Table of Contents

I. Introduction -------------------------------------------------------------------------------------------------2 A. Background of the Study -----------------------------------------------------------------------------2 B. Significance of the Study -----------------------------------------------------------------------------3

II.

Psychiatric Nursing Assessment --------------------------------------------------------------------4 A. Patients Profile -----------------------------------------------------------------------------------------4 B. Chief Co !laint -----------------------------------------------------------------------------------------4 C. "istory of Present #llness -----------------------------------------------------------------------------4 $. Past %edical "istory -----------------------------------------------------------------------------------4 &. Past Psychiatric "istory ------------------------------------------------------------------------------4 '. 'a ilial "istory -----------------------------------------------------------------------------------------4 (. Personal "istory ----------------------------------------------------------------------------------------4 ". %ental Status &)a ination --------------------------------------------------------------------------* #. # !ression+$iagnosis ---------------------------------------------------------------------------------,

III.

Clinical Discussion of the Disease-------------------------------------------------------------------8 A. Psychodyna ics ---------------------------------------------------------------------------------------B. Psycho!atho!hysiology-------------------------------------------------------------------------------. C. /aboratory and $iagnostic &)a ination --------------------------------------------------------01 $. $rug Study ---------------------------------------------------------------------------------------------02

IV.

Nursing Care Plan ---------------------------------------------------------------------------------------14 A. Proble /ist ---------------------------------------------------------------------------------------04

B. 2ursing Care Plan -------------------------------------------------------------------------------0*

V.

Process

ecording

--------------------------------------------------------------------------------------1! VI. Psychothera"ies -----------------------------------------------------------------------------------------#8 VII. $i%liogra"hy -----------------------------------------------------------------------------------------------41

APP&NDIC&' ---------------------------------------------------------------------------------------------------42 (ental 'tatus &)amination ---------------------------------------------------------------------------------A Process ecording --------------------------------------------------------------------------------------------$

eflection ---------------------------------------------------------------------------------------------------------C

#. #2T34$5CT#42 A. Background of the Study

Schi6o!hrenia is a !sychiatric diagnosis that describes a ental disorder characteri6ed by abnor alities in the !erce!tion or e)!ression of reality. #t ost co only anifests as auditory hallucinations7 !aranoid or bi6arre delusions or disorgani6ed s!eech and thinking in the conte)t of significant social or occu!ational dysfunction. 4nset of sy !to s ty!ically occurs in young adulthood. $iagnosis is based on the !atient8s self-re!orted e)!eriences and obser9ed beha9ior. 2o laboratory test for schi6o!hrenia currently e)ists. 2

The sy !to s of schi6o!hrenia are categori6ed into t:o a;or categories7 the !ositi9e or hard sy !to s :hich include delusion7 hallucinations7 and grossly disorgani6ed thinking7 s!eech7 and beha9ior7 and negati9e or soft sy !to s as flat affect7 lack of 9olition7 and social :ithdra:al or disco fort. There are * categories of schi6o!hrenia< Catatonic7 $isorgani6ed7 Paranoid7 3esidual7 and 5ndifferentiated. Catatonic schi6o!hrenia in9ol9es a disturbance in o9e ent7 9oluntary o9e ent for !rolonged !eriods of ti e. Disorgani*ed schi6o!hrenia in9ol9es7 a disorgani6ed thought !rocess = e otionally7 entally and 9erbally. Paranoid schi6o!hrenia is !ri arily characteri6ed by hallucinations and delusions >!erha!s about !ersecution or cons!iracies directed against the sufferer?. esidual schi6o!hrenia is diagnosed :hen the !atient isn8t really dis!laying significant sy !to s. The !erson is no longer in an acute schi6o!hrenic !hase7 but ay e)!erience sy !to s that are either less fre@uent or less se9ere than they :ere during the !eak of the disorder. +ndifferentiated schi6o!hrenia is characteri6ed by i)ed schi6o!hrenic sy !to s >of other ty!es? along :ith disturbances of thought7 affect7 and beha9ior. #t is diagnosed :hen one doesn8t ha9e the full sy !to s of one of the other subty!es. #n this study7 undifferentiated schi6o!hrenia :ill be used for the case analysis.

Aorld:ide about 0 !ercent of the !o!ulation is diagnosed :ith schi6o!hrenia. About 0.* illion !eo!le :ill be diagnosed :ith schi6o!hrenia this year around the :orld. > entalhel!.net?. 2inety-fi9e !ercent >.*B? suffer a lifeti eC thirty-three !ercent >33B? of all ho eless A ericans suffer fro schi6o!hreniaC fifty !ercent >*1B? e)!erience serious side effects fro edicationsC and ten !ercent >01B? kill the sel9es >Deltner7 211,?. According to study done E.,7*43 out of -E72407E., of 'ili!inos or a!!ro)i ately 1.-B are suffering fro schi6o!hrenia >cureresearch.co ?.

+ndifferentiated 'chi*o"hrenia is anifested by !ronounced delusions7 hallucinations7 and disorgani6ed thought !rocesses and beha9ior. The undifferentiated subty!e is diagnosed :hen !eo!le ha9e sy !to s of schi6o!hrenia that are not sufficiently for ed or s!ecific enough to !er it classification of the illness into one of the other subty!es. Patients in this category ha9e the characteristics of !ositi9e and negati9e sy !to s of schi6o!hrenia but do not eet the s!ecific criteria for the !aranoid7 disorgani6ed or catatonic subty!es. 4nset of sy !to s ty!ically occurs in young adulthood :ith around 0.*B !re9alence of the !o!ulation affected. The disorder is thought to ainly affect cognition7 but it also usually contributes to chronic !roble s :ith beha9ior and e otion 3

 5ndifferentiated schi6o!hrenia is a difficult diagnosis to ake :ith any confidence because it de!ends on establishing the slo:ly !rogressi9e de9elo! ent of the characteristic Fnegati9eG sy !to s of schi6o!hrenia :ithout any history of hallucinations7 delusions7 or other anifestations of an earlier !sychotic e!isode7 and :ith significant changes in !ersonal beha9ior7 anifest as a arked loss of interest7 idleness7 and social :ithdra:al. #t can be also based on the self-re!orted e)!eriences of the !erson7 and abnor alities in beha9ior re!orted by fa ily e bers7 friends7 or co:orkers7 follo:ed by a clinical assess ent by a ental health !rofessional. $iagnosis of undifferentiated subty!e ay best describe the i)ed clinical syndro e.

B. Significance of the Study (eneral 4b;ecti9e< The ain ob;ecti9e of this case study is to be able to !resent an e)tensi9e and co !rehensi9e case study of the chosen client that :ould !resent a co !rehensi9e discussion of Schi6o!hrenia7 5ndifferentiated to yield i !ortant infor ation for this case analysis. S!ecific 4b;ecti9e< #n order to eet the general ob;ecti9e7 the grou! ai s to<

Assess and inter!ret the !ertinent data gathered fro the !atient $eter ine the etiology factors >!reci!itating and !redis!osing? of the ental disorder &9aluate the !resence or absence of signs and sy !to s seen in the !atient in relation to the ental disorder 'or ulate effecti9e7 s!ecific7 easurable7 attainable7 realistic and ti e-bounded nursing care !lans base on identified actual and !otential nursing !roble s Pro9ide a!!ro!riate nursing care directed to:ards not only to the clients !sychological but also his !hysical :ell-being

##. PSHC"#AT3#C 253S#2( ASS&SS%&2T A. Patients Profile Sir I is a 4, year old7 ale7 'ili!ino and 3o an Catholic. "e is single and :as born on A!ril 47 0.E3 in 4ccidental %indoro. "e li9es at San %iguel "eights7 Jalen6uela City. "is educational attain ent is Jocational. The date of his ad ission is $ece ber 47 211E >3e-ad ission? :ith an ad itting $iagnosis of '21.3 5ndifferentiated Schi6o!hrenia7 unstable. B. Chief Co !laint 4

at

According to his sister in la:7 F$i natutulog7 aya: u ino ainitin and ulo.G

ng ga ot7 nag:a:ala

C. "istory of Present #llness The !atient has been entally ill since 0..1. "e :as read itted on $ece ber 47 211E in 2ational Center for %ental "ealth :ith the sa e diagnosis. "e had an irregular check-u! until his significant others noticed that he doesnt slee!s7 doesnt :ant to take edicines7 beca e short te !ered and sho:ed irrational beha9ior. $. Past %edical "istory "e has no history of sei6ure. Prior to ad ission7 the !atient :as non-diabetic7 non-hy!ertensi9e7 non-asth atic. &. Past Psychiatric "istory "e :as entally ill since the onset of attention of crisis during 0..1s. "e had an irregular check-u! until he :as obser9ed to beco e non-functional at ho e and beca e distracted. "ence7 his fa ily read its hi in the sa e institution. '. 'a ilial "istory "is father is deceased. There :ere no histories of diabetes ellitus7 or suicide atte !ts in the both side of his fa ily. There is no trace of any ental disorders in the clients fa ily. (. Personal "istory The !atient is a 9ocational graduate. "e s okes cigarette and drinks alcoholic be9erage but :ith no use of illegal drugs. "e has no suicidal and ho icidal tendencies. According to the !atient7 he studied for 2 years and :ork as a sea an7 radio o!erator7 guard7 i !rinting shirts and a agtatabakoG. "e :as self-su!!orting student and he said that his fa ily is fa ous in their !lace though he is !oor and he is ill. ". %ental Status &)a ination

