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A CASE STUDY OF

SUBSTANCE- INDUCED PSYCHOSIS

In Partial Fulfillment of the Requirements

in Nursing Care Management 102

Presented to the level III Clinical Instructors

Of Davao Doctors College

General Malvar Street

Davao City

By:

Abregana, Sheryl; Alinas, Kareen; Aparri, Alona; Cole, Sharon; Danque, Jobelle

Marie; Ebus, Jockra; Eguna, Jay-ar; Esteban, Carl


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TABLE OF CONTENTS

Page no.

CHAPTER I INTRODUCTION1CHAPTER II OBJECTIVES OR PURPOSE...4

CHAPTER III ANAMNESIS.....5

A. Informants5

B. Family Tree.15

a. Maternal and Paternal Lineage15

b. Parents.15c. Subject.17

CHAPTER IV COURSE IN THE HOSPITAL...18

A. Mental Status Examination

upon Initial and Final Introduction....18

B. Progress Notes and other Observations

on the Succeeding Interaction...26

CHAPTER V PSYCHODYNAMICS....36

A. Tabular Presentation.36

B. Schematic Presentation...38

CHAPTER VI LABORATORY EXAMINATIONS and RESULTS

of PSYCHOLOGICAL TESTING..40

A. Neuropsychological Test....40

B. Laboratory Test....41

CHAPTER VII DIAGNOSIS..42CHAPTER VIII MEDICAL MANAGEMENT.

CHAPTER IX NURSING CARE PLAN..

CHAPTER X PROGNOSIS and RECOMMENDATIONS..

CHAPTER XI BIBLIOGRAPHY...

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I. INTRODUCTION

Those aspects of clinical nursing care that involve interpersonal

relationship with individuals and group as well as a variety of other activitiescharacterize the practice of Psychiatric Nursing. Direct nursing care functions

may involve individual psychotherapy, group psychotherapy, family therapy

and sociotherapy. Our knowledge about the causes of mental disorders is

limited and until we know more, it will be difficult to measure with confidence

the results of prevention efforts. Certain life experiences are almost universal

and they are of such a critical nature that each can be examined as a unique

phenomenon. The persons involved would have developed mental illness hadone intervention not been made, it is not unreasonable to assure that

reduction of the intensity of stress associated with the experience by making

many of the unknown known lowers the likelihood of maladaptive behavior

and future unhealthy coping practices. (Manfrela and Krampity, Psychiatric

Nursing, 10th Edition)

A substance-induced psychotic disorder is sub-typed or categorized

based on whether the prominent feature is delusions or hallucinations.Delusions are fixed, false beliefs. Hallucinations are seeing, hearing, feeling,

tasting, or smelling things that are not there. In addition, the disorder is sub-

typed based on whether it began during intoxication on a substance or during

withdrawal from a substance. A substance-induced psychotic disorder that

begins during substance use can last as long as the drug is used. A

substance-induced psychotic disorder that begins during withdrawal may first

manifest up to four weeks after an individual stops using the substance. The

effects of drugs including alcohol, medications, and toxins directly cause a

substance-induced psychotic disorder, by definition.

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Psychotic symptoms can result from intoxication on alcohol,

amphetamines (and related substances), cannabis (marijuana), cocaine,

hallucinogens, inhalants, opioids, phencyclidine (PCP) and relatedsubstances, sedatives, hypnotics, anxiolytics, and other or unknown

substances. Psychotic symptoms can also result from withdrawal from

alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances.

The speed of onset of psychotic symptoms varies depending on the type of

substance. For example, using a lot of cocaine can produce psychotic

symptoms within minutes. On the other hand, psychotic symptoms may result

from alcohol use only after days or weeks of intensive use. (Kaplan, Harold I.,M.D., and Benjamin J. Sadock, M.D. Kaplan and Sadock's Synopsis of

Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th edition. Baltimore:

Williams and Wilkins, 2002.)

Substance abuse problems are serious medical and public health

issue responsible for increasing levels of morbidity and mortality as well as

considerable burden of disease in the united states and world wide (Holman,

English, Milne, & Winter, 1996). The 1996 US Preventative Services TaskForce recommended screening for alcohol dependence, abuse and risky or

harmful drinking by health care workers (Conigliaro , Lofgreen , & Hanusa,

1998). The National Institute on Alcohol Abuse and Alcoholism [NIAAA]

(2003, 2005) recommended that all primary care patients be screened for

alcohol use. The New York City Department of Health and Mental Hygiene

(2005) offered a continuing medical medication program to New York State

licensed physicians and nurse practitioner (NPs) promoting screening and

brief intervention (SBI) of all primary care patients for alcohol problems.

Screening and brief intervention is a clinician delivered counseling technique

that helps patients reduce risky behavior (NIAAA, 2005). It is a 4 step non

confrontational, non judgmental, and matter of fact approach that assesses

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current alcohol use, assesses for current abuse or dependence problem

( American Psychiatric Association, 2000), abuse or dependence problem

( American Psychiatric Association, 2000), provides patient with advice And

assistance to maintain healthy use, and provides follow up to support efforts

to maintain positive changes. The principles of SBI maybe applied to address

problematic use of other drug abuse.

The NIAAA (2005) standards identify problem drinker as those who

consume more than the recommended daily, weekly, or per occasion

amounts of alcohol. Maximum recommendation are 1 standard drink per day (

12 oz. of beer, 5 oz. of wine, or 1.5 oz. of distilled 80% proof spirits) for adult

women and persons older than 65 years not to exceed 7 drinks per week and2 drinks per day for adult men not to exceed 14 drinks per week. Risky or

binge drinking is identified as intake of more than 4 drinks per drinking

episode for women and 5 drinks for men, not necessarily exceeding the

weekly maximum of 14 drinks recommended by the NIAAA.

Illicit drug use is a contributing factor to many health related

consequences, including the transmission of HIV/AIDS, Hepatitis B and C,

and Tuberculosis (National Institute of Drug Abuse, 2003). In this project, any

illicit drug use was classified as problematic; including abuse of prescription

medication and use of illicitly procured street drugs. (Lori A. Neushotz and

Joyce J. Fitzpatrick: Improving Substance Abuse Screening and Intervention

in a Primary Care Clinic, Archives of Psychiatric Nursing, Vol. 22, No. 2

(April), 2008: pp 78-79)

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II. OBJECTIVES

General objectives:

In three weeks span of care, the proponent of the study will develop a

thorough perception about on A selective case, which is schizophrenic type

and to comply with requirements in nursing care management 102.

Specific objectives:

1. Compose an introduction and gather the background information of our

case as well as the brief history of the patients case that might affect her

present condition.2. Formulate specific, measurable, attainable, realistic, and time bounded

objective to serve as our guide in making the case study;

3. Trace the anamnesis of the patient by assessing psychological and

physiologically, collecting subject and objective data, gathering information in

the physical, psychological, social, familial and other aspect of health status

of the client and assessing her in great detail in a holistic manner.

4. Evaluate the client using the mental status examination the map out

progress notes of the client;

5. Present the predisposing and precipitating factors manifested by the client

and draw the schematic presentation;

6. Present laboratory examinations and diagnostic evaluation relevant to the

condition of the patient.

7. Discuss the patients medical diagnosis based on the clinical judgment,

conclusion and review of related information;

8. Discuss patient differential diagnosis and interpret it appropriately

9. Present the medical management the therapies appropriate to the clients

case;

10.Enumerate the identify drugs its action and the nursing responsibilities

accompanied by it;

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11.Present prognosis on the care towards the patient;

12.Present recommendation on the care towards the patient;

13.Present the sources used necessary for the completion of this case study.

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II. ANAMNESIS

A. Informants

Informant 1

Name: A.M.S.

Age: 86 years old

Address: Lot 19 Block 22 Pink St. Corner Orange Rojo, Dacoville Subd. Toril,

Davao City

Relationship to patient: FatherLength of time known of the patient: 56 yrs.

Apparent understanding of present illness of patient: The father verbalized,

Gipa-admit namu na siya sa Babista tungod naga-wild na siya pag mahubog.

Kada adlaw na lang jud na siya ga-inom, ug makasakit na ug lain pag

mahubog na.

Other Characteristics and Attitude of the Informant: The informant is friendly

and accommodating all throughout the interview. His thoughts are

preoccupied with low self-concept, negativism or hopelessness, and death-

related topics. He is not so orientated to time since he easily forgets. His

speech is sparse, repetitive and slow response.

