1 Republic of the Philippines DIVINE WORD COLLEGE OF BANGUED Bangued, Abra NURSING DEPARTMENT A Case Study on SCHIZOPHRENIA, UNDIFFERENTIATED TYPE In Partial Fulfillment of the Requirements in NCM 204 (RLE) National Center for Mental Health Mandaluyong, City Pavilion 3 Submitted to: Submitted by: Batalon, Holland Benosa,Jerra Mae Cadoy, Dexter Cariňo, Ester Erika Crisostomo, John Kennedy Dela Vega, Demie Caine Oblea, Ariane Quintos, Aizly Grace Terrenal, Geneva Joy Villamor, Ingrid Mae
Transcript
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Republic of the PhilippinesDIVINE WORD COLLEGE OF BANGUED
Bangued, Abra
NURSING DEPARTMENT
A Case Study on
SCHIZOPHRENIA, UNDIFFERENTIATED TYPE
In Partial Fulfillment of the Requirements in NCM 204 (RLE)
National Center for Mental HealthMandaluyong, City
Pavilion 3
Submitted to:
Submitted by:
Batalon, Holland Benosa,Jerra Mae
Cadoy, DexterCariňo, Ester Erika
Crisostomo, John KennedyDela Vega, Demie Caine
Oblea, ArianeQuintos, Aizly GraceTerrenal, Geneva JoyVillamor, Ingrid Mae
March 12, 2011BATCH 2012
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I. BACKGROUND OF THE STUDY
A. INTRODUCTION
Schizophrenia is a group of psychotic reactions that affect multiple areas of an individual’s
functioning including thinking and communication, perceiving and interpreting reality, feeling and
demonstrating emotions and behaving in a socially accepted manner. This condition causes distortion
and bizarre behavior, thoughts, movements, emotions and perceptions. This condition is usually
diagnosed in late adolescence or early adulthood and rarely manifest in childhood.
The symptoms of schizophrenia are divided into two major categories; the positive and negative
symptoms. The positive symptoms include delusions and its types, hallucinations, loose associations and
bizarre or disorganized behavior while the negative symptoms includes restricted emotions, anhedonia,
avolition, alogia, catatonia and social withdrawal. Most clients with schizophrenia have a mixture of
both types of symptoms. The diagnosis of this condition usually is made when the person begins to
display more actively positive symptoms of delusions, hallucinations and disordered thinking. Onset may
be abrupt but most clients slowly and gradually develop signs and symptoms such as social withdrawal,
unusual behavior, loss of interest and neglected hygiene.
Schizophrenia is also classified into five types and diagnosed according to the client’s
predominant symptoms. Paranoid type is characterized by persecutory or grandiose delusions,
hallucinations and occasionally excessive religiosity hostility and aggressive behavior. Disorganized type
is characterized by inappropriate or flat affect, disorganized speech and disorganized behavior. The
catatonic is characterized by marked psychomotor disturbance, either motionless or excessive motor
activity. Motor immobility may be manifested by waxy flexibility or stupor. Excessive motor activity is
apparently purposeless and not influenced by external stimuli. Other features include extreme
negativism, echolalia, echopraxia or even mutism. Undifferentiated type is characterized by mixed
schizophrenic symptoms of other types along with disturbances of affect and behavior. The
undifferentiated 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. The symptoms of any one person can fluctuate at different points in time, resulting in
uncertainty as to the correct subtype classification. Other people will exhibit symptoms that are
remarkably stable over time but still may not fit one of the typical subtype pictures.
Agency: National Center for Mental Health, Mandaluyong City
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D. CHIEF COMPLAINT
According to her husband, the client was hostile and showing untoward behaviors. She was
claiming that she was a prophet and speaks most often about Satan. The informant also added that the
client often says that she was not accepted by their church anymore because of her mother who sold
herself to Satan.
E. HISTORY OF PRESENT ILLNESS
The present condition of the client started when she was 35 years old. Due to some
circumstances, the client became hostile and showed untoward behaviors and even hurting her own
self. She was brought to the agency by her husband who is very worried because his wife is acting
strangely and is no longer able to do her part as wife to him and a mother to their children. Ms. Love
was admitted on October 6, 2010 with a diagnosis of Schizophrenia: Undifferentiated Type.
The client’s present condition was already stable and manageable, but sometimes she still
manifests some symptoms like grandiose delusions, flat affect and tends to mumble to herself.
F. PAST MEDICAL HISTORY
(-) Diabetes Mellitus
(-) Hypertension
(-) Heart Problems
(-) Asthma
(-) Allergy to meds and foods
G. PAST PERSONAL HISTORY
The client was a graduate of College Degree at the University of the East. Basically, her life
revolved around her family and her religious affiliations. She is married and has three children. She’s
been affiliated religiously at their church as a member and she is active to their church activities.
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H. FAMILIAL HISTORY
The client belongs to a well to do family. They were five siblings in their family and have already
their own families respectively and she was the only one who has the condition. Their family owns a
business. The client has two children and they were studying at a prestigious school in Metro Manila. On
both paternal and maternal side, they do not have a history of schizophrenia and she was the first to
have the condition. The client has a broke relationship with her parents because they were so strict to
her to the point of physically and emotionally abusing her every time she commits mistakes when she
was growing up.
I. PAST SOCIAL HISTORY
The client was an active member of her Religious affiliation. She was dedicated and goes along
with her colleagues religiously and acts accordingly. She spends most of her time on her affiliation and
has a normal state dealing with her colleagues. She’s fond of dealing with her co-members. The client
always remembers that she was singing at their church with other group members. The client’s social
atmosphere changed when one day she was not already a member of their church. She always claimed
that she was rejected due to the wrong doing of her mother. She became socially withdrawn, suspicious
and later became hostile and has disorganized behavior.
J. ERIK ERIKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT
The Psychosocial Stages of Development developed by Erikson enumerates eight stages through
which healthily developing human should pass from infancy to late adulthood. Every stage describes a
task to be accomplished. These development stages can be seen as a series of crisis and each stage
forms on the successful accomplishment of the earlier stages. Successful resolution of these crises
supports a healthy self-development. Failure to resolve the crises damages the ego and maybe expected
to reappear as problems in the future.
LIFE STAGE INDICATORS OF POSITIVE
RESOLUTION
INDICATORS OF NEGATIVE
RESOLUTION
ASSESSMENT JUSTIFICATION
Infancy (birth to 1 year)
Learning how to trust others
Mistrust, withdrawal, estrangement.
Mistrust Ms. Love’s mother did not breastfed her because she is having pain breastfeeding her so she bottle fed
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Central task: TRUST Vs. MISTRUST
The first stage, centers on the infant's basic needs being met by the parents. The infant depends on the parents, especially the mother, for food, sustenance, and comfort. If the parents expose the child to warmth anddependableaffection, the infant's view of the world will be one of trust. But if the caregivers are neglectful, the infant instead learns mistrust- that the world is in an unpredictable and an unsafe place.
Love in a timed manner believing that this would train the baby to be disciplined. But because their family owned a business, her mother is frequently busy. That is why most of the time; she would just stay with her siblings since she is the third child in the family. Because of her parent’s frequent absence, Love was given not enough attention and left under a care of her siblings, she had built a sense of mistrust to her parents. She has not been fed well since she’s being fed in a timed manner; she hasn’t felt the sense of comfort since her parents haven’t been there for her to cuddle her when she’s crying or to play with her when necessary.
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Early Childhood (1 to 3 years)
Central task: AUTONOMY Vs. SHAME AND DOUBT
If caregivers encourage self- sufficient behavior, child develops a sense of autonomy- a sense of being able to handle many things on their own. But if caregivers demand too much too soon, refuse to let children perform tasks of which they are capable; children may instead develop shame and doubt about their ability to handle things.
Self- control without loss of self –esteem; ability to cooperate and express oneself.
Compulsive self-discipline or compliance; willfulness and defiance.
Shame and DoubtBecause the client’s The patient was toilet trained when she was 2 years old. As she had her siblings to care for her most of the time, the mother instructed them to teach her to urinate and defecate in a potty because it irritates her mother to find urine and stool just anywhere, she was too demanding that the child will learn how to toilet train right away. On the other hand, her siblings don’t train her well; they have not disciplined the child well if the child pees anywhere. The child was unable to master this kind of task in this stage, since she developed the sense of shame and doubt in which she was unable to handle because of the different implementation of her siblings and mother.
Late Childhood Learning degree of Lack of self Initiative Love engages much
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(3 to 6 years)
Central task: INITIATIVE Vs. GUILT
This stage, the child learns to take initiative and get ready for leadership and goal achievement roles. If adults encourage andsupport children’sefforts, while also helping them make realistic and proper choices, children develop initiative- independence in planning and undertaking activities. But if, adults discourage the search of independent activities, children develop guilt about their needs and desires.
assertiveness and purpose influence theenvironment;begins to evaluate one’s own behavior.
confidence; pessimistic and over restriction of own activity.
in activities and plays. She loves talking and playing with her siblings since they are the one who is always there for her.
School Age (7 to 11 years)
Central Task: INDUSTRY Vs. INFERIORITY
At this stage, children are eager
Developing sense of competence and perseverance.
Sense of being mediocre; withdrawal from peers and school.
Inferiority During her school aged years, Love was often scolded by her parents every time she commits mistakes and every time her grades would not satisfy her parents.
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to learn and accomplish more complex skills: reading, writing, telling time. If children are encouraged to make and do things and are then praised for their accomplishments, they begin to demonstrate industry by being diligent, persevering at tasks until completed and putting work before pleasure. If children are instead ridiculed or punished for their efforts or if they find they are incapable of meeting their teachers' andparents'expectations, they develop feelings of inferiority about their capabilities.
Her folks have a great deal of expectation on her to do well even though she is still very young which caused her to feel inferior from her classmates even if she is doing her very best to satisfy her parent’s pressure on her.
Adolescence (13 to 19 years)
Central Task: IDENTITY Vs. ROLE CONFUSIONThe adolescent is
Sense of self and plans to actualize one’s abilities.
Feelings of confusion, hesitancy, and possible antisocialbehavior.
Role Confusion At this stage, the client carried her self inferiority which caused her not to gain friends. She was hesitant in mingling with
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newly concerned with how they appear to others. The sense of central identity appears through sexual, emotional, educational, ethnic, cultural, and vocational discovery. The adolescent person also develops coherent sense of self and plans to actualize one’s abilities. The sense of self can be confused if a core identity does not solidify. Feelings ofconfusion,hesitancy, and possible antisocial behavior may also emerge.
others because she is afraid that they would ridicule her. But then, a certain group of people made friends with her but they were bad influence. She started drinking and smoking because of peer pressure.
Early Adulthood (20 to 34 years)
Central Task: INTIMACY Vs. ISOLATION
Once people have established their identities, they are ready to make long-term commitments to others. They
Intimaterelationshipwith another person and has a sense of commitment to work and relationships.
Intimacy Despite the fact that Ms. Love had role confusion during her adolescent years, when she reached her early adulthood, she longed for an intimate relationship for her to feel that she is loved. She was eager to commit
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become capable of formingintimate,reciprocal relationships and willingly make the sacrifices and compromises that such relationships require. If people cannot form these intimate relationships--a sense of isolation may result.
herself with something that would help her forget her familial problems. And so she dedicated her self to her husband and her charity works at their church.
Middle Adulthood ( 35 to 65 years)
Central Task: GENERATIVITY Vs. STAGNATION
During middle age the primary developmental task is one of contributing to society and helping to guide future generations. When a person makes acontributionduring this period, perhaps by raising a family or working toward
Working towards the betterment of the society;being productive.
Lack ofproductivity;not helping society to move forward.
Stagnation The onset of the client’s present condition started at this stage. She started to have untoward behaviors like scolding her children for no apparent reason, destroying their household equipments every time she feels depressed about her parents. She’s having hallucinations and delusions which impeded her role as a mother to her children and her wife to her husband.
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the betterment of society, a sense of generativity- a sense of productivity and accomplishment- results. In contrast, a person who is self- centered and unable or unwilling to help society move forward develops a feeling ofstagnation-dissatisfactionwith the relative lack of productivity.A person in this stage should have time for companionship and recreation. He also knows his responsibilities and knows that he is accountable of whatever actions he takes.
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I. PHYSICAL AND MENTAL ASSESSMENT
A. GENERAL APPEARANCE
The client appears stated with her age of 36 years old, wearing the unit’s uniform with good eye
contact, but flat affect. Speech is hyper productive with inappropriate words. She’s taking a bath
everyday with a good daily routine. The client has a good posture, gait and coordination. During
interaction, she has a good eye to eye contact and flat affect with regards to a certain situation. She was
well nourished and has a fair skin as evidenced by his good body built and has no sleeping difficulties by
the absence of dark circles under her eyes. She was not oriented with time, place, date and reality. The
client considered the interview as a normal thing and she was guided accordingly with no harsh or
offending questions thrown to her during the interview. She was cooperative with consistency of
behavior.
B. GENERAL BEHAVIOR AND PHYSICAL ACTIVITY
The client is sometimes lethargic during interactions. There are also times that she is restless
where she can’t remain still. However, she was manageable most of the time and willingly participates in
the interactions.
C. ORIENTATION
The client was not oriented on date, time, place and reality. She can relate to her past
experiences however, she is unable to organized ideas and thoughts related to her present condition.
She knows and she is aware that she is at the National Center for Mental Health.
D. AFFECT AND MOOD
The client show flat affect with regards to a certain situation and sometimes, she suddenly
change in expression of mood and this makes it hard to identify whether she was on stated condition
and willing to cooperate and interested with the interaction. Sometimes, there was an alteration of the
affective state of the client which was inappropriate and contrary to his feelings and emotions.
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E. THOUGHT PROCESS AND CONTENT
Even if the client is at the Center, she has a normal and logical thought process. What she
uttered was meaningful and with sense. She didn’t use confabulation nor circumstantial. She can easily
catch up with what the interviewee mean and answer relevant to the questions.
