BULACAN STATE UNIVERSITYMojon, City of Malolos, Bulacan COLLEGE OF NURSING “A Case Study of Ms. Sue with a diagnosis of Manic Disorder with Pyschotic Feature (monosocial); to consider Paranoidal Schizophrenia” Submitted By: Group 2 De Leon, Charmaine P. De Leon, Lara Erika B De Leon, Mardielyn Rose M. dela Cruz, Albert S. dela Cruz, Jennelyn Y. Dungca, Rhenee Anne G. Eusebio, Omar Hilario, Ma. Antonette A. Iguban, Mickael John O. Leano, Gianina Marie P. Group 3 Lumba, Christine Joy O. Lumba, Eries L. Martin, Claire Rochelle Erika A. Nepomuceno, Anna Mhelysa F. Pagal, Mylene Perez, Ma. Cristina S. Pescador, John Robert A. Pingol, Criselle L. Placides, Marrose Arra R. In Partial Fulfillment of the Requirements in NCM 105 B – RLE Mariveles Mental Hospital Mariveles, Bataan (February 14, 2013) Submitted to: 3rd Level Clinical Instructors I. INTRODUCTION This is a case of MS. SUE, 55 years old, that was admitted at Mariveles Mental hospital last August 31, 2012 and was diagnosed of Bipolar Manic Disorder with Psychotic features. The patient was admitted at the female ward due to the complaints of the informants that the client escaped from home, refused to take medications, refused to eat meals except for fruits and was talking and singing aloud. Mood disorders, also called affective disorders, are pervasive alterations in emotions that are manifested by depression, mania, or both. There are two major classifications of mood disorder. The Major Depressive Disorder, which is characterized by occurrence of one or more depressive episodes and absence of manic, mixed and hypomanic episodes, and the Bipolar Disorder. Bipolar disorder or Bipolar Affective Disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis, defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood accompanied by abnormal behaviour with one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. They also experience depressive episodes, or symptoms, or a mixed state in which features of both mania and depression are present at the same time. These events are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is called rapid cycling. Severe manic episodes can sometimes lead to such psychotic symptoms as delusions. People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. For the purpose of medical diagnosis, Bipolar Disorder can are described as Bipolar I disorder—one or more manic or mixed episodes usually accompanied by major depressive episodes; Bipolar II disorder—one or more major depressive episode accompanied by at least one hypomanic episode. In short, in type 1, manic episodes are more prevalent while vice versa. Various theories for the etiology of mood disorders exist. Most recent research focuses on chemical biologic imbalances as the cause. Nevertheless psychosocial stressors and interpersonal events appear to trigger certain physiologic and chemical changes in the brain, which significantly alter the balance of neurotransmitters (Gabbard, 2000). Bipolar I disorder with psychotic features is a mood disorder characterized by unusually euphoric or agitated moods, along with depression or a mix of high and low moods. Psychotic symptoms are also part of this disorder, which can severely impact a person's ability to function. An accurate diagnosis and appropriate treatment plan are vital to the successful management of bipolar I disorder with psychotic features. According to PubMed-US National Library of Medicine National Institutes of Health, the Prevalence of Bipolar 1 Disorder in the World Mental Health Survey Initiative, the aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I). In United States, Bipolar Disorder has an incidence of approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. The median age of onset for bipolar disorder is 25 years, although the illness can start in early childhood or as late as the 40’s and 50’s.An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component. Locally, according to the record of Mariveles Mental Hospital as of 2012, there are 1030 patients who are admitted and only 50 or 4.85% of the total number of patients are diagnosed having Bipolar Manic Disorder. Among them, 62% (31) are Male while the remaining 38% (19) are female. References: • http://www.ncbi.nlm.nih.gov/pubmed/21383262 Videbeck 4th ed. • II. OBJECTIVES General Objectives The study aims to supply knowledge about its definition, manifestation, sign and symptoms, complications and treatment to students and to the patients regarding Bipolar Disorders. This study also aspires to enhance the skills of the student nurses in handling and caring for psychiatric nurses especially those with Bipolar Disorders. Another aim that this study wants to achieve is to inculcate or instill virtues such as patients understanding, kindness, devotion and dedication in the heart of nursing students. Client Centered • • • To improve condition by reorienting our client into reality. To express and explore client’s thoughts and feelings. To sustain an interactive conversation without or with decrease level of anxiety. Student Centered • • • To gain knowledge about Bipolar Manic Disorder, Schizophrenia and Pyschosis To improve therapeutic communication skills of the student nurse. To gain and develop trust with client through self-awareness. Biographic Data NAME: AGE: GENDER: ADDRESS: DATE OF BIRTH: PLACE OF BIRTH: NATIONALITY: CIVIL STATUS: RELIGION: HIGHEST EDUCATIONAL ATTAINMENT: DIAGNOSIS: DATE ADMITTED: TIME ADMITTED: TYPE OF ADMISSION: Ms. Bataan December 17. 2012 10:35am Old (3x) . Sue 55 y/o Female Mariveles. To consider Paranoidal Schizophrenia August 31. Iloilo Filipino Single Born Again Christian College Graduate Bipolar Manic Disorder with Pyschotic Feature (monosocial). NURSING ASSESSMENT A.III. 1957 Estancia. Her first admission was on November 05. she was seen again by the physician and was described as wearing appropriate clothes. being very noisy and difficulty sleeping. singing loudly “lalalalala” and she called her physician as “Dr. 2012. 2010. We met our client Ms. saying that she was the product manager in Malacanang since Marcos regime. She claimed that the people who are watching her are unknown to her. She does not like being late as observed when we were grooming her. but later said Upon Handling February 07. she stopped her medications August of that year. VM (friend) B. She participated on all of the activities and really showed enthusiasm in all of . polite and well behaved. History Illness Prior to Admission In 1999. On September 07. ACIS. with complains of stopping her medications. barefoot and was holding a water bottle while being interviewed. before being brought to a Mental Institution. We have also observed that the client is really conscious when it comes to time. she was seen by the psychiatrist and she was described as being hostile. with During Institutionalization At August 31. She was very conscious with her hygiene. She appears to be calm and easily controlled during our NPI. 2011. she was verbalizing “Ang aking kaharian”. According to the records. she was first brought to Bautista Home Care Facility because she was eliciting manifestations of mental illnesses. Quack-Quack”. signals the start of our Nurse Patient Interaction (NPI). Her 2nd Admission was on October 06.. Sue and she can be described as a cooperative patient.source: Ms. She was released in 2000 and is attending OPD check-ups on June and July(unknown institution) and was diagnosed with Bipolar Manic and Psychotic Features. Patient had several confinements at MMH. 2013.CHIEF COMPLAINT (recent admission): • • • • • Escaped from Home Refused to take Medications Poor Sleep Talking Singing Aloud Refuse to eat meal except for fruits . She was diagnosed again with Bipolar Manic and Psychotic Features. very noisy and uncooperative. She was exhibiting Delusion of Grandeur. 