".0 (eneral A!!earance and Beha9ior The !atient is tall and thin in ter s of uscularity7 :ith fair bro:n co !le)ion7 and

has short black hair :ith strands of :hite. "e has :ounds and lesions on right and left elbo: and has diabetic feet. 4n the first day of the nurse-!atient interaction7 he had his clothes ke!t not that clean and !leasant. "o:e9er on the second day7 he had taken a 5

bath and his unifor

:as neatly !ressed. "e also sha9ed his beard. "e has a hoarse7

husky and rough 9oice and intonation. "e :alks slo:ly :ith a shuffling gait. "e sits :ith his legs crossed and ta!s his one foot at ti es. Ahen he hears his na e7 he looks to his side and see :ho is calling. At ti es7 he leans for:ard :hile talking7 still but res!ond to light. ".2 Affect The !atient dis!layed a blunted or restricted affect during the first inutes of the aintaining good and straight eye contact throughout the interaction. "is eyes are dilated at ti es

interaction7 and once in a :hile7 sho:ed generally a!!ro!riate affect. #n an ob;ecti9e anner7 he a!!ears to be serious but he :as able to s ile for a second es!ecially if he feels that :ay. ".3 %ood $uring the inter9ie:7 he stated that he kno:s he has a !roble and he is ill.

"e :as :orried about his feet and ke!t re!eating that he needs FbayabasG. "e is used to touch his head !art and so eti es7 his face. 4b;ecti9ely7 he a!!ears to be concern on his situation :hile looking at his feet. 4nce in a :hile7 he s iles es!ecially if the to!ic is :orth s iling for.

".4 Thought Processes

The !atient s!eaks in a loud and s!ontaneous

anner. "e s!eaks 'ili!ino all the

ti e. "is s!eech is so eti es unclear and there are :ords that are !oorly articulated aking it difficult to understand. "is thoughts are generally logical7 and ans:er the @uestions being asked to hi by the student nurse. "e also anifests looseness of 6

association but he still

anages to ans:er so e @uestions. So eti es7 he also ediately. "e is @uite circu stantial7 another

anifest blocking but returns to function i

ans:ers @uestions but includes unnecessary details and ski!s one to!ic fro

ha9ing flight of ideas7 looseness of association7 !erse9eration and tangential thinking.

".* Thought Content

The client belie9es that his fa ily is fa ous and :ell kno:n by other !eo!le. %oreo9er7 he is also !reoccu!ied :ith thought that he is infertile and he is not good on aking lo9e7 thats :hy his !ast girlfriends left her. #n addition7 he feels un:orthy of hi self es!ecially regarding the condition of his feet. "e like:ise said that his father is in (ua 7 :hen in fact his father already died. 'urther ore7 he is inconsistent in re e bering real situations that ha!!ened to hi . >About his occu!ation< he graduated on a 9ocational course?. 4ther than that7 there :ere no noted signs of hallucination or any illusion. ".E Cogniti9e &9aluation

The !atient is fully a:ake and alert throughout the inter9ie: and is oriented to ti e7 !lace :here he is7 !erson :ho is :ith hi 7 and date of the interaction. "e :as able to< s!ell the :ord Ia!an and Sala at7 count 0 to 01 and count it back:ards7 and recite the al!habet co !letely fro A to K. 4n the first day7 the eaning of Donnichi:a eaning again is inter!reted to hi . And on the second day7 he :as asked about its and he :as able to re e ber it. Patient has a recent >/angit7 lu!a7 !uno? gi9en to hi that he lo9es ans:er si !le !oe during the first

e ory intact for 2+3 :ords

inutes of inter9ie:. "e forgot the last

:ord for t:o consecuti9e ti es. Ahen he :as asked about his fa9orite song7 he said any songs but :as unable to enu erate e9en one. "e is also able to athe atical calculations such as addition. "e :as able to recite a

entitled FTutubiG and inter!ret a !ro9erb in accordance to his understanding. And 7

:hen he :as already on his roo 7 he :as shouting the 3 :ords >/angit7 lu!a7 !uno? correctly and in se@uence. #n addition7 he :as not able to recall 4 historical e9ents and forgot 0 !ast !resident in the Phili!!ines.

"., #nsight

Patient kno:s that he has !roble

that is :hy he :as ad itted at the hos!ital. es!ecially the condition of his feet. bayabas so that it :ill heal entioned that he is ore like

"e also thinks that the reason :hy he is not allo:ed to lea9e the hos!ital and go ho e is because the doctors there are studying hi i According to hi 7 he al:ays asks the nurse to gi9e hi :ith the use of edicine instead of herbal. "e also ade

ediately but he said that they al:ays refuse. "e kno:s that his :ound is treated

of a !risoner because he :as in the hos!ital for 24 years already unlike the !risoner :ho suffers only on the ;ail for 01 years. "e is already tired of co !lying :ith his edicines but he said that he needs to take his drugs e9eryday so that he can already go ho e. "e is also able to identify the reason :hy he :as ad itted in the institution by saying F2a babastos da: ako sabi ng hi!ag ko kaya !inasok nila ako ditoG. "e :as able to co!e u! in his stay in the hos!ital but still desire to be :ith his fa ily. ".- Iudg ent

The !atient has fair and sound decisions regarding his e9eryday acti9ities in the hos!ital. "e coo!erates :ell :ith the thera!ies he is engaging too. "e is ready to ans:er @uestions asked by the student nurse. "e said that :hen he :ill be able to go back in his ho e7 he :ill ;ust take a rest and ha9e fun. #. Ad itting $iagnosis< '21.3 5ndifferentiated Schi6o!hrenia7 unstable ###. C/#2#CA/ $#SC5SS#42 4' T"& $#S&AS&

A. Psychodyna ics

Psychodyna ics e9ol9ed fro the :ork of Bleuler and 'reud. Their :orks indicate that schi6o!hrenia de9elo!ed because of the !sychic alterations that occurred :ithin a !erson. #n addition7 these alterations are contingent on the !oor caregi9ing that is !ro9ided :ithin the childs en9iron ent. "o:e9er7 they belie9ed that the !sychic alterations are so eho: tied to the genetic or !hysiological changes that de9elo! :ithin the childs en9iron ent.

$#AT"&S#S ST3&SS T"&43H in Patients :ith Schi6o!hrenia<

#ndi9iduals de9elo! Schi6o!hrenia based on the interactions of a nu ber of factors. /ike in the case of our !atient :ho :as diagnosed to ha9e 5ndifferentiated Schi6o!hrenia7 unstable. "e :as a kno:n to be a s oker and an alcohol drinker. According to hi 7 he started s oking during his younger years and use of alcohol but in a oderate a ount. This is under the en9iron ental factor that ay contribute to the de9elo! ent of Schi6o!hrenia. Another factor is his inter!ersonal relationshi!. The client :as not able to for a strong su!!ort syste :hich is 9ery essential in aintaining an indi9iduals ental health. #ts a fact that a :eak su!!ort syste could result to trigger beha9iors or !sychological disorders. All these !redis!osition factors are in con;unction :ith the !resence of stressors. This odel suggests that ental disorders are the result of an interaction bet:een nature and nurture. As for our !atient another !ossible contributory factor is the lo:er socio econo ic status that can create an en9iron ent susce!tible to stress for ation leading to !sychological dysfunction. 'irst7 co !rehensi9e easures of life stress gi9e ore !recise infor ation about the !articular stressful circu stances hy!othesi6ed to interact :ith diatheses. Second7 the influence of the diathesis on a !erson8s life is ty!ically ignored7 :hich results in se9eral ty!es of !ossible bias in the assess ent of life stress. 'inally7 infor ation is a9ailable on diatheses and stress for s!ecific disorders to !ro9ide a foundation for ore e !irically based hy!otheses about diathesis-stress interactions.

B.

Psychopathophysiology
Co !ensatory 'actors< Age >21 year oldonset? 9 (ender >%ale?

$eco !ensatory 'actors< /o:er socio econo ic status &n9iron ental Stressors /ifestyle< Alcohol be9erage drinker and cigarette s oker Sy !to triggers< /o: selfconce!t

C. Laboratory results
$iagnostic &)a 'BS 2or al Jalues 3.* to *.* ol+/ Significant 'indings 4.3, Analysis+#nter!retation 2or al

10

Cholesterol Triglycerides B52

L less than *.2 L 2.20 2.-1 = E.41 ol+/

ol+/

E..0.20 4.3,

#ncreased due to congested in the li9er 2or al 2or al

ol+/

MMM Caligayahan %edical Clinic and /aboratory >'ebruary 0.7 2101?

$iagnostic &)a Cholesterol Triglycerides

2or al Jalues L less than *.2 .1-0*1 ol+d/ ol+/

Significant 'indings 2.. -0.E

Analysis+#nter!retation 2or al $ecreased due to etabolic syndro e characteri6ed by e)cess adi!ose or fatty tissues.

