Comprehensive Case Study Paranoid Schizophrenia

Republic of the PhilippinesBATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING AND MIDWIFERY

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A Comprehensive Case Study

Paranoid Schizophrenia

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In Partial Fulfillment of the Requirements in

Psychiatric Nursing

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Submitted to:

Leonora Llandilar R.N., M.A.N.

Nemia de Leon-Calimbas R.N., M.A.N.

Caroline Santos R.N., M.A.N.

Clinical Instructor

Submitted by:

MTW Group 6

Jomar Dominic RosarioAve Maria ValenzuelaJoey Alvin QuiambaoDannie Rhea SeredioMa. Renalyn RamosKrizzia Anne VirayCharize MendozaLorryleen GaliciaAlma Joy Lupido Ellen Jane Pulos

Lyndon Cruz Riza Racion

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TABLE OF CONTENTS

UNIT I

I. DEDICATION AND ACKNOWLEDGEMENT

II. INTRODUCTION

III. PERSONAL DATA

IV. CHIEF COMPLAINTS

V. HEALTH HISTORY

a) Past Health History

b) Present Health History

c) Family History

d) Social History

i. Childhood

ii. Adolescence

iii. Adulthood

e) Sexual History

UNIT II

Mental Health Status / Analysis and Interpretation

UNIT III

a) Psychophatophysiology

b) Related Literature

UNIT IV

a) Nursing Care Plan

b) Pharmacology

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UNIT V

Psychotherapy

UNIT VI

Glossary

UNIT VII

References

UNIT VIII

Documentation

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UNIT I

I. ACKNOWLEDGEMENT AND DEDICATION

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ACKNOWLEDGMENT

Our group would like to extend our warmest gratitude to the following persons

whose contributions whether financial, moral, spiritual and intellectual contributed much in

the accomplishment of this manuscript.

We humbly acknowledge and sincerely appreciate those who have shared their

valuable assistance and encouragement toward the completion of this study.

To all our beloved families for their understandings, motivations, supports, care and

love that get us through all the hardships that we’ve encountered.

To Mrs. Leonora Llandilar R.N, our clinical instructor, for her tireless guidance

patience and valuable advises that guides us to finish with clarity and coherence this piece

of work.

To the staffs of Mariveles Mental Hospital for the wonderful display of cooperation,

support and guidance which dynamically contributed in data-gathering and completion of

the findings.

Above all, to Almighty God from heaven for all the glory and triumph extended to

the Author. All the glory and love be all yours.

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DEDICATION

This humble piece of work is lovingly dedicated to our beloved family.

To our fellow BPSU students who will benefit from this work.

And most of all to our LORD and SAVIOR JESUS CHRIST.

To Him is all the glory!

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VisionA university of excellence acknowledged in the country and the Asia-Pacific Region for

quality graduates and knowledge responsive to socio-economic needs

MissionProvide quality and relevant education that will develop highly qualified and competitive

human resources responsive to national and regional development

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UNIT I

II. INTRODUCTION

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Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions,

movements, and behavior. It cannot be defined as a single illness ; rather schizophrenia is

thought of as a syndrome or disease process with many different varieties and symptoms

much like the varieties of cancer. For decades, the public vastly misunderstood

schizophrenia, fearing it as dangerous and uncontrollable and causing wild disturbances and

violent outbursts. Many people believed that those with schizophrenia needed to be locked

away from society and institutionalized. Only recently has the mental health industry come

to learn and educate the community at large that schizophrenia has many different

symptoms and presentations and is an illness that medication can control. Thanks to the

increased effectiveness of newer atypical antipsychotic drugs and advances in community-

based treatment, many clients with schizophrenia live successfully in the community. Clients

whose illness is medically supervised and whose treatment is maintained often continue to

live and sometimes work in the community with family and outside support.

Schizophrenia usually is diagnosed in late adolescence or early adulthood. 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 (America Psychiatric Association, 2000).

Paranoid schizophrenia is the most common type of schizophrenia in most parts of

the world. The clinical picture is dominated by relatively stable, often paranoid, delusions,

usually accompanied by hallucinations, particularly of the auditory variety, and perceptual

disturbances. Disturbances of affect, volition, and speech, and catatonic symptoms, are not

prominent. With paranoid schizophrenia, your ability to think and function in daily life may

be better than with other types of schizophrenia. You may not have as many problems with

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memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious, lifelong

condition that can lead to many complications, including suicidal behavior.

Patients who have paranoid schizophrenia that has thought disorder may be obvious

in acute states, but if so it does not prevent the typical delusions or hallucinations from

being described clearly. Affect is usually less blunted than in other varieties of

schizophrenia, but a minor degree of incongruity is common, as are mood disturbances such

as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such as

blunting of affect and impaired volition are often present but do not dominate the clinical

picture. The course of paranoid schizophrenia may be episodic, with partial or complete

remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is

difficult to distinguish discrete episodes. The onset tends to be later than in the hebephrenic

and catatonic forms.

In the Philippine setting, the disability survey done in 2000 by the National Statistics

Office (NSO) found out that mental illness was the 3rd most common form of disability in

the country. The prevalence rate of schizophrenia was 88 cases per 100,000 populations and

was highest among the elderly group. This finding was supported by a more recent data

from the Social Weather Station Survey commissioned by DOH in 2004. It reveals that 0.7

percent of the total households have a family member afflicted with mental disability. The

Baseline Survey for the National Objectives for Health in 2000 stated that the more

frequently reported symptoms of an underlying mental health problem were sadness,

confusion, forgetfulness, and no control over the use of cigarettes and alcohol, and

delusions.

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The most recent study on the prevalence of mental health problems was conducted

by the National Epidemiology Center (DOH-NEC) in 2006 which showed revealing results

though the target population was limited only to government employees from the 20

national agencies in Metro Manila. Among 327 respondents, 32 percent were found to have

experienced a mental health problem at least once in their lifetime. The three most

prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%), depression and

schizophrenia (6%). Mental health problems were significantly associated with the following

respondent characteristics: ages 20-29 years, those who have big families, and those who

had low educational attainment. The prevalence rate generated from the survey was much

higher than those that were previously reported by 17 percent.

Currently, there is no method for preventing schizophrenia and there is no cure.

Minimizing the impact of disease depends mainly on early diagnosis and, appropriate

pharmacological and psycho-social treatments. Hospitalization may be required to stabilize

ill persons during an acute episode. The need for hospitalization will depend on the severity

of the episode. Mild or moderate episodes may be appropriately addressed by intense

outpatient treatment. A person with schizophrenia should leave the hospital or outpatient

facility with a treatment plan that will minimize symptoms and maximize quality of life.

We primarily chose this case because of all kinds of schizophrenia; the paranoid type

is the most manageable one. Moreover, according to studies with proper and effective

treatment, paranoid schizophrenic patients have a greater chance to have a normal life.

Aside from that Mr. A.M. was the most coherent and most responsive of all our clients. This

entire case is highly possible to be studied comprehensively within the limited time

available.

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UNIT I

III. PATIENT’S PERSONAL DATA

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NAME: Mr. A.M

ADDRESS: Capaz, Tarlac

AGE: 41 years old

BIRTHDAY: January 21, 1969

BIRTHPLACE: Isabela

CIVIL STATUS: Single

RELIGION: Roman Catholic

NATIONALITY: Filipino

EDUCATIONAL ATTAINMENT: High School Undergraduate

OCCUPATION: Miner

DATE ADMITTED: September 18. 2006

TIME ADMITTED: 10:15 a.m.

WARD: Male Ward B

ADMITTING DIAGNOSIS: Paranoid Schizophrenia

ATTENDING PHYSICIAN: Dra. Evangelista

LAST 15 YEARS OF CLIENT’S LIFE:

Mr. A.M. formerly lived at Benguet on 1995. He worked there as a helper on

a mining company. In 2004, when he was 35 y/o, their family moved in Capaz,

Tarlac. He worked as a farmer that time. As the client stated, it was his first

admission at Mariveles Mental Hospital on September 18, 2006. According to him,

he was confined from 2006 up to present. Mr. A.M. was 37 y/o when he was

admitted to the hospital and still been there for 4 years.

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UNIT I

IV. CHIEF COMPLAINTS

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CLIENTS CHIEF COMPLAINT

(Source of Data: Client’s Chart)

Loss of Appetite

Poor Sleep

Irritable

Hurts his Parents

Destroys Appliances at home

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UNIT I

V. HEALTH HISTORY

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a) Past Health History

From the client's history in chart, he was working in a mining company at 17 years

old. When in 1985, he was figured in a mining accident; he was trapped in a machine

with rocks. The client spare 6 months in the hospital for his physical injuries. Since

then, he became restless and anxious each time he heard loud noises. After

recovery, Mr. A.M., was able to return working in the mining company he had been

before but was fired from work because of carnapping the car owned by the

company.

In 1990, he reportedly began to use marijuana and alcohol. He developed a

behavioral disorder. He was restless, irritable and violent. He hit a child whereby a

case was filed to him but his family settled the case. As said in the chart he was

confined at Roseville Rehabilitation Center for 2 months for psychological treatment

commenced with CPZ, and depot injection. The client had requested treatments and

follow-ups. And in 1995, the client was confined again at Baguio General Hospital for

2 months at the Psychiatric Ward.

As claimed by the client, he was still addicted to marijuana and alcohol after

being discharged from Baguio General Hospital until they had moved in Capaz, Tarlac

on 2004.

There he worked as a farmer together with his father, in their own small

farm. He also had a fight with his brother that made the latter to leave their house

without permission.

In January 2006, he refused to take medications and go for follow-ups. The

family was unable to purchase depot prep. He became irritable, sleepless, and

restless.

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In August 2006, he stubbed his father with a nail. He was charged in court but

case was not pursued. The client was forced to take medications to lessen the signs

and symptoms he manifested.

b) Present Health History

One week before admission, the client was again noted to be irritable. He ran

after a kid with a knife and burned some appliances at home (bed and soft cushion).

This prompted his family to seek help from Mariveles Mental Hospital. Mr. A.M. was

then diagnosed with paranoid schizophrenia by Dra. Evangelista upon admission on

September 18,2006.

Mr. A.M. is currently confined at Mariveles Mental Hospital Ward B. The

client stayed at the ward for 4 years now. He talks with some clients in the ward.

Mr. A.M. said that he spent most of his time in sleeping. He sings when he wanted

to.

Mr. A.M. shows only a few of the presenting complains, such as; interrupted

sleep and irrelevant speech. Mr. A.M. was manageable and showed little

manifestation during daily interaction. Mr. A.M. participates well in the therapies

and other activities.

The father last visited the client on July 4, 2009. However, until now, none of

his family members came back to visit him.

Last July, the client has an order for conduction but still waiting for the

scheduled date of discharge.

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c) Family History

As the client said, they have no history of having hypertension or diabetes

mellitus both on his parent’s side. He did not remember that his family and other

relatives do have any hereditary illnesses.

Family history of having mental disorder was denied, as written on the chart. But

when we asked the client, his brother was confined at Mandaluyong Mental Hospital

until this time. He also stated that his uncle does have a mental disorder before.

d) Social History

i. Childhood

Mr. A.M. was born in Tuguegarao, but he grew up in Baguio City. He

spent his elementary days in Baguio. He did not have immunizations. As said

by the client, his common illnesses during childhood are fever, colds & cough.

Mr. A.M. had a good relationship with his parents, especially to his father.

The client is closer to his father than to his mother. As claimed by the client,

he & his siblings are in good terms when they are young.

The client stated that he was bullied when he was young. Some of his

childhood peers asked him to spanks their mate and he did it. He always

followed what his friends commanded to him. Mr. A.M. said that he does not

want to be out of place when he was with his friends, so he does whatever

his peers told him to do so.

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ii. Adolescence

During his adolescent age, he learned how to masturbate. The client

said that he learned it only by himself, when he was 12 or 13 as remembered.

He told us that it is a part of growing up.

When he was in 2nd year high school, he started to court a woman,

and this became his first and last relationship before he was confined to

MMH. The client also gained friends of the same and opposite sex. Mr. A.M.

joined a fraternity when he was a sophomore student. He only finished

second year high school due to insufficient financial status and he’s also lazy

in going school.

At the age of 17, he started to work at a mining company.

Unfortunately, in 1985, he was trapped in a machine with rocks. He was

confined in the hospital for 2 months. This results him to become restless and

anxious whenever he heard loud noises. This is the time when his 1st sign and

symptom started to manifest.

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iii. Adulthood

Mr. A.M. spent most of his adult years in Baguio City. He worked as a

helper on a mining company until he was 21 yrs old. The client was fired

from work due to the case of car napping. After that, he no longer had a job.

The client spent most of his times with his friends whereby he had the vices

of smoking, drinking alcohol and using marijuana. He became addicted to

marijuana. Mr. A.M. was no longer concern with his relationship to his

girlfriend or with his life that time. He did not have his own family or even

marry his girlfriend. The client stabbed his father with a nail when he scolded

him on the things he does, fortunately it’s not fatal. His behavior was also

changed, he became restless. He burned their bed foam and sofa cushion.

He also hit his brother. Mr. A.M. destroyed some appliances of their

neighbor. Lastly, he ran after a child with a knife which forced his parents to

bring him at MMH. At present, the client was 41 yrs old and is confined for 4

years at the mental hospital.

e) Sexual History

The client defined sex as a process of having a family. He started to

masturbate when he was 12 or 13 yrs old and said that it is a part of growing up. He

learned this by himself. The client has not yet experience having sex. He had only

kissed his girlfriend and nothing more than that. Mr.A.M. once discharged, wants to

marry his girlfriend and have 3 children, 2 boys and 1 girl.