2012. She claims that she wants to live alone. Previous Illnesses The client was also diagnosed with Type 2 Diabetes Mellitus 2 years ago and was prescribed to take Hypoglycemic Agents like Metformin. She admitted that she is dancing and singing. argumentative but polite. severely cheerful. During our last day handling her. singungaling yan!”. dated. The client also recalled having cough and cold prior to admission. 2012 (before the date of admission). 2012. “maraming galit sa akin. Last July 2012. On August 8. By August 05. speaks in English with mood disturbances while speaking. Quezon City where her friend lost contact from her. good mood. she was seen again by the physician and was described as having a well-kept appearance and behaviour. September 08. them. She was also exhibiting Persecutory delusions. On the following day. She was also suspicious saying “Yung gamot na binibigay nyo. pinapatay nila ako.complains of difficulty sleeping then she was diagnosed again like the previous. “huwag kang maniniwala. She was also exhibiting Referential Delusion verbalizing “nagbebenta ako ng imported giveaways”. she answered “Syempre. 2012. she would immediately get her salary from her company and start her life anew. di ko na kailangang gamot”. Masaya!!”. She stated that she complied to it because she is actually experiencing the manifestations that the informant told her. She even demonstrated delusion of grandeur as she verbalized that she would help us financially when she gets out of the facility to reward us for taking good care of her. . Tranquilizer that is SHABU!”. C. admits that she was called by the “king” of the Department of Budget and Managament. she obediently attends to her follow-up check-up at the OPD until June 2012. When asked why. talkative. the client started to refuse taking medications for her psychiatric condition and Medications for Liver. Before her present admission. then she went to Baesa. she was also observed with having poor insight saying “Magaling na ako eh. verbalizing “Ayaw kong minamahal ako o dinodomina ako”. verbalizing. Kidney and Diabetes Mellitus. diko alam kung bakit” (she was pertaining to Dela Cruz Family). We were surprised to see a new side of her as she is demonstrating hostility as she was begging her friend to take her home already. She also remembered having chickenpox when she was 12 years old. Non Smoker. She took the medications for one year and then she refused to take the said medications. This was the first time that we have seen her like that. She stated that she stopped because she listened to an advice (unknown informant) that the medications are the one causing her “Robot-like movements or feeling”. she was being visited by her friend. the informant learned that she was placed at a barangay station (unknown location) due to complains from the supermarket employees who she had a quarrel with. She was still mentioning that once she comes out from the facility. she accuses her guardian saying “ikaw ba talagang tapat sa akin? Sagutin mo ako!!”. she escaped from the house of the informant by climbing down a guava tree near the informants fence. Past Personal History The earliest event that the client remembered was playing with her siblings and friends at Iloilo City. According to the client. She told us she was average student and has never had a serious problem at school. her focus was to finish her studies and being able to help her family first. She is not married and she never had boyfriend even when she was young because according to her. Alma Moreno and Rudy Fernandez. She did not finish her studies as she took up nursing at Central Philippines University due to financial problems. . E. before she was diagnosed. she used to hang out with her friends especially with her bestfriend. The client worked as an attendant at the Bataan Hilltop Hotel during her younger years in which she recalled seeing many of the famous artists like FPJ. Family History According to her. she is very angry at her siblings after they brought her to 3 different Mental Health Institutions and refused to take responsibility of her.D. there is no previous history of mental illness within the family but her mother was diagnosed with heart condition. During her high school years. But recently. She used to hang out with her siblings and spend every Christmas together. she had a good relationship with her family. IV. Mental Status Examination LEVEL OF CONSCIOUSNESS Alert Drowsy Cooperative Eye contact AFFECT Flat Blunted Inappropriate MOOD Appropriate Anxious Agitated Elated Depressed DRESS Appropriate Neat HYGIENE Good Poor ORIENTATION Time Day1 * * * Day2 * * * Day3 * * * Day4 * * * Day5 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * . Place Person Situation MEMORY Recent (Dinner/Breakfast Recent (Current Events) * * * * * * * * * * * * * * * * * * * * * * * * * . . Immediate (Short Term) Remote ( Long Term) DEFENSE MECHANISM Displacement Denial Intellectualization Introjection Projection Rationalization Reaction Formation Regression Repression Sublimation Suppression Identification Isolation Others: EXTRA PYRAMIDAL SYMPTOMS PSEUDOPARKINSONISM Akinesia • Mask-like face • No swinging of arms • Hesitancy of Speech • Decrease muscle strengths • Shuffling gait • Drooling • Fine intention tremors ACUTE DYSTONIC REACTION • Muscle spasm of the jaw. neck. tongue. eyes * * * * * * * * * * * * * * * * * . tongue .face. and may extend to finger arms and trunk THINKING COMMUNICATIONS Loose Association • Neologism • Word Salad • Echolalia • Echopraxia • Clang Association • Illogical thinking Alogia Concrete Thinking Lack of Insight PERCEIVING AND INTERPRETING Delusions • Reference • Persecution * * * * * * * * * * .• Laryngeal spasm Akathesia • Restlessness • Tenseness • Inability to sit still • Rocking back and forth of feet • Crossing legs frequently • Inability to relax TARDIVE DYSKINESIA • Involuntary movement of mouth. She exhibits some extra pyramidal symptoms like fine intention tremors and tenseness. . person and situation.• External influences • Somatic • Grandiose Hallucination Cinesthetics Visual Olfactory Gustatory Auditory Tactile * SUMMARY OF MENTAL STATUS EXAMINATION: During the five days of assessing the Mental State of the patient. she shows alertness. She was dressed appropriately and neatly. She exhibits Projection as a defense mechanism because she believes that she doesn’t have mental illness. Her mood is appropriate and is oriented to time. she hates her family for bringing her to the Mental Institution. the reason why she wants them to experience her affliction inside the ward. and her hygiene is good. She still remembers recent events and has long term memory. and eye contact. the patient shows defense mechanism characterized as Denial and Projection. While conducting a Nurse. place.Patient Interaction. cooperativeness. She denied her condition because she has poor judgement which leads to the lack of knowledge about her mental condition. and systematic planning also emerge during this stage. people develop the ability to think about abstract concepts. Isolation ( 18 -25 yrs. interest in the welfare of others grows during this stage. Erikson believed it was vital that people develop close. STAGE DEFINITION During the final stage of psychosexual development. Skills such as logical thought.Conventional: Universal Ethical Principle Oriented Kolhberg’s final level of moral reasoning is based upon universal ethical principles and abstract reasoning.Adulthood) MORAL (Lawrence Kohlberg) Post . PSYCHOSEXUAL (Sigmund Freud) Genital Stage (12 . Where in earlier stages the focus was solely on individual needs. Those who are successful at this step will form relationships that are committed and secure.Adulthood) The formal operational stage begins at approximately age twelve to and lasts into adulthood. the individual develops a strong sexual interest in the opposite sex. even if they conflict with laws and rules. At this stage. the individual should now be . GROWTH AND DEVELOPMENT Name: SCB Age: 55 years THEORY PSYCHOSOCIAL (Erik Erikson) Intimacy vs. During this time. COGNITIVE (Jean Piaget) Formal Operational (12. If the other stages have been completed successfully. This stage begins during puberty but last throughout the rest of a person's life. people follow these internalized principles of justice.V. THEORETICAL FRAMEWORK A. old) This stage covers the period of early adulthood when people are exploring personal relationships. deductive reasoning. committed relationships with other people. well-balanced. client was able to identify ethical principles such as a person’s right and rules of the state but now she is unable to differentiate right from wrong. The goal of this stage is to establish a balance between the various life areas. Client developed a formal cognitive perception as evidenced by observed client’s ability to reason out answer to logical questions. warm and caring. Instead. she supported her family to the fullest. REMARKS/ANALYSIS Client was not able to satisfy this stage because she did not have her own family. This is evidenced by wrong judgement when asked about situational problems. Client did not pass through this stage completely because client did not satisfy her sexual desires as well as a need for family even though her reproductive system is functioning normal. Before. . Client is isolated due to the fact that she is separated from her relatives and loved ones. Also her decision making is somewhat affected due to her psychological problem. This can be defined as being able to maintain health with the help of oneself. which is self – care. b. But if one is psychologically incapacitated. Nightingale’s Environmental Theory Florence Nightingale Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.” Focuses on changing and manipulating the environment in We used this theory to determine the factors that will affect client’s health as well as in choosing appropriate interventions for our clients. This theory serves as a guide for us student nurses to act in helping out clients take care of themselves again or achieve maximum level of wellness as possible. he/she might not be able to do such task. Nursing promotes the goal of patient self-care. Theoretical Frameworks Theory Self-Care Theory Theorist Dorothea Orem Description The provision of self-care which is therapeutic in sustaining life and health. . a. in recovering from disease or injury.B. or coping with their effects. SELF-CARE DEFICIT results when the Self-care Agency (patient) can’t meet her/his selfcare needs or administer self-care Application of the Theory to the Patient Orem focused on a specific need of person. SELF-CARE .comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life. masses or nodules in the thyroid gland Palpation Asking the client to lower the chin slightly No areas of enlargement Normal SKIN . spaces are equal on both sides Lobes may not be palpable In midline of neck Normal Smoothness and areas of enlargement.order to put the patient in the best possible conditions for nature to act. Identified 5 environmental factors NECK AND LYMPH NODES Symmetry and visible mass of thyroid gland Inspection Glands ascends during swallowing but is not visible Not palpable No visible masses Normal Presence of tenderness or nodules in the lymph nodes Palpation No nodules or tenderness Normal Placement of trachea Palpation Central placement in the midline of neck. some birthmarks. yellow overtones to olive. Prominent on both legs. configuration. ruddy pink to light patches in the client’s face pink. and skin generally uniform except in areas exposed to the sun. type or structure Inspection and Palpation Freckles. within normal range Deviation from normal due to poor sanitation The patient has dry skin. color. size. shape. may be slower in elders Due to poor hydration and aging Skin springs back slowly Normal . Deviation from normal due to itchiness Observe and palpate skin moisture Inspection and Palpation Palpation Moisture in the skin folds and axillae Uniform.Inspect for color and uniformity Inspection Varies from light to deep There are no observable brown. no abrasions or other lesions There are noticeable scratch marks all over the body of the client. some flat and raised nevi. Normal Skin temperature is within normal range Note skin temperature Note for skin turgor Inspection NAILS Skin springs back to previous state. areas of lighter pigmentation in darkskinned people No edema and inflammation (-) edema Normal Inspect for the presence of edema Inspection and Palpation Normal Inspect and palpate for skin lesions according to location distribution. masses Inspection Palpation Quiet. No . Breathing patterns 2. Normal rhythmic breathing Normal Has an intact skin. chest wall intact. tenderness. has equal Normal warmth on both sides. rhythmic. and effortless respirations Skin intact. pinkish THORAX ANTERIOR THORAX 1. angle of nail plate about 160˚ No signs of early clubbing Normal Inspect fingernail and toenail texture Inspect fingernail and toenail bed color Inspection Inspection Smooth texture Highly vascular and pink in Smooth texture light skinned clients. Temperature.Inspect fingernail shape to determine its curvature and angle Inspection Convex curvature. dark Pink in color skinned clients may have brown or black pigmentation in longitudinal streaks Intact epidermis No presence of lesions Normal Inspect tissues surrounding nails Normal Inspection Normal Perform blanch test or capillary refill Inspection Prompt return of pink or usual color Skin return to its normal color. uniform temperature. Spinal alignment 3. has equal warmth on each side Normal Inspection Palpation Normal Normal Auscultation Vesicular and bronchovesicular No crackles. and masses 7. Anterior thorax auscultation Auscultation Bronchovesicular and vesicular breath sounds No crackles sounds on the upper thorax & lower thorax Normal POSTERIOR THORAX 1. Normal . heard on the breath sounds anterior and middle part of right and left lungs. no masses Has a anteroposterior to transverse diameter ratio of 1:2.no tenderness. no tenderness. Shape. no masses masses. elliptical in shape and symmetrical chest Has a vertical alignment No masses nor tenderness. Chest symmetric Spine vertically aligned Skin intact. uniform temperature. and comparison of anteroposterior thorax to transverse diameter 2. 