School of Nursing

NCM 117 - RLE

PSYCHIATRIC NURSING

DEMALATA, Gelli Mae T.

FRANCKE, Mari-Elysia M.

LACAY, Mico

MAGBULOS, Jennyfer M.

MAPALO, Kyla Franchesca N.

MATUNDAN, Aubrey Ann

MIECZKOWSKI, Marey Chris C.

MORALES, Bianca Marie R.

NERBES, Maria Concepcion R.

PALANOG, Erlan Joshua G.

 I. INTRODUCTION

Background of the Study

Schizophrenia is a severe impairment of mental and social functioning with grossly

impaired reality testing, sensory perception and with deterioration and regression of psychosocial
functioning. It is usually due to the elevation of dopamine levels. Its old terminology is dementia
praecox, coined by Emil Kraeplin while the given term “schizophrenia” is coined by Eugene
Bleuler. In this condition memory is not affected but rather the thoughts are affected. It has 5
types which are paranoid (presenting sign of suspiciousness), catatonic (with stereotyped
position and waxy flexibility), disorganized (where all behaviors are similar with toddlers since
they are anal fixated), undifferentiated or mixed (where symptoms of more than one type of
schizophrenia such as paranoia, catatonic, or disorganized), and residual (where it no longer
exhibits overt symptoms, no more delusions but still has negative symptoms).

Schizophrenia is characterized by distortions in thinking, perception, emotions, language,

sense of self and behaviour. Common experiences include hallucinations (hearing voices or
seeing things that are not there) and delusions (fixed, false beliefs), abnormal behaviour such as
wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing
unkempt, disorganised speech including incoherent or irrelevant speech, and/or disturbances of
emotions, and marked apathy. (Mental Health Nursing by Videbeck 5th edition).

Schizophrenia usually is diagnosed in late adolescence or early adulthood. Rarely does it

manifest in childhood. However, it commonly starts earlier among men. Schizophrenia is
associated with considerable disability and may affect educational and occupational
performance. People with schizophrenia are 2 - 3 times more likely to die early than the general
population. This is often due to physical illnesses, such as cardiovascular, metabolic and
infectious diseases. The researchers came up with a study that the cause of this condition would
be an interaction between genes and a range of environmental factors. However, psychosocial
factors may also contribute to schizophrenia (WHO, 2019).

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 It affects 20 million people worldwide but is not as common as many other mental
disorders. According to the World Health Organization, about one in 250 people in the world
suffers from this disorder. In the Philippines, it is the top brain disorder, affecting at least 42% of
patients who seek psychological treatment and consultation, according to the latest data from the
Philippine Health Information System (Manila Standard Lifestyle, 2018). Nonetheless,
schizophrenia is treated through palliative treatment which includes medicine and psychosocial
support. However, most people with chronic schizophrenia lack access to treatment that has
become one of the main problems to the worsening of the condition.

General Objectives
To be able to come up with an understanding of the disease process (Schizophrenia) and
to formulate a comprehensive nursing care plan utilizing the nursing process.

Specific Objectives
● Accurately present a thorough general assessment of the client which includes mental
status examination, history taking as well as physical assessment through the use of
observation technique.
● Understand the psychodynamics, psycho-pathophysiology and etiology of the case being
presented.
● Understand the role of drug therapy in managing the client related to the diagnosis and
the importance of laboratory and diagnostic procedures.
● Recognize the factors associated in the development of the diagnosis.
● Systematically present the data pertinent to the case being gathered.
● Efficiently provide appropriate and proper nursing diagnosis in line with the client’s
medical condition and skillfully formulate nursing care plans for the problems identified.
● Appropriately apply nursing interventions necessary for the patient’s condition in
reference with the learned theories and concepts of the disease.
● Exhibit mastery and act appropriately in answering relevant questions with a positive
attitude towards criticisms and suggestions.

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Significance of the Study

This study is of great significance in Psychiatric Nursing because this will give
knowledge and will serve as a source of information regarding the disease process
(Schizophrenia). In addition, this will help certain groups and individuals such as the nursing
students, professors or clinical instructors, and future researchers in the sense that this study will
provide awareness and it can be used as information for the students to better understand and
gather knowledge about the disorder in terms of their origin and the factors associated with the
development of the disorders, and determine the plan of care of the disorder, and also to the
professors to widen their perspective about the disorder and to provide additional information
about Schizophrenia. Therefore, the findings that will be obtained from this study will also help
the nursing community. Lastly, this can serve as a reference for future study.

II. PSYCHIATRIC NURSING ASSESSMENT

1. Profile

Name: Ryan Dela Cruz Age: 38 years old Sex: Male Marital Status: Single

Address:56 Bagong Lote - Philippines

Date of Birth: May 22, 1982 Place of Birth:

Nationality: Filipino Religion: Roman Catholic

Educational Attainment: Until 1 Semester of Mechanical School

Diagnosis: Undifferentiated Schizophrenia

Date of Admission: 2014

Nursing Homecare Address: Synergy Nursing Homecare Center

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 2. Chief of Complaint

Patient RDC is a 38 year old client admitted to the Synergy Nursing Home Care Center
with a chief complaint according to the mother “may mga bulong daw siyang naririnig”,
“nagiging bayolente na sya”, “ nag simula noong 2000 nung namatay ang lola niya”

3. History of Present Illness

Patient RDC verbalized that he started living at Synergy Nursing Homecare Center in
2014 as he was diagnosed with Undifferentiated Schizophrenia since 2000. Prior to admission at
the Synergy facility, Patient RDC expressed that he has been to other psychiatric facilities such
as the one in Laguna and at Philippine General Hospital for the same diagnosis.

According to the patient’s record at Philippine General Hospital from 2003, 3 years prior
to his admission at PGH he was admitted to Lungsod ng Maynila for having auditory
hallucinations. He was given Chlorpromazine, Biperiden, and Zolpidem. A decline in school
performance and personal hygiene was noted. 2 years prior to admission at PGH, he was
admitted for the first time at PGH in 2001 for agitation. He was given Amisulpride 200 mg BID
with improvement. Due to financial problems, the dose of his medication was reduced to half
which caused behavioral changes. 1 week prior to admission at PGH in 2003, the patient was
noted to have poor impulse control and hugged a female passerby. Patient was destructive at
home and could not be calmed down. Persistent symptoms prompted consultation and admission.

The patient’s mother expressed that the symptoms started in 2000 after his grandmother
passed away. She says that the patient has a history of being violent and hearing whispers around
him.

During the virtual interaction with the patient, symptoms such as auditory and visual
hallucinations, persecutory and sexual delusions, flight of ideas, circumstantial thinking, and
loose associations can be noted. The patient is prescribed Carbamazepine 200 mg,
Chlorpromazine 50 mg, Clozapine 100 mg BID, Biperidine Hydrochloride OD PRN for EPS,
Fluphenazine Decanoate 1 cc (25 mg) IM with BP Precaution, Rowatinex 1 cup TID,
Risperidone 2 mg BID, and lastly Diphenhydramine Benadryl 50 mg HS PRN for Impaired

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Sleep. Doctor has ordered a complete blood count for baseline/monitoring. Patient is on a low
salt and low-fat diet.

4. Past Medical History

Patient RDC had measles when he was 3 years old and had a head trauma at the age of 5.
He mentioned that he did not undergo any surgery. The patient admits that he used to smoke and
drink alcohol occasionally. He reported that he has an allergy that causes an itch to his skin due
to the changes of weather. The medications he's been taking include: enervon, clozapine,
carbamazepine, pyrosulfate and drug for toothache. In terms of other illnesses, the patient stated
that he had no history of asthma and cardiovascular diseases.

5. Past Psychiatric History

According to the Patient’s mother, Patient RDC started experiencing symptoms such
hostile behavior and auditory hallucination and was also diagnosed as “Schizophrenia
undifferentiated type” during the year 2000. Patient RDC stated that he has been experiencing
auditory, visual, and tactile hallucinations that usually occur every two days.

He started consulting a psychiatric doctor during the year 2009 and regularly goes to his
doctor’s appointment up to the present time. He was first admitted to “Lungsod ng maynila” for
having auditory hallucinations and was given Chlorpromazine, Biperiden and Zolpidem, with
resolution of symptoms. However, there was a note of progressive decline in his functioning in
school and personal hygiene, he was then admitted to “PGH” for agitation. He was given
amisulpride 200 mg BID where improvement was noted. Patient was then able to go back to his
daily activities and was not problematic at home but due to financial incapabilities the dose of his
medication was reduced to half and behavioral changes were noted. After that the patient was
noted to have very poor impulse control.
The patient became destructive at home and could not be tackled down, persistence of
patient’s symptoms promoted consultation and subsequent admission. According to the patient
he was admitted to a psychiatric facility in laguna but he was not able to state the exact year of

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his admission, he was later on transferred to Synergy nursing home care during the year 2014
and is still currently under the care of Synergy nursing home care.

6. Family History

Based off of the previous conversations with Patient RDC, he states that he has three
siblings namely, Gabi, BJ and Marlon. The patient also mentions that his mother named
“Arcenia” has hypertension, and his maternal uncle is diagnosed with a mental illness. Due to
Patient RDC having a flight of ideas, not much information about his family history was
extracted from the meetings since the topic was often changed.

7. Personal History

Patient RDC claims to be born in “Isabela Hospital” in Caloocan city. During his early
and middle childhood, the patient enjoyed playing games and activities such as patintero, biking,
tumbang preso, chako, sipa, sako, chinese garter, and even playing in the rain. The patient’s
dream job was apparently to be a waiter at Jollibee, but the patient grew up to take up a
mechanical course, which only lasted for one semester. The patient did not enjoy his course and
when asked what he thought about his chosen course, he verbalized, “Hindi ko po gusto.”
Despite this, he did enjoy the company of his classmates and friends. Further after his education,
the patient stated that he did not have an occupation. As for his family, the patient mentioned
three of his siblings Gabi, BJ, and Marlon, and he claims to have joyous memories with every
member. According to the patient, he has not been active when it comes to religion and church.
The patient was first admitted in a rehabilitation center in Laguna. However, in 2014 he started
residing in the Synergy Nursing Homecare. The patient says that he has been happy and
comfortable in his current place with his roommates “Jeffrey” and “Edison”. During a normal
day, the patient stated that he would only repeatedly eat, sleep, and hear voices and whispers. In
the patient’s legal history, he claims that he follows rules and regulations. Once, they are caught
along with his aunt by driving their jeep in a different route violating their designated
color-coded policy. Another one, he and Jeffrey Coronado was accused of a crime by stabbing a
person.

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 8. Mental Status Examination

COMPONENTS ASSESSMENT ANALYSIS &

INTERPRETATION

GENERAL Patient seems to have proper Generally, the patient can take
ASSESSMENT & hygiene and grooming. He wears care of his hygiene as he can be
MOTOR a simple top and has his hair well seen with clean hair, face, and
BEHAVIOR kept. The client makes eye contact clothes. He appears to be anxious
briefly before constantly looking as he constantly scans the room
around the room. He maintains a and only makes eye contact with
straight face with a stoic the camera when answering a
expression. His speech is clear question. He speaks clearly
and audible. No stutters or which can be understood by the
abnormal speech patterns are listener.
noted.

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MOOD & AFFECT The client expresses his emotions The mood of the client is often
as happy. When asked about his happy, anxious, and sad. When
stay in the Synergy Facility he he verbalizes his symptoms, he
describes this to be happy. He has seems to be anxious about the
friends in which he talks to and whispers that he experiences. He
plays basketball with. This is becomes sad because apparently
contraindicated during the last day the whispers are often offensive
of interaction in which he and mean towards him. He is
expressed that he does not have happy about his stay in Synergy.
any friends and people do not like During the virtual interaction, the
talking to him. He also expressed client can be seen with a blunted
that he hears whispers and sees affect.
certain person which causes him
to be anxious and sad. Most of the
time he has a straight face,
however, there are times when he
can smile when telling a story.

