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INTRODUCTION

Dissociative Identity Disorder was previously known as multiple personality disorder. It is considered the moost serious of the dissociative

disorders. Clients have two or more distinct personalities, each with its own behavior and attitudes.

While there is no proven specific cause of DID, the prevailing psychological theory about how the condition develops is as a reaction to

childhood trauma. Specifically, it is thought that one way that some individuals respond to being severely traumatized as a young child is to wall

off, in other words to dissociate, those memories. When that reaction becomes extreme, DID may be the result. As with other mental disorders,

having a family member with DID may indicate a potential vulnerability to developing the disorder but does not translate into the condition

being literally hereditary.

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality (different names,

ages, tone of voices and appearance and dress) states that continually have power over the person's behavior. With dissociative identity

disorder, there's also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness,

unremembered behaviours, discovery of items for which she cannot account, not recognizing oneself in front of the mirror Moreover, alongwith the dissociation and multiple or split personalities, people with dissociative disorders may experience depression, mood swings, suicidal

tendencies, sleep disorders, anxiety, panic attacks and phobias, alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms and

eating disorders. Other symptoms of dissociative identity disorder may include headache, amnesia, time loss, trances, and "out of body

experiences." Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-

inflicted and outwardly directed).

The primary treatment for multiple personality disorder is therapy, which may include hypnosis, grounding techniques, individual therapies such

as art therapy, and/or talk therapy and cognitive-behavioral therapies. The goal is to get alters in communication with each other, so that the

person does not continue to dissociate from reality. A secondary goal is to be sure the person is removed from any ongoing traumatic situations,such as removing a child from an abusive home.

There is no particular drug or combination of drugs that is specific to the treatment of client with dissociative disorder. Pharmacologic

interventions may be most useful in treating the target symptoms that often accompany dissociative identity disorder, as well as intrusive and

hyper arousal symptoms. Depression is also a common presenting symptom of clients with dissociative disorder and may be what first brings

them into the mental health system. No particular class of antidepressant is more effective than another; each needs to be evaluated on an

individual basis. Anger and severe internal disequilibrium accompany dissociation in varying degrees. Antipsychotics can be a useful adjunct to

treatment to assist the client in periods of dyscontrol or rapid dissociation. Atypical antipsychotics can be effective.


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OBJECTIVES


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NURSING HISTORY

DEMOGRAPHIC DATA

Patient K.A.M is a 24 years old, female, a Filipino and Roman Catholic is currently residing at Taal, Bocaue, Bulacan. She was born on July 19,

1988 at Isabela, Leyte.

CHIEF COMPLAINT

Unremembered behaviour called by different names, being accused of the things unkown and the sense of going insane accompanied by

suicidal ideations.

HISTORY OF PRESENT ILLNESS

1 year PTA, client is exhibiting inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness,

unremembered behaviours, discovery of items for which she cannot account, not recognizing oneself in front of the mirror, sleep and eating

disorders, depression, and the sense of being going insane.

4 months PTA, patient was encouraged to consult a psychiatrist with presenting signs and symptoms, exhibited auditory hallucinations

and had severe anxiety attacks. The doctor initially diagnosed the patient of having paranoid schizophrenia s evidenced by the presenting clinical

manifestations and thus refuses to continue the treatment compliance.

3 months PTA, client was referred to the Bulacan Psychiatric State Hospital for further evaluation. Initially, get baseline vital signs,mental status examination.

3 days PTA, through the therapeutic relationship and communication, therapies and different treatment modalities like hypnosis at

home health care services done to the client she was finally diagnosed as having Dissociative Identity Disorder.

Few hours PTA, client wishes to kill herself as someone inside her want to kill her or commit suicide so that a decision arises for client to

be admitted at the hospital.


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PAST MEDICAL HISTORY

Patient had common cold and flu, experienced severe headaches, insomnia and amnesia, depression and anxiety and shizophrenia. She

denies engagement on previous accidents but is always being warned because attacks commonly being manifested along the road.

