BSN4A (GROUP 2)1 I.

Introduction Drugs can be beneficial to us, thus it is called a therapeutic regimen to treat disease and ailments of the body. They come in various names and uses in complex mechanisms in order to produce a healing effect to people and then being dispensed in pharmacies to be available to the public. Contrary to that, it can also potentially be a threat to every individual; more so can be harmful and hazardous to the health. Drugs that were being mentioned are addicting and can be abused by a person who uses them excessively in large amounts publicly known as illegal drugs.As defined by the World Health Organization (2012), substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state. Here we will tackle the two drugs used by the patient which were the Methamphetamine and Marijuana. Methamphetamine is a central nervous system stimulant drug that is similar in structure to amphetamine, a white, odorless, bitter-tasting crystalline powder that easily

dissolves in water or alcohol and is taken orally, intranasally (snorting the powder), by needle injection, or by smoking. Marijuana dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa (NIDA, 2010). According to the same article that taking even small amounts of methamphetamine can result in many of the same physical effects as those of other stimulants, such as cocaine or amphetamines, including increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and hyperthermia. Marijuana acts mainly in the brain and produce rapid and harmful effects in the body such as distorted perceptions, impaired coordination, difficulty with thinking and problem solving, and problems with learning and memory.

BSN4A (GROUP 2)2 Philippines instituted laws and regulations so as to repeal the increasing incidence of drug abuse and many enforcers became vigilant in doing their jobs, actually our country had amended several laws such as Republic Act No. 9165: The Comprehensive Dangerous Drug Act of 2002 in aiding drug prevention and control. Substance abuse has become increasingly and vividly rampant in todays modernized society. Adults and teenagers even younger ones have no choice as to whom the victims of this menace. Countries banned these instruments of chaos but until now still it occurs and roams around from every corner. Looking at the drug situation of the Philippines, in 2004, drug users have climbed to an astounding 6.7 million. Methamphetamine hydrochloride or "shabu" and marijuana are the illegal drugs preferred by one in every 29 Filipinos aged 10 to 44 years (Aynfender, 2009). Now this is just only Philippine statistics, how much more of the population statistics globally? This is a case of a 31 year-old named L.J. ,a male resident of Research Education and Concern to Help (REACH) Foundation in Paglaum Village, Bacolod City who resorted in usage of prohibited drugs every day since he was 19 year old with a duration of more than 6 years due to influence of peers. He is currently admitted for the reason of the reaction of the drug to his system and undergone treatment according to his case. Among other patients, L.J.s case was the focal point of the groups case study because of its interesting and controversial story. Interviewing and probing the patient to knowwell how did he got into that situation and what could possibly led him to resort to usage of drugs. This case study aims to shed light as how substance abuse, specifically Methamphetamine and Marijuana develop, its factors associated, effects on the persons bod y, different managements and approaches and most of all to provide appropriate nursing care to individuals suffering from the altering effects of the drugs.

BSN4A (GROUP 2)3 II. Objectives of the Study General Objective After 1 hour of case presentation the student nurses will be able to: Present information regarding Substance Abuse specifically Methamphetamine and Marijuana in relation to patients clinical manifestations, treatment, and general health status. Specific Objectives After 1 hour of case presentation the student nurses will be able to: Knowledge: 1. Define substance abuse, enumerate its causes and explain its effects to the body. 2. Explain the Anatomy and Physiology of the Nervous System and the areas affected by the drug (Methamphetamine and Marijuana) used. 3. Trace the psychopathology of substance abuse, specifically on marijuana and methamphetamine. 4. Enumerate the prioritized nursing problems related to the case. 5. Identify therapeutic communication techniques utilized in interacting with the client. 6. State the importance of the Nursing Case Study in terms of dealing with future substance abused patients.

Skills: 1. Identify the classification, mechanism of action, indication, contraindications and adverse effects of the drugs used by the patient in the drug study. 2. Explain Nursing Care Plan on the identified and prioritized problems for substance abuse. 3. Present recommendations in areas that need improvement basing on the case.

BSN4A (GROUP 2)4 Attitude: 1. Demonstrate a positive attitude in caring for clients who have undergone substance abuse. 2. Participate attentively in presenting the case of the patient 3. Verbalize changes in outlook towards substance abused patients. 4. Display a positive behavior towards the possibility of having future patients with such disorder.

