Republic of the Philippines
Tarlac State University
College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
A Case Study Presented to Mariveles Mental Hospital
In partial fulfilment of the Requirements of the subject
Nursing Care Management 105
A.Y. 2017-2018
SCHIZOPHRENIA
Presented by:
Artates, Shelly Anne S.
Celebrados, Darene T.
Diza, Kimberly M.
Gonzales, Jeffster Nikka E.
Lomibao, Angela Joy D.
Macaraeg, Gina Marie B.
Meehleib, Rachelle Ayn S.
Padilla, Ana Veronica M.
Quiban, Kacelyn A.
Reyes, May D.
Saptang, Jolina E.
July 2018
1
ACKNOWLEDGEMENT
First and foremost, the students would like to express our deepest gratitude and appreciation to our
Almighty God, who gave us courage, determination, love, wisdom, protection and inner strength which enable us to
overcome all the difficulties during the challenging process of making this study.
To Prof. Ma. Susan Z. Maglaqui and Prof. Adora N. Obregon for their words of encouragement, guidance,
patience, valuable comments, suggestions, time and effort throughout this case study.
To our family, friends, and classmates who serve as an inspiration, thank you for the unwavering moral,
emotional and financial support, and motivations in doing this case study.
To the Mariveles Mental Hospital health personnels who welcomed us warmly, oriented us, and thaught us
the things we didn’t knew at first, we would like to extend our deep and heartfelt gratitude for letting us explore and
learn new things in your institution.
Thank you so much!
-The students
2
Table of Contents
Chapter 1
Introduction……………………………………………………………………………………....5
Theoretical Framework…………………………………………………………………………..7
Personal Data……………………………………………………………………………………..8
History of Present Illness…………………………………………………………………………8
History of Previous Illness………………………………………………………………………..8
Past Personal History……………………………………………………………………………..9
Family Health and Psychiatric History…………………………………………………………..9
Chapter 2: Mental Status Assessment (MSA)……………………………………………………………...10
General Appearance……………………………………………………………………………...10
Motor Behavior…………………………………………………………………………………..10
Sensorium and Cognitive ability…………………………………………………………………13
Perception………………………………………………………………………………………...12
Attitude and behavior……………………………………………………………………………11
Affective State ………………………………………………………………………………….11
Speech……………………………………………………………………………………………10
Thought process and content…………………………………………………………………….12
Chapter 3
Psychopathology…………………………………………………………………………………15
Related Literature and Studies…………………………………………………………………...17
Drug Study……………………………………………………………………………………….18
3
Chapter 4
Process Recordings………………………………………………………………………………22
Prioritized Psychiatric Nursing Diagnoses and Psychiatric Nursing Care Plan …………………39
Chapter 5
Psychotherapies Implemented……………………………………………………………………43
Bibliography………………………………………………………………………………………………..45
4
CHAPTER 1
Introduction
Schizophrenia is the most dominating case of admissions in Mariveles Mental Hospital. It is an extremely
complex mental disorder. In fact, it is probably much illness masquerading as one. A biochemical imbalance in the
brain is believed to cause symptoms. Recent research reveals the schizophrenia may be result of faulty neuronal
development in the fetal brain, which develops into full-blown illness in the late adolescence or early childhood.
Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years
of age for women. Its causes distorted and bizarre thoughts, perceptions, emotions, movement, and behaviour. It
cannot be defined as a single illness, rather thought as a syndrome or disease process with many different varieties
and symptoms. These symptoms are categorized into two major categories, the positive or hard symptoms which
include delusion, hallucinations, and grossly disorganized thinking, speech, and behavior, and negative or soft
symptoms as flat affect, lack of volition, and social withdrawal or discomfort. Medication treatment can control the
positive symptoms but frequently the negative symptoms persist after positive symptoms have abated. The
persistence of these negative symptoms over time presents a major barrier to recovery and improved the functioning
of client’s daily life. (Keltner, et al., Psychiatric Nursing, 5th Edition (28) page 339-366)
Gaebel and Zielasek (2015), revealed the newly revised version of Diagnostic and Statistic Manual for
mental disorders (DSM) that was published by American Psychiatric Association in 2013. In addition, there is
currently an ongoing revision process in clinical diagnostic criteria for mental disorders, including Schizophrenia by
the World Health Organization. The development of DSM – V is characterized by disorder group – specific working
groups of clinical and research experts, they reviewed the available evidence for classification issues of
Schizophrenia, and prepared suggestions for changes. The Classification of Schizophrenia in DSM – V and ICD –
11 are evident, omits the traditional clinical subtypes of Schizophrenia (Paranoid, Hebephrenic), because number of
studies have indicated that such clinical subtyping had little relevance for determining the prognosis or therapy.
World Health Organization statistics on Schizophrenia states that it affects more than 21 million people
worldwide.
The Philippine Health Information System on Mental Health (PHIS-MH) May 2014-2016, stated that
Schizophrenia is the Top Mental Health Problem in the Philippines, affecting 42%, and mostly male individuals.
Reasons for Choosing the Case
Patient-centered
To maintain and/or promote optimum level of mental health development of the patient, as to render our
learning experiences using therapeutic technique of communication.
Student-centered
To be able to understand the process of dealing with Schizophrenic patient by using our therapeutic
communication techniques, and to be able to learn the different therapies that will provide support and awareness to
our chosen client.
5
OBJECTIVES OF THE STUDY
General:
To be able to establish a working relationship with the patient and make use of our knowledge gathered and
studied about during our lecture days in psychiatric nursing, and applies it in our related learning experiences in
gathering the needed information to identify and prioritize the problem to promote mental health.
Specific:
1.
2.
3.
4.
5.
To assess properly and to determine the contributing factors regarding to their condition.
To use the different communication techniques and to promote therapeutic communication.
To provide and develop plan of care considering characteristics, and time bound plan that reflects the onset
date of problems identified.
To render and provide supportive and protective nursing interventions to the problems identified for the
patien’s care.
To evaluate all nursing interventions that has been established and outcome of the condition.
6
Theoretical Framework
Family Theories
Numerous theories implicating family interaction alone as a cause of schizophrenia have been proposed
and unsupported. Research has failed to support the theory that dysfunctional family interaction alone causes the
illness.
Individuals with schizophrenia who are raised by adoptive parents, who themselves showed elevated levels
of communication of deviance, demonstrated as much thought disorder as those raised in birth families. In contrast,
adoptees who were raised by adoptive parents with more functional communication were less likely to show thought
disorder as those raised in birth families. In contrast, adoptees who were raised by adoptive parents with more
functional communication were less likely to show thought disorder. In one study, this pattern was not evident in
control adoptees, there was no discernible relationship between thought disorder in the adoptees and
communication, deviance in the adoptive parents. In other words, these findings did not detect the presense of
‘’schizophrenia’’ environment for individuals without a pre existing genetic liability. This examples support the
view that genetic factors alone do not explain the development of schizophrenia, and that interaction with the
environment are important. Individuals who live in aversive environments tend to have a higher rate of
schizophrenia suggesting there maybe neighborhood and social context to development of the disease.
( Allardyce and Boydell, 2006)
7
Personal Data
Name: “Tisay”
Age: 34 y/o
Birthday: May 20, 1984
Female
Address: Orani, Bataan
Citizenship: Filipino
Date Admitted: September 11, 2017
Past Health History:
On January 16, 2012, 7:00 PM, Client was reported by tricycle driver in Mariveles Police Station and was
placed in the blotter for alleged jumping off from the tricycle upon arriving in Barangay Sisisman near the school.
According to the driver, he had observed her inside the tricycle, murmuring to herself. The Client revealed her name
and her age, 29 years old with unknown address.
She was referred to Municipal Social Welfare and Development (MSWD) Office for assistance and proper
case disposition. As observed, Client seemed to be harmless and cried when being questioned. While being
interviewed by two social workers, she took a pair of scissors, pointed and threatened them. On June 26, 2013 Client
was discharged with the Diagnosis of Undifferentiated Schizophrenia.
On November 7, 2014 she started to undergo scheduled check up with her sister in Mariveles Mental
Hospital.
In November 27, 2014, her sister came without the client, and reported that the client is pregnant.
January 15, 2015, her sister came to the Out-Patient Unit to report that the client cannot travel due to
financial constraints. She then reported that “Tisay” was 6 months pregnant, as per her RHU prenatal check-up.
Since then, no further check-up was done. However, there was no Obstetric History seen on the client’s chart.
On January 22, 2016, she was seen roaming around Olongapo City, naked, untidy, and wandering around,
does not want to talk to anybody. She was then admitted to the Olongapo Municipal Social Welfare and
Development Office and reported back to Municipal Social Welfare Development Office (MSWDO) Mariveles.
January 29, 2016, “Tisay” was surrendered by that City Social Welfare and Development of Olongapo City for
possible admission to Mariveles Mental Hospital. Thus, on that same day she was admitted to Mariveles Mental
Hospital. On August 30, 2016, patient was out for home conduction accompanied by MMH staff. August 31 2016,
she was successfully home conducted and accepted by her sister.
Present Health History
Last September 11, 2017, client was taken by the saturation team sleeping along Magsaysay drive. Client
was psychotic vagrant, and was always seen naked roaming and wandering in the streets, untidy and doesn’t want to
take a bath. After 2 days, the concerned citizen observed that she was close to the male residence and wants to sleep
8
with them. She was referred for safekeeping and proper disposition on September 14, 2017, and was admitted at
Mariveles Mental Hospital up to present.
Social History
During the NPI, “Tisay” claimed that she met unknown male individuals, and was made to believe that she
will work as an actress for a Hollywood film and will be paid 20 thousand pesos. She said she was married to Paul
Walker, a Hollywood actor and that they had three children. She confided that she was a very rich actress, living in
Alabang, and owns a house and luxury cars in California. She claimed that her former maids were admitted at MMH
female service wards. Client have stated that she left Bataan and proceeded to Olongapo to work as an actress for
Hollywood films, allegedly, she had sexual intercourse with males referred to as “kung sino-sino”.
Drug Abuse History
The client claimed she used tuber ecstacy and injectable methamphetamine prior to filming the said movie.
Forensic History
January 16, 2012, 7:00 PM, Client was reported by tricycle driver in Mariveles Police Station and was
placed in the blotter for alleged jumping off from the tricycle upon arriving in Barangay Sisisman near the school.
Family History
Patient’s relatives denied to be related to her. They confirmed that “Tisay” was only adopted. No further
family history was gathered in the client’s chart.
9
CHAPTER 2
MENTAL STATUS EXAMINATION
1.
GENERAL DESCRIPTION
1.1 APPEARANCE
DESCRIPTIONS
Congruent apparent age
Appropriate dressing
Clean/Hygiene
Good posture
Good gait
Appropriate facial expression
With eye contact
With pupil dilatation
With pupil constriction
Normal state of health & nutrition
NP1
NP2
NP3






