BULACAN STATE UNIVERSITY

Mojon, City of Malolos, Bulacan

COLLEGE OF NURSING

A Case Study of Ms. Sue with a diagnosis of Manic Disorder with Pyschotic Feature (monosocial); to consider Paranoidal Schizophrenia
Submitted By:
Group 2 De Leon, Charmaine P. De Leon, Lara Erika B De Leon, Mardielyn Rose M. dela Cruz, Albert S. dela Cruz, Jennelyn Y. Dungca, Rhenee Anne G. Eusebio, Omar Hilario, Ma. Antonette A. Iguban, Mickael John O. Leano, Gianina Marie P. Group 3 Lumba, Christine Joy O. Lumba, Eries L. Martin, Claire Rochelle Erika A. Nepomuceno, Anna Mhelysa F. Pagal, Mylene Perez, Ma. Cristina S. Pescador, John Robert A. Pingol, Criselle L. Placides, Marrose Arra R.

In Partial Fulfillment of the Requirements in NCM 105 B RLE

Mariveles Mental Hospital Mariveles, Bataan

(February 14, 2013)

Submitted to: 3rd Level Clinical Instructors

I.

INTRODUCTION

This is a case of MS. SUE, 55 years old, that was admitted at Mariveles Mental hospital last August 31, 2012 and was diagnosed of Bipolar Manic Disorder with Psychotic features. The patient was admitted at the female ward due to the complaints of the informants that the client escaped from home, refused to take medications, refused to eat meals except for fruits and was talking and singing aloud. Mood disorders, also called affective disorders, are pervasive alterations in emotions that are manifested by depression, mania, or both. There are two major classifications of mood disorder. The Major Depressive Disorder, which is characterized by occurrence of one or more depressive episodes and absence of manic, mixed and hypomanic episodes, and the Bipolar Disorder. Bipolar disorder or Bipolar Affective Disorder, historically known as manicdepressive disorder, is a psychiatric diagnosis, defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood accompanied by abnormal behaviour with one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. They also experience depressive episodes, or symptoms, or a mixed state in which features of both mania and depression are present at the same time. These events are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is called rapid cycling. Severe manic episodes can sometimes lead to such psychotic symptoms as delusions. People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. For the purpose of medical diagnosis, Bipolar Disorder can are described as Bipolar I disorderone or more manic or mixed episodes usually accompanied by major depressive episodes; Bipolar II disorderone or more major depressive episode accompanied by at least one hypomanic episode. In short, in type 1, manic episodes are more prevalent while vice versa. Various theories for the etiology of mood disorders exist. Most recent research focuses on chemical biologic imbalances as the cause. Nevertheless psychosocial stressors and interpersonal events appear to trigger certain physiologic and chemical changes in the brain, which significantly alter the balance of neurotransmitters (Gabbard, 2000). Bipolar I disorder with psychotic features is a mood disorder characterized by unusually euphoric or agitated moods, along with depression or a mix of high and low moods. Psychotic symptoms are also part of this disorder, which can severely impact a person's ability to function. An accurate diagnosis and appropriate treatment plan are vital to the successful management of bipolar I disorder with psychotic features.

According to PubMed-US National Library of Medicine National Institutes of Health, the Prevalence of Bipolar 1 Disorder in the World Mental Health Survey Initiative, the aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I). In United States, Bipolar Disorder has an incidence of approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. The median age of onset for bipolar disorder is 25 years, although the illness can start in early childhood or as late as the 40s and 50s.An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component. Locally, according to the record of Mariveles Mental Hospital as of 2012, there are 1030 patients
who are admitted and only 50 or 4.85% of the total number of patients are diagnosed having Bipolar Manic Disorder. Among them, 62% (31) are Male while the remaining 38% (19) are female.

References:

http://www.ncbi.nlm.nih.gov/pubmed/21383262 Videbeck 4th ed.

II. OBJECTIVES
General Objectives The study aims to supply knowledge about its definition, manifestation, sign and symptoms, complications and treatment to students and to the patients regarding Bipolar Disorders. This study also aspires to enhance the skills of the student nurses in handling and caring for psychiatric nurses especially those with Bipolar Disorders. Another aim that this study wants to achieve is to inculcate or instill virtues such as patients understanding, kindness, devotion and dedication in the heart of nursing students.

Client Centered To improve condition by reorienting our client into reality. To express and explore clients thoughts and feelings. To sustain an interactive conversation without or with decrease level of anxiety.

Student Centered To gain knowledge about Bipolar Manic Disorder, Schizophrenia and Pyschosis To improve therapeutic communication skills of the student nurse. To gain and develop trust with client through self-awareness.

III. NURSING ASSESSMENT

A. Biographic Data
NAME: AGE: GENDER: ADDRESS: DATE OF BIRTH: PLACE OF BIRTH: NATIONALITY: CIVIL STATUS: RELIGION: HIGHEST EDUCATIONAL ATTAINMENT: DIAGNOSIS: DATE ADMITTED: TIME ADMITTED: TYPE OF ADMISSION: Ms. Sue 55 y/o Female Mariveles, Bataan December 17, 1957 Estancia, Iloilo Filipino Single Born Again Christian College Graduate Bipolar Manic Disorder with Pyschotic Feature (monosocial), To consider Paranoidal Schizophrenia August 31, 2012 10:35am Old (3x)

CHIEF COMPLAINT (recent admission): Escaped from Home Refused to take Medications Poor Sleep Talking Singing Aloud Refuse to eat meal except for fruits - source: Ms. VM (friend)

B. History Illness Prior to Admission

In 1999, before being brought to a Mental Institution, she was first brought to Bautista Home Care Facility because she was eliciting manifestations of mental illnesses. She was released in 2000 and is attending OPD check-ups on June and July(unknown institution) and was diagnosed with Bipolar Manic and Psychotic Features; she stopped her medications August of that year.. Patient had several confinements at MMH. Her first admission was on November 05, 2010, with complains of stopping her medications, being very noisy and difficulty sleeping. She was diagnosed again with Bipolar Manic and Psychotic Features. Her 2nd Admission was on October 06, 2011, with

During Institutionalization
At August 31, 2012, ACIS, she was seen by the psychiatrist and she was described as being hostile, very noisy and uncooperative. According to the records, she was verbalizing Ang aking kaharian, singing loudly lalalalala and she called her physician as Dr. Quack-Quack. On September 07, 2012, she was seen again by the physician and was described as wearing appropriate clothes, barefoot and was holding a water bottle while being interviewed. She was exhibiting Delusion of Grandeur, saying that she was the product manager in Malacanang since Marcos regime. She claimed that the people who are watching her are unknown to her, but later said

Upon Handling
February 07, 2013, signals the start of our Nurse Patient Interaction (NPI). We met our client Ms. Sue and she can be described as a cooperative patient, polite and well behaved. She was very conscious with her hygiene. We have also observed that the client is really conscious when it comes to time. She does not like being late as observed when we were grooming her. She appears to be calm and easily controlled during our NPI. She participated on all of the activities and really showed enthusiasm in all of

complains of difficulty sleeping then she was diagnosed again like the previous. Before her present admission, she obediently attends to her follow-up check-up at the OPD until June 2012. Last July 2012, the client started to refuse taking medications for her psychiatric condition and Medications for Liver, Kidney and Diabetes Mellitus. She stated that she stopped because she listened to an advice (unknown informant) that the medications are the one causing her Robot-like movements or feeling. She stated that she complied to it because she is actually experiencing the manifestations that the informant told her. By August 05, 2012, she escaped from the house of the informant by climbing down a guava tree near the informants fence, then she went to Baesa, Quezon City where her friend lost contact from her. On August 8, 2012 (before the date of admission), the informant learned that she was placed at a barangay station (unknown location) due to complains from the supermarket employees who she had a quarrel with. Non Smoker.