THOUGHT The client can answer the The patient experiences

PROCESS AND questions being asked; however, circumstantial thinking in which
CONTENT he often goes off topic. He would he can answer the questions
answer the question before adding being asked before going off
other information that is not topic. He also experiences
relevant to the question being persecutory and sexual
asked. He also often verbalizes delusions. Flight of ideas and
that he sees a certain person and loose associations can also be
hears whispering around him. noted with the patient’s thought
They are often negative, and he process and content.
says that they do not like him
because he is arrogant and that

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 they make fun of him when he
masturbates. He says that there is
a woman who is right next to him
and is jealous of his mother.

SENSORIUM & While at first the patient seems to The client can answer basic
INTELLECTUAL be oriented with time, place, and questions and can follow basic
PROCESS year; however, with further commands and instructions. He
questions asked he started getting can concentrate for a short period
the years of when COVID-19 of time before being distracted
pandemic started and when Pope by his hallucinations. He got a
Francis came to the Philippines. few questions wrong which may
When asked to name 3 food and suggest that he has a difficulty
animals he was able to answer remembering certain things.
correctly. He was also able to
spell “MUNDO” correctly. When
asked to follow basic instructions
he was able to follow. He was
given 3 words in the beginning of
the test and towards the end he
was asked what the words were
mentioned, and he was not able to
remember them. He was also able
to provide the name of the current
president of the Philippines.
During the interaction the client
several times experienced hearing
whispers around him. He says that
they are often mean and negative.
They make fun of him for

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 masturbating and that they do not
like him because he is arrogant.

ABNORMAL During the interaction the client The client experiences auditory
SENSORY several times experienced hearing and visual hallucinations due to
EXPERIENCES OR whispers around him. He says that the whispers he hears and the
MISCONCEPTION they are often mean and negative. persons he sees that apparently is
S They make fun of him for jealous of his mother.
masturbating and that they do not
like him because he is arrogant.

JUDGEMENT & During the nurse-patient The patient has a good judgment
INSIGHTS interaction, the client was asked a as he has a meaningful capacity
question to test his judgment to make appropriate decisions
regarding real life and appropriate act on them in
problem-solving skills and the social decisions. He has
question was “What should he do answered the question suitably as
if he finds a stamped and this is what would a normal
addressed envelope?” Then he individual do with regards to the
answered that he will get it, look given situation.
at it and open it.

However with regards to his

Having said the patient’s
insights which will be in reference
responses, the patient may have a
to his illness and whether he
limited insight based on his
understands that the treatments he
awareness of illness and
has been receiving as well as the
treatments he has been receiving.
signs and symptoms he currently
However, this section was
experiences are not normal were
concluded as limited due to the
asked. In the first question, the
patient’s perception of reality as

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 client is aware of his he is still unaware that the voices
condition/illness as he has still he has been hearing are not real.
remembered his monthly This could also be supported that
consultation, rehabilitation and during the interaction, the client
the time he has experienced the seemed to utter things that may
initial symptoms of his condition. be attributed to his delusions and
With regards to his treatments and hallucinations.
medications, he was able to
enumerate some of them such as
enervon, clozapine,
carbamazepine and pyrosulfate.
Finally, during the 3rd day of our
interaction with the client, he was
asked if he’s aware that the voices
he has been hearing for a long
time aren’t true or real. However,
he answered that he doesn’t know
or simply, he’s not aware that
those aren’t part of reality.

SELF-CONCEPT In this section, three components The patient has a fair rating
will be evaluated and discussed regarding self-concept. He has a
with regards to patient RDC’s positive self-image as he’s
condition. These are self-image, consciously aware of the good
self-esteem and ideal self. These view of himself and this was
three components showed enumerated in his strengths. He
disturbances and limitations. He also recognized his potential as
has a positive self-image because he’s also better at other things.
he recognized his strengths and Poor self-esteem has been noted
weaknesses and also he had a because he thinks that other

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 social role (which he explained people are better than him and
during interaction that he had a due to that, he tends to feel
happy childhood and friends jealous and unwanted. Finally, a
currently in the homecare). good ideal self would be
However, ambivalence may also concluded because of his
be noted as the patient has a poor appropriate level of awareness
self-esteem. He stated that his regarding his personal interests
considered “friends” are not and condition.
catching sight of him. He feels
unwanted and unloved. With that,
he tends to feel jealous of them.
Lastly, his ideal self was also
evaluated and this can be
supported that he is aware of his
condition, favorites, likes/dislikes
as well as his treatments.

ROLES & Regarding this section, the client This section is concluded as
RELATIONSHIPS is partially aware of his role as a partial as there may be
patient or individual in the disturbances in the basic sense of
homecare. He cited his daily self. Even though he is able to do
activities in the said setting which his role as a patient, lapses
include eating and sleeping while regarding reality still exists.
also giving emphasis to his However, it could be concluded
childhood experiences and social that he has a good relationship
role. With regards to his with other people though
relationship with other people, he sometimes he experiences
has stated some of his friends jealousy. On the other hand, he
whom he usually mingles with as also has a good relationship with
well as his contact with his family. his family as he stated that they

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 call him every three months but
their last visit was way back in
2016.

PHYSIOLOGIC & During the interaction with the Overall, the client significantly
SELF-CARE client, he is able to perform usual performs physiologic and
CONSIDERATION activities of daily living which self-care as he also stated that
include bathing, dressing, after all the activities we have
toileting, eating healthily, sleeping presented to them, he felt
and resting as this can also be relieved meaning he was able to
seen in his physical appearance manage stress and sadness which
such as proper grooming and is very essential for self-care.
hygiene.

9. Impression/ Diagnosis
● Undifferentiated Schizophrenia

III. CLINICAL DISCUSSION OF THE DISEASE

1. Psychodynamics
There are different classifications that fall under the psychodynamic perspective of
schizophrenia. According to the Zurich psychiatric school, schizophrenia is caused by an
interplay of hereditary predispositions to illness and life experiences. Sigmund Freud’s had a
thought that people with Schizophrenia are individuals whose egos aren’t strong enough to deal
effectively with unwanted id impulses. The patient is in the Genital stage of psychosexual
developments. The patient shows aggressiveness in terms of attraction to opposite sex such as
delusions that many women is attracted to him and sexualizing women and claims seeing their
repreoductive part.

Jean Paiget’s theory of cognitive development not only focuses on understanding how
children acquire knowledge, but also on understanding the nature of intelligence. The ability to

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think about abstract ideas and solutions is the key hallmark of the formal operational stage of
cognitive development. This is the final stage of Paiget’s theory wherein people at the age of 12
and above become more capable of seeing multiple potential solutions to problems with the use
of deductive logic, or reasoning from a general principle to specific information. In this stage
they also begin to think more about moral, philosophical, ethical, social, and political issues that
require theoretical and abstract reasoning. The patient is having difficulty in identifying fiction
from reality and was not doubting the unrealistic state of the situation. He is convinced with the
hallucinations and does not reason with the event.

Growing up biologically puts up with a fixed process of development but unlike the
theory of psychosocial development it is integrated in a leveling manner. According to Erikson,
an individual passess through eight developmental stages. Problem solving is where an
individual develops their social behavior that molds a person in a lifetime. At the age of 17 years
old, the patient experiences his first symptoms where the stage of identity vs. confusion is
developing his values and beliefs. The patient states that he follows the law yet he and his aunt
broke the law by violating colorum. The patient verbalized “Ayoko ng nagmumura, nang
bubully”, “Yung sa mga taong malalakas yung nasa korte ganun po yung ayaw ko” which is a
stand of his personal values and beliefs influenced by his symptoms and experiences. Currently,
the patient is in the stage of intimacy vs. isolation where relationships are built, he explains that
he was ignored and disregarded by his friends and he's feeling jealous.

2. Psychopathophysiology/Schematic Diagram of the Disease

Schizophrenia is a condition that highly affects a person's thought process, perception and
cognitive dysfunction. The exact cause of Schizophrenia is unknown but it appears to be caused
by complicated interactions between heritable genetic risk factors and a range of environmental
exposures. Schizophrenia is interrelated with a number of causes, with many stemming back to
prenatal development. There are different theories about the causes and potential mechanisms of
schizophrenia, each with varied levels of research support, such as physical, genetic,
psychological and environmental factors. Research shows that there has been considerable
interest in genetic factors involved in schizophrenia due to findings that a person's risk for

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developing schizophrenia is higher if a first-degree relative has the condition. The hallmark
symptom of schizophrenia is psychosis, such as experiencing auditory hallucinations and
delusion.

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Diagram

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 3. Laboratory and Diagnostic Examination

Laboratory Normal Significant Unit Analysis/Interpretation

Values Findings

RBC 4.6-6.2 Decrease x 1012/L Carbamazepine, fluphenazine, may cause low

levels of red blood cells. In this case, the patient
may experience symptoms of shortness of
breath, feeling tired, and pale skin.

WBC 3.5-12.0 Decrease x 109/L The client’s medication involves clozapine,

carbamazepine, risperidone, fluphenazine and
chlorpromazine, which can occasionally reduce
the number of white blood cells in the body. It is
necessary to check the WBC count of the patient
on a regular basis to identify changes early
before it can cause problems.

Neutrophil 3000-5800 Decrease x 106/L In relation to taking clozapine, risperidone, and

fluphenazine, small reduction on neutrophils can
occur which can lead to neutropenia. This may
put an individual more vulnerable to infection.

Eosinophil 50-250 Increase x 106/L Abnormally high eosinophil may occur due to
chlorpromazine, clozapine, medication.

Platelet 150-350 Decrease x 109/L Upon taking carbamazepine and fluphenazine,

count the patient’s platelets in the blood may reduce.
Any signs of bleeding should be reported, such
as frequent nosebleed, unexplained bruising, or
black & tarry stool.

ALT 7-56 Increase U/L Based on the medication, the patient is

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 prescribed with Carbamazepine, high levels of
liver function in the blood may occur hepatic
dysfunction.

Diagnostic Exam Normal Values Significant Findings Analysis/Interpretation

Electrocardiogram PR interval: 120-200 The patient may Abnormal ECG are associated
(ECG) ms (3-5 squares on demonstrate increased with antipsychotic taken by
ECG paper). prevalence of heart rate, the client such as
QRS duration: 120 QTc prolongation and chlorpromazine, clozapine,
ms (3 squares on pathological Q waves. and risperidone.
ECG).
QT interval: 440 ms

DSM-5 Normal findings Axis I Schizophrenia, The clinical disorder of the

Axis V 100 undifferentiated type patient is undifferentiated
Axis II Defer schizophrenia. In terms of
Axis III none personality disorder and
Axis IV Financial mental retardation category,
Difficulties defer is noted which means
Axis V 21-30 there is a delay in action and
decision making. There are no
general medical conditions
noted. Meanwhile, for
psychosocial and
environmental problems the
client experiences financial
difficulties. For the global

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 assessment functioning, the
client score noted is 21-30.
This indicates serious to
severe social impairment since
the GAF scale is below 50.

Physical General General Appearance: Generally, the client is

Examination Appearance: - The client is oriented to time, place, person
Well-developed, oriented and situation, and can take
well-nourished, Eyes: care of his hygiene as he can
appearing stated age. - Pupils are equal, be seen with clean hair, face,
round and reactive and in comfortable clothes.
Alert, oriented to
to light Eyes are in normal findings,
time, place, person,
Ears, Nose, Mouth, following the ears, nose,
and situation. Recent
Throat: mouth and throat. For the
and remote memory
- Oral mucosa is respiratory it also appears to
intact. Good insight
moist and there is be in normal findings since
and cognitive
no obvious breathing sounds are clear
function.
bleeding in the without wheezes, following
Eyes: gums. the appearance of the skin of
Respiratory: the client is in normal
Conjunctiva pink, - Breath sounds are findings.
sclerae white, without clear bilaterally
jaundice. Pupils equal without rales
round, react to light rhonchi or
and accommodation wheezing
(PERRLA). Visual Skin:
fields intact to - No ulceration or
confrontation. induration present

Ears, Nose, Mouth,

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 Throat:
Ears and nose without
deformity, external
tenderness or
discharge.
Lips normal color,
without lesions. Teeth
present, good dental
hygiene. Gums (or:
gingiva) and mucous
membranes pink
without bleeding
Respiratory:
No rales, ronchi,
wheezes, or rubs
Skin:
Skin warm, dry, with
good turgor, No
abnormal
pigmentation,
bleeding, rash, or
other lesions.

