Case Pres. Psyche

7/30/2019 Case Pres. Psyche

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BULACAN STATE UNIVERSITY

Mojon, City of Malolos, Bulacan

COLLEGE OF NURSING

A Case Study of Ms. Sue with a diagnosis of Manic

Disorder with Pyschotic Feature (monosocial); to

consider Paranoidal SchizophreniaSubmitted By:

Group 2

De Leon, Charmaine P.

De Leon, Lara Erika B

De Leon, Mardielyn Rose M.

dela Cruz, Albert S.

dela Cruz, Jennelyn Y.

Dungca, Rhenee Anne G.

Eusebio, Omar

Hilario, Ma. Antonette A.

Iguban, Mickael John O.Leano, Gianina Marie P.

Group 3

Lumba, Christine Joy O.

Lumba, Eries L.

Martin, Claire Rochelle Erika A.

Nepomuceno, Anna Mhelysa F.

Pagal, Mylene

Perez, Ma. Cristina S.

Pescador, John Robert A.

Pingol, Criselle L.

Placides, Marrose Arra R.


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In Partial Fulfillment of the Requirements in NCM 105 B RLE

Mariveles Mental Hospital

Mariveles, Bataan

(February 14, 2013)

Submitted to:

3rd Level Clinical Instructors


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I. INTRODUCTION

This is a case of MS. SUE, 55 years old, that was admitted at Mariveles Mental hospital last August 31, 2012 and was diagnosed of Bipolar Manic Disorder

with Psychotic features. The patient was admitted at the female ward due to the complaints of the informants that the client escaped from home, refused to take

medications, refused to eat meals except for fruits and was talking and singing aloud.

Mood disorders, also called affective disorders, are pervasive alterations in emotions that are manifested by depression, mania, or both. There are two major

classifications of mood disorder. The Major Depressive Disorder, which is characterized by occurrence of one or more depressive episodes and absence of manic,

mixed and hypomanic episodes, and the Bipolar Disorder.

Bipolar disorder or BipolarAffective Disorder, historically known as manicdepressive disorder, is apsychiatric diagnosis

, defined by the presence of one or

more episodes of abnormally elevated energy levels, cognition

, andmood accompanied by abnormal behaviour with one or more depressive episodes. The elevated

moods are clinically referred to as mania or, if milder, hypomania. They also experience depressive episodes, or symptoms, or a mixed state in which features of

both mania and depression are present at the same time. These events are usually separated by periods of "normal"mood; but, in some individuals, depression and

mania may rapidly alternate, which is called rapid cycling. Severe manic episodes can sometimes lead to suchpsychotic symptoms as delusions.

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or

overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of

both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode. Bipolar disorder

symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness

can lead full and productive lives. For the purpose of medical diagnosis, Bipolar Disorder can are described as Bipolar I disorderone or more manic or mixed

episodes usually accompanied by major depressive episodes; Bipolar II disorderone or more major depressive episode accompanied by at least one hypomanic

episode. In short, in type 1, manic episodes are more prevalent while vice versa.

Various theories for the etiology of mood disorders exist. Most recent research focuses on chemical biologic imbalances as the cause. Nevertheless

psychosocial stressors and interpersonal events appear to trigger certain physiologic and chemical changes in the brain, which significantly alter the balance of

neurotransmitters (Gabbard, 2000). Bipolar I disorder with psychotic features is a mood disorder characterized by unusually euphoric or agitated moods, along with

depression or a mix of high and low moods. Psychotic symptoms are also part of this disorder, which can severely impact a person's ability to function. An accuratediagnosis and appropriate treatment plan are vital to the successful management of bipolar I disorder with psychotic features.
http://en.wikipedia.org/wiki/Affect_(psychology)http://en.wikipedia.org/wiki/Classification_of_mental_disordershttp://en.wikipedia.org/wiki/Cognitionhttp://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Major_depressive_episodehttp://en.wikipedia.org/wiki/Mixed_state_(psychiatry)http://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Rapid_cyclinghttp://en.wikipedia.org/wiki/Rapid_cyclinghttp://en.wikipedia.org/wiki/Psychotichttp://en.wikipedia.org/wiki/Delusionshttp://en.wikipedia.org/wiki/Delusionshttp://en.wikipedia.org/wiki/Classification_of_mental_disordershttp://en.wikipedia.org/wiki/Cognitionhttp://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Major_depressive_episodehttp://en.wikipedia.org/wiki/Mixed_state_(psychiatry)http://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Rapid_cyclinghttp://en.wikipedia.org/wiki/Psychotichttp://en.wikipedia.org/wiki/Delusionshttp://en.wikipedia.org/wiki/Affect_(psychology)


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According to PubMed-US National Library of Medicine National Institutes of Health, the Prevalence of Bipolar 1 Disorder in the World Mental Health

Survey Initiative, the aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I). In United States, Bipolar Disorder has an incidence of

approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. The median age of onset for bipolar disorder is 25

years, although the illness can start in early childhood or as late as the 40s and 50s.An equal number of men and women develop bipolar illness and it is found in

all ages, races, ethnic groups and social classes. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar

major depression, indicating that the disease has a heritable component. Locally, according to the record of Mariveles Mental Hospital as of 2012, there are 1030 patients

who are admitted and only 50 or 4.85% of the total number of patients are diagnosed having Bipolar Manic Disorder. Among them, 62% (31) are Male while the remaining 38%

(19) are female.

References:

http://www.ncbi.nlm.nih.gov/pubmed/21383262

Videbeck 4th ed.
http://www.ncbi.nlm.nih.gov/pubmed/21383262http://www.ncbi.nlm.nih.gov/pubmed/21383262


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II. OBJECTIVES

General Objectives

The study aims to supply knowledge about its definition, manifestation, sign and symptoms, complications and treatment to students and to the patientsregarding Bipolar Disorders. This study also aspires to enhance the skills of the student nurses in handling and caring for psychiatric nurses especially those with

Bipolar Disorders. Another aim that this study wants to achieve is to inculcate or instill virtues such as patients understanding, kindness, devotion and dedication in

the heart of nursing students.

Client Centered

To improve condition by reorienting our client into reality.

To express and explore clients thoughts and feelings.

To sustain an interactive conversation without or with decrease level of anxiety.

Student Centered

To gain knowledge about Bipolar Manic Disorder, Schizophrenia and Pyschosis

To improve therapeutic communication skills of the student nurse.

To gain and develop trust with client through self-awareness.


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III. NURSING ASSESSMENT

A. Biographic Data

NAME: Ms. SueAGE: 55 y/o

GENDER: Female

ADDRESS: Mariveles, Bataan

DATE OF BIRTH: December 17, 1957

PLACE OF BIRTH: Estancia, Iloilo

NATIONALITY: Filipino

CIVIL STATUS: Single

RELIGION: Born Again Christian

HIGHEST EDUCATIONAL ATTAINMENT: College Graduate

DIAGNOSIS: Bipolar Manic Disorder with Pyschotic Feature (monosocial), To consider Paranoidal Schizophrenia

DATE ADMITTED: August 31, 2012

TIME ADMITTED: 10:35am

TYPE OF ADMISSION: Old (3x)


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CHIEF COMPLAINT (recent admission):

Escaped from Home

Refused to take Medications

Poor Sleep

Talking Singing Aloud

Refuse to eat meal except for fruits

- source: Ms. VM (friend)

B. History Illness

Prior to Admission During Institutionalization Upon HandlingIn 1999, before being brought to a Mental

Institution, she was first brought to Bautista HomeCare Facility because she was eliciting

manifestations of mental illnesses. She was releasedin 2000 and is attending OPD check-ups on Juneand July(unknown institution) and was diagnosed

with Bipolar Manic and Psychotic Features; shestopped her medications August of that year..

Patient had several confinements at MMH. Her firstadmission was on November 05, 2010, with

complains of stopping her medications, being very

noisy and difficulty sleeping. She was diagnosedagain with Bipolar Manic and Psychotic Features.Her 2nd Admission was on October 06, 2011, with

At August 31, 2012, ACIS, she was seen by the

psychiatrist and she was described as being hostile,very noisy and uncooperative. According to the

records, she was verbalizing Ang aking kaharian,singing loudly lalalalala and she called herphysician as Dr. Quack-Quack.

