paranoid schizophrenia - case study

Paranoid Schizophrenia

A Case StudyPresented to the Faculty of

College of Nursing and MidwiferyBataan Peninsula State University

In Partial FulfillmentFor the Requirement in the Degree of

Bachelor of Science in Nursing

Alonzo, Mizzy AnneAngulo, Louie Anne

Antonio, John AndrewBarros, Hazelyn Joy

Buenaventura, mark RichardCortez, Romieline

Crisostomo, Florina MaeDe Mesa, AlvinDe Silva, Janelle

Dela Torre, Mariel KimDiego, Lorenz Anthony

Fajardo, CamilleFelipe, Yvette

Group11ThFs

1

TABLE OF CONTENTS

UNIT 1

I. Dedication and Acknowledgement………………………………………..II. Personal Data………………………………………………………………III. Chief Complaint…………………………………………………………….IV. Health History………………………………………………………………

a. Past health history………………………………………………………b. Present health history…………………………………………………...c. Family history…………………………………………………………...

i. Social history……………………………………………………ii. Childhood……………………………………………………….iii. Adolescence……………………………………………………..iv. Adulthood……………………………………………………….

d. Sexual history…………………………………………………………...

UNIT 2

Mental Status Assessment / Analysis and Interpretation…………………………

UNIT 3

a. Psychopathology………………………………………………………………..b. Related Literature………………………………………………………………

UNIT 4

a. Nursing Care Plans……………………………………………………………...b. Pharmacology…………………………………………………………………...

UNIT 5

Psychotherapy…………………………………………………………………………..

UNIT 6

Glossary…………………………………………………………………………………

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UNIT 7

Reference……………………………………………………………………………...

UNIT 8

Documentation………………………………………………………………………….

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UNIT I(Dedication, Acknowledgement, Introduction, Personal Data,

Chief Complaints and Health History)

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DEDICATION

This work is dedicated to our parents, family relatives and friends.

Without their patience, understanding, support

and most of all love, the completion

of this work would

not have been

possible.

Also, it is dedicated to our colleagues

who will conduct the

same studies in

the future.

And lastly, to our GOD who

provide us knowledge and

strength in making

this work.

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ACKNOWLEDGEMENT

First and foremost, we would like to thank to our Almighty God,

who gives us strength, knowledge, and good health in

pursuing this comprehensive

case study.

And also to our family who gave all the emotional and financial

support and motivations at all times and

they also serves as our

inspiration.

We would like also to acknowledge our clinical instructor

Sir Ronald Tyron dela Rosa for the support,

patience, knowledge, and contributions

to finish this comprehensive

case study.

We would like also to thank Sir Ronnell Dela Rosa

and Ma’am Irish Lee for helping and giving

some encouragement to make our duty

possible and able to enjoy

our stay in Mariveles.

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II. INTRODUCTION

Schizophrenia is a mental disorder characterized by the disturbances in thoughts,

sensory perception and deterioration in psychosocial functioning. It is also characterized by a

weak ego. The common defense mechanisms used by individual are regression, projection,

withdrawal and denial. There are four A’s to acknowledge in having schizophrenia, first, the

associative looseness, the blunted affect, ambivalence and the autistic thinking.

Paranoid schizophrenia is the most common type of schizophrenia in most parts of the

world. The clinical picture is dominated by relatively stable, often paranoid, delusions usually

accompanied by hallucinations particular auditory variety, and perceptual alterations.

Disturbances of affect, volition and speech, and catatonic symptoms are not prominent.

Paranoid Schizophrenia is manifested primarily through impaired thought processes, in which

the central focus is on distorted perceptions or paranoid behavior and thinking. Delusions are

in most cases grandiose, persecutory or both. (WHO 2005)

With paranoid schizophrenia, the ability to think and function in daily life is better

compare with other types of schizophrenia. It may not have as many problems with memory,

concentration or dull emotions. Still, paranoid schizophrenia is a serious, lifelong condition

that can lead to many complications, including suicidal behavior.

Those individuals who diagnosed with paranoid schizophrenia are not especially

prone to violence; often prefer to be alone. Studies show that if people have no record of

criminal violence prior to develop schizophrenia and are not substance abusers, then they are

unlikely to commit crimes after they become ill. Most violent crimes are not committed by

people with paranoid schizophrenia, and most people with schizophrenia do not commit

violent crimes. Substance abuse always increases violent behavior, whether or not the person

has schizophrenia.

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If someone with paranoid schizophrenia becomes violent, their violence is most often

directed at family members and takes place at home. These individuals may spend an

extraordinary amount of time thinking about ways to protect themselves from their

persecutors.

In the US paranoid schizophrenia reports issued by Centers for Disease Control and

Prevention (CDC) for 2000 revealed 121,000 diagnoses of paranoid schizophrenia in non-

Federal, short-stay hospitals (73,000 men and 47,000 women). Most individuals (62,000)

were between the ages of 15 and 44; none were under age 15; 37,000 were between 45 and

64; and 21,000 were 65 or older. According to geographic distribution, the highest prevalence

is in the South and Northeast regions of the US with the lowest prevalence in the West and

Midwest are almost equal. (Medical Disability Advisor, 2010)

The onset of the disorder is usually later than catatonic or disorganized schizophrenia.

Men have earlier onset, and more frequent than women. Women have a bimodal onset with

peaks in their 20’s and early 40’s. One study demonstrated within subtype age of

institutionalization gender differences only for paranoid schizophrenia (Salokangas et al.,

2003).

The present etiology of the paranoid schizophrenia are the following, genetics it is

known because people believed that mental disorder can be inherit. Other causes are

decreased dopamine, stress, alcohol abuse and substance abuse.

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http://www.mdguidelines.com/medical-topics

Prognosis of the disease is good when there is no familial history of the disease, the

patient has good social and professional adjustment prior to onset of symptoms, if the disease

come suddenly and the disorder is treated early, quickly, consistently. And onset symptoms

occur at later years of life and there is an absence of symptoms between psychotic episodes.

Paranoid schizophrenia is usually treated with a combination of therapies, tailored to

the individual's symptoms and needs. Anti-psychotic medications can reduce hallucinations

and disordered thinking, but do not affect the social withdrawal that is common among those

with paranoid schizophrenia. Failure to take medication even during remission periods can

result in a relapse. Psychotherapy is used to address the emotional and social issues that result

from paranoid schizophrenia. Group therapy can be especially helpful, because it creates

opportunities for socialization for individuals with paranoid schizophrenia.

The reason of choosing paranoid schizophrenia as study is to add knowledge, and to

know different contributing factors in developing the said illness. Perhaps to correct the

misconception of not all people who have mental illness are violent and dangerous. While

this may be true in some cases, the generalization has been made far too widely.

These attitudes contribute to a significant amount of prejudice against the mentally ill,

which may prevent people from seeking help. Stigma may also affect people’s recovery,

contributing to low self-esteem and decreased social contact. In contrast to physical health

issues, most people in our community avoid even discussing the subject of mental illness,

dancing around the issue in the shadow of these pervasive misconceptions.

Moreover, the preferred client had a superficial manifestations which seen directly to

the clients experiencing the said mental illness. And the client was cooperative and provided

primary information that we needed in conducting this study.

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III. Personal Data

Name: J.M

Age: 44

Sex: Male

Citizenship: Filipino

Civil Status: Separated

Religion: Roman Catholic

Place of Birth: Sampaloc, Manila

Date of Birth: September 3, 1966

Address: #42 Pag-asa Orion, Bataan

Occupation prior to admission: Police in Bureau of Custom

Education: Vocational Graduate

Date and time of admission: November 20, 2007 / 2:00 pm

Previous admissions: November 2, 1989- December 18, 1991

December 15, 1992 – December 18, 1992

December 11, 1195- August 31, 1996

August 23, 1997- June 21, 1998

January, 1999- February 25, 2000

February 28, 2000- January 12, 2004

May 29, 2004- September 19, 2007

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Admitting Diagnosis: Paranoid Schizophrenia

Attending Physician: Dr. Cortez

Place where he spent the last 15 years of his life:

(1990’s)Manila, Lubao, Bataan;

(2005-Aug2010)America;

(August 2010-present)MMH

Informant: JM’s cousin

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IV. CHIEF COMPLAINTS

Mang JM admitted on November 20, 2007 due to ff:

“Maraming J.M, patay na yung galing dito.”- Mang J.M

Positive delusions

Refused to medications

Neglected hygiene

Talking aloud

May 29, 2004

Refused to medications “Lason daw ang gamot”

Refused check- ups

Threatening his mother

Escape

Alcohol intake

February 28, 2000

Talkative pressure speech

Denial, auditory hallucination

Evasive and manipulative

Refused to medication

Smoked and drinks alcohol

Started fights and walking

January 19, 1999

Denied presenting complaints

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Oriented to place

Had positive persecutory as he said “ Hinampas ako ng tubo kahit nagbibigay ako ng

pera sa kanila”

Impaired sleep

Nagmumura, mainitin ang ulo

Nagbabanta

August 23, 1997

Morbid ideas “ Gusto ko na sanang mamatay kahit sinong pumatay walang

kasalanan”

December 11, 1995

Refused to oral medications

Suspicious and jealous to his wife and relative

Impaired sleep

Violent tendency when in influenced of marijuana

December 15, 1992

Impaired sleep

“Namumulot ng basura”

Denies auditory hallucination and tangentiality

Homicidal and suicidal

“Kung saan-saan humihiga”

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November 2, 1989

Nagwawala ( kung ano maisapan gawin gagawin, nambabato, hindi nakakakilala at

seloso)

Impaired sleep

Talking to self

20 months ago J.M claimed “Hindi na ko magmamaneho, magpapahinga muna ko”

Agitated

Nervous- as if afraid of something

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HEALTH HISTORY

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V. Health History

a. Past Health History

(From the chart and JM)

According to Mang J.M’s chart he was first admitted in Mariveles Mental

Hospital on November 2, 1989, when his cousin who lived in Orion, Bataan took him

in the MMH for checked –up because as he noticed, Mang J.M seemed agitated,

nervous and afraid of something for approximately 20 months after the incidence of

hitting an old man in the highway while he was a jeepney driver. Upon arriving at

home Mang J.M said that “Hindi na ko magmamaneho, magpapahinga muna

ako.”After his consultation, he was advised for the confinement. The manifestations

became persisted. He had chief complaints of having impaired sleep, talking to self,

became aggressive and violent (nagwawala, kung ano maisipan gagawin, nambabato,

hindi nakakakilala, at seloso). Mang J.M consumed 1 pack of cigarette per day and

drinks 2 bottles of red horse and san Mig light. Based on the reported cues of his

cousin, Mang J.M was then diagnosed of having bipolar manic and alcohol abuse by

his attending psychiatrist, Dr. Rivera.

During his confinements, he took medications such as Haloperidol 5mg,

Chlorpromazine 500mg, Risperdal ½ tablet, Roziman 50 mg, Diperidem HCL,

Valporic acid 500mg, Levomeprazine 100 mg, Tusperidone1/2 tab, Bepeoden 1tab

20mg. These various type of drugs are psychotropic medications which being used in

the treatment of mental illness.

After his first discharged on December 18, 1991, Mang J.M did not have a

follow up consultation in MMH because he refused to. His relatives brought him at

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NCMH to have his first check-up on April 1992 and noted that there was no follow up

due to Mang J.M refusal.

Mang J.M was brought in MMH on December 15, 1992. He had complaints of

impaired sleep, “namumulot ng basura at kung saan- saan nahihiga”, denies auditory

hallucination and tangentiality, having escape, homicidal and suicidal. After 3 days

observation at ACIS he was discharge on December 18, 1992.

On March 4, 1993, Mang J.M applied as a trainee messenger at Binondo,

Manila. He smoke heavily and suspected use of marijuana with unspecified amount

and frequency.

On December 11, 1995, according to his chart, he was admitted in MMH

again because he had impaired sleep and became jealous and made suspicion on his

wife-- he thought that his uncle was having affair with his wife at the point that he

saw the two having sex in their home, and started refusal in taking oral medications.

Mang J.M did not comply with his drug regimen. He appeared that he was having

violent tendency when he was influenced of marijuana as recorded on his chart, but he

continues to deny. He claimed that he never used marijuana because it causes skin

diseases. On, January 1, 1996 Mang J.M was placed on isolation by 15 days because

he became violent and aggressive, according to his chart. And he attempted escape on

May 28, 1996. Like on his previous admission, he recovered and was discharged on

Aug 31, 1996.

Mang J.M had a morbid ideas about his death, where he claimed that “gusto

ko na sana ng mamatay, kahit sinong pumatay walang kasalanan.” This was the

complaint on his admission on August 23, 1997.

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On June 21, 1998, Mang J.M had his home visit and went back in MMH

afterwards.

January 19, 1999 when he returned in MMH, Mang J.M denied presenting

complaints, oriented to place, had positive persecutory delusions as he said “hinampas

ako ng tubo, kahit nag bibigay ako ng pera sa kanila.” But there were no evidence of

physical injury upon assessment. Also, he had complaints of having impaired sleep,

“nagbabanta”, “mainitin ang ulo”, at “nagmumura.”

After a year, on February 25, 2000 he was discharged. At home, Mang J.M

started to become talkative and having pressured speech. He used to deny when he

was asked. He had auditory hallucination, become manipulative and evasive. Mang

J.M regains his vices and did not take his medications. He smoked and drinks alcohol

heavily. Also, he walks endlessly and started fights. Due to reported behaviors of

Mang J.M, he was placed back in MMH on February 28, 2000; he claimed that his

mother did not provide his medications upon interview. Mang J.M was admitted

thereafter. He was forced to take his medications to treat the displayed manifestations.

Mang J.M escaped in the hospital on December 25, 2000, but after several

days on January 2, 2001 he returned by his relatives. He was discharged on January

12, 2004.

After four months, Mang J.M was readmitted on May 29, 2004 because he

refused to take medications and claimed “lason ang gamot”, he done physical abuse to

his mother and threatened her. Mang J.M refused for check-ups, continues to drink

alcohol and escapes. These are the following complaints why he returned in MMH.

But on September 7, 2007 he was allowed for home conduction and discharged on

September 19, 2007.

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He had conversation last October of the same year and according to his chart

Mang J.M used to smoke and suddenly punch a neighbor. Later, Mang J.M refused to

medications and had an impaired sleep.

In contrary, Mang J.M said that he was just admitted last year and will be

discharged on the 3rd of February 2011.In fact he was 4 yrs at MMH since his recent

admission on November 20, 2007. According to him he was admitted in MMH not

because he was a mentally ill, but because his mother wants to keep him away from

the persons who wanted to steal his wealth and killed him after.

b. Present Health History

Mang J.M was been in MMH since his latest admission on November 20,

2007, around 2:00 pm with the diagnosis of paranoid schizophrenia by his attending

psychiatrist, Dr. Cortez. He was placed at male ward B. According to his chart, Mang

J.M’s chief complaints was having delusions and saying “Maraming J.M, patay na

yung galing dito”, refused to medications, neglected hygiene, irritable and talking

aloud. He was given Haloperidol 5mg 1amp, and Chlorpromazine 500mg tablet take

at bedtime. These are psychotherapeutic drugs used by Mang J.M for the treatment of

the disorder.