4. Drug Study

Generic & Classificati Mechanism Indication Contraindica Side & Nursing

Brand Name on of Action tion Adverse Responsibilitie
and Dosage Effects s

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Generic name: Tegretol Unknown. Indicated for Contraindicat Side effects: Watch for
Carbamazepine belongs to Thought to generalized ed in patients dizziness, loss worsening of
a class of stabilize tonic-clonic hypersensitive of coordination, seizures,
Brand name: drugs neuronal and complex to problems with especially in
Tegretol called membranes partial carbamazepin walking, patients with
anticonvuls and limit seizures, e or tricyclic nausea, mixed seizure
ants. seizure mixed antidepressant vomiting, and disorders,
Dosage: 200 activity by seizure s and in those drowsiness including
mg either patterns. with a history atypical
increasing May also be of previous Adverse absence
Drug class: efflux or used to treat bone marrow effects: seizures.
Anticonvulsant decreasing the suppression; skin rash, loss
influx of symptoms of also ℅ in of appetite, Never stop the
sodium ions epilepsy, those who right-sided drug suddenly
across cell trigeminal have taken an upper stomach when treating
membranes neuralgia MAO pain, dark seizures. Notify
in the motor and bipolar inhibitor urine, slow, fast the prescriber
cortex during mania. within 14 or pounding immediately if
generation of Tegretol may days of heartbeats, adverse
nerve be used therapy. fever, chills, reactions occur.
impulses alone or with Must be used sore throat,
other cautiously in mouth sores, Monitor lab
medications. patients with bleeding gums, tests such as
mixed seizure nosebleeds, baseline and
disorders pale skin, easy periodic CBCs
because they bruising, including
may unusual platelets,
experience an tiredness, reticulocytes,
increased risk lightheadedness serum
of seizures. , shortness of electrolytes and

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Also use with breath, serum iron,
caution in headache, liver function
patients with confusion, tests, BUN, and
hepatic severe complete
dysfunction. weakness, urinalysis.
feeling
unsteady, and Monitor for the
increased following
seizures reactions,
which
commonly
occur during
early therapy:
drowsiness,
dizziness,
light-headednes
s, ataxia,
gastric upset.

Give drug with

food to prevent
GI upset.

Do not mix
suspension with
other
medications or
elements—prec
ipitation may
occur.

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 Ensure that the
patient
swallows
tablets
whole—do not
cut, crush, or
chew.

Arrange for
frequent liver
function tests;
discontinue
drug
immediately if
hepatic
dysfunction
occurs.

Generic Classified Neuroleptic This Hypersensitivi Adverse Give with food

Name: as an that acts by medication ty; preexisting Reactions: or a full glass
Chlorpromazin antipsychot blocking the is used to CNS Tardive of fluid to
e ic drug postsynaptic treat certain depression, dyskinesia (on minimize GI
dopamine mental/mood coma, long-term distress.
Brand Name: receptor in disorders bone-marrow therapy).
Thorazine, the (such as suppression; Involuntary Ensure that the
Largactil, mesolimbic schizophreni pheochromoc movements of oral drug is
Chlorprom, dopaminergi a, psychotic ytoma; extremities may swallowed and
Chlorpromanyl c system and disorders, lactation. also occur. Dry not hoarded.
inhibits the manic phase mouth,
Dosage: release of of bipolar constipation, Mix

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50mg hypothalami disorder, urinary chlorpromazine
c and severe retention, concentrate just
Drug Class: hypophyseal behavioral mydriasis, before
Antipsychotic hormones. It problems in agitation, administration
has children). insomnia, in at least ½
antiemetic, depression and glass juice,
serotonin-blo convulsions; milk, water,
cking, and postural coffee, tea,
weak hypotension, carbonated
antihistamini ECG changes. beverage, or
c properties Allergic skin with semisolid
and slight reaction, food.
ganglion-blo amenorrhoea,
cking gynaecomastia, Ensure that the
activity. weight gain. drug is not
Hyperglycaemi chewed or
a and raised crushed. It must
serum be swallowed
cholesterol. whole.

Establish
baseline BP (in
standing and
recumbent
positions), and
pulse, before
initiating
treatment.

Monitor BP

25
frequently.

Monitor cardiac
status with
baseline ECG
in patients with
preexisting
cardiovascular
disease.

Be alert for
signs of
neuroleptic
malignant
syndrome.
Report
immediately.

Monitor I&O
ratio and
pattern: Urinary
retention due to
mental
depression and
compromised
renal function
may occur.

Monitor for
antiemetic

26
 effect of
chlorpromazine
, which may
obscure signs
of overdosage
of other drugs
or other causes
of nausea and
vomiting.

Generic Antiurolithi Promotes a For the Hypersensitivi Muscle Teach the

Name: c diuresis and treatment of ty to the drug; weakness, patient to take
Pinene alpha + relaxes urinary tract Patients with Dizziness, the drug by
beta, urinary tract spasm and severe colic, Stomach aches, swallowing the
Camphene, spasm, thus inflammatio anuria or Diarrhea, whole capsule.
Cineol, assisting the n associated severe Feeling of Do not
Fenchone, passage of with infection of suffocation, bite or chew the
Borneol, stones. The urolithiasis. the urinary Nausea, capsules.
Anethol and therapeutic Assists in tract. Stomach pain,
Olive Oil effect of the the Small eye Teach the
balanced dissolution pupils, patient to not
Brand Name: combination and Vomiting take a double
Rowatinex of terpenes expulsion of dose to make
reduces stones in the up for a
Dosage: urinary tract renal system. forgotten dose.
1 cap TID inflammation Just take it as
, stimulating soon as you
Drug Class: renal blood remember.
flow through Then go on
the kidneys taking your
and next dose at the

27
 increasing usual time.
the output of
less Remind the
concentrated patient to keep
urine. the capsules out
of the reach and
sight of
children.

Remind the
patient to not
store above
25˚C and to
store in a dry
place.

Generic name: Clozapine Clozapine's Clozapine is Contraindicat Adverse Clozapine can

Clozapine belongs to antipsychotic given in ed to patients Reactions: cause sedation
a class of action is severely ill with previous and impaired
Brand name: medication likely schizophreni hypersensitivi CNS: cognitive and
Clozaril, s called mediated c patients ty to Drowsiness, motor
FazaClo ODT, atypical through a who are clozapine or sedation, performance,
Versacloz antipsychot combination unresponsive any other dizziness, monitor the
ics. of to other component of vertigo, patient
Dosage: antagonistic therapies. this drug. headache, carefully for
100 mg BID effects at D2 seizures, CNS changes
receptors in This is also In patients syncope, and ensure the
Drug Class: the given to with tremor, patient’s safety.
Atypical mesolimbic reduce the myeloprolifer disturbed sleep
Antipsychotics pathway and risk of ative or nightmares, Monitor
5-HT2A recurrent disorders, restlessness, patients for

28
receptors in suicidal uncontrolled hypokinesia, or metabolic
the frontal behavior in epilepsy, akinesia, syndrome,
cortex. D2 schizophreni paralytic agitation, including
antagonism a or ileus, or a rigidity, significant
relieves schizoaffecti history of akathisia, weight gain and
positive ve disorders. clozapine-ind confusion, increased body
symptoms uced fatigue, mass index,
while agranulocytos insomnia, hypertension,
5-HT2A is or severe hyperkinesia, hyperglycemia,
antagonism granulocytope weakness, hypercholestero
alleviates nia. lethargy, ataxia, lemia, and
negative slurred speech, hypertriglyceri
symptoms. depression, demia.
myoclonus,
anxiety, fever. Monitor the
patient for
CV: signs and
Tachycardia, symptoms of
hypotension, myocarditis and
hypertension, cardiomyopath
chest pain, y.
ECG changes,
orthostatic Patients must
hypotension. immediately
report
symptoms of
EENT: infection,
Visual especially
flu-like
disturbances
symptoms.

GI:

29
Constipation,
excessive
salivation,
xerostomia,
nausea,
vomiting,
heartburn,
diarrhea.

GU:
Urinary
frequency or
urgency, urine
retention,
incontinence,
abnormal
ejaculation.

Hematologic:
Leukopenia,
neutropenia,
eosinophilia

Metabolic:
Hyperglycemia,
weight gain,
hypercholestero
lemia,
hypertriglyceri
demia.

30
 Musculoskelet
al:
Muscle pain or
spasm, muscle
weakness

Respiratory:
Respiratory
arrest

Skin:
Rash,
diaphoresis

Generic name: Risperidon Though its Risperidone Contraindicat Adverse Obtain baseline
Risperidone e belongs precise is indicated ed to patients Reactions: vital signs
to a class of mechanism for the with previous before starting
Brand names: medication of action is treatment of hypersensitivi CNS: therapy.
Risperdal, s called not fully schizophreni ty to Akathisia,
Risperdal antipsychot understood, a and risperidone or somnolence, Watch for
Consta, and ics. current focus irritability any other dystonia, orthostatic
Risperdal is on the associated component of headache, hypotension.
M-Tab. ability of with autistic this drug. insomnia,
risperidone disorder. It is agitation, Monitor the
Dosage: to inhibit the also anxiety, pain, patient for
2mg BID D2 indicated as parkinsonism, tardive
dopaminergi monotherapy neuroleptic dyskinesia
Drug class: c receptors , or adjunctly malignant which may
Antipsychotics and 5-HT2A with lithium syndrome, occur after
serotonergic or valproic suicide attempt, prolonged use.

31
receptors in acid, for the diziness, fever,
the brain. treatment of hallucinations, Watch for
Schizophreni acute mania mania, evidence of
a is thought or mixed impaired neuroleptic
to result episodes concentration, malignant
from an associated fatigue, syndrome
excess of with bipolar depression, (extrapyramidal
dopaminergi I disorder. tremor, effects,
c D2 and nervousness. hyperthermia,
serotonergic autonomic
5-HT2A CV: disturbance)
activity, Tachycardia, which is rare
resulting in chest pain, but can be fatal.
overactivity orthostatic
of central hypotension, Monitor the
mesolimbic peripheral patient for
pathways edema, symptoms of
and syncope, metabolic
mesocortical hypertension. syndrome
pathways, (significant
respectively. EENT: weight gain,
Rhinitis, increased body
sinusitis, mass index,
pharyngitis, hypertension,
abnormal hyperglycemia,
vision, hypercholestero
lemia, and
GI: hypertriglyceri
Constipation, demia)
nausea,

32
vomiting, Instruct the
dyspepsia, patient to take
abdominal the drug with or
pain, anorexia, without food.
xerostomia,
increased Advice the
saliva, diarrhea. patient to use
cautiously to
GU: prevent heat
Urinary stroke.
incontinence,
increased
urination,
decreased
libido.

Metabolic:
Weight gain or
loss,
hyperglycemia,
gynecomastia.

Respiratory:
Coughing
dyspnea, upper
respiratory tract
infection.

Skin:
Rash, dry skin,

33
 photosensitivity
reactions, acne.

Generic Diphenhyd Diphenhydra Diphenhydra Contraindica Side effects: Administer

Name: ramine is a mine HCl is mine is an ted to patients Drowsiness, with food if GI
Diphenhydrami first an antihistamin with: dizziness, upset occurs.
ne generation antihistamine e mainly hypersensitivi constipation,
antihistami with used to treat ty to the drug stomach upset, Administer
Brand Name: ne that is anticholinerg allergies. It itself, blurred vision, syrup form if
Benadryl used for ic (drying) can also be overactive or dry patient is
symptoms and sedative used for thyroid gland, mouth/nose/thr unable to take
Dosage: of allergic side effects. insomnia, increased oat may occur. tablets.
50 mg HS PRN rhinitis and Antihistamin symptoms of pressure in the
the es appear to the common eye, closed Adverse Monitor patient
Drug Class: common compete with cold, tremor angle effects: response, and
Antihistamine cold. It is histamine for in glaucoma, mental/mood arrange for
also cell receptor parkinsonis high blood changes (such adjustment of
commonly sites on m, and pressure, as restlessness, dosage to
used as a effector cells. nausea. stenosing, confusion), lowest possible
mild peptic ulcer , difficulty effective dose.
sleeping blockage of urinating,
aid. the urinary fast/irregular Since it’s just a
Diphenhyd bladder, heartbeat. standing order
ramine has enlarged Anaphylaxis and used as
not been prostate, an (rash, night sleeping
linked to inability to itching/swellin aid, monitor the
instances of completely g (especially of dosage to avoid
clinically empty the the complications.
apparent bladder, and face/tongue/thr
acute liver chronic oat,severe Instruct the
injury. idiopathic dizziness, client to take

34
 constipation. trouble the drug with
breathing), and food if GI upset
seizures. occurs.

