INTRODUCTION

Schizophrenia is one of the most damaging of all mental disorders that causes its victims to lose touch with reality. They often begin to hear, see, or feel things that aren't really there, they experience hallucinations or become convinced of things that simply aren't true, they experience delusions.

There are five subtypes of schizophrenia. Among these subtypes is the paranoid type. In the paranoid form of this disorder, they develop delusions of persecution or personal grandeur. The first signs of paranoid schizophrenia usually surface between the ages of ! and "#. There is no cure, but the disorder can be controlled with medications. Severe attac$s may re%uire hospitalization.

The causes of schizophrenia are still under debate. A chemical imbalance in the brain seems to play a role, but the reason for the imbalance remains unclear. &e do $now that an individual is a bit more li$ely to become schizophrenic if they have a family member with the illness. Schizophrenia usually develops gradually, although onset can be sudden. 'riends and family often notice the first changes before the victim does. Among the signs are( confusion, inability to ma$e decisions, hallucinations, changes in eating or sleeping habits, energy level, or weight, delusions, nervousness, strange statements or behavior, withdrawal from friends, wor$, or school, neglect of personal hygiene, anger, indifference to the opinions of others, a tendency to argue, a conviction that you are better than others, and that people are out to get you.

)rugs such as Thorazine, *aldol, and +isperdal combat symptoms in # out of ! patients. An acute attac$ usually can be cleared up in # to , wee$s. -ounseling and group therapy help recovering patients to understand the disease and to function effectively. &ithout medication and therapy, most paranoid schizophrenics are unable to function in the real world. If they fall victim to severe hallucinations and delusions, they can be a danger to themselves and those around them.

The heterogeneity nature of this disorder, posed a significant challenge among the student nurses to ta$e on the case history of client, .iguel /iadog 0argo, 1r., who is in his early "23s and diagnosed as schizophrenic4paranoid type.

This case study presents the opportunity of applying our learned s$ills of giving care to the mentally4ill patients and implies that we as future nurses must learn our roles effectively to function efficiently in our chosen field of profession.

OBJECTIVES
General Objective: At the end of the psychiatric exposure, the group will be able to come up with a case presentation aimed to impart a significant awareness on the conditions of this disorder, Schizophrenia45aranoid type. Specific Objectives: . 7. ". #. !. :. ;. ,. =. To identify a %ualified client for this study6 See$ approval from Administration of )avao .ental *ospital, and from the patient3s family to begin the conduct of this research6 8stablish good rapport with the patient and his family in order to have a smooth wor$ing relationship with the group6 9ather pertinent data regarding the patient and his family6 Assess health status of patient, past and present illnesses6 Identify predisposing and precipitating factors that contributed to the patient3s illness6 5resent the .ental Status 8xamination during initial and final interaction to ascertain progress and deterioration of patient3s condition6 'ormulate a feasible <ursing -are 5lan with the identified problems of the patient6 )etermine when prognosis ifs favorable or unfavorable6 and needs6

2. 5rovide patient with support system and health teachings appropriate to patient3s

ANA
!ers"nal !r"file: !atient#s C"$e Na%e &"spital C"$e A'e Se( A$$ress Civil Stat)s Birt* Date Birt* !lace Reli'i"n Nati"nalit+ ,at*er#s Na%e "t*er#s Na%e Date "f A$%issi"n : : : : : : : : : : : : :

NESIS

.iguel /iadog 0argo, 1r.

2222!2= "" years old .ale South /ay 0anang, )avao -ity Single >ctober 7=, =;7 )avao -ity +oman -atholic 'ilipino .iguel 0argo, Sr. 5erla 0argo =? !?27, 7? !?2", 2?2:?2", 7?7?2#, :? 7?2#, 2?7"?2#,#? !?2!,.,? !?2! @, admissionsA

Date "f Disc*ar'e A$%ittin' !*+sician Atten$in' !*+sician C*ief C"%plaints A$%ittin' Dia'n"sis ,inal Dia'n"sis Date St)$+ Be')n Date St)$+ En$e$

: : : : : : : :

=?77?27, "? #?2", 2? 2?2",7?:?2# :? :?2#, 2?7,?2#, #?77?2!, ,? ,?2! Ian 1. 0indong, ..). Ian 1. 0indong, ..). 8xhibited Biolence and *ostility Schizophrenia45aranoid Type Schizophrenia45aranoid Type 1anuary 722: 1anuary 722:

Inf"r%ants: 0ast 1anuary CC722:, our group went to the client3s residence at South /ay 0anang, )avao -ity to interview informants, which included family members, relatives, neighbors and other community leaders regarding their $nowledge and opinion on patient3s current mental condition. The people in the community greeted the group with warmth and generosity in giving the information that we needed. Informant 1: Name: Perla B. Largo Age:57 years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: &other Length of t#me kno'n to %at#ent: S#n(e )#rth *++ years, A%%arent -nderstand#ng of Present Illness: Miguels illness apparently started when he worked as a laborer in Samal Island sometime in June 2000. He came home from work telling his mother !Ma dalha ko ospital kay gihiloan ko".He was brought to #a$ao Medical %enter but the doctors found no e$idence of poisoning. Miguel was also brought to a traditional healer or !binisaya" to assess his condition. &hey were informed that Miguel indeed was poisoned and was made to drink a potion to counter the effects of the alleged poison ingested by the client. 'fter a month he became hostile and was always shouting about seeing a black cat. &hat was the first time he was brought to #a$ao Mental Hospital. (ast 'ugust )* 200* he had a relapse because according to the informant !nisuol iyang sakit kay gikan sa trabaho naligo sya nga init kayo ug gisal+angan man gud niya ang iyang tambal ug tulo ka adlaw maong nibalik ang iyang sakit". "hara(ter#st#( and Att#tude of Informant: &he informant was willing to share information with us. She waited for us that morning because Miguel informed her that the nursing students will be asking information about his illness. &he informant was moderately groomed hair kempt and e,hibited a pleasant disposition.

Informant .: Name: &#guel Largo, Sr. Age: /0 years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: 1ather Length of t#me kno'n to %at#ent: S#n(e )#rth *++ years, A%%arent -nderstand#ng of Present Illness: As !er)al#2ed )y the #nformant, 3Buotan na nga )ata s# &#guel. 4ala nay l#)og5. 6he #nformant adds, h#s #llness )egan 'hen he started 'ork#ng #n Samal. 7n one o((as#on, 'hen the (l#ent arr#!ed home, he demanded to )e )rought #mmed#ately to the hos%#tal, )e(ause he (la#med to ha!e )een %o#soned. 1urther, the (l#ent8s father stressed that the %at#ent 'as 'orr#ed so mu(h a)out the#r house that 'as under (onstru(t#on and #s st#ll not near to (om%let#on. 6he #nformant further %os#ted that the (l#ent #s a !ery re%ress#!e %erson and al'ays kee%s h#s feel#ngs and 'orr#es s to h#mself.1#nally, the #nformant ho%es that h#s son '#ll re(o!er soon, )e(ause he e9%ressed so mu(h lo!e for h#s son. "hara(ter#st#( and Att#tude of Informant: &he informant was hesitant at first but e$entually he was $ery cooperati$e and con$ersant. &he informant generally appeared moderately groomed and e,hibited a coherent manner of responding. Informant +: Name: Perl#ta Largo Age: +1 years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: S#ster Length of t#me kno'n to %at#ent: +1 years A%%arent -nderstand#ng of Present Illness: Perl#ta, s#ster of &#guel )el#e!ed that the (ause of her )rother8s #llness 'as 'hen they 'ere una)le to (om%lete the reno!at#on of the#r house )e(ause of #nsuff#(#ent funds. After'h#(h, &#guel as o)ser!ed )y Perl#ta, 3&otutok s#ya sa hollo')lo(ks, unya muh#lum, taudtaud mangla)ay ug )ato5. :e momentar#ly stares at the hollo' )lo(ks and suddenly thro's stones at the#r ne9tdoor ne#gh)or.

"hara(ter#st#( and Att#tude of Informant: )uring the interview, 5erlita was very accommodating and was willing to spend her time with us. She was very cooperative in answering our %uestions and she also shared about his brother as being a good4natured individual. Informant ;: Name: enn#s B. Largo Age: 19 years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: Brother Length of t#me kno'n to %at#ent: S#n(e )#rth *++ years, A%%arent -nderstand#ng of Present Illness: A((ord#ng to a (onstru(t#on 'orker. enn#s, the reason 'hy h#s )rother &#guel 'as adm#tted to a!ao &ental :os%#tal )e(ause of the #n(#dent #n Samal Island 'here &#guel 'orked as enn#s narrated that there 'as an #n(#dent that &#guel 'as a !#(t#m of 3%ag<daut5 or )la(k mag#(. 4hen &#guel 'ent home he 'as %ale, 3namugna' ang kala'asan ug mahadlukon5. Pale look#ng, (old (lammy )ody and #s afra#d of almost e!eryth#ng he en(ounters. 6hey (onsulted a %hys#(#an and no f#nd#ngs 'ere g#!en so they 'ent to an alternat#!e healer. "hara(ter#st#( and Att#tude of Informant: &he informant was willing to share information regarding his brother. &here was no hesitation seen on him and he hopes that his brother will be cured from his sickness because as Miguel priorly hoped that if he gets cured his brothers can continue their schooling. Informant 5: Name: Leo Largo Address: SI$ &at#na, Age: ;/ years old a!ao "#ty

$elat#onsh#% to Pat#ent: .nd degree (ous#n Length of t#me kno'n to %at#ent: s#n(e )#rth

A%%arent -nderstand#ng of Present Illness: A((ord#ng to the #nformant, the (l#ent8s #llness 'as due to de%ress#on. It started 'hen &#guel re(e#!ed 1;,000 from 3)u)oay5, 'h#(h he thought #t #s suff#(#ent fund to reno!ate the#r house. :e demol#shed the old house and '#th the money #n hand, 'anted to )u#ld a ne' one. -nfortunately, he 'asn8t a)le to f#n#sh #t due to f#nan(#al (onstra#nt. 6he unf#n#shed house house someho' (ontr#)uted to the de%ress#on. Later he e9h#)#ted unusual )eha!#or 'h#(h %rom%ted h#s mother to )r#ng the (l#ent to &ental :os%#tal to seek med#(al and %sy(h#atr#( attent#on. "hara(ter#st#( and Att#tude of Informant: &he informants comment about his cousin the client $ery sarcastic maybe because he is tired of financially helping them. #uring the inter$iew I learned that (eos family helped three of the clients siblings to school but still did not make use of their education. Informant /: Name: Arnel ad#ano Age: ++ years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: 1r#end Length of t#me kno'n to %at#ent: 10 years A%%arent -nderstand#ng of Present Illness: A((ord#ng to Arnel, &#guel #s a good fr#end. 6hey %lay )asket)all together dur#ng the#r le#sure t#me. A (onstant dr#nk#ng )uddy and (onf#dant at the near)y sar#<sar# store. 6he #nformant )el#e!es that &#guel8s #llness )egan 'hen he 'orked at Samal. 4hen he arr#!ed home, he (onstantly )e(omes !#olent and host#le 'hene!er he en(ounters a )la(k (at. "hara(ter#st#( and Att#tude of Informant: The informant was very open and accommodating as he related to us his experiences with his friend .iguel. There was no hesitation noted. a!ao

