paranoid schizophrenia case study (2).docx

7/23/2019 paranoid schizophrenia case study (2).docx

1/38

A Case Study on

SCHIZOPHRENIA PARANOID

Submitted to:

Aida Bautista RN, MAN

Clinical Instructor

Submitted by:

MENDOZA, STEANIOBEDOZA, EST!ER

ODRADA, E"IZABET!#ERO", MAE

S$N%A, &ARENTAN, 'EANETTE

(A"EROS, 'A)SON(ICENCIO, DIOSSA(I""AN$E(A, &ERSTINE

BSN 3Y2-2DTABLE OF CONTENTS:

1


2/38

"earnin* Ob+ecties.-..........................----3

Introduction..............................----- 4

#atient/s #ro0ile-............................-----6

#1ysical Assessment and MSE....--..................-7

#syc1osocial T1eory and Deelo2ment...................-9

%ordon/s unctional !ealt1 #attern..........-..........-13

Course in t1e 3ard..--........................---15

#syc1ot1era2ies............................--- 20

Anatomy and #1ysiolo*y---...............--........---21

#at1o21ysiolo*y---.......---....................-23

"aboratory...........-----................... 25

Dru* Study...--...........................--27

Nursin* Care #lan.....................------------------------.31

Recommendation.-..---......................------- .34

General Objectives

2


3/38

T1is case study aims to identi0y and determine t1e *eneral 1ealt1 2roblems and needs

o0 t1e 2atient 4it1 an admittin* dia*nosis o0 #aranoid Sc1i5o21renia- T1is study also

intends to 1el2 us 2romote 1ealt1 and medical understandin* o0 suc1 condition t1rou*1

t1e a22lication o0 t1e nursin* s6ills-

Specific Objectives

A0ter t1e com2letion o0 t1is case study, t1e students 4ill be able to:

De0ine #aranoid Sc1i5o21renia

Enumerate t1e ris6 0actors, di00erent si*ns and sym2toms and to trace t1e

2at1o21ysiolo*y o0 #aranoid Sc1i5o21renia

Identi0y and understand t1e di00erent 2syc1ot1era2ies

To understand t1e role o0 dru* t1era2y in mana*in* t1e client

ormulate a22ro2riate nursin* care 2lan and 2roide nursin* care

Rationale for choosin the case

3e c1ose t1is as our case study to en1ance 6no4led*e and ac7uire more in0ormation

to understand t1e mental disorder better- It 1as been obsered to be t1e most common

2syc1otic diseases accountin* 0or 1i*1 costs in mental 1ealt1 care- It is t1ere0ore

im2ortant 0or us student nurses and ital 0or t1e community to be 6no4led*eable ands6ill0ul in carin* 2atient 4it1 Sc1i5o21renia, its sym2toms and 1o4 best to 1andle

2atients su00erin* 0rom t1e disorder in order to ensure t1at suc1 indiiduals 4ill be lead

to a better and 0ul0illed lies and 4ill become a 0unctional member o0 t1e society-

Scope an! "i#itation$

T1is is a case o0 89 year old 0emale dia*nosed 4it1 #aranoid Sc1i5o21renia- T1e

2atient 4as admitted in National Center 0or Mental !ealt1, Mandaluyon*- Treatment,

laboratory results and ot1er si*ni0icant data are included 0or inter2retations- Reliabilityo0 in0ormation 0rom 2atient is ;


4/38

Schi%ophrenia ca&ses !istorte! and

bi5arre t1ou*1ts, 2erce2tions, emotions,

moements, and be1aior- It cannot be

de0ined as a sin*le illness= rat1er,

sc1i5o21renia is t1ou*1t o0 as a syndrome

or as a disease 2rocess 4it1 many

di00erent arieties and sym2toms, muc1

li6e t1e arieties o0 cancer- or decades,

t1e 2ublic astly misunderstood

sc1i5o21renia, 0earin* it as dan*erous and uncontrollable and causin* 4ild disturbances

and iolent outbursts- Many 2eo2le belieed t1at t1ose 4it1 sc1i5o21renia needed to be

loc6ed a4ay 0rom society and institutionali5ed- T1rou*1 2rolon* and in>de2t1 researc1

Only recently 1as t1e mental 1ealt1 industry come to learn and educate t1e community

at lar*e t1at sc1i5o21renia 1as many di00erent si*n and sym2toms and 2resentations

and is an illness t1at medication can control- Clients 41ose illness is medicallysu2erised and 41ose treatment is maintained o0ten continue to lie and sometimes

4or6 in t1e community 4it1 0amily and outside su22ort-

T1e 4ord ?sc1i5o21renia? comes 0rom t1e %ree6 roots sc1i5o @s2lit and 21rene @mind todescribe t1e 0ra*mented t1in6in* o0 2eo2le 4it1 t1e disorder- T1e sym2toms o0sc1i5o21renia and diided into t4o ma+or cate*ories: 2ositie or 1ard sym2toms, 41ic1include delusions, 1allucinations, and *rossly disor*ani5ed t1in6in*, s2eec1, and be1aiorand ne*atie or so0t sym2toms, 41ic1 include 0lat a00ect, lac6 o0 olition, and social4it1dra4al or discom0ort-

'aranoi! schi%ophrenia, also called sc1i5o21renia, 2aranoid ty2e is a sub>ty2e o0

sc1i5o21renia as de0ined in t1e Dia*nostic and Statistical Manual o0 Mental Disorders,

@DSM>I( is t1e most common ty2e o0 sc1i5o21renia in most 2arts o0 t1e 4orld- T1e

clinical 2icture is dominated by relatiely stable, o0ten 2aranoid, delusions, usually

accom2anied by 1allucinations, 2articularly o0 t1e auditory ariety-

4


5/38

A00ect is usually less blunted t1an in ot1er arieties o0

sc1i5o21renia, but a minor de*ree o0 incon*ruity is common, as

are mood disturbances is also common 41ic1 are described as

irritability, sudden an*er, 0ear0ulness, and sus2icion-

(a&ses

T1e causes o0 sc1i5o21renia are not 0ully 6no4n- !o4eer, it

a22ears t1at sc1i5o21renia usually results 0rom a com2le interaction bet4een *enetic

and enironmental 0actors-

)pi!e#iolo*

Sc1i5o21renia in Sout1eastern Asia

Country +ber of (ases

East Timor ,

Indonesia F,G,HH

"aos G,;;

