Paranoid Schizophrenia A Case Study Presented to the Faculty of College of Nursing and Midwifery Bataan Peninsula State University
In Partial Fulfillment For the Requirement in the Degree of Bachelor of Science in Nursing
Alonzo, Mizzy Anne Angulo, Louie Anne Antonio, John Andrew Barros, Hazelyn Joy Buenaventura, mark Richard Cortez, Romieline Crisostomo, Florina Mae De Mesa, Alvin De Silva, Janelle Dela Torre, Mariel Kim Diego, Lorenz Anthony Fajardo, Camille Felipe, Yvette Group11 ThFs
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TABLE OF CONTENTS
UNIT 1 I.
II. III. IV.
Dedication and Acknowledgement……………………………………….. Personal Data……………………………………………………………… Chief Complaint……………………………………………………………. Health History……………………………………………………………… a. Past health history……………………………………………………… b. Present health history…………………………………………………... c. Family history…………………………………………………………... i. Social history…………………………………………………… ii. Childhood………………………………………………………. iii. Adolescence…………………………………………………….. iv. Adulthood………………………………………………………. a. Sexual history…………………………………………………………...
UNIT 2 Mental Status Assessment / Analysis and Interpretation…………………………
UNIT 3 a. Psychopathology……………………………………………………………….. b. Related Literature……………………………………………………………… UNIT 4 a. Nursing Care Plans……………………………………………………………... b. Pharmacology…………………………………………………………………... UNIT 5 Psychotherapy…………………………………………………………………………..
UNIT 6 Glossary…………………………………………………………………………………
UNIT 7 1
Reference……………………………………………………………………………...
UNIT 8 Documentation………………………………………………………………………….
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UNIT I (Dedication, Acknowledgement, Introduction, Personal Data, Chief Complaints and Health History)
DEDICATION
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This work is dedicated to our parents, family relatives and friends. Without their patience, understanding, support and most of all love, the completion of this work would not have been possible.
Also, it is dedicated to our colleagues who will conduct the same studies in the future.
And lastly, to our GOD who provide us knowledge and strength in making this work.
ACKNOWLEDGEMENT First and foremost, we would like to thank to our Almighty God, who gives us strength, knowledge, and good health in 2
pursuing this comprehensive case study. And also to our family who gave all the emotional and financial support and motivations at all times and they also serves as our inspiration. We would like also to acknowledge our clinical instructor Sir Ronald Tyron dela Rosa for the support, patience, knowledge, and contributions to finish this comprehensive case study. We would like also to thank Sir Ronnell Dela Rosa and Ma’am Irish Lee for helping and giving some encouragement to make our duty possible and able to enjoy our stay in Mariveles. II.
INTRODUCTION Schizophrenia is a mental disorder characterized by the disturbances in thoughts,
sensory perception and deterioration in psychosocial functioning. It is also characterized by a weak ego. The common defense mechanisms used by individual are regression, projection, 1
withdrawal and denial. There are four A’s to acknowledge in having schizophrenia, first, the associative looseness, the blunted affect, ambivalence and the autistic thinking. Paranoid schizophrenia is the most common type of schizophrenia in most parts of the world. The clinical picture is dominated by relatively stable, often paranoid, delusions usually accompanied by hallucinations particular auditory variety, and perceptual alterations. Disturbances of affect, volition and speech, and catatonic symptoms are not prominent. Paranoid Schizophrenia is manifested primarily through impaired thought processes, in which the central focus is on distorted perceptions or paranoid behavior and thinking. Delusions are in most cases grandiose, persecutory or both. (WHO 2005) With paranoid schizophrenia, the ability to think and function in daily life is better compare with other types of schizophrenia. It may not have as many problems with memory, concentration or dull emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many complications, including suicidal behavior. Those individuals who diagnosed with paranoid schizophrenia are not especially prone to violence; often prefer to be alone. Studies show that if people have no record of criminal violence prior to develop schizophrenia and are not substance abusers, then they are unlikely to commit crimes after they become ill. Most violent crimes are not committed by people with paranoid schizophrenia, and most people with schizophrenia do not commit violent crimes. Substance abuse always increases violent behavior, whether or not the person has schizophrenia.
If someone with paranoid schizophrenia becomes violent, their violence is most often directed at family members and takes place at home. These individuals may spend an extraordinary amount of time thinking about ways to protect themselves from their persecutors. 2
In the US paranoid schizophrenia reports issued by Centers for Disease Control and Prevention (CDC) for 2000 revealed 121,000 diagnoses of paranoid schizophrenia in nonFederal, short-stay hospitals (73,000 men and 47,000 women). Most individuals (62,000) were between the ages of 15 and 44; none were under age 15; 37,000 were between 45 and 64; and 21,000 were 65 or older. According to geographic distribution, the highest prevalence is in the South and Northeast regions of the US with the lowest prevalence in the West and Midwest are almost equal. (Medical Disability Advisor, 2010)
The onset of the disorder is usually later than catatonic or disorganized schizophrenia. Men have earlier onset, and more frequent than women. Women have a bimodal onset with peaks in their 20’s and early 40’s. One study demonstrated within subtype age of institutionalization gender differences only for paranoid schizophrenia (Salokangas et al., 2003).
The present etiology of the paranoid schizophrenia are the following, genetics it is known because people believed that mental disorder can be inherit. Other causes are decreased dopamine, stress, alcohol abuse and substance abuse.
Prognosis of the disease is good when there is no familial history of the disease, the patient has good social and professional adjustment prior to onset of symptoms, if the disease come suddenly and the disorder is treated early, quickly, consistently. And onset symptoms occur at later years of life and there is an absence of symptoms between psychotic episodes. Paranoid schizophrenia is usually treated with a combination of therapies, tailored to the individual's symptoms and needs. Anti-psychotic medications can reduce hallucinations and disordered thinking, but do not affect the social withdrawal that is common among those 2
with paranoid schizophrenia. Failure to take medication even during remission periods can result in a relapse. Psychotherapy is used to address the emotional and social issues that result from paranoid schizophrenia. Group therapy can be especially helpful, because it creates opportunities for socialization for individuals with paranoid schizophrenia.
The reason of choosing paranoid schizophrenia as study is to add knowledge, and to know different contributing factors in developing the said illness. Perhaps to correct the misconception of not all people who have mental illness are violent and dangerous. While this may be true in some cases, the generalization has been made far too widely. These attitudes contribute to a significant amount of prejudice against the mentally ill, which may prevent people from seeking help. Stigma may also affect people’s recovery, contributing to low self-esteem and decreased social contact. In contrast to physical health issues, most people in our community avoid even discussing the subject of mental illness, dancing around the issue in the shadow of these pervasive misconceptions. Moreover, the preferred client had a superficial manifestations which seen directly to the clients experiencing the said mental illness. And the client was cooperative and provided primary information that we needed in conducting this study. III.
Personal Data
Name:
J.M
Age:
44
Sex:
Male
Citizenship:
Filipino
Civil Status:
Separated 2
Religion:
Roman Catholic
Place of Birth:
Sampaloc, Manila
Date of Birth:
September 3, 1966
Address:
#42 Pag-asa Orion, Bataan
Occupation prior to admission:
Police in Bureau of Custom
Education:
Vocational Graduate
Date and time of admission:
November 20, 2007 / 2:00 pm
Previous admissions:
November 2, 1989- December 18, 1991 December 15, 1992 – December 18, 1992 December 11, 1195- August 31, 1996 August 23, 1997- June 21, 1998 January, 1999- February 25, 2000 February 28, 2000- January 12, 2004 May 29, 2004- September 19, 2007
Admitting Diagnosis:
Paranoid Schizophrenia
Attending Physician:
Dr. Cortez
Place where he spent the last 15 years of his life: (1990’s)Manila, Lubao, Bataan; (2005-Aug2010)America; (August 2010-present)MMH
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Informant:
IV.
JM’s cousin
CHIEF COMPLAINTS
Mang JM admitted on November 20, 2007 due to ff: •
“Maraming J.M, patay na yung galing dito.”- Mang J.M
•
Positive delusions
•
Refused to medications
•
Neglected hygiene
•
Talking aloud
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May 29, 2004 •
Refused to medications “Lason daw ang gamot”
•
Refused check- ups
•
Threatening his mother
•
Escape
•
Alcohol intake
February 28, 2000 •
Talkative pressure speech
•
Denial, auditory hallucination
•
Evasive and manipulative
•
Refused to medication
•
Smoked and drinks alcohol
•
Started fights and walking
January 19, 1999 •
Denied presenting complaints
•
Oriented to place
•
Had positive persecutory as he said “ Hinampas ako ng tubo kahit nagbibigay ako ng pera sa kanila”
•
Impaired sleep
•
Nagmumura, mainitin ang ulo
•
Nagbabanta
August 23, 1997 •
Morbid ideas “ Gusto ko na sanang mamatay kahit sinong pumatay walang kasalanan” 1
December 11, 1995 •
Refused to oral medications
•
Suspicious and jealous to his wife and relative
•
Impaired sleep
•
Violent tendency when in influenced of marijuana
December 15, 1992 •
Impaired sleep
•
“Namumulot ng basura”
•
Denies auditory hallucination and tangentiality
•
Homicidal and suicidal
•
“Kung saan-saan humihiga”
November 2, 1989 •
Nagwawala ( kung ano maisapan gawin gagawin, nambabato, hindi nakakakilala at seloso)
•
Impaired sleep
•
Talking to self
•
20 months ago J.M claimed “Hindi na ko magmamaneho, magpapahinga muna ko”
•
Agitated
•
Nervous- as if afraid of something
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HEALTH HISTORY
II.
Health History a. Past Health History (From the chart and JM) According to Mang J.M’s chart he was first admitted in Mariveles Mental Hospital on November 2, 1989, when his cousin who lived in Orion, Bataan took him in the MMH for checked –up because as he noticed, Mang J.M seemed agitated, nervous and afraid of something for approximately 20 months after the incidence of hitting an old man in the highway while he was a jeepney driver. Upon arriving at home Mang J.M said that “Hindi na ko magmamaneho, magpapahinga muna ako.”After his consultation, he was advised for the confinement. The manifestations
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became persisted. He had chief complaints of having impaired sleep, talking to self, became aggressive and violent (nagwawala, kung ano maisipan gagawin, nambabato, hindi nakakakilala, at seloso). Mang J.M consumed 1 pack of cigarette per day and drinks 2 bottles of red horse and san Mig light. Based on the reported cues of his cousin, Mang J.M was then diagnosed of having bipolar manic and alcohol abuse by his attending psychiatrist, Dr. Rivera. During his confinements, he took medications such as Haloperidol 5mg, Chlorpromazine 500mg, Risperdal ½ tablet, Roziman 50 mg, Diperidem HCL, Valporic acid 500mg, Levomeprazine 100 mg, Tusperidone1/2 tab, Bepeoden 1tab 20mg. These various type of drugs are psychotropic medications which being used in the treatment of mental illness. After his first discharged on December 18, 1991, Mang J.M did not have a follow up consultation in MMH because he refused to. His relatives brought him at NCMH to have his first check-up on April 1992 and noted that there was no follow up due to Mang J.M refusal. Mang J.M was brought in MMH on December 15, 1992. He had complaints of impaired sleep, “namumulot ng basura at kung saan- saan nahihiga”, denies auditory hallucination and tangentiality, having escape, homicidal and suicidal. After 3 days observation at ACIS he was discharge on December 18, 1992. On March 4, 1993, Mang J.M applied as a trainee messenger at Binondo, Manila. He smoke heavily and suspected use of marijuana with unspecified amount and frequency. On December 11, 1995, according to his chart, he was admitted in MMH again because he had impaired sleep and became jealous and made suspicion on his
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wife-- he thought that his uncle was having affair with his wife at the point that he saw the two having sex in their home, and started refusal in taking oral medications. Mang J.M did not comply with his drug regimen. He appeared that he was having violent tendency when he was influenced of marijuana as recorded on his chart, but he continues to deny. He claimed that he never used marijuana because it causes skin diseases. On, January 1, 1996 Mang J.M was placed on isolation by 15 days because he became violent and aggressive, according to his chart. And he attempted escape on May 28, 1996. Like on his previous admission, he recovered and was discharged on Aug 31, 1996. Mang J.M had a morbid ideas about his death, where he claimed that “gusto ko na sana ng mamatay, kahit sinong pumatay walang kasalanan.” This was the complaint on his admission on August 23, 1997. On June 21, 1998, Mang J.M had his home visit and went back in MMH afterwards. January 19, 1999 when he returned in MMH, Mang J.M denied presenting complaints, oriented to place, had positive persecutory delusions as he said “hinampas ako ng tubo, kahit nag bibigay ako ng pera sa kanila.” But there were no evidence of physical injury upon assessment. Also, he had complaints of having impaired sleep, “nagbabanta”, “mainitin ang ulo”, at “nagmumura.” After a year, on February 25, 2000 he was discharged. At home, Mang J.M started to become talkative and having pressured speech. He used to deny when he was asked. He had auditory hallucination, become manipulative and evasive. Mang J.M regains his vices and did not take his medications. He smoked and drinks alcohol heavily. Also, he walks endlessly and started fights. Due to reported behaviors of Mang J.M, he was placed back in MMH on February 28, 2000; he claimed that his 2
mother did not provide his medications upon interview. Mang J.M was admitted thereafter. He was forced to take his medications to treat the displayed manifestations. Mang J.M escaped in the hospital on December 25, 2000, but after several days on January 2, 2001 he returned by his relatives. He was discharged on January 12, 2004. After four months, Mang J.M was readmitted on May 29, 2004 because he refused to take medications and claimed “lason ang gamot”, he done physical abuse to his mother and threatened her. Mang J.M refused for check-ups, continues to drink alcohol and escapes. These are the following complaints why he returned in MMH. But on September 7, 2007 he was allowed for home conduction and discharged on September 19, 2007. He had conversation last October of the same year and according to his chart Mang J.M used to smoke and suddenly punch a neighbor. Later, Mang J.M refused to medications and had an impaired sleep. In contrary, Mang J.M said that he was just admitted last year and will be discharged on the 3rd of February 2011.In fact he was 4 yrs at MMH since his recent admission on November 20, 2007. According to him he was admitted in MMH not because he was a mentally ill, but because his mother wants to keep him away from the persons who wanted to steal his wealth and killed him after. b. Present Health History Mang J.M was been in MMH since his latest admission on November 20, 2007, around 2:00 pm with the diagnosis of paranoid schizophrenia by his attending psychiatrist, Dr. Cortez. He was placed at male ward B. According to his chart, Mang J.M’s chief complaints was having delusions and saying “Maraming J.M, patay na
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yung galing dito”, refused to medications, neglected hygiene, irritable and talking aloud. He was given Haloperidol 5mg 1amp, and Chlorpromazine 500mg tablet take at bedtime. These are psychotherapeutic drugs used by Mang J.M for the treatment of the disorder.
In addition, Mang J.M had alterations in thought process, thinking and communication, in perceiving and interpreting, in behaving and interpreting Mang J.M manifested illusions, delusions, grandiosity, hyperactive and withdrawal.
