Schizophrenia Paranoid

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A Case Study on
SCHIZOPHRENIA PARANOID
Submitted to:
Ms. Melba Irene Gabuya, R.N.
Clinical Instructor
Sumitted by:
Glaiza Ayop
Lev Jasper A. Blanco
Kara Marise Cortez
Arriane Noelle Gamalinda
Lovely Ann Lim
Lord Jacob Nique
Kim Ryan Renejane
Regine Saso
Angelie Tan
Kevin Tipon
Charrae Zarragosa
BSN-3D
August 7, 2010
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TABLE OF CONTENTS
Acknowledgement
Introduction
Objectives (General& Specific)
Patient’s Data
Genogram
Health History
Personal History
Anamnesis
Theories of Development
Etiology
Symptomatology
Psychodynamics
Mental Status Exam
Multi Axial Diagnosis
Definition of Complete Diagnosis
Differential Diagnosis
Anatomy and Physiology
Doctor’s Order
Drug Study
Nursing Care plan and Nursing Theories
Medical Management
Prognosis
Recommendations
Significance of the Study
Conclusion
References
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ACKNOWLEDGEMENT
The group wishes to express their gratitude and appreciation to the people who supported
the group in their works and helped in the success of this case study.
First of all, the group would like to thank the almighty God who gave the group
protection at all times.
To the group’s clinical instructor, Ms. Melba Gabuya, R.N. for her patience, guidance
and knowledge that she imparted to the group throughout the whole duration of the group’s
psychiatric exposure. To Mrs. Anabel Bauzon, R.N., Ms. Magnolia Jadulang, R.N., M.N., and
Mr. Richard Cheng, R.N., for their guidance and precence during the psychiatric exposure. To
Mrs. Nancy Bargamento, R.N., M.N., for imparting her knowledge and preparing the whole class
in our lectures on Psychiatric Nursing concept before the actual psychiatric exposure.
The group would also like to thank the staff of Davao Mental Hospital, for the usage of
the facilities and allowing us to read our client’s latest and previous charts.
To the Lim family, the group is grateful for providing lodging and sustenance during the
production of this group project.
To the patient, for his cooperation and expressing his feelings and insights in relation to
his illness during the interview that the group conducted.
To our patient’s father, for the time he allotted in giving all the necessary information
needed to complete this study.
To our families and friends, thank you for the support and encouragement you have given
to the group, without all of you, this report would not be a success.
To the group members, thank you for your unwavering effort and unadulterated
dedication for the commencement and completion of this project.
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INTRODUCTION
Schizophrenia is a serious mental illness characterized by a disintegration of the process

of thinking and of emotional responsiveness It most commonly manifests as auditory
hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with
significant social or occupational dysfunction. Onset of symptoms typically occurs in young
adulthood, with around 1.5% lifetime prevalence of the population affected. Diagnosis is based
on the patient's self-reported experiences and observed behaviour. No laboratory test for
schizophrenia currently exists.
Schizophrenia Ranks among the top 10 causes of disability in developed countries

worldwide (World Health Organization, www.who.int) Schizophrenia is a disease that typically
begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia
slightly earlier than women; whereas most males become ill between 16 and 25 years old, most
females develop symptoms several years later, and the incidence in women is noticeably higher
in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia
onset is quite rare for people under 10 years of age, or over 40 years of age (schizophrenia.com).
Approximately 1 percent of people develop schizophrenia at some time during their lives.
Experts estimate that about 1.8 million people in the United States have schizophrenia. The
prevalence of schizophrenia is the same regardless of sex, race, and culture.
In the Philippines, the prevalence of schizophrenia is thought to be about 1% of the

population. About 90% of patient in treatments is between 18-55 years old. (www.doh.gov)
The group 2 of BSN-3D was given the opportunity to have a psychiatric exposure at the
Davao Mental Hospital last July 26 until August 6, 2010. Within these dates the group was
assigned to have the case of Kida which was diagnosed with schizophrenia paranoid. After the
group’s initial research about his case we found out that he had several recurrent admissions at
the institution. With this data the group ought to seek the factors that influenced his condition.
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OBJECTIVES
The group formulated one general objective which serves as the main goal of the case
study and a number of specific objectives which may lead to the completion of the study.
General Objective:
The group will be able to apply and relate the knowledge and skills gained from the
nursing concept of Psychiatric Nursing to achieve a comprehensive and intensive learning
experience on a case study.
Specific Objectives:
a. Choose a client to be the subject of the case study related to Mental Illness
b. Establish rapport and good therapeutic relationship with the client and the family
members to gain their trust and to attain relevant information in the process
c. Gather necessary data through interview with the client and family members which will
serve as the baseline data for the case study
d. Trace the genogram of the client to be able to identify occurrence of the present condition
of the client
e. Know the past and present health history of the client and the family which will help in
determining the factors that caused the condition of the client
f. Present the anamnesis by thorough gathering of the client’s pertinent data, selected
informants, and familial history taking.
g. Determine if the client followed or achieved the theories of development by Eric Erikson,
Robert Havighurst, Sigmund Freud and Jean Piaget
h. Trace the psychodynamic of the final diagnosis including the etiology, symptomatology,
the predisposing and precipitating factors
i. Assess the client’s mental status thoroughly during the orientation and termination phase
as well as the Multi-Axial diagnosis
j. Interpret and analyze nurse-patient interactions taken through effective use of therapeutic
communication
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k. Give at least 3 definition of the complete diagnosis of the client

l. Arise with a differential diagnosis in relation to the client’s maladaptive behaviors.
m. Discuss the human anatomy and physiology of the organs involve in the client’s
condition
n. Present a doctor’s order with rationalization.
o. Present diagnostic exams true to the condition of the client in order to know what
complications the client had undergone as well as its clinical interpretation
p. Review the drugs taken by the client including its classification, mechanism of action,
indications, contraindications, drug interactions, side effects and adverse effects and
nursing management of each medication that have been prescribed to the client
q. Formulate at least 10 nursing care plans for the management and implementation of the
different interventions for the client
r. Arise to a prognosis
s. Make recommendations
t. Provide the significance of the study

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PATIENT’S DATA
Name : Kida
Age : 36 years old
Address : Purok 1B, Hilltop Bajada
Birthday : October 6, 1974
Birth Place : Makilala, Cotabato
Gender : Male
Ordinal Rank : 2nd child
Civil Status : Single
Nationality : Filipino
Religion : Roman Catholic
Educational Attainment : Secondary Level Undergraduate
Occupation : Unemployed
Source of Information : Client, Father, Cousin and neighbors
Father Mother
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Name: Amakida Name: Inakida
Age: 64 years old Age: 59 years old
Occupation: Service Driver Occupation: Midwife
Educ. Attainment: College Level Educ. Attainment: College Level
Medical Data
Date of Admission : March 23, 2010
Admitting Physician : Al Raymond Tupas, M.D.
Diagnosis : Schizophrenia Paranoid
Institution : Davao Mental Hospital

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GENOGRAM
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HEALTH HISTORY
Past Health History
Kida was a shy type of child. He’s not fond of playing games with his siblings. During
his elementary years, specifically in grade 6, he engaged in premarital sex. The lady he had made
love with became pregnant. His parents did not know about it. When he was already in
secondary level he engaged in gangsters. Due to the influence of these gangsters, his studies
were affected. He used illegal drugs, specifically Marijuana. Aside from using drugs he also
became alcoholic. His vices became chronic which led to a conflict in the family. Because of this
behavior it became a problem in the family. Such behavior became a problem because Kida can
no longer perform basic household chores.
Present Health History
Kida has been admitted for several times in the same institution. His last admission was
last March 23, 2010 and was discharged July 20, 2010. At home Kida didn’t take his medicine
two days prior to the incident when he hurt a 5 year old child. One day he became irritable and
hostile which led to his admission.
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PERSONAL HISTORY
Pre-natal
Amakida said that his wife carried herself well and didn’t experience any bumps, falls
and other accidents during pregnancy. His wife had her prenatal check-ups every month. His
wife never experienced any sickness during her pregnancy to Kida. His wife didn’t have any
problems experienced during her pregnancy with Kida and according to Amakida, his wife had
normal pregnancy. His wife is very careful regarding to her pregnancy. The mother took
vitamins and supplements every day. His wife eats nutritious foods during her pregnancy.
Birth
According to Amakida, Inakida experienced a complete nine months of pregnancy. On

October 6, 1974 in Makilala, North Cotabato, Inakida gave birth to Kida in the hospital through
normal delivery without difficulty and no instrumental sequels. Attended by a doctor.
Infancy and Childhood Characteristics
Kida is breastfed for only 3 months after birth because his mother needs to go back to
work and after 3 months, they mix fed him. The feeding pattern during infancy is not normal
because he had different feeding patterns. He was taken care by a “Yaya” and sometimes by his
Lola.
According to Amakida, Kida and his mother cuddles and hugs him always when she
breastfeeds him. Kida completed the immunization.
His first tooth came out when he was 1 year old. He started talking at age 1 and also
walking at the same age. The toilet training started when he was 2 years old and it was mostly
done by the mother and she was not strict in it. He does it independently but with a mother’s
guidance.
According to Amakida, Kida thumb sucks. He have fever for 2-3 days.
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Psychosexual History
He got circumcised at the age of 10 and he started to become aware about sex is when he
was 15 years old and at that age he also started to masturbate. He reads porn magazines and
watches pornography. The age when his voiced lowered in pitch is when he is 18 years old.
Play Life
According to his father, he’s a silent type of person, he’s not talkative. The games he
mostly plays are basketball and “takyan”. He would play only in their yard together with his
siblings and cousins. And he has few playmates, both boys and girls, because he has difficulty
establishing rapport to other children. According to the father, when playing, he was a follower.
When he was in Grade school, he does not leave school to play but when he was in High
school he leaves school to play.
School History
He started schooling at the age of 4 years old and he left school during his 2nd year in
College at the age of 18 years old. He only completed his 1st year college and he stopped during
his 2nd year in college.
During Pre-school and Elementary, he studied in Jizon Elementary School but when his
family transferred to Fatima Street, Guerrero, he continued his High School there. According to
his father, Kida adjusted easily in school and in the community when they transferred.
When he was in Elementary and in High school, he was focused in school, he does not
skip classes and his performance in school is fair. He doesn’t have many friends, he is not
talkative and he is shy. His favorite subject is Home Economics.
During Elementary and High School, his grades were normal. Most of it were at 80 + but
in College, his grades were just enough to pass the subject.
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Religious and Social Adaptability
Kida has few selected friends, both male and female, and most of them are the same with
his age. He is a shy boy but when he became a teen, he joined a Gang and learned vices like
smoking Marijuana and drinking alcohol.
His family goes to church but is not that religious.
Occupational History
Patient wasn’t able to experience employment. Unemployed.
Marital History
Kida is not married. However, he did have relationships with the opposite sex. When
Kida was 20 years old, he had his first girlfriend. And after that according to his father, they live
for one month and decided to separate after his girlfriend got pregnant.
Onset of Present Illness
According to the father, there are many reasons why he was readmitted. Two weeks prior
to admission, he had positive late insomnia and he was noted to be violent to himself and started
to harm other people. Furthermore, he also hit his youngest sister without any apparent reasons,
thus Kida was restrained by his parents. This last incident prompted the father to seek for
hospitalization.
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ANAMNESIS
INFORMANTS
1.) Name: Amakida

Age: 64
Civil Status: Married
Address: Hilltop Bajada
Relationship to patient: Father
Length of time known to patient: Since birth
Apparent understanding of present illness of patient:
While Kida was still in college, his father started to suspect that he’s using illegal
drugs. He observed the changes of Kida’s behavior such as destroying their bathroom,
burning his clothes for no reasons, and stealing things that he doesn’t own and then sell them.
After they noticed the changes of Kida’s behavior, they decided to bring Kida to the San
Pedro Hospital to have a check-up. The result shows that he’s positive in using illegal drugs,
so the family finally has confirmed that he was under the use of illegal drugs. The doctor just
prescribed him a medicine. He doesn’t take his medications religiously, so Kida’s behavior
worsened.
Other characteristics and attitude of informant:
The informant was very accommodating and cooperative. He’s open in discussing about
Ronaldo’s mental illness. He shows concern on his son’s condition. He’s willing to answer
the questions that we asked.
2.) Name: Cuzkida

Age: 35
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Address: 170 Fatima Street Guerero
Relationship to patient: 1st Cousin
Length of time known to patient: 30 years
Cuzkida said that Kida is a quiet person and not very open in saying what he feels.
Kida don’t like to be asked with many questions. Kida’s family started to live with them in
Fatima Guerero when he was still in elementary. During high school he started to drink
alcoholic beverages and smoke cigarette. She said that kida’s illness only started during when
he was at college. He would still asked money to his grandparents, even though his parents
have already given him the money for the tuition fee. If his parents don’t give money, he
would sell his clothes. She mentioned that he might be influenced by his group of friends in
college on using drugs.
The informant was accommodating and kind to us. She was very responsive
in the conversation, and willing to tell the group everything that she knows about
the patient. She has shared to us much information about kida.
3.) Name: Girkida

Age: 38 years old
Address: Fatima Street Guerrero
Relationship to patient: Girlfriend

