Republic of the Philippines

DIVINE WORD COLLEGE OF BANGUED

Bangued, Abra

NURSING DEPARTMENT

A Case Study on

SCHIZOPHRENIA,
UNDIFFERENTIATED TYPE

In Partial Fulfillment of the Requirements in NCM 204 (RLE)

National Center for Mental Health

Mandaluyong, City
Pavilion 3

Submitted to:

Submitted by:

Batalon, Holland
Benosa,Jerra Mae
Cadoy, Dexter
Cariňo, Ester Erika
Crisostomo, John Kennedy
Dela Vega, Demie Caine
Oblea, Ariane
Quintos, Aizly Grace
Terrenal, Geneva Joy
Villamor, Ingrid Mae

March 12, 2011

BATCH 2012

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I. BACKGROUND OF THE STUDY

A. INTRODUCTION

Schizophrenia is a group of psychotic reactions that affect multiple areas of an individual’s

functioning including thinking and communication, perceiving and interpreting reality, feeling and
demonstrating emotions and behaving in a socially accepted manner. This condition causes distortion
and bizarre behavior, thoughts, movements, emotions and perceptions. This condition is usually
diagnosed in late adolescence or early adulthood and rarely manifest in childhood.

The symptoms of schizophrenia are divided into two major categories; the positive and negative
symptoms. The positive symptoms include delusions and its types, hallucinations, loose associations and
bizarre or disorganized behavior while the negative symptoms includes restricted emotions, anhedonia,
avolition, alogia, catatonia and social withdrawal. Most clients with schizophrenia have a mixture of
both types of symptoms. The diagnosis of this condition usually is made when the person begins to
display more actively positive symptoms of delusions, hallucinations and disordered thinking. Onset may
be abrupt but most clients slowly and gradually develop signs and symptoms such as social withdrawal,
unusual behavior, loss of interest and neglected hygiene.

Schizophrenia is also classified into five types and diagnosed according to the client’s
predominant symptoms. Paranoid type is characterized by persecutory or grandiose delusions,
hallucinations and occasionally excessive religiosity hostility and aggressive behavior. Disorganized type
is characterized by inappropriate or flat affect, disorganized speech and disorganized behavior. The
catatonic is characterized by marked psychomotor disturbance, either motionless or excessive motor
activity. Motor immobility may be manifested by waxy flexibility or stupor. Excessive motor activity is
apparently purposeless and not influenced by external stimuli. Other features include extreme
negativism, echolalia, echopraxia or even mutism. Undifferentiated type is characterized by mixed
schizophrenic symptoms of other types along with disturbances of affect and behavior. The
undifferentiated subtype is diagnosed when people have symptoms of schizophrenia that are not
sufficiently formed or specific enough to permit classification of the illness into one of the other
subtypes. The symptoms of any one person can fluctuate at different points in time, resulting in
uncertainty as to the correct subtype classification. Other people will exhibit symptoms that are
remarkably stable over time but still may not fit one of the typical subtype pictures.

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 As of 2010, statistics show that 697,543 out of 86,241,697 of Filipinos or approximately 0.8% are
suffering from schizophrenia.

Our client was classified and diagnosed as schizophrenia, undifferentiated type. Which means,
that she demonstrated mixed schizophrenic symptoms of others but not enough of them to define its
particular type. She experienced grandiose delusions claiming that she is a prophet and she speaks most
about Satan. She exhibited an untoward behavior and hostility because she was not able to cope up with
stress and depression brought about her broke relationship with her parents, because of this,
manifested an insidious and gradual reduction in her external relations and interests.

B. THEORETICAL FRAMEWORK

Harry Stack-Sullivan conceptualized the Learning Theory, believing that a developing individual is
being shaped by social interactions. Therefore, the complex feelings, thoughts and behavioral
expressions grew out of the individual’s experiences with those closest to her or him. For example, if
the child’s father was mean and dictatorial, the perception may have generalized to other men in
positions with authority. Or if the child’s mother coped problems by projecting blame onto others, the
child learn this pattern of behavior and alienated others by putting it into practice. As what the child
seen at early stage of life, these are the things she will be doing when she grow up to cope problems and
save her or his ego identity. According to Learning Theory, the irrational ways of handling situations, the
distorted thinking and the deficient communication patterns of person with schizophrenia are a result of
poor parental models in early childhood. Children learn what they are exposed to on daily basis, from
parents who have their own significant emotional problems. Thus, the child does not develop skill
forming good interpersonal relationships which she possesses when she grows up. If this was not to be
resolve, it will lead to some emotional distortions.

This theory is applicable to our client who has difficulty in coping when she was still at normal
state of life. Later, she developed untoward behaviors, hostility, and delusions which triggers the
development of her condition and was diagnosed to have schizophrenia, undifferentiated type. This is in
relation with the relationship of the client with her parents who were supposed to be the model of the
development of her young mind. She grew up with a strict father and mother which she never
inculcated during the interactions. And from this case, the client tends to blame her parents for the
development of the condition.

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C. PERSONAL DATA

Name: Ms. Love

Age: 36y/o

Birth date: March 31, 1975

Birthplace: Julo-Sulo

Address: Pasay City

Gender: Female

Civil Status: Married

Nationality: Filipino

Religion: Roman Catholic

Educatonal Attaiment: College Graduate

Date of Admission: October 6, 2010

Time of Admission: 1:13 pm

Admitting Physician: Julien V. Guiang

Chief Complaints: According to her husband, the client was hostile and showing
untoward behaviors. She was claiming that she was a prophet and speaks most often about Satan.
The informant also added that the client often says that she was not accepted by their church
anymore because of her mother who sold herself to Satan.

Admitting Diagnosis: Undifferentiated Schizophrenia

Agency: National Center for Mental Health, Mandaluyong City

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 D. CHIEF COMPLAINT

According to her husband, the client was hostile and showing untoward behaviors. She was
claiming that she was a prophet and speaks most often about Satan. The informant also added that the
client often says that she was not accepted by their church anymore because of her mother who sold
herself to Satan.

E. HISTORY OF PRESENT ILLNESS

The present condition of the client started when she was 35 years old. Due to some
circumstances, the client became hostile and showed untoward behaviors and even hurting her own
self. She was brought to the agency by her husband who is very worried because his wife is acting
strangely and is no longer able to do her part as wife to him and a mother to their children. Ms. Love
was admitted on October 6, 2010 with a diagnosis of Schizophrenia: Undifferentiated Type.

The client’s present condition was already stable and manageable, but sometimes she still
manifests some symptoms like grandiose delusions, flat affect and tends to mumble to herself.

F. PAST MEDICAL HISTORY

(-) Diabetes Mellitus

(-) Hypertension

(-) Heart Problems

(-) Asthma

(-) Allergy to meds and foods

G. PAST PERSONAL HISTORY

The client was a graduate of College Degree at the University of the East. Basically, her life
revolved around her family and her religious affiliations. She is married and has three children. She’s
been affiliated religiously at their church as a member and she is active to their church activities.

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 H. FAMILIAL HISTORY

The client belongs to a well to do family. They were five siblings in their family and have already
their own families respectively and she was the only one who has the condition. Their family owns a
business. The client has two children and they were studying at a prestigious school in Metro Manila. On
both paternal and maternal side, they do not have a history of schizophrenia and she was the first to
have the condition. The client has a broke relationship with her parents because they were so strict to
her to the point of physically and emotionally abusing her every time she commits mistakes when she
was growing up.

I. PAST SOCIAL HISTORY

The client was an active member of her Religious affiliation. She was dedicated and goes along
with her colleagues religiously and acts accordingly. She spends most of her time on her affiliation and
has a normal state dealing with her colleagues. She’s fond of dealing with her co-members. The client
always remembers that she was singing at their church with other group members. The client’s social
atmosphere changed when one day she was not already a member of their church. She always claimed
that she was rejected due to the wrong doing of her mother. She became socially withdrawn, suspicious
and later became hostile and has disorganized behavior.

J. ERIK ERIKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT

The Psychosocial Stages of Development developed by Erikson enumerates eight stages through
which healthily developing human should pass from infancy to late adulthood. Every stage describes a
task to be accomplished. These development stages can be seen as a series of crisis and each stage
forms on the successful accomplishment of the earlier stages. Successful resolution of these crises
supports a healthy self-development. Failure to resolve the crises damages the ego and maybe expected
to reappear as problems in the future.

