Chapter I Introduction
Schizo Schizophr phreni eniaa is a disord disorder er charact characteri erized zed by signif significa icant nt disorg disorgani anizat zation ion of thinki thinking ng manifested manifested by problems problems with communication communication and cognition; cognition; impaired impaired perceptions perceptions of reality reality mani manife fest sted ed by hallu halluci cina nati tion onss and and delu delusi sions ons;; and and some someti time mess in sign signif ific ican antt decr decrea ease sess in functioning. Appr Approxi oxima mate tely ly 2.2 mill millio ion n peopl people, e, or 1% of the the worl world d popu popula lati tion, on, suff suffer er from 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 schizoprhen schizoprhenia ia may occur late in adolescence adolescence or early in adulthood, usually 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 twent twentie ies, s, than than in women, women, who are are gener general ally ly affe affect cted ed in thei theirr twent twentie iess or earl early y thir thirti ties es.. ( 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)
Schizo Schizopre prenia nia are classi classifie fied d into into four four types: types: Parano Paranoid id Schizo Schizoprh prheni enia, a, Disorg Disorgani anized zed 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
Differ Different ent theori theorist st in the past past propos proposed ed theori theories es to explai explain n the possib possible le cause cause and development of schizophrenia: Psychoanaly Psychoanalysis sis theory by Sigmund Sigmund freud postulated postulated that shizophrenia shizophrenia resulted 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 defect defectss contri contribut buted ed to the sympto symptoms ms of schizo schizophr phreni enia. a. Ego interg intergrat ration ion in schizo schizoprh prheni eniaa 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).
Schizo Schizopre prenia nia are classi classifie fied d into into four four types: types: Parano Paranoid id Schizo Schizoprh prheni enia, a, Disorg Disorgani anized zed 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
Differ Different ent theori theorist st in the past past propos proposed ed theori theories es to explai explain n the possib possible le cause cause and development of schizophrenia: Psychoanaly Psychoanalysis sis theory by Sigmund Sigmund freud postulated postulated that shizophrenia shizophrenia resulted 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 defect defectss contri contribut buted ed to the sympto symptoms ms of schizo schizophr phreni enia. a. Ego interg intergrat ration ion in schizo schizoprh prheni eniaa 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).
Bioche Biochemic mical al and neuros neurostuc tuctur tural al theory theory includ includes es the dopami dopamine ne hypoth hypothesi esis: s: that that an excess excessive ive amount amount of neurot neurotran ransmi smitte tterr dopami dopamine ne allows allows nerves nerves impul impulses ses to bombar bombard d 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 symptoms of schizoprhenia. schizoprhenia. The abnormalitie abnormalitiess of neurocircuitr neurocircuitry y or signals signals from nuerons are being studied as well. A defective circuit can result in bombardment of infiltered information, possi possibly bly causing causing negati negative ve and positi positive ve sympto symptoms. ms. Overwh Overwhelm elmed ed the mind mind makes makes errors errors in per perce cept ptio ion n and and hall halluc ucin inat ates es,, draw drawss inco incorr rrec ectt conc conclu lusi sion on,, and and beco become mess delu delusi sion onal als. s. To compensate for this barrage , the mind withdraws and negative symptoms develop. (Beuer,2006) Organi Organicc or Pathoph Pathophysi ysiolo ologic gic Theory Theory sugges suggestt schizo schizophr phreni eniaa is a functi functional onal defici deficitt 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 starvatio starvation n during first trimester trimester of pregnancy . The development development of schizoprhenia schizoprhenia may occur during fetal life at critical points in the brain development generally the 34th or 35th week gestation. gestation. The incidence incidence of trauma trauma and injury injury during the second trimester 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)
Pseudom Pseudomutu utual al and Psuedo Psuedohos hostil tilee famili families es by Lyman Lyman Wynne, Wynne, some some famil families ies supres supresss emot emotio iona nall
expr expres essi sion on
by
cons consis iste tent ntly ly
usin using g
pseu pseudo domu mutu tual al
or
psue psuedo doho host stil ilee
verb verbal al
commun communica icati tion. on. In such such famil families ies,, a unique unique verbal verbal commun communica icatio tion n develop developss and when when child child leaves home and must relate to other persons, problems may arise the verbal communication may be incomprehensive to outsider( Brien 2007).