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UNIT II

MENTAL STATUS ASSESSMENT

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ORIENTATIONDAY 1 2 3 4 5 6 7 8 9 10 11 12

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ANALYSIS AND INTERPRETATION

Day 1: ORIENTATION

Day2: SELF-AWARENESS

Day3: The client is oriented to person, place, time, date and situation. He knew his name,

where he is, what is the time and date, and the reason why he’s confined to the

hospital.

Day4: The client is oriented to person, place, time, date and situation. He knew his name,

where he is, what is the time and date, and the reason why he’s confined to the

hospital.

Day5: The client is oriented to person, place, time, date and situation.

Day6: HOLIDAY

Day7: The client is oriented to person, place, time, date and situation.

Day8: The client knew his name, where he is, what is the date and time, and the reason

why he is confined at the hospital.

Day9: SCHOOL

Day10: HOLIDAY

Day11: Client is oriented to person, place, time, date and situation.

Day12: SCHOOL

- MANIFESTED X - NOT MANIFESTED

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DEFENSE MECHANISMSDAY 1 2 3 4 5 6 7 8 9 10 11 12

Repression

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Suppression X X X X X XRegression X X X X X XFixation X X X X X XDenial X X X X X XDisplacement X X X X X XConversion X X X X X XIdentification X X X X X XIntellectualization X X X X X XIntrojections X X X X X XProjection X X X X X XRationalization X X X X X XSublimation X X X X X XSubstitution X X X X X XSymbolism X X X X X XUndoing X X X X X XReaction Formation

X X X X X X

Fantasy X X X X X X


Day 1: ORIENTATION


Day3: The client didn’t show any defense mechanism. He just answered the questions

directly and appropriately. The client showed sincerity on what he’s saying by

means of direct eye contact.





directly and appropriately. The client maintained eye contact.


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Day6: HOLIDAY

Day7: The client didn’t show any defense mechanism during the interaction.

Day8: The client didn’t show any defense mechanism during the interaction.

Day9: SCHOOL

Day10: HOLIDAY




Day12: SCHOOL

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EXTRAPYRAMIDAL SYMPTOMS

DAY 1 2 3 4 5 6 7 8 9 10 11 12Pseudoparkinsonism

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1. Mask-like Face X X X X X X2. No Swining of

ArmsX X X X X X

3. Hesitancy of Speech

X X X X X X

4. Decrease Muscle Strenght

X X X X X X

5. Shuffling Gait X X X X X X6. Drooling X X X X X X7. Fine Intention Tremors

X X X X X X

Acute Dystonic Reaction1. Muscle spasm of jaw,tongue, neck, eyes.

X X X X X X

2. Laryngeal Spasm X X X X X XAkathisia X1. Restlessness X X X X X X2. Tenseness X X X X X X3. Inability to Sit Still X X X X X X4. Rocking back and forth on feet

X X X X X X

5. Crossing Leg Frequently

X X X X X X

6. Inability to Relax X X X X X XTardive Dyskinesia1. Involuntary movements of mouth, tongue, face, may extend to fingers, arms and trunk.

X X X X X X


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Day 1: ORIENTATION


Day3: We didn’t noticed any symptoms of akathisia/tardive dyskinesia towards Mr. A.M..

The client didn’t display any actions related to the said symptoms.





Day6: HOLIDAY

Day7: No EPS we’re seen on the client.

Day8: We didn’t notice any symptoms of EPS on the client.

Day9: SCHOOL

Day10: HOLIDAY



Day12: SCHOOL

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THINKING AND COMMUNICATIONDAY 1 2 3 4 5 6 7 8 9 10 11 12

Looseness of Association

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1. Neologism X X X X X X2. Word

SaladX X X X X

3. Echolalia X X X X X X4. Echopraxia X X X X X X5. Clang

Association

X X X X X X

6. Illogical thinking

X X X

Alogia X X X X X XConcrete Thinking

X X X X X X

Lack of Insight X X X X X XAphasia X X X X X XApraxia X X X X X XAgnosia X X X X X XFlight of Ideas X X X X


Day 1: ORIENTATION


Day3: The client did not show any manifestations regards to thinking and communication

disorder. Mr. A.M. spoke clearly and appropriately to the questions asked. He also

interpreted and understood our conversation well.

Day4: The client manifests illogical thinking during our interaction.

“SN: Ah, ano po ba ang naalala nyo sa gitara?

C: Dati nag-gigitara ko,lagi jamming ang tropa. Gumawa pa nga ko ng kanta. Pinadala Ko kay Britney Spears.”

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disorder. Mr. A.M. spoke clearly and appropriately to the questions asked.

Day6: HOLIDAY

Day7: The client thinks and shares stories illogically, with some ideas not related to the

topics discussed.

“SN: Mang A.M., ano nga pop ala ang relihiyon ninyo?

C: Jehovah Witness. Pero hindi pa ko baptized.

SN: Ah, ganun po ba Mang A.M.,

C: Oo, yung tiyuhin ko nga nilagyan nya ako ng brilyante sa ulo nun eh.

SN: Brilyante po?

SN: Eh, papanu naman po iyon nilagay sa ulo ninyo?

C: Oo, pinutol nila yun leeg ko tapos binalik nila ulit.”

Day8: The client says something that we did not understand (word salad).

“C: Attachment string. Iniipit nya ko. Hindi ako mapalagay mag rereaksyon na ko.”

Some ideas are not related to the topic being discussed (Flight of Ideas).

“SN: Ok na po ba kayo Mang AM?naaalala nyo po ba ang ginawa natin?

C: Nabusog ako, yung pumugot ng ulo ko iniipit ako eh.”

And the flow of our conversation goes illogical.

“SN: Ah ganon po ba?Masaya po? Eh napansin po naming na parang nakasimangot at seryoso po kayo masyado. Ano po ang dahilan?

C: Hindi kasi ako nakakatulog.

SN: Hindi nakatulog? Ano po ang dahilan?

C: May nag-iisip siguro sa akin.

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SN: Sino naman po kaya Mang A.M?

C: Yung pumugot ng ulo ko nung bata pa ako. Iniipit nya ku eh. Tinatawag nya ko.”

Day9: SCHOOL

Day10: HOLIDAY


disorder. Mr. A.M. spoke clearly and appropriately to the questions asked. He also

interpreted and understood our conversation well.

Day12: SCHOOL

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PERCEIVING AND INTERPRETINGDAY 1 2 3 4 5 6 7 8 9 10 11 12

Delusions

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1. Reference X X X X X2. Persecution X X X X 3. External

InfluenceX X X X X

4. Somatic X X X X X5. Grandiose X X X X X

Hallucinations X X X X Illusions X X X X XAttending to irrelevant Stimuli

X X X X X

Poor Reality testing X X X X X


Day 1: ORIENTATION


Day3: Mr. A.M. showed full understanding on what we are talking about by acting and

responding correctly on our interaction. He also interpreted the words and

expressions displayed during the conversation correctly. All his responses are

considered appropriate.







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- MANIFESTED X - NOT MANIFESTEDDay6: HOLIDAY

Day7: No abnormal manifestations of perception and interpretation we’re seen on the

client.

Day8: On our conversation with the client, he manifested delusion:

“SN: Eh napansin po naming na parang nakasimangot at seryoso po kayo masyado. Ano po ang dahilan?





C: Yung pumugot ng ulo ko nung bata pa ako. Iniipit nya ku eh. Tinatawag nya ko.”

And hallucination:

“SN: Mang AM. mag pahinga muna po kayo ha. Ihahatid nap o naming kayo sa ward. Tayong 3 lang po magkakasama Mang AM. wala na pong iba.

C:Naririnig ko sya sa attachment string.”

Day9: SCHOOL

Day10: HOLIDAY





Day12: SCHOOL

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FEELING AND AFFECTDAY 1 2 3 4 5 6 7 8 9 10 11 12

Flat

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olBlunted X X X XInappropriate X X X X X XLability X X X X X X


Day 1: ORIENTATION


Day3: We noticed that our client is in good mood. He also had the appropriate affect on

different situations we had talked about. Mr. A.M. responded accordingly.





Day6: HOLIDAY

Day7: The client’s feeling and affect is blunted. He thinks first for a moment before

answering.

Day8: the client’s feeling and affect is blunted. His reaction is delayed.

Day9: SCHOOL

Day10: HOLIDAY



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Day12: SCHOOL

- MANIFESTED X - NOT MANIFESTEDBEHAVING AND INTERACTING

DAY 1 2 3 4 5 6 7 8 9 10 11 12Withdrawal

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Motor Hyperactivity

X X X X X X

Motor Hypoactivity

X X X X X X

Ambivalence X X X X X XAnhedonia X X X X X XAbolition X X X X X XPoor Personal Hygiene

X X X X X X

Impulsive X X X X X XParanoia X X X X X X


Day 1: ORIENTATION


Day3: There is no problem with the behavior of our client. He behaved like a normal

individual with no mental disorder. Our interaction also went smooth because he

participated actively in the conversation.







Day6: HOLIDAY

Day7: No manifestation seen on the client.

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- MANIFESTED X - NOT MANIFESTEDDay8: Our client is behaved but interacted illogically.

Day9: SCHOOL

Day10: HOLIDAY




Day12: SCHOOL

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NEGATIVE COGNITIONDAY 1 2 3 4 5 6 7 8 9 10 11 12

Overgeneralization

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All-or-Nothing Thinking

X X X X X X

Should Statements X X X X X XLabeling X X X X X XMind Reading X X X X X XFortune Telling X X X X X X


Day 1: ORIENTATION


Day3: Our client did not display any manifestation under negative cognition. And he didn’t

possess negative cognition skills.

Day4: He did not possess any negative cognition skill.

Day5: Our client did not display any manifestation under negative cognition skills.

Day6: HOLIDAY

Day7: No manifestations seen on the client.

Day8: No manifestations seen on the client.

Day9: SCHOOL

Day10: HOLIDAY

Day11: Our client did not display any manifestation under negative cognition. And he didn’t

possess negative cognition skills.

Day12: SCHOOL

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- MANIFESTED X - NOT MANIFESTEDOTHERS

DAY 1 2 3 4 5 6 7 8 9 10 11 12Amnesia

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Fugue X X X X X XDepersonalization X X X X X XPhobias X X X X X XMemory

1. Remote 2. Recent 3. Recent part 4. Immediate

memory

5. Immediate recall


Day 1: ORIENTATION


Day3: Mr. A.M. did not manifest amnesia, fugue, depersonalization, phobias and other

memory problem.


memory problem.


memory problem.

Day6: HOLIDAY

Day7: The client’s memory is good and he did not manifest fugue, depersonalization,

amnesia and phobia.

Day8: The client’s memory is good and he did not manifest fugue, depersonalization,

amnesia and phobia.

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- MANIFESTED X - NOT MANIFESTEDDay9: SCHOOL

Day10: HOLIDAY


memory problem.

Day12: SCHOOL

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UNIT III

A) PSYCHOPATHOPHYSIOLOGY

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Alcoholism and Drug abuse(Long term used caused

addiction)

Disorganized thoughts and confusion

Paranoia

Violence

Marked social isolation

Altered mental and physical functioning

Delusions persecutionsAuditory hallucinations

SUBSTANCE ABUSE

(Theory of Drug Abuse)

(Disease Theory of Alcoholism)

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The theory of drug abuse views that drug is use as part of the individual’s attempt to

deal with needs and conflicts, relations with others, and the social environment in which he

or she lives. Since all of these vary with age and stage of life, one would expect drugs to be

used and abused for different purposes at different points in the life cycle.

In relation with the client’s past life experiences, he used and became addicted to

marijuana for so many years that led him to have disturbed thoughts and confusions.

The modern disease theory of alcoholism states that problem drinking is sometimes

caused by a disease of the brain, characterized by altered brain structure and function.

Alcoholism is a chronic, life-long disease, such as diabetes. However, if managed properly,

damage to the brain can be stopped and to some extent reversed. In addition to problem

drinking, the disease is characterized by symptoms including an impaired control over

alcohol, compulsive thoughts about alcohol, and distorted thinking.

The client was alcoholic since he was only 21 years old up to the time before he was

admitted to MMH. Too much consumption of alcohol may affect one’s thinking processes.

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http://en.wikipedia.org/wiki/Distorted_thinking

http://en.wikipedia.org/wiki/Brain_damage

http://en.wikipedia.org/wiki/Diabetes

http://en.wikipedia.org/wiki/Chronic_(medical)

http://en.wikipedia.org/wiki/Alcoholism

http://en.wikipedia.org/wiki/Neurological_disorder

Sadness

Stressed

Problem with concentration

Feeling of Inadequacy Maladaptive and disruptive behavior

Decrease self- esteem

Altered use of coping mechanism

Rejection/ Tension/ Frustration

Traumatic Life Experiences(Stressful work situation/

failed relationship)

Violent behavior

Hopelessness Worthlessness

Stressful Life Situations

(Maslow’s hierarchy of Needs)

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Highly stressful situations - may trigger schizoaffective disorder especially in those

people who have inherited a tendency to develop the disorder. Lack of loving and nurturing

care, one of many other factors, is thought to be responsible for mental problems in later life.

Maslow's hierarchy of needs- After physiological and safety needs are fulfilled, the third

layer of human needs are social and involve feelings of belongingness. This aspect of

Maslow's hierarchy involves emotionally based relationships in general, such as:

Friendship

Intimacy

Family

Love and belonging; Humans need to feel a sense of belonging and acceptance, whether

it comes from a large social group, such as clubs, office culture, religious groups,

professional organizations, sports teams, gangs, or small social connections (family

members, intimate partners, mentors, close colleagues, confidants). People need to love

and be loved (sexually and non-sexually) by others. In the absence of these elements, many

people become susceptible to loneliness, social anxiety, and clinical depression.

Adaptation Theory

Interdependence Mode: The close relationships of people and their purpose, structure

and development individually and in groups and the adaptation potential of these groups.

