3.Mental Status Exami nation A.APPEARANCE T he client appear s to be well gr oomed. Mr . I.R.

has a n o t i c e a b l y proper cut hair and is well combed. Mr. I.R. wears clothing appropriatelydepending on his mood and with the weather. Mr. I.R. refers wearing longsleeves but when it is hot, he wears the usual t-shirt along with his shortso r a n y available pants he has. For 3 consecutive days of duty, it wasobserved that he only took a bath on the third day then c h a n g e d h i s clothes; the patient is observed to brush his teeth before and after meals.His nails are trimmed and his beard and mustache are neatly shaved. Theclient appeared as the stated age of 56 years old with visibly white hairand some noticeably wrinkles on his face. B. BEHAVI OR 1.MANNER OF RELATING Mr. I.R. is participative during discussion. He actively and openlya n s w e r s q u e r i e s b e i n g a s k e d t o h i m b y t h e s t u d e n t n u r s e s . H e sometimes cracks jokes that make the conversation lively. He usuallyprefers to talk with student nurses rather than to his co-patients insidethe ward. 2.PSYCHOMOTOR ACTIVITES The patient has a good posture. However, he sometimes slouchesduring conversation with his legs and arms crossed and sometimeswith his hands on his lap, swaying his feet while looking around theroom. He usually stay on bed sitting or if not, sleeping. Patient has good posture, gait and station. He was observed to walk straight. Hehas mild hand tremors observed. 3.SPEECH/LANGUAGE The client talks with normal rate, rhythm and intensity. He speaksclearly and has good articulation of words. He elaborates his answerst o q u e s t i o n s a s k e d a n d s o m e t i m e s , h e s h a r e s s o m e t o p i c s t o b e discussed. It was also observed that he can easily find the right wordsto use when lost during conversation. To explai n further what are hist h o u g h t s . P a t i e n t i s a b l e t o t a l k i n E n g l i s h , T a g a l o g a n d I l o k a n o fluently.

4.RELEVANCE/COHERENCE T h e c l i e n t w a s a b l e t o a n s w e r r e l e v a n t l y a n d c o h e r e n t l y . H e used simple, concrete and easy to understand responses to the topicsbeing discussed during the NPI (Nurse-Patient-Interaction). 5 . DEVI ATI O NS There were no deviation like inventing, rhyming, stammering,c l a n g i n g o f w o r d s , r e p e t i t i o n o f w o r d s a n d s p e e c h e s i n p a r t i c u l a r questions being asked by the student nurses noted. 6 . VO CABUL ARY The patient uses appropriate terms to use when conversing. Hesometimes use terms related to his field of engineering such as thed i f f e r e n t m a c h i n e r i e s a n d g a d g e t s h e e n c o u n t e r e d w h i l e h e i s s t i l l studying and working abroad. Patient is able to adjust his choice of words depending on whom he is talking to. He would use simple wordst o h i s c o p a t i e n t w h i l e h e u s e s m o r e c o m p l e x v o c a b u l a r i e s t o t h e health care providers. C.MOOD and AFFECT Mr. I.R. stated okay naman pero minsan nadedepress. It wasobserved during the conversation that whenever the discussion dealswith his wife finding time visiting him, he feels very happy and is seensmiling. However, when the topic is about the incident where he wasntable to visit his sister and dads burial, he becomes very sad with tearyeyes. D.T HI NKI NG D u r i n g t h e c o n v e r s a t i o n , M r . I . R . w a s a b l e t o d i s c u s s t o p i c s concer ning religion, philosophy and history. He was able to discussrecent events of the world and how these are predicted by previousevents. He also talks about his work and how was he as an employeewhen he works abroad. He talks about his family often and mentioned Y u n g a s a w a k o n a g w o r k s a S a u d i at may isa akong anak.. Maagan a k a p a g a s a w a . M a y i s a n a a k o n g a p o . T h e r e w a s n o p a r a n o i d delusions observed from the client. However the patient was observeto avoid topics which concern on the reasons why he was brought to the hospital. Mr. I.R. is oriented to person, place, time and self. He canidentify who brought him to the ward. T h e p a t i e n t i s a b l e t o r e c a l l r e c e n t a n d p a s t e v e n t s