In addition, Mang J.M had alterations in thought process, thinking and

communication, in perceiving and interpreting, in behaving and interpreting Mang

J.M manifested illusions, delusions, grandiosity, hyperactive and withdrawal.

During the orientation, Mang J.M showed good cooperation with the SNs he

was very eager to talk then suddenly jumped into another topic and discuss unrelated

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matters. He said that he was single and a very rich man and owned not only houses,

but mansions. Mang J.M is always oriented to person, date, time and place.

Mang J.M refused on the grooming sessions in the first two weeks and done

grooming on the last week but only brushing of his teeth. Mang J.M wears a wrinkled

white shirt paired with abstract designed short until the last week, during Grand

socialization he puts on the uniform of MMH as his topped.

On the therapies, he was cooperative and active participant. He used to talk a

lot and listen attentively. Mang J.M’s laughed when his fellows provided wrong

answers and made his judgments afterwards. During the nurse- client interaction he

said that the persons around would kill him, and he added that he was just kidding. In

addition, Mang J.M told that they are making a big swimming pool on the side of

ACIS (MMH), he was a very rich man and owned the international corporation of san

Miguel,he denied used of illegal drugs but admitted that he drinks alcohol and until

now he used to smoke.

Moreover, according to Mang J.M, he had his own planet where exactly

looked like earth. He described that there are living things such as cow, carabao,

plants and people. He added that there is a big TV screen where he saw individuals

like his two student nurses together with their loved ones and also our clinical

instructor. Mang J.M named a thing which is “aparachi”. This thing was a peanut

shape like, covered with gold and brings out everything that people need, as he

explained. He also said that he had a conversation with the former president of USA,

George Washington.

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Lastly, Mang J.M appeared always hyperactive and talked about different

killings. In contrast he claimed that he was good and did not bring any harm to others.

He used to be keen listener and observer, Mang J.M knew when the questions are

being change but with the same thoughts. He also used various defense mechanisms

such as denial, projection and others. Moreover, Mang J.M manifested grandiosity,

illusions, and delusions.

c. Family history

According to Mang J.M., they were four and he was 2nd to the eldest in his family. His

father died when he was 6 years old due to heart attack while her mother was still alive. They

were raised and sent in good school by his mother, who was a dress maker. His three siblings

have their own family and lived separately while Mang J.M remained single, which is

contrary to the chart because his marital status is married and became separated to unnamed

woman and they have no child.

Also, he said that he had no known history of having mental illness in the family.

Same in the chart, there were no reports that somebody in their family suffered from the same

condition.

d. Social History

i. Childhood

Mang J. M told that he was born on September 3, 1966, in Sampaloc, Manila. He

grew together with his family, but his father was died when he 6 years old. His mother raised

them and sent to school. Mang J.M during his childhood, he once been like the other children,

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he played all day and love vacations. He was sent in Lubao, Pampanga every school break

with his siblings and lived with his grandmother.

His mother decided to bring him in schooling at Lubao Elementary School when he

was 8 years old. Mang J.M was then separated from his mother and siblings as well, though

he told that it was sad at first. But he was used to it because this was not usual to him. By this

time, he lived in Lubao in longer time. He joined his grandmother at home, helped her in

chores and taking good care of the cows in their farm, as he added. During his free time

according to Mang J.M, he played with their neighbors. Those routines ended when he came

back in Manila to continue his study for high school.

ii. Adolescence

He entered high school at St. Jude College. According to him he was an active

student. He joined competitions and different events whereas dancing and singing was his

forte. He was been an officer in CAT during his time. Mang J.M also had peers, and he joined

fraternity when he was 2nd year high school. He said that those persons were good. They had

bonding all the time and accompanied him through his ups and downs.

During his high school life, Mang J.M learned to smoke and drinks alcohol together

with his friends. He added that he consumed at least two bottles of each San Mig Light and

Red Horse and 1 pack of cigarettes per day.

In addition, he also met his first girl friend which is CD during intramurals in their

school, as he claimed that they last for almost six years. They were enjoying each others’

company, when there was a time that he experienced his first heartache because his girl friend

went with other man. Mang J.M felt loneliness and depression. But he added that he easily

coped up because he found a new love with EI. Like the first relationship it has to end.It last

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for one year and they totally separated because of the reason that he moved in Bataan to talk

with his godfather about abroad and EI went to Pangasinan.

Moreover, he experienced those heartaches during his college years and according to

Mang J.M he easily coped to those matters. In contrary, he said that he and CD were cool off

and still in touch with each other.He claimed again that he entered MAPUA for his course

police authority which is contrasting to his chart which showed that he finished vocational

course.He admitted that he continued smoking and drinking alcohol, and denied use of illegal

drugs.

iii. Adulthood

Mang J.M claimed that he went in US after his graduation in college from the

year 2000 up to 2005. He became a Navy in US as he claimed. His habits were smoking,

drinking alcohol, bar hopping but denied having sexual intercourse neither got married.

Mang J.M said that he could drink two bottles of each San Mig Light and Red Horse

because it was less expensive, consumed 1 packed of cigarettes per day, but consistently

denies used of illegal drugs like marijuana.

After Mang J.M came back from US, he became a driver in Orion, Bataan and

worked in Bureau of Customs where he was a police authority as he said.

He spent his life in Manila, and Orion where he went fishing; making his vices

and lived there for several years. According to Mang J.M, he also spends his life inside

MMH as his record showed he was started to admit since1989. But he claimed that this was

his first admission yet he claimed that he returned to work after his previous discharged.

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e. Sexual History

Based on his chart he was separated which he continues to deny. He always says that

he was single for the longest time and he claimed that giving roses to someone was a

burden.

Also, he admitted that he had previous relationships. He added that they were happy

having each other’s company, he admitted that he did kissing and touching private parts of

his previous girlfriend’s body as their mutual willingness. But not involved in sexual

intercourse as he added.

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UNIT II(Mental Status Assessment)

25

MENTAL STATUS ASSESSMENT

Name : Mang JM

Age : 44 years old

Ward : Male Ward A

ORIENTATIONDay

1Day

2Day

3Day

4Day

5Day

6Day

7Day

8Day

9Person

OR

IEN

TA

TIO

N

SE

LF

-A

WA

RE

NE

SS

Place Date Time Situation

Legend: - manifested by Mang JM

- not manifested by Mang JM

Analysis and Interpretation:

Day 1: Orientation

Day 2: Self awareness

Day 3

No unusual finding was noted on Mang JM’s orientation. He was oriented and we

knew it by his right response when we asked the above noted.

SN: “Ano pong pangalan niyo?”

C: “JM.”

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SN: “Alam niyo po ba kung nasaan po tayo ngayon?”

C: “Oo, nasa mental nagpapagaling.”

SN: “Ano pong petsa ngayon Mang JM?”

C: “Ngayon ay Friday January 14, 2011.”

According to Nightingale, changing and manipulating the environment in order to put

the patient in the best possible conditions for nature to act.

Day 4



SN: “Ano po pangalan niyo?”

C: “JM.”


C: “Oo sa mental nagpapagaling.”

SN: “Ano pong petse ngayon Mang JM?”

C: “Ngayon ay Miyerkules January 19, 2011, umaga.”

According to Sigmund Freud there is a part of the mind called preconscious,

thought and emotions are not currently in the person’s awareness, but he can recall

them with some effort

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Day 5




C: “JM.”


C: “Oo sa mental”


C: “Ngayon ay Huwebes ng umaga January 20, 2011.”

As mentioned on Helson’s Theory, adaptation is a process of responding

positively to environmental changes. Mang JM adapts effectively as he was able to

identify the changes in her environment and positively responds to it.

Day 6




C: “JM.”


C: “Oo dito Mariveles sa mental.”

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C: “Ngayon ay Biyernes ng umaga January 21, 2011.”

According to Nightingale, changing and manipulating the environment in

order to put the patient in the best possible conditions for nature to act.

Day 7




C: “JM.”


C: “Oo sa mental nagpapagaling.”


C: “Ngayon ay Miyerkules ng tanghali February 2, 2011.

According to Roy, awareness of self and environment is rooted in thinking and

feeling. Mang JM was aware of his environment.

Day 8




C: “JM.”

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SN: “Nasaan po ba tayo ngayon Mang JM?”

C: “Dito sa mariveles.”

SN: “Eh! Anu po bang araw ngayon?”

C: “Huwebes, Thursday February 3, 2011.”

SN: “Alam niyo po ba ang gagawin natin ngayon?”

C: “Sasayaw tayo ngayon.”



Day 9




C: “JM.”

SN: “Nasaan po ba tayo ngayon?”

C: “Dito sa pantry, sa mariveles.”

SN: “Alam niyo po ba ang gagawin natin ngayon?”

C: “Grand Socialization.”

SN: “Anu po bang araw ngayon?”

C: “Friday, February 4, 2011.”

30



31

DEFENSE MECHANISMS:

Day1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

a. Repression

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

b. Suppression c. Regression d. Fixation e. Denial f. Displacement g. Conversion h. Identification i. Intellectual j. Introjections k. Projection l. Rationalization m. Sublimation n. Substitution o. Symbolism p. Undoing q. Reaction Formation r. Fantasy




Day 1: Orientation


Day 3

Mang JM manifest one of the defense mechanism; Rationalization we noticed that he

always justify his answer. He also manifest Denial as he said “Hindi man ako malakas

uminom paminsan minsan lang.” and Projection during our conversation when we asked him

“Malakas po ba kayo iinum ng alak Mang JM?” he said “Hindi ah!mahina ako iinum eh,

siguro ikaw malaks kang iinom noh?”

32

According to Roger, the human being is a unified whole, possessing individual

integrity and manifesting characteristics that are more than and different from the sum

of parts.

Day 4

Mang JM manifest one of the defense mechanism; Fantasy we noticed that he always

says he was close to George Washington because he once went to United States of America

and met together and became friends. Maybe he wants us to be amazed of him.

SN: “Umano po kayo sa America Mang JM?”

C: “Wala may bahay kami doon, kakilala ako nun ni George Washington.”

According to Johnson, Each individual has patterned, purposeful, repetitive ways of

acting that comprises a behavioral system specific to that individual.

Day 5

We don’t recognize any defense mechanism.

Day 6

Mang JM manifest one of the defense mechanism; Denial and Reaction Formation,

we noticed that he’s angry but he denies it obviously he is because of the tone of his voice

and through his gestures my slapping his legs. He smiled unnaturally.

SN: “Nagagalit po ba kayo Mang JM.”

C: “Hindi ako galit.”

SN: “Oh, ngiti nap o kayo.”

33

C: (Smiled but looks uncomfortable)



of parts.

Day 7

Mang JM manifest one of the defense mechanism; Projection he often projects situations to

us.

SN: “Mang JM, ngayon pong malapit na ang valentines may plano po ba kayong pagbigyan ng flowers?

C: “Wala pa nga eh, hirap kasi baka may boyfriend na o may asawa na ang babae eh.”

SN: “Anu pong dahilan at nasabi niyong mahirap?

C: “wala naman, ikaw marami ka ng napagbigyan ng rosas noh?”

In erik erikson’s psychosocial theory, in infant stage, the infant must

learn to develop basic trust that she will be fed and taken care of, mistrust, the

negative outcome of this stage will impair the person’s development

throughout her life.

Day 8

Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, he

denies that he’s not ever try a drugs/ marijuana, reaction formation because he said that he’s a

good boy.

34

SN: “Mang JM nakapagtry nap o ba kayo ng Drugs?”

C: “Hindi hindi ako gumagamit ng ganon.”

SN: “Ano pong dahilan?”

C: “Hindi, bawal yun samin mabait ako, hindi ako nangaaway, hindi ako nagdaDrugs, mabait

ako.”



of parts.

Day 9

Mang JM manifest one of the defense mechanism; Denial and Reaction Formation,

Mang JM denies use of drugs/ marijuana, reaction formation because he said that its not good

for our body.

SN: “Anu po ba ang feeling kapag naka-drugs?”

C: “Ay hindi, hindi ako gumagamit ng ganon.”

SN: “Anu pong dahilan?”

C: “Eh! Bawal kasi samin yun, tsaka nakita mu ba yung iba may mga galis galis dahil sa

drugs yun.”

SN: “Talaga po Mang JM?”

C: “Oo, maniwala kayo masama sa katawan yun, mabait ako.”

35



of parts.

36

EXTRAPYRAMIDAL SYMPTOMS:

Day1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Pseudoparkinsonism

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

1. Masklike face

2. No swinging of arms

3. Hesitancy of speech 4. Decreased muscle

strength

5. Shuffling gait 6. Drooling

7. Fine intention tremors

Acute Dystonic Reaction

1. Muscle, spasm of jaw, tongue, neck, eyes

2. Laryngeal spasm Akathisia1. Restlessness 2. Tenseness 3. Inability to sit still 4. Rocking back and forth

of feet

5. Crossing leg frequently

6. Inability to relax Tardive Dyskinesia

1. Involuntary movements of mouth, face, may extend to fingers, arms and trunk




37

Day 1: Orientation


Day 3

Our client displayed EPS under akathisia, during conversation we observed that Mang

JM crossing leg frequently and inability to relax by rocking back and forth on feet and

appears restlessness.

In Orem’s self care model, the nurse should help the client by doing

pharmacotherapy to manage their movement because according to Orem, the

nurse provides assistance to those who are unable to meet self care needs. The

nurse is required therapeutic care to the client with self care deficits until the

person can care for herself.

Day 4

Our client displayed EPS under akathisia, during our therapy we noticed that Mang

JM crossing leg frequently that manifest all through our conversation.

According to Henderson, unique function of the nurse is to assist the

individual, sick or well, in the performance of those activities contributing to health or

its recovery that he would perform unaided if he had the necessary strength, will, or

knowledge.

Day 5

38



According to Ida Jean Orlando’s nursing process theory, she assumes that

freedom from mental or physical discomfort and feeling of adequacy and well being

contribute to health.

Day 6





its recovery (or to peaceful death) that he would perform unaided if he had the

necessary strength, will, or knowledge.

Day 7



According to Orem’s self care deficit theory, it describes why a person needs self care

but in the presence of illness, there was a deviation.

Day 8

Our client displayed EPS under akathisia, during our conversation we noticed that

Mang JM crossing leg frequently.



39



Day 9

Our client displayed EPS under akathisia, during our grand socialization we noticed

that Mang JM crossing leg frequently that manifest all through our conversation.





THINKING AND COMMUNICATION:

40

Day1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Looseness of Association

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

Neologism

Word salad

Echolalia

Echopraxia

Clang Association

Illogical thinking

Alogia

Concrete thinking

Lack of insight

Aphasia

Apraxia

Agnosia

Flight of ideas




Day 1: Orientation


Day 3

Our client displayed looseness of association, these are neologism and echolalia. He

mentioned the word “wisboro” which do not have meaning and repeating the questions we

asked.

41

According to King, Each individual brings a different set of values, ideas, attitudes,

perceptions to exchange.

Day 4

Our client displayed looseness of association, these are neologism and echolalia. He

mentioned the word “aparachi” which do not have meaning and echolalia such as the

shoemaker, the shoemaker which he unconsciously saying. Our client also manifested

concrete thinking of flight of ideas.

