Mental Status Assessment (1)

8/2/2019 Mental Status Assessment (1)

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MENTAL STATUS ASSESSMENT

Name : Aling D.N

Age : 36 years oldWard : female

ORIENTATION

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Analysis and Interpretation:

Day 1 : Pre- Interaction Phase

Day 2 : Our client is oriented in place, time, date and situation as evidenced by the following excerpts:Sn: Aling D nasaan po tayo ngayon?

C: Asa Mariveles, sa mental

Sn: O ano pong araw ngayon?C: Kahapon Linggo, Lunes ngayon! Ay! Di pala, Martes pala ngayonSn: Ano pong petsa ngayon at ano po ang ipinagdiriwang natin ngayon?

C: 14, February Araw ng mga Puso, Valentines

Day 3 : Our client is oriented about the place, time, date and situation as evidenced by the followingexcerpt:

Sn: Aling D, anong araw po ngayon?C: Miyerkules.

Sn: Anong petsa po?

C: 15Sn: Anong taon po?

C: 2012

Sn: Ano po ang panahon natin ngayon? Umaga, tanghali o hapon?C: umaga

After we conducted our newspaper therapy she was able to answer our questions.

Day 4: Our client is oriented about the date, time, place and situation as evidenced by the followingexcerpts:

Sn: Aling D magandang umaga poC: Magandang umaga din.

Sn: Nasaan po tayo ngayon?C: Nasa mental ang lamig ngayon

Sn: Oo nga po ang lamig, ano po ang petsa natin ngayon?C: February 20


2/15

When we were having the photo language therapy, our client participated and she was able toshare the pictures she picked. The client was not oriented in person as evidenced by the following

excerpts:Sn: Aling D, Ano po ang pangalan namin?

C: Hindi ko na matandaan eh.Sn: Eh ano po ang pangalan ng nurse na nakaduty po doon sa female ward?

C: Hindi ko din kilala eh

Day 5: Our client is oriented about the time, date, place and situation except the person as evidenced bythe following excerpts:

Sn: Good morning Aling D.C: Good morning din.

Sn: Ano pong araw ngayon?

C: February 21, 2012 Martes, malamig ang ginawww!Sn: Nasaan po tayo ngayon?

C: Nasa hospital, sa mental

Sn: Ano po ang mga pangalan namin?C: Hindi ko matandaan eh.

Sn; Eh ano po ung pangalan ng nurse na nakaduty sa female ward?

C: Di ko alam pangalan nunSn: Ung clinical instructor po namin. Ano po ang pangalan nya?C: Ewan ko, di ko din alam eh

Day 6: Chart Reading

Day 7: Our client is oriented about the person, place, time and situation but not oriented on the date

because she wrote on the bond paper is January 25, 2012. Here are some evidences:Sn: Aling D nasaan po tayo ngayon?

C: Nasa hospital.Sn: May activity po tayo mamaya, music and art. Ano po ang music and art para sa inyo?

C: Music? Tugtog yun. Yung art drawingSn: Tama po. Aling D, natatandaan nyo pa po ba kami?

C: Oo, ikaw si Reviecca.Sn: Eh siya po? (referring to Beverly)

C; Nakalimutan ko na.

Day 8: Our client is oriented about the time, place, person and situation except on date as evidenced bythe following excerpts:

Sn: Aling D anong petsa po ngayon?C: Ang date ngayon ay January 27, 2012.

Sn: Nasaan po tayo ngayon?C: Nasa Mariveles Mental Hospital, hospital ng mga may sakit sa pag-iisip.

Sn: Ano po ang mga pangalan namin?C: Si Reviecca at Beverly.

Day 9: General Grooming

Day 10: Our client is oriented about the place, time, person and situation as evidenced by the following

excerpts:Sn: Good morning Aling D.

C: Good morning din.Sn: Nasaan po tayo ngayon?

C: Nasa mental hospital sa Mariveles, BataanSn: Ano po ang mga pangalan namin?

C: Si Beverly at si Aileen

Sn: Reviecca po ang pangalan ko hindi po Aileen.

She is not oriented on the date because she wrote February 25 on the bond paper.