LIFE STAGE INDICATORS OF INDICATORS OF ASSESSMENT JUSTIFICATION

POSITIVE NEGATIVE
RESOLUTION RESOLUTION
Infancy (birth to Learning how to Mistrust, Mistrust Ms. Love’s mother
1 year) trust others withdrawal, did not breastfed her
estrangement. because she is having
pain breastfeeding
her so she bottle fed

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Central task: Love in a timed
TRUST Vs. manner believing
MISTRUST that this would train
the baby to be
disciplined. But
The first stage,
because their family
centers on the
owned a business,
infant's basic her mother is
needs being met frequently busy. That
by the parents. is why most of the
The infant time; she would just
depends on the stay with her siblings
parents, especially since she is the third
the mother, for child in the family.
Because of her
food, sustenance,
parent’s frequent
and comfort. If the
absence, Love was
parents expose given not enough
the child to attention and left
warmth and under a care of her
dependable siblings, she had built
affection, the a sense of mistrust to
infant's view of her parents. She has
the world will be not been fed well
one of trust. But since she’s being fed
in a timed manner;
if the caregivers
she hasn’t felt the
are neglectful, the
sense of comfort
infant instead since her parents
learns mistrust- haven’t been there
that the world is in for her to cuddle her
an unpredictable when she’s crying or
and an unsafe to play with her when
place. necessary.

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Early Childhood Self- control Compulsive self- Because
Shamethe
andclient’s
Doubt The patient was
(1 to 3 years) without loss of self discipline or toilet trained when
–esteem; ability to compliance; she was 2 years old.
Central task: cooperate and willfulness and As she had her
AUTONOMY Vs. express oneself. defiance. siblings to care for
SHAME AND her most of the
DOUBT time, the mother
instructed them to
If caregivers teach her to urinate
encourage self- and defecate in a
sufficient potty because it
behavior, child irritates her mother
develops a sense to find urine and
of autonomy- a stool just
sense of being anywhere, she was
able to handle too demanding that
many things on the child will learn
their own. But if how to toilet train
caregivers demand right away. On the
too much too other hand, her
soon, refuse siblings don’t train
to let children her well; they have
perform tasks of not disciplined the
which they are child well if the
capable; children child pees
may instead anywhere. The
develop shame child was unable to
and doubt about master this kind of
their ability to task in this stage,
handle things. since she
developed the
sense of shame and
doubt in which she
was unable to
handle because of
the different
implementation of
her siblings and
mother.

Late Childhood Learning degree of Lack of self Initiative Love engages much

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(3 to 6 years) assertiveness and confidence; in activities and
purpose influence pessimistic and plays. She loves
Central task: the over restriction of talking and playing
INITIATIVE Vs. environment; own activity. with her siblings
GUILT begins to evaluate since they are the
one’s own one who is always
This stage, the behavior. there for her.
child learns to take
initiative and get
ready for
leadership and
goal achievement
roles. If adults
encourage and
support children’s
efforts, while also
helping them
make realistic and
proper choices,
children develop
initiative-
independence in
planning and
undertaking
activities. But if,
adults discourage
the search of
independent
activities, children
develop guilt
about their needs
and desires.
School Age (7 to Developing sense Sense of being Inferiority During her school
11 years) of competence mediocre; aged years, Love
and perseverance. withdrawal from was often scolded
Central Task: peers and school. by her parents
INDUSTRY Vs. every time she
INFERIORITY commits mistakes
and every time her
At this stage, grades would not
children are eager satisfy her parents.
to learn and Her folks have a

9
accomplish more great deal of
complex skills: expectation on her
reading, writing, to do well even
telling time. If though she is still
children are very young which
encouraged to caused her to feel
make and do inferior from her
things and are classmates even if
then praised for she is doing her
their very best to satisfy
accomplishments, her parent’s
they begin to pressure on her.
demonstrate
industry by being
diligent,
persevering at
tasks until
completed and
putting work
before pleasure. If
children are
instead ridiculed
or punished for
their efforts or if
they find they are
incapable of
meeting their
teachers' and
parents'
expectations, they
develop feelings of
inferiority about
their capabilities.
Adolescence (13 Sense of self and Feelings of Role Confusion At this stage, the
to 19 years) plans to actualize confusion, client carried her self
one’s abilities. hesitancy, and inferiority which
caused her not to
Central Task: possible antisocial
gain friends. She was
IDENTITY Vs. ROLE behavior.
hesitant in mingling
CONFUSION
with others because
The adolescent is she is afraid that they
newly concerned would ridicule her.
with how they But then, a certain

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appear to others. group of people
The sense of made friends with
central identity her but they were
bad influence. She
appears through
started drinking and
sexual, emotional,
smoking because of
educational,
peer pressure.
ethnic, cultural,
and vocational
discovery. The
adolescent person
also develops
coherent sense of
self and plans to
actualize one’s
abilities. The sense
of self can be
confused if a core
identity does not
solidify. Feelings
of
confusion,
hesitancy, and
possible antisocial
behavior may also
emerge.
Early Adulthood Intimate Avoidance of Intimacy Despite the fact
(20 to 34 years) relationship relationship, that Ms. Love had
with another career or role confusion
Central Task: person and has a lifestyle during her
INTIMACY Vs. sense of commitment. adolescent years,
ISOLATION commitment to when she reached
work and her early
Once people have relationships. adulthood, she
established their longed for an
identities, they are intimate
ready to make relationship for her
long-term to feel that she is
commitments to loved. She was
others. They eager to commit
become capable of herself with
forming something that
intimate, would help her

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reciprocal forget her familial
relationships and problems. And so
willingly make the she dedicated her
sacrifices and self to her husband
compromises that and her charity
such relationships works at their
require. If people church.
cannot form these
intimate
relationships--a
sense of isolation
may result.

Middle Working towards Lack of Stagnation The onset of the

Adulthood ( 35 the betterment of productivity; client’s present
to 65 years) the society; not helping society condition started at
to move forward.
being productive. this stage. She
Central Task: started to have
GENERATIVITY Vs. untoward
STAGNATION behaviors like
scolding her
During middle age children for no
the primary apparent reason,
developmental destroying their
task is one of household
contributing to equipments every
society and time she feels
helping to guide depressed about
future her parents. She’s
generations. having
When a person hallucinations and
makes a delusions which
contribution impeded her role
during this period, as a mother to her
perhaps by raising children and her
a family or wife to her
working toward husband.
the betterment of
society, a sense of
generativity- a
sense of

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productivity and
accomplishment-
results. In
contrast, a person
who is
self- centered
and unable or
unwilling to help
society move
forward develops
a feeling of
stagnation-
dissatisfaction
with the relative
lack of
productivity.
A person in this
stage should have
time for
companionship
and recreation. He
also knows his
responsibilities
and knows that he
is accountable of
whatever actions
he takes.

I. PHYSICAL AND MENTAL ASSESSMENT

A. GENERAL APPEARANCE

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 The client appears stated with her age of 36 years old, wearing the unit’s uniform with good eye
contact, but flat affect. Speech is hyper productive with inappropriate words. She’s taking a bath
everyday with a good daily routine. The client has a good posture, gait and coordination. During
interaction, she has a good eye to eye contact and flat affect with regards to a certain situation. She was
well nourished and has a fair skin as evidenced by his good body built and has no sleeping difficulties by
the absence of dark circles under her eyes. She was not oriented with time, place, date and reality. The
client considered the interview as a normal thing and she was guided accordingly with no harsh or
offending questions thrown to her during the interview. She was cooperative with consistency of
behavior.

B. GENERAL BEHAVIOR AND PHYSICAL ACTIVITY

The client is sometimes lethargic during interactions. There are also times that she is restless
where she can’t remain still. However, she was manageable most of the time and willingly participates in
the interactions.

C. ORIENTATION

The client was not oriented on date, time, place and reality. She can relate to her past
experiences however, she is unable to organized ideas and thoughts related to her present condition.
She knows and she is aware that she is at the National Center for Mental Health.

D. AFFECT AND MOOD

The client show flat affect with regards to a certain situation and sometimes, she suddenly
change in expression of mood and this makes it hard to identify whether she was on stated condition
and willing to cooperate and interested with the interaction. Sometimes, there was an alteration of the
affective state of the client which was inappropriate and contrary to his feelings and emotions.

E. THOUGHT PROCESS AND CONTENT

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 Even if the client is at the Center, she has a normal and logical thought process. What she
uttered was meaningful and with sense. She didn’t use confabulation nor circumstantial. She can easily
catch up with what the interviewee mean and answer relevant to the questions.

F. MEMORY, PRESENT AND REMOTE

The client has a good memory and sometimes she had lapses. She can recall and remember her
past experiences and important events and people in her life. What were discussed in the previous days
were recalled which were integrated on the present scenario on the interaction.

G. JUDGMENT

The condition of the client started when she was on her early adulthood. Therefore, it doesn’t
mean that she can not make decisions on her own even though she is at the center. She can formulate
and think of other alternatives which later could be beneficial for solving her own problems but is not
eager to carry out so.

