F20 Schizophrenia Case Study

Republic of the Philippines
Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
A Case Study Presented to Mariveles Mental Hospital
In partial fulfilment of the Requirements of the subject
Nursing Care Management 105
A.Y. 2017-2018
SCHIZOPHRENIA
Presented by:
Artates, Shelly Anne S.
Celebrados, Darene T.
Diza, Kimberly M.
Gonzales, Jeffster Nikka E.
Lomibao, Angela Joy D.
Macaraeg, Gina Marie B.
Meehleib, Rachelle Ayn S.
Padilla, Ana Veronica M.
Quiban, Kacelyn A.
Reyes, May D.
Saptang, Jolina E.
July 2018
1
ACKNOWLEDGEMENT
First and foremost, the students would like to express our deepest gratitude and appreciation to our
Almighty God, who gave us courage, determination, love, wisdom, protection and inner strength which enable us to
overcome all the difficulties during the challenging process of making this study.
To Prof. Ma. Susan Z. Maglaqui and Prof. Adora N. Obregon for their words of encouragement, guidance,
patience, valuable comments, suggestions, time and effort throughout this case study.
To our family, friends, and classmates who serve as an inspiration, thank you for the unwavering moral,
emotional and financial support, and motivations in doing this case study.
To the Mariveles Mental Hospital health personnels who welcomed us warmly, oriented us, and thaught us
the things we didn’t knew at first, we would like to extend our deep and heartfelt gratitude for letting us explore and
learn new things in your institution.
Thank you so much!
-The students
2
Table of Contents
Chapter 1
Introduction……………………………………………………………………………………....5
Theoretical Framework…………………………………………………………………………..7
Personal Data……………………………………………………………………………………..8
History of Present Illness…………………………………………………………………………8
History of Previous Illness………………………………………………………………………..8
Past Personal History……………………………………………………………………………..9
Family Health and Psychiatric History…………………………………………………………..9
Chapter 2: Mental Status Assessment (MSA)……………………………………………………………...10
General Appearance……………………………………………………………………………...10
Motor Behavior…………………………………………………………………………………..10
Sensorium and Cognitive ability…………………………………………………………………13
Perception………………………………………………………………………………………...12
Attitude and behavior……………………………………………………………………………11
Affective State ………………………………………………………………………………….11
Speech……………………………………………………………………………………………10
Thought process and content…………………………………………………………………….12
Chapter 3
Psychopathology…………………………………………………………………………………15
Related Literature and Studies…………………………………………………………………...17
Drug Study……………………………………………………………………………………….18
3
Chapter 4
Process Recordings………………………………………………………………………………22
Prioritized Psychiatric Nursing Diagnoses and Psychiatric Nursing Care Plan …………………39
Chapter 5
Psychotherapies Implemented……………………………………………………………………43
Bibliography………………………………………………………………………………………………..45
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CHAPTER 1
Introduction
Schizophrenia is the most dominating case of admissions in Mariveles Mental Hospital. It is an extremely
complex mental disorder. In fact, it is probably much illness masquerading as one. A biochemical imbalance in the
brain is believed to cause symptoms. Recent research reveals the schizophrenia may be result of faulty neuronal
development in the fetal brain, which develops into full-blown illness in the late adolescence or early childhood.
Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years
of age for women. Its causes distorted and bizarre thoughts, perceptions, emotions, movement, and behaviour. It
cannot be defined as a single illness, rather thought as a syndrome or disease process with many different varieties
and symptoms. These symptoms are categorized into two major categories, the positive or hard symptoms which
include delusion, hallucinations, and grossly disorganized thinking, speech, and behavior, and negative or soft
symptoms as flat affect, lack of volition, and social withdrawal or discomfort. Medication treatment can control the
positive symptoms but frequently the negative symptoms persist after positive symptoms have abated. The
persistence of these negative symptoms over time presents a major barrier to recovery and improved the functioning
of client’s daily life. (Keltner, et al., Psychiatric Nursing, 5th Edition (28) page 339-366)
Gaebel and Zielasek (2015), revealed the newly revised version of Diagnostic and Statistic Manual for
mental disorders (DSM) that was published by American Psychiatric Association in 2013. In addition, there is
currently an ongoing revision process in clinical diagnostic criteria for mental disorders, including Schizophrenia by
the World Health Organization. The development of DSM – V is characterized by disorder group – specific working
groups of clinical and research experts, they reviewed the available evidence for classification issues of
Schizophrenia, and prepared suggestions for changes. The Classification of Schizophrenia in DSM – V and ICD –
11 are evident, omits the traditional clinical subtypes of Schizophrenia (Paranoid, Hebephrenic), because number of
studies have indicated that such clinical subtyping had little relevance for determining the prognosis or therapy.
World Health Organization statistics on Schizophrenia states that it affects more than 21 million people
worldwide.
The Philippine Health Information System on Mental Health (PHIS-MH) May 2014-2016, stated that
Schizophrenia is the Top Mental Health Problem in the Philippines, affecting 42%, and mostly male individuals.
Reasons for Choosing the Case
Patient-centered
To maintain and/or promote optimum level of mental health development of the patient, as to render our
learning experiences using therapeutic technique of communication.
Student-centered
To be able to understand the process of dealing with Schizophrenic patient by using our therapeutic
communication techniques, and to be able to learn the different therapies that will provide support and awareness to
our chosen client.
5
OBJECTIVES OF THE STUDY
General:
To be able to establish a working relationship with the patient and make use of our knowledge gathered and
studied about during our lecture days in psychiatric nursing, and applies it in our related learning experiences in
gathering the needed information to identify and prioritize the problem to promote mental health.
Specific:
1. To assess properly and to determine the contributing factors regarding to their condition.
2. To use the different communication techniques and to promote therapeutic communication.
3. To provide and develop plan of care considering characteristics, and time bound plan that reflects the onset
date of problems identified.
4. To render and provide supportive and protective nursing interventions to the problems identified for the
patien’s care.
5. To evaluate all nursing interventions that has been established and outcome of the condition.
6
Theoretical Framework
Family Theories
Numerous theories implicating family interaction alone as a cause of schizophrenia have been proposed
and unsupported. Research has failed to support the theory that dysfunctional family interaction alone causes the
illness.
Individuals with schizophrenia who are raised by adoptive parents, who themselves showed elevated levels
of communication of deviance, demonstrated as much thought disorder as those raised in birth families. In contrast,
adoptees who were raised by adoptive parents with more functional communication were less likely to show thought
disorder as those raised in birth families. In contrast, adoptees who were raised by adoptive parents with more
functional communication were less likely to show thought disorder. In one study, this pattern was not evident in
control adoptees, there was no discernible relationship between thought disorder in the adoptees and
communication, deviance in the adoptive parents. In other words, these findings did not detect the presense of
‘’schizophrenia’’ environment for individuals without a pre existing genetic liability. This examples support the
view that genetic factors alone do not explain the development of schizophrenia, and that interaction with the
environment are important. Individuals who live in aversive environments tend to have a higher rate of
schizophrenia suggesting there maybe neighborhood and social context to development of the disease.
( Allardyce and Boydell, 2006)
7
Personal Data
Name: “Tisay”
Age: 34 y/o
Birthday: May 20, 1984
Female
Address: Orani, Bataan
Citizenship: Filipino
Date Admitted: September 11, 2017
Past Health History:
On January 16, 2012, 7:00 PM, Client was reported by tricycle driver in Mariveles Police Station and was
placed in the blotter for alleged jumping off from the tricycle upon arriving in Barangay Sisisman near the school.
According to the driver, he had observed her inside the tricycle, murmuring to herself. The Client revealed her name
and her age, 29 years old with unknown address.
She was referred to Municipal Social Welfare and Development (MSWD) Office for assistance and proper
case disposition. As observed, Client seemed to be harmless and cried when being questioned. While being
interviewed by two social workers, she took a pair of scissors, pointed and threatened them. On June 26, 2013 Client
was discharged with the Diagnosis of Undifferentiated Schizophrenia.
On November 7, 2014 she started to undergo scheduled check up with her sister in Mariveles Mental
Hospital.
In November 27, 2014, her sister came without the client, and reported that the client is pregnant.
January 15, 2015, her sister came to the Out-Patient Unit to report that the client cannot travel due to
financial constraints. She then reported that “Tisay” was 6 months pregnant, as per her RHU prenatal check-up.
Since then, no further check-up was done. However, there was no Obstetric History seen on the client’s chart.
On January 22, 2016, she was seen roaming around Olongapo City, naked, untidy, and wandering around,
does not want to talk to anybody. She was then admitted to the Olongapo Municipal Social Welfare and
Development Office and reported back to Municipal Social Welfare Development Office (MSWDO) Mariveles.
January 29, 2016, “Tisay” was surrendered by that City Social Welfare and Development of Olongapo City for
possible admission to Mariveles Mental Hospital. Thus, on that same day she was admitted to Mariveles Mental
Hospital. On August 30, 2016, patient was out for home conduction accompanied by MMH staff. August 31 2016,
she was successfully home conducted and accepted by her sister.
Present Health History
Last September 11, 2017, client was taken by the saturation team sleeping along Magsaysay drive. Client
was psychotic vagrant, and was always seen naked roaming and wandering in the streets, untidy and doesn’t want to
take a bath. After 2 days, the concerned citizen observed that she was close to the male residence and wants to sleep
8
with them. She was referred for safekeeping and proper disposition on September 14, 2017, and was admitted at
Mariveles Mental Hospital up to present.
Social History
During the NPI, “Tisay” claimed that she met unknown male individuals, and was made to believe that she
will work as an actress for a Hollywood film and will be paid 20 thousand pesos. She said she was married to Paul
Walker, a Hollywood actor and that they had three children. She confided that she was a very rich actress, living in
Alabang, and owns a house and luxury cars in California. She claimed that her former maids were admitted at MMH
female service wards. Client have stated that she left Bataan and proceeded to Olongapo to work as an actress for
Hollywood films, allegedly, she had sexual intercourse with males referred to as “kung sino-sino”.
Drug Abuse History
The client claimed she used tuber ecstacy and injectable methamphetamine prior to filming the said movie.
Forensic History
January 16, 2012, 7:00 PM, Client was reported by tricycle driver in Mariveles Police Station and was
placed in the blotter for alleged jumping off from the tricycle upon arriving in Barangay Sisisman near the school.
Family History
Patient’s relatives denied to be related to her. They confirmed that “Tisay” was only adopted. No further
family history was gathered in the client’s chart.
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CHAPTER 2
MENTAL STATUS EXAMINATION
1. GENERAL DESCRIPTION
1.1 APPEARANCE
DESCRIPTIONS NP1 NP2 NP3 NP4 NP5

