Republic of the Philippines

PALAWAN STATE UNIVERSITY

College of Nursing and Health Sciences
Puerto Princesa City

In Partial Fulfilment of the Requirements in NCM 105-B

(Related Learning Experience)
GRAND CASE STUDY
Vicente Sotto Memorial Medical Center – Psychiatric Ward

SCHIZOPHRENIA

Presented by:
Bantol, Regine S.
Casilagan, Yrman Christian Rodrigo L.
Cervantes, Liana S.
Daganta, Patrice Jane A.
Enriquez, Meverie DC.
Fernandez, Bobby Jr. R.
Garcia, Kina Mae G.
Gonzales, Salihjanh Khan S.
Mayuga, Kate L.
Narido, Jerald B.
Rosellosa, Marjorie R.
Tierra, Shilly Mayffee O.
Tirapan, Jeneva J.

Presented to:
Rachel F. Labastilla, RN, MAN
Grace O. Teves, RN, MAN

1
 ACKNOWLEDGEMENT

The price of success is hard work, dedication to the job at hand, and the determination that no
matter what happened, I have applied the best of myself to the task at hand.

With this, we would like to extend our heartfelt gratitude to the following individuals who have
made the completion of this research possible.

First of all, the Almighty God, for continually providing abundant gift to us, for the blessings
which enabled us physically, mentally, socially, emotionally and spiritually. We bring back all the glory
and praises to His precious name.

To our cherished University President, Dr. Ramon Docto, for raising academic excellence in
Palawan State University.

To the faculty members of the College of Nursing and Health Sciences especially Dean Mary Joy
Habaradas, RN, MAN, ND, for the help and assistance on the activities and also for elevating the student’s
competencies.

To our beloved Clinical Instructor in the Male Psychiatric Ward, Mrs. Rachel Labastilla, RN,
MAN and Mrs. Grace O. Teves, RN, MAN for being the best Clinical Instructors, compassionate on
sharing their knowledge and for sacrificing their time and effort just to help us on conducting this study.
Also for their advice, constructive criticism, support and hard work. For allowing us to experience new
and exciting things. Rain or shine, you’re with us. Thank you!

To Vicente Sotto Memorial Medical Center for allowing us to affiliate in the hospital specifically
in the Male Psychiatric Ward.

To Psychiatric and Medical Nurses and Nurses Aids in the hospital, for their hospitality and trust
to share their knowledge regarding their work matters;

To our Parents, for inspiring us while extending moral and financial support as they face all the
obstacles to complete the study;

Friends, peers and classmates, who in one way or another helped, shared a bit of their ideas and
for their positive support even when things seems impossible to finish during the accomplishment of this
case study.

2
 INTRODUCTION
Schizophrenia is mental disorder that usually appears in late adolescence or early adulthood.
Characterized by delusion, hallucination, and other cognitive difficulties, Schizophrenia can often be a
lifelong struggle.

There were kinds of Schizophrenia such as Paranoid Schizophrenia where a person may have false
beliefs, or delusions, that an individual or group of people are conspiring to harm them or member of
their.; A person with Schizoaffective disorder experiences a combination of schizophrenia symptoms,
such as hallucination and delusions, and mood disorder symptoms, such as mania or depression.; Next is
Catatonic Schizophrenia can occur with Schizophrenia and range of other conditions including Bipolar
disorders. ; Childhood Schizophrenia normally appear during early adulthood, but they can sometimes
emerge during childhood, at the age of 10 years or earlier. It is extremely rare, with an incidence of less
than 0.04 percent. And lastly is Disorganized, or Hebephrenic Schizophrenia where a person may have
incoherent and illogical thoughts and speech. This can make it difficult to perform daily activities and this
can lead to frustration and agitation.

Researchers believe that a number of genetic and environment factors contribute to causation, and
life stressors may play a role in the disorder's onset and course. Since multiple factors may contribute,
scientists cannot yet be specific about the exact cause in individual cases. Since the term Schizophrenia
embraces several different disorders, variation in cause between cases is expected.

Schizophrenia most commonly strikes between the ages of 16 and 30, and males tend to show
symptoms at slightly younger age than females. Schizophrenia affects approximately 1 percent of all
adults, globally. In many cases, the disorder develops so slowly that the individual does not know that
they have had it for many years. However, in other cases, it can strike suddenly and develop quickly.

The New Philippines Health Information System on Mental health reported that Schizophrenia is
the most common mental disorder for Filipinos.

A survey was made to 2,562 mental health sufferers from 14 public and private hospital from May
2014 to May 2016.