Malaysia FG;,88

#1ili22ines HG9,8

Sin*a2ore 8,F8

T1ailand 8,H9

(ietnam HH,8GH

Accordin* to t1e record o0 Ca*ayan (alley Medical Center 2syc1iatry de2artment 0rom

'an- 'uly o0 ;F;, t1ere 4ere 2atients admitted in 0emale 4ard, and amon* t1ose

2atients t1ere 4ere H cases o0 sc1i5o21renia- T1ere are HG9,8 cases o0

sc1i5o21renia in t1e #1ili22ines, 98< are males and t1e rest are 0emales- And 8F

million 2eo2le 4orld4ide su00er 0rom sc1i5o21renia in 41ic1 males 1ae t1e 1i*1est

2ercenta*e- @;F, searc1cure

,p!ates

Researc1 1as 0ound a tentatie bene0it in usin* minocycline@antibiotic to treatsc1i5o21renia- T1e addition o0 minocycline to aty2ical anti2syc1otic dru*s in earlysc1i5o21renia 1ad si*ni0icant e00icacy on ne*atie sym2toms but 1ad a sli*1t e00ect ont1e attention domains o0 2atients 4it1 sc1i5o21renia- t1e mec1anism o0 action o0minocycline 4ould include a00ectin* *lutamate 2at14ays in t1e central nerous system,bloc6in* nitric oide>induced neurotoicity, or in1ibitin* micro*lial actiation in t1e brain,

5
http://en.wikipedia.org/wiki/Minocyclinehttp://en.wikipedia.org/wiki/Minocycline


6/38

causin* in0lammation- It may be considered as a ne4 ad+unct treatment 0or ne*atiesym2toms o0 sc1i5o21renia-Nidotherapyor e00orts to c1an*e t1e enironment o0 2eo2le 4it1 sc1i5o21renia toim2roe t1eir ability to 0unction, is also bein* studied= a collaboratie treatment inolin*t1e systematic assessment and modi0ication o0 t1e enironment to minimise t1e im2act

o0 any 0orm o0 mental disorder on t1e indiidual or on societyJ- !o4eer, t1ere is notenou*1 eidence yet to ma6e conclusions about its e00ectieness-

Patients Pr!"e

#atient/s name: Mrs- #

%ender: emale

Date o0 Birt1: 'une ;H, FG89

Admittin* dia*nosis: #aranoid Sc1i5o21renia

Ciil status: Married

A*e: 89 yKo

!os2ital L:;888H8

Educational attainment: %rade

Reli*ion: Cat1olic

Address: Sabon* Tabo6, "ae5ares, Nort1ern Samar

Citi5ens1i2: ili2ino

Birt12lace: Samar

Date o0 admission: December F8, ;F @8:; 2m

(hief (o#plaint$

Accordin* to t1e 2atient: #ina*>6a6aisa1an a6o n* m*a 2ulis, na6amanman sila sa

a6in

-istor* of 'resent llness$

6
http://en.wikipedia.org/wiki/Nidotherapyhttp://en.wikipedia.org/wiki/Nidotherapy


7/38

T1e 2atient came 0rom B*y- Tabo6, Nort1ern Samar 41o 4as 6no4n to be

0re7uently inoled in 0i*1ts 4it1 t1e nei*1bors- S1e 4as a22re1ended by NA#O"COM

last 'uly ;F- S1e 0iled a case a*ainst 2olicemen batterin* 1er and 4as t1en re0erred

to DO! by a teleision 2ro*ram o0 Tul0o and Attorney #ersida Acosta- S1e 4as t1en

re0erred to NCM! to ac7uire a medical certi0icate attestin* t1at s1e is ca2able to stand

trial a*ainst t1e 2olicemen 41o alle*edly abused 1er- S1e came alone and 4as

irritable, 0urious, cursin* and 4as 21ysically iolent 1ence admission in NCM!-

'ast #e!ical histor*$

#atient 1as no 6no4n 1istory o0 !#N, DM, #TB and ot1er medical disease-

No 2reious 1os2ital con0inement-

/a#il* health histor*$

No 6no4n 0amily 1ealt1 1istory o0 !#N, DM, #TB and ot1er medical disease-

*sical )a#ination

PHYSICAL E#A$ %NOIDENTIFIEDPHYSICALABNOR$ALITIES&

HEADnormocephalic, symmetrical facial

-movements, smooth without

masses or depressions and

symmetrical facial movements

NEC' no abnormal

swelling or masses

EYES no discharge and pink

conunctiva

EARS

no lesions or discoloration

NOSE nasal !aring

$OUTH

dry mouth, cracked lips

TEETH "ncomplete

CHEST

e#ual chest e$pansion, clear breath sounds

%


8/38

ABDO$EN

&lat, soft, normoactive, no

tenderness

E#TRE$ITIES full and e#ual

pulses

ental Stat&s )a#

#atient seen and eamined an adult 0emale o0 aera*e 1ei*1t and 4ei*1t- S1e 1as

bro4n s6in 4it1 s1oulder len*t1 blac6 1air- S1e 4as clad in red 1os2ital *o4n, 0airly

*roomed- S1e 1as 0air sustained eye contact- S1e 4as coo2eratie- 3it1 2syc1omotor

a*itation noted- Mood is labile- S2eec1 is s2ontaneous, 1y2er2roductie, audible andclear- #atient denied any 2erce2tual disturbances- S1e denied any 1omicidal and

suicidal t1ou*1ts- S1e still 1as 2ersecutory delusions- S1e became teary eyed 41en

as6ed about 41at 1a22ened at t1e 2olice station in t1e 2roince- Na6amanman an*

m*a 2ulis 2ero 4ala na naman sila- #atient is alert and oriented- S1e 1as 2oor insi*1t

4it1 im2aired +ud*ment and im2ulse control-

+e&roloical )a#

conscious, co1erent, 1y2er2roductie s2eec1, oriented to time and 2lace, able to do sim2le

commands

(ranial +erves

CN I> smell intact

CN II> 2u2ils e7ually round and reactie to li*1t

CN III, I(, (I> intact EOM

CN (> can clenc1 teet1

CN (II> no 0acial asymmetry

CN (III> intact 1earin*

CN I, > uula at t1e midline

CN I> s1ru*s s1oulders

'


