAGEMENT

Currently, there is no method for preventing schizophrenia and there is no cure.

Minimizing the impact of disease depends mainly on early diagnosis and, appropriate

pharmacological and psycho-social treatments. Hospitalization may be required to

stabilize ill persons during an acute episode. The need for hospitalization will depend

on the severity of the episode. Mild or moderate episodes may be appropriately

addressed by intense outpatient treatment. A person with schizophrenia should leave

the hospital or outpatient facility with a treatment plan that will minimize symptoms

and maximize quality of life.

A comprehensive treatment program can include:

Antipsychotic medication

Education & support, for both ill individuals and families

Social skills training

Rehabilitation to improve activities of daily living

Vocational and recreational support

Cognitive therapy

Medication is one of the cornerstones of treatment. Once the acute stage of a

psychotic episode has passed, most people with schizophrenia will need to take

medicine indefinitely. This is because vulnerability to psychosis doesn’t go away,

even though some or all of the symptoms do. In North America, atypical or second

generation antipsychotic medications are the most widely used. However, there are

many first-generation antipsychotic medications available that may still be

prescribed. A doctor will prescribe the medication that is the most effective for the ill

individual

Another important part of treatment is psychosocial programs and initiatives.

Combined with medication, they can help ill individuals effectively manage their

disorder. Talking with your treatment team will ensure you are aware of all available

programs and medications.

In addition, persons living with schizophrenia may have access to or qualify for

income support programs/initiatives, supportive housing, and/or skills development

programs, designed to promote integration and recovery.

NURSING INTERVENTIONS

Strengthening differentiation

Provide patient with honest and consistent feedback in a non threatening

manner.

Avoid challenging the content of patient’s behavior

Focus interactions on patient’s behavior.

Administer drugs as prescribed while monitoring and documenting

patient’s response to drug regimen.

Use simple and clear language when speaking with the patient.

Explain all procedures, test and activities to patient before starting them

Promoting socialization

Encourage patient to talk about feelings in the context of a trusting,

supportive relationship.

Allow patient to reveal delusions to you without engaging in power

struggle over the content or the entire reality of the delusions.

Use supportive, emphatic approach to focus on patient’s feelings about

troubling events or conflicts.

Provide opportunities for socialization and encourage participation in

group activities.

Be aware of personal space and use touch judiciously.

Help patient to identify behaviors that alienate significant others and

family members.

Ensuring safety:

Monitor patient for behaviors that indicate increased anxiety and

agitation.

Collaborate patient to identify anxious behaviors as well as causes.

Establish consistent limits on patient’s behavior and clearly communicate

these limits to patients, family member, and health care providers.

Secure all potential weapons and articles from patient’s room and the

unit environment that could be used to inflict injury.

Determine the need for external control, including seclusion or restraints.

Communicate the decision to patient and put plan into action.

Frequently monitor the patient within guidelines of facility’s policy on

restrictive devices and assess the patients level of agitation.

When patient’s level of agitation begins to decrease and self control

regained, establish a behavioral agreement that identifies specific

behaviors that indicate self control against are escalation agitation.

CHAPTER 2: Patient’s Profile

Demographic Data:

Name: R.M

Age: 35 years old

Gender: Male

Address: Maragondon Cavite

Date of Birth: December 27, 1975

Place of Birth: Cavite

Occupation: Home buddy

Nationality: Filipino

Civil Status: Single

Religion: Roman Catholic

Chief Complaint: (Nananakot)

Diagnosis: Residual Schizophrenia

Date Admitted: November 4, 1999

Source of Information: Patient, Patient’s Chart and Patient’s Relatives

NURSING HISTORY

A. Chief Complaint

The Patient was admitted by his relatives at Cavite Center for Mental

Health last November 4, 1999 due to personality disorder such as scaring them

and did different behaviors.

B. History of Present Illness

Started 2 weeks prior to consultation when patient showing violent

attitude towards his relatives.

Relapsed Schizophrenia (2007)

Residual Schizophrenia

C. Past Medical History

(+) Tuberculosis

(+) Schizophrenia

D. Medical Status Coordination

Prior admission the patient is:

- unkept

- uncooperative

- incoherent

- (+) visual & auditory hallucination

- disoriented

- poor memory & judgment

CHAPTER 3: Anatomy of the Brain

CEREBRAL CORTEX

Function:

The outermost layer of the cerebral hemisphere which is composed

of gray matter. Cortices are asymmetrical. Both hemispheres are

able to analyze sensory data, perform memory functions, learn new

information, form thoughts and make decisions.