huwag kang maniniwala, singungaling yan!. On the following day, September 08, 2012, she was seen again by the physician and was described as having a well-kept appearance and behaviour, severely cheerful, dated, good mood, talkative, argumentative but polite, speaks in English with mood disturbances while speaking. She admitted that she is dancing and singing. When asked why, she answered Syempre, Masaya!!. She was also exhibiting Referential Delusion verbalizing nagbebenta ako ng imported giveaways, admits that she was called by the king of the Department of Budget and Managament. She was also exhibiting Persecutory delusions, verbalizing, maraming galit sa akin, pinapatay nila ako, diko alam kung bakit (she was pertaining to Dela Cruz Family). She was also suspicious saying Yung gamot na binibigay nyo, Tranquilizer that is SHABU!. She claims that she wants to live alone, verbalizing Ayaw kong minamahal ako o dinodomina ako, she accuses her guardian saying ikaw ba talagang tapat sa akin? Sagutin mo ako!!, she was also observed with having poor insight saying Magaling na ako eh, di ko na kailangang gamot.

them. During our last day handling her, she was being visited by her friend. We were surprised to see a new side of her as she is demonstrating hostility as she was begging her friend to take her home already. This was the first time that we have seen her like that. She was still mentioning that once she comes out from the facility, she would immediately get her salary from her company and start her life anew. She even demonstrated delusion of grandeur as she verbalized that she would help us financially when she gets out of the facility to reward us for taking good care of her.

C. Previous Illnesses
The client was also diagnosed with Type 2 Diabetes Mellitus 2 years ago and was prescribed to take Hypoglycemic Agents like Metformin. She took the medications for one year and then she refused to take the said medications. The client also recalled having cough and cold prior to admission. She also remembered having chickenpox when she was 12 years old.

D. Past Personal History

The earliest event that the client remembered was playing with her siblings and friends at Iloilo City. She told us she was average student and has never had a serious problem at school. During her high school years, she used to hang out with her friends especially with her bestfriend. She did not finish her studies as she took up nursing at Central Philippines University due to financial problems. The client worked as an attendant at the Bataan Hilltop Hotel during her younger years in which she recalled seeing many of the famous artists like FPJ, Alma Moreno and Rudy Fernandez. She is not married and she never had boyfriend even when she was young because according to her, her focus was to finish her studies and being able to help her family first.

E. Family History
According to her, before she was diagnosed, she had a good relationship with her family. She used to hang out with her siblings and spend every Christmas together. But recently, she is very angry at her siblings after they brought her to 3 different Mental Health Institutions and refused to take responsibility of her. According to the client, there is no previous history of mental illness within the family but her mother was diagnosed with heart condition.

IV. Mental Status Examination

LEVEL OF CONSCIOUSNESS Alert Drowsy Cooperative Eye contact AFFECT Flat Blunted Inappropriate MOOD Appropriate Anxious Agitated Elated Depressed DRESS Appropriate Neat HYGIENE Good Poor ORIENTATION Time Day1 * * * Day2 * * * Day3 * * * Day4 * * * Day5 * * *

* *

* * * *

* * * *

* * * *

* * * *

* * * *

Place Person Situation MEMORY Recent (Dinner/Breakfast Recent (Current Events)

* * * * *

* * * * *

* * * * *

* * * * *

* * * * *

Immediate (Short Term) Remote ( Long Term) DEFENSE MECHANISM Displacement Denial Intellectualization Introjection Projection Rationalization Reaction Formation Regression Repression Sublimation Suppression Identification Isolation Others: EXTRA PYRAMIDAL SYMPTOMS PSEUDOPARKINSONISM Akinesia Mask-like face No swinging of arms Hesitancy of Speech Decrease muscle strengths Shuffling gait Drooling Fine intention tremors ACUTE DYSTONIC REACTION Muscle spasm of the jaw, neck, tongue, eyes

* *

* *

* *

* * *

* * *

 Laryngeal spasm Akathesia Restlessness Tenseness Inability to sit still Rocking back and forth of feet Crossing legs frequently Inability to relax TARDIVE DYSKINESIA Involuntary movement of mouth, tongue ,face, and may extend to finger arms and trunk THINKING COMMUNICATIONS Loose Association Neologism Word Salad Echolalia Echopraxia Clang Association Illogical thinking Alogia Concrete Thinking Lack of Insight PERCEIVING AND INTERPRETING Delusions Reference Persecution

* *

* *

* *

* *

 External influences Somatic Grandiose Hallucination Cinesthetics Visual Olfactory Gustatory Auditory Tactile

SUMMARY OF MENTAL STATUS EXAMINATION:

During the five days of assessing the Mental State of the patient, she shows alertness, cooperativeness, and eye contact. Her mood is appropriate and is oriented to time, place, person and situation. She was dressed appropriately and neatly, and her hygiene is good. She still remembers recent events and has long term memory. She exhibits some extra pyramidal symptoms like fine intention tremors and tenseness. While conducting a Nurse- Patient Interaction, the patient shows defense mechanism characterized as Denial and Projection. She denied her condition because she has poor judgement which leads to the lack of knowledge about her mental condition. She exhibits Projection as a defense mechanism because she believes that she doesnt have mental illness, she hates her family for bringing her to the Mental Institution, the reason why she wants them to experience her affliction inside the ward.

V. THEORETICAL FRAMEWORK
A. GROWTH AND DEVELOPMENT Name: SCB Age: 55 years THEORY PSYCHOSOCIAL (Erik Erikson) Intimacy vs. Isolation ( 18 -25 yrs. old) This stage covers the period of early adulthood when people are exploring personal relationships. Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will form relationships that are committed and secure. COGNITIVE (Jean Piaget) Formal Operational (12- Adulthood) The formal operational stage begins at approximately age twelve to and lasts into adulthood. During this time, people develop the ability to think about abstract concepts. Skills such as logical thought, deductive reasoning, and systematic planning also emerge during this stage. PSYCHOSEXUAL (Sigmund Freud) Genital Stage (12 - Adulthood) MORAL (Lawrence Kohlberg) Post - Conventional: Universal Ethical Principle Oriented Kolhbergs final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.

STAGE

DEFINITION

During the final stage of psychosexual development, the individual develops a strong sexual interest in the opposite sex. This stage begins during puberty but last throughout the rest of a person's life. Where in earlier stages the focus was solely on individual needs, interest in the welfare of others grows during this stage. If the other stages have been completed successfully, the individual should now be

well-balanced, warm and caring. The goal of this stage is to establish a balance between the various life areas.

REMARKS/ANALYSIS

Client was not able to satisfy this stage because she did not have her own family. Instead, she supported her family to the fullest. Client is isolated due to the fact that she is separated from her relatives and loved ones.

Client developed a formal cognitive perception as evidenced by observed clients ability to reason out answer to logical questions.

Client did not pass through this stage completely because client did not satisfy her sexual desires as well as a need for family even though her reproductive system is functioning normal.

Before, client was able to identify ethical principles such as a persons right and rules of the state but now she is unable to differentiate right from wrong. Also her decision making is somewhat affected due to her psychological problem. This is evidenced by wrong judgement when asked about situational problems.

B. Theoretical Frameworks
Theory
Self-Care Theory

Theorist
Dorothea Orem

Description
The provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects. Nursing promotes the goal of patient self-care. a. SELF-CARE - comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life. b. SELF-CARE DEFICIT results when the Self-care Agency (patient) cant meet her/his selfcare needs or administer self-care

Application of the Theory to the Patient

Orem focused on a specific need of person, which is self care. This can be defined as being able to maintain health with the help of oneself. But if one is psychologically incapacitated, he/she might not be able to do such task. This theory serves as a guide for us student nurses to act in helping out clients take care of themselves again or achieve maximum level of wellness as possible.