MMM 2C%" >August 037 211,?

$iagnostic &)a 'BS Cholesterol Triglycerides

2or al Jalues 3.* to *.* L less than *.2 .1-0*1 ol+d/ ol+/ ol+/

Significant 'indings 4.20 ,.14 0*1.1

Analysis+#nter!retation 2or al 2or al 2or al

MMM 2C%" >'ebruary .7 211,? $iagnostic &)a B52 5ric acid Sodiu Potassiu 2or al Jalues 2.-1 = E.41 ol+/ Significant 'indings *.3* 3*E.. u ol+/ 03..2 4.ol+/ ol+/ Analysis+#nter!retation 2or al 2or al 2or al 2or al

0**.11 = 42-.11 u ol+/ 03E.11 = 04*. 11 3.*1 = *.01 ol+/ ol+/

MMM 2C%" >'ebruary *7 211,? $iagnostic &)a "e oglobin &rythrocytes 2or al Jalues %< 03* = 0E1 g+/ %< 4.* = *.1 Significant 'indings 032 4.40,.2 1.12 1.14 Analysis+#nter!retation $ecreased due to abnor ality or disease. $ecreased due to enriched cholesterol #ncreased due to infection 2or al 2or al

Total ABC *.1 = 01.1 01N .+/ %onocytes 1.12 = 1.1E 01N .+/ &osino!hiles 1.10 = 1.1*1 01N .+/ MMM 2C%" >'ebruary 27 211,?

11

MMM2C%" >Iune 007 2101? $iagnostic &)a Alkaline Phos!hate S(4T S(PT Bilirubin7 Total Bilirubin7 $irect 2or al Jalues 21-041 #5+/ 01-34 #5+/ *-3* #5+/ 1.2-0.3 L1.3 g+d/ g+d/ Significant 'indings 2E.E 0-.2 0*.3 0.1.0* Analysis+#nter!retation 2or al 2or al 2or al #ncreased due to blockage of the bile ducts #ncreased due to blockage of the bile ducts

MMM 2C%" >$ece ber E7 211E?

Skin Cra!ing done on A!ril 27 211- in 2C%"< 34" >Pre!aration?< >O? 'ungal &le ents

$#A(24ST#C &PA%S< 3adiological< >Ianuary ,7 211-? C"&ST< Consider !ul onary arterial hy!ertension Pul onary e !hyse a bilateral 'ibriocalcific scarrings7 bilateral old rib fracture >Iuly 2E7 211,? &C(< 2on-s!ecific ST :a9e changes >'ebruary -7 211,?

D. Drug tu!y

12

Generic/ Brand/ Dosage/ Classificat ion

Mechani sm of Action 'loc(s !opa)i&e receptors i& brai& especially i& li)bic syste)* bloc( post sy&aptic D2 !opa)i&e

Indication

Contraindication

Side Effects

Nursing Responsi iliti es %+ssess )e&tal status #orie&tatio&. )oo!. beha0ior$ prior to a&! perio!ically !uri&g therapy %6o&itor /or tar!i0e !ys(i&esia #u&co&trolle! rhyth)ic )o0e)e&t o/ )outh. /ace. a&! e4tre)ities7 lip s)ac(i&g or puc(eri&g. pu//i&g o/ chee(s7 u&co&trolle! che2i&g. rapi! or 2or)%li(e )o0e)e&ts o/ to&gue$. 5eport i))e!iately7 )ay be irre0ersible. %5eport i&crease i& te)perature. hypote&sio&. )uscle rigi!ity #16 sy)pto)s$ %+s( patie&t to rise slo2ly to a0oi! orthostatic 13 hypote&sio&.

"aloperi !ol #"al!ol$

10 g "
% a&tipsychot ic

+cute a&! chro&ic psychotic !isor!ers i&clu!i&g, schi-ophre &ia. !rug% i&!uce! psychoses. +lso use/ul i& )a&agi&g aggressi0e or agitate! patie&ts.

"yper% se&siti0ity 1arro2 glauco)a 'o&e )arro2 !epressio& C1 !epressio&

ei-ures 34trapyra)i !al reactio&s Co&/usio& Dro2si&ess 5estless&es s Co&stipatio& Dry )outh

Generic/ Mechanis Indicatio Contraindication Brand/ m n Dosage/ of Action Classifica tion

Amlodipine 5 mg Calcium Channel Blocker ,osartan Antihypertensive

Side Effects

Nursing Responsi ilities

Aspirin 12 mg Analgesic

Antiinflammatory 7errous &rovides) sulphate 6 tab replaces 3I. elemental iron$ an essential 6 component in Iron formation of &reparation hemoglobin in red blood cell development

Inhibits influx Hyper-tension; !ick sinus &alpitations$ of calcium ion chronic stable syndrome; "nd or tachycardia$ across cell angina; #rd degree atrio- headache$ membranes to vasospastic ventricular block$ di''iness$ produce angina except %ith a fatigue relaxation of functioning coronary pacemaker vascular smooth muscle !electively -eduction in &atients %ho are .i''iness and blocks the the risk of hypersensitive to dose-related binding of cardio other orthostatic angiotensin II to vascular sulfonamidehypertension receptor sites in morbidity and derived drugs many tissues$ mortality in especially the hyper-tensive vascular smooth patients muscles and adrenal glands -elieves pain 3reatment of Hyper-sensitivity **43( and reduces mild-toto salicylates or di''iness; inflammation moderate pain 4!AI.!; tinnitus +I( by inhibition of hemophilia nausea; peripheral heartburn prostaglandin synthesis .ietary Hyper-sensitivity +I irritation$ supplement of to any ingredient$ anorexia$ iron hemosiderosis$ nausea$ hemolytic vomiting$ diarrhea &revention andanemia treatment of iron deficiency anemia

Assess cardiorespiratory status( angina pain$ B)&$ pulse$ respiration$ *C+ Advise client to avoid getting up too fast from a sitting or lying position +et up slo%ly and steady yourself to prevent a fall Assess patient/s B& before starting therapy and regularly thereafter Assess B)& and pulse 0onitor for adverse reactions

Assess pain( character$ location$ intensity$ -50 before and 6 hour after administration +ive %ith meals or after meal to avoid +I irritance 0onitor for adverse reaction( +I( nausea$ epigastric pain$ constipation$ diarrhea$ black stools$ anorexia 5thers( temporary teeth staining Caution patient to make position changes slo%ly to minimi'e orthostatic hypotension

89. 1:5 81; C+53 PL+1

A. ,I'- ./ P I. I-I0&D P'1C2IA- IC N+ 'IN3 DIA3N.'I'

14

Cues F Bakit ako kinuhanan noonQ (BP and weight).

Diagnosis

4ustification There :as an ob9ious anifestation of the !sychological !roble of the !atient that needs to be resol9ed for a !rogress in the rehabilitation of the client. According to hi 7 his father is for !etition in (ua 7 :hen in fact his father already died. #n addition7 he said that he :as being 9isited onthly but the last ti e :as still in the year of 211,.

$isturbed Thought Processes related to %ay kaso akoQG as disru!tion in cogniti9e 9erbali6ed by the !atient. and !sychological !rocess as anifested FBu:an-bu:an ako by ideas of delusions7 altered attention s!an dinadala:. %ga alas and disordered thought k:atro ng ha!on. Sabi ng se@uencing ka!atid ko !etition for (ua ang nanay ko. (anoon din ang tatay7 !etition for (ua .G as 9erbali6ed by the !atient.

F24 years na akong ganito. Tingnan o ang ga !aa ko. 2aluluto na. %akati siya7 kinaka ot ko na insan. 2aluluto na ang !aa ko. (usto ko ng bayabas !ara sa !aa ko.G as 9erbali6ed by the !atient.

# !aired skin integrity related to !resence of :ounds on lo:er e)tre ities as anifested by redness7 nu bness of affected area and !resence of itching and !ain at ti es.

The client :as noted to ha9e !resence of a diabetic feet and this is a concern since it ay !ossibly result to a further co !lication or infection. 3endering nursing inter9entions to the client is i !ortant to achie9e ti ely :ound healing.

ASS&SS%&2T Sub;ecti9e cues< F24 years na akong ganito. Tingnan o ang ga !aa ko. 2aluluto na.

$#A(24S#S # !aired skin integrity related to !resence of :ounds on lo:er e)tre ities as anifested by

P/A22#2( Short ter < After 0 day of nursing inter9entions7 the !atient :ill 9erbali6e the

#%P/&%&2TAT#42 #nde!endent< 2ote changes in skin color7 te)ture and turgor. Pal!ate skin lesions

3AT#42A/&

&JA/5AT#42 Short ter <

To !ro9ide baseline data

Assess ent

After 0 day of nursing inter9entions7 the !atient 9erbali6ed the

15

%akati siya7 kinaka ot ko na insan. 2aluluto na ang !aa ko. (usto ko ng bayabas !ara sa !aa ko.G as 9erbali6ed by the !atient.

redness7 nu bness of affected area and !resence of itching and !ain at ti es.

