Angeles University Foundation COLLEGE OF NURSING

PLAN OF CARE
NAME: Tristan Jay I. Arellano BSN III 4 GROUP Number: 1
I. MENTAL STATUS EXAMINATION (MSE)

CONTENT OF MSE General Appearance

ASSESSMENT Patient C of unknown age, is a Filipino Male who stands around 411 and weighs fairly average based on his appearance. He is fairly groomed, hi hair cut short and his nails a bit long with stains of yellow and black especially significant in his toe region. He presents patches of hair loss and the most significant is on the right frontal area of his head. C also has halitosis that is suppressed by brushing and cycles again after some hours. He has no front teeth in the upper area of his dental structures and his teeth are stained with yellow to brown hues. He also has growing hair around his mouth and jaw area, significant of an after shave cycle.

PSYCHOBIOLOGICAL RATIONALE Clients with schizophrenia may have significant self-care deficits. Inattention to hygiene and grooming needs are usually common. The client results to personal neglect due to his preoccupation to his psychotic ideations, hallucination, or delusions. Furthermore, it is also common that clients are unable to process the need to renovate self after a strenuous day or refurnish grooming due to dysfunctions in the temporal and frontal areas of the brain brought about by either the enlargement of ventricles or impairment in glucose and oxygen metabolism.

C wears a blue NCMH shirt, with a V neck collar Lastly, it is also very usual that clients suffering and a stiff material; an NCMH short that is colored schizophrenia precipitate a neglect in primary green and extends from his waist until 3 finger senses such as thirst, and hunger that is why they breadths above his ankle. are usually constipated and undernourished resulting further to lack of sufficient energy for C stands fairly stable, his gait slightly swingy. He movement and exercise. has short extremities and his legs are filled with macular rashes, nearly scabies like, and his feet are bombarded with pustules, macules, crusts, and wounds from severed skin infection. He also has two significant tattoos, one in his Left shoulder, a girl who is drawn in a basic fashion, and one other in his right hand, at the area of the thumb, the tattoo here are 5 dots.

Behavior

Although Patient Cs age is unobtainable from his records and from himself, stereotyping his physical features suggest that patient C is in his mid40s or early 50s already yet he acts in a regressed manner, similar to that age that falls between Infancy and Childhood as evidenced by his oral gratifying behavior which is thumb sucking.

For schizophrenic patients, their motor behavior, and behavior in general are commonly altered. Clients may be restless and are unable to sit still, in patient Cs case, he is observed to prefer pacing around the perimeter than sitting for minutes in a bench.

Consequently, the patient also presents Patient also moves very slowly and his pace is not psychomotor retardation resulting to regressed as active as that of how a normal person of his age behavioral manifestations and general slowing in moves about. Patient C also has difficulty the execution of movement. maintaining eye contact although he has a full stare at something but never on the person of nurse he is relating to. He presents vigil stare that are empty but prolonged. With regards to his facial expressions, he usually has a blank face and an exaggerated smile when hi is delighted. He reflects his delight by smiling and clapping. Also, patient has a difficulty in executing fine motor movements like drawing. He also could not read and write. It is also notable that the patient presents manifestations of catatonia that are evident in awkward opportunities such as that time when his foot is stepped by another patient, he did not remove the abused foot until he was told to do so. Patient C often walks around and does thumb sucking. He also has considerable liking of flowers and picking them up and later giving them to other student nurses. His movements are slowed down and are very limited although he is able to do his ADLs in a satisfactory rate. Patient C consumes much time and effort in answering. He also speaks in a childish manner that is fairly clear and understandable. He is usually dropping initial syllables of words. He speaks single words only when asked to answer and he also stutters.

Motor Activities

Walking and thumb sucking are evident manifestations of psychomotor retardations present among patients with schizophrenia

Speech Pattern

The core phenomenologic characteristics of schizophrenia can be considered to stem from anomalous organization, retrieval, and communication of complex "thought" and language. Thus, it follows that schizophrenia is likely to be a uniquely human condition and that some deficits in the neural organization of Patient C also manifests word salad, that when language must exist in schizophrenia. Numerous probed on a specific matter, he utters words that do aspects of both speech and its perception have not have any relationship with his previous been found to be deviant in studies of patients