Nightingales Environmental Theory

Florence Nightingale

Defined Nursing: The act of utilizing the environment of the patient to assist him in his recovery. Focuses on changing and manipulating the environment in

We used this theory to determine the factors that will affect clients health as well as in choosing appropriate interventions for our clients.

order to put the patient in the best possible conditions for nature to act. Identified 5 environmental factors

NECK AND LYMPH NODES Symmetry and visible mass of thyroid gland Inspection Glands ascends during swallowing but is not visible Not palpable No visible masses Normal

Presence of tenderness or nodules in the lymph nodes

Palpation

No nodules or tenderness

Normal

Placement of trachea

Palpation

Central placement in the midline of neck; spaces are equal on both sides Lobes may not be palpable

In midline of neck

Normal

Smoothness and areas of enlargement, masses or nodules in the thyroid gland

Palpation Asking the client to lower the chin slightly

No areas of enlargement

Normal

SKIN

Inspect for color and uniformity

Inspection

Varies from light to deep There are no observable brown, ruddy pink to light patches in the clients face pink, yellow overtones to olive; and skin generally uniform except in areas exposed to the sun, areas of lighter pigmentation in darkskinned people No edema and inflammation (-) edema

Normal

Inspect for the presence of edema

Inspection and Palpation

Normal

Inspect and palpate for skin lesions according to location distribution, color, configuration, size, shape, type or structure

Inspection and Palpation

Freckles, some birthmarks, some flat and raised nevi; no abrasions or other lesions

There are noticeable scratch marks all over the body of the client. Prominent on both legs.

Deviation from normal due to itchiness

Observe and palpate skin moisture

Inspection and Palpation Palpation

Moisture in the skin folds and axillae Uniform, within normal range

Deviation from normal due to poor sanitation The patient has dry skin. Normal Skin temperature is within normal range

Note skin temperature

Note for skin turgor Inspection NAILS Skin springs back to previous state; may be slower in elders

Due to poor hydration and aging

Skin springs back slowly Normal

Inspect fingernail shape to determine its curvature and angle

Inspection

Convex curvature, angle of nail plate about 160 No signs of early clubbing Normal

Inspect fingernail and toenail texture Inspect fingernail and toenail bed color

Inspection Inspection

Smooth texture Highly vascular and pink in Smooth texture light skinned clients; dark Pink in color skinned clients may have brown or black pigmentation in longitudinal streaks Intact epidermis No presence of lesions

Normal

Inspect tissues surrounding nails

Normal Inspection

Normal Perform blanch test or capillary refill Inspection Prompt return of pink or usual color Skin return to its normal color; pinkish

THORAX ANTERIOR THORAX 1. Breathing patterns 2. Temperature, tenderness, masses Inspection Palpation Quiet, rhythmic, and effortless respirations Skin intact; uniform temperature; chest wall intact; Normal rhythmic breathing Normal

Has an intact skin; has equal Normal warmth on both sides. No

no tenderness; no masses

masses.

3. Anterior thorax auscultation

Auscultation

Bronchovesicular and vesicular breath sounds

No crackles sounds on the upper thorax & lower thorax

Normal

POSTERIOR THORAX 1. Shape, symmetry, and comparison of anteroposterior thorax to transverse diameter 2. Spinal alignment 3. Temperature, tenderness, and masses 7. Posterior thorax auscultation CARDIOVASCULAR AORTIC and PULMONIC AREAS Auscultation No pulsations No pulsations felt Normal Inspection Palpation Anteroposterior to transverse diameter in ratio 1:2; Chest symmetric Spine vertically aligned Skin intact; uniform temperature; chest wall intact; no tenderness; no masses Has a anteroposterior to transverse diameter ratio of 1:2, elliptical in shape and symmetrical chest Has a vertical alignment No masses nor tenderness; has equal warmth on each side Normal

Inspection Palpation

Normal Normal

Auscultation

Vesicular and bronchovesicular No crackles, heard on the breath sounds anterior and middle part of right and left lungs.

Normal

TRICUSPID AREA APICAL AREA

Auscultation Auscultation

No pulsations; no lift or heave Pulsations visible in 50% of adults and palpable in most PMI in fifth LICS at or medial to MCL Aortic pulsations S1: Usually heard at all sites Usually louder at the apical area S2: Usually heard at all sites Usually louder at the base of heart Systole: silent interval; slightly shorter duration than diastole at normal heart rate (60 to 90 beats/min) Diastole: silent interval; slightly longer duration than systole at normal heart rates S3: in children and young adults S4: in many older adults

No pulsations of lifts Has full pulsation

Normal Normal

EPIGASTRIC AREA CARDIOVASCULAR AREAS AUSCULTATION

Auscultation Auscultation

Has pulsation Has full and rapid pulsation.

Normal Normal

Sounds on the aortic and pulmonic areas; has a lub Normal sound on the apex and dub sounds on the tricuspid area.

Normal

CAROTID ARTERIES

1. Carotid artery palpation

Palpation

Symmetric pulse volumes; full pulsations, thrusting quality; quality remains same when the client breathes, turns head, and changes from sitting to supine position; elastic arterial wall

Normal pulsation. Symmetrical pulse.

Normal

AXILLAE 1. Axillary, subclavicular, and supraclavicular lymph nodes ABDOMEN Inspection No tenderness, masses, or nodules Have no masses and nodules. Normal

1. Skin integrity 2. Abdominal contour 3. Enlargement of liver or spleen 4.Symmetry of contour 5. Abdominal movements associated with respirations, peristalsis or aortic pulsations

Inspection Inspection Inspection Inspection Inspection

Unblemished skin; uniform color Flat, rounded(convex), or scaphoid(concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area

Uniform color and has no blemishes Has a concave abdomen. No enlargement of the spleen and liver seen Has a symmetrical abdominal contour Abdominal movements noted when inhaling.

Normal Normal Normal Normal Normal

6. Vascular pattern MUSCULOSKELETAL SYSTEM MUSCLES 1. Muscle size and comparison on the other side 2. Fasciculation and tremors in the muscles 3. Muscle tonicity 4. Muscle strength JOINTS 1. Joint swelling

Inspection

No visible vascular pattern

Has no blood vessels visible

Normal

Inspection

Proportionate to the body; even Proportionate to the body; in both sides even in both sides No fasciculation and tremors Even and firm muscle tone Has tremors Even and firm muscle tone

Normal

Inspection Palpation Palpation

Deviation from normal due to the side effects of medications. Normal Normal

Has equal muscular strength on Has equal muscular strength both sides on both sides

Inspection

No swelling, no warmth, no redness, no pain, no crepitus No swelling, no warmth, no redness, no pain.

No swelling, no warmth, no redness, no pain, no crepitus No swelling, no warmth, no redness, no pain.

Normal

EXTREMETIES

Inspection, Palpation

Normal

PHYSICAL ASSESSMENT SUMMARY

GENERAL: The patient is a nourished female; alert and oriented. VITAL SIGNS: Temperature: 36C, PR: 82 bpm, RR: 28 cpm, BP: 110/80 mmHg HEENT: Head is normocephalic and atraumatic; Patches of alopecia are present, with thin hair, dry and flaky scalp; lice and lesions are present in the head. Presence of cerumen and wounds on both ears (pinna); Presence of mouth sores; Extraocular muscles are intact. NECK: No carotid bruits. No lymphadenopathy or thyromegaly. LUNGS: No crackles heard on the anterior and middle part of right and left lungs. HEART: Regular rate and rhythm without murmur. ABDOMEN: Soft, not tender, and not distended. No Hepatosplenomegaly. MUSCLE: Has tremors. SKIN: There are noticeable scratch marks all over the body of the client; presence of lesions on both legs; skin springs back slowly and with dry skin.

