Chronic Schizophrenia Undifferentiated

8/13/2019 Chronic Schizophrenia Undifferentiated

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Liceo de Cagayan University

College of Nursing

A Care Study of

Chronic Schizophrenia Undifferentiated

In Partial Fulfillment of the course NCM!"#!$

Su%mitted &y'

A%suelo( )u%y Amanda *+

Camp%ell( Marife

,ato( Martin -ason &+

,icritan( Ashria

-andayan( Nith -ay C+

Me.orada( )ona Ann &+

)ara( Crystel Alene L+

Salandaguit( /rizsha /aye

0urnuas( Aima -an ,+

Unson( )aymond 1+

Su%mitted 0o'

Sir 2incent La%ininay( )N MAN

,ate'

April "3( #!"!

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I. INTRODUCTION

A. OVERVIEW

Over 45 million people worldwide are affected by the so called

mental neurogical or behavioral problems. Defined as an abnormal mental

condition or disorder associated with significant dysfunction which

involves cognitive, emotional, behavioral and interpersonal impairments.

Mental illness is vague that it has different sub classifications and among

those is Schizophrenia.

t has been said, it !nows no boundaries. n the "hilippines alone,

there is an estimated accounted e#trapolated statistics of $%4,54& as of

'((4 and this was according to the )S *ensus +ureau nternational

Database.

-his study benefited our client /01 and those who have mentally

neurological or behavioral problems. -his provides !nowledge and

interventions. /s we go along in this study, we appreciated our individual

efforts and had witnessed /01 development from Day 2 to day 5 3nurse

patient relationship has been established as evidenced by the trust being

imposed by Sweet to our group.

On the first day of our visit, as une#pected, /01 did interact

and cooperate with us. -his gave us the inspiration to study her case with

honesty and respect to our patient.

/ccording to the mother, she was than!ful for the effort that

we, students, provided importance despite of their financial status. /01

also showed happiness with the presence of our group. -his was an

accomplishment to us, to witness the different manifestations of

Schizophrenia, and the trust that was being built along the way.

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B. OBJECTIVE AND PURPOSE OF THE STUDY

-his study generally aims to investigate a mentally ill patient

particularly Schizophrenia. /s healthcare providers, we sought to

investigate, plan and implement as we drive to6

7now the 8istory of the client and the family

-rac! down the developmental stages of the client

-race the incident that precipitated the mental illness of

the client

Describe the symptoms manifested by the client +uild 9urseclient relationship

/nticipate the needs pertaining to the client illness

"rovide nursing interventions

Develop positive coping mechanism

"romote positive self concept

:valuate progress and redefine goals as appropriate

*lient social function has improved and his isolation hasdecreased

-o establish the reality of the separation during the

termination phase

;eorient client and family of the contract

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-he purpose of the study is to gather significant data broaden our

understanding and !nowledge in psychiatric nursing and to improve our

abilities in determining and


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E. PATIENTS PROFILE

Name: Ms. /0

Age: '@ years old

Sex: ?emale

Bi!" Da!e: May 'A, 2%AA

Bi!" P#a$e: *abanglasang, +u!idnon

C%e&! Re'i(e&$e: Oro *hain Billage, *armen, *agayan de Oro

Heig"!: 5 feet, ' inches

Weig"!: $@ !g

Re#igi)&: +orn /gain

Na!i)&a#i!*: ?ilipino

Ci+i# S!a!%': Single

O$$%,a!i)&: Cast aitress, Dishwasher

*urrent 9one

P)'i!i)& i& !"e -ami#*:Eoungest of ' siblings

E(%$a!i)&a# A!!ai&me&!::lementary -- *abanglasng :lementary

School

8ighschool *ity 8igh

PARENTS:

Fa!"e' Name: Mr. / 3Deceased

Age: 52 years old

O$$%,a!i)&: Mechanic

M)!"e' Name: Mrs. +

Age: 5' years old

O$$%,a!i)&: 8ousewife

SIBLINS:

Name Age Ci+i# S!a!%' E(%$a!i)&a# A!!ai&me&!

+ro /. &' Married 8igh school Cevel

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II. ANAMNESIS

A. INFORMANTS

/. Name: Mrs. +

A((e'':Oro *hain Billage, *armen, *agayan de Oro

Re#a!i)&'"i, !) $#ie&!:Mother

Le&g!" )- Time 0&)1& !) Pa!ie&!:'@ years

A,,ae&! U&(e'!a&(i&g )- Pe'e&! I##&e''6

-he mother of the patient was the main informant during the course

of out assessment. She related to us the e#periences that shebelieved led to the current mental condition of the patient. t all

began when her daughter gave birth to her daughterF she was left

alone by her husband and was left alone with the responsibility of

raising her child alone. n order to support her family and growing

child her daughter went to Manila in order to wor! as a house helper

but only to be abused and humiliated by her employer. Out of

desperation she ran away in order to come home. /fter herdaughter came home she noticed changes in her behavior such as

tal!ing to herself, and being unable to perform tas!s. /s time

progressed her conditioned worsened she was already hallucinating

that there was a cat, she !eeps on wondering around. She once

wandered away from home and was found in Gusa by the DSD

wo!ers. n order to prevent this from happening again she chained

her to their home. t was when students from CD*) came to theirhouse that the chains were released and she was brought to the

doctor in order to receive help from professionals.

