combined na tanan!

Introduction

Paranoid schizophrenia is one of several types of schizophrenia, a mental illness

in which tends to experience persecutory or grandiose delusions and auditory

hallucination and also may exhibit behavioral changes such as anger, hostility or violent

behavior. Ability to think and function in daily life may be better in paranoid

schizophrenia compare to other type of schizophrenia. Still, it’s a serious lifelong

condition that can lead to many complications, including suicidal behavior.

Affect is usually less blunted than in other varieties of schizophrenia, but a minor

degree of incongruity is common, as are mood disturbances such as irritability, sudden

anger, fearfulness, and suspicion. "Negative" symptoms such as blunting of affect and

impaired volition are often present but do not dominate the clinical picture.

The onset of schizophrenia in men is usually in the teens or 20s. The onset in

women is usually in the 20’s or early 30’s. Paranoid schizophrenia tends to appear toward

the the later end of this range. (Another life Foundation, Colorado Springs, Colorado,

(719)).

Some scientists believe p aranoia may be a reaction to high levels of life stress.

Leading support to this opinion is the evidence that paranoia is more prevalent among

immigrants, prisonersof war and other undergoing severe stress.

(www.nexusbooks.net/health/paranoia3).

Its is believed to be widespread with world life prevalence rates estimated to be at

0.2% to 1.5% of the general population, meaning approximately 1% of the population

develop schizophrenia during their lives, with men and women being equally affected

(Jablensky, 1995). Clients with schizophrenia are at high risk for suicide. Approximately

10-15% of those with schizophrenia commit suicide: 50% attempt suide at least once.

These suicides rates can be compared to the general population, which is somewhere

around 0.01%. Approximately 20-30% of clients with schizophrenia, however, can lead

1

http://www.nexusbooks.net/health/paranoia3

somewhat normal lives. Another 20-30% continue to have moderate symptoms where as

the illness significantly impairs 40-60%.

The Philippines is one of the world’s most heavily populated countries. A high

level of poverty still exists and malnutrition and communicable diseases continue to be

the main cause of morbidity. The public health impact of mental illness lays in the fact

that it can cause disability for prolonged periods. In a disability survey by the National

Statistics Office in 2000, it was found that rate of Schizophrenia in the Philippines was 88

cases per 100,000 population in 2000. The region with the highest prevalence rate of

schizophrenia is Southern Tagalog at 132.9 cases per 100,000 population, followed by

NCR at 130.8 per 100,000 population and Central Luzon at 88.2 per 100,000 population.

In choosing this Case Study, a criterion was made with some defining points to

meet. One of which would be the consent or the willingness of the patient as well as the

patient’s family which would facilitate collaborative efforts of the group and patient.

Second would be the accessibility of the informants as well as their validity and

residence of the patient, the cooperation of these informants would prove to be of utmost

help for the reason that there statements would be taken into account for the researchers

to make a comprehensive picture of the course of the patients illness.

The patient’s age would constitute part of the criteria for which the consideration

of the patient’s development stage would be anchored on for us to envision what the

patient’s life was before the onset of the disorder.

2

OBJECTIVES OF THE STUDY

GENERAL:

The Primary goal of this Case Study is to achieve deeper understanding about the

nature of the case, to help the readers and future researchers know regarding the

medical and nursing management of patients with schizophrenia, paranoid type.

SPECIFIC OBJECTIVES:

•Extended our deepest appreciation on those people who contributed in the

completion of this case presentation.

•We will make an introductory statement about the schizophrenia paranoid type

and the case study.

•We will define the various terms used in the case study.

•We will gather necessary information about the patient from her immediate

family, friends and neighbors;

•We will conduct and present the mental status examination of the patient as well

as his capacity to relate and communicate with student nurses;

•We will identify the predisposing and precipitating factors that contribute to the

condition of the patient;

•We will be able to trace the psychodynamics of the case and relate it with Erik

Erikson’s theory of growth and development;

•We will define in our case presentation the psychiatric management needed by

3

the patient;

•We will present a drug study on all medications given to our patient in the case

study;

•We will formulate the appropriate and effective nursing care plans on the

identified problems experience by the patient;

•We will justify the possible prognosis of the patient on the case;

4

DEFINITION OF TERMS

Schizophrenia - a disease affecting the brain that causes distorted and bizarre thoughts,

perceptions, emotions, movements, and behavior.

Hallucinations- false sensory perceptions or perceptual experiences that do not exist in

reality.

Delusions- fixed false beliefs no basis in reality.

Apathy- feelings of indifference toward people, activities, events.

Affect-a person’s mood, feelings, or tone observable as an outward manifestation. Often

referred to as emotion. Affect may be referred to as inappropriate, flat or blunted.

Flat Affect- absence of any facial expression that would indicate emotions bsence of any

facial expression that would indicate emotions or mood.

Blunted Affect - restricted range of emotional feeling tone,or mood.

Inappropriate affect- inconsistency between expression and mood.

Flight of ideas- continuous flow of verbalization in which the person jumps rapidly from

one topic to another.

Associative looseness- fragmented or poorly related thoughts or ideas.

Denial- unconscious refusal to face thoughts,feelings,wishes,needs,or reality factors that

are consciously intolerable.

5

Depression- a mood state characterized by a feeling of

sadness,dejection,despair,discouragement,or hopelessness.

Psychosis-is a disorder in which a person displays more positive signs of

delusions,hallucinations,

Mananabang – a person who is not licensed and has no formal education who aids in

giving birth to a mother

Mananguete – a person who makes vinegar out from coconut juice and disordered

thinking.

Mania - is a severe medical condition characterized by extremely elevated mood, energy,

unusual thought patterns and sometimes psychosis.

Paranoia - is a thought process characterized by excessive anxiety or fear, often to the

point of irrationalityS and delusion.

6

http://en.wikipedia.org/wiki/Mood

IDENTIFICATION OF THE CASE

Patient’s Code Name: Ruby

Age: 42 years old

Sex: Female

Birth date: February 27, 1968

Birth Place: Island Garden City of Samal

Address: Talamo, Davao City

Nationality: Filipino

Civil Status: Single

Occupation: None

First Admission: 1997 at a Psychiatric institution in Mandaluyong due to

change in behavior

Second Admission: 1997 at Davao Mental Hospital due to her violent act

towards others

Third Admission: 2000 at Davao Mental Hospital due to her violent act

towards her mother

Fourth Admission: 2003 at Davao Mental Hospital due to violent act towards

others

Fifth Admission: July 20, 2010

Reason of Admission: Threat to the community

Date of Discharge: July 23, 2010

Admitting Diagnosis: Schizophrenia Paranoid Type

7

Final Diagnosis: None

Attending Physician: Paulo Woodruff A. Gonzales, MD

Date Study Begun: July 21, 2010

Date Study Ended: July 23, 2010

Time Spent in Actual Nursing Care: 3 hours

Time Spent in Home Visit: 2 hours

Source of Information / Informant: Primary source: Ruby

Patient’s Chart

Secondary Sources: Mother

Brother

Neighbors

Previous Co-workers

Previous employer

8

ANAMNESIS

Informant # 1

Name: Mother Lily

Age: 68 years old

Address: Talomo, Davao City

Relationship to the patient: Mother

Length of time known to patient: 42years

Personal Background of Informant and Apparent understanding of present illness of

patient:

Mother Lily was 68 years old, widowed for about 8 years and is the one who took care of

her children, 6 boys and two girls. She was from Samar City where Mr. M and she met. She

worked at Stanfilco when Ruby was working in Manila, but now she is a plain housewife.

On July 23, 2010, Mother Lily verbalized “ Buotan man siya pagkabata, permi niya

kadula iyang manghud na babae. Bright pud na siya, pag abot sa balay human kaon magstudy

dayon na siya. Makakuha pud na siya ug award or honor gikan sa elementary hantod highschool.

Katong nag second year highschool na siya, 15 years old siya ato, wala na siya ganahi

magskwela kay gina sungog na siya sa iyang mga classmate kay tungod nag cratches na siya ato

kay nabaril man iyang tuo na tiil. Ginasaway siya sa iyang mga classmate ug “piang”. Sukad ato

niadto ug Manila. Pag adto niya ug Manila, nagtrabaho siya didto as katabang tapos gipaskwela

9

pud siya sa iyang amo pero wala siya ka human. Taga bulan naga padala siya ug kwarta. Isa ka

adlaw, nakabalo si Ruby na ang iyang ginapadala na kwarta kay ang silingan makadawat tapos

ang mahatag na kwarta sa iyang pamilya kay gamay na lang. Sukad ato, nakita na lang siya sa

iyang amo na nga yaw-yaw ug istorya sa iyang sarili. Tapos gi admit siya sa Mandaluyong

Hospital.

Other characteristics and attitude of the informant:

Mother Lily was an accommodating person, she welcome us warmly. She is attentive and

responsive during the interaction. She showed enthusiasm and willingness to share her

daughter’s information despite the sensitivity of the issue being discussed and allowed us to

conduct an interview.

10

Informant # 2

Name: Silver

Age: 29 years old


Relationship to the patient: Brother

Length of time known to patient: 29 years


patient:

Silver is the youngest among the 8 children. He was 29 years old and single. He is

working as a tricycle driver and the bread winner of the family in replace of Ruby. He provided

their basic needs as well as the medications of Ruby. According to him, “Nagtawag iyang amo

diri ingon lahi na daw siya didto ug batasan mao gipauli siya, gisundo namo siya sa airport siya

lang man isa nag-uli. Sukad ato dili siya ganahan na walay ginauhat sa balay mao nang nangita

siya ug pama-agi na maka-kwarta. Nagtrabaho siya sa factory sa Mango juice sa Toril, 4 months

lang siya didto kay naglahi naman pud daw iyang batasan. Katong mga niaging adlaw, boutan pa

man to siya ginatabangan pa man gain niya si mama pero karon awayon na niya. Nigrabe na pud

iyang batasan kay wala naman siya ka inom ug tambal.

11


He is approachable and responds attentively to the questions that were asked. He also

provides whatever information related to his sister.

12

Informant # 3

Name: Gold

Age: 32 years old


Relationship to the patient: Brother



patient:

Gold is 32 years old, single and do not have work. He is the one who accompanied and

took good care of Ruby inside the CIU. According to him, “Katong gisundo namo siya ni Silver

sa Airport, ok pa man siya ato. Maistorya pa man siya. Tapos niagi ang isa ki simana natingala

nalang mi na nag bag-o na siya. Mag yaw-yaw nalang siya ug kalit tapos manakit napud siya.

Didto na pud nag sugod na naga pangluwa siya. Naay time na nag prepare ug pagkaon ako mama

tapos iyang gipang luwaan ang pagkaon. Siya na ang nag prepare sa iyang sariling pagkaon. Naa

pud time na napasakitan nako siya kay sobra na kayo iya ginapanghimo”.

13


He is approachable, talkative and responsive. He is also very defensive and secretive. He

shows willingness in answering the questions.

Informant # 4

Name: Sugar

Age: 26 years old


Relationship to the patient: Neighbor


Personal background of the informant and apparent understanding of the patient’s present

illness:

On July 23, 2010 Sugar verbalized, “Pag abot nako diri ing-ana na siya, sige siya ug yaw-

yaw bahin sa kwarta. Gikuha man to siya sa 911, mga pagka human ug paniudto buntis kay wala

siya gipasakay sa jeep na gina driban sa bana sa buntis. Unya sige pa jud daw ug katawa mao to

g atangan siya pag pauli gikan nag pa prenatal.

Other Characteristics and attitude of the informant:

14

She was attentive and responsive during conducting an interview, she was willing to

impart the things she knew about the patient.

Informant # 5

Name: Honey bee

Age: 21 years old





illness:

On July 23, 2010 Honeybee verbalized,” Sukad adtong nag kabo-ut ko naa na siya gamay

(exhibits behavioral changes) pero dili pa ing ana ka grabe, mastorya pa siya ug tarong pero dili

jud na siya gapangamigo ug lalake sukad sukad. Katong gikan siya ug manila na lahi na man siya

labi na ang iya batasan, naa gani to siya gi luwa-an na engineer sa amo kalsada. Tapos gapang

gukod na siya, mag lakaw lakaw tapos sige ug sulti na gi baboy daw siya sa mga lalake”.

15


He was cooperative and willing to answer questions that were asked.

Informant # 6

Name: Milky

Age: 45 years old





illness:

On July 23, 2010 Milky verbalized, “ Sukad pag ka bata boutan mana siya wala jud na

siya libog na pag ka tao pero di jud pud na siya gadoul- duol ug lalake. Pirmi ra na siya naa sa

ila balay gapanglimpyo sa silong ug sige ug tabang sa iya mama. Daghan mana siya ug

pangandoy sauna tungod pud siguro sa amo kalisud diri. Kanang ilang balay mas okey na na

karon kay sa sauna kay katumpagon jud na ba. Pero katong ga sugod na siya ug kalahi ang

batasan na gapangaway na, ginakulata mana siya sa iya mga igsoon na lalake labaw na si Gold

mao na siguro na samot ug ka boang si Ruby. Mahadlok mana siya sa iya mga igsoon nga lalake.

pag naa gani makita si Ruby nga galingkud dira dapit sa ilang payag-payag iya jud nang yab-an

ug tubig. Galakaw lakaw na siya gadala ug kutsilyo sa iya kilid tapos naa pa gani to panahon na

16

iya gi dunggab si Silver sa may kilid. Pero mayo mana siya ba pag maka inum o makapa

injection siya sa iya tambal. Malouy man ko sa ila kay halos wala gani na sila pang palit ug

pagkaon mao nang nabuang pud siguro na si Ruby, pampalit pa kaha ug tambal? Mao na sige ug

balik-balik iya sakit.


She felt sorry for what happen to the patient, she was helpful with the cooperation she has

given during the acquiring of information about the patient and her past experiences.

