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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)
Leading to the Degree Bachelor of Science in Nursing
I.
A. INTRODUCTION
Schizophrenia is a group of psychotic reactions that affect multiple areas of an
individuals 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
clients 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 last type which is residual is characterized by the absence of
prominent delusions, hallucinations, disorganized speech and grossly disorganized or
catatonic behavior.
B. THEORETICAL FRAMEWORK
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.
Sullivan was the principal proponent of learning theory, believing that the
developing individual was shaped by social interactions. Therefore, the complex feelings,
thoughts and behavioral expressions grew out of the individuals experiences with those
closest to her or him. For example, if the childs father was mean and dictatorial, the
perception may have generalized to other men in positions with authority. Or if the
childs 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, that was the things she will be doing when she grow up to cope
problems and save her or his ego identity.
This theory I think was indicated to my client who have difficulty in coping when
she was still at normal state of life. Later, she developed untoward behaviors when
triggers the development of her condition and was diagnosed to have schizophrenia,
undifferentiated type. This is in relationship with the relationship of the client with the
other members of the family especially her parents who were to be the model of the
young minds. She grew up with a mean father and mother which she never inculcated
during the interactions. And from this case, the client tend to blame her mother for the
development of the condition.
C. PERSONAL DATA
Name:
Age:
48 y/o
Birth date:
Birthplace:
Marikina City
Address:
Gender:
Female
Civil Status:
Married
Nationality:
Filipino
Religion:
Jehovas Witness
Educatonal Attaiment:
College Graduate
Date of Admission:
Time of Admission:
2:40 PM
Admitting Physician:
Chief Complaints: According to the Father, 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 because of her mother who sold herself to satan when they went to a tour
around the world.
Admitting Diagnosis:
Final Diagnosis:
Agency:
D. CHIEF COMPLAINT
According to the Father, 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
because of her mother who sold herself to satan when they went to a tour around the
world.
sleep. She also added that she was been admitted at the center before and taking up
medications like Haloperidol.
The client was been at the National Center for Mental Health for about 14 years
but sometimes in and out due to the progressive state of her condition.
II.
A. GENERAL APPEARANCE
The client appears stated with her age of 48 years old, wearing a pink dress with a
face towel at her back, well groomed and with good personal hygiene. Shes 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 an appropriate affect or facial
expression with regards to a certain situation. She was well nourished and has a fair skin
as evidenced by her good body built and has no sleeping difficulties by the absence of
dark circles under her eyes. She was well oriented with time, place, date and reality. The
client considered the interview 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 speech and behavior.
B. GENERAL BEHAVIOR AND ACTIVITY
The client sometimes lethargic and catatonic stupor during interactions. There are
also times that she was restless where she cant remain still. She has also hand tremors
which were involuntary, purposeless rhythmic movements.
C. ORIENTATION
The client was well oriented on date, time, place and reality. She can relate to past
experiences and able to organized ideas and thoughts related to her present condition. She
know and aware that she was at the National Center for Mental Health.
Even the client was at the center, she has a normal and logical thought process.
What she uttered was meaningful and with sense. She didnt use confabulation nor
circumstantial. She can easily catch up what the interviewee mean and answer relevant to
the questions.
F. MEMORY, PRESENT AND REMOTE
The client good memory but 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 only started when she was on her early adulthood.
Therefore, it doesnt mean that she can not make decisions on its own for she was at the
center. She can formulate and think of other alternatives which later beneficial for solving
her own problems.
H. INSIGHT
The client was knowledgeable and aware of her condition that she was 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 cant
answer directly.
J. COPING MECHANISMS
The client has good pattern in handling stressors that arises in her life. Since she
was able to formulate ideas and alternatives in order to divert her attention her problems,
she just did her responsibilities at the center and just 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
In the case of my 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, shes 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 I 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. Shes blaming and concluding that her physical handicap was
due to that event and it was a defense mechanism called conversion.
III.
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, Jesus Christ. 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.