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Girkida and Kida met during college. Both of them have the same set of friends and she
admitted that she has also tried using illegal drugs. They got lived in together for 1 month
only, and then she decided to part ways with him. So, Kida went back to his family in
Bajada. He didn’t know that she was already pregnant with his baby, until they heard about it
and his family searched for her. Almost 10 years after, he saw his child. As what she knows
about Kida is that he’s a quiet, good person, and an obsessive compulsive type of person. He
never talks to her about his problems; he only kept it to himself. According to her, Kida’s
group of friends was the main reason why he got addicted, because of their influenced to him
to take illegal drugs.
The informant was warm and welcoming to us. She was responsive and willing to answer our
questions.
4.) Name: Anakida

Age: 15 years old
Address: Fatima Guerrero
Relationship to patient: Kida’s son
According to Anakida, he first met his father at the age of 10. They only see each other
during weekdays. As what he knew also, his father was influenced by his friends in using
drugs.
He’s uncomfortable talking about his father’s condition, but somehow he was able to give
us some information that we need. He quiet anxious when he had talked to us.
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FAMILY HISTORY
Maternal and Paternal Grand Lineages
According to the reports, there’s no history of mental illness in both sides of parents.
Both on the maternal line and paternal line, no illness were reported to run in the family.
Aside from Kida’s mother, his grandmother on mother’s side also took care of him since
birth until he was 12 years old. When his mother is busy on her work, his grandmother is the
one who takes care of him.
Father
Amakida is now 64 years old. he works as a driver on Department of health According to the
informants, amakida is good father to his children and he does everything he can to provide
the needs of his family. He scold his children whenever they do something wrong, because
he just want them to learn from their own mistakes. He believes that as a father he must give
financial support to his family and security to his family. He thinks that he must also be a
good role model to his children. Although he wasn’t able to finish his studies, he still does
his best to give his family a good life. He only has the vices of drinking alcoholic beverages
and smoking, occasionally.
Mother
According to Kida’s father, his wife loves her children very much and she’s very supportive
to him and his children. She works as a midwife at the Makilala to supplement her family’s
needs. Whenever she’s on duty and his husband is on work, she would leave her children to
her mother or to a “yaya”. She disciplines her children in a typical Filipino way. Her
relationship with his husband is good, but they don’t see each other that much because both
are busy in their works.
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Siblings
The family is composed of four siblings; Brokida 1 being the eldest, followed by Kida,
then Brokida 3, and lastly Siskida as the youngest. Kida was close to all of his brothers and
sister, but much more closer with his sister, the youngest.
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THEORIES OF DEVELOPMENT
ERIK ERICKSON’S PSYCHOSOCIAL DEVELOPMENT THEORY
Erik Erickson’s developmental theory divides the human life cycle into eight distinct
psychosocial stages, each with its own conflicts to be resolved, significant relationships, and
favorable outcomes. Conflicts that are not resolved in a timely fashion cause difficulties and may
be rewarding therapy
* INFANCY (0 -1 ½ years old) – TRUST vs. MISTRUST
During the first year of life, an infant depends on the parents for all their physiologic and
psychological needs. Fulfillment of these needs is required for the infant to develop a basic sense
of trust. Parents can enhance this sense of trust by responding consistently to an infant’s needs,
providing a predictable environment in which routines are established and being sensitive to the
infants needs and meeting these needs skillfully and promptly.
TRUST
In Kida’s case he was breastfed for the first 3 months of life and bottle-fed after because
the mother needs to go back to work. Her mother is a midwife and is usually not at home. The
maternal-infant bonding was met only on the first 3 months of life. Her mother is a midwife, so
she wasn’t able to take care much of her children because of too much work. Also her father
wasn’t available all the time because of work and so he wasn’t able to take care of Kida all the
time. When his mother and father are not at home, his nanny and grandmother takes care of him.
They fed him and give attention and care to the child. As a conclusion, the task was met in this
stage which created mistrust to the infant.
* TODDLER (1 1.2 – 3 years old) – AUTONOMY vs. SHAME and DOUBT\
Toddler begin to develop their sense of autonomy by asserting themselves with the
frequent use of the word “no”. They are often frustrated by restraints to their behavior and
between ages 1 and 3 may have temper tantrums. Parents need to have a great deal of patience
coupled with an understanding of the importance of this developmental milestone. Caregivers
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need to give the child some measures of control and at the same time be consistent in setting
limits so that the child learns the results of misbehavior.
AUTONOMY
In Kida’s case, he was able to meet the task because he was able to learn and explore
more of his surroundings because of her mother giving measures of control and at the same time
being consistent in setting limits to the child so we can say that he had met autonomy.
The patient started talking when he was 1 year old and started walking on that age as
well. The patient was toilet trained when he was 2 years old. Toilet training was mostly
implemented by his mother, and she is not strict in it. Kida does it independently but with
mother’s guidance. The child was able to master this kind of task in this stage, since he
developed the sense of autonomy which he was able to handle things of his own.
* PRESCHOOLER (4 and 5 years old) - INITIATIVE vs. GUILT
During this stage, the child learns to take initiative and get ready for leadership and goal
achievement roles.
If adults encourage and support children’s efforts, while also helping them make realistic and
proper choices, children develop initiative- independence in planning and undertaking activities.
But if, adults discouraged the search of independent activities, children develop guilt about
their needs and desire.
GUILT
According to his father, he’s a silent type of person, he’s not talkative. He would play only in
their yard together with his siblings and cousins. And he has few playmates because he has
difficulty establishing rapport to other children. According to the father, when playing, he was a
follower. The child developed guilt.
* SCHOOL AGE (6 -12 years old) – INDUSTRY vs. INFERIORITY
At this time, children begin to create and develop a sense of competence and
perseverance. School age children are motivated by activities that provide as sense of worth.
They concentrate on mastering skills that will help them function in the adult world. If children
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have been successful in previous stage, they are motivated to be industrious and to cooperate
with others toward a common goal.
INDUSTRY
He entered elementary at the age of 6yrs.old. During his school age, Kida is fine. He
studies well and got average grades. He has no back subjects. He has met the expectations of his
parents from him, which is to do well in his studies.
* ADOLESCENCE (12 - 20 years old) – IDENTITY vs. ROLE CONFUSION
During this stage, Adolescents help one another through this identity crisis by forming
cliques and a separate young culture. Adolescents are usually concerned about their body, their
appearance and their physical abilities. New sense of identity on self is established, commitment
to career planning, sense of having a place in society, establishing relationship with opposite
sex, fidelity to friends, developments of personal values, testing out adult roles and mature
sexuality is achieved.
ROLE CONFUSION
Kida studied in Our Lady of Fatima during high school. According to his neighbor, which
is his classmate as well, he joined a gang during high school. He started drinking and smoking
because of peer pressure. Also, he started using marijuana, he’s cutting his class and because of
his vices he always got low grades. He studied college in MATS and stopped on his second year
for the reason that he prefers going out with his friends than going to school. His parents already
doubt that Kida started using marijuana because of behavioral changes and going home late at
night. At the age of 20, he was admitted to the Drug Detention Rehabilitation Center (DDRC)
because his father couldn’t control kida anymore. He is already violent and steals their things to
sell it in order to have money to buy marijuana. He developed role confusion.
YOUNG ADULTHOOD (20-30 years old) INTIMACY VS. ISOLATION
Trust is essential to establish intimate relationship. Intimacy involves mutual

compassion, commitment and acceptance.
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Once people have established their identities, they are ready to make long-term commitments to
others. They become capable of forming intimate, reciprocal relationships and willingly make
the sacrifices and compromises that such relationships require. If people cannot form these
intimate relationships--a sense of isolation may result.
INTIMACY
He had his first girlfriend at the age of 20. Their relationship did not last long but they had a
child. He had intimate relationship with his friends who are also drug addicts and are usually
with them most of the time. Kida developed intimacy because he was able to form intimate
relationship with friends.
MID-ADULTHOOD: (30-65 years old) GENERATIVITY VS. STAGNATION
Generativity is occurred when adults gained enough self-sufficiency and motivity to be

able to guide the next generation. Self absorption and caring for one is signs of stagnation.
During middle age the primary developmental task is one of contributing to society and helping
to guide future generations. When a person makes a contribution during this period, perhaps by
raising a family or working toward the betterment of society, a sense of generativity ,a sense of
productivity and accomplishment results. In contrast, a person who is self-centered and unable
or unwilling to help society move forward develops a feeling of stagnation- dissatisfaction with
the relative lack of productivity.
A person in this stage should have time for companionship and recreation. He also knows his
responsibilities and knows that he is accountable of whatever actions he takes.
STAGNATION
The patient is not so productive due to his illness. He’s being dependent to his family.
The little money he earned out of the stolen things he sold is being wasted for buying what is
being prohibited for him to be used, like marijuana and cigarettes that contributes in worsening
his illness. He doesn’t support his child that’s why he wastes his money for his own wants. He’s
not helping the country to move forward since he had violated the Republic Act 6425 or the
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Dangerous Drug Act of 1972, Article III, Sec. 8 which is regarding the usage of the prohibited
drugs.
SIGMUND FREUD’S PSYCHOSEXUAL THEORY
Oral Stage (0 to 18 months)
During the first stage of Sigmund Freud theory, the mouth is the major source of
gratification, exploration and source of pleasure and satisfaction. During this stage, the child
believes that his mouth is the source of pleasure because it is where he feeds and in turn brings
comfort, security and happiness to him. The major source of pleasure comes from sucking,
eating, biting, and chewing. If ever the child will not accomplish this pleasure then fixation can
happen.
In Kida’s case, his mother was able to supply him with regular Breast milk until 3months
of life with proper duration and in time interval. After 3months, Kida was mixed fed because her
mother is not at home all the time. Thumb sucking was evident. If his mother is not at home, her
grandma and nanny take care of him. If ever Kida cries, they immediately fed him to supply his
needs. The parent and the guardian were able to meet the pleasure site of the infant which is the
mouth. Oral stage is achieved.
Anal Stage (18 months to 4 years old)
The second stage of psychosexual development is the anal stage which occurs from 18
months of the child up to 4 years; in this stage, the child begins to control his muscles from
urination and defecation. The child explores his control on his body parts by either holding on
or letting go of his bodily waste. Toilet training is crucial in this stage. If the training is too
rigid, then the child may develop retentive personality in the future on which he becomes too
rigid, obsessive orderly and stringent. On the other hand, if the parent is to loose on toilet
training on which the child does not receive reward punishment at the right time then the child
may develop expulsive personality on which the child’s future becomes disordered, destructive
and careless.
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According to his father, they are not strict in Kida’s toilet training. They let Kida do it
independently but his mother guide him. He was able to handle things of his own. Therefore,
anal stage is achieved.
Phallic Stage (3 to 7 years old)
In this stage, the center of pleasure comes from the child’s genitals. The child now starts
to know gender differences and becomes aware of his genitals. The child starts to touch and
explore his body parts and it is in this stage that the child’s curiosity arises on masturbation.
Oedipus complex appears on boys on which they have feelings of intimate sexual possessiveness
for the mothers and Electra complex arises on the girls on which they also want to possess
intimate sexual possessiveness to their father. The child develops fear of punishment by the
parent of the same sex, guilt, and sexual identity. The child conflict is resolved when the child
identifies with the parent of the same sex.
Fixation occurs when he is unable to identify with the parent of the same sex and the
child may exhibit reckless, resolute, self-assumed, narcissistic behavior in the future.
Kida did complete the tasks identified in this stage. At this stage, he was able to learn
that a boy is for a girl, and a girl is for a boy. According to his father, he saw Kida holding his
penis while drinking milk and when taking a bath.
Latency Stage (7 to 12 years old)
In this stage, the child does not have any center of pleasure; the child uses most of his
energy to gain new skills in social relationships and knowledge. It is in this stage; the child
becomes more focused in dealing with friends and focuses on his academic performance. It is in
this stage the child masters the sense of industry.
He started to go to school by this time; he had gained few friends and few playmates. He got
good grades and performing well in school. The child achieved this stage.
Genital Stage (12 years up to 20 years old)

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During this stage the genitals again becomes the pleasure zone of the child. It is in this
stage that the child builds a sexual relationship with the opposite sex. There will come a time
that the child will now try to engage in sexual intercourse. The individual gains gratification
from his or her own body. During this stage, the individual develops satisfying sexual and
emotional relationships with members of the opposite sex.
In Kida’s case he was able to experience attraction to the opposite sex. And He
experienced sexual intercourse at the age of 20.
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
The Theory of Cognitive Development, one of the most historically influential theories was
developed by Jean Piaget, a Swiss Philosopher (1896–1980). His genetic epistemological theory
provided many central concepts in the field of developmental psychology and concerned the
growth of intelligence meant the ability to more accurately represent the world and perform
logical operations on representations of concepts grounded in interactions with the world. The
theory concerns the emergence and construction of schemata — schemes of how one perceives
the world — in "developmental stages", times when children are acquiring new ways of mentally
representing information. The theory is considered "constructivist", meaning that, unlike nativist
theories (which describe cognitive development as the unfolding of innate knowledge and
abilities) or empiricist theories (which describe cognitive development as the gradual acquisition
of knowledge through experience), it asserts that we construct our cognitive abilities through
self-motivated action in the world.
1. The Sensorimotor Period (birth to 2 years)
During this time, Piaget said that a child's cognitive system is limited to motor reflexes at birth,
but the child builds on these reflexes to develop more sophisticated procedures. They learn to
generalize their activities to a wider range of situations and coordinate them into increasingly
lengthy chains of behaviour.
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The father of Kida remembered that they noticed that Ronaldo responds to different reflexes
when he was a baby. He would move his body when both his parents touch him. He would grasp
things when handed to him. Breastfeeding and bottle feeding are the food provided by his mother
during her birth. When giving the bottle, the infant grasp it as a response of his hungriness.
2. Pre Operational Thought (2 to 6 or 7 years)
At this age, according to Piaget, children acquire representational skills in the areas mental
imagery, and especially language. They are very self-oriented, and have an egocentric view; that
is, preoperational children can use these representational skills only to view the world from their
own perspective.
Kida was a silent son and brother. He wasn’t that expressive towards his feelings because
he was not that open to everyone.
3. Concrete Operations (6/7 to 11/12)
A opposed to Preoperational children, children in the concrete operations stage are able to take
another's point of view and take into account more than one perspective simultaneously. They
can also represent transformations as well as static situations. Although they can understand
concrete problems, Piaget would argue that they cannot yet perform on abstract problems, and
that they do not consider all of the logically possible outcomes.
According to his father, Kida is a very organized person. His room and things are well
arranged. But when he started taking marijuana, his father noticed that Kida is disorganized and
breaks the things inside their house.
4. Formal Operations (11/12 to adult)
Children who attain the formal operation stage are capable of thinking logically and abstractly.
They can also reason theoretically. Piaget considered this the ultimate stage of development, and
stated that although the children would still have to revise their knowledge base, their way of
thinking was as powerful as it would get.
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The characteristics of this stage are:

• The person is capable of deductive and hypothetical reasoning.
• The logical quality of the adolescent's thought is when children are more likely to solve
problems in a trial-and-error fashion.
• During this stage the young adult is able to understand such things as love, "shades of gray",
logical proofs and values.
• During this stage the young adult begins to entertain possibilities for the future and is
fascinated with what they can be.
When asked, “Kung makakita ka ug pitaka na punog kwarta, unsaon man nimo ang pitaka, iuli o
gastuhon ang kwarta?”; he then replied “Iuli nako, kay basig kailangan sa tag-iya ang kwarta.”
He was able to draw conclusion from the given situation available.
ROBERT HAVIGHURST’S DEVELOPMENTAL TASKS
1. INFANCY AND EARLY CHILDHOOD (0-6yrs old)
*Learning to walk. * Learning to crawl. * Learning to take solid food. * Learning to

talk. * Learning to control the elimination of body wastes. * Learning sex differences
and sexual modesty. * Getting ready to read. * Forming concepts and learning language
to describe social and physical reality.
According to his Father, Kida was able to walk at the age of 1 year and able to eat solid
foods at the age of 7months. Makes gurgling sounds when left alone and when playing. He was
toilet trained and was able to control the elimination of body wastes. According to his father,
Kida is able to distinguish right from wrong.
2. MIDDLE CHILDHOOD (6yrs old-12 yrs old)

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*Learning physical skills necessary for ordinary games
*Achieving personal independence
* Developing fundamental skills reading, writing, and calculating:
* Achieving personal independence: To become an autonomous person, able to make plans

and to act in the present and immediate future independently of one's parents and other
adults. The young child has become physically independent of his parents but remains
emotionally dependent on them.
He was able to develop fundamental skills such as reading, writing and calculating. He was able
to learn physical skills necessary for ordinary games: such skills as throwing and catching,
kicking, and handling simple tools. Achieving personal independence: The young child has
become physically independent of his parents but remains emotionally dependent on them.
3. ADOLESCENCE (12yrs old -18yrs old)
• Achieving new and more mature relations with age mates of both sexes. * Achieving a
masculine or feminine social role. * Accepting one’s physique and using the body
effectively. * Achieving emotional independence of parents and other adults. * Preparing
for marriage and family life. * Acquiring a set of values and an ethical system as a guide
to behavior. * Desiring and achieving socially responsible behavior.* Selecting an
occupation.
He was able to learn a socially approved adult masculine social role. He enrolled BS-MT
during college but stopped on his second year. He achieved new and more mature relations with
age mates of both sexes. He was able to use his body effectively.
4. EARLY ADULTHOOD (18yrs old-30 yrs old)

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*Selecting a mate. * Learning to live with a partner. * Starting family. * Rearing

children. * Managing home. * Getting started in occupation. * Taking on civic
responsibility. * Finding a congenial social group.
Kida had a live in partner at the age of 20. Their relationship did not last long and
they had one child. He has no occupation. He did not take responsibility to his own child.
5. MIDDLE AGE (30 yrs old- 60 yrs old)
* Assisting teenage children to become responsible and happy adults. * Achieving adult
social and civic responsibility. * Reaching and maintaining satisfactory performance in
one’s occupational career. * Developing adult leisure time activities. * Relating oneself to
one’s spouse as a person. * To accept and adjust to the physiological changes of middle
age. * Adjusting to aging parents.
In the middle years, from about thirty to about fifty-five, men and women reach
the peak of their influence upon society, and at the same time the society makes its
maximum demands upon them for social and civic responsibility. It is the period of life
to which they have looked forward during their adolescence and early adulthood. And
the time passes so quickly during these full and active middle years that most people
arrive at the end of middle age and the beginning of later maturity with surprise and a
sense of having finished the journey while they were still preparing to commence it.
According to his father, Kida is not productive due to his illness. He’s being
dependent to his family. He has no job and spends most of his time with his friends that
are drug addicts. He doesn’t support his child that’s why he wastes his money for his own
wants. “Wala na xay pulos ” as verbalized by his father.
.
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ETIOLOGY
17
SYMPTOMATOLOGY
17
PSYCHODYNAMICS
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MENTAL STATUS EXAMINATION
Initial
Name: KIDA Diagnosis: Schizophrenia Paranoid type
Age: 36 years old Physician: Al Raymond Tupas M.D.
Ward: Crisis Intervention Unit Date of Examination: July 31, 2010
A. General description
1. Appearance: During our interview at the Crises intervention unit in Davao Mental
Hospital we observed that our client has a small body type, poorly groomed wearing
old clothing. He has short hair and dirty nails in both feet and hands and open wounds
due to insect bites on his left foot. He seemed to be healthy. No signs of anxiety
noted.
2. Behavior and psychomotor activity: The client is ambulatory. No mannerisms, tics

and spasms noted.
3. Speech: He can to talk with ease. No impairment in verbal communication noted such
as stuttering, echolalia and mumbling of words were noted.
4. Attitude toward examiner: The client was cooperative throughout the whole
interview.
B. Moods, feelings, and affect
1. Mood: Client has a euthymic mood or in the normal range of mood. No mood swing
and signs of irritability were noted.
2. Affect: Client has an appropriate affect. Client is not in the state of agitation, tension,
or panic.
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C. Perceptual Disturbance
No signs of illusions were noted during the whole duration of the interview. Client
claims that he was experiencing auditory hallucinations instructing him to do superfluous
actions such as burning his own clothes.
D. Thought Process
1. Stream of thought: Client speaks spontaneously with some loosening of associations

at some points during the interview. No circumstantiality, tangentiality, clang
associations, and blocking were noted.
2. Content of thought: Client claims that he was experiencing delusion of persecution.

Client always tuck the linens of his bed indicating signs of obsessive compulsion. No
suicidal ideation was noted.
E. Sensorium and Cognition
1. Consciousness: Client was alert throughout the whole duration of the interview.
2. Orientation: Client was asked “kung lunes gahapon miyerkules ugma, unsa adlaw
karon?” Client was able to answer “martes” indicating orientation to time. Client was
also oriented to the place that he is at the Mental Hospital. Client was able to identify
and name the examiners.
3. Memory: Client was able to recall significant events of his life even during his
childhood. He was able to remember his episodic admission at the institution for the
last 15 years.
4. Information and Intelligence: Client was able to reach 2 nd Year College of formal
education.
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5. Concentration: Client was given simple mathematical tasks like subtracting 5 from 50
and keeps subtracting 5.
F. Judgment
Patient said he knows his behavior why he was admitted. He also knows that his behavior
would cause harm to other people that is why he would stop doing it, he will also not use
things that will bring harm to other people.
G. Insight
Client was able to manifest intellectual insight. Client is aware that he is ill and that it
was a consequence of his actions in his past. Client understands his status but he does not
apply his knowledge to future experiences such as taking his medications conscientiously
upon his discharge.
H. Reliability
We can fairly say that his statements are realistic enough. He is able to report to
each questions are more likely to be accurate. He expresses his feelings and concerns
honestly to the examiners.
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Final
Name: KIDÀ Diagnosis: Schizophrenia Paranoid type
Age: 36 years old Physician: Al Raymond Tupas M.D.
Place of Interview: Hilltop Bajada, Davao City Date of Examination: August 5, 2010
A. General description
1. Appearance: During our latest home visit at their own house we observed that Client
has a small body type, groomed well wearing his old blue clothes. He still has short
hair and his nails are now trimmed well in both feet and hands. He seemed to be
healthy. He also seemed to look young for his age. Still no signs of anxiety noted.
2. Behavior and psychomotor activity: The client is ambulatory. No mannerisms, tics

and spasms noted. No echopraxia and retarded motor activity were noted. No signs of
agitation noted.
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3. Speech: He can to talk with ease and spontaneously. No impairment in verbal

communication noted such as stuttering, echolalia and mumbling of words were
noted.
4. Attitude toward examiner: Client was cooperative throughout the whole duration of
the interview.
B. Moods, feelings, and affect
1. Mood: The patient was able to maintain a normal mood all through the home
visit. He was responding well to the conversation and his mood was appropriate for
the discussion.
2. Affect: Client has an appropriate affect. His ideas are with harmony with his
sppech. Client is not in the state of agitation, tension, or panic.
C. Perceptual Disturbance
No signs of illusions were noted during the whole duration of the interview. During the
whole visit client stated that he longer experiences hallucinations after he was discharged.
D. Thought Process
1. Stream of thought: Client speaks spontaneously during the interview. No

circumstantiality, tangentiality, clang associations, and blocking were noted.
2. Content of thought: No delusions or false beliefs were noted. No suicidal and

homicidal ideation was noted.
E. Sensorium and Cognition
1. Consciousness: Client was alert throughout the whole duration of the interview.
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2. Orientation: Client was asked the same question during our interview at the
Davao Mental Hospital about his orientation to time, place, and person and he was
able answer all question correctly.
3. Memory: Client was able to recall recent events that happened at the Davao
Mental Hospital and the day he was discharged.
4. Information and Intelligence: Client was able to reach 2 nd Year College of formal
education.
5. Concentration The patient was given again given mathematical equations. Still, he
was able to answer all of them correctly and quickly.
F. Judgment
Client was given a situation to evaluate him. He was asked with “kung ginaaway
og ginasunlog-sunlog sa mga bata diri tungkol sa imo pamilya unsa imu buhaton? He was
able to answer awayon pud nako oi.
G. Insight
The client still has the same understanding about his illness. He also insists that
his vices especially smoking and drinking Coke, which the doctor prohibited, will not
do any harm to him and will not do any effect on his illness. With these statements,
we can say that he has a poor insight.
H. Reliability
We can fairly say that his statements are true to his emotions. His actions and
statements reflect to his feelings and emotions.
MULTIAXIAL DIAGNOSIS
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Axis I: Clinical Disorder
Schizophrenia Paranoid Type
This major type of Adult Schizophrenia is marked by one or more systematic persecutory
delusions, auditory hallucinations with a single theme (Deborah Antai-Otong (2003). Psychiatric
Nursing. Biological and behavioral concepts, 348)
Axis II: Personality Disorder
Schizoid Personality Disorder
Individuals with this disorder demonstrate a pervasive pattern of detachment from social
relationships and manifest a restricted range of emotional expression with others. The pattern is
apparent by early adulthood in a variety of context. These loners choose solitary activities that do
not require much participation with others. There is little interest in sexual activity with another
person, and there is minimal pleasure sought from sensory, bodily, or interpersonal experience.
There seems to be no direction in their lives and responses are passive to negative experiences.
These persons may do well in work conditions where they are socially isolated and may perform
well when left alone. (Deborah Antai-Otong (2003). Psychiatric Nursing. Biological and
behavioral concepts, 383)
Axis III: General Medical Condition
The client was not experiencing any medical conditions and/or physical disorders.
Axis IV: Psychosocial and Environmental Problem
The client is not very open to his feelings and emotions. Almost all of his significant
others are supportive to him but he is unable to respond to the support that his significant others
are offering. The client could not easily cope up with several stressors in life. His father stated
that he also had a history of substance abuse such as shabu and marijuana. He was once admitted
at a rehabilitation center but later on he was transferred to Davao Mental Hospital due to
financial constraints. He has an repetitive irregular admission at the institution for the past 15
years as stated by the client’s father. This was due to several episodes of his violent actions in
their community.
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Axis V: Global Assessment of Functioning

60-51: Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic
attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends,
conflicts with peers or co-workers).
DEFINITION OF COMPLETE DIAGNOSIS
Schizophrenia
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Schizophrenia is an extremely complex mental disorder: in fact it is probably many

illnesses masquerading as one. A biochemical imbalance in the brain is believed to cause
symptoms. Recent research reveals that schizophrenia may be a result of faulty neuronal
development in the fetal brain, which develops into full-blown illness in late adolescence or early
adulthood.
Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement,
and behavior. It cannot be defined as a single illness; rather thought as a syndrome or disease
process with many different varieties and symptoms. It is usually diagnosed in late adolescence
or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25
years of age for men and 25 to 35 years of age for women.
Source: http://nursingcrib.com/case-study/schizophrenia-case-study/
Schizophrenia - a serious mental illness, characterized by a disintegration of the process of

thinking and of emotional responsiveness. It most commonly manifests as
auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with
significant social or occupational dysfunction. Onset of symptoms typically occurs in young
adulthood with around 1.5% lifetime prevalence of the population affected. Diagnosis is based
on the patient's self-reported experiences and observed behavior. No laboratory test for
schizophrenia currently exists.
Source: "schizophrenia" Concise Medical Dictionary. Oxford University Press, 2010. Oxford
Reference Online. Oxford University Press. Maastricht University Library. 29 June 2010.
Schizophrenia paranoid
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Paranoid thinking is manifested by a persistent interpretation of the actions of others as

threatening or demeaning. Paranoid themes can color delusions and hallucinations as well as the
ordinary behavior of others. It is important for the student differentiate paranoid thinking
associates with a paranoid personality disorder from paranoid delusions. Paranoid thinking is less
severe than paranoid delusions. Paranoid thinking may be “corrected” with facts, whereas
paranoid delusions are not.
Source: Psychiatric Nursing 3rd edition Keltner, Schweke and Bostrom. Chapter 27
Schizophrenia and Other Psychoses page 359-360.
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.
The course of paranoid schizophrenia may be episodic, with partial or complete

remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is difficult
to distinguish discrete episodes. The onset tends to be later than in the hebephrenic and catatonic
forms.
Source: ICD-10 copyright © 1992 by World Health Organization.
Paranoid schizophrenia is a sub-type of schizophrenia as defined in the Diagnostic and

Statistical Manual of Mental Disorders, DSM-IV code 295.1
It is the most common type of schizophrenia. The clinical picture is dominated by

relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly
of the auditory variety (hearing voices), and perceptual disturbances. Disturbances of affect,
volition, and speech, and catatonic symptoms, are not prominent.
Source: Paranoid Schizophrenia DSM- IV

http://en.wikipedia.org/wiki/Paranoid_schizophrenia.
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295.3X SCHIZOPHRENIA, PARANOID TYPE
ESSENTIAL FEATURES
The individual shows a disturbance in thinking characterized by persecutory or grandiose

delusions or hallucinations with a persecutory or grandiose content.
MANIFESTATIONS
Physical Dimension
Doubts about gender identity and Violence
Emotional Dimension
Unfocused anxiety, Anger, Argumentativeness, Fear of being thought of as homosexual,

Intellectual Dimension
Persecutory delusions, grandiose delusions, Delusional jealousy, Hallucinations,
Social Dimension
Stilted, formal social relations
Source: adapted from American Psychiatric Association: Diagnostic and statistical manual of
mental disorders (DSM – III – R), Washington, D.C., 1987, The Association.
MENTAL HEALTH – PSYCHIATRIC NURSING A Holistc Life – Cycle Approach
DIFFERENTIAL DIAGNOSIS
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ANATOMY AND PHYSIOLOGY

17
ANATOMY AND PHYSIOLOGY
The brain is a large mass of soft nervous tissue made up of both neurons and supporting
neuroglial cells lying within the cranium of the skull. The brain contains both gray and white
matter. Gray matter is primarily nerve cell bodies, whereas white matter
contains myelinated nerve cell processes, giving it a white appearance. White matter is mostly
found in the cortex (shell) of the cerebral hemispheres. The brain has a highly complex
appearance, with convolutions referred to as gyri and valleys referred to as sulci. These
convolutions create a greater surface area within the same size skull.
Central nervous system
The central nervous system is made up of the brain and spinal cord. The major divisions of the
human brain are the brainstem, cerebellum, diencephalon, and cerebral hemispheres.
The meninges cover and protect the brain and spinal cord.
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BRAINSTEM The brainstem, made up of the midbrain, pons, and medulla, sits at the base of
the brain. The brainstem is involved in sensory input and motor output. Sensory input enters the
brainstem from the head, neck, and face area, while motor output from the brainstem controls
muscle movements in these areas as well. The brainstem also receives sensory input from
specialized cranial nerves for olfaction (smell), vision, hearing, gustation(taste), and balance. The
brainstem contains ascending and descending nerve pathways that carry sensory input and motor
output information to and from higher brain regions, like a relay center. Ascending nerve
pathways bring information through the brainstem into the rest of the brain, and descending
nerve pathways send information back that coordinates many activities, including motor
function. The brainstem also plays a role in vital functions such ascardiovascular and respiratory
activity and consciousness.
The medulla is a structure in the brainstem closest to the spinal cord. It is vaguely scoop shaped,
with longitudinalgrooves indicating the presence of many nerve tracts. It is responsible for
maintaining vital body functions such as breathing and heart rate.
The pons is named after the Latin word for bridge. In appearance, the pons seems to be a bridge
connecting the two hemispheres, but in reality the connection is indirect through a complicated
nerve pathway. The pons is involved in motor control, sensory analysis, and levels of
consciousness and sleep. Some structures within the pons are linked to the cerebellum, involving
them in movement and posture.
The midbrain, also called the mesencephalon, is the smallest and most anterior part of the
brainstem with a tubular appearance. It is involved in functions such as vision, hearing,
movement of the eyes, and body motor function. The anterior part of the midbrain contains the
cerebral peduncle, a large bundle of axons traveling from the cerebral cortex through the
brainstem. These nerve fibers (along with other structures) are important for voluntary motor
function.
CEREBELLUM The cerebellum, or "little brain," wraps around the brainstem. It is similar to
the cerebrum in that it has two hemispheres with a highly folded surface (cortex). The
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cerebellum is involved in regulation and coordination of movement, posture, balance, and also
some cognitive function.
DIENCEPHALON The diencephalon, or "between brain," lies between the cerebral hemispheres
and the midbrain. It is formed by the thalamus and hypothalamus, and has connections to
the limbic system and cerebral hemispheres.
The thalamus is a large body of gray matter at the top of the diencephalon, positioned deep
within the forebrain. The thalamus has sensory and motor functions. Almost all sensory
information enters this structure, where it is relayed to the cortex. Axons, or nerve endings, from
every sensory system except olfaction come together (synapse) here as the last relay site before
the information reaches the cerebral cortex. The synapse is the junction where nerve endings
meet and communicate with each other using chemical messengers that cross the junction.
The hypothalamus is a part of the diencephalon lying next to the thalamus. The hypothalamus is
involved inhomeostasis, emotional responses, coordinating drive-related behavior such
as thirst and hunger, circadian rhythms, control of the autonomic nervous system, and control of
the pituitary gland.
MENINGES AND VENTRICULAR SYSTEMS The meninges are membranes that cover and
protect the central nervous system (CNS) along with a fluid called cerebrospinal fluid (CSF) that
buoys up the brain. The brain is very soft and mushy; without the meninges and CSF, it would be
easily distorted and torn under the effects of gravity. The meninges are divided into three
membranes: the thick external dura mater provides mechanical strength; the middle web-like,
delicate arachnoid mater forms a protective barrier and a space for CSF circulation; and the
internalpia mater is continuous with all the contours of the brain and forms CSF. The dura mater
contains six major venous sinuses that drain the cerebral veins and several smaller sinuses.
Dural venous sinuses are formed in areas where the two layers of the dura mater separate,
forming spaces. The sinuses are triangular in cross-section and lined with endothelium. There are
six major dural sinuses that receive cerebral veins. The superior sagittal sinus, straight sinus, and
right and left transverse sinuses meet in a structure known as the confluence of the sinuses.
Venous blood circulation follows a pathway through the superior sagittal and straight sinuses into
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the confluence, and then through the transverse sinuses. Each transverse sinus then continues as
a sigmoid sinus, carrying the venous blood flow along an S-shaped course until it empties into
theinternal jugular vein. The major dural sinuses also connect with several smaller sinuses. The
inferior sagittal sinus,occipital sinus, and superior and inferior petrosal sinuses all empty into
different parts of the major sinus system.
The arachnoid mater follows the general shape of the brain, creating a space between the two
membranes. The space between the arachnoid and pia mater is called the subarachnoid space and
contains CSF. CSF enters venouscirculation through small protrusions into the venous
sinus called arachnoid villi. The pia mater forms part of thechoroid plexus, a
highly convoluted and vascular membranous material that lies within the ventricular system of
the brain and is responsible for most CSF production.
The brain contains four ventricles. A pair of long, C-shaped lateral ventricles lies within the
cerebral hemispheres. The lateral ventricles communicate with the narrow, slit-shaped third
ventricle of the diencephalon. The third ventricle then communicates with the tent-shaped fourth
ventricle of the pons and medulla, which protrudes into the cerebellum. The CSF of the brain
flows in a specific pattern that allows newly formed CSF to replace the old CSF several times a
day. The basic pattern of circulation is formation in lateral ventricles, flow into the third and then
fourth ventricles, into basal cisterns, up and over the cerebral hemispheres, into the arachnoid
villi, where drainage occurs into a venous sinus to return to the venous system. Some CSF
diverts from the basal cisterns into the subarachnoid space of the spinal cord. Blockage of the
circulation of CSF can cause a condition calledhydrocephalus, where the CSF pressure rises high
enough to expand the ventricles at the sacrifice of the surrounding brain. Blockage of CSF
circulation can occur at any point in the pathway. Hydrocephalus conditions are divided into two
types, communicating and noncommunicating. The classification depends on whether both
lateral ventricles are in communication with the subarachnoid space. Noncommunicating
hydrocephalus involves blockage in the ventricular system, which prevents the flow of CSF to
the subarachnoid space. Tumors sometimes causehydrocephalus, through instigating
either overproduction or physical obstruction of CSF. CSF circulation may also beobstructed in
the subarachnoid space by adhesions that form as a result of meningitis.
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CEREBRAL HEMISPHERES The cerebral hemispheres are made up of the cerebral