During the orientation, Mang J.M showed good cooperation with the SNs he was very eager to talk then suddenly jumped into another topic and discuss unrelated matters. He said that he was single and a very rich man and owned not only houses, but mansions. Mang J.M is always oriented to person, date, time and place.
Mang J.M refused on the grooming sessions in the first two weeks and done grooming on the last week but only brushing of his teeth. Mang J.M wears a wrinkled white shirt paired with abstract designed short until the last week, during Grand socialization he puts on the uniform of MMH as his topped.
On the therapies, he was cooperative and active participant. He used to talk a lot and listen attentively. Mang J.M’s laughed when his fellows provided wrong answers and made his judgments afterwards. During the nurse- client interaction he said that the persons around would kill him, and he added that he was just kidding. In addition, Mang J.M told that they are making a big swimming pool on the side of ACIS (MMH), he was a very rich man and owned the international corporation of san
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Miguel,he denied used of illegal drugs but admitted that he drinks alcohol and until now he used to smoke.
Moreover, according to Mang J.M, he had his own planet where exactly looked like earth. He described that there are living things such as cow, carabao, plants and people. He added that there is a big TV screen where he saw individuals like his two student nurses together with their loved ones and also our clinical instructor. Mang J.M named a thing which is “aparachi”. This thing was a peanut shape like, covered with gold and brings out everything that people need, as he explained. He also said that he had a conversation with the former president of USA, George Washington.
Lastly, Mang J.M appeared always hyperactive and talked about different killings. In contrast he claimed that he was good and did not bring any harm to others. He used to be keen listener and observer, Mang J.M knew when the questions are being change but with the same thoughts. He also used various defense mechanisms such as denial, projection and others. Moreover, Mang J.M manifested grandiosity, illusions, and delusions. c. Family history According to Mang J.M., they were four and he was 2 nd to the eldest in his family. His father died when he was 6 years old due to heart attack while her mother was still alive. They were raised and sent in good school by his mother, who was a dress maker. His three siblings have their own family and lived separately while Mang J.M remained single, which is contrary to the chart because his marital status is married and became separated to unnamed woman and they have no child.
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Also, he said that he had no known history of having mental illness in the family. Same in the chart, there were no reports that somebody in their family suffered from the same condition. d. Social History
i.
Childhood
Mang J. M told that he was born on September 3, 1966, in Sampaloc, Manila. He grew together with his family, but his father was died when he 6 years old. His mother raised them and sent to school. Mang J.M during his childhood, he once been like the other children, he played all day and love vacations. He was sent in Lubao, Pampanga every school break with his siblings and lived with his grandmother. His mother decided to bring him in schooling at Lubao Elementary School when he was 8 years old. Mang J.M was then separated from his mother and siblings as well, though he told that it was sad at first. But he was used to it because this was not usual to him. By this time, he lived in Lubao in longer time. He joined his grandmother at home, helped her in chores and taking good care of the cows in their farm, as he added. During his free time according to Mang J.M, he played with their neighbors. Those routines ended when he came back in Manila to continue his study for high school. ii.
Adolescence
He entered high school at St. Jude College. According to him he was an active student. He joined competitions and different events whereas dancing and singing was his forte. He was been an officer in CAT during his time. Mang J.M also had peers, and he joined fraternity when he was 2nd year high school. He said that those persons were good. They had bonding all the time and accompanied him through his ups and downs.
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During his high school life, Mang J.M learned to smoke and drinks alcohol together with his friends. He added that he consumed at least two bottles of each San Mig Light and Red Horse and 1 pack of cigarettes per day. In addition, he also met his first girl friend which is CD during intramurals in their school, as he claimed that they last for almost six years. They were enjoying each others’ company, when there was a time that he experienced his first heartache because his girl friend went with other man. Mang J.M felt loneliness and depression. But he added that he easily coped up because he found a new love with EI. Like the first relationship it has to end.It last for one year and they totally separated because of the reason that he moved in Bataan to talk with his godfather about abroad and EI went to Pangasinan. Moreover, he experienced those heartaches during his college years and according to Mang J.M he easily coped to those matters. In contrary, he said that he and CD were cool off and still in touch with each other.He claimed again that he entered MAPUA for his course police authority which is contrasting to his chart which showed that he finished vocational course.He admitted that he continued smoking and drinking alcohol, and denied use of illegal drugs. iii.
Adulthood Mang J.M claimed that he went in US after his graduation in college from the
year 2000 up to 2005. He became a Navy in US as he claimed. His habits were smoking, drinking alcohol, bar hopping but denied having sexual intercourse neither got married. Mang J.M said that he could drink two bottles of each San Mig Light and Red Horse because it was less expensive, consumed 1 packed of cigarettes per day, but consistently denies used of illegal drugs like marijuana.
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After Mang J.M came back from US, he became a driver in Orion, Bataan and worked in Bureau of Customs where he was a police authority as he said. He spent his life in Manila, and Orion where he went fishing; making his vices and lived there for several years. According to Mang J.M, he also spends his life inside MMH as his record showed he was started to admit since1989. But he claimed that this was his first admission yet he claimed that he returned to work after his previous discharged.
a. Sexual History Based on his chart he was separated which he continues to deny. He always says that he was single for the longest time and he claimed that giving roses to someone was a burden.
Also, he admitted that he had previous relationships. He added that they were happy having each other’s company, he admitted that he did kissing and touching private parts of his previous girlfriend’s body as their mutual willingness. But not involved in sexual intercourse as he added.
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UNIT II (Mental Status Assessment) 2
MENTAL STATUS ASSESSMENT
Name :
Mang JM
Age
44 years old
:
Ward :
Male Ward A
Day 1 Person Place Date Time Situation
O RI E N T A TI O N
Day 2 S E L FA W A R E N E S S
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
ORIENTATION
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Legend:
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation Day 2: Self awareness Day 3 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. SN: “Ano pong pangalan niyo?” C: “JM.” SN: “Alam niyo po ba kung nasaan po tayo ngayon?” C: “Oo, nasa mental nagpapagaling.” SN: “Ano pong petsa ngayon Mang JM?” C: “Ngayon ay Friday January 14, 2011.” According to Nightingale, changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. Day 4 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. SN: “Ano po pangalan niyo?” 2
C: “JM.” SN: “Alam niyo po ba kung nasaan po tayo ngayon?” C: “Oo sa mental nagpapagaling.” SN: “Ano pong petse ngayon Mang JM?” C: “Ngayon ay Miyerkules January 19, 2011, umaga.” According to Sigmund Freud there is a part of the mind called preconscious, thought and emotions are not currently in the person’s awareness, but he can recall them with some effort
Day 5 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. SN: “Ano po pangalan niyo?” C: “JM.” SN: “Alam niyo po ba kung nasaan po tayo ngayon?” C: “Oo sa mental” SN: “Ano pong petse ngayon Mang JM?” C: “Ngayon ay Huwebes ng umaga January 20, 2011.”
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As mentioned on Helson’s Theory, adaptation is a process of responding positively to environmental changes. Mang JM adapts effectively as he was able to identify the changes in her environment and positively responds to it.
Day 6 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. SN: “Ano po pangalan niyo?” C: “JM.” SN: “Alam niyo po ba kung nasaan po tayo ngayon?” C: “Oo dito Mariveles sa mental.” SN: “Ano pong petse ngayon Mang JM?” C: “Ngayon ay Biyernes ng umaga January 21, 2011.” According to Nightingale, changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. Day 7 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. SN: “Ano po pangalan niyo?” C: “JM.” SN: “Alam niyo po ba kung nasaan po tayo ngayon?”
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C: “Oo sa mental nagpapagaling.” SN: “Ano pong petse ngayon Mang JM?” C: “Ngayon ay Miyerkules ng tanghali February 2, 2011. According to Roy, awareness of self and environment is rooted in thinking and feeling. Mang JM was aware of his environment. Day 8 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. SN: “Ano po pangalan niyo?” C: “JM.” SN: “Nasaan po ba tayo ngayon Mang JM?” C: “Dito sa mariveles.” SN: “Eh! Anu po bang araw ngayon?” C: “Huwebes, Thursday February 3, 2011.” SN: “Alam niyo po ba ang gagawin natin ngayon?” C: “Sasayaw tayo ngayon.” According to Nightingale, changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. Day 9 No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted. 1
SN: “Ano po pangalan niyo?” C: “JM.” SN: “Nasaan po ba tayo ngayon?” C: “Dito sa pantry, sa mariveles.” SN: “Alam niyo po ba ang gagawin natin ngayon?” C: “Grand Socialization.” SN: “Anu po bang araw ngayon?” C: “Friday, February 4, 2011.” According to Nightingale, changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.
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DEFENSE MECHANISMS: Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
k. Projection
l. Rationalization
m. Sublimation
n. Substitution
o. Symbolism
p. Undoing
a. Repression b. Suppression c. Regression d. Fixation e. Denial f. Displacement g. Conversion h. Identification i. Intellectual j. Introjections
Day 1 O R I E N T A T I O N
Day 2 S E L F A W A R E N E S S
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q. Reaction Formation
r. Fantasy
Legend:
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation: Day 1: Orientation Day 2: Self awareness Day 3 Mang JM manifest one of the defense mechanism; Rationalization we noticed that he always justify his answer. He also manifest Denial as he said “Hindi man ako malakas uminom paminsan minsan lang.” and Projection during our conversation when we asked him “Malakas po ba kayo iinum ng alak Mang JM?” he said “Hindi ah!mahina ako iinum eh, siguro ikaw malaks kang iinom noh?” According to Roger, the human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts. Day 4 Mang JM manifest one of the defense mechanism; Fantasy we noticed that he always says he was close to George Washington because he once went to United States of America and met together and became friends. Maybe he wants us to be amazed of him. SN: “Umano po kayo sa America Mang JM?” C: “Wala may bahay kami doon, kakilala ako nun ni George Washington.”
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According to Johnson, Each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.
Day 5 We don’t recognize any defense mechanism. Day 6 Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, we noticed that he’s angry but he denies it obviously he is because of the tone of his voice and through his gestures my slapping his legs. He smiled unnaturally. SN: “Nagagalit po ba kayo Mang JM.” C: “Hindi ako galit.” SN: “Oh, ngiti nap o kayo.” C: (Smiled but looks uncomfortable) According to Roger, the human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts. Day 7 Mang JM manifest one of the defense mechanism; Projection he often projects situations to us. SN: “Mang JM, ngayon pong malapit na ang valentines may plano po ba kayong pagbigyan ng flowers?
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C: “Wala pa nga eh, hirap kasi baka may boyfriend na o may asawa na ang babae eh.”
SN: “Anu pong dahilan at nasabi niyong mahirap?
C: “wala naman, ikaw marami ka ng napagbigyan ng rosas noh?” In erik erikson’s psychosocial theory, in infant stage, the infant must learn to develop basic trust that she will be fed and taken care of, mistrust, the negative outcome of this stage will impair the person’s development throughout her life.
Day 8 Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, he denies that he’s not ever try a drugs/ marijuana, reaction formation because he said that he’s a good boy. SN: “Mang JM nakapagtry nap o ba kayo ng Drugs?” C: “Hindi hindi ako gumagamit ng ganon.” SN: “Ano pong dahilan?” C: “Hindi, bawal yun samin mabait ako, hindi ako nangaaway, hindi ako nagdaDrugs, mabait ako.” According to Roger, the human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts. Day 9 1
Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, Mang JM denies use of drugs/ marijuana, reaction formation because he said that its not good for our body. SN: “Anu po ba ang feeling kapag naka-drugs?” C: “Ay hindi, hindi ako gumagamit ng ganon.” SN: “Anu pong dahilan?” C: “Eh! Bawal kasi samin yun, tsaka nakita mu ba yung iba may mga galis galis dahil sa drugs yun.” SN: “Talaga po Mang JM?” C: “Oo, maniwala kayo masama sa katawan yun, mabait ako.” According to Roger, the human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts.
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EXTRAPYRAMIDAL SYMPTOMS: Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
1. Muscle, spasm of jaw, tongue, neck, eyes
2. Laryngeal spasm
Pseudoparkinsonism 1. Masklike face 2. No swinging of arms 3. Hesitancy of speech 4. Decreased muscle strength 5. Shuffling gait 6. Drooling 7. Fine intention tremors
Day 1 O RI E N T A TI O N
Day 2 S E L FA W A R E N E SS
Acute Dystonic Reaction
1
Akathisia 1. Restlessness
2. Tenseness
3. Inability to sit still
4. Rocking back and forth of feet
5. Crossing leg frequently
6. Inability to relax Tardive Dyskinesia 1. Involuntary movements of mouth, face, may extend to fingers, arms and trunk Legend:
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation Day 2: Self awareness Day 3 Our client displayed EPS under akathisia, during conversation we observed that Mang JM crossing leg frequently and inability to relax by rocking back and forth on feet and appears restlessness. In Orem’s self care model, the nurse should help the client by doing pharmacotherapy to manage their movement because according to Orem, the nurse provides assistance to those who are unable to meet self care needs. The
1
nurse is required therapeutic care to the client with self care deficits until the person can care for herself. Day 4 Our client displayed EPS under akathisia, during our therapy we noticed that Mang JM crossing leg frequently that manifest all through our conversation. According to Henderson, unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will, or knowledge.
Day 5 Our client displayed EPS under akathisia, during our therapy we noticed that Mang JM crossing leg frequently that manifest all through our conversation. According to Ida Jean Orlando’s nursing process theory, she assumes that freedom from mental or physical discomfort and feeling of adequacy and well being contribute to health. Day 6 Our client displayed EPS under akathisia, during our therapy we noticed that Mang JM crossing leg frequently that manifest all through our conversation. According to Henderson, unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or
2
its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. Day 7 Our client displayed EPS under akathisia, during our therapy we noticed that Mang JM crossing leg frequently that manifest all through our conversation. According to Orem’s self care deficit theory, it describes why a person needs self care but in the presence of illness, there was a deviation. Day 8 Our client displayed EPS under akathisia, during our conversation we noticed that Mang JM crossing leg frequently. According to Henderson, unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. Day 9 Our client displayed EPS under akathisia, during our grand socialization we noticed that Mang JM crossing leg frequently that manifest all through our conversation. According to Henderson, unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge.
