Undifferentiated Schizophrenia Case Study Sample

A Case Study Presented to the Faculty of The Ateneo de Davao University College of NursingA Case Study on Schizophrenia Undifferentiated Submitted to: Mrs. Anabel Bauzon, RN, MN Clinical Instructor – Panelist of the Case Study Submitted by: [Group 1] Abarquez, Eva Rica V. Ampilanon, Rae Maikko M. Ausa, Ryan S. Balboa, Tessa Marie R. Batuhan, Katherene P. Beltran, Maribel S. Bulosan, Von Rainier S. Cabonita, Kristi Ann J. Campaner,Marie Allexis I. BSN-3H 09 February 2010 TABLE OF CONTENTS Acknowledgement…………………………………………………………………..…..3 Introduction…………...……………………………………………………………….…4 Objectives (General & Specific)……………………………..……………………….….6 Personal Data…………………………………………...……………………………….9 Genogram……………………………………………………………………….………11 Anamnesis………………………………………………………………………….…...12 Theories of Development………………………………………………………….....…24 Etiology and Symptomatology….……………………………………………….……44 Psychodynamics………………………………………………………………..………62 Mental Status Exam……………………………………………………………….…..68 Multi Axial Assessment………………………………………………………………..78 Nurse Patient Interaction ……………………………………………………………..81 Complete Diagnosis…………………………………………………………......…….101 Differential Diagnosis……………………………………………………………....…104 Anatomy and Physiology…………………………………………………….…..……115 Doctor’s Order…………………………………………………………...……………126 Drug Study……………………………………………………………………….……130 Nursing Care plan ……………………………………………………………..………149 Prognosis………………………………………………………………..…….......……176 Recommendations………………………………..………………………...…………180 Significance of the Study……………………………………………………...………182 Appendices……………………………………………………..………………...……183 References……………………………………………………...………………...……195 2 ACKNOWLEDGEMENT The group wishes to express their deepest gratitude and warmest appreciation to the following people, who, in any way gave us the possibility making this case study a success: First of all, to the Almighty God, who never cease in loving us and for the continued guidance and protection. To the group’s clinical instructor, Mrs. Apple V. Guiao, R.N,M.N for her guidance and support in the duration of the study and during the psychiatric nursing exposure , whose help, stimulating suggestions and encouragement helped us in all the time of making this case study. To Mrs. Zenaida Lagrosa RN, Mrs. Anabel Bauzon RN and Mr. Richard Cheng,RN for their unlimited patience, guidance and being with us during our psychiatric nursing exposure . Finally to Ms. Melba Irene Gabuya RN for imparting knowledge and learning experience during our lectures on Psychiatric nursing. Without their encouragement and constant guidance, our Psychiatric Nursing exposure would not have been a very meaningful learning experience. The group also wishes to acknowledge the invaluable assistance and cooperation of the staff nurses of the Davao Mental Hospital (DMH), for allowing us to conduct this study, for essential assistance in reviewing the patient files and giving us the opportunity to care for the mentally-ill patients. Special appreciation is extended to the client subjected for this study and other informants for their selfless cooperation, time and entrusting personal information needed for this study. To the group, we would like to show our endless gratitude to each other by specifying our names; Maikz, Eva, Allexis, Kat, Bel, Kitty, Ryan, Tessa and Von; for the understanding, believing in each other, and teamwork. May we continue working hard for future studies. 3 And lastly, to our parents who have always been very understanding and supportive both financially and emotionally. INTRODUCTION Schizophrenia (from the Greek roots skhizein ("to split") and phrēn, phren- ("mind")) is a severe mental illness characterized by a variety of symptoms including but not limited to loss of contact with reality. Schizophrenia is not characterized by a changing in personality; it is characterized by a deteriorating personality. Simply stated, schizophrenia is one of the most profoundly disabling illnesses, mental or physical, that the nurse will ever encounter (Keltner, 2007). There are 5 subtypes of schizophrenia naming; paranoid, disorganized, catatonic, undifferentiated, and residual. Schizophrenia undifferentiated is the type of schizophrenia wherein characteristic symptoms (delusions. Hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms) are present, but criteria for paranoid, catatonic, or disorganized subtypes are not met. Schizophrenia is not a terribly common disease but it can be a serious and chronic one. Worldwide about 1 percent of the population is diagnosed with schizophrenia. About 1.5 million people will be diagnosed with schizophrenia this year around the world. (mentalhelp.net). Ninety-five percent (95%) suffer a lifetime; thirty-three percent (33%) of all homeless Americans suffer from schizophrenia; fifty percent (50%) experience serious side effects from medications; and ten percent (10%) kill themselves (Keltner, 2007). According to study done 697,543 out of 86,241,697 of Filipinos or approximately 0.8% are suffering from schizophrenia (cureresearch.com). Here in Davao, Dr. Padilla said that the Davao Mental Hospital receives an average of eight to 10 patients a day suffering from schizophrenia, depression and bi-polar illnesses (Positivenewsmedia.net). 4 N. between the ages of 15 and 25. and the incidence in women is noticeably higher in women after age 30.who. Bob.Schizophrenia Ranks among the top 10 causes of disability in developed countries worldwide (World Health Organization. The average age of onset is 18 in men and 25 in women. not his real name. Making this case is a good avenue to broaden the proponents’ knowledge about the mental illness involved. The patient. or over 40 years of age (schizophrenia. and was agreed by whole group.com). 2010 for their psychiatric exposure. The group chose Bob as their subject primarily because his case posed as a very intricate case requiring due understanding and knowledge. It was on that said dates that the group found a creditable case sensible to be presented as case presentation as suggested their Clinical Instructor Apple V. whereas most males become ill between 16 and 25 years old. M. R.N. Men tend to get develop schizophrenia slightly earlier than women. Guiao.int) Schizophrenia is a disease that typically begins in early adulthood. www. was one of the patients admitted to the Crisis Intervention Unit of Davao Mental Hospital due to Schizophrenia Undifferentiated. most females develop symptoms several years later. The group 1 of BSN-3H was given opportunity to have a hospital exposure in Davao Mental Hospital last January 19 – 30. Schizophrenia onset is quite rare for people under 10 years of age. 5 . • present the psychodynamics of the client’s diagnosis by recognizing its predisposing and precipitating factors with appropriate rationales. • • determine the etiology factors (precipitating and predisposing) of the mental disorder. the group aims to: Cognitive: • • interpret the pertinent data gathered from the patient and his significant others. Specific Objectives: In order to meet the general objective. and familial history tracing. • Interpret and analyze nurse-patient interaction taken through spontaneous and effective use of therapeutic communication. evaluate the presence or absence of signs and symptoms seen in the patient in relation to the mental disorder.OBJECTIVES General Objective: The main goal of the group is to be able to present an extensive and comprehensive case study of our chosen client that would present a comprehensive discussion of Schizophrenia Undifferentiated to yield important information for the case study. • evaluate the developmental stage of the patient according to the theories of Erikson. To track down the significant events during the client’s developmental stage as shown in the psychodynamics. 6 . present the anamnesis by thorough gathering of the client’s pertinent personal data. Freud and Piaget. appropriate selection of informants. attainable. and importance to the client’s condition. and effective therapeutic communication and interaction with the client and his significant others. contraindications. • • commence the patient with his personal data and present and past health history. formulate effective. • provide the significance of the case study. adverse reactions. measurable. • present the medications given to the client. trace the health history of the client and family illnesses (past and present) through a genogram. including their respective modes of action. • assess client’s mental status thoroughly during the orientation and termination phase as well as the Multi-Axial diagnosis. • • present the doctor’s order with its rationalization. • render quality nursing care in line with the formulated nursing care plans. come up with a differential diagnosis with accord to the client’s maladaptive behaviors. 7 . indications. realistic and time-bounded nursing care plans base on identified actual and potential nursing problems. nursing responsibilities. side effects.• • • thoroughly define the complete diagnosis of the patient. • arrive to a general realistic prognosis drawn from the information gathered and factors affecting the patient’s condition. discuss thoroughly the Anatomy and Physiology of the involved organs and organ systems in accord to the final diagnosis. specific. Psychomotor: • gather pertinent data about the client through detailed chart taking. his significant others and community. Affective: • • establish rapport to the patient and the patient’s significant others. and the group as a part of the nurse’s holistic care. 8 . and establish a trusting nurse-patient relationship with the client and his significant others through provision of holistic care toward the client and use of appropriate verbal and nonverbal therapeutic communication skills with the client and significant others during the data gathering. medical world.• impart appropriate recommendations to the client. PATIENT’S DATA PERSONAL DATA: CODE NAME: Bob AGE: 40 SEX: Male BIRTHDAY: April 9. 1 Rizalian. Davao city ORDINAL RANK: 1st CIVIL STATUS: Single NATIONALITY: Filipino RELIGION: Catholic EDUCATIONAL ATTAINMENT: 2nd Year College undergraduate OCCUPATION: None NUMBER OF CHILDREN: 0 NUMBER OF BROTHERS: 2 MOTHER: Aina AGE: 58 EDUCATIONAL ATTAINEMNT: college undergraduate OCCUPATION: Businesswoman FATHER: Danni EDUCAIONAL ATTAINMENT: college undergraduate 9 NUMBER OF SISTERS: 2 . Bayugan Agusan del Sur Tulip Drive. 1969 BIRTHPLACE: Cagayan de Oro City ADDRESS: Prk. Matina. OCCUPATION: Businessman CLINICAL DATA: WARD/SERVICE: Crisis Intervention Unit/Psychiatry ADMITTING PHYSICIAN: GIOIA FE D. 2010 INSTITUTION: Davao Mental Hospital 10 .D ADMITTING DIAGNOSIS: Schizophrenia. 2010 DATE OF DISCHARGE: January 21. undifferentiated PRINCIPAL DIAGNOSIS: Schizophrenia. undifferentiated DATE OF AMISSION: January 19. M. DINGLASAN. 11 . Male .GENOGRAM Super Lola Angelit o† Angeli ta † Apolin aria Ω Watusi Ω† Watus a† Super Lolo Ω † † as Apolinari o† † Gran Pa † Gran Ma † Lolo Al † Lola Al Ω † Jeorgin o Aina 58 years old Fielit aѲ Ronan Ronan aΩ Danni 59 years old Leo † Lea Legend: L .hypertension Ѳ .Diabetes Bob 40 years old ∞ Emman 39 years old Carmz 31 years old Dennz 26 years old Yose 20 years old †-deceased 12 .schizophrenia Ω .Female ∞ . 13 . started having the condition when he stopped schooling in late August of 1987 and went back to Agusan because he thought lessons in school are becoming too difficult for him. Bob also verbalized that something is wrong with him and that he needed a psychological check-up. Bob’s tongue shrunk. hindering his speech. Rizalian. her son. Bob. Bob was diagnosed with Schizophrenia Catatonic Type and was admitted for two weeks. Aina brought Bob back to Davao City for a check-up but transferred to Davao Mental Hospital. no diagnoses indicating any mental illness resulted and they were asked to come back for a follow-up check up the following month. In San Pedro. Yet. Agusan del Sur Sex: Female Civil Status: Married Relationship to Client: Mother Length of Time Known by the Patient: Since Birth up to Present (40 years) Apparent Understanding of the Present Illness of the Client: According to Aina. Bayugan.ANAMNESIS A. This event forced Aina to bring Bob to San Pedro Hospital for a check-up. after which. Aina did not pay attention to what he said. until two days after. There. On November 1987. She believes that Bob’s wild behavior which is the reason for his second admission in December 2007 and 14 . he was discharged and was asked to go back to the hospital once a month for psychiatric evaluation and for monthly doses of a depot. INTERVIEWS Informant #1 Name: Aina Age: 58 Address: Purok 1. Aina says that Bob at times would show extreme hostility and wild behavior. current admission this January 2010 is due to Bob’s incompliance with the advices of the doctor to stop drinking coke. Matina. Davao City Sex: Male Civil Status: Married Relationship to Client: Brother Length of Time Known by the Patient: Since Birth up to Present (39 years) Apparent Understanding of the Present Illness of the Client: Emman said that the illness began when Bob went to Bukidnon in August 1987 to fetch him and go home with him to Agusan. This action convinced the doctor that Bob may need a three-day admission at the CIU for observation. he was then discharged Characteristics and Attitude of Informant: Sincerity and concern regarding the condition of the patient is highly evident in the verbal and non verbal cues of the informant during the interview. he started having a convulsion and 15 . Bob and Aina were only at the Davao Mental Hospital to have Bob’s monthly dose of his depot but Bob shouted at the doctor without any apparent reason. On the night of Bob’s arrival. alcoholic beverages and smoking. After which. She looks straight to the eyes and is very cooperative all throughout the interview. trying her best to recall all events that took place in connection to the condition of her son. exhibiting extreme hostility and wild behavior. The current admission of Bob is already his third admission. Informant #2 Name: Emman Age: 39 Address: 162 Interior Tulip Drive. first as San Pedro then at DMH. She believes that Bob’s condition will be 16 . Informant #3 Name: Carmz Age: 18 Address: 162 Interior Tulip Drive. Bob was caught eating his own feces and drinking urine from a potty. Matina. Hours later. Davao City Sex: Female Civil Status: Single Relationship to Client: Sister Length of Time Known by the Patient: Since Birth up to Present (18) Apparent Understanding of the Present Illness of the Client: Mae understands Bob’s condition because she is a student nurse. Since then. He had shown efforts to recollect all salient points regarding the condition of his brother. prior to the recent admission. one in November 1987 then in December 2007. displaying disorganized speech and delusions. After the incident.was given paracetamol. Weeks later Bob was brought to Davao for a check-up. Bob has always been visiting Davao Mental Hospital and was even admitted two times. According to her. Since then. they went home to Agusan. Bob’s manifestations are indeed characteristics of schizophrenia. Bob started to think and talk illogically. the brother does not claim any knowledge. Characteristics and Attitude of Informant: Emman was very open and receptive to the group during the interview. As to the reason of the convulsion and the events that took place prior to the convulsion. Emman sees Bob’s condition rooted from that convulsion which took place in Bukidnon. Taking this information to consideration.best improved if Bob follows all medication orders of the doctor and strictly avoid everything that the doctor prohibits him to take. Bob is a burden to their family. She cited incidents wherein he wakes them up in the midnight because he was hungry and asks them for something to eat or drink. Emman wayback in May of 1990. the sister-in-law concluded that. in spite this. Bob also occasionally asks his mother to sleep with him at night. the family still show their invaluable support and love to Bob. Yet. Matina. somehow. the patient was 21years old by then. She noted that Bob is irritating to the family members at times because there are instances wherein he seems to act like a child. the patient has been isolated and withdrawn since she first met him when she married his brother. showing strong desire to tell the group everything that she knows about the illness of the patient. She can see that the siblings of Bob have been exhausted in trying to understand him. 17 . Davao City Sex: Female Civil Status: Married Relationship to Client: Sister-in-law Length of Time Known by the Patient: Since Marriage up to Present (20 years) Apparent Understanding of the Present Illness of the Client: According to Mimi . Informant #4 Name: Mimi Age: 39 Address: 162 Interior Tulip Drive. Characteristics and Attitude of Informant: The informant was very responsive in the conversation. He said that what Bob’s actions now are the same as what he does in the past. Boy also says that Bob’s strange actions like talking to the television. He could even go for a whole day without talking to anybody and just watch TV. self-preserved and indifferent with others. 18 . Characteristics of the informant: Boy was at the first visit unresponsive to the questions asked by the group. on the next home visit. flight of ideas and hostile behaviors are not unusual of Bob anymore. Davao City Sex: Male Civil Status: Single Relationship to Client: Nephew Length of Time Known by the Patient: Since Birth up to Present (18) Apparent Understanding of the Present Illness of the Client: Boy says that Bob’s condition was not improving. However. He was always isolated. he volunteered to talk about what he knows about his uncle in a warm manner. The warm and welcoming attitude of the informant made it possible for the group to know more about the patient. Matina. She made ways for the group to contact the family and talk to other members of the family in order to gather data that she could not provide. Informant #5 Name: Boy Age: 18 Address: 162 Tulip Drive.Characteristics of the informant: The informant was open and hospitable to the group. He impregnated the patient’s mother. a known small time businessman in their place at Agusan. no illness were reported to run in the family. thwarting him to finish his studies then at the University of Mindanao. He is a Civil Engineering Undergraduate and was able to finish only until 3rd year of the above course. he is a kind of father who would not spank or scold his children and he seldom verbalizes what he feels.B. FAMILY HISTORY a. due to his early fatherly obligation. an illness condition occurring singularly to be considered familial. b. except one family member having diabetes mellitus type 2. Most of his time is spent in their rice mill and would only go home in the afternoon or at night. As a father. owning a small rice mill enough to support the needs of his family. Moreover. Aside from the condition. Generally. On the paternal side. He would only speak to his children wherever they do something incorrect. no mental illness can be traced on both sides of the family. then eloped with her. prominent family illnesses only concern some members having hypertension. when he was only 19 years old. Father The father is 59 years old. he was lenient in his relationship with his children. 19 . Maternal and Paternal Lineage Direct bilateral lineage of the patient show no conditions of mental illness. no other illnesses run the family. On the maternal line. His relationship with his siblings is not so good. as she states. when they grew up and the illness took place. leaving them. followed by the second informant. As a child. he would still isolate himself when with them. then by Carmz. d. this is the best way for her to offer the best education and life to her children and help improve their business in Agusan. And put her children in their house in Davao City to pursue their education from elementary school. and visiting them once a week. she doesn’t also believe in punishing her children through spanking and the like when they do something wrong. Like the father. He never shares his thoughts with them. She was in her second year in college when she dropped out of her Chemical Engineering course. The mother says that she brought her children up in discipline and love. Mother The mother helps in their small rice mill. Denns and then Yose . 20 . Pregnant at the age of 18. Siblings The family is composed of five siblings. she left her children to the care of nannies when they were young. she was unable to finish her college education at the University of Mindanao. Bob being the eldest. However. Furthermore. still with a nanny. According to her. although they were the only ones that he would play with. the siblings gradually got irritated with him because of his hostility towards others.c. she said she doesn’t spank her children because it does them no good. Emman. The mother. described that her labor was very long. so instead. the mother was not ready and did not know what to do. b.III. She did not also breastfeed the patient because she is having pain breastfeeding him and as reported. no breast milk would come out. Aina. They provided her with enough support for her pregnancy. the mother has adequate prenatal check-ups at a nearby health center. the patient was an unexpected child. she bottle fed the patient with a 21 . Personality History a. On course of nine months. Only 18 when she was impregnated. No complications took place in the delivery. Birth Bob was born in the Provincial Hospital in Cagayan de Oro City on the 9th of April 1969 through Normal Spontaneous Vaginal Delivery. she was able to eat adequately because the parents of her husband supported them. so she eloped with the patient’s father without giving her parents the knowledge as to the reason why she ran away.) Prenatal Being the result of the early pregnancy of his mother. The mother stayed with the father’s family in Cagayan for the whole duration of her pregnancy. she started having labor pains in the morning and delivered in the afternoon. Moreover. the couple got busy with their rice mill that they decided to leave Bob in the care of Nena. Trying their luck in a new business. Toilet training was mostly implemented by the nanny Ging-ging. On the August of 1969.formula milk in a timed manner. considering her age. and she is not strict in it. in June of 1969 Aina went back to Agusan to talk to her parents. Aina and Danni married each other and decided to reside in Agusan. She told them that she ran away because she was pregnant and apologized for everything that she has done. Her parents did accept her apology and welcomed her back. Nena went home to her province and was replaced by another nanny named Ging-ging. while they attend to their business. Moreover. As he had a nanny. Bob’s nanny since birth. In cases that the baby would cry Ging-ging would just give him a pacifier for him to stop crying. Aina instructed the Ging-ging to teach him to urinate and defecate in a potty because 22 . a routine which continued until the patient was three years old. when Bob was almost five months. believing that this would help the nanny attend to other tasks while taking care of the baby. Aina instructed her nanny to continue the timed bottle feeding routine every three hours. Infancy and Childhood Characteristics After the birth. c. cuddling him always and looking after him. She instructed to feed the baby every three hours. Moreover. Bob was toilet trained when he was 2 years old. she hired a nanny named Nena to look after the baby because she did not have any experience in taking care of a baby. However. The nanny was very caring to the child. but what she does remember is that the patient had measles before he was one year old. This break-up with his only girlfriend bagged down his self esteem.it irritates her to find urine and stool just anywhere. he also engages in sexual activities with GROs. 23 . As to the strategies and the relationship of the nanny to the child. Psychosexual History The patient’s sexual awareness started when he was 16 years old. d. She carefully instructed the nannies to give to the children everything they want to keep them from having tantrums that could hinder the nanny from doing other household chores. the mother did not exactly describe because according to her. on his 4th year in high school. It was on this time that he started having a crush and actually had a girlfriend who after sometime broke up with him. she changed nannies several times. Ging-ging would just clean the mess. not correcting Bob. his mother also keeps on teasinf him that his girlfriend’s teeth resembles that of a rat which further decreased his self-confidence and esteem as he tried to compare himself with the boys of his age. The mother could not remember whether or not the patient’s immunization is complete. Aina is very strict in toilet training. According to her. In his adolescence. the relationship of the nanny was not so important to her as long as the needs of her children are met and her children’s safety is not harmed. In addition. But on instances that Bob would pee or defecate anywhere. Bob started talking when he was a year old and started walking on that certain age more or less as reported. Also. he likes being a follower in a game rather than a leader. He spent his high school days still at Fatima. In June of 1982. School History The patient began preschool in June of 1974. he is uncooperative and becomes aggressive when forced to play with other kids. where he formed new set of friends which he grew much attached to. he did not perform well in school and was not interested in studying. The first days in school were terrible for Bob.e. when he is 13 years old. which he did not really approve that he cries in between classes just to be sent home. He stayed in their residence in Davao which is in 162. He is withdrawn from the rest of his classmates and would talk only to a few people. extorting money from his parents and having low grades. He would only sit by himself and play alone in a corner. His playmates were his siblings and would choose to play only in their yard. he began cutting classes. he entered first year highschool. Play Life Bob does not engage so much in cooperative play and prefers solitary play. Furthermore. As a child. he started using marijuana. His grades were also affected by his isolation. He stayed in Davao together with his brother Emman and their nanny. He started drinking and smoking. he would cry inside their classroom and would not separate from his nanny. Matina. he was transferred to Our Lady of Fatima School. Davao City. In his third grade. when he was five years old where he was sent to Davao to study at Assumption up to second grade. Interior Tulip Drive. 