cortex, hippocampus, and basal ganglia containing the amygdala of the limbic system. The
cerebral hemispheres are divided by the interhemisphericfissure and are involved in higher motor
functions, perception, cognition (pertaining to thought and reasoning), emotion, and memory.
The cerebral cortex is divided into four major lobes. The frontal lobe contains the primary motor
cortex and premotor area involved in voluntary movement, Broca's area involved in writing and
speech, and the prefrontal cortex involved in personality, insight, and foresight. The parietal
lobe contains the primarysomatosensory cortex involved in tactile and positioning information,
while remaining sections are involved in spatial orientation and language comprehension. The
temporal lobe contains the primary auditory cortex, Wernicke's area involved in language
comprehension, and areas involved in the higher processing of visual input, along with aspects of
learning and memory associated with the limbic system. The occipital lobe contains the
primary visual cortex and the visual association cortex.
The limbic lobe is a subdivision consisting of portions of the frontal, parietal, and temporal lobes
that form a continuous band called the limbic system.
The limbic system, buried within the cerebrum, is also referred to as the "emotional brain." It
includes the thalamus, hypothalamus, amygdala, and hippocampus. Through these structures, the
limbic system is involved in drive-related behavior, memory, and emotional responses such as
feeding, defense, and sexual behavior. The thalamus and hypothalamus are parts of the
diencephalon, while the amygdala and hippocampus are parts of the cerebral hemispheres.
The left and right cerebral hemispheres are not equal in their functionality. In the human brain,
the left hemisphere is more important for the production and comprehension of language than the
right hemisphere. Damage to the left hemisphere is more likely to cause language deficits than
damage to the right hemisphere. Because of this variation in hemisphere contribution, the left
hemisphere is most commonly referred to as the dominant hemisphere and the right hemisphere
is referred to as the nondominant hemisphere. Nearly all right-handed people and most left-
handed people have a left-dominant brain. However, some people have a right-dominant brain or
comparable language representation in both hemispheres.
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The hippocampus is a curved sheet of cortex folded in the basal medial part of the temporal lobe.
It is divided into three multilayered sections, the dentate gyrus, hippocampus proper, and
the subiculum acting as a transitional zone between the two. The dentate gyrus receives input
from the cortex, and sends output to the hippocampus proper. The hippocampus proper then
sends output to the subiculum, which is the principal source of hippocampal output. The
hippocampus, referred to as the gateway to memory, is involved in learning and memory
functions. The hippocampus converts short-term memory to more permanent memory, is
involved in the storage and retrieval of long-term memory, and recalling learned spatial
associations.
The basal ganglia are masses of gray matter located deep in the cerebral hemispheres. The basal
ganglia contain the corpus striatum, which is involved mostly in motor activity. The striatum is
the major point of entry into basal ganglia circuitry, receiving input from almost
all cortical areas. It is subdivided into three further divisions called thecaudate nucleus, putamen,
and globus pallidus. The caudate nucleus is involved more with cognitive function than with
motor function. Of all the striatum subdivisions, the putamen is the most highly associated with
motor functions of the basal ganglia. The globus pallidus is a wedge-shaped section of the
striatum responsible for most basal ganglia output. The basal ganglia also contain the amygdala,
a portion of the limbic system involved in memory, emotion, and fear. The amygdala lies beneath
the surface of the temporal lobe where it causes a bulge called theuncus. The basal ganglia
collectively modulate the output of the frontal cortex involving motor function, but also
cognition and motivation.
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SPINAL CORD The spinal cord is a cord-like bundle of nerves comprising a major part of the
central nervous system, which conducts sensory and motor nerve impulses to and from the brain
and the periphery. It is a long tube-like structure extending from the base of the brain, through a
string of skeletal vertebrae, to the small of the back. The spinal cord is continuous with the
brainstem, and like the brain, it is encased in a triple sheath of membranes. Thirty-one pairs of
spinal nerves belonging to the peripheral nervous system (PNS) arise from the sides of the spinal
cord and branch out to both sides of the body. In addition to carrying impulses to and from the
brain, the spinal cord regulates reflexes. Reflexes produce a rapid motor response to
a stimulus because the sensory neuron synapses directly with the motor neuron in the spinal cord,
so the impulse does not need to travel to and from the brain.
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NERVOUS TRACTS Tracts are groups or bundles of nerve fibers that constitute an anatomical
and functional unit. Commissural tracts such as the corpus callosum connect the two cerebral
hemispheres. Association tracts make connections within the same hemisphere. Projection tracts
connect the brain with the spinal cord. Sensory tracts project upward from the spinal cord into
regions of the brain, bringing sensory input from the periphery via ascending pathways. Motor
tracts project down from the brain into the spinal cord, bringing motor output information to the
periphery via descending pathways. The internal capsule is the major structure carrying
ascending and descending nerve projection fibers to and from the cerebral cortex. It is a curved,
funnel-shaped group of cortical projection fibers divided into five regions, based on each region's
relationship to the putamen andglobus pallidus of the striatum.
Peripheral nervous system
The peripheral nervous system (PNS) is all of the nervous system outside the brain and spinal
cord, including the spinal and cranial nerves. The PNS is divided into the somatic and autonomic
subdivisions. The somatic nervous system, regulating activities that are under conscious control
such as the voluntary movement of skeletal muscles, includes the spinal and cranial nerves and
peripheral sensory receptors. Peripheral neurons that transmit information from the periphery
toward the CNS are called afferent neurons, whereas those that transmit information away from
the CNS toward the periphery are called efferent neurons.
The 31 pairs of spinal nerves are each named according to the location of their respective
vertebrae. Each spinal nerve consists of a dorsal root and a ventral root. The dorsal roots contain
afferent neurons transmitting information to the CNS from various kinds of sensory neurons. The
ventral roots contain the axons of efferent motor neurons transmitting information to the
periphery. Information travels great distances via interneurons, which are neurons that connect
neurons to each other. Spinal nerves have sensory fibers and motor fibers. The sensory fibers
supply nerves to specific areas of skin, while the motor fibers supply nerves to specific muscles.
A dermatome, which means "skin-cutting," is an area of skin supplied by nerve fibers originating
from a single dorsal nerve root. The dermatomes are named with respect to the spinal nerves that
17
supply them. Dermatomes form bands around the body. In the limbs, dermatome organization is
more complex as a result of being "stretched out" during embryological development. There is a
high degree of overlap of nerves between adjacent dermatomes. If one spinal nerve loses
sensation from the dermatome that it supplies, compensatory overlap from adjacent spinal nerves
occurs with reduced sensitivity. In addition to dermatomes supplying the skin, each muscle in the
body is supplied by a particular level or segment of the spinal cord and by its corresponding
spinal nerve. The muscle, in conjunction with its nerve, makes up a myotome. Although slight
variations do exist, dermatome and myotome patterns of distribution are relatively consistent
from person to person.
Cranial nerves also carry sensory information from the periphery to the brain, and motor
information away from the brain to the periphery. Humans have 12 pairs of cranial nerves
numbered by the level at which they enter the brain. Seven of the cranial nerves specialize in
information about olfaction, vision, hearing, gustation, and balance. The other cranial nerves
control eye and mouth movements, swallowing, and facial expressions. Cranial nerve X is called
the vagus nerve; it has effects on visceral gut function and has the ability to slow the heart
when stimulatedthrough the parasympathetic nervous system.
The autonomic nervous system includes further sympathetic, parasympathetic, and enteric
subdivisions. The autonomic nervous system regulates activities that are not under conscious
control but rather are involuntary, such as contractions of the heart and digestion of food. The
autonomic nervous system is involved in maintaining homeostasis in the body. The sympathetic
and parasympathetic subdivisions of the autonomic nervous system have opposite effects on the
organs they control. Most organs controlled by the autonomic nervous system are under the
influence of both the sympathetic and parasympathetic nervous systems, which strike a balance
with each other to maintain proper body function. The sympathetic nervous system generally
stimulates organs, whereas the parasympathetic nervous system generally suppresses organ
function or slows it down. An example of this coordination of activity is seen in the fight-or-
flight response, which is the body's response to a sudden threatening or stressful situation in
which excessive energy is needed to either deal with such an attack or run from it. In the fight-or-
flight response, both the sympathetic and parasympathetic nervous systems work in coordination
with each other to produce the appropriate results. The sympathetic and parasympathetic nervous
17
systems increase blood pressure and heart rate and slow digestion to enable the
physical exertion necessary to respond to the threatening circumstance.
The digestive system contains its own, local nervous system referred to as the enteric,
or intrinsic, nervous system. The enteric nervous system is extremely complex and contains as
many neurons as does the spinal cord. The enteric nervous system is divided into two networks,
or plexuses, of neurons, both of which are embedded in the walls of the digestive tract and
extend from the esophagus to the anus. The myenteric plexus is located between the longitudinal
and circular layers of muscle in the tunica muscularis and is involved in digestive tract motility.
Thesubmucous plexus lies buried in the submucosa. Its principal role is
regulating gastrointestinal blood flow and controlling epithelial cell function in response to the
environment within the lumen. In regions where these functions are minimal, such as the
esophagus, the submucous plexus is sparse. The enteric nervous system functions independently
from other nervous systems, but normal digestive function requires communication between the
enteric system, other PNS systems, and the CNS. Stimulation of the sympathetic nervous system
causes inhibition of gastrointestinal secretions and motor activity, while the parasympathetic
nervous system stimulates the same functions. Parasympathetic and sympathetic fibers connect
either the central and enteric nervous systems or connect the CNS directly within the digestive
tract. In this manner, the digestive system provides sensory information to the CNS, and the CNS
is involved in gastrointestinal function. The CNS can also relay input from outside of the
digestive system to the digestive system. An example is the sight or smell of food stimulating
stomach secretions.
17
DOCTOR’S ORDERS
DATE DOCTOR’S RATIONALE REMARKS

ORDER
February 7,2010 Please admit patient To establish a designated doctor DONE
to CIU with watcher to which all pertinent information
regarding the patient will be
referred to and for thorough
patient monitoring. A watcher is
needed for medical matters that
have to deal formally and
appropriately which the patient
may not be capable of doing.
VS q4, then record Vital signs are recorded to obtain DONE

day the patient’s baseline data and be
useful for further management. A
temperature higher than normal
may indicate the development of
infection. Pulse & respiration is
taken to watch out for changes in
the blood pressure to prevent
tachycardia or bradycardia which
may be subject to patient’s
feelings and emotions.
17
DAT To signify that the patient has no DONE

restrictions regarding intake of
solid or liquid foods.
Meds: Chlorpromazine is an DONE

Chlorpromazine antipsychotic. It is principally
200mg/TAB, ½ used in the treatment of
TAB in AM, 1 TAB schizophrenia. Chlorpromazine
HS blocks dopamine receptors.
Biperiden Biperiden is given to control and DONE

2mg/TAB, 1 TAB prevent extrapyramidal
BID prn for EPS symptoms secondary to the use of
flupentixol decanoate and
chlorpromazine.
Suicide/Homicide/ Patient is capable of doing so that DONE

Escape Precaution they will know better on how to
handle the patient since there is a
possibility that he may become
hostile and escaping tendencies.
Restrain if necessary For the patient and everyone’s DONE

safety in case the patient becomes
hostile.
Refer Referral is done to correct

unusualities as soon as possible
and to inform the attending
physician of the patient's
condition.
17
Continue meds All medications previously DONE

ordered by attending physician
should be continued to hasten
patient's recovery.
February 08, Meds: Increasing the dose is done to DONE

2010 ↑ chlorpromazine increase the therapeutic effects of
20mg/TAB, 1 TAB chlorpromazine. BP precautions
BID with BP are ordered to prevent some of
precautions the adverse effects of
chlorpromazine which are
orthostatic hypotension and
tachycardia.
To single cell Isolation of the patient is DONE

necessary to facilitate safety of
the patient as well as the other
patients and staff. This will also
decrease the risk for a potential
injury and violence.
February 09, Continue meds All medications previously DONE

2010 ordered by attending physician
patient's recovery.
February To open ward Isolation has also negative effects

10,2010 such as low self esteem. It is DONE
necessary for the patient to be in
17
the open ward to facilitate

socialization and recovery.

patient's recovery.
February ↑ chlorpromazine Increasing the dose is done to DONE

11,2010 200mg/TAB, 1 TAB increase the therapeutic effects of
TID with BP chlorpromazine. BP precautions
precaution are ordered to prevent some of
the adverse effects of
chlorpromazine which are
orthostatic hypotension and
tachycardia.
February Continue meds All medications previously DONE

12,2010 ordered by attending physician
patient's recovery.
February Continue meds All medications previously DONE

13,2010 ordered by attending physician
patient's recovery.

17
patient's recovery.

patient's recovery.
February Continue meds All medications DONE

16,2010 Previously ordered by attending
physician should be continued to
hasten patient's recovery.
Please inform the Instructions and health reminders DONE

Resident in charge if must be relayed by the doctor
patient’s watcher especially ones that concerns the
arrived. medication and follow up check
up.
MGH The patient has already recovered DONE

and the symptoms subsided and
can be managed by home
treatment.
Home medication:
chlorpromazine Chlorpromazine is an DONE

200mg/TAB, 1 TAB antipsychotic. It is principally
TID used in the treatment of
schizophrenia. Chlorpromazine
blocks dopamine receptors.
17
flupentixol Flupentixol decanoate is an DONE

decanoate antipsychotic that may be
20mg/amp 1 amp prescribed to alleviate psychotic
IM features such as paranoia and
give 1 dose prior to hallucinations.
discharge Side effects are similar to many
other typical antipsychotics,
namely extrapyramidal symptom
s of akathisia, parkinsonian
tremor and rigidity.
Biperiden Biperiden is given to control and DONE

2mg/TAB, 1 TAB prevent extrapyramidal
BID prn for EPS symptoms secondary to the use of
flupentixol decanoate and
chlorpromazine
Check up at OPD Follow up check provides DONE

after 2 weeks. constant monitoring of the
progress of the patient.
July 26, 2010 at Please admit patient To establish a designated doctor DONE
11:20 am to CIU with watcher to which all pertinent information
regarding the patient will be
referred to and for thorough
patient monitoring. A watcher is
needed for medical matters that
17
have to deal formally and

appropriately which the patient
may not be capable of doing.
Monitor VS now Vital signs are recorded to obtain DONE

and then q4 the patient’s baseline data and be
useful for further management. A
temperature higher than normal
may indicate the development of
infection. Pulse & respiration is
taken to watch out for changes in
the blood pressure to prevent
tachycardia or bradycardia which
may be subject to patient’s
feelings and emotions.
Meds: Flupentixol decanoate is an DONE

Flupentixol IM now antipsychotic that may be
then q2 for two prescribed to alleviate psychotic
weeks. features such as paranoia and
hallucinations.
Side effects are similar to many
other typical antipsychotics,
namely extrapyramidal symptom
s of akathisia, parkinsonian
tremor and rigidity.
Clozapine 100 mg 1 Clozapine is an anti-psychotic DONE

17
tab OD medication that works by

blocking receptors in the brain
for several neurotransmitters
(chemicals that nerves use to
communicate with each other)
including dopamine type 4
receptors, serotonin type 2
receptors, norepinephrine
receptors, acetylcholine
receptors, and histamine
receptors.
Halopenidol 5 mg Haloperidol is an antipsychotic DONE

IM now medication. Haloperidol
interferes with the effects of
neurotransmitters in the brain
which are the chemical
messengers that nerves
manufacture and release to
communicate with one another. It
blocks receptors for the
neurotransmitters (specifically
the dopamine and serotonin type
2 receptors) on the nerves. As a
result, the nerves are not
"activated" by the
neurotransmitters released by
other nerves.
Suicidal/ Homicide/ To inform the nurses of what the DONE

17
escape precautions patient is capable of doing so that

they will know better on how to
handle the patient since there is a
possibility that he may become
hostile and escaping tendencies.
Remove any hazards This will decrease the tendency DONE

prior to entry to CIU for violence and injury among the
patients.

patient's recovery.
SGPT Laboratory studies are necessary DONE RESULTS

CXR-PA to provide data regarding the NOT
CBC patient’s health status and ATTACHED TO
condition. SGPT is for liver CHART
function test to determine liver
injury. CXR is for the
visualization of the lobes of the
lungs. CBC stands for complete
blood count necessary to
establish a data for the cellular
make up of the blood.