According to King, Each individual brings a different set of values, ideas,

attitudes, perceptions to exchange.

Day 5

During the interview our client displayed lack of insight because sometimes he’s

saying something which has no sense or even relation on the topic and flight of ideas.

SN: “Anu po bang ginagawa niyo doon?”

C: “Nagtatrabaho, Nagbabantay ng bagahe, tapos may nahuhuli din akong isda noon.”

According to jean piaget’s stage of preoperational thought (2-7 yrs.). In this stage,

thinking and reasoning are intuitive, children learn without the use of reasoning.

Day 6

During the interview our client displayed looseness of association, these is neologism.

He mentioned the word “aparachi” which do not have meaning.

SN: “Anu po bang ginagawa niyo doon?”

C: “Nagbabantay ako dun, tas dun yung aparachi.”

42

SN: “Anu po yung aparachi?”

C: “ gold yun, kung saan may lualabas na kalabaw, truck at kung anu ano pa.”

According to King, Each individual brings a different set of values, ideas,

attitudes, perceptions to exchange.

Day 7

There were no alteration of Mang JM’s thinking and communication.

Day 8

During the interview our client displayed flight of ideas because Mang JM introduces

new topic without completing the topic.

SN: “ Ano pa po ba yung gingawa niyo doon?”

C: “wala naman nagbabantay, tignan mo yun oh mangga.”

Piaget viewed intelligence as an extension of biological adaptation that

has a logical structure. Every stage occurs at a certain age, and children show a

higher level of thought organization during each successive stage of

development.

Day 9

There were no alteration of Mang JM’s thinking and communication.

43

PERCEIVING AND INTERPRETING:

Day1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Delusion

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

1. Reference

2. Persecution

3. External influence

4. Somatic

5. Grandiose

Hallucination

Illusion Depersonalization

Attending to relevant stimuli

Poor reality testing

Attending to irrelevant stimuli

Poor reality testing




Day 1: Orientation

Day 2: Self- awareness

Day 3

There was no alteration noted on Mang JM’s perceiving and interpretation.

44

Day 4

There is an alteration on perceiving and thinking; Persecution Delusion by saying “if

you want to kill me just tell me” and Grandiose Delusions by saying he is very rich. He also

manifests illusion by saying that the clouds near on the mountain are smoke cause by burn.

According to Neuman, maintains balance and harmony between internal and external

environment by adjusting to stress and defending against tension-producing stimuli.

Day 5

There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by

saying “madami diyan sa paligid mamamatay tao” and Grandiose Delusion by saying

“marami kaming pera, nung minsan nagpunta dito yung mga truck namin ng pera”. He also

manifests illusion by saying “doon sa ACIS may swimming pool kaming pinagawa diyan.”

According to psychodynamic theory of Sigmund freud , this perceptual motor

syndrome is developing from a person with psychic alterations. In addition, these alterations

are contingent on the poor caregiving that is provided within the environment.

Day 6


saying “dito lang tayo ah, wag kayo lalabas may mga mamamatay tao doon.” And Grandiose

Delusion by saying “Oo maniwala ka sakinkami nagpagawa ng mga building na yun.” He

also manifests illusion by saying “nakita mo na aba yung swiiming pool sa may ACIS?”

45

According to Neuman, maintains balance and harmony between internal and

external environment by adjusting to stress and defending against tension-producing

stimuli.

Day 7

There is no alteration on perceiving and thinking, manifest Grandiose Delusion by

saying “Oo, meron kaming mansion dito sa Mariveles.”

Day 8

There is no alteration on perceiving and thinking, manifest Grandiose Delusion by

saying “Marami nga kaming mga sasakyan eh! Tsaka Pajero.”

According to King, human beings are open systems in constant interaction

with the environment.

Day 9


saying “tinago ako ni mommyko kasi maraming pumapatay diyan eh!” he also manifest

Grandiose Delusion by saying “marami ako pera, totoo yun.”

According to Neuman, maintains balance and harmony between internal and

external environment by adjusting to stress and defending against tension-producing

stimuli.

46

FEELING AND AFFECT:

Day1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Flat

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

Blunted

Inappropriate

Lability




Day 1: Orientation


Day 3

No unusual finding because client displays appropriate feeling and affect now.

Day 4

Our client manifest labile mood during our therapy he suddenly laughing for no

reason then suddenly back to serious mode.

47

According to Lazarrus (1982) he consider affect to be post-cognitive

that is, affect is thought to be elicited only after a certain amount of cognitive

processing of information has been accomplished

Day 5

Our client manifest blunted affect during our conversation, there is delay on our

communication.

According to Parses human becoming theory, the client determines whether to show

own affect/ feelings or not.

Day 6


communication and labile mood during our conversation he got irritable C: “ayaw mo

naming maniwala sakin eh!” (Slapped on his legs). He also manifests inappropriate affect.

SN: “nagagalit po ba kayo?” C: “hindi ako galit” (Smiled unnaturally) but his voice seems

angry.

According to Johnson, Each individual has patterned, purposeful, repetitive

ways of acting that comprises a behavioral system specific to that individual.

Day 7

No unusual findings because client displays appropriate feeling and affect now.

48

Day 8


communication. He also manifest labile mood because during the therapy Mang JM suddenly

keeps quiet and then he smiled again.

Based on Watson’s curative factors , we must promote and accept expression of the

client either it is positive or negative feelings and emotions.

Day 9

No unusual findings because client displays appropriate feeling and affect now.

49

BEHAVING AND INTERACTING:

Day1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Withdrawal

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

Motor hyperactivity

Motor hypoactivity

Ambivalence

Anhedonia

Avolition

Poor personal hygiene

Impulsive

Paranoia




Day 1: Orientation


Day 3

The behavior pattern of our client is predictable but we noticed that he has poor

personal hygiene and he had dark teeth that lead to bad breath and his nails were dirty.

According to Abdellah, she identified 21 problems and one of this is to

maintain personal hygiene.

50

Day 4

Our client manifests motor hyperactivity because of his mood, overexcitement to

express his feelings. We also noticed that he has poor personal hygiene and he had dark teeth

that leads to bad breath and his clothes smelled.

According to Freud, conscious mind is where we are paying attention at the moment.

Our way of thinking affects our attitude on how we are going to react in a certain situation.

Day 5

The behavior pattern of our client is predictable. But we noticed that he has poor

personal hygiene and he had dark teeth that lead to bad breath his clothes smelled and his

nails were dirty.

According to Orem’s self care deficit, the client can’t able to perform self care

because of the presence of mental pathology.

Day 6

The behavior pattern of our client is predictable, but we noticed that he has poor

personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.

According to Abdellah, she identified 21 problems and one of this is to maintain

personal hygiene.

Day 7

51




personal hygiene.

Day 8



According to Orem’s self care deficit, the client can’t able to perform self care

because of the presence of mental pathology

Day 9




personal hygiene.

52

NEGATIVE COGNITION:

Day1

Day2

Day3

Day 4

Day 5

Day6

Day7

Day8

Day9

Overgeneralization

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

All-or-nothing thinking

Should statement

Labeling

Middle reading

Fortune telling




Day 1: Orientation


Day 3

No alteration noted on Mang JM’s negative cognition.

As mentioned by Abdellah, a nurse should continue to observe and evaluate the

patient over a period of time to identify any attitudes and clues affecting her behavior in order

to identify the client’s problem.

53

Day 4


Day 5


Day 6


Day 7


Day 8


Day 9


54

OTHERS:

Day1

Day2

Day3

Day4

Day5

Day6

Day7

Day8

Day9

Amnesia

OR

IEN

TA

TIO

N

SE

LF

-AW

AR

EN

ES

S

Fugue

Depersonalization

Phobias

Memory

1. Remote (long term)

2. Recent (early am)

3. Recent part (current events)

4. Immediate memory (short term)

5. Immediate recall




Day 1: Orientation


Day 3

During our conversation with our client he had a remote memory because he was able

to determine his last 15 years of his life. He also remembered the food he eaten in the

55

morning and knows who the president of the Philippines is. He had also recalled us during

our conversation.

According to Parse, Man’s reality is given meaning through lived experiences

Day 4

Our client had remote memory because he remembered he went to America last 2005,

he also remembered his breakfast and knows who the president of the Philippines by saying

the name of Pres. Benigno Aquino. He also recognizes our name.

According from psychoanalytic theory of Freud, the mind can be divided into main

parts; the conscious mind includes everything that we are aware. A part of this includes our

memory which is not always part of consciousness but can be retrieved easily at any time and

brought into our awareness.

Day 5

Our client had remote memory because he remembered the things he did in the last 15

years of his life.

SN: “anu pong ginagawa niyo sa huling 15 taon ng buhay niyo?”.

C: “ mangingisda.”

He also recalled the food he was eaten in the morning.

SN: “ano po bang kinain niyo kanina?”.

C: “lugaw, nabusog nga ako eh.” .

He also knows the President of the Philippines by saying the name of Pres. Benigno Aquino.

He also recalled us during our conversation.

56


Day 6


years of his life y saying “nangingisda ako noon.” He also remembered we did yesterday by

saying “nagbingo tayo at nanalo akong 2 beses.” He also knows who the president of the

Philippines by saying the name of Pres. Benigno Aquino. He also recalls us during our

conversation.

According to Freud, preconscious thoughts and emotions are not currently in the

person’s awareness, but she can recall them with some effort.

Day 7


years of his life y saying “yung nanay ko nagtatahi ng magagandang damit.” He also

remembered we did last last week by saying “nagbingo, nanalo ng 2 beses at nagpakita ng

mga pictures tulad ng doctor, urse etc. He also knows who the president of the Philippines by

saying the name of Pres. Benigno Aquino. He also recalled we did before they go back in

their ward.

SN: “anu- ano nga po pala uli ginawa natin kanina?”

C: “food festival”.


Day 8

57


years of his life, he also remembered things we’ve done yesterday and ingredients of our food

by saying “food festival, yung mga sangkap ay gulaman, buko at cream.”, he also know

president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls

activity we did before they go back in their ward by saying “Oo sumayaw tayo kanina na

gagawin natin bukas.”

According to Freud, the preconscious system is composed of those mental events,

processes and contents capable of being brought into conscious awareness by the act of

focusing attention.

Day 9

Our client had remote memory because he remembered the reason why he is admitted here in

MMH in the year 1989 by saying “Sinave ako ni mama dun sa mga taong mangunguha, tsaka

hindi ako magkatulog.” He also remembered the steps we practice yesterday. He also recalls

us.

According to Parse, Man’s reality is given meaning through lived experiences.

58

UNIT III(Psychopathophysiology and Related Literatures)

59

PSYCHOPATHOPHYSIOLOGY

60

Substance abuse

(Marijuana, 2 bottles of alcohol. 1 pack cigarette per day)

Affect the normal function of the brain system

Neurologic disturbances

Altered thought process

Looseness of ability in thinking and perceiving responses

Illusions Delusion Grandiose Maladaptation Violent behavior

Persecutory

61

Analysis and Interpretation

Mang J.M took prohibited drugs as his record showed. But the amount and frequency

were not determined. Being a drug abuser, Mang J.M therefore became a drug addict. This is

the reason why he had looseness of ability in thinking and perceiving responses because of

the effect of the drug in the brain. He had been aggressive to do things whatever he wants; he

developed persecutory delusions and grandiosity.

Related Theory

Substance abuse would be describes according to Psychodynamic (Freudian) Theory from a

developmental perspectives. Freud believes that vulnerable to substance abuse have powerful

dependency needs that can be traced to their early years. They claim that when parents fail to

satisfy a young child’s need for nurturance, the child is likely to grow up depending

excessively on others for help and comfort, trying to find nurturance that was lacking during

their early years. If this search for outside support includes experimentation with a drug, the

person may well develop a dependent relationship with the drug which leads to substance

abuse.

Maslow said that human beings are motivated by unsatisfied needs and that certain

lower need to be satisfied before higher needs can be satisfied. Maslow ties the pre-

occupation use of drugs and the negative effects which result from alcohol/drug addiction. He

says that since addiction is a progressive illness, it destroys a person’s ability to achieve self-

actualization, eventually destroying the person’s ability to meet their other needs including

self-esteem, physiological need and safety.

Inadequate parental guidance

62

(death of father during childhood years and mother still at work)

Lack of moral advices and support from the parents

Inability to facilitate moral vs. immoral behavior

Seek help with trusting persons

Dependency

Influenced with immoral behaviors

Learned to use prohibited drugs, smoking, and drinking of alcohol

Substance dependency and intolerance

(increase amount of substances)

Irrational thinking developed

Violent behavior

(hurting his mother, nagwawala, kung ano maisipan gagawin, nambabato )

63

Analysis and interpretation

Due to early death of Mang J.M’s father, his mother needed to work hard to raise

them well. This resulting Mang J.M to become dependent and able to seek company of others

to fill the lacks of his parents’ assistance during growing years. And he did things that he

acquired from such people without thinking if it is good or bad.

Related Theory

According to Duldt-Battey, Bonnie Weaver - Humanistic Nursing Communication

Theory, The environment is a “booming, buzzing” world of strange sensations that must be

sorted out to determine which are the most important; this sorting is achieved through

communication with other people. The need to communicate is an innate imperative for

human beings. The purpose of nursing is to intervene to support, to maintain, and to augment

the client’s state of health.

Maslow's hierarchy explains human behavior in terms of basic requirements for

survival and growth. According to theory, when the individual's physiological and safety

needs are met, needs for love and belongingness emerge. These needs include longings for an

intimate relationship with another person as well as the need to belong to a group and to feel

accepted. Maslow emphasized that these needs involve both giving and receiving love.

64

Peer pressure

(Fraternity)

Bad influences caused by peers

Learned to use prohibited substance such as

Marijuana, alcohol, cigarette

Dependency

Intolerance

( increase amount and dosage)

Irrational thinking

Violent behavior

(nagwawala, kung ano maisipan gagawin, nambabato)

65


Mang J.M was a member of TAU GAMMA fraternity. Within this fraternity, we can

conclude that he learned to use prohibited drugs, possible experienced hazing and involved in

different troubles though he claimed that he was good and not participated in fights. These

may cause him to become a drug abuser and later develop dependency resulting him to

become violent.

Related Theory

There are several layers of assumptions that Johnson makes in the development of

conceptualization of the behavioral system mode there are 4 assumptions of system: First

assumption states that there is “organization, interaction, interdependency and integration of

the parts and elements of behaviors that go to make up The system ” A system “tends to

achieve a balance among the various forces operating within and upon it', and that man strive

continually to maintain a behavioral system balance and steady state by more or less

automatic adjustments and adaptations to the natural forces impinging upon him.”A

behavioral system, which both requires and results in some degree of regularity and

constancy in behavior, is essential to man that is to say, it is functionally significant in that it

serves a useful purpose, both in social life and for the individual. The final assumption states

“system balance reflects adjustments and adaptations that are successful in some way and to

some degree.” The integration of these assumptions provides the behavioral system with the

pattern of action to form “an organized and integrated functional unit that determines and

limits the interaction between the person and his environment and establishes the relation of

the person to the objects, events and situations in his environment.

