INTRODUCTION

Schizophrenia comes from Greek words meaning, “Split mind.”It causes

distorted and bizarre thoughts, perceptions, movements, emotions and
behaviors. It cannot be defined as a single illness; rather schizophrenia is
thought of as syndrome or disease process with many different varieties and
symptoms. It is usually diagnosed in late adolescence or early adulthood.
Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25
years of age for men and 25 to 35 years of age for women.

Symptoms of Schizophrenia:

Positive or Hard Symptoms Negative or Soft Symptoms

Ambivalence Alogia
Associate looseness Anhedonia
Delusions Apathy
Echopraxia Blunted affect
Flight of ideas Catatonia
Hallucinations Flat affect
Ideas of reference Lack of volition
Perseveration
The types of Schizophrenia according to DSM-IV-TR;

Undifferentiated Type: demonstrates delusions, hallucinations,

disorganized speech, disorganized behavior, and does not demonstrate
behaviors usually observed in paranoid, disorganized or catatonic types.

Catatonic Type: features marked psychomotor disturbance that may

involve motor immobility (waxy flexibility), excessive motor activity, extreme
negativism, mutism, posturing, echolalia or echopraxia.

Disorganized Type: uses disorganized speech and behavior and exhibits

flat or inappropriate behavior: does not exhibit catatonic behaviors
(psychomotor or language mimic).

Paranoid Type: uses delusions of persecutory or grandiosity, or both, less

often noted are delusional themes of jealousy, religiosity, or somatization.

Residual Type: criteria for schizophrenia and subtypes listed above are not
met; there is continuing evidence of negative symptoms and two or more of
these characteristic symptoms (delusions, hallucinations, disorganized
speech, and gross disorganization).

Although there is no cure for schizophrenia, effective treatment exist that

can improve the long term course of the illness. With many years of
treatment and rehabilitation, significant numbers of people with
schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication,
rehabilitation, and treatment of other problems the person may have.
Antipsychotics medications are prescribed primarily for their efficacy in
decreasing psychotic symptoms. They do not cure schizophrenia; they are
used to manage the symptoms of the disease. The drugs reduce or eliminate
psychotic symptoms such as hallucinations and delusions. The medications
can also help prevent these symptoms from returning. Common
antipsychotic drugs include respiridone (Risperdal), olanzapine (Zyprexa),
clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridaxine
(Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and
trifluoperazine (Stelazine).

Because many patients with schizophrenia continue to experience difficulties

despite taking medication, psychological and social rehabilitation is often
necessary. A variety of methods can be effective.Behavioral training
methods can also help them learn self-care skills such as personal hygiene,
money management, and proper nutrition.In addition, cognitive-behavioral
therapy, a type of psychotherapy, can help reduce persistent symptoms such
as hallucinations, delusions, and social withdrawal.

a. Individual and group therapy: It is supportive in nature, giving the

client an opportunity for social contact and meaning relationships.
Groups that focus on topics of concern such as medication
management, use of community supports and family concerns.

b. Family therapy: Family intervention programs can also benefit

people with schizophrenia. These programs focus on helping family
members understand the nature and treatment of schizophrenia, how
to monitor the illness, and how to help the patient make progress
toward personal goals and greater independence. They can also lower
the stress experienced by everyone in the family and help prevent the
patient relapsing or being re hospitalized.

c. Social skills training: Social skills training helps people with

schizophrenia learn specific behaviors for functioning in society, such
as making friends, purchasing items at a store, or initiating
conversations.

According to the record of CVMC psychiatry department as of Jan. - Dec. of

2009 there were 95 male patients admitted in the psychiatric and among
those patients there were 36 cases of schizophrenia and its prognosis is
much higher as of today’s because as of now from Jan. - July of 2010 there
were 71 patients admitted and among them there were 53 cases of
schizophrenia. And its prognosis is increasing in number. In female ward as
of Jan. – Dec. of 2009, there were 38 patients admitted and among those
patients, there were 21 cases of schizophrenia. From Jan. – July of 2010,
there were 43 patients admitted in female ward, and among those patients
there were 26 cases of schizophrenia. There are 697,543 cases of
schizophrenia in the Philippines, 75% are males and the rest are females.
And 51 million people worldwide suffer from schizophrenia in which males
have the most number of percent.

This statistics shows that males have the greater risk to develop psychiatric
disorder such as schizophrenia because of their lifestyle and keeping their
emotions.

We have chosen this case for the reason that we want to gain more
knowledge about the disorder and also to enhance the knowledge we
learned in Psychiatry Nursing in relation to it’s application in actual setting.

MENTAL STATUS EXAMINATION AND

PSYCHIATRIC NURSING ASSESSMENT

A. Appearance

 The patient dressed neatly and appropriately for his age. She is
very active and maintains eye contact whenever possible. He
experienced shaking of legs as a side effect of haloperidol.
Generally she is well-nourished.

