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Wesleyan University- Philippines

Mabini Extension, Cabanatuan City


Case Study
Mental Affiliation in National Center for Mental Health




Submitted by:
, ,
(Bsn3-4)







Submitted To:

Concept
Instructor


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Table of Contents
I. INTRODUCTION
a. Overview 3
b. Definition of Related terms 3
c. Signs and Symptoms Manifested by the Client...3
d. Defense Mechanism Used.. 3
II. PATIENTS HISTORY
a. Personal data 3
b. Marks4
c. Chief Complaints 4
d. Past Health History..4
e. Present Health History.... 4
f. Family History .................5
g. Review of System ...........5
h. Lifestyle and Health Practices- 24H day Description..5
i. Developmental Stage.....6
III. COLLECTING OBJECTIVE DATA
a. Course of Confinement............. 6
i. Medications Administered since date of admission ... 6
ii. Diagnostic Test since Date of Admission................. 14
IV. PYSCHOPATHOPHYSIOLOGY ..................15
V. NURSING CARE PLAN.................18
References...................19



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I. INTRODUCTION
a. Overview

Patient S.A. has been admitted on April 17. 2013 at 2:03 pm. A 43 years old Female
with a final diagnosis of Paranoid schizophrenia.
Schizophrenia is a chronic, severe, and disabling brain disorder that has affected
people throughout history.
Paranoid schizophrenia is one of several types of schizophrenia, a chronic mental
illness in which a person loses touch with reality (psychosis). The classic features of
paranoid schizophrenia are having delusions and hearing things that aren't real.
With paranoid schizophrenia, your ability to think and function in daily life may be
better than with other types of schizophrenia. You may not have as many problems
with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a
serious, lifelong condition that can lead to many complications, including suicidal
behavior.

b. Definition of Related terms
Schizophrenia- is a group of severe brain disorders in which people interpret
reality abnormally. Schizophrenia may result in some combination of
hallucinations, delusions, and disordered thinking and behavior.
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, particularly of the auditory
variety, and perceptual disturbances. Disturbances of affect, volition, and speech,
and catatonic symptoms, are not prominent.

c. Signs and Symptoms Manifested by the Client
According to client: Delusion of Grandeur (hearing her name in the TV and Radio)
Argumentativeness (yelling to other people)
Short tempered
Violence (trying to give her medication to her 7 yr. old daughter)
Auditory Hallucination (someone was commanding her)

d. Defense Mechanism Used:
Denial and Suppression

II. PATIENTS HISTORY
A. Personal Data
i. Name: Patient S.A.
ii. Age: 43 years old
iii. Gender: Female
iv. Birthday: May 16. 1970
v. Birthplace: Maligaya, Banni, Pangasinan
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vi. Civil Status: Single
vii. Address: Maligaya, Banni, Pangasinan
viii. Phone Number: -none as stated-
ix. Educational Level: College Graduate
x. Occupation: None
xi. Race/ Ethnic Group: Tagalog
xii. Religion: Iglesia ni Cristo
xiii. Nationality: Filipino
xiv. Citizenship: Filipino citizen
xv. Language spoken: Tagalog
xvi. Source of information: Chart of Patient
xvii. Reliability: 99%
xviii. Companion upon admission: Father
xix:

b. Marks
Moles: at Right Arm
Left side face
Right eye
Left deltoid
Abrasion in the Nape area

c. Chief Complaints:
i. Chief Complaint upon admission:
According to her Father- Dalawang araw nang hindi umiinom ng gamut
Kung ano-anong kababalaghan gingawa nya
Umaalis ng Bahay
Itapon sa kubeta yung bottle para pakuluan
Pinainom sa anak niya ang gamut niya

ii. Final Diagnosis: Paranoid Schizophrenia

d. Past Health History:
According to Chart:
The Patient is Re-admitted to the National Center for Mental Health

According to The Patient:
- She first experienced the symptoms of schizophrenia 14 years ago She knows
when her illness will attack by having an illusion of grandeur (shes hearing her
name in television and radio)
- 6 months after birth of her 2
nd
child, she experienced the symptoms of
schizophrenia and lack herself in the room every time she will experience the
symptoms.