66

According to Sullivan, individual self identity is built up over the years through his

perceptions of how significant people in his environment regard him. According also to

Sullivan, people are influenced mostly by their relationship with others.

67

Occupational stress

Traumatic life events

Frustration in life

Inability to cope up with life situation

Hopelessness occur

Stress

Disruption in behavior

Depression

Restlessness Agitation

68


Mang J.M had a history of hitting a man during he was a jeepney driver. Due to the

incidence he became agitated, always afraid of something and nervous for 20 months that

leads to his first confinement. This situation caused him to be always under stress and

become restless and agitated

Related Theory

Maslow's hierarchy explains human behavior in terms of basic requirements for

survival and growth. According to theory, once the individual's basic physical needs are met,

his or her needs for safety emerge. These include needs for a sense of security and

predictability in the world. The person tries to maintain the conditions that allow him or her

to feel safe and avoid danger. Maslow thought that inadequate fulfillment of these needs

might explain neurotic behavior and other emotional problems in some people.

According to Roy, the person is a bio-psycho-social being. The person is in constant

interaction with a changing environment. To cope with a changing world, person uses both

innate and acquired mechanisms which are biological, psychological and social in origin. To

respond positively to environmental changes, the person must adapt. The person’s adaptation

is a function of the stimulus he is exposed to and his adaptation level.

69

Poor coping mechanism

(Separation from loved ones)

Poor decision making and solving problems

Inability to cope- up with the situation

Use of illegal Stress

Substance, drinks alcohol

And smoked cigarettes change in mood and affect

Substance dependency

Anxiety develops

Intolerance (increased amount & dose)

Irrational thinking depression

Violent tendency and suicidal

Thoughts Self pity restlessness sleeplessness

Isolate self from others

70


Mang J.M has been separated from his wife. This situation may be a leading cause

why he was under stress that leads in development of anxiety to depression resulting to self

pity, restlessness and sleeplessness. On the other hand, it may also, causes Mang J.M to use

illegal substances and became dependent that brought him in having violence and suicidal

ideation.

Related Literate

According to Travelbee human conditions and life experiences encountered by all

men as sufferings, hope, pain and illness. Illness is being unhealthy, but rather explored the

human experience of illness. Suffering is a feeling of displeasure which ranges from simple

transitory mental, physical or spiritual discomfort to extreme anguish and to those phases

beyond anguishes the malignant phase of dispairful “not caring” and apathetic indifference.

Pain is not observable. A unique experience. Pain is a lonely experience that is difficult to

communicate fully to another individual. Hope is the desire to gain an end or accomplish a

goal combined with some degree of expectation that what is desired or sought is attainable.

Hopelessness is being devoid of hope. Nursing is an interpersonal process whereby the

professional nurse practitioner assists an individual, family or community to prevent or cope

with experience or illness and suffering, and if necessary to find meaning in these

experiences.

71

According to Henderson individual compose of biological, psychological,

sociological, and spiritual components. All external conditions and influences that affect life

and development. Nursing assists and supports the individual in life activities and the

attainment of independence. Nurse serves to make patient “complete” “whole", or

"independent." The nurse is expected to carry out physician’s therapeutic plan Individualized

care is the result of the nurse’s creativity in planning for care.

72

RELATED

LITERATURES

73

Paranoia Agent, Symptom, Cause, Treatment and Medication of Paranoia

Cause of Paranoia

1) Homosexual fixation: According to Freud, the patient suffering from the disease has

repressed his tendency to homosexual love to such an extent that he develops a fixation

concerning it. Freud's view has been found correct in many cases, but it does not explain each

and every case of the disease.

2) Feelings of inferiority: Here the psychologists have found that the main cause of paranoia

is a sense of inferiority that may be caused by a variety of condition such as failure, disgust,

sense of guilt.

3) Emotional complex: Certain psychologist points out emotional complexes, and also

believe that they are seen to be present in other mental diseases as also in normal individuals.

4) Personality type: Cameron believes a certain type to be more susceptible to this disease, a

personality that has sentimentally, jealousy, suspicion, ambition, selfishness and shyness etc.

Patients of paranoia do exhibit these peculiarities of personality but on this basis they cannot

be said to belong to definite personality.

5) Heredity: In the opinion of Fisher the main responsibility of paranoia lies fairly and

squarely upon heredity, although he does not deny the importance of repression and

emotional complexes. The causes of paranoia are not physical because no patient exhibits any

signs of physical deformity and among the causes there are many important" ones, such as

defects of personality, sense of inferiority, repression etc.

74

http://www.depression-guide.com/paranoia.htm

AREA OF THE ARTICLE THAT WE AGREE

We agree that people who have feeling of inferiority can significantly affect an individual.

These circumstances stressful to an individual and can be cause of schizophrenia.

AREA OF THE ARTICLE THAT WE DISAGREE

No disagreement in the article.

SIGNIFICANCE TO US AS A NURSE

The literature stated that feelings of inferiority are a cause of paranoid schizophrenia. It

means that a individual with poor coping mechanism are prone to schizophrenia. The nurse

must can assist the client and help the client to verbalize feelings to overcome such problems.

75

Substance abuse and the onset of schizophrenia

Martin Hambrecht, Heinz Häfner

Received 7 August 1995; received in revised form 7 November 1995

Up to 60% of chronic schizophrenic patients are reported to abuse alcohol or drugs. This

comorbidity raises the question whether one disorder is a consequence of the other. With the

structured interview “IRAOS,” the onset and course of schizophrenia and substance abuse

were retrospectively assessed in a representative first-episode sample of 232 schizophrenic

patients. Information by relatives validated the patients' reports. Alcohol abuse prior to first

admission was found in 24%, drug abuse in 14%—twice the rates in the general population.

Alcohol abuse more often followed than preceded the first symptom of schizophrenia. Drug

abuse preceded the first symptom in 27.5%, followed it in 37.9%, and emerged within the

same month in 34.6% of the cases. The study demonstrates a remarkable association between

first-episode schizophrenia and substance abuse, but a unidirectional causality is not

supported, nor is a specific psychotic disorder in comorbid cases.

Summary of the study

The study is all about the substance abuse and the onset of schizophrenia. It is about the

possible effects of substance abuse.

AREA OF THE ARTICLE WE AGREE

The area that we agree upon is that the study is about the possible causes of schizophrenia

and its onset. It gave us the knowledge of the effects of substance abuse. It also gave us

perspective to the outcome of abusing drugs.

76

yes platform+medline author author

AREA OF THE ARTICLE THAT WE DISAGREE



The significance of the study to us student nurses is that it gave us more insight of possible

causes on the onset of schizophrenia. With this knowledge we could use it as a baseline on

how substance abuse greatly affects on the onset of schizophrenia.

77

THE INS AND OUTS OF PEER PRESSURE

Written by Liisa Hawes. Liisa is a Marriage and Family Therapist in Calgary, Alberta,

Canada. She is a parent educator with the Family Program at the Calgary Community

Learning Association.

Imagine getting together for coffee with a group of friends. There is the laughter of adults

enjoying the company of other parents. The conversation turns to a discussion of a recent

Oprah show. "I just love that show" you chime in (you really hate it). Later, someone

suggests a movie. "Yes, let's!" you reply, even though you'd rather walk along the river and

continue talking. By the end of the evening, in spite of excellent coffee, old friends and a

reasonably good movie, you still feel "something" was missing. It was. Each time you

concealed your true feelings, you disregarded a part of yourself. You were missing.

When we pretend to take on another's perspectives, go along

when we really don't want to or fail to state our preferences, we

hide ourselves from others. We become invisible, and smaller

somehow, diminished in even our own eyes. "I just like to go

along," we say, yet if we see our children doing likewise, we may

wonder if they experiencing 'pressure' from their peers.

"As parents...we

are the first 'peers'

our children will

know."

Peer influences are normal and necessary in our lives. From earliest childhood, each time our

needs are met, our wants are considered and our expressions recognized we develop a sense

of ourselves as being worthy and valuable. Encouraged by these favorable positive

experiences, we reach out to supportive others again and again, learning confidence. In time,

the occasional let down from others doesn't disturb us overly much. The balance of our

78

experience is positive. We often refer to this inner resiliency as "healthy self-esteem" or a

"solid sense of self." But even when others don't grant our requests, if respectful, they teach

us that open disagreement has no negative effects on one's self. We learn again that we can

'be' ourselves; we esteem ourselves.

As parents, we seldom think of ourselves as peers to our children. In a broad human sense,

however, we are the first 'peers' our children will know. If we respond to our children's

feelings with respect, even when we disagree, they will come to expect respect. If we

encourage them to develop and express their own viewpoints, they will become accustomed

to healthy interactions.

Within this kind of healthy relationship, parents often notice more overlap then difference in

their values and those of their children's peer group. In some instances, such as the anxiety

associated with those dreaded skin breakouts, peers provide more support than parents ever

can! Even on a "pretty good" day, one's peers do much to support one's sense of self and

offer a sense of belonging.


The study is all about how peer influences our normal and necessary things in our lives. It

states that peers do much to support one's sense of self and offer a sense of belonging.


The area that we agree upon is that the study is about how peers greatly affect our lives. They

influence us in many ways.

79

AREA OF THE ARTICLE WE DISAGREE

The area that we disagree upon this article is that peers provide more support than parents

ever can. Our parents know and only want what is best for us. They are the ones we should

talk to when we have problems and they have better understanding than our peers.


The significance of the study to us student nurses is that as student nurses we should not only

focus on giving interventions on our clients we should also know their feelings and emotions

to get their trust and to be able to have their cooperation.

80

Occupational Stress 12 - Burnout

There are three separated stages to burnout. Each stage is its own little disorder and you don't

necessarily have to progress through each stage, although most sufferers do exactly that. One

could remain at one stage for years, as each stage is separate and distinct from the other two

(the big word for that is orthogonal domains). The first stage of burnout is emotional

exhaustion (EE) or feeling drained by contact with other people. Emotional exhaustion is

characterized by a cluster of internalized symptoms. Internalized means you are beating

yourself up instead of someone else. Do you dread seeing clients or meeting with customers?

Does just the thought of dealing with one more complaint about that faulty product or that

buggy application make you want to take the day off? These are the type of endorsements

supporting a state of emotional exhaustion. Clearly this emotional banging-your-head-

against-the-wall feeling is stressful. The research is clear about one thing: having unpleasant

contact with your supervisor and coworkers makes things even worse. Increased and

improved training, as well as the use of a strong peer support system, is one of the

recommended solutions, especially if EE is systemic within the group or department. It's not

as bad when you know everyone is in the same boat. Also, you can begin to brainstorm

solutions and stress-avoiding protocols. Isolation always makes things worse. One possible

treatment is moving toward a team approach to dealing with customers.

The second phase of Burnout is depersonalization. This is the outward or externalized phase.

Externalized referrers to beating up on others as opposed to yourself. In this phase, you are

rude, demeaning, and insulting toward the client or customer. You're no longer blaming

yourself. You're blaming others for having a problem. (Hey, I think I just figured out the

problem with Larry down in accounts receivable!) Of course, a client with a crashed program

is not to blame, but it appears there is only so much one can take of this endless stream of

81

people with the same problem! Are you often negative toward clients or callous toward the

problems of your valued customer? If so, you can put a little check in the box next to

depersonalization. What helps? Again, training is a key ingredient. It's very healing to know

when you are addressing the customer's problem in the most professional and efficacious

manner possible. Also, through training and professional assessment, you can begin to

understand that solving the problem may not exactly be in your job description. Your goal

may just be to do the best you can do with what you have while maintaining a professional

disposition. Wouldn't this be a self-affirming attitude? But these are perspectives you

sometimes can't put together by yourself, especially while working in an isolated situation.

Burnout's final phase is reduced personal accomplishment (RPA). This is characterized by

generalized feelings of disappointment, nonsuccess, and underachievement. Workers with

RPA endorsed statements such as, "I'm not getting anywhere," or "This job has lost all its

meaning." As I indicated earlier, having supportive supervisors and coworkers is an

important step in halting the progress of burnout's three stages.

Burnout is serious and the consequences are serious as well. Psychologists have good

instruments to assess this disorder and its progression. If you are experiencing one of these

phases, don't hesitate to talk to a professional about it.


Burnout is serious and the consequences are serious as well. Psychologists have good

instruments to assess this disorder and its progression. If you are experiencing one of these

phases, don't hesitate to talk to a professional about it.

82


Being stressed greatly influences our daily activities, especially at work. We cannot perform

well if we have something in mind that we keep on thinking. Our brain cannot function well.

AREA OF THE ARTICLE WE DISAGREE



The significance of the study to us student nurses is that we need to think more ways for us to

help our clients. As student nurses we need to make our client feel comfortable to lessen their

anxieties and stress. We also need to consider interventions will be used so that we can

achieve the upmost care that our client would have.

83

Understanding schizophrenia

A guide to the signs, symptoms and causes

Environmental causes of schizophrenia

Twin and adoption studies suggest that inherited genes make a person vulnerable to

schizophrenia and then environmental factors act on this vulnerability to trigger the disorder.

As for the environmental factors involved, more and more research is pointing to stress,

either during pregnancy or at a later stage of development. High levels of stress are believed

to trigger schizophrenia by increasing the body’s production of the hormone cortisol.

Research points to several stress-inducing environmental factors that may be involved in

schizophrenia, including:

Prenatal exposure to a viral infection

Low oxygen levels during birth (from prolonged labor or premature birth)

Exposure to a virus during infancy

Early parental loss or separation

Physical or sexual abuse in childhood

Abnormal brain structure

In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role

in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a

deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the

frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making.

Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and

amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of

brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in

any one region of the brain.

84

AREA OF THE ARTICLE 1 THAT WE AGREE

We agree that people who lost their parent can significantly affect an individual. These

circumstances stressful to an individual and can be cause of schizophrenia.

AREA OF ARTICLE 1 THAT WE DISAGREE



The literature helps us understand that there are different kinds of factors that cause paranoid

schizophrenia. And parental loss is one of them can lead to inadequate parental guidance, the

nurse should pay attention to the client who had loss a parent because it a risk factor in

developing paranoid schizophrenia.

SIGNIFICANCE TO OUR CASE

This article gives us much information about causes of paranoid schizophrenia.

85

UNIT IV(Process Recording and Drug Study)

86

PROCESS RECORDING

(Nursing Care Plan)

87

Process Recording and Theme Identification

PLACE: San Lazareto Hall

DATE: January 14, 2011

TIME: 2:00 pm

PHASE: Orientation Phase

I. Objectives

a. Client- centered objectives

1. To established trust and rapport with the nurse through the use of

various therapeutic communication techniques.

2. To enhance cognitive skills through participating actively in the

therapeutic activities.

3. To improve socialization of the client and reduce anxiety.

b. Nurse- centered objectives

1. To provide mental health care for the client.

2. To implement therapeutic plan necessary for improvement of

mental illness.

3. To develop positive coping behavior through therapeutic

communication.

II. Description of Setting

88

a. Describe the set up/ environment

It was a sunny Friday afternoon. We fetched our client from Male

Ward and introduced ourselves to the client and proceed to pantry area to

groom the patient. We let him brushed his teeth and waited for him to finish.