Congruent apparent age
Appropriate dressing
Clean/Hygiene   
Good posture
Good gait
Appropriate facial expression   
With eye contact
With pupil dilatation
With pupil constriction 
Normal state of health & nutrition
1.2 SPEECH
DESCRIPTION NP1 NP2 NP3 NP4 NP5

Rapid speech  
Slow speech
Loud volume  
Soft volume
Minimal speech
Pressured speech
Stuttering
Slurring of words
Unusual accents  
1.3 MOTOR ACTIVITY

Lethargic
Tensed   
Restless
Agitated  
With observed tics
Grimace 
Tremors  
Compulsive
10
1.4 INTERACTION DURING INTERVIEW

Hostile
Uncooperative
Irritable   
Guarded
Apathetic
Defensive
Suspicious
Seductive
Descriptive Analysis:
Appearance, Speech, Motor Activity & Interaction during Interview
Tisay has a congruent apparent age. During the interview, she has a good posture and gait, also very
cooperative and able to answer our questions with clear voice. Pediculosis is present. Tisay has a rapid speech and
loud voice, we observed that while conducting the interview she was tensed and both of her hands were shaking and
was irritable at some point, however, she was able to perform range of motion exercises at ease.
2. EMOTIONAL STATE
2.1 MOOD

Sad
Fearful
Hopeless
Euphoric 
Anxious 
Happy   
2.2 AFFECT

Congruent/Appropriate  
Flat
Labile
Descriptive analysis:
Mood and Affect
We have observed that our patient shows positive emotions on her facial expression such as
smiling all the time, establishing a fixed eye contact and shows interest to the interview. Her mood is
appropriate and she is cooperative.
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3. EXPERIENCES
3.1 PERCEPTIONS
DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

Hallucination: Auditory
Visual   
Tactile
Gustatory
Olfactory
Illusions  
Perceptions
During the interview, she stated that she was married to a Hollywood actor and she was a Hollywood
actress. She claimed that she won Miss Philippines and tops the Nursing Board Examination. It shows on her
records that she talks to herself with irrelevant topics in the ward.
4. THINKING
4.1 THOUGHT CONTENT

Delusion: religious
Somatic
Grandiose   
Paranoid
Thought Broadcasting
Thought insertion
Depersonalization
Hypochondriasis
Ideas of reference
Magical thinking
Nihilistic ideas
Obsession   
Phobia
4.2 Thought process

Circumstantial
Flight of ideas  
Loose association
Neologisms
Perseveration
Tangential
Thought Blocking   
12
Word salad
Though content, thought process
Based on the patient’s statement, there were presence of grandiose and obsession through her story, that she
was married with Paul Walker and they have 3 children. Sometimes, while she was talking she suddenly stop and
think for awhile then tried to continued her story. Her statement was spontaneous but in a grandiose manner wherein
there’s no evident relation to reality. Patient was delusional.
5. Sensorium and Cognition
5.1 Level of Consciousness

Confused
Sedated
Stuporous
Oriented to : Time   
Place   
Person   
5.2 Memory

Intact remote memory  
Intact recent memory
Intact immediate memory 
5.3 Level of concentration and calculation

Easily distracted 
With difficulty in simple math
5.4 Information and intelligence

With learning disability
With learning difficulty
Able to interpret simple proverb  
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5.5 Judgement

Appropriate judgement
With good relationship to others
5.6 Insight

Accepts presence of problem
Blames the problem on others
Level of Consciousness, Memory, Level of Concentration, Calculation, Information, Intelligence, Judgement, and
Insight.
Oriented to time, date and place; she was able to recognize us, and was not easily distracted and able to
answer simple math question. Tisay is also good in grammar, has good relationship to others, and was able to read
and write appropriately. She claimed that she had finished College and Topped the Nursing Board Exam.
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CHAPTER 3
Psychopathology
Book - based
Non-Modifiable Factors Modifiable Factors
 Genetics
 Gender  Alcohol drinking
 Age (late adolescent- young  Smoking
adulthood) 25-35 years old  Substance abuse
 Neurostructural  Lifestyle
abnormalities
Psychosocial stressor and

interpersonal events
Stimulation by different factors
Failure in development or a
subsequent loss of brain tissue
Diminished glucose meta, and

oxygen in frontal cortical
Decrease brain volume and

abnormal brain function in
frontal and temporal lobe
Malfunctioning of transmission
of electrical impulses
Transmission of signal requires a Drug increases dopaminergic Induced paranoia psychotic

complex series of biochemical events system activity symptoms
Actions of dopamine, serotonin, Drug blocking post synaptic Reduce psychotic behaviors
norepinephrine, acetylcholine, dopamine receptors
15
glumate
Three separate symptoms complexes/ syndromes
 Feelings of persecution
 Hallucinations  Grandiosity
 Delusions  Hostility
 Disorganized thoughts and behavior  Illusions
 Positive symptoms like:  Insomnia
 Abnormal thoughts  suspiciousness
 Agitation
 Bizarre behavior
 Delusions
 Excitement
Client - based
Non-Modifiable Factors Modifiable Factors
 Alcohol drinking (as claimed by

