Paranoid Schizophrenia Case Study

Paranoid
Schizophrenia
A Case Study
Presented to the Faculty of
College of Nursing and Midwifery
Bataan Peninsula State University
In Partial Fulfillment
For the Requirement in the Degree of
Bachelor of Science in Nursing
Alonzo, Mizzy Anne

Angulo, Louie Anne
Antonio, John Andrew
Barros, Hazelyn Joy
Buenaventura, mark Richard
Cortez, Romieline
Crisostomo, Florina Mae
De Mesa, Alvin
De Silva, Janelle
Dela Torre, Mariel Kim
Diego, Lorenz Anthony
Fajardo, Camille
Felipe, Yvette
Group11
ThFs
1
TABLE OF CONTENTS
UNIT 1
I. Dedication and Acknowledgement..

II. Personal Data
III. Chief Complaint.
IV. Health History
a. Past health history
b. Present health history...
c. Family history...
i. Social history
ii. Childhood.
iii. Adolescence..
iv. Adulthood.
d. Sexual history...
UNIT 2
Mental Status Assessment / Analysis and Interpretation
UNIT 3
a. Psychopathology..
b. Related Literature
UNIT 4
a. Nursing Care Plans...

b. Pharmacology...
UNIT 5
Psychotherapy..
UNIT 6
Glossary
2
UNIT 7
Reference...
UNIT 8
Documentation.
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UNIT I
(Dedication, Acknowledgement, Introduction, Personal Data,
Chief Complaints and Health History)
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DEDICATION
This work is dedicated to our parents, family relatives and friends.
Without their patience, understanding, support
and most of all love, the completion
of this work would
not have been
possible.
Also, it is dedicated to our colleagues
who will conduct the
same studies in
the future.
And lastly, to our GOD who
provide us knowledge and
strength in making
this work.
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ACKNOWLEDGEMENT
First and foremost, we would like to thank to our Almighty God,
who gives us strength, knowledge, and good health in
pursuing this comprehensive
case study.
And also to our family who gave all the emotional and financial
support and motivations at all times and
they also serves as our
inspiration.
We would like also to acknowledge our clinical instructor
Sir Ronald Tyron dela Rosa for the support,
patience, knowledge, and contributions
to finish this comprehensive
case study.
We would like also to thank Sir Ronnell Dela Rosa
and Maam Irish Lee for helping and giving
some encouragement to make our duty
possible and able to enjoy
our stay in Mariveles.
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II. INTRODUCTION
Schizophrenia is a mental disorder characterized by the disturbances in thoughts,
sensory perception and deterioration in psychosocial functioning. It is also characterized by a
weak ego. The common defense mechanisms used by individual are regression, projection,
withdrawal and denial. There are four As to acknowledge in having schizophrenia, first, the
associative looseness, the blunted affect, ambivalence and the autistic thinking.
Paranoid schizophrenia is the most common type of schizophrenia in most parts of the
world. The clinical picture is dominated by relatively stable, often paranoid, delusions usually
accompanied by hallucinations particular auditory variety, and perceptual alterations.
Disturbances of affect, volition and speech, and catatonic symptoms are not prominent.
Paranoid Schizophrenia is manifested primarily through impaired thought processes, in which
the central focus is on distorted perceptions or paranoid behavior and thinking. Delusions are
in most cases grandiose, persecutory or both. (WHO 2005)
With paranoid schizophrenia, the ability to think and function in daily life is better
compare with other types of schizophrenia. It may not have as many problems with memory,
concentration or dull emotions. Still, paranoid schizophrenia is a serious, lifelong condition
that can lead to many complications, including suicidal behavior.
Those individuals who diagnosed with paranoid schizophrenia are not especially
prone to violence; often prefer to be alone. Studies show that if people have no record of
criminal violence prior to develop schizophrenia and are not substance abusers, then they are
unlikely to commit crimes after they become ill. Most violent crimes are not committed by
people with paranoid schizophrenia, and most people with schizophrenia do not commit
violent crimes. Substance abuse always increases violent behavior, whether or not the person
has schizophrenia.
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If someone with paranoid schizophrenia becomes violent, their violence is most often
directed at family members and takes place at home. These individuals may spend an
extraordinary amount of time thinking about ways to protect themselves from their
persecutors.
In the US paranoid schizophrenia reports issued by Centers for Disease Control and
Prevention (CDC) for 2000 revealed 121,000 diagnoses of paranoid schizophrenia in non-
Federal, short-stay hospitals (73,000 men and 47,000 women). Most individuals (62,000)
were between the ages of 15 and 44; none were under age 15; 37,000 were between 45 and
64; and 21,000 were 65 or older. According to geographic distribution, the highest prevalence
is in the South and Northeast regions of the US with the lowest prevalence in the West and
Midwest are almost equal. (Medical Disability Advisor, 2010)
The onset of the disorder is usually later than catatonic or disorganized schizophrenia.
Men have earlier onset, and more frequent than women. Women have a bimodal onset with
peaks in their 20s and early 40s. One study demonstrated within subtype age of
institutionalization gender differences only for paranoid schizophrenia (Salokangas et al.,
2003).
The present etiology of the paranoid schizophrenia are the following, genetics it is
known because people believed that mental disorder can be inherit. Other causes are
decreased dopamine, stress, alcohol abuse and substance abuse.
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Prognosis of the disease is good when there is no familial history of the disease, the
patient has good social and professional adjustment prior to onset of symptoms, if the disease
come suddenly and the disorder is treated early, quickly, consistently. And onset symptoms
occur at later years of life and there is an absence of symptoms between psychotic episodes.
Paranoid schizophrenia is usually treated with a combination of therapies, tailored to
the individual's symptoms and needs. Anti-psychotic medications can reduce hallucinations
and disordered thinking, but do not affect the social withdrawal that is common among those
with paranoid schizophrenia. Failure to take medication even during remission periods can
result in a relapse. Psychotherapy is used to address the emotional and social issues that result
from paranoid schizophrenia. Group therapy can be especially helpful, because it creates
opportunities for socialization for individuals with paranoid schizophrenia.
The reason of choosing paranoid schizophrenia as study is to add knowledge, and to
know different contributing factors in developing the said illness. Perhaps to correct the
misconception of not all people who have mental illness are violent and dangerous. While
this may be true in some cases, the generalization has been made far too widely.
These attitudes contribute to a significant amount of prejudice against the mentally ill,
which may prevent people from seeking help. Stigma may also affect peoples recovery,
contributing to low self-esteem and decreased social contact. In contrast to physical health
issues, most people in our community avoid even discussing the subject of mental illness,
dancing around the issue in the shadow of these pervasive misconceptions.
Moreover, the preferred client had a superficial manifestations which seen directly to
the clients experiencing the said mental illness. And the client was cooperative and provided
primary information that we needed in conducting this study.
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III. Personal Data
Name: J.M
Age: 44
Sex: Male
Citizenship: Filipino
Civil Status: Separated
Religion: Roman Catholic
Place of Birth: Sampaloc, Manila
Date of Birth: September 3, 1966
Address: #42 Pag-asa Orion, Bataan
Occupation prior to admission: Police in Bureau of Custom
Education: Vocational Graduate
Date and time of admission: November 20, 2007 / 2:00 pm
Previous admissions: November 2, 1989- December 18, 1991
December 15, 1992 December 18, 1992
December 11, 1195- August 31, 1996
August 23, 1997- June 21, 1998
January, 1999- February 25, 2000
February 28, 2000- January 12, 2004
May 29, 2004- September 19, 2007
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Admitting Diagnosis: Paranoid Schizophrenia
Attending Physician: Dr. Cortez
Place where he spent the last 15 years of his life:
(1990s)Manila, Lubao, Bataan;
(2005-Aug2010)America;
(August 2010-present)MMH
Informant: JMs cousin
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IV. CHIEF COMPLAINTS
Mang JM admitted on November 20, 2007 due to ff:
Maraming J.M, patay na yung galing dito.- Mang J.M
Positive delusions
Refused to medications
Neglected hygiene
Talking aloud
May 29, 2004
Refused to medications Lason daw ang gamot
Refused check- ups
Threatening his mother
Escape
Alcohol intake
February 28, 2000
Talkative pressure speech
Denial, auditory hallucination
Evasive and manipulative
Refused to medication
Smoked and drinks alcohol
Started fights and walking
January 19, 1999
Denied presenting complaints
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Oriented to place
Had positive persecutory as he said Hinampas ako ng tubo kahit nagbibigay ako ng
pera sa kanila
Impaired sleep
Nagmumura, mainitin ang ulo
Nagbabanta
August 23, 1997
Morbid ideas Gusto ko na sanang mamatay kahit sinong pumatay walang
kasalanan
December 11, 1995
Refused to oral medications
Suspicious and jealous to his wife and relative
Impaired sleep
Violent tendency when in influenced of marijuana
December 15, 1992
Impaired sleep
Namumulot ng basura
Denies auditory hallucination and tangentiality
Homicidal and suicidal
Kung saan-saan humihiga
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November 2, 1989
Nagwawala ( kung ano maisapan gawin gagawin, nambabato, hindi nakakakilala at
seloso)
Impaired sleep
Talking to self
20 months ago J.M claimed Hindi na ko magmamaneho, magpapahinga muna ko
Agitated
Nervous- as if afraid of something
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HEALTH HISTORY
15
V. Health History
a. Past Health History
(From the chart and JM)
According to Mang J.Ms chart he was first admitted in Mariveles Mental
Hospital on November 2, 1989, when his cousin who lived in Orion, Bataan took him
in the MMH for checked up because as he noticed, Mang J.M seemed agitated,
nervous and afraid of something for approximately 20 months after the incidence of
hitting an old man in the highway while he was a jeepney driver. Upon arriving at
home Mang J.M said that Hindi na ko magmamaneho, magpapahinga muna
ako.After his consultation, he was advised for the confinement. The manifestations
became persisted. He had chief complaints of having impaired sleep, talking to self,
became aggressive and violent (nagwawala, kung ano maisipan gagawin, nambabato,
hindi nakakakilala, at seloso). Mang J.M consumed 1 pack of cigarette per day and
drinks 2 bottles of red horse and san Mig light. Based on the reported cues of his
cousin, Mang J.M was then diagnosed of having bipolar manic and alcohol abuse by
his attending psychiatrist, Dr. Rivera.
During his confinements, he took medications such as Haloperidol 5mg,
Chlorpromazine 500mg, Risperdal tablet, Roziman 50 mg, Diperidem HCL,
Valporic acid 500mg, Levomeprazine 100 mg, Tusperidone1/2 tab, Bepeoden 1tab
20mg. These various type of drugs are psychotropic medications which being used in
the treatment of mental illness.
After his first discharged on December 18, 1991, Mang J.M did not have a
follow up consultation in MMH because he refused to. His relatives brought him at
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NCMH to have his first check-up on April 1992 and noted that there was no follow up
due to Mang J.M refusal.
Mang J.M was brought in MMH on December 15, 1992. He had complaints of
impaired sleep, namumulot ng basura at kung saan- saan nahihiga, denies auditory
hallucination and tangentiality, having escape, homicidal and suicidal. After 3 days
observation at ACIS he was discharge on December 18, 1992.
On March 4, 1993, Mang J.M applied as a trainee messenger at Binondo,
Manila. He smoke heavily and suspected use of marijuana with unspecified amount
and frequency.
On December 11, 1995, according to his chart, he was admitted in MMH
again because he had impaired sleep and became jealous and made suspicion on his
wife-- he thought that his uncle was having affair with his wife at the point that he
saw the two having sex in their home, and started refusal in taking oral medications.
Mang J.M did not comply with his drug regimen. He appeared that he was having
violent tendency when he was influenced of marijuana as recorded on his chart, but he
continues to deny. He claimed that he never used marijuana because it causes skin
diseases. On, January 1, 1996 Mang J.M was placed on isolation by 15 days because
he became violent and aggressive, according to his chart. And he attempted escape on
May 28, 1996. Like on his previous admission, he recovered and was discharged on
Aug 31, 1996.
Mang J.M had a morbid ideas about his death, where he claimed that gusto
ko na sana ng mamatay, kahit sinong pumatay walang kasalanan. This was the
complaint on his admission on August 23, 1997.
17
On June 21, 1998, Mang J.M had his home visit and went back in MMH
afterwards.
January 19, 1999 when he returned in MMH, Mang J.M denied presenting
complaints, oriented to place, had positive persecutory delusions as he said hinampas
ako ng tubo, kahit nag bibigay ako ng pera sa kanila. But there were no evidence of
physical injury upon assessment. Also, he had complaints of having impaired sleep,
nagbabanta, mainitin ang ulo, at nagmumura.
After a year, on February 25, 2000 he was discharged. At home, Mang J.M
started to become talkative and having pressured speech. He used to deny when he
was asked. He had auditory hallucination, become manipulative and evasive. Mang
J.M regains his vices and did not take his medications. He smoked and drinks alcohol
heavily. Also, he walks endlessly and started fights. Due to reported behaviors of
Mang J.M, he was placed back in MMH on February 28, 2000; he claimed that his
mother did not provide his medications upon interview. Mang J.M was admitted
thereafter. He was forced to take his medications to treat the displayed manifestations.
Mang J.M escaped in the hospital on December 25, 2000, but after several
days on January 2, 2001 he returned by his relatives. He was discharged on January
12, 2004.
After four months, Mang J.M was readmitted on May 29, 2004 because he
refused to take medications and claimed lason ang gamot, he done physical abuse to
his mother and threatened her. Mang J.M refused for check-ups, continues to drink
alcohol and escapes. These are the following complaints why he returned in MMH.
But on September 7, 2007 he was allowed for home conduction and discharged on
September 19, 2007.
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He had conversation last October of the same year and according to his chart
Mang J.M used to smoke and suddenly punch a neighbor. Later, Mang J.M refused to
medications and had an impaired sleep.
In contrary, Mang J.M said that he was just admitted last year and will be
discharged on the 3rd of February 2011.In fact he was 4 yrs at MMH since his recent
admission on November 20, 2007. According to him he was admitted in MMH not
because he was a mentally ill, but because his mother wants to keep him away from
the persons who wanted to steal his wealth and killed him after.
b. Present Health History
Mang J.M was been in MMH since his latest admission on November 20,
2007, around 2:00 pm with the diagnosis of paranoid schizophrenia by his attending
psychiatrist, Dr. Cortez. He was placed at male ward B. According to his chart, Mang
J.Ms chief complaints was having delusions and saying Maraming J.M, patay na
yung galing dito, refused to medications, neglected hygiene, irritable and talking
aloud. He was given Haloperidol 5mg 1amp, and Chlorpromazine 500mg tablet take
at bedtime. These are psychotherapeutic drugs used by Mang J.M for the treatment of
the disorder.
In addition, Mang J.M had alterations in thought process, thinking and
communication, in perceiving and interpreting, in behaving and interpreting Mang
J.M manifested illusions, delusions, grandiosity, hyperactive and withdrawal.
During the orientation, Mang J.M showed good cooperation with the SNs he
was very eager to talk then suddenly jumped into another topic and discuss unrelated
19
matters. He said that he was single and a very rich man and owned not only houses,
but mansions. Mang J.M is always oriented to person, date, time and place.
Mang J.M refused on the grooming sessions in the first two weeks and done
grooming on the last week but only brushing of his teeth. Mang J.M wears a wrinkled
white shirt paired with abstract designed short until the last week, during Grand
socialization he puts on the uniform of MMH as his topped.
On the therapies, he was cooperative and active participant. He used to talk a
lot and listen attentively. Mang J.Ms laughed when his fellows provided wrong
answers and made his judgments afterwards. During the nurse- client interaction he
said that the persons around would kill him, and he added that he was just kidding. In
addition, Mang J.M told that they are making a big swimming pool on the side of
ACIS (MMH), he was a very rich man and owned the international corporation of san
Miguel,he denied used of illegal drugs but admitted that he drinks alcohol and until
now he used to smoke.
Moreover, according to Mang J.M, he had his own planet where exactly
looked like earth. He described that there are living things such as cow, carabao,
plants and people. He added that there is a big TV screen where he saw individuals
like his two student nurses together with their loved ones and also our clinical
instructor. Mang J.M named a thing which is aparachi. This thing was a peanut
shape like, covered with gold and brings out everything that people need, as he
explained. He also said that he had a conversation with the former president of USA,
George Washington.
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Lastly, Mang J.M appeared always hyperactive and talked about different
killings. In contrast he claimed that he was good and did not bring any harm to others.
He used to be keen listener and observer, Mang J.M knew when the questions are
being change but with the same thoughts. He also used various defense mechanisms
such as denial, projection and others. Moreover, Mang J.M manifested grandiosity,
illusions, and delusions.
c. Family history
According to Mang J.M., they were four and he was 2nd to the eldest in his family. His
father died when he was 6 years old due to heart attack while her mother was still alive. They
were raised and sent in good school by his mother, who was a dress maker. His three siblings
have their own family and lived separately while Mang J.M remained single, which is
contrary to the chart because his marital status is married and became separated to unnamed
woman and they have no child.
Also, he said that he had no known history of having mental illness in the family.
Same in the chart, there were no reports that somebody in their family suffered from the same
condition.
d. Social History
i. Childhood
Mang J. M told that he was born on September 3, 1966, in Sampaloc, Manila. He
grew together with his family, but his father was died when he 6 years old. His mother raised
them and sent to school. Mang J.M during his childhood, he once been like the other children,
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he played all day and love vacations. He was sent in Lubao, Pampanga every school break
with his siblings and lived with his grandmother.
His mother decided to bring him in schooling at Lubao Elementary School when he
was 8 years old. Mang J.M was then separated from his mother and siblings as well, though
he told that it was sad at first. But he was used to it because this was not usual to him. By this
time, he lived in Lubao in longer time. He joined his grandmother at home, helped her in
chores and taking good care of the cows in their farm, as he added. During his free time
according to Mang J.M, he played with their neighbors. Those routines ended when he came
back in Manila to continue his study for high school.
ii. Adolescence
He entered high school at St. Jude College. According to him he was an active
student. He joined competitions and different events whereas dancing and singing was his
forte. He was been an officer in CAT during his time. Mang J.M also had peers, and he joined
fraternity when he was 2nd year high school. He said that those persons were good. They had
bonding all the time and accompanied him through his ups and downs.
During his high school life, Mang J.M learned to smoke and drinks alcohol together
with his friends. He added that he consumed at least two bottles of each San Mig Light and
Red Horse and 1 pack of cigarettes per day.
In addition, he also met his first girl friend which is CD during intramurals in their
school, as he claimed that they last for almost six years. They were enjoying each others
company, when there was a time that he experienced his first heartache because his girl friend
went with other man. Mang J.M felt loneliness and depression. But he added that he easily
coped up because he found a new love with EI. Like the first relationship it has to end.It last
22
for one year and they totally separated because of the reason that he moved in Bataan to talk
with his godfather about abroad and EI went to Pangasinan.
Moreover, he experienced those heartaches during his college years and according to
Mang J.M he easily coped to those matters. In contrary, he said that he and CD were cool off
and still in touch with each other.He claimed again that he entered MAPUA for his course
police authority which is contrasting to his chart which showed that he finished vocational
course.He admitted that he continued smoking and drinking alcohol, and denied use of illegal
drugs.
iii. Adulthood
Mang J.M claimed that he went in US after his graduation in college from the
year 2000 up to 2005. He became a Navy in US as he claimed. His habits were smoking,
drinking alcohol, bar hopping but denied having sexual intercourse neither got married.
Mang J.M said that he could drink two bottles of each San Mig Light and Red Horse
because it was less expensive, consumed 1 packed of cigarettes per day, but consistently
denies used of illegal drugs like marijuana.
After Mang J.M came back from US, he became a driver in Orion, Bataan and
worked in Bureau of Customs where he was a police authority as he said.
He spent his life in Manila, and Orion where he went fishing; making his vices
and lived there for several years. According to Mang J.M, he also spends his life inside
MMH as his record showed he was started to admit since1989. But he claimed that this was
his first admission yet he claimed that he returned to work after his previous discharged.
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e. Sexual History
Based on his chart he was separated which he continues to deny. He always says that
he was single for the longest time and he claimed that giving roses to someone was a
burden.
Also, he admitted that he had previous relationships. He added that they were happy
having each others company, he admitted that he did kissing and touching private parts of
his previous girlfriends body as their mutual willingness. But not involved in sexual
intercourse as he added.
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UNIT II
(Mental Status Assessment)
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MENTAL STATUS ASSESSMENT
Name : Mang JM
Age : 44 years old
Ward : Male Ward A
ORIENTATION
Day Day Day Day Day Day Day Day Day
1 2 3 4 5 6 7 8 9
Person
ORIENTATION
Place
AWARENESS
Date
SELF-
Time
Situation
Legend: - manifested by Mang JM
- not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
Day 2: Self awareness
Day 3
No unusual finding was noted on Mang JMs orientation. He was oriented and we
knew it by his right response when we asked the above noted.
SN: Ano pong pangalan niyo?
C: JM.
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SN: Alam niyo po ba kung nasaan po tayo ngayon?
C: Oo, nasa mental nagpapagaling.
SN: Ano pong petsa ngayon Mang JM?
C: Ngayon ay Friday January 14, 2011.
According to Nightingale, changing and manipulating the environment in order to put
the patient in the best possible conditions for nature to act.
Day 4
SN: Ano po pangalan niyo?
C: JM.
C: Oo sa mental nagpapagaling.
SN: Ano pong petse ngayon Mang JM?
C: Ngayon ay Miyerkules January 19, 2011, umaga.
According to Sigmund Freud there is a part of the mind called preconscious,
thought and emotions are not currently in the persons awareness, but he can recall
them with some effort
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Day 5
C: JM.
C: Oo sa mental
C: Ngayon ay Huwebes ng umaga January 20, 2011.
As mentioned on Helsons Theory, adaptation is a process of responding
positively to environmental changes. Mang JM adapts effectively as he was able to
identify the changes in her environment and positively responds to it.
Day 6
C: JM.
C: Oo dito Mariveles sa mental.
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C: Ngayon ay Biyernes ng umaga January 21, 2011.
According to Nightingale, changing and manipulating the environment in
order to put the patient in the best possible conditions for nature to act.
Day 7
C: JM.
C: Oo sa mental nagpapagaling.
C: Ngayon ay Miyerkules ng tanghali February 2, 2011.
According to Roy, awareness of self and environment is rooted in thinking and
feeling. Mang JM was aware of his environment.
Day 8
C: JM.
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SN: Nasaan po ba tayo ngayon Mang JM?
C: Dito sa mariveles.
SN: Eh! Anu po bang araw ngayon?
C: Huwebes, Thursday February 3, 2011.
SN: Alam niyo po ba ang gagawin natin ngayon?
C: Sasayaw tayo ngayon.
Day 9
C: JM.
SN: Nasaan po ba tayo ngayon?
C: Dito sa pantry, sa mariveles.
SN: Alam niyo po ba ang gagawin natin ngayon?
C: Grand Socialization.
SN: Anu po bang araw ngayon?
C: Friday, February 4, 2011.
30
31
DEFENSE MECHANISMS:

1 2 3 4 5 6 7 8 9
a. Repression
b. Suppression
c. Regression
d. Fixation
e. Denial
f. Displacement
SELF-AWARENESS
g. Conversion ORIENTATION
h. Identification
i. Intellectual
j. Introjections
k. Projection
l. Rationalization
m. Sublimation
n. Substitution
o. Symbolism
p. Undoing
q. Reaction Formation
r. Fantasy
Day 1: Orientation
Day 3
Mang JM manifest one of the defense mechanism; Rationalization we noticed that he
always justify his answer. He also manifest Denial as he said Hindi man ako malakas
uminom paminsan minsan lang. and Projection during our conversation when we asked him
Malakas po ba kayo iinum ng alak Mang JM? he said Hindi ah!mahina ako iinum eh,
siguro ikaw malaks kang iinom noh?