On September 07, 2012, she was seen again by thephysician and was described as wearing appropriate

clothes, barefoot and was holding a water bottlewhile being interviewed. She was exhibiting

Delusion of Grandeur, saying that she was the

product manager in Malacanang since Marcosregime. She claimed that the people who arewatching her are unknown to her, but later said

February 07, 2013, signals the start of

our Nurse Patient Interaction (NPI). Wemet our client Ms. Sue and she can be

described as a cooperative patient,polite and well behaved. She was veryconscious with her hygiene. We have

also observed that the client is reallyconscious when it comes to time. She

does not like being late as observedwhen we were grooming her. She

appears to be calm and easily

controlled during our NPI. Sheparticipated on all of the activities andreally showed enthusiasm in all of


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complains of difficulty sleeping then she wasdiagnosed again like the previous. Before her

present admission, she obediently attends to herfollow-up check-up at the OPD until June 2012.

Last July 2012, the client started to refuse takingmedications for her psychiatric condition and

Medications for Liver, Kidney and DiabetesMellitus. She stated that she stopped because she

listened to an advice (unknown informant) that themedications are the one causing her Robot-like

movements or feeling. She stated that she compliedto it because she is actually experiencing the

manifestations that the informant told her. ByAugust 05, 2012, she escaped from the house of the

informant by climbing down a guava tree near theinformants fence, then she went to Baesa, QuezonCity where her friend lost contact from her. On

August 8, 2012 (before the date of admission), the

informant learned that she was placed at a barangaystation (unknown location) due to complains fromthe supermarket employees who she had a quarrel

with. Non Smoker.

huwag kang maniniwala, singungaling yan!.On the following day, September 08, 2012, she was

seen again by the physician and was described ashaving a well-kept appearance and behaviour,

severely cheerful, dated, good mood, talkative,argumentative but polite, speaks in English with

mood disturbances while speaking. She admittedthat she is dancing and singing. When asked why,

she answered Syempre, Masaya!!. She was alsoexhibiting Referential Delusion verbalizing

nagbebenta ako ng imported giveaways, admitsthat she was called by the king of the Department

of Budget and Managament. She was alsoexhibiting Persecutory delusions, verbalizing,

maraming galit sa akin, pinapatay nila ako, dikoalam kung bakit (she was pertaining to Dela CruzFamily). She was also suspicious saying Yung

gamot na binibigay nyo, Tranquilizer that is

SHABU!. She claims that she wants to live alone,verbalizing Ayaw kong minamahal ako odinodomina ako, she accuses her guardian saying

ikaw ba talagang tapat sa akin? Sagutin mo ako!!,she was also observed with having poor insight

saying Magaling na ako eh, di ko na kailanganggamot.

them. During our last day handling her,she was being visited by her friend. We

were surprised to see a new side of heras she is demonstrating hostility as she

was begging her friend to take herhome already. This was the first time

that we have seen her like that. She wasstill mentioning that once she comes

out from the facility, she wouldimmediately get her salary from her

company and start her life anew. Sheeven demonstrated delusion of

grandeur as she verbalized that shewould help us financially when she gets

out of the facility to reward us fortaking good care of her.

C. Previous Illnesses

The client was also diagnosed with Type 2 Diabetes Mellitus 2 years ago and was prescribed to take Hypoglycemic Agents like Metformin. She took

the medications for one year and then she refused to take the said medications. The client also recalled having cough and cold prior to admission. She also

remembered having chickenpox when she was 12 years old.


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D. Past Personal History

The earliest event that the client remembered was playing with her siblings and friends at Iloilo City. She told us she was average student and has

never had a serious problem at school. During her high school years, she used to hang out with her friends especially with her bestfriend. She did not finish her

studies as she took up nursing at Central Philippines University due to financial problems.

The client worked as an attendant at the Bataan Hilltop Hotel during her younger years in which she recalled seeing many of the famous artists like

FPJ, Alma Moreno and Rudy Fernandez. She is not married and she never had boyfriend even when she was young because according to her, her focus was to finish

her studies and being able to help her family first.

E. Family History

According to her, before she was diagnosed, she had a good relationship with her family. She used to hang out with her siblings and spend every

Christmas together. But recently, she is very angry at her siblings after they brought her to 3 different Mental Health Institutions and refused to take responsibility of

her. According to the client, there is no previous history of mental illness within the family but her mother was diagnosed with heart condition.


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IV. Mental Status Examination

LEVEL OF CONSCIOUSNESS Day1 Day2 Day3 Day4 Day5

Alert * * * * *

Drowsy

Cooperative * * * * *

Eye contact * * * * *

AFFECT

Flat

Blunted

Inappropriate

MOOD

Appropriate * * * * *

Anxious

Agitated

Elated *

Depressed

DRESS

Appropriate * * * * *

Neat * * * * *

HYGIENE

Good * * * * *

PoorORIENTATION

Time * * * * *


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Place * * * * *

Person * * * * *

Situation * * * * *

MEMORY

Recent (Dinner/Breakfast * * * * *

Recent (Current Events) * * * * *


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Immediate (Short Term)

Remote ( Long Term) * * * * *

DEFENSE MECHANISM

Displacement

Denial * * * * *

Intellectualization

Introjection

Projection * *

RationalizationReaction Formation

Regression

Repression

Sublimation

Suppression

Identification

Isolation

Others:

EXTRA PYRAMIDAL

SYMPTOMS

PSEUDOPARKINSONISMAkinesia

Mask-like face

No swinging of arms

Hesitancy of Speech

Decrease muscle strengths

Shuffling gait

Drooling

Fine intention tremors * * * * *

ACUTE DYSTONIC

REACTION

Muscle spasm of the jaw, neck, tongue,eyes


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Laryngeal spasm

Akathesia

Restlessness

Tenseness *

Inability to sit still

Rocking back and forth of feet

Crossing legs frequently

Inability to relax

TARDIVE DYSKINESIA

Involuntary movement of mouth,

tongue ,face, and may extend to

finger arms and trunk

THINKING

COMMUNICATIONS

Loose Association

Neologism

Word Salad Echolalia

Echopraxia

Clang Association

Illogical thinking

Alogia

Concrete Thinking * * * *

Lack of Insight * * * * *

PERCEIVING AND INTERPRETING

Delusions

Reference

Persecution


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External influences

Somatic

Grandiose *

Hallucination

Cinesthetics

VisualOlfactory

Gustatory

Auditory

Tactile

SUMMARY OF MENTAL STATUS EXAMINATION:

During the five days of assessing the Mental State of the patient, she shows alertness, cooperativeness, and eye contact. Her mood is appropriate and

is oriented to time, place, person and situation. She was dressed appropriately and neatly, and her hygiene is good. She still remembers recent events and has long

term memory. She exhibits some extra pyramidal symptoms like fine intention tremors and tenseness.

While conducting a Nurse- Patient Interaction, the patient shows defense mechanism characterized as Denial and Projection. She denied her

condition because she has poor judgement which leads to the lack of knowledge about her mental condition. She exhibits Projection as a defense mechanism

because she believes that she doesnt have mental illness, she hates her family for bringing her to the Mental Institution, the reason why she wants them to

experience her affliction inside the ward.


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V. THEORETICAL FRAMEWORK

A. GROWTH AND DEVELOPMENT

Name: SCB

Age: 55 years

THEORY PSYCHOSOCIAL(Erik Erikson)

COGNITIVE(Jean Piaget)

PSYCHOSEXUAL(Sigmund Freud)

MORAL(Lawrence Kohlberg)

STAGE Intimacy vs. Isolation

( 18 -25 yrs. old)

Formal Operational

(12- Adulthood)

Genital Stage

(12 - Adulthood)

Post - Conventional: Universal

Ethical Principle Oriented

DEFINITION This stage covers the periodof early adulthood when

people are exploringpersonal relationships.

Erikson believed it wasvital that people develop

close, committedrelationships with otherpeople. Those who are

successful at this step willform relationships that are

committed and secure.

The formal operational stagebegins at approximately age

twelve to and lasts intoadulthood. During this time,

people develop the ability tothink about abstract concepts.

Skills such as logical thought,deductive reasoning, andsystematic planning also

emerge during this stage.

During the final stage of

psychosexual development,the individual develops astrong sexual interest in the

opposite sex. This stage beginsduring puberty but last

throughout the rest of aperson's life.

Where in earlier stages the

focus was solely on individualneeds, interest in the welfare

of others grows during this

stage. If the other stages havebeen completed successfully,the individual should now be

Kolhbergs final level of moralreasoning is based upon

universal ethical principles andabstract reasoning. At this

stage, people follow theseinternalized principles of

justice, even if they conflictwith laws and rules.