This is the Mode of Adaptation, Mang A. failed to undergone. He was not able to adapt on

those highly stressful situations which caused his mental disorder.

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http://en.wikipedia.org/wiki/Clinical_depression

http://en.wikipedia.org/wiki/Social_anxiety

http://en.wikipedia.org/wiki/Belongingness

In relation with the client’s life, he had experienced stressful work situation (separation

from his family) and failure in love relationship. Failure of the client to adapt with those life

experiences, made a traumatic impact on him, which resulted Mr. A.M. to have a decrease

coping ability and low self esteem manifesting sadness, hopelessness, stressed, problem in

concentration and worthlessness.

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Lose ability to think/ perceive rationally

Delusions Hallucinations

Affects the brain processes

Lose control movement

Uncontrolled emotional response

Uncontrolled experience of pleasure and pain

Altered levels of dopamine and serotonin

Paranoia

Imbalance Neurotransmitter

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A Neurotransmitter imbalance—either too much or too little—of these

neurotransmitters is thought to generate psychiatric conditions such as anxiety, depression,

ADHD and other emotional disorders.

Dopamine. Regulation of dopamine plays a crucial role in our mental and physical

health. It moves into the frontal lobe and regulates the flow of information coming in from

other areas of the brain. A shortage or problem with the flow of dopamine can cause a

person to lose the ability to think rationally, demonstrated in schizophrenia. Also, an excess

of dopamine in the limbic system and not enough in the cortex may produce a suspicious

personality and possible paranoia.

Serotonin is key to our feelings of happiness and very important for our emotions

because it helps defend against both anxiety and depression. It has many different effects in

the human mind and body; it helps to regulate mood, sleep cycles, appetite, memory, and

some muscular functions. Deficiencies in serotonin availability have been linked to

depression, anxiety, irregular appetite, aggression and pain sensation. You may have a

shortage of serotonin if you have a sad depressed mood, anxiety, panic attacks, low energy,

migraines, sleeping problems, obsession or compulsions, feel tense and irritable, crave

sweets, and have a reduced interest in sex.

Our client with imbalances in the neurotransmitters dopamine and serotonin, has an

altered brain processes which lead him to have lose ability to think/perceive rationally

(delusions & hallucinations), uncontrolled experience of pleasure and pain, lose control

movement & uncontrolled emotional response (paranoia). Dopamine is responsible for his

thinking skills while serotonin is more on his moods/feelings. Either increase or decrease in

these neurotransmitters affect the client’s cognitive skills and emotional responses.

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Insufficient production of serotonin transporter protein(Gene necessary for production of serotonin)

Insufficient serotonin to help and modulate dopamine

Continuous increase in dopamine(excitatory)

Alteration in cognition, motivation, emotional response and complex movements

Genetic Factor

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It show the complex interactions that occur between mood disorder related genes

and their impact on mood disorder related brain circuitry. The study makes it clear that

individual genes have to be viewed in a context, both a genetic and an environmental

context.

Genetic Factor

Most genetic studies have focused on immediate families (i.e. parents, siblings,

offspring) to examine whether schizophrenia is genetically transmitted or inherited. Few

have focused on more distant relatives. The most important studies have centered on

twins; these findings have demonstrated that identical twins have a 50% risk for

schizophrenia; that is, if one twin has schizophrenia, the other has a 50% chance of

developing it as well. Fraternal twins have only a 15% risk (Kirkpatrick & Tek, 2005). This

finding indicates that schizophrenia is at least partially inherited.

Other important studies have shown that children with one biologic parent with

schizophrenia have a 15% risk; the risk rises to 35% if both biologic parents have

schizophrenia. Children adopted at birth into a family with no history of schizophrenia but

whose biologic parents have a history of schizophrenia still reflect the genetic risk of their

biologic parents. All these studies have indicated a genetic risk or tendency for

schizophrenia, but genetics cannot be the only factor: identical twins have only 50% risk

even though their genes are 100% identical (Riley & Kendler, 2005).

In relation with client’s family history, as claimed, his sibling and his uncle are also

having mental disorders. Beside of neurotransmitter imbalances, head trauma, stressful life

situations and substance abuse that are present with the client, studies show that genetics

is one of the major factors that may contribute in having paranoid schizophrenia.

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Personality changes Aggressive behaviorsPoor concentration

Part of the brain is affected

Neuropsychological problems

Leads to traumatic brain injury

Head Trauma

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Head trauma survivors may experience a range of neuropsychological problems

following a traumatic brain injury. Depending on the part of the brain affected and the

severity of the injury, the result on any one individual can vary greatly. Personality changes,

memory and judgement deficits, lack of impulse control, and poor concentration are all

common. Behavioral changes can be stressful for families and caregivers who must learn to

adapt their communication techniques, established relationships, and expectations of what

the impaired person can or cannot do. In some cases extended cognitive and behavioral

rehabilitation in a residential or outpatient setting will be necessary to regain certain skills. A

neuropsychologist also may be helpful in assessing cognitive deficits. However, over the

long term both the survivor and any involved family members will need to explore what

combination of strategies work best to improve the functional and behavioral skills of the

impaired individual.

Personality changes are often an exaggeration of the person's pre-injury personality

in which personality traits become intensified. Head trauma survivors may experience short-

term problems and/or amnesia related to certain periods of time. After a head trauma a

person may lack emotional responses such as smiling, laughing, crying, anger, or enthusiasm

or their responses may be inappropriate. This may be especially present during the earlier

stages of recovery. In some cases, neurological damage after a head trauma may cause

emotional volatility (intense mood swings or extreme reactions to everyday situations). Try

to change the person’s mood by agreeing with the person (if appropriate) and thus avoiding

an argument. Show extra affection and support to address underlying frustrations. The

person who has survived a head injury may lack empathy. That is, some head trauma

survivors have difficulty seeing things through someone else's eyes. The result can be

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thoughtless or hurtful remarks or unreasonable, demanding requests. This behavior stems

from a lack of abstract thinking. Head trauma survivors should be encouraged to develop

self-checks. Lack of awareness deficits is relatively common for a head injury survivor to be

unaware of his/her deficits. Remember that this is a part of the neurological damage and

not just obstinacies. After a head trauma, a person may experience either increased or

decreased interest in sex. The causes could be a result of brain regulation of hormonal

activity or an emotional response to the trauma.

In relation with the client, after being figured in a mining accident, part of his brain

was affected & had a traumatic brain injury which made him show the following

neuropsychological problems: poor concentration, personality changes and aggressive

behaviors.

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UNIT III

B) RELATED LITERATURE

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According to Healthy Place (2007), in the paranoid form of this disorder, the sufferer

develops delusions of persecution or personal grandeur. The first signs of paranoid

schizophrenia usually surface between the ages of 15 and 34. There is no cure, but the

paranoid schizophrenia can be controlled with antipsychotic medications. Severe attacks

may require hospitalization. The essential feature of Paranoid Schizophrenia is

preoccupation with one or more systematized delusions or with frequent auditory

hallucinations related to a single theme. In addition, symptoms characteristic of the

Disorganized and Catatonic Types such as incoherence, flat or grossly inappropriate affect,

catatonic behavior, or grossly disorganized behavior, are absent. When all exacerbations of

the disorder meet the criteria for Paranoid Type, the clinician should specify "Stable Type".

Associated features of Paranoid Schizophrenia include unfocussed anxiety, anger,

argumentativeness, and violence. Often a stilted, formal quality or extreme intensity in

interpersonal interaction is noted. The impairment in functioning in Paranoid Schizophrenia

may be minimal if the delusional material is not acted upon. Onset tends to be later in life

than the other types, and the distinguishing characteristics may be more stable over time.

Some evidence suggests that the prognosis for the Paranoid Type, particularly with regard

to occupational functioning and capacity for independent living, may be considerably better

than for other types of schizophrenia.

The abovementioned study provided the information about the paranoid

schizophrenia and its manifestation regarding about the mental illness itself. It also gives us

information about essential feature that one person my experience if he/ she is candidate in

having this kind of mental illness.

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http://www.healthyplace.com/thought-disorders/articles/beautiful-but-not-rare-recovery/menu-id-64/

http://www.healthyplace.com/thought-disorders/schizophrenia-treatment/atypical-antipsychotic-medications-for-treatment-of-schizophrenia/menu-id-1144/

http://www.healthyplace.com/thought-disorders/main/paranoid-schizophrenia/menu-id-64/#signs

http://www.healthyplace.com/thought-disorders/main/paranoid-schizophrenia/menu-id-64/#signs

We highly agree on what Healthy Place mentioned or written about paranoid

schizophrenia that the range of age or the onset of this mental illness is 15 - 34 years old,

because our client manifest or the manifestation of mental illness is between the ages given

by the writers.

Since our client manifest the same manifestation written above, there is no reason

to disagree the literature given by the Healthy Place.

As a student nurse the greatest implication of this information, is that we can expand

our knowledge about the situation of our client, it can also help us in assessing the client

about the sign and symptoms of the mental illness.

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Moreover, Thomas Hodge (2010) said that, paranoid schizophrenics tend to show a

history of increasing suspicions and a severe difficulty with interpersonal relationships.

Eventually, their thoughts are overwhelmed by absurd and illogical ideas and beliefs. These

illogical ideas are not simplistic in nature. Due the workings of the schizophrenic mind,

these conceptions are often highly elaborate in nature. The fears and irrational beliefs

contain more depth than the most elaborate suspense novel. They are highly organized with

depth, twists, and turns that develop a complex framework. Usually the schizophrenic is

being persecuted, chased, or in danger in this delusions. When a writer develops a fictional

story, he knows it is just a story. The schizophrenic does not know that his work of fiction is

fiction. He believes it. Delusions of grandeur are also common. Some may claim to be a

princess or a king or some great person. They usually invent imaginary characters in their

stories which they will carry on conversations with. With paranoid schizophrenics, an

amazing fact exists. Quite often, they are well put together. In their delusions, they are

being persecuted usually which will cause them to go to great lengths to hide their

delusions. Sometimes this makes them seem quite normal. The good news for a paranoid

schizophrenic is that treatments are always improving. Some schizophrenics have actually

accomplished quite a bit once they realized their condition. Some have actually managed to

control their delusions by sheer will.

The study mentioned on the writings of Thomas Hodge is that the ability to think in

this kind of mental illness is more negative point of view, also those people who suffer in

this kind of mental illness has more suspicious and has weak interpersonal relationship to

others. He also added that paranoid schizophrenia and its treatment are always improving.

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We agree in the part that the treatment for paranoid schizophrenia is still improving

although the illness itself has no cure. We also agree in part of writings that those client

suffer in this condition don’t know what is the difference between the reality and fantasy.

The greatest implication of the writing of Thomas Hodge in nursing profession is that

there is still a palliative treatment even though the hard fact is there is no treatment. It can

also give us information that this kind of mental illness, they have weak interpersonal

relationship to others and they are often suffering in delusions.

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According to P Jones et.al. (2010), although a genetic component in schizophrenia is

well established, it is likely that the contribution of genetic factors is not constant for all

cases. Several recent studies have found that the relatives of female or early onset

schizophrenic patients have an increased risk of schizophrenia, compared to relatives of

male or late onset cases. These hypotheses are tested in the current study.

The study mentioned above states that the genetic factor or through genes it can

transfer the paranoid schizophrenia and the other types of schizophrenia. That if there is

one of the family has schizophrenia more or less the other family members has a tendency

to have the same mental illness.

We agree on what P. Jones and her colleagues written because according to client

her uncle and his younger brother have the same mental illness he suffered. Therefore we

concluded that in runs through the blood of there family in having schizophrenia.

One its greatest implication on nursing profession is that through genes the mental

illness like schizophrenia can transfer. With the proper study it can help the nursing

profession to understand how the genetic factor of one person can transfer the mental

illness to other family members

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Mayo Clinic staffs (2010) also mentioned that with paranoid schizophrenia, your

ability to think and function in daily life may be better than with other types of

schizophrenia. You may not have as many problems with memory, concentration or dulled

emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many

complications, including suicidal behavior. But with effective treatment, you can manage the

symptoms of paranoid schizophrenia and work toward leading a happier, healthier life.

The study abovementioned by Mayo Clinic Staffs states that without proper

treatment the paranoid schizophrenia will lead to more serious complication like attempting

to have suicide. It also stated that having this kind of mental illness your ability to thing is

slower and you will suffer in poor concentration to many things.

We agreed on what Mayo Clinic Staffs said about, that of all kinds of schizophrenia,

the paranoid is the most manageable one. They also stated the same symptoms manifested

by the client like having hallucinations and an attempt on suicide. With proper and effective

treatment, paranoid schizophrenic patients still have the great chance to have a normal life

they had before.

The implication of this writings to the nursing profession and to student nurses it can

help us to understand that those client suffer in this kind of condition is that they have poor

coping mechanism. It can also help us in terms of giving more attention and time in helping

the client to cope to external environment.

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Furthermore, Nursing Crib (2008)they identify the symptoms of schizophrenia 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.

The studies gathered above provided information to increment the knowledge of the

readers about schizophrenia and its basic concept about the mental illness itself. This

research abovementioned tells the vital role of knowing the manifestations and treatment

that may use in client suffering this kind of condition.

We highly agree that there is two major categories that schizophrenic client may

experience because our client also suffer in the same kind of categories given. It also makes

us convince that this article is agreeable because the medication taking by our client only

treat the positive or hard symptoms.

The implication of this article to nursing profession is that we can understand what

are the classifications of schizophrenia and what are manifestation they shown. It also gives

information about the effect of medication and how it helps the schizophrenic client.

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SOURCES:

HealthyPlace.com Staff Writer. Paranoid Schizophrenia. http://www.healthyplace.com/thought-disorders/main/paranoid-schizophrenia/menu-id-1147/. March 28, 2007.