 Female the patient)
 34 years old  Smoking (as claimed by the
patient)
 Substance abuse (such as tuber
ecstasy and meth)
 Rejection of her love interests
(seven or more times)
Overwhelming stressful events
Drug abuse
Manifestations:
-Hallucination: Visual
-Hallucinations: Auditory – voices commenting or
discussing the patient in the third person 16
-Delusion of grandeur/ grandiosity
-Delusion of control
-Reference of delusion
RELATED LITERATURE AND STUDIES
Gaebel and Zielasek (2015), stated that by the year 2020, Schizophrenia will still be clinically defined as a
Primary Specific Disorder, and the treatment will improve with new Anti – Psychotic Drugs, drugs addressing
negative symptoms, more refined Psychotherapy approaches and the introduction of new treatment modalities, like
Transcranial Magnetic Stimulation to improve early detection and prevention. There is an imminent clinical
challenge to develop comprehensive diagnostic and treatment modules individually tailored to the time – variable
needs of patients and their families.
According to the study of Donker, et al. (2013), Suicide Prevention in Schizophrenia Spectrum Disorders
and Psychosis: A Systematic Review, a systematic review was conducted in order to investigate the effectiveness of
psychococial interventions in reducing suicidal behavior among schizophrenic patients, and the study concluded that
psychosocial interventions may be effective in reducing suicidal behavior in patients with schizophrenia disorders
and psychosis.
Based on the study of Siira V., et al (2013), it was stated that stability has been considered as an important
aspect of vulnerability to Schizophrenia. The temporal stability of the scales in the Minnesotta Multiphasic
Personality Inventory (MMPI) was examined, using adoptees from the Finnished Adoptive Family Study of
Schizophrenia. Adoptees who were high risked off spring of biological mothers having a Schizophrenia Spectrum
Disorder, and low risk controls were evaluated using 15 MMPI scales at the initial assessment (HR, or High Risk
mean age is 24 years old; LR ow Low Risk mean age is 23 years old). Stability of MMPI scales was also assessed in
the groups of adoptees, assigned according to the adoptive parents (N=44) Communication style using
Communication Deviance (CD) Scale as an environmental factor. Low CD had an effect on the stabilization of
personality traits, such as social withdrawal and restricted affectivity, assessed by correction and hostility.
According to McGrath et al. (2008), Schizophrenia: A Concise Overview of Incidence, Prevalence, and
Mortality, study shows concise overview of three related systematic reviews on the incidence, prevalence, and
mortality associated with Schizophrenia. The median incidence of Schizophrenia was 15.2 over 100,000 persons,
and the central 80% of estimates varied over a fivefold range. (7.7-43.0/100,000). The ratio for males: females were
1.4:1. On the basis of the standardixed mortality ratio, people with Schizophrenia have two – to three fold increased
risk of dying, and this differential gap in mortality has increased over recent decades. Compared with native – born
individuals, migrants have an increased incidence and prevalence of Schizophrenia. Exposure related to Urbanicity,
economic status, and latitude are also associated with various frequency measures.
In the study of Sullivan, P.F (2005), it was stated that Adoptions designs permit evaluation of the role of
genetic factors in Schizophrenia independently of the influence of family environments. The results from the studies
adoptees with Schizophrenia and their biological and adoptive relatives indicate that genetic factors play a highly
significant role in the risk for schizophrenia. This genetically mediated risk to relatives includes an increased
prevalence of both schizophrenia and a non-psychotic syndrome analogouos to Schizophrenia, but does not
represent a general liability to other forms of psychopathology.
17
DRUG STUDY
Name of Drug Route, Dosage Mechanism of Action Indication and Contraindication Side Effect Nursing Responsibilities
and Frequency
Generic Name: PO,2 mg tablet, Synthetic anticholinergic. >control of extrapyramidal >dry mouth >Take after meals to void gastric
Biperiden once daily Tremor may increase as disorders secondary to neuroleptic >blurred vision irritation. Do not stop abruptly
Hydrochloride spasticity is relieved. drug therapy. >drowsiness >increase fluid intake and fiber
Slight respiratory and CV >constipation intake to avoid constipation
effects. >bradycardia
Brand Name: >hypersensitivity to biperdin >Muscle weakness >use ice chips or hard candy for
Akinton >Inability to move dry mouth
certain muscle
Classifications:
Cholinergic >Avoid activities that require
blocking mental alertness until drug effects
drug,ati realized. May cause dizziness,
parkinson drug drowsiness or blurred vision .
change positions slowly to prevent
sudden drop in BP.
>Record stool; increase intake of

fluids, fruit juices, and fiber to
avoid constipation; report urinary
difficulties
18
and Frequency
Generic Name: P.O,10 mg Mechanism of action not >Treatment of schizophrenia >Dizziness > Monitor patient for tardive
Olanzapine tablet, once fully understood; Blocks >Acute mixed or manic episodes >somnolence dyskinesia, which may occur after
daily. dopamine receptors in the associated with bipolar1 disorder >Nervousness prolonged use. It may not appear
brain, depresses the RAS; and maintenance as monotherapy or >headache until months or year later and may
Brand Name: blocks serotonin receptor combined with lithium or valproate. >Akathisia disappear spontaneously or persist
Zyprexa sites; anticholinergic >peripheral edema for life.
‘anti-histamic and alpa- >tachycardia
Classification: adenargic blocking >hypotension >Take only as directed; do not
Antipsychotic activitymay cotribute >Contraindicated with allergy to >constipation share medication; do not exceed
Dopaminergic olanzapine, myeloproliferative >Abdominal pain prescribed dosage
Blocker disorder, sever CNS depression >cough
comatose states and location >Avoid changing positions
suddenly, especially from lying to
standing position r/t to low blood
pressure.
>Do not perform activities that

require mental alertness until the
drug effects realized.
19
and Frequency
Generic Name: PO,100 mg Alters effects of dopamine > Schizophrenia and psychoses >Drowsiness > Assess mental status prior to and
tablet, Once (D2) in CNS. Has Hyperexcitability, combat for >Dizziness periodically during therapy
Chlorpromazine Daily significant anticholinergic explosive behavior. And >Light headedness
/ alpha- adrenergic hyperactive with conduct disorder >Dry mouth >Monitor BP and pulse prior to
blocking activity. >Blurred vision and frequently during the period of
Brand Name: >Tiredness dosage adjustment. May cause QT
Thorazine >hypersensitivity sulphites or >Nausea interval changes on ECG
benzyl alcohol. >Constipation
>Weight Gain >The drug may be taken with or
Classification: >Trouble of without food
Anti-psychotic sleeping
Antiemetics >Observation patient carefully
when administering medication
>Monitor I &O rations and daily

weight.
>Monitor for development of

neuroleptic malignant syndrome
20
and Frequency
Generic Name: PO, 2 mg tablet, Block dopamine and 5 - >Parenteral therapy for >Depression >Rise slowly from a lying to a
Risperidone once daily HT2 receptors in the schizophrenia and treatment of >Somnolence sitting position, dangle legs before
brain. acute manic or mixed episodes from >dystonia standing; may cause drop in BP.
Brand Name: dipolar disorder. >headache
Risperidone >Insomnia >Drug may cause drowsiness and
>Anxiety impair judgment, motor skills and
Classification: >chest pain thinking and cause blurred vision;
Anti-psychotic >Contraindicated in patients >hypertension determine the drug effect engaging
hypertensive to drugs and in breast >rhinitis in activities that require mental
feeding woman >sinusitis alertness.
>abnormal vision
21
CHAPTER 4
Nurse’s Statements Patient’s Response Analysis of Patient’s Response Rationale of Nurses

(To include Defense Mechanism Statement
Used. ) (To include Therapeutic
Verbal Non-Verbal Communication Technique
used)
Mood is appropriate Giving recognition and
“Magandang umagaTisay, Ako “Good Morning Patient was smiling while fixing her hair Facilitate eye contact information
nga pala si Rachelle, studyante ng Rachelle, mag katunog
Tarlac State University” pala pangalan natig
dalawa”
“Kamusta ka naman Kaibigan, “Okay lang naman, oo Walk fast with visible excitement Patient is answered Seeking information
kumain ka na ba?” kumain na ako.” appropriately
“Tara kabigan, umupo tayo at ng “Sige, Tara Rachelle, Patient was smiling Patient is responsive Offering self
makapag kwentuahn tayo.” upo tayo.”
“Ako pala si Rachelle, 20 years “Ako naman si “Tisay”, Patient was getting ready for morning care Patient was able to introduce Giving information
old, kasalukuyang nag aaral sa 34 years old at taga herself appropriately with fast
Tarlac State University, 4th year Orani, Bataan.” speech
student.
“Nandito kami sa loob lamang ng Patient was excited to tell her story Patient expressed excitement on Formulating a plan of action
dalawang lingo para po sa aming Patient nods her facial expression
duty at makasama kayo para
gawin ang mga ibat ibang
activities katulad ng Pagsayaw,
pag awit, pag guhit at pag luluto.
Meron din po kaming ibat ibang
palaro para sainyo, Meron din po
kaming maihahandog na
duladulaan sa ating
socialization.”
“Opo, yun lamang po yung patient was smiling Giving information