This explanation suggests that schizophrenia has a psychosomatic cause the origin is
solely in the mind. At best it could only be a partial explanation of some symptoms, e.g.
delusions. In reality, Freud is denying the very experience of patients with schizophrenia. It
is unscientific and extremely difficult to test. Concepts such as repression are difficult to
observe and measure, although this difficulty does not invalidate the theory. The theory is
based on unrepresentative samples, case studies, from which it is difficult to generalize. And
it involves poor methodology. The theory fails to account for gender differences - the onset
for males is around 20 years, and for females 30 years. Nor does the theory explain why,
prior to diagnosis, their behavior has appeared normal. Further more, it excludes a
consideration of the environment.
Dysfunctional Families
This explanation suggests that schizophrenia is the result of dysfunctional families. In
contrast to the biological or medical approach which may be regarded as more humane,
attaching no blame to the individual, this model by implication is attaching blame to the
family. BATESON (1956) claimed that parents predispose their children to schizophrenia by
communicating in double binds. Double binds are a no-win situation for the child, e.g. a
parent might complain about a child, lack of affection, but when the child does give
affection, s/he is told that s/he is too old for that. BATESON used the term double bind to
explain these ideas of contradictory messages.
Support for this view comes from the work of BROWN (1966) who examined the
progress of patients with schizophrenia discharged from hospital. BROWN found that those
patients who came from families characterized by high expressed emotion (high conflict,
constant interference) were more likely to return to hospital in a shorter period of time. 58%
of patients returned to high EE families experienced a relapse compared with 10% returning
to low EE families. The implications of this research are that the environment has a
significant role to play in the course of the development of schizophrenia. However, the
direction of causation is unclear, it may be that living with a person with schizophrenia is
causing hostility and high expressed emotion within the family. Alternatively, it may be the
family that is causing the relapse. The effects of stress on the immune system and on the
incidence of disease and illness are well-known. If stress has a role in physical illness, it may
well have a role in mental illness.
Cognitive Deficits
Diathesis-Stress Model
The diathesis-stress model combines biological and genetic factors with levels of
stress. Diathesis refers to a predisposition (innate) and the stress is environmental (nurture).
This model suggests that mental disorders are the result of an interaction between nature and
nurture. Finnish study revealed that none of the adopted children raised in healthy families
developed schizophrenia, but 11% in severely disturbed families went on to do so. The biopsycho-social approach is a more eclectic approach to studying and understanding
schizophrenia.
The idea that schizophrenia is the result of schizophrenogenic families is based on
retrospective studies and may be unhelpful and highly destructive. Today, high expressed
emotion families which are hostile, critical, and over-involved, are seen as maintaining
schizophrenia rather than causing it. However, it should be noted that many patients with
schizophrenia are estranged from their families. It does seem as if there is a role for
attributions of relatives. Weisman (1998) found that relatives who tend to attribute positive
symptoms and delusions to a person mental illness do not hold them accountable. Relatives
attributing negative symptoms tend to become angry and critical. There are higher relapse
rates in families with highly critical attributions
This model suggests that schizophrenia is rooted in our physiology and is treated as a
disease or illness. The model operates at the level of genes, brain structure, brain chemistry,
hormones, and disease/illness. Schizophrenia has a tendency to run in families. First degree
relatives
are
18
times
more
at
risk.
However, family studies are conducted using interview techniques. Interviews are
retrospective involve looking back at the past and our memories are often inaccurate.
Interviews are also subjective based on opinions and interviewees do not have the benefit of
diagnostic criteria. Furthermore, family history studies fail to separate genes and
environment.