9/38

CN II> ton*ue is midline, no atro21y

's*schosocial heories of evelop#ent

Eri6sonJs sta*es o0 2syc1osocial deelo2ment, as articulated by Eri6 Eri6son, is a

2syc1oanalytic t1eory 41ic1 identi0ies ei*1t sta*es t1rou*1 41ic1 a 1ealt1ily deelo2in*

1uman s1ould 2ass 0rom in0ancy to late adult1ood- In eac1 sta*e, t1e 2erson con0ronts,

and 1o2e0ully masters, ne4 c1allen*es- Eac1 sta*e builds u2on t1e success0ul

com2letion o0 earlier sta*es- T1e c1allen*es o0 sta*es not success0ully com2leted may

be e2ected to rea22ear as 2roblems in t1e 0uture-

LIFE STA(E

INDICATIONS

OF POSITI)E

RESOLUTION

INDICATIONS

OF NE(ATI)E

RESOLUTION

ASSESS$ENT *USTIFICATION

nfanc* birth to 1 12

*ears ol!

(entral as$ r&st vs

istr&st

Centers on t1e in0ant/s

basic needs bein* met

by t1e 2arents- T1e

in0ant de2ends on t1e

2arents, es2ecially t1e

mot1er, 0or 0ood,

(earning

how to

trust others

)istrust,

withdrawal,

enstrangemen

t

)istrust *er mother did not

breastfeed her+

he was taken

care of by her

grandmother for ayear while her

mother worked+

(ola ko ang nag-

palaki sa akin+

)adalas ako iwan

ng nanay ko kasi

.


10/38

sustenance and com0ort-

I0 t1e 2arents e2ose t1e

c1ild to 4armt1 and

de2endable a00ection,

t1e in0ant/s ie4 o0 t1e

4orld 4ill be one o0 trust-But i0 t1e care*iers are

ne*lect0ul, t1e in0ant

instead learns t1at t1e

4orld is un2redictable

and unsa0e 2lace-

nagtrabaho siya+/

)arl* chil!hoo! 1 8 3

*ears ol!

(entral as$

:&tono#* vs Sha#e

an! o&bt

I0 care*iers encoura*e

sel0>su00icient be1aior,

c1ild deelo2s a sense

o0 autonomy> a sense o0

bein* able to 1andle

t1in*s on t1eir o4n- But

i0 care*iers demand too

muc1 too soon, re0use tolet c1ildren 2er0orm

tas6s o0 41ic1 t1ey are

ca2able= t1ey may

instead deelo2 s1ame

and doubt about t1eir

ability to 1andle t1in*s-

elf-co

ntrol

without loss

of self

esteem0

ability to

cooperate

and

e$press

oneself

Bo4el control:

F P years old

Daytime

bladder

control:

P years old

ompulsive

self-discipline

or

compliance0

willfulness and

deance

utonomy he client was

potty trained when

she was 2 years

old+

"ate (hil!hoo! 36

*ears ol!

(entral tas$ nitiative

vs G&ilt

T1e c1ild learns to ta6e

initiatie and *et ready

0or leaders1i2 and *oal

ac1ieement roles-

(earning

degree of

assertivene

ss and

purposein!uence

the

environmen

t 0 begins to

evaluate

ones own

ver

restriction of

own desired

activity

7uilt he client did not

engage much in

childhood play+ *er

mother did not

allow her to playoutside and

compelled her to

go shing with his

father on a regular

basis to earn a

living+

18


11/38

behavior

9i ako

pinapayagan mag-

laro sa labas,

nagagalit nanay

ko+ :inapasamaako mangisda

kasama ang tatay

ko kasi doon kami

kumikita+/

School :e 712 *ears

ol!

(entral as$ n!&str*

vs nferiorit*

C1ildren are ea*er to

learn and accom2lis1

more com2le s6ills=

readin*, 4ritin*, tellin*

time-

9eveloping

sense of

competenc

e and

perseveran

ce

ense of

being

mediocre0

withdrawal

from peers

and school

"nferiority 9isplayed poor

performance in

school due to

absences+ he

withdraws herself

with her

classmates+ he

only has a few

friends due to lack

of interaction with

them+ he dropped

out of school in 4th

grade due to

nancial reasons+

!indi a6o

masyadon*na6a6a2aso6 sa

es6u4ela 6asi 6a2os

at nan*in*isda 6ami

n* tatay 6o at

tumutulon* din ma*>

tinda sa 2alen*6e-:!olescence 1221

*ears ol!

(entral as$ !entit*

vs Role (onf&sion

Concerned 4it1 1o4

t1ey a22ear to ot1ers-

T1e sense o0 central

identity a22ears t1rou*1

seual, emotional,

Sense o0 sel0

and 2lans to

actuali5e

one/s abilities

eelin*s o0

con0usion,

2ressure,

1esitancy

Role

Con0usion

At t1e a*e o0 F, 1er

mot1er 1ad arran*ed

marria*e 0or 1er to be

ec1an*ed 0or a co4-

%usto 6asi n* nanay

6o n* mala6in* ba6a-

Na*lalaro 2a n*a a6o

noon nun* sinundo

a6o sa ba1ay n*

ma*ulan* n*

ma*i*in* asa4a 6o-

11


12/38

educational, et1nic,

cultural and ocational

discoery-

$na a6on* na*>

6aana6 nun* FH 2a

lan* a6o at sunod

sunod na yun*

dala4a 6o 2an*

ana6, isan* taon 2alan* an* 2a*itan

)arl* :!&lthoo!

2135 *ears ol!