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2. Name: Mrs. 92


Re#a!i)&'"i, !) !"e $#ie&!:9eighbor

Le&g!" )- !ime 3&)1& !) ,a!ie&!:2' years

A,,ae&! %&(e'!a&(i&g )- !"e Pe'e&! i##&e'':

/ lives in a compoundF a community were people live in harmony

and peace. Ms. 92 is one of the few persons residing in the

compound. She li!es on the house across. /lma>s house. She had

verbalized her thought has about /lma. /ccording to her /lma is

very a industrious individual ever since she had the illness. She had

always as!ed /lma for favor li!e doing the laundry and fetching

some water for their house. She also verbalized that when /lma was

not yet ill she refused in doing the favor. Ms. 92 returned the favor

by giving /lma some money. Ms. 92 verbalized that during /lma>s

teenage years she had observed that /lma has only a few friends

and has observed that /lma has no vices, neither smo!ing nordrin!ing. Ms. 92 has also hypothesized that the probable cause of

/lma>s illness must have been due to postpartum depression.

4. Name:Mr. 9'


Re#a!i)&'"i, !) !"e $#ie&!:9eighbor

Le&g!" )- !ime 3&)1& !) ,a!ie&!:2' years A,,ae&! %&(e'!a&(i&g )- !"e Pe'e&! I##&e'':

Mr. 9' is one of /lma>s neighbor he lives three houses away

from /lma>s. /ccording to Mr. 9' /lma is fond of going

anywhere and littering along the community. Mr. 9' also

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hypothesized that the probable cause of /lma>s condition is not

rating at the right time, he also included that it might be postpartum

depression because the father of her child left her. Mr. 9' also

noticed that ever since /lma went home from her employment in

Manila, she has been li!e that. /ccording to Mr. 9', /lma went

to Manila to wor! as a house helper but her employer mistreated

her.

B. FAMILY HISTORY

MATERNAL AND PATERNAL RAND LINEAES

During the interview, it was mentioned that there are genetic

factors that triggers the current psychological problem of the patient. /s

mentioned by the mother, that based on the side of her husband that the

aunt of our patient has also psychological problem as well as her

grandfather.

-hey believed that, this genetic factor may involve on ac=uiring the

said psychological problem. /lso as what had been proven in various

research that psychological problem maybe inherited from generations to

generations, as we interview the mother only her husband had engage in

vices li!e smo!ing, also they said that there are no serious illness

encountered by the patient and family.

FATHER

+ased on our interview and observation, the father of our patient is

less affectionate which he spent much of his time doing is Hob


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8e wor!s on a mechanic shop near their residency with only fair

salary, in which maybe could not support the needs of the family and also

he finished a vocational course such as mechanic, also the patient is not

ready to tal! or discuss about his downfall on his life.

MOTHER

-he mother of the patient is a considerate and a responsible parent.

:ven if she doesn>t have a wor! to support her family>s needs, she still

manages to find ways in providing their basic needs.

Disciplining her children in a proper way is what she>s always been

emphasizing and sometimes made a little punishment to her children in

order for them to learn that they were acting inappropriately.

SIBLINS

/01 is the youngest of the siblings, in he has a older brother and we

could name him as +ro1, his is now married and lives separately with the

family for almost two years already, they are blessed with a child and asthey do not have a appropriate relationship with his siblings and +ro1

only visits /01 and their family for only twice a month.

C. PERSONAL HISTORY

PRENATAL

+oth parents were very happy and delighted towards Mrs. />spregnancy. Mrs. / even recalled how e#cited her husband was in giving

birth of their second child.

-he mother mentioned that she was healthy during her pregnancy

but had not completed her prenatal chec!ups at 9orthern Mindanao

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Medical *enter formerly named "rovincial 8ospital because she was too

busy attending the needs of her sarisari store. She was able to receive

complete doses of tetanus to#oid during gestation. She had a good eating

habits, ate the right !ind of food li!e fruits and vegetables while in

gestation.

BIRTH

/01 is a full term baby and delivered through normal spontaneous

vaginal delivery. 8er mother didn>t have unusual incidents nor did she

had difficulties during the delivery of the baby. -he mother gave birth to

/01 at their home, +u!idnon. / mananabang (Hilot) helped her in the

delivery of the baby.

INFANCY AND CHILDHOOD CHARACTERISTICS

-he mother started giving formula mil! at ' months because she

encountered some health problems./t the age of 2 year and ' months, /01 was weaned to eat lugaw

along with the formula mil!.

During her infancy, the mother too! care of /01 and her husband

too! shifts especially at times when the mother has to do the laundry and

some of the household chores. /0>s1 first tooth erupted at the age of @

months and even before reaching the age of 2/01 already learned tospea! one or two syllables such as mama and papa. t was during her

'nd birthday that /01 began to spea!. She was able to wal! at the age of

2 year and si# months.