VIII. LABORATORY
Laboratory Procedure Blood Chemistry Date Ordered. Date of Result Ordered: December 20 Result: January 24, 2013 Indication/ Purposes A test to assess a wide range of conditions and the function of organ. 60-110.9 mg/dl 0-200 mg/dl 97-190.3 mg/dl 65.4 mg/dl 186.9 mg/dl 132.6 mg/dl Normal Normal Normal Normal Values Actual Values Analysis/ Interpretation Nursing Responsibilities Prior: - Define and explain the test. - State the specific purpose of the test. - Explain the procedure. - Discuss test preparation, procedure, and post test care. During: Ensure that the

FBS Cholesterol Triglycerides

specimen is secured in a sterile container. After: Apply manual pressure and dressings over puncture site. Monitor the puncture site for hematoma formation.

IX. Medical Management (Pharamacologic Treatments)

DRUG NAME MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE/ ADVERSE EFFECT NURSING CONSIDERATIONS

Generic Name: Clonazepam Classification: Anti-convulsant Anxiolytics Route/Dosage: 2mg tab PO HS then PRN tab

Probably acts by facilitating the effects of the inhibitory neurotransmitter GABA

Atypical absence seizures Akinetic and myoclonic seizures Panic disorder Acute manic episodes of bipolar disorder

Contraindicated in patients hypersensitive to benzodiazepine. Use cautiously in patients with mixed type seizure because drug may cause tonic-clonic seizures

Drowsiness Agitation Ataxia Slurred speech Tremor Confusion Behavioral Disturbance

Closely monitor all patients for changes in behavior that may indicate worsening of suicidal thoughts or behavior or depression/. Dont stop drug abruptly Assess elderly patients response closely. Elderly patients are more sensitive to CNS drug effects. Monitor CBC and liver function tests.

DRUG NAME

MECHANISM OF ACTION Probably facilitates the effects of the inhibitory neurotransmitter GABA.

INDICATIONS

CONTRAINDICATIONS

SIDE/ ADVERSE EFFECTS Dizziness Headache Blurred vision Back and neck pain

NURSING CONSIDERATIONS Give drugs with food to avoid to reduce adverse GI effects. Advise patient to immediately report malaise, weakness, lethargy, appetite loss, vomiting, or yellowing of skin or eyes. It can be a symptom of hepatic dysfunction. Dont stop drug abruptly.

Generic Name: Divalproex Sodium Classification: Anti-convulsant Route/Dosage: 250mg PO OD

Simple and complex absence seizures Complex partial seizures Mania associated with bipolar disorder Prevent migraine headache.

Contraindicated in patients hypersensitive to drug and in those with hepatic disease.

DRUG NAME

MECHANISM OF ACTION Blocks dopamine and serotonin receptors. Its action may be mediated through this anatagonism.

INDICATIONS

CONTRAINDICATIONS

SIDE/ ADVERSE EFFECTS Orthostatic hypotension Flulike syndrome Dizziness Headache Somnolence Skin Rash Wight gain Hyperglycemia

NURSING CONSIDERATIONS Dont break or crush tablets Give drug without regard for food Watch out for evidence of neuroleptic malignant syndrome (extrapyramidal effects, hyperthermia, autonomic disturbance) which is rare but deadly. Monitor patient for Tardive Dyskinesia, which may occur after prolonged use of drug. Monitor for metabolic syndrome ( wt. gain, hyperglycemia, hypercholesterolemia

Generic Name: Quetiapine Classification: Antipsychotics Route/Dosage: 300 mg HS

Schizophrenia Adjunct therapy with Lithium or Divalproex for the short term treatment of acute manic episodes associated with bipolar disorder. Depression associated with bipolar disorder.

Contraindicated in patients with hypersensitive to drug or its ingredients. Use cautiously in patients with conditions that can predispose hypotension and conditions in which core body temperature may be elevated.

DRUG NAME

MECHANISM OF ACTION Competes with histamine for H1receptor sites. Prevents, but doesnt reverse, histamine-mediated responses, particularly those of the bronchial tubes, GI tract, uterus and blood vessels.

INDICATIONS

CONTRAINDICATIONS

SIDE/ ADVERSE EFFECTS Hypotension Tremor Vertigo Headache Dry mouth Thickening of bronchial secretions.

NURSING CONSIDERATIONS Give drug with food or milk to reduce GI distress. Caution the client that the medication can cause drowsiness. Explain to the patient that arising quickly from a lying or sitting position may cause orthostatic hypotension. Inform patient that sugarless gum or hard candy may relieve dry mouth.

Generic Name: Dipenhydramine Classification: Anti-histamine; Antiparkinsonian Route/Dosage: 50 mg PO HS

Rhinitis and allergy symptoms Parkinsons disease Sedation Nighttime sleep aid Non-productive Cough

Contraindicated in patients hypersensitive to drug. Avoid use in patients with asthma. Contraindicated in patients taking MAO inhibitors.

DRUG NAME

MECHANISM OF ACTION Blocks Dopamine and 5-HT receptors in the brain

INDICATIONS

CONTRAINDICATIONS

SIDE/ ADVERSE EFFECTS Akathisia Somnolence Dystonia Insomia Agitation Parkinsonism Hallucination Tremor Abnormal Thinking Decreased libido Hypertension Hyperglycemia

NURSING CONSIDERATIONS Tell patient that he/she can take drug with or without food. Obtain baseline blood pressure measurements before therapy. Watch out for orthostatic hypotension. Monitor patient for tardive dyskinesia, which may occur after prolonged use. Life-threatening hyperglycemia may occur. Monitor patients with Diabetes.

Generic Name: Risperidone Classification: Atypical Antipsychotic Route/Dosage: 4mg tab

Schizophrenia Combination therapy with Lithium or valproate for 3 week treatment of acute manic or mixed episodes from bipolar I disorder.

Contraindicated in patients hypersensitive to drugs Use cautiously in patients with CV disease.

DRUG NAME

MECHANISM OF ACTION Block dopamine receptors in the brain; also alter dopamine release and turnover.

INDICATIONS

CONTRAINDICATIONS

SIDE/ ADVERSE EFFECTS Extrapyramidal reactions Sedation Tardive dyskinesia Pseudo parkinsonism Ocular changes

NURSING CONSIDERATIONS Advise patient not to crush, chew or break tablet. Make sure the medication is taken. Obtain baseline blood pressure measurements before therapy. Watch out for orthostatic hypotension. Monitor patient for tardive dyskinesia, which may occur after prolonged use. Dont stop drug abruptly.