(entral as$ nti#ac*

;s solation

ormin* adult, loin*

relations1i2s and

meanin*0ul attac1ments

to ot1ers-

Intimate

relations1i2

4it1 anot1er

2erson and

1as a sense

o0

commitment

to 4or6 and

relations1i2s

Aoidance o0

relations1i2,

career or

li0estyle

commitments

Isolation !er s2ouse 4or6ed

abroad in Dubai 0or

years as a

construction 4or6er-

S1e stayed at 1ome

and too6 care o0 1er

c1ildren and 1ad a

small sari>sari store-

S1e 1ad a rou*1

relations1i2 4it1 1er

inla4s re*ardin*

0inancial matters-

Mata*al 6amin* na*>

6a4alay n* asa4a

6o, 6asi na*traba1o

siya sa Dubai-

!inu1ut1utan sya n*

biyenan 6o at

2ina6ulam 2a a6o n*m*a 6ama* ana6 n*

asa4a 6o 2ara

ma6u1a nila m*a

ana6 6o- Itinali at

*ina2os- Nun*

nalaman n*

ma*ulan* 6o 6inu1a

nila a6o- Na*>1i4alay

na rin 6ami n* asa4a

6o 2a*>6au4i niya

6asi natata6ot a6o sa

2amilya niya ba6a

*a4an nila a6o ulit n*

masama-

12


13/38

i!!le :!&lthoo! 35

65 *ears ol!

(entral as$

Generativit* vsStanation

Contributin* to society

and 1el2in* to *uide

0uture *enerations-

31en a 2erson ma6es a

contribution durin* t1is

2eriod, 2er1a2s by

raisin* a 0amily or

4or6in* to4ard t1e

betterment o0 society> a

sense o0 2roductiity and

accom2lis1ment-

3or6in*

to4ards t1e

betterment o0

society=

bein*

2roductie

"ac6 o0

2roductiity, not

1el2in* society

to moe 0or4ard

%eneratiity S1e 4or6ed as a

1ouse serant 0or F;

years and saed u2

1er earnin*s- S1e

t1en started a small

u6ay>u6ay businessbac6 in t1e 2roince

41ic1 4as doin* 4ell

0or years until s1e

4as a22re1ended by

2olicemen and 4as

detained and

subse7uent

admission at NCM!-

"umu4as a6o n*

Manila at namasu6an

n* sam2un* taon-

Na6a2a* i2on at

umu4i n* 2robinsya

u2an* ma*>um2isa

n* u6ay u6ay-

Mala6as an* benta

n* m*a 2aninda 6o-

#a*6ata2os n*

tatlon* taon bi*la nalan* a6on* 1inuli n*

m*a 2ulis at 6inulon*

na 4alan*

6ada1ilanan-

GORO+


14/38

'ROR O :SSO+ ,'O+ )=:+:O+

-):"- ')R()'O+ :+

:+:G))+

No re*ular c1ec6 u2

4it1 t1e doctor

%oes to Albularyo

41en sic6

Ta6es otc dru*s 0ormild 0eer and colds

and use o0 1erbal

medicines

3illin* to listen to

1ealt1 teac1in*s

Com2liance 4it1

medication re*imen

Accordin* to 2atientMaluso* naman a6o

6aya lan* na* iisi2 a6o

6un* 6elan a6o

ma6a6alabas-

+,RO+:"):>O"( Eats a day @t1ere

are times t1at s1e

s6i22ed meals

because o0 1er 4or6

Drin6s 8>H *lasses o0

4ater eeryday

%ood a22etite

is1 and e*etables

Eats a day meal

Drin6s >8 *lasses o0

4ater eeryday

)"+:O+ $rinates 8>H times

daily 4it1out any 2ain

or di00iculty

Normal daily bo4el

moement in t1e

mornin*

(oids yello4 turbid

colored urine at least

> times a day

De0ecates 0ormed

stool once eery t4o

days

:(;?)=)R(S)

Could 2er0orm AD" 3or6s almost

eeryday

Stays in t1e cornerinside t1e 4ard

Aoid social interaction

4it1 ot1ers(OG+;)')R()',:" Could do sim2le

calculations

Intact memory and 1as

*ood 0und o0

6no4led*e

Res2onds

a22ro2riately to

21ysical and erbalstimuli

#atient denied suicide

and 1omicidal t1ou*1t

Denied any 2erce2tual

disturbances

14


15/38

S"))'R)S Normal 8>H 1ours o0

slee2 daily and no

na2s durin* t1e day

Aera*e o0 8 1ours o0

slee2 daily

re7uent a4a6enin*s

due to noises and

di00iculty o0 *oin* bac6

to slee2

S)"/')R()'O+S)"/ (O+()'

Sees 1ersel0 4it1 *ood

2ersonality

Describes 1ersel0 as

Masaya1in a6o tao at

matulun*in noon*

ara4

Accordin* to 2atient

Matanda at ma1ina na

a6o Diyos nalan*

na6a6aalam sa bu1ay

6o

RO")R)":O+S-' Married but se2arated

0or almost ; years

3it1 c1ildren@1as not

seen t1em since ;;8

No contact 4it1 1er

0amily

!as not seen 1er

c1ildren since ;;8

Absent o0 su22ort

system

S)=,:"?

R)'RO,(;)

Not seually actie Se2arated 4it1

1usband 0or ; years

Not seually actie

(O'+GSR)SS

O")R:+()