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-here was no proper toilet training for /01, she sometimes wets

her bed and bed wetting stopped at the age of %. -antrums and

stammering eventually disappeared before /01 turned A years old but

thumb suc!ing remained until $ years old. /s claimed by her mother, /01

never e#perienced mental disturbances during her childhood.

)nfortunately, /01 has a history of infantile convulsions. :ver

since, /01 hasn>t ac=uired any maHor health problems. ?ever and cough

were the usual health problems she encountered.

PSYCHO5SE6UAL FACTORS

-he mother was not sure when /01 gained se#ual awareness. She

had her menarche when she was 2' years old.

PLAY LIFE

n her childhood years, /01 used to play outdoor games li!e

patentero and jackstone. She played with girls and boys only in their

neighborhood 3near their house. She also played with both older and

younger children. +ut according to her mother, /01 is more of a followerthan a leader during games. /01 was also vulnerable to bullying.

Moreover, she is also tempted to play outdoor games with her neighbors

even if she still has to study her lessons and ma!e assignments, despite

that, she was still an honor student.

SCHOOL HISTORY

/01 entered grade 2 at the age of A and was enrolled in

!indergarten. 8e started her primary schooling at -- *abanglasan

:lementary School and completed her primary education there with an

award. She attended her secondary education at *ity 8igh School in

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*agayan de oro, and finished his secondary education at the same

institution, according to her mother that /01 has only few friends to get

along with during her high school days.

/lso according to her mother that /01 is a good student and

always go to school without any complaint, her grades was satisfying,

also she spent time on studying, she is a hard wor!ing student that the

teacher can rely on doing chores.

RELIIOUS AND SOCIAL ADAPTABILITY

/01 had Hust few friends in the neighborhood. :ven in high school

years, she did not have much close friends. During childhood years, she

can be depicted as shy and submissive. /lthough she was somewhat

=uiet and withdrawn, she still manages to fit into a crowd. hen there

are circle of gatherings, she would most prefer to observe than to Hoin.

She often attends mass every Sunday morning and li!es to sing

*hristian songs. 8er reactions toward failure or success are =uiteunnoticeable. She never e#presses her feelings whenever she commits a

serious mista!e and Hust !eeps them to herself.

OCCUPATIONAL HISTORY

/01 previous wor!s was on the mar!et place which she serve as a

dishwasher with fair salary to receive with, she was treated so nicely andeven reminds by the owner to eat on time, then after a year she wants to

ta!e a Hourney for success in which she went to manila to find for a

suitable Hob, then she land to be a house helper, unfortunately she was

not treated well, and even s!ipped her meals and also different types of

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abuse was e#perience, then she tried to escaped from that danger and

went bac! to her hometown in *agayan de oro from then different types

of unusual behavior was observed onto her.

MARITAL HISTORY

/s /01 wor!s in the mar!etplace as a dishwasher before the time she

went to manila for Hourney, she meet a guy and had a relationship with

that certain guy and as days or months had pass on the span of their

relationship /01 got pregnant, unfortunately they had misunderstanding

with his boyfriend and went for brea!ups, and their plans to be married

was disappeared, from then /01 conceived her daughter alone with

depression, financial problems and lac! of emotional supports.

ONSET OF PRESENT ILLNESS

-he incident that precipitated /01 present condition is =uite vague.

8er mother believed /01 started acting different when she returns

home from manila and also after she deliver her baby, they believed that

it was 9a bughat1 and s!ipping of meals are the mean cause of the

problem also the abuse that had occur during she wor!s in manila maybe

also one of the factors that triggers the psychological problem and also it

may be possible that /01 problem was a cause of "ostpartum psychosis.

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III. P'*$")(*&ami$'7A&a#)g*

The persons life can be compared with that of a book. Apparently, a

book isnt expressed solely by its body and skin. It has a set of mysteries that can

be unraveled through integration, which is the very characteristic of life.

A.J. can be compared with a book, like a book there are many

chapters in her life, chapters which molded her to be what she is right now. er life

started in the first chapter of the book when she came into this world. The pages

which serves to be the struggles of her existence.

There are many characters which add personality to the book. There

are good characters !parents, siblings and neighbors" and those who are bad

!employer, A.J.s partner !father of her child"".

#ar beyond, her $ourney in this world isnt always full of beautiful stories.

%ften than not, it is not always about fairy tales and happy endings but it also entails

of tragic ones. &ventually, as the pages of her life were unfolded, she explored the

world with her new friends, friends who can be compared with a rodent that slowly

degrades the substance of the book. !experience of abuse during her stay as a

house helper in 'anila".