Generic This drug A piperazine This drug is

Name: is under the phenothiazin used on
Fluphenazine classificati e that blocks patients with This drug Side Monitor the

Decanoate on post-synaptic Psychotic is Effects: patient for

antipsychot dopamine Disorders contraindi tardive

Extrapyram
Dosage: ics receptors in cated to dyskinesia
idal
1 cc (25 mg) the brain those after
Reactions,
IM hypersensi prolonged
tardive
tive to use which
dyskinesia,
Drug Class: drug and may appear
pseudoparki
Antipsychotics those with months or
nsonism,
coma, years later.
seizures,
CNS
neuro-malig Watch for
depression
nant symptoms
, bone
syndrome, of NMS.
marrow
sedation,
suppressio
EEG Do not
n, or other
changes, withdraw drug
blood
drowsiness, abruptly. Taper
dyscrasia,
dizziness instead.
subcortica
l damage,
or liver
damage Adverse

35
This drug Effects:
is to be
used Leukopenia,

cautiously agranulocytosis

in elderly , aplastic

individual anemia,

s or thrombocytope

debilitated nia, orthostatic

patients hypotension,

with tachycardia,

pheochro ECG changes,

mocytoma inhibited

, severe ejaculation,

cardiovasc gynecomastia

ular
disease,
peptic
ulcer,
respiratory
disorder,
hypocalce
mia,
seizure
disorder,
severe
reactions
to insulin
or ECT,
glaucoma,
mitral

36
 insufficien
cy, or
prostatic
hyperplasi
a

This is to be
used
cautiously in
patients
exposed to
extreme heat
or cold
(including
antipyretic
therapy)

Generic This drug This drug This drug is This drugs is Side Effects: Monitor BP
Brand: is classified relates to indicated for contraindicate Drowsiness, and pulse after
Biperiden under competitive the therapy d for patients euphoria, administration.
Hydrochloride anticholine antagonism of all forms hypersensitive disorientation,
rgic of of to biperiden, reduction in Change
Brand Name: acetylcholine parkinsonis narrow angle REM sleep positions
Akineton at m glaucoma, slowly
cholinergic (idiopathic, bowel Adverse especially from
Dosage: receptors in postencephal obstruction, Effects: recumbent to
2 mg OD PRN the corpus itic, and Decreased upright
for EPS striatum, arteriosclerot megacolon bowel sounds, position.
which then ic) urinary
restores the retention, Monitor for
balance To control delirium, adverse

37
 extrapyrami disorientation, reaction and
dal disorders anxiety, report
secondary to hallucinations, immediately
neuroleptic illusions,
drug therapy. confusion, Monitor Intake
incoherence, and Output
agitation,
hyperactivity, Educate clients
ataxia, loss of to not drive or
memory, engage in
paranoia, heavy
combativeness, machinery until
and seizure response to
may be present. drug is known.

The condition
can progress to
stupor, coma,
paralysis, and
cardiac and
respiratory
arrest and death

IV. NURSING CARE PLAN

1. Problem List

CUES NURSING DIAGNOSIS JUSTIFICATION

38
● “Inaasar ako pag Disturbed thought process Schizophrenia is a mental
nagma-masturbate related to mental disorder disorder that results in
ako” secondary to schizophrenia disturbed thought processes,
● “Nakita ko yung as manifested by sexual associative looseness,
vagina nung babae , delusions, hallucinations, delusions, and
yung sexy back at inappropriate social limited socialization
vagina nya” behavior, hallucinations, (asociality). The nurse
● “Ayaw nila sakin and assesses the patient for
ang yabang ko raw” suspiciousness. positive symptoms, negative
● “Nagagalit at symptoms, cognitive
minumura nila ako” symptoms and mood
● “Hindi ako symptoms. (WHO, 2018)
pinapansin nung
mga kaibigan ko, Disordered thoughts and
binabalewala ako, speech involve difficulty with
hinahayaan nila ako. thinking and speech, which
Hindi nila ako may be mild disorganized to
kaibigan. “Naiingit incoherent. This is a major
ako sa mga kaibigan symptom of schizophrenia.
ko” The patient's flow of thoughts
● “May katabi akong and ideas do not connect.
babae” (ITDC Nursing, nd.)
● “Oo nakikita, di ko
kasi nakita saturday
sunday, nagseselos
sila samen yung
tatay ko”
● “Nun nandun sila
samen, nagseselos
sila samen, kasi

39
 yung mga kaibigan
may mga kamag
anak.”
● “Minumura, iba
yung tingin nila
sakin nung nasa
paaralan, kasi yung
itsura ko, minumura
ako tsaka nanay ko”

● Auditory Disturbed sensory perception: Auditory hallucinations are

hallucinations. “May auditory and visual related to false perceptions of sound
mga bumubulong altered auditory and sensory while visual hallucinations
sakin” as verbalized perception as evidenced by are involved in seeing things
by the patient. visual and auditory that are not there. Auditory
visual hallucinations. hallucinations feature
hallucinations. prominently in many
● “May nakikita ako. psychiatric disorders.These
May katabi akong hallucinations are common in
babae.” as patients with Schizophrenia.
verbalized by the
patient.

● “ayaw nila sakin ang Impaired social interaction Poor social functioning is
yabang ko daw” as related to impaired thought seen in patients with
verbalized by the processes as evidenced by schizophrenia since certain
patient. inappropriate response to peers/ parts of the human brain are
● “Hindi ako others. responsible for social
pinapansin nung cognition were impaired.
mga kaibigan ko,

40
 binabalewala nila Some recent studies indicate
ako, hinahayaan nila that social cognitive skills are
ako. dependent on the connectivity
● ”Hindi nila ako of brain regions. Specific
kaibigan, Naiingit regions including amygdala
ako sa mga kaibigan for emotional processing, and
ko” medial orbitofrontal cortex
for cognitive control are only
some of the examples.
Schizophrenic clients have
dysfunction in the said
regions which impairs their
social cognitive performance
and social behavior.
(Dodell-Feder et.al, 2015)

● “naging biolente Risk for violence directed to Aggressive behavior and

sya” as verbalized others related to lack of impulsivity are often found in
by the patient’s impulsivity as evidenced by schizophrenia and can occur
mother. aggression and hostile during both acute and chronic
● The patient became behavior. phases of the illness.
destructive at home Impulsivity is defined as
and could not be action without planning or
tackled down reflection, and it seems to be
according to the related to a failure of
patient’s mother. behavioral filtering outside of
consciousness.

● Flight of ideas was Impaired verbal Schizophrenia patients are

41
 observed. communication related to known to experience two
● Redirects client to altered perception as evidence broad classes of
question by disturbances in cognitive communication difficulties:
associations. problems in conveying
meaning to others (expressive
language) and disturbances in
understanding the messages
of others (receptive
language).

● “Tumatawag lang Interrupted family process Family responses to having a

po, last 2016 yung related to mental disorder of a family member with
dalaw then hindi na family member secondary to schizophrenia include: care
dumalaw” schizophrenia as evidenced by burden, fear and
● “Kada 3 months changes in satisfaction with embarrassment about illness
tumatawag kasi family signs and symptoms,
binibigyan ako uncertainty about the course
pagkain tsaka pera” of the disease, lack of social
● “Gusto ko bisitahin support, and stigma. (South
ako everyone month, African Journal of Psychiatry,
oo nagtatawagan” 2016)
● “Masaya, naiisip ko
lang bigla nung nasa Untreated schizophrenia can
hospital ako naisip make people behave
ko na ampon lang erratically. The other partner
ako. May nang can find herself subject to
aagaw sakin” verbal abuse, emotional
neglect, and delusional
accusations. No healthy
relationship can sustain this.
(Iliades, MD. 2019)

42
● “Hindi ako Situational low self-esteem Regarding self-esteem as a
pinapansin nung related to lack of recognition consequence of mental
mga kaibigan ko, secondary to schizophrenia as illness, studies predictably
binabalewala ako, manifested by self-negating show that stigmatization and
hinahayaan nila ako. behaviors self-stigmatization may lower
Hindi nila ako self-esteem in persons with
kaibigan. Hinayaan mental illness. Low
lang nila ako, self-esteem also appears to
tinitignan lang nila increase the risk of
ako, ayaw nila ako psychiatric disorders such as
Naiingit ako sa mga depression, eating disorders
kaibigan ko.” and substance abuse. In
psychotic disorders, low
self-esteem has been
implicated in both the
development of delusions and
the maintenance of psychotic
symptoms. (BMC Psychiatry,
2011)

● "Hindi, tumatahimik Ineffective coping related to Individuals with

ako" as verbalized cognitive and perceptual schizophrenia tend to become
by the patient. impairment secondary to socially withdrawn because of
● "Tumatahimik ako, schizophrenia as manifested by the negative symptoms that
nagmumura". as saying foul words and not they experience. They may
verbalized by the verbalizing. also behave inappropriately
patient. such as becoming agitated
and shout or swear. Due to
these responses, friends and
family may misunderstand the
individual as being rude or

43
 hostile (Health Service
Executive, n.d.)

● “Masakit po yung Acute back pain related to The association of pain with
likod ko sir" as physical injuring agent as psychosis has yet to be
verbalized by the manifested by improper proved but some of the
patient. posture. studies shows that pain
● improper posture including headaches, leg, and
back pain are the most
common location of pain for
schizophrenic patients.

Postural dysfunction is
observed in individuals
diagnosed with schizophrenia.
Sensory functions and
Sensory Integration that are
responsible for postural
control are also compromised.
(Teng et.al .,2016)

● "Nagseselos sakin Defensive coping related to A study finding suggests that

ma'am ang pogi ko unrealistic expectations of self individuals with grandiosity
daw" as manifested by grandiosity have more positive symptoms
● "Nagkacrush sakin and are optimistic about the
mga babae, sa future. This allows them to
cellphone, yung cope with the stress caused by
magaganda the disorder (Bortolon et.al.,
● Maraming nag 2019)
kakacrus sakin"

44
45
 PROBLEM NO. 1: Disturbed thought process related to mental disorder secondary to
schizophrenia as manifested by sexual delusions, inappropriate social behavior,
hallucinations, and suspiciousness.

ASSESSMEN DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

T

Subjective: Disturbed Short Term: Independent:

“Inaasar ako thought process After 1 day 1. Explain to the 1. Giving a Short Term:
pag nag related to mental of client every clear After 1 day of
ma-masturbate disorder nurse-to-patie procedure before explanatio nurse-to-patient
ako” secondary to nt interaction, carrying them out n about the interaction, the
“Nakita ko schizophrenia as the patient procedure patient was able to
yung vagina manifested by will be able decreases develop trust with
nung babae , sexual delusions, to develop the anxiety the nurse, and
yung sexy inappropriate trust with the level of the verbalized his/her
back at vagina social behavior, nurse. patient, thoughts and
nya” hallucinations, this will concerns.
“Ayaw nila and Long Term: also help
sakin ang suspiciousness. After 4 days you to gain Long Term:
yabang ko of participatio After 4 days of
raw” nurse-to-patie n and nurse-to-patient
“ Nagagalit at nt interaction rapport. interaction the
minumura nila the patient patient was able to
ako” will be able 2. Provide 2. Reality-bas participate and have
“Hindi ako to sustain reality-based ed given the
pinapansin attention and interactions or activities appropriate amount
nung mga concentration activities to may help of attention and
kaibigan ko, to complete diverge the to decrease concentration to
binabalewala tasks or client’s attention delusional complete the
ako, activities. away from thoughts assigned activities.

46
hinahayaan delusional and
nila ako. Hindi After 4 days thoughts and hallucinati After 4 days of
nila ako of hallucinations, ons, these nurse-to-patient
kaibigan. nurse-to-patie activities like: activities interaction the client
“May katabi nt interaction ● Music and Art may also was able to name
akong babae” the client will Therapy aid in some of the coping
“Oo nakikita, demonstrate ● Recreational eliciting skills and has
di ko kasi coping skills Activities cognitive verbalized the use of
nakita saturday to minimize (guessing games, abilities, it to minimize
sunday, hallucination riddles, and etc) attention & episodes of delusion
nagseselos sila s& concentrati thoughts and
samen yung delusional on of the hallucinations.
tatay ko” thoughts. patient
“Nun nandun
sila samen, 3. Encourage 3. Maintainin
nagseselos sila healthy habits g a healthy
samen, kasi such as: physiologi
yung mga ● Maintaining c
kaibigan may regular sleep functioning
mga kamag pattern may
anak.” ● Eating healthy improve
“Minumura, and appropriate the client’s
iba yung tingin amounts of food. mood, and
nila sakin nung ● Maintaining decreases
nasa paaralan, medication the
kasi yung regimen likelihood
itsura ko, ● Proper hygiene of
minumura ako acquiring
tsaka nanay other
ko” diseases

47
4. Teach client 4. These are
coping skills to activities
minimize that the
delusional patient can
thoughts and do
hallucinations. independen
Coping skills tly to
including: minimize
● Exercise delusional
● Listening to thoughts
music/watching and
TV hallucinati
● Talking to ons
friend/attending
nurse

Collaboration:
1. Collaborate with 1. To achieve
other health maximal
team members in gains in
providing and function
assisting in and
rehabilitative psychosoci
activities. al
well-being.
Dependent:
1. Administer 1. To
medications are alleviate
prescribed by the the

48
doctor symptoms
of the
client.

49
 PROBLEM NO. 2: Disturbed sensory perception: auditory and visual related to altered
auditory and sensory perception as evidenced by visual and auditory hallucinations.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective Disturbed Short Term Independent: Short Term

Data: sensory Plan: 1. Decrease the 1. This Evaluation:
● “May mga perception: After 1 day, amount of stimuli in decreases the After 1 day, the
bumubulong auditory and the client will the client’s possibility of client is able to
sakin” as visual related be able to environment (e.g., forming trust the nurses and
verbalized to altered trust the low noise level, and inaccurate expresses his
by the auditory and nurses to few people) sensory hallucinations.
patient. sensory express his perceptions.
perception as hallucinations Long Term
● “May evidenced by . 2. Do not reinforce 2. Reality Evaluation:
nakikita visual and the hallucinations, orientation After 4 days, the
ako” as auditory Long Term let the client know decreases false client was:
verbalized hallucinations. Plan: that you do not share sensory 1. Able to
by the After 4 days, the same perception. perceptions and recognize his
patient. client will: enhances a auditory and
1. Be able to client's sense of visual
recognize self-worth and hallucinations.
auditory personal 2. Able to
and visual dignity. identify the
hallucinat factors that
ions. 3. Maintain reality 3. Keeping the contribute to
2. Identify through reorientation client oriented alterations in
factors and focus on real to reality sensory.
that situations and clarifies altered
contribute people. sensory
to perception.

50
alterations
in 4. Correct client’s 4. Explanation
sensory. description of of and
inaccurate participation in
perception, and real situations
describe the situation and real
as it exists in reality. activities
interferes with
the ability to
respond to
hallucinations.

5. Provide a feeling 5. To lessen

of security and anxiety,
stability in the suspiciousness
client’s environment and self-harm.
by allowing care to
be given by the same
personnel on a
regular basis if
possible.

Collaboration:
1. Collaborate with 1. To achieve
other health team maximal
members in gains in
providing and function
assisting in and
rehabilitative psychosocia
activities. l

51
 well-being.
Dependent:
1. Administer 1. To alleviate
medications are the
prescribed by the symptoms
doctor of the
client.

52
 PROBLEM NO. 3: Impaired social interaction related to Impaired thought process as
evidenced by inappropriate response to peers/others

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S

Subjective data: Impaired Short-term Independent: Independent: Short Term

social plan: Evaluation:
“Ayaw nila sakin interaction After 1 day of Remain with client The presence of After 1 day, the
ang yabang ko related to nurse-to-patien initial interactions a trusted client was able
daw” Impaired t interaction with others. individual to interact with
thought the client will provides a others in the
“Hindi ako process as attempt to feeling of presence of a
pinapansin nung evidenced by interact with security. trusted nurse.
mga kaibigan ko, inappropriate others in the
binabalewala response to presence of a Explain to the other Others may be
nila ako, peers/others trusted nurse. clients the meaning more accepting Long Term
hinahayaan nila of some of the of the client’s Evaluation:
ako. Long-term client’s nonverbal differentness if After 4 days, the
plan: gestures and they have a client was able to
”Hindi nila ako After 4 days signals. better interact with
kaibigan, client will: understanding others using
Naiingit ako sa of his behavior. behaviors that
mga kaibigan Client will be are socially
ko” as able to interact Use simple Positive, acceptable and
verbalized by the with others language to explain negative, and appropriate
client. using to client which aversive manner to the
behaviors that behaviors are reinforcements developmental
are socially acceptable and can contribute level.
acceptable and which are not. to desired
appropriate to changes in

53
developmental behavior.
level
Establish a The privileges
procedure for and penalties
behavior are individually
modification that determined as
offers rewards for the nurse learns
appropriate the likes and
behaviors and dislikes of the
renders an aversive client.
reinforcement in
response to the use
of inappropriate
behaviors.

Collaboration: Collaboration:
Collaborate with To achieve
other health team maximal gains
members in in function and
providing and psychosocial
assisting in well-being.
rehabilitative
activities.

Dependent: Dependent:
Administer To alleviate the
medications as symptoms of
prescribed by the the client.
physician.

54
 V. PROCESS RECORDING
1. Orientation Phase

DAY 1

Nurse Therapeutic Patient Analysis &

Technique Interpretation

Good Afternoon po, Giving Recognition “Robert” The student nurse asked
Ano po prefer nyo na the patient for a preferred
itawag namin sa inyo? nickname. This is to
establish rapport with the
client.

So magpapakilala po Giving Information ------- Introduction of the

muna kami, kami po student nurses for the
ang magiging student client to become familiar
nurses po ninyo ngayon with the names and faces
galing po FEU-NRMF building with the rapport
ako po si Aubrey and trust.
Matundan” Next in
order: “Marey...
Bianca… Maria…
Erlan…

Kami po yung student Giving Information ------- Orientation of the client

nurses na makikita niyo of the contract setting will
dito sa zoom for 2 provide the client an idea
weeks every Friday and of the role and
Saturday so 4 days in responsibility of the
total po. Tapos sa apat nurses in their care.
na araw na to
magkakaroon po tayo

55
ng mga activities para
naman po matulungan
kayo at mag enjoy kayo

Kamusta naman po Broad Openings Okay naman? Providing an opportunity

kayo? for the client to express
their thoughts or choose
the topic they would like
to talk about.

“Ngayon po ang first Giving Information “Sino ang student Orientation of the client
day natin so mag nurse?” of the contract setting will
kwentuhan lang po tayo provide the client an idea
para po mas makilala po of the role and
namin kayo, may responsibility of the
tanong po ba sila?” nurses in their care.The
client was able to ask a
question to clarify the
identity of the student
nurses.

Maari po bang Asking the patient for “Oo” Asking the patient for
magtanong ng tungkol consent consent before gathering
po sa background niyo? personal and medical
information regarding
himself.

Tanong ko lang po ilang Exploring “38 years old. May 22” The patient was able to
taon na po kayo? Kailan understand and answer
po ang birthday ninyo? the question of the nurse.

May asawa po ba kayo? Exploring “Wala, nanliligaw” The patient was able to
And kung may anak po understand and answer

56
ilan po ang mga anak the question of the nurse.
ninyo?

Saan po kayo nakatira? Exploring “56 Bagong Lote” The patient was able to
Doon po ba kayo understand and answer
lumaki? the question of the nurse,
however, he provided an
incomplete answer.

Nagtapos po ba kayo ng Exploring “Mechanical, 1 sem The patient was able to

high school o kolehiyo? lang, hindi ko natapos” understand and answer
Ano po ang course po the question of the nurse.
na kinuha ninyo?

Saan po kayo Exploring “Isabella Ospital po” The patient answered

pinanganak? which hospital he was
born, however, he did not
answer which location it
was.

Palagi po ba kayo Exploring ------- -------

binibisita ng pamilya
ninyo or mga friends
po?

Ano po yung libangan Exploring “Basketball, kasama The patient was able to
ninyo pag hindi po kayo sila Joshua at Ezkel…” understand the question
binibisita ng pamilya given and also gave
ninyo? names of some of his
playmates.

Ano po religion ninyo? Exploring “Catholic po” The patient was able to
understand and answered

57
 the nurse’s question right
away.

Kamusta naman po Encouraging “Kamuka mo tatay ko, The patient was not able
yung condition nyo Description of trabaho ko ay mag to answer the given
ngayon, may Perceptions jakol”. “May naririnig question; instead, he
nararanasan po ba ako sinasabi nila na answered something that
kayong mga sintomas hindi nila ako gusto was unrelated to the
nitong mga nakaraang kasi mayabang daw question given to him and
araw? ako” suddenly jumped from
one idea to another but
when the question was
repeated he was able to
answer the question given
to him.

Itong sintomas na po Focusing “Nagbubuti kapag The patient directly

itong nabanggit nyo, naliligo lang ako, answered the given
kelan po ba ito nakikita ko ang tatay ko question and then shifted
napabubuti o lumalala? sumasakit ang likod the topic from something
sabi ng nanay ko” unrelated to the subject.
“Inaasar ako pag
nag-mamasterbate po
ako” “everyday in two
days sir. Every other
day

Ano po yung mga Exploring “Mga vitamins, The patient was able to
treatment po na clozapine at gamot para answer the question and
pinagdaanan ninyo? ngipin, sumasakit kasi provide some of the
May gamot po ba? ngipin ko” procedure.
Therapy? “Ini-ecg ako, x-ray”

58
Vitamins po? ano po Seeking clarification “Vitamins, clozapine at The patient was able to
yun? gamot sa ngipin” repeat his answer to
clarify the question of the
student nurse.

Sa tingin niyo po ba Encouraging “Opo” The patient was able to

naging maayos naman expression repeat his answer to
po ba yung epekto nito clarify the question of the
sa mental health ninyo? student nurse.

Tanong ko lang po kung Exploring “Wala naman po, The patient was able to
nagkaroon na po kayo mahilig po ako sa kape answer the question and
ng sakit sa puso? minsan masakit” mention one of the factors
asthma? that possibly affect the
feeling of the pain in his
chest.

Wala naman po kayong Exploring “Wala naman” The patient was able to
iniinom gamot para sa understand and answer
puso? the question.

May allergies po ba? Exploring “Sa muka nangangati.” The patient was able to
understand and answer
the close ended question.

Allergy po ba to sa Seeking clarification “Hindi po sa panahon The patient was able to

pagkain or sa gamot? po” clarify the question given
by the student nurse.

May mga past surgeries Exploring “Injuries sa bike, The patient was able to
or injuries po ba? walang surgery. understand and answer
Sumasakit ulo ko, the close ended question.

59
 malala ito sabi ng
doctor”

So bukas magkakaroon Giving information Opo sir,....MA’AM! The patient agreed to the
po tayo ng activities, activities that the student
okay lang po ba sa nurse will be performing
inyo? on the following days.
This provides the
participation of the client.