Last April 23, 2019, we encountered a patient with schizophrenia. This patient has
caught our attention and has given the opportunity to study his case. The objective of this study is to
help us understand the disease process of schizophrenia and to orient our self for appropriate nursing
interventions that we could offer to the patient. This approach enables us to exercise our duties as
student nurse which is to render care. We were given the chance to improve the quality of care we can

3
offer and to pursue our chosen profession as future nurse. We humble our self to present our studied
case and submit our self for further corrections to widen the scope of our knowledge and understanding
about schizophrenia.

PATIENT PROFILE
NAME: Mr. R

GENDER: Male

STATUS: Widowed

ADDRESS: Compostela, Cebu

BIRTH PLACE: Iligan City

BIRTHDATE: June 12, 1960

AGE: 58 years old

EDUCATIONAL ATTAINMENT: Elementary Level (Grade 3)

OCCUPATION: Street Sweeper

RELIGION: Roman Catholic

DATE OF ADMISSION: April 12, 2019

CHIEF COMPLAINTS: Agitated Behavior

ADMITTING PHYSICIAN: Dr. Gian Alcris Villas

ADMITTING CLERK: Merl Clomente

ADMITTING DIAGNOSIS: Schizophrenia

4
Present Health History

Six months prior to confinement, patient was noted to stop taking his unrecalled maintenance
medicine and spit it out when asked to drink. Patient was seen walking around the municipal hall with
black sleeves and act as if he is blessing random people with holy water doing the cross sign with his
hand. Persistence of condition prompted to Mayor to send the patient for admission. According to
vagrant incident report, the incident happens on April 11, 2019 at 12:30 pm. Here is the incident report:
“Wala na makatrabaho, kay trabaho man ni siya sa munisipyo magsige ng lakaw lakaw, wala nay kaon,
wala na maka inom sa iya tambal.”

The patient was admitted on April 12, 2019. He was with the social worker when he was
admitted.

Past Health History

No history of hospitalizations, no known surgeries done, non-hypertensive, non-diabetic, non-

asthmatic, but the patient had a consultation in Vicente Sotto Memorial Medical Center for changes in
behavior after his wife died. Diagnosis and medicines were unrecalled.

Family History

Patient mother is also known to have a mental disorder but DSWD worker claim that they live in
a different household with the patient and doesn’t interact much. Patient eldest son also has mental
problem which was undiagnosed. The client stated that he has four children, two son and two daughters,
who live in Compostela Cebu. His wife died because of ovarian cancer.

Patient works as a street sweeper under the Solid Waste Department in Compostela Cebu.

5
6
GENOGRAM

Patient

Male

Female

Mental Disorder

Deceased

Unknown

7
 GROWTH AND DEVELOPMENT

Stage
Generativity vs. Stagnation
During middle adulthood, we
establish our careers, settle down
within a relationship, begin our own
families and develop a sense of
being a part of the bigger picture.
We give back to society through
Erik Erikson
raising our children, being
(Ages 40 to 65 productive at work, and becoming
years) involved in community activities
and organizations.
By failing to achieve these
objectives, we become stagnant and
feel unproductive. Success in this
stage will lead to the virtue of care.
Manifestation
Patient R stated, “Sa pag ka
matuod lang gibasol jud nako ang
akung kaugalingon na naah ko diri,
gipasagdan nako ang kung sarili.
Nadugmok sa mga problema na
dili nako gisuod sa akung
hunahuna na naapa ko mga anak na
nagdumdum sa akuah.
Mao gani karon nagapangamoyu
ko namuayo nako sa akung sakit
para maka guwas nako diri, ug
makauli nako sa akung mga anak
na akung napasagdan tungod sa
akung sakit, ug makatrabho napud
ko para makatabang nako sa akung
mga anak.”

8
 PATTERNS OF FUNCTIONING
Date of Examination: April 29, 2019

Patterns of Functioning Clinical Examinations Other Sources

Respiratory Respiratory rate:
O2 sat:
The client stated that he has no
history of chest pain and
difficulty of breathing. He had
a history of smoking. He
started smoking during his
adolescence years. He smokes
two sticks per day and drinks
alcohol occasionally.
Circulatory Blood Pressure:
The client doesn’t have any
history of hypertension, heart
attacks, or any cardiac problems.
He also clarified that he did not
experience any dizziness,
fainting, palpitation and chest
pain.

No history of edema and swelling

in parts of the body.

FOOD AND FLUID INTAKE During hospital stays, he

The client stated that he had his usually eats meals three times
meal three times, sometimes two a day. Morning, noon and
meals per day. He usually eats 2 dinner. Mr. R said that he
cups of rice and vegetables. usually eat egg, meat, fried
and plain rice. He usually
The water intake is usually two drinks approximately 3 liters
litres. Client’s water source is of water daily.
tap water. The client drinks 1
cup of coffee, 3 in 1, He
occasionally drinks soft drinks
like coke or juices at least once a
week.