July 27, 2010 ordered by attending physician
patient's recovery.
17
July 28, 2010 Continue meds All medications previously DONE

patient's recovery.
7:30 am Possible for A possibility for home treatment DONE

discharge in AM again after the presence of a
watcher or significant others.
July 29, 2010 Defer discharge Discharges are deferred if DONE

minimum requirement before a
patient is discharged are not met.
12:05 am For counseling c/o Counselling is necessary for the DONE

Psychologist patient to be fully assessed
medically and psychologically
before being discharged.

patient's recovery.
DRUG STUDY
17
17
NURSING CARE PLANS
DISTURBED THOUGHT PROCESS
Date & Cues Needs Nursing Diagnosis Objectives of Care Nursing Interventions Evaluation
Time
Subjective: C Disturbed thought Within days span of 1. Utilize safety measures to

processes related to therapeutic interaction, protect client or others, if client
" naa gusto mag O
disintegration of the patient will: believes he needs to protect
patay sa akoa”
G cognitive process as himself against specific person.
as verbalized by
evidenced by Precautions are needed.
the patient N
presence of A. maintain usual
 client's delusional thinking
I delusions reality
might dictate to him that he has
orientation
Objective: T to hurt others in order to be safe.
I  Schizophrenia
B. minimize
alters thought
• Delusion V episodes of 2. Offer self and listen with
process causing
of delusion. regard.
E disruption in
Persecuti
cognitive operation.  to show that you're available
on -
Most schizophrenic and there for the patient. This
• Restlessn P patients manifest lessens anxiety.
delusion which is a
17
ess noted E hallmark of the

mental illness.
R 3. Present reality concisely and
briefly. Focus on real people and
C
real events
E
 presenting reality allows
P patient to recognize what is
present and what is happening
T
around and helps distinguish
Videbeck, S.
U from what is unreal. Makes them
Psychiatric Mental
in touch with the reality.
A health nursing.
Chapter 14, p289
L
4. Do not argue with delusions.
P
 Arguing tends to reinforce

A
delusions and can make the
T patient angry. This will also
T increase client's defensive

position.
E
R
5. Avoid whispering or laughing
17
N around the patient unless they

can hear what is said.
 patient may misinterpret it and

may aggress. it will minimize
persecutory delusion
6. Do not touch the patient; use

gestures carefully.
 a psychotic person might

misinterpret touch as either
aggressive or sexual in nature
and might interpret gestures as
aggressive moves. Schizophrenic
patients particularly the
paranoid type need a lot of
personal space.
7. Refrain from forcing activities

or communications.
17
 Patient may feel threatened

and may withdraw or rebel.
8. Allow and encourage

verbalization of feelings and
thoughts. Interact with the
patient on the basis of things in
the environment.
 to guide them in staying in

touch with reality and it reduces
anxiety.
9. Help patient to identify the

stressors that might precipitate
hallucinations or delusions.
 this effort might lead to

identification and avoidance of
triggering events.
17
10. Observed keenly for

situations that trigger
hallucination or delusion and
immediately gets the patient's
attention.
 to limit or avoid delusions.

17
DISTURBED SENSORY PERCEPTION
Time
Subjective: C Disturbed sensory Within days of span of 1.Decrease environmental stimuli

perception: care, the patient will be when possible (low noise,
As verbalized O
“auditory” related able to: minimal activity)
by the patient “
G to altered sensory
naay naga ingon ® Decrease potential for anxiety
reception secondary
sa akoa na naay N that might trigger hallucinations.
to schizophrenia. A. Identify
gusto mulason Helps calm client.
I personal
sa akoa”
interventions 2. Stay with client when he is
T
 the sensory input that decrease or starting to hallucinate, and direct
I of schizophrenic lower the them to verify to his significant
Objective:
individuals, intensity and others for what he sees. Repeat
V
• Change including sight and frequency of often in a matter-of-fact manner.
in usual E sound, are sent as hallucination
response to fragments, with no such as
-
stimuli such chronology or socialization ® Clients can learn to distinguish
as P order, to the brain. and real from unreal by verification
exaggerated Normally, what we participating in of the objects he sees to his
E
emotional see and what we group activities significant others.
17
response R hear come together B. Improve level of 3. Keep simple, basic, reality-
• Change to the brain. cognition based topics of conversation.
C
in behavioral However, there is a Help client focus to one idea one
pattern E possibility that if at a time.
• Restlessn what is heard and
P ® Client’s thinking might be
ess what is seen are sent
confused and disorganized; this
• Auditory T as separate
intervention helps patient to
hallucination fragments, the brain
U focus and comprehend.
s conjures and fills in
A pieces of
information that are
L 4. Explore how the client
missing. An error in
experiences the hallucinations.
P circuitry from
within the brain
A
regions may impair
®Exploring the hallucination
T the processing of
and sharing the experience can
sensory input from
T help give the person a sense of
the external
power that he might be able to
E environment. There
manage the hallucinatory voices.
R is a possibility that
the "voices" they
N hear of people
17
talking to them are 5. Helps client to identify times

their own conscious, that the hallucinations are most
automatic thoughts prevalent and frightening.
and inner speech
perceived as
external. This is ® Helps both nurse and client
probable occurrence identify situations that increases
as there are many the level of anxiety of the client.
reports of auditory
hallucinations by
people who are 6. Engage client in simple
placed in solitary physical activities or tasks that
confinement or channel energy such as jogging
isolation. inside the premises of crisis
intervention unit.
http://serendip.bryn
mawr.edu/bb/neuro/ ® Redirecting client’s energies to
neuro02/web3/schan acceptable activities can decrease
.html the possibility of acting on
hallucinations.
17
7. Work with the client to find

which activities help reduce
anxiety and distract the client
from hallucinatory material.
Practice new skills with client.
® diversional activities will

decrease the possibilities of
acting up to hallucinations.
8. Monitor Drug Regimen
® to identify medications with

effects or drug interactions that
may exacerbate sensory
perceptual problems
17
9. Avoid Isolation of the client.
® there are many reports of

auditory hallucinations by people
who are placed in solitary
confinement or isolation. And
may exacerbate the current
condition
10. Interpret stimuli/offer

feedback to patient
® to assist client separate reality

from fantasy/altered perception
17
RISK FOR VIOLENCE
Time
17
Subjective S Risk for violence: Within day span of

Self/other related to nurse-patient
“ hapit na niya E Use calm and firm approach
history of aggressive interaction, the client
sunugon among
L behavior secondary will be able to : ® Provides structure and control
balay ”, as
to mental health for a client who is out of control.
verbalized by F
problem
the father
- a. Demonstrate
the ability to Use one-on-one or appropriate
P
® Paranoid control aggressive level of observation to monitor
Objective:
E schizophrenia impulses and delay rising levels of anxiety;
• auditory individuals are often gratification determine emotional and
R
hallucina tense, suspicious and situational triggers.
tions C guarded and may be b. Demonstrate
® External controls are needed
reported argumentative, respect for the
E for ego support and to prevent
hostile and rights of others
• history of acts of aggression and violence.
P aggressive. c. Demonstrate
violence
self-
against T
control/relaxed/
others I demonstrate
nonviolent
O Source:
behavior
Remove all dangerous objects
N 2002. Shives, L.R.,
from client’s environment.
17
Basic Concepts of ® Removal of dangerous objects

Psychiatric- Mental client, in an agitated, confused
-
Health Nursing. state, from harming self or
S Philadelphia PA. others.
L 4. Maintain a consistent
approach, employ consistent
F
expectations, and provide a
- structured environment.
C ® Clear and consistent limits and

expectations minimize potential
O
for client’s manipulation of staff
N
C
5. Remain neutral: avoid power
E struggles and value
judgments.
P
® Clients can use inconsistencies
T
and value judgments as
justification for arguing and
17
P escalating mania
T 6. Decrease environmental
stimuli
T
® Helps decrease escalation of
E
anxiety and manic symptoms
R
N
7. Assess client’s behavior
frequently for signs of increased
agitation and hyperactivity
® Early detection and

intervention of escalating mania
might help prevent harm to self
or others, and decrease need for
seclusion.
8. Process incidents with the

17
client to make it a learning

experience.
® Reality testing, problem

solving and testing new
behaviors are necessary to foster
cognitive growth.
9. Encourage feelings of concern

for others and remorse for
misdeeds.
® Development of empathy is a
therapeutic goal.
10. Give positive reinforcement

for client’s effort.
® encourages continuation of
desired behaviors.
17
RISK FOR INJURY
Time
17
J Subjective: Risk for injury Within our 5 hour span 1.) Establish Rapport with patient July 30, 2010
related ti history of of duty, our patient @12pm
U H
aggressive behavior will not experience
® Facilitates cooperation in the GOAL MET
L Objective: E secondary to mental injury towards self as
treatment plan
health problem manifested by: After 5 hours
Y History of A
span of care,
aggressive
3 L A. Maintain in safe our patient was
behavior 2.) Establish good and open
® Paranoid and calm not able to
0, T communication/therapeutic
schizophrenia environment experience
communication with the
2 H individuals are often B. Enumerate injury as
With medical patient.
tense, suspicious and traits that manifested by:
0 order for -
guarded and may be promotes injury
restraint a. Maintenanc
1 H argumentative, free ® promotes trusting situation in
e of safe
hostile and environment which the client is face to be open
0 E and calm
aggressive. and be honest with self and
With history of environmen
@ A therapist.
single cell (2002. Shives, L.R., t.
7AM isolation L Basic Concepts of
b. Enumerate
psychiatric nursing)
T 3.) Assess the environment for d
events that may trigger behavioral
-open wounds H
violence traits that
due to
M promote an
scratching
17
A ® maintaining a safe environment injury free

will lessen the incident of injury. environmen
- redness N
t such as
around affected
A calmness
area.
4.) Assess client’s mood, and and
G
personality styles patience.
E
M ® provide data for warning signs

and appropriate therapy
E
5.) Assess client’s emotional and
N
behavioral responces to
T violence.
® Determines client’s view of own
and others safety and provides
P appropriate intervention from the
nurse.
A
T
6.) Assess for any history of self-
T
inflicted injury.
E ® provides measure for
17
R prevention of reoccurrence
7.) Provide healthcare within a

culture of safety such as
maintaining bed/chair in
lowest position.
®this will reduce impact of injury

if it occurs.
8.) Inform patient of ways to

avoid sel-inflicted injury such
as calmness and patience.
® knowledge of the patient can be
a good source for personal
wellness.
9.) Encourage participation in

17
self-help programs such as a

positive self image
®Activities that enhance self-
esteem can lessen conflicts among
patients.
10.) Refer to other support

facilities such as counseling,
and psychotherapy
®professional help aides in the

promotion of psychological
wellness.
NONCOMPLIANCE
Time
17
J Subjective: Noncompliance to Within our 8 hour span 11.) Establish Rapport with July 31, 2010
drug regimen of duty, our patient patient @12pm
U “dili mn ko H
related to will be able to express
ganahan GOAL MET
L E unwillingness of compliance to drug
maginom ug ® Facilitates cooperation in the
patient secondary to therapy as manifested After 5 hours
Y tambal kay A treatment plan
paranoia by: spa of care, our
mubalik akong
3 L patient was
sakit”
C. Enumerate able to express
0, T 12.) Establish good and open
® There are disadvantages willingness to
communication/therapeutic
2 H persistent psychotic of comply with
Objective: communication with the
symptoms, noncompliance drug therapy
0 P patient.
-recurring especially paranoia, D. Make SMART as manifested
1 symptoms noted E grandiosity, goals for the by:
disordered thinking, recovery ® promotes trusting situation in
0 R c. Enumerate
and lack of E. Verbalize which the client is face to be open
d
@ -failure to keep C awareness of illness. commitment to and be honest with self and
disadvantag
appointments These kinds of mutually agreed therapist.
7AM E es of non-
symptoms lead to upon goals and
compliance
P active medication treatment plan.
such as
- multiple refusal because they 13.) Assess level of perception
T expensive
admissions to prevent the person or understanding of the
cost,
recovery center I from having insight condition
absence of
for 17 years
17
O into the need for immediate

medication. family once
N ® helps to identify factors of
readmitted
(http://www.schizop noncompliance
- and
hrenia.com/family/c
reoccurrenc
H ompliance1.html)
e of
14.) Assess level of compliance
E symptoms.
to the drug therapy by asking
A how many dose the patient’s d. Made
receive, describe the drug SMART
L
goals after
T recovery
® indicates if the patient is
such as
H mindful of his drug/medicine
being with
intakes
M family and
15.) Assess factors/conditions continue
A
that interfere with taking drug
N medications such as therapy to
depression and alcohol use. fully
A
® indicates conditions that can recover.
G interfere with the action of drug
e. Verbalized
or the willingness to take
E commitmen
medications
17
M t to
mutually
E 16.) Encourage binding a
agreed
verbal contract with patient to
N upon goals
adhere with treatment plan
and
T ® this will enhance commitment
treatment
of patient to follow through.
plan by
saying:
P
“Dili na nao
17.) Educate the client
A kalimtan
regarding effects of
mag-inom
T noncompliance such as
og tambal
recurring of symptoms and re-
T aron mayo
admission.
n a jud ko”
E
R ®knowledge of consequences can

motivation for the patient to
N
adhere
18.) Discuss with patient about

future plans after discharge.
® this can intensify the will of the
17
patient to recover and comply

with the drug therapy.
19.) Instruct client to

paraphrase instruction heard
about the drug therapy.
®To facilitate learning of the
client and understanding about
the drug regimen
20.) Ensure that support

systems will be available after
discharge
®Support systems are necessary
for the patients full recovery such
as family and support groups
17
Date Cues Need Nursing Objective of Nursing Evaluation

