54500904 ncmh case study gia
TRANSCRIPT
Chapter I
Introduction
Schizophrenia is a disorder characterized by significant disorganization of thinking
manifested by problems with communication and cognition; impaired perceptions of reality
manifested by hallucinations and delusions; and sometimes in significant decreases in
functioning.
Approximately 2.2 million people, or 1% of the world population, suffer from
schizoprenia . Statistics indicate that approximately 40% of these individual (1.8 million people)
do not receive psychiatric treatment on any given day, resulting in homelessness, incarceration,
or violence.(National Advisory Mental Health Council,2005).
The onset of schizoprhenia may occur late in adolescence or early in adulthood, usually
before the age of 30. Although the disorder has been diagnosed in children, approximately 75%
of person diagnosed as having schizoprhenia develop the clinical symptoms between ages of 16
and 25 years. Schizoprhenia usually first appears earlier in men, in their late teens or early
twenties, than in women, who are generally affected in their twenties or early thirties.
( shives,2008)
Age at onset appears to be an important factor in how the client fares: those who develop
the illness earlier show worse outcomes than those who develop it later. Younger clients display
a poorer premorbid adjustment, more prominent negative sign, and greater cognitve impairment
than do older clients. Those who experience a gradual onset of the disease (about 50%) tend to
have both poorer immediate and long term course than those who experience an acute and
sudden onset (Buchanan and Carpenter, 2005)
Schizoprenia are classified into four types: Paranoid Schizoprhenia, Disorganized
Schizophrenia, Catatonic Shizophrenia, Residual schizophrenia and Undifferentited type was
charcterized by mixed shizoprhenic symptoms along with disturbances of thought, affect and
behavior.
This was a case of a 39 years old, female client from Sorsogon City, with an early onset
of undifferentiated shizophrenia since 1990 and admitted at National Center for Mental Health in
Pavillion 2 accompanied by her father, later on she was transferred in Unit 2, Pavillion 5 because
of agitation and assultive behavior to other client.
Theoretical Framework
Different theorist in the past proposed theories to explain the possible cause and
development of schizophrenia:
Psychoanalysis theory by Sigmund freud postulated that shizophrenia resulted form
development of fixation that occurred earlier that those culminating in the development of
neuroses. These fixations produced defects in ego development and freud postulated that such
defects contributed to the symptoms of schizophrenia. Ego intergration in schizoprhenia
represent a return to the time when the ego was not yet , or had just begun to be established.
Because the ego affects the interpretation of reality and control the inner drives such as sex and
agression. These ego functions are impaired, thus , intrapsychic conflict arising from the early
fixation and the ego defects which may resulted from early object relations, full of psychotic
symptoms. (Kennedy,2007)
Genetic predisposition theory suggest that the risk in inheriting schizophrenia is 10% to
20% in those who have one immediate family member with the disease, and approximately 40%
if the disease affects both parents or an identical twins. (Shives, 2008).
Biochemical and neurostuctural theory includes the dopamine hypothesis: that an
excessive amount of neurotransmitter dopamine allows nerves impulses to bombard the
mesolimbic pathway, thye part of the brain normally involved in arousal and motivation. Normal
cell communication is disrupted, resulting in the development of hallucinations and delusions,
symptoms of schizoprhenia. The abnormalities of neurocircuitry or signals from nuerons are
being studied as well. A defective circuit can result in bombardment of infiltered information,
possibly causing negative and positive symptoms. Overwhelmed the mind makes errors in
perception and hallucinates, draws incorrect conclusion, and becomes delusionals. To
compensate for this barrage , the mind withdraws and negative symptoms develop. (Beuer,2006)
Organic or Pathophysiologic Theory suggest schizophrenia is a functional deficit
occuring in the brain caused by stressors such as viral infection, toxins, trauma or abnormal
substances.( Well-connected,2006)
Perinatal Theory suggest that the risk of schizophrenia exist if the developing fetus or
newborn is deprived of oxygen during pregnancy or if the mother suffers from malnutrition or
starvation during first trimester of pregnancy . The development of schizoprhenia may occur
during fetal life at critical points in the brain development generally the 34th or 35th week
gestation. The incidence of trauma and injury during the second trimester and birth also been
considered in the development of schizoprenia. ( Well-connected,2006)
Schisms and Skewed families by Theodore Lidz described two abnormal patterns of
family behaviors. In one family type, with a prominant schism between the parents, one parent is
overly close to a child of the opposite gender. In the other family type a skwed relationship
between a child and one parent involves a power struggle between one parent. These dynamics
stress the tenuous adaptive capacity of schizoprenic person.( Balllard 2009)
Pseudomutual and Psuedohostile families by Lyman Wynne, some families supress
emotional expression by consistently using pseudomutual or psuedohostile verbal
communication. In such families, a unique verbal communication develops and when child
leaves home and must relate to other persons, problems may arise the verbal communication may
be incomprehensive to outsider( Brien 2007).
Psychological or Experiential theory found that prefrontal lobes of the brain are
extremely responsive to stress. Individuals with schizophrenia experiences stress when family
members and acquaintances respond negatively to the individual’s emotional needs. These
negative responses already vulnerable neurologic state, possibly trigerring and excerbating
existing symptoms. Stressors that have been thought to contribute to the onset of schizophrenia
include poor mother-child relationships, deeply disturbed family intrepersonal relationships,
impaired sexual identity and body image, rigid concept of reality, and repeated exposure to
double bind situation. A double-bind stuation is a no win experience, one in which there is no
correct choice. (kolb,2005).
Double bind concept by Gregory Bateson and Donald Jackson is to described the
hypothetical family in which children receive conflicting parental messages about their behavior,
attitudes and feelings. Children withdraw into a psychotic sate to escape the unsolvable
confusion of double bind. (Ballard 2009).
Environmental or cultural Theory state that person who develops schizoprhenia has a
faulty reaction to the environment, being unable to respond selectively to numerous social
stimuli. Theorist also believe that person who come from low socioeconomic areas or single-
parent homes in deprived areas are not exposed to situations in which they can achive or become
succesful in life.
Patient Personal Data:
Name: Patient JD
Age: 39 yrs. Old
Address: Sorsogon, City
Sex: Female
Date of Birth: July 12, 1971
Place of Birth: Pasig, City
Race/Religion: Filipino/ Catholic
Marital Status: Single
Education: Highschool Graduate
Occupation: none, former plywood cutter and Garments Factory worker
Source of Refferal:
The patient was brought to Ortho by social worker at Sorsogon, City because of assultive
behavior with post inflammatory scar on both lower extremities and fever for first intervention
then finally admitted to National Center forMental Health Pavillion 2 accompanied by her father,
later on she was transferred in Unit 2, Pavillion 5 for further monitoring of behavior.