BSN4A (GROUP 2)5 III. Anatomy and Physiology of the Nervous System

Structures of the Nervous System A. The neurologic system consists of two main divisions, the central nervous system (CNS) and the peripheral nervous system (PNS). The autonomic nervous system (ANS) is composed of both central and peripheral elements. 1. The CNS is composed of the brain and spinal cord. 2. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the spinal nerves. 3. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory) nuclei in the brain and spinal cord. Its peripheral division is made up of visceral efferent and afferent nerve fibers as well as autonomic and sensory ganglia. B. The brain is covered by three membranes. 1. The dura matter is a fibrous, connective containing vessels. 2. The arachnoid membrane is a delicate serous membrane. 3. The pia matter is a vascular membrane. C. The spinal cord extends from the medulla oblongata to the lower border of the first lumbar vertebrae. It contains millions of nerve fibers, and it consists of 31 nerves 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral. D. Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia matter. It flows through the foramen of Monro into to the third ventricle, then through the aqueduct of Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen of Magendie and the two foramens of Luska. It then flows into the cistema magna, and tissue several structure blood

BSN4A (GROUP 2)6 finally it circulates to the subarachnoid space of the spinal cord, bathing both the brain and the spinal cord. Fluid is absorbed by the arachnoid membrane Functions of the Nervous System A. CNS 1. Brain a. The cerebrum is the center for consciousness, thought, memory, sensory input, and motor activity; it consists of two hemispheres (left and right) and four lobes, each with specific functions. i. The frontal voluntary lobe controls muscle

movements and contains motor areas, including the area for speech; it also contains the centers for personality, behavioral,

autonomic and intellectual functions and those for emotional and cardiac responses. ii. The temporal lobe is the center for taste, hearing and smell, and in the brains dominant hemisphere, the center for interpreting spoken language. iii. The parietal lobe coordinates and interprets sensory information from the opposite side of the body. iv. The occipital lobe interprets visual stimuli.

b. The thalamus further organizes cerebral function by transmitting impulses to and from the cerebrum. It also is responsible for primitive emotional responses, such as fear, and for distinguishing between pleasant and unpleasant stimuli.

BSN4A (GROUP 2)7 c. Lying beneath the thalamus, the hypothalamus is an

automatic center that regulates blood libido, pressure, appetite, temperature, breathing,

sleeping patterns, and peripheral nerve discharges associated with certain behavior and emotional expression. It also helps control pituitary secretion and stress reactions. d. The cerebellum or hindbrain,

controls smooth muscle movements, coordinates sensory impulses with muscle activity, and maintains

muscle tone and equilibrium. e. The brain stem, which includes the mesencephalon, pons, and medulla oblongata, relays nerve impulses between the brain and spinal cord. 2. The spinal cord forms a two-way conductor pathway between the brain stem and the PNS. It is also the reflex center for motor activities that do not involve brain control. B. The PNS connects the CNS to remote body regions and conducts signals to and from these areas and the spinal cord. C. The ANS regulates body functions such as digestion, respiration, and cardiovascular function. Supervised chiefly by the hypothalamus, the ANS contains two divisions. 1. The sympathetic nervous system serves as an emergency preparedness system, the flight-for-fight response. Sympathetic impulses increase greatly when the body is

BSN4A (GROUP 2)8 under physical or emotional stress causing bronchiole dilation, dilation of the heart and voluntary muscle blood vessels, stronger and faster heart contractions, peripheral blood vessel constriction, decreased peristalsis, and increased perspiration. Sympathetic stimuli are mediated by norepinephrine. 2. The parasympathetic nervous system is the dominant controller for most visceral effectors for most of the time. Parasympathetic impulses are mediated by acetylcholine. The main function of the nervous system is to keep a control over the systems of the body. Let us have a look at the various functions of the nervous system in the following list.

1. Sensory receptors of the nervous system are useful for the extraction of information from the environment and sending it to the central nervous system. The sensory neurons carry the information from sensory receptors to the central nervous system. 2. The central nervous system collects information from the sensory receptors and carries out the processing. The task of transferring and interpreting the information is carried out by the interneurons. 3. The peripheral nervous system sends information processed in the central nervous system to the glands and muscles of the body. An appropriate response is then activated by these glands or muscles. The motor neurons carry out the function of sending instructions to muscles or glands. 4. The autonomous nervous system responds involuntarily, i.e. it may not have to depend on the brain to activate the responses. The involuntary processes of the body such as breathing, digestion, body temperature regulation, etc., are carried out by the autonomous nervous system. 5. The autonomous nervous system is sub-divided into sympathetic and parasympathetic nervous systems. The former helps increase the activity of the autonomous nervous system while the later acts in a reverse manner.