Psychol Psychologi ogical cal or Experie Experienti ntial al theory theory
found found that prefr prefront ontal al lobes lobes of the brain brain are
extremely responsive to stress. Individuals with schizophrenia experiences stress when family member memberss and acquain acquaintan tances ces respond respond negativ negatively ely to the indivi individua dual’s l’s emoti emotional onal needs. needs. These These negative negative responses responses already already vulnerable vulnerable neurologic neurologic state, state, possibly possibly trigerri trigerring ng and excerbating excerbating existing symptoms. Stressors that have been thought to contribute to the onset of schizophrenia include include poor mother-chi mother-child ld relationsh relationships, ips, deeply disturbed disturbed family family intreperso intrepersonal nal relationsh relationships, ips, 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 Double bind bind concep conceptt by Gregor Gregory y Bateso Bateson n and Donald Donald Jackso Jackson n is to descri described bed the hypothetical family in which children receive conflicting parental messages about their behavior, attit attitudes udes and feeli feelings ngs.. Childr Children en withdr withdraw aw into into a psychot psychotic ic sate sate to escape escape the unsolv unsolvabl ablee 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
Good grooming
DAY 2
DAY 3
DAY 4
*
*
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
CRITERIA AUTOMATISM HYPERKINESTHESIA WAXY FLEXIBILITY CATAPLEXY CATALEPSY STEREOTYPE COMPULSION PSYCHOMOTOR RETARDATION ECHOPRAXIA CATATONIC STUPOR CATATONIC EXCITEMENT
DAY 1
DAY 2
DAY 3
DAY 4
TICS AND SPASMS IMPULSIVENESS CHOREIFORM MOVEMENTS
Analysis: Patient doesn’t exhibit any problem in motor behavior.
C. Sensorium and Recognition
CRITERIA
DAY 1
DAY 2
DAY 3
DAY 4
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
CRITERIA •
HALLUCINATION
•
VISUAL
•
OLFACTORY
•
AUDITORY
•
TACTILE
DAY 1
DAY 2
DAY 3
DAY 4
*
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
CRITERIA
DAY 1
DAY 2
COOPERATION
*
*
DAY 3
DAY 4 *
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
CRITERIA
DAY 1
DAY 2
DAY 3
DAY 4
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
CRITERIA VERBIGERATION RHYMING PUNNING
MUTISM
DAY 1
DAY 2
DAY 3
DAY 4
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 .
CRITERIA
DAY 1
DAY 2
DAY 3
DAY 4
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
CAUSES: SCHIZOPRHENIA
Neurostructural factors : Biochemical factors:
-Increase dopamine activity in the
-Enlarge ventricles -brain atrophy -decrease cortical blood flow in the prefrontal lobe
Genetics :
Psychodynamic:
-can be inherited
-Developmental
because schizophrenia runs
stage. -family relationship
i
• • • •
Symptoms: Disturbance in perception Disturbance in thought process Disturbance in reality testing Disturbance in feeling ,behavior, attention
Decline in psychosocial functioning
Acute Phase:
Stabilizing Phase:
Stable Phase:
The patient experiences severe psychotic symptoms.
The patient gets better.
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 byRobert 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 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.
