BSN 3Y2-2B

Clinical Instructor : Aida I Bautista RN, MAN

At the end of the case presentation,
the students will gain knowledge,
skills and attitude in the care of client
with Other Specified Schizophrenia
Spectrum.
1. Discuss various etiology of Other Schizophrenia.
2. Describe a functional and mental status assessment for a
client with Other Schizophrenia.
3. Apply the nursing process to the care of a client with
Other Schizophrenia.
4. Evaluate the effectiveness of antipsychotic medications
for client with Other Schizophrenia.
5. Evaluate your own feelings, beliefs, and attitudes
regarding client with Other Schizophrenia.
Schizophrenia from the Greek roots skhizein (to
split) and phren (mind). Schizophrenia is a
chronic and severe mental disorder that affects
how a person thinks, feels, and behaves. People
with schizophrenia may seem like they have lost
touch with reality. The symptoms of
schizophrenia fall into three categories: positive,
negative, and cognitive.
1. Positive symptoms: “Positive” symptoms are psychotic
behaviors not generally seen in healthy people. People
with positive symptoms may “lose touch” with some
aspects of reality. Symptoms include: Hallucinations,
delusions, thought disorders and movement disorders.

2. Negative symptoms: “Negative” symptoms are associated with

disruptions to normal emotions and behaviors. Symptoms
include: “Flat affect” (reduced expression of emotions via
facial expression or voice tone), reduced feelings of pleasure in
everyday life, difficulty beginning and sustaining activities and
reduced speaking.
3.Cognitive symptoms: For some patients, the cognitive
symptoms of schizophrenia are subtle, but for others, they
are more severe and patients may notice changes in their
memory or other aspects of thinking. Symptoms include:
Poor “executive functioning” (the ability to understand
information and use it to make decisions), trouble focusing
or paying attention and problems with “working memory”
(the ability to use information immediately after learning
it)
Other Specified Schizophrenia Spectrum and Other
Psychotic Disorder are related to, but distinguished
from schizophrenia in terms of presenting symptoms
and the duration or magnitude of impairment. This
diagnosis means a person shows significant distress
or impairment in social, occupational, or other
important areas of functioning due to psychotic
symptoms that do not meet the full criteria for a
schizophrenic or other-psychotic disorder diagnosis.
Criterion A lists the five key symptoms of psychotic
disorder, at least one of these must be present:

1.Delusions (a firmly-held idea that a person has despite

clear and obvious evidence that it isn’t true. Often,
these delusions involve illogical or bizarre ideas or
fantasies)