17

Name Age Address Relation to patient

Length of time known to patient

Apparent understanding of the present illness

Characteristics of the informant

Mother Lily

68 years old

Talomo, Davao City

Mother 42 years Informant: “Sukad niadto

siya ug Manila, nagtrabaho

siya didto as katabang tapos

gipaskwela pud siya sa iyang

amo pero wala siya ka

human. Taga bulan naga

padala siya ug kwarta. Isa ka

adlaw, nakabalo si Ruby na

ang iyang ginapadala na

kwarta kay ang silingan

makadawat tapos ang

mahatag na kwarta sa iyang

pamilya kay gamay na lang.

Sukad ato, nakita na lang

siya sa iyang amo na nga

yaw-yaw ug istorya sa iyang

sarili. Tapos gi admit siya sa

Mandaluyong Hospital.

The informant was an

accommodating person,

she welcome us warmly.

She is attentive and

responsive during the

interaction. She showed

enthusiasm and

willingness to share her

daughter’s information

despite the sensitivity of

the issue being discussed

and allowed us to

conduct an interview.

INFORMANTS DATA

18





Silver 29 years old

Talomo, Davao City

Brother 29 years Informant: “Nagtawag iyang

amo diri ingon lahi na daw siya

didto ug batasan mao gipauli

siya, gisundo namo siya sa

airport siya lang man isa nag-

uli. Sukad ato dili siya ganahan

na walay ginauhat sa balay

mao nang nangita siya ug

pama-agi na maka-kwarta.

Nagtrabaho siya sa factory sa

Mango juice sa Toril, 4 months

lang siya didto kay naglahi

naman pud daw iyang batasan.

Katong mga niaging adlaw,

boutan pa man to siya

ginatabangan pa man gain niya

si mama pero karon awayon na

niya. Nigrabe na pud iyang

batasan kay wala naman siya

ka inom ug tambal.

The informant is

approachable and responds

attentively to the questions

that were asked. He also

provides whatever

information related to his

sister.

19

Name Age AddressR Relation to Patient



Characteristic of the Informant

Gold 32 years old

Talomo, Davao City

Brother 32 years Informant: “Katong gisundo

namo siya ni Silver sa Airport,

ok pa man siya ato. Maistorya

pa man siya. Tapos niagi ang

isa ki simana natingala nalang

mi na nag bag-o na siya. Mag

yaw-yaw nalang siya ug kalit

tapos manakit napud siya.

Didto na pud nag sugod na

naga pangluwa siya. Naay time

na nag prepare ug pagkaon ako

mama tapos iyang gipang

luwaan ang pagkaon. Siya na

ang nag prepare sa iyang

sariling pagkaon. Naa pud time

na napasakitan nako siya kay

sobra na kayo iya

ginapanghimo”.

The informant is

approachable, talkative and

responsive. He is also very

defensive and secretive. He

shows willingness in

answering the questions.

20


Length of time known to Patient

Apparent understanding of the illness

Characteristics of the

informant

Sugar 26 years old

Talomo, Davao

City

Neighbor 2 years Informant verbalized,

“Pag abot nako diri ing-

ana na siya, sige siya ug

yaw-yaw bahin sa kwarta.

Gikuha man to siya sa

911, mga pagka human ug

paniudto kay gigukod niya

ang among silingan na

buntis kay wala siya

gipasakay sa jeep na gina

driban sa bana sa buntis.

Unya sige pa jud daw ug

katawa mao to g atangan

siya pag pauli gikan nag

pa prenatal”.

The informant

was attentive and

responsive

during

conducting an

interview, she

was willing to

impart the things

she knew about

the patient.

22




Characteristics of the

informant

Honeybee 21 years old

Talomo, Davao

City

Neighbor 15 years Informant verbalized,”

Sukad adtong nag kabo-ut

ko naa na siya gamay

(exhibits behavioral

changes) pero dili pa ing

ana ka grabe, mastorya pa

siya ug tarong pero dili jud

na siya gapangamigo ug

lalake sukad sukad. Katong

gikan siya ug manila na

lahi na man siya labi na ang

iya batasan, naa gani to

siya gi luwa-an na engineer

sa amo kalsada. Tapos

gapang gukod na siya, mag

lakaw lakaw tapos sige ug

sulti na gi baboy daw siya

sa mga lalake”.

The informant

was cooperative

and willing to

answer questions

that were asked.

23





Milky 45 years old Talomo, Davao City Neighbor 42 years Informant

verbalized, “…

katong ga sugod

na siya ug kalahi

ang batasan na

gapangaway na,

ginakulata mana

siya sa iya mga

igsoon na lalake

labaw na si -----

mao na siguro na

samot ug ka

boang si Ruby.

Mahadlok mana

siya sa iya mga

igsoon nga

lalake. pag naa

gani makita si

The informant felt

sorry for what

happen to the

patient, she was

helpful with the

cooperation she

has given during

the acquiring of

information about

the patient and

her past

experiences.

25

Ruby nga

galingkud dira

dapit sa ilang

payag-payag iya

jud nang yab-an

ug tubig.

Galakaw lakaw

na siya gadala ug

kutsilyo sa iya

kilid tapos naa

pa gani to

panahon na iya

gi dunggab

si------ sa may

kilid. Pero mayo

mana siya ba pag

maka inum o

makapa injection

siya sa iya

tambal…”

26

GENOGRAM

PATERNAL MATERNAL

27

Mr. M

Carlo Bruno

Charice

Mother Lily

GARNET

GEM GOLD

LEGEND:

Male Arthritis

Female Mental Illness

Deceased

AMETHYST

TOPAZ SILVER

Yuri

Yen

Leah Jeny Nina

Mae

Jericho

Iyaz

Cristine

RUBY DIAMOND

FAMILY HISTORY

Paternal Grand Lineage

The group was not able to get the information about the patient’s grandfather

because the family could not remember any information with regards to their grandfather

because they had have not seen their grandfather even before. Additionally, the patient’s

family mentioned that there was no mental disorder in relation to their grandfathers’ side.

Maternal Grand Lineage

Mother Lily came from a broken family and was the only child of White and

Peach. Mother lily also claimed that her parents had other children with different

partners. In addition, mother lily said that her mother –in –law (violet) had a history of

mental illness. Other than that, there is no history of delinquency, addiction, suicide,

dependency, chronic unemployment and other traits on inefficiency in their family,

according to Mother Lily.

Father

According to his wife, Mother Lily, Mr. M had a live-in partner before they met

each other. Nevertheless, they separated so he went to Samar for vacation. Mother Lily’s

cousin stayed at Mr. M’s house. Mr. M was 21 years old then, and Mother Lily was still

14 years old. Mr. M had not courted her, but instead, he went to her parents and asked

28

them to let her marry him. Mr. M married her and after two years, they were blessed with

a baby boy and were blessed with seven more after succeeding years. In addition, Mr. M

was born on January 07, 1937, as he was described by his wife, Mother Lily, he was a

responsible husband and a womanizer but still able to provide what his family’s basic

needs. He is also a disciplinarian father and got along with his friends and he would

socialize through alcohol drinking. When it comes to his educational attainment, Mr. M

only reached grade 6 due to financial constraint. He worked as a carpenter and a

“mananguete” as his source of income and earns enough money to suffice their basic

needs. Furthermore, Mr. M died at the age of 65 years old due to complications that they

cannot specify. As Mother Lily had verbalized, her daughter ruby was not able to accept

her father’s death.

Mother

Mother Lily is 68 years old and was born at Davao City and reached only 2nd year

high school. She came from a socially – deprived community and they were 3 siblings

in the family, one girl and two boys. Accroding to her, she had cared for her children

since they were young until they grew up. She did not let anyone attend to her children

but herself. She never laid a hand over her children instead she just talked to them when

committing any mistakes. Before she worked in Stanfilco a factory that processes banana

products but now she is a plain housewife and dependent to the income of her daughter.

She also said that she had a good relationship with her husband and children; whenever

thay had a conflict she would just keep quiet and never argue with them.

29

Siblings

They were 8 siblings in the family. The eldest is Garnet, male, 44 years old.

Currently living in Mati, Davao Oriental. Second is Ruby, 42 years old, attained 1 st year

high school only at Andres Bonifacio Talomo, Davao City. Third is Amethyst, male, 40

years old. Fourth is Diamond, female, 38 years old. Fifth is Gem, male, 36 years old.

Sixth is Topaz, male, 34 years old, he was a Pastor. Seventh is Gold, male, single, 32

years old. And lastly is Silver, male, single, 29 years old, he is a tricycle driver.

According to Mother Lily, when they were young, Ruby was much closed to her

younger sister Diamond. There were also times that Ruby and her brother had a conflict

but settled afterwards.

At present, Ruby is the bread winner in the family. She was able to sustain the

financial needs of her family by working as a housekeeper in Manila. According to Ruby,

her siblings were her inspirations in life to strive more because she wanted them to finish

their studies, according to Silver. However, due to high aspiration in life, she was

pressured because of her small minimum wage by that she can’t able to continue

supporting her family. When it comes to social aspect, she is a non-smoker, non-alcoholic

drinker. Furthermore, the siblings had good relationship with each other. Each of them

helped one another to provide their needs and during times of problem.

30

PERSONAL HISTORY

Pre-natal

Mother Lily said that she did not think of her pregnancy with Ruby as a problem.

During the prenatal period, Mother Lily was not able to have a medical prenatal check up

throughout her pregnancy but instead she went to “binisaya” or quack doctors because of

their tradition and beliefs. During her first and second pregnancy, the only foods that she

usually eats are; egg, meat, dried fish and canned goods. Sometimes, she rather prefers

biscuit and soda as her breakfast. She denied that those unhealthy eating habits might

have influenced the growing fetus. In addition, she only stayed at home during pregnancy

and never went anywhere. According to her, she has no history of fall and accidents

during pregnancy.

Birth

Mother Lily gave birth to Ruby on February 27, 1968; full term cephalic

presentation via Normal Spontaneous Vaginal Delivery (NSVD) and was attended by her

father who was a “mananabang” at their house. She claimed that she had no difficulty in

labor. And her father took good care of her after delivery.

Infancy

As she was described by her mother, from birth to one month Ruby could lift her

head slightly off the bed. She was provided with hanging toys. She would cry to express

31

discontentment, and smiles when contented. Complete immunizations such as BCG,

OPV, DPT, Hepa B, and measles vaccines were received, as verbalized by mother Lily.

Ruby was breastfed since birth until she reached two years old.

At 6 months, eruption of teeth begins, during teething Ruby manifested fever and

managed by giving paracetamol specifically Tempra.

At the age of one year old, Ruby was able to utter only one to two words such as

“mama” and “papa.” She began to grasp objects and played games such as “peek-a-boo.”

At the age of two years old, Mother Lily weaned Ruby by way of applying

bronchorub ointment or Vicks on her nipples. During weaning, gradual introduction of

solid foods begins such as cereal usually rice. At this age, Ruby begins to thumb sucked.

In addition, Mother Lily said that Ruby was experienced bed wetting and stops when she

reached two years old. Toilet training was emphasized; Ruby was trained to defecate

beside their house.

Childhood

At three years old, her vocabulary increased and she showed proper use of

pronouns such as “ako” (me) and “ikaw” (you). She walked downstairs using alternate

feet. Night time bladder control developed. At this stage, toilet training was completed.

At this age, common health problems were experienced by Ruby like dental caries and

chicken pox.

And at the age of 6 years old, Ruby was able to dress and feed self with less

assistance from her parents.

32

At this age also, she was sent to primary school at Andres Bonifacio Talomo, Davao City.

Ruby was able to write and read. She already had a circle of friends and was reported

that Ruby has gained high grades.

Adolescent

At this age, Ruby had developed a sense of competence by way of maintaining

good grades at school. She also developed her self identity and self esteem by having

friends. She didn’t have any difficulty adapting to puberty. She is always determined in

achieving what she wants and she never bends her own principles just to please others.

At the age of 15 years old, Ruby was accidentally shot at her right leg when she

was sleeping at around 9pm; and began teasing by her classmates as verbalized by her

Mother.

At the age of 16, Ruby gained independence. She went to manila to work as a

Housekeeper and a Nanny for about 10 years.

Play Life

She enjoyed imitative and dramatic play such as dressing up and doll houses. She

also acts a leader and only plays only with her younger sister Diamond and follows any

play that her younger sister wants to. Ruby preferred to have a female playmate rather

than a male because she is not comfortable when she plays with an opposite sex.

Moreover, as verbalized by her mother, Ruby always plays with her younger sister near

from their house and sometimes thay had a quarrel whenever they had misunderstandings

but settled thereafter.

33

School History

Ruby was sent to school at the age of 6 years old at at Andres Bonifacio Talomo,

Davao City.. “Wala na siya niagi og kinder, diretso na Grade 1.” As verbalized by

Mother Lily. She was able to write when she was 2 years old. She only finished her 1st

year high school at Andres Bonifascio Talomo, Davao City. She was kind, silent type and

responsible student. She spends an hour for studying and wasn’t forced to go to school.

She has no enemies in school and has a good relationship with her teachers. She was

good at school, quiet, and responsible from elementary up to high school. She also

maintained good grades at school. She even got 3rd honors and 2nd honors during her

elementary years. Ruby’s favorite subject was Mathematics, English and Science.

According to Mother Lily, Ruby’s highest grade was 85-87 % and the lowest was 83%.

When she reached 2nd year high school at the age of 15 years old, she was teased by her

classmates because she was using crutches due to gunshot wound at her right leg because

of that she decided to stop going to school.

Psychosexual History

Ruby never talked about liking someone according to her mother. When she

reached high school, she just focused on her studies. Mother Lily said that she and her

husband did not forbid her to get involved in relationships but Ruby just decided not to.

She had her menarche at the age of 12 years old, since then she had her regular monthly

period and only lasts for 3 days.

