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Wesleyan University- Philippines Mabini Extension, Cabanatuan City Case Study Mental Affiliation in National Center for

Wesleyan University- Philippines

Mabini Extension, Cabanatuan City

Case Study

Mental Affiliation in National Center for Mental Health

Submitted by:

Jenilyn Faye M. Orpilla

Instructor

(Bsn3-4)

Submitted To:

Prof. Miriam Gonzales RN MAN

Concept

Table of Contents

I. INTRODUCTION

a. Overview……………………………………………………………………………… 3

b. Definition of Related terms…………………………………………………………… 3

c. Signs and Symptoms Manifested by the Client………………………………………

3

d. Defense Mechanism Used……………………………………………………………

3

II. PATIENT’S HISTORY

a. Personal data……………………………………………………………………… 3

b. Marks………………………………………………………………………………4

c. Chief Complaints ………………………………………………………………… 4

d. Past Health History……………………………………………………………… 4

e. Present Health History…………………………………………………………

4

f. Family History …………………………………………………………

5

g. Review of System …………………………………………………………

5

h. Lifestyle and Health Practices- 24H day Description…………………………… 5

i. Developmental Stage……………………………

………………………………

6

III. COLLECTING OBJECTIVE DATA

a. Course of Confinement…………………………………………………………

6

i. Medications Administered since date of admission ………………………………

6

ii. Diagnostic Test since Date of Admission………………………………

14

IV. PYSCHOPATHOPHYSIOLOGY ………………………………

V. NURSING CARE PLAN………………………………

References………………………………

…………….15

………………………18

…………….…………………………….19

I. INTRODUCTION

a. Overview

Patient S.A. has been admitted on April 17. 2013 at 2:03 pm. A 43 years old Female with a final diagnosis of Paranoid schizophrenia.

Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history.

Paranoid schizophrenia is one of several types of schizophrenia, a chronic mental illness in which a person loses touch with reality (psychosis). The classic features of paranoid schizophrenia are having delusions and hearing things that aren't real.

With paranoid schizophrenia, your ability to think and function in daily life may be better than with other types of schizophrenia. You may not have as many problems with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many complications, including suicidal behavior.

b. Definition of Related terms

Schizophrenia- is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior.

Paranoid schizophrenia- is the most common type of schizophrenia in most parts of the world. The clinical picture is dominated by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic symptoms, are not prominent.

c. Signs and Symptoms Manifested by the Client According to client: Delusion of Grandeur (hearing her name in the TV and Radio) Argumentativeness (yelling to other people) Short tempered Violence (trying to give her medication to her 7 yr. old daughter) Auditory Hallucination (someone was commanding her)

d. Defense Mechanism Used:

Denial and Suppression

II. PATIENT’S HISTORY A. Personal Data i. Name: Patient S.A.

ii. Age: 43 years old

iii. Gender: Female

iv. Birthday: May 16. 1970

v. Birthplace: Maligaya, Banni, Pangasinan

vi.

Civil Status: Single

vii. Address: Maligaya, Banni, Pangasinan

viii. Phone Number: -none as stated-

ix. Educational Level: College Graduate

x. Occupation: None

xi. Race/ Ethnic Group: Tagalog

xii. Religion: Iglesia ni Cristo

xiii. Nationality: Filipino

xiv. Citizenship:

xv. Language spoken: Tagalog

xvi. Source of information: Chart of Patient

xvii. Reliability: 99% xviii. Companion upon admission: Father

xix:

Filipino citizen

b. Marks Moles: at Right Arm Left side face Right eye Left deltoid Abrasion in the Nape area

c. Chief Complaints:

i. Chief Complaint upon admission:

According to her Father- “Dalawang araw nang hindi umiinom ng gamut” “Kung ano-anong kababalaghan gingawa nya” “Umaalis ng Bahay” “Itapon sa kubeta yung bottle para pakuluan” “Pinainom sa anak niya ang gamut niya”

ii. Final Diagnosis: Paranoid Schizophrenia

d. Past Health History:

According to Chart:

The Patient is Re-admitted to the National Center for Mental Health

According to The Patient:

- She first experienced the symptoms of schizophrenia 14 years ago… She knows when her illness will attack by having an illusion of grandeur (she’s hearing her name in television and radio) - 6 months after birth of her 2 nd child, she experienced the symptoms of schizophrenia and lack herself in the room every time she will experience the symptoms.

e. Present Health History:

The patient is aware of having an illness which is the reason why she is currently hospitalized and she is being paranoid in the past. The patient remembers everything in the past including being locked in a room and tied with a rope by her father.

f. Family History:

She was 2 nd out of four siblings in the family. Her father was a farmer who sold vegetables in the market. She was not closed to her mother, and her mother-in-law is the one who sends her money for her children although she and father of her children are not married.

g. Review of System

1. Skin, Hair & Nails-

Skin Brown (normal)

Hair- Black (presence of Lice and Pus)

Nails- Pinkish

2. Head and Neck

Head- No headache reported

Neck- with abrasion in the nape area

3. EENT & Sinuses

Ears- No drainage or ringing ears reported

Eyes- Blurred Vision when reading (Farsighted)

Nose- No discharges

Throat- No pain or hoarseness of voice felt

4. Chest and Lungs

Chest- No pain reported

Lungs- No shortness of breath or pain reported

5. Heart, Neck Vessels & Central CVS

Heart- No pain, distress or palpitations felt

Neck vessels- are not distended.

Cardiovascular System- No tightness, edema, or orthopnea reported

6. PVS

With no varicosities

7. Abdomen

No abdominal pain, bowel movements are good, with linea nigra

8. Anus, Rectum

Anus- No itchiness or lesion reported

Rectum- No itchiness or lesion reported

9. Musculoskeletal System and Extremities

No muscle pain, stiffness or swelling felt

10. Neurologic

With dizziness and weakness as reported

h. Lifestyle and Health Practices- 24H day Description

ii. Activity & Exercise

She walks in corridor

iii. Rest and Sleep

The client claimed she’s lack of sleep every night because of the bed bugs (surot), lice and pus at the occipital area

iv. Medication and Supplements

The Client takes her ant-psychotic medications religiously

v.

Self-concept and self care

The client is aware of her illness

vi. Social activities

The patient was called as “nanay” by the younger pavilion 3 younger

patient. She claimed that she understands the other patient because they are also ill. vii. Spiritual, Cultural, Values and Belief System

The patient said she was an Iglesia ni cristo member viii. Education and work

She was a Education College Graduate.

ix. Stress Level and Management/ Coping Stress

Patient A claimed when she is angry, her paranoia will occur… She talks loudly and shouts at her family but never harmed them.

x. Environment & Neighborhood

Patient S.A. said that the other patient are friendly while she cannot understands the others because of their talkativeness ant apathetic.

i. Developmental Stage

i. Theory: Erik Erickson’s Psychosocial Development

Generativity vs. Stagnation (Middle adulthood 40-64 years)- The client has self confident of raising her child. She is devoted to her family and to their community. She wants her children to be educated and to be good person someday. She is confident of raising her children so that someday, her children will do the same to her.

III. COLLECTING OBJECTIVE DATA

a. Course of Confinement

i. Medications Administered since date of admission

Physician’s Order

Ascorbic acid 1cap BID P.O.

Generic Name

Ascorbic Acid

Brand Name

Apo-C, Ascorbicap, Cebid, Cecon, Cenolate, Cemill, C-Span, Cetane, Cevalin, Cevi-Bid, Ce-Vi-Sol, Cevita, Flavorcee, Redoxon, Schiff Effervescent Vitamin C, Vita-C.