3. chest wall intact. Posterior thorax auscultation CARDIOVASCULAR AORTIC and PULMONIC AREAS Auscultation No pulsations No pulsations felt Normal Inspection Palpation Anteroposterior to transverse diameter in ratio 1:2. symmetry. Temperature. tenderness. no lift or heave Pulsations visible in 50% of adults and palpable in most PMI in fifth LICS at or medial to MCL Aortic pulsations S1: Usually heard at all sites Usually louder at the apical area S2: Usually heard at all sites Usually louder at the base of heart Systole: silent interval. slightly shorter duration than diastole at normal heart rate (60 to 90 beats/min) Diastole: silent interval. has a lub Normal sound on the apex and dub sounds on the tricuspid area. Normal Normal Sounds on the aortic and pulmonic areas. slightly longer duration than systole at normal heart rates S3: in children and young adults S4: in many older adults No pulsations of lifts Has full pulsation Normal Normal EPIGASTRIC AREA CARDIOVASCULAR AREAS AUSCULTATION Auscultation Auscultation Has pulsation Has full and rapid pulsation.TRICUSPID AREA APICAL AREA Auscultation Auscultation No pulsations. Normal CAROTID ARTERIES . and supraclavicular lymph nodes ABDOMEN Inspection No tenderness. and changes from sitting to supine position. peristalsis or aortic pulsations Inspection Inspection Inspection Inspection Inspection Unblemished skin. rounded(convex). No enlargement of the spleen and liver seen Has a symmetrical abdominal contour Abdominal movements noted when inhaling. full pulsations. Skin integrity 2. turns head.Symmetry of contour 5. Abdominal contour 3. Abdominal movements associated with respirations. masses. thrusting quality. uniform color Flat. Normal AXILLAE 1. visible peristalsis in very lean people. Axillary. or nodules Have no masses and nodules. Normal Normal Normal Normal Normal . or scaphoid(concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration.1. Enlargement of liver or spleen 4. quality remains same when the client breathes. subclavicular. elastic arterial wall Normal pulsation. Normal 1. aortic pulsations in thin persons at epigastric area Uniform color and has no blemishes Has a concave abdomen. Carotid artery palpation Palpation Symmetric pulse volumes. Symmetrical pulse. no warmth. no warmth. no redness. no warmth. Joint swelling Inspection No visible vascular pattern Has no blood vessels visible Normal Inspection Proportionate to the body. no pain. Muscle tonicity 4. no warmth. no redness. no crepitus No swelling. Palpation Normal . Fasciculation and tremors in the muscles 3. no crepitus No swelling. Muscle size and comparison on the other side 2.6. no pain. no pain. no redness. No swelling. Vascular pattern MUSCULOSKELETAL SYSTEM MUSCLES 1. in both sides even in both sides No fasciculation and tremors Even and firm muscle tone Has tremors Even and firm muscle tone Normal Inspection Palpation Palpation Deviation from normal due to the side effects of medications. even Proportionate to the body. Normal EXTREMETIES Inspection. Normal Normal Has equal muscular strength on Has equal muscular strength both sides on both sides Inspection No swelling. no pain. no redness. Muscle strength JOINTS 1. PR: 82 bpm. . lice and lesions are present in the head.PHYSICAL ASSESSMENT SUMMARY GENERAL: The patient is a nourished female. NECK: No carotid bruits. skin springs back slowly and with dry skin. BP: 110/80 mmHg HEENT: Head is normocephalic and atraumatic. Presence of mouth sores. not tender. alert and oriented. dry and flaky scalp. Extraocular muscles are intact. MUSCLE: Has tremors. LUNGS: No crackles heard on the anterior and middle part of right and left lungs. SKIN: There are noticeable scratch marks all over the body of the client. presence of lesions on both legs. Presence of cerumen and wounds on both ears (pinna). HEART: Regular rate and rhythm without murmur. RR: 28 cpm. ABDOMEN: Soft. Patches of alopecia are present. VITAL SIGNS: Temperature: 36˚C. No lymphadenopathy or thyromegaly. No Hepatosplenomegaly. with thin hair. and not distended. 60-110.Discuss test preparation.4 mg/dl 186. LABORATORY Laboratory Procedure Blood Chemistry Date Ordered.9 mg/dl 0-200 mg/dl 97-190.Explain the procedure.Define and explain the test.VIII. .6 mg/dl Normal Normal Normal Normal Values Actual Values Analysis/ Interpretation Nursing Responsibilities Prior: .3 mg/dl 65. During: Ensure that the - FBS Cholesterol Triglycerides . 2013 Indication/ Purposes A test to assess a wide range of conditions and the function of organ. and post test care.State the specific purpose of the test.9 mg/dl 132. Date of Result Ordered: December 20 Result: January 24. procedure. . . specimen is secured in a sterile container. Monitor the puncture site for hematoma formation. After: Apply manual pressure and dressings over puncture site. - . Monitor CBC and liver function tests. Use cautiously in patients with mixed type seizure because drug may cause tonic-clonic seizures • • • • • • • Drowsiness Agitation Ataxia Slurred speech Tremor Confusion Behavioral Disturbance • • • • Closely monitor all patients for changes in behavior that may indicate worsening of suicidal thoughts or behavior or depression/. Medical Management (Pharamacologic Treatments) DRUG NAME MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE/ ADVERSE EFFECT NURSING CONSIDERATIONS Generic Name: Clonazepam Classification: Anti-convulsant Anxiolytics Route/Dosage: 2mg tab PO HS then PRN ½ tab Probably acts by facilitating the effects of the inhibitory neurotransmitter GABA • • • • Atypical absence seizures Akinetic and myoclonic seizures Panic disorder Acute manic episodes of bipolar disorder • • Contraindicated in patients hypersensitive to benzodiazepine.IX. Don’t stop drug abruptly Assess elderly patient’s response closely. . Elderly patients are more sensitive to CNS drug effects. appetite loss. It can be a symptom of hepatic dysfunction. Generic Name: Divalproex Sodium Classification: Anti-convulsant Route/Dosage: 250mg PO OD • • • • Simple and complex absence seizures Complex partial seizures Mania associated with bipolar disorder Prevent migraine headache. weakness.DRUG NAME MECHANISM OF ACTION Probably facilitates the effects of the inhibitory neurotransmitter GABA. lethargy. Don’t stop drug abruptly. • Contraindicated in patients hypersensitive to drug and in those with hepatic disease. • • . or yellowing of skin or eyes. vomiting. INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE EFFECTS • • • • Dizziness Headache Blurred vision Back and neck pain NURSING CONSIDERATIONS • Give drugs with food to avoid to reduce adverse GI effects. Advise patient to immediately report malaise. It’s action may be mediated through this anatagonism. which may occur after prolonged use of drug. Monitor for metabolic syndrome ( wt. autonomic disturbance) which is rare but deadly. Monitor patient for Tardive Dyskinesia. Depression associated with bipolar disorder. hypercholesterolemia Generic Name: Quetiapine Classification: Antipsychotics Route/Dosage: 300 mg HS • • • Schizophrenia Adjunct therapy with Lithium or Divalproex for the short term treatment of acute manic episodes associated with bipolar disorder. • • Contraindicated in patients with hypersensitive to drug or its ingredients. Use cautiously in patients with conditions that can predispose hypotension and conditions in which core body temperature may be elevated. INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE EFFECTS • • • • • • • • Orthostatic hypotension Flulike syndrome Dizziness Headache Somnolence Skin Rash Wight gain Hyperglycemia NURSING CONSIDERATIONS • • • Don’t break or crush tablets Give drug without regard for food Watch out for evidence of neuroleptic malignant syndrome (extrapyramidal effects.DRUG NAME MECHANISM OF ACTION Blocks dopamine and serotonin receptors. • • . gain. hyperglycemia. hyperthermia. Generic Name: Dipenhydramine Classification: Anti-histamine. INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE EFFECTS • • • • • • Hypotension Tremor Vertigo Headache Dry mouth Thickening of bronchial secretions.DRUG NAME MECHANISM OF ACTION Competes with histamine for H1receptor sites. but doesn’t reverse. Explain to the patient that arising quickly from a lying or sitting position may cause orthostatic hypotension. Inform patient that sugarless gum or hard candy may relieve dry mouth. • • . Prevents. Contraindicated in patients taking MAO inhibitors. NURSING CONSIDERATIONS • • Give drug with food or milk to reduce GI