24 . he is not talkative. These friends of him were not of good influence because when they started hanging out. f. Furthermore. he did not have good grades and still continued cutting classes and indulging in his vices. although it was really true. However. his mother was once called by the Guidance Office because he threw an eraser to his teacher because the eraser hit him when the teacher threw the eraser at his classmate. the patient still follows the Catholic Faith and does not go to Seventh-day Adventist religious celebrations. he finally decided to stop. in the Civil Engineering course. he spent his two years of college education at the University of Mindanao. Troubles in school were rampant. Yet he is able to graduate from high school in the March of 1986. being evident even when he is already in college. Occupational History 25 . g. Religious and Social Adaptability The family is Roman Catholic. He was also suspected of using marijuana during this time but is persistently denying the accusations. Peer pressure can be seen as a great contributing factor in his use of marijuana because his friends would tease him when he refuses to use marijuana. when he was in college. these events pulled his confidence down.His bad school records started worsening when his girlfriend in his fourth year high school broke up with him. claiming that he is already having difficulty catching up with the lessons. On his second year. However. that he started isolating himself and increased his use of marijuana. He was occasionally caught brawling with classmates. their family converted to Seventh-day Adventists. drinking and smoking. However. In his college days. h. According to his verbalizations. late in the August of 1987. i.When the patient stopped studying during his second year in college. he is looking forward to marrying someday. Onset of the present illness The recent admission is already the third admission of Bob. j. According to him. He suddenly shouted at a doctor in the hospital upon having his monthly depot injection and check-up. Marital History The patient is single. he already told the maid that he wanted to marry her. However. he would help in the loading and unloading sacks of rice and also in operating the mill. he stayed in Agusan and helped in their rice mill business. 26 . Bob doesn’t get regular salary because what he gets is ten percent of the day’s income. the maid ran away. he wants to be married so badly that he would even marry their maid at home. but unfortunately. after telling her. There. Recurrence of hostile behavior is the primary reason why Bob was admitted for three days in the CIU of Davao Mental Hospital. did not breastfeed Bob because she is having breastfeeding no breast pain him milk and as reported and would come out. so instead. his mother. Each theory has its own perspective on the development of man. to trust others withdrawal. it also gives us profound insights into who we are as adults. she bottle fed the patient in a 27 . from birth to the end of life. ERIK ERIKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT The Psychosocial Stages of Development developed by Erikson enumerates eight stages though which healthily developing human should pass from infancy to late adulthood. LIFE STAGE INDICATORS OF POSITIVE INDICATORS OF NEGATIVE ASSESSMENT JUSTIFICATION RESOLUTION RESOLUTION Infancy (birth to Learning how Mistrust. 1 year) Central Trust Mistrust The first stage. This very young science not only enables us to understand how each individual develops. These development stages can be seen as a series of crisis and each stage forms on the successful accomplishment of the earlier stages. Successful resolution of these crises supports a healthy self-development. Failure to resolve the crises damages the ego and maybe expected to reappear as problems in the future.THEORIES OF DEVELOPMENT These are just a few of the fascinating aspects of the field of “human development”: the science that studies how we learn and develop psychologically. Every stage describes a task to be accomplished. estrangement Mistrust Aina. centers infant's on the basic task: vs. the infant's view of the world will be one of trust. Yaya Nena left and Yaya Ging-ging took over her place in taking care of Bob. believing that this would baby train to the be disciplined. especially sustenance. experience in taking considering her age. Because Bob was given not enough attention and left under a care of a nanny he had built a sense of mistrust to his parents. He has not been fed well since he’s being fed in a timed manner. infant depends on the timed manner. for food. she hired a Yaya Nena to look after the baby because she did not have care of any a baby. that the world is . parents the warmth dependable affection. She would feed the baby every three hours. After 5 months on the service. he hasn’t feel the 28 child caregivers neglectful. But if the are the instead mistrustan an unsafe the and If the expose to and mother.needs being met by the parents. comfort. The parents. Moreover. infant learns in unpredictable and place. develops a sense of autonomy.sense of comfort since his parents haven’t been there for him to cuddle him with Early Childhood Self(2 to 3 years) Central Autonomy task: self vs.a sense of being able to handle many things on their own. But if caregivers demand refuse to too let much too soon. Shame and doubt The patient started talking when he was 1 year old and started walking on that age as well. ability cooperate control Compulsive –esteem. Yaya Ging-ging doesn’t 29 . The patient was toilet trained when he was 2 years old. children instead may develop Ging-ging to teach him to urinate and defecate in a potty because it irritates his mother to find urine and stool just anywhere. mother Yaya without loss of self-discipline Shame & Doubt If caregivers express oneself self- encourage sufficient behavior. she was too demanding that the child will learn how to toilet train right away. child As he had a nanny (Yaya the instructed Ging-ging). On the other hand. children perform tasks of which they are capable. Or compliance. to willfulness and and defiance when him he’s when crying or to play necessary. he’s a silent type of person. since he developed the sense of shame and doubt in which he was unable to handle because different implementation of the nanny and his Late Childhood Learning degree Lack task: and of self Guilt mother.shame and doubt about things. she has not disciplined the child well if the child anywhere of ging was the pees because unstrict training Yaya Gingimplemented unable to on Bob. According to his mother and brother. he’s not 30 to this begins stage. their ability to handle train him well. the child evaluate one’s learns to take own behavior. He much play would of things the (4 to 6 years) Central Initiative Guilt During of assertiveness confidence. initiative and get ready for . and prefers solitary only sit and play alone in a corner. The child master this kind of task in this stage. The client does not engage cooperative play. purpose pessimistic and the over restriction of own activity vs. influence environment. children develop initiativeindependence in planning undertaking activities. when playing. children develop guilt about their needs desires. while helping make and choices. perseverance Sense of being Inferiority of mediocre.leadership roles. he was a follower. from peers and school. School Age (7 to Developing 12 years) Central Industry Inferiority sense vs. also them realistic proper and talkative. When he was grade 3. As verbalized by the mother. adults discourage the search of independent activities. He likes playing with his bike and would play goal achievement adults and only in their yard together with his siblings. If encourage support children’s efforts. But if. He attended his nursery until Grade 2 in Holy Cross of Davao College. he transferred at 31 and and Task: competence and withdrawal . persevering tasks completed putting at until and work withdraws himself with his classmates. are learn Our Lady of Fatima School.At this to stage. telling and classmates. he only have few friends due to lack of interaction with them. as he needed to leave friends. accomplish complex reading. he again developed a separation anxiety. time. There. If children are instead ridiculed or punished for their efforts or if they find they are incapable meeting teachers' of their and 32 . He was a silent type of person and not very cooperative expressive. He has expectations of his parents from him. they begin to demonstrate industry by being diligent. which is to do well in his studies. displays performance school uninterested not met He also poor in and with the his studies. before pleasure. and He If children are encouraged make and to do things and are then praised for their accomplishments . his old teachers children eager and more skills: writing. adolescent person develops pressure. A certain group of people make friends with him but they were bad influence.parents' expectations. and possible antisocial behavior of Role Confusion At this stage the client had his first year high school at Holy Cross College of Davao and later on. Identity vs. He started drinking and because started marijuana. they’ve transferred to Cebu. they feelings develop of inferiority about their capabilities. Adolescence (13 Sense of to 19 years) Central Confusion The adolescent is newly concerned with how they appear to others. and cultural. they have sessions smoking of peer using when group he’s Task: actualize one’s hesitancy. he coherent sense of self and plans to actualize abilities. educational. Role abilities appears through discovery. one’s The sense of self can cutting his class and 33 . and there. vocational The also sense of identity and plans self Feelings to confusion. emotional. Also. The central sexual. he enrolled himself to Cebu Avillana High School. due to being a shy type. he had not gained new friends. ethnic. in the Civil course. When he was 4th year high school (16 years old). this incident bagged down his self-esteem. he met his first love and became his girlfriend. possible antisocial behavior also emerge. may and identity of does not solidify.be confused if a core Feelings confusion. but when he brought her at home. grades and he did not have continued in his cutting classes and finally studying school 34 when he was in 2nd . hesitancy. good still indulging vices and stopped year high Engineering However. because of his vices he always got low grades. her girlfriend was being criticized by his mother to have big front teeth which are similar to a rat. He spent his two years of college education at the University of Mindanao. of intimate. After though never another relationship had not the crushing developed intimate with form with relationship he had. He continues to isolate himself from others. If people cannot these form intimate such They forming become capable another woman. He felt that he’s being envied by his friends. though he considers people to be his friends. or another career sense of commitments of Isolation lessons. reciprocal relationships and willingly make the sacrifices and compromises that relationships require. he didn’t trust them enough. person and has lifestyle people commitment to and have established work their identities. relationships they are ready to make long-term commitments to others. with other girls. he vs.due to difficulty in catching up with his Early Adulthood Intimate (20 to 34 years) Central Intimacy Isolation Once relationship Task: with a Avoidance relationship. relationships--a sense of isolation may result. Middle Working Lack of Stagnation The patient is not so 35 . He intimate relationships friends. by family raising this perhaps a or a to and betterment task: the the productivity. though generating small income for helping in the Rice Mill. of not forward helping society. When a person makes contribution during period. who is In selfand contrast. When he had free time.Adulthood ( 35 towards to 65 years) Central Stagnation During middle age the primary developmental task is one of contributing society future generations. The client 36 working toward the betterment of society. He’s being dependent to his family. being productive helping to guide illness. a person centered .a sense of productivity and accomplishmentresults. he went to the plazas or parks to eat or drink. He has no support that’s why money for his own wants. society to move productive due to his illness. He also loves to watch television shows. a sense of generativity. but still he’s not being productive because the little money he earned what is is being being wasted for buying prohibited for him to be used. like marijuana cigarettes contributes worsening own he family wasted and that in his to his Generativity vs. he hasn’t understand fully for and him this needs to unwilling to help forward develops stagnationdissatisfaction with the relative lack productivity. should time for of further explanation understand. he is a registered voter and planned to vote for Noynoy Aquino in the coming election period. And as a Filipino citizen. he has done his part in becoming a good citizen.unable society a feeling or move of also adapt to his physical changes in his body and accepted this as part of him. He also knows violated Republic Act 6425 or the Dangerous 37 . in a way he’s being productive because he has done his duty for the betterment of the country. he’s not helping the country forward had to move the since he companionship recreation. A person in this stage have and his responsibilities and knows that he is accountable of whatever actions he takes. about his disease. But still. training. sources the of Controlling and NOT feces ACHIEVED should be when ACHIEVED JUSTIFICATION Though the mother. still he feds Bob through bottle-feeding but in a timed manner which is every 3 hours. The Feeding should necessary. Major weaning ANAL (1 1/2 The to 3 years) and conflict: provided pleasure are the anus expelling (sensual bladder give pleasure and Toilet training be a satisfaction. it is security or safety. trained self control). it is the produces major pleasure satisfaction exploration. sense of comfort. 8 which is regarding the usage of the prohibited drugs. . Each stage is characterized by erogenous zone that is the source of libidinal drive during that certain stage. SIGMUND FREUD’S PSYCHOSEXUAL THEORY The concept posits that from birth human have intellectual sexual appetites (libido) which unfold in a series of stages. nanny which was instructed by his mother to instruct him to defecate in 38 Major conflict: toilet should pleasurable experience. source of pleasure. Article III. Toilet was Bob not was by training strict. toilet his child’s primary need be pleasurable.Drug Act of 1972. Aina. LIFE STAGE CHARACTERISTICS IMPLICATIONS ASSESSMENT Oral (Birth to 1 The center of pleasure Feeding NOT 1/2 year) is the mouth. Sec. a sense and of comfort or and ease and safety. doesn’t breastfed her child because she felt that it is painful. parent fantasy. mother Bob of was still urinating and defecating everywhere. Major conflicts: the Oedipus Complex (refers to the male child's attraction for or sexual 39 . he was able to learn that a boy is for a girl. issues matter. and questioning outside of adults about sexual family. Yaya Ging-ging not well able when discipline was to Bob it comes to toilet PHALLIC (4-6 The genitals are the The years) center of gratification. Other actions include opposite sex and later takes on a the experimentation with love relationship peers. determines Masturbation offer together with the of the pleasure to the child. Her Yaya was to well nanny. and a girl is for a boy.a potty. child ACHIEVED training. Ging-ging not able implement the instructions of her Ma’am Aina. At this stage. the Bob. study his lessons. until now . He started to go to school by this time. he maturity and function parents. he He prefers himself to isolates himself to his peers.his mother his and father) unfriendly towards attitudes and Electra Complex (refers to the female's attraction for her father and sees her mother as her rival). which resolves when the when child the identifies child identifies with parent of same sex. Encourage sports other with Develop relationships and between peers of the activities same sex. Genital (puberty after) Energy and toward is full directed Encourage sexual separation being NOT from ACHIEVED He is not still 40 independent. intellectual Sexual impulses tend pursuits. He had not performing to school uninterested been well and to he had few friends and few same-sex peers. . LATENCY (6 Energy is heading for Encourage child NOT years puberty) to physical and with physical and ACHIEVED intellectual activities. to be repressed. gained playmates because be alone. JEAN PIAGET’S STAGES OF COGNITIVE DEVELOPMENT This theory pertains to the nature and development of human intelligence. like asking money to have together sexual with gratification some GROs and to buy marijuana or cigarettes. especially when it comes to his basic needs and as well as to meet his personal needs to gratify his desires. inACHIEVED (birth-2years) fants build an understanding of the world by coordinating sensory exJUSTIFICATION The client as an infant was not by being her breastfed mother. to make right and good decisions lives with his to parents and being dependent them.and development of independent and skills needed to cope able with the environment. LIFE STAGE CHARACTERISTICS ASSESSMENT Sensorimotor Thought • In this stage. he was fed with the use of the 41 . He’s not matured when it comes to his sexuality. Thinking is still egocentric: has Preoperational Thought (2-7 years) • ACHIEVED At this age. at times. when giving the bottle. • The child learns that he is separated from his environment and that aspects of his environment continues to exist even they may be outside the reach of his senses. Thought derives from sensation and movement. instinctual action at birth to the beginning of symbolic thought toward the end of the stage. was fond of drawing that 42 . motoric actions. gives him a pacifier when the child is crying thus fulfilling the child’s wants.periences (such as seeing and hearing) with physical. An infant progresses from reflexive. Infants gain knowledge of the world from the physical actions they perform on it. the infant Bob grasp it as a response hungriness. • bottle. of his The mother. The children begin to represent the world with images and words. Concrete Operational • Thought (7-12 years) NOT ACHIEVED Bob does not know how to arrange his things systematically or in order depending on its size. the child isn’t able to conceptualize abstractly. The child starts to think abstractly and conceptualize.difficulty taking the point of view of others. He also draws to show what is inside of him. shape or any characteristics. Symbolic thought goes further than connections of sensory information and physical action. especially by significant feature. • Objects are classified in simple ways. to express his feelings through images that he creates. other he’s disorganized when it comes to his things. • represents his ideas. forming logical structures that explains his or her physical experiences. • Children can execute operations and logical reasoning replaces intuitive thought as 43 . Though he never courted the girl. he 44 . They focus on the dynamic change in the problem. • Children show thinking is decentered -they consider multiple aspects of the problem (e. most importantly. if given he a really Thought (12 years and wanted to marry their helper. ACHIEVED During this stage. And. the client was able to understand what love means . The person is capable of deductive and hypothetical reasoning. The logical quality of the adolescent's thought is when children are more likely to solve problems in a trial-and-error fashion. understanding the significance of height and width).long as reasoning can be applied to specific or concrete examples. according to him.He shared about his plans about getting married in the future chance.g. they show the reversibility of true Formal above) • Operational • mental operation. • During this stage the young adult is able to understand such things as love, "shades of gray", logical proofs and values. just directly asked her to marry him but the woman home refused to to their answer him and went hometown. In addition to that, when asked, “Kung makakita ka ug pitaka na punog kwarta, unsaon man nimo ang pitaka, iuli o gastuhon ang kwarta?”; he then replied “Iuli nako, kay basig kailangan sa tag-iya ang kwarta.” He was able to draw conclusion from the given available. situation • During this stage the young adult begins to entertain possibilities for the future and is fascinated with what they can be. • At this stage, they can also reason logically and draw conclusion from what information is available. 45 ETIOLOGY AND SYMPTOMATOLOGY A. ETIOLOGY Predisposing Present/ Absent Factors Family History Absent Rationale Individuals schizophrenia seem Justification with Schizophrenia is not to present in any of the inherit a predisposition to family members of the disorder because the patient in both runs in paternal and maternal schizophrenia families. The relatives of lineages. individuals schizophrenia have with a greater incidence of the disorder than chance would allow. amazing resources directed genetic at Although amount have finding cause an of been the of schizophrenia, the results are far from specific. In fact, almost every 46 chromosome has been linked with schizophrenia. Keltner, Neurostructural Anomalies Absent N. Psychiatric have The patient’s chart that did not show any Nursing. Chapter 4. The theorists proposed schizophrenia, is a direct laboratory results to effect of three confirm the existence defects. of such anomalies if nuerostructural Ventricular brain enlargement, such are present in and the patient. cerebral These atrophy dysfunctional blood flow. anatomical anomalies in the brain play a major role in the illness. Keltner, N. Psychiatric Nursing. Chapter 4. Precipitating Present/ Absent Factors Intake of drugs, Present substances chemicals increase dopamine. or which levels of Rationale Justification Dopamine is known to be The patient admittedly the neurotransmitter which takes marijuana since is prominently affecting he was thirteen. All the occurrence of informants also concur the patient is 47 schizophrenia. In patients that with dopamine schizophrenia, indeed levels are marijuana. using invariably high. Therefore, intake or use of drugs, substances and chemicals which elevation promote of the dopamine levels in the brain would trigger Example levodopa, schizophrenia. of these are ampethamines and marijuana. Keltner, Perinatal Factors Absent N. Psychiatric Nursing. Chapter 4. Some researchers believe The mother did not that schizophrenia can be report linked exposure birth to to during perinatal abnormalities influenza, complications winter, her pregnancy any and during and exposure to lead, minor birth. The mother also malformations during early verbalized no exposure gestation, exposure to to any infections viruses from house cats during her pregnancy. and complications of pregnancy, particularly 48 For Meyer. For Freud. poor fragile factors ego ego. ambivalent relationships and arrested psychosexual development. events in early life can cause problems that are as severe as schizophrenia. Keltner. Furthermore. Developmental factors There are some stages include the internal of development reaction of an individual to according to Erikson life stressors or conflicts. inadequate development. Erikson believed that 49 . Psychiatric Nursing. regressed or id behavior. ego superego dominance. Chapter 4. considered here: Meyer. that the patient did not Three theorists could be successfully meet. Developmental Factors Present N. developmental include boundaries.during labor and delivery. Freud and Erikson. The series of involuntary con.incident. Keltner.Informants quently roll upward or to attested that after the one side during a convul. sometimes causing serious bites to the 50 . have muscles. The teeth disturbance in thought usually are tightly process. breathing appears la. in medicine. and saliva oozes behavior the having patient odd and from the mouth.started bored.convulsion when he tractions of the voluntary was 18 years old. Chapter pp. of the The accomplishment or failure in the levels affect a person’s aspect. clenched. The eyeballs fre. Mistrust highly influences development condition. Convulsion Present Psychiatric patient had a developmental Nursing.N. Convulsion.eight-stage human model of development starting from Trust Vs. sion. A doctor should be notified whenever a convulsion occurs. brain tumors or hemorrhages. toxemias. such as uremia or lead or cocaine poisoning. usually last only a few minutes and are not dangerous. emergency treatment is directed to51 . Until the arrival of a physician. called febrile convulsions. and acute or chronic alcoholism. chemical disorders. They also occur in young children as a part of the reaction of the body to infection. such as hypoglycemia.tongue and the cheeks. Such convulsions. Other causes of convulsions are virus infections. Convulsions are a common symptom of epilepsy. Furthermore. brain cell damage is irreversible. © 1993-2008 Microsoft Corporation.ward protection of the victim from biting or other forms of self-injury. Damage to brain tissues range from mild to severe depending on the type of convulsion and how long. and phenytoin. SYMPTOMATOLOGY Symptoms Present/Abse Rationale Justification 52 . Microsoft ® Encarta ® 2009. B. All rights reserved. phenobarbital. Anticonvulsant drugs include diazepam. A convulsion may have a significant effect in an individual due to restriction of brain oxygenation in the occurrence of the convulsion. Psychiatric Nursing. Alterations in Personal Relationships Decreased attention to appearance and social amenities related to introspection and autism. N. patients become less The patient has troubled concerned with their appearance and relationship with other might not bathe without persistent people. prodding. Table manners and other social skills might diminish to the point that the patient becomes disgusting to others. well before statements. these problems develop over a constant long period. of the patient show incoherent Often. and the become more pronounced as the tangentiality illness progresses. Psychiatric Nursing. It is not like which are highly uncommon to hear that a person was indicative of inadequate asocial. Keltner. 53 . schizophrenia is diagnosed.nt OBJECTIVE SIGNS A. Inadequate or inappropriate communication Present Present Frequently. and circumstantiality. Keltner. N. loner or a social misfit and before being diagnosed. inappropriate communication. Patients with schizophrenia have Communication troubled personal skills relationships. tumbling tables and chairs and wants to hit people. Psychiatric Nursing. Keltner. Patient has diminished or lost interest in communicating with people. Psychiatric Nursing B. . The patient has tantrums. Alterations in Activity Absent Psychomotor retardation. which distances patient from others. N. the markedly slow speech and body movements which occurs as a symptom of schizophrenia The patient did not exhibit this symptom. Withdrawal Present Patients withdraw.Hostility Present Hostility can also be a common theme. Moreover in his adolescence he would hangout with a few friends. with which schizophrenia further As the informant could remember the patient prefers solitary play in his childhood. compromises their ability to engage in meaningful activities. confronting people with no apparent reason. Psychiatric Nursing Patients with schizophrenia also display alterations of activity. Keltner. The patient did not exhibit this symptom 54 Psychomotor retardation Catatonic rigidity Absent Keltner. N. As the illness progresses the hostility became apparent in the patient. They may be too active or they may be inactive or catatonic. N. Like hallucinations.google. tactile. books. Altered Perception Present Hallucinations which are false Hallucinations.ph/books? Paranoid thinking Present isbn=0471245313 Suspiciousness of others and their actions also occur as a symptom of schizophrenia which happens due to the alteration of the normal In connection to persecutory delusions of the patient. Hallucinations sensory perceptions. especially those which are auditory in form is highly evident in the verbalizations of the patient and also in his actions as described by the informants. which can be auditory. visual. Hallucinations caused are by hyperdopaminergic state in the limbic areas. gustatory or somatic probably .Keltner. N.com. The patient does not exhibit this symptom. Keltner. N. illusions also occur as a result of hyperdopaminergic state in limbic areas. Psychiatric Nursing SUBJECTIVE SIGNS A. Psychiatric Nursing Illusions Absent Illusions are misinterpretations of stimuli. he is becoming suspicious and distrustful of people around 55 perceptual pattern of an individual . This occurs as a result of the altered thought process in individuals with schizophrenia. He is in deep belief that people are out there trying to kill him. he becomes paranoid. www.au him. Retardation Absent Retardation is the slowing of mental activity. N. B. which is also a direct effect of thought process alterations in individuals affected by schizophrenia. Keltner.affected by the condition. thus. Alterations of Thought This is the stringing together of unrelated topics with vague connection.unimelb.edu. Psychiatric Nursing. Loose associations can be traced in many of the statements made by the patient in conversations. Details which do not have anything to do with the topic are being mentioned by the patient. Loose associations Present . 