B. Speech

C. He talks in moderate and loud, his words are clear but sometimes
stuttered. He skips from 1 topic to another, when he answered the
question “marunong kang magsulat kuya?” he answered “opo ma’am,
kumakanta at sumasayaw pa ako ma’am ah.” He talks non-stop, his
responses are not minimal by yes or no, and rather he elaborates
answers to questions asked. Most of the time the content of his words
is relevant. He doesn’t manifest neologism.

D. Level of Consciousness

E. He is responsive and not confused. He was able to sustain attention but

sometimes distracted with other patients when they talk very loud. He
answers questions accurately and can follow simple instructions such
as to sit down and carry the chair.
F.Emotional Status

G. Most of the time he is happy but sometimes he cries in silent because

he always remember her sister E. he verbalized that “sana andito siya,
para kunin na niya ako dito.”

H. Cognitive Functioning

I. He is oriented with person, place and time. He knows his full name, and
his sister’s name. He is aware of the present day, month and year. He
knows his birthday. He was able to spell children, can count 1-100 and
can name days of the week and months of the year correctly. And also
do simple calculation.

J. Abstract Thinking

K. When he was asked to interpret the common proverb “Kung mayroong

itinago, May madudukot” he provides a little explanation which is “Nu
indulin mu ti kwarta, adda maalam.” He also explained “Aanhin pa ang
damo kung patay na ang kabayo” with “Awanen a ma’am, natay met
diay kabayo nga mangan kuma.”

 During the working phase we also asked him to explain the

massage of the song “ kanlungan”, he answered” Para sa akin
po, ang ibig sabihin ng kantang yan ay, isang buhay lang ang
meron tayo at dapat nating pahalagahan ito dahil kapag tayo’y
namatay, mga ala-ala nalang ang maiiwan”.He can’t interpret
the meaning thus concrete thinking is present.

L. Insight and Judgment

M. When we asked “Nu adda ti mapidut mu nga pera anya ti aramidam?”

He answered “isublik a ma’am ngem nu singko haanen panggatung ku
latta ti sigarilyo kun”. While in the ward, he still engages in smoking
and even exchanges his things with cigarette. Hence, he has a poor
judgment.

N.He manifests good insight since he accepts the responsibility for his
actions. He verbalized “Napabarkada kasi ako noon ma’am,
naninigarilyo ako at umii,om ako ng hard liquor un bang gin ma’am. He
also verbalized “Behave na ako ma’am, kapag nakalabas na ako
ma’am di na ako maninigarilyo at iinom ng alak.”

O. Memory
  Recent: when he said “nagluto ako ng nilagang saging noon
ma’am, nung si ma’am Alona pa ang student nurse ko eh”.

 Immediate: when he immediate knew his student nurse’s

name, he stated that “si ma’am Alona Foronda ang student
nurse ko ma’am”.

 Remote: when he said “ naalala ko ma’am nung natanggal si

Estrada bilang Pangulo, naimpitch pa nga siya eh, ang pumalit si
GMA pero nandaya naman siya dahil dun sa Hello Garsi!”

I. Physiologic and Self Care Considerations

 The patient stated that he eats 3 times a day with 2 snacks, takes
a bath everyday, changes his clothes daily and brushes his teeth
thrice a day. He usually sleeps for 8 hours and takes a nap at
daytime as a side effect of the drug. He takes his medicine at
morning and night. The patient knows proper hygiene and
complies with the medications.
 OBJECTIVES

GENERAL OBJECTIVES:

At the end of the case presentation, we the presenters aim to share to our
audience the knowledge that we have gained about schizophrenia, the skills
required to manage the patient and the attitude that we must obtain to
become an effective and efficient nurse to the patient that we may
encounter in the future.

SPECIFIC OBJECTIVES:

Specifically, we aim to:

 Define what is schizophrenia disorder

 Enumerate the different types and the signs and symptoms manifested
in the disorder.

 Determine the patient ‘s psychiatric health history

 Discuss the patient’s mental status

 Review the Anatomy and physiology of the disorder

 Trace the psychopathology of the disorder

 Interpret the laboratory result of the patient

 Formulate Nursing care Plan utilizing the nursing process

 Discuss the medication of the patient

 Interplay the nurse patient interaction

 PSYCHIATRIC NURSING HISTORY
A.GENERAL INFORMATION
Patient’s initial: A.DG

Age: 39 years old

Gender: Male

Marital Status: Single

Address: Magapit, Lallo Cagayan

Birthday: October 16, 1969

Birthplace: Lallo, Cagayan

Religion: Roman Catholic

Dialect: Tagalong, Iloko, English

Educational Attainment: High School Graduate

Occupation: Vendor

Date of Admission: March 9, 2009

Chief complaints: He claimed that “sinira ko yung parlor ng ate ko, sa

pagwawala ko,pinagpapatay ko ang manok namin,
‘di ako makatulog ng ilang araw”. And “lagi syang
nagsasalita mag-isa” as been added by his sister
w/c is his companion when he was admitted.

Final Diagnosis: Schizophrenia UT, In relapse

Attending physician: Dr. Jerry Sagabaen

Dr. Leonara Juliana

Source of information: Patient, Patient’s chart and Staff

 B. PSYCHIATRIC HEALTH HISTORY

1. PSYCHIATRIC HISTORY
Patient ADG stated that he had experienced episodes of depression when their
parents left them and he was still in elementary level. He stated that “ may balak
akong magbigti, uminom ng acetone, maglaslas at magpasagasa sa dami ng iniisip
kong problema. Pero hindi ko nagawa ang mga yun dahil sa ate ko, sobra kasi ang
pag aalaga nya samin.” He also stated that “ may time na nagbabago ang ugali ko
hindi ako nambubugbog pero pumapatay ako ng manok kung saan saan ko
tinatapon, minsan sinusunog ko na lang, minsan tumawa ako mag isa, nagsasalita
ako mag isa”.

A week before patient ADG was admitted he claims that “sinira ko yung parlor ng
ate ko sa pag wa wala ko, pinagpapatay ko ang manok namin, at ‘di ako makatulog
ng ilang araw”.and his sister added “ lagi syang nagsasalita mag isa”, in w/c his
companion when he was admitted.

MEDICAL HISTORY
According to patient ADG when was still a child he experienced colds, cough and
fever. He stated that “ kwento ng ate ko, naglalagay ang nanay ko ng dahon ng
oregano sa noo ko noon, pati yung dahon ng saging sa may tiyan ko pag may
lagnat ako eh. Pero pag malalana ang sakit ko gamot nlang ang binibigay nila sa
akin gaya ng Biogesic”. He added that he had not incurred any type of surgery. He
only sustained superficial wound on the temporal area of his face and his left and
right eyebrow after he made his co- patients (R.P., S. V., M. F., and R. F.) get mad
because of his being talkative.

2. PERSONAL AND SOCIOECOMIC HISTORY

According to patient ADG, he only finished secondary level with the age of
20. He stated that “ mabarkada kasi ako noon. Naninigarilyo ako( Malboro
and Philip 3sticks/day) at umiinom ako ng alak (Gin) pag may occasion lalo
na pag birthday ng barkada ko”. He also said that he had been in live-in
relationship with Ms. P for 5 yrs. and Ms. L for 3 yrs. He stated that “ ayaw na
ayaw kong magpakasal, mas gusto kong ibahay nalang ang babae.”

According to him, he had been a vendor of ‘mani’ and juices like buko juice
for 4 yrs infort of the schools. This is to help his sister E to earn money. He
stated that “ pagmay sobra sa binebenta ko yung hindi nabili binibigay ko
lahat sa mga pamangkin ko at mga apo”.
According to him, they were left by his parents when he was in elementary
level. He stated that “ mas malapit ako sa ate ko kasi siya na ang nag alaga
samin, kaya ayaw na ayaw ko siyang saktan, kung pwede lang gagawin ko
ang lahat para sa kanya”.

3. HISTORY OF PRESENT ILLNESS

According to patient ADG one week before he was admitted, he stated that “
nasira ko ang parlor ng ate ko sa pagwawala ko, hindi rin ako makatulog
siguro mga limang araw na,pinag papatay ko din ang mga manok, tinatapon
ko pa nga ang mga yun ,minsan sinusunog ko na lang at nagsasalita ako
mag isa kung anu ano pinagsasabi ko”. He added that “mas lagi ko itong
ginagawa simula noong binagbintangan akong nirape ko ang anak ng ka live-
in ko noon, hindi nila alam na wala akong ginawa dahil tinuring ko din naman
tunay na anak yun”.

According to him, maybe because of these things and concern his sister E
accompanied him to be admitted in CVMV Psychiatric ward. In there, he was
admitted last March 9, 2009 with a diagnosis of Schizophrenia, UT In relapse.

4. DEVELOPMENTAL HISTORY
 According to patient ADG, his sister told him that when he was an
infant he was been breastfed, he also stated that “ kung anu ano daw
ang sinusubo ko noon.” He learned how to walk before he reaches his
first year of life. He also added that “marunong na daw akong mag
hawak ng kutsara at tinidor kaso nagkakalat naman ang mga pagkain
ko kaya yun lagi akong pinapagalitan daw ni nanay, yun ang sabi ni
ate E____.

 When he was 3 yr. Old, he was trained to urinate with the use of
“arenola”. But when he defecate, he just defecate anywhere at their
backyard at daytime and use “arenola” during night time, he said that
“ang sabi ni ate noong nagkekwento siya, ginigising ko ang nanay
pagnatatae ako ng gabi noon, umiiyak pa daw ako ng malakas pag ‘di
nila ako pinapansin”.

 When he was 5 yr. old, he said that “ tinutiruan akong magbilang noon
gamit ang tingting at mais,nagdodrawing ako ng linya noon, mga
bahay tapos kinukulayan ko, kahit ABC tinuturo sa akin.” He also
added that “namimili daw ako ng kalaro ko noon, mas gusto ko daw na
kalaro ang mga lalake noon,yun ang sabi nila, bihira pa nga daw akong
magshort noon kaya yun nilalaro ang ari ko noon.”

 During his elementary life, he said that “sumasali nak ti sala ken
kinnantaan nu adda ti program ti iskwela mi”. He also added that “
nagkaroon ako ng puppy love, mas matanda sa akin. Naalala ko pa nga
noon inaabangan ko siya lagi, nagbibigay ako ng sulat”.
 During his High school life, he stated that “ nagkaroon na ako ng
Girlfriend pero nagbreak din kami kasi palaaway ako noon. Dito ako
natutong manigarilyo, uminom ng alak at bumarkada. Nagtagal ako sa
high school pero dahil sa ate ko tinuloy kong mag aral at mabuti na
lang nakatapos parin ako”. According to him, he was circumsized
during his high school life. He also added that when he was in high
school, he had his first sex at the age of 18. He has never had
homosexual experiences.

 At the age of 26, he stated that “ nagkaroon ako ng ka live-in noon si

P_____ at si L___ may mga dati na silang asawa. Si P_____ mahigit
limang taon na kami pero mas gusto nyang maglagi at magtrabaho sa
manila kaya yun iniwan niya ako. Tapos si L__ mahigit tatlong ataon
kami noon, may dalawa siyang anak tinuring ko na din mga anak yun
kahit hindi galing skin, nagkahiwalay lang kami noong pinagbintanagan
akong rereypin ko ang ank niya na saktong nadatnan niyang
naghuhubad sa harap ko”. He also added that “ nagtitinda ako ng mani
at mga juice sa harap ng skul noon, yung hindi ko nabenta
pinamimigay ko sa mga pamangkin at apo ko”.

According to the client, he never has any weight problems or any

inferiority problems.

ANATOMY AND PHYSIOLOGY

 LABORATORY AND OTHER DISGNOSTIC
EXAMS
RADIOLOGIC EXAMINATION

04-11-09
NOR
MAL
RES
ULTI Interpretation:
NTE
RPR Chest (PA)
ETA Both lungs fields are clear and with normal vascular pattern. Heart and
TIO great vessels are normal in size and configuration. Other chest structures
N are unremarkable.
4.1-
5.9
NOR Impression:
MAL
TES No radiographic abnormality within the chest.
TRE
SUL
T

1-
5.2
LABORATORY RESULT
NOR
RESULT
MAL
Gluc
ose
4.6
mm
ol/L

0-
1.69
NOR
MAL
Chol
este
rol
5.2

0-
1.6
NOR
MAL UNIVERSITY OF CAGAYAN VALLEY
Trigl
ycer COLLEGE OF HEALTH
ide
1.8 TUGUEGARAO CITY
0-
3.35
NOR
MAL
Dire
Grand case Presentation
ct
HDL
C1.
On
1

0-.9
Schizophrenia, UT In relapse
1NO
RMA
LLD
L3.3
6

HDL.82
In partial fulfillment of the requirements in NCM 104
Related Learning Experience

Presented by:

Cloyd P. Sagundo

Bong-bong A. Taguinod

Jelanie T. Calimag

Karelle Kilgerinn Q. Discipulo

Alona Jane T. Foronda

Angelica M. Morales

Angelie M. De Polonia

Jenevie C. Sabban

Group D; Cluster A

Presented to:

Mr. Lourish B. Conag RN, MSN

Clinical Coordinator

College of Health

Nurse-Patient Interaction
I
n
s
i
g
h
t
s
/
O
b
s
e
r
v
a
t
i
o
n
s

peutic

munic

Techn

Patien

Respo

O
R
I
E
N
T
A
T
I
O
N

P
H
A
S
E

G
r
W
O
R
KI
N
G
P
H
A
SE

Gr
eet
ing
the
cli
ent
ind
ica
tes
tha
t
she
is
bei
ng
rec
og
niz
ed
by
the
SN
as
a
per
son
.


Su
gg
esti
ng
col
lab
ora
tio
n.
Th
e
SN
see
ks
to
off
er
a
rel
ati
ons
hip
in
wh
ich
the
cli
ent
can
ide
ntif
y
pro
ble
ms
in
livi
ng
wit
h
oth
ers
,
gro
w
em
oti
on
all
y
an
d
im
pro
ve
abi
lity
to
for
m
sati
sfa
cto
ry
rel
ati
ons
hip
s.


Sh
ow
ing
co
nce
rn
by
ask
ing
the
cli
ent
s
co
ndi
tio
n
wo
uld
let
the
cli
ent
fee
l
tha
t
he
is

be
in
g
ca
re
d
ab
ou
t.

Ex
plo
rin
g
hel
ps
in
exa
mi
nin
g
the
rea
l
iss
ue
an
d
gat
her
ing
mo
re
inf
or
ma
tio
n.
An
y
co
nce
rn
of
the
pat
ien
t
can
be
bet
ter
un
der
sto
od
if
ex
plo
rin
g
in
de
pth
.


Sil
enc
e
giv
es
the
cli
ent
tim
e
to
org
ani
ze
thi
ng
dir
ect
the
top
ic
of
int
era
cti
on
or
foc
us
on
iss
ues
tha
t
are
mo
re
im
por
tan
t.


En
co
ura
gin
g
des
cri
pti
on
of
per
cep
tio
ns
hel
ps
the
SN
to
un
der
sta
nd
the
cli
ent
.
En
co
ura
gin
g
the
cli
ent
to
des
cri
be
ide
as
full
y
ma
y
reli
eve
the
ten
sio
n
the
cli
ent
is
fee
lin
g
an
d
he
mi
ght
be
les
s
lik
ely
to
tak
e
act
ion
on
ide
as
tha
t
are
har
mf
ul
or
fri
ght
eni
ng.

Gi
vin
g
rec
og
niti
on
giv
es
sel
f-
co
nfi
de
nce
to
the
cli
ent
.


Gi
vin
g
rec
og
niti
on
giv
es
sel
f-
co
nfi
de
nce
to
the
cli
ent
.


Bu
ildi
ng
co
ntr
act
s
to
the
cli
ent
suc
h
as
go
od
gro
om
ing
co
uld
hel
p
bot
h
SN
an
d
the
cli
ent
on
the
ne
xt
me
eti
ng
act
ivit
ies
for
mo
re
co
op
era
tio
n,
go
od
dea
lin
g
an
d
eff
ect
ive
co
m
mu
nic
ati
on.


Co
nsi
ste
nt
ap
pro
ach
an
d
ap
pra
isal
sho
uld
be
ex
pre
sse
d
by
SN
for
the
cli
ent
to
fee
l
tha
t
he
is
wo
rth
y
an
d
tha
t
he
ma
kes
so
me
on
e
life
ha
pp
y
bei
ng
wit
h
her
.





Re
cap
itul
ati
on
wo
uld
ref
res
h
the
cli
ent
’s
mi
nd
ab
out
the
rec
ent
co
nv
ers
ati
ons
tha
t
has
tra
nsp
ire
d
the
last
me
eti
ng.



Gi
vin
g
the
pat
ien
t
the
nec
ess
ary
inf
or
ma
tio
n
wo
uld
let
the
pat
ien
t to
ask
par
tic
ula
r
qu
esti
ons
if
the
re
are
an
y
for
her
to
les
sen
an
xie
ty
an
d
to
par
tic
ula
rly
fee
d
hi
m
the
inf
or
ma
tio
n
on
wh
at
to
ex
pec
t.

Gi
vin
g
rec
og
niti
on
giv
es
sel
f-
co
nfi
de
nce
to
the
cli
ent
.


En
co
ura
gin
g
des
cri
pti
on
of
per
cep
tio
ns
hel
ps
the
SN
to
un
der
sta
nd
the
cli
ent
.
En
co
ura
gin
g
the
cli
ent
to
des
cri
be
ide
as
full
y
ma
y
reli
eve
the
ten
sio
n
the
cli
ent
is
fee
lin
g
an
d
she
mi
ght
be
les
s
lik
ely
to
tak
e
act
ion
on
ide
as
tha
t
are
har
mf
ul
or
fri
ght
eni
ng.

Se
eki
ng
inf
or
ma
tio
n
reg
ard
ing
on
e’s
str
en
gth
s
wo
uld
let
the
pat
ien
t
rec
og
niz
e
the
go
od
par
t in
hi
m.


Gi
vin
g
rec
og
niti
on
giv
es
sel
f-
co
nfi
de
nce
to
the
pat
ien
t.


Su
gg
esti
ng
col
lab
ora
tio
n.
Th
e
SN
see
ks
to
off
er
a
rel
ati
ons
hip
in
wh
ich
the
cli
ent
can
ide
ntif
y
pro
ble
ms
in
livi
ng
wit
h
oth
ers
,
gro
w
em
oti
on
all
y
an
d
im
pro
ve
abi
lity
to
for
m
sati
sfa
cto
ry
rel
ati
ons
hip
s.


At
the
en
d
of
eve
ry
NP
I,
we
mu
st
so
me
up
wh
at
has
tra
nsp
ire
d
for
the
pat
ien
t to
rec
og
niz
e
tha
t
wh
at
has
bee
n
tal
ke
d
ab
out
we
re
all
rel
eva
nt.

 


Ma
ga
nd
an
g
ha
po
n
din
po
Ma
’a
m
ok
lan
g
na
ma
n
po
ak
o.
(S
mil
es
bac
k)


(Ju
st
foll
ow
ed
the
ins
tru
cti
on
giv
en)


Op
o
Ma
’a
m.
Ma
hi
mb
ing
ng
a
po
an
g
tul
og
ko.
Na
na
gin
ip
ng
a
po
ak
o
eh.


Na
ka
uw
i
na
ra
w
po
ak
o
at
kas
am
a
ko
na
ra
w
po
mg
a
ka
pat
id
ko.