NP4
NP5
NP4
NP5
NP4
NP5

1.2 SPEECH
DESCRIPTION
Rapid speech
Slow speech
Loud volume
Soft volume
Minimal speech
Pressured speech
Stuttering
Slurring of words
Unusual accents
NP1
NP2
NP3






1.3 MOTOR ACTIVITY
DESCRIPTION
Lethargic
Tensed
Restless
Agitated
With observed tics
Grimace
Tremors
Compulsive
NP1
NP2



NP3





10
1.4 INTERACTION DURING INTERVIEW
DESCRIPTION
Hostile
Uncooperative
Irritable
Guarded
Apathetic
Defensive
Suspicious
Seductive
NP1
NP2

NP3

NP4
NP5

Descriptive Analysis:
Appearance, Speech, Motor Activity & Interaction during Interview
Tisay has a congruent apparent age. During the interview, she has a good posture and gait, also very
cooperative and able to answer our questions with clear voice. Pediculosis is present. Tisay has a rapid speech and
loud voice, we observed that while conducting the interview she was tensed and both of her hands were shaking and
was irritable at some point, however, she was able to perform range of motion exercises at ease.
2.
EMOTIONAL STATE
2.1 MOOD
DESCRIPTION
Sad
Fearful
Hopeless
Euphoric
Anxious
Happy
NP1
NP2



NP3

NP4
NP5
NP4
NP5

2.2 AFFECT
DESCRIPTION
Congruent/Appropriate
Flat
Labile
NP1
NP2

NP3

Descriptive analysis:
Mood and Affect
We have observed that our patient shows positive emotions on her facial expression such as
smiling all the time, establishing a fixed eye contact and shows interest to the interview. Her mood is
appropriate and she is cooperative.
11
3.
EXPERIENCES
3.1 PERCEPTIONS
DESCRIPTION
Hallucination: Auditory
Visual
Tactile
Gustatory
Olfactory
Illusions
NPI 1
NPI 2
NPI 3





NPI 4
NPI 5
Descriptive Analysis:
Perceptions
During the interview, she stated that she was married to a Hollywood actor and she was a Hollywood
actress. She claimed that she won Miss Philippines and tops the Nursing Board Examination. It shows on her
records that she talks to herself with irrelevant topics in the ward.
4.
THINKING
4.1 THOUGHT CONTENT
DESCRIPTION
Delusion: religious
Somatic
Grandiose
Paranoid
Thought Broadcasting
Thought insertion
Depersonalization
Hypochondriasis
Ideas of reference
Magical thinking
Nihilistic ideas
Obsession
Phobia
NPI 1
NPI 2
NPI 3






NPI 1
NPI 2
NPI 3




NPI 4
NPI 5
NPI 4
NPI 5
4.2 Thought process
DESCRIPTION
Circumstantial
Flight of ideas
Loose association
Neologisms
Perseveration
Tangential
Thought Blocking

12
Word salad
Descriptive Analysis:
Though content, thought process
Based on the patient’s statement, there were presence of grandiose and obsession through her story, that she
was married with Paul Walker and they have 3 children. Sometimes, while she was talking she suddenly stop and
think for awhile then tried to continued her story. Her statement was spontaneous but in a grandiose manner wherein
there’s no evident relation to reality. Patient was delusional.
5.
Sensorium and Cognition
5.1 Level of Consciousness
DESCRIPTION
Confused
Sedated
Stuporous
Oriented to :
Time
Place
Person
NPI 1
NPI 2
NPI 3
NPI 4
NPI 5









NPI 1

NPI 2
NPI 3

NPI 4
NPI 5
NPI 1
NPI 2
NPI 3

NPI 4
NPI 5
NPI 1
NPI 2
NPI 3
NPI 4
NPI 5
5.2 Memory
DESCRIPTION
Intact remote memory
Intact recent memory
Intact immediate memory

5.3 Level of concentration and calculation
DESCRIPTION
Easily distracted
With difficulty in simple math
5.4 Information and intelligence
DESCRIPTION
With learning disability
With learning difficulty
Able to interpret simple proverb


13
5.5 Judgement
DESCRIPTION
Appropriate judgement
With good relationship to others
NPI 1
NPI 2
NPI 3
NPI 4
NPI 5
NPI 1
NPI 2
NPI 3
NPI 4
NPI 5
5.6 Insight
DESCRIPTION
Accepts presence of problem
Blames the problem on others
Descriptive Analysis:
Level of Consciousness, Memory, Level of Concentration, Calculation, Information, Intelligence, Judgement, and
Insight.
Oriented to time, date and place; she was able to recognize us, and was not easily distracted and able to
answer simple math question. Tisay is also good in grammar, has good relationship to others, and was able to read
and write appropriately. She claimed that she had finished College and Topped the Nursing Board Exam.
14
CHAPTER 3
Psychopathology
Book - based
Non-Modifiable Factors
Modifiable Factors
 Genetics
 Gender
 Age (late adolescent- young
adulthood) 25-35 years old
 Neurostructural
abnormalities




Alcohol drinking
Smoking
Substance abuse
Lifestyle
Psychosocial stressor and
interpersonal events
Stimulation by different factors
Failure in development or a
subsequent loss of brain tissue
Diminished glucose meta, and
oxygen in frontal cortical
Decrease brain volume and
abnormal brain function in
frontal and temporal lobe
Malfunctioning of transmission
of electrical impulses
Transmission of signal requires a
complex series of biochemical events
Actions of dopamine, serotonin,
norepinephrine, acetylcholine,
glumate
Drug increases dopaminergic
system activity
Induced paranoia psychotic
symptoms
Drug blocking post synaptic
dopamine receptors
Reduce psychotic behaviors
15
Three separate symptoms complexes/ syndromes









Hallucinations
Delusions
Disorganized thoughts and behavior
Positive symptoms like:
Abnormal thoughts
Agitation
Bizarre behavior
Delusions
Excitement