Classification

Vitamin

Mechanism of Action

Vitamin C or L-ascorbic acid, or simply ascorbate (the anion of ascorbic acid), is an essential nutrient for humans and certain other animal species. Vitamin C refers to a number of vitamers that have vitamin C activity in animals, including ascorbic acid and its salts, and some oxidized

 

forms of the molecule like dehydroascorbic acid. Ascorbate and ascorbic acid are both naturally present in the body when either of these is introduced into cells, since the forms interconvert according to pH. Vitamin C is a cofactor in at least eight enzymatic reactions including several collagen synthesis reactions that, when dysfunctional, cause the most severe symptoms of scurvy.

Side Effects GI disturbances in high doses (nausea, vomiting, and diarrhea).

Nursing Management

Instruct Client to take the medication after meals to avoid GI upset.

 

Instruct client to measure and follow the prescribed dosage of the medication to avoid overdosing.

Bright yellow discoloration of urine

Advise the client that yellow discoloration of urine is normal

Adverse Effects Rarely, hypersensitivity reaction

Nursing Management

Instruct the client to discontinue the medication, and refer to the doctor.

Flatulence, constipation

Instruct the client to discontinue the medication, and refer to the doctor.

Heartburn,

Instruct the client to take the medication after meals to avoid adverse reactions.

Physician’s Order

Risperidon 2mg/tablet BID P.O.

Generic Name

Risperidon

Brand Name

Quilvet

Classification

Atypical antipsychotic

Mechanism of Action

Risperidone is an atypical antipsychotic drug that is used for treating schizophrenia, bipolar mania and autism. Other atypical antipsychotic drugs include Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify) and paliperidone (Invega). Atypical antipsychotics differ from typical antipsychotics due to the lesser degree of extrapyramidal (movement) side effects and constipation. Risperdal Consta is an injectable, long-acting form of risperidone.

 

The exact mechanism of action of risperidone is not known, but, like other anti-psychotics, it is believed that risperidone affects the way the brain works by interfering with communication among the brain's nerves. Nerves communicate with each other by making and releasing chemicals called neurotransmitters. The neurotransmitters travel to other nearby nerves where they attach to receptors on the nerves. The attachment of the neurotransmitters either stimulates or inhibits the function of the nearby nerves. Risperidone blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors. It is believed that many psychotic illnesses are caused by abnormal communication among nerves in the brain and that by altering communication through neurotransmitters, risperidone can alter the psychotic state. Risperidone was approved by the FDA in December,

1993.

Side Effects

most commonly-noted side effects associated with risperidone are extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity, tiredness, abdominal pain, fatigue, fever and nausea. Risperidone may cause a condition called orthostatic hypotension during the early phase of treatment (the first week or two). Patients who develop orthostatic hypotension have a drop in their blood pressure when they rise from a lying position and may become dizzy or even lose consciousness.

Nursing Consideration

Maintain seizure precautions, especially when initiating therapy and increasing dosage.

·

Mix oral solution with 34 oz of

water, coffee, orange juice, or low-fat

milk. Do not mix with cola or tea.

Monitor T. If fever occurs, rule out underlying infection, and consult

·

physician for appropriate comfort measures.

Advise patient to use contraception during drug therapy.

·

·

Follow guidelines for

discontinuation or reinstitution of the

drug carefully.

Physician’s Order

Biperiden Hydrochloride 2mg P.O. for extrapyramidal symptoms

Generic Name

Biperiden Hydrochloride

 

Brand Name

Akineton

 

Classification

Antiparkinsonism

drug

(anticholinergic

type)

Mechanism of Action

Anticholinergic activity in the CNS that is believed to help normalize the hypothesized imbalance of cholinergic and dopaminergic neurotransmission in the basal ganglia in the brain of a parkinsonism patient. Reduces severity of rigidity, and to a lesser extent akinesia and tremor characterizing parkinsonism; less effective overall than levodopa; peripheral anticholinergic effects suppress secondary symptoms of parkinsonism, such as drooling.