H. INSIGHT

The client was knowledgeable and aware that she is at the National Center for Mental Health.
She knows the state of her illness being manageable and how was the progression with regards to her
rehabilitation and in response to medication regimen and psychotherapies. She was able to respond of
what was going on and can comprehend appropriately.

I. INTELLECT

She has a good sense of reasoning but it was limited. She was able to pinpoint and defend her
answers but if asked for the main reason why she was at the Center, she can’t answer directly.

J. COPING MECHANISMS

The client has a poor pattern in handling stressors that arises in her life especially with regards
of her relationship with her parents. But ever since she was rehabilitated at the Center, she was able to
formulate ideas and alternatives in order to divert her attention from her problems, she did her
responsibilities at the Center and enjoyed the therapies especially during plays for her not to think or
not be bothered by her problems even in a short period of time.

K. DEFENSE MECHANISM

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 In the case of our client, she used denial as a defense mechanism. In the reason why she was at
the center, she elaborated that she only wanted to rest because she was already tired and exhausted,
but in fact, she’s been hostile and doing unacceptable manner. In some of the activities that were done,
the client never excels in such, but became a winner in the play therapies; therefore she was
compensating on her actions that was not succeeded on her part. And one thing also that was noticed
was that, she tend and often said that her attitude of mumbling and rattling of speech was due to
limited visitation by her family.

II. PSYCHOPATHOPHYSIOLOGY

A. PSYCHODYNAMICS

According to Freud, schizophrenia is a form of regression, back to the oral stage of

development.  The oral stage is the first stage of psychosexual development.  A baby is born a bundle of
id; ID is self-indulgent and concerned only with a satisfaction of his/her needs.  There is a need to gratify
these impulses but their experiences in the real world result in conflict.  People with schizophrenia are
overwhelmed by anxiety because their egos are not strong enough to cope with id impulses.  In
schizophrenia, this can lead to self-indulgent symptoms such as delusions of grandeur. As the patient is
still living in the real world, this may result in further DELUSIONS such as hearing voices which may have
an ultimate authority such as God. Schizophrenia is the result of a weak ego. The development of the
ego has been inhibited by a symbiotic parent/child relationship. Because the ego is weak, the use of
ego defense mechanisms in times of extreme anxiety is maladaptive, and behaviors are often
representations of the id segment of the personality.

B. PREDISPOSING AND PRECIPITATING FACTORS

The relationship between members of the family has a big role in the development of the
condition. Parenting in the early stage of life which the child seen during those years, she may manifest
and carried until she grows up. In the client’s case, she felt withdrawn from her interpersonal or social
relationships because she became vulnerable to stress as she never gave much attention in dealing with
her problems. She disclosed them all with herself and was not able to know what the alternatives for the
coping of her problems were.

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 Nature of work also predispose the development of the condition, if the person is always
ridiculed even she thinks that she did her best and her work is good but it has no effect on his boss,
feeling of guilt a and inadequacy and inferiority begins. That’s why, the person maybe have fascinating
effects that someday her boss would be please on what she had done or maybe think of hostility against
her boss.

Low Frustration Tolerance also a factor that triggers the development of the illness. Like on the
nature of work, she may not be able to cope up with the problems she may encounter that makes her
think of something that were not appropriate to reality and acts contrary.

Severe Religiosity was also included as a part of the past social history of the client. She was very
active to her religion and she did anything for that her faith in God and to their church may not be
ruined. But one that predisposed was the wrong act of her mother that the latter cause her to be
rejected to their church. In this case, the client become hostile and shows untoward behaviors towards
other and towards self.

Since the client has well to do family, socio economic status has a lesser effect on the
development of her condition, but the main thing connected to it was the attitude of family members
like her parents which is very mean and strict to her.

C. PSYCHOPATHOLOGY

The brain is made up of nerve cells, called neurons, and chemicals, called neurotransmitters. An
imbalance of one neurotransmitter, dopamine, is thought to cause the symptoms of schizophrenia.
Recent studies suggest that serotonin, another neurotransmitter, may also play a significant role in
causing the symptoms of schizophrenia.

Brain activity differs in a brain with schizophrenia and a brain without schizophrenia. In the brain
with schizophrenia, far more neurotransmitters are released between neurons. Thus, the symptoms of
schizophrenia occur.

Two hypotheses are considered to cause the occurrence and progression of symptoms in
schizophrenia. The "dopamine hypothesis" has been the main theory regarding the cause of the
symptoms of schizophrenia. Researchers believe that many of the symptoms of schizophrenia are a

17
result of excess of dopamine in the brain. Anti psychotic medications block dopamine transmission and
are used to treat and improve the symptoms of schizophrenia. New theories suggest that the
neurotransmitter serotonin may also play a role in causing the symptoms of schizophrenia. Some anti
psychotic medications treat symptoms of schizophrenia by blocking dopamine and serotonin
transmissions. Many patients who have not been helped by "dopamine only” medications have been
helped by medications that affect both dopamine and serotonin transmissions, such as Clozaril,
Risperdal and Zyprexa.

Schizophrenia is a group of psychotic reactions that affect multiple areas of an individual’s

functioning including thinking and communication, perceiving and interpreting reality, feeling and
demonstrating emotions and behaving in a socially accepted manner. This condition causes distortion
and bizarre behavior, thoughts, movements, emotions and perceptions. This condition is usually
diagnosed in late adolescence or early adulthood and rarely manifest in childhood.

In relation to the predisposing and precipitating factors, the client’s cause of illness is severe
religiosity, parenting (family relationships and attitudes towards other), low frustration tolerance and
the nature of work.

The onset of the symptoms usually occurs in the adolescence or early adulthood and the onset
can be gradual or sudden. Course of schizophrenia is variable and remissions may occur. Some clients
may recover completely. Some have chronic, unremitting disorder. Schizophrenic clients have difficulty
in perceiving reality and disturbances on ego. These individuals have poor sense of identity as well as
lowered self esteem.

The signs and symptoms which manifested by the client when admitted were delusions
(grandiose), hostility, loose associations, disorganized behavior, social withdrawal and restricted
emotions.

D. RELATED LITERATURE AND STUDIES

University of Manchester researcher Paul Hammersley is to tell two international conferences,

in London and Madrid on 14 June 2006, that child and adult abuse can cause schizophrenia. The
groundbreaking and highly contentious theory, co-presented by New Zealand clinical psychologist Dr
John Read, has been described as "an earthquake" that will radically change the psychiatric profession.

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 Mr Hammersley, Programme Director for the COPE (Collaboration of Psychosocial Education)
Initiative at the School of Nursing Midwifery and Social Work, said: "We are not returning to the 1960s
and making the mistake of blaming families, but professionals have to realize that child abuse was a
reality for large numbers of adult sufferers of psychosis." He added: "We work very closely in
collaboration with the Hearing Voices Network that is with the people who hear voices in their head.
The experience of hearing voices is consistently associated with childhood trauma regardless of
diagnosis or genetic pedigree." Dr Read said: "I hope we soon see a more balanced and evidence-based
approach to schizophrenia and people using mental health services being asked what has happened to
them and being given help instead of stigmatizing labels and mood-altering drugs." Hammersley and
Read argue that two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse
and thus it is shown to be a major, if not the major, cause of the illness. With a proven connection
between the symptoms of post-traumatic stress disorder and schizophrenia, they say, many
schizophrenic symptoms are actually caused by trauma. Their evidence includes 40 studies, which
revealed childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric
patients and a review of 13 studies of schizophrenics found abuse rates from a low of 51% to a high of
97%. Psychiatric patients who report abuse are much more likely to experience hallucinations –
flashbacks which have become part of the schizophrenic experience and hallucinations or voices that
bully them as their abuser did thus causing paranoia and a mistrust of people close to them. They admit
not all schizophrenics suffered trauma and not all abused people develop the illness, but believe less
traumatic childhood maltreatment, rather than actual abuse, may be an important difference. In their
review of the 33,648 studies conducted into the causes of schizophrenia between 1961 and 2000, they
found that less than 1% was spent on examining the impact of parental care. Still, they say, there have
been enough studies to suggest negative or confusing early care may be an important addition to abuse
as a cause. Genes may still have a role to play but other evidence Hammersley and Read cite shows that
genes alone do not cause the illness. —ScienceDaily (June 14, 2006)

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 E. PSYCHOPHARMACOLOGY

F.

Generic Name/ Brand Name Classification Adverse Effects Nursing Considerations

Mechanism of Action

Haloperidol Antipsychotic CNS: Lethargy Although drug is least sedating of

Haldol A butyrophenone that probably
exerts antipsychotic effects by
blocking post synaptic dopamine
receptors in the brain.
the antipsychotics, warn patient
CV: Tachycardia to avoid activities that require
alertness and good coordination
GI: Dry mouth until effects of the drugs are
known.

