Schizo Paranoid

8/13/2019 Schizo Paranoid

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INTRODUCTION

Schizophrenia is one of the most damaging of all mental disorders that causes its

victims to lose touch with reality. They often begin to hear, see, or feel things that aren't

really there, they experience hallucinations or become convinced of things that simply aren't

true, they experience delusions.

There are five subtypes of schizophrenia. Among these subtypes is the paranoid type.

In the paranoid form of this disorder, they develop delusions of persecution or personal

grandeur. The first signs of paranoid schizophrenia usually surface between the ages of !

and "#. There is no cure, but the disorder can be controlled with medications. Severe attac$s

may re%uire hospitalization.

The causes of schizophrenia are still under debate. A chemical imbalance in the brain

seems to play a role, but the reason for the imbalance remains unclear. &e do $now that an

individual is a bit more li$ely to become schizophrenic if they have a family member with

the illness. Schizophrenia usually develops gradually, although onset can be sudden. riends

and family often notice the first changes before the victim does. Among the signs are(

confusion, inability to ma$e decisions, hallucinations, changes in eating or sleeping habits,

energy level, or weight, delusions, nervousness, strange statements or behavior, withdrawal

from friends, wor$, or school, neglect of personal hygiene, anger, indifference to the

opinions of others, a tendency to argue, a conviction that you are better than others, and that

people are out to get you.


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)rugs such as Thorazine, *aldol, and +isperdal combat symptoms in # out of !

patients. An acute attac$ usually can be cleared up in # to wee$s. -ounseling and group

therapy help recovering patients to understand the disease and to function effectively.

&ithout medication and therapy, most paranoid schizophrenics are unable to function in the

real world. If they fall victim to severe hallucinations and delusions, they can be a danger to

themselves and those around them.

The heterogeneity nature of this disorder, posed a significant challenge among the

student nurses to ta$e on the case history of client, iguel /iadog 0argo, 1r., who is in his

early "23s and diagnosed as schizophrenic4paranoid type.

This case study presents the opportunity of applying our learned s$ills of giving care

to the mentally4ill patients and implies that we as future nurses must learn our roles

effectively to function efficiently in our chosen field of profession.


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OBJECTIVES

General Objective:

At the end of the psychiatric exposure, the group will be able to come up with a case

presentation aimed to impart a significant awareness on the conditions of this disorder,

Schizophrenia45aranoid type.

Specific Objectives:

. To identify a %ualified client for this study6

7. See$ approval from Administration of )avao ental *ospital, and from the

patient3s family to begin the conduct of this research6

". 8stablish good rapport with the patient and his family in order to have a smooth

wor$ing relationship with the group6

#. 9ather pertinent data regarding the patient and his family6

!. Assess health status of patient, past and present illnesses6

:. Identify predisposing and precipitating factors that contributed to the patient3s

illness6

;. 5resent the ental Status 8xamination during initial and final interaction to

ascertain progress and deterioration of patient3s condition6

. ormulate a feasible


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A N A N E S I S

!ers"nal !r"file:

!atient#s C"$e Na%e : iguel /iadog 0argo, 1r.

&"spital C"$e : 2222!2=

A'e : "" years old

Se( : ale

A$$ress : South /ay 0anang, )avao -ity

Civil Stat)s : Single

Birt* Date : >ctober 7=, =;7

Birt* !lace : )avao -ity

Reli'i"n : +oman -atholic

Nati"nalit+ : ilipino

,at*er#s Na%e : iguel 0argo, Sr.

"t*er#s Na%e : 5erla 0argo

Date "f A$%issi"n : =?!?27, 7?!?2", 2?2:?2", 7?7?2#,

:?7?2#, 2?7"?2#,#?!?2!,.?!?2!

@ admissions

Date "f Disc*ar'e : =?77?27, "?#?2", 2?2?2",7?:?2#

:?:?2#, 2?7?2#, #?77?2!, ??2!

A$%ittin' !*+sician : Ian 1. 0indong, .).

Atten$in' !*+sician : Ian 1. 0indong, .).

C*ief C"%plaints : 8xhibited Biolence and *ostility

A$%ittin' Dia'n"sis : Schizophrenia45aranoid Type

,inal Dia'n"sis : Schizophrenia45aranoid Type

Date St)$+ Be')n : 1anuary 722:

Date St)$+ En$e$ : 1anuary 722:


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Inf"r%ants:

0ast 1anuary CC722:, our group went to the client3s residence at South /ay 0anang,

)avao -ity to interview informants, which included family members, relatives, neighbors

and other community leaders regarding their $nowledge and opinion on patient3s current

mental condition.

The people in the community greeted the group with warmth and generosity in

giving the information that we needed.

Informant 1:

Name: Perla B. Largo Age:57 years old

Address: Purok 9 South Bay, Lanang a!ao "#ty

$elat#onsh#% to Pat#ent: &other

Length of t#me kno'n to %at#ent: S#n(e )#rth *++ years

A%%arent -nderstand#ng of Present Illness:

Miguels illness apparently started when he worked as a laborer in Samal

Island sometime in June 2000. He came home from work telling his mother !Ma dalha ko

ospital kay gihiloan ko".He was brought to #a$ao Medical %enter but the doctors found no

e$idence of poisoning. Miguel was also brought to a traditional healer or !binisaya" to

assess his condition. &hey were informed that Miguel indeed was poisoned and was made to

drink a potion to counter the effects of the alleged poison ingested by the client. 'fter a

month he became hostile and was always shouting about seeing a black cat. &hat was the

first time he was brought to #a$ao Mental Hospital. (ast 'ugust )* 200* he had a relapse

because according to the informant !nisuol iyang sakit kay gikan sa trabaho naligo sya

nga init kayo ug gisal+angan man gud niya ang iyang tambal ug tulo ka adlaw maong

nibalik ang iyang sakit".

"hara(ter#st#( and Att#tude of Informant:

&he informant was willing to share information with us. She waited for us

that morning because Miguel informed her that the nursing students will be asking

information about his illness. &he informant was moderately groomed hair kempt and

e,hibited a pleasant disposition.


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Informant :

Name: guel Largo, Sr. Age: /0 years old


$elat#onsh#% to Pat#ent: ather



As !er)al#2ed )y the #nformant, 3Buotan na nga )ata s# guel. 4ala nay

l#)og. 6he #nformant adds, h#s #llness )egan 'hen he started 'ork#ng #n Samal. n one

o((as#on, 'hen the (l#ent arr#!ed home, he demanded to )e )rought #mmed#ately to the

hos%#tal, )e(ause he (la#med to ha!e )een %o#soned. urther, the (l#ent8s father stressed

that the %at#ent 'as 'orr#ed so mu(h a)out the#r house that 'as under (onstru(t#on and

#s st#ll not near to (om%let#on. 6he #nformant further %os#ted that the (l#ent #s a !ery

re%ress#!e %erson and al'ays kee%s h#s feel#ngs and 'orr#es s to h#mself.#nally, the

#nformant ho%es that h#s son '#ll re(o!er soon, )e(ause he e%ressed so mu(h lo!e for h#s

son.