2.Hallucinations (are sounds or other sensations

experienced as real when they exist only in your mind. It
involves any of the five senses)
3.Disorganized speech (may respond to queries with
unrelated answer, start sentences with one topic
and end somewhere completely different, speak
incoherently or say illogical things)
4.Grossly disorganized or catatonic behavior
(disrupts goal directed activity, impairing your
ability to take care of yourself) 5.Negative
symptoms (refer to the absence of normal
behaviors found in healthy individuals)
1. Genetic factors:
Evidence that the disorder is partly inherited comes
from studies of twins. Identical twins share the same
genes. In identical twins, if one twin develops
schizophrenia, the other twin has a one in two
chance of developing it, too. This is true even if
they're raised separately. In non-identical twins,
who have different genetic make-ups, when one
twin develops schizophrenia, the other only has a
one in seven chance of developing the condition.
2.Neurotransmitters
Some studies indicate an imbalance between
the two may be the basis of the problem.
Because drugs that alter the levels of
neurotransmitters in the brain are known to
relieve some of the symptoms of
schizophrenia. Research suggests schizophrenia
may be caused by a change in the level of two
neurotransmitters: dopamine and serotonin.
3.Pregnancy and birth complications
Research has shown people who develop
schizophrenia are more likely to have
experienced complications before and during
their birth, such as: a low birth weight,
premature labor, a lack of oxygen (asphyxia)
during birth. It may be that these things have a
subtle effect on brain development.
4. Stress
The main psychological triggers of schizophrenia are
stressful life events, such as: bereavement, losing
your job or home, divorce, the end of a relationship,
physical, sexual or emotional abuse. These kinds of
experiences, although stressful, don't cause
schizophrenia. However, they can trigger its
development in someone already vulnerable to it.
5. Drug abuse
Studies have shown drug misuse increases the risk of
developing schizophrenia. Certain drugs, particularly cannabis,
cocaine, amphetamines, may trigger symptoms of
schizophrenia in people who are susceptible. Using
amphetamines or cocaine can lead to psychosis, and can cause
a relapse in people recovering from an earlier episode. Three
major studies have shown teenagers under 15 who use
cannabis regularly, especially "skunk" and other more potent
forms of the drug, are up to four times more likely to develop
schizophrenia by the age of 26.
Other schizophrenia usually is diagnosed in late adolescence or early
adulthood. Rarely does it manifest in childhood. The peak incidence of
onset is 15-25 years of age for men and 25-35 years of age for women.
The prevalence is estimated at about 1% of the total population. In the
United States, this translates nearly 3 million people who are, have
been, or will be affected by the disease. The incidence and the lifetime
prevalence are roughly the same throughout the world. According to
the study done 697,543 out of 86,241,697 of Filipinos or approximately
0.8% are suffering from schizophrenia. According to World Health
Organization (WHO) Schizophrenia ranks among the top 10 causes of
disability in developed countries worldwide.
Rationale for choosing the case:
During our first Nurse-Patient Interaction (NPI) we
have noticed that the client is sitting in a corner,
very quiet and he was always lethargic. It seems
like he does not want to socialize with us and with
the other patients. And when we were given the
opportunity to read all the patients charts, we
found out that this client was diagnosed with
Other Schizophrenia with suicidal precaution.
On that time we decided to choose this case as a study
because we got curious about the difference of Other
Specified Schizophrenia Spectrum from Schizophrenia and
we want to know more about the patient. We want to
know the patient feels and the patient reasons behind
suicidal ideation. Perhaps to correct the misconception of
not all people who have mental illness are violent and
dangerous.
Moreover, the preferred client was cooperative and
provided primary information that we needed in
conducting this study.
A. Patient’s Profile and History
B. Psychosocial development by Eric Ericson
C. Physical Assessment
D. Mental Status Exam
E. Gordon’s Functional Health Pattern
 Name: A.J
Age: 15 years old Sex: Male
Address: Taguig City
Nationality: Filipino Religion: Christian Civil Status: Single
(Dating Daan)
Date of Admission: 07/26/18
07/26/18
Admitting Other Schizophrenia
Diagnosis:
Attending Physician: Dr. X
i. Chief Complaint
 According to his Mother: “Nangungulit, palakad-lakad, nananakit ng mga
kapatid.”
 According to patient: “Dinala ako ni mama.”
ii. History of Present Illness
Five months PTA, patient experienced difficulty of sleeping which
prompted him to ask help from his mother. He was noted irritable
with suicidal thoughts. Patient together with his mother went for
consultation at NCMH and was prescribed with the following
medications: Olanzapine 5 mg OD PM, Risperidone 2 mg OD AM,
and Biperiden HCL PRN for poor sleep.
Three months PTA, patient was still noted to have suicidal thoughts
and claimed to see a hanging rope in his mind, restless and asked
questions repeatedly. Mother claimed that the patient was
compliant to medication.
One month PTA, patient was noted to be restless, “palakad-lakad,”
with blunt affect. “Makulit,” and asked questions to his family like,
“masama ba ‘to?”. Again, patient and his mother went for
consultation at the emergency room because they felt like the
symptoms started to worsened but they were only sent home with
the same medication.
Few days PTA, mother claimed that the patient was easily irritated.
He was still hyperactive, restless, and always asked about,
“masama ba ‘to?”. Patient with his mother decided to seek consult
at NCMH and was subsequently admitted on July 26, 2018.
iii.History of Past Medical Illness
Patient is non-diabetic, non-hypertensive, non-
asthmatic with no history of accidents, injuries,
blood transfusion, allergies to food and medication.
He has maintenance of medication for his
psychiatric problem. Patient’s mother claimed that
AJ had completed vaccination. He experienced
mumps, german measles, and chickenpox of
unrecalled age.
iv.Family History
Hypertension on maternal side and history of psychiatric
disorder on the paternal side. He claimed that his
grandmother was also admitted at NCMH of unrecalled
years and his grandmother’s sisters also suffered mental
disorders.

v. Substance History
Patient denied of using illicit drugs and smoking but claimed
to drink alcohol once with his peer group.
Trust vs Mistrust JA was a product of planned and wanted pregnancy. He is
Infant first born among four siblings. He was delivered via normal
spontaneous delivery. Breastfed up to 6 months. He was a
0 to 1 ½ years old
cry baby during infancy. He was able to say “mama” at 8
months old and walked at 1 year old. Mother is the primary
caregiver.
Autonomy vs Shame Toilet training started at 2 years old but still bed wets at 4
and doubt years old. Grandmother was his other caregiver. He was an
Toddler active child.