Left Hemisphere

Function:

Sequential Analysis: systematic, logical interpretation of information. Interpretation

and production of symbolic information: language, mathematics, abstraction and

reasoning. Memory stored in a language format.

Right Hemisphere

Function:

Holistic Functioning: processing multi-sensory input simultaneously to provide

"holistic" picture of one's environment. Visual spatial skills. Holistic functions such as

dancing and gymnastics are coordinated by the right hemisphere. Memory is stored

in auditory, visual and spatial modalities.

CORPUS CALLOSUM

Function:

Connects right and left hemisphere to allow for communication

between the hemispheres. Forms roof of the lateral and third

ventricles.

Associated Signs and Symptoms:

Damage to the Corpus Callosum may result in "Split Brain" syndrome.

FRONTAL LOBE

Function:

Cognition and memory.

Prefrontal area: The ability to concentrate and attend, elaboration of

thought. The "Gatekeeper"; (judgment, inhibition). Personality and

emotional traits.

Movement: Motor Cortex (Brodman's): voluntary motor activity.

Premotor Cortex: storage of motor patterns and voluntary activities.

Language: motor speech

Associated Symptoms:

Impairment of recent memory, inattentiveness, inability to concentrate,

behavior disorders, difficulty in learning new information. Lack of inhibition

(inappropriate social and/or sexual behavior). Emotional lability. "Flat" affect.

Contralateral plegia, paresis.

Expressive/motor aphasia

PARIETAL LOBE

Function:

Processing of sensory input, sensory discrimination

Body orientation

Primary/ secondary somatic area


Inability to discriminate between sensory stimuli.

Inability to locate and recognize parts of the body (Neglect).

Severe Injury: Inability to recognize self.

Disorientation of environment space.

Inability to write

OCCIPITAL LOBE

Function:

Primary visual reception area.

Primary visual association area: Allows for visual interpretation.


Primary Visual Cortex: loss of vision opposite field.

Visual Association Cortex: loss of ability to recognize object seen in opposite

field of vision, "flash of light", "stars".

TEMPORAL LOBE

Function:

Auditory receptive area and association areas.

Expressed behavior.

Language: Receptive speech.

Memory: Information retrieval.


Hearing deficits.

Agitation, irritability, childish behavior.

Receptive/ sensory aphasia

LIMBIC SYSTEM

Functions:

Olfactory pathways:

Amygdala and their different pathways.

Hippocampi and their different pathways.

Limbic lobes: Sex, rage, fear; emotions. Integration of recent memory, biological rhythms.

Hypothalamus.


Loss of sense of smell.

Agitation, loss of control of emotion. Loss of recent memory.

BASAL GANGLIA

Functions:

Subcortical gray matter nuclei. Processing link between thalamus

and motor cortex. Initiation and direction of voluntary

movement. Balance (inhibitory), Postural reflexes.

Part of extrapyramidal system: regulation of automatic movement.


Movement disorders: chorea, tremors at rest and with initiation of movement,

abnormal increase in muscle tone, difficulty initiating movement.

Parkinson’s

THALAMUS

Functions:

Processing center of the cerebral cortex. Coordinates and

regulates all functional activity of the cortex via the

integration of the afferent input to the cortex (except olfaction).

Contributes to effectual expression.


Altered level of consciousness.

Loss of perception.

Thalamic syndrome - spontaneous pain opposite side of body.

HYPOTHALAMUS

Functions:

Integration center of Autonomic Nervous System (ANS):

Regulation of body temperature and endocrine function.

Anterior Hypothalamus: parasympathetic activity (maintenance function).

Posterior Hypothalamus: sympathetic activity ("Fight" or "Flight", stress response).

Behavioral patterns: Physical expression of behavior.

Appestat: Feeding center. Pleasure center.


Hormonal imbalances.

Malignant hypothermia.

Inability to control temperature.

INTERNAL CAPSULE

Functions:

Motor Tracts


Contralateral plegia (Paralysis of the opposite side of the body)

RETICULAR ACTIVATING SYSTEM (RAS)

Functions:

Responsible for arousal from sleep, wakefulness, attention.


Altered level of consciousness.

CEREBELLUM

Functions:

Coordination and control of voluntary movement.


Tremors.

Nystagmus (Involuntary movement of the eye).