2
THINKING AND COMMUNICATION: Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Word salad
Echolalia
Echopraxia
Aphasia
Apraxia
Agnosia
Flight of ideas
Looseness of Association Neologism
Clang Association Illogical thinking Alogia Concrete thinking Lack of insight
Legend:
ORI ENT ATI ON
SEL FAW ARE NES S
- manifested by Mang JM - not manifested by Mang JM 1
Analysis and Interpretation:
Day 1: Orientation Day 2: Self awareness Day 3 Our client displayed looseness of association, these are neologism and echolalia. He mentioned the word “wisboro” which do not have meaning and repeating the questions we asked. According to King, Each individual brings a different set of values, ideas, attitudes, perceptions to exchange. Day 4 Our client displayed looseness of association, these are neologism and echolalia. He mentioned the word “aparachi” which do not have meaning and echolalia such as the shoemaker, the shoemaker which he unconsciously saying. Our client also manifested concrete thinking of flight of ideas. According to King, Each individual brings a different set of values, ideas, attitudes, perceptions to exchange. Day 5 During the interview our client displayed lack of insight because sometimes he’s saying something which has no sense or even relation on the topic and flight of ideas. SN: “Anu po bang ginagawa niyo doon?” 3
C: “Nagtatrabaho, Nagbabantay ng bagahe, tapos may nahuhuli din akong isda noon.” According to jean piaget’s stage of preoperational thought (2-7 yrs.). In this stage, thinking and reasoning are intuitive, children learn without the use of reasoning. Day 6 During the interview our client displayed looseness of association, these is neologism. He mentioned the word “aparachi” which do not have meaning. SN: “Anu po bang ginagawa niyo doon?” C: “Nagbabantay ako dun, tas dun yung aparachi.” SN: “Anu po yung aparachi?” C: “ gold yun, kung saan may lualabas na kalabaw, truck at kung anu ano pa.” According to King, Each individual brings a different set of values, ideas, attitudes, perceptions to exchange. Day 7 There were no alteration of Mang JM’s thinking and communication. Day 8 During the interview our client displayed flight of ideas because Mang JM introduces new topic without completing the topic. SN: “ Ano pa po ba yung gingawa niyo doon?” C: “wala naman nagbabantay, tignan mo yun oh mangga.” Piaget viewed intelligence as an extension of biological adaptation that has a logical structure. Every stage occurs at a certain age, and children show a 1
higher level of thought organization during each successive stage of development. Day 9 There were no alteration of Mang JM’s thinking and communication.
PERCEIVING AND INTERPRETING: Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
1. Reference
2. Persecution
Attending to irrelevant stimuli
Poor reality testing
Delusion
3. External influence 4. Somatic 5. Grandiose Hallucination Illusion Depersonalization Attending to relevant stimuli Poor reality testing
Legend:
O RI E N T A TI O N
S E L FA W A R E N E SS
- manifested by Mang JM - not manifested by Mang JM
2
Analysis and Interpretation:
Day 1: Orientation Day 2: Self- awareness Day 3 There was no alteration noted on Mang JM’s perceiving and interpretation.
Day 4 There is an alteration on perceiving and thinking; Persecution Delusion by saying “if you want to kill me just tell me” and Grandiose Delusions by saying he is very rich. He also manifests illusion by saying that the clouds near on the mountain are smoke cause by burn. According to Neuman, maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli. Day 5 There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by saying “madami diyan sa paligid mamamatay tao” and Grandiose Delusion by saying “marami kaming pera, nung minsan nagpunta dito yung mga truck namin ng pera”. He also manifests illusion by saying “doon sa ACIS may swimming pool kaming pinagawa diyan.”
2
According to psychodynamic theory of Sigmund freud , this perceptual motor syndrome is developing from a person with psychic alterations. In addition, these alterations are contingent on the poor caregiving that is provided within the environment. Day 6 There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by saying “dito lang tayo ah, wag kayo lalabas may mga mamamatay tao doon.” And Grandiose Delusion by saying “Oo maniwala ka sakinkami nagpagawa ng mga building na yun.” He also manifests illusion by saying “nakita mo na aba yung swiiming pool sa may ACIS?” According to Neuman, maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli. Day 7 There is no alteration on perceiving and thinking, manifest Grandiose Delusion by saying “Oo, meron kaming mansion dito sa Mariveles.” Day 8 There is no alteration on perceiving and thinking, manifest Grandiose Delusion by saying “Marami nga kaming mga sasakyan eh! Tsaka Pajero.” According to King, human beings are open systems in constant interaction with the environment. Day 9
1
There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by saying “tinago ako ni mommyko kasi maraming pumapatay diyan eh!” he also manifest Grandiose Delusion by saying “marami ako pera, totoo yun.” According to Neuman, maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli.
FEELING AND AFFECT:
Flat Blunted Inappropriate Lability
Legend:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
O RI EN TA TI O N
SE LF A W A RE NE SS
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation
1
Day 2: Self awareness Day 3 No unusual finding because client displays appropriate feeling and affect now. Day 4 Our client manifest labile mood during our therapy he suddenly laughing for no reason then suddenly back to serious mode. According to Lazarrus (1982) he consider affect to be post-cognitive that is, affect is thought to be elicited only after a certain amount of cognitive processing of information has been accomplished
Day 5 Our client manifest blunted affect during our conversation, there is delay on our communication. According to Parses human becoming theory, the client determines whether to show own affect/ feelings or not.
Day 6 Our client manifest blunted affect during our conversation, there is delay on our communication and labile mood during our conversation he got irritable C: “ayaw mo naming maniwala sakin eh!” (Slapped on his legs). He also manifests inappropriate affect. SN: “nagagalit po ba kayo?” C: “hindi ako galit” (Smiled unnaturally) but his voice seems angry. 3
According to Johnson, Each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual. Day 7 No unusual findings because client displays appropriate feeling and affect now.
Day 8 Our client manifest blunted affect during our conversation, there is delay on our communication. He also manifest labile mood because during the therapy Mang JM suddenly keeps quiet and then he smiled again. Based on Watson’s curative factors , we must promote and accept expression of the client either it is positive or negative feelings and emotions. Day 9 No unusual findings because client displays appropriate feeling and affect now.
1
BEHAVING AND INTERACTING: Day 1
Day 2
Withdrawal Motor hyperactivity Motor hypoactivity Ambivalence Anhedonia Avolition Poor personal hygiene Impulsive Paranoia
Legend:
O RI E N T A TI O N
SE LF A W A R E N ES S
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation Day 2: Self awareness
1
Day 3 The behavior pattern of our client is predictable but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his nails were dirty. According to Abdellah, she identified 21 problems and one of this is to maintain personal hygiene. Day 4 Our client manifests motor hyperactivity because of his mood, overexcitement to express his feelings. We also noticed that he has poor personal hygiene and he had dark teeth that leads to bad breath and his clothes smelled. According to Freud, conscious mind is where we are paying attention at the moment. Our way of thinking affects our attitude on how we are going to react in a certain situation. Day 5 The behavior pattern of our client is predictable. But we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath his clothes smelled and his nails were dirty. According to Orem’s self care deficit, the client can’t able to perform self care because of the presence of mental pathology. Day 6 The behavior pattern of our client is predictable, but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled. According to Abdellah, she identified 21 problems and one of this is to maintain personal hygiene. 1
Day 7 The behavior pattern of our client is predictable, but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled. According to Abdellah, she identified 21 problems and one of this is to maintain personal hygiene. Day 8 The behavior pattern of our client is predictable, but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled. According to Orem’s self care deficit, the client can’t able to perform self care because of the presence of mental pathology Day 9 The behavior pattern of our client is predictable, but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled. According to Abdellah, she identified 21 problems and one of this is to maintain personal hygiene.
2
NEGATIVE COGNITION:
Day 1 Overgeneralization All-or-nothing thinking Should statement Labeling Middle reading Fortune telling Legend:
O RI E N T A TI O N
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
SE LF A W A RE NE SS
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation Day 2: Self awareness Day 3 No alteration noted on Mang JM’s negative cognition.
1
As mentioned by Abdellah, a nurse should continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting her behavior in order to identify the client’s problem.
Day 4 No alteration noted on Mang JM’s negative cognition. Day 5 No alteration noted on Mang JM’s negative cognition.
Day 6 No alteration noted on Mang JM’s negative cognition. Day 7 No alteration noted on Mang JM’s negative cognition. Day 8 No alteration noted on Mang JM’s negative cognition. Day 9 No alteration noted on Mang JM’s negative cognition.
1
OTHERS: Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
4. Immediate memory (short term)
5. Immediate recall
Amnesia Fugue Depersonalization Phobias Memory 1. Remote (long term) 2. Recent (early am) 3. Recent part (current events)
Legend:
O RI E N T A TI O N
S E L FA W A R E N E SS
- manifested by Mang JM - not manifested by Mang JM
Analysis and Interpretation:
Day 1: Orientation Day 2: Self awareness Day 3
1
During our conversation with our client he had a remote memory because he was able to determine his last 15 years of his life. He also remembered the food he eaten in the morning and knows who the president of the Philippines is. He had also recalled us during our conversation. According to Parse, Man’s reality is given meaning through lived experiences Day 4 Our client had remote memory because he remembered he went to America last 2005, he also remembered his breakfast and knows who the president of the Philippines by saying the name of Pres. Benigno Aquino. He also recognizes our name. According from psychoanalytic theory of Freud, the mind can be divided into main parts; the conscious mind includes everything that we are aware. A part of this includes our memory which is not always part of consciousness but can be retrieved easily at any time and brought into our awareness. Day 5 Our client had remote memory because he remembered the things he did in the last 15 years of his life. SN: “anu pong ginagawa niyo sa huling 15 taon ng buhay niyo?”. C: “ mangingisda.” He also recalled the food he was eaten in the morning. SN: “ano po bang kinain niyo kanina?”. C: “lugaw, nabusog nga ako eh.”
.
2
He also knows the President of the Philippines by saying the name of Pres. Benigno Aquino. He also recalled us during our conversation. According to Parse, Man’s reality is given meaning through lived experiences Day 6 Our client had remote memory because he remembered the things he did in the last 15 years of his life y saying “nangingisda ako noon.” He also remembered we did yesterday by saying “nagbingo tayo at nanalo akong 2 beses.” He also knows who the president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls us during our conversation. According to Freud, preconscious thoughts and emotions are not currently in the person’s awareness, but she can recall them with some effort. Day 7 Our client had remote memory because he remembered the things he did in the last 15 years of his life y saying “yung nanay ko nagtatahi ng magagandang damit.” He also remembered we did last last week by saying “nagbingo, nanalo ng 2 beses at nagpakita ng mga pictures tulad ng doctor, urse etc. He also knows who the president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalled we did before they go back in their ward. SN: “anu- ano nga po pala uli ginawa natin kanina?” C: “food festival”. According to Parse, Man’s reality is given meaning through lived experiences
1
Day 8 Our client had remote memory because he remembered the things he did in the last 15 years of his life, he also remembered things we’ve done yesterday and ingredients of our food by saying “food festival, yung mga sangkap ay gulaman, buko at cream.”, he also know president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls activity we did before they go back in their ward by saying “Oo sumayaw tayo kanina na gagawin natin bukas.” According to Freud, the preconscious system is composed of those mental events, processes and contents capable of being brought into conscious awareness by the act of focusing attention. Day 9 Our client had remote memory because he remembered the reason why he is admitted here in MMH in the year 1989 by saying “Sinave ako ni mama dun sa mga taong mangunguha, tsaka hindi ako magkatulog.” He also remembered the steps we practice yesterday. He also recalls us. According to Parse, Man’s reality is given meaning through lived experiences.
1
UNIT III (Psychopathophysiology and Related Literatures)
3
PSYCHOPATHOPHYSIOLOGY
Substance abuse
3
(Marijuana, 2 bottles of alcohol. 1 pack cigarette per day)
Affect the normal function of the brain system
Neurologic disturbances
Altered thought process
Looseness of ability in thinking and perceiving responses
Illusions
Delusion
Grandiose
Maladaptation
Violent behavior
Persecutory
Analysis and Interpretation
3
Mang J.M took prohibited drugs as his record showed. But the amount and frequency were not determined. Being a drug abuser, Mang J.M therefore became a drug addict. This is the reason why he had looseness of ability in thinking and perceiving responses because of the effect of the drug in the brain. He had been aggressive to do things whatever he wants; he developed persecutory delusions and grandiosity.
Related Theory
Substance abuse would be describes according to Psychodynamic (Freudian) Theory from a developmental perspectives. Freud believes that vulnerable to substance abuse have powerful dependency needs that can be traced to their early years. They claim that when parents fail to satisfy a young child’s need for nurturance, the child is likely to grow up depending excessively on others for help and comfort, trying to find nurturance that was lacking during their early years. If this search for outside support includes experimentation with a drug, the person may well develop a dependent relationship with the drug which leads to substance abuse.
Maslow said that human beings are motivated by unsatisfied needs and that certain lower need to be satisfied before higher needs can be satisfied. Maslow ties the preoccupation use of drugs and the negative effects which result from alcohol/drug addiction. He says that since addiction is a progressive illness, it destroys a person’s ability to achieve selfactualization, eventually destroying the person’s ability to meet their other needs including self-esteem, physiological need and safety. Inadequate parental guidance (death of father during childhood years and mother still at work)
1
Lack of moral advices and support from the parents
Inability to facilitate moral vs. immoral behavior
Seek help with trusting persons
Dependency Influenced with immoral behaviors
Learned to use prohibited drugs, smoking, and drinking of alcohol
Substance dependency and intolerance (increase amount of substances)
Irrational thinking developed
Violent behavior (hurting his mother, nagwawala, kung ano maisipan gagawin, nambabato )
Analysis and interpretation
1
Due to early death of Mang J.M’s father, his mother needed to work hard to raise them well. This resulting Mang J.M to become dependent and able to seek company of others to fill the lacks of his parents’ assistance during growing years. And he did things that he acquired from such people without thinking if it is good or bad.
Related Theory
According to Duldt-Battey, Bonnie Weaver - Humanistic Nursing Communication Theory, The environment is a “booming, buzzing” world of strange sensations that must be sorted out to determine which are the most important; this sorting is achieved through communication with other people. The need to communicate is an innate imperative for human beings. The purpose of nursing is to intervene to support, to maintain, and to augment the client’s state of health. Maslow's hierarchy explains human behavior in terms of basic requirements for survival and growth. According to theory, when the individual's physiological and safety needs are met, needs for love and belongingness emerge. These needs include longings for an intimate relationship with another person as well as the need to belong to a group and to feel accepted. Maslow emphasized that these needs involve both giving and receiving love.
Peer pressure (Fraternity)
1
Bad influences caused by peers
Learned to use prohibited substance such as Marijuana, alcohol, cigarette
Dependency
Intolerance ( increase amount and dosage)
Irrational thinking
Violent behavior (nagwawala, kung ano maisipan gagawin, nambabato)
Analysis and interpretation
2
Mang J.M was a member of TAU GAMMA fraternity. Within this fraternity, we can conclude that he learned to use prohibited drugs, possible experienced hazing and involved in different troubles though he claimed that he was good and not participated in fights. These may cause him to become a drug abuser and later develop dependency resulting him to become violent.
Related Theory There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system mode there are 4 assumptions of system: First assumption states that there is “organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up The system ” A system “tends to achieve a balance among the various forces operating within and upon it', and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him.”A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man that is to say, it is functionally significant in that it serves a useful purpose, both in social life and for the individual. The final assumption states “system balance reflects adjustments and adaptations that are successful in some way and to some degree.” The integration of these assumptions provides the behavioral system with the pattern of action to form “an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects, events and situations in his environment.
According to Sullivan, individual self identity is built up over the years through his perceptions of how significant people in his environment regard him. According also to Sullivan, people are influenced mostly by their relationship with others.