1 ½ to 3 years old
Initiative vs Guilt At 5 years old, he entered kinder. He cried at first day of
Preschool school and the mother stayed with him for one week. He was
3 to 6 years old a quiet student. He was not involved in any fights with peers.
Industry vs He had usually a grade below 78 in his subjects and was
Inferiority noted slow to learn. His mother would spank him for being
slow in grade 1. He was a quiet student and does not
School age
participate in school activities. He doesn’t play much with
6 to 12 years old children of his age. He plays toys for the boys alone at home
such as ball, toy gun, etc. Both his mother and father were
strict to him.
His father usually punishes him and would tell him to go
inside the room when he did something wrong. At 10 years
old, his father often reprimanded him because of being
untidy and his father would usually tell him to clean himself.
His father would also scold him for being a slow learner. Even
with difficulty in school, he was able to graduate elementary.
Ego identity vs Role At 12 years old, he stopped going to school because he was bullied
Confusion by his classmates, saying negative words on him. His classmates
Adolescence would take his money and would provoke him to fight. He claimed
that he is a silent type of student. He stated, “pakiramdam ko
12 to 21 years old (male)
napapahiya ako”, “masakit po talaga”. His uncle slapped him because
12 to 18 years old (female) he refused to go to school and his grandmother also physically hurt
him for being stubborn on not going to school. At 13 years old, he
resumed school and was enrolled in grade 7. However, he would
only go to school once a week. He still had low grades
In march 2018, his adviser told him that he didn’t pass and will not
be promoted to grade 8. Since then he had difficulty sleeping and
said he is a hopeless dumb. He would verbalize that he will commit
suicide. He is noted irritable. He would wake up late, with poor
appetite and had blank stares and weight loss thus seek consultation
to the agency.
Skin Warm and dry. No jaundice. No pallor. He
has an 8 cm abrasion on the left forearm
due to accidentally scratching his skin.
Head Bald haircut. No presence of scar or
abrasion on head.
Eyes Sleepy eyes with rheum. Sensitive to light
whenever he tried to look at it.
Ears Equal in size and symmetrical. Auricles
aligned with the corner of the eyes. No
discharge.
Nose Nasal structure alignment is straight. No
discharge.
Mouth and Throat Excessive production of saliva due to
the adverse effect of drugs.
Heart Adynamic precordium. Normal rate &
rhythm. No murmurs.
Lungs Symmetrical chest expansion. No
retractions. No abnormal breath
sounds.
Abdomen Flat, soft abdomen, non-tender.
Extremities Normal extremities. Mole at right
forearm. Scars at left and right lower
leg.
 MENTAL STATUS EXAM ASSESSMENT
General Appearance Skinny male adolescent with 5’4” height
and weight of 90 lbs., wearing a blue
hospital gown and black slippers. He has a
shaved head and has fair complexion.
Patient has poor personal hygiene. He has
eye boogers, drooling because of excess
saliva in the mouth, causing his gown to
stink; and always picking his nose.
Behavior and Attitude Calm and cooperative, with good eye
contact but sleepy. He was able to
answer questions directly.
Speech Speaks in normal rate but asked questions
repeatedly such as, “Ma’am, kakain na
po?” “Ma’am, ano pong pagkain?” etc.
Mood and Affect Sad and with constricted affect.

Thought Content No visual but with auditory hallucinations,

“May naririnig ako sumisitsit sa akin kaya
hindi ako nakakatulog ng maayos.” And
with suicidal thoughts, “Ma’am, gusto ko
nang mamatay. Pakiramdam ko wala
naman akong kwenta.”
Thought Process Coherent, logical but with disorganized
and suicidal thoughts.
Memory Remote: Patient was able to recall the
events happened from the past.

Recent: He was able to enumerate what

he had on morning for breakfast.
Cognitive Patient was able to do simple
calculations. When asked, “Ano yung
sagot sa five plus five?” and he
answered, “sampu.”
Abstract Thinking Patient has good abstract thinking. He was able to
identify the difference between pencil and
ballpen. He said that “lapis” and “ballpen” were
both used for writing but only the ballpen has an
ink in it.
Insight He has a complete acceptance of his situation and
believes that medications will make him better.
Judgement Patient has good judgement and decision making.
When asked, “Anong gagawin mo kapag may
nakita kang wallet na may lamang pera at saka i.d.
ng may-ari?” and he answered, “isasauli ko po o
kaya ipapasuyo ko nalang.”
 FUNCTIONAL HEALTH BEFORE HOSPITALIZATION DURING HOSPITALIZATION
PATTERN
A. Health Perception and Patient was able to Patient completely
Health Management perform his daily living accepted of his situation
such as going to school, and believe that
caring self, eating, playing medications will make him
and others. better.
When sicked his mother
managed him with over the
counter drugs.
B. Nutrition and Metabolic Patient has good appetite Patient after felt hungry
Pattern and not picky eater. He doesn’t consume food
likes to eat vegetables like offered to him.
ampalaya and fruit such as He usually gave it to his co-
banana. patients.
C. Elimination Pattern Patient experience no Patient does not defecate
difficulty defecating, and he every day but he has no
defecates soft formed stool difficulty to urinating.
every day.
He has no difficulty in
urinating with light yellow
colored urine.
D. Activity-Exercise Pattern Patient stays at home, Patient participates with
playing on his cellphone the planned therapeutic
and watching horror activities.
movies.
E. Sleep-Rest Pattern Patient has good sleep Patient always stated want
pattern. Sleep at least 8 to sleep. He looked groggy,
hours at night. bow head on the table, eyes
looks sleepy.
F. Cognitive-Perceptional Patient is a grade 8 Patient was able to do
Pattern student. There was no simple calculations. When
problem with his grade but asked, ”Ano yung sagot sa
he claimed didn’t five plus five?” and he
participated any activities answered, “Sampu.”
in his class and always
quiet in school. He is being
bullied by his classmates.
G. Self-Perception/ Patient has low self- Patient still has low self-
Self-Concept Pattern esteem “Alam ko naman sa esteem “Wala na po kasing
sarili ko na hindi ako kwenta buhay ko”
magaling kaya hindi na rin
ako nakikipag participate
sa school”.
H. Role-Relationship Patient live with his Patient felt worthless
Pattern parents but moves in to because the only one
his grandmother due to supporting and visiting
abusive father. him is his grandmother.
I. Coping/Stress Patient just watching Patient lying or just
Tolerance horror movies and going to the corner to
playing on his get his mind relax and
cellphone. He pray.
J. Value-Belief Pattern Patient is a Christian Patient believes that
(Dating daan). God exist and will
Rarely goes to the always help them.
church but pray
sometimes.
THE BRAIN
 Modifiable Other Schizophrenia Non - modifiable
Social Factors Age
- Socioeconomic status – - 15 years old, adolescence (12-21
lower middle class male)
- victim of child abuse and
lack of emotional support Genetic predisposition
from family (family stress) Paternal side – grandmother, was
- victim of bullying in school previously admitted at NCMH as
Neurostructural claimed by the patient
- 2 of his grandmother’s siblings
Abnormalities also suffered mental illness