Ataxia, lack of coordination.

MIDBRAIN

Functions:

Nerve pathway of cerebral hemispheres.

Auditory and Visual reflex centers.

Cranial Nerves:

CN III - Oculomotor (Related to eye movement), [motor].

CN IV - Trochlear (Superior oblique muscle of the eye

which rotates the eye down and out), [motor].


Weber's: CN III palsy and ptosis (drooping) ipsalateral (same side of body).

Pupils:

Size: Midposition to dilated.

Reactivity: Sluggish to fixed.

LOC (Loss of consciousness): Varies

Movement: Abnormal extensor ( muscle that extends a part).

Respiratory: Hyperventilating.

CN (Cranial Nerve) Deficits: CN III, CN IV.

PONS

Functions:

Respiratory Center.

Cranial Nerves:

CN V - Trigeminal (Skin of face, tongue, teeth; muscle of mastication), [motor and sensory].

CN VI - Abducens (Lateral rectus muscle of eye which rotates eye outward), [motor].

CN VII - Facial (Muscles of expression), [motor and sensory].

CN VIII - Acoustic (Internal auditory passage), [sensory].


Pupils:

Size: Pinpoint

LOC:

Semi-coma

"Akinetic Mute".

"Locked In" Syndrome.

Movement:

Abnormal extensor.

Withdrawal.

Respiratory:

Apneustic (Abnormal respiration marked by sustained inhalation).

Hyperventilation.

CN Deficits: CN VI, CN VII.

MEDULLA OBLONGATA

Functions:

Crossing of motor tracts.

Cardiac Center.

Respiratory Center.

Vasomotor (nerves having muscular control of the blood vessel walls) Center

Centers for cough, gag, swallow, and vomit.

Cranial Nerves:

CN IX - Glossopharyneal (Muscles and mucous membranes of pharynx, the

constricted openings from the mouth and the oral pharynx and the posterior third of

tongue.), [mixed].

CN X - Vagus (Pharynx, larynx, heart, lungs, stomach), [mixed].

CN XI - Accessory (Rotation of the head and shoulder), [motor].

CN XII - Hypoglossal (Intrinsic muscles of the tongue), [motor].


Movement: Ipsilateral (same side) plegia (paralysis).

Pupils:

Size: Dilated.

Reactivity: Fixed.

LOC: Comatose.

Respiratory: Abnormal breathing patterns. Ataxic. Clustered. Hiccups.

CHAPTER 4: PsychopathologyModifiable factors:

*Environmental factors- Low economic status / poverty

*Stress

Non-Modifiable factors:

*Gender - Male*Age – 24 years

-age range:15 – 25 years old

Neuro Chemical Factor

Complex senses of biochemical event

Neuro Anotomic

factor

Diminished of glucose metabolism & oxygen

Diminished of glucose metabolism & oxygen

Increase activity of dopamine &

serotonin

Decreased brain tissue and CSF

Decreased brain tissue and CSF

Increased activity of glutamate, acetylcholine & other neurotransmitters

Increased activity of glutamate, acetylcholine & other neurotransmitters

CHAPTER 5: Mental Status Examination

A. Appearance

- The Patient is family groomed, appropriately dressed

- Slightly Pale

- Maintain eye contact with interviewer

B. Speech

- Speech is sluggish

- Verbigeration present

- Rate is slow with low volume

- Good Articulation

C. Mood and Affect

Increase dopamine and

serotonin

UncooperatedIncoherentDisorientedPoor mental judgement

UncooperatedIncoherentDisorientedPoor mental judgement

Enlarged ventricle and cortical atrophyEnlarged ventricle and cortical atrophy

Decreased brain volume & brain function

Decreased brain volume & brain function

Temporal dysfunctionTemporal dysfunction

RESIDUAL SCHIZOPHRENIA

RESIDUAL SCHIZOPHRENIA

- Patients claim that he feels happy but he misses his sister

- Affect is blunted

D. Thinking Process

- Patient’s answer occasionally relevant and organized.

- No hallucination, illusions, delusions and suicidal or homicidal intention.

E. Sensorium

Patient is alert, disoriented to 3 spheres, retrograde memory, no consideration.