e. Present Health History:
The patient is aware of having an illness which is the reason why she is currently
hospitalized and she is being paranoid in the past. The patient remembers everything in
the past including being locked in a room and tied with a rope by her father.
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f. Family History:
She was 2
nd
out of four siblings in the family. Her father was a farmer who sold
vegetables in the market. She was not closed to her mother, and her mother-in-law is
the one who sends her money for her children although she and father of her children
are not married.

g. Review of System
1. Skin, Hair & Nails-
Skin Brown (normal)
Hair- Black (presence of Lice and Pus)
Nails- Pinkish
2. Head and Neck
Head- No headache reported
Neck- with abrasion in the nape area
3. EENT & Sinuses
Ears- No drainage or ringing ears reported
Eyes- Blurred Vision when reading (Farsighted)
Nose- No discharges
Throat- No pain or hoarseness of voice felt
4. Chest and Lungs
Chest- No pain reported
Lungs- No shortness of breath or pain reported
5. Heart, Neck Vessels & Central CVS
Heart- No pain, distress or palpitations felt
Neck vessels- are not distended.
Cardiovascular System- No tightness, edema, or orthopnea reported
6. PVS
With no varicosities
7. Abdomen
No abdominal pain, bowel movements are good, with linea nigra
8. Anus, Rectum
Anus- No itchiness or lesion reported
Rectum- No itchiness or lesion reported
9. Musculoskeletal System and Extremities
No muscle pain, stiffness or swelling felt
10. Neurologic
With dizziness and weakness as reported

h. Lifestyle and Health Practices- 24H day Description

ii. Activity & Exercise
She walks in corridor
iii. Rest and Sleep
The client claimed shes lack of sleep every night because of the bed bugs
(surot), lice and pus at the occipital area
iv. Medication and Supplements
The Client takes her ant-psychotic medications religiously
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v. Self-concept and self care
The client is aware of her illness
vi. Social activities
The patient was called as nanay by the younger pavilion 3 younger
patient. She claimed that she understands the other patient because they
are also ill.
vii. Spiritual, Cultural, Values and Belief System
The patient said she was an Iglesia ni cristo member
viii. Education and work
She was a Education College Graduate.
ix. Stress Level and Management/ Coping Stress
Patient A claimed when she is angry, her paranoia will occur She talks
loudly and shouts at her family but never harmed them.
x. Environment & Neighborhood
Patient S.A. said that the other patient are friendly while she cannot
understands the others because of their talkativeness ant apathetic.

i. Developmental Stage
i. Theory: Erik Ericksons Psychosocial Development
Generativity vs. Stagnation (Middle adulthood 40-64 years)-
The client has self confident of raising her child. She is devoted to her family and to
their community. She wants her children to be educated and to be good person
someday. She is confident of raising her children so that someday, her children will
do the same to her.


III. COLLECTING OBJECTIVE DATA

a. Course of Confinement
i. Medications Administered since date of admission

Physicians Order Ascorbic acid 1cap BID P.O.
Generic Name Ascorbic Acid
Brand Name Apo-C, Ascorbicap, Cebid, Cecon,
Cenolate, Cemill, C-Span, Cetane,
Cevalin, Cevi-Bid, Ce-Vi-Sol, Cevita,
Flavorcee, Redoxon, Schiff Effervescent
Vitamin C, Vita-C.
Classification Vitamin
Mechanism of Action Vitamin C or L-ascorbic acid, or
simply ascorbate (the anion of ascorbic
acid), is an essential
nutrient for humans and certain other
animal species. Vitamin C refers to a
number of vitamers that have vitamin C
activity in animals, including ascorbic
acid and its salts, and some oxidized
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forms of the molecule
like dehydroascorbic acid. Ascorbate and
ascorbic acid are both naturally present in
the body when either of these is
introduced into cells, since the forms
interconvert according to pH.
Vitamin C is a cofactor in at least
eight enzymatic reactions including
several collagen synthesis reactions that,
when dysfunctional, cause the most
severe symptoms of scurvy.
Side Effects
GI disturbances in high doses (nausea,
vomiting, and diarrhea).



Bright yellow discoloration of urine
Nursing Management
Instruct Client to take the medication
after meals to avoid GI upset.
Instruct client to measure and follow
the prescribed dosage of the
medication to avoid overdosing.
Advise the client that yellow
discoloration of urine is normal
Adverse Effects
Rarely, hypersensitivity reaction

Flatulence, constipation

Heartburn,
Nursing Management
Instruct the client to discontinue the
medication, and refer to the doctor.
Instruct the client to discontinue the
medication, and refer to the doctor.
Instruct the client to take the
medication after meals to avoid
adverse reactions.