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Informant 2

Name: A.M.J

Address: Lot 19 Block 22 Pink St. Corner Orange Rojo, Dacoville Subd. Toril,

Davao City

Relationship to patient: Younger Brother

Length of time known of the patient: 46 yrs.

Apparent understanding of present illness of patient: During the interview, he

verbalized, Katong adlawa buntag sayo iyang gina-bang ang door pabalik-

balik. Gibadlong nako siya, nasuko siya ug iya ko gilabay ug bato. Dili nagyud normal iyang nilihukan, dapat na gyud namo siya ipaadmit usab kay

dilikado na basig kami pa madisgrasya niya. Abnormal naman pud kaayo

nilihukan niya ato. Mao gipasulod nalang gyud namo siya sa Babista kay

murag nituyok naman gud utok niya sa iyang mga bisyo.

Other characteristics and attitudes: The informant is the primary care taker of

the patient. He is friendly and cooperative all throughout the interview. He

answered the questions spontaneously and with confidence.

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Informant 3

Name: Er. G

Address: Lansona, Matina, Davao City

Relationship to the patient: Sister


Apparent understanding of the present illness of the patient: As verbalized by

his sister, Naay kaisa gitawag na siya sa iyang amigo, unya pagbalik niya

kay nag kurog-kurog na siya. Ingon siya sa amo dal-a ko ninyo sa doctor kay

taas na kaayo ko. Ngano nakaingon man siya nga taas na siya maam,naunsa diay siya ato?, asked by the student nurse. Nag gamit man gud sila

drugs unya injection pa jud, mao jud to nakadaot sa iyang utok. answered by

the informant. Unsa pud iyang gamit na injection maam sa imong nahibaw-

an? Nubain, informant answered.

Other characteristic & attitude of the informant: The informant does not know

more about the client because shes not the one who took good care of the

client. She was studying when the client became violent. She is also younger

than Mr. Vin. Although, throughout the interview, she answered the questions

and there were instances also that she defended her parents the way her

parents raised Mr. Vin.

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Informant 4

Name: Raffy Aron

Address: Dacoville, Toril Davao City

Relationship to the patient: Neighbor


Apparent understanding of the present illness of the patient: Dili mana nako

siya ginatagaan og tuba kung mupalit kay kabalo man me sa iyahang sakit na

kung mahubog mutukar na siya , as verbalized by their neighbor.

Other characteristic & attitude of the informant: The informant is the Tuba

vendor in their place. He is cooperative throughout the interview and

answered all the questions being asked by the student nurse.

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Informant 5

Name: Eve




Apparent understanding of the present illness of the patient: Mu adto na siya

diri magdala ug tanduay. Diri na niya gina inom siya ra pud isa atubangan sa

amo tindahan. Dili na namo ginatagaan ug tuba kay basig unsa na pud

buhaton pag mahubog, mutuyok na pud iyang utok., as verbalized by theinformant.

Other characteristic & attitude of the informant: This informant is the wife of

Tuba vendor in Dacoville. She is also cooperative and direct to the point

answering all the questions I asked.

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Informant 6

Name: Dodong




Apparent understanding of the present illness of the patient: The informant

verbalized,Magsige man gud na sila gamit ug marijuana, mao jud tong

nakadaot sa iyang utok ba.

Other characteristic & attitude of the informant: The informant is confident and

direct to the point in answering the question with eye-to-eye contact.

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Informant 7

Name: Zen




Apparent understanding of the present illness of the patient: Kana si Vinz

mao naingon-ana siya kay tungod sigeg gamit marijuana, mao tong

nakapatuyok sa iyang utok. Pag mahubog pud mag maoy,as verbalized by

the informant.

Other characteristic & attitude of the informant: The informant was very warm

and opens to everyone. He was cooperative throughout the interview and

answered all the questions being asked.

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Informant 8

Name: Carlito




Apparent understanding of the present illness of the patient: Si Vinz buotan

man na siya, mag sakaysakay sa akong tricycle na walay bayad-bayad. Kung

naay pasahero gusto musakay dili na lang kay naa man si Vinz nanimaho kaywala man siyay ligo ug ilis

Other characteristic & attitude of the informant: This informant is the one who

saw Mr. Vinz in Dacoville. He is a tricycle driver. He is very cooperative and

he shared all the details he knows about Mr. Vinz.

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Informant 9

Name: Rodi




Apparent understanding of the present illness of the patient: Maglakaw-lakaw

man na siya magsigeg yawyaw bisag walay kaistorya , nakit-an pud nako

siya na naghubo tanan, kung mahubog siya mag ma-oy, usahay muadto siya

diri sa balay mangayo ug pagka-on gina tagaan naku siya pero sa gawas ranako gina pakaon basig mag wild diri sa sulod. Tapulan pud kaayo na si

Vincent gana-gana lang mu trabaho

Other characteristic & attitude of the informant: This informant is the long time

friend of the father of Mr. Vinz. He shared the information he knows about Mr.

Vinz, he is interactive with eye-to-eye contact.

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Informant 10

Name: Mel




Apparent understanding of the present illness of the patient: Mag istorya lang

man na si Vinz siya lang isa, ginalabay niya ang botilya sa tanduay gawas sa

ilahang gate kung mahuman ug inum sa tanduay, makig istorya man siya

usahay pero kaisa nadunggan nako iyahang papa nangayo ug tabang, dali-dali dayon ku ug gawas kay ge tabangan nako iyang papa nga puspusan

unta niya ug kahoy na bangko, nagpatunga ku sa ilaha pero ge labay gihapon

ni Vinz ang bangko likod sa iyahang papa.

Other characteristic & attitude of the informant: This informant is the one who

witnessed what Mr. Vinz can do to his father. He shared to us all the details

that he knows.

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a. Maternal and Paternal Lineage

According to Mr. Vins father, their family has no known history of

hereditary illnesses either mental, nervous, cardiopulmonary and other

illnesses. In addition, they have no history of drug addiction and suicide, since

he said that he strived hard to survive and sustain his familys needs.

However, they have history of alcoholism. The Grandfather of Mr. Vin is a

former Guerilla member during the Japanese era. Yet, he has joined the

Armed Forces of the Philippines after the Japanese Colonization and World

War II and was killed by Japanese soldiers during the war. He also added that

his wifes lineage is known to be asthmatic and has hereditary illnesses of theheart. It was further added by A.M.J.(8 th child) that there is a history of

alcoholism, delinquency and drug addiction on their mothers side since they

have a cousin (mothers niece) who is known to be admitted in a rehabilitation

center due to drug addiction.

b. Parents

The father of Mr. Vin is a retired Colonel of the Armed Forces of the

Philippines. He was not always present during his growing years because of

his occupation, which is very unstable in terms of location. When asked how

he is as a father/husband, he said that he is kind, hardworking and a good

provider to his family. He said that Mr. Vin once beaten by a broomstick

during his teenage years. However, he often gives consideration to Mr. Vin

despite his sons superiority, vices and delinquency.

When Mr. Vin was imprisoned for many times when he was still in

high school, he said that he always went home to bail out his son. But there

was a time when he left his son in jail to teach him a lesson, but his wife cried

and persuaded him to get Mr. Vin out of jail. His philosophy about a husband

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and wife relationship, involves each of them in supporting the childrens

financial and basic need, and family planning should not be practiced. For

him, he is the provider of the family in terms of money while the mother is the

one giving guidance to their children. In upbringing their children, he is always

away from home due to his job so he seldom bond with his children even on

important occasions in the family. He is financially stable and can adequately

provide the needs of his family. He was not able to finish his law education so

he ended up as a noble soldier. He was a former Guerilla member during the

Japanese era. His failures as a father are: 1. showing too much consideration

to Mr. Vin which made his son spoiled; 2.his lack of physical presence in

disciplining his children; 3. The way he transferred his family from one place

to another because of his work and; 4. The time when he brought along theyoung Mr. Vin to a war in Sulu when he was 16 years old. According to the

father, he has no liking to alcoholism and has no experience in drug addiction.

He plays ma-jong and gambles sometimes but not to the point of sacrificing

his familys finances. He also said that he is very loyal to his wife despite of

being away from her most of the time.

The mother of Mr.Vin, as described by the father is so kind, caring

and loving. She worked as an elementary teacher and has been a principal

also at Magallanes Elementary School, for additional supplement for their

familys budget. She did not entrust the care for her children to relatives or

neighbors. When we asked the father who took care of Mr. Vin during his

infancy, he said that it was the eldest child, E.M. Mr. Vins mother disciplines

her children from the eldest down to Mr. Vin by just talking, confronting and

telling the right thing to do.