He said that he have no food

allergies. He likes foods like
kakanin like biko for merienda.
He also likes to eat spicy foods.

9
ELIMINATION Clients move his bowel once a
The client moves his bowel once day usually morning at 6:00 o
a day every morning at 7:00 with ’clock, yellowish brown in
a color of yellowish to brownish color
in color. He voided He voids 6 to 7 times a with an
approximately 3 times a day with amount of approximately
an amount of approx. 150 ml per 200ml per void. Yellowish in
void. color.

• REGULATORY Body Temperature:

MECHANISMS
The client experienced
intermittent fever for days
associated with cough and
colds. He took Paracetamol 500
mg once a day and increased
his water intake as a relief
measure.
HYGIENE He takes full bath twice a day
and changed his clothes once
The client takes a full bath once
a day also. He uses whatever
a day. He changed his clothes two
shampoo and soap is
to three times a day. He use Head
available. He didn’t brush
and Shoulder as his shampoo
his teeth during clinical
and safeguard as his bath soap
examination. He has
everytime he takes a bath. He
yellowish color of teeth with
had no allergies in self-care
cavities. And have a mouth
products. He brushes his teeth 3
odor.
times a day after meal. He uses
Colgate as his toothpaste.

ACTIVITY & EXERCISE He’s having exercise only

He has no certain exercise but
he walked every Saturday and
Sunday to his farm which serve
as his exercise
REST AND SLEEP
The client sleep at 9:00 pm and
rises at 6:00 am. He had no
difficulty in sleeping.
He uses mosquito net and two
pillows when sleeping. He
prefers to sleep in a supine
position. He always prays before
going to bed.
before therapies which are
conducted by nursing
students.
Mr. R sleeps at 8:00 in the
evening and wake up at 5:00
in the morning. He sometimes
had a difficulty in sleeping
due to uncomfortable bed and
surroundings. He uses one
pillow when sleeping.

10
COMMUNICATION AND Mr. R can hear within one
SPECIAL SENSES meter and far. He speaks and
hear clearly. He speaks Bisaya
According to him he
but also understands tagalog
doesn’t have visual and
language.
auditory disturbances. He uses
Bisaya in communicating and
uses his right hand when writing.

COGNITION & He is oriented to time, date,

PERCEPTION place and person. He responds
(sensory) to verbal and tactile stimulant.
The client doesn’t have a history
of convulsion, loss of
consciousness nor epilepsy.

PAIN AND DISCOMFORT No pain felt during hospital

stay.
Clients said that he felt back
pain before. He just take
mefenamic 500mg to relieve
his pain

RECREATION AND Mr. R said the he doesn’t

DIVERSION
He usually listen to radio for
music and news when he had
nothing to do.
have certain diversional and
recreational activities. He just
sleep when there’s nothing
to do. He attends exercise and
participate in therapies when
there is any.

He never went to church ever

since he was admitted to the
• RELIGIOUS LIFE hospital but makes sure that he
The client is a Roman always pray. He prays before
Catholic. He goes regularly to going to sleep, in the morning
church every Sunday. He also when he wakes up, and every
prays every day before going to time before he eats.
bed.

ROLE AND RELATIONSHIP During interview, when Mr. r

He was a farmer before, and
then he applied for street
sweeper and become one.
When he started as a street
sweeper, he rarely come to his
’s wife died he started to
have depression, he started to
loose his children. His
children stopped attending

11
farm. He visited his farm school. They had to work for
during weekdays only. living and lived in separate
ways.

12
 PHYSICAL ASSESSMENT
Date: April 29, 2019

Vital Signs Normal Values Result Interpretation

Blood Pressure 120/80 mmHg 130/80 mmHg This signifies high blood pressure. High
blood pressure can be a cause of heart
illnesses.

Respiration 12-20 cpm 24 cpm The result is not within the normal range.
High rate of respiration can be the result of
anything from lung infection to heart
failure.

Pulse Rate 60-100 bpm 45 bpm The result is not within the normal range.
Low pulse rate or bradycardia is a sign of a
problem with the heart’s electrical system.

Temperature 36.5-37.5˚C 36.7 ˚C Within in normal limits. High body

temperature can be a cause of infection.

Oxygen 95-100% 99% Within normal limits. Low rate of Oxygen

Saturation Saturation signifies insufficient oxygen in
the blood.