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well-balanced, warm and

caring. The goal of this stageis to establish a balance

between the various life areas.

REMARKS/ANALYSIS Client was not able to satisfy

this stage because she did nothave her own family. Instead,

she supported her family to thefullest. Client is isolated due to

the fact that she is separatedfrom her relatives and loved

ones.

Client developed a formal

cognitive perception asevidenced by observed clients

ability to reason out answer tological questions.

Client did not pass through

this stage completely becauseclient did not satisfy her sexual

desires as well as a need forfamily even though her

reproductive system isfunctioning normal.

Before, client was able to

identify ethical principles suchas a persons right and rules of

the state but now she is unableto differentiate right from

wrong. Also her decisionmaking is somewhat affected

due to her psychologicalproblem. This is evidenced by

wrong judgement when asked

about situational problems.


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B. Theoretical Frameworks

Theory Theorist Description Application of the Theory to thePatient

Self-Care Theory Dorothea Orem The provision of self-care which istherapeutic in sustaining life andhealth, in recovering from disease

or injury, or coping with theireffects.

Nursing promotes the goal ofpatient self-care.

a. SELF-CARE

- comprises those activitiesperformed independently by an

individual to promote and maintain

personal well-being throughoutlife.

b. SELF-CARE DEFICITresults when the Self-care Agency

(patient) cant meet her/his self-care needs or administer self-care

Orem focused on a specific need ofperson, which is self care. This canbe defined as being able to maintain

health with the help of oneself. But ifone is psychologically incapacitated,

he/she might not be able to do suchtask. This theory serves as a guide

for us student nurses to act in helpingout clients take care of themselves

again or achieve maximum level ofwellness as possible.

Nightingales Environmental Theory Florence Nightingale Defined Nursing:The act ofutilizing the environment of the

patient to assist him in his

recovery.

Focuses on changing and

manipulating the environment in

We used this theory to determine thefactors that will affect clients health

as well as in choosing appropriateinterventions for our clients.


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order to put the patient in the bestpossible conditions for nature to

act.

Identified 5 environmental factors

NECK AND LYMPH

NODES

Symmetry and visible

mass of thyroid gland

Presence of tenderness or

nodules in the lymph

nodes

Placement of trachea

Smoothness and areas of

enlargement, masses or

nodules in the thyroid

gland

SKIN

Inspection

Palpation

Palpation

Palpation

Asking the client

to lower the chinslightly

Glands ascends during

swallowing but is not visible

Not palpable

Central placement in themidline of neck; spaces are

equal on both sides

Lobes may not be palpable

No visible masses

No nodules or tenderness

In midline of neck

No areas of enlargement

Normal

Normal

Normal

Normal


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Inspect for color anduniformity

Inspect for the presence

of edema

Inspect and palpate for

skin lesions according to

location distribution,

color, configuration, size,

shape, type or structure

Observe and palpate skin

moisture

Note skin temperature

Note for skin turgor

NAILS

Inspection

Inspection andPalpation

Inspection and

Palpation

Inspection andPalpation

Palpation

Inspection

Varies from light to deepbrown, ruddy pink to light

pink, yellow overtones to olive;generally uniform except in

areas exposed to the sun, areasof lighter pigmentation in dark-

skinned people

No edema and inflammation

Freckles, some birthmarks,

some flat and raised nevi; noabrasions or other lesions

Moisture in the skin folds andaxillae

Uniform, within normal range

Skin springs back to previousstate; may be slower in elders

There are no observablepatches in the clients face

and skin

(-) edema

There are noticeable scratch

marks all over the body ofthe client. Prominent onboth legs.

The patient has dry skin.

Skin temperature is within

normal range

Skin springs back slowly

Normal

Normal

Deviation from normal due to itchiness

Deviation from normal due to poor sanitation

Normal

Due to poor hydration and aging

Normal


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Inspect fingernail shape

to determine its curvature

and angle

Inspect fingernail and

toenail texture

Inspect fingernail and

toenail bed color

Inspect tissues

surrounding nails

Perform blanch test or

capillary refill

THORAX

Inspection

InspectionInspection

Inspection

Inspection

Convex curvature, angle of nail

plate about 160

Smooth textureHighly vascular and pink inlight skinned clients; dark

skinned clients may havebrown or black pigmentation in

longitudinal streaks

Intact epidermis

Prompt return of pink or usualcolor

No signs of early clubbing

Smooth texturePink in color

No presence of lesions

Skin return to its normal

color; pinkish

Normal

Normal

Normal

Normal

ANTERIOR THORAX

1. Breathing patterns Inspection Quiet, rhythmic, and effortless

respirations

Normal rhythmic breathing Normal

2. Temperature,

tenderness, masses

Palpation Skin intact; uniform

temperature; chest wall intact;

Has an intact skin; has equal

warmth on both sides. No

Normal


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no tenderness; no masses masses.

3. Anterior thorax

auscultation

Auscultation Bronchovesicular and vesicular

breath sounds

No crackles sounds on the

upper thorax & lower

thorax

Normal

POSTERIOR

THORAX

1. Shape, symmetry, and

comparison of

anteroposterior thorax to

transverse diameter

Inspection

Palpation

Anteroposterior to transverse

diameter in ratio 1:2; Chest

symmetric

Has a anteroposterior to

transverse diameter ratio of

1:2, elliptical in shape and

symmetrical chest

Normal

2. Spinal alignment Inspection Spine vertically aligned Has a vertical alignment Normal

3. Temperature,

tenderness, and masses

Palpation Skin intact; uniform

temperature; chest wall intact;

no tenderness; no masses

No masses nor tenderness;

has equal warmth on each

side

Normal

7. Posterior thorax

auscultation

Auscultation Vesicular and bronchovesicular

breath sounds

No crackles, heard on the

anterior and middle part of

right and left lungs.

Normal

CARDIOVASCULAR

AORTIC andPULMONIC AREAS Auscultation No pulsations No pulsations felt Normal


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TRICUSPID AREA Auscultation No pulsations; no lift or heave No pulsations of lifts Normal

APICAL AREA Auscultation Pulsations visible in 50% of

adults and palpable in most

PMI in fifth LICS at or medial

to MCL

Has full pulsation Normal

EPIGASTRIC AREA Auscultation Aortic pulsations Has pulsation Normal

CARDIOVASCULAR

AREAS

AUSCULTATION

Auscultation S1: Usually heard at all sites

Usually louder at the apical

area

S2: Usually heard at all sites

Usually louder at the base of

heart

Systole: silent interval; slightly

shorter duration than diastole atnormal heart rate (60 to 90

beats/min)

Diastole: silent interval;

slightly longer duration than

systole at normal heart rates

S3: in children and young

adults

S4: in many older adults

Has full and rapid pulsation.

Sounds on the aortic and

pulmonic areas; has a lub

sound on the apex and dub

sounds on the tricuspid area.

Normal

Normal

Normal

CAROTID ARTERIES


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1. Carotid artery

palpation

Palpation Symmetric pulse volumes; full

pulsations, thrusting quality;

quality remains same when the

client breathes, turns head, and

changes from sitting to supine

position; elastic arterial wall

Normal pulsation.

Symmetrical pulse.

Normal

AXILLAE

1. Axillary, subclavicular,

and supraclavicular

lymph nodes

Inspection No tenderness, masses, or

nodules

Have no masses and

nodules.

Normal

ABDOMEN

1. Skin integrity Inspection Unblemished skin; uniform

color

Uniform color and has no

blemishes

Normal

2. Abdominal contour Inspection Flat, rounded(convex), or

scaphoid(concave)

Has a concave abdomen. Normal

3. Enlargement of liver or

spleen

Inspection No evidence of enlargement of

liver or spleen

No enlargement of the

spleen and liver seen

Normal

4.Symmetry of contour Inspection Symmetric contour Has a symmetrical

abdominal contour

Normal

5. Abdominal movements

associated with

respirations, peristalsis or

aortic pulsations

Inspection Symmetric movements caused

by respiration; visible

peristalsis in very lean people;

aortic pulsations in thinpersons at epigastric area

Abdominal movements

noted when inhaling.