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." 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 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)
Drug study
NAME
ACTION
ADVERSE REACTION Competitively Management of Severe toxic CNS Glaucoma, blocks dopamine Tourette depression or comotose seizure disorder, receptor s to cause disorders; control states from any cause; hepatic and renal sedation and also of adults; parkinson disease. impairment causes alpha- management of adrenergic and severe behavioral anticholonergic problems in blockade. It children . long depressescerebral term antipsychotic cortex, therapy. hypothalamus and limbic system, which control activity and aggression but also cause significant extrapyrimidal effects
Haloperidol
INDICATION
CONTRAINDICATION
NURSING INTERVENTION 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. ADVERSE NURSING •
NAME
Chlorpromazine Thorazine
ACTION
INDICATION
CONTRAINDICATION
REACTION Blocks Management of Comatose states, presence Drowsiness, postsynaptics manifestations pf of large amounts of CNS jaundice, postural dopamine receptors psychotic depressants, presence of hypotension, in brain. disorders, to bone marrow extrapyrimidal control nausea and depression.hypersensitivity. effects. Persistent vomiting, relief of abnormal restlessness and movement, apprehension cerebral edema, before surgery, hematologic acute intermittent disorders, ECG porphyria, adjunct changes. 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 child ked
INTERVENTION 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. •
•
Chlorpromazine Thorazine
REACTION Blocks Management of Comatose states, presence Drowsiness, postsynaptics manifestations pf of large amounts of CNS jaundice, postural dopamine receptors psychotic depressants, presence of hypotension, in brain. disorders, to bone marrow extrapyrimidal control nausea and depression.hypersensitivity. effects. Persistent vomiting, relief of abnormal restlessness and movement, apprehension cerebral edema, before surgery, hematologic acute intermittent disorders, ECG porphyria, adjunct changes. 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.
INTERVENTION 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 •
NAME Biperiden
ACTION
INDICATION
CONTRAINDICATION
ADVERSE REACTION Synthetic Parkinsonian Narrowangle CNS and anticholinergic syndrome glaucoma, mechanical peripheral effects, drugs, block especially to stenoses in skin rashes, cholinergic counteract gastrointestinal and dyskinesia, ataxia, response in the muscular rigidity megacolon; prostatic twitching, CNS. and tremor; adenoma and disease impaired speech, extrapyrimidal leading to perilous micturition syndrome. tachycardia. difficulties. Hypersensitivity to biperiden.
NURSING INTERVENTION 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 bdo d •
NAME Biperiden
ACTION
INDICATION
CONTRAINDICATION
ADVERSE REACTION Synthetic Parkinsonian Narrowangle CNS and anticholinergic syndrome glaucoma, mechanical peripheral effects, drugs, block especially to stenoses in skin rashes, cholinergic counteract gastrointestinal and dyskinesia, ataxia, response in the muscular rigidity megacolon; prostatic twitching, CNS. and tremor; adenoma and disease impaired speech, extrapyrimidal leading to perilous micturition syndrome. tachycardia. difficulties. Hypersensitivity to biperiden.
NURSING INTERVENTION 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.Increa se fluids, add fiber to diet and excercise. •
NAME Amoxicillin
ACTION
INDICATION
CONTRAINDICATION
Prevents bacterial cell Treatment of Hypersensitivity to wall synthesis during infections of penicilin, replication.Bactericidal respiratory tract, cephalosphorins,or skin and skin imipenem. Not used to structures, treat severe pneumonia, genitourinary tract, empyema, bactemeria, otitis media, pericarditis, meningitis meningitis, and purulent or septic septicemia,sinusitis arthritis during acute bacterial stage. endocarditis prophylaxis.
ADVERSE REACTION Dizziness, fatigue, insomia, reversible hyperacidity, urticaria, maculopapular to exfoliative dermititis.
NURSING INTERVENTION 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 •
•
•
NAME Amoxicillin
ACTION
INDICATION
CONTRAINDICATION
Prevents bacterial cell Treatment of Hypersensitivity to wall synthesis during infections of penicilin, replication.Bactericidal respiratory tract, cephalosphorins,or skin and skin imipenem. Not used to structures, treat severe pneumonia, genitourinary tract, empyema, bactemeria, otitis media, pericarditis, meningitis meningitis, and purulent or septic septicemia,sinusitis arthritis during acute bacterial stage. endocarditis prophylaxis.
ADVERSE REACTION Dizziness, fatigue, insomia, reversible hyperacidity, urticaria, maculopapular to exfoliative dermititis.
NURSING INTERVENTION 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. •
NAME Paracetamol
ACTION Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation.
INDICATION
CONTRAINDICATION
ADVERSE REACTION Relief of mild to Hypersensitivity, Stimulation, moderate pain; intolerance totertazine, dowsiness, nausea, treatment of fever. alcohol, table sugar, vomiting, saccharin. abdominal pain, hepatoxicity, hepatic seizure, renal failure.