2. Working Phase

DAY 2

Nurse Therapeutic Patient Analysis &

Technique Interpretation

Good Afternoon po Giving Information “Good afternoon, The student nurses

Ryan! Kami po ang okay lang po” introduce themselves
mga student nurse to the client to
from FEU-NRMF, establish rapport and
Kamusta po kayo? trust.

Naalala nyo pa po ba Exploring “Opo, yung kahapon The patient was able
yung mga pangalan po” to recognize the
namin? student nurses but
was not able to call
their names”

Kamusta naman po Encouraging “Nag enjoy po” The patient was able
yung activities ninyo expression to express himself to
kanina? Nag enjoy the student nurses.
po ba kayo sa mga

60
inihandang activities
ng mga student
nurses natin?

So ngayon po, Giving Information “Okay po” The patient was

gagawin lang po natin provided an idea for
yung ginawa natin the activity. This will
kahapon. Yung help client to become
nag-uusap lang po more aware. As well,
tayo. Magtatanong po for nurses to gain the
kami sa inyo at kayo trust of the patient.
rin po pwede mag
tanong sa amin kung
meron po kayong
gusto itanong.

Kagaya po kahapon, Giving Information ---- Providing

kung ano po yung information and
mapag-usapan natin reassurance to the
ngayon ito po ay patient about
hindi lalabas sa grupo confidentiality Nurse
na ito. Mananatiling reassures the client
confidential po ito. that the information
gathered will remain
confidential. This will
encourage client to
share personal
information and to
give trust to the
nurses.

Kelan po kayo Exploring “2014” The patient directly

61
nagsimula tumira answered the
dyan po sa Synergy question.
Nursing Homecare?

Bago po kayo tumira Exploring “Nasa ibang rehab The patient was able
sa Synergy saan po ako, laguna” to answer the
kayo nakatira? Sino question.
po yung mga kasama
po ninyo dun sa
bahay?

Kamusta naman po Encouraging “Masaya, may The patient was able

dyan sa synergy? expression bumubulong sakin.” to answer the
Komportable naman “Mabutii” question.
po ba ang pagsta-stay
ninyo?

Ikwento mo naman Exploring “Kumakain , The patient shared his

samin kung ano-ano natutulog, daily routine and
ang mga ginagawa nagtatanghalian, answered the
mo dyan sa isang tapos pagkatapos question given to
araw. Nakakaligo po kumain matutulog. him.
ba sila? Nakakakain Opo kumakain”
araw araw?

May kasama po ba Exploring “Si Jeffrey, Edison The patient was able
kayo sa kwarto (room kahapon” to answer the
mate?) question.

May gusto po ba Exploring “Gusto ko bisitahin The patient was able

kayong puntahan? ako every month, o to answer the
natatawagan ako” question and was able
to express himself

62
 about what he wants.

Saan po kayo Exploring “Isabela hospital” Patient directly

pinanganak? answered the
question where he
was born.

Ano-ano po yung Exploring “ Wala naman” The patient was able

mga naging trabaho to answer the
mo Ryan? question.

Sabi mo po kahapon, Focusing “Masaya, may mga The patient was able
nag-aral po kayo ng 1 best friend” to answer the
sem ng mechanical. question.
Saan na school po
iyon?

Gusto mo ba ang Exploring “hindi ko poo gusto” The patient was able
iyong kurso? to answer the
question.

Kamusta naman po Encouraging “masaya, may mga The patient was able
pakikitungo nyo sa Expression best friend” to answer the
classmates niyo dati? question.

Nagsisimba po ba Exploring “hindi na” The patient was able

kayo Ryan? to answer the
question.

Pwede niyo po ba Asking patient for “Naglalaro kami The patient was able
kaming kwentuhan consent patintero, Bike, to answer the
ng buhay po ninyo tumbang preso, question and share
nung bata pa po chako, sipa, tsaka nag the things he enjoyed

63
kayo? lalaro kami sa ulan.” when he was little.

Mahilig po ba sila Exploring “Chako, sipa, The patient was able

maglaro? Ano po chinese garter” to answer the
yung mga paborito question.
ninyong laro nung
bata pa po kayo?

Nung mga 20’s po Exploring “Masaya naman po. The patient answered
ano po yung naalala Nakikita ko yung and shared his
niyo? Ano ano po mga kabarkada ko. experiences in the
yung mga hilig niyo Masaya po. process of adulthood.
noon? Nakikipaglaro at
uminom ng alak”

Ano po yung dream Exploring “Waiter sa jollibee” The patient was able
job po ninyo nung to answer the close-
bata pa po kayo? ended question .

May kapatid po ba Exploring “May kapatid ma'am The patient was able
sila? Nung kasama ako gabi,bj, marlon, to answer the
niyo po yung mga ako apat kami question and shared
kapatid at magulang magkakapatid. Dami experience among his
niyo kamusta po yung nagseselos sakin kasi siblings.
relasyon niyo sa maganda daw akong
isat-isa? lalaki”

Dati po nung nakatira Asking “Masaya. Nung bata The patient was able
pa po kayo sa po ako nag inuman to answer the
pamilya niyo. po kami ng pinsan ko question.
Nakikipag usap po ba babae at lalki french
sila sa mga fries”

64
kapitbahay?

Meron po ba kayong Exploring “Meron po, marami. The patient was able
mga kaibigan? Pwede Magandang lalaki, to answer the
nyo po ba idescribe malakas, siga, question.
yung relationship nyo palamura.”
po sa kanila?

Gaano po kayo Exploring “Palagi po, simula The patient was able
kadalas mag nung 2009. to answer the
pakonsulta sa doctor Nagpapa-injection, question.
nyo? 500 isa.”

Kelan po ang huli Exploring “Chineck up kami The patient was able
nyong pag konsulta mga Last january to answer the
sa doctor nyo? lang. Si Dr. Pascual question.
Kamusta na daw,
palagi naman tanong
sakin kamusta”

Nitong mga Encouraging “Masakit po yung The patient was able

nakaraang araw po o Expression likod ko sir.” to answer the
linggo ay nagkasakit question.
kayo? O may iba po
kayong
nararamdaman?

Ano po yung mga Exploring “Okay lang naman The patient was able
karaniwang sintomas masaya.” to answer the
na nararamdaman “Nagkapanaginip question.
ninyo? ako.”

65
Ilang taon po kayo Encouraging “15. May The patient was able
nung nagsimula po Expression bumubulong sakin, to answer the
maramdaman niyo Maja , Kimchiu” question. However,
yung mga sintomas? “33 po” seems unsure in
Pwede niyo po ba answering the
idescribe samin? question about his
(repeat, tama po ba?) age when the first
symptom started.

Nabanggit niyo po Seeking information “Enervon , clozapine, The patient was able
samin last time na Carbamaziphine, to answer the
may iniinom po pyrosulfate” question, and he
kayong vitamins? included his other
Natatandaan niyo po medication even
ba yung pangalan though it was not
asked.

Nabanggit niyo po Seeking Information “Drawing” The patient was able

samin na naging to directly answer the
maganda yung epekto question.
ng treatment sainyo?
May nagustuhan po
ba kayong activities?

Dati po ba umiinom Seeking Information “Opo dati, minsan The patient was able
kayo ng mga alak or lang po” to answer the
naninigarilyo? question.

Yun lamang ang mga Giving recognition “Okay po” The patient listened
katanungan namin, and responded until
magkikita pa po tayo the last statement of
the student nurse.

66
sa susunod. Thank
you po.

DAY 3

Nurse Therapeutic Patient Analysis &

Technique Interpretation

Good afternoon ryan, Encouraging “Mabuti” Upon the first

Kamusta po kayo? Expression interaction, student
nurses allow the
patient to express his
feelings and thoughts.

So kami po yung Giving information ---------- The student nurses

nakilala nyo last introduce themselves
saturday/friday one by one for the
magpapakilala muna patient to recognize
sila sayo. Ako si them.
(Introduced ourselves
to the patient)

Yung gagawin po Giving Information ---------- The student nurse

natin kagaya ng last informed the patient
time on the activity. This
magkukwentuhan will provide an
lang po tayo, awareness and
Magtatanong po kami understanding for the
sa inyo at kayo rin po client.
pwede mag tanong sa

67
amin kung meron po
kayong gusto itanong.

Nabanggit niyo po Seeking information “Nagagalit at The patient was able

last time na may minumura ako” to directly answer the
naririnig po kayo na question.
boses nung unang
sintomas po ng
condition niyo,
narerecall niyo pa ba
kung anong sinasabi
nito kung okay lang
sa inyo na ishare.

May iba paba kayong Exploring “May katabi akong The patient was able
nararamdaman? babae” to directly answer the
question.

Nalalaman niyo ba na Exploring “Hindi po” The patient was able

hindi totoo yung to directly answer the
naririnig niyo? question.

Nung bago po ba “Gumaling na ako The patient was able

kayo nagkaroon ng nung dumating si to directly answer the
sintomas ay naiistress Pope Francis” question.
po ba kayo?

Clarify ko lang Seeking Clarification “Opo nung 2016” The patient was able
dumating si pope? to directly answer the
question.

May naiisip po ba Exploring “May tumatabi sakin” The patient was able
kayo na mga bagay to directly answer the

68
na nagpapalala sa question.
sintomas niyo?

Kamusta naman po Exploring “Masaya, naiisip ko The patient was able

yung relationship lang bigla nung nasa to express his
niyo with your hospital ako naisip ko thoughts about his
family? Madalas na ampon lang ako. family.
naman po ba kayo Masaya, naisip ko na
dati nagbobonding? ampon ako, may nang
aagaw sakin.”
“Minsan lang,
pumunta lang kami sa
perya sa cubao.”

Clarify ko lang po Seeking Clarification “Sisa yung sa laguna, The patient was able
pangalan ng nanay di po yun yung nanay to answer the
niyo ay sisa? ko po si arcenia” question.

Sino po si sisa? Exploring “Babae na nagtitinda, The patient are

di ko po kilala. inconsistent in
Tawag ko lang sisa.” answering the
question. At first, he
claimed sisa as his
mother, then ended
up being someone
that he made up in his
mind.

Madalas po ba sila sa Exploring “Tumatawag lang po, The patient was able
inyo dumadalaw? last 2016 yung dalaw to answer the
Ano po yung ibang then hindi na question and gave
way mo ng dumalaw” details on when was

69
pakikipag-communic “Kada 3 months their last
ate sa kanila? tumatawag kasi communication and
binibigyan ako what he did for them.
pagkain tsaka pera”

Sa family niyo po, Exploring “Opo, dumadalaw At first, the patient

meron po bang sakin” seemed to repeat his
miyembro sakanila na “Sino po?” answer from the
same po ng condition “Saming pamilya?” previous question.
niyo ngayon? “Wala po” But still was able to
clarify and answer the
question.

Ano po yung mga Seeking information “Masaya, maayos The patient was able
strengths niyo like amoy, malinis” to directly answer the
masipag, masayahin? question.

Ano naman yung mga Seeking information “Mabilis magalit, lagi The patient was able
weaknesses niyo like mainit ulo” to directly answer the
irritable, magastos? question.

Favorite color? Seeking information “orange, dilaw, blue” The patient was able
to directly answer the
question.

Favorite food? Exploring “Dinuguan , menudo The patient was able

and laing ” to directly answer the
question.

Ayaw na ugali ng Seeking information “Ayoko yung The patient was able
tao? nagmumura, nang to directly answer the
bubully” question.

70
So cla-clarify ko lang Seeking Clarification “Yung sa mga taong The patient was able
po. Ayaw mo po yung malalakas yung nasa to directly answer the
sa mga tao na court ganun po yung question.
nagmumura o ayaw ko.”
nagbubully?

Tanong ko lang po Exploring “Oo sumusunod po” The patient was able
kung pala sunod po to directly answer the
kayo sa batas question.
halimbawa sa tamang
tawiran, tamang
tapunan ng basura?