Frontal lobe Temporal lobe Occipital lobe Limbic system Basal ganglia
hypometabolism hypometabolism hypometabolism hypometabolism Caudete nucleus –
- difficulty - auditory Hippocampus – learning and me
- visual
impaired learning and
planning and hallucinations hallucinations Globus pallidus –
memory
organizing Hypothalamus – loss of GABA secretion
thoughts appetite
Thalamus – lack of Substantia Nigra –
information process dopamine
Amygdala – lack of secretion
Imbalance of Neurotransmitters emotions (apathy)
 Imbalance of Neurotransmitters

Dopamine – Increased Serotonin – decreased Glutamate / GABA

Symptoms: Symptoms: Symptoms:
- hallucinations - depression - anergia
- delusions - pessimism - apathy
-agitation or tension - anxiety - insomnia
- bizarre behavior - repetitive thoughts and - anhedonia
obsessive thinking - inability to focus
- insomnia - lack of anger/joy
- anxiety
- Loss of appetite

Disturbed sleep Risk for suicide related to

pattern; insomnia negative self appraisal
related to auditory Imbalanced nutrition; less
hallucinations as than body requirements
manifested by related to loss of appetite
patient’s verbalization as manifested by body
weight loss
 ACTIVITIES GOALS/ OBJECTIVES OUTCOME
DAY 1- Monday (august 20, 2018)
General orientation at NCMH
-To know the policies of the NCMH, -We learned the policies of NCMH
To know the don’ts and do’s, to
learn more about NCHM.
Observation at the area. (pavilion To familiarize at the area. -We get familiarized at the area.
14)
Open forum -To get to know each other And it -We get to know each other more.
help before we handle the patient. -We get familiarized and know
-To know what activities we will be what activities we will do the next
Planning for the activities. doing every day until the end of days.
duty.
DAY 2- Tuesday (august 21, 2018)
No Class. Holiday
Ninoy Aquino day and Eid’lAdha
DAY 3- Wednesday -to establish rapport -we introduced ourselves, we also
(august 22, 2018) and nurse-patient establish rapport and gathered
Orientation Phase contract, to gain patient’s trust. The patient did not
-nurse patient patient trust and to cooperate well in NPI but answer some
interaction (NPI) gathered data about question asked. He is hungry and
the patient. sleepy, he verbalized “may naririnig
akong sumisitsit sakin kaya hindi ako
makatulog ng maayos”, “gusto ko ng
bumalik sa loob, inaantok nako”, “gusto
ko na po mamatay”, “wala na po kasi
kwenta buhay ko”.
We get our NCP, “disturbed sleep
pattern” and “risk for suicidal”
Snack -To augment nutritional -the patient ate the
GO FOOD needs of the patient. food we gave but
-juice (big 250 apple) -to provide the body with there’s food left that
he gave to other
-1pc. of pandesal energy.
patient.
GLOW FOOD
-2pcs. of banana (saba) -to help supply the body
with vitamin and mineral to
keep the body healthy
DAY 4- Monday (august
27, 2018)
No duty. Holiday
National Heroes day.
DAY 5- Tuesday (august 28, -to work on the clients -the patient is much more
2018) problem and to gather more comfortable than the first day
Woking Phase information. of NPI, but still sleepy and
-Nurse Patient Interaction hungry.
(NPI)