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(ow A.J s is undergoing a new chapter in her life, she is now under the

influence of a new experience. !diagnosis of schi)ophrenia"

III. COURSE DURIN HOMEVISITS

A.MENTAL STATUS E6AMINATION

D/ D2 D4 D8 D9A. e&ea#A,,eaa&$e

)n!empt,not wellgroomed



*lean, wellgroomed

*lean, wellgroomed

B. P)'!%e Slouched Slouched Slouched Slouched Slouched

C. Be"a+i) sociable sociable sociable sociable sociable

D. Pa!ie&!5

N%'eI&!ea$!i)&

*ooperative *ooperative *ooperative *ooperative *ooperative

E. S,ee$"

Soft

Coud8esitant SlurredSuperior8umor?rightenedF. D)e' "i' '!*#e

a&( +)$a%#a*$)&+e* 5

*oynessSuspiciousness/rroganceSecrecySuperiority8umor ?ear. S!eam )-

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!a#3

Spontaneous Deliberate"ressuredH. Oga&i;a!i)&

)- !a#3;elevant rrelevant ncoherentCoose /ssociation?light of deas-angentiality*ircumstantiality"erseveration*lang /ssociation

9eologism:cholalia:chopra#iaI. M))( a&(

A--e$!

2. Mood:uthymic Depressed:uphoric'. /ffect

?lat+lunt/ngry:lated/n#ious?earful&. ;ange of/ffectivee#pression*onsistent

Cabile/nhedonic/ppropriate to thesituation IfeelingsverbalizedJ. Pe$e,!i)&

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8allucination auditory visual olfactory gustatory

tactileDelusion grandeur persecutory reference others 3specifyllusionDerealizationDepersonalizationdentification

-hought+roadcastingDJHK vu0amis vu0. Oie&!a!i)&

a&( Mem)*

2. dentifies datecorrectly

'. :stimates timeof the day

&. 7nows whereshe is4. 7nows thee#aminer L L L L 5. ;ecalls eventsprior to admission

$. ;ecallsactivities donewithin '4 hours

A. ;ecalls

activities donewithin 2 wee!

L. Ne%)5+ege!a!i+e

F%&$!i)&i&g

Sleep ;est"attern normal sleep

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early morningawa!ening

middle nightawa!ening hyperinsomnia

difficulty offalling asleep interruptedsleep othersM. E#imi&a!i)&

+owel 2# '# 2# 2# 2#+ladder '# '#N. A'!a$!T"i&3i&g Ai#i!*

poor poor poor poor poor

O. J%(geme&! poor poor poor poor poor

B. PRORESS NOTES

Day 1(June 27, 2009)

Orientation phase with the family through interview and observingthe type of environment our patient was exposed to !he group set the

"ontra"t of the time we will be spending with/01

Day 2(June 29, 2009)

#e"ond day of visit with our "lient, we brought fruits and dis"ussedhow to maintain personal hygiene, and good sleep pattern

Day 3(June $0, 2009)

!hird day of visit with our "lient, we "ondu"ted interviews with ourpatient, her mother and neighbors

Day 4(July %, 2009)

!his was the s"heduled day for us to obtain medi"al re"ord at

&orthern 'indanao 'edi"al enter with 'rs but the mother of *J+ was

not there be"ause she had important errands to do so we "ame ba" in

the afternoon -nfortunately, her mother "hanged her mind in

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a""ompanying us in the hospital .e de"ided to get her "onsent to allow

us to get the ne"essary data about *J+ "ondition

Day 5(July 2, 2009)

!his is the last day of our visit .e rendered health tea"hings about

religiously attending to her treatment regimen .e gave fruits and a pair

of shirts as re/uested by *J+

IV. PSYCHODYNAMICS

A. TABULAR PRESENTATION

FACTORS PRESENT RATIONALE

PREDISPOSIN

A. BIOLOICFACTORS

a.8eredity

b. +iochemical

/. based on themothers !nowledge,that /0>s1 aunt andgrandfather has amental orpsychological problemwhich may trigger thesaid status of patient/01.

b. ncreaseddopaminergic activity

Substantial evidencesuggests that thediagnosis of schizophreniahas a heritablecomponent.

D/ 3dopamine theory inschizophrenia, accordingto Davis is associated withincreased activity at

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B. PSYCHOSOCIAL

FACTORS

TRUST

SHAME A! !"U#T

During nfancy stagethe mother was ableto meet the needs ofthe baby thus the

child developed agood sense of trust.

9o proper toilettraining

dopaminergic receptorsites and antipsychoticdrugs e#ert their clinicaleffect by reducingincreased D/ activity,

which leads to predictionsthat6 drugs whichincrease D/ activityshould produceschizophrenia and drugswhich decrease D/activity should reduceschizophrenia.

/ccording to 7endra Banagner, caregivers whoare inconsistent andemotionally unavailable,

contribute to feelings ofmistrust in the childrenthey care for.

/s said by -ara 7uther, ifparents and caregiversprovide for physical andemotional needs, the

infant will develop a basicsense of trust in theircaregivers and the world.

Ci!e ?reud, :ri!sonbelieved that toilettraining was a vital part ofthis process. 8owever,

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$$T$AT$%E

$!USTR&

?ollower duringplaytimes

:nHoys pretend play

with friends.

*lients receivesufficient attentionand could be trustedon handling householdchores.

:ri!sonNs reasoning was=uite different than that of?reudNs. :ri!son believethat learning to controlone>s body functions leadsto a feeling of control anda sense of independence.