Nareport na po ba Exploring “Lumabag sa batas? The patient has a lot

kayo na lumabag sa Minsan huli, of additional
batas halimbawa po dumadaan kami sa information that
nagkakaraoke tapos kabilang daanan seems confusing at
hating gabi ganun. pupunta kase kami sa first. However, the
tita ko jeep colored question is still
kase bawal dumaan answered at the last
kami don sa kabila part of the statement.
don sa kabilang, color
coding”

Eto pong tanong ko Encourage expression “Minsan po nung The patient was able
kung komportable of perception second year po to share his
lang kayo ishare, if napagbintang akong experience in being
kayo mismo lumabag nanaksak, Jeffrey involved in an
sa batas or may coronado at ako po si accident.
nagawang krimen? ryan dela cruz”

Napagbintangan lang Seeking clarification “Opo” The patient was able

71
po? to directly answer the
question.

So, may mga Asking patient for “Opo okay” Asking the patient for
itatanong lang po consent consent before
kami ni Nurse assessing the patient.
Aubrey sayo para
ma-assess po yung
pag iisip po ninyo.
Okay lang po ba?

Ilang taon na po ba Exploring “38, 38” The patient was able

kayo? to answer the
question.

Alam niyo po ba Exploring “Synergy synergy The patient was able

kung nasaan po kayo home care, to answer the
ngayon? nagpapatayan dito” question. However,
during his last
statement, it doesn’t
suit the appropriate
response.

Anong araw po Exploring “5 - march 5” The patient was able

ngayon? to answer the
question.

Sino po ang Exploring “President Duterte” The patient was able

presidente natin to answer the
ngayon? question.

May sasabihin lang Giving information -------- Instructed the patient

po ako na 3 bagay on what to do.

72
and pakiulit po yung
sasabihin ko:

● Red rose Active listening “Red rose” The patient was able
to follow the
instruction by
repeating the given
word.

● Vanilla cake Active listening “Vanilla cake” The patient was able
to follow the
instruction by
repeating the given
word.

● High school Active listening “High school” The patient was able
to follow the
instruction by
repeating the given
word.

Pakiulit po lahat Active listening “Vanilla cake, high The patient was able
school, strawberry to follow the
cake” instruction by
repeating all of the
given words.

Okay alalahanin niyo Giving information -------- Reminded the patient

po yang tatlo kase on what to do
tatanungin po ulit kita
mamaya.

Pwede po pakiulit Active listening “Kamuka mo yung The patient was not

73
po? kaklase ko na nag able to answer the
aaral sa La Salle” question; instead he
“Kamukha mo yung answered something
kaklase ko, Gregorio that was unrelated to
elementary school” the question given to
him and suddenly
jumped from one idea
to another.

Bigyan niyo po ako Active listening “picha pie, spaghetti, The patient was able
ng tatlo pagkain fried chicken” to answer the
question.

Bigyan niyo po ako Active listening “kambing, falcon” The patient was able
ng tatlo animals to answer the
question.

Pwede niyo po ba Active listening “Mundo? The patient was able

ispell “MUNDO” O.D.N.U.M” to follow the
ngayon po pabalik instruction by
naman po mula “O” properly spelling the
given word
backwards.

Ano po ang tawag Making observation “salamin” The patient was able
dito? (Show glasses) to follow the
instruction by stating
the object that was
shown to him by the
student nurse.

Ano po ang tawag Making observation “Ballpen” The patient was able
dito? (Show ballpen) to follow the

74
 instruction by stating
the object that was
shown to him by the
student nurse.

Hawakan niyo po Making observation *nasunod The patient was able

yung ilong niyo gamit to follow the
ang iyong right hand instruction given by
the student nurse.

Hawakan niyo po Making observation *nasunod The patient was able

yung left ear niyo po to follow the
gamit ang iyong right instruction given by
thumb the student nurse.

Ano po ulit yung 3 Seeking Information “Strawberry cake… The patient was not
bagay na sinabi ko po ano yung isa? able to remember the
kanina? Strawberry cake lang words given before.
naman naaalala ko
ano pa ba? Chocolate
cake”

Kung naman po Encouraging “iceman, si iceman” The patient was able

magkakaroon kayo Expression to answer the
ng super powers ano question.
po kaya yun?

Maari nyo po bang Exploring “Dahil magiging ice The patient was able
iexplain sakin bakit ako tas lalamig ulo to answer the
yun ang napili nyo? ko, tsaka invisible question.
man”

Magtatanong naman Giving Information ---------------- Giving information to

75
po ako ng isang the patient about the
situation na kung instructions on what
saan sasagutin nyo po to do next.
ito sa kung ano po
ang naisip nyo.

Kung sakali po ay Encouraging “kukunin, kukunin ko The patient was able

naglalakad kayo at description of po, tas titignan” to answer the
may nakita kayo na expression question.
envelope na naka
sealed or naka sarado
pa, ano po ang inyong
gagawin?

Bubuksan mo po ba? Restating “Kukunin po at The patient was able

bubuksan ko” to answer the
question.

---------- Active Listening “Meron pong The patient suddenly

bumubulong sakin, expressed that he was
nagagalit sa nanay seeing and hearing
ko, nagmumura people whispering
nagseselos sa nanay and cursing with
ko. Nakikita ko po words.
dun sa taas.
Kay nanay po
bumubulong”

Sabi mo Ryan na Restating “Opo at sa taas” The patient was able

bumubulong nanay to answer the
mo? question.

76
Kelan mo last nakita? Exploring “Kanina lang” The patient was able
to answer the
question.

3. Termination Phase

DAY 4

Nurse Therapeutic Patient Analysis &

Technique Interpretation

Hello Ryan! Kamusta Broad Opening “Masaya, mamimiss This allow the patient
ka na? po namin kayo” to express his feelings
and thoughts

Nag enjoy ka ba Encourage “Masaya po” The patient was able

kanina sa program description of to answer the
natin? expression question.

Naaalala mo po ba Exploring “Opo” The patient was able

kami? At yung mga to answer the
bago nating student question.
nurses kahapon?

Osige, so Giving information ------- Every student nurse

magsisimula na po introduced
tayo. Uulitin lang po themselves so that the
namin. Ako po si... patient will recognize
(Introduced ourselves them. As well to
to the patient) So establish rapport.
I-eexplain ni Nurse

77
Macon ang gagawin
natin ngayon.

So ngayon po, nasa Giving information --------- The student nurse

termination phase na explained the things
po tayo ibig sabihin to be done for the day
eto na po ang last na to provide awareness.
pag uusap natin after As well, reassure the
ng 3 sessions. client that any
Kagaya po kahapon, information will be
kung ano po yung kept confidential. In
mapag-usapan natin this way, the patient
ngayon ito po ay will be more
hindi lalabas sa grupo encouraged to share
na ito. Mananatiling during the interview.
confidential po ito.

Naaalala niyo pa bo Encourage expression “Opo. Drawing. Nag The patient was able
pa lahat ng activities drawing kami, to recall and share his
natin, pwede mo po zumba, exercise, experience in the
ba ikwento yung mga kumain kami biscuit.” therapy conducted
nangyari? “Nagdrawing kami, this week.
zumba, exercise.
Kumain ng spaghetti.
Nakadalawang
spaghetti ako.”

San po kayo natuwa? Exploring “Drawing. Sa The patient was able

San po kayo drawing. Sa mga to determine the
nahirapan? games sa mga activity that he
paghuhula. enjoys, as well as the

78
 Paghuhula ng kanta, things that he finds
mga iba ibang difficult.
bagay.”

Tingin nyo po ba Reflecting “Opo, masayang The patient was able

itong mga activities masaya po kami ” to express his feelings
ay nakatulong sa inyo in terms of
? participating in the
activity.

Ano sa tingin mo ang Reflecting “Meron, sa pag iisip The patient had
mga changes na ko tsaka yung sa difficulty in sharing
nangyari after ng 3 galaw…. malungkot his perception.
sessions nang pag ako tapos sumaya”
uusap natin?

Ano ano po yung Reflecting “Gumaan yung The patient was able
mga natutunan niyo pakiramdam ko. to answer the
sa sarili niyo? Nag umaan ang question.
improve po ba? pakiramdam ko.”

So ryan since last day Encourage expression “Hindi ako The patient was able
natin. May gusto ka pinapansin nung mga to share his thoughts
bang itanong samin? kaibigan ko, and feelings.
Since lagi nalang binabalewala ako,
kami nag tatanong. hinahayaan nila ako.
Hindi nila ako
kaibigan.”
“Naiingit ako sa mga
kaibigan ko”

Sa nakwento nyo po Seeking clarification “Bek shoot lang ako The patient answered
samin. May kasi di ako abruptly.

79
nabanggit kang mga marunong, tsaka
kalaro sa basketball minsan sumasali ako”

Consider niyo po Seeking information “Opo” The patient was able

silang kaibigan niyo to answer the
question.

Sino pa ba ang Exploring “Si Joshua, Edison, The patient was able
considered nyo pong Edmon, Ian, Jeffrey, to identify and
mga kaibigan? Kenny…. mention his friend's
Ian, Jeffrey, Benedict, name.
Edison...”

Ano po ginagawa Exploring “Wala pumupunta The patient was able

ninyo? lang ako dun sa to answer the
manila” question.

So sa nabanggit nyo Exploring “Hindi po ako The patient was able

po Sir ah ryan masyado nagsasalita, to answer the
mayroon po kayong minsan lang” question.
mga kaibigan.

Bakit? May mga di Exploring “Hindi ako nag The patient only
ka ba naiishare or sasalita” repeated his answer
salita sa kanila? from the previous
May mga hindi ka ba question. However,
na-share kaya di ka he did not explain
nagsasalita? further.

Napagusapan natin Seeking clarification “Oo nakikita, di ko The patient was able
kahapon na parang kasi nakita saturday to answer. However,
may nabanggit ka na sunday, nagseselos at the end statement
may bumubulong he incorporates words

80
yung mommy, sila samen yung tatay that do not relate to
nararamdaman mo pa ko” the question.
din ba or nakikita mo “Nun nandun sila
pa din ba? samen, nagseselos
sila samen, kasi yung
mga kaibigan may
mga kamag anak,”

Saan sila nagseselos? Focusing “Oo” The patient was able

Sayo ba? to answer the
question.

Sige kwento mo lang Exploring “Nagseselos siya sa The patient tends to

nanay ko kasi.” skip in the middle of
“Nagagalit sa nanay the sentence, and
ko, tinutukso nanay change the topic.
ko.”

Ano na madalas na Exploring “Minumura, iba ying The patient was able
binbulong, oh ano tingin nila sakin nung to answer the
sinasabi sayo? nasa paaralan, kasi question and
yung itsura ko, indicated why.
minumura ako tsaka
nanay ko”

Kapag naririnig mo Exploring “Hindi, tumatahimik The patient was able

yung bumubuling ako” to answer the
sayo ano ginagawa question.
mo don para ma
lessen???

Kapag naririnig mo Exploring “Tumatahimik ako The patient was able

yung mga nagmumura, to answer the

81
bumubulong sayo, Nagseselos lang ata question given by the
ano yung mga sakin” student nurse.
ginagawa mo para
malessen? Diba may
mga bumubulong
sayo? Kinakausap mo
ba?

Kelan mo huling Focusing “Bihira lang, mga The patient was able
narinig yan? isang araw lang” to answer the
Ngayong araw “Nagseselos sakin question given by the
narinig mo po ma’am ang gwapo ko student nurse.
ba?Nung isang araw daw. “

Ryan diba nabanggit Seeking clarification “Medyo po, opo. yun The patient was able
mo na naririnig mo po” to answer the
sila? Pero alam mo ba “Kaibigan ko rin si question given by the
na yung mga naririnig liam borus michael student nurse. But
nyo ay parte ng coronel” added something
sintomas ninyo? unrelated to the topic.

Dati ba tuwing Formulating a plan of “Tutulog na lang po, The patient was able
nararamdaman mo action iinom ng tubig.” to answer the
yan ano ginagawa “Umiinom ng tubig” question given by the
mo? student nurse.

Kapag umiinom ka ba Reflecting “Opo nawawala” The patient was able

ng tubig to answer the
nabababwasan ba o question.
na wawala

82
Sa tuwing kailan mo Seeking clarification “Every two days” The patient was able
nararamdaman ulit to answer the
yon? question.