Generic Name: Chlorpromazine Classification: Typical anti-psychotic Route/Dosage: 100 mg HS

Psychosis Mania Behavioral disorders; hyperactivity

Contraindicated in patients hypersensitive to drug. Contraindicated in those with CNS depression. Use cautiously in patients with severe CV disease (may suddenly decrease blood pressure)

X. PROCESS RECORDING
CONVERSATION DEFENSE MECHANISM with ANALYSIS THERAPEUTIC COMMUNICATION TECHNIQUES USED

FIRST DAY OF INTERACTION N1: Good morning po. Ano po pangalan nyo? P: Good morning, kayo ba magiging nurse ko? Ako si S.B. N2: Opo, ako po si Chelle, siya nman po si Criselle at ito naman po si Eries. P: Hello Nurse Chelle, Nurse Criselle at Nurse Eries. N3: Sana po maging masaya kayo kasama kame. P: Mukha naming mag eenjoy ako sa inyo at mababait naman kayo. Maliligo ba ako? N1: Hindi po, magtutooth brush ka muna po at maghihilamos po kayo. Tutulungan po naming kayong gawin iyon. P: Osige. Salamat ha. (AFTER THE SAID GROOMIING) N2: May mga sugat po ba kayo? P: Oo, dito sa may ulo, dahil ito sa balikubak e, ang tapang kse ng ginagamit naming sabon, Perla. N3: Ganoon po ba? Osge po, gagamutin po natin ang mga sugat nyo. Sabihin nyo po kung masakit at mahapdi ha. P: Osige. Salamat ha. EXPLORING GIVING INFORMATION OR INFORMING

OFFERING SELF

RATIONALIZATION

(NURSE DOES THE WOUND CARING) N1: okay na po. Yan lang po ba ang sugat nyo? Wala nap o sa katawan? P: Wala na e. ano na ang susunod nating gagawin? N3: pupunta po tayo sa area kung saan tayo gagawa ng mga activities. Tara po, lakarin napo natin. P: Osige. (WHILE WALKING) N3: Alam nyo po ba kung anong araw ngayon? P: oo, Thursday. February 7. Db? N2: Opo. Bali makakasama nyo po kami hanggang sa susunod na byernes, bale pitong araw po tayong magkakasama at may mga activities na gagawin. Sali po kayo ha, dapat po manalo lagi ang grupo natin. P: Oo naman sige. (AT THE ACTIVITY AREA) N1: Upo po tayo maam, magkwentuhan tayo. N3: ilang taon napo kayo? P: 55 years old. 3rd year nursing student na din ba kayo? N3: opo. N2: ilang taon na po kayong nakaconfine dito? P: mga aanim na buwan palangg. Pero ito na ang pangatlong beses kong napasok dito. Gusto ko na ngang umuwi e. N3: taga saan po ba kayo? P: Taga Ilo-ilo talaga ako, kaya lang nanirahan ako sa QC dahil sa Malacanan ako nagtatrabaho noon. N1: sino po bang nagpadala dito sa inyo? P: yung mga kapatid ko. May nangyari kasi sa akin

GIVING INFORMATION OR INFORMING

GIVING INFORMATION OF INFORMING

OFFERING SELF EXPLORING

COMPENSATION

at ayaw nila akong paniwalaan, hindi nila ako iniintindi. N3: ano po ba iyon? P; mahabang kwento e, at baka hindi nyo ako paniwalaan. N1: makikinig po kami sa inyo, asahan nyo po iyon. P: talaga? Yung mga kapatid ko kasi hindi ito pinaniniwalaan at sabi nila sira ulo daw ako, e hindi naman ako sira ulo e. N2: ano po bang nangyari? P: august 25, 1995 may nangyari sa akin. Galing ako sa trabaho nun eh, mga alas nyebe ng gabi, nagpaphinga ako sa terrace ng bahay ko. Tapos pumasok na ako sa kwarto ko, may bigla akong naramdaman na kuryente na nagsimula sa bumbunan ko pababa sa buong katawan ko. Itong mga mata ko, napakasakit dahil hinugot ito pababa sa baba pa ng lupa at nakita ko ang palasyo ng kadiliman, ang namamahala ditto ay si Satanas. Si Satanas ang pumasok sa katawan ko, at inaalog alog pa nila ang katawan ko para magkasya pa ang napakarami niyang kamppon. Dahil malapit na daw ang paghuhukom at kailangan nilang pagtago sa katawan ko dahil ako ay ligtas sa paghuhukom, ang tawag nila sa akin ay Ang Batang Walang Malay. Kapag daw sila ay pumasok sa katawan ko, magiging ligtas na sila. Nakikita ko ang sila, pumapasok dito sa bumbunan ko, ito kasi ay malambot, napakasakit. N1: ano pa po ang nakita nyo? Naramdaman? P: may mga uod na kumakain sa laman ko. N2: pano po yon natapos? P: napakasakit sa katawan at napakabigat sa pakiramdam. Madaming mga diablo at si Satanas ay

OFFERING SELF DENIAL EXPLORING CONVERSION

ENCOURAGING DESCRIPTION OF PERCEPTIONS

EXPLORING

pumasok sa katawan ko. Alam nyo ba, nakakausap ko din ang Panginoon. N3: Ano po ang pinag-uusapan nyo? P: ang sabi niya tatagan ko ang loob ko laban kay Satanas at may binigay syang misyon sa akin. N1: ano po ang misyon na iyon? P: ang patayin si satanas at puksain ang kasamaan nito. N3: hanggang ngayon po ba nakakausap nyo sila? P: Oo, nakakausap ko sila, at unti unti nang nababawasan ang nasa loob ng katawan ko. N2: ano po ang nararamdaman nyo pag ganon? P: maaliwalas sa pakiramdam. Ngunit ayaw parin akong paniwalaan ng kapatid ko tungkol doon at dinala nila ako dito. Gustong gusto ko nang umuwi, nakakainip pa dito. N3: ano po ba ang mga pang araw araw na ginagawa nyo dito? P: wala. Dun lang kame sa ward, kakain, matutulog. N1: kamusta naman po ang mga kasama nyo? P: okay naman, mabuti nga at walang nakikipag away doon sa ward naming e. N2: napaaway na po ba kayo dati? P: Oo, sa ibang ward pa ako non, ayoko sanang patulan pero pag hindi ako lalaban lalo nila akong sasaktan. N3: e ang pagkain nyo naman po, kamusta? P: naku, lutong baboy. Pero wala na akong magawa kung hindi kainin to, kung hindi magugutom ako. N2: pano po kayo sa pagligo? P: araw araw, alas kwatro ng madaling araw, sabay sabay kami, walang damit lahat. N1: osge po, maam, may gagawin po tayong activity

ENCOURAGING EVALUATION OR EVALUATING PROJECTION

EXPLORING EXPLORING

ASKING QUESTION EXPLORING GIVING INFORMATION OR INFORMING

ha. P: osge. (ALL PATIENTS PERFORMED ACTIVITY/THERAPY, CLIENT SB PARTICIPATES WELL. AFTER THE ACTIVITY PATIENTS ATE MIRYENDA AND TOOK THEM AGAIN IN THEIR RESPECTIVE WARDS) (while walking back to the clients ward) N2: sana po ay nag enjoy kayo. P: Oo nmana. Salamat ha. N3: magkikita pa po tayo ulit bukas ha. Salamat po. Mag iingat po kayo. P: mag ingat din kayo. Salamat. SECOND DAY OF INTERACTION P: Hello. Good morning po. N1: Hi. Good morning din po. N2: Hello Susan. Good morning! N3: Good morning. Natatandaan mo pa ba ang mga pangalan namin? P: Oo naman po. N2: Sige nga po. Sino ako? P: Ikaw si Nurse Chelle. N3: Eh ako naman po sino? P: Nurse Criselle at siya si Nurse Eries. N1: Wow Susan. Matandain ka pala. N2: Oo nga. Tara, grooming na tayo. P: Sige po. (GROOMING AREA)

Seeking Clarification Seeking Clarification Seeking Clarification Giving Recognition

N3: Magtoothbrush ka muna bago magshampoo para hindi mabasa damit mo. P: Sige po. N2: Eto na po ang toothbrush mo. P: Tapos na po. N1: Sige magshampoo ka naman. P: Sige po. N2: Eto ang sabon oh. Maghilamos ka naman. Eto rin ang face towel. Magpunas ka rin. P: Sige po. P: Tapos na po. Lalaban ko na rin po tong face towel para malinis. N3: Ay sige po. Ang bait mo naman. N1: Oh eto po ang cotton buds. Linis ka muna ng tenga mo. Tapos maglotion ka rin saka naming lagyan ng betadine yung sugat mo sa ulo. P: Sige po pero sabi ni Maam 15minutes lang daw. May 15minutes na ba? N2: Ay, ok lang po yun. Ang mahalaga malinis at magamot naming yung sugat mo. At saka maglalakad lakad din tayo para may exercise ka. N3: Ayan okay na. Tara na po lakad lakad muna tayo bago magpunta dun sa pinuntahan natin kahapon. (WHILE WALKING) N3: Kumusta naman po kayo? Maayos ba ang naging tulog niyo? P: Ayos naman po ako. Puro ako na lang ang kinukumusta nyo, kayo po ba kumusta? N2: Ay, ayos lang din naman po kami. Salamat sa pagtatanong. N1: May activity po ulit tayo ngayon ha.