Op
o.
(Si
le
nc
e)


Par
a
sa
aki
n
po,
an
g
ibi
g
sab
ihi
n
ng
ka
nta
ng
ya
n
ay,
isa
ng
bu
ha
y
lan
g
an
g
me
ron
tay
o
at
da
pat
nat
ing
pa
hal
aga
ha
n
ito
da
hil
ka
pa
g
tay
o’y
na
ma
tay
,
mg
a
ala
-
ala
nla
ng
ma
iiw
an.


Jus
t
sm
iles
bac
k.


Hi
ndi
na
ma
n
po
ma
’a
m.
(S
mil
es
bac
k)



O
p
o

M
a
’
a
m
.
(
S
m
i
l
e
s
b
a
c
k
)



Si
g
e
p
o
M
a’
a
m
as
a
h
a
n
k
o
p
o
ul
it
k
a
y
o
m
a
m
h
a.
S
al
a
m
at
di
n
(
S
m
 il
es
b
a
c
k)


Op
o
Ma
’a
m.


Op
o
m
a
m,
m
as
ay
a
po
ku
ng
ga
nu
n.(
sm
ili
ng
)


Hi
nd
i
na
m
an
ga
an
o
m
ar
a
mi
m
a’
a
m.
(s
mi
lin
g)


Op
o.
Ma
say
a,
exc
ite
d
na
ng
a
po
ak
o
eh,
bu
kas
na
lan
g
po
sab
ad
o
na.
Ka
ka
nta
po
ak
o
tap
os
sas
aya
w.
(la
ug
h)



 

Op
o
ma
’a
m,
pal
agi
ng
a
po
ak
on
g
na
nal
o
eh.


Op
o.
(la
ug
h)


Op
o
ma
’a
m.


Op
o,
siy
em
pre
ma
’a
m
(S
mil
e)



M
a
g
a
n
d
a
n
g
h
a
p
o
n
p
o
k
u
y
a
B
u
b
u
t,
k
u
m
u
s
t
a
n
a
p
o
?
(
S
m
il
e
)



H
a
li
n
a
p
o
k
a
y
o
,
u
p
o
p
o
t
a
y
o
d
u
n
.
(
L
e
a
d
i
n
g
t
o
a
p
l
a
c
e
w
h
e
r
e
N
P
I
c
o
u
l
d
t
a
k
e
p
l
a
c
e
)



N
a
k
a
k
a
p
a
g
p
a
h
i
n
g
a
n
a
m
a
n
p
o
b
a
k
a
y
o
k
u
y
a
n
g
m
a
i
g
i
?






A
n
o
n
a
m
a
n
p
o
n
a
p
a
n
a
g
i
n
i
p
a
n
n
y
o
?



G
a
n
u
n
p
o
b
a
?
(
S
il
e
n
c
e
)






ctivit
y:
singi
ng
the
song
“kanl
unga
n”


K
u
y
a
s
a
s
a
r
il
i
n
y
o
p
o
n
g
p
a
n
a
n
a
w
,
a
n
o
p
o
i
b
i
g
i
p
a
h
i
w
a
ti
g
n
a
k
a
n
t
a
n
g
y
a
n
?



W
o
w

a
n
g
g
a
li
n
g
p
o
a
h
.
(
S
m
il
e
)



A


A
n
g
g
a
li
n
g
n
y
o
n
g
m
a
g
l
a
r
o
k
u
y
a
a
h
,
n
a
p
a
g
o
d
p
o
b
a
k
a
y
o
?
(
S
m
il
e
)



S
a
l
u
n
e
s
p
o
u
li
t
b
a
g
o
n
a
m
i
n
g
k
a
y
o
k
u
k
u
n
i
n
s
a
s
u
s
u
n
o
d
n
a
l
u
n
e
s
p
o
d
a
p
a
t
n
a
k
a
li
g
o
n
a
k
a
y
o
,
n
a
k
a
t
o
o
t
h
b
r
u
s
h
,
n
a
k
a
p
a
li
t
n
g
d
a
m
it
a
t
n
a
k
a
i
n
o
m

n
a
p
o
k
a
y
o
n
g
g
a
m
o
t
n
y
o
.
M
a
li
n
a
w

p
o
b
a
y
u
n
?
(
S
m
il
e
)



S
i
g
e
p
o
k
u
y
a
B
u
b
u
t,
i
h
a
h
a
ti
d
k
o
n
a
p
o
k
a
y
o
s
a
l
o
o
b
.
S
a
l
u
n
e
s
p
o
u
li
t
?
M
a
r
a
m
i
n
g
s
a
l
a
m
a
t
p
o
k
u
y
a
B
u
b
u
t,
s
a
o
r
a
s
.
(
S
m
il
e
)



econ
d
week
activi
ty:
playi
ng
bingg
o


D
i
b
a
p
o
k
u
y
a
B
u
b
u
t
n
a
p
a
g
u
s
a
p
a
n
n
a
ti
n
n
u
n
g
i
s
a
n
g
li
n
g
o
n
a
n
g
a
y
o
n
t
a
y
o
m
a
g
l
a
l
a
r
o
n
g
b
i
n
g
o
.