56 This symptom is not exhibited by the patient.asialink. N. Keltner. N. Ambivalence Absent Ambivalence is a state in which two opposite strong feelings exist This symptom is not exhibited by the patient. Blocking Present Blocking is the interruption of a thought and inability to recall it.Keltner. Schizophrenic patients may be immobilized by their ambivalence regarding a matter as simple as deciding whether to drink an apple juice or an orange juice. Delusions are defined as false belief firmly held by a person even Persecutory delusions are highly evident 57 . There are several instances wherein he would suddenly stop right in the middle of a conversation. Psychiatric Nursing. Psychiatric Nursing. N. Blocking is apparent in conversations with the patient. delusions or emotional factors. Blocking may be caused by the intrusion of hallucinations. simultaneously. Delusions are fixed false beliefs and can take many forms. Delusions Present Keltner. Psychiatric Nursing. CIA. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality (see Psychosis). such as the belief that people have been abducted by aliens. A grandiose delusion is a belief that one is extremely famous or that one has special powers. 58 . For example. a person who truly believes he is Napoleon Bonaparte is delusional. A person with a delusion of reference believes that events or people refer specifically to him or her when they do not.though other people recognize the belief as obviously untrue. are not delusions because they are widely held beliefs. such as in the patient’s verbalizations and actions described by the informants. or the Mafia—are trying to harm or plot against him or her. a woman with schizophrenia may believe that a television news broadcaster is talking personally to her rather than to the entire viewing audience. A person with a paranoid delusion believes that others—such as the FBI. For example. There are many different types of delusions. Religious beliefs or popular conceptions. In psychiatry. Ideas of Reference Absent Keltner.the ability to magically heal people Keltner. This is not manifested by the patient. significance. en. Psychiatric Nursing. unrelated or innocuous phenomena in the world refer to them directly or have special personal This is not exhibited by the patient. Ideas of reference and delusions of reference involve people having a belief or perception that irrelevant. Autism occurs when patients are so This is not manifested by the patient introspective that they are distracted from external events. Autism Absent Keltner.org/wiki/Delusion Poverty of Speech Absent Poverty of speech is manifested by the inability to formulate and articulate thoughts that are relevant to the discussion at hand. N. Psychiatric Nursing. This is also highly connected in the alterations of thought process taking place in individuals with schizophrenia. Psychiatric Nursing. N. N.wikipedia. delusions of reference form part of the diagnostic criteria for psychotic illnesses such as schizophrenia during the elevated stages of mania. Patients become preoccupied with themselves and may be 59 . Keltner.This results in a personalized view of reality. N. Psychiatric Nursing. Altered Consciousness Confusion Present Confusion is an anxiety-producing symptom that is associated with psychosis.oblivious to the reality around them. incoherent speech is also a direct effect of schizophrenia in the The patient displays incoherent speech as evidenced by the disorganization of thoughts and flight of ideas which are illogical to fol60 functioning of an affected individual. Keltner. N. N. The patient is obviously confused as to the time and chronological arrangement of events in his life. Psychiatric Nursing. Psychiatric Nursing. . C. Disorientation to time is evident in the patient. Keltner. Incoherent Speech Present Like confusion. Keltner. Psychiatric Nursing. Because of emotional limitations. Alterations in Affect Absent Affective flattening. Overreaction Present Keltner. Inappropriate. Flat affect is a cardinal symptom of negative schizophrenia and may only respond to an atypical antipsychotic drug. flattened or labile lability are affective symptoms sometimes associated with schizophrenia. It can be defined as a lack of concern or interest. It is the inability to generate a normal response to people. blunted. Apathy is another symptom associated with the affective alterations brought about by schizophrenia. . schizophrenic patients overreact to normal events to overcome mental and social inertia. Psychiatric Nursing. the The patient overreacts to normal situations. This is not manifested by the patient. They often respond to antipsychotic drug. The informants verbalized that the 61 This is not manifested by the patient. inappropriateness. situations or the environment. N. N. D. Apathy Absent Keltner. Psychiatric Nursing. N.low. from This is not manifested by the patient.patient overreacts even in simple television shows. schizophrenia. suffering N. Nursing. Anhedonia Absent Anhedonia is the inability to experience pleasure which is highly associated with the detrimental effects of schizophrenia in the affect of individuals Keltner. Psychiatric 62 . PSYCHODYNAMICS 63 . Aina felt labor pains early in the morning. the mother’s emotional state during pregnancy may bring about long term effects in the fetus. premature labor and delivery and even spontaneous abortion. In the course of her pregnancy.. According to researches. guilt and shame caused emotional distress in both of them in this stage. Bob at high risk of fetal abnormalities. Aina had adequate prenatal check-ups at a nearby heath center. eloped at the age of 18 and 19 respectively. the mother may experience complications. Both undergraduates in their courses. unfortunately. provided a jeepney for Bob to use as a temporary means of income for them to use in the course of Aina’s pregnancy. During birth. Depression during pregnancy may also induce immunologic and neurological anomalies in growing fetus. the mother’s pregnancy is highly affecting the baby. They lived together with Danni’s parents there while Aina’s parents did not know about anything. This is so because stress-induced changes in the endocrine system of a woman during pregnancy is said to cross the placental barrier. 9th of April 1969. Danni’s parents. Anxiety. supportive of their child. In the prenatal stage. Aina and Danni. she 64 . Al.NARRATIVE PSYCHODYNAMICS Bob’s parents. Aina and Danni. affecting the fetal environment. together with motor retardation may also be possible. stopped studying and were dependent to Danni’s parents to support them in Aina’s pregnancy. They ran away to Cagayan because Aina got pregnant. et. Danni was out making a living. presented that depressed and anxious mothers during pregnancy were more likely to have negative consequences to the baby which extend far beyond the events of childbirth. and it was some time before Danni was successfully called by a neighbor that his wife was already in labor. Aina was rushed to Cagayan de Oro Provincial Hospital. Aina’s situation puts her child. thereby. Cognitive impairment. Researches in low income African American populations in 2002 made by Mulder. Young for pregnancy and emotionally anxious. There. delivered Bob through NSVD without any complication. However, according to her labor was rather long and extremely painful. From birth, Bob was left in the care of a nanny named Nena. Aina entrusted Bob to Nena because she did not have enough skills in tending a child. Furthermore, she also has to go home to Agusan in order to talk to her parents. Bob was not breastfed because Aina felt pain when she attempted to breastfeed Bob. So she decided to feed him with formula milk in a timed manner every three hours. Bob being left to the care of a nanny and the limited presence of his parents, started building the sense of mistrust in the part of Bob as a baby. Furthermore, as Bob was not able to be breastfed, he was unable to absorb significant nutrients from his mother, together with oxytocin and colustrum, which directly contributes to poor mother-child bonding. In the August of 1969, Aina and Danni married each other in Agusan and moved there, starting a rice mill business. Trying their luck on their new business, the couple got busy in their rice mill and left Bob to the care of Nena. They would only go home at night and has poor bonding with the child. As a result feelings of Mistrust formed in the child’s psyche. Moving on, in Bob’s toddlerhood, the core conflict in this stage, according to Erikson is Autonomy Vs. Shame and Doubt. And in the resolution of this conflict, the child must learn to imitate. Imitation being the core process involved in the resolution of the conflict in this stage, Bob is not at all fortunate. His parents’ availability was limited and the attitude of his mother and nanny were very variable. Thus, Bob developed a sense of confusion and inability to identify to any of his parents. Bob was unable to master skills such as eliminating and dressing up because everything was just handed to him readily by the nanny. Although this “spoiling” of the nanny to Bob may 65 contribute to his sense of autonomy, his lack of figures of attachment bringing about confusion and inability to master certain tasks further outweighs his derived autonomy. Thus, Bob gained doubt. During his play age, Bob was a loner. He would want to be in solitary play. He would only play with his siblings and would only play inside their yard. He was not open to other children. In this stage, the core conflict is Initiative Vs. Guilt. Initiative is the inquiry of the child to the world. The child begins to explore and uncover the wonders of the world around him and use his senses to perceive the order of things. In this stage the child learns to adapt and resolve the conflict thru education. However, Bob was a loner, withdrawing from other people in play. Furthermore, first signs of hostility were noted on Bob at this stage, because he would become hostile whenever asked or forced to join other kids in their play. Bob is also a good follower rather than a leader in games. During this stage, he did not accomplish the developmental task of forming initiative but instead formed sense of guilt. In school age, Bob was as withdrawn as he is in his past developmental stage. He has a difficulty in relating to others and as a result, his school performance is highly affected. He consistently has separation anxiety and cries inside the classroom every time his nanny would be out of his sight. Because of this, Bob was unable to form meaningful relationships with others and thus formed inferiority. In his adolescence, Bob entered high school at the age of 13 in the June of 1982. Bob became attached to a certain group of friends who doesn’t seem to be a good influence to him. As a shy person, Bob didn’t have many friends, so when this small group of people asked him to hang out with them, Bob was overwhelmed, believing that they could provide belongingness and acceptance. Bob treasured this small group of friends because this is all that he has. Bob was easily affected by peer pressure. Fearing rejection if he does not do what his friends would want him to do. 66 So when his friends asked him to join them in their vices, Bob also joined in. Bob started drinking alcoholic beverages and smoking. Worse, Bob also began using marijuana. During his fourth year in high school, Bob was 16 years of age, he met a girl named Rowena and courted her. Rowena became Bob’s only girlfriend. There was actually a time wherein Bob brought Rowena home, but his mother disapproved of her because she said her teeth looks like rat teeth. This created anger and insecurity in Bob. Later on, Rowena broke up with him for an unknown reason. This break up bagged down Bob’s self esteem. He started isolating himself again and increased his use of marijuana, drinking and smoking. In this stage, Bob is obviously not in control of his life. His decisions were affected by the people around him. Even his role in the society and the people that he chooses to be with are dictated by peer pressure and the ideas of his mother. Bob therefore has role confusion. Entering college at 17, Bob went to the University of Mindanao for Civil Engineering course. However, due to his constant to constant absences and tardiness, Bob’s academic performance trampled. Coupled with his consistent use of marijuana, cigarettes and alcohol, Bob’s life was greatly affected. Behavioral changes emerged, his hostility grown so large that he already fights with teachers and brawls with classmates. He was also called in by the Guidance Counselor regarding his behavior. With this in mind, Bob therefore failed to achieve this stage of development and formed isolation. It was also in this stage that the first onset of the illness happened. Bob was 18 back then when Bob stopped studying, he went back to Agusan with his brother. Prior to going to Agusan, he had a convulsion in a trip to Bukidnon in the August of 1987, there he ate his own stool and drank urine from a potty. First persecutory delusion also emerged there. After the incident, Bob was never the same again. He is already having flight of ideas, disorganized speech, hallucinations and extreme hostility. Because of this and his verbalization that there is something wrong with him, he 67 was brought to Davao City for a psychological chec-up. In San Pedro Hospital, no mental illness was diagnosed, but upon their return the next month and transferred to DMH, Bob was diagnosed with schizophrenia catatonic type. After then, Bob constantly visits DMH for his depot. At first, control of symptoms were at its best, but as the years progressed, he was again admitted in the December of 2007 because of the recurrence of symptoms of hostile behavior. The following admission, which is on the 19th of January 2010 was also due to his hostile behavior. 68 Dinglasan.MENTAL STATUS EXAMINATION INITIAL Name: Bob Age: 40 years old Ward: Crisis Intervention Unit I. B. Activity – The patient’s movement are organized and purposeful during the interview. He has dirty clothing. He was composed and receptive to whatever the group asks him. He moves in a normal pace and does not show any signs of over and under activity. Posture and Gait – The patient slouches when seated but holds himself erect when standing and walking. the patient was alert and responsive. unkempt hair. b. 2009 . MD Date of Examination: January 21. His mannerisms include manually hyper extending his fingers and scratching his head. At the time of the interview. Facial Expression – The patient’s facial expressions are very much appropriate to his verbal responses during the interview. and a pair of slippers and is seated on bed with his mother and sister-in-law. The patient appears to be untidy. PRESENTATION A. c. 69 Diagnosis: Schizophrenia Undifferentiated Physician: Gioia Fe D. he wore a green polo shirt. denim shorts. General Apperance The patient appears to be younger than his real age which is 40. long fingernails and toenails with traces of dirt evidently seen on both. During the interview at Crisis Intervention Unit in Davao Mental Hospital. General Mobility a. we noticed that he is spontaneous most of the time. we apparently observe succession of circumstantiality and tangentiality. in his answers. However. II. He provides an excessive amount of irrelevant detail before finally arriving at the answer. he has a good relationship with his mother and his sister-in-law who were present at that time. 70 . there are times in which blocking is evident in between his speech. Organization of Talk – The patient was eager to talk with the group. the patient’s mood was euthymic. He entertained our questions and answered almost all of them. D. he doesn’t arrive at the answer at all.C. Characteristic of Talk – During our conversation with the patient. He tries to answer every question the group asks him however. He was sitting on bed calmly. Behavior The patient was friendly and warm to us during the interview. He interacts well with the group and as what we had observed. His articulation words were clear but the content is slightly vague. His feelings were appropriate to the situations as he relays his answers to the group. STREAM OF TALK A. III. Mood – At the course of the interview. B. or at times. However. Attitude towards the Examiner The patient accepted the group warmly. his eye contact was poor. He often looks down. EMOTIONAL STATES AND REACTION A. THOUGHT CONTROL A. the group observed manifestations of illusions and hallucinations.His mood was just appropriate and basing from his gestures and other nonverbal cues.” with a smile. “Lipay kaayo ui. “Naa may gahong-hong sa ako usahay na mag wild daw ko. NEUROVEGETATIVE STATE A. hate him because they are jealous of him. Alangan.”. he told us that there are times that he hears someone whispering to him. and confirmed by the mother who witnessed them all. the mother and the sister-in-law attested that during tantrums. the patient claimed that there is some sort of outside force controlling his thought. He denied that he had any visual hallucinations however. he replied. “Unsa may nabati nimu kadtong nagka-uyab mo?”. When asked. Perceptions – Throughout the interview. especially his friends. Sleep The patient usually sleeps at 12 in the midnight and usually wakes up at 5am getting at least 5 hours of sleep. emotional response. Affect – The patient’s affect is appropriate as well. compelling him into the belief that somebody has aa plan to kill him – which is a clear sign of persecutory delusion. He also has a feeling that others. his mood is fitting to the situation. He says that he finds it hard to sleep at night and in71 . First. There is a marked harmony between thought content. V. Delusion – There are several types of delusions that are present in the patient as claimed by the patient himself. IV. When the patient was asked if he experiences any of the two. as claimed by the patient. Kaw gud daw magka uyab. and expressiveness. B. the patient verbalizes that he sees someone whom they cannot see. B. he is unable to do such. basing on the date of the interview. Mga 2008. he just spends his time watching television until he falls asleep. Other times. He eats a lot however. “Ganahan man gud ko mukaon samot na kung lami ang sud-an.stead. “Kusog kaayo mukaon nang bataa na. as the conversation progressed. reported by the patient. “Two months ago. Five in the morning for the patient is too early for him to wake up that is why he attempts to go back to sleep. restless. Appetite The patient has increased appetite. When asked during the interview if what date and time was it.” The group finds this statement confusing since two months ago. pero pili-an lang jud ug sud-an. He is usually fine in the morning and gets. Orientation The patient is well oriented of the time. place and person.”. but then. uneasy. his day starts out worse in the morning and feels better later on. Memory 72 . However. he answered. when did he last used marijuana. he is choosy in his food. C. and irritable as the day progresses. we noticed that he is confused and not well oriented with the time. This is a manifestation of late or terminal insomnia. B. as verbalized by his mother. he answered correctly. VI. B. Diurnal Variation The patient’s mood varies during the day. When asked. The patient is also oriented with the situation since he knows that he is the Davao Mental Hospital for his treatment.”. GENERAL SENSORIUM AND INTELLECTUAL STATUS A. is around November of last year (2009). Abstract Thinking.” VII. Since he was 18. Calculation The patient was given simple mathematical tasks like 1+1. However. INSIGHTS The patient understands that he needs to go to the hospital for his treatment. he knew that there is a problem in him and he even asked his mother to bring him to the doctor. 2-1. He was asked to explain the quote Try and try until you succeed. 6x7 and the like. Judgement and Reasoning The patient was given a maxim translated in Visaya to evaluate his reasoning and abstract thinking. he refused to. 18-7. he does not have concrete understanding of what his illness 73 . General Information The patient knows basic general information like the current president of the Philippines and even of the United States.” On the other hand. Di man na akoa so dapat nako i-uli. When asked what his age when he went to Bukidnon was.” And when asked to elaborate.The patient has difficulty recalling remote memories. He was able to explain it but not profoundly. He replied. He said. D. He know the capital of some Philippine provinces and he was able to name the national hero of the country. “Ambot lang. he replied. C. the patient has a good memory when it comes to remembering recent and immediate memories. E. Wala ko kahinumdom. He was also given a situation wherein someone left her wallet. “Akong i-uli. He was able to answer all of them but there we long pauses before he can finally give the answer. and he was asked what he should do. “Maningkamot gud. He believes that there is a lube (grasa) in his brain that is why he is acting differently.is. he has a fair insight. thus. 74 . b. He was actually getting himself ready to go back to Agusan. PRESENTATION A. He looked happy to see us again for the second time. D. Activity – During the interview. Bob looked younger that his age which is 40. B. Dinglasan. He was properly groomed and looked like he had just taken a bath. MD Place of Interview: 162. Interior Tulip Drive. His fingernails and toenails are still long and dirty.C. General Mobility a. the patient was wearing a blue shirt and denim pants. 75 .FINAL Name: Bob Age: 40 years old Diagnosis: Schizophrenia Undifferentiated Physician: Gioia Fe D. Posture and Gait – The patient still slouches when seated but holds himself erect when standing and walking. He was very calm and composed along the interview. 2009 I. the patient was again warm and yet a little aloof to us. During the interview. There is no overactivity or underactivity nor impulsiveness noted. General Apperance During the home visit the group did. His mannerisms are still present and evident throughout the interview. Again. Date of Examination: January 23. the patient was able to sit straight and fo- cus on answering the questions asked to him. he tries to answer the questions we gave him. 76 . Facial Expression – The patient was able to exhibit appropriate facial expression towards a certain topic. Organization of Talk –Most of his statements were not comprehensible this time. Perceptions – Throughout the interview. Behavior/Attitude towards the examiner The patient was still accommodating to the group but we noticed that he is a little shy this time. He was responding well to the conversation and his mood was appropriate for the discussion. STREAM OF TALK A. C. Circumstantiality and Tangentiality still surfaced during the interview. Affect – The patient’s affect was still appropriate as well. He maintains limited eye contact this time and prefers to look down and do his mannerisms. B. IV. III.c. His attention was still in the conversation though. EMOTIONAL STATES AND REACTION A. Blocking was still evident especially when we bring in the discussion on his use of marijuana. II. Mood – The patient was able to maintain a normal mood all through the home visit. the group did not observe any manifestations of illusions or hallucinations. He still cooperates with the discussion and still. Characteristic of Talk – He speaks in a loud tone and his words were very clear to us. B. He was very calm and composed. His statements jive very well with his facial expressions and gestures. THOUGHT CONTROL A. He seated on one corner and has minimal eye contact. When he was asked why did he say so. NEUROVEGETATIVE STATE A. He was eating his breakfast well and was able to consume a moderate amount of rice and viand. he answered. “Dugay ra ko gaduda ana nila. He did not have any feeling of discomfort or uneasiness during the interview. He believes that his friends were very much jealous of him since his family owns a rice mill.” B. C. “Naa man koy grasa sa utok. Murag gud ug makina. According to his sister-in-law. GENERAL SENSORIUM AND INTELLECTUAL STATUS A. Diurnal Variation It was around 7:30am when we conducted the home visit and so far.B. Madaot. Sleep The patient said that he had a good sleep the night before the interview. he slept at around 11pm and woke up at around 5am. Maka ingon jud ko na na sina ni sila nako kay din a muduol nako. VI. He was also asked about his illness. “Na injectionan man gud ko gahapon mao nang maayo akong tulog. Appetite The patient had a good appetite. he was relaxed and comfortable. Orientation 77 . Delusion –Delusion of paranoia was present. V. He said that he did not have any difficulty sleeping at night.” This is a manifestation of a somatic delusion.” This is a manifestation of delusion of paranoia. ” C. He is aware of the time and the place as well. “Si Noynoy jud akong iboto kay maayo nang tao. Estrada. said with calm emotion by the client. Memory Most of our questions to him were about his adolescent life and we can say that he has difficulty remembering details. He replied “Ambot lang” and “Dili ko sigurado. He said that he would vote for Aquino since his mother was a good example to everyone. D. he insistently an78 . He was them each correctly but with limited words. General Information The patient was asked to enumerate the presidentiables he knows for this upcoming election in May 2010.The patient is well oriented of the time. He was still able to recognize our group after two days of not seeing each other. he was able to answer all of them correctly and quickly. Calculation The patient was given again given mathematical equations. Long pauses before answering indicate that he was trying to retain information for him to come up with the answer. “Pila man imong edad gasugod kag gamit ug marijuana?”. E. Aquino. When asked if he would cheat on a quiz if the teacher is not around.”