Normal


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6. Vascular pattern Inspection No visible vascular pattern Has no blood vessels visible Normal

MUSCULOSKELETAL

SYSTEM

MUSCLES

1. Muscle size and

comparison on the other

side

Inspection Proportionate to the body; even

in both sides

Proportionate to the body;

even in both sides

Normal

2. Fasciculation and

tremors in the muscles

Inspection No fasciculation and tremors Has tremors Deviation from normal due to the side effects of

medications.

3. Muscle tonicity Palpation Even and firm muscle tone Even and firm muscle tone Normal

4. Muscle strength Palpation Has equal muscular strength on

both sides

Has equal muscular strength

on both sides

Normal

JOINTS

1. Joint swelling Inspection No swelling, no warmth, no

redness, no pain, no crepitus

No swelling, no warmth, no

redness, no pain, no crepitus Normal

EXTREMETIES Inspection,

Palpation


redness, no pain.


redness, no pain. Normal


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PHYSICAL ASSESSMENT SUMMARY

GENERAL: The patient is a nourished female; alert and oriented.

VITAL SIGNS: Temperature: 36C, PR: 82 bpm, RR: 28 cpm, BP: 110/80 mmHg

HEENT: Head is normocephalic and atraumatic; Patches of alopecia are present, with thin hair, dry and flaky scalp; lice and lesions are present in the head.

Presence of cerumen and wounds on both ears (pinna); Presence of mouth sores; Extraocular muscles are intact.

NECK: No carotid bruits. No lymphadenopathy or thyromegaly.

LUNGS: No crackles heard on the anterior and middle part of right and left lungs.

HEART: Regular rate and rhythm without murmur.

ABDOMEN: Soft, not tender, and not distended. No Hepatosplenomegaly.

MUSCLE: Has tremors.

SKIN: There are noticeable scratch marks all over the body of the client; presence of lesions on both legs; skin springs back slowly and with dry skin.


27/59

VIII. LABORATORY

Laboratory

Procedure

Date Ordered.

Date of Result

Indication/

Purposes

Normal Values Actual Values Analysis/

Interpretation

Nursing

Responsibilities

Blood Chemistry

- FBS- Cholesterol

- Triglycerides

Ordered:

December 20

Result:January 24, 2013

A test to assess a

wide range of

conditions andthe function oforgan.

60-110.9 mg/dl0-200 mg/dl

97-190.3 mg/dl

65.4 mg/dl186.9 mg/dl

132.6 mg/dl

NormalNormal

Normal

Prior:

- Define and

explain thetest.

- State the

specificpurpose of the

test.- Explain the

procedure.- Discuss test

preparation,procedure, and

post test care.

During:

- Ensure that the


28/59

specimen issecured in a

sterilecontainer.

After:

- Apply manual

pressure anddressings overpuncture site.

- Monitor thepuncture site

for hematomaformation.


29/59

IX. Medical Management (Pharamacologic Treatments)

DRUG NAME MECHANISM OFACTION

INDICATION CONTRAINDICATION SIDE/ ADVERSEEFFECT

NURSINGCONSIDERATIONS

Generic Name:Clonazepam

Classification:Anti-convulsant

Anxiolytics

Route/Dosage:2mg tab PO HS then

PRN tab

Probably acts byfacilitating the effects ofthe inhibitory

neurotransmitter GABA

Atypical absenceseizures

Akinetic and

myoclonicseizures

Panic disorder

Acute manic

episodes of

bipolar disorder

Contraindicated inpatients

hypersensitive tobenzodiazepine.

Use cautiously in

patients with mixedtype seizurebecause drug may

cause tonic-clonicseizures

Drowsiness

Agitation

Ataxia

Slurred speech

Tremor

Confusion

Behavioral

Disturbance

Closely monitorall patients for

changes inbehavior that

may indicateworsening of

suicidal thoughtsor behavior or

depression/.

Dont stop drug

abruptly

Assess elderlypatients responseclosely. Elderly

patients are moresensitive to CNS

drug effects.

Monitor CBC

and liver functiontests.


30/59


INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSEEFFECTS


Generic Name:

Divalproex Sodium

Classification:Anti-convulsant

Route/Dosage:250mg PO OD

Probably facilitates the

effects of the inhibitoryneurotransmitter GABA.

Simple and

complex absenceseizures

Complex partial

seizures

Mania associated

with bipolar

disorder

Prevent migraine

headache.

Contraindicated in

patientshypersensitive to

drug and in thosewith hepatic

disease.

Dizziness

Headache

Blurred vision

Back and neck

pain

Give drugs with

food to avoid toreduce adverse

GI effects.

Advise patient to

immediately

report malaise,weakness,

lethargy, appetiteloss, vomiting, or

yellowing of skinor eyes. It can bea symptom of

hepaticdysfunction.

Dont stop drug

abruptly.


31/59




Generic Name:Quetiapine

Classification:Antipsychotics

Route/Dosage:

300 mg HS

Blocks dopamine andserotonin receptors. Itsaction may be mediated

through thisanatagonism.

Schizophrenia

Adjunct therapy

with Lithium or

Divalproex forthe short term

treatment of acutemanic episodes

associated withbipolar disorder.

Depression

associated with

bipolar disorder.

Contraindicated in

patients withhypersensitive to

drug or itsingredients.

Use cautiously in

patients with

conditions that canpredispose

hypotension andconditions in

which core bodytemperature maybe elevated.

Orthostatic

hypotension

Flulike syndrome

Dizziness

Headache

Somnolence

Skin Rash

Wight gain

Hyperglycemia

Dont break or crus

tablets

Give drug without

regard for food

Watch out for

evidence of

neuroleptic malignasyndrome

(extrapyramidaleffects, hypertherm

autonomicdisturbance) which

rare but deadly. Monitor patient for

Tardive Dyskinesia

which may occurafter prolonged use

of drug.

Monitor for

metabolic syndromwt. gain,

hyperglycemia,hypercholesterolem


32/59

DRUG NAME MECHANISM OF

ACTION

INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE

EFFECTS

NURSING

CONSIDERATIONS

Generic Name:Dipenhydramine

Classification:

Anti-histamine; Anti-parkinsonian

Route/Dosage:

50 mg PO HS

Competes withhistamine for H1-

receptor sites. Prevents,but doesnt reverse,

histamine-mediatedresponses, particularly

those of the bronchialtubes, GI tract, uterus

and blood vessels.

Rhinitis andallergy symptoms

Parkinsons

disease

Sedation

Nighttime sleep

aid

Non-productive

Cough

Contraindicated inpatients

hypersensitive todrug.

Avoid use in

patients with

asthma.

Contraindicated in

patients taking

MAO inhibitors.

Hypotension Tremor

Vertigo

Headache

Dry mouth

Thickening of

bronchial

secretions.

Give drug with fooor milk to reduce G

distress.

Caution the client

that the medicationcan cause

drowsiness.

Explain to the patie

that arising quickly

from a lying orsitting position may

cause orthostatic

hypotension. Inform patient that

sugarless gum orhard candy may

relieve dry mouth.


33/59




Generic Name:Risperidone

Classification:Atypical Antipsychotic

Route/Dosage:

4mg tab

Blocks Dopamine and5-HT receptors in thebrain

Schizophrenia

Combination

therapy with

Lithium orvalproate for 3

week treatment ofacute manic or

mixed episodesfrom bipolar I

disorder.

Contraindicated in


drugs

Use cautiously in

patients with CVdisease.

Akathisia

Somnolence

Dystonia

Insomia

Agitation

Parkinsonism

Hallucination

Tremor

Abnormal

Thinking

Decreased libido Hypertension

Hyperglycemia

Tell patient that

he/she can takedrug with or

without food.

Obtain baseline

blood pressuremeasurements

before therapy.Watch out for

orthostatichypotension.

Monitor patientfor tardive

dyskinesia, whichmay occur after

prolonged use.

Life-threatening

hyperglycemia

may occur.Monitor patients

with Diabetes.


34/59




Generic Name:Chlorpromazine

Classification:Typical anti-psychotic

Route/Dosage:

100 mg HS

Block dopaminereceptors in the brain;also alter dopamine

release and turnover.

Psychosis

Mania

Behavioral

disorders;hyperactivity

Contraindicated in


drug.

Contraindicated in

those with CNSdepression.

Use cautiously in

patients with

severe CV disease(may suddenly

decrease bloodpressure)

Extrapyramidal

reactions

Sedation

Tardive dyskinesia

Pseudo

parkinsonism

Ocular changes

Advise patient

not to crush,chew or break

tablet.