Informant 7: Name: Analyn 7mas<as Age: .= years old a!ao "#ty Address: Purok 9 South Bay, Lanang

$elat#onsh#% to Pat#ent: Ne#gh)or>"hldhood 1r#end Length of t#me kno'n to %at#ent: .= years A%%arent -nderstand#ng of Present Illness: Analyn )el#e!ed that the (ause of &#guel8s mental #llness 'as 'hen &#guel fa#led to f#nan(#ally %ro!#de for the (om%let#on of the#r house reno!at#on. Also, 'hen the (l#ent '#tnessed a )la(k (at that 'as k#lled )y the#r ne#gh)or. After those #n(#dents, &#guel 'a soften seen star#ng )lankly and talk#ng )y h#mself. :e 'ould shout #n!e(t#!es to any)ody he en(ounters and thre' stones at the#r ne#gh)ors houses. Ne!ertheless, the #nformant %os#ted that &#guel #s a good<natured %erson and #s !ery hard'ork#ng and res%ons#)le to the needs of h#s fam#ly. :e )egan do#ng men#al ?o)s at a !ery young age ?ust to augment the fam#ly #n(ome. "hara(ter#st#( and Att#tude of Informant: ur#ng the #nter!#e', the #nformant 'as !ery a((ommodat#ng. She had kno'n h#m s#n(e )#rth. A((ord#ng to Analyn, &#guel 'as de%r#!ed of h#s youth )e(ause all he 'anted and thought of 'as ho' to %ro(ure money for the fam#ly. Informant =: Name: Nena &e?#as Age: /7 years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent:Ne#gh)or Length of t#me kno'n to %at#ent: 10 years A%%arent -nderstand#ng of Present Illness: A((ord#ng to the #nformant, &#guel #s a good (h#ld. :e hel%s h#s %arents earn a l#!#ng. :e #s a (onstru(t#on 'orker #n Samal Island. A((ord#ng to her, the #llness of the %at#ent started 'hen he 'ent home from Samal after a long<day of 'ork. 3Basa s#ya kayo ug s#ngot, %ag a)ot sa )alay, nal#go dayon ug nag s#ge na ug s#ngg#t ug #r#ng< #r#ng ha'a d#ha@5 as !er)al#2ed )y the #nformant.

"hara(ter#st#( and Att#tude of Informant: &he informant was $ery cooperati$e while talking to us. She was $ery spontaneous in narrating what she knew about the family in general and Miguel in particular. Informant 9: Name: Lu2 $ed#sm#nda Age: ;; years old a!ao "#ty Address: Purok 9 South Bay, Lanang

$elat#onsh#% to Pat#ent: Ne#gh)or and 1r#end of Pat#ent8s &other Length of t#me kno'n to %at#ent: .7 years A%%arent -nderstand#ng of Present Illness: A((ord#ng to Lu2, &#guel started to go #nsame, 'hen he '#tnessed ho' a (at 'as slaughtered to death. 6hereafter, the %at#ent 'as seen shout#ng and some'hat e9em%l#f#es the sound of a (at #n d#stress. 6he %at#ent 'as also seen to ha!e dug a hole on the ground and l#e there unt#l the %at#ent resorts to !#olen(e 'hen he #s re%r#manded. So the %eo%le #n the#r area, restra#n h#m. "hara(ter#st#( and Att#tude of Informant #uring the entire inter$iew the informant was willing to share all the necessary information about Miguel. She was $ery cooperati$e and accommodating. Informant 10: Name: $olando Lo)uternos Age: +; years old Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: Ne#gh)or Length of t#me kno'n to %at#ent: .7 years A%%arent -nderstand#ng of Present Illness: A((ord#ng to the #nformant, &#guel started to go #nsame 'hene he re(e#!ed some money from the#r sa!#ngs fund.6he money, the (l#ent used to f#nan(e the reno!at#on of the#r house. But the (l#ent fa#led to (om%lete the reno!at#on #n t#me, that resulted to an9#ety and 'orry that led h#m to go out of h#s m#nd. a!ao "#ty

"hara(ter#st#( and Att#tude of Informant &he informant was $ery cooperati$e and was willing to share his opinion about the illness of Miguel. &o him he really knew Miguel since they were young. Informant 11: Name: Lol#ta Beton#o Age: +7 years old a!ao "#ty Address: Purok 9 South Bay, Lanang $elat#onsh#% to Pat#ent: Ne#gh)or Length of t#me kno'n to %at#ent: .7 years A%%arent -nderstand#ng of Present Illness: A((ord#ng to the #nformant, the last atta(k 'as due to, as !er)al#2ed 3 6ungod man to %ag<ul# n#ya g#kan sa #n#t, s#ngot kayo, nal#go kal# tug n##nom ug )ugna'5. "hara(ter#st#( and Att#tude of Informant &he informant was cooperati$e in fact she was the one who approached us and said something about the clients situation. 5eople who have $nown the patient have mixed feelings about the patient. The family have expressed unconditional love and concern for fast recovery of the patient. The neighbors and friends have witnessed how the family struggled to stay afloat in the midst of their crisis and misfortunes. They felt sorry for the patient and the family. They hope that the patient would soon recover from her malady and for the family to have better life.

,A I-. &ISTOR.
-aternal and Maternal .rand (ineages There is no history of nervous and mental disease. *owever a history of alcoholism, gambling and other traits of inefficiency in the family is noted. The patient3s father is an alcoholic and a gambler.

/ather .r. .iguel 0argo, Sr. wor$ed as a sawmill operator before and is currently wor$ing as a part4time carpenter. .r. 0argo as a father was ineffective and unable to provide for the basic necessities of the family, because of his gambling and alcoholism. The money that was supposedly be spent on daily expenses of the family are s%uandered to all his vices. The family scavenges for food from their neighbors. .r. 0argo, as expected denies of these charges and accusations. Mother The patient3s biological mother is .rs. 5erla 0argo. She was previously a Dsalt vendorE and is currently a housewife. &hen she was wor$ing before, as a vendor, she usually leaves the $ids with relatives and often times, let .iguel accompany her. Siblings They are eight children in the family. Fnfortunately, their fifth died as a premature delivery. They are listed hereunder in order( . <eil G ": years old G .arried with 7 $ids @cohabitatingA6 living separately from family 7. Alberto G "# years old G .arried with family ". .iguel 1r4 "" years old G Single living with parents #. 5erlita G " years old G Single parent with one $id6 living with parents !. +uel G deceased :. 9abriel G 7 years old G single6 living with a relative ;. )ennis G = years old G single6 living with parents6 out of school youth ,. 0eo G , years old G single6 living with parents6 out of school youth. Their parents were not good providers during their younger years. Sibling rivalry is noted until this time among <eil, Alberto and .iguel, 1r., the client. 5erlita, the only girl in the family is very close to the patient and the one who accompanies the patient to the hospital whenever he has an attac$. $id @cohabitatingA6 living separately from

,A I-. TREE GENOGRA

,at*er i')el -ar'" Sr/ 01 +/"/

"t*er !erla -ar'" 23 +/"/

<eil ":

Alberto "#

&#guel ++

5erlita "

+uel deceased

9abriel 7

)ennis =

0eo ,

!ERSONA- &ISTOR.
!renatal .rs. 0argo was delighted to $now that she was pregnant. She was prepared to face the anticipated demands of pregnancy.. *owever, her worry of financial problems constantly disturbed her pregnancy. *er husband contributed to the burden of not remitting his salary to supplement the expenses needed for pregnancy and the needs of the family. Therefore, she had inade%uate nutrition and was unable to comply with all her vaccinations. &hile the client3s mother was pregnant, she would need to wor$ as a salt vendor at the same time to support the needs of the family. Birt* The patient was born on >ctober 7=, =;7, full term and delivered in breech position and cord coil by an alternative doctor. The client3s mother was in labor while delivering the client for 7 days and 7 nights. It was posited that the delivery was a difficult and laborious one. The client was not subHected to any type of immunizations. Infanc+ an$ C*il$*""$ C*aracteristics The patient3s first tooth appeared at : months of age and her first wal$ at year old with rice porridge as his first meal. The patient was exclusively breastfed and done in between chores or during chores. The clients was observed to thumbsuc$ from age ! months until 7 years of age. The client noted to be wal$ing and tal$ing at age 7 year old. It was apparently difficult to determine the success of toilet training, since the voiding facility was a distance away from the home. At age 7 year old, the patient experienced convulsion due to intense fever. The patient was generally remembered to be unhygienically presented, termed as DyungitE. !s+c*"se()al &ist"r+ The client was circumcised at age years old. .asturbation practices suspected by age : years old. Secondary sex characteristics such as voice change noted by age , years old. The client was noted to have gained sexual awareness by age 72 years old. At age 72 year old, the patient was noted to have physical attraction with one neighbor, named D9emmaE, who was an

entertainer D1apayu$iE, but was unable to express attraction and got frustrated for failing not to confess his emotions. !la+ -ife As a child, he preferred playing Dpinoy gamesE available, especially Dholen?$asingE. *e preferred playing with same sex playmates and plays near the neighborhood. The patient was also claimed to be a shy individual, so it could be inferred that he played the role as a follower in the group. The patient was very much overwhelmed with playing that attending school. Sc*""l &ist"r+ It was noted that at age ; year old, the patient entered schooling. *owever, by age 2 year old, the patient stopped going to school, because the patient expressed disli$e on going to school for failure to absorb day4to4day lectures by the teachers. This disli$e for school was very much evident when the patient was caught cutting his classes by going to the sawmill and wor$ed as D$argadorE of firewoods together with friends of same ages. *owever, during schooldays, the patient expressed that he loved the 'ilipino subHect. The reason posed by the patient for li$ing to wor$, was to have money, so when he goes to school, he has DbaonE or spending money. Reli'i")s an$ S"cial &ist"r+ 8ver since, the patient was $nown to be a timid and %uite person. *e used to do things on his own, but gradually established friendship with his neighbors of the same age. The patient was always noted to be very particular with his things and wouldn3t want his things to be used by others without prior permission. *owever, he is not noted to be selfish, but he is very thrifty and goal4oriented in helping his family. As a +oman -atholic, he didn3t go to church religiously and didn3t participate in any church activities, because he had no money to spend for fare to get to their church. The patient was also noted to get easily disappointed and frustrated for goals that have not been realized.