&he informant was hesitant at first but e$entually he was $ery cooperati$e

and con$ersant. &he informant generally appeared moderately groomed and e,hibited a

coherent manner of responding.

Informant +:

Name: Perl#ta Largo Age: +1 years old


$elat#onsh#% to Pat#ent: S#ster

Length of t#me kno'n to %at#ent: +1 years


Perl#ta, s#ster of guel )el#e!ed that the (ause of her )rother8s #llness 'as

'hen they 'ere una)le to (om%lete the reno!at#on of the#r house )e(ause of #nsuff#(#ent

funds. After'h#(h, guel as o)ser!ed )y Perl#ta, 3&otutok s#ya sa hollo')lo(ks, unya

muh#lum, taudtaud mangla)ay ug )ato. e momentar#ly stares at the hollo' )lo(ks and

suddenly thro's stones at the#r netdoor ne#gh)or.


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)uring the interview, 5erlita was very accommodating and was willing to

spend her time with us. She was very cooperative in answering our %uestions and she also

shared about his brother as being a good4natured individual.

Informant ;:

Name: enn#s B. Largo Age: 19 years old


$elat#onsh#% to Pat#ent: Brother



A((ord#ng to enn#s, the reason 'hy h#s )rother guel 'as adm#tted to

a!ao &ental os%#tal )e(ause of the #n(#dent #n Samal Island 'here guel 'orked as

a (onstru(t#on 'orker. enn#s narrated that there 'as an #n(#dent that guel 'as a

!#(t#m of 3%ag


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A((ord#ng to the #nformant, the (l#ent8s #llness 'as due to de%ress#on. It

started 'hen guel re(e#!ed 1;,000 from 3)u)oay, 'h#(h he thought #t #s suff#(#ent

fund to reno!ate the#r house. e demol#shed the old house and '#th the money #n hand,

'anted to )u#ld a ne' one. -nfortunately, he 'asn8t a)le to f#n#sh #t due to f#nan(#al

(onstra#nt. 6he unf#n#shed house house someho' (ontr#)uted to the de%ress#on. Later he

eh#)#ted unusual )eha!#or 'h#(h %rom%ted h#s mother to )r#ng the (l#ent to a!ao

&ental os%#tal to seek med#(al and %sy(h#atr#( attent#on.


&he informants comment about his cousin the client $ery sarcastic maybe

because he is tired of financially helping them. #uring the inter$iew I learned that (eos

family helped three of the clients siblings to school but still did not make use of their

education.

Informant /:

Name: Arnel ad#ano Age: ++ years old


$elat#onsh#% to Pat#ent: r#end

Length of t#me kno'n to %at#ent: 10 years


A((ord#ng to Arnel, guel #s a good fr#end. 6hey %lay )asket)all together

dur#ng the#r le#sure t#me. A (onstant dr#nk#ng )uddy and (onf#dant at the near)y sar#


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Informant 7:

Name: Analyn mas


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&he informant was $ery cooperati$e while talking to us. She was $ery

spontaneous in narrating what she knew about the family in general and Miguel in

particular.

Informant 9:

Name: Lu2 $ed#sm#nda Age: ;; years old


$elat#onsh#% to Pat#ent: Ne#gh)or and r#end of Pat#ent8s &other



A((ord#ng to Lu2, guel started to go #nsame, 'hen he '#tnessed ho' a

(at 'as slaughtered to death. 6hereafter, the %at#ent 'as seen shout#ng and some'hat

eem%l#f#es the sound of a (at #n d#stress. 6he %at#ent 'as also seen to ha!e dug a hole on

the ground and l#e there unt#l the %at#ent resorts to !#olen(e 'hen he #s re%r#manded. So

the %eo%le #n the#r area, restra#n h#m.

"hara(ter#st#( and Att#tude of Informant

#uring the entire inter$iew the informant was willing to share all the

necessary information about Miguel. She was $ery cooperati$e and accommodating.

Informant 10:

Name: $olando Lo)uternos Age: +; years old


$elat#onsh#% to Pat#ent: Ne#gh)or



A((ord#ng to the #nformant, guel started to go #nsame 'hene he re(e#!ed

some money from the#r sa!#ngs fund.6he money, the (l#ent used to f#nan(e the reno!at#on

of the#r house. But the (l#ent fa#led to (om%lete the reno!at#on #n t#me, that resulted to

an#ety and 'orry that led h#m to go out of h#s m#nd.


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"hara(ter#st#( and Att#tude of Informant

&he informant was $ery cooperati$e and was willing to share his opinion

about the illness of Miguel. &o him he really knew Miguel since they were young.

Informant 11:

Name: Lol#ta Beton#o Age: +7 years old


$elat#onsh#% to Pat#ent: Ne#gh)or



A((ord#ng to the #nformant, the last atta(k 'as due to, as !er)al#2ed 3

6ungod man to %ag


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/ather

r. iguel 0argo, Sr. wor$ed as a sawmill operator before and is currently wor$ing as a

part4time carpenter. r. 0argo as a father was ineffective and unable to provide for the basic

necessities of the family, because of his gambling and alcoholism. The money that was

supposedly be spent on daily expenses of the family are s%uandered to all his vices. The family

scavenges for food from their neighbors. r. 0argo, as expected denies of these charges and

accusations.

Mother

The patient3s biological mother is rs. 5erla 0argo. She was previously a Dsalt vendorE

and is currently a housewife. &hen she was wor$ing before, as a vendor, she usually leaves the

$ids with relatives and often times, let iguel accompany her.

Siblings

They are eight children in the family. Fnfortunately, their fifth died as a premature

delivery. They are listed hereunder in order(

.


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,AI-. TREE

GENOGRA

,at*er

i')el -ar'" Sr/

01 +/"/

"t*er !erla -ar'"

23 +/"/

+uel

deceased

guel

++

5erlita

"

9abriel

7

)ennis

=Alberto"#


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!ERSONA- &ISTOR.

!renatal

rs. 0argo was delighted to $now that she was pregnant. She was prepared to face the

anticipated demands of pregnancy.. *owever, her worry of financial problems constantly

disturbed her pregnancy. *er husband contributed to the burden of not remitting his salary to

supplement the expenses needed for pregnancy and the needs of the family. Therefore, she had

inade%uate nutrition and was unable to comply with all her vaccinations. &hile the client3s

mother was pregnant, she would need to wor$ as a salt vendor at the same time to support the

needs of the family.

Birt*

The patient was born on >ctober 7=, =;7, full term and delivered in breech position and

cord coil by an alternative doctor. The client3s mother was in labor while delivering the client for

7 days and 7 nights. It was posited that the delivery was a difficult and laborious one. The client

was not subHected to any type of immunizations.