F. Insight and Judgment

Good

CHAPTER 6: Problem List

PRIORITIZING PROBLEMS

Ineffective Verbal Communication

Ineffective thought process

Disturbed personal identity

CHAPTER 7: List of Nursing Care Plan

Ineffective Verbal Communication

Assessment

Diagnosis Planning Interventions Rationale Evaluation

Subjective:

[No subjective cues]

Objective:

Disoriented

(+) verbigeration

Inappropriate verbalization

Speaks in a soft manner

Ineffective Verbal

communication

related to psychotic barriers sec. to

residual schizophre

nia as manifested by positive verbigerati

on and inappropri

ate verbalizati

on

At the end of the

rotation, the patient will be able

to verbalize his ideas

effectively and

appropriately.

- Establish rapport

- Assess environmental factors that may affect ability to communicate

- Maintain eye contact when communicating to the patient

- Provide the patient sufficient time to respond

- Keep communication simple, speaking to short sentences, using appropriate words, and using all modes for accessing information

- Reduce environmental noise that can interfere with comprehension

- Provide therapeutic activities such as art therapy

- to gain trust and to know the patient- to prevent environmental stressors that can affect communication abilities of the patient- to show interest and sincerity in communicating with the patient

- to construct his thoughts

- for them to understand phrases effectively and appropriately

- it can interfere / confuse patients

- to improve their capacity to think

At the end of the

rotation, the patient was able to verbalize his ideas

and thoughts

effectively and

appropriately.


Assessment

Diagnosis Planning Interventions Rationale Evaluation

Subjective:“Gusto ko mag pa-ospital, gusto ko ng green, gusto ko ng maliit” as verbalized by the patient

Objective:

Inappropriate verbalization

Disoriented

Rarely engaged on eye contact

Short attention span

(+) verbiigeration


related to psychologi

cal conflicts sec. to

residual schizophre

nia as manifested

by inappropri

ate verbalizati

on, disoriented

, short attention span and positive

verbigeration

At the end of the

rotation, the client

will be able to

demonstrate organize thinking process

- Establish therapeutic relationship

- Redirect client away from problem situation

- Provide the patient sufficient time to respond

- Provide therapeutic activities such as art therapy

- Maintain reality-oriented relationship and environment

- to gain trust

- to avoid confusion and stressors

- to orient them in reality

- to construct their thoughts

- to improve their capacity to think

At the end of the


was able to demonstrate organize thinking process

Disturbed Personal Identity

Assessmen Diagnosis Planning Interventions Rationale Evaluatio

t n

Subjective:“28 years old na ako” as verbalized by the patient

Objective:

- disoriented

- confused

- retrograde amnesia

Disturbed personal identity

related to poor ego

differentiation as

manifested by

disorientation in 3 spheres (time,

person & place), and retrograde

amnesia

At the end of the


will be able to

demonstrate

improvement on ego

demonstration (such as, being

oriented to 3 spheres)

- Establish therapeutic communication

- Determine distortion of reality

- Encourage patient to appropriately express his feelings.

- Provide calm environment

- Allow client to deal with situation in small steps

- to gain trust

- to orient patient in 3 spheres

- to relieve stress

- to help client to remain calm

- to prevent stress overload

At the end of the


was able to demonstrat

e improvement on ego

demonstration (such as, being

oriented to 3 spheres)

CHAPTER 8: Drug Study

Drug & Classificatio

n

Indication & Contraindicatio

n

Mechanism of Action

Adverse Effect

Nursing Responsibilities

Generic Name:

Risperidone

Brand Name:

Risperdal, Risperdal

Consta

Anti - psychotic

Indication

Schizophrenia

Bipolar Mania

Irritability symptoms of aggression toward others, deliberate self-injury, and temper tantrums associated with autistic disorder

Contraindication

Hypersensitivity to drug

Has antipsychotic

effect, apparently caused by dopamine-

and serotonin-receptor

blocking in CNS.

aggressive behavior, dizziness, headache,

fatigue, anxiety, transient ischemic attack,

cerebrovascular accident, neuroleptic syndrome,

Tachycardia, chest pain,

bradycardia, orthostatic

hypotension, arrhythmia, Rash, skin

discoloration, skin

ulceration, acne, dry

skin, seborrhea, pruritus, Rhinitis, abnormal

vision, pharyngitis,

conjunctivitis, otitis media,

blurred vision,

earache. Vomiting increased salivation,

constipation, abdominal

pain. Dyspepsia, nausea, dry

mouth, anorexia.