Occ)pati"nal &ist"r+ &hen the patient stopped going to school, he wor$ed as a D$argadorE of firewoodE. -urrently, he is a construction wor$er on a contractual basis. *is salary, he remits to his mother. )uring Saturdays, he spends his day pay with his friends socially drin$ing. Onset "f Illness The condition of the patient was claimed to have started at the time when the patient was poisoned in Samal, as he wor$ed as a construction wor$er. The patient with his family sought medical assistance but had negative findings. So they decided to have the patient be attended by an alternative doctor and was observed to have been really poisoned and was given treatment. *owever, several days after, the patient manifested violence and erratic behavior whenever he encounters a blac$ cat. The patient had several admissions at )avao .ental *ospital. It was on the year 7227, that the first attac$ occurred. Specifically, September of 7227, the patient was admitted for wee$ due to behavior changes, such as lying down on hot surfaced ground, stiffness and muscular rigidity. /y 'ebruary 722", admitted bac$ for episodes of violence self4directed and to others and was later released by .arch 722". Third admission was on >ctober 722", brought in by relatives and noted to have poor compliance with medications. 5atient was noted to be restless and was tal$ing alone prior to admission, then was discharged # days after. 'ourth admission was last 'ebruary 722# , patient was admitted because the patient was wal$ing aimlessly and was staring blan$ly. It was claimed that the condition was aggravated to the level of episode of violence due to a misunderstanding on a betting game, Dcoc$fight derbiE. )ischarged four days later. 'ifth admission was last 1une 722# and discharged days after for same episodic reasons. Sixth admission was last >ctober 722# and discharged days after due to the same reasons and poor compliance with medications. Seventh Admission was last April 722! for the same reasons posted. The patient was last attended by a physician for his condition last August !, 722!. <o follow4up was done to this date. 5rior to admission, the patient heard that their neighbor, a friend of his, was stabbed and was $illed. After the $nowing of the incident, the patient had episodic attac$s again, such as shouting and throwing stones and was constantly staring blan$ly on bric$ walls. Then discharged " days after, symptoms were controlled through medication compliance.

COURSE IN T&E &OS!ITAINITIANa%e: i')el -ar'"5 Jr/ Date: A)')st 625 7112 I/ !resentati"n A/ General Appearance: The patient is poorly groomed and has poor personal hygiene, as manifested by failure to ta$e a bath during the interaction, suspicious and loose eye contact. B/ General "bilit+ 6/ !"st)re an$ 'ait I J normal I J appropriate I x J inappropriate Describe: The integrity among his body parts and the manner of his wal$ing appeared to be inappropriately carried out. 7/ Activit+ I J normoactive I J psychomotor retardation I J hyperactive I x J agitated 8/ ,acial E(pressi"n I J smiling I I J happy I I J ecstatic I J worried I J tearful I J frightened J tense I x J angry I J distant J sad I J suspicious ENTA- STATUS E4A INATION

C/ Be*avi"r: The patient exhibited an unpleasant disposition, was constantly frowning and appeared agitated. D/ D"ct"r9 N)rse: !atient Interacti"n I J cooperative I x J uncooperative I J initially only I K J throughout interview ;)alit+: I J warm I J tal$ative II/ Strea% "f Tal< A/ C*aracter "f Tal< I J spontaneous B/ Or'ani=ati"n "f Tal< I J relevant I J tangential I J flight of ideas IKJ deliberate I J irrelevant I J circumstantial I J incoherent I x J loose association I J distant I x J hostile I J suspicious I J others

III/ E%"ti"nal State an$ Reacti"ns A/ ""$ IK J euthymic I J others I J depression I x J euphoria

Describe: The patient exhibited a normal, homeostatic mood. B/ Affect I J appropriate I K J inappropriate J elated J hostile ;)alit+: I J flat I J labile I J others

I xJ blunted I I J histrionic I

C/ Depers"nali=ati"n an$ Dereali=ati"n I K J absent I J present D/ S)ici$al !"tential E/ &"%ici$al !"tential I J absent I J absent I K J present I K J present

IV/ T*")'*t C"ntr"l A/ T*")'*t !r"cess 0ooseness in Association I K J B/ !ercepti"ns I x J present I J absent Type( denies A?B hallucination V/ Ne)r"ve'etative D+sf)ncti"n A/ Sleep I x J normal I J late insomnia B/ Appetite I x J normal

I J hypersomnia I J mixed insomnia I J increase I J decrease

,/ Attenti"n Span I x J present I J absent Describe: The patient is fairly attentive throughout interview. VI/ General Sens"ri)% an$ Intellect)al Stat)s A/ Orientati"n I x J time I x J person I x J place I x J situation

B/

e%"r+

I x J remote I x J recent

I x J immediate I J impaired

C/ Calc)lati"ns The patient has poor calculation. D/ General Inf"r%ati"n The status of the patient3s general information was very good as demonstrated by $nowledge of the current 5hilippine 5resident. E/ J)$'%ent I xJ impaired IunimpairedJ

,/ Abstract T*in<in' Abilit+ The patient was unable to interpret statements with his understanding. VII/ Insi'*t The patient exhibited poor insight. VIII/ S)%%ar+ "f ental Stat)s E(a%inati"n A/ Dist)rbance in: > ( ? !resentati"n > ( ? Strea% "f Tal< > ( ? E%"ti"nal State an$ Reacti"ns > ( ? T*")'*t C"ntr"l > ? Ne)r"ve'etative D+sf)ncti"n > ( ? General Sens"ri)% > ( ? Intellect)al Stat)s DS IV Axis Schizophrenia, 5aranoid

,INANa%e: i')el -ar'"5 Jr/ Date: A)')st 735 7112 I/ !resentati"n

ENTA- STATUS E4A INATION

A/ General Appearance: The patient is fairly groomed, appeared suspicious, agitated and loose eye contact. B/ General "bilit+ 6/ !"st)re an$ 'ait I J normal I J appropriate I x J inappropriate Describe: The integrity among his body parts and the manner of his wal$ing appeared to be inappropriately carried out. 7/ Activit+ I J normoactive I J psychomotor retardation I J hyperactive I x J agitated 8/ ,acial E(pressi"n I x J smiling I I x J happy I I J ecstatic I J worried I J tearful I J frightened J tense I J angry I J distant J sad I J suspicious

C/ Be*avi"r: The patient exhibited a pleasant disposition, was accommodating and receptive to every %uestion thrown at him. D/ D"ct"r9 N)rse: !atient Interacti"n I x J cooperative I J uncooperative I J initially only I K J throughout interview ;)alit+: I x J warm I x J tal$ative II/ Strea% "f Tal< A/ C*aracter "f Tal< I J spontaneous B/ Or'ani=ati"n "f Tal< I x J relevant I J tangential I J flight of ideas III/ E%"ti"nal State an$ Reacti"ns IKJ deliberate I J irrelevant I J circumstantial I J incoherent I J loose association I I J distant J hostile I x J suspicious I J others

A/

""$ IK J euthymic I J others I J depression I x J euphoria

Describe: The patient exhibited a normal, homeostatic mood. B/ Affect I J appropriate I K J inappropriate J elated J hostile ;)alit+: I J flat I J labile I J others

I xJ blunted I I J histrionic I

C/ Depers"nali=ati"n an$ Dereali=ati"n I K J absent I J present D/ S)ici$al !"tential E/ &"%ici$al !"tential I x J absent I x J absent I J present I J present

IV/ T*")'*t C"ntr"l A/ T*")'*t !r"cess 0ooseness in Association I K J B/ !ercepti"ns I x J present I J absent Type( denies A?B hallucination C/ Del)si"ns I x J present I J absent Type( delusion of persecution. )escription( &hen he sees a cat, he frea$s out, as if the cat brings along with him a curse that would endanger his life. V/ Ne)r"ve'etative D+sf)ncti"n A/ Sleep I x J normal I J late insomnia B/ Appetite I x J normal

I J hypersomnia I J mixed insomnia I J increase I J decrease

,/ Attenti"n Span I x J present I J absent Describe: The patient is very attentive throughout interview. VI/ General Sens"ri)% an$ Intellect)al Stat)s

A/ Orientati"n

I x J time I x J person I x J remote I x J recent

I x J place I x J situation I x J immediate I J impaired

B/

e%"r+

C/ Calc)lati"ns The patient has improved calculation. D/ General Inf"r%ati"n The status of the patient3s general information was good as demonstrated by $nowledge of the current 5hilippine 5resident. E/ J)$'%ent I xJ impaired IunimpairedJ

,/ Abstract T*in<in' Abilit+ The patient was unable to interpret statements with his understanding. VII/ Insi'*t The patient exhibited poor insight. VIII/ S)%%ar+ "f ental Stat)s E(a%inati"n A/ Dist)rbance in: > ( ? !resentati"n > ( ? Strea% "f Tal< > ( ? E%"ti"nal State an$ Reacti"ns > ( ? T*")'*t C"ntr"l > ? Ne)r"ve'etative D+sf)ncti"n > ( ? General Sens"ri)% > ( ? Intellect)al Stat)s C/ DS Dia'n"stic an$ Statistical an)al

Axis Schizophrenia, 5aranoid Axis 7 5aranoid 5ersonality )isorder Axis " <o current medical condition Axis # 5sychosocial 8nvironment( 5oor Support System

5atient( Age( Sex( .ale

.iguel 0argo, 1r. "" years old

Attending 5hysician( Ian 1. 0indong, ..). )ate Admitted ( =? !?27, 7? !?2", 2?2:?2", 7?7?2#, :? 7?2#, 2?7"?2#,#? !?2!,.,? !?2! @, admissionsA )iagnosis( Schizophrenia45aranoid Type

-enter( )avao .ental *ospital )escription of the 5atient(

The patient was generally fairly groomed, and seen wearing blue shirt and denim shorts. *e exhibited a distinct smell that intensified his rubbish appearance. The patient responds when as$ed and appears warm and receptive to the interview. >bHectives( . To establish rapport with the patient6 7. To gain the trust of the patient6 and ". To encourage the patient to respond in ways comfortable to the patient but also understandable for the student nurse

NURSE:!ATIENT INTERACTION NURSE T&ERA!IST <( .aayong buntag .igo .iguel. A$o diay si .a3am /ing, student nurse sa <orth Balley -ollege. .ag4interview unta mi imo $aron, $abalo na ba $aL <( .aayo $ung ningana. .igo, bahin sa imong pag$asa$it, $anus4a pa man na nagsugodL !ATIENT 5( .aayong buntag sab m3am. 9isultihan bitaw $o sa nurse didto sa hospital ma3am nga magadto daw mo dinhi sa amoa. ANA-.SIS &hen my patient nodded and replied to my statement, I was happy to $now, that he is cooperative and receptive to the interview. DOCU ENTATIONS &hen meeting the client for the first time, introducing oneself and establishing a contract for the relationship is an appropriate start for therapeutic communication. @5sychiatric .ental *ealth <ursing by Bidebec$ page 7!A /road >penings G 'or the client who is hesitant about tal$ing, broad openings may stimulate him to ta$e the initiative. @5sychiatric .ental *ealth <ursing by Bidebec$ page :A In therapeutic communication, the nurse must as$ specific %uestions to get the entire story from the clients perspective, to clarify assumptions, and to develop empathy with the client. @5sychiatric .ental *ealth <ursing by Bidebec$ page #A

5( Maron pag$aadmita ma3am upat $o $aadlaw didto sa hospital, pero $adaghan na$o nagpabali$bali$ sa hospital. .asal4angan man gud na$o ug inom ang a$ong tambal, $ay usahay di mi $apalit.