Adjunct in the therapy of parkinsonism

(post-encephalitic, arteriosclerotic, and idiopathic types)

Relief of symptoms of extrapyramidal

disorders that accompany phenothiazine therapy

Side Effects

CNS: Some are characteristic of centrally acting anticholinergic drugs:

disorientation, confusion, memory loss, hallucinations, psychoses, agitation, nervousness, delusions, delirium, paranoia, euphoria, excitement, light- headedness, dizziness, depression, drowsiness, weakness, giddiness, paresthesia, heaviness of the limbs

Peripheral anticholinergic effects

CV: Tachycardia, palpitations,

hypotension, orthostatic hypotension

Dermatologic: Rash, urticaria, other

 

dermatoses

EENT: Blurred vision, mydriasis,

diplopia, increased intraocular tension, angle-closure glaucoma

GI: Dry mouth, constipation, dilation of the colon, paralytic ileus, acute

suppurative parotitis, nausea, vomiting, epigastric distress

GU: Urinary retention, urinary

hesitancy, dysuria, difficulty achieving or maintaining an erection

Other: Flushing, decreased sweating, elevated temperature, muscular weakness, muscular cramping

Contraindication

Contraindicated with hypersensitivity to benztropine; glaucoma, especially angle- closure glaucoma; pyloric or duodenal obstruction, stenosing peptic ulcers, achalasia (megaesophagus); prostatic hypertrophy or bladder neck obstructions; myasthenia gravis. Use cautiously with tachycardia, cardiac arrhythmias, hypertension, hypotension, hepatic or renal dysfunction, alcoholism, chronic illness, people who work in hot environment; hot weather; lactation.

Physician’s Order

Diphenhydramine Hydrochloride 5mg OD PRN for poor sleep

Generic Name

Diphenhydramine Hydrochloride

Brand Name

Allerdryl (CAN), AllerMax Caplets, Banophen, Banophen Allergy, Benadryl Allergy, Diphen AF, Diphenhist, Diphenhist Captabs, Genahist, Siladryl, Silphen Cough

Classification

Antihistamine, Anti-motion sickness drug, Sedative-hypnotic, Antiparkinsonian, Cough suppressant

Mechanism of Action

Diphenhydramine blocks histamine H1- receptors on effector cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some anticholinergic action.

Adverse Effects

CNS depression, dizziness, headache, sedation; paradoxical stimulation in children; dryness of mouth, thickened

 

respiratory secretion, blurring of vision, urinary retention; GI disturbances; blood dyscrasias.

Nursing Consideration:

Assessment

History: Allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation

Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential

Interventions

Administer with food if GI upset occurs.

Administer syrup form if patient is unable to take tablets.

Monitor patient response, and arrange for adjustment of dosage to lowest possible effective dose.

Teaching points

Take as prescribed; avoid excessive dosage.

Take with food if GI upset occurs.

Avoid alcohol; serious sedation could occur.

These side effects may occur:

Dizziness, sedation, drowsiness (use caution driving or performing tasks requiring alertness); epigastric distress, diarrhea or constipation (take drug with meals); dry mouth (use frequent mouth care, suck sugarless lozenges); thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier).

 Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual

Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.

Physician’s Order

Haloperidol

5mg/cc

1cc

IM

with

BP

Precaution

Generic Name

Haloperidol

Brand Name

Haldol, Peridol,

 

Classification

central nervous system agent; psychotherapeutic; antipsychotic; butyrophenone

 

Mechanism of Action

Potent, long-acting butyrophenone derivative with pharmacologic actions similar to those of piperazine phenothiazines but with higher incidence of extrapyramidal effects and less hypotensive and relatively low sedative activity.

Decreases psychotic manifestations and exerts strong antiemetic effect.