Physicians Order Risperidon 2mg/tablet BID P.O.
Generic Name Risperidon
Brand Name Quilvet
Classification Atypical antipsychotic
Mechanism of Action Risperidone is an atypical antipsychotic
drug that is used for treating
schizophrenia, bipolar mania and autism.
Other atypical antipsychotic drugs
include Olanzapine (Zyprexa),
Quetiapine (Seroquel), Ziprasidone
(Geodon), Aripiprazole (Abilify) and
paliperidone (Invega). Atypical
antipsychotics differ from typical
antipsychotics due to the lesser degree of
extrapyramidal (movement) side effects
and constipation. Risperdal Consta is an
injectable, long-acting form of
risperidone.
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The exact mechanism of action of
risperidone is not known, but, like other
anti-psychotics, it is believed that
risperidone affects the way the brain
works by interfering with communication
among the brain's nerves. Nerves
communicate with each other by making
and releasing chemicals called
neurotransmitters. The neurotransmitters
travel to other nearby nerves where they
attach to receptors on the nerves. The
attachment of the neurotransmitters either
stimulates or inhibits the function of the
nearby nerves. Risperidone blocks
several of the receptors on nerves
including dopamine type 2, serotonin
type 2, and alpha 2 adrenergic receptors.
It is believed that many psychotic
illnesses are caused by abnormal
communication among nerves in the
brain and that by altering communication
through neurotransmitters, risperidone
can alter the psychotic state. Risperidone
was approved by the FDA in December,
1993.
Side Effects

most commonly-noted side effects
associated with risperidone are
extrapyramidal effects (sudden, often
jerky, involuntary motions of the head,
neck, arms, body, or eyes), dizziness,
hyperactivity, tiredness, abdominal pain,
fatigue, fever and nausea. Risperidone
may cause a condition called orthostatic
hypotension during the early phase of
treatment (the first week or two). Patients
who develop orthostatic hypotension
have a drop in their blood pressure when
they rise from a lying position and may
become dizzy or even lose consciousness.
Nursing Consideration Maintain seizure precautions, especially
when initiating therapy and increasing
dosage.
Mix oral solution with 34 oz of
water, coffee, orange juice, or low-fat
milk. Do not mix with cola or tea.
Monitor T. If fever occurs, rule out
underlying infection, and consult
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physician for appropriate comfort
measures.
Advise patient to use contraception
during drug therapy.
Follow guidelines for
discontinuation or reinstitution of the
drug carefully.

Physicians Order Biperiden Hydrochloride 2mg P.O. for
extrapyramidal symptoms
Generic Name Biperiden Hydrochloride
Brand Name Akineton
Classification Antiparkinsonism drug (anticholinergic
type)
Mechanism of Action Anticholinergic activity in the CNS that
is believed to help normalize the
hypothesized imbalance of cholinergic
and dopaminergic neurotransmission in
the basal ganglia in the brain of a
parkinsonism patient. Reduces severity of
rigidity, and to a lesser extent akinesia
and tremor characterizing parkinsonism;
less effective overall than levodopa;
peripheral anticholinergic effects
suppress secondary symptoms of
parkinsonism, such as drooling.

Adjunct in the therapy of parkinsonism
(post-encephalitic, arteriosclerotic, and
idiopathic types)
Relief of symptoms of extrapyramidal
disorders that accompany phenothiazine
therapy
Side Effects

CNS: Some are characteristic of centrally
acting anticholinergic drugs:
disorientation, confusion, memory loss,
hallucinations, psychoses, agitation,
nervousness, delusions, delirium,
paranoia, euphoria, excitement, light-
headedness, dizziness, depression,
drowsiness, weakness, giddiness,
paresthesia, heaviness of the limbs
Peripheral anticholinergic effects
CV: Tachycardia, palpitations,
hypotension, orthostatic hypotension
Dermatologic: Rash, urticaria, other
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dermatoses
EENT: Blurred vision, mydriasis,
diplopia, increased intraocular tension,
angle-closure glaucoma
GI: Dry mouth, constipation, dilation
of the colon, paralytic ileus, acute
suppurative parotitis, nausea, vomiting,
epigastric distress
GU: Urinary retention, urinary
hesitancy, dysuria, difficulty achieving or
maintaining an erection
Other: Flushing, decreased sweating,
elevated temperature, muscular
weakness, muscular cramping
Contraindication Contraindicated with hypersensitivity to
benztropine; glaucoma, especially angle-
closure glaucoma; pyloric or duodenal
obstruction, stenosing peptic ulcers,
achalasia (megaesophagus); prostatic
hypertrophy or bladder neck obstructions;
myasthenia gravis.
Use cautiously with tachycardia, cardiac
arrhythmias, hypertension, hypotension,
hepatic or renal dysfunction, alcoholism,
chronic illness, people who work in hot
environment; hot weather; lactation.