&hen I heard his voice and eager to explain, I was gradually put at ease and I started to feel relaxed.

<( Fnsa man ang 5( <agsugod man gud ni huningdan nga nag$asa$it ma3am $adtong na$a$ita $o $aL ug itom nga iring. A$ong gilabayan ug tsinelas and iring para mopahawa, su$ad adto nag$asa$it na$o.

The patient replied with a straightforward answer but coherent to the %uestion as$ed. *owever, it appeared to me that the response was hard to comprehend.

The transition from the orientation stage to wor$ing phase is not smoothly defined. 5atient3s anxiety may increase when they are wor$ing on the issues. IMeltner, 5sychiatric <ursingJ <( Sa wala pa $a mag$asa$it migo, unsa man ang trabaho nimoL 5( <agtrabaho $o ug construction, laborer sa Samal. 7227 $o nagsugod trabaho, ug 72 ang adlaw na$o. 5( Ihatag na$o sa a$ong mama, sa paggasto, bayad sa utang sa tindahan u gang uban lingaw4lingaw inom4 inom. 5( Tan4aw pud mi ug B*S, $anang action, idol na$o si /ong +evilla, $ay gwapo modala ug salida. I diverted the %uestion, to give 5atient3s feelings should be way for more probing %uestions heard, accepted and respected. about the nature of my patient3s IMeltner, 5sychiatric <ursingJ character. I perceived the patient, to be also lin$ed with alcohol. -alling the client by name shows that the nurse recognizes the client as a person, as an individual. @5sychiatric .ental health <ursing by Bidebec$ page ;A 8ncouraging evaluation G as$ing for patients3 views of the meaning or importance of something. @5sychiatric <ursing by Meltner "rd 8dition page =A 5atients need to feel respected, valued, and accepted by the

<( .iguel, Fnya, unsa ang buhaton nimo sa imong suweldoL

<( Fnya mag inom inom ra moL

I probed deeper to $now what other past time escapades the patient is accustomed to enHoy himself.

<( 9awas dire sa inyong dapit, asa man $a

5( )idto sa unahan sa gamay nga sabongan. Tan4aw ug

I learned that the patient has other addiction problem.

magsuroyanL

sabong. Fsahay mamusta

nurse, even if all of theirs behaviors are not tolerated. A nurse should not evaluate patients3 beliefs, feelings, and behaviors as right or wrong. @5sychiatric <ursing by Meltner "rd 8dition page ,A I as$ed %uestions that would probe the state of recovery of the patient, whether he has future plans that would define that he has a good grasp of the evnts that would unfold in the future and assist him to recovery. The nurse enhances patients3 abilities to be open and honest by explaining the need to $now about a sensitive area, by as$ing %uestions in a $ind and matter4of4fact manner, by conveying empathy and by reiterating a desire to help. 8xploring G Any problem or concern can be better understood if explored in depth @ Bidebec$A I than$ed my patient for the time and effort to be with me. 5atient3s feelings should be heard, accepted and respected

<( .igo, $ung maayo na $a sa imong sa$it, unsa man ang imong himuonL <( Fnsa man ang imong mga damgo para sa imong $augmaonL

5( .agtrabaho $ay panhuman na$o ang among balay. 5( .apahuman lang ning balay mam.

<( Sige migo, mayo man 5( 0agi mam. .ag ipon $o, $ung naa $ay hangdom sa unya pahinay hinayon ra. $inabuhi. 5ero, unta maghinay hinay pud $a ha, $ay dili man Hud lalim magpabuhat ug balay. <( Salamt migo ha sa imo 5( Salamat pud mam sa inyo panahon. dala nga groceries. +eferences( Meltner, 5sychiatric <ursing, 7227 Bidebec$ 5sychiatric .ental *ealth <ursing, 722

!S.C&OD.NA ICS
,ACTORS !REDIS!OSING ,ACTORS 6/ A'e 'irst onset at the age of 7, years old. The patient at present is "" years of age. The onset of Schizophrenia may occur late in adolescent, early in childhood, usually before the age of "2. Approximately ;!N of persons diagnosed as having Schizophrenia develop the clinical symptoms between ages : O 7!. @5sychiatric .ental *ealth <ursing, !th 8d, ShrivesA Although schizophrenia affects men and women with e%ual fre%uency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties. @9rohol 722!, 5sych -entralA !RESENT RATIONA-E

7/ Se(

The patient is .ale.

!RECI!ITATING ,ACTORS 6/ ,a%il+ 9!""r S)pp"rt S+ste% The family was a deteriorated and distorted support system for the patient. The father who was supposed to stand by and provide for the basic needs of the family, was a gambler and an alcoholic. The mother, who was supposedly the parent to nurture the emotional and psychological development of the children was focused on providing their physical needs in order to survive. The loss of parental supervision led the patient to explore of what the outside world could give him. The patient sought to assume role as a provider, as he wanted to help augment the family income at such an early age. The patient began ta$ing sips of alcohol, socially drin$ing with friends. The patient3s parents noted also that his spends his money to buy alcohol. &hen the relationships of young adolescents with members of their families deteriorate as adolescence progresses,the fault usually lies both sides. 5arents far too often refuse to modify their concepts as their children3s abilities enhances as they grow older.

7/ Alc"*"l

According to Maplan and Saddoc$s, alcohol interfere with the normal process of food digestion and absorption. As a result, food is not consumed well and inade%uately digested. .uscle wea$ness is side effect of alcohol and can depress the brain too much. According to .anfreda O Mrampitz, drives may be expressed in an individual3s behavior reaction to such everyday incidents as disappointment, reHection,

8/ E%"ti"nal

5atient lac$s emotional security with a disrupted family support system.

deprivations, marital difficulties, failure in one ambitions, inferiorities, and economic reverses. All of these, and many other life incidents, produces uncomfortable feelings of tension and anxiety which when continued for long periods are believed to brea$ down the person3s constitutional resistance. )isorganization of one3s personality results. @/ !""r e$ical C"%pliance 5atient was not able to maintain medications due to lac$ of financial resource. The discontinuance of drugs which appear to activate a paranoid reactions results in reversal of personality in due time. @5sychiatric <ursing by .anfredaA

2/ -ac< "f E$)cati"nal S)pp"rt

The lac$ of productive &hen the patient opted to diversional activity, an wor$ to help the family than individual experiences a obtain education for decreased stimulation or himself. interest in engaging in productive activities. @Intervention by 9ulanic$A The patient3s family socio4 economic standing has exposed the patient to the hard realities of survival in life at such an early age. Social -ausation *ypothesis proposes that stresses experienced by members of low socio4 economic group contribute to the development of schizophrenia. @ Synopsis of 5sychiatry by Mapla, p.#:7A According to *orroc$s O /enimoff, the leisure activity is the adolescent3s real world, providing him a stage upon which to try out himself and others. The leisure activity offers the

0/ S"ci":Ec"n"%ic Stat)s

3/ Un*ealt*+ -eis)re Activit+

The patient was fond of attending coc$fight derbi and was so engrossed with betting to earn money.

adolescent a world in which he may socialize in a climate where the value that counts are those that are set not by adults, but by other of his own age. The recreational outlet is a vital importance to the adolescent. A/ !ers"nalit+ The patient3s personality problem of not being able to ventilate his true emotions and his inability to handle frustrations and disappointments in life has aggravated his condition. The development of personality disorders is related to a combination of biological, psychological and social ris$ factors. The interaction of these factors determines whether or not strong personality traits develop into personality disorders. The social environment coupled with psychological vulnerability strongly influences the individual3s coping mechanism @5aris, =="A.

Sc*e%atic !resentati"n
!REDIS!OSING ,ACTORS A'e Se( Genetics !RECI!ITATING ,ACTORS 6/ ,a%il+9 !""r S)pp"rt S+ste% 7/ Alc"*"l 8/ E%"ti"nal @/ !""r e$ical C"%pliance 2/ -ac< "f E$)cati"nal S)pp"rt 0/ S"ci":Ec"n"%ic Stat)s 3/ Un*ealt*+ -eis)re Activit+ A/ !ers"nalit+

!RENATA- &ISTOR. &anted and 8xpected 5regnancy <o prenatal care <o nourishing foods 'ather contributed to the burden of not remitting his salary .other during pregnancy had inade%uate nutrition and was unable to comply with all her vaccinations. &hile the client3s mother was pregnant, she would need to wor$ as a salt vendor at the same time to support the needs of the family. emotional and financial problems

BIRT& The patient was born on >ctober 7=, =;7 'ull term and delivered in breech position and cord coil by an alternative doctor. The client3s mother was in labor while delivering the client for 7 days and 7 nights. It was posited that the delivery was a difficult and laborious one. The client was not subHected to any type of immunizations.