NURSING INTERVENTION 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
NAME Paracetamol
ACTION Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation.
INDICATION
CONTRAINDICATION
ADVERSE REACTION Relief of mild to Hypersensitivity, Stimulation, moderate pain; intolerance totertazine, dowsiness, nausea, treatment of fever. alcohol, table sugar, vomiting, saccharin. abdominal pain, hepatoxicity, hepatic seizure, renal failure.
NURSING INTERVENTION 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. •
NAME Vitamin C
ACTION
INDICATION
Needed for wound Inhance healing, collagen natural synthesis, function. antioxidant, carbohydrate metabolism, protein, lipid synthesis, prent infection.
body immune
CONTRAINDICATION
ADVERSE REACTION
NURSING INTERVENTION 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. •
NAME Vitamin C
ACTION
INDICATION
Needed for wound Inhance healing, collagen natural synthesis, function. antioxidant, carbohydrate metabolism, protein, lipid synthesis, prent infection.
CONTRAINDICATION
ADVERSE REACTION
body immune
NURSING INTERVENTION 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
Is physical . To teach the activity that is patient the some planned, exercises. structured, and repetitive for the 2. To assess purpose ofmotor abilities conditioning of the patients.
Procedure/Activities
Patient Role/Patient Analysis
Let have atleast one Patient follows or two leader. the step and does the -Set a joyful and exercise. lively music with a beat.
Role of the Nurse
I encourage her to do the exercise and assist her.
Chapter IV Psychotherapies Implemented
1. Exercise Therapy Description
Goal
Is physical . To teach the activity that is patient the some planned, exercises. structured, and repetitive for the 2. To assess purpose ofmotor abilities conditioning of the patients. any part of the body. 3. To give
Procedure/Activities
Let have atleast one Patient follows or two leader. the step and does the -Set a joyful and exercise. lively music with a beat.
-Let the client to follow the Steps. Caution: Remind the simple condition of the instructions that clients to consider the patient can follow.
4. Safety is the priority. 5. To promote wellness
Patient Role/Patient Analysis
Role of the Nurse
I encourage her to do the exercise and assist her.
2. Dance Therapy Description
Goal
Procedure/Activities
Patient Role/Patient Analysis
The To teach the -Let atleast two to The patient follows therapeutic use three students to lead the dance step and patient the of movement movements of the the step in the song. cooperates well. to further the dance. emotional, -Have a good choice social, 2. To assess motor of music it should be cognitive, and lively. abilities of the physical integration of patients. -Ensure the step must the individual be applicable to the 3. To give simple in the clients. instructions that treatment of a variety of the patient can -Assure that most of follow. social, the extremities will emotional, move. 4. Safety is the cognitive, and priority. physical disorders.
3. Music and Arts Therapy
Role of the Nurse
Wemake dance steps together with my classmates and teach them the steps.
Description
Goal
It is an 1. Appreciate the music and put the interpersonal process infeeling of the drawing. which uses music and all of 2. Discuss and its facets— show the drawing. physical, 3. Divert attention emotional, something mental, social, into aesthetic, and more productive. spiritual—to help clients to improve or maintain their health.
Procedure/Activities
1.Prepare material
Patient Role/Patient Analysis
all
the The clients draw and share her drawing to 2. Be sure that all everyone. materials are adequate. 3. Gather all clients into one area. 4. Explain the purpose and procedure of the therapy.
Role of the Nurse
Provide drawing materials and explain again the procedure to the patient. Listen to the sharing of patient’s drawing. Appreciate patient’s sharing.
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.
4. Bibliotherapy Description
Goal
Procedure/Activities
Patient Role/Patient
Role of the
Analysis
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 -Prepare a story with an individual elaborate images. self-concept -Arrange the sits of 2. Increase the client into a good setting: theatrical understanding. setting is more 3. Foster an advisable. individual -Story telling must be honest selfin form of appraisal. monologue.
Nurse
The patient can Arrange the express their learning chairs in semi about the story the circle for the heard. And give patients insight and comments on the different Listen to the situation on the story. learning’s of patients Give appreciation or recognition.
