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TABLE OF CONTENTS

I. Activites and Therapies conducted


a. Orientation Program
Pagtirirpon .3

b. Watchers Class .8

c. Occupational Therapy ..11

d. Music Therapy.15

e. Culminating Activity
Kasadyahan 20

f. Medications Given.26

g. ABC Charting30
II. Grand Case
a. Behavioral Analysis..32
b. Contribution and Expenditures77
c. Other supporting documents and files79

III. Insights and Reflections..81

1
ACTIVITIES
AND
THERAPIES
CONDUCTED

2
ORIENTATION PROGRAM
I. Title of Activity

PAGTIRIRIPON: An Orientation Program

II. Date Conducted:


March 6, 2017

III. Objectives:

Sa sulod sang isa ka oras,


a. Makakilalahay kag makatukod sang propesyunal nga relasyon
kami nga mga student nurses sa mga pasyente, bantay kg personnel sang
PMHU.
b. Mapahibalo namon sa mga pasyente, kag ila bantay ang mga
aktibidadeskag mga buluhaton nga amon pagahiwatonsa sulod sang duwa
ka semana.
c. Mapatigayon nga mangin mabinungahon ang ini nga pagtiriripon.

IV. Planning and Preparations


Few days prior to the activity, committee assignment where identified, each
member chose a duty of their interest, several groups have been formed that are
tasked to facilitate on, namely; food, program, technical, backdrop, flyers,
community song and intermission numbers. It was never easy for us at the start for
we are all new in doing this, we all know that the psychiatric ward is far different
from other area of RLE rotation but because of our open-communication we were
able to coordinate well and conducted our orientation program smoothly.

3
Night meeting and practice
for our intermission

Backdrop making of the team!

V. Output

You are invited! Ta tipon ta!

Everybodys fruit of labor!

4
Community Song
Subong ari kami tanan
Magpakilala sa inyo
Ang tuyo namon makilala kamo
Dali na!
Mag irmaway kita
Indi pagkakulbaan
Magkilalahanay kita subong2x

Chorus: Dali na kag mag intra sa amon nga


programa
Magsugilabon kita kag mag sinadya
Indi mag duwa duea
All are registered! Hooray! Magtilipon 'ta
Kilalahanon ta gid ang isa kag isa
Dali, dali, dali na
Karo kamo, ulupod kita
Dali, dali, dali na
Lyrics by: Sonnylyn Elauria BSN 3C

Opening Remarks
Sa mga pasyente, watchers, nurses kag staff sang ini nga institusyon,
maayong hapon sa tanan. Ako si Eugene G. Omilig level 3 student nurse sang West
Visayas State University College of Nursing. Kaupod akun mga groupmates kag
clinical instructors. Kami magakadto diri kag magahiwat sang mga activities sa sulod
sang duwa ka semana.
Sa sini nga adlaw kita magkilalahay kag mag-ululupod paagi sa atin
acquintance program nga naga titulo Pagtiriripon sa mga mga sunod naman nga
adlaw, magahiwat naman kita sang music therapy, occupational therapy, kag
magahatag sang bulong. Sa march 15, miyerkules nga adlaw ang katapusan namun
nga pagbalik, magahiwat naman kami sang culminating activity.
Amon guid gina encourage nga mag cooperar kamo kag mag partisipar kamo
kay tanan nga ini gin preparar guid para sa inyo.
By: Eugene G. Omilig BSN 3D

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Closing Remarks
In behalf sang third year section c and d sang WVSU, kami
nagapasalamat sa tanan nga pasyente, bantay kag staff nurses. Paagi sini nga
pagtiriripon kita magkilalahanay Kag ini mangin sugod sang mabinungahun nga
nurse patient relationship. Pag tapos sini nga pagtiriripon, maga distribute kami
sang snacks tanda sang amun nga pasasalamat sa inyo.
Sa masunod nga isa ka oras may mga student nurses nga maga sugilanon
sa iban ninyo nga pasyente tani sila inyo iga abi abi. Sa liwat madamo gd nga
salamat kag maayong hapon sa tanan.
By: Khryss Paula Baldonado BSN 3C

VI. Insights and Reflections


Pagtiriripon was our first activity at the Pototan Mental Health Unit. This serves as
our orientation and introduction of ourselves to the patients, watchers, and staff. This
also implies in reverse with them. As one of the facilitator of this activity, I told myself
that it should be a powerful foundation. Introduction for me is an important thing
wherein one could make herself known to that person. Powerful foundation for a
therapeutic nurse-client relationship. Even though I have in my mind that I should make
it a great impact, I am still in doubt I could but good, I have my partner who made me
more confident. She helped me have that energy and at the end of the orientation we
made it a success in facilitating. One thing I have learned with our first activity,
teamwork. Without the effort of each and every one in our group, it wont happen the
way it is and it will never be a glory for us. -Vhlessy Ree Janan Poras / BSN 3C

Speaking in a crowd and having the control of it through your words is not easy,
especially if you dont know how they would react about it. Being one of the masters of
ceremony on our orientation day at Pototan Mental Health Unit (PMHU) last March 6,
2017 gave me the opportunity to know how able I am to stand in front of people,
mentally ill people to be specific, and how to handle the situation. Unfortunately,

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anxiety took its place in my system first and I was not able to adapt to it readily and it
reflected my performance that day. I was conscious as to what I say or act that might
be insignificant or non-therapeutic. However, seeing that the patients in the said
institution were very participative, cooperative, and manageable, it somehow lessened
my anxiety. Thus, it takes confidence, courage, self-control, and a lot of common sense
and good judgment as to be a person standing in front, speaking and interacting with
people. It is not an easy job, yes. But it will be surely worth it after everything falls on
its own places. Christine Joy Quilla / BSN 3D

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Watchers class
I. Title of Activity

HIBALUON TA

II. Date Conducted:


March 7, 2017
III. Objectives:
a. Ma-explikar kag madiscuss kung ano ang naglain-lain nga mga
sintomas nga maobserbahan sa pasyente.
b. Mapa-athag sa mga bantay ang importansya sang mga bulong para din
na ma-experyensyahan sang pasyente ang mga sintomas
c. Isa-isahon ang management sang mga sintomas
IV. Planning and Preparations

The student nurses first think of the possible signs and symptoms to
be discussed. After having four symptoms, such as violence, hallucination,
delusion, and depression they then appointed specific student that will
explain the said signs and symptoms. A powerpoint presentation was made to
have a picture projected for the watchers.
Before the proper presentation at the PMHU, a dry run was done along
with their RLE preceptors.

Kaagi bala nagingbayolente ang inyo pasyente?

8
V. Output

Tarp ready.

Student nurse discussing

RLE preceptor explaining thoroughly the


importance of compliance to the drugs.

9
VI. Insights and Reflection
We had our watcher's class on our 2nd week. And I was tasked to discuss
violence, the types and what to do when their patients will manifest it. It feels good
to be able to share what you have learned to others especially to the watchers of
the patients. Speaking in front of them is inspiring knowing that they are all
interested. Though at start there are some who are shy and hesitant. I felt
conscious because all eyes are on me. My voice is shaking obviously. But i was able
to finish my discussion. The overall activity went well.

I also had fun especially with the bloopers when the activity was about to
end. Im happy that I've been able to somehow help them know what to do in case
their patients would behave unusually. Im thankful for having the chance to speak
in front because it made me realize the things I need to develop and improve.
Ma. Hearty C. Sernicula / BSN 3D

I was assigned to be the Emcee during our watchers class at Pototan


Mental Health Unit. It was definitely a unique experience for me. Speaking in
front of many people makes me anxious. It makes me out of my comfort zone.
Also, I was really nervous because I might say something wrong or
inappropriate. During the Program, I was really happy about the topic we chose
because we are very sure that the watchers can relate to our chosen topic.

I was also happy that some of them are sharing their experiences with
regards to that symptoms manifested by their patient. Although some would cry
while they are sharing, but at least we were able to answer their questions to the
best we can and also with the help of our Clinical Instructors. And finally, I was
able to overcome my stage-fright and somehow I gained some self-confidence
through this activity. Gail Krizelle Mediodia / BSN 3D

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OCCUPATIONAL
THERAPY
I. Title of Activity

Frame of Life

II. Date Conducted:


March 13, 2017

III. Objectives:
a. Mabuligan ang mga pasyente nga mapakita kag ma improve ang ila
mga talento kag kumpyansa sa kaugalingon paagi sa pag ubra sang produkto
nga maka bulig gd sa ila.
b. Pauswagon ang pisikal kag sosyal nga buluhaton sang mga
pasyente.
c. Patigayunon ang kinaugalingon kag propesyonal mga

IV. Planning and Preparations


Day before the therapy, student nurses have prepared rolled old
magazines that will be use as a boarder for the frame. They went to the
central market to buy needed materials like colored native flowers and
buttons. For the chip boards they went to
a school supplies store.

11
Cutting out of letters done.

V. O
uRoll that paper. Roll it! Roll it!
t
put

Frame of life. Paste yourstory.

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Smile! Cameras focusing!

Materials Used

DOUBLE-SIDED TAPE
YARN ROLLED MAGAZINE

GLUE
CHIP BOARD
BUTTONS

FLOWERS

Procedure
Step 1: Ihigot ang yarn sa duwa ka buho sa clip board. Ini amu ang gamiton
para makabit sa dingding.
Step 2: Irolyo ang mga magazine nga gin-utod utod.

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Step 3: Angmga ginrolyo nga magazine, itapik sa kilid sang chip board. Pwede
pahigda ukon pabatang.
Step 4: Butangan sang dekorasyon ang frame gamit ang bulak kag butones. Pwd
mn iban nga dekorasyon, depende sa kung ano ang inyo gusto nga style.

VI. Insights and Reflection

Being one of the facilitators in Occupational Therapy made me feel


anxious, happy and satisfied at the same time. Anxious because I have a really
complicated relationship to public speaking. The mere fact that I will be talking in
front of many people make me want to throw up. Literally. Especially when Im
talking to a group of people whose minds are unusual and extraordinary.
During the program, Im scared that I might not be therapeutic with them
and might made an error because as what I have observed, they are so active
and always listen to what you say. They might laugh at your mistakes especially
those patients who are diagnosed with bipolar disorder. But as the program
flows by, I already found myself already comfortable talking in front which was a
good thing for me. All in all I had fun in this activity because we helped them in
a way that they forget whats going on through their mind for a while and
concentrate in doing the activity. We also taught them on how to earn money
using the frame that we made for them. They can use this for business or hobby.
And watching their finish product gave a smile to my face. Indeed they can
really be creative. Im so happy and satisfied because I had overcome my fear in
talking in front of the crowd. This experience was a great help and a good start
for me to enhance more of my skills and confidence about myself in talking in
front of others. They have expressed their deepest gratitude to us and we can
see that they really enjoyed the activity we have conducted. I can say that this
was one of the best experience because it doesnt only mold me as an effective
facilitator but also a productive individual. Denis Marie P. De Asis / BSN 3C

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When I was teaching the patients during our occupational therapy, I felt
anxious at first. But I prepared myself for this day and allowed to give enough
patience for them to follow the activity. But it seems that they were more excited
than I expected and some are even pasting and decorating already.
And my communication came through naturally. Some even say I didnt
even look scared.And I even enjoyed working with them in making the picture
frame, all my fear and anxiety I spent on concentrating on making and catching
up to the patients.
And in the end, a lot made beautiful works and everyone enjoyed, so did
I. Beatriz Dela Pena/ BSN 3D

MUSIC THERAPY
I. Title of the Activity:

MUSIC THERAPY

II. Date Conducted:

March 14, 2017

III. Objectives:
a. Makatudlo sa mga pasyente sang isa ka kanta nga kung sa diin sila
maka- reflect kag makapabutyag kung ano ang ila nabatyag.
b. Makarelaks ang mga pasyente paagi sa gintudlo nga kanta.
c. Mahatagan inspirasyon ang mga pasyente.
IV. Planning and Preparation:

The members to head the therapy were Ms. Rizzi Fern Grace A. Nuyad, Ms.
Sonnyleen Elauria and Mr. Henry Gomez.
A day before the activity, we held a conference at the students quarter
regarding the upcoming activity. We had planned that Ms. Elauria and Ms. Nuyad
will be the facilitators, and Mr. Gomez and Ms. Elauria will be the singers. We had
chosen Today my Life Begins by Bruno Mars to be the inspiring song which we
taught to our patients.

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March 14, 2017, before going to the Pototan Mental Health Unit, we had our
dry run together with our RLE preceptors where we practiced the song entitled
today my life begins along with our dance energizer.

V. Output

Backdrop for the music therapy

SNs preparing the area for the activity

"Today My Life Begins"


By: Bruno Mars

I've been working hard so long


Seems like pain has been my only friend
My fragile heart's been done so wrong
I wondered if I'd ever heal again

Oh just like all the seasons never stay the same


All around me I can feel a change (oh)

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I will break these chains that bind me, happiness will find me
Leave the past behind me, today my life begins
A whole new world is waiting its mine for the taking
I know I can make it today my life begins

Yesterday has come and gone


And I've learn how to leave it where it is
And I see that I was wrong
For ever doubting I could win

Oh just like all the seasons never stay the same


All around me I can feel a change (oh)

I will break these chains that bind me happiness will find me


Leave that past behind me today my life begins
A whole new world is waiting its mine for the taking
I know I can make it today my life begins

Life's too short to have regrets


So I'm learning now to leave it in the past and try to forget
Only have one life to live
So you better make the best of it

I will break these chains that bind me happiness will find me


Leave the past behind me today my life begins
A whole new world is waiting its mine for the taking
I know I can make it today my life begins

I will break these chains that bind me happiness will find me


Leave the past behind me today my life begins
A whole new world is waiting its mine for the taking
I know I can make it today my life begins

VI. Insights and Reflections

As one of the facilitators, I was anxious at first because the patients were
observing our every actions intently. My heart is beating loudly inside my chest
as the program started. As first, I was a bit shy in talking but as soon as I saw
them cooperating it was slowly fading. When the song started playing, I can see

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enthusiasm in their eyes and they were very willing to participate and sing with
us. During the sharing, almost everyone shared what they feel when the sang
the song, most of them feel inspired and happy. When they were asked to whom
they will sing the song for, most of them answered to their family. Throughout
the therapy, I observed that were able to express their feeling through the song
we had played. Rizzi Fern Grace Nuyad / BSN 3C

And those who were seen dancing were thought to be insane by


those who could not hear the music. A saying from Friedrich Nietzsche.
Truly, Music speaks what cannot be expressed, soothes the mind and
gives it a rest, heals the heart and makes it a whole. Feels like an angel is
talking that flows from heaven to the soul.

I led a music therapy in our exposure at Pototan Mental Health Unit


together with Ms. Rizzi Fern Grace A. Nuyad. It went great! Everyone was
really clicking with the music, singing and dancing along and they all
seemed to be enjoying despite some Facilitator mistake. When I was
asked to be a facilitator in music therapy, I hesitated at first because I
dont like speaking in front of many people I can feel every eye is looking
at me when I talk in front. So, I reasoned out that I dont want to. Our
activity could fail if I breakdown and that Im not good at speaking. Yes,
Im very talkative but its different when youre facilitating an activity
especially with patients having mental disorders because i could say or do
something that could trigger their illness. But then, I saw the frustration in
my group mates eyes that leads me in agreeing to facilitate the music
therapy but only do it with Ms. Nuyad. Fortunately, convincing Ms. Nuyad
to be my partner was easy.

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Fast forward to actually holding our Music therapy, I had to come
early that day because I was so hype and I really want it to finish it
already because I was so nervous. Maam Lao checked our script and
suggested some lines to make it better. And so I endorsed the
suggestions to my partner. On the road going there I literally prayed that
it would go flawlessly that God my guide us to have a successful therapy.
Entering the Pototan Mental Health Unit while the microphones and the
laptop, my stomach sank. I became so nervous that I nearly cried but
then I remembered the times that I would humiliate myself talking in front
and I dont want it to happen again now that Im a college student, that
once in our life we have to talk in front of everyone else.

The activity started I really sweated a lot. It literally takes me 10


seconds to actually say something in the mic. Ms. Porras was really
pushing me to start saying the announcement that our activitys going to
start but I couldnt say a thing. So Ms. Nuyad just did it.

Focusing on my script, praying harder. I put the mic near in my


mouth and then the activity started. Teaching patients with mental
Disorder was really something not what I expected especially when
theyre called at the front and say their insights. WOW I thought. Some
patients said that theyre happy learning the song of Bruno Mars Today
My Life Begins. Some would dedicate it to their parents, some would like
some of the lines in the lyrics. I even discovered that one parent cried
after hearing his son that he would dedicate it to him. You can never
measure a parents love to his child. The activity went well that I wasnt
expected. The diaphoresis, irregular heartbeat, GI upset, and
lightheadness were all worth it!

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Everything was all worth it! Sonnyleen Elauria / BSN 3C

Culminating activity
I. Title of Activity

KASADYAHAN: A Culminating Activity

II. Date Conducted:


March 15, 2017
III. Objectives:
Pagkatapos sang isa ka oras nga culminating program, ginalauman
nga:
a. Mapasalamatan ang mga personnel, mga watchers, kag ilabi nagid ang
mga pasyente sa ila mainit nga pag abi-abi kag pagpartisipar sa tanan nga
mga aktibidades nga ginhiwat
b. Makapreparar sa pagatakop sang koneksyon sang kada student nars
kag ila mga pasyente
c. Makahatag sang oportunidad sa mga student nars kag mga clinical
instructors nga mahibaluan ang kauswagan sang mga aktibidades nga ila
ginhiwat
IV. Planning and Preparations

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Students were divided into several groups and were given specific
tasks, but prior to the activity they analyzed and understood the objectives of
the activity. They identified suitable tokens to be distributed, games,
intermission number and food. Some students were also given the task to
give a short message.

V. Output

ONE TEAM

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PRIZES

TOKENS

Wow! Many registered patient! Join us!


Sadya na ta.

Community Song
MAGSINADYA
Magsinadya kita subong, tindog na ulupod kita
Magkiay-kiay wala too,
Dungan kita, wala too
Sa lahat salamat gid
Sa kooperasyon kag pagwelcome nyo,

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Malipayon kami tanan,
Kay kami nakabulig man
Iwagayway na ang kamot ta,
Umpisa dalum, pakilid,tunga, shake shake
Dalum, kilid, tunga, shake shake
Handa na para magsinadya,ahaa
Magsinadya kita tindog na, ulupod ta
Magkiay-kiay halin too pawala
Libot gamay, ipalakpak ang kamay
Kita magtilipon kag magsaot, tara na!!
Magsinadya kita tindog na, ulupod ta
Magkiay-kiay halin too pawala
Libot gamay, ipalakpak ang kamay
Ating kamay iwagayway,iwagayway ating kamay.
Opening
Sa tanan nga staffs and personnel sang PMHU, ilabi na guid kay Mam
Andrea Posa, mga watchers, kag mga pasyente. Maayong hapon sa inyo tanan.
Ako Angelie Villegas, isa ka student nurse sang WVSU-CON kag ari ako para mag
welcome sa inyo tanan sa atun pinaka ulihi nga aktibidad, ang culminating
activity nga ginatituluhan "Kasadyahan". Kabay nga masadyahan guid kita sa ini
nga aktibidad tungod may ara kita pagkanta-kanta, games, kag pag hambal sang
atun mga nahibal-an sa bilog nga tatlo ka semana. Madamo gid nga salamat sa
inyo pagkari diri kag sa liwat, welcome sa atun culminating activity.
Norbeth Angelie Villegas / BSN 3D
Closing remarks
In behalf of BSN 3C and #d hrou 4 of West Visayas State University, we
are thanking all of the patient, watchers and staff nurses for your participation in
our program.
In our 2 weeks of visit here in Pototan Mental Health Unit, we learned a
lot and understood a lot from you. After this culminating activity, we will
distribute snacks that will serve as our thank you for your cooperation. In the
next hour, there will be students who will interact with the other patients. We
are informing you that this will be our last visit here in Pototan Meantal Health
Unit but there will still be another group from the otehr section who will come
here and visit you.

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Again, thank you and good afternoon to all.
Marvic Joy Kaw / BSN 3C

Acknowledgement
Kami nga RLE Group 4 sang BSN 3C kag 3D gapasalamat gid sa tanan nga
nagbulig nga mangin mabinungahon ang aton programa.
Sa staff sang Pototan Mental Health Unit nga ginapangunahan ni Ma'am Andrea
Posa, sa mga clinical instructors, sa mga watchers, labi na gid sa mga pasyente
MADAMO GID NGA SALAMAT!

Reflection:
Student Nurse
Mayong Hapon sa tanan, ako si Kimberly S. Mandilag. Sa amon duwa ka
semana nga pagbalik-balik diri sa PMHU nahatagan kami opportunidad nga
makasugilanon kag makahibalo sang kabuhininyo, sa amon mga nahibaloan mas
naintsindihan namon kamo. Kami na gapasalamat sa paghatag niyo sang salig
kag nagging parte kami sainyo pagtinir diri. Honestly amoni nga rotation ang
amon nahulat-hulat gid, sa tanan na pulaw, pangabudlay kag challenges na
amon naeksperyensyahan, gakadula ina kung Makita namon kamo na
gakaoperar kag nalipay sa amon mga gin preparer na mga aktibidades. Tungod
sini nga rotation kami nangin mas epektibo nga student nurse kag mas mangin
epektibo nga registered nurse sa ulihi. Sa tanan nga staff, watchers kag labi sa
tanan ang aton mga pasyente halin sa amon tanan nga student nurses madamo
gid nga salamat. Kimberly Mandilag BSN 3C

Patient
Magandang umaga sa lahat! Ako pala si R. Nagpapasalamat ako sa lahat,
sa mga personnel, nurses at mga estudyante dahil tinutulungan ninyo kami.
Nasisiyahan ako kasi nandyan kayo palagi para sa aming lahat. Marami din
akong natutunan at hindi naging boring yung buhay ko dito. Hindi ko
makakalimutan kung paano niyo kami tinulungan kasi naging parte na din kayo

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sa araw-araw naming pamumuhay. At masaya ako kasi nakikita ko talaga na
nagbago ako. Sa uulitin, maraming salamat po talaga sa inyong lahat!
R.B.

Watcher
Mayong hapon sa tanan. Gapasalamat guid kami hindi lang sa mga staff
pero tungod man sa mga studyante. Kay tungod nga ari kamo dih, nakabulig
guid kamo samon indi lg samon mga patiente samon man. So, nagapasalamat
kami liwat kag biskan papano nag sadya man ag urupdnanay naton noh. So sa
liwat, madamo guid nga salamat. A.B.

VI. Insights and Reflection


Being one of the facilitators of the program was great. I am very comfortable
with my partner, Henry. Honestly, I did feel nervous at first because of the thought
that I may not be a good one. But, as the program went on, I became more
confident and I realized that the nervousness wasnt there anymore. I was able to
enjoy my responsibilities as a facilitator and it was amazing! Seeing them smiling
and cooperating made my heart flutter. Little things made me happy.
My favorite part was the games. I saw how they enjoyed it and I saw how
they cooperate with each other. For me, the patients that time werent acting like
patients, they were acting like how normal people do and that makes me happy. It
was really satistifying to see them that way.
The experience made my self-esteem boost up a little bit. It made me realize
that theres really nothing wrong in trying. Sometimes, you do have to exceed to the
limits because life will keep on pushing you. Gay Malhi Catedral / BSN 3C
As an emcee and a host during our Culminating program is both an exciting
and a tensile work. We do not just read on our flash cards or recite the words on
the screen but what we do is communicate to the patients. Not just communicate
by words but, also by feelings, emotions and thoughts. If words are not enough
then our presence is an importance for them, to our patients. In our program, our
existence made their mood lighten made their faces contract while smiling and
made their eyes sparkle with both determination and joy. Those moments when you

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see them listen to you, cooperate in the activities, raise their own thoughts, and
most especially they are there in front of you is both an honor and a responsibility.
Not just to us student nurses, CIs and Staffs, but also to their families and friends.
We took pride in our work and passion to our service where we are selfless to others
who are in need. Without these patients, we are nothing.
Henry Maurice Gomez /BSN 3C

Medications given
LIST OF MEDICATIONS
Antipsychotics
- class of medication primarily used to manage psychosis
Typical
- sometimes referred to as first generation
antipsychotics, conventional antipsychotics, classical
neuroleptics, traditional antipsychotics, or major tranquilizers
are a class of antipsychotic drugs first developed in the
1950s and used to treat psychosis (in particular,
schizophrenia)

CHLORPROMAZINE

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HALOPERIDOL

Atypical Antipsychotics
-also known as second generation antipsychotics (SGAs)) are a group
of antipsychotic drugs, antipsychotic drugs in general are also known as major
tranquilizers and neuroleptics
OLANZAPINE

CLOZAPINE

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RISPERIDONE

Anticonvulsant/Anti epileptic
- used to prevent or reduce the severity of epileptic fits or other convulsions
OXCARBAZEPINE

LAMOTRIGINE

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Antiparkinsonian Agent
- a substance that blocks the neurotransmitter acetylcholine in
the central and the peripheral nervous system.

BIPERIDINE

Antigout
- work to either correct overproduction or under excretion of
uric acid.

COLCHICINE

Biguanides
- lowers blood sugar by causing the pancreas to produce
insulin

METFORMIN HYDROCHLORIDE

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Abc charting
Patient #1

2 PM
Clad in clean clothes appropriate for weather
long hair neatly tied in a bun
fingernails trimmed and clean
affect appropriate to thought content
behaved and manageable
appears fidgety
tremors noted
rigid gait noted while walking
cooperative to procedure
able to manage activities of daily living with minimum assistance
responsive to inquiries in a spontaneous manner
talks in normal audible voice with coherence and gives relevant answers
oriented to time, place, person
7pm Endorsed to NOD

30
Patient #2

2pm

Received awake and lying on bed


Clad in clean clothes
Fairly kempt in grooming
Unshaven facial hair and untrimmed fingernails and toenails
Good eye contact
Posture is slightly slumped
Behaved and manageable
Verbally responsive to inquiries with relevant answers
Talks in a normal audible voice with coherence
Oriented to time, place, person
7pm Endorsed to NOD

Patient #3
2pm Received sitting in one of the Kubos
Clad in clean clothes
Fairly kempt in grooming
Fingernails are trimmed
Good eye contact
Does not associate with his co-patients
Behaved and manageable
Verbally responsive to inquiries with relevant answers
Oriented to time, place, person
7pm Endorsed to NOD

Patient #4
2pm > Clad in clean clothes
>Fairly kempt in grooming
>With short hair and neatly combed
>Fingernails are short and clean
>Good eye contact noted
>Posture is slumped

31
>Affect appropriate to thought
>Does not mingle with co-patients inside the ward
>Behaved and manageable
>Noted to engage himself in deep thoughts sometimes
>Seen mumbling to self
>Prefers to stay in bed or in one corner
>Able to manage activities of daily living without assistance
>Responsive to inquiries in a spontaneous manner
>Talks in a normal audible voice with coherence
>Speech is soft and in an appropriate tone
>Oriented to time, place, person
>with good immediate, remote, recent recall
>Looseness of association noted
>Flight of ideas noted
>Blood pressure of 140/100 mmHg and referred to Nurse on Duty
7pm >Endorsed to NOD

32
BEHAVIORAL
ANALYSIS

PSYCHIATRIC NURSING
RLE Group 4-BSN 3C and 3D
presents

Past Burned 33
Into Ashes

A PSYCHIATRIC NURSING CASE PRESENTATION


ON BIPOLAR MANIC

Clinical Instructors:
PROF. RUDINIA J. DAYOT, RN, MAN
MARY EIRENE O. LAO, RN

GENERAL OBJECTIVE
At the end of the case presentation the students must have delivered and
discussed a well-organized and systematic presentation from pertinent data gathered
upon assessing E.B.B. with a diagnosis of Bipolar Manic by utilizing the Behavioral
Analysis.

34
SPECIFIC OBJECTIVES

At the end of the case presentation, the students must have:


1. Presented thoroughly the psychiatric nursing history of E.B.B. including the general
data, chief complaint, history of present illness, past history, family history, past
personal history and relevant family history;
2. Determined the past and the present factors that contributed to the current condition
of E.B.B;
3. Identified deviations from the Mental Status Examination and their significance;
4. Presented the progression of E.B.B.s condition from childhood to present;
5. Comprehensively discussed Bipolar Manic based on textbook;
6. Enumerated the various signs and symptoms manifested by E.B.B that were
identified during assessment and interview;
7. Listed and prioritized nursing problems that were identified;
8. Elaborated the different nursing, medical and pharmacologic management;
9. Evaluated the effectiveness of interventions given to E.B.B.; and,
10. Listed and presented the recommendations and discharge plans provided to E.B.B

Psychiatric Nursing History

a. General Data
1. Name: E.B.B.
2. Age: 19 years old
3. Civil status: Single
4. Nationality: Filipino

35
5. Occupation: Unemployed
6. Address: Brgy. Sangcate, Sta. Barbara, Iloilo

b.Chief Complaint:
kay gin sunog ko amon balay, as verbalized by the client
kay daw indi dugid tana mabatas. Tapos gin sunog napa ang balay kag
namahug pa nga patyon na kami, as verbalized by the patients mother.

c. History of Present Illness


1. Onset, duration, or change of symptoms over time

2012 ( Around May, 3 days after fiesta), patient left and came back
in the afternoon, when asked where he went he verbalized naglagaw
lang ko sa Iloilo City. According to his sibling he was seemed confused
that time and daw wala sa kaugalingon.

2013 (About end of the year), patient had a sudden, intolerable, and
pounding headache, with a pain level of 9/10 in a scale of 10 being the
highest and 1 being the lowest. He was brought to a manug hilot by his
older brother but it did not offered relief. Furthermore, his sister also
noticed some personality changes to the patient such as daw waay sa
kaugalingon niya permi. No consultation was done.

2014 (middle of the year), patient went missing for 3 days. He was
found in jail after announced by the family in the radio. When he was
asked, insa giya timo kalab ot, nag ano timo di? the patient answered,
waay man ko kamaan, may gahutik kanakun nga mapanaw nga
mapanaw. The patient also manifested flight of ideas and looseness of
association, so it prompted his family to bring to Western Visayas Medical
Center (WVMC). Upon arrival, he was restrainted because he did not want
to go there and he kept on claiming that indi ako buang. He was
admitted for two weeks and after was scheduled for check-ups which he
was compliant about. He undergone several diagnostic procedures such as
Electro Cardio Gram (ECG), Complete Blood Count (CBC), Chest X-ray to
confirm his illness but it revealed normal findings. He was prescribed with

36
Risperidone 2x a day and Valproic Acid three times a day as maintenance.
However, his family noticed that everytime he takes the medication, he
experiences weakness and claimes to feel nga daw robot.

2015 (January to June for six months), patient complained of


recurrent headache. He was also noncompliant to medications and check-
up and complains of indi ko magtumar kay ga robot ako, as verbalized.

November 2015 to May 2016, patient had auditory hallucination of


ubra ka malain, ubra ka malain and visual hallucination of a long haired
black lady in his house as claimed by his mother. He was also still
noncompliant to his medications because of the said reason above.

July 2016, patient was involved in a drug operation TokHang that


threatened him to be imprisoned if he continues to use drugs. However, it
did not stop him in consuming more.

December 23, 2016, patient became violent and breaks their plates
and other kitchen utensils because he thought that his siblings have no
plan in celebrating his birthday for the next day. His mother was so
nervous of him and ran to seek help. Patient went to his father and asks
for 100 pesos. His father gave him money which the patient used to buy
one pack of Marlboro green and Mountain Dew. A little later, he went back
to their house and the thought of burning it came to his mind, and so he
did. His mother rushed to their house upon knowing what happened and
sought help. However, when she went back, it was too late; the house
was already burned to ashes.
The next day, patient went to Jaro plaza and then called his father
and told him, Pa ginsunog ko ang balay. Without knowing, his older
sister was already monitoring him and by the time he told his father
where he was, the police was already surrounding him. He was captured
and was brought to Jaro Police station. According to the patient, he
pretended to have a mental illness and became violent inside the prison to
escape imprisonment and so he was just referred to Pototan Mental
Health Unit (PMHU), thus this admission.

37
2. Stressful events, especially losses
Somehow, seeing his siblings and mother being physically and
verbally abused by his father caused trauma to the patient. In addition,
when the patients parents separated, he started to manifest unusual
behaviors. Since the patient was very close to his father, his parents
separation greatly affects him.

3. Patient perception of any change in himself or the perception of change in the


patient by another individual

Kay daw ka hyper kanakun permi kag nanamian lang gid ko


maglagaw biskan waay rason, as verbalized by the patient.
Nakit-an lang namun siya nga nagsakay sa jeep. Wala kami kabalo
kung diin siya makadto. Tapos nadula siya tatlo ka-adlaw may nagsugid
nga ato to siya sa Cabatuan. Ti gin sugat man to siya namun kag gin
pamangkot kung nag ano siya ato, wala man siya kuno kabalo. Umpisa
lang man dan kang nag third year highschool siya nga daw indi na siya
mapuslan. Gab-e lang gauli kag permi lang ga inom kag gapanigarilyo
imaw ang barakada na, as verbalized by his mother.

4. Previous psychiatric illness or treatment


a. Medications
Valproic Acid 250mg/cap, 1 cap TID duration of intake unrecalled
Respiridone 1tab twice a day duration of intake unrecalled
b. Hospitalizations
Patient was hospitalized once at WVMC because of personality
changes
c. Other therapy
Patient claimed that he had undergone Detox at Western Visayas
Medical Center for four times already of which dates are unrecalled.
d. Responses to treatment
The treatments were effective as claimed by the patients mother for
he became manageable after some dosage. However, the patient
chose not to take medications that have a side effect of him being
robotic in behaviors. He also went back to his vices which are
smoking and drinking, thus aggravating his symptoms.

38
5. Legal issues with current illness
Patient was involved in a drug operation TokHang last July 2016
that threatened him to be imprisoned if he continues to use drugs. Five
months later, he burnt down their house because he was under the
influence of Marijuana and Shabu that time. He was brought to Jaro Police
Station and was supposedly to be imprisoned but since he has a mental
illness, he was referred to Pototan Mental Health Unit.
6. Secondary gain (Monetary compensation, relief from responsibilities at home,
school or work)
According to the patient, he pretended to have a mental illness and
became violent inside the prison to escape imprisonment.

d.Past History

While patients mother was still pregnant, patients mother claimed


that she had verbal argument and fights with his husband because of his
womanizer attitude. Growing up, E.B.B. witnessed how his father lands a
hand on his mother and siblings which leaves a trauma in his memory.
Patient also claimed that ako pa gina sugo ni papa nga madul ong sang
pagkaun sa iya kirida sang una, as verbalized. He sought relief by being
with his friend but he was led in to wrong direction. He was influenced to
use illegal drugs and to consume excessive amount of alcoholic beverages
and cigarette smoking which also triggered his illness.

e. Family History

(+) first cousin paternal side; Undiagnosed Bipolar Disorder

i. Undergone psychiatric hospitalization or any other mental health


treatment?
None as claimed by the patients mother
ii. Attempted suicide?
None as claimed by the patients mother
iii. Problems with alcohol?

39
Patients father was an alcoholic drinker who would often drinks
everyday and could consume 2 lapad junior per session.
iv. Other psychiatric problems?
None as claimed

f.Past Personal History

1. Developmental milestones
a. Patients early development (mothers pregnancy and delivery and
information from patient, family members, or hospital records)

E.B.B was a planned pregnancy according to his mother. She was


also able to follow-up her prenatal check-ups and followed doctors order
and prescriptions. She claimed that she did not take any harmful drugs
and teratogenic substances while pregnant but vitamins and supplements
only.

At around December 24, 1997, E.B.B.s mother started laboring and


since it was about time for Christmas Eve, it took longer time for the
ambulance to reach their place. Since Sta. Barbara is miles away from
Western Visayas Medical Center (WVMC), E.B.B.s mother just gave birth
in the ambulance at that very moment and according to his mother, he
was a healthy baby boy (weight unrecalled) and there were no
complications noted upon the arrival at WVMC.

He was the youngest among his four siblings of which the eldest is
30 years old (Female, a nursing attendant), 28 (Male, a construction
worker), 24 (Female, a nursing attendant), 21 (Male, a marine engineer),
respectively.

b. Temperament as a child (determine any important family events that may


have influenced the childs temperament)

Growing up, E.B.B. was adored and loved by his family, especially
his father. He was a quiet child and usually plays with his older siblings.

40
According to his mother, he was an easy child and she does not have any
problem with him after all.

c. Early experiences and relationships


i. School experiences ( academic performance, delinquency)

During the patients kindergarten years, he was active and joins a


lot of extra co-curricular activities in school as verbalized by his mother.
He was also said to be participative and excels in his academic
performance as well as in sports like basketball and soccer not until third
year high school came where he started to manifest unusual behaviors as
noted by his mother and siblings. He was expelled from his previous
school in Sangcate because he was bullied and called buang which
resulted into a school fight. He was also involved in various school fights
and his mothers attention was always called by his teacher because he
was always absent and was seen in computer shops playing computer
games. His highest educational attainment was only up until third year
highschool.

ii. Friends, family stability, early sexual experiences, history of neglect and
abuse

Since E.B.B. was a school age, he saw and witnessed how his
father physically and verbally abused his mother and siblings, but his
father never land a hand on him. He would always just sit on a corner,
cry, and stare blankly after seeing that moment.

iii. Early relationships with parents, siblings and friends

E.B.B. has a good relationship with his mother and siblings, but he
was closely attached to his father. Even though his siblings would often
get jealous on him because he was really adored by their father, they
never had a thought of hurting him.

41
Moving on, when E.B.B. started consuming alcoholic beverages and
cigarettes frequently, (and without them knowing that he was using illegal
substances such as Marijuana and Shabu) his older siblings started
abusing him verbally such as telling him: Mango ka! Gago! Buang!
waay ka dun puturo.

d. Assess important cultural and religious influences that affect the patient

Four years prior to confinement, E.B.Bs parents believed that he


was a manghihilot because his grandfather was formerly one. And so
every time that they feel anything unusual about themselves, they would
usually just seek consultations to Surhano or quack doctors.

Then there was a time that E.B.B. was not feeling well and his
brother brought him to a quack doctor. According to the patient, gin
banyusan ako sang gas, and he believed that it was the start of him
manifesting psychotic symptoms.

2. Social History

a. Breadth of patients social life (loner? difficulty in establishing friendships?,


present and past levels of functioning in various social roles)
According to his mother, E.B.B. is an active and friendly child. He
socializes with other people and he also has a lot of friends in their
neighborhood. However, patient is a loud and talkative person thus made
him prone to be involved in an argument which later on will result to a
physical and verbal fight.
b. Changes in personality

Patients personality started to change when he started taking


drugs. He became irritable, easily get angry, restless, and indi mapuslan
as verbalized by his mother. He would also tend to roam around and could
not stay in one place for a long period of time. According to the patient,
he started hearing and seeing things which normal people could not,
which were the reason of his violent behaviors.

42
c. Marital status or environment in an intimate relationship; current level of
sexual functioning and sexual orientation

Patient claimed that he had three ex-girlfriends of which each


relationship lasted for about one to three months only because according
to him, he abandoned his first girlfriend. On the other hand, his second
girlfriend wanted to make him stop in smoking but he refuses, and so the
girl just chose to leave him. Lastly, on his third relationship, the girls
family did not accept their relationship. Furthermore, the girls father
physically harmed the patient and so they broke up.

Patient claimed that he had sexual contact with his third girlfriend.
Now that she had a new boyfriend, the problem with E.B.B. is that he
boasted to everyone that natandog ko na na siya, as verbalized.

d. Employment history

i. Number of jobs held; reasons the jobs were terminated

E.B.B. is a student and is being supported financially by his parents


and siblings. However, because of his being involved in a group of friends
that influenced him to use illegal drugs and vices, he opted to work as
manoggama in order to sustain his vices. According to the patient, he is
good at his work and has a minimum salary of one hundred pesos per
day. Thus he was stable in his job.

ii. Problems with alcoholism

Patient started drinking alcoholic beverages at the age of fifteen.


He drinks pilsen and redhorse, about one to two bottles per session
whenever he has money to buy one.

iii. Presence of antisocial behavior at work

None as claimed. The patient is very socially active.

43
3. Family History

Families often deny significant psychiatric history

a. Genetic risk for mental disorders


According to patients mother, they have a relative who has a
similar disorder as of him, however it was undiagnosed.

b. Family attitudes toward mental illness and treatment


Patients eldest sister pushed the patient to seek consultation and
rehab at WVMC. His family supported his finances in his treatment
and he was in and out of the institution for several months.

c. Is any family member successfully using any psychotropic medication for


the same illness?
None as claimed
If so, there is a good chance that the medication will also help the patient.
Not applicable

4. Previous psychiatric history

a. Note the recurrence of an earlier problem (list episodes of other psychiatric


illness chronologically)
He got addicted in consuming alcoholic beverages and cigarette
smoking when he was in first year higschool. He also started using
drugs (Marijuana (Cannabis Sativa) and Shabu
(Methampethamine)) when he was in third year high school, due to
peer pressure.

b. Note and record any previous treatments in chronological order (name of


therapist, length of treatment, medications and dosages, and
outcome of treatment)

Patient claimed that he had undergone Detox at Western Visayas


Medical Center for four times already under the supervision of unrecalled

44
name of physician, of which dates are unrecalled. He was prescribed with
Valproic Acid 250mg/cap, 1 cap TID duration of intake unrecalled and
Respiridone 1tab twice a day duration of intake unrecalled of which the
patient was compliant. However, he stopped taking it when he started
manifesting side effect such as robotic behavior.

5. Substance use and abuse

a. Alcohol and drug problems

Patient started drinking alcoholic beverages at the age of fifteen.


He drinks pilsen and redhorse, about one to two bottles per session
whenever he has money to buy one. He was also using drugs (Marijuana
(Cannabis Sativa) and Shabu (Methampethamine)).

b. Use of tobacco
Patient usually smokes one to two packs of cigarette per day.

c. Note any negative consequences of substance use (tolerance, withdrawal,


effect on the present illness)
Patient became more hyper because of consuming these
substances. His signs and symptoms was also aggravated.

g. Relevant Family History


7. Childhood
None as claimed
8. Adolescence
None as claimed
9. Use of Drugs
None as claimed
10. Family physical or mental problems
(+) Asthma- Maternal side
(+) Pneumonia- Maternal side (Mother)
(+) Tuberculosis Paternal side (Uncle)

45
11. Was there an unusual or outstanding event the client would like to
mention?
None as claimed

B. MENTAL STATUS EXAMINATION March 13,


2017

Appearance:
Appeared appropriate with age, height and weight, body build is mesomorph,
neat, clean, wears a gray shirt, navy blue shorts and gray slippers, with good grooming
as evidenced by clean and well- trimmed fingernails and toenails, with erect posture, no
body or breath odor noted.
Affect:
Patient E. B. B exhibited an appropriate affect during the entire nurse- patient
interaction with the topics discussed. When the patient was asked about how he feels
during the occupational therapy, he verbalized Na sadyahan gid ko, nag enjoy gid ko
mag ubra. With a smile plastered on his face. In adition, when he was asked Ano
nabatyagan mo sang gin sunog mo inyo balay? he answered Daw matangis ko,
nasubuan gid k okay ara to daan tanan nga memories pero sunog na tanan subong.
With a sad face. These responses imply that there is congruency in his affect.
Mood:
Patient E.B.B was asked Kamusta ka sir? he answered, Okay man ko, medyo
hyper ko subong with emotion of happiness and excitement. He was happy and
excited most of the time during the interaction. However, when asked about his family,
he replied waay gid takon may napatunayan sa ila. He was sad and looks
disappointed.
Memory:
Immediate: patient E.B.B was able to recall three unrelated items after three minutes
namely ; Dahon, Lapis, Sapatos
Recent: When asked Ano sir ginhiwat nga aktibidad kagaina? He replied
Occupational Therapy, nag ubra kami picture frame.

46
Remote: When patient E.B.B was asked Sir, ano nga petsa ikaw natawo? He replied
December 24, 1997. He answered the date congruent to the information found on the
chart.
He was able to recall immediate, recent and remote memory.
Attention:
Patient E.B.B was able to have a good attention span as he was able to spell
word
W O R L D backwards. Thus, he was able to sustain focus on the task given.
Concentration:
When patient E.B.B was asked to subtract 7s in succession from 100, he was
able to answer until number 2. He was able to subtract correctly until number 2 with
only one error. This would imply that he was able to focus and maintain concentration.

Eye contact:
Patient E. B. B was able to maintain good eye contact during the nurse- patient
interaction especially when he expressed his feelings and problems regarding the
current state of his life. However, there are times that he would look at a distance or
looked down on the floor especially when he shares stories about his past and about his
family.
Motor Activity:
The client placed his feet flat on the floor most of the time. However, he would
also raise his foot and place it on the bench. Arms are on his sides most of the times
but would also lean forward and use hand gestures when he would emphasized what
hes talking. He acts normally with a good body posture.

Speech
Patient E.B.B speaks in a clear, audible, fast pace, soft tone of voice. His
responses are appropriate to the topics being discussed. He would usually answer the
questions asked in long sentences because he tries to explain it briefly. Moreover, he
speaks in a Karay- a language.

47
Intellect
When he was asked Sir, Pwede ka kapangalan lima (5) ka mga dati nga
presidente sang Pilipinas? He answered Emilio Aguinaldo, Jose Laurel, Manuel Roxas,
Benigno Noynoy Aquino kag Ferdinand Marcos. He enumerated five (5) past
presidents and all of his answers were correct. In line with this, He is knowledgeable
and aware of the Presidents of the Philippines.
Judgement
Patient E. B. B was asked Kung may nasimhotan ka nga aso sa sulod sang
damo nga tawo nga sinehan, ano imo ubrahon? He answered, Pangitaon kung diin
halin ang aso kag ma gwa kag ihambal sa naga bantay. With this, it implies that his
response was a good judgement.
Delusions
During the entire interaction, Patient E.B. B did not display or verbalized any
delusional thoughts.
Hallucinations
Patient E. B. B didnt have any hallucinations during the interaction. No cues of
hallucinations were observed.
Insights And Problems
Patient E. B. B has a good insight and he was able to recognize the reason for
his admission. When he was asked Pwede namon sir mabalan ang rason ngaman nga
gindala ka diri sa PMHU? He the responded Kay gin sunog ko ang amon balay. He
was able to recohis medications, its purpose, frequency, and dosage as well. He was
also able to acknowledge the help of support system on him. He added that he
complied with the treatment inorder for him to recover from his condition.
Orientation
Person: When asked his name, he verbalized, E.B.B maam ah
Place: When asked, Sa diin kita subong sir? He replied sa Pototan Mental Health Unit
Time: When asked about the date, he answered March 13, 2017 andwhen asked ano
oras subong sir? he replied HApon, Maam mga 4:00 na ah
Situation: When asked Pwede namon sirmabalab ang rason ngaa gindala ka di? he
answered kay gin sunog ko amon balay

48
He has a good orientation to person, place, time and situation. He knows his
name, where he is, the date and time for today and the reason why he was admitted.
Thought Content
E.B.B. has appropriate thought content in the entire nurse-patient interaction. He
didnt have any hallucination, delusion, preoccupations, obsessions, phobias, suicidal
ideations, ideas of reference. He was able to express his thoughts appropriately and in
a relevant manner.
Suicidal Ideations
He has no suicidal ideations during the entire interaction.
Homicidal Ideations
The client has no homicidal ideations during the whole duration of interaction.
Thought Process
E.B.B. answers are appropriate and relevant.
Interview Behavior
E.B.B. behaves calmly and appropriately during the whole interaction. He is
responsive and cooperative as well. He immediately and appropriately answered the
questions being asked on him. He also expressed his thought and feelings in a relevant
manner. He also exhibited willingness and enthusiasm to work well and form an alliance
with the student nurses.

Diagnosis formulation or nursing impression


a. Clients central problem in diagram form

Predisposing Factors Precipitating Factors


Gender: Male Able to witness arguments of parents
Age: 19 years old Able to witness physical abuse from father to
Familial predisposition of mother and siblings except him
psychiatric disorder: (+) Parents separation
paternal Degraded by siblings 49
Nutrition Substance abuse (marijuana and shabu)
Hormonal Fluctuations Use of alcohol (1 bottle of whiskey/ day)
Low socioeconomic status Smoking (2 packs/ day)
Increased stress and
anxiety

Ineffective coping

Further increase in stress


and anxiety

Use of Defense Mechanism


(Suppression, Displacement, Acting out)

Ineffective and maladaptive


Use of defense mechanism

Ego disintegration

50
Failure to correct altered
ego process
Burning of their Visual and Auditory
Hallucinations
own house
Increased
activity and
Ineffective Individual Coping Disturbed Thought Process Disturbed Sensory Perception
energy

Ineffective Impulse Control Self- care deficit Risk for violence: self-
directed or other-directed
Suicidal Ideations and
attempt
Risk for injury Self-harm: head banging

Flight of ideas
Poor judgment
Easily distracted

BIPOLAR DISORDER:
MANIC

b. Identify contributory problems/s


Gender: Male
Age: 19 years old
Able to witness arguments of parents
Able to witness physical abuse from father to mother and siblings except
him
Parents separation
Degraded by siblings
Substance abuse (marijuana and shabu)
Use of alcohol (1 bottle of whiskey/ day)
Smoking (2 packs/ day)
Bullying from school
School drop out
Computer addiction as early as elementary years

51
History of suicide ideations and attempt as manifested by attempting to
hang himself
Self-harm: head banging

c. Conceptualization of clients problem

Edwin's life was depicted on the picture above. Slowly his self was
burned with trials, ups and downs, adversities and trials. Family problems,
witnessed battering of his father to his mom, received degrading from some of his
siblings and bad influence of his friends were some of the factors that keep his
past in fire.
Despite of these, Edwin still holds on tightly on a portion of himself, to
his dreams, and to that little hope seeding in his heart.
His burned self represents his past turned into ashes. His now,
represented by the unburned one looking up to that little light above portraying
God giving him strength to keep going and chase his dreams.
d. Criteria for making diagnosis: behavioral symptoms, mental status, history,
physical, and laboratory examinations
Signs and Symptoms:
1. Extreme mood swings from episodes of mania to depression

52
2. Suicidal ideations- also known as suicidal thoughts, concerns thoughts about or an
unusual preoccupation with suicide
3. Exaggerated self-esteem- they believe they can accomplish anything
4. Sleeplessness- inability to sleep; insomnia
5. Flight of ideas- a rapid flow of thought, manifested by accelerated speech with
abrupt changes from topic to topic: a symptom of some mental illnesses, especially
manic disorder.
6. Reduced ability to filter out extraneous stimuli/ Easily distracted-
having the attention diverted.
7. Increased energy- the capacity for vigorous activity
8. Increased activity- the situation in which a lot of things are happening or people
are moving around
9. Poor judgment
10. Excessive involvement in pleasure seeking/ risk-taking activities- the act or fact of
doing something that involves danger or risk in order to achieve a goal
11. Hallucinations- an experience involving the apparent perception of something not
present.
12. Feeling of hopelessness- They do not believe they have any control or that they can
help themselves to feel better.
13. Easily frustrated- a feeling of anger or annoyance caused by being unable to do
something
14. Anger towards self and others
15. Negative/ pessimistic thinking- is a state of mind in which one anticipates
undesirable outcomes or believes that the evil or hardships in life outweigh the good or
luxuries. Value judgments may vary dramatically between individuals, even when
judgments of fact are undisputed.

e. Diagnostic classification based on DSM 5

BIPOLAR Present on Patient

53
A. A distinct period of abnormally and (+)
persistently elevated, expansive, or irritable
mood and abnormally and persistently
increased goal-directed activity or energy,
lasting at least 1 week and present most of
the day, nearly every day (or any duration if
hospitalization is necessary).

B. During the period of mood disturbance (+) Inflated self- esteem


and increased energy or activity, three (or
(+) More talkative than usual or pressure to
more) of the following symptoms (four if the
keep talking
mood is only irritable) are present to a
significant degree and represent a noticeable (+) Flight of ideas
change from usual behavior:
(+) Distractibility
1. Inflated self-esteem or grandiosity.
(+) Excessive involvement in activities
2. Decreased need for sleep
3. More talkative than usual or pressure to
keep talking.
4. Flight of ideas or subjective experience
that thoughts are racing.
5. Distractibility
6. Increased in goal-directed activity
(either socially at work or school, or
sexuality) or psychomotor agitation.
7. Excessive involvement in activities that
have a high potential for painful
consequences

C. The mood disturbance is sufficiently (+)


severe to cause marked impairment in social
or occupational functioning or to necessitate
hospitalization to prevent harm to self or
others, or there are psychotic features

54
D. The episode is not attributable to the (+)
psychological effects of a substance or to
another medical condition.

D. Psychodynamic Formulation
a. Description of Clients Developmental Stage
A. Description of clients developmental stage
Erik Eriksons Stages Of Psychosocial Development
Erikson proposed a life span model of development, taking in five stages up to the
stages of 18 years and three further stages beyond, well into adulthood. In each stage
the person must complete a life task that is essential to his or her well being and
mental health. These tasks allows the person to achieve life virtues: hope, purpose,
fidelity, love caring and wisdom
Eriksons eight psychosocial stages of development are still widely used in a variety
of disciplines. In Eriksons view, psychosocial growth occurs in sequential phases, each
stage dependent on completion of the previous stage and life task. For example in the
infant stage, (birth to 18 months), trust versus mistrust, the baby must learn to develop
basic trust (the positive outcome) such as trust that he or she will be fed and taken
care of. The formation of trust essential: mistrust, the negative outcome of his stage,
will impair the persons development throughout his or her life. (Videbeck, 2013 p. 47)
This outcome of this maturation timetable is a wide and integrated set of life skills
and abilities that function together within the autonomous individual. However, instead
of focusing on sexual development (like Freud), he was interested in how this affects
their sense of self (McLeod, S. A. 2013)

Current Description Client's behavior Analysis


Developmental according to
Stage textbook

55
Intimacy vs Isolation According we begin He was engaged into (+) Intimacy
to share ourselves several relationships
(18-40 years old or (-) Isolation
more intimately with but he never
young adult)
others. We explore introduced a - He established
relationships leading girlfriend to his intimacy with
toward longer-term family. opposite sex and was
commitments with involved in an
someone other than emotionally requiring
a family member. relationships.
Successful
completion of this
stage can result in
happy relationships
and a sense of
commitment, safety,
and care within a
relationship.

Avoiding intimacy,
fearing commitment
and relationships can
lead to isolation,
loneliness, and
sometimes
depression. Success
in this stage will lead
to the virtue of love.
(McLeod S. A. 2013)

Virtue: Love
Task:
Forming adult, loving
relationships and
meaningful

56
attachment to others.
(Videbeck, 2013, p.
47)

Sigmund Freuds Psychoanalytic (theory (Psychosexual Developmental


Stage)
Freud was the founding father of psychoanalysis, a method for treating mental
illness and also a theory which explains human behavior. Freud sought to understand
the nature and variety of these illnesses by retracting the sexual history of his patients.
This was not primarily an investigation of sexual experiences as such. Far more
important were the patients wishes and desires, their experience of love, hate, shame,
guilt and fear and how they handled this powerful emotions. It was this that led to the
most controversial part of Freuds work- his theory of psychosexual development and of
the Oedipus Complex, Freud believed the children are born with Libido- a sexual
(pleasure) urge. There are a number of stages of childhood, during which the child
seeks pleasure from different object.
Freud based his theory of childhood development on the belief that sexual energy,
termed libido, was the driving force of human behavior. He proposed that children
progressed through five stages of psychosexual development : oral (birth- 18 months),
anal (18-36 months), phallic/oedipal (3-5 years), latency (5-11 years or 13 years), and
genital (11-13 years). Psychopathology results when a person has a difficulty making
the transitionfrom one stage to the next or when a person remained stalled at a
particular stage or regresses to an earlier stage. Freuds open discussion of sexual
impulses, particular in children, was considered shocking of his time. (Videbeck 2013, p.
44)

Current Description Client's behavior Analysis


Developmental according to
Stage textbook

57
Genital Final stage of He was circumcised He developed sexual
(puberty to Psychosexual when he was 11 maturity and was
adulthood) Development. years old. able to establish
relationship with
opposite sex. Thus
Begins with puberty He was involved client attained the
and the biologic sexual activities with normal level of
capacity for orgasm, his former girlfriend. developmental stage.
involves the capacity
for true intimacy. (S.
Videbeck, pg. 46, 6th
Ed.)

Jean Piagets Cognitive Theory


Piaget's (1936) theory of cognitive development explains how a child constructs a
mental model of the world. He disagreed with the idea that intelligence was a fixed
trait, and regarded cognitive development as a process which occurs due to biological
maturation and interaction with the environment.
Piaget (1936) described his work as genetic epistemology (i.e. the origins of
thinking). Genetics is the scientific study of where things come from (their origins).
Epistemology is concerned with the basic categories of thinking, that is to say, the
framework or structural properties of intelligence.
The goal of the theory is to explain the mechanisms and processes by which the
infant, and then the child, develops into an individual who can reason and think using
hypotheses.
To Piaget, cognitive development was a progressive reorganization of mental
processes as a result of biological maturation and environmental experience. Children
construct an understanding of the world around them, then experience discrepancies
between what they already know and what they discover in their environment.

Current Description Client's behavior Analysis


Developmental according to
textbook

58
Stage

Formal Operations The child learns to According to his Patient attains normal
think and reason in mother, EBB was an level of formal
(age 11+ - operational thought
abstract terms, average student and
adolescence and based on his
further develops was also participates
adulthood) manifested behavior.
logical thinking and in school activities.
reasoning, and
achieves cognitive
maturity. (S. He was kicked out
Videbeck, pg. 47, 6th from school because
Ed.) of his socially
unacceptable
behavior. Patients
The formal highest educational
operational stage attainment was 3rd
begins at year high school
approximately age
eleven and lasts into
adulthood. During
He could able to
this time, people
make an appropriate
develop the ability to
judgment to certain
think about abstract
concepts, and situations and could
logically test respond in an
hypotheses. appropriate manner.

59
E. Psychopathology

Predisposing Factors Precipitating Factors


Genetics - Paternal (+) Adolescent engaging in risky behavior: bringing knife
Age Teen 20-30 yrs. Old
to school
(Px=19 y.o)
Neurochemical Underachiever
Influences School drop out
Hormonal Fluctuations Substance abuse:
Nutrition -Marijuana and Shabu
Low Socioeconomic -2 packs of cigarette per day
Status -1 bottle of whiskey per day
Computer addiction as early as elementary years
Early witness of physical abuse by father towards
siblings and wife
Degraded by siblings
Parents separation
History of Suicide Ideation as manifested by:
-Attempting to hang self
-Head Banging

F.

60
Signs and Symptoms

Criteria Found in Textbook Manifested by Patient

General Bipolar Disorder Symptoms

Extreme mood swings from episodes of (+)


mania to depression

Suicidal Ideations/Attempts (+)

Manic Episode Symptoms

Heightened, grandiose or agitated mood (+)

High self-esteem (+)

Sleeplessness (+)

Flight of Ideas (+)

Reduced ability to filter out extraneous (+)


stimuli/ easily distractible

Increased Energy/Activity (+)

High risk activities with possible side effects (+)

Poor Judgement

Excessive involvement in pleasure-seeking (+)


activities

Delusions

Hallucinations (+)

Feeling of Hopelessness (+)

Anxiety

Very low self-esteem

Easily frustrated (+)

Anger towards self and others (+)

61
Anhedonia

Minimal social interaction

Negative/ pessimistic thinking (+)

Suicidal Ideations/ Attempts (+)

Delusions

Anergia

Noise intolerance (+)

G. Specific Nursing Problems and interventions


PROBLEM LIST INTERVENTION AND RATIONALE DATE RESOLVED

Risk for Injury Provide structured solitary activities RESOLVED. March 15,
with the assistance of a nurse or aide. 2017
Structure provides focus and
security.
No injuries noted
throughout the RLE
Exposure at PMHU.
Provide frequent rest periods.
Prevents exhaustion.

Provide frequent high-calorie fluids


(e.g., fruit shake, milk). Prevents
the risk of serious dehydration.

Maintain a low level of stimuli in


clients environment (e.g., loud
noises, bright light, low-temperature
ventilation). Helps minimize

62
escalation of anxiety.

Acute mania might warrant the use of


phenothiazines and seclusions to
decrease any physical harm.
Exhaustion and death result
from dehydration, lack of sleep,
and constant physical activity.

Protect client from giving away money


and possessions. Hold valuables in a
hospital safe until rational judgment
returns. Clients generosity is a
manic defense that is consistent
with irrational, grandiose
thinking.

Redirect violent behavior. Physical


exercise can decrease tension
and provide focus.

Risk for Violence: Self- Frequently assess clients behavior for RESOLVED. March 15,
Directed or Other signs of increased agitation and 2017
Directed hyperactivity. Early detection and
intervention of escalating mania
will prevent the possibility of No violence noted
harm to self or others, and throughout the RLE
Exposure at PMHU.
decrease the need for seclusions.

Use a calm and firm approach.


Provides structure and control

63
for a client who is out of control.

Use short, simple and brief


explanations or statements. Short
attention span limits
understanding to small pieces of
information.

Remain neutral as possible; Do not


argue with the client; Client can use
inconsistencies and value
judgments as justification for
arguing and escalating mania.

Maintain a consistent approach,


employ consistent expectations, and
provide a structured environment.
Clear and consistent limits and
expectations minimize potential
for clients manipulation of staff.

Redirect agitation and potentially


violent behaviors with physical outlets
in an area of low stimulation (e.g.,
punching bag). Can help to relieve
pent-up hostility and relieve
muscle tension.

Decrease environmental stimuli (e.g.,


by providing a calming environment
or assigning a private room) Helps

64
decrease escalation
of anxiety and manic symptoms.

Ineffective Individual Assess and recognize early signs of UNRESOLVED


Coping manipulative behavior, and intervene
appropriately: For example:

Taunting staff by pointing out faults


or oversights.

Pitting one staff member against


another (You are more appreciative
than Nurse Paul Martin, do you know
what she said to me?) or pitting one
group against another (morning shift
versus night shift).

Aggressively demanding behaviors


that can trigger exasperation and
frustration in staff.Setting limits is
an important step in the
intervention of bipolar clients,
especially when intervening in
manipulative behaviors. Staff
agreement on limits set and

65
consistency is imperative if the
limits are to be carried out
effectively.

Observe for destructive behavior


toward self or others. Intervene in the
early phases of escalation of manic
behavior.Hostile verbal behaviors,
poor impulse control, provocative
behaviors, and violent acting out
against others or property are
some of the symptoms of this
disease and are seen in extreme
and/or acute mania. Early
detection and intervention can
prevent harm to client or others
in the environment.

Maintain a firm, calm, and neutral


approach at all times. Avoid:
Arguing with the client.
Getting involved in power struggles.
Joking or clever repartee in
response and other clients. to clients
cheerful and humorous
mood.These behaviors by the
staff can escalate environmental
stimulation and, consequently,
manic activity. Once the manic
client is out of control, seclusion

66
might be required, which can be
traumatic to the manic individual
as well as the staff.

Provide hospital legal service when


and if the client is involved in making
or signing important legal documents
during an acute manic
phase.Judgement and reality
testing are both impaired during
acute mania. Client might need
legal advice and protection
against making important
decisions that are not in their
best interest.

Administer an antimanic medication


and PRN tranquilizers, as ordered,
and evaluate for efficacy, and side
and toxic effects.Administer
an antimanic medication and
PRN tranquilizers, as ordered,
and evaluate for efficacy, and
side and toxic effects.

67
H. Evaluation of Interventions
Before After

3/6/17 3/15/17
Patient participated actively in the orientation Participated in the games with other
program patients and performed an intermission
number in the culminating activity.

Patient introduced himself in front


Patient stayed until the end of the program.

Patient is easily distracted

Patient tends to go outside during the program

3/7/17 3/13/17
Patient verbalized Nami tulog ko di, 7:30 sang Patient verbalized, Hindi ko gawa katulog
gab-e pa lang tuyo na ko. subong kay kainit kag damo langaw.

Patient seems relaxed and comfortable. Patient seems irritated.

3/6/17 3/15/17
Speaks in a fast manner with loud voice Still speaks in a fast manner with a loud
voice

Maintained good eye contact


Still with good eye contact

3/13/17 3/15/17
Patient verbalized Bag-o ko di magsulod, akon Patient verbalized, Kung gaan ko chansa
lang kaugalingon akon napanumdom nga kag makagwa ko di, untaton ko na tanan.
makabisyo ko kag makuha tanan ko na gusto.
Hindi na ko magbalik sa bisyo kay
mabuang lang ko da.
Patient seemed to be in deep thought

68
Patient broke eye contact to look away and
smiled.

3/7/17 3/14/17
Patient appears to be hyperactive and restless Still hyperactive and restless

Tends to walk around and jump in the hallway or Laughs and sings loudly
in the garden.

Sings loudly.

3/6/17 3/15/17
Nang budlay kanakon dasig ko mapikon kag Patient seems to get along with the otehr
madumot ko na tao. patients and interacts with them,

Nagtapungolay kami gina ni Kent kay nagarit-


garit ya gid ko.

3/6/17 3/15/17
Patient verbalized Sang ara ko sa gwa, dungol- Kakita man ko away diri pero grabi gid na
dungol gid sa akon. Permi gani gahibi si nanay. di ang disiplina ya. as verbalized by the
patient
Patient laughed.
Patient maintained good eye contact

3/7/17 3/15/17
Hindi ko mabaton kung mapirde ko sa mga Naperdikami gina sa duwa gid ka hampang
hampang or sa biskan diin lang, as verbalized by pero okay lang ah kay game man lang na.
the patient. Dapat batunon mo lang, as verbalized by
the patient.

69
Patient smiled and maintained good eye
contact.

3/7/17 313/17
Patient verbalized, waay gid ko ya gasimba ah Patient verbalized, Makagwa ko una ko gid
pero gapangadi man ko kung isipon ko palang ubrahon mangumpisar ko para makakas
magbasa bible nakunsensya ko dayon. mga sala ko.
Patient looked away.

I. Recommendations or Discharge Plans


1. Medical Management
A. Drug Therapy
ANTIPSYCHOTIC AGENTS
The major action of all anti psychotics in the nervous system is to block receptors
for the neurotransmitter dopamine; however, the therapeutic mechanism is only
partially understood.
Conventional/Standard Antipsychotic Agents - Phenothiazines are used as the
prototype for these drugs. They are usually expensive; however, they have more
troubling side effects than the newer generations of antipsychotics. They target
predominantly the positive symptoms of schizophrenia (e.g. Hallucinations,
delusions, paranoia, abnormal thought formations).

Chlorpromazine
Typical antipsychotics produces more extra pyramidal side effects, which includes
acute dystonia, pseuparkinsonism and akathisia. The patient or the significant
other should be informed about this signs and symptoms and to report to health
providers so that it can be treated with anticholinergics or anti parkinsonian
agents immediately and accordingly.
An adverse side effect of typical antipsychotics is Nueroleptic Malignant
Syndrome (NMS). NMS is a potentially fatal idiosyncratic reaction to an
antipsychotic drug. Inform client or significant others to immediately report to

70
the nearest health establishments when the patient is manifesting rigidity; high
fever; autonomic instability such as unstable blood pressure, diaphoresis, pallor
and delirium.
caution the patient and inform the significant other, to avoid activities that
require alertness and good coordination such as driving,. And to slowly rise from
a sitting or lying position to prevent a sudden drop in blood pressure.
Inform patient and significant other to avoid going out or to use sun block or
protective clothing when under the sun because the skin is more susceptible to
sunburn in just less than 30 minutes especially if it is dry season. And to take
frequent sips of water or chew a sugarless gum when dry mouth is a problem.
Warm the patient and significant other that medication should not be stopped
abruptly after long term use. Avoid taking the medications with alcohol because
it potentiate its effects. Smoking also increases the metabolism of neuroleptics so
it may require the pateint to go to her primary physician because she may need
an increase in dosage. Avoid other over-the-counter drugs without the approval
of your primary physician. Also contact primary physician when pregnant
because safe use of neuroleptics has not been established.
encourage compliance.

Olanzapine
Monitor for the many possible drug interactions before beginning therapy.
Monitor elderly patients for dehydration and institute remedial measures
promptly; sedation and decreased sensation of thirst related to CNS effects of
drug can lead to dehydration.
Encourage patient to void before taking the drug to help decrease anticholinergic
effects of urinary retention.
Monitor for elevations of temperature and differentiate between infection and
neuroleptic malignant syndrome.
Monitor for orthostatic hypotension and provide appropriate safety measures as
needed.
Monitor patient regularly for signs and symptoms of diabetes mellitus.
Inform patient or significant others to take this drug exactly as prescribed; do
not change dose without consulting your health care provider.
Inform patient regarding these side effects: Drowsiness, dizziness, sedation,
seizures (avoid driving, operating machinery, or performing tasks that require
concentration); dizziness, faintness on arising (change positions slowly, use

71
caution); increased salivation (if bothersome, contact your health care provider);
constipation (consult with your health care provider for appropriate relief
measures); fast heart rate (rest and take your time if this occurs).
Instruct patient to report lethargy, weakness, fever, sore throat, malaise, mouth
ulcers, and flulike symptoms.

ANTICONVULSANT AGENTS
Anticonvulsants are drugs that prevent or reduce the severity and frequency of
seizures in various types of epilepsy. The different types of anticonvulsants
may act on different receptors in the brain and have different modes of action.
Two mechanisms that appear to be important in anticonvulsants are enhancement
of GABA action and inhibition of sodium channel activity. Other mechanisms are
inhibition of calcium channels and glutamate receptors.

Oxcarbazepine
Know the patient with allergic reaction to carbamazepine may have
hypersensitivity to oxcarbazepine.
Implement seizure precautions as needed.
Watch closely for evidence of multi-organ hypersensitivity, such as fever, rash,
organ dysfunction, lymphadenophathy, hepatitis, liver function abnormalities,
pruritus, nephratis, oliguria, hepatorenal syndrome, arthralgia, and asthenia. If
suspected, notify prescriber and expect to stop drug. Provide supportive care, as
prescribed.
Monitor patient closely for evidence of suicidal thinking or behavior, especially
when therapy starts or dosage changes.
Inform patient that he may experience dizziness, double vision, and unsteady
gait,
Instruct patient not to drink alcohol during oxcarbazepine therapy.
Alert patient to possibility of hypersensitivity or serious skin reactions and
importance of reporting them to prescriber.
Warn patient to notify prescriber immediately if he develops a fever; rash;
swelling of face, eye, lips, tongue; difficulty swallowing or breathing; or other
evidence of hypersensitivity because drug may need to be stopped and
emergency medical care given.

72
ANTICHOLINERGIC AGENTS
An anticholinergic agent is a substance that blocks the neurotransmitter
acetylcholine in the central and the peripheral nervous system. Anticholinergics
inhibit parasympathetic nerve impulses by selectively blocking the binding of
the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve
fibers of the parasympathetic system are responsible for the involuntary
movement of smooth muscles present in the gastrointestinal tract, urinary tract,
lungs, and many other parts of the body. Anticholinergics are divided into three
categories in accordance with their specific targets in the central and/or
peripheral nervous system: antimuscarinic agents, ganglionic blockers, and
neuromuscular blockers.
Biperiden
Biperiden may cause blurred vision, dizziness, lightheadedness, or drowsiness.
Advice patient not to do anything else that could be dangerous until he knows
how to react to biperiden. Using biperiden alone, with certain other medicines, or
with alcohol may lessen his ability to perform other potentially dangerous tasks.
Biperiden may cause dizziness, lightheadedness, or fainting. Alcohol, hot
weather, exercise, and fever can increase these effects. To prevent them, advice
client to sit up or stand slowly, especially in the morning. Also,advice him to sit
or lie down at the first sign of dizziness, lightheadedness, or weakness.
Advice client not become overheated in hot weather or during exercise or other
activities because heatstroke may occur.
Sucking on sugarless hard candy, drinking fluids, or practicing good dental
hygiene can relieve dry mouth.
Advice significant others to let patient rise from sitting or standing slowly to
prevent orthostatic hypotension.
Tell significant others not to abruptly stop the drug to prevent withdrawal
symptoms which can be manifested by insomnia, involuntary movements,
anxiety and tachycardia
Instruct significant others that client's doses should not double, but missed doses
may be taken up to 2 hours before next dose.

73
2. Nursing Management
A. Promoting the safety of the client and others
Approach the client in a nonthreatening manner. Making demands or being
authoritative only increases the clients fears.
Keep voice in a low manner and speak slowly as much as possible. High-pitched
or loud tone of voice can elevate anxiety levels while slow speaking aids
understanding.
Avoid touching the client. Touch by an unknown person can be misinterpreted as
a sexual or threatening gesture.
Observe for signs of agitation or escalating behavior such as intensity of pacing,
loud talking or yelling and hitting or kicking objects.
Interactions should be short, frequent periods with a client throughout the day.
Short periods are less stressful, and periodic meetings give a client a chance to
develop familiarity and safety and avoid agitation.
Administer medications, moving client to a quiet, less stimulating environment,
and extreme situation, temporary using seclusion or restraints.

B. Establishing a Therapeutic Relationship


Perform a planned interaction, brief, frequent and not demanding
Maintain consistency and honesty in interactions
Provide clear, direct, and easy to understand explanations
Include good eye contact, a relaxed body posture, and facial expressions that
convey genuine interest and concern
Addressing client by ones name, it is helpful in establishing trust as well as reality
orientation.
Create a sense of trust through brief interactions that communicate caring and
respect.
C. Using therapeutic communication
Maintain Verbal and non verbal communication congruence with the client
Effective communication requires the use of empathy, not sympathy. With
empathetic communication, the nurse attempts to understand the patient's point

74
of view, rather than trying to feel the emotions of the patient. Empathetic
communication implies an understanding of the patient's perception
Therapeutic communication requires active listening. This type of listening
requires the nurse to put aside preoccupations and interruptions, and to truly
focus on the message the patient is trying to convey. This includes interpreting
messages and using clarification to make sure the nurse understands the patient
during the interview and care process.
Being genuine and knowing personal thoughts and feelings can make the
communication process more effective. The nurse must first acknowledge and be
aware of his or her own biases and prejudices prior to the initial conversation
with the patient.
The nurse must strive to use clear, direct and nonjudgmental communication
with all patients. Nurses working with patients who have a mental illness also
require an understanding of how communication can affect the symptom profile
of certain illnesses.
Nurses must always be cognizant of safety issues that may develop when
working with patients who are experiencing altered thought processes. By using
therapeutic communication techniques, nurses can increase patient satisfaction,
improve healthcare outcomes, and provide care in a safe environment.
Call the client by name, make references to day and time, and commenting on
the environment are all helpful way to continue to make contact with a client
who is having problems with reality orientation and verbal communication.

D. Coping with socially inappropriate behavior


Protecting the client is a prime nursing responsibility and included protecting the
client form retaliation by others who experience the client's intrusions and
socially unacceptable behavior.
Do not focus on hallucinations or delusions and present reality.
Do not focus or strengthen the suspicion or delusional ideas.
Maintain consistency of your verbal and nonverbal communication.
Maintain your own communications in order to remain clear and unambiguous.
Tell the patient that you do not agree with the perception of the client, but the
validation that you believe that the hallucinations are real to the client.

75
The client should not feel shunned or punished for inappropriate behavior.
Engage client to appropriate activities.

E. Teaching Client and Family


Stress compliance to medications and follow-ups and to avoid alcohol and other
substances which patient is at risk of abusing
Education and ongoing support in the maintenance if the patient's health.
Providing facts regarding bipolar such as the identification of early signs of relapse
and teaching health practices to promote physical and psychological well-being.
Fatigue or lack of adequate sleep or proper nutrition can be indicators of relapse.
Family members should be reminded that they are not the cause of bipolar
disorder. they can also join in alliances and organizations to help them with their
emotional exhaustion.
Teach the patient and the family about brief psychotic disorder. They must
understand that these are illnesses, not lack of will power or motivation. Learning
about the beginning symptoms of relapse may assist patient to seek treatment
early and avoid lengthy recurrence.
Counseling and educating family/significant others about the biologic cause and
clinical courses or brief psychotic disorder and the need of ongoing support.
J. Bibliography
Forchuk, C., et al. (2000). The developing nurse-client relationship: Nurses
perspectives. Journal of the American Psychiatric Nurses Association, 6(1), 3-10
Videbeck, S.L. (2011) Psychiatric Mental Health Nursing Sixth Edition
National Institute of Mental Health and Medscape

76
CONTRIBUTION
AND
EXPENDITURES

77
Student Nurse Week One Week Two Week Three

AMISCUA, CHEZKA DANIELLE 250 250 250

BALDONADO, KHRYSS PAULA 250 250 250

CATEDRAL, GAY MALHI 250 250 250

DE ASIS, DENISE MARIE 250 250 250

ELAURIA, SONNYLEEN 250 250 250

GOMEZ, HENRY MAURICE 250 250 250

KAW, MARVIC JOY 250 250 250

MANDILAG, KIMBERLY 250 250 250

NUYAD, RIZZI FERN GRACE 250 250 250

PORRAS, VHLESSY REE JANAN 250 250 250

ANINON, JAESA FAE 250 250 250

CATEDRAL, KEZIA MARIE 250 250 250

DELA PENA, BEATRIZ 250 250 250

ESPINA, DINAH 250 250 250

HARO, KAYE 250 250 250

LAMASLIG, MARIELLE 250 250 250

MEDIODIA, GAIL 250 250 250

OMILIG, EUGENE 250 250 250

QUILLA, CHRISTINE 250 250 250

SERNICULA, MA. HEARTY 250 250 250

VILLEGAS, NORBETH ANGELIE 250 250 250

Total: 15, 750 5250 5250 5250

78
OTHER
SUPPORTING
DOCUMENTS
AND FILES

79
80
INSIGHTS
AND
REFLECTIONS

81
People die every day, some physically,
some emotionally and some mentally.
Psychiatric nursing, first heard of it when I was
little. I couldnt remember any memory that has
to do with Psychiatric nursing. But now, as a
third year nursing student, all I can say about
my exposure at Pototan Mental Health Unit
was; fulfilling!
Before entering a nursing school, my
idea or perception before about Psych patients
was that they are mad people, that they are in
their correct or normal state of mind, they are
either born with it or it is somehow drug
Sonnyleen B. Elauria related. I have learned that people who have
Mental Disorders should not be treated
differently from normal person but with special care. I didnt know that there are
different types of disorders, Delusions, delusions, types of speech and signs and
symptoms if with Mental Disorder. Knowing those really opened up my mind on how to
understand them, manage them, care for them, talk to them and how to help
them.Going back and forth at the Pototan Mental Health Unit every Monday until
Wednesday was really amazing First interaction with my patient, I was a little bit
anxious and very worried on how our interaction can be therapeutic or what will be by
next question and absolutely worried on gaining the trust of our patient. While learning
these Mental Disorder, Ive learned that trust is the very foremost hard to establish with
patient having a mental disorder because first, I am a stranger to them, they dont
know me and somehow, in the past, maybe their trust was broken by someone whos
important to them or theyve trusted wrong people that could have somehow lead them
into having Mental Disorders or hardships. But somehow having trained on how to
handle them and talk with them. Together with my partner Ms. Kimberly S. Mandilag, It
wasnt hard for us on building rapport
Life is hard and it isnt fair and it really hurts like hell, Sometimes. But if you
focus on what is within your power to change for the better you can and you will. A
saying Ive seen from the internet. I believe that nobody can change anybody but
themselves. Looking back to the second week or our interaction, my patient really has
become comfortable with me, he was able to express himself fully, tell stories that
somehow I concluded that triggered his mental illness and its signs and symptoms, he

82
would tell me his goals and ambitions in life and also his disappointments. Its a great
feeling that you could help someone. Im happy that my patient is open with us. Just
lending him our time and listening ears we could make him feel better and get rid of
those excess baggage he ha
Here comes the third or our RLE exposure at Pototan Mental Health Unit, Im
about 45% happy but 55% sad. Im happy because thinking about the things and in
such ways we did help our patients but sad because we had to terminate our
interaction and we couldnt go back at the PMHU anymore. Because I think we can give
more help to those patients and their families if we were given more time but I also
understand why we were given just a short period of time.
In my RLE Exposure at PMHU I learned that despite of all the requirements we
need to pass every week and in the whole rotation and the travel we had to do theres
a patient waiting for me at the PMHU that needs help, needs a listening ears, just a
person whom he can talk to and express his desires in life, goals and life stories and
families that need guidance with their family member who have mental disorder, who
needs answers to their whys and hows. Psychiatric Nursing has taught me how to cope
with my own stresses, develop patience and learning that mental health is a growing
problem and we should not ignore. Nevertheless, everything was all worth it in the end!

83
This rotation gave a big impact in the way I see
people. It made me realize how we really think
differently of people with mental disorders until we
get to meet one face to face. I used to think of
people with mental disorders as people who really
cannot function in society like a normal person
would, but my experience in the psychiatric ward
really changed my point of view. I was assigned to a
person diagnosed with schizophrenia. At first I had
all kinds of presumptions and ideas about him but
the first time I sat down to talk to him, all those
presumptions flew away. I then quickly realized how
much of a person he is. He may be different, but he
is still human. We all are. Not just him, but I got to
Chezka Danielle G. Amiscua
interact with almost all of them, all of different
mental disorders and stories to tell. Each one of
them had a different story in life which we all gladly listened to. People like them just
need people who would understand them, because no one wants to be alone.

It's also great that, although we had to cut our time in PMHU short, we had
helped our patients even just a little. We had all sorts of activities and programs for
them and at the end of our rotation, it really felt satisfying how they thanked us for
being there for them as they do their best to get better. We also did see improvements
in our short stay there. Little by little you could really see how different they were the
first time you meet them compared to the last day when you have to say goodbye. We
also have to thank them for changing our views for all the people out there with mental
disorders, for changing my view at least. All I can say is that, we can't blame anyone
for seeing them differently. But if you keep an open mind, and see things from their
perspective, the world of people with mental disorders is just our same world seen
differently.

84
Psych Rotation is the most awaited
rotation, I think, for all third year student nurses.
Hearing the fact that you will take good care of a
mentally ill client is an exciting one. At first,
questions are running in my mind. The what ifs.
Until the day of having out duty at PMHU came.
This is it! This is really is it! Two weeks of going
back and forth to the area is very exhausting but
fulfilling. Hearing stories from different patients
will leave you an awe when it comes to life. Truly
life is an everyday battle and everyday carrying of
the cross. Some were vulnerable, some strong.
Differences of each individual make him or her
Vhlessy Ree Janan Poras unique. But for me one thing is for sure, staying
strong and being strong is the key to keep on
moving. You need to be strong in taking steps and you need to stay strong as you go
on. Nothing to fear about. You know why? Because God is always with us. Go near to
Him and pray. Have faith!
-

85
Psychiatric Mental Health nursing is one of
the most exciting and thrilling rotation in my whole
experience as a student nurse. Since the start of our
lectures in Psych Im already looking forward to this
area because of the stories our lecturer are sharing.
In this rotation almost everything is different from
the normal ward; the charting, the way of giving of
medications and most especially the patients. In
dealing with a client with mental illness all of your
actions should be therapeutic because in one mistake
the patient can be suspicious already. In our first
interaction Im very anxious and conscious about
Kimberly S. Mandilag my actions. That what if I say or act something
wrong feeling is popping in my head but thankfully
Ive concurred that feeling and interact with my client therapeutically. Since we have
build rapport ad set contract in our first interaction, in our second day I can say that its
much easier for us. Day by day Im learning the story of my client and through this Im
able to know and understand him more. Through this also I felt the pity to the patients
experiencing mental health problems because I can see how hard it is for them to live
with this kind of situation. Not only in their mental aspect but also to their social life;
living with this disorder can have many symptoms that the other people can see. I also
learned how hard it is for them to live with the everyday criticism they hear from others
which increase the burden of their disorders. One more thing that Ive observed is that
psych patients are very observant and very cooperative. Im happy to see in my own
eyes how the staff nurses took care of the patients, I can see how well they know their
profession and their passion. I can say that the institution itself are helping the patients,
its aura is very different to the normal hospitals and its just like a small community
which I think is good to the patients condition. This rotation is the most hectic and
complicated when it comes to the requirements. However I have the best partner which
helped me all throughout this rotation. We spend sleepless night just to come out with
a good output to pass the next day. Im happy that Ms. Elauria became my partner, she
encourage me when Im down and honestly tell me my weaknesses. In this rotation,
our group experienced a lot of challenges but because of our strong bond we finished
this rotation happy and full of learning. Even if our activities are not that perfect for me
the important thing is our learnings and the happiness that we brought to our patients.
What will you do with your high grades if you didnt learn something? Im also thankful
to my groupmates, each of us has our strength and weaknesses; since we have a year

86
to be together we knew what to expect from each other and help each and everyone of
the group.
As a student nurse I learned a lot not only regarding the disorders in Psych but
also about myself. This rotation act as an eye opener to me, it taught me lessons that I
can use in my whole life. I learned how to be more conscious and concerned of other
peoples reaction to my actions, how important nonverbal cues are and how simple I
can help to someone just by listening to their stories; In that simple manner it can
already mean a lot to them. Ill finish this reflection by leaving a quote, Dont be
ashamed of your story it will inspire others, each and everyone of us has our own story
to tell and each of us can inspire someone. Dont hesitate and start sharing not only to
help others but also to help yourself.

87
-Arthur Miller once said, Self-realization
and self-fulfillment are the sine qua non for
human existence. I try to live by that
perspective every single day because I believe
that it is what I have to do in order to say
someday that I lived.
This rotation taught me a lot of things
about myself, about the people around me and
the people I will meet someday. I learned how
to cope with stress in this rotation because we
had this rotation together with our finals so it
really measured my determination to finish and
pass this year. Also, I learned a lot about myself
when it comes to the way I treat people and
Marvic Joy C. Kaw how I interact with them. I learned what to do
in different situations and how my actions would
affect my surroundings. Next is, I learned a lot about the people around me. It made
me realize how lucky I am to be with them and how lucky I am when I thought I used
to carry the whole world in my shoulder. It wasnt the case. We all have our own
problems in this world and mine wasnt the worst. In fact, it was just a petty thing
compared to the others. These rotations made me mature in some ways that I act like
the bigger person now when encountering arguments with others. Before judging them,
I try to understand them. Thats what this rotation made me to be. Next are my
patients. They are more than just their disorders and thoughts. I learned that they need
our most special care because thats the only way we can help them because unlike the
patients in the hospital who are dealing with their aliments physically, these patients
are dealing with a lot bigger than that. Imagine yourself dealing with your thoughts.
What would you do when your thoughts will deceive you? You cant ask for help
because for one, its all in your head. Empathy is required. You have to know what
situation they are in order to give our best care for them. You have to understand them
in ways that other people couldnt. At the middle of this rotation, I even considered
pursuing this line. I wanted to be a psych nurse and believe it or not I really looked
forward to go experience this rotation since I entered this college.
At the end of this rotation, all the sleepless nights, the hardships, the almost
giving up thoughts in 2 in the morning when drinking your 5th cup of coffee of the
day, it was all worth it. And if given the chance to do it again, I will. Thank you to our
clinical instructors for guiding us along the way and for the never ending patience when
dealing with our shortcomings. Thank you so much!
-

88
If I would describe how I feel during the psychiatric
RLE rotation in just two words, I would say it was
WORTH IT. My experience was full of happiness and
enjoyment with a pinch of tiredness. But, in the end, I
realized that all of it happened for a reason. All those
sleepless nights and struggling thoughts was for me to
grow emotionally and intellectually. Indeed, this rotation
is extraordinary!The learning process for the entire
rotation started with goal settings and familiarization of
Gay Malhi C. Catedral everything. Self- awareness plays a vital role in
preparing us for the intensive dealing of the different
patients with psychiatric problems.
Everyday became a challenge to all of us. At first, I was hesitant to deal with the
patients and I felt the fear that I may not function as a competent student nurse and
that they may not cooperate with me. But, as days passed by, all my fearful thoughts
and false expectations were proven wrong. All my fears were turned to confidence and
it became a contributing factor to function as a therapeutic nurse. With this, we find our
role as a student nurse as full of fun and full of hopes that we had extended our
necessary roles and functions to maximize delivery of public health. We learned through
active participation, concept exploration, interactive discussions, dialogue, individual
reflection and team collaborationThe best thing in this rotation was when I realized that
the patients were more than what we thought they are. Further, I realized that behind
what they look outside is a story worth telling for. And it made me think that they
deserve to be understood and to be loved. I do hope that we, the student nurses, were
able to help them in recovering.
This rotation taught me a lot of things. First is about the importance of teamwork.
During the rotation, I saw and observed how I and my group mates worked together to
prepare everything for he activities. In those times, I realized that no matter how
different each one of us was, as long as there is harmony, everything will work out.
Second, it taught me about myself. After the rotation, I became more self-aware
especially in how I think and feel. In addition, I think I became more understanding to
others thinking and believing that each one us has a reason for acting that way. Just
like the patients, I learned that it is best to understand them because they never
wanted their current situation to happen. Last, it taught me about life. I learned to
value life more due to the fact that I realized how blessed I am for having a good
coping skills. Because seeing those patients made me think of how important it is to
stay strong despite every circumstances we face.

89
-
Our duty in Pototan Mental Hospital Unit
taught me a lot. It really helped me deal with
patients with mental illnesses. But it felt
different since we are handling a different type
of people compared to the other patients that
wed handled in the hospitals during our
previous rotations. It gave me chills and anxiety
during the first day in the institution. I dont
know how to handle them and what to expect
with the patient at first. Im also scared that my
approach will not be therapeutic. But when the
Denise Marie P. de Asis time goes by, I learned how to be therapeutic
in talking to them. I also feel comfortable
talking in crowd and I gain a lot of confidence
during this rotation.
Also because of this rotation, we developed team work and coordination with the
other sections. Even if there are misunderstandings sometimes but we still manage to
work together without grudges in each other. I feel happy and sad at the same time
because, this is our first and last duty in this rotation. I will miss all the fun and
excitement that we had. The late night drives after duty from Pototan to Iloilo, the sing
along moment inside the car, the siksikan moment, and most especially the patients
that are assigned to each one of us. It feels satisfying that I can help them in a way
that we became a diary about their life. They really developed rapport with us and
therefore I conclude that our objectives were met. I can say that this is he best rotation
I have experienced in my entire nursing school. I really had fun! It is tiring, but worth
it.

90
- Our RLE exposure at the Pototan
Mental Health Unit was totally different from
that of our clinical rotations at the hospital.
During the first day, I felt anxious because I
am not that confident as to how to interact
with mentally ill people for we were used to
intermingle with sick patients who were
confined in the hospital. It was really a
challenge to be therapeutic at all times
therefore I deemed it inevitable to have non
therapeutic interaction lapses.

Rizzi Fern Grace A. Nuyad In this exposure, I was able to gain


confidence due to the occasions when we
were all required to speak in front of the crowd. Consequently, I was able to conquer it.
Through this exposure, it enabled me to open my mind to different aspects of life. Such
experience taught me to never judge a person by his outer look, rather be sensitive
because we dont know the battles they are struggling to fight inside their mind. In
addition, this said exposure had lot of activities, like therapies for example, which
demand most of our time for preparations alone. This was the most tiring exposure that
even on a Sunday we had to meet to practice and plan for the upcoming activities. Yet,
all the efforts were worth it. All the sweat and blood were paid off and we were able to
pull it off which subsequently made our clients happy.
I really enjoyed this rotation despite of the requirements and hectic schedule. It
was like riding a car and everything was on fire. Since this would be our last rotation, it
was also one way for us RLE groupmates to be much closer to each other, even were
tired we were able to manage to smile and laugh because we are the best.
-

91
In my four weeks of going back and forth in
Pototan, I realized 3 things in mind. This rotation
will be one of my most awaited of all rotations
because of the thrill and excitement it will give me,
not only a challenge but I also consider this
rotation as a stepping stone on my journey of
becoming a registered nurse someday. Handling
patients with mental illness would be hard but you
can never say its hard if havent tried it. Its funny
to think that people would usually stereotype about
mental issues but unknowingly people who are
suffering in those disorders would just live a
normal life like us. They even have the mental
-Khryss Paula S. Baldonado capacity which other normal people cannot do. As
what I have observed during my stay, you can
never underestimate a person who is mentally challenged. Second realization I have
was this rotation will be a big burden in terms of requirements, paper works and
finances. It really was a pain in my wallet. My food, fare and extra expenses for the
requirements were hassle. But at the end of our rotation, it was all worth it. Our clinical
instructors were happy, the patients were happy and that makes us an effective
advocator of happiness and serves as an inspiration for us to continue what we have
started. The patients there were not only talented but can also adjust to what society
do.
I felt nervous when interacting with the clients at first because I was afraid to be
non-therapeutic and it will affect there interaction with us but I was wrong. The
patients viewed us that we are a big help to them. We can lend our ears for them to tell
their own problems or share their past experiences. Lastly, the final realization I have
was the patient who were admitted there were lonely type of people. And when we
have our activities and therapies, I can see smiles on their faces which indicates that
what we did for them, for us it may be simple and for school purposes but them it was
a day full of laughter and the same time it was a great time for them to learn new
things.

92
It was first week of our exposure, we were
assigned In Pototan Mental Health Unit. It was my first
exposure in psychiatric ward and I was nervous that how
would patient response to me and how would I take
history from patient although theoretically, I have sound
knowledge about communication with psychiatric patient
but practically, it was my first exposure. In the psychiatric
ward, there were few patients. We were assigned
together with my partner Ms. Amiscua a patient with the
diagnosis of Schizophrenia named Robin. We have taken
prior data and history from the patient according to
therapeutic manner, and use communication skills.
Because of that, our relationship with the patient is
stable. I observed myself that I became more come
comfortable each passing day. Due to noticing through
nonverbal communication, I also observed that the
Henry Maurice G. Gomez
patient become more comfortable to share his feeling,
thinking, and his problems. Because of my
communication skills, I identified most of my patients problems which were also
noticeable from doctors.
Each program that we have prepared is something exciting and a must priority
in each and every one of us. From orientation until the culminating program, we found
ourselves slightly relaxed and joyful when we can see our patients are there and
cooperating with us which is a really heat warming experience to all of us. Although
the patients mental soundness is impaired but is something we cannot control, we are
mostly have the knowledge to handle and to communicate with them which helps us
and them to facilitate our management and therapeutic skills.
At the end of the week, I learned that Therapeutic communication skills are the
most powerful tool that we should have in facing these kinds of patients. It is the basis
of therapeutic nurse-patient relationship. I feel every time I communicate with our
patient, and base to my experience, that communication is a complex process and a
need to be practiced to be used effectively. In my opinion, based on my experience and
knowledge combined, I define Therapeutic Communication Techniques are methods
that is used to encourage patients to interact in a manner that promotes their growth
and moves them toward their treatment goals. All the communication must be aimed at
preserving the self-respect of both the helper and the helpee.
-

93
Psychiatric Mental Health Nursing RLE was
far more different than the other rotations. Unlike
the other areas, here, we were exposed to Pototan
Mental Health Unit a mental institution, we were
able to interact with the mentally ill people, we had
lots of programs and activities, we were not allowed
to take down notes during interviews and we must
be very cautious in our words and actions. These
may be are some among the important guidelines
that we must keep in our mind, even those
guidelines are sometimes hard to follow yet the
sacrifices are all worth it.
From the very start of this rotation, I already
learned a lot during our self-awareness activities, I
Dinah Espina was able to open up a part of my life and I felt light
and at the same time glad to myself since opening
up is not my thing. The second week up to the end of the rotation was the most
exhausting time of my entire nursing life, with all the requirements and preparations
which caused me strains, however, Im always looking forward each day to new
experiences and unforgettable moments. Everything was overwhelming especially when
I saw the patients smiling faces, their thankful gestures and appreciative words.
Hearing their life stories made me realized how lucky and blessed I am to have a good
and healthy body and mind. This rotation taught me to be contented of what I have
and be glad to have a supportive people surrounding me. Furthermore, the whole
learning experience will always be remembered as this imparted so many lessons to my
life.

94
Seeing mentally ill persons, or buang as what
we call it in dialect, gives one a thought of a
gross, weird, dirty, unhygienic, hurt others,
and loud person because that is what the
stigma usually implicates. However, after being
exposed to Pototan Mental Health Unit
(PMHU), I did not just learned and applied the
lessons weve learned in our school lectures
but the exposure somehow changed my
Christine Joy Quilla perception not just towards the mentally ill
persons but also my perception and the way I
interact with others.
In this rotation, I was able to know my capacity as a student nurse in terms of
having and maintaining a therapeutic relationship with my assigned mentally ill patient
with no other instruments or apparatus used but my words and my clinical judgment
regarding particular situations. This rotation was also far different from the clinical since
in this rotation; you only have yourself and your words as your shield and armor in
interacting with patients.
Moreover, it was such a great opportunity to be able to hear and witness how
the family and its members showed their unconditional love and support to their
respective patients and how they are passionate, hopeful, and eager to see them get
treated and became their own selves again for not everyone is given the chance to
know and to probe deeper to the story behind the story of each of these patients have
but we, the nurses. And the best part is that when the rotation ends and the family
would say a lot of thank yous about what youve done (even if its just taking the
patients vital signs and giving their medications). Its the most fulfilling and satisfying
thing that no money could ever buy when youre a nurse, a student nurse.
It has been a productive month and it was such a great learning experience.

95
Our psych rotation is indescribable. The whole
4 weeks was so fast. At the start of the area, I'm
wishing to end it soon because of the requirements
and the activities were preparing each day.
However, our last week really had an impact on me.
A lot had happened and it made me realize that
simple things need appreciation. Even by just the
eye contact or the smile of each patient, everything
was so fulfilling. Being able to know their stories will
make you understand them more. This rotation also
Ma. Hearty C. Sernicula made me discover the extent of my flexibility skills.
It also helped me improve my talent and build
stronger relationship with my group. My experiences
in this rotation is memorable because of our group's teamwork and our CI's guidance.
Goals met. *thumbs up

96
They may say Psychiatric Rotation is the most
challenging rotation in a way that we will handle
different kind of patients than the usual patients we
taken cared of in the hospital and also this rotation is
hard and we should invest so much effort. Yes, they are
correct in terms of the requirements and all the
activities and most of all dealing with the patients who
are mentally-ill. In short, we should be prepare our
selves physically and mentally for us to be able handle
those stresses and obligations that we need to do in
Jaesa Fae G. Anion order for us to be successful in this rotation. In this
rotation, you should first need to engaged yourself in
self-awareness activity and you yourself should know
your limitations and capabilities as person before dealing with the patient who are
mentally impaired. It is hard to deal with them in terms of communication, so we
should keep in our mind the lessons taught to us on how to become therapeutic in all
aspects while we are communicating to them. We should be aware and more cautious
on what we are saying or on what we are acting to avoid misunderstanding and
misinterpretation of those verbal and non verbal cues.As we are doing our exposure at
Pototan Mental Health, first, I was so very nervous and anxious and I dont know what
to say or act around our patients but as time passed by I learned to be more confident
and act naturally around those patients as if they are just normal person who are
talking and giving us informations that we need. We also conducted lot of activities
which could surely help them divert their attention and help them recover. I really
enjoyed all the things weve done in that institution.
We student nurses also learned many things about our patients on how they
acquired this kind of situation, how they felt about it and how they cope and help
themselves in order for them to recover fast. We also heard all their sides and also their
families side regarding to this matter. And it is sad to say that their selves also do not
know why their family is having this kind of situation. I learned that it is important that
we should be more considerate on our patients because they are experiencing different
kinds of hallucinations and delusions that can alter their thought process. And also we
should understand their situation because in the first place they dont also want to be in
that situation. I also learned in this rotation that even small actions could affect on the
things around you. So we should be more careful on what we are doing to avoid
situations that can bring you to harm and can cause problem to yourself and other
people.

97
As a Student Nurse, it is required for us to
study and to be exposed in Psychiatric Health
Nursing. When I was in High School, every time
we went to Iloilo, we were able to passed by the
Pototan Mental Health Unit. Sometimes, I wonder
whats inside the institution.
This time, I was able to answer my questions
and thoughts when I was in High School. Luckily, I
was able to chose nursing as my course. But
Gail Krizelle V. Mediodia
before we were exposed in the PMHU, we had our
Self-Awareness activity first. I have also received
some endorsement from the other group that this rotation is really fun but there are
lots of requirements to be passed. As we start our tour in the PMHU, I was really
nervous and I dont know what to feel. Theres already questions and thoughts in my
mind of whats going to happen next when we go there. As we arrived, my expectations
is beyond on what I saw inside the PMHU. As we went there, I was very anxious
because I have a fear of people weve known as buang.
In this rotation, I was able to know my strength and weaknesses and also my
capacity as a Student Nurse. What I have learned during our lectures is very helpful to
us. I was also challenged to maintain a therapeutic relationship with my assigned
patient. This rotation was also far different from the other rotation. We only have few
minutes to interact with our patient yet every interaction is very important. Knowing
that they suffer in mental illness but still we have to listen very deeply in them. It was
also a great opportunity to be able to hear their stories. I was also able to witness their
families struggles and unconditional love and support to their loved ones. I was very
happy knowing that somehow, we were able to help them and lessen their anxiety.
Seeing them enjoying every activity we were conducting, it was very fulfilling in our
part. Nothing could compare how we feel seeing them like that, all the struggles were
facing every day is getting lighter whenever we felt like we were able to help them. And
thats what makes a good nurse.

98
Clinical rotations are a critical component
of nursing education. Clinical experience
presents the opportunity to work with real
patients, experience work environments, and
learn how to work with fellow nurses,
physicians, and other members of the health
care team. It may sound intimidating, and
maybe even frightening, but exposure in the
Psychiatric and Mental Health Nursing offers a
learning opportunity to build the foundation of
nursing education.

Marielle Patrice S. Lamaslig Being in the PMHU stripped out the


stigma society planted in my head. It gave me
realizations after realizations of things I thought I could not do, but did. It also
heightens my skill in therapeutic communication and in areas of both verbal and non-
verbal communication. It expands my understanding of people and it molded my
patience into a larger container. I have learned how to manage myself and maintain
composure amidst all the time-constriction and stress.

Above all, I have realized that lack of awareness, increasing statistics of mental
health illness, and lack of funds despite the increasing need demands for Mental
Health Law to be implemented and the government should take lead in the awareness
campaign for the society to be motivated and be more sensible to issues around them,
unseen by the naked eye.

99
Psychiatric Mental Health Nursing is the
rotation I dread about but at the same time it
excites me. Before the start of this rotation I
have been hearing feedbacks about how tiring
this rotation is, from going to Pototan and back
to Iloilo, going home late and finishing
requirements. I keep on asking those who have
already been on this rotation and I always get
the same response.
I really prepared myself prior to this
rotation because I know this is the last in this
semester and it will be also on Finals month,
Kezia Marie Catedral with research and all those requirements.
For time of being there in PMHU I really feel conscious because I know that
patients there are very sensitive and also I cant erase in my thoughts the possibility of
what could happen Ive been really anxious but as day by day I overcame it and I
started to adapt. It was my first time to interact with someone who has a mental illness
so it really is a challenge to me with regards to communicating with the patient. When I
saw the improvement of the patient as weeks have past I felt a sense of happiness for
the patient, although my help may not be that much but still know that I did my part to
make the patient better and it really is very fulfilling.
This rotation came by too fast, maybe because we were busy that we havent
notice it. It was not only hardships but also I really had fun all throughout especially
riding that small van which is always overloaded because we have to fit 24 persons
inside. All those jamming moments was priceless.

I learned a lot because of this rotation it enhanced my way of dealing with


situations especially the self awareness activity, it gave me a lot of realizations and Im
really thankful for that activity. These moments will forever be with me it makes me
glad that I decided to be a nurse.

100
First and foremost, the whole rotation was
revealing!. It was just a blink, except for the
requirements like right in this exact moment I'm
writing this reflection I'm also editing our behavioural
analysis and cramming for the movie analysis, but
anyways back to my reflection.

Psychiatric nursing in the first place is a major


eye-opening rotation for every student nurses, it's
where we become aware of our own thoughts and
understanding, the way we facilitate our coping
Eugene Omilig against stress. It's the rotation of a lifetime, the
activities, the travels, the road music, the laughs and
conflicts and all of those therapeutic communication skills.

Every week is a long week if you're on duty. My capability as a human being is


being tested in this rotation when school stuffs overwhelm your daily life pattern to the
point where you forget what time it is, and repeatedly ask you self Do I really need to
sleep?, but anyways the EXPERIENCE is mesmerising and someday I'll surely miss this
rotation.

Tears been shed, and it feels deserving to take nursing to a whole new level, it's
where I realized the purpose of holistic care. This rotation surely deserves a part of my
student nurse experience.

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It was the most challenging and tiring rotation.
Thats what everyone said to us, but it was also one of
the most memorable rotations. We prepared ourselves
upon entering the psych rotation especially that our
schedule is heavily loaded of lectures, everyday
quizzes, post tests, and final exam. That we should be
mentally and physically ready especially that we have
lots of requirements to do which is to be submitted on
the next day and a planned activity every day on our
duty. It was a great help and also a good way for us
that our RLE instructors have us an activity called self
Kaye Marie Haro awareness before our contact with our patients and Im
thankful for that. It taught me a better understanding
of myself, to know my area of strength and weakness and most especially that I had
identified the areas where to make improvements.

On our first visit in Pototan Mental Health Unit, which is our orientation, I was
excited and very anxious at the same time. I dont know if my actions, the way I speak
and react are appropriate. But as time goes by I felt comfortable speaking and talking
with the patients although Im still a little bit anxious to the words Im using. I was
happy seeing our patients participate i9n our activities. Seeing them smile, laugh, and
speak in front of the other patients made me realized that they are also like us normal
people. Speaking through therapeutic communication is also a one big help for me. I
learned the importance of therapeutic communication in this rotation, not only that but
also the genuineness you give to the patient. We student nurses have learned many
things in this rotation. Being a one team, to build trust not only to our patients but also
in our members, to empathize, and to be true. Having an exposure in this area made
me more knowledgeable to mental health. To many, having such disease or illness is a
stigma to our society and by that there should be awareness and knowledge to this
area.

At the end of this rotation, I have seen a part of our patients lives. It was a
great opportunity to be in this rotation despite of sleepless nights, paper works,
program planning, practice, and study. I can say that it was all worth it. I know from
the start that we can survive this rotation and we did.

102
During my 4 weeks of exposure to psyche
rotation, Ive been able to discuss my fears my
strengths and weaknesses on the first day of our self-
awareness. It was stressful but relieving to know that
although youve been vulnerable, you have been
honest with yourself and with others. And the first
that came to might mind as soon I left the building
after a god cry is that the world got brighter than I
remember. The next few days will be the thrill of my
life that I will never forget. Being the odd one out,
meant that I left with nobody around most of the
time and having only anxiety, self-degrading thoughts
and self-pity as company. But my friends tried their
Beatriz Dela Pena best to make me feel part of the team, that I can be
fine just being there and rebuild my self-esteem. It
was no easy task, I tell you.
To give enough of your effort to both your patient, your studies and to be a good
student and daughter at the same time takes more than 75% of twice the person that I
am. And I have to admit, Ive had times where I just want to quit. My shortcomings and
never-ending responsibilities tempted me to just take one long break from it all. But
seeing my patients, my friends, my Clinical Instructors, seeing everyone like this,
enjoying the program, sharing stories; it gave me unknown strength to push on. And
like the staff nurses and bantays, though it may seem impossible to reach your goal,
and perhaps there will never be an end to it all, but to give and serve for the people
that you care for and cares for you. Its rejuvenating.
They may not be the same person as before, no one is. Not even me. But to be
where the people that you care for and just for being there is what makes me human,
what makes me happy. Know that there is no straight way to do things right, it just
have to done with the right people.

103
This rotation gave me so much to learn, it
brought me into a somewhat whole new level of
being a student nurse. I was tasked to speak for the
opening remarks of of our culminating activity. I was
at first, kind of hesitant because I didn't know how
to speak in deep ilonggo. I made my speech one
day prior to the event which was really very last
minute. I asked help from my friends.
I didn't know what to expect because i will

Norbeth Angelie Villegas be speaking in front of our patients and their


watchers. This rotation really was a blast. . its just
sad that this is our very last day in PMHU because although it was really tiring here, I
still learned a lot from it and it gave me a lot of realizations in life. It taught me how
blessed I am to be normal and to have a good life. Some people out there are already
struggling so much to live yet here I am, having so many blessings in life. Everything I
have right now is from the Big Guy up there.
And so this rotation made me realize that I should be thankful of whatever I
have right now. I also gained something for myself. I have made a change for myself. I
became more productive, I believe. I learned to work in a group without making any
indifferences towards each other. This rotation is by far on of the best!

104
Thank You!
From BSN 3C and 3D
Batch 2018
The Infinites

105

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