32
According to Roger, the human being is a unified whole, possessing individual
integrity and manifesting characteristics that are more than and different from the sum
of parts.
Day 4
Mang JM manifest one of the defense mechanism; Fantasy we noticed that he always
says he was close to George Washington because he once went to United States of America
and met together and became friends. Maybe he wants us to be amazed of him.
SN: Umano po kayo sa America Mang JM?
C: Wala may bahay kami doon, kakilala ako nun ni George Washington.
According to Johnson, Each individual has patterned, purposeful, repetitive ways of
acting that comprises a behavioral system specific to that individual.
Day 5
We dont recognize any defense mechanism.
Day 6
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation,
we noticed that hes angry but he denies it obviously he is because of the tone of his voice
and through his gestures my slapping his legs. He smiled unnaturally.
SN: Nagagalit po ba kayo Mang JM.
C: Hindi ako galit.
SN: Oh, ngiti nap o kayo.
33
C: (Smiled but looks uncomfortable)
of parts.
Day 7
Mang JM manifest one of the defense mechanism; Projection he often projects situations to
us.
SN: Mang JM, ngayon pong malapit na ang valentines may plano po ba kayong pagbigyan
ng flowers?
C: Wala pa nga eh, hirap kasi baka may boyfriend na o may asawa na ang babae eh.
SN: Anu pong dahilan at nasabi niyong mahirap?
C: wala naman, ikaw marami ka ng napagbigyan ng rosas noh?
In erik eriksons psychosocial theory, in infant stage, the infant must
learn to develop basic trust that she will be fed and taken care of, mistrust, the
negative outcome of this stage will impair the persons development
throughout her life.
Day 8
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, he
denies that hes not ever try a drugs/ marijuana, reaction formation because he said that hes a
good boy.
34
SN: Mang JM nakapagtry nap o ba kayo ng Drugs?
C: Hindi hindi ako gumagamit ng ganon.
SN: Ano pong dahilan?
C: Hindi, bawal yun samin mabait ako, hindi ako nangaaway, hindi ako nagdaDrugs, mabait
ako.
of parts.
Day 9
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation,
Mang JM denies use of drugs/ marijuana, reaction formation because he said that its not good
for our body.
SN: Anu po ba ang feeling kapag naka-drugs?
C: Ay hindi, hindi ako gumagamit ng ganon.
SN: Anu pong dahilan?
C: Eh! Bawal kasi samin yun, tsaka nakita mu ba yung iba may mga galis galis dahil sa
drugs yun.
SN: Talaga po Mang JM?
C: Oo, maniwala kayo masama sa katawan yun, mabait ako.
35
of parts.
36
EXTRAPYRAMIDAL SYMPTOMS:

1 2 3 4 5 6 7 8 9
Pseudoparkinsonism
1. Masklike face
2. No swinging of arms
3. Hesitancy of speech
4. Decreased muscle

strength
5. Shuffling gait
6. Drooling
7. Fine intention tremors
Acute Dystonic Reaction

SELF-AWARENESS
ORIENTATION
1. Muscle, spasm of jaw,

tongue, neck, eyes
2. Laryngeal spasm
Akathisia
1. Restlessness
2. Tenseness
3. Inability to sit still
4. Rocking back and forth

of feet
5. Crossing leg frequently
6. Inability to relax
Tardive Dyskinesia
1. Involuntary
movements of
mouth, face, may
extend to fingers,
arms and trunk
37
Day 1: Orientation
Day 3
Our client displayed EPS under akathisia, during conversation we observed that Mang
JM crossing leg frequently and inability to relax by rocking back and forth on feet and
appears restlessness.
In Orems self care model, the nurse should help the client by doing
pharmacotherapy to manage their movement because according to Orem, the
nurse provides assistance to those who are unable to meet self care needs. The
nurse is required therapeutic care to the client with self care deficits until the
person can care for herself.
Day 4
Our client displayed EPS under akathisia, during our therapy we noticed that Mang
JM crossing leg frequently that manifest all through our conversation.
According to Henderson, unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health or
its recovery that he would perform unaided if he had the necessary strength, will, or
knowledge.
38
Day 5
According to Ida Jean Orlandos nursing process theory, she assumes that
freedom from mental or physical discomfort and feeling of adequacy and well being
contribute to health.
Day 6
its recovery (or to peaceful death) that he would perform unaided if he had the
necessary strength, will, or knowledge.
Day 7
According to Orems self care deficit theory, it describes why a person needs self care
but in the presence of illness, there was a deviation.
Day 8
Our client displayed EPS under akathisia, during our conversation we noticed that
Mang JM crossing leg frequently.
39
Day 9
Our client displayed EPS under akathisia, during our grand socialization we noticed
that Mang JM crossing leg frequently that manifest all through our conversation.
40
THINKING AND COMMUNICATION:

1 2 3 4 5 6 7 8 9
Looseness of Association
Neologism
Word salad
Echolalia
Echopraxia
SELF-AWARENESS

ORIENTATION
Clang Association
Illogical thinking
Alogia
Concrete thinking
Lack of insight
Aphasia
Apraxia
Agnosia
Flight of ideas
Day 1: Orientation
Day 3
Our client displayed looseness of association, these are neologism and echolalia. He
mentioned the word wisboro which do not have meaning and repeating the questions we
asked.
41
According to King, Each individual brings a different set of values, ideas, attitudes,
perceptions to exchange.
Day 4
Our client displayed looseness of association, these are neologism and echolalia. He
mentioned the word aparachi which do not have meaning and echolalia such as the
shoemaker, the shoemaker which he unconsciously saying. Our client also manifested
concrete thinking of flight of ideas.
According to King, Each individual brings a different set of values, ideas,
attitudes, perceptions to exchange.
Day 5
During the interview our client displayed lack of insight because sometimes hes
saying something which has no sense or even relation on the topic and flight of ideas.
SN: Anu po bang ginagawa niyo doon?
C: Nagtatrabaho, Nagbabantay ng bagahe, tapos may nahuhuli din akong isda noon.
According to jean piagets stage of preoperational thought (2-7 yrs.). In this stage,
thinking and reasoning are intuitive, children learn without the use of reasoning.
Day 6
During the interview our client displayed looseness of association, these is neologism.
He mentioned the word aparachi which do not have meaning.
SN: Anu po bang ginagawa niyo doon?
C: Nagbabantay ako dun, tas dun yung aparachi.
42
SN: Anu po yung aparachi?
C: gold yun, kung saan may lualabas na kalabaw, truck at kung anu ano pa.
According to King, Each individual brings a different set of values, ideas,
attitudes, perceptions to exchange.
Day 7
There were no alteration of Mang JMs thinking and communication.
Day 8
During the interview our client displayed flight of ideas because Mang JM introduces
new topic without completing the topic.
SN: Ano pa po ba yung gingawa niyo doon?
C: wala naman nagbabantay, tignan mo yun oh mangga.
Piaget viewed intelligence as an extension of biological adaptation that
has a logical structure. Every stage occurs at a certain age, and children show a
higher level of thought organization during each successive stage of
development.
Day 9
There were no alteration of Mang JMs thinking and communication.
43
PERCEIVING AND INTERPRETING:

1 2 3 4 5 6 7 8 9
Delusion
1. Reference
2. Persecution
3. External influence
4. Somatic
SELF-AWARENESS
5. Grandiose
ORIENTATION
Hallucination
Illusion
Depersonalization
Attending to relevant

stimuli
Poor reality testing
Attending to irrelevant

stimuli
Poor reality testing
Day 1: Orientation
Day 2: Self- awareness
Day 3
There was no alteration noted on Mang JMs perceiving and interpretation.
44
Day 4
There is an alteration on perceiving and thinking; Persecution Delusion by saying if
you want to kill me just tell me and Grandiose Delusions by saying he is very rich. He also
manifests illusion by saying that the clouds near on the mountain are smoke cause by burn.
According to Neuman, maintains balance and harmony between internal and external
environment by adjusting to stress and defending against tension-producing stimuli.
Day 5
There is an alteration on Mang JMs perceiving and thinking; Persecution Delusion by
saying madami diyan sa paligid mamamatay tao and Grandiose Delusion by saying
marami kaming pera, nung minsan nagpunta dito yung mga truck namin ng pera. He also
manifests illusion by saying doon sa ACIS may swimming pool kaming pinagawa diyan.
According to psychodynamic theory of Sigmund freud , this perceptual motor
syndrome is developing from a person with psychic alterations. In addition, these alterations
are contingent on the poor caregiving that is provided within the environment.
Day 6
saying dito lang tayo ah, wag kayo lalabas may mga mamamatay tao doon. And Grandiose
Delusion by saying Oo maniwala ka sakinkami nagpagawa ng mga building na yun. He
also manifests illusion by saying nakita mo na aba yung swiiming pool sa may ACIS?
45
According to Neuman, maintains balance and harmony between internal and
external environment by adjusting to stress and defending against tension-producing
stimuli.
Day 7
There is no alteration on perceiving and thinking, manifest Grandiose Delusion by
saying Oo, meron kaming mansion dito sa Mariveles.
Day 8
There is no alteration on perceiving and thinking, manifest Grandiose Delusion by
saying Marami nga kaming mga sasakyan eh! Tsaka Pajero.
According to King, human beings are open systems in constant interaction
with the environment.
Day 9
saying tinago ako ni mommyko kasi maraming pumapatay diyan eh! he also manifest
Grandiose Delusion by saying marami ako pera, totoo yun.
According to Neuman, maintains balance and harmony between internal and
external environment by adjusting to stress and defending against tension-producing
stimuli.
46
FEELING AND AFFECT:

1 2 3 4 5 6 7 8 9
Flat
SELF-AWARENESS

ORIENTATION
Blunted
Inappropriate
Lability
Day 1: Orientation
Day 3
No unusual finding because client displays appropriate feeling and affect now.
Day 4
Our client manifest labile mood during our therapy he suddenly laughing for no
reason then suddenly back to serious mode.
47
According to Lazarrus (1982) he consider affect to be post-cognitive
that is, affect is thought to be elicited only after a certain amount of cognitive
processing of information has been accomplished
Day 5
Our client manifest blunted affect during our conversation, there is delay on our
communication.
According to Parses human becoming theory, the client determines whether to show
own affect/ feelings or not.
Day 6
communication and labile mood during our conversation he got irritable C: ayaw mo
naming maniwala sakin eh! (Slapped on his legs). He also manifests inappropriate affect.
SN: nagagalit po ba kayo? C: hindi ako galit (Smiled unnaturally) but his voice seems
angry.
According to Johnson, Each individual has patterned, purposeful, repetitive
ways of acting that comprises a behavioral system specific to that individual.
Day 7
No unusual findings because client displays appropriate feeling and affect now.
48
Day 8
communication. He also manifest labile mood because during the therapy Mang JM suddenly
keeps quiet and then he smiled again.
Based on Watsons curative factors , we must promote and accept expression of the
client either it is positive or negative feelings and emotions.
Day 9
No unusual findings because client displays appropriate feeling and affect now.
49
BEHAVING AND INTERACTING:

1 2 3 4 5 6 7 8 9
Withdrawal
Motor hyperactivity
Motor hypoactivity
SELF-AWARENESS
Ambivalence
Anhedonia ORIENTATION
Avolition
Poor personal hygiene
Impulsive
Paranoia
Day 1: Orientation
Day 3
The behavior pattern of our client is predictable but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his nails were dirty.
According to Abdellah, she identified 21 problems and one of this is to
maintain personal hygiene.
50
Day 4
Our client manifests motor hyperactivity because of his mood, overexcitement to
express his feelings. We also noticed that he has poor personal hygiene and he had dark teeth
that leads to bad breath and his clothes smelled.
According to Freud, conscious mind is where we are paying attention at the moment.
Our way of thinking affects our attitude on how we are going to react in a certain situation.
Day 5
The behavior pattern of our client is predictable. But we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath his clothes smelled and his
nails were dirty.
According to Orems self care deficit, the client cant able to perform self care
because of the presence of mental pathology.
Day 6
The behavior pattern of our client is predictable, but we noticed that he has poor
personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.
According to Abdellah, she identified 21 problems and one of this is to maintain
personal hygiene.
Day 7
51
personal hygiene.
Day 8
According to Orems self care deficit, the client cant able to perform self care
because of the presence of mental pathology
Day 9
personal hygiene.
52
NEGATIVE COGNITION:

1 2 3 4 5 6 7 8 9
Overgeneralization
SELF-AWARENESS
All-or-nothing thinking
ORIENTATION
Should statement

Labeling

Middle reading

Fortune telling
Day 1: Orientation
Day 3
No alteration noted on Mang JMs negative cognition.
As mentioned by Abdellah, a nurse should continue to observe and evaluate the
patient over a period of time to identify any attitudes and clues affecting her behavior in order
to identify the clients problem.
53
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
54
OTHERS:

1 2 3 4 5 6 7 8 9
Amnesia
Fugue
Depersonalization
Phobias
SELF-AWARENESS
ORIENTATION
Memory
1. Remote (long term)
2. Recent (early am)