NUTRITIONAL-METABOLIC PATTERN

Patient seldom eats her dinner because she feels tired from all day work at school and wishes instead to sleep in regaining energy. She

spends longer time eating her breakfast and reports early satiety thus leaving half of the food on the plate not eaten. But there are times when

returning home from school, she eats a lot, reporting that she feels hungry like a man not fed for a year. She stated that she was advised by her

guardian to take vitamins for supplementation. She eats a piece of bread for breakfast and a cup of milk oftentimes and seldom eats rice

ELIMINATION PATTERN

Patient reports change in the frequency of bowel movements from the usual 2 times a day to 2-3 times a week. She describes it as bulky

and takes an effort to be eliminated which made her decide to take oral laxatives. She voids at least 4 times per day draining amber to yellowish

urine without any associated difficulties.

SLEEP AND REST PATTERN

Patient has difficulty falling sleep almost at all nights. She wakens at the middle of the night because of the current nightmares being

experienced. It takes couple of hours to fall asleep again. Most of the time, she reads books in order for her to fall asleep and the usual drinking

of warm water before bedtime but there are times drinking alcohol beverages soothes the discomfort of remaining asleep. Reports fatigue the

day after and sometimes stated that she would be awaken lying on the floor and being confused how she got there. She wishes to sleep all-day

during her leisure time.

COPING-STRESS PATTERN

Patient believes appraising people is the most stressful situation in her life. She just recently loss her best friends trus t and

understanding, has had an argument with her tita and has had lost her interest in studying.


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ROLES-ROLE RELATIONSHIP PATTERN

Patient has a history of family abandonment due to a homicidal event. She is presently living with her tita who is not staying at home for

longer periods of time arising from the need to work. She is a graduating Psychology student at a prestigious university in nearby their vicinities.

She spends most of her time studying with her best friend. She has had recently a quarrel between her best friend.

SENSORY- PERCEPTUAL PATTERN

Patient needs to wear eyeglasses although out the day to appropriately perform daily tasks. Reports hearing buzzing of voices on her

head and easily get startled when exposed to any environmental noises especially the sounds of a metal and developed fear on certain objects

like a glass of coffee.


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MENTAL STATUS EXAMINATION

GENERAL APPEARANCE

1ST

DAY 2ND

DAY 3RD

DAY

Act out like a caring woman in the mid

adulthood

Act out like a young adult man Appears younger than age, acting out like a

child

Cooperative attitude and behavior Cooperative but has difficulty sitting still Uncooperative and bizarre through exhibiting

violent cues and acts towards others

Uncomfortable if the nurse is too close Comfortable but is not Easily startling to environmental noises

Wears clothing with long sleeves, eyeglasses,

not appropriate to age but somehow

appropriate to weather

Wears pants and shirt, covered with black

jacket, not appropriate to weather and sex

Wears kiddie apparel, tied on a ponytails,

appropriate to weather but not to age

Relaxed, sudden shift from elation to sadness,

from calm to hyper alert and anxious

Appears anxious or agitated and have

difficulty sitting still

Appears anxious and agitated and sometimes

violent often need to pace or move around a

place

Not recognizing self to mirror Not recognizing self to mirror Not recognizing self to mirror

MOOD AND AFFECT

1ST

DAY 2ND

DAY 3RD

DAY

Looks sad and lonely then shifts from beingjoyous and wears smile, uses sweet but low

tone of voices

Uses high tone of voices like that of an adultman

Looks terrified and may cry or scream orattempt to hide or run away

Unable to identify any emotions or feelings Bossy and act like a commander Report feeling dead inside

Frightened or scared that someone wishes to

kill him inside

Irritated and anxious


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THOUGHT PROCESSES AND CONTENT

1ST

DAY 2ND

DAY 3RD

DAY

Knows the behavior, appearance and plans of

the other two alters

Always theres a need to be obeyed, wishes to

hurt people when they do not do what she

says

Experienced nightmares and flashbacks

Reports hallucinations and buzzing voices in

her head that someone wishes to kill her and

ran before her

COGNITIVE/INTELLECTUAL FUNCTION

1ST

DAY 2ND

DAY 3RD

DAY

Experienced memory gaps, period of time for

which she has no clear memories

Losses concentration or paying attention

when experiencing hallucinations and unable

to communicate at all

Oriented to reality Oriented to reality but unable to concentrate

and has an impaired judgment, decision

making and problem solving

SPEECH

1ST

DAY 2ND

DAY 3RD

DAY

Low tone of voice

Coherent

Calm and direct

Loud tone of voice

Coherent

Loud speech

Moderate to high tone of voice

Rapid speech

Incoherent as evidenced by the presence of

loose association


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PHYSICAL ASSESSMENT

AREA OF

EXAMINATION NORMAL FINDINGS ACTUAL FINDINGSMarch 08, 2012 ACTUAL FINDINGSMarch 09, 2012 CLINICAL SIGNIFICANCEVITAL SIGNS T: 36.5-37.4C