distress. histamine-mediated responses. particularly those of the bronchial tubes. Caution the client that the medication can cause drowsiness. uterus and blood vessels. Antiparkinsonian Route/Dosage: 50 mg PO HS • • • • • Rhinitis and allergy symptoms Parkinson’s disease Sedation Nighttime sleep aid Non-productive Cough • • • Contraindicated in patients hypersensitive to drug. Avoid use in patients with asthma. GI tract. • • • .DRUG NAME MECHANISM OF ACTION Blocks Dopamine and 5-HT receptors in the brain INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE EFFECTS • • • • • • • • • • • • Akathisia Somnolence Dystonia Insomia Agitation Parkinsonism Hallucination Tremor Abnormal Thinking Decreased libido Hypertension Hyperglycemia NURSING CONSIDERATIONS • Tell patient that he/she can take drug with or without food. which may occur after prolonged use. • • Contraindicated in patients hypersensitive to drugs Use cautiously in patients with CV disease. Monitor patients with Diabetes. Obtain baseline blood pressure measurements before therapy. Watch out for orthostatic hypotension. Life-threatening hyperglycemia may occur. Monitor patient for tardive dyskinesia. Generic Name: Risperidone Classification: Atypical Antipsychotic Route/Dosage: 4mg tab • • Schizophrenia Combination therapy with Lithium or valproate for 3 week treatment of acute manic or mixed episodes from bipolar I disorder. Contraindicated in those with CNS depression.DRUG NAME MECHANISM OF ACTION Block dopamine receptors in the brain. also alter dopamine release and turnover. Make sure the medication is taken. Use cautiously in patients with severe CV disease (may suddenly decrease blood pressure) • • • • . Don’t stop drug abruptly. chew or break tablet. which may occur after prolonged use. hyperactivity • • • Contraindicated in patients hypersensitive to drug. Obtain baseline blood pressure measurements before therapy. Generic Name: Chlorpromazine Classification: Typical anti-psychotic Route/Dosage: 100 mg HS • • • Psychosis Mania Behavioral disorders. Watch out for orthostatic hypotension. Monitor patient for tardive dyskinesia. INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE EFFECTS • • • • • Extrapyramidal reactions Sedation Tardive dyskinesia Pseudo parkinsonism Ocular changes NURSING CONSIDERATIONS • Advise patient not to crush. dito sa may ulo. N3: Ganoon po ba? Osge po. ako po si Chelle.B. Nurse Criselle at Nurse Eries. (AFTER THE SAID GROOMIING) N2: May mga sugat po ba kayo? P: Oo. Ano po pangalan nyo? P: Good morning. N2: Opo. PROCESS RECORDING CONVERSATION DEFENSE MECHANISM with ANALYSIS THERAPEUTIC COMMUNICATION TECHNIQUES USED FIRST DAY OF INTERACTION N1: Good morning po. N3: Sana po maging masaya kayo kasama kame. P: Mukha naming mag eenjoy ako sa inyo at mababait naman kayo. P: Hello Nurse Chelle. Sabihin nyo po kung masakit at mahapdi ha. Perla. Tutulungan po naming kayong gawin iyon. P: Osige. dahil ito sa balikubak e. gagamutin po natin ang mga sugat nyo. EXPLORING GIVING INFORMATION OR INFORMING OFFERING SELF RATIONALIZATION . Salamat ha. siya nman po si Criselle at ito naman po si Eries. kayo ba magiging nurse ko? Ako si S. Salamat ha.X. magtutooth brush ka muna po at maghihilamos po kayo. P: Osige. Maliligo ba ako? N1: Hindi po. ang tapang kse ng ginagamit naming sabon. kaya lang nanirahan ako sa QC dahil sa Malacanan ako nagtatrabaho noon. ano na ang susunod nating gagawin? N3: pupunta po tayo sa area kung saan tayo gagawa ng mga activities. Sali po kayo ha. N3: taga saan po ba kayo? P: Taga Ilo-ilo talaga ako. P: Osige. Gusto ko na ngang umuwi e. N1: sino po bang nagpadala dito sa inyo? P: yung mga kapatid ko. Thursday. Yan lang po ba ang sugat nyo? Wala nap o sa katawan? P: Wala na e. February 7. dapat po manalo lagi ang grupo natin. Bali makakasama nyo po kami hanggang sa susunod na byernes. magkwentuhan tayo. lakarin napo natin. Tara po. bale pitong araw po tayong magkakasama at may mga activities na gagawin. N3: ilang taon napo kayo? P: 55 years old.(NURSE DOES THE WOUND CARING) N1: okay na po. 3rd year nursing student na din ba kayo? N3: opo. N2: ilang taon na po kayong nakaconfine dito? P: mga aanim na buwan palangg. May nangyari kasi sa akin GIVING INFORMATION OR INFORMING GIVING INFORMATION OF INFORMING OFFERING SELF EXPLORING COMPENSATION . (AT THE ACTIVITY AREA) N1: Upo po tayo maam. (WHILE WALKING) N3: Alam nyo po ba kung anong araw ngayon? P: oo. Pero ito na ang pangatlong beses kong napasok dito. P: Oo naman sige. Db? N2: Opo. Kapag daw sila ay pumasok sa katawan ko. Madaming mga diablo at si Satanas ay OFFERING SELF DENIAL EXPLORING CONVERSION ENCOURAGING DESCRIPTION OF PERCEPTIONS EXPLORING . Nakikita ko ang sila. 1995 may nangyari sa akin.at ayaw nila akong paniwalaan. N1: ano pa po ang nakita nyo? Naramdaman? P: may mga uod na kumakain sa laman ko. pumapasok dito sa bumbunan ko. magiging ligtas na sila. Itong mga mata ko. may bigla akong naramdaman na kuryente na nagsimula sa bumbunan ko pababa sa buong katawan ko. asahan nyo po iyon. N2: pano po yon natapos? P: napakasakit sa katawan at napakabigat sa pakiramdam. at baka hindi nyo ako paniwalaan. napakasakit dahil hinugot ito pababa sa baba pa ng lupa at nakita ko ang palasyo ng kadiliman. Dahil malapit na daw ang paghuhukom at kailangan nilang pagtago sa katawan ko dahil ako ay ligtas sa paghuhukom. ang tawag nila sa akin ay “Ang Batang Walang Malay”. N2: ano po bang nangyari? P: august 25. hindi nila ako iniintindi. mga alas nyebe ng gabi. ang namamahala ditto ay si Satanas. ito kasi ay malambot. mahabang kwento e. napakasakit. N1: makikinig po kami sa inyo. P: talaga? Yung mga kapatid ko kasi hindi ito pinaniniwalaan at sabi nila sira ulo daw ako. N3: ano po ba iyon? P. nagpaphinga ako sa terrace ng bahay ko. Galing ako sa trabaho nun eh. Tapos pumasok na ako sa kwarto ko. Si Satanas ang pumasok sa katawan ko. e hindi naman ako sira ulo e. at inaalog alog pa nila ang katawan ko para magkasya pa ang napakarami niyang kamppon. maam. N2: napaaway na po ba kayo dati? P: Oo. Ngunit ayaw parin akong paniwalaan ng kapatid ko tungkol doon at dinala nila ako dito. N2: ano po ang nararamdaman nyo pag ganon? P: maaliwalas sa pakiramdam. alas kwatro ng madaling araw. N1: osge po. Alam nyo ba. nakakausap ko sila. N1: kamusta naman po ang mga kasama nyo? P: okay naman. Dun lang kame sa ward. walang damit lahat. kakain. N3: hanggang ngayon po ba nakakausap nyo sila? P: Oo. N3: e ang pagkain nyo naman po. ayoko sanang patulan pero pag hindi ako lalaban lalo nila akong sasaktan. nakakainip pa dito. Gustong gusto ko nang umuwi. may gagawin po tayong activity ENCOURAGING EVALUATION OR EVALUATING PROJECTION EXPLORING EXPLORING ASKING QUESTION EXPLORING GIVING INFORMATION OR INFORMING . N3: Ano po ang pinag-uusapan nyo? P: ang sabi niya tatagan ko ang loob ko laban kay Satanas at may binigay syang misyon sa akin. matutulog. kung hindi magugutom ako. N3: ano po ba ang mga pang araw araw na ginagawa nyo dito? P: wala. nakakausap ko din ang Panginoon. at unti unti nang nababawasan ang nasa loob ng katawan ko. sa ibang ward pa ako non. mabuti nga at walang nakikipag away doon sa ward naming e. sabay sabay kami. N2: pano po kayo sa pagligo? P: araw araw. N1: ano po ang misyon na iyon? P: ang patayin si satanas at puksain ang kasamaan nito. Pero wala na akong magawa kung hindi kainin to. kamusta? P: naku. lutong baboy.pumasok sa katawan ko. P: Oo nmana. SECOND DAY OF INTERACTION P: Hello. (ALL PATIENTS PERFORMED ACTIVITY/THERAPY. N1: Hi. Good morning! N3: Good morning. AFTER THE ACTIVITY PATIENTS ATE MIRYENDA AND TOOK THEM AGAIN IN THEIR RESPECTIVE WARDS) (while walking back to the client’s ward) N2: sana po ay nag enjoy kayo. Matandain ka