3. Recent part (current
events)
4. Immediate memory (short

term)
5. Immediate recall
Day 1: Orientation
Day 3
During our conversation with our client he had a remote memory because he was able
to determine his last 15 years of his life. He also remembered the food he eaten in the
55
morning and knows who the president of the Philippines is. He had also recalled us during
our conversation.
According to Parse, Mans reality is given meaning through lived experiences
Day 4
Our client had remote memory because he remembered he went to America last 2005,
he also remembered his breakfast and knows who the president of the Philippines by saying
the name of Pres. Benigno Aquino. He also recognizes our name.
According from psychoanalytic theory of Freud, the mind can be divided into main
parts; the conscious mind includes everything that we are aware. A part of this includes our
memory which is not always part of consciousness but can be retrieved easily at any time and
brought into our awareness.
Day 5
Our client had remote memory because he remembered the things he did in the last 15
years of his life.
SN: anu pong ginagawa niyo sa huling 15 taon ng buhay niyo?.
C: mangingisda.
He also recalled the food he was eaten in the morning.
SN: ano po bang kinain niyo kanina?.
C: lugaw, nabusog nga ako eh. .
He also knows the President of the Philippines by saying the name of Pres. Benigno Aquino.
He also recalled us during our conversation.
56
Day 6
years of his life y saying nangingisda ako noon. He also remembered we did yesterday by
saying nagbingo tayo at nanalo akong 2 beses. He also knows who the president of the
Philippines by saying the name of Pres. Benigno Aquino. He also recalls us during our
conversation.
According to Freud, preconscious thoughts and emotions are not currently in the
persons awareness, but she can recall them with some effort.
Day 7
years of his life y saying yung nanay ko nagtatahi ng magagandang damit. He also
remembered we did last last week by saying nagbingo, nanalo ng 2 beses at nagpakita ng
mga pictures tulad ng doctor, urse etc. He also knows who the president of the Philippines by
saying the name of Pres. Benigno Aquino. He also recalled we did before they go back in
their ward.
SN: anu- ano nga po pala uli ginawa natin kanina?
C: food festival.
Day 8
57
years of his life, he also remembered things weve done yesterday and ingredients of our food
by saying food festival, yung mga sangkap ay gulaman, buko at cream., he also know
president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls
activity we did before they go back in their ward by saying Oo sumayaw tayo kanina na
gagawin natin bukas.
According to Freud, the preconscious system is composed of those mental events,
processes and contents capable of being brought into conscious awareness by the act of
focusing attention.
Day 9
Our client had remote memory because he remembered the reason why he is admitted here in
MMH in the year 1989 by saying Sinave ako ni mama dun sa mga taong mangunguha, tsaka
hindi ako magkatulog. He also remembered the steps we practice yesterday. He also recalls
us.
According to Parse, Mans reality is given meaning through lived experiences.
58
UNIT III
(Psychopathophysiology and Related Literatures)
59
PSYCHOPATHOPHYSIOLOGY
60
Substance abuse
(Marijuana, 2 bottles of alcohol. 1 pack cigarette per day)
Affect the normal function of the brain system
Neurologic disturbances
Altered thought process
Looseness of ability in thinking and perceiving responses
Illusions Delusion Grandiose Maladaptation Violent behavior
Persecutory
61
Analysis and Interpretation
Mang J.M took prohibited drugs as his record showed. But the amount and frequency
were not determined. Being a drug abuser, Mang J.M therefore became a drug addict. This is
the reason why he had looseness of ability in thinking and perceiving responses because of
the effect of the drug in the brain. He had been aggressive to do things whatever he wants; he
developed persecutory delusions and grandiosity.
Related Theory
Substance abuse would be describes according to Psychodynamic (Freudian) Theory from a
developmental perspectives. Freud believes that vulnerable to substance abuse have powerful
dependency needs that can be traced to their early years. They claim that when parents fail to
satisfy a young childs need for nurturance, the child is likely to grow up depending
excessively on others for help and comfort, trying to find nurturance that was lacking during
their early years. If this search for outside support includes experimentation with a drug, the
person may well develop a dependent relationship with the drug which leads to substance
abuse.
Maslow said that human beings are motivated by unsatisfied needs and that certain
lower need to be satisfied before higher needs can be satisfied. Maslow ties the pre-
occupation use of drugs and the negative effects which result from alcohol/drug addiction. He
says that since addiction is a progressive illness, it destroys a persons ability to achieve self-
actualization, eventually destroying the persons ability to meet their other needs including
self-esteem, physiological need and safety.
Inadequate parental guidance
62
(death of father during childhood years and mother still at work)
Lack of moral advices and support from the parents
Inability to facilitate moral vs. immoral behavior
Seek help with trusting persons
Dependency
Influenced with immoral behaviors
Learned to use prohibited drugs, smoking, and drinking of alcohol
Substance dependency and intolerance
(increase amount of substances)
Irrational thinking developed
Violent behavior
(hurting his mother, nagwawala, kung ano maisipan gagawin, nambabato )
63
Analysis and interpretation
Due to early death of Mang J.Ms father, his mother needed to work hard to raise
them well. This resulting Mang J.M to become dependent and able to seek company of others
to fill the lacks of his parents assistance during growing years. And he did things that he
acquired from such people without thinking if it is good or bad.
Related Theory
According to Duldt-Battey, Bonnie Weaver - Humanistic Nursing Communication
Theory, The environment is a booming, buzzing world of strange sensations that must be
sorted out to determine which are the most important; this sorting is achieved through
communication with other people. The need to communicate is an innate imperative for
human beings. The purpose of nursing is to intervene to support, to maintain, and to augment
the clients state of health.
Maslow's hierarchy explains human behavior in terms of basic requirements for
survival and growth. According to theory, when the individual's physiological and safety
needs are met, needs for love and belongingness emerge. These needs include longings for an
intimate relationship with another person as well as the need to belong to a group and to feel
accepted. Maslow emphasized that these needs involve both giving and receiving love.
64
Peer pressure
(Fraternity)
Bad influences caused by peers
Learned to use prohibited substance such as
Marijuana, alcohol, cigarette
Dependency
Intolerance
( increase amount and dosage)
Irrational thinking
Violent behavior
(nagwawala, kung ano maisipan gagawin, nambabato)
65
Mang J.M was a member of TAU GAMMA fraternity. Within this fraternity, we can
conclude that he learned to use prohibited drugs, possible experienced hazing and involved in
different troubles though he claimed that he was good and not participated in fights. These
may cause him to become a drug abuser and later develop dependency resulting him to
become violent.
Related Theory
There are several layers of assumptions that Johnson makes in the development of
conceptualization of the behavioral system mode there are 4 assumptions of system: First
assumption states that there is organization, interaction, interdependency and integration of
the parts and elements of behaviors that go to make up The system A system tends to
achieve a balance among the various forces operating within and upon it', and that man strive
continually to maintain a behavioral system balance and steady state by more or less
automatic adjustments and adaptations to the natural forces impinging upon him.A
behavioral system, which both requires and results in some degree of regularity and
constancy in behavior, is essential to man that is to say, it is functionally significant in that it
serves a useful purpose, both in social life and for the individual. The final assumption states
system balance reflects adjustments and adaptations that are successful in some way and to
some degree. The integration of these assumptions provides the behavioral system with the
pattern of action to form an organized and integrated functional unit that determines and
limits the interaction between the person and his environment and establishes the relation of
the person to the objects, events and situations in his environment.
66
According to Sullivan, individual self identity is built up over the years through his
perceptions of how significant people in his environment regard him. According also to
Sullivan, people are influenced mostly by their relationship with others.
67
Occupational stress
Traumatic life events
Frustration in life
Inability to cope up with life situation
Hopelessness occur
Stress
Disruption in behavior
Depression
Restlessness Agitation
68
Mang J.M had a history of hitting a man during he was a jeepney driver. Due to the
incidence he became agitated, always afraid of something and nervous for 20 months that
leads to his first confinement. This situation caused him to be always under stress and
become restless and agitated
Related Theory
Maslow's hierarchy explains human behavior in terms of basic requirements for
survival and growth. According to theory, once the individual's basic physical needs are met,
his or her needs for safety emerge. These include needs for a sense of security and
predictability in the world. The person tries to maintain the conditions that allow him or her
to feel safe and avoid danger. Maslow thought that inadequate fulfillment of these needs
might explain neurotic behavior and other emotional problems in some people.
According to Roy, the person is a bio-psycho-social being. The person is in constant
interaction with a changing environment. To cope with a changing world, person uses both
innate and acquired mechanisms which are biological, psychological and social in origin. To
respond positively to environmental changes, the person must adapt. The persons adaptation
is a function of the stimulus he is exposed to and his adaptation level.
69
Poor coping mechanism
(Separation from loved ones)
Poor decision making and solving problems
Inability to cope- up with the situation
Use of illegal Stress
Substance, drinks alcohol
And smoked cigarettes change in mood and affect
Substance dependency
Anxiety develops
Intolerance (increased amount & dose)
Irrational thinking depression
Violent tendency and suicidal
Thoughts Self pity restlessness sleeplessness
Isolate self from others
70
Mang J.M has been separated from his wife. This situation may be a leading cause
why he was under stress that leads in development of anxiety to depression resulting to self
pity, restlessness and sleeplessness. On the other hand, it may also, causes Mang J.M to use
illegal substances and became dependent that brought him in having violence and suicidal
ideation.
Related Literate
According to Travelbee human conditions and life experiences encountered by all
men as sufferings, hope, pain and illness. Illness is being unhealthy, but rather explored the
human experience of illness. Suffering is a feeling of displeasure which ranges from simple
transitory mental, physical or spiritual discomfort to extreme anguish and to those phases
beyond anguishes the malignant phase of dispairful not caring and apathetic indifference.
Pain is not observable. A unique experience. Pain is a lonely experience that is difficult to
communicate fully to another individual. Hope is the desire to gain an end or accomplish a
goal combined with some degree of expectation that what is desired or sought is attainable.
Hopelessness is being devoid of hope. Nursing is an interpersonal process whereby the
professional nurse practitioner assists an individual, family or community to prevent or cope
with experience or illness and suffering, and if necessary to find meaning in these
experiences.
71
According to Henderson individual compose of biological, psychological,
sociological, and spiritual components. All external conditions and influences that affect life
and development. Nursing assists and supports the individual in life activities and the
attainment of independence. Nurse serves to make patient complete whole", or
"independent." The nurse is expected to carry out physicians therapeutic plan Individualized
care is the result of the nurses creativity in planning for care.
72
RELATED
LITERATURES
73
Paranoia Agent, Symptom, Cause, Treatment and Medication of Paranoia
Cause of Paranoia
1) Homosexual fixation: According to Freud, the patient suffering from the disease has
repressed his tendency to homosexual love to such an extent that he develops a fixation
concerning it. Freud's view has been found correct in many cases, but it does not explain each
and every case of the disease.
2) Feelings of inferiority: Here the psychologists have found that the main cause of paranoia
is a sense of inferiority that may be caused by a variety of condition such as failure, disgust,
sense of guilt.
3) Emotional complex: Certain psychologist points out emotional complexes, and also
believe that they are seen to be present in other mental diseases as also in normal individuals.
4) Personality type: Cameron believes a certain type to be more susceptible to this disease, a
personality that has sentimentally, jealousy, suspicion, ambition, selfishness and shyness etc.
Patients of paranoia do exhibit these peculiarities of personality but on this basis they cannot
be said to belong to definite personality.
5) Heredity: In the opinion of Fisher the main responsibility of paranoia lies fairly and
squarely upon heredity, although he does not deny the importance of repression and
emotional complexes. The causes of paranoia are not physical because no patient exhibits any
signs of physical deformity and among the causes there are many important" ones, such as
defects of personality, sense of inferiority, repression etc.
74
AREA OF THE ARTICLE THAT WE AGREE
We agree that people who have feeling of inferiority can significantly affect an individual.
These circumstances stressful to an individual and can be cause of schizophrenia.
AREA OF THE ARTICLE THAT WE DISAGREE
No disagreement in the article.
SIGNIFICANCE TO US AS A NURSE
The literature stated that feelings of inferiority are a cause of paranoid schizophrenia. It
means that a individual with poor coping mechanism are prone to schizophrenia. The nurse
must can assist the client and help the client to verbalize feelings to overcome such problems.
75
Substance abuse and the onset of schizophrenia
yes platform+medline author author
Martin Hambrecht, Heinz Hfner
Received 7 August 1995; received in revised form 7 November 1995
Up to 60% of chronic schizophrenic patients are reported to abuse alcohol or drugs. This
comorbidity raises the question whether one disorder is a consequence of the other. With the
structured interview IRAOS, the onset and course of schizophrenia and substance abuse
were retrospectively assessed in a representative first-episode sample of 232 schizophrenic
patients. Information by relatives validated the patients' reports. Alcohol abuse prior to first
admission was found in 24%, drug abuse in 14%twice the rates in the general population.
Alcohol abuse more often followed than preceded the first symptom of schizophrenia. Drug
abuse preceded the first symptom in 27.5%, followed it in 37.9%, and emerged within the
same month in 34.6% of the cases. The study demonstrates a remarkable association between
first-episode schizophrenia and substance abuse, but a unidirectional causality is not
supported, nor is a specific psychotic disorder in comorbid cases.
Summary of the study
The study is all about the substance abuse and the onset of schizophrenia. It is about the
possible effects of substance abuse.
AREA OF THE ARTICLE WE AGREE
The area that we agree upon is that the study is about the possible causes of schizophrenia
and its onset. It gave us the knowledge of the effects of substance abuse. It also gave us
perspective to the outcome of abusing drugs.
76
AREA OF THE ARTICLE THAT WE DISAGREE
The significance of the study to us student nurses is that it gave us more insight of possible
causes on the onset of schizophrenia. With this knowledge we could use it as a baseline on
how substance abuse greatly affects on the onset of schizophrenia.
77
THE INS AND OUTS OF PEER PRESSURE
Written by Liisa Hawes. Liisa is a Marriage and Family Therapist in Calgary, Alberta,
Canada. She is a parent educator with the Family Program at the Calgary Community
Learning Association.
Imagine getting together for coffee with a group of friends. There is the laughter of adults
enjoying the company of other parents. The conversation turns to a discussion of a recent
Oprah show. "I just love that show" you chime in (you really hate it). Later, someone
suggests a movie. "Yes, let's!" you reply, even though you'd rather walk along the river and
continue talking. By the end of the evening, in spite of excellent coffee, old friends and a
reasonably good movie, you still feel "something" was missing. It was. Each time you
concealed your true feelings, you disregarded a part of yourself. You were missing.
When we pretend to take on another's perspectives, go along when
we really don't want to or fail to state our preferences, we hide "As parents...we are
ourselves from others. We become invisible, and smaller the first 'peers' our
somehow, diminished in even our own eyes. "I just like to go children will
along," we say, yet if we see our children doing likewise, we may know."
wonder if they experiencing 'pressure' from their peers.
Peer influences are normal and necessary in our lives. From earliest childhood, each time our
needs are met, our wants are considered and our expressions recognized we develop a sense
of ourselves as being worthy and valuable. Encouraged by these favorable positive
experiences, we reach out to supportive others again and again, learning confidence. In time,
the occasional let down from others doesn't disturb us overly much. The balance of our
78
experience is positive. We often refer to this inner resiliency as "healthy self-esteem" or a
"solid sense of self." But even when others don't grant our requests, if respectful, they teach
us that open disagreement has no negative effects on one's self. We learn again that we can
'be' ourselves; we esteem ourselves.
As parents, we seldom think of ourselves as peers to our children. In a broad human sense,
however, we are the first 'peers' our children will know. If we respond to our children's
feelings with respect, even when we disagree, they will come to expect respect. If we
encourage them to develop and express their own viewpoints, they will become accustomed
to healthy interactions.
Within this kind of healthy relationship, parents often notice more overlap then difference in
their values and those of their children's peer group. In some instances, such as the anxiety
associated with those dreaded skin breakouts, peers provide more support than parents ever
can! Even on a "pretty good" day, one's peers do much to support one's sense of self and
offer a sense of belonging.
The study is all about how peer influences our normal and necessary things in our lives. It
states that peers do much to support one's sense of self and offer a sense of belonging.
The area that we agree upon is that the study is about how peers greatly affect our lives. They
influence us in many ways.
79
AREA OF THE ARTICLE WE DISAGREE
The area that we disagree upon this article is that peers provide more support than parents
ever can. Our parents know and only want what is best for us. They are the ones we should
talk to when we have problems and they have better understanding than our peers.
The significance of the study to us student nurses is that as student nurses we should not only
focus on giving interventions on our clients we should also know their feelings and emotions
to get their trust and to be able to have their cooperation.
80
Occupational Stress 12 - Burnout
There are three separated stages to burnout. Each stage is its own little disorder and you don't
necessarily have to progress through each stage, although most sufferers do exactly that. One
could remain at one stage for years, as each stage is separate and distinct from the other two
(the big word for that is orthogonal domains). The first stage of burnout is emotional
exhaustion (EE) or feeling drained by contact with other people. Emotional exhaustion is
characterized by a cluster of internalized symptoms. Internalized means you are beating
yourself up instead of someone else. Do you dread seeing clients or meeting with customers?
Does just the thought of dealing with one more complaint about that faulty product or that
buggy application make you want to take the day off? These are the type of endorsements
supporting a state of emotional exhaustion. Clearly this emotional banging-your-head-
against-the-wall feeling is stressful. The research is clear about one thing: having unpleasant
contact with your supervisor and coworkers makes things even worse. Increased and
improved training, as well as the use of a strong peer support system, is one of the
recommended solutions, especially if EE is systemic within the group or department. It's not
as bad when you know everyone is in the same boat. Also, you can begin to brainstorm
solutions and stress-avoiding protocols. Isolation always makes things worse. One possible
treatment is moving toward a team approach to dealing with customers.
The second phase of Burnout is depersonalization. This is the outward or externalized phase.
Externalized referrers to beating up on others as opposed to yourself. In this phase, you are
rude, demeaning, and insulting toward the client or customer. You're no longer blaming
yourself. You're blaming others for having a problem. (Hey, I think I just figured out the
problem with Larry down in accounts receivable!) Of course, a client with a crashed program
is not to blame, but it appears there is only so much one can take of this endless stream of
81
people with the same problem! Are you often negative toward clients or callous toward the
problems of your valued customer? If so, you can put a little check in the box next to
depersonalization. What helps? Again, training is a key ingredient. It's very healing to know
when you are addressing the customer's problem in the most professional and efficacious
manner possible. Also, through training and professional assessment, you can begin to
understand that solving the problem may not exactly be in your job description. Your goal
may just be to do the best you can do with what you have while maintaining a professional
disposition. Wouldn't this be a self-affirming attitude? But these are perspectives you
sometimes can't put together by yourself, especially while working in an isolated situation.
Burnout's final phase is reduced personal accomplishment (RPA). This is characterized by
generalized feelings of disappointment, nonsuccess, and underachievement. Workers with
RPA endorsed statements such as, "I'm not getting anywhere," or "This job has lost all its
meaning." As I indicated earlier, having supportive supervisors and coworkers is an
important step in halting the progress of burnout's three stages.
Burnout is serious and the consequences are serious as well. Psychologists have good
instruments to assess this disorder and its progression. If you are experiencing one of these
phases, don't hesitate to talk to a professional about it.
Burnout is serious and the consequences are serious as well. Psychologists have good
instruments to assess this disorder and its progression. If you are experiencing one of these
phases, don't hesitate to talk to a professional about it.
82
Being stressed greatly influences our daily activities, especially at work. We cannot perform
well if we have something in mind that we keep on thinking. Our brain cannot function well.
AREA OF THE ARTICLE WE DISAGREE
The significance of the study to us student nurses is that we need to think more ways for us to
help our clients. As student nurses we need to make our client feel comfortable to lessen their
anxieties and stress. We also need to consider interventions will be used so that we can
achieve the upmost care that our client would have.
83
Understanding schizophrenia
A guide to the signs, symptoms and causes
Environmental causes of schizophrenia
Twin and adoption studies suggest that inherited genes make a person vulnerable to
schizophrenia and then environmental factors act on this vulnerability to trigger the disorder.
As for the environmental factors involved, more and more research is pointing to stress,
either during pregnancy or at a later stage of development. High levels of stress are believed
to trigger schizophrenia by increasing the bodys production of the hormone cortisol.
Research points to several stress-inducing environmental factors that may be involved in
schizophrenia, including:
Prenatal exposure to a viral infection
Low oxygen levels during birth (from prolonged labor or premature birth)
Exposure to a virus during infancy
Early parental loss or separation
Physical or sexual abuse in childhood
Abnormal brain structure
In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role
in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a
deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the
frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making.
Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and
amygdala are connected to schizophrenias positive symptoms. But despite the evidence of
brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in
any one region of the brain.
84
AREA OF THE ARTICLE 1 THAT WE AGREE
We agree that people who lost their parent can significantly affect an individual. These
circumstances stressful to an individual and can be cause of schizophrenia.
AREA OF ARTICLE 1 THAT WE DISAGREE
The literature helps us understand that there are different kinds of factors that cause paranoid
schizophrenia. And parental loss is one of them can lead to inadequate parental guidance, the
nurse should pay attention to the client who had loss a parent because it a risk factor in
developing paranoid schizophrenia.
SIGNIFICANCE TO OUR CASE
This article gives us much information about causes of paranoid schizophrenia.
85
UNIT IV
(Process Recording and Drug Study)
86
PROCESS
RECORDING
(Nursing Care Plan)
87
Process Recording and Theme Identification
PLACE: San Lazareto Hall
DATE: January 14, 2011
TIME: 2:00 pm
PHASE: Orientation Phase
I. Objectives
a. Client- centered objectives
1. To established trust and rapport with the nurse through the use of
various therapeutic communication techniques.
2. To enhance cognitive skills through participating actively in the
therapeutic activities.
3. To improve socialization of the client and reduce anxiety.
b. Nurse- centered objectives
1. To provide mental health care for the client.
2. To implement therapeutic plan necessary for improvement of
mental illness.
3. To develop positive coping behavior through therapeutic
communication.
II. Description of Setting
88
a. Describe the set up/ environment
It was a sunny Friday afternoon. We fetched our client from Male
Ward and introduced ourselves to the client and proceed to pantry area to
groom the patient. We let him brushed his teeth and waited for him to finish.
After that, we went to the ruins and have our first interaction with the client.
The chairs were scattered around the ruins facing our client. After an hour of
interaction the facilitator were assigned to ask them the time, place and
weather of that day and was given recognitions for each.
b. Describe the nature, behavior, affect and mood of the client
Our client Mang JM was wearing his own set of dirty white wrinkled
clothes and green patterned shorts with cut on sides. He seemed happy and
always smiling. When we greet him, he recognized us as his new nurses for
that afternoon and easily remembered our names in particular. Mang JM did
the grooming excitedly and rapidly. As we fetched him for the activity his gait
was moderate while looking at the floor. When we interviewed Mang JM, he
showed a lot of facial expressions. He always said that he was happy, and it
shows. He seemed anxious when he was recalling things from the past and
whenever he thought of a good answer. He always answered the questions
being asked with his medium tone. He was excited to answer some questions
and stuttered because of it.
III. Process Recording
Nurse- Client Therapeutic Analysis and
89
Conversation (include Communication Interpretation based on
non- verbal cues) Technique Used theories
SN: Magandang tanghali Giving Recognition Greeting or noting Mang
po Mang J.M. JMs effort show that his
student nurses recognizes
C: (smiled and nodding) his individuality.
According to Sullivan,
recognition can establish
rapport towards the
client.
SN: Tara na po sa pantry Offering Ones self The nurses offer their
para po makapag linis help to the client in doing
kayo ng ngipin niyo. self-care.
C: (nodding)
According to King,
human beings are open
SN: Gusto niyo po ba
systems in constant
tulungan po namin
interaction with the
kayo?
environment
C: Hindi na. Meron na

akong toothbrush dito.
SN: Ako po si Mark at Giving Information Giving information to the
ako naman po si Hazel client promotes a good
kami po yung student and trusting relationship
nurse niyo sa loob ng between the nurse and
tatlong linggo. the client.
C: Ahh(Smiled and According to Roy, a

nodding) person is an open
adaptive system who
uses coping skills to deal
90
with stressor.
SN: Mang JM, alam nyo Assessing orientation to Assessing such questions
po ba kung anong petsa at date and situation enables the student nurse
kung nasaan kayo to assess Mang JMs
ngayon? orientation on date and
situation.
C: Oo. January 14, 2011
na tayo e no? According to Newman,
time and space have
SN: Opo. complementary
relationship based on
C: Tapos nasa hospital Newmans concept of
naman ako. date and space.
SN: Opo. Accepting This indicates that Mang

JMs student nurses
accepts and understands
Mang JM said.
According to Roger,
patterns identify human
being and reflect their
innovative wholeness.
SN: Kelan pa po kayo Seeking Clarification Mang JM verbalizes

dito Mang J.M? clearer statement that
provides necessary
C: Nung birthday ko ako information of his past.
dinala dito, nitong taon
lang. According Nancy Roper,
her assumption in her
theory model of living,
alteration on the clients
91
activities of living like
sleeping, communicating.
Bathing may result to
actual or potential
problem.
SN: Anu po ang dahilan Exploring Mang JM gives more

ng pagdala po sa inyo information about his
dito? life. Student nurses had
chance for gathering
C: Hindi ako makatulog. more data.
Paminsan kapag natulog
ako buong araw, pag According to Hall, major
hindi ako makatulog purpose of care is to
haggang kinabukasan di achieve an interpersonal
ako nakakatulog. Pero relationship with the
hindi ako nagda-drugs, individual that will
makakalabas na nga ako facilitate the
sa February eh! development of the core.
SN: Sino po ang Focusing Mang JM concentrates

kasama nyo nung dinala on specific topic during
kayo dito? conversation that enables
his student nurses to get
C: Ako lang. Tapos their goal of interaction.
sinundan lang ako ng Ate
92
ko. According to King in
goal attainment theory,
SN: Ahh.. Anu po plano nursing is a process of
niyo paglabas niyo po action, reaction, and
dito? interaction whereby
nurse and client share
C: Babalik ako sa information about their
pinagtatrabahuhan ko. perception in the nursing
situation
SN: Anu po ba ang Seeking Clarification Mang JM provides
trabaho niyo? clearer statements about
his background.
C: Dun sa
byubyurubyuuu custom. According to Roger,
nursing is using
SN: Anu po uli yon knowledge for human
Mang J.M? betterment.
C: Bureau of Custom.
SN: Ilang taon na po Focusing Mang JM concentrating

kayong nagtatrabaho on a single point picking
doon? up on central topics or
areas given by nurse.
C: Matagal na. Siguro
mga 15 taon na. According to Peplau, it is
Hanggang ngayon dun pa one way of establishing
din ako nagtatrabaho. of interaction between
the client and the nurse.
SN: Mang J.M, kamusta Focusing Selecting one main topic
po ang tulog niyo help to prevent confusion
kagabi? on the part of the client.
93
C: (looking around, According to Watson, it
thinking and tearing is important to help the
leaves) patient identify his own
thoughts and feelings to
C: Ahh..mabuti naman, gain better understanding
kaso natulog ako kagabi of his self.
mga bandang alas dose
pasado na.
C: (looks up) Eroplano

ba yon?
SN: Opo. Ano po ang Exploring The client verbalizes his

dahilan ng pagtulog niyo thoughts and a student
po ng ganung oras? nurse identifies his
sleeping patterns.
C: Kasi
nagkukuwentuhan kami According to Watson,
ng mga kasama ko eh! there is an independency
and integration of the
parts and elements of
thoughts and behaviors
that make up the system.
SN: Maaari po bang Exploring It allows the client to
malaman kung ano pong describe something more
madalas ninyong pinag- fully and more detailed.
uusapan ng inyong mga
kasama? According to Maslow,
one must feel the
C: Wala naman. belongingness and love
Nagyoyosi lang needs especially
kame.(whispering) affiliation.
94
SN:Paano po kayo
nagkaroon ng sigarilyo?
C: Pinapabili namen sa
labas.
SN: Ano po ang ginawa Exploring The client gives
nyo kaninang umaga? information and able to
verbalize certain feelings
C: Wala. Nasa ward and student nurses had a
lang. chance to get more
information. It suggests
SN: Wala po ba kayong that Mang JM has a good
nurse kaninang umaga? recent memory.
C: Wala. Wala namang According to Henderson,

kumuha sakin kanina. patients require help
towards achieving
independence.
SN: Taga saan po kayo Identifying Participants The client identifies and
Mang JM? and Relationships states the relationship of
characters in his life and
C: Taga Orion. Sa Pag- capable of determining
asa. whos involve to his life.
SN: Sa Orion po, sini-

