Angeles University Foundation COLLEGE OF NURSING
PLAN OF CARE NAME: Tristan Jay I. Arellano BSN III – 4 I.
GROUP Number: 1
MENTAL STATUS EXAMINATION (MSE)
CONTENT OF MSE General Appearance
ASSESSMENT
PSYCHOBIOLOGICAL RATIONALE
Patient “C” of unknown age, is a Filipino Male
Clients with schizophrenia may have significant
who stands around 4’11’’ and weighs fairly average
self-care deficits. Inattention to hygiene and
based on his appearance. He is fairly groomed, hi
grooming needs are usually common. The client
hair cut short and his nails a bit long with stains of results
to
personal to
neglect
yellow and black especially significant in his toe
preoccupation
his
region. He presents patches of hair loss and the
hallucination, or delusions.
due
psychotic
to
his
ideations,
most significant is on the right frontal area of his head. C also has halitosis that is suppressed by
Furthermore, it is also common that clients are
brushing and cycles again after some hours. He has
unable to process the need to renovate self after a
no front teeth in the upper area of his dental
strenuous day or refurnish grooming due to
structures and his teeth are stained with yellow to
dysfunctions in the temporal and frontal areas of
brown hues. He also has growing hair around around his
the brain brought about by either the enlargement
mouth and jaw area, significant of an after shave
of ventricles or impairment in glucose and oxygen
cycle.
metabolism.
C wears a blue NCMH shirt, with a V neck collar
Lastly, it is also very usual that clients suffering
and a stiff material; an NCMH short that is colored
schizophrenia precipitate a neglect in primary
green and extends from his waist until 3 finger
senses such as thirst, and hunger that is why they
breadths above his ankle.
are
usually
constipated
and
undernourished
resulting further to lack of sufficient energy for C stands fairly stable, his gait slightly swingy. He has short extremities and his legs are filled with macular rashes, nearly scabies like, and his feet are bombarded with pustules, macules, crusts, and wounds from severed skin infection. He also has two significant tattoos, one in his Left shoulder, a girl who is drawn in a basic fashion, and one other in his right hand, at the area of the thumb, the tattoo here are 5 dots.
movement and exercise.
Behavior
Although Patient C’s age is unobtainable from his
For
schizophrenic
patients,
their
motor
records and from himself, stereotyping his physical
behavior, and behavior in general are commonly
features suggest that patient C’ is in his mid40’s or
altered. Clients may be restless and are unable to
early 50’s already yet he acts in a regressed manner,
sit still, in patient C’s case, he is observed to prefer
similar to that age that falls between Infancy and
pacing around the perimeter than sitting for
Childhood as evidenced by his oral gratifying
minutes in a bench.
behavior which is thumb sucking. Consequently,
the
patient
also
presents
Patient also moves very slowly and his pace is not
psychomotor retardation resulting to regressed
as active as that of how a normal person of his age
behavioral manifestations and general slowing in
moves
the execution of movement.
about.
Patient
C
also
has
difficulty
maintaining eye contact although he has a full stare at something but never on the person of nurse he is relating to. He presents vigil stare that are empty but prolonged. With regards to his facial expressions, he usually has a blank face and an exaggerated smile when hi is delighted. He reflects his delight by smiling and clapping. Also, patient has a difficulty in executing fine motor movements like drawing. He also could not read and write. It is also notable that the patient presents manifestations of catatonia that are evident in awkward opportunities such as that time when his foot is stepped by another patient, he did not remove the abused foot until he was told to do so.
Motor Activities
Patient C often walks around and does thumb
Walking
and
thumb of
sucking
psychomotor
are
evident
sucking. He also has considerable liking of flowers
manifestations
retardations
and picking them up and later giving them to othe r
present among patients with schizophrenia
student nurses. His movements are slowed down and are very limited although he is able t o do his ADL’s in a satisfactory rate.
Speech Pattern
Patient C consumes much time and effort in
The core phenomenologic characteristics of
answering. He also speaks in a childish manner that
schizophrenia can be considered to stem from
is fairly clear and understandable. He is usually
anomalous
dropping initial syllables of words. He speaks single
communication
words only when asked to answer and he also
language. Thus, it follows that schizophrenia is
stutters.
likely to be a uniquely human condition and that
organization, of
complex
retrieval, "thought"
and and
some deficits in the neural organization of Patient C also manifests word salad, that when
language must exist in schizophrenia. Numerous
probed on a specific matter, he utters words that do
aspects of both speech and its perception have
not
been found to be deviant in studies of patients
have
any
relationship
with
his
previous
statements. He’s speech is also limited to only direct
with schizophrenia.
succinct answers and does not exert any effort to keep conversations going.
