Tarlac State University College of Nursing Lucinda Campus, Brgy.

Ungot, Tarlac City

Psychiatric Movie Review Report

Submitted by: GROUP A2 Agcaoili, Claire P. Baluyut, Donna C. Bautista, Karen L. Brojan, May Daisyree C. Bugayong, Emmanuel, Dominic Raymond M. Calendas, Arcelene Joy E. Catap, Stephanie Jill L. Daet, Ryan I. Perez, Kristian Q. Saptang, Romuene M. Sumitted to: Mr. Apollo Gueco Facun, RN, MSN PSYCHOTHERAP

A. Title of the Movie The Aviator B. Synopsis of the Movie The movie begins with the young Howard Hughes being bathed by his mother who has OCD, warns him of disease: "You are not safe." That showed the root of his obsession with germs. The film next shows him as a young man preparing to direct Hell's Angels. Realizing that the audience will not be able to have a sense of space from the shot dogfight footage, Hughes becomes obsessed with finding "clouds that look like giant breasts full of milk" to re-shoot again. He then hires a meteorologist, Professor Fitz to determine the perfect formation, and ends up waiting eight months. When the Professor tells him there are clouds in California, Hughes moves production there, and re-shoots the dogfight himself. The film is a huge hit, and Hughes is very pleased with the results. However, there is one goal he relentlessly pursues: aviation. During this time, he also pursues Katharine Hepburn. During this time Hepburn becomes a major support and confidant to Hughes, and helps alleviate the symptoms of his obsessive-compulsive disorder somewhat. He eventually takes an interest in commercial-passenger travel, and purchases majority interest in Transcontinental & Western Air (TWA). In 1935, he test-flies the H-1 Racer, breaks the speed record of Charles Lindbergh, and crashes in a beet field. Three years later, he flies around the world in four days, shattering the previous record by three days. Meanwhile, Juan Trippe, owner of Pan American Airlines, and Senator Owen Brewster worry over the possibility that Hughes might beat them in the quest for commercial expansion. Brewster has just introduced the Commercial Airline Bill, which will give world expansion solely to Pan Am. Trippe advises Brewster to check to the "disquieting rumors about Mr. Hughes." Hepburn takes Hughes to meet her family in Connecticut, which turns into a disaster. Back on the set of her new film, Katharine finds herself confiding about her escalating difficulties with Howard to Spencer Tracy. She finally tells Hughes she has fallen in love and is leaving him. Howard responds by burning all his clothes that night. He soon has a new interest: 15-year old Faith Domergue and also fights the Motion Picture Association of America over the steamy scenes in The Outlaw. He then secures contracts with the Army on two projects, a spy plane and a troop plane. By 1946, Hughes has only finished the XF-11 reconnaissance aircraft and is building the H-4 Hercules ("Spruce Goose") flying boat. The budget is increasing, the deadline is looming, and Hughes starts to show signs of alarming behavior, such as worry over dust and germs in the air and repeating phrases over and over. That July, he takes the XF-11 for a test flight. One of the propellers malfunctions, causing severe power and control problems; Hughes attempts to land it on a golf course in Beverly Hills, but crashes into a neighborhood. He is rushed to the hospital, where he slowly recuperates. When he is discharged, the whole TWA fleet is built and ready to go, but he is in danger of being bankrupted by the airline and the plane. Afraid of the media trying to find him, Hughes places microphones and taps Ava's phone lines to keep track of any suspicious activity. After being confronted by Gardner, he returns home to find the Federal Bureau of Investigation searching his house for incriminating evidence of him embezzling government funds. The incident is both a powerful trauma for Hughes and gives his enemies knowledge about his condition. Hughes meets with Brewster, who offers to