Giving Recognition

Broad Opening

P: Talaga po? Anong gagawin natin? N2: Newspaper reading po ang gagawin. P: Ah. Sige po. N1: Ayan malapit na tayo sa students area. (STUDENTS AREA) N2: Upo ka na Susan. P: Salamat po. N1: Bale Susan, Friday ngayon. Hindi tayo magkikita bukas at sa Sunday ha. Monday na ulit tayo magkikita. P: Ah. Uuwi na ulit kayong Bulacan? N3: Oo, kaya hindi muna tayo magkikita ng dalawang araw. P: Okay po. N2: Tara, magsimula na tayo sa pagbabasa. (AFTER NEWSPAPER READING) N3: Ano po ang masasabi mo? P: Mataas na yung P125 na umento. Bihira sila magtaas ng ganon sa sweldo. Siguro sa mahal na rin ng mga bilihin. N1: Nung panahon niyo po ba madalas magtaas ng sweldo? P: Nako, hindi. Kaya nga maswerte ang mga nagtatrabaho ngayon kasi mataas na yung P125 na umento. N2: Doon naman po sa pagiging hydrated? Malakas ka po bang uminom ng tubig? P: Hindi po ako gaano umiinom ng tubig dito. N1: Anong dahilan at hindi ka umiinom?

GIVING INFORMATION OR INFORMING GIVING INFORMATION OR INFORMING

GIVING INFORMATION OR INFORMING

Presenting Reality

Broad Opening

Exploring

Exploring Exploring

P: Malakas akong uminom ng water noong wala pa ako dito. Kasi mineral water ang inumin naming sa bahay. Dito kasi sa gripo lang. N3: Pwede naman pong inumin yung nasa gripo. Hindi naman po nila ipapainom sa inyo yun kung hindi pwede. P: Malinis naman. Kaya lang minsan may mga lumalabas na uod at maliliit na ahas. Kaya bihira lang akong uminom ng tubig. N2: Ay, ganon po ba? Hindi po kayo nanghihingi ng mineral water? P: Sa payward lang sila nagpapainom ng mineral water. N1: Ganon po ba? Nakahingi na po ba kayo minsan ng mineral water sa nurse? P: Pag nauuhaw ako at may dumaan na nurse nanghihingi ako. N3: Ah. Okay po. N1: Teka lang po ha. Ayusin ko po yung meryenda niyo. N3: Tulong na po ako sa kanya. P: Sige po. P: Nurse Chelle, natanong mo na po ba kay Maam kung pwede akong gumawa ng sulat para sa ate ko? N2: Di ba po gumawa na kayo ng sulat kahapon? Para pa nga po sa kanilang lahat yun eh. P: Hindi, iba pa yung kay ate lang. Gusto ko na kasi talagang makalabas dito eh. N2: Sige po tatanong ko mamaya kay Maam. P: Salamat Nurse Chelle. N2: Walang anoman po. Kumusta naman po ang mga kapatid niyo? Lahat po ba sila nasa Ilo-ilo? P: Tatlo lang yung nasa Ilo-ilo. Dalawa kaming

Presenting Reality

Exploring

Exploring

Broad Opening

nandito sa Bataan at yung dalawa naman eh nasa Dubai. N2: Wow. Dubai. Ano naman po ang trabaho nila doon? P: Isang civil engineer at isang accountant ang nandoon. N2: Ay. Ang galing naman po nila. P: Isa lang ang hindi nakagraduate sa amin. Nagsisisi nga siya kung bakit hindi siya nagpatuloy sa pagaaral. Gusto nga sana niyang mag-aral ulit kaya lang matanda na siya. N2: Eh ano naman po ang trabaho niya ngayon? P: Mangingisda siya ngayon. Pero nag-aaral naman lahat ng anak niya. N2: Ayon naman po pala eh. Sana makatapos po lahat ng anak niya at sila naman ang tumulong sa tatay nila. P: Sana nga. Kaya kayo tapusin niyo yang pag-aaral niyo. Sayang lang talaga at hindi ko natapos ang pagnanurse ko. N2: Oo nga po eh. Ano po ba ang nangyari at hindi niyo natapos ang kursong nursing? P: Nagkaroon kasi ng ibang babae ang tatay ko. Kaya lahat kami naging working student. N2: Ang galing niyo naman po palang magkakapatid. P: Ganon talaga. Gusto kasi naming mga magsipagaral. N2: Eh may kapatid po ba kayo sa tatay niyo? Ilan po sila? P: Oo meron. Tatlo sila. N2: Close naman po ba kayo sa kanila? P: Ay hindi. Hindi kami mga nag-uusap.

Exploring

Giving Recognition

Exploring

Exploring

Giving Recognition

Exploring Exploring

N2: Nasaan po ba sila? P: Nasa Ilo-ilo rin sila. Huli kaming mga nagkita at nagkausap nung patay si tatay. After noon wala ng communication. N2: Ah, ganon po pala. Ayan po. Meryenda na muna po kayo. P: Kayo po, kain tayo. N1: Sige po tapos na po kami kanina sa dorm. (AFTER MERYENDA) N3: Ayan. Nabusog po ba kayo? P: Opo. Salamat po sa meryenda. N1: Dun naman po tayo sa may activity center. Practice po tayo ng power clap at cheering natin. P: Sige po masaya yun. N2: Tara po. (AFTER POWER CLAP AND CHEERING PRACTICE @ ACTIVITY CENTER) N2: Napagod po ba kayo? P: Hindi naman gaano. N1: Masaya po ba? P: Opo masaya. Nag-enjoy po ako. N3: Mabuti naman po kung ganon. N2: Paano Susan kailangan na naming umalis. Magaayos pa kami ng iba naming gamit bago umuwi sa Bulacan. P: Sige po. See you next week. Ingat kayo sa biyahe niyo ha. N1: Ingat ka rin po dito. Hanggang sa muli. P: Bye bye Nurse Chelle, Nurse Criselle and Nurse

Exploring

GIVING INFORMATION OR INFORMING

Presenting Reality

Eries. Salamat sa inyo. N1, N2 and N3: Bye bye Susan. 3rd day Interaction N1: Hello. Good morning. P: Hi, good morning po. N2: Kamusta ka naman po? P: Ok lang naman ako. Kayo po ba? N3: Ayus lang din naman kami. Kumusta weekends mo? P: Ayus naman, walang bago. N2: Tara po, mag-grooming na tayo. P: sige po. N3: Kumusta naman po ang mga sugat nyo sa ulo? Gumagamit parin po ba kayo ng Perla? P: Ok naman, hindi na ako gumamit ng perla kaninang umaga e. N3: Ganon po ba, osige po, mag sha-shampoo ka ngayon. N2: Mauna na po tayo sa pagtotoothbrush nyo. P: Sige, salamat ha. (AFTER TOOTHBRUSH, SHAMPOO, etc.) N3: gagamutin na po natin ngayon ang mga sugat nyo sa ulo ha. P: sige. N1: mahapdi po ba pag nilalagyan namin ng gamot? P: medyo, pero ok lang. Gusto ko nga yung mahapdi eh. N1, N2 and N3: (Silence)