However, this method of disciplining has changed over time

because of how Mr. Vin became so manipulative and superior to the family.

She then became so strict and practiced intensive corporal punishment to the

other younger siblings of Mr. Vin. According to A.M.J. (8th child), their mother

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had miscarriage twice. The first was between Mr. Vin and El.M (4 th child).

while the second was between L.M. (5th child) and Mi.M. (6th child).

c. Subject

Patient Name: Mr. Vin

Address Dacoville, Toril Davao City

Birthday: January 22, 1954

Age: 56 y.o.

Sex: Male

Civil Status: Single

Date of Admission: January 7, 2010 (2:25pm)Previous work: Company driver in Johnson & Johnsons

Siblings:

Order Name Age in

yrs.

Occupation

1 E. M. Deceased on year 1993 due to asthma2 M.M. Deceased on 1994 due to bone fracture3 Patient 56 None4 El. L 54 Central Bank of Cebu( Accountancy)

5 L.M. 52 Pastor and Assistant of one of the Councilor in Davao

6 Mi. M. 50 Contractual Worker at Holcim7 Er. G.* 49 O.I.C.: City Planning of Davao8 A.M.J.

*

47 Out from Task Force

9 T.M. 45 Liason Officer (J Marketing)* able to be interviewed.

Personal and Social History:

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Infancy born in Laoag and delivered via Normal Spontaneous

Vaginal Delivery in mixed feeding both bottle fed and breastfed. Informant

cannot recall patient immunization records.

Pre-school - Informant cannot recall.

Adolescent Patient is an honor student, good in declamation, good

in singing and guitar playing. At the age of 14, he started to have barkadas

and participated in gangs. He started to drink and smoke.

Adulthood

a.) Social At the age of 14, patient started drinking and smoking with hisbarkadas. When he was 15 years old he started using marijuana and he

finished his highschool at the age of 18. When he reached 22 he started to

use injectable which is nubain. Before, patient worked in Johnson and

Johnsons as an employee but his informant cannot recall further information.

b.) Baccalaureate Patient took up customs in RMC up to 3 years in college

but he stop in that time because he admitted in the DMH due to visual and

auditory hallucinations.

c.) Sexual There was a time when Mr. Vin brought her girlfriend to their

house at the age of 24. Kaisa lang man to siya nagdala ug uyab sa balay.

Pagkahuman ato wala nako kabalo, as verbalized by the younger brother.

History of present Illness- would hurt (Gibunalan ang amahan ug

giguba ang pultahan. Persistence of the condition prompted his sister and

brother to bring him in Davao Mental Hospital through the help of the

policeman. On January 1, 2010, patient attended their family reunion and he

was shy at that time enjoying singing on videoke. Prior to patient admission

this morning of January 7, 2010, patient threw a stone to his brother because

Naa daw siya gipangayo na wala nahatag,as verbalized by the informant.

Pre-morbid history:

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Sometime in 1980, patient was influenced by his peers to use

prohibited substance like cigarette smoking and alcohol drinking at the age of

14 and when he reached 15 he started using marijuana. Because of this,

patient develops behavioral changes like talking to self and became

suspicious to others. Later on his in 1981, he was brought to Davao Mental

Hospital.

1981 During his college years, he met Luis Santos and they become

friends for several years. He influenced the patient to take marijuana as his

drug of choice at the same time, it influenced him to drink and smoke cigars

but the informant cannot recalled the exact amount of it and the times orfrequency the patient is doing it. The patient has been admitted of Davao

Mental Hospital several times since 1981 and last admission was on 1990s

with no maintenance medication. Since then, the patient is non-functional at

home since he was manageable and non-hostile. Patient started to talk to

himself alone and became hostile and violent when his demands are not

provide by his parents. Informant stated that Gitutukan niya ug kutsilyo

amuang mama then the family prompted the patient to brought him to Taguig

City because his father stayed and worked there as a Colonel in Manila and

was admitted to Taguig Rehabilitation prior to that incident. No visitation was

made by his family except for a phone call done by his father.

Patients words = Gidala man ko nila sa rehab.

Companion words = Gilabayan man niya ug batong among brother

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Patient history of previous admission:

Date in year Hospital /

Rehabilitation

Center

Duration Age of Patient

(in years)

1981-1990s Davao Mental

Hospital

several times

(unrecalled

dates)

27

1992 Taguig

Rehabilitation

Center

9 years 38

2003 St. ElizabethRehabilitation

Center

(unrecalleddate)

49

2005 Dela Rosa

Psychiatric

Facility

1 month 51

2010 NDRC

2001 After patient was discharged on Taguig Rehabilitation and brought

back in their house here in Davao. He was able to do household works suh as

cooking and cleaning their house. Patient has poor personal hygiene.

Informant stated Ginabalik-balik niya iyang ginasuot, unya masuko siya pag

tagan namo ug bag-o na suoton.

No followed up check up was made and sometimes visited by a

doctor for his monthly injection as verbalized by his sister but she cannot

recalled the Doctors name and the medicine that was given. Patient

constantly drinks and smoke cigarette. He is able to consumed 1 Jr. Lapad of

Tanduay and 1 pack of cigarettes daily and after he was drunk, patient got

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sleep. Patient also drinks caffeinated beverages such as coffee for about 4-5

cups/day as mentioned by his sister.

2003 Patient was admitted to St. Elizabeth Rehab somewhere in San Pedro

St. due to hostility, informant verbalized, Gituok niya si Papa.Patient was

discharged and stayed in their house again; continued with his social life with

good relationship with neighbors. Patient still drinks and smokes as he got

used to and he was given an allowance of P50.00 everyday from his father.

As, recalled by his sister, she saw the patient again talking to himself alone.

Patient is writing to a paper with observed words such as Shit!and

Bullshit.And the patients younger brother forgot the name of the medicine.

2005 Patient was admitted to dela Rosa Psychiatric Facility for 1 month.

Patient was doing well and was discharged; still followed up check up and

maintenance as verbalized by the informant.

4 weeks prior to admission Patient is easily irritable and has low attention

span as stated by his sister. The present condition started about 4 weeks

himself and was restless. The patient was non-hostile, with good sleep and

good appetite. About a 2 weeks prior to admission, there was persistence of

the above condition; this time assessed with hostility such that he threatened

his family, he was irritable and anxious and would hurt others. (Gibunalan

ang amahan, giguba ang pultahan). Persistence of the condition prompted

his mother to bring him in this institution through the help of the policeman.

IV. COURSE IN THE HOSPITALA. Mental status examination upon initial introduction

DAVAO DOCTORS COLLEGEGen. Malvar St., Davao CityCOLLEGE OF NURSING

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NCM 102 CMO#30 2ND SEMESTER SY 2009-10PSYCHIATRIC NURSING (Maladaptive Pattern of Behavior)

MENTAL STATUS EXAMINATION FORMINITIAL

NAME: ______Mr. Vin _______ DATE: __Jan. 22, 2010__

I. PRESENTATION:A. GENERAL APPEARANCE ____Mr. Vin is wearing a violet shirt and blue

shorts with blue slippers. Good grooming was noted with trimmed fingernails.

Normal posture and gait is observed and patient is smiling during the

conversation.

B. GENERAL MOBILITY

1. Posture & Gait () Normal ( ) Appropriate ( ) Inappropriate

Describe: The client walks with good posture and the gait is normal. He

neither walks slowly nor fast. Flexion and extension of knees whilewalking is of good range of motion._______________________________

2. Activity () Normoactive ( ) Hyperactive, Restlessness

( ) Agitated ( ) Psychomotor Retardation

3. Facial Expression: () Appropriate ( ) Inappropriate

Quantity:

( ) Smiling ( ) Worried ( ) Angry ( ) Happy( ) Tensed ( ) Suspicious ( ) Ecstatic ( ) Frightened

( ) Tearful ( ) Fearful ( ) Sad ( ) Distant

Describe: The facial expression of the client is happy and its congruent on what

he is saying.

C. BEHAVIOR

() Friendly ( ) Impulsive ( ) Sullen ( ) Embarrassed

( ) Dramatic ( ) Negativistic ( ) Seductive ( ) Indifferent

( ) WithdrawnDescribe: The client is friendly because he is showing kindness.