13
Assessment Normal Values Clinical Examinations
General Appearance  Skin is uniform in  Appears neat and clean
color  Skin color is fair
 Can respond to
 Appears neat & clean questions
 Conscious, alert and  Awake
responds to questions
 Facial expression is
appropriate for the
situation
 Responds to external
stimulants
Head, Hair and Scalp  Smooth and soft  With white
 Evenly distributed  (+) Presence of dandruff
 No presence of lice, and (-) lice
dandruff, lesions, mass  (-) lesions and masses
and discharge.  Round and symmetric
 Face is symmetrical,
centered-head position.
Eyes  Blinking symmetrically
and involuntary  Eyelashes and
 No discharges other than eyebrows are well
tears and eye dirt distributed and equal
 Eyebrows are evenly  No swelling, masses
distributed and lesions
 Eyebrows are horizontally  Sclera appeared white
aligned with each other and right periplural
 Eyelids are moist and vision not intact.
pinkish PERRLA
 Pupil is equally round and  No discoloration
reactive to light  Can move in 6 cardinal
movements
Ear  Ears are equal in size with
similar appearance  Pinna are aligned with
 Color must be the same outer canthus of the
with the skin color eyes

14
  Skin in the external ear
must be smooth and pink
Nose  Aligned at the center of
the face
 No redness in nasal
mucosa
 No discharges
 Able to sniff in both
nostrils
Lips and Mouth
 No lesions and mass
 32 number or teeth
 Can open mouth without
pain or disturbances
 Can chew and bite
 (+) Gag reflex
Neck  Can move from side to
side, up and down.
 No mass and lesions
 Color must be the same
with the skin color
Upper Extremities  Can do abduction,
adduction, extension and
flexion without any pain
 Smooth
 Can feel the radial and
branchial pulse
 Complete fingers
15
 Color of the ears are the
same with the skin
color
 Both ears can hear 1
meter away
 No presence of
discharges
 No tenderness
 No lesions, masses and
tenderness
 No inflammation
 No nasal discharges
 Able to sniff in both
nostrils
 No presence of lesions,
masses and tendernes
 Gums appeared pinkish
and firm and no
presence of lesions
 Yellowish teeth
 (+) Tooth decay in
upper and lower moral
 Can move up and down
 No presence of lesions,
masses and tenderness
 No swelling
 No presence of lesions,
masses, swelling and
tenderness
 Able to move freely
without any discomfort
 clean fingernails
 Fingers are complete
 (-) Edema
  Fingernails are well-
trimmed and clean
Lower Extremities  Can walk  No presence of lesions,
 No lesions, mass and masses and tenderness
wounds  No swelling
 Smooth  (+) scars
 Can do abduction,  Able to walk without any
adduction, extension and discomfort
flexion without any pain
or discomfort
 No scars
Cardiovascular  Vital signs are within  No cardiac heaves
normal range  No jugular vein distention
 No jugular vein distention  (-) Heart murmur
 No cardiac heaves or lifts
Musculoskeletal and  Can smile, frown, wrinkle  Can express himself very
Neurological the forehead and puff the well
cheeks  Can smile, frown, puff the
 Oriented to time and place cheeks, and wrinkle the
forehead
 Appropriate response
 Oriented in time and place

16
 ANATOMY AND PHYSIOLOGY OF NERVOUS SYSTEM

The anatomy of the brain is complex due its intricate structure and function. Thisamazing organ acts as a
control center by receiving, interpreting, and directing sensoryinformation throughout the body. There
are three major divisions of the brain. They arethe forebrain, the midbrain, and the hindbrain.

 The nervous system is your body's decision and communication center.

 The central nervous system (CNS) is made of the brain and the spinal cord andthe peripheral nervous system
(PNS) is made of nerves.

 The adult human brain weighs on average about 3 lbs. (1.5 kg) with a volume of around 1130 cubic centimetres
(cm³) in women and 1260 cm³ in men

17
 Anatomy of the Brain: Brain Divisions
 The forebrain is responsible for a variety of functions including receiving and processing
sensory information, thinking, perceiving, producing and understanding language, and
controlling motor function. There are two major divisions of forebrain: the diencephalon and the
telencephalon. The diencephalon contains structures such as the thalamus and hypothalamus
which are responsible for such functions as motor control, relaying sensory information, and
controlling autonomic functions. The telencephalon contains the largest part of the brain, the
cerebral cortex. Most of the actual information processing in the brain takes place in the cerebral
cortex.
 The midbrain and the hindbrain together make up the brainstem. The midbrain is the portion of
the brainstem that connects the hindbrain and the forebrain. This region of the brain is involved
in auditory and visual responses as well as motor function.
 The hindbrain extends from the spinal cord and is composed of the metencephalon and
myelencephalon. The metencephalon contains structures such as the pons and cerebellum. These
regions assists in maintaining balance and equilibrium, movement coordination, and the
conduction of sensory information. The myelencephalon is composed of the medulla oblongata
which is responsible for controlling such autonomic functions as breathing, heart rate, and
digestion.