. The nurse asked. Judgement and Reasoning The patient was given another set of situations and questions to evaluate him. place and person. Still. Abstract Thinking. He was able to name Villar. B. He was asked to tell the group the meaning of certain idiomatic expressions like parang basing sisiw. and Gordon. liwat sa iyang mama. “Dili mana maayo nang manikas ka. Delusions were more evident this time. With these statements. are helpful to him. which the doctor prohibited. we can say that he has a poor insight. Maski wala pa gatan-aw ang teacher. gatan-aw man ang Ginoo. Manifestation This time. VII.swered NO. 79 . He also insists that his vices especially smoking and drinking Coke.” He explained. he insists his false belief that marijuana is not harmful to him and even claimed that it is therapeutic for him. INSIGHTS The patient still had the same understanding of his illness. People with schizotypal personality disorder often have trouble engaging with others and appear emotionally distant. and reduced capacity for. and experience extreme anxiety in social situations. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with. and disorganized thought processes and behavior. as indicated by five or more of the following: 1. and beliefs. Axis II Schizotypal Personality Disorder Schizotypal personality disorder. These people tend to turn inward rather than interact with others. or simply schizotypal disorder. Ideas of reference (excluding delusions of reference) 80 . and eventually develop distorted perceptions about how interpersonal relationships form. and often unconventional beliefs. Mary Ann Boyd. hallucinations. 2007) Individuals with schizotypal personality disorder have odd thoughts. perceptions. 2003). close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. Diagnostic criteria fort 301. (Psychiatric Nursing: contemporary practice. odd behavior and thinking.Schizophrenia Undifferentiated This type of schizophrenia is manifested by pronounced delusions. but criteria for other types of schizophrenia are not met (Antai-Otong.22 Schizotypal Personality Disorder A. by beginning by early adulthood and present in a variety of contexts. affects. They find their social isolation painful. is a personality disorder that is characterized by a need for social isolation.MULTIAXIAL ASSESSMENT Axis I. superstitiousness. “Schizotypal Personality Disorder (Premorbid) 6÷10 ×100 =60% Axis III. another Psychotic Disorder.g. or “sixth sense in children and adolescents. including bodily illusions 4. overelaborate.inability to go back to school.g. behavior or appearance that is odd. unusual perceptual experiences. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. The reason for stopping school 81 .. add “Premorbid.2.Axis 3 is not applicable to the client. He was a 2nd-year undergraduate at the University of Mindanao with a course of Civil Engineering. metaphorical. circumstantial. belief in clairvoyance. bizarre fantasies or preoccupations) 3. unemployment Napoleon was unable to finish his schooling.. Axis IV.. Does not occur exclusively during the course of Schizophrenia. inappropriate or constricted affect 7.g. lack of close friends or confidants other than first-degree relatives 9. or stereotyped) 5. odd thinking and speech (e.” e. or a Pervasive Developmental Disorder       Note: If criteria are met prior to the onset of Schizophrenia. eccentric or peculiar 8. vague. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e. suspiciousness or paranoid ideation 6. a Mood Disorder with Psychotic Features. telepathy. was due o the onset of his illness. he doesn’t arrive at the answer at all. b) Final Assessment (51-60) Moderate symptoms or moderate difficulty in social. or school functioning. The patient is currently living with his parents and depends on them for his basic needs. The patient’s educational attainment also made him unable to land a job.Global Assessment of Functioning a) Initial Assessment (51-60) Moderate symptoms or moderate difficulty in social. he finds it hard to sleep at night. Axis V. he has not landed a permanent job and is currently unemployed. or at times. According to Bob. 82 . occupational. circumstantiality and tangentiality is still noted in his speech. During the final assessment. or school functioning. he is quite withdrawn to people around him like the workers of his parents’ business. he has very few friends. He usually sleeps at around 12am and wakes around 5am. occupational. Also. As a result of the patient’s mental illness. According to the patient. He was also quite aloof to the group. Circumstantial and tangential speech is also noted since he provides an excessive amount of irrelevant detail before finally arriving at the answer. when the interview and assessment was being conducted. 430 curiosity at Ok ra man. broad P: Exhibits boredom over his openings may stimulate him or her 83 establish a muuli. of Nursing by smile and pangutana? nars sa Ateneo uses hand Davao gestures to University. Ok ra ba nimu? Kumusta imong man Looks the purpose of acknowledges the nurses with a Fundamentals the interview smile and shows interest and Kozier. For the client who is and share hesitant about talking. down ko Tries to open up a Broad openings make explicit that ka? Unsa man the patient lang kaayo akong and pamati and smiles Starts karong adlawa? to Gusto looks conversation by using questions the client has the lead in the that encourages patient to talk interaction.NURSE-PATIENT INTERACTION Name: Bob Age: 40 years old Ward: Crisis Intervention Unit Diagnosis: Schizophrenia Undifferentiated Physician: Gioia Fe D. B. p. . Dinglasan. Laay Scratches head N: paminaw na dire. Unsa diay student nurses family a warm greeting to create presence as well as creating a good Looks curious establish a good rapport asking Patient: disposition. Naa introduce lang miy pipila the group ka pangutana sa members imo. 2009 – 1:40 pm FIRST NURSE-PATIENT INTERACTION NURSE Verbal Maayong buntag! diay estudyanteng de PATIENT INTERPRETATION ANALYSIS acknowledge knowing client’s client’s Nonverbal Verbal Nonverbal Greets the Maayong buntag Looks at the Nurse: Gives the patient and his Greetings mga with a inyong and smiles upon a positive atmosphere Greets and start back and Kami patient pud. MD Date: January 21. This can help his own illness patient be examine better If the issue if N: Reports understanding that he morefully. It is also used meaningful or vague. information P: His change of know more about client’s feelings. Naa Makes an eye N: Attempt to evaluate patient’s Exploring is delving further into a may hong gahong. dire? Magpatambal man ko. Psychiatric Mental Health Nursing the patient communicates his interest to to make clear that which is not participate in the conversation Ah. commanding in nature. Tapos naa na pud doctor nga balik 84 . the nurse must respect his or her wishes. Changes into a N: Asks a question to seek viable Seeking information is used to Pero pirmi man comfortable mi dire sige balik sitting position balik. Mental Health and Psychiatric Nursing by Ann Isaacs p.197 Auditory hallucinations are false sensory impression heard by the patient. mga sa injection nang pangutana balik.good rapport hospital stay and expresses wish to take the initiative.contact sa ako the nurse with understanding and perception of subject or idea. Kabalo pd Continues ka nganong naa to ka diri karon ug maintain kung by Frisch p 185 Kabalo ui. unwillingness to share. patient expresses ngano eye contact usahay na mag gabalik balik mo wild daw ko. Any problem or concern needs to be treated and evaluated can once in a while by a doctor understood explored. to go home Psychiatric Mental Health Nursing by Frisch p 185 Kanus-a pa man Looks diay ka diri? at Tulo na kaadlaw. position thoughts and ideas. Pa ba. usually. 197 lubricant. naa down again Ngano? closer Unsa diay sakit the patient ingon man ka na the patient imong utok? Basta hyperextending the discussion into a single topic repetitive manner mulain na akong his fingers in a P: Verbalizes his thought about topics or cues given by the client.Mental Health and Psychiatric Magpatambal ka? nimu? Moves Nursing by Ann Isaacs p. N Ngano naay naka Looks grasa at Mailhan nako. what he believes towards his The nurse encourages the client to illness.112-113 N: Attempts to focus and bring in Focusing is concentrating on a single point.197 O. Murag gud ug makina. or invite the client to P: Explains his understanding of explain. mannerisms. Purpose is to help nurse to what the patient has said. Magpatambal Scratches head N: Repeats the statement made Clarification is putting into words to ko. understand. vague ideas or unclear thoughts of Asks further questions to delve in the client. Starts to show his concentrate his energies on a sing le point. Psychiatric Nursing by Keltner. kaylangan looks by the client to seek clarification. his illness. paminaw. which may prevent a multitude of factors or problems from overwhelming the client. Patient has a false idea Mental Health and Psychiatric that his brain had some sort of a Nursing by Ann Isaacs p. Kunga ayuhon. His belief that there is a lube (grasa) in his brain is a manifestation of Somatic delusion. Kani man gud and niy grasa. This type of delusion is a false notion or belief concerning body image or body function. maguba. Picking up on central akong utok. man Manually Chap 9 pp. 85 . N Unya. buhaton the patient tuohan man nako and bitaw ug tinuod. Scratching his head is be better understood if explored. Any problem or concern can saying. perspective. 86 . and he might be less likely to take action on ideas that are harmful or frightening.197 N: Asks question to open and Encouraging description of the patient hung sa ako nga hyperextending explore a certain topic. share. the nurse pause in between his lines is a must see things from client’s manifestation of blocking speech. repetitive (pause) manner perceptions is asking the client to mag wild daw ko his fingers in a P: Retells what he experiences verbalize what he or she perceives. Psychiatric Nursing by Keltner.Mental Health and Psychiatric Unsa diay imung Looks mga gipangbati? at Naay mag hung Manually Nursing by Ann Isaacs p. The To understand the client. whenever his illness recurs. This can help P: Patient has the tendency to patient examine the issue more heed to whatever this stimulus is fully. If another mannerism evident in the patient expresses unwillingness to patient.197 pud kay mu ana nga patyon daw ko sa usa ka tao. unsa pud Looks imung anang ga hung and hung nimo? hand gestures to convey message at Usahay uses kay mura kay Looks pud head Chap 9 p 233 down N: Evaluates how the patient Exploring is delving further into a scratches reacts to such stimulus subject or idea. Mental Health and Psychiatric Nursing by Ann Isaacs p. Encouraging the client to describe fully may relieve the tension the client is feeling. ug Usahay maglagot. the nurse must respect his or her wishes. Nikalit Looks at the N: Tries to stimulate the patient Seeking information is used to ra man ni. Kamaguwangan (pause) man ko. Looks at his N: Assesses patients relationship Focusing is concentrating on a and towards his family at the tone of voice his family The pause in is between again.197 Blocking is usually caused by affectively delusional preoccupations. Pero nurse kabalo ko na naay jud lain mao to gusto pd ko padoktor. Suod ming Emman. It is also used present illness. significant event which he thinks Psychiatric Mental Health Nursing is a contributing factor. which may prevent a his multitude of factors or problems a from overwhelming the client. Picking up on central The nurse encourages the client to le point. Ah! Kung mag Looks away mo Chap 9 p 233 at Wala uy! Okay Looks at the N: Asks question to look at the General leads indicate that the kaayo among nurse with a current topic being discussed for nurse is listening and following sa the patient 87 . Okay ra to recall past events of his life know more about client’s feelings. akong manghud. Samot na ni smiles looks mga mama ug papa? presents a mama. that could have contributed to his thoughts and ideas.Panan-aw nimu. Mental Health and Psychiatric Nursing by Ann Isaacs p. to make clear that which is not P: Patient cannot remember any meaningful or vague. statement single point. Psychiatric Nursing by Keltner. Tells the nurse how close he is to concentrate his energies on a sing relasyon eye contact Palangga man ko mother nila. Kadtong nagsunod sa ako. by Frisch p 185 man. Continues nganong nasakit eye cotact man ka? Naay ba kay mahinumduman ngano nagka ingon ana ka? Ah… Kumusta Maintains man nimo sa imong and Imung igsuon? mga conveying hand gesture Wala man. or then P: Expresses seriousness in his topics or cues given by the client. Suod pud mi sa nurse again manifestation of blocking speech. N charged thoughts topics. irrelevant data before answering amount of irrelevant details before sa ilang mga dula.191 N: Commends the patient for the Giving recognition good insight given. of voice tone. N interested his speech on as the he topic. Dula Scratches head is nang eye contact dula. Nursing by Ann Isaacs p. daghan ba kag kadula? sa balay. Naa gud.imung isgsuon imong ug mga sa mga pamilya. show that the patient is not Psychiatric Nursing by Keltner. This helps elevate client’s self P: Expresses gloom through fall esteem. naka sinakitay mo? Tama Maayo ingon pud no.197 is a therapeutic using Kadtong bata pa ba ka. his fingers in a P: Restricted facial expression open-ended questions to achieve and inconsistency of eye contact relevance and depth discussion. what the client is saying without Seeks interaction. Manually N: Uses open-ended questions to Questioning kaayo hyperextending allow patient to explain communication technique magdagan dagan. Blocking of speech Mental Health and Psychiatric is evident. Nganong di man Sits on bed Dagan pud malingaw? ka and maintains Lami dagan. I-agi ra face that tries further assessment gud sa storya. They also encourage P: Strongly denies any presence taking away the initiative for the affirmation from the nurse by the client to continue if he is asking “Diba”. Chap 9 p 93 provides the patient provides and excessive Circumstantiality is evident on If in response to a direct question. Pero di man ko malingaw sa ilang mga (pause) dulay usahay mao nang ako na lang isa madula sulod indicating Assess the patient’s childhood to appraisal to the client’s actions. hesitant or uncomfortable about the topic. eye contact Dili ko ganahan repetitive 88 . Samukan ko. Di to convince man diba? kinhanglan magsinakitay of domestic violence. Maintains ana. Mental Health and Psychiatric Nursing by Ann Isaacs p. get viable information acknowledging and ginikanan. manner Daghan kaayo sila. If patient expresses unwillingness to share. Uses bugoy talks Bisyo Chap 9 p 113 hand N: Changes the topic since the Questioning is started to exhibit communication disinterest in the conversation a therapeutic using Barkada barkada. bisyo. Ana lang gud. chiks chiks. man pag Looks the Ok ug patient Bugoy kadali. gestures as he patient technique open-ended questions to achieve P: Is interested again in the relevance and depth discussion. Ganahan Looks patient Nursing by Ann Isaacs p. the nurse must respect his or her wishes. finally answering the question. Picking up on central diay kag Coke? 89 . Looks up at the N: Focuses the topic on a Focusing is concentrating on a Kadtong New ceiling particular subject single point. This can help P: Blocking is evident in his fully. Sigarilyo ug Coke Does his finger N: ganahan. Psychiatric Nursing by Keltner.the question. Mental Health and Psychiatric Mura ra ug ordinaryong Bisyo? Unsa pud Maintains na nga bisyo? studyante. N rises and as he gestured while Chap 9 p 93 talking Tries to explore and Exploring is delving further into a patient examine the issue more be better understood if explored. the condition circumstantiality. conversation as his vocal tone Psychiatric Nursing by Keltner.again vices eye contact jud ako (pause) mannerisms inom. gud ra gud. encourage the patient to recall his subject or idea. N is called Kadtong elementary kumusta imong skwela? high school ka. Any problem or concern can speech as he enumerates his vices Ah. inom.197 at Ganahan mo lang. 197 Wala nitisting pud ka Maintains Droga??? Shabu? Looks ui. Kami tanan sa among barkada ana. head mana di Marijuana Pero droga. Mental Health and Psychiatric Nursing by Ann Isaacs p. down N: Explores for anang eye contact Wala scratches significant details an prohibited and dangerous drug droga droga? P: has a delusion marijuana is not thoughts and ideas. which may prevent a multitude of factors or problems from overwhelming the client. Boring man gud maghulat ug alas dose. and nuon.197 further Seeking information is used to know more about client’s feelings.Year. kanus-a facial keeping an gagamit with Unsa patient diay Looks eye contact Ganahan man gud ko sa feeling ba. P: Retells a particular event topics or cues given by the client. peers and their marijuana use was This restatement lets the client brought in know that he or she communicated the idea effectively. Kadtong Smirks high school pa ko. Uso mana didto sa agro. concentrate his energies on a sing le point. It is also used Nagagamit marijuana? Sukad pa? kag Conveys curious expression while Oo ui. Mental Health and Psychiatric Nursing by Ann Isaacs p. to make clear that which is not meaningful or vague. at Lami kaayo sa Smiles and N: Seeks significant information Exploring is delving further into a 90 . where his craving for Coke was The nurse encourages the client to evident. Psychiatric Mental Health Nursing by Frisch p 185 N: Uses restatement to verify The nurse repeats what the client acquired information has said in approximately or nearly P: Smiked when the topic on his the same words the client has used. halos isa ka case ako nahurot. Mental Health and Psychiatric Nursing by Ann Isaacs p. Mura looks kag galutaw sa nurse hangin pero. Mag sige lang kag katawa. Walay problema. Mental Health and Psychiatric Nursing by Ann Isaacs p. at Dili mana Shakes makadaot. the nurse marijuana use is not good neither can indicate what is real. Any problem or concern can be better understood if explored. ra Tistingi gud. Si bahin head N: Gives information and When it is obvious that the client is ng the patient and frowns presents reality to patient that misinterpreting reality. looks discussed to get more information subject or idea.mabati-an nimu the patient kung mugamit ka ana? paminaw ui. Scratches head N: Explores on the kung the patient Pero di man ko and mutuo niya. The nurse beneficial shook his head and frowned does this by calmly and quietly or the facts not by way of arguing with the client or belittling h is experience. This can help P: Insists his belief that marijuana patient examine the issue more is not harmful fully.197 91 . at Muhilom lang. enjoys marijuana Mental Health and Psychiatric Nursing by Ann Isaacs p. This can help patient patient examine the issue more P: Shows elated response as he fully. Any problem or concern can smiles and verbalized how he be better understood if explored. sige pa ko man gani na. kasab-an daw maayo. at the on the effect of marijuana to the subject or idea.199 topic Exploring is delving further into a P: Shows disagreement as he expressing the nurse’s perceptions ana kay di lage Unsa pud imu Looks ginabuhat kasab-an ka sa imong mama.197 Kabalo ba kang Looks makadaot marijuana imo? sa maganahan ka. Wa down man ko nadaot. Makatambal mama. If he thinks that his food is poisoned. paying special attention to his nutritional status. or offer him foods ang pagkaon ba. Looking down could indicate disappointment. Mental Health and Psychiatric Nursing by Ann Isaacs p. pagsabot sa try and try until you succeed? musundog nako. Encouraging the client P: Provided irrelevant answers to describe fully may relieve the and never arrived to the real tension the client is feeling.Panan-aw nimu? Stands up Ang Dili kaha mao from nang ka? rason sitting Continues to maintain eye contact nganong nasakit position ganina. the nurse looks on how marijuana affected his must see things from client’s illness perspective. imo Dapat muundang skwela. Bob. dili N: Evaluates the abstract thinking of the patient of the client P: Uses self as example. Monitor his weight if he isn't eating. nikaon. N Chap 9 p 93 1.192 Tangentiality is when patient gets lost in unnecessary and irrelevant details and never answers the question. 92 . Assess the patient's ability to carry out the activities of daily living. Has concrete understanding of the the quotation given. allow him to fix his own food when possible. on ideas that are harmful or frightening. and he answer – a manifestation of might be less likely to take action tangentiality. dapat skwela maabot pangarap Dapat ka dili Looks down ug Sige ug para ang ba. Psychiatric Nursing by Keltner. babae Shakes wala and Sayang down head N: Assesses patient’s perception To understand the client. naa koy ipa Smiles explain Unsa nimu. Administer medication to decrease symptoms and anxiety. Meet the patient's needs. Reward positive behav93 . Don't avoid or overwhelm him. 4.2. 3. Keep in mind that short. If you give liquid medication in a unit-dose container. Use physical restraints according to your facility's policy to ensure the patient's safety and that of others. minimizing stimuli. allow the patient to open the container. but only do for the patient what he can't do for himself. 5. Adopt an accepting and consistent approach with the patient. repeated contacts are best until trust has been established. Maintain a safe environment. in closed containers that he can open. Avoid promoting dependence. determine if they're command hallucinations that place the patient or oth94 . If he has auditory hallucinations. outpatient day care. If necessary. Provide reality-based explanations for distorted body images or hypochondriacal complaints.ior to help the patient improve his level of functioning. and sheltered workshops. or neologisms. set limits on inappropriate behavior. Clarify private language. Engage the patient in reality-oriented activities that involve human contact: inpatient social skills training groups. explaining to the patient that what he says isn't understood by others. explore the content of the hallucinations. autistic inventions. 7. 6. If the patient is hallucinating. Tell the patient you don't hear the voices but you know they're real to him. That procedure will be done on the floor. If necessary. if possible. change the subject. 9. clearly explain to him. thinking he is being told to lie down on the floor. Don't tease or joke with the patient. For example. may become frightened. For instance. Avoid arguing about the hallucinations. Don't touch the patient without telling him first exactly what you're going to do. Choose words and phrases that are unambiguous and clearly understood. I'm going to put this cuff on your arm so I can take your blood pressure. postpone procedures that require physical contact 95 .ers at risk. a patient who's told. 8. Mobilize community resources to provide a support system for the patient and reduce his vulnerability to stress. 10. and malignant neuroleptic 96 . including drug-induced parkinsonism. tardive dyskinesia. Ongoing support is essential to his mastery of social skills. Encourage compliance with the medication regimen to prevent relapse. Also monitor the patient carefully for adverse effects of drug therapy. akathisia. Remember. institutionalization may produce new symptoms and handicaps in the patient that aren't part of his diagnosed illness. 12.with facility personnel until the patient is less suspicious or agitated. acute dystonia. so evaluate symptoms carefully. 11. positively to nurse’s statement 97 . waves hand Adto mog balay ha? Kita kita ta didto Sabado. N Chap 9 p 93 Testing the abstract thinking ability is a test to note the congruence between the patient’s economic status and his abstracting abilities. p 470 na pd ta.194 and N: Terminates the conversation The nurse gives recognition in a and orients patient on the nonjudgmental way. B. Psychiatric Nursing by Keltner. Shows gratitude to patient for the Kozier.syndrome. Smiles Nursing by Ann Isaacs p. Sige sige. P: Shows understanding by and cooperation responding throughout who was accommodating to the participation Fundamentals cooperation Nursing by the during the whole interview. The nurse then terminates the the interaction client and of for by his scheduled meeting Okay ra kaayo ui. Ayos ba na? Salamat sa imung panahon. sa panahon. Bisitahun ra ka namu inyong karong para unya sa balay Sabado magstorya Aw. Make sure you document and report such effects promptly. Mental Health and Psychiatric Diay ba? Dire Taps lang sa mi kutob patient’s sa among back pagpangutana. karong Salamat inyong Recognizes effort of the patient thanking group conversation time he and his family spared for us. 2009 – 7:30 pm NURSE PATIENT INTERPRETATION ANALYSIS Verbal Nonverbal Verbal Nonverbal Maayong buntag Smiles and Nindot kaayo ang Stares blankly Nurse: Greets the patient to The nurse greets the patient Bob! Kumusta man looks at the adlaw. Broad openings lead or invite the Open-ended manglaba karon kay down Patient: Able to answer the client to explore thoughts or question but circumstantiality is feelings. Circumstantiality is when in a response to a direct question. Nakatulog man kog tarong. Davao City (Patient’s City Address) Date: January 23. Ok lang man. Lami and looks create a positive environment and upon seeing each other and establish conversation opening. noted. Interior Tulip Drive. 98 . Sayo sayo gani ko kamata. rapport. ang imong tulog patient kagabii? init. evident and poor eye contact was questions specify only the topic to be discussed and invite answers that are longer than one or two words. using a Starts uses broad openings to start broad their conversation.SECOND NURSE-PATIENT INTERACTION Place of Interview: 162. the patient provides amount an of excessive irrelevant detail before finally answering the question. high and certain topic. feelings regarding his stay in the Acknowledgment hospital. B. with nonverbal. in a look nonjudgmental way. Fundamentals of or understanding.Kozier. Maayo. Kadtong P: Shares his experiences and relevance previous discussion (not closed/yes-no relationship in a comical manner. 470. Fundamentals of Nursing. The nurse ask Irrelevant details are provided questions to explore and gain before arriving to answer – a information from a new topic. Kozier. Chapter 26. school pa ko. Kani? Mubalik Touches na man gud ming and smiles mama sa Agusan. an effort to may verbal a be or and the client has made. Mao Smiles pud diay sayo ka nakaligo no? Asa diay ka muadto ron? Nindot man lage kag suot? Aw. shirt N: Acknowledges patient’s effort Giving to P: groom Shows self and presentable during the interview. Diay ba? Abi nako Smiles and Ang among bugasan Looks at the N: Asks a question to explore a Questioning uses open-ended naay kay pormahan establishes karong adlawa? eye contact Nagkauyab ba ka? sa Oo. p. Pero dili naman mi uyab 99 . without Nursing. questions). Gikapoy na man gud ko didto sa hospital ba. Excited na gani ko. Ah. B. Chapter 26. excitement while enthusiasm recognition. opinions about his questions to and achieve depth in kaayo ug kita. of a change in behavior. or a conversing contribution with the nurse and expresses his communication. Agusan Ka-usa kusog nurse smiles ra. 469. p. et. 5th Edition. al. Patient is trying to stating the main concerns relationship lasted. 