Chief Complain:
Nagwawala, Balisa, Ayaw uminom ng Gamot, mainitin ang ulo as verbalized by the Father.
Diagnosis: Undifferentiated Schizoprenia
History of Present Illness:
Patient is on Unit 2, Pavillion 5 for further monitoring of behavior, She was on good
mood state with normoproductive speech, She had poor recent, remote and immediate memory,
she only remembers the memory when she was at the age of 16-33. She was disoriented in time
and date but know what place she was. She denied any suicidal attempts and hurting others. She
said she had good sleeping pattern and also she denied any visual hallucination but sometimes
she experience auditory and gustatory hallucination such as “binubuyo niya akong saktan ang
sarili ko pero di ko na pinapansin yun” and “walang lasa ang pagkain dito palagi”.she also said
she always complied to her medicine but complain of positive dizziness.she also had unusual
mannerism and gesture such as scratching her plam and her head.
Past Personal History:
The patient was mentally ill since 1990’s with previous admission at an ortho because of
post inflammatory scar at both lower extremities, she was discharge as improved, following
medication was initially complain. Patient was eventually loss to follow-up with the medication
given because of low financial assistance.
Few days prior to admission, patient was noted to be restless, agitated and have
perceptual disturbances. January 15, 2008 family was decided to admit her at NCMH Pavillion 2
accompanied by her Father, after three months she exhibited normal cognition and physical state
then later on she was transferred to Pavillion 5 unit 2 because of escape and suicidal attempts,
assultive behavior to co-client,flight of ideas with looseness of association, poor impulse control,
agitated, tangentially and visual and auditory hallucination.She had 2x2 cm 2x 1.5 contrusion
hematoma on left Zygomattic area after having first fight last July 10, 2008. On October 29,2008
she was brought to restrain and undergo Electroconvulsive therapy on the following day. At
Novemeber 7, 2008 another incidental report happen when the patient was on restlessness nd
accidentally bumped her head on the cemented wall 3x4 cm contrusion on mid forehead.
Family History:
Her Father was 64 years old, jobless and her mother was 59 years old manicurista both
live at Sorsogon, City and earn 2,400 a month. She had a older brother who had own his family.
There is no data about history of having schizoprhenia in the family. But because of low
financial assistant with on and off medication serves as the rooted of worse progression of
patient diagnosis.
Chapter II
General Appearance
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
Good grooming * *
Appropriate facial expression
* * *
Appropriate posture
* * *
Maintain eye contact
* * *
During student nurse- patient interaction, the patient’s grooming was not good prior to
morning care she wear dirty ward gown without slippers but on the second day and later part she
improves and shows good grooming. Most of the time she exhibited appropriate facial
expression and posture during interactions. She also displays and maintain good eye contact and
show ineterest on the topic but she was easily get distracted by environmental stimuli such as
other student nurse in the room or preparing something. As days passes by student nurse
established rapport on the patient.
Motor Behavior
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
AUTOMATISM
HYPERKINESTHESIA
WAXY FLEXIBILITY
CATAPLEXY
CATALEPSY
STEREOTYPE
COMPULSION
PSYCHOMOTOR RETARDATION
ECHOPRAXIA
CATATONIC STUPOR
CATATONIC EXCITEMENT
TICS AND SPASMS
IMPULSIVENESS
CHOREIFORM MOVEMENTS
Analysis: Patient doesn’t exhibit any problem in motor behavior.
C. Sensorium and Recognition
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
ORIENTATION
TIME
PLACE * * *
PERSON * * *
CONCENTRATION
MEMORY
REMOTE
RECENT
IMMEDIATE RETENTION
Analysis: During our NPI patient was oriented in place and people but not in time and
date, lack of orientation may indicate possibility of a medical or nuerological brain disorder.
Some patient also with schizophrenia may give incorrect or bizzare answer to the question.
(Saddock,2007). She’s also has poor remote, recent, immediate retention in memory because
she’s doesn’t recall her past past experiences it may be because of the cognitive impairment.She
also exhibited poor concentration because she was easily distracted by environmental stimuli..
Patient with schizophrenia typically exhibit cognitive impairment in the domains of attention,
working, recent, remote and immediate memory, this impairements cannot function as a
diagnostic tools but they are strongly related to the functional outcome of the illness.
(saddock,2007) .
D.Perception
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
HALLUCINATION
VISUAL
OLFACTORY
AUDITORY *
TACTILE
GUSTATORY
ILLUSIONS
DELUSIONS
Analysis: The patient shows auditory hallucination during day 2 of nurse patient
interaction, Any fives senses may be affected by hallucinatory experiences in patient with
schizophrenia. The mosy common hallucination was auditory with voices that are often
threatening, obscene, accussatory or insulting. That may comment on the patient’s life behavior.
( Saddock, 2007) . On my patient her auditory hallucination was ” sabunutan daw po kita” . as
patient verbalized. Auditory Hallucination was under the categories of positive symptoms
schizophrenia where in Patient with Undifferentiated schizoprenia may experience it (Videbeck
2008).
E.ATTITUDE AND BEHAVIOR
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
COOPERATION * * *
OUTGOING
WITHDRAWN
EVASIVE
SARCASTIC
AGGRESSIVE
PERPLEXED
APPREHENSIVE
ARROGANT
DRAMATIC
SUBMISSIVE
FEARFUL
SEDUCTIVE
UNCOOPERATIVE
IMPATIENT
RESISTANT
IMPULSIVE
Analysis: The patient is cooperative throughout the exposure she cooperates well and
interacts with us and participates in the activities.
F.DEFENSE MECHANISM
Criteria Day 1 Day 2 Day 3 Day 4
DENIAL
REPRESSION * * *
SUPPRESSION
RATIONALIZATION
PROJECTION
DISPLACEMENT
INTROJECTION
CONVERSION
SYMBOLIZATION
DISSOCIATION
UNDOING
REGRESSION
SUBSTITUTION
FANTASY
REACTION FORMATION
SUBLIMATION
COMPENSATION
Analysis: The patient show repression. Repression was excluding painful or anxiety-
provoking thoughts and feelings from contious awareness, a person use this kind of defense
mechanism to cover-up her fears (Keltner2007). She remember her memory when she was 33
years old and doesn’t recall any previous experiences, she doesn’t know why she was in NCMH.
According to Frued it is unconscious defense mechanism in which unacceptable mental contents
are banished or kept out of consciousness; important in psychological development and in
neurotic ans psychotic symptoms formation( Saddock,2007).