Feelings of persecution
Grandiosity
Hostility
Illusions
Insomnia
suspiciousness
Client - based
Non-Modifiable Factors
Modifiable Factors
 Alcohol drinking (as claimed by
the patient)
 Smoking (as claimed by the
patient)
 Substance abuse (such as tuber
ecstasy and meth)
 Rejection of her love interests
(seven or more times)
 Female
 34 years old
Overwhelming stressful events
Drug abuse
Manifestations:
-Hallucination: Visual
-Hallucinations: Auditory – voices commenting or
discussing the patient in the third person
-Delusion of grandeur/ grandiosity
-Delusion of control
-Reference of delusion
16
RELATED LITERATURE AND STUDIES
Gaebel and Zielasek (2015), stated that by the year 2020, Schizophrenia will still be clinically defined as a
Primary Specific Disorder, and the treatment will improve with new Anti – Psychotic Drugs, drugs addressing
negative symptoms, more refined Psychotherapy approaches and the introduction of new treatment modalities, like
Transcranial Magnetic Stimulation to improve early detection and prevention. There is an imminent clinical
challenge to develop comprehensive diagnostic and treatment modules individually tailored to the time – variable
needs of patients and their families.
According to the study of Donker, et al. (2013), Suicide Prevention in Schizophrenia Spectrum Disorders
and Psychosis: A Systematic Review, a systematic review was conducted in order to investigate the effectiveness of
psychococial interventions in reducing suicidal behavior among schizophrenic patients, and the study concluded that
psychosocial interventions may be effective in reducing suicidal behavior in patients with schizophrenia disorders
and psychosis.
Based on the study of Siira V., et al (2013), it was stated that stability has been considered as an important
aspect of vulnerability to Schizophrenia. The temporal stability of the scales in the Minnesotta Multiphasic
Personality Inventory (MMPI) was examined, using adoptees from the Finnished Adoptive Family Study of
Schizophrenia. Adoptees who were high risked off spring of biological mothers having a Schizophrenia Spectrum
Disorder, and low risk controls were evaluated using 15 MMPI scales at the initial assessment (HR, or High Risk
mean age is 24 years old; LR ow Low Risk mean age is 23 years old). Stability of MMPI scales was also assessed in
the groups of adoptees, assigned according to the adoptive parents (N=44) Communication style using
Communication Deviance (CD) Scale as an environmental factor. Low CD had an effect on the stabilization of
personality traits, such as social withdrawal and restricted affectivity, assessed by correction and hostility.
According to McGrath et al. (2008), Schizophrenia: A Concise Overview of Incidence, Prevalence, and
Mortality, study shows concise overview of three related systematic reviews on the incidence, prevalence, and
mortality associated with Schizophrenia. The median incidence of Schizophrenia was 15.2 over 100,000 persons,
and the central 80% of estimates varied over a fivefold range. (7.7-43.0/100,000). The ratio for males: females were
1.4:1. On the basis of the standardixed mortality ratio, people with Schizophrenia have two – to three fold increased
risk of dying, and this differential gap in mortality has increased over recent decades. Compared with native – born
individuals, migrants have an increased incidence and prevalence of Schizophrenia. Exposure related to Urbanicity,
economic status, and latitude are also associated with various frequency measures.
In the study of Sullivan, P.F (2005), it was stated that Adoptions designs permit evaluation of the role of
genetic factors in Schizophrenia independently of the influence of family environments. The results from the studies
adoptees with Schizophrenia and their biological and adoptive relatives indicate that genetic factors play a highly
significant role in the risk for schizophrenia. This genetically mediated risk to relatives includes an increased
prevalence of both schizophrenia and a non-psychotic syndrome analogouos to Schizophrenia, but does not
represent a general liability to other forms of psychopathology.
17
DRUG STUDY
Name of Drug
Route, Dosage
and Frequency
Mechanism of Action
Indication and Contraindication
Side Effect
Nursing Responsibilities
Generic Name:
Biperiden
Hydrochloride
PO,2 mg tablet,
once daily
Synthetic anticholinergic.
Tremor may increase as
spasticity is relieved.
Slight respiratory and CV
effects.
>control of extrapyramidal
disorders secondary to neuroleptic
drug therapy.
>dry mouth
>blurred vision
>drowsiness
>constipation
>bradycardia
>Muscle weakness
>Inability to move
certain muscle
>Take after meals to void gastric
irritation. Do not stop abruptly
>increase fluid intake and fiber
intake to avoid constipation
Brand Name:
Akinton
Classifications:
Cholinergic
blocking
drug,ati
parkinson drug
>hypersensitivity to biperdin
>use ice chips or hard candy for
dry mouth
>Avoid activities that require
mental alertness until drug effects
realized. May cause dizziness,
drowsiness or blurred vision .
change positions slowly to prevent
sudden drop in BP.
>Record stool; increase intake of
fluids, fruit juices, and fiber to
avoid constipation; report urinary
difficulties
18
Name of Drug
Route, Dosage
and Frequency
Mechanism of Action
Indication and Contraindication
Side Effect
Nursing Responsibilities
Generic Name:
Olanzapine
P.O,10 mg
tablet, once
daily.
Mechanism of action not
fully understood; Blocks
dopamine receptors in the
brain, depresses the RAS;
blocks serotonin receptor
sites; anticholinergic
‘anti-histamic and alpaadenargic blocking
activitymay cotribute
>Treatment of schizophrenia
>Acute mixed or manic episodes
associated with bipolar1 disorder
and maintenance as monotherapy or
combined with lithium or valproate.
>Dizziness
>somnolence
>Nervousness
>headache
>Akathisia
>peripheral edema
>tachycardia
>hypotension
>constipation
>Abdominal pain
>cough
> Monitor patient for tardive
dyskinesia, which may occur after
prolonged use. It may not appear
until months or year later and may
disappear spontaneously or persist
for life.
Brand Name:
Zyprexa
Classification:
Antipsychotic
Dopaminergic
Blocker
>Contraindicated with allergy to
olanzapine, myeloproliferative
disorder, sever CNS depression
comatose states and location
>Take only as directed; do not
share medication; do not exceed
prescribed dosage
>Avoid changing positions
suddenly, especially from lying to
standing position r/t to low blood
pressure.
>Do not perform activities that
require mental alertness until the
drug effects realized.
19
Name of Drug
Route, Dosage
and Frequency
Mechanism of Action
Indication and Contraindication
Side Effect
Nursing Responsibilities
Generic Name:
PO,100 mg
tablet, Once
Daily
Alters effects of dopamine
(D2) in CNS. Has
significant anticholinergic
/ alpha- adrenergic
blocking activity.
> Schizophrenia and psychoses
Hyperexcitability, combat for
explosive behavior. And
hyperactive with conduct disorder
>Drowsiness
>Dizziness
>Light headedness
>Dry mouth
>Blurred vision
>Tiredness
>Nausea
>Constipation
>Weight Gain
>Trouble of
sleeping
> Assess mental status prior to and
periodically during therapy
Chlorpromazine
Brand Name:
Thorazine
Classification:
Anti-psychotic
Antiemetics
>hypersensitivity sulphites or
benzyl alcohol.
>Monitor BP and pulse prior to
and frequently during the period of
dosage adjustment. May cause QT
interval changes on ECG
>The drug may be taken with or
without food
>Observation patient carefully
when administering medication
>Monitor I &O rations and daily
weight.
>Monitor for development of
neuroleptic malignant syndrome
20
Name of Drug
Route, Dosage
and Frequency
Mechanism of Action
Indication and Contraindication
Side Effect
Nursing Responsibilities
Generic Name:
Risperidone
PO, 2 mg tablet,
once daily
Block dopamine and 5 HT2 receptors in the
brain.
>Parenteral therapy for
schizophrenia and treatment of
acute manic or mixed episodes from
dipolar disorder.