nakalaan na oras namin para “ahh ganun ba, osige,
makasama kayo.” mag eenjoy naman ako.”
“Pwede ko bang itanong kung “Nanunood ako ng Patient smiled and showed glad expressions Patient answered accordingly Exploring
anong ginagawa mo sa ward teleserye yung sa GMA,
22
niyo?” yung kontesa at kambal
karibal.”
“Ano yung mga hilig mong “gusto ko nakikipag Patient smiled Patient was able to verbalize the Broad opening
gawin kaibigan?” kwenthan sa mga importance of communication
kaibigan ko” and friendship
“Tungkol saan naman ang “Madalas tungkol sa Patient smiled Patient expressed her openness Focusing
pinagusapan niyo?” teleserye na pinapanuod
namin, minsan naman
tungkol sa buhay sa
labas.”
“Kaibigan pwede ko pang “Noon kasi mahilig ako Patient leans forward while talking Patient showed no hesitation Exploring
maitanong kung ano yung mamasyal, lagi akong regarding on her personal
nagging buhay mo sa labas ng nagpupunta ng information
Mariveles Mental Hospital” Olongapo.”
“Anong dahilan at ikay “Mahilig kasi ako Patient was doing hand gestures like playing Patient was able to express her Encouraging Expression
nagpupunta ng Olongapo.” mamasayal gusto ko dun with her fingers likes
yung beach tapos
lumalangoy ako dun.”
“Ano pa ba mga ginagawa mo o “Ang nanay ko kasi dun Patient was keeps on doing hand gestures Patient was expressed openness Focusing
pinupuntahan sa Olongapo, siya nagwork bilang
Kaibigan?” GRO, dun ako
pinanganak, tatay ko ay
foreigner.”
“Nasan na yung nanay mo “Namatay na yung tunay Patient slouched and sighed heavily Patient expression changed Exploring
ngayon kaibigan?” kong mama, ipinakupkop
lang niya ako sa kaibigan
niya dito sa Orani.”
“Kamusta naman ang naging “Okay naman, masaya, Patient was excited but showed gloomy Patient was able to express her Encouraging expression
karanasan mo sa Olongapo may mga nagbibigay expression feelings
kaibigan?” naman g pagkain sakin
kasi wala na akong
pera.”
“Ahh may mga nagbibigay pala “Oo kapag nanlilimos Patient verbalized in a sad manner but tried Facial expression changed Restating
sayo ng pagkain doon kaibigan.” ako minsan sa tindahan to smile
ako nakikitulog.”
“Kaibigan, ikaw ba’y may “meron, madami na She was making hand movements while Patient was able to admit but Open ended question
pamilya na?” akong anak iba iba nga storytelling then became complusive
23
lang yung mga tatay.”
“Hindi mo na ba sila nakakausap “Hindi na, buhat nung di She keeps on doing hand geatures Patient seems to show denial Exploring
kaibigan?” na kami nagsasami ng because she doesn’t showed
mga tatay nila.” direct eye contact
“Ah ganun ba kaibigan, pero “oo kasi may asawa She was leaning forward and started to move Patient speech becames fast and Seeking information
kilala ka ba nila?” akong foreigner siya, her feet spontaneous
may anak kami, tatlo.”
“Anong pangalan ng anak mo?” “Si Elisha, Stephanie at Patientwas looks directly to my eyes Patient showed delusions Seeking information
Patricia. Namatay na
yung asawa ko sa car
crash.”
“Ano ulet pangalan ng anak mo?” “Si Elisha, Stephanie at Patient did not break the eye contact Patient admitted that she was Restating
Patricia Walkers. Asawa married to a Hollywood actor
ko kasi si Paul Walker.” which is not rekevant to reality
which also shows delusion
“Ano ba ang nangyare sa asawa “Naaksidente yung She keeps on leaning forward Patient is delusional and making Focusing
mo kaibigan?” asawa kong si Paul up stories
Walkers dahil sa car
crash.”
“Ah ganun ba kaibigan, sana “Oo nga eh miss ko na Suddenly showed sa d expression on her Patient admitted showed feeling Giving recognition
maayos ang mga anak mo.” sila, sana palang hindi na face of regrets
lang ako umuwi ng
Pilipinas.”
“Ano ba ang kadahilanan ng “Galing kasi ako ng She keeps on making hand gestures Patient is delusional Seeking information
paguwi mo?” America doon ako
nagtrabaho.”
“Maari ko bang malaman kung “Graduate kasi ako ng Patient smiled while Nodding his head Patient showed behavior of fast Focusing
ano yung naging trabaho mo sa Nursing, nurse ako, nag speech with delusional thoughts
Amerika.” aral ako sa BPSU nag top
6 pa nga ako sa board
exam ko, nagtrabaho ako
dun ng care giver kaso
hinihupuan ako nung
matandang amo ko kaya
umalis na lang ako
binigyan niya ako ng
dollars, umuwi na lang
ako.”
24
“Ahh sige kaibigan punta na tayo “Okay sige Rachelle, Patient nod and carried her chair in the Patient cooperated well Offering self
dun at may activity tayong tara.” corner
gagawin. ”
“Maraming salamat sa “Salamat din, Rachelle. Patient smiled Patient express feeling of Giving reacognition
kooperasyon mo kaibigang Nag enjoy ako.” enjoyment
Tisay.”
“Bukas ulet kaibigan. Salamat.” “Sige, Thank you, Patient waved her hand while saying Patient facila expression seems Accepting and offering self
Salamat Ba-bye” goodbye happy with the conversation
Nurse’s Statements Patient’s Response Analysis of Patient’s Response Rationale of Nurses Statement
(To include Defense Mechanism (To include Therapeutic
Verbal Non Verbal Used. ) Communication Technique
used)
“Magandang umaga Tisay, “Hello Rachelle, eto okay naman.” Patient was smiling while Patient anwered appropriately Giving recognition
kamusta ka?” fixing her hair
“Tara kaibigan, mag morning “Sige, Dito na lang tayo, pasensya na hindi Patient walks fast Patient showed awareness and Offering self
care.” ako nakasama kahapon.” the mood was appropriate
“okay lang nakapagpahinga ka “oo, okay na ako ngayon.” Patient smiled Patient express feeling of good Encouraging expression
naman ba?” modd behavior
“Tara punta na tayo dun at may “Sige ano ba gagawin natin, music and Patient smiled while Patient showed eagerness to Offering self and giving
activity tayong gagawin.” art?” walking know the activity information
“Oo, magddrawing tayo.” “Gusto ko yan, Tara na.” Patient nods Patient showed cooperatedness General lead
“Nasabi mo saakin kahapon na “Oo meron si Elisha, Stephanie at Joanna Patient seemed very Patient is delusional Placing event in time or
ikay may tatlong anak.” Marie Walkers.” excited sequence
“Wala ka bang balak pasyalan o “Meron babalik ako ng 2019, bibisita lang Patient was looking around Patient showed delusional Formulating aplan of action
Makita yung mga anak mo?” ako kasi may bahay ako sa Alabang” like she was looking for thoughts
something
25
“Ah may bahay ka sa Alabang, “Oo, meron sa may Fablier Subdivision Patient was smiling while Patient showed delusional Restating
kaibigan?” baka kasi pasukan ng magnanakaw, Ayan looking at the ceiling thoughts
si Angela Manansala at si Pia Mina
katulong ko sila. ”
“Katulong mo sila kaibigan?” “Oo kaso tong si Angela kinuha niya yung Patient was pointing at Patient showed delusional Restating
mga atm ko susi ng bahay at kotse, patient Ann thoughts
pinalayas niya mga katulong ko, tapos
kinuha niya mga gamit ko.”
“Nabanggit mo saakin kaibigan “Oo, Father ko si Michael Watchman.” Patient sighed heavily Patient showed confused Summarizing
na anak ka ng Foreigner?” expression
“Hindi mo ba siya nakakausap “Nakausap ko siya sa facebook noon kaso Patient frowned while Patient was tenses upon Voicing doubt
noon?” dinideny niya ako.” entertwining her fingers answering the question
“Ano ba ang sabi mo sakanya “Do you remember my mother’s name, Patient smiled and looked Patient recalls memory from Focusing
kaibigan?” Amelia Lumanog? I am your daughter left at the ceiling years ago
here in the Philippines, you abandoned
me”
“Anong nireply niya sa mensahe “I don’t remember your mother’s name. I Patientshrugged then Patient restates what her Offering general leads
mo kaibigan?” don’t know who you are. I am not your looked down conversation went
father. ”
“Ano sinabi mo sakanya?” “Thank you sir for your conversation. Im Patient looked at me with Restaes her conversation Focusing
sorry for, tapos nag sorry ako then wala disappointment
na.”
26
“Eh yung mother moa san na “Wala na patay na siya namatay siya dahil Patient smiled then looked Patient cooperates well with the Exploring
siya?” sa appencitis, maglalaba at nagbubuhat down conversation
siya kaya naputukan siya, buntis pa siya
kamo ng 5 months.”
“saan mo nalaman na wala na “sa kaibigan niya, hinanap niya ako at si Patient had a slight of Patient answered appropriately Exploring
siya?” nanay conrada ko, yung step mother ko. emotional feeling
May dalang picture ng mother ko at sabi
niya ako yung nawawalag anak.”
“May mga kapatid ka ba sa nanay “Wala ako lang at yung dinadala sana niya Patient nodded then pouted Patient asnweres appropriately Seeking information
Amelia mo kaibigan?” noon.” her lips
“Kamusta naman ang pag aalaga “Maayos naman, mabait naman nany ko, 2 Patient was looking around Patient was responsive Encouraging expression
sayo ng Nanay Conrada mo?” months pa lang ako kinuha na niya ako.” while talking
“Pinag aral ka ba ng nanay “Oo nung elementary ako sa Taplao Patient was smiling while Patient remembers details of the Exploring
Conrada mo kaibigan? Elementary School tapos sa Jose Rizal nodding past
Institute nung high school. Nung college
naman sa BPSU.”
“Ahh mabuti naman kung ganun “Nag nursing ako graduate ako ng 2009, Patient was smiling while Patient was delusional Exploring
kaibigan, ano ang kinuha mong nag take nga ako ng board exam sa UP doing hand gestures
kurso noon?” Diliman naka pasa ako.”
“Pakatapos mo ng college “ Oo, 2010 nung nag apply ako ditto nag 1 Patient nodded her head Patient was having delusional Seeking information
nagtrabahao kaba kaibigan?” month ako diyan tapos 1 week na nursing while pointing the building thoughts
attendant kaso pinasok nila ako dito.” outside the gym
“Noong nagaaral ka kaibigan, “oo masaya naman, may mga kaibigan Patient smiled and looked Patiwent answered Offering general lead
masaya naman ba? May mga naman ako.” at me directly appropriately
kaibigan k aba?”
27
“Naaalala mo pa ba sila “Hindi ko na sila maalala kasi na black out Patientstated to stare while Repression – repress her Placing event in time or
kaibigan?” ako.” playing with her hair thoughts about that event sequence
“Ano ba kadahilanan ng paka “Na burial kasi ako, akala nila na patay na Patientsmiled while Patient was cooperative yet Focusing
blackout mo? ” ako parang nabangungot ganun.” answering my questions delusional at the same time
“Kailan naman yun kaibigan?” “Nung May 31, si Anne ang nagbibigay ng Patient had a serious face Patient was delusional claims Encouraging description of
kape at tinapay, alam niya. Nailagay ako that she was buried perceptions
sa kabaong di nila ako inembalsamo tapos
after 6 days nagising ako tapos inuwi ako
netong si anne sa Taplao.”
“Anong reaksyon nila nung “Wala masaya lang sila, binuksan ko yung Patient smiled at me Patient was delusional amd Encouraging expression
nakita ka nilang gumising” kabaong naka make-up ako at gown akala looked happy with her answer
daw nila patay na ako kasi ilang araw na
akong hindi nagigising.”
Silence “Inuwi niya ako sa taplao, pinaltan muna Patient smiled while Patient is delusional. Using Silence
niya yung damit ko, inayos niya ako. nodding
Tapos nung June, July, August, September
hanggang sa naggala ako, libot libot
ganun, kain tulog hanggang Sept 15 na
dinampot ako at dinala ditto.”
“Ano yung ginawa mo nung “Wala kain tulog lang, namamasyal, uuwi Patient nodded while Patient was open to share her Exploring
panahon nay un?” sa bahay kakain,maghuhugas ng plato at answering my questions experiences
maglalaba.”
“Nabanggit mo saakin na hilig “Naglalakad tapos yung natitira kong pera Patient was doing hand Patient admitted what she had Summarizing
mo sa Olongapo.” pinambibili ko ng pagkain tapos minsan gestures like pointing at done before yet was tensed at
binibigyan ako sa tindahan.” something some points
28
“Hindi kaba nagtrabaho?” “Hindi ako nagtrabaho, wala na akong Patient shooked his head Patient is delusional. Exploring
trabaho, yung last ko lang ginawa yung
Avatar tsaka Under The World.”
“Wala ka bang naging kaibigan “Wala wala akong nakilala mahilig lang Patient shooked his head Patient was serious and Exploring
sa Olongapo?” ako magpunta sa gotohan, sa lugawan answered in a very straight
ganun bumibili ako bente pesos.” forward manner
“Nabanggit mo sa akin na galing “oo, nung 2013 pinasok ako ditto ng dswd, Patient nodded Patient answered appropriately Summarizing
kana dito nung 2012?” dinala ako.”
“tapos nakalabas ka sa dahilang?” “conduction” Patient smiled Patient answered appropriately Offering general leads
“pagkatapos anong ginawa mo?” “namasyal na naman ako tapos ganun Patient was doing hand Patient was tensed while telling Offering general leads
ulet,panay ganun naman nangyayare sakin gesturswhile pointing at her story
di ba nasa chart ko yan. Nakita mo naba somehing
chart ko”
“ang sabi mo sakin kaibigan nag “oo, the assignment, the donkey, basta Patient nodded counting Patient is delusional. Summarizing
shoot ka ng film” Makita mo yun sa youtube Michelle with her fingers
Movies”
Patient shooked her head Patient still insist of being an Encouraging comparison
actress and a director.
“nung nasa olongapo ka wala “wala eh tapos huling ginawa ko din yung
kaba naging film” the decades”.
“ano naman yung naging ganap “anak ako dun, anak ni vilma santos.” Patient nodded with a Patient’s delusional episodes Exploring
mo kaibigan?” serious face continues
“Gusto mo na bang mag drawing “Pwede na ba? Pwede na ba talaga?” Patient showed excitement Patient expressed feelings of Broad openings
kaibigan” excitement
29
“Eto Michelle, tatlong bond paper “Sige Thank you salamat Rachelle.” Client nodded then tapped She cooperated well in y Offering general leads
at crayons mo, gagamitin mo yan my hand instructions
sa activity mo.”
“Saan gawa yung bahay mo “Sa bato gawa yung bahay.” She pointed out her She seemed to be confident in Exploring
kaibigan?” drawing and nod her answer
Delving further into subject or
an idea
“Kanino bahay yang ginawa “Kay nanay Conrada ko, bahay ng Patient was stamping her She answered the question Exploring
mo?” matanda” feet appropriately
an idea
“Sino yung iniisip mo nung “Nanay ko. Eto si ate Arsenia ko at ako Patient smiles and points She answered the questions Exploring
dindrawing mo yan?” pag umaga nag e-energen kami.” out her drawing appropriately
an idea
“Kung sakali kaibigan, gusto mo “Ayaw ko, mas gusto ko yung bahay ko sa Patient shooked her head She answered the questions Encouraging description of
bang sayo na ang bahay nayan?” Alabang.”“May mayari nan g bahay nayan appropriately perceptions
si Kuya Eduardo ko.”
Asking the client to verbalize
what she percieves
“Kung sayo yung bahay nayan, “Yung malapit sa sala, kasi mahilig akong She nodded and pointed She seemed to be straight Formulating a plan of action
saan ang gusto mong kwarto?” manuod ng TV tsaka ng movies.” with her fingers. forward with her answers
Asking the client to consider
kinds of behavior likely to be
appropriate in the future
situations
“Nabanggit mo saakin kaibigan “oo ako si Cameron R. Diaz na naging Patient nodded and smiled She seemed to be delusional Restating
na Artista ka?” Michelle Rodriguez”
Repeating the main idea
expressed
30
“Anong naiisip mo nung “Namimiss ko yung ate ko kapag Patient smiled She seemed to be happy in Focusing
ginuguhit mo yan?” pinagluluto niya ako.” talking about her sister.
Concentrating on a single point
“Anong naaalala mo sakanya “Mabait naman si ate kahit pinapagalitan Patient kept smiling She seemed to be confident with Exploring
maliban sa pagluluto niya.” niya ako kapag lumilibot ako” her answer
an idea
“Hindi pa ba kayo nag away ng “Nag away na rin kami ng ate ko kapag Patient shooked her head She answered appropriately Encouraging Expression
Ate Arsenia mo? lumilibot libot ako.”
Asking the client to appraise
the quality of her experience
“Anong nababanggit niya kapag “Kapag ikaw nadisgrasya na naman sa She did hand gestures She answered appropriately Offering general leads
lumillibot ka? lalake, sabi niyang ganun.” while pointing out with her
index finger Giving encouragement to
continue
“Madidisgrasya ka na naman sa “Baka madisgrasya ako sa lalake, ma-rape She still points out her She reinacts what her sister is Exploring
lalake, sa anong paraan?” ganun, gagala daw ako, magiingat daw index finger telling her
ako.” Delving further into subject or
an idea
“Nung sinabi niya sayo yun, “Hindi nga ako nakinig kaya napadpad ako She showed disappointed She seemed to be unhappy with Exploring
nakinig ka naman ba kaibigan?” dito, naggala ako.” face. the topic
an idea
“Ano pa yung ibang dahilan ng “Ah yun, na depress ako, stress ganun.” She slouched and looked She seemed to be unhappy with Placing events in time or
napadpad ka ditto maliban sa down the question but still answered sequence
paggagala mo?” respectfully.
Clarifying the relationship of
events in time
“Anong kadahilanan mo ng na- “Namatayan ako ng anak, nakunan ako sa She looks down She seemed to be serious about Encouraging Expression
depressed ka?” loob ng hospital.” continiously the topic
31
“Ilang buwan na yun?” “5 months na yun.” She looks down She was very straight forward Placing events in time or
continiously into answering my question sequence