1
Occupational stress
Traumatic life events
2
Frustration in life
Inability to cope up with life situation
Hopelessness occur
Stress
Disruption in behavior
Depression
Restlessness
Agitation
Analysis and interpretation
Mang J.M had a history of hitting a man during he was a jeepney driver. Due to the incidence he became agitated, always afraid of something and nervous for 20 months that
1
leads to his first confinement. This situation caused him to be always under stress and become restless and agitated
Related Theory Maslow's hierarchy explains human behavior in terms of basic requirements for survival and growth. According to theory, once the individual's basic physical needs are met, his or her needs for safety emerge. These include needs for a sense of security and predictability in the world. The person tries to maintain the conditions that allow him or her to feel safe and avoid danger. Maslow thought that inadequate fulfillment of these needs might explain neurotic behavior and other emotional problems in some people. According to Roy, the person is a bio-psycho-social being. The person is in constant interaction with a changing environment. To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin. To respond positively to environmental changes, the person must adapt. The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.
Poor coping mechanism (Separation from loved ones)
Poor decision making and solving problems
2
Inability to cope- up with the situation
Use of illegal
Stress
Substance, drinks alcohol And smoked cigarettes
change in mood and affect
Substance dependency Anxiety develops Intolerance (increased amount & dose) Irrational thinking
depression
Violent tendency and suicidal Thoughts
Self pity
restlessness
sleeplessness
Isolate self from others
Analysis and interpretation
Mang J.M has been separated from his wife. This situation may be a leading cause why he was under stress that leads in development of anxiety to depression resulting to self pity, restlessness and sleeplessness. On the other hand, it may also, causes Mang J.M to use
1
illegal substances and became dependent that brought him in having violence and suicidal ideation.
Related Literate
According to Travelbee human conditions and life experiences encountered by all men as sufferings, hope, pain and illness. Illness is being unhealthy, but rather explored the human experience of illness. Suffering is a feeling of displeasure which ranges from simple transitory mental, physical or spiritual discomfort to extreme anguish and to those phases beyond anguishes the malignant phase of dispairful “not caring” and apathetic indifference. Pain is not observable. A unique experience. Pain is a lonely experience that is difficult to communicate fully to another individual. Hope is the desire to gain an end or accomplish a goal combined with some degree of expectation that what is desired or sought is attainable. Hopelessness is being devoid of hope. Nursing is an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or illness and suffering, and if necessary to find meaning in these experiences.
According to Henderson individual compose of biological, psychological, sociological, and spiritual components. All external conditions and influences that affect life and development. Nursing assists and supports the individual in life activities and the attainment of independence. Nurse serves to make patient “complete” “whole", or "independent." The nurse is expected to carry out physician’s therapeutic plan Individualized care is the result of the nurse’s creativity in planning for care.
2
2
RELATED LITERATURES
Paranoia Agent, Symptom, Cause, Treatment and Medication of Paranoia Cause of Paranoia 1) Homosexual fixation: According to Freud, the patient suffering from the disease has repressed his tendency to homosexual love to such an extent that he develops a fixation concerning it. Freud's view has been found correct in many cases, but it does not explain each and every case of the disease. 2) Feelings of inferiority: Here the psychologists have found that the main cause of paranoia is a sense of inferiority that may be caused by a variety of condition such as failure, disgust, sense of guilt.
1
3) Emotional complex: Certain psychologist points out emotional complexes, and also believe that they are seen to be present in other mental diseases as also in normal individuals. 4) Personality type: Cameron believes a certain type to be more susceptible to this disease, a personality that has sentimentally, jealousy, suspicion, ambition, selfishness and shyness etc. Patients of paranoia do exhibit these peculiarities of personality but on this basis they cannot be said to belong to definite personality. 5) Heredity: In the opinion of Fisher the main responsibility of paranoia lies fairly and squarely upon heredity, although he does not deny the importance of repression and emotional complexes. The causes of paranoia are not physical because no patient exhibits any signs of physical deformity and among the causes there are many important" ones, such as defects of personality, sense of inferiority, repression etc.
AREA OF THE ARTICLE THAT WE AGREE We agree that people who have feeling of inferiority can significantly affect an individual. These circumstances stressful to an individual and can be cause of schizophrenia.
AREA OF THE ARTICLE THAT WE DISAGREE No disagreement in the article.
SIGNIFICANCE TO US AS A NURSE The literature stated that feelings of inferiority are a cause of paranoid schizophrenia. It means that a individual with poor coping mechanism are prone to schizophrenia. The nurse must can assist the client and help the client to verbalize feelings to overcome such problems. 2
Substance abuse and the onset of schizophrenia Top of Form yes
platform+medline
author
author
Ma rtin Hambrecht, Heinz Häfner Bottom of Form Received 7 August 1995; received in revised form 7 November 1995 Up to 60% of chronic schizophrenic patients are reported to abuse alcohol or drugs. This comorbidity raises the question whether one disorder is a consequence of the other. With the structured interview “IRAOS,” the onset and course of schizophrenia and substance abuse were retrospectively assessed in a representative first-episode sample of 232 schizophrenic patients. Information by relatives validated the patients' reports. Alcohol abuse prior to first admission was found in 24%, drug abuse in 14%—twice the rates in the general population. Alcohol abuse more often followed than preceded the first symptom of schizophrenia. Drug abuse preceded the first symptom in 27.5%, followed it in 37.9%, and emerged within the 2
same month in 34.6% of the cases. The study demonstrates a remarkable association between first-episode schizophrenia and substance abuse, but a unidirectional causality is not supported, nor is a specific psychotic disorder in comorbid cases. Summary of the study The study is all about the substance abuse and the onset of schizophrenia. It is about the possible effects of substance abuse. AREA OF THE ARTICLE WE AGREE The area that we agree upon is that the study is about the possible causes of schizophrenia and its onset. It gave us the knowledge of the effects of substance abuse. It also gave us perspective to the outcome of abusing drugs. AREA OF THE ARTICLE THAT WE DISAGREE No disagreement in the article. SIGNIFICANCE TO US AS A NURSE The significance of the study to us student nurses is that it gave us more insight of possible causes on the onset of schizophrenia. With this knowledge we could use it as a baseline on how substance abuse greatly affects on the onset of schizophrenia.
2
THE INS AND OUTS OF PEER PRESSURE Written by Liisa Hawes. Liisa is a Marriage and Family Therapist in Calgary, Alberta, Canada. She is a parent educator with the Family Program at the Calgary Community Learning Association. Imagine getting together for coffee with a group of friends. There is the laughter of adults enjoying the company of other parents. The conversation turns to a discussion of a recent Oprah show. "I just love that show" you chime in (you really hate it). Later, someone suggests a movie. "Yes, let's!" you reply, even though you'd rather walk along the river and continue talking. By the end of the evening, in spite of excellent coffee, old friends and a reasonably good movie, you still feel "something" was missing. It was. Each time you concealed your true feelings, you disregarded a part of yourself. You were missing.
When we pretend to take on another's perspectives, go along
"As
parents...we
when we really don't want to or fail to state our preferences, we
are the first 'peers'
hide ourselves from others. We become invisible, and smaller
our
children
will
1
somehow, diminished in even our own eyes. "I just like to go along," we say, yet if we see our children doing likewise, we may
know."
wonder if they experiencing 'pressure' from their peers. Peer influences are normal and necessary in our lives. From earliest childhood, each time our needs are met, our wants are considered and our expressions recognized we develop a sense of ourselves as being worthy and valuable. Encouraged by these favorable positive experiences, we reach out to supportive others again and again, learning confidence. In time, the occasional let down from others doesn't disturb us overly much. The balance of our experience is positive. We often refer to this inner resiliency as "healthy self-esteem" or a "solid sense of self." But even when others don't grant our requests, if respectful, they teach us that open disagreement has no negative effects on one's self. We learn again that we can 'be' ourselves; we esteem ourselves. As parents, we seldom think of ourselves as peers to our children. In a broad human sense, however, we are the first 'peers' our children will know. If we respond to our children's feelings with respect, even when we disagree, they will come to expect respect. If we encourage them to develop and express their own viewpoints, they will become accustomed to healthy interactions. Within this kind of healthy relationship, parents often notice more overlap then difference in their values and those of their children's peer group. In some instances, such as the anxiety associated with those dreaded skin breakouts, peers provide more support than parents ever can! Even on a "pretty good" day, one's peers do much to support one's sense of self and offer a sense of belonging. Summary of the study The study is all about how peer influences our normal and necessary things in our lives. It states that peers do much to support one's sense of self and offer a sense of belonging.
2
AREA OF THE ARTICLE WE AGREE The area that we agree upon is that the study is about how peers greatly affect our lives. They influence us in many ways.
AREA OF THE ARTICLE WE DISAGREE The area that we disagree upon this article is that peers provide more support than parents ever can. Our parents know and only want what is best for us. They are the ones we should talk to when we have problems and they have better understanding than our peers. SIGNIFICANCE TO US AS A NURSE The significance of the study to us student nurses is that as student nurses we should not only focus on giving interventions on our clients we should also know their feelings and emotions to get their trust and to be able to have their cooperation.
2
Occupational Stress 12 - Burnout There are three separated stages to burnout. Each stage is its own little disorder and you don't necessarily have to progress through each stage, although most sufferers do exactly that. One could remain at one stage for years, as each stage is separate and distinct from the other two (the big word for that is orthogonal domains). The first stage of burnout is emotional exhaustion (EE) or feeling drained by contact with other people. Emotional exhaustion is characterized by a cluster of internalized symptoms. Internalized means you are beating yourself up instead of someone else. Do you dread seeing clients or meeting with customers? Does just the thought of dealing with one more complaint about that faulty product or that buggy application make you want to take the day off? These are the type of endorsements supporting a state of emotional exhaustion. Clearly this emotional banging-your-headagainst-the-wall feeling is stressful. The research is clear about one thing: having unpleasant contact with your supervisor and coworkers makes things even worse. Increased and improved training, as well as the use of a strong peer support system, is one of the recommended solutions, especially if EE is systemic within the group or department. It's not as bad when you know everyone is in the same boat. Also, you can begin to brainstorm solutions and stress-avoiding protocols. Isolation always makes things worse. One possible treatment is moving toward a team approach to dealing with customers. The second phase of Burnout is depersonalization. This is the outward or externalized phase. Externalized referrers to beating up on others as opposed to yourself. In this phase, you are 2
rude, demeaning, and insulting toward the client or customer. You're no longer blaming yourself. You're blaming others for having a problem. (Hey, I think I just figured out the problem with Larry down in accounts receivable!) Of course, a client with a crashed program is not to blame, but it appears there is only so much one can take of this endless stream of people with the same problem! Are you often negative toward clients or callous toward the problems of your valued customer? If so, you can put a little check in the box next to depersonalization. What helps? Again, training is a key ingredient. It's very healing to know when you are addressing the customer's problem in the most professional and efficacious manner possible. Also, through training and professional assessment, you can begin to understand that solving the problem may not exactly be in your job description. Your goal may just be to do the best you can do with what you have while maintaining a professional disposition. Wouldn't this be a self-affirming attitude? But these are perspectives you sometimes can't put together by yourself, especially while working in an isolated situation. Burnout's final phase is reduced personal accomplishment (RPA). This is characterized by generalized feelings of disappointment, nonsuccess, and underachievement. Workers with RPA endorsed statements such as, "I'm not getting anywhere," or "This job has lost all its meaning." As I indicated earlier, having supportive supervisors and coworkers is an important step in halting the progress of burnout's three stages. Burnout is serious and the consequences are serious as well. Psychologists have good instruments to assess this disorder and its progression. If you are experiencing one of these phases, don't hesitate to talk to a professional about it.
Summary of the study
Burnout is serious and the consequences are serious as well. Psychologists have good
2
instruments to assess this disorder and its progression. If you are experiencing one of these phases, don't hesitate to talk to a professional about it. AREA OF THE ARTICLE WE AGREE Being stressed greatly influences our daily activities, especially at work. We cannot perform well if we have something in mind that we keep on thinking. Our brain cannot function well. AREA OF THE ARTICLE WE DISAGREE No disagreement in the article. SIGNIFICANCE TO US AS A NURSE The significance of the study to us student nurses is that we need to think more ways for us to help our clients. As student nurses we need to make our client feel comfortable to lessen their anxieties and stress. We also need to consider interventions will be used so that we can achieve the upmost care that our client would have.
3
Understanding schizophrenia A guide to the signs, symptoms and causes
Environmental causes of schizophrenia Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder. As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol. Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including: •
Prenatal exposure to a viral infection
•
Low oxygen levels during birth (from prolonged labor or premature birth)
•
Exposure to a virus during infancy
•
Early parental loss or separation
•
Physical or sexual abuse in childhood
Abnormal brain structure In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making. Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of
2
brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.
AREA OF THE ARTICLE 1 THAT WE AGREE We agree that people who lost their parent can significantly affect an individual. These circumstances stressful to an individual and can be cause of schizophrenia.
AREA OF ARTICLE 1 THAT WE DISAGREE No disagreement in the article.
SIGNIFICANCE TO US AS A NURSE The literature helps us understand that there are different kinds of factors that cause paranoid schizophrenia. And parental loss is one of them can lead to inadequate parental guidance, the nurse should pay attention to the client who had loss a parent because it a risk factor in developing paranoid schizophrenia.
SIGNIFICANCE TO OUR CASE This article gives us much information about causes of paranoid schizophrenia.
2
UNIT IV (Process Recording and Drug Study)
3
PROCESS RECORDING (Nursing Care Plan)
2
Process Recording and Theme Identification PLACE: San Lazareto Hall DATE: January 14, 2011 TIME: 2:00 pm PHASE: Orientation Phase I.
Objectives a. Client- centered objectives 1. To established trust and rapport with the nurse through the use of
various therapeutic communication techniques. 2. To enhance cognitive skills through participating actively in the
therapeutic activities. 3. To improve socialization of the client and reduce anxiety.
a. Nurse- centered objectives 1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of
mental illness. 3. To develop positive coping behavior through therapeutic communication.
I.
Description of Setting
a. Describe the set up/ environment
1
It was a sunny Friday afternoon. We fetched our client from Male Ward and introduced ourselves to the client and proceed to pantry area to groom the patient. We let him brushed his teeth and waited for him to finish. After that, we went to the ruins and have our first interaction with the client. The chairs were scattered around the ruins facing our client. After an hour of interaction the facilitator were assigned to ask them the time, place and weather of that day and was given recognitions for each.
b. Describe the nature, behavior, affect and mood of the client Our client Mang JM was wearing his own set of dirty white wrinkled clothes and green patterned shorts with cut on sides. He seemed happy and always smiling. When we greet him, he recognized us as his new nurses for that afternoon and easily remembered our names in particular. Mang JM did the grooming excitedly and rapidly. As we fetched him for the activity his gait was moderate while looking at the floor. When we interviewed Mang JM, he showed a lot of facial expressions. He always said that he was happy, and it shows. He seemed anxious when he was recalling things from the past and whenever he thought of a good answer. He always answered the questions being asked with his medium tone. He was excited to answer some questions and stuttered because of it.
I.
Process Recording
3
Nurse-
Client Therapeutic
Conversation
(include Communication
non- verbal cues)
Technique Used
Analysis
and
Interpretation based on theories
SN: “Magandang tanghali Giving Recognition
Greeting or noting Mang
po Mang J.M.”
JM’s effort show that his student nurses recognizes
C: (smiled and nodding)
his individuality. According to Sullivan, recognition can establish rapport
towards
the
client. SN: “Tara na po sa pantry Offering One’s self
The nurses offer their
para po makapag linis
help to the client in doing
kayo ng ngipin niyo.”
self-care.