Anatomy of the Brain: Structures

The brain contains various structures that have a multitude of functions. Below is a list of major
structures of the brain and some of their functions.
 Basal Ganglia - Involved in cognition and voluntary movement
- Diseases related to damages of this area are Parkinson's and Huntington's
 Brainstem - Relays information between the peripheral nerves and spinal cord to the upper parts
of the brain
- Consists of the midbrain, medulla oblongata, and the pons
 Broca's Area - Speech production
- Understanding language
 Central Sulcus (Fissure of Rolando) - Deep grove that separates the parietal and frontal lobes
 Cerebellum - Controls movement coordination
- Maintains balance and equilibrium
 Cerebral Cortex - Outer portion (1.5mm to 5mm) of the cerebrum
- Receives and processes sensory information
- Divided into cerebral cortex lobes
 Cerebrum - Largest portion of the brain
- Consists of folded bulges called gyri that create deep furrows

18
Cerebral Cortex Lobes
 Frontal Lobes - involved with decision-making, problem solving, and planning
 Occipital Lobes - involved with vision and color recognition
 Parietal Lobes - receives and processes sensory information
 Temporal Lobes - involved with emotional responses, memory, and speech

 Corpus Callosum - Thick band of fibers that connects the left and right brain hemispheres
 Cranial Nerves -Twelve pairs of nerves that originate in the brain, exit the skull, and lead to the head, neck and
torso
 Fissure of Sylvius (Lateral Sulcus) - Deep grove that separates the parietal and temporal lobes

Limbic System Structure

 Amygdala - involved in emotional responses, hormonal secretions, and memory
 Cingulate Gyrus - a fold in the brain involved with sensory input concerning emotions and the
regulation of aggressive behaviour
 Fornix - an arching, fibrous band of nerve fibers that connect the hippocampus to the
hypothalamus
 Hippocampus - sends memories out to the appropriate part of the cerebral hemisphere for long-
term storage and retrieves them when necessary
 Hypothalamus - directs a multitude of important functions such as body temperature, hunger,
and homeostasis
 Olfactory Cortex - receives sensory information from the olfactory bulb and is involved in the
identification of odours
 Thalamus - mass of grey matter cells that relay sensory signals to and from the spinal cord and
the cerebrum
 Medulla Oblongata - Lower part of the brainstem that helps to control autonomic functions
Meninges
- Membranes that cover and protect the brain and spinal cord
 Olfactory Bulb - Bulb-shaped end of the olfactory lobe
- Involved in the sense of smell
 Pineal Gland - Endocrine gland involved in biological rhythms
- Secretes the hormone melatonin
 Pituitary Gland - Endocrine gland involved in homeostasis
- Regulates other endocrine glands
 Pons - Relays sensory information between the cerebrum and cerebellum Reticular Formation
- Nerve fibers located inside the brainstem
- Regulates awareness and sleep
 Tectum - The dorsal region of the mesencephalon (mid brain)
 Substantia Nigra - Helps to control voluntary movement and regualtes mood
 Tegmentum - The ventral region of the mesencephalon (mid brain). Ventricular System - connecting
system of internal brain cavities filled with Cerebrospinal fluid

19
 Aqueduct of Sylvius - canal that is located between the third ventricle and the fourth ventricle
 Choroid Plexus - produces cerebrospinal fluid
 Fourth Ventricle - canal that runs between the pons, medulla oblongata, and the cerebellum
 Lateral Ventricle - largest of the ventricles and located in both brain hemispheres
 Third Ventricle - provides a pathway for cerebrospinal fluid to flow
 Wernicke's Area - Region of the brain where spoken language is understood

20
 PATHOPHYSIOLOGY OF ACUTE CEREBROVASCULAR ACCIDENT

Predisposing Factors: Precipitating Factors:

-Hereditary -Hypertension
-Gender: Male -Cardiovascular Diseases
-Age: 65 years old -Cigarette Smoking
-High Cholesterol
-Being Overweight
-Heavy Drinking
-Obstructive Sleep Apnea
-Diabetes Milletus

Narrowing of blood vessels

Formation of plaque deposit

21
 Occlusion of major vessels

Increase pressure in the blood vessels

Due to thrombosis, some neurons die because of lack of oxygen and nutrients

CVA (Stroke)

Cerebral Ischemia

Initiation of ischemic cascade

Anaerobic metabolism of mitochondria, which generates a large amount of lactic acid