Dance Therapy -to reduce the client’s stress -the patient did not
participated at the dance
therapy because he is tired, he
Recreational therapy -to help the patient to focus verbalized “maam inaantok po
-Paper Dance and to help patient in his ako”
balance.
-Question and answer -to test the patient’s critical -the patient participated in the
thinking. games but not actively, he
looks tired and sleepy.
Snacks - to provide the body -the patient unable to
GO FOODS with energy. consumed the food that
-juice (big 250 apple) we served and verbalized
2pcs. biscuit. -to keep the body well. “wala akong gana
GLOW FOOD kumain” we get our third
2pcs. banana (lakatan) NCP “imbalance nutrition
less than body
Hygiene requirements”
-washing hands
-washing face
-toothbrush -to maintain the patient
-giving powder for face cleanliness -the patient only washed
his hands.
DAY 6- Wednesday (august 29,
2018) -to assess the patient needs and -the patient is cooperative while
Continuation of working to continue working on the talking to him and less sleepy.
phase client’s problem
-Nurse Patient Interaction
-the patient looks tired but still
(NPI) managed to dance.

-to manage the clients mood. -the patient participated in the

Dance Therapy
activity.
-to improve self-esteem and to
Music and arts therapy. help the patient express his
feelings through art.
Recreational activity -he joined in the games but
-cup stacking -to test the patient’s speed. verbalized “maam di pa po ba
kakain?” “nagugutom nap o ako
-to test the patient’s
maam”
-solve the knot (Dr.kwakkwak) cooperation in teamwork.
Snacks
GO FOODS -to provide energy to -the patient ate his
-Juice (big 250 apple) the patient. food with some left
-2pcs. pandesal over that he gave to
-1pc. mammon other patient.

Hygiene
-washing hands -to prevent
-washing face development of illness. -the patient did not do
-toothbrush his hygiene.
-giving powder for face
 DAY 7-Monday (September 03, -to assess the patient’s need and -the patient cooperated in the
2018) to work with our case. NPI.
Continuation of working phase
-Nurse Patient Interaction (NPI)

Dance therapy - to increase the patient energy -the patient participated in the
dance therapy.
Recreational activity -to learn how to work as a team.
-calamansi relay -the patient participated in the
-to learn how to work as a team. games and seems that he
-balloon relay enjoyed the games.
-to test the critical thinking
-jigsaw puzzle -the client participated in this
-to develop, restore, or improve activity. He enjoy doing graham
Occupational therapy required skills, habits, and roles balls and he eats what he did but
Graham balls for independent, meaningful, still there is left over that he
and productive living. gives to other patient.
Snacks -to provides the body -he consumed the snack
GO FOODS with energy. we served.
-juice (big 250 apple)
-1pc. pandesal
- +the graham balls they
did.

Hygiene -hygiene for the patient - the patient did the

-washing hands to maintain cleanliness hygiene, but not properly.
-washing face and also to help prevent
-toothbrush some disease.
-giving powder
 ACTIVITY GOALS/OBJECTIVE OUTCOME
Day 8 Tuesday (September 04,
2018) -to further assess the patient’s -the patient is cooperative while
Nurse patient interaction needs. talking to him but sometimes
verbalized “maam inaantok po
ako”

Dance therapy -to increase client’s energy -the patient participated in the
dance activity even he looks
Recreational games: -to test the clients ability to focus tired.
-hep hep hooray and his attention.
-pinoy henyo -to test the client’s critical -the client participated in this
thinking games.
Bibliography -to promote social development
as well as the love literature in -the client fall asleep.
general and to reduce feeling of
isolation.
Snacks: -to provide client’s energy
GO FOOD that he needs for the day. -the patient consumed
-1pc. Juice (big 250 apple) the snack we served with
-1pc. Biscuit -to help client to maintain minimal left overs.
GLOW FOOD healthy body.
-2pcs. banana

Hygiene
-Washing hands. -to promote self-esteem
-washing face. -the patient only washed
-Toothbrush. his hands and his face.
-giving powder for face.
Day 9 Wednesday (September 05,
2018) -the patient is much active in
Nurse Patient Interaction -to know if there is an improvement therapeutic communication.
on some NCP.
-the patient participated in the dance
Dance Therapy -to keep the patient awake. therapy and when asked sino dito
nakatulog ng maayos kagabi, he
raised his hands and verbalized
“medyo maayos po ang tulog ko
kagabi”

Recreational activity: -to assess the patient’s ability to -the patient participated on the
-color separation think. games.
-to assess the patient’s speed
-moving up cups -to check for the patient’s teamwork.
-catching eggs -to improve his social, cognitive, and
physical skills and enhance -the patient looks sleepy he bows his
Remotivational Therapy engagement in programs. head on the table but when asked
some question he answered.
Snacks: -to augment nutritional
GO FOOD needs of the patient and -the patient likes the food
-Egg Sandwich provide energy we served he consumed
-cheesebread the food with no left over.
GROW FOOD -to help the body grow
-Milk with yogurt (Bear and make the bones
brand yogu) strong.