Instruct patient to take prescribed dose once or twice daily as prescribed, without regard to meals. Advise patient to take with food if GI upset occurs. Instruct patient using oral solution to use calibrated pipette to measure each dose. Advise patient that solution may be mixed with 3 to 4 oz of water, coffee, orange juice, or low-fat milk (but not with cola or tea) prior to administration. Caution patient using orally disintegrating tablet not to open the blister until ready to take the dose. Advise patient that dose will be started low and then increased until max benefit is obtained. Instruct patient not to stop taking risperidone when feeling better. Tell patient to immediately report altered

mental status, high fever, irregular pulse, muscle rigidity, rash, seizures, or sweating to health care provider.


n


n

Mechanism of Action

Adverse Effect


Generic name:

chlorpromazine

Brand name:

Thorazine

Anti - psychotic

Indication

- Acute and chronic psychoses, particularly when accompanied by increased psychomotor activity. Nausea and vomiting.

- Also used in the treatment of intractable hiccups

Contraindication

• Hypersensitivity.

•Cross-sensitivity may exist among phenothiazines. Should not be used in narrow-angle glaucoma.•Should not be used in patients who have CNS depression.

• Block dopamine receptors in the brain; also alter dopamine release and turnover.

• Prevention of seizures

neuroleptic malignant syndrome, sedation,

extrapyramidal reactions,

tardive dyskinesia, hypotension (increased

with IM, IV), blurred

vision, dry eyes, lens opacities,

constipation, dry mouth, anorexia, hepatitis,

ileus, agranulocyto

sis, leucopenia,

photosensitivity, pigment

changes, rashes.

• Assess mental status prior to and periodically during therapy.• Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May cause QT interval changes on ECG.• Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded.•Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration.• Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness,

severe muscle stiffness, loss of bladder control. Report symptoms immediately. May also cause leukocytosis, elevated liver function tests, elevated CPK.• Advice patient to take medication as directed. Take missed doses as soon as remembered, with remaining doses evenly spaced throughout the day.


n


n

Mechanism of Action

Adverse Effect


Generic name:

Biperiden HCL

Other brand names

containing Biperiden:

Akineton; Akinophyl

Anti - cholinergic

Indication

For use as an adjunct in the therapy of all forms of parkinsonism and control of extrapyramidal disorders secondary to neuroleptic drug therapy.

Contraindication

Hypersensitivity to biperiden

Narrow angle glaucoma

Bowel obstruction

Megacolon

Parkinsonism is thought to

result from an imbalance

between the excitatory

(cholinergic) and inhibitory (dopaminergic) systems in the corpus

striatum. The mechanism of

action of centrally

active anticholinergic drugs such as biperiden is considered to relate to competitive

antagonism of acetylcholine at cholinergic receptors in the corpus striatum,

which then restores the

balance.

dilated and sluggish

pupils, warm, dry skin,

facial flushing,

decreased secretions of the mouth, pharynx, nose, and

bronchi, foul-smelling breath, elevated

temperature, tachycardia,

cardiac arrhythmias,

decreased bowel

sounds, urinary

retention, delirium,

disorientation, anxiety,

hallucinations, illusions, confusion,

incoherence, agitation,

hyperactivity, ataxia, loss of

memory, paranoia,

combativeness, and

seizures.

Instruct patient to take it with food and avoid alcohol.

Avoid the use of the herb Kava as it causes Parkinsonism.

Avoid driving, the drug cause blurred vision.

Avoid vitamin B6 or protein rich foods because it decreases the absorption of the drug.



Mechanism of Action

Adverse Effect


http://www.flexyx.com/A/Akinophyl.html

http://www.flexyx.com/A/Akineton.html

n n

Generic Name:

Fluphenazine Decanoate

Brand Name:Prolixin

Decanoate

Anxiolytic & Anti-

psychotic

Indication

A long-acting parenteral antipsychotic drug intended for use in the management of patients requiring prolonged parenteral neuroleptic therapy (e.g., chronic schizophrenics).

Contraindication

- Hypersensitivity to drug

- MAO inhibitor use within past 14 days

Unclear. May alter

postsynaptic mesolimbic dopamine

receptors in brain and

reduce release of

hypothalamic and

hypophyseal hormones thought to

depress reticular

activating system, thereby

preventing psychotic

symptoms.