Broad Opening Exploring

Exploring

Exploring

(AFTER WOUND CARE) P: pwede ba akong humingi ng cotton buds? Lilinisin ko yung tenga ko e, may mga sugat nga e. N1: patingin nga po. N2: Oo nga, teka po, kuha ako panlinis ha. P: osige. Maraming salamat sa inyo. (AFTER WOUND CARE) P: Naku, nahuli na tayo sa kanila. N3: ok lang po iyan. P: tara na, ready na ako. N2: Tara po, lakad na tayo. N3: Ang unang activity natin ngayon ay photo therapy, alam nyo po ba iyon? P: ah, yung ipapaliwanag yung mga larawan. N1: opo, yun po ang gagawin natin ngayon, magparticipate ka po ha. P: oo naman sige. (CLIENT PARTICIPATED WELL) (AFTER THE ACTIVITY) N1: nag-enjoy po ba kayo? P: ok lang, N3: magmiryenda na po kayo. Eto po. P: salamat, kayo ba? Kain na din kayo. N2: sige lang po, mamaya na po kami. P: napakabait nyo sa akin. Kayo kapag nakalabas na ako dito tutulungan ko kayo, sana kung ano man yung mabibigay kong mga tulong sa inyo tanggapin nyo ha. N2: oo naman po. P: pag nakalabas na ako dito aayusin ko na ang

GIVING INFORMATION OR INFORMING

buhay ko. N1: maari po ba naming malaman kung pano nyo uupisahan ayusin ang buhay nyo kung sakaling makalabas na kayo dito? P: tapos na ang pinakaunang misyon ko eh, wala na si Satanas, kaya wala nang babagabag sa loob ko. Ang natitirang misyon ko nalang ay puksain ang kasamahan ni satanas, yung mga taong criminal, at makasalanan, kailangan na nilang mawala. Napanuod nyo na ba yung movie na The Monster? N1, n2, n3: hindi po e. ano po ba iyon? P: totoo yung movie na iyon, ang monster yun ay Pugita, yun si Satanas at ang mga Galamay nung pugita ay ang mismong mga galamay din ni satanas. Ngayon ay nasa Karagat na sila ng apoy at lugar ng walang katapusang kaparusahan, at yung end of the world, totoo yun, sinabi ng panginoon sa akin yun. N2: sinabi po ba niya kung kelan iyon? P: Oo, ngayon na iyon, dahil sa satanas ay pinaparusahan na at susunod na ang mga taong gumagawa ng mga gawa niya. N3: ano pong mangyayari sa mga tao nun? P: mapaprusahan sila, kaya kayo dapat ay ang mga itinuri lang ng Panginoon ang gawin nyo, wag masasamang bagay. N2: opo. P: kaya nga may galit ako sa mga kapatid ko, dahil hindi nila ako inintindi. N1: kung makikita niyo po sila ngayon, ano po ang sasabihin niyo sa kanila? P: ilabas na nila ako dito, gusto ko maranasan din nila ang hirap na naranasan ko dito sa mental, labis nila akong pinarusahan, hindi na nga ako nakapag-

Broad Opening

Exploring

Exploring

Exploring

asawa dahil sa kanila, dahil sa kakatrabaho sapagkat sila ang priority ko, tapos ito pa ang iginanti nila sa akin. Nagagalit ako sa kanila. N3: hindi nyo na po ba sila mapapatawad? P: ewan ko, basta gusto ko maranasan nila ang naranasan ko dito, ang hirap. N1: sana po ay gumaan ang pakiramdam nyo sa ating pag-uusap ngayon. Pasensya na po, pero oras na para kayo ay ibalik sa ward. Marami pa naman tayong pag-uusapan bukas. P: osige, bukas ulit ha. N2: tara po, hated na namin kayo. P: salamat. N1, n2, n3: salamat din po. ingat po. 4th day Interaction N1, N2, N3: good morning po. P: goodmorning din po. N1: kumusta po kayo? Kumusta pagtulog nyo? P: Ok naman po. Kayo po? N2: Ok naman po. Malamig po ngayon no, ok lang po ba kayo? P: Oo malamig nga, presko, pero ok lang ako sa ganyang panahon. N3: naligo po ba kayo kaninang madaling araw? P: Oo, napakalamig, ngunit wala naman akong magagawa. N1: Oo nga po. Tara, grooming na po tayo, tsaka po natin lilinisin mga sugat nyo sa ulo. P: Oo sige. (AFTER GROOMING AND WOUND CARE)

Projection

Broad Opening

EXPLORING

OFFERING SELF

N2: Dun po tayo sa Activity Center. P: Ano ang activity natin na gagawin ngayong araw? N3: Maglalaro po tayo, tas kakanta at sasayaw, at pag kaya po ng oras manunuod po tayo ng palabas. P: Ah, yung tugtog sa laptop? N2: Opo. N3: Gusto nyo po ba iyon? P: Oo, N1: Sali po tayo sa lahat ah. Ready po ba kayo? P: Oo naman, enjoy nga yun e. (AFTER THE ACTIVITIES) N2: Kain na po kayo. P: Sige, kayo ba? Kain na din kayo, sabay na kayo sakin. N3: Nag-almusal po kame kanina, sige lang po kain na kayo. P: pagkatapos kong kumain pwede bang hingi ako ng papel at ballpen, susulatan ko yung kapatid ko. N1: osige po. Hindi na po ba kayo galit sa kapatid nyo? P: Galit pa, dahil nga dinala nila ako dito. N2: hanggang ngayon po ba? P: Oo N3: paano po kung makalabas na kayo dito? Galit parin po ba kayo sa kanila? P: Basta iuna ko muna ang paglabas ko dito bago namin pag-usapan ang tungkol sa galit ko sa kanila. N1: Paano po ba kayo magalit? P: yung pinapagalitan ko sila. N3: sa sarili nyo po? Hindi nyo naman po sinasaktan sarili nyo?

GIVING INFORMATION OR INFORMING

Exploring Projection EXPLORING

Exploring Exploring

P: Hindi naman. Hindi ko naman sinasaktan sarili ko pag galit ako. (AFTER THE CLIENT INTERPRETED MESSAGE FOR HER SISTERS LETTER) P: Ipadala nyo sa kapatid ko ha, kailangan ko na talagang makalabas dito dahil napakahirap dito. Kailangan ko nadin iayos sa tama at magsimula ulit sa buhay ko. N2: ipapadala po natin, ang CI na po ang bahala. N3: tara na po, ihahatid na po namin kayo sa ward nyo. P: salamat ha. Bukas ulit. N1: sana po nag-enjoy kayo. Salamat.

XI. Therapys done

Bulacan State University Malolos, Bulacan

College of Nursing

THERAPY PLANNING

Title of Therapy Family Therapy

Descriptions

Learning Contents

Learning Objectives

Mechanics

Resources

Expected Outcome
After 15minutes of the therapy, the client were able to: Used their cognitive skills o recall their family Expressed their feelings while remembering memories with each of the family member

Family therapy is a type Family therapy involves After 15minutes of the of psychotherapy that multiple therapy sessions, therapy the client will involves all members of usually lasting at least be able to: a nuclear family one hour each, conducted or stepfamily and, in at regular intervals (for Use their some cases, members of example, once weekly) cognitive skills the extended family for several months. to recall their (e.g., grandparents). A Typically, family therapy family therapist or team of is initiated to address a Express their therapists conducts specific problem, such as feelings while multiple sessions to help an adolescent with remembering families deal with a psychological memories with important issues that disorderor adjustment to each of the may interfere with the a death in the family. family functioning of the member family and the home environment.