BSN4A (GROUP 2)9 6. Coordination of body movements and homeostasis is carried out by the hind brain. Hind brain consists of different parts such as medulla, cerebellum and pons. 7. The receptors are classified as exteroceptors, interoceptors and proprioceptors. The exteroceptors are used by the nervous system in smelling, listening, looking, touching, tasting and feeling. The signals associated with blood pressure, alimentary canal, bladder and osmotic pressure of blood plasma are received by the interoceptors. The movement and position of body parts is tracked by the proprioceptors. 8. The kind of stimulus received by receptors in also one of the mode of classifying the receptors. Chemical receptors, mechanoreceptors and thermoreceptors are different types of receptors classified on the basis of the above-mentioned criteria. 9. Thermoreceptors which consist of 'warmth' and 'cold' fibers are excited by rising and falling temperatures respectively. The mechanoreceptors carry information about the mechanical stimulation to the central nervous system. The chemical receptors are subdivided into olfactory, gustatory and glucose detectors, which are responsible for detecting smell, taste and glucose respectively. The glucose detectors are also responsible for providing information about the acid-base balance in the body.

BSN4A (GROUP 2)10 IV. Definition of Terms

1. Cranial nerves-The nerves of the brain, which emerge from or enter the skull (the cranium), as opposed to the spinal nerves, which emerge from the vertebral column. There are 12 cranial nerves, each of which is accorded a Roman numeral and a name 2. Illicit drugs- a substance that alters the mind in a psychoactive way but is illegal in the eyes of the law and punishable with criminal justice 3. Impulse- a wave of excitation transmitted through tissues and especially nerve fibers and muscles that results in physiological activity or inhibition. 4. Libido- the psychic and emotional energy associated with instinctual biological drives. 5. Pons -A part of the brain located in the brainstem. It contains nerve fibers that carry information to and from the cerebral cortex, as well as between several other areas of the brain. Some functions of the pons include breathing and arousal, feeling and movement in the face and eyes, and hearing. 6. Psychoactive substance- a drug that can produce mood changes and distorted perceptions. 7. Shabu- street name for methamphetamine 8. Spinal nerve- Any of the nerves that arise in pairs from the spinal cord. There are 31 pairs of spinal nerves in the human body. 9. Therapeutic regimen - means a systematic plan for therapy (often including diet) to cure or treat a disease.

BSN4A (GROUP 2)11 V. Baseline Data Name: Address: Age: Birth Date: Birth Place: Gender: Marital Status: Number of Dependents: Religion: Educational Level: Nationality: Occupation: Person next to kin: Relationship: Date of Admission: Attending Physician: Chief Complaint: L.J. Jaro, Ilo-ilo City 31 years old March 13, 1981 Jaro, Ilo-ilo City Male Single 2 Roman Catholic College Undergraduate (Caregiver) Filipino None M.J. Mother March 22, 2012 Dr. Gauzon Reaction to Drugs (Marijuana and Methamphetamine): uncontrolled addiction to drugs, sleep deprivation and headache Name of Agency: Research Education and Concern to Help Foundation (REACH)

BSN4A (GROUP 2)12 Last Use of Drugs: Length of drug use: Frequency: Source of Drugs: Number of Times Admitted: Diagnosis: 2012 More than 6 yrs Daily Friends/Peers 2 Substance Abuse (Methamphetamine and Marijuana)

BSN4A (GROUP 2)13 VI. Nursing History (Anamnesis) Eriksons Stages of Psychosocial Development One of the main elements of Erikson's psychosocial stage theory is the development of ego identity.Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly Prenatal- The pregnancy was planned and it is accepted. His parents used family planning methods such as oral contraceptives or pills. His mother does not have any illnesses or vices during pregnancy and she submits herself for prenatal check-up and complies with supplementations. Personal History Patients Anamnesis

