Paranoid Schizophrenia A Case Study Presented to the Faculty of College of Nursing and Midwifery Bataan Peninsula State University In Partial Fulfillment For the Requirement in the Degree of Bachelor of Science in Nursing Alonzo, Mizzy Anne Angulo, Louie Anne Antonio, John Andrew Barros, Hazelyn Joy Buenaventura, mark Richard Cortez, Romieline Crisostomo, Florina Mae De Mesa, Alvin De Silva, Janelle Dela Torre, Mariel Kim 1
i attached a video here connected on this paper work... it was the history of the patient on this study...
http://www.youtube.com/watch?v=MiveGEe4cxY
we called this case study as 93.8% guess what does it mean.....
nanana.... :)
after so many days of doing this study,,, we were so happy coz what we all spent (days, money, time, foods) we came up with this great (for us - the group) work.. thanks for appreciating this and for the compliment given by the panelist.. we are so flattered sir... it was really worth it for us.. Godspeed.. goodluck for those who will also study this kind of mental illness...
by: BPSU BSN - SN2012
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Transcript
Paranoid Schizophrenia
A Case StudyPresented to the Faculty of
College of Nursing and MidwiferyBataan Peninsula State University
In Partial FulfillmentFor the Requirement in the Degree of
I. Dedication and Acknowledgement………………………………………..II. Personal Data………………………………………………………………III. Chief Complaint…………………………………………………………….IV. Health History………………………………………………………………
a. Past health history………………………………………………………b. Present health history…………………………………………………...c. Family history…………………………………………………………...
i. Social history……………………………………………………ii. Childhood……………………………………………………….iii. Adolescence……………………………………………………..iv. Adulthood……………………………………………………….
d. Sexual history…………………………………………………………...
UNIT 2
Mental Status Assessment / Analysis and Interpretation…………………………
UNIT 3
a. Psychopathology………………………………………………………………..b. Related Literature………………………………………………………………
UNIT 4
a. Nursing Care Plans……………………………………………………………...b. Pharmacology…………………………………………………………………...
UNIT 5
Psychotherapy…………………………………………………………………………..
UNIT 6
Glossary…………………………………………………………………………………
2
UNIT 7
Reference……………………………………………………………………………...
UNIT 8
Documentation………………………………………………………………………….
3
UNIT I(Dedication, Acknowledgement, Introduction, Personal Data,
Chief Complaints and Health History)
4
DEDICATION
This work is dedicated to our parents, family relatives and friends.
Without their patience, understanding, support
and most of all love, the completion
of this work would
not have been
possible.
Also, it is dedicated to our colleagues
who will conduct the
same studies in
the future.
And lastly, to our GOD who
provide us knowledge and
strength in making
this work.
5
ACKNOWLEDGEMENT
First and foremost, we would like to thank to our Almighty God,
who gives us strength, knowledge, and good health in
pursuing this comprehensive
case study.
And also to our family who gave all the emotional and financial
support and motivations at all times and
they also serves as our
inspiration.
We would like also to acknowledge our clinical instructor
Sir Ronald Tyron dela Rosa for the support,
patience, knowledge, and contributions
to finish this comprehensive
case study.
We would like also to thank Sir Ronnell Dela Rosa
and Ma’am Irish Lee for helping and giving
some encouragement to make our duty
possible and able to enjoy
our stay in Mariveles.
6
II. INTRODUCTION
Schizophrenia is a mental disorder characterized by the disturbances in thoughts,
sensory perception and deterioration in psychosocial functioning. It is also characterized by a
weak ego. The common defense mechanisms used by individual are regression, projection,
withdrawal and denial. There are four A’s to acknowledge in having schizophrenia, first, the
associative looseness, the blunted affect, ambivalence and the autistic thinking.
Paranoid schizophrenia is the most common type of schizophrenia in most parts of the
world. The clinical picture is dominated by relatively stable, often paranoid, delusions usually
accompanied by hallucinations particular auditory variety, and perceptual alterations.
Disturbances of affect, volition and speech, and catatonic symptoms are not prominent.
Paranoid Schizophrenia is manifested primarily through impaired thought processes, in which
the central focus is on distorted perceptions or paranoid behavior and thinking. Delusions are
in most cases grandiose, persecutory or both. (WHO 2005)
With paranoid schizophrenia, the ability to think and function in daily life is better
compare with other types of schizophrenia. It may not have as many problems with memory,
concentration or dull emotions. Still, paranoid schizophrenia is a serious, lifelong condition
that can lead to many complications, including suicidal behavior.
Those individuals who diagnosed with paranoid schizophrenia are not especially
prone to violence; often prefer to be alone. Studies show that if people have no record of
criminal violence prior to develop schizophrenia and are not substance abusers, then they are
unlikely to commit crimes after they become ill. Most violent crimes are not committed by
people with paranoid schizophrenia, and most people with schizophrenia do not commit
violent crimes. Substance abuse always increases violent behavior, whether or not the person
has schizophrenia.
7
If someone with paranoid schizophrenia becomes violent, their violence is most often
directed at family members and takes place at home. These individuals may spend an
extraordinary amount of time thinking about ways to protect themselves from their
persecutors.
In the US paranoid schizophrenia reports issued by Centers for Disease Control and
Prevention (CDC) for 2000 revealed 121,000 diagnoses of paranoid schizophrenia in non-
Federal, short-stay hospitals (73,000 men and 47,000 women). Most individuals (62,000)
were between the ages of 15 and 44; none were under age 15; 37,000 were between 45 and
64; and 21,000 were 65 or older. According to geographic distribution, the highest prevalence
is in the South and Northeast regions of the US with the lowest prevalence in the West and
Midwest are almost equal. (Medical Disability Advisor, 2010)
The onset of the disorder is usually later than catatonic or disorganized schizophrenia.
Men have earlier onset, and more frequent than women. Women have a bimodal onset with
peaks in their 20’s and early 40’s. One study demonstrated within subtype age of
institutionalization gender differences only for paranoid schizophrenia (Salokangas et al.,
2003).
The present etiology of the paranoid schizophrenia are the following, genetics it is
known because people believed that mental disorder can be inherit. Other causes are
decreased dopamine, stress, alcohol abuse and substance abuse.
20mg. These various type of drugs are psychotropic medications which being used in
the treatment of mental illness.
After his first discharged on December 18, 1991, Mang J.M did not have a
follow up consultation in MMH because he refused to. His relatives brought him at
16
NCMH to have his first check-up on April 1992 and noted that there was no follow up
due to Mang J.M refusal.
Mang J.M was brought in MMH on December 15, 1992. He had complaints of
impaired sleep, “namumulot ng basura at kung saan- saan nahihiga”, denies auditory
hallucination and tangentiality, having escape, homicidal and suicidal. After 3 days
observation at ACIS he was discharge on December 18, 1992.
On March 4, 1993, Mang J.M applied as a trainee messenger at Binondo,
Manila. He smoke heavily and suspected use of marijuana with unspecified amount
and frequency.
On December 11, 1995, according to his chart, he was admitted in MMH
again because he had impaired sleep and became jealous and made suspicion on his
wife-- he thought that his uncle was having affair with his wife at the point that he
saw the two having sex in their home, and started refusal in taking oral medications.
Mang J.M did not comply with his drug regimen. He appeared that he was having
violent tendency when he was influenced of marijuana as recorded on his chart, but he
continues to deny. He claimed that he never used marijuana because it causes skin
diseases. On, January 1, 1996 Mang J.M was placed on isolation by 15 days because
he became violent and aggressive, according to his chart. And he attempted escape on
May 28, 1996. Like on his previous admission, he recovered and was discharged on
Aug 31, 1996.
Mang J.M had a morbid ideas about his death, where he claimed that “gusto
ko na sana ng mamatay, kahit sinong pumatay walang kasalanan.” This was the
complaint on his admission on August 23, 1997.
17
On June 21, 1998, Mang J.M had his home visit and went back in MMH
afterwards.
January 19, 1999 when he returned in MMH, Mang J.M denied presenting
complaints, oriented to place, had positive persecutory delusions as he said “hinampas
ako ng tubo, kahit nag bibigay ako ng pera sa kanila.” But there were no evidence of
physical injury upon assessment. Also, he had complaints of having impaired sleep,
“nagbabanta”, “mainitin ang ulo”, at “nagmumura.”
After a year, on February 25, 2000 he was discharged. At home, Mang J.M
started to become talkative and having pressured speech. He used to deny when he
was asked. He had auditory hallucination, become manipulative and evasive. Mang
J.M regains his vices and did not take his medications. He smoked and drinks alcohol
heavily. Also, he walks endlessly and started fights. Due to reported behaviors of
Mang J.M, he was placed back in MMH on February 28, 2000; he claimed that his
mother did not provide his medications upon interview. Mang J.M was admitted
thereafter. He was forced to take his medications to treat the displayed manifestations.
Mang J.M escaped in the hospital on December 25, 2000, but after several
days on January 2, 2001 he returned by his relatives. He was discharged on January
12, 2004.
After four months, Mang J.M was readmitted on May 29, 2004 because he
refused to take medications and claimed “lason ang gamot”, he done physical abuse to
his mother and threatened her. Mang J.M refused for check-ups, continues to drink
alcohol and escapes. These are the following complaints why he returned in MMH.
But on September 7, 2007 he was allowed for home conduction and discharged on
September 19, 2007.
18
He had conversation last October of the same year and according to his chart
Mang J.M used to smoke and suddenly punch a neighbor. Later, Mang J.M refused to
medications and had an impaired sleep.
In contrary, Mang J.M said that he was just admitted last year and will be
discharged on the 3rd of February 2011.In fact he was 4 yrs at MMH since his recent
admission on November 20, 2007. According to him he was admitted in MMH not
because he was a mentally ill, but because his mother wants to keep him away from
the persons who wanted to steal his wealth and killed him after.
b. Present Health History
Mang J.M was been in MMH since his latest admission on November 20,
2007, around 2:00 pm with the diagnosis of paranoid schizophrenia by his attending
psychiatrist, Dr. Cortez. He was placed at male ward B. According to his chart, Mang
J.M’s chief complaints was having delusions and saying “Maraming J.M, patay na
yung galing dito”, refused to medications, neglected hygiene, irritable and talking
aloud. He was given Haloperidol 5mg 1amp, and Chlorpromazine 500mg tablet take
at bedtime. These are psychotherapeutic drugs used by Mang J.M for the treatment of
the disorder.
In addition, Mang J.M had alterations in thought process, thinking and
communication, in perceiving and interpreting, in behaving and interpreting Mang
J.M manifested illusions, delusions, grandiosity, hyperactive and withdrawal.
During the orientation, Mang J.M showed good cooperation with the SNs he
was very eager to talk then suddenly jumped into another topic and discuss unrelated
19
matters. He said that he was single and a very rich man and owned not only houses,
but mansions. Mang J.M is always oriented to person, date, time and place.