Thomas Hodge. Socy Berty. Paranoid Schizophrenia.

http://socyberty.com/psychology/paranoid-schizophrenia/. November 20, 2010.

Peter Jones (et.al.). Schizophrenia related to good health. Irish Health Magazines.

November 29, 20010

Mayo Clinic. Paranoid Schizophrenia. November 28, 2010

Nursingcrib.com. Studies about Schizophrenia. September 11, 2008.

http://nursingcrib.com/studies_about_shizophrenia

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http://nursingcrib.com/studies_about_shizophrenia

http://socyberty.com/psychology/paranoid-schizophrenia/

UNIT IV

A) NURSING CARE PLAN

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ORIENTATION PHASE DAY 3NOVEMBER 10, 20102:00 P.M. – 4:00 P.M.MMW TENNIS COURT

I. OBJECTIVES:

a. Client-Centered Objective:

Setting the contract and discussing it thoroughly.

Obtain personal data.

Obtain some history from the past.

b. Nurse-Centered Objective:

Introduced ourselves to the patient.

Establish rapport

Remember and interpret verbal and non-verbal cues correctly.

II. DESCRIPTION OF SETTING

a. Describe the environment:

It was a cloudy afternoon, the sun does not shining directly and the wind

blows softly when we received Mr. A.M. from the male ward B, under the

supervision of our Clinical Instructor, Mrs. Nemia Calimbas. First, we assisted the

client in grooming his self. Afterwards, we walked with him and went to the tennis

court. There we prepared our chairs approximately 3-4 feet away in front away from

him. We started the conversation by greeting Mr. A.M. a pleasant afternoon and

introducing ourselves. We discussed the contract to him thoroughly, that he showed

interest on the days we will be together. The client started to give information when

we asked him about his personal data. As the conversation continues, we felt that

Mr. A.M. was comfortable talking to us. And as a positive result, we didn’t find it

hard having a good conversation with our client.

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b. Describe the nature, behavior, affect and mood of the client.

Mr. A.M. walking towards to us from his ward looks at ease, quiet and slightly

serious. He smiled and nodded on us when he was introduced to us by Mrs.

Calimbas. When we went to the grooming area, he saw other clients playing

chess. He said that he wanted to play chess, too.

The client fixed himself a very few assistance from us. He showed

independence on grooming his self.

While we are walking on our way to the tennis court, we noticed that our

client is relaxed and calmed. Our conversation started with him listening

attentively. Mr. A.M. answered our questions appropriately. He also displayed

the right affect on the situations we’d talked about.

The client showed trust on us by sharing a lot of essential information

regarding his past and his experiences before he was admitted. The conversation

flows smooth and substantial because Mr. A.M. talked with us freely. He trusted

us so then, he’s comfortable in sharing his story.

Mr. A.M. said that he only shared those issues of his life only to us, he didn’t

told those stories to the student nurses of the morning shift.

All throughout the time that he’s with us, we felt like Mr. A.M. had already

recovered from his disorder and it looked like we are talking to an individual with

good mental status.

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III. PROCESS RECORDING

Nurse-Client Conversation Therapeutic Communication Technique Used

Analysis and Interpretation based on Theories

SN: Magandang hapon po Mang A.M.

C: Magandang hapon din.

(while walking on the way to the tennis court)

SN: Mang A.M. ako po si Riza at siya naman po si Joey, kami po ang mga student nurses niyo ngayong hapon. Galling po kami sa BPSU, Bataan Peninsuala State University po, sa Balanga. Isang buwan po tayong magkakasama, mula lunes po hanggang miyerkules. Ngaung lingo po tsaka sa susunod na lingo, twing hapon po tayo magkikita, bandang alas doa po ng hapon hanggang alas kwatro po. Pero sa susunod pang dalawang lingo, pag umaga na po tayo, mga alas-9 po ng umaga hanggang alas-11 po. Malinaw po ba?

C: Ah, nagyong linggo saka sa susunod na linggo pang-hapon tayo, tas sa susunod pang 2 linggong session natin umaga na?

SN: Opo Mang A.M. Ganun na nga po.

C: Kanina kasama ko yung Nickson, kilala nyu sya?

GIVING RECOGNITION

GIVING INFORMATION

Greeting the client shows that the nurse recognizes the client as a person, as an individual and at the same time, the student nurses were able to give respect to the client.

Includes giving the client right information on the things needed during the interaction therapy. It helps in establishing a trusting relationship with the client. Information given by the student nurses also sets the contract of the whole nurse-patient interaction. By this means, the client was able to understand when and where the interactions will happen.

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SN: Opo, magka-batch po kami sa BPSU.

(at the tennis court)

SN: Mang A.M., andito po kami para makipagkwentuhan sainyo, para po makausap niyo.

C: Oo nga eh, naiinip ako, lagi lang akong natutulog sa ward.

SN: Maari po ba naming malaman ang inyong pangalan?

C: Ako si Mang A.M.

SN: Ilang taon na po kayo?

C: 41 na ako. Apat na taon na ko dito.

SN: Ganun po ba? San po ba kayo nakatira bago po kayo mapunta dito?

C: Taga Capaz, Tarlac ako pero laki ako sa Benguet.

SN: Alam niyo pub a kung saan kayo ipinanganak?

OFFERING SELF

ACCEPTING

It implies that the nurse offers presence, interest, and desire to understand. The client feels more comfortable having a conversation on a nurse who shows interest on what he/she’s saying. Offering self to the client also facilitates collaboration in performing tasks.

An accepting response indicates the nurse has heard, understood and is willing to listen on what the client wants to share. It makes conversation effective and meaningful. The student nurse was able to make Mr. A.M. to verbalize other information needed to understand his condition.

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C: Oo. Sa Isabela.

SN: OH kelan naman po ang birthday nyo?

C: Ah, January 21, 1969

SN: Mang A.M. ano po ba ang relihiyin ninyo?

C: Roman Catholic, pero dapat Jehovah’s Witnesses na ako. Hindi lang ako nabaptize kasi nga dinala ako dito.

SN: ah, katoliko po kayo dati tapos po lilipat dapat kayo sa saksi ni Jehovah, ganun po ba? Tama po ba ang intindi ko?

C: Oo, ganun na nga, kaso hindi ako natuloy.

SN: Naaalala niyo pub a kung nasaan kayo nung 1995?

C: 1995? Hindi na gaano. Nasa benguet pa ata ako noon. Oo nasa Benguet pa nga ako.

SN: Nasa Benguet po kayu nung 1995?

C: Oo.

CONSENSUAL VALIDATION

CLARIFYING

For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both participants. Validating what was heard and understood must be clear for both student nurses and the client. Such, is to make the conversation meaningful, and to avoid misunderstandings or wrong information taken. At this way, the client was able to validate or not the information understood by the student nurses.

Helps the client clarify their own thoughts and maximizes mutual understanding between the nurse and the client.

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SN: Sino naman po ang kasama niyo doon?

C: Eh di pamilya ko. Sila Tatay at Nanay, saka dalawa kung kapatid. May nobya nga ako noon eh.

SN: Ano pong pangalan ng tatay at nanay niyo?

C: Tatay ko si RM, tas nanay ko si LM.

SN: eh ung mga kapatid niyo po?

C: Si Gm ung sumunod sakin tas si SM ung bunso.

SN: ah, ilan taon nap o sila?

C: si GM 37 na siguro yon, tas si SM 21 na.

SN: bale po apat na taon ang tanda ninyo ka GM?

C: Oo.

ASKING DIRECT QUESTIONS


Asking direct questions to the client will merely assess the client’s capability to think, rationalize, and give answers to a specific question. It also helps getting important information specific to support student nurses ‘assessment. The client responded with answers specific and appropriate with the question asked to him.

For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both participants. Validating what was heard and understood must be clear for both student nurses and the client. Such is to make the conversation meaningful, and to avoid misunderstandings or wrong information taken. At this way, the client was able to validate or not the information understood by the student nurses.

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SN: Ano po bang natapos niyo?

C: 3rd year high school lang eh. NAgtrabaho kasi ako agad. Nainggit ako sa kanilang nagtatrabaho.

SN: Sa anong dahilan po at naiinggit kayo?

C: Tinatamad na akong mag-aral eh. Tsaka para makatulong nadin siguro.

SN: Ano po ba ang trabaho ninyo?

C: Helper ako noon sa Philex Mine, Utility Man kasi doon ang tatay ko.

SN: Ah ok po. Kailan po kayo nalipat sa Tarlac?

C: 35 yata ako noon, dalawang taon po kami doon bago ko nadala dito.


EXPLORING

Asking direct questions to the client will merely assess the client’s capability to think, rationalize, and give answers to a specific question. The client responded with answers specific and appropriate with the question asked to him. It also helps getting important information specific to support student nurses ‘assessment.

Exploring can help them to examine the topic more fully. Any problem or concern can be better understood if explored in depth. The student nurse was able to seek for the client’s real reason in doing such thing by asking him deeply.

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SN: Kung 35 na po kayo noon, 2004 na po noon, ganun po ba?

C: Oo, gusto ko ng umuwi. Naiinip na ko dito. Matutulungan niyo ba ko?

SN: Sa ano pong dahilan bakit gusto niyo ng umuwi?

C: Gusto ko nang Makita nag nobya ko. Namimiss ko na siya!

SN: Nais niyo na pong makauwi para makasama niyo na ang nobya niyo?


EXPLORING

VERBALIZING THE IMPLIED

For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both participants. Validating what was heard and understood must be clear for both student nurses and the client. Such is to make the conversation meaningful, and to avoid misunderstandings or wrong information taken. At this way, the client was able to validate or not the information understood by the student nurses.

Exploring can help them to examine the topic more fully. Any problem or concern can be better understood if explored in depth. The student nurse was able to seek for the client’s real reason in doing such thing by asking him deeply.

Putting into words what the client has implied or said indirectly tends to make the discussion less obscure. The nurse should be as direct as possible without being unfeelingly blunt or obtuse. The client may have difficulty in communicating directly. Verbalizing the implied makes the conversation clearer and easier for the client to understand the thoughts he’s talking about.

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C: Oo, matagal na kasi kaming hindi nagkikita.

SN: Kailan po kayo huling nagkita?

C: Matagal na eh. Hindi nga ako nakapagpaalam sakanya bago ako lumipat ng Tarlac eh.

SN: Ah ganun po ba? Ang tagal na nga pu pala. Kamusta naman po ang huli ninyong pagkikita?Mailalarawan niyo po ba?

(silence for about 3minutes)

C: Ayos naman kami nun. May karibal nga ako sakanya eh. Pero mahal na mahal ko siya kaya malaki tiwala ko sakanya, saka alm kong ako din ang mahal niya.

ENCOURAGING A DESCRIPTION OF PERCEPTIONS

SILENCE

To understand the client, the nurse must see things from his or her perspectives. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and he or she might be less likely to take actions on ideas that are harmful or frightening. This also provided the way Mr. A.M. views that certain situation in his life.

Silence often encourages the client to verbalize, provided that it is interested and expectant. Silence gives the client time to organize thoughts, direct the topic of interaction, or focus on issues that are most important.

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SN: Sige po tuloy niyo pa po.

C: dati nga nagpupunta ako sakanila, nagkakasabay pa kami nung karibal ko.

SN: Anu pung naramdaman niyo nung nagkita kayo?

C: Uhhhm. Wala naman, kasi tiwala naman ako sa nobya ko. Ako naman ang mahal niya.

SN: Gaano na pu ba kayo katagal?

C: Simula nung 3rd year high school ako, Kame na.

SN: hanggang ngaun po?

C: Oo kami pa din.

SN: Mang A.M. alam niyo pu ba kung nasaan kayo?

C: Oo. Sa Mariveles Mental Ward

OFFERING GENERAL LEADS

GIVING BROAD OPENINGS

General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. By this way, the client felt freely to continue sharing his story with the student nurses without hesitancy.

Broad openings make explicit that the client has the lead in the interaction. For the client who is hesitant about talking, broad openings stimulate him or her to take the initiative. By this way, Mr. A.M. was able to express himself freely and within the basis of his own thinking.

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SN: Mariveles Mental Hospital na po ito ngayon. Alam niyo pu ba kung para saan ang lugar na ito?

C: Oo, para sa may mga diperensya sa pag-iisip.

SN: Ah, mabuti naman po pala at naiintindihan ninyo. Sa tingin niyo po ba nu ang dahilan at nadala kayo dito?

C: Binaklas ko kasi ung rice cooker at radio ng kapitbahay naming kaya nadala ko dito.

SN: Binaklas po ninyo ang rice cooker at radio ng kapitbahay ninyo?Sa anung dahilan pu kaya Mang A.M.?

C: Addict kasi ako nun eh. Nung nasa labas ako gumagamit ako ng Marijuana.

SN: Natuto po kayong mag-Marijuana? Sa tingin niyo pu ba mubuti ito?

REFLECTING

EXPLORING

REFLECTING

Reflections encourage the client to recognize and accept his or her own feelings. The nurse indicates that the client’s point of view has value, and that the client has the right to have options, make decisions and think independently. It also helped the client to distinguish right from wrong.

Exploring can help them to examine the topic more fully. Any problem or concern can be better understood if explored in depth.


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C: Hindi, kasi sa barkada eh, Peer Pressure ba.

SN: Ano po ang pakiramdam ng gumagamit noon? Makilarawan nga po.

C: Heaven. Para kong lutang.

SN: Alam po ba ito ng nobya niyo?

C: Oo. Ka-jamming ko pa nga kuya niya eh.

SN: Kasama niyo po sa paggamit ng Marijuana ang kuya niya?

Ano po ang reaksyon nya dito?

C: Oo, ayun nalungkot siya para sa akin.

ENCOURAGING A DESCRIPTION

ASKING DIRECT QUESTION

CLARIFYING

FOCUSING

To understand the client, the nurse must see things from his or her perspectives. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and he or she might be less likely to take actions on ideas that are harmful or frightening. This also provided the way Mr. A.M. views that certain situation in his life.

Asking direct questions to the client will merely assess the client’s capability to think, rationalize, and give answers to a specific question.


The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It also a useful technique in avoiding flight of ideas of the client.

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SN: Hindi pu ba kayo nalungkot nung nalaman niyong nalungkot siya para sa inyo?

C: Nalungkot din, pero wala na akong magawa kasi adik na ako noon, tsaka tanggap niya parin ako.

SN: Alam po ba niyang nandirito kayo?

C: Hindi.

SN: Ano na po kaya kayo paglabas niyo dito?

C: magpapakasal kami. Magbabago na talaga ko. Mahal na mahal ko siya.

SN: Kumbaga po Mang A.M. siya lang po ang naging nobya nito simula nung high school palang kayo at kayo padin bago kayo ma-admit dito? Tama po ba ang pagkakaintindi ko?

C: Oo. Ganun na nga kaya gusto ko na makauwe.

SN: Eh paano sila Nanay at aTatay nito? Ung pamilya mo?

C: Nobya ko muna. Si tatay ko kasi nagkaroon ng sama ng loob sa akin.

SN: May sama po sya ng loob sa inyo? Sa anu pong dahilan?

REFLECTING


SEEKING VALIDATIONS

EXPLORING

Reflections encourage the client to recognize and accept his or her own feelings. The nurse indicates that the client’s point of view has value, and that the client has the right to have options, make decisions and think independently. . It also helped the client to distinguish right from wrong.

Broad openings make explicit that the client has the lead in the interaction. For the client who is hesitant about talking, broad openings stimulate him or her to take the initiative.

For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both participants. Sometimes words, phrases, or slang terms have different meanings and can be easily misunderstood. At this way, the client was able to validate or not the information understood by the student nurses.


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C: Nasaksak ko kasi siya ng pako noon.

SN: Nasaksak niyo po ang tatay nio? Sa anu pong dahilan at nagawa ninyo ito?

C: Eh high ako noon, nadaplisan ko lang siya sa tagiliran.

SN: Kailan po nangyari ito?

C: Hindi ko na matandaan eh.

SN: Anu pong nauna, nag pagsaksak nyo sa tatay niyo o ang pag-baklas niyo ng rice cooker?

C: ah, nauna ung kay tatay, mga dalawang taon siguro nung nagawa ko ung kay tatay.

SN: Ah ganon po ba. Ilan taon po ba kayo nung na-admit kayo dito?

C: September 18, 2006 yun e, 37 na ako noon, apat na taon na kasi dito.

SN: So Mang A.M. 37 na po kayo nung nadala ditto dahil sa pagbaklas niyo ng rice cooker at radio?

C: Oo.

SN: Tapos 35 na po kayo nung nasaksak niyo ang tatay nyo, tama po ba ang pagkaintindi ko?

ENCOURAGE TO PLACE EVENTS IN TIME OR SEQUENCE

CLARIFYING

SEEKING VALIDATION

Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and –effect behavior and consequences, or the client may be able to see that perhaps something are not related. The nurse may gain information about recurrent patterns or themes in the client’s behavior or relationship.


For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both participants. Sometimes words, phrases,

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C: Oo ganun na nga. Ang tagal niay na nga akung di nadadalaw eh.

SN: Kelan po ang huli?

C: Noong July 4 last year.

SN: Ano po ang nasabi na sainyo? Maaari po bang malaman?

C: ayon sabi nya dito muna ko. Magpagaling daw ako. Susunduin daw niya ko agad paggaling ko.

SN: Sige po tuloy niyo pa po.

C: Nagconduction na nga ako nung July lang. July 29, sabi sakin ng diktor ok na daw ako. Maghintay nalang daw ako.

SN: Ang tagal na po pala kayong hindi nadadalaw.

C: Oo nga eh. Mahigit isang taon na.

SN: Nagtatampo po ba kayo sakanila kasi hindi nila kayo napupuntahan?

C: hindi naman, baka nag-iipon pa ng pamasahe. Sa December, sa pasko baka mapuntahan na niya ko.

BROAD OPENINGS


REFLECTING

or slang terms have different meanings and can be easily misunderstood. At this way, the client was able to validate or not the information understood by the student nurses.


General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic.


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SN: Mabuti naman pu pala kung ganon.

C: Kaya nga gusto ko na umuwe para magkasama na kame ng nobya ko saka nila tatay at nanay pati mga kapatid ko.

SN: Darating din po yung panahon na iyon. Basta po magpagaling kayo ditto sabi nga ng tatay niyo. Mang A.M. magmimiryenda na po kayo. Ako po ulit si Riza at sya po si Joey. Wag niu po kami kakalimutan hah?

C: Oo. Salamat Riza at Joey.

(after group dynamics)

SN: Oh Mang A.M. nabusog po ba kayo? Masarap po ba?

C: Oo salamat.

SN: Naaalala niu pu ba pinag-usapan natin kanina?

C: Oo yung buhay ko.

SN: Buti naman po at naaalala niyo pa. Yaan niyo po sa atin lang tatlo yun. Hindi malalaman ng iba.

C: Sige salamat. Sa inyo ko lang sinabi iyon. Kala Nickson hindi.

SUMMARIZINGSummarizing seeks to bring out the important points of the discussion and to increase the awareness and understanding of both participants. It omits the irrelevant and organizes the pertinent aspects of the interaction. It allows both client and the nurse to depart with the same ideas and provides a sense of closure at a completion of each discussion.

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SN: Salamat po sa tiwala ninyo. Sa lunes na po tayo magkikita. Ganitong oras parin po.

C: Sige hintayin ko kayo. Salamat. Ingat.

SN: Opo salamat din. Kayo din po.

ACCEPTING An accepting response indicates the nurse has heard, understood and is willing to listen on what the client’s want to share. It makes conversation effective and meaningful. The student nurse was able to make Mr. A.M. to verbalize other information needed to understand his condition.

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IV. THEME IDENTIFICATION

Content Theme

The conversation took for more than 1hour. Much information are shared by

Mr. A.M. . But we noticed that our client’s focus was on his first girlfriend. He stated

that he wanted to go home to see her girlfriend before his family. Mr. A.M. also told

us that he wanted to marry his girlfriend. As each issue opens the client always

included his girlfriend. He loves her so much, up to the point that the woman was

always on his mind until now.

Interaction Theme

Mr. A.M. answered our questions appropriately. He also displayed correct

affect on what we are talking about. The client knows and remembered his life

before he was admitted. Mr. A.M. also knew the exact dates when the important

events of his life occurred. He talked about lots of stories and experiences he had

before. So our first conversation with him came out very substantial.

Mood Theme

The client appeared calmed and smiling when we received him from the

ward. When our conversation started, he showed interest and cooperation on us.

Mr. A.M. answered our questions appropriately. He also showed direct eye contact.

The client shared his stories on us freely. We felt that he’s comfortable with us while

he’s sharing important issues in his life.

V. NURSING DIAGNOSIS

Risk for Loneliness r/t separation from loved ones and boredom as evidenced

by verbalization of feelings and dull affect

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VI. NURSING INTERVENTION

Establish rapport to the client to gain trust and cooperation. Offer one self.

Orient to future activity. And maintain eye contact when talking to client to show

sincerity and interest.

VII. SUMMARY AND EVALUATION

Our conversation with Mr. A.M. was taken at the tennis court. It took for

more or less than 1 hour. The client showed interest and cooperation on us. So we

have discussed the contract thoroughly and obtain personal data and some past

history. We also introduced ourselves to him and established rapport easily. He’s

also appropriate in his affect and answered our questions directly. Mr. A.M. shared

stories about addiction, his love for his girlfriend and the issue that he picked his

father with a nail. The client remembered all the things that he’d talked about with

us. Mr. A.M. showed trust on us and made our conversation useful.

VIII. REFERENCE

Psychiatric mental health nursing. 3rd edition. Shiela L. Videbeck. Lippincott Williams

and Wilkins

Nurse’s Pocket Guide.10th edition. Doenges, Moorhouse and Murr

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WORKING PHASE DAY 4COMIC READING AND PHOTO LANGUAGE THERAPY

NOVEMBER 15, 20102:00 P.M. – 4:00 P.M.MMW TENNIS COURT

I. OBJECTIVES:


Continue/improve the rapport that has been established on the first day

of our interaction.

Enhance cognitive skills by encouraging the client to participate actively in

the therapeutic activities.

Help the client to express his self through the therapies that will be done.


Provide appropriate mental health care and utilize various therapeutic

communications techniques

Implement plan of actions (therapies) that will help the client in achieving

mental health.

Interpret client’s communication cues and make appropriate nursing

diagnosis.

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The weather that afternoon was cloudy and the wind blew softly, when we

received Mr. A.M. from the male ward B. Afterwards we went to the tennis court in

where we will be doing the comic reading and photo language therapy. Before

proceeding to the planned activities we had first a short conversation with the client.

We asked him if he still remember us, and how he’s doing. The client luckily

remembered us and answered the questions appropriately.


Mr. A.M. smiled, showed happiness and excitement upon seeing us. He

doesn’t wait instruction from us that he must groomed first. The client showed

initiative in performing personal hygiene. When we started talking to him, we

felt like he’s more comfortable with us now. Mr. A.M. doesn’t hesitate

answering our questions directly. His behavior is also good, without showing any

violence or manifestations of having mental disorder.

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SN: Magandang hapon po Mang A.M.

C: Magandang hapon din.SN: Naaalala nyo pa po ba kami?

C:Oo.ikaw si Riza,tas si Joey.

SN: Opo.Kamusta na po kayo?

C: Ayos naman ganun pa din.SN: Tara po Mang AM. maghilamos na po kayo.

(after grooming, at the tennis court)

SN: Mang AM. Meron po tayong mga activities na gagawin ngayon comic reading pos tsaka photo language magbabasa po kayo ng komiks.Alam niyo po ba kung ano ang komiks?

C: Oo, dati binabasa ko yung hiwaga.

SN: Ah ganun po ba?

pagkatapos po sa comic reading, mamimili po kayo ng larawan. Ipapaliwanag iyon ng facilitator mamaya.Naiintindahan niyo po ba?

C: Oo.

ACCEPTING

GIVING INFORMATION

CLARIFYING

Indicates that the nurse has heard, understood and is willing to listen on what the client’s want to share. It makes conversation effective and meaningful.

It is stated in Kings theory of goal attainment (1960), that if a nurse with special knowledge and skill to communicate the appropriate information to the client, mutual goal setting and goal attainment will occur.

Verifying your impressions may help the client become more aware of their feelings.

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(COMIC READING THERAPY)

SN: Mang AM. eto po yung komiks na babasahin nyo. Makakaya nyo po bang mag-isa?kung hindi po matutulungan namin kayo.

C: Nababasa ko ng malinaw.

(AFTER READING)

SN: O Mang AM, ano po ang pamagat ng komiks?

C: Yung Gilmer.

SN: Ah, yung Gigimik ba si Gilmer po?

C: Oo yun.

SN: Ano po ba ang naaalala nyo sa kwento?

C: Si Gilmer nag-aaral sa Maynila. Tapos inaaya syang lumbas ng mga kaibigan niya. Buti nakininig sya sa mga magulang niya.

SN: Ah opo. Ano po bang natutunan ninyo sa inyong nabasa?

C: Ah wala namang masamang makipagkaibigan basta tama ang ginagawa.

SN:Uhm. Ano pa po?

C: Ah dapat sundin ang mga payo ng magulang.

SN: Meron pa po ba?

C: Sakin dapat alam ang

SUGGESTING COLLABORATION

EXPLORING


Emphasizes working with the client, not doing with the client. Encourages the view that change is possible through collaboration.

According to Abdellah, one step in identifying the client’s problem is to continue observing and evaluation the client to identify attitude and cues affecting his behavior.

General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is

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Tama sa Mali.

SN: Opo ganun na nga po. May parte po ban g kwento na nahahawig sa buhay nyo?

C: Oo.

SN: Alin po doon? Maikkwento nyo po ba?

C: Yun nga, dati kasi marami akong barkada. Natuto akong magbisyo Drugs, Marijuana.

SN: Sa tingin nyo po ba Tama iyon?

C: Mali.

SN: Sa paanong paraan po naging Mali?

C: Kasi dapat kahit na may barkada ka, wag sasama sa masama.

SN: Kayo po ba ay napasama?

C: Oo.

SN: Sa anong dahilan at sumama kayo sa kanila?

C: Eh kasi peer pressure na eh. Mahirap tanggihan.

SN: Ano po ba para sainyo ang peer pressure? Pakilarawan po!

C: Peer pressure. Yung yung kung ano ang gusto ng barkada mo gagawin mo din.


REFLECTING


hesitant or uncomfortable about the topic.


A client’s statement is redirected towards him through similar wording which makes him think about it again from another perspective.-Directs questions or feelings back to client so that they may be recognized and accepted.

To understand the client, the nurse must see things from his or her perspectives. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and he or she might

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SN: Ano po ang dahilan at gagawin nyo din?

C: Syempre para di ka maiwan tsaka makantyawan.

SN: Sumusunod po kayo sa barkada niyo kasi ayaw niyo po mapag-iwanan?

C: Oo ganun na nga.

SN: Ano pong sabi sainyo ng mga magulang ninyo?

C: Pinayuhan nila ako.

SN: Sinunod nyo po ba sila?

C: Hindi eh, na peer pressure nya kasi ako.

SN: Ano po ba ang pakiramdam nyo kapag barkada nyo o pamilya nyo kasama ninyo?