Does not drin6 alco1ol

Does not smo6e

&ee2s 2roblem to

1ersel0

Social isolation

#reoccu2ation 4it1

un+usti0ied doubts

about trust4ort1inesso0 0riends

;:",)>)")/ Roman Cat1olic

Attends Sunday mass

No restrictions in any

treatments brou*1t by

reli*ion

15


16/38

COURSE IN THE +ARD

:? 1 arch 3 2015 Nurse/s Notes:;;am F:;; noon

Assisted in administration o0 medications @Ris2eridone m*

BID, multiitamins F tab OD, bi2eriden m* #RN,

Receied 2atient in clean 1os2ital *o4n, 0airly *roomed, and

4earin* sli22ers

Brou*1t client out 0rom t1e 4ard to t1e actiity area

E2lained roles as a student nurse

Conducted nurse 2atient interaction: Orientation 21ase

%at1ered 2ertinent data about t1e client

Discussed duration and limitations o0 t1e relations1i2

are de0ined

Discussed nurse and 2atient interaction 0rom eac1ot1er

Ra22ort is built by demonstratin* acce2tance and

non>+ud*mental attitude

Establis1ed trust

As6ed client about t1e 2ositie bene0its o0 re*ular eercise

acilitated dance eercise @S2a*1etti

Stated Na6a6abu1ay n* du*o

%ames conducted@21ysical and mental *ames

Re0used to 2artici2ate @s1o4ed discom0ort and 4as

uncommunicatie 4it1 team members

Sered snac6 and drin6 @re0used to eat

%ame 2ri5es *ien

Assisted 4it1 1y*iene care

Assisted 2atient bac6 to 4ard


17/38

:? 2 arch 4 2015 Nurse/s Notes

:;;am F:;;noon




4earin* sli22ers




Stated Na6a6a2a*2ala6as

%ames conducted @21ysical and mental *ames

#artici2ation and coo2eration noted

Music and art t1era2y 2roided

As6ed to e2lain 1er dra4in* @3rote Na6a6alun*6ot an*

6anta and dre4 a small 0lo4er

Sered snac6 and drin6

A4arded *ame 2ri5es


Conducted nurse 2atient interaction: Orientation 21ase

%at1ered 2ertinent data about t1e client

Discussed duration and limitations o0 t1e relations1i2

are de0ined

Discussed nurse and 2atient interaction 0rom eac1

ot1er

Ra22ort is built by demonstratin* acce2tance and

non>+ud*mental attitude

Establis1ed trust



18/38

:? 3 arch 9 2015 Nurse/s Notes:;;am F:;;noon




4earin* sli22ers

Brou*1t client out 0rom t1e 4ard to t1e actiity areaAs6ed client about t1e 2ositie bene0its o0 re*ular eercise


%ames conducted


Remotiation t1era2y 2roided

Stimulated social s6ills and interest in t1eir enironment

As6ed to e2lain 1er dra4in* @3rote Na6a6alun*6ot an*6anta and dre4 a small 0lo4er


A4arded *ame 2ri5es


Conducted nurse 2atient interaction: 3or6in* #1ase

Maintained relations1i2 and trust

Encoura*ed client in sel0>disclosure

#romoted a 2ositie sel0>conce2t

Ealuated and rede0ined *oals as a22ro2riate



19/38

:? 4 arch 10 2015 Nurse/s Notes:;;am F:;; noon


BID, multiitamins F tab OD, bi2eriden m* #RN


4earin* sli22ers





%ames conducted


Bibliot1era2y 2roided

Stimulated 2atient to e2lore t1e real 4orld

As6ed to re0lect on 41at 4as read


A4arded *ame 2ri5es


Conducted nurse 2atient interaction: 3or6in* #1ase

Maintained relations1i2 and trust

Encoura*ed client in sel0>disclosure

#romoted a 2ositie sel0>conce2t

Ealuated and rede0ined *oals as a22ro2riate



20/38

:? 5 arch 11 2015 Nurse/s Notes:;; F:;; noon


BID, multiitamins F tab OD, bi2eriden m* #RN


4earin* sli22ers

Brou*1t client out 0rom t1e 4ard to t1e actiity areaAs6ed client about t1e 2ositie bene0its o0 re*ular eercise



%ames conducted


Bibliot1era2y 2roided

Stimulated 2atient to e2lore t1e real 4orld

As6ed to re0lect on 41at 4as read


A4arded *ame 2ri5es

Assisted 4it1 1y*iene care:

Conducted nurse 2atient interaction: Termination #1ase

Assessed client emotional stability

Tal6ed about 2ro*ress o0 t1e relations1i2



21/38

PSYCHOTHERAPIES

:ctivit* Goals St&!ent+&rse (lient

:erobics an! )ercise

>To 2romote 21ysical and

mental 1ealt1

>To let client dance actiely

acilitated S2a*1etti mornin*

eercise dance

Coordinated moements and

stated Na6a6abu1ay n*

du*o

Recreational herap*

>To 1el2 t1e client ac1iee a

balance o0 4or6 and 2lay in

1er li0e

>To 1el2 client sociali5e 4it1

ot1ers

>En1ance memory>Encoura*e 2artici2ation and

coo2eration

acilitated arious indiidual

and team *ames- #roided

re4ards 0or t1e 4inners and as

4ell as consolation 2ri5es-

Durin* t1e 0irst day s1e

s1o4ed discom0ort

interactin* and 4as

uncommunicatie 4it1 team

members- T1e 0ollo4in* day

s1e 2artici2ated and 4as

more coo2eratie-

/oo! an! +&trition

>To 2roide t1e necessary

nutritional needs o0 t1e client

#roided *o, *ro4, and *lo4

li*1t meals

Dis2layed *ood a22etite-

Re#otivation herap*

>To stimulate communication,

ocational, and social s6ills

and interest in t1eir

enironment

acilitated t1e readin* and

ob+ectie e2lanation o0 a

2oem entitled, An* *ulay

S1e 2roided ariety o0

di00erent eam2les o0

e*etables and t1eir di00erent

uses-

>ibliotherap*

>Deelo2 ability to re0lect on

41at 4as read

>To stimulate 2atients to be

0ello4 and e2lore t1e real

4orld

acilitated t1e readin* and

re0lection on a s1ort story

called, N* Da1il Sa #era

Attentie= 41en as6ed about

41at s1e learned, s1e

stated, N* da1il sa 2era sila

ay na*1ira2

&sic an! :rts herap*

>To enable t1e client identi0y

and 4or6 on resolin* issues

Instructed to dra4 usin*

crayons 41ile listenin* to a

slo4 son* T1ousand )ears in

t1e bac6*round

3rote Na6a6alun*6ot an*

6anta and dre4 a small

0lo4er-


22/38

t1rou*1 music and arts

>To e2ress ideas and 0eelin*s

>To 1el2 client e2ress 1er

t1ou*1ts


23/38

ANATO$Y AND PHYSIOLO(Y

The brain is one of the most complex and magnificent organs in the human body. Ourbrain gives us awareness of ourselves and of our environment, processing a constant

stream of sensory data. It controls our muscle movements, the secretions of ourglands, and even our breathing and internal temperature. Every creative thought,

feeling, and plan is developed by our brain. The brains neurons record the memory ofevery event in our lives.The brain controls thoughts, memory and speech, arm and legmovements, and the function of many organs within the body. It also determines howpeople respond to stressful situations (i.e. writing of an exam, loss of a ob, birth of a child,

illness, etc.! by regulating heart and breathing rates. The brain is an organi"ed structure,divided into many components that serve specific and important functions.