According to Ropper,
sino ang mga kasama nyo
most individuals
roon?
experience significant
life events which can
C: Mga magulang ko
affect ALs causing actual
saka kapatid ko.
95
and potential problems.
SN: Alam nyo po ba
kung nasaan na sila
ngayon?
C: Yung mga kapatid ko

nasa Japan. Yung isa nasa
Cavite.
SN: Ahh. Sa Orion po

ba, marami kayong
barkada doon? Sinu-sino
po?
C: Uo. Si Ana saka si

Azon.
SN: Sa nakaraang 15 Asking Open- Ended Mang JM answers the
taon, anu po ang mga Question question directly and
ginagawa niyo? appropriate for taking of
information.
C: Nangingisda.
According to Peplau,
SN: Ahh.. Anu- ano po stressed the importance
mga nahuhuli niyong of nurses ability to
isda.? understand own
behaviour to help others
C: Marami tulad ng identify perceived
alumahan, tilapia, mga difficulties.
maliliit na isda.
SN: Anu po ang

ginagawa niyo kapag
madami po kayong
96
nahuling isda?
C: Ibinebenta, paminsan
pulutan.
SN: Ahhhh Accepting Mang JM feels that his

nurses were listening and
understands what he had
said.
According to Hall, major

purpose of care is to
achieve an interpersonal
relationship with the
individual that will
facilitate the
development of the core.
SN: Anu po gingawa Restating Allows the client to agree
niyo kapag marami po or disagree and promotes
kayong nabebenta? clarification of the
information.
C: Umiinom, kasama
According to Johnson,
mga barkada ko dun.
individuals maintain
stability and balance
SN: Kasama nyo rin po
through adjustments and
bang mangisda ang mga
adaptation to the forces
barkada nyo?
that impinges them.
C: Uo.
SN: Bukod po sa pag-

iinom anu pa po ang
ginagawa niyo ng
97
barkada niyo?
C: Wala na.
SN: Ano po ang madalas Humor Mang JM was given a
niyong inuming alak? break of something funny
to decrease tension
C: Ahh..hindi ako between our
umiinum ng Emperador, conversations.
San mig lang kung
According to Kolcaba,
minsan Red Horse.
health care needs are
needs for comfort,
SN: Anu pong dahilan at
arising from stressful
ayaw niyo po ng
health care situations that
Emperador?
cannot be met by
recipients traditional
C: Mahal kasi eh!
support system.
(laughed)
SN: Malakas po ba kayo

iinum ng alak Mang
JM?
C: Hindi ah!mahina ako

iinum eh, siguro ikaw
malaks kang iinom noh?
SN: Mang J.M may Exploration Mang JM allows to
asawa na po ba kayo? describe something more
fully and more detailed.
C: Wala.
The client capable of
SN: Anung pong dahilan Restating agree or disagreeing
at wala pa kayong about the statement and
asawa? promote to clarify what
98
has been heard.
C: Wala ako
nagustuhan. Saka According to Maslow,
mahirap. Di lang naman one must feel sense of
ganoon yon di ba? belongingness and love
Syempre pag mag-aasawa needs in order for him to
ka sisiguraduhin mo get for self actualization.
munang wala syang
boyfriend, wala pa syang
anak at asawa. Tapos
bibigyan mo pa ng
rosas.
SN: Sa buhay nyo po,

may nabigyan na po ba
kayo ng rosas?
C:Wala pa naman.
SN: Napansin ko pong Making Observation Mang JM explained
linga po kayo ng linga, reason why his staring
anu po bang tinitignan someone. The client
niyo? clarifies what has been
observed.
C: Ah!wala naman yung
dumadaan lang. According to Roy, the
degree of internal or
external environmental
change and the persons
ability to cope with that
change is likely to
determine the persons
health status.
99
SN: Ahh..ganun po ba? Seeking Clarification It helps the nurse to
verify unclear statements
C: Oo. made by their client.
According to Roger,
nursing is using
knowledge for human
betterment.
SN: Anu- ano pa po ang General Leads The client was given a
ginagawa niyo po nung chance to continue on
kabataan niyo? what he is talking about
and this indicates that the
C: Nagpapastol ng client is on right tract to
kalabaw sa bukid, alas proceed.
kwatro palang gumigising
na ako. According to Parse,
human becoming is co-
SN: Ahh..my bukid din creating rhythmic
po kayo sa Orion? patterns or relating in
mutual process in the
C: Hindi, sa mga Lolo universe.
ko sa Lubao.
Sn: May bahay din po

pala kayo sa Lubao. Sige
po Mang J.M ikuwento
niyo pa po.
C: Minsan natutulog ako

sa ibabaw ng kalabaw.
SN: Mang JM next week Formulating Plan of The client provided
100
po pang umaga na po Action information necessary for
kami kung saan may mga our next week set of
gagawin po tayong activities and the client
activities, anu po ba gusto wont be surprised about
niyong gawin natin? activities.
C: Ahh, ganun ba? According to Roy,

Wala naman basta yung informing patient of facts
Masaya. lets the patient know
what to expect. All other
SN: Opo Mang stimuli that strengthen
JM,maasahan po ba the effect of focal
namin uli ang inyong stimulus.
kooperasyon?
C: Oo naman, maraming
salamat.
SN: Mang JM anu po ba Summarizing Mang JM remembered
yung mga ginawa natin the things weve done for
ngayong araw? today that indicates he
has a good recent
C: Oo, ngayon mo lang memory. It helps to
ako kinuha dba? Tsaka bring out important
pinagusapan natin kung points of the
anu ang trabaho ko dati at conversation and
kung anu ang mga activities. With this, the
ginawa ko noon. client becomes more
aware of certain activities
SN: Opo, galing naman to be done. This will be
po pala ni Mang JM the closure of
natandaan pa po ang mga conversation.
ginawa natin ngayon.
101
C: (Smiled) interpersonal process that
functions cooperatively
with others to make
health possible.
IV. A. Theme identification
Content Theme
The conversation was all about the clients personal data, family
backgrounds, and his condition.
Interaction Theme
Mang JM responded well on our questions and reacted appropriately to
the questions being asked. Showed interest in answering the questions but
when hes not being asked, he only remained silent with blunted facial
expression and looked around the environment to divert his attention and
ease the boredom.
Mood Theme
Client had no sudden change in his mood. He expressed himself
through smiling with good eye contact. Clients movement often feels
restless.
B. Nursing Diagnosis
Altered thought process related to decreased attention secondary to obsessive
thoughts as evidence by:

102
SN: Napansin ko pong linga kayo ng linga. Ano po ba ang tinitingnan nyo?
C: Ah wala naman. Yung mga dumadaan lang.
V. Nursing Interventions
We started to greet our client a pleasant afternoon. After that we fetched him
from the ward, we assisted my patient in his grooming before the activity, I
informed him of what will happen on the therapy. I encourage him to express
feelings and verbalized concerns regarding the conducted activity. After we
finished grooming, we asked him to go with us to have conversation with him.
The orientation was conducted at the Lazaretto building. It was started with asking
the clients personal data and backgrounds for us to go further. We also wanted
him to gain trust and established therapeutic nurse-client relationship with us. The
conducted interaction went good.
VI. Summary and Evaluation
In the Friday afternoon, as we received the client, Mang JM, he presented a
happy and face and excited mood. As we go on for his grooming session, we
observed that he has a good hygiene.
The client was very cooperative on the conducted conversation that afternoon.
He was able to follow instructions and did it well.
103
We gained his trust and rapport that had been established during our interaction.
He also verbalized feelings of concern openly with us. We got along with him
easily and he participated actively in the group socialization.
VII. Reference
NANDA 10th edition
Psychiatric-Mental Health Nursing 5th Edition
104
Name of Therapy: Role Identification Therapy
Place: Under the tree (MMH)
Date: January 19, 2011
Time: 9:00 AM
Phase: Working Phase (Day 4)
I. Objectives
1. To enhance the thinking and analyzing ability of the client.
2. To analyze and determine the knowledge and understanding of clients
with occupation roles.
3. To gain knowledge
2. To implement therapeutic plan necessary for improvement of mental
illness.
communication.
4. To assess clients memory status.
It was a fine windy day of Wednesday around 9:00 in the morning of
January 19, 2011 when we received our client. We fetched him to the pantry
105
area for grooming but he refused to, so we proceed to the area where the role
identification activity will be held. The place was clean and the seats were
arranged alternately with the client facing the facilitators of the said activity.
The place was conducive for the activity and they were comfortably
seated on each chair. After the warm greetings of each facilitator and
explaining the procedure of the activity, each patient were asked to identify
what were the roles of the picture presented to them and was given
recognitions for each. After the activity, we proceed under the mango tree to
find shade from sunlight and to conduct another conversation. We reviewed
Mang JM about the recent activity and asked him what was his reaction about
it and presented another set of pictures. This time, he can identify roles
according to his own intellectual functioning, and not by imitating his
neighbors answers. Between our conversation, we gave him snacks that he
seemed enjoying while eating those. At around 11:00 am, we returned our
client to his ward after the therapy and the conversation.
We received our client wearing his own set of wrinkled dirty white
Boysen shirt and green patterned shorts which was the same as last week. We
noticed that he was opistotonic that time and non-initiating when we fetched
him from the ward. His gait was slow and he always looking at the floor with
his arching back. Before the program, we approached him and he was very
excited and always laughing with no apparent reason. He verbalized different
106
ideas and looking around his environment a lot of times. During the program,
he was actively participating and behaved well. When he heard of his
neighbors answer, he laughed very hard. He displayed a lot of facial
expressions like smiling, laughing, raising eyebrows, and frowning before and
during the activity. Before the activity, he talked loudly and excitedly that he
stuttered while speaking. And during the activity, he was serious and listened
very carefully to the instructions and pictures presented to him. As we go
along on our conversation, different behaviors were manifested, congruent
affect have been projected by the client.

SN: Magandang umaga Giving Recognition The client did not look at
po Mang J.M. us but he use gestures or
non verbal cues to make
C: (smiled and nodding) communicate with his
student nurses.
According to Peplau, the

initial interaction
between the nurse and
the patient wherein the
latter has a felt need and
expresses the desire for
professional assistance.
SN: Tara na po sa pantry Placing event in time or Mang JM refused for the
para po makapag linis po sequence grooming session.
107
kayo.
According to Abdellah,
C: Hindi na, naligo na she identified 21
ako ng 2 beses kanina problems and one of it is
pa. to promote good personal
hygiene.
SN: Anung oras po kayo
naligo Mang JM?
C: Bali kaninang 4am at

6am.
SN: Mang JM kilala Seeking Clarification The patient failed to
niyo pa po kami? recognize his student
nurses.
C: Sino nga ba?
Nakalimutan ko na. According to Johnson,
Each individual has
patterned, purposeful,
repetitive ways of acting
that comprises a
behavioral system
specific to that individual
SN: Ako po si Mark at Giving Information The patient was provided

ako naman po si Hazel information about his
kami po yung student student nurses. This also
nurse niyo po. builds trust to the client.
C: Ahh.. oo natatandaan According to King,

ku na.(Smiled and human beings are open
nodding) systems in constant
interaction with the
environment
108
SN: Kayo po ba Mang Exploration The patient was able to
JM, may girlfriend na po express his feelings about
kayo? a certain situation and
reasons behind those
C: Wala eh! statements.
SN: Anu pong dahilan at According to Maslow,

wala pa po kayong one must feel the sense
girlfriend? of love and
C: Eh, wala pa ako belongingness.
nabibigyan ng bulaklak at
pera eh.
SN: Wala pa po ba
kayong nagugustuhan?
C: Bagito pa kasi ako sa

mga bagay na ganyan.
(Smiled)
SN: Mang JM napansin Making Observation This determines the
po namin na tawa po congruence of affect and
kayo ng tawa. Anu po ba the mood of the client
ang pinagtatawanan during the conversation.
niyo. This may clarifies
student nurses perception
C: (Stop Laughing) about the appearance of
her client.
According to Roy, the

109
change is likely to
health status.
C: Tingnan niyo yung

ulap oh. (pointing
towards the mountain)
SN: Ano po iyon Mang Focusing The client selected one

JM? topic in order to prevent
confusion to the topic
C: May sunog doon being introduced.
oh.Tignan mo yung
usok. According to Peplau, it is
one way of establishing
of interaction between
SN: Ahh Mang JM Presenting Reality The patient will be able

iyan po ay isang ulap at to know what the real
hndi poi sang usok. thing is. He recognizes
reality.
According to Neuman,
flexible lines of
resistance - Surround
basic core
SN: Saan po kayo Focusing The client was able to
nakatira Mang JM? concentrate and pick a
single topic to prevent
C: Sa orion sa may pag- confusion and flight of
asa. ideas.
110
SN: Paano po kayo According to Peplau, it is
napunta ditto? one way of establishing
C: Ahh.. kasi my mansion the client and the nurse.
kami dito mariveles.
SN: Talaga po Mang Voicing Doubt Student nurse clarifies or

JM? validate clients
statement that needs to
C: Oo, meron kaming 5 be understand to prevent
mansion dito sa misunderstanding.
mariveles. Mayaman
kami. According to Roger,
nursing is using
knowledge for human
betterment.
It permits the client to

SN: (Silence) Silence become aware that others
do not necessarily
perceived events in the
same way. These will
make the client re-
organize and prevent
overloading.
SN: Saan po ba kayo Exploring The client answered the
nagtatrabaho Mang JM? question and examined
the issue more fully.
C: Sa San Miguel. Kami
ang may ari ng San According to Rogers,
Miguel. unique focus of nursing
is on the unitary or
irreducible human being
111
and the environment
(both are energy fields)
rather than health and
illness
SN:Talaga po Mang Voicing Doubt Mang JM clarifies topic

JM? Saan pong branch ng which seems unclear to
San Miguel? student nurses ideas.
C: Oo! Sa buong According to Parse,

Pilipins kami ang nag human becoming is
mamay-ari ng San freely choosing personal
Miguel, pati sa ibang meaning in situation in
bansa. May mga building the intersubjective
rin kami sa United States process of relating value
of America. Kasama ko priorities.
roon si Presidente George
Washington. Saka si Joan
Miguel. Si Joan Miguel.
SN: Talaga po Mang Exploring The client became
JM? specific of what he is
talking about a certain
C: Oo! Kauuwi ko nga scenario. It stresses the
lang galling ng United ideas and thoughts of the
States of America. US client more fully.
Marine ako doon, saka
military saka US Navy. According to Watson,
caring as a nurturant way
SN: Ano po ba ulit ang or responding to a valued
trabaho nyo Mang JM? client towards whom the
nurse feels a personal
C: Wala na. Pensionado sense of commitment and
na ko. responsibility
112
SN: Ganoon po ba Mang
Jm?
C: (Silence)
SN: Sino po ang kasama Identifying Participants The client explains more
nyo sa bahay nyo ditto sa and Relationships about their relationship
Mariveles? and significant to others.
C: Mga Miguel. Kaya According to King,

kami ngapagawa ng mga human beings are open
mansion kasi nawask systems in constant
yung Pilipins nuon. interaction with the
Bumagsak tapos environment such as
natanggal yung mga Society example are
semento saka daan. Pro Family, religious groups,
alam ko may sumira nung schools, work, peers
Pilipins e.
SN: Alam nyo po ba

kung sino ang sumira ng
Pilipins?
C: Di ko nga alam e.
Pero may sumira talaga
ng Pilipins.
SN: Sa tingin nyo po

Mang Jm, pag natukoy
nyo po kung sino yung
sumira ng Pilipins, ano
po ang gagawin nyo?
113
C: (Silence)
C: Alam nyo ba, dyan sa
tabi-tabi maraming
mamamatay tao.
SN: Paano nyo po Focusing The client was

nasabi yun Mang Jm? encouraged to focus and
determine his thoughts
C: Nararamdaman ko. and feelings about the
situation.
According to Neuman, a
person maintains balance
and harmony between
internal and external
environment by adjusting
to stress and defending
against tension-
producing stimuli
SN: Nabanggit nyo pong Encourage Elaboration The client was
kasama nyo si Presidente encouraged for further
George Washingto sa explanations to clearer
America, ano po ang and better understanding
relasyon nyo sa kanya? of the situation.
C: Meron kasi syang According to Abdellah,

aparachi! to identify and accept
positive and negative
SN: Ano po yung expressions, feelings and
aparachi? reactions.
C: Parang mani yun na

may balat na gold, o kaya
114
light yellow tapos
merong laman sa loob na
kalabaw, tao, kabayo,
kayamanan, mga pera,
The client emphasizes
SN: Tama po ba ang Seeking Clarification and explained more
narinig ko? Arang mani detailed scenario in
na nilalabasan ng tao? which a nurse has vague
understanding on Mang
C: Uo. Pag nakakuha JMs statement.
ako, bibigyan kita.
According to Roger,
nursing is using
knowledge for human
betterment.
SN: Mang Joel, naaalala Exploration Mang JM has a good

nyo pa po ba ang mga recent memory because
pinag usapan natin he was able to recall the
kanina? conversation we have.
C: Uo. Yung shshshoe According to Hall, major

maker, shoe maker. Saka purpose of care is to
yung doctor na nag achieve an interpersonal
chechck up sa bata, yung relationship with the
ginagamot yung puso. individual that will
facilitate the
SN: Ok po. Mang Joel development of the core.
bukas po magkakaroon
ulit tayo ng panibagong
activity. Inaasahan po
naming ang inyong
kooperasyon.
115
C: (nodding)
SN: Mang JM sa Formulating a Plan of The patient is more

susunod po nating Action aware to what will he do
IV. A
activities anu po ang for the future activities.
.
gusto niyo pong
gagawin? According to Roy,
informing patient of facts
T
C: Ahh..wala lets the patient know
h what to expect. All other
SN:
e Sasagot pa po ba stimuli that strengthen
kayo sa mga katanungan the effect of focal
m
naming kapag po may stimulus.
eactivities po?
C: Oo
i
SN: Okay po Mang JM Summarizing The client was able to
d
ang mga nagawa po natin recall what we talked and
ngayo
e ay mga activities did about for today that
kung saan may pinakita indicates better recent
n
kaming larawan at alamin memory.
t
kung anu ang kanilang
mga
i ginagawa. According to Peplau,
interpersonal process that
f
C: Opo, nasagot ko yung functions cooperatively
iShoemaker at Waitress. with others to make
c health possible.
SN: Napagusapan din po
a
naten yung mga sinasabi
tniyo pong mansion niyo.
ion
Content Theme
116
We established nurse patient interaction focused primarily on the role
identification therapy in which the client can identify the roles of people
that are represented by pictures. It will provide the client the stimulus to
assess their intellectual functioning. Moreover, it serves as guide for their
thoughts and behavior.
Interaction Theme
Mang JM responded well on our questions and reacted appropriately
the questions being asked. Showed interest in answering the questions but
when hes not being asked, he only remained silent looking around the
environment where he can divert his attention.
Mood Theme
The client had sudden changes in his behavior. He changed his mood
and affect suddenly according to his reactions and situation. He always
diverts his attention around his environment whenever he didnt feel
like answering some questions.
Social Isolation Related to poor problem solving secondary to unsatisfying
relationship as evidenced by:
SN: Kayo po ba Mang JM may girlfriend nap o ba kayo?
117
C: Wala eh!
According to Abraham Maslow Hierarchy of needs, after physiological and
safety needs are fulfilled, the third layer of human needs is social and involves
feelings of belongingness. Humans need to feel a sense of belonging and
acceptance, whether it comes from a large social group, such as clubs, office
culture, religious groups, professional organizations, sports teams, gangs, or small
social connections (family members, intimate partners, mentors, close colleagues,
confidants). They need to love and be loved (sexually and non-sexually) by others.
In the absence of these elements, many people become susceptible to
loneliness, social anxiety, and clinical depression.
We encourage Mang JM to talk with other client while waiting with the others
to arrive, this will help Mang JM to realize that talking with other people will
make him feel that he belong to a group. We encourage him to sing to the group,
this will help to develop his self confidence. We provide activity that will help
Mang JM to relate his life on the character. We encourage Mang JM to verbalize
his feeling regarding the activity and give the moral lesson he gain in the story.
We give recognition to the answer of Mang JM by doing this the client will feel
that people around him appreciate the effort he give. We provide a quiet
environment for the activity and conversation with our client. During the
conversation with Mang JM, we encourage him to verbalize everything on his
mind, by doing this we will able to identify the possible problem that maybe the
reason why Mang JM has no relationship.
118
Today, we held an activity that can assess the intellectual ability of the
patient by conducting the role identification therapy. Weve prepared a
conducive, quiet area with less stimuli to let the patient concentrate for the
said activity. The flow of the activity went good and we can say that Mang JM
enjoyed it as manifested by his laughs. After that, we had our one on one
conversation with the client and we observed that the client had sudden change
in his mood and affect.
VII. Reference
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincot.
Williams and Wilkins. (5th Edition).
119
Name of Therapy: Bingo Social Therapy
Place: Under the Tree (MMH)
Time: 9:30 AM
Phase: Working Phase (Day5)
I. Objectives
1. To improve the socialization skills of the patient
2. To develop the self-esteem of the clients
3. To assess the knowledge perception of the client about different
fruits and vegetables.
4. To assess the memory of the client
mental illness.
communication.
120
It was Thursday morning when we fetched our client to the grooming
area and assisted him for the therapy. The weather is sunny, and we chose the
perfect setting for the therapy where they can mingle with the other clients
while the trees provided them sheds against the sunlight. We arranged the
clients seats facing each other with long table between them. The place was
conducive for the activity and they were comfortably seated on each chair.
The procedures of the therapy were explained to them clearly and they
understood the mechanics of the therapy. We viewed the reactions and facial
expressions of Mang JM while participating in the activity and noticed that he
was very eager to win. When the patterns were given and none of them
corresponds to the cards of Mang JM, he felt very disappointed. Mang JM
won 2 times and felt very happy. Upon receiving his prizes, he offered us
some of it and insisted to share the prize with us.
We received our client wearing the same set of clothes the same as
yesterday. When he saw us, it seems that he was happy seeing us. His gait was
moderate and he always looked at the floor with his arching back. He initiates
conversation on how he groomed himself before we arrived. We went to the
pantry area for his grooming session, but he refused to. When we accompanied
him to the activity area, he was silent and wore a flat affect. But at the time he
was seated on the chair, we approached him on how he was aware and
oriented to his environment, on time and place and he was talking hard with
his arm gestures. During the activity, he showed excitement and eagerness to
win and seriously focused on the activity. After the activity we proceed for
121
another conversation and reviewed him about the recent therapy. As we go
affect have been projected by the client, but sometimes he answered late and
showed no interest.