Hygiene -the patient did his

-Washing hands. -to maintain client’s hygiene but not properly.
-washing face. cleanliness and self-
-Toothbrush. esteem
-giving powder for face.
Day 10 - Monday
(September 10, 2018) -to achieve cognitive, -the patient danced well
physical, and social and verbalized “medyo
Dance Therapy integration. nakatulog na ko ng
maayos”

Recreational Games. -to test the patients -the patient participated

-stand the crayola. concentrating. actively in the games and
-to test the patient some therapeutic
-set the clock. knowledge about the activities.
time.
-flip the bottle. -to to know the client’s
ability to flip the bottle.
Snacks -to give energy for work and -the patient able to
GO FOODS play. consumed the food we
-juice (apple big 250) prepared with no left over.
-2pcs. pandesal -to help you grow tall and
GROW FOOD strong.
-scrambled egg with ham
GLOW FOOD -to maintain healthy body.
-1pc.apple

Hygiene -to maintain cleanliness and -the client did his hygiene.
-Washing hands. to prevent from some
-washing face. disease.
-Toothbrush.
-giving powder for face.
Day 11- Tuesday
(September 11, 2018)

Dance therapy -to achieve cognitive, -the patient participated

physical, and social in dance therapy.
integration.
Recreational activities.
-shoot the ping pong ball. -the client participated in
-to test the patience of the games we play.
-blow the ping pong ball. the patient.
-to learn how to
cooperate in the team.
Snacks -to help to gain - the patient able to
GO FOODS energy. consumed the food
-juice (250 big apple) we prepared with no
-egg sandwich left over.

Hygiene -the client did his

-Washing hands. -to maintain hygiene.
-washing face. cleanliness and to
-Toothbrush. prevent from some
-giving powder for disease.
face.
Day 12- Wednesday -to help the client socialized -the client participated
(September 12, 2018) with others, to help the actively in all the activities
GRAND SOCIALIZATION DAY. client enjoy our last day. we did and he enjoyed all
the activity we did, the
client verbalized “maraming
salamat po sa natulong niyo
samin lahat” “naging
Masaya po kaming lahat
ngayon”
Termination Phase -to evaluate the progress
NPI towards the goal, to -the client thanks us for the
summarized entire 1month that we stayed
communication, to bring a there.
therapeutic end to the
relationship.
 Drug Name Mechanism of Drug rationale Contraindication
action
Multivitamins to treat vitamin Diet supplement Contraindicated in
500mg deficiencies (lack patients
of vitamins) hypersensitive to
Classification: caused by illness, drug.
vitamin pregnancy, poor
nutrition,
Route: P.O. digestive
Indication disorders, and
vitamin many other
deficiency conditions.
 Side effects Nursing consideration
No side effects seen in the patient Never take more than the
recommended dose of a
Possible side effects: multivitamin.

Constipation, diarrhea, or upset Informed the client that these side

stomach may occur. These effects effects are usually temporary.
are usually temporary and may
disappear as your body adjusts to
this medication
 Drug Name Mechanism of Drug rationale Contraindication
action
Risperidone 2mg Block the dopamine Used to reduce Contraindicated
receptive at the psychotic in patients
Classifiation: post synaptic symptoms such as hypersensitive to
Antipsychotic membrane thus hallucination and Risperidone
Route :P.O. x 1dose decrease dis-oragnized
O.D. dopaminergic thinking and
activities behavior

Drug indication
Schizophrenia
 Side effects Nursing considerations
Side effects seen in patient: drowsiness, Monitor patient for presence of
headache, salivation and dizziness
EPS
Possible side effects:
CNS: EPS, anxiety, aggressiveness Instructed the patient to change

CV: tachycardia, chest pain, orthostatic position gradually to prevent

hypotension orthostatic hypotension
GI: constipation, nausea, vomiting,
Obtain baseline blood pressure
abdominal pain, and anorexia
measurements before starting
Skin: photosensitivity and dermatitis
therapy, and monitor regularly.
Drug Name Mechanism of Drug rationale Contraindication
action
Diphenhydramine are typically used Used to promote Contraindicated in
hydrochloride to ease allergy sleep to the patients
50mg/cc symptoms, and patient because of hypersensitive to
Classification: work by blocking their powerful drug
Antihistamine histamines' sedating qualities.
attachment to
Route: IM receptors,
preventing the
compounds from
Drug indication carrying out their
Allergies functions.
 Side effects Nursing considerations
Side effects seen in patient: Advised patient that drowsiness is
drowsiness dizziness, and restlessness very common initially, but may be
reduced with continued use of drug.
Possible side effects:

CNS: insomnia, nervousness,

headache, sedation

CV: palpitations, hypotension, and

tachycardia.

GI: nausea and vomiting, diarrhea, dry

mouth and constipation
 Drug Name Mechanism of Drug rationale Contraindication
action
Divalproex Sodium Increases level of It is used in Contraindicated in
500 mg GABA in brain, conjunction with patients
Classification: which decreases anti psychotic hypersensitive to
anticonvulsant seizure activity drug to combat drug.
EPS
Route: P.O

Indication
Seizures
 Side effects Nursing considerations
Seen in patient: dizziness Monitor patient for presence of EPS

Possible side effects: Assess for GI complaints

CNS: sedation, aggressiveness,
incoordinatoin, emotional upset, and
ataxia

GI: nausea, vomiting, indigestion,

diarrhea, abdominal cramps, and
anorexia

Musculoskeletal: muscle weakness

 Drug Name Mechanism of Drug rationale Contraindication
action
Ascorbic acid Increases Necessary for Contraindicated in
(Vitamnin C) protection wound healing patients
mechanism of the and resistance to hypersensitive to
Classification: immune system infection drug.
vitamins
Use cautiously in
Route: P.O. patients with renal
Indication insufficiency
Dietary
supplement
 Side effects Nursing considerations
No side effects seen in patient Advised patient about risk of dizziness
upon standing quickly.
Possible side effects:

CNS: faintness, dizziness

GI: diarrhea, GI discomfort.

GU: acid urine, oxaluria, renal calculi.

 URINALYSIS RESULT

RESULT 7/27/18 REMARKS

Color Dark - yellow Lack of fluid
intake
Transparency Slightly turbid Normal
SP Gravity 1.015 Normal
pH alkaline Normal
sugar (-) Normal
Protein (-) Normal
Parameter Result Normal remarks
values
WBC 10 0-11 / uL Normal
RBC 11 0-11 / uL Normal
Epithelial 22 0-11 / uL Normal
cell
bacteria 45 0 – 111 / uL Normal
 HEMATOLOGY

Laboratory Result Normal remarks

test values
Complete 8/23/2018
Blood Count
hemoglobin 145 140-180g/L normal
hematocrit 0.43 0.40 normal
RBC count 5.15 4.0-6.0 x 10^ normal
12L
WBC count 8.6 5.0-10.0 x normal
10^9L
Differential Count
Neutrophil 0.60 0.45 – 0.65 normal
Lymphocyte 0.20 0.20 – 0.35 normal
Monocyte 0.05 0.02 – 0.06 normal
Eosinophil 0.04 0.02 – 0.04 normal
Basophil 0.01 0.00 – 0.005 normal
Platelet count 344 150 – 450 x normal
10^ 9/L
RDW 0.13 0.10 – 0.16 normal
Red Cell Indices
MCV 82.5 80.0 – normal
99.9 fL
MCH 28.2 27.0 – normal
31.0 pg
MCHC 341 330 – 370 normal
g/L
NCP # 1 AUGUST 22, 2018
Assessment Nursing Diagnosis Planning
SUBJECTIVE Disturbed sleep pattern; Within 2 weeks of nursing
“May naririnig ako sumisitsit sa akin intervention the patient will
kaya hindi ako nakakatulog ng Insomnia related to
maayos. Gusto ko na bumalik sa
achieve optimal amount of
auditory hallucination sleep as evidenced by
loob. Inaantok ako” as patient’s
verbalized. as manifested by
OBJECTIVE: patient’s verbalization : rested appearance,
- Yawning : verbalization of feeling
- Restlessness of viability to sleep
rested
- Fatigued appearance
: can sleep 6 – 8 hours per
- irritability
- poor concentration
night
- dark circle underneath his eyes : become more active in
- drooping eyes socialization and therapeutic
- bowing his head on the table activities
- sleeps 4 hours at night
often refused to join activities
 Nursing Intervention Rationale
Established rapport To gain trust and to get accurate answers

Encouraged the patient to participate in daily To provide day time activity thus prevent
therapeutic activities such as exercise in the daytime napping
morning, recreational therapy and etc.

Instructed the patient to do the night routines To promote physical comfort that could
like toothbrush, washing the face and etc. promote sleep

Instructed the patient to minimized sleep To improve sleep duration and quality
disrupting factor such as talking with others and
thinking negative thoughts during night time

Encouraged the patient to avoid day time To promote normal sleep – wake pattern
napping

Instructed the patient to limit evening fluid To avoid awakening during the night
intake
 Evaluation
After 2 weeks of nursing intervention the goal was partially met as
evidenced by

: Patient’s verbalization
“medyo nakakatulog na ako ng maayos”
: was able to sleep 6 hours per night but sometimes it wasn’t
straight
: became more active in socialization and therapeutic activities
 NCP 2 August 22, 2018
ASSESSMENT DIAGNOSIS PLANNING
SUBJECTIVE: Risk for suicide related Long term goal:
‘’ Mam gusto ko ng to negative perception After 4 weeks of nursing
mamatay, pakiramdam ko of self as manifested by intervention the client
wala naman akong kwenta.’’ patients verbalization of
as verbalized by the patient will: Refrain self from
wanting to commit committing suicide.
suicide.
OBJECTIVE: develop positive
Sad facial expression
perception of self.
-Social withdrawal.
-Apathetic
Restless
decreased attention
 INTERVENTION RATIONALE
-Established rapport. -To gain trust.
-Developed therapeutic nurse-client -Effective nurse – patient relationship
relationship, provided consistent care. helps patient to verbalize thought of
suicide to the nurse/student nurse.
Made time to listen to patient’s
expression of negative thoughts and -Providing time and acceptance of
feelings. patient decreases his feeling of
-Allowed patient to express feelings and worthiness.
thoughts of suicide. -Expression of thoughts and feelings is a
therapeutic technique in preventing of
suicide.
 INTERVENTION RATIONALE
-Gave patient diversional activities such as -Diversions prevent the patient from
recreational activities, dancing therapy, preoccupation of suicide thoughts.
remotivational techniques, bibliotherapy
and occupational techniques.
-Maintained observation of client and -To increase client safety or reduce risk of
check environment for hazards that could impulsive behavior.
be used to commit suicide.
-Identified patient (+) aspect about -To help patient see himself as a
himself. worthwhile person.
-Continually assessed the client’s potential -Patients with negative thoughts are at risk
for suicide. for suicide.
-Assisted in the administration of -To reduce psychotic symptoms.
Risperidone 2 mg 1 tab OD
 EVALUATION
Within 4 weeks of nursing intervention the
goal was partially met as evidenced by: -still
with (-) perception of self
-participating actively in activities and
interacting with others.
-increased concentration and attention.
NCP #3 AUGUST 28, 2018
Assessment Nursing Diagnosis Planning
Subjective: Imbalanced nutrition less After 3 weeks Nursing
“Wala akong gana kumain” than body requirements intervention, the patient will
As verbalized by the patient., related to loss of appetite as be
Objectives: evidenced by body weight Demonstrate increased
● Unable to consume food loss. appetite to regain appropriate
served weight: 112.0lb/50.8kg
● Lack of Energy
● Lack of Concentrative
● Anorexia (Skinny)
● “Takaw tingin”
Body Weight: 90lbs
Height: 5’4”
BMI= 15.4
 Nursing Intervention Rationale
● Evaluate total daily food intake ●Reveals possible cause of malnutrition
changes that could be made in client’s intake
● Monitored client weighted at regular
intervals and document results ● Monitors effective dietary plan

● Encouraged client to choose seems ● Stimulates the appetite of the client

appealing
● This promotes comfort to the patient and
● Promote pleasant relieving environment encourages good eating habit
including socialization
● Determine appropriate BMI according to
● Monitor the patient weight and height patient age nutritional intake
 Nursing Intervention Rationale
● Consult with dietician and nutritional support ● To have an accurate dietary intake for long term
team as necessary needs

● Offered attractive & nutritional food as snack ● To augment nutritional needs of the patient
thus help in increased body weight

●Taught client the importance of food serve ● Foods served are essential for the body to
supply nutrients and needed energy

●Discussed with the patient the effect of body ● Body weight loss caused by inadequate
weight loss nutrition affects the body’s functioning and
thinking

●Discussed with the client the importance of ● To differentiate food groups supplies different
food intake & value base for the basic food group: nutrients needed by the body to sustain different
Go, Grow and Glow needs
 Evaluation
Within 3 weeks of nursing intervention the goal was
partially met as evidence by:

● Increased energy thus involvement in group activities

● Increased body weight
● Increased appetite; able to consume food served.
MEDICATION:

Vitamin C 500mg per orem OD

Multivitamins 500 mg 1tab OD
Risperidone 2 mg 1 tab OD
Diphenhydramine 50 mg/cc
Divalproex Sodium 500 mg
EXERCISE/ENVIRONMENT:

Advised the client to avoid stressful events such as

worrying and anger.
Provided safe environment by removing objects that
he can use in hurting himself
Encouraged client to exercise regularly. Exercise can
boost self-esteem.
TREATMENT:

Taught the client relaxation techniques such as deep

breathing, and guided imagery, and reading. A daily
relaxation practice can be very effective in reducing
stress.
Encouraged patient to participate in different ward
activities.
HEALTH TEACHING:

Encouraged the client to get 8 hours of sleep every night.

Having enough sleep can help increase concentration,
decrease mood swing and keep immune system healthy.
Advised the client to maintain a good proper hygiene to
improve well being.
Explained to the client the importance of compliance to
medication and therapies.
OUT PATIENTS

Emphasized the importance of having regular check-ups

with his psychiatrist as scheduled when discharged.

DIET:

Encouraged patient to eat healthy food like fruits and

vegetables.
Encouraged to consume all food that are served to him.
SUPPORT SYSTEM:

Emphasized the need of a family members in the

provision of emotional support and basic care of
the client.
Encouraged the patient to spend time to another
patient.