-Someone should introduce the story. -At the end of the therapy the clients must share insights and thoughts about he story.
5. Remotivation Therapy Description Goal
A therapy of very simple group therapy of an objective nature used in an effort to reach the unwounded areas of the patient’s personality & get them moving back into the
1. To stimulate patient to be fellow explorer of the real world . 2. To develop the ability to communicate & share ideas & experience with other. •
•
Procedure/Activities
1 .Introduction
The patient can able to site example and 2. Ask any body what give comments on they can say about the the poem, also to the drawing and if drawing and give anybody see a forest. their learning’s.
•
•
Patient Role/Patient Analysis
3. Poem reading “ Kalikasan ating Pagingatan” 4. Evaluation Summary.
and
Role of the Nurse
Listen to patient’s sharing and give recognition.
reality.
3. To develop feeling of acceptance & Recognition. •
6. Socialization
Description
Goal
Is the primary 1. To develop means by which cooperation. human infants begin to acquire 2. Safety is the skills prioritized. necessary to perform as a 3. To develop functioning interaction with member of their other patients. society, and is the most 4. To develop influential camaraderie learning with other processes one schools. can experience.
Procedure/Activities
Patient Role/Patient Analysis
Role of the Nurse
1. Introduction
The patient enjoyed and participated in the games and activities.
Arrange chairs and prizes.
2. National anthem 3.Prayer 4Opening remarks
The patient increases self confidence and cooperate.
Assist patients in the games Join patient in dancing.
1. Exercises 6.Yell/ Cheer 7.Intermission numbers 8Games 9. Closing remarks
Chapter V Nurse Patient Interaction
Cleaning the place.
Day 1 Nurse Response
“Hello Ma’am”
Analysis of Nurse Response Giving recognition
Patient’s Response
“hello!(smile)”
Analysis of Patient’s Response 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
Giving information
“ ako si patient JD”
Borlongan, galling pos a URC sa malolos bulacan, ako po ang
And
The patient responds directly in the
seeking information
question by stating her
inyong student nurse.
name and with smile
Kayo po maari niyo
on her face. The
po bang ibigay ang
patient can able to
inyong pangalan?”
answer the question.
“Ilang taon na po
Seeking information
“33 years old.”
kayo?”
Patient answered the question by stating her age with maintained eye contact to the
“Kailan
po
birthday niyo?”
ang
•
Seeking
Information
“July 12, 1971”
student nurse. Patient answered the question by stating her birthday maintained
with eye
contact to the student
nurse. The patient was oriented. “Saan
po
kayo
nakatira?”
•
Seeking
“Pasig, City”
Patient answered the question
Information
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?”
Information
Seeking
“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?”
Information
question directly and
•
stating the relationship
Seeking
“oo. Isa. Kuya ko ”
Patient answered the
of the person to her. The patient still remember her siblings. “Alam ninyo po ba
•
Seeking
“hindi ko alam eh!”
kung anong araw at Information oras ngayon?
Patient answered the question with low
(yumuko)
tone of voice,then bow her head, it
seems that she’s feels “
Ngayon
po
ay
•
Providing
shy on her answer. Patient get oriented in
“ ah, ganun ba”
huwebes, ika-17 ng information,
time and date, and
febrero 2011, at 11:15 orientation
deeply listening to the
na po ng umaga
information given by
“
anu
po
trabaho
ninyo dati”
•
Seeking
Information
the student nurse . “ Nagtrarabaho ako sa Patient answer the pasig Plywood cutter, question with tas
sa
Antipolo irrelevent information
nagtatangal ng mga because it is sobrang damit
sinulid mula
hanggang
“Ilang
taon
na
po
kayo dito sa NCMH?”
•
Seeking
sa impossible that she
lunes works as plywood
biyernes, cutter at the same time
7:00-7:00.parehong
works in the garment
oras at araw
in same time and
“ tatlong taon na”
days. Patient answered the question while
Information
counting with the used of her fingers.the patient was thinking “Sino po nagdala sa
•
inyo dito?”
Information
Seeking
“yung tatay ko”
before answering. Patients answered the question by stating the person who brought her to NCMH with sadness on her face. It seems that she was
“ Alam ninyo po ba kung
bakit
nadala dito?”
•
Asking relate
kayo question, clarifying.
“hindi (umiling)
ko
depress. alam”. 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 “May gusto po ba kayong
sabihin
•
Encouraging
sa patient to express
akin?”
feelings
answer. “ gusto ko na umuwi Patientanswered the sa amin, miss ko na questioned by nga sila, kelan ba ako expressing her maaring umuwi?.
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,
“ anu daw po ba ang
•
Asking and
no one visited her. Sabi matagal pa daw, Patient answered the
sabi ng doctor at nurse clarifying information
kasi nasa probinsya question by giving
dito?
through the use of
daw sila, dito muna details on what she
questioning
daw ako. ( with teary
had been heard
eye)
explanation from other health care provider. While telling this to the student nurse it seems
“siguro po pag mabuti Giving opinion and
“okey
naman
that she want to cry. ako, Patient give detailed
na
ang
inyong seeking for
ayos na ako matulog, information about her
kalagayan, papayagan information
at iniinom ko naman condition, and she
na po kayo umuwi,
ang gamut ko.
kamusta na po kayo?
explained to the student nurse what that she doesn’t experiences difficulties unlike
Ma’am pakibigay po ulit
ang
•
testing if the
akin patient are oriented to
before . “ikaw si Gia, student Patient answered the nurse kita
question with
pangalan, natatandaan the person interacted,
smilling, and she was
ninyo pa po ba?
clarifying previous in
able to remember the
interaction
student nurse name. It seems that she can recall the name of the person she’s ineract
“bukas po, may mga therapy
po
•
Giving
Oo, sigeh(smile)
tayong information,
gagawin,maaasahan
with. Patient answered the question through smile and argees to
encouraging the
ko po ba ang inyong patient to join to the
cooperate in the
paglahok?.
activities. It seems
activities.
that the patient was interested with the “
bukas
po
ulit
•
Thanking for
(smile)
incoming activities. Patient answeres
ma’am, salamat pos a the information she
through non verbal
pagbabahagi
communication by
gathered.
impormasyonng
smiling and waving ,
inyong sarili”
it is a gesture saying goodbye. The patient also expecting the
student nurse in the next exposure.
Day 2 Nurse Response
Analysis of Nurse
Patient’s Response
Analysis of Patient’s
“Hello Ma’am,
Response Giving recognition
“ok naman!(smile).
Response The patient answered
kamusta na po kayo?
and testing client if
Ikaw si gia”
the question with
Tanda ninyo po ba
she remember the
smile and she’s also
ako?”
nurse
stating the name of the student nurse which means that she still remember the student nurse. The patient answered the question
“ nagustuhan ninyo po seeking information
“ oo, sumayaw nga
correctly. The patient answered
ba ang mga activity
ako, tas nagdrawing
the question by sating
ngaun?
pa”
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 “Kailan
po
ang
birthday niyo?”
•
clarifying
“July 12, 1971”
contact. Patient answered the nurse’s question same
Information
as previous interaction with maintained eye contact to the student nurse. “Saan
po
kayo clarifying Information
“Pasig, City”
nakatira?”
Patient answered the nurse’s question same as previous interaction witha maintained eye contact to the student nurse.
“May asawa po ba
clarifying Information
“Wala.”(yumuko)
kayo?”
Patient answered the nurse’s question same as previous interaction with maintained eye contact to the student nurse while having a gesture of turning her head side to side as a sign that she doesn’t have.
“May kapatid po ba kayo?”
clarifying Information
“oo. Isa.”
Patient answered the nurse’s question same as previous interaction with maintained eye contact to the student
nurse. “Ano
po
ang
pinakagustong
•
Seeking
Information
“yung
kwento
maria makiling!”
activity na ginawa?
ni Patient answered the nurse’s question in interesting manner with smile on her face. It seems that she really liked the story
“ bakit po?