i n h i s personal history. He can still recall up to now that hes 56 years old thememorable experience he had when he was 6 years old which made hisparents got mad. He said May ilog kasi doon malapit sa bahay namin.Naliligo kami ng walang paalam kaya pag-uwi namin, palagi kamingnabubuking kaya napapalo kami.When the patient was asked to tell the name of one of our costudent nurse that was introduced to him for no longer t h a n 1 5 minutes, he said Si Earl, oo yung mataba. Siya yung una kong nakitanung pagpasok niyo. Malaking tao kasi.. E.ABSTRACTION When the patient was asked of how did he understand the sayingA hard beginning maketh a good ending. He responded immediately Parang ganito sa situation ko, para akong nakakulong ngayon perot h e r e s a p u r p o s e w h y I a m h e r e h o w e v e r t a k i n g t h a t a l l i n t o c o n s i d e r a t i o n , I a m p o s i t i v e t h a t t h i s t u r mo i l i s t o m a k e m e a n d m y family stronger than before. 1.CALCULATION AND CONCENTRATION The patient was able to compute simple mathematical equationsas fast as 5 to 10 seconds when asked to answer 9 x 23=___. He canconcentrate even if the ward seems so noisy. 2 . I N S I G H T When he was asked how can he sees himself as a father to hischild, he simply said I have been a good father or a parent. In fact notonly that, I know I have been a good husband to my wife kasi ginawako lahat para mabigyan sila ng magandang buhay sa pamamagitan ngpagtatrabaho ko at pagtitiis ko sa Iran for income out of hard work.Hea l s o c l a i me d H y p e r t e n s i o n t a l a g a p r o b l e ma k o . H i n d i n a ma n akob a l i w . W a l a a k o n g n a k i k i t a o n a k a k a u s a p o n a r i r i n i g n a g a ya ngnaririnig at nakikita nung i ba kong kasamahan dito.The patientm e n t i o n e d a l s o M a g b a b a k a s y o n m u n a a k o s a Z a m b o a n g a pagnakalabas ako dito para makapagpahinga na din. Kasama ko angasawa kong pupunta siguro.7 3.JUDGMENT The client mentioned along with the discussion that he hadsome fight with his neighbor and was asked of what he will do when hesees his neighbor again and he said Makikipag ayos na ako. Siguro ngatalagang kailangan na ng peace-of-mind kaya makipag=ayos na.

F.SUPEREGO F UNCTIONING/IMPULSE CONTROL The client stated that Noong hindi ko natulungan yung ate kofinancially at noong hindi ako nakapunta nung burol nya when he wasasked what he or makes him guilty or what he regrets the most.G . S E L F - C O N C E P T T h e p a t i e n t h a s l o w s e l f - e s t e e m a s h e i s s h y a n d h e d o e s n t mingle or talk with the other patients in the ward. When conversingwith him he often focuses on his positive behavior like being a goodhusband to his wife and father to his son, which indicates that he istrying to elevate his self-esteem .H.PHYSICAL COMPLAINTS/PROBLEMS The client doesnt have any physical deformities. He is slow whenwalking because of aging. He has tremors and claimed that Ganito tokasi side effect ng gamot, which indicates a circulatory problem becauseof HPN

E.PSYCHOPATHOLOGY 1.Biological Cause A.Neurotr ansmi tter Alter ati on A.1 Increase Dopamine- Overproduction of dopamine causes the nerve circuits tomisfire and create a split state in the mind where delusions andh a l l u c i n a t i o n s m a k e t h e r e a l i t y o f t h e o u t s i d e w o r l d e a s i e r t o ac cept A.2 Increase Serotonin level- An increase in serotonin levels indicates Mania / Manic inBipolar Disorder. Because he has the three signs of mania whichare Auditory Hallucinations, delusions and paranoia A.3 Decrease Serotonin Level- A decrease in serotonin levels indicates depression. He hast h e s y m p t o m s o f d e p r e s s i o n l i k e s o c i a l w i t h d r a w a l , l o w s e l f esteem and persistent sadness B. Genetic Predisposition B.1 Being ShyH e h a s t h e p r e s e n c e o f t h e t y p e A p e r s o n a l i t y , w h i c h i s in herently acquired thus he has poor IPR to others 2. Psychosocial Causes

A. Development of Mistrust- It is according to Freuds Psycho-social theory. Presented by poorI P R t o o t h e r p e o p l e , u n a b l e t o e x p r e s s f e e l i n g s , l a c k o f c l o s e friends, isolates self, social withdrawal B. Cultural Norms- Because they have a close-knit family C. Traumatic Experience C.1 Separation from family members- Being alone and independent in an area that is unfamiliar C.2 Death of his Sister- As presented by Long term depression C.3 Living alone for several years- As manifested by anxiety and fear D. Use of Defense MechanismIneffective use of Denial as manifested by unrealistic perceptionof the situation