Freuds Developmental Stages Freud believed that personality develops through a series of childhood stages during which the pleasureseeking energies of the id become focused on certain erogenous areas. This psychosexual energy,

or libido was described as the changing due to new experiences driving force behind behavior. If these psychosexual stages are completed successfully, the result is a healthy personality. If certain issues are not resolved at the appropriate stage, fixation can occur. A fixation is a persistent focus on an earlier psychosexual stage. Until this conflict is resolved, the individual will remain "stuck" in this stage. and information we acquire in our daily interactions with others. In addition to ego identity, Erikson also believed that a sense of competence motivates behaviors and actions. Each stage in Erikson's theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which is sometimes referred to as ego strength or ego quality.If the stage is managed poorly, the person will emerge with a sense of inadequacy. In each stage, Erikson believed people experience a conflict that serves as a turning point in development. In Erikson's view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for

Delivery- The type of delivery was normal spontaneous vaginal delivery. The general condition of the baby was good.

BSN4A (GROUP 2)14 failure. (http:// psychology .about.com)

1.) Oral Stage (birth- 18 months) in this stage, the critical experience is weaning or withholding breastfeeding. This may cause a lot of stress to the infant since he become dependent on is mothers milk to nourish him. This anxiety may bring problems with eating and habits such as smoking or biting nails. This is because the center of pleasure is derived trough the stimulation of the mouth such as sucking, biting and swallowing at this point. A wide range of adult behaviors from excessive optimisms to sarcasm, cynicism, pessimism has been attributed to problems during this stage fixation at this stage characterized by narcissism and incorporation of loved objects (the instinctual behavior that motivates the person to receive gratification by symbolically swallowing the important others).

1.)

Trust vs. Mistrust

His mother was the significant person in his life. He grew up in Iloilo City with the care of his mother and father. Just like any other child, he does not want to be away with his parents but sometimes he also likes to be with other people like his grandparents and relatives. He learned to crawl at 7 months, stood with assistance at 10 months and walked at 1 year. He was weaned at the age of 9 months, biscuits such as Marie, cereals and rice was the usual food given to him. Different foods were introduced to him by his parents gradually.

(birth- 1 year/ infancy) Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child's caregivers. If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable.

BSN4A (GROUP 2)15 (Pillitteri, A. (2007), Maternal and Child Health Nursing 6th edition, pp. 398)

2. Anal Stage (18 months- 3 years) during the anal stage, sexual gratification shifts to the anus. This occurs during the period of toilet training. The child is concerned with retaining or letting go of the feces, problems occurring in resolution of this phase may result to the rebelliousness and an exaggerated need to be in control across the lifespan. If fixation is with retention or holding in the adult may be excessively clean, neat and compulsive. If however, compulsion is the problem the adult may be dirty, wasteful and extravagant.

2. Autonomy vs. Shame and Doubt (1-3 years/ toddler) Erikson believe that learning to control one's bodily functions leads to a feeling of control and a sense of independence. Other important events include gaining more control over food choices, toy preferences, and clothing selection. Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and selfdoubt.

The patient was toilet trained by his mother when he was between 2-3 years of age. He was provided with his own urinal/ potty to be use when he feels the urge to urinate or defecate in order for him not to wet his pants or briefs.

He loves to play with any kind of toy but his favorite was cars and trucks. He plays independently and tries to follow simple instructions of his mother such as arranging his toys properly after playing. He was very active and enthusiastic.

He also had temper tantrums, which is very common to all toddlers, he would usually cry if he was not able to get what he want and his mother would sometimes ignore him or offer him with toys or foods for him to stop his tantrums.

3. Phallic stage (3-6 years) is the setting for the greatest, most crucial sexual conflict in Freud's model of

3.Initiative vs. Guilt (3-5 years/P r e s c h o o l ) The stage is important in developing initiative which paves

He entered kinder at Tapas Elementary School in Capiz at the age of 5. During his preschool, he was shy and he

BSN4A (GROUP 2)16 development. In this stage, the child's erogenous zone is the genital region. As the child becomes more interested in his genitals, and in the genitals of others, conflict arises. The conflict, labeled the Oedipus complex (The Electra complex in women), involves the child's unconscious desire to possess the opposite-sexed parent and to eliminate the same-sexed one. Fixation at the phallic stage develops a phallic character, who is reckless, resolute, selfassured, and narcissistic-excessively vain and proud. The failure to resolve the conflict can also cause a person to be afraid or incapable of close love; Freud also postulated that fixation could be a root cause of homosexuality. (www.victorianweb.com) the way in forming direction and purpose. Acting as strengths to be resolve. (Pilliteri 2007). Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of initiative. (http://psychology.about.com) Although he was very close to his mother, he was aware of his gender identity as a man and he try to imitate his father. wanted his parents to be with him. On the later days, he was able to adjust and have playmates. He loves to play with his classmates and friends and enjoys his accomplishments in play. At this stage also, he asked questions frequently.