:illingness and ability to anage situation of cleaning his :ounds.

for the si6e7 sha!e7 consistency and te !erature and hydration. #ns!ect surrounding skin for erythe a7 induration and aceration. Dee! the area clean+ dry7 carefully clean the :ounds :ith antise!tic solution. &ncourage client to 9erbali6e feelings and discuss ho: to anage :ound cleaning on his o:n. $e9elo! re!ositioning of the client and encourage early a bulation. 5se a!!ro!riate !adding de9ices

!ur!oses to deter ine se9erity of skin integrity

:illingness and ability to anage situation of cleaning his :ounds.

/ong ter < 4b;ecti9e cues< Rdiabetic feet Rnu bness of affected area R!resence of itching and !ain at ti es Rdecreased self estee After :eeks of nursing inter9entions7 the !atient :ill dis!lay ti ely healing of skin lesion+:ounds !ressure sores :ithout co !lication.

/ong ter < To !re9ent infection After :eeks of nursing inter9entions7 the !atient still anifested !resence of itching and redness on the affected area. A!!earance of :ound :as still noted.

To increase inde!endence and concern on his condition

Pro otes circulation

To reduce !ressure and enhance circulation

$e!endent< Ad inister antibiotic for !ro!hyla)is as !rescribed by the !hysician To !re9ent infection

Ca!itol %edical Center Colleges

S4 Sto. $o ingo A9e.7 Tue6on City

9. P5<C3

53C<5D81;
16

1P8 = 1 #<rie&tatio& Phase$

$ate< August 0,7 2101C Tuesday Ti e< 02<4*-0<01 ! Setting< "all:ay 2a e< Sir I Age< 4, years old &ducational Attain ent< Jocational $ate of Ad ission< $ece ber 47 211E $iagnosis< '21.3 5ndifferentiated $iagnosis 5nstable Descri"tion of "atient5 The client is a tall and thin an7 :earing his unifor 7 not that neatly !ressed. "e is fully a:ake7 conscious7 alert and coo!erati9e. "e has a fair bro:n co !le)ion. "air is short and color black :ith strands of :hite hair. "e has a ustache. "is eyes are color black and ha9e a good eye contact. "e sits :ith legs crossed and ta!s his foot. There :as no unto:ard beha9ior e)!erienced during the nursing!atient interaction. Descri"tion of en6ironment5 Sir I is in the !a9ilion 20. $uring the first inutes7 the 2P# ha!!ened at the hall:ay outside the :ard because there :as no s!ace inside due to other affiliated schools acti9ity. #t :as a rainy and :indy day. The surrounding is slightly noisy because there are other students :ho are !resent outside the area. .%7ecti6es5 0. To establish ra!!ort and trust 2. To orient the client 3. To for contract :ith the client

4. To assess clients strengths and :eaknesses *. To hel! the client co unicate

253S& %agandang ha!on Io9en. Ako si $iana 4rti67 student nurse ng Ca!itol %edical Center. Ako ang agiging nurse o ngayong ara:7 bukas at ne)t :eek7 /unes at %artes. Ano ang gusto ong ita:ag ko sayoQ Io9en. 2agagalak akong akilala ka. Ako ang akakasa a o hanggang

Thera!eutic Techni@ue &stablish ra!!ort (i9ing infor ation

Patient Io9en. "o9en.

Analysis The !atient ans:ered the @uestion of the student nurse.

Ackno:leding

(usto ko ala an ang !agaaral.

The !atient chose a to!ic of con9ersation.

17

a aya 3 ! . %ay ga inihanda ka ing acti9ities !ara sa inyo. Ano ang gusto ong !agusa!an natin ngayonQ Pag-aaral. Daninong !agaaralQ Ah. (usto ong ala an ang !agaaral koQ 'ourth Hear na ako. #ka: na an ang gusto kong akilala. Ano nga !ala ang nagdala sa iyo ditoQ Ano ang nangyariQ

Pro9iding general leads

Seeking clarification

Sye !re sayo. Pagaaral o7 4o. $inala ako ng ka!atid kong babae dito noong 211E.

The client :as able to clarify :hat he :ants to talk about.

5se of o!enended @uestion Sabe hindi da: ako akausa! ng aayos at aya: ko da: u ino ng ga ot. 2ag:a:ala din ako insan. Seeking clarification 4o. 2agsa:a na ako. 24 years na akong u iino ng ga ot. Pero :ala na ing nangyayari7 2andito na ako noong 0..4 ta!os u alis ulit ta!os bu alik nitong 211E lang. Silence Pabalik-balik na lang ako lage. 4, years old na ako. (anoon !a din. %ay sakit !a din ako.

"e had re e bered the date :hen he :as brought to the institution but it :as not his sister :ho acco !anied hi . "e still kne: :hy he :as brought to the hos!ital.

Ang ibig ong sabihin hindi ka u iino ng ga otQ

"e 9erbali6ed his feelings about the situation.

"e anifested circu stantiality.

"e continued 9erbali6ation of :hat he feels and stating ho: old he is.

Ano ang ibig ong sabihin na ay sakit kaQ #bigQ

Pro9iding general leads

%ay sakit ako7 sabi ng doctor7 baog da: ako eh. "indi da: ako ibig. #ibig. Baog da: ako sabe ng ga doctor. "indi da: ako arunong aki!ag

Self-de!reciation

18

se). Sinabi nila iyonQ Seeking clarification 4o. (anoon siguro talaga !ag dukha. At !inagkaitan ng %ayka!al. 4kay na an. >Silence? Ang ga doctor dito !inagaaralan nila ang ga tao. Aya: ko na nga u ino ng ga ot eh !ero kailangan !ara u:i na. Parang hindi ka nanini:ala sa ga doctor na tu itingin sayoQ 'ocusing 24 years na akong ganito. Tingnan o ang ga !aa ko7 naluluto na. 2aluluto na. %akati siya. Dinaka ot ko na insan. 2aluluto na ang !aa ko. (usto ko ng bayabas !ara sa !aa ko. 4o. %ay !roble a kasi talaga ako. $i da: kasi ako arunong ag-se) eh. Sabi din na an ng ga naging girlfriend ko. #lan taon ka na baQ Ah ganoon. 4o. 'light of #deas Self-de!reciation

Ano ang narara da an ngayonQ

Pro9iding general leads

'ro his :ords7 it only sho:ed that he :as an)ious about his feet.

2akikita ko na asyadong kang nag-aalala sa iyong kalagayan.

Being tentati9e rather than absolute

/ooseness of Association

0. years old. %a aya !ala Io9en ay ga acti9ities tayo na inaasahan ko na agiging coo!erati9e ka. Tara doon tayo sa loob ag!atuloy ag-usa!. Anong !inagkakaabalahan o bago ka nag!unta ditoQ

5se of o!enended @uestion

2ag-aral ako dati. 2 years. Self- su!!orting ako7 naging radio o!erator sa /a 5nion. 2ag-i !rinta ng da it. 2ag stay din ako sa 4riental %indoro. Sea an7 dati interland7 ngayon international. Datulad ng tatay ko

So atic delusion

19

!ero !atay na siya ngayon. /ahat ng binanggit o ay naging trabaho oQ Silence 2ga !ala7 ay ala ibang salitaQ ka bang Seeking clarification 4o. Silence %eron. Arigato. "e :as able to re e ber the true eaning of the :ord taught to hi .

Ano ibig sabihin nunQ %ay isa !a akong ala . Donnichi:a. Donnichi:a. #big sabihin7 agandang ha!on. Danina ay nabanggit o yung tungkol sa tatay o. 2asaan na an ang nanay oQ

Seeking clarification

Sala at. Ano yunQ

(i9ing infor ation

Ah. %agandang ha!on !ala. $i ko ala . Aala na akong balita sa kanya eh. Sabi ng ka!atid kong babae7 hindi da: niya ala . Daya gusto ko talaga ka ustahin. Bu:an-bu:an ako dinadala:. %ga alas k:atro ng ha!on. Sabi ng ka!atid ko !etition for (ua ang nanay ko. (anoon din ang tatay7 !etition for (ua . Teka lang7 iihi una ako. $iyan ka na lang. %au!o ka na. Ako na lang ag-isa !u!unta ng banyo.

"e acce!ted ne: infor ation fro the student-nurse. "e :as able to ans:er the @uestion.

Pro9iding general leads

Dailan ka ba huling dinala: ng ka!atid oQ

Closed-ended @uestion

"e :as inconsistent about :hat he kno:s about his father.

>Tatayo sana ako !ara sa ahan siya?

"e sho:ed a ani!ulati9e beha9ior.

"indi sasa ahan na lang kita. Dahit dyan lang bago lu abas. %ala!it na tayo agsi ula sa ga acti9ities. %ada i

4ffering Self

Sige.

Su ari6ing and Planning

Sige7 $iana.

The client acce!ted the notion about :hat the

20

na din tayong na!agusa!an sa kalahating oras. Bukas na an ay as !alala:akin !a natin ang ga to!ic natin haQ 5!o ka na. Sala at.

student nurse told hi .

&9aluation and re arks<

The student nurse :as able to establish ra!!ort in order to gain the trust of the client. After introducing7 orienting and for ing contract7 the student nurse :as able to gather so e infor ation about the client es!ecially ho: :as he feeling by that ti e. "e :as ready to ans:er the @uestions though there is so e inconsistency in his thoughts. "e anifested circu stantiality7 flight of ideas7 looseness of association and self-de!reciation. There is no e9idence of other thought disorders. The goals are et.