Physicians Order Diphenhydramine Hydrochloride 5mg
OD PRN for poor sleep
Generic Name Diphenhydramine Hydrochloride
Brand Name Allerdryl (CAN), AllerMax Caplets,
Banophen, Banophen Allergy, Benadryl
Allergy, Diphen AF, Diphenhist,
Diphenhist Captabs, Genahist, Siladryl,
Silphen Cough
Classification Antihistamine, Anti-motion sickness
drug, Sedative-hypnotic,
Antiparkinsonian, Cough suppressant
Mechanism of Action Diphenhydramine blocks histamine H1-
receptors on effector cells of the GI tract,
blood vessels and respiratory tract. It also
causes sedation and has some
anticholinergic action.
Adverse Effects CNS depression, dizziness, headache,
sedation; paradoxical stimulation in
children; dryness of mouth, thickened
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respiratory secretion, blurring of vision,
urinary retention; GI disturbances; blood
dyscrasias.
Nursing Consideration:


Assessment
History: Allergy to any
antihistamines, narrow-angle
glaucoma, stenosing peptic ulcer,
symptomatic prostatic hypertrophy,
asthmatic attack, bladder neck
obstruction, pyloroduodenal
obstruction, third trimester of
pregnancy, lactation
Physical: Skin color, lesions, texture;
orientation, reflexes, affect; vision
examination; P, BP; R, adventitious
sounds; bowel sounds; prostate
palpation; CBC with differential

Interventions
Administer with food if GI upset
occurs.
Administer syrup form if patient is
unable to take tablets.
Monitor patient response, and arrange
for adjustment of dosage to lowest
possible effective dose.
Teaching points
Take as prescribed; avoid excessive
dosage.
Take with food if GI upset occurs.
Avoid alcohol; serious sedation could
occur.
These side effects may occur:
Dizziness, sedation, drowsiness (use
caution driving or performing tasks
requiring alertness); epigastric
distress, diarrhea or constipation (take
drug with meals); dry mouth (use
frequent mouth care, suck sugarless
lozenges); thickening of bronchial
secretions, dryness of nasal mucosa
(use a humidifier).
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Report difficulty breathing,
hallucinations, tremors, loss of
coordination, unusual bleeding or
bruising, visual disturbances, irregular
heartbeat.


Physicians Order Haloperidol 5mg/cc 1cc IM with BP
Precaution
Generic Name Haloperidol
Brand Name Haldol, Peridol,
Classification central nervous system agent;
psychotherapeutic; antipsychotic;
butyrophenone
Mechanism of Action Potent, long-acting butyrophenone
derivative with pharmacologic actions
similar to those of piperazine
phenothiazines but with higher incidence
of extrapyramidal effects and less
hypotensive and relatively low sedative
activity.

Decreases psychotic manifestations and
exerts strong antiemetic effect.
Adverse Effects CNS:Extrapyramidal reactions:
Parkinsonian symptoms, dystonia,
akathisia, tardive dyskinesia (after long-
term use); insomnia, restlessness,
anxiety, euphoria, agitation, drowsiness,
mental depression, lethargy, fatigue,
weakness, tremor, ataxia, headache,
confusion, vertigo; neuroleptic malignant
syndrome, hyperthermia, grand mal
seizures, exacerbation of psychotic
symptoms.
CV:Tachycardia, ECG changes,
hypotension, hypertension (with
overdosage).
Endocrine:Menstrual irregularities,
galactorrhea, lactation, gynecomastia,
impotence, increased libido,
hyponatremia, hyperglycemia,
hypoglycemia.
SpecSenses:Blurred vision.
Hematologic:Mild transient leukopenia,
agranulocytosis (rare).
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GI:Dry mouth, anorexia, nausea,
vomiting, constipation, diarrhea,
hypersalivation.
Urogenital:Urinary retention, priapism.
Respiratory:Laryngospasm,
bronchospasm, increased depth of
respiration, bronchopneumonia,
respiratory depression.
Skin:Diaphoresis, maculopapular and
acneiform rash, photosensitivity.
other:Cholestatic jaundice, variations in
liver function tests, decreased serum
cholesterol.
Nursing Consideration:


Monitor for therapeutic effectiveness.
Because of long half-life, therapeutic
effects are slow to develop in early
therapy or when established dosing
regimen is changed. Therapeutic
window effect (point at which
increased dose or concentration
actually decreases therapeutic
response) may occur after long period
of high doses.
Target symptoms expected to decrease
with successful haloperidol treatment
include hallucinations, insomnia,
hostility, agitation, and delusions.
Monitor patients mental status daily.
Monitor for neuroleptic malignant
syndrome (NMS) , especially in those
with hypertension or taking lithium.
Symptoms of NMS can appear
suddenly after initiation of therapy or
after months or years of taking
neuroleptic (antipsychotic) medication.
Immediately discontinue drug if NMS
suspected.Monitor for parkinsonism
and tardive dyskinesia . Risk of tardive
dyskinesia appears to be greater in
women receiving high doses and in
older adults. It can occur after long-
term therapy and even after therapy is
discontinued.
Monitor for extrapyramidal
(neuromuscular) reactions that occur
frequently during first few days of
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treatment. Symptoms are usually dose
related and are controlled by dosage
reduction or concomitant
administration of antiparkinson drugs.
Be alert for behavioral changes in
patients who are concurrently
receiving antiparkinson drugs.
Monitor for exacerbation of seizure
activity.
Observe patients closely for rapid
mood shift to depression when
haloperidol is used to control mania or
cyclic disorders. Depression may
represent a drug adverse effect or
reversion from a manic state.
Lab tests: Monitor WBC count with
differential and liver function in
patients on prolonged therapy.



ii. Diagnostic Test since Date of Admission

Name of
Diagnostic
Test
Result Normal
Values
Unit of
Measurement
Implication
Complete CBC
(May 12. 2013)
Hemoglobi
n mass



Hematocrit



WBC
Count

RBC Count







100




0.32



7.9


3.98







Female: 110
158
Male: 138 to
182

0.37 0.54



5 10


4-6







g/dl




fraction of
RBC


x

/L


x

/L







Indicates a decrease in
Red blood cell
production.


Indicates a decrease in
Red blood cell
production

Normal.


A Decrease in RBC
count may indicate
Anemia.
hemoglobin.


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Differential
Count
Neutrophil



Lymphocyte

Monocyte



0.76



0.19

0.05


0.45-0.75



0.20-0.35

0.02-0.06








An Increase value may
indicate an acute
infection.

Infection is present.

Normal
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IV. PYSCHOPATHOPHYSIOLOGY
Anatomic abnormalities
Neuroimaging studies in patients with
schizophrenia show abnormalities such as
enlargement of the ventricles, decreased brain
volume in medial temporal areas, and changes in
the hippocampus.

These findings are of interest
more for research purposes than for clinical
application.
Interest has also focused on the various
connections within the brain rather than on
localization in a single part of the brain.
Magnetic resonance imaging (MRI) studies
show anatomic abnormalities in a network of
neocortical and limbic regions and
interconnecting white matter tracts. A meta-
analysis of studies using diffusion tensor
imaging (DTI) to examine white matter found
that 2 networks of white-matter tracts are
reduced in schizophrenia.
In the Edinburgh High-Risk Study, brain
imaging showed reductions in whole-brain
volume and in left and right prefrontal and
temporal lobe volumes in 17 of 146 people who were at high genetic risk for schizophrenia. The changes
in prefrontal lobes were associated with increasing severity of psychotic symptoms.
In a meta-analysis of 27 longitudinal MRI studies comparing schizophrenic patients with control subjects,
Olabi et al found that schizophrenia was associated with structural brain abnormalities that progressed
over time. The abnormalities identified included loss of whole-brain volume in both gray and white
matter and increases in lateral ventricular volume.
Neurotransmitter system abnormalities
Abnormalities of the dopaminergic system are thought to exist in schizophrenia; however, there is little
direct evidence to support this belief. The first clearly effective antipsychotic drugs, chlorpromazine and
reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs
that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that
stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms.
Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and
hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist.
(Negative and positive symptoms are defined below; see Presentation.) Moreover, the newer
antipsychotic drugs block both dopamine D2 and 5-hydroxytryptamine (5-HT) receptors.
Clozapine, perhaps the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist.
Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid
(GABA), are undoubtedly involved. Some research focuses on the N -methyl-D-aspartate (NMDA)
17