4.Latency Stage (6- 12 years) the early school age years constitute a period of quiescence. The child begins to submit the demand of the super ego and sublimate instincts. The way the person handles the internal and external demands, for better or for worse, becomes 4. Industry vs. Inferiority (5 to 11 years/ school age) Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities. Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief

He studied elementary at Colegio de San Jose, Iloilo. His grades were fairly good/ passing and he tend to get help from his mother in making his assignments. He like sports such as basketball, he also like to watch movies and listen to music. When he was in Grade 6, his

BSN4A (GROUP 2)17 consolidated during this time. in their skills. Those who receive Peer group experience, intellectual growth and group identification are the critical little or no encouragement from parents, teachers, or peers will doubt their abilities to be left arm was fractured while he was playing basketball with his friends, cast was applied. They stayed in the hospital for one week because of that incident. After a few weeks, he was able to continue his normal activities and continue to play basketball. According to him, he was not the kind of person who wanted to take the lead instead he was *Pre-puberty and adolescence (12- 15 years old) This is the stage where heterosexual relationships are established the task which is to develop social control over instincts. Identity, turmoil and consideration of needs of others (Pilliteri 2007). just contented being a follower.

experiences during this stage. successful. Fixation result in difficulty in identifying with others and in developing social skills , resulting in a sense of adequacy and inferiority.

5. Genital Stage (15 yearsadult) at the start of adolescence, this final stage begins. Heterosexual behavior is evident and person undertakes various activities in preparation for marriage and family. Sexual maturity is reach at this stage. The major task is to resolve dependentindependent conflict. Inability to negotiate this stage could result in difficulties in becoming

5. Identity vs. Confusion (12-18 years/ adolescence) Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will feel insecure and confused about themselves and the future. (http://psychology.about.com/)

In 1999, before he entered college, he stated that he was already taking up prohibited substances like shabu.

The patient states that he had his first girlfriend when he was 15 years old but unfortunately, they broke up. And when he was 16 years old, he got his second girlfriend pregnant but still he continues studying at San Agustin University taking up Computer Engineering. He and his girlfriend decided to live

BSN4A (GROUP 2)18 emotionally and financially independent, lack of strong personal identity and future goals and inability to form satisfying intimate relationship (Pilliteri, 2007). in with the guidance of his girlfriends parents. After 2 years, they had their second child.

6.Intimacy vs. Isolation (19- 35 years/ young adulthood) This stage covers the period of early adulthood when people are exploring personal relationships. Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will form relationships that are committed and secure. Remember that each step builds on skills learned in previous steps. Erikson believed that a strong sense of personal identity was important for developing intimate relationships. Studies

Unsatisfied with the course he had taken up, he shifted into another course which is Caregiver at the age of 25.

Forming adult, the patient has meaningful attachments with others and they had a close family tie.

When his family found out about this, they admitted him to New Life Rehabilitation Center in iloilo. In year 2009, he was detoxified and after 3 months, he was discharged but still he continues to take drugs for

have demonstrated that those with about 3 years. a poor sense of self tend to have less committed relationships and are more likely to suffer emotional isolation, loneliness, and depression. (http://psychology.about.com/) Now that he is still confined at the facility, he believes that he will be able to avoid the On March 22, 2012, L.J. had his second admission at REACH in Bacolod City with Dr. Gauzon as the attending physician.

BSN4A (GROUP 2)19 temptations around him. He has faith in God that He will guide him and will help them to change for the better. And if he will be discharge soon, he would like to apologize to his family especially to the parents of his girlfriend and to their children.