93. and N: Inquires about the history on Questioning uses open-ended how the relationship with her questions former girlfriend started. man Pangit gud na siya. 470. irrelevant detail before finally answering the question. experience remember with how a long topic of importance. Chapter 26. of Circumstantiality is when in a response to a direct question. Nursing. Ni ngisi ra pud kog balik. amusing manner as relevance he questions). Pero wa ni abot ug tuig. Psychiatric Nursing. Kozier. specified more information and look into expand on and develop a his past experiences. Ah. Kadto siya? Si Points finger at N: Focuses on the topic to gather Focusing is helping the client Rowena. The focus may be an idea or feeling. manifestation circumstantiality. Mga pipila ka bulan. Dugay dugay pud. Naka crush siguro ba. Taga dinha the Namalhin na man siguro to sila. It is former wait until the client finishes their before attempting to focus. Chapter Unsa may pangalan Maintains ato? Nagdugay pud eye contact mo ato? 7. ra man to sa una oh! direction ngisi ra man to siya scratches head P: Narrates their story in an discussion (not closed/yes-no The nurse 100 . B. p. Fundamentals of Ah! Gi unsa nimu Smiles pagka uyab sa iya? Gi ligawan pa ba nimu siya? Wala na uy! Ning Giggles nako. p. to and achieve depth in P: Shares information about his important for the nurse to girlfriend.karon. the patient provides amount an of excessive Ngipon niya murag ngipon sa ilaga. Keltner. 473. 93. al. Chapter on 7. Pero sa edad nimu Conveys ron. Psychiatric Nursing. remembered between them. Pero kataw. 93. ni-una. Wala na Laughs diay kaayo ka no continues to man ka yang babae man look at the nagustuhan. B. 5th Edition.Mao to. et. gives a positive recognition as P: Shares to the nurse his lack of a response to the patient’s interest in having a relationship statement. family about his decision of Kozier. feelings on the previous topic by asking and behaviors and the nurse questions. Pagkahuman na uyab? sa iya? Wala na kay patient koy continues 7. gusto pa ka more magminyo? serious facial expression a Gusto man uy! gani Gusto Manually N: Explores nako hyperextending perceptions and thoughts about explore thoughts and feelings among his fingers in a getting married at his age. nonverbal to verbal and communications. Chapter 26. Psychiatric Nursing. p. The nurse married and his intention of tries to assess the client’s marrying their helper. patient’s The nurse assists the client to and acquires understanding women. what happened questions or inquires about the client’s past history. Keltner.Gwapo Laughs and Wala na. et. The nurse then resumes focusing patterns of thinking. and his perceptions about Keltner. Chapter Kuyawa ba. Uyab na dayon mi. Bati ug nawong. Fundamentals of marrying their helper. 5th Edition. Mga scratch head pangit na man ang uban uy. minyoon katabang pangit. p. Nursing. al. 101 . p.manner an ra man ko nila man pag ako silang ingnon. Patient perceptions to the questions tells the nurse the reaction of his asked. bahalag repetitive P: States his interest in getting from the client. and N: Actively listens to client and Active listening pays close to compliments on his physical attention attributes by giving recognition. Chapter 26. Kozier. and N: Clarifies the patient’s Clarification is a method o meaning of the more statement on his objective of making the client’s broad marrying their helper. The nurse still to explore on the magkita na pud mo barkada? P: Shares insights about his tries his views about them.nurse panabis. Di na jud siguro ko maminyo ani. B. 473. nako. The focus may be an idea or Sigeg scratches head patient’s feelings towards his topic friends. karong Looks at the Ambot ato nila ui. B. Wala looks down na may lain. Pero di man musugot si mama. Fundamentals of Nursing. p. To clarify the noticeable desperation. gyud Looks at the N: Focuses on the topic and seeks Focusing is helping the client and an understanding from the expand on and develop a of importance. p. overall according to him is unattractive. Sige silag tan. Unya Bob. Giunsa pagkabalo nimu Maintains nga eye contact Mabati-an aw nako. Looks at the N: Shifts topic to explore on The nurse assists the client to pag-uli sa imong nimu. Chapter 26. message P: Replies to question with understandable. patient mga Nasina man to sila nurse nako kay ako tig operate sa rice mill unya sila kay driver lang. another subject that may have explore thoughts and feelings significance illness. the nurse can restate that he is no longer interested the basic message or confess with the topic. Shows message. Smiles Kadto na lang. even if. Kozier. Di na ko nasina sila nimu? 102 . with his mental and acquires understanding from the client. 470.Ngano gusto man Maintains pud nimu minyoon eye contact inyo katabang nga pangitan man diay ka? Wala namay lain. Di na lang ko muduol nila kay lain naman sila. friends back in his hometown and patient’s perceptions on the question asked. Fundamentals of Nursing. confusion and ask the client to repeat or restate the message. away N: Seeks more information. Kozier. et. Fundamentals of according to his observations. on the topic. about his friends. relevance and depth in P: Responded according to what discussion (not closed/yes-no he felt and from his viewpoint questions). 470. 93. by The nurse seeks informing by shakes topic. Wala nila pud ka Maintains unya Wala na uy! Klaro Looks na lain jud ilang and buot sa ako. Chapter 26.ganahan nila. al. Circumstantiality is when in a response to a direct question. P: Answers accordingly from the meaning or importance of appropriate behavior. answering the I-uli. the patient provides an excessive amount of irrelevant detail before finally question. Dili man 103 . 5th Edition. mustorya P: Relates his thoughts and feeling. Bahala head gud sila. B. pitaka Looks at the N: Evaluates patient’s judgment Encouraging evaluation asks from the given situation. Nursing. kung kita ka Looks at the Daghan ug Unsa pitaka. nurse Alangan. p. 7. Questioning uses openunderstand his situation with his ended questions to achieve friends. from the patient to further topic. man unya patient imu nabilin sa tag-iya. The nurse then seeks feelings about his friends and understanding after focusing how they respond to him. Psychiatric was observed when asked to Nursing. Lack of interest Keltner. baligya sa gawas ba. approach his friends. given situation that for patient’s views of the showed something. p. Chapter nitisting ug duol eye contact mangutana? na kaayo sa TB TB from the nurse asking questions regarding the asking questions about the Bob. buhaton? Akong na ako. 5th Edition. al. Encouraging ako. na Dili uy. na. p. or understanding. P: Responded from to the their irrelevant or a contribution to a be or nurse communication. Chapter Dili pud kaha nimu Maintains kuhaon? Kwarta na eye contact gud Makatabang nimu. kawatan kung nako usahay dira sa nurse silingan. Kung wala koy and looks at judgment evaluation asks for patient’s of something. respond from it. 93. Samot na gabii. differs from circumstantiality in that the patient gets lost in unnecessary and irrelevant detail and never directly 104 . head N: Further evaluates patient’s The nurse is trying to evaluate from the given on the client’s judgment situation and how he would further. Psychiatric Nursing. et. al. situation. 93. Masakpan pa gani Provides reinforcement to the patient’s on the client’s behavior and positive behavior in the given an effort the client has made. a correct behavior from the given Keltner. Acknowledgment with nonverbal. Dili jud nako na hilabtan. 5th Edition. topic. may verbal without Tangentiality Tangentiality was noted. et.Keltner. magayo ra the nurse gud ko. P: Explained his intention of views of the meaning or returning the money that showed importance situation. Psychiatric Nursing. 7. p. Chapter 7. Dili man na Shakes kwarta. affirmative The nurse gives recognition Wow! Maayo no Smiles and Daghan kaayo ug Looks at the N: kay i-uli jud nimu maintains ang pitaka eye contact magkina-unsa man. Chapter 6. Relates it to his uses open-ended questions to reason of taking up his course. 470. Gikapoy na pud ko Sige mo Bob. P: Answered most of well as exploring on the the client’s ability to solve paborito nimu nga patient calculations asked to him to solve mathematical solutions. Ahmm.answers the question. 48! 5 (pause) 97? Paborito Smiles and Sige. 33. Chapter 26. 93. 1+1? 7+2? 40-7? 6x8? 25/5? 100-7? Tama! math. Fundamentals of Bob. Kay excited na Smiles pud ko muuli. ba Looks at the Math. et. Grabe pud. solve. p. The and shows acknowledgment by nurse then terminates the giving recognition. Keltner. Si papa lang man gud isa sa balay. P: Answered appropriately to the in a new topic.. Kozier. and N: Evaluates the client’s skill in The nurse is evaluating as the calculation. Mao ganing Looks at the N: Asks a question to explore on The nurse asks a new nag Civil nurse smiles and a new topic. achieve relevance and depth in discussion (not closed/yesno questions). Psychiatric-Mental questions that were quite hard to Health Nursing. p. Questioning question asked. eye contact kay Laughs looks ceiling at 7. patient 9. al. N: Provides a positive feedback The nurse gives recognition to the client’s skill in calculation in a nonjudgmental way. Chapter Sige daw bi.107. 5th Edition. question to the client to delve Engineering ko. jud Moves closer to the 2 uy. Establishes interaction by thanking the information that the nurse is client for his participation and nimu siguro ang maintains Murag mulakaw na 105 . on his own. Psychiatric Nursing. p. subject? unsa Nursing. B. Took time answering Videbeck. Salamat pud sa pag storya storya nako. 470. nurse-client Kozier. Mulakaw na lang pud mi ug una. leaving and wishes him well cooperation during the whole upon their next encounter. Pamansin ha? 106 . P: Responds appropriately and shows an eagerness to go back home and see his father. p. Fundamentals of Nursing. Terminates relationship. interview. B. Chapter 26.naghulat Mama na si dire. nimu. Salamat! Hangtod sa atong sunod na pagkita. 107 . and by deterioration in psychosocial functioning. depending on when the disorder manifests itself and if symptoms of the schizophrenia are compounded by a person’s use of alcohol or other substance (Brunette and Drake. disorganized speech. and avolition (APA. Australia. 1998). Schizophrenia is a disorder associated with a variety of a complex combination of symptoms. delusions). including hallucinations. Persons experiencing an earlier onset of schizophrenia usually have more problems with movement from adolescence into adulthood and development of inappropriate social relationships and interactions. 351). Psychiatric Nursing: Biological and behavioural concepts (p. Deborah Antai-Otong. 347).3rd Edition (1999) Philippines: C&E Publishing Inc. disorganization. thought disorders. 2000. withdrawal from society. etc. flat affect. schizophrenia is one of the most profoundly disabling illnesses. Bleuler. hallucinations. Refers to a group of psychotic disorders in which there are certain characteristic disorders like disturbances in reality testing. it is characterized by a deteriorating personality. Psychiatric Nursing (p. delusions. It is not characterized by a changing personality. alogia. mental or physical.DEFINITION OF COMPLETE DIAGNOSIS SCHIZOPHRENIA UNDIFFERENTIATED SCHIZOPHRENIA Schizophrenia is one of the most common causes of psychosis. It is a diagnostic term used by mental health professional to describe a major psychotic disorder. It is characterized by disturbances in thought and sensory perception (hallucinations.The course of the disease may be different for each person. Clifton Park. al. 1950). Keltner. et. 108 . NY: Thomson/ Delmar Learning (2003). Simply. delusions. people with schizophrenia may withdraw from the outside world or act out in confusion and fear. Australia. Abnormal Psychology (p. and disorganized thought processes and behavior. Phils. schizophrenia makes it difficult—even frightening—to negotiate the activities of daily life. believe that others are trying to harm them. Psychiatric Nursing: Biological and behavioural concepts (p. perception and mood. or feel like they’re being constantly watched. In response. With such a blurred line between the real and the imaginary.” Schizophrenia ranges from mild to intense. RMSIA Publishing. and sees the world. It is most closely approximate what most of us think as “craziness. 109 . often a significantloss of contact with reality. (2004) UNDIFFERENTIATED TYPE Undifferentiated schizophrenia is manifested by pronounced delusions. Jafar Mahmud. Deborah Antai-Otong. Psychiatric Nursing: A Textbook and A Reviewer (p. speak in strange or confusing ways.Schizophrenia is a major mental disorder having a characteristic set of symptoms. hallucinations. 231). thinks. (2002) Schizophrenia is a brain disorder that affects the way a person acts. APH Publishing Corp. Clifton Park. Maria Loreto Evangelist-Sia. They may see or hear things that don’t exist. 186). by bizarre behaviour and by social withdrawal. 348). It is the label given to a group of psychoses in which deterioration of functioning is marked by severe distortion of thought. Quezon City. People with schizophrenia have an altered perception of reality. NY: Thomson/ Delmar Learning (2003). Mosby Inc. 406). Quezon City. 188). APH Publishing Corp. Louis. Clients with diagnosis of undifferentiated schizophrenia display forbid psychotic symptoms (delusions. 4th Edition. disorganized behavior) that do not clearly fit under any other category. Abnormal Psychology (p. Psychiatric Nursing: A Textbook and A Reviewer (p. Phils. (2004) 110 . 113). St. incoherence. RMSIA Publishing. Hobeken. Missouri.Subtype in which the clients clearly meet the general criteria of schizophrenia. yet do not fit into any of the other three subtypes. (2002) This type is characterized by some symptoms seen in all of the other types but not enough of any one of them to define it a particular type of schizophrenia. N.: Wiley (2005). 231). James Hansen & Lisa Damour. Psychiatric Nursing Care Plans (p. Jafar Mahmud. Abnormal Psychology (p. Forti Nash & Holoday Worret. The essential feature of undifferentiated schizophrenia is that it cannot be classified in any category listed or that meet the criteria for more than one of the other mentioned schizophrenic disorders.J.. Maria Loreto Evangelist-Sia. hallucinations. catatonic behavior.e.DIFFERENTIAL DIAGNOSIS SCHIZOPHRENIA Schizophrenia is one of a cluster of related psychotic brain disorders. disorganized speech. perceptual disturbances. affective disruptions and impaired social competency. It is a combination of disordered thinking. They are defined by their symptomatology.60 Residual Type Diagnostic Criteria for Schizophrenia A. behavioral abnormalities.90 Undifferentiated Type 295. The diagnosis of a particular subtype of schizophrenia is based on the clinical picture that occasioned the most recent evaluation or admission to clinical care and may therefore change over time. each present for a significant portion of time during a 1-month period (or less if successfully treated): (1) delusions (2) hallucinations (3) disorganized speech (e.10 Disorganized Type 295. The disorder lasts for at least 6 months and includes at least one month of the active phase symptoms namely two or more of the following: hallucinations. negative symptoms).30 Paranoid Type 295. alogia or avolition) 111    . Two or more of the following. Characteristic symptoms.g.20 Catatonic Type 295. The subtypes are: 295. frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior (5) negative symptoms (i. affective flattening. or two or more voices conversing with each other. Manic. During these prodromal or residual periods the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in attenuated form (e. unusual perceptual experiences. Social/occupational dysfunction.Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts.e. academic. a drug of abuse. a medication) or a general medical condition F. or selfcare are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence. interpersonal relations.g. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder. Total 7÷10×100= 70% 112     . odd beliefs. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e. Duration Continuous signs of the disturbance persist for at least 6 months. or (2) if mood episodes have occurred during active-phase symptoms.g. or occupational achievement) C. This 6month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i. Or Mixed Episodes have occurred concurrently with the active-phase symptoms. E. one or more major areas of functioning such as work. active-phase symptoms) and may include periods of prodromal or residual symptoms. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out because either (1) no Major Depressive. failure to achieve expected level of interpersonal.) D. the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated. their total duration has been brief relative to the duration of the active and residual periods. B. For a significant portion of the time since the onset of the disturbance. disorganized behavior 3. TOTAL  1÷2×100 = 50% 295. Criteria for the Catatonic Type of Schizophrenia are not met. disorganized speech. None of the following is prominent: disorganized speech.10 Schizophrenia Disorganized Type The essential features of the Disorganized Type of Schizophrenia are disorganized speech. Delusions are typically persecutory or grandiose or both but delusions with other themes may also occur. disorganized or catatonic behavior.30 Paranoid Type A.295.g. if present. disorganized behavior. are fragmentary and not organized into a coherent theme. disorganized speech 2. or flat or inappropriate affect.10 Disorganized Type A. Diagnostic criteria for 295. flat or inappropriate affect B. The criteria are not met for catatonic type TOTAL   1÷4×100 = 50% 113 . catatonic or disorganized behavior) are not prominent. Hallucinations are also typically related to the content of the delusional theme.30 Schizophrenia Paranoid Type The essential feature of the Paranoid Type of Schizophrenia is the presence of prominent delusions or auditory hallucinations in the context of a relative preservation of cognitive functioning and affect.. Symptoms characteristic of the Disorganized and Catatonic Types (e. Preoccupation with one or more delusions or frequent auditory hallucinations B. flat or inappropriate affect. and delusions or hallucinations. and flat or inappropriate affect. Diagnostic criteria for 295. All of the following are prominent 1. 114 .295.20 Catatonic Type A type of Schizophrenia in which the clinical picture is dominated by at least two of the following 1. Additional feature include stereotypes. or prominent grimacing 5. mannerisms. extreme negativism. hallucinations. prominent mannerisms. and automatic obedience or mimicry. echolalia. excessive motor activity (that is apparently purposeless and not influence by external stimuli) 3. excessive motor activity.20 Schizophrenia Catatonic Type The essential feature of the Catatonic Type of Schizophrenia is a marked psychomotor disturbance that may involve motoric immobility. or echopraxia. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor 2. mutism. Diagnostic criteria for 295. peculiarities of voluntary movement as evidenced by posturing √ (voluntary assumption of inappropriate bizarre postures). stereotyped movements. echolalia or echopraxia TOTAL 1÷5×100 =20% 295. peculiarities of voluntary movement. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism 4. incoherence and disorganized behavior that do not clearly fit under any category. 90 Schizophrenia Undifferentiated Type Clients with a diagnosis of Undifferentiated Schizophrenia display florid psychotic symptoms like delusions. Diagnostic criteria for 295. disorganized speech and grossly disorganized or catatonic behavior. but the current clinical picture is without prominent positive psychotic symptoms (e. Diagnostic criteria fort 301. or Catatonic Type TOTAL  1÷1×100 = 100% 295.. present in an attenuated form (e.Diagnostic criteria for 295. as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia. affects.22 Schizotypal Personality Disorder Individuals with schizotypal personality disorder have odd thoughts.60 Schizophrenia Residual Type The Residual Type of Schizophrenia should be used when there has been at least one episode of Schizophrenia. disorganized speech. There is a continuing evidence of the disturbance as indicated by the presence of negative symptoms or two or more attenuated positive symptoms. If delusions or hallucinations are present. Absence of prominent delusions. perceptions. A pervasive pattern of social and interpersonal deficits marked by acute 115 . delusions. unusual perceptual experience) TOTAL 1÷2×100 = 50%  301. hallucinations. hallucinations. B.22 Schizotypal Personality Disorder A. There is continuing evidence of the disturbance. they are not prominent and are not accompanied by strong affect. or behavior).90 Undifferentiated Type A type of Schizophrenia in which symptoms that meet Criterion A are present.g.. Disorganized.60 Residual Type A. and beliefs.g. odd beliefs. but the criteria are not met for the Paranoid. Does not occur exclusively during the course of Schizophrenia.” e. or “sixth sense in children and adolescents. suspiciousness or paranoid ideation 6. close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.g. vague. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. eccentric or peculiar 8. and reduced capacity for. inappropriate or constricted affect 7. add “Premorbid. metaphorical.. unusual perceptual experiences.. another Psychotic Disorder. or a Pervasive Developmental Disorder Note: If criteria are met prior to the onset of Schizophrenia. as indicated by five or more of the following: 1. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.20 Schizoid Personality Disorder 116       . bizarre fantasies or preoccupations) 3. odd thinking and speech (e. Diagnostic criteria for 301.g. including bodily illusions 4. lack of close friends or confidants other than first-degree relatives 9.g. “Schizotypal Personality Disorder (Premorbid) 6÷10 ×100 =60% Schizoid Personality Disorder Individuals with schizoid personality disorder are emotionally detached and prefer to be left alone. circumstantial. or stereotyped) 5. by beginning by early adulthood and present in a variety of contexts. behavior or appearance that is odd. telepathy. overelaborate. superstitiousness.. belief in clairvoyance. a Mood Disorder with Psychotic Features. Ideas of reference (excluding delusions of reference) 2.discomfort with. appears indifferent to the praise or criticism of others 7. detachment. another Psychotic Disorder. Nonbizarre delusions (i.. “Schizoid Personality Disorder (Premorbid)” TOTAL 4÷8 ×100 =50% 297. poisoned. if any . Note: If criteria are met prior to the onset of Schizophrenia. add “Premorbid. if any. or deceived by spouse or 117 . or flattened activity  B. a Mood Disorder With Psychotic Features. involving situations that occur in real life. such as being followed. if present are not prominent.. lacks close friends or confidants other than first degree    relatives 6. loved at a distance.e. shows emotional coldness. Tactile or olfactory hallucinations may be present if they are related to delusional themes. beginning by early adulthood and present in a variety of contexts.1 Delusional Disorder The essential feature of Delusional Disorder is the presence of one or more nonbizarre delusions that persist for at least 1 month. takes pleasure in few. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. interest in having sexual experiences with another person 4. almost always chooses solitary activities 3.” e. activities 5. including being a part of a family 2. infected. neither desires nor enjoys close relationship. or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. Auditory or visual hallucinations. Does not occur exclusively during the course of Schizophrenia.g. Diagnostic Criteria for 297. as indicated by four (or more) of the following: Criteria Present 1.A.1 Delusional Disorder A. has little. physical examination. or having a disease) of at least 1 month’s duration. C. Criterion A for Schizophrenia has never been met. TOTAL  2÷5×100 =40% Substance-Induced Psychotic Disorder The essential features of Substance-Induced Psychotic Disorder are prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance. If mood episodes have occurred concurrently with delusions. a medication) or a general medical condition. The diagnosis is not made if the psychotic symptoms occur only during the course of delirium. Medication use is etiologically related to the disturbance C. the symptoms of Criterion A developed during or within a month of. Note: Do not include hallucinations if the person has insight that they are substance induced B. D. functioning is not markedly impaired and behavior is not obviously odd or bizarre. The disturbance is not better accounted for by a Psychotic disorder that is not substance induced. Apart from the impact of the delusion(s) or its ramifications. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme. There is evidence from the history. Substance intoxication or Withdrawal 2. E. or laboratory findings of either (1) or (2): 1. The disturbance is not due to the direct physiological effects of a substance (e.lover.. The disturbance must not be better accounted for by a Psychotic Disorder that is not substance induced. Diagnostic criteria for Substance-Induced Psychotic Disorder A. a drug of abuse. Prominent hallucinations or delusions. Evidence that the symptoms are better accounted for by a 118   . their total duration has been brief relative to the duration of the delusional periods.g. B. Hallucinations that the individual realizes are substance induced are not included here and instead would be diagnosed as Substance Intoxication or Substance Withdrawal with accompanying specifier With Perceptual Disturbances. D. Their psychotic symptoms. = 20% Diagnostic criteria for 295. must persist for some time in the absence of any mood syndrome. at some time.70b Schizoaffective Disorder Patients with schizoaffective disorder have psychotic episodes that resemble schizophrenia but with prominent mood disturbances. Note: This diagnosis should be made instead of a diagnosis of Substance intoxication or Substance Withdrawal only when the symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention. the symptoms persist for a substantial period of time (e.. there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.g.. there is either a Major Depressive Episode. Note: The Major Depressive Episode must include criterion A1: depressed mood. about a month) after the cessation of acute withdrawal or severe intoxication.Psychotic Disorder that is not a substance induced might include the following: the symptoms precede the onset of the substance use (or medication use). During the same period of illness. however. or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use. 1÷5×100 TOTAL 295. The disturbance does not occur exclusively during the course of delirium. or a Mixed Episode concurrent with symptoms that meet criterion A for Schizophrenia. 119 . a history of recurrent non-substance related episodes. a Manic Episode.g. or there is other evidence that suggests the existence of an independent non-substance –induced Psychotic Disorder (e. An uninterrupted period of illness during which.70b Schizoaffective Disorder A. B. C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness. or laboratory findings of either (1) or (2) Criteria Present 1. disorientation. A change in cognition (such as memory deficit. Disturbance in consciousness(i..e. a medication) or a general medication. language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting. medication use is etiologically related to the disturbance* 2÷5×100 =40% INITIAL SUMMARY Schizophrenia Paranoid Type Disorganized Type Catatonic Type Undifferentiated Type Residual Type Schizotypal Personality Disorder 60% 120 70% 50% 50% 20% 100% 0%   . The disturbance is not due to the direct physiological effects of a substance (e. sustain or shift attention B.D. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. or evolving dementia C.  1÷4×100 = 25% Substance Intoxication Delirium Diagnostic criteria for Substance Intoxication Delirium A. physical examination. a drug of abuse. There is evidence from the history. reduced clarity of awareness of the environment) with reduced ability to focus. the symptoms in Criteria A and B developed during Substance Intoxication 2.g. D. established.. diencephalon. and memory. Cranial nerves exit the brainstem.Schizoid Personality Disorder Delusional Disorder Schizophreniform Disorder Substance-Induced Psychotic Disorder Schizoaffective Disorder Substance Intoxication Delirium 40% 50% 20% 25% 40% ANATOMY AND PHYSIOLOGY 50% The nervous system is an intricate. The spinal cord is connected to a section of the brain called the brainstem and runs through the spinal canal. The major parts of the brain include: the brain stem. The two main subdivisions of the nervous system are the central nervous system and the peripheral nervous system. making decisions and taking actions. cerebellum. 121 . The spinal cord carries signals (messages) back and forth between the brain and the peripheral nerves. cranial nerves. The structures that make up the nervous system include the brain. Nerve roots exit the spinal cord to both sides of the body. highly organized network of billions of neurons and neuroglia. enteric plexuses and sensory receptors. The central nervous system consists of the brain and spinal cord. and cerebrum. It also is the center for the intellect. ganglia. correlating them with one another and with stored information. behavior. emotions. spinal nerves. The brain is the center for registering sensations. The medulla contains the cardiac. that the cerebellum plays more diverse roles such as participating in some types of memory and exerting a complex influence on musical and mathematical skills. respiratory. and epithalamus. Superior to the brain stem is the diencephalon. The thalamus acts a relay center for all sensory impulses. however. The hypothalamus is involved in the acceleration or deceleration of the 122 . which consists of the thalamus. the cerebellum has been known to control equilibrium and coordination and contributes to the generation of muscle tone. pons. heart rate and blood pressure.The brain stem is continuous with the spinal cord and consists of the medulla oblongata. Traditionally. The pons is a bridge that connects parts of the brain with one another. and midbrain. to the cerebral cortex. The midbrain extends from the pons to the diencephalon. vomiting and vasomotor centers and deals with breathing. The medulla oblongata forms the inferior part of the brain stem. Posterior to the brain stem is the cerebellum. hypothalamus. except smell. It has more recently become evident. The midbrain is a short section of the brain stem between the diencephalon and the pons. The surface of the cerebral cortex has grooves or infoldings (called sulci). the hypothalamus inhibits the feeding center. fear. speech. the largest of which are termed fissures. Some fissures separate lobes. the contraction of cutaneous blood vessels. The hypothalamus is also involved in the regulation of hunger and control of gastrointestinal activity. the hypothalamus is associated with specific emotional responses. A specialized sexual center in the hypothalamus responds to sexual stimulation of the tactile receptors within the genital organs. Each convolution is delimited by two sulci and is also called a gyrus (gyri in plural). and memory. A mass of fibers called the corpus callosum links the hemispheres. Impulses from the posterior hypothalamus produce a rise in arterial blood pressure and an increase of the heart rate. fatty acids and amino acids are partially responsible for the sensation of hunger elicited from the hypothalamus. known as the right and left hemispheres. A belownormal blood temperature causes the hypothalamus to relay impulses that result in heat production and retention through the initiation of shivering. the hypothalamus initiates impulses that cause heat loss through sweating and vasodilation of cutaneous vessels of the skin. When sufficient amounts of food have been ingested. pain and pleasure. If the arterial blood flowing through the anterior portion of the hypothalamus is above normal level. senses. The cerebrum is the largest part of the brain and controls voluntary actions. thought. It also regulates sleeping and wakefulness. 123 . Supported on the diencephalon and brain stem is the cerebrum. The hypothalamus produces neurosecretory chemicals that stimulate the anterior pituitary gland to release various hormones. The right hemisphere controls voluntary limb movements on the left side of the body. Also. Impulses from the anterior portion have the opposite effect. The convolutions of the cortex give it a wormy appearance. Low levels of blood glucose. The hypothalamus is also involved in body-temperature regulation. which is the largest part of the brain. The cerebrum is divided into two halves.heart. such as anger. The epithalamus is the posterior portion of the diencephalon. the processing includes information about numbers. Almost every person has one dominant hemisphere. In addition. and touch. The frontal lobes are located in the front of the brain and are responsible for voluntary movement and. and memory. taste. via their connections with other lobes. 124 . participate in the execution of sequential tasks. the space around one’s body. They receive and process visual information. pain. They process sensory information such as temperature. The temporal lobes are located on each side of the brain. attentiveness to the position of one’s body parts. Each hemisphere is divided into four lobes. and certain aspects of behavior.and the left hemisphere controls voluntary limb movements on the right side of the body. mood. They process memory and auditory (hearing) information and speech and language functions. The occipital lobes are located at the back of the brain. or areas. and one's relationship to this space. which are interconnected. The parietal lobes are located behind the frontal lobes and in front of the occipital lobes. speech output. organizational skills. In the frontal lobes. acetylcholine activates muscles.Neurotransmitters are chemicals which relay. sex. It plays a role in regulating neuronal excitability throughout the nervous system. and neutral stimuli that become associated with them. Examples of neurotransmitters are acetylcholine. In the central nervous system. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder. drugs. working memory. GABA is also directly responsible for the regulation of muscle tone. In humans. voluntary movement. Gamma-Aminobutyric acid (GABA) is the chief inhibitory neurotransmitter in the mammalian central nervous system. motivation. Recent studies indicate 125 . Dopamine disorders in this region of the brain can cause a decline in neurocognitive functions. the cholinergic system. acetylcholine and the associated neurons form a neurotransmitter system. inhibition of prolactin production (involved in lactation and sexual gratification). attention. attention. and learning. providing feelings of enjoyment and reinforcement to motivate a person proactively to perform certain activities. dopamine. glutamate. and problem-solving. The chemical compound acetylcholine (often abbreviated ACh) is a neurotransmitter in both the peripheral nervous system (PNS) and central nervous system (CNS) in many organisms including humans. and modulate signals between a neuron and another cell. punishment and reward. Dopamine is released (particularly in areas such as the nucleus accumbens and prefrontal cortex) by naturally rewarding experiences such as food. gamma-aminobutyric acid. which tends to cause excitatory actions. mood. In the peripheral nervous system. Some neurotransmitters are commonly described as "excitatory" or "inhibitory". sleep. Dopamine is commonly associated with the pleasure system of the brain. The only direct effect of a neurotransmitter is to activate one or more types of receptors. and serotonin. and is a major neurotransmitter in the autonomic nervous system. dopamine controls the flow of information from other areas of the brain. especially memory. aspartate. amplify. dopamine. Dopamine has many functions in the brain. including important roles in behavior and cognition. called the mesolimbic and mesocortical systems. In instances of bipolar disorder. manic subjects can become hypersocial. which connect the zona incerta in the posterodorsal diencephalon with the anterior hypothalamus and septal area. the nigrostriatal dopamine system. The former. e which inhibit the release of prolactin and melanocyte-stimulating hormone from the anterior and intermediate lobes of the pituitary. Projection neurons that produce dopamine are found in the diencephalon and the brainstem. anhedonia) are thought to be related to a hypodopaminergic state in certain areas of the brain. Sociability is also closely tied to dopamine neurotransmission. the dorsal motor of the nucleus of the vagus. The function of the VTA’s dopamine projections to the forebrain. This is credited to an increase in dopamine. because mania can be reduced by dopamine-blocking anti-psychotics. A third dopamine projection system arises from neurons scattered along the ventricular system in the periaqueductal gray. 126 . dopamine cell bodies give rise to tuberopophysial dopamine projections. which directly or indirectly lead to an increase of dopamine in the mesolimbic reward pathway of the brain.that aggression may also stimulate the release of dopamine in this way. Low D2 receptor-binding is found in people with social anxiety. and the incertohypothalamic projections. nicotine. is particularly important in the control of motor function. apathy. and the nucleus solitarius. arguing that this dopamine pathway is pathologically altered in addicted persons. Longer dopamine projection systems arise from the substantia nigra and the ventral tegmental area (VTA) of the midbrain. as well as hypersexual. This theory is often discussed in terms of drugs such as cocaine. In the diencephalon. and amphetamines. The preventricular system provides terminals in the gray matter along the course of the ventricles. has been linked to the complex group of disease we refer to as schizophrenia. respectively. and in relation to neurobiological theories of chemical addiction (not to be confused with psychological dependence). Traits common to negative schizophrenia (social withdrawal. but some of those in the medulla produce epinephrine. One type of tumor. Most produce norepinephrine. lying dorsolateral to the oral pontine reticular nucleus. which store it. Modulation of serotonin at synapses is a thought to be a major action of several classes of pharmacological antidepressants.[1][2] The remainder is synthesized in serotonergic neurons in the CNS where it has various functions. called carcinoid. including the regulation of mood. Serotonin secreted from the enterochromaffin cells eventually finds its way out of tissues into the blood. A third catecholamine is dopamine. muscle contraction. and by certain nuclei of the hypothalamus. sleep. sometimes secretes large amounts of serotonin into the blood. a transmitter used by the large neurons of the substantia nigra and ventral tegmental area. it is actively taken up by blood platelets. they disgorge serotonin. The locus ceruleus is the largest of about a dozen nuclei I the brainstem that produce cathecolamines. When the platelets bind to a clot. The nucleus (also known as nucleus pigmentosus) is partly in the pons and partly in the midbrain. and excreted by the kidneys. and some cognitive functions including memory and learning. Serotonin or 5-Hydroxytryptamine (5-HT) is a monoamine neurotransmitter that is primarily found in the gastrointestinal (GI) tract and central nervous system (CNS) of humans and animals. Serotonin is eventually metabolized to 5-HIAA by the liver. appetite. Approximately 80 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut. There.The locus ceruleus at the rostal end of the floor of the fourth ventricle on each side marks the position of a nucleus with a rich vascular supply and consisting of neurons containing melanin pigment. which 127 . Serotonin also is a growth factor for some types of cells. which may give it a role in wound healing. where it serves as a vasoconstrictor and helps to regulate hemostasis and blood clotting. where it is used to regulate intestinal movements. Motor or Both 128 Function . glutamate receptors. Because of its role in synaptic plasticity. Due to serotonin's growth promoting effect on cardiac myocytes. in contrast to spinal nerves which emerge from segments of the spinal cord. CRANIAL NERVES Cranial nerves are nerves that emerge directly from the brain stem. At chemical synapses. glutamate is stored in vesicles. such as the NMDA receptor. bind glutamate and are activated. Glutamate is the most abundant excitatory neurotransmitter in the vertebrate nervous system. and these are: Cranial nerve number Name Sensory. and heart problems. There are 12 pairs cranial nerves emerging from the brain. caused by proliferation of myocytes onto the valve. In the opposing post-synaptic cell. Nerve impulses trigger release of glutamate from the pre-synaptic cell. glutamate is involved in cognitive functions like learning and memory in the brain.causes various forms of the carcinoid syndrome of flushing. persons with serotinin-secreting carcinoid may suffer a right heart (tricuspid) valve disease syndrome. diarrhea. medial rectus. Located insuperior orbital fissure Provides motor innervation to the muscles of facial expression. and intorts the eyeball.inferior rectus. Located in internal acoustic canal Receives taste from the posterior 1/3 of the tongue. rotation and gravity (essential for balance & movement). Located insuperior orbital fissure Receives sensation from the face and innervates the muscles of mastication Innervates the lateral rectus. provides secretomotor innervation to the parotid gland. and provides secretomotor innervation to the salivary glands (except parotid) and the lacrimal gland. Located in superior orbital fissure Innervates the superior oblique muscle. superior rectus. Located in optic canal Innervates levator palpebrae superioris. the Mostly sensory vestibular branch carries impulses for equilibrium and the cochlear branch carries impulses for hearing. receives the special sense of taste from the anterior 2/3 of the tongue. which depresses. Located in olfactory foramina of ethmoid Transmits visual information to the brain. and inferior oblique. and stapedius muscle. which collectively perform most eye movements.I II Olfactory nerve Optic nerve Purely Sensory Purely Sensory Transmits the sense of smell. and provides motor innervation to 129 . rotates laterally (around the optic axis). More specifically. posterior belly of the digastric muscle. which abducts the eye. Located and runs through internal acoustic canal to facial canal and exits at stylomastoid foramen III Oculomotor nerve Mainly Motor IV Trochlear nerve Mainly Motor V VI Trigeminal nerve Abducens nerve Both Sensory and Motor Mainly Motor VII Facial nerve Both Sensory and Motor Vestibulocochlear nerve (or auditoryVIII vestibular nerveor statoacoustic nerve) IX Glossopharyngeal nerve Both Sensory and Motor Senses sound.. Important for swallowing (bolus formation) and speech articulation. A major function: controls muscles for voice and resonance and the soft palate. and thermal sensation. overlaps with functions of the vagus. and receives the special sense of taste from the epiglottis. Located in jugular foramen Accessory nerve XI (or cranial accessory nerve or spinal accessory nerve) Mainly Motor Controls sternocleidomastoid and trapezius muscles. Some sensation is also relayed to the brain from the palatine tonsils. which is innervated by the glossopharyngeal). Sensation is relayed to opposite thalamus and some hypothalamic nuclei. Symptoms of damage: dysphagia (swallowing problems). provides parasympathetic fibers to nearly all thoracic and abdominal viscera down X Vagus nerve Both Sensory and Motor to the splenic flexure.velopharyngeal insufficiency. Examples of symptoms of damage: inability to shrug. weak head movement.the stylopharyngeus (essential for tactile. pain. Located in hypoglossal canal 130 . Located in jugular foramen Provides motor innervation to the muscles of the XII Hypoglossal nerve Mainly Motor tongue and other glossal muscles. Located in jugular foramen Supplies branchiomotor innervations to most laryngeal and all pharyngeal muscles (except the stylopharyngeus. DOCTOR’S ORDER Date 01/19/10 2:40pm Order Please admit to CIU. When persons. Rationale and proper management of his condition. DAT with aspiration This is done to give appropriate Done precaution. to This is done to ensure that the Secured. doctors obtain informed Remarks For close monitoring of the patient Admitted permissible. consent is a if informed legally such legally consent. consent and families in crisis situation. and rescued individuals Secure care. The crisis intervention unit is a special unit operating on a 24-hour basis. are legally incapable permission authorized substitute of giving from person. and adequate nourishment with the prevention or minimization of risk factors in the patient at risk for 131 . To secure the consent of the client is important for legal purposes. client or significant others has been adequately informed of and significant information concerning treatment processes procedures. which serves as a receiving and action center for walk-in referred. due to age or mental status. Hcl Biperiden is commonly used to 2mg/tab 1 tab BID improve parkinsonian signs and symptoms related to antipsychotic PRN for EPS Biperiden drug therapy. Flupentixol injection weekly is to a long or acting three with Given and record please given two people schizophrenia who have a poor compliance with medication and suffer frequent relapses of illness. especially the medications he receives that could be a contributing factor in the variation results of the vital signs. medical interventions in the form of restraints to reduce safety risks posed by violent patients and to 132 Restrain patient when Psychiatric facilities often use Done . Meds: Haloperidol q12 Flupentixol dec 20mg 1ampule now then q monthly 5mg Haloperidol is an older 1amp IM now then antipsychotic used in the treatment of schizophrenia. and This is ordered so that the patient Done tendencies will be monitored closely and to precaution avoid the harming of patient's life or others. Homicidal suicidal escape please necessary. Monitor vsq6 and Vital signs are important for Taken baseline assessment and to recorded. monitor patients condition which evaluates the whole treatment course.aspiration. This is an atypical ½ tab in am. assessment and constant monitoring. Start Chlorpromazine This is given as a substitute for decanoate 200 mg/tab Haloperidol.. Chlorpromazine 200mg 1tab.prevent patients from harming themselves and others. 133 This is ordered as patient's maintenance medications for his condition. 1 tab at drug and is considered to have less HS. Refer accordingly This may create a collaborative Referred treatment among the client and the health care providers. The patient is advised to go home so the patient may go back to his normal life. Biperiden HCL 2g/tab 1tab BID 3. thus it also makes a good coordination on the treatment of the client. To promote the patient's well Done Done Given For possible discharge being. 01/21/10 07:40 AM CONTINUE MEDS EPS side effects. MGH: The patient’s psychotic episodes have diminished. 01/20/10 11:40am Hold Haloperidol IM To change to chlorpromazine. ½ in AM 2. Home meds: 1. Flupentixol dec 20mg/1amp IM qmonthly (last dose 1/1910) >Follow up at OPD This is ordered for patient's reafter 1 month. Done . 134 . Peluces.O. A butyrophenone that probably exerts antipsychotic effects by blocking postsynaptic dopamine receptors in the brain. 2 mg. ROUTE P. Dozic. 100 mg/ml Haloperidol lactate: Injection – 5mg/ml.V. Oral concentration: 2 mg/ml.5 mg. and Sigaperidol Classification(s): Suggested Dose: Individualized dose depends on indication and response.DRUG STUDY Generic Name: Brand Name: Haloperidol Aloperidin. ONSET Unknown Unknown 3-6 hr PEAK DURATION Unknown Unknown 135 Unknown . Ordered dose: Mode of Action: Typical Antipsychotic S. 2010) Unknown. AVAILABLE FORMS: Haloperidol: Tablets – 0. 20 mg. Einalon Haldol. Linton. Serenase. Bioperidolo. Halosten. Brotopon. Eukystol. 5mg. I. Haloperidol 5 mg 1 amp IM now then q 12 (January 19. Duraperidol (Germany). 10 mg. Keselan. Haloperidol decanoate: Injection – 50mg/ml. Serenace. 1 mg. M. Initially.d.r. t. severe CV disorders. Drug Interaction: Drug – Drug ♂ Anticholinergics: May increase anticholinergic effect and glaucoma.) ♂ Tourette Syndrome (Adults: 0. and in those and those taking anticonvulsants anticoagulants.i. or urine retention.d.i. or p. b. in patients with history of seizures or EEG abnormalities. macrolides: May increase haloperidol level.i. Azole antifungals. Lithium: May cause 136 .) ♂ Chronic psychosis requiring prolong therapy (Adults: 50 to 100 mg I.i. Carbamazepine: May increase haloperidol level. or t.M.d. ♂ Use cautiously in elderly and deliberated patients.5 to 5 mg P. buspirone. b. 0..M. CNS depressants: May increase CNS depression. or lithium. allergies. (lactate) Unknown Indications: ♂ 10-20 min Unknown Psychotic disorders (Adults and children older than age 12: Dosage varies for each patient. antiparkinsonians. Or. haldol lactate q 4 to 8 hours. (decanoate) Unknown 3-9 days Unknown I.. haloperidol decanoate q 4 weeks.d. although hourly administration may be needed until control is obtained.I.O.n. glaucoma. CNS depression.O.M.5 to 5 mg P.) Contraindications: ♂ In patients hypersensitive to drug and in those with parkinsonism. coma. 2 to 5 mg I. dyspepsia. confusion. nausea. Side Effects: ♂ CNS: severe extrapyramidal reactions. vomiting. Rifampin: May decrease haloperidol level. ♂ Hepatic: Jaundice. ♂ GU: urine retention. ECG changes ♂ EENT: blurred vision. Adverse Effects: ♂ CNS: seizures and neuroleptic malignant syndrome. ♂ Other: gynecomastia. use. Drug – Lifestyle ♂ Alcohol use: May increase CNS depression. diarrhea. tardive dyskinesia. ♂ Skin: rash.V. ♂ Hematologic: leukocytosis. anorexia. other skin reactions. Methyldopa: May cause dementia. priapism. diaphoresis. 137 . menstrual irregularities. insomnia. ♂ CV: torsades de pointes. constipation. lethargy. headache. warn patient to avoid activities that require alertness and good coordination until effects of the drugs are known. hypotension. sedation. ♂ GI: dry mouth. hypertension. vertigo. drowsiness.lethargy and confusion after high doses. ♂ CV: tachycardia. ♂ Educate patient that drowsiness and dizziness usually subside after a few weeks. ♂ Hematologic: Leukopenia Nursing Responsibilities: ♂ Although drug is least sedating of the antipsychotics. with I. loss of bladder control.♂ Inform patient to avoid alcohol while taking this drug. ♂ Tell patient to relieve dry mouth with sugarless gum or hard candy. difficulty with breathing. 138 . Discard the drug if there is a markedly discolorations in the solutions. Slight yellowing injection or concentrate is common and doesn’t affect potency. or tiredness. BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott Williams and Wilkins. a high fever. unusually pale skin. which is rare but fatal. Pharmaceutical Directory Review. increased sweating. severe muscle stiffness. a fast heartbeat. ♂ Monitor the client for signs of tardive dyskinesia which may occur after prolonged use. It may not appear until months or years later and may disappear spontaneously or persist for life. ♂ Inform patient to do not withdraw the drug abruptly unless required by severe adverse reactions. despite ending drug. 7th edition. ♂ Watch out for signs and symptoms of neuroleptic malignant syndrome. Phil. ♂ Remind patient to always protect the drug from light. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS). high or low blood pressure. ♂ Always remember. don’t give deconate form IV. ♂ Stop taking haloperidol and check the patient with their doctor right away if they have any of the following symptoms while using haloperidol: convulsions (seizures). Flupenthixol is a type of thioxanthene drug and acts by antagonism of D1 and D2 dopamine receptors (as well as serotonin). Depixol-Conc Typical Antipsychotics Flupentixol decanoate 20 mg 1 amp now then q monthly (January 19. Depixol Low Volume.Generic Name: Brand Name: Classification(s): Ordered dose: 2010) Mode of Action: Flupentixol Fluanxol. Depixol. Side effects are similar to 139 . o max 3mg/day (2mg in the elderly). o doses above 2mg (1mg in the elderly) should be gived as divided doses. max. However. o if tolerated. ♂ Depression Dose: o initially 1mg/day.initially 3-9mg twice daily. further dose of 20-40mg after 7 days. dose 18mg/day Depot antipsychotic (Depixol) (brand name: Fluanxol Depot in Australia) o test dose of 20mg IM. increased after 1 week to 2mg/day. 400mg IM weekly. parkinsonian tremor and rigidity. Indications: ♂ Schizophrenia and other psychoses Dose: oral (rarely used) . o usual maintenance dose between 50mg every 4 weeks and 300mg every 2 weeks. 140 . o usual interval 2-4 weeks between doses. o use half above doses in the elderly. namely extrapyramidal symptoms of akathisia. anticholinergic adverse effects are low.many other typical antipsychotics. The typical antipsychotics are less commonly used now that the atypical antipsychotics are available (with less side effects). o max. bromocriptine. diphenhydramine). muscle relaxants (e.g. atropinelike drugs.seizure drugs. narcotic pain relievers (e. they may interact with each other.. codeine). drowsiness-causing antihistamines (e.g. anti. especially those that may cause drowsiness such as: sedatives. pramipexole). ♂ If patient has history of kidney problem.g. antidepressants or other psychiatric medicine. ♂ If patient has a problem of enlarged prostate.. dopamine-type drugs (e.Contraindications: ♂ If patient is allergic to flupentixol or any other medicine of this class. pergolide. ♂ If patient has a problem of heart disease. anti-anxiety agents (e.g.. food supplements or herbal medicine. cyclobenzaprine). or plan to become pregnant. Drug Interaction: ♂ Prescription and nonprescription medications. Side Effects: 141 .g.. ♂ If patient is allergic to any other medicine including preservative and dyes. ♂ Many cough-and-cold products contain ingredients that may add a drowsiness effect. diazepam).. thyroid problem or Parkinson’s disease. high blood pressure or diabetes. ♂ If patient is pregnant. If patient is taking any prescribed or non-prescribed. liver problem or epilepsy. cabergoline. ♂ If two drugs are taken together. ♂ Elderly people should be prescribed flupentixol with caution. sore throat. blurred vision. dark urine. severe dizziness. • Less common side effects of flupentixol include skin rashes. If patient experiences this. including dental or emergency treatment. urine problem. constipation. dizziness while rising from bed. weakness. Nursing Responsibilities: ♂ Educate patient that Flupentixol can cause drowsiness. doctor or dentist that you are taking flupentixol. weakness.