IN,ANC. 1:6A ONT&S @T+FST BS .IST+FSTA

"t*er B Breastfe$ t*e patient b)t $"ne in betCeen c*"res

,at*er B rarel+ ar")n$ f"r b"n$in' ti%e B a 'a%bler an$ an alc"*"lic

!atient D:E F)alit+ ti%e Cit* fat*er D:E %aternal b"n$5 since inappr"priatel+ breastfe$ D:E "ral nee$s n"t s)fficientl+ %et DGE first t""t* appeare$ at 0 %"nt*s "f a'e DGE first Cal< at 6 +ear "l$ DGE t*)%bs)c< fr"% a'e 2 %"nt*s )ntil 7 +ears "f a'e DGE )n*+'ienicall+ presente$

Devel"pe$ %istr)st

T*e $evel"p%ental tas< "n t*is sta'e is attac*%ent t" %"t*er/ T*e p""r infant: %aternal relati"ns*ip5 as intensifie$ b+ fail)re t" establis* str"n' %aternal b"n$ t*r")'* breastfee$in' an$ t*e n"te$ t*)%bs)c<in' be*avi"r as in$icative "f fail)re t" %eet "ral nee$s are evi$entl+ n"te$ in t*e patient/ Ulti%atel+5 t*is le$ t" t*e patient#s $evel"p%ent "f %istr)st/

EAR-. C&I-D&OOD 6A ONT&S:8 .EARS @AFT><>.P BS S*A.8 A<) )>F/TA "t*er 4 with direct supervision and a strict disciplinarian ,at*er 4 no active role in child rearing 4 all vices @gambling, drin$ing, smo$ingA 4 physically disciplines children

!atient tal<in' an$ Cal<in' at 7 +ears "l$ t"ilet trainin' at 7 +ears "l$ as<s per%issi"n t" )rinate an$ $efecate n" t"+s t" pla+ Cit* D "t*er faile$ t" pr"vi$e t"+s beca)se "f C"r<E parents are strict $isciplinarians

Devel"pe$ S*a%e an$ D")bt

T*e $evel"p%ental tas< "n t*is sta'e 'ainin' s"%e basic c"ntr"l "ver self an$ envir"n%ent/ T*e patient#s ver+ restrictive envir"n%ent5 $i$ n"t c)ltivate a sense "f a)t"n"%+5 since *e j)st %erel+ f"ll"Ce$ r)les an$ re')lati"ns an$ t*e parents are ver+ strict $isciplinarians t*at $i$ n"t c)ltivate as sense "f self:c"ntr"l an$ Cillp"Cer5 beca)se t*ere is an "verC*el%in' parental p"Cer t*at $i$ n"t c)ltivate t*eir "Cn abilities an$ talents/ Ulti%atel+5 t*is le$ t" t*e patient#s $evel"p%ent "f s*a%e an$ $")bt/

-ATE C&I-D&OOD 8:2 .EARS O-D @I<ITIATIB8 BS 9FI0TA "t*er ,at*er 4 with no direct supervision 4 no active role in child rearing 4 delegated responsibility of her younger children to the care of her older children !atient 4 shy and timid 4 have homosexual friends only 4 a follower with playmate neighbors 4 accompanies mother to sell salt for food left to the care of older brothers when he does not accompany his mother to wor$

@QA identified playing with male4oriented toys @top, marbles, rubberbandsA @QA maHority of the friends were male @QA accompanies mother to wor$ @QA left under the care of older brothers

Devel"pe$ Initiative

T*e $evel"p%ental tas< "n t*is sta'e bec"%in' p)rp"sef)l an$ $irective/ T*e patient $i$ n"t i$entif+ Cell Cit* t*e parent "f sa%e se(5 beca)se it Cas "nl+ t*e %"t*er C*" Cas alCa+s ar")n$/ T*is sta'e is cr)cial sta'e "f c)ri"sit+ an$ e(pl"rati"n/ T*e c*il$ %)st spen$ a%ple ti%e creatin' *ealt*+ c"%petiti"ns Cit* pla+%ates5 rat*er t*an c"nstantl+ acc"%pan+in' *is %"t*er t" sell/ T*e c*il$ Cas intr"$)ce$ t" t*e perils "f $a+:t":$a+ livin' at a ver+ +")n' a'e/ T*is $evel"p%ental sta'e5 is %ar<e$l+ i$entifie$ as a fail)re5 b+ t*e patient#s inabilit+ t" balance initiative Cit* restraint5 settin' realistic '"als/ Ulti%atel+5 t*is le$ t" t*e patient#s $evel"p%ent "f ')ilt/

SC&OO- AGE 0:67 .EARS O-D @I<)FST+P BS I<'8+I>+ITPA "t*er 4 poor parental supervision because of wor$ing to provide for basic needs of family !atient at age ; year old, the patient entered schooling by age 2 years old, the patient stopped going to school patient expressed disli$e on going to school for failure to absorb day4to4day lectures by the teachers cutting his classes by going to the sawmill and wor$ed as D$argadorE of firewoods reason posed by the patient for li$ing to wor$, was to have money, so when he goes to school, he has DbaonE or spending money. ,at*er 4 no parental supervision

Devel"pe$ Inferi"rit+

T*e $evel"p%ental tas< "n t*is sta'e5 $evel"pin' s"cial5 p*+sical an$ sc*""l s<ills/ T*e patient#s inabilit+ t" 'ain a sense "f c"%petence t*r")'* <eepin' )p Cit* t*e $e%an$s "f sc*""l5 in$icates a sense "f lac< "f pr"$)ctivit+ in *is c*aracter/ T*e li<eli*""$ "f atte%ptin' t" s)bstit)te C"r< f"r sc*""l5 *as pr"ven t*e inabilit+ t" balance C"r< an$ pla+/ In t*is case5 t*e balance "f sc*""l an$ $esire t" $eviate fr"% str)ct)ral learnin'/ Ulti%atel+5 t*is le$ t" t*e patient#s $evel"p%ent "f inferi"rit+/ ADO-ESCENSE 67:71 .EARS O-D @I<)FST+P BS +>08 -><'FSI><A "t*er 4 inade%uate maternal supervision !atient starte$ %ast)rbatin' H 60 +ears "l$ sec"n$ar+ se( c*aracteristics n"te$ b+ 6A +ears "l$ i$entifie$ Cit* Catc*in' acti"n fil%s i$"li=e$ a str"n' %ale act"r DB"n' RevillaE 'aine$ se()al aCareness b+ a'e 71 +ears "l$ ,at*er 4 absence of father4bonding

Devel"pe$ R"le C"nf)si"n

T*is sta'e is C*en t*e c*il$ learns t" ac*ieve neC an$ %"re %at)re relati"ns Cit* a'e:%ates "f b"t* se(es5 %asc)line "r fe%inine s"cial r"le5 accepte$ "ne#s p*+siF)e an$

aCare "f "ne#s b"$+ p*+siF)e/ T*ere Cas n" parental s)pervisi"n t*at C")l$ *ave assiste$ *i% in t*is transiti"n/ I*en *e st"ppe$ sc*""lin'5 beca)se *e preferre$ C"r<in' t" "btain spen$in' %"ne+ an$ *elp a)'%ent fa%il+ inc"%e5 pave$ t*e Ca+ f"r t*e $evel"p%ent "f r"le c"nf)si"n5 as *e ca%e int" battle Cit* *is p)rp"se "f bein' t*e c*il$ C*" st)$ies an$ t*e in$ivi$)al C*" C"r<s t" *elp t*e fa%il+ an$ pr"vi$e *is pers"nal nee$s C*ic* *is parents5 in partic)lar *is fat*er *as faile$ t" acc"%plis*/ T*e patient $evel"pe$ r"le c"nf)si"n in t*e pr"cess/

EAR-. ADU-T&OOD 71:82 .EARS O-D @I<TI.A-P BS IS>0ATI><A

"t*er 4 inade%uate maternal supervision !atient

,at*er 4 absence of father4bonding

p*+sical attracti"n Cit* "pp"site se( fr)strati"n "f n"t bein' able t" e(press e%"ti"ns t" *is "bject "f interest C"r<e$ as a c"nstr)cti"n C"r<er in Sa%al fr)strate$ an$ $isapp"inte$ f"r failin' t" c"%plete t*e ren"vati"n "f t*eir *")se stares blan<l+ at bric< Calls is"lati"n b+ l"sin' t")c* Cit* realit+

@QA unable to express feelings @QA unable to establish interaction @QA low self4esteem

 @QA recurrent admissions @QA losing touch with reality

Devel"pe$ Is"lati"n

T*is sta'e calls f"r establis*in' inti%ate b"n$s "f l"ve an$ frien$s*ip/ &"Cever5 t*e patient#s sense "f inti%ac+ is 'reatl+ $ist)rbe$ as *e appeare$ ver+ Cit*$raCn an$ passive/ &is represse$ e%"ti"ns t"Car$ t*e "pp"site se( c"ntrib)te$ t" t*e fr)strati"n an$ $isapp"int%ent t*at event)all+ %a$e t*e patient $etac*e$ "r is"late$ fr"% *is e%"ti"n/ &is illness is in$icative "f fail)re t" *an$le fr)strati"ns an$ $isapp"int%ent t*at %a$e *i% l"se t")c* "f realit+/ ONSET O, I--NESS The condition of the patient was claimed to have started at the time when the patient was poisoned in Samal, as he wor$ed as a construction wor$er. The patient with his family sought medical assistance but had negative findings. So they decided to have the patient be attended by an alternative doctor and was observed to have been really poisoned and was given treatment. *owever, several days after, the patient manifested violence and erratic behavior whenever he encounters a blac$ cat. The patient had several admissions at )avao .ental *ospital. It was on the year 7227, that the first attac$ occurred. Specifically, September of 7227, the patient was admitted for wee$ due to behavior changes, such as lying down on hot surfaced ground, stiffness and muscular rigidity. /y 'ebruary 722", admitted bac$ for episodes of violence self4directed and to others and was later released by .arch 722". Third admission was on >ctober 722", brought in by relatives and noted to have poor compliance with medications. 5atient was noted to be restless and was tal$ing alone prior to admission, then was discharged # days after. 'ourth admission was last 'ebruary 722# , patient was admitted because the patient was wal$ing aimlessly and was

staring blan$ly. It was claimed that the condition was aggravated to the level of episode of violence due to a misunderstanding on a betting game, Dcoc$fight derbiE. )ischarged four days later. 'ifth admission was last 1une 722# and discharged days after for same episodic reasons. Sixth admission was last >ctober 722# and discharged days after due to the same reasons and poor compliance with medications. Seventh Admission was last April 722! for the same reasons posted. The patient was last attended by a physician for his condition last August !, 722!. <o follow4up was done to this date. 5rior to admission, the patient heard that their neighbor, a friend of his, was stabbed and was $illed. After the $nowing of the incident, the patient had episodic attac$s again, such as shouting and throwing stones and was constantly staring blan$ly on bric$ walls. Then discharged " days after, symptoms were controlled through medication compliance. 5rompted admission

DI,,ERENTIA!ARANOID DIAGNOSIS T.!E

I/ Sc*i="p*renia . -atatonia A. Stupurous -atatonia( . .ute or nearly so stereotyped 7. <egativistic ". 8chopraxia #. /ody +igidity !. Sudden or Fnprovo$ed outburst of activity :. Sitting, lying, standing and in fixed position ;. In contact with and aware of the environment but lac$s verbal response ,. retain saliva, urine and feces =. gestures, grimacing grinning, immobile 2. stares on the floor . believed they3ve spo$en their thoughts T>TA0 K K K K ? K K K K ? K 7? @ 22A R ,N