BSN4A (GROUP 2)20 VII. Mental Status Examination

A. Baseline Data Name: Address: Age: Birth Date: Birth Place: Gender: Marital Status: Number of Dependents: Religion: Educational Level: Nationality: Occupation: Person next to kin: Relationship: Date of Admission: Attending Physician: Chief Complaint: L.J. Jaro, Ilo-ilo City 31 years old March 13, 1981 Jaro, Ilo-ilo City Male Single 2 Roman Catholic Undergraduate (Caregiver) Filipino None M.J. Mother March 22, 2012 Dr. Gauzon Reaction to Drugs (Marijuana and Methamphetamine): uncontrolled addiction to drugs, sleep deprivation and headache

BSN4A (GROUP 2)21 Name of Agency: Research Education and Concern to Help Foundation (REACH) Last Use of Drugs: Length of drug use: Frequency: Source of Drugs: Number of Times Admitted: Diagnosis: Nursing Diagnoses: 1. Disturbed sleep pattern related to excessive daytime sleeping secondary to medications as evidenced by difficulty falling asleep at night, long hours of sleep at daytime and fatigue on awakening. 2. Risk for loneliness related to therapeutic isolation secondary to substance abuse. B. History of Present Illness In 1999 L.J. started taking illegal drugs (methamphetamine and marijuana) back when he was in high school. It was first introduced to him by his high school friends. Since then, he continued taking methamphetamine until the year 2009. Patient claims their family has a history of Diabetes Mellitus and Hypertension. He was an alcoholic and a chronic smoker. In the year 2009, L.J. was detoxified and was admitted in the New Life Rehabilitation Center at Iloilo. He was discharged after three months of stay in the rehabilitation center. However, a week after his discharge, the client started taking methamphetamine again and it continued until for about three years. On March 22, 2012, L.J. had his second admission at REACH in Bacolod City with Dr. Gauzon as the attending physician. The client is admitted for about five months and is still currently inside the institution. 2012 More than 6 yrs Daily Friends/Peers 2 Substance Abuse

BSN4A (GROUP 2)22 Prior to admission, L.J. complained of uncontrolled addiction to drugs, sleep deprivation and headache. He was brought for consultation and physical exam; X-Ray, Urinalysis, Stool Exam and CBC were done. A week after the admission patient claimed that signs and symptoms did not persist. He was given medications listed as follows: Nutricee 500 mg, OD Polynerve 500 mg, OD Benadryl 50mg,ODHS Rivotril D/C when consumed

1. General Appearance and Behavior The client appears normal. In terms of neatness, the client wears clean clothing and fixes his hair with hair gel. His nails were short and clean. The clients attend to his daily hygiene in the center. In terms of the clients behavior, he can be considered an extrovert type, mingling always with the crowd in the institution. During activities, like Morning Prayer for example, the client always participates actively and volunteers to reflect and give sentiments upon the topics discussed. Out of the group, L.J. is the most outgoing and participative. During nurse-patient interaction, he freely opens up topics to the student nurse. He likes to talk about his past life events, especially his love life. The client is talkative most of the time and jokes around with his fellow mates. L.J. manages well his daily activities without any assistance needed. He was cooperative and interactive during the interview for the Mental Status Examination. 2. Characteristics of Speech and Communication Pattern During the interactions and the interviews, the client talks within the range of volume of a casual conversation and talks in a well-modulated voice. He speaks clearly and talks with

BSN4A (GROUP 2)23 hand gestures most of the time. However, there are times that the client would have

difficulty recalling or pronouncing foreign words and past events. All in all, no abnormal characteristic of speech was noted and his communication pattern was normal. 3. Mood and Affect The client is in good mood at all times. He is energetic and outgoing in every activity that the student nurses would give and also being participative in every conversation as well. The client displays a normal affect at all times. This can be seen in conversations and activities throughout the week of exposure. L.J. displays an appropriate affect for every situation which is evidenced during varied activities such as smiling when he is enjoying and covering his face when he is a bit embarrassed. However, during conversations, the client cannot establish a straight eye contact and tends to look left to right most of the time. 4. Thought Process and Content In terms of the thought process of the client, it was noted as normal, with no loose association or tangentiality noted. He speaks normally with every idea coherent and correlated to each other. His sentences were also well organized with proper grammar and pronunciation of words and are easily understandable. All in all, no abnormal patterns were noted. 5. Sensorium Function Orientation 10 Khans Questions: a. What is the name of this institution? REACH

b. Where is it located? Paglaum, Bacolod

c. What day of the week is today? Huwebes (Thursday)

d. What is the month now?