D.R.F.F.T. Indication Contraindications Educate patient that drowsiness

and dizziness usually subside after
D- 10mg Psychotic Disorders Hypersensitivity to drug and those a few weeks.
R- oral with Parkinsonism, coma or CNS
F- BID depression Inform patient to avoid alcohol
F- tablet while taking this drug.
T-
Tell patient to relieve dry mouth
with sugarless gum or hard candy.

Inform patient to do not withdraw

the drug abruptly unless required
by severe adverse reactions.

Drug Study No.1

 Generic Name/ Brand Name Classification
Mechanism of Action
Lithium Carbonate Anti-manic
Mechanism for the antimanic
effect of lithium is unknown.
Various hypothesis include: a
decrease in catecholamine
neurotransmitter levels caused by
lithium’s effect on sodium-
potassium ATpase to improve
transneuronal membrane
transport of sodium ion
D.R.F.F.T. Indication
D- 450 mg Control of mania in manic-
R- oral depressive clients.
F- BID
F- tablet
T-
Drug Study No.2
Adverse Effects
Due to initial therapy: Fine hand
tremors or polyuria, thirst,
transient and mild nausea,
general discomfort.
Contraindications
Cardiovascular or renal disease.
Brain damage. Dehydration and
sodium depletion, clients
receiving diuretics.
Nursing Considerations
Note indications for therapy other
agents trailed, characteristics and
S&S, and behavioral presentation.
Inform client to take with food
immediately after meals. Avoid
any caffeinated beverages/foods
because these may aggravate
mania.
Monitor lithium levels
 Generic Name/ Brand Name Classification Adverse Effects Nursing Considerations
Mechanism of Action

Ascorbic Acid Vitamins Temporary dizziness Monitor for S&S of acute

hemolytic anemia, sickle cell
Ascorbic acid is reversibly oxidized crisis.
to dehydroascorbic acid in the
body. These two forms of the Take large doses of vitamin C in
vitamin are believed to be divided amounts because the
important in oxidation-reduction body uses only what is needed at
reactions. a particular time and
excretes the rest in urine.

D.R.F.F.T. Indication Contraindications

Mega doses can interfere with
D- 450 mg Use of sodium ascorbate in absorption of vitamin
R- oral Prophylaxis and treatment of patients on sodium B12.
F- OD scurvy and as a dietary restriction; use of calcium
supplement. Increases protection ascorbate in patients Note: Vitamin C increases the
F- tablet
receiving digitalis.
T- 8am mechanism of the absorption of iron when taken at
immune system, thus supporting the same time as iron-rich foods.
wound healing. Necessary for
wound healing and resistance to
infection.

Drug Study No.3

III. NURSE PATIENT RELATIONSHIP

A. PROCESS RECORDING

Name of patient: Ms. Love

Age: 36 years old

Diagnosis: Undifferentiated Schizophrenia

Pavilion: 3

Date of Interaction: December 6-17, 2010

Time of Interaction: 7:00AM-3:00PM

Duration of Interaction: 2-3 hours

ORIENTATION PHASE

OBJECTIVES:

 to establish rapport and trust and cooperation

 to establish roles and purposes of the meeting

 to identify client’s problems and clarify expectations

ASSESSMENT:

 Wears unit’s uniform with a face towel at her back

 Well groomed with good personal hygiene with good posture and gait

 Has good eye contact during interaction, good mood but flat affect

 Not oriented on time, place, date and reality

 Well nourished with fair skin

 Spontaneous speech and with relevant answers

 Unable to recall past experiences and relate to the present situation and reality

 Alert and had good judgment


NURSE
Magandang umaga po,
kumusta po kayo?
Ako po si Ariane Oblea. Galing
po ako sa Divine Word College
of Bangued sa Abra po. Ako po
ang magiging student nurse
ninyo mula December 6
hanggang 17, 2010 maliban
lamang po sa sabado at linggo.
Magsisimula po tayo ng alas
nuebe ng umaga hanggang alas
tres ng hapon. Pag-uusapan po
natin ang inyong mga
karanasan, at mga bagay-bagay
na makakatulong sa inyong
paggaling. Lahat po ang pag-
uusapan natin ay mananatiling
sikreto at tayo lamang pong
dalawa ang nakakaalam.
Maari po bang kayo naman ang
magpakilala?
Matagal na po ba kayo rito?
Anong dahilan naman po na
napunta kayo dito
May asawa po pala kayo, ilan
naman po ang anak ninyo?
Ano po ba ang trabaho niyo
dati?
ORIENTATION PHASE
(Dec.9, 2010 / 9am)
CLIENT THERAPEUTIC RATIONALE
COMMUNICATION
Okay naman ako, Giving recognition Greeting the client
magandang hapon din. indicates that she is
acknowledged and
recognized as a person.
(Ngumiti) Ganun ba? Offering self, This gives the client an
establishing rapport and overview what were the
trust ; giving reasons why you were
information there and make her aware
what are the boundaries
of the interaction, the
purposes, the time and
place and who were to be
involved. Establishing
rapport and trust can help
to make client feel at ease
with the nurse.
Ako naman si Love Providing General Leads It encourages the client to
nakatira sa Pasay City, continue what she is
36y/o saying and that the nurse
is active in listening.
Magdadalawang buwan Seeking Information Helps the client facilitate
palang ako dito. thoughts, feelings and
ideas clearly.
Dinala ako ng asawa ko Exploring Helps them both the client
dito. and the nurse to examine
the issue more fully.
May dalawang anak na Restating and seeking Restating helps in
ako,, pareho silang information. clarifying previous issue
babae. told by the patient.
Tumutulong ako sa Seeking information Helps the client facilitate
karinderya ng pamilya thoughts, feelings and
ko. ideas clearly.
Nakatapos po ba kayo sa pag-
aaral? Saang paparalan naman
po?
(tumango) nabanggit niyo po
na
Hindi kayo natapos sa pag-
aaral,sa anong dahilan po?
May nais pa po ba kayong pag-
usapan ate?
Cge po ate love bukas po ulit
tayo magkikita, alas nuebe ng
umaga. Maraming salamat po
ate.
Computer secretarial ang Seeking Information Helps the client facilitate
kurso ko dati pero di ako thoughts, feelings and
nakatapos, nag-aral ako ideas clearly.
sa pamantasan ng
lunsod ng Pasay.
Tinamad na akong mag- Summarizing, and This helps to organize key
aral, kaya dina ako Exploring issues that have been
nagpatuloy. discussed and for the
nurse to examine the
issue further.
Wala na po. Offering self Making oneself available
and showing interest and
concern to the client let
them feel more
comfortable and will
develop further trust
Maraming salamat din. Giving Recognition Greeting the client
(ngumiti) indicates the she is
acknowledge and
recognize as a person.

WORKING PHASE

OBJECTIVES:

 To identify issues and concerns causing problems

 To guide client to examine feelings and responses

 To develop coping skills and more positive self image

 To examine consistency of thoughts and ideas

ASSESSMENT:

 Well dressed with pink dress

 Well groomed with pink hair band

 With good eye contact during interaction and oriented on date, time, place and
identity

 With euthymic mood and appropriate affect

  Spontaneous speech, consistent answers to questions asked

 Has good communication skills, insight and judgment

 Alert, able to think abstractly and make generalization

WORKING PHASE DAY 2 (Dec. 10, 2010)