pala. N1: Wow Susan. Salamat ha. Good morning din po. N3: magkikita pa po tayo ulit bukas ha. Natatandaan mo pa ba ang mga pangalan namin? P: Oo naman po. grooming na tayo. N2: Hello Susan. CLIENT SB PARTICIPATES WELL. N2: Oo nga. Sino ako? P: Ikaw si Nurse Chelle. P: Sige po. P: mag ingat din kayo. Tara. N3: Eh ako naman po sino? P: Nurse Criselle at siya si Nurse Eries.ha. P: osge. N2: Sige nga po. Salamat po. (GROOMING AREA) Seeking Clarification Seeking Clarification Seeking Clarification Giving Recognition . Salamat. Mag iingat po kayo. Good morning po. Tapos maglotion ka rin saka naming lagyan ng betadine yung sugat mo sa ulo. ok lang po yun. P: Sige po pero sabi ni Ma’am 15minutes lang daw. Tara na po lakad lakad muna tayo bago magpunta dun sa pinuntahan natin kahapon. N3: Ay sige po. N1: Oh eto po ang cotton buds. P: Tapos na po. P: Tapos na po. P: Sige po. N2: Eto ang sabon oh. (WHILE WALKING) N3: Kumusta naman po kayo? Maayos ba ang naging tulog niyo? P: Ayos naman po ako.N3: Magtoothbrush ka muna bago magshampoo para hindi mabasa damit mo. Giving Recognition Broad Opening . N3: Ayan okay na. kayo po ba kumusta? N2: Ay. Puro ako na lang ang kinukumusta nyo. Linis ka muna ng tenga mo. P: Sige po. N1: Sige magshampoo ka naman. ayos lang din naman po kami. May 15minutes na ba? N2: Ay. N1: May activity po ulit tayo ngayon ha. At saka maglalakad lakad din tayo para may exercise ka. Magpunas ka rin. Maghilamos ka naman. Ang bait mo naman. Salamat sa pagtatanong. Lalaban ko na rin po tong face towel para malinis. Ang mahalaga malinis at magamot naming yung sugat mo. P: Sige po. N2: Eto na po ang toothbrush mo. Eto rin ang face towel. P: Ah. magsimula na tayo sa pagbabasa. P: Okay po. N1: Ayan malapit na tayo sa student’s area. N1: Nung panahon niyo po ba madalas magtaas ng sweldo? P: Nako. N2: Tara. Monday na ulit tayo magkikita. N2: Doon naman po sa pagiging hydrated? Malakas ka po bang uminom ng tubig? P: Hindi po ako gaano umiinom ng tubig dito.P: Talaga po? Anong gagawin natin? N2: Newspaper reading po ang gagawin. Bihira sila magtaas ng ganon sa sweldo. N1: Bale Susan. P: Ah. (STUDENT’S AREA) N2: Upo ka na Susan. Uuwi na ulit kayong Bulacan? N3: Oo. hindi. Hindi tayo magkikita bukas at sa Sunday ha. (AFTER NEWSPAPER READING) N3: Ano po ang masasabi mo? P: Mataas na yung P125 na umento. Sige po. kaya hindi muna tayo magkikita ng dalawang araw. Siguro sa mahal na rin ng mga bilihin. Kaya nga maswerte ang mga nagtatrabaho ngayon kasi mataas na yung P125 na umento. P: Salamat po. Friday ngayon. N1: Anong dahilan at hindi ka umiinom? GIVING INFORMATION OR INFORMING GIVING INFORMATION OR INFORMING GIVING INFORMATION OR INFORMING Presenting Reality Broad Opening Exploring Exploring Exploring . Ayusin ko po yung meryenda niyo. N2: Sige po tatanong ko mamaya kay Ma’am. Kaya bihira lang akong uminom ng tubig. N1: Teka lang po ha. P: Salamat Nurse Chelle. P: Hindi. Kumusta naman po ang mga kapatid niyo? Lahat po ba sila nasa Ilo-ilo? P: Tatlo lang yung nasa Ilo-ilo. Kasi mineral water ang inumin naming sa bahay. iba pa yung kay ate lang. N2: Walang anoman po. N3: Pwede naman pong inumin yung nasa gripo. P: Sige po. Gusto ko na kasi talagang makalabas dito eh. natanong mo na po ba kay Ma’am kung pwede akong gumawa ng sulat para sa ate ko? N2: Di ba po gumawa na kayo ng sulat kahapon? Para pa nga po sa kanilang lahat yun eh. N3: Ah. Dito kasi sa gripo lang. N1: Ganon po ba? Nakahingi na po ba kayo minsan ng mineral water sa nurse? P: Pag nauuhaw ako at may dumaan na nurse nanghihingi ako. Dalawa kaming Presenting Reality Exploring Exploring Broad Opening . N2: Ay.P: Malakas akong uminom ng water noong wala pa ako dito. Hindi naman po nila ipapainom sa inyo yun kung hindi pwede. N3: Tulong na po ako sa kanya. Okay po. ganon po ba? Hindi po kayo nanghihingi ng mineral water? P: Sa payward lang sila nagpapainom ng mineral water. P: Nurse Chelle. Kaya lang minsan may mga lumalabas na uod at maliliit na ahas. P: Malinis naman. Exploring Giving Recognition Exploring Exploring Giving Recognition Exploring Exploring . Gusto kasi naming mga magsipagaral. Sana makatapos po lahat ng anak niya at sila naman ang tumulong sa tatay nila. Nagsisisi nga siya kung bakit hindi siya nagpatuloy sa pagaaral. N2: Ay. P: Sana nga. Kaya kayo tapusin niyo yang pag-aaral niyo. N2: Oo nga po eh. N2: Ayon naman po pala eh. P: Ganon talaga. Hindi kami mga nag-uusap. P: Isa lang ang hindi nakagraduate sa amin. N2: Close naman po ba kayo sa kanila? P: Ay hindi. Sayang lang talaga at hindi ko natapos ang pagnanurse ko. N2: Wow. Ang galing naman po nila. N2: Ang galing niyo naman po palang magkakapatid.nandito sa Bataan at yung dalawa naman eh nasa Dubai. Gusto nga sana niyang mag-aral ulit kaya lang matanda na siya. Pero nag-aaral naman lahat ng anak niya. Dubai. N2: Eh may kapatid po ba kayo sa tatay niyo? Ilan po sila? P: Oo meron. N2: Eh ano naman po ang trabaho niya ngayon? P: Mangingisda siya ngayon. Tatlo sila. Ano naman po ang trabaho nila doon? P: Isang civil engineer at isang accountant ang nandoon. Kaya lahat kami naging working student. Ano po ba ang nangyari at hindi niyo natapos ang kursong nursing? P: Nagkaroon kasi ng ibang babae ang tatay ko. N3: Mabuti naman po kung ganon. Salamat po sa meryenda. P: Bye bye Nurse Chelle. N1: Sige po tapos na po kami kanina sa dorm. kain tayo. P: Sige po. N1: Dun naman po tayo sa may activity center. ganon po pala. N1: Masaya po ba? P: Opo masaya. (AFTER POWER CLAP AND CHEERING PRACTICE @ ACTIVITY CENTER) N2: Napagod po ba kayo? P: Hindi naman gaano. Ayan po. Hanggang sa muli. Huli kaming mga nagkita at nagkausap nung patay si tatay. N1: Ingat ka rin po dito. Meryenda na muna po kayo. N2: Paano Susan kailangan na naming umalis. (AFTER MERYENDA) N3: Ayan. P: Sige po masaya yun. Practice po tayo ng power clap at cheering natin. Nabusog po ba kayo? P: Opo. N2: Ah. Ingat kayo sa biyahe niyo ha. Magaayos pa kami ng iba naming gamit bago umuwi sa Bulacan. Nurse Criselle and Nurse Exploring GIVING INFORMATION OR INFORMING Presenting Reality . N2: Tara po.N2: Nasaan po ba sila? P: Nasa Ilo-ilo rin sila. After noon wala ng communication. See you next week. Nag-enjoy po ako. P: Kayo po. mag sha-shampoo ka ngayon. walang bago. P: Hi. mag-grooming na tayo.Eries. N3: Ganon po ba. salamat ha. N2: Kamusta ka naman po? P: Ok lang naman ako. Gusto ko nga yung mahapdi eh.) N3: gagamutin na po natin ngayon ang mga sugat nyo sa ulo ha. Good morning. Kumusta weekends mo? P: Ayus naman. pero ok lang. Salamat sa inyo. 3rd day Interaction N1: Hello. osige po. N1. etc. hindi na ako gumamit ng perla kaninang umaga e. P: Sige. N2 and N3: Bye bye Susan. P: sige. P: sige po. SHAMPOO. N2: Mauna na po tayo sa pagtotoothbrush nyo. (AFTER TOOTHBRUSH. Kayo po ba? N3: Ayus lang din naman kami. N1: mahapdi po ba pag nilalagyan namin ng gamot? P: medyo. N1. N3: Kumusta naman po ang mga sugat nyo sa ulo? Gumagamit parin po ba kayo ng Perla? P: Ok naman. N2 and N3: (Silence) Broad Opening Exploring Exploring Exploring . good morning po. N2: Tara po. (AFTER WOUND CARE) P: pwede ba akong humingi ng cotton buds? Lilinisin ko yung tenga ko e. nahuli na tayo sa kanila. sana kung ano man yung mabibigay kong mga tulong sa inyo tanggapin nyo ha. yun po ang gagawin natin ngayon. Kayo kapag nakalabas na ako dito tutulungan ko kayo. yung ipapaliwanag yung mga larawan. ready na ako. N2: sige lang po. may mga sugat nga e. P: osige. lakad na tayo. kayo ba? Kain na din kayo. mamaya na po kami. magparticipate ka po ha. N3: ok lang po iyan. P: salamat. Eto po. P: tara na. N2: oo naman po. P: pag nakalabas na ako dito aayusin ko na ang GIVING INFORMATION OR INFORMING . N2: Oo nga. kuha ako panlinis ha. Maraming salamat