Ca!itol %edical Center Colleges

S4 Sto. $o ingo A9e.7 Tue6on City
2P# S 2 >Aorking Phase? $ate< August 0-7 2101C Aednesday Ti e< 00<1*-00<3* a Setting< 5nder the treeC and beside the :ard7 under the roof 2a e< Sir I

21

Age< 4, years old &ducational Attain ent< Jocational $ate of Ad ission< $ece ber 47 211E $iagnosis< '21.3 5ndifferentiated $iagnosis 5nstable Descri"tion of "atient5 The !atient has a shuffling gait. "e is alert and coo!erati9e. "is co !le)ion is bro:n. "e has a good hygiene this ti e. "is clothes are :ell-ke!t. "e has sha9ed his ustache and his hair :as short. "is eyes are color black and ha9e a good eye contact. 2ails are short and clean. "e sits :ith legs crossed and ta!s his foot. 4nce in a :hile7 he leans for:ard :hile talking. "e so eti es scratches his head and cru !les his face. Descri"tion of en6ironment5 The :orking !hase of the nurse-!atient interaction ha!!ened under the tree after doing the different thera!ies. $ro!s of rain are felt that ade us transfer to another area :here a roof can !rotect us fro the scattered rain sho:er. The area :as conduci9e. .%7ecti6es5 0. Pro ote !ositi9e self-conce!t 2. 3ealistic goal-setting 3. &ncourage client to 9erbali6e feelings and e)!lore self 4. $e9elo! !ositi9e co!ing beha9iors *. Take action to eet the goals set :ith the client 253S& %agandang ara: sayo Io9enU Ang galing o kanina sa ga acti9ities natin. 2akita kong nag!artici!ate ka talaga. Bago ang lahat7 ay ibibigay akong 3 salita ta!os tandaan o ito7 a aya i!a!aulit ko uli sayo. /angit7 /u!a7 Puno. 5litin o nga. %agaling. %agk:entuhan ulit tayo. Ano nga ulit yung nata!os ong kursoQ Being s!ecific Thera!eutic Techni@ue &stablish ra!!ort by greetings Patient 4h. 4o. Analysis

4o. Talaga. Ackno:ledging

%S& Co !onent

Sige. Ano yunQ

"e agreed to :hat the student nurse asked hi to do.

/angit7 /u!a7 Puno. /angit7 /u!a7 Puno 3adio o!erator. 2ag-aral ako sa Sa son. Sa 3ecto. Sa %aynila. 2 taon akong nagaral.

"e :as able to re!eat the 3 :ords gi9en to hi . "e had ans:ered the @uestion :ith details about his school days.

22

Ah. At !agkata!os7 anong !inasukan ong trabahoQ /ahat yan naging trabaho oQ Ano ginaga:a o noong bata ka !aQ

Jalidating data fro !re9ious con9ersation. Seeking clarification 5sing o!enended @uestion

Sea an7 sa dagat. 2agtatabako. 2ag-ii !rinta ng da it. (uard. 4o7 ada i akong !inagkaabalahan noon. 2ung bata ako7 ahilig akong aglaro ng kard. Pusoy dos. Baraha. At nag;o;olen din ako kasa a ng aking ga kaibigan. 4o. Dasa a ko ga ka!atid ko at ga !insan na naglalaro. %ga ka!atid ko. , ka ing agkaka!atid lahat. 2asa (ua ang 4 kong ka!atid. Si #linoy7 $alisay7 Angelito at Anastacio. Hung 37 sina $anilo7 at A7 Io9en. $ito sa %aynila. Pang-a!at.

"e had a false belief about his :ork of being a sea an.

"e :as able to ans:er the @uestion.

2aging asaya ba childhood days oQ Sino ang ga kasa a niyo sa bahayQ

Close-ended @uestion 5sing o!enended @uestion

"e stated the na es of his siblings and :here they reside.

Pang ilan ka ba sa agkaka!atidQ Ano yung asasayang ara: or e ories o na kasa a o silaQ "aQ Ang ibig ong sabihin ay asaya ka ka!ag ay !atayQ Anong nagaga:a ng !akira da ong yan sa iyoQ

Clarifying relationshi! status 5sing o!enended @uestion Perce!tion seeking+ 3estating 5sing o!enended @uestion to e)!lore feelings &9aluating if the client is oriented to date.

Da!ag

ay !atay.

"indiU Sye !re ku !leto ka ing !a ilya. /ahat ka i ku !leto !ag bu ibisita. %asaya nga.

"e :as able to clarify his feelings.

"e did not further elaborate his res!onse.

Io9en7 ano nga !ala date ngayonQ

August 0-.

"e :as able to ans:er the @uestion correctly.

2111 anoQ &h anong ara:Q Saan ka nga !ala !inanganakQ

2101. %iyerkules. %indoro. "e :as able to ans:er the @uestion correctly sho:ing that

23

Dailan !ala birthday Saan ka nakatiraQ

oQ &)!loring clients i !ortant thoughts about his life

A!ril 47 0.E3. 4, na ako. %aynila.

hes a:are and ca!able to re e ber e9ents in his life. "e is co !rehensible. "e stated his fa9orite foods.

Anong ga !agkain yung !aborito oQ Anong kanta na an yung gusto oQ Datulad ngQ

"otdog. /ongganisa. "otdog. /ongganisa. /ongganisa. %ada i akong gusto. Basta ada i.

"e :as not able to enu erate the title of so e of his fa9orite songs. "e 9erbali6ed his feelings about his relationshi! :ith other his !ast girlfriends.

#lan na nga ulit naging girlfriend oQ

Close-ended @uestion

%ada i na !ero lahat sila ini:an ako dahil nga hindi da: ako arunong aki!ag se). Ah. (anoon.

Ah. Io9en7 u aa bon. /i!at tayo dun sa ay bubong. Ayan. $i na tayo auulanan. Sabihin o nga ulit yung !angalan ko. 2akita o ata sa na e !late ko ehU /augh Io9en sabihin o nga ulit yung 3 salita na sinabi ko sayo kanina. /angit7 lu!a7 !uno. Dailan ka !ala na!unta ditoQ

Sho:ing Concern 4o. $iana. Testing 4o nabasa ko. S ile /angit. /u!a. >!ause? Bundok. %S& Co !onent /angit7 lu!a7 !uno. &9aluating if he still re e bers :hen he :as brought to the hos!ital August 37 0.-, ako una nandito. Ta!os u alis. Ta!os bu alik ulit. 2oong 211E. $ece ber E7 211E. 2101 na ngayon dibaQ "e forgot the last :ord gi9en to hi . "e re!eated the sa e :ords gi9en to hi . "e had a false belief of the date :hen he :as first ad itted in the institution. #t :as 0..1 and it :as $ece ber 47 211E for his read ission.

24

4o. BakitQ Ano bang nanyari at bu alik ka ditoQ

Probing 5sing o!enended @uestion

24 years na !ala no. Tagal ko ng nandito. 2a babastos da: ako sabi ng hi!ag ko. 2anggugulo. 2akiki!ag a:ay. "e :as able to recall the reason :hy he :as ad itted and :ho brought hi to the hos!ital.

Silence &h alakQ &)!loring

2aninigarilyo din ako bata !a lang. Alak onti lang. Pag du adaan ako sa ay sa a in7 bigyan nila ako ng 0shot. #sa lang talaga ta!os u:i na ko. Si Tess nga. 2oong kata!usan. $inala: ako ng !a angkin ko.

"e re e bered his lifestyle :hen it co es to 9ices.

(anoon ba. Anong !angalan ng hi!ag oQ Ah. Dailan ka huling dinala: ng ahal o sa buhayQ

&)!loring clients i !ortant thoughts about his life

%is!erce!tion of :hen he :as 9isited by his lo9ed one. The last 9isitation :as 211, by his brother.

(anon. %ahal o ba ga agulang oQ 2asaan agulang ngayonQ o &)!loring clients ideas and thoughts

4o. 2asa (ua sila.

%ay kakaiba ka bang naririnig o nakikita dati at ngayonQ 2asaan ka ba ngayonQ Sino ga kaibigan ditoQ Ano ginaga:a sa :ardQ o

Aala na an.

Sa %ental. /ahat sila. %ada i. Aala. Sabe hindi da: !:ede u alis kaya di ako akau:i. 4o. Silence.

"e kne: :here he :as.

o dito

Tu utulong ka baQ Io9en7 ta:ag tayo sa loob. Duhanan ka da: ng BP. Silence. AsoQ Seeking

%ay kaso ba akoQ Bat ako kinuhanan nunQ

25

clarification Ah. Daso. >/augh?. Aala. Tiningnan lang natin BP at ti bang o !ara akita kung ataas ba ang !resyon o sa dugo at kung ano ti bang o. Ano da: kaso oQ

>!ertaining to BP and :eight? %ay kaso akoQ Ah. Akala ko kasi eron akong kaso. Sabi kasi nila ay kaso da: ako.

(i9ing infor ation

"e thought that he had done so ething :rong thats :hy his BP and height :as obtained.