Adverse Effects

CNS:Extrapyramidal reactions:

 

Parkinsonian symptoms, dystonia, akathisia, tardive dyskinesia (after long- term use); insomnia, restlessness, anxiety, euphoria, agitation, drowsiness, mental depression, lethargy, fatigue, weakness, tremor, ataxia, headache, confusion, vertigo; neuroleptic malignant syndrome, hyperthermia, grand mal seizures, exacerbation of psychotic symptoms. CV:Tachycardia, ECG changes, hypotension, hypertension (with overdosage). Endocrine:Menstrual irregularities, galactorrhea, lactation, gynecomastia, impotence, increased libido, hyponatremia, hyperglycemia, hypoglycemia. SpecSenses:Blurred vision. Hematologic:Mild transient leukopenia, agranulocytosis (rare).

 

GI:Dry mouth, anorexia, nausea, vomiting, constipation, diarrhea, hypersalivation. Urogenital:Urinary retention, priapism. Respiratory:Laryngospasm, bronchospasm, increased depth of respiration, bronchopneumonia, respiratory depression. Skin:Diaphoresis, maculopapular and acneiform rash, photosensitivity. other:Cholestatic jaundice, variations in liver function tests, decreased serum cholesterol.

Nursing Consideration:

Monitor for therapeutic effectiveness. Because of long half-life, therapeutic effects are slow to develop in early therapy or when established dosing regimen is changed. “Therapeutic window” effect (point at which increased dose or concentration actually decreases therapeutic response) may occur after long period of high doses.

Target symptoms expected to decrease with successful haloperidol treatment include hallucinations, insomnia, hostility, agitation, and delusions.

Monitor patient’s mental status daily.

Monitor for neuroleptic malignant syndrome (NMS) , especially in those with hypertension or taking lithium. Symptoms of NMS can appear suddenly after initiation of therapy or after months or years of taking neuroleptic (antipsychotic) medication. Immediately discontinue drug if NMS suspected.Monitor for parkinsonism and tardive dyskinesia . Risk of tardive dyskinesia appears to be greater in women receiving high doses and in older adults. It can occur after long- term therapy and even after therapy is discontinued.

Monitor for extrapyramidal (neuromuscular) reactions that occur frequently during first few days of

treatment. Symptoms are usually dose related and are controlled by dosage reduction or concomitant administration of antiparkinson drugs.

Be alert for behavioral changes in patients who are concurrently receiving antiparkinson drugs.

Monitor for exacerbation of seizure activity.

Observe patients closely for rapid mood shift to depression when haloperidol is used to control mania or cyclic disorders. Depression may represent a drug adverse effect or reversion from a manic state.

Lab tests: Monitor WBC count with differential and liver function in patients on prolonged therapy.

ii. Diagnostic Test since Date of Admission

Name of

Result

Normal

Unit of

Implication

Diagnostic

Values

Measurement

Test

Complete CBC (May 12. 2013)

       

Hemoglobi

100

Female: 110

g/dl

Indicates a decrease in Red blood cell production.

n mass

158

Male: 138 to

182

 

Hematocrit

0.32

0.37 0.54

fraction of

Indicates a decrease in Red blood cell production

RBC

WBC

7.9

5 10

x

/L

Normal.

Count

RBC Count

3.98

4-6

x

/L

A Decrease in RBC count may indicate Anemia. hemoglobin.

Differential

     

Count

Neutrophil

0.76

0.45-0.75

An Increase value may indicate an acute infection.

Lymphocyte

0.19

0.20-0.35

Infection is present.

Monocyte

0.05

0.02-0.06

Normal

IV. PYSCHOPATHOPHYSIOLOGY

IV. PYSCHOPATHOPHYSIOLOGY Anatomic abnormalities Neuroimaging studies in patients with schizophrenia show abnormalities

Anatomic abnormalities

Neuroimaging studies in patients with schizophrenia show abnormalities such as enlargement of the ventricles, decreased brain volume in medial temporal areas, and changes in the hippocampus. These findings are of interest more for research purposes than for clinical application.

Interest has also focused on the various connections within the brain rather than on localization in a single part of the brain. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white matter tracts. A meta- analysis of studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in schizophrenia.