D. NURSE-PATIENT INTERACTION () Cooperative ( ) Uncooperative

( ) Initially only () Throughout Interview ( ) Later only

Quality: ( ) Warm ( ) Distant ( ) Suspicious

( ) Talkative ( ) Hostile

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Describe: The client able to answer the questions given throughout the interview.

II. STREAM OF TALK

A. CHARACTER OF TALK ( /) Spontaneous ( ) Deliberate

( ) Blocking ( ) Pressured

Describe: The client can

B. ORGANIZATION OF TALK

( ) Relevant ( ) Loose of Association ( ) Flight of Ideas

( ) Circumstantial () Tangential ( ) Perseveration

( ) Neologism ( ) Clang Association ( ) Echolalia

( ) Echopraxia

Describe: The client was answering but his answers were not related to the

question.C. ACCESSIBILITY ( ) Good () Fair ( ) Self-Absorbed

( ) Inaccessible ( ) Defensive ( ) Mute

Describe: The client cooperates with the student nurse fairly.

III. EMOTIONAL STATE AND REACTION

A. MOOD: () Euthymic ( ) Depression ( ) Euphoric

The client is neither depressed nor feels euphoria.

B. AFFECT: ( ) Appropriate ( ) Inappropriate

Quality: ( ) Flat ( ) Elated ( ) Histrionic ( ) Angry

() Blunted ( ) Labile ( ) Anxious

C. DEPERSONALIZATION & DEREALIZATION

( ) Present () Absent

The client neither see himself as another person nor feels that some part of his

body is missing. He is retained or remain in contact with reality.

E. SUICIDAL POTENTIAL ( ) Present () Absent

The client does not show signs or means of communicating in a suicidal way. He

also said that he does not allow anything to harm himself.

F. HOMICIDAL POTENTIAL ( ) Present () Absent

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The client does not show actions of hurting others. In fact, he is friendly and

calm.

IV. THOUGHT CONTENT

A. DELUSIONS: ( ) Present () AbsentType: ( ) Thought control, Broadcasting, Insertion

( ) Influence ( ) Paranoia-persecutory, grandiose

( ) Somatic

The client does not have fixed false beliefs.

B. IDEAS OF REFERENCE

Absent - The client said that he does not feel or thinks that the reason of acertain conflict or catastrophe is him. Furthermore, he does not think/believe that

news/shows on the television is talking to him.

C. PREOCCUPATION, RUMINATION

( ) Preoccupied ( ) Rumination ( ) Rituals

( ) Intrusive thoughts ( ) Phobias ( ) Dejavu & Jamais Vu

Absent The client is not pre-occupied of something or someone. He also does

not ruminate or talk something over and over again.

V. PERCEPTION

A. ILLUSIONS ( ) Present () Absent

Absent The client do not think a certain stimuli as another thing.

B. HALLUCINATION

Type: ( ) Auditory ( ) Visual ( ) Olfactory ( ) Gustatory

( ) Kinesthetic/ Tactile

The client does not report anything that he sees/hears/smells/feels/tastes

something without a stimuli.

VI. NEUROVEGETATIVE DYSFUNCTION

A. SLEEP () Normal ( ) Hyperinsomnia ( ) Insomnia

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( ) Early ( ) Late ( ) Mixed

B. APPETITE: Mr. Vins appetite is good as he said that he was able to eat their

lunch meal fully without left-overs and as observed during snack time that he

eats the food being served to him without hesitation or left-overs.

C. WEIGHT:_ 65Kg_

D. DIURNALVARIATION: Client is sometimes hyperactive especially during

therapy and when he was asked to dance, and sometimes during

therapies he felt drowsy.

E. ATTENTION SPAN: (/) Good ( ) Fair

Mr. Vin is attentive and cooperative during activities of Recreational Therapy,

Remotivational Therapy, Occupational Therapy and Music Therapy only for a

short period of time.________________________________________________

F. LIBIDO:

The client shows enthusiasm and is appropriately cheerful all throughout the

activities especially that it is his birthday.________________________________

VII. GENERAL SENSORIUM & INTELLECTUAL STATUS

A. ORIENTATION: () Time () Place () Person () Situation

The client knows that it is his birthday today and is aware of the date and the day

of the week. He is aware that he is in NDRC and he was able to distinguish his

relatives who came to celebrate his birthday. He knows exactly the situation in

which the family is present for his birthday and that SNs will come to do activities.

B. MEMORY:

REMOTE () Unimpaired ( ) Impaired

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Client was able to answer when he was asked, Ika pila ka sa inyong

mag-igsuon migo?. Client: kinamanghuran man ko.

RECENT () Unimpaired ( ) ImpairedClient was able to answer when he was asked, Unsa sud-an nimo

ganiha migo? Client: pinakbet man to maam.

IMMEDIATE () Unimpaired ( ) Impaired

Client was able to answer the question given by the student nurse when

he was asked to spell the word FLOWER backwards.

C.CALCULATION: Progressive Subtraction of 7s from 100

() Good ( ) Fair ( ) Poor

Mr. Vin is able to progressively subtract 7s from 100 without hesitation and

mistakes._________________________________________________________

D.GENERAL INFORMATION

The client is able to answer correctly that the current president of the nation isPresident Gloria Macapagal-Arroyo.

E. ABSTRACT THINKING ABILITY

The patient was asked about how he understand the proverb Aanhin pa ang

damo kung patay na ang kabayo and he replied Aanhin pa ang kabayo kung

wala na ang damo._The client only rephrase the sentence.

F. JUDGEMENT AND REASONING: ( ) Unimpaired ( ) Impaired

__He said that if he saw a wallet he will return it to the owner._______________

VIII. INSIGHT

__Impaired. He said that he was admitted to that institution because he took a

coconut wood from their backyard and thus, he was caught and brought there. He

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also added that it was about a family problem and a personal matter, then he

hesitated to talk._____________________________________________________

IX. SUMMARY OF MENTAL STATUS EXAMINATION

A. DISTURBANCE IN ( ) Presentation() Stream of Talk

() Emotional state and reaction

( ) Thought

( ) Perception

( ) Neurovegetative dysfunction

() General Sensorium and Intellectual state

() Insight

( ) Positive signs of Organicity

B. DIAGNOSTIC CATEGORY

() Functional ( ) Organic () Psychotic

( ) Non-psychotic ( ) both Functional and Organic

DAVAO DOCTORS COLLEGEGen. Malvar St., Davao CityCOLLEGE OF NURSING

NCM 102 CMO#30 2ND SEMESTER SY 2009-10PSYCHIATRIC NURSING (Maladaptive Pattern of Behavior)

MENTAL STATUS EXAMINATION FORMFINAL

NAME: ______Mr. Vin_______ DATE: __Jan. 29, 2010__

I. PRESENTATION:

A. GENERAL APPEARANCE ____Mr. Vin is wearing a violet shirt and blue

shorts with black slippers. Good grooming was noted with trimmed fingernails.

Normal posture and gait is observed and patient is smiling during the

conversation.

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B. GENERAL MOBILITY

2. Posture & Gait () Normal ( ) Appropriate ( ) Inappropriate

Describe: The client walks with good posture and the gait is normal. He

neither walks slowly nor fast. Flexion and extension of knees while

walking is of good range of motion._______________________________3. Activity () Normoactive ( ) Hyperactive, Restlessness

( ) Agitated ( ) Psychomotor Retardation

4. Facial Expression: () Appropriate ( ) Inappropriate

Quantity:

( ) Smiling ( ) Worried ( ) Angry ( ) Happy

( ) Tensed ( ) Suspicious ( ) Ecstatic ( ) Frightened

( ) Tearful ( ) Fearful ( ) Sad ( ) Distant

C. BEHAVIOR() Friendly ( ) Impulsive ( ) Sullen ( ) Embarrassed

( ) Dramatic ( ) Negativistic ( ) Seductive ( ) Indifferent

( ) Withdrawn

D. NURSE-PATIENT INTERACTION () Cooperative ( ) Uncooperative

( ) Initially only () Throughout Interview ( ) Later only

Quality: ( ) Warm ( ) Distant ( ) Suspicious

( ) Talkative ( ) Hostile

II. STREAM OF TALK

A. CHARACTER OF TALK ( ) Spontaneous ( ) Deliberate

() Blocking ( ) Pressured

B. ORGANIZATION OF TALK

( ) Relevant ( ) Loose of Association ( ) Flight of Ideas

( ) Circumstantial () Tangential ( ) Perseveration

( ) Neologism ( ) Clang Association ( ) Echolalia

( ) EchopraxiaThe client hesitates to verbalize on certain matters of his life especially when

asked about the cause of his admission. He does answer certain questions such

as his age and is still on denial stage.__________________________________

C. ACCESSIBILITY ( ) Good () Fair ( ) Self-Absorbed

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( ) Inaccessible ( ) Defensive ( ) Mute