SN: Magandang umaga Giving Recognition The client greeted back.
po Mang J.M. He shows interest for
todays activity.
C: Magandang umaga
din! (smiled) According to Henderson,
she identified 14 basic
needs one of it was
communicating with
others which is essential
to establish a therapeutic
relationship.
SN: Tara po Mang J.M Placing event in time or The client refuses for our
maglinis na po kayo. sequence grooming session.
C: hindi na,naligo na According to Abdellah,

ako kanina 2 beses. there are 21 problems she
identified and one of it is
SN: Kanina po? Anung to promote good personal
oras po? hygiene.
C: Kaninang
122
pagkagising ko 4am at
kaninang 6am.
SN: Mang JM, kilala Seeking Clarification The client recognizes his
niyo po ba ako? student nurses. This
indicates a good recent
C: Oo, ikaw si mark. memory he still
remember our names.
SN: Eh, yung isa ko pa
pong kasama? According to Johnson,
each individual has
C: Si hazel. patterned, purposeful,
that comprises a
behavioral system
specific to that
individual.
SN: Kamusta po ba ang Focusing Mang JM concentrates
tulog niyo po Mang JM? on specific topic to
gather accurate
C: Mabuti naman, information on given
nakatulog ng maayos. questions.
SN: Mabuti po yan According to Rogers, life

mang JM, anung oras po processes of human
ba kayo nakatulog? beings evolve
irreversibly and
C: Mga Bandang 7pm. unidirectional along a
space-time continuum.
SN: Nakatulog po ba
kayo ng maayos kagabi?
C: Oo.
SN: Anu pong kinain Focusing Mang JM concentrates
123
niyo kanina? on specific topic during
conversation that enables
C: Lugaw. his student nurses to get
their goal of interaction.
SN: Nabusog naman po
ba kayo sa kinain niyo? According to Abdellah,
there are 21 problems
C: Oo, nabusog ako. being identified and one
Kayo kakain din kayo of them is to facilitate
baka nagugutuman maintaince of nutrition.
kayo.
C: Kaming mga siga
doon maraming
nakukuhang pagkain kaya
hindi kami nagugutuman
doon.
SN: Anu po yun Mang Restating Mang JM had given a

JM, Siga po kayo sa chance to elaborate and
loob? to discuss more of his
C: Oo, pero hindi ako identify accurate
yung nakikipag away information.
doon, mabait ako hindi
ako nanakit. According to Parse,
human becoming is
freely choosing personal
meaning in situation in
the intersubjective
process of relating value
priorities.
SN: Mang JM alam Offering Ones Self Mang JM feels secured
niyo po ba ang gagawin to do activity for today
124
natin ngayon? because his student
nurses show willingness
C: Gagawin? to help him doing
Hmmmmag bibingo activities.
tayo ngayon di ba?
According to Peplau, in
SN: Opo Mang JM. interpersonal relationship
theory, it is important for
C: Oo,gusto ko yan. the nurse to recognize
May kornik ba? and respond to the
patients needs for help.
SN: Opo meron po
kelangan po nating
galingan para po manalo
tayo.
C: (Smiled)
SN: Tutulungan ko po
kayo sa paglalaro natin
mamaya.
SN: Mang JM, yung Giving Information The client shows better
bingo po natin ngayun understanding on what
hindi po numbers ang will happen for todays
gamit, ang mga nakalgay activity because he was
po doon is mga fruits and given appropriate
vegetables. information about the
activity.
C: Ahh ganun ba?
According to Travelbee,
SN: Opo, masaya po the nurse is responsible
yun. Magbibigay naman for helping the patient
125
po ng mga pattern po avoid and alleviate the
mamaya kung paano po distress of unmet needs
ang gagawin niyo.
C: Ahh sige.
SN: Napansin ko pong Making Observation This determines the
madalas po kayong congruence of affect and
lingon ng lingon may the mood of the client
hinahanap po ba kayo? during the conversation.
This may clarifies
C: Ahh.wala naman. student nurses perception
about the client
manifesting.

change is likely to
health status.
SN: Kamusta po Exploring Mang JM expresses his
pagbibingo niyo Mang thoughts and feelings
JM nagenjoy po ba about the activity.
kayo?
According to Watson,
C: Oo, nagenjoy ako. there is an independency
(Smiled) and integration of the
thoughts and behaviors
that make up the system.
126
Student nurse identifies
Making Observation his mood and to clarify
SN: Napansin ko pong his feelings.
masayang Masaya po
kayo, nanalo po ba According to Roy, the
kayo? degree of internal or
C: Oo, Masaya-masaya. change and the persons
2 beses ako nanalo. ability to cope with that
change is likely to
health status.
SN: Anu po plano Seeking Clarification Mang JM states his plans
niyong gawin diyan sa about his prices.
mga napanalunan niyong
mga pagkain? According to Roger,
nursing is using
C: knowledge for human
Dito?hmmm..kakainin betterment.
ko nalang mamaya.
(Smiled)
SN: Next time pong my

bingo gagalingan niyo po
para manalo po ule
kayo.
SN: Saan po ba kayo Focusing The client selected one
nakatira Mang JM? topic in order to prevent
confusion to the topic
C: Sa Orion, tapos being introduced.
merun din kaming
planeta eh. According to Peplau, it is
127
SN: Planeta po Mang Restating Mang JM had a chance to

JM? clarify his statement to
elaborate or make it
C: Oo, bukod di ba sa clearer on the side of hi
Venus, Mars, Jupiter student nurses.
Meron pang lugar doon
na planeta. According to Orem,
persons major task is to
SN: Paano po kayo maintain integrity in face
nakakapunta doon sa of these environmental
planeta niyo? stimuli.
C: May sinasakyan
kaming jet.
SN: Yung planeta niyo Encouraging Mang JM differentiated
po bang sinasabi ay Comparison the differences and
kagaya din po ng lugar similarities of earth and
natin? what he called as his
planet.
C: Oo, meron doon
farm, ako nagtatanim
doon, merun ding mga
Individuals maintain
building doon.
stability and balance
through adjustments and
adaptation to the forces
that impinges them.
The client will be able to

SN: Mang JM, baka po
prevent him to suffer
ang sinasabi niyong Presenting Reality
delusions, hallucination
128
planeta ay ang mundo po and other abnormal
natin. perception.
C: Hindi, maniwala ka According to Sullivan,

sakin meron talaga ng interaction among client
sinasabi ko. is beneficial that helps
client him to cope to
reality.
With this Mang JM was

SN: (Silence) able to organize thoughts
Using Silence and feelings. Mang JM
feels that his student
nurses were listening to
him.
SN: Sige po Mang JM, General Leads Mang JM maintains the
ano pa po ba ang mga conversation and tells
gusto niyong sabihin o more about his life.
ikuwento po samin?
C: ikuwento?hmmm.. each individual has
diyan sa acis meron diyan patterned, purposeful,
swimming pool,kami repetitive ways of acting
nagpagawa niyan. that comprises a
behavioral system
SN: Po?Talaga po Mang specific to that
JM meron pong individual.
swimming pool sa my
acis?
C: Oo, meron diyan

ayan oh!nakita mu yung
gilid na yun? Andun ang
129
pool.
SN: Mang JM, wala Presenting Reality The client will be able to
pong pool sa sinasabi prevent him to suffer
niyo, wala pong delusions, hallucination
bakanting lote doon para and other abnormal
po pagtayuan ng perception.
swiiming pool na
sinasabe niyo po. According to Roy,
viewed humans as
C: Hindi ayun oh, Biopsychosocial beings
papasok ka pa ng konti sa constantly interacting
iskinita nay un. with a changing
environment and who
cope with their
environment through
Biopsychosocial
adaptation mechanisms.
C: Dito nalang tayo,
maraming mamamatay
tao diyan.
SN: Saan po Mang JM? Exploring Mang JM gives more

information about his
C: Ayan basta diyan, perception on other
maraming masasamang person he sees. Student
tao diyan eh. nurses had chance for
data gathering.

achieve an interpersonal
relationship with the
130
facilitate the
development of the core.
Mang JM expresses
SN: Paano niyo po ba Seeking Clarification himself in away that he
nasabi yan Mang JM? provides clear statement
regarding of his thoughts.
C: Basta diyan,
magiingat kayo ah! According to Parse,
creating rhythmic
patterns or relating in
universe.
With this Mang JM was

able to organize thoughts
SN: (Silence) Using Silence and feelings. He feels
that his student nurses
were listening to him.
SN: Napansin ko pong Encourage Elaboration Mang JM clarifies certain
madalas niyo pong events of his life. He also
sinasabing maraming elaborates if someone
masamang tao diyan sa hurts him.
tabi, may nanakit po ba sa
inyo Mang JM? According to Johnson, a
steady state is maintained
C: Ahh.. wala hindi through adjusting and
naman ako pala adapting to internal and
away,hindi ako external forces.
sumasama sa mga
trouble.
131
With this Mang JM feels
SN: Uhhhhh Accepting appreciated by his
student nurses.
SN: Mang JM sa Formulating a Plan of The client provided
susunod po nating Action information necessary for
activities anu po ang our next set of activities
gusto niyo pong and the client wont be
gagawin? surprised about activities.
C: Ahh..wala According to Roy,

informing patient of facts
SN: Maaasahan pa po ba lets the patient know
namin yung pakikisama what to expect. All other
niyo po sa activities stimuli that strengthen
Mang JM? the effect of focal
stimulus.
C: Oo
SN: Maraming salamat

po Mang JM.
SN: Alam niyo pa po ba Summarizing The client was able to
ang ginawa po natin recall what the things
kanina Mang JM? weve done this day are.
It also is a sign of good
C: Oo, nag Bingo tayo. recent memory of the
Nanalo ako ng 2 beses. client.
SN: Wow, ang galing According to Peplau,

naman po pala ni Mang interpersonal process that
JM,napagusapan din po functions cooperatively
natin yung about pos a with others to make
pagiging siga niyo at ang health possible.
mga sinasabi niyo pong
132
masasamang tao.
Content Theme
We established nurse patient interaction focused primarily on how we
explained and assisted the patient in participating to the activity. The
therapy will help the patient on how to interact with other patient and how
to react on different situations presented in every part of the game.
Moreover, it serves as guide for their thoughts and behavior and on how to
act appropriately in every situation.
Interaction Theme
Mang JM responded well and reacted appropriately to the therapy
being conducted. He showed interest in participating to the game and was
very approaching to his fellow players. After the therapy, Mang JM
showed different reactions regarding on his recent activity. He responded
well on each questions being asked on him. He projected behaviors that
seemed he was agitated about his environment and gave warnings about it.
Mood Theme
Client had sudden changes on his mood depending on questions being
thrown on him. He expressed agitation, and showed different perception
about his environment. Clients movement often feels restless
133
Risk for other-directed violence related to threats as evidenced by verbal
threats of against property as evidence by:
SN: Marami po ba kayong nakain ngayon?
C: Oo, kaming mga siga marami kaming nakukuhang pagkain sa loob.
We started to greet our client a pleasant afternoon. We encouraged him to
change his clothes and cooperate on our grooming session but he always refused
to and always reason out his grooming. After that we accompanied him to the
activity area and assisted him throughout the game. After that, we conducted a
review and conversation about his recent therapy and asked his comments and
reactions about it. The conducted interaction went good.
Today we conducted an activity through which we can assess the cognitive
ability and patience of the client. We had BINGO SOCIAL using fruits and
vegetables on every card. When we informed our client about the therapy, he was
very excited. During the therapy he listened very carefully to every ball and
wanted us to assist him in every pattern of the game. The therapy went good and
he was very happy wining two times in the said therapy.
VII. Reference
Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition,
2008
134
Name of Therapy: Story Telling Therapy
Place: Under the tree (MMH)
Time: 9:30 AM
Phase: Working Phase (Day 6)
I. Objectives
1. To assessed the clients reading comprehension
2. To develop clients concentration
3. To assess client memory status
4. To exercise clients natural imagination in gaining lessons through
story.
mental illness.
communication.
4. To evaluate client understanding about the story he was read.
135
It was Friday morning when we fetched our client to the grooming area
and assisted him for the therapy. The weather is sunny, and we chose the
appropriate setting for the therapy the trees provided them sheds against the
sunlight. We were facing the client, handed them a book of Ang Kalabaw at
ang Pagong. The place was conducive for the activity and he was
comfortably seated on his chair. The procedures of the therapy were explained
to him clearly and he understood that after reading the story he should
formulate or get a moral lesson from it. We viewed the reactions and facial
expressions of Mang JM while participating in the activity and noticed that he
was interested.
We received our client wearing the same set of clothes the same as
yesterday. His gait was moderate and he always looked at the floor with his
arching back. He initiates conversation on how he groomed himself before we
arrived and refused us in grooming him again. When we accompany him to
the activity area, he was initiating stories. We accompany him to the activity
area and was seated on a chair facing us. During the activity, he showed
interest in reading the story. After the activity we proceed for another
conversation and reviewed him about the recent therapy. As we go along on
our conversation, different behaviors were manifested, congruent affect have
been projected by the client, but sometimes he answered late.
136

SN: Magandang umaga Giving Recognition The client looks back
po Mang J.M. with a smile. He shows
interest for todays
C: Magandang umaga activity.
din! (Smiled and
Nodding) According to Peplau, the
initial interaction
between the nurse and
the patient wherein the
latter has a felt need and
expresses the desire for
professional assistance.
SN: Tara po Mang J.M Placing event in time or The client refuses for our
maglinis na po kayo. sequence grooming session
wherein he says sequence
C: Hindi na,naligo na of activity he did in the
ako kanina 2 beses. morning.
SN: Kanina po? Anung According to Abdellah,

oras po? she identified 21
problems and one of it is
C: Kaninang to promote good personal
pagkagising ko 4am at hygiene.
kaninang 6am.
SN: Mang JM, napansin Making Observation The client responds
ko pong hindi niyo appropriately and accepts
pinapalitan ang damit the implied without
niyo? misunderstanding what
his nurse said.
137
C: (Smiled and Nodding)
change is likely to
health status.
Mang JM had given a

SN: Sana po susunod Humor break of something funny
kung may pamilit po to decrease tension
kayo ng damit magpalit between our
po kayo Mang JM. Para conversations.
po mas gwapo kayo lalo.
health care needs are
C: (Nodding)
needs for comfort,
arising from stressful
cannot be met by
recipients traditional
support system.
SN: Kilala niyo po ba Seeking Clarification The client recognizes his
ako Mang JM? student nurses.
C: Oo, si Mark. According to Orem, self

care requisites are
SN: Ang galling naman insights of actions that a
po pala ni Mang JM, eh person must be able to
yung isa niyo pa pong meet and perform in
student nurse, anu po order to achieve well
138
pangalan? being.
C: Si hasel.
SN: Hazel po Mang

JM.
SN: Kamusta po ba ang Focusing Mang JM concentrates
tulog niyo po Mang JM? on a single point picking
Nakatulog po ba kayo ng up on topics or areas
maayos kagabi? given by nurse.
C: Mabuti naman, According to Peplau, it is

nakatulog ng maayos. one way of establishing
SN: Mabuti po yan the client and the nurse.
mang JM, anung oras po
ba kayo nakatulog?
C: Mga Bandang 9pm,

may mga tugtugan kasi
kayo eh
SN: Uhhhhnapanuod Accepting This indicates that Mang

niyo po pala ang JMs student nurses
kasiyahan naming accepts and understands
kagabi. Mang JM said. The client
feels appreciated because
the student nurses were
listening to him.
According to Roger,
patterns identify human
being and reflect their
139
innovative wholeness.
SN: Natatandaan niyo Seeking Clarification The client still
pa po ba kung anu po ang remembers activity
ginawa natin kahapon weve done yesterday.
Mang JM?
According to Orem, self
C: Ahh nagbingo. care requisites are
insights of actions that a
SN: Opo Mang JM, person must be able to
nanalo po ba kayo? meet and perform in
order to achieve well
C: Oo, nanalo ako. being.
SN: Ngayon po Mang Giving Information The client was provided

JM may activities po ule necessary information
tayong gagawin, ang about the activities to be
tawag po sa gagawin done for today. Mang JM
natin ngayon ay demonstrates better
storytelling. understanding about the
activity.
C: Oo, gusto ko yun.
According to Roy,
SN: Sige po Mang JM informing the patient
mamaya po ipapaliwanag know what to expect. All
po ng facilitator yung other stimuli that
gagawin. strengthen the effect of
the focal stimulus.
C: (Smiled and Nodding)
SN: Mang Jm kaya niyo Offering Ones Self The client may feel
po ba magbasa? comfortable to do
therapy.
C: Oo.
According to Peplau, in
140
SN: Sige po Mang JM interpersonal relationship
kapag po nahirapan po theory, it is important for
kayo tutulungan po the nurse to recognize
naming kayo sa and respond to the
babasahin niyo. patients needs for help.
C: Salamat. (Smiled)
SN: Mang JM sino po Exploring The client demonstrates a
uli ang bida sa kwentong sense of understanding
binasa niyo? on the story.
C: Ahh..si kalabaw at si According to Watson,

pagong? The carabao and there is an independency
the turtle. and integration of the
SN: Anu pong masasabi thoughts and behaviours
niyo sa binasa niyo that make up the system.
ngayon Mang JM?
C: Maganda, si pagong
ang nanalo sa karera nila
ni kalabaw.
SN: Kayo po ba Mang Focusing The client concentrates to
JM naranasan niyo na po the topic during the
bang makipagkarera? conversation.
C: Hindi pa eh, pero According to Peplau, it is

nakasakay na ako sa one way of establishing
kalabaw. Ako kasi ang of interaction between
nagpapastol ng kalabaw the client and the nurse.
samin noon.
SN: Talaga po Mang Voicing Doubt With this, the client will
141
JM? Kayo po ang be able to explain more
nagpapastol ng kalabaw of his thoughts to prove
noon? the truth which is not
provided in the chart.
C: Oo.
According to Roger,
nursing is using
knowledge for human
betterment.
General Leads Mang JM continuously