T1e cerebral 1emis21eres o0 t1e brain are diided into 2airs o0 lobes as 0ollo4s:

rontal t1e lar*est lobe, located in t1e 0ront o0 t1e brain- T1e ma+or 0unctions o0 t1is

lobe are concentration, abstract tho&ht, infor#ation storae or #e#or*, and

#otor f&nction- It contains Broca/s area 41ic1 is located in t1e le0t 1emis21ere and is


24/38

critical 0or #otor control of speech- T1e 0rontal lobe is also res2onsible in lar*e 2art

0or a personle0t orientation-

Tem2oral located in0erior to t1e 0rontal and 2arietal lobes, t1is lobe contains t1e

auditory rece2tie areas and 2lays a role in memory o0 sound and understandin* >

Occi2ital located 2osterior to t1e 2arietal lobe, t1is lobe is res2onsible 0or isual

inter2retation and memory-

+e&rotrans#itters$

Do2amine> Plays important roles inmotor control,motivation,arousal, cognition, andreward.

Serotonin> Res2onsible 0or maintainin* mood balance, 0ood inta6e control, slee2 and

4a6e0ulness and tem2erature re*ulation

%lutamate> Ma+or mediator o0 ecitatory si*nals in t1e central nerous system and is inoled in

most as2ects o0 normal brain 0unction includin* co*nition, memory and learnin*-
http://en.wikipedia.org/wiki/Motor_controlhttp://en.wikipedia.org/wiki/Motivationhttp://en.wikipedia.org/wiki/Arousalhttp://en.wikipedia.org/wiki/Reward_systemhttp://en.wikipedia.org/wiki/Motor_controlhttp://en.wikipedia.org/wiki/Motivationhttp://en.wikipedia.org/wiki/Arousalhttp://en.wikipedia.org/wiki/Reward_system


25/38

'S?(-O':-O"OG?

Eti",

ocial &actors"ndividual "nterpersonal

-eparation

fromchildren;spou

se

-health

-ge 5%

-elease of hormone adrenaline, noradrenaline,

cortisol

daptive energy is drained out

9ecrease blood supply in the

brain


26/38

&rontal lobe hypometabolism

difficulty

concentrating

hostile

suspiciousness

:ersecutory delusion

ctions of?

-dopamine

- serotonin

-glutamate

)alfunction of

transmission in

electrical impulses


27/38

LABORATORY RESULT

He.at",

He.at", Res/"t Nr.a" )a"/es

RBC

+BC

He.,"0in

He.at1rit

Diferential Count

Ne/tri"

L.1te

$n1te

Esini"

P"ate"et C/nt

RD+

Red Cell Indices

$C)

$CH

$CHC

4+'

6+6

125

8+3'

8+68

8+25

8+85

8+82

333

8+13

''

2.+2

332

4+6 @ 1812 ;(

5+18 @ 18. ;(

128-168 g;(

8+ 36 -8+42


28/38


29/38

inalysis

(rss E4a.inatin $i1rs1i1 !n5in,s

C"r: Ye""6

Transaren1: T/r0i5

Se1i!1 ,ra7it: 892

H: A1i5i1

Prtein: Psiti7e%;;&

S/,ar: ne,ati7e

+BC: 2< -2=

RBC: 3->

Eite"ia" 1e""s: $5erate

$/1/s Trea5s: Fe6

A.r/s /rates: $5erate


30/38

DRU( STUDY

r& +a#e r& (lass r&

Rationale

:ction Si!e )ffects +&rsin (onsi!eration

%eneric

Name:

Risperi!one

Brand Name:

Risper!al

m* BID

Aty2ical

Anti2syc1o

tics

is used to

treat certain

mentalKmood

disorders

@suc1 as

sc1i5o21renia, bi2olar

disorder,

irritability

associated

4it1 autistic

disorder-

T1is

medication

can 1el2 you

to t1in6

clearly and

ta6e 2art in

eeryday li0e-

Bloc6s

do2amine

rece2tors in

t1e brain-

@non obsered

>4ei*1t *ain

>dro4siness

>di55iness

>droolin*

>nausea

>muscles2asms

>tremors

>insomnia

>E2lain t1e im2ortance and action o0 t1e dru*

> Monitor 2atient 0or tardie dys6inesia, 41ic1 may occur a0te

2rolon*ed use- It may not a22ear until mont1s or years later

and may disa22ear s2ontaneously or 2ersist 0or li0e, des2ite

sto22in* dru*-
http://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/bipolar-disorder/default.htmhttp://www.webmd.com/bipolar-disorder/default.htmhttp://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/bipolar-disorder/default.htmhttp://www.webmd.com/bipolar-disorder/default.htm


31/38

%eneric

Name:

biperi!en

Brand Name:

:ineton

m* #RN

Antic1oline

r*ic

#reent E#S

secondary to

neurole2tic

dru* t1era2y

side e00ects

be0ore t1ey

actually

occur-

Synt1etic

antic1oliner*ic

dru*, bloc6s

c1oliner*ic

res2onses in t1e

CNS

Dry mout1

>dry mout1

>blurred

ision

>dro4siness

>urinary

retention

>2ostural

1y2otension

>consti2ation

>a*itation

>Adise 2atient to increase 0luid inta6e to aoid dry mout1 an

consti2ation

r& +a#e r& (lass r&

Rationale

:ction Si!e )ffects +&rsin (onsi!eration

%eneric

Name:

#&ltivita#ins

F tab OD

Multiitamin

s and

minerals

>used to

2roide

itamins t1at

are not ta6en

in t1rou*1

t1e diet

>also used to

treat itamin

de0iciencies

#romotes

normal

bioc1emical

reactions,

stren*t1ens

t1e immune

system,

su22orts

normal *ro4t1

and

deelo2ment

and 1el2s

@non obsered

>stomac1

u2set

>1eadac1e

>un2leasant

Aoid ta6in* more t1an one itaminKmineral 2roduct at t1e

same time unless your doctor tells you to- Ta6in* similar

itamin 2roducts to*et1er can result in a itamin oerdose-


32/38

2reent *ro4t1

retardation in

c1ildren and

youn* adult

taste in t1e

mout1


33/38


34/38

ASSESS$ENT DIA(NOSIS PLANNIN( INTER)ENTIONS RATIONALE E)ALUATIS&bjective$

#ina*>6a6aisa1an a6o

n* m*a tao- Tatlon*

beses na a6on* 1inuli n*

m*a 2ulis at 6inulon*-

3ala a6on* *ina4an*

masama, minaltrato nila

a6o at lina*ay sa

bartolina as erbali5ed

by t1e client-

Objective$

>1y2eri*ilance

>sus2iciousness

>easily distracted

>a22re1ensie @uneasy

>al4ays on *uard

>socially 4it1dra4n

Disturbed t1ou*1t

2rocess: 2ersecutory

delusion related to

im2aired co*nitie

0unction secondary to

mental illness as

mani0ested by delusional

t1in6in* and

1y2eri*ilance-

S1ort term:

3it1in F day o0 nursin*

interentions, t1e client

4ill conerse about

concrete 1a22enin*s in

t1e enironment 0or at

least F8 minutes or more

durin* nurse 2atient

interaction-

"on* term:

3it1in 4ee6s o0

nursin* interentions,

t1e client 4ill be able to

demonstrate t1at t1e

disturbed t1ou*1ts are

less intense and less

0re7uent

Aoided lau*1in*,

41is2erin*, or tal6in*

7uietly 41ere client can

see but not1ear 41at is bein* said

Bein* sincere 41en

communicatin*- Aoided

a*ue or easie remar6s

Encoura*ed to 2artici2ate

in 4ard actiities and

tau*1t client co2in* s6ills

t1at minimi5e 4orryin*

t1ou*1ts- @tal6in* to

someone, sin*in*, readin*

Consistent in settin*

e2ectations, en0orcin*

rules

Reco*ni5ed t1e client/s

delusions as t1e client/s

2erce2tion o0 t1e

enironment

Did not ar*ue 4it1 t1e

client or try to conince t1e

client t1at t1e delusions are0alse or unreal

Interacted 4it1 t1e client on

t1e basis o0 real t1in*s= did

not d4ell on t1e delusional

t1ou*1ts

Reco*ni5ed and su22ort

client/s accom2lis1ments

@2ro+ects com2leted,

interactions initiated

S1o4ed em2at1y

re*ardin* client/s 0eelin*s=

Sus2icious clients o0ten

beliee ot1ers are tal6in*

about t1em, and

secretie be1aiors

rein0orce t1e 2aranoid

0eelin*s

Easie comments or

1esitation rein0orces

mistrust or delusions-

31en t1in6in* is 0ocused

on reality based

actiities, 1el2s 0ocus

attention eternally and

not on t1e delusions

Clear, consistent limits

2roide a secure

structure 0or t1e client

Reco*ni5in* t1e client/s

2erce2tions can 1el2

understand t1e 0eelin*s

s1e/s e2eriencin*

"o*ical ar*ument does

not dis2el delusional

ideas and can inter0ere

4it1 t1e deelo2ment o0

trust

Interactin* about reality

is 1ealt1y 0or t1e 2atient

Reco*ni5in* t1e client/s

accom2lis1ments can

increase client/s sel0

conce2t and trust on

ot1ers

Em2at1y coneys carin*,

S1ort term:

A0ter F day o

nursin*

interentions

*oal 4as met

T1e client

conersed ab

concrete

1a22enin*s i

t1e enironm

0or at least F8

minutes durin

nurse 2atient

interaction-

"on* term:

A0ter 4ee6s

nursin*

interentions

*oal 4as 2art

met- T1e clie

demonstrated

disturbed

t1ou*1ts are

intense and

0re7uent as

eidenced by

>Delusions 4

not obsered

durin* actiiti

>#artici2ated

more on *rou

actiities


35/38

DA) F

reassured o0 2resence and

acce2tance

Collaboratie: Assisted in

t1e administration o0

Ris2eridone m* @BID

interest and acce2tance

o0 t1e client-

Bloc6s do2aminer*ic

rece2tor sites t1ere0ore

decreasin* delusional

t1ou*1ts o0 t1e client-

ASSESS$ENT DIA(NOSIS PLANNIN( INTER)ENTIONS RATIONALE E)ALUATION

S&bjective$

Ayo6o ma6i1alubilo

sa iba, 2a6iramdam 6o

6asi sasa6tan at

lolo6o1in lan* nila 6o-

as erbali5ed by t1e

2atient-

Objective$

> Social 3it1dra4al

> #re0ers to be alone

> Reluctance to

inole in *rou2

actiities

> #oor eye contact

durin* interaction> $ncommunicatie

4it1 ot1ers

> #re>occu2ation 4it1

o4n t1ou*1ts

> Sense o0 discom0ort

4it1 ot1ers-

Social Isolation

related to disturbed

t1ou*1t 2rocess as

mani0ested by eident

discom0ort in social

situation

S1ort Term:

3it1in 1ours o0


t1e 2atient 4ill

understand causes

and tec1ni7ues to

correct isolation-

"on* Term:

3it1in 4ee6s o0


t1e 2atient 4ill

2artici2ate 4illin*ly in

t1era2eutic actiities

and inole sel0 in

social interaction-

Deelo2 a t1era2eutic

nurse>2atientrelations1i2 t1rou*1

0re7uent brie0

contacts and an

acce2tin* attitude-

Encoura*e 2atient to

e2ress 0eelin*s and

2erce2tions o0

2roblems-

Assess 2atient/s use

o0 co2in* s6ills and

de0ense mec1anisms-

S1o4 unconditional

2ositie re*ard-

#roide 2ositie

rein0orcement 0or

2atient/s oluntary

Acce2tance and

coneyanceen1ances 0eelin*s o0

sel0>4ort1 and

0acilitates trust-

!el2s identi0y and

clari0y reasons 0or

di00iculties in

interactin* 4it1 ot1er

2eo2le-

De0ense

mec1anisms used to

2rotect t1e indiidual

t1at may contribute

to 0eelin*s o0

isolation-

T1is coneys a belie0

in t1e 2atient as a

4ort1 41ile social

bein*-

#ositie

rein0orcement

S1ort Term:

A0ter 1ours o

nursin*

interentions,

t1e 2atient 4as

able to

understand

causes and

tec1ni7ues t1a

corrects isolati

as eidenced b

absence o0

discom0ort in

social situation

"on* Term:A0ter 4ee6s

nursin*

interentions,

t1e 2atient 4as

able to

2artici2ate

4illin*ly in

t1era2eutic

actiities and

inoled sel0 in

social

interaction-


36/38

DA) F

interactions 4it1

ot1ers-

Encoura*e t1e

2atient in reality>

oriented actiities t1at

inoled 1uman

contact 4it1 1er co>

2atient-

en1ances sel0>

esteem and it

encoura*es

re2etition o0 desirable

be1aiors-

To minimi5e stimuli

t1at 4ill tri**er

sym2toms o0 t1e

condition-

ASSESS$ENT DIA(NOSIS PLANNIN( INTER)ENTIONS RATIONALE E)ALUATIONSub+ectie:

$u2a6an na 6ita

dyan e1Q #or6et

matanda na a6o

2ina*6a6aisa1an niyo

a6oQ as erbali5ed by

t1e 2atient in

res2onse to anot1er

clientJs statement-

Ob+ectie:

DA)

Ris6 0or iolence:

directed to ot1ers

related to disturbed

t1ou*1t 2rocess and

ra*e reactions to

t1reatenin* situation

as deliered by

2atient-

S1ort:

3it1in ; minutes o0

2er0ormin* nursin*

interentions, t1e

2atient 4ill learn to

assess situation

realistically be0ore

ta6in* action

"on* term:

3it1in 4ee6s o0

2er0ormin* nursin*

interentions, t1e

2atient 4ill

F- Deelo2 strate*ies

to control im2ulse-

- Re0rain 0rom

1urtin* ot1ers-

Maintained lo4 leel o0

stimuli in client/s

enironment-

>Assisted in identi0yin*

situation and stimuli t1at

initiated an*ry outburst and

t1e means o0 dealin* 4it1

stimuli, suc1 as 4al6in*

a4ay or ta6in* dee2

breat1s

>#roided sa0eenironment by remoin*

all dan*erous ob+ects 0rom

clients/ enironment-

Remained calm and stated

limits on ina22ro2riate

be1aior in a 0irm manner-

Obsered clients be1aior

0re7uently-

As6ed directly i0 client is

t1in6in* o0 actin* on

t1ou*1ts or 0eelin*s-

Reie4ed 4it1 client t1e

0actors @0eelin*s and

eents t1at 2reci2itate

iolent be1aior-

Discussed im2act o0

be1aior on ot1ers and

conse7uences o0 action-

Aniety leel rises in a

stimulatin* enironment

t1us increases iolent

be1aior

#roides in0ormation

needed 0or 2roblem

solin*- T1e client can

t1en identi0y alternatie

res2onses-

Remoal o0 dan*erousob+ects 2reents client

in an a*itated,

con0used state 0rom

usin* t1em to 1arm

ot1ers-

To assist in controllin*

be1aior-

Close obseration is

im2ortant , because

a22ro2riate

interentions can be

2roided immediately

To determine iolent

intent-

To 2roide o22ortunity

0or client to understand

reason and tec1ni7ues

to 2reent iolent

be1aior-

To assist client to

acce2t res2onsibility 0or

im2ulsie be1aior-

S1ort term: A0ter

; minutes o0

nursin*

interentions,

*oal 4as met-

T1e client learned

to assess

situation

realistically be0ore

ta6in* action as

eidenced by

>"eain* t1e

stimulus and

com2osed 1ersel0

>T1en e2lained

1er 0eelin*s in a

noncon0rontin*

manner

"on*term:

A0ter 4ee6s o0

2er0ormin*

nursin*

interentions, t1e

2atient 1asdeelo2ed

strate*ies to

control im2ulse

and re0rained

0rom 1urtin*

ot1ers-


37/38

RECO$$ENDATIONS

Medications:

Em21asi5e t1e im2ortance o0 ta6in* medications re*ularly and reli*iously

E2lain t1e indication and side e00ects o0 t1e dru* @lac6 o0 6no4led*e may result

to noncom2liace o0 t1e dru*

Em21asi5e non>com2liance to dru*s results to rela2se

In0orm client to secure disability card 0rom t1e local *oernment and 2resent cardat t1e 21armacy to aail discounted or 0ree medications 41en disc1ar*ed

Enironment:

#roide a sa0e and secure enironment-

Enironmental sanitation is needed to 2roide a 1ealt1y mind and body

reat#ent$

amily t1era2y @su22ort *rou2 aailable 0or 0amilies relaties 41erein t1ey *at1er

once a mont1 to 1el2 t1em deal 4it1 liin* 4it1 a 0amily member 4it1 mentalillness

Encoura*ed to as6 7uestions @2re2aration o0 disc1ar*e

-ealth eachin$

!ae ade7uate slee2 and eercise eeryday

Aoid alco1ol- Alco1ol interacts 4it1 medicine used to treat sc1i5o21renia-

Continue 2artici2atin* in t1era2eutic actiities

#romote sel0>care, 2ersonal 1y*iene and actiities o0 daily liin*,

Instruct t1e 0amily members to monitor t1e client/s 2erce2tion in reality-

O&tpatient$

ollo4>u2 c1ec6 u2s


38/38

Return i0 2roblems 4it1 slee2 and eatin* 2attern 4ill be obsered and 1ae

7uestions or concerns about condition o0 care-

iet an! +&trition$

31ole>*rain carbo1ydrates, antioidants @0ruits and niacin- C1ic6en, 2eanuts,

salmon, and tur6ey are ric1 sources o0 Niacin, 41ic1 1el2s conert 0ood intoener*y, 1el2in* essential 0atty>acid metabolism o0 t1e brain-

Reduce inta6e o0 su*ar, re0ined carbo1ydrates, ca00eine and stimulant dru*s

Eat lo4 *lycemic load diet

Date post:	17-Feb-2018
Category:	Documents
Upload:	jayson-valeros
View:	227 times
Download:	0 times

paranoid schizophrenia case study (2).docx

Documents