Comprehensive Case Study Paranoid Schizophrenia

Republic of the Philippines
BATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING AND MIDWIFERY
________________________
A Comprehensive Case Study
Paranoid Schizophrenia
_______________________
In Partial Fulfillment of the Requirements in
Psychiatric Nursing
________________________
Submitted to:
Leonora Llandilar R.N., M.A.N.
Nemia de Leon-Calimbas R.N., M.A.N.
Caroline Santos R.N., M.A.N.
Clinical Instructor
Submitted by:
MTW Group 6
Jomar Dominic Rosario
Ave Maria Valenzuela
Joey Alvin Quiambao
Dannie Rhea Seredio
Ma. Renalyn Ramos
Krizzia Anne Viray
Charize Mendoza
Lorryleen Galicia
Alma Joy Lupido
Ellen Jane Pulos
Lyndon Cruz
Riza Racion
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TABLE OF CONTENTS
UNIT I
I. DEDICATION AND ACKNOWLEDGEMENT
II. INTRODUCTION
III. PERSONAL DATA
IV. CHIEF COMPLAINTS
V. HEALTH HISTORY
a) Past Health History
b) Present Health History
c) Family History
d) Social History
i. Childhood
ii. Adolescence
iii. Adulthood
e) Sexual History
UNIT II
Mental Health Status / Analysis and Interpretation
UNIT III
a) Psychophatophysiology
b) Related Literature
UNIT IV
a) Nursing Care Plan
b) Pharmacology
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UNIT V
Psychotherapy
UNIT VI
Glossary
UNIT VII
References
UNIT VIII
Documentation
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UNIT I
I. ACKNOWLEDGEMENT AND DEDICATION
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ACKNOWLEDGMENT
Our group would like to extend our warmest gratitude to the following persons
whose contributions whether financial, moral, spiritual and intellectual contributed much in
the accomplishment of this manuscript.
We humbly acknowledge and sincerely appreciate those who have shared their
valuable assistance and encouragement toward the completion of this study.
To all our beloved families for their understandings, motivations, supports, care and
love that get us through all the hardships that we’ve encountered.
To Mrs. Leonora Llandilar R.N, our clinical instructor, for her tireless guidance
patience and valuable advises that guides us to finish with clarity and coherence this piece
of work.
To the staffs of Mariveles Mental Hospital for the wonderful display of cooperation,
support and guidance which dynamically contributed in data-gathering and completion of
the findings.
Above all, to Almighty God from heaven for all the glory and triumph extended to
the Author. All the glory and love be all yours.
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DEDICATION
This humble piece of work is lovingly dedicated to our beloved family.
To our fellow BPSU students who will benefit from this work.
And most of all to our LORD and SAVIOR JESUS CHRIST.
To Him is all the glory!
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Vision
A university of excellence acknowledged in the country and the Asia-Pacific Region for
quality graduates and knowledge responsive to socio-economic needs
Mission
Provide quality and relevant education that will develop highly qualified and competitive
human resources responsive to national and regional development
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UNIT I
II. INTRODUCTION
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Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions,
movements, and behavior. It cannot be defined as a single illness ; rather schizophrenia is
thought of as a syndrome or disease process with many different varieties and symptoms
much like the varieties of cancer. For decades, the public vastly misunderstood
schizophrenia, fearing it as dangerous and uncontrollable and causing wild disturbances and
violent outbursts. Many people believed that those with schizophrenia needed to be locked
away from society and institutionalized. Only recently has the mental health industry come
to learn and educate the community at large that schizophrenia has many different
symptoms and presentations and is an illness that medication can control. Thanks to the
increased effectiveness of newer atypical antipsychotic drugs and advances in community-
based treatment, many clients with schizophrenia live successfully in the community. Clients
whose illness is medically supervised and whose treatment is maintained often continue to
live and sometimes work in the community with family and outside support.
Schizophrenia usually is 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 (America Psychiatric Association, 2000).
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. With paranoid schizophrenia, your ability to think and function in daily life may
be better than with other types of schizophrenia. You may not have as many problems with
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memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious, lifelong
condition that can lead to many complications, including suicidal behavior.
Patients who have paranoid schizophrenia that has thought disorder may be obvious
in acute states, but if so it does not prevent the typical delusions or hallucinations from
being described clearly. Affect is usually less blunted than in other varieties of
schizophrenia, but a minor degree of incongruity is common, as are mood disturbances such
as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such as
blunting of affect and impaired volition are often present but do not dominate the clinical
picture. 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.
In the Philippine setting, the disability survey done in 2000 by the National Statistics
Office (NSO) found out that mental illness was the 3rd most common form of disability in
the country. The prevalence rate of schizophrenia was 88 cases per 100,000 populations and
was highest among the elderly group. This finding was supported by a more recent data
from the Social Weather Station Survey commissioned by DOH in 2004. It reveals that 0.7
percent of the total households have a family member afflicted with mental disability. The
Baseline Survey for the National Objectives for Health in 2000 stated that the more
frequently reported symptoms of an underlying mental health problem were sadness,
confusion, forgetfulness, and no control over the use of cigarettes and alcohol, and
delusions.
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The most recent study on the prevalence of mental health problems was conducted
by the National Epidemiology Center (DOH-NEC) in 2006 which showed revealing results
though the target population was limited only to government employees from the 20
national agencies in Metro Manila. Among 327 respondents, 32 percent were found to have
experienced a mental health problem at least once in their lifetime. The three most
prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%), depression and
schizophrenia (6%). Mental health problems were significantly associated with the following
respondent characteristics: ages 20-29 years, those who have big families, and those who
had low educational attainment. The prevalence rate generated from the survey was much
higher than those that were previously reported by 17 percent.
Currently, there is no method for preventing schizophrenia and there is no cure.
Minimizing the impact of disease depends mainly on early diagnosis and, appropriate
pharmacological and psycho-social treatments. Hospitalization may be required to stabilize
ill persons during an acute episode. The need for hospitalization will depend on the severity
of the episode. Mild or moderate episodes may be appropriately addressed by intense
outpatient treatment. A person with schizophrenia should leave the hospital or outpatient
facility with a treatment plan that will minimize symptoms and maximize quality of life.
We primarily chose this case because of all kinds of schizophrenia; the paranoid type
is the most manageable one. Moreover, according to studies with proper and effective
treatment, paranoid schizophrenic patients have a greater chance to have a normal life.
Aside from that Mr. A.M. was the most coherent and most responsive of all our clients. This
entire case is highly possible to be studied comprehensively within the limited time
available.
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UNIT I
III. PATIENT’S PERSONAL DATA
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NAME: Mr. A.M
ADDRESS: Capaz, Tarlac
AGE: 41 years old
BIRTHDAY: January 21, 1969
BIRTHPLACE: Isabela
CIVIL STATUS: Single
RELIGION: Roman Catholic
NATIONALITY: Filipino
EDUCATIONAL ATTAINMENT: High School Undergraduate
OCCUPATION: Miner
DATE ADMITTED: September 18. 2006
TIME ADMITTED: 10:15 a.m.
WARD: Male Ward B
ADMITTING DIAGNOSIS: Paranoid Schizophrenia
ATTENDING PHYSICIAN: Dra. Evangelista
LAST 15 YEARS OF CLIENT’S LIFE:
Mr. A.M. formerly lived at Benguet on 1995. He worked there as a helper on
a mining company. In 2004, when he was 35 y/o, their family moved in Capaz,
Tarlac. He worked as a farmer that time. As the client stated, it was his first
admission at Mariveles Mental Hospital on September 18, 2006. According to him,
he was confined from 2006 up to present. Mr. A.M. was 37 y/o when he was
admitted to the hospital and still been there for 4 years.
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UNIT I
IV. CHIEF COMPLAINTS
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CLIENTS CHIEF COMPLAINT
(Source of Data: Client’s Chart)
 Loss of Appetite
 Poor Sleep
 Irritable
 Hurts his Parents
 Destroys Appliances at home
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UNIT I
V. HEALTH HISTORY
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a) Past Health History
From the client's history in chart, he was working in a mining company at 17 years
old. When in 1985, he was figured in a mining accident; he was trapped in a machine
with rocks. The client spare 6 months in the hospital for his physical injuries. Since
then, he became restless and anxious each time he heard loud noises. After
recovery, Mr. A.M., was able to return working in the mining company he had been
before but was fired from work because of carnapping the car owned by the
company.
In 1990, he reportedly began to use marijuana and alcohol. He developed a
behavioral disorder. He was restless, irritable and violent. He hit a child whereby a
case was filed to him but his family settled the case. As said in the chart he was
confined at Roseville Rehabilitation Center for 2 months for psychological treatment
commenced with CPZ, and depot injection. The client had requested treatments and
follow-ups. And in 1995, the client was confined again at Baguio General Hospital for
2 months at the Psychiatric Ward.
As claimed by the client, he was still addicted to marijuana and alcohol after
being discharged from Baguio General Hospital until they had moved in Capaz, Tarlac
on 2004.
There he worked as a farmer together with his father, in their own small
farm. He also had a fight with his brother that made the latter to leave their house
without permission.
In January 2006, he refused to take medications and go for follow-ups. The
family was unable to purchase depot prep. He became irritable, sleepless, and
restless.
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In August 2006, he stubbed his father with a nail. He was charged in court but
case was not pursued. The client was forced to take medications to lessen the signs
and symptoms he manifested.
b) Present Health History
One week before admission, the client was again noted to be irritable. He ran
after a kid with a knife and burned some appliances at home (bed and soft cushion).
This prompted his family to seek help from Mariveles Mental Hospital. Mr. A.M. was
then diagnosed with paranoid schizophrenia by Dra. Evangelista upon admission on
September 18,2006.
Mr. A.M. is currently confined at Mariveles Mental Hospital Ward B. The
client stayed at the ward for 4 years now. He talks with some clients in the ward.
Mr. A.M. said that he spent most of his time in sleeping. He sings when he wanted
to.
Mr. A.M. shows only a few of the presenting complains, such as; interrupted
sleep and irrelevant speech. Mr. A.M. was manageable and showed little
manifestation during daily interaction. Mr. A.M. participates well in the therapies
and other activities.
The father last visited the client on July 4, 2009. However, until now, none of
his family members came back to visit him.
Last July, the client has an order for conduction but still waiting for the
scheduled date of discharge.
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c) Family History
As the client said, they have no history of having hypertension or diabetes
mellitus both on his parent’s side. He did not remember that his family and other
relatives do have any hereditary illnesses.
Family history of having mental disorder was denied, as written on the chart. But
when we asked the client, his brother was confined at Mandaluyong Mental Hospital
until this time. He also stated that his uncle does have a mental disorder before.
d) Social History
i. Childhood
Mr. A.M. was born in Tuguegarao, but he grew up in Baguio City. He
spent his elementary days in Baguio. He did not have immunizations. As said
by the client, his common illnesses during childhood are fever, colds & cough.
Mr. A.M. had a good relationship with his parents, especially to his father.
The client is closer to his father than to his mother. As claimed by the client,
he & his siblings are in good terms when they are young.
The client stated that he was bullied when he was young. Some of his
childhood peers asked him to spanks their mate and he did it. He always
followed what his friends commanded to him. Mr. A.M. said that he does not
want to be out of place when he was with his friends, so he does whatever
his peers told him to do so.
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ii. Adolescence
During his adolescent age, he learned how to masturbate. The client
said that he learned it only by himself, when he was 12 or 13 as remembered.
He told us that it is a part of growing up.
When he was in 2nd year high school, he started to court a woman,
and this became his first and last relationship before he was confined to
MMH. The client also gained friends of the same and opposite sex. Mr. A.M.
joined a fraternity when he was a sophomore student. He only finished
second year high school due to insufficient financial status and he’s also lazy
in going school.
At the age of 17, he started to work at a mining company.
Unfortunately, in 1985, he was trapped in a machine with rocks. He was
confined in the hospital for 2 months. This results him to become restless and
anxious whenever he heard loud noises. This is the time when his 1 st sign and
symptom started to manifest.
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iii. Adulthood
Mr. A.M. spent most of his adult years in Baguio City. He worked as a
helper on a mining company until he was 21 yrs old. The client was fired
from work due to the case of car napping. After that, he no longer had a job.
The client spent most of his times with his friends whereby he had the vices
of smoking, drinking alcohol and using marijuana. He became addicted to
marijuana. Mr. A.M. was no longer concern with his relationship to his
girlfriend or with his life that time. He did not have his own family or even
marry his girlfriend. The client stabbed his father with a nail when he scolded
him on the things he does, fortunately it’s not fatal. His behavior was also
changed, he became restless. He burned their bed foam and sofa cushion.
He also hit his brother. Mr. A.M. destroyed some appliances of their
neighbor. Lastly, he ran after a child with a knife which forced his parents to
bring him at MMH. At present, the client was 41 yrs old and is confined for 4
years at the mental hospital.
e) Sexual History
The client defined sex as a process of having a family. He started to
masturbate when he was 12 or 13 yrs old and said that it is a part of growing up. He
learned this by himself. The client has not yet experience having sex. He had only
kissed his girlfriend and nothing more than that. Mr.A.M. once discharged, wants to
marry his girlfriend and have 3 children, 2 boys and 1 girl.
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UNIT II
MENTAL STATUS ASSESSMENT
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ORIENTATION
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Self - Awareness
Person      
Orientation
Place      
Holiday
Holiday
School
School
Date      
Time      
Situation      
ANALYSIS AND INTERPRETATION
Day 1: ORIENTATION
Day2: SELF-AWARENESS
Day3: The client is oriented to person, place, time, date and situation. He knew his name,
where he is, what is the time and date, and the reason why he’s confined to the
hospital.
Day4: The client is oriented to person, place, time, date and situation. He knew his name,
where he is, what is the time and date, and the reason why he’s confined to the
hospital.
Day5: The client is oriented to person, place, time, date and situation.
Day6: HOLIDAY
Day7: The client is oriented to person, place, time, date and situation.
Day8: The client knew his name, where he is, what is the date and time, and the reason
why he is confined at the hospital.
Day9: SCHOOL
Day10: HOLIDAY
Day11: Client is oriented to person, place, time, date and situation.
Day12: SCHOOL
 - MANIFESTED X - NOT MANIFESTED

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DEFENSE MECHANISMS
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Repression X X X X X X
Suppression X X X X X X
Regression X X X X X X
Fixation X X X X X X
Denial X X X X X X
Displacement X X X X X X
Conversion X X X X X X
Identification Self – Awareness X X X X X X
Orientation
Intellectualization X X X X X X
Holiday
Holiday
School
School
Introjections X X X X X X
Projection X X X X X X
Rationalization X X X X X X
Sublimation X X X X X X
Substitution X X X X X X
Symbolism X X X X X X
Undoing X X X X X X
Reaction
X X X X X X
Formation
Fantasy X X X X X X
Day 1: ORIENTATION
Day3: The client didn’t show any defense mechanism. He just answered the questions
directly and appropriately. The client showed sincerity on what he’s saying by
means of direct eye contact.
directly and appropriately. The client maintained eye contact.
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Day6: HOLIDAY
Day7: The client didn’t show any defense mechanism during the interaction.
Day8: The client didn’t show any defense mechanism during the interaction.
Day9: SCHOOL
Day10: HOLIDAY
Day12: SCHOOL
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EXTRAPYRAMIDAL SYMPTOMS
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Pseudoparkinsonis
m
1. Mask-like Face X X X X X X
2. No Swining of
X X X X X X
Arms
3. Hesitancy of
X X X X X X
Speech
4. Decrease Muscle
X X X X X X
Strenght
5. Shuffling Gait X X X X X X
6. Drooling X X X X X X
7. Fine Intention
X X X X X X
Tremors
Acute Dystonic
Reaction
Self - Awareness
1. Muscle spasm of
Orientation
jaw,tongue, neck, X X X X X X
Holiday
Holiday
School
School
eyes.
2. Laryngeal Spasm X X X X X X
Akathisia X
1. Restlessness X X X X X X
2. Tenseness X X X X X X
3. Inability to Sit Still X X X X X X
4. Rocking back and
X X X X X X
forth on feet
5. Crossing Leg
X X X X X X
Frequently
6. Inability to Relax X X X X X X
Tardive Dyskinesia
1. Involuntary
movements of
mouth, tongue, face,
X X X X X X
may extend to
fingers, arms and
trunk.
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Day 1: ORIENTATION
Day3: We didn’t noticed any symptoms of akathisia/tardive dyskinesia towards Mr. A.M..
The client didn’t display any actions related to the said symptoms.
Day6: HOLIDAY
Day7: No EPS we’re seen on the client.
Day8: We didn’t notice any symptoms of EPS on the client.
Day9: SCHOOL
Day10: HOLIDAY
Day12: SCHOOL
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THINKING AND COMMUNICATION
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Looseness of
Association
1. Neologism X X X X X X
2. Word
X X X X  X
Salad
3. Echolalia X X X X X X
4. Echopraxia X X X X X X
5. Clang
Self - Awareness
Orientation
Associatio X X X X X X
Holiday
Holiday
School
School
n
6. Illogical
X  X   X
thinking
Alogia X X X X X X
Concrete
X X X X X X
Thinking
Lack of Insight X X X X X X
Aphasia X X X X X X
Apraxia X X X X X X
Agnosia X X X X X X
Flight of Ideas X X X   X
Day 1: ORIENTATION
Day3: The client did not show any manifestations regards to thinking and communication
disorder. Mr. A.M. spoke clearly and appropriately to the questions asked. He also
interpreted and understood our conversation well.
Day4: The client manifests illogical thinking during our interaction.
“SN: Ah, ano po ba ang naalala nyo sa gitara?
C: Dati nag-gigitara ko,lagi jamming ang tropa. Gumawa pa nga ko ng kanta.