sa inyo. (AFTER WOUND CARE) P: Naku. alam nyo po ba iyon? P: ah. P: napakabait nyo sa akin. teka po. (CLIENT PARTICIPATED WELL) (AFTER THE ACTIVITY) N1: nag-enjoy po ba kayo? P: ok lang. N1: patingin nga po. P: oo naman sige. N2: Tara po. N1: opo. N3: Ang unang activity natin ngayon ay photo therapy. N3: magmiryenda na po kayo. at makasalanan. kailangan na nilang mawala. gusto ko maranasan din nila ang hirap na naranasan ko dito sa mental. N1: kung makikita niyo po sila ngayon. n3: hindi po e. Ang natitirang misyon ko nalang ay puksain ang kasamahan ni satanas. sinabi ng panginoon sa akin yun.buhay ko. N2: opo. wag masasamang bagay. N2: sinabi po ba niya kung kelan iyon? P: Oo. kaya wala nang babagabag sa loob ko. at yung end of the world. ano po ba iyon? P: totoo yung movie na iyon. N1: maari po ba naming malaman kung pano nyo uupisahan ayusin ang buhay nyo kung sakaling makalabas na kayo dito? P: tapos na ang pinakaunang misyon ko eh. dahil sa satanas ay pinaparusahan na at susunod na ang mga taong gumagawa ng mga gawa niya. Napanuod nyo na ba yung movie na “The Monster”? N1. yun si Satanas at ang mga Galamay nung pugita ay ang mismong mga galamay din ni satanas. ngayon na iyon. wala na si Satanas. yung mga taong criminal. ang monster yun ay Pugita. totoo yun. dahil hindi nila ako inintindi. hindi na nga ako nakapag- Broad Opening Exploring Exploring Exploring . Ngayon ay nasa Karagat na sila ng apoy at lugar ng walang katapusang kaparusahan. labis nila akong pinarusahan. ano po ang sasabihin niyo sa kanila? P: ilabas na nila ako dito. kaya kayo dapat ay ang mga itinuri lang ng Panginoon ang gawin nyo. P: kaya nga may galit ako sa mga kapatid ko. n2. N3: ano pong mangyayari sa mga tao nun? P: mapaprusahan sila. Tara. P: goodmorning din po. N1: Oo nga po. N2: tara po. pero ok lang ako sa ganyang panahon. tsaka po natin lilinisin mga sugat nyo sa ulo. P: salamat. N3: naligo po ba kayo kaninang madaling araw? P: Oo. ang hirap.asawa dahil sa kanila. n3: salamat din po. N1: kumusta po kayo? Kumusta pagtulog nyo? P: Ok naman po. ngunit wala naman akong magagawa. napakalamig. ingat po. Kayo po? N2: Ok naman po. n2. Pasensya na po. basta gusto ko maranasan nila ang naranasan ko dito. bukas ulit ha. N1. N3: hindi nyo na po ba sila mapapatawad? P: ewan ko. P: osige. Nagagalit ako sa kanila. 4th day Interaction N1. Malamig po ngayon no. Marami pa naman tayong pag-uusapan bukas. ok lang po ba kayo? P: Oo malamig nga. grooming na po tayo. P: Oo sige. N2. tapos ito pa ang iginanti nila sa akin. pero oras na para kayo ay ibalik sa ward. N3: good morning po. N1: sana po ay gumaan ang pakiramdam nyo sa ating pag-uusap ngayon. hated na namin kayo. (AFTER GROOMING AND WOUND CARE) Projection Broad Opening EXPLORING OFFERING SELF . presko. dahil sa kakatrabaho sapagkat sila ang priority ko. enjoy nga yun e. N3: Gusto nyo po ba iyon? P: Oo. P: Ah. yung tugtog sa laptop? N2: Opo.N2: Dun po tayo sa Activity Center. sige lang po kain na kayo. N2: hanggang ngayon po ba? P: Oo N3: paano po kung makalabas na kayo dito? Galit parin po ba kayo sa kanila? P: Basta iuna ko muna ang paglabas ko dito bago namin pag-usapan ang tungkol sa galit ko sa kanila. susulatan ko yung kapatid ko. kayo ba? Kain na din kayo. P: Sige. sabay na kayo sakin. N1: Sali po tayo sa lahat ah. P: pagkatapos kong kumain pwede bang hingi ako ng papel at ballpen. P: Ano ang activity natin na gagawin ngayong araw? N3: Maglalaro po tayo. N3: Nag-almusal po kame kanina. (AFTER THE ACTIVITIES) N2: Kain na po kayo. N1: osige po. Hindi na po ba kayo galit sa kapatid nyo? P: Galit pa. at pag kaya po ng oras manunuod po tayo ng palabas. N1: Paano po ba kayo magalit? P: yung pinapagalitan ko sila. tas kakanta at sasayaw. Ready po ba kayo? P: Oo naman. dahil nga dinala nila ako dito. N3: sa sarili nyo po? Hindi nyo naman po sinasaktan sarili nyo? GIVING INFORMATION OR INFORMING Exploring Projection EXPLORING Exploring Exploring . N1: sana po nag-enjoy kayo. ang CI na po ang bahala. Salamat. Kailangan ko nadin iayos sa tama at magsimula ulit sa buhay ko. N2: ipapadala po natin. kailangan ko na talagang makalabas dito dahil napakahirap dito.P: Hindi naman. . P: salamat ha. (AFTER THE CLIENT INTERPRETED MESSAGE FOR HER SISTER’S LETTER) P: Ipadala nyo sa kapatid ko ha. Bukas ulit. N3: tara na po. Hindi ko naman sinasaktan sarili ko pag galit ako. ihahatid na po namin kayo sa ward nyo. Therapy’s done Bulacan State University Malolos.XI. Bulacan College of Nursing THERAPY PLANNING . . the • Student facilitator Nurse and instructed the the patient patient as well as the student nurse Materials: assisted them • Bond paper through • Crayons encouraging to think their loved ones and write it down on the tree Facilitator: Albert dela Cruz • Title of Therapy Photo Therapy Descriptions Use of photograph in a therapeutic encounter. family and nature) Expected Outcome After 30mins of phototherapy. the client were able to: • Used their cognitive skills o recall their family Expressed their feelings while remembering memories with each of the family member Family therapy is a type Family therapy involves After 15minutes of the of psychotherapy that multiple therapy sessions. in at regular intervals (for • Use their some cases. It may use the clients own family album or personal snapshot. such as feelings while multiple sessions to help an adolescent with remembering families deal with a psychological memories with important issues that disorderor adjustment to each of the may interfere with the a death in the family. After the music and Manpower: art therapy. conducted or stepfamily and. to recall their (e. family therapy family therapist or team of is initiated to address a • Express their therapists conducts specific problem. once weekly) cognitive skills the extended family for several months. A Typically.g. the client will be able to: • Mechanics The client are instructed to look at the pictures then the student nurses will ask them to share the ideas regard to the picture Resources Manpower: • Student Nurse and patient Resources: • Pictures (home. therapy the client will involves all members of usually lasting at least be able to: a nuclear family one hour each. grandparents).Title of Therapy Family Therapy Descriptions Learning Contents Learning Objectives Mechanics Resources Expected Outcome After 15minutes of the therapy. members of example. Learning Contents The therapy engages conversation with the client that might be stimulated by the photographs as memories emotions ideas and questions raised by the images Learning Objectives After 30mins of phototherapy. family functioning of the member family and the home environment. the client were able to: • think abstractly through sharing their ideas about the picture showed to them • Expressed their feelings after they see the picture • think abstractly through sharing their ideas about the picture showed to them Facilitator/s: Express their feelings after they see the picture . social skills as they enjoy playing with other patients .Title of Therapy Play Therapy Descriptions Play therapy is a treatment modality in which the therapist engages in play with the child and adults. Play activities are used as the primary basis for communication between the child and the psychotherapist Learning Contents Learning Objectives Mechanics The facilitator will explain the procedure and demonstrate how the play will be done. in their world.g laptop. Play therapy offers • alleviate their a direct route to engage anxiety children/adult on their • practice their terms. speaker) • Bond paper • Pentel pen • Cups Expected Outcome After 30 minutes of Play therapy the patient were able to: • to make clients practice their