>Depression
>Somnolence
>dystonia
>headache
>Insomnia
>Anxiety
>chest pain
>hypertension
>rhinitis
>sinusitis
>abnormal vision
>Rise slowly from a lying to a
sitting position, dangle legs before
standing; may cause drop in BP.
Brand Name:
Risperidone
Classification:
Anti-psychotic
>Contraindicated in patients
hypertensive to drugs and in breast
feeding woman
>Drug may cause drowsiness and
impair judgment, motor skills and
thinking and cause blurred vision;
determine the drug effect engaging
in activities that require mental
alertness.
21
CHAPTER 4
Nurse’s Statements
Patient’s Response
Verbal
“Magandang umagaTisay, Ako
nga pala si Rachelle, studyante ng
Tarlac State University”
“Kamusta ka naman Kaibigan,
kumain ka na ba?”
“Tara kabigan, umupo tayo at ng
makapag kwentuahn tayo.”
“Ako pala si Rachelle, 20 years
old, kasalukuyang nag aaral sa
Tarlac State University, 4th year
student.
“Nandito kami sa loob lamang ng
dalawang lingo para po sa aming
duty at makasama kayo para
gawin ang mga ibat ibang
activities katulad ng Pagsayaw,
pag awit, pag guhit at pag luluto.
Meron din po kaming ibat ibang
palaro para sainyo, Meron din po
kaming maihahandog na
duladulaan sa ating
socialization.”
“Opo, yun lamang po yung
nakalaan na oras namin para
makasama kayo.”
“Pwede ko bang itanong kung
anong ginagawa mo sa ward
Analysis of Patient’s Response
(To include Defense Mechanism
Used. )
Non-Verbal
“Good Morning
Rachelle, mag katunog
pala pangalan natig
dalawa”
“Okay lang naman, oo
kumain na ako.”
“Sige, Tara Rachelle,
upo tayo.”
Patient was smiling while fixing her hair
“Ako naman si “Tisay”,
34 years old at taga
Orani, Bataan.”
Walk fast with visible excitement
Mood is appropriate
Facilitate eye contact
Patient is answered
appropriately
Patient is responsive
Seeking information
Patient was getting ready for morning care
Patient was able to introduce
herself appropriately with fast
speech
Giving information
Patient was excited to tell her story
Patient nods
Patient expressed excitement on
her facial expression
Formulating a plan of action
Patient was smiling
patient was smiling
“ahh ganun ba, osige,
mag eenjoy naman ako.”
“Nanunood ako ng
teleserye yung sa GMA,
Rationale of Nurses
Statement
(To include Therapeutic
Communication Technique
used)
Giving recognition and
information
Patient smiled and showed glad expressions
Offering self
Giving information
Patient answered accordingly
Exploring
22
niyo?”
“Ano yung mga hilig mong
gawin kaibigan?”
“Tungkol saan naman ang
pinagusapan niyo?”
“Kaibigan pwede ko pang
maitanong kung ano yung
nagging buhay mo sa labas ng
Mariveles Mental Hospital”
“Anong dahilan at ikay
nagpupunta ng Olongapo.”
“Ano pa ba mga ginagawa mo o
pinupuntahan sa Olongapo,
Kaibigan?”
“Nasan na yung nanay mo
ngayon kaibigan?”
“Kamusta naman ang naging
karanasan mo sa Olongapo
kaibigan?”
“Ahh may mga nagbibigay pala
sayo ng pagkain doon kaibigan.”
“Kaibigan, ikaw ba’y may
pamilya na?”
yung kontesa at kambal
karibal.”
“gusto ko nakikipag
kwenthan sa mga
kaibigan ko”
“Madalas tungkol sa
teleserye na pinapanuod
namin, minsan naman
tungkol sa buhay sa
labas.”
“Noon kasi mahilig ako
mamasyal, lagi akong
nagpupunta ng
Olongapo.”
“Mahilig kasi ako
mamasayal gusto ko dun
yung beach tapos
lumalangoy ako dun.”
“Ang nanay ko kasi dun
siya nagwork bilang
GRO, dun ako
pinanganak, tatay ko ay
foreigner.”
“Namatay na yung tunay
kong mama, ipinakupkop
lang niya ako sa kaibigan
niya dito sa Orani.”
“Okay naman, masaya,
may mga nagbibigay
naman g pagkain sakin
kasi wala na akong
pera.”
“Oo kapag nanlilimos
ako minsan sa tindahan
ako nakikitulog.”
“meron, madami na
akong anak iba iba nga
Patient smiled
Patient was able to verbalize the
importance of communication
and friendship
Patient expressed her openness
Broad opening
Patient leans forward while talking
Patient showed no hesitation
regarding on her personal
information
Exploring
Patient was doing hand gestures like playing
with her fingers
Patient was able to express her
likes
Encouraging Expression
Patient was keeps on doing hand gestures
Patient was expressed openness
Focusing
Patient slouched and sighed heavily
Patient expression changed
Exploring
Patient was excited but showed gloomy
expression
Patient was able to express her
feelings
Encouraging expression
Patient verbalized in a sad manner but tried
to smile
Facial expression changed
Restating
She was making hand movements while
storytelling
Patient was able to admit but
then became complusive
Open ended question
Patient smiled
Focusing
23
“Hindi mo na ba sila nakakausap
kaibigan?”
“Ah ganun ba kaibigan, pero
kilala ka ba nila?”
“Anong pangalan ng anak mo?”
“Ano ulet pangalan ng anak mo?”
“Ano ba ang nangyare sa asawa
mo kaibigan?”
“Ah ganun ba kaibigan, sana
maayos ang mga anak mo.”
“Ano ba ang kadahilanan ng
paguwi mo?”
“Maari ko bang malaman kung
ano yung naging trabaho mo sa
Amerika.”
lang yung mga tatay.”
“Hindi na, buhat nung di
na kami nagsasami ng
mga tatay nila.”
“oo kasi may asawa
akong foreigner siya,
may anak kami, tatlo.”
“Si Elisha, Stephanie at
Patricia. Namatay na
yung asawa ko sa car
crash.”
“Si Elisha, Stephanie at
Patricia Walkers. Asawa
ko kasi si Paul Walker.”
“Naaksidente yung
asawa kong si Paul
Walkers dahil sa car
crash.”
“Oo nga eh miss ko na
sila, sana palang hindi na
lang ako umuwi ng
Pilipinas.”
“Galing kasi ako ng
America doon ako
nagtrabaho.”
“Graduate kasi ako ng
Nursing, nurse ako, nag
aral ako sa BPSU nag top
6 pa nga ako sa board
exam ko, nagtrabaho ako
dun ng care giver kaso
hinihupuan ako nung
matandang amo ko kaya
umalis na lang ako
binigyan niya ako ng
dollars, umuwi na lang
ako.”
She keeps on doing hand geatures
She was leaning forward and started to move
her feet
Patient seems to show denial
because she doesn’t showed
direct eye contact
Patient speech becames fast and
spontaneous
Patientwas looks directly to my eyes
Patient showed delusions
Seeking information
Patient did not break the eye contact
Patient admitted that she was
married to a Hollywood actor
which is not rekevant to reality
which also shows delusion
Patient is delusional and making
up stories
Restating
Suddenly showed sa d expression on her
face
Patient admitted showed feeling
of regrets
Giving recognition
She keeps on making hand gestures
Patient is delusional
Seeking information
Patient smiled while Nodding his head
Patient showed behavior of fast
speech with delusional thoughts
Focusing
She keeps on leaning forward
Exploring
Seeking information
Focusing
24
“Ahh sige kaibigan punta na tayo
dun at may activity tayong
gagawin. ”
“Maraming salamat sa
kooperasyon mo kaibigang
Tisay.”
“Bukas ulet kaibigan. Salamat.”
“Okay sige Rachelle,
tara.”
Patient nod and carried her chair in the
corner
Patient cooperated well
Offering self
“Salamat din, Rachelle.
Nag enjoy ako.”
Patient smiled
Patient express feeling of
enjoyment
Giving reacognition
“Sige, Thank you,
Salamat Ba-bye”
Patient waved her hand while saying
goodbye
Patient facila expression seems
happy with the conversation
Accepting and offering self
Analysis of Patient’s Response
(To include Defense Mechanism
Used. )
Rationale of Nurses Statement
(To include Therapeutic
Communication Technique
used)
Patient’s Response
Nurse’s Statements
Verbal
Non Verbal
“Magandang umaga Tisay,
kamusta ka?”
“Hello Rachelle, eto okay naman.”
Patient was smiling while
fixing her hair
Patient anwered appropriately
Giving recognition
“Tara kaibigan, mag morning
care.”
“Sige, Dito na lang tayo, pasensya na hindi
ako nakasama kahapon.”
Patient walks fast
Patient showed awareness and
the mood was appropriate
Offering self
“okay lang nakapagpahinga ka
naman ba?”
“oo, okay na ako ngayon.”
Patient smiled
Patient express feeling of good
modd behavior
Encouraging expression
“Tara punta na tayo dun at may
activity tayong gagawin.”
“Sige ano ba gagawin natin, music and
art?”
Patient smiled while
walking
Patient showed eagerness to
know the activity
Offering self and giving
information
“Oo, magddrawing tayo.”
“Gusto ko yan, Tara na.”
Patient nods