After that, we went to the ruins and have our first interaction with the client.

The chairs were scattered around the ruins facing our client. After an hour of

interaction the facilitator were assigned to ask them the time, place and

weather of that day and was given recognitions for each.

b. Describe the nature, behavior, affect and mood of the client

Our client Mang JM was wearing his own set of dirty white wrinkled

clothes and green patterned shorts with cut on sides. He seemed happy and

always smiling. When we greet him, he recognized us as his new nurses for

that afternoon and easily remembered our names in particular. Mang JM did

the grooming excitedly and rapidly. As we fetched him for the activity his gait

was moderate while looking at the floor. When we interviewed Mang JM, he

showed a lot of facial expressions. He always said that he was happy, and it

shows. He seemed anxious when he was recalling things from the past and

whenever he thought of a good answer. He always answered the questions

being asked with his medium tone. He was excited to answer some questions

and stuttered because of it.

III. Process Recording

89

90

Nurse- Client

Conversation (include

non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and

Interpretation based on

theories

SN: “Magandang tanghali

po Mang J.M.”

C: (smiled and nodding)

Giving Recognition Greeting or noting Mang

JM’s effort show that his

student nurses recognizes

his individuality.

According to Sullivan,

recognition can establish

rapport towards the

client.

SN: “Tara na po sa pantry

para po makapag linis

kayo ng ngipin niyo.”

C: (nodding)

SN: “Gusto niyo po ba

tulungan po namin

kayo?”

C: “ Hindi na. Meron na

akong toothbrush dito.”

Offering One’s self The nurses offer their

help to the client in doing

self-care.

According to King,

human beings are open

systems in constant

interaction with the

environment

SN: “Ako po si Mark at

ako naman po si Hazel

kami po yung student

nurse niyo sa loob ng

tatlong linggo.”

C: “Ahh…(Smiled and

nodding)

Giving Information Giving information to the

client promotes a good

and trusting relationship

between the nurse and

the client.

According to Roy, a

person is an open

adaptive system who

uses coping skills to deal

with stressor.

SN: “Mang JM, alam nyo

po ba kung anong petsa at

kung nasaan kayo

ngayon?”

C: “Oo. January 14, 2011

Assessing orientation to

date and situation

Assessing such questions

enables the student nurse

to assess Mang JM’s

orientation on date and

situation.

IV. A. Theme identification

Content Theme

The conversation was all about the client’s personal data, family

backgrounds, and his condition.

Interaction Theme

Mang JM responded well on our questions and reacted appropriately to

the questions being asked. Showed interest in answering the questions but

when he’s not being asked, he only remained silent with blunted facial

expression and looked around the environment to divert his attention and

ease the boredom.

Mood Theme

Client had no sudden change in his mood. He expressed himself

through smiling with good eye contact. Client’s movement often feels

restless.

B. Nursing Diagnosis

Altered thought process related to decreased attention secondary to obsessive

thoughts as evidence by:

SN: Napansin ko pong linga kayo ng linga. Ano po ba ang tinitingnan nyo?

91

C: Ah wala naman. Yung mga dumadaan lang.

V. Nursing Interventions

We started to greet our client a pleasant afternoon. After that we fetched him

from the ward, we assisted my patient in his grooming before the activity, I

informed him of what will happen on the therapy. I encourage him to express

feelings and verbalized concerns regarding the conducted activity. After we

finished grooming, we asked him to go with us to have conversation with him.

The orientation was conducted at the Lazaretto building. It was started with asking

the client’s personal data and backgrounds for us to go further. We also wanted

him to gain trust and established therapeutic nurse-client relationship with us. The

conducted interaction went good.

VI. Summary and Evaluation

In the Friday afternoon, as we received the client, Mang JM, he presented a

happy and face and excited mood. As we go on for his grooming session, we

observed that he has a good hygiene.

The client was very cooperative on the conducted conversation that afternoon.

He was able to follow instructions and did it well.

We gained his trust and rapport that had been established during our interaction.

He also verbalized feelings of concern openly with us. We got along with him

easily and he participated actively in the group socialization.

VII. Reference

92

NANDA 10th edition

Psychiatric-Mental Health Nursing 5th Edition

Name of Therapy: Role Identification Therapy

Place: Under the tree (MMH)

Date: January 19, 2011

Time: 9:00 AM

Phase: Working Phase (Day 4)

93

I. Objectives


1. To enhance the thinking and analyzing ability of the client.

2. To analyze and determine the knowledge and understanding of clients

with occupation roles.

3. To gain knowledge



2. To implement therapeutic plan necessary for improvement of mental

illness.


communication.

4. To assess client’s memory status.



It was a fine windy day of Wednesday around 9:00 in the morning of

January 19, 2011 when we received our client. We fetched him to the pantry

area for grooming but he refused to, so we proceed to the area where the role

identification activity will be held. The place was clean and the seats were

arranged alternately with the client facing the facilitators of the said activity.

94

The place was conducive for the activity and they were comfortably

seated on each chair. After the warm greetings of each facilitator and

explaining the procedure of the activity, each patient were asked to identify

what were the roles of the picture presented to them and was given

recognitions for each. After the activity, we proceed under the mango tree to

find shade from sunlight and to conduct another conversation. We reviewed

Mang JM about the recent activity and asked him what was his reaction about

it and presented another set of pictures. This time, he can identify roles

according to his own intellectual functioning, and not by imitating his

neighbor’s answers. Between our conversation, we gave him snacks that he

seemed enjoying while eating those. At around 11:00 am, we returned our

client to his ward after the therapy and the conversation.


We received our client wearing his own set of wrinkled dirty white

Boysen shirt and green patterned shorts which was the same as last week. We

noticed that he was opistotonic that time and non-initiating when we fetched

him from the ward. His gait was slow and he always looking at the floor with

his arching back. Before the program, we approached him and he was very

excited and always laughing with no apparent reason. He verbalized different

ideas and looking around his environment a lot of times. During the program,

he was actively participating and behaved well. When he heard of his

neighbor’s answer, he laughed very hard. He displayed a lot of facial

expressions like smiling, laughing, raising eyebrows, and frowning before and

95

during the activity. Before the activity, he talked loudly and excitedly that he

stuttered while speaking. And during the activity, he was serious and listened

very carefully to the instructions and pictures presented to him. As we go

along on our conversation, different behaviors were manifested, congruent

affect have been projected by the client.


96


97

Nurse- Client


non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and


theories

SN: “Magandang umaga

po Mang J.M.”

C: (smiled and nodding)

Giving Recognition The client did not look at

us but he use gestures or

non verbal cues to make

communicate with his

student nurses.

According to Peplau, the

initial interaction


the patient wherein the

latter has a felt need and

expresses the desire for

professional assistance.


para po makapag linis po

kayo.”

C: “Hindi na, naligo na

ako ng 2 beses kanina

pa.”

SN: “Anung oras po kayo

naligo Mang JM?”

C: “ Bali kaninang 4am at

6am.”

Placing event in time or

sequence

Mang JM refused for the

grooming session.

According to Abdellah,

she identified 21

problems and one of it is

to promote good personal

hygiene.

SN: “Mang JM kilala

niyo pa po kami?”

C: “Sino nga ba?

Nakalimutan ko na.”

Seeking Clarification The patient failed to

recognize his student

nurses.

According to Johnson,

Each individual has

patterned, purposeful,

repetitive ways of acting

that comprises a

behavioral system

specific to that individual

Content Theme

We established nurse patient interaction focused primarily on the role

identification therapy in which the client can identify the roles of people

that are represented by pictures. It will provide the client the stimulus to

assess their intellectual functioning. Moreover, it serves as guide for their

thoughts and behavior.

Interaction Theme

Mang JM responded well on our questions and reacted appropriately

the questions being asked. Showed interest in answering the questions but

when he’s not being asked, he only remained silent looking around the

environment where he can divert his attention.

Mood Theme

The client had sudden changes in his behavior. He changed his mood

and affect suddenly according to his reactions and situation. He always

diverts his attention around his environment whenever he didn’t feel

like answering some questions.


Social Isolation Related to poor problem solving secondary to unsatisfying

relationship as evidenced by:

SN: Kayo po ba Mang JM may girlfriend nap o ba kayo?

98

C: Wala eh!


According to Abraham Maslow Hierarchy of needs, after physiological and

safety needs are fulfilled, the third layer of human needs is social and involves

feelings of belongingness. Humans need to feel a sense of belonging and

acceptance, whether it comes from a large social group, such as clubs, office

culture, religious groups, professional organizations, sports teams, gangs, or small

social connections (family members, intimate partners, mentors, close colleagues,

confidants). They need to love and be loved (sexually and non-sexually) by others.

In the absence of these elements, many people become susceptible to

loneliness, social anxiety, and clinical depression.

We encourage Mang JM to talk with other client while waiting with the others

to arrive, this will help Mang JM to realize that talking with other people will

make him feel that he belong to a group. We encourage him to sing to the group,

this will help to develop his self confidence. We provide activity that will help

Mang JM to relate his life on the character. We encourage Mang JM to verbalize

his feeling regarding the activity and give the moral lesson he gain in the story.

We give recognition to the answer of Mang JM by doing this the client will feel

that people around him appreciate the effort he give. We provide a quiet

environment for the activity and conversation with our client. During the

conversation with Mang JM, we encourage him to verbalize everything on his

99

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

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

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

mind, by doing this we will able to identify the possible problem that maybe the

reason why Mang JM has no relationship.


Today, we held an activity that can assess the intellectual ability of the

patient by conducting the role identification therapy. We’ve prepared a

conducive, quiet area with less stimuli to let the patient concentrate for the

said activity. The flow of the activity went good and we can say that Mang JM

enjoyed it as manifested by his laughs. After that, we had our one on one

conversation with the client and we observed that the client had sudden change

in his mood and affect.

VII. Reference

Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincot.

Williams and Wilkins. (5th Edition).

100

Name of Therapy: Bingo Social Therapy

Place: Under the Tree (MMH)


Time: 9:30 AM

Phase: Working Phase (Day5)

I. Objectives


1. To improve the socialization skills of the patient

2. To develop the self-esteem of the clients

3. To assess the knowledge perception of the client about different

fruits and vegetables.

4. To assess the memory of the client




mental illness.


communication.

101



It was Thursday morning when we fetched our client to the grooming

area and assisted him for the therapy. The weather is sunny, and we chose the

perfect setting for the therapy where they can mingle with the other clients

while the trees provided them sheds against the sunlight. We arranged the

client’s seats facing each other with long table between them. The place was

conducive for the activity and they were comfortably seated on each chair.

The procedures of the therapy were explained to them clearly and they

understood the mechanics of the therapy. We viewed the reactions and facial

expressions of Mang JM while participating in the activity and noticed that he

was very eager to win. When the patterns were given and none of them

corresponds to the cards of Mang JM, he felt very disappointed. Mang JM

won 2 times and felt very happy. Upon receiving his prizes, he offered us

some of it and insisted to share the prize with us.


We received our client wearing the same set of clothes the same as

yesterday. When he saw us, it seems that he was happy seeing us. His gait was

moderate and he always looked at the floor with his arching back. He initiates

conversation on how he groomed himself before we arrived. We went to the

pantry area for his grooming session, but he refused to. When we accompanied

him to the activity area, he was silent and wore a flat affect. But at the time he

was seated on the chair, we approached him on how he was aware and

102

oriented to his environment, on time and place and he was talking hard with

his arm gestures. During the activity, he showed excitement and eagerness to

win and seriously focused on the activity. After the activity we proceed for

another conversation and reviewed him about the recent therapy. As we go


affect have been projected by the client, but sometimes he answered late and

showed no interest.


103


104

Nurse- Client


non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and


theories


po Mang J.M.”

C: “Magandang umaga

din!” (smiled)

Giving Recognition The client greeted back.

He shows interest for

today’s activity.

According to Henderson,

she identified 14 basic

needs one of it was

communicating with

others which is essential

to establish a therapeutic

relationship.

SN: “Tara po Mang J.M

maglinis na po kayo.”

C: “hindi na,naligo na

ako kanina 2 beses.”

SN: “Kanina po? Anung

oras po?”

C: “ Kaninang

pagkagising ko 4am at

kaninang 6am.”


sequence

The client refuses for our

grooming session.


there are 21 problems she

identified and one of it is


hygiene.

SN: “Mang JM, kilala

niyo po ba ako?”

C: “Oo, ikaw si mark.”

SN: “Eh, yung isa ko pa

pong kasama?”

C: “Si hazel.”

Seeking Clarification The client recognizes his

student nurses. This

indicates a good recent

memory he still

remember our names.

According to Johnson,

each individual has

patterned, purposeful,

repetitive ways of acting

that comprises a

behavioral system

specific to that

individual.

Content Theme

We established nurse patient interaction focused primarily on how we

explained and assisted the patient in participating to the activity. The

therapy will help the patient on how to interact with other patient and how

to react on different situations presented in every part of the game.

Moreover, it serves as guide for their thoughts and behavior and on how to

act appropriately in every situation.

Interaction Theme

Mang JM responded well and reacted appropriately to the therapy

being conducted. He showed interest in participating to the game and was

very approaching to his fellow players. After the therapy, Mang JM

showed different reactions regarding on his recent activity. He responded

well on each questions being asked on him. He projected behaviors that

seemed he was agitated about his environment and gave warnings about it.

Mood Theme

Client had sudden changes on his mood depending on questions being

thrown on him. He expressed agitation, and showed different perception

about his environment. Client’s movement often feels restless


Risk for other-directed violence related to threats as evidenced by verbal

threats of against property as evidence by:

105

SN: “Marami po ba kayong nakain ngayon?”

C: “Oo, kaming mga siga marami kaming nakukuhang pagkain sa loob.”


We started to greet our client a pleasant afternoon. We encouraged him to

change his clothes and cooperate on our grooming session but he always refused

to and always reason out his grooming. After that we accompanied him to the

activity area and assisted him throughout the game. After that, we conducted a

review and conversation about his recent therapy and asked his comments and

reactions about it. The conducted interaction went good.


Today we conducted an activity through which we can assess the cognitive

ability and patience of the client. We had BINGO SOCIAL using fruits and

vegetables on every card. When we informed our client about the therapy, he was

very excited. During the therapy he listened very carefully to every ball and

wanted us to assist him in every pattern of the game. The therapy went good and

he was very happy wining two times in the said therapy.

VII. Reference

Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition,

2008

Name of Therapy: Story Telling Therapy

Place: Under the tree (MMH)


106

Time: 9:30 AM

Phase: Working Phase (Day 6)

I. Objectives


1. To assessed the clients reading comprehension

2. To develop clients concentration

3. To assess client memory status

4. To exercise client’s natural imagination in gaining lessons through

story.




mental illness.


communication.

4. To evaluate client understanding about the story he was read.



It was Friday morning when we fetched our client to the grooming area

and assisted him for the therapy. The weather is sunny, and we chose the

107

appropriate setting for the therapy the trees provided them sheds against the

sunlight. We were facing the client, handed them a book of “Ang Kalabaw at

ang Pagong”. The place was conducive for the activity and he was

comfortably seated on his chair. The procedures of the therapy were explained

to him clearly and he understood that after reading the story he should

formulate or get a moral lesson from it. We viewed the reactions and facial

expressions of Mang JM while participating in the activity and noticed that he

was interested.