34

Religious and Social Adaptability

Ruby is a Roman Catholic. She goes to church every Sunday to attend mass but

she did not involve herself in other religious activities such as seminars and youth

organization activities because she is not interested to join to. Moreover, she also didn’t

involve herself in community activities whenever their community celebrated fiesta,

contests, or etc.

Since she came back from Manila, between the year 1997 and 2010 she stopped

going to church according to her mother because she already manifesting such behavioral

changes. She has few friends and most of them are females. She was not that friendly to

her neighbors.

Occupational History

At the age of 16, Ruby went to Manila with her friend to work and did not ask

permission to her parents. She just wrote a letter to her family after arriving in Manila

saying she did it because she wanted to help her family.

She worked as a househelper in Makati, Manila for 10 years. She left several

employers and found new ones for reasons of finding a better salary. After 10 years of

working, she went back here to Davao City in 1994 and stayed home for several months.

She left for Makati again to continue working as a househelper with another employer. In

the year 1997, one of her employers called her family to inform them that she would be

sent back because she was mentally ill and was being put at one of the Mental Hospitals

in Mandaluyong.

35

When she arrived at Davao City in the same year, she stayed at their home for

several months and worked as a factory worker for 4 months at one of the juice factories

in the city. Between the year 1997 and 2010, she worked several jobs within the City. In

January 2010, Ruby was 42 years old that time; she worked as a bakery helper for several

months. She was pulled out from her work since she was not understood by her co-

workers.

Before she was brought to DMH, she recently worked as a laundry girl. She was

paid from 150 – 200 pesos. Her salary from her previous work was not known by her

family. Aside from their lot, no savings have been reported.

Marital History/Relationship History

According to Mother Lily, she and her husband (Mr. M) did not forbid her to get

involved in relationships but Ruby just decided not to. Ruby was not married. She had

never been involved in a relationship as she reported.

Onset of Present Illness

Mother Lily as well as other family members could not specify what precipitated

her condition. All they know is that after working in Makati, a sudden change in her

behavior occurred such as talking to oneself. Mother Lily reported that her employer had

noticed her to be talking to herself as if someone was with her though her employer does

not see any one. She was noted to have lost her appetite and often out stares out blankly.

Also, she became unresponsive to questions. Her employer brought her to a Mental

36

Hospital in Mandaluyong in 1997, and she was confined for a week for a treatment and

was sent back to Davao.

And Ruby was brought to DMH with her brother by 911 last July 20, 2010 due to

assaulting a pregnant neighbor. It began when she was not allowed by a jeepney driver to

ride in his jeepney since she was known not to pay for her fare. The said jeepney driver

was her neighbor and who happened to be the husband of the victim. So, she directed her

anger to the driver’s wife and followed her on the street but her siblings stopped her from

such an act. The injured party suggested to Silver to confine Ruby at the Davao Mental

Hospital for her and everybody’s safety in the community.

On July 23, 2010, she was instructed by her Doctor that she may go home and

continue to comply with her medication.

NURSING ASSESSMENT TOOL

Date: July 23, 2010

HISTORY OF PRESENT ILLNESS

She was admitted lately for attempting to assault her pregnant neighbor. It began

when she was not allowed by a jeepney driver to ride in his jeepney since she was known

not to pay for her fare. The said jeepney driver was her neighbor and who happened to be

37

the victim’s husband. So, she directed her anger to the driver’s wife and followed her on

the street but her siblings stopped her from such an act. The victim suggested to Silver to

confine Ruby at the Davao Mental Hospital for her and everybodys safety in the

community.

PAST MEDICAL HSTORY

She was first admitted at a psychiatric institution in Mandaluyong for one week in

1997 by her employer due to a change in behavior. In the same year, she was admitted at

Davao Mental Hospital for several days by her family after her violent act towards others.

Her third admission at the Davao Mental Hospital was in 2000 for four days due to her

violent act towards her mother. In the year 2003, she was again admitted at the Davao

Mental Hospital for three days due to violent act towards others. She is currently

admitted at the Davao Mental Hospital for she was a threat to the community.

FAMILY HISTORY OF ILLNESS

There is no known family history of asthma, hypertension, diabetes and other

family history of illness on both sides of the family.

PHYSICAL ASSESSMENT

General Survey

Patient noted to be in euthymic mood with broad affect and good eye contact. She

is wearing a white t-shirt and a gray short. Fingernails and toenails are well-trimmed.

38

Upright posture was noted. With Vital Signs of T: 36 degree Celsius, P: 86bpm, R:

20cpm, BP: 100/80 mm Hg

Skin

Skin has fair complexion, generally uniform in color with good skin turgor and

mobility. She has a temperature of 36 oC. Hair is black, dry and evenly distributed. Nail

surface is slightly curved. Nail edge ridges are smooth and clean. A Capillary refill result

of less than 2 seconds. Scar noted at right upper leg 3 inches long and 1 inch wide and at

right lower leg3 inches long and 4 inches wide.

Eyes

Eyelashes are evenly distributed along the lid margins and curve outward.

Eyeballs are aligned in their sockets. Pupils are equally round, reactive to light and

accommodation. No masses, tenderness and lesions were noted. Extra ocular muscles

were coordinated. She is able read newsprints without any difficulty at a distance of

3feet.

Ears

Ears are of equal size with the same color to facial skin and feel firm. Pinna

recoils back. No discharges were noted. No masses, tenderness and lesions were noted.

She has no difficulty in hearing the ticking sound of the watch when placed near her ears.

Nose

39

Nose is symmetric, placed midline and proportion to facial features. No

discharges were noted. No masses, tenderness and lesions noted.

Mouth

Lips are pink and dry. Inner surface is also pink . Dental carries and tartar can be

noted. Patient’s teeth are twelve, eight in the upper area and four in the lower part. Gums

appear pink. Tongue is placed in the midline and able to move freely. Tonsils are visible.

Uvula rises in midline on phonation. No masses, tenderness and lesions noted.

Respiratory System

Chest is symmetrical. Scapula is also placed symmetrically. When inhaling, her

diaphragm descends and ascends when exhaling. Respiratory excursions are symmetrical.

She has a respiratory rate of 20 cycles per minute. No accessory muscles were used upon

breathing. No masses, tenderness and lesions were noted. No abnormal breath sounds

noted on both lung fields upon auscultation. Vibration felt upon performing tactile

fremitus

Circulatory System

A capillary refill result of less than 2 seconds. No jugular vein distension. Carotid

pulse can be felt symmetrically. Pulses are palpable on both upper and lower extremities.

When radial and ulnar arteries were depressed, blood flow returns via ulnar artery within

less than 2 seconds. No jugular vein distention. She has a blood pressure of 100/80

mmHg and a pulse rate 86 beats per minute.

40

Abdomen

Skin has fair complexion all throughout the abdomen with good skin turgor.

Abdomen is round. Patient has decreased appetite. Snacks served was not consumed.

There were no masses and tenderness noted.

Genitourinary System

Patient can void freely. She had not experienced any pain when urinating. There

were no reports of hematuria or urinary incontinence.

Elimination

She is able to defecate without pain daily. No reports of melena or hemtochezia

Musculoskeletal System

Patient moves with good coordination. Upright posture noted whether he is

standing or in a sitting position. She is able to move her joints smoothly.

Speech

The stream of talking is at an even pace. However, she formulates words that it is

difficult to understand. Sometimes, the questions being asked to her were not properly

answered.

41

Sleep

She has intervals of sleep. During day time and night time, patient wakes up late

at night because she feels she’s not at home. She sleeps every 10 in the evening and

wakes at 5:30 in the morning.

Activities of Daily Living

She is able to feed and bathe herself. Since the activities of daily are not strictly

implemented in the center, hygiene is fair.

Habit

The patient does not drink and smoke.

Present Behavior

She was sitting in an upright posture. She’s cooperative and talkative during the

interaction.

REVIEW OF SYSTEMS

General Survey

She feels comfortable, with no muscle weakness, fatigue or fever. She claims to

be in a good health condition.

42

Skin

The patient has no known allergies to food and drugs. She applies lotion after

bathing. She reported scars in her right upper thigh and right lower leg due to gunshot

wound. She reported occurrences of minimal hair fall when bathing. She cuts her nails

every week and she does not like putting any polish on it.

Head

Patient claims to be confined in this institution due to some problems in her brain

which she termed as migraine. However, she had no history of any head injury and had

not experienced dizziness. When she is mad, she can feel headaches.

Eyes

Client claimed to be diagnosed with astigmatism when she was 30 years old. She

does not use any devices to aid her vision.

Ears

The patient has no known history of hearing problems. She cleansed her ears with

the use of cotton buds thrice a week. She does not use any hearing aids.

Nose

The patient did not experience problems in smelling. During cold season, she

easily acquires colds.

43

Mouth and Throat

The patient has no known history of difficulty of swallowing and eating problems.

She can eat well in any forms of food. However, she claims to have decreased appetite

upon staying at the institution due to unpalatable food. She could not recall the last time

she had a dental check-up. She did not experienced any instances of gum bleeding.

Respiratory System

The patient has reported no history of asthma or any other chronic or acute

respiratory problems, and that she does not smoke.

Circulatory System

No known history of hypertension or any cardiovascular problems, as claimed by

the patient.

Gastrointestinal

The patient reported abdominal discomfort whenever she drinks a cup of coffee.

She has no history of hemorrhoids and had not experienced constipation or diarrhea.

Genitourinary

Patient reported no difficulty upon urinating, with characteristics of yellow

colored urine in moderate amount. No history of hematuria or dysuria.

44

Musculoskeletal

Patient reported that she was hit by a bullet on the right lower leg when she was

13 years old. Client also reported that she did not use any assistive device.

Neurological System

She did not experienced fainting, seizures or weakness on upper and lower

extremities as claimed by the patient.

Elimination

She claims to be defecating every other day. She did not complain of any

difficulty in elimination such as constipation or diarrhea. However, she verbalized

discomfort in defecating at the institution due to poor toilet facilities.

Sleep

According to the patient, she wakes up late at night because she feels she is not at

home.

Psychiatric

Whenever she is mad, she feels nervous and tensioned. She did not noticed any

changes in her mood and behavior since she left to work at Manila, as verbalized.

45

Sometimes, she feels homesick whenever she remembers birthdays of one of her family

members whenever she is away from home, as she reports.

MENTAL STATUS EXAMINATION

Orientation Phase

46

PERSONAL DATA

Name: Ruby ` Date: July 22, 2010

Address: Talomo, Davao City Time: 1:40 pm

Age: 42 Sex: F Civil Status: Single Occupation: None

Nationality: Filipino Religion: Catholic

Date of Admission: July 20, 2010

Reason for Admission: Assaulting a pregnant women

Medical Diagnosis: Schizophrenia, Paranoid Type

Attending Physician: Dr. Dova M. Sayon, M.D.

I.GENERAL DESCRIPTION

General Appearance

Ruby appeared to be happy. She was dressed in a white t-shirt and a gray short, Her face

appeared to be cleaned. Her hair is short and pony tailed, she wore rubber slippers. Her

fingernails and toenails were well trimmed. She appeared properly groomed and has no

foul smelling odors.

Behavior & Psychomotor Activity

A. General Mobility

a. Posture & Gait

47

(√ )Normal ( )Inappropriate

Justification: She has an upright position when sitting and standing. She has a

well coordinated gait. She ambulates without assistance.

b. Actions & Gestures

(√) Normal ( ) Inappropriate

Justification: Ruby’s actions and gestures were appropriate. She was able to

follow instructions like raising her hand to the right and left.

Reaction:

(√)Normoactive ( )Psychomotor retardation

( )Rigidity ( )Agitated

Justification: Ruby was just sitting. She has upright position when sitting and

standing. She has a well coordinated gait. She can walk without assistance.

c. Facial Expression

( √ )Smiling ( )Worried ( )Sad

( )Ecstatic ( )Tense ( )Tearful

( √ )Happy ( )Frightened ( )Distant

( )Angry ( )Suspicious

Justification: Ruby’s facial expression was appropriate. She laughs and smile

when she shares her happy moments.

B. Behavior

48

( √ )Friendly ( )Impulsive ( )Angry

( )Embarrassed ( )Negativistic ( )Seductive

( )Indifferent ( )Withdrawn ( )Manic

Justification: Ruby greeted all the student nurses. She was comfortable in

talking with student nurses. She participates in the interaction and mingles to the student

nurses.

Student Nurse:’’Maayong Hapon Ruby”

Ruby:”Maayong hapon pud. (smiling)

Student Nurse:”kumusta man ka?”

Ruby:”Maayo man, nag paycheck up ra man ko diri.”

C. NURSE PATIENT INTERACTION

a. Attention

(√) Cooperative ( ) Uncooperative ( √ ) Allthroughout

( ) Initially ( ) Lately

Justification: Ruby was cooperative and participates all throughout the

interview, she pays attention to every question and answered the questions

appropriately.

Student Nurse:’’Kanus.a ra ka di admit diri?”

Ruby:”ganina lang buntag, ana si Silver mag pa check up lang man mi”.

49

Student Nurse:”unsa may ingon sa doctor nimu?”

Ruby:”gipa inom man ko nya ug tambal, tapos diri sad aw ko.”

b. Quality

(√)Warm ( )Distant ( )Dependent

( )Hostile ( )Suspicious ( √ )Talkative

Justification: Ruby was warm. She openly expresses her thoughts and feelings

without hesitation and hostility as an indication that she developed trust.

Student Nurse:’’karon, kumusta man imung paminaw?”

Ruby:”Okay lang man pag human nako ug inum ug tambal, kamu musta man

mo? Graduating nab a mo?”

Student Nurse:”okay lang ,man mi Ruby, o, graduating na.”

Ruby:”Maayo kay mu graduate na jud mo.”

I. EMOTIONAL STATE & REACTION MOOD

a. Mood

( ) Depressed ( ) Angry ( )Frightened

( ) Anxious ( ) Suspicious ( √ )Talkative

Justification: Ruby was in the mood for interview there was no indication of

depression, anger and anxiety. She was able to express her thoughts happily.