Patient showed cooperatedness
General lead
“Nasabi mo saakin kahapon na
ikay may tatlong anak.”
“Oo meron si Elisha, Stephanie at Joanna
Marie Walkers.”
Patient seemed very
excited
Patient is delusional
Placing event in time or
sequence
“Wala ka bang balak pasyalan o
Makita yung mga anak mo?”
“Meron babalik ako ng 2019, bibisita lang
ako kasi may bahay ako sa Alabang”
Patient was looking around
like she was looking for
something
Patient showed delusional
thoughts
Formulating aplan of action
25
“Ah may bahay ka sa Alabang,
kaibigan?”
“Oo, meron sa may Fablier Subdivision
baka kasi pasukan ng magnanakaw, Ayan
si Angela Manansala at si Pia Mina
katulong ko sila. ”
“Katulong mo sila kaibigan?”
Patient was smiling while
looking at the ceiling
Patient showed delusional
thoughts
Restating
“Oo kaso tong si Angela kinuha niya yung
mga atm ko susi ng bahay at kotse,
pinalayas niya mga katulong ko, tapos
kinuha niya mga gamit ko.”
Patient was pointing at
patient Ann
Patient showed delusional
thoughts
Restating
“Nabanggit mo saakin kaibigan
na anak ka ng Foreigner?”
“Oo, Father ko si Michael Watchman.”
Patient sighed heavily
Patient showed confused
expression
Summarizing
“Hindi mo ba siya nakakausap
noon?”
“Nakausap ko siya sa facebook noon kaso
dinideny niya ako.”
Patient frowned while
entertwining her fingers
Patient was tenses upon
answering the question
Voicing doubt
“Ano ba ang sabi mo sakanya
kaibigan?”
“Do you remember my mother’s name,
Amelia Lumanog? I am your daughter left
here in the Philippines, you abandoned
me”
Patient smiled and looked
at the ceiling
Patient recalls memory from
years ago
Focusing
“Anong nireply niya sa mensahe
mo kaibigan?”
“I don’t remember your mother’s name. I
don’t know who you are. I am not your
father. ”
Patientshrugged then
looked down
Patient restates what her
conversation went
Offering general leads
“Ano sinabi mo sakanya?”
“Thank you sir for your conversation. Im
sorry for, tapos nag sorry ako then wala
na.”
Patient looked at me with
disappointment
Restaes her conversation
Focusing
26
“Eh yung mother moa san na
siya?”
“Wala na patay na siya namatay siya dahil
sa appencitis, maglalaba at nagbubuhat
siya kaya naputukan siya, buntis pa siya
kamo ng 5 months.”
Patient smiled then looked
down
Patient cooperates well with the
conversation
Exploring
“saan mo nalaman na wala na
siya?”
“sa kaibigan niya, hinanap niya ako at si
nanay conrada ko, yung step mother ko.
May dalang picture ng mother ko at sabi
niya ako yung nawawalag anak.”
Patient had a slight of
emotional feeling
Patient answered appropriately
Exploring
“May mga kapatid ka ba sa nanay
Amelia mo kaibigan?”
“Wala ako lang at yung dinadala sana niya
noon.”
Patient nodded then pouted
her lips
Patient asnweres appropriately
Seeking information
“Kamusta naman ang pag aalaga
sayo ng Nanay Conrada mo?”
“Maayos naman, mabait naman nany ko, 2
months pa lang ako kinuha na niya ako.”
Patient was looking around
while talking
Patient was responsive
Encouraging expression
“Pinag aral ka ba ng nanay
Conrada mo kaibigan?
“Oo nung elementary ako sa Taplao
Elementary School tapos sa Jose Rizal
Institute nung high school. Nung college
naman sa BPSU.”
Patient was smiling while
nodding
Patient remembers details of the
past
Exploring
“Ahh mabuti naman kung ganun
kaibigan, ano ang kinuha mong
kurso noon?”
“Nag nursing ako graduate ako ng 2009,
nag take nga ako ng board exam sa UP
Diliman naka pasa ako.”
Patient was smiling while
doing hand gestures
Patient was delusional
Exploring
“Pakatapos mo ng college
nagtrabahao kaba kaibigan?”
“ Oo, 2010 nung nag apply ako ditto nag 1
month ako diyan tapos 1 week na nursing
attendant kaso pinasok nila ako dito.”
Patient nodded her head
while pointing the building
outside the gym
Patient was having delusional
thoughts
Seeking information
“Noong nagaaral ka kaibigan,
masaya naman ba? May mga
kaibigan k aba?”
“oo masaya naman, may mga kaibigan
naman ako.”
Patient smiled and looked
at me directly
Patiwent answered
appropriately
Offering general lead
27
“Naaalala mo pa ba sila
kaibigan?”
“Hindi ko na sila maalala kasi na black out
ako.”
Patientstated to stare while
playing with her hair
Repression – repress her
thoughts about that event
Placing event in time or
sequence
“Ano ba kadahilanan ng paka
blackout mo? ”
“Na burial kasi ako, akala nila na patay na
ako parang nabangungot ganun.”
Patientsmiled while
answering my questions
Patient was cooperative yet
delusional at the same time
Focusing
“Kailan naman yun kaibigan?”
“Nung May 31, si Anne ang nagbibigay ng
kape at tinapay, alam niya. Nailagay ako
sa kabaong di nila ako inembalsamo tapos
after 6 days nagising ako tapos inuwi ako
netong si anne sa Taplao.”
Patient had a serious face
Patient was delusional claims
that she was buried
Encouraging description of
perceptions
“Anong reaksyon nila nung
nakita ka nilang gumising”
“Wala masaya lang sila, binuksan ko yung
kabaong naka make-up ako at gown akala
daw nila patay na ako kasi ilang araw na
akong hindi nagigising.”
Patient smiled at me
Patient was delusional amd
looked happy with her answer
Encouraging expression
“Inuwi niya ako sa taplao, pinaltan muna
niya yung damit ko, inayos niya ako.
Tapos nung June, July, August, September
hanggang sa naggala ako, libot libot
ganun, kain tulog hanggang Sept 15 na
dinampot ako at dinala ditto.”
Patient smiled while
nodding
Patient is delusional.
Using Silence
“Ano yung ginawa mo nung
panahon nay un?”
“Wala kain tulog lang, namamasyal, uuwi
sa bahay kakain,maghuhugas ng plato at
maglalaba.”
Patient nodded while
answering my questions
Patient was open to share her
experiences
Exploring
“Nabanggit mo saakin na hilig
mo sa Olongapo.”
“Naglalakad tapos yung natitira kong pera
pinambibili ko ng pagkain tapos minsan
binibigyan ako sa tindahan.”
Patient was doing hand
gestures like pointing at
something
Patient admitted what she had
done before yet was tensed at
some points
Summarizing
Silence
28
“Hindi kaba nagtrabaho?”
“Hindi ako nagtrabaho, wala na akong
trabaho, yung last ko lang ginawa yung
Avatar tsaka Under The World.”
Patient shooked his head
Patient is delusional.
Exploring
“Wala wala akong nakilala mahilig lang
ako magpunta sa gotohan, sa lugawan
ganun bumibili ako bente pesos.”
Patient shooked his head
Patient was serious and
answered in a very straight
forward manner
Exploring
“Nabanggit mo sa akin na galing
kana dito nung 2012?”
“oo, nung 2013 pinasok ako ditto ng dswd,
dinala ako.”
Patient nodded
Patient answered appropriately
Summarizing
“tapos nakalabas ka sa dahilang?”
“conduction”
Patient smiled
Patient answered appropriately
Offering general leads
“pagkatapos anong ginawa mo?”
“namasyal na naman ako tapos ganun
ulet,panay ganun naman nangyayare sakin
di ba nasa chart ko yan. Nakita mo naba
chart ko”
Patient was doing hand
gesturswhile pointing at
somehing
Patient was tensed while telling
her story
Offering general leads
“ang sabi mo sakin kaibigan nag
shoot ka ng film”
“oo, the assignment, the donkey, basta
Makita mo yun sa youtube Michelle
Movies”
Patient nodded counting
with her fingers
Patient is delusional.
Summarizing
Patient shooked her head
Patient still insist of being an
actress and a director.
Encouraging comparison
“Wala ka bang naging kaibigan
sa Olongapo?”
“nung nasa olongapo ka wala
kaba naging film”
“wala eh tapos huling ginawa ko din yung
the decades”.
“ano naman yung naging ganap
mo kaibigan?”
“anak ako dun, anak ni vilma santos.”
Patient nodded with a
serious face
Patient’s delusional episodes
continues
Exploring
“Gusto mo na bang mag drawing
kaibigan”
“Pwede na ba? Pwede na ba talaga?”
Patient showed excitement
Patient expressed feelings of
excitement
Broad openings
29
“Eto Michelle, tatlong bond paper
at crayons mo, gagamitin mo yan
sa activity mo.”
“Sige Thank you salamat Rachelle.”
Client nodded then tapped
my hand
She cooperated well in y
instructions
Offering general leads
“Saan gawa yung bahay mo
kaibigan?”
“Sa bato gawa yung bahay.”
She pointed out her
drawing and nod
She seemed to be confident in