Infanc+ an$ C*il$*""$ C*aracteristics

The patient3s first tooth appeared at : months of age and her first wal$ at year old withrice porridge as his first meal. The patient was exclusively breastfed and done in between chores

or during chores. The clients was observed to thumbsuc$ from age ! months until 7 years of age.

The client noted to be wal$ing and tal$ing at age 7 year old. It was apparently difficult to

determine the success of toilet training, since the voiding facility was a distance away from the

home. At age 7 year old, the patient experienced convulsion due to intense fever. The patient was

generally remembered to be unhygienically presented, termed as DyungitE.

!s+c*"se()al &ist"r+

The client was circumcised at age years old. asturbation practices suspected by age

: years old. Secondary sex characteristics such as voice change noted by age years old. The

client was noted to have gained sexual awareness by age 72 years old. At age 72 year old, the

patient was noted to have physical attraction with one neighbor, named D9emmaE, who was an


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entertainer D1apayu$iE, but was unable to express attraction and got frustrated for failing not to

confess his emotions.

!la+ -ife

As a child, he preferred playing Dpinoy gamesE available, especially Dholen?$asingE. *e

preferred playing with same sex playmates and plays near the neighborhood. The patient was

also claimed to be a shy individual, so it could be inferred that he played the role as a follower in

the group. The patient was very much overwhelmed with playing that attending school.

Sc*""l &ist"r+

It was noted that at age ; year old, the patient entered schooling. *owever, by age 2

year old, the patient stopped going to school, because the patient expressed disli$e on going to

school for failure to absorb day4to4day lectures by the teachers. This disli$e for school was very

much evident when the patient was caught cutting his classes by going to the sawmill and

wor$ed as D$argadorE of firewoods together with friends of same ages. *owever, during

schooldays, the patient expressed that he loved the ilipino subHect. The reason posed by the

patient for li$ing to wor$, was to have money, so when he goes to school, he has DbaonE or

spending money.

Reli'i")s an$ S"cial &ist"r+

8ver since, the patient was $nown to be a timid and %uite person. *e used to do things on

his own, but gradually established friendship with his neighbors of the same age. The patient was

always noted to be very particular with his things and wouldn3t want his things to be used by

others without prior permission. *owever, he is not noted to be selfish, but he is very thrifty and

goal4oriented in helping his family.

As a +oman -atholic, he didn3t go to church religiously and didn3t participate in any

church activities, because he had no money to spend for fare to get to their church. The patient

was also noted to get easily disappointed and frustrated for goals that have not been realized.


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COURSE IN T&E &OS!ITA-

INITIA- ENTA- STATUS E4AINATION

Na%e: i')el -ar'"5 Jr/

Date: A)')st 625 7112

I/ !resentati"n

A/ General Appearance: The patient is poorly groomed and has poor personal

hygiene, as manifested by failure to ta$e a bath duringthe interaction, suspicious and loose eye contact.

B/ General "bilit+

6/ !"st)re an$ 'ait

J normal J appropriate x J inappropriate

Describe: The integrity among his body parts and the manner ofhis wal$ing appeared to be inappropriately carried out.

7/ Activit+

J normoactive J psychomotor retardation

J hyperactive x J agitated

8/ ,acial E(pressi"n

J smiling J worried J tearful J frightened J happy J tense x J angry J distant

J ecstatic J sad J suspicious

C/ Be*avi"r: The patient exhibited an unpleasant disposition, was constantly frowning

and appeared agitated.

D/ D"ct"r9 N)rse !atient Interacti"n

J cooperative x J uncooperative

J initially only K J throughout interview

;)alit+: J warm J distant J suspicious

J tal$ative x J hostile J others

II/ Strea% "f Tal


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III/ E%"ti"nal State an$ Reacti"ns

A/ ""$

K J euthymic J depression x J euphoria

J others

Describe:The patient exhibited a normal, homeostatic mood.

B/ Affect

J appropriate K J inappropriate

;)alit+:

J flat xJ blunted J elated J labile J histrionic J hostile

J others

C/ Depers"nali=ati"n an$ Dereali=ati"n K J absent J present

D/ S)ici$al !"tential J absent K J present

E/ &"%ici$al !"tential J absent K J present

IV/ T*")'*t C"ntr"l

A/ T*")'*t !r"cess

0ooseness in Association K J

B/ !ercepti"ns x J present J absent

Type( denies A?B hallucination

V/ Ne)r"ve'etative D+sf)ncti"n

A/ Sleep

x J normal J hypersomnia

J late insomnia J mixed insomnia

B/ Appetite

x J normal J increase J decrease

,/ Attenti"n Span x J present J absent

Describe: The patient is fairly attentive throughout interview.

VI/ General Sens"ri)% an$ Intellect)al Stat)s

A/ Orientati"n x J time x J place

x J person x J situation


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B/ e%"r+ x J remote x J immediate

x J recent J impaired

C/ Calc)lati"ns

The patient has poor calculation.

D/ General Inf"r%ati"n

The status of the patient3s general information was very good asdemonstrated by $nowledge of the current 5hilippine 5resident.

E/ J)$'%ent

xJ impaired unimpairedJ

,/ Abstract T*in ( ? !resentati"n

> ( ? Strea% "f Tal ( ? E%"ti"nal State an$ Reacti"ns

> ( ? T*")'*t C"ntr"l

> ? Ne)r"ve'etative D+sf)ncti"n

> ( ? General Sens"ri)%

> ( ? Intellect)al Stat)s

DS IV

Axis Schizophrenia, 5aranoid

.


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,INA- ENTA- STATUS E4AINATION

Na%e: i')el -ar'"5 Jr/

Date: A)')st 735 7112

I/ !resentati"n

A/ General Appearance: The patient is fairly groomed, appeared suspicious, agitated

and loose eye contact.

B/ General "bilit+

6/ !"st)re an$ 'ait

J normal J appropriate x J inappropriate

Describe: The integrity among his body parts and the manner of

his wal$ing appeared to be inappropriately carried out.

7/ Activit+

J normoactive J psychomotor retardation J hyperactive x J agitated

8/ ,acial E(pressi"n

x J smiling J worried J tearful J frightened

x J happy J tense J angry J distant J ecstatic J sad J suspicious

C/ Be*avi"r: The patient exhibited a pleasant disposition, was accommodating and

receptive to every %uestion thrown at him.

D/ D"ct"r9 N)rse !atient Interacti"n

x J cooperative J uncooperative J initially only K J throughout interview

;)alit+: x J warm J distant x J suspicious

x J tal$ative J hostile J others

II/ Strea% "f Tal


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A/ ""$

K J euthymic J depression x J euphoria

J others

Describe:The patient exhibited a normal, homeostatic mood.

