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A CASE PRESENTATION ON

UNDIFFERENTIATED SCHIZOPHRENIA

In partial fulfilment of the requirements inNCMH Related Learning Experience

Submitted by:

Nael, Dianne GraceNajera, Kristine Faye

Nanquil, Richard SimonNeri, Lloyd Lawrence

Nivera, AbigaelNoble, Kristine Elaine

Oba, Jian OdessaObedoza, Katrina Maenne

Obispo, Raphaella

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Oliveros, Krizell Anne

Level IV Section 5 Group 19August 9, 2010

C.I.: Mrs. Mary Grace Gutierrez, RN, MAN

TABLE OF CONTENTS

I. Introduction-----------------------------------------------------------------------2A. Background of the Study --------------------------------------------------------------------2

B. Objective of the Study------------------------------------------------------------------------2

II. Psychiatric Assessment-------------------------------------------------------3A. Patient’s Profile---------------------------------------------------------------------------------

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B. Chief Complaint--------------------------------------------------------------------------------3

C. History of Present Illness -------------------------------------------------------------------3

D. Previous Illness -------------------------------------------------------------------------------3

E. Psychosexual History -----------------------------------------------------------------------3

F. Family History ----------------------------------------------------------------------------------

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G. Laboratory Tests ------------------------------------------------------------------------------4

H. Mental Status Examination -----------------------------------------------------------------5

III. Clinical Discussion of the Disease-----------------------------------------6A. Psychodynamic--------------------------------------------------------------------------------6

B. Psychopathology------------------------------------------------------------------------------9

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C. Drug Study and Nursing Responsibilities ---------------------------------------------10

IV. Nursing Process -------------------------------------------------------------12

V. Therapies ---------------------------------------------------------------------15

VI. Process Recording ----------------------------------------------------------17

VII. References---------------------------------------------------------------------26

I. INTRODUCTIONA. Background of the Study

Undifferentiated Schizophrenia is manifested by pronounced delusions, hallucinations, and disorganized thought processes and behavior.

Studies suggest that genetics, early environment, neurobiology, psychological and social processes are important contributory factors

The undiffrentiated subtype is diagnosed when people have symptoms of schizophrenia that are not sufficiently formed or specific enough to permit classification of the illness into one of the other subtypes.

Patients in this category have the characterisitcs positive and negative symptoms of schizophrenia but do not meet the specific criteria for the paranoid, disorganized or catatonic subtypes.

Onset of symptoms typically occurs in young adulthood with around 1.5% prevalence of the population affected.

Increased dopamine activity in the mesolimbic pathway of the brain is commonly found in people with schizophrenia.

The disorder is thought to mainly affect cognition, but it also usually contributes to chronic problems with behavior and emotion

Diagnosis is based on the self-reported experiences of the person, and abnormalities in behaivor reported by family members, friends, or co-workers, followed by a clinical assessment by a mental health professional

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Diagnosis of undifferentiated subtype may best describe the mixed clinical syndrome.

B. Objectives of the Study

General Objective To provide comprehensive information about Undifferentiated Schizophrenia.

Specific Objective To help in the client’s psychological well being. To gain better understanding of the illness, which will aid in the nursing care planning To provide appropriate nursing care directed towards not only to the client’s psychological but

also his physical well being.

II. PSYCHIATRIC ASSESSMENT

A. Patient’s Profile

Name: Mr. ChizAge: 27Birthday: May 16, 1983Gender: MaleReligion: Roman CatholicProvince: Western SamarPsychiatrist: Dr. GodinesAdmitting Diagnosis: Undifferentiated SchizophreniaChief Complain: According to informant: “sinusugatan ang sarili, pinapaso ung kamay, sinusunog ung damit, nagmamasturbate, hindi nakakatulog.”

According to Patient: “Hindi naman, Wala naman.”

Reliability of informant: Fair

B. History of present illnessThe patient has been diagnosed with mental illness since September 2009 with previous admission on October 2009, He was discharged on December 2009 with unrecalled medicine to which he was non-compliant.

C. Personal HistoryHe and his family moved to Cabalyog Samar. He was lost to follow up at home. He was non-functional. On and off relapses were observed but tolerated.

Until 1 month, He was observed to have difficulty of sleeping and restlessness as he walked. He would pour water on himself repeatedly.