her answer
Exploring
Delving further into subject or
an idea
“Kanino bahay yang ginawa
mo?”
“Kay nanay Conrada ko, bahay ng
matanda”
Patient was stamping her
feet
She answered the question
appropriately
Exploring
Delving further into subject or
an idea
“Sino yung iniisip mo nung
dindrawing mo yan?”
“Nanay ko. Eto si ate Arsenia ko at ako
pag umaga nag e-energen kami.”
Patient smiles and points
out her drawing
She answered the questions
appropriately
Exploring
Delving further into subject or
an idea
“Kung sakali kaibigan, gusto mo
bang sayo na ang bahay nayan?”
“Ayaw ko, mas gusto ko yung bahay ko sa
Alabang.”“May mayari nan g bahay nayan
si Kuya Eduardo ko.”
Patient shooked her head
She answered the questions
appropriately
Encouraging description of
perceptions
Asking the client to verbalize
what she percieves
“Kung sayo yung bahay nayan,
saan ang gusto mong kwarto?”
“Yung malapit sa sala, kasi mahilig akong
manuod ng TV tsaka ng movies.”
She nodded and pointed
with her fingers.
She seemed to be straight
forward with her answers
Formulating a plan of action
Asking the client to consider
kinds of behavior likely to be
appropriate in the future
situations
“Nabanggit mo saakin kaibigan
na Artista ka?”
“oo ako si Cameron R. Diaz na naging
Michelle Rodriguez”
Patient nodded and smiled
She seemed to be delusional
Restating
Repeating the main idea
expressed
30
“Anong naiisip mo nung
ginuguhit mo yan?”
“Namimiss ko yung ate ko kapag
pinagluluto niya ako.”
Patient smiled
She seemed to be happy in
talking about her sister.
Focusing
Concentrating on a single point
“Anong naaalala mo sakanya
maliban sa pagluluto niya.”
“Mabait naman si ate kahit pinapagalitan
niya ako kapag lumilibot ako”
Patient kept smiling
She seemed to be confident with
her answer
Exploring
Delving further into subject or
an idea
“Hindi pa ba kayo nag away ng
Ate Arsenia mo?
“Nag away na rin kami ng ate ko kapag
lumilibot libot ako.”
Patient shooked her head
She answered appropriately
Encouraging Expression
Asking the client to appraise
the quality of her experience
“Anong nababanggit niya kapag
lumillibot ka?
“Madidisgrasya ka na naman sa
lalake, sa anong paraan?”
“Nung sinabi niya sayo yun,
nakinig ka naman ba kaibigan?”
“Kapag ikaw nadisgrasya na naman sa
lalake, sabi niyang ganun.”
She did hand gestures
while pointing out with her
index finger
She answered appropriately
“Baka madisgrasya ako sa lalake, ma-rape
ganun, gagala daw ako, magiingat daw
ako.”
She still points out her
index finger
She reinacts what her sister is
telling her
“Hindi nga ako nakinig kaya napadpad ako
dito, naggala ako.”
She showed disappointed
face.
Offering general leads
Giving encouragement to
continue
Exploring
Delving further into subject or
an idea
She seemed to be unhappy with
the topic
Exploring
Delving further into subject or
an idea
“Ano pa yung ibang dahilan ng
napadpad ka ditto maliban sa
paggagala mo?”
“Ah yun, na depress ako, stress ganun.”
She slouched and looked
down
She seemed to be unhappy with
the question but still answered
respectfully.
Placing events in time or
sequence
Clarifying the relationship of
events in time
“Anong kadahilanan mo ng nadepressed ka?”
“Namatayan ako ng anak, nakunan ako sa
loob ng hospital.”
She looks down
continiously
She seemed to be serious about
the topic
Encouraging Expression
Asking the client to appraise
31
the quality of her experience
“Ilang buwan na yun?”
“5 months na yun.”
She looks down
continiously
She was very straight forward
into answering my question
Placing events in time or
sequence
Clarifying the relationship of
events in time
“Kilala mo ba yung tatay ng
ipinagbuntis mo?”
“pagkadisgrasya sa lalake.”
She pouted her lips
She seemed to be disappointed
in regards to the topic
Exploring
Delving further into subject or
an idea
“May tanong ako tungkol sa
drawing mo.”
“Oo sige ano yun?”
She looked staright at me
She seemed to agree
Giving information
Making available the facts that
the client needs
“Anong naiisip mo tungkol sa
drawing mo?”
“Bahay ng nanay ko yan, diyan kasi ako
nagsstay, bahay sa Taplao, Orani.”
She was holding her paper
while pointing her drawing
Patient answered appropriately
Exploring
Delving further into subject or
an idea
“Nung nasa bahay ka nay an
kaibigan, masaya ka ba o
malungkot?”
“Masaya naman pero may mga oras na
malungkot”
“Anong naiisip mo na nagiging
masaya ka?”
“Yung nakakapag isa ako sa kwarto ko,
yung wala akong iniisip kung hindi
kain,tulog, maglibot,magpunta sa
computer shop ganun, yung inienjoy ko
lang ang buhay.”
She continued to look
down and was playing
with her fingers
She seemed to be unhappy
regarding the topic.
“kung paano ko maasikaso yung pera ko,
nagpasok ako ng check kaso yung voters
ID nung May pa binigay, January
nagpasok ako ng 2M pesos na napalanunan
She leaned forward and
stares at me completely
She seemed to be serious with
her answers.
“Anong naiisip mo kapag magisa
ka sa kwarto?”
She had a serious face and
stamped her feet
Patient seemed to be confident
Exploring
Delving further into subject or
an idea
Encouraging Expression
Asking the client to appraise
the quality of her experience
Offering self
Making oneself available
32
ko sa Singing contest, tapos pinasok ko sa
bangko wala akong dalang ID bumalik
nalang daw ako, eh nakulong naman ako
ditto nung September, nagpirma at
thumbmark naman ako. Kasama ko si
Jocelyn kumain kami sa Jollibee nagpunta
kami ng bangko, sinumpong ako ng sakit
ko pero pag labas ko aayusin ko ID ko.
“Ano naman ang mga
malulungkot mong naranasan sa
bahay niyo?”
“Nung kinulong ako ng kuya at ate ko sa
kwarto.”
“Anong kadahilanan at ikinulong
ka sa kwarto?”
“Nag gagala daw ako, naloloko kasi ako
ng lalake, halimbawa nakikipag text at call
ako ganun tapos magmmeet kami at aayain
ako mag sex.”
She looked at me and
nodded.
“binibigay lang ng mga friends ganun.
Meet meet lang”
She was fixing her hair
“saan mo naman nakukuha yung
mga number?”
She looked down and
slouched
Patient seemed to be
disappointed in the topic
Exploring
Delving further into a subject or
an idea
Patient cooperated well in
answering my questions
Exploring
Delving further into a subject or
an idea
She seemed arouse
Placing events in time or
sequence
Clarifying the relationship of
events in time
“Nakikipag kilala ka?”
“alam mo pa ba kung ilan ang
mga anak mo?”
“Oo sa bahay nila mismo na, nadidisgrasya
nga ako, nag ssex kami ng lalake, tapos di
na ako pananagutan, pinapa adopt ng ate
ko yung mga anak ko.”
She fixed her hair and her
clothing
“oo may anak ako quadruplets pinaampon
ng ate ko 2016 nanganak ako.”
She nodded and smiled
She seemed arouse while
talking about her sexual
intercourse
She seemed to be confident with
her answer
Restating
Repeating the main idea
expressed
Exploring
Delving further into a subject or
an idea
“Kilala mo pa ba yung ama mga
anak mo?”
“Kilala ko si Menald Catchuella, yung dati
kong asawa, ni rape niya ako sa kusina ng
bahay. Tumutuloy ako sa dirty kitchen
nabuntis niya ako.”
She had hand gestures and
played with her thumb
Patient seemed to be confident
with her answer. She was
moving quite a lot
Exploring
Delving further into a subject or
an idea
33
“Magkasama na ba kayo sa isang
bahay?”
“dati asawa ko siya, may dalawa kaming
anak.”
Patient showed her two
fingers
Patient seemed to be confident
in her answer
Focusing
Concentrating on a single point
“Siya ba yung kasama mo sa
picture?”
“Nagkasama na ba kayo ni
Jimmy”
“Hindi, si Jimmy Dela Pena yun,
Boyfriend ko ditto taga Mabalacat,
Pampanga”
Patient nodded and pointed
somewhere
“Oo, nagkasama na kami, meron na rin
kaming anak na lalake, pina ampon ni
jimmy sa pinsan niya”
Patient nodded while
doing hand gestures
Patient cooperated well
Encouraging Expression
Asking the client to appraise
the quality of her experience
Patient cooperated well and
answered my question
confidently
Encouraging description of
perceptions
Asking the clinet to verbalize
what she percieves
“Ilang taon na yung anak niyo ni
Jimmy?”
nodding
“Sinasaktan ka ng asawa mo,