SN: Sige po Mang JM telling some of his past.
magkwento pa po kayo. And kept conversation on
the right tract of
C: Yun tuwing umaga communication.
gumigising ako ng maaga
para magpastol at According to Parse,
mangisda. human becoming is co-
creating rhythmic
universe.
SN: Anu pong natutunan Focusing The client concentrates to
niyo sa binasa niyo Mang the topic and evaluates
JM? Mang JMs
understanding on what he
C: Uhhmmwag lagi just read.
magaaway, dapat
nagbibigayan. According to Peplau, it is
142
SN: Sa pamilya niyo po Seeking Clarification Mang JM was able to
ba Mang JM may clarify things about his
nagaaway? family.
C: Wala, kasi lahat kami According to Roger,

mabait walang kaaway. nursing is using
Hindi kami pumapatay, knowledge for human
Hindi kami kumukuha ng betterment.
babae.
SN: Ano pong dahilan at

nasabi niyo pong hindi
kayo pumapatay Mang
JM?
C: May masasama
kasing tao doon sa labas,
kumukuha ng mga babae
sa mga bahay. Hindi
kami yun.
SN: Napansin ko pong Making Observation Mang JM emphasizes

madalas niyong masabi and clarifies some of his
na maraming masamang sayings in which there is
tao diyan, anu po bang better explanation of
dahilan? what he just said.
C: Marami kasi diyan According to Roy, the

pumapatay. degree of internal or
change is likely to
143
health status.
SN: Kayo po ba Mang Exploring Mang JM tells more
JM, may nakaaway na? about himself.
C: Ako? Hindi ako baka According to Henderson,

yung isang JM yun patay patients require help
na yun towards achieving
independence.
SN: Patay na po? Restating The client clarifies

himself about he just
C: Oo, ako mabait ako said. And capable of
wala akong kaaway wala determining if there is
ako inaaway. wrong about he said.
According to Abdellah,
nursing care is person
directed towards self
love.
SN: Mang JM, sa Giving Information Mang JM was provided

susunod pong linggo information that is
wala po kami kasi po essential to the care for
may pagsusulit po kami. him. The client manifests
understanding about our
C: Ahh Oh sige sige. absence for next week.
SN: Pagkatapos po ng According to Roy, a

linggo na yun babalik po person is an open
kami at kukuhanin po adaptive system who
144
namin kayo tuwing uses coping skills to deal
tanghali naman po kami with stressor.
noon.
C: (Nodding)
SN: Mang JM sa Formulating a Plan of Mang JM was being
susunod po nating Action prepared for our activity
pagkikita may gagawin for the next meeting.
po uli tayong mga
activities na mageenjoy According to Roy,
po kayo. Anu po ba gusto informing patient of facts
niyong gawin natin? lets the patient know
C: Ahh..wala naman stimuli that strengthen
basta yung Masaya. the effect of focal
stimulus.
SN: Maaasahan pa po ba
namin yung pakikisama
niyo po sa activities
Mang JM?
C: Oo
SN: Maraming salamat

po Mang JM.
SN: Alam niyo pa po ba Summarizing The client was able to
ang ginawa po natin recall what the things
kanina Mang JM? weve done this day are.
It also is a sign of good
C: Oo, nag Story Telling recent memory of the
tayo. Tungkol kay client.
Pagong at Kalabaw.
145
SN: Wow, ang galing interpersonal process that
naman po pala ni Mang functions cooperatively
JM,napagusapan din po with others to make
natin yung sa sinasabi health possible.
niyo pong kamuka
niyong c Mang JM.
Content Theme
We established nurse patient interaction focused primarily on the story
telling therapy in which the client reads the story then identify the moral
lesson on the story assigned to them. With this therapy, we can assess their
memory and their cognitive ability on how they explain what the story had
told them.
Interaction Theme
During the therapy we noticed that he had different ideas in
deciphering the story. While reading, we reviewed his memory by asking
the recent events and details in the story. After that, we had our
conversation to assess what were the lessons he learned by reading the
story. Some of his answers were irrelevant to the situation and he will put
some stories of his own which were not related to the storytelling therapy.
He didnt concentrate on the story because he had his own stories that he
wanted to discuss with us. He can recall every detail of the story but a little
146
different from the original events. We can say that he didnt enjoy the
therapy that much. Hes only active when hes discussing his own story.
Mood Theme
During our interaction to the client, Mang JM responded well to the
questions although there are some unrealistic answers. He always observed
his environment when hes not being asked. He projected appropriate
moods and behaviors but his attention was concentrated on his
environment.
Disturbed Thought Process Related to misinterpretation as evidenced by:
SN: Ano po ang dahilan at nasabi nyo po na hindi kayo pumapatay:
C: May masasama kasing tao doon sa labas kumukuha ng mga babae sa bahay,
hindi kami yun.
We encourage Mag Jm to perform the Routine Grooming. We ask him to
participate to the activity that we will going to conduct today. W encourages him
to verbalize his feeling regarding the therapy. We asked him to read the story and
formulate his own lesson that he gain in the story. We encourage Mang Jm to
verbalize the thing on his mnd to be able for as to assess any problem that he feels.
147
In the Friday afternoon, as we received the client, Mang JM, he presented a
smiling face and a happy mood. He refused us to groom him, again, so we proceed
to the activity area for the story telling therapy. The client was very cooperative
on the conducted activity that afternoon. He was able to identify the moral lesson
in the story though it was not clearly explained to us because of his flight of
different ideas. He was very agitated around his environment.
He also verbalized feelings of concern openly with us.
VII. Reference
2008
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia.
Lippincott, Williams and Wilkins. (5th Edition
148
Name of Therapy: Food Festival
Place: Canteen (MMH)
Date: February 2, 2011
Time: 2:00 PM
I. Objectives
1. To improve the socialization skills of the patient
2. To develop clients self-esteem
3. To assess clients ability in following procedures
4. To assess the clients memory
mental illness.
communication.
It was a fine sunny day of Wednesday around 2:00 in the afternoon of
February 2, 2011 when we received our client. He first greeted us with a smile
149
and initiated to go to the pantry area which was a good thing. We let him
groom himself in the area and after his grooming we proceed to the canteen
for their activity. The place was clean and the seats were arranged semi circle
facing the table where the facilitators will do their demonstration of the
activity.
They were oriented in time, place and date and the procedure of the
activity were explained very clearly for the benefit of orderliness of the
activity. A brief conversation and review were conducted after the activity to
assess what he had learned and to check his recent memory. At around 4:00
pm, we returned our client to his dorm after the therapy and the conversation.
Boysen shirt and green patterned shorts which was the same two weeks ago.
He greeted us with a smile and initiated to go to the pantry room. His gait is
moderate and was looking to the floor at times. He brushed his teeth very hard
and requested a cologne and powder to finish his grooming session. After that,
we accompany him to the activity area and noticed that he was very excited
and always smiled at everyone. During the program, he was actively
participating and behaved well. He was serious and focused himself to the
procedures. He was able to compute the total price of all the ingredients used
in the food festival. After the program, we conducted a brief session to review
what he has learned to observe some improvements in his behavior. As we go
150
affect have been projected by the client. We observed that he was very happy
and excited about his discharge soon.

SN: Magandang umaga Giving Recognition The client smiled and
po Mang JM greeted back that suggest
he is comfortable with us.
C: Magandang umaga din
naman. (Smiled and According to Peplau, the
Nodding) initial interaction between
the nurse and the patient
wherein the latter has a felt
need and expresses the
desire for professional
assistance.
SN: Tara na po sa pantry Offering ones Self Mang JM feels that his
Mang JM para nurses were here just for
makapaglinis po kayo. him.
C: Hindi naligo na ako According to Peplau, in

kanina pa 2 beses. interpersonal relationship
theory, it is important for
SN: Tara na po doon para the nurse to recognize and
po makapaghugas na po respond to the
kayo ng kamay niyo umihi patients needs for help.
po kasi kayo eh
C: oh sige.
151
SN: Para na din po mas
maging gwapo po kayo
Mang JM.
C: (Smiled)
SN: Kamusta po kayo Broad Opening The client encourages
Mang JM? being bad by a response of
what he wants to state on
C: mabuti naman, any cues of
masaya. communication.
According to Watson, it is
important to help the
patient identify his own
gain better understanding
of his self.
SN: Anu pong dahilan at Focusing The client was happy
masaya po kayo Mang because we fetch him in
JM? his dorm.
C: wala naman, dahil According to Watson,

nakalabas ako ulit sa there is an independency
ward. and integration of the parts
and elements of thoughts
and behaviours that make
up the system.
SN: Nakikilala niyo pa po Focusing The client still remembers
ba ako Mang JM? who we are including our
name which means that he
C: Oo, ikaw si Mark. had a good immediate
memory.
SN: eh, yung isa ko pa
152
pong kasama? According to Watson,
there is an independency
C: Uhmmm...hahosy? and integration of the parts
Hasi? and elements of thoughts
and behaviours that make
SN: Hazel po Mang JM. up the system.
C: Ay, oo nakalimutan ko
kasi.
SN: Kamusta po ba ang Focusing The client still remembers
tulog niyo Mang JM? the time he fell asleep last
night.
C: Mabuti naman.
According to Watson,
SN: Anung oras po kayo there is an independency
nakatulog kagabi? and integration of the parts
and elements of thoughts
C: 8pm. and behaviours that make
up the system.
SN: Natatandaan niyo pa Seeking Clarification The client still remembers
po ba yung ginawa natin the things weve done for
last last week po? the last 2 weeks.
C: Oo, Bingo at yung According to Orem, self

pinakita yung care requisites are insights
mgapictures. of actions that a person
must be able to meet and
SN: Ilan beses po kayo perform in order to
nanalo Mang JM sa achieve well being.
bingo?
C: dalawa.
SN: Alm niyo po ba yung Giving Information The client provided
153
gagawin po natin ngayon information necessary for
Mang JM? the activities of the today.
C: Oo, magagawa tayo ng According to Roy,

mga pagkain. informing the patient
know what to expect. All
SN: Opo Mang JM, other stimuli that
tuturuan po naming kau strengthen the effect of the
gumawa ng buko salad. focal stimulus.
SN: Kamusta po ang Exploring The client verbalizes his
paggawa niyo ng buko feelings about the activity
salad Mang JM? being done for today.
C: ahh... mabuti naman. According to Watson,

there is an independency
SN: Magkano po ule and integration of the parts
yung lahat lahat ng and elements of thoughts
magagastos para sa and behaviours that make
paggawa po ng buko up the system.
salad?
C: 118.
SN: Galing naman po

pala.
SN: Kayo po ba Mang Asking Direct Questions The client shared what she
JM nung hindi pa po kayo does before she was
napupunta ditto nagluluto admitted at Mental.
p okay sa bahay niyo ng
pagkain? According to King, a
person has ability to record
C: oo naman,tulad ng their history through their
hotdog, isda atbp. own language and
154
symbols.
SN: Kasipag naman po
pala ni Mang JM.
C: (Smiled)
SN: Mang JM, ngayon Exploring The client verbalizes his
pong malapit na ang feelings about a girl she
valentines may plano po wants to give flower for
ba kayong pagbigyan ng the coming valentines
flowers? day.
C: Wala pa nga eh, hirap According to Maslow, one

kasi baka may boyfriend must feel the sense of love
na o may asawa na ang and belongingness
babae eh.

nasabi niyong mahirap?
C: wala naman, ikaw

marami ka ng napagbigyan
ng rosas noh?
SN: Halimbawa po Mang Role Playing We ask the client to
JM si Hazel po yung gusto consider people and events
niyong babae anu po gusto in light of his own
niyong sabihin sakanya? appraisal in order for him
to express his feelings.
C: uhmm...mahal na
mahal kita, aalagaan kita According to Orem,
ng mabuti. persons major task is to
maintain integrity in face
SN: Wow ang sweet of these environmental
naman po pala ni Mang stimuli.
155
JM eh.
C: (Smiled)
SN: Sa ngayon po ba Exploring The client verbalizes his
Mang JM may plano na po feelings about marrying
ba kayo magasawa someone.
paglabas niyo dito?
According to Maslow, one
C: Ahh...wala, babalik must feel the sense of love
ako sa trabaho ko. and belongingness
SN: Saan po kayo

tutuloy?
C: Sa nanay ko.
SN: Di ba po Mang JM Seeking Clarification The client had a chance to
nasabi niyo pong napunta re- evaluate what he just
na po kayo sa America? said.
C: Oo, sa mga ninong According to Orlando, it is

ko. important for the client to
know that he has heard.
SN: Anu pong mga With this the client will
ginawa niyo doon? make her feel accepted.
C: Naginom sa mga bar.

SN: Sa pakikipag inuman Humor The client was able to
niyo po sa America wala decrease his anxiety in a
po ba kayo nakakilalang way that we give some of
babae doon? humors in order for him to
verbalize.
C: Wala eh.
156
SN: Talaga po Mang JM? health care needs are needs
Ayaw niyo lang po ata for comfort, arising from
mag- share eh? stressful health care
situations that cannot be
C: (Laughing) met by recipients
traditional support system.
SN: sige na po Mang JM
i-Share niyo na po yan.
C: Wala nga. (Smiled)

SN: Mang JM bukas po Formulating Plan of The client was provided
magkikita po tayo uli ang Action information in order for
activity po natin bukas ay him to be prepared on
dance therapy, anu po ba what the things will be
ang gusto niyong dance done and the things to
step? expect.
C: basta bukas nalang. According to Roy,

(Smiled) informing patient of facts
lets the patient know what
SN: Anu pa po ba gusto to expect. All other stimuli
niyong tugtog para pos a that strengthen the effect
sayaw natin bukas? of focal stimulus.
C: Kahit ano basta yung

masaya.
SN: Mang JM, anu- ano Summarizing The client has a good
po uli mga gnawa po natin recent memory, he recalled
ngayong araw? the things being done for
today. It helps to bring out
C: food festival, sinabi important points of the
niyo kung magkano ang conversation and
mga sangkap. activities. It increases
157
awareness and
SN: Galing naman pop understanding of both
ala ni Mang JM. participants. This provides
as a sense of closure at the
C: (Smiled) discussion.
According to Orem,
Supportive- educative
helping patient to learn
self care and emphasizing
on the importance of
nurses role.
SN: Mang JM, ano po ang Evaluation Evaluation allows the
masasabi niyo sa ginawa client to evaluate the
natin kanina? outcome of the conducted
therapy.
C: natutuwa ako dahil

marami akong na tutunan.
IV. Theme identification
Content Theme
We established nurse patient interaction focused primarily on the food
festival in which the patient demonstrated procedures in preparing buko
salad. This therapy will provide the client the stimulus to assess their
158
ability to follow procedures and do it independently and creatively.
Moreover, it serves as guide for their thoughts and behavior.
Interaction Theme
During the therapy while the facilitators were explaining the
procedure, he was focused on every detail. But when his fellow clients
demonstrate their procedure he seemed bored and not interested. When his
turn to demonstrate, he did it very well. After the therapy, we had our short
conversation to review his memory about the recent activity and to assess
what the therapy has taught him and to assess for any improvements in his
behavior. He responded well in every question thrown at him and showed
interest in the conversation.
Mood Theme
During the conversation, he showed appropriate moods and affect
congruent to the questions being asked. He often smiled and laughed and
seldom looked away to divert his attention. He had a good eye contact
while having our conversation and his statements were clearly
represented.
Readiness for enhanced coping related to verbalization of feelings as evidence
by:
SN: Mang JM, ano po ang masasabi niyo sa ginawa natin kanina?
C: natutuwa ako dahil marami akong na tutunan.
159
We fetched Mang JM from the ward and we received a warm smile
from him. He initiated to go to the pantry area so we had the chance to groom
him. He did grooming himself and asked for cologne and powder without
changing his clothes though we always encouraged him to do so. During the
activity, we assisted him in preparing the food. And after that we had a short
conversation to identify his improvements in the past weeks of therapy.
On February 2, 2011 we conducted another therapy to help them work
independently following procedure. The facilitators of the said therapy oriented them before
doing every procedure. Mang JM looked excited for his turn to make his own version of buko
salad. He was able to identify the total amount of all the ingredients needed in the therapy.
While the facilitators were demonstrating every procedure he was listening very well and
focused on every detail of the procedure while others were doing their turns in re-
demonstrating the procedures he seemed bored and not interested while silently
demonstrating every procedure, he did it very well and was given recognition for it. Before
eating his meal, he offered his meal to everyone and he wanted to share his meal with us. He
enjoyed eating his meal and appreciated it very much.
After the therapy, we conducted brief conversation about the recent activity. He was
none initiating that time and was looking around his environment. He said that the food
festival was good and it would help him get stronger for the day. Eye contact was lacking that
time because his attention was drowned around his environment. His memory was good
160
because he identified the ingredients of the salad with its corresponding prices. He returned to
the dorm with gratitude and appreciation.
VII. Reference
NANDA 10th edition
Psychiatric-Mental Health Nursing 5th Edition
161
Name of Therapy: Dance Therapy
Time: 1:30 PM
I. Objectives
1. To develop the clients self esteem
2. To improve the clients interpersonal relationship with others and to
reduce anxiety
3. To assess and develop his movement and coordination
illness.
communication.
162
It was a Thursday of February 3 when we received our client. We
conducted another activity called Dance Therapy. We prepared seats in a
straight line and oriented them before doing the therapy. After the facilitators
greeted and explained every procedures of the therapy, we showed them the
whole dancing activity before teaching them step by step. After teaching them
the steps, they performed the dance to the other clients while assisting them
how to. They were given great recognitions after the dance therapy and were
deeply appreciated. After the program, we gave the client something to eat and
drink to regain his energy and conducted the conversation for assessing
improvements. At around 4:00 pm, we returned our client to his ward after the
therapy and the conversation.
We received our client wearing his clothes with MMHs male uniform.
The uniform was colored blue and semi-wrinkled. He greeted us with a smile
and proceed to grooming area but he didnt want to be groomed so we insisted
him to do so. His gait is moderate and was looking to the floor at times. He
washed his face rigidly and brushed his teeth very hard and requested a
cologne and powder to finish his grooming session. After that, we accompany
him to the activity area and noticed that his affect was somehow flat and
steadily looking at the floor. During the program, he is silent and seldom
smiled while doing the steps. He was serious and focused himself to the
activity. His memory was sharp because he can recognize each step easily and
his movement and coordination was good.. After the program, we conducted a
brief session to observe some improvements in his behavior while eating his
163
merienda. As we go along on our conversation, different behaviors were
manifested, congruent affect have been projected by the client. We observed
that he was very happy and excited about our conversation on his past
relationships.

SN: Magandang Giving Recognition Mang JM looks back and
Tanghali po Mang J.M. greeted us. This shows
that he is comfortable to
C: Magandang Tanghali us.
din
According to Peplau
(1952), a nurse is
stranger to the patient. It
is therefore important to
remind the patient who
we are and be consistent
with the information we
are giving to him to gain
their trust.
SN: Tara na po sa pantry Offering Ones self The client feels the
para po makapag linis po presence of his student
kayo Mang JM. nurses.
C: hindi na naligo na According to Henderson,

ako kanina. unique function of the
nurse is to assist the
SN: Tara na po doon individual, sick or well,
164
kahit po maghilamos at in the performance of
toothbrush nalang po those activities
kayo. contributing to health or
its recovery that he
C: Sige. would perform unaided if
he had the necessary
strength, will, or
knowledge.
SN: Mang JM ano pong Seeking Clarification The client recognizes his
pangalan ko? student nurses.
C: Ahh..ikaw si Mark. According to Sullivan,

interaction among client
SN: Eh!yung kasama ko is beneficial that helps
po sino po yun? client him to cope to
reality.
C: Si Hazel.
SN: Galing naman po

pala ni Mang JM
natatandaan yung
pangalan naming
C: (nod)
SN: Mang JM bukas po Giving Information The client has provided
last day na po namin necessary information for
kayong maalagaan. him to expect what will
happen for the following
C: Ah, maraming days.
salamat po sa pagaalaga
sakin. According to Leiningers,
nursing is a learned
SN: Walang anu man po humanistic and scientific
165
Mang JM,pagkatapos po profession and discipline
kasi ng bukas hindi niyo which is focused on
napo uli kami makikita. human care phenomena
and activities in order to
C: Sige. assist, support, facilitate,
or enable individuals or
groups to maintain or
regain their well being in
culturally meaningful
and beneficial ways.
SN: Natatandaan niyo Exploring Mang JM remembered
pa po ang ginawa natin things we did yesterday.
kahapon Mang JM? And able nurses to check
his recent memory.
C: Oo, gumawa tayo ng
salad kahapon. According to Hall, major
SN: Ano po ang achieve an interpersonal
masasabi niyo sa ginawa relationship with the
niyong salad? individual that will
facilitate the
C: Masarap. development of the core.
SN: Natatandaan niyo

pa po ba ang mga
sangkap na ginamit
natin?
C: Buko, gulaman,
cream.
SN: Alam niyo po ba Giving Information The client has provided
ang gagawin natin necessary information for
ngayon Mang JM? him to expect what will
166
happen for todays
C: Oo, magsasayaw activity. Mang JM shows
tayo. understanding of activity.
SN: Opo, galing naman According to Orem,

po pala ni Mang JM. nurses actions are to
help the client
C: (Smiled) develop/learn their own
self-care abilities through
SN: Yung tugtog po knowledge, support and
natin ay 2012, alam niyo encouragement.
po bay un Mang JM?
C: Hindi eh, anu ba

yun?
SN: O sige po mamaya

po paparinig ko po sa
inyo.
SN: Kaya niyo po bang Focusing Mang JM concentrates
sumayaw Mang JM? on specific topic during
conversation and
C: Oo. expresses that he can
dance.
SN: Sumasayaw po ba
kayo nung kabataan According to Abdellah,
niyo? one step in identifying
the clients problem is to
C: Oo, sumasali kami sa continue observing and
mga dance contest. evaluation the patient to
identify attitude and cues
SN: Talaga po Mang affecting his behavior.
JM?
167
C: Nung High School.
Mang JM continuously
SN: Sige po Mang JM, General Leads expressing and telling
magkuwento pa po kayo whats on his mind. And
tungkol sa kabataan able to recall his early
niyo? life.
C: CAT din ako dati. According to Parse,

creating rhythmic
universe.
This therapeutic
SN: Oh? Talaga po Voicing Doubt communication is used
Mang JM? because there is no
pertinent data was
C: Oo, ako yung gathered including chart
nagsasabi ng harap sa reading that will proved
kaaaanan, harap sa if the client statement is
kaliiiiiwa. true or not.
SN: Wow! Ang galing According to Roy, the

naman po pala niyo Mang degree of internal or
JM. external environmental
change is likely to
health status.
SN: Edi sumasali din po Humor Mang JM had given a
168
kayo niyan sa mga Mr. & break of something funny
Ms.? to decrease tension
between our
C: Ay, hindi. Hindi man conversations.
ako gwapo eh. (Smiled)
SN: Talaga po ba Mang health care needs are
JM?PaHumble lang kayo needs for comfort,
eh arising from stressful
C: Hindi, hindi talaga. cannot be met by
(Laughed) recipients traditional
support system.
SN: May naging Focusing The client concentrates
girlfriend po ba kayo on specific topic
noon? necessary to gather
information on his early
C: Oo meron si Cristina life.
Dee.
According to Hall, The
SN: Gaano po kayo major purpose of care is
katagal ng gf niyo? to achieve an
interpersonal relationship
C: Mga 6 years din. with the individual that
will facilitate the
SN: Anu pong dahilan at development of the core.
naghiwalay po kayo?
C: eh!nakuha siya ng
ibang lalaki eh.
SN: Ganun po ba? Anu

po ginawa niyo para po
169
maka- move on?
C: wala, may minahal

kasi ako agad nun.
SN: Sino po? Anu pong

pangalan? Paano po kayo
nagkakilala?
C: Si Ella Iribe
magkapit- bahay kami
dun sa sampaloc.
SN: Hanggang ngayon

po ba kayo pa?
C: Ay, hindi na
nagkahiwalay kasi kami
umuwi ako ditto sa
bataan siya naman sa
pangasinan.
SN: Sa tagal po ng Focusing Mang JM was able to
naging relasyon niyo, concentrate and pick a
may nangyari po ba sa single topic to prevent
inyo? confusion and flight of
ideas.
C: Ahh..wala wala.
(Smiled) According to Peplau, it is
SN: Talaga po Mang Making Observation Mang JM emphasizes
170
JM? Npansin ko pong iba and clarifies his gestures
ang ngiti niyo ayaw niyo in which there is better
lang po ata magkwento explanation of what he is
eh. expressing.
C: (Naughty Smiled) According to Roy, the