•
Asking the
in the activity. “ kasi iba yung pag- She answered the
patient to elaborate
iibigan
nila
ni
the answer
dula,
tsaka
gat question by giving the yung qualities of the
pagmamahal niya sa character in the story magulang nya”
and also telling a part of the story. It seems that she can relate the character of the story
“anu pong paguugali
•
Asking the
“
mapagmahal
ni maria ang maaring patient to relate it to
mapagalaga
ihalintulad sa inyo”
magulang,
herself
to her qualities. at Patient answered the sa question with smile
maganda and giving her same
pa
qualities base on the qualities of the character and her. It seems that she can relate on the qualities
”may gusto pa po ba kayong kwento?
tauhan
•
Seeking
sa Information
of the character. “ si gat dula, para Patient answered the 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, Patient providing
gwapo kasi un”
information about a specific person that she knows from the past with smile on her face .It seems that she
“ Nagkatuluyan po ba
•
kayo?
information
Asking
“hindi
kasi
kaming
likes this person. pareho Patient answered the
mahiyain, question, by stating
piloto un.
what happen to her and to the person
“may gusto pa po ba kayong ibahagi?
•
Encouraging
“yung
tatay
involve. ko Patient answer the
patient to express
katulad ng tatay ni question in which she
feelings
maria,
pinapagalitan relate the qualities of
din ako?.
the father to the qualities of the character in the story. It seems she had childhood experiences where she experienced repremmanded by her
“ baka naman po kayo napapagalitan
•
Giving
kasi opinion and seeking
“
oo
ganun
nga(smile)
father. na Patient answered the question with smile
may mali po kayong for information
and agreed to the
nagawa., madalas po
opinion of the student
ba napapagalitan?
kayo
nurse. It seems that she approved to the opinion of the student
“nagustuhan pop
la
ninyo Summarizing and lahat
Wala na
ng asking question.
nurse. Patient answered the question and seems
activity, may gusto pa
she don’t want to open
ba kayong ibahagi?
another conversation
Ako naman po ang
about the topic. Patient answered the
magtatanong,
•
Seeking
“thorazine
alam information
question directly by
ninyo po ba inyong
stating the name of
gamut?
her drugs.this means that she was aware on
“ngayon
po
•
Seeking
the drugs she’s taking. Patient
Oo,
nakakaranas pa po ba information
respond
with
kayo ng pagbulong?
question
by
the stating
yes,which means she was
experienced
auditory hallucination. Auditory Hallucination
was
under the categories of positive symptoms schizophrenia in
where
Patient
with
Undifferentiated schizoprenia experience
may it
(Videbeck 2008). “anu naman po ang binubulong sa inyo”
•
Seeking
information
Sabi daw
sabunutan
ka Patient respond to the question by stating her auditory hallucination.
It seems that she hallucination symptoms are not yet “ ano po ulit ang sabi?
Clarifying
•
information
Hindi
subsiding. yun, Patient answered the
dati
ngayon
medyo question by trying to
nawawaqla na
cover up what she’s been heard. It seems
Silence
silence
•
Napapagod pwede
na
na
that she withrawn it. ako Patient Expresses
ba
ako what she feel and she
pumasok
want to go back in the ward. It seems that it is her way to escape reality that she had
O sige po
respond to the
•
Smile
auditory hallucination. Patient respond with nonverbal
patient question
communication by means of smiling.
Day4 Nurse Response
Analysis of Nurse
Patient’s Response
Analysis of Patient’s
“Hello Ma’am,
Response Giving recognition
“ok naman!(smile).
Response The patient answered
kamusta na po
and testing client if
Ikaw si gia”
the question with
kayo?.tanda ninyo po
she remember the
smile and recall what
ba ako?”
nurse
the name of her student nurse. The patient can still remember the student
nurse. It seems that the student nurse established rapport “ may socialization po
Giving information
“ oo, sigeh, may
well. Patient agrees to the
tayo ngaun, sana po
and encouraging to
sayaw ba dun?”
suggestion and asked
makilahok kayo sa
join to the activity.
information with
mga laro
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
seeking information
“oo
kayo sa socialization?
Patient answered the n question directly about what she feel on the activity. It seems that she enjoyed the
“Kailan
po
birthday niyo?”
ang
•
clarifying
“July 12, 1971”
activity well. Patient answered the nurse’s question same
Information
as previous interaction she had a week before. The patient answered it correctly “Saan nakatira?”
po
kayo clarifying Information
“Pasig, City”
Patient answered the nurse’s question same as previous interaction
a week before with maintained eye contact on the student nurse. “May asawa po ba
clarifying Information
“meron.”
kayo?”