Transient Ischemic Attack (weakness of the face, fingers, hands, arms)

Altered Cerebral Metabolism and decrease cerebral perfusion

Damage of the hemisphere of brain

22
 Increased Intracranial Pressure

-Numbness on the left side of the brain

-Trouble speaking
-Difficulty of walking, dizziness
-Sudden severe headache
If not manage If manage

Space occupying blood clot put more -Palliative care

pressure on the brain tissue -Frequent vital sign and neuro vital sign

The ruptured cerebral vessels may constrict to Good cerebral perfusion

limit blood loss, however, this vasospasm
will result to further ischemia and necrosis of brain tissue Good improvement

BRAIN CELLULAR NECROSIS Good prognosis

23
 LABORATORY STUDY

CHEMISTRY SECTION

DATE TEST RESULT REFERE INTERPRETATI SIGNIFICANCE

NCE ON
VALUES
BUN levels help
determine how
APRIL BUN 12.27 7.87-20.25 NORMAL
well your kidneys
13, 2019 mg/dl
Indicates that the function. When
kidney is BUN levels
functioning well. increase, your
kidney function
may be impaired.

Creatinine levels
help determine
CREATIN 0.94 0.8-1.3 NORMAL
how well your
INE mg/dl
Indicates that the kidneys function.
kidney is When creatinine
functioning well. levels increase,
your kidney
function may be
impaired.

SODIUM 137.70 135-140 NORMAL Helps maintain

mmo1/L mmo1/L fluid balance
There is normal and works on
sodium level nerve impulse
which is essential transmission.
to your body. Deficiency may
Sodium is result to muscle
particularly cramps and
important reduced appetite
for nerve and while if
muscle function excess could result
to high
blood pressure.

24
 POTASSI 3.93 3.50-5.50 NORMAL Helps maintain
UM mmo1/L Indicates that fluid balance
Renal System is and works on
functioning well. nerve and muscle
function.

CHLORID 104.90 98.00- NORMAL Chloride is an

E 108.00 Indicates that the electrolyte that
mmo1/L negatively charged helps maintain
ion works with proper fluid and
other electrolytes acid/base balance
to help regulate the in the body
amount of fluid in
the body and
maintain the acid-
base balance.

IMMUNOLOGYSEROLOGY SECTION

DATE TEST RESULT METHO INTERPRETATI SIGNIFICANCE

D ON
APRIL HBSAG NON- ICT No hepatitis B An antigen that
13,2019 REACTIV surface antigen marks active
E was found infection with
hepatitis B and
helps in the
prediction of the
clinical outcome
and management of
hepatitis B virus
(HBV) infection.
Anti-HCV NON- ICT No Hepatitis C An antigen that
REACTIV surface antigen marks active
E was found infection with
hepatitis C.
TYPHOID POSITIVE ICT Indicates that the Antibodies that are
IgG patient has dengue produced by the
fever infection in body in response to
the past. a dengue fever
infection IgG
antibody are
produced more
slowly in response
to an infection than
IgM.
TYPHOID NEGATIV ICT Indicates that the the first
IgM E patient has no immunoglobulin
current infection class produced in a
and has strong primary response to
immunity. an antigen. IgM

25
 antibodies are
relatively short
lived, disappearing
earlier than IgG.
Presence of
specific IgM
against a pathogen
in the serum of
patients indicates
recent/acute
infection and helps
in disease
diagnosis.

HEMATOLOGY SECTION
DATE LABORATO RESUL NORMA INTERPRETATI SIGNIFICANC
RY EXAMS T L ON E
VALUES
WBC 8.68 4.4-11.0 NORMAL Producing
April x 10^9/L Indicates that the antibodies to
13,2019 body is producing develop
enough antibodies immunity against
for immunity. infections. It
defends the body
against bacteria,
parasites, viruses
and tumors.
RBC 5.12 4.5-5.9 NORMAL RBCs contain
x 10^9/L The result is within hemoglobin,
normal range, this which carries
indicates that the oxygen to your
supply of oxygen in body’s tissues.
the blood is The number of
sufficient therefore RBCs you have
the organs and can affect how
tissues inside the much oxygen
body received your tissues are
sufficient receiving. Your
tissues need
oxygen to
function
effectively