SN: Anu po Mang JM? external environmental
C: Hindi hindi wala ability to cope with that
nangyari talaga, touch change is likely to
touch lang. (Smiled) determine the persons
health status.
SN: Anu pong dahilan?
Ayaw niyo po ba?
C: Hindi mahirap na
kasi eh, tsaka aral na
muna. Silence It permits the client to
become aware that others
SN: (Silence) do not necessarily
perceived events in the
same way. These will
make the client re-
organize and prevent
overloading.
SN: Mang JM, may Exploring Mang JM gives more
fraternity po ba kayong information about his
sinalihan? early life. Student nurses
had chance for gathering
C: Tau Gamma Phi, more data.
APO.
171
SN: anu po bang mga purpose of care is to
gingawa doon Mang achieve an interpersonal
JM? relationship with the
C: Hinahampas ka ng facilitate the
mga paddle nila habang development of the core.
may sinasabi ka.
SN: Edi kasama po kayo

sa mga trouble?
C: Ahh.. hindi ako

sumasali doon.
SN: Nakatikim po ba Seeking Clarification Mang JM denies the use
kayo Mang JM ng of marijuana.
Marijuana?
C: Hindi, bawal samin Each individual has
yun. patterned, purposeful,
SN: Khait konti po di that comprises a
niyo po natikman yun? behavioral system
specific to that
C: Hindi. individual.
SN: Mang JM Formulating Plan of Mang JM was prepared
natatandaan niyo pa po ba Action for tomorrows activity
ang dance steps natin? and he provided
information about our
C: Oo naman. (Smiled) last day.
SN: Bukas dapat mas According to Roy,

gagalingan niyo pa po informing patient of facts
ang pagsayaw ah! lets the patient know
172
C: (Nodding) stimuli that strengthen
the effect of focal
SN: Anu po ba gusto stimulus.
niyong palaro bukas sa
grand socialization?
C: Kahit ano.
SN: O sige po Mang Jm

basta po gagalingan niyo
sa mga palaro po para po
manalo kayo ng mga
prices naming inihanda.
C: (Nodding)
SN: Maasahan pa po ba
namin ang inyong
kooperasyon Mang JM?
C: Oo. (Smiled)
SN: Ow Mang JM Summarizing The client was able to
natatandaan niyo pa ba recall what the things
ang ginawa natin weve done this day are.
ngayong araw? It also is a sign of good
recent memory of the
C: Opo, sumayaw tayo. client.
SN: Opo very good po According to Peplau,

Mang JM, pinagusapan interpersonal process that
din po natin ngayong functions cooperatively
araw tungkol sa mga with others to make
173
naging Girlfriends niyo at health possible.
kung anu pa po ang mga
ginawa niyo nung mga
kabataan niyo.
C: Oo.
SN: Basta po Mang JM

bukas po ang last day
naming pagkatapos po
nun hindi niyo na o uli
kami makikita.
C: (Smiled)
Content Theme
We established nurse patient interaction focused primarily on dance
therapy in which the facilitators oriented the clients on how the activity
will flow. Each student nurses taught their clients the steps for the dance
therapy while assessing their movements, coordination, and behavior.
Interaction Theme
During the therapy while the facilitators were explaining the
procedure, he was focused on every detail. While teaching him the steps
and at the same time having a conversation with him, his affect was a little
flat and seldom smiled. He only smiled when he was given recognition. He
174
responded well in every question thrown at him and showed interest in the
conversation.
Mood Theme
During the program where he presented to the other client what steps he
has learned in the dance, he was very proud and always smiled at the
audience. During the conversation, he showed appropriate moods and
affect congruent to the questions being asked. He seldom smiled and
laughed and looked on his environment while doing the steps. He had a
good eye contact while having our conversation after the therapy and his
statements were clearly represented.
Ineffective denial related to fear of consequences on negative past experiences
as evidence by:
SN: Anu po ginawa niyo para po maka- move on?
C: wala, may minahal kasi ako agad.
We received our client wearing the same clothes but with MMHs male
uniform as his topper. We assisted him in his grooming session and
encouraged him to change his clothes. After that, we accompanied him to the
activity area and orient him for the preparedness and orderliness of the
activity. We taught him steps in the dance activity while assessing his
behaviors and movements. The client was given a chance to present his dance
175
to his fellow clients ad was given recognitions and appreciations after that. A
brief conversation was conducted after the activity and he was reminded that
tomorrow will be our last conversation and meeting. We fetched him to the
male ward afterwards.
On February 3, we conducted a therapy where in we taught the patient how to
dance while assessing their movement and coordination and developing their self
esteem. We oriented the client about the therapy and showed them the steps. Mang
JM seemed uninterested and very silent while watching the performance.
During the therapy Mang JM showed flatness of affect and non initiating
behaviors. When learning every step, he can easily memorize each.
After teaching the steps, Mang Jm performed the dance in front of his fellow
clients. We noticed that he had sudden change of moods. While performing, he was
happy and proud performing in front of his audience. We didnt have a hard time
assisting him in performing because he memorized all the step.
After the program, we had a conversation and review his reactions about the
therapy. The conversation manifested that he didnt enjoyed the practice. He only
enjoyed performing.
VII. Reference
2008
176
Grand Socialization
Place: MMH
Time: 9:00 AM
Phase: Termination Phase (Day 9)
I. Objectives
1. To stimulate mind and body through socialization to other clients.
2. To develop the self esteem of the client
3. To assess the improvements of the patient in following instructions
4. To assess the memory of the client
5. To terminate the relationship.
illness.
communication
It was a sunny day of Friday of February 4, 2011 when we conducted
the Grand Socialization for all the patients handled by the BPSU nursing
177
students. Everyones busy decorating the place with red balloons, and multi
colored crepe papers. The music committee was all set up. The games,
programs and prizes were properly arranged. The chairs were arranged in 3
straight lines in front of the sound system facing the Grand Socialization
tarpaulin. The place was enough to accommodate all the patients and students
and was conducive for the activity.
Boysen shirt and green patterned shorts topped with blue male ward uniform.
He greeted us with a smile and reminded us that it was our grand socialization
day today. His gait is moderate with his arching back. He brushed his teeth
very hard and washed his face very thoroughly. After that, we accompany him
to the activity area. During the program, he was actively participating and
behaved well. During the games, he always raised his hands and always
willing to participate in the game. He was serious and focused himself to each
and every instructions of the game. When he won, he put his prizes inside of
his shirt. And when his fellow clients won the game, he was snatching some of
the prizes of his fellow patients. During the program, he was very happy. After
the program, we conducted a brief session to observe some improvements in
his behavior. As we go along on our conversation, different behaviors were
manifested, congruent affect have been projected by the client. We observed
that he was very happy and satisfied on what his experiences on the grand
socialization brought him.
178

SN: Magandang Umaga Giving Recognition The client smiled and
po Mang J.M. greeted back that suggest
he is comfortable with
C: Magandang Umaga us.
din naman. (Smiled)
According to Peplau
(1952), a nurse is
stranger to the patient. It
is therefore important to
remind the patient who
we are and be consistent
with the information we
are giving to him to gain
their trust.
SN: Tara na po sa pantry Offering Ones self The client feels the
para po makapag linis po presence of his student
kayo Mang JM. nurses.
C: hindi na naligo na According to Henderson,

ako kanina. unique function of the
nurse is to assist the
SN: Tara po individual, sick or well,
maghilamos at toothbrush in the performance of
nalang po kayo. those activities
contributing to health or
C: O sige. (Smiled) its recovery that he
would perform unaided if
SN: Para po mas gwapo he had the necessary
po kayo ngayon. strength, will, or
179
knowledge.
SN: Oh! Mang JM anu Seeking Clarification The client recognizes his
po pangalan ko? student nurses.
C: Mark. According to Orem, self

care requisites are
SN: Eh, eto pong insights of actions that a
kasama ko? person must be able to
meet and perform in
C: Si Hazel. (Smiled) order to achieve well
being.
SN: Galing naman po
pala ni Mang JM eh.
SN: Mang JM last day Giving Information The client has provided
na po namin ngayon. necessary information for
him to expect what will
C: Oo nga. happen for the following
days.
SN: Pagkatapos po nito
hindi na po tayo
magkikita. According to Roy,
informing the patient
C: Oo, basta wag niyo know what to expect. All
sana kami other stimuli that
makakalimutan. strengthen the effect of
the focal stimulus.
SN: Syempre naman po
Mang Jm.
SN: Natatandaan niyo Exploring The client verbalize
pa po ang sayaw natin feelings concerning the
kahapon Mang JM? activity will be done
today.
180
C: Oo naman, diba ayun
ang gagamitin natin sa According to Henderson,
sayaw mamaya. one of the 14 basic needs
of an individual is
SN: Opo Mang JM, playing/ participating in
basta wag niyo pong various forms of
kakalimutang ang sign ng recreation.
pogi ah!
C: Oo. (Smiled)
SN: Sasabayan naman Offering Ones Self The client feels secured
namin kayo sumayaw and confident for the
mamaya. coming dance number.
According to Maslow,
one must fulfill safety
needs in order for him to
have self actualization.
SN: Alam niyo po ba Seeking Clarification The client has good
ang huling activity po recent memory. The
natin ngayon Mang JM? nurse has the chance to
re- evaluate clients
C: Oo naman, Grand remote memory.
Socialization.
According to Orem,
SN: Opo, magaling po nurses actions are to
Mang JM, ngayon po help the client
natin sasayawin yung develop/learn their own
sayaw natin kahapon po. self-care abilities through
knowledge, support and
C: Oo sige sige. encouragement.
SN: Gusto niyo po ba ng Focusing The client focuses to the
181
kornik Mang JM? topic that has been
introduced.
C: Oo, meron ba?
According to Parse, there
SN: Opo meron po, pero are three assumptions of
syempre po hindi po becoming a human being
naming basta basta one of those was human
ibibigay yun sa inyo becoming is freely
Mang JM kailangan po choosing personal
sumali po kayo sa mga meaning in situation in
games para po makakuha the intersubjective
kayo ng mga prices. process of relating value
priorities.
C: Ahh ganun ba?O sige
sige.
SN: Gagalingan niyo po

Mang JM ah, para po
makakuha kayo ng
maraming prices.
C: sige sige. (Smiled)
SN: (Silence)
SN: Nag- enjoy po ba Exploring The client shared his
kayo ngayon Mang JM? feelings about the games
for the previous
C: Oo nagenjoy ako. socialization.
SN: Kamusta po ba
According to Orem, self-
yung mga palaro? Nanalo
care comprises those
po ba kayo?
activities performed
182
C: Oo ito ito marami independently by an
ako napanalunan. individual to promote
and maintain person
SN: Wow, galing naman well-being.
po pala ni Mang JM.
C: (Smiled)
SN: Sabi ko po sa inyo

eh basta gagalingan niyo
lang sa games mananalo
kayo.
C: Salamat
salamat.(Smiled)
SN: Anu po bang Seeking Clarification Mang JM expresses
masasabi niyo ngayon himself about what he
Mang JM? did for today.
C: Masaya, at nanalo According to Johnson,

ako. Each individual has
SN: Galing naman pop repetitive ways of acting
ala ni Mang JM eh. that comprises a
behavioral system
C: (Smiled) specific to that individual
SN: Kamusta po kayo Asking Direct Questions The client recognizes her
ng unang niyong ex girlfriend as a part of
girlfriend Mang JM si his past.
Cristina Dee?
According to King, a
C: Ahh wala hindi ku na person has ability to
siya nakikita at record their history
183
natatawagan eh. through their own
language and symbols.
hindi niyo na siya
tinatawagan?
C: wala na kasi ako

kontak niya eh tsaka
hindi kun a din alam
kung may asawa na siya
ngayon eh.
SN: Nung nagbreak po Seeking Clarification Mang JM able to recall
kayo ng una niyong his past and determine
girlfriend ano pong his last 15 years of life.
ginawa niyo para
makapag- move on po According to Johnson,
kayo? Each individual has
C: Hindi kami nagbreak, repetitive ways of acting
cool off lang. (Smiled) that comprises a
behavioral system
SN: Ay, ganun po ba? specific to that
Eh anu pong nangyari? individual.
C: Wala may minahal

kasi akong iba.
JM? May sumunod po be able to explain more
pala sakanya. of his thoughts to prove
the truth which is not
C: Oo kapitbahay ko provided in the chart.
siya doon sa Manila si
184
Ella Iribe. According to Roger,
nursing is using
knowledge for human
betterment.
SN: Hanggang ngayon Exploring Mang JM tells the

po ba kayo pa din? sequence of his past
relationship.
C: Hindi na, nagkalayo
kasi kami, umuwi ako According to Watson,
ditto sa Bataan siya there is an independency
naman sa Pangasinan. and integration of the
SN: Ngayon po ba may thoughts and behaviours
communication pa po ba that make up the system.
kayo?
C: Wala hindi na baka

may asawa na yun.
SN: Mang JM nakapag Asking Direct Questions Mang JM answers the
try na po ba kayo ng question directly and
Drugs? O ng marijuana appropriate for taking of
po? information. The client
denies use of marijuana.
C: Ay, hindi hindi.
SN: Anu pong dahilan stressed the importance
Mang JM? of nurses ability to
understand own
C: Eh! Bawal kasi samin behaviour to help others
yun, tsaka nakita mu ba identify perceived
yung iba may mga galis difficulties.
galis dahil sa drugs yun.
185
JM? be able to explain more
of his thoughts to prove
C: Oo, maniwala kayo the truth which is not
masama sa katawan yun, provided in the chart.
mabait ako.
According to Roger,
nursing is using
knowledge for human
betterment.
SN: Mang JM bukas po Formulating Plan of Mang JM was prepared
hindi niyo na po kami Action for our last duty. He
makakasama. demonstrates
understanding and ability
C: Oo nga eh, sana hindi to cope for our
kayo makalimot. termination phase.
SN: Syempre hindi po According to Roy,

namin kayo informing patient of facts
makakalimutan Mang lets the patient know
JM, ngayon pong last day what to expect. All other
namin anu pong plano stimuli that strengthen
niyo sa susunod pong the effect of focal
magiging student nurse stimulus.
niyo?
C: wala naman alagaan

din nila ako tulad niyo.
SN: Sige po Mang JM,

sana po maasahan pa din
po ng susunod na batch
186
ang kooperasyon niyo.
C: Opo, sige sige

maraming salamat at sana
makapasa kayo sa board
exam.
SN: Mang JM Summarizing Mang JM able to recall
natatandaan niyo pa po ba all our set of activities for
ang mga ginawa natin sa the whole time of duty.
mga nakaraang lingo? This shows that Mang
JM was learned from us.
C: Oo, nagpakita ng
mga pictures tulad ng According to Peplau,
doctor, nurse at shoe interpersonal process that
maker, nagbasa ng mga functions cooperatively
story, at nagbingo po with others to make
nanalo ako ng 2 beses. health possible.
(Smiled)
SN: Bukod pa po diyan

anu pa po ginawa natin?
C: Ginawa? Hmm
naggawa ng salad,
nagsayaw at ngayon
grand socialization.
SN: Ang galling po

talaga ni Mang JM.
187
A. Theme identification
Content Theme
The therapy was all about developing the interpersonal relationship of
the client with others and assess his improvements throughout the
whole 3 week therapies.
Interaction Theme
Mang JM participate well to the game. He was very cooperative and able
to listened to the instruction. He was able to remember all the step we
taught him yesterday. During our last conversation with him he maintained
his eye contact with us. He said thank you to us.
Mood Theme
During the conversation, he showed appropriate moods and affect
congruent to the questions being asked. He often smiled and laughed and
seldom looked away to divert his attention. He had a good eye contact
while having our conversation and his statements were clearly represented.
Risk for loneliness related to termination of relationship with nursing students.
SN: Mang JM last day na po namin ngayon.
C: Oo, basta wag niyo sana kami makakalimutan.(looks sad)
188
IV. Nursing Interventions
In Hildegard Peplau, Phases of nurse client relationship, termination phase is
the final stagein the nurse-client relationship. Both nurse and client usually have
feelings about ending the relationship; the client especially may feel the
termination as an impending loss.
We plan a grand socialization for our client where they will enjoy the food ang
games we prepare for them. We encourage Mang JM to participate in the game;
this will help him to develop his confidence in facing crowd. We perform a dance
number with our client. During our conversation with Mang JM, we encourage
him to verbalize his feeling regarding the termination of our relationship with him,
by doing this we can evaluate what he feel about the termination. We encourage
Mang JM to verbalize what are the things he learn from the therapy we previously
done, by doing this we can evaluate if we solve the problem of Mang JM and if
we become an effective student nurses. We tell Mang JM that we enjoy the time
we spent with him.
V. Summary and Evaluation
This was the last day that we had our care and conversation with the patient.
He seemed very happy during the grand socialization day. We let him participate
in the games and won many times. He kept his prizes inside his clothes and some
of it was shared to others. While eating his meal, we had the chance to talk to him
189
for the last time and to explain to him that this was the last day where we can able
to care, talk to him and do activities.
He understood the termination of the care and wished that we wont forget him.
VI. Reference
Lippincot. Williams and Wilkins. (5th Edition).
Octavino Eufemia F., and Balita, Carl E> (2008). Theoretical Foundation of
Nursing> Balikan Prints and Binding Enterprises.
190
PHARMACOLOGY
191
Name of Drug Mechanism Contraindication Indication Adverse Nursing
of Action Effect Consideration
Generic May act by Contraindicated > patient > mild 1. Monitor

Name: antagonizing in patient with with restlessness mood changes.
dopamine hypersensitivity schizophrenia > headache Assess for
Risperidone and to drug suicidal
serotonin in > bipolar tendencies
the central mania especially
nervous during early
system > irritability therapy
symptoms of
Brand Name:
aggression 2. Observe
toward patient when
Risperdal
others, administering
deliberate medication to
self-injury, ensure that
Classification:
and temper medication is
tantrums swallowed and
Anti-psychotic
associated not hoarded.
with autistic
(atypical
disorder 3. Monitor
antipsychotic)
patient for
onset of
extrapyramidal
Dosage,
side effect.
Route,
Report these
Frequency:
symptoms;
reduction of
2mg tab,
dosage or
PO, BID
discontinuation
of medication
may be
necessary.
192
Name of Mechanism Contraindica Indication Adverse Nursing
Drug of Action tion Effect Consideration
Generic Unknown. >hypersensiti >symptom >confusio 1. Monitor patient

