MANILA TYTANA COLLEGES

Manila Doctors College of Nursing

Pres. Diosdado Macapagal Blvd., Metropolitan Park, Pasay City


Mild Mental Retardation


Submitted To:

Mrs. Carangian, R.N., M.A.N.

Submitted By:
Nario, Achernar
Nazareth, Kyle
Orbe, Jizelle Ma. Stephanie
Olis, Mercedes
Perena, Yvette
Perez, Daren Erlin
Piamonte, Renz Henreik
Quilla, Kathy
Quilapio, Myleen
Rapio, Gabriel Rafael
Regalado, Karla Tricia
Ricafort, Jomari
Group 3
CON III-A1


NURSING PROCESS

I. Case Abstract

Mental retardation is a generalized disorder appearing before adulthood, characterized
by significantly impaired cognitive functioning and deficits in two or more adaptive
behaviors. It has historically been defined as an Intelligence Quotient score under 70.
Mild Mentally Retarded has an IQ of atleast 50-70, while a Moderate
Mentally Retarded patient has an IQ of 35-55. Severe mentally reteraded
patients usually has an IQ of 20-40 and lastly, Profound mentally retarded
has an IQ below 20.

Mental retardation occurs in 4. 6 % of the general population in the
Philippines (DOH, October 2008). Children with special needs are enrolled in
schools: 156,270 Mentally Retarded: 12,456(DepEd) It begins in childhood or
adolescence before the age of 18. In most cases, it persists throughout adulthood.

Mental retardation occurs in families of all income levels. It has been observed,
however, that the largest number of mentally retarded children are born to parents
living in poverty. Mothers in these families may receive poor or no prenatal care.
Nutrition is inadequate. Children may receive little affection and intellectual
stimulation from overworked parents who often have large families.

Syndromic mental retardation is intellectual deficits associated with other medical
and behavioral signs and symptoms. Non-syndromic mental retardation refers to
intellectual deficits that appear without other abnormalities.

Risk factors are related to the causes. Causes of mental retardation can be roughly
broken down into several categories, Infections (Present at birth or occurring at birth),
such as congenital rubella, encephalitis, HIV infection, listeriosis and meningitis.
Chromosomal abnormalities, Environmental (Deprivation Syndrome), Genetic
Abnormalities and inherited metabolic disorders, Metabolic, Nutritional, Toxic,
Trauma (Before and after birth) and Unexplained.

The clients current functioning is classified as Mild Mentally Retarded and
equivalent to a mental age of 10 years and 5 months. His Binet IQ score of 67. Has a
history of meningitis when he was 4 months old. Was diagnosed to have mild
mental retardation at the age of 3. He would bump his head on the wall also at the age
of 3. He was also diagnosed as having a hyperactivity disorder at the National Center
for Mental Health when he was a child. Medications were given to extinguish deviant
behaviors related to hyperactivity. The deviant behaviors have lessened in frequency.
However, he has temper outburst and aggressive behaviors. He has been staying at
the facility ward for 6 years and 9 months. Patient had numerous confinement and last
of which was at San Juan De Dios (2001-2003 on and off) He was stubborn and
destructive , usually had a blank stare. Started drinking and smoking at the age of 16,
and started using drugs at the age of 17. He used to drink 5 times a week and smoke
every day, particularly every after meal. He would smoke 1 pack of cigarettes a day,
drink 5 bottles of beer and use isang guhit of marijuana and shabu at his friends
houses.

The nursing interventions covered for impaired parenting will be to encourage and
allow to express feelings, listen to the client. As for the imbalance nutrition,
interventions covered provide diet modifications, avoid foods that cause intolerance.
For the sleeping deprivation, avoid eating large late night meals, provide calm
environment. Lastly, knowledge deficit. Interventions done to assess readiness of the
patient to learn and make him aware of his condition.






II. Nursing Health History

a. Biographic Data

Patients Initial:
I.O.M
Gender:
Male
Age:
30 years old
Date of Birth:
1982-07-08
Educational
Attainment:
Vocational
Occupation:
NA
Monthly Income:
NA
Place of Birth:
Manila
Date of
Admission:
2005-11-03
No. of days in
hospital:
6 years and 9
months
Order of
Admission:
ambulatory
Source of
Information:
informant

b. Chief Complaint

Alis siya ng alis ng bahay As verbalized by the relative .
(Always leaves the house.)

Parati kasi akong nagdrudrugs nun eh. Di ko na mapigilan sarili ko. As
verbalized by the patient.
(I used to always use drugs. I cannot stop myself.)

c. History of Present Illness

Onset: 1998, the client has a history of meningitis when he was 4 months old.
At the age of 3, he was diagnosed to have mild mental retardation. Also, he would
bump his head on the wall. He was also diagnosed as having a hyperactivity
disorder at the National Center for Mental Health when he was a child.
Medications were given to extinguish deviant behaviors related to hyperactivity.
The deviant behaviors have lessened in frequency. However, temper outburst and
aggressive behaviors have became more prevalent. He was said to be stubborn
and destructive, also had a blank stare. He had numerous confinement due to his
drug addiction. He started drinking and smoking at the age of 16, and started
using drugs at the age of 17. He used to drink 5 times a week and smoke every
day, particularly every after meal. He would smoke 1 pack of cigarettes a day,
drink 5 bottles of beer and use isang guhit of marijuana and shabu at his
friends houses. The client would have different fights when hes under the
influence of drugs and alcohol and he has already experienced going to jail
because of being framed up with marijuana, he then dropped school, and got his
family hate him for it when they found out that he was using drugs. The client
also said that he used to steal from his parents and other people like his
neighbours just so he can have money to buy drugs, alcohol and cigarette. Before
divine mercy, he was last admitted at San Juan De Dios year 2001-2003 been on
and off because of his drug addiction. Although when he was last confined at San
Juan he was able to escape and then hid in an apartment in pasay with a few of his
friends and went back to being a drug addict. A few years after, he got caught by
police officers that his father sent to look for him and was then brought to divine
mercy.

d. History of Past Illness

Childhood illness: Meningitis, Chicken pox
Childhood/Adult immunization: Cannot Recall
Accidents and Injuries: binato ako ng ate ko ng suklay sa noo
(1991)
sumemplang ung tricycle na sinasakyan ko
(1995)
sinaksak ako ng ice pick sa likod (1997)
Previous hospitalization/Surgery: Meningitis (1982)
Stabbed wound (1997)
Medication prior to confinement: Haloperidol (2002), Tegretol (2002), Serenace
(2002)



e. Family History

General Family Information:
Name Relation Age Gender Occupation Educational
Attainment
Diseases/
Disorder
I.O.M Father 62 Male Lawyer College
graduate
None
M.S.M Mother 52 Female Accountant College
graduate
None
M.K.M Sister 34 Female Therapist College
graduate
None
K.L.M Sister 26 female Stewardess College
graduate
None

Heredo Familial Illness:
None

f. Developmental History

Theory Age Developmental
Task
Client
Description
Interpretation
Psychosexual 30 Genital Stage He has a lot of
friends but
has no stable
or any love
relationship
with the
opposite sex,
only with his
parents
especially his
mom. He had
only sexual
relationship in
both men and
women for
money. When
asked if he
wants to settle
down one day
the client
stated Ayaw
ko, ayaw pa ni
mama (I
dont want to.
My mom
doesnt want
me to.) Does
not have his
own place and
used to stay in
his parents
house.
Has not settled
down in a
loving one-to-
one
relationship.
Has not
achieved
independence
and decision
making.
Attached and
dependent
from the
parents.
Psychosocial 30 Generativity
vs. Stagnation
Poor self
concept when
asked to
describe
Not productive
and creative in
both career and
family. No
himself.
Feeling
inadequate.
Dependent
individual
who still lives
with his
parents.
Raising a
family is not
part of his
priorities but
has grown
realization
that he wants
to stop his
vices and will
try to go back
to school if he
gets out.
personal and
professional
growth or any
social and
parental
responsibility
Cognitive 30 Formal
Operation
When given a
simple
mathematical
equation the
client cannot
understand
and answer.
During Art
Therapy, he is
able to draw
and the
concept of his
drawing has
sense but not
throughout,
there are still
times when
his
verbalizations
is not
connected.
Difficulty in
understanding
age
appropriate
words and
statements,
when asked to
interpret Pag
binato ka ng
bato, batuhin
mo ng
tinapay The
client did not
understand the
statement and
cannot explain
in his own
words on
what he thinks
about it. Also,
when he was
Mathematical
and scientific
reasoning is
not complete.
Cognitive
deficit in
acquiring and
using verbal
concepts. Has
not developed
the capacity to
use hypothetic
reasoning
especially due
to his
impoverished
find of
vocabulary that
is why is is
seemingly
constrained in
verbalizing his
responses.
Verbalizations
made makes
sense
sometimes
when being
asked, and
patient is able
to answer right
away.
asked lawyer
ba tatay mo?
and he
answered
hindi siya
lawyer!
Attorney
siya! He can
also perform
self- help
activities but
has
limitations.
Although he
is able to
adjust to his
environment
and with skills
required to
cope
Moral 30 Conventional:
Stage 4, Law
and Order
Orientation
No
established
rules from
authorities
since his
parents was
not always
around.
Aware of the
rules and
follows it
during his
stay on the
facility ward.
Although
before, he was
aware that he
could go to
jail but he did
not comply
and also
escaped from
his previous
hospital.
Decisions and
behaviour is
due to the
influence of
his friends.
Client has no
established
rules from
authorities.
Reason for
decisions and
behaviour does
not demand a
response.
Spiritual 30 Individuating-
Reflexive
He knows that
drugs is not
good for him
that is why he
has come to
the realization
to refrain
from using
drugs if ever
he gets
discharged
saying
masama sa
Conscious of
his wrong
doings. His
view as an
individual has
changed and
willing to
make these
changes once
he gets
discharged.
tao ang drugs
eh. Although
they are
permitted to
smoke at the
facility, the
client refuses
to and
verbalized
ayoko na
manigarilyo
simula pa
nung pinasok
ako dito.
Due to the
years spent in
the ward he is
no longer
defined by the
group to
which he used
to belong that
encouraged
and
influenced
him to
continue using
drugs. He also
wants to study
if he gets
discharged.

g. Environmental History

The patient used to live with his parents in a three-storey house inside a
village. Their house is separated into two: first half is where they live in and the
other half was used as an apartment in which 2 not-related-families are renting.
Their house contains two bedrooms, one bathroom, one kitchen with a dining area
and one living room. Outside their house, there are nearby stores and eateries. The
police station, fire station, barangay hall, church and school are walking distance
away. Waste segregation is not practiced but placed neatly outside their house.
The client also stated that he is close to almost everyone in the neighborhood.

h. Personal/Social History

Habits: Playing basketball, dancing
Vices: Drinking, smoking, and use of drugs.
The client states that when he was growing up, he would see his mother
smoke, and see his father and younger sister drink and smoke also. He says that it
didnt affect him because his friends were the ones who influenced him with his
vices. He started drinking and smoking at the age of 16, and started using drugs at
the age of 17. He used to drink 5 times a week and smoke every day, particularly
every after meal. He would smoke 1 pack of cigarettes a day, drink 5 bottles of
beer and use isang guhit of marijuana and shabu at his friends houses. The
client admitted that his use of drugs has caused him problems with his family,
school, and the legal system. The client would have different fights when hes
under the influence of drugs and alcohol and he has already experienced going to
jail because of being framed up with marijuana, dropped school, and got his
family hate him for it when they found out that he was using drugs. Although he
did try to stop using drugs when his father found out about it, he wasnt able to
stop completely due to his addiction for it and thats when his father decided to
send him to the mental hospital. The client stopped using drugs and drinking
alcohol when he was admitted to Divine Mercy and even though they are allowed
to smoke inside the facility, the client managed to refrain from smoking. All the
more, the client states that if ever he gets discharged, he plans to continue
refraining from his vices and would distract himself by going back to school and
making his life a better one.

i. OB/Gyne History
Not Applicable

III. Gordons Typology of 11 Functional Health Pattern

a. Health Perception/ Health Management Pattern

During the clients stay in the facility, he rates his health with a 7, not a perfect 10
because he knows theres still something wrong with him but is not aware exactly
what it is. may dahilan naman kung bakit ako nandito, di ko lang alam kung
bakit. As verbalized by the patient. His health goal is to grow taller and refrain
from using drugs if ever he gets discharged saying masama sa tao ang drugs eh.
The client doesnt undergo any routine physical examination although their vital
signs are being taken every day. Following the instruction of nurses and doctors
such as drinking his medicines religiously and eating his meals on time never did
become a problem to him. The client takes a bath every day, practices hand
washing and brushes his teeth only when he wakes up and before bedtime, trims
his nails weekly, and wears slippers all the time. Although they are permitted to
smoke at the facility, the client refuses to saying ayoko na manigarilyo simula pa
nung pinasok ako dito. The facility is said to be well ventilated and has adequate
lighting. Water supply is also sufficient and food is served neatly three times a
day or five times even. Theres also presence of vectors such as cockroaches and
rats.

Of 52 psychiatric inpatients, 81% believed that factors such as proper diet, sleep,
and exercise affect the development of illnesses, and 23% believed that sin-related
factors, such as sinful thoughts or acts, have such an effect. (Sheehan, W. 2000)

Isagani seemed to be aware of the factors that caused him to stay in the facility
with the reasoning masama sa tao ang drugs eh. And his goal to refrain from
using it further even when he gets discharged.

b. Nutritional/ Metabolic Pattern

During the clients stay in the facility, the client said that his main idea regarding
proper nutrition is kumain ng madami. The client loves to eat junk food and
does not eat a lot of nutritious food. hindi ako kumakain ng gulay, ang pangit
kasi ng lasa. Gusto ko mga chocolate tsaka canton tsaka chichirya tsaka apple
juice. The facility supplies food for the client 3-5 times a day (breakfast, lunch,
merienda, dinner, midnight snack). The client could no longer recall his three-
day-diet-recall but he said that he didnt like the food. He would not eat much.
The longer he stayed in the facility, the lesser his appetite became. As of his
present condition, his food restrictions are chocolates and caffeinated drinks.

The Committee on the Medical Aspects of Food and Nutrition (Department of
Health, 1994) has recommended a reduction in dietary fat and salt and an increase
in complex carbohydrates. The Food Standards Agency recommends that at least
five portions of fruit or vegetables should be consumed per day and at least two
portions of oily fish should be eaten per week (Food Standards Agency, 2001).
Patients should be given advice on healthy eating and be provided with healthy
dishes on the menu.

The client still prefers to eat unhealthy foods such as junk foods, chocolate,
processed foods and the like even though the facility caters healthy and complete
meal. He sometimes refuses to eat it or just forces himself to ingest it just so he
could satisfy his hunger.

c. Elimination Pattern

During the clients stay in the facility, the client defecates once or twice a day,
brown in color, a bit hard, and with no discomforts. He voids approximately 6
times a day, clear, without discomfort. Client perspires when hot but with no body
odor.

The frequency of defecation is highly individual vary from several time per day
or three time per weeks. Feces are normally brown, chiefly due to presence of
sterocoblin and urobilin. Which are derived from bilirubin and another factor
effect of color is bacteria (Fundamental of Nursing, 2004) The average adult
bladder holds between 400 and 700 ml of urine. Normal patterns of urination may
vary considerably; adults generally void 5 to 6 times daily but no more than once
after retiring. The average 24-hour urinary output is 1200 to 1500 ml. Urinary
frequency may occur because of either increased urine volume or decreased
bladder capicity (i.e., less than 200 ml). (Wrenn, K., 2002)

The clients elimination pattern seems to be of normal rate as compared to the
standard values of an average adult. Perspiring when hot is normal and since the
client doesnt have any body odor, he exhibits well grooming.

d. Activity-Exercise Pattern

During the clients stay in the facility, the clients usual activities in a day is from
the moment he wakes up, he takes a bath, eats breakfast, sleep, get checked for his
vital signs, sleep again, eat lunch, drinks his medicines, joke around for hours,
watch TV, sleep again. Hindi na kami masyado nakakapagexercise kasi maulan,
di na pwede magbasketball. Nakakayamot na nga dito, wala ako magawa. He
expressed how much he wanted to go home for he misses his old life where he
could do anything he want. He said that he has more than sufficient energy in
completing desired activities since he doesnt have any happenings to dwell it in.

Physical activity has many beneficial effects on health. It can improve
cardiorespiratory fitness, body strength, flexibility, balance, body shape and
posture. Regular exercise will alter body composition by increasing muscle and
reducing body fat. (Forwood & Larsen, 2000). Other beneficial effects of exercise
are improved self-esteem, socialisation and sleep (Honeybourne et al, 2000: pp.
199233). Daley (2002) described some beneficial effects of exercise therapy on
the mental state of patients with depression and schizophrenia.

The client doesnt get enough exercise that could help him improve his well-
being. His only activity is basketball but due to the weather these past few weeks,
they are not allowed to play which leaves them no choice but to stay inside the
facility. As much as he wants to do different activities he would just settle for
watching TV or force himself to sleep.

e. Sleep-Rest Pattern

During the clients stay in the facility, the client usually sleeps for 6 hours at
night, from 10pm-4am. He said that he wakes up in the middle of his sleep
usually around 2am just to void. He said that he sometimes have a hard time
sleeping due to different reasons like he still wants to watch television and he still
wants to eat. There are times when he thinks about his family at night which
bothers him that adds up to the reason why he couldnt sleep. The client sleeps in
the afternoon saying wala naman ibang magawa dito kundi matulog eh. The
client experiences wet dreams usually and doesnt have nightmares.

Monophasic sleep is essentially what most people would call a normal sleeping
pattern. A person sleeps for around 8 hours per night, variable per person. Its the
most common sleeping pattern and the one most societies have adopted.
(Greggy, P., 2001)

The clients sleeping pattern turned out to be otherwise than the standard pattern
of sleep which is supposed to be eight hours per night. The client has different
reasons as to why he couldnt sleep but re-gains his liveliness by sleeping in the
afternoon to compensate with his energy needs.

f. Cognitive-Perceptual Pattern

During the clients stay in the facility, he could read words from newsprint but
has slow articulation. He can write words but has difficulty with spelling. He can
also interpret his drawings during Art therapy but some interpretations were not
clear and did not make sense or has no connection. The patient stated that he has
complete hearing loss in the left ear and was confirmed during our Rinnes and
Webbers examination. He has no problem with his vision and was confirmed
during our Snellens Chart examination. The client has difficulty recalling recent
information such as his three-day-diet-recall and what happened for the past few
days. The client couldnt speak clearly and words are hard to understand. There
are no changes in smell or taste. Easiest way to learn things is through
demonstrations. Vocabulary was tested with the question lawyer ba tatay mo?
and he answered hindi siya lawyer! Attorney siya!

Short-term memory, also known as active memory, is the information we are
currently aware of or thinking about. In Freudian psychology, this memory would
be referred to as the conscious mind. Paying attention to sensory memories
generates the information in short-term memory.(Cherry,K., 2012) Short-term
memory is recall of one to several days.(Western Schools Psychiatric Nursing,
2009) Cognitive abilities are those elements of thinking that determine attention,
concentration, perception, reasoning, intellect, and memory. They are generally
thought of as higher functioning areas of thought. (Western Schools Psychiatric
Nursing, 2009)

In his short term memory assessment, Isagani failed to recall recent information.
Based on his social case report, he has a mild congenital deafness and his slow
maturation in language may be attributed to this defect. He also exhibited a poor
fund of vocabulary.

g. Self-perception/Self-concept Pattern

During the clients stay in the facility, the client described himself as a happy-go-
lucky person. When asked if hes contented with the way he looked, he answered
ayos lang, marami ako NBA cards, yung mga kumikintab pa nga tol eh! and
when the question was re-directed to magaling ka ba sa school? he answered
sabi nila bobo ako, ewan ko. He expresses his thoughts and feelings toward
others by verbalizing it directly. He is usually in calm mood but is easily angered
especially when he doesnt get what he wants. He feels depressed every time he
thinks of his family.

Level of Self Perception: This dimension refers to the degree to which the
individual perceives he/she possesses this attribute. Does the individual see
himself or herself as highly introverted (trait), or a very good tennis player
(competency), or a hard worker (value)? This dimension deals with the issue of
where individuals see themselves, relative to their ideal selves, and is directly
related to the issue of high and low self-esteem. It is manifested in High versus
Low self-concept. (Scholl,R. 2005)

Based on projections, Isagani seems to be an immature and dependent individual
who has a poor self-concept. He tends to use compensatory defences to cover up
his weaknesses. His aggressive bahaviors, temper tantrums and irritability may be
brought about by his feelings of inadequacy and inability to express his true
feelings and thoughts. At times, therefore, he becomes withdrawn and evasive, as
he may feel that people around him do not understand him.

h. Role-Relationship Pattern

During the clients stay in the facility, he stated that his mother visits once a
month and when asked eh tatay mo ba binibisita ka? he answered hindi, busy
yun palagi. Attorney yun eh! Isang beses lang ako dinalaw nun sa anim na taon ko
dito He also mentioned how much he misses his family and his friends. He said
that he has a lot of friends outside the facility and they were the ones who taught
him how to smoke, drink and use drugs.

Ideally, children grow up in family environments which help them feel
worthwhile and valuable. They learn that their feelings and needs are important
and can be expressed. Children growing up in such supportive environments are
likely to form healthy, open relationships in adulthood. However, families may
fail to provide for many of their childrens emotional and physical needs. In
addition, the families communication patterns may severely limit the childs
expressions of feelings and needs. Children growing up in such families are likely
to develop low self-esteem and feel that their needs are not important or perhaps
should not be taken seriously by others. As a result, they may form unsatisfying
relationships as adults. (Board of Trustees of the University of Illinois, 2007)

Isaganis longing for his parents attention may have contributed with the way he
act and think. Since families do play an important role in honing a childs being,
Isagani seemed to be deprived from the affection and attention that he was
supposed to have achieved when he was younger but since his parents are both
busy with their different works, Isagani was left alone at home all the time thus
leading him to be close to people that influenced with different vices.

i. Sexuality-Reproductive Pattern

During the clients stay in the facility, he admitted that he is sexually active ever
since he was 18 years old and refuses to use condom. He has had sexual
relationships with women and his same gender. He satisfies his sexual desires
through masturbation saying wala naman kasi babaeng ma-ano dito! He
sometimes experiences wet dreams which gives him ejaculation in the morning.

Among women aged 15 to 44, average age at first sexual intercourse was 17.3
years. Their male counterparts lost their virginity at 17.0 years on average.
Several demographic characteristics are associated with the loss of virginity at a
younger or older age. People who lived with both parents at age 14 waited longer
to engage in sex for the first time than did those in other family situations.
(Human Sexual Behavior, 2008)

Isaganis lack of guidance from his parents may have contributed with his
behaviour towards sex. His sexual behaviour is a perfect example of the reality
that men and women lose their virginity at such a young age and that guidance
from families is necessary in order to prevent a child from doing foolish acts.

j. Coping-Stress Tolerance Pattern

During the clients stay in the facility, the client feels stressed when he couldnt
sleep. maingay kasi yung mga iba dyan eh! Hirap makatulog! Magugulo! He
recovers by confronting the people who are noisy or sometimes, he just ignores it.
He doesnt have any medications to help him relax although he says that
chichirya lang okay na ko.

One of the unhealthy ways in coping with stress is smoking, drinking too much,
sleeping too much, overeating and taking out stress on others such as lashing out,
outbursts, and physical violence. (Stress Management, 2003)

Isaganis ability to resolve a problem may have been honed from past
experiences. He seemed equipped with skills required to cope with and adjust to
his environment but is unaware that his way of handling stress is not appropriate
and would actually cause more damage in the long run.

k. Value-Belief Pattern

During the clients stay in the facility, he said that religion is very important to
him because he was raised with religious practices such as going to church on
Sundays but he would hear mass alone because his parents arent always around
to go with him. He would pray every night inside the facility and would
participate in religious activities that are being held there once a month. His plan
for the future is to study again and refuses to have his own family saying ayaw
ng mommy ko eh.

Parents face many obstacles in raising kids. When you add all the distractions and
the pressures in today's world, Parenting becomes even more than a challenge. A
huge part of that challenge is passing on your faith to kids whose priorities are
more focused on video games, sporting events, and the latest trends in clothes.
And let's not forget to mention peer pressure and media pressure that offers
temptations to kids to do drugs, drink alcohol and get involved sexually. Today's
kids face an overall absence of godly examples and moral living in a society that
is moving toward "freedom from religion" instead of "freedom of religion."
(Raising Christian Children, 2008)

At his current age, he shows lack of concern about success. He seems more
focused on the recognition and appreciation he receives from other people,
particularly from his family. Although he was raised with religious values, it
seemed to be not enough because his parents werent always there to guide and
support him with his decisions so he ended up doing wrong choices in life.

IV. Physical Assessment

V. Anatomy and Physiology

VI. Psychopathology

VII. Laboratory Results
None

VIII. Drug Study

IX. List of Prioritized Problems

Cues Nursing Diagnosis Rank Justification
Subjective Cues:

When asked eh tatay
mo ba binibisita ka?
he answered hindi,
busy yun palagi.
Attorney yun eh! Isang
beses lang ako dinalaw
nun sa anim na taon ko
dito
(Does your dad visit
you? he answered,
Nope, hes always
Impaired Parenting
related to
Inadequate
Parenting
Performance
1
st
Priority Impaired parenting is
our first priority due
to the lack of
affection and love.
His parents were not
always around that is
why he was
influenced by his
friends.
busy. Hes an
attorney! Been staying
here for 6 years but he
only came here once.

Objective Cues:
Inappropriate child
caring skills
Sleep
disruption/deprivation
Depression
History of mental
illness/ substance
abuse
Subjective Cues:

hindi ako kumakain ng
gulay, ang pangit kasi ng
lasa. Gusto ko mga
chocolate tsaka canton
tsaka chichirya tsaka
apple juice. (I dont eat
vegetables, I dont like
the taste of it. I like
chocolate, canton, junk
foods and apple juice.)

Objective Cues:
40kg.
BMI 15 (underweight)
Loss of appetite

Imbalanced
nutrition: less than
body requirements
related to
decreased appetite
and low BMI.

2
nd
priority Imbalanced nutrition
because even though
the facility provides
meal atleast 3 or 4
times a day the client
does not have the
appetite to eat.
Importance of proper
nutrition shall be
taught to the patient.
Subjective Cues:

Nahihirapan ako
makatulog sa gabi kasi
naiisip ko pamilya ko at
gusto ko pa manood ng
t.v at kumaen.(Im
having a hard time to
sleep at night because I
keep thinking about my
family and I still want to
watch tv and eat junk
foods.)

Objective Cues:
irritability

Sleep deprivation
related to
environmental
stimulation

3
rd
priority Sleep is important to
be able to perform
daily activities.
There are times when
the patient is not able
to sleep or cannot
sleep properly since
there are things he
still wants to do.
Subjective Cues:

may dahilan naman
kung bakit ako
nandito, di ko lang
alam kung bakit.
(he knows theres still
something wrong with
him but is not aware
exactly what it is.) As
verbalized by the
patient.



Knowledge Deficit
related to
Substance Use
Control

4
th
Priority Last priority, we
want the patient to be
aware of his
condition. To be able
to try and control
himself and build a
few concept about
himself.

Objective Cues:
Lack of information
Cognitive
limitations/interference
with learning
Lack of recall


X. Nursing Care Map
XI. Nurse-Patient Interaction

XII. Evidence-based Nursing

Exploring the Comorbidity of Attention-Deficit/Hyperactivity Disorder and
Language, Speech and Reading Disorders

Present Practice Evidence-based Nursing Recommendations to Present
Practice
(Muller and Tomblin,
2012)
--explores a common
clinical experience,
whereby clients present
with more than one
condition.This happens
so frequently; we suspect
it is often taken for
granted that vulnerability
in one area
opens up vulnerability in
other areas.
Attention-deficit/hyperactivity
disorder (ADHD)
is one of the most common co-
occurring
conditions experienced by
children with
developmental communication
disorders (i.e.,
speech, language, or reading
impairments).
Indeed, it is arguable that
clinicians working with
school-aged children see this
so frequently that
the phenomenon is accepted as
commonplace
and uninteresting. A second
point to this issue,
however, is to demonstrate
how the
co-occurrence, or comorbidity,
of ADHD with
communication disorders is
important for
understanding the nature of
these developmental
disorders, as well as their
clinical management.
The first question we address
is whether ADHD
co-occurs with various forms
of developmental
speech and language disorders
(including reading)
at rates greater than expected
by chance. If this is
indeed the case, why does this
happen? All
possible reasons need to be
considered; however,
a focus of this issue involves
the possibility that
these disorders have at least
Aimed at encouraging further
consideration of the
importance of comorbidity in
research on developmental
communication
disorders. Emphasize how
comorbidity
allows us to see beyond the
boundaries of a label
or diagnosis and can be used
to gain insight into
what are likely related, and
perhaps very similar,
conditions.
partial genetic
overlap, which could then
explain the overlap at
the symptom, or phenotype,
level. If this is true,
we might find these
different developmental
disorders are not, in fact, so
distinctly different
but rather have fuzzy
boundaries at the symptom
level, which continue on down
through
neurodevelopmental systems
and genetics. The
clinical implications of such
understanding are
hard to predict; however, we
can be sure that
understanding more about the
clinical conditions
with which we work is better
than knowing less.
If we see that some of the
neuropsychological
pathways in ADHD are in fact
shared with
developmental communication
disorders, it is
important to incorporate this
insight into clinical
management.


XIII. Ongoing Appraisal

DATE PROGRESS NOTES DIAGNOSTIC
PROCEDURE
MEDICATIONS
1August2012













9August2012









-received patient asleep
-kempt in appearance
-ambulatory
-BP taken and recorded
-breakfast served and
consumed
-with good appetite
-safety measures provided
-need attended
-endorsed




-received patient on bed
-kempt in appearance
-behave and manageable
-cooperative to ward
command
-breakfast taken and
consumed; with good
appetite
-oral care done
-took a bath

Nozinan 50mg 1tab
HS



Chlorprominazine
300mg 1tab HS






Nozinan 50mg 1tab
HS





















11August2012


-took a nap
-watch TV on bed
-lunch taken and consumed
-BP taken and recorded
-mingled with other patient
-ambulatory inside the
ward
-safety measure observed
-seen every now and then
-needs attended
-endorsed



-received patient awake
-appropriately dressed and
kempt in appearance
-has a good posture
-cooperative to ward
commands
-BP checked and recorded
-breakfast taken and
consumed; with good
appetite
-mingled with student
nurses and other patients
-maintained eye contact
during interaction
-relaxed and participated
actively during art therapy
-lunch taken and consumed
-needs attended
-endorsed for continuity of
care










Nozinan 50mg 1tab
HS




XIV. Health Teaching Plan

XV. Discharge Plan