Student Nurse:’’Pila mo ka mag igsuon Ruby?”

Ruby:”walo mi kabuok, ika duha ko, tapos Akong magulang tua karon sa mati.”

Student Nurse:”unsa pud trabaho sa imung ma ug papa?”

50

Ruby:”akong papa kay boksengero dati, unya akong mama kay naga laba lang

sa mga silingan namu. Unya naa man koy yaya dati”

b. Affect

( √ )Appropriate ( ) Inappropriate

Justification: Ruby’s emotion was congruent with her accompanying ideas

and thoughts.

c. Quality

( )Flat ( )Blunted Others: (√) Euthymic

Justification:

Ruby has normal quality of affect from its mood. She laughs when something is

funny or her emotions is appropriate with the environment.

II. N1EUROVEGETATIVE FUNCTION

A.Sleep

( √ ) Normal ( ) Hypersomnia ( ) Mixed Insomnia

( ) Early Insomnia ( )Late Insomnia

Justification: She verbalized that she can sleep well at the DMH. No signs

of fatigue during the entire interview.

B. Appetite

51

( √ )Normal ( )Increased ( )Decreased

Justification: Ruby’s appetite was normal. She eats three times a day. She

take a snacks in between meals.

Student Nurse: ”Naa ba ka gana mukaon?”

Ruby:” Oo, nikaon man gani ko ganina, salamat diay aning mirienda, kaunon

ko ni unya.”

C. Weight

( ) Increased ( )Decreased ( )No Changes

Justification:

Unable to assess weight.

D. Diurnal Variation: Absent

Justification: There was no diurnal variation noted. She maintained the same

mood throughout our interaction. She was attentive and responsive during interaction.

E. Libido

Justification: Ruby participated well on the interaction. Most of the time, she

will do all the talking and we where only listening. Ruby doesn’t show any

interest to men.

IV. Speech and Stream of Talk

A. Character

(√)Spontaneous ( )Deliberate ( )Loud ( √ )Talkative

( )Whispered ( )Mumbled ( ) Hesitant ( )Pressured

52

Justification: Ruby answers questions appropriately and the pacing of speech

is normal.

Student Nurse:’’Ruby, unsa diay imung trabaho dati?”

Ruby:”katong 16 pa ko, nag adto ko ug manila para mag trabaho, katabang ug

yaya, tapos ginapadalhan nako akong mga igsuon para makaskwela sila.”

Student Nurse:”unya, pila man pud ka katuig nag trabaho didto?.”

Ruby:”10 years ko didto, lain lain akong amo, mubalhin lang ko ug amo pag

gamay ang sweldo nako.”

B. Accessibility

( √ )Good ( )Defensive ( )Fair ( )Mute

Justification: Ruby expresses her thoughts and feelings in a clear

understandable manner. She was able to talk with no doubt and hesitation.

Student Nurse:’’nganong nag uli diay ka ug Davao Ruby?”

Ruby:”Kuan, pag graduate atong alaga nako, didto nako nag decide na muuli,

gihatod paman gani ko sa akong amo, buutan pud tong amo nako bah.”

C. Organization of Thoughts

(√) Relevant () Irrelevant ( ) Circumstantial

Justification: Ruby was able to verbalized relevant information when asked.

She doesn’t show any thought disturbance.

53

V. Perception

( )Present ( √ )Absent

Justification: Ruby does not manifest any signs of hallucinations.

VI. Thoughts

A. Delusion

( )Present (√ )Absent

Justification: Ruby doesn’t show any delusions, or hallucinations during the interview.

B.Suicidal Potential


Justification:No evidence of suicidal potential

Student Nurse:”Ruby, usahay ba makahuna huna ka na pasakitan imung

sarili?”

Ruby:”aw, dili ui, dili jud nako na mabuhat sa akong sarili.”

C. Homicidal Potential

( √ )Present ( ) Absent

Justification: Shows potential in committing homicide.

Ruby:”musulod ko sa military, magbuhat ko ug bomba, unya didto nako pa

butuhon sa akong mga yawa na silingan na nag baligaya sa akong yuta.”

54

VII. Sensorium & Cognition

A.,Orientation

( ) Time

Justification: ( )Impaired ( √ )Unimpaired

Ruby was oriented to time

Student Nurse: ”Unsang adlaw karon uby ug unsang oras na sa tan-

aw nimu?’’

Ruby:”July 23, 2010, alas 2 sa hapon na.”

( ) Place

Justification: ( )Impaired ( √ ) Unimpaired

Ruby was oriented to place

Student Nurse:”Kabalo ka asa ka karun?”

Ruby:”Sa Davao Mental Hospital, nagpa check-up lang ko..”

( ) Person


Ruby was oriented to person

Student Nurse:”Unsa pangalan sa imung kauban karun?”

Ruby:”Si Silver.”

B. Memory

( ) Remote

Justification: ( )Impaired (√ ) Unimpaired

Student Nurse:”Asa ka nagraduate?”

Ruby:”Sa Andres Bonifacio Talomo.”

55

( ) Recent


Student Nurse:”Asa ka last nagtrabaho,Ruby?”

Ruby:”Kompanya sa factory na mango juice sa Toril Lizada.”

( ) Recent Past


Student Nurse: ”Unsa man pangalan sa imung amo didto sa imung

gitrabahuan sa kompanya?”

Ruby:”Incorporate man gud to,daghan tag-iya.”

( ) Immediate


Student Nurse: ”Unsa imung gikaon ganinang buntag ruby?”

Ruby: ” odong na naay tinapa, unya kan-on.”

C.Attention Span

( √) Good ( ) Fair ( ) Poor

Justification :Ruby was responsive and listened to our questions all

throughout our interactions.

A. Calculation

Justification:Ruby was able to answer correctly the calculation.

SN:”100-7=?”

Ruby:”93.”

SN:”93-7=?”

Ruby:”86.”

56

E.Spelling

Justification:When asked to spell her name,she answered it correctly

but wasn’t able to spell it backward.

SN:”i-spell daw imung pangalan?”

Ruby:”Ruby= R-U-B-Y”

A. Abstract Thinking Ability

I. A.Judgement

( ) Impaired ( √ ) Unimpaired

Justification: Ruby has no impairment in judgement..

SN:”Kung nahulog akong pitaka na wala ko kabalo,unsay may

buhaton

nimo?”

Ruby:”Akong iuli sa imuha.”

B.Insight


Justification:

SN:”Unsay pasabot nimu niani, kung may tiyaga may nilaga?”

Ruby:”Kung maningkamot nay pagkaon.”

Summary of Mental Status

Disturbances in:

( ) General Description

( ) Emotional State & Reaction Mood

( ) Neurovegetative Function

57

( ) Speech & Stream of Talk

( ) Perception

(/) Thought

( ) Sensorium & Cognition

(/) Judgement & Insights

Diagnostic Category

(/) Psychotic ( ) Non-Psychotic

Justification:

Patient’s thought processes seemed become disrupted, she exhibited Delusion of

Grandeur and of Persecution towards her neighbors. Also, patient was able to display

poor judgment. However, symptoms of psychotic disorder are minimal.

DSM IV Diagnosis

Axis I – Schizophrenia Paranoid

Axis II – Narcissistic Personality Disorder

Axis III – none

Axis IV - Traumatic experience (shot by a bullet at her right leg)

Social Problems (withdrawn from peers)

Possible traumatic experienced (Patient claims to be raped)

Axis V - 51 – 60: moderate symptoms or moderate difficulty in social,

occupational or school functioning.

58

MENTAL STATUS EXAMINATION

Termination Phase

PERSONAL DATA

Name: Ruby ` Date: July 23, 2010

Address: Talomo, Davao City Time: 2:30 pm

Age: 42 Sex: F Civil Status: Single Occupation: None

Nationality: Filipino Religion: Catholic

Date of Admission: July 20, 2010 Reason for Admission:

Medical Diagnosis: Schizophrenia, Paranoid Type

Attending Physician: Dr. Dova M. Sayon, M.D.

I.GENERAL DESCRIPTION

General Appearance

Ruby appeared to be happy. She was dressed in a light green t-shirt and a gray short, Her

face appeared to be cleaned. Her hair is short and not properly combed, she wore rubber

slippers. Her fingernails and toenails were well trimmed. She appeared properly groomed

and has no foul smelling odors.

Behavior & Psychomotor Activity

A.General Mobility

a.Posture & Gait

59

(√ )Normal ( )Inappropriate

Justification: She has an upright position when sitting and standing. She has a

well coordinated gait. She ambulates without assistance.

b.Actions & Gestures

(√) Normal ( ) Inappropriate

Justification: Ruby’s actions and gestures were appropriate. She was able to

follow instructions like raising her hand to the right and left.

Reaction:

(√)Normoactive ( )Psychomotor retardation

( )Rigidity ( )Agitated

Justification: Ruby was just sitting. She has upright position when sitting and

standing. She has a well coordinated gait. She ambulates without assistance.

c.Facial Expression

( √ )Smiling ( )Worried ( )Sad

( )Ecstatic ( )Tense ( )Tearful

( √ )Happy ( )Frightened ( )Distant

( )Angry ( )Suspicious

Justification: Ruby’s facial expression was appropriate. She laughs and smile

when she shares her happy moments.

B.Behavior

60

( √ )Friendly ( )Impulsive ( )Angry

( )Embarrassed ( )Negativistic ( )Seductive

( )Indifferent ( )Withdrawn ( )Manic

Justification: Ruby greeted all the student nurses. She was comfortable in

talking with student nurses.She participates in the interaction and mingles to other

people.

Student Nurse:’’Maayong Hapon Ruby”

Ruby:”Maayong hapon,sa inyo gikan tong grocery Maam?

Student Nurse:”OO”

Ruby:”Ali Maam.” (smiling face)

C.NURSE PATIENT INTERACTION

a.Attention

(√) Cooperative ( ) Uncooperative ( √ ) Allthroughout

( ) Initially ( ) Lately

Justification: Ruby was cooperative and participate all throughout the

interview, she pays attention to every question and answered the questions

appropriately.

b.Quality

(√)Warm ( )Distant ( )Dependent

( )Hostile ( )Suspicious ( √ )Talkative

61

Justification:Ruby was warm. She openly expresses her thoughts and feelings

without hesitation and hostility as an indication that she developed trust.

III. EMOTIONAL STATE & REACTION MOOD

a.Mood

( )Deppressed ( ) Angry ( )Frightened

( ) Anxious ( ) Suspicious ( √ )Talkative

Justification:Ruby was in the mood for interview there was no indication of

depression,anger and anxiety.

b.Affect

( √ )Appropriate ( ) Inappropriate

Justification: Ruby’s emotion was congruent with her accompanying ideas

and thoughts.

c.Quality

( )Flat ( )Blunted Others: (√) Euthymic

Justification:

Ruby has normal quality of affect from its mood. She laughs when something is

funny or her emotions is appropriate with the environment.

IV. N1EUROVEGETATIVE FUNCTION

62

A.Sleep

( ) Normal ( ) Hypersomnia ( ) Mixed Insomnia

( ) Early Insomnia ( )Late Insomnia

Justification:

B. Appetite

( √ )Normal ( )Increased ( )Decreased

Justification:Ruby’s appetite was normal. She eats three times a day. She

take a snacks in between meals.

Student Nurse:”Naa ba ka gana mukaon?”

Ruby:” Oo ,kakaonon gani ko run…kung sa amuang balay,daghan kaayo ko

makaon..”

C.Weight

( ) Increased ( )Decreased ( )No Changes

Justification:

Unable to assess weight.

D.Diurnal Variation: Absent

Justification: There was no diurnal variation noted. She maintained the same

mood throughout our interaction. She was attentive and responsive during interaction.

E.Libido

Justification: Ruby participated well on the interaction.

63

IV.Speech and Stream of Talk

A.Character

(√)Spontaneous ( )Deliberate ( )Loud ( √ )Talkative

( )Whispered ( )Mumbled ( ) Hesitant ( )Pressured

Justification: Ruby answers questions appropriately and the pacing of speech

is normal.

B.Accessibility

( √ )Good ( )Defensive ( )Fair ( )Mute

Justification: Ruby expresses her thoughts and feelings in a clear

understandable manner. She was able to talk with no doubt and hesitation.

C. Organization of Thoughts

( ) Relevant (√) Irrelevant ( ) Circumstantial

Justification:

Ruby: “Ma’am mga kristyano mo no, dli man gud ko katulugon sa inyu di

pareha atong nag-interbyu sa ako ganina.”

SN:

V.Perception


Justification:Ruby does not manifest any signs of hallucinations.

Student Nurse:”Naa ba ka makit-an o madunggan bisan ikaw lang isa.?”

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Ruby:”Wala.”

VI.Thoughts

A.Delusion

( √ )Present ( )Absent

Justification:

Ruby: Ma’am/sir, naa moy dugong H?

SN: “unsa man nang dugong H ruby?

Ruby: “dugong Hero ba..kanang dugong sundalo gud.”

Ruby exhibits disturbance in thinking specifically neologism.

B.Suicidal Potential


Justification:No evidence of suicidal potential

Nurse:”Nakahuna-huna ba ka na pasakitan imu sarili?”

Ruby:”Dili oi,nganu saktan man naku akong sarili,sakit man na.”

C. Homicidal Potential

( )Present ( √ ) Absent

Justification:

Student Nurse:”Nakahuna huna ba ka na pasakitan ang imung mga kauban

diri sa sulod?”

Ruby:”Wala pud,kay religious ako.”

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VII. Sensorium & Cognition

A.,Orientation

( ) Time


Ruby was oriented to time

Student Nurse:”Unsa orasa na karun,Ruby?’’

Ruby:”2:30 sa hapon.”

( ) Place


Ruby was oriented to place

Student Nurse:”Kabalo ka asa ka karun?”