drop the charges if Hughes supports the CAB Bill and sells the TWA stock to Trippe. During the meeting Brewster carefully and deliberately does things to inflame Hughes's OCD. Hughes defiantly refuses but sinks into a deep depression afterwards, shutting himself in his screening room, terrified of germs, urinating into dozens of empty milk bottles, with his OCD growing exponentially worse. Hepburn visits him, talking to him from outside the door, and begs Hughes to let her help him, to either let her in or to open the door and come out, but he does neither. Trippe then pays Hughes a visit, but an enraged Hughes vows he will never sell TWA to Trippe. After nearly three months, Hughes finally emerges and prepares to face the Senate, with encouragement from Ava Gardner, who forces him to get cleaned up. Hughes arrives at the Hearings, and starts off with counter-claiming Brewster's charges. Humiliated and enraged by this turn of events, the Senator formally states that Hughes charged the Defense Department $56 million USD for planes that never flew. Then, Hughes states that other companies did not deliver planes either, yet they have not been charged with embezzlement. He also shows that he himself poured millions of dollars into the planes, losing money in the process. In a final blow to Brewster and Trippe's Pan Am monopoly scheme, Hughes exposes their offer to drop the charges, if he sold his stock over to Trippe and Pan Am, and he adds that on their little date, Brewster told him this would never take place, if he would just give up, and also exposes the longstanding ties and bribes between Brewster and Trippe. Appraisal Hughes successfully rebuts the charges. Hughes then proves he was right about the Spruce Goose by personally flying it himself. Hughes seems to be free of his inner demons, until he suddenly sees three businessmen in suits and white gloves who seem to be menacing him. They might be figments of his imagination but Dietrich's reaction implies that they are real; after Hughes asks if the businessmen work for him, he responds "Everybody works for you Howard." This suddenly sets him into an obsessive-compulsive fit, constantly repeating "The way of the future" in reference to the jet aircraft the three men had been discussing. Dietrich and Odie hide Hughes in a bathroom and keep him there while they can get a doctor. Howard has a flashback of his boyhood self, being washed by his mother and making the promise to fly the fastest plane ever built, make the biggest movies ever and become the richest man in the world. The darkness surrounds him, and he knows that madness is inevitable. As the film ends, he keeps muttering "the way of the future...the way of the future", emphasizing the link between his business genius and his mental illness. C. Central Characters Howard Hughes played by Leonardo DiCaprio (December 24, 1905 - April 5, 1976) was an American aviator, engineer, industrialist, film producer, film director, philanthropist, and one of the wealthiest people in the world. He gained fame in the late 1920s as a maverick film producer, making big budget and often controversial films like Hell's Angels, Scarface, and The Outlaw. Hughes was one of the most influential aviators in history. He also set multiple world air-speed records (for which he won many awards, including the Congressional Gold Medal), built the Hughes H-1 Racer and H-4 "Hercules" aircraft, and acquired and expanded Trans World Airlines. Hughes is remembered today, however, for his eccentric behavior and reclusive lifestyle in later life, caused in part by a worsening obsessive-compulsive disorder. Hughes' legacy is maintained through the Howard Hughes Medical Institute.

D. Psychiatric Medical Diagnosis a) Anxiety Disorder (Obsessive Compulsive Disorder) The Aviator, tells the story of the first forty years of Howard Hughes life. A man obsessed with beautiful women, with making movies, and with designing and flying, to his own near demise larger and faster airplanes. Hughes was afflicted with another obsession, now recognized as obsessive compulsive disorder (OCD). The disease is not so uncommon: 1 in 50 of the population is afflicted with it. OCD is manifested by obsessive thoughts and compulsive behavior. Hughes was haunted by the threat of microbial infections from food and from his surroundings and reacted by avoiding contact with possible sources of dirt and by constant washing of his hands. Typically of OCD sufferers, he also could not stop himself from repeating again and again certain phrases that came to his mind.

b) Stuart Stress Adaptation Model Book-based PREDISPOSING FACTORS Psychoanalytic Interpersonal Behavioral Family Biological