• Nausea. ♂ Remind client that alcohol will increase feelings of drowsiness. irregular heartbeat. ♂ Educate the patient that the symptoms of overdose may include seizers. difficult breathing. ♂ Flupentixol can cause some people's skin to become more sensitive to sunlight than it usually is. dizziness and blurred vision. ♂ Inform client that Flupentixol can occasionally cause a dry mouth. convulsions. dizziness. muscle spasms. and difficulty in breathing. try chewing sugar-free gum. tell the surgeon. constipation and coma. insomnia. Avoid strong sunlight and sunbeds until you know how your skin reacts and use a suncream higher than factor 15. ♂ If client experience 'flu like' symptoms such as stiffness. decreased sex drive and painful erection. muscle problem. ♂ Remind patient that before having any surgery. abnormal paleness. tremor. high temperature. drowsiness. increased sweating. fever. fast heartbeat. diarrhea. sucking sugar-free sweets or pieces of ice. 142 . disturbed concentration. leaking bladder and a racing heartbeat contact their doctor or go to the accident and emergency department of your local hospital immediately. chest pain and muscle spasms. drowsiness. vomiting. yellowness of skin and eyes. slow heart rate. irregular blood pressure and convulsions. Anticholinergic 143 .♂ Inform patient to take the medicine with a full glass of water. ♂ Instruct to the patient that he can swallow the medicine as whole. Phil. Pharmaceutical Directory Review. Bipiden. ♂ Remind the patient that the medicine can be taken with or without food. Berofin. Benzum 2. Desiperiden Anti-Parkinson's Agent. 7th edition. BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott Williams and Wilkins. Generic Name: Brand Name: Classification(s): Suggested Dose: Adults: Biperiden Akineton. Biperen. Don’t cut or chew the medicine. tremor. improves abnormal gait. reduces abnormal sweating and salivation.D. megacolon ♂ Myasthenia gravis 144 .I. and arteriosclerotic). and to lesser extent. ♂ Improve parkinsonian signs and symptoms related to antipsychotic drug therapy. prn for EPS (January 19. Indications: ♂ Adjunctive treatment of all forms of Parkinson's disease (postencephalitic. idiopathic. Contraindications: ♂ Hypersensitivity to biperiden or any component of the formulation ♂ Narrow-angle glaucoma ♂ Bowel obstruction.Parkinsonism: 2 mg 3-4 times/day Extrapyramidal: 2 mg 1-3 times/day Elderly: Initial: 2 mg 1-2 times/day Ordered dose: Mode of Action: Biperiden Hcl 2 mg / tab 1 tab B. ♂ Relieves muscle rigidity. The beneficial effects in Parkinson's disease and neuroleptic-induced extrapyramidal symptoms are believed to be due to the inhibition of striatal cholinergic receptors. 2010) Biperiden is a weak peripheral anticholinergic agent with nicotinolytic activity. monitor for increased effect. patients with a known history of seizures and those with potentially dangerous tachycardia. ♂ Anticholinergic agents: Central and/or peripheral anticholinergic syndrome can occur when administered with opioid analgesics. and antihistamines. ♂ Cholinergic agents: Anticholinergics may antagonize the therapeutic effect of cholinergic agents. ♂ Neuroleptics: Anticholinergics may antagonize the therapeutic effects of neuroleptics.♂ Caution in patients with obstructive diseases of the urogenital tract. tricyclic antidepressants. includes tacrine and donepezil. phenothiazines and other antipsychotics (especially with high anticholinergic activity). ♂ Levodopa: Anticholinergics may increase gastric degradation and decrease the amount of levodopa absorbed by delaying gastric emptying. ♂ Atenolol: Anticholinergics may increase the bioavailability of atenolol (and possibly other beta-blockers). quinidine and some other antiarrhythmics. Side Effects: 145 . Drug Interaction: Drug – Drug ♂ Amantadine. rimantadine: Central and/or peripheral anticholinergic syndrome can occur when administered with amantadine or rimantadine. ♂ Digoxin: Anticholinergics may decrease gastric degradation and increase the amount of digoxin absorbed by delaying gastric emptying. delirium. nasal dryness ♂ Genitourinary: Urinary retention ♂ Neuromuscular & skeletal: Choreic movements ♂ Ocular: Blurred vision Nursing Responsibilities: ♂ Instruct patient to use caution when driving. agitation. Tachycardia may be noted. With high doses nervousness. agitation. disorientation. dry mouth. headache. Biperiden may lower the seizurethreshold. 146 . anxiety. sleep disorder (decreased REM sleep and increased REM latency) ♂ Gastrointestinal: Constipation. and obstipation are frequent. euphoria. Biperiden may cause dizziness or blurred vision. vertigo. ♂ Eyes : Biperiden causes mydriasis with or without photophobia. and confusion. dry throat. ♂ Peripheral side effects : Blurred vision. If patient experience dizziness or blurred vision. Allergic skin reactions may occur.♂ CNS : Drowsiness. It may precipitate narrow angle glaucoma. and dizziness are frequent. operating machinery. avoid these activities. Adverse Effects: ♂ Cardiovascular: Orthostatic hypotension. or performing other hazardous activities. xerostomia. bradycardia ♂ Central nervous system: Drowsiness. abdominal discomfort. impaired sweating. gum disease). headache. Phil. This could lead to heat stroke in hot weather or with vigorous exercise. Instruct client to take special care with their dental hygiene (e. Do not double the dose to catch up. cavities.♂ Remind patient to use alcohol cautiously. ♂ Remind client to avoid becoming overheated.. BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott Williams and Wilkins.g. an effect that can increase gum and tooth problems (e.g. 7th edition 147 .. If patient misses a dose. or dizziness. ♂ ♂ ♂ ♂ Educate client to take each dose with a full glass of water. flossing) and have regular dental check-ups. skip the missed dose and resume their usual dosing schedule. brushing. ♂ If client experiences signs of hyperthermia such as mental/mood changes. and seek immediate medical attention. promptly seek cool or air-conditioned shelter and/or stop exercising. Pharmaceutical Directory Review. ♂ ♂ Remind patient to not share the medication to others. Remind the patient to store biperiden at room temperature away from moisture and heat. Educate patient to take biperiden after a meal if it upsets his stomach. Alcohol may increase drowsiness and dizziness while client is taking biperiden. If it is near the time of the next dose. Biperiden may cause decreased sweating. remind them to take it as soon as they remember. This medication decreases saliva production. 2010) Unknown.. 50 mg. I. 100 mg Syrup: 10 mg/5ml Tablets: 10 mg.M. A piperidine phenothiazine that probably blocks postsynaptic dopamine receptors in the brain. 25 mg. ONSET 30-60min Unknown PEAK Unknown 4-6hr DURATION Unknown Unknown 148 . Thorazine Typical Antipsychotic Individualized dose depends on indication and response.O. 100 mg. 300 mg. ROUTE P. Largactil. 100 mg/ml Suppositories: 25 mg.Generic Name: Brand Name: Classification(s): Suggested Dose: Chlorpromazine Hydrochloride Chlorpromanyl. Novo-Chlorpromazin. AVAILABLE FORMS: Capsules (extended release): 200 mg. Injections: 25 mg/ml Oral concentrate: 30 mg/ml. 200 mg Ordered dose: Mode of Action: Chlorpromazine 200g/tab (January 20. I.V. severe CV disease. or subcortical damage. Barbiturates. 25 mg I. lithium: May decrease phenothiazine effect. Drug Interaction: Drug – Drug ♂ Antacids: May inhibit absorption of oral phenothiazines.) Contraindications: ♂ In patients hypersensitive to drug.d. Centrally acting anthypertensives: May decrease 149 . bone marrow suppression.M. Indications: ♂ >1hr Unknown 3-4 hr Psychosis.d. ♂ Use cautiously in acutely ill or dehydrated children.i. respiratory disorders. 25 mg IM initially. hypocalcemia. Or.R. p.i. or q. Anticonvulsants: May lower seizure threshold.) ♂ Acute intermittent porphyria.i. antiparkinsonians: May increase anticholinergic activity.) ♂ Tetanus (Adults: 25 to 50 mg IV or IM t. aggravated parkinsonian symptoms. glaucoma.d.d. pr prostatic hyperplasia. in those with CNS depression.i. ♂ Use cautiously in elderly and deliberated patients and in patients with hepatic or renal disease. intractable hiccups (Adults: 25 to 50 mg PO t.P. mania (Adults: for hospitalized patients with acute disease.r.) ♂ Nausea and vomiting (Adults: 10 to 25 mg PO q 4 to 6 hours.n. and in those in coma. or q. Anticholinergics such as tricyclic antidepressants. particularly psychomotor skills. pain at IM injection site Adverse Effects: ♂ CNS: Seizures and neuroleptic malignant syndrome. Side Effects: ♂ CNS: extra pyramidal reactions. tardive dyskinesia. CSN depressants: May increase CNS depression. agranulocytosis. Drug – Lifestyle ♂ Alcohol use: May increase CNS depression. constipation ♂ GU: urine retention ♂ Skin: mild photosensitivity reactions. and monitor regularly. 150 . which may occur after prolonged use. ♂ Hematologic: Leukopenia. Warfarin: May decrease effect of oral anticoagulants. Watch client for orthostatic hypotension. Propanolol: May increase levels of both propanolol and chlorpromazine. ♂ Monitor client for tardive dyskinesia. aplastic anemia. Lithium: May increase neurologic effects. thrombocytopenia Nursing Responsibilities: ♂ Obtain baseline blood pressure measurements before starting therapy. sedation. pseudoparkinsonism.antihypertensive effect. Electroconvulsive therapy. ♂ Warn patient to avoid activities that require alertness or good coordination until effects of drug are known. insulin: may cause severe reactions. ♂ Remind client that drowsiness and dizziness usually subside after a few weeks. Meperidine: May cause excessive sedation and hypotension. ♂ CV: orthostatic hypotension ♂ GI: dry mouth. ♂ Advise client to relieve dry mouth with sugarless gum or hard candy. paper-wrapped joints and tobacco-leaf-wrapped blunts. one-hitters. tea. BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott Williams and Wilkins. or break extended release capsule form before swallowing. Pharmaceutical Directory Review. Marihuana. and orally. symptoms of blood dyscrasia. hallucinogen ROUTE OF ADMINISTRATION: Inhaled smoke. ♂ Withhold dose and notify prescriber if jaundice. Marijuana. bongs. screened bowls. chew. ♂ Educate patient to avoid alcohol while taking the drug. Phil. bubblers (small pipes with water chambers). 7th edition. ♂ Remind patient to use sunblock and to wear protective clothing to avoid oversensitivity to the sun. ♂ Have the patient to report signs of urine retention or constipation. chillums. Hemp. SCIENTIFIC NAME: BRAND/STREET NAME: CLASSIFICATION: Cannabis sativa L. Hashish Psychoactive drug.♂ Advise patient not to crush. depressant. stimulant. or persistent extrapyramidal reactions develop. 151 . CHEMICAL CONSTITUENTS: Cannabis chemical constituents including about 100 compounds responsible for its characteristic aroma. These are mainly volatile terpenes and sesquiterpenes. INDICATIONS: • • • • Amelioration of nausea and vomiting Stimulation of hunger in chemotherapy and AIDS patients Lowers intraocular eye pressure (shown to be effective for treating glaucoma) General analgesic effects (pain reliever) CONTRAINDICATIONS: • • Hypersensitivity to cannabis Pregnant women, or planning to get pregnant DRUG INTERACTIONS: • • • • • • Alcohol: Make both drugs stronger. Amphetamines Cocaine: (Uppers and downers) Ecstasy: Extends and expands the experience of ecstasy. Heroin: Complimentary effects. Ketamine: Increases cannabis effects. SIDE EFFECTS: • • • • General sense of well being and relaxation, giggliness and euphoria Eyes: Reddening, decreased intraocular pressure. Dreaminess, increased appreciation of music, sleepiness and time distortion Dryness of the mouth 152 • • • • Increase heart rate Muscle relaxation Low blood pressure Impairment of short-term episodic memory, working memory, psychomotor coordination, and concentration • Anxiety, panic, paranoia and feelings of impending doom ADVERSE EFFECTS: • • • • • Lung cancer Chronic fungal infections Paranoia Confusion Long-lasting toxic psychosis NURSING RESPONSIBILITIES: • Reassure client that anxiety attacks are common side effects of the drug and will disappear within hours. • Provide a supportive environment for the client when experiencing feelings of paranoia and anxiety. • Remind client to avoid strenuous activities like driving or operating machinery until the effects of the drug diminishes. • Educate client that effects at first can be subtle, first time users usually detect little or no effect at all. • Inform the client that if he is possibly experiencing marijuana OD symptoms, it is recommended that he calls the local emergency line. 153 • Educate client that if he is a regular cannabis smoker (every day) and stopped smoking, he will experience some of the following withdrawal symptoms: restlessness, irritability, mild agitation, insomnia, nausea, sleep disturbance, sweats, and intense dreams. 154 155 NURSING CARE PLAN TIME AND DATE Januar SUBJECTIVE: y @ 12:30 P.M. 21, “Naay 2009 C CUES NEED NURSING DIAGNOSIS Disturbed sensory At the end of 2 perception related hours to alteration in care, tissue ®It is the change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, impaired response to such stimuli. Schultz, M.J.;Videback, S.L.; Lippincott’s or of nursing the patient 1. Establish rapport and January 21, 2009 build trust with the @ 2:30 PM client GOAL UNMET ® The client must trust the nurse before talking about hallucinations and other sensory-perceptual alterations 2. Continuously orient • The paGOAL OF CARE INTERVENTIONS EVALUATION nagahung- O hung sa akoa usahay G nga mag-wild daw ko N ug maglagot” by as I the T I V OBJECTIVE • • Disoriented to time E P verbalized patient function of brain will be able to • maintain orientation to time, person, for time; • demonstrate accurate perception of the environment by responding appropriately to stimuli in the surroundings; and ®Brief, frequent orientation helps to present reality to the client with sensoryperception disturbance place, and tient was able to maintain orientation to time, place, person and situation. “Huwebes karon. Mga udto na man siguro. Naa ko sa Mental hospital para magpacheck-up” • However, the client was not able to circumstances specified of period Auditory and E visual hallu- R cinations C E of P T the client to actual environmental events or activities in a nonchallenging way. • Misinterprets actions others • to U make simple A L decisions Inability 156 • Inappropriate responses P A T T E R N Manual Psychiatric Nursing of Care • lessen visual and auditory hallucinations demonstrate ac3. Reinforce and focus on reality. Talk about real events and real people. Use real situations and events to divert client from long, tedious, repetitive verbalizations ideas ® Working with reality lessens patient’s initiation of his hallucinations. 4. Correct client's deof false curate perception of the environment as evidenced by the presence of delusion and hallucination • Presence of auditory hallucination is still evident. Plans 7th edition scription of inaccurate perception, and describe the situation as it exists in reality ® Explanation of, and participation in, real situations and real activities interferes 157 with the ability to respond to hallucinations. 5. Observe for verbal and nonverbal behaviors associated with hallucinations ® Early recognition of sensory-perceptual disturbance promotes timely interventions and alleviation of the client’s symptoms. 6. Describe the hallucinatory behaviors to the client. ® The client may be unable to disclose perceptions and the nurse can openly facilitate disclosure by reflect- 158 ing on observations of the client’s behaviors, which helps the client engage in more open discussion with the nurse, which in itself brings relief. 7. Explore the content of hallucinations to determine the possibility to harm self, others or the environment ® Exploring the content of the hallucination helps the nurse identify if the sensoryperceptual disturbance is threatening or dangerous to the client, such as a command type of hallucination that may be telling the 159 Use clear. direct.client to harm or kill the client or others. verbal communication rather than unclear or nonverbal gestures ®Unclear or directions can instructions confuse the client and promote distorted perceptions or misinterpretations of reality. 8. 9. The nurse can then reinforce treatment and safety precautions. Modify the client’s environment to decrease situations that provoke anxiety ®Decreased anxiety can reduce the occur- 160 . 161 .rence tions of hallucina- 10. Reassure the client (frequently if necessary) that the client is safe and will not be harmed ®Alleviation of fear is necessary for the client to begin to trust the environment and to feel safe. is asked what cial expression and posture. such as gestures. Be sincere and hon. He is oriented time day But still to when it he is. 2.MET tremely sensitive • client able The was to about others and can recognize insincerity. • the patient 1. fareinforce 21. with the GOAL PARTIALLY ®Clients are ex. conceptualthe to Delusion of perse. Evasive remarks mistrust. At the end of 2 to care. Kani O man gud akong utok.P disruption cognitive operations activities. • Demonstrate reality based thinking in verbal and nonverbal those by is • behavior. “Magpatambal ko.” as verbalized N by the patient I T I OBJECTIVE • • • • • cution noia Thought insertion Incoherent speech Demonstrates disturbance sleep pattern • Presence of auditory hallucinations a in V E R C E P T U A L thought process hours of nursing will be able to Maintain reality ori®It is the in and entation.M 2009 CUES NEED NURSING DIAGNOSIS GOAL OF CARE INTERVENTIONS EVALUATION SUBJECTIVE C Disturbed related disintegration thinking. naa G niy grasa. and Demonstrate ability abstract.E Delusion of para. Cognitive processes include mental processes which knowledge mental maintain reality orientation.TIME AND DATE Januar y @ 7:00 A. These cupied with his may help to meet 162 . Assess client’s nonverbal behavior.January 21.@ 12:30 PM cating client. 2009 est when communi. ®This assessment preocdelu- acquired. 3. clinical in the A in may to ize. reason and calculate consistent with ability to the client’s needs that cannot be conveyed speech. comprehension. Show empathy to the client’s feelings. His mannerism is and largely he observed wasn’t able to establish eye contact with any of the inter- 163 . disruption these processes lead inaccurate interpretations of environment and may result in an inability to evaluate reality accurately. awareness. Alterations thought processes any group. Encourage client to the express through sions about his jealous him • client The was being to mental feelings and do not pry cross examine for information ®Probing increases client’s suspicion and interferes with the therapeutic relationship 4. and judgment.P A T T E R N processes include reality orientation. or one are age not limited to gender. reassure the client of your presence tance ®The client’s exand accep- not able to demonstrate realitybased thinking in verbal and nonverbal responses. ®Suspicious clients often believe others are discussing them. Give simple directions using short words and simple calculation 164 . or talking quietly where client can see but not hear what is being said. viewer.01) periences can be distressing. Empathy conveys acceptance of the client your caring and interest. Avoid laughing.cfm? plan=53. ment abilities. (http://www1. Ho he a reajudgand was able to positive ab- whispering. • wever.elsevierhealth. son. 5.us . and secretive behaviors reinforce the paranoid feelings. 6. exhibit stract.problem.c om/MERLIN/G ulanick/Constru ctor/index. 8. Maintain oriented ment ® Maintaining reality based relationship and environreality relation- ship and environ- 165 . Never convey to the client that his delusions and hallucinations are real ®The delusion or hallucination would be reinforce if it’s accepted.sentences. ® Giving simple directions lessen or prevent confusion of the patient 7. ®What the client feels or thinks is not funny for him. Do not judge or belittle liefs.ment lets the patient know that the relationship is temporary and prevents separation anxiety 9. The client may feel client’s be- 166 . 10. Give positive feedbacks and acknowledge the client ®Positive feedback enhances sense of well-being and makes a more positive situation for the client. rejected proached if by apat- tempts of humor. 167 . P Lack social inter.TIME AND DATE . 2. Acknowledge pain of loss.R Has little interest E P in activities Talks only when T I asked O N was unable to verbalize understanding of things that lead to current situation • The patient was unable to demonstrate behaviors show self-esteem evidenced that positive as by inability to have 168 . January 21. basta ing-ana” @ 12 OBJECTIVE: :30 PM • • • • tact action Lacking eye con. Januar y 2010 CUES NEED NURSING DIAGNOSIS GOAL OF CARE INTERVENTIONS EVALUATION SUBJECTIVE: S L F E C Situational low At the end of 2 self-esteem related cognitive impairment • It is the state in which previously positive esteem experience a • negative feeling towards self due to a certain situation Handbook Nursing Diagnosis by of an had selfindividual who Verbalize understanding of things that precipitate current situation. and Demonstrate behaviors that show positive self-esteem hours of nursing to care. Support client through process of grieving. will: the patient 1. Encourage client to express honest feelings in relation to loss of prior level of functioning. Devise methods for assisting client to is turned in selfinward on the self. 2010 @ 2:30 PM GOAL UNMET • The patient “Maulaw man gyud ko E 21. ® Client may be fixed in anger stage of grieving process. which resulting diminished esteem. allowing him to acknowledge his own strength and weakness.. If verbalizations are not understandable. ® The ability to communicate 169 .Lynda CarpenitoMuyet Juall express properly. express to client what you think he or she intended to say. It may be necessary to reorient client frequently. ® To explore the feelings client of the thereby feelings an ing eye-contact down at as well as lookduring the interview. Encourage client's attempts to communicate. 3. Sharing picture albums. Encourage reminiscence and discussion of life review. Also discuss present-day events. if possible.effectively self-esteem. Encourage participation in group ac- 170 . is especially good. ® Reminiscence and life review help the client resume progression through the grief process associated with disappointing life events and increase selfesteem as successes are reviewed. 5. with others may enhance 4. ® Focus on accomplish- 171 . ® feedback increase esteem.tivities. Offer support and empathy client when expresses at Positive from self- group members will embarrassment inability to remember people. 6. regardless of limitations in verbal communication. and places. events. until he or she feels secure that the group members will be accepting. Caregiver may need to accompany client at first. 7. Encourage client to be as independent as possible in selfcare activities. ®It enables the self- client to develop trust and thereby establish communication 172 .ments to lift self-esteem. Listen to patient’s concerns and verbalizations without comment or judgment. ® The ability to perform independently preserves esteem. 8. 173 .9. Provide feedback to client’s feelings. ®To allow the negative client experience a different view. Provide opportuni.L 174 . I aw 2008 diay” OBHECTIVE: • • time V E E Disorientation to P Observed expe. memory related nursing care.R rience of forget.January 21. and Accept limitations current condition of months he was referring N about his last used of I marijuana. Encourage the “Usahay gyud makalimot na ko” • The patient was able to verbalize acceptance client to use written cues such as calendars or notebooks ®Written cues decrease the client’s need to recall activities. 2010 @12:30 PM CUES NEED NURSING DIAGNOSIS GOAL OF CARE INTERVENTIONS EVALUATION SUBJECTIVE: The exactly clarified was the C when O 2 G Impaired At the end of 3 day 1. the client are recall information. cence or recall past events ®Long-term memory may persist after loss of recent memory. Depending o n the areas of the brain.TIME AND DATE January 21. client The may unable to to: • Verbalize awareness of memory problems.@ 2:30 PM GOAL MET • The patient was able to verbalize awareness of memory problems as he verbalized 2. he verbalized T “Kadtong 2007 man to.C ting • Scratches E his P head when he is T unable to recall U information • A Inability to de. plans and so on from memory. either remote or recent. the to neurological patient will be able disturbances ®Impaired memory to effects is of or • directly related general medical condition of ongoing effects substance. Reminiscence is usually an enjoyable activity for the client. 2010 ties for reminis. Encourage ventilation of feelings of frustration. ®It is important to 175 . lessness. ®To lessen feelings of powerlessness/hope lessness 4. Allow the client to do tasks on his own. to 3. Provide for proper pacing of activities and having appropriate rest ®To avoid fatigue 5. Refocus attention to areas of focus and progress. but do not rush him to do it. Make the client feel that he can still do things independently.termine if a behavior forme is per- confabulate memories. helpand so of his limitations due to his conditions fill in those lost forth. Do not contradict the client who experiences an illusion.maximize independent function. Instead. ®Client with memory cannot multistep tions 8. ®To meet individual needs. maximizing independence. Assist the client and deal with functional limitations identify resources. 6. simimpairment remember instrucwhen are 176 . Provide single step instructions instructions needed. assist the client when memory has deteriorated further. 7. and find some practical solutions to the problem ®Therapeutic responses promote reality while offering solutions that help enhances the client’s sense and may reduce fear. anxiety. 9. Determine client’s response to medication prove medications to imattention. prescribe concentration. 177 . and confusion.ply explain reality. Monitor client’s behavior and assist in use of stress-management techniques ®To reduce frustration 10. as 12:30 verbalized by the P. 2009 @ 2:30 PM GOAL PARTIALLY MET GOAL OF CARE scribed. Wala pa gani ko 2010 @ ligo ron. 2. ®Helpful in deciding whether quality of life is improved when using the preEVALUATION medications TIME AND DATE January SUBJECTIVE: “Makatamad usahay 21. the client was able to: difficulty in selfa) ver balize self care. care need R: underlying cause afb) but fects choice of inwas unable to demonterventions/ strate- 178 . Identify After 2 hours of reason for nursing care.M. the bathing / client will be able hygiene related to: a) verto lack of balize self motivation care need ® The patient b) De has an impaired monstrate ability to techniques provide self care to meet requisites due to self-care environmental needs and 1. R: to gain client’s trust and facilitate a good working relationship. INTERVENTIONS rapport.memory process and to lift spirits and modify emotional responses. Establish January 21. OBJECTIVE: Unkempt hair noted food stains visible on clothing untrimmed fingernails and toenails with visible dirt noted A C T I V I T Y E X E CUES NEED NURSING DIAGNOSIS Self care deficit: After 2 hours of nursing care. maligo. Kapoy pud manlimpyo ug kuko”. patient. Discuss on of strate techniques to meet selfcare needs. 5. R: increases the client’s awareness of different materials for 179 . Determine hygienic needs and provide assistance as of needed nails with and activities like care brushing teeth. Orient client to different equipment for selfcare like various toiletries. R: makes client aware of how hygiene is vital in caring for oneself.R C I S E P A T T E R N psychological factors. importance hygiene. 4. 3. gies. R: basic hygienic needs may be forgotten. Discuss the negative possible implications of not taking a bath such as infections and odor.self-care. R: Encourages the patient to understand the need for hygiene. 