Pinadala Ko kay Britney Spears.”
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disorder. Mr. A.M. spoke clearly and appropriately to the questions asked.
Day6: HOLIDAY
Day7: The client thinks and shares stories illogically, with some ideas not related to the
topics discussed.
“SN: Mang A.M., ano nga pop ala ang relihiyon ninyo?
C: Jehovah Witness. Pero hindi pa ko baptized.
SN: Ah, ganun po ba Mang A.M.,
C: Oo, yung tiyuhin ko nga nilagyan nya ako ng brilyante sa ulo nun eh.
SN: Brilyante po?
SN: Eh, papanu naman po iyon nilagay sa ulo ninyo?
C: Oo, pinutol nila yun leeg ko tapos binalik nila ulit.”
Day8: The client says something that we did not understand (word salad).
“C: Attachment string. Iniipit nya ko. Hindi ako mapalagay mag rereaksyon na ko.”
Some ideas are not related to the topic being discussed (Flight of Ideas).
“SN: Ok na po ba kayo Mang AM?naaalala nyo po ba ang ginawa natin?
C: Nabusog ako, yung pumugot ng ulo ko iniipit ako eh.”
And the flow of our conversation goes illogical.
“SN: Ah ganon po ba?Masaya po? Eh napansin po naming na parang nakasimangot

at seryoso po kayo masyado. Ano po ang dahilan?
C: Hindi kasi ako nakakatulog.
SN: Hindi nakatulog? Ano po ang dahilan?
C: May nag-iisip siguro sa akin.
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SN: Sino naman po kaya Mang A.M?
C: Yung pumugot ng ulo ko nung bata pa ako. Iniipit nya ku eh. Tinatawag nya ko.”
Day9: SCHOOL
Day10: HOLIDAY
disorder. Mr. A.M. spoke clearly and appropriately to the questions asked. He also
interpreted and understood our conversation well.
Day12: SCHOOL
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PERCEIVING AND INTERPRETING
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Delusions
1. Reference X X X X X
2. Persecution X X X X 
3. External
Self - Awareness
X X X X X
Influence Orientation
Holiday
Holiday
School
School
4. Somatic X X X X X
5. Grandiose X X X X X
Hallucinations X X X X 
Illusions X X X X X
Attending to
X X X X X
irrelevant Stimuli
Poor Reality testing X X X X X
Day 1: ORIENTATION
Day3: Mr. A.M. showed full understanding on what we are talking about by acting and
responding correctly on our interaction. He also interpreted the words and
expressions displayed during the conversation correctly. All his responses are
considered appropriate.
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Day6: HOLIDAY
Day7: No abnormal manifestations of perception and interpretation we’re seen on the
client.
Day8: On our conversation with the client, he manifested delusion:
“SN: Eh napansin po naming na parang nakasimangot at seryoso po kayo

masyado. Ano po ang dahilan?
C: Hindi kasi ako nakakatulog.
SN: Hindi nakatulog? Ano po ang dahilan?
C: May nag-iisip siguro sa akin.
SN: Sino naman po kaya Mang A.M?
C: Yung pumugot ng ulo ko nung bata pa ako. Iniipit nya ku eh. Tinatawag nya ko.”
And hallucination:
“SN: Mang AM. mag pahinga muna po kayo ha. Ihahatid nap o naming kayo sa
ward. Tayong 3 lang po magkakasama Mang AM. wala na pong iba.
C:Naririnig ko sya sa attachment string.”
Day9: SCHOOL
Day10: HOLIDAY
Day12: SCHOOL
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FEELING AND AFFECT
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Flat Self - Awareness X X X X X X
Orientation
Blunted X X X   X
Holiday
Holiday
School
School
Inappropriat
X X X X X X
e
Lability X X X X X X
Day 1: ORIENTATION
Day3: We noticed that our client is in good mood. He also had the appropriate affect on
different situations we had talked about. Mr. A.M. responded accordingly.
Day6: HOLIDAY
Day7: The client’s feeling and affect is blunted. He thinks first for a moment before
answering.
Day8: the client’s feeling and affect is blunted. His reaction is delayed.
Day9: SCHOOL
Day10: HOLIDAY
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Day12: SCHOOL

BEHAVING AND INTERACTING
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Withdrawal X X X X X X
Motor
X X X X X X
Hyperactivity
Motor
Self – Awareness
X X X X X X
Orientation
Hypoactivity
Holiday
Holiday
School
School
Ambivalence X X X X X X
Anhedonia X X X X X X
Abolition X X X X X X
Poor Personal
X X X X X X
Hygiene
Impulsive X X X X X X
Paranoia X X X X X X
Day 1: ORIENTATION
Day3: There is no problem with the behavior of our client. He behaved like a normal
individual with no mental disorder. Our interaction also went smooth because he
participated actively in the conversation.
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Day6: HOLIDAY
Day7: No manifestation seen on the client.

Day8: Our client is behaved but interacted illogically.
Day9: SCHOOL
Day10: HOLIDAY
Day12: SCHOOL
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NEGATIVE COGNITION
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Overgeneralization Self - Awareness X X X X X X
All-or-Nothing
X X X X X X
Orientation
Thinking
Holiday
Holiday
School
School
Should Statements X X X X X X
Labeling X X X X X X
Mind Reading X X X X X X
Fortune Telling X X X X X X
Day 1: ORIENTATION
Day3: Our client did not display any manifestation under negative cognition. And he didn’t
possess negative cognition skills.
Day4: He did not possess any negative cognition skill.
Day5: Our client did not display any manifestation under negative cognition skills.
Day6: HOLIDAY
Day7: No manifestations seen on the client.
Day8: No manifestations seen on the client.
Day9: SCHOOL
Day10: HOLIDAY
Day11: Our client did not display any manifestation under negative cognition. And he didn’t
possess negative cognition skills.
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Day12: SCHOOL

OTHERS
DAY 1 2 3 4 5 6 7 8 9 10 11 12
Amnesia X X X X X X
Fugue X X X X X X
Depersonalization X X X X X X
Phobias X X X X X X
Self – Awareness
Orientation
Memory
Holiday
Holiday
School
School
1. Remote      
2. Recent      
3. Recent part      
4. Immediate
     
memory
5. Immediate
     
recall
Day 1: ORIENTATION
Day3: Mr. A.M. did not manifest amnesia, fugue, depersonalization, phobias and other
memory problem.
memory problem.
memory problem.
Day6: HOLIDAY
Day7: The client’s memory is good and he did not manifest fugue, depersonalization,
amnesia and phobia.
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Day8: The client’s memory is good and he did not manifest fugue, depersonalization,
amnesia and phobia.

Day9: SCHOOL
Day10: HOLIDAY
memory problem.
Day12: SCHOOL
Page | 38
UNIT III
A) PSYCHOPATHOPHYSIOLOGY
Page | 39
SUBSTANCE ABUSE
(Theory of Drug Abuse) Alcoholism and Drug abuse

(Long term used caused
addiction)
(Disease Theory of Alcoholism)
Altered mental and physical

functioning
Disorganized thoughts and

confusion
Auditory hallucinations Paranoia Delusions persecutions
Violence
Page | 40
Marked social isolation
The theory of drug abuse views that drug is use as part of the individual’s attempt to
deal with needs and conflicts, relations with others, and the social environment in which he
or she lives. Since all of these vary with age and stage of life, one would expect drugs to be
used and abused for different purposes at different points in the life cycle.
In relation with the client’s past life experiences, he used and became addicted to
marijuana for so many years that led him to have disturbed thoughts and confusions.
The modern disease theory of alcoholism states that problem drinking is sometimes
caused by a disease of the brain, characterized by altered brain structure and function.
Alcoholism is a chronic, life-long disease, such as diabetes. However, if managed properly,
damage to the brain can be stopped and to some extent reversed. In addition to problem
drinking, the disease is characterized by symptoms including an impaired control over
alcohol, compulsive thoughts about alcohol, and distorted thinking.
The client was alcoholic since he was only 21 years old up to the time before he was
admitted to MMH. Too much consumption of alcohol may affect one’s thinking processes.
Page | 41
Stressful Life Situations
Traumatic Life
Experiences
(Stressful work situation/
failed relationship)
(Maslow’s hierarchy of Needs)
Rejection/ Tension/
Frustration
Altered use of coping

mechanism
Decrease self- esteem
Feeling of Inadequacy Maladaptive and

disruptive behavior
Sadness Problem with Violent behavior

concentration
Page | 42
Highly stressful situations - may trigger schizoaffective disorder especially in those
people who have inherited a tendency to develop the disorder. Lack of loving and nurturing
care, one of many other factors, is thought to be responsible for mental problems in later life.
Maslow's hierarchy of needs- After physiological and safety needs are fulfilled, the third
layer of human needs are social and involve feelings of belongingness. This aspect of
Maslow's hierarchy involves emotionally based relationships in general, such as:
 Friendship
 Intimacy
 Family
Love and belonging; Humans need to feel a sense of belonging and acceptance, whether
it comes from a large social group, such as clubs, office culture, religious groups,
professional organizations, sports teams, gangs, or small social connections (family
members, intimate partners, mentors, close colleagues, confidants). People need to love
and be loved (sexually and non-sexually) by others. In the absence of these elements, many
people become susceptible to loneliness, social anxiety, and clinical depression.
Adaptation Theory
Interdependence Mode: The close relationships of people and their purpose, structure
and development individually and in groups and the adaptation potential of these groups.
This is the Mode of Adaptation, Mang A. failed to undergone. He was not able to adapt on
those highly stressful situations which caused his mental disorder.
Page | 43
In relation with the client’s life, he had experienced stressful work situation (separation
from his family) and failure in love relationship. Failure of the client to adapt with those life
experiences, made a traumatic impact on him, which resulted Mr. A.M. to have a decrease
coping ability and low self esteem manifesting sadness, hopelessness, stressed, problem in
concentration and worthlessness.
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Imbalance Neurotransmitter
Altered levels of
dopamine and serotonin
Affects the brain

processes
Lose ability to think/ Uncontrolled emotional

perceive rationally response
Uncontrolled experience Lose control movement

of pleasure and pain
Paranoia
Delusions Hallucinations
Page | 45
A Neurotransmitter imbalance—either too much or too little—of these
neurotransmitters is thought to generate psychiatric conditions such as anxiety, depression,
ADHD and other emotional disorders.
Dopamine. Regulation of dopamine plays a crucial role in our mental and physical
health. It moves into the frontal lobe and regulates the flow of information coming in from
other areas of the brain. A shortage or problem with the flow of dopamine can cause a
person to lose the ability to think rationally, demonstrated in schizophrenia. Also, an excess
of dopamine in the limbic system and not enough in the cortex may produce a suspicious
personality and possible paranoia.
Serotonin is key to our feelings of happiness and very important for our emotions
because it helps defend against both anxiety and depression. It has many different effects in
the human mind and body; it helps to regulate mood, sleep cycles, appetite, memory, and
some muscular functions. Deficiencies in serotonin availability have been linked to
depression, anxiety, irregular appetite, aggression and pain sensation. You may have a
shortage of serotonin if you have a sad depressed mood, anxiety, panic attacks, low energy,
migraines, sleeping problems, obsession or compulsions, feel tense and irritable, crave
sweets, and have a reduced interest in sex.
Our client with imbalances in the neurotransmitters dopamine and serotonin, has an
altered brain processes which lead him to have lose ability to think/perceive rationally
(delusions & hallucinations), uncontrolled experience of pleasure and pain, lose control
movement & uncontrolled emotional response (paranoia). Dopamine is responsible for his
thinking skills while serotonin is more on his moods/feelings. Either increase or decrease in
these neurotransmitters affect the client’s cognitive skills and emotional responses.
Page | 46
Page | 47
Genetic Factor
Insufficient production of serotonin transporter protein

(Gene necessary for production of serotonin)
Insufficient serotonin to help and modulate dopamine
Continuous increase in dopamine

(excitatory)
Alteration in cognition, motivation, emotional response and

complex movements
Page | 48
It show the complex interactions that occur between mood disorder related genes
and their impact on mood disorder related brain circuitry. The study makes it clear that
individual genes have to be viewed in a context, both a genetic and an environmental
context.
Genetic Factor
Most genetic studies have focused on immediate families (i.e. parents, siblings,
offspring) to examine whether schizophrenia is genetically transmitted or inherited. Few
have focused on more distant relatives. The most important studies have centered on
twins; these findings have demonstrated that identical twins have a 50% risk for
schizophrenia; that is, if one twin has schizophrenia, the other has a 50% chance of
developing it as well. Fraternal twins have only a 15% risk (Kirkpatrick & Tek, 2005). This
finding indicates that schizophrenia is at least partially inherited.
Other important studies have shown that children with one biologic parent with
schizophrenia have a 15% risk; the risk rises to 35% if both biologic parents have
schizophrenia. Children adopted at birth into a family with no history of schizophrenia but
whose biologic parents have a history of schizophrenia still reflect the genetic risk of their
biologic parents. All these studies have indicated a genetic risk or tendency for
schizophrenia, but genetics cannot be the only factor: identical twins have only 50% risk
even though their genes are 100% identical (Riley & Kendler, 2005).
In relation with client’s family history, as claimed, his sibling and his uncle are also
having mental disorders. Beside of neurotransmitter imbalances, head trauma, stressful life
situations and substance abuse that are present with the client, studies show that genetics
is one of the major factors that may contribute in having paranoid schizophrenia.
Page | 49
Head Trauma
Part of the brain is