Mang J.M refused on the grooming sessions in the first two weeks and done
grooming on the last week but only brushing of his teeth. Mang J.M wears a wrinkled
white shirt paired with abstract designed short until the last week, during Grand
socialization he puts on the uniform of MMH as his topped.
On the therapies, he was cooperative and active participant. He used to talk a
lot and listen attentively. Mang J.M’s laughed when his fellows provided wrong
answers and made his judgments afterwards. During the nurse- client interaction he
said that the persons around would kill him, and he added that he was just kidding. In
addition, Mang J.M told that they are making a big swimming pool on the side of
ACIS (MMH), he was a very rich man and owned the international corporation of san
Miguel,he denied used of illegal drugs but admitted that he drinks alcohol and until
now he used to smoke.
Moreover, according to Mang J.M, he had his own planet where exactly
looked like earth. He described that there are living things such as cow, carabao,
plants and people. He added that there is a big TV screen where he saw individuals
like his two student nurses together with their loved ones and also our clinical
instructor. Mang J.M named a thing which is “aparachi”. This thing was a peanut
shape like, covered with gold and brings out everything that people need, as he
explained. He also said that he had a conversation with the former president of USA,
George Washington.
20
Lastly, Mang J.M appeared always hyperactive and talked about different
killings. In contrast he claimed that he was good and did not bring any harm to others.
He used to be keen listener and observer, Mang J.M knew when the questions are
being change but with the same thoughts. He also used various defense mechanisms
such as denial, projection and others. Moreover, Mang J.M manifested grandiosity,
illusions, and delusions.
c. Family history
According to Mang J.M., they were four and he was 2nd to the eldest in his family. His
father died when he was 6 years old due to heart attack while her mother was still alive. They
were raised and sent in good school by his mother, who was a dress maker. His three siblings
have their own family and lived separately while Mang J.M remained single, which is
contrary to the chart because his marital status is married and became separated to unnamed
woman and they have no child.
Also, he said that he had no known history of having mental illness in the family.
Same in the chart, there were no reports that somebody in their family suffered from the same
condition.
d. Social History
i. Childhood
Mang J. M told that he was born on September 3, 1966, in Sampaloc, Manila. He
grew together with his family, but his father was died when he 6 years old. His mother raised
them and sent to school. Mang J.M during his childhood, he once been like the other children,
21
he played all day and love vacations. He was sent in Lubao, Pampanga every school break
with his siblings and lived with his grandmother.
His mother decided to bring him in schooling at Lubao Elementary School when he
was 8 years old. Mang J.M was then separated from his mother and siblings as well, though
he told that it was sad at first. But he was used to it because this was not usual to him. By this
time, he lived in Lubao in longer time. He joined his grandmother at home, helped her in
chores and taking good care of the cows in their farm, as he added. During his free time
according to Mang J.M, he played with their neighbors. Those routines ended when he came
back in Manila to continue his study for high school.
ii. Adolescence
He entered high school at St. Jude College. According to him he was an active
student. He joined competitions and different events whereas dancing and singing was his
forte. He was been an officer in CAT during his time. Mang J.M also had peers, and he joined
fraternity when he was 2nd year high school. He said that those persons were good. They had
bonding all the time and accompanied him through his ups and downs.
During his high school life, Mang J.M learned to smoke and drinks alcohol together
with his friends. He added that he consumed at least two bottles of each San Mig Light and
Red Horse and 1 pack of cigarettes per day.
In addition, he also met his first girl friend which is CD during intramurals in their
school, as he claimed that they last for almost six years. They were enjoying each others’
company, when there was a time that he experienced his first heartache because his girl friend
went with other man. Mang J.M felt loneliness and depression. But he added that he easily
coped up because he found a new love with EI. Like the first relationship it has to end.It last
22
for one year and they totally separated because of the reason that he moved in Bataan to talk
with his godfather about abroad and EI went to Pangasinan.
Moreover, he experienced those heartaches during his college years and according to
Mang J.M he easily coped to those matters. In contrary, he said that he and CD were cool off
and still in touch with each other.He claimed again that he entered MAPUA for his course
police authority which is contrasting to his chart which showed that he finished vocational
course.He admitted that he continued smoking and drinking alcohol, and denied use of illegal
drugs.
iii. Adulthood
Mang J.M claimed that he went in US after his graduation in college from the
year 2000 up to 2005. He became a Navy in US as he claimed. His habits were smoking,
drinking alcohol, bar hopping but denied having sexual intercourse neither got married.
Mang J.M said that he could drink two bottles of each San Mig Light and Red Horse
because it was less expensive, consumed 1 packed of cigarettes per day, but consistently
denies used of illegal drugs like marijuana.
After Mang J.M came back from US, he became a driver in Orion, Bataan and
worked in Bureau of Customs where he was a police authority as he said.
He spent his life in Manila, and Orion where he went fishing; making his vices
and lived there for several years. According to Mang J.M, he also spends his life inside
MMH as his record showed he was started to admit since1989. But he claimed that this was
his first admission yet he claimed that he returned to work after his previous discharged.
23
e. Sexual History
Based on his chart he was separated which he continues to deny. He always says that
he was single for the longest time and he claimed that giving roses to someone was a
burden.
Also, he admitted that he had previous relationships. He added that they were happy
having each other’s company, he admitted that he did kissing and touching private parts of
his previous girlfriend’s body as their mutual willingness. But not involved in sexual
intercourse as he added.
24
UNIT II(Mental Status Assessment)
25
MENTAL STATUS ASSESSMENT
Name : Mang JM
Age : 44 years old
Ward : Male Ward A
ORIENTATIONDay
1Day
2Day
3Day
4Day
5Day
6Day
7Day
8Day
9Person
OR
IEN
TA
TIO
N
SE
LF
-A
WA
RE
NE
SS
Place Date Time Situation
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano pong pangalan niyo?”
C: “JM.”
26
SN: “Alam niyo po ba kung nasaan po tayo ngayon?”
C: “Oo, nasa mental nagpapagaling.”
SN: “Ano pong petsa ngayon Mang JM?”
C: “Ngayon ay Friday January 14, 2011.”
According to Nightingale, changing and manipulating the environment in order to put
the patient in the best possible conditions for nature to act.
Day 4
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano po pangalan niyo?”
C: “JM.”
SN: “Alam niyo po ba kung nasaan po tayo ngayon?”
C: “Oo sa mental nagpapagaling.”
SN: “Ano pong petse ngayon Mang JM?”
C: “Ngayon ay Miyerkules January 19, 2011, umaga.”
According to Sigmund Freud there is a part of the mind called preconscious,
thought and emotions are not currently in the person’s awareness, but he can recall
them with some effort
27
Day 5
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano po pangalan niyo?”
C: “JM.”
SN: “Alam niyo po ba kung nasaan po tayo ngayon?”
C: “Oo sa mental”
SN: “Ano pong petse ngayon Mang JM?”
C: “Ngayon ay Huwebes ng umaga January 20, 2011.”
As mentioned on Helson’s Theory, adaptation is a process of responding
positively to environmental changes. Mang JM adapts effectively as he was able to
identify the changes in her environment and positively responds to it.
Day 6
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano po pangalan niyo?”
C: “JM.”
SN: “Alam niyo po ba kung nasaan po tayo ngayon?”
C: “Oo dito Mariveles sa mental.”
28
SN: “Ano pong petse ngayon Mang JM?”
C: “Ngayon ay Biyernes ng umaga January 21, 2011.”
According to Nightingale, changing and manipulating the environment in
order to put the patient in the best possible conditions for nature to act.
Day 7
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano po pangalan niyo?”
C: “JM.”
SN: “Alam niyo po ba kung nasaan po tayo ngayon?”
C: “Oo sa mental nagpapagaling.”
SN: “Ano pong petse ngayon Mang JM?”
C: “Ngayon ay Miyerkules ng tanghali February 2, 2011.
According to Roy, awareness of self and environment is rooted in thinking and
feeling. Mang JM was aware of his environment.
Day 8
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano po pangalan niyo?”
C: “JM.”
29
SN: “Nasaan po ba tayo ngayon Mang JM?”
C: “Dito sa mariveles.”
SN: “Eh! Anu po bang araw ngayon?”
C: “Huwebes, Thursday February 3, 2011.”
SN: “Alam niyo po ba ang gagawin natin ngayon?”
C: “Sasayaw tayo ngayon.”
According to Nightingale, changing and manipulating the environment in
order to put the patient in the best possible conditions for nature to act.
Day 9
No unusual finding was noted on Mang JM’s orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: “Ano po pangalan niyo?”
C: “JM.”
SN: “Nasaan po ba tayo ngayon?”
C: “Dito sa pantry, sa mariveles.”
SN: “Alam niyo po ba ang gagawin natin ngayon?”
C: “Grand Socialization.”
SN: “Anu po bang araw ngayon?”
C: “Friday, February 4, 2011.”
30
According to Nightingale, changing and manipulating the environment in
order to put the patient in the best possible conditions for nature to act.
31
DEFENSE MECHANISMS:
Day1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
a. Repression
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
b. Suppression c. Regression d. Fixation e. Denial f. Displacement g. Conversion h. Identification i. Intellectual j. Introjections k. Projection l. Rationalization m. Sublimation n. Substitution o. Symbolism p. Undoing q. Reaction Formation r. Fantasy
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
Mang JM manifest one of the defense mechanism; Rationalization we noticed that he
always justify his answer. He also manifest Denial as he said “Hindi man ako malakas
uminom paminsan minsan lang.” and Projection during our conversation when we asked him
“Malakas po ba kayo iinum ng alak Mang JM?” he said “Hindi ah!mahina ako iinum eh,
siguro ikaw malaks kang iinom noh?”
32
According to Roger, the human being is a unified whole, possessing individual
integrity and manifesting characteristics that are more than and different from the sum
of parts.
Day 4
Mang JM manifest one of the defense mechanism; Fantasy we noticed that he always
says he was close to George Washington because he once went to United States of America
and met together and became friends. Maybe he wants us to be amazed of him.
SN: “Umano po kayo sa America Mang JM?”
C: “Wala may bahay kami doon, kakilala ako nun ni George Washington.”
According to Johnson, Each individual has patterned, purposeful, repetitive ways of
acting that comprises a behavioral system specific to that individual.
Day 5
We don’t recognize any defense mechanism.
Day 6
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation,
we noticed that he’s angry but he denies it obviously he is because of the tone of his voice
and through his gestures my slapping his legs. He smiled unnaturally.
SN: “Nagagalit po ba kayo Mang JM.”
C: “Hindi ako galit.”
SN: “Oh, ngiti nap o kayo.”
33
C: (Smiled but looks uncomfortable)
According to Roger, the human being is a unified whole, possessing individual
integrity and manifesting characteristics that are more than and different from the sum
of parts.