7. 6. Encourage to the client to perform self-care maximum of ability as defined by the 180 . him to meet the need. R: Broadens the patient’s idea about the problem and encourages 8. Let the pa- tient enumerate his ideas on the importance of hygiene. 9. tasks.client. Do not rush client. R: Enhances esteem and convey aliveness. provide clothes. Assist with colorful Allot plenty of time to perform dressing neatly or 181 . 10. R: cognitive impairment may interfere with ability to manage even simple activities. R: promotes independence and sense of control. may decrease feelings of helplessness. 182 . It was until after two months. The patient went to the Davao Medical Hospital for his third admission last January 19. 183 . November 1987 that they decided to bring Bob to the hospital for check-up when Bob’s tongue shrunk. The onset of illness was poor since the family waited that the situation of Bob worsened and did not immediately seek medical advice immediately when there was changes in his behavior like when he ate stool and showed illogical speech Duration of illness ☻ and flight of ideas.PROGNOSIS GOOD FAIR POOR Onset of the illness ☻ JUSTIFICATION Bob first experiences the signs and symptoms of schizophrenia when he was 18 years old and now he is 40 years old. The client has been diagnosed with schizophrenia catatonic 22 years ago. The first signs that Bob showed was when he ate feces and since then people who are close to him noticed that he has illogical speech and flight of ideas. 2010 and was diagnosed with schizophrenia undifferentiated. As we can see. the duration of illness has been very long since it was years ago since he was mentally sick thus rating him with poor prognosis. Bob was 184 Willingness to take medications and treatment ☻ . cigarette and soft drinks.Precipitating factors ☻ Intake of drugs. Because of this. substances or chemicals which increase levels of dopamine and developmental factors are the present precipitating factors seen in Bob. shame and doubt. Bob developed mistrust. For a person to be treated he must not only take the drugs prescribed but also to stop things that are contraindicated for him for his treatment. The proponents rated this area as poor since Bob is abusing substances like marijuana. Bob has appropriate mood and affect therefore rating him with good prognosis. inferiority. Bob submits himself properly to the medication without missing any single dose. taking marijuana and even drinking soft drinks. smoking. The family understood what he is undergoing and giving him the support he need for his recovery. however. They are helping him financially as well as emotionally. He may be taking the proper regimen. alcohol. Family Support ☻ During the interview the mother and the sister-inlaw was with the patient. he is not listening to the advice of the doctor to stop alcohol. guilt. The patient is receiving appropriate family support since his family is doing all they can to help him recover. As the interview progresses the student nurses observed that the family is supporting the patient. role confusion. In his development. Bob was brought to the hospital for check-up because he demanded to his parents saying that something is wrong with him. him poor. and isolation which rated Mood and Affect ☻ During the interview. The duration of illness is long since it was last November 1987 that he was first diagnosed of Catatonic Schizophrenia and just this last January 19.6 1. shame and doubt. The onset of illness was 22 years ago. 2010 that he was diagnosed of Schizophrenia undifferentiated. Not getting the things he wants won’t make him depress but instead. Bob goes wild and becomes hostile.7-2. the patient does not show any depressive features. Even though he is aware that something is wrong with him.rated with prognosis with the willingness to take the Depressive features ☻ medication and treatment. inferiority. according to the calculation. During the interview. guilt. And during his development. of recovering from his illness. He also abused many substances like marijuana. He didn’t finish college but he is not depressed with this fact. alcohol. Computation:  Poor: (3*1)/7  Fair: Total 3 1 3 (1*2)/7 = 3/7 = 2/7 = 9/7 2. and isolation which rated him poor. role confusion. cigarette and soft drinks. He was not immediately brought to the hospital but they waited 2 months and decided to bring him to the hospital because of shrinking of his tongue and he demanded so. he developed mistrust. 185 . Bob knew that something is wrong with him and he need medical attention.4-3.00 = POOR  Good: (3*3)/7 Total: General Prognosis: 1-1. he is still not depressed with this fact.3 = FAIR 2.0 = GOOD Rationale for Fair Prognosis: Bob has a fair prognosis therefore he has small chance. taking marijuana and drinking soft drinks. Even though he is aware that something is wrong with him. 186 . His father is supporting him financially but is not able to go with him because of his work back in Agusan. Bob goes wild and becomes hostile. the patient does not show any depressive features. Bob has appropriate mood and affect therefore rating him with good prognosis. Bob knew that something is wrong with him and he need medical attention. He has good family support as evidenced by the support of his mother and sister-in-law while he is in the hospital. he is still not depressed with this fact.In addition to that. he submits himself to the regimen. Not getting the things he wants won’t make him depress but instead. during the interview. taking the medications promptly even going to the hospital every month for his medication. he didn’t listen to the advice of the doctor to stop alcohol. He didn’t finish college but he is not depressed with this fact. Furthermore. The family understood what he is undergoing and giving him the support he need for his recovery. smoking. However. Lastly. They are challenged to not just teach but impart to us as well nursing experiences that we may apply in the course of caring for our future patients. To the patient’s family: The patient’s family plays an important role in the patient’s mental illness and recovery. They are encouraged to continue interacting with the patient so that ideas of violence towards self and others will be diverted. themselves. The family should make themselves physically present so that the patient would feel their support and concern. He should realize the importance of complying with his medication and the benefits this practice would bring to the improvement of his well-being. the medication and therapeutic regimen designed for his rehabilitation. To the Davao Mental Hospital: 187 .RECOMMENDATION The group 1 of section 3H would like to recommend the following: To the patient: He is advised to take part in complying with the treatment. it is of prime importance that they are oriented and educated regarding the patient’s mental illness so that they will understand him even better and assist him in his daily activities. In addition. To the Ateneo de Davao University. must be equipped with the knowledge and skill that they may impart to student nurses.College of Nursing: The faculty and staff are encouraged to continue improving the standards of the Ateneo Nursing Curriculum by providing quality education to students. Also they. Also they are recommended to know the latest trends in improving therapeutic communication between them and the patients. because still they deserve due treatment. The patients must be kept clean. and improve our therapeutic technique in caring for our patients. The hospital must provide a safe and therapeutic environment to the patients and staff. so that appropriate care is rendered to them. Address the needs of each patient by first assessing the level of severity of the patient’s condition. and have mattresses to sleep on. To the student nurses: Even if nursing students find it difficult to establish therapeutic relationships with mentallyill patients because of the relatively short time spent in the clinical area. 188 . still we have to render amounts of effort. time and trust to our patients. that we may play a part in the rehabilitation of our mentally-ill patients. let every patient be submitted for history and physical examination and be evaluated by a psychiatrist.The group recommends that they should improve their facilities in treating the mentally-ill patients. well-fed. The proponents recommend that the psychiatric team would work together in order to provide mental health care service that promotes rehabilitation of the patient. acceptance. physiology. and social relations of the patient. Moreover. Some of the mentally ill patients remain undiagnosed and untreated because they never sought medical attention due to old stigmas and societal attitudes towards mental illness. This case study will give us better understanding regarding mentally-ill patients. It will give us better grasp why certain people experience being mentally unstable by looking deeper into the history.SIGNIFICANCE OF THE STUDY This study will be a significant undertaking in depth understanding the reason behind our subject’s mental illness. development of physical. this study will be helpful to aid the family in caring their mentally-ill member. emotional and cognitive. 189 . and how to deal with the illness and issues concerning it. This study will also be beneficial to the students and clinical instructors in College of Nursing in making use of different concepts taught inside the classroom related to psychiatric nursing. giving them more understanding. Stigmas results in the social exclusion of people with a mental illness and is detrimental to the part of the family. brain chemistry. provide recommendations on how to deal with them in the future. catatonic behavior.g. each present for a significant portion of time during a 1-month period (or less if successfully treated): (6) delusions (7) hallucinations (8) disorganized speech (e.30 Paranoid Type 295. perceptual disturbances. frequent derailment or incoherence) (9) grossly disorganized or catatonic behavior (10) negative symptoms (i.APPENDICES DIAGNOSTIC STATISTICAL MANUAL CRITERIA FOR DIFFRENTIAL DIAGNOSIS Schizophrenia is one of a cluster of related psychotic brain disorders.90 Undifferentiated Type 295. It is a combination of disordered thinking. The subtypes are: 295. affective disruptions and impaired social competency. The diagnosis of a particular subtype of schizophrenia is based on the clinical picture that occasioned the most recent evaluation or admission to clinical care and may therefore change over time. The disorder lasts for at least 6 months and includes at least one month of the active phase symptoms namely two or more of the following: hallucinations. affective flattening.60 Residual Type Diagnostic Criteria for Schizophrenia G. They are defined by their symptomatology. alogia or avolition) Only one Criterion A symptom is required if delusions are bizarre or 190 . negative symptoms).10 Disorganized Type 295. Two or more of the following. Characteristic symptoms. behavioral abnormalities.e. disorganized speech.20 Catatonic Type 295. active-phase symptoms) and may include periods of prodromal or residual symptoms. For a significant portion of the time since the onset of the disturbance. K. failure to achieve expected level of interpersonal.g. H. Or Mixed Episodes have occurred concurrently with the active-phase symptoms. During these prodromal or residual periods the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in attenuated form (e. academic. Duration Continuous signs of the disturbance persist for at least 6 months. the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated. unusual perceptual experiences.g. interpersonal relations. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder. a medication) or a general medical condition L. their total duration has been brief relative to the duration of the active and residual periods.hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts. Social/occupational dysfunction. Total 191 . Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out because either (1) no Major Depressive. This 6month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i. or selfcare are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence. a drug of abuse. or occupational achievement) I. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e. one or more major areas of functioning such as work.) J. Manic. or two or more voices conversing with each other. or (2) if mood episodes have occurred during active-phase symptoms. odd beliefs.e. and delusions or hallucinations. The criteria are not met for catatonic type TOTAL 192 . Hallucinations are also typically related to the content of the delusional theme. disorganized speech 2.295. disorganized behavior. flat or inappropriate affect B. Criteria for the Catatonic Type of Schizophrenia are not met. Symptoms characteristic of the Disorganized and Catatonic Types (e. Diagnostic criteria for 295. Delusions are typically persecutory or grandiose or both but delusions with other themes may also occur. Preoccupation with one or more delusions or frequent auditory hallucinations B.30 Schizophrenia Paranoid Type The essential feature of the Paranoid Type of Schizophrenia is the presence of prominent delusions or auditory hallucinations in the context of a relative preservation of cognitive functioning and affect.10 Schizophrenia Disorganized Type The essential features of the Disorganized Type of Schizophrenia are disorganized speech. disorganized behavior 3.10 Disorganized Type A. or flat or inappropriate affect. disorganized speech. None of the following is prominent: disorganized speech. are fragmentary and not organized into a coherent theme. All of the following are prominent 1.g.. flat or inappropriate affect. Diagnostic criteria for 295. and flat or inappropriate affect. if present. disorganized or catatonic behavior.30 Paranoid Type A. catatonic or disorganized behavior) are not prominent. TOTAL 295. mannerisms. excessive motor activity (that is apparently purposeless and not influence by external stimuli) 3. Additional feature include stereotypes. peculiarities of voluntary movement. Diagnostic criteria for 295. incoherence and disorganized behavior that do not clearly fit under any category.295. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor 2. 90 Schizophrenia Undifferentiated Type Clients with a diagnosis of Undifferentiated Schizophrenia display florid psychotic symptoms like delusions. hallucinations. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism 4. Disorganized. mutism. stereotyped movements. extreme negativism.20 Catatonic Type A type of Schizophrenia in which the clinical picture is dominated by at least two of the following 1.20 Schizophrenia Catatonic Type The essential feature of the Catatonic Type of Schizophrenia is a marked psychomotor disturbance that may involve motoric immobility.60 Schizophrenia Residual Type 193 . or echopraxia. prominent mannerisms. but the criteria are not met for the Paranoid.90 Undifferentiated Type A type of Schizophrenia in which symptoms that meet Criterion A are present. peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate bizarre postures). and automatic obedience or mimicry. or prominent grimacing 5. excessive motor activity. echolalia. Diagnostic criteria for 295. echolalia or echopraxia TOTAL 295. or Catatonic Type TOTAL 295. suspiciousness or paranoid ideation 6.g. There is continuing evidence of the disturbance. Diagnostic criteria fort 301. Ideas of reference (excluding delusions of reference) 2. odd beliefs. Diagnostic criteria for 295. close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. unusual perceptual experience) TOTAL 301.g.. unusual perceptual experiences. hallucinations. B..g. Absence of prominent delusions. they are not prominent and are not accompanied by strong affect. circumstantial. inappropriate or constricted affect 194 . overelaborate. as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia. as indicated by five or more of the following: 1. present in an attenuated form (e. or “sixth sense in children and adolescents. belief in clairvoyance. bizarre fantasies or preoccupations) 3. perceptions. or behavior). disorganized speech. delusions. affects. If delusions or hallucinations are present.. superstitiousness. disorganized speech and grossly disorganized or catatonic behavior. but the current clinical picture is without prominent positive psychotic symptoms (e. vague.The Residual Type of Schizophrenia should be used when there has been at least one episode of Schizophrenia. metaphorical.22 Schizotypal Personality Disorder A..22 Schizotypal Personality Disorder Individuals with schizotypal personality disorder have odd thoughts. and beliefs. hallucinations. telepathy. including bodily illusions 4. by beginning by early adulthood and present in a variety of contexts. There is a continuing evidence of the disturbance as indicated by the presence of negative symptoms or two or more attenuated positive symptoms.g. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with. odd thinking and speech (e. and reduced capacity for. or stereotyped) 5. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.60 Residual Type A. “Schizotypal Personality Disorder (Premorbid) Schizoid Personality Disorder Individuals with schizoid personality disorder are emotionally detached and prefer to be left alone. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. another Psychotic Disorder.. or a Pervasive Developmental Disorder Note: If criteria are met prior to the onset of Schizophrenia. lack of close friends or confidants other than first-degree relatives 9. has little. shows emotional coldness. activities 5. lacks close friends or confidants other than first degree relatives 6. a Mood Disorder with Psychotic Features.7. Diagnostic criteria for 301.” e. add “Premorbid. if any. eccentric or peculiar 8. neither desires nor enjoys close relationship. including being a part of a family 2. Does not occur exclusively during the course of Schizophrenia. Does not occur exclusively during the course of Schizophrenia. appears indifferent to the praise or criticism of others 7. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self B. another Psychotic Disorder.20 Schizoid Personality Disorder A. or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a 195 . or flattened activity B. takes pleasure in few.g. as indicated by four (or more) of the following: Criteria Present 1. beginning by early adulthood and present in a variety of contexts. behavior or appearance that is odd. detachment. if any . almost always chooses solitary activities 3. a Mood Disorder With Psychotic Features. interest in having sexual experiences with another person 4. “Paranoid Personality Disorder (Premorbid)” 196 . as indicated by four (or more) of the following: Criteria Present 1. beginning by early adulthood and present in variety of contexts. persistently bear grudges . perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack 7. add “Premorbid. “Schizoid Personality Disorder (Premorbid)” TOTAL 301.. i. or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. suspects. without sufficient basis.general medical condition. regarding fidelity of spouse or sexual partner B. or slights 6. is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates 3. without justification. reads hidden demeaning or threatening meanings into benign remarks or events 5. injuries. Does not occur exclusively during the course of Schizophrenia. that others are exploiting. another Psychotic Disorder. has recurrent suspicions.0 Paranoid Personality Disorder People with paranoid personality disorder are distrustful and suspicious and anticipate harm and betrayal. Note: If criteria are met prior to the onset of Schizophrenia. Diagnostic Criteria for 301. a Mood Disorder With Psychotic Features. Note: If criteria are met prior to the onset of Schizophrenia.. is unforgiving of insults. is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her 4.g.” e.0 Paranoid Personality Disorder A..” e.g. harming or deceiving him or her 2. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.e. add “Premorbid. Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.. C. or Schizophrenia and is not due to the direct physiological effects of a substance (e. Apart from the impact of the delusion(s) or its ramifications. disorganized speech or grossly disorganized or catatonic behavior Diagnostic Criteria for 298. poisoned. 197 . a drug of abuse.1 Delusional Disorder A. Diagnostic Criteria for 297.8 Brief Psychotic Disorder The essential feature of Brief Psychotic Disorder is a disturbance that involves the sudden onset at least one of the following positive psychotic symptoms: delusions. loved at a distance.1 Delusional Disorder The essential feature of Delusional Disorder is the presence of one or more nonbizarre delusions that persist for at least 1 month. if present are not prominent. Presence of one (or more) of the following symptoms 1. Tactile or olfactory hallucinations may be present if they are related to delusional themes.e.TOTAL 298. disorganized speech 4. Schizoaffective Disorder. involving situations that occur in real life.g. or deceived by spouse or lover. or having a disease) of at least 1 month’s duration. grossly disorganized catatonic behavior Note: Do not include a symptom if it is a culturally sanctioned response pattern B. hallucinations.8 Brief Psychotic Disorder A. with eventual full return to premorbid level of functioning C.. B. Duration of an episode of the disturbance is at least 1 day but less than 1 month. Auditory or visual hallucinations. hallucination 3. delusion 2. functioning is not markedly impaired and behavior is not obviously odd or bizarre. infected. a medication) or a general medical condition TOTAL 297. such as being followed. The disturbance is not better accounted for by a Mood Disorder With Psychotic Features . Nonbizarre delusions (i. and residual phases) lasts at least 1 month but less than 6 months. Diagnostic criteria for Substance-Induced Psychotic Disorder A. The diagnosis is not made if the psychotic symptoms occur only during the course of delirium. (When the diagnosis must be made without waiting for recovery. Medication use is etiologically related to the disturbance 198 . D. TOTAL 295. Prominent hallucinations or delusions.. Note: Do not include hallucinations if the person has insight that they are substance induced B. The disturbance is not due to the direct physiological effects of a substance (e. If mood episodes have occurred concurrently with delusions. Diagnostic Criteria for 295. Criteria A. physical examination. a drug of abuse. There is evidence from the history. their total duration has been brief relative to the duration of the delusional periods. active.40 Schizophreniform Disorder The essential features of Schizophreniform Disorder are identical to those of Schizophrenia (Criteria A) except for two differences: the total duration of the illness (including prodromal. it should be qualified as “Provisional.”) TOTAL Substance-Induced Psychotic Disorder The essential features of Substance-Induced Psychotic Disorder are prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance. and E of Schizophrenia are met B.g. The disturbance must not be better accounted for by a Psychotic Disorder that is not substance induced. the symptoms of Criterion A developed during or within a month of. or laboratory findings of either (1) or (2): 1. E. active. and residual phases) is at least 1 month but less than 6 months and impaired social or occupational functioning during some part of the illnesses not require although it may occur. Substance intoxication or Withdrawal 2.D.40 Schizophreniform Disorder A. a medication) or a general medical condition. An episode of the disorder (including prodromal. Hallucinations that the individual realizes are substance induced are not included here and instead would be diagnosed as Substance Intoxication or Substance Withdrawal with accompanying specifier With Perceptual Disturbances. g. physical examination.. 199 . There is evidence from the history. about a month) after the cessation of acute withdrawal or severe intoxication. or there is other evidence that suggests the existence of an independent non-substance –induced Psychotic Disorder (e.xx Psychotic Disorder Due to General Medical Condition Diagnostic criteria for 293. TOTAL 295. The disturbance does not occur exclusively during the course of delirium. Prominent hallucination or delusions B. the symptoms persist for a substantial period of time (e.C. The disturbance is not better accounted for by a Psychotic disorder that is not substance induced. or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition C. Evidence that the symptoms are better accounted for by a Psychotic Disorder that is not a substance induced might include the following: the symptoms precede the onset of the substance use (or medication use). D. a history of recurrent non-substance related episodes.g. TOTAL 293. D. or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use. The disturbance does not occur exclusively during the course of a delirium..70b Schizoaffective Disorder Patients with schizoaffective disorder have psychotic episodes that resemble schizophrenia but with prominent mood disturbances. Their psychotic symptoms. must persist for some time in the absence of any mood syndrome.xx Psychotic Disorder Due to General Medical Condition A. however. Note: This diagnosis should be made instead of a diagnosis of Substance intoxication or Substance Withdrawal only when the symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention. The disturbance is not better accounted for by another mental disorder. A change in cognition (such as memory deficit. a medication) or a general medication. the symptoms in Criteria A and B developed during Substance Intoxication 2. The disturbance is not due to the direct physiological effects of a substance (e. there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. reduced clarity of awareness of the environment) with reduced ability to focus.Diagnostic criteria for 295. a drug of abuse. C. Substance Intoxication Delirium Diagnostic criteria for Substance Intoxication Delirium A. or a Mixed Episode concurrent with symptoms that meet criterion A for Schizophrenia. An uninterrupted period of illness during which. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. Note: The Major Depressive Episode must include criterion A1: depressed mood. language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting. there is either a Major Depressive Episode. There is evidence from the history. sustain or shift attention B.. at some time. Disturbance in consciousness(i. physical examination. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.70b Schizoaffective Disorder A. a Manic Episode. B.e.. or laboratory findings of either (1) or (2) Criteria Present 1. During the same period of illness. or evolving dementia C. disorientation. medication use is etiologically related to the disturbance* 200 . D. established. D.g. American Psychiatric Association.Missouri 12. DSM-IV-TR. James Hansen. McGraw-hill inc. Psychia nursing:biological &behavioural concepts (Deborah Antai- Drong)p. Abnormal psychology: current perspective.al c1996. Concepts of Anatomy and Physiology 4th edition.R.thomson/Delmar learning.et. Keltner.net/am2/publish/Health_21/P4-M_Davao_mental_hospital_multipurpose_building_to_rise_next_year. Human Anatomy & Physiology 11th edition by Tortora and Derrickson 8. J. Psychiatric nursng care plans. 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