/s stated by 7endra Banagner>s statement,during the preschoolyears, children begin to

assert their power andcontrol over the worldthrough directing play andother social interaction.-hose who fail to ac=uirethese s!ills are left with asense of guilt, selfdoubt,and lac! of initiative.

/ccording to Doug Davis,children who areencouraged andcommended by parentsand teachers develop afeeling of competence andbelief in their s!ills.

n consistent with Davis>

statement, :ri! :ri!sonasserted that if childrenare encouraged andreinforced for theirinitiative, they begin tofeel industrious and feelconfident in their ability toachieve oals. f this

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R"'E "US$"

$T$MA&

Cess emotionalconnection to familyand friends, thus poorpersonal e#ploration.

"atient is able tosustain mutuallysatisfying

relationships withfamily members andmembers of thecommunity.

initiative is notencouraged, if it isrestricted by parents orteacher, then the childbegins to feel inferior,

doubting his own abilitiesand therefore may notreach his potential.

n line with 7endra Banagner>s statement,those who receive properencouragement andreinforcement throughpersonal e#ploration will

emerge from this stagewith a positive behavior.

/s said by Davis,successful completion canlead to comfortablerelationships and a senseof commitment, safety,and care within a

relationship. )nsuccessfulrelationships can lead toisolation, loneliness, andsometimes depression.

In the initial stage of being anadult we seek one or morecompanions and love. As wetry to find mutually satisfyingrelationships, primarilythrough marriage and friends,we generally also begin tostart a family, though this agehas been pushed back formany couples who today don*tstart their families until theirlate thirties. If ne otiatin this

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C.ENVIRONMENTAL

FACTORS

$TERA'

ATHER

M"THER

Smo!er

or!aholicCow incomeF cannotprovide completeneeds

Cess affectionate

"arental roleconfusion

stage is successful, we canexperience intimacy on adeep level.

If we*re not successful,isolation and distance fromothers may occur. And whenwe don*t find it easy to createsatisfying relationships, ourworld can begin to shrink as,in defense, we can feelsuperior to others.

%ur significant relationshipsare with marital partners and

friends.

Dr. 8are>s research

suggests that socialisolation 3i.e. limitedsocial interaction withother children and pooror disrupted interpersonalrelations during childhood,teen and early adult yearsappears to increase anindividual>s ris! for futuredevelopment of

schizophreniaspectrumdisorders. ;esearch alsosuggests that socialisolation and poor socialrelations are indicators ofhigh levels of social stressand an#iety in the child.

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C. SCHEMATIC DIARAM

PSYCHOLOICAL FACTORS

EMOTIONAL E6PERIENCE BIOCHEMICAL+ s!ipping meals e#cess activity of neurotransmitter dopamine+ Depression due to partner separation e#cess dopamine may cause schizophrenia+Abused during her work in 'anila+ lack of emotional support !parents"

9*;:/S: B)C9:;/+C-E

-O M:9-/C DSO;D:;


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9?/9*E -ODDC:; ";:S*8OOC:; S*8OOC:; /DOC:S*:9- EO)9G /D)C-

P'*$")')$ia# Fa$!)'

During Infancy

stage the

mother was abe

to meet the

nee!s of the

baby thus the

chi! !e"eo#e!

a goo! sense of

trust.

$%o #ro#er

toiet training

&oower

!uring

#aytimes

'n(oys

#reten! #ay

with frien!s.

)ients

recei"e

sufficient

attention

an! cou!

be truste!

on han!ing

househo!

chores.

*ess

emotiona

connection

to famiy

an! frien!s+

thus #oor

#ersona

e,#oration

-atient is

abe to

sustain

mutuay

satisfying

reationshi#

s with

famiy

members

an!members of

the

community.

rust/hame an!

Doubt

Initiati"e Inferiorityoe

)onfusionIntimacy


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4N2I)1NM4N0AL FAC01)S

IN04)NAL 4504)NAL

FA0*4) M10*4) SI&LIN6S S1CIAL N4071)/S S1CI1CUL0U)AL C1MMUNI08

+ workaholic +ess emotional + -lose ties + id not continue + living in poor connection with her siblings introverted and has college education congested area+ ow income/ less close friends due to povertycannot providecomplete needs + oes not share + (o %ccupation

personal problems+ ess affectionate to her friends

0oor socioeconomic ess emotional connection status 0arental role Inade1uate

-onfusion social support


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Inade1uate #amily 2upport 0oor &nvironmental -ontrol

-1&34515!6 !O '&!1 511#

ow 2elf+esteem

74A/4N4, 461 FUNC0I1NIN6

P)4M1)&I,

!2ilent and 2hy"

3se of ,4F4NS4 M4C*ANISMS4 5epression

enial

P)4CIPI0A0IN6 FAC01)S

a. skipping of mealsb. epression due partner separation


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45A664)A04, US4 1F ,4F4NS4 M4C*ANISMS

MALA,AP0I24 &4*A2I1)

0*1U6*0 P4)C4P0I1N &4*A2I1)AL

SC*I91P*)4NIA( C*)1NIC !'ental isorder"


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V. DIANOSIS

-he client was diagnosed with *hronic Schizophrenia last 0anuary 2@

'((@ by attending physician Dr. :ric +orromeo.