We received our client wearing the same set of clothes the same as

yesterday. His gait was moderate and he always looked at the floor with his

arching back. He initiates conversation on how he groomed himself before we

arrived and refused us in grooming him again. When we accompany him to

the activity area, he was initiating stories. We accompany him to the activity

area and was seated on a chair facing us. During the activity, he showed

interest in reading the story. After the activity we proceed for another

conversation and reviewed him about the recent therapy. As we go along on

our conversation, different behaviors were manifested, congruent affect have

been projected by the client, but sometimes he answered late.


108


109

Nurse- Client


non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and


theories


po Mang J.M.”

C: “Magandang umaga

din!” (Smiled and

Nodding)

Giving Recognition The client looks back

with a smile. He shows

interest for today’s

activity.


initial interaction


the patient wherein the

latter has a felt need and

expresses the desire for

professional assistance.

SN: “Tara po Mang J.M

maglinis na po kayo.”

C: “Hindi na,naligo na

ako kanina 2 beses.”

SN: “Kanina po? Anung

oras po?”

C: “ Kaninang

pagkagising ko 4am at

kaninang 6am.”


sequence

The client refuses for our

grooming session

wherein he says sequence

of activity he did in the

morning.


she identified 21

problems and one of it is


hygiene.

SN: “Mang JM, napansin

ko pong hindi niyo

pinapalitan ang damit

niyo?”

C: (Smiled and Nodding)

Making Observation The client responds

appropriately and accepts

the implied without

misunderstanding what

his nurse said.

According to Roy, the

degree of internal or

external environmental

change and the person’s

ability to cope with that

change is likely to

determine the person’s

health status.

Content Theme

We established nurse patient interaction focused primarily on the story

telling therapy in which the client reads the story then identify the moral

lesson on the story assigned to them. With this therapy, we can assess their

memory and their cognitive ability on how they explain what the story had

told them.

Interaction Theme

During the therapy we noticed that he had different ideas in

deciphering the story. While reading, we reviewed his memory by asking

the recent events and details in the story. After that, we had our

conversation to assess what were the lessons he learned by reading the

story. Some of his answers were irrelevant to the situation and he will put

some stories of his own which were not related to the storytelling therapy.

He didn’t concentrate on the story because he had his own stories that he

wanted to discuss with us. He can recall every detail of the story but a little

different from the original events. We can say that he didn’t enjoy the

therapy that much. He’s only active when he’s discussing his own story.

Mood Theme

110

During our interaction to the client, Mang JM responded well to the

questions although there are some unrealistic answers. He always observed

his environment when he’s not being asked. He projected appropriate

moods and behaviors but his attention was concentrated on his

environment.


Disturbed Thought Process Related to misinterpretation as evidenced by:

SN: Ano po ang dahilan at nasabi nyo po na hindi kayo pumapatay:

C: May masasama kasing tao doon sa labas kumukuha ng mga babae sa bahay,

hindi kami yun.


We encourage Mag Jm to perform the Routine Grooming. We ask him to

participate to the activity that we will going to conduct today. W encourages him

to verbalize his feeling regarding the therapy. We asked him to read the story and

formulate his own lesson that he gain in the story. We encourage Mang Jm to

verbalize the thing on his mnd to be able for as to assess any problem that he feels.


In the Friday afternoon, as we received the client, Mang JM, he presented a

smiling face and a happy mood. He refused us to groom him, again, so we proceed

to the activity area for the story telling therapy. The client was very cooperative

on the conducted activity that afternoon. He was able to identify the moral lesson

111

in the story though it was not clearly explained to us because of his flight of

different ideas. He was very agitated around his environment.

He also verbalized feelings of concern openly with us.

VII. Reference


2008

Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia.

Lippincott, Williams and Wilkins. (5th Edition

Name of Therapy: Food Festival

Place: Canteen (MMH)

Date: February 2, 2011

Time: 2:00 PM

112


I. Objectives


1. To improve the socialization skills of the patient

2. To develop client’s self-esteem

3. To assess client’s ability in following procedures

4. To assess the client’s memory




mental illness.


communication.



It was a fine sunny day of Wednesday around 2:00 in the afternoon of

February 2, 2011 when we received our client. He first greeted us with a smile

and initiated to go to the pantry area which was a good thing. We let him

groom himself in the area and after his grooming we proceed to the canteen

for their activity. The place was clean and the seats were arranged semi circle

facing the table where the facilitators will do their demonstration of the

activity.

113

They were oriented in time, place and date and the procedure of the

activity were explained very clearly for the benefit of orderliness of the

activity. A brief conversation and review were conducted after the activity to

assess what he had learned and to check his recent memory. At around 4:00

pm, we returned our client to his dorm after the therapy and the conversation.



Boysen shirt and green patterned shorts which was the same two weeks ago.

He greeted us with a smile and initiated to go to the pantry room. His gait is

moderate and was looking to the floor at times. He brushed his teeth very hard

and requested a cologne and powder to finish his grooming session. After that,

we accompany him to the activity area and noticed that he was very excited

and always smiled at everyone. During the program, he was actively

participating and behaved well. He was serious and focused himself to the

procedures. He was able to compute the total price of all the ingredients used

in the food festival. After the program, we conducted a brief session to review

what he has learned to observe some improvements in his behavior. As we go


affect have been projected by the client. We observed that he was very happy

and excited about his discharge soon.


Nurse- Client


non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and


theories

114


po Mang JM”

C: “Magandang umaga din

naman.” (Smiled and

Nodding)

Giving Recognition The client smiled and

greeted back that suggest

he is comfortable with us.


initial interaction between

the nurse and the patient

wherein the latter has a felt

need and expresses the

desire for professional

assistance.


Mang JM para

makapaglinis po kayo.”

C: “Hindi naligo na ako

kanina pa 2 beses.”

SN: “Tara na po doon para

po makapaghugas na po

kayo ng kamay niyo umihi

po kasi kayo eh”

C: “oh sige.”

SN: “Para na din po mas

maging gwapo po kayo

Mang JM.”

C: (Smiled)

Offering one’s Self Mang JM feels that his

nurses were here just for

him.

According to Peplau, in

interpersonal relationship

theory, it is important for

the nurse to recognize and

respond to the

patients needs for help.

SN: “Kamusta po kayo

Mang JM?

Broad Opening The client encourages

being bad by a response of

what he wants to state on

any cues of

115

C: “mabuti naman,

masaya.”

communication.

According to Watson, it is

important to help the

patient identify his own

thoughts and feelings to

gain better understanding

of his self.

SN: “Anu pong dahilan at

masaya po kayo Mang

JM?”

C: “wala naman, dahil

nakalabas ako ulit sa

ward.”

Focusing The client was happy

because we fetch him in

his dorm.

According to Watson,

there is an independency

and integration of the parts

and elements of thoughts

and behaviours that make

up the system.

SN: “Nakikilala niyo pa po

ba ako Mang JM?”

C: “Oo, ikaw si Mark.”

SN: “eh, yung isa ko pa

pong kasama?”

C: “Uhmmm...hahosy?

Hasi?”

SN: “Hazel po Mang JM.”

C: “Ay, oo nakalimutan ko

kasi.”

Focusing The client still remembers

who we are including our

name which means that he

had a good immediate

memory.






up the system.

SN: “Kamusta po ba ang Focusing The client still remembers

116

tulog niyo Mang JM?”

C: “Mabuti naman.”

SN: “ Anung oras po kayo

nakatulog kagabi?

C: “8pm.”

the time he fell asleep last

night.






up the system.

SN: “Natatandaan niyo pa

po ba yung ginawa natin

last last week po?”

C: “Oo, Bingo at yung

pinakita yung

mgapictures.”

SN: “ Ilan beses po kayo

nanalo Mang JM sa

bingo?”

C: “dalawa.”

Seeking Clarification The client still remembers

the things we’ve done for

the last 2 weeks.

According to Orem, self

care requisites are insights

of actions that a person

must be able to meet and

perform in order to

achieve well being.

SN: “Alm niyo po ba yung

gagawin po natin ngayon

Mang JM?

C: “Oo, magagawa tayo ng

mga pagkain.”

SN: “Opo Mang JM,

tuturuan po naming kau

gumawa ng buko salad.”

Giving Information The client provided

information necessary for

the activities of the today.

According to Roy,

informing the patient

know what to expect. All

other stimuli that

strengthen the effect of the

focal stimulus.

SN: “Kamusta po ang

paggawa niyo ng buko

Exploring The client verbalizes his

feelings about the activity

117

salad Mang JM?”

C: “ahh... mabuti naman.”

SN: “Magkano po ule

yung lahat lahat ng

magagastos para sa

paggawa po ng buko

salad?

C: “118.”

SN: “Galing naman po

pala.”

being done for today.






up the system.

SN: “Kayo po ba Mang

JM nung hindi pa po kayo

napupunta ditto nagluluto

p okay sa bahay niyo ng

pagkain?”

C: “oo naman,tulad ng

hotdog, isda atbp.”

SN: “ Kasipag naman po

pala ni Mang JM.”

C: (Smiled)

Asking Direct Questions

The client shared what she

does before she was

admitted at Mental.

According to King, a

person has ability to record

their history through their

own language and

symbols.

SN: “Mang JM, ngayon

pong malapit na ang

valentines may plano po

ba kayong pagbigyan ng

flowers?

C: “Wala pa nga eh, hirap


feelings about a girl she

wants to give flower for

the coming valentine’s

day.

118

kasi baka may boyfriend

na o may asawa na ang

babae eh.”

SN: “Anu pong dahilan at

nasabi niyong mahirap?

C: “wala naman, ikaw

marami ka ng napagbigyan

ng rosas noh?”

According to Maslow, one

must feel the sense of love

and belongingness

SN: “Halimbawa po Mang

JM si Hazel po yung gusto

niyong babae anu po gusto

niyong sabihin sakanya?

C: “uhmm...mahal na

mahal kita, aalagaan kita

ng mabuti.”

SN: “Wow ang sweet

naman po pala ni Mang

JM eh.”

C: (Smiled)

Role Playing We ask the client to

consider people and events

in light of his own

appraisal in order for him

to express his feelings.

According to Orem,

person’s major task is to

maintain integrity in face

of these environmental

stimuli.

SN: “Sa ngayon po ba

Mang JM may plano na po

ba kayo magasawa

paglabas niyo dito?

C: “Ahh...wala, babalik

ako sa trabaho ko.”

SN: “Saan po kayo


feelings about marrying

someone.

According to Maslow, one

must feel the sense of love

and belongingness

119

tutuloy?”

C: “Sa nanay ko.”

SN: “Di ba po Mang JM

nasabi niyo pong napunta

na po kayo sa America?

C: “Oo, sa mga ninong

ko.”

SN: “Anu pong mga

ginawa niyo doon?”

C: “Naginom sa mga bar.”

Seeking Clarification The client had a chance to

re- evaluate what he just

said.

According to Orlando, it is

important for the client to

know that he has heard.

With this the client will

make her feel accepted.

SN: “Sa pakikipag inuman

niyo po sa America wala

po ba kayo nakakilalang

babae doon?”

C: “Wala eh.”

SN: “Talaga po Mang JM?

Ayaw niyo lang po ata

mag- share eh?”

C: (Laughing)

SN: “sige na po Mang JM

i-Share niyo na po yan.”

C: “Wala nga.” (Smiled)

Humor The client was able to

decrease his anxiety in a

way that we give some of

humors in order for him to

verbalize.

According to Kolcaba,

health care needs are needs

for comfort, arising from

stressful health care

situations that cannot be

met by recipients’

traditional support system.

SN: Mang JM bukas po

magkikita po tayo uli ang

activity po natin bukas ay

Formulating Plan of

Action

The client was provided

information in order for

him to be prepared on

120

dance therapy, anu po ba

ang gusto niyong dance

step?

C: “basta bukas nalang.”

(Smiled)

SN: “Anu pa po ba gusto

niyong tugtog para pos a

sayaw natin bukas?

C: “Kahit ano basta yung

masaya.”

what the things will be

done and the things to

expect.

According to Roy,

informing patient of facts

lets the patient know what

to expect. All other stimuli

that strengthen the effect

of focal stimulus.

SN: “Mang JM, anu- ano

po uli mga gnawa po natin

ngayong araw?

C: “food festival, sinabi

niyo kung magkano ang

mga sangkap.”

SN: “Galing naman pop

ala ni Mang JM.”

C: (Smiled)

Summarizing The client has a good

recent memory, he recalled

the things being done for

today. It helps to bring out

important points of the

conversation and

activities. It increases

awareness and

understanding of both

participants. This provides

as a sense of closure at the

discussion.

According to Orem,

Supportive- educative

helping patient to learn

self care and emphasizing

on the importance of

nurses’ role.

SN: Mang JM, ano po ang

masasabi niyo sa ginawa

Evaluation Evaluation allows the

client to evaluate the

121

natin kanina?

C: natutuwa ako dahil

marami akong na tutunan.

outcome of the conducted

therapy.

IV. Theme identification

Content Theme

We established nurse patient interaction focused primarily on the food

festival in which the patient demonstrated procedures in preparing buko

salad. This therapy will provide the client the stimulus to assess their

ability to follow procedures and do it independently and creatively.

Moreover, it serves as guide for their thoughts and behavior.

Interaction Theme

During the therapy while the facilitators were explaining the

procedure, he was focused on every detail. But when his fellow clients

demonstrate their procedure he seemed bored and not interested. When his

turn to demonstrate, he did it very well. After the therapy, we had our short

conversation to review his memory about the recent activity and to assess

what the therapy has taught him and to assess for any improvements in his

122

behavior. He responded well in every question thrown at him and showed

interest in the conversation.

Mood Theme

During the conversation, he showed appropriate moods and affect

congruent to the questions being asked. He often smiled and laughed and

seldom looked away to divert his attention. He had a good eye contact

while having our conversation and his statements were clearly

represented.


Readiness for enhanced coping related to verbalization of feelings as evidence

by:

SN: “Mang JM, ano po ang masasabi niyo sa ginawa natin kanina?”

C: “natutuwa ako dahil marami akong na tutunan.”


We fetched Mang JM from the ward and we received a warm smile

from him. He initiated to go to the pantry area so we had the chance to groom

him. He did grooming himself and asked for cologne and powder without

changing his clothes though we always encouraged him to do so. During the

activity, we assisted him in preparing the food. And after that we had a short

conversation to identify his improvements in the past weeks of therapy.


123

On February 2, 2011 we conducted another therapy to help them work

independently following procedure. The facilitators of the said therapy oriented them before

doing every procedure. Mang JM looked excited for his turn to make his own version of buko

salad. He was able to identify the total amount of all the ingredients needed in the therapy.

While the facilitators were demonstrating every procedure he was listening very well and

focused on every detail of the procedure while others were doing their turns in re-

demonstrating the procedures he seemed bored and not interested while silently

demonstrating every procedure, he did it very well and was given recognition for it. Before

eating his meal, he offered his meal to everyone and he wanted to share his meal with us. He

enjoyed eating his meal and appreciated it very much.

After the therapy, we conducted brief conversation about the recent activity. He was

none initiating that time and was looking around his environment. He said that the food

festival was good and it would help him get stronger for the day. Eye contact was lacking that

time because his attention was drowned around his environment. His memory was good

because he identified the ingredients of the salad with its corresponding prices. He returned to

the dorm with gratitude and appreciation.

VII. Reference

NANDA 10th edition

Psychiatric-Mental Health Nursing 5th Edition

124

Name of Therapy: Dance Therapy



Time: 1:30 PM


I. Objectives


125

1. To develop the client’s self esteem

2. To improve the client’s interpersonal relationship with others and to

reduce anxiety

3. To assess and develop his movement and coordination





illness.


communication.



It was a Thursday of February 3 when we received our client. We

conducted another activity called Dance Therapy. We prepared seats in a

straight line and oriented them before doing the therapy. After the facilitators

greeted and explained every procedures of the therapy, we showed them the

whole dancing activity before teaching them step by step. After teaching them

the steps, they performed the dance to the other clients while assisting them

how to. They were given great recognitions after the dance therapy and were

deeply appreciated. After the program, we gave the client something to eat and

drink to regain his energy and conducted the conversation for assessing

126

improvements. At around 4:00 pm, we returned our client to his ward after the

therapy and the conversation.


We received our client wearing his clothes with MMH’s male uniform.

The uniform was colored blue and semi-wrinkled. He greeted us with a smile

and proceed to grooming area but he didn’t want to be groomed so we insisted

him to do so. His gait is moderate and was looking to the floor at times. He

washed his face rigidly and brushed his teeth very hard and requested a

cologne and powder to finish his grooming session. After that, we accompany

him to the activity area and noticed that his affect was somehow flat and

steadily looking at the floor. During the program, he is silent and seldom

smiled while doing the steps. He was serious and focused himself to the

activity. His memory was sharp because he can recognize each step easily and

his movement and coordination was good.. After the program, we conducted a

brief session to observe some improvements in his behavior while eating his

merienda. As we go along on our conversation, different behaviors were

manifested, congruent affect have been projected by the client. We observed

that he was very happy and excited about our conversation on his past

relationships.


127

128

Nurse- Client


non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and


theories

SN: “Magandang

Tanghali po Mang J.M.”

C: “Magandang Tanghali

din”

Giving Recognition Mang JM looks back and

greeted us. This shows

that he is comfortable to

us.

According to Peplau

(1952), a nurse is

stranger to the patient. It

is therefore important to

remind the patient who

we are and be consistent

with the information we

are giving to him to gain

their trust.



kayo Mang JM.”

C: “hindi na naligo na

ako kanina.”

SN: “Tara na po doon

kahit po maghilamos at

toothbrush nalang po

kayo.”

C: “Sige.”

Offering One’s self The client feels the

presence of his student

nurses.


unique function of the

nurse is to assist the

individual, sick or well,

in the performance of

those activities

contributing to health or

its recovery that he

would perform unaided if

he had the necessary

strength, will, or

knowledge.

SN: “Mang JM ano pong

pangalan ko?”

C: “Ahh..ikaw si Mark.”

SN: “Eh!yung kasama ko

po sino po yun?”


student nurses.

According to Sullivan,

interaction among client

is beneficial that helps

client him to cope to

reality.


Content Theme

We established nurse patient interaction focused primarily on dance

therapy in which the facilitators oriented the clients on how the activity

will flow. Each student nurses taught their clients the steps for the dance

therapy while assessing their movements, coordination, and behavior.

Interaction Theme

During the therapy while the facilitators were explaining the

procedure, he was focused on every detail. While teaching him the steps

and at the same time having a conversation with him, his affect was a little

flat and seldom smiled. He only smiled when he was given recognition. He

responded well in every question thrown at him and showed interest in the

conversation.

129

Mood Theme

During the program where he presented to the other client what steps he

has learned in the dance, he was very proud and always smiled at the

audience. During the conversation, he showed appropriate moods and

affect congruent to the questions being asked. He seldom smiled and

laughed and looked on his environment while doing the steps. He had a

good eye contact while having our conversation after the therapy and his

statements were clearly represented.


Ineffective denial related to fear of consequences on negative past experiences

as evidence by:

SN: “Anu po ginawa niyo para po maka- move on?”

C: “wala, may minahal kasi ako agad.”


We received our client wearing the same clothes but with MMH’s male

uniform as his topper. We assisted him in his grooming session and

encouraged him to change his clothes. After that, we accompanied him to the

activity area and orient him for the preparedness and orderliness of the

activity. We taught him steps in the dance activity while assessing his

behaviors and movements. The client was given a chance to present his dance

to his fellow clients ad was given recognitions and appreciations after that. A

brief conversation was conducted after the activity and he was reminded that

130

tomorrow will be our last conversation and meeting. We fetched him to the

male ward afterwards.


On February 3, we conducted a therapy where in we taught the patient how to

dance while assessing their movement and coordination and developing their self

esteem. We oriented the client about the therapy and showed them the steps. Mang

JM seemed uninterested and very silent while watching the performance.

During the therapy Mang JM showed flatness of affect and non initiating

behaviors. When learning every step, he can easily memorize each.

After teaching the steps, Mang Jm performed the dance in front of his fellow

clients. We noticed that he had sudden change of moods. While performing, he was

happy and proud performing in front of his audience. We didn’t have a hard time

assisting him in performing because he memorized all the step.

After the program, we had a conversation and review his reactions about the

therapy. The conversation manifested that he didn’t enjoyed the practice. He only

enjoyed performing.

VII. Reference


2008

Grand Socialization

Place: MMH

131


Time: 9:00 AM

Phase: Termination Phase (Day 9)

I. Objectives


1. To stimulate mind and body through socialization to other clients.

2. To develop the self esteem of the client

3. To assess the improvements of the patient in following instructions

4. To assess the memory of the client

5. To terminate the relationship.




illness.


communication



It was a sunny day of Friday of February 4, 2011 when we conducted

the Grand Socialization for all the patients handled by the BPSU nursing

students. Everyone’s busy decorating the place with red balloons, and multi

colored crepe papers. The music committee was all set up. The games,

132

programs and prizes were properly arranged. The chairs were arranged in 3

straight lines in front of the sound system facing the Grand Socialization

tarpaulin. The place was enough to accommodate all the patients and students

and was conducive for the activity.



Boysen shirt and green patterned shorts topped with blue male ward uniform.

He greeted us with a smile and reminded us that it was our grand socialization

day today. His gait is moderate with his arching back. He brushed his teeth

very hard and washed his face very thoroughly. After that, we accompany him

to the activity area. During the program, he was actively participating and

behaved well. During the games, he always raised his hands and always

willing to participate in the game. He was serious and focused himself to each

and every instructions of the game. When he won, he put his prizes inside of

his shirt. And when his fellow clients won the game, he was snatching some of

the prizes of his fellow patients. During the program, he was very happy. After

the program, we conducted a brief session to observe some improvements in

his behavior. As we go along on our conversation, different behaviors were

manifested, congruent affect have been projected by the client. We observed

that he was very happy and satisfied on what his experiences on the grand

socialization brought him.


133

134

Nurse- Client


non- verbal cues)

Therapeutic

Communication

Technique Used

Analysis and


theories

SN: “Magandang Umaga

po Mang J.M.”

C: “Magandang Umaga

din naman.” (Smiled)

Giving Recognition The client smiled and

greeted back that suggest

he is comfortable with

us.

According to Peplau

(1952), a nurse is

stranger to the patient. It

is therefore important to

remind the patient who

we are and be consistent

with the information we

are giving to him to gain

their trust.



kayo Mang JM.”

C: “hindi na naligo na

ako kanina.”

SN: “Tara po

maghilamos at toothbrush

nalang po kayo.”

C: “O sige.” (Smiled)

SN: “Para po mas gwapo

po kayo ngayon.”

Offering One’s self The client feels the

presence of his student

nurses.


unique function of the

nurse is to assist the

individual, sick or well,

in the performance of

those activities

contributing to health or

its recovery that he

would perform unaided if

he had the necessary

strength, will, or

knowledge.

SN: “Oh! Mang JM anu

po pangalan ko?”

C: “Mark.”

SN: “Eh, eto pong

kasama ko?”


student nurses.

According to Orem, self

care requisites are

insights of actions that a

person must be able to

meet and perform in

A. Theme identification

135

Content Theme

The therapy was all about developing the interpersonal relationship of

the client with others and assess his improvements throughout the

whole 3 week therapies.

Interaction Theme

Mang JM participate well to the game. He was very cooperative and able

to listened to the instruction. He was able to remember all the step we

taught him yesterday. During our last conversation with him he maintained

his eye contact with us. He said thank you to us.

Mood Theme

During the conversation, he showed appropriate moods and affect

congruent to the questions being asked. He often smiled and laughed and

seldom looked away to divert his attention. He had a good eye contact

while having our conversation and his statements were clearly represented.


Risk for loneliness related to termination of relationship with nursing students.

SN: “Mang JM last day na po namin ngayon.”

C: “Oo, basta wag niyo sana kami makakalimutan.”(looks sad)

IV. Nursing Interventions

136

In Hildegard Peplau, Phases of nurse client relationship, termination phase is

the final stagein the nurse-client relationship. Both nurse and client usually have

feelings about ending the relationship; the client especially may feel the

termination as an impending loss.

We plan a grand socialization for our client where they will enjoy the food ang

games we prepare for them. We encourage Mang JM to participate in the game;

this will help him to develop his confidence in facing crowd. We perform a dance

number with our client. During our conversation with Mang JM, we encourage

him to verbalize his feeling regarding the termination of our relationship with him,

by doing this we can evaluate what he feel about the termination. We encourage

Mang JM to verbalize what are the things he learn from the therapy we previously

done, by doing this we can evaluate if we solve the problem of Mang JM and if

we become an effective student nurses. We tell Mang JM that we enjoy the time

we spent with him.

V. Summary and Evaluation

This was the last day that we had our care and conversation with the patient.

He seemed very happy during the grand socialization day. We let him participate

in the games and won many times. He kept his prizes inside his clothes and some

of it was shared to others. While eating his meal, we had the chance to talk to him

for the last time and to explain to him that this was the last day where we can able

to care, talk to him and do activities.

He understood the termination of the care and wished that we won’t forget him.

137

VI. Reference


Lippincot. Williams and Wilkins. (5th Edition).

Octavino Eufemia F., and Balita, Carl E> (2008). Theoretical Foundation of

Nursing> Balikan Prints and Binding Enterprises.

138

PHARMACOLOGY

139

Name of Drug Mechanism of Action

Contraindication Indication Adverse Effect

Nursing Consideration

Generic Name:

Risperidone

May act by antagonizing dopamine and serotonin in the central nervous system

Contraindicated in patient with hypersensitivity to drug

> patient with schizophrenia

> bipolar mania

> irritability symptoms of aggression toward others, deliberate self-injury, and temper tantrums associated with autistic disorder

> mild restlessness> headache

1. Monitor mood changes. Assess for suicidal tendencies especially during early therapy

2. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.

3. Monitor patient for onset of extrapyramidal side effect. Report these symptoms; reduction of dosage or discontinuation of medication may be necessary.

Brand Name:

Risperdal

Classification:

Anti-psychotic

(atypical antipsychotic)

Dosage, Route, Frequency:

2mg ½ tab, PO, BID

140

Name of Drug

Mechanism of Action

Contraindication

Indication Adverse Effect


Generic Name:

Haloperidol

Unknown. Thought to block postsynaptic dopamine receptors in brain. Inhibiting signs and symptoms of psychosis

>hypersensitivity to drug

> severe central nervous system depression

> Parkinson’s disease

>symptomatic treatment of psychotic disorders

>schizophrenia in patients who need prolonged parental anti-psychotic therapy

> psychotic disorders

>hyperactivity

> manic states

>confusion

1. Monitor patient for onset of akathisia which may appear within 6 hour of first dose and may be difficult to distinguish from psychotic agitation

2. Assess mental status (orientation, mood, behavior) prior to and periodically during therapy


Brand Name:

Haldol

Classification:

Anti-psychotic

(typical antipsychotic)


1amp, 5mg IM

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Name of Drug

Mechanism of Action

Contraindication

Indication Adverse

Effect

Nursing Consideratio

n

Generic Name:

Levomepromazine

Exerts its actions through a central adrenergic-blocking, a dopamine-blocking, a serotonin-blocking, and a anticholinergic blocking

No absolute contraindications

> used for the treatment of psychosis, particular those of schizophrenia, and manic phases of bipolar disorder

>dry mouth

1. watch out for seizures

2. caution in combining levomepromazine with other anticholinergic drugs

3. monitor vital signs

Brand Name:

Nozinan

Classification:

Anti-psychotic


10mg ½ tab, HS

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Name of Drug Mechanism of Action

Contraindication Indication Adverse Effect


Generic Name:

Flupentixol

It inhibits the central monoamine receptors, particularly the dopamine D₁ and D₂ receptors. Therefore, it increases the amount of serotonin and noradrenaline that control mood and thinking, and improve mood

> With known hypersensitivity to the thioxanthenes

> presence of CNS depression due to any cause, comatose states

>maintenance therapy of chronic schizophrenic patients whose main manifestations do not include excitement, agitation or hyperactivity

> dizziness> headache

1. careful observation for early symptoms of tardive dyskinesia


Brand Name:

Fluanxol

Classification:

AnxiolyticAntidepressiveMood stabilizer


1cc, IM

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Name of Drug

Mechanism of Action

Contraindication

Indication Adverse Effect


Generic Name:

Chlorpromazine

Block dopamine receptors in the brain, prevention of seizures

>hypersensitivity to drug

> should not be used in patients who have CNS depression

> acute and chronic psychoses particularly when accompanied by increased psychomotor activity

>dry mouth

1. assess mental status prior to and periodically during therapy


3. monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizres)

Brand Name:

Thorazine

Classification:

Anti-psychotic

(typical antipsychotic)


500mg 2tabs, HS

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UNIT V(Psychotherapy)

145

Psychotherapy

146

Name of Therapy: Role Identification Therapy



Time: 9:30 AM


DEFINITION

This therapy uses a picture of people and their different kind of occupation.

This therapy involves identifying the different kinds of occupation in the picture and

also explaining their role in the society.

OBJECTIVES

To enhance the thinking and analyzing ability of the client.

To analyze and determine the knowledge and understanding of clients with

occupation roles.

To gain knowledge

PROCEDURES

1. First the leader will initiate the mood of the client.

2. Then the facilitator is responsible for asking questions to the client. They

will ask the client if they know what the picture is and what is represents.

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3. If the client has wrong answer, the facilitator will correct them.

4. After that the clients was distributed to their own nursing student for

individual discussion of the pictures.

5. Finally the leader will gather the patient for evaluation of the therapy.

ANALYSIS AND INTERPRETATION

Mang JM cooperates well and actively. He answered the questions according

to his own intellectual capacity. He always laughed at his inmates whenever he felt

that their answer was wrong.

According to Roy, through two adaptive mechanisms, regulator and cognator,

an individual demonstrates adaptive responses or ineffective responses requiring

nursing interventions.