PR: 60-100 beats/min.RR: 12-20 breaths/min.BP: 120/80mmHg

T: 36.4CPR: 61beats/min.RR: 19 breaths/min.BP: 100/60mmHg

T: 37.5.CPR: 110 beats/min.RR: 25 breaths/min.BP: 140/90mmHg

Vital signs are low during depressive state

due to low amount of serotonin. Vital signs

are increased when anxious because the

body is compensating and the effect of

norepinephrine takes place

SKIN Varies from light todeep brown, ruddy pink

to light pinkNo abrasions or lesionsIf pinched, skin goesback to previous state

2 secs.

Fingernails plate

shape is in convexRound, hard

immobilecapillary refills >3

secs.

Pale nailbeds and slow capillary refill may

indicate low blood concentration usually

when not having adequate resting periods.


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prompt return of pink,

generally


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Pinna easily recoils

NOSE Straight and symmetricNo dischargeNo nasal flaringUniform in colorFacial sinuses are non-

tenderAir moves freely to as

the client breathes

through the nares

Straight and

symmetricNo discharge

Slightly congestedNo nasal flaringUniform in colorFacial sinuses are non-

tenderAir moves slightly not

freely to as the client

breathes through the

nares

Straight and

symmetricNo dischargeWith nasal flaring

notedUniform in colorFacial sinuses are

non-tenderAir moves freely to

as the client

breathes through

the nares

An increase need for oxygen can manifest

nasal flaring

MOUTH Lips are uniform incolor, soft, moist

smoothSymmetric in contourAble to purse lips32 teeth, smooth

enamel, pink gums withno retractions

Lips are slightly dry

with symmetrical

contourAble to purse lipsDry oral cavity

Lips are slightly dry

with symmetrical

contourAble to purse lipsDry oral cavity

Maybe patient have low fluid intake or

hygiene deficitNORMALMaybe due to low fluid intake

NECK Muscles equal in size,head centeredCoordinated

movementsNo lesions or massLymph nodes are non-

equal neck symmetrySuperficial dilated

blood vessels notedequal neck

symmetrySuperficial dilated

blood vessels noted

The neck examinations were all found to be

NORMAL.


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palpableTHORAX AND

LUNGS SymmetricSpine is verticallyalignedAntero-posterior tolateral diameter in ratio

of 1:2Full symmetric chest

expansionNo deformities and

massesResonate except over

scapulaBroncho and vesicular

breath sounds

Full symmetric chest

expansionNo deformitiesNo massesSpinal column isstraight and vertically

alignedNormal breath

sounds; medium

pitch, medium

intensityResonate except over

scapula

Full symmetric chest

expansionNo deformitiesNo massesSpinal column isstraight and

vertically alignedRapid, breathing;

medium pitch,

medium intensityResonate except

over scapula

Rapid breathing is due to the effect of

noreephinephrine during fight or flight

response

.

ABDOMEN Unblemished skin,uniform in colorRounded or flat in

contourSymmetricalStools are brown to

dark brownColor of emesis variesHigh-pitched irregulargurgles, 5-35

times/min. presently

equalDull in all four

quadrants over bowelNon-tenderSoft

Symmetrical

Decreased bowel

soundsSymmetrical

Decreased bowel

soundsDecreased bowel sound is maybe due to

decreased gastric motility related to

depressive and anxiety episodes


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No masses


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THERAPEUTIC COMMUNICATION

NURSE PATIENT TECHNIQUE USED RATIONALE

Good morning, ako nga pala si nurse Gretchen, ako ang

magiging nurse mo simula ngayon at sa mga susunod na araw.

Upang matulungan kita sa paggaling mo.