Seizures,anxiety,headache,insomnia,weakness,tremor,fatigue,suicidal,ideation,

dizziness. Chest

pain,palpitations,prolonge

d QTc interval.

visual disturbances,stuffy nose,

sinusitis, pharyngitis,

nausea,vomiting,diarrhea,constipation,dry mouth, anorexia, urinary

frequency,sexual

dysfunction,dysmenorrhea, hypoglycaem

ia, hypocalcemia

, hyponatremi

a, hypouricemia, joint, back or muscle

pain, URTI, cough,

dyspnea, respiratory

distress, diaphoresis,p

ruritus, flushing,

rash.

Encourage patient for signs and symptoms of depression. Assess for suicidal ideation.

Tell patient drug may take 4 weeks or longer to be fully effective.

Caution patient to avoid driving and hazardous activities until he knows how drug affects concentration and alertness.

Instruct patient to minimize adverse GI effects by eating frequent, small servings of healthy food, and drinking adequate fluids.

Advise patient to discuss anti-itching medicine with prescriber if rash develops

Not allowed if the patient is pregnant.

CHAPTER 9: Recommendation

We would like to recommend this to the family of the patient to participate and

act accordingly to the following guidelines for the improvement and betterment of

the patient condition:

- Help the patient to recover from his condition by visiting them to

the hospital.

- Encourage the family of the patient to comply well with the rules

and regulations of the hospital.

- Advise the family of the patient to actively participate the planned

activities of the hospital for the fast recovery of the patient.

- Instruct the family to initiate therapy for the patient’s recovery (e.g.

music and arts therapy.

- The patient’s family plays an important role in the patient’s illness

and recovery. Encourage the family to make their physically

present so that the patient would somehow feel their support and

concern. They are encouraged to be the patient’s source of strength

and inspiration as she undergoes painful, traumatic and harrowing

procedures. In addition, it is of prime importance that they are

oriented and educated basic facts regarding the patient’s condition

so that they will understand her even better and assist him in his

daily activities.

CHAPTER 10: Evaluation

Patient reported outcomes in Schizophrenia relate either to evaluate of illness

or benefit from treatment or to resilience of the self of the former, needs for care

treatment satisfaction and the therapeutic relationship are most common.

Less common are symptoms, insight, attitude towards medication and clinical

communication. Increasing expectations of treatment have led to new measures

assessing resilience of the self including empowerment, self-esteem & recovery.

Scores of different patient related outcomes, overlap, are influenced by a general

tendency, largely influenced by mood for more or less positive appraisal.

General appearance of the patient was able to sustain. Has a good hygiene

during the period of engagement.

Good grooming was sustained with careful attention on his clothes and looks.

Motor behavior, patients able to calm down and lessen anxiety during

interaction as manifested by ability to follow instructions and pays attention longer,

indulge in muscle exercises and other motivational activities and ability to set longer.

Speech of patient, presence of same manifestation of echolalia is observed.

Rambling of speech still observed exist tone of voice is kept intermittently between

very soft to moderate. The general tendencies of the patient is grossly dependent on

patients mode of patient, remains flat affect as significant identifier by the disease.

CHAPTER 11: Curriculum Vitae

ERARDO, Darius Daniel Gonzales

“Darius”

September 13, 1987

22 years old

[email protected]

ERGUIZA, Mianne Nicole Empalmado

“Nicole”

August 13, 1990

20 years old

[email protected]

ERIBAL, Charmaine delos Reyes

“Maine”

November 21, 1990

19 years old

[email protected]

ESGUERRA, Jose Mari Filipinas

“Joemari”

January 17, 1991

19 years old

[email protected]

ESMERO, Jimmel Obejas

“Jim”

January 8, 1990

19 years old

[email protected]

ESPAÑOL, Nikko Jan Tristan Respicio

“Nix”

November 27, 1989

20 years old

[email protected]

ESPAÑOLA, Alberto Miguel Moscoso

“Am”

April 26, 1986

24 years old

[email protected]

ESTACIO, Mary Grace Natividad

“Grace”

July 14, 1980

30 years old

[email protected]

ESTACIO, Precious Ann Sernande

“Precious; Prei”

December 19, 1990

19 years old

[email protected]

ESTEPA, Kevin Marlo Alonzo

“Kevin; Kevs”

October 26, 1991

18 years old

[email protected] & [email protected]

ESTRADA, Ralph Edison Clemente

“Rap”

October 24, 1989

20 years old

[email protected]

EVANGELISTA, Lorna Tabudlong

“Lorna”

October 23, 1968

41 years old

[email protected]

Case Study - CCMH

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