PRECIPITATING STRESSORS Physical Integrity Self- System

APPRAISAL OF STRESSORS

COPING RESOURCES

COPING MECHANISMS Task oriented Ego oriented

Constructive

Destructive

CONTINUUM OF ANXIETY RESPONSES

Adaptive Responses

Maladaptive Responses

Anticipation Patient-based

Mild

Moderate

Severe

Panic

Predisposing Factors Interpersonal Behavioral Precipitating Factors (Unorganized things, perceived objects/ foods as dirty) Appraisal of Stressors (Controlling of feelings toward the stimuli) Coping Resources (Economic assets, problem solving abilities, social support) Coping Mechanisms (Task Oriented (attack Behavior) Constructive Moderate Anxiety Family

E. Mental Status Examination Clip 1 1. General Description 1.1. Appearance Descriptors Yes No Remarks Howard is 41 years old and act appropriately on his age. Clothing appropriate on the situation. Neat in appearance. Erect posture.

Congruent apparent age Appropriate dressing Clean / Hygienic Good posture

   

Good gait

Appropriate facial expression With eye contact With pupil dilatation With pupil constriction Normal state of health & nutrition 1.2. Speech Descriptors Rapid speech Slow speech Loud volume Soft volume Minimal speech Pressured speech Stuttering Slurring of words Unusual accents 1.3. Motor Activity Descriptors Lethargic Tensed Restless Agitated With observed tics Grimaces

 

Walking in a rapid pace Facial expression congruent to emotions and verbal communications. With eye to eye interaction N/A N/A N/A Remarks He has rapid speech due to anxiety. With rapid speech Talked in a normal tone of voice With a normal tone of voice Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Remarks The patient is active The patient is anxious The patient is still in control of the situation The patient is still in control of the situation No tics observed The patient tries to stop his repetitive behavior The patient experiences involuntary hand movement The patient is compulsive (repeating words)

Yes 

No

        Yes      No 

Tremors

Compulsive 1.4. Interaction During Interview

Descriptors Hostile Uncooperative

Yes

No  

Irritable Guarded

 

Apathetic Defensive

 

Suspicious Seductive 2. Emotional State 2.1. Mood Descriptors Sad Fearful Hopeless Euphoric Anxious Happy 2.2. Affect Descriptors

 

Remarks The patient is still in control of the situation The patient is cooperative The patient is irritated due to the pollutants that are present Not guarded Responds properly to the person he is talking to Not defensive The patient is suspicious about the pollutants brought by the sweeper No seduction noted

Yes 

No 

    Yes No

Remarks No sad emotion showed Fear of dirt or germs No feeling of hopelessness seen. The patient is not overjoyed. Due to the presence of dirt No happy emotion showed Remarks The emotion is appropriate to the situation The patient is responsive Consistent emotion

Congruent / Appropriate Flat Labile 3. Experiences 3.1. Perceptions Descriptors

  

Yes

No

Remarks

Hallucinations: Auditory Visual Tactile Gustatory Olfactory Illusions 4.Thinking 4.1. Thought content Descriptors Delusion: Religious Somatic Grandiose

     

N/A N/A N/A N/A N/A N/A

Yes

No   

Paranoid Thought broadcasting Thought insertion Depersonalization Hypochondriasis Ideas of reference Magical thinking Nihilistic ideas

       

Obsession Phobia 4.2. Thought process Descriptors Circumstantial Flight of ideas Loose associations Neologisms

  Yes No    

Remarks N/A N/A N/A Paranoid due to possibility of acquiring disease from the dust and dirt he sees N/A N/A N/A N/A N/A N/A N/A Obsessed due to fear of possibility of acquiring disease from the dust and dirt he sees N/A Remarks N/A N/A N/A N/A Presence of repetitive words that is, Show me all the blue prints N/A N/A N/A

Perseveration Tangential Thought blocking Word salad

   