critical thinking skills and concentration • alleviated their anxiety • practiced their social skills as they enjoy playing with other patients It is used in identifying After 30 minutes of and appreciating Play therapy the childhood mental patient will be able to: disorders and how they • to make clients pull away from normal practice their functioning. The student nurses assist and play with their patient. and as well as their play with concentration peers. thinking skills academic performances. This can critical affect their home lives. Facilitator/s: Resources Manpower: • Student Nurses and Patient Resources: • Electronic devices (e. g and dance. Also increases communication skills and develop positive body image Learning Objectives After 30mins of Song and dance therapy the client will be able to: • • • Reduce their anxiety. Laptop. anxiety and depression. Facilator/s: • • . stress and depression Relaxed as they sing and dance Socialized with other patients through communicati ons The facilitator Manpower: will explain first • Student the procedure Nurses and then the student Patient nurses will show how it done and Resources: next will teach • Electronic the patient to sing Devices (e.Title of Therapy Song and Dance Therapy Descriptions Song and Dance therapy uses movements to improve mental and physical well being while singing Learning Contents It helps the patient to reduce their stress. to show Speakers) the talents to others. Lastly. stress and depression Relax as they sing and dance Socialize with other patients through communications Mechanics Resources Expected Outcome After 30mins of Song and dance therapy the client will be able to: • Reduced their anxiety. . Title of Therapy Descriptions Cinema therapy is the process of using movies made for the big screen or television for therapeutic purposes. and ultimately deal with life's ups and downs. After watching their student nurses may ask them to tell something about the videos they watched. Tell them to watch carefully and to reflect. Learning Objectives After 30mins of Movie and Cinema Therapy the client will be able to: watch films with conscious awareness explore their minds and feelings by the help of the student nurses inspire patients through movies help patients to open up communications to their student nurses about their thoughts and feelings Mechanics Ask patients to gather and sit in front of the monitor. laptop. It allows us to gain awareness of our deeper layers of consciousness to help us move toward new perspectives or behavior as well as healing and integration of the total self. Learning Contents This therapy will help the patient to change the way they think and feel. Resources Manpower: • Student Nurse and the patient Resources: Electronic devices (projector. speaker) Expected Outcome After 30mins of Movie and Cinema Therapy the client were able to: watched films with conscious awareness explored their minds and feelings by the help of the student nurses inspired patients through movies helped patients to open up communications to their student nurses about their thoughts and feelings Movie and Cinema Therapy . Movie Therapy is a mind therapy that involves the client viewing certain films that under the supervision of a therapist in order to help treat emotional and mental conditions. "(American challenged clients OCCUPATIONAL Occupational Therapy especially their motor THERAPY Association Executive functions through making a board). be productive. self-care. . It may include adaptation of task or This small bag or basket environment to achieve making as an Occupational maximum independence Therapy contributes to the and to enhance the quality development of mentally of life. obligation or choice taking. the clients will be able to somehow increase his/her development or commit leisure by practicing their function through the use of making small basket or bag out of used newspaper folded in thin sizes. and play activities to increase development and prevent disability. the clients must be done making their handmade basket or bag.TITLE OF THERAPY DESCRIPTIONS LEARNING CONTENTS LEARNING OBJECTIVES MECHANICS RESOURCES EXPECTED OUTCOME Occupational Therapy is defined as “The therapeutic use of work. After the time given by the student nurse. restful or symptoms of drug they are fun. the client will be able to increase his/her development or commit leisure by practicing their function through the use of making small basket or bag out of used newspaper folded in thin sizes The student nurse will provide the materials for the client to make a small basket or bag out of used newspaper folded into thin sizes. gives us purpose. and that which fulfills us. and function in the world around us to the best of our ability. It can be defined as how we is a good activity also to spend our time. MANPOWER -Student Nurse -Clients MATERIALS -Old Newspapers -Glue At the end of the therapy. and allows us to interact with. whether combat the Extrapyramidal paid or unpaid. At the end of 1 hour of therapy. One's occupation handmade basket or bag. Facilitator/s: Resources Man power: • Student nurse and the patient Materials: • Book • Flash Cards Expected Outcome After 15 minutes of psychotherapy. productive ways. A story will be read by the facilitators and after the storytelling. • Determined the connection of the story on their lives and • Verbalized a better and positive outlook in life. both real and imagined. the clients will be asked to verbalize/express their feelings and opinions about the story. Learning Objectives After 15 minutes of psychotherapy. . Learning Contents Storytelling involves stories that use metaphor and imagery to change the way they see their lives and the world. the client have: • Reflected on the story told and had a better outlook in life. the client will be able to: • Reflect on the story told and express their feelings about the story. Mechanics The facilitators will first explain the activity to the clients. • Determine the connection of the story on their lives and • Verbalize having a better and positive outlook in life. offering healing and growth to everyone.Title of Therapy Storytelling Descriptions It is an accessible and creative form of communicating and reflecting upon experience. it helps the clients think and behave in new. It also encourages the patients to verbalize ideas regarding the topic. Mechanics 1. Providing basic information about places/events may motivate the clients to follow the medical regimen to be well. It encourages the patients to show emotions and reactions about the latest news. Gather materials needed 3. newspaper reading(15-20 minutes) 5. *patients will be able to provide ideas/ suggestions/ comments/ conclusions about the topic . Newspaper therapy is cutting clippings from newspaper and sharing this information to the clients and knowing their feelings and ideas about the information given. Exercise 2. Learning Objectives *To be able to provide the clients an information on what is happening outside and the current news. explain the concept of newspaper reading 4. *To be able to introduce topics that will facilitate client’s participation in reading *to be able to assess client’s reading comprehension through asking question about the news.Title of Therapy Newspaper Reading Descriptions Newspaper therapy is giving information to the clients about events and what is happening outside. Learning Contents Reading can help jumpstart the brain. giving comments/ideas about the topic Resources *Newspaper Venue: Mariveles Mental Hospital Duration: 15-20 minutes Expected Outcome *Patients will be able to talk about the news they read and how they respond about it.