C: Kapag barkada kasi Masaya kaya lang ganun ang trip nila.

SN: Eh sa pamilya nyo po?

C: Masaya naman kaso kasi binata pa ko noon kaya nabarkada talaga ako.

SN: Noong nabasa nyo po ang kwento. Ano pong naramdaman niyo?

EXPLORING

FOCUSING

ENCOURAGING A COMPARISON

FOCUSING

be less likely to take actions on ideas that are harmful or frightening.


The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It also a useful technique when a client jumps from one topic to another.

Help the client clarify similarities and differences.

The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a

Page | 86

C: Nalungkot.

SN: Ano po ang dahilan?

C: Kasi Gilmer sinunod nya ang magulang nya ako hindi.

SN: Tapos po?

C: Ayon napabayaan ko sarili ko nalulong ako sa droga. Nadala ako dito.

SN: Uhm, Mang AM naalala nyo po ba lahat ng napag-usapan natin?

C: Oo yung tungkol kay Gilmer tsaka kahawig sa buhay ko.



SUMMARIZING

multitude of factors or problems from overwhelming the client. It also a useful technique when a client jumps from one topic to another.


General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic.

It is stated by Orlando (1980), that individuals have their own subjective perceptions and feeling that may not be observed directly. Therefore, it is important to set the client know their perception are accepted and heard to encourage verbalization of thoughts.-Reviewing the main points of discussion will help the client remember what was discussed and its significance.

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(PHOTO LANGUAGE)

SN: Mang AM pipili kayo ng 2 larawan na pinakagusto nyo po? Naiintindahan niyo po ba ang sinabi ng facilitator kanina?

C: Oo.

SN: Sige po kuha na po kayo.

(AFTER CHOOSING)

SN: O Mang AM, ano po ang napili nyo?

C: Yung gitara tsaka yung bahay.

SN: Ano pong pinagkaiba ng gitara tsaka bahay?

C: Yung gitara tinutugtog, yung bahay tinitirhan.

SN: Ano pong dahilan at eto ang napili nyo?

C: Napili ko ang gitara kasi dati mahilig akong tumugtog kasama kaibigan ko.

SN: Eh yung bahay po?

C: Para kapag nagkaasawa at anak ako may titirhan kami.

SN: Ah, ano po ba ang naalala nyo sa gitara?

C: Dati nag-gigitara ko,lagi jamming ang tropa. Gumawa pa nga ko ng kanta. Pinadala Ko kay Britney Spears.


ENCOURAGING COMPARISON

EXPLORING


For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both participants. Sometimes words, phrases, or slang terms have different meanings and can be easily misunderstood.

Help the client clarify similarities and differences.


Asking direct questions to the client will merely assess the client’s capability to think, rationalize, and give answers to a specific question.

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SN: Nagpadala po kayo ng komposisyon kay Britney Spears?

C: Oo apat na kanta yun.

SN: Sino po ba si Britney Spears sa inyo? Makilarawan po.

C: Alam ko Amerika yun. Siya kumanta ng toxic tsaka yung Im not a girl, not yet a woman. Kilala mo sya?

SN: Ah opo, medyo naririnig ko sya. Sa bahay po ano ang naalala niyo?

C: Pamilya ko sila Nanay, Tatay.

SN: Ano po ang naalala nyo sa kanila?

C: Dati namamasyal kami ganun.

SN: Kanina po pinili nyo ang bahay para may tirhan ang magiging asawa at mga anak niyo po? Sino po ang gusto ninyong maging asawa?

C: Yung nobya ko si J.E.

SN: Siya po ba ang naikwento po saamin di po ba?





To understand the client, the nurse must see things from his or her perspectives. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and he or she might be less likely to take actions on ideas that are harmful or frightening.


Page | 89

C: Oo sya yun mahal na mahal ko sya.

SN: Mang AM, sabi nyo po samin dati Highshool palang kayo hanggang sa malipat kayo sa Tarlac ay kayo na. Ang tagal na po noon nasa 20 taon na.

C: Oo ang tagal na naming hindi na kasi ako nanligaw ng iba pa.

SN: Paglabas nyo po dito sa tingin nyo po kayo pa din?

C: Ewan ko, kaya balak ko talaga puntahan sya para makausap.

SN: Ano po ang mararamdaman nyo kung paglabas nyo may asawa na sya?

C: Malulungkot ako. Tatangapin ko na lang.

SN: Kung mangyari man po yung ano pong plano nyo?

C: Siguro tatanggapin ko nalang maghahanap ng trabaho marami pa namang babae, hindi lang sya makakahanap din ako.


REFLECTING

FOCUSING

ENCOURAGING PLAN OF ACTION


A client’s statement is redirected towards him through similar wording which makes him think about it again from another perspective.-Directs questions or feelings back to client so that they may be recognized and accepted.


Allows the client to identify alternative actions for interpersonal situations. The client finds disturbing (when anger or anxiety is provoked).

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SN: Mabuti kung ganon. Mang AM, naalala nyo po ba yung ginawa at napag-usapan natin sa photo language?

C: Oo.

SN: Anu-ano po yun?

C: Pinapili ninyo ako ng litrato. Gitara tsaka Bahay kinuha ko. Tapos naalala ko yung barkada ko, nobya ko tsaka pamilya ko.

SN: Ah, mabuti naman po at naaalala niyo po lahat. Mag meryenda na po kayo Mang A.M. maupo na po kayo doon.

ACCEPTING An accepting response indicates the nurse has heard, understood and is willing to listen on what the client’s want to share. It makes conversation effective and meaningful.

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Content Theme

COMIC READING

The reading we prepared for Mr. AM is entitled “ Gigimik ba si Gilmer?”. After

reading the comic, we asked him to tell & interpret the story to us again. The client

perceived the right thought implied by the story. Mr.AM related himself to the story

by means of remembering those times that he was on a peer pressure and did not

mind to follow his parent’s advice for him. The client realized that the thing had

done before are wrong. He also started if he had only followed his parents, maybe

his life during his adulthood will be on the right way. Lastly, Mr. AM said that a man

must choose his friends; must follow his parents & must distinguished the right from

wrong.

PHOTO LANGUAGE

Mr.AM chooses the picture of the great house & a guitar. When he asked, he

chose the guitar because it could play it, & he has the ability in composing the songs.

The client also shared that he was always play guitar with his friend before. While his

reason in choosing the picture oh house is that, his ready when he will have his own

family. His for his wife 7 children has to be.

Interaction Theme

The client told the stories of his life not in sequence. But, when we asked him

about the dates of these events, he still remembers what happen first before the

other. The only things needed is we must ask him in a more understanding &

comprehensible way. All the matter he had to talk about is with sense & important in

knowing the life he had before his admission.

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Mood Theme

We noticed that the client was in a good mood. He displayed the right affect

on different situations Mr.AM also participated actively in the therapies done.


Anxiety r/t unsteady relationship to opposite sex as evidenced by hesistant

behavior when discussing the topic and NPI

“SN: Paglabas nyo po dito sa tingin nyo po kayo pa din?

C: Ewan ko, kaya balak ko talaga puntahan sya para makausap.

SN: Ano po ang mararamdaman nyo kung paglabas nyo may asawa na sya?

C: Malulungkot ako. Tatangapin ko na lang.”


Listen actively to client. Encourage verbalization of feelings. Respect client.

Accept client as is. Focus on the client’s verbalization. Provide light and

comfortable athmosphere during conversation. Acknowledge anxiety.


The activities we have done this afternoon were comics reading & photo

language. During the comic therapy, he was able to read understand the story well

Mr.AM got the moral lesson of the story w/c is to follow your parents & to choose

your peers. While on the photo language, he chose the picture of a guitar to

remember the times he played his own guitar & his friends before; & the picture of

the house in w/c he dreamed to have that house for his family. Through the

therapies done, was too able to express himself & his life before. The therapies are

done successfully & the help of Mr. AM Summary & evaluation active participation.

Page | 93

VIII. REFERENCE


and Wilkins


Page | 94

WORKING PHASE DAY 5PUZZLE AND PLAY THERAPY

NOVEMBER 16, 20102:00 P.M. – 4:00 P.M.

BPSU STUDENT CENTER AND MMW TENNIS COURTI. OBJECTIVES:


Continue/improve the rapport that has been established on the previous

days of interaction.

Enhance cognitive skills by encouraging the client to participate actively in

the therapeutic act.

Observe verbal/non-verbal communication ones during interaction that

may help in interpreting & evaluating the case of patient.


Provide appropriate mental health care & utilize various therapeutic

communication techniques.

Implement the plans of actions (therapies) that will help the client in

achieving mental health.

Formulate appropriate msg. diagnosis based on cognitive skills & behavior

of the client during therapies.

Page | 95



It was a cloudy afternoon, the sun not shining directly & the rain just passed

by when received Mr. A.M from the male ward. We first want to the grooming

area w/ assistant his self; we walked together from the male ward to the BPSU

student center. There were set the tables & chair conducive to the puzzle

therapy. Only the patients could seat & the student nurse are on their sides. Two

tables were placed apart each & 3 patients. We started the puzzle therapy first

by orienting our clients & giving them the instructions on how they will do the

puzzle. Simple do complex puzzles were prepared by each student nurse. After

having the puzzle therapy, we discussed & have short evaluation of it with our

client.

Play Therapy

This play was done in the tennis court after having the puzzle therapy. Each

pair of student nurses prepared an indoor & outdoor game. Mr. A.M wanted to

play chess so we chose it for him in the indoor game, while for the outdoor game

the group agreed to play the ball for all our clients. First, we formed a big circle &

played the ball by passing & catching e the client/student nurse, and those who

would not be able to catch the ball will be out. Mr. A.M participated actively in

the game while preparing the board; Mr. A.M was so excited arranging the

officials of the chess he won in the chess for 3 rounds. Mr A.M. showed

enjoyment in doing the play therapy.

Page | 96


From the time we received Mr. A.M., we noticed that he’s in good mood. He

smiled on us when he saw us coming to him.

During the puzzle therapy, Mr. A.M. showed interest in the activity by

listening attentively to the facilitator. He was able to differentiate the simple puzzle

from the complex one. The client did the puzzle seriously. He was able to do the

simple puzzle by his self, but in the complex puzzle we assisted him.

While on having the play therapy, Mr. A.M. was so excited upon hearing that

we will play chess and the ball game. He really wanted to play chess. The client

behaved accordingly when he did not win in the ball game. He said that it’s alright.

While on the chess, he’s so happy that he won, but not up to the point that he

boasted it.

All throughout the therapies done, the client displayed right affect, was in

good mood and behaved properly.

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SN: Magandang hapon po Mang A.M !

C: Magandang hapon din.

SN: Kamusta kayo?

C: Ok naman nakatulog ako. Nakapag-almusal din ng maayos.

SN: Tara po doon, maghilamos muna po kayo.

(After grooming, at the BPSU student center.)

SN: Mang A.M,ang gagawin po natin ngayon ay puzzle at maglalaro po tayo pagkatapos.

C: Ah sige. Meron bang chess?

SN: Opo Mang A.M

(PUZZLE THERAPY)(@nurse client interaction)

SN: Mang A.M,ano po yung nagustuhan nyong puzzle?

C: Yung spongebob kasi makonti lang medaling buuin.

GIVING RECOGNITION

GIVING INFORMATION


According to Peplau (1952), a nurse is stranger to the patient, it is therefore important to remind the client who we are and be consistent with the information we are giving to them to gain their trust.

Included in the 10 carative factor of Jean Watson is the cultivation of sensitivity to one’s self and to others. Asking the said question will measure the client’s memory retention level.

Page | 98

SN: Ah ganun po ba, ano po o sino po ang naaalala nyo nung binubuo nyo ang puzzle?

C: Yung pamilya ko.

SN: Ano po yung dahilan bakit pamilya ninyo ang inyong naalala?

C: Kasi nga parang puzzle, hiwa hiwalay kami ng pamilya ko.

SN: Ano po yung nararamdaman ninyo habang binubuo po ninyo ang puzzle?

C: Nalungkot kasi nga naalala ko yung pamilya ko.

SN:Eh yung nabuo ninyo na po ang puzzle ano po ang naramdaman ninyo?

C: Masaya kasi iniisip ko na tulad ng puzzle mabubuo rin yung pamilya ko.

SN: Ah ganun po ba? Ayos po yun. Eh Mang A.M, naalala po ba ninyo ano ang pinag –uusapan natin?

C: Oo. Yung tungkol sa puzzle na naihambing sa pamilya ko.

SN: Sige po Mang A.M., susunod na po maglalaro na tayo.

REFLECTING

EXPLORING

SUMMARIZING

A client’s statement is redirected towards him through similar wording which makes him think about it again from another perspective.


-It is stated by Orlando (1980), that individuals have their own subjective perceptions and feeling that may not be observed directly. Therefore, it is important to set the client know their perception are accepted and heard to encourage verbalization of thoughts.

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(PLAY THERAPY)

SN: Mang A.M. maglalaro na po tayo ng pasahang bola. Dapat po masalu nyo para hindi kayo mataya.Galingan niyo po ah.

C: Sige.

(The outdoor game last for more than 10 mins.)

SN: Oo Mang A.M., maglalaro na po tayo ng hiniling nyong laro samin.

C: Chess?

SN:Oo po Mang A.M.,tara po maglaro na po tayo.

(The client wins over Riza with the score of 3-0)

SN: Ang galing-galing nyo naman po Mang A.M. Masaya po ba kayo?

C: Oo, pinasaya niyo ko. Ang tagal ko na kasing hindi nakakapaglaro ng chess.

SN: Ah ganun po ba?Maraming Salamat po Walang anuman po.

C: Salamat din.

SN: Tara po kain na po kayo. Malapit na po kasing mag-4 babalik na po kayo sa ward.