SC&IJO!&RENIA

/. -atatonic 8xcitement( . Fnorganized and aggressive motor action 7. 5urposeless, stereotyped, confined ". Impulsive, unpredictable #. Suddenly attac$ bystander or brea$ window !. )estroy clothing, nude :. <egativism ;. .utism ,. 8xhaust syndrome =. Attempt to destroy himself 2. Shouts, tal$s loudly . 'light of ideas T>TA0 K K ? K K K K K K ? ? "? @ 22A R 7;N

7. 5aranoid( . Tensed, suspicious and reserved 7. )elusion of poison ". )elusion of grandeur #. +eligious preoccupation, unrealistic thin$ing !. Irritable :. Fnpredictable ;. *allucinations ,. Ideas of +eference =. )epression 2. 0ac$s drive for achievement and career . +egress and deteriorate T>TA0 ". Simple?Schizoid( . The subHect is vague 7. 0oss interest in activity ". .oody #. Irritable !. 0ac$ing spontaneity K ? ? ? ? ? ? K K ? ? K ? K ? K :? @ 22A R :2N

:. Apathetic ;. 9oals no longer realistic ,. Fnable to assume mature roles =. -riticisms?concerns ma$e no impression 2. -omplaints of nervousness and fatigue T>TA0 #. Fndifferentiated( . Apathy 7. Ideas of reference ". 5rominent delusions #. <egativistic behavior !. 5erplexity :. *allucinations ;. Incoherent communication ,. 9rossly disorganized =. Socially aberrant behavior 2. Impoverish relationship with family T>TA0 !. +esidual /orderline( . *ealth of at least previous episode of Schiz. with prominent psychotic symptoms 7. Shy ". 8asily irritated #. 5erceived as peculiar !. 8motional /lunting :. Illogical thin$ing ;. )isorganized behavior ,. Absence of prominent delusions and hallucinations T>TA0 II. Affective )isorders( a. .anic Type( . Inflated self4esteem 7. )ecreased need for sleep ". .ore tal$ative than usual #. 'light of Ideas !. )istractibility

K ? K K K !? 2 @ 22A R !2N

K K K ? K K ? ? ? ? !? 2 @ 22A R !2N ? ? ? x x x ? x #?,@ 22A R !2N

x x x ? x

:. 8xcessive involvement in pleasurable activities hat have a high potential of painful conse%uence ;. +hyming ,. 8xhibitionistic /ehavior T>TA0 b. )epressive Type( . )epressed mood occurring most of the day 7. .ar$edly diminished interest in all activities ". Significant weight loss or weight gain #. Insomnia or hypersomnia nearly everyday !. 5sychomotor retardation or agitation :. 'atigue or loss of energy nearly every day ;. 'eeling of worthlessness ,. Indecisiveness =. Suicidal Ideation T>TA0

x x x ?,@ 22A R 7.!N

x ? x x ? K ? ? ? "?=@ 22A R!!N

III. 5ersonality )isorders( a. eccentric 5ersonality )isorders a. 5aranoid type( . Suspicious 7. .istrust ". 1ealousy #. +estricted Affect !. 5roHection a.7 Schizoid?Schizotypal type( . 8motional aloofness 7. &ithdrawn ". >dd Speech #. )etachment T>TA0

? ? K ? K ? K ? ? :?= @ 22A R ::N

b. )ramatic48rratic 5ersonality )isorders b. *istrionic Type . )ramatic 7. 8xaggerated emotions ". Temper4Tantrums #. Impressionality !. )ependence on authority figures b.7 Antisocial Type . .anipulative 7. 8xtroverted ". -harming #. Impaired conscience with lying !. -heating :. )esire for immediate pleasure ;. 0ac$ of commitment and intimacy ,. 5oor wor$ history =. 0ac$ of concern about right and wrong T>TA0

K K K K K K K K K K K K K K 2? # @ 22A R 2N

c. Anxious4'earful 5ersonality )isorders c. Avoidant Type . hypersensitivity to others 7. 'ear of reHection or failure ". 'ear or discomfort of being alone #. >verly serious !. /lunted emotional expression :. )evaluation of personal abilities c.7 >bsessive4-ompulsive type( . +elentless 7. Striving for organization and order ". demanding #. -ontrolling !. 8xcessive dedication to wor$ :. 5erfectionism ;. +igidity

K K K K K K K K K K K K K

,. 1udgmental attitudes towards others =. .oralistic T>TA0

K K 2? ! @ 22A R 2N

SU DISORDERS . S-*IS>5*+8<IA .a -atatonia 6/b !aran"i$ .c Simple?Schizoid .d Fndifferentiated .e +esidual 7. A''8-TIB8 7.a .anic 7/b Depressive ". 58+S><A0ITP 8/a Eccentric ".b )ramatic48rratic ".c Anxious or 'earful

AR. O, DI,,ERENTIA- DIAGNOSIS !ERCENT 77.!N 01L !2N !2N !2N 7.!N 22L 00L 2N 2N RANKING "rd 6st 7nd A 7nd / 7nd 7nd 6st 6st 4 4

DIAGNOSIS
The disorder manifests itself in a broad range of unusual behaviors, which cause profound disruption in the lives of the patients suffering from the condition and in the lives of the people around them. Schizophrenia stri$es without regard to gender, race, social class or culture. >ne of the most important $inds of impairment caused by schizophrenia involves the person's thought processes. The individual can lose much of the ability to rationally evaluate his surroundings and interactions with others. There can be hallucinations and delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic's abnormal perceptions and beliefs. !aran"i$ Sc*i="p*renia There are five subtypes of schizophrenia. Among these subtypes is the paranoid type. In the paranoid form of this disorder, they develop delusions of persecution or personal grandeur.

The first signs of paranoid schizophrenia usually surface between the ages of ! and "#. There is no cure, but the disorder can be controlled with medications. Severe attac$s may re%uire hospitalization. Ca)ses The causes of schizophrenia are still under debate. A chemical imbalance in the brain seems to play a role, but the reason for the imbalance remains unclear. &e do $now that an individual is a bit more li$ely to become schizophrenic if they have a family member with the illness. Schizophrenia usually develops gradually, although onset can be sudden. 'riends and family often notice the first changes before the victim does. Among the signs are( confusion, inability to ma$e decisions, hallucinations, changes in eating or sleeping habits, energy level, or weight, delusions, nervousness, strange statements or behavior, withdrawal from friends, wor$, or school, neglect of personal hygiene, anger, indifference to the opinions of others, a tendency to argue, a conviction that you are better than others, and that people are out to get you. Si'ns9S+%pt"%s Schizophrenia usually develops gradually, although onset can be sudden. 'riends and family often notice the first changes before the victim does. Among the signs are(

-onfusion Inability to ma$e decisions *allucinations -hanges in eating or sleeping habits, energy level, or weight )elusions <ervousness Strange statements or behavior &ithdrawal from friends, wor$, or school <eglect of personal hygiene Anger Indifference to the opinions of others A tendency to argue A conviction that you are better than others, or that people are out to get you

!aran"i$ Sc*i="p*renia

tensed, suspicious and reserved delusion of poison

delusion of grandeur religious preoccupation, unrealistic thin$ing irritable unpredictable hallucinations ideas of reference depression lac$s drive for achievement and career regress and deteriorate

Care )rugs such as Thorazine, *aldol, and +isperdal combat symptoms in # out of ! patients. An acute attac$ usually can be cleared up in # to , wee$s. -ounseling and group therapy help recovering patients to understand the disease and to function effectively. Ris<s &ithout medication and therapy, most paranoid schizophrenics are unable to function in the real world. If they fall victim to severe hallucinations and delusions, they can be a danger to themselves and those around them. T*erap+ Treatment for an acute attac$ can re%uire full4time hospitalization in a loc$ed inpatient unit. As symptoms subside, you may be transferred to a partial care program in which you are able to return home after each day's therapy. Inpatients may wear their own clothes, but are customarily searched for sharp obHects such as scissors or nail files, which are held in a staff office. 5atients who present a danger outside the hospital can be involuntarily hospitalized for up to " days by the police or a doctor. &hile hospitalized, you may encounter the following procedures.

Gr")p T*erap+: These meetings are somewhat li$e a support group session, allowing patients to share coping strategies. The meetings are run by medical staff. In$ivi$)al T*erap+: This is a time for you to meet alone with your therapist to discuss ways of dealing with the illness. ,a%il+ eetin's: In these sessions, medical staff will prepare you and your family for

your return home.

Ti%e O)t: If you become unable to control yourself, the staff may separate you from the other patients, either in your own room or444if you seem violent444in a Tsafety room.T

Restraints: 5atients who pose a danger to themselves or others may be physically restrained with leather bands. Electr"c"nv)lsive T*erap+: 'or patients who become severely withdrawn or depressed, this form of treatment can help speed recovery. Also $nown as 8-T or shoc$ therapy, it applies a mild electric current to the brain. Although the treatment temporarily disrupts the memory, full recall typically returns within 7 wee$s.

DOCTOR#S ORDER
7? !?2" admit to I-F w? watcher )AT B?S shift and record 0A/S ( -/-, F?A, '/S .edications o *aloperidol ! mg I. now then % , o /iperiden *-l 7 mg tab 7x?day as needed *omicidal Suicidal 8scape precaution +estrain if necessary +efer accordingly 7? :?2" )?- .eds -hlorpromazine 722 7? ;?2" cont meds 2?:?2" admit to -IF w? watcher )AT B?S % shift and record 0abs( -/-, FA

tab

 .eds o *aloperidol ! mg amp I. now then % , o /iperiden *cl 7 mg?tab tab TI) 5+< for reaction *omicidal?Suicidal? 8scape precaution +efer accordingly 2?;?2" -?) *aloperdiol -ont. meds 7?7?2# Admit to -IF w? watcher )AT BS % shift and record .eds o *aloperidol ! mg amp I. now then % , o /iperiden *cl 7 mg?tab tab TI) 5+< for reaction +estrain if necessary Suicidal? *omicidal? 8scape precaution +efer

7?"?2# cont. meds 7?#?2# -?) *aloperidol -hlorpromazine 7?!?2# cont meds 'or >T :? "?2# )?- *aloperidol I. -hlorpromazine 2?7"?2# admit to -IF B?S % shift and record o *aloperidol ! mg amp I. now then % , o /iperiden *cl 7 mg?tab tab TI) 5+< for reaction +estrain if necessary Suicidal? *omicidal? 8scape precaution

 +efer 2?7#?2# -hlorpromazine 722 mg tab U tab at *S 2?7!?2# 'or possible discharge tomorrow -ont. meds 2?7:?2# for >T today cont. meds 2?7;?2# still for >T ,? !?2! admit pt to -IF with watcher )AT BS % shift 0A/S( -/-, FA .8)S( o *aloperidol ! mg?amp I. now them % , o /iperiden *-l 7mg?tab, tab /I) 5+< for 85S homicidal?suicidal?escape ideation restrain if necessary &atch for signs of 85S +efer ,? :?2! -?) *aloperidol I. Shift to chlorpromazine 22 mg tab, U tab /I) ,? ;?2! continue meds still for report ,? ,?2! .9* *ome meds o -hlorpromazine 22 mg?tab, U tab /I) o /iperident *-l 7mg?tab, tab /I) T-/ after two wee$s