tama ba kaibigan?”
“hindi ko na maalala, may anak pa pala
akong babae kaso di ko nainamin kay
Jimmy si Ellismina, 6 years old na kay
Jennifer Simbol, kapitbahay ko.”
Patient shrugged
“May anak ako kay Menald Catchuella
pinakasalan ko siya sa Paris, dalawa anak
naming si Kacy at si CJ. Humiwalay ako
binubugbog niya ako at nagsshabu.”
Patient was nodding
“Oo, iniwan ko siya.”
She nodded then pointed in
her back
Patient seemed to answere my
question with slight of
hesitation
Patient continued to tell her
story
Exploring
Delving further into a subject or
an idea
Acceptance
Indicating reception
Patient was confident
Restating
Repeating the main idea
expressed
“Ano ba ang nangyare at umalis
ka bigla?”
“Gusto mo na bang umuwi sa
bahay na ginuhit mo?”
“Pinagtabuyan niya ako, sinaktan, kaya
hindi na ako bumalik, tapos nabuntis niya
yung babae niya, nagpakasal sila ng
illegal.”
Patient had an aggressive
look
“Uuwi ako kaso hindi stay in, babalik ako
sa bahay ko sa Alabang, aasikasuhin ko
Patient nodded but then
pouted her lips and
Patient seemed to be serious
regarding the topic
Encouraging description of
perception
Asking the client toverbalize
what she percieves
Patient cooperated well and was
thrilled in telling stories
Exploring
34
yung bahay baka mamaya kasi pasukan ng
magnanakaw, mauubos lahat ng gamit ko,
kompleto pa naman ako sa gamit, may ref,
may washing machine, may la Germania
na kalan, may cabinet, may tv na flat
screen, JVC na radio component, kama na
Salem at waterbed baka manakawan ako
saying ang naipundar.”
shooked her head.
“Hindi pa, 2010 ginawa yung bahay, 2018
na, 8 years ko ng bahay yun. Magbabayad
pa nga ako ng anulyar paglabas ko para
hindi mahila ng gobyerno.”
Patient nodded while
playing with her nails
“wala ka na bang gustong iexplain tungkol sa bahay na
ginuhit mo?”
“Eto kasing pulang kulay kasi andiyan
yung pagmamahal, puso ng pagiibigan,
pagkakaisa n gaming pamilya.”
Patient was pointing out
her drawing
“Anong nararamdaman mo nung
ginuhit mo ikaw at ate mo?”
“Masaya na malungkot, namimiss ko na
kasi ang ate arsenia ko.”
Patient nodded and smiled
“Hindi mo ba naidala si Ate
Arsenia mo sa bahay mo sa
Alabang?”
Delving further into a subject or
an idea
Patient was cooperative and has
willingness into sharing her
story
Placing events in time or
sequence
Clarifying the relationship of
events in time
Patient was explaining her
thoughts well she was confident
with her actions.
Patient cooperated well
Broad Openings
Allowing the client to take the
initiative in introducing the
topic
Encouraging Expression
Asking the client to appraise
the quality of her experience
“Ano mga naaalala mo tungkol sa
ate arsenia mo?
“Ano ang nararamdaman mo sa
taong ginuhit mo?”
“Mga pangaral niya saakin, mahal ko ate
ko, pinayaman ko na yun. Inuwi ko saknya
mga cheke na napalanunan ko nung 2015
Miss Philippines ako si Michelle
Rodriguez Atencia 1st runner up inuwi ko
yung 10 Million tapos nung 2016 tinago
ako bilang Stephanie Grey, Ms World
2016 naibigay ko ulet sa ate ko yung 20
Million Dollars.”
Patient smiled while
stretching out her fingers
“Mahal ko ang ate Arsenia ko.”
Patient nods
Patient seemed to be happy
talking about her sister yet she
is somewhat tensed regarding
the topic.
Patient was cooperative but
looked unhappy
Exploring
Delving further into a subject or
idea
Encouraging Expression
Asking the client to appraise
35
the quality of her experience
“Ganun din ba ang
nararamdaman mo sa ibang tao?”
“oo parang ganun din, mahal ko din si
Jimmy, pati mga kaibigan ko mahal ko sila
kasi di nila ako sinasaktan”
Patient nods and placed
her hand in her legs
Patient was cooperative in
answering my questions
Encouraging description of
perceptions
Asking the clinet to verbalize
what she percieves
“Kamusta nman yung mga
kapatid mo?”
“Ano sa tingin mo ang dahilan
nila?””
“Mabait naman kaso wala na silang
pakialam saakin, kasi si Kuya Ernesto ko
kinuha niya mga gamit ko tinago niya,
ayaw niya isurrender saakin ginawa akong
pulubi.”
Patient smiled then looked
down
“hindi ko nga alam eh.”
Patient shooked her head
Patient easily answered my
question but seemed to be down
or disappointed about the topic
Placing event in time or
sequence
Clarifying the relationship of
the events in time
Patient cooperated well
Offering general leads
Giving encouragement to
continue
“Hindi mo pa ba sila
nakakausap?”
“Sa anong kadahilanan na nasabi
mo na pinupulubi ka nila?”
“Saan mo naman nakuha yung
pera nay un?”
“nakausap ko sila, sabi ko pa nga, kuya
pakibalik po mga gamit ko, wala na akong
gagamitin. Sabi niya anong gamit, kung
gusto mo makuha gamit mo, tubusin mo
ng pera.”
Patient nodded while
playing wth her fingertips
“Tinago nila yung gamit ko pati greencard
ko, passpot, SSS card, at voters ID ko sa
US. Tinubos ko ng 50k sa kuya Ernesto
ko.”
Patient stares straight into
my eyes and leaned
forward
Patient seemed to be tensed
“may pera nga ako sa bangko, minsan
magpapapalit ng Dollars, minsan dala ko
ang cheke. Yan kasing si Manansala
kinuha yung card ko, pwede mo siyang
tanungin kung kakilala niya ako, nakasama
ko nay an sa bahay at hotel, kinuha niya
yung bag ko, susi ng kotse at bahay mga
ATM cards ko. Sabi naman ni Anne
Patient kept on staring
directly to my eyes while
leaning forward closer to
me and holding on to her
clothes
Patient seemed to be tensed in
telling her story, she keeps on
moving while telling her story
Patient seemed to be serious
with the conversation
Placing event in time or
sequence
Clarifying the relationship of
the events in time
Focusing
Concentrating on a single point
Exploring
Delving further into a subject or
an idea.
36
nakapark naman mga sasakyan sa garahe.
Noon nga naguwi ako ng Toyota sa Orani
kaso binenta nila ng 200k pagkatapos kong
sumali ng Miss Universe, inangkin nila.”
Silence
“Kasi dito Mental for Health, mga may
sakit at diperensiya sa isip eh, mga
naliligaw ng landas sa pagiisip.”
Patient smiles while
nodding and pointing out
some buildings in the
location
Patient was thrilled in telling her
story. She seemed comfortable
in sharing her experiences.
Patient smiled
Patient was happy and
contented
“Ako sakit ko lang kapag nagugutom ako
nag gagala ako, lakad ako ng lakad,
pupunta ng simenteryo ganun,”
Using silence
Absence of verbal
communication, which provides
time for the client to put
thoughts or feelings into words,
to regain composure or to
continue talking
“Eto naman kasing si Anne nagdrugs eh,
kinuha niya mga gamit ko, atm ko, susi ng
bahay at sasakyan, katulong ko yan dun
sila ni Pia Mina
“Ganun ba kaibigan, So ayan
tapos na tayo sa Activity natin,
nag enjoy ka naman ba?”
“oo, nag enjoy ako, mahilig kasi akong
magdrawing.”
“Buti naman at nag enjoy ka, tara
na balik na tayo dun sa ward mo.
Next week ulet ha.”
“Oo sige tara, oo next week ha?”
*while walking*
Eto kasing si Anne nalulong sa drugs,
ewan ko ba diyan siiya kumuha sa mga
gamit ko sa Alabang. Nagdrugs kasi yan.”
Patient was walking while
pointing out at another
patient
Patient was tensed
“Hindi, ay oo pala gumamit ako, yung
Patient tapped a student
Patient was jolly and very
“Ikaw ba kaibigan, hindi k aba
Encouraging Expression
Asking the client to appraise
the quality of her experience
Patient nodded
Patient seemed to be excited
Suggesting Collaboration
Offering to share, to strive, and
to work with the client for her
benefit
Silence
Absence of verbal
communication, which provides
time for the client to put
thoughts or feelings into words,
to regain composure or to
continue talking
Encouraging Comparison
37
gumamit nun?”
“Sige, Salamat Kaibigang
Michelle sayong oras, kain ka ng
dinner mo, ingat ka. Sa susunod
ulet.”
tinutusok dito, tsaka yung tabletas na puti
na maliit, ecstacy yun.”
nurses arm in a friendly
manner while smiling
cooperative
“Oo, Thank you, salamat Rachelle, Bye! I
miss you, I love you, I love you all”
Patient smiles and waved
her hand
Patient looks happy and enjoyed
the day
Asking that similarities and
differences be noted
Suggesting Collaboration