This suggests that genes do play a significant role in schizophrenia. However, the
concordance rate is not 100%. There remains the problem that Tienaris study is ongoing and
the critical period for the onset for females has only just been reached. These figures are
likely to be underestimates as the figures fail to include information about the biological
father. Genes do not operate in isolation and are linked to brain chemistry
Brain Chemistry
The evidence for this hypothesis lies in the fact that phenothiazines reduce symptoms
of schizophrenia. They inhibit levels of dopamine activity. L-Dopa is a synthetic dopamine
releasing drug which induces the symptoms of schizophrenia. Also, Parkinsons disease,
shaking of limbs are common side effects associated with the effects of anti-psychotic
medication. Parkinsons disease is associated with low levels of dopamine. Further support
for the dopamine hypothesis comes from studies of amphetamines. These release dopamine
at the central synapses. They worsen the symptoms of schizophrenia.
The relationship between members of the family has a big relationship 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 shed grow up. As to the blaming of others for
problems and maybe a problem with authority figures. In this case, the person may be able to
be withdrawn and may not develop interpersonal or social relationships, she may also
vulnerable to stress as she never know what were the alternatives for the coping of her
problems.
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. Thats 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 father which is very mean and strict to them.
Other factors include the acquisition of influenza virus by the mother during the
second trimester of pregnancy. The virus may create maternal antibodies. In the fetus, there
become auto antibodies which an external source of developmental change. In this case, this
is a great factor in the development of adult schizophrenia. Others include trauma like head
injuries or diseases during childhood and substance abuse.
C. PSYCHOPATHOLOGY
Schizophrenia is a group of psychotic reactions that affect multiple areas of an
individuals 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 clients 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, jealous, persecution and reference), hallucinations (auditory and
visual), hostility, loose associations, disorganized behavior, social withdrawal and restricted
emotions.
D. DRUG STUDY
DIVINE WORD COLLEGE OF BANGUED
BANGUED, ABRA
DRUG STUDY NO.1
GENERIC/
BRAND
NAME
Haloperidol/
Haldol
DOSAGE
5 mg tablet
once a day
CLASSIFICATION
Antipsychotic
INDICATION
Psychotic Disorders
MECHANISM
OF
ACTION
A butyrophenone
that probably
exerts
antipsychotic
effects by
blocking post
synaptic
dopamine
receptors in the
brain.
CONTRAINDICATION
Hypersensitivity
to drug and
those with
Parkinsonism,
coma or CNS
depression
THERAPEUTIC PRECAUTION
EFFECTS
Exerts
antipsychotic
effects to the
client
Use cautiously
in elderly
clients, those
with history of
seizures, CV
disorders and
those using
lithium.
SIDE &
ADVERSE
EFFECT
CNS: severe
extra pyramidal
reactions,
dyskinesia,
seizures,
lethargy
CV:
hypotension,
tachycardia
GI: anorexia,
constipation,
dry mouth
NURSING
IMPLICATION
- Monitor
patient for
tardive
dyskinesia
which may
occur after
prolong use.
- Watch for
signs and
symptoms of
extra
pyramidal
effects
- Tell client to
relieve dry
mouth with
sugarless
candy
EVALUATION
CLASSIFICATION
Antipsychotic
DOSAGE
INDICATION
100 mg capsule
once a day
Psychotic Disorders
MECHANISM
OF
ACTION
A piperidone
phenothiazine
that may block
post synaptic
dopamine
receptors in the
brain.
CONTRAINDICATION
Hypersensitivity
to drug and
those with
Parkinsonism,
coma or CNS
depression
THERAPEUTIC PRECAUTION
EFFECTS
Exerts
antipsychotic
effects to the
client
Use cautiously
in elderly
clients, those
with history of
seizures, CV
disorders and
respiratory
disorders
SIDE &
ADVERSE
EFFECT
CNS: severe
extra
pyramidal
reactions,
dyskinesia,
dizziness,
drowsiness
CV:
tachycardia
GI: nausea
constipation,
dry mouth
NURSING
IMPLICATION
-Monitor
blood pressure
regularly.
- Watch for
orthostatic
hypotension
-Monitor for
tardice
dyskinesia
-Watch for
signs and
symptoms of
neurolyptic
malignant
syndrome
-Advise client
not to chew
extended
release capsule
before
swallowing
EVALUATION
IV.
OBJECTIVES:
ASSESSMENT:
Well groomed with good personal hygiene with good posture and gait
Has good eye contact during interaction, good mood and appropriate affect
Able to recall past experiences and relate to the present situation and reality
Ako po si Roderick
Ancheta, and magiging
student Nurse ninyo.
Tawagin mo naang po
akong Rhod. Galing po
ako Sa Divine Word
College of Bangued.
Simula po sa araw na ito,
July 7, 2009 makakasama
niyo po ako at
makakausap hanggang sa
susunod na Linggo, July
16, 2009. Magsisimula po
tayo ng alas otso ng
umaga hanggang alas tres
ng hapon. Pag-uusapan po
natin ang inyong mga
karanasan at mga dahilan
kung paano po kayo
napunta ditto. Lahat po
ang pag-uusapan natin ay
mananatiling sikreto at
tayo lamang pong dalawa
ang nakakaalam.
Tapos na po akong
magpakilala, pwede po
bang kayo naman po ang
magpakilala?
CLIENT
THERAPEUTIC
RATIONALE
COMMUNICATION
Okay naman ako, Giving recognition
Greeting the
magandang hapon
client indicates
din.
the she is
acknowledge
and recognize as
a person.
Ganun ba?
Giving Information
This gives the
client an
overview what
were the
reasons why
you were there
and make her
aware what are
the boundaries
of the
interaction, the
purposes, the
time and place
and who were to
be involved
Ako si Charito
Laureano, naktira
sa Marikina City.
Providing General
Leads
48 years old na
ako.
Seeking information
It encourages
the client to
continue what
she is saying
and that the
nurse is active
in listening.
Helps the client
facilitate
thoughts,
Matagal na po ba kayo
rito?
Fourteen years na
ako rito pero
yung 6 years,
pabalik-balik ako
at yong walong
taon diretso
hanggang
ngayon.
Maari po ba ninyong
Ipinasok ako ng
ilahad kung ano po ang
tatay ko ditto
dahilan kung pano po
tsaka gusto ko na
kayo napasok ditto?
ding magpahinga
at magrelax.
Ano po sa palagay ninyo
Di ko na maalala.
ang dahilan kung bakit
Basta ipinasaok
kayo ipinasok na tatay
nlang nila ako
niyo rito?
rito.
Ano po ba ang trabaho
Bale tinutulungan
ninyo dati at nasabi po
ko lang yong
ninyong pagod na kayo?
tatay ko sa
pagtitinda?
Ano po ung mga itinitinda Mga pare parts ng
ninyo?
mga sasakyan
Ano pong kurso ang
Business
tinapos ninyo, maari kop o Management ako
bang malaman?
sa University of
the East.
May mga gusto pa po ba
Wala na Rhod.
kayong sabihin sakin?
Seeking Information
Giving Recognition
Sige, maraming
salamat. Paalam
Exploring
feelings and
ideas clearly.
Helps the client
facilitate
thoughts,
feelings and
ideas clearly.
Seeking Information
Seeking Information
Seeking Information
Seeking Information
Offering self
Making oneself
available and
showing interest
and concern to
the client let
them feel more
comfortable and
will develop
further trust.
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
ASSESSMENT:
With good eye contact during interaction and oriented on date, time, place and
identity
CLIENT
THERAPEUTIC
RATIONALE
COMMUNICATION
Magandang
Giving recognition
Greeting the
umaga din Rhod.
client indicates
the she is
acknowledge
and recognize as
a person.
Maaga kasi akong Making observations
To make them
nagising kaya
aware what are
naligo na ako.
their actions and
Masaya ako dahil
what the client
andito ka na
feels.
naman.
Nagpakilala tayo Summarizing
This seeks to
sa isat isa at
bring out the
pinag-usapan
important points
natin kung bakit
of the
ako andito?
discussion and
increase
awareness to the
client
Gusto ko lang
Seeking information
magrelax at
magpahinga
Kumakanta
Seeking information
lamang ako.
Kahit anong
religious song
Gumagaan
pakiramdam ko
dahil di ako
pinababayaan ng
Diyos.
Seeking Information
Encouraging
expression
Encouraging
expression
Encouraging the
client to make
her own
appraisal rather
than to accept
opinions from
others.
Naalala ko kasi
yong mga anak
ko at pamilya ko.
Oo, gusto ko
nang umuwi.
Magpapakabuti
ako ditto at
sinusunod ko
yunmg mga
sinasabi ng mga
nurses at doctor.
Ano naman po ang una
Magsisimba ako
niyong gagawin kapag
para
nakalabas na kayo ditto?
magpasalamat sa
Diyos at
mamamasyal
kaming buong
pamilya
Maari niyo po bang
May tatlo akong
ibahagi sa akin tungkol sa anak, dalawang
inyong pamilya?
lalaki at isang
babae.
Nasaan po sila ngayon?
Nag-aaral sila
Sino po ang nag-aalaga sa Yung tatay at
kanila?
asawa ko.
Ano po ba ang pangalan
Fernando yung
ng asawa at Tatay Ninyo? asawa ko at yung
tatay ko eh
clarito.
Ano po yung trabaho nila? Wla nasa bahay
lang yung asawa
ko, ung tatay ko
naman ay nasa
shop.
Sinabi po ninyo kahapon
Pagod na kasi ako
na gusto niyo ppong
eh, kaya gusto ko
magpahinga at magrelax.
nang
Iyon lang po ba ang
magpahinga.
dahilan?
Sa palagay niyo po ba
Oo, kasi konti
Seeking information
Translating into
feelings
Exploring
Seeking information
Seeking information
Seeking information
Seeking information
Seeking information
Seeking information
Seeking information
Seeking information
This technique
is to verbalize
clients feeling
of what she said
indirectly
Helps them both
the client and
the nurse to
examine the
issue more fully.
makakapgpahinga po
kayo rito kung andito po
kayo?
May gusto pa po ba
kayong ibahagi sa akin?
Sige bukas ulitCharito.
Offering Self
Salamat, Paalam
Giving Recognition
CLIENT
(Client smiled)
Magandang
Umaga din
THERAPEUTIC
COMMUNICATION
Giving recognition
Offering self
Mabuti naman
Seeking information
Katatapos lang at
uminom nari ako
ng gamut.
(Client smiled)
Seeking information
Mga religious
songs. Gusdto mo
kumanta ako.
(Client sung)
Clarifying
Salamat
Giving recognition
Sa simbahan
naming, active
kasi ako doon.
Jehovas Witness
Seeking information
Masaya (Client
become silent)
Seeking information
(Client become
silent)
Silence
RATIONALE
General leads
Clarifies further
knowledge and
understanding
on what is
verbalized
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Seeking information
Making silence
let the client
formulate and
organize ideas
and makes feel
the client that
she is
understood and
with
companion.
May sasabihin pa po ba
kayo sa akin?
Sige po Nanay Charito,
bukas po ulit. Punta na po
tayo dun sa mga
kasamahan natin at may
gagawin po tayong
activity.
Wala na.
Seeking Information
(Client smiled
Giving Recognition
and just followed)
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
CLIENT
Magandang
umaga din
Mabuti naman at
nakakatulog din
Naiisip ko lang
yung mga anak
ko. Parang
nakikita ko sila
kapag andito ka.
THERAPEUTIC
RATIONALE
COMMUNICATION
Giving recognition
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Seeking information
Making Observations
To make them
aware and to
know what
really the client
feels
Habang pinag-uusapan po
natin sila, parang naluluha
po kayo, ano po ang
dahilan?
Ano pa po?
Sige po Nanay Charito,
hanggang sa susunod ulit.
May gagawin po tayo
Si Frederick ay sa
UE, civil
engineering at si
Ruth sa POLA.
Salamat
Giving Recognition
Namimiss ko na
kasi sila at
naaawa ako sa
kanila kasi di ko
sila maalagaan
dahil andito ako
sa Mental
Lalo na ksi yung
bunso, di ko siya
naalagaan at
nagyon malaki na
siya at pasalamat
ako di siya
pinabayaan ng
Diyos.
Opo
Making Observations
Masay, kahit
papano
nakakalimutan ko
yung mga
problema ko at
para rin sa mga
anak ko yun,
inspirasyon ko
kasi sila.
Miss ko na sila,
gusto ko nang
umuwi.
Sige (client
smiled)
Encouraging
expression
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
To make them
aware what are
their actions and
what the client
feels.
Giving recognition
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Encouraging the
client to make
her own
appraisal rather
than to accept
opinions from
others.
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
DAY 4 (July 13, 2009)
NURSE
CLIENT
Magandang
umaga din
Ano po ang
nararamdaman ninyo?
Napansin ko po nung
Makita ninyo yung
larawan, napahawak po
kayo sa inyong dibdib,
ano po yung naalala
ninyo?
Ano po yung mga naalala
ninyo tungkol sa inyong
mga anak?
Iyon lang po ba ang
dahilan?
THERAPEUTIC
RATIONALE
COMMUNICATION
Giving recognition
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Seeking information
Giving recognition
Summarizing.
This seeks to
bring out the
important points
of the
discussion and
increase
awareness to the
client
Clarifying
Clarifies further
knowledge and
understanding
on what is
verbalized
To make them
aware what are
their actions and
what the client
feels.
Making observations
Seeking informations
Seeking information
Wala na.
Seeking information
Sige
Giving recognition.
CLIENT
Magandang
umaga din Rhod.
Mabuti naman.
THERAPEUTIC
RATIONALE
COMMUNICATION
Giving recognition
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Seeking information
Seeking information
Seeking information
Giving recognition
Seeking information
Seeking information
Seeking information.
Exploring
May gusto pa po ba
Wala na.
Offering self
kayong sabihin sa akin?
Sige po, puntahan na natin Sige. Salamat
Giving recognition.
yung mga kasama natin,
(Client smiled
may activity po tayo ulit.
and followed)
TERMINATION PHASE (July 15, 2009)
NURSE
CLIENT
Magandang umaga po
Nanay Charito.
Kumusta po kayo?
Ngayon pong araw na ito,
bale ito nap o yung huli
nating pagsasamat paguusap. May kunti po
tayong programa at
maaasahan kop o ba ang
kooperasyon ninyo?
Mabuti naman
Ganun ba, sige.
Nag-enjoy po ba kayo?
Sige po, hanggang ditto
nalang po an gating paguusap Nanay Charito.
Maraming salamat pos a
inyong kooperasyon at
tiyaga sa pakikinig sa
amin.
THERAPEUTIC
RATIONALE
COMMUNICATION
Giving recognition
Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Seeking information
Giving Information
SUBJECTIVE:
>Gusto ko nang umuwi,
miss ko na mga anak ko.
OBJECTIVE:
>poor eye contact at
times
> grimacing
> hand tremors
> restless
SUBJECTIVE:
>Malungkot ditto kapag
walang student nurse.
OBJECTIVE:
>sadness
> poor eye contact at
times
>absent of significant
others
>isolates self in room
most of the time
NURSING DIAGNOSIS
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.
JUSTIFICATION
Disturbed sensory perception
should be given first priority
for the client may manifest
untoward behavior towards
self and other clients due to
misinterpretation of stimuli
OBJECTIVE:
>talks to self
frequently
> leaves area
suddenly without
explanation
>poor
concentrations
>Has difficulty
maintaining
conversations
BACKGROUND
KNOWLEDGE
The client
experience
disturbed sensory
perception which is
incongruent with
actual stimuli. In
this case, the client
misinterpreted and
acts contrary to
what is real.
PATIENTS
PROBLEM
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.
OBJECTIVE
OF
INTERVENTIONS
After
Nursing
interventions,
the
client
will
demonstrate ability
to hold conversation
without hallucinating
and ceases to talk to
self.
OBJECTIVE:
>poor eye contact
at times
> grimacing
> hand tremors
> restless
BACKGROUND
KNOWLEDGE
Uneasy feeling of
discomfort
accompanied by
autonomic
response. The client
experiences anxiety
for she thought that
shell be discharged
and be
accompanied by her
family.
PATIENTS
PROBLEM
Anxiety related to
prolong
rehabilitation as
evidenced by
grimacing, poor
eye contact at
times, hand
tremors and
restlessness.
OBJECTIVE
OF
INTERVENTIONS
After Nursing
interventions, the
clients leve; of
anxiety will be
lessened.
BACKGROUND
KNOWLEDGE
Aloneness
experienced by the
individual are
perceived as
imposed by others
and as a negative or
threatening state.
PATIENTS
PROBLEM
Social Isolation
related to sadness,
poor eye contact
at times, absent of
significant others
and isolation of
self in room most
of the time.
OBJECTIVE
OF
INTERVENTIONS
After nursing
interventions, the
client will be able to
engage self in all
social activities
actively and
verbalize willingness
to social interactions.
V.
THERAPIES
The third game was also an exercise which we made it as a game, the
lean forward, and lean backward. The song was sung the student nurses
together with the client. Each client will be sitting and follow the action. A client
who will not be able to follow will be out of the game. The song was sung faster
and faster until only one will be left and never committed a mistake, she will be
declared as the winner.
3. 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 expresses his 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
Objectives:
1. To know as a diagnostic tool, collecting signs and symptoms to supply
psychiatric and to give correct diagnosis.
2. To release past trauma in life unconsciously.
3. To interpret psychological drawing
4. To discuss emotional problem and to give reasons and ideas regarding
such problems
5. To develop interpersonal relationship
During this activity, we gave each client one bond paper and a set of
crayons. Then, we played a happy and fast music. We let them draw what they
feel and later they interpreted it. Secondly, with the set of crayons and another
bond paper, we played a sad and slow music and we let them also draw what they
really feel. Since my client has hand tremors, she was not able to finish her
activity until the song had finished, so we played again the song until all of them
were finish doing the activity.
Objectives:
1.
2.
3.
4.
VI.
Severe religiosity can cause a disorder when really obsessed to the religious
affiliation itself.
Schizophrenia can be manageable with the aid of the family as the main
source of strength and hope of the client.
Constant visitation should be done to the client in order for them to feel
valued and cared by the family.
VII.
NARRATIVE REPORT
of them were competitive even the other clients who were very silent and rare to talk.
They were willing to get the prize and declared to be winners. And one more thing was,
when we played the lean forward, we even tend to give up because as we sung the song
and became faster and faster, our three competitors were very good and no one ever to be
a loser, so thats why we declared the three of them to be winners after a very long rally.
It was an overwhelming experience and I was happy again because of what had happened
even were 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.
cutted out the necessary materials needed for our first activity this morning, art therapy.
For this activity, we prepared cut outs for them to form and this would enhance their hand
coordination for their roper manipulation and placement of every cutted parts for the
activity.
Since the rain stopped pouring for a while, we entered our designated area and
interacted with our clients and joined them on their routine activities like the flag
ceremony and their daily exercise and after, we proceeded to the pantry for their activity.
Since it was an art therapy, it was simple and meaningful even we have our companion
school at the pantry, we ended our activity successfully and the output od each client was
a butterfly and a flower. As a summary and generalization of what they have done, we
asked them their interpretation of the activity and what they felt while doing the activity.
They shared their ideas and expressed their feelings. I had the chance also to interact with
my client and followed up our activity and she told me that it was her first time to do that
activity and cited that she was happy because she had her name and the corresponding
student nurse in the activity and she misses to see butterflies especially during her
childhood years. I learned that doing this kind of activity, we were given the chance to
explore more about our clients and give them the chance to recall their happy moments in
life.