III. EMOTIONAL STATE AND REACTION

A. MOOD: () Euthymic ( ) Depression ( ) EuphoricThe client is neither depressed nor feels euphoria.________________________

B. AFFECT: () Appropriate ( ) Inappropriate

Quality: ( ) Flat ( ) Elated ( ) Histrionic ( ) Angry

( ) Blunted ( ) Labile ( ) Anxious

C. DEPERSONALIZATION & DEREALIZATION

( ) Present () AbsentThe client neither see himself as another person nor feels that some part of his

body is missing. He is retained or remain in contact with reality. ______________

E. SUICIDAL POTENTIAL ( ) Present () Absent

The client does not show signs or means of communicating in a suicidal way. He

also said that he does not allow anything to harm himself.___________________

F. HOMICIDAL POTENTIAL ( ) Present () AbsentThe client does not show actions of hurting others. In fact, he is friendly and

calm.____________________________________________________________

IV. THOUGHT CONTENT

A. DELUSIONS: ( ) Present () Absent

Type: ( ) Thought control, Broadcasting, Insertion

( ) Influence ( ) Paranoia-persecutory, grandiose

( ) SomaticThe client does not have fixed false beliefs._

B. IDEAS OF REFERENCE

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Absent - The client said that he does not feel or thinks that the reason of a

certain conflict or catastrophe is him. Furthermore, he does not think/believe that

news/shows on the television is talking to him.

C. PREOCCUPATION, RUMINATION( ) Preoccupied ( ) Rumination ( ) Rituals

( ) Intrusive thoughts ( ) Phobias ( ) Dejavu & Jamais Vu

Absent The client is not pre-occupied of something or someone. He also does

not ruminate or talk something over and over again. ______________________

V. PERCEPTION

A. ILLUSIONS () Present ( ) Absent

The client thinks a certain stimuli as another thing.____________ ___________

B. HALLUCINATION

Type: ( ) Auditory ( ) Visual ( ) Olfactory ( ) Gustatory

( ) Kinesthetic/ Tactile

The client does not report anything that he sees/hears/smells/feels/tastes

something without a stimuli.__________________________________________

VI. NEUROVEGETATIVE DYSFUNCTION

A. SLEEP () Normal ( ) Hyperinsomnia ( ) Insomnia

( ) Early ( ) Late ( ) Mixed

B. APPETITE: Mr. Vins appetite is good as he said that he was able to eat their

lunch meal fully witout left-overs and as observed during snack time that he ate

the food being served to him without hesitation or left-overs._________________

C. WEIGHT:_______65Kg___________________________________________

D. DIURNALVARIATION: The usual day to day activities (from morning to night)of the client involves the following: Taking a bath Breakfast Therapeutic

Activities with SNs of morning shift Lunch Rest Therapeutic Activities with

SNs of afternoon shift Taking a half bath Dinner Sleep time by 9pm. There

is also a variation in his ADLs when Exercise time (before taking a bath in the

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morning) is present if the climate is good or is being cancelled if raining. The

client is able to adjust or adapt to it.____________________________________

E. ATTENTION SPAN: ( ) Good () Fair

Mr. Vin is attentive and cooperative to conversation and in activities ofRecreational Therapy, Remotivational Therapy, Occupational Therapy and Music

Therapy._________________________________________________________

F. LIBIDO:

The client shows enthusiasm and is appropriately cheerful all throughout the

activities.________________________________

VII. GENERAL SENSORIUM & INTELLECTUAL STATUS

A. ORIENTATION: () Time () Place () Person () SituationThe client is aware of the date and the day of the week. He is aware that he is in

NDRC and he was able to distinguish his SNs and nurses. He knows exactly the

situation in which SNs will come to do activities.

B. MEMORY:

REMOTE () Unimpaired ( ) Impaired

The client is able to name his father and his relatives.

RECENT () Unimpaired ( ) Impaired

The client is able to describe is usual ADLs of yesterday.___________________

IMMEDIATE () Unimpaired ( ) Impaired

The client is able to memorize easily the yells/cheering of the group.__________

C.CALCULATION: Progressive Subtraction of 7s from 100

() Good ( ) Fair ( ) Poor

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Mr. Vin is able to progressively subtract 7s from 100 without hesitation and

mistakes.

D.GENERAL INFORMATION

The client is able to answer correctly that the current mayor of Davao City isMayor Rody Duterte.

E. ABSTRACT THINKING ABILITY

The student nurse asked, unsa may pagsabot nimo anang, Dont

judge the book by its cover?. The client answered, dili dayon ta

muhusga og tao maam. The client answer the question based on her own

understanding.

F. JUDGEMENT AND REASONING: ( ) Unimpaired ( ) Impaired

He said that if he found a wallet he will return it to the owner.

VIII. INSIGHT

The patient has a good insight since he understands that he has an illness

and needs to be in the institution to be cured.

IX. SUMMARY OF MENTAL STATUS EXAMINATION

A. DISTURBANCE IN ( ) Presentation

() Stream of Talk

( ) Emotional state and reaction

( ) Thought

() Perception

( ) Neurovegetative dysfunction

() General Sensorium and Intellectual state

() Insight

( ) Positive signs of Organicity

B. DIAGNOSTIC CATEGORY

() Functional ( ) Organic () Psychotic

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( ) Non-psychotic ( ) both Functional and Organic

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C. Progress notes and other observations on the succeeding interaction.

12/1/10

S = Birthday naku ugma.

= Mabuti man ako, maam.

= Masaya ako ngayon ditto sa recovery center.= Sana bumisita sila, maam, sa aking birthday.

= Ako si (stated name)

= Happy ako ngayon

O = calm tone of voice

= smiling face was noted

= patient is happy

= warm

= poor insight= (+) for denial

A = Improving but still in denial stage

P = Refer to Dr. A.M.B.

= for psychiatric education on 1/22/10

= One on one counseling

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DAVAO DOCTORS COLLEGEGen. Malvar st., Davao City

College of Nursing

NCM 102 LEVEL III 2ND SEMESTER SY 2008-09PSYCHIATRIC NURSING (Maladaptive patterns of Behavior)

NURSING MANAGEMENTINITIAL

NURSE-PATIENT INTERACTION

Name of the Patient : Mr. Vin

Date of Admission : Jan. 7, 2010

Place of Interaction : NDRC

Age : 56 years old

Date & Time of Interaction : Jan.22, 2010/1-5PMSex : Male

Civil Status : Single

Diagnosis : Schizophrenia

General Objectives:

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At the end of our 3 weeks exposure the patient will be able to build a

trusting relationship between the patient and the student nurse.

Specific Objectives:

To be able the patient to rechanneled unwanted feelings that is kept deep

in him.

To let the patient feel self belongingness to others.

To be able the patient to have increase self-esteem.

To be able to assess the client feelings and anxiety.

To be able the client to express his problems, thoughts and feelings.

NURSE PATIENT ANALYSIS DOCUMENTATION

Maayong hapon

migo

Maayong

hapon pud

maam

The Student nurse

recognizes the

presence of the

patient.

The client

responds to the

student nurse

greetings.

Giving recognition.Greeting the client byname, indicatingawareness of change,or noting efforts theclient has made allshow that the nurserecognizes the client

as a person, as anindividual. Suchrecognition does notcarry the notion ofvalue, that is, of beinggood or bad.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Accepting. Anaccepting responseindicates the nursehas heard andfollowed the train ofthought. It does notindicate agreementbut is nonjudgmental.

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Migo, ako diay si

Maam sai-sai

kauban nako si

Maam Khae.

Kami imong mgastudent nurse

karon Migo gikan

ala una sa hapon

hangtod alas

singko sa hapon,

og naa pud me

diri migo kadahuwebes,

biyernes og

sabado sa ing ani

nga oras

gihapon.

Makauban me

nimo migo sa tulo

ka semina. Kutod

lng me diri

karong petsa

Enero 6, 2010

migo og mao na

The student nurse

starts to enter in

the introductory

phase and begins

to give informationsuch as the

students nurse

name. In this way

she could

establish rapport.

Facial expression,tone of voice, and soforth also mustconvey acceptance orthe words lose their

meaning. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets the

client know what toexpect. The nurse isfunctioning as aresource person.Giving informationalso build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

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nga adlaw ang sa

atong

culmination.

Kamusta man

imong tulog

kaganina migo?

Kauban ninyotongkaganinangbuntag maam?

Ok lng man

maam, sayo ko

nakatulog

The client is trying

to interact with the

student nurse.

The student nurse

is starting in

establishingrapport to the

client.

The client

responds to the

student nurse

question.

Seeking information.The nurse shouldseek clarificationthroughoutinteractions withclients. Doing so canhelp the nurse toavoid makingassumptions thatunderstanding haveoccurred when it has

not. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)Encouragingexpression. The nurseasks the client to

consider people andevents in light of his orher own values. Doingso encourages theclient to make his orher own appraisalrather than to acceptthe opinion of others.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 107)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what to

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Unya Migo

kamusta man

imong adlaw

karon?

Ok lng man

maam

The Student nurse

starts seeking

information from

the client.

The client

responds to the

student nurse

question.

expect. The nurse isfunctioning as aresource person.Giving informationalso build trust with

the client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Seeking information.The nurse shouldseek clarificationthroughoutinteractions with

clients. Doing so canhelp the nurse toavoid makingassumptions thatunderstanding haveoccurred when it hasnot. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.(Videbeck, Sheila;

Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Encouragingexpression. The nurseasks the client toconsider people andevents in light of his orher own values. Doingso encourages theclient to make his orher own appraisalrather than to acceptthe opinion of others.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 107)

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Migo kame man

imong mga

student nurse

karon kong naa

kay kailangan

naa lang me diri

ha para

mutabang sa

imoha kong

kailangan na me

nimo.

Migo unsa gane

imong tinuod nga

pangalan? Taga

asa pud ka

migo? Pila na

pud gane imong

edad migo?

O maam.

The student nurse

is still establishing

rapport to the

client.

Client fullyaccepted the offer

presented by the

student Nurse.

The student nurse

still seeking

information to the

client.

Offering self. Thenurse can offer his orher presence, interest,and desire to

understand. If isimportant that thisoffer is unconditional,that is, the client doesnot have to respondverbally to get thenurses attention.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Accepting. Anaccepting responseindicates the nursehas heard andfollowed the train ofthought. It does notindicate agreementbut is nonjudgmental.Facial expression,tone of voice, and so

forth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Seeking information.The nurse shouldseek clarificationthroughoutinteractions withclients. Doing so canhelp the nurse toavoid makingassumptions thatunderstanding have

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Migo unsa man

imong gusto

istoryahan nato

karon?

Vincent R.

Moran maam,

taga Dacoville

ko maam akong

edad kay 48.

Silence

The patient replied

the student nurse

questions in

complete details.

The student nurse

allowing the client

to take the

initiative in

introducing a

topic.

The client using a

occurred when it hasnot. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.

(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what to

expect. The nurse isfunctioning as aresource person.Giving informationalso build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Broad Opening. BroadOpenings makeexplicit that the clienthas the lead in theinteraction. For theclient who is hesitantabout talking, broadopenings maystimulate him or hertake the imitative.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 107)

Silence. Silence oftenencourages the client

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Migo nganong

ako man

magbuot ikaw

diay?

Silence

therapeutic

communication in

a silent way.

The student nurse

validating the

clients answer.

The client using a

therapeutic

communication in

to verbalize, providedthat it is interestedand expectant.Silence gives theclient time to organize

thoughts, direct thetopic of interaction, orfocus on issues thatare most important.Much nonverbalbehavior takes placeduring silence, andthe nurse needs to beaware of the clientand his or her ownnonverbal behavior.


Seeking information.The nurse shouldseek clarificationthroughoutinteractions withclients. Doing so can

help the nurse toavoid makingassumptions thatunderstanding haveoccurred when it hasnot. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Silence. Silence oftenencourages the clientto verbalize, providedthat it is interestedand expectant.

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Migo nganongnaa man ka diri?

Gusto ka

istoryahan nato

na migo?

Naa langgamay nga

problemamaam

a silent way.

Student nurse

seeks more

information by

exploring past

experiences of the

client.

The client is

partially

cooperative and

with hesitation

considering the

people and events

Silence gives theclient time to organizethoughts, direct thetopic of interaction, orfocus on issues that

are most important.Much nonverbalbehavior takes placeduring silence, andthe nurse needs to beaware of the clientand his or her ownnonverbal behavior.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourth

edition; page 109)Suggestingcollaboration. Thenurse seeks to offer arelationship in whichthe client can identifyproblems in living withothers, growemotionally, andimprove the ability to

form satisfactoryrelationships. Thenurse offers to dothings with, rather thatfor, the client.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 109)

Suggestingcollaboration. Thenurse seeks to offer arelationship in whichthe client can identifyproblems in living withothers, growemotionally, andimprove the ability to

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Unsa mana

imong gamay

nga problem

amigo?

Wala manmaam

in light of his past

experiences.

The student nurse

tries to validate

the clients answer.

The client is

answering

respond to the

question of the

student nurse.

form satisfactoryrelationships. Thenurse offers to dothings with, rather thatfor, the client.


Exploring. Whenclients deal with topicssuperficially, exploringcan help themexamine the issuemere fully. Any

problem or concerncan be betterunderstood if exploredin depth. If the clientexpresses anunwillingness toexplore a subject,however, the nursemust respect his orher wishes.(Videbeck, Sheila;

Psychiatric-MentalHealth Nursing; fourthedition; page 107)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse isfunctioning as aresource person.Giving informationalso build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourth

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Migo muapil ta

sa mga activities

karon ha?

Unya migo unsa

man imong gibati

sa atong mga

gipangbuhat

ganina?

O maammuapil ko

The student nurse

encourages the

client to

participate the

activities during

the program.

The patient replied

to the student

nurse actively.

The student nurse

encourages the

patients to

verbalize her

feelings about the

edition; page 107)

Suggestingcollaboration. Thenurse seeks to offer a

relationship in whichthe client can identifyproblems in living withothers, growemotionally, andimprove the ability toform satisfactoryrelationships. Thenurse offers to dothings with, rather thatfor, the client.


Accepting. Anaccepting responseindicates the nursehas heard andfollowed the train ofthought. It does not

indicate agreementbut is nonjudgmental.Facial expression,tone of voice, and soforth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Encouragingexpression. The nurseasks the client toconsider people andevents in light of his orher own values. Doing

49


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Migo ugma na

pud ha, ing ani

gihapon nga

oras. Mao

gihapon to ang

atong mgapagabuhaton.

Bye-bye migo.

Nalipay komam kaynalingaw pudko ganina.

Sige maamugma na pud,bye-bye pudmaam.

activity done.

The client

verbalizes his

Feelings towards

the activity given.

The student nurse

doing the

termination phase

and giving the

information for the

next day activity.

The patient replies

the student nurse

directly.

so encourages theclient to make his orher own appraisalrather than to acceptthe opinion of others.


Alogia. Tendency tospeak very little or toconvey littlesubdtance ofmeaning. (Videbeck,Sheila; Psychiatric-

Mental HealthNursing; fourthedition; page 269)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse is

functioning as aresource person.Giving informationalso build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107

Accepting. Anaccepting responseindicates the nursehas heard andfollowed the train ofthought. It does notindicate agreementbut is nonjudgmental.Facial expression,

50


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tone of voice, and soforth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,

Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

DAVAO DOCTORS COLLEGEGen. Malvar st., Davao City

College of Nursing

NCM 102 LEVEL III 2ND SEMESTER SY 2008-09PSYCHIATRIC NURSING (Maladaptive patterns of Behavior)

NURSING MANAGEMENTFINAL

NURSE-PATIENT INTERACTION

Name of the Patient : Mr. Vin Date

of Admission : Feb. 05, 2010_______

Place of Interaction : NDRC ___________________

Age: 56 years old______________

Date & Time of Interaction : 1-5pm/Jan.22, 2010 _________ Sex:

Male____________________

Civil Status : Single ____________________

Diagnosis: Schizophrenia_____________

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General Objectives:

At the end of our 3 weeks exposure the patient will be able to build a

trusting relationship between the patient and the student nurse.

Specific Objectives:

To be able the patient to rechanneled unwanted feelings that is kept deep

in him.

To let the patient feel self belongingness to others.

To be able the patient to have increase self-esteem.

To be able to assess the client feelings and anxiety.