B/ Affect

J appropriate K J inappropriate

;)alit+:

J flat xJ blunted J elated

J labile J histrionic J hostile

J others

C/ Depers"nali=ati"n an$ Dereali=ati"n

K J absent J present

D/ S)ici$al !"tential x J absent J present

E/ &"%ici$al !"tential x J absent J present

IV/ T*")'*t C"ntr"l

A/ T*")'*t !r"cess

0ooseness in Association K J

B/ !ercepti"ns x J present J absentType( denies A?B hallucination

C/ Del)si"ns x J present J absentType( delusion of persecution.

)escription( &hen he sees a cat, he frea$s out, as if the cat brings along with him

a curse that would endanger his life.

V/ Ne)r"ve'etative D+sf)ncti"n

A/ Sleep

x J normal J hypersomnia J late insomnia J mixed insomnia

B/ Appetite

x J normal J increase J decrease

,/ Attenti"n Span x J present J absent

Describe: The patient is very attentive throughout interview.

VI/ General Sens"ri)% an$ Intellect)al Stat)s


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A/ Orientati"n x J time x J place

x J person x J situation

B/ e%"r+ x J remote x J immediate

x J recent J impairedC/ Calc)lati"nsThe patient has improved calculation.

D/ General Inf"r%ati"n

The status of the patient3s general information was good as

demonstrated by $nowledge of the current 5hilippine 5resident.

E/ J)$'%ent

xJ impaired unimpairedJ

,/ Abstract T*in ( ? !resentati"n

> ( ? Strea% "f Tal ( ? E%"ti"nal State an$ Reacti"ns

> ( ? T*")'*t C"ntr"l

> ? Ne)r"ve'etative D+sf)ncti"n

> ( ? General Sens"ri)%

> ( ? Intellect)al Stat)s

C/ DS Dia'n"stic an$ Statistical an)al

Axis Schizophrenia, 5aranoid

Axis 7 5aranoid 5ersonality )isorderAxis "


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5atient( iguel 0argo, 1r. Attending 5hysician( Ian 1. 0indong, .).

Age( "" years old )ate Admitted ( =?!?27, 7?!?2", 2?2:?2", 7?7?2#,

Sex( ale :?7?2#, 2?7"?2#,#?!?2!,.?!?2!

@ admissions

-enter( )avao ental *ospital )iagnosis( Schizophrenia45aranoid Type

)escription of the 5atient(

The patient was generally fairly groomed, and seen wearing blue shirt and denim shorts. *e exhibited a distinct smell that

intensified his rubbish appearance. The patient responds when as$ed and appears warm and receptive to the interview.

>bHectives(

. To establish rapport with the patient67. To gain the trust of the patient6 and

". To encourage the patient to respond in ways comfortable to the patient but also understandable for the student nurse


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NURSE!ATIENT INTERACTION

NURSE T&ERA!IST !ATIENT ANA-.SIS DOCUENTATIONS


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magsuroyanL


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!S.C&OD.NAICS

,ACTORS !RESENT RATIONA-E

!REDIS!OSING

,ACTORS

6/ A'e

7/ Se(

irst onset at the age of 7years old. The patient at

present is "" years of age.

The patient is ale.

The onset of Schizophreniamay occur late in

adolescent, early in

childhood, usually before

the age of "2.Approximately ;!N of

persons diagnosed as having

Schizophrenia develop theclinical symptoms between

ages : O 7!. @5sychiatric

ental *ealth


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!RECI!ITATING

,ACTORS

6/ ,a%il+ 9!""r S)pp"rt

S+ste%

7/ Alc"*"l

8/ E%"ti"nal

The family was a

deteriorated and distortedsupport system for the

patient. The father who wassupposed to stand by and

provide for the basic needs

of the family, was a

gambler and an alcoholic.The mother, who was

supposedly the parent to

nurture the emotional andpsychological development

of the children was focusedon providing their physicalneeds in order to survive.

The loss of parental

supervision led the patientto explore of what the

outside world could give

him. The patient sought to

assume role as a provider,as he wanted to help

augment the family income

at such an early age.

The patient began ta$ingsips of alcohol, socially

drin$ing with friends. The

patient3s parents noted also

that his spends his money tobuy alcohol.

5atient lac$s emotional

security with a disrupted

family support system.

&hen the relationships of

young adolescents with

members of their familiesdeteriorate as adolescence

progresses,the fault usuallylies both sides. 5arents far

too often refuse to modify

their concepts as their

children3s abilities enhancesas they grow older.

According to Maplan and

Saddoc$s, alcohol interferewith the normal process of

food digestion and

absorption. As a result, food

is not consumed well andinade%uately digested.

uscle wea$ness is side

effect of alcohol and candepress the brain too much.

According to anfreda OMrampitz, drives may be

expressed in an individual3s

behavior reaction to sucheveryday incidents as

disappointment, reHection,


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@/ !""r e$icalC"%pliance

2/ -ac< "f E$)cati"nal

S)pp"rt

0/ S"ci"Ec"n"%ic Stat)s

3/ Un*ealt*+ -eis)re

Activit+

5atient was not able tomaintain medications due tolac$ of financial resource.

&hen the patient opted to

wor$ to help the family thanobtain education for

himself.

The patient3s family socio4

economic standing has

exposed the patient to the

hard realities of survival inlife at such an early age.

The patient was fond ofattending coc$fight derbi

and was so engrossed with

betting to earn money.

deprivations, marital

difficulties, failure in oneambitions, inferiorities, and

economic reverses. All of

these, and many other life

incidents, producesuncomfortable feelings of

tension and anxiety whichwhen continued for long

periods are believed to

brea$ down the person3s

constitutional resistance.)isorganization of one3s

personality results.

The discontinuance of drugs

which appear to activate aparanoid reactions results inreversal of personality in

due time. @5sychiatric


30/71

/ !ers"nalit+ The patient3s personalityproblem of not being able to

ventilate his true emotions

and his inability to handlefrustrations and

disappointments in life hasaggravated his condition.

adolescent a world in which

he may socialize in aclimate where the value that

counts are those that are set

not by adults, but by other

of his own age. Therecreational outlet is a vital

importance to theadolescent.

The development of

personality disorders isrelated to a combination of

biological, psychological

and social ris$ factors. Theinteraction of these factors

determines whether or notstrong personality traitsdevelop into personality

disorders. The social

environment coupled withpsychological vulnerability

strongly influences the

individual3s coping

mechanism @5aris, ==".


31/71

Sc*e%atic !resentati"n

!REDIS!OSING ,ACTORS !RECI!ITATING ,ACTORS

!RENATA- &ISTOR.

&anted and 8xpected 5regnancy emotional and financial problems


32/71

IN,ANC. 16 ONT&S

@T+FST BS IST+FST

"t*er ,at*er Breastfe$ t*e patient b)t $"ne in beteen c*"res rarel+ ar")n$ f"r b"n$in' ti%e

a 'a%bler an$ an alc"*"lic

!atient

F)alit+ ti%e it* fat*er

%aternal b"n$5 since inappr"priatel+ breastfe$

"ral nee$s n"t s)fficientl+ %et

first t""t* appeare$ at 0 %"nt*s "f a'e

first al< at 6 +ear "l$

t*)%bs)c< fr"% a'e 2 %"nt*s )ntil 7 +ears "f a'e

)n*+'ienicall+ presente$

T*e $evel"p%ental tas< "n t*is sta'e is attac*%ent t" %"t*er/ T*e p""r infant

%aternal relati"ns*ip5 as intensifie$ b+ fail)re t" establis* str"n' %aternal b"n$

t*r")'* breastfee$in' an$ t*e n"te$ t*)%bs)c


33/71

EAR-. C&I-D&OOD 6 ONT&S8 .EARS

@AFT>P BS S*A8 AF/T

"t*er ,at*er

4 with direct supervision and a 4 no active role in child rearingstrict disciplinarian 4 all vices @gambling, drin$ing, smo$ing

4 physically disciplines children

!atient

tal


34/71

-ATE C&I-D&OOD 82 .EARS O-D

@I


35/71

T*e $evel"p%ental tas< "n t*is sta'e bec"%in' p)rp"sef)l an$ $irective/ T*e

patient $i$ n"t i$entif+ ell it* t*e parent "f sa%e se(5 beca)se it as "nl+ t*e

%"t*er *" as ala+s ar")n$/ T*is sta'e is cr)cial sta'e "f c)ri"sit+ an$

e(pl"rati"n/ T*e c*il$ %)st spen$ a%ple ti%e creatin' *ealt*+ c"%petiti"ns it*

pla+%ates5 rat*er t*an c"nstantl+ acc"%pan+in' *is %"t*er t" sell/ T*e c*il$ as

intr"$)ce$ t" t*e perils "f $a+t"$a+ livin' at a ver+ +")n' a'e/ T*is $evel"p%ental

sta'e5 is %ar


36/71

T*e $evel"p%ental tas< "n t*is sta'e5 $evel"pin' s"cial5 p*+sical an$ sc*""l s


37/71

aare "f "ne#s b"$+ p*+siF)e/ T*ere as n" parental s)pervisi"n t*at ")l$ *ave assiste$

*i% in t*is transiti"n/ *en *e st"ppe$ sc*""lin'5 beca)se *e preferre$ "r


38/71

@Q recurrent admissions

@Q losing touch with reality

T*is sta'e calls f"r establis*in' inti%ate b"n$s "f l"ve an$ frien$s*ip/ &"ever5 t*e

patient#s sense "f inti%ac+ is 'reatl+ $ist)rbe$ as *e appeare$ ver+ it*$ran an$ passive/

&is represse$ e%"ti"ns t"ar$ t*e "pp"site se( c"ntrib)te$ t" t*e fr)strati"n an$

$isapp"int%ent t*at event)all+ %a$e t*e patient $etac*e$ "r is"late$ fr"% *is e%"ti"n/ &is

illness is in$icative "f fail)re t" *an$le fr)strati"ns an$ $isapp"int%ent t*at %a$e *i% l"se

t")c* "f realit+/

ONSET O, I--NESS

The condition of the patient was claimed to have started at the time when the patient was

poisoned in Samal, as he wor$ed as a construction wor$er. The patient with his family sought

medical assistance but had negative findings. So they decided to have the patient be attended by

an alternative doctor and was observed to have been really poisoned and was given treatment.

*owever, several days after, the patient manifested violence and erratic behavior whenever he

encounters a blac$ cat.

The patient had several admissions at )avao ental *ospital. It was on the year 7227,

that the first attac$ occurred. Specifically, September of 7227, the patient was admitted for

wee$ due to behavior changes, such as lying down on hot surfaced ground, stiffness andmuscular rigidity. /y ebruary 722", admitted bac$ for episodes of violence self4directed and to

others and was later released by arch 722". Third admission was on >ctober 722", brought in

by relatives and noted to have poor compliance with medications. 5atient was noted to be restless

and was tal$ing alone prior to admission, then was discharged # days after. ourth admission

was last ebruary 722# , patient was admitted because the patient was wal$ing aimlessly and was

Devel"pe$ Is"lati"n


39/71

staring blan$ly. It was claimed that the condition was aggravated to the level of episode of

violence due to a misunderstanding on a betting game, Dcoc$fight derbiE. )ischarged four days

later. ifth admission was last 1une 722# and discharged days after for same episodic reasons.

Sixth admission was last >ctober 722# and discharged days after due to the same reasons and

poor compliance with medications. Seventh Admission was last April 722! for the same reasons

posted.

The patient was last attended by a physician for his condition last August !, 722!.


40/71

/. -atatonic 8xcitement(

. Fnorganized and aggressive motor action K

7. 5urposeless, stereotyped, confined K

". Impulsive, unpredictable ?

#. Suddenly attac$ bystander or brea$ window K!. )estroy clothing, nude K

:. TA0

"?@22 R

7;N

7. 5aranoid(

. Tensed, suspicious and reserved ?

7. )elusion of poison ?

". )elusion of grandeur K

#. +eligious preoccupation, unrealistic thin$ing K!. Irritable ?

:. Fnpredictable ?

;. *allucinations K

. Ideas of +eference ?

=. )epression K

2. 0ac$s drive for achievement and career ?

. +egress and deteriorate K

T>TA0:?@22 R

:2N

". Simple?Schizoid(

. The subHect is vague K

7. 0oss interest in activity ?

". oody ?

#. Irritable ?

!. 0ac$ing spontaneity ?


41/71

:. Apathetic K

;. 9oals no longer realistic ?

. Fnable to assume mature roles K

=. -riticisms?concerns ma$e no impression K

2. -omplaints of nervousness and fatigue K

T>TA0!?2 @22 R

!2N

#. Fndifferentiated(

. Apathy K

7. Ideas of reference K

". 5rominent delusions K

#. TA0

!?2 @22 R

!2N

!. +esidual /orderline(

. *ealth of at least previous episode of Schiz. with prominentpsychotic symptoms

?

7. Shy ?

". 8asily irritated ?

#. 5erceived as peculiar x

!. 8motional /lunting x

:. Illogical thin$ing x

;. )isorganized behavior ?

. Absence of prominent delusions and hallucinations x

T>TA0

#?@22 R

!2N

II. Affective )isorders(

a. anic Type(

. Inflated self4esteem x

7. )ecreased need for sleep x

". ore tal$ative than usual x

#. light of Ideas ?

!. )istractibility x


42/71

:. 8xcessive involvement in pleasurable activities hat have a high

potential of painful conse%uence

x

;. +hyming x

. 8xhibitionistic /ehavior x

T>TA0 ?@22 R7.!N

b. )epressive Type(

. )epressed mood occurring most of the day x

7. ar$edly diminished interest in all activities ?

". Significant weight loss or weight gain x

#. Insomnia or hypersomnia nearly everyday x

!. 5sychomotor retardation or agitation ?

:. atigue or loss of energy nearly every day K

;. eeling of worthlessness ?. Indecisiveness ?

=. Suicidal Ideation ?

T>TA0 "?=@22

R!!N

III. 5ersonality )isorders(

a. eccentric 5ersonality )isorders

a. 5aranoid type(

. Suspicious ?

7. istrust ?

". 1ealousy K

#. +estricted Affect ?

!. 5roHection K

a.7 Schizoid?Schizotypal type(

. 8motional aloofness ?

7. &ithdrawn K

". >dd Speech ?

#. )etachment ?

T>TA0 :?= @22 R::N


43/71

b. )ramatic48rratic 5ersonality )isorders

b. *istrionic Type

. )ramatic K

7. 8xaggerated emotions K". Temper4Tantrums K

#. Impressionality K

!. )ependence on authority figures K

b.7 Antisocial Type

. anipulative K

7. 8xtroverted K

". -harming K

#. Impaired conscience with lying K

!. -heating K

:. )esire for immediate pleasure K;. 0ac$ of commitment and intimacy K

. 5oor wor$ history K

=. 0ac$ of concern about right and wrong K

T>TA0 2?# @22 R2N

c. Anxious4earful 5ersonality )isorders

c. Avoidant Type

. hypersensitivity to others K

7. ear of reHection or failure K

". ear or discomfort of being alone K

#. >verly serious K

!. /lunted emotional expression K

:. )evaluation of personal abilities K

c.7 >bsessive4-ompulsive type(

. +elentless K

7. Striving for organization and order K

". demanding K

#. -ontrolling K

!. 8xcessive dedication to wor$ K

:. 5erfectionism K

;. +igidity K


44/71

. 1udgmental attitudes towards others K

=. oralistic K

T>TA0 2?! @22 R2N

SUAR. O, DI,,ERENTIA- DIAGNOSIS

DISORDERS !ERCENT RANKING

. S-*I>5*+8


45/71

The first signs of paranoid schizophrenia usually surface between the ages of ! and "#. There is

no cure, but the disorder can be controlled with medications. Severe attac$s may re%uire

hospitalization.

Ca)ses

The causes of schizophrenia are still under debate. A chemical imbalance in the brain

seems to play a role, but the reason for the imbalance remains unclear. &e do $now that an

individual is a bit more li$ely to become schizophrenic if they have a family member with the

illness. Schizophrenia usually develops gradually, although onset can be sudden. riends and

family often notice the first changes before the victim does. Among the signs are( confusion,

inability to ma$e decisions, hallucinations, changes in eating or sleeping habits, energy level, or

weight, delusions, nervousness, strange statements or behavior, withdrawal from friends, wor$,

or school, neglect of personal hygiene, anger, indifference to the opinions of others, a tendency

to argue, a conviction that you are better than others, and that people are out to get you.

Si'ns9S+%pt"%s

Schizophrenia usually develops gradually, although onset can be sudden. riends and family

often notice the first changes before the victim does. Among the signs are(

-onfusion

Inability to ma$e decisions

*allucinations

-hanges in eating or sleeping habits, energy level, or weight

)elusions


46/71

delusion of grandeur

religious preoccupation, unrealistic thin$ing

irritable

unpredictable

hallucinations

ideas of reference

depression

lac$s drive for achievement and career

regress and deteriorate

Care

)rugs such as Thorazine, *aldol, and +isperdal combat symptoms in # out of ! patients.

An acute attac$ usually can be cleared up in # to wee$s. -ounseling and group therapy help

recovering patients to understand the disease and to function effectively.

Ris


47/71

Restraints: 5atients who pose a danger to themselves or others may be physically

restrained with leather bands.

Electr"c"nv)lsive T*erap+:or patients who become severely withdrawn or depressed,

this form of treatment can help speed recovery. Also $nown as 8-T or shoc$ therapy, it

applies a mild electric current to the brain. Although the treatment temporarily disrupts

the memory, full recall typically returns within 7 wee$s.

DOCTOR#S ORDER

7?!?2"

admit to I-F w? watcher

)AT

B?S shift and record

0A/S ( -/-, F?A, /S

edications

o *aloperidol ! mg I now then %

o /iperiden *-l 7 mg tab 7x?day as needed

*omicidal Suicidal

8scape precaution

+estrain if necessary

+efer accordingly

7?:?2"

)?- eds

-hlorpromazine 722 tab

7?;?2"

cont meds

2?:?2"

admit to -IF w? watcher

)AT

B?S % shift and record

0abs( -/-, FA


48/71

eds

o *aloperidol ! mg amp I now then %

o /iperiden *cl 7 mg?tab tab TI) 5+< for reaction

*omicidal?Suicidal? 8scape precaution

+efer accordingly

2?;?2"

-?) *aloperdiol

-ont. meds

7?7?2#

Admit to -IF w? watcher

)AT

BS % shift and record

eds




Suicidal? *omicidal? 8scape precaution

+efer

7?"?2#

cont. meds

7?#?2#

-?) *aloperidol

-hlorpromazine

7?!?2#

cont meds

or >T

:?"?2#

)?- *aloperidol I

-hlorpromazine

2?7"?2#

admit to -IF

B?S % shift and record




Suicidal? *omicidal? 8scape precaution


49/71

+efer

2?7#?2#

-hlorpromazine 722 mg tab U tab at *S

2?7!?2# or possible discharge tomorrow

-ont. meds

2?7:?2#

for >T today

cont. meds

2?7;?2#

still for >T

?!?2!

admit pt to -IF with watcher

)AT

BS % shift

0A/S( -/-, FA

8)S(

o *aloperidol ! mg?amp I now them %

o /iperiden *-l 7mg?tab, tab /I) 5+< for 85S

homicidal?suicidal?escape ideation

restrain if necessary &atch for signs of 85S

+efer

?:?2!

-?) *aloperidol I

Shift to chlorpromazine 22 mg tab, U tab /I)

?;?2!

continue meds

still for report

??2!

9*

*ome meds

o -hlorpromazine 22 mg?tab, U tab /I)

o /iperident *-l 7mg?tab, tab /I)

T-/ after two wee$s


50/71

!ROGRESS NOTES

7?!?2"

S?> awa$e, responsive

fairly groomed able to sleep well

able to eat well with good appetite

appropriate affect

denies of auditory hallucinations

A

schi4paranoid type 4 guarded5

continue meds

7?:?2"S?>

pt seen awa$e and sitting

not hostile

good sleep

good appetite

euthymic

A


51/71

schizophrenia, paranoid

5

continue meds

watch for signs of 85S

7?;?2"S?>

good sleep

good grooming

good appetite

good affect

@4 hallucinationsA


5

continue meds


2?:?2"

S?>


not hostile

good sleep

good appetite

euthymic

A

schizophrenia, paranoid5

continue meds


2?;?2"

S?>

awa$e, fairly groomed

euthymic mood, appropriate affect

good sleep and appetite

@C AB hallucinations

@4 violent behavior

@4 delusions and preoccupations

+esponds spontaneously

9ood eye contact

A


52/71


5

continue meds


7?7?2#

S?>

good sleep

good appetite

@4 hallucinations

Awa$e, responsiveA


5

continue meds


7?"?2#

S?>

good sleep

good grooming

good appetite

good affect

@4 hallucinations


continue meds


7?#?2#

S?>

good sleep

good appetite

@4 hallucinations

Awa$e, responsiveA


continue meds



53/71

7?!?2#

awa$e, responsive

fairly groomed

able to sleep well


appropriate affect denies of auditory hallucinations

A

schi4paranoid type 4 guarded

5

continue meds

:?"?2#

S?>

awa$e, responsive

fairly groomed

able to sleep well


appropriate affect


A


5

continue meds

2?7"?2#

S?>

good sleep

good appetite

@4 hallucinations

Awa$e, responsiveA


5

continue meds


2?7#?2#

S?>

awa$e, responsive


54/71

fairly groomed

able to sleep well


appropriate affect


A schi4paranoid type 4 guarded

5

continue meds

2?7!?2#

S?>


not hostile

good sleep

good appetite

euthymic

A


5

continue meds


?:?2!

S?> awa$e, responsive fairly groomed

able to sleep well


appropriate affect


A


5

continue meds

?;?2!

S?>


not hostile

good sleep

good appetite


55/71

euthymic

A


continue meds


??2!

S?>

pt. seen awa$e and responsive

able to sleep

good appetite

non hostile

@4 AB hallucination

A


5

continue meds



56/71

DRUG STUD.

Generic

Na%e

General

Classificati"n "$e "f Acti"n

D"sa'e M

R")te A$verse

Reacti"n

C"ntrain$icati"n N)rsin' Resp"nsibilities

-hlorpro

mazine*ydrochl

oride

Anti4psychotic6

Anti4anxiety

Antipsychotic drug

bloc$s postsynapticdopamine receptors in

the brain involve with

wa$efulness and emesis6

anticholinergic,

antihistamine and alpha4

adrenergic bloc$ing

722mg

tab /I)5.>.

)rowsiness,

insomnia,vertigo,

salivation, dry

mouth, nausea

and vomiting,

anorexia,

orthostatic

hypotension,

anemia,

photophobia.

V Allergy to

chlorpromazineV -omatose or severely

depressed states

V /one marrow

depression

V -irculatory collapse

V Sub cortical brain

damage.

V 5ar$inson3s disease

V 0iver damage

V -erebral or coronary

arteriosclerosis

V +espiratory disordersV Severe hypotension or

hypertension

V Always observe ten rights in administering drugs.

V 5atient should be advise about the possibility oftardive dys$inesia.

V Aspiration precaution because of suppressed cough

reflex

V onitor renal function test, discontinue if serum

creatinine or /F< become abnormal.

V onitor -/-, discontinue if &/- count is depressed.

V &ithdraw drug gradually after high dose therapy6

possible gastritis, nausea, dizziness, headache,

tachycardia , and insomnia after abrupt withdrawal.

V Fse with caution in hot weather, ris$ of heat stro$e6

$eep up fluid inta$e and do not over exercise in a hot

climate.


57/71


58/71

DRUG STUD.

Generic

Na%e

General

Classificati

"n

"$e "f

Acti"n

D"sa'e

an$

R")te

A$verse Reacti"n C"ntrain$icati"ns N)rsin' Resp"nsibilit+

/iperiden*ydrochlo

ride

Anti45ar$insonis

m

Antipar$insonians include

synthetic

anticholinergicand

dopaminergic

drug and the

anti4viral drug

amantidine.

Anticholinergi

cs probable

prolong the

action of

dopamine by

bloc$ing its re4

upta$e into

pre4synapticneurons in the

-


59/71

NURSING CARE !-AN

CUES DIAGNOSIS OBJECTIVE 9 !-AN INTERVENTION RATIONA-E EVA-UATION

S(

D Manang iringa,

maglagot Hud $o,gilabayn na$o na ug

tsinelas, su$ad naa na,

mag andar $o $a buangE

as verbalized by the

patient

>(

restless

irritability

tense facial

expression

rigid posture

5otential for violence

directed at others r?t

paranoid ideation

)efinition(

A state in which an

individual experiences

behaviors that can be

physically and

emotionally harmful to

others

+eference(


60/71

NURSING CARE !-AN

C)es9Evi$ences N)rsin' Dia'n"sis Objectives N)rsin' Interventi"ns Rati"nale Eval)ati"n

S(D *umana $o ligo,tong isa $aadlawE asverbalized by patient.

>(

wears uncleanshirt O short pant6

in state of poor

hygiene O grooming6

has distinct bodyO breath odor

exhibiteduntrimmed and dirtyfinger and toe nails.

un$empt hair

Self4care deficit+elated to 5oor5ersonal *ygiene

Source( State in whicha person experiencesdifficulty in

performing tas$s ofdaily living, such asfeeding self, dressing,

bathing, toileting,transferring from bed,and wal$ing.

+eference(


61/71

NURSING CARE !-AN

C)es9Evi$ences N)rsin' Dia'n"sis Objectives N)rsin'

Interventi"ns

Rati"nale Eval)ati"n

S(D )ili Hud $o anan

iring, $anang irangpag naa na,mag$asa$it Hud $o.E

>(

tal$ative

restlessness

@Q flight of ideas

@Q auditory andvisual

hallucinations

Impaired socialinteraction r?t

altered thoughtprocess asevidenced by

patientslo%uaciousness

)efinition(The state in which

individualparticipates in an

insufficient orexcessive %uantity

or ineffective%uality of social

exchange

+eference(


62/71

NURSING CARE !-AN

C)es9Evi$ences N)rsin'

Dia'n"sis

Objectives N)rsin' Interventi"ns Rati"nale Eval)ati"n

SubHective(

D )i $omahimutang,wlaa na$omahuman ang

balay, lagot $ayo$o, ngano walana$o human.E as

verbalized bythe patient.

>bHective(

perspiration

restlessness

flushing

voice%uavering

feelings ofhelplessness anddiscomfort

increasedtension

Anxiety related to

5ersonal -onflictSource( A vagueuneasy feeling thatusually stems froman impending oranticipatedcircumstance orevent. It cane be

focused on apatient, obHect, or

situation orunfocused and

more generalized.It is believed to be

primarilyinternallymotivated, and itssource is non4specific orun$nown to the

personexperiencing it.+eference(

rientation and awareness of thesesurroundings promotes comfort and a

decrease in anxiety.!. +ecognition and exploration of

factors leading to or reducing anxiousfeelings are important steps indeveloping alternative responses.5atient may be unaware of therelationship between emotionalconcerns and anxiety.:. Ability to recognize anxietysymptoms at lower intensity levelsenables patient to intervene more%uic$ly to manage her anxiety.

9oal met as patient

verbalized a reduction oanxiety and recognizes tta$e it step by step.


63/71


64/71

!ROGNOSIS

Criteria:

A/ Onset "f Illness: !""r

irst onset at the age of 7 years old. The patient at present is "" years of age. The patient

is ale.

B/ D)rati"n "f Illness: !""r

The patient had several admissions at )avao ental *ospital. It was on the year 7227,

that the first attac$ occurred. Specifically, September of 7227, the patient was admitted for

wee$ due to behavior changes, such as lying down on hot surfaced ground, stiffness and

muscular rigidity. /y ebruary 722", admitted bac$ for episodes of violence self4directed and to

others and was later released by arch 722". Third admission was on >ctober 722", brought in

by relatives and noted to have poor compliance with medications. 5atient was noted to be restless

and was tal$ing alone prior to admission, then was discharged # days after. ourth admission

was last ebruary 722# , patient was admitted because the patient was wal$ing aimlessly and was

staring blan$ly. It was claimed that the condition was aggravated to the level of episode of

violence due to a misunderstanding on a betting game, Dcoc$fight derbiE. )ischarged four days

later. ifth admission was last 1une 722# and discharged days after for same episodic reasons.Sixth admission was last >ctober 722# and discharged days after due to the same reasons and

poor compliance with medications. Seventh Admission was last April 722! for the same reasons

posted.

The patient was last attended by a physician for his condition last August !, 722!.


65/71

C/ !recipitatin' ,act"rs: !""r

6/ ,a%il+ 9!""r S)pp"rt S+ste%

The family was a deteriorated and distorted support system for the patient. The father

who was supposed to stand by and provide for the basic needs of the family, was a gambler and

an alcoholic. The mother, who was supposedly the parent to nurture the emotional andpsychological development of the children was focused on providing their physical needs in

order to survive. The loss of parental supervision led the patient to explore of what the outside

world could give him. The patient sought to assume role as a provider, as he wanted to help

augment the family income at such an early age.

7/ Alc"*"l

The patient began ta$ing sips of alcohol, socially drin$ing with friends. The patient3sparents noted also that his spends his money to buy alcohol.

8/ E%"ti"nal

5atient lac$s emotional security with a disrupted family support system.

@/ !""r e$ical C"%pliance

5atient was not able to maintain medications due to lac$ of financial resource.

2/ -ac< "f E$)cati"nal S)pp"rt

&hen the patient opted to wor$ to help the family than obtain education for himself.

0/ S"ci"Ec"n"%ic Stat)s

The patient3s family socio4economic standing has exposed the patient to the hard realities

of survival in life at such an early age.

3/ Un*ealt*+ -eis)re Activit+

The patient was fond of attending coc$fight derbi and was so engrossed with betting toearn money.

/ !ers"nalit+

The patient3s personality problem of not being able to ventilate his true emotions and his

inability to handle frustrations and disappointments in life has aggravated his condition


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D/ ""$ an$ Affect: G""$

The patient3s state of mood is euthymic, he was in a normal and homeostatic mood.

*owever, his affect was also appropriate.E/ Attit)$e an$ illin'ness t" t*e e$icati"n an$ Treat%ent: ,air

The patient is willing to ta$e medications and have regular follow4up chec$4ups, but

because of financial constraints, there is poor compliance to medication.

,/ An+ Depressive ,eat)re : G""$

The patient verbalized a sense of purpose or the need to wor$, because he claims he

wants to finish the completion of their house renovation.

G/ ,a%il+ S)pp"rt: ,air

amily plays a significant role in the recovery process. negative family climates may help

cause Schizophrenia @-omer, ===. The members of the family supports the patient, however

some are not responsive to the patient3s needs.

S)%%ar+

p""r 893 @8 L

fair 793 7 L

'""$ 793 7 L

OverAll !r"'n"sis: The following criteria lead us to a poor prognosis with an

increasing chance for improvement. The expectancy for relief is increased with every

compliance of medications and psychotherapy.

/


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RECOENDATION

,"r t*e client:

The 9roup recommends the client to(

. Ta$e his medications regularly.

7. )o her necessary activities of daily living.

". Berbalize her feelings and needs to her family members in order for them to ma$e

necessary interventions.

#. 5rovide client with tas$s to enhance her sense of responsibility.

!. 5rovide opportunities to client wherein she can participate in goal setting and planning.

,"r t*e fa%il+:

The group recommends the family to(

. Assist the client with necessary activities of daily living.

7. 5rovide the client with therapeutic environment.

". 5rovide a safe environment for the client.

#. 5rovide emotional support.

!. 8xplain to the client the reason for ta$ing medications so that he will comply with the

regimen and will at least control over situations.

:. 8ncourage the client to verbalize his feelings and needs.

;. -onvey the feelings of acceptance, love and understanding of the client.

,"r t*e c"%%)nit+:

The group recommends the community to(

. Show acceptance and understanding to the client.

7. Interact with the client in order to develop self4confidence.


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,"r t*e Instit)ti"n:

The group recommends the institution to(

. -onduct therapy sessions to enable client to engage in activities to exercise their

cognitive and motor abilities.

7. acilitate A)0 to ensure compliance and optimal cleanliness with regard to

personal hygiene.

T" t*e St)$ent N)rses:

. Accept and respect patient3s condition


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EVA-UATION

In a short span of time that we have $nown the patient and his family, the group was able

to establish good rapport with them to the extent that we were able to gather pertinent data

regarding the patient3s past and present health history. The data that we have obtained were all

carefully organized and processed. /y then, we have identified predisposing and precipitating

factors that contributed to the patient3s illness. The result of our initial and final ental Status

8xamination presented us information revealing the effectiveness of treatments and medications

given to the patient.

&ith the $nowledge we have learned from different sources regarding the patient3s case,

we were able to come up with appropriate nursing interventions and health teachings beneficial

to the patient and his family.

&e hope that the health teachings we have imparted to the family would give them a

better understanding on the nature of the patient3s illness and may they cooperate with the health

care providers in implementing the suitable interventions.


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BIB-IOGRA!&.

Maplan, *.I., Saddoc$, /.1., S+n"psis "f !s+c*iatr+:th8dition, /altimore, aryland( &illiamsO &il$ins, ==

Meltner, !s+c*iatric N)rsin', 7227

Mozier, /.6 8rb, 9.6 /lais, M. and &il$inson, 1.6 ,)n$a%entals "f N)rsin'!th8dition, Addison4

&esley 5ublishing -ompany, 722

anfreda, .0., S. Mramptiz, !s+c*iatric N)rsin'5 2th

8dition, 5hiladelphia( .A. )avis -o.,==;

"sb+#s !"c


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Documents

Schizo Paranoid