NURSE CLIENT THERAPEUTIC RATIONALE

Magandang hapon ate love.
Kumusta po ang araw niyo?
Napansin ko po na palangiti
po kayo ngayon. Kumusta
naman po ang tulog niyo?
Maaari niyo po bang ilahad
kung ano ang ginawa natin
kahapon?
May kapatid po ba kayo?
May naalala pa po ba kayo
nung bata kayo? Pwede niyo
po bang ikwento?
Ano po bang hilig niyong
gawin noong bata kayo?
COMMUNI
-CATION
Magandang hapon Giving Greeting the client
din Ariane recognition indicates the she is
acknowledge and
recognize as a person.
Mabuti naman ang Making To make them aware
tulog ko, Masaya observations what are their actions
lang ako kasi and what the client
nandito ulit kayo. feels.
(ngumiti)
Nagpakilala tayo sa Summarizing This seeks to bring out
isa’t isa. the important points of
the discussion and
increase awareness to
the client
Bali lima kami na Seeking It helps the patient to
magkakapatid, ako information. articulate thoughts,
ang pangatlo ideas and feelings
clearly.
Mayroon kaming Encouraging Encourages her to make
family business dati, expression her own appraisal rather
kaya mga kapatid than to accept the
ang nag-aalaga sa opinion of others.
akin, sila lagi ang
kasama ko sa
bahay.
Mahilig kami Exploring Exploring helps her to
maglaro dati ng examine the issue more
mga kapatid ko kasi fully.
lagi kaming iniiwan
nina mama sa
bahay.
Mahiliog po ba kayong Marunong lang Providing Encourages the patient
kumanta? nang kunti. general leads. to continue discussion
Ano naman po ang paborito Yung “have you Seeking Helps the client facilitate
niyong kanta ate? ever” information thoughts, feelings and
ideas clearly.
Sino naman po ang kumanta Hindi ko na maalala Encouraging This may fully relieve the
nun? eh. description of tension the client is
perception feeling.
At kanino niyo naman po Sa mga anak ko.. Encouraging This may fully relieve the
gustong ihandog ang kanta? description of tension the client is
perception feeling.
Sa anong dahilan po na Dahil mahal ko sila, Broad openings Open-ended questions
gusto niyong ihandog ang at ayaw ko silang provide opportunity for
kantang ito sa mga anak mawala sakin. the client to introduce
ninyo? topic.
Ano naman po Gumagaan Encouraging Encouraging the client to
nararamdaman niyo tuwing pakiramdam ko. expression make her own appraisal
kinakanta niyo ito? rather than to accept
opinions from others.
Sa activity po natin kanina Masaya at medyo Encouraging Encouraging the client to
na Music therapy, ano po malungkot. expression make her own appraisal
ang nararamdaman ninyo rather than to accept
habang kumakanta tayo ng opinions from others.
kanlungan?
Ano pong dahilan at nasabi Naalala ko kasi Seeking Helps the client facilitate
po ninyong malungkot? yong mga anak ko information thoughts, feelings and
at pamilya ko. ideas clearly
Ang ibig niyo po bang Oo, gusto ko nang Translating into This technique is to
sabihin ay gusto na po umuwi. feelings verbalize clients feeling
ninyong umuwi at maksama of what she said
ang pamilya ninyo? indirectly
Ano naman po yung mga Magpapakabuti ako Formulating a Making definite plans
naiisip ninyong paraan o dito at sinusunod ko plan of action increases the likelihood
solusyon para makauwi na yun mga sinasabi ng that the client will cope
kayo? mga nurses at more effectively in
doctor.Iinumin ang similar situation
mga gamut ko.
Nasaan po sila ngayon? Nag-aaral sila Seeking Helps the client facilitate
information thoughts, feelings and
ideas clearly
Sino po ang nag-aalaga sa Yung asawa ko. Seeking Helps the client facilitate
kanila? information thoughts, feelings and
ideas clearly
Sa music and art therapy
naman po, anong dahilan na
bulaklak and ginuhit ninyo?
At kanino niyo po gustong
ihandog ang inyong guhit?
Ano naman po ang
nraramdaman niyo habang
gumuguhit kayo?
May gusto pa po ba kayong
ibahagi sa akin?
Sige po ate love bukas po
ulit.
Kasi marami akong Encouraging Doing so encourages the
tanim na maga description of client to verbalize ideas
halaman sa bahay perception fully.
namin.
Sa pamilya ko. Translating into Helps to understand on
feelings what the client might be
feeling to express
herself that way
Namimis ko ang Broad opening. Make explicit that the
mga anak ko. client has the lead in the
interaction. This may
stimulate her to take the
intiative.
Wala na. Offering Self Making oneself available
and showing interest
and concern to the
client let them feel more
comfortable and will
develop further trust
Salamat, Paalam Giving Greeting the client
Recognition indicates the she is
acknowledge and
recognize as a person.

WORKING PHASE DAY 3 (Dec. 13, 2010)

THERAPEUTIC
NURSE CLIENT COMMUNICATIO ANALYSIS
N
Hello po ate love Magandang umaga Giving recognition Greeting the client
magandang umaga. din indicates the she is
Nandito na naman po acknowledge and recognize
ako. as a person.
Anong araw po ngayon Dec 13, 2010 Presenting reality Offers considerations
ate love? which are real.
Ano po ang Ok lang naman ako. Encouraging Encouraging the client to
nararamdaman niyo expression make her own appraisal
ngayon? rather than to accept
opinions from others.
Nabanggit niyo po Oo tama. Summarizing This seeks to bring out the
kahapon ang tungkol sa important points of the
inyong pamilya, tama po discussion and increase
ba? awareness to the client.
Pwede pa po ba kayong Mahilig kaming Placing event in Helps both the nurse and
magkwento tunkol sa maglaro,tapos pag time or sequence the client to see them in
elementary day’s niyo? napapabayaan perspective, the nurse may
namin ang grades gain information about
namin recurrent patterns in the
pinapagalitan kami client’s behavior.
nina mama
Nodding Pagkagraduate ko Silence Often encourages to
nung elementary verbalize, and gives the
mahiyain ako,kunti client’s time to organize
lang ang kaibigan thoughts and direct the
ko,tapos nang topic of interaction.
makilala ko na yong
mga kabarkada ko
natutunan kong
manigarilyo at
uminum.

Ano naging reaksyon ng Lagi nila kong Encouraging This may fully relieve the
mga magulang niyo nung pinapagalitan tapos description of tension the client is feeling
nalaman nila ang tungkol pinagbawalan nila perception and she might be less likely
sa bisyo niyo? akong makipagkita to take actions on ideas
sa mga kabarkada that are harmful or
ko. Feeling ko dati frightening.
lahat ng ginagawa
ko mali sa paningin
nila.
(Nodding) Ngayong Ah ganun ba? Di Giving information Informing the client of facts
umaga po, mag kakaroon ako magaling ; silence increases her knowledge,
ulit tayo ng activity na sumayaw eh. and orients her on what to
dance at recreational (ngumiti) expect.
therapy . Marunong po Often encourages to
ba kayong sumayaw? verbalize, and gives the
client’s time to organize
thoughts and direct the
topic of interaction.
Ah ganun po ba? OO, yun ba yung Broad opening. Make explicit that the
Pamilyar naman po ba nasa TV? Pero di ko client has the lead in the
kayo sa larong Pinoy
Henyo?
Iyon po kasi ang lalaruin
natin mamaya.
Opo,huwag po kayong
mag-alala, kasi po
makakatulong po ito sa
inyong paggaling
Ready na po kayo sa mga
activity natin ngayong
umaga?
Wala na po kayong
idadagdag?
Sige po, pumunta na po
tayo sa mga kasamahan
ninyo.
WORKING PHASE DAY 4 (Dec. 14, 2010)
NURSE
Magandang umaga Ate love
Anong oras po kayo nagising
kanina?
Ano pong petsa ngaun ang
anong araw?
Magaling. Tama po.
masyado kabisado interaction. This may
eh. stimulate her to take the
intiative.
Lahat ba kame Giving information Informing the client of facts
sasali?baka matalo increases her knowledge,
ako. and orients her on what to
expect.
Ganun ba, o sige. Giving information Increases her knowledge
about the topic.
Oo naman Encouraging Encouraging the client to
expression make her own appraisal
rather than to accept
opinions from others.
Wala na Giving recognition Greeting the client
indicates the she is
acknowledge and recognize
as a person
Sige.
THERAPEUTIC
CLIENT COMMUNICATION ANALYSIS
Magandang umaga Giving recognition Greeting the client
din Ariane indicates the she is
acknowledge and
recognize as a
person.
5:00 kasi naligo pa Seeking To make them aware
kame, tapos nag- information what are their
almusal. actions and what the
client feels.
Dec. 14, 2010 Presenting reality The intent is to
indicate an
alternative line of
thought to the client.
(client Smiled) Giving recognition Greeting the client
indicates the she is