affected
Leads to traumatic brain

injury
Neuropsychological
problems
Poor concentration Personality changes Aggressive behaviors
Page | 50
Head trauma survivors may experience a range of neuropsychological problems
following a traumatic brain injury. Depending on the part of the brain affected and the
severity of the injury, the result on any one individual can vary greatly. Personality changes,
memory and judgement deficits, lack of impulse control, and poor concentration are all
common. Behavioral changes can be stressful for families and caregivers who must learn to
adapt their communication techniques, established relationships, and expectations of what
the impaired person can or cannot do. In some cases extended cognitive and behavioral
rehabilitation in a residential or outpatient setting will be necessary to regain certain skills. A
neuropsychologist also may be helpful in assessing cognitive deficits. However, over the
long term both the survivor and any involved family members will need to explore what
combination of strategies work best to improve the functional and behavioral skills of the
impaired individual.
Personality changes are often an exaggeration of the person's pre-injury personality
in which personality traits become intensified. Head trauma survivors may experience short-
term problems and/or amnesia related to certain periods of time. After a head trauma a
person may lack emotional responses such as smiling, laughing, crying, anger, or enthusiasm
or their responses may be inappropriate. This may be especially present during the earlier
stages of recovery. In some cases, neurological damage after a head trauma may cause
emotional volatility (intense mood swings or extreme reactions to everyday situations). Try
to change the person’s mood by agreeing with the person (if appropriate) and thus avoiding
an argument. Show extra affection and support to address underlying frustrations. The
person who has survived a head injury may lack empathy. That is, some head trauma
survivors have difficulty seeing things through someone else's eyes. The result can be
Page | 51
thoughtless or hurtful remarks or unreasonable, demanding requests. This behavior stems
from a lack of abstract thinking. Head trauma survivors should be encouraged to develop
self-checks. Lack of awareness deficits is relatively common for a head injury survivor to be
unaware of his/her deficits. Remember that this is a part of the neurological damage and
not just obstinacies. After a head trauma, a person may experience either increased or
decreased interest in sex. The causes could be a result of brain regulation of hormonal
activity or an emotional response to the trauma.
In relation with the client, after being figured in a mining accident, part of his brain
was affected & had a traumatic brain injury which made him show the following
neuropsychological problems: poor concentration, personality changes and aggressive
behaviors.
Page | 52
UNIT III
B) RELATED LITERATURE
Page | 53
According to Healthy Place (2007), in the paranoid form of this disorder, the sufferer
develops delusions of persecution or personal grandeur. The first signs of paranoid
schizophrenia usually surface between the ages of 15 and 34. There is no cure, but the
paranoid schizophrenia can be controlled with antipsychotic medications. Severe attacks
may require hospitalization. The essential feature of Paranoid Schizophrenia is
preoccupation with one or more systematized delusions or with frequent auditory
hallucinations related to a single theme. In addition, symptoms characteristic of the
Disorganized and Catatonic Types such as incoherence, flat or grossly inappropriate affect,
catatonic behavior, or grossly disorganized behavior, are absent. When all exacerbations of
the disorder meet the criteria for Paranoid Type, the clinician should specify "Stable Type".
Associated features of Paranoid Schizophrenia include unfocussed anxiety, anger,
argumentativeness, and violence. Often a stilted, formal quality or extreme intensity in
interpersonal interaction is noted. The impairment in functioning in Paranoid Schizophrenia
may be minimal if the delusional material is not acted upon. Onset tends to be later in life
than the other types, and the distinguishing characteristics may be more stable over time.
Some evidence suggests that the prognosis for the Paranoid Type, particularly with regard
to occupational functioning and capacity for independent living, may be considerably better
than for other types of schizophrenia.
The abovementioned study provided the information about the paranoid
schizophrenia and its manifestation regarding about the mental illness itself. It also gives us
information about essential feature that one person my experience if he/ she is candidate in
having this kind of mental illness.
Page | 54
We highly agree on what Healthy Place mentioned or written about paranoid
schizophrenia that the range of age or the onset of this mental illness is 15 - 34 years old,
because our client manifest or the manifestation of mental illness is between the ages given
by the writers.
Since our client manifest the same manifestation written above, there is no reason
to disagree the literature given by the Healthy Place.
As a student nurse the greatest implication of this information, is that we can expand
our knowledge about the situation of our client, it can also help us in assessing the client
about the sign and symptoms of the mental illness.
Page | 55
Moreover, Thomas Hodge (2010) said that, paranoid schizophrenics tend to show a
history of increasing suspicions and a severe difficulty with interpersonal relationships.
Eventually, their thoughts are overwhelmed by absurd and illogical ideas and beliefs. These
illogical ideas are not simplistic in nature. Due the workings of the schizophrenic mind,
these conceptions are often highly elaborate in nature. The fears and irrational beliefs
contain more depth than the most elaborate suspense novel. They are highly organized with
depth, twists, and turns that develop a complex framework. Usually the schizophrenic is
being persecuted, chased, or in danger in this delusions. When a writer develops a fictional
story, he knows it is just a story. The schizophrenic does not know that his work of fiction is
fiction. He believes it. Delusions of grandeur are also common. Some may claim to be a
princess or a king or some great person. They usually invent imaginary characters in their
stories which they will carry on conversations with. With paranoid schizophrenics, an
amazing fact exists. Quite often, they are well put together. In their delusions, they are
being persecuted usually which will cause them to go to great lengths to hide their
delusions. Sometimes this makes them seem quite normal. The good news for a paranoid
schizophrenic is that treatments are always improving. Some schizophrenics have actually
accomplished quite a bit once they realized their condition. Some have actually managed to
control their delusions by sheer will.
The study mentioned on the writings of Thomas Hodge is that the ability to think in
this kind of mental illness is more negative point of view, also those people who suffer in
this kind of mental illness has more suspicious and has weak interpersonal relationship to
others. He also added that paranoid schizophrenia and its treatment are always improving.
Page | 56
We agree in the part that the treatment for paranoid schizophrenia is still improving
although the illness itself has no cure. We also agree in part of writings that those client
suffer in this condition don’t know what is the difference between the reality and fantasy.
The greatest implication of the writing of Thomas Hodge in nursing profession is that
there is still a palliative treatment even though the hard fact is there is no treatment. It can
also give us information that this kind of mental illness, they have weak interpersonal
relationship to others and they are often suffering in delusions.
Page | 57
According to P Jones et.al. (2010), although a genetic component in schizophrenia is
well established, it is likely that the contribution of genetic factors is not constant for all
cases. Several recent studies have found that the relatives of female or early onset
schizophrenic patients have an increased risk of schizophrenia, compared to relatives of
male or late onset cases. These hypotheses are tested in the current study.
The study mentioned above states that the genetic factor or through genes it can
transfer the paranoid schizophrenia and the other types of schizophrenia. That if there is
one of the family has schizophrenia more or less the other family members has a tendency
to have the same mental illness.
We agree on what P. Jones and her colleagues written because according to client
her uncle and his younger brother have the same mental illness he suffered. Therefore we
concluded that in runs through the blood of there family in having schizophrenia.
One its greatest implication on nursing profession is that through genes the mental
illness like schizophrenia can transfer. With the proper study it can help the nursing
profession to understand how the genetic factor of one person can transfer the mental
illness to other family members
Page | 58
Mayo Clinic staffs (2010) also mentioned that with paranoid schizophrenia, your
ability to think and function in daily life may be better than with other types of
schizophrenia. You may not have as many problems with memory, concentration or dulled
emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many
complications, including suicidal behavior. But with effective treatment, you can manage the
symptoms of paranoid schizophrenia and work toward leading a happier, healthier life.
The study abovementioned by Mayo Clinic Staffs states that without proper
treatment the paranoid schizophrenia will lead to more serious complication like attempting
to have suicide. It also stated that having this kind of mental illness your ability to thing is
slower and you will suffer in poor concentration to many things.
We agreed on what Mayo Clinic Staffs said about, that of all kinds of schizophrenia,
the paranoid is the most manageable one. They also stated the same symptoms manifested
by the client like having hallucinations and an attempt on suicide. With proper and effective
treatment, paranoid schizophrenic patients still have the great chance to have a normal life
they had before.
The implication of this writings to the nursing profession and to student nurses it can
help us to understand that those client suffer in this kind of condition is that they have poor
coping mechanism. It can also help us in terms of giving more attention and time in helping
the client to cope to external environment.
Page | 59
Furthermore, Nursing Crib (2008)they identify the symptoms of schizophrenia are
categorized into two major categories, the positive or hard symptoms which include
delusion, hallucinations, and grossly disorganized thinking, speech, and behavior,
and negative or soft symptoms as flat affect, lack of volition, and social withdrawal or
discomfort. Medication treatment can control the positive symptoms but frequently the
negative symptoms persist after positive symptoms have abated. The persistence of these
negative symptoms over time presents a major barrier to recovery and improved the
functioning of client’s daily life.
The studies gathered above provided information to increment the knowledge of the
readers about schizophrenia and its basic concept about the mental illness itself. This
research abovementioned tells the vital role of knowing the manifestations and treatment
that may use in client suffering this kind of condition.
We highly agree that there is two major categories that schizophrenic client may
experience because our client also suffer in the same kind of categories given. It also makes
us convince that this article is agreeable because the medication taking by our client only
treat the positive or hard symptoms.
The implication of this article to nursing profession is that we can understand what
are the classifications of schizophrenia and what are manifestation they shown. It also gives
information about the effect of medication and how it helps the schizophrenic client.
Page | 60
SOURCES:
HealthyPlace.com Staff Writer. Paranoid Schizophrenia.

http://www.healthyplace.com/thought-disorders/main/paranoid-schizophrenia/menu-id-
1147/. March 28, 2007.
Thomas Hodge. Socy Berty. Paranoid Schizophrenia.
http://socyberty.com/psychology/paranoid-schizophrenia/. November 20, 2010.
Peter Jones (et.al.). Schizophrenia related to good health. Irish Health Magazines.
November 29, 20010
Mayo Clinic. Paranoid Schizophrenia. November 28, 2010
Nursingcrib.com. Studies about Schizophrenia. September 11, 2008.
http://nursingcrib.com/studies_about_shizophrenia
Page | 61
UNIT IV
A) NURSING CARE PLAN
Page | 62
ORIENTATION PHASE DAY 3
NOVEMBER 10, 2010
2:00 P.M. – 4:00 P.M.
MMW TENNIS COURT
I. OBJECTIVES:
a. Client-Centered Objective:
 Setting the contract and discussing it thoroughly.
 Obtain personal data.
 Obtain some history from the past.
b. Nurse-Centered Objective:
 Introduced ourselves to the patient.
 Establish rapport
 Remember and interpret verbal and non-verbal cues correctly.
II. DESCRIPTION OF SETTING
a. Describe the environment:
It was a cloudy afternoon, the sun does not shining directly and the wind
blows softly when we received Mr. A.M. from the male ward B, under the
supervision of our Clinical Instructor, Mrs. Nemia Calimbas. First, we assisted the
client in grooming his self. Afterwards, we walked with him and went to the tennis
court. There we prepared our chairs approximately 3-4 feet away in front away from
him. We started the conversation by greeting Mr. A.M. a pleasant afternoon and
introducing ourselves. We discussed the contract to him thoroughly, that he showed
interest on the days we will be together. The client started to give information when
we asked him about his personal data. As the conversation continues, we felt that
Mr. A.M. was comfortable talking to us. And as a positive result, we didn’t find it
hard having a good conversation with our client.
Page | 63
b. Describe the nature, behavior, affect and mood of the client.
Mr. A.M. walking towards to us from his ward looks at ease, quiet and slightly
serious. He smiled and nodded on us when he was introduced to us by Mrs.
Calimbas. When we went to the grooming area, he saw other clients playing
chess. He said that he wanted to play chess, too.
The client fixed himself a very few assistance from us. He showed
independence on grooming his self.
While we are walking on our way to the tennis court, we noticed that our
client is relaxed and calmed. Our conversation started with him listening
attentively. Mr. A.M. answered our questions appropriately. He also displayed
the right affect on the situations we’d talked about.
The client showed trust on us by sharing a lot of essential information
regarding his past and his experiences before he was admitted. The conversation
flows smooth and substantial because Mr. A.M. talked with us freely. He trusted
us so then, he’s comfortable in sharing his story.
Mr. A.M. said that he only shared those issues of his life only to us, he didn’t
told those stories to the student nurses of the morning shift.
All throughout the time that he’s with us, we felt like Mr. A.M. had already
recovered from his disorder and it looked like we are talking to an individual with
good mental status.
Page | 64
III. PROCESS RECORDING
Therapeutic Communication Analysis and Interpretation

Nurse-Client Conversation
Technique Used based on Theories
SN: Magandang hapon po GIVING RECOGNITION Greeting the client shows

Mang A.M. that the nurse recognizes the
client as a person, as an
C: Magandang hapon din. individual and at the same
time, the student nurses
(while walking on the way to were able to give respect to
the tennis court) the client.
SN: Mang A.M. ako po si Riza

at siya naman po si Joey,
kami po ang mga student GIVING INFORMATION Includes giving the client
nurses niyo ngayong hapon. right information on the
Galling po kami sa BPSU, things needed during the
Bataan Peninsuala State interaction therapy. It helps
University po, sa Balanga. in establishing a trusting
Isang buwan po tayong relationship with the client.
magkakasama, mula lunes Information given by the
po hanggang miyerkules. student nurses also sets the
Ngaung lingo po tsaka sa contract of the whole nurse-
susunod na lingo, twing patient interaction. By this
hapon po tayo magkikita, means, the client was able to
bandang alas doa po ng understand when and where
hapon hanggang alas kwatro the interactions will happen.
po. Pero sa susunod pang
dalawang lingo, pag umaga
na po tayo, mga alas-9 po ng
umaga hanggang alas-11 po.
Malinaw po ba?
C: Ah, nagyong linggo saka sa

susunod na linggo pang-
hapon tayo, tas sa susunod
pang 2 linggong session natin
umaga na?
SN: Opo Mang A.M. Ganun

na nga po.
C: Kanina kasama ko yung

Nickson, kilala nyu sya?
Page | 65
SN: Opo, magka-batch po
kami sa BPSU.
(at the tennis court)
SN: Mang A.M., andito po OFFERING SELF

kami para
makipagkwentuhan sainyo, It implies that the nurse
para po makausap niyo. offers presence, interest, and
desire to understand. The
client feels more
comfortable having a
conversation on a nurse who
shows interest on what
he/she’s saying. Offering self
to the client also facilitates
collaboration in performing
tasks.
C: Oo nga eh, naiinip ako,
lagi lang akong natutulog sa
ward.
SN: Maari po ba naming

malaman ang inyong
pangalan?
C: Ako si Mang A.M.
SN: Ilang taon na po kayo?
C: 41 na ako. Apat na taon

na ko dito.
SN: Ganun po ba? San po ba ACCEPTING

kayo nakatira bago po kayo
mapunta dito? An accepting response
indicates the nurse has
heard, understood and is
willing to listen on what the
client wants to share. It
makes conversation effective
and meaningful. The student
C: Taga Capaz, Tarlac ako nurse was able to make Mr.
pero laki ako sa Benguet. A.M. to verbalize other
information needed to
SN: Alam niyo pub a kung understand his condition.
saan kayo ipinanganak?
Page | 66
C: Oo. Sa Isabela.
SN: OH kelan naman po ang

birthday nyo?
C: Ah, January 21, 1969
SN: Mang A.M. ano po ba

ang relihiyin ninyo?
C: Roman Catholic, pero

dapat Jehovah’s Witnesses
na ako. Hindi lang ako
nabaptize kasi nga dinala ako
dito.
SN: ah, katoliko po kayo dati CONSENSUAL VALIDATION

tapos po lilipat dapat kayo sa
saksi ni Jehovah, ganun po For verbal communication to
ba? Tama po ba ang intindi be meaningful, it is essential
ko? that the words being used
have the same meaning for
both participants. Validating
what was heard and
understood must be clear for
both student nurses and the
C: Oo, ganun na nga, kaso client. Such, is to make the
hindi ako natuloy. conversation meaningful,
and to avoid
SN: Naaalala niyo pub a kung misunderstandings or wrong
nasaan kayo nung 1995? information taken. At this
way, the client was able to
C: 1995? Hindi na gaano. validate or not the
Nasa benguet pa ata ako information understood by
noon. Oo nasa Benguet pa the student nurses.
nga ako.
SN: Nasa Benguet po kayu CLARIFYING

nung 1995?
Helps the client clarify their
own thoughts and maximizes
mutual understanding
between the nurse and the
C: Oo. client.
Page | 67
SN: Sino naman po ang
kasama niyo doon?
C: Eh di pamilya ko. Sila

Tatay at Nanay, saka dalawa
kung kapatid. May nobya
nga ako noon eh.
SN: Ano pong pangalan ng ASKING DIRECT QUESTIONS

tatay at nanay niyo?
Asking direct questions to
C: Tatay ko si RM, tas nanay the client will merely assess
ko si LM. the client’s capability to
think, rationalize, and give
SN: eh ung mga kapatid niyo answers to a specific
po? question. It also helps getting
important information
C: Si Gm ung sumunod sakin specific to support student
tas si SM ung bunso. nurses ‘assessment. The
client responded with
SN: ah, ilan taon nap o sila? answers specific and
appropriate with the
C: si GM 37 na siguro yon, question asked to him.
tas si SM 21 na.
SN: bale po apat na taon ang CONSENSUAL VALIDATION

tanda ninyo ka GM?
For verbal communication to
be meaningful, it is essential
that the words being used
what was heard and
client. Such is to make the
conversation meaningful,
and to avoid
misunderstandings or wrong
information taken.
At this way, the client was
able to validate or not the
information understood by
C: Oo. the student nurses.
Page | 68
SN: Ano po bang natapos ASKING DIRECT QUESTIONS
niyo?
Asking direct questions to
the client will merely assess
the client’s capability to
C: 3rd year high school lang answers to a specific
eh. NAgtrabaho kasi ako question. The client
agad. Nainggit ako sa responded with answers
kanilang nagtatrabaho. specific and appropriate with
the question asked to him. It
also helps getting important
information specific to
support student nurses
SN: Sa anong dahilan po at EXPLORING ‘assessment.
naiinggit kayo?
Exploring can help them to
examine the topic more fully.
Any problem or concern can
be better understood if
explored in depth. The
student nurse was able to
seek for the client’s real
reason in doing such thing by
C: Tinatamad na akong mag- asking him deeply.
aral eh. Tsaka para
makatulong nadin siguro.
SN: Ano po ba ang trabaho

ninyo?
C: Helper ako noon sa Philex

Mine, Utility Man kasi doon
ang tatay ko.
SN: Ah ok po. Kailan po kayo

nalipat sa Tarlac?
C: 35 yata ako noon,

dalawang taon po kami doon
bago ko nadala dito.
Page | 69
SN: Kung 35 na po kayo CONSENSUAL VALIDATION For verbal communication to
noon, 2004 na po noon, be meaningful, it is essential
ganun po ba? that the words being used
what was heard and
client. Such is to make the
conversation meaningful,
and to avoid
misunderstandings or wrong
information taken. At this
C: Oo, gusto ko ng umuwi. way, the client was able to
Naiinip na ko dito. validate or not the
Matutulungan niyo ba ko? information understood by
the student nurses.
SN: Sa ano pong dahilan

bakit gusto niyo ng umuwi?
EXPLORING Exploring can help them to
examine the topic more fully.
C: Gusto ko nang Makita nag explored in depth. The
nobya ko. Namimiss ko na student nurse was able to
siya! seek for the client’s real
reason in doing such thing by
asking him deeply.
SN: Nais niyo na pong
makauwi para makasama VERBALIZING THE IMPLIED Putting into words what the
niyo na ang nobya niyo? client has implied or said
indirectly tends to make the
discussion less obscure. The
nurse should be as direct as
possible without being
unfeelingly blunt or obtuse.
The client may have difficulty
in communicating directly.
Verbalizing the implied
makes the conversation
clearer and easier for the
client to understand the
thoughts he’s talking about.
Page | 70
C: Oo, matagal na kasi
kaming hindi nagkikita.
SN: Kailan po kayo huling

nagkita?
C: Matagal na eh. Hindi nga

ako nakapagpaalam sakanya
bago ako lumipat ng Tarlac
eh.
SN: Ah ganun po ba? Ang ENCOURAGING A To understand the client, the

tagal na nga pu pala. DESCRIPTION OF nurse must see things from
Kamusta naman po ang huli PERCEPTIONS his or her perspectives.
ninyong pagkikita? Encouraging the client to
Mailalarawan niyo po ba? describe ideas fully may
relieve the tension the client
is feeling and he or she might
be less likely to take actions
on ideas that are harmful or
frightening. This also
provided the way Mr. A.M.
views that certain situation
in his life.
(silence for about 3minutes) SILENCE Silence often encourages the

client to verbalize, provided
that it is interested and
expectant. Silence gives the
client time to organize
thoughts, direct the topic of
interaction, or focus on
issues that are most
important.
C: Ayos naman kami nun.

May karibal nga ako sakanya
eh. Pero mahal na mahal ko
siya kaya malaki tiwala ko
sakanya, saka alm kong ako
din ang mahal niya.
Page | 71
SN: Sige po tuloy niyo pa po. OFFERING GENERAL LEADS General leads indicate that
the nurse is listening and
following what the client is
saying without taking away
the initiative for the
interaction. By this way, the
client felt freely to continue
sharing his story with the
student nurses without
hesitancy.
C: dati nga nagpupunta ako

sakanila, nagkakasabay pa
kami nung karibal ko.
SN: Anu pung naramdaman GIVING BROAD OPENINGS Broad openings make explicit
niyo nung nagkita kayo? that the client has the lead in
the interaction. For the
client who is hesitant about
talking, broad openings
stimulate him or her to take
the initiative. By this way,
Mr. A.M. was able to express
C: Uhhhm. Wala naman, kasi himself freely and within the
tiwala naman ako sa nobya basis of his own thinking.
ko. Ako naman ang mahal
niya.
SN: Gaano na pu ba kayo

katagal?
C: Simula nung 3rd year high

school ako, Kame na.
SN: hanggang ngaun po?
C: Oo kami pa din.
SN: Mang A.M. alam niyo pu

ba kung nasaan kayo?
C: Oo. Sa Mariveles Mental

Ward
Page | 72
SN: Mariveles Mental
Hospital na po ito ngayon.
Alam niyo pu ba kung para
saan ang lugar na ito?
C: Oo, para sa may mga

diperensya sa pag-iisip.
SN: Ah, mabuti naman po REFLECTING Reflections encourage the

pala at naiintindihan ninyo. client to recognize and
Sa tingin niyo po ba nu ang accept his or her own
dahilan at nadala kayo dito? feelings. The nurse indicates
that the client’s point of view
has value, and that the client
has the right to have options,
make decisions and think
independently. It also helped
the client to distinguish right
from wrong.
C: Binaklas ko kasi ung rice
cooker at radio ng
kapitbahay naming kaya
nadala ko dito.
SN: Binaklas po ninyo ang

rice cooker at radio ng
kapitbahay ninyo? EXPLORING Exploring can help them to
Sa anung dahilan pu kaya examine the topic more fully.
Mang A.M.? Any problem or concern can
explored in depth.
C: Addict kasi ako nun eh.
Nung nasa labas ako
gumagamit ako ng
Marijuana.
Reflections encourage the
SN: Natuto po kayong mag- REFLECTING client to recognize and
Marijuana? Sa tingin niyo pu accept his or her own
ba mubuti ito? feelings. The nurse indicates
has value, and that the client
independently. It also helped
from wrong.
Page | 73
C: Hindi, kasi sa barkada eh,
Peer Pressure ba.
SN: Ano po ang pakiramdam ENCOURAGING A

ng gumagamit noon? DESCRIPTION To understand the client, the
Makilarawan nga po. nurse must see things from
his or her perspectives.
Encouraging the client to
describe ideas fully may
relieve the tension the client
is feeling and he or she might
C: Heaven. Para kong lutang. on ideas that are harmful or
frightening. This also
provided the way Mr. A.M.
views that certain situation
in his life.
SN: Alam po ba ito ng nobya ASKING DIRECT QUESTION
niyo? Asking direct questions to
the client will merely assess
C: Oo. Ka-jamming ko pa answers to a specific
nga kuya niya eh. question.
SN: Kasama niyo po sa CLARIFYING

paggamit ng Marijuana ang Helps the client clarify their
kuya niya? own thoughts and maximizes
mutual understanding
between the nurse and the
client.
Ano po ang reaksyon nya FOCUSING
dito? The nurse encourages the
client to concentrate his or
her energies on a single
point, which may prevent a
multitude of factors or
problems from
overwhelming the client. It
also a useful technique in
avoiding flight of ideas of the
C: Oo, ayun nalungkot siya client.
para sa akin.
Page | 74
SN: Hindi pu ba kayo REFLECTING Reflections encourage the
nalungkot nung nalaman client to recognize and
niyong nalungkot siya para accept his or her own
sa inyo? feelings. The nurse indicates
C: Nalungkot din, pero wala has value, and that the client
na akong magawa kasi adik has the right to have options,
na ako noon, tsaka tanggap make decisions and think
niya parin ako. independently. . It also
helped the client to
SN: Alam po ba niyang distinguish right from wrong.
nandirito kayo?
C: Hindi.
SN: Ano na po kaya kayo GIVING BROAD OPENINGS Broad openings make explicit
paglabas niyo dito? that the client has the lead in
C: magpapakasal kami. client who is hesitant about
Magbabago na talaga ko. talking, broad openings
Mahal na mahal ko siya. stimulate him or her to take
the initiative.
SN: Kumbaga po Mang A.M. SEEKING VALIDATIONS For verbal communication to

siya lang po ang naging be meaningful, it is essential
nobya nito simula nung high that the words being used
school palang kayo at kayo have the same meaning for
padin bago kayo ma-admit both participants.
dito? Tama po ba ang Sometimes words, phrases,
pagkakaintindi ko? or slang terms have different
meanings and can be easily
C: Oo. Ganun na nga kaya misunderstood. At this way,
gusto ko na makauwe. the client was able to
validate or not the
SN: Eh paano sila Nanay at a information understood by
Tatay nito? Ung pamilya the student nurses.
mo?
C: Nobya ko muna. Si tatay

ko kasi nagkaroon ng sama
ng loob sa akin.
Exploring can help them to
SN: May sama po sya ng loob EXPLORING examine the topic more fully.
sa inyo? Sa anu pong Any problem or concern can
dahilan? be better understood if
explored in depth.
Page | 75
C: Nasaksak ko kasi siya ng
pako noon.
SN: Nasaksak niyo po ang

tatay nio? Sa anu pong
dahilan at nagawa ninyo ito?
C: Eh high ako noon,

nadaplisan ko lang siya sa
tagiliran.
SN: Kailan po nangyari ito?
C: Hindi ko na matandaan
eh.
Putting events in proper
SN: Anu pong nauna, nag ENCOURAGE TO PLACE sequence helps both the
pagsaksak nyo sa tatay niyo EVENTS IN TIME OR nurse and the client to see
o ang pag-baklas niyo ng rice SEQUENCE them in perspective. The
cooker? client may gain insight into
cause-and –effect behavior
C: ah, nauna ung kay tatay, and consequences, or the
mga dalawang taon siguro client may be able to see
nung nagawa ko ung kay that perhaps something are
tatay. not related. The nurse may
gain information about
SN: Ah ganon po ba. Ilan recurrent patterns or themes
taon po ba kayo nung na- in the client’s behavior or
admit kayo dito? relationship.
C: September 18, 2006 yun

e, 37 na ako noon, apat na
taon na kasi dito.
Helps the client clarify their
SN: So Mang A.M. 37 na po CLARIFYING own thoughts and maximizes
kayo nung nadala ditto dahil mutual understanding
sa pagbaklas niyo ng rice between the nurse and the
cooker at radio? client.
C: Oo.
SN: Tapos 35 na po kayo SEEKING VALIDATION For verbal communication to

nung nasaksak niyo ang tatay be meaningful, it is essential
nyo, tama po ba ang that the words being used
pagkaintindi ko? have the same meaning for
both participants.
Sometimes words, phrases,
Page | 76
or slang terms have different
misunderstood. At this way,
the client was able to
C: Oo ganun na nga. Ang validate or not the
tagal niay na nga akung di information understood by
nadadalaw eh. the student nurses.
SN: Kelan po ang huli?
C: Noong July 4 last year.
SN: Ano po ang nasabi na BROAD OPENINGS Broad openings make explicit
sainyo? Maaari po bang that the client has the lead in
malaman? the interaction. For the
C: ayon sabi nya dito muna talking, broad openings
ko. Magpagaling daw ako. stimulate him or her to take
Susunduin daw niya ko agad the initiative.
paggaling ko.
SN: Sige po tuloy niyo pa po. OFFERING GENERAL LEADS General leads indicate that
C: Nagconduction na nga ako following what the client is
nung July lang. July 29, sabi saying without taking away
sakin ng diktor ok na daw the initiative for the
ako. Maghintay nalang daw interaction. They also
ako. encourage the client to
continue if he or she is
SN: Ang tagal na po pala hesitant or uncomfortable
kayong hindi nadadalaw. about the topic.
C: Oo nga eh. Mahigit isang

taon na.
Reflections encourage the
SN: Nagtatampo po ba kayo REFLECTING client to recognize and
sakanila kasi hindi nila kayo accept his or her own
napupuntahan? feelings. The nurse indicates
C: hindi naman, baka nag- has value, and that the client
iipon pa ng pamasahe. Sa has the right to have options,
December, sa pasko baka make decisions and think
mapuntahan na niya ko. independently. It also helped
from wrong.
Page | 77
SN: Mabuti naman pu pala
kung ganon.
C: Kaya nga gusto ko na

umuwe para magkasama na
kame ng nobya ko saka nila
tatay at nanay pati mga
kapatid ko.
SN: Darating din po yung

panahon na iyon. Basta po
magpagaling kayo ditto sabi
nga ng tatay niyo. Mang
A.M. magmimiryenda na po
kayo. Ako po ulit si Riza at
sya po si Joey. Wag niu po
kami kakalimutan hah?
C: Oo. Salamat Riza at Joey.
(after group dynamics)
SN: Oh Mang A.M. nabusog

po ba kayo? Masarap po ba?
C: Oo salamat.
Summarizing seeks to bring
SN: Naaalala niu pu ba pinag- SUMMARIZING out the important points of
usapan natin kanina? the discussion and to
increase the awareness and
C: Oo yung buhay ko. understanding of both
participants. It omits the
SN: Buti naman po at irrelevant and organizes the
naaalala niyo pa. Yaan niyo pertinent aspects of the
po sa atin lang tatlo yun. interaction. It allows both
Hindi malalaman ng iba. client and the nurse to
depart with the same ideas
C: Sige salamat. Sa inyo ko and provides a sense of
lang sinabi iyon. Kala closure at a completion of
Nickson hindi. each discussion.
Page | 78
ACCEPTING An accepting response
indicates the nurse has
heard, understood and is
SN: Salamat po sa tiwala
ninyo. Sa lunes na po tayo
client’s want to share. It
magkikita. Ganitong oras
parin po.
and meaningful. The student
nurse was able to make Mr.
C: Sige hintayin ko kayo.
A.M. to verbalize other
Salamat. Ingat.
information needed to
understand his condition.
SN: Opo salamat din. Kayo
din po.
Page | 79
IV. THEME IDENTIFICATION
Content Theme
The conversation took for more than 1hour. Much information are shared by
Mr. A.M. . But we noticed that our client’s focus was on his first girlfriend. He stated
that he wanted to go home to see her girlfriend before his family. Mr. A.M. also told
us that he wanted to marry his girlfriend. As each issue opens the client always
included his girlfriend. He loves her so much, up to the point that the woman was
always on his mind until now.
Interaction Theme
Mr. A.M. answered our questions appropriately. He also displayed correct
affect on what we are talking about. The client knows and remembered his life
before he was admitted. Mr. A.M. also knew the exact dates when the important
events of his life occurred. He talked about lots of stories and experiences he had
before. So our first conversation with him came out very substantial.
Mood Theme
The client appeared calmed and smiling when we received him from the
ward. When our conversation started, he showed interest and cooperation on us.
Mr. A.M. answered our questions appropriately. He also showed direct eye contact.
The client shared his stories on us freely. We felt that he’s comfortable with us while
he’s sharing important issues in his life.
V. NURSING DIAGNOSIS
Risk for Loneliness r/t separation from loved ones and boredom as evidenced
by verbalization of feelings and dull affect
Page | 80
VI. NURSING INTERVENTION
Establish rapport to the client to gain trust and cooperation. Offer one self.
Orient to future activity. And maintain eye contact when talking to client to show
sincerity and interest.
VII. SUMMARY AND EVALUATION
Our conversation with Mr. A.M. was taken at the tennis court. It took for
more or less than 1 hour. The client showed interest and cooperation on us. So we
have discussed the contract thoroughly and obtain personal data and some past
history. We also introduced ourselves to him and established rapport easily. He’s
also appropriate in his affect and answered our questions directly. Mr. A.M. shared
stories about addiction, his love for his girlfriend and the issue that he picked his
father with a nail. The client remembered all the things that he’d talked about with
us. Mr. A.M. showed trust on us and made our conversation useful.
VIII. REFERENCE
 Psychiatric mental health nursing. 3rd edition. Shiela L. Videbeck. Lippincott Williams
and Wilkins
 Nurse’s Pocket Guide.10th edition. Doenges, Moorhouse and Murr
Page | 81
WORKING PHASE DAY 4
COMIC READING AND PHOTO LANGUAGE THERAPY
NOVEMBER 15, 2010
2:00 P.M. – 4:00 P.M.
MMW TENNIS COURT
I. OBJECTIVES:
 Continue/improve the rapport that has been established on the first day
of our interaction.
 Enhance cognitive skills by encouraging the client to participate actively in
the therapeutic activities.
 Help the client to express his self through the therapies that will be done.
 Provide appropriate mental health care and utilize various therapeutic
communications techniques
 Implement plan of actions (therapies) that will help the client in achieving
mental health.
 Interpret client’s communication cues and make appropriate nursing
diagnosis.
Page | 82
The weather that afternoon was cloudy and the wind blew softly, when we
received Mr. A.M. from the male ward B. Afterwards we went to the tennis court in
where we will be doing the comic reading and photo language therapy. Before
proceeding to the planned activities we had first a short conversation with the client.
We asked him if he still remember us, and how he’s doing. The client luckily
remembered us and answered the questions appropriately.
Mr. A.M. smiled, showed happiness and excitement upon seeing us. He
doesn’t wait instruction from us that he must groomed first. The client showed
initiative in performing personal hygiene. When we started talking to him, we
felt like he’s more comfortable with us now. Mr. A.M. doesn’t hesitate
answering our questions directly. His behavior is also good, without showing any
violence or manifestations of having mental disorder.
Page | 83

SN: Magandang hapon po
Mang A.M.
C: Magandang hapon din.

SN: Naaalala nyo pa po ba
kami?
C:Oo.ikaw si Riza,tas si Joey.
SN: Opo.Kamusta na po ACCEPTING Indicates that the nurse has

kayo? heard, understood and is
C: Ayos naman ganun pa din. client’s want to share. It
SN: Tara po Mang AM. makes conversation effective
maghilamos na po kayo. and meaningful.
(after grooming, at the

tennis court)
SN: Mang AM. Meron po GIVING INFORMATION It is stated in Kings theory of

tayong mga activities na goal attainment (1960), that
gagawin ngayon comic if a nurse with special
reading pos tsaka photo knowledge and skill to
language magbabasa po communicate the
kayo ng komiks.Alam niyo po appropriate information to
ba kung ano ang komiks? the client, mutual goal
setting and goal attainment
C: Oo, dati binabasa ko yung will occur.
hiwaga.
SN: Ah ganun po ba? CLARIFYING Verifying your impressions

may help the client become
pagkatapos po sa comic more aware of their feelings.
reading, mamimili po kayo
ng larawan. Ipapaliwanag
iyon ng facilitator
mamaya.Naiintindahan niyo
po ba?
C: Oo.
Page | 84
(COMIC READING THERAPY)
SN: Mang AM. eto po yung SUGGESTING Emphasizes working with the
komiks na babasahin nyo. COLLABORATION client, not doing with the
Makakaya nyo po bang mag- client. Encourages the view
isa?kung hindi po that change is possible
matutulungan namin kayo. through collaboration.
C: Nababasa ko ng malinaw.
(AFTER READING)
SN: O Mang AM, ano po ang

pamagat ng komiks?
C: Yung Gilmer.
SN: Ah, yung Gigimik ba si

Gilmer po?
C: Oo yun.
SN: Ano po ba ang naaalala

nyo sa kwento?
C: Si Gilmer nag-aaral sa
Maynila. Tapos inaaya syang
lumbas ng mga kaibigan
niya. Buti nakininig sya sa
mga magulang niya.
SN: Ah opo. Ano po bang EXPLORING According to Abdellah, one

natutunan ninyo sa inyong step in identifying the client’s
nabasa? problem is to continue
observing and evaluation the
C: Ah wala namang client to identify attitude and
masamang makipagkaibigan cues affecting his behavior.
basta tama ang ginagawa.
SN:Uhm. Ano pa po? OFFERING GENERAL LEADS General leads indicate that
C: Ah dapat sundin ang mga following what the client is
payo ng magulang. saying without taking away
the initiative for the
SN: Meron pa po ba? interaction. They also
encourage the client to
C: Sakin dapat alam ang continue if he or she is
Page | 85
Tama sa Mali. hesitant or uncomfortable
about the topic.
SN: Opo ganun na nga po.
May parte po ban g kwento
na nahahawig sa buhay nyo?
C: Oo.
SN: Alin po doon? GIVING BROAD OPENINGS Broad openings make explicit
Maikkwento nyo po ba? that the client has the lead in
C: Yun nga, dati kasi marami client who is hesitant about
akong barkada. Natuto talking, broad openings
akong magbisyo Drugs, stimulate him or her to take
Marijuana. the initiative.
SN: Sa tingin nyo po ba Tama REFLECTING A client’s statement is

iyon? redirected towards him
through similar wording
C: Mali. which makes him think about
it again from another
SN: Sa paanong paraan po perspective.
naging Mali? -Directs questions or feelings
back to client so that they
C: Kasi dapat kahit na may may be recognized and
barkada ka, wag sasama sa accepted.
masama.
SN: Kayo po ba ay
napasama?
C: Oo.
SN: Sa anong dahilan at

sumama kayo sa kanila?
C: Eh kasi peer pressure na

eh. Mahirap tanggihan.
SN: Ano po ba para sainyo ENCOURAGING A To understand the client, the

ang peer pressure? DESCRIPTION nurse must see things from
Pakilarawan po! his or her perspectives.
C: Peer pressure. Yung yung describe ideas fully may
kung ano ang gusto ng relieve the tension the client
barkada mo gagawin mo din. is feeling and he or she might
Page | 86
frightening.
SN: Ano po ang dahilan at EXPLORING According to Abdellah, one

gagawin nyo din? step in identifying the client’s
problem is to continue
C: Syempre para di ka observing and evaluation the
maiwan tsaka makantyawan. client to identify attitude and
cues affecting his behavior.
SN: Sumusunod po kayo sa
barkada niyo kasi ayaw niyo
po mapag-iwanan?
C: Oo ganun na nga.
SN: Ano pong sabi sainyo ng FOCUSING The nurse encourages the
mga magulang ninyo? client to concentrate his or
her energies on a single
C: Pinayuhan nila ako. point, which may prevent a
SN: Sinunod nyo po ba sila? problems from
C: Hindi eh, na peer pressure also a useful technique when
nya kasi ako. a client jumps from one topic
to another.
SN: Ano po ba ang ENCOURAGING A Help the client clarify

pakiramdam nyo kapag COMPARISON similarities and differences.
barkada nyo o pamilya nyo
kasama ninyo?
C: Kapag barkada kasi

Masaya kaya lang ganun ang
trip nila.
SN: Eh sa pamilya nyo po?
C: Masaya naman kaso kasi

binata pa ko noon kaya
nabarkada talaga ako.
SN: Noong nabasa nyo po FOCUSING The nurse encourages the

ang kwento. Ano pong client to concentrate his or
naramdaman niyo? her energies on a single
point, which may prevent a
Page | 87
C: Nalungkot. multitude of factors or
problems from
also a useful technique when
a client jumps from one topic
to another.
SN: Ano po ang dahilan? GIVING BROAD OPENINGS Broad openings make explicit
that the client has the lead in
C: Kasi Gilmer sinunod nya the interaction. For the
ang magulang nya ako hindi. client who is hesitant about
the initiative.
SN: Tapos po? OFFERING GENERAL LEADS General leads indicate that
C: Ayon napabayaan ko sarili following what the client is
ko nalulong ako sa droga. saying without taking away
Nadala ako dito. the initiative for the
interaction. They also
encourage the client to
continue if he or she is
hesitant or uncomfortable
about the topic.
SN: Uhm, Mang AM naalala SUMMARIZING It is stated by Orlando

nyo po ba lahat ng napag- (1980), that individuals have
usapan natin? their own subjective
perceptions and feeling that
C: Oo yung tungkol kay may not be observed
Gilmer tsaka kahawig sa directly. Therefore, it is
buhay ko. important to set the client
know their perception are
accepted and heard to
encourage verbalization of
thoughts.
-Reviewing the main points
of discussion will help the
client remember what was
discussed and its
significance.
Page | 88
(PHOTO LANGUAGE)
SN: Mang AM pipili kayo ng 2 CONSENSUAL VALIDATION For verbal communication to

larawan na pinakagusto nyo be meaningful, it is essential
po? Naiintindahan niyo po that the words being used
ba ang sinabi ng facilitator have the same meaning for
kanina? both participants.
C: Oo. or slang terms have different
SN: Sige po kuha na po kayo. misunderstood.
(AFTER CHOOSING)
SN: O Mang AM, ano po ang

napili nyo?
C: Yung gitara tsaka yung

bahay.
SN: Ano pong pinagkaiba ng ENCOURAGING Help the client clarify

gitara tsaka bahay? COMPARISON similarities and differences.
C: Yung gitara tinutugtog,

yung bahay tinitirhan.
SN: Ano pong dahilan at eto EXPLORING According to Abdellah, one

ang napili nyo? step in identifying the client’s
C: Napili ko ang gitara kasi observing and evaluation the
dati mahilig akong tumugtog client to identify attitude and
kasama kaibigan ko. cues affecting his behavior.
SN: Eh yung bahay po?
C: Para kapag nagkaasawa at

anak ako may titirhan kami.
SN: Ah, ano po ba ang ASKING DIRECT QUESTIONS Asking direct questions to
naalala nyo sa gitara? the client will merely assess
C: Dati nag-gigitara ko,lagi think, rationalize, and give
jamming ang tropa. Gumawa answers to a specific
pa nga ko ng kanta. Pinadala question.
Ko kay Britney Spears.
Page | 89
SN: Nagpadala po kayo ng CONSENSUAL VALIDATION For verbal communication to
komposisyon kay Britney be meaningful, it is essential
Spears? that the words being used
C: Oo apat na kanta yun. both participants.
misunderstood.
SN: Sino po ba si Britney ENCOURAGING A To understand the client, the

Spears sa inyo? DESCRIPTION nurse must see things from
Makilarawan po. his or her perspectives.
C: Alam ko Amerika yun. Siya describe ideas fully may
kumanta ng toxic tsaka yung relieve the tension the client
Im not a girl, not yet a is feeling and he or she might
woman. Kilala mo sya? be less likely to take actions
SN: Ah opo, medyo naririnig frightening.
ko sya. Sa bahay po ano ang
naalala niyo?
C: Pamilya ko sila Nanay,

Tatay.
SN: Ano po ang naalala nyo

sa kanila?
C: Dati namamasyal kami

ganun.
SN: Kanina po pinili nyo ang CONSENSUAL VALIDATION For verbal communication to
bahay para may tirhan ang be meaningful, it is essential
magiging asawa at mga anak that the words being used
niyo po? Sino po ang gusto have the same meaning for
ninyong maging asawa? both participants.
C: Yung nobya ko si J.E. or slang terms have different
SN: Siya po ba ang misunderstood.
naikwento po saamin di po
ba?
Page | 90
C: Oo sya yun mahal na
mahal ko sya.
SN: Mang AM, sabi nyo po CONSENSUAL VALIDATION For verbal communication to
samin dati Highshool palang be meaningful, it is essential
kayo hanggang sa malipat that the words being used
kayo sa Tarlac ay kayo na. have the same meaning for
Ang tagal na po noon nasa both participants.
20 taon na. Sometimes words, phrases,
C: Oo ang tagal na naming meanings and can be easily
hindi na kasi ako nanligaw ng misunderstood.
iba pa.
SN: Paglabas nyo po dito sa REFLECTING A client’s statement is

tingin nyo po kayo pa din? redirected towards him
C: Ewan ko, kaya balak ko which makes him think about
talaga puntahan sya para it again from another
makausap. perspective.
-Directs questions or feelings
back to client so that they
may be recognized and
accepted.
SN: Ano po ang FOCUSING The nurse encourages the

mararamdaman nyo kung client to concentrate his or
paglabas nyo may asawa na her energies on a single
sya? point, which may prevent a
C: Malulungkot ako. problems from
Tatangapin ko na lang. overwhelming the client. It
to another.
SN: Kung mangyari man po ENCOURAGING PLAN OF Allows the client to identify
yung ano pong plano nyo? ACTION alternative actions for
interpersonal situations. The
C: Siguro tatanggapin ko client finds disturbing (when
nalang maghahanap ng anger or anxiety is
trabaho marami pa namang provoked).
babae, hindi lang sya
makakahanap din ako.
Page | 91
SN: Mabuti kung ganon.
Mang AM, naalala nyo po ba
yung ginawa at napag-
usapan natin sa photo
language?
C: Oo.
SN: Anu-ano po yun?
C: Pinapili ninyo ako ng

litrato. Gitara tsaka Bahay
kinuha ko. Tapos naalala ko
yung barkada ko, nobya ko
tsaka pamilya ko.
SN: Ah, mabuti naman po at ACCEPTING An accepting response

naaalala niyo po lahat. Mag indicates the nurse has
meryenda na po kayo Mang heard, understood and is
A.M. maupo na po kayo willing to listen on what the
doon. client’s want to share. It
and meaningful.
Page | 92
Content Theme
COMIC READING
The reading we prepared for Mr. AM is entitled “ Gigimik ba si Gilmer?”. After
reading the comic, we asked him to tell & interpret the story to us again. The client
perceived the right thought implied by the story. Mr.AM related himself to the story
by means of remembering those times that he was on a peer pressure and did not
mind to follow his parent’s advice for him. The client realized that the thing had
done before are wrong. He also started if he had only followed his parents, maybe
his life during his adulthood will be on the right way. Lastly, Mr. AM said that a man
must choose his friends; must follow his parents & must distinguished the right from
wrong.
PHOTO LANGUAGE
Mr.AM chooses the picture of the great house & a guitar. When he asked, he
chose the guitar because it could play it, & he has the ability in composing the songs.
The client also shared that he was always play guitar with his friend before. While his
reason in choosing the picture oh house is that, his ready when he will have his own
family. His for his wife 7 children has to be.
Interaction Theme
The client told the stories of his life not in sequence. But, when we asked him
about the dates of these events, he still remembers what happen first before the
other. The only things needed is we must ask him in a more understanding &
comprehensible way. All the matter he had to talk about is with sense & important in
knowing the life he had before his admission.
Page | 93
Mood Theme
We noticed that the client was in a good mood. He displayed the right affect
on different situations Mr.AM also participated actively in the therapies done.
Anxiety r/t unsteady relationship to opposite sex as evidenced by hesistant
behavior when discussing the topic and NPI
“SN: Paglabas nyo po dito sa tingin nyo po kayo pa din?
C: Ewan ko, kaya balak ko talaga puntahan sya para makausap.
SN: Ano po ang mararamdaman nyo kung paglabas nyo may asawa na sya?
C: Malulungkot ako. Tatangapin ko na lang.”
Listen actively to client. Encourage verbalization of feelings. Respect client.
Accept client as is. Focus on the client’s verbalization. Provide light and
comfortable athmosphere during conversation. Acknowledge anxiety.
The activities we have done this afternoon were comics reading & photo
language. During the comic therapy, he was able to read understand the story well
Mr.AM got the moral lesson of the story w/c is to follow your parents & to choose
your peers. While on the photo language, he chose the picture of a guitar to
remember the times he played his own guitar & his friends before; & the picture of
the house in w/c he dreamed to have that house for his family. Through the
therapies done, was too able to express himself & his life before. The therapies are
done successfully & the help of Mr. AM Summary & evaluation active participation.
Page | 94
VIII. REFERENCE
and Wilkins
Page | 95
WORKING PHASE DAY 5
PUZZLE AND PLAY THERAPY
NOVEMBER 16, 2010
2:00 P.M. – 4:00 P.M.
BPSU STUDENT CENTER AND MMW TENNIS COURT
I. OBJECTIVES:
 Continue/improve the rapport that has been established on the previous
days of interaction.
 Enhance cognitive skills by encouraging the client to participate actively in
the therapeutic act.
 Observe verbal/non-verbal communication ones during interaction that
may help in interpreting & evaluating the case of patient.
 Provide appropriate mental health care & utilize various therapeutic
communication techniques.
 Implement the plans of actions (therapies) that will help the client in
achieving mental health.
 Formulate appropriate msg. diagnosis based on cognitive skills & behavior
of the client during therapies.
Page | 96
It was a cloudy afternoon, the sun not shining directly & the rain just passed
by when received Mr. A.M from the male ward. We first want to the grooming
area w/ assistant his self; we walked together from the male ward to the BPSU
student center. There were set the tables & chair conducive to the puzzle
therapy. Only the patients could seat & the student nurse are on their sides. Two
tables were placed apart each & 3 patients. We started the puzzle therapy first
by orienting our clients & giving them the instructions on how they will do the
puzzle. Simple do complex puzzles were prepared by each student nurse. After
having the puzzle therapy, we discussed & have short evaluation of it with our
client.
Play Therapy
This play was done in the tennis court after having the puzzle therapy. Each
pair of student nurses prepared an indoor & outdoor game. Mr. A.M wanted to
play chess so we chose it for him in the indoor game, while for the outdoor game
the group agreed to play the ball for all our clients. First, we formed a big circle &
played the ball by passing & catching e the client/student nurse, and those who
would not be able to catch the ball will be out. Mr. A.M participated actively in
the game while preparing the board; Mr. A.M was so excited arranging the
officials of the chess he won in the chess for 3 rounds. Mr A.M. showed
enjoyment in doing the play therapy.
Page | 97
From the time we received Mr. A.M., we noticed that he’s in good mood. He
smiled on us when he saw us coming to him.
During the puzzle therapy, Mr. A.M. showed interest in the activity by
listening attentively to the facilitator. He was able to differentiate the simple puzzle
from the complex one. The client did the puzzle seriously. He was able to do the
simple puzzle by his self, but in the complex puzzle we assisted him.
While on having the play therapy, Mr. A.M. was so excited upon hearing that
we will play chess and the ball game. He really wanted to play chess. The client
behaved accordingly when he did not win in the ball game. He said that it’s alright.
While on the chess, he’s so happy that he won, but not up to the point that he
boasted it.
All throughout the therapies done, the client displayed right affect, was in
good mood and behaved properly.
Page | 98

SN: Magandang hapon po GIVING RECOGNITION
Mang A.M !
C: Magandang hapon din. According to Peplau (1952), a

nurse is stranger to the
SN: Kamusta kayo? patient, it is therefore
important to remind the
C: Ok naman nakatulog ako. client who we are and be
Nakapag-almusal din ng consistent with the
maayos. information we are giving to
them to gain their trust.
SN: Tara po doon, GIVING INFORMATION
maghilamos muna po kayo.
(After grooming, at the BPSU

student center.)
SN: Mang A.M,ang gagawin

po natin ngayon ay puzzle at
maglalaro po tayo
pagkatapos.
C: Ah sige. Meron bang

chess?
SN: Opo Mang A.M
(PUZZLE THERAPY)
(@nurse client interaction)
SN: Mang A.M,ano po yung ASKING DIRECT QUESTIONS

nagustuhan nyong puzzle?
C: Yung spongebob kasi Included in the 10 carative

makonti lang medaling factor of Jean Watson is the
buuin. cultivation of sensitivity to
one’s self and to others.
Asking the said question will
measure the client’s memory
retention level.
Page | 99
SN: Ah ganun po ba, ano po REFLECTING
o sino po ang naaalala nyo
nung binubuo nyo ang
puzzle?
C: Yung pamilya ko. A client’s statement is

redirected towards him
which makes him think about
it again from another
perspective.
SN: Ano po yung dahilan EXPLORING
bakit pamilya ninyo ang
inyong naalala?
According to Abdellah, one
C: Kasi nga parang puzzle, step in identifying the client’s
hiwa hiwalay kami ng problem is to continue
pamilya ko. observing and evaluation the
client to identify attitude and
SN: Ano po yung cues affecting his behavior.
nararamdaman ninyo
habang binubuo po ninyo
ang puzzle?
C: Nalungkot kasi nga naalala

ko yung pamilya ko.
SN:Eh yung nabuo ninyo na

po ang puzzle ano po ang
naramdaman ninyo?
C: Masaya kasi iniisip ko na

tulad ng puzzle mabubuo rin
yung pamilya ko.
SN: Ah ganun po ba? Ayos po SUMMARIZING

yun. Eh Mang A.M, naalala -It is stated by Orlando
po ba ninyo ano ang pinag – (1980), that individuals have
uusapan natin? their own subjective
perceptions and feeling that
C: Oo. Yung tungkol sa puzzle may not be observed
na naihambing sa pamilya directly. Therefore, it is
ko. important to set the client
know their perception are
SN: Sige po Mang A.M., accepted and heard to
susunod na po maglalaro na encourage verbalization of
tayo. thoughts.
Page | 100
(PLAY THERAPY)
SN: Mang A.M. maglalaro na

po tayo ng pasahang bola.
Dapat po masalu nyo para
hindi kayo mataya.Galingan
niyo po ah.
C: Sige.
(The outdoor game last for

more than 10 mins.)
SN: Oo Mang A.M.,

maglalaro na po tayo ng
hiniling nyong laro samin.
C: Chess?
SN:Oo po Mang A.M.,tara po

maglaro na po tayo.
(The client wins over Riza

with the score of 3-0)
SN: Ang galing-galing nyo GIVING RECOGNITION

naman po Mang A.M.
Masaya po ba kayo?
C: Oo, pinasaya niyo ko. Ang -According to Peplau (1952),

tagal ko na kasing hindi a nurse is stranger to the
nakakapaglaro ng chess. patient, it is therefore
SN: Ah ganun po ba? client who we are and be
Maraming Salamat po consistent with the
Walang anuman po. information we are giving to
C: Salamat din.
SN: Tara po kain na po kayo.