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D. Psychosexual HistoryHe was irritable and aggressive to his mother and verbally assaultive at times. He was seen laughing to himself. He burned himself with cigarettes on his right arm and forehead. He burned his clothing too. When apprehended, He threatened them with rocks and masturbates in public.

E. Past Medical HistoryPatient has no history of seizure, hypertension, allergy or asthma but had a recent head trauma and was scheduled for ECT last 2009.

F. Family Medical HistoryThere is no history of mental illness or suicide attempts in his family. His father has been diagnosed with a medical illness, lung disease.

G. Social HistoryThe patient smokes 1 pack of cigarette everyday and drinks occasionally but denies the use of illegal drugs.

H. Laboratory results

Hematology Results Normal values InterpretationHemoglobin 143 Male: 140-180

Female:120-160Normal

Hematocrit 0.44 Male: 0.40-0.54Female:0.36-0.42

Normal

Red blood Cell (RBC) 4.87 4-6 x10 12/L NormalWhite blood Cell (WBC)

10.5 5-10 x10 9/L A increase in WBC signifies infection

Differentiated Count

Neutrophil 0.76 0.45-.65 Elevated neutrophil can be caused by damage or inflammation of tissue e.g burn injuries

Lymphocyte 0.17 0.20-0.35 Decreased level of lymphocyte may

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indicate nerve damage or poor conduction of nerve impulses.

Monocyte 0.07 0.02-0.06 Elevated monocyte indicates infection.

Platelets 227 150-450 x10 9/L Normal

I. Mental Status Examination1. GENERAL APPEARANCE AND BEHAVIOR

The patient is average in terms of muscularity, with fair brown complexion, and has black hair. He also has scars on right and left arms and legs and a mole on the right lateral pat of the neck. On the first day of interaction with his student nurse, he had his clothes neat, but on the next day, his clothes were powdered, showing there is no consistency in his good grooming; but his feet are neat and clean. During the first interaction, he always taps his feet and has minimal eye contact with his interviewer but for the following NPI, he has now an eye contact and minimal taps of his feet.

2. AFFECTThe patient has blunted affect, and has appropriate affect. Objectively, he appears

serious but he can smile at times when the topic is worth giving a smile.

3. MOODThe patient, during the interview looks serious at times but manages to give a single

smile when appropriate.

4. THOUGHT PROCESSESThe patient speaks spontaneously, and since he is just a high school graduate, he seldom

speaks in English, but rather spoke spontaneously in Filipino, clearly. His thoughts are generally logical, and answer the questions being thrown to him by the student nurse. He has a poverty of speech because he seldom elaborates his answers, but it is direct.

5. THOUGHT CONTENTThe client has disoriented thought content because he is claiming that he has 3 siblings,

when in fact he has 4; other than that, there were no noted signs of hallucination, or illusion, or delusions.

6. COGNITIVE EVALUATION

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The patient is alert throughout the interview and is oriented to place, person, and date. He is also able to make simple mathematics calculations such as addition and subtraction. He was able to count 1 to 10 and backward. Patient was also able to spell “Philippines and house” correctly, and was able to recall 5 presidents of the Philippines spontaneously (ROXAS, QUIRINO, AQUINO, ESTRADA, ARROYO). The patient indeed has a good memory able to recall 3 objects after 5 minutes.

7. INSIGHTPatient is aware of his own responsibilities; he is a helper in the ward and does his duty

diligently. He is also not able to identify the reason why he was admitted in the institution, but was able to cope up with it. He understands about his condition.

8. JUDGMENTThe patient can make fair decisions regarding his everyday activities. He can cooperate

with the staff but he did not participate in one of the activities due to his duty as the helper in the ward like the exercise inside the ward.

III. CLINICAL DISCUSSION OF THE DISEASE

A. Psychodynamic

The Nervous System is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. The central nervous system contains the brain and spinal cord. The peripheral nervous system consists of sensory neurons, clusters of neurons called ganglia, and nerves connecting them to each other and to the central nervous system. These regions are all interconnected by means of complex neural pathways.

At a more integrative level, the primary function of the nervous system is to control the body. It does this by extracting information from the environment using sensory receptors, sending signals that encode this information into the central nervous system, processing the information to determine an appropriate response, and sending output signals to muscles or glands to activate the response.