F. MEMORY, PRESENT AND REMOTE
The client has a good memory and sometimes she had lapses. She can recall and remember her
past experiences and important events and people in her life. What were discussed in the previous days
were recalled which were integrated on the present scenario on the interaction.
G. JUDGMENT
The condition of the client started when she was on her early adulthood. Therefore, it doesn’t
mean that she can not make decisions on her own even though she is at the center. She can formulate
and think of other alternatives which later could be beneficial for solving her own problems but is not
eager to carry out so.
H. INSIGHT
The client was knowledgeable and aware that she is at the National Center for Mental Health.
She knows the state of her illness being manageable and how was the progression with regards to her
rehabilitation and in response to medication regimen and psychotherapies. She was able to respond of
what was going on and can comprehend appropriately.
I. INTELLECT
She has a good sense of reasoning but it was limited. She was able to pinpoint and defend her
answers but if asked for the main reason why she was at the Center, she can’t answer directly.
J. COPING MECHANISMS
The client has a poor pattern in handling stressors that arises in her life especially with regards
of her relationship with her parents. But ever since she was rehabilitated at the Center, she was able to
formulate ideas and alternatives in order to divert her attention from her problems, she did her
responsibilities at the Center and enjoyed the therapies especially during plays for her not to think or
not be bothered by her problems even in a short period of time.
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K. DEFENSE MECHANISM
In the case of our client, she used denial as a defense mechanism. In the reason why she was at
the center, she elaborated that she only wanted to rest because she was already tired and exhausted,
but in fact, she’s been hostile and doing unacceptable manner. In some of the activities that were done,
the client never excels in such, but became a winner in the play therapies; therefore she was
compensating on her actions that was not succeeded on her part. And one thing also that was noticed
was that, she tend and often said that her attitude of mumbling and rattling of speech was due to
limited visitation by her family.
II. PSYCHOPATHOPHYSIOLOGY
A. PSYCHODYNAMICS
According to Freud, schizophrenia is a form of regression, back to the oral stage of
development. The oral stage is the first stage of psychosexual development. A baby is born a bundle of
id; ID is self-indulgent and concerned only with a satisfaction of his/her needs. There is a need to gratify
these impulses but their experiences in the real world result in conflict. People with schizophrenia are
overwhelmed by anxiety because their egos are not strong enough to cope with id impulses. In
schizophrenia, this can lead to self-indulgent symptoms such as delusions of grandeur. As the patient is
still living in the real world, this may result in further DELUSIONS such as hearing voices which may have
an ultimate authority such as God. Schizophrenia is the result of a weak ego. The development of the
ego has been inhibited by a symbiotic parent/child relationship. Because the ego is weak, the use of
ego defense mechanisms in times of extreme anxiety is maladaptive, and behaviors are often
representations of the id segment of the personality.
B. PREDISPOSING AND PRECIPITATING FACTORS
The relationship between members of the family has a big role in the development of the
condition. Parenting in the early stage of life which the child seen during those years, she may manifest
and carried until she grows up. In the client’s case, she felt withdrawn from her interpersonal or social
relationships because she became vulnerable to stress as she never gave much attention in dealing with
her problems. She disclosed them all with herself and was not able to know what the alternatives for the
coping of her problems were.
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Nature of work also predispose the development of the condition, if the person is always
ridiculed even she thinks that she did her best and her work is good but it has no effect on his boss,
feeling of guilt a and inadequacy and inferiority begins. That’s why, the person maybe have fascinating
effects that someday her boss would be please on what she had done or maybe think of hostility against
her boss.
Low Frustration Tolerance also a factor that triggers the development of the illness. Like on the
nature of work, she may not be able to cope up with the problems she may encounter that makes her
think of something that were not appropriate to reality and acts contrary.
Severe Religiosity was also included as a part of the past social history of the client. She was very
active to her religion and she did anything for that her faith in God and to their church may not be
ruined. But one that predisposed was the wrong act of her mother that the latter cause her to be
rejected to their church. In this case, the client become hostile and shows untoward behaviors towards
other and towards self.
Since the client has well to do family, socio economic status has a lesser effect on the
development of her condition, but the main thing connected to it was the attitude of family members
like her parents which is very mean and strict to her.
C. PSYCHOPATHOLOGY
The brain is made up of nerve cells, called neurons, and chemicals, called neurotransmitters. An
imbalance of one neurotransmitter, dopamine, is thought to cause the symptoms of schizophrenia.
Recent studies suggest that serotonin, another neurotransmitter, may also play a significant role in
causing the symptoms of schizophrenia.
Brain activity differs in a brain with schizophrenia and a brain without schizophrenia. In the brain
with schizophrenia, far more neurotransmitters are released between neurons. Thus, the symptoms of
schizophrenia occur.
Two hypotheses are considered to cause the occurrence and progression of symptoms in
schizophrenia. The "dopamine hypothesis" has been the main theory regarding the cause of the
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symptoms of schizophrenia. Researchers believe that many of the symptoms of schizophrenia are a
result of excess of dopamine in the brain. Anti psychotic medications block dopamine transmission and
are used to treat and improve the symptoms of schizophrenia. New theories suggest that the
neurotransmitter serotonin may also play a role in causing the symptoms of schizophrenia. Some anti
psychotic medications treat symptoms of schizophrenia by blocking dopamine and serotonin
transmissions. Many patients who have not been helped by "dopamine only” medications have been
helped by medications that affect both dopamine and serotonin transmissions, such as Clozaril,
Risperdal and Zyprexa.
Schizophrenia is a group of psychotic reactions that affect multiple areas of an individual’s
functioning including thinking and communication, perceiving and interpreting reality, feeling and
demonstrating emotions and behaving in a socially accepted manner. This condition causes distortion
and bizarre behavior, thoughts, movements, emotions and perceptions. This condition is usually
diagnosed in late adolescence or early adulthood and rarely manifest in childhood.
In relation to the predisposing and precipitating factors, the client’s cause of illness is severe
religiosity, parenting (family relationships and attitudes towards other), low frustration tolerance and
the nature of work.
The onset of the symptoms usually occurs in the adolescence or early adulthood and the onset
can be gradual or sudden. Course of schizophrenia is variable and remissions may occur. Some clients
may recover completely. Some have chronic, unremitting disorder. Schizophrenic clients have difficulty
in perceiving reality and disturbances on ego. These individuals have poor sense of identity as well as
lowered self esteem.
The signs and symptoms which manifested by the client when admitted were delusions
(grandiose), hostility, loose associations, disorganized behavior, social withdrawal and restricted
emotions.
D. RELATED LITERATURE AND STUDIES
University of Manchester researcher Paul Hammersley is to tell two international conferences,
in London and Madrid on 14 June 2006, that child and adult abuse can cause schizophrenia. The
groundbreaking and highly contentious theory, co-presented by New Zealand clinical psychologist Dr
John Read, has been described as "an earthquake" that will radically change the psychiatric profession.