!ROGRESS NOTES
7? !?2"

S?>
A schi4paranoid type 4 guarded 5 continue meds 7? :?2" S?> pt seen awa$e and sitting not hostile good sleep good appetite euthymic A awa$e, responsive fairly groomed able to sleep well able to eat well with good appetite appropriate affect denies of auditory hallucinations

 schizophrenia, paranoid 5 continue meds watch for signs of 85S 7? ;?2" S?> good sleep good grooming good appetite good affect @4A hallucinations A schizophrenia, paranoid 5 continue meds watch for signs of 85S 2?:?2" S?> pt seen awa$e and sitting not hostile good sleep good appetite euthymic A schizophrenia, paranoid 5 continue meds watch for signs of 85S 2?;?2" S?> awa$e, fairly groomed euthymic mood, appropriate affect good sleep and appetite @CA AB hallucinations @4A violent behavior @4A delusions and preoccupations +esponds spontaneously 9ood eye contact A

 schizophrenia, paranoid 5 continue meds watch for signs of 85S 7?7?2# S?> A 5 7?"?2# S?> 5 7?#?2# S?> A 5

good sleep good appetite @4A hallucinations Awa$e, responsive schizophrenia, paranoid continue meds watch for signs of 85S

good sleep good grooming good appetite good affect @4A hallucinations schizophrenia, paranoid continue meds watch for signs of 85S

good sleep good appetite @4A hallucinations Awa$e, responsive schizophrenia, paranoid continue meds watch for signs of 85S

7?!?2# A 5

awa$e, responsive fairly groomed able to sleep well able to eat well with good appetite appropriate affect denies of auditory hallucinations schi4paranoid type 4 guarded continue meds

:? "?2# S?> awa$e, responsive fairly groomed able to sleep well able to eat well with good appetite appropriate affect denies of auditory hallucinations A schi4paranoid type 4 guarded 5 continue meds

2?7"?2# S?> good sleep good appetite @4A hallucinations Awa$e, responsive A schizophrenia, paranoid 5 continue meds watch for signs of 85S 2?7#?2# S?> awa$e, responsive

 A 5

fairly groomed able to sleep well able to eat well with good appetite appropriate affect denies of auditory hallucinations

schi4paranoid type 4 guarded continue meds 2?7!?2# S?> pt seen awa$e and sitting not hostile good sleep good appetite euthymic A schizophrenia, paranoid 5 continue meds watch for signs of 85S

,? :?2! S?>
A schi4paranoid type 4 guarded 5 continue meds ,? ;?2! S?> pt seen awa$e and sitting not hostile good sleep good appetite awa$e, responsive fairly groomed able to sleep well able to eat well with good appetite appropriate affect denies of auditory hallucinations

 euthymic A schizophrenia, paranoid 5 continue meds watch for signs of 85S ,? ,?2! S?> pt. seen awa$e and responsive able to sleep good appetite non hostile @4A AB hallucination A schizophrenia, paranoid 5 continue meds watch for signs of 85S

DRUG STUD.
Generic Na%e -hlorpro mazine *ydrochl oride General Classificati"n Anti4psychotic6 Anti4anxiety "$e "f Acti"n Antipsychotic drug bloc$s postsynaptic dopamine receptors in the brain involve with wa$efulness and emesis6 anticholinergic, antihistamine and alpha4 adrenergic bloc$ing D"sa'e M R")te 722mg tab /I) 5.>. A$verse Reacti"n )rowsiness, insomnia, vertigo, salivation, dry mouth, nausea and vomiting, anorexia, orthostatic hypotension, anemia, photophobia. C"ntrain$icati"n V Allergy to chlorpromazine V -omatose or severely depressed states V /one marrow depression V -irculatory collapse V Sub cortical brain damage. V 5ar$inson3s disease V 0iver damage V -erebral or coronary arteriosclerosis V +espiratory disorders V Severe hypotension or hypertension N)rsin' Resp"nsibilities V Always observe ten rights in administering drugs. V 5atient should be advise about the possibility of tardive dys$inesia. V Aspiration precaution because of suppressed cough reflex V .onitor renal function test, discontinue if serum creatinine or /F< become abnormal. V .onitor -/-, discontinue if &/- count is depressed. V &ithdraw drug gradually after high dose therapy6 possible gastritis, nausea, dizziness, headache, tachycardia , and insomnia after abrupt withdrawal. V Fse with caution in hot weather, ris$ of heat stro$e6 $eep up fluid inta$e and do not over exercise in a hot climate.

DRUG STUD.
Generic Na%e *aloper idol )ecano ate General Classificati"n Antipsychotic "$e "f Acti"n Fn$nown. A butyrophen one that probably exerts its antipsychoti c effects by bloc$ing postsynapti c dopamine receptors in the brain. D"sa'e an$ R")te ! units %, A$verse Reacti"n W -<S( severe extrapyramidal reactions, tardive dys$inesia, sedation, drowsiness, lethargy, headache, insomnia, confusion, vertigo, seizures. W -B( tachycardia, hypotension, hypertension, 8-9 changes. W 9I( dry mouth, anorexia, constipation, diarrhea, nausea, vomiting, dyspepsia. W 9F( urine retention, menstrual irregularities, priapism. W *epatic( altered liver function test results, Haundice. W S$in( rash, other s$in reactions, diaphoresis. W >ther( neuroleptic malignant syndrome, gynecomastia. CI W -ontraindicated in patients with hypersensitivity to drug and in those experiencing par$insonism, coma, or -<S depression N)rsin' Resp"nsibilit+ W Fse cautiously in elderly and debilitated patients6 in patients with history of seizures or 889 abnormalities, severe -B disorders, allergies, glaucoma, or urine retention6 also use cautiously with anticonvulsants, anticoagulants, antipar$insonians, or lithium. W 5rotect drug from light. Slight yellowing of inHection or concentrate is common and doesn't affect potency. )iscard mar$edly discolored solutions. W )on't withdraw drug abruptly unless the patient has severe adverse reactions. W .onitor patient for tardive dys$inesia, which may occur after prolonged use. It may not appear until months or years later and disappear spontaneously or persist for life, despite discontinuation of drug. W Alert( &atch for symptoms of neuroleptic malignant syndrome @extrapyramidal effects, hyperthermia, autonomic disturbanceA, which is rare but fre%uently fatal. It isn't necessarily related to length of drug use or type of neuroleptic6 however, more than :2N of affected patients are men. W Alert( )on't confuse *aldol with *alcion or *alog. W Although drug is the least sedating of the antipsychotics, warn patient to avoid activities that re%uire alertness and good psychomotor coordination until -<S effects of drug are $nown. )rowsiness and dizziness usually subside after a few wee$s. W &arn patient to avoid alcohol while ta$ing drug. W Advise patient to relieve dry mouth with sugarless gum or hard candy.

DRUG STUD.
Generic Na%e /iperiden *ydrochlo ride General Classificati "n Anti4 5ar$insonis m D"sa'e an$ R")te 7 mg tab, tab /I) for 85S

"$e "f Acti"n Antipar$insoni ans include synthetic anticholinergic and dopaminergic drug and the anti4viral drug amantidine. Anticholinergi cs probable prolong the action of dopamine by bloc$ing its re4 upta$e into pre4synaptic neurons in the -<S and by suppressing central cholinergic activity. )opaminergic drugs act in the brain by increasing dopamine availability thus by improving motor function

A$verse Reacti"n W fatigue, dizziness. dry mouth, swelling of salivary glands, accomodation difficulties, mydriasis and photophobia, hypohydrosis, constipation, gastric symptoms, nausea, tachycardia, bradycardia, especially at higher doses. W restlessness, agitationanxiety, confusion, impairment of memory, hallucinations, headache, ataxia, muscle twitching and speech impairment.

C"ntrain$icati"ns Fntreated narrow angle glaucoma, mechanical stenosis of the 9IT, megacolon and ileus.

N)rsin' Resp"nsibilit+ W Instruct patient to ta$e drug exactly as prescribed and warn him not to stop drug suddenly. W Advise patient to ta$e drug with food to prevent stomach upset. WTeach patient how to manage anticholinergic effect, if appropriate. -aution patient to avoid hazardous tas$s if adverse -<S effects occur. W Tell him to avoid alcohol during therapy. 8ncourage patient to report severe or persistent adverse reactions.

NURSING CARE !-AN

CUES S( D Manang iringa, maglagot Hud $o, gilabayn na$o na ug tsinelas, su$ad naa na, mag andar $o $a buangE as verbalized by the patient >( restless irritability tense facial expression rigid posture

DIAGNOSIS 5otential for violence directed at others r?t paranoid ideation )efinition( A state in which an individual experiences behaviors that can be physically and emotionally harmful to others +eference( <ursing )iagnoses in 5sychiatric <ursing 7nd 8dition ..-. Townsend

OBJECTIVE 9 !-AN At the end of exposure, patient will manifest a decrease of ris$ to hurt others

INTERVENTION

RATIONA-E

EVA-UATION 9oal not met. 5atient sometimes show some signs of aggressive behavior.

maintain low level of stimuli in patients environment @e.g. few people, low noise levelA remove all dangerous obHects from patients environment redirect the violent behavior with physical outlet for the patients hostility maintain and convey a calm attitude to patient

anxiety and agitation rise in a stimulating environment patient may not use them to harm others physical exercise is a safe and effective way of relieving pent Gup tension anxiety is contagious and can be transmitted from nurse to patient

NURSING CARE !-AN

C)es9Evi$ences S( D *umana $o ligo, tong isa $aadlawE as verbalized by patient. >( wears unclean shirt O short pant6 in state of poor hygiene O grooming6 has distinct body O breath odor exhibited untrimmed and dirty finger and toe nails. un$empt hair N)rsin' Dia'n"sis Self4care deficit +elated to 5oor 5ersonal *ygiene Source( State in which a person experiences difficulty in performing tas$s of daily living, such as feeding self, dressing, bathing, toileting, transferring from bed, and wal$ing. +eference( <ursing )iagnosis and Interventions by 9radishar Objectives At the end of the psychiatric exposure, the patient safely performs body, hair grooming and oral care with minimal assistance. N)rsin' Interventi"ns . 8stablish rapport. 7. Assist patient in accepting necessary amount of dependence. ". Set short4range goals with patient. #. 8ncourage independence, but intervene when patient cannot perform. !. 5rovide fre%uent encouragement and assistance as needed with dressing. :. 8ncourage patient to comb own hair. ;. 8ncourage patient to perform minimum of oral4facial hygiene ASA5. Assist with brushing teeth and shaving, as needed. ,. Assist patient with care of fingernails and toenails as re%uired. =. >ffer fre%uent encouragement Rati"nale . To gain the client3s trust, confidence and cooperation. 7. If disease?illness resulting in self4care deficit is recent, patient may need to grieve before accepting that dependence is possible. ". To facilitate learning and decrease frustration. #. To decrease frustration. Eval)ati"n 9oal met as patient. safely performs body, hair grooming and oral care with minimal assistance.