Seeking clarification Agreeing

"indi ko ala . Sabi kasi ni &lsi kali utan ko na lang at :ag isi!in kaya di ko ala kaso ko. 4o7 :ag da: isi!in eh. Dali utan na lang. $ahil sa s:i ing7 trabaho ko. "e :as a:are that he has edicine for his feet to be healed. "e used to belie9e in herbal edicine to restore his feet. "e thought that doctors dont :ant hi to be healed because he :as being studied.

(anoonQ 4o nga :ag o na lang gaano isi!in. Ano nangyari diyan sa !aa oQ Ano ginaga:a gu alingQ o !ara

Anong ga ot ginaga it oQ Sinabi o ba sa doctor na gusto o bayabas ang ga itinQ

5sing o!en ended @uestion

(a ot. %ay binibigay na ga ot. (a ot eh. (usto ko nga bayabas !ara gu aling na. Aya: na an ako bigyan. 4o. Pero !inagaaralan nila ang !aa ko. Aya: ata !agalingin. Pero ala ko gagaling !a yung !aa ko. 4o.

Han ang !anini:ala

oQ Presenting reality

Ala o ba na ang ga doctor7 ginaga ot nila ang ga ay sakit. At ang ga nurse tinutulungan nila ang doctor sa ga ga:ain nito at sye !re tinutulungan din nila ang ay sakit. 4o. 2a i iss o na ba ang !a ilya oQ

Ah ganoon !ala yon.

"e agreed to :hat the student nurse e)!lained.

(i9ing infor ation

Close ended @uestion

4o. Ala o ba sikat ang !a ilya ko sa a in. Ang ga "e belie9es that his fa ily is fa ous and

26

agulang ko. Ang tito ko7 sikat sa !robinsiya. Silence Silence %as grabe !a ako sa nakakulong. Sa:a na ko dito. 24 years na. Ano ang ibig sabihinQ ong Seeking clarification $i ba ang ga nakakulong 01 taon lang sila sa kulungan !ero ako7 sobra !a sa 01 taon ako nandito. "indi !:ede lu abas. 2akakulong din ako. Aalang Dalayaan. Ah ganoon !ala. $e!ende sa kaso.

kno:n by any !eo!le in their !ro9ince.

"e 9erbali6ed his feelings of being tired staying in the hos!ital co !aring it to !eo!le :ho are in ;ail. "e like:ise said that hes ore of a !risoner7 no freedo .

Sa !agkakaala ko kasi7 de!ende sa kaso na naga:a ng isang tao kung gaano siya akukulong eh. 4o. Dung grabe ang naga:a ng isang tao7 katulad na lang kung naka!atay siya na sinasadya at !lanado7 !:ede siyang akulong habang buhay. Io9en7 banggitin o nga ulit yung 3 salita na sinabi ko sayo kanina. /angit7 lu!a7 !uno. Ayan. 3ecite o na an un letters ng al!habet. (alingU 2gayon7 agbilang ka na an ula 0 to 01. Ta aU S!ell o nga yung :ord na Ia!an. &h un tagalog :ord na sala at. " . EO3Q

Presenting reality

Agreeing to the student nurse Ah. (anoon !ala yun.

(i9ing infor ation

/angit7 lu!a7 dagat.

"e still forgot the last :ord gi9en to hi a :hile ago.

/angit7 lu!a7 !uno. %S& Co !onent A-B-C-$-&-'-(-"-#-I-D-/-%-24-P-T-3-S-T-5-J-A-P-H-K

0-2-3- 4-*-E-,---.-01 I-A-P-A-2 S-A-/-A-%-A-T . "e :as able to ans:er the @uestions correctly to e9aluate his cogniti9e ability.

27

,OEQ 2O*Q %agalingU 2aaalala o !a ba kaha!on yung tinuro ko sayong salitaQ Hung Donnichi:a. Anong ibig sabihin nunQ %S& Co !onent

03 , Ano dunQ

%agandang "a!on.

"e re e bered the eaning of the :ord gi9en to hi yesterday. Jerbali6ation of feelings.

Ta a. Da!ag !inayagan ka ng u alis dito7 anong gaga:in o !ag nasa labas ka naQ Ah talagaQ 00<31. BakitQ

&)!loring ideas

%ag!a!ahinga ako !aglabas7 en;oy. Punta ko sa look. $un ako ag!a!ahinga. Anong oras na baQ Ta!os na ba inter9ie:Q Pasok na tayo. 00<31 na !ala. Ah ganon. Sige.

"e asked about the ti e and re@uesting that he :ill already go inside.

(anoon ba. Sige. Io9en7 agkita tayo ulit ne)t :eek ha. Sa %artes na Sociali6ation day natin. Tara7 !asok na tayo.

Su ari6ing and Planning

&9aluation and 3e arks< The client :as able to ans:er the @uestions being asked to hi cases there :ere still so e inconsistencies in his ideas+thoughts and the real situation. So e of his ans:ers are different fro orientation !hase. "e had the 3 :ords gi9en to hi though in so e is!erce!tion of

his ans:ers during the

anifested circu stantiality and looseness of association. e ory. "e :as coo!erati9e during

There is no e9idence of hallucination or illusion. "e had also difficulty in re e bering to e9aluate his short ter et. the nurse-!atient interaction. "e had unto:ard beha9ior. The goals are aintained a good eye contact and sho:ed no

28

Ca!itol %edical Center Colleges

S4 Sto. $o ingo A9e.7 Tue6on City

2P# S 3 >continuation of Aorking Phase? $ate< August 237 2101C %onday Ti e< 0<01-0<31 ! Setting< Tree house 2a e< Sir I Age< 4, years old &ducational Attain ent< Jocational $ate of Ad ission< $ece ber 47 211E $iagnosis< '21.3 5ndifferentiated $iagnosis 5nstable $escri!tion of !atient< The !atient has a shuffling gait. "e is alert and coo!erati9e. "is co !le)ion is bro:n. "is eyes are color black and ha9e a good eye contact. "e sits :ith legs crossed and ta!s his foot. 4nce in a :hile7 he leans for:ard :hile talking. "e so eti es scratches his head and cru !les his face.

29

$escri!tion of en9iron ent< The continuation of the :orking !hase of the nurse-!atient interaction ha!!ened in the tree house in the afternoon after he had eaten his lunch. The en9iron ent :as conduci9e7 @uiet and co fortable. 4b;ecti9es< 0. Pro ote !ositi9e self-conce!t 2. &ncourage client to 9erbali6e feelings and e)!lore self 3. $e9elo! !ositi9e co!ing beha9iors 4. Take action to eet the goals set :ith the client 253S& "i. Da usta Io9enQ Thera!eutic Techni@ue &stablish ra!!ort 5sing o!enended @uestion "indi. %ag 2P# tayo at !agkata!os ag ga es. Pinoy "enyo. 4o. /ast day na na ing ngayon. Bukas sociali6ation na natin. 4 anong gusto ong food natinQ Ah. Anong kinain tanghalianQ %asara! baQ $escribe o na an sa akin fa ly o. 2asaan agulang oQ Anong dahilan bakit hindi o sila kasa aQ Anong dahilan bakit hindi o sila kasa aQ Ano ba rason bakit andito kaQ o sa (i9ing infor ation Ah ganoon ba. Patient %abuti na an. Ano gaga:in natenQ %agdadra:ingQ Analysis "e asked about the acti9ity.

Dahit ano. 5sing o!enended @uestion Baboy. Paksi:. 4o. 2asa (ua nanay at tatay ko. Petition for 5nited States. Sa /ondon din. Andon din ga ka!atid ko. 2asa 5S sila. Tatay ko !atay na. 2anay ko Petition. Andito ko sa loob eh. Paano ako sasa aQ 2akiki!ag-a:ay nga. Tsaka sabi ng nanay at ka!atid ko nagsasalita da: ako ng :alang kausa!. %abilis da: ako agsalita. Aalang kausa!. Daya dinala nila ako ditto. "e :as able to 9erbali6e his thoughts. "e anifested delusion. "is father already died. #nconsistent thought. "e :as able to ans:er the @uestion of the student nurse.

'ocusing and 5sing o!enended

30

@uestion Sino ba kinakausa! Ano.. Dailan ka huling dinala: ditoQ Anong narara da an o noong !inasok ka nila ditoQ Io9en7 iino ng ga ot. M"e took his ka da: ulit edicine. oQ

2oong una7 sila. Ta!os yung hi!ag ko nagdala sa akin. Aala nga. %ental nga diba. 2oong kata!usan. 2g ka!atid ko. Ayoko na dito. "e anifested delusion. "e :as last 9isited 211,.

(a ot ulit. /agi na lang ga ot. 2agsasa:a na ako.

Buti at inino o !a din ang ga ot o.

Ayoko na. Sa:a na ako. 24 years na ako u iino ng ga ot. "indi na an ako gu agaling. Sa:a na ako. Ang tagal-tagal na eh. $ito na ako sa ental atagal. %ay sakit ako. Daya nga !inasok ako dito eh. %ay ka!ansanan ako.

Dailangan o !a din u ino ng ga ot o !ara gu aling ka.