Sa tuwing nag-uusap po
tayo, ano po yung mga
naaalala ninyo?
Saan po yung mga lugar na
parati ninyong
pinupuntahan?
Ano po yung ginagawa niyo
dun kapag pumupunta po
kayo?
Kung sakali po, makakalabas
kayo dito, saan po yung
lugar na pupuntahan ninyo
at ano yung mga gagawin
ninyo?
Talaga pong sabik na kayo sa
mga anak niyo,ano po ang
gagawin ninyo para
gumaling kaagad?
Mabuti po kung
ganun.Pumunta na po
tayong sa mga kasamahan
niyo ate.
TERMINATION PHASE (Dec 16, 2010 9am)
NURSE
Magandang Ate love Ganu din sayo (Client
smiled)
acknowledge and
recognize as a person
Mga anak ko at Placing event in Helps both the nurse
asawa ko, miss na time or sequence and the client to see
miss ko na kasi sila at them in perspective,
yung mga lugar na the nurse may gain
parati naming information about
pinupuntahan. recurrent patterns in
the client’s behavior.
Sa luneta, at minsan Broad opening. Make explicit that
sa mall, minsan the client has the
naman lead in the
nagvovolunteer ako interaction. This may
kasama ang mga stimulate her to take
anak ko sa simbahan. the initiative.
Nagpipicnic kame,o Seeking To make them aware
kaya nanonood ng information. what are their
sine. actions and what the
client feels
Uuwi ako sa bahay Exploring Helps them both the
namin tapos client and the nurse
mamasyal kame ng to examine the issue
mga anak ko. Kahit more fully.
saan siguro basta
kasama ko sila.
Sobra. Translating into This technique is to
Magpapakabait ako feelings verbalize clients
dito, iinum ng mga feeling of what she
gamut ko at susundin said indirectly
ang doctor ko.
Sige. Salamat (Client Giving recognition. Greeting the client
smiled and followed) indicates the she is
acknowledge and
recognize as a
person.
CLIENT THERAPEUTIC ANALYSIS
COMMUNICATION
Giving recognition Greeting the client
indicates the she is

Kumusta po kayo? Mabuti naman
Ngayon pong araw na Oo naman.
ito, bale ito na po yung
huli nating pagsasama’t
pag-uusap. May kunti
po tayong programa at
maaasahan ko po ba ang
kooperasyon ninyo?
Nag-enjoy po ba kayo?
Ngayon na po ang huling
pagkikita natin ate, nais ko
pong magpasalamat sa
magandang pakikitungo
ninyo sa akin sa mga
nakaraang araw. Sana po
may naitulong ako sa inyong
kalagayan. May mga nais pa
po ba kayong sabihin bago
tayo maghiwalay?
B. LIST OF NURSING DIAGNOSIS (NANDA)
CUES
SUBJECTIVE:
>Gusto ko nang umuwi,
miss ko na mga anak ko.
OBJECTIVE:
acknowledge and
recognize as a
person.
Seeking information To make them
aware what are their
actions and what
the client feels
Giving Information Informing the client
of facts increases
her knowledge
about a topic and
orients the client on
what to expect.
AFTER THE PROGRAM
Oo nag-enjoy ako Seeking information To make them
(smiled) aware what are
their actions and
what the client
feels
Maraming salamat Giving recognition Informing the
din Ariane. Wala client of facts,
na, paalam. increases her
(smiled) knowledge about a
topic and orients
the client on what
to expect.
NURSING DIAGNOSIS JUSTIFICATION
Anxiety related to prolong Anxiety level of the client should
rehabilitation as evidenced by be given first priority for it will
grimacing, poor eye contact at also lead the client to danger if
times, hand tremors and uncontrolled. Therefore, it
restlessness. should monitored and managed
for the client’s safety.
>poor eye contact at times
> grimacing
> hand tremors
> restless
SUBJECTIVE:
OBJECTIVE:
>talks to self frequently
> leaves area suddenly
without explanation
>poor concentrations
>has difficulty maintaining
conversations
SUBJECTIVE:
>Malungkot dito kapag
walang student nurse.
OBJECTIVE:
>sadness
> poor eye contact at times
>absent of significant
others
>isolates self in room most
of the time
Disturbed sensory perception
related to loneliness and
isolation as evidenced by talking
to self frequently, leaves
suddenly without explanations,
poor concentration and has
difficulty in maintaining
conversations.
Social Isolation related to
sadness, poor eye contact at
times, absent of significant
others and isolation of self in
room most of the time.
Disturbed sensory perception
should be given importance for
the client may manifest
untoward behavior towards self
and other clients due to
misinterpretation of stimuli.
Social isolation would be the last
for it requires least nursing
interventions but it should also
be given importance for the
benefit and success of the
client’s rehabilitation. The client
will be able to develop social
skills and social acceptance if it is
properly given appropriate
nursing interventions.
 DIVINE WORD COLLEGE OF BANGUED
BANGUED, ABRA
CUES BACKGROUND PATIENTS OBJECTIVE OF NURSING ACTIONS AND RATIONALE
KNOWLEDGE PROBLEM INTERVENTIONS

SUBJECTIVE: Uneasy feeling of Anxiety related to After Nursing >Provide therapeutic Environment
“ Gusto ko ng discomfort prolong interventions, the _To gain client’s trust
makita pamilya ko. accompanied by rehabilitation as client’s level; of >Be available to client at all times
Gusto ko ng autonomic response. evidenced by anxiety will be _to make the client’s feel valued and has
umuwi. “ – as The client grimacing, poor lessened. importance.
verbalized. experiences anxiety eye contact at >Stay at the clients and provide a comfortable
because of the times and environment.
OBJECTIVE: limited visitation of restlessness. _To make client’s feel valued and relieves the
>poor eye contact her family which level of anxiety and releases tension
at times caused her to >Encourage client to engage self in activities
> grimacing mumble to herself _Activities helps the client divert attention
> restless sometimes. from anxiety and from undesirable behaviors.
>Encourage client to acknowledge and express
feelings
_To explore the cause of feeling of
apprehension.
Nursing Care Pan No.1
DIVINE WORD COLLEGE OF BANGUED
BANGUED, ABRA
 CUES BACKGROUND PATIENTS OBJECTIVE OF NURSING ACTIONS AND RATIONALE
KNOWLEDGE PROBLEM INTERVENTIONS

SUBJECTIVE: The client experience Disturbed sensory After Nursing >Establish a therapeutic relationship.
disturbed sensory perception related interventions, the _To gain client’s trust
perception which is to loneliness and client will demonstrate >Orient the client continuously to actual
incongruent with isolation as ability to hold environment, events and activities.
actual stimuli. In this evidenced by conversation and _Frequent orientation helps to present reality
case, the client talking to self ceases to talk to self. to the client
OBJECTIVE: misinterpreted and frequently, leaves >Call the client by name.
>talks to self acts contrary to what suddenly without _Using correct names reinforce reality are
frequently is real. explanations, poor reducing hallucinations.
> leaves area concentration and >State your reality about the client’s
suddenly without has difficulty in hallucinating experience.
explanation maintaining _The client is helped to distinguish the actual
>poor conversations. voices which promote reality.
concentrations >Use clear and distinctive voice
>has difficulty _To avoid misinterpretations
maintaining >Encouraged the client to engaged in activities
conversations _Activities are alternatives and distractions to
hallucinations
>Accept and support feelings of the client
_This convey empathy and understanding
which reduces fear or anxiety.

Nursing Care Plan No.2

DIVINE WORD COLLEGE OF BANGUED
BANGUED, ABRA
CUES BACKGROUND PATIENTS OBJECTIVE OF NURSING ACTIONS AND RATIONALE
 KNOWLEDGE PROBLEM INTERVENTIONS

SUBJECTIVE: Aloneness Social Isolation After nursing >Provide therapeutic Environment

“Malungkot dito experienced by the related to sadness, interventions, the _To gain client’s trust
kapag walang individual are poor eye contact at client will be able to > Provide a positive reinforcement when client
student nurse.” – perceived as imposed times, absent of engage self in all social makes moves towards others.
as verbalized. by others and as a significant others activities actively and _It encourages continuation of efforts.
negative or and isolation of self verbalize willingness to >Promote participation in activities.
threatening state. in room most of social interactions. _This facilitates socialization
OBJECTIVE: the time. >Engage other client to interact with the client
>sadness _this promotes social skills in a safe setting.
> poor eye contact >Help the client seek out clients to socialize
at times with who have similar interest.
>absent of _Shared common interest promote more
significant others enjoyable socialization which may be
> isolation of self in repeated.
room most of the >Praise the client for attempts to seek out
time. others for activities and interactions
_Praises promotes repeated positive social
behavior.

Nursing Care Pan No.3

V. THERAPIES

1. ACTIVITIES OF DAILY LIVING - An activity done by an individual which is necessary for the
promotion of good personal hygiene which can be done with or without assistance/ supervision
to an individual. It is usually performed in the course of normal day in a person’s life such as
bathing, brushing teeth, eating, toileting, and dressing.

Indication and Purpose:

1. To promote and improve personal hygiene and grooming
2. To promote self-independence
3. To encourage participation
4. To develop interpersonal relationship
5. Evaluation through return demonstration

Standard Rule and Technique Used:

 Client performs the activities of daily living everyday to become her habit.
 The student nurse allow the client to do the personal hygiene techniques by herself such
as washing of face, brushing teeth, putting face powder and the like. The student nurse
also explains the importance of these routines.
 The student nurse facilitates exercises.
 A short orientation and introduction among student nurses and clients were done.
 The client and the student nurse will then have a nurse-patient interaction. Client will
actively participate in the therapeutic activities by the student nurses.