-he researchers have sought information through interviews, history

ta!ing and referred to the diagnostic criteria of the DSMB-; to come up

with different diagnoses of the client.

t was found out that6

During our visits and interactions with her, we further categorized the

type of schizophrenia our client has, which is undifferentiated type. -he

criteria were ta!en from Diagnostic and Statistical Manual of Mental Disorder

B -e#t ;evision and these guidelines were enumerated. -o be

diagnosed as having schizophrenia, a person must display6

/ *haracteristic symptoms6 -wo or more of the following, each

present for a significant portion of time during a onemonth period

3or less, if successfully treated

hallucinations

Delusions

disorganized speech 3e.g., fre=uent derailment or incoherenceF

spea!ing in abstracts

grossly disorganized behavior 3e.g. dressing inappropriately,

crying fre=uently or catatonic

9egative symptoms, i.e., affective flattening3lac! or decline in

emotional response, alogia 3lac! or decline in speech,

anhedonia, apathy, or lac! of volition 3lac! or decline in

motivation.

9ote6 Only one *riterion / symptom is re=uired if delusions are bizarre or

hallucinations consist of hearing one voice participating in a running

commentary of the patientNs actions or of hearing two or more voices

conversing with each other.
http://en.wikipedia.org/wiki/Hallucinationhttp://en.wikipedia.org/wiki/Abstracthttp://en.wikipedia.org/wiki/Affective_flatteninghttp://en.wikipedia.org/wiki/Alogiahttp://en.wikipedia.org/wiki/Avolitionhttp://en.wikipedia.org/wiki/Hallucinationhttp://en.wikipedia.org/wiki/Abstracthttp://en.wikipedia.org/wiki/Affective_flatteninghttp://en.wikipedia.org/wiki/Alogiahttp://en.wikipedia.org/wiki/Avolition


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+ Socials e#perience when she was abused when she was still

wor!ing as a house helper in Manila.

Specifically, the client had auditory and visual hallucinations. She

stated that she is seeing and hearing a cat. -he client displayed

inappropriate affect which was very noticeable throughout the 5 day

duration of the visitations.
http://en.wikipedia.org/wiki/Mood_disorderhttp://en.wikipedia.org/wiki/Pervasive_developmental_disorderhttp://en.wikipedia.org/wiki/Mood_disorderhttp://en.wikipedia.org/wiki/Pervasive_developmental_disorder


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VI. MULTI5A6IAL DIANOSIS

A6IS I Schizophrenia

A6IS II ":;SO9/C-E DSO;D:;S /9D M:9-/C ;:-/;D/-O9

A6IS II G:9:;/C M:D*/C DSO;D:;

A6IS /V "SE*8OCOG*/C /9D :9B;O9M:9-/C ?/*-O;S

A6IS V GCO+/C /SS:SSM:9- O? ?)9*-O99G 3 G/?

A6IS I: CLINICAL DISORDER

C")&i$ S$"i;),"e&ia< U&(i--ee&!ia!e( !*,e

*hronic Schizophrenia is a longstanding disorder with debilitating

symptoms that challenges the client, family, health care wor!ers, and the

community. -he client periodically e#periences psychosis such as delusions

and hallucinations, which may be frightening to the client and others. -he

client may need protection if hallucination is a command type that orders the

client to harm or !ill self or others. / disorder with symptoms that affect the

client>s thought processes, mood, emotions, and social functions throughout

the client>s lifetime.

-he client is bestowed this diagnosis because upon onset of illness she

demonstrated manifestations that suit the standard for a chronic type of

schizophrenia with psychotic disorders which are6 hallucinations, looseness

of associations, and inappropriate affect.

A6IS II: PERSONALITY DISORDERS AND MENTAL RETARDATION


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DEPENDENT PERSONALITY DISORDER

*lient has been observed to be dependent on others in order to complete

daily tas!s such as bathing and doing simple house hold chores.

coping mechanism6

L Denial

L ;egression

A6IAL III: ENERAL MEDICAL DISORDER

-here is no presence of a medical diagnosis relative to the client>s

disorder.

A6IAL IV: PSYCHOSOCIAL AND ENVIRONMENTAL FACTORS

"sychosocial or :nvironmental "roblems6

Cow Socio:conomic Status due to unemployment

"roblems with the primary support group 3parents

Cow educational attainment

)nsafe home environment

Cac! of support from partner

A6IAL V: LOBAL ASSESSMENT OF FUNCTIONIN = AF >

On a scale (2((, the client manifests $' of being

Schizophrenic. *hronic type with moderate symptoms of in social

occupational functioning.


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VII. NURSIN MANAEMENT

A. IDEAL NURSIN CARE PLAN

Diag&)'i':Sel*+care de*icit, -.giene/ grooming/ toileting related to

cogniti0e impairment1

O?e$!i+e:/t the end of nursing intervention, the client will be able to

perform selfcare activities within level of own ability.

I&!e+e&!i)&' @ Ra!i)&a#e:

2. "romote client>s participation in problem identification and desired

goals and decision ma!ing.