C: Sige

(Then, the client went back to ward)

GIVING RECOGNITION

-According to Peplau (1952), a nurse is stranger to the patient, it is therefore important to remind the client who we are and be consistent with the information we are giving to them to gain their trust.

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Content Theme

PUZZLE

Mr.A.M. started to form the pieces of the puzzle on the side of the frame.

He found the simple puzzle easier then the complex because there is a fewer

number of pieces in the simple puzzle. The client stated that be remembered his

family while performing the puzzle. He wanted his family to become completely

again. This is one of his goals when he will be discharged in the ward. He also

remembered the typhoon that passed on the hospital when he is forming the

puzzle of the huge tree. Mr.AM. said that many trees full down during the

typhoon.

PLAY

The client focused on the chess. He remembered the times he joined the

tournament on their school in the board games. Mr.A.M. said that he missed so

much playing the chess. He also remembered his friends when we are playing it.

Interaction Theme

Mr.A.M. followed the instructions of the puzzle & play correctly. He was able

to compare in contrast the simple & complex puzzle. The client reflected to the

puzzle therapy by thinking of the way on how he could make his family completely

again. He answered are question about the issue appropriately. While we are on

playing the chess, he remembered his days when his joining contest on chess. He

said that he placed as a 1st runner-up during his times in their school. All throughout

the interaction his oriented, in sequence & makes sense on the things had talking

about.

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Mood Theme

Mr.A.M. appeared exciting upon seeing is when he discussed the activities for

the day, he appeared so interested. During the 2 therapies done, he participated

actively & behaved accordingly the client also practiced sportsmanship during the

ball game, when didn’t win Mr.A.M. also displayed appropriate affect during the

interaction.


Anxiety r/t conflicated family relationship as evidenced by restlessness during

conversation, poor eye contact when discussing the topic and NPI,

“SN: Ah ganun po ba, ano po o sino po ang naaalala nyo nung binubuo nyo ang puzzle?

C: Yung pamilya ko.

SN: Ano po yung dahilan bakit pamilya ninyo ang inyong naalala?

C: Kasi nga parang puzzle, hiwa hiwalay kami ng pamilya ko.”


Stay with and listen to the client. Encourage client to acknowledge and express

feelings. Focus on client’s verbalization. Maintain eye contact to show interest

and sincerity. Maintain an ideal therapeutic environvent during the conversation.

Determine client’s use of coping skills and defense mechanisms. Speak in brief

statements using simple words.

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The therapies done that afternoon are puzzle & play. During the puzzle

therapy, the client was able to differentiate the simple from complex puzzle. He

found the simple puzzle easier to form their complex due to fewer members of the

puzzle pieces. Mr.A.M. remembered his family on the typhoon passed on the

hospital after forming the puzzle. Write on the play therapy, he enjoyed the ball

game a lot. It is our first time to saw Mr.A.M. that happy. He also has fun playing

chess. The client said that he missed playing chess so much. He remembered the

times he joined the chess tournament in their school.

At the end of our interaction, the client thanked us for giving him enjoyment

& time to talk. Mr.A.M. looked like he has no disorder & acted normally & good

behavior, affect & sense on what his saying.

VIII. REFERENCE


and Wilkins


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WORKING PHASE DAY 7BIBLIO THERAPY

NOVEMBER 22, 20109:00 A.M. – 11:00 A.M.

BPSU STUDENT CENTER AND MMW TENNIS COURT

I. OBJECTIVES:


Enhance cognitive skills by encouraging the client to participate in the

therapeutic activities.

Provide some reflection to client’s life by allowing then to verbalize the

things they remember during the therapy.

The patients analyze and learn the moral lesson of the story.


Facilitate the activities for that day accordingly.

Offer oneself himself while the client reflects his life on the story &

verbalizes his feelings & understanding towards the situation.

Have a through behavioral & mental status assessment during the

intervention.



It was a sunny morning, & the wind blew softly that could make us sleepy.

After the biblio therapy, we sat under the acacia tree to have some

interpretation about the activity. Our chairs are place approximately 3-4 ft away

in front of the client. There the client verbalized that his uncle cut his head off &

put a diamond inside of it when he was 6 y/o. and the reason for doing this, as

the client said is to make him intelligent.

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The client wears his uniform but not that clean, when we saw him coming out

from the male ward B. We went to the grooming area in order for him to groom

his self. He smiled on us and asked if how we are doing. The client is in good

mood during the therapy. He listened and participated actively during the

interaction.




SN: Magandang umaga po.

C: Magandang umaga din.

SN: Oh Mang A.M. naalala niyopa po ba kame?

C: Oo si Riza at si Joey.

SN: Opo mang A.M. May gagawin po tayo mamaya. Manonood po kayo ng maikling kwento mula sa bibliya. Tawag po doon Bibliotheraphy.

(BIBLIOTHERAPHY)

SN: Oh, Mang A.M. maaari nio po bang ikwento sa min kung ano po naalala ninyo sa kwento?

C: Si Noe binalaan siya ng Dyos na may malaking baha na darating kya sinabi nito na gumawa siya ng arko pero

GIVING RECOGNITION

GIVING INFORMATION

ASKING DIRECT QUESTION

-According to Peplau (1952), a nurse is stranger to the patient, it is therefore important to remind the client who we are and be consistent with the information we are giving to them to gain their trust.

-It is stated in Kings theory of goal attainment (1960), that if a nurse with special knowledge and skill to communicate the appropriate information to the client, mutual goal setting and goal attainment will occur.

-Included in the 10 carative factor of Jean Watson is the cultivation of sensitivity to one’s self and to others. Asking the said question will measure the client’s memory retention level.

Page | 105

yung ibang tao hindi naniwala sa kanya kaya nung dumating na ang malaking baha,ung mga taong hindi naniniwala sa Diyos ay nangalunod sila.

SN: Opo Mang A.M., ano naman po ang aral na natutunan ninyo sa kwento?

C: Ung dapat sumunod at makinig sa Diyos.

SN: Opo Mang A.M. kasi po wala naman po gagawing hindi mabuti ang Diyos. Nananalig po ba kayo sa kanya?

C: Oo. Nagdarasal naman ako tsaka humihingi ng patawad sa Diyos.

SN: Opo, Mang A.M. maganda po iyon. Mang A.M. habang pinapanood po ninyo yung maikling kwento, ano po o sino ang naaalala ninyo?

C: Ung lolo ko. Siya kasi yun gumawa ng bahay namin eh.

SN: Ah, ganun po ba Mang A.M., balik po tayo sa ating usapan, sino po para sa inyo ang Diyos?

C: Ang Diyos,siya ang magliligtas sa atin sa anumang kapahamakan.

SN: Mang A.M., ano nga pop ala ang relihiyon ninyo?


REFLECTING

- Asking questions about the therapy will assess client’s ability in terms of memory including his immediate recall.

-A client’s statement is redirected towards him through similar wording which makes him think about it again from another perspective.-Directs questions or feelings back to client so that they may be recognized and accepted.

Page | 106

C: Jehovah Witness. Pero hindi pa ko baptized.

SN: Ah, ganun po ba Mang A.M.,

C: Oo, yung tiyuhin ko nga nilagyan nya ako ng brilyante sa ulo nun eh.

SN: Brilyante po?

SN: Eh, papanu naman po iyon nilagay sa ulo ninyo?

C: Oo, pinutol nila yun leeg ko tapos binalik nila ulit.

SN: Mang A.M. hindi po ba pag pinutol ang leeg naten ay mamamatay tayo?

C: Hindi kasi may orasyon naman yon.

SN: Ganun po ba. Kasi po Mang A.M. wala din namang bakat ng tahi sa leeg ninyo kaya po imposible ang sinasabi ninyo.

(After Group Dynamics)

CLARIFYING

EXPLORING

PRESENTING THE REALITY

- Verifying your impressions may help the client become more aware of their feelings.

-According to Abdellah, one step in identifying the client’s problem is to continue observing and evaluation the client to identify attitude and cues affecting his behavior.

- clarifying misconceptions that client may be expressing

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SN: Oh, Mang A.M., kumain na po kayo at magpahinga.

C: Oo sige.

(After eating)

SN: Naaalala nyo pa po ba ang napag usapan natin?

C: Oo, ung tungkol sa kwento na mula sa bibliya na pinamagatang “Si Noe at ang Dakilang Baha” , tapos ung aral na nakuha ko sa kwento.

SN: Opo., mabuti naman po at naaalala ninyo.

SUMMARIZING

-It is stated by Orlando (1980), that individuals have their own subjective perceptions and feeling that may not be observed directly. Therefore, it is important to set the client know their perception are accepted and heard to encourage verbalization of thoughts.-Reviewing the main points of discussion will help the client remember what was discussed and its significance.

Page | 108


Content Theme

The focus of our conversation after the biblio therapy was on Mr. A.M.’s

childhood experiences with his uncle and the diamond on his about to inherit. The

client told us that his head was cut-off and a diamond was put inside in his head

when he was 6 y/o. It is intended to make him intelligent and it was done by his own

uncle. He said that his spirit separated from his body, in that way he saw how his

head was cut-off. Mr. A.M. also remembered his grandfather in the part of the story

when Noe build the ark, because his grandfather was also the one who repaired

their house in Baguio.

Interaction Theme

During our interaction with the client after the therapy, he is not logical or in

sequence when he is telling us the story of the diamond on his head. He also did not

have concrete answer. The client changes his answer to a question when it is

repeated. His affect was also not that good, it is blunted.

Mood Theme

Mr. A.M was in good mood from the moment we received him from the ward

up to the time we brought him back there. His behavior was the same with our

previous interaction. The only thing changed is affect and his answers are not that

appropriate to the question we asked. Fortunately, the client participated actively in

the therapy.

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Disturbed thought processes r/t psychological disorder as evidenced by non-reality

based thinking.


Maintain a pleasant quiet environment & approach in a slow, calm manner. Give

simple direction, using shorts words & simple sentences. Listen with regards.

Present reality concisely and briefly. Do not challenge illogical thinking. Allow more

time for client to respond to question or comments. Clarify things to client especially

when they are in doubt of it.

VII.SUMMARY AND EVALUATION

The biblio therapy was successfully done that morning. Our client was

oriented & instructed clearly. Mr. A.M. watched and listened on the story

attentively. Afterwards, we evaluated our client’s understanding about the therapy.

He was able to recall the story and recognized the moral lesson for it. Mr. A.M. also

verbalized another story of his life, the diamond on his head. This started him to be

illogical in what he’s saying. His answers are inappropriate and he said things that

are impossible.

VIII. REFERENCE


and Wilkins


Page | 110

WORKING PHASE DAY 8EXPRESSIVE ART AND SONG THERAPY

NOVEMBER 23, 20109:00 A.M. – 11:00 A.M.BPSU STUDENT CENTER

I. OBJECTIVES:a. Client-Centered Objective:

Let the client imagine and create his own art.

Provide one on one interaction to the client to verbalize the thing he

remembered.

Enhance imagination skills & cognitive skills.


Facilitate the activity of the day accordingly.

Offers one’s self while the client reflects his life on the art he did.

Have a thorough behavioral & mental status assessment during the

intervention.



It was a sunny morning and the wind blow softly. We sat under the Camachile

Tree beside the BPSU student center for our Expressive Arts Therapy. The clients

are seated as a group when they are making their art during the interaction.

Mr.A.M. verbalized that there was something bothering him last night. He was

bothering me last night.

Page | 111


The client wears is uniform & not the clean. We groomed him first at the

grooming area. He smiled at us and asked what will do that day. The client is to

good mood & behaved good during the therapy. He participated actively during

the interaction. But after the Expressive Arts Therapy he was serious and

nervous.

Page | 112




SN: Magandang umaga po Mang A.M.

C: Magandang Umaga din.

SN: Naaalala nyo pa po ba kami?

C: Oo ikaw si Riza at si Joey.

Sn: Tama po. Oh tara po maghilamos at magsepilyo muna po kayo.

(In Front Of BPSU Student Center)

SN: Oh Mang AM kamusta naman po kayo?

C: Ayos naman. Ano bang gagawin gayon?

SN: Mang AM, ang una po nating gagawin ay expressive at therapy. Ipapaliwanag poi yon ng facilitator natin.

(After Facilitating..)

SN: Oh Mang AM naiintindhan po ba ninyo ang gagawin?

C: Expressive Art

SN: Opo. Bibigyan po naming kayo ng mga palito ng posporo, glue, bond paper. Ididikit po ninyo ang mga palito ng posporo sa

GIVING RECOGNITION

GIVING INFORMATION

Provides appreciation on the good thing that the client did. Helps the client to keep on doing good things, which enhances his behavior. Our client responds properly on the greetings by his student nurse.

Give the information only needed for the client to enhance understanding. This facilitates clear information to perceive by the client. As

Page | 113

bondpaper. Kayo na po bahala kung ano po ang gusto ninyong design ng art nyo. Kung ano po ang nasa isip nyo, yun po ang gawin ninyo. Malinaw po ba?

C: Oo.

SN: Sige po simulan nyo na. kung kailangan nyo po ng maliit na piraso ng posporo sabihin nyo lamang po at ipapagupit naman kayo nito.

C: Sige.

(After during the art)

SN: Mang A.M. ano po ang ginagawa nyo?makipagliwanag po.

C: Eto yung bahay tapos may puno, mountain at sun rays.

SN: Ano po ang naaalala nyo dito?

C: Yung bahay naming sa Capaz Tarlac.

SN: Uhm tapos po?

C: May puno kami ng kamatsile sa tabi, tapos may bahay naming ginawa yan nila tatay at lolo ko.

OFFERING SELF



the therapy goes along our client has a good thinking motivation in doing the activity for this day. He has lots of ideas in doing the activity for today.