C: (nodding)
According
SN: “Gusto niyo po ba tulungan
po
namin
kayo?”
to
King,
human beings are open systems
in
interaction
constant with
the
environment
C: “ Hindi na. Meron na akong toothbrush dito.” SN: “Ako po si Mark at Giving Information
Giving information to the
ako naman po si Hazel
client promotes a good
kami po yung student
and trusting relationship
nurse niyo sa loob ng
between the nurse and
tatlong linggo.”
the client.
C: “Ahh…(Smiled and
According to Roy, a
nodding)
person adaptive
is
an
system
open who
uses coping skills to deal with stressor. 1
II.
A. Theme identification Content Theme The conversation was all about the client’s personal data, family backgrounds, and his condition.
Interaction Theme Mang JM responded well on our questions and reacted appropriately to the questions being asked. Showed interest in answering the questions but when he’s not being asked, he only remained silent with blunted facial expression and looked around the environment to divert his attention and ease the boredom.
Mood Theme Client had no sudden change in his mood. He expressed himself through smiling with good eye contact. Client’s movement often feels restless.
B. Nursing Diagnosis Altered thought process related to decreased attention secondary to obsessive thoughts as evidence by:
SN: Napansin ko pong linga kayo ng linga. Ano po ba ang tinitingnan nyo?
C: Ah wala naman. Yung mga dumadaan lang.
2
I.
Nursing Interventions We started to greet our client a pleasant afternoon. After that we fetched him from the ward, we assisted my patient in his grooming before the activity, I informed him of what will happen on the therapy. I encourage him to express feelings and verbalized concerns regarding the conducted activity. After we finished grooming, we asked him to go with us to have conversation with him. The orientation was conducted at the Lazaretto building. It was started with asking the client’s personal data and backgrounds for us to go further. We also wanted him to gain trust and established therapeutic nurse-client relationship with us. The conducted interaction went good.
II.
Summary and Evaluation In the Friday afternoon, as we received the client, Mang JM, he presented a happy and face and excited mood. As we go on for his grooming session, we observed that he has a good hygiene.
The client was very cooperative on the conducted conversation that afternoon. He was able to follow instructions and did it well. We gained his trust and rapport that had been established during our interaction. He also verbalized feelings of concern openly with us. We got along with him easily and he participated actively in the group socialization.
III.
Reference NANDA 10th edition Psychiatric-Mental Health Nursing 5th Edition
3
Name of Therapy: Role Identification Therapy Place: Under the tree (MMH) Date: January 19, 2011 Time: 9:00 AM Phase: Working Phase (Day 4)
I.
Objectives a. Client- centered objectives
2
1. To enhance the thinking and analyzing ability of the client. 2. To analyze and determine the knowledge and understanding of clients with occupation roles. 3. To gain knowledge
a. Nurse- centered objectives 1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of mental
illness. 3. To
develop
positive
coping
behavior
through
therapeutic
communication. 4. To assess client’s memory status.
I.
Description of Setting a. Describe the set up/ environment It was a fine windy day of Wednesday around 9:00 in the morning of January 19, 2011 when we received our client. We fetched him to the pantry area for grooming but he refused to, so we proceed to the area where the role identification activity will be held. The place was clean and the seats were arranged alternately with the client facing the facilitators of the said activity.
The place was conducive for the activity and they were comfortably seated on each chair. After the warm greetings of each facilitator and explaining the procedure of the activity, each patient were asked to identify what were the roles of the picture presented to them and was given recognitions for each. After the activity, we proceed under the mango tree to
1
find shade from sunlight and to conduct another conversation. We reviewed Mang JM about the recent activity and asked him what was his reaction about it and presented another set of pictures. This time, he can identify roles according to his own intellectual functioning, and not by imitating his neighbor’s answers. Between our conversation, we gave him snacks that he seemed enjoying while eating those. At around 11:00 am, we returned our client to his ward after the therapy and the conversation.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing his own set of wrinkled dirty white Boysen shirt and green patterned shorts which was the same as last week. We noticed that he was opistotonic that time and non-initiating when we fetched him from the ward. His gait was slow and he always looking at the floor with his arching back. Before the program, we approached him and he was very excited and always laughing with no apparent reason. He verbalized different ideas and looking around his environment a lot of times. During the program, he was actively participating and behaved well. When he heard of his neighbor’s answer, he laughed very hard. He displayed a lot of facial expressions like smiling, laughing, raising eyebrows, and frowning before and during the activity. Before the activity, he talked loudly and excitedly that he stuttered while speaking. And during the activity, he was serious and listened very carefully to the instructions and pictures presented to him. As we go along on our conversation, different behaviors were manifested, congruent affect have been projected by the client.
2
I.
Process Recording
1
NurseConversation
Client Therapeutic (include Communication
non- verbal cues)
Technique Used
Analysis
and
Interpretation based on theories
SN: “Magandang umaga Giving Recognition
The client did not look at
po Mang J.M.”
us but he use gestures or non verbal cues to make
C: (smiled and nodding)
communicate
with his
student nurses. According to Peplau, the initial
interaction
between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional assistance. SN: “Tara na po sa pantry Placing event in time or Mang JM refused for the para po makapag linis po sequence
grooming session.
kayo.” According to Abdellah, C: “Hindi na, naligo na
she
identified
21
ako ng 2 beses kanina
problems and one of it is
pa.”
to promote good personal hygiene.
SN: “Anung oras po kayo naligo Mang JM?” C: “ Bali kaninang 4am at 6am.” SN: “Mang JM kilala Seeking Clarification
The patient
niyo pa po kami?”
recognize
his
failed
to
student
nurses. C:
“Sino
nga
Nakalimutan ko na.”
ba? According to Johnson, Each
individual
has 2
II.
A. Theme identification
Content Theme We established nurse patient interaction focused primarily on the role identification therapy in which the client can identify the roles of people that are represented by pictures. It will provide the client the stimulus to assess their intellectual functioning. Moreover, it serves as guide for their thoughts and behavior.
Interaction Theme
Mang JM responded well on our questions and reacted appropriately the questions being asked. Showed interest in answering the questions but when he’s not being asked, he only remained silent looking around the environment where he can divert his attention.
Mood Theme
The client had sudden changes in his behavior. He changed his mood and affect suddenly according to his reactions and situation. He always diverts his attention around his environment whenever he didn’t feel like answering some questions. B. Nursing Diagnosis Social Isolation Related to poor problem solving secondary to unsatisfying relationship as evidenced by: 3
SN: Kayo po ba Mang JM may girlfriend nap o ba kayo?
C: Wala eh!
I.
Nursing Interventions According to Abraham Maslow Hierarchy of needs, after physiological and safety needs are fulfilled, the third layer of human needs is social and involves feelings of belongingness. Humans need to feel a sense of belonging and acceptance, whether it comes from a large social group, such as clubs, office culture, religious groups, professional organizations, sports teams, gangs, or small social connections (family members, intimate partners, mentors, close colleagues, confidants). They need to love and be loved (sexually and non-sexually) by others. In the absence of these elements, many people become susceptible to loneliness, social anxiety, and clinical depression.
We encourage Mang JM to talk with other client while waiting with the others to arrive, this will help Mang JM to realize that talking with other people will make him feel that he belong to a group. We encourage him to sing to the group, this will help to develop his self confidence. We provide activity that will help Mang JM to relate his life on the character. We encourage Mang JM to verbalize his feeling regarding the activity and give the moral lesson he gain in the story. We give recognition to the answer of Mang JM by doing this the client will feel that people around him appreciate the effort he give. We provide a quiet environment for the activity and conversation with our client. During the conversation with Mang JM, we encourage him to verbalize everything on his
1
mind, by doing this we will able to identify the possible problem that maybe the reason why Mang JM has no relationship.
II.
Summary and Evaluation Today, we held an activity that can assess the intellectual ability of the patient by conducting the role identification therapy. We’ve prepared a conducive, quiet area with less stimuli to let the patient concentrate for the said activity. The flow of the activity went good and we can say that Mang JM enjoyed it as manifested by his laughs. After that, we had our one on one conversation with the client and we observed that the client had sudden change in his mood and affect.
III.
Reference
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincot. Williams and Wilkins. (5th Edition).
2
Name of Therapy: Bingo Social Therapy Place: Under the Tree (MMH) Date: January 20, 2011 Time: 9:30 AM Phase: Working Phase (Day5)
I.
Objectives a. Client- centered objectives 1. To improve the socialization skills of the patient 2. To develop the self-esteem of the clients 3. To assess the knowledge perception of the client about different fruits and vegetables. 4. To assess the memory of the client a. Nurse- centered objectives 1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of
mental illness. 3. To develop positive coping behavior through therapeutic communication.
I.
Description of Setting
3
a. Describe the set up/ environment It was Thursday morning when we fetched our client to the grooming area and assisted him for the therapy. The weather is sunny, and we chose the perfect setting for the therapy where they can mingle with the other clients while the trees provided them sheds against the sunlight. We arranged the client’s seats facing each other with long table between them. The place was conducive for the activity and they were comfortably seated on each chair. The procedures of the therapy were explained to them clearly and they understood the mechanics of the therapy. We viewed the reactions and facial expressions of Mang JM while participating in the activity and noticed that he was very eager to win. When the patterns were given and none of them corresponds to the cards of Mang JM, he felt very disappointed. Mang JM won 2 times and felt very happy. Upon receiving his prizes, he offered us some of it and insisted to share the prize with us. b. Describe the nature, behavior, affect and mood of the client We received our client wearing the same set of clothes the same as yesterday. When he saw us, it seems that he was happy seeing us. His gait was moderate and he always looked at the floor with his arching back. He initiates conversation on how he groomed himself before we arrived. We went to the pantry area for his grooming session, but he refused to. When we accompanied him to the activity area, he was silent and wore a flat affect. But at the time he was seated on the chair, we approached him on how he was aware and oriented to his environment, on time and place and he was talking hard with his arm gestures. During the activity, he showed excitement and eagerness to
3
win and seriously focused on the activity. After the activity we proceed for another conversation and reviewed him about the recent therapy. As we go along on our conversation, different behaviors were manifested, congruent affect have been projected by the client, but sometimes he answered late and showed no interest.
I.
Process Recording
2
Nurse-
Client Therapeutic
Conversation
(include Communication
non- verbal cues)
Technique Used
Analysis
and
Interpretation based on theories
SN: “Magandang umaga Giving Recognition
The client greeted back.
po Mang J.M.”
He shows interest for today’s activity.
C: “Magandang umaga din!” (smiled) According to Henderson, she identified 14 basic needs one of it was communicating
with
others which is essential to establish a therapeutic relationship.
SN: “Tara po Mang J.M Placing event in time or The client refuses for our maglinis na po kayo.”
sequence
grooming session.
C: “hindi na,naligo na
According to Abdellah,
ako kanina 2 beses.”
there are 21 problems she identified and one of it is
SN: “Kanina po? Anung
to promote good personal
oras po?”
hygiene.
C:
“
Kaninang
pagkagising ko 4am at kaninang 6am.” SN: “Mang JM, kilala Seeking Clarification
The client recognizes his
niyo po ba ako?”
student
nurses.
This
indicates a good recent C: “Oo, ikaw si mark.”
memory
he
still
remember our names. SN: “Eh, yung isa ko pa pong kasama?”
According to Johnson, 2
II.
A. Theme identification
Content Theme We established nurse patient interaction focused primarily on how we explained and assisted the patient in participating to the activity. The therapy will help the patient on how to interact with other patient and how to react on different situations presented in every part of the game. Moreover, it serves as guide for their thoughts and behavior and on how to act appropriately in every situation.
Interaction Theme Mang JM responded well and reacted appropriately to the therapy being conducted. He showed interest in participating to the game and was very approaching to his fellow players. After the therapy, Mang JM showed different reactions regarding on his recent activity. He responded well on each questions being asked on him. He projected behaviors that seemed he was agitated about his environment and gave warnings about it.
Mood Theme Client had sudden changes on his mood depending on questions being thrown on him. He expressed agitation, and showed different perception about his environment. Client’s movement often feels restless
B. Nursing Diagnosis
3
Risk for other-directed violence related to threats as evidenced by verbal threats of against property as evidence by:
SN: “Marami po ba kayong nakain ngayon?” C: “Oo, kaming mga siga marami kaming nakukuhang pagkain sa loob.”
I.
Nursing Interventions We started to greet our client a pleasant afternoon. We encouraged him to change his clothes and cooperate on our grooming session but he always refused to and always reason out his grooming. After that we accompanied him to the activity area and assisted him throughout the game. After that, we conducted a review and conversation about his recent therapy and asked his comments and reactions about it. The conducted interaction went good.
II.
Summary and Evaluation Today we conducted an activity through which we can assess the cognitive ability and patience of the client. We had BINGO SOCIAL using fruits and vegetables on every card. When we informed our client about the therapy, he was very excited. During the therapy he listened very carefully to every ball and wanted us to assist him in every pattern of the game. The therapy went good and he was very happy wining two times in the said therapy.
III.
Reference Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition, 2008
Name of Therapy: Story Telling Therapy Place: Under the tree (MMH) 1
Date: January 21, 2011 Time: 9:30 AM Phase: Working Phase (Day 6)
I.
Objectives a. Client- centered objectives 1. To assessed the clients reading comprehension 2. To develop clients concentration 3. To assess client memory status 4. To exercise client’s natural imagination in gaining lessons through story.
a. Nurse- centered objectives 1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of
mental illness. 3. To develop positive coping behavior through therapeutic communication. 4. To evaluate client understanding about the story he was read.
I.
Description of Setting
a. Describe the set up/ environment
It was Friday morning when we fetched our client to the grooming area and assisted him for the therapy. The weather is sunny, and we chose the
3
appropriate setting for the therapy the trees provided them sheds against the sunlight. We were facing the client, handed them a book of “Ang Kalabaw at ang Pagong”. The place was conducive for the activity and he was comfortably seated on his chair. The procedures of the therapy were explained to him clearly and he understood that after reading the story he should formulate or get a moral lesson from it. We viewed the reactions and facial expressions of Mang JM while participating in the activity and noticed that he was interested.
b. Describe the nature, behavior, affect and mood of the client
We received our client wearing the same set of clothes the same as yesterday. His gait was moderate and he always looked at the floor with his arching back. He initiates conversation on how he groomed himself before we arrived and refused us in grooming him again. When we accompany him to the activity area, he was initiating stories. We accompany him to the activity area and was seated on a chair facing us. During the activity, he showed interest in reading the story. After the activity we proceed for another conversation and reviewed him about the recent therapy. As we go along on our conversation, different behaviors were manifested, congruent affect have been projected by the client, but sometimes he answered late.
I.
Process Recording
2
Nurse-
Client Therapeutic
Conversation
(include Communication
non- verbal cues)
Technique Used
Analysis
and
Interpretation based on theories
SN: “Magandang umaga Giving Recognition
The client looks back
po Mang J.M.”
with a smile. He shows interest
C: “Magandang umaga din!”