events in time
“Kilala mo ba yung tatay ng “pagkadisgrasya sa lalake.” She pouted her lips She seemed to be disappointed Exploring
ipinagbuntis mo?” in regards to the topic
an idea
“May tanong ako tungkol sa “Oo sige ano yun?” She looked staright at me She seemed to agree Giving information
drawing mo.”
Making available the facts that
the client needs
“Anong naiisip mo tungkol sa “Bahay ng nanay ko yan, diyan kasi ako She was holding her paper Patient answered appropriately Exploring
drawing mo?” nagsstay, bahay sa Taplao, Orani.” while pointing her drawing
an idea
“Nung nasa bahay ka nay an “Masaya naman pero may mga oras na She had a serious face and Patient seemed to be confident Exploring
kaibigan, masaya ka ba o malungkot” stamped her feet
malungkot?” Delving further into subject or
an idea
“Anong naiisip mo na nagiging “Yung nakakapag isa ako sa kwarto ko, She continued to look She seemed to be unhappy Encouraging Expression
masaya ka?” yung wala akong iniisip kung hindi down and was playing regarding the topic.
kain,tulog, maglibot,magpunta sa with her fingers Asking the client to appraise
computer shop ganun, yung inienjoy ko the quality of her experience
lang ang buhay.”
“Anong naiisip mo kapag magisa “kung paano ko maasikaso yung pera ko, She leaned forward and She seemed to be serious with Offering self
ka sa kwarto?” nagpasok ako ng check kaso yung voters stares at me completely her answers.
ID nung May pa binigay, January Making oneself available
nagpasok ako ng 2M pesos na napalanunan
32
ko sa Singing contest, tapos pinasok ko sa
bangko wala akong dalang ID bumalik
nalang daw ako, eh nakulong naman ako
ditto nung September, nagpirma at
thumbmark naman ako. Kasama ko si
Jocelyn kumain kami sa Jollibee nagpunta
kami ng bangko, sinumpong ako ng sakit
ko pero pag labas ko aayusin ko ID ko.
“Ano naman ang mga “Nung kinulong ako ng kuya at ate ko sa She looked down and Patient seemed to be Exploring
malulungkot mong naranasan sa kwarto.” slouched disappointed in the topic
bahay niyo?” Delving further into a subject or
an idea
“Anong kadahilanan at ikinulong “Nag gagala daw ako, naloloko kasi ako She looked at me and Patient cooperated well in Exploring
ka sa kwarto?” ng lalake, halimbawa nakikipag text at call nodded. answering my questions
ako ganun tapos magmmeet kami at aayain Delving further into a subject or
ako mag sex.” an idea
“saan mo naman nakukuha yung “binibigay lang ng mga friends ganun. She was fixing her hair She seemed arouse Placing events in time or
mga number?” Meet meet lang” sequence