Name: Thought to vity to drug atic n for onset of
block treatment akathisia which
Haloperido postsynaptic > severe of may appear
l dopamine central psychotic within 6 hour of
receptors in nervous disorders first dose and
Brand brain. system may be difficult
Name: Inhibiting depression >schizophr to distinguish
signs and enia in from psychotic
Haldol symptoms of > Parkinsons patients agitation
psychosis disease who need
Classificat prolonged 2. Assess mental
ion: parental status
anti- (orientation,
Anti- psychotic mood, behavior)
psychotic therapy prior to and
periodically
(typical > during therapy
antipsychot psychotic
ic) disorders 3. Observe
patient when
>hyperacti administering
Dosage, vity medication to
Route, ensure that
Frequency > manic medication is
: states swallowed and
not hoarded.
1amp, 5mg
IM
193
Name of Drug Mechanis Contraindica Indication Adver Nursing
m of tion se Consideratio
Action Effect n
Generic Exerts its No absolute > used for >dry 1. watch out
Name: actions contraindicati the mouth for seizures
through a ons treatment
Levomeproma central of 2. caution in
zine adrenergic- psychosis, combining
blocking, a particular levomeproma
dopamine- those of zine with
blocking, a schizophre other
serotonin- nia, and anticholinergi
blocking, manic c drugs
Brand Name: and a phases of
anticholiner bipolar 3. monitor
Nozinan gic disorder vital signs
blocking
Classification
:
Anti-psychotic
Dosage,
Route,
Frequency:
10mg tab,
HS
194
Name of Drug Mechanism Contraindication Indication Adverse Nursing
of Action Effect Consideration
Generic It inhibits the > With known >maintenance > dizziness 1. careful
Name: central hypersensitivity therapy of > observation
monoamine to the chronic headache for early
Flupentixol receptors, thioxanthenes schizophrenic symptoms of
particularly patients tardive
the dopamine > presence of whose main dyskinesia
D and D CNS depression manifestations
receptors. due to any cause, do not include 2. Observe
Brand Name: Therefore, it comatose states excitement, patient when
increases the agitation or administering
Fluanxol amount of hyperactivity medication to
serotonin and ensure that
noradrenaline medication is
that control swallowed and
mood and not hoarded.
thinking, and
Classification: improve
mood
Anxiolytic
Antidepressive
Mood
stabilizer
Dosage,
Route,
Frequency:
1cc, IM
195
Name of Mechanism Contraindi Indication Adverse Nursing
Drug of Action cation Effect Consideration
Generic Block >hypersensit > acute and >dry 1. assess

Name: dopamine ivity to drug chronic mouth mental status
receptors in psychoses prior to and
Chlorpromaz the brain, > should not particularly periodically
ine prevention of be used in when during therapy
seizures patients who accompanie
have CNS d by 2. Observe
Brand depression increased patient when
Name: psychomoto administering
r activity medication to
Thorazine ensure that
medication is
swallowed and
not hoarded.
Classificatio
n: 3. monitor for
development of
Anti- neuroleptic
psychotic malignant
syndrome
(typical (fever,
antipsychotic respiratory
) distress,
tachycardia,
seizres)
Dosage,
Route,
Frequency:
500mg 2tabs,
HS
196
UNIT V
(Psychotherapy)
197
Psychotherapy
198
Name of Therapy: Role Identification Therapy
Time: 9:30 AM
DEFINITION
This therapy uses a picture of people and their different kind of occupation.
This therapy involves identifying the different kinds of occupation in the picture and
also explaining their role in the society.
OBJECTIVES
To enhance the thinking and analyzing ability of the client.
To analyze and determine the knowledge and understanding of clients with
occupation roles.
To gain knowledge
PROCEDURES
1. First the leader will initiate the mood of the client.
2. Then the facilitator is responsible for asking questions to the client. They
will ask the client if they know what the picture is and what is represents.
199
3. If the client has wrong answer, the facilitator will correct them.
4. After that the clients was distributed to their own nursing student for
individual discussion of the pictures.
5. Finally the leader will gather the patient for evaluation of the therapy.
ANALYSIS AND INTERPRETATION
Mang JM cooperates well and actively. He answered the questions according
to his own intellectual capacity. He always laughed at his inmates whenever he felt
that their answer was wrong.
According to Roy, through two adaptive mechanisms, regulator and cognator,
an individual demonstrates adaptive responses or ineffective responses requiring
nursing interventions.
200
Name of Therapy: Bingo Social Therapy
Time: 9:30 AM
DEFINITION
This therapy is like the usual bingo we played. Instead of numbers, fruits and
vegetables were used in the game. This therapy is used for assessing knowledge of the
mentally-ill patients about fruits and vegetables.
201
OBJECTIVES
To improve the socialization skills of the patient
To develop the self-esteem of the clients
To assess the knowledge perception of the client about different fruits and
vegetables.
To assess the memory of the client
PROCEDURES
1. Orient the client about various types of fruits and vegetables.
2. Explain the mechanics and therapy simple briefly and clearly
3. Encourage the client to participate in the entire theory
4. During the working phase give recognition to the winning clients and provide
prizes.
5. Summarized and evaluate the therapy
With this kind of activity, we used fruits and vegetables on every BINGO
cards. Instead of numbers when we informed our client about the therapy, he was very
excited. He was very eager to win and get the prize. During the therapy, he listened
very carefully to every ball and wanted us to assists him in every pattern at the game.
The therapy went good and he enjoyed the game and very thankful for winning it.
According to King, perceptions, judgments and actions of the patient and the
nurse lead to reaction, interaction, and transaction (Process of nursing)
202
Name of Therapy: Storytelling
Place: under the tree (MMH)
Time: 9:30 AM
DEFINITION
The book that is use is about the animals and it is short that the client will not
get bored reading it. It also have picture that show what the characters are doing.
Story telling is done to assess the reading comprehension of the client and his ability
to formulate his own moral lessons that he gain to the story.
OBJECTIVES
To assessed the clients reading comprehension
To develop clients concentration
To assess client memory status
PROCEDURE
1. First the facilitator will explain to the client the name of the therapy
2. The facilitator will tell to the client the short story they will go to read.
3. The two student nurses will show to the client the short story they will go to
read.
4. The client will read the tagalong versions of the story
203
5. The student nurses will asked the client what is the moral study of the story.
Today, the therapy was all about storytelling. We let the client read the story
and get lessons from it. During the therapy, we noticed that he had different ideas in
deciphering the story. We asked him questions to review every detail of the story.
Some of his answers were irrelevant to the situations and he will put some stories not
related to the storytelling therapy.
He didnt concentrate on the therapy because he had his own different stories
that he wanted to discuss with us. He can recall some of details in the stories but a
little different from the original one. We can say that he got bored reading the story
and during the therapy. Hes only active discussing his own stories.
According to Pender, Identifies cognitive, perceptual factors in clients which
are modified by demographical and biological characteristics, interpersonal
influences, situational and behavioral factors that help predict in health promoting
behavior.
204
Name of Therapy: Food Festival
Time: 2:00 PM
DEFINITION
Food festival is a therapy done in order for the client to have basic knowledge
in preparing foods. This is done to assess the clients ability in following procedures
and to assess their memory while they are socially incline with other patients. This
would help them to work independently and creatively.
OBJECTIVES
To improve the socialization skills of the client
To develop the self-esteem of the client
To assess the clients ability in following procedures
To assess clients memory
PROCEDURES
1. Prepare all the ingredients needed.
2. Discuss every detail of the therapy.
205
3. Inform the client about the each ingredient with their corresponding price.
4. Demonstrate the procedure.
5. Allow the client to make their own salad.
6. Evaluate their works
On February 2, 2011 we conducted another therapy to help them work
independently following procedure. The facilitators of the said therapy oriented them
before doing every procedure. Mang JM looked excited for his turn to make his own
version of buko salad. He was able to identify the total amount of all the ingredients
needed in the therapy. While the facilitators were demonstrating every procedure he
was listening very well and focused on every detail of the procedure while others
were doing their turns in re-demonstrating the procedures he seemed bored and not
interested while silently demonstrating every procedure, he did it very well and was
given recognition for it. Before eating his meal, he offered his meal to everyone and
he wanted to share his meal with us. He enjoyed eating his meal and appreciated it
very much.
After the therapy, we conducted brief conversation about the recent activity.
He was none initiating that time and was looking around his environment. He said
that the food festival was good and it would help him get stronger for the day. Eye
contact was lacking that time because his attention was drowned around his
environment. His memory was good because he identified the ingredients of the salad
with its corresponding prices. He returned to the dorm with gratitude and
appreciation.
206
According to Peplau, interpersonal theory nurse assumes several roles which
empower and equip her in meeting the needs of the patient .Teaching Role Gives
instruct ions and provides training; involves analysis and synthesis of the learners
experience.
207
Name of Therapy: Dance Therapy
Time: 1:30 PM
DEFINITION
This therapy is done to assess the clients movement and coordination, as well
as his ability to memorize every step. This therapy is intended also to relieve their
anxiety and to create recreation. This is also done to develop the clients socialization
to others.
OBJECTIVES
1. To develop the clients self esteem
2. To improve the clients interpersonal relationship with others and to reduce
anxiety
3. To assess and develop his movement and coordination
6. To implement therapeutic plan necessary for improvement of mental illness.
7. To develop positive coping behavior through therapeutic communication.
208
ANALYSIS & INTERPRETATION:
On February 3, we conducted a therapy where in we taught the patient how to
dance. We orient the patient about the therapy and showed them the dance. Mang JM
seemed uninterested and very silent while watching the steps of the dance.
During the therapy, Mang JM showed flatness of affect and non initiating
behaviors while we were teaching him every step. He can easily do the steps and
memorized each very well though he seemed silent throughout the entire practice.
After teaching the steps Mang JM performed the dance in front of his fellow
clients. We noticed that he had sudden change of mood while performing. He was
happy and proud while dancing. We didnt have a hard time assisting him in his
performance because he memorized every step.
After the program, we had a conversation and review his reactions about the
therapy. The conversation manifested that he didnt enjoyed the practice of the dance
and enjoyed his performance only.
According to Wiedenbach the Art of nursing includes understanding patients
needs and concerns, developing goals and actions intended to enhance patients ability
and directing the activities related to the medical plan to improve the patients
condition.
209
UNIT VI
(Glossary)
210
GLOSSARY
Acute Dystonic Reaction- extreme contraction of the jaw muscles, which can result
in dislocation of the jaw bones and difficulty in opening the mouth. These symptoms
may be caused by an adverse reaction to an antipsychotic drug.
Affect- is the outward expression of the clients emotional state.
Affective disorder- refers to disorders of mood.
Agnosia is a loss of ability to recognize objects, persons, sounds, shapes, or smells
while the specific sense is not defective nor is there any significant memory loss.
Akathisia- Motor restlessness ranging from a feeling of inner disquiet, often localized
in the muscles, to an inability to sit still or lie quietly.
Alcohol Abuse- use of alcoholic beverages to excess, either on individual occasions
("binge drinking") or as a regular practice.
Alogia - Poverty of speech, as commonly occurs in schizophrenia.
Ambivalence- presence of two opposing feelings.
Amnesia - refers to the loss of memory
Anhedonia- loss of interest in pleasurable things.
Antipsychotic Drugs- class of medicines used to treat psychosis and other mental and
emotional conditions.
Anxiety- is a psychological and physiological state characterized by somatic,
emotional, cognitive, and behavioral components. Anxiety is considered to be
a normal reaction to a stressor. It may help a person to deal with a difficult situation
211
by prompting one to cope with it. When anxiety becomes excessive, it may fall under
the classification of ananxiety disorder.
Aphasia- loss or impairment of the power to use or comprehend words.
Apraxia- inability to carry out purposeful motor activities.
Autistic Thinking- preoccupation with inner thoughts, daydreams, fantasies, private
logic; egocentric, subjective thinking lacking objectivity and connection with external
reality.
Avolition- lack of motivation.
Blunting is an objective absence of noral emotional rersponses, without evidence of
depression.
Bradykinesia- neurologic condition characterized by a generalized slowness of motor
activity.
Clang Association- the sound of the words gives direction to the flow of thought.
Concrete Thinking- predominance of actual objects and events and the absence of
concepts and generalizations.
Defense mechanism- unconscious psychological strategies brought into play by
various entities to cope with reality and to maintain self-image. Healthy persons
normally use different defenses throughout life. An ego defense mechanism becomes
pathological only when its persistent use leads to maladaptive behavior such that the
physical and/or mental health of the individual is adversely affected.
Delusions- a fixed, false belief not based in the reality.
212
Denial- failure to acknowledge an intolerance thought, feeling, experience or reality.
Depersonalization- feeling of strangeness towards ones self.
Depression- a condition of general emotional dejection and withdrawal, sadness
greater and more prolonged than that warranted by any objective reason.
Disorientation- a state of mental confusion characterized by inadequate or incorrect
perceptions of place, time, or identity. Disorientation may occur in organic mental
disorders, in drug and alcohol intoxication, and, less commonly, after severe stress.
Displacement- the redirection of feelings to a less threatening object.
Dopamine- monoamine neurotransmitter formed in the brain from the amino acid
tyrosine essential for the healthy functioning of the central nervous system it has
effects on emotion, perception and movement.
Echolalia- pathological repetition of words of others.
Echopraxia- the pathological imitation of posture/ action of others.
Family Conflict- conflicts that occur within a family-between husband and wife,
parents and children, between siblings, or with extended families (grandparents, aunts,
uncles, etc.)
Fantasy- conscious distortion of unconscious feelings or wishes.
Fixation- arrest of maturation at certain stages of development.
Flat Affect A severe reduction in emotional expressiveness.
Flight Of Ideas- shifting of ideas from one subject to another in a somewhat related
way.
213
Fugue- a person suddenly, without planning or warning, travels far from home or
work and leaves behind a past life.
Genetics- study of hereditary traits passed on through the genes.
Group Therapy- form of psychotherapy that involves sessions guided by a therapist
and attended by several clients who confront their personal problems together.
Hallucination- false perceptions or perceptual experiences that do not really exist.
Illogical Thinking- thinking of something with out a logical reason or explanation.
Immediate Memory- what you can repeat immediately after perceiving it.
Immediate Recall- retrieval of events or information from the past.
Impulsive- characterized by actions based on sudden desires, whims, or inclinations.
Inappropriate Affect- an emotional tone or outward emotional reaction out of
harmony with the idea, object, or thought accompanying it.
Insanity- a deranged state of the mind usually occurring as a specific disorder.
Intellectualization- over use of intellectual concepts by an individual to avoid
expression of feelings.
Introjections- symbolic assimilation or taking into ones self a loved/ hated object.
Labile Mood- when a persons feelings or mood frequently fluctuates.
Mental Illness- is a psychiatric disorder that results in a disruption in a person's
thinking, feeling, moods, and ability to relate to others.
Motor Hyperactivity- a general restlessness or excess of movement.
214
Motor Hypoactivity- abnormally inactive.
Mortality Rate- measure of the number of deaths in some population.
Neologism- pathological coining of new words.
Occupational Stress- physical or psychological disorder associated with an
occupational environment and manifested in symptoms such as extreme anxiety, or
tension, or cramps, headaches, or digestion problems.
Paranoid Schizophrenia- characterized by persecutory (feeling victimized) or
grandiose delusions, hallucinations, and occasionally, excessive religiosity(delusional
religious focus)or hostile and aggressive behaviour.
Peer Pressure- social pressure by members of one's peer group to take a certain
action, adopt certain values, or otherwise conform in order to be accepted.
Pharmacological Treatments- curing and treating illness that deals in the science of
nature and action of drugs and medicines.
Phobia- an exaggerated and often disabling fear usually inexplicable to the subject
and having sometimes a logical but usu. an illogical or symbolic objects or situation.
Prevalence Rate- total number of cases of a specific disease in existence in a given
population at a certain time.
Prognosis- foretelling of the probable course of a disease.
Projection- attributing to others ones unconscious wishes/ fear.
215
Psuedoparkinsonism- reversible syndrome resembling parkinsonism that may result
from the dopamine-blocking action of antipsychotic drugs. Also known as drug-
induced parkinsonism.
Psychotherapy- treatment of mental and emotional disorders through the use of
psychological techniques designed to encourage communication of conflicts and
insight into problems.
Rationalization- justifying ones actions which are based on other motives.
Reaction Formation- expression of feelings that is the direct opposite of ones real
feelings.
Recent Memory- ability to recover information about past events or knowledge.
Regression- returning to an earlier level of development in the face of stress.
Remote Memory- ability to remember things that happened years ago.
Repression- unconscious forgetting.
Schizophrenia- a form of mental illness in which there is a withdrawal from reality.
It cannot be defined as a single illness; rather, schizophrenia is thought of as a
syndrome or disease process with many different varieties and symptoms.
Self- Inflicted Injury- act of harming oneself.
Stress- body's reaction to a change that requires a physical, mental or emotional
adjustment or response.
Sublimation- the rechanneling of unacceptable instinctual drive with one that is
acceptable.
216
Substance Abuse- excessive use of a substance.
Substitution- replacing the desired unattainable goal with one that is attainable.
Suicidal Behavior- deliberate action with potentially life-threatening consequences.
Suppression- Conscious forgetting a deliberate process of thought blocking.
Symbolism- less threatening object is used to represent another.
Tardive Dyskinesia- chronic disorder of the nervous system characterized by
involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually
developing as a late side effect of prolonged treatment with antipsychotic drugs.
Undoing- an attempt to erase an act, thought, feeling or desire.
Violent Behavior- a person harms themselves or others.
Withdrawal- the act of taking back or away something.
Word Salad- incoherent mixture of words and phrases.
217
UNIT VII
(References)
218
References
Books
NANDA 10th edition. Psychiatric-Mental Health Nursing 5th Edition
Octavino Eufemia F.and Balita, Carl E> (2008). Theoretical Foundation of
Nursing> Balikan Prints and Binding Enterprises.
Sia, Maria Loreto. Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition, 2008
Lippincot. Williams and Wilkins. (5th Edition).
Electronics
Colburn, Rebekah. Understanding schizophrenia: A guide to the signs, symptoms
and causes. (http://www.suite101.com/content/understanding-schizophrenia---brain-
disorder-a214502)
Glickman, Ian Ph.D. Occupational Stress 12 Burnout.
(http://ezinearticles.com/?Occupational-Stress-12---Burnout&id=2246896)
Hambrecht, Martin and Hfner, Heinz. Substance abuse and the onset of
schizophrenia. (http://www.biologicalpsychiatryjournal.com/article/S0006-
3223(95)00609-5/abstract)
Hawes Liisa. The Ins and Outs of Peer Pressure. Calgary's Child Magazine
Calgary, Alberta, Canada.
(http://www.calgaryallergy.ca/Articles/English/peerpressure.html)
219
UNIT VIII
(Documentation)
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Paranoid Schizophrenia Case Study

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Paranoid Schizophrenia Case Study

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Paranoid

Alonzo, Mizzy Anne

I. Dedication and Acknowledgement..

Mental Status Assessment / Analysis and Interpretation

a. Nursing Care Plans...

This work is dedicated to our parents, family relatives and friends.

Without their patience, understanding, support

and most of all love, the completion

of this work would

not have been

Also, it is dedicated to our colleagues

who will conduct the

And lastly, to our GOD who

provide us knowledge and

First and foremost, we would like to thank to our Almighty God,

who gives us strength, knowledge, and good health in

pursuing this comprehensive

support and motivations at all times and

they also serves as our

We would like also to acknowledge our clinical instructor

Sir Ronald Tyron dela Rosa for the support,

patience, knowledge, and contributions

to finish this comprehensive

We would like also to thank Sir Ronnell Dela Rosa

and Maam Irish Lee for helping and giving

some encouragement to make our duty

possible and able to enjoy

our stay in Mariveles.

Schizophrenia is a mental disorder characterized by the disturbances in thoughts,

sensory perception and deterioration in psychosocial functioning. It is also characterized by a

accompanied by hallucinations particular auditory variety, and perceptual alterations.

Paranoid Schizophrenia is manifested primarily through impaired thought processes, in which

in most cases grandiose, persecutory or both. (WHO 2005)

concentration or dull emotions. Still, paranoid schizophrenia is a serious, lifelong condition

that can lead to many complications, including suicidal behavior.

Midwest are almost equal. (Medical Disability Advisor, 2010)

institutionalization gender differences only for paranoid schizophrenia (Salokangas et al.,

decreased dopamine, stress, alcohol abuse and substance abuse.

Paranoid schizophrenia is usually treated with a combination of therapies, tailored to

opportunities for socialization for individuals with paranoid schizophrenia.

The reason of choosing paranoid schizophrenia as study is to add knowledge, and to

dancing around the issue in the shadow of these pervasive misconceptions.

primary information that we needed in conducting this study.

Civil Status: Separated

Religion: Roman Catholic

Place of Birth: Sampaloc, Manila

Date of Birth: September 3, 1966

Address: #42 Pag-asa Orion, Bataan

Occupation prior to admission: Police in Bureau of Custom

Education: Vocational Graduate

Date and time of admission: November 20, 2007 / 2:00 pm

Previous admissions: November 2, 1989- December 18, 1991

December 15, 1992 December 18, 1992

December 11, 1195- August 31, 1996

August 23, 1997- June 21, 1998

January, 1999- February 25, 2000

February 28, 2000- January 12, 2004

May 29, 2004- September 19, 2007

Attending Physician: Dr. Cortez

Place where he spent the last 15 years of his life:

(1990s)Manila, Lubao, Bataan;

Informant: JMs cousin

Mang JM admitted on November 20, 2007 due to ff: