A Case Study Presented to the Faculty of the

Ateneo de Davao University

School of Nursing

Case Study on
Substance-Induced Psychotic Disorder Cannot Fully R/O Mood Disorder

Submitted to:
Mr. Leonardo L. Molina RN, MN

Submitted by:
Dayanghirang, Earl John C.
Gulle, Christine May B.
Jamora, Janis Sushmita Marie Q.
Ledda, Lejaen Star Lyka J.
Mainopaz, Trexie Sharmaine M.
Mapundo, Settie Jamila M.
Nomus, Fritzie Beatrice P.
BSN 3A Group 2

March 5, 2015
TABLE OF CONTENTS

Acknowledgementi
Introduction..1
Objectives (General & Specific)..3
Patients Data...6
Genogram.8
Anamnesis..13
Theories of Development
Erik Eriksons Development Theory.19
Sigmund Freuds Psychosexual Theory.26
Jean Piagets Stages of Cognitive Development30
Anatomy and Physiology...34
Mental Status Examination
Initial..43
Final...48
Psychodynamics.52
Etiology & Symptomatology.....56
Differential Diagnosis60
Multi Axial Assessment.67
Complete Diagnosis...73
Doctors Order...75
Laboratory Tests.81
NPI

Initial..99
Final.101
Nursing Theories
Florence Nightingale103
Lydia Hall.104
Sister Callista Roy106
Nursing Care Plans
Disturbed Thought Process..108
Disturbed Sensory Perception..112
Impaired Verbal Communication.115
Readiness for Enhanced Therapeutic Regimen Management....119
Risk for Other Directed Violence.122
Drug Study...128
Prognosis..134
Recommendations137
Significance of the Study.139
References140

ACKNOWLEDGEMENT
The group wishes to express their sincerest gratitude and warmest appreciation to
the following people who provided the group the possibility of making this case study a
success.
First, to the Almighty God, who never ceased in loving and providing the group
his constant guidance and protection.
To the groups clinical instructor, Leonardo Molina R.N. M.N., for his supervision
and support during the study and the psychiatric nursing exposure. His help, motivation,
suggestions, and encouragement helped us while making this case study.
To Melba Irene Gabuya R.N.M.N. and Apple Alvarez R.N. M.N. for their
unlimited patience, assistance, encouragement, presence during the psychiatric nursing
exposure and also for imparting their knowledge and learning experience to the group.
Without their help, encouragement, and constant guidance, the Psychiatric Nursing
exposure would not have been a very significant learning experience.
To the staff nurses of the Southern Philippines Medical Center Institute of
Psychiatric and Behavioral Medicine, for allowing us to conduct this study, and for their
indispensable assistance in reviewing the patient files and giving us the opportunity to
care for the mentally-ill patients. This special appreciation is also extended to the client
subjected for this study and other informants for their selfless cooperation, time and trust.
And lastly, to our parents who have always been very considerate and
compassionate both financially and emotionally.

INTRODUCTION
People with mental illness are often misunderstood. They are misunderstood
because, their so called beliefs are detrimental to society and thats why they are viewed
as sick or ill. Although they might have a point, but for the majority their point is not
taken or seen and their views and perspective are often rejected. As normal persons, we
cannot see thoroughly the perspective of a mentally ill person. Only those with mental
disorders truly understand the pain, the stigma, the frustration, rejection, the feeling of
utter loss, the loneliness and sadness that mental illness brings.
Mental health and mental illness are often difficult to define. When people are able
to carry out their roles in society and their behavior is appropriate and adaptive, they are
viewed as being healthy. Conversely, when a person fails to fulfill roles and carry out
responsibilities, or his or her behavior is inappropriate, the person is viewed ill. The
culture of any society strongly influences its values and beliefs, and this in turn affects
how health and illness are defined. What is viewed as an acceptable and appropriate
behavior in one society may be seen as maladaptive or inappropriate in another.
According to the Australian Health Ministers (2003) mental health is a state of emotional
and social wellbeing in which the individual can cope with the normal stresses of life. It
includes being able to work productively and contribute to community life. Mental health
describes the capacity of individuals and groups to interact, inclusively and equitably,
with one another and with their environment in ways that promote subjective wellbeing,
and optimize opportunities for development and the use of mental abilities. Disturbance
in mental health however causes mental disorder or mental illness. Mental illness is a
general term that refers to a group of illness that affects the brain, in the same way that
heart disease refers to a group of illness that affects the heart. Mental disorder or mental
illness is defined as a clinically significant behavior or psychological syndrome or pattern
that occurs in an individual that is associated with present distress or disability or with a
significantly increased risk of suffering, death, pain, disability, or an important loss of
freedom (The American Psychiatric Association, 1994) One of a common cause that may
lead to mental illness is substance abuse.
According to the World Health Organization (WHO) substance abuse refers to the
1

harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.
Psychoactive substance use can lead to dependence syndrome - a cluster of behavioral,
cognitive, and physiological phenomena that develop after repeated substance use and
that typically include a strong desire to take the drug, difficulties in controlling its use,
persisting in its use despite harmful consequences, a higher priority given to drug use
than to other activities and obligations, increased tolerance, and sometimes a physical
withdrawal state. Between 149 million and 271 million people worldwide used an illicit
drug at least once in 2009; which equals 1 in 20 people aged 15 to 64 who have used an
illegal drug and 2 billion people worldwide have drank alcohol. In the Philippines as of
November 14, 2012 an estimated 1.7 million Filipinos are hooked on drugs, with 1,700 of
them dying each year, and 2,492 went to rehabilitation and mental & behavioral facilities
due to their addiction (Dangerous Drug Board 2012, Office of the President).
The case that was given for us to study was Peter with a diagnosis which is
substance induced psychosis. We are going to present the history of his condition which
is considered in the schematic presentation. This study also includes his childhood and
life experiences that affect his present condition. The family also allowed us to conduct
the study; with full participation they were able to open up and gave us a lot vital
information with full honesty that contributed in the progress of this case study. With the
information that we get, we would identify possible problems, as proponents of this case
study, we are accountable for possible application of nursing interventions. This case
study will contribute to nursing education through provision of information for planning
of care to the client. This study will provide nurses and student nurses information about
the condition of our client which will be helpful in the application of nursing practice.

OBJECTIVES

General Objectives:
Within a span of two weeks, the group should be able to conduct an extensive and
comprehensive case study of our chosen client that would present a wide-ranging
discussion of our patients condition which is substance induced psychotic disorder to
yield the essential information for our case study.

Specific Objective:
The group has created certain aims that will help in achieving their general
objectives. Within the two weeks of exposure, the group aims to:

Cognitive:

Gather all necessary information regarding the chosen client as it may be related

to our case study.

Ascertain clients and the whole familys past and present health history
Trace the family tree of the client through a genogram.
Determine the Developmental theories in accordance with the clients

development.
Explain the psychodynamics or the pathophysiology of the clients diagnosis by

recognizing the predisposing and precipitating factors with appropriate rationales.

Repot the results of the mental status examination, the progress notes in relation

to the clients condition, and the doctors order.

Exhibit the complete diagnosis in accordance to the clients maladaptive
behaviors through the DSM-IV checklist;

Define the differential diagnosis and multiaxial assessment that would explain the

condition of our client.

Discuss thoroughly the Anatomy and Physiology of the involved organs and organ

systems in accordance to the diagnosis;

Analyze the doctors order with justification by the right rationales.
Distinguish and determine the neuropsychological test and diagnostic test that our
client has undergone including their implications, normal and abnormal values,
findings for comparison, and specific interventions associated with each

diagnostic procedure.
Identify the drugs and therapies or medical management given/ prescribed to our
client, including their actions, indications, contraindications, side and adverse

effects, and nursing responsibilities.

Present the formulated nursing care plans based on the three nursing theories that

are applicable to the clients condition;

Validate clients prognosis according to the following categories: onset of illness,
duration of illness, precipitating factors, mood and affect, attitude and willingness

to take medications and treatment, any depressive features and family support.
Cite the sources used in this case study through an outlined reference.

Psychomotor

Render health teachings to the client and especially to his family to promote

health and help with fast recovery.

Display patience in dealing with the client in understanding and analyzing his
overall behavior.

Display competence while dealing with the client and while speaking to the
family members, neighbors and friends.

Affective

Establish rapport with the client, family members, neighbors and his friends.
Actively listen to significant others to be able to know clients concerns and

attend to his needs.

Give time for him to express his feelings and talk about his life.
Show genuineness and willingness in serving the client.
Develop a caring, non-judgmental, and therapeutic attitude towards the client and

all his significant others.

Be aware of the clients progress on the succeeding interactions.

PATIENTS DATA
(PERSONAL DATA)
Patients Name: Stephen Sabas
Code Name: Peter
Age: 23 years old
Sex: Male
Birthday: July 1, 1991
5

Birthplace: Maternity Clinic, Davao City

Address: Dona Asuncion Phase 8 Blk 80 Lt. 16 Angeles St., Sasa Davao City
Ordinal Rank: 1st
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Educational Attainment: College Level (BSIT - 2nd Yr. College)
Occupational: Undergraduate Student
Number of Brother: 0
Number of Sister: 0
Mother: Liza Sabas
Age: 46 Years Old
Religion: Ang Dating Daan
Educational Attainment: College Level (BSC Major in Accounting)
Occupation: Business Woman (Candles)
Father: Juanito Baliente

(CLINICAL DATA)
Ward/Service: Crisis Intervention Unit/Psychiatry
Admitting Physician: Alsa Katrina V. Francisco, MD
Admitting Clerk: Valen Grace T. Suclan
Admitting Diagnosis: T/C Substance induced psychotic disorder cannot fully R/O mood
disorder
Chief Complaint: Repeatedly shouting the word dark hole
Date & Time of Admission: February 13, 2015; 11:25 PM
Date of Discharge: February 26, 2015; 7:00 PM
Institution: Southern Philippines Medical Center - Institute of Psychiatric and Behavioral
Medicine (SPMC-IPBM)

GENOGRAM

Mark
84

Matthew

Ezra
58

Esther
52

Jonah
51

Luke
50

Ruth
79

Micah
46

Eve
42

Jezebel

40

Leah
38

Miriam
36

John
34

Ezekiel
44

LEGEND:

- Male
- Female

- Mother
- Father

Peter
23

- Stroke
- Hypertension
- Diabetic

- Anemic
8

- Patient
- Separated

B. FAMILY HISTORY
a.

Maternal and Paternal Grand Lineages

There was no history of being diagnosed or admitted due to a mental illness in their family.
Peters grandfather on his maternal side had stroke, Ezra and Jonah his aunties have
hypertension and diabetes mellitus and his mother Micah has anemia. Micah, at the age of 23
gave birth to Peter from her boss at Diamond Glass at Uyanguren named Matthew. They
separated after she gave birth to Peter at the Maternity Clinic because Ezra took Micah at the
house of Matthew because Ezra got mad because Micah was staying at the house of Matthew
with his legal wife. After they have separated, Micah got married to another married man who
is a navy and is now deceased because of stroke and their marriage was void because he is still
not annulled with his legal wife who is in Japan. They doesnt have any children but his
husband has a child from his legal wife that is working in Japan.

b.

Father
Matthew, the father of Peter has no connections to Micah and Peter after they got separated.
According to Micah, she never contacted him after she was took by Ezra, her sister. Micah also
said that he is already dead. But the 2nd husband whom she was with, stand as the father of
Peter in which at first he didnt like Peter to stay their with them because he is not his own
child but as the time goes by he accepted Peter and held him as his own son.

c.

Mother
Micah, 46 years old, the mother of Peter, is a business woman. She has a business of candles in
which her sisters are the ones who are making the candles and she is the one that manages it.
Their candle factory is located at San Lorenzo, Davao City. She also worked as a Secretary at
Diamond Glass at Uyanguren and that is where she met the father of Peter. They make candles
per order, they are also making scented candles, colored candles and normal candles.

d.

Siblings
Peter has no sisters or brother because Micah and Matthew got separated but Peter has a
stepsister in the 2nd husband of Micah.

C. PERSONALITY HISTORY

a.

Prenatal
Peter was the only child. Ezra, the sister of Micah verbalized that Micahs pregnancy is
unplanned and was an accident. Micah verbalized that she had prenatal check ups every
trimester and she have complete immunizations before she gave birth to Peter. She gave birth
to Peter at the Maternity Clinic, Davao City. Micah verbalized that Peter is completely
immunized.

b.

Birth
Peter was born July 1, 1991 via Normal Spontaneous Vaginal Delivery, full term without
complications at the Maternity Clinic. Micah verbalized that she never regret having a child
even though it was an accident and unplanned pregnancy. She also verbalized that she had no
difficulties while in labor.

c.

Infancy and Childhood Characteristics

Peter was born on July 1, 1991. According to Ezra his aunt, Peter was able to sit and talk
independently. Peter had his 1st teeth when he was 3 months old.

d.

Psychosexual History
Peter was toilet trained by his aunt and mother as verbalized by Micah, his mother. His mother
once caught Peter masturbating and she just let Peter do it because it was normal for men to
masturbate as verbalized by Micah. Peter was circumcised when he was in grade 2 at the age
of 7. According to Micah, his mother, he had his 1 st girlfriend when he was in high school and
MedTech student in San Pedro College that lasted for 2 years. But according to Peter, he had
13 girlfriends and one of them is named Marian who is a gingerbread and his mistress and he
added naa sa lain world.

e.

Play Life
According to his mother and aunt, he is not fun of playing outside the house and making
friends in the neighborhood. He is a loner person according his mother. He usually play a
Mario & Luigi game in a playing station in which you will pay P1.00 and play for how many
minutes. He also had a gun toy according to his mother. When he stopped in college, he
became addicted to computer games (MMORPG). According to his mother, he usually spends

10

3 - 5 hours of playing MMORPG at the internet cafe. And he sometimes tend to skip his meal
because of playing MMORPG but he never skips his class. One of his cousins and friend are
his playmates in MMORPG.
f.

School History
Peter entered preschool at 6 years old. According to his mother, he is a diligent and studious
student. In his grade school and high school life he studies at Fatima de Davao. According to
his mother his favorite subjects are math and science. He was never a trouble maker in school.
He refers to be alone than being with his classmates in school. According to his mother he
finished preschool until high school continuously but when he started his college he doesnt
enrolled to school continuously because of lack of financial support from his mother because
the allotted for his school payment goes to the church in which his mother is attending as
verbalized by his aunt Ezra.

g.

Religious and Social Adaptability

Micahs religion is Ang Dating Daan the mother of Peter. She is an active member of the
church and she was one of the officers of their church. According to Ezra, his aunt, Peter
doesnt like the religion of his mother because she spends more time in her church than him
and all their money goes their and Peter doesnt go with her mother when he was asked to go
with her. Peter was a Roman Catholic but he is not an active member in their church and he
doesnt attend mass every Sunday.

h.

Occupational History
Peter started working as a dicer in a convenience store for 3 months in the year 2013. He was
told by his mother to stop working because they will go to Manila for his neurologic
examination for the requirement for his navy.

i.

Marital History
Peters civil status is single but he claimed that he is married Jonah Marie Sabas, 22 years old,
a pharmacist student at UIC and they have a child named Ken-ken Sabas, 19 years old, an alien
and was being kidnapped and put in maze as he verbalized. But the truth is Jonah Marie is his
crush they dont have any child.

11

j.

Onset of Present Illness

Peters weird actions started when he came back from jogging in February 11, 2015, 2 days
prior to confinement. Peter was seen by his mother sitting outside their comfort room from
8AM to 12noon. murag naa siyay gibasbasan as verbalized by the mother. No consultations
was done; instead his mother just let him from what he is doing but the condition persisted.
According to his mother, 10PM he keeps on ranting, talking repeatedly about death, secret and
defense. He also said the name of Jonah and Marian. Until February 12, 2015, he never slept
and when its dawn he laughed so loud as verbalized by the mother.
February 13, 2015 he was shouting and being complained by the neighborhood. His mother
then go to their house and ask him Phen, dalahon tika sa Psychiatric Clinic (Babista) Lanang.
Ipaadmit ka para maayo ka then Peter replied sige Mommy. Ikaw na bahala sa akoa. then
her mother called 911 and brought him to the Babista but when they have inquired their, it was
so expensive so, the mother decided to bring him to SPMC-IBPM in which it is less expensive
and she can afford to pay everything including the medications needed by Peter.
February 14, 2015, Peter was running around the Crisis Intervention Unit and he was
restrained. February 15, 2015, 3 - 5 PM his mother visited him at the Crisis Intervention Unit
but he keeps on mumbling about space - space and he requested his mother to buy double
chicken time with coleslaw at minute burger.
February 19, 2015, his mother visited him again and talked about his school. His mother
verbalized Phen, niadto ko ug UM para isettle ang baydanan nimu sa imung school. Para
makapadayon ka ug eskwela pag okay naka. Peter replies Magshift nako ug Pharma
Mommy.
February 20, 2015, Peter was restrained because he punched a 14 year old guy that mentions
the name RYAN in which it was his enemy in MMORPG.

12

ANAMNESIS
Informants
Informant # 1
Name: Liza
Age: 41 years old
Address: Dona Asusnsion, Sasa, Davao City
Relationship to client: Mother
Length of time known by the client: Since birth- 23 years

Apparent Understanding of the Present Illness of the client:

According to Liza, Stephens condition was caused by a lot of factors including
the death of his step father, he wasnt able to pass the neurological exam in the navy, he
was pressured because his relatives kept on comparing him to his cousins, and he doesnt
eat and sleep because of playing too much computer games.

Characteristics and Attitude of Informant:

During the interview, Liza was accommodating and participative in answering our
questions. There were just some questions that she was hesitant because of some personal
matters. She was not able to give us the complete details about their family and she is
aware of the shortcomings that she has on his son.

13

Informant # 2
Name: Priscilla
Age: 58 years old
Address: Plain View, Sasa, Davao City
Relationship to the Client: Aunt of Hawaiian
Length of Time Known by the Client: Birth- 23 years

Apparent understanding of the Present Illness of the Client:

Priscilla is the aunt of the client and has taken care of him since birth up until 7
years old because his mother was busy working. Priscilla said that she was hurt when she
learned about the situation of the client because she treated him as her own. She said that
the mother of the client was the main reason why he has experienced this disorder
because she didnt give the attention that he needs. Pirmi wala iyang inahan kay tua sa
iyang simbahan unya gina pasagdan lang iyang anak. Ma hutdan ug pang tuition kay
gastador kaayo iyang mama. Na depress to siya unya ang iyang problema iyang gina
tago. Sige pud to siyag computer unya ma gutman, mao to ang mga naka contribute sa
iyang sitwasyon.

Characteristics and Attitude of the Informant:

Priscilla was very honest and straightforward in answering our questions. Her face
was really sincere and teary eyed when we asked about her insight towards the client's
situation. She was ready to tell us the things that we wanted to know however she felt
restricted because Liza was with us and she told us that maybe their relationship would

14

change. Priscilla was the one who told us about the real status of their family. She also
stressed out that Liza is the main contributor of the clients condition.

Informant # 3
Name: Stella
Age: 51 years old
Address: San Lorenzo
Relationship to the Client: Aunt of Hawaiian
Length of Time Known by the Client: Birth- 23 years

Apparent understanding of the Present Illness of the Client:

Lain tong bataa to kay di naga laag2, di hilig mag bonding2. Sa tanaw pd nko na
depress siya, unya sigeg computer, way saktong kaon, kabuhi ni saka sa utok. Bago
siya na admit, ni anhi siya diri mag sigeg istorya nga siya lang, sige ingon concentrate,
concentrate, concentrate! Tawo- Tawo! The aunt also told us that she thinks that failing
the neurological exam in the army also contributed to his condition.

Characteristics and Attitude of the Informant:

Stella was participative in our interview, she has eye contact and she told us
things that she knows about the client. She felt really devastated on what happened to his
nephew. Stella was not stressing that it ws all his mothers fault. She told us that it was
because of a lot of factors.

15

Informant # 4
Name: Elma
Age: 52 years old
Address: San Lorenzo
Relationship to the Client: Worker
Length of Time Known by the Client: 11 years

Apparent understanding of the Present Illness of the Client:

Elma works in their candle business and has known the client for quite some time.
Di ko ka tuo sa nahitabo sa iya kay buotan to siya. Unya pag mu anhi siya diri, mag
storya2 mi ug mag kinataw-anay. Na depress siya kay gusto maka human ug skwela
pero ang mama dili siya gina supportahan.

Characteristics and Attitude of the Informant:

Elma was cooperative during our interview and provided us the information that
we need. She had proper eye contact and she has the willingness to tell us what she
knows

about

the

client.

Informant # 5
Name: Brenth
Age: 17 years old
Address: San Lorenzo
Relationship to the Client: Cousin of Hawaiian

16

Length of Time Known by the Client: 10 years

Apparent understanding of the Present Illness of the Client:

Brenth is the first cousin of the client and according to him they are not that close.
Sometimes they play Dota together and chill and hang out in Mati. Di ko katuo nga ma
ingana siya. Buotan, hilumon ug di mu sulti ug problema. He said that before the client
was admitted, the client visted their house and noticed something different kalit lang
siyag yaw-yaw, tagalong pajud. Apir Apir sa iyang sariling kamot. Brenth thinks that his
situation was caused by depression.

Characteristics and Attitude of the Informant:

Elma was cooperative during our interview and provided us the information that
we need. She had proper eye contact and she has the willingness to tell us what she
knows about the clien

Informant # 6
Name: Jennifer
Age: 25 years old
Address: Fatima, Bajada, Davao City
Relationship to the Client:Friend
Length of Time Known by the Client: 1 year

17

Apparent understanding of the Present Illness of the Client:

Jennifer is a classmate and a close friend of the client. They have known each
other for a year. Para sa akoa, depression ang cause kay gina tago lang niya ang iyang
mga problema. Gusto niya pirmi lang lipay2. Buotan ug bright sya ug kabalo magpa
katawa masking problemado. Nag share sya sa amo na layo iyang loob sa iyang mama
kay murag wala daw pakealam iyang mama sa iya. Ang mga problema niya gina agi nlng
niya sa dota.

Characteristics and Attitude of the Informant:

Jennifer was very accommodating and participative in our interview. She was able
to give us some information that we haven't gathered from his family. Jennifer knows
about the family issues of the clients family because they were close friends and they
share each others problems.

18

THEORIES OF DEVELOPMENT

These are just a few of the fascinating aspects of the field of human
development: the science that studies how we learn and develop psychologically, from
birth to the end of life. This very young science not only enables us to understand how
each individual develops, it also gives us profound insights into who we are as adults.
Each theory has its own perspective on the development of man.

ERIK ERIKSONS PSYCHOSOCIAL STAGES OF DEVELOPMENT

The Psychosocial Stages of Development developed by Erikson enumerates eight
stages though which healthily developing human should pass from infancy to late
adulthood. Every stage describes a task to be accomplished. These development stages
can be seen as a series of crisis and each stage forms on the successful accomplishment of
the earlier stages. Successful resolution of these crises supports a healthy selfdevelopment. Failure to resolve the crises damages the ego and maybe expected to
reappear as problems in the future.
Stage
Description
Result
Infancy (birth to 1 The first stage, centers Mistrust

Justification
The mother was not

year)

on the infant's basic

able to provide the

needs being met by the

patients basic needs

Central task:

parents.

as

Trust vs. Mistrust

depends on the parents,

patient

especially the mother,

breast fed for only 1

for food, sustenance,

week and was left to

The

infant

an

infant.

The

was

only

19

and comfort.
parents

If the

expose

his aunt because his

the

mother had to work.

child to warmth and

He was then bottle fed

dependable

since

affection,

then.

The

the infant's view of the

mother was not able

world will be one of

to bond enough with

trust.

him

But if the caregivers

neglectful because of

are

her work. The father

neglectful,

the

and

infant instead learns

is

not

mistrust- that the world

already.

with

was

them

is in an unpredictable
and an unsafe place.

Early Childhood (2 to If caregivers encourage Autonomy

The patient was toilet

3 years)

trained by his aunt

self-sufficient
child

and mother when he

develops a sense of

was 2 years old. The

Autonomy vs. Shame autonomy- a sense of

mother gives him the

& Doubt

being able to handle

freedom and ability to

many things on their

explore

own. But if caregivers

achieved

demand too much too

because he was able

behavior,
Central task:

things.

He

autonomy

to sit and talk at the

20

let

age of 10 months. The

children perform tasks

patient was able to

of

walk at the age of 1.

soon,

refuse

which

to

they

are

capable; children may

instead develop shame
and doubt about their
ability

to

handle

things.

Late Childhood (4 to During this stage, the Guilt

Patient had a low self-

6 years)

child learns to take

confidence. He is a

initiative and get ready

shy-type person and

Central task:

for leadership and goal

prefers to be alone.

Initiative vs. Guilt

achievement roles.

According to his aunt,

If adults encourage and

support

childrens

efforts,

while

also

helping

them

make

realistic

and

proper

choices,

children

develop

initiative-

independence
planning

he likes to play inside

their house and does
not like playing with
others

children

outside.

in
and
21

undertaking activities.
But

if,

adults

discourage the search

of

independent

activities,
develop

children
guilt

about

their needs and desires.

School Age (7 to 12 At this stage, children Industry

He

years)

are eager to learn and

elementary years in

accomplish

Fatima

Central Task:
Industry
Inferiority

more

attended

his

Elementary

complex

skills:

School. According to

vs. reading,

writing,

his mother, he was a

good

telling time.
If

children

are

encouraged to make
and do things and are
then praised for their
accomplishments, they

student.

He

exams

on

passed
different

subjects

specially

in

mathematics. He likes
to study.

begin to demonstrate
industry

by

being

diligent, persevering at
tasks until completed
and
before

putting

work

pleasure.

If
22

children

are

instead

ridiculed or punished
for their efforts or if
they

find

they

are

incapable of meeting
their

teachers'

parents'

and

expectations,

they develop feelings

of

inferiority

about

their capabilities.
Adolescence (13 to 19 The
adolescent
years)

Central Task:

is Identity

newly concerned with

friends and they bond

how they appear to

through

others.

watching movies. The

Identity vs. Role The sense of central

Confusion

The patient has a few

eating

and

patient does not drink

identity

appears

alcohol

through

sexual,

smoke.

or

even

The patient

emotional, educational,

wants to finish college

ethnic, cultural,

but due to financial

vocational

and

discovery.

problems

he

was

The adolescent person

forced to stop. He

also develops coherent

then started with his

sense of self and plans

addiction

to

MMORPG game.

actualize

ones

in

23

abilities. The sense of

self can be confused if
a core identity does not
solidify. Feelings of
confusion,

hesitancy,

and possible antisocial

behavior

may

also

emerge.
Early Adulthood (20 Once people

have Isolation

The patient stays only

to 34 years)

their

in their house and

established
identities,

Central Task:

they

are

does

not

socialize

ready to make long-

with his friends. He

Intimacy vs. Isolation term commitments to

just goes out of the

others. They become

house when he wants

capable

to play

of

intimate,

forming
reciprocal

relationships

and

willingly

the

make

sacrifices

and

compromises that such

relationships require. If
people
these

cannot

form

intimate

relationships--a

sense
24

of isolation may result.

SIGMUND FREUDS PSYCHOSEXUAL THEORY

The concept posits that from birth human have intellectual sexual appetites
(libido) which unfold in a series of stages. Each stage is characterized by erogenous zone
that is the source of libidinal drive during that certain stage.
LIFE STAGE
CHARACTERISTICS
IMPLICATIONS
ASSESSMENT
JUSTIFICATION
Oral (Birth to 1 1/2 year)
The center of pleasure is the mouth; it is the major source of pleasure and satisfaction and
exploration. The childs primary need is security or safety.
Major conflict: weaning
Feeding produces pleasure, a sense of comfort or ease and safety. Feeding should be
pleasurable, it should be provided when necessary.
NOT ACHIEVED
The mother breastfed him only for 1 week and started bottle fed and started introducing
food at the age of 1 year and 6 months. The mother still bottled-fed him until 2 years old.
The aunt observes him thumb sucking.
ANAL (1 1/2 to 3 years)

The sources of pleasure are the anus and the bladder (sensual satisfaction, self-control).
Major conflict: toilet training.
Controlling and expelling feces give pleasure and sense of comfort. Toilet training should
be a pleasurable experience.
25

NOT ACHIEVED
Toilet training was too loose. The patient was not toilet trained by his mother. They said
that he just learned it all by himself by seeing others do toileting.
PHALLIC (4-6 years)

The genitals are the center of gratification. Masturbation offer pleasure to the child. Other
actions include fantasy, experimentation with peers, and questioning of adults about
sexual issues or sexual matter.
Major conflicts: the Oedipus Complex (refers to the male child's attraction for his mother
and unfriendly attitudes towards his father) and Electra Complex (refers to the female's
attraction for her father and sees her mother as her rival), which resolves when the child
identifies when the child identifies with parent of same sex.
The child determines together with the parent of the opposite sex and later takes on a love
relationship outside the family.
NOT ACHIEVED
The patient is not close to his mother. At this stage, he was able to learn that a boy is for a
girl, and a girl is for a boy.
LATENCY (6 years to puberty)
Energy is heading for physical and intellectual activities. Sexual impulses tend to be
repressed. Develop relationships between peers of the same sex.
Encourage child with physical and intellectual pursuits. Encourage sports and other
activities with same-sex peers.
NOT ACHIEVED
He started to go to school by this time; he had gained few friends and but not playmates
because he prefers himself to be alone. He isolates himself to his peers although he had
been performing well to school and interested to study his lessons. He finish grade school
and high school. He had few friends
Genital (puberty and after)
26

Energy is directed toward full sexual maturity and function and development of skills
needed to cope with the environment.
Encourage separation from parents, being independent and able to make right and good
decisions
NOT ACHIEVED
He is not independent, until now, he still lives with his mother and still dependent to his
mother in his basic needs and as well to meet personal needs.

JEAN PIAGETS STAGES OF COGNITIVE DEVELOPMENT

This theory pertains to the nature and development of human intelligence.
LIFE STAGE

CHARACTERISTICS

ASSESSMEN

JUSTIFICATION

Sensorimotor

T
In this stage, infants build an ACHIEVED

The patient as an

Thought

understanding of the world

infant was being

(birth-2years)

by

sensory

breastfed by her

experiences (such as seeing

mother in a short

and hearing) with physical,

time

motoric actions. Infants gain

bottle fed him after

knowledge of the world from

because her mother

the physical actions they

is busy at work.

perform

infant

When giving the

progresses from reflexive,

bottle, the infant

instinctual action at birth to

grasp

the beginning of symbolic

implies that there

thought toward the end of the

was

stage.
Thought

between the sense

coordinating

on it. An

derives

from

only

it.

and

This

coordination

and the reflexes of

27

sensation and movement.

The child learns that he is
separated

from

Rocky.

his

environment and that aspects

of his environment continues
to exist even they may be
outside the reach of his
Preoperational

senses.
Thinking is still egocentric: ACHIEVED

At this age, he

Thought (2-7

has difficulty taking the point

started

years)

of view of others.
The children begin

According to the

to

aunt, the patient

represent the world with

likes

images and words. Symbolic

images

thought goes further than

represent his ideas

connections

of

sensory

since he does not

information

and

physical

like to play with

action.
Objects

are

classified

good

that

in

math

according to his

isnt able to conceptualize

draw

patient was also

significant feature; the child

abstractly.
The child starts to think

to

other children. The

in

simple ways, especially by

Concrete

schooling.

parents
ACHIEVED

According to his

Operational

abstractly and conceptualize,

mother, he knows

Thought (7-12

forming

how to arrange his

years)

that explains his or her

things

physical experiences.
Children
can
execute

systematically

operations

on its size, shape

logical

and

structures

logical

or

in order depending

reasoning replaces intuitive

or

thought as long as reasoning

characteristics;

any

other

can be applied to specific or

28

concrete examples.
Children show thinking is

hes

decentered

consider

his things. He is

of

actually good in

multiple

-they
aspects

the

problem (e.g. understanding

organized

when it comes to

Math.

the significance of height and

width). They focus on the
dynamic

change

problem.

And,

in

the
most

importantly, they show the

reversibility of true mental
operation.
The person is capable of ACHIEVED

When Rocky was

Operational

deductive and hypothetical

asked,

Thought

(12

makakita

years

and

reasoning.
The logical quality of the
adolescent's thought is when

kwarta,

children are more likely to

man

solve problems in a trial-and-

pitaka,

error fashion.
During this stage the young

gastuhon

Formal

above)

adult is able to understand

such things as love, "shades
of gray", logical proofs and

values.
During this stage the young
adult begins to entertain
possibilities for the future
and is fascinated with what

they can be.

At this stage, they can also

Kung
ka

ug

pitaka na punog
unsaon
nimo
iuli

ang
o
ang

kwarta?; he then
replied Iuli nako,
kung naay kaila ko
sa tag-iya, pero ug
wala,

kuhaon

nalang nako He
was able to draw
conclusion

from

the given situation

available.

reason logically and draw

conclusion

from

what
29

information is available.

ANATOMY AND PHYSIOLOGY

Nervous System
The nervous system is responsible for coordinating all of the body's activities. It controls
not only the maintenance of normal functions but also the body's ability to cope with
emergency situations.
Function
The nervous system has three general functions: a sensory function, an interpretative
function and a motor function.
1. Sensory nerves gather information from inside the body and the outside
environment. The nerves then carry the information to central nervous
system (CNS).
2. Sensory information brought to the CNS is processed and interpreted.
3. Motor nerves convey information from the CNS to the muscles and the
glands of the body.
Structure
The nervous system is divided into two parts:

30

1. the central nervous system consisting of the brain and spinal cord. These
structures are protected by bone and cushioned from injury by the
cerebrospinal fluid (CSF)
2. the peripheral system which connects the central nervous system to the rest
of the body.

The central nervous system

Central nervous system
These structures are protected by bone and cushioned from injury by the cerebrospinal
fluid (CSF).
Brain
The brain is a mass of soft nerve tissue, which is encapsulated within the skull. It is made
up of grey matter, mainly nerve cell bodies, and white matter which are the cell
processes. The grey matter is found at the periphery of the brain and in the centre of the
spinal cord. White matter is found deep within the brain, at the periphery of the spinal
31

cord and as the peripheral nerves.

The brain is divided into:

Cerebrum - the largest part of the brain. It is the centre for thought and
intelligence. It is divided into right and left hemispheres. The right controls
movement and activities on the left side of the body. The left controls the
right side of the body. Within the cerebrum are areas for speech, hearing,
smell, sight, memory, learning and motor and sensory areas.

Cerebral cortex - the outside of the cerebrum. Its function is learning,

reasoning, language and memory.

Cerebellum - lies below the cerebrum at the back of the skull. Its functions
are to control voluntary muscles, balance and muscle tone.

Medulla - controls heart rate, breathing, swallowing, coughing and

vomiting. Together with the pons and the midbrain, the medulla forms the
brainstem that connects the cerebrum to the spinal chord.

Lobes of the brain

It is important to have an understanding of how the brain functions and which parts
control our functioning and behaviour. For example, when a casualty suffers from a
stroke, the part of the brain that is affected controls function. If it is the frontal lobe,
speech, thought and movement may be affected.
The spinal cord
The spinal cord is about 45 cms long, extending from the medulla down to the second
lumbar vertebrae. It acts as a message pathway between the brain and the rest of the body.
Nerves conveying impulses from the brain, otherwise known as efferent or motor nerves,

32

travel through the spinal cord down to the various organs of the body. When the impulses
reach the appropriate level they leave the cord to travel to the' target organ.
Sensory or afferent nerve impulses also use the spinal cord to travel from various parts of
the body up to the brain.

Peripheral system
The peripheral system connects the central nervous system to the rest of the body. The
main divisions of the Peripheral Nervous System are:

The autonomic nervous system which controls the automatic functions

of the body: the heart, smooth muscle (organs) and glands. It is divided
into the fight-or-flight system and the resting and digesting" system.

The somatic nervous system which allows us to consciously or

voluntarily control our skeletal muscles. The somatic system contains 12
cranial nerves and 31 spinal nerves.

Nerves which are made up of special cells called neurons. Neurons are
comprised of a dendrite, a cell body and an axon. Impulses travel to the
dendrite into the cell body and then onto the axon. A special sheath called
myelin, which increases the conductivity of the neuron, covers some
nerves.

As messages travel from one neuron to the next they move across a synapse. At each
synapse there is a chemical called a neurotransmitter. At various parts of the body
specific neurotransmitters facilitate communication, for example dopamine (motor
function), serotonin (mood) and endorphins (painkillers). Sensory neurons carry

33

messages from a receptor to the brain. The brain then interprets the message. Motor
neurons then send the message to an affector in muscles and glands.
Receptor (sensory organ) sends a signal to the sensory neuron which sends a signal to the
brain/spinal chord which sends a signal to the motor neuron which sends a signal to the
affector (muscle/gland).
The neurone
The basic unit of the nervous system, is a specialised cell called the neurone. These nerve
cells make up a massive network of specialised cells that transmit messages, very rapidly,
from one part of the body to another. Information is transmitted via electrical impulses.
The neurone is comprised of a nerve cell and its adjoining processes called an axon and
dendrites. Every nerve cell has one or more processes attached to it. Electrical impulses
enter the neurone via the dendrites and leave via the axon. The space between the axon of
one cell and the dendrites of another is called a synapse. Specialised chemicals called
neurotransmitters help conduct impulses through the synapse onto the next cell.

Limbic System
The limbic system, or paleomammalian brain , is a set of brain structures, including the
hippocampus, amygdala, anterior thalamic nuclei, septum, limbic cortex and fornix, that
supports a variety of functions including emotion, behavior, motivation, long term
memory, and olfaction. The term "limbic" comes from the Latin limbus, for "border" or
"edge" because the limbic system forms the inner border of the cortex.

34

Limbic System
The position of the limbic system is highlighted in red.
The limbic system includes many structures in the cerebral pre-cortex and sub-cortex of
the brain. The term has been used within psychiatry and neurology, although its exact role
and definition have been revised considerably since the term was introduced.
Limbic System Anatomy
Hippocampus and associated structures

Hippocampus: Required for the formation of long-term memories and implicated in

maintenance of cognitive maps for navigation

Amygdala: Involved in signaling the cortex of motivationally significant stimuli,

such as those related to reward and fear, in addition to social functions, such as
mating

Fornix: Carries signals from the hippocampus to the mammillary bodies and septal
nuclei

Mammillary body: Important for the formation of memory

Septal nuclei

35

Located anterior to the interventricular septum, the septal nuclei provide critical
interconnections between the limbic system

Limbic lobe

Parahippocampal gyrus: Plays a role in the formation of spatial memory

Cingulate gyrus: Autonomic functions regulating heart rate, blood pressure, and
cognitive and attentional processing

Dentate gyrus: Thought to contribute to formation of new memories

Additional structures

Entorhinal cortex: Important memory and associative components

Piriform cortex: Processes olfactory information

Fornicate gyrus: Region encompassing the cingulate, hippocampus, and

parahippocampal gyrus

Nucleus accumbens: Involved in reward, pleasure, and addiction

Orbitofrontal cortex: involved in cognitive processing during decision-making

Limbic System Function
The limbic system operates by influencing the endocrine system and the autonomic
nervous system. It is highly interconnected with the nucleus accumbens, the brain's
pleasure center, which plays a role in sexual arousal and the "high" derived from certain
recreational drugs.
The limbic system is also tightly connected to the prefrontal cortex. Some scientists
contend that this connection is related to the pleasure obtained from solving problems. To
cure severe emotional disorders, this connection was sometimes surgically severed, a

36

procedure of psychosurgery, called a prefrontal lobotomy. Patients who underwent this

procedure often became passive and lacked all motivation.

Dopamine
Dopamine is a neurotransmitter released by the brain that plays a number of roles in
humans and other animals. Some of its notable functions are in:

movement

memory

pleasurable reward

behavior and cognition

attention

inhibition of prolactin production

sleep

mood

learning

Excess and deficiency of this vital chemical is the cause of several disease conditions.
Parkinson's disease and drug addiction are some of the examples of problems associated
with abnormal dopamine levels.
Where is dopamine produced?
Dopamine is produced in the dopaminergic neurons in the ventral tegmental area (VTA)
of the midbrain, the substantia nigra pars compacta, and the arcuate nucleus of
the hypothalamus.

37

Dopamine in movement
A part of the brain called the basal ganglia regulates movement. Basal ganglia in turn
depend on a certain amount of dopamine to function at peak efficiency. The action of
dopamine occurs via dopamine receptors, D1-5.
Dopamine reduces the influence of the indirect pathway, and increases the actions of the
direct pathway within the basal ganglia. When there is a deficiency in dopamine in the
brain, movements may become delayed and uncoordinated. On the flip side, if there is an
excess of dopamine, the brain causes the body to make unnecessary movements, such as
repetitive tics.

Dopamine in pleasure reward seeking behavior

Dopamine is the chemical that mediates pleasure in the brain. It is released during
pleasurable situations and stimulates one to seek out the pleasurable activity or
occupation. This means food, sex, and several drugs of abuse are also stimulants of
dopamine release in the brain, particularly in areas such as the nucleus accumbens and
prefrontal cortex.
Dopamine and addiction
Cocaine and amphetamines inhibit the re-uptake of dopamine. Cocaine is a dopamine
transporter blocker that competitively inhibits dopamine uptake to increase the presence
of dopamine.
Amphetamine increases the concentration of dopamine in the synaptic gap, but by a
different mechanism. Amphetamines are similar in structure to dopamine, and so can
enter the presynaptic neuron via its dopamine transporters. By entering, amphetamines

38

force dopamine molecules out of their storage vesicles. By increasing presence of

dopamine both these lead to increased pleasurable feelings and addiction.
Dopamine in memory
Levels of dopamine in the brain, especially the prefrontal cortex, help in improved
working memory. However, this is a delicate balance and as levels increase or decrease to
abnormal levels, memory suffers.
Dopamine in attention
Dopamine helps in focus and attention. Vision helps a dopamine response in the brain and
this in turn helps one to focus and direct their attention. Dopamine may be responsible for
determining what stays in the short term memory based on an imagined response to
certain information. Reduced dopamine concentrations in the prefrontal cortex are
thought to contribute to attention deficit disorder.
Dopamine in cognition
Dopamine in the frontal lobes of the brain controls the flow of information from other
areas of the brain. Disorders of dopamine in this region lead to decline in neurocognitive
functions, especially memory, attention, and problem-solving.
D1 receptors and D4 receptors are responsible for the cognitive-enhancing effects of
dopamine. Some of the antipsychotic medications used in conditions like schizophrenia
act as dopamine antagonists. Older, so-called "typical" antipsychotics most commonly act
on D2 receptors, while the atypical drugs also act on D1, D3 and D4 receptors.
Regulating prolactin secretion
Dopamine is the main neuroendocrine inhibitor of the secretion of prolactin from the
anterior pituitary gland. Dopamine produced by neurons in the arcuate nucleus of the

39

hypothalamus is released in the hypothalamo-hypophysial blood vessels of the median

eminence, which supply the pituitary gland. This acts on the lactotrope cells that produce
prolactin. These cells can produce prolactin in absence of dopamine. Dopamine is
occasionally called prolactin-inhibiting factor (PIF), prolactin-inhibiting hormone(PIH),
or prolactostatin.
Social functioning
Low D2 receptor-binding is found in people with social anxiety or social phobia. Some
features of negative schizophrenia (social withdrawal, apathy, anhedonia) are thought to
be related to a low dopaminergic state in certain areas of the brain.
On the other hand those with bipolar disorder in manic states become hypersocial, as well
as hypersexual. This is credited to an increase in dopamine. Mania can be reduced by
dopamine-blocking anti-psychotics.
Dopamine levels and psychosis
Abnormally high dopaminergic transmission has been linked to psychosis and
schizophrenia. Both the typical and the atypical antipsychotics work largely by inhibiting
dopamine at the receptor level.
Pain processing
Dopamine plays a role in pain processing in multiple levels of the central nervous system.
This includes the spinal cord, periaqueductal gray (PAG), thalamus, basal ganglia, insular
cortex, and cingulate cortex. Low levels of dopamine are associated with painful
symptoms that frequently occur in Parkinson's disease.
Dopamine in nausea and vomiting
Dopamine is one of the neurotransmitters implicated in the control of nausea and

40

vomiting via interactions in the chemoreceptor trigger zone. Metoclopramide is a D2receptor antagonist and prevents nausea and vomiting.

MENTAL STATUS EXAMINATION

INITIAL

I.

NAME: Stephen Sabas

DIAGNOSIS: Substance Abuse

AGE: 23 years old

PHYSICIAN: Dr. Alisa V. Francisco, MD

WARD: Crisis Intervention Unit

DATE OF EXAMINATION: Feb. 19, 2015

PRESENTATION
a. GENERAL APPEARANCE
Patient calmly walked towards the interviewer from the bathroom and was told to
sit for an initial interview. He had just finished taking a bath. The patient appears
masculine and healthy. He is calm and cooperative. He was well groomed, hair is short,
fingernails and toenails were both trimmed. He was properly clothed as well, wearing the
facilities clothing. He is 23 years old and his chronologic age is congruent with his
apparent age. During the interview, he would always smile and laugh but he was alert and
41

responsive.
b. GENERAL MOBILITY
a. Posture and Gait The patient slouches when seated. He was able to sit,
walk, and move freely without any assistance. No jerking and other
involuntary muscular observed.
b. Activity The patients activity is normoactive. He was able to participate in
the activities and follows instructions being discussed and given to him. His
movements are organized and purposeful during the interview.
c. Facial Expression The patient has an appropriate facial expression to his
verbal responses and stimulus presented. The patient appears happy most of
the time. He usually smiles and laugh during the interview.
d. Behaviour During the interview, the patient is calm and cooperative.
Although he usually laugh most of the time, he was able to answer all of the
questions.
e. Attitude towards the examiner the patient was cooperative and answered
all of the questions from the group. He did not hesitate to share something. He
showed proper eye contact to the interviewer and answer directly.
II. STREAM OF TALK
a. Character of Talk
The patient was spontaneous during the interview even though he suddenly
laughs and repeats few words such as privacy.
b. Organization of Talk
The patient responds to the questions immediately. He comfortably speaks to the
interviewer without hesitancy but gets distracted easily. He had flight of ideas
and suddenly talks to himself, laughing, and then saying the name Marian and
numbers.
c. Accessibility
42

The patient was very cooperative during the interview. He was able to answer all
of the questions. He was not frustrated and angry with the questions. He was
honest in answering all of the questions during the interview.

III.EMOTIONAL STATES AND REACTION

a. Mood
During the interview, the patient was euphoric. His mood was appropriate with
his verbal responses and with what is going on with his surroundings.
b. Affect
The patient has appropriate affect. His actions and emotions were appropriate
with his verbal responses.
c. Suicidal and Homicidal Potential
He has no signs of suicide tendencies. He had no suicidal thoughts and never
thought of killing himself. He had not tried to physically harm others.
IV. THOUGHT CONTENT
a. Perceptions and Hallucinations
Although the patient denies it, visual hallucinations were present. He claims that
he sees a black hole that sucks bad spirit in it and he can still see it. He said that
he has an alien son that is 19 years old and wife named Jonah. He also said that
he has a mistress named Marian who is a half spirit and half alien. He often
calls the name Marian and state numbers again and again.
b. Delusions
Delusion of grandeur was present in the patient. He would verbalize, Mao diay
dato kayo mi kay naa diay candle business si Mommy. Erotomania is also

43

present since he claims that he has a wife that loves him so much. He would
often say, Dili man masuko akoang asawa basta magbinut-an lang mo.
c. Dj

vu

and

Jamais

vu

Dj vu and Jamais vu is not present in the patient.

V. NEUROVEGETATVE DYSFUNCTON
a. Sleep
According to the patient, he is having a hard time falling asleep. He said that
often times he wakes up at dawn, he finds it hard to go back to sleep.
b. Appetite
There is no problem with his appetite. He denies having lack of appetite.
c. Weight
The patient does not know his weight and not interested to know his current
weight.
d. Attention Span
The patient has a short attention span. Although he was able to answer all of our
questions, he gets distracted easily by his hallucinations. He would suddenly call
out Marian as if they were talking and giggles.
VI. GENERAL SENSORUM AND INTELLECTUAL STATUS
a. Orientation
The patient was oriented with the time, place, and person. When asked what day
and what time of the day it was, he verbalized Huwebes karon mam sa hapon.
When asked where he was, he said that he is in the mental hospital. When asked
what he was doing at the moment, he said that he was told to have an interview
with the group.

44

b. Memory
The patients immediate memory is not impaired. He can still remember what he
had eaten earlier. His recent memory was not also impaired for he can still
remember his family members. His remote memory is not also impaired because
he can still remember facts about his past experiences and cooperatively shares
them with us.
c. Calculations
Calculations were good. The patient was asked to progressively add 3s from 10
and was able to answer all of them. (13, 16, 19, 22 and, 25)
d. General Information
The patient knows the basic information such as the capital of the Philippines
and the current president of the Philippines.
e. Abstract Thinking Ability
He was given a statement to evaluate his reasoning and abstract thinking. He was
asked to explain the quote Nasa Diyos and awa, nasa tao ang gawa. He was
able to explain it well. The patient verbalized Maningkamot dapat para tabangan
ta sa Ginoo.
f. Judgement and Reasoning
Patients judgement and reasoning was not impaired. When we ask him what he
would do when he found a wallet, the patient responded: Ibalik na ko kung kaila
ko sa tag-iya pero kung wala akoa na lang

45

VII.

INSIGHT
Patients insight was impaired. When he was asked why he was admitted to the
mental hospital, the patient responded, Ana man gud sila mam nabuang daw
ko.

FINAL
NAME: Stephen Sabas

DIAGNOSIS: Substance Abuse

AGE: 23 years old

PHYSICIAN: Dr. Alisa V. Francisco, MD

WARD: Crisis Intervention Unit

DATE OF EXAMINATION: Feb. 19, 2015

I. PRESENTATION
a. GENERAL APPEARANCE
The patient was still at the Crisis Intervention Unit when we last visited him. He
was restrained both hands and feet. He was wearing a soaked facilitys uniform for
patients. He looks bothered because he peed on his pants and he feels like he is smelly
but he was still cooperative and not irritable.
b. General Mobility
a. Posture and Gait The patients posture and gait was not assessed because
he was restrained.
b. Activity The patient was not able to participate in our activity because he
was restrained but he was able to answer questions without getting irritated.
c. Facial Expression The patient has an inappropriate facial expression to his
verbal responses and stimulus presented. He keeps on laughing most of the
time during the interview.
d. Behaviour During the interview, the patient is calm and cooperative.
Although he usually laughs most of the time, he was able to answer all of the
questions.
46

e. Attitude towards the examiner The patient was cooperative and answered
all of the questions from the group. He did not hesitate to share something. He
showed proper eye contact to the interviewer and answer directly.
II. STREAM OF TALK
a.
Character of Talk
The patient was spontaneous during the interview even though he suddenly
laughs that inappropriate to his verbal response.
b. Organization of Talk
The patient responds to the questions immediately. He comfortably speaks to the
interviewer without hesitancy. He did not get distracted easily. He had flight of
ideas and suddenly laugh.
c. Accessibility
The patient was very cooperative during the interview. He was able to answer all
of the questions. He was not frustrated and angry with the questions. He was
honest in answering all of the questions during the interview.
III.

EMOTIONAL STATES AND REACTION

a. Mood
During the interview, the patient was euphoric. His mood was inappropriate with
his verbal responses and with what is going on with his surroundings.

b. Affect
The patient has appropriate affect. His actions and emotions were appropriate
with his verbal responses.
c. Suicidal and Homicidal Potential
The patient still does not have signs of suicide tendencies. He had no suicidal
47

thoughts and never thought of killing himself but he punched a 14 year old boy
in the CIU. According to the patient, he had no intentions of killing the boy. He
was just angry at that moment.
IV.

THOUGHT CONTENT
a. Perceptions and Hallucinations
Visual hallucinations were not present in the patient when interviewed.
b. Delusions
Delusion of grandeur were not present as well.
c. Dj

V.

vu

and

Jamais

vu

Dj vu and Jamais vu is not present in the patient from the start.

NEUROVEGETATVE DYSFUNCTON
a. Sleep
According to the patient, he is still having a hard time falling asleep. He said that
often times he wakes up at dawn, he finds it hard to go back to sleep.
b. Appetite
The appetite of the patient did not change.

c. Weight
The patient still does not know his weight and not interested to know his current
weight.
d. Attention Span
The patient has a better attention span during the interview that the last, he does
not have hallucinations during the interview.
VI. GENERAL SENSORUM AND INTELLECTUAL STATUS
48

a. Orientation
The patient was still oriented with the time, place, and person.
b. Memory
Most of our questions were already asked to him in the previous interview and he
can still remember the answers he said to us before. He did not have a long pause
before answering, which indicates that he has remembered all those informations.
c. Calculations
Calculations were still good. The patient was asked to progressively subtract 3s
from 15 and was able to answer all of them. (12, 9, 6, 3, and 0)
d. General Information
The patient still knows the basic information such as the capital of the
Philippines and the current president of the Philippines.
e. Abstract Thinking Ability
He was given a statement to evaluate his reasoning and abstract thinking. He was
asked to explain the quote Pag may tiyaga may nilaga. He was able to explain
it well. The patient verbalized Maningkamot dapat para maabot ang atong
pangarap.
f. Judgement and Reasoning
Patients judgement and reasoning was not impaired. When we ask him what he
would do when his change is more than the correct change, the patient
responded, Isaul jud nako ang sobra na kambyo mam
VII.

INSIGHT
Patients insight was still impaired. When he was asked why he was admitted to

49

the mental hospital, the patient responded, Nabuang man gud ko mam, nabuang
ko sa gugma

50

ETIOLOGY

Substance Abuse
PREDISPOSING FACTORS
Etiologic

Present

Factor
Genetics

Absent

Rationale

Justification

Drug abuse is often attributed to a The family of the

lack of willpower or self-control, patient
meaning that people who have have
addictions
choice

make

to

engage

doesnt
any

vices.

conscious When

we

in

her

their interviewed

destructive behavior, but experts mother and asked

know that some forms of addiction if

any

have their roots deep in the cells family

of

people

who

The American

use

drugs. was

of

the

members
using

any

Psychological drugs or alcohol,

Association, for example, states she told us that

that about half of a persons none of them uses
tendency toward drug addiction it.
Age

can be blamed on genetic factor.

Alcohol and drug use tends to The age of the
begin in mid-to-late adolescence, patient is 23 years
though

it

is

greater

among old and his age fits

individuals who experience early the

factors

that

51

puberty (O'Connell et al, 2009). affect

substance

The earlier the age at which abuse.

someone

starts

drinking

the

greater the risk that he will

develop alcohol-related problems
later in life. A delay in drinking
until 20- to 21-years-old reduces
the risk of developing alcoholrelated problems (Chou et al,
Gender

1992).
Research

on

influences

substance

how

gender The patient is male

use

and and fits the criteria

substance-abuse-related problems of

at

risk

of

has established clear differences substance abuse.

between women and men in
several important areas. Women
typically consume less alcohol
than men when they drink, drink
alcohol less frequently, and are
less likely to develop alcoholrelated

problems

than

men

(Fillmore et al. 1997). Similarly,

women are less likely than men to
use illicit drugs and to develop
52

drug-related problems (Greenfield

et al. 2003a).

Precipitating
Etiologic

Present

Absent

Rationale

Justification

Factor
Family

Parental discipline style was one The patient is not

Relations

of factors, Lack of a warm and close

hips

emotionally rich environment at mother ( his father

and

Structure

home,

with

his

lack of supervision by died and his sister

parents, Another risk factor was is

identified
especially

as

copying

the

father

Disrupted/disintegrated

currently

parents Manila).

in
The

and mother admits that

family it

structure.

is

her

fault

because she lacks

(C. M. Kodjo and J. D. Klein, support to his son.

Prevention and risk of adolescent
substance abuse. The role of
adolescents,

families,

and

communities, Pediatric Clinics of

Peer
Influence

North America)
Peer pressure and engaging with The patient doesnt
the wrong crowd would stem from have

lot

of
53

their own personality that would friends and when

innately attract this type of people. he goes out with
Being teased and criticized by his close friends,
friends as the main factor for drug they just eat and
abuse and positive expectation watch
from friends.

movies.

They dont have

(N. Nakhaee and N. Jadidi, Why any vices.

do some teens turn to drugs a
focus group study of drug users'
experiences, Journal

of

Addictions Nursing, vol. 20, no. 4,

Individual

pp. 203208, 2009)

Personality problems as the main The patient doesnt

Characteri

risk factor in turning towards express

his

stics

drugs, denial as a mechanism and feelings and keeps

a reason to continue on their drug it from himself. He
abuse.

doesnt open up

(E. Goode, Theories of drug his

use,

in Drugs

in

problems

to

American other people.

Society, chapter 3, McGraw Hill,

Boston, Mass, USA, 7th edition,
Gateway
Effect

2007)
Drug abuse is a transition from According to his
lighter use such as water pipe, mother

and

54

cigarettes, hashish, and alcohol. friends, he doesnt

Some

individuals

identified use any drugs and

biological factors as the main risk alcohol. His drug

factor in this transition, gateway test results are also
effect through social factors.
(C.

Spooner,

correlates
abuse

of

and

negative.

Causes

and

adolescent

drug

implications

treatment, Drug

and

for

Alcohol

Review, vol. 18, no. 4, pp. 453

Environm

ent

475, 1999.)
Identified more environmental risk Their place is quiet
factors such as poverty, type of and
neighborhood,

lack

is

not

of leisure crowded.

facilities, and normalized attitude

towards drug abuse.
(P.

Slovic,

Perception

of

risk, Science, vol. 236, no. 4799,

pp. 280285, 1987)
SYMPTOMATOLOGY
Signs and
symptoms
Neglectin
g

Present

Absen
t

Rationale
Neglecting

responsibilities

Justification
at The patient isnt

school, work, or home (e.g. neglecting

his
55

responsibi

flunking classes, skipping work, responsibilities at

lities

neglecting your children) because school. He doesnt

of drug use.

cut

class

attends
Using

and
school

regularly.
Such as driving while on drugs, The patient isnt

drugs

using dirty needles, or having using drugs under

under

unprotected sex.

dangerous

dangerous

conditions.

conditions
or taking
risks
while
high
Drug use

Such as arrests for disorderly The patient did not

is getting

conduct,

into legal

influence, or stealing to support a into legal trouble.

trouble
Drug use

drug habit.
Such as fights with your partner Drugs are not the

driving

under

the experience getting

is causing

or family members, an unhappy cause

problems

boss, or the loss of old friends.

of

problem

in

in

relationship

relationsh

his family.

the
the
with

ips

56

DIFFERENTIAL DIAGNOSIS

Substance Abuse: Substance-Induced Mood Disorder

Substance-Induced Mood Disorder is a common depressive illness of clients in substance
abuse treatment. It is defined in DSM-IV-TR as a prominent and persistent disturbance
of mood . . . that is judged to be due to the direct physiological effects of a substance (i.e.,

57

a drug of abuse, a medication, or somatic treatment for depression, or toxin exposure)

(APA, 2000, p. 405). The mood can manifest as manic (expansive, grandiose, irritable),
depressed, or a mixture of mania and depression. Generally, substance-induced mood
disorders will only present either during intoxication from the substance or on withdrawal
from the substance and therefore do not have as lengthy a course as other depressive
illnesses. Potentially severe, usually temporary, but sometimes persisting central nervous
system (CNS) syndromes that develop in the context of the effects of substances use
disorders, in which a cluster of cognitive, behavioral and physiological symptoms
contribute to the continued use of a substance despite significant substance-related
problems.
Diagnostic Criteria for Substance/ Medication-Induce Psychotic Disorder

Presence of one or both of the following symptoms:

1. Delusions

2. Hallucinations

B. There is evidence from the history, physical examination, or

laboratory findings of both (1) and (2):
1. The symptoms Criterion A developed during or soon after

substance intoxication or withdrawal or after exposure to a

medication.

58

2. The involved substance/medication is capable of producing the

symptoms in Criterion A.
C. The disturbance is not better explained by a psychotic disorder
that is not substance/ medication- induced. Such evident of an
independent psychotic disorder could include the following:
The symptoms preceded the onset of the substance/ medication
use; the symptoms persist for a substantial period time after the

cessation of acute withdrawal or severe intoxication; or there is

other evidence of an independent non- substance/ medicationinduced psychotic disorder.
D. The disturbance does not occur exclusively during the course of

delirium.
E. The disturbance causes clinically significant distress or

impairment in social, occupational, or other important areas of

functioning.
Result: Criteria Met

6/7 = .86 x 100%

86%

59

Diagnostic Criteria for 298.8 Brief Psychotic Disorders

A. Presence of one or more of the following

symptoms:

Delusion

Hallucinations

Disorganized Speech; and/or

Grossly

disorganized

or

catatonic

behavior
B. Duration of an episode of the disturbance is at
least 1 day but less than 1 month, with eventual

full return to premorbid level of functioning.

C. The disturbance is not better accounted for by

Mood

Disorder

with

Psychotic

Features,

Schizoaffective Disorder, or Schizophrenia and

is not due to the direct physiological effects of a
substance or a general medical condition.
Result: Criteria Not Met

3/6 = .5 x 100 %

50 %

60

Diagnostic Criteria for 295.40 Schizophreniform Disorder

A. Criteria A, D and E of Schizophrenia are met.

B. An episode of the disorder lasts at least 1 month but less than

6 months.
Result: Criteria Met

2/2= 0.5 x 100%

100%

Diagnostic Criteria for 293.xx Psychotic Disorder Due to A Medical Condition

A. Prominent hallucinations or delusions.

B. There is evidence from the history,

physical

examination,

laboratory

findings that the disturbance is the direct

physiological consequence of a general

61

medical condition.
C. The disturbance is not better accounted

for by another mental disorder.

D. The

disturbance

does

not

occur

excessively during the course of the

X
delirium.
Result: Criteria Not Met

2/4= .5x 100%

50%

Diagnostic Criteria for Schizophrenia

A. Presence of one or more of the following symptoms:

Delusion

Hallucinations

Disorganized Speech; and/or

Grossly disorganized or catatonic behavior

Negative Symptoms (i.e affective flattening,

X
X

alogia or avolition)
62

B. Social/ Occupational Dysfunction

For a significant portion of the time since the onset of

the disturbance, one or more major areas of
functioning such as work, interpersonal relations, or
self- care are markedly below the level achieved prior
to the onset (or when the onset is in childhood or
adolescence, failure to achieve expected level of
interpersonal, academic or occupational achievement)
C. Duration

Continuous sign of persist for at least 6 months. This

6- month period must include at least 1 month of
symptoms (or less if successfully treated) that meet
Criterion A (ie. Active- phase symptoms) may include
periods of prodromal or residual symptoms. During
these prodromal or residual periods the signs of the
disturbance may be manifested by only negative
symptoms or two or more symptoms listed in
Criterion A present attenuated form (eg. Odd beliefs,
unusual perceptual experiences
D. Schizoaffective and Mood Disorder Exclusion:

63

Schizoaffective Disorder and Mood Disorder with

Psychotic Features have been ruled out because either

(1) no Major Depressive, Manic or Mixed Episodes
have occurred concurrently with the active- phase
symptoms; or (2) if mood episodes have occurred
during active-phase symptoms, their total duration
has been brief relative to the duration of the active
and residual periods.
E. Substance/ General Medical Condition Exclusion:

The disturbance is not due to the direct physiological

effects of a substance (eg. A drug abuse, a
medication) or general medical condition.
F. Relationship to a Pervasive Developmental Disorder
If there is a history of Autistic Disorder or another X
Pervasive Developmental Disorder, the additional
diagnosis of Schizophrenia is made only if prominent
delusions or hallucinations are also present for at least
a month or less if successfully treated.
Result: Criteria Met

4= 0.4 x 100%

40 %

Initial Summary of Differential Diagnoses

64

Substance/ Medication-Induce Psychotic Disorder

86%

Brief Psychotic Disorders

50 %

Schizophreniform Disorder
100%
Psychotic Disorder Due to A Medical Condition

50 %

Schizophrenia

40%

MULTIAXIAL ASSESSMENT

Axis I. Diagnostic Categories

A substance-induced psychotic disorder is subtyped or categorized based on
whether the prominent feature is delusions or hallucinations. Delusions are fixed, false
beliefs. Hallucinations are seeing, hearing, feeling, tasting, or smelling things that are not
there. In addition, the disorder is subtyped based on whether it began during intoxication
on a substance or during withdrawal from a substance. A substance-induced psychotic
disorder that begins during substance use can last as long as the drug is used. A
substance-induced psychotic disorder that begins during withdrawal may first manifest up

65

to

four

weeks

after

an

individual

stops

using

the

substance.

Axis II. Personality Disorder and Mental Retardation

Substance-induced psychotic disorder are usually seen in people who have
personality disorders such as paranoid personality disorder, schizoid personality disorder
and borderline personality disorder.
Diagnostic criteria for 301.0 Paranoid Personality Disorder
A.

pervasive

distrust

and

suspiciousness of others such that

their motives are interpreted as
malevolent, beginning by early
adulthood and present in a variety
of contexts, as indicated by four

(or more) of the following:

(1)

suspects,

without

sufficient

basis, that others are exploiting,

harming, or deceiving him or her

(2) is preoccupied with unjustified
doubts

about

trustworthiness

the

loyalty

or

of

friends

or

associates
(3) is reluctant to confide in others
because of unwarranted fear that
the

information

will

be

used

maliciously against him or her

(4) reads hidden demeaning or

X
X
X

threatening meanings into benign

remarks

or

events
66

(5)

persistently

i.e.,

is

bears

unforgiving

injuries,

grudges,

of

insults,

or

slights

(6) perceives attacks on his or her

character or reputation that are
not apparent to others and is
quick

to

react

angrily

or

to

counterattack
(7)

has

without

recurrent

suspicions,

justification,

regarding

fidelity of spouse or sexual partner

B. Does not occur exclusively during

the

course

a Mood
Features,

of Schizophrenia,

Disorder With
or

another

Psychotic
Psychotic

Disorder and is not due to the

direct physiological effects of a
general medical condition.
Result: Criteria Not Met

1/8 = 0.125x100%

12.5%

Diagnostic criteria for 301.20 Schizoid Personality Disorder

A. A pervasive pattern of detachment
from social relationships and a
restricted range of expression of
emotions
settings,

in
beginning

interpersonal
by

early

adulthood and present in a variety

of contexts, as indicated by four

X
67

(or more) of the following:

(1) neither desires nor enjoys
close

relationships,

being

part

of

including
a

family

(2) almost always chooses solitary

activities
(3) has little, if any, interest in

X
X

having sexual experiences with

another

person

(4) takes pleasure in few, if any,

activities
(5)

lacks

close

friends

or

confidants other than first-degree

relatives
(6)

appears

praise
(7)

or

shows

indifferent

criticism

of

emotional

detachment,

to

the

others

coldness,

or flattened

affectivity

B. Does not occur exclusively during

the

course

a Mood

of Schizophrenia,

Disorder With

Features,

Psychotic

another

Disorder,

or

Psychotic
a Pervasive

Developmental Disorder and is not

due to the direct physiological
effects

of

general

medical

condition.
68

Result: Criteria Not Met

3/8 = 0.375x100%
Diagnostic criteria for 301.83 Borderline Personality Disorder

37.5%

A pervasive pattern of instability of

interpersonal
image,

relationships,

and affects,

impulsivity

and

beginning

self-

marked

by

early

adulthood and present in a variety

of contexts, as indicated by five (or

more) of the following:

(1) frantic efforts to avoid real or
imagined

abandonment.

Note: Do not include suicidal or selfmutilating

behavior

covered

in

Criterion 5.
(2)

pattern

of

unstable

and

intense interpersonal relationships

characterized

by

alternating

between extremes of idealization

and devaluation
(3) identity disturbance: markedly
and persistently unstable self-image
or sense of self
(4) impulsivity in at least two areas
that are potentially self-damaging
(e.g.,
Abuse,

spending,
reckless

sex, Substance
driving,

X
X

binge

eating).
Note: Do not include suicidal or self69

mutilating

behavior

covered

in

Criterion 5.
(5)

recurrent

gestures,

or

suicidal

behavior,

threats,

or

self-

mutilating behavior

(6) affective instability due to a

marked

reactivity

of mood (e.g.,

intense
episodic dysphoria, irritability,
or anxiety usually

lasting

few

hours and only rarely more than a

few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or
difficulty

controlling

frequent

displays

anger
of

(e.g.,

temper,

constant anger, recurrent physical

fights)
(9)

transient,

stress-

related paranoid ideation

or

severe dissociative symptoms

Result: Criteria Not Met

2/9 = 0.22x100%

22%

Axis III. General Medical Conditions

None
Axis IV. Psychosocial and Environment Problems
70

1. Problems with Primary Support

2. Educational Problems
3. Economic Problems
Axis V. Global Assessment of Functioning
a.) Initial Assessment (60/51)
Moderate symptoms or moderate difficulty in social, occupational, or
school functioning. Circumstantial speech was also noted since he verbalized
words which were not relevant to the questions asked. According to his friends,
he is a friendly person and very outgoing and likes to play DOTA. They were not
able to notice that he was already changing because they didnt get to see each
other lately due to their busy schedules, his neighbors and mother were the ones
who noticed that he was acting unlike his usual self.

b.) Final Assessment (60/51)

Moderate symptoms or moderate difficulty in social, occupational, or
school functioning. Was not able to see him during the final assessment as he did
not want to see the group.

71

DEFINITION OF COMPLETE DIAGNOSIS

Initial Diagnosis:
To consider Substance induced psychotic disorder cannot fully rule out Mood Disorder
Substance Induced Psychotic Disorder
Definition 1
A substance-induced psychotic disorder is subtyped or categorized based on whether the
prominent feature is delusions or hallucinations. Delusions are fixed, false beliefs.
Hallucinations are seeing, hearing, feeling, tasting, or smelling things that are not there.
In addition, the disorder is subtyped based on whether it began during intoxication on a
substance or during withdrawal from a substance. A substance-induced psychotic disorder

72

that begins during substance use can last as long as the drug is used. A substance-induced
psychotic disorder that begins during withdrawal may first manifest up to four weeks
after an individual stops using the substance.
Source: http://www.minddisorders.com/Py-Z/Substance-induced-psychotic-disorder.html
Definition 2
A chronic relapsing brain disease that is characterized by compulsive drug
seeking and use, despite harmful consequences; it implies the misuse of certain
substances.
Source: Drug Use and Abuse: A Comprehensive Introduction by Howard Abadinsky
Definition 3
Differentiated from nonpathological use by a pattern of pathological use,
impairment in social or occupational functioning due to substance use, and a minimal
duration of one month.
Source: Substance Abuse and Pychopathology ( Applied Clinical Psychology) by Arthur
Alterman

Mood Disorder
Definition 1
A psychotic feature, but excludes those delusions most typicall of schizophrenia,
such as bizarre delusions or voices with running commentary.
Source: Neurobiology of Mental Illness; Fourth Edition by Dennis Charney, Eric J.
Nestler, Pamela Sklar and Joseph Buxbaum
Definition 2

73

Characterized by a syndrome that includes psychological and somatic symptoms.

They consist of disorders that characterized by depressive symptoms only, without
history of manic, mixed or hypomanic episodes.
Source: Treatment of Depression Newer Pharmacotherapies: Evidence Report by
Cynthia D. Mulrow
Definition 3
any of several psychological disorders characterized by abnormalities of
emotional state and including especially major depressive disorder, dysthymia, and
bipolar disorder
Source:

Merriam

Webster

2014;

http://www.merriam-webster.com/medical/mood

%20disorder

DOCTORS ORDERS
Doctors Orders
Rationale

Date and
Time
February 13, Admit to CIU
2015;
11:20pm

Remarks

Crisis intervention unit is an Done

emergency psychological care
aimed at assisting individuals in
a crisis situation to restore
equilibrium
to
their
biopsychosocial functioning and
to minimize the potential
for psychological trauma. It also
helps doctors in observing the
patients
behavior
before
admitting the patient.
Source:
http://en.wikipedia.org/wiki/Crisi
s_intervention

74

Secure
to care

consent -

To secure approval from the Done

client or guardian for the
treatment to be received, so that
if any casualties happen the
institution wont be held liable.

Source:www.enotes.com/informedconsent-reference
- Monitoring
the
patients Done
temperature,
pulse
rate,
respiratory rate, and blood
pressure serves as the baseline
data and helps in determining
any unusuality on the patients
vital signs which helps in
preventing unexpected situations.

VSQ2

DAT

Labs:
- CBC
platelet
- UA

Source:
Kozier
and
Erbs
Fundamentals
of
Nursing:
Concepts, Processes, Practice.
Eight Edition
- Diet as tolerated is prescribed Done
because the client can tolerate
any food, if this will not lead to
any complications and if the
client needs further monitoring
for lab test.
- A Test that evaluates the three
types of cells that circulates in
the blood.
- A Test done to check any Done
abnormalities with the urine,
which may lead to further
diagnosis of the condition.
- It is to diagnose conditions Done
affecting the chest, its contents
and nearby structures.

CXR

Drug Test -

SPGT/
SGOT

To determine whether the patient Done

has recently taken drugs and if
they have any cause to the signs
& symptoms.
To evaluate the status of the liver Done
through these liver enzymes.

75

-Homicidal,
Meds
- used for treating insomnia.
Done
suicidal,
- used for the relief of nasal and
escape
1. Diphenhy
non-nasal symptoms of various
precaution
dramine
allergic conditions
- watch out
50mg/am
for
p, 1 amp
hypertension,
IM now
Source:
tachycardia,
http://www.medicinenet.com/dip
diaphoresis,
henhydramine/article.htm
seizure,
tremors,
N&V
-4
points
restrictions
until sedated
2. Risperido ne 2mg/
quickle,
quicklet
now

11:50pm

an atypical antipsychotic drug Done

that
is
used
for
treating schizophrenia, bipolar
mania, and autism.

Source:
http://www.medicinenet.com/risp
eridone/article.htm
3. Clonazep - an anti-anxiety medication
Done
am
- used for treating panic disorder
2mg/tab,
and preventing certain types of

tab
seizures
PRN
Source:
http://www.medicinenet.com/clo
nazepam/article.htm
May admit to - To avoid causing harm to other Done
single cell
people
Refer
Accordingly

February 14, May

transfer 2015; 2:30 patient to CIU
am

To report unusualities will direct Done

prompt treatment and prevent
further complications.
Crisis intervention unit is an
emergency psychological care
aimed at assisting individuals in
a crisis situation to restore
equilibrium
to
their
biopsychosocial functioning and
to minimize the potential
for psychological trauma. It also
76

helps doctors in observing the

patients
behavior
before
admitting the patient.
Source:
http://en.wikipedia.org/wiki/Crisi
s_intervention
Refer
Accordingly
9:20 am
-shouting
loud

Haloperidol
5mg/amp,
amp, IM now

To report unusualities will direct Done

prompt treatment and prevent
further complications.

antipsychotic medication. It also Done

is used to control tics and vocal.
Haloperidol interferes with the
effects of neurotransmitters in
the brain which are the chemical
messengers
that
nerves
manufacture and release to
communicate with one another.

Source:
http://www.medicinenet.com/hal
operidol/article.htm
Restraint patient - To avoid causing harm to other Done
on bed
people

10:45am

Monitor closely

Monitoring of complications Done

must be done for early detection
of problems so they can give
proper and quick management.

Refer

To report unusualities will direct Done

prompt treatment and prevent
further complications.
an atypical antipsychotic drug Done
that
is
used
for
treating schizophrenia, bipolar
mania, and autism.

Start Risperidone 2mg/ tab

Source:
http://www.medicinenet.com/risp
eridone/article.htm

77

Start Olanzapine 10mg

The mechanism of action of Done

olanzapine in the treatment of
acute manic or mixed episodes
associated with bipolar I
disorder.

Source:
http://psychopharmacologyinstit
ute.com/antipsychotics/olanzapin
e/mechanism-actionpharmacodynamics-olanzapine/
3:00 pm
May
Remove - To avoid causing harm to other Done
restrains
people/ patient.
Refer
- To report unusualities will direct Done
prompt treatment and prevent
further complications.
February 15, May
restrain - To avoid causing harm to other Done
2015;
temporarily
people/ patient.
10:00am
(+) agitation
Continue Meds

To maintain the pharmacological Done

effect
of
medications
as
indicated.

Source: Pharmacology, a Nursing

Approach 6th edition by Joyce
LeFever Kee
Refer
- To report unusualities will direct Done
prompt treatment and prevent
further complications.
February 16, May
Remove - the medication that has been Done
2015; 6:15 restraints
taken has took its affect and the
am
patient is calm at this time.
Continue Meds
- To maintain the pharmacological Done
effect
of
medications
as
indicated.
Source: Pharmacology, a Nursing
Approach 6th edition by Joyce
LeFever Kee

78

February 17, Continue Meds

2015; 12:30
pm

To maintain the pharmacological Done

effect
of
medications
as
indicated.
Source: Pharmacology, a Nursing
Approach 6th edition by Joyce
LeFever Kee

February 18,
2015;
10:15am
February 19,
2015; 7:05am

Refer

Olanzapine
10mg/tab

To report unusualities will direct Done

prompt treatment and prevent
further complications.
To control agitation
Done

Co- Amoxiclav 1g/tab; 1 tab BID

x 7 days

Anti-bacterial drug that inhibits Done

the synthesis of bacterial cell
walls.

Continue Meds

Source:
http://www.emedexpert.com/fact
s/amoxicillin-clavulanatefacts.shtml
- To maintain the pharmacological Done
effect
of
medications
as
indicated.
Source: Pharmacology, a Nursing
Approach 6th edition by Joyce
LeFever Kee

Refer

February 20, Continue Meds

2015; 8:41am

To report unusualities will direct Done

prompt treatment and prevent
further complications.
To maintain the pharmacological Done
effect
of
medications
as
indicated.
Source: Pharmacology, a Nursing
Approach 6th edition by Joyce
LeFever Kee

Refer

To report unusualities will direct Done

prompt treatment and prevent
further complications.

79

LABORATORY TESTS

Date/
Time

Test

Result

Reference
Range

Interpretation

Clinical
Significance

Nursing
Responsibilities

URINAL
Feb.
17,
2015

YSIS
Physical
Examinat
ion

Dark
yellow

Light
yellow

Normal

1. Inform

the

patient

that

The color of

to

normal

urine

deep amber

ranges

from

the
Color

test

is

used to assist
light yellow to
in
deep

the

amber.
diagnosis of

Color depends
80

on the patients

renal disease,

state

urinary tract

of

hydration, diet,

infections,

medication,

and

regimen,

and

exposure

to

neoplasms of
the

urinary

other

tract and as

substances that

an indication

may contribute

of

to

or

unusual

color or odor.

systemic

inflammatory
disease.
2. Instruct

Appearan
ce

Clear

Clear

Normal

Turbid

the

urine
patient to use

may

contain
midstream

red or white
catch
cells, bacteria,
fat

or

technique.
the
chyle 3. Label

and

may

appropriate

reflect

renal

collection

infection.

container
with

Chemical
Analysis

the

correspondin
g

patient

81

pH

demographic
6 pH

4.5- 8.0 pH

Normal

Urine pH is an
s, date, and
indication

of
time

the

of

kidneys

collection.
ability to help 4. Instruct
maintain

patient

balanced

report

hydrogen

ion

to

symptoms

concentration

such as pain

in the blood.

during
urinary
elimination.

Specific

1.025

Gravity

1.010-

Normal

1.025

Specific
gravity is a
reflection

of

the
concentration
ability of the
kidneys.
Glucose

Negati
ve

Negative

Normal

Glucose

in

urine is used as
an indicator of
diabetes.

82

Protein

Negati
ve

Negative

Normal

Urine
is

protein

the

most

common
indicator
renal

of

disease,

although there
are conditions
that can cause
benign
proteinuria.
Urine
Flowcytometry
17

0.0
High
11.0 /uL

WBC

Turbid
may

urine
contain

red or white
cells, bacteria,
fat

RBC

32.9

0.0
High
11.0 /uL

or

chyle

and

may

reflect

renal

infection.
Hemoglobin
indicates

83

presence

of

blood, which is
associated with
renal disease.

Date/
Time

Test

Result

Refere-nce
Range

Interpre Clinical
-tation
Significance

Nursing
Responsibilities

Hematolo
Feb.
16,
2015

gy

1. Explain
the

to

patient

that this test

Complete

is

blood

evaluate

count

151.0
g/L

115.0
Normal
175.0 g/L

Decreased:

used

blood

count
detect

Indicative

of

to

Hemoglob

anemia

or

possible

in

blood

loss;

Increased:

to

blood
disorders.
2. Reassure the

Level is high
patient

that

the patient may

drawing

have
blood sample
polycythemia.
will only take
less

that

84

Hematocri

0.47

0.36 0.52

Normal

Decreased:

minutes.
3. Inform
the

Low count in
patient

that

hematocrit
food or fluids
may result in
need not to
having
be restricted
Anemia.
before

the

test.
RBC

5.27 x 4.2 6.1 5 Normal

10^9/
x 10^9/L
L

Decrease
RBC

in
count

may be due to
the result of
red cell loss by
bleeding

or

hemolysis,
failure

of

marrow
production, or
may be due to
secondary
dilution factors
(intravenous
fluids) Increase
in RBC count

85

may

be

the

result

of

primary
polycythemia
including
stress.

RBC

count

is

normally
higher

in

individuals
residing

at

high altitudes.

WBC

11.21
x
10^9/
L

5.0 10.0 High

x 10^9/L

An

elevated

WBC

count

commonly
signals
infection, such
as an abscess,
meningitis,
appendicitis, or
tonsillitis.
high

A
count

86

may also result

from leukemia
and

tissue

necrosis due to
burns,
myocardial
infarction,

or

gangrene.

MCV

89.00
fL

79.0 94.8 High

fL

The test is an
indicator

for

the size of the

RBC's or red
blood cells. It
helps

to

determine

if

there is risk for

certain anemia.
Differenti
al Count

Neutrophi
l

72.0

55.0 75.0

Normal

Neutrophils
serve

as

the
87

body's primary
defense against
infection
through

the

process

of

phagocytosis.
Usually
to

used

diagnose

specific type of
illnesses.

Lypmhocy 19
te

2.0 35.0

Low

The

test

determines
lymphocyte
blood

count.

Lymphocytes
initiate
immunologic
responses.
Increase

in

lymphocyte
count

is
88

associated with
viral
infections.

Monocyte

7.0

2.0 10.0

Normal

A decreased or
increased level
of

monocytes

in the blood
may

indicate

bacterial

or

viral invasion
in the body.
Increased
number
indicates
there's
kind

that
some
of

infection
present.

Eosinophi
l

2.0

1.0 8.0

Normal

Increased

by:

Allergic

89

disorders:
asthma,

food,

drug
sensitivity,
Skin diseases,
Neoplastic
diseases,
Parasitic
infections
Decreased by:
Stress
response,
Cushings
syndrome.

Basophil

0.0 1.0

Increased
levels:

Rare

allergic
reactions (e.g.,
hives,

food

allergy),
Inflammation
(rheumatoid
90

arthritis,
ulcerative
colitis)

and

Some
leukemias.

Platelet
count

232 x 150.0
Normal
10^3 / 400.0 /uL
uL

Increased
(thrombocytosi
s):
can result from
hemorrhage,
infectious
disorders, iron
deficiency
anemia,
inflammatory
disorders.
Decreased
(thrombocytop
enia):
Can
from

result
aplastic

or hypoplastic

91

bone marrow,
vit

B12

deficiency,
folic

acid

deficiency,
enlarged
spleen, DIC, or
mechanical
injury

to

platelets.

Date/

Test

Result

time

Reference

Interpre Clinical

Nursing

Range

-tation

Responsibilities

Significance

OPD
Feb.

Chemistr

16,

1. Observe
venipuncture

2015

site of

SGPT
(ALT)

86.0

14.0 63. High

ALT is found

bleeding or

u/L

0 u/L

in plasma and

hematoma

in

various

formation.
2. Monitor

bodily tissues,
intake and
but

is

most
output for

commonly
fluid
associated with
92

the

liver.

catalyzes

It
the

imbalance in
renal

two parts of

dysfunction

the

and

alanine

cycle.

It

is

dehydration.
3. Instruct to

commonly
resume usual
measured
diet, fluids,
clinically as a
medications,
part

of

a
or activity, as

diagnostic
directed by
evaluation

of
the health

hepatocellular
care
injury,

to
practitioner.

determine liver
health.

Blood

4.30

2.9 7.1 Normal

Urea

Urea

mmol/

mmol/L

nonprotein

Nitrogen

(BUN)

is

nitrogen
compound
formed in the
liver

from

ammonia as an
93

end product of
protein
metabolism.
Urea

diffuses

freely

into

extracellular
and
intracellular
fluid

and

is

ultimately
excreted by the
kidneys. Blood
urea

nitrogen

(BUN)

levels

reflect

the

balance
between
production
and

the
of

excretion

of urea.
SGOT

89.00

15.00

(AST)

u/L

41.00 u/L

High

AST catalyzes
the

reversible

transfer of an
94

alpha-amino
group between
aspartate

and

glutamate and,
as such, is an
important
enzyme

in

amino

acid

metabolism.
AST is found
in

the

liver,

heart, skeletal
muscle,
kidneys, brain,
and red blood
cells, and it is
commonly
measured as a
marker
liver

for
health.

High levels of
AST
caused

maybe
by:

95

liver

damage

from
conditions
such

as

hepatitis

or

cirrhosis,
decay

of

large tumor, a
heart

attack,

medications,
having

taken

high doses of
vitamin A, or
kidney or lung
disease.
Creatinine

85.69

39.0

Normal

Creatinine

mmol/

113.0

the

mmol/L

substance

is
ideal
for

determining
renal clearance
because

fairly constant
quantity

is
96

produced
within

the

body.

The

creatinine
clearance

test

measures

blood
to

sample

determine

the

rate

at

which

the

kidneys

are

clearing
creatinine from
the blood.

97

Patients Name: Peter

Age: 23 years old
Sex: Male

Institution: Institute of Psychiatry and Behavioral Medicine

Date & Time: February 18, 2015 @ 1:30pm

Initial Nurse- Patient Interaction

Date and Nurse
Time
Verbal
Non Verbal
Februar Nganong
Establishes
y
18, nakaingon
eye contact.
2015 @ man ka na dili
1 pm
normal
ang
imong anak na
si Kenken?

Patient
Verbal
Si
Kenken
man gud kay
dili parehas sa
atoa,
alien
man gud si
Kenken

Nurses Feelings Analysis

& Thoughts
Non Verbal
Sad at first It is clear that he Delusion
then laughs is having a false
out loud
belief that he has
a son. As a
student nurse we
informed
him
that
Kenken
doesnt exist and
theres no alien.
This will allow
him
to
understand that
Kenken doesnt
exist and he
should
stop
believing
he
exist

Interpretations

The patient stated

that
his
son
Kenken is alien
and was abducted
and put into a
maze. Delusion is
a fixed false belief
based on incorrect
inference
about
external reality.

98

Kinsa mana Maintains eye Si Marian? Laughs

si Marian?
contact
Kalaguyo
nako na siya,
si Marian kay
powerful
kaayo na siya.
Dili na siya
tao, spirit na
siya
Unsa
man Continues to Black hole,
tong
maintain eye kana
tong
ginaingon
contact
magsuyop sa
nimo na black
tanang
hole
kadautan
sa
kalibutan siya
ang cleaner,
kana
oh
makit.an man
naku

Stares at
back
started
recite
numbers
started
talk
someone
behind
back

It is very obvious Delusion of The

client
that he is having Grandeur
believes that he
a false belief that
has a special
he has an affair
relationship with a
with
a
spirit
named
supernatural
Marian.
being

our The client is Visual

the seeing thing that hallucination
to we cant see. He s
said he can see
and the black hole.
to As a student
to nurse we inform
him that we cant
our see what he is
seeing and we
told him to stop
believing it exist
because it is not
real.

99

Final Nurse- Patient Interaction

Date
and
Time

Nurse
Verbal
Unsa
imong
pangalan?

Patient
Non
Verbal
Establishe
s
eye
contact.

Verbal
Peter
akong
pangalan
maam

Nurses Feelings Analysis

& Thoughts
Non
Verbal
The
patient
smiled.

Interpretations

He is still aware
of his name

100

101

NURSING THEORIES

Florence Nightingale
Environmental Theory
According to Florence Nightingale, Nursing ought to signify the proper use of
fresh air, light, warmth, cleanliness, quiet, and proper selection and administration of diet
All at the least expense of vital power to the patient. She viewed the manipulation of
the physical environment as a major component of nursing care.

Nightingale identified some of the following aspects regarding physical, social,

and psychological environment that the nurse could control:

Health of houses

Ventilation & warming

Light

Noise

Variety

Bed & Bedding

Cleanliness of Rooms & walls

Personal Cleanliness

Nutrition & Taking Food

Chattering Hopes & Advices

102

Observation of the sick

Petty Management

Application to the patient:

Patient Peter is admitted in the Institute of Psychiatry and Behavioral Medicine.
The environment he is currently situated in a small room together with the other patients.
They have their own beds close to each other. The surrounding was clean but it doesnt
smell good. During our home visit in Dona Pilar, the place of Patient Peter is big enough
for the family with two members, they have 2 dogs; one stray, a kitten and a Chinese
rooster that Patient Peter considers as a part of the family. The house is not that clean
there are protruding nails and unfinished ceiling hat has cobwebs. We as healthcare
providers are expected not just to care for the patient but we should also need to maintain
or manipulate the wellness of the environment that can cause or produce new risk for the
patient or even worsen the state of the patient. We may not be able to change the whole
environment as we want it to be but at least we can try to improve it.

Lydia Hall; Core, Care, Cure Model

Halls theory contains of three independent but interconnected circles. These are
core, care and cure. According to the theory, the core is the person or patient to whom
nursing care is directed and needed. The core, in addition, behaved according to his
feelings, and value system. The cure, on the other hand is the attention given to the
patients by the medical professionals. The model explains that the cure circle is shared by

103

the nurse with other health care professionals. These are the interventions or actions
geared on treating or curing the patient from whatever illness or disease he may be
suffering from. The care circle explains the role of the nurse, and focused on performing
the noble task of nurturing the patients, meaning the component of this model is the
motherly care provided by the nurses, which may include limited to the provision of
comfort measures, provision of patient teaching activities and helping the patient meet
their needs where help is needed.

Application to the Patient:

The group utilized the theory of Lydia Hall which is the Core, Care, Cure model
since it is applicable to the patients current condition. The theory was used to further
enhance in rendering of care to our patient. In this theory, there is collaborative work
done by the physicians, nurses, student nurses as well as the significant others. The first
aspect, the core, is the patient, wherein he is the center of both cure and care. In addition,
we visited and made ourselves available on his side to offer emphatic concerns by
interviewing and giving teaching and advices to the significant others. The second part of
the theory, the cure, is when the physician gives orders and procedures for Patient Peter.
With that, our patients condition is in need of constant monitoring and follow up checkups for his recovery. Moreover, to achieve good outcome, the care aspect which includes
the nurses, student nurses and significant other to constantly communicate and
collaborate with the health team.

104

Sister Callista Roy

The Goal of nursing is to promote adaptation for individuals and groups in each of
the four adaptive modes, thus contributing to health , quality of life, and
dignity with dying-Roy 1999
Explicit a s s u m p t i o n s

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.

Health and illness are inevitable dimensions of the persons life.

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

The persons adaptation level is such that it comprises a zone indicating the range
of stimulation that will lead to a positive response.

The person has 4 modes of adaptation: physiologic needs, self- concept, role
function and inter-dependence.

"Nursing accepts the humanistic approach of valuing other persons opinions, and
view points" Interpersonal relations are an integral part of nursing

There is a dynamic objective for existence with ultimate goal of achieving dignity
and integrity.

Implicit assumptions
105

A person can be reduced to parts for study and care.

Nursing is based on causality.

Patients values and opinions are to be considered and respected.

A state of adaptation frees an individuals energy to respond to other stimuli.

Application to the Patient:

Based on Roy, humans are holistic beings that are in constant interaction with
their environment. Humans use a system of adaptation, both innate and acquired, to
respond to the environmental stimuli they experience. Human systems can be individuals
or groups, such as families, organizations, and the whole global community. In
Adaptation Model, nurses are facilitators of adaptation. They assess the patients
behaviors for adaptation, promote positive adaptation by enhancing environment
interactions and helping patients react positively to stimuli. Nurses eliminate ineffective
coping mechanisms and eventually lead to better outcomes. A nurses role in the
Adaptation Model is to manipulate stimuli by removing, decreasing, increasing or
altering stimuli so that the patient. In line with this, nurses develop a plan of care to
promote adaptation.

106

NURSING CARE PLANS

Date/
Time/
Shift
Feb.
18,
2015/
2:00
pm/
73

Cues
Subjective:
Makakita ko ug
blackhole,
suyupon ani tanan
masasamang
espirito
Mao diay dato
kayo mi kay naa
diay
candle
business
si
mommy
as
verbalized.
Objective:
* Hallucination
* Delusions
* Labile affect
* Short attention
span
* Confabulation

Need
C
O
G
N
I
T
I
V
E
P
E
R
C
E
P
T
U
A
L
P
A
T
T
E

Nursing
Diagnosis
Disturbed thought
Processes
r/t
Disruption
in
cognitive
operations
and
activities
Rationale:
Thought
processes become
disordered, and
the continuity of
thoughts
and
information
processing
is
disrupted (Cancro
&
Lehman,
2000).
Videbeck, S. D.
(2004).
Psychiatric
mental
health
nursing 2nd ed.

Objective of Care

Intervention

Within an hour of 1)
Establish
nursing
rapport with the
interventions, the patient.
patient would:
2)
a) Respond to Explain procedu
reality-based
res, and try to be
interactions
sure the client
initiated by the understands the
student nurse.
procedures
before
b)
Sustain carrying them
attention
and out.
concentration to
complete tasks or 3) Interact with
activities
the patient on
the basis of real
c) Be free from things; do not
delusions
or dwell on the
demonstrate
delusional
ability to function material.
without
Show
responding
to 4)
empathy
persistent
regarding
the
delusional
patients
thoughts

Rationale

Evaluation

To gain the After an hour of

patients
trust interview,
the
and cooperation patient was not
able to respond
When the client to reality-based
has
full interactions by
knowledge
of providing
procedures, he answers relevant
or she is less to the questions.
likely to feel He was able to
tricked by the concentrate but
nurse.
was not able to
ignore
any
delusional
Interacting
thoughts.
about reality is
healthy for the GOAL
patient.
PARTIALLY
MET.

The
patients
delusion can be
distressing.
Empathy

107

R
N

Philadelphia:
Lippincott
Williams
&
Wilkins.

feelings;
reassure
the
patient of your
presence
and
acceptance.

conveys
your
acceptance
of
the patient and
your caring and
interest
.

5) Do not be
judgmental or
belittle or joke
about
the
patients beliefs.

6) Never convey
to the patient
that you accept
the delusions as
reality.

The
patients
delusions
and
feelings are not
funny to him or
her. The patient
may
feel
rejected by you
or
feel
unimportant if
approached by
attempts
at
humor.

You
would
reinforce
the
delusion (thus,
the
patients
illness) if you
indicated belief

108

7)
Directly
interject doubt
regarding
delusion as soon
as the patient
seems ready to
accept
this.
(e.g., I find that
hard
to
believe.)
Do
not argue with
the patient, but
present a factual
account of the
situation as you
see it.
8) Attempt to
discuss
the
delusional
thoughts as a
problem in the
patients
life;
ask the patient if
he or she can
see that the
delusions
interfere
with
his or her life.
9)

in the delusion.

As the patient
begins to trust
you, he or she
may
become
willing to doubt
the delusions if
you
express
your doubt.

Discussion
of
the
problems
caused by the
delusion is a
focus on the
present and is
reality based.

Encourage

109

patients
to
discuss
rather
than act on
feelings
and
impulses. Focus
on
feelings
about,
rather
than details of,
the delusions
10) Do not
argue
with
patient
about
whether
delusions
are
real; state, if
asked, that you
do not perceive
the stimuli that
patients
perceive.

Focusing
on
feelings, which
are
real,
minimizes
emphasis on the
delusion.

Arguing
or
expressing
skepticism does
not affect the
belief of patients
in the reality of
the delusion and
can disrupt trust
and
the
therapeutic
relationship.

110

Date &
Cues
Time
Feb. 19, Subjective:
2015
kalaguyo nako
si Marian, half
73 shift alien,
half
espiritu.
as
1PM
verbalized by
the client.
Objective:
He
is
talking to
someone
during the
interview.

Need
s
S
E
L
F
P
E
R
C
E
P
T
I
O

Nursing Diagnosis

Objective of Care

Nursing Interventions

Evaluation

Disturbed
sensory
perception
r/t
hallucinations
R: A hallucination is a
distorted
sensory
perception. There are
many different types of
hallucinations, including
auditory,
olfactory,
tactile,
gustatory
(involving the sense of
taste), hypnagogic (vivid
dream at the onset of
sleep),
hypnopompic
(vivid
dream
on
awakening), kinesthetic
(involving a sense of
bodily
movement),
somatic (the perception
of a physical experience
occurring within the
body), and lilliputian (in
which objects seem
smaller
than
they
actually are).

Within the 8 hours 1. Provide a consistent physical After performing

shift the patient
environment and a daily the
nursing
will be able to:
routine.
interventions the
Client
will R: Routine eliminates the element client was able to:
his
state, using a of surprise, over stimulation, and Scale
further
confusion
scale from 0
hallucinations
to 10 (0 being 2. Provide access to familiar
as 0 in which
objects, when possible.
that he is
he
doesnt
R: Familiarity helps reduce
experiencing
experience
confusion
no
any
hallucinations 3. Provide a low-stimulation
hallucinations
environment
at all and 10
already.
R:
A
disruption
in
the
quality
or
that he the medicine regimen will support compliance (Boyd, pg. 299).
R:being
Understanding
quantity of incoming stimuli can
experiences
GOAL MET!
affect
a
persons
cognitive
status.
hallucinations
multiple times Sensory overload blocks out
a day and meaningful stimuli
they
are 4. Provide for adequate rest,
sleep, and daytime naps.
extremely
R: Reduces over stimulation and
frightening).
fatigue, which may be contributing
factors to confusion.
5. Use a calm and unhurried
approach when interacting
R: Promotes communication that
enhances the persons sense of
dignity.
Drug-induced
6. Speak to the client in a slow,
hallucinations tend to be

111

N
S
E
L
F
C

visual. Other forms of

drug-induced
hallucinations,
however,
include
unformed
tinnitus
(ringing or other sound
in the ears) and hearing
bangs, thuds, whistles,
singing, or even music
not
actually
there.
Hallucinations can be an
isolated adverse effect of
a drug or medication, but
more commonly occur
as a result of druginduced psychosis.

O
N
C
E
P
T
I
O

Hallucinations
are
sometimes
reexperienced
as
'flashbacks',
although
usually after the use of
recreational drugs such
as
lysergic
acid
diethylamide
(LSD),
cannabis,
and
methylenedioxymetham
phetamine
(ecstasy).
Ketamine and other
drugs in its class (such
as
tiletamine
and

distinct
manner
with
appropriate volume.
R: The client who has difficulty
hearing will be better able to lip
read
and comprehend speech
7. Listen attentively.
R: Effective listening is essential
in a nurseclient relationship. Poor
listening skills can undermine trust
and
block
therapeutic
communication
8. Use simple words and short
sentences, as appropriate.
R: Using simple terms and short
sentences facilitates understanding
and minimizes anxiety.
9. Help the client to identify
times that the hallucinations
are most prevalent and
frightening.
R: Helps both the nurse and the
client identify situations and times
that might be most anxiety
producing and threatening to the
client (Varcarolis, pg. 237).
10. Explore
how
the
hallucinations are experienced
by the client.
R: Exploring the hallucinations
and sharing the experience can

112

P
A
T
T

phencyclidine
[PCP])
may have legitimate
medical
(and/or
veterinary) uses, but
they can also cause
flashbacks (and are also
used recreationally).
Source:
http://www.diseasesandc
onditions.net/hallucinati
ons.html

help give the person a sense of

power that he might be able to
manage hallucinations.
11. Inform client that medications
should be taken as prescribed
by the physician. Tell the
client that side effects are
expected, medication may
take several weeks until it is
effective, and that medication
should not be stopped unless
directed by physician.

E
R: Understanding the medicine
regimen will support compliance
(Boyd, pg. 299).

R
N

Date/

Cues

Needs

Nursing

Objectives

Intervention

Rationale

Evaluation

113

Time
Feb.

Diagnosis
Impaired verbal Within

Subjective:

an Establish

18,

56751265245

communication:

hour,

the

2015

67,

Jonah,

incomprehensible

patient would

2 pm

Marian, as the

statements

73

patient

verbalized.

flight of ideas

effectively,

Clients

demonstrate

by

often

impaired

interaction

incomprehen

communication

wherein his

sible
Would rapidly

such as flight of

responses

ideas

can

change from

impaired thought

understood

one topic to

disorders.

by

another

Source:

student

Shives,

L.

to

R.

Basic Concepts of
P

Psychiatric-

Mental

Health

trust patient was able to:

and cooperation a. Express himself

the

interview.
understanding by 2. This approach

himself

due

patients
during

a. Express

may

gain Within an hour, the

Facilitate trust and

Rationale:

Statements are

with the patient.

r/t be able to:

E
Objective:

rapport 1. To

as evidenced
an

respecting

and

conveys
empathy

and

patients

may encourage

statements

patient

e communication

the

communicat
e with the

3. It would reveal
being
by
and

would also help

in

student

nurses as he was

others

clarification

the

issues.

perceived

Seek validation and

were

with the student

is

nurses.
b. Effectively

that

disclose painful

how the patient

patterns.

answers

nurses.
to b. Communicate

incomprehensibl
be

give

understood by

maintaining

private.
Attempt to decode

as he was able to

in

knowing

more on why

able to respond
to the questions
of the student
nurses but some
of his answers
were far from
reality as some
were not real.
c. Actively

114

Nursing

student

statements.

nurse

evidenced

by improved

as

Attend to patients

nurses

verbal/ nonverbal

communicat
ion initiated
by
student
nurses.

the

communication

current

initiated by the
student nurses as
he answered the

assumptions and
genuinely
attempts

expressions.

understand

participate
the

his

making

student

in

participate in the

situation.
4. Prevents

responses to

questions.
c. Actively

the patient is in

by the student
to

for

patients

needs

until

functional

nurses.

the

patient.
5. Conveys
Anticipate and care

questions asked

GOAL

interest

and

concern

and

PARTIALLY
MET

note as it may
hold significant

communication

information.
pattern returns. 6. Patients safety
Orient patient to
and comfort are
reality by name
nursing
and
validate
priorities.
those aspects of
communication

115

that

help 7. These facilitate

differentiate

restoration

between what is

functional

real and what is

communication

not.
Use confrontational
skills,

of

patterns of the
patient.

when

appropriate, with
an

established

nurse-client
relationship.
8. To
clarify
Provide sufficient
discrepancies
time for patient
between verbal
to respond.
and nonverbal
Talk to the patient
cues.
one student nurse
at a time.
9. Individuals may
talk more easily
when they are
rested

and

116

relaxed.
10. They may talk
more

easily

when

they

talking to one
person at a time.

Date and
Time

Cues

Need

Nursing
Diagnosis

Objective of Care

Nursing Intervention

Evaluation

117

Date:
February
28, 2015
73
10:00am

Subjective:
Nag ingon si
Peter na ayaw
nalang tagu-i ng
mga tabal ma.
Kay ako nalang
mag inom ana,
para ma maayo
nako.
Pirmi
man pud daw
ko wala As
verbalized by
the mother

T
E
A
C
H
I
N
G
&
L
E
A
R
N
I

Readiness
for
enhanced
therapeutic
Regimen
Management r/t
patient expressing
desire to manage
the illness

After
performing 1. Establish rapport to
nursing interventions,
the client.
the patient will be able
R: To gain trust and
to:
cooperation.
a.
Assume 2. Verify clients level
responsibility
for
of understanding of
managing treatment
the
therapeutic
regimen.
regimen.
b. Demonstrate
R:
Provides
proactive
opportunity
to
management
by
assure accuracy and
Scientific
anticipating
and
completeness
of
Rationale: A
planning
for
knowledge
pattern to educate
eventualities
of
regarding
the
and instruct the
condition/potential
therapeutic regimen.
patient and
complications.
3. Note specific heath
significant other
goals.
or parent
R: In order to
in physical,
determine the extent
psychospiritual,
of care needed for
environment or
the client.
social dimension
4. Identify
steps
that can be
necessary to reach
strengthened for
desired health goals.
the maintenance
R:
Understanding
and continual
the process enhances
management of
commitment and the
therapeutic health
likelihood
of
regimen.
achieving
these
goals.
5. Accept
clients
Source:

After
performing
nursing interventions,
the patient was able to:
a.
Assume
responsibility
for
managing
treatment
regimen; as verbalized
by mother Ingon siya
na dili nalang daw
nako tagu-on tung mga
tambal kay siya na
daw mag inom, kay
pirmi man daw pud ko
wala, siya nalang
daw
b. The client hasnt
fully
demonstrated
proactive management
by anticipating and
planning
for
eventualities
of
condition/potential
complications.
As
verbalized by mother
Nag dula gihapon
siya ug computer. Nag
mata siya ug alas-tres
sa kadlawun ganina.
Ug nag dula siya

118

N
G

http://www.scribd
.com/doc/491987
73/NCP-2#scribd

evaluation of own
strengths
and
limitations.
R: Promotes sense
of self-esteem and
confidence.
6. Acknowledge
individual
efforts
and capabilities to
reinforce movement
toward attainment of
desired outcomes.
R: Provides positive
reinforcement
encouraging
continued progress
toward
desired
goals.
7. Promote client and
significant
others
choices involvement
in planning for
implementing added
task
and
responsibilities.
R: To involve the
significant others in
the
whole
therapeutic process.
8. Assist
in
implementing

hantud
alas-singko,
dapat ni relax nalang
unta siya, dili pa baya
siya gyud na ayo pa.
Pero nikaon
man
gihapon siya, ug ni
tumar ug tambal. Ang
pag dula lang niya,
and gika guol nako
Goal Partially Met

119

strategies
for
monitoring progress
and responses to
therapeutic regimen.
R: To help in
patients recovery.
9. Document patients
response and refer
accordingly.
R:
For
proper
intervention to be
given.
10. Instill hope for the
client.
R: It will boost the
clients confidence
in the course of his
illness.

120

Date/
Time/
Shift

Cues

Need
s

Subjective:
February Girestrain man
20, 2015 daw to siya kay
nanumbang

R
O
L
E

Objective:
history
of
assaultive
behavior
>
threatening
verbalization
> overt and
aggressive acts

R
E
L
A
T
I
O
N
S
H
I
P
P
A
T
T
E

Nursing
Diagnosis

Objectives of Care

Nursing interventions

Evaluation

Risk for other Within 8 hrs of nursing 1. Intervene

At the end of the
Directed
care the client will
immediately if the shift the client the
Violence.
demonstrate absence of
client demonstrates client demonstrated
violent or aggressive
aggressive behavior absence of violent or
R:
In
manic behavior
toward self or others. aggressive behavior.
R:
Immediate
phase,
the
intervention
in
negative,
clients
harm
or
uncontrolled
assault
risk
thoughts, feelings
behaviors
may
and
behaviors
prevent harm or
pose a threat or
injury.
danger to harm
2.
Listen for verbal
others. They are
threats or hostile
aggressive,
remarks towards self
hostile and cannot
or others.
evaluate
the
R: The client verbal
consequences of
threats,
physical
their behaviors.
contact and acting
out
may
be
precursors or cues to
impending violence.
3. Help
the
client
manage
anger,

121

R
N

inappropriate
or
intrusive behaviors
in a therapeutic but
firm direct manner
R: Helping the client
manage
anger
inappropriate
or
intrusive behaviors
early
in
the
escalation of phase
may prevent assault
or violence.
4. Reduce milieu noise
and stimulation or
accompany client to
a calmer, quieter
environment at early
signs
of
anger,
frustration
or
agitation.
R: A calm external
environment often
helped to promote a
relaxed internal state
within the client and
may lessen agitation
and
prevent

122

violence.
5. Remind the client to
continue
seeking
staff when first
experiencing
frustration,
anger,
hostility
or
suspiciousness rather
than waiting until
the
negative
thoughts
and
feelings are out of
control, which can
lead to violence.
R: Staff can help the
client
prevent
negative
feelings
from
reaching
destructive levels if
they know the clients
state in advance.
Staff can engage
client in therapeutic
activities/exercises
and
can
offer
medications
when
necessary.

123

6. Praise the clients

efforts
made to
control anger or
hostility to self and
others.
R:
Positive
feedback reinforces
repetition of positive
functional behaviors.
7. Teach the client and
the
family
to
recognize early signs
and symptoms of
escalating agitation
or
hypomanic
behaviors (yelling,
cursing, threatening,
pacing) that can lead
to full blown mania,
self harm, assault or
violence.
R: it is important to
equip the client
family
effectively
with resources and
interventions when
the clients behavior

124

threatens the safety

of self or others and
the integrity of the
environment.
8. Observe closely the
behavior of the
patient (every 15
minutes). Do this as
a routine activity for
the patient to avoid
any suspicion in the
patient.
R: Close observation
is important, because
then
appropriate
interventions can be
provided
immediately and to
always ensure that
patients are safe.
9. Try to channel your
self-destructive
behavior to other
things to reduce
patient anxiety (eg,
hitting sandbags).
R: Physical exercise

125

is a safe way to
release
patients
tensions.
10. Provide appropriate
medication therapy
treatment program.
Monitor
the
effectiveness
of
drugs and their side
effects.
R:
For faster
recovery of the
patient.

126

DRUG STUDY
Generic Name

Diphenyhydramine
Hyrexin-50

Brand Name

Classification

Antihistamine, Sedative/hypnotic
Action on blood vessel, GI, respiratory tract by antagonizing the
effects of histamine for H1-Receptor site decreases allergic
General Action
response by blocking histamine caused increased heart rate,
vasodilation secretions; significant CNS depressant and
anticholinergic.
Dose & Route
Diphenhydramine 50 mg/amp, IM now
It is used for the symptomatic relief of allergic conditions
Indications or
including urticaria and angioedema. Diphenhydramine is used for
Purposes
its abtimiscarinic properties in the control of parkinsonism and
drug-induced extrapyramidal disorders
Orthostatic hypotension
Palpitations
Side Effects
Drowsiness
Sedation
Disturbed coordination
Hypersensitivity to diphenhydramine hydrochloride and other
Contraindications
antihistamines of similar chemical structure.
Nursing
1 Assess respiratory status: rate, rhythm and increase in bronchial
Responsibilities
secretions wheezing and chest tightness: provide fluids to 2L
day to decrease secretion thickness.
2 May cause drowsiness. Caution patient to avoid driving or
other activities requiring alertness until response to drug is
known.
3 Supervise ambulation and use side-rails as necessary.
Drowsiness is most prominent during the first few days of
therapy and often disappears with continued therapy. Older
adults are especially likely to manifest dizziness, sedation, and
hypotension.
4 Inform patient that drug may cause dry mouth; frequent oral
rinses, good oral hygiene and sugarless gum or candy may
minimize the effect.
5 Teach sleep hygiene techniques (dark room, quiet, bedtime
ritual, limit daytime napping, avoidance of nicotine and
caffeine) to patients taking diphenhydramine to aid sleep.
6 Advise patient to use sunscreen and protective clothing to
prevent photosensitivity reactions.
127

Explain to the client that arising quickly from a lying or sitting

position may cause orthostatic hypotension.
8 Caution patient to avoid use of alcohol and other CNS
depressants concurrently with this medication.
9 Stop the drug and notify the physician immediately if
confusion, excessive sedation, chest tightness, wheezing,
bleeding or easy bruising develops while taking antihistamine.
10 Stop therapy 72-96 hr. prior to skin testing. Report adverse
effect and lack of response.
Generic Name

Risperidone
Risperdal

Brand Name
Classification
General Action
Dose & Route
Indications or
Purposes

Side Effects

Contraindications
Nursing
Responsibilities

Anti-psychotic
Risperidone is an atypical antipsychotic drug that is used for
treating schizophrenia, bipolar mania, and autism.
Risperidone 2mg/quicklet, quicklet now
Acute and maintenance treatment of schizophrenia in adults.
CNS: akathisia, somnolence, dystonia, headache, insomnia,
agitation, anxiety, pain, parkinsonism, neuroleptic malignant
syndrome, suicide attempt, dizziness, fever, hallucination, mania,
impaired concentration.
CV: tachycardia, chest pain, orthostatic hypotension, peripheral
edema, syncope, hypertension.
EENT: rhinitis, sinusitis, pharyngitis, abnormal65 vision, ear
disorder.
GI: constipation, nausea, vomiting, dyspepsia, abdominal pain.
Contraindicated in patients hypersensitive to drug.
1. Take it after meals or with food to decrease stomach upset.
2. Drink plenty of water or liquid to prevent dehydration,
especially from prolonged exposure to hot weather.
3. Advise patient that medication may cause photosensitivity and
to use sunscreen or wear protective clothing until tolerance to
the sun/UV light is determined.
4. Advise patient that drug may impair judgment, thinking, or
motor skills, or cause drowsiness, and to use caution while
driving or performing other tasks requiring mental alertness
until tolerance is determined.
5. Advise patient to avoid strenuous activity during periods of
high temperature or humidity.
6. It is important to understand that after your manic symptoms
abate, you will need to continue taking your medication to
prevent relapse.
7. If you miss a dose, take as soon as possible, within 2-3hours of
128

the scheduled dosing.

8. If it is close to your next scheduled dose, skip the missed dose
and continue on your regular dosing schedule, but do not take
double doses.
9. Tell patient to immediately report altered mental status, high
fever, irregular pulse, muscle rigidity, rash, seizures, or
sweating to health care provider.
10.Contact your physician if you have fever or diarrhea.
Generic Name
Brand Name

Clonazepam
Klonopin

Classification

Benzodiazepines
Clonazepam is an effective anticonvulsant. It raises the threshold
for propagation of seizure activity and prevents generalization
General Action
of focal or local activity. Clinically, it improves focal epilepsy and
generalized seizures.
Dose & Route
Clonazepam 2 mg/tab. tab PRN for insomnia
Indications or
Acute manic episodes of bipolar disorder and adjunct treatment for
Purposes
schizophrenia.
Drowsiness
Abnormal eye movements
Anorexia
Side Effects
Dysuria
Leukopenia
Shortness of breath
Skin rashes
Contraindicated in patients hypersensitive to benzodiazepines and
Contraindications
in those with significant hepatic disease.
Nursing
1. Advise patient to avoid driving or other potentially hazardous
Responsibilities
activities until drugs CNS effects are known.
2. Monitor for S&S of overdose, including somnolence,
confusion, irritability, sweating, muscle and abdominal cramps,
diminished reflexes, coma.
3. Report severe dizziness, weakness, drowsiness that persists,
rash or skin lesions, difficulty voiding, palpitations, swelling in
the extremities.
4. Do not self-medicate with OTC drugs before consulting the
physician.
5. Take drug exactly as prescribed; do not stop taking drug (longterm therapy) without consulting health care provider.
6. Do not swallow the tablet whole. Allow it to dissolve in your
mouth without chewing.
7. Swallow several times as the tablet dissolves. If desired, you
may drink liquid to help swallow the dissolved tablet.
129

8. Take the missed dose as soon as you remember. Skip the missed
dose if it is almost time for your next scheduled dose. Do not
take extra medicine to make up the missed dose.
9. Drinking alcohol can increase certain side effects of Klonopin.
This medication may impair your thinking or reactions.
10. You may have thoughts about suicide while taking Klonopin.
Your doctor will need to check you at regular visits. Do not
miss any scheduled appointments.
Generic Name

Haloperidol
Haldol

Brand Name
Classification
General Action
Dose & Route
Indications or
Purposes

Anti-psychotic
Alters
the
effects
of
dopamine
in
the CNS.
Haloperidol 5mg/amp IM
Acute psychotic symptoms and relieves hallucinations,
delusions, disorganized thinking.

Side Effects

extrapyramidal symptom
spasm
posture leaning forward
masklike facial appearance
blurred vision
urinary frequency
anemia
photosensitivity
dry mouth
nausea-vomiting
anorexia

such

as

muscle

rigidity

or

Contraindications Contraindicated to those with seizure disorder.

Nursing
1. Assess mental status prior to and periodically during therapy.
Responsibilities
2. Monitor BP and pulse prior to and frequently during the period
of dosage adjustment.
3. Monitor I&O. Assess for signs and symptoms of dehydration.
4. Monitor for development of neuroleptic malignant syndrome
(fever, respiratory distress, tachycardia and seizures). Report
symptoms immediately.
5. Warn patient to avoid activities that require alertness and good
coordination until effects of the drug is known.
6. Observe patients closely for rapid mood shift to depression.
7. Educate patient that drowsiness and dizziness usually subside
130

after a few weeks.

8. Inform patient to relieve dry mouth with sugarless gum or hard
candy.
9. Monitor the patient for signs of tardive dyskinesia which may
occur after prolonged use.
10.Avoid overexposure to sun or sunlamp and use sunscreen; drug
can cause a photosensitivity reaction.
Generic Name

Olanzapine
Zyprexa

Brand Name
Classification

Anti-psychotic
The exact mechanism of action of olanzapine is not known. It may
work by blocking receptors for several neurotransmitters
General Action
(chemicals that nerves use to communicate with each other) in the
brain.
Dose & Route
Olanzapine 10 mg/1 tab @HS
Treatment of schizophrenia and acute mixed or manic episodes associated
Indications or
with bipolar 1disorder and maintenance of bipolar 1disorder as
Purposes
monotherapy or combined with lithium or valproate.
Somnolence, dizziness, nervousness, headache, akathisia, personality
disorders, tardivedyskinesia, neuroleptic malignant syndrome, orthostatic
Side Effects
hypotension, peripheral edema, tachycardia, constipation, abdominal pain,
cough, pharyngitis.
Contraindicated with allergy toolanzapine, myeloproliferative disorders,
Contraindications
severe CNS depression and comatose states.
Nursing
1. Encourage patient to void before taking the drug to help
Responsibilities
decrease anticholinergic effects of urinary retention.
2. Monitor for elevations of temperature and differentiate between
infection and neuroleptic malignant syndrome.
3. Monitor for orthostatic hypotension and provide appropriate
safety measures as needed.
4. Report lethargy, weakness, fever, sore throat, malaise, mouth
ulcers, and flulike symptoms.
5. It may impair your thinking or reactions. Be careful if you drive
or do anything that requires you to be alert.
6. Avoid getting up too fast from a sitting or lying position, or you
may feel dizzy. Get up slowly and steady yourself to prevent a
fall.
7. Avoid becoming overheated or dehydrated.
8. Drink plenty of fluids, especially in hot weather and during
exercise.
9. Do not swallow the tablet whole. Allow it to dissolve in the
mouth without chewing.
131

10.Swallow several times as the tablet dissolves. If desired, you

may drink liquid to help swallow the dissolved tablet.

Generic Name

Co-Amoxiclav
Amoclav

Brand Name
Classification

Antibacterial
Co-amoxiclav is an antibacterial combination consisting
of amoxicillin (as sodium) and the beta-lactamase inhibitor,
clavulanic acid (as potassium clavulanate).Amoxicillin is the 4General Action
hydroxy analogue of ampicillin. Amoxicillin hinders the cell wall
synthesis of sensitive bacteria and is bactericidal against many
Gram-positive and Gram-negative bacteria.
Dose & Route
Co-Amoxiclav 1gm/1 tab BID x7 days
Known or suspected amoxicillin-resistant infections including
respiratory tract, skin and soft tissue, genitourinary, and ear, nose
Indications or
and throat infections. Effective against strains of Escherichia coli,
Purposes
Proteusmirabilis, Haemophilus influenza, Streptococcus faecalis,
Streptococcus pneumoniae and some beta-lactamase-producing
organisms.
Lethargy, hallucinations, seizures, glossitis, sore mouth, furry
Side Effects
tongue, black hairy tongue, nausea and vomiting, diarrhea,
abdominal pain, bloody diarrhea, enterocolitis.
Penicillin hypersensitivity and history of co-amoxiclav-associated
Contraindications
or penicillin-associated jaundice or hepatic dysfunction.
1. Assess bowel pattern before and during treatment as pseudo
membranous colitis may occur.
2. Report hematuria or oliguria as high doses can be nephrotoxic.
3. Assess respiratory status.
4. Observe for anaphylaxis.
5. Ensure that the patient has adequate fluid intake during any
diarrhea attack.
6. Ice chips and crackers are given to prevent nausea and
Nursing
vomiting.
Responsibilities
7. The drug must be taken in equal doses around the clock to
maintain level in the blood.
8. If the patient develops a rash, wheezing, itching, fever or
swelling in the joints, this could indicate an allergy and should
be reported.
9. May cause maculopapular rashes almost always in presence
of grandular fever.
10.Should be swallowed with a glass of water.
PROGNOSIS
132

Criteria

Good

Fair

Poor

Justification
Peters mother verbalized Nagsaka ang
kabuhi sa ulo as the start of his illness as he
was not able to eat at the right time because he

Onset of

would

prioritize playing DOTA than eating.

According to his mother, she noticed him

Illness

talking to himself and would verbalize

different numbers and the names Ryan,
Jonah and Marian and the words death,
secret, and defense.
Peter has been diagnosed with the disorder

Duration of
Illness

last February 13, 2015 at SPMC-IPBM but

X

experienced symptoms of the disorder a few

days before he was admitted. He was
discharged last February 22, 2015.
Peter lives in a small house in Doa Asuncion
Ph. 8 Blk. 80 Lot 16, Angeles St., Sasa, Davao
City. He sleeps outside their house in a small

Environment

space surrounded by broken appliances such

X

as broken electric fans and even boxes of

pizza. It is full of dust and spider webs. His
neighbors said that he was very addicted to

Family

DOTA and it lead to his current situation.

Peter is supported by his mother. But, the

Support

mother was not able to fully take care of him

X

as he was growing up as she was busy serving

her religion and her business which was
candle-making. His aunts helped in taking
care of him when he was young his.
According to his aunt, his mother also spends
money too much wherein she spends it in her
133

religion and not on Peter.

The mother is able to supply the medications
Willingness

prescribed by the physician. According to the

to take

mother, Peter told her to give him the

medications

medications so that he would not forget to

take them.
Peter is not close with his mother in which the
mother also admitted. His father is already

Precipitating

Factors

dead and his sister is currently in Manila. He

also doesnt express his problems to anyone
and keeps it to himself.
Peter is already 23 years old wherein his age

Predisposing

Factors

fits that factors of substance abuse and he is

also a male, whom are prone to substance
abuse.

CALCULATIONS:
Good: 1 x 1 = 1
Fair: 2 x 4 = 8
Poor: 1 x 2 = 2
TOTAL: 11 = 11/7 = 1.6

Range of Value:

1.0 1.6 for Poor

1.7 2.3 for Fair
2.4 3.0 for Good

Result:
The patient has a poor prognosis as evidenced by the computation seen above. His
own mother was not able to see his growth when he was younger and it was his aunts
134

who took care of him and have seen him grow as his mother was busy with her religion
and her candle-making business. According to his aunt, his mother would spend a lot of
money on her religion and not on Peter. He is sometimes hostile when he hears the name
Ryan, who was his enemy in DOTA. His aunt and mother said that they saw him talking
to his self and laughing and shouting. The patients symptoms would be more aggravated
by these events. He also believes that he is married to a woman named Jonah which is
not true and his family does not know anyone with the name Jonah.

RECOMMENDATIONS

The group 2 of section 3A would like to recommend the following:

To the patient:
135

He has to comply with the treatment regimen prescribed to him especially to take
the medications on time. He has to observe the instructions set by the healthcare team. He
has to recognize the significance of this practice because this is for the improvement of
his well-being. He also has to cooperative with the series of evaluation that will be done
to assess the severity or progress of his condition with the treatment.
To the patients family:
They have to always keep in mind that they play an important role in the clients
mental illness and recovery. Being there with the client to watch over and assist him with
his daily activities definitely becomes very significant to aid the client in apprehending
reality. They have to continue in interacting with the client to divert him from his
delusions or hallucination. They also have to become the clients advocate in the clients
limitations. They have to be cooperative and as well to comply with prescribed treatment.
To the Ateneo de Davao University- School of Nursing:
The faculty and staff are encouraged to maintain the standards of the Ateneo
Nursing Curriculum by providing quality education to students. They have to continue
inspiring the student nurses in their duties through emphasizing the value of the things
they do, not only for the sake of achieving a high grade or just complying with the
requirements but fulfillment of being men and women for others. The School of Nursing
have to continue in providing the students the significant exposures throughout the
duration of their learning so they able to realistically apply the things they learned in their
future clients.
To the Institute of Psychiatry of Behavioral Medicine:
The group recommends that they must not settle for the present situation in their

136

area. Rather they have to always seek on how to improve their services and especially
their facilities. They must provide the clients a better place to sleep on. They have to keep
the clients clean not only whenever there are student nurses. If possible, they have to add
more staff nurses so attention and care can be well allocated. The staff nurses have to be
more patient and passionate in their work and as much as possible not to take for granted
every client. Every client deserves the proper health services. They have to observe what
are also the latest approach in communicating with the mentally-challenged clients.
To our student nurses:
To be exposed to mentally challenged patients, first we have to know ourselves
very well, so we could deal with familiar situations with our clients at the same time
preserve our sanity. It is always important that we have to be always diligent in the things
we do and value importance of teamwork to get things done and to serve the essence of
our planned activities. Let us appreciate the opportunity of having the chance to render
care and attention to the most needy. We have to develop and practice therapeutic
communication for this helps big in the rehabilitation of our mentally-challenged clients.

SIGNIFICANCE OF THE STUDY

This study will be significant in aiding the proponents in understanding the nature
of the patient's mental illness. The study will also benefit the School of Nursing, the
clinical instructors, and future researchers by providing significant and relevant data
137

regarding bipolar disorder.

The case study was significant to the proponents because it has given a better
understanding on the development Substance induced psychotic disorder cannot fully rule out Mood
Disorder

as well as its relevant significance in accordance to the developmental theories

proposed by Freud, Erikson, and Piaget.

Furthermore, in allowing the proponents to study the

psychodynamics,

precipitating and predisposing factors, doctor's order, ordered drugs, the proponents as
well as the clinical instructors were able to formulate sound recommendations and
nursing plan of care to the patient and significant caregivers in order to improve cognitive
functioning and promote optimal well-being.
Often the problem with helping patients with mental illness is that too much focus
is given to the illness and not enough focus given to promoting existing mental health. In
order to better aid the patient as well as the patient's family to cope with this illness, the
study was imperative in determining the causes of the disease and its adverse effects on
mental health.
Through this study, the proponents were able to help the patient to understand the
nature of this disease and to take measures to promote better mental health by seeking
necessary and appropriate care and to encourage effective coping mechanisms.
REFERENCES
Books:

Drug Use and Abuse: A Comprehensive Introduction by Howard Abadinsky

Substance Abuse and Pychopathology ( Applied Clinical Psychology) by Arthur
Alterman

138

Neurobiology of Mental Illness; Fourth Edition by Dennis Charney, Eric J.

Nestler, Pamela Sklar and Joseph Buxbaum

Treatment of Depression Newer Pharmacotherapies: Evidence Report by

Cynthia D. Mulrow
Pharmacology, a Nursing Approach 6th edition by Joyce LeFever Kee
Kozier and Erbs Fundamentals of Nursing: Concepts, Processes, Practice. Eight
Edition

C. M. Kodjo and J. D. Klein, Prevention and risk of adolescent substance abuse.

The role of adolescents, families, and communities, Pediatric Clinics of North
America

N. Nakhaee and N. Jadidi, Why do some teens turn to drugs a focus group study
of drug users' experiences, Journal of Addictions Nursing, vol. 20, no. 4, pp.
203208, 2009

E. Goode, Theories of drug use, in Drugs in American Society, chapter 3,

McGraw Hill, Boston, Mass, USA, 7th edition, 2007

C. Spooner, Causes and correlates of adolescent drug abuse and implications for
treatment, Drug and Alcohol Review, vol. 18, no. 4, pp. 453475, 1999

P. Slovic, Perception of risk, Science, vol. 236, no. 4799, pp. 280285, 1987

Internet:

http://www.hindawi.com/journals/jad/2014/352835/

http://www.news-medical.net/health/Dopamine-Functions.aspx
https://www.boundless.com/physiology/textbooks/boundless-anatomy-andphysiology-textbook/central-nervous-system-cns-12/cerebral-cortex-or-cerebralhemispheres-120/limbic-system-653-1969/

139

http://lrrpublic.cli.det.nsw.edu.au/lrrSecure/Sites/LRRView/7700/documents/5657

/5657/5657_05.htm
http://behavenet.com/node/21539
http://en.wikipedia.org/wiki/Crisis_intervention
www.enotes.com/informed-consent-reference
http://www.medicinenet.com/diphenhydramine/article.htm
http://www.medicinenet.com/risperidone/article.htm
http://www.medicinenet.com/clonazepam/article.htm
http://en.wikipedia.org/wiki/Crisis_intervention
http://www.medicinenet.com/haloperidol/article.htm
http://www.medicinenet.com/risperidone/article.htm
http://psychopharmacologyinstitute.com/antipsychotics/olanzapine/mechanism-

action-pharmacodynamics-olanzapine/
http://www.emedexpert.com/facts/amoxicillin-clavulanate-facts.shtml
http://www.merriam-webster.com/medical/mood%20disorder
http://www.minddisorders.com/Py-Z/Substance-induced-psychotic-disorder.html
http://www.scribd.com/doc/37409412/DRUG-STUDY#scribd
http://www.scribd.com/doc/124976724/Co-Amoxiclav#scribd
http://www.drugs.com/zyprexa.html
http://www.scribd.com/doc/126502567/Psych-Drug-Study#scribd
http://rnspeak.com/drug-study/haloperidolperidol-drug-study/
http://www.scribd.com/doc/37696608/HALOPERIDOL-drug-study#scribd
http://www.drugs.com/klonopin.html
http://www.scribd.com/doc/14717022/Drug-Study-Clonazepam#scribd
http://www.scribd.com/doc/62815655/Clonazepam-Drug-Study-www-

RNpedia#scribd
http://www.drugs.com/ppa/risperidone.html
http://www.medicinenet.com/risperidone/article.htm
http://www.nursing-nurse.com/drug-study-diphenhydramine-163/
http://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-

Guide/51225/all/diphenhydrAMINE
http://www.drugs.com/pro/diphenhydramine-injection.html
http://www.scribd.com/doc/37040698/Drug-Study#scribd

140

141