Meron ka pa bang Broad Opening “Kaibigan ko si The patient shared

gustong itanong george, nagkacrush what was on his
samin or sabihin? sakin mga babae, sa mind. He told us
cellphone, yung different things that
magaganda” are not related to each
“Maraming nag other.
kakacrus sakin”
“Yung pamilya ko po
nakikita ko”
“Nakita ko yung
vagina nung babae ,
yung sexy back at
vagina nya”

VI. PSYCHOTHERAPIES

Day 2: Feb 27, 2021 (Sat)

Therapy Definition Purpose Technique Analysis/

Interpretation

83
Recreational Recreational ● To improve This therapy The therapy
Therapy therapy are physical and takes place in a encourages the
activities that are cognitive virtual zoom patient to
mostly done for skills meeting as the express their
pleasure. They ● To decrease means of own thoughts
may help anxiety, communication and to elicit their
improve mental feelings of for the student cognitive
and physical isolation & nurses abilities through
health, as well as depression (facilitators) to a series of
relieve stress ● To develop the patients interactive
and help you ability to (participants). games such as
rest. express The patients riddles and
Recreational thoughts and were oriented guessing games.
activities are emotion about the This therapy not
typically done ● Increases therapy's only allows
away from work, self-esteem definition, them to think of
school and ● Strengthens purpose, and the possible answers
day-to-day life social steps that will be but also to
duties and by connections done by improve their
people of all participating in current mood.
ages. They can the siad games During this
be as passive as and activities. activity, we
reading a book The first game observed that the
or as active as was called clients were
swimming or “Bugtong” in actively
hiking. which the participating
student nurse trying out
who was different
facilitating the answers until
activity will read they were able to

84
and present come up with
riddles to the the correct
patients who are answers. We
the participants. were also able to
The patients will notice the
have to think eagerness of the
and guess what patients to
word is being answer the
presented behind questions or
the said riddle. images that are
Each riddle was being flashed on
answered and the screen as
the patients were they are focused
participating and silent before
well in the giving their
activity. answers. In
On the second conclusion, we
activity, a game can say that the
called “4 pics 1 therapy was a
word” was done success because
in which the the patients were
student nurses able to express
will show a slide their own
that contained thoughts and
four different answer what is
pictures but had being asked. We
the same word to can also
it. This was conclude that we
played by the somehow
patients trying to increased their

85
 guess the word self-esteem since
behind the we observed that
pictures being clients were not
shown to them. afraid to try out
The activity different
finished possible answers
successfully and that they could
the patients come up with.
showed interest
in participating.

Music & Art Art therapy is a ● Decreasing The therapy This type of
Therapy body-mind anxiety & takes place in a therapy
therapy. Many depression. zoom meeting as encouraged the
experts have ● Improving means of patients to
seen and self-esteem. communication. express their
documented ● Enhancing The student feelings in a
major benefits expressive nurses as form of music
among people and receptive facilitators and and art in which
who have done communicati the patient as our they are free to
art therapy, such on. participants, the draw what they
as improved ● Supporting patients were were currently
mood, fewer the grieving oriented about thinking and
depression process. the therapy's feeling while
symptoms, and ● Processing a definition, listening to the
better overall traumatic purpose, and the music being
quality of life. event. steps that will be played and then
Doing art ● Developing done during the openly express
therapy or coping skills. activity. Before their finished
making art on ● Strengthenin the therapy, the work to others.
your own can be g fine and patients prepared The patients

86
an effective form gross motor the materials were able to
of distraction as skills. that will be used dance during the
well. in the activity. fast instrumental
To start the and elicit a
activity, the positive affect
Music therapy facilitator played such as smiling.
uses music to a fast On the slow
promote healing instrumental instrumental, the
and enhance (upbeat) and let patient's are well
quality of life. the participants behaved and
It's a feel the music. focused in
complementary They're free to drawing. The
therapy that is dance and feel patients
used along with the music yet demonstrate
other cancer stays in their interest in the
treatments. It position. After activity given
helps patients the 1st music, evident by the
cope mentally the patients will patients act of
and physically be sitting down asking questions
with their and the 2nd and clarifying
diagnosis. Music music will be the procedure
therapy may played which is that is said. The
involve listening a slow outcome of the
to music, instrumental activity is
making music, (calming), satisfactory
singing, and during this because the
discussing period, the patients are able
music, along patients are to express
with guided going to draw on dreams and
imagery with a piece of paper aspirations in

87
music. using crayons their drawings
anything they yet there is one
want. The patient who isn't
patients are able to finish his
expressing their drawing because
thoughts and of time limit and
emotions he wasn't able to
through give its
drawing. When interpretation
patients are but only the
already done description.
drawing, each
patient will be
interpreting their
drawing to the
facilitators.
After the
activity,
facilitators will
collect and
check the
materials and
drawings if
complete then
all the drawing
will be compiled
for
documentation.

Day 3: March 5, 2021 (Fri)

88
 Therapy Definition Purpose Technique Analysis/
Interpretation

Recreational Recreational ● To improve The therapy In this activity, it

Therapy: therapy are physical and takes place via encouraged
Pinoy Henyo activities that are cognitive Zoom meeting. interaction
mostly done for skills At the between each
pleasure. They ● To decrease beginning, each partner. This
may help anxiety, student nurse allows them to
improve mental feelings of introduced have a social
and physical isolation & themselves to relationship with
health, as well as depression the participants. the other
relieve stress ● To develop The first activity individual. Also
and help you ability to is a game called it challenges
rest. express the “Pinoy their cognitive
Recreational thoughts and Henyo,” upon skills, since in
activities are emotion starting the the game it let’s
typically done ● Increases student nurse a person be the
away from work, self-esteem explained the guesser as well a
school and ● Strengthens definition, clue giver.
day-to-day life social instructions, and In other words,
duties and by connections objectives of the it allows a client
people of all game. The client to experience
ages. They can takes turns in both sides of the
be as passive as being a guide game. The
reading a book and being the “guesser” is able
or as active as one to guess the to explore their
swimming or word. Each mind and come
hiking. partner is given up with
a time which is questions that
monitored by the potentially can

89
 student nurse lead them to the
facilitator. answer.
Meanwhile, the
“clue-giver” is
able to
understand the
question and
respond
appropriately.
During this
activity, most
patients guess
the words right
and some are not
able to guess
correctly. Still, it
was a success.
The
collaboration
and interes are
shown by the
client.

Bibliotherapy: Bibliotherapy is ● To provide The therapy This therapy

Storytelling a form of information takes place in a allows the
(Ang batang therapy in which or insight zoom meeting as participants to
Ayaw maligo) structured ● To stimulate means of understand the
readings are discussion communication. lesson behind
used as an about The student the story. This
adjunct to problems nurses as also provides
psychotherapy. ● Communicate facilitators and them with how

90
 It can be used to new values or the patient as our important it is to
reinforce attitudes participants, the take care of
learning or ● Create patients were ourselves.
insights gained awareness of oriented about During the
in the the existence the therapy's activity, we
therapeutic of the definition, and observed that
session or to problem in purpose. The they put
give individuals the wider 2nd activity is a attention in the
additional population form of presented video.
professional ● To provide storytelling They were able
resources to help potential entitled “Ang to actively listen.
in personal solution to the Batang Ayaw Therefore, the
growth and problems Maligo.” This is conducted
development presented activity was a
through a success.
recorded video.
In the content of
the story, it
includes lessons
and realization
about self care.
Generally, in this
activity the
client will watch
the video as well
understand the
message behind
the story.

Recreational Recreational ● To improve The therapy In this 3rd

Therapy: therapy are physical and takes place in a activity, it

91
Exercise activities that are cognitive zoom meeting as requires
mostly done for skills means of participants to
pleasure. They ● To decrease communication. move their body
may help anxiety, The student which is helpful
improve mental feelings of nurses as in their overall
and physical isolation & facilitators and health physically
health, as well as depression the patient as our and mentally.
relieve stress ● Increases participants, the During the
and help you self-esteem patients were activity, we
rest. ● Strengthens oriented about observed that the
Recreational social the therapy's members really
activities are connections definition, put an effort to
typically done ● Improved purpose, and the follow the steps
away from work, muscle tone steps that will be in the video.
school and and strenght done during the They are
day-to-day life activity. The last actively
duties and by activity for the watching at the
people of all 3rd day is a form same time
ages. They can of exercise. In dancing through
be as passive as the therapy, the the music. In
reading a book participants are conclusion, it
or as active as provided with a was successful
swimming or video, as well as each patient
hiking the student nurse performed and
will take a role participated in
as a dance the zumba
instructor which activity.
will guide the
clients for the
next step of the

92
 dance.

Day 4: March 6, 2021 (Sat)

Therapy Definition Purpose Technique Analysis/

Interpretation

Recreational Recreational ● To improve The therapy This type of

Therapy: therapy are physical and takes place in a therapy
Category game activities that are cognitive zoom meeting as encourages the
mostly done for skills the means of participants to
pleasure. They ● To decrease communication. participate in the
may help anxiety, The student game which
improve mental feelings of nurses as increases their
and physical isolation & facilitators and self-esteem and
health, as well as depression the patients as reduces their
relieve stress ● To develop our participants, anxiety and their
and help you ability to the patients were feelings of
rest. express oriented about isolation or
Recreational thoughts and the therapy's depression. It
activities are emotion definition, and also enables
typically done ● Increases purpose. The them to improve
away from work, self-esteem first activity is their cognitive
school and ● Strengthens called the skills by
day-to-day life social Category Game, challenging
duties and by connections wherein the them in trying to
people of all facilitators will guess and think
ages. They can present their of what category
be as passive as slides and on the group of
reading a book each slide there words shown in
or as active as are words that the slides are in.

93
swimming or the participants During the
hiking. will have to activity, we
guess the observed that the
category of participants in
those words. the game are
showing their
interest in the
activity and that
they were able to
answer all of the
slides. In
conclusion, we
can say that the
therapy was a
success and that
we have
somehow
increased their
self-esteem since
we observed that
clients were
answering
properly and are
not afraid to try
out different
possible answers
that they could
come up with.
They were also
able to express

94
 themselves in an
active manner.

Humor Humor therapy ● To facilitate This therapy In conclusion to

Therapy: (sometimes the expression takes place in a this therapeutic
Bubble gang called of feelings, zoom meeting as activity, it was a
segment therapeutic thoughts and means of success since we
humor) involves emotions communication. have observed
humor and uses ● To enhance The student that the
the power of interactions nurses as the participants are
smiles and ● To decrease facilitators and more likely to
laughter to aid anxiety, the patients as pay attention
healing. Humor feelings of our participants, and show more
therapy helps isolation & the patients were interaction when
you find ways to depression oriented about watching videos
make yourself ● To release the therapy's that were being
(or others) smile fears, anger, definition, and shown to them.
and laugh more. and stress, all purpose. After We have also
of which can orienting the somehow
harm the clients about the decreased their
body over 2nd activity, a anxiety since we
time. recorded video have observed
was presented to their reactions of
them. In the laughing and
content of the smiling while
video, it includes watching the
comedic and video. It kept
entertaining them entertained
scenes that were and that they
played by the were able to
student nurses, laugh and/or

95
inspired from express their
the show bubble thoughts,
gang. feelings and
emotions not
only to
themselves but
to others too.

96
BIBLIOGRAPHY

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https://www.who.int/mental_health/world-mental-health-day/paper_wfmh.pdf
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/diphenhydramine
-hydrochloride/
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gretol/
https://nurseslabs.com/schizophrenia-nursing-care-plans/6/
https://www.aamft.org/Consumer_Updates/Schizophrenia.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138106/
https://www.everydayhealth.com/hs/schizophrenia-caregiver-guide/coping-with-schizophre
nia-as-a-family-pictures/
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-136
http://www.southsudanmedicaljournal.com/archive/may-2010/how-to-read-an-electrocardi
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https://www.rdash.nhs.uk/wp-content/uploads/2014/02/DP5865-Clozapine-web.pdf
https://www.pharmachoice.com/medication_search/tegretol/
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97