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DEFENSE MECHANISM

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a. Repression

Pre-InteractionP

hase

x x x x

ChartReading

x x

GeneralGrooming

x

b. Suppression x x x x x x x

c. Regression x x x x x x xd. Fixation x x x x x x x

e. Denial x x x x x

f. Displacement x x x x x x x

g. Conversion x x x x x x x

h. Identification x x x x x x x

i. Intellectualization x x x x x x x

j. Introjections x x x x x x x

k. Projection x x x x x x x

l. Rationalization x x x x x

m. Sublimation x x x x x x x

n. Substitution x x x x x x x

o. Symbolism x x x x x x xp. Undoing x x x x x x x

q. Reaction formation x x x x x x x

r. Fantasy x x x x x

s. Resistance x x x x x x x

t. Restitution x x x x x x x

u. Compensation x x x x x x x

v. Dissociation x x x x x x x

w. Splitting x x x x x x x


Day 1: Pre- Interaction PhaseDay 2: Our client used denial as evidenced by this excerpt:

Sn: Ano po ba ang dahilan at dinala kayo dito sa Mariveles Mental Hospital?

C: Naglalakad ako sa park gumagala ako nun tapos nagcollapse ako. Pagkagising ko nakasakay nako sa ambulansya tapos dinala nila ako dito.

Day 3: The client did not exhibit any of the following defense mechanism.

Day 4: Our client fantasized as evidenced by this excerpt:

C: Naiimagine ko na lumilipad kami ni kuya sa langit, basta pag nag-iimagine ka lahat magagawamo.

Day 5: Our client still fantasized as evidenced by the following excerpts:

C: May kapangyarihan ako eh!

Sn: Anong klaseng kapangyarihan naman po iyon?C: Nakakalipad ako, tumatalon ako, lulundag ako ng mataas tapos inaabot ko yung langit at

minsan kumukuha ako ng mga stars, natamaan na nga ako ng kidlat eh dahil lipad ako ng lipad.


Day 7: Our client did not exhibit any of the following defense mechanism


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Day 8: Our client used denial as evidenced by the following excerpts:

Sn: Aling D, nasaan po tayo ngayon?

C: Nasa mental hospital tayo, sa hospital ng mga may sakit sa pag-iisip.Sn: Nasabi nyo po na ospital ito ng mga may sakit sa pag-iisip pero nandito po kayo ngayon.

Masasabi nyo po ba na may sakit din kayo sa pag-iisip?C: Hindi, wala akong sakit sa pag-iisip. Iba ang sakit ko, may sakit lang ako sa balat, itong

mga sugat ko.

Our client also rationalized as evidenced by the following excerpts:

Sn: nag-enjoy po ba kayo sa pagbuo ng puzzle?

C: ooSn: Ano nga po pala ulit yung mga puzzle na binuo ninyo?

C: Yung ano un eh, Ano nga ba yon? Nakalimutan ko na. Eto ang hirap sa akin eh hindi ako

makaalala.


Day 10: Our client rationalized as evidenced by this excerpt:

Sn: Ano po ang dahilan at dinala ninyo ang mga anak nyo sa bahay ampunan?C: Eh kaya ko lang naman sila dinala sa pamahalaan ng mga bata kasi hindi ko sila kayang

alagaan.


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EXTRAPYRAMIDAL SYMPTOMS

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Pseudoparkinsonism

1. Masklike face

Pre-interactio

nPhase

x x x x

Chartreading

x x

GeneralGro

oming

x2. No swinging of arms x x x x x x x

3. Hesitancy of speech x x x x x x x

4. Decreased muscle strength x x x x x x

5. Shuffling gait x x x x x x

6. Drooling x x x x x x x

7. Fine intention tremors

Acute Dystonic Reaction

1. Muscle spasm of jaw, tongue,

neck, eyes

x x x x x x x

2. Laryngeal spasm x x x x x x x

Akathisia

1. Restlessness x x x x x x

2. Tenseness x x x x x x x

3. Inability to sit still x x x x x x x

4. Rocking back and forth on feet x x x x x x x

5. Crossing leg frequently x x x x x x x

6. Inability to relax x x x x x x x

Tardive Dyskinesia

1. Involuntary movements of mouth,

tongue, face, may extend to fingers,

arms and trunk



Day 2 : Our client has fine intention tremors when she was cutting her nails, she also has uncoordinated gait whileshe was walking. She is relax while sitting and talking to us but before she answered our questions her tongue has

involuntary movements probably due to the side effect of antipsychotic drug that shes taking.