(Smiled
for
today’s
activity.
and
Nodding) According to Peplau, the initial
interaction
between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional assistance. SN: “Tara po Mang J.M Placing event in time or The client refuses for our maglinis na po kayo.”
sequence
grooming
session
wherein he says sequence C: “Hindi na,naligo na
of activity he did in the
ako kanina 2 beses.”
morning.
SN: “Kanina po? Anung
According to Abdellah,
oras po?”
she
identified
21
problems and one of it is C:
“
Kaninang
pagkagising ko 4am at
to promote good personal hygiene.
kaninang 6am.” SN: “Mang JM, napansin Making Observation
The
ko
appropriately and accepts
pong
pinapalitan
hindi
niyo
ang
damit
niyo?”
the
client
responds
implied
misunderstanding
without what
his nurse said. C: (Smiled and Nodding) 2 According to Roy, the
II.
A. Theme identification
Content Theme
We established nurse patient interaction focused primarily on the story telling therapy in which the client reads the story then identify the moral lesson on the story assigned to them. With this therapy, we can assess their memory and their cognitive ability on how they explain what the story had told them.
Interaction Theme
During the therapy we noticed that he had different ideas in deciphering the story. While reading, we reviewed his memory by asking the recent events and details in the story. After that, we had our conversation to assess what were the lessons he learned by reading the story. Some of his answers were irrelevant to the situation and he will put some stories of his own which were not related to the storytelling therapy. He didn’t concentrate on the story because he had his own stories that he wanted to discuss with us. He can recall every detail of the story but a little different from the original events. We can say that he didn’t enjoy the therapy that much. He’s only active when he’s discussing his own story. 4
Mood Theme
During our interaction to the client, Mang JM responded well to the questions although there are some unrealistic answers. He always observed his environment when he’s not being asked. He projected appropriate moods and behaviors but his attention was concentrated on his environment.
B. Nursing Diagnosis Disturbed Thought Process Related to misinterpretation as evidenced by: SN: Ano po ang dahilan at nasabi nyo po na hindi kayo pumapatay: C: May masasama kasing tao doon sa labas kumukuha ng mga babae sa bahay, hindi kami yun. I.
Nursing Interventions
We encourage Mag Jm to perform the Routine Grooming. We ask him to participate to the activity that we will going to conduct today. W encourages him to verbalize his feeling regarding the therapy. We asked him to read the story and formulate his own lesson that he gain in the story. We encourage Mang Jm to verbalize the thing on his mnd to be able for as to assess any problem that he feels. II.
Summary and Evaluation In the Friday afternoon, as we received the client, Mang JM, he presented a smiling face and a happy mood. He refused us to groom him, again, so we proceed
2
to the activity area for the story telling therapy. The client was very cooperative on the conducted activity that afternoon. He was able to identify the moral lesson in the story though it was not clearly explained to us because of his flight of different ideas. He was very agitated around his environment. He also verbalized feelings of concern openly with us.
III.
Reference Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition, 2008 Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincott, Williams and Wilkins. (5th Edition
Name of Therapy: Food Festival Place: Canteen (MMH) Date: February 2, 2011 2
Time: 2:00 PM Phase: Working Phase (Day7)
I.
Objectives a. Client- centered objectives 1. To improve the socialization skills of the patient 2. To develop client’s self-esteem 3. To assess client’s ability in following procedures 4. To assess the client’s memory a. Nurse- centered objectives 1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of mental illness. 3. To
develop
positive
coping
behavior
through
therapeutic
communication.
I.
Description of Setting a. Describe the set up/ environment It was a fine sunny day of Wednesday around 2:00 in the afternoon of February 2, 2011 when we received our client. He first greeted us with a smile and initiated to go to the pantry area which was a good thing. We let him groom himself in the area and after his grooming we proceed to the canteen for their activity. The place was clean and the seats were arranged semi circle facing the table where the facilitators will do their demonstration of the activity.
2
They were oriented in time, place and date and the procedure of the activity were explained very clearly for the benefit of orderliness of the activity. A brief conversation and review were conducted after the activity to assess what he had learned and to check his recent memory. At around 4:00 pm, we returned our client to his dorm after the therapy and the conversation.
b. Describe the nature, behavior, affect and mood of the client We received our client wearing his own set of wrinkled dirty white Boysen shirt and green patterned shorts which was the same two weeks ago. He greeted us with a smile and initiated to go to the pantry room. His gait is moderate and was looking to the floor at times. He brushed his teeth very hard and requested a cologne and powder to finish his grooming session. After that, we accompany him to the activity area and noticed that he was very excited and always smiled at everyone. During the program, he was actively participating and behaved well. He was serious and focused himself to the procedures. He was able to compute the total price of all the ingredients used in the food festival. After the program, we conducted a brief session to review what he has learned to observe some improvements in his behavior. As we go along on our conversation, different behaviors were manifested, congruent affect have been projected by the client. We observed that he was very happy and excited about his discharge soon.
I.
Process Recording
2
Nurse-
Client Therapeutic
Conversation
(include Communication
non- verbal cues)
Technique Used
Analysis
and
Interpretation based on theories
SN: “Magandang umaga Giving Recognition
The
client
smiled
and
po Mang JM”
greeted back that suggest he is comfortable with us.
C: “Magandang umaga din naman.” Nodding)
(Smiled
and
According to Peplau, the initial interaction between the nurse and the patient wherein the latter has a felt need and expresses the desire
for
professional
assistance.
2
SN: “Tara na po sa pantry Offering one’s Self
Mang JM feels that his
Mang
nurses were here just for
JM
para
makapaglinis po kayo.”
him.
C: “Hindi naligo na ako
According to Peplau, in
kanina pa 2 beses.”
interpersonal relationship theory, it is important for the nurse to recognize and
SN: “Tara na po doon para
respond
to
the
po makapaghugas na po
patients needs for help.
kayo ng kamay niyo umihi po kasi kayo eh”
C: “oh sige.”
SN: “Para na din po mas maging gwapo po kayo Mang JM.”
C: (Smiled)
3
SN: “Kamusta po kayo Broad Opening
The
client
encourages
Mang JM?
being bad by a response of what he wants to state on any
C:
“mabuti
naman,
cues
of
communication.
masaya.” According to Watson, it is important
to
help
the
patient identify his own thoughts and feelings to gain better understanding of his self. SN: “Anu pong dahilan at Focusing
The
masaya po kayo Mang
because we fetch him in
JM?”
his dorm.
C: “wala naman, dahil
According
nakalabas
there is an independency
ward.”
ako
ulit
sa
client
was
to
happy
Watson,
and integration of the parts and elements of thoughts and behaviours that make up the system.
4
SN: “Nakikilala niyo pa po Focusing
The client still remembers
ba ako Mang JM?”
who we are including our name which means that he had a good immediate
C: “Oo, ikaw si Mark.”
memory.
SN: “eh, yung isa ko pa
According
pong kasama?”
there is an independency
to
Watson,
and integration of the parts and elements of thoughts C:
“Uhmmm...hahosy?
Hasi?”
and behaviours that make up the system.
SN: “Hazel po Mang JM.”
C: “Ay, oo nakalimutan ko kasi.” SN: “Kamusta po ba ang Focusing
The client still remembers
tulog niyo Mang JM?”
the time he fell asleep last night.
C: “Mabuti naman.” According
to
Watson,
there is an independency SN: “ Anung oras po kayo
and integration of the parts
nakatulog kagabi?
and elements of thoughts and behaviours that make up the system.
C: “8pm.”
5
SN: “Natatandaan niyo pa Seeking Clarification
The client still remembers
po ba yung ginawa natin
the things we’ve done for
last last week po?”
the last 2 weeks.
C: “Oo, Bingo at yung
According to Orem, self
pinakita
care requisites are insights
yung
mgapictures.”
of actions that a person must be able to meet and perform
SN: “ Ilan beses po kayo nanalo
Mang
JM
in
order
to
achieve well being.
sa
bingo?”
C: “dalawa.” SN: “Alm niyo po ba yung Giving Information
The
client
provided
gagawin po natin ngayon
information necessary for
Mang JM?
the activities of the today.
C: “Oo, magagawa tayo ng
According
to
Roy,
mga pagkain.”
informing
the
patient
know what to expect. All other SN:
“Opo
Mang
JM,
tuturuan po naming kau
stimuli
that
strengthen the effect of the focal stimulus.
gumawa ng buko salad.”
6
SN: “Kamusta po ang Exploring
The client verbalizes his
paggawa niyo ng buko
feelings about the activity
salad Mang JM?”
being done for today.
C: “ahh... mabuti naman.”
According
to
Watson,
there is an independency and integration of the parts SN: “Magkano po ule
and elements of thoughts
yung
lahat
magagastos paggawa
po
lahat
ng
and behaviours that make
para
sa
up the system.
ng
buko
salad?
C: “118.”
SN: “Galing naman po pala.”
7
SN: “Kayo po ba Mang Asking Direct Questions
The client shared what she
JM nung hindi pa po kayo
does
napupunta ditto nagluluto
admitted at Mental.
before
she
was
p okay sa bahay niyo ng pagkain?” According
to
King,
a
person has ability to record C: “oo naman,tulad ng
their history through their
hotdog, isda atbp.”
own
language
and
symbols. SN: “ Kasipag naman po pala ni Mang JM.”
C: (Smiled)
8
SN: “Mang JM, ngayon Exploring
The client verbalizes his
pong
ang
feelings about a girl she
valentines may plano po
wants to give flower for
ba kayong pagbigyan ng
the
flowers?
day.
C: “Wala pa nga eh, hirap
According to Maslow, one
kasi baka may boyfriend
must feel the sense of love
na o may asawa na ang
and belongingness
malapit
na
coming
valentine’s
babae eh.”
SN: “Anu pong dahilan at nasabi niyong mahirap?
C: “wala naman, ikaw marami ka ng napagbigyan ng rosas noh?”
9
SN: “Halimbawa po Mang Role Playing
We ask the client to
JM si Hazel po yung gusto
consider people and events
niyong babae anu po gusto
in
niyong sabihin sakanya?
appraisal in order for him
light
of
his
own
to express his feelings. C:
“uhmm...mahal
na
mahal kita, aalagaan kita
According
to
Orem,
ng mabuti.”
person’s major task is to maintain integrity in face of
SN:
“Wow
ang
sweet
these
environmental
stimuli.
naman po pala ni Mang JM eh.”
C: (Smiled) SN: “Sa ngayon po ba Exploring
The client verbalizes his
Mang JM may plano na po
feelings about marrying
ba
someone.
kayo
magasawa
paglabas niyo dito? According to Maslow, one C: “Ahh...wala, babalik
must feel the sense of love
ako sa trabaho ko.”
and belongingness
SN:
“Saan
po
kayo
tutuloy?”
C: “Sa nanay ko.”
10
SN: “Di ba po Mang JM Seeking Clarification
The client had a chance to
nasabi niyo pong napunta
re- evaluate what he just
na po kayo sa America?
said.
C: “Oo, sa mga ninong
According to Orlando, it is
ko.”
important for the client to know that he has heard. With this the client will
SN:
“Anu
pong
mga
make her feel accepted.
ginawa niyo doon?”
C: “Naginom sa mga bar.”
11
SN: “Sa pakikipag inuman Humor
The client was able to
niyo po sa America wala
decrease his anxiety in a
po ba kayo nakakilalang
way that we give some of
babae doon?”
humors in order for him to verbalize.
C: “Wala eh.” According
to
Kolcaba,
health care needs are needs SN: “Talaga po Mang JM?
for comfort, arising from
Ayaw niyo lang po ata
stressful
mag- share eh?”
situations that cannot be met
health by
care
recipients’
traditional support system. C: (Laughing)
SN: “sige na po Mang JM i-Share niyo na po yan.”
C: “Wala nga.” (Smiled)
12
SN: Mang JM bukas po Formulating
Plan
of The client was provided
magkikita po tayo uli ang Action
information in order for
activity po natin bukas ay
him to be prepared on
dance therapy, anu po ba
what the things will be
ang gusto niyong dance
done and the things to
step?
expect.
C: “basta bukas nalang.”
According
(Smiled)
informing patient of facts
to
Roy,
lets the patient know what to expect. All other stimuli SN: “Anu pa po ba gusto
that strengthen the effect
niyong tugtog para pos a
of focal stimulus.
sayaw natin bukas?
C: “Kahit ano basta yung masaya.”
13
SN: “Mang JM, anu- ano Summarizing
The client has a good
po uli mga gnawa po natin
recent memory, he recalled
ngayong araw?
the things being done for today. It helps to bring out important points of the
C: “food festival, sinabi
conversation
niyo kung magkano ang
activities.
mga sangkap.”
awareness
and It
increases and
understanding
of
both
participants. This provides SN: “Galing naman pop
as a sense of closure at the
ala ni Mang JM.”
discussion.
C: (Smiled)
According
to
Supportive-
Orem, educative
helping patient to learn self care and emphasizing on
the
importance
of
nurses’ role. SN: Mang JM, ano po ang Evaluation
Evaluation
masasabi niyo sa ginawa
client
natin kanina?
outcome of the conducted
to
allows
the
evaluate
the
therapy.
C: natutuwa ako dahil marami akong na tutunan.
14
II.
Theme identification Content Theme We established nurse patient interaction focused primarily on the food festival in which the patient demonstrated procedures in preparing buko salad. This therapy will provide the client the stimulus to assess their ability to follow procedures and do it independently and creatively. Moreover, it serves as guide for their thoughts and behavior. Interaction Theme During the therapy while the facilitators were explaining the procedure, he was focused on every detail. But when his fellow clients demonstrate their procedure he seemed bored and not interested. When his turn to demonstrate, he did it very well. After the therapy, we had our short conversation to review his memory about the recent activity and to assess what the therapy has taught him and to assess for any improvements in his behavior. He responded well in every question thrown at him and showed interest in the conversation. Mood Theme During the conversation, he showed appropriate moods and affect congruent to the questions being asked. He often smiled and laughed and seldom looked away to divert his attention. He had a good eye contact while having our conversation and his statements were clearly represented. B. Nursing Diagnosis Readiness for enhanced coping related to verbalization of feelings as evidence by:
1
SN: “Mang JM, ano po ang masasabi niyo sa ginawa natin kanina?” C: “natutuwa ako dahil marami akong na tutunan.” I.
Nursing Interventions We fetched Mang JM from the ward and we received a warm smile from him. He initiated to go to the pantry area so we had the chance to groom him. He did grooming himself and asked for cologne and powder without changing his clothes though we always encouraged him to do so. During the activity, we assisted him in preparing the food. And after that we had a short conversation to identify his improvements in the past weeks of therapy.
II.
Summary and Evaluation
On February 2, 2011 we conducted another therapy to help them work independently following procedure. The facilitators of the said therapy oriented them before doing every procedure. Mang JM looked excited for his turn to make his own version of buko salad. He was able to identify the total amount of all the ingredients needed in the therapy. While the facilitators were demonstrating every procedure he was listening very well and focused on every detail of the procedure while others were doing their turns in redemonstrating the procedures he seemed bored and not interested while silently demonstrating every procedure, he did it very well and was given recognition for it. Before eating his meal, he offered his meal to everyone and he wanted to share his meal with us. He enjoyed eating his meal and appreciated it very much. After the therapy, we conducted brief conversation about the recent activity. He was none initiating that time and was looking around his environment. He said that the food festival was good and it would help him get stronger for the day. Eye contact was lacking that 1
time because his attention was drowned around his environment. His memory was good because he identified the ingredients of the salad with its corresponding prices. He returned to the dorm with gratitude and appreciation.