Diagnosis Care Interventions
July Subjective: R Risk for infection Within over 5 1. Establish July 30, 2010 @
30, related to open hours of span rapport with 12:00 pm
I
2010 wounds care, our patient patient.
Objective: S secondary to will not be able to
@ 7am
insect bites. have wound ® Facilitates GOAL MET
• Presence of K
infection as cooperation in the
17
mosquito manifested by: treatment plan After 5 hours of

bites noted span of care, our
F ® Rash from a. Disinfected 2. Establish good and
patient was not
mosquito bite is wound; open
O able to have an
a form of severe b. Clean and dry communication/the infection as
R reaction. The wound; rapeutic manifested by:
rash has
c. Absence of foul communication
appearance a. Disinfected wound;
odor on affected with the patient.
I similar to blisters
area b. Clean and dry
or bruises, with ® Promotes
N d. Absence of fever. wound;
redness and trusting situation in
F itching around which the client is
c. Absence of foul
the bitten areas. face to be open and
E order on affected
be honest with self
(http://www.buzz area;
C and therapist.
le.com)
d. Absence of fever.
T 3. Assess area of
skin wound or
I
damage.
O
® Baseline for
N therapy and
provides
knowledge of the
extent of the
17
problem
4. Observe for
baseline infections.
®Provides proper
documentation and
formal action of
intervention for
patient’s wellness.
5. Observe for
existence of
causative factor.
® Risk factors for

the aggravation of
the condition must
be eliminated.
6. Provide basic
remedy such as
disinfection of the
wound.
17
® Cleaning the
wound will
minimize risk for
infection.
7. Inform patient
of the benefit of
maintaining good
hand hygiene.
® This will
minimize the risk
for infection and
transfer of bacteria.
8. Instruct not to
frequently touch
nor scratch insect
bites.
® Frequent contact
wounded skin can
aggravate the
condition.
9. Encourage
17
intake of oral fluids

such as water.
® Frequent water
intake cleanses the
body thus excreting
bacteria.
10. Encourage
intake of food high
vitamin c to
improve body
resistance.
® Elevated body
resistance can
minimize risk for
infection.
17
FAYE ABDELLAH’S 21 NURSING PROBLEM
“Although Abdellah spoke of the patient-centered approaches, she wrote of nurses identifying
and solving specific problems. This identification and classification of problems was called the
typology of 21 nursing problems. Abdellah’s typology was divided into three areas: (1) the
physical, sociological, and emotional needs of the patient; (2) the types of interpersonal
relationships between the nurse and the patient; and (3) the common elements of patient care.
Adbellah and her colleagues thought the typology would provide a method to evaluate a
student’s experiences and also a method to evaluate a nurse’s competency based on outcome
measures.” (Tomey & Alligood, Nursing theorists and their work 4th ed., p. 115).
Abdellah’s Typology of 21 Nursing Problems are as follows:
1. To promote good hygiene and physical comfort

2. To promote optimal activity, exercise, rest, and sleep
3. To promote safety through prevention of accidents, injury, or other trauma and through the
prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformities
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept the interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
17
developmental needs
19. To accept the optimum possible goals in light of physical and emotional limitations
20. To use community resources as an aid in resolving problems arising from illness
21. To understand the role of social problems as influencing factors in the cause of illness
17
IMPAIRED VERBAL COMMUNICATION
Time
Subjective: Impaired verbal After days of 1.) Determine patient’s primary

communication rendering nursing language spoken
R
related to care, the patient will be
O unrealistic thinking able to:
® Determining language is
and alterations in
L important to ensure that the
mental status as
patient is able to understand the
Objective: E evidenced by loose a. Communicate
nurse during conversation
association of ideas appropriately
-Loose
and
association
R comprehensibly
noted 2. Asses surroundings for
® Patients with
E factors that would affect
unrealistic thinking
b. Gain client’s patients interest in talking
L and alterations in
-Poor eye interest in
mental status
contact noted A conversation
experience problems ® Patient may not want to
T in verbal participate if there is presence of
communication c. Establish eye unwanted objects, noise, improper
- Refused to talk I
because of the contact lighting, and the like
by constantly
17
facing away O negative changes in

from the nurse the cognitive field of
N 3.Note presence of anger
during the brain, delay in
conversation S the developmental
task or events ® Emotional disturbance may
H
causing emotional affect communication with patient
- with no and I pain affecting
inappropriate speech and
P
response to expression of 4.Keep sentences simple and
questions thoughts short
P
® This would help the patient to
A http://serendip.bryn
understand more what the nurse
mawr.edu/bb/neuro/
T is saying. It provides easier
neuro02/web3/schan
understanding for the patient so
T .html
he/she can make appropriate
E responses.
N 5.Maintain eye contact during

conversation
® To have a trusting relationship
17
with the patient so he/she can

express concerns to the nurse
without any hesitations
6. Promote patient
participation in special
activities and discussions
preferred by the patient in a
setting that the he/she views
as safe
® To have an avenue conducive
for patient’s expression of
thoughts
7. Orient client to reality as

required. Call the client by
name. Validate those aspects
of communication that help
differentiate between what is
real and not real.
17
®These techniques may facilitate

restoration of functional
communication patterns in the
client
8. Maintain a calm, unhurried

manner and give sufficient
for the client to respond.
Avoid frequent corrections.
® client may talk more easily
when they are calm and relaxed.
9. Provide positive
reinforcement when client
makes moves toward making
conversation with others
®Encourages continuation of
efforts
17
10. Refer to therapist as

appropriate
®To facilitate patient’s progress
SELF-ESTEEM DISTURBANCE
17
Time
Subjective: S Self esteem Within my weeks span 1. Establish rapport/therapeutic

disturbance r/t of care my patient will relationship with the patient.
E
feeling of different be able to;
“ dili ko ganahan L from others as
ug daghan tao” as evidenced by poor  To have a good working and
F
verbalized by the social interaction.  Participate in trusting relationship with the
patient. - activities/therap patient and to increase the level
ies being of participation.
P
 Mental health conducted
E research shows that
depression and low  Demonstrate 2. Establish good and open
Objective: R
self esteem goes positive communication/therapeutic
C hand-in-hand with behaviors communication with the patient.
mental illness. towards self-
• withdrawn E
Several research image as
behavior  Promotes trusting situation in
P studies refute claims evidenced by
noted which client is free to be open
that stigma is social
T and be honest with self and
relatively interaction and
I therapist.
inconsequential. In improved social
• dull affect
fact, studies suggest
17
noted O that stigma strongly skills.

influences the self-
N Determine factors of low esteem
esteem of people
related to current situation.
• aloof - who have mental
illness. When,
S
because you have a
 Current crises may exacerbate
E mental illness, you
long-standing feelings and self-
are repeatedly
L evaluation.
rejected as a friend,
F an employee, a
neighbor, or an
-
intimate partner
C and devalued as a
person who is less
O Discuss client perceptions of self.
trustworthy, less
N intelligent, and less
 Addressing issues openly
competent, it’s
C provides opportunity for change.
difficult to feel good
E about yourself and
P the situation you

Encourage participation in-
find yourself in.
group activities/therapies
T
being conducted.
17
A http://www.healthy  To develop and enhance

place.com/other- patient’s social
T
info/mental-health- interaction/increase self esteem.
T newsletter/low-self-
esteem-and-mental-
E
illness/menu-id- Involve in activities/exercise,
R 1902/ programs and promote
socialization.
N
 Enhances sense of well being/

help energize patient, increases
chances to participate on
activities/therapies.
Give positive reinforcement for

progress noted.
 Positive words of
encouragement promote
17
continuation of efforts and

enhance patients self esteem.
Emphasize importance of
grooming and personal
hygiene.
 People feel better about

themselves when they present a
positive outer appearance.
Conduct learning activities such

as communication skills/
positive self-image activities.
 To assist with learning new

skills and to promote self-esteem.
17
Model behaviors being taught,

involving client in goal setting
and decision-making.
 Facilitates clients developing

trust in own unique strengths.
INEFFECTIVE THERAPEUTUC REGIMEN
DATE CUES NEED NSG DX: GOAL OF CARE INTERVENTIONS EVALUTAION:

17
J S: H Ineffective Within our 5 hours 1.) Establish rapport with July 30, 2010 12:00 PM
Therapeutic span of care our patient.
U “Makalimot man gud E Regimen Mgt patient will have
ko inom usahay kay related to effective R: Facilitates cooperation
L walay nagahatag.” A in the treatment plan. GOAL MET!
complicated therapeutic regimen
Y L healthcare mgt as manifested 2.) Establish good and
system as by: open
O: T After 5 hours span of
evidenced by communication/therapeutic
a. self-awareness of care, our patient was
30, H lack of medicine communication with the
- Unable to take the medication; able to have effective
supply. patient.
medication in demonstrate therapeutic regimen as
the right time. behavioral changes manifested by:
- Medications R: promotes trusting
2 P necessary for
taken only if R: Use requires situation in which the a. Self- awareness
available. maintaining client is face to be open
0 E that patients of the time of
- Less number of therapeutic regimen and honest with self and medication.
nurses receive the such as willingness
1 R therapist. b. Demonstrate
available. appropriate to take the drug. behavioral
0 - 5 nurses is to C medicine, in the 3.) Assess knowledge of changes
50 patients. proper dose, for px regarding to the necessary for
E an adequate maintaining
condition & therapeutic
period of time. therapeutic
@ P regimen.
regimen.
7:00 T R: enables patient to be
aware of own self-needs &
AM I medication need.
O 4.) Assess the effect of the
N problem such as
17
recurrence of symptoms.
H R: facilitate proper
identification of the extent
E of the effect of the
A problem to the client’s
progress.
L
5.) Assess availability of
T the drug.
H R: lack of supply leads to

ineffective therapeutic
management.
M
6.) Assess availability of
A primary caregivers.
N R: presence of a caregiver
is necessary to provide
A monitory of the
maintenance of the
G
therapy.
E
7.) Instruct client to
M paraphrase instruction
heard about the drug
E therapy.
N R: facilitate learning of the
T client & understanding
17
about the drug regimen.
P 8.) Educate client about

consequences of
A ineffective therapeutic
T management such as slow
progress.
T
R: this will promote
E understanding that can
lead to wellness of the
R
client.
N
9.) Refer to counseling or
therapy to a group or
psychologist, as
prescribed.
R: professional guidance
from an expert or sharing
of experiences with co-
patients can ease
understanding and
wellness.
10.) Identify home and

community based nursing
services for follow up or
assistance.
R: this will enhance

17
confidence of the patient

the there are people who
can support him outside
the center.
17
IMPAIRED SKIN INTEGRITY
Time
J Subjective: Impaired skin Within our 5 hour span 21.) Establish Rapport with July 30, 2010
integrity related to of duty, our patient patient @12pm
U “Daghan man N
insect bites as will be able to have
gud lamok GOAL MET
L U manifested by open improved skin integrity
mamaak. Katol ® Facilitates cooperation in the
wound due to as manifested by: After 5 hours
Y kayo, kiloton T treatment plan
scratching spa of care, our
pud nko”
3 R F. Wounds are patient was
disinfected able to have
0, I 22.) Establish good and open
® Rash from a G. Enumerate improved skin
Objective: communication/therapeutic
2 T mosquito bite is a ways of integrity as
communication with the
-mosquito bites form of severe prevention of manifested by:
0 I patient.
noted at the reaction. The rash has the problem
f. Wounds
1 lower extremity O appearance similar to such as
were
blisters or bruises, maintaining ® promotes trusting situation in
0 N disinfected
with redness and good hygiene which the client is face to be open
and kept
@ -open wounds A itching around the and be honest with self and
dry and
due to bitten areas. therapist.
7AM L-M clean
scratching (http://www.buzzle.
17
E com/articles/insect- g. Enumerate
bite-rashes.html) d ways of
- redness T 23.) Assess extent of skin
preventing
around affected injury
A the
area.
problem
B
® Establish proper assessment of such as
O health problem trimming
nails and
L
maintaining
I 24.) Assess underlying factors cleanliness.
causing skin injury
C
® facilitates extermination on the