ORIENTATION PHASE

Offering self

Builds trust and

understanding

Introduce self

and identify

relationship

Withdrawn

clients

commonly fear

close contact

with someoneInaasahan ko na magiging maluwag sa puso mo na tulungan

kita. Kung ditto sa lugar na to gusto mong makipagusap, sge.

Mga 9 ng umaga hanggang 12 ng tanghali ang oras natin at

depende sa haba narin ng mapaguusapan. May mga

pagkakataon na pupunta rito kasama natin ang mahahalagang

tao sa buhay mo.

ORIENTATION PHASE

Nurse-client written

contract

Time, place, length of

sessions

When will be

terminated

Who will be involved

in the treatment plan

Cline responsibilitiesNurse responsibilities

Overcome

nervousness

and convey

feelings of

warmth,

expertise and

understanding

to be more

likely successful

and to meetestablished

goals

Ang anumang mapaguusapan natin ay makakaasa kang sa atin

lamang dalawa. May mga pagkakataong kailangan kong

kausapin ang mga kaibigan mo at kapwa ko nurses pero

makakaasa ka na hihingi muna ako ng permiso mula sayo.

opo. Sige po. (Shy) ORIENTATION PHASE

Utilization of

Confidentiality

Builds trust and

self-esteem

Ano nga pala ang gusto mong itawag ko sayo? ahmmm.. ako si angela. WORKING PHASE Provide


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Broad Openings opportunity for

the client to

introduce a

topic

Ideal in

popping out

thealters

Ilang taon na si angela? Hmm. Di ko alam eh. WORKING PHASE

Focusing

Concentrate on

a single,

important

point

ah. Tell me about angela.. Medyo mahiyain at ayoko

talagang nakikisama sa mga tao..

ayoko ng ganitong nakikipagusap..

pasenya ka na ha.. (still in timidstate)

WORKING PHASE

General Leads

Encourage

continuation

To be orientedmore with the

behviors

unique to that

specific alter

sige. (nodding) nasusundan kita at ok lang yan.. WORKING PHASE

Accepting

Implicates that

the nurse has

heard and is

willing to hear

what the client

wants to sayGaano ka ba naaapektuhan ng pagiging mahiyain mo? ewanko, basta..tara na nga.. bakit

ba kasi tayo nandito.. nagugutom

na ko at masakit ang ulo ko kaya

go na..

WORKING PHASE

Encouraging

descriptions of

perceptions

Having the

client describe

her view of an

experience.

Parang nawawalan ka ng interes kausapin ako? Db sabi mo

kanina gusto mo ng kausap?

Masakit lang talaga ulo ko eh..

gusto ko pa matulog..

WORKING PHASE

Making observations

Verbalizing

what the nurse

sees in clients

behaviour


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In order for the

conversation

Ayos lang ba ang pakiramdam mo? Gusto ko lang matulog pa.. WORKING PHASEFocusing

Concentrate on

the feelings

experienced by

the client

sge. Naiintindihan ko kung yan ang gusto mo.. WORKING PHASE

Accepting

Implicates that

the nurse has

heard and is

willing to hear

what the client

wants to say

Boost the

likelihood of

the client totalk

Pagbalik natin, may assignment ka.. gusto ko isulat mo mamaya

ang mga naramdaman mo ngayong araw.. kung OK na ang

pakiramdam mo mamaya. Asahan mong pupuntahan

kita..maliwanag ba yun?

Oo sige.. WORKING PHASE

Summarizing

Orientation to

Journaling

Giving the

client

responsibility

needed for her

full recovery.

Journaling

helps client

express feelings

and thoughtsthrough

written form

when

otherwise has

difficulty

verbalizing due

to the

dissociation


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kasi! Encourage clarification

boyfriend? oo! Baka tinatago niyo siya kaya

wala pa siya till now? (galit)

WORKING PHASE

Focusing

Concentrate on single,

important point

nagiging irritable kana? Hay naku, ilabas niyo siya.. totoo

noh? gusto mong makatikim ha??

Kaya siguro kami nag aaway dahil

sa inyo? (galit)

WORKING PHASE

Making observation

Verbalizing what the client

has observed from the client

Anong ibig sabihin mo sa makatikim?

Gusto mo ba kaming saktan?

Obvious ba? Kaya ilabas niyo

na.amp! (aakma)

WORKING PHASE

Restating

Shows what is really meant

by the clients statement and

behaviour and anticipate if

theres a need for an

immediate action to prevent

harm

Teka lang! (medyo confront na..) ang

sabi mo kahapon sa akin, si angela

maaruga, Tapos ngayon gusto mokaming saktan?

stop for awhile) oo nga, (reflect) WORKING PHASE

Confronting

Reflecting

Direct clients thought back

to the client

Prevent harm or injury

outwardly done

The primary personality is

being called usually the

protector in order to prevent

so

Gusto kong maramdaman ngayon ang

protekyon na yan.. bilang iyong

kaibigan..

WORKING PHASE

tsaka may boyfriend nako.. (smile) smile a little) ok sge, pasensya na. WORKING PHASE

Humor

Alleviate clients anxiety

Hinga ka muna ng malalim..(tuturuan kung paano mag DBE) (shows rapid breathing) WORKING PHASEGrounding and relaxation

techniques

Release tension

Anung nararamdaman mo ngayon? Ok naman. (makalma) WORKING PHASE

General leads

Encourage continuation and

aim at the established goal

gusto mu bang ipaliwanag ko ang Di na ok na. WORKING PHASE To help client what she has


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nangyari sayo kanina? Suggesting collaboration had experienced previously

sge. Magpatuloy tayo. Tell us about

you and your boyfriend?

Masaya na malungkot.. (sad) WORKING PHASE

Assessing relationship

Further gather information

about the clients experience

malungkot? May napagdaanan ka ba

sa buhay na tulad ng nararamdaman

mo ngayon?

(stop.. cry flashback ng boses..

noises..)(Nurses empathize.. allow silence..

offer hanky..salamat. (parang confused pa)

WORKING PHASE

Encouraging comparison

Silence

Period of silence gives client

time to express strong

feelings and reflect towards

self

Naiintindihan namin.. anong naiisip

mo?

hmmm.. WORKING PHASE

Broad opening

Encouraging client to

verbalize further

Maari mo bang sabihin kung anong

nangyari sa buhay mo?

madugo.. (stare lang) WORKING PHASE

Broad opening

Encouraging client to

verbalize further

Anong ibig mong sabihin ng madugo sa

buhay mo?

Mga lalaki.. armado.. baril dito..

baril dun.. ang ingay.. maraeng

sigaw.. (stare lang)(stop)

WORKING PHASE

Focusing

Concentrate on a single, most

important detail

pagkatapos? Sge nakakasunod kami.

Sabihin mo ang nangyari..

Nakita ko sina mommy.. sina

daddy, sina ate.. sina kuya..

walang buhay.. (stare lang)(crying)

WORKING PHASE

Accepting

Shows active listening and

willingness

comfort ni nurse Gretchen Napakaganid ng mundo! (medyogalit)

WORKING PHASE

Focusing

To further elaborate

ganid? basta. WORKING PHASEFocusing

Seek clarifications

Alam kong kahit papaano nagging

mabuti kang kaibigan at girlfriend.. sa

mga taong mahalaga sa iyo. At huwag

mong isipin na you deserve to

witnessed that kind of tragedy. And

ypu deserve to lose them.

reflect)

basta. Wag kang makulit..ayoko na

alalahanin pa. Ibaon na.

WORKING PHASE

Cognitive reframing

Reflecting

Helping the client that the

experienced is not deserved

by her and is not to put the

blame on

Avoid negative self talk that

will complicate more the


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dissociative episodes

kalimutan? Naiinis na ko sayo.. will u just shut

up! (galit ulit)

kayo may kasalanan eh.. sa mga

ganyan niyo.. kayongl ahat!!

WORKING PHASE

Translating into feelings

Encourage continuation and

seeking clarifications

Maaari ka bang kumalma muna? Oo na! WORKING PHASE

Confronting

Approach client in

nonjudgmental way

Ang sabi mo parang nalulungkot ka

kasi nawala na ang lahat?

Anong gagawin mo sa mga taong

natitira pa sayo?

Bahala na.. WORKING PHASE

Formulating plan of action

Help the client in enhancing

coping strategies, decision

making and problem solving

Sa higit kalahating oras na nag usap

tayo.. makakaasa ka na sa atin lamang

tatlo ang mga ito..N2: may gusto ka bang ipaalam sa mga

kaibigan mo?

Naku wala. Aarte lang yun..asan

nga ba sila?

TERMINATING PHASE

Summarizing

Recall client of the important

points being conversed to

decrease ignorance and

participate well the next time

sge. Hanggang sa muli. Paalam. Sge. TERMINATING PHASE End the conversation


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NURSING CARE PLANS

ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION

S: Dapat noon ko pa

ginawa to eh, para hindi

na ko nasaktan, para hindi

na ko nagkaganito.

O:

>with lacerations and

bruises on the ventral

forearms

>with dark circle round

eyes noted

>sudden mood swings>clenched fists

Short term goal

Partially compensatory

After 5 hours of nursing

intervention, the patient

will manage anger towards

self and others.

Focus on examining the

clients behaviors closely

for abrupt changes that

may signal a risk for

suicide. (gestures, threats

and plans).

Facilitate on monitoringbehavioral changes such

as:

-voice tone

-facial expressions

-movements

-verbal expressions

Restrict from passing

judgment on the client,

instead let the client know

she is a worthwhile

individual with strengths

and not responsible for

early childhood traumas.

Facilitate on structuring

the environment to reduce

external stimulation.

Close observation allows

nurse to intervene early in

and interrupt self-

destructive act: also

provides opportunity to

interact with the client

rather than resorting to

physical interventions.

Safety is the number one

priority.

Behavioural changes thatare clues to risk for

violence are important for

staff to anticipate ensuring

the clients safety.

The client is relieved from

blame, which decreases

guilt and shame and builds

self-esteem.

Calm surroundings

precipitate less stressful

internal state within the

Patient condition

PREVENTED.

NURSING DIAGNOSIS

RISK FOR SUICIDE and

OTHER-DIRECTED

VIOLENCE related to the

presence of auditory

hallucinations and an alter

who wishes to kill self

(Kristine) secondary to


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dissociation. -reduce noise, lights and

extraneous activities

-assist the client to avoid

stressful environment

when practical.

Facilitate on assisting the

client to identify

alternatives to aggression

or violence.

-verbalize feelings in a safe

setting

-write thoughts and

feelings in a journal

Depend on administeringmedication:

-Olanzapine(Zyprexa)

10mg/mL IM PRN

client and reduce the risk

for violence.

These activities will divert

the overwhelming

impulses of anger and

hostility toward

constructive behviors.

May mediateantipsychotics activity by

both dopamine and

serotonin type 2 ( 5-

hydroxytryptamine [HT]2)

antagonism: also mat

antagonize muscarinic

receptors, histaminic (H1)-

and alpha adrenergic

receptors


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S: Nandiyan na sila...hinahabol nila ko...

nandiyan na sila! as

verbalized by the client.

O:

>poor eye contact

>hypervigilant, scanning

>Scared

>diaphoretic

>Facial flushing

>BP:150/90PR: 110bpm

RR: 25rpm

Short- term goal


After 4 hours of nursing

interventions, the patient

appears relaxed and

verbalizes healthy ways to

deal with them.

Facilitate on assessingpalpitations, elevated

pulse and blood pressure.

Facilitate on

acknowledging

fear/anxiety by validating

observations with client.

(You seem to be afraid?)

Facilitate on

acknowledging reality of

situation as the client sees

it, without challenging the

belief.

Facilitate on maintaining

frequent contact with the

client. Be available for

listening and talking as

needed.

Restrict from empty

reassurances, with

statements of everything

will be alright. Instead,

specific information.

Changes in vital signs maysuggest the degree of

anxiety the client is

experiencing

Feelings are real, and it is

helpful to bring them out

in the open so they can be

discussed and dealt with

Client my need to deny

reality until ready to deal

it. It is not helpful to force

the client to face facts.

Establishes rapport,

promotes expression of

feelings and helps client

look at realities without

confronting issues they re

not ready to deal with.

False reassurance maybe

interpreted s lack of

understanding or honesty,

further isolating the client.

Patients conditionIMPROVED.

NURSING DIAGNOSIS

SEVERE ANXIETY related to

acute stressor secondary

to the presence of

auditory hallucinations.


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Facilitate on instructing

relaxation techniques such

as deep-breathing

exercises.

Facilitate on providing

therapeutic use of self and

touch.

Depend on administering

medication: Diazepam(Valium) 5mg IM PRN

Mindfulness is a method

of being in the here and

now, concentrating on

what is happening in the

moment.

Requires the nurse the

nurse to have specific

knowledge and experience

to use the hands to correct

energy field disturbances

by redirecting human

energies to help or heal

Depresses the CNS at the

limbic system andsubcortical level of the

brain.


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S: I have to strive harderat all times... Im trying to

do everything to please

him but it was all

nonsense... wasted! as

verbalized by the client.

O:

>restless

>negative self-talks as

observed>angry

Long term goal


After a month of nursing

interventions, patient will

enhance coping strategies

and its positive effects on

life functions

Facilitate on protective theclient from harm injury

during dissociate episode:

accompanied client to

assigned area, move

furniture against the light

prevent others to injury

cause by client confused

state.

Facilitate to demonstrateto the client that staff will

intervene to help the

client cope more

effectively during times of

dissociation:

-remain calm and

accepting of the clients

behaviour

-listen actively to the client

and try to identify which

personality is currently

dominant

-arrange protection if

violent personality

dominates.

-direct primary personality

to monitor and control the

behaviours of the

Client my becomeconfused, disoriented, or

frightened during

dissociative episodes and

may require safety

measures by an alert staff.

A reliable confident staff,using a consistent team

approach, helps to assure

the client that someone in

control when the client is

unable to cope and may

fear going insane or

falling apart.

Patients conditionIMPROVED

NURSING DIAGNOSIS

INEFFECTIVE INDIVIDUAL

COPING related to a need

from escape from

dissociation.


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DRUG STUDYGENERIC BRAND CLASSIFICATION DOSAGE

AND

ROUTE

MECHANISM

OF ACTION

INDICATION CONTRAINDICATION SIDE EFFECTS NURSING

IMPLICATIONS

FLUOXETINE

HYDROCHLORIDE

Prozac Atypical

antidepressant

(selective-

serotonin

reuptake

inhibitor)

20

mg/cap

OD PO

Inhibits the

CNS

neuronal

uptake of

serotonin

Short-term

management

of depressive

illness

Hypersensitivity to

drugs

Taking with

Monoamine oxidase

(MAO) inhibitorswithin 14 days of

starting therapy

Nervousness

Anxiety

Insomnia

Headache

Drowsiness

Tremor

Dizziness

-Observe 10

Rs of

administering

medication

-Use

cautiously inpatients at

high risk for

suicide or a

history of

hepatic, renal,

cardiovascular

disease, DM

or seizures.

-Should avoid

giving in the

afternoon to

prevent sleep

disturbances.

-Rashes or

pruritus may

appear usually

early in the

treatment.


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GENERIC BRAND CLASSIFICATION DOSAGE

AND

ROUTE

MECHANISM

OF ACTION

INDICATION CONTRAINDICATION SIDE

EFFECTS

NURSING

IMPLICATIONS

DIAZEPAM Valium Anxiolytics

(Benzodiazepine)

5mg/ml

IM PRN

Depresses

the CNS at

the limbic

system and

subcortical

level of the

brain.

Tension,

muscle

spasm,

moderate-

severe

anxiety

Known

hypersensitivity to

drug

Drowsiness

Lethargy

Transient

hypotension

Bradycardia

Hangover

Blurred

vision

Observe 10

Rs of

administering

medication

Do not use

with alcohol

and any CNS

depressant

Watch out for

signs of

withdrawal

syndrome


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pin rolling).

Extra pyramidal

effects (EPS)

including akathisia,

tardive dyskinesia,

pseudoparkinsonism.

Provide decreased

stimuli by dimming

light, avoiding loud

noises.

Provide supervised

ambulation until

stabilized on

medication; do not

involve instrenuous exercise

program because

fainting is possible;

patients should not

stand still for long

periods.

Inform patient that

orthostatic

hypotension occurs

often and to rise

from sitting or lying

position gradually.

Do not withdraw

this drug abruptly,

or EPS may result:

drug should be

withdrawn slowly.

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