The neurologic system consists of two main divisions, the central nervous system (CNS) and the peripheral nervous system (PNS). The autonomic nervous system (ANS) is composed of both central and peripheral elements.

1. The CNS is composed of the brain and spinal cord.2. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the spinal nerves.3. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory) nuclei in the brain and spinal cord. Its peripheral division is made up of visceral efferent and afferent nerve fibers as well as autonomic and sensory ganglia.

The nervous system is primarily made up of two categories of cells: neurons and glial cells.

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Neurons send signals to other cells as electrochemical waves travelling along thin fibres called axons, which cause chemicals called neurotransmitters to be released at junctions called synapses. A cell that receives a synaptic signal may be excited, inhibited, or otherwise modulated. Sensory neurons are activated by physical stimuli impinging on them, and send signals that inform the central nervous system of the state of the body and the external environment. Motor neurons, situated either in the central nervous system or in peripheral ganglia, connect the nervous system to muscles or other effector organs. Central neurons, which in vertebrates greatly outnumber the other types, make all of their input and output connections with other neurons. The interactions of all these types of neurons form neural circuits that generate an organism's perception of the world and determine its behavior. Along with neurons, the nervous system contains other specialized cells called glial cells (or simply glia), which provide structural and metabolic support.

Glial cells are non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin, and participate in signal transmission in the nervous system. In the human brain, it is estimated that the total number of glia roughly equals the number of neurons, although the proportions vary in different brain areas. Among the most important functions of glial cells are to support neurons and hold them in place; to supply nutrients to neurons; to insulate neurons electrically; to destroy pathogens and remove dead neurons; and to provide guidance cues directing the axons of neurons to their targets.

Anatomy of the Brain: Structures

The brain contains various structures that have a multitude of functions. Below is a list of major structures of the brain and some of their functions.

Basal Ganglia Involved in cognition and voluntary movement Diseases related to damages of this area are Parkinson's and Huntington's

Brainstem Relays information between the peripheral nerves and spinal cord to the upper parts of the

brain Consists of the midbrain, medulla oblongata, and the pons

Cerebellum Controls movement coordination Maintains balance and equilibrium

Cerebral Cortex

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Outer portion (1.5mm to 5mm) of the cerebrum Receives and processes sensory information Divided into cerebral cortex lobes

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

Cerebrum Largest portion of the brain Consists of folded bulges called gyri that create deep furrows

Limbic System Structures

Amygdala - involved in emotional responses, hormonal secretions, and memory

Cingulate Gyrus - a fold in the brain involved with sensory input concerning emotions and the regulation of aggressive behavior

Hippocampus - sends memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieves them when necessary

Neurons and synapses

Major elements in synaptic transmission. An electrochemical wave called an action potential travels along the axon of a neuron. When the wave reaches a synapse, it provokes release of a puff of neurotransmitter molecules, which bind to chemical receptor molecules located in the membrane of the target cell.

Synapses may be electrical or chemical. Electrical synapses make direct electrical connections between neurons, but chemical synapses are much more common, and much more diverse in function. At a chemical synapse, the cell that sends signals is called presynaptic, and

the cell that receives signals is called postsynaptic. When the presynaptic terminal is electrically stimulated, an array of molecules embedded in the membrane are activated, and cause the contents of the vesicles to be released into the narrow space between the presynaptic and

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postsynaptic membranes, called the synaptic cleft. The neurotransmitter then binds to receptors embedded in the postsynaptic membrane, causing them to enter an activated state. Depending on the type of receptor, the resulting effect on the postsynaptic cell may be excitatory, inhibitory, or modulatory in more complex ways. The entire synaptic transmission process takes only a fraction of a millisecond, although the effects on the postsynaptic cell may last much longer (even indefinitely, in cases where the synaptic signal leads to the formation of a memory trace).

Many synapses use more than one neurotransmitter—a common arrangement is for a synapse to use one fast-acting small-molecule neurotransmitter such as glutamate or GABA, along with one or more peptide neurotransmitters that play slower-acting modulatory roles.

B. Psychopathology

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S/S: Delusions, hallucinations, disorganized speech & behavior, negative symptoms

UNDIFFERENTIATED SCHIZOPHRENIA

PREDISPOSING FACTORS:Gender: MaleAge: 27y/oGenetic

PRECIPITATING FACTOR:Lower socioeconomic status

Decreased dopamine metabolism in the mesocortical pathwayDecreased glutamate (decreased prefrontal cortical functions)

Enlargement of ventricular system with subsequent decreased in brain volume;Reduced regional hippocampus, thalamus and frontal lobes

Neuronal loss in some cortical areasDecreased cerebral blood flow

Decreased metabolic activity

Disturbance in 5 system areas:Anatomical systems (prefrontal, limbic, basal ganglia)

Functional systems (language & learning )

Deteriorating personalityDisturbances in thought & sensory perception

Deterioration in psychosocial functioning

Nursing Diagnoses:Risk for self-mutilationImpaired verbal communicationAltered sensory and perceptionAltered thought processIneffective copingPersonal identity disturbanceDisturbed self-esteem

C. Drug Study

Drug / Classification Dosage Indication Contraindication Side Effects Nursing Responsibilities

haloperidol (Haldol)

- antipsychotic

10mg BID

Acute and chronic psychotic disorders including: schizophrenia, manic states, drug-induced psychoses. Also useful in managing aggressive or agitated patients.

Hypersensitivity

Narrow glaucoma

Bone marrow depression

CNS depression.

Seizures

Extrepyramidal reactions

Confused

Drowsiness

Restlessness

Constipation

Dry mouth

-assess mental status (orientation, mood, behavior) prior to and periodically during therapy-monitor for tardive dyskinesia (uncontrolled ryhtmic movement of mouth, face, and extremities; lip smacking or puckering, puffing of cheeks; uncontrolled chewing, rapid or worm-like movements of tongue). Report immediately; may be irreversible.

chlorpromazine(Chlorpromanyl

)

100mg BID

Acute and chronic psychoses, particularly when

Hypersensitivity

Hypersensitivity to sulfites

Neoleptic malignant syndrome

-assess mental status (orientation, mood, behavior) prior to and

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-antiemetics-antipsychotic

accompanied by increased psychomotor activity. Nausea and vomiting. Intractable hiccups.

(injectable) or benzyl alcohol (sustained-release capsule)

Cross-sensitivity with other phenothiazines may occur

Narrow-angle glaucoma

Sedation

Hypotension

Constipation

Dry mouth

Tachycardia

periodically during therapy

-monitor patient for onset of akathisia (restlessness) and extrapyuramidal side effects.

-monitor for tardive dyskinesia

biperiden HCl(Akineton)

-antiparkinson agents-anticholinergic

2mg OD Adjunctive treatment of all forms of Parkinsoin’s disease, including drug-induced extrapyramidal effects and acute dystonic reactions

Hypersensitivity

Narrow glaucoma

Bowel obstruction

Mega-colon

Tardive dyskinesia.

Confussion

Depression

Dizziness

Headache

Constipation

Dry mouth

Hallucinations

-assess parkinsonian and extrapyramidal symptoms (restlessness or desire to keep moving, rigidity, tremors, pill rolling, mask-like face,shuffling gait, muscle spasms, twisting motions) before and throughout therapy.

ascorbic acid(Vitamin C)

-vitamins

500mg OD

Treatment and prevention of vitamin C deficiency with dietary supplementation.

Tartrazine hypersensitivity

High doses:

Diarrhea

Nausea

Vomiting

Abdominal pain

Hyperuricemia

-monitor client’s condition

-assess for the presence or absence of associated symptoms

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V. THERAPIES

THERAPY DEFINITION PURPOSE RESPONSE INTERPRETATION1.Recreational

Therapy ( “Pinoy Ako” sing & dance )

Activity which is different that provides a change from the patient’s usual routine.

Revitalizes the patient’s interest & helps him to relax & refreshed.

Able to follow the simple steps and sang well.

Gerry was able to follow the steps with a slight difficulty and sang a little bit shy.

2.Bibliotherapy ( Ang Langgam at

ang Tipaklong )

(Proverbs)“ Ang mabigat ay gumagaan, kung pinagtutulungan”

Use of printed words or picture characters in modifying or stimulating emotions.

Reading may help lift a depressed patient; to improve the attention span of the individual with power of concentration, to stimulate the imagination & ideas in patients.

Student Nurse : Anong masasabi ninyo sa ating kwento na ang “ langgam at tipaklong”?

Gerry: “kailangan nating mag ipon habang maaga”

Gerry: “Halimbawa sa trabaho, kung magtutulungan tayo mas gagaang ang trabaho “

The patient was able to verbalize his own understanding about the story. It shows that he attentively listening to the presentor of the bibliotherapy.

The patient was able to read the proverbs and able to express his understanding that helping each other will make the work easier.

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3.Music & Arts( Fast & Slow

instrumental Song )

Use of unique properties & potential of music in a therapeutic situation.

It encourages a person to express & understand emotions through artistic expression & through creative process.

To change human behavior so that the individual affected will be able to function as worthwhile members of today’s as well as tomorrow’s society.

Use of music to aid relaxation.

Helps in reconciling emotional conflicts as well as promoting self-awareness & personal growth.

Fast Music:

Gerry drew their house at the province. He also draw himself together with his sister.

“ Ito yung bahay namin sa probinsya kasama ang aking kapatid na babae”

Slow Music:

He drew coconut trees illustrating their house in the province.

“ Maraming puno ng buko doon sa bahay namin sa Samar .“

It shows that he misses their house in the province and his family specially his sister.

4.Remotivation Therapy

( Ang Agila )

Technique of very simple group therapy which aims to bridge the fantasy world of the psychotics to the real world.

To stimulate patients to be fellow explorer of the real world.

To develop feelings of acceptance.

To develop their ability to communicate & share ideas & experiences with the other people.

To promote group harmony

Student Nurse: Anong masasabi ninyo tungkol sa ating tula na “ Ang Agila?”

Gerry: “ Ang agila ay lumilipad pababa sa kabundukan”

The patient was able to state what the bird does in the story. He listened to the poem attentively and shows that he understood it.

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& identification.5. Occupation

al Therapy( Card Making )

Form of rehabilitation or any activity, mental or physical , prescribed & guided to suggested activities: Painting, sketching, toy making or card making.

To encourage patients to participate in selected activities that will equip them to function independently in everyday life, such as arts & crafts.

The patient drew a fish on the cover of the card and said: “ Mabitamina ang isda” On the inside page he drew a sun above the mountain with 2 coconuts in it. He said: “ Dito kami kumukuha ng pangkabuhayan ng pamilya ko”

He drew this card for her mother.

SN: “ Gano mo kamahal ang nanay mo?” Gerry: “ higit pa sa buhay ko.”

His perception is towards the benefits of eating fish and the occupation of him & his family in the province.

It also shows that he misses his mother a lot and is the most precious and important person in his life.

VI. PROCESS RECORDING

Date: August 03, 2010Time: 1.30-2.00 pmName: Gerry B. BaleroAge: 27 years old

Description of patient:My patient is Gerry B. Balero 27 years old. He is alert and cooperative. His complexion is brown.

He is well groom, with clean clothing. Hair is short and color black. His eyes are color black and have a poor eye contact. Nails are short and clean. He always taps his foot. He has no untoward behavior.

Description of environment:Gerry is in pavilion 1 ward 7. There is no bed at the ward because they can be using it to harm

their self’s or the other patients and the comfort room has no door so that the nurse on duty can see what they are doing inside. The first nurse patient interaction was happen at corridor because it’s raining. There are many trees surround the area so that they can inhale fresh air.

Objectives: 1. To establish rapport

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2. To orient the patient3. To gather information

Nurse patient interaction inferences Nursing actionNurse: magandang umaga.Gerry: magandang umaga din.

Nurse: ako si abby from capitol medical center colleges. Ako ang magiging nurse mo simula ngayong martes, bukas (wednesday), at sa lunes at martes. Sa martes ang huli nating pagsasama. May mga activities tayong gagawin gaya ng pag exercise, music and art therapy, bibliotherapy, remotivation at occupational. nandito ako para gabayan ka sa mga activities na gagawin natin.

Nurse: maari ko bang malaman ang pangalan mo?

Gerry: ako si gerry b. balero

Nurse: ngayon ay august 3, 2010. 1.30 ng hapon

Nurse: kamusta ka naman?Gerry: ito ayos lang naman.

Nurse: ilang taon ka na?Gerry: 27 years old

Nurse: Saan ka nakatira?Gerry: sa Fairview.

Nurse: Kailan ang birthday mo?Gerry: may 16, 1983.

Client was sitting andlooking at me in theeyes.

He was sitting stilllooking at me in theeyes.

Sitting while his eyes started to Look around and start tapping his foot.

Sitting with eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Giving recognition to indicate that you are aware of him.

Establishing rapport and offering your self- Giving Information totell the client whoyou are.

Clarification-you clarify his name even though you knew it from the start.

Presenting reality toknow that whatreally is true.

Broad openings- to encourage the patient to talk.

Giving information how old he is.

Giving information where he lives.

Giving information when his birthday

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Nurse: my asawa ka na?Gerry: wala pa.Nurse: girlfriend?Gerry: wala din.

Nurse: ano natapos mo?Gerry: high school graduate lang. dahil walang pera.

Nurse: gaano kana katagal dito? Gerry: 2 monthsNurse: ano ang dahilan sa pag punta mo dito?Gerry: hindi ko alam.

Nurse: maaari mo bang idescribe sa akin ang iyong pamilya?Gerry: apat kaming magkakapatid. Bunso ako sa apat na magkakapatid.

Nurse: sige kwentuhan mo pa ako sa pamilya mo. Ano ang mga pangalan nila?Gerry: reggie yong panganay, gina ung pangalawa at si gerlie yong pangatlo.

Nurse: ilang taon na sila?Gerry: reggie- 38 years old, gina- 31 years old at gerlie- 29 years old.

Nurse: iyong mga magulang mo?Gerry: mama ko pangalan niya ay si lilbeth. 55 years old.Papa ko ay si Gerry sr. ay 63 years old tapos nag dradrive ng bus.

Nurse: dumadalaw ba sila dito?

He was smiling when ask about this question.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Listening- allow him to compose words that he want to say.

Exploring- so can dig deeper about his family.

Validation the client’s answer

Giving information toknow the

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Gerry: oo, yong mama at papa ko.

Nurse: anong masasayang alaala mo ang natatandaan mo?Gerry: pag nag pupunta kami sa luneta.

Nurse: ibig mo bang sabihin na ang pamamasyal sa luneta ang ang masayang alaala mo?Gerry: oo

Nurse: sino mga kasama mo?Gerry: pamilya ko.Nurse: ano ang madalas nyong gawin sa luneta?Gerry: kumain at mag laro ng basketball.

Nurse: Anong posisyon ang nilalaro mo?Gerry: guard.

Nurse: sinong idol mo sa paglalaro ng basketball?Gerry: si James Yap at Kobe Bryant.

Nurse: ano nagagawa ng pamamasyal sayo?Gerry: nakakatanggal ng pagod at bonding din.

Nurse? Pagod saan?Gerry: sa trabaho.

Nurse: ano ba ang trabaho mo na nakakapagod sa iyo? Gerry: gumagawa ng karton.

Nurse: ano pa ang mga pabortio mong libangan?Gerry: mag luto at kumanta.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

the people who are visitinghim.

Clarification- clarifying an important event in his life.

Validation- pt is asked to give feedback about the accuracy of the nurse’s perception.

Listening- to allow him to compose want he want to say.

Paraphrasing- restatement of what the pt has said.

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Nurse: anong paborito mong lutuin at kantahin? Gerry: pinakbet,at mga prito paborito kung kantahin ang Iwill always love you pero di ako masyadong magaling kumanta.

Nurse: sige Gerry dito na natatapos ang ating pag uusap. Bukas ulit. Salamat.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Sitting with no eye contact and tapping his foot.

Listening- to give him a time to speak.

Evaluation and remarks: My goals are partially met. I was able to orient and gather some information of the client. To know if the establishing rapport is met, we will see if with the coming days he will go to open up with me. My patient is a serious type of person. He was just answer what you are going to ask about him.

Date: August 04, 2010Time: 10.30-11.00amName: Gerry B. BaleroAge: 27 years old

Description of patient:My patient is Gerry B. Balero 27 years old. He is alert and cooperative. His complexion is brown.

He has a good hygiene. He knows the proper tooth brushing. He put powdered on his clothes and cologne on his neck. Hair is short and color black. His eyes are color black and have a poor eye contact. Nails are short and clean. He always taps his foot. He has no untoward behavior.

Description of environment:Gerry is in pavilion 1 ward 7. There is no bed at the ward because they can be using it to harm

their self’s or the other patients and the comfort room has no door so that the nurse on duty can see what they are doing inside. The second nurse patient interaction was happen under the trees after the therapies that we did. There are many trees surround the area so that they can inhale fresh air.

Objectives: 1. to establishing trust2. to assist him3. to gather more information

Nurse patient interaction Inferences Nursing action

Nurse: magandang umagaGerry: magandang umagaa din.

Sitting with eye contact. Giving recognition to indicate that you are aware of him

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Nurse: ngayon ay august 4, 2010. 10.30 ng umaga

Nurse: Gerry: maari mo bang sabihin sa akin kung ano ang aking pangalan?Gerry: abby

Nurse: galing naman, Ilang taon ka na?Gerry: 27 years oldNurse: ilan kayong magkakapatid?Gerry: apat

Sitting with eye contact.

Sitting with eye contact.

Presenting the reality

Clarification- if he knows who you are.

Validation to confirmif the client said istrue.

Nurse: Gerry, kwentuhan mo naman ako tungkol sa buhay mo?Gerry: simple lang naman ang buhay ko.

Nurse: ikwento mo naman sa akin itong drinawing mo kanina?(fast song)Gerry: yan yong bahay naming sa samar.Nurse: ano itong palaruan at itong mga tao?Gerry: ako yan at yong ate gina ko naglalaro sa seesaw.

Nurse: itong susunod n drawing?(slow song)Gerry: sa samar din yan,, madaming puno ng buko sa amin.

Nurse: so ang ibig mo bang sabihin na itong mga drawing mo ay sa probinsya nyo?Gerry: oo sa probinsya naming sa samar.

Nurse: ilang taon ka tumira sa samar?Gerry: mga halos isang taon lang.

Sitting with no eye contact and begins tapping his foot.

Sitting with eye contact and pointing the drawing where he and his sister love to play.

Sitting with eye contact.Sitting with eye contact and pointing out the coconut trees.

Sitting with no eye contact and tapping his foot

Sitting with no eye contact and tapping his foot

Broad openings- to encourage the patient to talk.

Validating- pt is asked to give feedback about the accuracy of the nurse’s perception

Validation- pt is asked to give feedback about the accuracy of the nurse’s perception

Clarification- to know if you get the message properly.

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Nurse: anong pinagkakaitaan nyo doon?Gerry: yong mga bunga ng niyog.

Nurse: ibig mong sabihin sa bunga ng niyog kayo kumuha ng pantustos nyo sa kabuhayan nyo? Gerry: oo, hinihintay naming maging brown yong buko saka pinipitas. Pag katapos bibilad at kinuha yong laman nito.Nurse: magkano naman ang benta nyo dito?Gerry: mga isang sako 500 pesos.

Nurse: salamat Gerry sa oras binigay mo sa akin ngayon sa araw na ito.Sa lunes at martes ulit. Tapos sa martes na yong huling araw namin ditto.

August 09, 2010

Nurse: magandang hapon GerryGerry: magandang hapon din.

Nurse: Gerry, ano name ko?Gerry: galing naman ni Gerry.

Nurse: Anong araw ngayon?Gerry: lunes, august 08, 2010Nurse: ngayon ay lunes august 09, 2010.

Nurse: Gerry ilan kayong magkakapatid?Gerry: apat

Nurse: Gerry, ano ang dahilan

Sitting with no eye contact and tapping his foot

Sitting with no eye contact and tapping his foot

Sitting with eye contact and tapping his foot

Sitting with eye contact and smiling

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Validating- pt is asked to give feedback about the accuracy of the nurse’s perception

Giving recognition to indicate that you are aware of him

Presenting the reality

Clarification- to know if you get the message properly.

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ng pagpunta mo ditto?Gerry: hindi ko alam.

Nurse: anong nangyari sa mga peklat mo dyan sa mga kamay mo?Gerry: hindi ko alam kung saan ko nakuha itong mga ito.

Nurse: may mga bisyo ka ba?Gerry: sigarilyo lang at paminsan minsan umiinom din pag may okasyon.Nurse: ilang sticks ang nauubos mo per day?Gerry: isang stick lang

Nurse: Gerry, mahal mo ba ang nanay mo?Gerry: oo higit pa sa buhay ko.Nurse: ang tatay mo?Gerry: ganon din.

Nurse: ano naman ang nararamdaman mo ditto sa loob?Gerry: MasayaNurse: sino yong mga kaibigan mo ditto?Gerry: sila carlito at yong iba pa.

Nurse: Gerry ano itong drinawing mo ditto sa card?Gerry: isda kasi mabitaminaNurse: itong mga puno?Gerry: puno ng niyog kung saan kami kumukuha ng kabuhayan ng pamilya ko.

Nurse: Gerry magbibigay ako ng 3 object tapos sabihin mo siya ulit sa akin after 5 minutes.

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Clarification- encourages recall of particular experience.

Confrontation

Confrontation- if he love his mother

Clarification- clarifying what he feels toward his co patient.

Listening- allow time to the client to compose what he want to say.

Evaluation of cognitive development

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Gerry: sige.Nurse: paper, pencil and eraser.Gerry: paper, pencil and eraser

Nurse: ngayon magbilang naman tayo ng 1-10.Gerry: 1-2-3-4-5-6-7-8-9-10.Nurse: ngayon pabaliktad naman.Gerry: 10-9-8-7-6-5-4-3-2-1.

Nurse: ngayon spelling naman ng word na Philippines.Gerry: p-h-i-l-i-p-p-i-n-e-sNurse: pabaliktad naman.Gerry: s-e-n-i-p-p-i-l-i-h-pNurse: ngayon yong word na house naman.Gerry: h-o-u-s-eNurse: pabaliktad namanGerry: e-s-u-o-h

Nurse: ngayon bigyan mo naman ako ng limang president.Gerry: roxas, quirino, ninoy Aquino, estrada at arroyo.Nurse: ngayon ang present nating president ay si ninoy Aquino.

Nurse: ngayon ay mag addition naman tayo.1+1Gerry: 2Nurse: 2+2Gerry: 4Nurse: 4+4Gerry: 8Nurse: 8+8Gerry: 16Nurse: 5+5

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Evaluation of cognitive development

Evaluation of cognitive development

Evaluation of cognitive development

Evaluation of cognitive development

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Gerry: 10

Nurse: ngayon mag subtraction naman tayo.6-6Gerry: 0Nurse: 3-2Gerry: 1Nurse: 11-5Gerry: 6Nurse: 4-2Gerry: 2Nurse: 7-4Gerry: 3

Nurse: ngayon basahin mo naman itong salawikain tapos ipaliwanag mo kung ano ang natutunan mo sa binasa moGerry: “ang palay ay hindi kusang lalapit sa manok”.Ang ibig sabihin lahat ng bagay ay pinaghihirapan natin. Hndi ito basta basta nakakamit.

Nurse: ngayon sabihin mo na sa akin yong tatlong object kanina?Gerry: paper, pencil and eraser.Nurse: galling, galling naman ni Gerry.

Nurse: Gerry, salamat sa pagbibigay ng impormasyon sa akin.Alis na kami. Bukas ang huli nating araw at magkakaroon tayo ng socialization. Participate tayo ha.Gerry: oo, salamat din.

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact

Sitting with eye contact and smiling.

Evaluation of cognitive development

Evaluation of cognitive development

Evaluation of cognitive development

Evaluation and remarks:

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Client was able to talk about his life. He was able to participate in all activities we did. He can able to explain his drawing. Client still doesn’t talk if you don’t ask him questions. Patient is still denial about the reason why he consults to the institution.

VII. REFERENCES Psychiatric Nursing Biological and Behavioral Concepts. Second Edition. Deborah Antai-Otong.

2008 Psychiatric Nursing. Third Edition. Keltner, Schwecke, Bostrom. 1999 http://psychcentral.com/lib/2006/undifferentiated-schizophrenia/. Retrieved August 07, 2010 http://medical-dictionary.thefreedictionary.com/undifferentiated+schizophrenia. Retrieved

August 07, 2010 www.wikipedia.com

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