Crow has suggested that language deviance is the basis for the development of the nuclear symptoms of schizophrenia (Crow, 1998a) and that "Schizophrenia is the price Homo sapiens pays for language" (Crow 1997). He further states that the development of cerebral structural asymmetries
during
hominid
evolution
is
responsible for the uniquely human components of language (as discussed by Geschwind and Galaburda 1987 and Corballis 1991) and that these asymmetries are anomalous in schizophrenia (Crow 1998b). In support of this hypothesis, we previously have shown that reduced cerebral asymmetries are present early in the course of schizophrenia and that some components of asymmetry are inherited
Concentration
Patient C has varying attention span. He spends
Videbeck reasons out how concentration is
less than a minute during assessment by the nurse
impaired in schizophrenia by going back to the
and he spends long minutes while staring blankly on
preoccupations of every schizophrenic patient
trees, birds, ants, and flowers. He also could not
with
focus and participate well during the therapies
thinking, and ideations.
their
hallucinations,
delusions,
magical
because he is easily distracted by almost anything.
Orientation
Patient C is not oriented to Time . He reckons no
Significantly, due to the lack of function of the
memory of any current president in office, no recall
temporal lobe which is far attributed to the
of the details of the day, and no estimation of time.
resolution of memory, recall, and processing of
With regards to place, he describes and relates to
new
places by using proximities but never being able to
disorientation and confusion to the surroundings.
site the name of places. Significantly, he is aware o f
It also may be attributed to the imbalances in the
the people around him although he could not
neurotransmitter, dopamine.
information,
its
impairment
leads
to
mention their names.
Memory
Patient does not have a stable memory of what has
Memory is impaired in schizophrenia because
been done previously or what had been talked
of the significant imbalances in dopamine which is
about previously. He also could not detail his own
significantly important in recall and an anatomic
familial history although he mentions having a
deviation in the temporal regions of the brain.
mother and 2 siblings. Other details are unobtainable
Thought Clarity
Thought Content
With regards to thought clarity, the patient presents
Thought clarity, content and process, and
a very poor rating. He could not process questions at
intellectual functioning are usually altered and are
an instance and one the repeat. He also has a hard
significantly
time doing comparisons or making choices
patients.
This
Patient C presents obsessions on flowers, leaves,
identified
as
ants, river, stones, and houses. He ke pt of saying
alterations
these topics even when question no longer require
constitutes
such supplying.
schizophrenia. (Videbeck, 2011)
common
in to
among
disease a
had
thought
the the
schizophrenic
been disorder
aforementioned primary
popularly because aspects
features
of
Thought Process Intellectual Functioning
Patient C blocks himself from answering questions that render his past and also manifests word salad,
Aside from the anatomical deviations rooted
loose associations and flight of ideas.
from enlargement of ventricles and decline in
Patient C cannot process mathematical activities
oxygen and glucose metabolism, neurochemical
such as counting and adding, he also significantly has
studies have postulated that neuronal networks
difficulty distinguishing colors and names all other
which transmit information by electrical signals
shades as White. He also could not make
from a nerve cell to another is of grave
connections with statements and could not reason
malfunction. This ultimately results to a disruption
out or explain
in intellectual functioning, and in the processing of thought thus clouding the clarity of ideas and declining its content.
Mood Affect
The patient sustains varying moods from being
Clients with schizophrenia often present and
happy, sad, irritable, and flat
demonstrate wide variances in mood and affect.
The patient has blunt affect, showing very slow-to-
They are often identified as having either flat
respond facial reactions. He also says “mabuti”
affect of blunt affect. The typical facial expression
(well) even if his facial reactions would say
often described among these clients is mask-like.
otherwise These manifestations are again blamed on the impairment in brain signals and neuronal network brought
by
neurochemical
alterations
and
anatomic abnormalities.
Insight
The patient is not able to gather his own insight on
Insight may also be severely impaired among
things. He may present some insight yet t hey are
clients with schizophrenia, especially during the
majorly not in line with the subject.
early course of the disease when the patient’s family and immediate social network do not understand the disease condition of their familial member.
Judgment
The patient capable of basic judgment, In particular, noting which fruit is rotten or edible.
Judgment is frequently impaired in clients with schizophrenia. Because judgment is based on the ability to interpret the environment correctly, it follows that the client with disordered thought processes and environmental misinterpretations will have great difficulties in judging.
Abstract Thinking
The patient is not capable of performing
Impairment in abstraction is greatly derived
abstractions nor minor hypothetical or conclusive
from the impairment in the thought processing,
evaluating constitutions.
content, and clarity of the patient. It is further aggravated by the difficulty in judgment and intellectual functioning which precipitates into a nearly basic, primitive, and superficial manner of interpretations when problems are let down for the client’s analysis.