Day 3 : Our client still has fine intention tremors because when she was eating her meal and while she was holding

her cup of juice her hand is moving involuntarily and her tongue is also moving involuntarily.

Day 4: Our client has fine intention tremors while cutting her nails and holding the cup of juice. She is relaxed but

her tongue has involuntary movements.

Day 5: Our client has fine intention tremors while holding her cup of juice and while eating her meal and she stillhas involuntary movements of the tongue.


Day 7: Our client has no swinging of arms when we were walking. She also has fine intention tremors because

when we gave the soap to her, her hands were shaking. She also has involuntary movements of tongue.

Day 8: Our client has fine intention tremors when she is holding her toothbrush and she also had involuntarymovements of the tongue.



6/15

Day 10: When our client is dancing, she cant move her hands freely and she has decreased muscle strength. Shehas fine intention tremors when she is holding the cup of juice and when she is holding the soap. She also had

involuntary movements of the tongue probably because of the side effect of the drugs that she is taking.

THINKING AND COMMUNICATING

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1. Looseness of

Association

Pre-InteractionPhase

x

ChartReading

x

GeneralGrooming

2. Neologism x x x x x x x

3. Word salad x x x x x x x

4. Echolalia x x x x x x x

5. Echopraxia x x x x x x x

6. Clang Association x x x x x x x

7. Illogical thinking x x x x x

8. Delusion

a. Reference x x x x x x x

b. Persecution x x x x c. Grandiose x

d. External Influence x x x x x x x

e. Erotomania x x x

f. Somatic x x x

9. Alogia x x x x x x x

10. Concrete thinking x x x x x

11. Lack of insight x x x x x x x

12. Aphasia x x x x x x x

13. Apraxia x x x x x x x

14. Agnosia x x x x x x x

15. Flight of Ideas x

16. Punning x x x x

17. Rhyming x x x x x x x

18. Blocking x x x x x x x

19. Circumstantiality x x x x x x x

20. Tangentiality x x

21. Mutism x x x x x x x

22. Verbigeration x x x x x x x

23. Distractibility x x

24. Confabulation x x x x x x


Day 1: Pre- interaction Phase

Day 2 : There is looseness of association as evidenced by this excerpt:C: May bumubulong sa akin eh, sabi uuwi na daw ako. Yung kasamahan ko doon sa loob ng

ward 1 palagi akong sinisigawan kaya hindi ako makatulog ng maayos.There is delusion of persecution as evidenced by this excerpt:

C: Noong bata pa ako kinidnap ako ng mga terrorismo.There is delusion of grandiose as evidenced by this excerpt:

C: Tuwing Valentines iniimbita ako ng mga friends kong mayayaman sa bahay nila,madami ngang mayayaman dyan sa ward 1.

There is delusion of somatic as evidenced by this excerpt: C: Palagi ngang sumasakit yung tuhod ko, may kanser kasi ako sa buto. Inoperahan nga

ako sa ulo, sa mata, sa ilong tsaka sa bibig.There is concrete thinking as evidenced by this excerpt:

Sn: Ano po ang kahulugan ng Valentines Day para sa inyo?C: edi puso


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There is flight of ideas as evidenced by this excerpt:C: Nagtrabaho na ako dati eh, may bumubulong sa akin na uuwi na ako. Palagi ngang

nandito si Michael pagala gala dyan dinadalaw ako nakamotor sya.

Day 3 : Our client manifest looseness of association as evidenced by this excerpt:

C: Si Michael may anak yun tatlo, 76 na taon na yun eh, nandito sya sa loob kasi noongnagwiwithdraw sya ng pera binaril sya at napunta sya dito.