:nhances commitment to plan, optimizing outcomes, and

supporting recovery and health promotion.

'. "ractice and promote shortterm goal setting and achievement.

-o recognize that today>s success is as important as any longterm

goal, accepting ability to do one thing at a time, and

conceptualization of selfcare in a broader sence.

&. Support client in ma!ing healthrelated decisions and assist in

developing selfcare practices and goals that promote health.

-o help client achieve her goal.

4. :ncourage !eeping a Hournal of progress and practicing of

independent living s!ills.

-o foster selfcare and selfdetermination.

5. /ssists needs

Ex,e$!e( O%!$)me:

/t the end of nursing intervention, the client is e#pected to perform

selfcare activities within level of own ability.


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Diag&)'i':!isturbed t-oug-t process related to disintegration o* t-inking

processes


demonstrate behaviors


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Diag&)'i':$ne**ecti0e -ealt- maintenance related to cogniti0e impairment1


assume responsibility for own healthcare needs within level of ability.

I&!e+e&!i)&' @ Ra!i)&a#e:

6. Discuss with client>s beliefs about health and reasons for not

following prescribed plan of care.

Determine client>s view about current situation and potential for

change.

7. Develop plan with client for selfcare.

/llows for incorporating e#isting disabilities with client>s desires and

ability to adapt and organize care activities.

8. "rovide anticipatory guidance.

-o maintain and manage effective health practices during periods

of wellness and identify ways client can adapt when progressive

illness


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Diag&)'i':$ne**ecti0e coping related to inade2uate coping met-ods as

E0idenced b. poor sel*+concept1

O?e$!i+e:/t the end of nursing intervention, the client will be able to meet

psychological need as evidenced by appropriate e#pression of feelings,

identification of options, and use of resources.

I&!e+e&!i)&' @ Ra!i)&a#e:

2. *all client by name. /scertain how client prefers to be addressed.

)sing client>s name enhances sense of self and promotes

individuality


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Diag&)'i':Altered t-oug-t process related to disintegration o* t-inking

process as e0idenced b. presence o* delusional s.stem and inaccurate

interpretation o* en0ironment

Objective: /t the end of @ hours of nursing intervention, the patient will

increase capacity to cope effectively with them by elimination of pathological

thin!ing and, the client will establish interpersonal relationships to other

people.

I&!e+e&!i)&' @ Ra!i)&a#e:

2. :stablish a therapeutic nurseclient relationship

"rovides an emotionally safe milieu that enables interpersonal

interaction and decreases autism.

'. )se therapeutic communications

;educes autistic thin!ing.

&. Determine severity of client>s altered thought processes

:nables planning of appropriate interventions

4. Share appropriate thin!ing and set limits 3cognitive therapy

:nhances selfesteem and promotes safety for the client and others.

5. /dminister medications such as 8aloperidol in a right dosage and time

-o reduce psychotic symptoms

E6PECTED OUTCOMES:

/t the end of nursing intervention, the patient have met the following

obHectives such as, increasing capacity to cope effectively with them byeliminating her pathological thin!ing and established interpersonalrelationships to other people.


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B. ACTUAL NURSIN CARE PLAN

DATE: DAY / =A,i# /4< 2/>

S

)sahay rana siya ga!aligo ayha ra>g bali!bali!on ug ingon o !unglain tao ang magingon sa iyaha,1 as verbalized by the mother.

)ntidy appearanceDirty ?ingernails;umpled hairearing dirty clothes and sandals+ad breath

A Selfcare deficit related to cognitive impairment as evidenced by

inability to maintain appearance at a satisfactory level.P Cong term6

/t the end of 5 days of visiting to the client, the client can performcertain self care.

Short term6/t the end 2 hour the patient will be able to free from body odor

I

/. Observed for cause of inability to bathe.

2. /ssess client>s ability to bath4. /s!ed significant others for input on bathing methods and

timing of bath8. -each client and family an individualized bathing routine9. :ncouraged significant others to supervise client during

bathing

E

/t the end of 5 days the patient is free from body odor and canperform certain self care


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DATE: DAY 2 =A,i# /8< 2/>

S ala lagi tarong tulog niya ana pati !ami usahay ga!abilar niya !aymumata mana siya>g gabie napod !au.1 /s verbalized by the mother.

O selfinduced impairment of normal pattern less than agenormed total sleep time changes in behavior and performance

A Disturbed Sleep "attern related to ruminative presleep thoughts asevidenced by away from home

P

L)&g !em6 /t the end of & days, the patient will be able to reportimprovement in sleep< rest pattern and report increased sense of wellbeing and feeling of rested.

S")! !em6 /t the end of 2 day, the patient will be able to verbalizedunderstanding of sleep disturbance.

I

2. Cisten to subHective reports of sleep =uality.

'. "rovide =uiet environment and comfort measures.

&. dentify circumstances that interrupt sleep and fre=uency.

4. Observe physical signs of fatigue 3e.g., restlessness, handtremors, thic! speech.

5. Determine recent traumatic events in client>s life.

E "atient wasn>t able to show changes of sleep disturbance due to impairedsensory perception resulting to hallucinations.