To be able the client to express his problems, thoughts and feelings.

NURSE PATIENT ANALYSIS DOCUMENTATION

Maayong hapon

migo

Maayong

hapon pud

maam

The Student nurse

recognizes the

presence of the

patient.

The client

responds to the

student nurse

Giving recognition.Greeting the client by

name, indicatingawareness of change,or noting efforts theclient has made allshow that the nurserecognizes the clientas a person, as anindividual. Suchrecognition does notcarry the notion ofvalue, that is, of being

good or bad.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Accepting. Anaccepting response

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Migo, ako diay si

Maam sai-sai

kauban nako si

Maam Khae.

Kami imong mga

student nurse

karon Migo gikan

ala una sa haponhangtod alas

singko sa hapon,

og naa pud me

diri migo kada

huwebes,

biyernes og

sabado sa ing aninga oras

gihapon.

Makauban me

nimo migo sa tulo

ka semina. Kutod

lng me diri

karong petsa

Enero 6, 2010

migo og mao na

nga adlaw ang sa

atong

culmination.

Kauban ninyotongkaganinangbuntag maam?

greetings.

The student nurse

starts to enter in

the introductory

phase and begins

to give informationsuch as the

students nurse

name. In this way

she could

establish rapport.

The client is trying

to interact with the

student nurse.

indicates the nursehas heard andfollowed the train ofthought. It does notindicate agreement

but is nonjudgmental.Facial expression,tone of voice, and soforth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse isfunctioning as aresource person.Giving information

also build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Seeking information.The nurse shouldseek clarification

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Kamusta man

imong tulog

kaganina migo?

Unya Migo

kamusta man

imong adlaw

karon?

Ok lng man

maam, sayo ko

nakatulog

Ok lng man

maam

The student nurse

is starting in

establishing

rapport to the

client.

The client

responds to the

student nurse

question.

The Student nurse

starts seeking

information from

the client.

throughoutinteractions withclients. Doing so canhelp the nurse toavoid making

assumptions thatunderstanding haveoccurred when it hasnot. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Encouragingexpression. The nurseasks the client toconsider people andevents in light of his orher own values. Doingso encourages theclient to make his orher own appraisal

rather than to acceptthe opinion of others.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 107)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse isfunctioning as aresource person.Giving informationalso build trust withthe client. (Videbeck,

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Migo kame man

imong mga

student nurse

karon kong naa

kay kailangan

naa lang me diriha para

mutabang sa

imoha kong

kailangan na me

nimo.

O maam.

Vincent R.

Moran maam,

taga Dacoville

ko maam akong

edad kay 48.

The client

responds to the

student nurse

question.

The student nurse

is still establishing

rapport to the

client.

Client fully

accepted the offer

presented by the

student Nurse.

Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)


not. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Encouragingexpression. The nurse

asks the client toconsider people andevents in light of his orher own values. Doingso encourages theclient to make his orher own appraisalrather than to acceptthe opinion of others.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 107)

Offering self. Thenurse can offer his orher presence, interest,and desire to

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Migo unsa gane

imong tinuod nga

pangalan? Taga

asa pud ka

migo? Pila na

pud gane imong

edad migo?

Migo unsa man

imong gusto

istoryahan nato

karon?

Silence

Silence

The student nurse

still seeking

information to the

client.

The patient replied

the student nurse

questions in

complete details.

The student nurse

allowing the client

to take the

initiative in

introducing a

topic.

The client using a

understand. If isimportant that thisoffer is unconditional,that is, the client doesnot have to respond

verbally to get thenurses attention.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Accepting. Anaccepting responseindicates the nursehas heard and

followed the train ofthought. It does notindicate agreementbut is nonjudgmental.Facial expression,tone of voice, and soforth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,Sheila; Psychiatric-


Seeking information.The nurse shouldseek clarificationthroughoutinteractions withclients. Doing so canhelp the nurse toavoid makingassumptions thatunderstanding haveoccurred when it hasnot. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.

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Migo nganong

ako man

magbuot ikaw

diay?

Migo nganong

naa man ka diri?

Gusto ka

Naa langgamay ngaproblemamaam

Wala man

therapeutic

communication in

a silent way.

The student nurse

validating theclients answer.

The client using a

therapeutic

communication in

a silent way.


Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse isfunctioning as aresource person.Giving informationalso build trust with

the client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Broad Opening. BroadOpenings makeexplicit that the clienthas the lead in the

interaction. For theclient who is hesitantabout talking, broadopenings maystimulate him or hertake the imitative.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 107)

Silence. Silence oftenencourages the clientto verbalize, providedthat it is interestedand expectant.Silence gives theclient time to organize

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istoryahan nato

na migo?

Unsa mana

imong gamay

nga problem

amigo?

maam

O maammuapil ko

Student nurse

seeks more

information by

exploring past

experiences of the

client.

The client is

partiallycooperative and

with hesitation

considering the

people and events

in light of his past

experiences.

The student nurse

tries to validate

the clients answer.

thoughts, direct thetopic of interaction, orfocus on issues thatare most important.Much nonverbal

behavior takes placeduring silence, andthe nurse needs to beaware of the clientand his or her ownnonverbal behavior.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 109)


not. It helps the clientto articulate thoughts,feelings, and ideasmore clearly.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 108)

Silence. Silence oftenencourages the clientto verbalize, providedthat it is interestedand expectant.Silence gives theclient time to organizethoughts, direct thetopic of interaction, orfocus on issues that

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Migo muapil ta

sa mga activities

karon ha?

Unya migo unsaman imong gibati

sa atong mga

gipangbuhat

ganina?

Nalipay koman kaynalingaw pudko ganina.

Sige maamugma na pud,bye-bye pudmaam.

The client is

answering

respond to the

question of the

student nurse.

The student nurse

encourages the

client to

participate the

activities during

the program.

The patient replied

to the student

nurse actively.

are most important.Much nonverbalbehavior takes placeduring silence, andthe nurse needs to be

aware of the clientand his or her ownnonverbal behavior.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 109)

Suggestingcollaboration. The

nurse seeks to offer arelationship in whichthe client can identifyproblems in living withothers, growemotionally, andimprove the ability toform satisfactoryrelationships. Thenurse offers to dothings with, rather that

for, the client.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 109)

Suggestingcollaboration. Thenurse seeks to offer arelationship in whichthe client can identifyproblems in living withothers, growemotionally, andimprove the ability toform satisfactoryrelationships. Thenurse offers to dothings with, rather that

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Migo ugma na

pud ha, ing ani

gihapon nga

oras. Mao

gihapon to ang

atong mga

pagabuhaton.

Bye-bye migi.

The student nurse

encourages the

patients to

verbalize her

feelings about the

activity done.

The clientverbalizes his

Feelings towards

the activity given.

The student nurse

doing the

termination phaseand giving the

information for the

next day activity.

The patient replies

the student nurse

directly.

for, the client.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourthedition; page 109)

Exploring. Whenclients deal with topicssuperficially, exploringcan help themexamine the issuemere fully. Anyproblem or concerncan be betterunderstood if exploredin depth. If the client

expresses anunwillingness toexplore a subject,however, the nursemust respect his orher wishes.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing;fourth edition; page107)

Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse isfunctioning as aresource person.Giving informationalso build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Suggesting

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collaboration. Thenurse seeks to offer arelationship in whichthe client can identifyproblems in living with

others, growemotionally, andimprove the ability toform satisfactoryrelationships. Thenurse offers to dothings with, rather thatfor, the client.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourth

edition; page 109)Accepting. Anaccepting responseindicates the nursehas heard andfollowed the train ofthought. It does notindicate agreementbut is nonjudgmental.Facial expression,

tone of voice, and soforth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107)

Encouragingexpression. The nurseasks the client toconsider people andevents in light of his orher own values. Doingso encourages theclient to make his orher own appraisal

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rather than to acceptthe opinion of others.(Videbeck, Sheila;Psychiatric-MentalHealth Nursing; fourth

edition; page 107)

Alogia. Tendency tospeak very little or toconvey littlesubdtance ofmeaning. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourth

edition; page 269)Giving information.Informing the client offacts increases his orher knowledge abouta topic or lets theclient know what toexpect. The nurse isfunctioning as aresource person.