Offering to share, to strive, and
to work with the client for her
benefit
38
PRIORITIZED PSYCHIATRIC NURSING DIAGNOSES & PSYCHIATRIC NURSING CARE PLAN
First Nurse – Patient Interaction
Assessment
-
-
Poorly related
thoughts and ideas.
(+) delusions
(+) Flight of Ideas
Percept experiences
that do not exist in
reality.
(+) Tension
(+) Rapid speech
with loud volume.
Diagnosis: Disturbed
thought process related to
physiological brain
dysfunction
Psychodynamics and
Theory
Interpersonal Model
(Sullivan, Peplau)
- Holds that human
development results
from interpersonal
relationships, and
that behavior is
motivated by
avoidance of anxiety
and attainment of
satisfaction.
- Nurses must
promote the nursepatient relationship
to build trust and
foster healthy
behavior.
- Therapeutic use of
self promotes
healing.
- The therapeutic
relationship is
directed toward
meeting the patients
needs.
Goal and Objectives
-
-
-
Recognize changes
in thinking behavior
-Identify
interventions to deal
effectively with
situations.
Demonstrate
behavior changes to
prevent/minimize
changes in
mentation.
Maintain usual
reality orientation.
Nursing Interventions
1.
2.
3.
4.
5.
Assess attention
span and
distractibility and
ability to make
decisions.
Schedule structured
activity and rest
periods.
Note occurrence of
delusions and
hallucinations.
Reorient to time,
place, and person as
needed.
Present reality
concisely and briefly
and do not challenge
illogical thinking.
Rationale
-
-
To determine ability
to participate in
planning/executing
care.
Provide stimulation
without undue
fatigue and to
reduce/prevent
tension.
-
To prevent
deterioration.
-
Defensive reactions
may result.
Evaluation: Response to interventions and actions performed, progress towards desired outcomes are met, so as to the modifications to plan of care.
39
40
Third Nurse – Patient Interaction
Assessment
Subjective:
“Dati kong asawa si Paul
Walker. Kaso namatay siya sa
car crash.”, “Alam mo si
Richard Gutierrez? Naging
leading lady ako nun sa mga
movies niya noon.”
Objective:
- Exaggerated
emotional responses.
- Disoriented with
people.
- (+) Hallucinations
and bizarre thinking.
- (+) Rapid speech
with loud volume.
Diagnosis: Disturbed
sensory perception related
to altered sensory
perception
Psychodynamics and
Theory
Interpersonal Model
(Sullivan, Peplau)
- Holds that human
development results
from interpersonal
relationships, and
that behavior is
motivated by
avoidance of anxiety
and attainment of
satisfaction.
- Nurses must
promote the nursepatient relationship
to build trust and
foster healthy
behavior.
- Therapeutic use of
self promotes
healing.
- The therapeutic
relationship is
directed toward
meeting the patients
needs.
Goals and Objectives
-
-
Regain usual level of
cognition.
Recognize and
correct for sensory
impairment.
Identify factors that
contribute to
alterations in
sensory/perceptual
abilities
Nursing Interventions
Rationale
1.
Provide diversional
activities as able
such as drawing a
house, tree and
person.
-
2.
Provide explanation
of and plan of care
as much as possible.
Determine use/abuse
of addictive drugs.
-
3.
4.
5.
Keep client in
continuous view and
observation
accordingly.
Present reality
concisely and briefly
and do not challenge
illogical thinking.
Diverts the patients
attention and for the
nurse to be able to
gather more data and
information in the
interpretation of the
drawings.
To reduce anxiety
and feeling of threat
to the client.
-
To be able to
determine the
underlying cause to
the sensory
alteration.
-
To prevent harm and
injury.
-
Defensive reactions
may result.
Evaluation: Response to interventions and actions performed, progress towards desired outcomes are met, so as to the modifications to plan of care.
41
42
CHAPTER 5
Process Recording and Psychiatric Nursing Care Plan
Psychotherapies Conducted
Strategy Used
Patient’s Response
Group Exercise
This activity may help the patient to
increase self-esteem by providing a
sense of accomplishment, reducing
stress, and improving the appearance
and mood. It can also provide ways to
increase self-confidence and social
interaction through participation. After
finishing the activities of daily living,
the patient will exercise in the tune of
“Mag Exercise Tayo Tuwing Umaga”
for atleast 5 minutes.
The patient in this activity actively and
cooperatively follows the steps. She is
focused on what she is doing, that you
can’t talk to her while she is exercising.
You can only speak to her afterwards. She
follows the instructions being given to her
correctly.
Music Therapy
The music therapy entitled “Galing ng
Pinoy” patient may help to improve the
sense of identity and musical
experience, knowledge and awareness
of one self and other people and their
relationship with them, improve the
sense of identity with musical
experience, also facilitating selfexpression and promoting
psychological growth, encourage
verbal and nonverbal communication
and development psychomotor
cognitive emotional and social
expression communication activity.
The students let the patients read the
lyrics written first, and sing with the
tune afterwards.
The patient in this activity is actively
listening and participating in the activity.
In fact, her voice is very loud and rapid
while she is reading the lyrics and singing.
She is very competitive, in the way that
she overpowered others’ voices when it
comes in activity and she takes it very
seriously.
Dance Therapy
For the dance therapy, patient with
schizophrenia in this activity it helps
express movement feelings that they
cannot put into words. This may
promotes self-awareness, self-esteem
and a safe space for the expression of
feelings.
They are formed in window formation,
and dances to the tune of “Girl In The
Mirror” for atleast 6 minutes.
In this activity, patient is actively
following the dance steps, and she is good
at dancing. Just like in the group exercise,
she will not entertain you while you speak
and ask question. She just wants to focus
her attention in what she is doing.
Psychotherapy
43
House Tree Person Test
This activity may help to appraise the
total personality of the client in an
individual type of examination, to
obtain data concerning the client’s
progress while under treatment, to in
the establishment of rapport between
the nurse and client and also to help the
subject gain insight through her own
interpretation of own drawing
They are given the materials needed,
such as the bond paper, and crayons.
Afterwards, the student nurses are
going to instruct them with what to
draw each drawing has an allotted time
of 5 minutes, and ask them questions
afterwards to further interpret the
drawing.
In this activity patient is cooperative,
displays congruent facial expression and
gestures. And for the interpretation, she
entertains and answers the questions
cooperatively and shows interest in
venting out her feelings about each
drawing. However, delusions of grandeur
are still observed while she answers the
questions asked.
44
BIBLIOGRAPHY
Buchaman R.W. & Carpenter, W.T. (2005). Concept of Schizophrenia. In B.J Sadock & V.A.
Sadock (Eds.), Comprehension textbook of psychiatry. (Vol. 1 8th ed., pp. 1329-1345). Philadelphia: Lippincott Williams &
Wilkins.
Deutsch, A (1937). Mental Illness in America, New York: Doubleday
Doenges, M.E., Moorhouse, M.F., Murr, A.C., 12 th edition. Nurse’s Pocket Guide. Diagnoses, Prioritized Interventions, &
Rationales.
Keltner, N.L., Bostrom, C.E., McGuiness, T.M., (6 th Edition), 2012, “Keltner’s &Psychiatric Nursing, Philippine Edition,
Elsevier (Singapore)
Otong, D.A ,. 2003. “Psychiatric Nursing Biological & Behavioral Concepts. Pp 88. Thomson Asian Edition.
Spratto, G.R., Woods, A.L., 2007 edition. “PDR Nurse’s Drug Handbook”
Videbeck, S.L.m (5th edition). 2011. “Psychiatric-Mental Health Nursing”,. Wolters Kluwer, Lippincott Williams & Wilkins.
Pp 102-104, 251-275
World Health Organization, 2006
Retrieved from: www.reasone.org/dis/ds/icd_f20.htm
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