Ruby:”Sa Mental.”

( ) Person


Ruby was oriented to person

Student Nurse:”Unsa pangalan sa imung kauban karun?”

Ruby:”Si bing2x.”

Student Nurse:”Unsa tinuod pangalan ni bing2x?”

Ruby:”Rey.”

B. Memory

( ) Remote


Student Nurse:”Asa ka nagraduate?”

Ruby:”Sa Andres Bonifacio Talomo.”

( ) Recent

66


Student Nurse:”Asa ka last nagtrabaho,Ruby?”

Ruby:”Kompanya sa factory na mango juice sa Toril Lozada.”

( ) Recent Past


Student Nurse:”Unsa man pangalan sa imung amo didto sa imung

gitrabahuan sa kompanya?”

Ruby:”Incorporate man gud to,daghan tag-iya.”

( ) Immediate


Student Nurse:”Unsa imung gikaon ganinang buntag ruby?”

Ruby:”Breakfast,odong na naay tinapa.”

C.Attention Span

( √) Good ( ) Fair ( ) Poor

Justification:Ruby was responsive and listened to our questions all

throughout our interactions.

B. Calculation

Justification:Ruby was able to answer correctly the calculation.

SN:”100-7=?”

Ruby:”93.”

SN:”93-7=?”

Ruby:”86.”

E.Spelling

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Justification:When asked to spell her name,she answered it correctly

but wasn’t able to spell it backward.

SN:”i-spell daw imung pangalan?”

Ruby:”Elenita=E-L-E-N-I-T-A=

B. Abstract Thinking Ability

II. A.Judgement


Justification: Ruby has no impairment in judgement..

SN:”Kung nahulog akong pitaka na wala ko kabalo,unsay may

buhaton

nimo?”

Ruby:”Akong iuli sa imuha.”

B.Insight


Justification:

SN:”Unsay pasabot nimu niani, kung may tiyaga may nilaga?”

Ruby:”Kung maningkamot nay pagkaon

III. Summary of Mental Status

A. Disturbances in:

( ) General Description

( ) Emotional State & Reaction Mood

( ) Neurovegetative Function

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( ) Speech & Stream of Talk

( ) Perception

( √ ) Thought

( ) Sensorium & Cognition

( ) Judgment & Insights

Diagnostics Category

( ) Psychotic ( √ ) Non-Psychotic

B. DSM IV Diagnosis

Axis I Schizophrenia Paranoid

Axis II Narcissistic Personality Disorder

Axis III None

Axis IV Traumatic Experience (shot by a bullet at her right leg)

Social Problems (withdrawn from peers)

Possible traumatic experienced (Patient claims to be raped)

Axis V 51 – 60: moderate symptoms or moderate difficulty in

social, occupational or school functioning.

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NURSE PATIENT INTERACTION

ORIENTATION PHASE

Name of Patient: Ruby Age: 42 years old Status: Single

Date and Time of Assessment: July 22, 2010 2:00PM

Phase Interaction: Orientation Phase

Goal of Interaction:

To continue establishing rapport.

To maintain therapeutic communication.

To encourage verbalization of feelings.

Objectives:

1. To introduce self;

2. To orient patient about the purpose of interaction;

3. To enable patient to share information about herself; and

Environment:

During our conversation we are sitting on the hammock. It was quite and peaceful. And we are comfortably interacting.

General Appearance:

Patient was dressed in yellow-green color shirt and short pants appears tidy. Her face appeared to be clean. She has bent and slouched posture. Her fingernails and toenails were well trimmed. Patient appeared groomed and she has no foul smelling odor.

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NURSE PATIENT ANALSIS/INTERPRETATION

“Maayong hapon Ruby” (smiles and looks at the patient in the eye using a gentle voice).

“Mayong hapon” (smiles a little) Giving Recognition

Greeting the patient by name indicates recognition of the individual as a person regardless of the formality or length of the relationship, each nurse actively encourages patient to feel comfortable in the relationship. Patient responds appropriately and gives a sign of good start.

“Ruby kami diay ang mga student nurse sa Brokenashire college. Kami imung makauban karon ug hangtud unyang alas dos” (speaks in a gentle voice.)

“ duha lang diay mo ka oras” Giving information

Making available of the facts the client needs. It builds trust with the client and introducing oneself is the initial step in social interaction and establishing rapport. The nurse should established roles, the purpose of meeting and parameters of subsequent meeting that clarifies expectations. The patients response emphasizes that she understand the information given.

“OO, hangtud alas dos lang, tapos balik na pud mi ugma. Naa lang koy mga pangutana bahin sa imung kinabuhi. Storya lang kung unsa tong mga kaagi nimu dati.”

“okay Sir” Giving information and encouraging

Allowing the patient to know specific information with regards to his participation providing psychotherapeutic activities. The patients way of answering the question initiates acceptance and understanding of the information provided.

“Unsa imung tibuok na pangalan?” (Look

“Ruby ” Seeking information

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at the patient and smiled)

“Ang edad nimu?”

“Pangalan sa imung Mama ug edad?”

“Imung Papa? Unsa iyang pangalan ug pila ang edad?”

“42 na ko.”

“Si Antonia, 62.”

“Luciano, 77, patay na sya.”

“Unsa iyang gi-kamatyan Ruby?”

“unsa pud ang trabaho sa imung mama?”

“Imung papa, unsa iyang trabaho sa una?

“tapos, unsa man ang iyang sunod na trabaho katong nag retire na sya?”

“Arthritis man to”

“Wala, sa balay lang man to sya, kay sukad atong nag trabaho ko sa maynila, ako na naga supporta sa akong manghod.”

“Boxer to sya sa una, mga 20 pa iyang edad nag sugod, tapos ang last nyang nakalaban kay si flash elorde.”

“mananggiti.”

Seeking Information

The student nurse is assessing whether the patient knows how to spell.

“asa pud ka nag skwela tong highschool ka?”

“wow, kugihan jud diay ka.”

“sa talomo highschool, honor student ko, unya valedictorian ko atong elementary ko. Pirmi ko top one sa highschool.”

Seeking Information and Clarification

As the student nurse we should seek for clarification throughout the interactions with the patient. Doing so can help us to avoid making assumptions that understanding has occurred when it has not.

The patient responses show that she is

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aware of himself and the ability to spell is not impaired.

“Ruby, pila mo kabuok mag-igsuon?”

“mapanganlan ba nimu tong walo nimu ka igsuon?”

“walo mi kabuok, duha ang babae.”

“O, si Danilo 44, tapos ako, edito 40, Vilma 38, Alan 36, Rolando 34, Rey 32, ug si Luciano Jr. 30.”

Seeking information

Helps the patient articulate thoughts, feelings and ideas more clearly by asking the patient to compute, patient was logically active and yet participative and can compute w/out using calculator just by his mental ability.

“naunsa diay nang paa nimu Ruby, dako lagi na peklat?”

“Pag human?”

“Na-igo ni sya ug bala tong 15 pa akong edad, natulog ko ato na nakasandig ang tiil sa bintana.”

“Human ato, gidala ko sa Regional, November 14, 1983 man to, unya nag-gawas ko sa hospital December 24, 1983.”

Seeking information and giving information

The student nurse is seeking information regarding the patient's ability in remembering. What was the date of going to manila.

”Pila imung edad na ni-adto kag manila?”

“tapos?”

“unya unsa kang tuiga ning balik sa Davao?”

“unsa to syang tuiga Ruby?”

“kuan ko ato, 16, ni-adto na kog manila para mag trabaho ug katabang sa Quezon, tapos nagbalhin ko ug amo kay gamay ang sweldo, sa Marikina.”

“ako na ang naga pa eskwela sa akong lima ka manghud.”

“naga uli-uli man ko, katong pag-graduate sa akong alaga sa manila, didto nako ning-uli.”

Using open ended question

Asking broad questions that leads or invite the client to explore. Patient seems to be interested.

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“Tapos, pagbalik nimu diri, unsa napud imung gi-applyan?”

“2001 to.”

“Nanglabada, nag trabaho ko diha sa may factory sa Toril, human nag trabaho pud ko diha sa Bakery sa may Ulas.”

“katong naga trabaho pa ka didto sa manila, ginapasakitan ba ka sa imung amo?”

“wala man, mga buutan man ang Amo, ginahatag among 13th month pay.”

Using open ended question

Asking broad questions that leads or invite the client to explore. Patient seems to be interested.

“katong bata pa ka, unsa imung gina dulaan?”

Kinsa man pud imung mga kadula?”

“Ruby, napasakitan nab a sa imung papa tong bata pa ka?”

Unsa diay ang nahitabo nganong gibunalan ka?”

“Manika,usahay syatong.”

“Ako lang mang mga manghud ang kadula nako”

“wala man…ay, kaisa.”

“nakabuak man yata ko ato, tapos gibunalan ko atong 1x1 na kahoy

Seeking information

As the patient responded, he gives us the idea that he wants it secretly.Patient seems to be aware of his condition, during interaction. Patient responds in a good mood and can establish relationship by expressing his true feelings without hesitation. She answers questions

“katong high school pa ka, unsa unta imung kuhaon na kurso?”

“Ruby, kailangan na namu manglakaw, 2 hours lang baya to si kinsa man?”

“BSEd”

“ah okay, sige, okay ra sa ako..”

Offering self

Suggesting one's presence interest or wish to understand the client without making any demands or attaching conditions that the client must comply. Patient responds by nodding his head. It feels like it needs more convincing words to feel comfortable when having interraction.

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“Salamat sa imung oras ruby ha?”

“kita-kita lang ang nakabalo ato Ruby, sa ato lang to magtuyok?”

“

“La man, wala pud koy madungog.

“Uist! Kanang, pwede ato-ato lang tong gi-istoryahan? Dili man nako apilun ang school.”

“okay, salamat kayo ha.”

Seeking Information

Asking her the information about what happened to his eyes, the possible cause and the treatment used.

Patient responds with imaginary words like he is hallucinating.

Patient's awareness of the medication gives us an idea that he has a good memory and can familiarize the medication being used to her

EVALUATION:

Patient was able to:

1. Be orient about the purpose of interaction

2. Share information about herself; and

3. Reveal and express views, feelings and memory.

Student Nurse was able to:

1. Establish rapport to the patient;

2. Obtain information needed from the patient; and

3. Assess mental status of the patient.

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NURSE PATIENT INTERACTION

Name of Patient: Ruby Age: 42 years old Status:Single

Date and Time of Assessment: July 23,2010 2:00PM

Phase Interaction: Working Phase

Goal of Interaction:

To continue establishing rapport.

To maintain therapeutic communication.

To encourage verbalization of feelings.

Environment:

During our conversation we are sitting on the hammock. It was quite and peaceful. And we are comfortably interacting.

General Appearance:

Patient was dressed in blue color shirt and gray short pants appears tidy. Her face appeared to be clean with properly shaven facial hair. She has bent and slouched posture. Handcuffed noted and his fingernails and toenails were well trimmed. Patient appeared groomed and she has no foul smelling odor.

Nursing goals and objectives for this interaction:

1. To explore and understand thoughts and feeling;

2. To have a much deeper interaction with the patient;

3. To do necessary action and aid the patient plan a program of action to meet pre-

established goals.

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NURSE PATIENT ANALSIS/INTERPRETATION

“Maayong hapon Ruby” (smiles and looks at the patient in the eye using a gentle voice).

“Mayong hapon” (smiles a little) Giving Recognition

Greeting the patient by name indicates recognition of the individual as a person regardless of the formality or length of the relationship, each nurse actively encourages patient to feel comfortable in the relationship. Patient responds appropriately and gives a sign of good start.

“Kumusta imu tulog Ruby” (maintains eye contact to the patient)

“Asa gud?”

“Nindot ako pagtulog”. (still looking to the student nurse with a little smile)

“Nakadungog ka sa helicopter? Kusog kayo noh?”

“Hehehe..bugol man ka sir oi.”

Seeking information and Clarification

Maintaining eye contact while asking the patient. Patient responds appropriately and has sign of good sleep with good facial expression and also patient begins to experience auditory hallucination bys asking the student nurse on what he had heard it gave ideas that still the patient has hallucination.

“Ruby kaila pa ka sa ako?”

“Ruby lami ang snack?”

“Unsa pangalan sa imong igsoon r?”

“Kaila pako”

“Lami kayo.”

“Baby Bear”.

Seeking Information

Helps the patient articulate thoughts and feelings and ideas more clearly. Based on the pt’s response it is appropriate to the situation. Pt gave ideas that he feels better and nice while he

77

was asked by the student nurse and it is a sign of good heart.

“Kinsa gani ko Ruby?”

“Ruby asa man ang nurse station?”

“Very good”.

“Si Jude, sudent nurse nako”.

“Tua ra oh!” (Pointing to the nurse station)

Seeking Information

Helps the patient articulate thoughts, feelings, and ideas more clearly.(Psychiatric Nursing by Keltner)

The nurse asked questions to assesst the patient’s awareness of her.

The patient shows consciousness and awareness of oneself and also the environment she stayed in.

“Ah mayo Ruby. Ahh sige, kabalo ka og spelling?”

“Uhmmm kabalo man”. Seeking Information

The student nurse is assessing whether the patient knows how to spell.

“Spell daw akoa name?” (Maintains eye contact)

“very good Ruby! Sige ha, spell Tuesday?”

“Spell August?”

“Ahhh.. J-U-D-E

“T-U-E-S-D-A-Y”

“A-U-G-U-S-T”

Seeking Information and Clarification

As the student nurse we should seek for clarification throughout the interactions with the patient. Doing so can help us to avoid making assumptions that understanding has occurred when it has not.

The patient responses show that she is aware of himself and the ability to spell is not impaired.

“ Ahh. Very good. Oh sige math na pod ta. One hundred minus eighty two, pila man?”