There is illogical thinking as evidenced by this excerpt:

Sn: Ilan po bale ang naging asawa nyo?C: Ano, 16

There is delusion of persecution as evidenced by this excerpt:

C: Sabi ng asawa ko mas mabuti pang mamatay na lang ako para hindi ko makita ang mgakasamaan na ginagawa nya.

There is delusion of grandiose as evidenced by this excerpt:C: Marami akong kaibigan dyan sa ward mayaman kasi ako eh, mag aaround the world nga

ako eh.

There is delusion of somatic as evidenced by this excerpt:C: Sabi nga ng mga kaibigan ko wala na daw nabubuhay sa sakit na ito at hindi na daw

gagaling to.

There is flight of ideas as evidenced by this excerpt:C: oo, jan sa ward marami dyan na mayaman tsaka makapangyarihan, meron nga dyan

madami syang kaibigan kinokontrol nya lahat gumagamit sya ng black crystal.The client was easily distracted in the people walking.

Day 4: There is looseness of association as evidenced by this excerpt:

C: Etong baboy (referring to the picture) alaga namin ni Lacson, marami kaming alaga nitokaya lang sabi nila mamamatay na daw ako kasi wala na daw nabubuhay sa ganitong sakit, sabi nga nung

isang kasama ko sa ward wala na daw akong pag-asang gumaling pa dahil nawala ko yung libro.There is delusion of erotomania as evidenced by this excerpt:C: Marami na akong naing asawa, nasa hundreds na kasi maraming nagkakagusto sa akin.

There is delusion of grandiose as evidenced by this excerpt:C: Mayaman ako dati kaso sabi ng mga kasama ko sa loob mas yumaman pa daw ako ngayon.

Ang taas nga ng bills ko pero palagi kong nababayaran.

There is delusion of somatic as evidenced by this excerpt:C: Lagi ngang sumasakit ung ulo ko, mas masakit kaysa sa mga tumutubo sa akin inoperahan

kasi ako dati sa ulo.

There is tangentiality as evidenced by this excerpt:

C: Marami nga kaming alagang hayop eh, may baboy, kambing tsaka baka peropinakamasarap alagaan baboy kasi kinakaen ng tao yun eh. Marami ngang nagkakagusto sa akin eh nag-alaga din ako ng Ibong Adarna hindi ko nga alam kung buhay pa yun eh. Sabi ng mga tao sa akin mamamatay

na daw ako dahil sa sakit na to.

She is distracted when we were having a conversation, her eyes are not in focus to us but it isfocused on the food behind her.

Day 5: There is delusion of erotomania as evidenced by this excerpt:

C: Marami kasi akong naging asawa eh, maraming nagkakagusto sa akin.

Sn: Maaari po ba kayong magbanggit ng isa sa kanila?C: Si Ardel, sinundan nya pa nga ako dito eh, nandyan sya sa loob.

There is also presence of punning as evidenced by this excerpt:

Sn: Sino nga po pala ulit si Noah?C: Ako!hehehe.


8/15

She is easily distracted when we were having the group dynamics and when we were having a

conversation she is looking at the trees and sky.


Day 7: There is looseness of association as evidenced by this excerpt:Sn: Ano po ang naramdaman nyo nung nakita nyong may kasiping ang asawa ninyo?

C: Wala naman akong naramdaman, Masaya naman silang kasama kaso dapat marami kangpera, yung mga kasamahan ko nga dyan sa loob laging kinukuha yung higaan ko ang ingay nga nila eh sobra,

tapos pagtutulungan ka nila sisipain tas hahampasin sa ulo.There is delusion of grandiose as evidenced by this excerpt:

C: Ako?, mayaman ako, mayaman na mayaman hindi ko na nga pinoproblema ang pera eh.

There is delusion of erotomania as evidenced by this excerpt:

C: May nangyari nga sa amin ni Michael eh, nags*x kami, wala naman akong magawa kasi

mapusok ang mga kabataan.