Malapit na po kasing mag-4
babalik na po kayo sa ward.
C: Sige
(Then, the client went back

to ward)
Page | 101
Content Theme
PUZZLE
Mr.A.M. started to form the pieces of the puzzle on the side of the frame.
He found the simple puzzle easier then the complex because there is a fewer
number of pieces in the simple puzzle. The client stated that be remembered his
family while performing the puzzle. He wanted his family to become completely
again. This is one of his goals when he will be discharged in the ward. He also
remembered the typhoon that passed on the hospital when he is forming the
puzzle of the huge tree. Mr.AM. said that many trees full down during the
typhoon.
PLAY
The client focused on the chess. He remembered the times he joined the
tournament on their school in the board games. Mr.A.M. said that he missed so
much playing the chess. He also remembered his friends when we are playing it.
Interaction Theme
Mr.A.M. followed the instructions of the puzzle & play correctly. He was able
to compare in contrast the simple & complex puzzle. The client reflected to the
puzzle therapy by thinking of the way on how he could make his family completely
again. He answered are question about the issue appropriately. While we are on
playing the chess, he remembered his days when his joining contest on chess. He
said that he placed as a 1st runner-up during his times in their school. All throughout
the interaction his oriented, in sequence & makes sense on the things had talking
about.
Page | 102
Mood Theme
Mr.A.M. appeared exciting upon seeing is when he discussed the activities for
the day, he appeared so interested. During the 2 therapies done, he participated
actively & behaved accordingly the client also practiced sportsmanship during the
ball game, when didn’t win Mr.A.M. also displayed appropriate affect during the
interaction.
Anxiety r/t conflicated family relationship as evidenced by restlessness during
conversation, poor eye contact when discussing the topic and NPI,
“SN: Ah ganun po ba, ano po o sino po ang naaalala nyo nung binubuo nyo
ang puzzle?
C: Yung pamilya ko.
SN: Ano po yung dahilan bakit pamilya ninyo ang inyong naalala?
C: Kasi nga parang puzzle, hiwa hiwalay kami ng pamilya ko.”
Stay with and listen to the client. Encourage client to acknowledge and express
feelings. Focus on client’s verbalization. Maintain eye contact to show interest
and sincerity. Maintain an ideal therapeutic environvent during the conversation.
Determine client’s use of coping skills and defense mechanisms. Speak in brief
statements using simple words.
Page | 103
The therapies done that afternoon are puzzle & play. During the puzzle
therapy, the client was able to differentiate the simple from complex puzzle. He
found the simple puzzle easier to form their complex due to fewer members of the
puzzle pieces. Mr.A.M. remembered his family on the typhoon passed on the
hospital after forming the puzzle. Write on the play therapy, he enjoyed the ball
game a lot. It is our first time to saw Mr.A.M. that happy. He also has fun playing
chess. The client said that he missed playing chess so much. He remembered the
times he joined the chess tournament in their school.
At the end of our interaction, the client thanked us for giving him enjoyment
& time to talk. Mr.A.M. looked like he has no disorder & acted normally & good
behavior, affect & sense on what his saying.
VIII. REFERENCE
and Wilkins
Page | 104
WORKING PHASE DAY 7
BIBLIO THERAPY
NOVEMBER 22, 2010
9:00 A.M. – 11:00 A.M.
BPSU STUDENT CENTER AND MMW TENNIS COURT
I. OBJECTIVES:
 Enhance cognitive skills by encouraging the client to participate in the
therapeutic activities.
 Provide some reflection to client’s life by allowing then to verbalize the
things they remember during the therapy.
 The patients analyze and learn the moral lesson of the story.
 Facilitate the activities for that day accordingly.
 Offer oneself himself while the client reflects his life on the story &
verbalizes his feelings & understanding towards the situation.
 Have a through behavioral & mental status assessment during the
intervention.
It was a sunny morning, & the wind blew softly that could make us sleepy.
After the biblio therapy, we sat under the acacia tree to have some
interpretation about the activity. Our chairs are place approximately 3-4 ft away
in front of the client. There the client verbalized that his uncle cut his head off &
put a diamond inside of it when he was 6 y/o. and the reason for doing this, as
the client said is to make him intelligent.
Page | 105
The client wears his uniform but not that clean, when we saw him coming out
from the male ward B. We went to the grooming area in order for him to groom
his self. He smiled on us and asked if how we are doing. The client is in good
mood during the therapy. He listened and participated actively during the
interaction.

SN: Magandang umaga po. GIVING RECOGNITION -According to Peplau (1952),
a nurse is stranger to the
C: Magandang umaga din. patient, it is therefore
SN: Oh Mang A.M. naalala client who we are and be
niyo consistent with the
pa po ba kame? information we are giving to
C: Oo si Riza at si Joey.
SN: Opo mang A.M. May GIVING INFORMATION -It is stated in Kings theory of
gagawin po tayo mamaya. goal attainment (1960), that
Manonood po kayo ng if a nurse with special
maikling kwento mula sa knowledge and skill to
bibliya. Tawag po doon communicate the
Bibliotheraphy. appropriate information to
the client, mutual goal setting
(BIBLIOTHERAPHY) and goal attainment will
occur.
SN: Oh, Mang A.M. maaari ASKING DIRECT QUESTION
nio po bang ikwento sa min -Included in the 10 carative
kung ano po naalala ninyo sa factor of Jean Watson is the
kwento? cultivation of sensitivity to
one’s self and to others.
Asking the said question will
measure the client’s memory
retention level.
C: Si Noe binalaan siya ng
Dyos na may malaking baha
na darating kya sinabi nito
na gumawa siya ng arko pero
Page | 106
yung ibang tao hindi
naniwala sa kanya kaya nung
dumating na ang malaking
baha,ung mga taong hindi
naniniwala sa Diyos ay
nangalunod sila.
ASKING DIRECT QUESTIONS
SN: Opo Mang A.M., ano
naman po ang aral na - Asking questions about the
natutunan ninyo sa kwento? therapy will assess client’s
ability in terms of memory
including his immediate
C: Ung dapat sumunod at recall.
makinig sa Diyos.
SN: Opo Mang A.M. kasi po

wala naman po gagawing
hindi mabuti ang Diyos.
Nananalig po ba kayo sa
kanya?
C: Oo. Nagdarasal naman

ako tsaka humihingi ng
patawad sa Diyos. REFLECTING
SN: Opo, Mang A.M.

maganda po iyon. Mang -A client’s statement is
A.M. habang pinapanood po redirected towards him
ninyo yung maikling kwento, through similar wording
ano po o sino ang naaalala which makes him think about
ninyo? it again from another
perspective.
C: Ung lolo ko. Siya kasi yun -Directs questions or feelings
gumawa ng bahay namin eh. back to client so that they
may be recognized and
SN: Ah, ganun po ba Mang accepted.
A.M., balik po tayo sa ating
usapan, sino po para sa inyo
ang Diyos?
C: Ang Diyos,siya ang

magliligtas sa atin sa
anumang kapahamakan.
SN: Mang A.M., ano nga pop

ala ang relihiyon ninyo?
Page | 107
C: Jehovah Witness. Pero
hindi pa ko baptized.
SN: Ah, ganun po ba Mang

A.M.,
C: Oo, yung tiyuhin ko nga

nilagyan nya ako ng brilyante
sa ulo nun eh.
CLARIFYING
SN: Brilyante po? - Verifying your impressions
may help the client become
more aware of their feelings.
EXPLORING
SN: Eh, papanu naman po -According to Abdellah, one
iyon nilagay sa ulo ninyo? step in identifying the client’s
C: Oo, pinutol nila yun leeg observing and evaluation the
ko tapos binalik nila ulit. client to identify attitude and
cues affecting his behavior.
PRESENTING THE REALITY

SN: Mang A.M. hindi po ba - clarifying misconceptions
pag pinutol ang leeg naten that client may be expressing
ay mamamatay tayo?
C: Hindi kasi may orasyon

naman yon.
SN: Ganun po ba. Kasi po

Mang A.M. wala din namang
bakat ng tahi sa leeg ninyo
kaya po imposible ang
sinasabi ninyo.
(After Group Dynamics)
Page | 108
SN: Oh, Mang A.M., kumain
na po kayo at magpahinga.
C: Oo sige.
(After eating)
SN: Naaalala nyo pa po ba SUMMARIZING -It is stated by Orlando

ang napag usapan natin? (1980), that individuals have
their own subjective
C: Oo, ung tungkol sa kwento perceptions and feeling that
na mula sa bibliya na may not be observed directly.
pinamagatang “Si Noe at ang Therefore, it is important to
Dakilang Baha” , tapos ung set the client know their
aral na nakuha ko sa kwento. perception are accepted and
heard to encourage
SN: Opo., mabuti naman po verbalization of thoughts.
at naaalala ninyo. -Reviewing the main points of
discussion will help the client
remember what was
discussed and its significance.
Page | 109
Content Theme
The focus of our conversation after the biblio therapy was on Mr. A.M.’s
childhood experiences with his uncle and the diamond on his about to inherit. The
client told us that his head was cut-off and a diamond was put inside in his head
when he was 6 y/o. It is intended to make him intelligent and it was done by his own
uncle. He said that his spirit separated from his body, in that way he saw how his
head was cut-off. Mr. A.M. also remembered his grandfather in the part of the story
when Noe build the ark, because his grandfather was also the one who repaired
their house in Baguio.
Interaction Theme
During our interaction with the client after the therapy, he is not logical or in
sequence when he is telling us the story of the diamond on his head. He also did not
have concrete answer. The client changes his answer to a question when it is
repeated. His affect was also not that good, it is blunted.
Mood Theme
Mr. A.M was in good mood from the moment we received him from the ward
up to the time we brought him back there. His behavior was the same with our
previous interaction. The only thing changed is affect and his answers are not that
appropriate to the question we asked. Fortunately, the client participated actively in
the therapy.
Page | 110
Disturbed thought processes r/t psychological disorder as evidenced by non-reality
based thinking.
Maintain a pleasant quiet environment & approach in a slow, calm manner. Give
simple direction, using shorts words & simple sentences. Listen with regards.
Present reality concisely and briefly. Do not challenge illogical thinking. Allow more
time for client to respond to question or comments. Clarify things to client especially
when they are in doubt of it.
The biblio therapy was successfully done that morning. Our client was
oriented & instructed clearly. Mr. A.M. watched and listened on the story
attentively. Afterwards, we evaluated our client’s understanding about the therapy.
He was able to recall the story and recognized the moral lesson for it. Mr. A.M. also
verbalized another story of his life, the diamond on his head. This started him to be
illogical in what he’s saying. His answers are inappropriate and he said things that
are impossible.
VIII. REFERENCE
and Wilkins
WORKING PHASE DAY 8

EXPRESSIVE ART AND SONG THERAPY
Page | 111
NOVEMBER 23, 2010
9:00 A.M. – 11:00 A.M.
BPSU STUDENT CENTER
I. OBJECTIVES:
 Let the client imagine and create his own art.
 Provide one on one interaction to the client to verbalize the thing he
remembered.
 Enhance imagination skills & cognitive skills.
 Facilitate the activity of the day accordingly.
 Offers one’s self while the client reflects his life on the art he did.
 Have a thorough behavioral & mental status assessment during the
intervention.
It was a sunny morning and the wind blow softly. We sat under the Camachile
Tree beside the BPSU student center for our Expressive Arts Therapy. The clients
are seated as a group when they are making their art during the interaction.
Mr.A.M. verbalized that there was something bothering him last night. He was
bothering me last night.
Page | 112
The client wears is uniform & not the clean. We groomed him first at the
grooming area. He smiled at us and asked what will do that day. The client is to
good mood & behaved good during the therapy. He participated actively during
the interaction. But after the Expressive Arts Therapy he was serious and
nervous.
Page | 113
SN: Magandang umaga po GIVING RECOGNITION Provides appreciation on the
Mang A.M. good thing that the client
did. Helps the client to keep
C: Magandang Umaga din. on doing good things, which
enhances his behavior. Our
SN: Naaalala nyo pa po ba client responds properly on
kami? the greetings by his student
nurse.
C: Oo ikaw si Riza at si Joey.
Sn: Tama po. Oh tara po

maghilamos at magsepilyo
muna po kayo.
(In Front Of BPSU Student

Center)
SN: Oh Mang AM kamusta

naman po kayo?
C: Ayos naman. Ano bang

gagawin gayon?
SN: Mang AM, ang una po

nating gagawin ay expressive
at therapy. Ipapaliwanag poi
yon ng facilitator natin.
(After Facilitating..)
SN: Oh Mang AM
naiintindhan po ba ninyo ang
gagawin?
C: Expressive Art
SN: Opo. Bibigyan po naming GIVING INFORMATION Give the information only
kayo ng mga palito ng needed for the client to
posporo, glue, bond paper. enhance understanding. This
Ididikit po ninyo ang mga facilitates clear information
palito ng posporo sa to perceive by the client. As
bondpaper. Kayo na po the therapy goes along our
Page | 114
bahala kung ano po ang client has a good thinking
gusto ninyong design ng art motivation in doing the
nyo. Kung ano po ang nasa activity for this day. He has
isip nyo, yun po ang gawin lots of ideas in doing the
ninyo. Malinaw po ba? activity for today.
C: Oo.
SN: Sige po simulan nyo na. OFFERING SELF To facilitate cooperation in

kung kailangan nyo po ng activities and makes feel the
maliit na piraso ng posporo client not alone; also
sabihin nyo lamang po at provides collaboration in
ipapagupit naman kayo nito. performing activities. We’ve
noticed that Mr. A.M has
C: Sige. eagerness in starting and
performing the therapy for
today.
(After during the art)
SN: Mang A.M. ano po ang GIVING BROAD OPENINGS The nurse must practice to
ginagawa nyo? give broad openings in order
makipagliwanag po. to make the interaction
effective and substantial. In
C: Eto yung bahay tapos may this way, the client will be
puno, mountain at sun rays. the one to prolong the
conversation. After therapy
SN: Ano po ang naaalala nyo we noticed that Mr. A. M. in
dito? term of interpreting the
finish product he has a still
C: Yung bahay naming sa recall or remembers his
Capaz Tarlac. family.
SN: Uhm tapos po? OFFERING GENERAL LEADS The nurse must facilitate the
continuation of their
conversation. It makes the
client feel that the nurse is
interested and willing to
listen on his story. Mr. A. M
was answered appropriate to
C: May puno kami ng the question asked.
kamatsile sa tabi, tapos may
bahay naming ginawa yan
nila tatay at lolo ko.
Page | 115
SN: Sinu-sino po kayo sa ASKING DIRECT QUESTIONS The nurse asking direct
bahay nyo? questions, gains specific
answers. It makes the client
C: Tatlo kami sila to answer the questions
Nanay,Tatay at ako. appropriately. He answers
straight to the point and
looks sincere.
SN: Eh Mang A.M ito po yung EXPLORING It facilitates deeper

sun rays ano po ang ibig conversation particularly on
sabihin nito sa inyo? the stories that are very
important for the client. In
C: Pag-asa. Kasi pag nakikita this way, the nurse gets
ko ang sikat ng araw more information about the
nagkakaroon ako ng pag-asa. client. He answered very
significantly and interprets
the picture with all his
knowing.
SN: Pag-asa saan po? FOCUSING The nurse encourages the

client to concentrate on his
C: Makapag bagong buhay, or her energies on a single
habang may buhay may pag- point, which may prevent a
asa. multitude of factors or
problems from
SN: Ano po yung overwhelming the client. It
nararamdaman ninyo also a useful technique when
habang ginagawa ito? a client jumps from one topic
to another. When we start to
C: Masaya. analyze his emotion towards
the therapy done we’ve
SN: Sa ano pong dahilan? noticed that he has still full
of hope that he and his
family will reunite again but
the facial expression he
shown was not appropriate.
C: Kasi naalala ko yung
pamilya ko lang
magkakasama pa kami.
SN: Ah ganon po ba?Masaya MAKING OBSERVATIONS Indicates that the nurse is

po? Eh napansin po naming caring and concern on
na parang nakasimangot at client’s general appearance,
seryoso po kayo masyado. mood, behavior and affect.
Ano po ang dahilan? As we continue observing the
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clients reaction we noticed
C: Hindi kasi ako that he manifested some
nakakatulog. flight of ideas towards his
past and it is very significant
SN: Hindi nakatulog? Ano po to us.
ang dahilan?
C: May nag-iisip siguro sa

akin.
SN: Sino naman po kaya

Mang A.M?
C: Yung pumugot ng ulo ko

nung bata pa ako. Iniipit nya
ku eh. Tinatawag nya ko.
SN: Tinatawag po kayo Mang PRESENTING REALITY It makes the client know and
A.M.?sa paanong pong face the reality. It also
paraan? Tayong tatlo lang po makes his words to have
ang anditio. Wala nang iba sense and his understanding
pa. enhanced. By this way, the
nurse helps the client to
C: Attachment ring. Iniipit distinguish the real things
nya ko. Hindi ako mapalagay from not.
mag rereaksyon na ko. To provide clearer
information & to help the
client give assurance on what
he is saying. When we tell
the reality to the client he
still hallucinating about the
experience according to him.
SN: Ano po yung attachment INVOICING DOUBT To provide clearer

ring? Hanggang ngayon po information and to help the
ba iniipit nya kayo? client give assurance on what
he is saying. When we asked
the client about the
“attachment ring” he
answered very irrelevant
C: Inilagay na ng tyuhin ko that can make us convince
nung pinugot nya ulo ko. that his mental illness was
Hanggang ngayon tinatawag occurring.
na nya ko. Iniipit ako. Mag
la-lock-jaw na ako.
(Kinausap si Ma’am)
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SN: Ayo slang po ba kayo
Mang AM?
C: Babalik na ako sa ward.

Mag rereaksyon na ako.
SN: Bakit po gutom na kayo?