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Mr Hammersley, Programme Director for the COPE (Collaboration of Psychosocial Education)
Initiative at the School of Nursing Midwifery and Social Work, said: "We are not returning to the 1960s
and making the mistake of blaming families, but professionals have to realize that child abuse was a
reality for large numbers of adult sufferers of psychosis." He added: "We work very closely in
collaboration with the Hearing Voices Network that is with the people who hear voices in their head.
The experience of hearing voices is consistently associated with childhood trauma regardless of
diagnosis or genetic pedigree." Dr Read said: "I hope we soon see a more balanced and evidence-based
approach to schizophrenia and people using mental health services being asked what has happened to
them and being given help instead of stigmatizing labels and mood-altering drugs." Hammersley and
Read argue that two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse
and thus it is shown to be a major, if not the major, cause of the illness. With a proven connection
between the symptoms of post-traumatic stress disorder and schizophrenia, they say, many
schizophrenic symptoms are actually caused by trauma. Their evidence includes 40 studies, which
revealed childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric
patients and a review of 13 studies of schizophrenics found abuse rates from a low of 51% to a high of
97%. Psychiatric patients who report abuse are much more likely to experience hallucinations –
flashbacks which have become part of the schizophrenic experience and hallucinations or voices that
bully them as their abuser did thus causing paranoia and a mistrust of people close to them. They admit
not all schizophrenics suffered trauma and not all abused people develop the illness, but believe less
traumatic childhood maltreatment, rather than actual abuse, may be an important difference. In their
review of the 33,648 studies conducted into the causes of schizophrenia between 1961 and 2000, they
found that less than 1% was spent on examining the impact of parental care. Still, they say, there have
been enough studies to suggest negative or confusing early care may be an important addition to abuse
as a cause. Genes may still have a role to play but other evidence Hammersley and Read cite shows that
genes alone do not cause the illness. —ScienceDaily (June 14, 2006)
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E. PSYCHOPHARMACOLOGY
F.
Generic Name/ Brand Name ClassificationMechanism of Action
Adverse Effects Nursing Considerations
Haloperidol
Haldol
Antipsychotic
A butyrophenone that probably exerts antipsychotic effects by blocking post synaptic dopamine receptors in the brain.
CNS: Lethargy
CV: Tachycardia
GI: Dry mouth
Although drug is least sedating of the antipsychotics, warn patient to avoid activities that require alertness and good coordination until effects of the drugs are known.
Educate patient that drowsiness and dizziness usually subside after a few weeks.
Inform patient to avoid alcohol while taking this drug.
Tell patient to relieve dry mouth with sugarless gum or hard candy.
Inform patient to do not withdraw the drug abruptly unless required by severe adverse reactions.
D.R.F.F.T. Indication Contraindications
D- 10mgR- oralF- BIDF- tabletT-
Psychotic Disorders Hypersensitivity to drug and those with Parkinsonism, coma or CNS depression
Drug Study No.1
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Generic Name/ Brand Name ClassificationMechanism of Action
Adverse Effects Nursing Considerations
Lithium Carbonate Anti-manic
Mechanism for the antimanic effect of lithium is unknown. Various hypothesis include: a decrease in catecholamine neurotransmitter levels caused by lithium’s effect on sodium-potassium ATpase to improve transneuronal membrane transport of sodium ion
Due to initial therapy: Fine hand tremors or polyuria, thirst, transient and mild nausea, general discomfort.
Note indications for therapy other agents trailed, characteristics and S&S, and behavioral presentation.
Inform client to take with food immediately after meals. Avoid any caffeinated beverages/foods because these may aggravate mania.
Monitor lithium levels
D.R.F.F.T. Indication Contraindications
D- 450 mgR- oralF- BIDF- tabletT-
Control of mania in manic- depressive clients.
Cardiovascular or renal disease. Brain damage. Dehydration and sodium depletion, clients receiving diuretics.
Drug Study No.2
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Generic Name/ Brand Name ClassificationMechanism of Action
Adverse Effects Nursing Considerations
Ascorbic Acid Vitamins
Ascorbic acid is reversibly oxidized to dehydroascorbic acid in the body. These two forms of the vitamin are believed to be important in oxidation-reduction reactions.
Temporary dizziness Monitor for S&S of acute hemolytic anemia, sickle cellcrisis.
Take large doses of vitamin C in divided amounts because the body uses only what is needed at a particular time andexcretes the rest in urine.
Mega doses can interfere withabsorption of vitaminB12.
Note: Vitamin C increases the absorption of iron when taken at the same time as iron-rich foods.
D.R.F.F.T. Indication Contraindications
D- 450 mgR- oralF- ODF- tabletT- 8am
Prophylaxis and treatment of scurvy and as a dietarysupplement. Increases protection mechanism of theimmune system, thus supportingwound healing. Necessary for wound healing and resistance toinfection.
Use of sodium ascorbate inpatients on sodiumrestriction; use of calciumascorbate in patientsreceiving digitalis.
Drug Study No.3
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III. NURSE PATIENT RELATIONSHIP
A. PROCESS RECORDING
Name of patient: Ms. Love
Age: 36 years old
Diagnosis: Undifferentiated Schizophrenia
Pavilion: 3
Date of Interaction: December 6-17, 2010
Time of Interaction: 7:00AM-3:00PM
Duration of Interaction: 2-3 hours
ORIENTATION PHASE
OBJECTIVES:
to establish rapport and trust and cooperation
to establish roles and purposes of the meeting
to identify client’s problems and clarify expectations
ASSESSMENT:
Wears unit’s uniform with a face towel at her back
Well groomed with good personal hygiene with good posture and gait
Has good eye contact during interaction, good mood but flat affect
Not oriented on time, place, date and reality
Well nourished with fair skin
Spontaneous speech and with relevant answers
Unable to recall past experiences and relate to the present situation and reality
Alert and had good judgment
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ORIENTATION PHASE
(Dec.9, 2010 / 9am)
NURSE CLIENT THERAPEUTIC COMMUNICATION
RATIONALE
Magandang umaga po, kumusta po kayo?
Okay naman ako, magandang hapon din.
Giving recognition Greeting the client indicates that she is acknowledged and recognized as a person.
Ako po si Ariane Oblea. Galing po ako sa Divine Word College of Bangued sa Abra po. Ako po ang magiging student nurse ninyo mula December 6 hanggang 17, 2010 maliban lamang po sa sabado at linggo. Magsisimula po tayo ng alas nuebe ng umaga hanggang alas tres ng hapon. Pag-uusapan po natin ang inyong mga karanasan, at mga bagay-bagay na makakatulong sa inyong paggaling. Lahat po ang pag-uusapan natin ay mananatiling sikreto at tayo lamang pong dalawa ang nakakaalam.
(Ngumiti) Ganun ba? Offering self, establishing rapport and trust ; giving information
This gives the client an overview what were the reasons why you were there and make her aware what are the boundaries of the interaction, the purposes, the time and place and who were to be involved. Establishing rapport and trust can help to make client feel at ease with the nurse.
Maari po bang kayo naman ang magpakilala?
Ako naman si Love nakatira sa Pasay City, 36y/o
Providing General Leads It encourages the client to continue what she is saying and that the nurse is active in listening.