subclass of glutamate receptors because NMDA antagonists, such as phencyclidine and ketamine, can
lead to psychotic symptoms in healthy subjects.
Inflammation and immune function
Immune system function is disturbed in schizophrenia.

Overactivation of the immune system (eg, from
prenatal infection or postnatal stress) may result in overexpression of inflammatory cytokines and
subsequent alteration of brain structure and function. For example, schizophrenic patients have elevated
levels of proinflammatory cytokines that activate the kynurenine pathway, by which tryptophan is
metabolized into kynurenic and quinolinic acids; these acids regulate NMDA receptor activity and may
also be involved in dopamine regulation.
Insulin resistance and metabolic disturbances, which are common in the schizophrenic population, have
also been linked to inflammation. Thus, inflammation might be related to both the psychopathology of
schizophrenia and to metabolic disturbances seen in patients with schizophrenia.

Neurochemical factors likely involve dopamine, serotonin, norepinephrine, glutamate, and gamma-
aminobutyric acid neurotransmission. Glutamate (glu), involved in learning and memory, may be
responsible for some of the cognitive symptoms; glu is necessary for the breakdown of dopamine and
other transmitters, which affects the efficiency of prefrontal information processing. Excessively high
levels of norepinephrine are associated with positive symptoms, while paranoid symptoms have been
related to increased dopamine aactivity. No single neurotransmitter is clearly responsible for
schizophrenia.
Schizophrenia often disrupts the filtering process, causing sensory overload; when there are too many
messages arriving at the cortex at the same time, thinking becomes disorganized and fragmented.
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V. NURSING CARE PLAN
Name: Patient S.A.
Diagnosis: Paranoid Schizophrenia
Date and time: May 19, 2013 (7am-3pm)
Assessment Diagnosis Planning Implementation Scientific Rationale Evaluation
Subjective
Data:
Hindi ako
makatulog
kasi
madaming
akong kuto at
may pigsa pa
ako sa ulo as
manifested by
the mother.

Objective
Data:
Presence of
Lice, with Pus
at the occipital
area


Disturbed
sleep
pattern
related to
head lice
and pus
Long term Goal:
To provide health
teaching about using
anti-head lice shampoo
and proper prevention of
getting a pus.

Short Term Goal:
After 16 hours of duty,
The patient will be able
to relieve itchiness by
using small spaced-
combed and


Independent
Intervention:
Explain to the client
the procedures and its
purpose


Instruct patient to sit
instead of stand during
care and other
activities.

Instruct patient to
comb her hair using
thin-spaced comb to
decrease presence of
lice and nits.

Assist the patient in
Shampooing by the
use of anti-lice
shampoo while giving
instruction how often
to apply the said
shampoo

Instruct patient to
avoid skin contact to


To reduce anxiety of the
patient.
To prepare the patient for
the Procedure.

To increase activity level
as tolerated



To provide independency
while giving a health
teaching



The patient will be able
to return demonstration.






To avoid another
incidence of having pus


The patient is
able to
improve her
activities of
daily living
especially her
sleep hours.


Goal met:

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the patient with open
wound

Apply Povidone
Iodine in the Pus area



For infection and to
avoid futher complication



REFERENCES:
http://www.nimh.nih.gov/health/publications/schizophrenia/what-is-schizophrenia.shtml
http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862
http://www.mayoclinic.com/health/schizophrenia/DS00196
http://www.schizophrenia.com/szparanoid.htm
http://www.scribd.com/doc/52857393/Paranoid-Schizophrenia-Case-Study
http://emedicine.medscape.com/article/288259-overview#aw2aab6b2b3aa
http://allnurses.com/nursing-student-assistance/pathophysiology-of-schizophrenia-276654.html
http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862/DSECTION=risk-factors
http://www.nlm.nih.gov/medlineplus/ency/article/000936.htm