Chapter I

Introduction

Schizophrenia is a disorder characterized by significant disorganization of thinking

manifested by problems with communication and cognition; impaired perceptions of reality

manifested by hallucinations and delusions; and sometimes in significant decreases in

functioning.

Approximately 2.2 million people, or 1% of the world population, suffer from

schizoprenia . Statistics indicate that approximately 40% of these individual (1.8 million people)

do not receive psychiatric treatment on any given day, resulting in homelessness, incarceration,

or violence.(National Advisory Mental Health Council,2005).

The onset of schizoprhenia may occur late in adolescence or early in adulthood, usually

before the age of 30. Although the disorder has been diagnosed in children, approximately 75%

of person diagnosed as having schizoprhenia develop the clinical symptoms between ages of 16

and 25 years. Schizoprhenia usually first appears earlier in men, in their late teens or early

twenties, than in women, who are generally affected in their twenties or early thirties.

( shives,2008)

Age at onset appears to be an important factor in how the client fares: those who develop

the illness earlier show worse outcomes than those who develop it later. Younger clients display

a poorer premorbid adjustment, more prominent negative sign, and greater cognitve impairment

than do older clients. Those who experience a gradual onset of the disease (about 50%) tend to

have both poorer immediate and long term course than those who experience an acute and

sudden onset (Buchanan and Carpenter, 2005)

 Schizoprenia are classified into four types: Paranoid Schizoprhenia, Disorganized

Schizophrenia, Catatonic Shizophrenia, Residual schizophrenia and Undifferentited type was

charcterized by mixed shizoprhenic symptoms along with disturbances of thought, affect and

behavior.

This was a case of a 39 years old, female client from Sorsogon City, with an early onset

of undifferentiated shizophrenia since 1990 and admitted at National Center for Mental Health in

Pavillion 2 accompanied by her father, later on she was transferred in Unit 2, Pavillion 5 because

of agitation and assultive behavior to other client.

Theoretical Framework

Different theorist in the past proposed theories to explain the possible cause and

development of schizophrenia:

Psychoanalysis theory by Sigmund freud postulated that shizophrenia resulted form

development of fixation that occurred earlier that those culminating in the development of

neuroses. These fixations produced defects in ego development and freud postulated that such

defects contributed to the symptoms of schizophrenia. Ego intergration in schizoprhenia

represent a return to the time when the ego was not yet , or had just begun to be established.

Because the ego affects the interpretation of reality and control the inner drives such as sex and

agression. These ego functions are impaired, thus , intrapsychic conflict arising from the early

fixation and the ego defects which may resulted from early object relations, full of psychotic

symptoms. (Kennedy,2007)

Genetic predisposition theory suggest that the risk in inheriting schizophrenia is 10% to

20% in those who have one immediate family member with the disease, and approximately 40%

if the disease affects both parents or an identical twins. (Shives, 2008).

 Biochemical and neurostuctural theory includes the dopamine hypothesis: that an

excessive amount of neurotransmitter dopamine allows nerves impulses to bombard the

mesolimbic pathway, thye part of the brain normally involved in arousal and motivation. Normal

cell communication is disrupted, resulting in the development of hallucinations and delusions,

symptoms of schizoprhenia. The abnormalities of neurocircuitry or signals from nuerons are

being studied as well. A defective circuit can result in bombardment of infiltered information,

possibly causing negative and positive symptoms. Overwhelmed the mind makes errors in

perception and hallucinates, draws incorrect conclusion, and becomes delusionals. To

compensate for this barrage , the mind withdraws and negative symptoms develop. (Beuer,2006)

Organic or Pathophysiologic Theory suggest schizophrenia is a functional deficit

occuring in the brain caused by stressors such as viral infection, toxins, trauma or abnormal

substances.( Well-connected,2006)

Perinatal Theory suggest that the risk of schizophrenia exist if the developing fetus or

newborn is deprived of oxygen during pregnancy or if the mother suffers from malnutrition or

starvation during first trimester of pregnancy . The development of schizoprhenia may occur

during fetal life at critical points in the brain development generally the 34th or 35th week

gestation. The incidence of trauma and injury during the second trimester and birth also been

considered in the development of schizoprenia. ( Well-connected,2006)

Schisms and Skewed families by Theodore Lidz described two abnormal patterns of

family behaviors. In one family type, with a prominant schism between the parents, one parent is

overly close to a child of the opposite gender. In the other family type a skwed relationship

between a child and one parent involves a power struggle between one parent. These dynamics

stress the tenuous adaptive capacity of schizoprenic person.( Balllard 2009)

 Pseudomutual and Psuedohostile families by Lyman Wynne, some families supress

emotional expression by consistently using pseudomutual or psuedohostile verbal

communication. In such families, a unique verbal communication develops and when child

leaves home and must relate to other persons, problems may arise the verbal communication may

be incomprehensive to outsider( Brien 2007).

Psychological or Experiential theory found that prefrontal lobes of the brain are

extremely responsive to stress. Individuals with schizophrenia experiences stress when family

members and acquaintances respond negatively to the individual’s emotional needs. These

negative responses already vulnerable neurologic state, possibly trigerring and excerbating

existing symptoms. Stressors that have been thought to contribute to the onset of schizophrenia

include poor mother-child relationships, deeply disturbed family intrepersonal relationships,

impaired sexual identity and body image, rigid concept of reality, and repeated exposure to

double bind situation. A double-bind stuation is a no win experience, one in which there is no

correct choice. (kolb,2005).

Double bind concept by Gregory Bateson and Donald Jackson is to described the

hypothetical family in which children receive conflicting parental messages about their behavior,

attitudes and feelings. Children withdraw into a psychotic sate to escape the unsolvable

confusion of double bind. (Ballard 2009).

Environmental or cultural Theory state that person who develops schizoprhenia has a

faulty reaction to the environment, being unable to respond selectively to numerous social

stimuli. Theorist also believe that person who come from low socioeconomic areas or single-
parent homes in deprived areas are not exposed to situations in which they can achive or become

succesful in life.
Patient Personal Data:

Name: Patient JD

Age: 39 yrs. Old

Address: Sorsogon, City

Sex: Female

Date of Birth: July 12, 1971

Place of Birth: Pasig, City

Race/Religion: Filipino/ Catholic

Marital Status: Single

Education: Highschool Graduate

Occupation: none, former plywood cutter and Garments Factory worker

Source of Refferal:

The patient was brought to Ortho by social worker at Sorsogon, City because of assultive
behavior with post inflammatory scar on both lower extremities and fever for first intervention
then finally admitted to National Center forMental Health Pavillion 2 accompanied by her father,
later on she was transferred in Unit 2, Pavillion 5 for further monitoring of behavior.

Chief Complain:

Nagwawala, Balisa, Ayaw uminom ng Gamot, mainitin ang ulo as verbalized by the
Father.

Diagnosis: Undifferentiated Schizoprenia

History of Present Illness:

Patient is on Unit 2, Pavillion 5 for further monitoring of behavior, She was on good
mood state with normoproductive speech, She had poor recent, remote and immediate memory,
she only remembers the memory when she was at the age of 16-33. She was disoriented in time
and date but know what place she was. She denied any suicidal attempts and hurting others. She
said she had good sleeping pattern and also she denied any visual hallucination but sometimes
she experience auditory and gustatory hallucination such as “binubuyo niya akong saktan ang
sarili ko pero di ko na pinapansin yun” and “walang lasa ang pagkain dito palagi”.she also said
she always complied to her medicine but complain of positive dizziness.she also had unusual
mannerism and gesture such as scratching her plam and her head.

Past Personal History:

The patient was mentally ill since 1990’s with previous admission at an ortho because of
post inflammatory scar at both lower extremities, she was discharge as improved, following
medication was initially complain. Patient was eventually loss to follow-up with the medication
given because of low financial assistance.
Few days prior to admission, patient was noted to be restless, agitated and have
perceptual disturbances. January 15, 2008 family was decided to admit her at NCMH Pavillion 2
accompanied by her Father, after three months she exhibited normal cognition and physical state
then later on she was transferred to Pavillion 5 unit 2 because of escape and suicidal attempts,
assultive behavior to co-client,flight of ideas with looseness of association, poor impulse control,
agitated, tangentially and visual and auditory hallucination.She had 2x2 cm 2x 1.5 contrusion
hematoma on left Zygomattic area after having first fight last July 10, 2008. On October 29,2008
she was brought to restrain and undergo Electroconvulsive therapy on the following day. At
Novemeber 7, 2008 another incidental report happen when the patient was on restlessness nd
accidentally bumped her head on the cemented wall 3x4 cm contrusion on mid forehead.

Family History:
Her Father was 64 years old, jobless and her mother was 59 years old manicurista both
live at Sorsogon, City and earn 2,400 a month. She had a older brother who had own his family.
There is no data about history of having schizoprhenia in the family. But because of low
financial assistant with on and off medication serves as the rooted of worse progression of
patient diagnosis.

Chapter II
General Appearance
 CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

Good grooming * *
Appropriate facial * * *
expression

Appropriate * * *
posture

Maintain eye * * *
contact

During student nurse- patient interaction, the patient’s grooming was not good prior to
morning care she wear dirty ward gown without slippers but on the second day and later part she
improves and shows good grooming. Most of the time she exhibited appropriate facial
expression and posture during interactions. She also displays and maintain good eye contact and
show ineterest on the topic but she was easily get distracted by environmental stimuli such as
other student nurse in the room or preparing something. As days passes by student nurse
established rapport on the patient.
Motor Behavior
CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

AUTOMATISM

HYPERKINESTHESIA

WAXY FLEXIBILITY

CATAPLEXY

CATALEPSY

STEREOTYPE

COMPULSION

PSYCHOMOTOR RETARDATION

ECHOPRAXIA

CATATONIC STUPOR

CATATONIC EXCITEMENT
 TICS AND SPASMS

IMPULSIVENESS

CHOREIFORM MOVEMENTS

Analysis: Patient doesn’t exhibit any problem in motor behavior.

C. Sensorium and Recognition

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

ORIENTATION

• TIME

• PLACE * * *

• PERSON * * *

CONCENTRATION

MEMORY

• REMOTE

• RECENT

• IMMEDIATE RETENTION

Analysis: During our NPI patient was oriented in place and people but not in time and

date, lack of orientation may indicate possibility of a medical or nuerological brain disorder.

Some patient also with schizophrenia may give incorrect or bizzare answer to the question.

(Saddock,2007). She’s also has poor remote, recent, immediate retention in memory because

she’s doesn’t recall her past past experiences it may be because of the cognitive impairment.She

also exhibited poor concentration because she was easily distracted by environmental stimuli..

Patient with schizophrenia typically exhibit cognitive impairment in the domains of attention,

working, recent, remote and immediate memory, this impairements cannot function as a
diagnostic tools but they are strongly related to the functional outcome of the illness.

(saddock,2007) .

D.Perception

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

• HALLUCINATION

• VISUAL

• OLFACTORY

• AUDITORY *

• TACTILE

GUSTATORY

• ILLUSIONS

• DELUSIONS

Analysis: The patient shows auditory hallucination during day 2 of nurse patient

interaction, Any fives senses may be affected by hallucinatory experiences in patient with

schizophrenia. The mosy common hallucination was auditory with voices that are often

threatening, obscene, accussatory or insulting. That may comment on the patient’s life behavior.

( Saddock, 2007) . On my patient her auditory hallucination was ” sabunutan daw po kita” . as

patient verbalized. Auditory Hallucination was under the categories of positive symptoms

schizophrenia where in Patient with Undifferentiated schizoprenia may experience it (Videbeck

2008).

E.ATTITUDE AND BEHAVIOR

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

COOPERATION * * *
 OUTGOING

WITHDRAWN

EVASIVE

SARCASTIC

AGGRESSIVE

PERPLEXED

APPREHENSIVE

ARROGANT

DRAMATIC

SUBMISSIVE

FEARFUL

SEDUCTIVE

UNCOOPERATIVE

IMPATIENT

RESISTANT

IMPULSIVE

Analysis: The patient is cooperative throughout the exposure she cooperates well and

interacts with us and participates in the activities.

F.DEFENSE MECHANISM

Criteria Day 1 Day 2 Day 3 Day 4

 DENIAL

REPRESSION * * *

SUPPRESSION

RATIONALIZATION

PROJECTION

DISPLACEMENT

INTROJECTION

CONVERSION

SYMBOLIZATION

DISSOCIATION

UNDOING

REGRESSION

SUBSTITUTION

FANTASY

REACTION FORMATION

SUBLIMATION

COMPENSATION

Analysis: The patient show repression. Repression was excluding painful or anxiety-

provoking thoughts and feelings from contious awareness, a person use this kind of defense

mechanism to cover-up her fears (Keltner2007). She remember her memory when she was 33

years old and doesn’t recall any previous experiences, she doesn’t know why she was in NCMH.

According to Frued it is unconscious defense mechanism in which unacceptable mental contents

are banished or kept out of consciousness; important in psychological development and in

neurotic ans psychotic symptoms formation( Saddock,2007).

G.AFFECTIVE STATE

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

 EUPHORIA

FLAT AFFECT

BLUNTING

ELATION

EXULTATION

ECTSTASY

ANXIETY

FEAR

AMBIVALENCE

DEPERSONALIZATION

IRRITABILITY

RAGE

LABILITY

DEPRESSION *

Analysis: The patient does exhibit depresion on the first day, because when we talk about

her family, she expresses feelings of loneliness and longing to go home. Depression may be part

of the psychopathology of schizophrenia, and studies, on the average, have suggest that 25% or

more of schizophrenic patient experience depression (keck, 2007)

H. SPEECH

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

VERBIGERATION

RHYMING

PUNNING

MUTISM
 APHASIA

UNUSUAL TONE RATES

UNUSUAL VOLUME OF SPEECH

UNUSUAL INTONATION

UNUSUAL MODULATION

Analysis: The patient does not exhibit any problem of the speech behavior above.

I. THOUGHT PROCESS AND CONTENT

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4

BLOCKING

FLIGHT IDEAS *

WORLD SALAD

PERSEVERATION

NEOLOGISM

CIRCUMSTANTIALITY

ECHOLAGIA

CONDENSATION

DELUSION

PHOBIA

OBSESSION

HYPOCHONDRIAC

Analysis: The patient show flight of ideas during 4th day of exposure, One of the

symptoms of Schizophrenia was flight of ideas where in there is a overproductivity of talk and

verbal thinking skipping from one idea to another.Although talk is continously, the ideas are
 fragmently. Connections between segment of speech often are determine between segment of

speech.( shives, 2008). On Patient she answer the question about ahow many child she had then

she answer it 3 then turn her answer about her husband eventhough she had no husband and

children. Flight of ideas was of the disorder in thought process and it concern in the way ideas

and language are formulated, thought control in which outsides forces are controlling what the

patients thinks or feels.( Saddock, 2007)

Chapter III

Book based
CAUSES: SCHIZOPRHENIA

Neurostructural factors:
Biochemical Genetics: Psychodynamic:
factors: -Enlarge ventricles
-brain atrophy -can be inherited -Developmental
-Increase dopamine -decrease cortical blood because stage.
activity in the flow in the prefrontal schizophrenia runs
limbic system lobe in the families. -family relationship
i

Symptoms:
• Disturbance in perception
• Disturbance in thought process
• Disturbance in reality testing
• Disturbance in feeling ,behavior, attention

Decline in psychosocial functioning

Acute Phase: Stabilizing Phase: Stable Phase:

The patient experiences The patient gets better. The patient might still
severe psychotic experiences hallucinations
symptoms. and delusion but the
hallucination and delusion
are not severe not as
disabling as they were
during acute phase.

Five types of schizophrenia:

Paranoid schizophrenia, disorganized schizophrenia,

Catatonic schizophrenia, Residual schizophrenia and
undifferentiated schizophrenia.

According to Kelther (2007) there are different factors that causes Schizophrenia first the
Biochemical factors in which there is increase dopamine activity that contibute in activating
positive symptoms of schizophrenia, second was neurostuctural in which there is large
ventricles, brain atrophy and has decrease in blood flow in prefrontal cortex of the brain, third
the genetics which it can be inherited by a person who has schizoprhenia runs in the family and
lastly the psychodynamic factors in which a person with schizophrenia has tendency that he or
she had deprive in her or his developmental stage or a person may experienced conflict with
family relationship. There are different psychotic symptoms that may be seen such as d
Disturbance in perception , thought process, reality testing, feeling ,behavior, attention which may be
result in decline of psychosocial functioning. There are three phase that the patient might be experienced
first, in acute phase the patient experiences severe psychotic symptoms followed by stabilizing phase in
which patient gets better and lastly the stable phase, in this phase the patient might experiences
hallucination and delusion but the hallucination and delusion are not as severe nor disabling as were
during acute phase.

Client based Undifferentiated Schizophrenia

diagnosed since 1990’s

Patient experiences
agitation, restlessness,
and perceptual
disturbance

She exhibit normal

cognitive and physical
state.

After three months she was been shown

to be poor impulse control, agitated,
tangentially with flight of ideas with looseness
of association and visual and auditory
hallucination, she revealed escape and suicidal
attempts,
The onset of patient assultive behavior
shizophrenia to co-client.
was diagnosis since 1990, there’s no data of any family
members having schizophrenia except of her. The patient was brougth to ortho for her post
inflammatory scar in both lower extremities , she was discharge as improved, following
medication was initially complain. Patient was eventually loss to follow-up with on and off
rooted complain because of low financial assistance. Few days prior to admission patient
exhibited restlessness, agitation, perceptual diturbance. Then after three months she was been
shown to be poor impulse control, agitated, tangentially with flight of ideas with looseness of
association and visual and auditory hallucination, she revealed escape and suicidal attempts,
assultive behavior to co-client.
Related literature

Different studies are conducted to give possible explanation in the development of

schizoprhenia:

Gene Study Suggests New Target for Schizophrenia Tx Reviewed by Robert Jasmer,

MD; Associate Clinical Professor of Medicine, University of California, San Francisco and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner stated that defects in a pathway with

a misleading name may underlie some cases of schizophrenia, according to researchers

conducting a genetic study.

Genomic variants known as microduplications in or near the gene for the vasoactive

intestinal peptide (VIP) receptor were 14 times as common in a sample of patients with

schizophrenia relative to normal controls, reported Jonathan Sebat, PhD, of the University of

California San Diego, and colleagues, in the Feb. 24 issue of Nature.VIP is actually a

multifunctional protein that is produced throughout the body and is active in a host of body

systems. In addition to playing multiple roles in the intestinal tract and circulatory systems, VIP

helps regulate vaginal secretions, prolactin release, and circadian rhythms. This last function is

located in the brain, and previous studies have linked circadian rhythm disturbances with

schizophrenia.

They undertook the study because earlier studies had identified copy number gains

involving large DNA sequences (more than 500,000 bases) that were more common in

schizophrenic patients, and wondered if replication of shorter sequences might also be linked to

the disorder.
 The researchers conducted the scans in a two-stage study. They first searched for copy

number variants in 802 schizophrenia patients and 742 controls, which yielded positive

findings in 114 genomic "regions of interest."

In the second stage, Sebat and colleagues looked more closely at these regions in samples

from 7,488 patients and 6,689 controls.They found that microduplications within a 362-kilobase

region at chromosomal location 7q36.3 -- in or near the VIP receptor gene known as VIPR2 --

were significantly more common in the patients, with an odds ratio of 14.1 (95% CI 3.5 to

123.9).

"While duplications of VIPR2 account for a small percentage of patients, the rapidly

growing list of rare copy number variants that are implicated in schizophrenia suggests that this

psychiatric disorder is, in part, a constellation of multiple rare diseases," the researchers wrote.

"This knowledge, along with a growing interest in the development of drugs targeting rare

disorders, provides an avenue for the development of new treatments for schizophrenia."

(http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?

utm_source=twitterfeed&utm_medium=twitter)

According to Dr. A Bassett of the university of Toronto,the first true etologic subtype of

shizoprenia, the consequence of a chromosome deletion refered to as the 22q1deletion syndrome.

Person with this syndrome have distinct facial appearance, abnormalities of the palate, heart

defects, and immunologic deficits. The risk of developing shizoprhenia in the presence of this

syndrome appears to be approximately 25%. Genetic locations of schizophrenia, believed to be

on chromosomes 13 and 8. One study found thatmothers of client with schizophrenia had a high

incidence of gene type H6A-B44 (shives,2008)

Drug study

NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING

REACTION INTERVENTION
Haloperidol Competitively Management of Severe toxic CNS Glaucoma, • asses pt.
blocks dopamine Tourette depression or comotose seizure disorder, disorder and
receptor s to cause disorders; control states from any cause; hepatic and renal mental status
sedation and also of adults; parkinson disease. impairment before drug
causes alpha- management of therapy.
adrenergic and severe behavioral Reassses affect,
anticholonergic problems in orientation,
blockade. It children . long mood, behavior,
depressescerebral term antipsychotic sleep pattern.
cortex, therapy. • Monitor
hypothalamus and possible adverse
limbic system, reaction such as
which control CNS, severe
activity and extrapyramidal
aggression but also reactions.
cause significant • Monitor
extrapyrimidal swallowing of
effects oral
administration
medication and
check for
hoarding or
giving meds to
other client.

• Monitor
vital signs.
NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
 REACTION INTERVENTION
Chlorpromazine Blocks Management of Comatose states, presence Drowsiness, • asses for
postsynaptics manifestations pf of large amounts of CNS jaundice, postural mental status:
Thorazine dopamine receptors psychotic depressants, presence of hypotension, delusions,
in brain. disorders, to bone marrow extrapyrimidal hallucinations,
control nausea and depression.hypersensitivity. effects. Persistent disorganized
vomiting, relief of abnormal speech,
restlessness and movement, disorganized or
apprehension cerebral edema, catatonic
before surgery, hematologic behavior, and
acute intermittent disorders, ECG negative
porphyria, adjunct changes. symptoms
in the treatment of before initial
tetanus, to control therapy
manifestation of • Monitor
the manic type swallowing of
manic depressive oral
illness, relief of administration
intractable medication and
hiccups, treatment check for
of severe hoarding or
behavioral giving meds to
problems in other client.
children marked
by combativeness • Monitor
or hyperexcitable input and output
behavior.
 NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
REACTION INTERVENTION
Biperiden Synthetic Parkinsonian Narrow- angle CNS and • Document
anticholinergic syndrome glaucoma, mechanical peripheral effects, indication for
drugs, block especially to stenoses in skin rashes, therapy, onset of
cholinergic counteract gastrointestinal and dyskinesia, ataxia, signs and
response in the muscular rigidity megacolon; prostatic twitching, symptoms and
CNS. and tremor; adenoma and disease impaired speech, other agent tried
extrapyrimidal leading to perilous micturition and outcomeof
syndrome. tachycardia. difficulties. therapy.
Hypersensitivity to • Assess for
biperiden. parkinsonism,
EPS: shuffling
gait, muscle
rigidity,
involuntary
movement, pill
rolling, spasm
and drooling
during
treatment.

• Monitor
constipation,
cramping pain in
abdomen and
abdominal
distention.Increa
se fluids, add
fiber to diet and
excercise.
 NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
REACTION INTERVENTION
Amoxicillin Prevents bacterial cell Treatment of Hypersensitivity to Dizziness, • Obtain pt.
wall synthesis during infections of penicilin, fatigue, insomia, history of
replication.Bactericidal respiratory tract, cephalosphorins,or reversible allergy
skin and skin imipenem. Not used to hyperacidity, • Asses pt.
structures, treat severe pneumonia, urticaria, for sign and
genitourinary tract, empyema, bactemeria, maculopapular to symptoms of
otitis media, pericarditis, meningitis exfoliative infection,
meningitis, and purulent or septic dermititis. wound
septicemia,sinusitis arthritis during acute characteristic,
bacterial stage. sputum, urine
endocarditis stool, fever and
prophylaxis. WBC count.
• Monitor
sign of
nephrotoxicity:
urine cast,
oliguria,
proteinuria,
increase BUN

• Monitor for
bleeding,
ecchymosis,
bleeding gums,
hematuria.
 NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
REACTION INTERVENTION
Paracetamol Decreases fever by Relief of mild to Hypersensitivity, Stimulation, • asses pt.
inhibiting the moderate pain; intolerance totertazine, dowsiness, nausea, fever or pain,
effects of pyrogens treatment of fever. alcohol, table sugar, vomiting, location,
on the saccharin. abdominal pain, intensity,
hypothalamic heat hepatoxicity, duration,
regulating centers hepatic seizure, temperature,
and by a renal failure. diaphoresis.
hypothalamic • Assess
action leading to allergic reaction:
sweating and rash, urticaria; if
vasodilation. these occur,
drug may have
to be
discontinued.
• Monitor
liver and renal
function.,
• Check input
and output ratio.

• Asses
hepatoxicity.
 NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
REACTION INTERVENTION
Vitamin C Needed for wound Inhance body • asses pt.
healing, collagen natural immune nurtitional status
synthesis, function. for inclusion of
antioxidant, foods hign in
carbohydrate vitamin C: citrus
metabolism, fruits.
protein, lipid • Monitor
synthesis, prent input and
infection. output: polyuria
• Monitor
ascorbic acid
levels
throughout
treatment..

• Assess
patient
knowledge on
drug therapy.
 Chapter IV

Psychotherapies Implemented

1. Exercise Therapy

Description Goal Procedure/Activities Patient Role of the

Role/Patient Nurse
Analysis

Is physical . To teach the Let have atleast one Patient follows I encourage her
activity that is patient the some or two leader. the step and to do the
planned, exercises. does the exercise and
structured, and -Set a joyful and exercise. assist her.
repetitive for the 2. To assess lively music with a
purpose of motor abilities beat.
conditioning
of the patients.
any part of the -Let the client to
body. 3. To give follow the Steps.
Caution: Remind the
simple
condition of the
instructions that clients to consider
the patient can
follow.

4. Safety is the
priority.

5. To promote
wellness
 2. Dance Therapy

Description Goal Procedure/Activities Patient Role of the

Role/Patient Nurse
Analysis

The To teach the -Let atleast two to The patient follows Wemake dance
therapeutic use patient the three students to lead the dance step and steps together
of movement movements of the the step in the song. cooperates well. with my
to further the
dance. classmates and
emotional, -Have a good choice
social, teach them the
2. To assess motor of music it should be steps.
cognitive, and lively.
abilities of the
physical
integration of patients. -Ensure the step must
the individual be applicable to the
3. To give simple
in the clients.
treatment of a instructions that
variety of the patient can -Assure that most of
social, follow. the extremities will
emotional, move.
cognitive, and 4. Safety is the
physical priority.
disorders.

3. Music and Arts Therapy

 Description Goal Procedure/Activities Patient Role of the
Role/Patient Nurse
Analysis

It is an 1. Appreciate the 1.Prepare all the The clients draw Provide drawing
interpersonal music and put the material and share her materials and
process in feeling of the drawing to explain again
drawing. 2. Be sure that all everyone. the procedure to
which uses
materials are adequate. the patient.
music and all of 2. Discuss and 3. Gather all clients into
its facets— show the drawing. one area. Listen to the
physical, sharing of
emotional, 3. Divert attention 4. Explain the purpose patient’s
mental, social, into something and procedure of the drawing.
aesthetic, and more productive. therapy.
Appreciate
spiritual—to
5. Distribute materials. patient’s
help clients to sharing.
improve or 6. Play music
maintain their
health. 7. Let the client to draw
.

8. Inform clients to
share the work later.

9. When drawing
recognized client.

10. Repeat the music

when needed.

4. Bibliotherapy

Description Goal Procedure/Activities Patient Role/Patient Role of the

 Analysis Nurse

Bibliotherapy 1.To develop -Prepare a story with The patient can Arrange the
is rendered an individual elaborate images. express their learning chairs in semi
with the use of self-concept about the story the circle for the
a story with -Arrange the sits of heard. And give patients
elaborate 2. Increase the client into a good insight and comments
images to be understanding. setting: theatrical on the different Listen to the
helpful for the setting is more situation on the story. learning’s of
client to 3. Foster an advisable. patients
imagine the individual
story. -Story telling must be Give
honest self-
in form of appreciation or
appraisal. monologue. recognition.

-Someone should
introduce the story.

-At the end of the

therapy the clients
must share insights
and thoughts about
he story.

5. Remotivation Therapy
Description Goal Procedure/Activities Patient Role of the
Role/Patient Nurse
Analysis

A therapy of • 1. To 1 .Introduction The patient can able Listen to

very simple stimulate patient to site example and patient’s
group therapy to be fellow 2. Ask any body what give comments on sharing and
of an objective explorer of the they can say about the the poem, also to the give
nature used in real world drawing and if drawing and give recognition.
an effort • . anybody see a forest. their learning’s.
to reach the • 2. To
unwounded develop the 3. Poem reading “
areas of the ability to Kalikasan ating
patient’s communicate & Pagingatan”
personality & share ideas &
get them experience with 4. Evaluation and
moving other. Summary.
back into the •
reality. • 3. To
develop feeling
of acceptance &
Recognition.

6. Socialization

Description Goal Procedure/Activities Patient Role/Patient Role of the

Analysis Nurse

Is the primary 1. To develop 1. Introduction The patient enjoyed Arrange chairs

means by which cooperation. and participated in and prizes.
human infants 2. National anthem the games and
begin to acquire 2. Safety is activities. Assist patients
the skills prioritized. 3.Prayer in the games
necessary to The patient increases
perform as a 3. To develop 4Opening remarks self confidence and Join patient in
functioning interaction with cooperate. dancing.
member of their other patients. 1. Exercises
society, and is Cleaning the
the most 4. To develop 6.Yell/ Cheer place.
influential camaraderie
learning with other 7.Intermission
processes one schools. numbers
can experience.
8Games

9. Closing remarks

Chapter V

Nurse Patient Interaction

Day 1

Nurse Response Analysis of Nurse Patient’s Response Analysis of Patient’s

Response Response
“Hello Ma’am” Giving recognition “hello!(smile)” The patient response
through verbal by
saying hello and non
verbal communication
which is smiling, it
seems that she’s a
little bit shy to the
student nurse during
first interaction.
“ ako po si Gia Giving information “ ako si patient JD”
Borlongan, galling
And The patient responds
pos a URC sa malolos
directly in the
bulacan, ako po ang
seeking information
question by stating her
inyong student nurse.
name and with smile
Kayo po maari niyo
on her face. The
po bang ibigay ang
patient can able to
inyong pangalan?”
answer the question.

“Ilang taon na po Seeking information “33 years old.” Patient answered the
kayo?” question by stating her
age with maintained
eye contact to the
student nurse.
“Kailan po ang • Seeking “July 12, 1971” Patient answered the
birthday niyo?” Information question by stating her
birthday with
maintained eye
contact to the student
 nurse. The patient was
oriented.

“Saan po kayo • Seeking “Pasig, City” Patient answered the

nakatira?” Information question by stating
were she live.It seems
that she only
remember the place
where she grow up
because according to
the chart, the patient
live in Sorsogon, city.

“May asawa po ba • Seeking “Wala.” Patient answered the

kayo?” Information nurse’s question
seriously with
maintained eyecontact
to the student nurse.
The patient answer
same on the data on
the chart.

“May kapatid po ba • Seeking “oo. Isa. Kuya ko ” Patient answered the

kayo?” Information question directly and
• stating the relationship
of the person to her.
The patient still
remember her
siblings.

“Alam ninyo po ba • Seeking “hindi ko alam eh!” Patient answered the

kung anong araw at Information question with low
(yumuko)
oras ngayon? tone of voice,then
bow her head, it
 seems that she’s feels
shy on her answer.
“ Ngayon po ay • Providing “ ah, ganun ba” Patient get oriented in
huwebes, ika-17 ng information, time and date, and
febrero 2011, at 11:15 orientation deeply listening to the
na po ng umaga information given by
the student nurse .
“ anu po trabaho • Seeking “ Nagtrarabaho ako sa Patient answer the
ninyo dati” Information pasig Plywood cutter, question with
tas sa Antipolo irrelevent information
nagtatangal ng mga because it is
sobrang sinulid sa impossible that she
damit mula lunes works as plywood
hanggang biyernes, cutter at the same time
7:00-7:00.parehong works in the garment
oras at araw in same time and
days.
“Ilang taon na po • Seeking “ tatlong taon na” Patient answered the
kayo dito sa NCMH?” Information question while
counting with the
used of her fingers.the
patient was thinking
before answering.
“Sino po nagdala sa • Seeking “yung tatay ko” Patients answered the
inyo dito?” Information question by stating the
person who brought
her to NCMH with
sadness on her face. It
seems that she was
depress.
“ Alam ninyo po ba • Asking relate “hindi ko alam”. The patient answered
kung bakit kayo question, clarifying. (umiling) the question by saying
nadala dito?” she didn’t know and
 non verbal
communication by
turning his head a
gesture that means she
doesn’t know the
answer.
“May gusto po ba • Encouraging “ gusto ko na umuwi Patientanswered the
kayong sabihin sa patient to express sa amin, miss ko na questioned by
akin?” feelings nga sila, kelan ba ako expressing her
maaring umuwi?. feelings of longing to
her family members
with sadness on her
face. Also seeking for
information about the
time were she can go
home.It seems that she
has strong desire to go
home, because since
the time she was
admitted in NCMH,
no one visited her.
“ anu daw po ba ang • Asking and Sabi matagal pa daw, Patient answered the
sabi ng doctor at nurse clarifying information kasi nasa probinsya question by giving
dito? through the use of daw sila, dito muna details on what she
questioning daw ako. ( with teary had been heard
eye) explanation from
other health care
provider. While
telling this to the
student nurse it seems
that she want to cry.
“siguro po pag mabuti Giving opinion and “okey naman ako, Patient give detailed
na ang inyong seeking for ayos na ako matulog, information about her
kalagayan, papayagan information at iniinom ko naman condition, and she
na po kayo umuwi, ang gamut ko. explained to the
kamusta na po kayo? student nurse what
that she doesn’t
experiences
difficulties unlike
before .
Ma’am pakibigay po • testing if the “ikaw si Gia, student Patient answered the
ulit ang akin patient are oriented to nurse kita question with
pangalan, natatandaan the person interacted, smilling, and she was
ninyo pa po ba? clarifying previous in able to remember the
interaction student nurse name. It
seems that she can
recall the name of the
person she’s ineract
with.
“bukas po, may mga • Giving Oo, sigeh(smile) Patient answered the
therapy po tayong information, question through
gagawin,maaasahan encouraging the smile and argees to
ko po ba ang inyong patient to join to the cooperate in the
paglahok?. activities. activities. It seems
that the patient was
interested with the
incoming activities.
“ bukas po ulit • Thanking for (smile) Patient answeres
ma’am, salamat pos a the information she through non verbal
pagbabahagi gathered. communication by
impormasyonng smiling and waving ,
inyong sarili” it is a gesture saying
goodbye. The patient
also expecting the
 student nurse in the
next exposure.

Day 2

Nurse Response Analysis of Nurse Patient’s Response Analysis of Patient’s

Response Response
“Hello Ma’am, Giving recognition “ok naman!(smile). The patient answered
kamusta na po kayo? and testing client if Ikaw si gia” the question with
Tanda ninyo po ba she remember the smile and she’s also
ako?” nurse stating the name of the
student nurse which
means that she still
remember the student
nurse. The patient
answered the question
correctly.
“ nagustuhan ninyo po seeking information “ oo, sumayaw nga The patient answered
ba ang mga activity ako, tas nagdrawing the question by sating
ngaun? pa” what sh’ve done on
the activity, It means
that there is
acceptance,
recognition and it
seems that she
enjoyed the activity.

“Ilang taon na po ulit clarifying information “33 years old.” Patient answered the
kayo?” nurse’s question same
as the previous
interaction in student
 nurse with
maintained eye
contact.
“Kailan po ang • clarifying “July 12, 1971” Patient answered the
birthday niyo?” Information nurse’s question same
as previous interaction
with maintained eye
contact to the student
nurse.

“Saan po kayo clarifying Information “Pasig, City” Patient answered the

nakatira?” nurse’s question same
as previous interaction
witha maintained eye
contact to the student
nurse.

“May asawa po ba clarifying Information “Wala.”(yumuko) Patient answered the

kayo?” nurse’s question same
as previous interaction
with maintained eye
contact to the student
nurse while having a
gesture of turning her
head side to side as a
sign that she doesn’t
have.

“May kapatid po ba clarifying Information “oo. Isa.” Patient answered the

kayo?” nurse’s question same
as previous interaction
with maintained eye
contact to the student
 nurse.

“Ano po ang • Seeking “yung kwento ni Patient answered the

pinakagustong Information maria makiling!” nurse’s question in
activity na ginawa? interesting manner
with smile on her
face. It seems that she
really liked the story
in the activity.
“ bakit po? • Asking the “ kasi iba yung pag- She answered the
patient to elaborate iibigan nila ni gat question by giving the
the answer dula, tsaka yung qualities of the
pagmamahal niya sa character in the story
magulang nya” and also telling a part
of the story. It seems
that she can relate the
character of the story
to her qualities.
“anu pong paguugali • Asking the “ mapagmahal at Patient answered the
ni maria ang maaring patient to relate it to mapagalaga sa question with smile
ihalintulad sa inyo” herself magulang, maganda and giving her same
pa qualities base on the
qualities of the
character and her. It
seems that she can
relate on the qualities
of the character.
”may gusto pa po ba • Seeking “ si gat dula, para Patient answered the
kayong tauhan sa Information siyang si cocoy” question and giving
kwento? example of specific
person that she knows
that has the same
qualities to the
 character of the story.

“Sino po si cocoy? • Seeking “yung crush ko, Patient providing

Information gwapo kasi un” information about a
specific person that
she knows from the
past with smile on her
face .It seems that she
likes this person.
“ Nagkatuluyan po ba • Asking “hindi kasi pareho Patient answered the
kayo? information kaming mahiyain, question, by stating
piloto un. what happen to her
and to the person
involve.
“may gusto pa po ba • Encouraging “yung tatay ko Patient answer the
kayong ibahagi? patient to express katulad ng tatay ni question in which she
feelings maria, pinapagalitan relate the qualities of
din ako?. the father to the
qualities of the
character in the story.
It seems she had
childhood experiences
where she experienced
repremmanded by her
father.
“ baka naman po kayo • Giving “ oo ganun na Patient answered the
napapagalitan kasi opinion and seeking nga(smile) question with smile
may mali po kayong for information and agreed to the
nagawa., madalas po opinion of the student
ba kayo nurse. It seems that
napapagalitan? she approved to the
opinion of the student
 nurse.
“nagustuhan ninyo Summarizing and Wala na Patient answered the
pop la lahat ng asking question. question and seems
activity, may gusto pa she don’t want to open
ba kayong ibahagi? another conversation
about the topic.
Ako naman po ang • Seeking “thorazine Patient answered the
magtatanong, alam information question directly by
ninyo po ba inyong stating the name of
gamut? her drugs.this means
that she was aware on
the drugs she’s taking.
“ngayon po • Seeking Oo, Patient
nakakaranas pa po ba information respond with the
kayo ng pagbulong? question by stating
yes,which means she
was experienced
auditory hallucination.
Auditory
Hallucination was
under the categories
of positive symptoms
schizophrenia where
in Patient with
Undifferentiated
schizoprenia may
experience it
(Videbeck 2008).

“anu naman po ang • Seeking Sabi sabunutan ka Patient respond to the

binubulong sa inyo” information daw question by stating her
auditory hallucination.
 It seems that she
hallucination
symptoms are not yet
subsiding.
“ ano po ulit ang sabi? • Clarifying Hindi dati yun, Patient answered the
information ngayon medyo question by trying to
nawawaqla na cover up what she’s
been heard. It seems
that she withrawn it.
Silence • silence Napapagod na ako Patient Expresses
pwede na ba ako what she feel and she
pumasok want to go back in the
ward. It seems that it
is her way to escape
reality that she had
auditory hallucination.
O sige po • respond to the Smile Patient respond with
patient question nonverbal
communication by
means of smiling.

Day4

Nurse Response Analysis of Nurse Patient’s Response Analysis of Patient’s

Response Response
“Hello Ma’am, Giving recognition “ok naman!(smile). The patient answered
kamusta na po and testing client if Ikaw si gia” the question with
kayo?.tanda ninyo po she remember the smile and recall what
ba ako?” nurse the name of her
student nurse. The
patient can still
remember the student
 nurse. It seems that
the student nurse
established rapport
well.
“ may socialization po Giving information “ oo, sigeh, may Patient agrees to the
tayo ngaun, sana po and encouraging to sayaw ba dun?” suggestion and asked
makilahok kayo sa join to the activity. information with
mga laro interesting manner by
knowing what
activities she may
cooperates and she
also smiles.It seems
that she was excited
on upcoming
activities.

“ Nagenjoy po ba seeking information “oo Patient answered the n

kayo sa socialization? question directly
about what she feel on
the activity. It seems
that she enjoyed the
activity well.
“Kailan po ang • clarifying “July 12, 1971” Patient answered the
birthday niyo?” Information nurse’s question same
as previous interaction
she had a week
before. The patient
answered it correctly

“Saan po kayo clarifying Information “Pasig, City” Patient answered the

nakatira?” nurse’s question same
as previous interaction
 a week before with
maintained eye
contact on the student
nurse.

“May asawa po ba clarifying Information “meron.” Patient answered the

kayo?” nurse’s question
different from the
previous interaction
because previously
she tells she had no
husband with smile on
her face. It seems that
she experiencing
delusion.

“May kapatid po ba clarifying Information “oo. Isa.” Patient answered the

kayo?” nurse’s question same
as previous interaction
with maintained eye
contact on the student
nurse.

“anu po pangalan ng • Seeking “cocoy!” Patient answered the

asawa ninyo ? Information nurse’s question with
the smile and giving
the name of the person
she talking about.
“ Di ba po sabi ninyo • clarifying “ meron, tatlo nga Answered question
wala kayong asawa? Information anak namin eh. with explanation, and
giving information
about the person. The
patient answer was
new to the student
 nurse, she had
different answer on
the previous
ineraction.
“anu po mga pangalan • seeking “ joan, anna, miguel Patient aswered the
ng anak ninyo?” information question with smile
and stating the name
of the sibling she
had.This is part of her
delusions because she
had no children.
”ilan taon na sila? • Seeking “di ko alm eh, piloto Patient answer the
Information si cocoy,” question with light of
ideas, the answer was
not connected to each
other. Because the
question of student
nurse was focused on
the children she
answered it is
irrelevant to the
question.
“kasal nap o ba kayo • Seeking “hindi, di ko alm kung Patient answer the
ni cocoy? Information nasaan sya.” question with Flight
of ideas, it is not
related to each other
with maintained eye
contact. flight of ideas
where in there is a
overproductivity of
talk and verbal
thinking skipping
 from one idea to
another(shives,2008).
It is sign of disturbed
thought process.
“ Ito po ang huling thanksgiving “salamat din sa mga Giving thanks, and
araw naming dito, ako natutunan ko, alam ko expressing what she
po’y lubos na na kailanagn maglinis learned from the
nagpapasalamat at ng katawan lagi at student nurse with
nagbahagi kayo sa salamat kasi smile on her face and
akin. nabubusog ako shaking hand with
her , a gesture of
thanks giving and
saying goodbye.
Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Objective Data: After Nursing 2. Explain task -A complex task After the exposure
exposure the patient in short simple will be easier for the patient able to :
-Patient wears dirty Self care deficit will be able to: manner. the client it is
ward gown and related to poor broken down into a. Participated
without slippers personal hygiene. a. Participate in series of steps. in self care
self care activities activities.
-bad breath 3. Allow patient -It may take
sufficient time to longer to
-patient has foul complete any complete task
odor b. Demonstrate task. because of lack of b. Can able to
independence concentration and perform self
short attention care activities
span. on her own

-trying to rush the

4. Remain with the patient will
client throughout frustrate him/her
the task: do not and make
attempt to hurry completion of the
the client task impossible.

It is important for
5. Gradually the client to gain
withdraw independence as
assistant and soon as possible.
supervision to the
patient grooming
and other self
care skills.
Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Data: After Nursing 1. Reorienting -help patient After the exposure
exposure the patient the patient. maintain her level the patient able to :
“Hindi ko alm kung Disturbed thought will be able to: of orientation;
anung oras na o process related to increase her a. Can state
anung araw na auditory a. Oriented in ability to become the right time
ngayon, kanina hallucination, time and date. more oriented. and date.
sinabi nung nurse disoriented in
pero di ko na time and date. 2. Continue - It promoted and
maalala ” as therapeutic nurse- strengthens trust
verbalized by the b. Present into patient alliance. between the b. Presented
patient reality. patient and nurse. into reality

“Sabi daw niya -It increases

sabutan daw po kita” 3. Use short simple patient ability to
as verbalized by the directions and understand and
patient explanation. follow.
Chapter VI

• Journal

Day 1: February 17, 2011

At first I feel combination of nervous and excitement because I don’t know what type of
client I will handle. I don’t know what kind of approach I will give to be able to gain rapport and
I feel also shock to the kind of environment they were staying because I’m expecting it was like
ward I was seen in the movie. I learned that in interacting them to gain rapport we should not
force to answer all our question and we need to ask them little by little, because it is not easy for
them to open up especially like us stranger or newly met, and there are lots of painful of
experience they encounter, and that their emotional coping mechanism was not that stable. I also
learned that I’m blessed because I have my family to support me in times of problem that can
help me to cope. I also feel lucky that I’m not craving for food like them and I was in good
condition. As a future nurse someday I learned that in handling patient during initial interaction
we should maintain eye contact, let the patient feel that you are not harmful to them that you can
lend your ears to hear their feelings and lastly face them with optimism appearance even though
they had poor hygiene. And it is nice to know and hear about different qualities I didn’t found to
myself that other could see it.

Day 2: February 18, 20011

On the second day of the exposure I’m quite comfortable to the place, first we arrange
the table and the chairs that we’ve been using for the different therapy. At first we do the routine
of patient hygiene, exercise, dance therapy where I know I discovered my dancing talent and
think simple step in a short time, music and arts and bibliography. I’m gently listening to their
sharing about the learning and the meaning of the drawing they draw and I’ve learned that partly
the activity or the therapy they connected it to the previous experience they have. During the
patient inter action I was shocked when my patient tell me about her auditory hallucination “ sabi
daw sabunutan kita” then I stop talking but maintaining my eye contact to her then I asked
clarification question like “anu po ulit yung naririnig ninyo?” then she said “wag ka mag-alala di
ko na sila pinapansin” and I learned that it is nice to help the client express her feelings and be
calm enough to interact to them even if you are afraid about what they are saying.
Day 3: February 23, 2011

This was the third day of the duty; we are all excited for the Ms. Valentine pageant, we
are tasked to design the sash that been using at the pageant, I know in this simple tasked I used
again my artistic talent in designing the sash. In this duty we all witness the talent and question
and answer portion. I can say that by this type of motivation it helps the client to gain their
confidence and boost their talent. They touched my heart about the question and answer
especially when they were given the time to give thanks to the audience, I can see their hope and
their happiness in their eyes. I learned also only their mind can betray them but on the other side
of it their hope and feelings that they want to be free from their disease.

Day 4: February 24, 2011

This was the last day of the exposure. The grand socialization, we are all busy preparing
in this day. And the very good thing I established camaraderie to other student nurse from the
different school. The greatest learning I’ve learned about is the talk of our C. I that socialization
is not intended only for the residents but also to the student as well, so that they know how to
mingle to others, how to give and take knowledge and strategies, it is not about completion about
other schools but learning how to interact with them. I realized from this that our group may be
together now but after we are graduated and pass the board exam we go different way and it is
better to practice camaraderie not only to our group because we did established it but to others
also, because some point in time we may cross our path and be my co- health workers in the
future. After the socialization we have is interaction to the patient, I’m glad to know that even in
a short time my patient can know my name even without looking at my name tag. And it is nice
to know that she learned something on me, me as well.

Appendices

Definition of terms
 Definition of terms

Automatism - repeated purposeless behaviors often indicative of anxiety, such as

drumming fingers, twisting locks of hair, or tapping the foot.

Psychomotor Retardation - overall slowed movements.

Waxy Flexibility - maintenance of posture or position over time even when it is awkward

or uncomfortable.

Delusion - a fixed false belief not based in reality.

Hallucination - false sensory perception or perceptual experiences that do not really

exist.

Flat Affect - showing no facial expression.

Echolalia - the client’s imitation or repetition of what the nurse says.

Compulsion - ritualistic or repetitive behaviors or mental acts that a person carries out

continuously in an attempt to neutralize anxiety.

Echopraxia - imitation of the movements and gestures of someone an individual is

observing.

Cataplexy - is a sudden and transient episode of loss of muscle tone, often triggered by

emotions.

Catalepsy - is a nervous condition characterized by muscular rigidity and fixity

of posture regardless of external stimuli, as well as decreased sensitivity to pain.

Catatonic Stupor - is a motionless, apathetic state in which one is oblivious or does not

react to external stimuli.

Catatonic excitement - is a state of constant purposeless agitation and excitation.

Individuals in this state are extremely hyperactive, although, as aforementioned, the

activity seems to lack purpose.

Choreiform movement - is characterized by repetitive and rapid, jerky, involuntary

movements that appear to be well-coordinated, but are rather performed involuntarily by

the patient afflicted with such a disorder.

Impulsiveness - is a personality trait characterized by the inclination of an individual to

initiate behavior without adequate forethought as to the consequences of their actions,

acting on the spur of the moment.

Regression - a defensive reaction to some unaccepted impulses.

Suppression - is the process of deliberately trying to stop thinking about certain thoughts.

Euphoria - is the process of deliberately trying to stop thinking about certain thoughts.

Blunting - lack of emotional reactivity on the part of an individual. It is manifest as a

failure to express feelings either verbally or non-verbally, even when talking about issues

that would normally be expected to engage the emotions.

Depersonalization - is a malfunction or anomaly of the mechanism by which an

individual has self-awareness.

Word Salad - flow of unconnected words that convey no meaning to the listener.

Neologism- invented words that have meaning only for the client.

Phobia - an illogical, intense, and persistent fear of specific object or social situation that

causes extreme distress and interferes with normal functioning.

Aphasia - deterioration of language function.

Mutism - is a speaking disorder in which a person, most often a child, who is normally

capable of speech, is unable to speak in given situations, or to specific people.

Patient output
 The patient drew a house using the color blue which indicates severe depression. Using

the blue color, she also drew a human stick that she labeled as Cinderella. Using the same color,

she drew two cats and two kids playing piko. Around and in between the pictures she had drawn,

she had shade it with the color violet which reflects depression, she also used that color to write

her name at the top of the paper. As the drawing specifies, the patient reminisces the past

especially her childhood. From all her experiences, she insisted that she was only 33 years old

but in reality she is already 39 years old.

Bibliography
 Sadock M.D et. al (2007). Synopsis of Psychiatry. Lipprincott& Williams.United State of
America.

Kelther N.(2007). Psychiatric Nursing( 5th ed). Elvevier Piecta. Singapore.

Kaufman (2006). Essentials of Abnormal Psychology. John Wiley& Sons Inc. United
State of America.

Videbeck, S. L. (2008). Psychiatric Mental Health Nursing. (5th ed). Wolters Kluwer
Health.

Shives, L. R. (2008). Psychiatric Mental Health Nursing. (7th ed). Lippincott Williams &

Wilkins.

Kennedy P. (2008) Psychiatric Mental Health Nursing. Jones and Barlett Publishers, Inc.

United State of America.

Internet sources:

http://www.medpagetoday.com/Psychiatry/Schizophrenia/25040?utm_source=twitterfeed

&utm_medium=twitter

http://www.nursingscrib.com

http://psychopathology.wikispaces.com/Schizophrenia

University of Regina Carmeli

Catmon, City of Malolos

College of Allied Medical Sciences

In PartialL Fulfillment in NCM 105 RLE

PSYCHIATRIC CASE STUDY

Submitted to:

Mrs. Perlita Espinoza

Submitted by:

Borlongan, Gia Pauline A.

BSN3