"e :as able to 9erbali6e his feelings. "e doesnt :ant to take his edicines any ore but still7 he co !lies to take it. "e is concerned about his health.

Anong ka!ansanan

oQ

%ay ka!ansanan ako. Daya nandito ako. Daya nga nasa Crossings eh. Sa %andaluyong. Seeking clarification 4o ito. 4o. Jalidation of the congruency of his !ast ans:ers to !resent Sa %indoro nga. Ano ba na an ito. /ook. 4o. Taga %aynila ka baQ 2ag stay din ako sa %aynila. (rade 3 !a lang ako. ental nga. Ano ba na an

"e anifested tangential thinking7 circu stantiality.

CrossingsQ Ah. Crossings sa %andaluyong. Pasensya Saan ka nga ulit nakatiraQ Saan sa %indoroQ Probinsya yonQ 4o. BakitQ

"e :as slightly annoyed of re!eated @uestion asked.

"e :as able to ans:er the @uestion

31

#big ong sabihin grade 3 ka !a lang7 nag-aral ka na dito sa %aynilaQ Sino kasa a oQ

Para!hrasing

"indi. 2a a asyal lang ako sa %aynila. &di !a ilya ko.%agulang. %ga ka!atid. 2a a asya. 2ag!u!unta sa ga ka!itbahay. Dung saansaan7. Pero ayoko dito sa %aynila. Ayoko dito sa %aynila. Aala.

and he 9erbali6ed his thoughts and feelings.

Anong ginaga:a niyo !ag nandito kayo sa %aynilaQ Sa anong dahilanQ %ay ga naging karanasan ka ba habang nasa %aynila ka !aQ Da usta na an !agkabinata oQ 2aaalala o si DayeQ

'ocusing and 5sing o!en ended @uestion

4kay lang. %ay sakit !a din. Ayoko na ng ga ot. 4o. Ayoko ng ga ot. Ang tagal-tagal na eh. 24 years na.

"e anifested !erse9eration.

%ukhang aya: o at nagsasa:a ka na talaga u ino ng ga ot ha. Pero kailangan ong u ino ng ga ot o. Para sa ikabubuti o din yan. Sino ba ang doctor Dailan ka huling chineck-u!Q %ay ga bisyo ka baQ oQ

'ocusing

5sing o!en ended @uestion

Si $r. Ta ayo. Si $r. "o. Si $r. Daligayahan. %atagal na. 4o. 2agyoyosi. Danina yosi.

AnoQ 2agyoyosi kaQ Saan o nakuha yung yosi oQ Sinong kasa aQ Aala da: batas na ba:al ag yosi ditoQ %asa a iyan sa kalusugan o.

Clarifying 'ocusing and 5sing o!en ended @uestion

"indi ba:al. Aalang batas. 2agyosi. $ito din sa Bigay. ga kasa a ko. "e anifested delusion.

Sila. Binibigay lang. Aalang batas. P:ede. 2agyoyosi. "indi. Hosi lang.

32

%ay !eklat ka ba diyan sa ulo oQ (anoon ba. %agbigay ka nga Io9en ng * naging !residente ng Pili!inas. * ga ahahalagang nangyari na an sa Pili!inas. Hung naaalala o sa historyQ Ah. &)!lain o na an sa akin yung sala:ikain na FAng !alay ay hindi kusang lala!it sa anok.G %agaling. 4 Io9en7 agsi ula na da: ang Pinoy "enyo. Sali ka ah. Babye Io9en. Bukas ulit ha. Sociali6ation na. "uling ara: na natin. Anong CodeQ Ah. Hung !o:derQ Sige. Planning %S& Co !onent

Aala. Aala no. %anuel 3o)as. %anuel Tue6on. 2inoy A@uino. Cora6on A@uino. >!ause? %anuel Tue6on. >!ause? Aala. Aala akong ala . >!ause? 2oong du ating ang ga kastila. Hon lang. Ang biyaya. Ang biyaya ay hindi dadating !ag hindi !inaghihira!an. $a!at aghira! !ara agkaroon ng biyaya. 4o. "e re!eated %anuel Tue6on.

"e :as not able to recall historical e9ents in the Phili!!ines. "e inter!reted the !ro9erbs gi9en to hi .

(anoon ba. $alhan Alaska. Code.

o ako

Alaska. Code. Basta. Hung Pulbo. 4o. $a ihan bahala. o ha. Da: na

"e de anded so ething for to orro:s Sociali6ation day and ter ination !hase.

Sige Io9en. Babye ulit.

Sige $iana.

&9aluation and 3e arks< 'or the continuation of the Aorking Phase7 still7 the client :as able to ans:er the @uestions being asked to hi though in so e cases there :ere still is!erce!tion of the real his ans:ers during the anifested delusion7 so e inconsistencies in his ideas+thoughts and situation. So e of his ans:ers are different fro

orientation and first !art of the :orking !hase. "e had

circu stantiality7 looseness of association7 !erse9eration and tangential thinking. 33

There is no e9idence of hallucination or illusion. "e had also difficulty in re e bering historical e9ents in the Phili!!ines and :as not able to co !lete * Past Presidents of our country for his cogniti9e e9aluation. "e :as coo!erati9e during the nurse-!atient interaction. "e had sho:ed no unto:ard beha9ior. The goals are aintained a good eye contact and et.

Ca!itol %edical Center Colleges

S4 Sto. $o ingo A9e.7 Tue6on City

2P# S 4 >Ter ination Phase? $ate< August 247 2101C Tuesday Ti e< 02<4*-02<** ! Setting< 4utdoor7 under the tree 2a e< Sir I Age< 4, years old &ducational Attain ent< Jocational $ate of Ad ission< $ece ber 47 211E $iagnosis< '21.3 5ndifferentiated $iagnosis 5nstable $escri!tion of !atient< The !atient is ha!!y and e)cited u!on seeing the token of a!!reciation. "e is alert and coo!erati9e. "e is rela)ed and feels co fortable. Still7 he aintains a good eye contact. "e leans for:ard :hile talking. $escri!tion of en9iron ent< The ter ination !hase of the nurse-!atient interaction ha!!ened under the tree i ediately after the sociali6ation day. The en9iron ent :as in high s!irit and co fortable. 4ther !atients and student-nurses are beside us. 4b;ecti9es< 0. Pro ote self-care 2. 3ecogni6e increasing an)iety

34

3. 4. *.

#ncrease inde!endence $e onstrate e otional stability &9aluate goals achie9ed by the !atient 253S& "i. Da usta ka Io9enQ Thera!eutic Techni@ue &stablish ra!!ort 5sing o!enended @uestion Sala at sayo kanina ha. 2ag!artici!ate ka talaga sa ga inihanda na in. Ta!os na sociali6ation day natin. Ano !akira da o ngayonQ TalagaQ Buti na an. Dasi ako nag-en;oy din ako. &to !ala yung !ina!abili o sa akin. 3e@uest o. Aelco e. 4kay lang yun na naka unifor ka. Hun na an talaga da!at suotin dito diba. 2aging %asaya ako na nakasa a ko kayo. "aQ "indi ah. Aag ka ani:ala sa kanya. "indi ako aya an. "indi Io9en7 hindi ako aya an. %arketQ Clarifying Ackno:ledging Pro9iding general lead Ayun. Sala at. %ada i ha. Sala at. 2akaunifor ako7 Sorry. 2aka unifor eh. $a!at ag!artici!ate. Patient 4kay na an. Analysis

&n;oy. %asaya ako.

Client :as able to inter!ret and 9erbali6e his feelings and thoughts about the situation.

Ah. %asaya. %aya an ka baQ

Presenting reality Jerbali6ation of feeling Sabi niya7 aya an ka da: eh. %aya an ka !ala. Client :as asking the student nurse and 9erbali6ed his obser9ations.

&di

ay shoe

art kayoQ

Shoe art.

Ah7 shoe art. Aala ha. $i ako aya an.

Ah7 iibigin ka noQ

35

AkoQ "indi ko ala . "aha. "indi na an. 4 ika:7 ano bago sayoQ TalagaQ Saan ka !u!untaQ DailanQ Sino nag sabi sayoQ Ah7 ganoon ba. Aalis na din ako a aya. "uling ara: na na in ngayon dibaQ 3e inds client that ter ination is near

4o iibigin ka eh. /alabas na ako eh. 5sing o!enended @uestion Aalis na. /alabas na da: ako eh. Sa kata!usan. Aalis na ako. Aalis na nga ako. Ah ganoon ba. 4o. "e thought the he :ill already lea9e the institution.

(usto ko ag!asala at sayo kasi da i ko natutunan sayo eh.

Ako din. $a!at ag!artici!ate talaga tayo. Para %asaya.

"e recogni6ed his res!onsibility. "e thanked the student nurse.

2ashare o din sa akin ga e)!eriences and ga narara da an o dibaQ And sana natulungan din kita kahit !a!aano. Sala at ha. 4 ta:ag na tayo sa loob. 4 ingatan o sarili o habang nandito ka ah. Pakabait ka sa susunod na akakasa a o dito.

&9aluate goal achie9e ent

4o. Sala at din. MSilence.