Interpretation and Analysis:

Our client performed the different hygienic activities well. She was able to understand
the importance of the different hygiene techniques. The activities that were introduced to
the client helped her in achieving or improving self care by performing daily healthy habits
and routine.

2. MUSIC AND ART THERAPY- Is the opportunity for socialization and self expression and
sometimes realization affected by certain musical activities. Art therapy is the process by letting
the patient express her feelings and thoughts through various artistic means particularly
sketching and drawing. One type of therapy with purposeful use of music and arts as a
participative or listening experienced in the treatment of the patient to improve and motivate
their mental and emotional state.

Indication and Purpose:

1. To know as a diagnostic tool, collecting signs and symptoms to supply
psychiatric and to give correct diagnosis.
2. To interpret psychological drawing
3. To discuss emotional problem and to give reasons and ideas regarding such
problems
4. To develop interpersonal relationship
5. To release past trauma in life unconsciously.

Standard Rule and Technique Used:

During this activity, we gave each client one bond paper and a set of crayons. Then,
we played slow music entitled “I Will Be Here”. We let them draw what they feel or what
came to their minds upon hearing the song and later they interpreted it.

Interpretation and Analysis:

Our client had drawn a flower with which she used red color. She said that she loves
flowers and that she misses the flowers in their house. She dedicated this flower to her
daughters whom she misses a lot too. These reasons from the client indicates that she is
badly longing for her family. The client’s drawing was positioned in the center of the bond
paper which signifies her desire for attention. While the music is playing, the client was very
focus on the drawing she was making.

3. MUSIC THERAPY- One type of therapy with purposeful use of music as a participative
experienced in the treatment of the patient to improve and motivate their mental and
emotional state. It is one way of having self-expression of the client through reflecting on a
piece of song that was introduced.
 Standard Rule and Technique Used:

This activity helps the client to reflect their feelings to the song. This will help them to
remember their past and relate it to the song and share it. A piece of song entitled
“Kanlungan“was written in a manila paper. First, we let them sing the whole piece. Then,
each paragraph was sung by one client at a time. After this, we ask them on what they
remember on the song. We let them reflect their feelings to the song that was being
emphasized.

Interpretation and Analysis:

The client participates well on this activity. She expresses her feelings on the group.

4. PLAY/RECREATIONAL THERAPY – Recreation would refer to any activity which revitalizes

one’s mind and body. A technique that makes it possible for the patient to express himself. Free
play enables the individual a unique opportunity to discharge strong motion and secure
atmosphere. It is also a form of Psychotherapy for regressed psychotics to an extent of making
its impossible to communicate with them through verbal channels. This activity also serves as a
break in the monotony of their hospitalization life and aims to eliminate boredom.

Indication and Purpose:

1. To help patient interact with other patients in a slightly competitive but thoroughly
enjoyable level, manner
2. The client will be able to express themselves through acceptance and enjoyable
means
3. To promote diversion from usual routinely experienced by the client in favor of a
more dynamic activities
4. To promote cooperation and sportsmanship
5. Allow free expression of feelings and thoughts

Standard Rule and Technique Used:

In this activity, we had the “Pinoy Henyo” as our game. First, the facilitator
explains the mechanics of the game. A partner was needed- the client and the student
 nurse. There are prepared words to be picked and to be guessed. The client will be the
one who will guess the word and the student nurse will answer her questions either
“Yes, No, or Maybe”. Two minutes are only given to them to guess the word. The
Partner who get the least time would be the winner.

Interpretation and analysis:

With this therapy, the client showed interest and became a winner on the game.
She was able to guess the word “Mangga”. She showed competitiveness and very active.
This time, she said that this activity we’ve done was a good diversional activity for her.

5. BIBLIOTHERAPY - Use of literature, film or feature on creative writing with group discussion
to promote self-acknowledgement and inter action of thoughts and feelings. Enhances patient’s
awareness regarding an article of material s well as it increase with the information and content
of such reading materials. It stimulates the inner self by expressing their feelings regarding with
given story.

Indication and Purpose:

1. To stimulate the psychological, sociological and aesthetic values from books into
human character, personality and behavior
2. To provide stimulus for the memory to compare events with their own interpersonal
and intra psychic experience.
3. To increase level of understanding with information from the reading materials.

Standard rule and Technique Used:

In this therapy, we used a poem entitled “Puno ng Buhay”. The poem is about
the coconut tree. First we showed a picture of a said tree and we let them identify the
different parts of it. All together, the clients read the poem. After which, we asked some
questions about the poem and they answered well. We let them enumerate the products
that can be obtained from the tree. Each client was very willing to answer and the activity
was done smoothly.
 Interpretation and Analysis:

The client participated well in the discussions we had. She was able to identify and
enumerate different advantages of the coconut tree. She listen attentively and cooperate
well.

6. OCCUPATIONAL THERAPY - Any activity mental and physical guided to an individual to

recover from a handicap. There is an increasing awareness that process and not the product of
the process is the greatest importance. Manual recreational and creative technique to facilitate
personal experiences and increase social responses and self esteem.

Indications and Purpose:

1. To improve general performance
2. To obtain essential skills of living
3. To assist in symptom reduction
4. To increase the sense of accomplishment, satisfaction and control over one’s
own life
5. To increase social responses
6. To increase self-esteem

Standard rule and Technique used:

The group taught the clients how to wrap a bottled gift. We have plastic bottles,
Japanese paper, and ribbon. The idea of the activity is to design papers as our materials. We
cut the materials before going to the institution to avoid accidents among the clients. The
facilitator explained the procedure step by step as one of the student nurse demonstrates it.
Then we let the clients decorate the gifts assisted also by their student nurses.

Interpretation and Analysis:

Our client performed well during the activity. She followed the direction carefully. She
was able to make a good output from the materials given.
7. REMOTIVATION TECHNIIQUE - Is a technique of every simple group therapy of an objective
nature used in an effort to reach the wounded areas of the patient’s personality and get them
moving in the direction of reality

Indications and Purpose:

1. To stimulate client to think about something and talk about himself
2. To develop ability to communicate and share idea and experience with others
3. To develop feeling of acceptance and recognition

Standard rule and Technique used:

We have chosen the story “Paid with a Full Glass of Milk” as our medium on discussion
in this technique. We portray the story by dramatizing it. The whole group acted the way
they could be to in order to extend the meaning of the story. After the demonstration, we
asked the clients the lesson they got from the story. They also relate the story in some parts
of their life.

Interpretation and Analysis:

The client was able to share information about her experiences related to the story. The
lesson of the story was understood by the client. Helpfulness was emphasized.
VI. CONCLUSION AND RECOMMENDATIONS

As a result of the study and interaction of the client, the following conclusion are being
gathered and seen:

 There is a great influence of the family and significant others in the development and
progression of the illness.

 Schizophrenia can be manageable with the aid of the family as the main source of
strength and hope of the client.

 Clients who develop this kind of disorder have a connection to their development task
which were unmet that makes them vulnerable to stress.

 In relation to their treatment, psychotherapies were used for the rehabilitation and
will prepare the clients for their recovery and readiness to face challenges when they go
outside the center.

 In relation to the management and interventions, close monitoring and guidance were
important for the safety of the client especially for the recurrence of the signs and
symptoms of the illness.

The following are the recommendations:

 Constant visitation should be done to the client in order for them to feel valued and
cared by the family.

 Close monitoring should be done to client in order not to develop the recurrence of
symptoms which are harmful to them and to other clients.

 Therapeutic communication should always be used and observed for clients not to be
offended for they were already at the rehabilitation area, they have absolutely feelings to
be hurt and may feel rejection.
VII. BIBLIOGRAPHY

Books

Lippincott’s Manual of Psychiatric Nursing care Plans. 7th edition by Schultz and Videbeck

Psychiatric Nursing. Norma.Keltner,et.al.pte Ltd. C2007

Psychiatric Nursing:biological &behavioural concepts (Deborah Antai

Drong)p.351.thomson/Delmar learning;c2003

Abnormal psychology. James Hansen; Lisa Damour. Hobeken, NJ: Willey c2005

Internet

http://positivenewsmedia.net/am2/publish/Health_21/P4-M_Davao_mental_hospital_multi-
purpose_building_to_rise_next_year.shtml)

http://www.cureresearch.com/s/schizophrenia/stats-country.htm

http://www.schizophrenia.com/szfacts.htm

http://www.ppa.ph/files/PPA%20Research%20Abstracts.pdf
VIII. NARRATIVE REPORT

December 6, 2010

It was the first day of our duty at the National Center for Mental Health. To be honest,
we were all so nervous because it was our first time to enter in a mental hospital and soon to
deal with clients with different type of disorders.