events in time
“Nakikipag kilala ka?” “Oo sa bahay nila mismo na, nadidisgrasya She fixed her hair and her She seemed arouse while Restating
nga ako, nag ssex kami ng lalake, tapos di clothing talking about her sexual
na ako pananagutan, pinapa adopt ng ate intercourse Repeating the main idea
ko yung mga anak ko.” expressed
“alam mo pa ba kung ilan ang “oo may anak ako quadruplets pinaampon She nodded and smiled She seemed to be confident with Exploring
mga anak mo?” ng ate ko 2016 nanganak ako.” her answer
Delving further into a subject or
an idea
“Kilala mo pa ba yung ama mga “Kilala ko si Menald Catchuella, yung dati She had hand gestures and Patient seemed to be confident Exploring
anak mo?” kong asawa, ni rape niya ako sa kusina ng played with her thumb with her answer. She was
bahay. Tumutuloy ako sa dirty kitchen moving quite a lot Delving further into a subject or
nabuntis niya ako.” an idea
33
“Magkasama na ba kayo sa isang “dati asawa ko siya, may dalawa kaming Patient showed her two Patient seemed to be confident Focusing
bahay?” anak.” fingers in her answer
Concentrating on a single point
“Siya ba yung kasama mo sa “Hindi, si Jimmy Dela Pena yun, Patient nodded and pointed Patient cooperated well Encouraging Expression
picture?” Boyfriend ko ditto taga Mabalacat, somewhere
Pampanga” Asking the client to appraise
“Nagkasama na ba kayo ni “Oo, nagkasama na kami, meron na rin Patient nodded while Patient cooperated well and Encouraging description of
Jimmy” kaming anak na lalake, pina ampon ni doing hand gestures answered my question perceptions
jimmy sa pinsan niya” confidently
Asking the clinet to verbalize
what she percieves
“Ilang taon na yung anak niyo ni “hindi ko na maalala, may anak pa pala Patient shrugged Patient seemed to answere my Exploring
Jimmy?” akong babae kaso di ko nainamin kay question with slight of
Jimmy si Ellismina, 6 years old na kay hesitation Delving further into a subject or
Jennifer Simbol, kapitbahay ko.” an idea
nodding “May anak ako kay Menald Catchuella Patient was nodding Patient continued to tell her Acceptance
pinakasalan ko siya sa Paris, dalawa anak story
naming si Kacy at si CJ. Humiwalay ako Indicating reception
binubugbog niya ako at nagsshabu.”
“Sinasaktan ka ng asawa mo, “Oo, iniwan ko siya.” She nodded then pointed in Patient was confident Restating
tama ba kaibigan?” her back
Repeating the main idea
expressed
“Ano ba ang nangyare at umalis “Pinagtabuyan niya ako, sinaktan, kaya Patient had an aggressive Patient seemed to be serious Encouraging description of
ka bigla?” hindi na ako bumalik, tapos nabuntis niya look regarding the topic perception
yung babae niya, nagpakasal sila ng
illegal.” Asking the client toverbalize
what she percieves
“Gusto mo na bang umuwi sa “Uuwi ako kaso hindi stay in, babalik ako Patient nodded but then Patient cooperated well and was Exploring
bahay na ginuhit mo?” sa bahay ko sa Alabang, aasikasuhin ko pouted her lips and thrilled in telling stories
34
yung bahay baka mamaya kasi pasukan ng shooked her head.
magnanakaw, mauubos lahat ng gamit ko, Delving further into a subject or
kompleto pa naman ako sa gamit, may ref, an idea
may washing machine, may la Germania
na kalan, may cabinet, may tv na flat
screen, JVC na radio component, kama na
Salem at waterbed baka manakawan ako
saying ang naipundar.”
“Hindi mo ba naidala si Ate “Hindi pa, 2010 ginawa yung bahay, 2018 Patient nodded while Patient was cooperative and has Placing events in time or
Arsenia mo sa bahay mo sa na, 8 years ko ng bahay yun. Magbabayad playing with her nails willingness into sharing her sequence
Alabang?” pa nga ako ng anulyar paglabas ko para story
hindi mahila ng gobyerno.” Clarifying the relationship of
events in time
“wala ka na bang gustong i- “Eto kasing pulang kulay kasi andiyan Patient was pointing out Patient was explaining her Broad Openings
explain tungkol sa bahay na yung pagmamahal, puso ng pagiibigan, her drawing thoughts well she was confident
ginuhit mo?” pagkakaisa n gaming pamilya.” with her actions. Allowing the client to take the
initiative in introducing the
topic
“Anong nararamdaman mo nung “Masaya na malungkot, namimiss ko na Patient nodded and smiled Patient cooperated well Encouraging Expression
ginuhit mo ikaw at ate mo?” kasi ang ate arsenia ko.”
“Ano mga naaalala mo tungkol sa “Mga pangaral niya saakin, mahal ko ate Patient smiled while Patient seemed to be happy Exploring
ate arsenia mo? ko, pinayaman ko na yun. Inuwi ko saknya stretching out her fingers talking about her sister yet she
mga cheke na napalanunan ko nung 2015 is somewhat tensed regarding Delving further into a subject or
Miss Philippines ako si Michelle the topic. idea
Rodriguez Atencia 1st runner up inuwi ko
yung 10 Million tapos nung 2016 tinago
ako bilang Stephanie Grey, Ms World
2016 naibigay ko ulet sa ate ko yung 20
Million Dollars.”
“Ano ang nararamdaman mo sa “Mahal ko ang ate Arsenia ko.” Patient nods Patient was cooperative but Encouraging Expression
taong ginuhit mo?” looked unhappy
35
“Ganun din ba ang “oo parang ganun din, mahal ko din si Patient nods and placed Patient was cooperative in Encouraging description of
nararamdaman mo sa ibang tao?” Jimmy, pati mga kaibigan ko mahal ko sila her hand in her legs answering my questions perceptions
kasi di nila ako sinasaktan”
Asking the clinet to verbalize
what she percieves
“Kamusta nman yung mga “Mabait naman kaso wala na silang Patient smiled then looked Patient easily answered my Placing event in time or
kapatid mo?” pakialam saakin, kasi si Kuya Ernesto ko down question but seemed to be down sequence
kinuha niya mga gamit ko tinago niya, or disappointed about the topic
ayaw niya isurrender saakin ginawa akong Clarifying the relationship of
pulubi.” the events in time
“Ano sa tingin mo ang dahilan “hindi ko nga alam eh.” Patient shooked her head Patient cooperated well Offering general leads
nila?””
Giving encouragement to
continue
“Hindi mo pa ba sila “nakausap ko sila, sabi ko pa nga, kuya Patient nodded while Patient seemed to be serious Placing event in time or
nakakausap?” pakibalik po mga gamit ko, wala na akong playing wth her fingertips with the conversation sequence
gagamitin. Sabi niya anong gamit, kung
gusto mo makuha gamit mo, tubusin mo Clarifying the relationship of
ng pera.” the events in time
“Sa anong kadahilanan na nasabi “Tinago nila yung gamit ko pati greencard Patient stares straight into Patient seemed to be tensed Focusing
mo na pinupulubi ka nila?” ko, passpot, SSS card, at voters ID ko sa my eyes and leaned
US. Tinubos ko ng 50k sa kuya Ernesto forward Concentrating on a single point
ko.”
“Saan mo naman nakuha yung “may pera nga ako sa bangko, minsan Patient kept on staring Patient seemed to be tensed in Exploring
pera nay un?” magpapapalit ng Dollars, minsan dala ko directly to my eyes while telling her story, she keeps on
ang cheke. Yan kasing si Manansala leaning forward closer to moving while telling her story Delving further into a subject or
kinuha yung card ko, pwede mo siyang me and holding on to her an idea.
tanungin kung kakilala niya ako, nakasama clothes
ko nay an sa bahay at hotel, kinuha niya
yung bag ko, susi ng kotse at bahay mga
ATM cards ko. Sabi naman ni Anne
36
nakapark naman mga sasakyan sa garahe.
Noon nga naguwi ako ng Toyota sa Orani
kaso binenta nila ng 200k pagkatapos kong
sumali ng Miss Universe, inangkin nila.”
Silence “Kasi dito Mental for Health, mga may Patient smiles while Patient was thrilled in telling her Using silence
sakit at diperensiya sa isip eh, mga nodding and pointing out story. She seemed comfortable
naliligaw ng landas sa pagiisip.” some buildings in the in sharing her experiences. Absence of verbal
location communication, which provides
“Ako sakit ko lang kapag nagugutom ako time for the client to put
nag gagala ako, lakad ako ng lakad, thoughts or feelings into words,
pupunta ng simenteryo ganun,” to regain composure or to
continue talking
“Eto naman kasing si Anne nagdrugs eh,
kinuha niya mga gamit ko, atm ko, susi ng
bahay at sasakyan, katulong ko yan dun
sila ni Pia Mina
“Ganun ba kaibigan, So ayan “oo, nag enjoy ako, mahilig kasi akong Patient smiled Patient was happy and Encouraging Expression
tapos na tayo sa Activity natin, magdrawing.” contented
nag enjoy ka naman ba?” Asking the client to appraise
“Buti naman at nag enjoy ka, tara “Oo sige tara, oo next week ha?” Patient nodded Patient seemed to be excited Suggesting Collaboration
na balik na tayo dun sa ward mo.
Next week ulet ha.” Offering to share, to strive, and
to work with the client for her
benefit
*while walking* Eto kasing si Anne nalulong sa drugs, Patient was walking while Patient was tensed Silence
ewan ko ba diyan siiya kumuha sa mga pointing out at another
gamit ko sa Alabang. Nagdrugs kasi yan.” patient Absence of verbal
communication, which provides
time for the client to put
thoughts or feelings into words,
to regain composure or to
continue talking
“Ikaw ba kaibigan, hindi k aba “Hindi, ay oo pala gumamit ako, yung Patient tapped a student Patient was jolly and very Encouraging Comparison
37
gumamit nun?” tinutusok dito, tsaka yung tabletas na puti nurses arm in a friendly cooperative
na maliit, ecstacy yun.” manner while smiling Asking that similarities and
differences be noted
“Sige, Salamat Kaibigang “Oo, Thank you, salamat Rachelle, Bye! I Patient smiles and waved Patient looks happy and enjoyed Suggesting Collaboration
Michelle sayong oras, kain ka ng miss you, I love you, I love you all” her hand the day
dinner mo, ingat ka. Sa susunod Offering to share, to strive, and
ulet.” to work with the client for her
benefit
38
PRIORITIZED PSYCHIATRIC NURSING DIAGNOSES & PSYCHIATRIC NURSING CARE PLAN
First Nurse – Patient Interaction
Assessment Psychodynamics and Goal and Objectives Nursing Interventions Rationale