Kain muna po kayo.
C: Sige.
(On the way to ward)
SN: Ok na po ba kayo Mang SUMMARIZING Brings together all the

A.M.? naaalala nyo po ba important points discussed
ang ginawa natin? during the interaction. As we
summarized our therapy to
C: Nabusog ako, yung our client he still
pumugot ng ulo ko iniipit ako emphasizing the one who cut
eh. his head and the attachment
ring he mentioned on the
SN: Mang AM. mag pahinga previous conversation. Mr.
muna po kayo ha. Ihahatid A.M. was still need more
na po naming kayo sa ward. rehabilitation because he can
Tayong 3 lang po still remember the past
magkakasama Mang AM. traumatic experience.
wala na pong iba.
C:Naririnig ko sya sa
attachment string.
SN: Expressive art po ang

ginawa natin. Gumawa kayo
ng bahay, bundok, puno at
sunrays. Sige po magpahinga
na po kayo Mang AM.
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Content Theme
The activity for that morning is expressive arts therapy, wherein our client
was able to form a house tree & mountain sunrays through matchsticks posted on a
bond paper. Mr.AM said that he remembered his family from the art he had done.
We noticed our client is very serious & nervous, so we asked if there something
bothering him. He replied, “ Yung pumugot ng ulo ko, iniipit nya ko kagabi kaya wala
akong tulog.” And this started Mr. A.M to have blusted yet appropriate answer &
flight of ideas. As our conversation you, kept on telling that thing.
Interaction Theme
During our interaction, Mr. A.M did not play of his attention on what we are
doing. He is anxious & does have flight of ideas. The client answers are appropriate
but blunted. He does listen but c in a short period of time, he was not able to read
what we had talked about. Mr.AM was not focused on our therapy & interaction,
due to someone’s bothering him, as he claimed.
Mood Theme
The client was not that in good mood from the moment we saw him. He did
not even smile on us, but he followed our instructions. Mr.AM did his art, but at the
time we evaluated his work, he started to show behaviors that are present in our
previous days. He responded on us congruently but blunted and has fight of ideas.
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Impaired social interaction r/t altered thought processes as evidenced by
inability to communicate a satisfying sense of shared stories.
Ascertain ethnic / cultural or religious implications for the client. Observe client
while relating to family. Encourage client to verbalized feeling of discomfort
about social situations. Encourage client to verbalize problems and perceptions
of reasons for problems. Determine client’s use of coping skills and defense
mechanisms. Provide positive reinforcement for improvement in social
behaviors and interactions. Work with the client to alleviate underlying negative
self-concepts. Provide positive feedback during interactions with client.
We cannot able to summarize, because our client was attack of his disorder.
VIII. REFERENCE
and Wilkins
TERMINATION PHASE DAY 11
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GRAND SOCIALIZATION
NOVEMBER 30, 2010
9:00 A.M. – 11:00 A.M.
RUINS / BACK OF LECTURE ROOM
I. OBJECTIVES:
 Help the client cope up with our separation.
 Assist the client in reviewing all the therapies done.
 Let the patient analyze the lessons he learned throughout the interaction.
 Facilitate the activities for that day accordingly.
 Explain and terminate the contract effectively.
 Evaluate the client’s learning from the start of the interaction up to the
termination.
It was a sunny morning, & the wind blew softly when we fetched Mr. A.M.
from the ward. We started to talk about our termination in the grooming area
and we explained the activity for the day in the ruins. The program for the Grand
Socialization day took place at the back of the lecture room.
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The client wears his uniform but not that clean, when we saw him coming out
from the male ward B. He groomed his self, and we started to talk about the
termination of contract. He appeared sad when he knew that he would not see
us anymore. Despite of it, he still participated in the activities for that day. He
thanked for the times we are with him. We saw smiles on his face and we said
goodbye to each other in a nice way.
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SN: Magandang umaga po
Mang A.M. !
C: Magandang umaga din

Joey at Riza.
SN: Kamusta na po kayo? ASKING OPEN-ENDED Broad openings make explicit

QUESTIONS that the client has the lead in
C: Mabuti naman. the interaction. For the
the initiative.
SN: Mang A.M., Grand GIVING INFORMATION Includes giving the client
socialization na po natin right information on the
ngayon. Ibig sabihin po ito things needed during the
na po ung huli nating interaction therapy.
pagkikita.
C: ah ganun ba?
SN: Opo Mang A.M.. Ano FOCUSING The nurse encourages the
pong nararamdaman ninyo client to concentrate his or
ngayong hindi na tayo her energies on a single
magkikita sa mga susunod na point, which may prevent a
araw? multitude of factors or
problems from
to another.
C: Malungkot kasi aalis na According to Maslows

kayo. Saka magpapasko na, Hierarchy of needs, love and
gusto ko makasama sana belongingness involves
pamilya ko. emotionally based
relationships such as family.
People need to love and be
loved by others. Absence of
this element may cause
anxiety, loneliness and
SN: Uhm.. may magiging depression to the client. In
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student nurses din naman po relation to our client signifies
kayo pagdating ng January, lack of this need because of
iba naman po ang his condition.
maghandle sa inyo. Ano po
masasabi ninyo sa apat na ENCOURAGING EVALUATION Asking patient’s views of the
linggong nagkasama tayo? meaning or importance of
something/asking client to
C: Masaya. Ok naman kayo appraise the quality of his or
makisama sakin. her experience
SN: sa anong paraan po at

nasabi ninyong ayos kami
para sa inyo?
C:Kasi kayo nakikinig sa mga

kwento ko, ung iba hindi EXPLORING Exploring can help them to
naman ako pinapakinggan. examine the topic more fully.
SN: Ah ganun po ba ? By be better understood if
January din naman po may explored in depth.
ibang student nurses n
hahawak sa inyo, at
makakasama ninyo.
C: ah ganun ba?
SN: opo. Mang A.M. may

itatnung po kami sainyo,
kaso po medyo maselan.
C: o sige ano yun?
SN:Kailan po kayo natutong

magmasturbate?
C: Masturbate? Siguro mga ASKING DIRECT QUESTIONS Asking direct questions to

grade 6 na ako noon. the client will merely assess
answers to a specific
question. According to
Freud’s Psychosexual Theory,
an adolescence age of 12 to
18 is in genital stage which
they establishes relationship
with the opposite sex, where
they find gratifying work.
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And also he says that every
stages must be fulfilled in
order for the person to
moved forward to another
stage of development. Sexual
development happens in
each person on the same
stage, the same way but
some remain stagnant and
some are moving forward.
SN: Mang A.M. grade 6 po ? VALIDATING For verbal communication to

edi mga 12-13 y/o po kayo be meaningful, it is essential
nun ? that the words being used
C: oO. 12 y/o na ko nun. both participants.
Parte naman un ng Sometimes words, phrases,
pagbibinata ehh. or slang terms have different
misunderstood.
SN: Ah, Mang A.M. eh ano ENCOURAGING A To understand the client, the
po ang pananaw ninyo sa DESCRIPTION nurse must see things from
sex? his or her perspectives.
C: Sex? Ah, siguro ung describe ideas fully may
papamilya na din. relieve the tension the client
is feeling, and he or she
SN: Pamilya po? Ilan po ba might be less likely to take
ang gusto ninyong anak ? actions on ideas that are
harmful or frightening.
C: mga 3, 2 lalaki at isang
babae.
SN: ah.. ayos po pala.. HUMOR Harmless humor can reduce

mild to moderate anxiety,
C: para masaya, ( he laughs) gives perspective on life
events and reduces social
SN: Mang A.M. natatandaan distance.
po ba ninyo lahat ng
natutunan ninyo sa amin?
C: oo. Ung mga therapy

natin.
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SN: opo. Ung mga
natutunan po ba ninyo eh
ibabahagi po ninyo yun sa
mga kasama ninyo sa ward?
C: oo. Ang dami ku nga

natutunan sainyo eh .
SN: Tulad po ng ano Mang REFLECTING Reflections encourage the

A.M? client to recognize and
accept his or her own
C: Natuto ako makisama feelings. The nurse indicates
saka makihalubilo sa mga that the client’s point of view
tao. has value, and that the client
independently.
SN: opo. Kami din po ang ACCEPTING An accepting response

dami namin natutunan sa indicates the nurse has
inyo. Maraming Salamat po heard, understood and is
Mang A.M. willing to listen on what the
client’s want to share. It
C: Maraming salamat din. makes conversation effective
and meaningful.
SN: Tara po Mang A.M.
magsisimula na po yung
program.
(after the program)
SN: Ang galing naman ni GIVING RECOGNITION Greeting the client by name,
Mang A.M. lagi nananalo sa indicating awareness of
mga games. change, or noting efforts the
client has made all show that
C: oo nga eh ( he laughs) the nurse recognizes the
client as a person, as an
SN: Maraming salamat po individual. Such recognition
sainyo ulit ha ? does not carry the value, that
is, of being “good” or “bad”.
C: maraming salamat din.
SN: opo Mang A.M. , Paalam
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na po. Pagaling po kayo ha?
C: paalam din. Ingat kayo.
SN: Opo,. Sila nickson na po

ang maghahatid sainyo. Para
sila naman po ang
magpaalam.
C: sige.
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Content Theme
The main topic of our conversation was the termination of contract, the
therapies we have done and the lessons the client learned during the interaction.
We explained it to him well, and he responded accordingly. Becoming sad is normal,
and he did not show any abnormal behavior when we said goodbye to him.
Interaction Theme
During the times we are talking about our termination, Mr. A.M. was sad, and
it is quite normal. We reviewed all the therapies we have done, and he still
remember all of those. He also shared the lessons he learned during the times we
are together. The client participated well in the Grand Socialization Day. He joined
the games, and enjoyed the activities for that day. The interaction for our last day
went smooth and effective.
Mood Theme
Mr. A.M was in good mood from the moment we received him from the ward
up to the time he was brought back there. Although he was sad because of our
termination, he still participated actively in the Grand Socialization Day. Mr. A.M.
thanked us for listening on his stories and for those times, we are with him. He did
not show any anger or any other abnormal behavior upon saying goodbye; instead,
he smiled, thanked and waved us goodbye in a nice way. The termination of our
contract with Mr. A.M. went good.
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Risk for anxiety R/T seperation from student nurses
Be honest and terminate the relationship completely without giving false
promises. Be available to the client for talking and listening. Observe for possible
defense mechanism that might be used. Focus on how the client will accept the
end of the therapeutic relationship. Encourage client to express and
acknowledge feeling. Give patient time to analyze feelings and emotion.
The termination of the contract and the Grand Socialization Day were
successfully done. We ended our interaction with the client in a good manner. We
reviewed all the activities we have done, and the client still remembered all of those.
Mr. A.M. was able to learn some lessons from the days we are together. He
reflected well on it. The activities went smooth. The client behaved normally and
participated well in the Grand Socialization Day. Good to say, the morning ended up
in the way it should be, with the clients behaving normally, and the activities were
done successfully.
VIII. REFERENCE
and Wilkins
Page | 129
UNIT IV
B) PSYCHOPHARMACOLOGY
Page | 130
NSG.
NAME OF INDICATIO CONTRAINDI
ACTION SIDE EFFECTS RESPONSIBIL
DRUG N CATION
ITIES
Brand name: Use to help Psychotic Contraindic Extra Do not
Haldol control the disorder ated in CNS pyramidal confuse Hal
symptoms of depression or symptoms, dol with
Generic psychosis coma and in especially Medrol , a
name: and may help patient with akathisia and corticosteroi
Apo- the patient parkinsonism dystomas, ds
Haloperidol became occurs more
more frequently Watch for
Classification receptive to than with signs and
: psycho phenothiazine symptoms of
Anti therapy s parkinsonism
psychotics and tardive
Modifies Sedation dyskinesia
Dosage & thought
route: disorder, Hypothensio Avoid
5mg 1m blunted n exposing
3.4 doses affect client to
(deadend activities that
emotions require
and apathy) mental
and alertness
abnormal until drug
behavior effects are
associated realized
w/ psycho
motor and Monitor BP
mental
retardationth Report
ought muscle
disorder, weakness/sti
blunted ffness.
affect
(deadend Change
emotions position
and apathy) slowly to
and avoid sudden
abnormal drop of BP.
behavior
associated Avoid over
w/ psycho exposure to
motor and sun
mental
retardation Avoid
abrupt
Page | 131
withdrawal
of this med.
NAME OF ACTION INDICATIO CONTRAINDI SIDE EFFECTS NSG.

DRUG N CATION RESPONSIBIL
ITIES
Page | 132
Generic  High Psychotic Clients with sedation Begin the
name: incidence of disorders phenothiazine therapy with
Fluphenazin extrapyramid that tardive hydrochlorid
e HCL al symptoms schizoph sensitivity dyskinesia e before
and a low ernia may cause giving
Brand name: incidence of undue EENT – dry deconocate
Flupentixol sedation, reactions eyes blurred
anticholinerg vision
Classification ic effects,
Phenothiazin anti-emetic
e, effects and
Anti- orthostatic
psychotic hypotension
NAME OF ACTION INDICATIO CONTRAINDI SIDE EFFECTS NSG.

DRUG N CATION RESPONSIBIL
Page | 133
ITIES
Generic Has senizoph pt with sedation Do not
name: significant enia known hyper confuse
Chlorpromaz anti-emetic, sensitivity to tardive chlorpromazi
ine hypotensive, phenothizines dyskinesia ne with
HCL and sedative and related chlopropami
effect, compounds EENT – dry de (oral
Brand name: moderate pt with eyes blurred diabetic)
Morazine anticholinerg blood vision chlorothiazid
ic and dyscarias and e (thiazide
Classification extrapyramid bone marrow CV – diuretics)
Anti al effects depression hypotension
psychotic because With food
chlorpromazi GI – administer or
Dosage ne may constipation, milk to
10mg induce dry mouth prevent GI
agranucocyto upset
sis GU – urinary
retention Avoid
performing
Skin – activity that
rashes requires
mental
Blood – acconity.
agranulo
cytosis Assess for
symptoms of
possible side
effect.
Page | 134
UNIT V
PSYCHOTHERAPY
COMIC READING THERAPY
Page | 135
DEFINITION
Comic reading therapy helps the client to assess how their reading skills work in
terms of reading a comic. How they relate scripted words in their everyday life, this is used
to test how they can read comprehensively and make their mind work.
GOALS
1. To let the client understand and verbalize words.
2. To develop their comprehensive ability.
3. To promote thorough process.
4. To understand the level of ability in terms of reading.
PROCEDURES
1. The facilitator orients the client about the therapy and how it should be done.
2. The client allows reading.
3. After reading, they were asked a few questions about the content by their student
nurse.
4. All the clients were asking to state their thought regarding the therapy.
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ANALYSIS & INTERPRETATION
Once were started the therapy, we noticed that Mr. A.M has eagerness in reading.
He read the comic story entitled “Gigimik ba si Gilmer?”
During the interaction, we asked him to tells us and interpret the story to us again.
And he do that. The client perceived the right thought implied by the story. Mr. A.M related
himself to the story by means of remembering those times that he was in a peer pressure &
did not mind to follow his parent’s advises for him. The client realized that the things led
done before a wrong. He also stated that if he had only followed his parents, maybe his life
during his adulthood would be on the right way. I think that the client develop his
comprehensive ability during the therapy.
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PHOTO LANGUAGE THERAPY
DEFINITION
Photo Language Therapy helps the client to verbalized and state the level of their
thinking by formulating an idea on the photos they picked, this is used to test thinking skills
of the client and make their mind work.
GOALS
1. To let the client to verbalized his/her insights, thoughts and feelings about the
picture.
2. To develop client’s cooperation.
3. To promote thought process and verbalization of the client.
4. To let the client participate and socialize in a group discussion.
PROCEDURE
1. The facilitator orients the clients about the therapy and give instructors.
2. The client was asking to pick two photos they like.
3. After a minute of looking of the photos, they were asked to speak out the idea they
made about the photo and asked why did they picked that pictures
4. All the clients were asking to state their thought regarding the photos.
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Once we have started the therapy, we noticed that MR. A.M had high enthusiasm on
choosing an image for the therapy. When he saw the picture of a guitar, he picked it up.
Then he also chooses the picture of amazing house, and when he saw a picture of food, he
picked it up. Then he asked him what had like the most on the 3 pictures, he choose the
picture of a guitar and the house. When he asked him why he chooses, the guitar he says
that he remembered the times that are playing a guitar with his friends. Then, when we
asked him why he chooses the house, he says that it is for his future family for his wife and
children to be. Because when he can go home, he wants to have his own family.
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PUZZLE THERAPY
DEFINITION
A puzzle is a problem or enigma that tests the ingenuity of the solver. Puzzle therapy
is purposely to evaluate the client’s cognitive and problem-solving ability. Puzzle was
created to advance development this instilling aptness on the part of the client.
GOALS
1. To access the client’s memory, cognition and problem-solving ability.
2. To augment their thinking abilities and independence.
3. To imbibe self-esteem and fulfillment on the client.
PROCEDURE
1. The facilitator commences the assigned activity of that day, explaining its nature,
description and how it will be done.
Page | 141
2. Give the necessary materials for the activity, 2 simple and 2 complex puzzles.
3. Let the client choose 1 simple and 1 complex.
4. Start with the simple puzzle. Give sufficient amount of time for the client to scan and
see what the puzzle look like.
5. Record the duration of the first puzzle building.
6. Present the next puzzle, the complex. Again, give sufficient amount of time for the
client to scan and see what the puzzle look like.
7. Record the duration of the second puzzle building.
8. Evaluate the outcomes of the activity with the client.
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Page | 143
The client was able to differentiate the simple puzzle from the complex one. He
solved the simple puzzle for about 1 minute & the complex for 4 minutes. Mr. A.M. started
to form the puzzle at the side of the frame. He did the simple puzzle by his self, but in the
complex, he needed our assistance.
Mr.A.M. found the simple puzzle easier to form than the complex because of the
fewer number of puzzle pieces on it. He was able to do the therapy well & it tested his
problem solving ability.
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PLAY THERAPY
DEFINITION
Play therapy refers to social recreation activity that requires strategies & physical
strength. There 2 kinds of play therapy, first is the indoor games, which are played inside
the house example of this are snake & ladders, chess, damath, etc. ; the other one is
outdoor games, this are played outside the house examples are basketball, volleyball,
badminton & etc.
This therapy is used to help to interact & for socialization purposes and, to
encourage them to be competitive in any type of game. It is a tool to encourage client to
have their exercise them forget their boredom.
GOALS
1. To help the client to socialize & other people.
2. To help the client to be competitive & to trust their planned strategies.
3. To encourage their client to conceptualized ideas on how to win.
4. To give client new information outside the hospital.
PROCEDURE
Prepare the necessary equipment needed for indoor games (chess, snakes, &
ladders, puzzles) outdoor (Badminton, Basketball, Volleyball).
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Mr. AM participated actively in both games. We did first the outdoor game, wherein
he practiced sportsmanship after losing the game. He behaved well although he did not win.
While in the indoor game (Chess), he is very happy winning 3 rounds of the game.
However, the client did not boast it.
Mr. AM showed good mood & behavior, right affect & appropriate actions during the
play.
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BIBLIO THERAPY
DEFINITION
It cultivates & enhances the client’s memory capacities as well as reasoning & learning
ability in recalling the title. The character & the values regarding the story play which is
based from the Bible. It also served as a means of instruments in recognizing good manners
& values since the story was based from the bible.
GOALS
1. To enhance the client’s intellectual & memory capacity in recalling the important
facts & details to the therapeutic activities and retain this to his mind in order to use
it for future goals.
2. To provide a means of the entertainment & enjoyment in order to provide a lively &
active working environment to the client.
3. To enhance the client thought about good manners & values and be able to apply it
to his relationship with others.
4. To assess the client feelings and thoughts regarding his view about the story and its
relationship to her experiences in life in order to explore the feelings of the client
even more.
5. To enhance the clients understanding & reminding regarding the thought of the
topic & be able to express the opinion.
PROCEDURE
1. Prepare all the necessary equipment/ materials.
2. Make a television image the put curtains around it.
3. Present the improvised television together with the puppets handled by the student
nurses behind the blanket.
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4. Allow the clients to watch the whole play & ask them if they recall the important
details regarding the story on a group dynamics as wells as one on one interview
with the client.
Si Noe at ang Dakilang baha
Narrator: Si Noe ay isang lalaking sumasamba sa Diyos. Ang bawat isa ay galit at suwail sa
Diyos.
Isang araw, nagsabi ang Diyos ng mga ilang bagay na katakut- takot.
Diyos: Noe, makinig ka! Sisirain ko ang mga masasama sa mundo. Ang iyong sambahayan at
ikaw lamang ang makakaligtas.
Noe: Panginoon, ano po ang dapat kong gawin?
Diyos: Magkakaroon ng malaking baha ng tubig sa ibabaw ng mundo. Gagawa ka ng daong