Make sure the

medication istaken.

Obtain baseline

blood pressure

measurementsbefore therapy.

Watch out fororthostatic

hypotension.

Monitor patient

for tardive

dyskinesia, whichmay occur after

prolonged use.

Dont stop drug

abruptly.


35/59

X. PROCESS RECORDING

CONVERSATION DEFENSE MECHANISM with ANALYSIS THERAPEUTIC COMMUNICATIONTECHNIQUES USED

FIRST DAY OF INTERACTION

N1: Good morning po. Ano po pangalan nyo?

P: Good morning, kayo ba magiging nurse ko? Akosi S.B.

N2: Opo, ako po si Chelle, siya nman po si Criselleat ito naman po si Eries.

P: Hello Nurse Chelle, Nurse Criselle at Nurse Eries.N3: Sana po maging masaya kayo kasama kame.

P: Mukha naming mag eenjoy ako sa inyo at

mababait naman kayo. Maliligo ba ako?N1: Hindi po, magtutooth brush ka muna po atmaghihilamos po kayo. Tutulungan po naming

kayong gawin iyon.P: Osige. Salamat ha.

(AFTER THE SAID GROOMIING)

N2: May mga sugat po ba kayo?P: Oo, dito sa may ulo, dahil ito sa balikubak e, angtapang kse ng ginagamit naming sabon, Perla.

N3: Ganoon po ba? Osge po, gagamutin po natin angmga sugat nyo. Sabihin nyo po kung masakit at

mahapdi ha.P: Osige. Salamat ha.

RATIONALIZATION

EXPLORING

GIVING INFORMATION OR INFORMING

OFFERING SELF


36/59

(NURSE DOES THE WOUND CARING)

N1: okay na po. Yan lang po ba ang sugat nyo? Walanap o sa katawan?

P: Wala na e. ano na ang susunod nating gagawin?

N3: pupunta po tayo sa area kung saan tayo gagawang mga activities. Tara po, lakarin napo natin.P: Osige.

(WHILE WALKING)N3: Alam nyo po ba kung anong araw ngayon?

P: oo, Thursday. February 7. Db?N2: Opo. Bali makakasama nyo po kami hanggang

sa susunod na byernes, bale pitong araw po tayongmagkakasama at may mga activities na gagawin. Salipo kayo ha, dapat po manalo lagi ang grupo natin.

P: Oo naman sige.(AT THE ACTIVITY AREA)

N1: Upo po tayo maam, magkwentuhan tayo.N3: ilang taon napo kayo?

P: 55 years old. 3rd year nursing student na din bakayo?

N3: opo.N2: ilang taon na po kayong nakaconfine dito?

P: mga aanim na buwan palangg. Pero ito na angpangatlong beses kong napasok dito. Gusto ko na

ngang umuwi e.N3: taga saan po ba kayo?

P: Taga Ilo-ilo talaga ako, kaya lang nanirahan akosa QC dahil sa Malacanan ako nagtatrabaho noon.

N1: sino po bang nagpadala dito sa inyo?P: yung mga kapatid ko. May nangyari kasi sa akin

COMPENSATION


GIVING INFORMATION OF INFORMING

OFFERING SELF

EXPLORING


37/59

at ayaw nila akong paniwalaan, hindi nila akoiniintindi.

N3: ano po ba iyon?P; mahabang kwento e, at baka hindi nyo ako

paniwalaan.N1: makikinig po kami sa inyo, asahan nyo po iyon.

P: talaga? Yung mga kapatid ko kasi hindi ito

pinaniniwalaan at sabi nila sira ulo daw ako, e hindinaman ako sira ulo e.N2: ano po bang nangyari?

P: august 25, 1995 may nangyari sa akin. Galing akosa trabaho nun eh, mga alas nyebe ng gabi,

nagpaphinga ako sa terrace ng bahay ko. Tapospumasok na ako sa kwarto ko, may bigla akong

naramdaman na kuryente na nagsimula sa bumbunanko pababa sa buong katawan ko. Itong mga mata ko,napakasakit dahil hinugot ito pababa sa baba pa ng

lupa at nakita ko ang palasyo ng kadiliman, angnamamahala ditto ay si Satanas. Si Satanas ang

pumasok sa katawan ko, at inaalog alog pa nila angkatawan ko para magkasya pa ang napakarami

niyang kamppon. Dahil malapit na daw angpaghuhukom at kailangan nilang pagtago sa katawan

ko dahil ako ay ligtas sa paghuhukom, ang tawagnila sa akin ay Ang Batang Walang Malay. Kapag

daw sila ay pumasok sa katawan ko, magiging ligtasna sila. Nakikita ko ang sila, pumapasok dito sa

bumbunan ko, ito kasi ay malambot, napakasakit.N1: ano pa po ang nakita nyo? Naramdaman?

P: may mga uod na kumakain sa laman ko.N2: pano po yon natapos?

P: napakasakit sa katawan at napakabigat sapakiramdam. Madaming mga diablo at si Satanas ay

DENIAL

CONVERSION

OFFERING SELF

EXPLORING

ENCOURAGING DESCRIPTION OF

PERCEPTIONS

EXPLORING


38/59

pumasok sa katawan ko. Alam nyo ba, nakakausapko din ang Panginoon.

N3: Ano po ang pinag-uusapan nyo?P: ang sabi niya tatagan ko ang loob ko laban kay

Satanas at may binigay syang misyon sa akin.N1: ano po ang misyon na iyon?

P: ang patayin si satanas at puksain ang kasamaan

nito.N3: hanggang ngayon po ba nakakausap nyo sila?P: Oo, nakakausap ko sila, at unti unti nang

nababawasan ang nasa loob ng katawan ko.N2: ano po ang nararamdaman nyo pag ganon?

P: maaliwalas sa pakiramdam. Ngunit ayaw parinakong paniwalaan ng kapatid ko tungkol doon at

dinala nila ako dito. Gustong gusto ko nang umuwi,nakakainip pa dito.N3: ano po ba ang mga pang araw araw na ginagawa

nyo dito?P: wala. Dun lang kame sa ward, kakain, matutulog.

N1: kamusta naman po ang mga kasama nyo?P: okay naman, mabuti nga at walang nakikipag

away doon sa ward naming e.N2: napaaway na po ba kayo dati?

P: Oo, sa ibang ward pa ako non, ayoko sanangpatulan pero pag hindi ako lalaban lalo nila akong

sasaktan.N3: e ang pagkain nyo naman po, kamusta?

P: naku, lutong baboy. Pero wala na akong magawakung hindi kainin to, kung hindi magugutom ako.

N2: pano po kayo sa pagligo?P: araw araw, alas kwatro ng madaling araw, sabay

sabay kami, walang damit lahat.N1: osge po, maam, may gagawin po tayong activity

PROJECTION

ENCOURAGING EVALUATION OR

EVALUATING

EXPLORING

EXPLORING

ASKING QUESTION

EXPLORING



39/59

ha.P: osge.

(ALL PATIENTS PERFORMEDACTIVITY/THERAPY, CLIENT SB

PARTICIPATES WELL. AFTER THE ACTIVITYPATIENTS ATE MIRYENDA AND TOOK THEM

AGAIN IN THEIR RESPECTIVE WARDS)

(while walking back to the clients ward)N2: sana po ay nag enjoy kayo.P: Oo nmana. Salamat ha.

N3: magkikita pa po tayo ulit bukas ha. Salamat po.Mag iingat po kayo.

P: mag ingat din kayo. Salamat.

SECOND DAY OF INTERACTION

P: Hello. Good morning po.N1: Hi. Good morning din po.

N2: Hello Susan. Good morning!N3: Good morning. Natatandaan mo pa ba ang mga

pangalan namin?P: Oo naman po.

N2: Sige nga po. Sino ako?P: Ikaw si Nurse Chelle.

N3: Eh ako naman po sino?P: Nurse Criselle at siya si Nurse Eries.

N1: Wow Susan. Matandain ka pala.N2: Oo nga. Tara, grooming na tayo.

P: Sige po.

(GROOMING AREA)

Seeking Clarification



Giving Recognition


40/59

N3: Magtoothbrush ka muna bago magshampoo parahindi mabasa damit mo.

P: Sige po.N2: Eto na po ang toothbrush mo.

P: Tapos na po.N1: Sige magshampoo ka naman.

P: Sige po.