Theory
- Poorly related Interpersonal Model - Recognize changes 1. Assess attention - To determine ability
thoughts and ideas. (Sullivan, Peplau) in thinking behavior span and to participate in
- (+) delusions - Holds that human - -Identify distractibility and planning/executing
- (+) Flight of Ideas development results interventions to deal ability to make care.
- Percept experiences from interpersonal effectively with decisions. - Provide stimulation
that do not exist in relationships, and situations. 2. Schedule structured without undue
reality. that behavior is - Demonstrate activity and rest fatigue and to
- (+) Tension motivated by behavior changes to periods. reduce/prevent
- (+) Rapid speech avoidance of anxiety prevent/minimize tension.
with loud volume. and attainment of changes in
satisfaction. mentation.
- Nurses must - Maintain usual 3. Note occurrence of
promote the nurse- reality orientation. delusions and - To prevent
patient relationship hallucinations. deterioration.
to build trust and 4. Reorient to time,
foster healthy place, and person as - Defensive reactions
behavior. needed. may result.
Diagnosis: Disturbed - Therapeutic use of 5. Present reality
thought process related to self promotes concisely and briefly
physiological brain healing. and do not challenge
dysfunction - The therapeutic illogical thinking.
relationship is
directed toward
meeting the patients
needs.
Evaluation: Response to interventions and actions performed, progress towards desired outcomes are met, so as to the modifications to plan of care.
39
40
Third Nurse – Patient Interaction
Assessment Psychodynamics and Goals and Objectives Nursing Interventions Rationale