26
 Hgb 153.00 140-175 NORMAL Hemoglobin is
g/L The result is within main
normal intracellular
range, this indicates protein of
that the erythrocytes. It
supply of oxygen in carries oxygen
the blood is and remove
sufficient therefore carbon dioxide.
the organs
and tissues inside
the body
received sufficient
O2.
Hematocrit 44.700% 41.5-50.4 NORMAL The hematocrit
Indicates normal measures the
percentage of RBC percentage of
in the blood plasma. RBC in the blood
plasma. This
determines if the
patient is at risk
for anemia,
dehydration and
low amount of
oxygen in the
blood.
Platelet Ct. 537 150-450 ABOVE NORMAL Needed for
x 10^9/L A high platelet normal blood
count can happen clotting; initiating
when something clotting
causes the bone cascade by
marrow to make clinging to turn
too many platelets. area; helps to
When the reason control blood
is unknown, it is loss
called primary, or
essential,
thrombocytosis.
When excess
platelets are due to
an infection or
other condition, it
is called secondary
thrombocytosis.
Differential NORMAL Phagocytes in the
Count: blood. These are

27
Neutrophil 53.30 55-65% Indicates that the the body’s first
body has no line of defense
infection and has against infection
good immune and bacteria.
defense.
Lymphocyte 30.30 25-35% BELOW Responsible for
NORMAL immune response
Below normal. It against microbial
indicates that invasion.
the patient is They are also
immunocompromis responsible for
ed fighting tumors
and wasn’t able to and viruses and
fight the inactivation of B
possible presence of cells.
microbes or
infection in the
blood
Monocyte 5.50 3-11% NORMAL Monocytes’ main
Normal. This function is to
indicates that the remove cellular
patient have active debris and
phagocytic microorganisms,
response a process called
phagocytosis.
Eosinophil 8.40 2-4% ABOVE NORMAL They help protect
Indicates that there the body
is a Parasitic against disease
disease or allergic and infections
reactions to by moving
medication. around and eating
some types of
bacteria, foreign
substances, and
other cells.
They are very
helpful in
defending the
body against
parasites.
Basophil 0.50 0-1% NORMAL Appear in many
Normal. This specific kinds of
indicates that the inflammatory
patient has active reactions,
immune response particularly those

28
 and is able to fight that cause allergic
presence and symptoms.
possible presence of Basophils contain
inflammatory anticoagulant
reactions. heparin, which
prevents blood
from clotting too
quickly. They
also contain the
vasodilator
histamine, which
promotes blood
flow to tissues.

29
 DRUG STUDY

GENERIC /BRAND INDICATION CONTRAINDICATION ADVERSE/ SIDE

NAME DRUG DOSSAGE EFFECT NURSING
CLASSIFICATION RESPONSIBILITIES

GENERIC NAME: Adverse Effects:

Olanzapine Antipsychotic 5- 10 mg BID  Treatment of  Contraindication  Somnolence,  Inspect I.M
treatment with allergy to dizziness, solution for
BRAND NAME: Dopaminergic schizophrenia olanzapine nervousness, particulation
zyprexa blocker  Acute mixed or myeloproliferative headache, matter and
manic episodes disorder severe akathisia, discoloration
associated with CNS depression personality before
bipolar 1 comatose states disorder, administration.
disorder and and lactation tardive
maintenance of dyskinesia,  Encourage patient
bipolar neuroleptic to void before
1disorder as malignant taking the drug to
immunotherapy syndrome, help decrease
or combined orthostatic anticholinergic
with lithium or hypotension, effect of urinary
valproate peripheral retention.
 Agitated edema,
associated with tachycardia,  Monitor elevation
schizophrenia constipation, of temperation and
and bipolar 1 abdominal differentiate
and mania pain, cough, between infection
pharyngitis and neuroliptic
malignant
syndrome.

30
 NURSING CARE PLAN

ASSESTMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired verbal At the end of
communication 30minutes to 1  Established  To gain patients At end of 30
Objective: hour of nursing rapport to cooperation. minutes to 1hour
intervention the the patient. of nursing
patient will intervention
Improved verbal patient verbal
communications.  Assess for  Establishing a baseline communications
incoherence facilitates the has improvement:
in speech is establishment of Speech
chronic or if realistic goals, the Clarity
is more foundation for planning
sudden, as effective care.
in an
exacerbation
of
symptoms.

 Identify the  Therapeutic levels of an

duration of antipsychotic aids clear
psychotic thinking and diminishes
medication derailment or looseness
of the client. of association.

 Encourage
patient to
talk slowly

 Keep voice  A high-pitched/loud

in a low tone of voice can
manner and elevate anxiety levels

31
 speak while slow speaking
slowly as aids understanding.
much as
possible.

 Keep anxiety from

 Keep escalating and
environment increasing confusion
calm, quiet and
and as free hallucinations/delusions.
of stimuli as
possible.

 Short periods are less

 Plan short, stressful, and periodic
frequent meetings give the client
periods with a chance to develop
a client familiarity and safety.
throughout
the day.