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DATE: DAY 4 =A,i# /< 2/>

S!ung pangutanon a!ong ana! !ung !insa ang atong presidente!aron, iya itubag !ay si :rap as 0erbali4ed b. t-e mot-er1

8allucinations Delusions nsomnia )n!empt appearance

A/ltered thought process related to disintegration of thin!ing process asevidenced by presence of delusional system and inaccurateinterpretation of environment.

P

/t the end 2 hour of nursing intervention, the client will establish

interpersonal relationships to other people.

I

/.>:stablished a therapeutic nurseclient relationship.

2.>)sed therapeutic communications li!e agreeing, etc.

4.>Determined severity of client>s altered thought processes

8.> #hared appropriate thining and set limits ("ognitive therapy)

9.>/dministered medications such as 8aloperidol in a right dosage and

time.

E+y the end of @ hours of nursing intervention, the patients have metthe following obHectives such as, increasing capacity to cope effectivelywith them by eliminating her pathological thin!ing and establishedinterpersonal relationships to other people.


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Day 4(April 17, 2010)

!his was the s"heduled day for us to obtain medi"al re"ord at &orthern

'indanao 'edi"al enter with 'rs but the mother of #weet was not there

be"ause she had important errands to do so we "ame ba" in the afternoon-nfortunately, her mother "hanged her mind in a""ompanying us in the

hospital .e de"ided to get her "onsent to allow us to get the ne"essary data

about #weets "ondition

Day 5(April 18, 2010)

!his is the last day of our visit .e rendered health tea"hings about

religiously attending to her treatment regimen .e bought % liter of oe

and bread as re/uested by #weet


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VIII. MEDICAL MANAEMENT

Name of,rug

,ate1rdered

Classification,ose:

Fre;uency:)oute

Mechanismof action

SpecificIndication

Contra>?

Antiparkinsonian 7mg 05( Anticholinergicactivity in the-(2 that is

believed to helpnormali)ed thehypothesi)edimbalance ofcholinergic anddofaminergicneurotransmission in basal gangliain the brain of aparkinsonismpatient.

5elief ofsymptoms ofextrapyramid

al disordersthataccompanyphenothia)ine therapy

-ontra+indicated inpatients

hypersen+sitivity toben)odia)ipine.

isorientation,confusion,memory lose,

hallucination,tachycardia,hypotension,rash, drymouth,constipation.

+ecreasedosage ordiscontinue

temporarily ifdry mouthmakesswallowing orspeaking isdifficult.+@ive withmeals if @Iupset occurs/give before ifwith dry mouth/give after ifnausea occurs.

+&nsure thatpatient voids

$ust beforereceiving eachdose of drugs ifurinaryretention is aproblem.


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Name of,rug

,ate1rdered

Classification

,ose:

#re1uency

)oute

Mechanism ofaction

SpecificIndication

Contra>?

Antipsychotic 7:mg TI, % Is neuroe#tic thatacts by bocing

the #ostsyna#tic

!o#amine

rece#tor in the

mesoimbic

!o#aminergicsystem an! inhibits

the reease of

hy#othaamic

an!hy#o#hysea

hormones. It has

antiemetic+

serotoninbocing+

an! wea

antihistaminic #ro#

erties an! sight

gangionbocing

acti"ity.

chronic

#sychoses+

#articuary

when

accom#anie!

by increase!

#sychomotoracti"ity.

%ausea an!

"omiting.

y#ersensiti"

ity.

)ross

sensiti"ity may

e,ist among

#henothiaines

. /hou! not beuse! in

narrowange

gaucoma.

/hou! not be

use! in

#atients who

ha"e )%/

!e#ression.

)%/

neuroe#tic

maignant

syn!rome+

se!ation+

e,tra#yrami!a

reactions+tar!i"e

!ysinesia

)

hy#otension

increase!

with I+ I:

''%

burre! "ision+

!ry eyes+ ens

o#acities

;I

consti#ation+

!ry mouth+

anore,ia+

he#atitis+ ieus

;


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Name of,rug

,ate1rdered

Classification

,ose:

#re1uency

)oute

Mechanism ofaction

SpecificIndication

Contra>?

Antipsychotic :mg TA= 3nknown.A butyrophenonethat probablyexertsantipsychoticeffects blocking

postsynapticdopaminereceptor in thebrain.

#or chronicpsychoticdisorder4schi)ophrenic

-ontra+indicatedin patientshypersensitive to drugsand in those

withparkinsonismand -(2depression

ypotension,drowsiness,tachycardia,blurredvision,nausea and

vomiting, drymouth,menstrualirregularities,

$aundice, skinrashesdiaphoresis


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I6. PRONOSIS AND RECOMMENDATION

-he prognosis of our client is "OO; based on the following criteria6

CRITERIA RESULT OOD

PRONOSIS

POOR

PRONOSIS

/. Onset ofillness

-he onset of illnessstarted during heradolescence stage.

3 3P

+. Duration ofillness

She suffered frommental illness

Documents

Chronic Schizophrenia Undifferentiated