N2: Eto ang sabon oh. Maghilamos ka naman. Etorin ang face towel. Magpunas ka rin.P: Sige po.

P: Tapos na po. Lalaban ko na rin po tong face towelpara malinis.

N3: Ay sige po. Ang bait mo naman.N1: Oh eto po ang cotton buds. Linis ka muna ng

tenga mo. Tapos maglotion ka rin saka naminglagyan ng betadine yung sugat mo sa ulo.P: Sige po pero sabi ni Maam 15minutes lang daw.

May 15minutes na ba?N2: Ay, ok lang po yun. Ang mahalaga malinis at

magamot naming yung sugat mo. At sakamaglalakad lakad din tayo para may exercise ka.

N3: Ayan okay na. Tara na po lakad lakad muna tayobago magpunta dun sa pinuntahan natin kahapon.

(WHILE WALKING)

N3: Kumusta naman po kayo? Maayos ba ang

naging tulog niyo?P: Ayos naman po ako. Puro ako na lang ang

kinukumusta nyo, kayo po ba kumusta?N2: Ay, ayos lang din naman po kami. Salamat sa

pagtatanong.N1: May activity po ulit tayo ngayon ha.

Giving Recognition

Broad Opening


41/59

P: Talaga po? Anong gagawin natin?N2: Newspaper reading po ang gagawin.

P: Ah. Sige po.N1: Ayan malapit na tayo sa students area.

(STUDENTS AREA)

N2: Upo ka na Susan.P: Salamat po.N1: Bale Susan, Friday ngayon. Hindi tayo

magkikita bukas at sa Sunday ha. Monday na ulittayo magkikita.

P: Ah. Uuwi na ulit kayong Bulacan?N3: Oo, kaya hindi muna tayo magkikita ng

dalawang araw.P: Okay po.N2: Tara, magsimula na tayo sa pagbabasa.

(AFTER NEWSPAPER READING)

N3: Ano po ang masasabi mo?

P: Mataas na yung P125 na umento. Bihira silamagtaas ng ganon sa sweldo. Siguro sa mahal na rin

ng mga bilihin.N1: Nung panahon niyo po ba madalas magtaas ng

sweldo?P: Nako, hindi. Kaya nga maswerte ang mga

nagtatrabaho ngayon kasi mataas na yung P125 naumento.

N2: Doon naman po sa pagiging hydrated? Malakaska po bang uminom ng tubig?

P: Hindi po ako gaano umiinom ng tubig dito.N1: Anong dahilan at hindi ka umiinom?




Presenting Reality

Broad Opening

Exploring

Exploring

Exploring


42/59

P: Malakas akong uminom ng water noong wala paako dito. Kasi mineral water ang inumin naming sa

bahay. Dito kasi sa gripo lang.N3: Pwede naman pong inumin yung nasa gripo.

Hindi naman po nila ipapainom sa inyo yun kunghindi pwede.

P: Malinis naman. Kaya lang minsan may mga

lumalabas na uod at maliliit na ahas. Kaya bihiralang akong uminom ng tubig.N2: Ay, ganon po ba? Hindi po kayo nanghihingi ng

mineral water?P: Sa payward lang sila nagpapainom ng mineral

water.N1: Ganon po ba? Nakahingi na po ba kayo minsan

ng mineral water sa nurse?P: Pag nauuhaw ako at may dumaan na nursenanghihingi ako.

N3: Ah. Okay po.N1: Teka lang po ha. Ayusin ko po yung meryenda

niyo.N3: Tulong na po ako sa kanya.

P: Sige po.P: Nurse Chelle, natanong mo na po ba kay Maam

kung pwede akong gumawa ng sulat para sa ate ko?N2: Di ba po gumawa na kayo ng sulat kahapon?

Para pa nga po sa kanilang lahat yun eh.P: Hindi, iba pa yung kay ate lang. Gusto ko na kasi

talagang makalabas dito eh.N2: Sige po tatanong ko mamaya kay Maam.

P: Salamat Nurse Chelle.N2: Walang anoman po. Kumusta naman po ang

mga kapatid niyo? Lahat po ba sila nasa I lo-ilo?P: Tatlo lang yung nasa Ilo-ilo. Dalawa kaming

Presenting Reality

Exploring

Exploring

Broad Opening


43/59

nandito sa Bataan at yung dalawa naman eh nasaDubai.

N2: Wow. Dubai. Ano naman po ang trabaho niladoon?

P: Isang civil engineer at isang accountant angnandoon.

N2: Ay. Ang galing naman po nila.

P: Isa lang ang hindi nakagraduate sa amin. Nagsisisinga siya kung bakit hindi siya nagpatuloy sa pag-aaral. Gusto nga sana niyang mag-aral ulit kaya lang

matanda na siya.N2: Eh ano naman po ang trabaho niya ngayon?

P: Mangingisda siya ngayon. Pero nag-aaral namanlahat ng anak niya.

N2: Ayon naman po pala eh. Sana makatapos polahat ng anak niya at sila naman ang tumulong satatay nila.

P: Sana nga. Kaya kayo tapusin niyo yang pag-aaralniyo. Sayang lang talaga at hindi ko natapos ang

pagnanurse ko.N2: Oo nga po eh. Ano po ba ang nangyari at hindi

niyo natapos ang kursong nursing?P: Nagkaroon kasi ng ibang babae ang tatay ko.

Kaya lahat kami naging working student.N2: Ang galing niyo naman po palang

magkakapatid.P: Ganon talaga. Gusto kasi naming mga magsipag-

aral.N2: Eh may kapatid po ba kayo sa tatay niyo? Ilan

po sila?P: Oo meron. Tatlo sila.

N2: Close naman po ba kayo sa kanila?P: Ay hindi. Hindi kami mga nag-uusap.

Exploring

Giving Recognition

Exploring

Exploring

Giving Recognition

Exploring

Exploring


44/59

N2: Nasaan po ba sila?P: Nasa Ilo-ilo rin sila. Huli kaming mga nagkita at

nagkausap nung patay si tatay. After noon wala ngcommunication.

N2: Ah, ganon po pala. Ayan po. Meryenda na munapo kayo.

P: Kayo po, kain tayo.

N1: Sige po tapos na po kami kanina sa dorm.

(AFTER MERYENDA)

N3: Ayan. Nabusog po ba kayo?

P: Opo. Salamat po sa meryenda.N1: Dun naman po tayo sa may activity center.

Practice po tayo ng power clap at cheering natin.P: Sige po masaya yun.N2: Tara po.

(AFTER POWER CLAP AND CHEERING

PRACTICE @ ACTIVITY CENTER)

N2: Napagod po ba kayo?P: Hindi naman gaano.

N1: Masaya po ba?P: Opo masaya. Nag-enjoy po ako.

N3: Mabuti naman po kung ganon.N2: Paano Susan kailangan na naming umalis. Mag-

aayos pa kami ng iba naming gamit bago umuwi saBulacan.

P: Sige po. See you next week. Ingat kayo sa biyaheniyo ha.

N1: Ingat ka rin po dito. Hanggang sa muli.P: Bye bye Nurse Chelle, Nurse Criselle and Nurse

Exploring


Presenting Reality


45/59

Eries. Salamat sa inyo.N1, N2 and N3: Bye bye Susan.

3rd day Interaction

N1: Hello. Good morning.P: Hi, good morning po.

N2: Kamusta ka naman po?

P: Ok lang naman ako. Kayo po ba?N3: Ayus lang din naman kami. Kumusta weekendsmo?

P: Ayus naman, walang bago.N2: Tara po, mag-grooming na tayo.

P: sige po.N3: Kumusta naman po ang mga sugat nyo sa ulo?

Gumagamit parin po ba kayo ng Perla?P: Ok naman, hindi na ako gumamit ng perla

kaninang umaga e.N3: Ganon po ba, osige po, mag sha-shampoo ka

ngayon.

N2: Mauna na po tayo sa pagtotoothbrush nyo.P: Sige, salamat ha.

(AFTER TOOTHBRUSH, SHAMPOO, etc.)

N3: gagamutin na po natin ngayon ang mga sugatnyo sa ulo ha.

P: sige.N1: mahapdi po ba pag nilalagyan namin ng gamot?

P: medyo, pero ok lang. Gusto ko nga yung mahapdieh.