III.
Reference NANDA 10th edition Psychiatric-Mental Health Nursing 5th Edition
2
Name of Therapy: Dance Therapy Place: Canteen (MMH) Date: February 3, 2011 Time: 1:30 PM Phase: Working Phase (Day8)
I.
Objectives a. Client- centered objectives 1. To develop the client’s self esteem 2. To improve the client’s interpersonal relationship with others and to reduce anxiety 3. To assess and develop his movement and coordination 4. To assess the client’s memory a. Nurse- centered objectives
1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of mental
illness. 3. To
develop
positive
coping
behavior
through
therapeutic
communication.
I.
Description of Setting a. Describe the set up/ environment
3
It was a Thursday of February 3 when we received our client. We conducted another activity called Dance Therapy. We prepared seats in a straight line and oriented them before doing the therapy. After the facilitators greeted and explained every procedures of the therapy, we showed them the whole dancing activity before teaching them step by step. After teaching them the steps, they performed the dance to the other clients while assisting them how to. They were given great recognitions after the dance therapy and were deeply appreciated. After the program, we gave the client something to eat and drink to regain his energy and conducted the conversation for assessing improvements. At around 4:00 pm, we returned our client to his ward after the therapy and the conversation.
b. Describe the nature, behavior, affect and mood of the client We received our client wearing his clothes with MMH’s male uniform. The uniform was colored blue and semi-wrinkled. He greeted us with a smile and proceed to grooming area but he didn’t want to be groomed so we insisted him to do so. His gait is moderate and was looking to the floor at times. He washed his face rigidly and brushed his teeth very hard and requested a cologne and powder to finish his grooming session. After that, we accompany him to the activity area and noticed that his affect was somehow flat and steadily looking at the floor. During the program, he is silent and seldom smiled while doing the steps. He was serious and focused himself to the activity. His memory was sharp because he can recognize each step easily and his movement and coordination was good.. After the program, we conducted a brief session to observe some improvements in his behavior while eating his merienda. As we go along on our conversation, different behaviors were
2
manifested, congruent affect have been projected by the client. We observed that he was very happy and excited about our conversation on his past relationships.
I.
Process Recording
2
Nurse-
Client Therapeutic
Conversation
(include Communication
non- verbal cues) SN:
Technique Used
“Magandang Giving Recognition
Tanghali po Mang J.M.”
Analysis
and
Interpretation based on theories Mang JM looks back and greeted us. This shows that he is comfortable to
C: “Magandang Tanghali
us.
din” According (1952),
to a
Peplau
nurse
is
stranger to the patient. It is therefore important to remind the patient who we are and be consistent with the information we are giving to him to gain their trust. SN: “Tara na po sa pantry Offering One’s self
The
client
feels
the
para po makapag linis po
presence of his student
kayo Mang JM.”
nurses.
C: “hindi na naligo na
According to Henderson,
ako kanina.”
unique function of the nurse is to assist the
SN: “Tara na po doon
individual, sick or well,
kahit po maghilamos at
in the performance of
toothbrush
those
nalang
po
kayo.”
contributing to health or its
C: “Sige.”
activities
recovery
that
he
would perform unaided if he had the necessary strength,
will,
or
knowledge. SN: “Mang JM ano pong Seeking Clarification
The client recognizes his
pangalan ko?”
student nurses.
3
II.
A. Theme identification
Content Theme We established nurse patient interaction focused primarily on dance therapy in which the facilitators oriented the clients on how the activity will flow. Each student nurses taught their clients the steps for the dance therapy while assessing their movements, coordination, and behavior.
Interaction Theme During the therapy while the facilitators were explaining the procedure, he was focused on every detail. While teaching him the steps and at the same time having a conversation with him, his affect was a little flat and seldom smiled. He only smiled when he was given recognition. He responded well in every question thrown at him and showed interest in the conversation.
4
Mood Theme During the program where he presented to the other client what steps he has learned in the dance, he was very proud and always smiled at the audience. During the conversation, he showed appropriate moods and affect congruent to the questions being asked. He seldom smiled and laughed and looked on his environment while doing the steps. He had a good eye contact while having our conversation after the therapy and his statements were clearly represented.
B. Nursing Diagnosis Ineffective denial related to fear of consequences on negative past experiences as evidence by: SN: “Anu po ginawa niyo para po maka- move on?” C: “wala, may minahal kasi ako agad.”
I.
Nursing Interventions We received our client wearing the same clothes but with MMH’s male uniform as his topper. We assisted him in his grooming session and encouraged him to change his clothes. After that, we accompanied him to the activity area and orient him for the preparedness and orderliness of the activity. We taught him steps in the dance activity while assessing his behaviors and movements. The client was given a chance to present his dance to his fellow clients ad was given recognitions and appreciations after that. A brief conversation was conducted after the activity and he was reminded that
2
tomorrow will be our last conversation and meeting. We fetched him to the male ward afterwards.
II.
Summary and Evaluation On February 3, we conducted a therapy where in we taught the patient how to dance while assessing their movement and coordination and developing their self esteem. We oriented the client about the therapy and showed them the steps. Mang JM seemed uninterested and very silent while watching the performance. During the therapy Mang JM showed flatness of affect and non initiating behaviors. When learning every step, he can easily memorize each. After teaching the steps, Mang Jm performed the dance in front of his fellow clients. We noticed that he had sudden change of moods. While performing, he was happy and proud performing in front of his audience. We didn’t have a hard time assisting him in performing because he memorized all the step. After the program, we had a conversation and review his reactions about the therapy. The conversation manifested that he didn’t enjoyed the practice. He only enjoyed performing.
III.
Reference Maria Loreto- Sia- Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition, 2008
Grand Socialization Place: MMH Date: February 4, 2011 2
Time: 9:00 AM Phase: Termination Phase (Day 9)
I.
Objectives a. Client- centered objectives 1. To stimulate mind and body through socialization to other clients. 2. To develop the self esteem of the client 3. To assess the improvements of the patient in following instructions 4. To assess the memory of the client 5. To terminate the relationship.
b. Nurse- centered objectives 1. To provide mental health care for the client. 2. To implement therapeutic plan necessary for improvement of mental
illness. 3. To
develop
positive
coping
behavior
through
therapeutic
communication
I.
Description of Setting a. Describe the set up/ environment It was a sunny day of Friday of February 4, 2011 when we conducted the Grand Socialization for all the patients handled by the BPSU nursing students. Everyone’s busy decorating the place with red balloons, and multi colored crepe papers. The music committee was all set up. The games, programs and prizes were properly arranged. The chairs were arranged in 3 straight lines in front of the sound system facing the Grand Socialization
2
tarpaulin. The place was enough to accommodate all the patients and students and was conducive for the activity.
b. Describe the nature, behavior, affect and mood of the client We received our client wearing his own set of wrinkled dirty white Boysen shirt and green patterned shorts topped with blue male ward uniform. He greeted us with a smile and reminded us that it was our grand socialization day today. His gait is moderate with his arching back. He brushed his teeth very hard and washed his face very thoroughly. After that, we accompany him to the activity area. During the program, he was actively participating and behaved well. During the games, he always raised his hands and always willing to participate in the game. He was serious and focused himself to each and every instructions of the game. When he won, he put his prizes inside of his shirt. And when his fellow clients won the game, he was snatching some of the prizes of his fellow patients. During the program, he was very happy. After the program, we conducted a brief session to observe some improvements in his behavior. As we go along on our conversation, different behaviors were manifested, congruent affect have been projected by the client. We observed that he was very happy and satisfied on what his experiences on the grand socialization brought him.
I.
Process Recording
3
Nurse-
Client Therapeutic
Conversation
(include Communication
non- verbal cues)
Technique Used
Analysis
and
Interpretation based on theories
SN: “Magandang Umaga Giving Recognition
The client smiled and
po Mang J.M.”
greeted back that suggest he is comfortable with
C: “Magandang Umaga
us.
din naman.” (Smiled) According (1952),
to a
Peplau
nurse
is
stranger to the patient. It is therefore important to remind the patient who we are and be consistent with the information we are giving to him to gain their trust. SN: “Tara na po sa pantry Offering One’s self
The
client
feels
the
para po makapag linis po
presence of his student
kayo Mang JM.”
nurses.
C: “hindi na naligo na
According to Henderson,
ako kanina.”
unique function of the nurse is to assist the
SN:
“Tara
po
individual, sick or well,
maghilamos at toothbrush
in the performance of
nalang po kayo.”
those
activities
contributing to health or C: “O sige.” (Smiled)
its
recovery
that
he
would perform unaided if SN: “Para po mas gwapo
he had the necessary
po kayo ngayon.”
strength,
will,
or
knowledge. SN: “Oh! Mang JM anu Seeking Clarification
The client recognizes his 3
A. Theme identification 5
Content Theme The therapy was all about developing the interpersonal relationship of the client with others and assess his improvements throughout the whole 3 week therapies.
Interaction Theme Mang JM participate well to the game. He was very cooperative and able to listened to the instruction. He was able to remember all the step we taught him yesterday. During our last conversation with him he maintained his eye contact with us. He said thank you to us.
Mood Theme During the conversation, he showed appropriate moods and affect congruent to the questions being asked. He often smiled and laughed and seldom looked away to divert his attention. He had a good eye contact while having our conversation and his statements were clearly represented.
B. Nursing Diagnosis Risk for loneliness related to termination of relationship with nursing students. SN: “Mang JM last day na po namin ngayon.” C: “Oo, basta wag niyo sana kami makakalimutan.”(looks sad)
I.
Nursing Interventions
1
In Hildegard Peplau, Phases of nurse client relationship, termination phase is the final stagein the nurse-client relationship. Both nurse and client usually have feelings about ending the relationship; the client especially may feel the termination as an impending loss.
We plan a grand socialization for our client where they will enjoy the food ang games we prepare for them. We encourage Mang JM to participate in the game; this will help him to develop his confidence in facing crowd. We perform a dance number with our client. During our conversation with Mang JM, we encourage him to verbalize his feeling regarding the termination of our relationship with him, by doing this we can evaluate what he feel about the termination. We encourage Mang JM to verbalize what are the things he learn from the therapy we previously done, by doing this we can evaluate if we solve the problem of Mang JM and if we become an effective student nurses. We tell Mang JM that we enjoy the time we spent with him.
II.
Summary and Evaluation
This was the last day that we had our care and conversation with the patient. He seemed very happy during the grand socialization day. We let him participate in the games and won many times. He kept his prizes inside his clothes and some of it was shared to others. While eating his meal, we had the chance to talk to him for the last time and to explain to him that this was the last day where we can able to care, talk to him and do activities. He understood the termination of the care and wished that we won’t forget him.
1
III.
Reference
Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincot. Williams and Wilkins. (5th Edition).
Octavino Eufemia F., and Balita, Carl E> (2008). Theoretical Foundation of Nursing> Balikan Prints and Binding Enterprises.
1
PHARMACOLOGY
2
Name of Drug Mechanism of Action
Contraindication
Generic Name:
Contraindicated in patient with hypersensitivity to drug
Risperidone
Brand Name:
Risperdal
Classification :
Anti-psychotic
(atypical antipsychotic)
Dosage, Route, Frequency:
May act by antagonizing dopamine and serotonin in the central nervous system
Indication
Adverse Effect
> patient > mild with restlessness schizophrenia > headache > bipolar mania
> irritability symptoms of aggression toward others, deliberate self-injury, and temper tantrums associated with autistic disorder
Nursing Consideration
1. Monitor mood changes. Assess for suicidal tendencies especially during early therapy
2. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
3. Monitor patient for onset of extrapyramidal side effect. Report these symptoms; reduction of dosage or discontinuation of medication may be necessary.
2mg ½ tab, PO, BID
2
3
Name of Drug
Mechanism of Action
Contraindica tion
Indication
Adverse Effect
Generic Unknown. >hypersensiti >symptom >confusio Name of Drug Mechanis Contraindica Name: Thought to vity to drug aticIndicationn Adver m of tion se block treatment Action Effect postsynaptic of psychotic Haloperido dopamine > severe receptors in disorders l Generic Exerts its central No absolute > used for >dry brain. Name: actions contraindicati the mouth nervous Inhibiting through a ons treatment system signs and >schizophr Brand central of depression of in symptoms enia Name: adrenergicpsychosis, Levomepromapsychosis patients blocking, a particular zine who need dopamine- > Parkinson’s prolonged those of Haldol blocking, a disease schizophre parental serotoninnia, and antiblocking, manic psychotic and a phases of Classificat therapy Brand Name: anticholiner bipolar ion: gic disorder blocking > Nozinan Antipsychotic psychotic disorders
Classification (typical :antipsychot ic)
>hyperacti vity
Anti-psychotic
> manic states
Nursing Consideration
1. Monitor patient forNursing onset of Consideratio akathisia which n may appear within 6 hour of first dose and 1. watch out may be difficult for seizures to distinguish from psychotic agitation 2. caution in combining levomeproma 2. Assess mental zine with status other (orientation, anticholinergi mood, behavior) cprior drugs to and periodically during therapy 3. monitor vital signs 3. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
Dosage, Route, Frequency Dosage, :Route, Frequency: 1amp, 5mg IM 10mg ½ tab, HS 4
5
Name of Drug
Mechanism of Action
Contraindication
Generic Name:
It inhibits the central monoamine receptors, particularly the dopamine D₁ and D₂ receptors. Therefore, it increases the amount of serotonin and noradrenaline that control mood and thinking, and improve mood
> With known hypersensitivity to the thioxanthenes
Flupentixol
Brand Name:
Fluanxol
Classification :
> presence of CNS depression due to any cause, comatose states
Indication
Adverse Effect
Nursing Consideration
>maintenance > dizziness 1. careful therapy of observation > chronic for early headache schizophrenic symptoms of patients tardive whose main dyskinesia manifestations do not include excitement, 2. Observe agitation or patient when hyperactivity administering medication to ensure that medication is swallowed and not hoarded.
Anxiolytic Antidepressive Mood stabilizer
Dosage, Route, Frequency:
1cc, IM
6
Name of Drug
Generic Name:
Chlorpromaz ine
Brand Name:
Thorazine
Classificatio n:
Antipsychotic
(typical antipsychotic )
Mechanism of Action
Contraindi cation
Indication
Block dopamine receptors in the brain, prevention of seizures
>hypersensit > acute and ivity to drug chronic psychoses particularly > should not when accompanie be used in patients who d by increased have CNS psychomoto depression r activity
Adverse Effect
>dry mouth
Nursing Consideration
1. assess mental status prior to and periodically during therapy
2. Observe patient when administering medication to ensure that medication is swallowed and not hoarded.
3. monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizres)
Dosage, Route, Frequency:
500mg 2tabs, HS
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UNIT V (Psychotherapy)
8
Psychotherapy
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Name of Therapy: Role Identification Therapy Place: Under the Tree (MMH) Date: January 19, 2011 Time: 9:30 AM Phase: Working Phase (Day4)
DEFINITION This therapy uses a picture of people and their different kind of occupation. This therapy involves identifying the different kinds of occupation in the picture and also explaining their role in the society.