Matagal na po ba kayo rito? Magdadalawang buwan palang ako dito.
Seeking Information Helps the client facilitate thoughts, feelings and ideas clearly.
Anong dahilan naman po na napunta kayo dito
Dinala ako ng asawa ko dito.
Exploring Helps them both the client and the nurse to examine the issue more fully.
May asawa po pala kayo, ilan naman po ang anak ninyo?
May dalawang anak na ako,, pareho silang babae.
Restating and seeking information.
Restating helps in clarifying previous issue told by the patient.
Ano po ba ang trabaho niyo dati?
Tumutulong ako sa karinderya ng pamilya
Seeking information Helps the client facilitate thoughts, feelings and
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ko. ideas clearly.Nakatapos po ba kayo sa pag-aaral? Saang paparalan naman po?
Computer secretarial ang kurso ko dati pero di ako nakatapos, nag-aral ako sa pamantasan ng lunsod ng Pasay.
Seeking Information Helps the client facilitate thoughts, feelings and ideas clearly.
(tumango) nabanggit niyo po na Hindi kayo natapos sa pag-aaral,sa anong dahilan po?
Tinamad na akong mag-aral, kaya dina ako nagpatuloy.
Summarizing, and Exploring
This helps to organize key issues that have been discussed and for the nurse to examine the issue further.
May nais pa po ba kayong pag-usapan ate?
Wala na po. Offering self Making oneself available and showing interest and concern to the client let them feel more comfortable and will develop further trust
Cge po ate love bukas po ulit tayo magkikita, alas nuebe ng umaga. Maraming salamat po ate.
Maraming salamat din. (ngumiti)
Giving Recognition Greeting the client indicates the she is acknowledge and recognize as a person.
WORKING PHASE
OBJECTIVES:
To identify issues and concerns causing problems
To guide client to examine feelings and responses
To develop coping skills and more positive self image
To examine consistency of thoughts and ideas
ASSESSMENT:
Well dressed with pink dress
Well groomed with pink hair band
With good eye contact during interaction and oriented on date, time, place and identity
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With euthymic mood and appropriate affect
Spontaneous speech, consistent answers to questions asked
Has good communication skills, insight and judgment
Alert, able to think abstractly and make generalization
WORKING PHASE DAY 2 (Dec. 10, 2010)
NURSE CLIENT THERAPEUTIC COMMUNI -
CATION
RATIONALE
Magandang hapon ate love. Magandang hapon din Ariane
Giving recognition
Greeting the client indicates the she is acknowledge and recognize as a person.
Kumusta po ang araw niyo?Napansin ko po na palangiti po kayo ngayon. Kumusta naman po ang tulog niyo?
Mabuti naman ang tulog ko, Masaya lang ako kasi nandito ulit kayo.(ngumiti)
Making observations
To make them aware what are their actions and what the client feels.
Maaari niyo po bang ilahad kung ano ang ginawa natin kahapon?
Nagpakilala tayo sa isa’t isa.
Summarizing This seeks to bring out the important points of the discussion and increase awareness to the client
May kapatid po ba kayo? Bali lima kami na magkakapatid, ako ang pangatlo
Seeking information.
It helps the patient to articulate thoughts, ideas and feelings clearly.
May naalala pa po ba kayo nung bata kayo? Pwede niyo po bang ikwento?
Mayroon kaming family business dati, kaya mga kapatid ang nag-aalaga sa akin, sila lagi ang kasama ko sa bahay.
Encouraging expression
Encourages her to make her own appraisal rather than to accept the opinion of others.
Ano po bang hilig niyong gawin noong bata kayo?
Mahilig kami maglaro dati ng mga kapatid ko kasi
Exploring Exploring helps her to examine the issue more fully.
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lagi kaming iniiwan nina mama sa bahay.
Mahiliog po ba kayong kumanta?
Marunong lang nang kunti.
Providing general leads.
Encourages the patient to continue discussion
Ano naman po ang paborito niyong kanta ate?
Yung “have you ever”
Seeking information
Helps the client facilitate thoughts, feelings and ideas clearly.
Sino naman po ang kumanta nun?
Hindi ko na maalala eh.
Encouraging description of perception
This may fully relieve the tension the client is feeling.
At kanino niyo naman po gustong ihandog ang kanta?
Sa mga anak ko.. Encouraging description of perception
This may fully relieve the tension the client is feeling.
Sa anong dahilan po na gusto niyong ihandog ang kantang ito sa mga anak ninyo?
Dahil mahal ko sila, at ayaw ko silang mawala sakin.
Broad openings Open-ended questions provide opportunity for the client to introduce topic.
Ano naman po nararamdaman niyo tuwing kinakanta niyo ito?
Gumagaan pakiramdam ko.
Encouraging expression
Encouraging the client to make her own appraisal rather than to accept opinions from others.
Sa activity po natin kanina na Music therapy, ano po ang nararamdaman ninyo habang kumakanta tayo ng kanlungan?
Masaya at medyo malungkot.
Encouraging expression
Encouraging the client to make her own appraisal rather than to accept opinions from others.
Ano pong dahilan at nasabi po ninyong malungkot?
Naalala ko kasi yong mga anak ko at pamilya ko.
Seeking information
Helps the client facilitate thoughts, feelings and ideas clearly
Ang ibig niyo po bang sabihin ay gusto na po ninyong umuwi at maksama ang pamilya ninyo?
Oo, gusto ko nang umuwi.
Translating into feelings
This technique is to verbalize clients feeling of what she said indirectly
Ano naman po yung mga naiisip ninyong paraan o solusyon para makauwi na kayo?
Magpapakabuti ako dito at sinusunod ko yun mga sinasabi ng mga nurses at doctor.Iinumin ang mga gamut ko.
Formulating a plan of action
Making definite plans increases the likelihood that the client will cope more effectively in similar situation
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Nasaan po sila ngayon? Nag-aaral sila Seeking information
Helps the client facilitate thoughts, feelings and ideas clearly
Sino po ang nag-aalaga sa kanila?
Yung asawa ko. Seeking information
Helps the client facilitate thoughts, feelings and ideas clearly
Sa music and art therapy naman po, anong dahilan na bulaklak and ginuhit ninyo?
Kasi marami akong tanim na maga halaman sa bahay namin.
Encouraging description of perception
Doing so encourages the client to verbalize ideas fully.
At kanino niyo po gustong ihandog ang inyong guhit?
Sa pamilya ko. Translating into feelings
Helps to understand on what the client might be feeling to express herself that way
Ano naman po ang nraramdaman niyo habang gumuguhit kayo?
Namimis ko ang mga anak ko.
Broad opening. Make explicit that the client has the lead in the interaction. This may stimulate her to take the intiative.
May gusto pa po ba kayong ibahagi sa akin?
Wala na. Offering Self Making oneself available and showing interest and concern to the client let them feel more comfortable and will develop further trust
Sige po ate love bukas po ulit.
Salamat, Paalam Giving Recognition
Greeting the client indicates the she is acknowledge and recognize as a person.
WORKING PHASE DAY 3 (Dec. 13, 2010)
NURSE CLIENTTHERAPEUTIC COMMUNICATION
ANALYSIS
Hello po ate love magandang umaga. Nandito na naman po ako.
Magandang umaga din
Giving recognition Greeting the client indicates the she is acknowledge and recognize as a person.
Anong araw po ngayon ate love?
Dec 13, 2010 Presenting reality Offers considerations which are real.
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Ano po ang nararamdaman niyo ngayon?
Ok lang naman ako. Encouraging expression
Encouraging the client to make her own appraisal rather than to accept opinions from others.
Nabanggit niyo po kahapon ang tungkol sa inyong pamilya, tama po ba?
Oo tama. Summarizing This seeks to bring out the important points of the discussion and increase awareness to the client.
Pwede pa po ba kayong magkwento tunkol sa elementary day’s niyo?
Mahilig kaming maglaro,tapos pag napapabayaan namin ang grades namin pinapagalitan kami nina mama
Placing event in time or sequence
Helps both the nurse and the client to see them in perspective, the nurse may gain information about recurrent patterns in the client’s behavior.
Nodding Pagkagraduate ko nung elementary mahiyain ako,kunti lang ang kaibigan ko,tapos nang makilala ko na yong mga kabarkada ko natutunan kong manigarilyo at uminum.
Silence Often encourages to verbalize, and gives the client’s time to organize thoughts and direct the topic of interaction.
Ano naging reaksyon ng mga magulang niyo nung nalaman nila ang tungkol sa bisyo niyo?
Lagi nila kong pinapagalitan tapos pinagbawalan nila akong makipagkita sa mga kabarkada ko. Feeling ko dati lahat ng ginagawa ko mali sa paningin nila.
Encouraging description of perception
This may fully relieve the tension the client is feeling and she might be less likely to take actions on ideas that are harmful or frightening.
(Nodding) Ngayong umaga po, mag kakaroon ulit tayo ng activity na dance at recreational
Ah ganun ba? Di ako magaling sumayaw eh. (ngumiti)
Giving information ; silence
Informing the client of facts increases her knowledge, and orients her on what to expect.
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therapy . Marunong po ba kayong sumayaw?
Often encourages to verbalize, and gives the client’s time to organize thoughts and direct the topic of interaction.
Ah ganun po ba? Pamilyar naman po ba kayo sa larong Pinoy Henyo?
OO, yun ba yung nasa TV? Pero di ko masyado kabisado eh.
Broad opening. Make explicit that the client has the lead in the interaction. This may stimulate her to take the intiative.
Iyon po kasi ang lalaruin natin mamaya.
Lahat ba kame sasali?baka matalo ako.
Giving information Informing the client of facts increases her knowledge, and orients her on what to expect.
Opo,huwag po kayong mag-alala, kasi po makakatulong po ito sa inyong paggaling
Ganun ba, o sige. Giving information Increases her knowledge about the topic.
Ready na po kayo sa mga activity natin ngayong umaga?
Oo naman Encouraging expression
Encouraging the client to make her own appraisal rather than to accept opinions from others.
Wala na po kayong idadagdag?
Wala na Giving recognition Greeting the client indicates the she is acknowledge and recognize as a person
Sige po, pumunta na po tayo sa mga kasamahan ninyo.
Sige.
WORKING PHASE DAY 4 (Dec. 14, 2010)
NURSE CLIENTTHERAPEUTIC
COMMUNICATION ANALYSISMagandang umaga Ate love Magandang umaga
din ArianeGiving recognition Greeting the client
indicates the she is acknowledge and recognize as a person.
Anong oras po kayo nagising kanina?
5:00 kasi naligo pa kame, tapos nag-
Seeking information
To make them aware what are their
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almusal. actions and what the client feels.
Ano pong petsa ngaun ang anong araw?
Dec. 14, 2010 Presenting reality The intent is to indicate an alternative line of thought to the client.
Magaling. Tama po. (client Smiled) Giving recognition Greeting the client indicates the she is acknowledge and recognize as a person
Sa tuwing nag-uusap po tayo, ano po yung mga naaalala ninyo?
Mga anak ko at asawa ko, miss na miss ko na kasi sila at yung mga lugar na parati naming pinupuntahan.
Placing event in time or sequence
Helps both the nurse and the client to see them in perspective, the nurse may gain information about recurrent patterns in the client’s behavior.
Saan po yung mga lugar na parati ninyong pinupuntahan?
Sa luneta, at minsan sa mall, minsan naman nagvovolunteer ako kasama ang mga anak ko sa simbahan.
Broad opening. Make explicit that the client has the lead in the interaction. This may stimulate her to take the initiative.
Ano po yung ginagawa niyo dun kapag pumupunta po kayo?
Nagpipicnic kame,o kaya nanonood ng sine.
Seeking information.
To make them aware what are their actions and what the client feels
Kung sakali po, makakalabas kayo dito, saan po yung lugar na pupuntahan ninyo at ano yung mga gagawin ninyo?
Uuwi ako sa bahay namin tapos mamasyal kame ng mga anak ko. Kahit saan siguro basta kasama ko sila.
Exploring Helps them both the client and the nurse to examine the issue more fully.
Talaga pong sabik na kayo sa mga anak niyo,ano po ang gagawin ninyo para gumaling kaagad?
Sobra. Magpapakabait ako dito, iinum ng mga gamut ko at susundin ang doctor ko.
Translating into feelings
This technique is to verbalize clients feeling of what she said indirectly
Mabuti po kung ganun.Pumunta na po tayong sa mga kasamahan
Sige. Salamat (Client smiled and followed)
Giving recognition. Greeting the client indicates the she is acknowledge and
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niyo ate. recognize as a person.
TERMINATION PHASE (Dec 16, 2010 9am)
NURSE CLIENT THERAPEUTIC COMMUNICATION
ANALYSIS
Magandang Ate love Ganu din sayo (Client smiled)
Giving recognition Greeting the client indicates the she is acknowledge and recognize as a person.
Kumusta po kayo? Mabuti naman Seeking information To make them aware what are their actions and what the client feels
Ngayon pong araw na ito, bale ito na po yung huli nating pagsasama’t pag-uusap. May kunti po tayong programa at maaasahan ko po ba ang kooperasyon ninyo?
Oo naman. Giving Information Informing the client of facts increases her knowledge about a topic and orients the client on what to expect.
AFTER THE PROGRAMNag-enjoy po ba kayo? Oo nag-enjoy ako
(smiled)Seeking information To make them
aware what are their actions and what the client feels
Ngayon na po ang huling pagkikita natin ate, nais ko pong magpasalamat sa magandang pakikitungo ninyo sa akin sa mga nakaraang araw. Sana po may naitulong ako sa inyong kalagayan. May mga nais pa po ba kayong sabihin bago tayo maghiwalay?
Maraming salamat din Ariane. Wala na, paalam.(smiled)
Giving recognition Informing the client of facts, increases her knowledge about a topic and orients the client on what to expect.
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B. LIST OF NURSING DIAGNOSIS (NANDA)
CUES NURSING DIAGNOSIS JUSTIFICATIONSUBJECTIVE:>Gusto ko nang umuwi, miss ko na mga anak ko.
OBJECTIVE:>poor eye contact at times> grimacing> hand tremors> restless
Anxiety related to prolong rehabilitation as evidenced by grimacing, poor eye contact at times, hand tremors and restlessness.
Anxiety level of the client should be given first priority for it will also lead the client to danger if uncontrolled. Therefore, it should monitored and managed for the client’s safety.
SUBJECTIVE:
OBJECTIVE:>talks to self frequently> leaves area suddenly without explanation>poor concentrations>has difficulty maintaining conversations
Disturbed sensory perception related to loneliness and isolation as evidenced by talking to self frequently, leaves suddenly without explanations, poor concentration and has difficulty in maintaining conversations.
Disturbed sensory perception should be given importance for the client may manifest untoward behavior towards self and other clients due to misinterpretation of stimuli.
SUBJECTIVE:>Malungkot dito kapag walang student nurse.
OBJECTIVE:>sadness> poor eye contact at times>absent of significant others>isolates self in room most of the time
Social Isolation related to sadness, poor eye contact at times, absent of significant others and isolation of self in room most of the time.
Social isolation would be the last for it requires least nursing interventions but it should also be given importance for the benefit and success of the client’s rehabilitation. The client will be able to develop social skills and social acceptance if it is properly given appropriate nursing interventions.
34
DIVINE WORD COLLEGE OF BANGUED
BANGUED, ABRA
CUES BACKGROUND
KNOWLEDGE
PATIENTS
PROBLEM
OBJECTIVE OF
INTERVENTIONS
NURSING ACTIONS AND RATIONALE
SUBJECTIVE:
“ Gusto ko ng
makita pamilya ko.
Gusto ko ng
umuwi. “ – as
verbalized.
OBJECTIVE:
>poor eye contact
at times
> grimacing
> restless
Uneasy feeling of
discomfort
accompanied by
autonomic response.
The client
experiences anxiety
because of the
limited visitation of
her family which
caused her to
mumble to herself
sometimes.
Anxiety related to
prolong
rehabilitation as
evidenced by
grimacing, poor
eye contact at
times and
restlessness.
After Nursing
interventions, the
client’s level; of
anxiety will be
lessened.
>Provide therapeutic Environment
_To gain client’s trust
>Be available to client at all times
_to make the client’s feel valued and has
importance.
>Stay at the clients and provide a comfortable
environment.
_To make client’s feel valued and relieves the
level of anxiety and releases tension
>Encourage client to engage self in activities
_Activities helps the client divert attention
from anxiety and from undesirable behaviors.
>Encourage client to acknowledge and express
feelings
_To explore the cause of feeling of
apprehension.
Nursing Care Pan No.1
DIVINE WORD COLLEGE OF BANGUED
35
BANGUED, ABRA
CUES BACKGROUND KNOWLEDGE
PATIENTS PROBLEM
OBJECTIVE OF INTERVENTIONS
NURSING ACTIONS AND RATIONALE
SUBJECTIVE:
OBJECTIVE:>talks to self frequently> leaves area suddenly without explanation>poor concentrations>has difficulty maintaining conversations
The client experience disturbed sensory perception which is incongruent with actual stimuli. In this case, the client misinterpreted and acts contrary to what is real.
Disturbed sensory perception related to loneliness and isolation as evidenced by talking to self frequently, leaves suddenly without explanations, poor concentration and has difficulty in maintaining conversations.
After Nursing interventions, the client will demonstrate ability to hold conversation and ceases to talk to self.
>Establish a therapeutic relationship._To gain client’s trust>Orient the client continuously to actual environment, events and activities._Frequent orientation helps to present reality to the client>Call the client by name._Using correct names reinforce reality are reducing hallucinations.>State your reality about the client’s hallucinating experience._The client is helped to distinguish the actual voices which promote reality.>Use clear and distinctive voice_To avoid misinterpretations>Encouraged the client to engaged in activities_Activities are alternatives and distractions to hallucinations>Accept and support feelings of the client_This convey empathy and understanding which reduces fear or anxiety.
Nursing Care Plan No.2
DIVINE WORD COLLEGE OF BANGUED
BANGUED, ABRA
36
CUES BACKGROUND KNOWLEDGE
PATIENTS PROBLEM
OBJECTIVE OF INTERVENTIONS
NURSING ACTIONS AND RATIONALE
SUBJECTIVE:“Malungkot dito kapag walang student nurse.” – as verbalized.
OBJECTIVE:>sadness> poor eye contact at times>absent of significant others> isolation of self in room most of the time.
Aloneness experienced by the individual are perceived as imposed by others and as a negative or threatening state.
Social Isolation related to sadness, poor eye contact at times, absent of significant others and isolation of self in room most of the time.
After nursing interventions, the client will be able to engage self in all social activities actively and verbalize willingness to social interactions.
>Provide therapeutic Environment_To gain client’s trust> Provide a positive reinforcement when client makes moves towards others._It encourages continuation of efforts.>Promote participation in activities._This facilitates socialization>Engage other client to interact with the client_this promotes social skills in a safe setting.>Help the client seek out clients to socialize with who have similar interest._Shared common interest promote more enjoyable socialization which may be repeated.>Praise the client for attempts to seek out others for activities and interactions_Praises promotes repeated positive social behavior.
Nursing Care Pan No.3
37
V. THERAPIES
1. ACTIVITIES OF DAILY LIVING - An activity done by an individual which is necessary for the
promotion of good personal hygiene which can be done with or without assistance/ supervision
to an individual. It is usually performed in the course of normal day in a person’s life such as
bathing, brushing teeth, eating, toileting, and dressing.
Indication and Purpose:
1. To promote and improve personal hygiene and grooming
2. To promote self-independence
3. To encourage participation
4. To develop interpersonal relationship
5. Evaluation through return demonstration
Standard Rule and Technique Used:
Client performs the activities of daily living everyday to become her habit.
The student nurse allow the client to do the personal hygiene techniques by herself such
as washing of face, brushing teeth, putting face powder and the like. The student nurse
also explains the importance of these routines.
The student nurse facilitates exercises.
A short orientation and introduction among student nurses and clients were done.
The client and the student nurse will then have a nurse-patient interaction. Client will
actively participate in the therapeutic activities by the student nurses.
Interpretation and Analysis:
Our client performed the different hygienic activities well. She was able to understand
the importance of the different hygiene techniques. The activities that were introduced to
the client helped her in achieving or improving self care by performing daily healthy habits
and routine.
2. MUSIC AND ART THERAPY- Is the opportunity for socialization and self expression and
sometimes realization affected by certain musical activities. Art therapy is the process by letting
38
the patient express her feelings and thoughts through various artistic means particularly
sketching and drawing. One type of therapy with purposeful use of music and arts as a
participative or listening experienced in the treatment of the patient to improve and motivate
their mental and emotional state.
Indication and Purpose:
1. To know as a diagnostic tool, collecting signs and symptoms to supply
psychiatric and to give correct diagnosis.
2. To interpret psychological drawing
3. To discuss emotional problem and to give reasons and ideas regarding such
problems
4. To develop interpersonal relationship
5. To release past trauma in life unconsciously.
Standard Rule and Technique Used:
During this activity, we gave each client one bond paper and a set of crayons. Then,
we played slow music entitled “I Will Be Here”. We let them draw what they feel or what
came to their minds upon hearing the song and later they interpreted it.
Interpretation and Analysis:
Our client had drawn a flower with which she used red color. She said that she loves
flowers and that she misses the flowers in their house. She dedicated this flower to her
daughters whom she misses a lot too. These reasons from the client indicates that she is
badly longing for her family. The client’s drawing was positioned in the center of the bond
paper which signifies her desire for attention. While the music is playing, the client was very
focus on the drawing she was making.
3. MUSIC THERAPY- One type of therapy with purposeful use of music as a participative
experienced in the treatment of the patient to improve and motivate their mental and
emotional state. It is one way of having self-expression of the client through reflecting on a
piece of song that was introduced.
39
Standard Rule and Technique Used:
This activity helps the client to reflect their feelings to the song. This will help them to
remember their past and relate it to the song and share it. A piece of song entitled
“Kanlungan“was written in a manila paper. First, we let them sing the whole piece. Then,
each paragraph was sung by one client at a time. After this, we ask them on what they
remember on the song. We let them reflect their feelings to the song that was being
emphasized.
Interpretation and Analysis:
The client participates well on this activity. She expresses her feelings on the group.
4. PLAY/RECREATIONAL THERAPY – Recreation would refer to any activity which revitalizes
one’s mind and body. A technique that makes it possible for the patient to express himself. Free
play enables the individual a unique opportunity to discharge strong motion and secure
atmosphere. It is also a form of Psychotherapy for regressed psychotics to an extent of making
its impossible to communicate with them through verbal channels. This activity also serves as a
break in the monotony of their hospitalization life and aims to eliminate boredom.
Indication and Purpose:
1. To help patient interact with other patients in a slightly competitive but thoroughly
enjoyable level, manner
2. The client will be able to express themselves through acceptance and enjoyable
means
3. To promote diversion from usual routinely experienced by the client in favor of a
more dynamic activities
4. To promote cooperation and sportsmanship
5. Allow free expression of feelings and thoughts
Standard Rule and Technique Used:
In this activity, we had the “Pinoy Henyo” as our game. First, the facilitator
explains the mechanics of the game. A partner was needed- the client and the student
40
nurse. There are prepared words to be picked and to be guessed. The client will be the
one who will guess the word and the student nurse will answer her questions either
“Yes, No, or Maybe”. Two minutes are only given to them to guess the word. The
Partner who get the least time would be the winner.
Interpretation and analysis:
With this therapy, the client showed interest and became a winner on the game.
She was able to guess the word “Mangga”. She showed competitiveness and very active.
This time, she said that this activity we’ve done was a good diversional activity for her.
5. BIBLIOTHERAPY - Use of literature, film or feature on creative writing with group discussion
to promote self-acknowledgement and inter action of thoughts and feelings. Enhances patient’s
awareness regarding an article of material s well as it increase with the information and content
of such reading materials. It stimulates the inner self by expressing their feelings regarding with
given story.
Indication and Purpose:
1. To stimulate the psychological, sociological and aesthetic values from books into
human character, personality and behavior
2. To provide stimulus for the memory to compare events with their own interpersonal
and intra psychic experience.
3. To increase level of understanding with information from the reading materials.
Standard rule and Technique Used:
In this therapy, we used a poem entitled “Puno ng Buhay”. The poem is about
the coconut tree. First we showed a picture of a said tree and we let them identify the
different parts of it. All together, the clients read the poem. After which, we asked some
questions about the poem and they answered well. We let them enumerate the products
that can be obtained from the tree. Each client was very willing to answer and the activity
was done smoothly.
41
Interpretation and Analysis:
The client participated well in the discussions we had. She was able to identify and
enumerate different advantages of the coconut tree. She listen attentively and cooperate
well.
6. OCCUPATIONAL THERAPY - Any activity mental and physical guided to an individual to
recover from a handicap. There is an increasing awareness that process and not the product of
the process is the greatest importance. Manual recreational and creative technique to facilitate
personal experiences and increase social responses and self esteem.
Indications and Purpose:
1. To improve general performance
2. To obtain essential skills of living
3. To assist in symptom reduction
4. To increase the sense of accomplishment, satisfaction and control over one’s
own life
5. To increase social responses
6. To increase self-esteem
Standard rule and Technique used:
The group taught the clients how to wrap a bottled gift. We have plastic bottles,
Japanese paper, and ribbon. The idea of the activity is to design papers as our materials. We
cut the materials before going to the institution to avoid accidents among the clients. The
facilitator explained the procedure step by step as one of the student nurse demonstrates it.
Then we let the clients decorate the gifts assisted also by their student nurses.
Interpretation and Analysis:
Our client performed well during the activity. She followed the direction carefully. She
was able to make a good output from the materials given.
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7. REMOTIVATION TECHNIIQUE - Is a technique of every simple group therapy of an objective
nature used in an effort to reach the wounded areas of the patient’s personality and get them
moving in the direction of reality
Indications and Purpose:
1. To stimulate client to think about something and talk about himself
2. To develop ability to communicate and share idea and experience with others
3. To develop feeling of acceptance and recognition
Standard rule and Technique used:
We have chosen the story “Paid with a Full Glass of Milk” as our medium on discussion
in this technique. We portray the story by dramatizing it. The whole group acted the way
they could be to in order to extend the meaning of the story. After the demonstration, we
asked the clients the lesson they got from the story. They also relate the story in some parts
of their life.
Interpretation and Analysis:
The client was able to share information about her experiences related to the story. The
lesson of the story was understood by the client. Helpfulness was emphasized.
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VI. CONCLUSION AND RECOMMENDATIONS
As a result of the study and interaction of the client, the following conclusion are being
gathered and seen:
There is a great influence of the family and significant others in the development and
progression of the illness.
Schizophrenia can be manageable with the aid of the family as the main source of
strength and hope of the client.
Clients who develop this kind of disorder have a connection to their development task
which were unmet that makes them vulnerable to stress.
In relation to their treatment, psychotherapies were used for the rehabilitation and
will prepare the clients for their recovery and readiness to face challenges when they go
outside the center.
In relation to the management and interventions, close monitoring and guidance were
important for the safety of the client especially for the recurrence of the signs and
symptoms of the illness.
The following are the recommendations:
Constant visitation should be done to the client in order for them to feel valued and
cared by the family.
Close monitoring should be done to client in order not to develop the recurrence of
symptoms which are harmful to them and to other clients.
Therapeutic communication should always be used and observed for clients not to be
offended for they were already at the rehabilitation area, they have absolutely feelings to
be hurt and may feel rejection.
VII. BIBLIOGRAPHY
44
Books
Lippincott’s Manual of Psychiatric Nursing care Plans. 7th edition by Schultz and Videbeck