“Uhmmm eighteen po” (maintains eye contact, then responds correctly)

Seeking information

Helps the patient articulate thoughts, feelings and ideas

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more clearly by asking the patient to compute, patient was logically active and yet participative and can compute w/out using calculator just by his mental ability.

“Wow! Ang galing”

“One hundred eighty six plus two hundred sixty, pila man?”

“Ay Ruby, time na. Balik lang mi ugma ha. Thank you! (maintaining eye contact)

“Four hundred fourty po” (maintains eye contact and smiling while bowing his head)

(Nods) Thanks you po! (with eye contact)

Seeking information and giving information

The student nurse is seeking information regarding the patient's ability in mathematics. In multiplication, division, subtraction and addition. Patient responds directly to the question.

Evaluation:

The student nurse was able:

1. To explore and understand thoughts and feeling;

2. To have a much deeper interaction with the patient ; and

3. To do necessary action and aid the patient plan a program of action to

meet pre-established goals.

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PREDISPOSING FACTORS:

Dysfunctional family relationship

Gender Family history

PRENATAL:

Doesn’t visit clinics for prenatal check-up but instead consult to “quackdoctors”.

Planned/expected pregnancy

usually eat egg, meat, dried fish and canned goods

PSYCHODYNAMICS

TODDLER(18 months to 3 years old)

AUTONOMY VS SHAME & DOUBT

Mother lily claimed that her daughter also experienced bed wetting and stopped when she reached the age of 2years. At the age of two years old, Mother Lily weaned Ruby by way of applying bronchorub ointment or Vicks on her nipples.She doesn’t have playmates and only wants to play with her younger sister.Follower in the game.Develops cooperativeness and the ability to delay gratification of needs.

AUTONOMYRuby developed autonomy because she was able to verbalize her toilet needs. Developed self-control without loss of self-esteem and has the ability to cooperate and to express oneself.

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PREDISPOSING FACTORS:

Dysfunctional family relationship

Gender Family history

PRENATAL:

Doesn’t visit clinics for prenatal check-up but instead consult to “quackdoctors”.

Planned/expected pregnancy

usually eat egg, meat, dried fish and canned goods

BIRTH:

Mother Lily gave birth to Ruby on February 27, 1968; full term via Normal Spontaneous Vaginal Delivery (NSVD).

Was attended by her father who was a “mananabang” at their house. No history of fall and accidents during pregnancy as verbalized by Mother

Lily.

INFANCY(Birth -18 months)

TRUST VS MISTRUST

Cuddled during breastfeeding Ruby was left under the care of her mother since birth Mother lily applies bronchorub ointment or vicks on her nipples in weaning her child. After weaning, Ruby had experienced thumbsucking Ruby had experienced childhood disease like chickenpox and consulted a doctor and was advised

to avoid taking a bath for 5 days. Ruby was breastfed for 2 years and mother lily claimed that she doesn’t use any formula milk. At 1 ½ years of age, ruby was already able to walk, talk and manifested fever during teething. She

began her toilet training also about this age wherein she was trained to defecate beside their house.

Child is comforted when crying.

PRESCHOOL(3 years old to 6 years old) INITIATIVE VS GUILT

At three years old, her vocabulary increased and she showed proper use of pronouns such as “mama” (mother) and “papa” (father).Ruby started going to school at age of 6. “Wala na siya niagi og kinder, diretso na Grade 1.” As verbalized by Mother Lily and was able to write when she was 2 years old.She accompanied by her mother on the first day of school and eventually learned to go to school alone.She would always like to stay inside the house.

INITIATIVERuby was able to learn the degree to which assertiveness and purpose influence the environment and beginning ability to evaluate one’s own behavior.

SCHOOLAGE(6 years old to 12 years old)

INDUSTRY VS INFERIORITY

Ruby loved playing during her early days such as dolls.She is confident in doing task like household choresRuby’s favorite subjects are mathematics, English and science.She has no enemies in school and has good relationship with her teachers.Excelled academically at school, received honors.

INDUSTRYRuby begins to create, develop, and manipulate and developed sense of competence and perseverance and was doing outstandingly and politely at school.

she

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ADOLESCENCE(12 years old to 20 years old)

IDENTITY VS ROLE CONFUSION

She didn’t have any difficulty adapting to puberty She had her menarche at the age of 12 years old and only lasts for 3 days. She only finished 1st year high school She was teased by her classmates because she was using crutches due to gunshot wound at her

right leg. She was kind, silent type and responsible student. She spends an hour for studying and wasn’t

forced to go to school. According to mother Lily Ruby’s highest grade was 85-87 % and the lowest was 83%. She is always determined in achieving what she wants and she never bends her own principles

just to please others. Ruby values hard work and responsibility

feelings of Confusion,

indecisiveness and anti social

behavior manifested by running

away from home.

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ADOLESCENCE(12 years old to 20 years old)

IDENTITY VS ROLE CONFUSION

She didn’t have any difficulty adapting to puberty She had her menarche at the age of 12 years old and only lasts for 3 days. She only finished 1st year high school She was teased by her classmates because she was using crutches due to gunshot wound at her

right leg. She was kind, silent type and responsible student. She spends an hour for studying and wasn’t

forced to go to school. According to mother Lily Ruby’s highest grade was 85-87 % and the lowest was 83%. She is always determined in achieving what she wants and she never bends her own principles

just to please others. Ruby values hard work and responsibility

ADULTHOOD(40 years old to 65 years old)

GENERATIVITY VS STAGNATION

Develops sense of stagnation because she doesn’t care about her family members including her mother, brother and sisters, not politically active sometimes she doesn’t recognized her brothers and sister but instead always insisting that they are fake family members and her true family lived on Manila.

ADMISSION:

Brought to DMH with her brother by 911 (July 20, 2010) due to uncontrolled behavior.

She was admitted at Davao Mental Hospital and confined at CIU for observation.

On July 23, 2010, she was instructed by her Doctor that she may go home.

YOUNG ADULT(20 years old -40 years old)

INTIMACY VS ISOLATION

Unable to develop lasting relationships with other people. She

hated boys. And doesn’t have many friends.

Lacks emotional maturity and exhibits possessiveness and

suspiciousness instead. She was kick out of her job because of her

behavioral changes.

Develops a sense of mistrust in building permanent intimate

relationship due to immaturity handling it.

Since then the patient was not able to form significant relationship,

declined making new friend and did not feel safe and secure with

her surroundings.

Precipitating Factors

Stress Frustrations Traumatic

event Non-

compliance with medications

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Schizophrenia Paranoid type

Stage Age Central task Indicators of positive resolution

Indicators of negative resolution

Actual task Indication

Infancy Birth to 18 Months

Trust vs. Mistrust

Shows strong affectional tie and exhibits attachments behaviors toward her mother.The child have good motor ad social development.

Parents show affection and love while handling the child.

Parents allow infants to satisfy his oral needs and respond to infants signal in a well-timed, appropriate fashion.

Shows avoidant or resistant attachment towards parents. The child has delayed physical, motor and social development.

Parents have showed anger or have fought, while handling the child.

Parents cannot interpret infants signals and

Ruby was born

Feb 27, 1968 via

Normal

Spontaneous

Delivery full term

at their house.

Breastfed for 2

years and mother

claimed that she

doesn’t use any

formula milk.

Cuddled during

breastfed

After weaning

ruby experienced

thumb sucking.

At 1 year of age,

ruby was already

able to walk and

According To Erik

Erikson the baby

will develop trust to

the person who

takes care of him,

the mother is the

major person whom

the trust may be

developed.

In this age the

needs of the infant

must be provided so

that trust will be

developed.

If she fulfils this

task she will have

84

discourages thumbsucking at this stage.

talk.

Child is comforted

when crying.

the ability to relate

well with others

and share her

thoughts and

concern.

She will feel safe

and secure to give

affection and

expect the same

affection in return.

Build trust and

confidence in her

self and others.

85

Toddler 18 months to 3 years

Autonomy vs. shame and

doubt

Self-control without loss of self-esteem

Lack of self confidence, pessimism, fear of wrong doing.

Learns to become

independent in

performing simple

activities or task

Develops

cooperativeness

and the ability to

delay gratification

of needs

Parents allow the

child try new

things and

discover the world

around her.

Also experienced

bed wetting and

stopped when she

reached the age of

2years.

Children take pride

in new

accomplishments

and want to do

everything

independently. If

parents recognize

toddlers need to do

what they are

capable of doing at

their own pace and

in their own time

then children

develop a sense of

being able to

control their

muscles and

impulses during

this time. If

children leave this

stage with last

86

Develops a

autonomy than

shame or doubt,

they can be

disabled in their

attempts to achieve

independence and

may lack

confidence in their

abilities to achieve

well into

adolescence and

adulthood.

87

Preschool 3 to 6 years

Initiative vs. Guilt

positive

response to

the world’s

challenges.

Has the

confidence to

try

something

that he has

not done

before. Child

is exposed to

a wide

variety of

experiences

and play

materials

Her parents allow

her to play near

their house, but

she will refuse to

play outside their

house. She would

always like to stay

inside the house.

She entered school

at the age of 6

years old. She

accompanied by

her mother on the

first day of school

and eventually

learned to go to

school alone.

Erikson defines

developmental task

of the preschool

period as learning

initiative vs. guilt.

Learning initiative

is learning how to

do things. Children

can initiate motor

activities of various

sorts on their own

and no longer

merely respond to

or imitate the

actions of other

children or of their

parents. Whether

children leave this

stage with a sense

of initiative

outweighing a

sense of guilt

88

Beginning to create, Loved playing

depends largely on

hoe parents respond

to self-initiated

activities.

89

School age 6 to 12 years

Industry vs. Inferiority

develop and

manipulate.

Developing sense of

competence and

perseverance

Coherent

Sense of self.

during her early

days such as

manika, luto-luto

and balay-balay.

She is confident in

doing task like

household chores

Good follower in

the game

favorite subject are

Mathematics

English and

science

Excelled

academically at

school, received

honors.

Knows herself and

how she fits to the

School age children

develop a sense of

industry by

working, being

confident, and

feeling of

accomplishment.

According to

90

Adolescence 12-20 years old

Identity Vs. Role Confusion

Plans to

actualize

ones

abilities.

rest of society. She

is always

determined in

achieving what she

wants and she

never bends her

own principles just

to please others.

Ruby values hard

work and

responsibility

Accepts and adjust

changes in body

image. She didn’t

have any difficulty

adapting to

puberty.

According to her

mother she had her

menarche at the

age of 12.

Erikson

adolescence must

bring together

everything they

have learned about

them selves as son

or daughter.

Erikson also

believed the new

interpersonal

dimension that

emerges during

adolescence in the

sense of identity

versus role

confusion.

In ruby’s case she

developed identity

rather than Role

confusion.

91

Unable to develop

lasting

relationships with Intimacy is the

ability to relate well

92

Young Adult 18-25 years

Intimacy Vs. Isolation

Impersonal

relationship

Avoidance of

relationship

career or

lifestyle

commitments

other people. She

hated boys. And

doesn’t have many

friends.

Lacks emotional

maturity and

exhibits

possessiveness and

suspiciousness

instead. She was

kick out of her job

because of her

behavioral

changes.

Develops a sense

of mistrust in

building

permanent

intimate

relationship due to

immaturity

handling it.

with other people,

not only with

members of

opposite sex but

also with one’s own

sex from one

lasting friendship.

In Ruby’s case she

developed Isolation

because she cannot

develop lasting

relationship with

others, and doesn’t

trust anyone and for

the reason also that

she didn’t feel safe

and secure with her

environment.

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Since then the

patient was not

able to form

significant

relationship,

declined making

new friend and did

not feel safe and

secure with her

surroundings.

Develops sense of

stagnation because

she doesn’t care

about her family

members including

her mother,brother

and sisters,not

politicallyactive

sometimes she

doesn’t recognized

her brothers and

94

sister but instead

always insisting

that they are fake

family members

and her true family

lived on Manila.

According to

Erikson people with

95

Adulthood 25-65 years

Generativity Vs. Stagnation

Self

indulgence,

self concern

lack of interest

and

commitments

sense of

generativity are self

confident and better

able to juggle their

various lives.

People without

sense become

stagnated and self

absorbed. In Ruby’s

case she developed

Stagnation because

she doesn’t care

about people

around her.

96

DOCTOR’S ORDER

7/20/2010 >Please admit patient to CIU with watcher

2pm > on DAT with AP

>Monitor vsq4 and record please

> Meds:

Fluopentixol dec 20g IM now

Haloperidol 5mg IM nows

Biperidine HCL 2mg 1 tab BID prn

>Suicidal, Homicidal, Escape precaution

>Remove any safety hazards prior to entry to CIU

>Secure consent for admission

>Refer

Dova M. Sayon, M.D.

7/21/2010 >Meds:

Shift haloperidol IM to Haloperidol 5mg per tab, 1 tab BID

Start Lithium Carbonate 450mg per tab, 1 Tab BID

Dr. Oligario

7/22/2010 >Increase Haloperidol to 20mg/tab, ½ Tab BID

10:30am >Continue Meds

Dr. Gonzaga

07/23/2010 > MGH

10:15 am >Continue Home Meds

Dr. Gonzaga

97

DRUG STUDY

Generic name

Brand name

Classification Mechanism of action

Route and Dosage

Indication Contraindication

Adverse reaction

Nursing responsibilities

HALOPERIDOL

HALDOL

ANTIPSYCHOTIC

A butyrophenone that probably exerts antipsychotic effects by blocking post-synaptic dopamine receptors in the brain

20 mg/tab ½ tab BID

>Psychotic disorders

>chronic psychosis requiring prolonged therapy

>Toirette syndrome

Contraindicated in patients hypersensitive to drug and in those with Parkinsonism, coma, or CNS depression

Use cautiously in elderly and debilitated patients, in patients with seizures, or EEG abnormalities, severe CV disorders, allergies and glaucoma

>Tardaive dyskinesia

>Sedation

>Drowsiness

>Lethargy

>Headache

>Insomnia

>Confusion

>Blurred vision

>Dry mouth

>Anorexia

>Nausea and vomiting

>Diaphoresis

>assess severity of symptoms>assist in ambulation and provide safety>advice to rest and avoid alcoholic beverages>assist in activities of daily living>note serum levels for any abnormalities especially creatinine levels>caution when engaging in activities requiring alertness or clear vision>encourage to increase OFI>advise to eat nutritious food and monitor weight daily>give small frequent feedings>advise to apply lotion

98

DRUG STUDY

Generic name

Brand name


Route and Dosage


Adverse reaction

Nursing responsibilities

BIPERIDEN

AKINETON

ANTICHOLINERGIC

Weak peripheral anti cholinergic agent with nicotinolytic activity, inhibition of striatal cholinergic receptors

20 mg/tab 1 tab PRN for EPS

> control of extra pyramidal disorders secondary to neuroleptic drug therapy

>as an adjunct in the therapy of all forms of Parkinsonism

Contraindicated in patients hypersensitivity to biperiden

Narrow angle glaucoma

Bowel obstruction

>Drowsiness

>Insomnia

>Blurred vision

>Dry mouth

>muscle and joint pain

>Dizziness

>Increased saliva

>instruct the patient to get up slowly when rising from sitting or lying position>avoid alcoholic beverages, schedule rest and activity periods>advise not to take naps in the morning>increase oral fluid intake>advise to use mouthcare>Advise to practice good oral hygiene>caution when engaging in activities requiring alertness or clear vision>provide hot compress>advise to rest and teach how to do passive ROM exercises.

99

DRUG STUDY

Generic name

Brand name


Route and

Dosage


Adverse reaction Nursing responsibilities

FLUPENTIXOL

ANTIPSYCHOTIC

Specifically antagonizes D1 and D2 dopamine receptors(as well as serotonin)

20 mg/amp 1 amp IM

>Depression involving anxiety, lack of initiative.>Chronic neuroses with anxiety, depression and inactivity>Psychosomatic disorders with asthenic reactions. >Anxiety and tension states.>Schizophrenia and allied psychoses especially with symptoms; eg.Hallucination, paranoid delusions and thought disturbances with apathy, energy andwithdrawal.

Extreme excitability and overactive patients, acute barbiturate, alcohol and opiate poisoning; pregnancy, patients with bone marrow depression and comatose states

>Restlessness >insomnia>extrapyramidal syndrome>sedation>antimuscarinic effects may also occur, tardive dyskinesia

>Monitor patient condition before and therapy.>assess for any heart problems, liver, kidney, breathing problems, jaundice, and postural hypotension.>assess if patient is pregnant, trying for a baby or breastfeeding.>Should be monitored carefully in patients on long term therapy.>Can be taken with or without meal.

100

Nursing Care Plan

Name of Patient: Ruby

Age: 42 years old

Date and time of admission: 07- 20 – 2010 : 2 PM

Date and time of assessment: July 22, 2010 @ 1 – 2 PM Date and time of evaluation: July 23, 2010 @ 1 – 2 PM

Cues & evidences NURSING

DIAGNOSIS OBJECTIVES

NURSING

INTERVENTION RATIONALEEVALUATION

Subjective:

“Musulod ko ug

airforce kay

magbuhat ko ug

bomba, didto

nako pabuthon

sakong mga

silingan” as

verbalized.

Risk for other

violence related

to auditory

hallucination.

Rationale:

Violence is a

state in which

an individual

That at the end 4 hours

of nursing care, patient

will decreased number

of violent responses as

manifested by:

Showing control

of individual

behavior with

assistant care from

.> Establish rapport

with the client.

>Observed client’s

behavior frequently.

Do this through

routine activities and

interactions; avoid

appearing watchful

and suspicious.

>To promote cooperation.

>Close observation is

required so that intervention

can occur if required to

ensure clients ( and others

safety.)

Goal Met:Within 2 hours of care, patient was able to:

>Show control of behavior with assistance from other.

>absence manifestations of desire to inflict pain to others.

101

Objectives:

History

Of suicidal

Potential.

History of

Homicidal

Potential.

Depress

Ion noted.

Impulsive

Behavior

noted.

experience

behaviors that

can be

physically

harmful either

to self or to

others. Since

patient has

schizophrenia,

and he is

paranoid type,

paranoia may

occur and may

provoke her to

Become

violent.

Bibliography:

Videbeck,

Sheila,

other.

Absence of

manifestations of

desire to inflict

pain to others such

as threats, uttering

of illicit language

and facial

expressions.

Demonstrate

satisfying

relationship with

others.

>Maintain person’s

personal space. Avoid

being too touchy to the

client.

>Remain aware of

cues indicating that

the client is

hallucinating (intent

listening for no

apparent reason,

talking to someone

when no one is

present, muttering to

self, inappropriate

facial expression.)

>Help the client

identify and practice

ways to relieve

anxiety such as deep

.> To avoid feelings of

entrapment on the part of the

individual.

>The client may act on what

she “hears. Your early

response to cues indicating

active hallucinations

decreases the chance of

acting out or aggressive

behavior.

>With decreased anxiety the

client will be able to solve

problems, learn new

behaviors and establish

relationship with others.

102

Lippincotts

Manual of

Psychiatric

Nursing.

Seventh

Edition.

Lippincott,

Williams and

Wilkins,

Walter kluwers

Company.

Phiulad.

Copyright @

2008

Pg. 187

breathing, listening to

music, and relaxation.

103

NURSING CARE PLAN


Age: 42 years old



Cues & evidences

NURSING DIAGNOSIS OBJECTIVES

NURSING INTERVENTION RATIONALE EVALUATION

S/O:

“Mutukar na ang

iyang sakit, kung

dili siya

makainum ug

tambal tungod

kay wala kwarta

pampalit, “as

verbalized by her

brother (Silver)

Non – compliance

to medication

related to

financial aspect.

Rationale:

Maintaining the

medication

regimen is vital to

the successful

outcome for

clients with

schizophrenia.

Within 4 hours span of

care, patient will be able

to :

a.) Verbalize

accurate

knowledge and

understanding of

treatment

regimen.

b.) Verbalize the

importance of

complying to

Develop

therapeutic nurse –

patient

relationship.

Explore client

involvement in or

lack of mutual

goal setting.

Contract with the

patient for the

participation in

To promote trust,

provides atmosphere in

which the patient can

freely express views and

concerns.

To be able to follow

through the goals she

participated in

developing.

To enhance commitment

to follow through.

Goal Met:

After 4 hours of

care, patient was

able to:

Verbalize the

importance of

complying

with

medication

and

understanding

104

Failure to take

medications as

prescribed is one

of the most

frequent reasons

for recurrence of

psychotic

symptoms and

hospital

admission.

(Psychiatric

Mental Health

Nursing by Sheila

L Videbeck, page

318)

With regards to

our patient’s

condition, she

demonstrated

occurrence of

schizophrenia due

medication. care.

Accept the

patient’s choice /

point of view even

if it appears to be

self – destructive,

avoid

confrontation

regarding beliefs.

Encourage the

importance of

complying with

medication.

To maintain open

communication.

In order for the patient

not to manifest behaviors

or occurrence of illness.

about

treatment

regimen.

105

to failure in

taking or

complying

medical regimen.

NURSING CARE PLAN


Age: 42 years old

106



Cues & evidences NURSING DIAGNOSIS OBJECTIVES

NURSING INTERVENTION RATIONALE EVALUATION

S/O:

“Sir, naa ka’y

dugong “H”?, kana

gud dugong Hero,”

as verbalized by

the patient.

- Has

delusional

thinking

( neologism)

- Inappropriate

or non –

reality based

thinking.

- Confabulation

Disturbed

thinking process

related to

mental

disorders

secondary to

schizophrenia.

Rationale:

Disruption in

cognitive

operations

affects the

physical,

mental,

psychological

Within 4 hours span of

care, patient will be

able to:

a.) Respond to

reality – based

interactions

initiated by the

student nurse.

Assess the level of

thinking of the

patient with

regards to time,

place, and person.

Orient the patient

to time, place and

person.

Approach the

patient is a slow,

calm way when

communicating.

Avoid making

promises that you

cannot keep.

Avoid of being

judgmental or

To identify the alteration

in cognitive functioning

of the patient.

To provide information

and present reality.

A clam approach helps

the patient to avoid

distorting the client’s

sensory field which

could promote disturbed

thoughts.

Because broken promises

reinforce the patient’s

Goal Met:

After 4 hours of

care, patient was able

to:

Respond to

reality – based

interactions

initiated by the

student nurse.

107

and spiritual

function of a

person

experiencing

this kind of

mental disorder.

making jokes

about the patient’s

beliefs.

Give positive

feedback for the

patient’s success

or when the

patient begins to

show or

differentiate

reality – based and

non – reality based

thoughts and

behaviors.

Distract the patient

from the delusion

by engaging the

patient in a less

threatening or

more comforting

topic.

mistrust of others.

The patient’s delusions

and feelings are not

funny to her. The patient

may not understand or

may feel rejected by

attempts of humor.

Positive feedback for the

patient’s genuine success

enhances the patient’s

sense of well being and

helps not to make non-

delusional reality.

Dwelling on delusional

content may increase the

patient’s anxiety or other

dysfunctional behavior.

108

Do not argue with

the patient or

trying to convince

the patient that the

delusions are false

or unreal.

Because delusional

arguments could or

might lead to

misunderstanding or

interfere with the

development of trust.

109

PROGNOSIS

Criteria Poor Fair Good Ideal Actual

Onset of illness Onset may be abrupt or

insidious, but most

clients slowly and

gradually develop signs

and symptoms such as

social withdrawal and

unusual behavior. Those

who develop the illness

earlier show worse

outcomes than those

who develop it later.

(Videbeck, Psychiatric

Mental Health Nursing,

2004)

The patient was

manifesting behavioral

changes since she was

working in Manila at the

age of 29. She is admitted

first at Mandaluyong and

with unknown diagnosis.

Lasts July 20, 2010 ; 2:00

pm she was admitted at

Davao Mental Hospital

due to violence

specifically able to fight

against her neighbor due

to land property and was

diagnosed with

schizophrenia, paranoid.

Duration of

illness

Those that experience a

gradual onset of the

disease tend to have

poorer and immediate

long term course than

those that experience an

acute sudden episode

( Psychiatric Mental

Health Nursing, 4th

edition, Chapter 14 by

Shiela Videbeck, 2008)

The patient’s duration of

illness is considered poor

since she manifested the

signs and symptoms of

schizophrenia such as

delusions hallucinations,

hostility and paranoia

were observed by her

employer while working

in Makati, Manila at the

said age of 29 though had

sought for medical help;.

110

Increasing presence of

schizophrenic symptoms

was presumed to be a

poor prognosis (Kaeplan

and Saddocks synopsis

of Psychiatry)

Patient noted to be hostile

able to fight against her

neighbor due to land

property and became

violent. Her brother

decides to put Ruby in a

rehabilitation center on

July 20, 2010 at Davao

Mental Hospital. After 3

days she was discharged

and functional.

Environment Based on environmental

or cultural theory,

theorist believe that

persons who come from

low socio – economic

areas or single – parent

homes in deprived areas

do not have the chance

to experience

achievements. (Shives,

Louise Rebecca

Psychiatric Mental

Health Nursing, Page

264)

Ruby together with her

family lived in a

community housing in

Talomo, Davao City The

community was also

aware of patient’s

condition including their

neighbors and friends, and

thus she is considered as a

threat to public safety in

the neighborhood. At

present, Ruby is confined

in Davao Mental Hospital

where medications are

available. Additionally,

the said institution is a

training ground for student

nurses who offer social

interaction that may

prevent isolation and self

111

– preoccupied. There were

also a proper approach in

giving care and having a

proper guidance in

patients.

Attitude toward

medication and

treatment

Maintaining the

medication regimen is

vital to a successful

outcome for client

having schizophrenia.

Failing to take the

medication regimen is

one of the frequent

reasons of the recurrence

of the illness and

hospital admission.

(Psychiatric Mental

Health Nursing, 4th

edition, Chapter 14 page

288 by Shiela L.

Videbeck, 2008).

Antipsychotics are

valuable medications,

but they do not cure

schizophrenia.

(Psychiatric Mental

Health Nursing 3rd

edition, Chapter 13 page

243 by Noreen Cavan

During her admission at

Davao Mental Hospital,

she has good compliance

in taking her medications

and treatment. After she

was discharged,

prescribed medication was

given. In addition, family

support when it comes to

financial aspect is also

important to be

emphasized in order for

the patient to continue to

comply with medications,

because non-compliance

with medications may

endanger the patient for

relapses.

112

Frisch, 2006)

Mood and Affect Patients with

schizophrenia report and

demonstrate wide

variances in mood and

affect. (Psychiatric

Mental Health Nursing,

4th Edition, Chapter 14

by Shiela Videbeck,

2008)

On the course of our

exposure at Davao Mental

Hospital, patient is

attentive and responsive

during the interaction.

Family Support Family is a source of

social support and also

be a key factor to the

recovery of the patient

with the psychiatric

illnesses although family

members are not always

positive resource in

mental health. They

often play the most

important part.

(Psychiatric Mental

Health, 4th edition,

Chapter 14 by Shiela

L.Videbeck, 2008)

When it comes to financial

aspect, it is poor because

they can’t able to sustain

the medication for the

patient. But when it comes

to emotional aspect, a

family member provides

enough emotional support

by way of visiting her at

Davao Mental Hospital,

and showing concern and

acceptance towards the

patient’s condition.

Criteria:

Onset of illness - Poor

113

Duration of illness - Poor

Environment - Good

Attitude toward medication and treatment - Good

Mood and Affect - Good

Family Support – Fair

Total:

Poor : 2/6 = 0.33 % x 100 = 33 %

Fair : 1/6 = 0.17 % x 100 = 17 %

Good : 3/6 = 0.5% x 100 = 50 %

In general, having ( 2 ) points for poor prognosis with a percentage of 33 %; ( 1 ) point

for fair prognosis with a percentage of 17% and ( 3 ) points for good prognosis with a

percentage of 50%. Having 50 % as the highest value of good prognosis this means that Ruby is

an indicative of a good outcome for recovery. On the course of our exposure in Davao Mental

Hospital, patient Ruby is complying with medications. Emotional and family support was given.

Additionally, Ruby was responsive and attentive during the interaction. At present, Ruby is

already discharged on July, 23, 2010 with a prescribed medication given.

RECOMMENDATION

114

For the family

1. They must seek education about schizophrenia and undergo counseling.

2. The family members must know how to prevent and manage relapse.

3. They must know the importance of medication in managing symptoms and preventing recurrence.

4. Family members need ongoing support and evaluation, including reassurance that they are not the cause of schizophrenia.

5. They must be aware of community support system and self-help groups.

6. They should get involved with group programs pertaining schizophrenia such as seminars.

7. The family must help client regain with reality by gently introducing conversation or activities.

8. The family must maintain patient’s medication compliance and following scheduled check ups.

9. They must know how to formulate realistic goals for the client.

10. The family members should minimize stimulating the patient by avoiding presentations of stressors.

11. The family members must maintain adequate nutrition and fluids of the client for physical and emotional wellbeing.

For the community

1. A case manager maybe assigned to the patient to provide assistance in handing the wide variety of challenges to the patient in community setting

2. Depending on the funding, the patient maybe referred to a social worker or may directly refer patient to case management services.

115

Includes assistance with housing and transportation.

Nursing management.

Socialization and recreation.

3. Community support program assess the patient’s quality of life to continue monitoring for planning of care.

For the Patient

1. Watching TV, listening to music, writing are useful to divert her attention from distressing thoughts.

2. Involve patient to reality-based activity such as playing cards, participating in occupational therapy, or listening to music.

3. The patient must comply with her medication avoid relapse.

4. Patient must be exposed to opportunities where he can make her own decisions and experience small successes.

116

Personalities Accurately Judged by Physical Appearance Alone

Science Daily (Dec. 11, 2009)

Observers were able to accurately judge some aspects of a stranger's personality from

looking at photographs, according to a study in the current issue of Personality and Social

Psychology Bulletin (PSBP), the official monthly journal of the Society for Personality and

Social Psychology. Self-esteem, ratings of extraversion and religiosity were correctly judged

from physical appearance

Researchers asked participants to assess the personalities of strangers based first on a

photograph posed to the researchers' specifications and then on a photograph posed the way the

subject chose. Those judgments were then compared with how the person and acquaintances

rated that individual's personality. They found that while both poses provided participants with

accurate cues about personality, the spontaneous pose showed more insight, including about the

subject's agreeableness, emotional stability, openness, likability, and loneliness.

The study suggested that physical appearance alone can send signals about their true

personality.

"As we predicted, physical appearance serves as a channel through which personality is

manifested," write authors Laura P. Naumann, University of California, Berkeley, Simine

Vazire, Washington University in St. Louis, Peter J. Rentfrow, University of Cambridge, Samuel

D. Gosling, University of Texas at Austin. "By using full-body photographs and examining a

broad range of traits, we identified domains of accuracy that have been overlooked, leading to

the conclusion that physical appearance may play a more important role in personality judgment

than previously thought."

117

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials

provided by SAGE Publications, via EurekAlert!, a service of AAAS.

SUMMARY:

The study suggested that Physical Appearance alone can send signals about their

personality. It shows that physical appearance has a basis of what kind of personality you have.

If you’re happy your picture will appear smiling, when you are lovely you appear sad. If you are

hungry your picture will become hostile. If you are eager you become aggressive that shows how

your personality evaluated by your appearance.

As we predicted, physical appearance serves as a chemical through which personality is

manifested. In conclusion physical appearance may play a more important role in personality

judgment than previously thought.

REACTION:

This article described that personality was determined by physical appearance it was a

basis of knowing what kind of personality a person herd. Ive agree about what the another

written on this journal reading because sometimes our facial expression with in show what kind

emotion we felt. And it is said in this article that physical appearance serves as a channel through

which personality is manifested. As a student nurse we should practice to used our clinical eye to

118

assess and to observed what kind of personality a person was experiencing and to know how

does she/he felt for the movement.

119

New Ways To Predict Violent Behavior?

Science Daily (February. 27, 2010)

In the future, diagnosing severe personality disorders, evaluating the childhood

environment, assessing alcohol consumption and the analysis of the MAOA genotype may

provide more accurate means for assessing risk among violent offenders, according to the

Finnish research carried out jointly at the University of Helsinki and the Helsinki University

Central Hospital Psychiatry Centre.

"The many negative effects of violence could be alleviated by improving the accuracy of

predicting violent behavior. Lack of knowledge about the root causes of violence is, however, an

impediment for such predictions," says Roope Tikkanen, MD, who has published his doctoral

dissertation on the subject.

Tikkanen analyzed the risk factors of violent reconvictions and mortality, using research

data collated by Professor Matti Virkkunen based on court-ordered mental status examinations

carried out in Finland during 1990-1998. The majority of the 242 men participating in the study

suffered from alcoholism and severe personality disorders. The control group comprised 1,210

Finnish males matched by sex, age and place of birth. Following a nine-year follow-up period,

the risk analyses were conducted based on criminal register (Legal Register Centre) and

mortality (Statistics Finland) data.

Risk variables used in the analyses were antisocial personality disorder (ASPD),

borderline personality disorder (BPD), the co morbidity of ASPD and BPD, childhood

adversities, alcohol consumption, age, and the monoamine oxidize A (MAOA) genotype. In

120

addition to these factors, the temperament dimensions were also assessed using the

Tridimensional Personality Questionnaire (TPQ).

The prevalence of recidivistic acts of violence (32%) and mortality (16%) was high among the

offenders. Severe personality disorders and childhood adversities increased the risk of recidivism

and mortality both among offenders and in comparison to the controls. Offenders with BPD and

a history of childhood maltreatment stood out as having a particularly poor prognosis.

The MAOA genotype was associated with the effects of alcohol consumption and aging on

recidivism. With high-activity MAOA (MAOA-H) offenders, alcohol consumption and age

affected the risk of violent reconvictions – alcohol increasing it and aging decreasing it – while

with low-activity MAOA (MAOA-L) offenders no such link existed.

The temperament dimensions of offenders included high novelty seeking, high harm avoidance,

and low reward dependence which correspond to the definition of an explosive personality.

"The risks of violent reconvictions and mortality accumulate in clear subgroups of violent

offenders. Diagnosing severe personality disorders, assessing childhood environments and long-

term alcohol consumption, and analyzing the MAOA genotype may be tools that can in the

future be employed in the prevention of recidivism and mortality and improving the accuracy of

risk assessment among offenders," says Tikkanen.

Story Source:


provided by University of Helsinki, via EurekAlert!, a service of AAAS.

121

SUMMARY:

This study reveals how to determine new ways to predict violent behavior one of it was

geno typing. Geno typing may provide more accurate means of assessing risk among violent

offenders. Childhood environment would also vary because child situation in the environment

during childhood will brought up in the future. If she live the kind of environment which is not

good example she will mostly adopt the bad traits. But if she lives in an environment that set

good example will help her to become a good example. The prevalence of recidivistic acts of

violence (32%) and (16%) was high among the offenders. Severe personality disorders and

childhood adversities increased the risk of recivism and morality both among offenders and in

comparison to the controls.

Diagnosing severe personality disorders, assessing childhood environment and long term

alcohol consumption and analyzing the genotype may be tool that can in the future be employed

in the prevention of recidivism and mortality and improving the accuracy of risk assessment

among offenders.

REACTION:

This journal reading shows new ways to predict violent behavior. Evaluating childhood

environment is on of the best factor in assessing violent behavior. In my own opinion what you

see is what you get if you live in good environment you will be good. If you live in unpeaceful

environment you will manifest inappropriate behavior. I also agree that continuation study to this

prediction of future violent behavior will help offenders to prevent and find ways how to prevent

122

it. As a student nurses we are bound to study keenly some personality disorder that will bring

violent to other people. We should render patience like this. Therefore, being violent is not good

that’s why certain studies will help to prevent some of these cases.

123

In Schizophrenia and Bipolar Disorder, Life Is Not Black and White

ScienceDaily (Feb. 23, 2010)

Schizophrenia and bipolar disorder affect tens of millions of individuals around

the world. These disorders have a typical onset in the early twenties and in most cases have a

chronic or recurring course. Neither disorder has an objective biological marker than can be used

to make diagnoses or to guide treatment. Findings in Biological Psychiatry, published by

Elsevier suggest that electroretinography (ERG), a specialized measure of retinal function might

be a useful biomarker of risk for these disorders, and retinal deficits may contribute to the

perceptual problems associated with schizophrenia and bipolar disorder.

Over the past several years, research has suggested that cognitive impairments in

schizophrenia might be linked to early stages of visual perception. This work is now drawing

attention to the function of the retina, the component of the eye that detects light. Within the

retina, rods are light sensors that respond to black and white, but not to color. Rods are

particularly important for maintaining vision under conditions of low light and for detecting

stimuli at the periphery of vision. Cones are light sensors that detect color and perceive stimuli at

the center of vision.

Using ERG, Canadian researchers Marc Hébert, Michel Maziade and their colleagues observed

that the ability of light to activate rods was significantly reduced in currently healthy individuals

who descended from multigenerational families that had members diagnosed with either

schizophrenia or bipolar disorder. In contrast, the response of their cones to light was normal.

"We take for granted that other people experience the world in the same way that we do. It is

important to appreciate that for schizophrenia and bipolar disorder, as for colorblindness or

selective hearing loss, people who appear to perceive the world normally may actually have

124

subtle but important problems with perception, which may contribute to other adaptive

impairments," comments Dr. John Krystal, Editor of Biological Psychiatry.

Scientists are still searching for a valid biomarker for the heritable risk for schizophrenia and

bipolar disorder. Although the current data are interesting, extensive testing is still needed before

the utility of this measure as a risk biomarker can be evaluated.

The article is by Marc Hébert, Anne-Marie Gagné, Marie-Eve Paradis, Valérie Jomphe, Marc-

André Roy, Chantal Mérette, and Michel Maziade. All authors are affiliated with Centre de

recherche Université Laval Robert-Giffard, Québec, Canada. The article appears in Biological

Psychiatry, Volume 67, Issue 3 (February 1, 2010), published by Elsevier.

|

Story Source:


provided by Elsevier, via EurekAlert!, a service of AAAS.

Journal Reference:

1. M. Hébert, A. Gagné, M. Paradis, V. Jomphe, M. Roy, C. Mérette, M. Maziade. Retinal

Response to Light in Young Nonaffected Offspring at High Genetic Risk of

Neuropsychiatric Brain Disorders. Biological Psychiatry

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http://www.elsevier.com/

http://www.eurekalert.org/

SUMMARY:

Schizophrenia and Bipolar disorder affects ten millions of individuals around the world.

(Elsevier Sluggurt that Eleetroretionography (ERG)). Specialized a measure of retinal function

might be useful biometer of risk for these disorder, and retinal deficits may contribute to the

perceptual problems associated with schizophrenia and Bipolar disorders.

In the past study research suggested that cognitive impairment in schizophrenia might be

linked to early stage of visual perception. It shows that Illusion can affect normal perception. It

alters the state of the mind. Retina plays important role in visual perception and illusion is one of

alteration in retinal function.

REACTION:

Our opinion in this article is lying Electroretinography will help as a biomater of risk for

disorder of perceptual problems such as schizophrenia and Bipolar disorder. Life is not black and

white indeed its just the alteration in perceptual impairment would be the factor for that matter.

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EVALUATION

General:

The case study provided us a better understanding on schizophrenia, paranoid type.

Specific: at the end of our case study, we were able to:

•Extended our deepest appreciation on those people who contributed in the completion of this case presentation.

•We had made an introductory statement about the schizophrenia paranoid type and the case study.

•We had defined the various terms used in the case study.

•We had gathered necessary information about the patient from her immediate family, friends and neighbors;

•We had conducted and presented the mental status examination of the patient as well as his capacity to relate and communicate with student nurses;

•We had identified the predisposing and precipitating factors that contributed to the condition of the patient;

•We was able to trace the psychodynamics of the case and relate it with Erik Erikson’s theory of growth and development;

•We had defined in our case presentation the psychiatric management needed by

the patient;

•We had presented a drug study on all medications given to our patient in the case study;

•We had formulated the an appropriate and effective nursing care plans on the identified problems experience by the patient;

•We had justified the possible prognosis of the patient on the case;

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BIBLIOGRAPHY

Videbeck, Shiela Psychiatric Mental Health Nursing, 2nd Edition, 2004

Keltner, et. al. Psychiatric Nursing, 3rd Edition, 2002

Cook, J. Sue and Fontaine, Karen Lee Essentials of Mental Health Nursing, 1987

Thompson, et. al. Mosby’s Clinical Nursing, 4TH Edition

Otong, Deborah Psychiatric Nursing Biological and Behavioral Concepts, Thomson Asian

Edition, 2003

Jarvis, C. Physical Examination and Health Assessment, 4th Edition, 2004

Doenges,M. Nursing Care Plans ,11th Edition

Kozier, B. Fundamentals of Nursing, 9th Edition

Saunders, Nursing Drug Handbook, 2007

INTERNET SOURCES:

www.encyclpoedia.com

www.wikipedia.com

www.sciencedaily.com

www.yahoo.com

www.google.com

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http://www.google.com/

http://www.yahoo.com/

http://www.sciencedaily.com/

http://www.wikipedia.com/

http://www.encyclpoedia.com/

combined na tanan!

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