After the music and Manpower: art therapy, the Student facilitator Nurse and instructed the the patient patient as well as the student nurse Materials: assisted them Bond paper through Crayons encouraging to think their loved ones and write it down on the tree Facilitator: Albert dela Cruz

Title of Therapy Photo Therapy

Descriptions
Use of photograph in a therapeutic encounter. It may use the clients own family album or personal snapshot.

Learning Contents
The therapy engages conversation with the client that might be stimulated by the photographs as memories emotions ideas and questions raised by the images

Learning Objectives
After 30mins of phototherapy, the client will be able to:

Mechanics
The client are instructed to look at the pictures then the student nurses will ask them to share the ideas regard to the picture

Resources
Manpower: Student Nurse and patient Resources: Pictures (home, family and nature)

Expected Outcome
After 30mins of phototherapy, the client were able to: think abstractly through sharing their ideas about the picture showed to them Expressed their feelings after they see the picture

think abstractly through sharing their ideas about the picture showed to them Facilitator/s: Express their feelings after they see the picture

Title of Therapy Play Therapy

Descriptions
Play therapy is a treatment modality in which the therapist engages in play with the child and adults. Play activities are used as the primary basis for communication between the child and the psychotherapist

Learning Contents

Learning Objectives

Mechanics
The facilitator will explain the procedure and demonstrate how the play will be done. The student nurses assist and play with their patient. Facilitator/s:

Resources
Manpower: Student Nurses and Patient Resources: Electronic devices (e.g laptop, speaker) Bond paper Pentel pen Cups

Expected Outcome
After 30 minutes of Play therapy the patient were able to: to make clients practice their critical thinking skills and concentration alleviated their anxiety practiced their social skills as they enjoy playing with other patients

It is used in identifying After 30 minutes of and appreciating Play therapy the childhood mental patient will be able to: disorders and how they to make clients pull away from normal practice their functioning. This can critical affect their home lives, thinking skills academic performances, and as well as their play with concentration peers. Play therapy offers alleviate their a direct route to engage anxiety children/adult on their practice their terms, in their world. social skills as they enjoy playing with other patients

Title of Therapy Song and Dance Therapy

Descriptions
Song and Dance therapy uses movements to improve mental and physical well being while singing

Learning Contents
It helps the patient to reduce their stress, anxiety and depression. Also increases communication skills and develop positive body image

Learning Objectives
After 30mins of Song and dance therapy the client will be able to: Reduce their anxiety, stress and depression Relax as they sing and dance Socialize with other patients through communications

Mechanics

Resources

Expected Outcome
After 30mins of Song and dance therapy the client will be able to: Reduced their anxiety, stress and depression Relaxed as they sing and dance Socialized with other patients through communicati ons

The facilitator Manpower: will explain first Student the procedure Nurses and then the student Patient nurses will show how it done and Resources: next will teach Electronic the patient to sing Devices (e.g and dance. Laptop, Lastly, to show Speakers) the talents to others. Facilator/s:

Title of Therapy

Descriptions
Cinema therapy is the process of using movies made for the big screen or television for therapeutic purposes. It allows us to gain awareness of our deeper layers of consciousness to help us move toward new perspectives or behavior as well as healing and integration of the total self. Movie Therapy is a mind therapy that involves the client viewing certain films that under the supervision of a therapist in order to help treat emotional and mental conditions.

Learning Contents
This therapy will help the patient to change the way they think and feel, and ultimately deal with life's ups and downs.

Learning Objectives
After 30mins of Movie and Cinema Therapy the client will be able to: watch films with conscious awareness explore their minds and feelings by the help of the student nurses inspire patients through movies help patients to open up communications to their student nurses about their thoughts and feelings

Mechanics
Ask patients to gather and sit in front of the monitor. Tell them to watch carefully and to reflect. After watching their student nurses may ask them to tell something about the videos they watched.

Resources
Manpower: Student Nurse and the patient Resources: Electronic devices (projector, laptop, speaker)

Expected Outcome
After 30mins of Movie and Cinema Therapy the client were able to: watched films with conscious awareness explored their minds and feelings by the help of the student nurses inspired patients through movies helped patients to open up communications to their student nurses about their thoughts and feelings

Movie and Cinema Therapy

TITLE OF THERAPY

DESCRIPTIONS

LEARNING CONTENTS

LEARNING OBJECTIVES

MECHANICS

RESOURCES

EXPECTED OUTCOME

Occupational Therapy is defined as The therapeutic use of work, self-care, and play activities to increase development and prevent disability. It may include adaptation of task or This small bag or basket environment to achieve making as an Occupational maximum independence Therapy contributes to the and to enhance the quality development of mentally of life."(American challenged clients OCCUPATIONAL Occupational Therapy especially their motor THERAPY Association Executive functions through making a board). One's occupation handmade basket or bag. It can be defined as how we is a good activity also to spend our time; whether combat the Extrapyramidal paid or unpaid, restful or symptoms of drug they are fun, obligation or choice taking. and that which fulfills us, gives us purpose, and allows us to interact with, be productive, and function in the world around us to the best of our ability.

At the end of 1 hour of therapy, the client will be able to increase his/her development or commit leisure by practicing their function through the use of making small basket or bag out of used newspaper folded in thin sizes

The student nurse will provide the materials for the client to make a small basket or bag out of used newspaper folded into thin sizes. After the time given by the student nurse, the clients must be done making their handmade basket or bag.

MANPOWER -Student Nurse -Clients MATERIALS -Old Newspapers -Glue

At the end of the therapy, the clients will be able to somehow increase his/her development or commit leisure by practicing their function through the use of making small basket or bag out of used newspaper folded in thin sizes.

Title of Therapy Storytelling

Descriptions
It is an accessible and creative form of communicating and reflecting upon experience, both real and imagined.

Learning Contents
Storytelling involves stories that use metaphor and imagery to change the way they see their lives and the world, it helps the clients think and behave in new, productive ways, offering healing and growth to everyone.

Learning Objectives
After 15 minutes of psychotherapy, the client will be able to: Reflect on the story told and express their feelings about the story. Determine the connection of the story on their lives and Verbalize having a better and positive outlook in life.

Mechanics
The facilitators will first explain the activity to the clients. A story will be read by the facilitators and after the storytelling, the clients will be asked to verbalize/express their feelings and opinions about the story. Facilitator/s:

Resources
Man power: Student nurse and the patient Materials: Book Flash Cards

Expected Outcome
After 15 minutes of psychotherapy, the client have: Reflected on the story told and had a better outlook in life. Determined the connection of the story on their lives and Verbalized a better and positive outlook in life.

Title of Therapy
Newspaper Reading

Descriptions
Newspaper therapy is giving information to the clients about events and what is happening outside. Newspaper therapy is cutting clippings from newspaper and sharing this information to the clients and knowing their feelings and ideas about the information given. Providing basic information about places/events may motivate the clients to follow the medical regimen to be well.

Learning Contents
Reading can help jumpstart the brain. It encourages the patients to show emotions and reactions about the latest news. It also encourages the patients to verbalize ideas regarding the topic.

Learning Objectives
*To be able to provide the clients an information on what is happening outside and the current news. *To be able to introduce topics that will facilitate clients participation in reading *to be able to assess clients reading comprehension through asking question about the news.

Mechanics
1. Exercise 2. Gather materials needed 3. explain the concept of newspaper reading 4. newspaper reading(15-20 minutes) 5. giving comments/ideas about the topic

Resources
*Newspaper Venue: Mariveles Mental Hospital Duration: 15-20 minutes

Expected Outcome
*Patients will be able to talk about the news they read and how they respond about it. *patients will be able to provide ideas/ suggestions/ comments/ conclusions about the topic