We are gathered at Maoay Gymnasium. We waited for the orientation program to start
as a part of the routine before starting our exposure at the institution. We saw lots of students
from different schools that will also have their affiliation in the said institution. As we finally
entered the hall, the anxiety we felt lessened because of the accommodating speakers like Mrs.
Lucila O. Espinoza, the Chief Nurse. She was so good in speaking. She did talk about therapeutic
techniques and therapeutic communications. The second speaker talked about the history of
NCMH and the orientation was done smoothly. After the orientation, we went to our designated
Pavilion together with our clinical instructor. Ms. Coleen Castaneda was good and very vocal.
We were assigned to Pavilion 3, I think we were so lucky because we had already a good
teacher, and at the same time we had a good ambiance. We didn’t yet get inside the ward but
we’d already seen the place where we are assigned. The day and the time had gone fast and we
went home after a very exciting day. And from the endeavor we can say that we learned a lot!

December 7, 2010

It was the second day of our duty at the National Center for Mental Health. We came
early that day, our instructor ma’am Coleen also came early. We did not interact with our clients
yet, instead we had a discussion regarding different mental disorders. We also tackled about
ECT, its purposes its indication and contraindication. Luckily we had the chance to observe ECT.
Some of my classmates even had the chance to assist during the therapy along with the other
schools. We noticed that most of the patients became unconscious or disoriented after the
therapy. The therapy was at the 2nd floor were they put patients with severe mental illnesses.
After the observation we continued our discussion. After lunch we had given an assignment to
have an essay regarding our self. And so we went home early.
December 8, 2010

This day, we had our Self-Awareness. One by one, we shared our experiences in life, our
weaknesses and strengths, our limitations and our goals in life. Most of us cried because we
were able to recall some of our painful experiences in the past. We finished the self-awareness
with a half day session, just in time for us to have our break for lunch.

In the afternoon we did not had an interaction with our clients again, since the head
nurse has not yet designated patients for our school, so we again had a discussion instead. Time
goes and its time for us to go home .

December 9, 2010

It was a pleasant Thursday morning. The day came to spend our whole day stay at the
Pavilion 3 where we were assigned. It was a busy day for us and to our clients. As I observed
during the activities inside the area, all clients were so active and participative with the
activities. Before we go inside the ward, our instructor gave as a briefing regarding our clients.
As we proceed inside, I felt nervous. But after her name was called I was relieved to see a happy
smile coming from her. She look friendly, we had our first interaction that day.

We started with an exercise in order to boast up their energy and motivate them. Then
we had a one on one interaction with our clients. She told me the reason why she was at NCMH,
and we talked about her family and her background. After the snack we accompanied them
inside their ward. At exactly 1:00 PM, we entered the area together with our instructor and we
had our chart reading. I was able to know my client’s information and her diagnosis. After that
we went home.

December 10, 2010

It was already our fifth day of duty at the Pavilion 3. We do our activities of daily living
and we had our exercise as a start of the activity. After that a short talk with our patient before
proceeding to our first activity. Our activity was music that was facilitated by one of the member
of the group. The song entitled “Kanlungan “ played and everybody had sing along. When ask
what they felt while singing the song everybody expressed their thoughts and feelings.
 Music and art therapy was conducted after the first one. We asked them what they
know about music and arts therapy and I couldn’t believed that everybody wanted to answer.
First, we played a fast music and we let them draw what they felt while listening to the fast
music and afterwards, one by one explained their works. Secondly, we also played a soft and sad
music and we let them also draw what they feel and think when they heard a sad music and
later on, we let them also explained individually. We ended up the activity with their snacks and
the activity gone smoothly and also we enjoyed it and I learned a lot including the mechanics
and what to do consider in order for the activity to be interesting and memorable to our clients.

December 13, 2010

It was a pleasant Monday morning. The journey in Pavilion 3 continues as we go to our

duty. As we waited to our Clinical Instructor, we prepared ourselves for our activity for this day.
We practice and finalized our steps in our dance that were going to teach to the clients as their
exercise. Others are formulating the words to be guess used in our Recreational therapy. Before
we entered into the ward, our Clinical Instructor briefs us what to be done.

As a daily routine, we assist our clients in performing first their activities in daily living
such as tooth brushing and washing face. Then, we teach our dance to them. We are all
graciously dancing in the tune of”WAKA-WAKA”. After which, we have a time for one on one
interaction with our patient. Then, we proceeded in our next activity, the Recreational Therapy.
We played the game “Pinoy Henyo”. Both the clients and the student nurses have fun in
guessing the word and also in answering the questions that are asked. The clients are all actively
participating well. As we observed Ms. Love was able to participate in our activity. As we end up
our interaction to our client this day, we gave them their snacks and juice.

In the afternoon, we had our lecture again with our Clinical Instructor. She also
evaluated the day’s activity and had some comments. She also reminded us that there is no duty
on Pavilion 3 by tomorrow because of the Pavilion’s Christmas Party. We spent our remaining
time in chatting while waiting for the service car.

December 14, 2010

It’s Tuesday morning. A day that was very exciting. Exciting because we had a lot of
activities to be done. There are three therapeutic therapies on this day. As we met again our
clients, we assist them performed first their ADL’s. After that, we had a short time nurse-patient
interaction. The client express herself again. Then we preceded to our first activity- the
Bibliotherapy. In this activity, we had a composed poem entitled “Puno ng Buhay” was
discussed. The poem is about the coconut tree. During the discussions, the client participates.
She was one on their group that was able to give answers to what is asked. We have discussed
the different parts of a coconut tree and products that can be made out of this tree. We
emphasized to them what is really the reason why the coconut tree is called the tree of life. This
form of therapy will let the clients explore and express themselves as we dig more about their
lives.

Our second activity is the Remotivation Therapy. In here, some student nurses became
actors and actresses as we portray the story of “Paid with full glass of Milk”. As we looked to our
client’s faces, we know that they are really enjoyed the role playing. After that, we proceeded to
discussions about the subject. All the clients express their thoughts and ideas on the said
stories. They were able to give moral lessons from the story.

The last therapy for the day is the Occupational Therapy. First, the facilitator of the
activity explained the rules on the client. The student of each client remained in their back to
assist them in making the output. The activity is all about how to wrap a bottled gift. As the
facilitator enumerating the directions, the clients are doing it step by step. As an output, there I
a beautiful wrapped bottled gift created by the clients. After which, we asked some questions to
boost their mind and making them express what they feel. We end up with their snacks. It was
an overwhelming experience and I was happy again because of what had happened even we’re
a little bit tired, at least, we had given them happiness and we gave our best for them feel that
they were also people who were longing for happiness.

December 15, 2010

We have no interaction to our client because of the Pavilion’s Party. We do not have our
duty on this day. We spent our time in preparing for the activities that will be done for the next
day for our socialization day.
December 16, 2010

Two days left in NCMH! And it’s Socialization Day! In that day, while we are waiting for
our Clinical Instructor, we realized that we are only this day to meet and interact to our clients.
It’s a mixed emotion for us. Mixed emotions that can either be happy or lonely. Happy because
we are all excited to the experience the Socialization fever of Pavilion 3. Three groups of three
schools are united to have joined forces of Socialization in Pav.3. On the other hand, we felt sad
it is because we knew that we’ll going to miss this institution and the clients.

First thing we do is to prepare the curtains, chairs and the like that are needed in the
event. We set the stage for the program. We also rehearsed ourselves in the dance number we
going to present to the clients. After a few hours of preparation and the clients are also
prepared, we met now all the clients. We had the program very enjoyably and memorable.
There are the funny games, beautiful numbers from the student nurses of the three schools, and
of course the eating of the snacks. It was very memorable to us. After the socialization, our
Clinical instructor gave us the time to say goodbye to our clients. She gave us the chance to have
a short time to talk with them one on one to thank and say goodbye. It’s really hard to say
goodbye but it’s a must. Even though we had only short period staying and dealing with our
clients we had already developed trust between us student nurses ad so with our clients. From
this socialization, we hope still gave them happiness by means of the presentations and games
we prepared for them.

December 17, 2010

It’s our last day to NCMH! And it’s the foundation day of the institution. It’s been an
exciting day because we witnessed the celebration of the institution to their foundation day.
First thing done is the exercise conducted on the grounds of the Center to boast up energy.
After the exercise, a community mass was held as a part of the celebration. After the mass, we
had our tour in the whole institution. We visited the different pavilions of the institution and
met other clients. We enjoyed the tour. As a remembrance, we took pictures in the different
beautiful areas of the Center. Indeed, it was a great experience for us in having a duty in this
institution. We hope that we had done our parts.