BSN4A (GROUP 2)24 August

e. What is the year now? 2012

f. How old are you? 31 na ako

g. What month were you born? March

h. What year were you born? 1981

i. Who is the president now? Si Noynoy Aquino

j. Who was the president before? Evaluation: The patient is oriented to place, date and time. He ans wered 10 out of 10 in Khans questions correctly. He recognizes the institution where he is now as well as the location of the institution. The client is oriented to the exact day of the week as well as to his birthdate. All in all, the client has no organic brain syndrome. Memory/ Recall Immediate- Intact immediate memory was evidenced by NURSE: Sino gani ang una nag interview sa imo? PATIENT: Siya oh, siAljay Correct Recent- Intact recent memory as evidenced by NURSE: Ano nakita mo sang isa ka semana sa balita oh? si Gloria Macapagal Arroyo

BSN4A (GROUP 2)25 PATIENT: Ahw. Grabe ang ulan sa Manila, grabe to ya ang baha sa ila Correct Remote- Intact far past as evidenced by NURSE: Sino ang una nga nagtudlo sa imo mag-gamit sang ilegal nga drugs? PATIENT: Akon nga barkada Correct. As seen in the chart, drugs were introduced to him by his friends when he was 19 years old. Rote -Poor remote memory as evidenced by NURSE: Ano gani ang ngalan ko? Matandaan mo pa? PATIENT: Uhmmm.nalipat na ko! Client was unable to recall the name of the nurse which is Richard/ Bok. Attention/ Concentration The clients level of concentration and attention were tested through activities such as spelling challenges and mathematical questions. The client was asked to spell his complete name and was able to do it correctly. He was also asked to get the sum of sets of numbers and was able to answer them all correctly. 6. Insight and Judgment The clients judgment was tested by citing a situation requiring analysis regarding what he would do if he was placed in a situation wherein a stranger or his friend would offer him grams of shabu for free for a month. Without thinking further, L.J. answered that he would ignore it and would never return to drugs any more. He stated that half of his life was already wasted and he is already getting old. He stated that when he gets out of the institution, he would find a job at the call center since he was good at speaking and live a new life with his two sons again.

BSN4A (GROUP 2)26 On the other hand, the clients insight was tested by asking him if he knows th e reason why he is inside the facility. He said that he was placed here so that he could recover from his addiction to methamphetamine and start his life over again. 7. Prognosis Factors 1. Onset of Illness A. Early 20s and above 40s B. Between 20-40 2. Educational Attainment A. High school B. College 3. Sex A. Male B. Female 4. History of Present Illness A. Familial B. None 5. History of Admission A. Chronic B. Acute 6. Socio-economic Status A. Poor B. Rich 7. Family Support A. With family support B. Without family support 8. Pre-morbid Personality A. Introvert Good Poor

BSN4A (GROUP 2)27 B. Extrovert 9. Compliance medication A. With compliance B. Without compliance

Evaluation: Based on the evaluation done, it has been found out that the client has good prognosis with six (6) checks out of nine criterions. This means that the client has the ability to cope easily since he has a supportive family and has a good economic status. In addition, he also takes his medications as prescribed and has an extrovert personality. However, since the patient started at the age of 19 years old, and already has a chronic case, this having only 3 checks in the poor column does not guarantee a good prognosis since the selected ones in the poor columns have greater weight compared to the other 6. Since the client is a male, this makes him more prone to suppress his feelings, compared to women that are expressive. This is one factor that leads more men to choose using drugs resort to forget their problems. During our week exposure in REACH, we were able to interviewed the nurse on duty, he stated that L.J. was caught smoking which is another contributing factor that affect his prognosis. In addition, the client has been admitted twice, with his first admission last 2009 and has been a chronic user since 1999. Therefore, with these four contributing factors, it can be concluded that the client can be theoretically categorized as under poor prognosis. 8. Reliability The percentage of the reliability of the information is 90%. This is for the following reasons:

BSN4A (GROUP 2)28 -The client has a normal and organized way of thinking as evidenced by his statements which are congruent to those stated in the chart. - Not able to interview L.J.s significant others. - The statements given by the client was verified with the staff nurse and the chart -The remaining 10% was considered unreliable since the client wasnt able to remember every exact detail of his past events especially during the first years of his drug abuse. In addition, we were not able to interview significant others about patient L.J, thus validity of data are affected. 9. References/ Informant of Information Client Patients Chart Verification with the staff nurse