N1, N2 and N3: (Silence)

Broad Opening

Exploring

Exploring

Exploring


46/59

(AFTER WOUND CARE)

P: pwede ba akong humingi ng cotton buds? Lilinisinko yung tenga ko e, may mga sugat nga e.

N1: patingin nga po.N2: Oo nga, teka po, kuha ako panlinis ha.

P: osige. Maraming salamat sa inyo.

(AFTER WOUND CARE)P: Naku, nahuli na tayo sa kanila.N3: ok lang po iyan.

P: tara na, ready na ako.N2: Tara po, lakad na tayo.

N3: Ang unang activity natin ngayon ay phototherapy, alam nyo po ba iyon?

P: ah, yung ipapaliwanag yung mga larawan.N1: opo, yun po ang gagawin natin ngayon,magparticipate ka po ha.

P: oo naman sige.

(CLIENT PARTICIPATED WELL)(AFTER THE ACTIVITY)

N1: nag-enjoy po ba kayo?

P: ok lang,N3: magmiryenda na po kayo. Eto po.

P: salamat, kayo ba? Kain na din kayo.N2: sige lang po, mamaya na po kami.

P: napakabait nyo sa akin. Kayo kapag nakalabas naako dito tutulungan ko kayo, sana kung ano man

yung mabibigay kong mga tulong sa inyo tanggapinnyo ha.

N2: oo naman po.P: pag nakalabas na ako dito aayusin ko na ang



47/59

buhay ko.N1: maari po ba naming malaman kung pano nyo

uupisahan ayusin ang buhay nyo kung sakalingmakalabas na kayo dito?

P: tapos na ang pinakaunang misyon ko eh, wala nasi Satanas, kaya wala nang babagabag sa loob ko.

Ang natitirang misyon ko nalang ay puksain angkasamahan ni satanas, yung mga taong criminal, at

makasalanan, kailangan na nilang mawala.Napanuod nyo na ba yung movie na The Monster?

N1, n2, n3: hindi po e. ano po ba iyon?P: totoo yung movie na iyon, ang monster yun ay

Pugita, yun si Satanas at ang mga Galamay nungpugita ay ang mismong mga galamay din ni satanas.

Ngayon ay nasa Karagat na sila ng apoy at lugar ngwalang katapusang kaparusahan, at yung end of theworld, totoo yun, sinabi ng panginoon sa akin yun.

N2: sinabi po ba niya kung kelan iyon?P: Oo, ngayon na iyon, dahil sa satanas ay

pinaparusahan na at susunod na ang mga taonggumagawa ng mga gawa niya.

N3: ano pong mangyayari sa mga tao nun?P: mapaprusahan sila, kaya kayo dapat ay ang mga

itinuri lang ng Panginoon ang gawin nyo, wagmasasamang bagay.

N2: opo.P: kaya nga may galit ako sa mga kapatid ko, dahil

hindi nila ako inintindi.N1: kung makikita niyo po sila ngayon, ano po ang

sasabihin niyo sa kanila?P: ilabas na nila ako dito, gusto ko maranasan din

nila ang hirap na naranasan ko dito sa mental, labisnila akong pinarusahan, hindi na nga ako nakapag-

Broad Opening

Exploring

Exploring

Exploring


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asawa dahil sa kanila, dahil sa kakatrabaho sapagkatsila ang priority ko, tapos ito pa ang iginanti nila sa

akin. Nagagalit ako sa kanila.N3: hindi nyo na po ba sila mapapatawad?

P: ewan ko, basta gusto ko maranasan nila angnaranasan ko dito, ang hirap.

N1: sana po ay gumaan ang pakiramdam nyo saating pag-uusap ngayon. Pasensya na po, pero oras

na para kayo ay ibalik sa ward. Marami pa namantayong pag-uusapan bukas.

P: osige, bukas ulit ha.N2: tara po, hated na namin kayo.

P: salamat.N1, n2, n3: salamat din po. ingat po.

Projection

4th day Interaction

N1, N2, N3: good morning po.

P: goodmorning din po.N1: kumusta po kayo? Kumusta pagtulog nyo?P: Ok naman po. Kayo po?

N2: Ok naman po. Malamig po ngayon no, ok langpo ba kayo?

P: Oo malamig nga, presko, pero ok lang ako saganyang panahon.

N3: naligo po ba kayo kaninang madaling araw?P: Oo, napakalamig, ngunit wala naman akong

magagawa.N1: Oo nga po. Tara, grooming na po tayo, tsaka po

natin lilinisin mga sugat nyo sa ulo.

P: Oo sige.(AFTER GROOMING AND WOUND CARE)

Broad Opening

EXPLORING

OFFERING SELF


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N2: Dun po tayo sa Activity Center.P: Ano ang activity natin na gagawin ngayong araw?

N3: Maglalaro po tayo, tas kakanta at sasayaw, atpag kaya po ng oras manunuod po tayo ng palabas.

P: Ah, yung tugtog sa laptop?N2: Opo.

N3: Gusto nyo po ba iyon?P: Oo,

N1: Sali po tayo sa lahat ah. Ready po ba kayo?P: Oo naman, enjoy nga yun e.

(AFTER THE ACTIVITIES)

N2: Kain na po kayo.

P: Sige, kayo ba? Kain na din kayo, sabay na kayosakin.N3: Nag-almusal po kame kanina, sige lang po kain

na kayo.P: pagkatapos kong kumain pwede bang hingi ako ng

papel at ballpen, susulatan ko yung kapatid ko.N1: osige po. Hindi na po ba kayo galit sa kapatid

nyo?P: Galit pa, dahil nga dinala nila ako dito.

N2: hanggang ngayon po ba?P: Oo

N3: paano po kung makalabas na kayo dito? Galitparin po ba kayo sa kanila?

P: Basta iuna ko muna ang paglabas ko dito bagonamin pag-usapan ang tungkol sa galit ko sa kanila.

N1: Paano po ba kayo magalit?P: yung pinapagalitan ko sila.

N3: sa sarili nyo po? Hindi nyo naman po sinasaktansarili nyo?

Projection


Exploring

EXPLORING

Exploring

Exploring


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P: Hindi naman. Hindi ko naman sinasaktan sarili kopag galit ako.

(AFTER THE CLIENT INTERPRETED MESSAGEFOR HER SISTERS LETTER)

P: Ipadala nyo sa kapatid ko ha, kailangan ko natalagang makalabas dito dahil napakahirap dito.

Kailangan ko nadin iayos sa tama at magsimula ulitsa buhay ko.

N2: ipapadala po natin, ang CI na po ang bahala.N3: tara na po, ihahatid na po namin kayo sa ward

nyo.P: salamat ha. Bukas ulit.

N1: sana po nag-enjoy kayo. Salamat.


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XI. Therapys done

Bulacan State University

Malolos, Bulacan

College of Nursing

THERAPY PLANNING

Title of

Therapy

Descriptions Learning Contents Learning

Objectives

Mechanics Resources Expected

Outcome

Family

Therapy

Family therapy is a type

of

psychotherapy

thatinvolves all members of

Family therapy involves

multiple therapy sessions,usually lasting at least

After 15minutes of the

therapy the client willbe able to:

After the music and

art therapy, thefacilitator

Manpower:

Student

Nurse and

After 15minutes of

the therapy, theclient were able to:


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a nuclear familyor stepfamily and, in

some cases, members ofthe extended family

(e.g., grandparents). Atherapist or team of

therapists conducts

multiple sessions to helpfamilies deal withimportant issues that

may interfere with thefunctioning of the

family and the homeenvironment.

one hour each, conductedat regular intervals (for

example, once weekly)for several months.

Typically, family therapyis initiated to address a

specific problem, such as

an adolescent witha psychologicaldisorderor adjustment to

a death in the family.

Use their

cognitive skillsto recall their

family

Express their

feelings while

rememberingmemories witheach of the

familymember

instructed thepatient as well as

the student nurseassisted them

throughencouraging to

think their loved

ones and write itdown on the tree

Facilitator:Albert dela Cruz

the patient

Materials:

Bond paper

Crayons

Used their

cognitiveskills o recall

their family

Expressed

their feelings

whilerememberingmemories

with each ofthe family

member

Title ofTherapy

Descriptions Learning Contents LearningObjectives

Mechanics Resources ExpectedOutcome

Photo

Therapy

Use of photograph ina therapeutic

encounter. It may usethe clients own family

album or personalsnapshot.