In the Edinburgh High-Risk Study, brain imaging showed reductions in whole-brain volume and in left and right prefrontal and temporal lobe volumes in 17 of 146 people who were at high genetic risk for schizophrenia. The changes in prefrontal lobes were associated with increasing severity of psychotic symptoms.

In a meta-analysis of 27 longitudinal MRI studies comparing schizophrenic patients with control subjects, Olabi et al found that schizophrenia was associated with structural brain abnormalities that progressed over time. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume.

Neurotransmitter system abnormalities

Abnormalities of the dopaminergic system are thought to exist in schizophrenia; however, there is little direct evidence to support this belief. The first clearly effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms.

Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. (Negative and positive symptoms are defined below; see Presentation.) Moreover, the newer antipsychotic drugs block both dopamine D2 and 5-hydroxytryptamine (5-HT) receptors.

Clozapine, perhaps the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved. Some research focuses on the N -methyl-D-aspartate (NMDA)

subclass of glutamate receptors because NMDA antagonists, such as phencyclidine and ketamine, can lead to psychotic symptoms in healthy subjects.

Inflammation and immune function

Immune system function is disturbed in schizophrenia. Overactivation of the immune system (eg, from prenatal infection or postnatal stress) may result in overexpression of inflammatory cytokines and subsequent alteration of brain structure and function. For example, schizophrenic patients have elevated levels of proinflammatory cytokines that activate the kynurenine pathway, by which tryptophan is metabolized into kynurenic and quinolinic acids; these acids regulate NMDA receptor activity and may also be involved in dopamine regulation.

Insulin resistance and metabolic disturbances, which are common in the schizophrenic population, have also been linked to inflammation. Thus, inflammation might be related to both the psychopathology of schizophrenia and to metabolic disturbances seen in patients with schizophrenia.

Neurochemical factors likely involve dopamine, serotonin, norepinephrine, glutamate, and gamma- aminobutyric acid neurotransmission. Glutamate (glu), involved in learning and memory, may be responsible for some of the cognitive symptoms; glu is necessary for the breakdown of dopamine and other transmitters, which affects the efficiency of prefrontal information processing. Excessively high levels of norepinephrine are associated with positive symptoms, while paranoid symptoms have been related to increased dopamine aactivity. No single neurotransmitter is clearly responsible for schizophrenia. Schizophrenia often disrupts the filtering process, causing sensory overload; when there are too many messages arriving at the cortex at the same time, thinking becomes disorganized and fragmented.

V. NURSING CARE PLAN

Name: Patient S.A. Diagnosis: Paranoid Schizophrenia Date and time: May 19, 2013 (7am-3pm)

 

Assessment

Diagnosis

 

Planning

Implementation

Scientific Rationale

Evaluation

Subjective

Disturbed

 

Long term Goal:

Independent

   

Data:

sleep

To provide health teaching about using anti-head lice shampoo and proper prevention of getting a pus.

Intervention:

“Hindi ako makatulog kasi madaming akong kuto at may pigsa pa ako sa ulo” as manifested by the mother.

pattern

Explain to the client the procedures and its purpose

To reduce anxiety of the patient. To prepare the patient for the Procedure.

The patient is able to improve her activities of daily living

especially her sleep hours.

Goal met:

related to

head lice

and pus

 

Short Term Goal:

Instruct patient to sit instead of stand during care and other activities.

To increase activity level as tolerated

After 16 hours of duty, The patient will be able to relieve itchiness by using small spaced- combed and

Objective

Instruct patient to comb her hair using thin-spaced comb to decrease presence of lice and nits.

To provide independency while giving a health teaching

 

Data:

 

Presence of Lice, with Pus at the occipital area

Assist the patient in Shampooing by the use of anti-lice shampoo while giving instruction how often to apply the said shampoo

The patient will be able to return demonstration.

Instruct patient to avoid skin contact to

To avoid another incidence of having pus