P causative factors.
A 25.) Assess other medical

condition that can aggravate
T
the condition such as diabetes
T mellitus.
® other medical disorder can
E
trigger and even exacerbate the
R skin injury.
17
26.) Assess blood supply and

sensation on affected area.
® evaluates the actual impairment
of circulation
27.) Ascertain attitude of

patient to the condition
®provides a baseline for patient’s

will to cooperate in the regimen.
28.) Educate the patient

regarding the effects of having
wounds.
® this will open the mind of the
patient and will eventually
participate in the treatments.
17
29.) Provide first aid remedy

such as disinfecting and
cleansing
®Ensure that the risk for
infection will be minimal
30.) Instruct patient on how to

minimize the problem such as
keeping a well trimmed nails
and frequent washing.
®Good hygiene can prevent

occurrence of infection
17
MEDICAL MANAGEMENT
Milieu Management
Hospitalization
It is a primary mode of treatment for people with mental illness. The highest priority for
admission to hospital-based care is safety for self and others, necessitating 24-hour supervision
in a secure environment. This includes recognition of individuals who are actively suicidal, self-
mutilating, or threatening others with harm. Hospitalization provides thorough medical and
psychiatric evaluation to identify the underlying cause of their symptoms. The goal of hospital-
based care is to assist individuals with attaining initial stabilization and safe level of functioning
and to assess for appropriate referrals for aftercare.
Milieu Therapy
Milieu (or environment) management is a proactive approach to care that forges

therapeutic benefits from patients’ surroundings, whether in the home, hospital, or out-patient
setting. The concept of milieu therapy involved clients’ interactions with one another, that is,
practicing interpersonal relationship skill, giving one another feedback about behavior, and
working cooperatively as a group to solve day-to-day problems.
Milieu therapy was one of the primary modes of treatment in the acute hospital setting. In
today’s health care environment, however, in-patient hospital stays are often too short for clients
to develop meaningful relationships with one another. Therefore, the concept of milieu therapy
receives little attention. Management of milieu, or environment, is still a primary role for the
nurse in terms of providing safety and protection for all clients and promoting social interaction.
Therapeutic Management
17
Psychotherapy
The goal of a psychotherapy group is for members to learn about their behavior and to
make positive changes in their behavior by interacting and communicating with others as a
member of a group. Groups may be organized around a specific medical diagnosis, such as
depression, or a particular issue, such as improving interpersonal skills or managing anxiety.
Group techniques and processes are used to help group members also learn they have
responsibilities to others and can help other members achieve their goal.
Psychotherapy groups are often formal in structure, with one or two therapists as group
leaders. One task of the group leader or the entire group is to establish the rules of the group.
These rules deal with confidentiality, punctuality, and attendance, and social, contact between
members outside of group time.
Play Therapy
It is a form of therapy that brings fun and form of exercise, socialization with others
cooperation, diversion of attention, promote sportsmanship and express feelings and thoughts. It
is an activity that makes it possible for the client to express himself freely. Free play enables the
individual a unique opportunity to discharge strong emotions in a secure atmosphere.
Music Therapy
This therapy is a purposeful use of music as a participative or listening experience in the

treatment of patients to improve and motivate the patients’ mental and emotional state. Its
activity is for socialization and self-expression and sometimes realization through musical
activities. It is also a process of letting the patients express their feelings and thoughts through
various artistic means like drawing, sketching, painting and many more. Music therapy
significantly diminishes patients' negative symptoms, increased their ability to converse with
others, reducing their social isolation, and increasing their level of interest in external events.
17
Art Therapy
This is a form of expression by which emotionally and mentally ill patients can
communicate their problems by expressing it through drawings and paintings. It is a tool for
stimulating self-expression, as a diagnostic therapy from which modifications in treatment can be
made, it facilitates group process, it provides opportunities for self-esteem, and it promotes
personal growth.
Biblio-Therapy
It is a non-physical psychotherapeutic technique in which the patient is induced to read

books or any reading materials. Literature is a means of achieving therapeutic goals. The therapy
makes use of literature, films, creative writing, and group discussion to promote expression of
thoughts and feelings. It aims to stimulate psychological, social and aesthetic values from books
in relation to human character, personality and behavior. This provides stimuli for the memory to
compare events with other patients. The purposes of this therapy are: to widen cultural horizon,
to lift up depressed feeling, educate the patient, improve the span of attention of the individual
with limited concentration, and to stimulate imagination.
Occupational Therapy
This therapy is a manual, recreational and creative technique to facilitate personal

experience and increase social responses and self-esteem. In this therapy, the process and not the
product is of greater importance. It is also rehabilitative procedure that diverts patient’s attention
and this develops their creative abilities for a purposeful living and lead to the mastery of self
and environment. This is also a method of treatment in which patients are given some kind of
light work, directed towards meeting patients to work through unconscious conflict through the
mechanism of sublimation or acting it out.
Group Therapy
17
The goal of group therapy is the alteration of behavioral patterns of group members
through the development of new and more effective ways of coping with stress.
In group therapy, clients participate in sessions with a group of people. The members
share a common purpose and are expected to contribute to the group to benefit from others in
return. Group rules are established that all members must observe. These rules vary according to
the type of group. Being a member of a group allows the client to learn new ways of looking at a
problem or ways of coping with or solving problems and also helps hi or her to learn important
interpersonal skills. For example, by interacting with other members, clients often receive
feedback on how others perceive and react to them and their behavior. This is extremely
important information for many clients with mental disorders, who often have difficulty with
interpersonal skills.
The therapeutic results of group therapy include the following:
• Gaining new information and learning

• Gaining inspiration and hope
• Interacting with others
• Feeling of acceptance and belonging
• Becoming aware that one is not alone and that others share the same problems
• Gaining insight into one’s problems and behaviors and how they affect others
• Giving of oneself for the benefit of others (altruism)
Remotivation Therapy
This is to make an individual’s most basic psychological needs are to be loved ( to be

involved ) and to feel worthwhile ( to have respect from self and others ). These needs must be
met responsibly and within the context of reality. Responsibility is fulfilling one’s needs without
interfering with others who are fulfilling their needs. This therapy can be used in any situation,
17
regardless of the length of time the client has been hospitalized, his age or the reason of his
illness and sex. This aims to stimulate clients to think about something and talk about himself,
develop the ability to communicate and share idea and experience with others and to develop
feeling of acceptance and recognition.
17
PROGNOSIS
POOR FAIR GOOD JUSTIFICATION
His illness started last 1993

and she was 19 years old on
that year. According to Ama
Kida, the continuous signs
1.) Duration of
Illness last for at least 6 months. At

present, he is 36 years old
and so it is 17 years that she
has the illness. She was
admitted via his father.
Kida first symptoms of

schiazophrenia appeared
when he was 19 years old. It
was mentioned by his father
that Kida started to move
suspiciously and
schizophrenia paranoid type
set in before the age of 25. It
2.) Onset of Illness 
typically first occurs in
adolescence or early
adulthood, at time during
which brain maturation is
almost complete.
17
Paranoid type is more

common in single persons
than married ones. He does
3.) Civil Status  have a girlfriend but they
separated.
Precipitating factors include

interpersonal influences,
major life events, and social
environment. The girlfriend
of Kida got pregnant, but
unfortunately, they
separated. He tends to
4.)Precipitating choose his friends.

Factors According to the informants,
when they migrated in
Fatima they live in a place
were addiction is very prone.
They have a good housing
condition.
5.)Mood and Affect All throughout the activity

Kida showed calmness and
he is much behaved. He
 shows blunted affect. At
times so you really need to
repeat the question to get her
17
attention. She has this

blunted affect since from the
start of the therapy.
He only had few friends and

he intensely chooses the
friends he wanted to have.
6.)Premorbid Schizophrenia can cause a
Personality diminished energy level
 (anergia), which complicates

social interactions.
Schizophrenia does not

manifests depressive
disorders and depressive
features are not visible.
However he is observed to
7.)Depressive have denials. Kida is
Features changing the topic when the

student nurse focuses on
love life; it is his way of
defense mechanism.
8.)Attitudes and  Kida is not willingly to take

Willingness to Take the medicines and
17
treatments. He has a
negative behavior in
the Medicines and accomplishing the treatment
Treatment regimen.
The immediate family of

Mr. Kida gave their full
emotional and financial
support to him. The family
tries to understand Mr.
Kida’s despite of his
9. ) Family Support  condition. They concerned
to Ms. Kida by bringing him
to Davao Mental Hospital
for proper treatment and
management.
Computation
Good 4 x 3 = 12
Fair 3x2=6
17
Bad 2x1=2
= 20/9
= 2.22
Range
Good = 1.0 – 1.6
Fair = 1.7 – 2.3
Poor = 2.4 – 3.0
General Prognosis
The computation illustrates that Mr. Kida has fair prognosis. It suggests that he has a
higher chance of recovering in this condition. If Mr. Kida will continue in complying the
treatment and as long as the immediate family members will still support Mr. Kida, without
hesitation, it will aid in his recuperation process.
RECOMMENDATIONS
TO THE CLIENT:
17
1. Encourage the client to continue the prescribed medication even after the
symptoms.
2. Persistent information regarding the signs and symptoms about the illness,
adverse or side effects and contraindication of the medications should be given to
the client.
3. Assist the client to join in psychotherapy activity like individual psychotherapy,
group therapy, family therapy, music therapy, etc.
4. Encourage the patient to verbalize thoughts and feelings to know the patient’s
need and able to perform and take appropriate actions for it.
5. Encourage the importance of proper hygiene, because it promotes and keeps him
free from infection.
TO THE FAMILY AND SIGNIFICANT OTHERS:
1. Encourage the family to truly accept the real situation and condition of the client
to lessen the emotional burden.
2. Give the actual information about the illness, so that they will be aware of the
present condition that will reduce anxiety and can support optimum decision
making will make them accept the situation.
3. Describe symptoms and problems that should be reported or expected to provide
prompt care.
4. Have support groups available for families to help them deal with living with a
member having mental illness.
5. Encourage family members to observe and evaluate significant changes and
progress of the rehabilitation of their mentally ill love one.
6. Information about the community resources and organization should be given to
family for client’s benefit.
7. Family member’s significant other should be given health teachings, in order to
help the client cope up with his problems, anxieties, frustrations, and help him to
become productive member of the society.
17
8. Every member of the family should operate as a whole including communication

and manipulation of the environment for problem solving.
TO THE COMMUNITY:
1. Encourage the community members to be more open and understanding in

dealing with mentally ill client.
2. Avoid arguing with patient about content of mood disorders because it may get
irritated or frustrated and may exhibit aggressiveness toward self and others.
3. Maintain a kindly attitude and avoid being over friendly toward the client because
it may affect the patient’s sense of independence and may withdraw or become
aggressive.
4. Tell the neighbors not to tolerate the patient during mood disorders, but rather
help the patient.
5. The community should be educated to recognize how feelings affect behavioral
and influence relationship.
6. Information should be provided on how to support the mentally ill client without
criticism or judgment.
TO THE STUDENTS AND FUTURE RESEARCHERS:
1. Proper assessment and evaluation of the patient must be done.

2. Future researchers are encouraged to develop sense of empathy, understanding
and be compassionate to the mentally ill patient.
3. Future researchers should provide reliable and factual information to avoid false
result of the conducted research study.
4. They are encouraged to understand the goals, objectives and methods of research
to have a reliable nursing intervention and management.
SIGNIFICANCE OF THE STUDY
17
REFERRENCES
17

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17

Schizophrenia is a serious mental illness characterized by a disintegration of the process

Schizophrenia Ranks among the top 10 causes of disability in developed countries

In the Philippines, the prevalence of schizophrenia is thought to be about 1% of the

k. Give at least 3 definition of the complete diagnosis of the client

n. Present a doctor’s order with rationalization.

t. Provide the significance of the study

Age : 36 years old

Address : Purok 1B, Hilltop Bajada

Birthday : October 6, 1974

Birth Place : Makilala, Cotabato

Ordinal Rank : 2nd child

Civil Status : Single

Religion : Roman Catholic

Educational Attainment : Secondary Level Undergraduate

Source of Information : Client, Father, Cousin and neighbors

Name: Amakida Name: Inakida

Age: 64 years old Age: 59 years old

Occupation: Service Driver Occupation: Midwife

Educ. Attainment: College Level Educ. Attainment: College Level

Date of Admission : March 23, 2010

Admitting Physician : Al Raymond Tupas, M.D.

Diagnosis : Schizophrenia Paranoid

Institution : Davao Mental Hospital

Past Health History

Present Health History

According to Amakida, Inakida experienced a complete nine months of pregnancy. On

Infancy and Childhood Characteristics

Religious and Social Adaptability

His family goes to church but is not that religious.

Patient wasn’t able to experience employment. Unemployed.

Onset of Present Illness

1.) Name: Amakida

Civil Status: Married

Address: Hilltop Bajada

Relationship to patient: Father

Length of time known to patient: Since birth

Apparent understanding of present illness of patient:

Other characteristics and attitude of informant:

2.) Name: Cuzkida

Address: 170 Fatima Street Guerero

Relationship to patient: 1st Cousin

Length of time known to patient: 30 years

Apparent understanding of present illness of patient:

Other characteristics and attitude of informant:

the patient. She has shared to us much information about kida.

3.) Name: Girkida

Address: Fatima Street Guerrero

Relationship to patient: Girlfriend

Length of time known to patient: 18 years

Apparent understanding of present illness of patient:

Other characteristics and attitude of informant:

4.) Name: Anakida

Address: Fatima Guerrero

Relationship to patient: Kida’s son

Length of time known to patient: 5 years

Apparent understanding of present illness of patient:

Other characteristics and attitude of informant:

Maternal and Paternal Grand Lineages

ERIK ERICKSON’S PSYCHOSOCIAL DEVELOPMENT THEORY

* INFANCY (0 -1 ½ years old) – TRUST vs. MISTRUST

* TODDLER (1 1.2 – 3 years old) – AUTONOMY vs. SHAME and DOUBT\

* PRESCHOOLER (4 and 5 years old) - INITIATIVE vs. GUILT

Learning to walk. Learning to crawl. * Learning to take solid food. * Learning to

Selecting a mate. Learning to live with a partner. * Starting family. * Rearing