The therapy engagesconversation with theclient that might bestimulated by thephotographs as

memories emotionsideas and questionsraised by the images

After 30mins ofphototherapy, the

client will be able to:

think

abstractly

throughsharing their

ideas about the

picture showedto them

Express their

feelings afterthey see the

picture

The client areinstructed to look

at the pictures thenthe student nurses

will ask them toshare the ideas

regard to thepicture

Facilitator/s:

Manpower:

Student

Nurse andpatient

Resources:

Pictures

(home,

family and

nature)

After 30mins ofphototherapy, the

client were able to:

think

abstractlythrough

sharing theirideas about

the picture

showed tothem

Expressed

their feelingsafter they see

the picture


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Title ofTherapy DescriptionsLearning Contents

LearningObjectives Mechanics Resources ExpectedOutcome

Play

Therapy

Play therapy is a

treatment modality inwhich the therapist

engages in play with thechild and adults. Play

activities are used as theprimary basis for

communicationbetween the child and

the psychotherapist

It is used in identifying

and appreciatingchildhood mental

disorders and how theypull away from normal

functioning. This canaffect their home lives,

academic performances,as well as their play with

peers. Play therapy offers

a direct route to engagechildren/adult on theirterms, in their world.

After 30 minutes of

Play therapy thepatient will be able to:

to make clients

practice their

criticalthinking skills

andconcentration

alleviate their

anxiety practice their

social skills as

they enjoyplaying with

other patients

The facilitator will

explain theprocedure and

demonstrate howthe play will be

done. The studentnurses assist and

play with theirpatient.

Facilitator/s:

Manpower:

Student

Nurses and

Patient

Resources:

Electronic

devices (e.g

laptop,

speaker) Bond paper

Pentel pen

Cups

After 30 minutes of

Play therapy thepatient were able to:

to make

clients

practice theircritical

thinkingskills and

concentration

alleviatedtheir anxiety

practiced

their socialskills as they

enjoy playingwith other

patients


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Title ofTherapy

Descriptions Learning Contents LearningObjectives

Mechanics Resources ExpectedOutcome

Song and

Dance

Therapy

Song and Dance

therapy usesmovements to improve

mental and physicalwell being while

singing

It helps the patient to

reduce their stress,anxiety and depression.

Also increasescommunication skills

and develop positivebody image

After 30mins of Song

and dance therapy theclient will be able to:

Reduce their

anxiety, stress

and depression

Relax as they

sing and dance

Socialize withother patientsthrough

communications

The facilitator

will explain firstthe procedure

then the studentnurses will show

how it done andnext will teach

the patient to singand dance.

Lastly, to showthe talents to

others.

Facilator/s:

Manpower:

Student

Nurses andPatient

Resources:

Electronic

Devices (e.g

Laptop,

Speakers)

After 30mins of Song

and dance therapythe client will be able

to:

Reduced their

anxiety, stressand

depression

Relaxed as

they sing anddance

Socialized

with other

patientsthrough

communications


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Title of Descriptions Learning Contents Learning Mechanics Resources Expected


56/59

Title of

Therapy


Objectives


Outcome

Movie and

Cinema

Therapy

Cinema therapy is the

process of using moviesmade for the big screen

or television fortherapeutic purposes. It

allows us to gainawareness of our deeper

layers of consciousnessto help us move toward

new perspectives orbehavior as well as

healing and integrationof the total self.

Movie Therapy is amind therapy that

involves the clientviewing certain films

that under thesupervision of a

therapist in order to helptreat emotional and

mental conditions.

This therapy will help the

patient to change the waythey think and feel, and

ultimately deal with life'sups and downs.

After 30mins of

Movie and CinemaTherapy the client will

be able to:

watch films with

consciousawareness

explore theirminds and

feelings by thehelp of the

student nurses

inspire patients

through movies

help patients to

open upcommunications

to their studentnurses about their

thoughts andfeelings

Ask patients to

gather and sit infront of the

monitor. Tell themto watch carefully

and to reflect. Afterwatching their

student nurses mayask them to tell

something aboutthe videos they

watched.

Manpower:

Student

Nurse and thepatient

Resources: Electronic

devices

(projector,laptop,

speaker)

After 30mins of

Movie and CinemaTherapy the client

were able to:

watched films

with consciousawareness

explored theirminds and

feelings by thehelp of the

student nurses

inspired patients

through movies

helped patients

to open upcommunication

to their studentnurses about

their thoughtsand feelings

TITLE OF LEARNING LEARNING EXPE


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TITLE OF

THERAPYDESCRIPTIONS

LEARNING

CONTENTS

LEARNING

OBJECTIVESMECHANICS RESOURCES

EXPE

OUT

OCCUPATIONALTHERAPY

Occupational Therapy isdefined as The therapeutic

use of work, self-care, and

play activities to increasedevelopment and preventdisability. It may include

adaptation of task orenvironment to achieve

maximum independenceand to enhance the quality

of life."(AmericanOccupational Therapy

Association Executiveboard). One's occupationcan be defined as how we

spend our time; whetherpaid or unpaid, restful or

fun, obligation or choiceand that which fulfills us,

gives us purpose, andallows us to interact with,

be productive, and functionin the world around us to

the best of our ability.

This small bag or basketmaking as an Occupational

Therapy contributes to thedevelopment of mentally

challenged clientsespecially their motor

functions through making ahandmade basket or bag. It

is a good activity also to

combat the Extrapyramidalsymptoms of drug they are

taking.

At the end of 1 hour oftherapy, the client will

be able to increasehis/her development or

commit leisure bypracticing their function

through the use ofmaking small basket or

bag out of used

newspaper folded inthin sizes

The student nurse will

provide the materialsfor the client to make

a small basket or bagout of used

newspaper folded intothin sizes. After the

time given by thestudent nurse, the

clients must be done

making theirhandmade basket or

bag.

MANPOWER

-Student Nurse-Clients

MATERIALS

-Old Newspapers

-Glue

At the therapy

will bsomeho

his/her dor com

by pracfunctionuse of m

basket oused n

folded in

Title of Descriptions Learning Contents Learning Mechanics Resources Expected


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Title of

Therapy


Objectives


Outcome

Storytelling It is an accessible andcreative form of

communicating and

reflecting uponexperience, both real

and imagined.

Storytelling involves

stories that use metaphorand imagery to change

the way they see theirlives and the world, it

helps the clients thinkand behave in new,

productive ways,offering healing and

growth to everyone.

After 15 minutes of

psychotherapy, theclient will be able to:

Reflect on the

story told and

express theirfeelings aboutthe story.

Determine the

connection of

the story ontheir lives and

Verbalize

having a better

and positiveoutlook in life.

The facilitators will

first explain theactivity to the

clients. A story willbe read by the

facilitators andafter the

storytelling, theclients will be

asked toverbalize/express

their feelings andopinions about the

story.

Facilitator/s:

Man power:

Student

nurse andthe patient

Materials: Book

Flash Cards

After 15 minutes of

psychotherapy, theclient have:

Reflected on

the story told

and had abetter outlookin life.

Determined the

connection of

the story ontheir lives and

Verbalized a

better and

positiveoutlook in life.

Title of Descriptions Learning Learning Mechanics Resources Expected


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Title of

Therapy

Descriptions Learning

Contents

Learning

Objectives


OutcomeNewspaperReading

Newspaper therapy isgiving information to

the clients about eventsand what is happening

outside. Newspaper

therapy is cuttingclippings fromnewspaper and sharing

this information to theclients and knowing

their feelings and ideasabout the information

given. Providing basicinformation about

places/events maymotivate the clients to

follow the medicalregimen to be well.

Reading can helpjumpstart the brain. It

encourages the patients toshow emotions and

reactions about the latest

news. It also encouragesthe patients to verbalizeideas regarding the topic.

*To be able to providethe clients an

information on what ishappening outside and

the current news.

*To be able tointroduce topics thatwill facilitate clients

participation inreading

*to be able to assessclients reading

comprehensionthrough asking

question about thenews.

1. Exercise2. Gather materials

needed3. explain the

concept of

newspaper reading4. newspaperreading(15-20

minutes)5. giving

comments/ideasabout the topic

*Newspaper

Venue:Mariveles Mental

Hospital

Duration:15-20 minutes

*Patients will beable to talk about

the news they readand how they

respond about it.

*patients will beable to provide

ideas/ suggestions/comments/

conclusions aboutthe topic

Case Pres. Psyche

Documents

Transcript of Case Pres. Psyche