Concentration

Orientation

Memory

Thought Clarity

Thought Content

statements. Hes speech is also limited to only direct with schizophrenia. succinct answers and does not exert any effort to keep conversations going. Crow has suggested that language deviance is the basis for the development of the nuclear symptoms of schizophrenia (Crow, 1998a) and that "Schizophrenia is the price Homo sapiens pays for language" (Crow 1997). He further states that the development of cerebral structural asymmetries during hominid evolution is responsible for the uniquely human components of language (as discussed by Geschwind and Galaburda 1987 and Corballis 1991) and that these asymmetries are anomalous in schizophrenia (Crow 1998b). In support of this hypothesis, we previously have shown that reduced cerebral asymmetries are present early in the course of schizophrenia and that some components of asymmetry are inherited Patient C has varying attention span. He spends Videbeck reasons out how concentration is less than a minute during assessment by the nurse impaired in schizophrenia by going back to the and he spends long minutes while staring blankly on preoccupations of every schizophrenic patient trees, birds, ants, and flowers. He also could not with their hallucinations, delusions, magical focus and participate well during the therapies thinking, and ideations. because he is easily distracted by almost anything. Patient C is not oriented to Time. He reckons no Significantly, due to the lack of function of the memory of any current president in office, no recall temporal lobe which is far attributed to the of the details of the day, and no estimation of time. resolution of memory, recall, and processing of With regards to place, he describes and relates to new information, its impairment leads to places by using proximities but never being able to disorientation and confusion to the surroundings. site the name of places. Significantly, he is aware of It also may be attributed to the imbalances in the the people around him although he could not neurotransmitter, dopamine. mention their names. Patient does not have a stable memory of what has Memory is impaired in schizophrenia because been done previously or what had been talked of the significant imbalances in dopamine which is about previously. He also could not detail his own significantly important in recall and an anatomic familial history although he mentions having a deviation in the temporal regions of the brain. mother and 2 siblings. Other details are unobtainable With regards to thought clarity, the patient presents Thought clarity, content and process, and a very poor rating. He could not process questions at intellectual functioning are usually altered and are an instance and one the repeat. He also has a hard significantly common among schizophrenic time doing comparisons or making choices patients. This disease had been popularly identified as a thought disorder because Patient C presents obsessions on flowers, leaves, alterations in the aforementioned aspects ants, river, stones, and houses. He kept of saying constitutes to the primary features of these topics even when question no longer require schizophrenia. (Videbeck, 2011) such supplying.

Thought Process Intellectual Functioning

Patient C blocks himself from answering questions that render his past and also manifests word salad, loose associations and flight of ideas. Patient C cannot process mathematical activities such as counting and adding, he also significantly has difficulty distinguishing colors and names all other shades as White. He also could not make connections with statements and could not reason out or explain

Mood Affect

The patient sustains varying moods from being happy, sad, irritable, and flat The patient has blunt affect, showing very slow-torespond facial reactions. He also says mabuti (well) even if his facial reactions would say otherwise

Aside from the anatomical deviations rooted from enlargement of ventricles and decline in oxygen and glucose metabolism, neurochemical studies have postulated that neuronal networks which transmit information by electrical signals from a nerve cell to another is of grave malfunction. This ultimately results to a disruption in intellectual functioning, and in the processing of thought thus clouding the clarity of ideas and declining its content. Clients with schizophrenia often present and demonstrate wide variances in mood and affect. They are often identified as having either flat affect of blunt affect. The typical facial expression often described among these clients is mask-like. These manifestations are again blamed on the impairment in brain signals and neuronal network brought by neurochemical alterations and anatomic abnormalities. Insight may also be severely impaired among clients with schizophrenia, especially during the early course of the disease when the patients family and immediate social network do not understand the disease condition of their familial member. Judgment is frequently impaired in clients with schizophrenia. Because judgment is based on the ability to interpret the environment correctly, it follows that the client with disordered thought processes and environmental misinterpretations will have great difficulties in judging. Impairment in abstraction is greatly derived from the impairment in the thought processing, content, and clarity of the patient. It is further aggravated by the difficulty in judgment and intellectual functioning which precipitates into a nearly basic, primitive, and superficial manner of interpretations when problems are let down for the clients analysis.

Insight

The patient is not able to gather his own insight on things. He may present some insight yet they are majorly not in line with the subject.

Judgment

The patient capable of basic judgment, In particular, noting which fruit is rotten or edible.

Abstract Thinking

The patient is not capable of performing abstractions nor minor hypothetical or conclusive evaluating constitutions.