Tell hi res!onsibility for his careC Achie9e s ooth transition to other caregi9erC &)!resses thought about ter ination !hase

4o. #ingat ako.

"e recogni6ed his res!onsibility.

"e ga9e so e re inders to the student nurse. #ka: din $iana. Du ain ka ng asusustansyang !agkain. 4o7 5 ino ka din ng gatas gabi-gabi !ara lu usog ka. 4o. (a itin ko yan. "e thanked the student nurse.

4o na an. #ka: din da!at. "ehe. Sige. #ka: din ha7 yung gatas na binigay ko sayo7 ga itin o. #ngat ka Io9en. 4o. Sala at sa ga

%ag-ingat ka din. Sige $iana. Babye. Sala at

36

!aalala o sa akin. Babye Io9en.

sayo ha. Sige !asok na. Sala at.

&9aluation and 3e arks< $uring the ter ination !hase7 "e had anifested circu stantiality7

looseness of association7 delusion. There is no e9idence of hallucination or illusion. "e :as alert and coo!erati9e during the nurse-!atient interaction. "e had aintained a good eye contact and sho:ed no unto:ard beha9ior. "e see ed to be ha!!y and contented :ith the token of a!!reciated he had. "e e9en ga9e re inders to the student-nurse. There :as no increase an)iety le9el on the !art of the client during the ter ination !hase. The goals are et.

98. P >C"<?"35+P83
-2& AP1
Calisthenic+ &)ercise thera!y

D&/INI-I.N
A free body e)ercise !erfor ed :ith 9arying degrees of intensity V rhyth 7 e !loy otions #t is a treat ent odality as an energi6er and enable !atient to en;oy.

P+ P.'&
To energi6e the client and to re9itali6es the !atients interest V hel!s hi to be rela)ed V be refreshed

-&C2NI8+&
5se of different otions such bending7 stretching7 ;u !ing7 hand shaking7 head and ankle rotation :ith a background sound of Solo and &ye of the Tiger Asked the !atients to ake a cheer !rior to ga e. & !loyed different @uestions that enhanced their e ory. >Sa Bugha:7 Sa $ila:?

ANA,1'I'
Sir I :as able to do si !le ste!s like hand shaking7 head rotation and stretching. "o:e9er7 he has a slo:er o9e ent :hen it co es to ;u !ing and ankle rotation. Probably he takes e)tra effort in handling his lo:er e)tre ities due to his diabetic feet. The client :as able to acti9ely !artici!ate in the ga es7 raising the colored card to ans:er @uestions. "e :as asked to enu erate 3 kinds of food that has a sou!7 he ite i6e the ff< Sinigang na baboy7 Sinigang na isda and Sinigang na baka.

Play thera!y

Pro9ides a change fro the !atients usual routine and enable !atient to e)!erience intense e otion in a safe en9iron ent

37

Singing thera!y

#t is a recreational thera!y that allo: !atient to sing and read lyrics :ith rhyth >%usic? 5se of uni@ue !ro!erties V !otential of usic in a thera!eutic situation.

To learn a ne: song that :ill re9itali6es !atients interest V hel!s hi to be rela)ed V be refreshed >%usic? To change hu an beha9ior so that the indi9idual affected :ill be able to function as :orth:hile !erson. >Arts? 5se of usic to aid rela)ation. "el!s in reconciling e otional conflicts as :ell as !ro oting self-a:areness V gro:th.

Aith the use of anila !a!er7 the client sang Aont last a day :ithout you and 5 agang Day (anda

The client :as able to follo: the lyrics of the songs that :ere taught to the grou!. "e :as focusing on the reading rather on singing.

%usic V Arts >'ast V Slo: #nstru ental Song ?

>Arts? A Creati9e+ &)!ressi9e art thera!y that encourages a !erson to e)!ress V understand e otions through artistic e)!ression V through creati9e !rocess.

The client :as gi9en a bond !a!er. "e :rote his na e abo9e it and :hile !laying the background usic7 he :as asked to dra: :hat is in his ind. The student nurse let hi choose the color he :ants to use. The fast usic :as !layed first follo:ed by the slo: instru ental song.

'or the fast song7 he had dra:n a circle :ith trees around it. "e used a bro:n color in outlining the circle and green for trees. 4n the right side7 he dra: 3 candles using an orange color and :rote on the center7 FcoronaG. Based on his inter!retation7 he said that "allo:een is near thats :hy he dra:n candles sy boli6ing his fa ily e bers :ho already died and left hi . The corona signifies the gift he is offering to his deceased lo9ed ones. And in addition7 he said that :hen it is near to Christ as7 he :ill dra: a different thing again. 'or the slo: song7 he has dra:n a stick an !laying inside a basketball court using only one color7 green. "e said that he :as !laying those younger years. The dra:ing for the fast song sho:ed that he thinks ore of the occasions he e)!eriences yearly s!ecifically the ti es :hen he and his fa ily reunites during 9isitation of the deceased e bers of his fa ily :hile for the slo: song7 it can be inter!reted that he isses the ti es :hen he :as able to !lay basketball during the years :hen he :as outside the hos!ital.

Biblio-thera!y >Story Telling?

5se of !rinted :ords in odifying or sti ulating e otions and a:areness

To i !ro9e the attention s!an of the indi9idual :ith !o:er of concentration7 and to

The story :as entitled FAng Ti!aklong at ang /angga G. #t :as !resented :ith the use of !u!!ets7 art

After the story telling7 :hen the !atient :as asked :hat he understood of the story7 he :as able to 9erbali6e that F$a!at nag-ii!on ng !agkain !ara hindi aguguto G.

38

sti ulate the i agination V ideas of the !atient

:orks7 dra:ing V 9oice dubbing :hile the student nurses are behind the cloth.

#t sho:s that he :as attenti9ely listening to the story !resented and he understands that the ant beca e cautious in gathering his food so that it :ill not get hungry in the future.

Biblio-thera!y >Pro9erbs #nter!retation?

5se of !rinted !icture to identify characters in the story that :ill odify or sti ulate e otions and understanding.

3eading ay hel! lift a de!ressed !atient. To facilitate e)!ression

Sir I :as asked to read the !ro9erb :ritten on a bond !a!er7 FSa Panahon ng Dagi!itan7 akikilala ang Tunay na DaibiganG.

"e e)!lained that FDa!ag agkaibigan7 da!at nagtutulungan. "ali ba:a sa !agga:a ng bahay7 da!at ada ing tao ang gu a:a !ara as atibay at aganda ang aging bahay.G "e had e)!ressed his understanding of :hat he read. According to hi 7 friends should hel! one another to ake :ork easier though the real eaning of the !ro9erb is one :ill be able to recogni6e his true friends in ti es of do:nfall. Patient :as able to coo!erate in the grou! thera!y though he goes to the co fort roo t:ice during the thera!y. Ahen he :as asked about the relation of the ountain to his e)!eriences7 he said7 FDu ukuha ka i noon ng ibat-ibang !rutas sa bundok. %ay okra7 ko!ra7 a!!le7 orange7 !atatas. 2a i itas ka i dati sa bundok.G Ahen asked about the essage of the !oe 7 he said7 F$a!at natin !angalagaan ang kalikasan7 bundok. Bigay ito sa atin ng Panginoon. $a!at alagaan at ingatan.G The clients res!onse to the acti9ity is good. "e a!!reciated the occu!ational thera!y done. "e :as !artici!ati9e :hile the facilitator e)!lains the !rocedure.

3e oti9ation thera!y

Techni@ue of a si !le grou! thera!y that uses a !oe and a dra:ing :hich ai s to bridge the fantasy :orld of the !sychotics to the real :orld.

To sti ulate !atients to be fello: e)!lorer of the real :orld. To de9elo! their ability to co unicate V share ideas V e)!eriences :ith the other !eo!le. To !ro ote grou! har ony V identification. .

Patient is seated in a 5-for ation. The facilitator !ro9ided a !oe and a !icture about a ountain. The student-nurse asked sti ulating @uestions leading to the to!ic and asked to relate it in his e)!eriences in life.

4ccu!ational Thera!y > Banana S!lit ?

Treat ent of !hysical and !sychiatric conditions by encouraging !atients to undertake s!ecific selected

"el! clients to reach their a)i u le9el of function and inde!endence in all as!ects of daily life.

The clients are !ro9ided :ith the aterials and ingredients needed for aking a banana s!lit. Student nurses are beside the to assist and hel!

39

acti9ities

the :hile doing the thera!y. Ste!s are :ritten in a anila !a!er :hile the facilitator e)!lains the !rocedure.

J##. B#B/#4(3AP"H Psychiatric 2ursing Biological and Beha9ioral Conce!ts. Second &dition. $eborah Antai-4tong. 2112urses Pocket (uide 00th &dition by $oenges7 etc. htt!<++!sychcentral.co +lib+211E+undifferentiated-schi6o!hrenia+. 3etrie9ed August 1,7 2101 :::.:iki!edia.co htt!<++!sychcentral.co +lib+211E+undifferentiated-schi6o!hrenia+ htt!<++aids.about.co +od+nutrition+@t+choltri.ht htt!<++:::.scribd.co +doc+2,*-.E-3+5ndifferentiated-Schi6o!hrenia

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