There is flight of ideas as evidenced by this excerpt:

C: Etong drawing na bahay malungkot yan kasi malungkot yung kulay, maraming gamit saloob nyan may tv,ref hindi ka magugutom dyan. May ganyan kaming bahay eh, yan ang pangarap kong bahaylahat ng gusto ko nandyan,makapangyarihan yan eh.

Client exhibit punning as evidenced by this excerpt:

C: Nahirapan nga akong manganak dati, nanganak kasi ako ng aso.

Client also exhibit tangentiality as evidenced by this excerpt:Sn: Ano po ang naramdaman nyo nung nakita nyo si Jacquielyn at ung asawa nyo na

nags**x?C: Wala Masaya naman kasi silang kasama eh, masarap silang kasama sa galaan, sana nga

makaalis na ako dito, magugulo kasi ung mga nasa ward 1 laging inaagaw ung higaan ko.

She was easily distracted because she is always looking at the tree and in the people walking.

Day 8: There is looseness of association as evidenced by the following excerpt:

Sn: Aling D. mahilig po ba kayong magtanim noong nasa labas pa kayo?C: Oo, nagtatanim ako ng gulay, sementeryo ba ito? Kasi yung lupa dito parang sa

sementeryo eh.

There is delusion of grandiose as evidenced by this excerpt:

C: Madami akong pera, hindi ko na pinoproblema ang pera, madami akong pera sa bangko naming,may sarili kaming bangko eh.


Day 10: There is looseness of association as evidenced by the following excerpt:Sn: Ano po ang mga pangalan ng 4 nyong anak?

C: Wala pa silang pangalan eh, mga sanggol pa kasi yun. Pwede kayang tumira sa bahay na to? Ditomismo sa bahay na ito. Sabihin ko nga sa computer gawan nya ko ng ganitong bahay.

There is illogical thinking as evidenced by this excerpt:

C: Nasa pamahalaan ng mga bata yung mga anak ko kasi sabi ni kuya,ano ba yan D. kuting namanyang mga anak mo, itapon mo nga yan.

There is delusion of persecution as evidence by this excerpt:C: Hinuli nga ako ng mga military tapos dinala nila ako dito.

There is delusion of grandiose as evidenced by this excerpt:C: Artista ako dati, sikat ako nakatrabaho ko na nga si Tito, Vic and Joey.


9/15

There is delusion of erotomania as evidenced by this excerpt:

C: Nagustuhan ako nung may-ari nung club, madaming costumer nagkakagusto sa akin dinadala nilaako sa hotel.

There is delusion of somatic as evidenced by this excerpt:

C: Hindi na nga ako pwedeng mag-artista kasi nagkaroon na ako ng mga ganitong sugat, tinahi payung ulo ko kaya laging masakit ulo ko eh.

The client has concrete thinking as evidenced by this excerpt:

Sn: Para po sa inyo, ano po ang ibig sabihin ng haligi ng tahanan?C: Edi, tatay

The client has flight of ideas as evidenced by this excerpt:C: Kapag pwede na akong umuwi titira ako sa ganitong bahay (referring to the drawing), etong bahay

na to Masaya tumira dito makapangyarihan, madaming pagkain punong puno ng pera. Sasabihin ko sa

omputer na bigyan nya ako ng ganitong bahay.

The client punned as evidenced by this excerpt:

C: Nanganak nga ako ng mga kuting ang dami nga nila kaso pinatapon ni kuya.hehe

There is tangentiality as evidenced by this excerpt:

C: Ginahasa ako dati ng mga terorismo, madami sila pinasok ako sa club nagustuhan nila ko,nagsasayaw nga din ako ng naka-*** yung bold dancing kasi nag-artista ako dati madami nga akong

fans, may fans club nga ako eh.

The client was easily distracted because of the people walking and she was always looking at the trees.The client confabulated as evidenced by this excerpt:

C: May tanim akong marijuana sa bahay namin eh, tas may armalight din kami madami.