B
a
l
e
p
o
a
n
g
l
a
r
o
n
g
it
o
a
y
m
a
y
n
a
k
a
l
a
a
n
n
a
p
r
e
m
y
o
k
u
n
g
s
i
n
o
m
a
n
a
n
g
m
a
n
a
n
a
l
o
.



A


M
a
r
a
m
i
k
a
y
o
n
g
n
a
k
u
h
a
n
g
p
r
e
m
y
o
k
u
y
a
a
h
?



B
a
l
e
p
o
m
a
g
k
a
k
a
r
o
o
n
p
o
t
a
y
o
n
g
s
o
c
i
a
li
z
a
ti
o
n
s
a
m
i
y
e
r
k
u
l
e
s
,
a
n
o
p
o
n
g
n
a
r
a
r
a
m
d
a
m
a
n
n
y
o
p
a
y
m
a
y
m
g
a
g
a
n
it
o
n
g
a
c
ti
v
it
i
e
s
?



M
a
h
il
i
g
p
o
b
a
k
a
y
o
n
g
m
a
k
i
s
a
li
s
a
m
g
a
p
a
l
a
r
o
t
u
w
i
n
g
m
a
y
s
o
c
i
a
li
z
a
ti
o
n
?



W
o
w

g
a
li
n
g
p
o
m
a
b
u
ti
n
a
m
a
n
p
o
k
u
n
g
g
a
n
u
n
.



S
o
d
a
p
a
t
p
o
p
a
g
h
a
n
d
a
a
n
n
a
ti
n
p
a
r
a
s
a
g
a
n
u
n
m
a
n
a
l
o
p
o
t
a
y
o
u
li
t
s
a
m
g
a
p
a
l
a
r
o
.



S
o
k
u
y
a
B
u
b
u
t
n
a
p
a
g
-
u
s
a
p
a
n
n
a
n
g
a
p
o
n
a
ti
n
n
a
m
a
g
k
a
k
a
r
o
o
n
n
g
a
t
a
y
o
n
g
s
o
c
i
a
li
z
a
ti
o
n
a
t
m
a
r
a
m
i
p
o
t
a
y
o
n
g
a
c
ti
v
it
i
e
s
n
a
g
a
g
a
w
i
n
,
a
a
s
a
h
a
n
k
o
p
o
 n
a
t
a
l
a
g
a
n
g
m
a
k
i
k
il
a
h
o
k
k
a
h
a
.

S
i
g
e
p
o
k
u
y
a
B
u
b
u
t
h
a
n
g
g
a
n
g
b
u
k
a
s
p
o
u
li
t.
(
S
m
il
e
)


TE
R
MI
N
AT
IO
N
P
H
A
SE

Gr
ee
ti
ng
th
e
cli
en
t
in
di
ca
te
s
th
at
sh
e
is
be
in
g
re
co
gn
iz
ed
by
th
e
S
N
as
a
pe
rs
on
.


N
ot
in
g
th
e
ef
fo
rt
s
th
e
cli
en
t
ha
s
m
ad
e
all
sh
o
w
th
at
th
e
S
N
re
co
gn
iz
es
th
e
cli
en
t
as
a
pe
rs
on
/in
di
vi
du
al
th
us
th
e
cli
en
t
gi
ve
s
a
fe
eli
ng
of
se
lf-
co
nfi
de
nc
e.


Su
gg
es
ti
ng
co
lla
bo
ra
ti
on
.
Th
e
S
N
se
ek
s
to
of
fe
r
a
re
la
ti
on
sh
ip
in
w
hi
ch
th
e
cli
en
t
ca
n
id
en
tif
y
pr
ob
le
m
s
in
liv
in
g
wi
th
ot
he
rs,
gr
o
w
e
m
ot
io
na
lly
an
d
im
pr
ov
e
ab
ilit
y
to
fo
r
m
sa
tis
fa
ct
or
y
re
la
ti
on
sh
ip
s.


Of
fe
ri
ng
on
e’
s
se
lf
co
ul
d
le
ss
en
up
th
e
an
xi
et
y
le
ve
l
of
th
e
cli
en
t.
Wi
th
ou
r
kn
o
wl
ed
ge
th
at
th
e
cli
en
t
w
e
ar
e
ha
nd
lin
g
ha
ve
ce
rt
ai
n
po
in
ts
in
th
ei
r
liv
es
w
he
re
in
th
er
e
eg
o
w
as
w
ea
k
an
d
th
ei
r
se
lf-
es
te
e
m
w
er
e
lo
w.
Wi
th
th
is,
w
e
sh
ou
ld
of
fe
r
ou
r
se
lv
es
an
d
de
vo
te
so
m
e
of
ou
r
ti
m
e
to
th
e
m
fo
r
th
e
m
to
fe
el
th
at
pe
op
le
ar
e
re
ad
y
to
gu
id
e
th
e
m
w
he
n
th
ey
ne
ed
gu
id
an
ce
.