Day 7
Mang JM manifest one of the defense mechanism; Projection he often projects situations to
us.
SN: “Mang JM, ngayon pong malapit na ang valentines may plano po ba kayong pagbigyan ng flowers?
C: “Wala pa nga eh, hirap kasi baka may boyfriend na o may asawa na ang babae eh.”
SN: “Anu pong dahilan at nasabi niyong mahirap?
C: “wala naman, ikaw marami ka ng napagbigyan ng rosas noh?”
In erik erikson’s psychosocial theory, in infant stage, the infant must
learn to develop basic trust that she will be fed and taken care of, mistrust, the
negative outcome of this stage will impair the person’s development
throughout her life.
Day 8
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, he
denies that he’s not ever try a drugs/ marijuana, reaction formation because he said that he’s a
good boy.
34
SN: “Mang JM nakapagtry nap o ba kayo ng Drugs?”
C: “Hindi hindi ako gumagamit ng ganon.”
SN: “Ano pong dahilan?”
C: “Hindi, bawal yun samin mabait ako, hindi ako nangaaway, hindi ako nagdaDrugs, mabait
ako.”
According to Roger, the human being is a unified whole, possessing individual
integrity and manifesting characteristics that are more than and different from the sum
of parts.
Day 9
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation,
Mang JM denies use of drugs/ marijuana, reaction formation because he said that its not good
for our body.
SN: “Anu po ba ang feeling kapag naka-drugs?”
C: “Ay hindi, hindi ako gumagamit ng ganon.”
SN: “Anu pong dahilan?”
C: “Eh! Bawal kasi samin yun, tsaka nakita mu ba yung iba may mga galis galis dahil sa
drugs yun.”
SN: “Talaga po Mang JM?”
C: “Oo, maniwala kayo masama sa katawan yun, mabait ako.”
35
According to Roger, the human being is a unified whole, possessing individual
integrity and manifesting characteristics that are more than and different from the sum
of parts.
36
EXTRAPYRAMIDAL SYMPTOMS:
Day1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Pseudoparkinsonism
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
1. Masklike face
2. No swinging of arms
3. Hesitancy of speech 4. Decreased muscle
strength
5. Shuffling gait 6. Drooling
7. Fine intention tremors
Acute Dystonic Reaction
1. Muscle, spasm of jaw, tongue, neck, eyes
2. Laryngeal spasm Akathisia1. Restlessness 2. Tenseness 3. Inability to sit still 4. Rocking back and forth
of feet
5. Crossing leg frequently
6. Inability to relax Tardive Dyskinesia
1. Involuntary movements of mouth, face, may extend to fingers, arms and trunk
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
37
Day 1: Orientation
Day 2: Self awareness
Day 3
Our client displayed EPS under akathisia, during conversation we observed that Mang
JM crossing leg frequently and inability to relax by rocking back and forth on feet and
appears restlessness.
In Orem’s self care model, the nurse should help the client by doing
pharmacotherapy to manage their movement because according to Orem, the
nurse provides assistance to those who are unable to meet self care needs. The
nurse is required therapeutic care to the client with self care deficits until the
person can care for herself.
Day 4
Our client displayed EPS under akathisia, during our therapy we noticed that Mang
JM crossing leg frequently that manifest all through our conversation.
According to Henderson, unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health or
its recovery that he would perform unaided if he had the necessary strength, will, or
knowledge.
Day 5
38
Our client displayed EPS under akathisia, during our therapy we noticed that Mang
JM crossing leg frequently that manifest all through our conversation.
According to Ida Jean Orlando’s nursing process theory, she assumes that
freedom from mental or physical discomfort and feeling of adequacy and well being
contribute to health.
Day 6
Our client displayed EPS under akathisia, during our therapy we noticed that Mang
JM crossing leg frequently that manifest all through our conversation.
According to Henderson, unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health or
its recovery (or to peaceful death) that he would perform unaided if he had the
necessary strength, will, or knowledge.
Day 7
Our client displayed EPS under akathisia, during our therapy we noticed that Mang
JM crossing leg frequently that manifest all through our conversation.
According to Orem’s self care deficit theory, it describes why a person needs self care
but in the presence of illness, there was a deviation.
Day 8
Our client displayed EPS under akathisia, during our conversation we noticed that
Mang JM crossing leg frequently.
According to Henderson, unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health or
39
its recovery (or to peaceful death) that he would perform unaided if he had the
necessary strength, will, or knowledge.
Day 9
Our client displayed EPS under akathisia, during our grand socialization we noticed
that Mang JM crossing leg frequently that manifest all through our conversation.
According to Henderson, unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health or
its recovery (or to peaceful death) that he would perform unaided if he had the
necessary strength, will, or knowledge.
THINKING AND COMMUNICATION:
40
Day1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Looseness of Association
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
Neologism
Word salad
Echolalia
Echopraxia
Clang Association
Illogical thinking
Alogia
Concrete thinking
Lack of insight
Aphasia
Apraxia
Agnosia
Flight of ideas
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
Our client displayed looseness of association, these are neologism and echolalia. He
mentioned the word “wisboro” which do not have meaning and repeating the questions we
asked.
41
According to King, Each individual brings a different set of values, ideas, attitudes,
perceptions to exchange.
Day 4
Our client displayed looseness of association, these are neologism and echolalia. He
mentioned the word “aparachi” which do not have meaning and echolalia such as the
shoemaker, the shoemaker which he unconsciously saying. Our client also manifested
concrete thinking of flight of ideas.
According to King, Each individual brings a different set of values, ideas,
attitudes, perceptions to exchange.
Day 5
During the interview our client displayed lack of insight because sometimes he’s
saying something which has no sense or even relation on the topic and flight of ideas.
SN: “Anu po bang ginagawa niyo doon?”
C: “Nagtatrabaho, Nagbabantay ng bagahe, tapos may nahuhuli din akong isda noon.”
According to jean piaget’s stage of preoperational thought (2-7 yrs.). In this stage,
thinking and reasoning are intuitive, children learn without the use of reasoning.
Day 6
During the interview our client displayed looseness of association, these is neologism.
He mentioned the word “aparachi” which do not have meaning.
SN: “Anu po bang ginagawa niyo doon?”
C: “Nagbabantay ako dun, tas dun yung aparachi.”
42
SN: “Anu po yung aparachi?”
C: “ gold yun, kung saan may lualabas na kalabaw, truck at kung anu ano pa.”
According to King, Each individual brings a different set of values, ideas,
attitudes, perceptions to exchange.
Day 7
There were no alteration of Mang JM’s thinking and communication.
Day 8
During the interview our client displayed flight of ideas because Mang JM introduces
new topic without completing the topic.
SN: “ Ano pa po ba yung gingawa niyo doon?”
C: “wala naman nagbabantay, tignan mo yun oh mangga.”
Piaget viewed intelligence as an extension of biological adaptation that
has a logical structure. Every stage occurs at a certain age, and children show a
higher level of thought organization during each successive stage of
development.
Day 9
There were no alteration of Mang JM’s thinking and communication.
43
PERCEIVING AND INTERPRETING:
Day1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Delusion
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
1. Reference
2. Persecution
3. External influence
4. Somatic
5. Grandiose
Hallucination
Illusion Depersonalization
Attending to relevant stimuli
Poor reality testing
Attending to irrelevant stimuli
Poor reality testing
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self- awareness
Day 3
There was no alteration noted on Mang JM’s perceiving and interpretation.
44
Day 4
There is an alteration on perceiving and thinking; Persecution Delusion by saying “if
you want to kill me just tell me” and Grandiose Delusions by saying he is very rich. He also
manifests illusion by saying that the clouds near on the mountain are smoke cause by burn.
According to Neuman, maintains balance and harmony between internal and external
environment by adjusting to stress and defending against tension-producing stimuli.
Day 5
There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by
saying “madami diyan sa paligid mamamatay tao” and Grandiose Delusion by saying
“marami kaming pera, nung minsan nagpunta dito yung mga truck namin ng pera”. He also
manifests illusion by saying “doon sa ACIS may swimming pool kaming pinagawa diyan.”
According to psychodynamic theory of Sigmund freud , this perceptual motor
syndrome is developing from a person with psychic alterations. In addition, these alterations
are contingent on the poor caregiving that is provided within the environment.
Day 6
There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by
saying “dito lang tayo ah, wag kayo lalabas may mga mamamatay tao doon.” And Grandiose
Delusion by saying “Oo maniwala ka sakinkami nagpagawa ng mga building na yun.” He
also manifests illusion by saying “nakita mo na aba yung swiiming pool sa may ACIS?”
45
According to Neuman, maintains balance and harmony between internal and
external environment by adjusting to stress and defending against tension-producing
stimuli.
Day 7
There is no alteration on perceiving and thinking, manifest Grandiose Delusion by
saying “Oo, meron kaming mansion dito sa Mariveles.”
Day 8
There is no alteration on perceiving and thinking, manifest Grandiose Delusion by
saying “Marami nga kaming mga sasakyan eh! Tsaka Pajero.”
According to King, human beings are open systems in constant interaction
with the environment.
Day 9
There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by
saying “tinago ako ni mommyko kasi maraming pumapatay diyan eh!” he also manifest
Grandiose Delusion by saying “marami ako pera, totoo yun.”
According to Neuman, maintains balance and harmony between internal and
external environment by adjusting to stress and defending against tension-producing
stimuli.
46
FEELING AND AFFECT:
Day1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Flat
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
Blunted
Inappropriate
Lability
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
No unusual finding because client displays appropriate feeling and affect now.
Day 4
Our client manifest labile mood during our therapy he suddenly laughing for no
reason then suddenly back to serious mode.
47
According to Lazarrus (1982) he consider affect to be post-cognitive
that is, affect is thought to be elicited only after a certain amount of cognitive
processing of information has been accomplished
Day 5
Our client manifest blunted affect during our conversation, there is delay on our
communication.
According to Parses human becoming theory, the client determines whether to show
own affect/ feelings or not.
Day 6
Our client manifest blunted affect during our conversation, there is delay on our
communication and labile mood during our conversation he got irritable C: “ayaw mo
naming maniwala sakin eh!” (Slapped on his legs). He also manifests inappropriate affect.
SN: “nagagalit po ba kayo?” C: “hindi ako galit” (Smiled unnaturally) but his voice seems
angry.
According to Johnson, Each individual has patterned, purposeful, repetitive
ways of acting that comprises a behavioral system specific to that individual.
Day 7
No unusual findings because client displays appropriate feeling and affect now.
48
Day 8
Our client manifest blunted affect during our conversation, there is delay on our
communication. He also manifest labile mood because during the therapy Mang JM suddenly
keeps quiet and then he smiled again.
Based on Watson’s curative factors , we must promote and accept expression of the
client either it is positive or negative feelings and emotions.
Day 9
No unusual findings because client displays appropriate feeling and affect now.