G.AFFECTIVE STATE
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
EUPHORIA
FLAT AFFECT
BLUNTING
ELATION
EXULTATION
ECTSTASY
ANXIETY
FEAR
AMBIVALENCE
DEPERSONALIZATION
IRRITABILITY
RAGE
LABILITY
DEPRESSION *
Analysis: The patient does exhibit depresion on the first day, because when we talk about
her family, she expresses feelings of loneliness and longing to go home. Depression may be part
of the psychopathology of schizophrenia, and studies, on the average, have suggest that 25% or
more of schizophrenic patient experience depression (keck, 2007)
H. SPEECH
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
VERBIGERATION
RHYMING
PUNNING
MUTISM
APHASIA
UNUSUAL TONE RATES
UNUSUAL VOLUME OF SPEECH
UNUSUAL INTONATION
UNUSUAL MODULATION
Analysis: The patient does not exhibit any problem of the speech behavior above.
I. THOUGHT PROCESS AND CONTENT
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4
BLOCKING
FLIGHT IDEAS *
WORLD SALAD
PERSEVERATION
NEOLOGISM
CIRCUMSTANTIALITY
ECHOLAGIA
CONDENSATION
DELUSION
PHOBIA
OBSESSION
HYPOCHONDRIAC
Analysis: The patient show flight of ideas during 4th day of exposure, One of the
symptoms of Schizophrenia was flight of ideas where in there is a overproductivity of talk and
verbal thinking skipping from one idea to another.Although talk is continously, the ideas are
fragmently. Connections between segment of speech often are determine between segment of
speech.( shives, 2008). On Patient she answer the question about ahow many child she had then
she answer it 3 then turn her answer about her husband eventhough she had no husband and
children. Flight of ideas was of the disorder in thought process and it concern in the way ideas
and language are formulated, thought control in which outsides forces are controlling what the
patients thinks or feels.( Saddock, 2007)
Chapter III
Book based
i
CAUSES: SCHIZOPRHENIA
Biochemical factors:
-Increase dopamine activity in the limbic system
Neurostructural factors:
-Enlarge ventricles-brain atrophy-decrease cortical blood flow in the prefrontal lobe
Genetics:
-can be inherited because schizophrenia runs in the families.
Psychodynamic:
-Developmental stage.
-family relationship
Symptoms: Disturbance in perception Disturbance in thought process Disturbance in reality testing Disturbance in feeling ,behavior, attention
Decline in psychosocial functioning
Acute Phase:
The patient experiences severe psychotic symptoms.
Stabilizing Phase:
The patient gets better.
Stable Phase:
The patient might still experiences hallucinations and delusion but the hallucination and delusion are not severe not as disabling as they were during acute phase.
Five types of schizophrenia:
Paranoid schizophrenia, disorganized schizophrenia, Catatonic schizophrenia, Residual schizophrenia and undifferentiated schizophrenia.
According to Kelther (2007) there are different factors that causes Schizophrenia first the
Biochemical factors in which there is increase dopamine activity that contibute in activating
positive symptoms of schizophrenia, second was neurostuctural in which there is large
ventricles, brain atrophy and has decrease in blood flow in prefrontal cortex of the brain, third
the genetics which it can be inherited by a person who has schizoprhenia runs in the family and
lastly the psychodynamic factors in which a person with schizophrenia has tendency that he or
she had deprive in her or his developmental stage or a person may experienced conflict with
family relationship. There are different psychotic symptoms that may be seen such as d
Disturbance in perception , thought process, reality testing, feeling ,behavior, attention which may be
result in decline of psychosocial functioning. There are three phase that the patient might be experienced
first, in acute phase the patient experiences severe psychotic symptoms followed by stabilizing phase in
which patient gets better and lastly the stable phase, in this phase the patient might experiences
hallucination and delusion but the hallucination and delusion are not as severe nor disabling as were
during acute phase.
Client based Undifferentiated Schizophrenia diagnosed since 1990’s
Patient experiences agitation, restlessness,
and perceptual disturbance
She exhibit normal cognitive and physical
state.
After three months she was been shown to be poor impulse control, agitated, tangentially with flight of ideas with looseness of association and visual and auditory hallucination, she revealed escape and suicidal attempts, assultive behavior to co-client.
The onset of patient shizophrenia was diagnosis since 1990, there’s no data of any family
members having schizophrenia except of her. The patient was brougth to ortho for her post
inflammatory scar in both lower extremities , she was discharge as improved, following
medication was initially complain. Patient was eventually loss to follow-up with on and off
rooted complain because of low financial assistance. Few days prior to admission patient
exhibited restlessness, agitation, perceptual diturbance. Then after three months she was been
shown to be poor impulse control, agitated, tangentially with flight of ideas with looseness of
association and visual and auditory hallucination, she revealed escape and suicidal attempts,
assultive behavior to co-client.
Related literature
Different studies are conducted to give possible explanation in the development of
schizoprhenia:
Gene Study Suggests New Target for Schizophrenia Tx Reviewed by Robert Jasmer,
MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner stated that defects in a pathway with
a misleading name may underlie some cases of schizophrenia, according to researchers
conducting a genetic study.
Genomic variants known as microduplications in or near the gene for the vasoactive
intestinal peptide (VIP) receptor were 14 times as common in a sample of patients with
schizophrenia relative to normal controls, reported Jonathan Sebat, PhD, of the University of
California San Diego, and colleagues, in the Feb. 24 issue of Nature.VIP is actually a
multifunctional protein that is produced throughout the body and is active in a host of body
systems. In addition to playing multiple roles in the intestinal tract and circulatory systems, VIP
helps regulate vaginal secretions, prolactin release, and circadian rhythms. This last function is
located in the brain, and previous studies have linked circadian rhythm disturbances with
schizophrenia.
They undertook the study because earlier studies had identified copy number gains
involving large DNA sequences (more than 500,000 bases) that were more common in
schizophrenic patients, and wondered if replication of shorter sequences might also be linked to
the disorder.
In the second stage, Sebat and colleagues looked more closely at these regions in samples
from 7,488 patients and 6,689 controls.They found that microduplications within a 362-kilobase
region at chromosomal location 7q36.3 -- in or near the VIP receptor gene known as VIPR2 --
were significantly more common in the patients, with an odds ratio of 14.1 (95% CI 3.5 to
123.9).
"While duplications of VIPR2 account for a small percentage of patients, the rapidly
growing list of rare copy number variants that are implicated in schizophrenia suggests that this
psychiatric disorder is, in part, a constellation of multiple rare diseases," the researchers wrote.
"This knowledge, along with a growing interest in the development of drugs targeting rare
The researchers conducted the scans in a two-stage study. They first searched for copy
number variants in 802 schizophrenia patients and 742 controls, which yielded positive
findings in 114 genomic "regions of interest."
disorders, provides an avenue for the development of new treatments for schizophrenia."
(http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?
utm_source=twitterfeed&utm_medium=twitter)
According to Dr. A Bassett of the university of Toronto,the first true etologic subtype of
shizoprenia, the consequence of a chromosome deletion refered to as the 22q1deletion syndrome.
Person with this syndrome have distinct facial appearance, abnormalities of the palate, heart
defects, and immunologic deficits. The risk of developing shizoprhenia in the presence of this
syndrome appears to be approximately 25%. Genetic locations of schizophrenia, believed to be
on chromosomes 13 and 8. One study found thatmothers of client with schizophrenia had a high
incidence of gene type H6A-B44 (shives,2008)
Drug study
NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING INTERVENTION
Haloperidol Competitively blocks dopamine receptor s to cause sedation and also causes alpha-adrenergic and anticholonergic blockade. It depressescerebral cortex, hypothalamus and limbic system, which control activity and aggression but also cause significant extrapyrimidal effects
Management of Tourette disorders; control of adults; management of severe behavioral problems in children . long term antipsychotic therapy.
Severe toxic CNS depression or comotose states from any cause; parkinson disease.
Glaucoma, seizure disorder, hepatic and renal impairment
asses pt. disorder and mental status before drug therapy. Reassses affect, orientation, mood, behavior, sleep pattern.
Monitor possible adverse reaction such as CNS, severe extrapyramidal reactions.
Monitor swallowing of oral administration medication and check for hoarding or giving meds to other client.
Monitor vital signs.
NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING INTERVENTION
Chlorpromazine
Thorazine
Blocks postsynaptics dopamine receptors in brain.
Management of manifestations pf psychotic disorders, to control nausea and vomiting, relief of restlessness and apprehension before surgery, acute intermittent porphyria, adjunct in the treatment of tetanus, to control manifestation of the manic type manic depressive illness, relief of intractable hiccups, treatment of severe behavioral problems in children marked by combativeness or hyperexcitable behavior.
Comatose states, presence of large amounts of CNS depressants, presence of bone marrow depression.hypersensitivity.
Drowsiness, jaundice, postural hypotension, extrapyrimidal effects. Persistent abnormal movement, cerebral edema, hematologic disorders, ECG changes.
asses for mental status: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms before initial therapy
Monitor swallowing of oral administration medication and check for hoarding or giving meds to other client.
Monitor input and output
NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING INTERVENTION
Biperiden Synthetic anticholinergic drugs, block cholinergic response in the CNS.
Parkinsonian syndrome especially to counteract muscular rigidity and tremor; extrapyrimidal syndrome.
Narrow- angle glaucoma, mechanical stenoses in gastrointestinal and megacolon; prostatic adenoma and disease leading to perilous tachycardia. Hypersensitivity to biperiden.
CNS and peripheral effects, skin rashes, dyskinesia, ataxia, twitching, impaired speech, micturition difficulties.
Document indication for therapy, onset of signs and symptoms and other agent tried and outcomeof therapy.
Assess for parkinsonism, EPS: shuffling gait, muscle rigidity, involuntary movement, pill rolling, spasm and drooling during treatment.
Monitor constipation, cramping pain in abdomen and abdominal distention.Increase fluids, add fiber to diet and excercise.
NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING INTERVENTION
Amoxicillin Prevents bacterial cell wall synthesis during replication.Bactericidal
Treatment of infections of respiratory tract, skin and skin structures, genitourinary tract, otitis media, meningitis, septicemia,sinusitis bacterial endocarditis prophylaxis.
Hypersensitivity to penicilin, cephalosphorins,or imipenem. Not used to treat severe pneumonia, empyema, bactemeria, pericarditis, meningitis and purulent or septic arthritis during acute stage.
Dizziness, fatigue, insomia, reversible hyperacidity, urticaria, maculopapular to exfoliative dermititis.
Obtain pt. history of allergy
Asses pt. for sign and symptoms of infection, wound characteristic, sputum, urine stool, fever and WBC count.
Monitor sign of nephrotoxicity: urine cast, oliguria, proteinuria, increase BUN
Monitor for bleeding, ecchymosis, bleeding gums, hematuria.
NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING INTERVENTION
Paracetamol Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation.
Relief of mild to moderate pain; treatment of fever.
Hypersensitivity, intolerance totertazine, alcohol, table sugar, saccharin.
Stimulation, dowsiness, nausea, vomiting, abdominal pain, hepatoxicity, hepatic seizure, renal failure.
asses pt. fever or pain, location, intensity, duration, temperature, diaphoresis.
Assess allergic reaction: rash, urticaria; if these occur, drug may have to be discontinued.
Monitor liver and renal function.,
Check input and output ratio.
Asses hepatoxicity.
NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING INTERVENTION
Vitamin C Needed for wound healing, collagen synthesis, antioxidant, carbohydrate metabolism, protein, lipid synthesis, prent infection.
Inhance body natural immune function.
asses pt. nurtitional status for inclusion of foods hign in vitamin C: citrus fruits.
Monitor input and output: polyuria
Monitor ascorbic acid levels throughout treatment..
Assess patient knowledge on drug therapy.
Chapter IV
Psychotherapies Implemented
1. Exercise Therapy
Description Goal Procedure/Activities Patient Role/Patient
Analysis
Role of the Nurse
Is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body.
. To teach the patient the some exercises.
2. To assess motor abilities of the patients.
3. To give simple instructions that the patient can follow.
4. Safety is the priority.
5. To promote wellness
Let have atleast one or two leader.
-Set a joyful and lively music with a beat.
-Let the client to follow the Steps.Caution: Remind the condition of the clients to consider
Patient follows the step and does the exercise.
I encourage her to do the exercise and assist her.
2. Dance Therapy
Description Goal Procedure/Activities Patient Role/Patient
Analysis
Role of the Nurse
The therapeutic use of movement to further the emotional, social, cognitive, and physical integration of the individual in the treatment of a variety of social, emotional, cognitive, and physical disorders.
To teach the patient the movements of the dance.2. To assess motor abilities of the patients.3. To give simple instructions that the patient can follow.4. Safety is the priority.
-Let atleast two to three students to lead the step in the song.
-Have a good choice of music it should be lively.
-Ensure the step must be applicable to the clients.
-Assure that most of the extremities will move.
The patient follows the dance step and cooperates well.
Wemake dance steps together with my classmates and teach them the steps.
3. Music and Arts Therapy
Description Goal Procedure/Activities Patient Role/Patient
Analysis
Role of the Nurse
It is an interpersonal process in which uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health.
1. Appreciate the music and put the feeling of the drawing.
2. Discuss and show the drawing.
3. Divert attention into something more productive.
1.Prepare all the material
2. Be sure that all materials are adequate.3. Gather all clients into one area.
4. Explain the purpose and procedure of the therapy.
5. Distribute materials.
6. Play music
7. Let the client to draw.
8. Inform clients to share the work later.
9. When drawing recognized client.
10. Repeat the music when needed.
The clients draw and share her drawing to everyone.
Provide drawing materials and explain again the procedure to the patient.
Listen to the sharing of patient’s drawing.
Appreciate patient’s sharing.
4. Bibliotherapy
Description Goal Procedure/Activities Patient Role/Patient Analysis
Role of the Nurse
Bibliotherapy is rendered with the use of a story with elaborate images to be helpful for the client to imagine the story.
1.To develop an individual self-concept
2. Increase understanding.
3. Foster an individual honest self-appraisal.
-Prepare a story with elaborate images.
-Arrange the sits of the client into a good setting: theatrical setting is more advisable.
-Story telling must be in form of monologue.
-Someone should introduce the story.
-At the end of the therapy the clients must share insights and thoughts about he story.
The patient can express their learning about the story the heard. And give insight and comments on the different situation on the story.
Arrange the chairs in semi circle for the patients
Listen to the learning’s of patients
Give appreciation or recognition.
5. Remotivation TherapyDescription Goal Procedure/Activities Patient
Role/Patient Analysis
Role of the Nurse
A therapy of very simple group therapyof an objective nature used in an effortto reach the unwounded areas of thepatient’s personality & get them
1. To stimulate patient to be fellow explorer of the real world.2. To develop the ability to communicate & share ideas & experience with other.
1 .Introduction
2. Ask any body what they can say about the drawing and if anybody see a forest.
3. Poem reading “ Kalikasan ating Pagingatan”
4. Evaluation and
The patient can able to site example and give comments on the poem, also to the drawing and give their learning’s.
Listen to patient’s sharing and give recognition.
movingback into the reality.
3. To develop feeling of acceptance &Recognition.
Summary.
6. Socialization
Description Goal Procedure/Activities Patient Role/Patient Analysis
Role of the Nurse
Is the primary means by which human infants begin to acquire the skills necessary to perform as a functioning member of their society, and is the most influential learning processes one can experience.
1. To develop cooperation.
2. Safety is prioritized.
3. To develop interaction with other patients.
4. To develop camaraderie with other schools.
1. Introduction
2. National anthem
3.Prayer
4Opening remarks
1. Exercises
6.Yell/ Cheer
7.Intermission numbers
8Games
9. Closing remarks
The patient enjoyed and participated in the games and activities.
The patient increases self confidence and cooperate.
Arrange chairs and prizes.
Assist patients in the games
Join patient in dancing.
Cleaning the place.
Chapter V
Nurse Patient Interaction
Day 1
Nurse Response Analysis of Nurse Response
Patient’s Response Analysis of Patient’s Response
“Hello Ma’am” Giving recognition “hello!(smile)” The patient response
through verbal by
saying hello and non
verbal communication
which is smiling, it
seems that she’s a
little bit shy to the
student nurse during
first interaction.
“ ako po si Gia
Borlongan, galling
pos a URC sa malolos
bulacan, ako po ang
inyong student nurse.
Kayo po maari niyo
po bang ibigay ang
inyong pangalan?”
Giving information
And
seeking information
“ ako si patient JD”
The patient responds
directly in the
question by stating
her name and with
smile on her face.
The patient can able
to answer the
question.
“Ilang taon na po
kayo?”
Seeking information “33 years old.” Patient answered the
question by stating
her age with
maintained eye
contact to the student
nurse.
“Kailan po ang Seeking Information “July 12, 1971” Patient answered the
birthday niyo?” question by stating
her birthday with
maintained eye
contact to the student
nurse. The patient was
oriented.
“Saan po kayo
nakatira?”
Seeking Information “Pasig, City” Patient answered the
question by stating
were she live.It seems
that she only
remember the place
where she grow up
because according to
the chart, the patient
live in Sorsogon, city.
“May asawa po ba
kayo?”
Seeking Information “Wala.” Patient answered the
nurse’s question
seriously with
maintained eyecontact
to the student nurse.
The patient answer
same on the data on
the chart.
“May kapatid po ba
kayo?”
Seeking Information “oo. Isa. Kuya ko ” Patient answered the
question directly and
stating the
relationship of the
person to her. The
patient still remember
her siblings.
“Alam ninyo po ba
kung anong araw at
oras ngayon?
Seeking Information “hindi ko alam eh!”
(yumuko)
Patient answered the
question with low
tone of voice,then
bow her head, it
seems that she’s feels
shy on her answer.
“ Ngayon po ay
huwebes, ika-17 ng
febrero 2011, at 11:15
na po ng umaga
Providing
information,
orientation
“ ah, ganun ba” Patient get oriented in
time and date, and
deeply listening to the
information given by
the student nurse .
“ anu po trabaho
ninyo dati”
Seeking Information “ Nagtrarabaho ako sa
pasig Plywood cutter,
tas sa Antipolo
nagtatangal ng mga
sobrang sinulid sa
damit mula lunes
hanggang biyernes,
7:00-7:00.parehong
oras at araw
Patient answer the
question with
irrelevent information
because it is
impossible that she
works as plywood
cutter at the same time
works in the garment
in same time and
days.
“Ilang taon na po
kayo dito sa NCMH?”
Seeking Information “ tatlong taon na” Patient answered the
question while
counting with the
used of her fingers.the
patient was thinking
before answering.
“Sino po nagdala sa
inyo dito?”
Seeking Information “yung tatay ko” Patients answered the
question by stating the
person who brought
her to NCMH with
sadness on her face. It
seems that she was
depress.
“ Alam ninyo po ba
kung bakit kayo
nadala dito?”
Asking relate
question, clarifying.
“hindi ko alam”.
(umiling)
The patient answered
the question by saying
she didn’t know and
non verbal
communication by
turning his head a
gesture that means she
doesn’t know the
answer.
“May gusto po ba
kayong sabihin sa
akin?”
Encouraging patient
to express feelings
“ gusto ko na umuwi
sa amin, miss ko na
nga sila, kelan ba ako
maaring umuwi?.
Patientanswered the
questioned by
expressing her
feelings of longing to
her family members
with sadness on her
face. Also seeking for
information about the
time were she can go
home.It seems that
she has strong desire
to go home, because
since the time she was
admitted in NCMH,
no one visited her.
“ anu daw po ba ang Asking and clarifying Sabi matagal pa daw, Patient answered the
sabi ng doctor at nurse
dito?
information through
the use of questioning
kasi nasa probinsya
daw sila, dito muna
daw ako. ( with teary
eye)
question by giving
details on what she
had been heard
explanation from
other health care
provider. While
telling this to the
student nurse it seems
that she want to cry.
“siguro po pag mabuti
na ang inyong
kalagayan, papayagan
na po kayo umuwi,
kamusta na po kayo?
Giving opinion and
seeking for
information
“okey naman ako,
ayos na ako matulog,
at iniinom ko naman
ang gamut ko.
Patient give detailed
information about her
condition, and she
explained to the
student nurse what
that she doesn’t
experiences
difficulties unlike
before .
Ma’am pakibigay po
ulit ang akin
pangalan, natatandaan
ninyo pa po ba?
testing if the patient
are oriented to the
person interacted,
clarifying previous in
interaction
“ikaw si Gia, student
nurse kita
Patient answered the
question with
smilling, and she was
able to remember the
student nurse name. It
seems that she can
recall the name of the
person she’s ineract
with.
“bukas po, may mga
therapy po tayong
gagawin,maaasahan
Giving information,
encouraging the
patient to join to the
Oo, sigeh(smile) Patient answered the
question through
smile and argees to
ko po ba ang inyong
paglahok?.
activities. cooperate in the
activities. It seems
that the patient was
interested with the
incoming activities.
“ bukas po ulit
ma’am, salamat pos a
pagbabahagi
impormasyonng
inyong sarili”
Thanking for the
information she
gathered.
(smile) Patient answeres
through non verbal
communication by
smiling and waving ,
it is a gesture saying
goodbye. The patient
also expecting the
student nurse in the
next exposure.
Day 2
Nurse Response Analysis of Nurse
Response
Patient’s Response Analysis of Patient’s
Response
“Hello Ma’am,
kamusta na po kayo?
Tanda ninyo po ba
ako?”
Giving recognition
and testing client if
she remember the
nurse
“ok naman!(smile).
Ikaw si gia”
The patient answered
the question with
smile and she’s also
stating the name of
the student nurse
which means that she
still remember the
student nurse. The
patient answered the
question correctly.
“ nagustuhan ninyo po seeking information “ oo, sumayaw nga The patient answered
ba ang mga activity
ngaun?
ako, tas nagdrawing
pa”
the question by sating
what sh’ve done on
the activity, It means
that there is
acceptance,
recognition and it
seems that she
enjoyed the activity.
“Ilang taon na po ulit
kayo?”
clarifying information “33 years old.” Patient answered the
nurse’s question same
as the previous
interaction in student
nurse with
maintained eye
contact.
“Kailan po ang
birthday niyo?”
clarifying Information “July 12, 1971” Patient answered the
nurse’s question same
as previous interaction
with maintained eye
contact to the student
nurse.
“Saan po kayo
nakatira?”
clarifying Information “Pasig, City” Patient answered the
nurse’s question same
as previous interaction
witha maintained eye
contact to the student
nurse.
“May asawa po ba
kayo?”
clarifying Information “Wala.”(yumuko) Patient answered the
nurse’s question same
as previous interaction
with maintained eye
contact to the student
nurse while having a
gesture of turning her
head side to side as a
sign that she doesn’t
have.
“May kapatid po ba
kayo?”
clarifying Information “oo. Isa.” Patient answered the
nurse’s question same
as previous interaction
with maintained eye
contact to the student
nurse.
“Ano po ang
pinakagustong
activity na ginawa?
Seeking Information “yung kwento ni
maria makiling!”
Patient answered the
nurse’s question in
interesting manner
with smile on her
face. It seems that she
really liked the story
in the activity.
“ bakit po? Asking the patient to
elaborate the answer
“ kasi iba yung pag-
iibigan nila ni gat
dula, tsaka yung
pagmamahal niya sa
magulang nya”
She answered the
question by giving the
qualities of the
character in the story
and also telling a part
of the story. It seems
that she can relate the
character of the story
to her qualities.
“anu pong paguugali
ni maria ang maaring
ihalintulad sa inyo”
Asking the patient to
relate it to herself
“ mapagmahal at
mapagalaga sa
magulang, maganda
pa
Patient answered the
question with smile
and giving her same
qualities base on the
qualities of the
character and her. It
seems that she can
relate on the qualities
of the character.
”may gusto pa po ba
kayong tauhan sa
kwento?
Seeking Information “ si gat dula, para
siyang si cocoy”
Patient answered the
question and giving
example of specific
person that she knows
that has the same
qualities to the
character of the story.
“Sino po si cocoy? Seeking Information “yung crush ko,
gwapo kasi un”
Patient providing
information about a
specific person that
she knows from the
past with smile on her
face .It seems that she
likes this person.
“ Nagkatuluyan po ba
kayo?
Asking information “hindi kasi pareho
kaming mahiyain,
piloto un.
Patient answered the
question, by stating
what happen to her
and to the person
involve.
“may gusto pa po ba
kayong ibahagi?
Encouraging patient
to express feelings
“yung tatay ko
katulad ng tatay ni
maria, pinapagalitan
din ako?.
Patient answer the
question in which she
relate the qualities of
the father to the
qualities of the
character in the story.
It seems she had
childhood experiences
where she
experienced
repremmanded by her
father.
“ baka naman po kayo
napapagalitan kasi
may mali po kayong
nagawa., madalas po
ba kayo
napapagalitan?
Giving opinion and
seeking for
information
“ oo ganun na
nga(smile)
Patient answered the
question with smile
and agreed to the
opinion of the student
nurse. It seems that
she approved to the
opinion of the student
nurse.
“nagustuhan ninyo
pop la lahat ng
activity, may gusto pa
ba kayong ibahagi?
Summarizing and
asking question.
Wala na Patient answered the
question and seems
she don’t want to
open another
conversation about the
topic.
Ako naman po ang
magtatanong, alam
ninyo po ba inyong
Seeking information “thorazine Patient answered the
question directly by
stating the name of
gamut? her drugs.this means
that she was aware on
the drugs she’s taking.
“ngayon po
nakakaranas pa po ba
kayo ng pagbulong?
Seeking information Oo, Patient
respond with the
question by stating
yes,which means she
was experienced
auditory hallucination.
Auditory
Hallucination was
under the categories
of positive symptoms
schizophrenia where
in Patient with
Undifferentiated
schizoprenia may
experience it
(Videbeck 2008).
“anu naman po ang
binubulong sa inyo”
Seeking information Sabi sabunutan ka
daw
Patient respond to the
question by stating
her auditory
hallucination. It seems
that she hallucination
symptoms are not yet
subsiding.
“ ano po ulit ang sabi? Clarifying
information
Hindi dati yun,
ngayon medyo
nawawaqla na
Patient answered the
question by trying to
cover up what she’s
been heard. It seems
that she withrawn it.
Silence silence Napapagod na ako
pwede na ba ako
pumasok
Patient Expresses
what she feel and she
want to go back in the
ward. It seems that it
is her way to escape
reality that she had
auditory hallucination.
O sige po respond to the patient
question
Smile Patient respond with
nonverbal
communication by
means of smiling.
Day4
Nurse Response Analysis of Nurse
Response
Patient’s Response Analysis of Patient’s
Response
“Hello Ma’am,
kamusta na po
kayo?.tanda ninyo po
ba ako?”
Giving recognition
and testing client if
she remember the
nurse
“ok naman!(smile).
Ikaw si gia”
The patient answered
the question with
smile and recall what
the name of her
student nurse. The
patient can still
remember the student
nurse. It seems that
the student nurse
established rapport
well.
“ may socialization po Giving information “ oo, sigeh, may Patient agrees to the
tayo ngaun, sana po
makilahok kayo sa
mga laro
and encouraging to
join to the activity.
sayaw ba dun?” suggestion and asked
information with
interesting manner by
knowing what
activities she may
cooperates and she
also smiles.It seems
that she was excited
on upcoming
activities.
“ Nagenjoy po ba
kayo sa socialization?
seeking information “oo Patient answered the n
question directly
about what she feel on
the activity. It seems
that she enjoyed the
activity well.
“Kailan po ang
birthday niyo?”
clarifying Information “July 12, 1971” Patient answered the
nurse’s question same
as previous interaction
she had a week
before. The patient
answered it correctly
“Saan po kayo
nakatira?”
clarifying Information “Pasig, City” Patient answered the
nurse’s question same
as previous interaction
a week before with
maintained eye
contact on the student
nurse.
“May asawa po ba
kayo?”
clarifying Information “meron.” Patient answered the
nurse’s question
different from the
previous interaction
because previously
she tells she had no
husband with smile on
her face. It seems that
she experiencing
delusion.
“May kapatid po ba
kayo?”
clarifying Information “oo. Isa.” Patient answered the
nurse’s question same
as previous interaction
with maintained eye
contact on the student
nurse.
“anu po pangalan ng
asawa ninyo ?
Seeking Information “cocoy!” Patient answered the
nurse’s question with
the smile and giving
the name of the
person she talking
about.
“ Di ba po sabi ninyo
wala kayong asawa?
clarifying Information “ meron, tatlo nga
anak namin eh.
Answered question
with explanation, and
giving information
about the person. The
patient answer was
new to the student
nurse, she had
different answer on
the previous
ineraction.
“anu po mga pangalan
ng anak ninyo?”
seeking information “ joan, anna, miguel Patient aswered the
question with smile
and stating the name
of the sibling she
had.This is part of her
delusions because she
had no children.
”ilan taon na sila? Seeking Information “di ko alm eh, piloto
si cocoy,”
Patient answer the
question with light of
ideas, the answer was
not connected to each
other. Because the
question of student
nurse was focused on
the children she
answered it is
irrelevant to the
question.
“kasal nap o ba kayo
ni cocoy?
Seeking Information “hindi, di ko alm kung
nasaan sya.”
Patient answer the
question with Flight
of ideas, it is not
related to each other
with maintained eye
contact. flight of ideas
where in there is a
overproductivity of
talk and verbal
thinking skipping
from one idea to
another(shives,2008).
It is sign of disturbed
thought process.
“ Ito po ang huling
araw naming dito, ako
po’y lubos na
nagpapasalamat at
nagbahagi kayo sa
akin.
thanksgiving “salamat din sa mga
natutunan ko, alam ko
na kailanagn maglinis
ng katawan lagi at
salamat kasi
nabubusog ako
Giving thanks, and
expressing what she
learned from the
student nurse with
smile on her face and
shaking hand with her
, a gesture of thanks
giving and saying
goodbye.
Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONObjective Data:
-Patient wears dirty ward gown and without slippers
-bad breath
-patient has foul odor
Self care deficit related to poor personal hygiene.
After Nursing exposure the patient will be able to:
a. Participate in self care activities
b. Demonstrate independence
2. Explain task in short simple manner.
3. Allow patient sufficient time to complete any task.
4. Remain with the client throughout the task: do not attempt to hurry the client
5. Gradually withdraw assistant and supervision to the patient grooming and other self care skills.
-A complex task will be easier for the client it is broken down into series of steps.
-It may take longer to complete task because of lack of concentration and short attention span.
-trying to rush the patient will frustrate him/her and make completion of the task impossible.
It is important for the client to gain independence as soon as possible.
After the exposure the patient able to :
a. Participated in self care activities.
b. Can able to perform self care activities on her own
Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONSubjective Data:
“Hindi ko alm kung anung oras na o anung araw na ngayon, kanina sinabi nung nurse pero di ko na maalala ” as verbalized by the patient
“Sabi daw niya sabutan daw po kita” as verbalized by the patient
Disturbed thought process related to auditory hallucination, disoriented in time and date.
After Nursing exposure the patient will be able to:
a. Oriented in time and date.
b. Present into reality.
1. Reorienting the patient.
2. Continue therapeutic nurse-patient alliance.
3. Use short simple directions and explanation.
-help patient maintain her level of orientation; increase her ability to become more oriented.
- It promoted and strengthens trust between the patient and nurse.
-It increases patient ability to understand and follow.
After the exposure the patient able to :
a. Can state the right time and date.
b. Presented into reality
Chapter VI
Journal
Day 1: February 17, 2011
At first I feel combination of nervous and excitement because I don’t know what type of
client I will handle. I don’t know what kind of approach I will give to be able to gain rapport and
I feel also shock to the kind of environment they were staying because I’m expecting it was like
ward I was seen in the movie. I learned that in interacting them to gain rapport we should not
force to answer all our question and we need to ask them little by little, because it is not easy for
them to open up especially like us stranger or newly met, and there are lots of painful of
experience they encounter, and that their emotional coping mechanism was not that stable. I also
learned that I’m blessed because I have my family to support me in times of problem that can
help me to cope. I also feel lucky that I’m not craving for food like them and I was in good
condition. As a future nurse someday I learned that in handling patient during initial interaction
we should maintain eye contact, let the patient feel that you are not harmful to them that you can
lend your ears to hear their feelings and lastly face them with optimism appearance even though
they had poor hygiene. And it is nice to know and hear about different qualities I didn’t found to
myself that other could see it.
Day 2: February 18, 20011
On the second day of the exposure I’m quite comfortable to the place, first we arrange
the table and the chairs that we’ve been using for the different therapy. At first we do the routine
of patient hygiene, exercise, dance therapy where I know I discovered my dancing talent and
think simple step in a short time, music and arts and bibliography. I’m gently listening to their
sharing about the learning and the meaning of the drawing they draw and I’ve learned that partly
the activity or the therapy they connected it to the previous experience they have. During the
patient inter action I was shocked when my patient tell me about her auditory hallucination “ sabi
daw sabunutan kita” then I stop talking but maintaining my eye contact to her then I asked
clarification question like “anu po ulit yung naririnig ninyo?” then she said “wag ka mag-alala di
ko na sila pinapansin” and I learned that it is nice to help the client express her feelings and be
calm enough to interact to them even if you are afraid about what they are saying.
Day 3: February 23, 2011
This was the third day of the duty; we are all excited for the Ms. Valentine pageant, we
are tasked to design the sash that been using at the pageant, I know in this simple tasked I used
again my artistic talent in designing the sash. In this duty we all witness the talent and question
and answer portion. I can say that by this type of motivation it helps the client to gain their
confidence and boost their talent. They touched my heart about the question and answer
especially when they were given the time to give thanks to the audience, I can see their hope and
their happiness in their eyes. I learned also only their mind can betray them but on the other side
of it their hope and feelings that they want to be free from their disease.
Day 4: February 24, 2011
This was the last day of the exposure. The grand socialization, we are all busy preparing
in this day. And the very good thing I established camaraderie to other student nurse from the
different school. The greatest learning I’ve learned about is the talk of our C. I that socialization
is not intended only for the residents but also to the student as well, so that they know how to
mingle to others, how to give and take knowledge and strategies, it is not about completion about
other schools but learning how to interact with them. I realized from this that our group may be
together now but after we are graduated and pass the board exam we go different way and it is
better to practice camaraderie not only to our group because we did established it but to others
also, because some point in time we may cross our path and be my co- health workers in the
future. After the socialization we have is interaction to the patient, I’m glad to know that even in
a short time my patient can know my name even without looking at my name tag. And it is nice
to know that she learned something on me, me as well.
Appendices
Definition of terms
Definition of terms
Automatism - repeated purposeless behaviors often indicative of anxiety, such as
drumming fingers, twisting locks of hair, or tapping the foot.
Psychomotor Retardation - overall slowed movements.
Waxy Flexibility - maintenance of posture or position over time even when it is awkward
or uncomfortable.
Delusion - a fixed false belief not based in reality.
Hallucination - false sensory perception or perceptual experiences that do not really
exist.
Flat Affect - showing no facial expression.
Echolalia - the client’s imitation or repetition of what the nurse says.
Compulsion - ritualistic or repetitive behaviors or mental acts that a person carries out
continuously in an attempt to neutralize anxiety.
Echopraxia - imitation of the movements and gestures of someone an individual is
observing.
Cataplexy - is a sudden and transient episode of loss of muscle tone, often triggered by
emotions.
Catalepsy - is a nervous condition characterized by muscular rigidity and fixity
of posture regardless of external stimuli, as well as decreased sensitivity to pain.
Catatonic Stupor - is a motionless, apathetic state in which one is oblivious or does not
react to external stimuli.
Catatonic excitement - is a state of constant purposeless agitation and excitation.
Individuals in this state are extremely hyperactive, although, as aforementioned, the
activity seems to lack purpose.
Choreiform movement - is characterized by repetitive and rapid, jerky, involuntary
movements that appear to be well-coordinated, but are rather performed involuntarily by
the patient afflicted with such a disorder.
Impulsiveness - is a personality trait characterized by the inclination of an individual to
initiate behavior without adequate forethought as to the consequences of their actions,
acting on the spur of the moment.
Regression - a defensive reaction to some unaccepted impulses.
Suppression - is the process of deliberately trying to stop thinking about certain thoughts.
Euphoria - is the process of deliberately trying to stop thinking about certain thoughts.
Blunting - lack of emotional reactivity on the part of an individual. It is manifest as a
failure to express feelings either verbally or non-verbally, even when talking about issues
that would normally be expected to engage the emotions.
Depersonalization - is a malfunction or anomaly of the mechanism by which an
individual has self-awareness.
Word Salad - flow of unconnected words that convey no meaning to the listener.
Neologism- invented words that have meaning only for the client.
Phobia - an illogical, intense, and persistent fear of specific object or social situation that
causes extreme distress and interferes with normal functioning.
Aphasia - deterioration of language function.
Mutism - is a speaking disorder in which a person, most often a child, who is normally
capable of speech, is unable to speak in given situations, or to specific people.
Patient output
The patient drew a house using the color blue which indicates severe depression. Using
the blue color, she also drew a human stick that she labeled as Cinderella. Using the same color,
she drew two cats and two kids playing piko. Around and in between the pictures she had drawn,
she had shade it with the color violet which reflects depression, she also used that color to write
her name at the top of the paper. As the drawing specifies, the patient reminisces the past
especially her childhood. From all her experiences, she insisted that she was only 33 years old
but in reality she is already 39 years old.
Bibliography
Sadock M.D et. al (2007). Synopsis of Psychiatry. Lipprincott& Williams.United State of
America.
Kelther N.(2007). Psychiatric Nursing( 5th ed). Elvevier Piecta. Singapore.
Kaufman (2006). Essentials of Abnormal Psychology. John Wiley& Sons Inc. United
State of America.
Videbeck, S. L. (2008). Psychiatric Mental Health Nursing. (5th ed). Wolters Kluwer
Health.
Shives, L. R. (2008). Psychiatric Mental Health Nursing. (7th ed). Lippincott Williams &
Wilkins.
Kennedy P. (2008) Psychiatric Mental Health Nursing. Jones and Barlett Publishers, Inc.
United State of America.
Internet sources:
http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed
&utm_medium=twitter
http://www.nursingscrib.com
http://psychopathology.wikispaces.com/Schizophrenia
University of Regina Carmeli
Catmon, City of Malolos
College of Allied Medical Sciences
In PartialL Fulfillment in NCM 105 RLE
PSYCHIATRIC CASE STUDY
Submitted to:
Mrs. Perlita Espinoza
Submitted by:
Borlongan, Gia Pauline A.
BSN3