Se
ek
in
g
inf
or
m
at
io
n
re
ga
rd
in
g
on
e’
s
st
re
ng
th
w
ou
ld
le
t
th
e
pa
ti
en
t
re
co
gn
iz
e
th
e
go
od
pa
rt
in
hi
m
.


Su
gg
es
ti
ng
co
lla
bo
ra
ti
on
.
Th
e
S
N
se
ek
s
to
of
fe
r
a
re
la
ti
on
sh
ip
in
w
hi
ch
th
e
cli
en
t
ca
n
id
en
tif
y
pr
ob
le
m
s
in
liv
in
g
wi
th
ot
he
rs,
gr
o
w
e
m
ot
io
na
lly
an
d
im
pr
ov
e
ab
ilit
y
to
fo
r
m
sa
tis
fa
ct
or
y
re
la
ti
on
sh
ip
s.


W
e
sh
ou
ld
al
so
co
ns
id
er
no
nv
er
ba
l
cu
es
th
e
pa
ti
en
t
sh
o
w
s
fo
r
th
is
w
ou
ld
he
lp
us
de
te
r
mi
ne
th
e
co
ng
ru
en
cy
of
da
ta
th
at
th
e
pa
ti
en
t
gi
ve
s
us
.
O
bs
er
vi
ng
al
so
th
e
re
ac
ti
on
s
of
th
e
pa
ti
en
t
to
a
ce
rt
ai
n
sti
m
uli
w
ou
ld
le
t
us
de
te
r
mi
ne
if
he
re
sp
on
ds
ap
pr
op
ri
at
el
y
or
no
t.



En
co
ur
ag
in
g
ex
pr
es
si
on
.
Th
e
S
N
as
ks
th
e
cli
en
t
to
co
ns
id
er
pe
op
le
an
d
ev
en
ts
in
lig
ht
of
hi
s
o
w
n
va
lu
es
.
D
oi
ng
so
en
co
ur
ag
es
th
e
cli
en
t
to
m
ak
e
hi
s
o
w
n
ap
pr
ai
sa
l
ra
th
er
ac
ce
pt
in
g
th
e
op
ini
on
of
ot
he
rs.


Gi
vi
ng
th
e
pa
ti
en
t
th
e
ne
ce
ss
ar
y
inf
or
m
at
io
n
w
ou
ld
le
t
th
e
pa
ti
en
t
to
as
k
pa
rti
cu
la
r
qu
es
ti
on
s
if
th
er
e
ar
e
an
y
fo
r
hi
m
to
le
ss
en
an
xi
et
y
an
d
to
pa
rti
cu
la
rl
y
fe
ed
hi
m
th
e
inf
or
m
at
io
n
on
w
ha
t
to
ex
pe
ct.


Co
nsi
ste
nt
ap
pr
oa
ch
an
d
ap
pr
ais
al
of
po
siti
ve
res
ult
s
sh
ou
ld
be
ex
pr
ess
ed
for
the
cli
ent
to
fee
l
wo
rth
y
an
d
to
gai
n
co
op
era
tio
n
in
the
su
cc
ee
di
ng
int
era
cti
on
s.

 Ok lang po Ma’am. (Smile back)

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 Siyempre naman po ma’am.

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 Just followed instruction given.

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 Opo ma’am.
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 Kakanta po ako tapos sasayaw ma’am.

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 Opo ma’am para po mas masaya. (laugh)

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 Masaya po kasi marami na akong premyo, pero malungkot din kasi aalis na
kayo.
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 Mabuti naman po kung ganun ma’am. Para makalabas po ulit kami. (Smiles
back)
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 Maraming salamat din po ma’am. (Smile back)

 Hello po kumusta na po kayo? (Smile)


 Wow, ang ganda po ng damit mo ah, talagang pinaghandaan nyo po ang socialization natin ah.
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 Hali na po kayo ate, doon po tayo. (Leading to the socialization area.

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 Kuya galingan nyo po mamaya sa mga palaro natin ah, tutulungan ko po kayo. (Smile)
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 Ano pong ipapakita ninyong talent po para sa program natin.

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 Gusto nyo po bang dalawa tayong sasayaw at kakanta.

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 ***During the socialization, I continually observed my patient actively participating with

the games that our group has prepared.

 Kuya Bubut ito na po ang huling araw na makasama mo ako bilang ma’am mo, ano pong
nararamdaman nyo?
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 Pagkatapos po namin ay may ibang grupo na naman po kayong makakasama kaya magiging
masaya po ulit kayo, diba po? (Smile)
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 So sana po kuya may natutunan po kayo sa amin kahit papaano po maraming salamat din po na
naging parte po kayo ng buhay ko. At marami po akong natutunan po mula sa inyo. Maraming
salamat po kuya Bubut. (Smile)