10/15

PERCEIVING AND INTERPRETING

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Hallucinations Pre-InteractionPhase

ChartR

eading

GeneralG

rooming

a. Visual x x x x x x x

b. Auditory x x x x x

c. Olfactory x x x x x x x

d. Tactile x x x x x x x

e. Gustatory x x x x x x x

Illusions x x x x x x

Depersonalization x x x x x x x

Poor reality testing x



Day 2 : Our client experienced auditory hallucination as evidenced by:C: May bumubulong sa akin malapit na daw akong umuwi

Day 3 : The client has poor reality testing as evidenced by this excerpt:Sn: Bale ilan na po ang naging asawa nyo?

C: Anu, 16.

Day 4: The client has poor reality testing as evidenced by:C: Madami na kong naging asawa eh nasa hundreds na.

Day 5: The client has poor reality testing as evidenced by:

C: Ang dami ko na ngang nagastos dito sa sugat ko na to eh, 18 thousand na pero hindi nagagaling to, sabi ko nga pag namatay na ako wala na, wala ng kaibigan kasi malala na to, hindi na to gagaling.


Day 7: The client has poor reality testing as evidenced by:C: Nanganak ako ng aso eh.

Yung pusa nagbobomba ng tubig na may kasamang juice.

The client illusion as evidenced by:

C: Iyan(she saw a cat), tigre yan eh pero ang tawag lang sa ganyan eh pusa.

Day 8: The client has poor reality testing as evidenced by:C: Wala naman akong sakit sa utak eh, madami lang akong sugat kaya nandito ako.


Day 10: The clients hallucinate auditory as evidenced by:


11/15

C: May kumakausap sa akin binubulungan ako pero hindi ko naman kilala kung sino sya.

The client has poor reality testing as evidenced by:C: Nanganak ako dati ng kuting.

FEELING AND AFFECT

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Flat

Pre-

interactio

n

x x xChart

Reading

x xGeneral

x

Blunted x x x x x x

Inappropriate x x x x

Lability x x x x x x x


Day 1: Pre- interaction Phase

Day 2: Our client exhibit flat and blunted affect when we said to her if she is happy, she just said Oo but herfacial expression is flat. During the activity, she exhibits a little emotion or happiness. She also has

inappropriate affect because when she said that she has many wounds, she just laughed and smiled to us.

Day 3: The client always wears her smile every time when we ask her if she is happy and she always smile andsaid yes.

Day 4: The client replied that she is happy but her facial expression is sad.

Day 5: The client doesnt show any behavior that was stated above because anytime we ask her if she is happy

she just smiled and replied yes and when she is talking about sad stories of her life she seemed to cry and she

has teary eyes.


Day 7: The client did not exhibit any of the following written above because when we asked her if she is happy

she just smiled and said Oo, Masaya

Day 8: The client doesnt show or exhibit any feeling and affect that was stated above because her affect iscongruent in every word she said.


Day 10: The client has inappropriate affect as evidenced by:

Sn: Ano po ang ginawa ninyo nung ginahasa kayo?C: (smiled and laughed) Gahasa? Masakit yun sa una pero masarap yun maghapon magdamag

yun eh ganun lang gagawin mo.


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BEHAVING AND INTERACTING

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Withdrawal


x x x x

ChartReading

x x

GeneralGrooming

x

Motor hyperactivity x x x x

Motor hypoactivity x x x x

Ambivalence x x x x x x x

Anhedonia x x x x x x

Avolition x x x x x x

Poor Personal Hygiene x

Impulsive x x x x x x x

Paranoia x x x x x x x

Echopraxia x x x x x x x

Tics and spasm x x x x x x x

Waxy flexibility x x x x x x x

Pathological Lim

Rigidity

x x x x x x x


Day 1: Pre-interaction phase

Day 2 : The client exhibit a little effort or she had motor hypoactivity because when we asked her she

will reply but when we are silent she is also silent. She is saying that she is happy talking with us but herexpression is not congruent on what she said and she is saying that there should have a meryenda because

it is Valentines Day. She also has poor personal hygiene because she has foul odor and she has wounds.

Day 3 : When we fetch our client from the ward she has a good looking face but she has many wounds inher body, she smiled to us and when we asked her if she took a bath she said oo, kanina, hindi na ako

nagtago sa nurse and she is always cooperating all throughout the activity.

Day 4: The client feels sleepy because of the windy weather and when we received her she had manywounds compared last week. She said that she doesnt want to take a bath because the water is cold.

Day 5: The client exhibit anhedonia as evidenced by:

C: Hindi ako nabusog sa pagkain, hindi katulad dati maraming hamburger,maraming pagkain nabusog ako dun.

She also has poor personal hygiene because even if she took a bath she still wearing ablood stain uniform due to her wounds.


Day 7: The client is hyperactive she always laughed and she is talkative, she also has poor personalhygiene because she had wounds that are dry.


13/15

Day 8: Our client is so hyperactive because when she was talking shes always smiling and talkative

unlike before. She has poor hygiene because when we fetched her from the ward she has foul odor.


Day 10: When we fetched her from the ward she was hypoactive because she felt sleepy and when wehad an activity she was hyperactive and she said Woohhh!! Gumising ka! Galaw galaw ang katawan

NEGATIVE COGNITION

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Day11

Day12

Overgeneralization Pre-interaction

x x x x Cha

rtReading

x xGeneral

x

All-or-nothing thinking x x x x x x x

Should statements x x x x x xLabeling x x x x x x x

Mind reading x x x x x x x

Fortune telling x x x x x x x


Day 1: The client exhibit should statement as evidenced by:

C: Dapat talaga tumakas ako sa mga kumidnap sa akin, dapat talaga gumawa ako ngparaan pero wala akong nagawa.

Day 2: The client did not exhibit negative cognition.










14/15

OTHERS

Day

1

Day

2

Day

3

Day

4

Day

5

Day

6

Day

7

Day

8

Day

9

Day

10

Day

11

Day

12Amnesia


x x x

ChartReading

x x

GeneralGrooming

Fugue x x x x x x x

Depersonalization x x x x x x x

Phobias x x x x x x x

Memory

1. Remote (long term) x x x x

2. Recent (early am)

3. Recent part (current

events)

x x x x x x

4. Immediate

memory/recall (short

term)

x x


Day 1: Pre-interaction Phase

Day 2: The client exhibit amnesia as evidenced by:SN: Ano po ang pangalan ng asawa nyo?

C: Hindi ko alam eh basta kalbo sya.

The client has recent part memory as evidenced by:Sn: Ano pong ipinagdiriwang ngayon?

C: Araw ng mga Puso

The client has recent memory as evidenced by:SN: Ano po ang kinain nyo kanina?

C: Hindi ako nakakain kasi natutulog ako.

The client has immediate memory as evidenced by:Sn: nasaan po tayo ngayon?

C: Nasa mental.

Day 3: After we conducted our newspaper therapy, our client answered our questions about what she had read on

the newspaper and she replied correctly and she also remembers about what she did early am because according to

her she eat hotdog on her breakfast.


15/15

Day 4: The client cant remember how old she is when Lacson adopted them. She remembered that she eat themost delicious beans early am. She remembered that we had an activity and she remembered that she had chosen

the picture of the pig, bird and scenery.

Day 5: According to the client she ate champorado and the staff nurse cleaned her wound but she cant rememberthe story they have watched past few minutes she cant remember all about the story.


Day 7: Our client remembered what she ate early am and she said goto and she also remembered that she took a

bath, she cant remember the activity that we had done earlier. She also remembered that her favorite music isclassic and her favorite dance is tango, she also remember that she saw Jacquielyn and her husband cheating on

her.

Day 8: Our client remembered our names and she remembered what she ate earlier but she didnt remember thename of the plant that we planted earlier.


Day 10: The client has amnesia as evidenced by:

Sn: Paano po kayo nakarating dito sa Bataan?C: Hindi ko alam eh, wala akong matandaan.

The client has remote memory as evidenced by:C: Naaalala ko nung dinadala ko yung mga anak ko sa pamahalaan ng mga bata.

The client has recent memory as evidenced by:

Sn: Ano pong ginawa nyo kanina?C: Naligo ako kaninang madaling-araw.

The client has immediate memory as evidenced by:

Sn: Ano po sa tingin nyo ngayon, umaga, tanghali, o hapon?C: Umaga

Documents

Mental Status Assessment (1)