5. Sensorium and Cognition 5.1. Level of consciousness Descriptors Confused Sedated Stuporous Oriented to: Time Place Person 5.2. Memory Descriptors Intact remote memory Intact recent memory Intact immediate memory 5.3. Level of concentration and calculation Descriptors Easily distracted With difficulty in simple math 5.4. Information and Intelligence Descriptors With learning disability With learning difficulty Able to interpret simple proverb 5.5. Judgment Descriptors Appropriate judgment

Yes

No   

   Yes    Yes  No

Remarks The patient is well oriented The patient is conscious The patient is conscious Oriented Oriented Oriented Remarks Intact memory Intact memory Intact memory Remarks Easily distracted on the presence of dirt N/A Remarks N/A N/A N/A Remarks Exaggerated way of thinking to the sweeper Has a good relationship to the person he is talking to Remarks Able to find solution to the problems Blaming the janitor from the presence of dust

No

Yes

No

Yes

No 

With good relationship to others 5.6. Insight Descriptors Accepts presence of problem Blames the problem on others Clip 2 1. General Description 1.1. Appearance

 Yes   No

Descriptors Congruent apparent age Appropriate dressing Clean / Hygienic Good posture Good gait Appropriate facial expression With eye contact With pupil dilatation With pupil constriction Normal state of health & nutrition 1.2. Speech Descriptors Rapid speech Slow speech Loud volume Soft volume Minimal speech Pressured speech Stuttering Slurring of words Unusual accents 1.3. Motor Activity Descriptors Lethargic Tensed Restless Agitated With observed tics Grimaces

Yes  

No

   

Remarks Acts appropriately on his age Clothing is appropriate in the situation Performs repetitive hand washing Exhibits good posture Able to mobilize Appropriate to the emotions N/A N/A N/A N/A Remarks N/A N/A N/A N/A N/A N/A N/A N/A N/A Remarks Active behavior Anxious Can handle the situation Has the control of the situation No presence of tics None Presence of involuntary hand movement due to anxiety Repetitive hand movement by hand washing

Yes

No

Yes 

No     

Tremors

Compulsive 1.4. Interaction During Interview

Descriptors Hostile Uncooperative Irritable Guarded Apathetic Defensive Suspicious Seductive 2. Emotional State 2.1. Mood Descriptors Sad Fearful Hopeless Euphoric Anxious Happy 2.2. Affect Descriptors

Yes

No 

Remarks Not hostile N/A Feeling of being unclean N/A Has appropriate facial expression N/A He suspects that all things are dirty N/A

Yes 

No 

    Yes No

Remarks No sad emotion noted Fear of acquiring germs No feeling of hopelessness seen. The patient is not overjoyed. Due to the presence of dirt No happy emotion showed Remarks The emotion is appropriate to the situation The patient is responsive Consistent emotion

Congruent / Appropriate Flat Labile 3. Experiences 3.1. Perceptions Descriptors Hallucinations: Auditory Visual Tactile Gustatory Olfactory Illusions

  

Yes

No

Remarks N/A N/A N/A N/A N/A N/A

4.Thinking 4.1. Thought content Descriptors Delusion: Religious Somatic Grandiose Paranoid Thought broadcasting Thought insertion Depersonalization Hypochondriasis Ideas of reference Magical thinking Nihilistic ideas Obsession Phobia 4.2. Thought process Descriptors Circumstantial Flight of ideas Loose associations Neologisms Perseveration Tangential Thought blocking Word salad 5. Sensorium and Cognition 5.1. Level of consciousness Descriptors Confused Sedated Stuporous Oriented to: Time Place Person 5.2. Memory Descriptors Intact remote memory

Yes

No   

          Yes No

Remarks N/A N/A N/A Paranoid that the doorknob is dirty N/A N/A N/A N/A N/A N/A N/A Fear of dirt and germs N/A Remarks N/A N/A N/A N/A N/A N/A N/A N/A

Yes

No   

Remarks The patient is well oriented The patient is conscious The patient is conscious N/A N/A N/A Remarks N/A

Yes

No

Intact recent memory Intact immediate memory 5.3. Level of concentration and calculation Descriptors Easily distracted With difficulty in simple math 5.4. Information and Intelligence Descriptors With learning disability With learning difficulty Able to interpret simple proverb 5.5. Judgment Descriptors Appropriate judgment With good relationship to others 5.6. Insight Descriptors Accepts presence of problem Blames the problem on others Clip 3 1. General Description 1.1. Appearance Descriptors Congruent apparent age Appropriate dressing Clean / Hygienic Good posture Good gait Appropriate facial expression With eye contact With pupil dilatation With pupil constriction Normal state of health & nutrition 1.2. Speech Descriptors Rapid speech Slow speech Loud volume

N/A N/A Yes No Remarks N/A N/A Remarks N/A N/A N/A Remarks N/A N/A Remarks

Yes

No

Yes

No

Yes

No

Yes    

No

 

Remarks Acts appropriately on his age Clothing is appropriate in the situation Neat Exhibits good posture N/A Appropriate to the emotions With eye to eye interaction N/A N/A N/A Remarks Speaks normally Speaks normally Speaks normally

Yes

No   

Soft volume Minimal speech Pressured speech Stuttering Slurring of words Unusual accents 1.3. Motor Activity Descriptors Lethargic Tensed Restless Agitated With observed tics Grimaces Tremors Compulsive 1.4. Interaction During Interview Descriptors Hostile Uncooperative Irritable Guarded Apathetic Defensive

      Yes No 

Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Remarks Not lethargic Tensed due to the dog crushing his feet Can handle the situation Has the control of the situation No presence of tics Grimacing due to the dog crushing his feet None Not compulsive Remarks Not hostile The patient is cooperative Feeling of being unclean N/A Has appropriate facial expression N/A He is suspicious about the dirt brought by the dog. N/A

       Yes No   

Suspicious Seductive 2. Emotional State 2.1. Mood Descriptors Sad Fearful Hopeless Euphoric

Yes 

No 

 

Remarks No sad emotion noted Fear of acquiring germs No feeling of hopelessness seen. The patient is not

Anxious Happy 2.2. Affect Descriptors

  Yes No

overjoyed. Due to the presence of dog No happy emotion showed Remarks The emotion is appropriate to the situation The patient is responsive Consistent emotion

Congruent / Appropriate Flat Labile 3. Experiences 3.1. Perceptions Descriptors Hallucinations: Auditory Visual Tactile Gustatory Olfactory Illusions 4.Thinking 4.1. Thought content Descriptors Delusion: Religious Somatic Grandiose Paranoid Thought broadcasting Thought insertion Depersonalization Hypochondriasis Ideas of reference Magical thinking Nihilistic ideas Obsession Phobia 4.2. Thought process Descriptors

  

Yes

No

Remarks N/A He sees the food surrounded with worms N/A N/A N/A N/A

Yes

No            

Remarks N/A N/A N/A N?A N/A N/A N/A N/A N/A N/A N/A Fear of dirt and germs N/A Remarks

Yes

No

Circumstantial Flight of ideas Loose associations Neologisms Perseveration Tangential Thought blocking Word salad 5. Sensorium and Cognition 5.1. Level of consciousness Descriptors Confused Sedated Stuporous Oriented to: Time Place Person 5.2. Memory Descriptors Intact remote memory Intact recent memory Intact immediate memory 5.3. Level of concentration and calculation Descriptors Easily distracted With difficulty in simple math 5.4. Information and Intelligence Descriptors With learning disability With learning difficulty Able to interpret simple proverb 5.5. Judgment Descriptors Appropriate judgment With good relationship to others 5.6. Insight Descriptors Accepts presence of problem Blames the problem on others

       

N/A N/A N/A N/A N/A N/A N/A N/A

Yes

No   

Remarks The patient is well oriented The patient is conscious The patient is conscious N/A N/A N/A Remarks N/A N/A N/A Remarks Due to presence of dirt N/A Remarks N/A N/A N/A Remarks

Yes

No

Yes 

No

Yes

No

Yes

No

Yes

No

Remarks

Clip 4 1. General Description 1.1. Appearance Descriptors Congruent apparent age Appropriate dressing Clean / Hygienic Good posture Good gait Appropriate facial expression With eye contact With pupil dilatation With pupil constriction Normal state of health & nutrition 1.2. Speech Descriptors Rapid speech Slow speech Loud volume Soft volume Minimal speech Pressured speech Stuttering Slurring of words Unusual accents 1.3. Motor Activity Descriptors Lethargic Tensed Restless Agitated With observed tics Grimaces Tremors Compulsive 1.4. Interaction During Interview  Yes No        Remarks Acts not appropriately on his age Nude Unclean and with poor hygiene Exhibits good posture Walks erectly Appropriate to the emotions With eye to eye interaction N/A N/A N/A Remarks Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Speaks normally Remarks Not lethargic Not tensed Can handle the situation Has the control of the situation No presence of tics None None Saying of repetitive words

Yes

No          No       

Yes

Descriptors Hostile Uncooperative Irritable Guarded Apathetic Defensive Suspicious Seductive 2. Emotional State 2.1. Mood Descriptors Sad Fearful Hopeless Euphoric Anxious Happy 2.2. Affect Descriptors

Yes

No  

Remarks Not hostile N/A Not irritable N/A Has appropriate facial expression N/A N/A N/A

Yes

No      

Remarks No sad emotion noted The patient is not fearful No feeling of hopelessness seen. The patient is not overjoyed. Due to the presence of dog No happy emotion showed Remarks The emotion is appropriate to the situation The patient is responsive Consistent emotion

Yes

No

Congruent / Appropriate Flat Labile 3. Experiences 3.1. Perceptions Descriptors Hallucinations: Auditory Visual Tactile Gustatory Olfactory Illusions

  

Yes

No

Remarks N/A N/A N/A N/A N/A N/A

4.Thinking 4.1. Thought content Descriptors Delusion: Religious Somatic Grandiose Paranoid Thought broadcasting Thought insertion Depersonalization Hypochondriasis Ideas of reference Magical thinking Nihilistic ideas Obsession Phobia 4.2. Thought process Descriptors Circumstantial Flight of ideas Loose associations Neologisms Perseveration Tangential Thought blocking Word salad 5. Sensorium and Cognition 5.1. Level of consciousness Descriptors Confused Sedated Stuporous Oriented to: Time Place Person 5.2. Memory Descriptors Intact remote memory Intact recent memory

Yes

No              No       

Remarks N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Remarks N/A N/A N/A N/A Saying repeated words N/A N/A N/A

Yes

Yes

No   

Remarks The patient is well oriented The patient is conscious The patient is conscious N/A N/A N/A Remarks N/A N/A

Yes

No

Intact immediate memory 5.3. Level of concentration and calculation Descriptors Easily distracted With difficulty in simple math 5.4. Information and Intelligence Descriptors With learning disability With learning difficulty Able to interpret simple proverb 5.5. Judgment Descriptors Appropriate judgment With good relationship to others 5.6. Insight Descriptors Accepts presence of problem Blames the problem on others

N/A Yes No Remarks N/A N/A Remarks N/A N/A N/A Remarks

Yes

No

Yes

No

Yes

No

Remarks

F. Process Recording Nurse s Statement Patient's Response Verbal Non-Verbal Analysis Therapeutic (To include Communication identification of Technique Used by patient's use of the Nurse Defense Mechanisms) Focusing y Anxiety (used to center on key elements or concepts of a message; used to guide direction of conversation to an important area) Providing y Anxiety Information (telling others what they need or want to know) y Obsession and compulsion y Obsession and compulsion y Intellectualization N/A Focusing (used to center on key elements or concepts of a message; used to guide direction of conversation to an Clinical Instructor's Comments

Christ almighty, you've seen Goddamn wheels. Choose one, please. Just one of them.

I know, I know. This one? I know this one this one's pretty close. Pretty close.

y Edginess y Preoccupation

Name's Nick, something like that.

Odie. That man sweeping up over there...does he works for me? I mean, have you seen him before? Why's he looking at me? Fire him. And make sure they use damp brooms from now on. Respiratory diseases are expensive, and I

y Fidgeting y Strained face y Hyper vigilance y Uneasiness y Tension y Self consciousness y Fear of illness y Self consciousness

I don't know. But can we at least proceed with the instrument panel? The tool shop's ready.

Look, Howard, the deadline is now completely unrealistic.

don't want lawsuits. I want to see the blueprints.

important area) y Preoccupation y Jitteriness y Obsession and compulsion Confrontation (direct confrontation to help person be aware of inconsistencies in his/her feelings, attitudes, beliefs, or behaviors) Confrontation (direct confrontation to help person be aware of inconsistencies in his/her feelings, attitudes, beliefs, or behaviors)

The war is going to be over by the time she's done. I need you to help consult on vital decisions, and you're off dealing with movies. You got hundreds of workers waiting for you to make a decision... All right.

Hey, Odie! Take it easy, all right. You're under pressure, but it's going to do me no good if you crack up on me. All right?

y Frustration

y Anxiety y Projection

Okay.

Look...take a couple of hours off, all right. You just relax a little. Okay. See your wife. Be sure to show me all the blueprints.

y Avoidance

y Anxiety

y Frustration

y Anxiety

Active Listening (being attentive to what client is saying both verbally and nonverbally) Active Listening (being attentive to

All right. Howard.

Howard.

Show me all the blueprints. Show me all the blueprints. I'm serious, now. Show me all the blueprints. Show me all the blueprints. Show me all the blueprints. Show me all the blueprints. Show me all the blueprints. Show me all the blueprints. I want to get this done right. Show me all the blueprints. Show me all the blueprints. Show me all the blueprints. Show me all the blueprints.

y Frustration y Rapid speech

y Perseveration y Obsession and compulsion

what client is saying both verbally and nonverbally) Active Listening (being attentive to what client is saying both verbally and nonverbally)

y Alarm y Frustration y Rapid speech

y Perseveration y Obsession and compulsion

Active Listening (being attentive to what client is saying both verbally and nonverbally)

N/A

N/A

Show me all the blueprints. Show me all the blueprints. Show me all the blueprints... Quarantine. Q... ...U... ...A... ...R... ...A... ...N... ...T... ...l... ...N... ...E. Quarantine.

y Alarm y Frustration y Flight y Rapid speech y Eyelid twitching y Inhibition y Blocking of thoughts

y Perseveration y Obsession and compulsion

N/A

y Anxiety y Regression

N/A

G. Psychiatric Nursing Diagnosis Assessment Subjective Cue: Planning Implementation The patient will reduce anxiety  Help the patient identify to a mild level and will protect and describe underlying Objective Cues: from harm and will feelings. the patient demonstrate adaptive ways of  Approach y thoughts of unhurriedly. contamination (images coping with stress.  Modify and decrease of dirt and germs) environmental stimuli y Excessive hand washing (provide an accepting y Perseveration atmosphere; don't show y Suspicious shock, amusement, or y Paranoid criticism of the ritualistic y Easily distracted behavior)  Limit the patient s Nursing Diagnosis: interaction with other to y Moderate anxiety minimize the contagious related to sexual aspect of anxiety. conflict as evidenced by  Limit, but do not interrupt, excessive hand the compulsive acts such as washing, repetitive allowing the patient time to saying of words and carry out the ritualistic recurrent thoughts of behavior (unless it's dirt and germs. dangerous) until he can be distracted into some other activity.  Teach the client to use alternate coping methods to decrease anxiety. Expected Outcome

Assessment Objective Cues: y Stayed alone inside the room for nearly 3 months

Planning Implementation The patient will resume his  Allow patient to discuss usual lifestyle and obtain feelings regarding the maximum interpersonal problem and describe satisfaction by establishing and behavior interfering social maintaining self- enhancing interaction.  Provide honest, immediate relationship with others. Nursing Diagnosis: feedback about behavioral y Social Isolation related change. to external stressors  Communicate knowledge such as pressure from and understanding of the media. emotional responses.  Engage the patient in activities to create positive accomplishments and raise his self-esteem and confidence.  Review existing and potential social resources.  Provide anticipatory guidance regarding common physical, emotional and psychological responses.  Explore relationship with significant others.  Encourage the patient to discuss the situation with trusted and supportive

Expected Outcome The patient will resume his usual lifestyle and obtain maximum interpersonal satisfaction by establishing and maintaining self- enhancing relationship with others.

people.

Assessment Objective Cues:

Planning Implementation The patient will select  Encourage discussion of constructive rather than selfthoughts and feelings. destructive ways of coping in  Listen to the patient and Nursing Diagnosis: facing his fear. approach in a calm manner Fear related to acquire germs and offering feedback. or dirt.  Identify cues that trigger his behavior.  Decrease environmental stimuli and modify the environment.  Systematically exposed to the anxiety-producing thoughts or behaviors, beginning with the least upsetting.  The patient is asked to endure the feared event or image without engaging in the compulsion. (For example, a person with a contamination obsession might be asked to touch a series of increasingly dirty

Expected Outcome The patient will select constructive rather than selfdestructive ways of coping in facing his fear.

objects without washing their hands).  Assist the patient with new ways to solve problems and to develop more effective coping skills by setting limits on unacceptable behavior (for example, by limiting the number of times per day he may indulge in obsessive behavior).  Avoid creating situations that increase frustration and provoke anger, which may interfere with treatment. Assessment Objective Cues: y Excessive hand washing y Aggressive behavior when flying his planes. Nursing Diagnosis: Risk for injury related to repetitive actions. Planning Implementation Expected Outcome The patient will not physically  Initially accept and support, The patient will not physically harm himself. rather than attack, the harm himself. patient s defenses.  Facilitate the awareness, labeling, and expression of feelings.  Do not ask the patient why symptoms exist and do not leave the patient alone.  Acknowledge the reality of the pain associated with the patient s present coping mechanisms. Do not

focus on the ritual or physical complaint itself. Give feedback to the patient about behavior, stressors, appraisal of stressors, and coping resources. Reinforce the idea that physical health is related to emotion health and that this area that will need exploration. Modify the environment and remove harmful objects. Encourage active diversional resources, such as whistling or humming a tune, to divert attention from the unwanted thoughts and to promote a pleasurable experience. Keep the patient's physical health in mind (For example, compulsive hand washing may cause skin breakdown. Help the patient recognize unhealthy coping mechanism and identify

alternative coping. Assessment Objective Cues: y long hair y untrimmed and dirty nails y long & thick mustache y no clothes

means

of

Planning Implementation The patient will be able to  Encourage to verbalize his perform personal hygiene anxiety regarding self-care. activities such as bathing,  Encourage to perform shaving and brushing teeth. personal hygiene.  Tell patient the importance of proper hygiene  Assist patient performing self-care Nursing Diagnosis:  Assure patient not to leave Self-care deficit related to him alone when performing feelings of depression. activities  Assure for patient s safety  Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in ritualistic thoughts and behaviors to the point of self-neglect

Expected Outcome The patient will be able to perform personal hygiene activities such as bathing, shaving and brushing teeth.