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.
“May kapatid po ba
clarifying Information
“oo. Isa.”
kayo?”
Patient answered the nurse’s question same as previous interaction with maintained eye contact on the student nurse.
“anu po pangalan ng
•
asawa ninyo ?
Information
Seeking
“cocoy!”
Patient answered the nurse’s question with the smile and giving the name of the person
“ Di ba po sabi ninyo
•
wala kayong asawa?
Information
clarifying
she talking about. “ meron, tatlo nga Answered question anak namin eh.
with explanation, and giving information about the person. The patient answer was new to the student
nurse, she had different answer on the previous “anu po mga pangalan
•
ng anak ninyo?”
information
seeking
“ joan, anna, miguel
ineraction. Patient aswered the question with smile and stating the name of the sibling she had.This is part of her delusions because she
”ilan taon na sila?
•
Seeking
Information
had no children. “di ko alm eh, piloto Patient answer the si cocoy,”
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
“kasal nap o ba kayo
•
ni cocoy?
Information
Seeking
question. “hindi, di ko alm kung Patient answer the nasaan sya.”
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 “ Ito po ang huling thanksgiving
thought process. “salamat din sa mga Giving thanks, and
araw naming dito, ako
natutunan ko, alam ko expressing what she
po’y
lubos
na
na kailanagn maglinis learned from the
nagpapasalamat
at
ng katawan lagi at student nurse with
nagbahagi
sa
salamat
akin.
kayo
nabubusog ako
kasi smile on her face and shaking hand with her , a gesture of thanks giving and saying goodbye.
Nursing Care Plan ASSESSMENT Objective Data:
PLANNING After Nursing exposure the patient -Patient wears dirty Self care deficit will be able to: ward gown and related to poor a. Participate in without slippers personal hygiene. self care activities -bad breath
-patient odor
has
DIAGNOSIS
foul b. Demonstrate independence
INTERVENTION RATIONALE EVALUATION 2. Explain task -A complex task After the exposure in short simple will be easier for the patient able to : manner. the client it is broken down into a. Participated series of steps. in self care activities. 3. Allow patient -It may take sufficient time to longer to complete any complete task task. because of lack of b. Can able t o concentration and perform self short attention care activities span. on her own
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.
-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.
Nursing Care Plan ASSESSMENT Subjective 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
DIAGNOSIS
Disturbed thought process related to auditory hallucination, disoriented in time and date.
PLANNING After Nursing exposure the patient will be able to:
INTERVENTION 1. Reorienting the patient.
a. Oriented in time and date.
b. Present reality.
into
2. Continue therapeutic nurse patient alliance.
RATIONALE EVALUATION -help patient After the exposure maintain her level the patient able to : of orientation; increase her a. Can state ability to become the right time more oriented. and date.
- It promoted and strengthens trust between the b. Presented patient and nurse. into reality
-It increases 3. Use short simple patient ability to directions and understand and explanation. follow.
Nursing Care Plan ASSESSMENT Subjective 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
DIAGNOSIS
Disturbed thought process related to auditory hallucination, disoriented in time and date.
“Sabi daw niya sabutan daw po kita” as verbalized by the patient
PLANNING After Nursing exposure the patient will be able to:
INTERVENTION 1. Reorienting the patient.
a. Oriented in time and date.
b. Present reality.
into
2. Continue therapeutic nurse patient alliance.
RATIONALE EVALUATION -help patient After the exposure maintain her level the patient able to : of orientation; increase her a. Can state ability to become the right time more oriented. and date.
- It promoted and strengthens trust between the b. Presented patient and nurse. into reality
-It increases 3. Use short simple patient ability to directions and understand and explanation. follow.
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
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. Day 2: February 18, 20011 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.
Day 3: February 23, 2011 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. Day 4: February 24, 2011 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 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. 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.
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
University of Regina Carmeli Catmon, City of Malolos College of Allied Medical Sciences