!. This helps patient to organize and carry out self4 care s$ills. :. To promote a one4handed tas$. ;. To promote a one4handed tas$.

,. To promote a one4handed tas$ =. 5atients often have difficulty seeing progress.

NURSING CARE !-AN

C)es9Evi$ences S( D )ili Hud $o anan iring, $anang irang pag naa na, mag$asa$it Hud $o.E >( tal$ative restlessness @QA flight of ideas @QA auditory and visual hallucinations N)rsin' Dia'n"sis Impaired social interaction r?t altered thought process as evidenced by patients lo%uaciousness )efinition( The state in which individual participates in an insufficient or excessive %uantity or ineffective %uality of social exchange +eference( <ursing )iagnoses in 5sychiatric <ursing 7nd 8dition. ..-. Townsend Objectives At the end of the psychiatric exposure, patient will be able to socialize with other people without harming. N)rsin' Interventi"ns . 8stablish rapport. 7. +ecognize the purpose of this behavior to reduce the feeling of insecurity ". )o not argue, bargain or try to reason out with the patient #. *elp patient recognize conse%uences of own behavior !. pre4orient patient as necessary Rati"nale . To gain the client3s trust, confidence and cooperation. 7. Fnderstanding the motivation behind the manipulation may facilitate acceptance of the individual behavior ". Ignoring this attempt may wor$ to decrease manipulative behavior. #. 5atient must accept responsibility for own behavior before adaptive change can occur !. +eorienting will enhance patient3s reality testing ability and overall mental status :. 8stablishes peer relationship and interaction and at the same time promote positive behavior. Eval)ati"n 9oal partially met, as patient still shows improvement in social interaction.

:. 8xpose client to social interactions.

NURSING CARE !-AN

C)es9Evi$ences SubHective( D )i $o mahimutang, wlaa na$o mahuman ang balay, lagot $ayo $o, ngano wala na$o human.E as verbalized by the patient. >bHective( perspiration restlessness flushing voice %uavering feelings of helplessness and discomfort increased tension N)rsin' Dia'n"sis Anxiety related to 5ersonal -onflict Source( A vague uneasy feeling that usually stems from an impending or anticipated circumstance or event. It cane be focused on a patient, obHect, or situation or unfocused and more generalized. It is believed to be primarily internally motivated, and its source is non4 specific or un$nown to the person experiencing it. +eference( <A<)A by &eber Objectives At the end of psychiatric exposure, patient will verbalize a reduction in the level of anxiety experienced . N)rsin' Interventi"ns .Ac$nowledged awareness of patient3s anxiety. 7. .aintained a calm and tolerant manner while interacting with patient. ". 8stablished a wor$ing relationship with patient through continuity of care. #. >riented patient to the environment as needed. !. As patient3s anxiety subsides, encourage patient to explore specific events preceding both the onset and reduction of the anxious feelings. :. Assisted patient in recognizing symptoms of increasing anxiety and explore alternatives to use to prevent anxiety from immobilizing her. Rati"nale .Ac$nowledgment of patient3s feelings validates the feelings and communicates an acceptance of those feelings 7. Staff3s anxiety maybe easily perceived by patient. The patient3s feeling of stability in a calm and non4 threatening atmosphere. ". An on4going relationship establishes a basis for communicating anxious feelings. #. >rientation and awareness of these surroundings promotes comfort and a decrease in anxiety. !. +ecognition and exploration of factors leading to or reducing anxious feelings are important steps in developing alternative responses. 5atient may be unaware of the relationship between emotional concerns and anxiety. :. Ability to recognize anxiety symptoms at lower intensity levels enables patient to intervene more %uic$ly to manage her anxiety. Eval)ati"n 9oal met as patient verbalized a reduction of anxiety and recognizes to ta$e it step by step.

!ROGNOSIS
Criteria: A/ Onset "f Illness: !""r 'irst onset at the age of 7, years old. The patient at present is "" years of age. The patient is .ale. B/ D)rati"n "f Illness: !""r The patient had several admissions at )avao .ental *ospital. It was on the year 7227, that the first attac$ occurred. Specifically, September of 7227, the patient was admitted for wee$ due to behavior changes, such as lying down on hot surfaced ground, stiffness and muscular rigidity. /y 'ebruary 722", admitted bac$ for episodes of violence self4directed and to others and was later released by .arch 722". Third admission was on >ctober 722", brought in by relatives and noted to have poor compliance with medications. 5atient was noted to be restless and was tal$ing alone prior to admission, then was discharged # days after. 'ourth admission was last 'ebruary 722# , patient was admitted because the patient was wal$ing aimlessly and was staring blan$ly. It was claimed that the condition was aggravated to the level of episode of violence due to a misunderstanding on a betting game, Dcoc$fight derbiE. )ischarged four days later. 'ifth admission was last 1une 722# and discharged days after for same episodic reasons. Sixth admission was last >ctober 722# and discharged days after due to the same reasons and poor compliance with medications. Seventh Admission was last April 722! for the same reasons posted. The patient was last attended by a physician for his condition last August !, 722!. <o follow4up was done to this date. 5rior to admission, the patient heard that their neighbor, a friend of his, was stabbed and was $illed. After the $nowing of the incident, the patient had episodic attac$s again, such as shouting and throwing stones and was constantly staring blan$ly on bric$ walls. Then discharged " days after, symptoms were controlled through medication compliance.

C/ !recipitatin' ,act"rs: !""r 6/ ,a%il+ 9!""r S)pp"rt S+ste% The family was a deteriorated and distorted support system for the patient. The father who was supposed to stand by and provide for the basic needs of the family, was a gambler and an alcoholic. The mother, who was supposedly the parent to nurture the emotional and psychological development of the children was focused on providing their physical needs in order to survive. The loss of parental supervision led the patient to explore of what the outside world could give him. The patient sought to assume role as a provider, as he wanted to help augment the family income at such an early age. 7/ Alc"*"l The patient began ta$ing sips of alcohol, socially drin$ing with friends. The patient3s parents noted also that his spends his money to buy alcohol. 8/ E%"ti"nal 5atient lac$s emotional security with a disrupted family support system. @/ !""r e$ical C"%pliance

5atient was not able to maintain medications due to lac$ of financial resource. 2/ -ac< "f E$)cati"nal S)pp"rt &hen the patient opted to wor$ to help the family than obtain education for himself. 0/ S"ci":Ec"n"%ic Stat)s The patient3s family socio4economic standing has exposed the patient to the hard realities of survival in life at such an early age. 3/ Un*ealt*+ -eis)re Activit+ The patient was fond of attending coc$fight derbi and was so engrossed with betting to earn money. A/ !ers"nalit+ The patient3s personality problem of not being able to ventilate his true emotions and his inability to handle frustrations and disappointments in life has aggravated his condition

D/

""$ an$ Affect: G""$

The patient3s state of mood is euthymic, he was in a normal and homeostatic mood. *owever, his affect was also appropriate. E/ Attit)$e an$ Iillin'ness t" t*e e$icati"n an$ Treat%ent: ,air The patient is willing to ta$e medications and have regular follow4up chec$4ups, but because of financial constraints, there is poor compliance to medication. ,/ An+ Depressive ,eat)re : G""$ The patient verbalized a sense of purpose or the need to wor$, because he claims he wants to finish the completion of their house renovation. G/ ,a%il+ S)pp"rt: ,air 'amily plays a significant role in the recovery process. negative family climates may help cause Schizophrenia @-omer, ===A. The members of the family supports the patient, however some are not responsive to the patient3s needs.
S)%%ar+

p""r: 893N @8 L fair: 793N 7O L '""$: 793N 7O L Over:All !r"'n"sis: The following criteria lead us to a poor prognosis with an increasing chance for improvement. The expectancy for relief is increased with every compliance of medications and psychotherapy.

RECO
,"r t*e client: The 9roup recommends the client to( . Ta$e his medications regularly.

ENDATION

7. )o her necessary activities of daily living. ". Berbalize her feelings and needs to her family members in order for them to ma$e necessary interventions. #. 5rovide client with tas$s to enhance her sense of responsibility. !. 5rovide opportunities to client wherein she can participate in goal setting and planning. ,"r t*e fa%il+: The group recommends the family to( . Assist the client with necessary activities of daily living. 7. 5rovide the client with therapeutic environment. ". 5rovide a safe environment for the client. #. 5rovide emotional support. !. 8xplain to the client the reason for ta$ing medications so that he will comply with the regimen and will at least control over situations. :. 8ncourage the client to verbalize his feelings and needs. ;. -onvey the feelings of acceptance, love and understanding of the client. ,"r t*e c"%%)nit+: The group recommends the community to( . Show acceptance and understanding to the client. 7. Interact with the client in order to develop self4confidence.

,"r t*e Instit)ti"n: The group recommends the institution to( . -onduct therapy sessions to enable client to engage in activities to exercise cognitive and motor abilities. 7. 'acilitate A)0 to ensure compliance and optimal cleanliness with regard to personal hygiene. T" t*e St)$ent N)rses: . Accept and respect patient3s condition their

EVA-UATION
In a short span of time that we have $nown the patient and his family, the group was able to establish good rapport with them to the extent that we were able to gather pertinent data regarding the patient3s past and present health history. The data that we have obtained were all carefully organized and processed. /y then, we have identified predisposing and precipitating factors that contributed to the patient3s illness. The result of our initial and final .ental Status 8xamination presented us information revealing the effectiveness of treatments and medications given to the patient.

&ith the $nowledge we have learned from different sources regarding the patient3s case, we were able to come up with appropriate nursing interventions and health teachings beneficial to the patient and his family.

&e hope that the health teachings we have imparted to the family would give them a better understanding on the nature of the patient3s illness and may they cooperate with the health care providers in implementing the suitable interventions.

BIB-IOGRA!&.

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Soreff, S. CCC/e e$icine/c"%/Inc 722" Townsend, .., N)rsin' Dia'n"ses "n !s+c*iatric N)rsin' 7nd 8dition, 8ducational 5ublishing *ouse, 5hilippines, ==, Bidebec$, !s+c*iatric ental &ealt* N)rsin', 722

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