 Client might have

 Use clear or difficulty processing
simple even simple sentences.
words, and
keep
directions as
simple as
well.

32
 Look for  Often client’s choice of
themes in words is symbolic of
what is said, feelings.
even though
spoken
words
appear
coherent
(e.g.,
fearful,
sadness,
guilt).

33
34
35
ASSESTMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Disturbed thought At the end of  Established  To gained At the end of
Subjective: process 30minutes and rapport to patients 30minutes and
1hour of nursing the patient. cooperation. 1hour of nursing
intervention the intervention the
Objective: patient will develop  Attempt to  Important patient will develop
trust in at least one understand clues to trust in his nursing
nursing student. the underlying student and other
significance fears and staff at Ward 12 of
of these issues can be psychiatric.
beliefs to the found in the
client at their clients
time of their seemingly
presentation. illogical
fantasies.
 Recognizes
the client’s  Recognizing
delusions as the client’s
the client’s perception can
perception of help you
the understand the
environment. feelings he is
experiencing.

Identify feelings
related to delusions.
For example;

 If clients
believe
someone is
going to
36
 harm him,
client is
experiencing
fear.
 If clients
believe When people believe
someone or that they are
something is understood, anxiety
controlling might lessen.
his thoughts,
client is
experiencing
helplessness.

 Do not touch
the client;  Suspicious
use gestures clients might
carefully. misinterpret
touch as either
aggressive or
sexual in
nature and
might interpret
it as
threatening
gesture. People
who are
psychotic need
a lot of
personal space.

 Arguing will
 Initially do only increase
not argue clients
with the defensive
clients’ position,
37
 beliefs or try thereby
to convince reinforcing
the clients false beliefs.
that the This will result
delusions are in the client
false and feeling even
unreal. more isolated
and
misunderstood.

38
39
40
ASSESTMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Defensive coping At the end of  Established  To gained the At the end of
30minutes and rapport. patients 30minutes and
Objective: 1hour of nursing cooperation. 1hour of nursing
intervention the  Explain to  Prepares the intervention the
patient will client what you client patient will
interacts with are going to do beforehand interacts with
others appropriately before you do and minimizes others appropriately
it. misinterpreting to the student nurse
your intent as and to other patient.
hostile or
aggressive.
 Assess and
observe clients  Intervene
regularly for before client
signs of loses control.
increasing
anxiety and
hostility.

 Use a  There is less

nonjudgmental, chance for a
respectful, and suspicious
neutral client to
approach with misinterpret
the client. intent or
meaning if
content is
neutral and
approach is
respectful and
non-
judgmental.

41
  Diffuse angry  When student
verbal attacks nurse become
with non- defensive,
defensive anger escalates
stand. for both client
and student
nurse. A non-
judgmental
attitude
provides an
atmosphere
can be
explored more
easily.

Be aware of client’s
tendency to have ideas
of references; do not
do things in front of Suspicious clients will
client that can be automatically think
misinterpret: that they are the target
 Laughing or of the interaction and
whispering. interpret in a negative
 Talking quietly manner (e.g., you are
when client laughing or
can see but not whispering about
hear what is them).
being said.

42
 DISCHARGE PLAN

Nursing Order Discharge Instruction Rationale

Medication  Instruct the clients to take the prescribed medications and  To avoid drug toxicity.
emphasize the correct dosage, time and other special
instruction or precautions
 Discuss the importance of taking the home medications to  This will help to realize the importance of home
the patient. medications.

Exercise
 Instruct the client to walk and exercise every day.  To regain strength and promote good circulation.

Treatment  Encourage patient to participate to psychotherapy may  Psychotherapy may help to normalize thought patterns.
include:
- Individual therapy  Supportive group help decrease social isolation.
- Family or group therapy
- Life skills training (social skills training and  Learning social and vocational skills can help reduce
vocational rehabilitation isolation and improve quality of life.

Hygiene  Instruct the patient to take a bath every day and change
clothes as well.
 Encourage the patient to brush his teeth 2 times a day.
 Wash hands before and after eating
OPD  Advise the clients to go back for check-up as
recommended by his physicians
 Discuss the importance of follow up check-up
 To give comfort to the client and to avoid having other
illnesses.
 Washing of hands before and after doing anything
decreases the risk of contamination and spread of
microorganisms.
 This is to see if his condition is getting worst or better
 To make the client understand the importance of follow-
up check-up.

43
 Diet  Encourage the patient to eat nutritious food, well cooked  To avoid food contamination.
food and drink clean water.
 Encourage to drink more water at least 6 glass a day  To avoid dehydration.
Spirituality  Encourage the client to pray every day for his good health  To immense faith and strengthen his belief in God.

44
45