Theory
Subjective: Interpersonal Model - Regain usual level of 1. Provide diversional - Diverts the patients
“Dati kong asawa si Paul (Sullivan, Peplau) cognition. activities as able attention and for the
Walker. Kaso namatay siya sa - Holds that human - Recognize and such as drawing a nurse to be able to
car crash.”, “Alam mo si development results correct for sensory house, tree and gather more data and
Richard Gutierrez? Naging from interpersonal impairment. person. information in the
leading lady ako nun sa mga relationships, and - Identify factors that interpretation of the
movies niya noon.” that behavior is contribute to drawings.
motivated by alterations in 2. Provide explanation - To reduce anxiety
Objective: avoidance of anxiety sensory/perceptual of and plan of care and feeling of threat
- Exaggerated and attainment of abilities as much as possible. to the client.
emotional responses. satisfaction. 3. Determine use/abuse
- Disoriented with - Nurses must of addictive drugs. - To be able to
people. promote the nurse- determine the
- (+) Hallucinations patient relationship underlying cause to
and bizarre thinking. to build trust and the sensory
- (+) Rapid speech foster healthy 4. Keep client in alteration.
with loud volume. behavior. continuous view and
- Therapeutic use of observation - To prevent harm and
Diagnosis: Disturbed self promotes accordingly. injury.
sensory perception related healing. 5. Present reality
to altered sensory - The therapeutic concisely and briefly
perception relationship is and do not challenge - Defensive reactions
directed toward illogical thinking. may result.
meeting the patients
needs.
Evaluation: Response to interventions and actions performed, progress towards desired outcomes are met, so as to the modifications to plan of care.
41
42
CHAPTER 5
Process Recording and Psychiatric Nursing Care Plan
Psychotherapies Conducted
Psychotherapy Strategy Used Patient’s Response
Group Exercise This activity may help the patient to The patient in this activity actively and
increase self-esteem by providing a cooperatively follows the steps. She is
sense of accomplishment, reducing focused on what she is doing, that you
stress, and improving the appearance can’t talk to her while she is exercising.
and mood. It can also provide ways to You can only speak to her afterwards. She
increase self-confidence and social follows the instructions being given to her
interaction through participation. After correctly.
finishing the activities of daily living,
the patient will exercise in the tune of
“Mag Exercise Tayo Tuwing Umaga”
for atleast 5 minutes.
Music Therapy The music therapy entitled “Galing ng The patient in this activity is actively
Pinoy” patient may help to improve the listening and participating in the activity.
sense of identity and musical In fact, her voice is very loud and rapid
experience, knowledge and awareness while she is reading the lyrics and singing.
of one self and other people and their She is very competitive, in the way that
relationship with them, improve the she overpowered others’ voices when it
sense of identity with musical comes in activity and she takes it very
experience, also facilitating self- seriously.
expression and promoting
psychological growth, encourage
verbal and nonverbal communication
and development psychomotor
cognitive emotional and social
expression communication activity.
The students let the patients read the
lyrics written first, and sing with the
tune afterwards.
Dance Therapy For the dance therapy, patient with In this activity, patient is actively
schizophrenia in this activity it helps following the dance steps, and she is good
express movement feelings that they at dancing. Just like in the group exercise,
cannot put into words. This may she will not entertain you while you speak
promotes self-awareness, self-esteem and ask question. She just wants to focus
and a safe space for the expression of her attention in what she is doing.
feelings.
They are formed in window formation,
and dances to the tune of “Girl In The
Mirror” for atleast 6 minutes.
43
House Tree Person Test This activity may help to appraise the In this activity patient is cooperative,
total personality of the client in an displays congruent facial expression and
individual type of examination, to gestures. And for the interpretation, she
obtain data concerning the client’s entertains and answers the questions
progress while under treatment, to in cooperatively and shows interest in
the establishment of rapport between venting out her feelings about each
the nurse and client and also to help the drawing. However, delusions of grandeur
subject gain insight through her own are still observed while she answers the
interpretation of own drawing questions asked.
They are given the materials needed,
such as the bond paper, and crayons.
Afterwards, the student nurses are
going to instruct them with what to
draw each drawing has an allotted time
of 5 minutes, and ask them questions
afterwards to further interpret the
drawing.
44
BIBLIOGRAPHY
Buchaman R.W. & Carpenter, W.T. (2005). Concept of Schizophrenia. In B.J Sadock & V.A.
Sadock (Eds.), Comprehension textbook of psychiatry. (Vol. 1 8th ed., pp. 1329-1345). Philadelphia: Lippincott Williams &
Wilkins.
Deutsch, A (1937). Mental Illness in America, New York: Doubleday
Doenges, M.E., Moorhouse, M.F., Murr, A.C., 12 th edition. Nurse’s Pocket Guide. Diagnoses, Prioritized Interventions, &
Rationales.
Keltner, N.L., Bostrom, C.E., McGuiness, T.M., (6 th Edition), 2012, “Keltner’s &Psychiatric Nursing, Philippine Edition,
Elsevier (Singapore)
Otong, D.A ,. 2003. “Psychiatric Nursing Biological & Behavioral Concepts. Pp 88. Thomson Asian Edition.
Spratto, G.R., Woods, A.L., 2007 edition. “PDR Nurse’s Drug Handbook”
Videbeck, S.L.m (5th edition). 2011. “Psychiatric-Mental Health Nursing”,. Wolters Kluwer, Lippincott Williams & Wilkins.
Pp 102-104, 251-275
World Health Organization, 2006

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Republic of the Philippines

Tarlac State University

A Case Study Presented to Mariveles Mental Hospital

In partial fulfilment of the Requirements of the subject

Nursing Care Management 105

Artates, Shelly Anne S.

Gonzales, Jeffster Nikka E.

Lomibao, Angela Joy D.

Macaraeg, Gina Marie B.

Meehleib, Rachelle Ayn S.

Padilla, Ana Veronica M.

Thank you so much!

History of Present Illness…………………………………………………………………………8

History of Previous Illness………………………………………………………………………..8

Past Personal History……………………………………………………………………………..9

Family Health and Psychiatric History…………………………………………………………..9

Chapter 2: Mental Status Assessment (MSA)……………………………………………………………...10

Sensorium and Cognitive ability…………………………………………………………………13

Attitude and behavior……………………………………………………………………………11

Affective State ………………………………………………………………………………….11

Thought process and content…………………………………………………………………….12

Related Literature and Studies…………………………………………………………………...17

Reasons for Choosing the Case

( Allardyce and Boydell, 2006)

Birthday: May 20, 1984

Address: Orani, Bataan

Date Admitted: September 11, 2017

Past Health History:

Present Health History

Drug Abuse History

DESCRIPTIONS NP1 NP2 NP3 NP4 NP5

DESCRIPTION NP1 NP2 NP3 NP4 NP5

1.3 MOTOR ACTIVITY

DESCRIPTION NP1 NP2 NP3 NP4 NP5

DESCRIPTION NP1 NP2 NP3 NP4 NP5

Appearance, Speech, Motor Activity & Interaction during Interview

DESCRIPTION NP1 NP2 NP3 NP4 NP5

DESCRIPTION NP1 NP2 NP3 NP4 NP5

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

4.2 Thought process

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

Though content, thought process

5. Sensorium and Cognition

5.1 Level of Consciousness

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

5.3 Level of concentration and calculation

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

5.4 Information and intelligence

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

DESCRIPTION NPI 1 NPI 2 NPI 3 NPI 4 NPI 5

Non-Modifiable Factors Modifiable Factors

Psychosocial stressor and

Stimulation by different factors

Diminished glucose meta, and

Decrease brain volume and

Transmission of signal requires a Drug increases dopaminergic Induced paranoia psychotic

Non-Modifiable Factors Modifiable Factors

 Alcohol drinking (as claimed by

>Record stool; increase intake of

>Do not perform activities that