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Name of Therapy: Bingo Social Therapy



Time: 9:30 AM


DEFINITION

This therapy is like the usual bingo we played. Instead of numbers, fruits and

vegetables were used in the game. This therapy is used for assessing knowledge of the

mentally-ill patients about fruits and vegetables.

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OBJECTIVES

To improve the socialization skills of the patient

To develop the self-esteem of the clients

To assess the knowledge perception of the client about different fruits and

vegetables.

To assess the memory of the client

PROCEDURES

1. Orient the client about various types of fruits and vegetables.

2. Explain the mechanics and therapy simple briefly and clearly

3. Encourage the client to participate in the entire theory

4. During the working phase give recognition to the winning clients and provide

prizes.

5. Summarized and evaluate the therapy


With this kind of activity, we used fruits and vegetables on every BINGO

cards. Instead of numbers when we informed our client about the therapy, he was very

excited. He was very eager to win and get the prize. During the therapy, he listened

very carefully to every ball and wanted us to assists him in every pattern at the game.

The therapy went good and he enjoyed the game and very thankful for winning it.

According to King, perceptions, judgments and actions of the patient and the

nurse lead to reaction, interaction, and transaction (Process of nursing)

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Name of Therapy: Storytelling

Place: under the tree (MMH)


Time: 9:30 AM


DEFINITION

The book that is use is about the animals and it is short that the client will not

get bored reading it. It also have picture that show what the characters are doing.

Story telling is done to assess the reading comprehension of the client and his ability

to formulate his own moral lessons that he gain to the story.

OBJECTIVES

To assessed the clients reading comprehension

To develop clients concentration

To assess client memory status

PROCEDURE

1. First the facilitator will explain to the client the name of the therapy

2. The facilitator will tell to the client the short story they will go to read.

3. The two student nurses will show to the client the short story they will go to

read.

4. The client will read the tagalong versions of the story

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5. The student nurses will asked the client what is the moral study of the story.


Today, the therapy was all about storytelling. We let the client read the story

and get lessons from it. During the therapy, we noticed that he had different ideas in

deciphering the story. We asked him questions to review every detail of the story.

Some of his answers were irrelevant to the situations and he will put some stories not

related to the storytelling therapy.

He didn’t concentrate on the therapy because he had his own different stories

that he wanted to discuss with us. He can recall some of details in the stories but a

little different from the original one. We can say that he got bored reading the story

and during the therapy. He’s only active discussing his own stories.

According to Pender, Identifies cognitive, perceptual factors in clients which

are modified by demographical and biological characteristics, interpersonal

influences, situational and behavioral factors that help predict in health promoting

behavior.

152

Name of Therapy: Food Festival



Time: 2:00 PM


DEFINITION

Food festival is a therapy done in order for the client to have basic knowledge

in preparing foods. This is done to assess the client’s ability in following procedures

and to assess their memory while they are socially incline with other patients. This

would help them to work independently and creatively.

OBJECTIVES

To improve the socialization skills of the client

To develop the self-esteem of the client

To assess the client’s ability in following procedures

To assess client’s memory

PROCEDURES

1. Prepare all the ingredients needed.

2. Discuss every detail of the therapy.

153

3. Inform the client about the each ingredient with their corresponding price.

4. Demonstrate the procedure.

5. Allow the client to make their own salad.

6. Evaluate their works


On February 2, 2011 we conducted another therapy to help them work

independently following procedure. The facilitators of the said therapy oriented them

before doing every procedure. Mang JM looked excited for his turn to make his own

version of buko salad. He was able to identify the total amount of all the ingredients

needed in the therapy. While the facilitators were demonstrating every procedure he

was listening very well and focused on every detail of the procedure while others

were doing their turns in re-demonstrating the procedures he seemed bored and not

interested while silently demonstrating every procedure, he did it very well and was

given recognition for it. Before eating his meal, he offered his meal to everyone and

he wanted to share his meal with us. He enjoyed eating his meal and appreciated it

very much.

After the therapy, we conducted brief conversation about the recent activity.

He was none initiating that time and was looking around his environment. He said

that the food festival was good and it would help him get stronger for the day. Eye

contact was lacking that time because his attention was drowned around his

environment. His memory was good because he identified the ingredients of the salad

with its corresponding prices. He returned to the dorm with gratitude and

appreciation.

154

According to Peplau, interpersonal theory nurse assumes several roles which

empower and equip her in meeting the needs of the patient .Teaching Role Gives

instruct ions and provides training; involves analysis and synthesis of the

learner’s experience.

155

Name of Therapy: Dance Therapy



Time: 1:30 PM


DEFINITION

This therapy is done to assess the client’s movement and coordination, as well

as his ability to memorize every step. This therapy is intended also to relieve their

anxiety and to create recreation. This is also done to develop the client’s socialization

to others.

OBJECTIVES

1. To develop the client’s self esteem

2. To improve the client’s interpersonal relationship with others and to reduce

anxiety

3. To assess and develop his movement and coordination



6. To implement therapeutic plan necessary for improvement of mental illness.

7. To develop positive coping behavior through therapeutic communication.

156

ANALYSIS & INTERPRETATION:

On February 3, we conducted a therapy where in we taught the patient how to

dance. We orient the patient about the therapy and showed them the dance. Mang JM

seemed uninterested and very silent while watching the steps of the dance.

During the therapy, Mang JM showed flatness of affect and non initiating

behaviors while we were teaching him every step. He can easily do the steps and

memorized each very well though he seemed silent throughout the entire practice.

After teaching the steps Mang JM performed the dance in front of his fellow

clients. We noticed that he had sudden change of mood while performing. He was

happy and proud while dancing. We didn’t have a hard time assisting him in his

performance because he memorized every step.

After the program, we had a conversation and review his reactions about the

therapy. The conversation manifested that he didn’t enjoyed the practice of the dance

and enjoyed his performance only.

According to Wiedenbach the Art of nursing includes understanding patient’s

needs and concerns, developing goals and actions intended to enhance patient’s ability

and directing the activities related to the medical plan to improve the patient’s

condition.

157

UNIT VI(Glossary)

158

GLOSSARY

Acute Dystonic Reaction- extreme contraction of the jaw muscles, which can result

in dislocation of the jaw bones and difficulty in opening the mouth. These symptoms

may be caused by an adverse reaction to an antipsychotic drug.

Affect- is the outward expression of the client’s emotional state.

Affective disorder- refers to disorders of mood.

Agnosia – is a loss of ability to recognize objects, persons, sounds, shapes, or smells

while the specific sense is not defective nor is there any significant memory loss.

Akathisia- Motor restlessness ranging from a feeling of inner disquiet, often localized

in the muscles, to an inability to sit still or lie quietly.

Alcohol Abuse- use of alcoholic beverages to excess, either on individual occasions

("binge drinking") or as a regular practice.

Alogia - Poverty of speech, as commonly occurs in schizophrenia.

Ambivalence- presence of two opposing feelings.

Amnesia - refers to the loss of memory

Anhedonia- loss of interest in pleasurable things.

Antipsychotic Drugs- class of medicines used to treat psychosis and other mental and

emotional conditions.

Anxiety- is a psychological and physiological state characterized by somatic,

emotional, cognitive, and behavioral components. Anxiety is considered to be

a normal reaction to a stressor. It may help a person to deal with a difficult situation

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http://en.wikipedia.org/wiki/Stress_(biological)

http://en.wikipedia.org/wiki/Normality_(behavior)

by prompting one to cope with it. When anxiety becomes excessive, it may fall under

the classification of ananxiety disorder.

Aphasia- loss or impairment of the power to use or comprehend words.

Apraxia- inability to carry out purposeful motor activities.

Autistic Thinking- preoccupation with inner thoughts, daydreams, fantasies, private

logic; egocentric, subjective thinking lacking objectivity and connection with external

reality.

Avolition- lack of motivation.

Blunting – is an objective absence of noral emotional rersponses, without evidence of

depression.

Bradykinesia- neurologic condition characterized by a generalized slowness of motor

activity.

Clang Association- the sound of the words gives direction to the flow of thought.

Concrete Thinking- predominance of actual objects and events and the absence of

concepts and generalizations.

Defense mechanism- unconscious psychological strategies brought into play by

various entities to cope with reality and to maintain self-image. Healthy persons

normally use different defenses throughout life. An ego defense mechanism becomes

pathological only when its persistent use leads to maladaptive behavior such that the

physical and/or mental health of the individual is adversely affected.

Delusions- a fixed, false belief not based in the reality.

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

Denial- failure to acknowledge an intolerance thought, feeling, experience or reality.

Depersonalization- feeling of strangeness towards ones self.

Depression- a condition of general emotional dejection and withdrawal, sadness

greater and more prolonged than that warranted by any objective reason.

Disorientation- a state of mental confusion characterized by inadequate or incorrect

perceptions of place, time, or identity. Disorientation may occur in organic mental

disorders, in drug and alcohol intoxication, and, less commonly, after severe stress.

Displacement- the redirection of feelings to a less threatening object.

Dopamine- monoamine neurotransmitter formed in the brain from the amino acid

tyrosine essential for the healthy functioning of the central nervous system it has

effects on emotion, perception and movement.

Echolalia- pathological repetition of words of others.

Echopraxia- the pathological imitation of posture/ action of others.

Family Conflict- conflicts that occur within a family-between husband and wife,

parents and children, between siblings, or with extended families (grandparents, aunts,

uncles, etc.)

Fantasy- conscious distortion of unconscious feelings or wishes.

Fixation- arrest of maturation at certain stages of development.

Flat Affect – A severe reduction in emotional expressiveness.

Flight Of Ideas- shifting of ideas from one subject to another in a somewhat related

way.

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Fugue- a person suddenly, without planning or warning, travels far from home or

work and leaves behind a past life.

Genetics- study of hereditary traits passed on through the genes.

Group Therapy- form of psychotherapy that involves sessions guided by a therapist

and attended by several clients who confront their personal problems together.

Hallucination- false perceptions or perceptual experiences that do not really exist.

Illogical Thinking- thinking of something with out a logical reason or explanation.

Immediate Memory- what you can repeat immediately after perceiving it.

Immediate Recall- retrieval of events or information from the past.

Impulsive- characterized by actions based on sudden desires, whims, or inclinations.

Inappropriate Affect- an emotional tone or outward emotional reaction out of

harmony with the idea, object, or thought accompanying it.

Insanity- a deranged state of the mind usually occurring as a specific disorder.

Intellectualization- over use of intellectual concepts by an individual to avoid

expression of feelings.

Introjections- symbolic assimilation or taking into one’s self a loved/ hated object.

Labile Mood- when a person’s feelings or mood frequently fluctuates.

Mental Illness- is a psychiatric disorder that results in a disruption in a person's

thinking, feeling, moods, and ability to relate to others.

Motor Hyperactivity- a general restlessness or excess of movement.

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Motor Hypoactivity- abnormally inactive.

Mortality Rate- measure of the number of deaths in some population.

Neologism- pathological coining of new words.

Occupational Stress- physical or psychological disorder associated with an

occupational environment and manifested in symptoms such as extreme anxiety, or

tension, or cramps, headaches, or digestion problems.

Paranoid Schizophrenia- characterized by persecutory (feeling victimized) or

grandiose delusions, hallucinations, and occasionally, excessive religiosity(delusional

religious focus)or hostile and aggressive behaviour.

Peer Pressure- social pressure by members of one's peer group to take a certain

action, adopt certain values, or otherwise conform in order to be accepted.

Pharmacological Treatments- curing and treating illness that deals in the science of

nature and action of drugs and medicines.

Phobia- an exaggerated and often disabling fear usually inexplicable to the subject

and having sometimes a logical but usu. an illogical or symbolic objects or situation.

Prevalence Rate- total number of cases of a specific disease in existence in a given

population at a certain time.

Prognosis- foretelling of the probable course of a disease.

Projection- attributing to others one’s unconscious wishes/ fear.

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Psuedoparkinsonism- reversible syndrome resembling parkinsonism that may result

from the dopamine-blocking action of antipsychotic drugs. Also known as drug-

induced parkinsonism.

Psychotherapy- treatment of mental and emotional disorders through the use of

psychological techniques designed to encourage communication of conflicts and

insight into problems.

Rationalization- justifying one’s actions which are based on other motives.

Reaction Formation- expression of feelings that is the direct opposite of one’s real

feelings.

Recent Memory- ability to recover information about past events or knowledge.

Regression- returning to an earlier level of development in the face of stress.

Remote Memory- ability to remember things that happened years ago.

Repression- unconscious forgetting.

Schizophrenia- a form of mental illness in which there is a withdrawal from reality.

It cannot be defined as a single illness; rather, schizophrenia is thought of as a

syndrome or disease process with many different varieties and symptoms.

Self- Inflicted Injury- act of harming oneself.

Stress- body's reaction to a change that requires a physical, mental or emotional

adjustment or response.

Sublimation- the rechanneling of unacceptable instinctual drive with one that is

acceptable.

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Substance Abuse- excessive use of a substance.

Substitution- replacing the desired unattainable goal with one that is attainable.

Suicidal Behavior- deliberate action with potentially life-threatening consequences.

Suppression- “Conscious forgetting” a deliberate process of thought blocking.

Symbolism- less threatening object is used to represent another.

Tardive Dyskinesia- chronic disorder of the nervous system characterized by

involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually

developing as a late side effect of prolonged treatment with antipsychotic drugs.

Undoing- an attempt to erase an act, thought, feeling or desire.

Violent Behavior- a person harms themselves or others.

Withdrawal- the act of taking back or away something.

Word Salad- incoherent mixture of words and phrases.

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UNIT VII(References)

166

References

Books

NANDA 10th edition. Psychiatric-Mental Health Nursing 5th Edition

Octavino Eufemia F.and Balita, Carl E> (2008). Theoretical Foundation of

Nursing> Balikan Prints and Binding Enterprises.

Sia, Maria Loreto. Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition, 2008


Lippincot. Williams and Wilkins. (5th Edition).

Electronics

Colburn, Rebekah. Understanding schizophrenia: A guide to the signs, symptoms

and causes. (http://www.suite101.com/content/understanding-schizophrenia---brain-

disorder-a214502)

Glickman, Ian Ph.D. Occupational Stress 12 – Burnout. (http://ezinearticles.com/?

Occupational-Stress-12---Burnout&id=2246896)

Hambrecht, Martin and Häfner, Heinz. Substance abuse and the onset of

schizophrenia. (http://www.biologicalpsychiatryjournal.com/article/S0006-

3223(95)00609-5/abstract)

Hawes Liisa. The Ins and Outs of Peer Pressure. Calgary's Child Magazine

Calgary, Alberta, Canada.

(http://www.calgaryallergy.ca/Articles/English/peerpressure.html)

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http://www.calgaryallergy.ca/Articles/English/peerpressure.html

http://www.biologicalpsychiatryjournal.com/article/S0006-3223(95)00609-5/abstract)

http://www.biologicalpsychiatryjournal.com/article/S0006-3223(95)00609-5/abstract)

http://ezinearticles.com/?Occupational-Stress-12---Burnout&id=2246896

http://ezinearticles.com/?Occupational-Stress-12---Burnout&id=2246896

UNIT VIII(Documentation)

168

paranoid schizophrenia - case study

Documents