Giving informationalso build trust withthe client. (Videbeck,Sheila; Psychiatric-Mental HealthNursing; fourthedition; page 107

Accepting. Anaccepting responseindicates the nursehas heard andfollowed the train ofthought. It does notindicate agreementbut is nonjudgmental.Facial expression,tone of voice, and so

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forth also mustconvey acceptance orthe words lose theirmeaning. (Videbeck,Sheila; Psychiatric-


B. Progress notes and other observations on the succeeding interaction.

V. PSYCHODYNAMICS

According to Manfreda and Krampitz, predisposing causes are

those conditions, which make the individual susceptible to the effect of the

later, precipitating cause, and thus more likely to develop psychosis. It is

generally believed that no human being can escape completely all

predispositions to mental disorders. While precipitating causes of mental

disorders are considered by many investigators to be more dynamic,

motivating and damaging causes of mental illness. If it is possible to identify

the physical etiologic factors through laboratory examinations and specific

test, the psychic and emotional precipitating factors are not easily identified or

understood.

A. Tabular Presentation

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Factors Present Rationale

A.Predisposing

Factors

a. Hereditary

b. Age

According to

Mr. Vins

younger

brother, there

are alcoholics

in their fathers

side.

Mr. Vin started

using

Biologic factor (Hereditary)

Dick and Bevrit formed that 50 % to

60% of variation in causes of

alcoholism was the result of genetics,

with the remainder caused by

environmental influences.

(Videbeck, Shiela, Psychiatric MentalHealth Nursing p. 372, 4th ed.)

In addition to genetic links to

alcoholism, family dynamics are

thought to play apart. Children of

alcoholics are four times as likely to

develop alcoholism schuckit (2005)

compared with the general

population period. Some theorists

believe that inconsistency in the

parents behavior, poor role

modeling, and lack of nurturing pave

the way for the child to adapt as

similar style adaptive coping, stormy

relationships, and substance abuse.

(Videbeck, Shiela, Psychiatric MentalHealth Nursing p. 372 4th ed.)

According to Manfreda and Krampitz,

there are three periods in life when

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marijuana at

the age of 15

yrs. old and

used injectable

drugs at the

age of 22.

persons appear to be constitutionally

vulnerable to mental disorders:

adolescence, the menopause, and

the senile periods. We are much

aware that during these periods the

body undergoes very definite

physiological changes. Combined

with stress and strain of everyday

living and its inevitable problems,

change may prove vastly

overwhelming for some persons.

(Psychiatric Nursing, 10th Editionp.11)

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c. Sex The client is

male.

Age in general, younger

experimenters use substances that

carry less social disapproval such as

alcohol and drugs, whereas older

people use drugs such as cocaine

and opioids that are more costly and

rate higher disapproval.

(Videbeck, Shiela, Psychiatric Mental

Health Nursing p. 372, 4th ed.)Maximum recommendations are

one standard drink per day(12oz. of

bear, 5 oz. of wine or 1.5 ounce of

distilled 80% proof spirits) for adult

women and person older than

65years not to exceed 7 drinks per

week and 2 drinks per day for adultmen not to exceed 14 drinks per

week. Risky or binge drinking is

identified as intake of more than 4

drinks per drinking episode per

women and 5 drinks per men, not

necessarily exceeding the weekly

maximum of 14 drinks recommended

by the NIAAA.

(Reference: Neushotz, L. and

Fitzpatrick, J.)

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d.Social and

Environmental

Mr. Vin had

many friends

who

influenced

him to drink

alcoholic

drinks and

use drugs.


the mores and customs of ones

culture may become problematic,

particularly if a person migrates to a

different environment and becomes

involved in the assimilation process.

Very important environmental social

factors are the feelings which exist in

relationships between familymembers. A child who feels

emotionally insecure and unwanted is

potentially the victim of psychiatric

disorder in later life. The child who is

over-protected and unable to

emancipate himself from parental

control may become predisposed to

later mental disorder.

(Psychiatric Nursing, 10th Edition p.11)

Cultural factors, special attitudes,

peer behaviors, laws, cost and

availability all influence initial and

continued use of substances(Jaffe

and Anthony,2005), thus,

environment and social customs caninfluence a persons use of

substances.


Health Nursing p. 372, 4th ed.)

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B.Precipitating

Factors

a. Trauma

b. Intoxicants

At the age of

14 y/o Mr. Vin

was already

involved in

gang wars and

experiencedbeing hit at the

head with a

cue ball.

At the age of

14 y/o Mr. Vin

started

drinking

alcoholic

drinks and he

was 15 y/o

when he used

marijuana and

injectables

drugs.


sometimes a few or several months

following the date of injury,

pronounced changes in an

individuals personality and behavior

are noted.(Psychiatric Nursing, 10th Edition p.13)


narcotics, alcohol, bromides,

barbiturates and Benzedrine, when

taken in large amounts over a long

period of time, many accumulate in

the body and cause by the individual

to manifest psychiatric symptoms.

Most investigators believe, however

that persons who take these drugs

already endowed with a predisposing

sociopathic or neurotic personalitystructure. (Psychiatric Nursing, 10th

Edition p.13)

Alcohol is a central neurons system

depressant that is absorbed rapidly

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c. Lifestyle Mr. Vin is an

early morning

alcoholic.

into the bloodstream. Initially, the

effects are relaxation and loss of

inhibitions. With intoxication, there is

slurred speech, unsteady gait, lack of

coordination and impaired attention,

concentration, memory and

judgment. Some people become

aggressions or display inappropriate

sexual behavior when intoxicated.

The person who is intoxicated may

experience black out.

(Videbeck, Shiela, Psychiatric MentalHealth Nursing p. 373, 4th ed.)

Marijuana begins to act less than 1

minute after inhalation. Peak effect

usually occurs in 20 to 30 minutes

and last at least 2 to 3 hours. Users

report a high feeling seminar to that

with alcohol, lowered inhibitions,relaxation, euphoria and increased

appetite. Symptom of intoxication

include impaired judgment and short

term memory, and distortions of time

and perception.


Health Nursing p. 376, 4th ed.)

A rare binge will probably not cause

permanent memory problems, but

habitually abusing alcohol can cause

real damage. In fact, short-term

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memory loss is one of the hallmarks

of alcoholism. Alcohol destroys brain

tissue and interferes with the process

of absorbing information so that it

never enters long-term memory.

Prolonged alcohol abuse causes

permanent damage to the memory

system. Short-term memory loss is

often the first indicator of alcohol-

related neurological damage. This

type of memory loss means a person

has difficulty remembering newinformation, so the learning process

takes longer. It also reduces a

person's higher-level thinking (the

ability to think in abstract terms).

Excessive drinking changes the

underlying brain chemistry that

controls ability and skills. People whohabitually drink too much may also

experience blackouts -- periods of

amnesia that occur when the amount

of alcohol consumed prevents the

formation of memories in the brain. If

untreated, chronic alcoholics may

develop a confused state of thinking

that can lead to severe amnesia and

disorientation.

(Reference: Richard C. Mohs, Ph.D.)

B. Schematic Presentation

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During this age, children begin to develop a sense of pride in their

accomplishments. They initiate projects, see through completion and feel

good about what they have achieved. Teachers at this time play a role in the

development of child. If children are encouraged and for their initiative they

begin to feel confident in their ability to achieve goals. If they are discouraged

by parents or teachers, then the child begins to feel inferior, doubting his own.

Abilities and therefore may not reach his potential.

School Age (5-12 yrs old)

Industry vs Inferiority

71

Mother

Pamperedpatient

Father financially supports family pampers need of patient whenever present give rewards to the patient in his

accom lishments

Although his

busy at workhe still have

time to his

children in

regards to theireducation

His elder

sister is the

one who

Engagewith

patient in


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Adolescence ( 9- 18 yrs old)

Identity vs role confusion

During adolescence, the transition from childhood to adulthood is most

important. children are becoming more independent, and begin to look at the

future and terms of career, relationship, families, housing, etc. During this

period, they explore possibilities and begin to form their own identity upon the

outcome of their explorations. This sense of who they are can be hindered,with results in a sense of confusion. (I dont know what I want to be when I

grow up) about themselves and their role in the world.

Give rewards tothe patient in his

accomplishments

Give love

and support

Became an honor

student

72

FatherPraise topatient in hisachievement

Patient had

discovered anddevelops his own

capabilities

Industry

Praise to

patient in hisachievement

Mother Father Sibling Peers


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Young Adult (18 30 yrs old)Intimacy vs Isolation

Occurring in young adulthood, we begin to share ourselves more

intimately with others. To explore relationships leading toward longer term

commitments with someone other than a family member. Successful

completion can lead to comfortable relationship and a sen

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