na kahoy, malaking sasakyan para sa iyong sambahayan at maraming mga hayupan.
Narrator: Minanduhan ng Diyos si Noe. Binigyan si Noe ng tumpak na utos. Si Noe ay

kumilos agad. Kinutya si Noe ng mga tao habang nagpapaliwanag kungbakit gumagawa ng
daong o arko. Sinabi niya sa mga tao ang tungkol sa baha ngunit walng nakinig sa kanya.
Mga tao: Kalokohan! Paano babaha dito at ni minsan ay hindi pa naulan. Niloloko mo
lamang kami. Hindi kami naniniwala sayo. Sinungaling!
Noe: Malaki ang tiwala ko sa Panginoon. Naniniwala ako sa kanyang pahayag kahit hindi pa
naulan kahit kalian.
Narrator: Kaya’t sinunod ni Noe ang ipinag- utos ng Diyos. Gumawa siya ng malaking arko.
Nang matapos na ito ay handa ng lagyan ng mga pangkailangan. Ngayon dumating ang iba’t
ibang uri ng hayop. May mga ibon, may mga malalakin hayop, maliliit, at matatangkad. Ang
lahat ng ito ay pumasok sa arko.
Pinagtawanan ng mga tao si Noe.
Mga tao: Ha ha ha ha ha! Ha haha haha haha! Ha ha!
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Narrator: Hindi sila naniniwala tungkol sa mlakimg pagbaha kaya’t sila ay walang takot at
pinagpatuloy ang kanilang masasamang Gawain. Ngayon lahat ng mga hayop at mga iboon
ay nasa daong na, gayundin ang pamilya ni Noe. Si Noe, ang kanyang asawa, ang 3 anak na
lalaki at ang kanilang mga asawa ay nagsipasok na sa arko. Sinara ng Diyos ang pintuan!
Pagkatapos ay biglang dumating ang ulan. Malakas na malakas ang ulan na bumaha
ng bumaha sa ibabaw ng lupa. Nalunod ang mga taong hindi naniniwala kay Noe.
Gusto man nilang pumasok sa arko ngunit huli na ang lahat. Bumaha sa lahat ng
lungsod at nayon.
Mga Tao: Tulong! Tulungan niyo kami.
Nagsisisi na kami sa mga nagawa naming kasalanan.
Noe! Papasukin mo kami. Patawarin mo kami. Maawa na kayo. Tulong!
Narrator: Nang huminto ang ulan, ang mga kabundukan ay inapawan ng tubig. Habang
palalim ang bahang tubig, lumutang ang daong sa ibabaw. Ang daong ang nakaligtas kay
Noe at kanyang sambahayan sa malaking baha.
Nang matapos ang limang buwang baha, nagpadala ang Diyos ng pangtuyong
hangin. Dahan- dahan, ang daong ay huminto sa ibabaw ng Bundok Ararat. Pinalabas ni
Noe ang isang kalapati.
Noe: Humayo ka at humanap ng tuyong lupa upang ating pagdaungan.
Narrator: Hindi ito nakakita ng tuyong lupa kaya’t nagbalik ang kalapati. Nang dumaan ang 1
linggo, pinalabas muli ni Noe ang kalapati. Bumalik ito na may dalang dahon ng olibo sa
kanyang tuka.
Noe: Kung gayon ay mayroong tuyong lupa! Salamat Panginoon!
Diyos: Ito na ang takdang panahon. Oras na upang umalis kayong lahat sa daong. Pagpalain
ka Noe dahil sa iyong pagsunod at pagtitiwala sa akin.
Ang bahaghari na ito ay siyang sumisimbolo ng aking pangako. Hindi na
muling magbabaha sa mundo upang parusahan ang mga may kasalanan.
Noe: Purihin ang Panginoon! Diyos na dakila sa lahat. Maraming salmat po at iniligtas ninyo
kami sa kapahamakan.
Narrator: Gumawa si Noe ng altar at sumamba sa Diyos na nagligtas sa kanya at sa kanyanh

sambahayan sa malaking baha ng tubig. Si Noe at ang kanyang pamilya ay nakahanap muli
ng bagong pamumuhay pagkatapos ng dakilang baha.
TAPOS…
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Mr.AM watched & listened attentively to our puppet showed entitled “Si Noeh at
ang Dakilang baha”. He was able to tell the story again to us after watching. The client
got the moral lesson of the story. He remembered his grandfather on the part of the
story wherein Noeh build the ark, because it was his grandfather who made their house.
However suddenly, he opened the topic wherein he said that a diamond was placed
inside his head by his own uncle. The client was able to analyze the story &
comprehended well on it; but at the end of our interaction, he possessed flight of ideas,
telling stories unrelated to what we are really talking about.
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EXPRESSIVE ARTS THERAPY
DEFINITION
Expressive arts therapy is the use of the creative arts as a form of therapy. It is predicted on
the assumption that a client can heal through use of imagination and the various forms of
creative expression. It is also about reclaiming innate capacity as human beings for creative
expression of an individual and collective human experience its artistic form.
GOALS
1. To express his ideas and feelings.
2. To lessen the anxiety felt by the client in terms of entertainment.
3. To help the client to express his thoughts.
4. To assess the clients working attitudes.
5. To assess clients creativeness.
PROCEDURE
1. The facilitator commences the assigned activity of the day, explaining its nature,
description and how it is done.
2. Prepare the necessary materials needed (A4 paper, glue, and matches w/o the head
part).
3. Instruct the client to make us of the matchsticks by creating images/ figures that
comes into their mind and stick then with glue.
4. Allow them to finish their work and then interpret what image they create.
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Mr. A.M. formed the matchsticks into a house, tree, mountain & sunrays & he
pasted it in a bond paper. He did his art well, it appeared good and the best from other
finished products of the clients. As he said, he remembered his family in the art he did. The
sunrays symbolize hope for him. Then, Mr. A.M. appeared anxious, from the time, we
received him, and so we asked what is bothering him. He said that his uncle was talking to
him through the attachment string his uncle put inside his said. He started to become
blunted & have flight of ideas. At the end of our interaction, the client was able to do the
therapy but he is not that good when we evaluated and interpreted his work.
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SONG THERAPY
DEFINITION
Song therapy will motivate client to enhance their memory by memorizing lyrics of
song as well as the steps or interpretation of it. It will also develop their interpretation
about the meaning of the song on w/c they will easily understand the message of the song.
They will also have to energize their physical strength.
GOALS
1. To encourage client to express feelings by singing a song that is appropriate with
their emotions.
2. To enhance their memory by singing the song repetitively.
3. To enhance their physical strength by having exercised while dancing so that they
can use their strength in more progressive way.
4. To develop their talents about singing & dancing where in client will regain their self-
esteem.
5. To assess client capacity to follow instruction by copying steps from the steps from
the students nurses.
6. To enhance client social relationship w/ others by dancing & singing all together.
PROCEDURE
1. Find & select an aspiring song that is appropriate for the community song.
2. Write the lyrics in the Manila paper.
3. Practice the song until memorized.
4. Create steps threat will match the sentences from every stanzas.
5. Practice together with the patient. Teach them the song & steps.
6. Sing a loud & clear & play the steps gracefully.
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STAR NG PASKO
Kung kailan pinakamadilim
Ang mga tala ay mas nagniningning
Gaano man kakapal ang ulap
Sa likod nito ay may liwanag
Ang liwanag na ito

Nasa 'ting lahat
Mas sinag ang bawat pusong bukas
Sa init ng mga yakap
Maghihilom ang lahat ng sugat
Ang nagsindi nitong ilaw

Walang iba kundi ikaw
Salamat sa liwanag mo
Muling magkakakulay ang pasko
Tayo ang ilaw sa madilim na daan

Pagkakapit bisig ngayon higpitan
Dumaan man sa malakas na alon
Lahat tayo's makakaahon
Ang liwanag na ito

Nasa 'ting lahat
Mas sinag ang bawat pusong bukas
Sa init ng mga yakap
Maghihilom ang lahat ng sugat

Kikislap ang pag-asa

Kahit kanino man
Dahil ikaw Bro, dahil ikaw Bro
Dahil ikaw Bro
Ang star ng pasko
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Dahil ikaw Bro, dahil ikaw Bro

Dahil ikaw Bro
Ang star ng pasko!
ANALYSIS AND EVALUATION
The client back to the ward earlier because he’s formed a reaction after the first
therapy, so he didn’t attend the song therapy.
But on the performance of the song on the grand socialization day, he can follow the
song and the steps done by the student nurses and the other clients.
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UNIT VI
GLOSSARY
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GLOSSARY
Affect-is the outward expression of the client’s emotional state
Catatonic schizophrenia-characterized by marked psychomotor disturbance, either
motionless or excessive motor activity.
Ambivalence-presence of two opposing feelings.
Anhedonia-loss of interest in pleasurable things.
Aphasia-loss or impairment of the power to use or comprehend words.
Apraxia-inability to carry out purposeful motor activities.
Avolotion-lack of motivation.
Clang association-the sound of the words gives direction to the flow of thought.
Delusions-a fixed, false belief not based in the reality.
Denial-failure to acknowledge an intolerance thought, feeling, experience or reality.
Depersonalization-feeling of strangeness towards ones self.
Displacement-the redirection of feelings to a less threatening object.
Echolalia-pathological repetition of words of others.
Echopraxia-the pathological imitation of posture/ action of others.
Fantasy-conscious distortion of unconscious feelings or wishes.
Fixation-arrest of maturation at certain stages of development.
Flight of ideas-shifting of ideas from one subject to another in a somewhat related way.
Hallucination-false perceptions or perceptual experiences that do not really exist.
Intellectualization-over use of intellectual concepts by an individual to avoid expression of
feelings.
Introjections-symbolic assimilation or taking into one’s self a loved/ hated object.
Neologism-pathological coining of new words.
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Paranoid schizophrenia-characterized by persecutory (feeling victimized) or grandiose
delusions, hallucinations, and occasionally, excessive religiosity(delusional religious focus)or
hostile and aggressive behaviour.
Pharmacological treatments-curing and treating illness that deals in the science of nature
and action of drugs and medicines.
Phobia-an exaggerated and often disabling fear usually inexplicable to the subject and
having sometimes a logical but usu. an illogical or symbolic objects or situation.
Projection-attributing to others one’s unconscious wishes/ fear.
Rationalization-justifying one’s actions which are based on other motives.
Reaction formation-expression of feelings that is the direct opposite of one’s real feelings.
Regression-returning to an earlier level of development in the face of stress.
Repression-unconscious forgetting.
Schizophrenia-a form of mental illness in which there is a withdrawal from reality. It cannot
be defined as a single illness; rather, schizophrenia is thought of as a syndrome or disease
process with many different varieties and symptoms.
Sublimation-the rechanneling of unacceptable instinctual drive with one that is acceptable.
Substitution-replacing the desired unattainable goal with one that is attainable.
Suppression-“Conscious forgetting” a deliberate process of thought blocking.
Symbolism-less threatening object is used to represent another.
Undoing-an attempt to erase an act, thought, feeling or desire.
Word salad-incoherent mixture of words and phrases.
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UNIT VII
REFERENCES
Page | 161
Ann Isaacs,RN,MS,APRN-BC. “Mental Health and Psychiatric Nursing” Lippincotts
Review Series, 4th Series. Philippines, 2005
Shiela L. Videbeck. “Psychiatric Mental Health Nursing”, 2nd Edition. Philippines
2004
Marilynn E.D., et al. “Nurses Pocket Guide: Diagnosis, Prioritized Interventions and
Rationales” 10th Edition. F.A.Davis Company, Philadelphia, Pennsylvania, 2006
PPD’s, “Nursing Drug Guide” Malan Press Inc. Philippines, 2007
Merriam-Webster's Medical Dictionary, Merriam-Webster, Incorporated, United
States of America, 2006
Ray A. Gapuz et al. "Mosby's Essential Concepts for the Philippine Nurse Licensure
Exam" Philippines, 2010
Maria loreto evangelista-Sia."Psychiatric Nursing", RMSIA Publishing, Philippines,
2004
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UNIT VIII
DOCUMENTATION
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Comprehensive Case Study Paranoid Schizophrenia

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Republic of the Philippines

BATAAN PENINSULA STATE UNIVERSITY

I. DEDICATION AND ACKNOWLEDGEMENT

III. PERSONAL DATA

IV. CHIEF COMPLAINTS

a) Past Health History

b) Present Health History

Mental Health Status / Analysis and Interpretation

a) Nursing Care Plan

I. ACKNOWLEDGEMENT AND DEDICATION

the accomplishment of this manuscript.

valuable assistance and encouragement toward the completion of this study.

support and guidance which dynamically contributed in data-gathering and completion of

the Author. All the glory and love be all yours.

This humble piece of work is lovingly dedicated to our beloved family.

And most of all to our LORD and SAVIOR JESUS CHRIST.

To Him is all the glory!

movements, and behavior. It cannot be defined as a single illness ; rather schizophrenia is

increased effectiveness of newer atypical antipsychotic drugs and advances in community-

Schizophrenia usually is diagnosed in late adolescence or early adulthood. Rarely

and 25 to 35 years of age for women (America Psychiatric Association, 2000).

Paranoid schizophrenia is the most common type of schizophrenia in most parts of

usually accompanied by hallucinations, particularly of the auditory variety, and perceptual

condition that can lead to many complications, including suicidal behavior.

as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such as

and catatonic forms.

frequently reported symptoms of an underlying mental health problem were sadness,

higher than those that were previously reported by 17 percent.

Currently, there is no method for preventing schizophrenia and there is no cure.

pharmacological and psycho-social treatments. Hospitalization may be required to stabilize

of the episode. Mild or moderate episodes may be appropriately addressed by intense

III. PATIENT’S PERSONAL DATA

ADDRESS: Capaz, Tarlac

AGE: 41 years old

BIRTHDAY: January 21, 1969

CIVIL STATUS: Single

RELIGION: Roman Catholic

EDUCATIONAL ATTAINMENT: High School Undergraduate

DATE ADMITTED: September 18. 2006

TIME ADMITTED: 10:15 a.m.

WARD: Male Ward B

ADMITTING DIAGNOSIS: Paranoid Schizophrenia

ATTENDING PHYSICIAN: Dra. Evangelista

LAST 15 YEARS OF CLIENT’S LIFE:

Mr. A.M. formerly lived at Benguet on 1995. He worked there as a helper on

admission at Mariveles Mental Hospital on September 18, 2006. According to him,

admitted to the hospital and still been there for 4 years.

IV. CHIEF COMPLAINTS

(Source of Data: Client’s Chart)

 Hurts his Parents

 Destroys Appliances at home

In 1990, he reportedly began to use marijuana and alcohol. He developed a

confined at Roseville Rehabilitation Center for 2 months for psychological treatment

2 months at the Psychiatric Ward.

In January 2006, he refused to take medications and go for follow-ups. The

and symptoms he manifested.

b) Present Health History

then diagnosed with paranoid schizophrenia by Dra. Evangelista upon admission on

Mr. A.M. is currently confined at Mariveles Mental Hospital Ward B. The

and other activities.

his family members came back to visit him.

scheduled date of discharge.

As the client said, they have no history of having hypertension or diabetes