OBJECTIVES •
To enhance the thinking and analyzing ability of the client.
•
To analyze and determine the knowledge and understanding of clients with occupation roles.
•
To gain knowledge
PROCEDURES 1. First the leader will initiate the mood of the client. 2. Then the facilitator is responsible for asking questions to the client. They will ask the client if they know what the picture is and what is represents. 3. If the client has wrong answer, the facilitator will correct them. 10
4. After that the clients was distributed to their own nursing student for individual discussion of the pictures. 5. Finally the leader will gather the patient for evaluation of the therapy.
ANALYSIS AND INTERPRETATION Mang JM cooperates well and actively. He answered the questions according to his own intellectual capacity. He always laughed at his inmates whenever he felt that their answer was wrong. According to Roy, through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions.
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Name of Therapy: Bingo Social Therapy Place: Under the Tree (MMH) Date: January 20, 2011 Time: 9:30 AM Phase: Working Phase (Day5)
DEFINITION This therapy is like the usual bingo we played. Instead of numbers, fruits and vegetables were used in the game. This therapy is used for assessing knowledge of the mentally-ill patients about fruits and vegetables.
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OBJECTIVES •
To improve the socialization skills of the patient
•
To develop the self-esteem of the clients
•
To assess the knowledge perception of the client about different fruits and vegetables.
•
To assess the memory of the client
PROCEDURES 1. Orient the client about various types of fruits and vegetables. 2. Explain the mechanics and therapy simple briefly and clearly 3. Encourage the client to participate in the entire theory 4. During the working phase give recognition to the winning clients and provide prizes. 5. Summarized and evaluate the therapy
ANALYSIS AND INTERPRETATION With this kind of activity, we used fruits and vegetables on every BINGO cards. Instead of numbers when we informed our client about the therapy, he was very excited. He was very eager to win and get the prize. During the therapy, he listened very carefully to every ball and wanted us to assists him in every pattern at the game. The therapy went good and he enjoyed the game and very thankful for winning it. According to King, perceptions, judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing) Name of Therapy: Storytelling 13
Place: under the tree (MMH) Date: January 21, 2011 Time: 9:30 AM Phase: Working Phase (Day6)
DEFINITION The book that is use is about the animals and it is short that the client will not get bored reading it. It also have picture that show what the characters are doing. Story telling is done to assess the reading comprehension of the client and his ability to formulate his own moral lessons that he gain to the story. OBJECTIVES •
To assessed the clients reading comprehension
•
To develop clients concentration
•
To assess client memory status
PROCEDURE 1. First the facilitator will explain to the client the name of the therapy 2. The facilitator will tell to the client the short story they will go to read. 3. The two student nurses will show to the client the short story they will go to read. 4. The client will read the tagalong versions of the story 5. The student nurses will asked the client what is the moral study of the story.
14
ANALYSIS AND INTERPRETATION Today, the therapy was all about storytelling. We let the client read the story and get lessons from it. During the therapy, we noticed that he had different ideas in deciphering the story. We asked him questions to review every detail of the story. Some of his answers were irrelevant to the situations and he will put some stories not related to the storytelling therapy.
He didn’t concentrate on the therapy because he had his own different stories that he wanted to discuss with us. He can recall some of details in the stories but a little different from the original one. We can say that he got bored reading the story and during the therapy. He’s only active discussing his own stories. According to Pender, Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioral factors that help predict in health promoting behavior.
Name of Therapy: Food Festival Place: Canteen (MMH)
15
Date: February 2, 2011 Time: 2:00 PM Phase: Working Phase (Day7)
DEFINITION Food festival is a therapy done in order for the client to have basic knowledge in preparing foods. This is done to assess the client’s ability in following procedures and to assess their memory while they are socially incline with other patients. This would help them to work independently and creatively.
OBJECTIVES •
To improve the socialization skills of the client
•
To develop the self-esteem of the client
•
To assess the client’s ability in following procedures
•
To assess client’s memory
PROCEDURES 1. Prepare all the ingredients needed. 2. Discuss every detail of the therapy. 3. Inform the client about the each ingredient with their corresponding price. 4. Demonstrate the procedure. 5. Allow the client to make their own salad.
16
6. Evaluate their works
ANALYSIS AND INTERPRETATION On February 2, 2011 we conducted another therapy to help them work independently following procedure. The facilitators of the said therapy oriented them before doing every procedure. Mang JM looked excited for his turn to make his own version of buko salad. He was able to identify the total amount of all the ingredients needed in the therapy. While the facilitators were demonstrating every procedure he was listening very well and focused on every detail of the procedure while others were doing their turns in re-demonstrating the procedures he seemed bored and not interested while silently demonstrating every procedure, he did it very well and was given recognition for it. Before eating his meal, he offered his meal to everyone and he wanted to share his meal with us. He enjoyed eating his meal and appreciated it very much. After the therapy, we conducted brief conversation about the recent activity. He was none initiating that time and was looking around his environment. He said that the food festival was good and it would help him get stronger for the day. Eye contact was lacking that time because his attention was drowned around his environment. His memory was good because he identified the ingredients of the salad with its corresponding prices. He returned to the dorm with gratitude and appreciation. According to Peplau, interpersonal theory nurse assumes several roles which empower and equip her in meeting the needs of the patient .Teaching Role Gives
17
instruct ions and provides training; involves analysis and synthesis of the learner’s experience.
18
Name of Therapy: Dance Therapy Place: Canteen (MMH) Date: February 3, 2011 Time: 1:30 PM Phase: Working Phase (Day8)
DEFINITION This therapy is done to assess the client’s movement and coordination, as well as his ability to memorize every step. This therapy is intended also to relieve their anxiety and to create recreation. This is also done to develop the client’s socialization to others.
OBJECTIVES 1. To develop the client’s self esteem 2. To improve the client’s interpersonal relationship with others and to reduce anxiety 3. To assess and develop his movement and coordination 4. To assess the client’s memory 5. To provide mental health care for the client. 6. To implement therapeutic plan necessary for improvement of mental illness.
7. To develop positive coping behavior through therapeutic communication. 19
ANALYSIS & INTERPRETATION: On February 3, we conducted a therapy where in we taught the patient how to dance. We orient the patient about the therapy and showed them the dance. Mang JM seemed uninterested and very silent while watching the steps of the dance. During the therapy, Mang JM showed flatness of affect and non initiating behaviors while we were teaching him every step. He can easily do the steps and memorized each very well though he seemed silent throughout the entire practice. After teaching the steps Mang JM performed the dance in front of his fellow clients. We noticed that he had sudden change of mood while performing. He was happy and proud while dancing. We didn’t have a hard time assisting him in his performance because he memorized every step. After the program, we had a conversation and review his reactions about the therapy. The conversation manifested that he didn’t enjoyed the practice of the dance and enjoyed his performance only. According to Wiedenbach the Art of nursing includes understanding patient’s needs and concerns, developing goals and actions intended to enhance patient’s ability and directing the activities related to the medical plan to improve the patient’s condition.
20
UNIT VI (Glossary)
GLOSSARY 21
Acute Dystonic Reaction- extreme contraction of the jaw muscles, which can result in dislocation of the jaw bones and difficulty in opening the mouth. These symptoms may be caused by an adverse reaction to an antipsychotic drug. Affect- is the outward expression of the client’s emotional state. Affective disorder- refers to disorders of mood. Agnosia – is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. Akathisia- Motor restlessness ranging from a feeling of inner disquiet, often localized in the muscles, to an inability to sit still or lie quietly. Alcohol Abuse- use of alcoholic beverages to excess, either on individual occasions ("binge drinking") or as a regular practice. Alogia - Poverty of speech, as commonly occurs in schizophrenia. Ambivalence- presence of two opposing feelings. Amnesia - refers to the loss of memory Anhedonia- loss of interest in pleasurable things. Antipsychotic Drugs- class of medicines used to treat psychosis and other mental and emotional conditions. Anxiety- is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. Anxiety is considered to be a normal reaction to a stressor. It may help a person to deal with a difficult situation by prompting one to cope with it. When anxiety becomes excessive, it may fall under the classification of ananxiety disorder. 22
Aphasia- loss or impairment of the power to use or comprehend words. Apraxia- inability to carry out purposeful motor activities. Autistic Thinking- preoccupation with inner thoughts, daydreams, fantasies, private logic; egocentric, subjective thinking lacking objectivity and connection with external reality. Avolition- lack of motivation. Blunting – is an objective absence of noral emotional rersponses, without evidence of depression. Bradykinesia- neurologic condition characterized by a generalized slowness of motor activity. Clang Association- the sound of the words gives direction to the flow of thought. Concrete Thinking- predominance of actual objects and events and the absence of concepts and generalizations. Defense mechanism- unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image. Healthy persons normally use different defenses throughout life. An ego defense mechanism becomes pathological only when its persistent use leads to maladaptive behavior such that the physical and/or mental health of the individual is adversely affected. Delusions- a fixed, false belief not based in the reality. Denial- failure to acknowledge an intolerance thought, feeling, experience or reality. Depersonalization- feeling of strangeness towards ones self.
23
Depression- a condition of general emotional dejection and withdrawal, sadness greater and more prolonged than that warranted by any objective reason. Disorientation- a state of mental confusion characterized by inadequate or incorrect perceptions of place, time, or identity. Disorientation may occur in organic mental disorders, in drug and alcohol intoxication, and, less commonly, after severe stress. Displacement- the redirection of feelings to a less threatening object. Dopamine- monoamine neurotransmitter formed in the brain from the amino acid tyrosine essential for the healthy functioning of the central nervous system it has effects on emotion, perception and movement. Echolalia- pathological repetition of words of others. Echopraxia- the pathological imitation of posture/ action of others. Family Conflict- conflicts that occur within a family-between husband and wife, parents and children, between siblings, or with extended families (grandparents, aunts, uncles, etc.) Fantasy- conscious distortion of unconscious feelings or wishes. Fixation- arrest of maturation at certain stages of development. Flat Affect – A severe reduction in emotional expressiveness. Flight Of Ideas- shifting of ideas from one subject to another in a somewhat related way. Fugue- a person suddenly, without planning or warning, travels far from home or work and leaves behind a past life. Genetics- study of hereditary traits passed on through the genes. 24
Group Therapy- form of psychotherapy that involves sessions guided by a therapist and attended by several clients who confront their personal problems together. Hallucination- false perceptions or perceptual experiences that do not really exist. Illogical Thinking- thinking of something with out a logical reason or explanation. Immediate Memory- what you can repeat immediately after perceiving it. Immediate Recall- retrieval of events or information from the past. Impulsive- characterized by actions based on sudden desires, whims, or inclinations. Inappropriate Affect- an emotional tone or outward emotional reaction out of harmony with the idea, object, or thought accompanying it. Insanity- a deranged state of the mind usually occurring as a specific disorder. Intellectualization- over use of intellectual concepts by an individual to avoid expression of feelings. Introjections- symbolic assimilation or taking into one’s self a loved/ hated object. Labile Mood- when a person’s feelings or mood frequently fluctuates. Mental Illness- is a psychiatric disorder that results in a disruption in a person's thinking, feeling, moods, and ability to relate to others. Motor Hyperactivity- a general restlessness or excess of movement. Motor Hypoactivity- abnormally inactive. Mortality Rate- measure of the number of deaths in some population. Neologism- pathological coining of new words.
25
Occupational Stress- physical or psychological disorder associated with an occupational environment and manifested in symptoms such as extreme anxiety, or tension, or cramps, headaches, or digestion problems. Paranoid Schizophrenia- characterized by persecutory (feeling victimized) or grandiose delusions, hallucinations, and occasionally, excessive religiosity(delusional religious focus)or hostile and aggressive behaviour. Peer Pressure- social pressure by members of one's peer group to take a certain action, adopt certain values, or otherwise conform in order to be accepted. Pharmacological Treatments- curing and treating illness that deals in the science of nature and action of drugs and medicines. Phobia- an exaggerated and often disabling fear usually inexplicable to the subject and having sometimes a logical but usu. an illogical or symbolic objects or situation. Prevalence Rate- total number of cases of a specific disease in existence in a given population at a certain time. Prognosis- foretelling of the probable course of a disease. Projection- attributing to others one’s unconscious wishes/ fear. Psuedoparkinsonism- reversible syndrome resembling parkinsonism that may result from the dopamine-blocking action of antipsychotic drugs. Also known as druginduced parkinsonism. Psychotherapy- treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems.
26
Rationalization- justifying one’s actions which are based on other motives. Reaction Formation- expression of feelings that is the direct opposite of one’s real feelings. Recent Memory- ability to recover information about past events or knowledge. Regression- returning to an earlier level of development in the face of stress. Remote Memory- ability to remember things that happened years ago. Repression- unconscious forgetting. Schizophrenia- a form of mental illness in which there is a withdrawal from reality. It cannot be defined as a single illness; rather, schizophrenia is thought of as a syndrome or disease process with many different varieties and symptoms. Self- Inflicted Injury- act of harming oneself. Stress- body's reaction to a change that requires a physical, mental or emotional adjustment or response. Sublimation- the rechanneling of unacceptable instinctual drive with one that is acceptable. Substance Abuse- excessive use of a substance. Substitution- replacing the desired unattainable goal with one that is attainable. Suicidal Behavior- deliberate action with potentially life-threatening consequences. Suppression- “Conscious forgetting” a deliberate process of thought blocking. Symbolism- less threatening object is used to represent another.
27
Tardive Dyskinesia- chronic disorder of the nervous system characterized by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually developing as a late side effect of prolonged treatment with antipsychotic drugs. Undoing- an attempt to erase an act, thought, feeling or desire. Violent Behavior- a person harms themselves or others. Withdrawal- the act of taking back or away something. Word Salad- incoherent mixture of words and phrases.
28
UNIT VII (References)
References Books NANDA 10th edition. Psychiatric-Mental Health Nursing 5th Edition Octavino Eufemia F.and Balita, Carl E> (2008). Theoretical Foundation of Nursing> Balikan Prints and Binding Enterprises. Sia, Maria Loreto. Psychiatric Nursing, A Textbook and Reviewer, 2nd Edition, 2008
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Videbeck, Sheila L. (2008). Psychiatric-Mental Health Nursing. Philadelphia. Lippincot. Williams and Wilkins. (5th Edition). Electronics Colburn, Rebekah. Understanding schizophrenia: A guide to the signs, symptoms and causes. (http://www.suite101.com/content/understanding-schizophrenia---braindisorder-a214502) Glickman, Ian Ph.D. Occupational Stress 12 – Burnout. (http://ezinearticles.com/? Occupational-Stress-12---Burnout&id=2246896) Hambrecht, Martin and Häfner, Heinz. Substance abuse and the onset of schizophrenia.
(http://www.biologicalpsychiatryjournal.com/article/S0006-
3223(95)00609-5/abstract) Hawes Liisa. The Ins and Outs of Peer Pressure. Calgary's Child Magazine Calgary,
Alberta,
Canada.
(http://www.calgaryallergy.ca/Articles/English/peerpressure.html)
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UNIT VIII
31
(Documentation)
32
33
34
35
36
37
38
39