49
BEHAVING AND INTERACTING:
Day1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Withdrawal
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
Motor hyperactivity
Motor hypoactivity
Ambivalence
Anhedonia
Avolition
Poor personal hygiene
Impulsive
Paranoia
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
The behavior pattern of our client is predictable but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his nails were dirty.
According to Abdellah, she identified 21 problems and one of this is to
maintain personal hygiene.
50
Day 4
Our client manifests motor hyperactivity because of his mood, overexcitement to
express his feelings. We also noticed that he has poor personal hygiene and he had dark teeth
that leads to bad breath and his clothes smelled.
According to Freud, conscious mind is where we are paying attention at the moment.
Our way of thinking affects our attitude on how we are going to react in a certain situation.
Day 5
The behavior pattern of our client is predictable. But we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath his clothes smelled and his
nails were dirty.
According to Orem’s self care deficit, the client can’t able to perform self care
because of the presence of mental pathology.
Day 6
The behavior pattern of our client is predictable, but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.
According to Abdellah, she identified 21 problems and one of this is to maintain
personal hygiene.
Day 7
51
The behavior pattern of our client is predictable, but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.
According to Abdellah, she identified 21 problems and one of this is to maintain
personal hygiene.
Day 8
The behavior pattern of our client is predictable, but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.
According to Orem’s self care deficit, the client can’t able to perform self care
because of the presence of mental pathology
Day 9
The behavior pattern of our client is predictable, but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.
According to Abdellah, she identified 21 problems and one of this is to maintain
personal hygiene.
52
NEGATIVE COGNITION:
Day1
Day2
Day3
Day 4
Day 5
Day6
Day7
Day8
Day9
Overgeneralization
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
All-or-nothing thinking
Should statement
Labeling
Middle reading
Fortune telling
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
No alteration noted on Mang JM’s negative cognition.
As mentioned by Abdellah, a nurse should continue to observe and evaluate the
patient over a period of time to identify any attitudes and clues affecting her behavior in order
to identify the client’s problem.
53
Day 4
No alteration noted on Mang JM’s negative cognition.
Day 5
No alteration noted on Mang JM’s negative cognition.
Day 6
No alteration noted on Mang JM’s negative cognition.
Day 7
No alteration noted on Mang JM’s negative cognition.
Day 8
No alteration noted on Mang JM’s negative cognition.
Day 9
No alteration noted on Mang JM’s negative cognition.
54
OTHERS:
Day1
Day2
Day3
Day4
Day5
Day6
Day7
Day8
Day9
Amnesia
OR
IEN
TA
TIO
N
SE
LF
-AW
AR
EN
ES
S
Fugue
Depersonalization
Phobias
Memory
1. Remote (long term)
2. Recent (early am)
3. Recent part (current events)
4. Immediate memory (short term)
5. Immediate recall
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
During our conversation with our client he had a remote memory because he was able
to determine his last 15 years of his life. He also remembered the food he eaten in the
55
morning and knows who the president of the Philippines is. He had also recalled us during
our conversation.
According to Parse, Man’s reality is given meaning through lived experiences
Day 4
Our client had remote memory because he remembered he went to America last 2005,
he also remembered his breakfast and knows who the president of the Philippines by saying
the name of Pres. Benigno Aquino. He also recognizes our name.
According from psychoanalytic theory of Freud, the mind can be divided into main
parts; the conscious mind includes everything that we are aware. A part of this includes our
memory which is not always part of consciousness but can be retrieved easily at any time and
brought into our awareness.
Day 5
Our client had remote memory because he remembered the things he did in the last 15
years of his life.
SN: “anu pong ginagawa niyo sa huling 15 taon ng buhay niyo?”.
C: “ mangingisda.”
He also recalled the food he was eaten in the morning.
SN: “ano po bang kinain niyo kanina?”.
C: “lugaw, nabusog nga ako eh.” .
He also knows the President of the Philippines by saying the name of Pres. Benigno Aquino.
He also recalled us during our conversation.
56
According to Parse, Man’s reality is given meaning through lived experiences
Day 6
Our client had remote memory because he remembered the things he did in the last 15
years of his life y saying “nangingisda ako noon.” He also remembered we did yesterday by
saying “nagbingo tayo at nanalo akong 2 beses.” He also knows who the president of the
Philippines by saying the name of Pres. Benigno Aquino. He also recalls us during our
conversation.
According to Freud, preconscious thoughts and emotions are not currently in the
person’s awareness, but she can recall them with some effort.
Day 7
Our client had remote memory because he remembered the things he did in the last 15
years of his life y saying “yung nanay ko nagtatahi ng magagandang damit.” He also
remembered we did last last week by saying “nagbingo, nanalo ng 2 beses at nagpakita ng
mga pictures tulad ng doctor, urse etc. He also knows who the president of the Philippines by
saying the name of Pres. Benigno Aquino. He also recalled we did before they go back in
their ward.
SN: “anu- ano nga po pala uli ginawa natin kanina?”
C: “food festival”.
According to Parse, Man’s reality is given meaning through lived experiences
Day 8
57
Our client had remote memory because he remembered the things he did in the last 15
years of his life, he also remembered things we’ve done yesterday and ingredients of our food
by saying “food festival, yung mga sangkap ay gulaman, buko at cream.”, he also know
president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls
activity we did before they go back in their ward by saying “Oo sumayaw tayo kanina na
gagawin natin bukas.”
According to Freud, the preconscious system is composed of those mental events,
processes and contents capable of being brought into conscious awareness by the act of
focusing attention.
Day 9
Our client had remote memory because he remembered the reason why he is admitted here in
MMH in the year 1989 by saying “Sinave ako ni mama dun sa mga taong mangunguha, tsaka
hindi ako magkatulog.” He also remembered the steps we practice yesterday. He also recalls
us.
According to Parse, Man’s reality is given meaning through lived experiences.
58
UNIT III(Psychopathophysiology and Related Literatures)
59
PSYCHOPATHOPHYSIOLOGY
60
Substance abuse
(Marijuana, 2 bottles of alcohol. 1 pack cigarette per day)
Affect the normal function of the brain system
Neurologic disturbances
Altered thought process
Looseness of ability in thinking and perceiving responses
mind, by doing this we will able to identify the possible problem that maybe the
reason why Mang JM has no relationship.
VI. Summary and Evaluation
Today, we held an activity that can assess the intellectual ability of the
patient by conducting the role identification therapy. We’ve prepared a
conducive, quiet area with less stimuli to let the patient concentrate for the
said activity. The flow of the activity went good and we can say that Mang JM
enjoyed it as manifested by his laughs. After that, we had our one on one
conversation with the client and we observed that the client had sudden change
in his mood and affect.
VII. Reference
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincot.
Williams and Wilkins. (5th Edition).
100
Name of Therapy: Bingo Social Therapy
Place: Under the Tree (MMH)
Date: January 20, 2011
Time: 9:30 AM
Phase: Working Phase (Day5)
I. Objectives
a. Client- centered objectives
1. To improve the socialization skills of the patient
2. To develop the self-esteem of the clients
3. To assess the knowledge perception of the client about different
fruits and vegetables.
4. To assess the memory of the client
b. Nurse- centered objectives
1. To provide mental health care for the client.
2. To implement therapeutic plan necessary for improvement of
mental illness.
3. To develop positive coping behavior through therapeutic
communication.
101
II. Description of Setting
a. Describe the set up/ environment
It was Thursday morning when we fetched our client to the grooming
area and assisted him for the therapy. The weather is sunny, and we chose the
perfect setting for the therapy where they can mingle with the other clients
while the trees provided them sheds against the sunlight. We arranged the
client’s seats facing each other with long table between them. The place was
conducive for the activity and they were comfortably seated on each chair.
The procedures of the therapy were explained to them clearly and they
understood the mechanics of the therapy. We viewed the reactions and facial
expressions of Mang JM while participating in the activity and noticed that he
was very eager to win. When the patterns were given and none of them
corresponds to the cards of Mang JM, he felt very disappointed. Mang JM
won 2 times and felt very happy. Upon receiving his prizes, he offered us
some of it and insisted to share the prize with us.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing the same set of clothes the same as
yesterday. When he saw us, it seems that he was happy seeing us. His gait was
moderate and he always looked at the floor with his arching back. He initiates
conversation on how he groomed himself before we arrived. We went to the
pantry area for his grooming session, but he refused to. When we accompanied
him to the activity area, he was silent and wore a flat affect. But at the time he
was seated on the chair, we approached him on how he was aware and
102
oriented to his environment, on time and place and he was talking hard with
his arm gestures. During the activity, he showed excitement and eagerness to
win and seriously focused on the activity. After the activity we proceed for
another conversation and reviewed him about the recent therapy. As we go
along on our conversation, different behaviors were manifested, congruent
affect have been projected by the client, but sometimes he answered late and
showed no interest.
III. Process Recording
103
IV. A. Theme identification
104
Nurse- Client
Conversation (include
non- verbal cues)
Therapeutic
Communication
Technique Used
Analysis and
Interpretation based on
theories
SN: “Magandang umaga
po Mang J.M.”
C: “Magandang umaga
din!” (smiled)
Giving Recognition The client greeted back.
He shows interest for
today’s activity.
According to Henderson,
she identified 14 basic
needs one of it was
communicating with
others which is essential
to establish a therapeutic
relationship.
SN: “Tara po Mang J.M
maglinis na po kayo.”
C: “hindi na,naligo na
ako kanina 2 beses.”
SN: “Kanina po? Anung
oras po?”
C: “ Kaninang
pagkagising ko 4am at
kaninang 6am.”
Placing event in time or
sequence
The client refuses for our
grooming session.
According to Abdellah,
there are 21 problems she
identified and one of it is
to promote good personal
hygiene.
SN: “Mang JM, kilala
niyo po ba ako?”
C: “Oo, ikaw si mark.”
SN: “Eh, yung isa ko pa
pong kasama?”
C: “Si hazel.”
Seeking Clarification The client recognizes his
student nurses. This
indicates a good recent
memory he still
remember our names.
According to Johnson,
each individual has
patterned, purposeful,
repetitive ways of acting
that comprises a
behavioral system
specific to that
individual.
Content Theme
We established nurse patient interaction focused primarily on how we
explained and assisted the patient in participating to the activity. The
therapy will help the patient on how to interact with other patient and how
to react on different situations presented in every part of the game.
Moreover, it serves as guide for their thoughts and behavior and on how to
act appropriately in every situation.
Interaction Theme
Mang JM responded well and reacted appropriately to the therapy
being conducted. He showed interest in participating to the game and was
very approaching to his fellow players. After the therapy, Mang JM
showed different reactions regarding on his recent activity. He responded
well on each questions being asked on him. He projected behaviors that
seemed he was agitated about his environment and gave warnings about it.
Mood Theme
Client had sudden changes on his mood depending on questions being
thrown on him. He expressed agitation, and showed different perception
about his environment. Client’s movement often feels restless
B. Nursing Diagnosis
Risk for other-directed violence related to threats as evidenced by verbal
threats of against property as evidence by:
105
SN: “Marami po ba kayong nakain ngayon?”
C: “Oo, kaming mga siga marami kaming nakukuhang pagkain sa loob.”
V. Nursing Interventions
We started to greet our client a pleasant afternoon. We encouraged him to
change his clothes and cooperate on our grooming session but he always refused
to and always reason out his grooming. After that we accompanied him to the
activity area and assisted him throughout the game. After that, we conducted a
review and conversation about his recent therapy and asked his comments and
reactions about it. The conducted interaction went good.
VI. Summary and Evaluation
Today we conducted an activity through which we can assess the cognitive
ability and patience of the client. We had BINGO SOCIAL using fruits and
vegetables on every card. When we informed our client about the therapy, he was
very excited. During the therapy he listened very carefully to every ball and
wanted us to assist him in every pattern of the game. The therapy went good and
he was very happy wining two times in the said therapy.
VII. Reference
Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition,
2008
Name of Therapy: Story Telling Therapy
Place: Under the tree (MMH)
Date: January 21, 2011
106
Time: 9:30 AM
Phase: Working Phase (Day 6)
I. Objectives
a. Client- centered objectives
1. To assessed the clients reading comprehension
2. To develop clients concentration
3. To assess client memory status
4. To exercise client’s natural imagination in gaining lessons through
story.
b. Nurse- centered objectives
1. To provide mental health care for the client.
2. To implement therapeutic plan necessary for improvement of
mental illness.
3. To develop positive coping behavior through therapeutic
communication.
4. To evaluate client understanding about the story he was read.
II. Description of Setting
a. Describe the set up/ environment
It was Friday morning when we fetched our client to the grooming area
and assisted him for the therapy. The weather is sunny, and we chose the
107
appropriate setting for the therapy the trees provided them sheds against the
sunlight. We were facing the client, handed them a book of “Ang Kalabaw at
ang Pagong”. The place was conducive for the activity and he was
comfortably seated on his chair. The procedures of the therapy were explained
to him clearly and he understood that after reading the story he should
formulate or get a moral lesson from it. We viewed the reactions and facial
expressions of Mang JM while participating in the activity and noticed that he
was interested.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing the same set of clothes the same as
yesterday. His gait was moderate and he always looked at the floor with his
arching back. He initiates conversation on how he groomed himself before we
arrived and refused us in grooming him again. When we accompany him to
the activity area, he was initiating stories. We accompany him to the activity
area and was seated on a chair facing us. During the activity, he showed
interest in reading the story. After the activity we proceed for another
conversation and reviewed him about the recent therapy. As we go along on
our conversation, different behaviors were manifested, congruent affect have
been projected by the client, but sometimes he answered late.
III. Process Recording
108
IV. A. Theme identification
109
Nurse- Client
Conversation (include
non- verbal cues)
Therapeutic
Communication
Technique Used
Analysis and
Interpretation based on
theories
SN: “Magandang umaga
po Mang J.M.”
C: “Magandang umaga
din!” (Smiled and
Nodding)
Giving Recognition The client looks back
with a smile. He shows
interest for today’s
activity.
According to Peplau, the
initial interaction
between the nurse and
the patient wherein the
latter has a felt need and
expresses the desire for
professional assistance.
SN: “Tara po Mang J.M
maglinis na po kayo.”
C: “Hindi na,naligo na
ako kanina 2 beses.”
SN: “Kanina po? Anung
oras po?”
C: “ Kaninang
pagkagising ko 4am at
kaninang 6am.”
Placing event in time or
sequence
The client refuses for our
grooming session
wherein he says sequence
of activity he did in the
morning.
According to Abdellah,
she identified 21
problems and one of it is
to promote good personal
hygiene.
SN: “Mang JM, napansin
ko pong hindi niyo
pinapalitan ang damit
niyo?”
C: (Smiled and Nodding)
Making Observation The client responds
appropriately and accepts
the implied without
misunderstanding what
his nurse said.
According to Roy, the
degree of internal or
external environmental
change and the person’s
ability to cope with that
change is likely to
determine the person’s
health status.
Content Theme
We established nurse patient interaction focused primarily on the story
telling therapy in which the client reads the story then identify the moral
lesson on the story assigned to them. With this therapy, we can assess their
memory and their cognitive ability on how they explain what the story had
told them.
Interaction Theme
During the therapy we noticed that he had different ideas in
deciphering the story. While reading, we reviewed his memory by asking
the recent events and details in the story. After that, we had our
conversation to assess what were the lessons he learned by reading the
story. Some of his answers were irrelevant to the situation and he will put
some stories of his own which were not related to the storytelling therapy.
He didn’t concentrate on the story because he had his own stories that he
wanted to discuss with us. He can recall every detail of the story but a little
different from the original events. We can say that he didn’t enjoy the
therapy that much. He’s only active when he’s discussing his own story.
Mood Theme
110
During our interaction to the client, Mang JM responded well to the
questions although there are some unrealistic answers. He always observed
his environment when he’s not being asked. He projected appropriate
moods and behaviors but his attention was concentrated on his
environment.
B. Nursing Diagnosis
Disturbed Thought Process Related to misinterpretation as evidenced by:
SN: Ano po ang dahilan at nasabi nyo po na hindi kayo pumapatay:
C: May masasama kasing tao doon sa labas kumukuha ng mga babae sa bahay,
hindi kami yun.
V. Nursing Interventions
We encourage Mag Jm to perform the Routine Grooming. We ask him to
participate to the activity that we will going to conduct today. W encourages him
to verbalize his feeling regarding the therapy. We asked him to read the story and
formulate his own lesson that he gain in the story. We encourage Mang Jm to
verbalize the thing on his mnd to be able for as to assess any problem that he feels.
VI. Summary and Evaluation
In the Friday afternoon, as we received the client, Mang JM, he presented a
smiling face and a happy mood. He refused us to groom him, again, so we proceed
to the activity area for the story telling therapy. The client was very cooperative
on the conducted activity that afternoon. He was able to identify the moral lesson
111
in the story though it was not clearly explained to us because of his flight of
different ideas. He was very agitated around his environment.
He also verbalized feelings of concern openly with us.
VII. Reference
Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition,
2008
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia.
Lippincott, Williams and Wilkins. (5th Edition
Name of Therapy: Food Festival
Place: Canteen (MMH)
Date: February 2, 2011
Time: 2:00 PM
112
Phase: Working Phase (Day7)
I. Objectives
a. Client- centered objectives
1. To improve the socialization skills of the patient
2. To develop client’s self-esteem
3. To assess client’s ability in following procedures
4. To assess the client’s memory
b. Nurse- centered objectives
1. To provide mental health care for the client.
2. To implement therapeutic plan necessary for improvement of
mental illness.
3. To develop positive coping behavior through therapeutic
communication.
II. Description of Setting
a. Describe the set up/ environment
It was a fine sunny day of Wednesday around 2:00 in the afternoon of
February 2, 2011 when we received our client. He first greeted us with a smile
and initiated to go to the pantry area which was a good thing. We let him
groom himself in the area and after his grooming we proceed to the canteen
for their activity. The place was clean and the seats were arranged semi circle
facing the table where the facilitators will do their demonstration of the
activity.
113
They were oriented in time, place and date and the procedure of the
activity were explained very clearly for the benefit of orderliness of the
activity. A brief conversation and review were conducted after the activity to
assess what he had learned and to check his recent memory. At around 4:00
pm, we returned our client to his dorm after the therapy and the conversation.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing his own set of wrinkled dirty white
Boysen shirt and green patterned shorts which was the same two weeks ago.
He greeted us with a smile and initiated to go to the pantry room. His gait is
moderate and was looking to the floor at times. He brushed his teeth very hard
and requested a cologne and powder to finish his grooming session. After that,
we accompany him to the activity area and noticed that he was very excited
and always smiled at everyone. During the program, he was actively
participating and behaved well. He was serious and focused himself to the
procedures. He was able to compute the total price of all the ingredients used
in the food festival. After the program, we conducted a brief session to review
what he has learned to observe some improvements in his behavior. As we go
along on our conversation, different behaviors were manifested, congruent
affect have been projected by the client. We observed that he was very happy
and excited about his discharge soon.
III. Process Recording
Nurse- Client
Conversation (include
non- verbal cues)
Therapeutic
Communication
Technique Used
Analysis and
Interpretation based on
theories
114
SN: “Magandang umaga
po Mang JM”
C: “Magandang umaga din
naman.” (Smiled and
Nodding)
Giving Recognition The client smiled and
greeted back that suggest
he is comfortable with us.
According to Peplau, the
initial interaction between
the nurse and the patient
wherein the latter has a felt
need and expresses the
desire for professional
assistance.
SN: “Tara na po sa pantry
Mang JM para
makapaglinis po kayo.”
C: “Hindi naligo na ako
kanina pa 2 beses.”
SN: “Tara na po doon para
po makapaghugas na po
kayo ng kamay niyo umihi
po kasi kayo eh”
C: “oh sige.”
SN: “Para na din po mas
maging gwapo po kayo
Mang JM.”
C: (Smiled)
Offering one’s Self Mang JM feels that his
nurses were here just for
him.
According to Peplau, in
interpersonal relationship
theory, it is important for
the nurse to recognize and
respond to the
patients needs for help.
SN: “Kamusta po kayo
Mang JM?
Broad Opening The client encourages
being bad by a response of
what he wants to state on
any cues of
115
C: “mabuti naman,
masaya.”
communication.
According to Watson, it is
important to help the
patient identify his own
thoughts and feelings to
gain better understanding
of his self.
SN: “Anu pong dahilan at
masaya po kayo Mang
JM?”
C: “wala naman, dahil
nakalabas ako ulit sa
ward.”
Focusing The client was happy
because we fetch him in
his dorm.
According to Watson,
there is an independency
and integration of the parts
and elements of thoughts
and behaviours that make
up the system.
SN: “Nakikilala niyo pa po
ba ako Mang JM?”
C: “Oo, ikaw si Mark.”
SN: “eh, yung isa ko pa
pong kasama?”
C: “Uhmmm...hahosy?
Hasi?”
SN: “Hazel po Mang JM.”
C: “Ay, oo nakalimutan ko
kasi.”
Focusing The client still remembers
who we are including our
name which means that he
had a good immediate
memory.
According to Watson,
there is an independency
and integration of the parts
and elements of thoughts
and behaviours that make
up the system.
SN: “Kamusta po ba ang Focusing The client still remembers
116
tulog niyo Mang JM?”
C: “Mabuti naman.”
SN: “ Anung oras po kayo
nakatulog kagabi?
C: “8pm.”
the time he fell asleep last
night.
According to Watson,
there is an independency
and integration of the parts
and elements of thoughts
and behaviours that make
up the system.
SN: “Natatandaan niyo pa
po ba yung ginawa natin
last last week po?”
C: “Oo, Bingo at yung
pinakita yung
mgapictures.”
SN: “ Ilan beses po kayo
nanalo Mang JM sa
bingo?”
C: “dalawa.”
Seeking Clarification The client still remembers
the things we’ve done for
the last 2 weeks.
According to Orem, self
care requisites are insights
of actions that a person
must be able to meet and
perform in order to
achieve well being.
SN: “Alm niyo po ba yung
gagawin po natin ngayon
Mang JM?
C: “Oo, magagawa tayo ng
mga pagkain.”
SN: “Opo Mang JM,
tuturuan po naming kau
gumawa ng buko salad.”
Giving Information The client provided
information necessary for
the activities of the today.
According to Roy,
informing the patient
know what to expect. All
other stimuli that
strengthen the effect of the
focal stimulus.
SN: “Kamusta po ang
paggawa niyo ng buko
Exploring The client verbalizes his
feelings about the activity
117
salad Mang JM?”
C: “ahh... mabuti naman.”
SN: “Magkano po ule
yung lahat lahat ng
magagastos para sa
paggawa po ng buko
salad?
C: “118.”
SN: “Galing naman po
pala.”
being done for today.
According to Watson,
there is an independency
and integration of the parts
and elements of thoughts
and behaviours that make
up the system.
SN: “Kayo po ba Mang
JM nung hindi pa po kayo
napupunta ditto nagluluto
p okay sa bahay niyo ng
pagkain?”
C: “oo naman,tulad ng
hotdog, isda atbp.”
SN: “ Kasipag naman po
pala ni Mang JM.”
C: (Smiled)
Asking Direct Questions
The client shared what she
does before she was
admitted at Mental.
According to King, a
person has ability to record
their history through their
own language and
symbols.
SN: “Mang JM, ngayon
pong malapit na ang
valentines may plano po
ba kayong pagbigyan ng
flowers?
C: “Wala pa nga eh, hirap
Exploring The client verbalizes his
feelings about a girl she
wants to give flower for
the coming valentine’s
day.
118
kasi baka may boyfriend
na o may asawa na ang
babae eh.”
SN: “Anu pong dahilan at
nasabi niyong mahirap?
C: “wala naman, ikaw
marami ka ng napagbigyan
ng rosas noh?”
According to Maslow, one
must feel the sense of love
and belongingness
SN: “Halimbawa po Mang
JM si Hazel po yung gusto
niyong babae anu po gusto
niyong sabihin sakanya?
C: “uhmm...mahal na
mahal kita, aalagaan kita
ng mabuti.”
SN: “Wow ang sweet
naman po pala ni Mang
JM eh.”
C: (Smiled)
Role Playing We ask the client to
consider people and events
in light of his own
appraisal in order for him
to express his feelings.
According to Orem,
person’s major task is to
maintain integrity in face
of these environmental
stimuli.
SN: “Sa ngayon po ba
Mang JM may plano na po
ba kayo magasawa
paglabas niyo dito?
C: “Ahh...wala, babalik
ako sa trabaho ko.”
SN: “Saan po kayo
Exploring The client verbalizes his
feelings about marrying
someone.
According to Maslow, one
must feel the sense of love
and belongingness
119
tutuloy?”
C: “Sa nanay ko.”
SN: “Di ba po Mang JM
nasabi niyo pong napunta
na po kayo sa America?
C: “Oo, sa mga ninong
ko.”
SN: “Anu pong mga
ginawa niyo doon?”
C: “Naginom sa mga bar.”
Seeking Clarification The client had a chance to
re- evaluate what he just
said.
According to Orlando, it is
important for the client to
know that he has heard.
With this the client will
make her feel accepted.
SN: “Sa pakikipag inuman
niyo po sa America wala
po ba kayo nakakilalang
babae doon?”
C: “Wala eh.”
SN: “Talaga po Mang JM?
Ayaw niyo lang po ata
mag- share eh?”
C: (Laughing)
SN: “sige na po Mang JM
i-Share niyo na po yan.”
C: “Wala nga.” (Smiled)
Humor The client was able to
decrease his anxiety in a
way that we give some of
humors in order for him to
verbalize.
According to Kolcaba,
health care needs are needs
for comfort, arising from
stressful health care
situations that cannot be
met by recipients’
traditional support system.
SN: Mang JM bukas po
magkikita po tayo uli ang
activity po natin bukas ay
Formulating Plan of
Action
The client was provided
information in order for
him to be prepared on
120
dance therapy, anu po ba
ang gusto niyong dance
step?
C: “basta bukas nalang.”
(Smiled)
SN: “Anu pa po ba gusto
niyong tugtog para pos a
sayaw natin bukas?
C: “Kahit ano basta yung
masaya.”
what the things will be
done and the things to
expect.
According to Roy,
informing patient of facts
lets the patient know what
to expect. All other stimuli
that strengthen the effect
of focal stimulus.
SN: “Mang JM, anu- ano
po uli mga gnawa po natin
ngayong araw?
C: “food festival, sinabi
niyo kung magkano ang
mga sangkap.”
SN: “Galing naman pop
ala ni Mang JM.”
C: (Smiled)
Summarizing The client has a good
recent memory, he recalled
the things being done for
today. It helps to bring out
important points of the
conversation and
activities. It increases
awareness and
understanding of both
participants. This provides
as a sense of closure at the
discussion.
According to Orem,
Supportive- educative
helping patient to learn
self care and emphasizing
on the importance of
nurses’ role.
SN: Mang JM, ano po ang
masasabi niyo sa ginawa
Evaluation Evaluation allows the
client to evaluate the
121
natin kanina?
C: natutuwa ako dahil
marami akong na tutunan.
outcome of the conducted
therapy.
IV. Theme identification
Content Theme
We established nurse patient interaction focused primarily on the food
festival in which the patient demonstrated procedures in preparing buko
salad. This therapy will provide the client the stimulus to assess their
ability to follow procedures and do it independently and creatively.
Moreover, it serves as guide for their thoughts and behavior.
Interaction Theme
During the therapy while the facilitators were explaining the
procedure, he was focused on every detail. But when his fellow clients
demonstrate their procedure he seemed bored and not interested. When his
turn to demonstrate, he did it very well. After the therapy, we had our short
conversation to review his memory about the recent activity and to assess
what the therapy has taught him and to assess for any improvements in his
122
behavior. He responded well in every question thrown at him and showed
interest in the conversation.
Mood Theme
During the conversation, he showed appropriate moods and affect
congruent to the questions being asked. He often smiled and laughed and
seldom looked away to divert his attention. He had a good eye contact
while having our conversation and his statements were clearly
represented.
B. Nursing Diagnosis
Readiness for enhanced coping related to verbalization of feelings as evidence
by:
SN: “Mang JM, ano po ang masasabi niyo sa ginawa natin kanina?”
C: “natutuwa ako dahil marami akong na tutunan.”
V. Nursing Interventions
We fetched Mang JM from the ward and we received a warm smile
from him. He initiated to go to the pantry area so we had the chance to groom
him. He did grooming himself and asked for cologne and powder without
changing his clothes though we always encouraged him to do so. During the
activity, we assisted him in preparing the food. And after that we had a short
conversation to identify his improvements in the past weeks of therapy.
VI. Summary and Evaluation
123
On February 2, 2011 we conducted another therapy to help them work
independently following procedure. The facilitators of the said therapy oriented them before
doing every procedure. Mang JM looked excited for his turn to make his own version of buko
salad. He was able to identify the total amount of all the ingredients needed in the therapy.
While the facilitators were demonstrating every procedure he was listening very well and
focused on every detail of the procedure while others were doing their turns in re-
demonstrating the procedures he seemed bored and not interested while silently
demonstrating every procedure, he did it very well and was given recognition for it. Before
eating his meal, he offered his meal to everyone and he wanted to share his meal with us. He
enjoyed eating his meal and appreciated it very much.
After the therapy, we conducted brief conversation about the recent activity. He was
none initiating that time and was looking around his environment. He said that the food
festival was good and it would help him get stronger for the day. Eye contact was lacking that
time because his attention was drowned around his environment. His memory was good
because he identified the ingredients of the salad with its corresponding prices. He returned to
the dorm with gratitude and appreciation.
VII. Reference
NANDA 10th edition
Psychiatric-Mental Health Nursing 5th Edition
124
Name of Therapy: Dance Therapy
Place: Canteen (MMH)
Date: February 3, 2011
Time: 1:30 PM
Phase: Working Phase (Day8)
I. Objectives
a. Client- centered objectives
125
1. To develop the client’s self esteem
2. To improve the client’s interpersonal relationship with others and to
reduce anxiety
3. To assess and develop his movement and coordination
4. To assess the client’s memory
b. Nurse- centered objectives
1. To provide mental health care for the client.
2. To implement therapeutic plan necessary for improvement of mental
illness.
3. To develop positive coping behavior through therapeutic
communication.
II. Description of Setting
a. Describe the set up/ environment
It was a Thursday of February 3 when we received our client. We
conducted another activity called Dance Therapy. We prepared seats in a
straight line and oriented them before doing the therapy. After the facilitators
greeted and explained every procedures of the therapy, we showed them the
whole dancing activity before teaching them step by step. After teaching them
the steps, they performed the dance to the other clients while assisting them
how to. They were given great recognitions after the dance therapy and were
deeply appreciated. After the program, we gave the client something to eat and
drink to regain his energy and conducted the conversation for assessing
126
improvements. At around 4:00 pm, we returned our client to his ward after the
therapy and the conversation.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing his clothes with MMH’s male uniform.
The uniform was colored blue and semi-wrinkled. He greeted us with a smile
and proceed to grooming area but he didn’t want to be groomed so we insisted
him to do so. His gait is moderate and was looking to the floor at times. He
washed his face rigidly and brushed his teeth very hard and requested a
cologne and powder to finish his grooming session. After that, we accompany
him to the activity area and noticed that his affect was somehow flat and
steadily looking at the floor. During the program, he is silent and seldom
smiled while doing the steps. He was serious and focused himself to the
activity. His memory was sharp because he can recognize each step easily and
his movement and coordination was good.. After the program, we conducted a
brief session to observe some improvements in his behavior while eating his
merienda. As we go along on our conversation, different behaviors were
manifested, congruent affect have been projected by the client. We observed
that he was very happy and excited about our conversation on his past
relationships.
III. Process Recording
127
128
Nurse- Client
Conversation (include
non- verbal cues)
Therapeutic
Communication
Technique Used
Analysis and
Interpretation based on
theories
SN: “Magandang
Tanghali po Mang J.M.”
C: “Magandang Tanghali
din”
Giving Recognition Mang JM looks back and
greeted us. This shows
that he is comfortable to
us.
According to Peplau
(1952), a nurse is
stranger to the patient. It
is therefore important to
remind the patient who
we are and be consistent
with the information we
are giving to him to gain
their trust.
SN: “Tara na po sa pantry
para po makapag linis po
kayo Mang JM.”
C: “hindi na naligo na
ako kanina.”
SN: “Tara na po doon
kahit po maghilamos at
toothbrush nalang po
kayo.”
C: “Sige.”
Offering One’s self The client feels the
presence of his student
nurses.
According to Henderson,
unique function of the
nurse is to assist the
individual, sick or well,
in the performance of
those activities
contributing to health or
its recovery that he
would perform unaided if
he had the necessary
strength, will, or
knowledge.
SN: “Mang JM ano pong
pangalan ko?”
C: “Ahh..ikaw si Mark.”
SN: “Eh!yung kasama ko
po sino po yun?”
Seeking Clarification The client recognizes his
student nurses.
According to Sullivan,
interaction among client
is beneficial that helps
client him to cope to
reality.
IV. A. Theme identification
Content Theme
We established nurse patient interaction focused primarily on dance
therapy in which the facilitators oriented the clients on how the activity
will flow. Each student nurses taught their clients the steps for the dance
therapy while assessing their movements, coordination, and behavior.
Interaction Theme
During the therapy while the facilitators were explaining the
procedure, he was focused on every detail. While teaching him the steps
and at the same time having a conversation with him, his affect was a little
flat and seldom smiled. He only smiled when he was given recognition. He
responded well in every question thrown at him and showed interest in the
conversation.
129
Mood Theme
During the program where he presented to the other client what steps he
has learned in the dance, he was very proud and always smiled at the
audience. During the conversation, he showed appropriate moods and
affect congruent to the questions being asked. He seldom smiled and
laughed and looked on his environment while doing the steps. He had a
good eye contact while having our conversation after the therapy and his
statements were clearly represented.
B. Nursing Diagnosis
Ineffective denial related to fear of consequences on negative past experiences
as evidence by:
SN: “Anu po ginawa niyo para po maka- move on?”
C: “wala, may minahal kasi ako agad.”
V. Nursing Interventions
We received our client wearing the same clothes but with MMH’s male
uniform as his topper. We assisted him in his grooming session and
encouraged him to change his clothes. After that, we accompanied him to the
activity area and orient him for the preparedness and orderliness of the
activity. We taught him steps in the dance activity while assessing his
behaviors and movements. The client was given a chance to present his dance
to his fellow clients ad was given recognitions and appreciations after that. A
brief conversation was conducted after the activity and he was reminded that
130
tomorrow will be our last conversation and meeting. We fetched him to the
male ward afterwards.
VI. Summary and Evaluation
On February 3, we conducted a therapy where in we taught the patient how to
dance while assessing their movement and coordination and developing their self
esteem. We oriented the client about the therapy and showed them the steps. Mang
JM seemed uninterested and very silent while watching the performance.
During the therapy Mang JM showed flatness of affect and non initiating
behaviors. When learning every step, he can easily memorize each.
After teaching the steps, Mang Jm performed the dance in front of his fellow
clients. We noticed that he had sudden change of moods. While performing, he was
happy and proud performing in front of his audience. We didn’t have a hard time
assisting him in performing because he memorized all the step.
After the program, we had a conversation and review his reactions about the
therapy. The conversation manifested that he didn’t enjoyed the practice. He only
enjoyed performing.
VII. Reference
Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition,
2008
Grand Socialization
Place: MMH
131
Date: February 4, 2011
Time: 9:00 AM
Phase: Termination Phase (Day 9)
I. Objectives
a. Client- centered objectives
1. To stimulate mind and body through socialization to other clients.
2. To develop the self esteem of the client
3. To assess the improvements of the patient in following instructions
4. To assess the memory of the client
5. To terminate the relationship.
b. Nurse- centered objectives
1. To provide mental health care for the client.
2. To implement therapeutic plan necessary for improvement of mental
illness.
3. To develop positive coping behavior through therapeutic
communication
II. Description of Setting
a. Describe the set up/ environment
It was a sunny day of Friday of February 4, 2011 when we conducted
the Grand Socialization for all the patients handled by the BPSU nursing
students. Everyone’s busy decorating the place with red balloons, and multi
colored crepe papers. The music committee was all set up. The games,
132
programs and prizes were properly arranged. The chairs were arranged in 3
straight lines in front of the sound system facing the Grand Socialization
tarpaulin. The place was enough to accommodate all the patients and students
and was conducive for the activity.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing his own set of wrinkled dirty white
Boysen shirt and green patterned shorts topped with blue male ward uniform.
He greeted us with a smile and reminded us that it was our grand socialization
day today. His gait is moderate with his arching back. He brushed his teeth
very hard and washed his face very thoroughly. After that, we accompany him
to the activity area. During the program, he was actively participating and
behaved well. During the games, he always raised his hands and always
willing to participate in the game. He was serious and focused himself to each
and every instructions of the game. When he won, he put his prizes inside of
his shirt. And when his fellow clients won the game, he was snatching some of
the prizes of his fellow patients. During the program, he was very happy. After
the program, we conducted a brief session to observe some improvements in
his behavior. As we go along on our conversation, different behaviors were
manifested, congruent affect have been projected by the client. We observed
that he was very happy and satisfied on what his experiences on the grand
socialization brought him.
III. Process Recording
133
134
Nurse- Client
Conversation (include
non- verbal cues)
Therapeutic
Communication
Technique Used
Analysis and
Interpretation based on
theories
SN: “Magandang Umaga
po Mang J.M.”
C: “Magandang Umaga
din naman.” (Smiled)
Giving Recognition The client smiled and
greeted back that suggest
he is comfortable with
us.
According to Peplau
(1952), a nurse is
stranger to the patient. It
is therefore important to
remind the patient who
we are and be consistent
with the information we
are giving to him to gain
their trust.
SN: “Tara na po sa pantry
para po makapag linis po
kayo Mang JM.”
C: “hindi na naligo na
ako kanina.”
SN: “Tara po
maghilamos at toothbrush
nalang po kayo.”
C: “O sige.” (Smiled)
SN: “Para po mas gwapo
po kayo ngayon.”
Offering One’s self The client feels the
presence of his student
nurses.
According to Henderson,
unique function of the
nurse is to assist the
individual, sick or well,
in the performance of
those activities
contributing to health or
its recovery that he
would perform unaided if
he had the necessary
strength, will, or
knowledge.
SN: “Oh! Mang JM anu
po pangalan ko?”
C: “Mark.”
SN: “Eh, eto pong
kasama ko?”
Seeking Clarification The client recognizes his
student nurses.
According to Orem, self
care requisites are
insights of actions that a
person must be able to
meet and perform in
A. Theme identification
135
Content Theme
The therapy was all about developing the interpersonal relationship of
the client with others and assess his improvements throughout the
whole 3 week therapies.
Interaction Theme
Mang JM participate well to the game. He was very cooperative and able
to listened to the instruction. He was able to remember all the step we
taught him yesterday. During our last conversation with him he maintained
his eye contact with us. He said thank you to us.
Mood Theme
During the conversation, he showed appropriate moods and affect
congruent to the questions being asked. He often smiled and laughed and
seldom looked away to divert his attention. He had a good eye contact
while having our conversation and his statements were clearly represented.
B. Nursing Diagnosis
Risk for loneliness related to termination of relationship with nursing students.
SN: “Mang JM last day na po namin ngayon.”
C: “Oo, basta wag niyo sana kami makakalimutan.”(looks sad)
IV. Nursing Interventions
136
In Hildegard Peplau, Phases of nurse client relationship, termination phase is
the final stagein the nurse-client relationship. Both nurse and client usually have
feelings about ending the relationship; the client especially may feel the
termination as an impending loss.
We plan a grand socialization for our client where they will enjoy the food ang
games we prepare for them. We encourage Mang JM to participate in the game;
this will help him to develop his confidence in facing crowd. We perform a dance
number with our client. During our conversation with Mang JM, we encourage
him to verbalize his feeling regarding the termination of our relationship with him,
by doing this we can evaluate what he feel about the termination. We encourage
Mang JM to verbalize what are the things he learn from the therapy we previously
done, by doing this we can evaluate if we solve the problem of Mang JM and if
we become an effective student nurses. We tell Mang JM that we enjoy the time
we spent with him.
V. Summary and Evaluation
This was the last day that we had our care and conversation with the patient.
He seemed very happy during the grand socialization day. We let him participate
in the games and won many times. He kept his prizes inside his clothes and some
of it was shared to others. While eating his meal, we had the chance to talk to him
for the last time and to explain to him that this was the last day where we can able
to care, talk to him and do activities.
He understood the termination of the care and wished that we won’t forget him.
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VI. Reference
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia.
Lippincot. Williams and Wilkins. (5th Edition).
Octavino Eufemia F., and Balita, Carl E> (2008). Theoretical Foundation of
Nursing> Balikan Prints and Binding Enterprises.
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PHARMACOLOGY
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Name of Drug Mechanism of Action
Contraindication Indication Adverse Effect
Nursing Consideration
Generic Name:
Risperidone
May act by antagonizing dopamine and serotonin in the central nervous system
Contraindicated in patient with hypersensitivity to drug
> patient with schizophrenia
> bipolar mania
> irritability symptoms of aggression toward others, deliberate self-injury, and temper tantrums associated with autistic disorder
> mild restlessness> headache
1. Monitor mood changes. Assess for suicidal tendencies especially during early therapy
2. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
3. Monitor patient for onset of extrapyramidal side effect. Report these symptoms; reduction of dosage or discontinuation of medication may be necessary.
Brand Name:
Risperdal
Classification:
Anti-psychotic
(atypical antipsychotic)
Dosage, Route, Frequency:
2mg ½ tab, PO, BID
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Name of Drug
Mechanism of Action
Contraindication
Indication Adverse Effect
Nursing Consideration
Generic Name:
Haloperidol
Unknown. Thought to block postsynaptic dopamine receptors in brain. Inhibiting signs and symptoms of psychosis
>hypersensitivity to drug
> severe central nervous system depression
> Parkinson’s disease
>symptomatic treatment of psychotic disorders
>schizophrenia in patients who need prolonged parental anti-psychotic therapy
> psychotic disorders
>hyperactivity
> manic states
>confusion
1. Monitor patient for onset of akathisia which may appear within 6 hour of first dose and may be difficult to distinguish from psychotic agitation
2. Assess mental status (orientation, mood, behavior) prior to and periodically during therapy
3. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
Brand Name:
Haldol
Classification:
Anti-psychotic
(typical antipsychotic)
Dosage, Route, Frequency:
1amp, 5mg IM
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Name of Drug
Mechanism of Action
Contraindication
Indication Adverse
Effect
Nursing Consideratio
n
Generic Name:
Levomepromazine
Exerts its actions through a central adrenergic-blocking, a dopamine-blocking, a serotonin-blocking, and a anticholinergic blocking
No absolute contraindications
> used for the treatment of psychosis, particular those of schizophrenia, and manic phases of bipolar disorder
>dry mouth
1. watch out for seizures
2. caution in combining levomepromazine with other anticholinergic drugs
3. monitor vital signs
Brand Name:
Nozinan
Classification:
Anti-psychotic
Dosage, Route, Frequency:
10mg ½ tab, HS
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Name of Drug Mechanism of Action
Contraindication Indication Adverse Effect
Nursing Consideration
Generic Name:
Flupentixol
It inhibits the central monoamine receptors, particularly the dopamine D₁ and D₂ receptors. Therefore, it increases the amount of serotonin and noradrenaline that control mood and thinking, and improve mood
> With known hypersensitivity to the thioxanthenes
> presence of CNS depression due to any cause, comatose states
>maintenance therapy of chronic schizophrenic patients whose main manifestations do not include excitement, agitation or hyperactivity
> dizziness> headache
1. careful observation for early symptoms of tardive dyskinesia
2. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
Brand Name:
Fluanxol
Classification:
AnxiolyticAntidepressiveMood stabilizer
Dosage, Route, Frequency:
1cc, IM
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Name of Drug
Mechanism of Action
Contraindication
Indication Adverse Effect
Nursing Consideration
Generic Name:
Chlorpromazine
Block dopamine receptors in the brain, prevention of seizures
>hypersensitivity to drug
> should not be used in patients who have CNS depression
> acute and chronic psychoses particularly when accompanied by increased psychomotor activity
>dry mouth
1. assess mental status prior to and periodically during therapy
2. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
3. monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizres)
Brand Name:
Thorazine
Classification:
Anti-psychotic
(typical antipsychotic)
Dosage, Route, Frequency:
500mg 2tabs, HS
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UNIT V(Psychotherapy)
145
Psychotherapy
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Name of Therapy: Role Identification Therapy
Place: Under the Tree (MMH)
Date: January 19, 2011
Time: 9:30 AM
Phase: Working Phase (Day4)
DEFINITION
This therapy uses a picture of people and their different kind of occupation.
This therapy involves identifying the different kinds of occupation in the picture and
also explaining their role in the society.
OBJECTIVES
To enhance the thinking and analyzing ability of the client.
To analyze and determine the knowledge and understanding of clients with
occupation roles.
To gain knowledge
PROCEDURES
1. First the leader will initiate the mood of the client.
2. Then the facilitator is responsible for asking questions to the client. They
will ask the client if they know what the picture is and what is represents.
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3. If the client has wrong answer, the facilitator will correct them.
4. After that the clients was distributed to their own nursing student for
individual discussion of the pictures.
5. Finally the leader will gather the patient for evaluation of the therapy.
ANALYSIS AND INTERPRETATION
Mang JM cooperates well and actively. He answered the questions according
to his own intellectual capacity. He always laughed at his inmates whenever he felt
that their answer was wrong.
According to Roy, through two adaptive mechanisms, regulator and cognator,
an individual demonstrates adaptive responses or ineffective responses requiring
nursing interventions.
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Name of Therapy: Bingo Social Therapy
Place: Under the Tree (MMH)
Date: January 20, 2011
Time: 9:30 AM
Phase: Working Phase (Day5)
DEFINITION
This therapy is like the usual bingo we played. Instead of numbers, fruits and
vegetables were used in the game. This therapy is used for assessing knowledge of the
mentally-ill patients about fruits and vegetables.
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OBJECTIVES
To improve the socialization skills of the patient
To develop the self-esteem of the clients
To assess the knowledge perception of the client about different fruits and
vegetables.
To assess the memory of the client
PROCEDURES
1. Orient the client about various types of fruits and vegetables.
2. Explain the mechanics and therapy simple briefly and clearly
3. Encourage the client to participate in the entire theory
4. During the working phase give recognition to the winning clients and provide
prizes.
5. Summarized and evaluate the therapy
ANALYSIS AND INTERPRETATION
With this kind of activity, we used fruits and vegetables on every BINGO
cards. Instead of numbers when we informed our client about the therapy, he was very
excited. He was very eager to win and get the prize. During the therapy, he listened
very carefully to every ball and wanted us to assists him in every pattern at the game.
The therapy went good and he enjoyed the game and very thankful for winning it.
According to King, perceptions, judgments and actions of the patient and the
nurse lead to reaction, interaction, and transaction (Process of nursing)
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Name of Therapy: Storytelling
Place: under the tree (MMH)
Date: January 21, 2011
Time: 9:30 AM
Phase: Working Phase (Day6)
DEFINITION
The book that is use is about the animals and it is short that the client will not
get bored reading it. It also have picture that show what the characters are doing.
Story telling is done to assess the reading comprehension of the client and his ability
to formulate his own moral lessons that he gain to the story.
OBJECTIVES
To assessed the clients reading comprehension
To develop clients concentration
To assess client memory status
PROCEDURE
1. First the facilitator will explain to the client the name of the therapy
2. The facilitator will tell to the client the short story they will go to read.
3. The two student nurses will show to the client the short story they will go to
read.
4. The client will read the tagalong versions of the story
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5. The student nurses will asked the client what is the moral study of the story.
ANALYSIS AND INTERPRETATION
Today, the therapy was all about storytelling. We let the client read the story
and get lessons from it. During the therapy, we noticed that he had different ideas in
deciphering the story. We asked him questions to review every detail of the story.
Some of his answers were irrelevant to the situations and he will put some stories not
related to the storytelling therapy.
He didn’t concentrate on the therapy because he had his own different stories
that he wanted to discuss with us. He can recall some of details in the stories but a
little different from the original one. We can say that he got bored reading the story
and during the therapy. He’s only active discussing his own stories.
According to Pender, Identifies cognitive, perceptual factors in clients which
are modified by demographical and biological characteristics, interpersonal
influences, situational and behavioral factors that help predict in health promoting
behavior.
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Name of Therapy: Food Festival
Place: Canteen (MMH)
Date: February 2, 2011
Time: 2:00 PM
Phase: Working Phase (Day7)
DEFINITION
Food festival is a therapy done in order for the client to have basic knowledge
in preparing foods. This is done to assess the client’s ability in following procedures
and to assess their memory while they are socially incline with other patients. This
would help them to work independently and creatively.
OBJECTIVES
To improve the socialization skills of the client
To develop the self-esteem of the client
To assess the client’s ability in following procedures
To assess client’s memory
PROCEDURES
1. Prepare all the ingredients needed.
2. Discuss every detail of the therapy.
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3. Inform the client about the each ingredient with their corresponding price.
4. Demonstrate the procedure.
5. Allow the client to make their own salad.
6. Evaluate their works
ANALYSIS AND INTERPRETATION
On February 2, 2011 we conducted another therapy to help them work
independently following procedure. The facilitators of the said therapy oriented them
before doing every procedure. Mang JM looked excited for his turn to make his own
version of buko salad. He was able to identify the total amount of all the ingredients
needed in the therapy. While the facilitators were demonstrating every procedure he
was listening very well and focused on every detail of the procedure while others
were doing their turns in re-demonstrating the procedures he seemed bored and not
interested while silently demonstrating every procedure, he did it very well and was
given recognition for it. Before eating his meal, he offered his meal to everyone and
he wanted to share his meal with us. He enjoyed eating his meal and appreciated it
very much.
After the therapy, we conducted brief conversation about the recent activity.
He was none initiating that time and was looking around his environment. He said
that the food festival was good and it would help him get stronger for the day. Eye
contact was lacking that time because his attention was drowned around his
environment. His memory was good because he identified the ingredients of the salad
with its corresponding prices. He returned to the dorm with gratitude and
appreciation.
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According to Peplau, interpersonal theory nurse assumes several roles which
empower and equip her in meeting the needs of the patient .Teaching Role Gives
instruct ions and provides training; involves analysis and synthesis of the
learner’s experience.
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Name of Therapy: Dance Therapy
Place: Canteen (MMH)
Date: February 3, 2011
Time: 1:30 PM
Phase: Working Phase (Day8)
DEFINITION
This therapy is done to assess the client’s movement and coordination, as well
as his ability to memorize every step. This therapy is intended also to relieve their
anxiety and to create recreation. This is also done to develop the client’s socialization
to others.
OBJECTIVES
1. To develop the client’s self esteem
2. To improve the client’s interpersonal relationship with others and to reduce
anxiety
3. To assess and develop his movement and coordination
4. To assess the client’s memory
5. To provide mental health care for the client.
6. To implement therapeutic plan necessary for improvement of mental illness.
7. To develop positive coping behavior through therapeutic communication.
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ANALYSIS & INTERPRETATION:
On February 3, we conducted a therapy where in we taught the patient how to
dance. We orient the patient about the therapy and showed them the dance. Mang JM
seemed uninterested and very silent while watching the steps of the dance.
During the therapy, Mang JM showed flatness of affect and non initiating
behaviors while we were teaching him every step. He can easily do the steps and
memorized each very well though he seemed silent throughout the entire practice.
After teaching the steps Mang JM performed the dance in front of his fellow
clients. We noticed that he had sudden change of mood while performing. He was
happy and proud while dancing. We didn’t have a hard time assisting him in his
performance because he memorized every step.
After the program, we had a conversation and review his reactions about the
therapy. The conversation manifested that he didn’t enjoyed the practice of the dance
and enjoyed his performance only.
According to Wiedenbach the Art of nursing includes understanding patient’s
needs and concerns, developing goals and actions intended to enhance patient’s ability
and directing the activities related to the medical plan to improve the patient’s
condition.
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UNIT VI(Glossary)
158
GLOSSARY
Acute Dystonic Reaction- extreme contraction of the jaw muscles, which can result
in dislocation of the jaw bones and difficulty in opening the mouth. These symptoms
may be caused by an adverse reaction to an antipsychotic drug.
Affect- is the outward expression of the client’s emotional state.
Affective disorder- refers to disorders of mood.
Agnosia – is a loss of ability to recognize objects, persons, sounds, shapes, or smells
while the specific sense is not defective nor is there any significant memory loss.
Akathisia- Motor restlessness ranging from a feeling of inner disquiet, often localized
in the muscles, to an inability to sit still or lie quietly.
Alcohol Abuse- use of alcoholic beverages to excess, either on individual occasions
("binge drinking") or as a regular practice.
Alogia - Poverty of speech, as commonly occurs in schizophrenia.
Ambivalence- presence of two opposing feelings.
Amnesia - refers to the loss of memory
Anhedonia- loss of interest in pleasurable things.
Antipsychotic Drugs- class of medicines used to treat psychosis and other mental and
emotional conditions.
Anxiety- is a psychological and physiological state characterized by somatic,
emotional, cognitive, and behavioral components. Anxiety is considered to be
a normal reaction to a stressor. It may help a person to deal with a difficult situation