To facilitate cooperation in activities and makes feel the client not alone; also provides collaboration in performing activities. We’ve noticed that Mr. A.M has eagerness in starting and performing the therapy for today.

The nurse must practice to give broad openings in order to make the interaction effective and substantial. In this way, the client will be the one to prolong the conversation. After therapy we noticed that Mr. A. M. in term of interpreting the finish product he has a still recall or remembers his family.

The nurse must facilitate the continuation of their conversation. It makes the client feel that the nurse is interested and willing to listen on his story. Mr. A. M was answered appropriate to the question asked.

Page | 114

SN: Sinu-sino po kayo sa bahay nyo?

C: Tatlo kami sila Nanay,Tatay at ako.

SN: Eh Mang A.M ito po yung sun rays ano po ang ibig sabihin nito sa inyo?

C: Pag-asa. Kasi pag nakikita ko ang sikat ng araw nagkakaroon ako ng pag-asa.

SN: Pag-asa saan po?

C: Makapag bagong buhay, habang may buhay may pag-asa.

SN: Ano po yung nararamdaman ninyo habang ginagawa ito?

C: Masaya.

SN: Sa ano pong dahilan?

C: Kasi naalala ko yung pamilya ko lang magkakasama pa kami.

SN: Ah ganon po ba?Masaya po? Eh napansin po naming na parang nakasimangot at seryoso po kayo masyado.


EXPLORING

FOCUSING

MAKING OBSERVATIONS

The nurse asking direct questions, gains specific answers. It makes the client to answer the questions appropriately. He answers straight to the point and looks sincere.

It facilitates deeper conversation particularly on the stories that are very important for the client. In this way, the nurse gets more information about the client. He answered very significantly and interprets the picture with all his knowing.

The nurse encourages the client to concentrate on his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It also a useful technique when a client jumps from one topic to another. When we start to analyze his emotion towards the therapy done we’ve noticed that he has still full of hope that he and his family will reunite again but the facial expression he shown was not appropriate.

Indicates that the nurse is caring and concern on client’s general appearance, mood, behavior and affect.

Page | 115

Ano po ang dahilan?





C: Yung pumugot ng ulo ko nung bata pa ako. Iniipit nya ku eh. Tinatawag nya ko.

SN: Tinatawag po kayo Mang A.M.?sa paanong pong paraan? Tayong tatlo lang po ang anditio. Wala nang iba pa.

C: Attachment ring. Iniipit nya ko. Hindi ako mapalagay mag rereaksyon na ko.

SN: Ano po yung attachment ring? Hanggang ngayon po ba iniipit nya kayo?

C: Inilagay na ng tyuhin ko nung pinugot nya ulo ko. Hanggang ngayon tinatawag na nya ko. Iniipit ako. Mag la-lock-jaw na ako.

PRESENTING REALITY

INVOICING DOUBT

As we continue observing the clients reaction we noticed that he manifested some flight of ideas towards his past and it is very significant to us.

It makes the client know and face the reality. It also makes his words to have sense and his understanding enhanced. By this way, the nurse helps the client to distinguish the real things from not.To provide clearer information & to help the client give assurance on what he is saying. When we tell the reality to the client he still hallucinating about the experience according to him.

To provide clearer information and to help the client give assurance on what he is saying. When we asked the client about the “attachment ring” he answered very irrelevant that can make us convince that his mental illness was occurring.

Page | 116

(Kinausap si Ma’am)

SN: Ayo slang po ba kayo Mang AM?

C: Babalik na ako sa ward. Mag rereaksyon na ako.

SN: Bakit po gutom na kayo? Kain muna po kayo.

C: Sige.

(On the way to ward)

SN: Ok na po ba kayo Mang A.M.? naaalala nyo po ba ang ginawa natin?

C: Nabusog ako, yung pumugot ng ulo ko iniipit ako eh.

SN: Mang AM. mag pahinga muna po kayo ha. Ihahatid na po naming kayo sa ward. Tayong 3 lang po magkakasama Mang AM. wala na pong iba.

C:Naririnig ko sya sa attachment string.

SN: Expressive art po ang ginawa natin. Gumawa kayo ng bahay, bundok, puno at sunrays. Sige po magpahinga na po kayo Mang AM.

SUMMARIZING Brings together all the important points discussed during the interaction. As we summarized our therapy to our client he still emphasizing the one who cut his head and the attachment ring he mentioned on the previous conversation. Mr. A.M. was still need more rehabilitation because he can still remember the past traumatic experience.

Page | 117


Content Theme

The activity for that morning is expressive arts therapy, wherein our client

was able to form a house tree & mountain sunrays through matchsticks posted on a

bond paper. Mr.AM said that he remembered his family from the art he had done.

We noticed our client is very serious & nervous, so we asked if there something

bothering him. He replied, “ Yung pumugot ng ulo ko, iniipit nya ko kagabi kaya wala

akong tulog.” And this started Mr. A.M to have blusted yet appropriate answer &

flight of ideas. As our conversation you, kept on telling that thing.

Interaction Theme

During our interaction, Mr. A.M did not play of his attention on what we are

doing. He is anxious & does have flight of ideas. The client answers are appropriate

but blunted. He does listen but c in a short period of time, he was not able to read

what we had talked about. Mr.AM was not focused on our therapy & interaction,

due to someone’s bothering him, as he claimed.

Mood Theme

The client was not that in good mood from the moment we saw him. He did

not even smile on us, but he followed our instructions. Mr.AM did his art, but at the

time we evaluated his work, he started to show behaviors that are present in our

previous days. He responded on us congruently but blunted and has fight of ideas.

Page | 118


Impaired social interaction r/t altered thought processes as evidenced by

inability to communicate a satisfying sense of shared stories.


Ascertain ethnic / cultural or religious implications for the client. Observe client

while relating to family. Encourage client to verbalized feeling of discomfort

about social situations. Encourage client to verbalize problems and perceptions

of reasons for problems. Determine client’s use of coping skills and defense

mechanisms. Provide positive reinforcement for improvement in social

behaviors and interactions. Work with the client to alleviate underlying negative

self-concepts. Provide positive feedback during interactions with client.


We cannot able to summarize, because our client was attack of his disorder.

VIII. REFERENCE


and Wilkins


Page | 119

TERMINATION PHASE DAY 11GRAND SOCIALIZATION

NOVEMBER 30, 20109:00 A.M. – 11:00 A.M.

RUINS / BACK OF LECTURE ROOM

I. OBJECTIVES:


Help the client cope up with our separation.

Assist the client in reviewing all the therapies done.

Let the patient analyze the lessons he learned throughout the interaction.


Facilitate the activities for that day accordingly.

Explain and terminate the contract effectively.

Evaluate the client’s learning from the start of the interaction up to the

termination.



It was a sunny morning, & the wind blew softly when we fetched Mr. A.M.

from the ward. We started to talk about our termination in the grooming area

and we explained the activity for the day in the ruins. The program for the Grand

Socialization day took place at the back of the lecture room.

Page | 120


The client wears his uniform but not that clean, when we saw him coming out

from the male ward B. He groomed his self, and we started to talk about the

termination of contract. He appeared sad when he knew that he would not see

us anymore. Despite of it, he still participated in the activities for that day. He

thanked for the times we are with him. We saw smiles on his face and we said

goodbye to each other in a nice way.

Page | 121




SN: Magandang umaga po Mang A.M. !

C: Magandang umaga din Joey at Riza.

SN: Kamusta na po kayo?

C: Mabuti naman.

SN: Mang A.M., Grand socialization na po natin ngayon. Ibig sabihin po ito na po ung huli nating pagkikita.

C: ah ganun ba?

SN: Opo Mang A.M.. Ano pong nararamdaman ninyo ngayong hindi na tayo magkikita sa mga susunod na araw?

C: Malungkot kasi aalis na kayo. Saka magpapasko na, gusto ko makasama sana pamilya ko.

SN: Uhm.. may magiging

ASKING OPEN-ENDED QUESTIONS

GIVING INFORMATION

FOCUSING


Includes giving the client right information on the things needed during the interaction therapy.


According to Maslows Hierarchy of needs, love and belongingness involves emotionally based relationships such as family. People need to love and be loved by others. Absence of this element may cause anxiety, loneliness and depression to the client. In

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student nurses din naman po kayo pagdating ng January, iba naman po ang maghandle sa inyo. Ano po masasabi ninyo sa apat na linggong nagkasama tayo?

C: Masaya. Ok naman kayo makisama sakin.

SN: sa anong paraan po at nasabi ninyong ayos kami para sa inyo?

C:Kasi kayo nakikinig sa mga kwento ko, ung iba hindi naman ako pinapakinggan.

SN: Ah ganun po ba ? By January din naman po may ibang student nurses n hahawak sa inyo, at makakasama ninyo.

C: ah ganun ba?

SN: opo. Mang A.M. may itatnung po kami sainyo, kaso po medyo maselan.

C: o sige ano yun?

SN:Kailan po kayo natutong magmasturbate?

C: Masturbate? Siguro mga grade 6 na ako noon.

ENCOURAGING EVALUATION

EXPLORING


relation to our client signifies lack of this need because of his condition.

Asking patient’s views of the meaning or importance of something/asking client to appraise the quality of his or her experience


Asking direct questions to the client will merely assess the client’s capability to think, rationalize, and give answers to a specific question. According to Freud’s Psychosexual Theory, an adolescence age of 12 to 18 is in genital stage which they establishes relationship with the opposite sex, where they find gratifying work.

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SN: Mang A.M. grade 6 po ? edi mga 12-13 y/o po kayo nun ?

C: oO. 12 y/o na ko nun. Parte naman un ng pagbibinata ehh.

SN: Ah, Mang A.M. eh ano po ang pananaw ninyo sa sex?

C: Sex? Ah, siguro ung papamilya na din.

SN: Pamilya po? Ilan po ba ang gusto ninyong anak ?

C: mga 3, 2 lalaki at isang babae.

SN: ah.. ayos po pala..

C: para masaya, ( he laughs)

SN: Mang A.M. natatandaan po ba ninyo lahat ng natutunan ninyo sa amin?

C: oo. Ung mga therapy natin.

VALIDATING


HUMOR

And also he says that every stages must be fulfilled in order for the person to moved forward to another stage of development. Sexual development happens in each person on the same stage, the same way but some remain stagnant and some are moving forward.


To understand the client, the nurse must see things from his or her perspectives. Encouraging the client to describe ideas fully may relieve the tension the client is feeling, and he or she might be less likely to take actions on ideas that are harmful or frightening.

Harmless humor can reduce mild to moderate anxiety, gives perspective on life events and reduces social distance.

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SN: opo. Ung mga natutunan po ba ninyo eh ibabahagi po ninyo yun sa mga kasama ninyo sa ward?

C: oo. Ang dami ku nga natutunan sainyo eh .

SN: Tulad po ng ano Mang A.M?

C: Natuto ako makisama saka makihalubilo sa mga tao.

SN: opo. Kami din po ang dami namin natutunan sa inyo. Maraming Salamat po Mang A.M.

C: Maraming salamat din.

SN: Tara po Mang A.M. magsisimula na po yung program.

(after the program)

SN: Ang galing naman ni Mang A.M. lagi nananalo sa mga games.

C: oo nga eh ( he laughs)

SN: Maraming salamat po sainyo ulit ha ?

C: maraming salamat din.

SN: opo Mang A.M. , Paalam

REFLECTING

ACCEPTING

GIVING RECOGNITION

Reflections encourage the client to recognize and accept his or her own feelings. The nurse indicates that the client’s point of view has value, and that the client has the right to have options, make decisions and think independently.

An accepting response indicates the nurse has heard, understood and is willing to listen on what the client’s want to share. It makes conversation effective and meaningful.

Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show that the nurse recognizes the client as a person, as an individual. Such recognition does not carry the value, that is, of being “good” or “bad”.

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na po. Pagaling po kayo ha?

C: paalam din. Ingat kayo.

SN: Opo,. Sila nickson na po ang maghahatid sainyo. Para sila naman po ang magpaalam.

C: sige.

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Content Theme

The main topic of our conversation was the termination of contract, the

therapies we have done and the lessons the client learned during the interaction.

We explained it to him well, and he responded accordingly. Becoming sad is normal,

and he did not show any abnormal behavior when we said goodbye to him.

Interaction Theme

During the times we are talking about our termination, Mr. A.M. was sad, and

it is quite normal. We reviewed all the therapies we have done, and he still

remember all of those. He also shared the lessons he learned during the times we

are together. The client participated well in the Grand Socialization Day. He joined

the games, and enjoyed the activities for that day. The interaction for our last day

went smooth and effective.

Mood Theme

Mr. A.M was in good mood from the moment we received him from the ward

up to the time he was brought back there. Although he was sad because of our

termination, he still participated actively in the Grand Socialization Day. Mr. A.M.

thanked us for listening on his stories and for those times, we are with him. He did

not show any anger or any other abnormal behavior upon saying goodbye; instead,

he smiled, thanked and waved us goodbye in a nice way. The termination of our

contract with Mr. A.M. went good.

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Risk for anxiety R/T seperation from student nurses


Be honest and terminate the relationship completely without giving false

promises. Be available to the client for talking and listening. Observe for possible

defense mechanism that might be used. Focus on how the client will accept the

end of the therapeutic relationship. Encourage client to express and

acknowledge feeling. Give patient time to analyze feelings and emotion.

VII.SUMMARY AND EVALUATION

The termination of the contract and the Grand Socialization Day were

successfully done. We ended our interaction with the client in a good manner. We

reviewed all the activities we have done, and the client still remembered all of those.

Mr. A.M. was able to learn some lessons from the days we are together. He

reflected well on it. The activities went smooth. The client behaved normally and

participated well in the Grand Socialization Day. Good to say, the morning ended up

in the way it should be, with the clients behaving normally, and the activities were

done successfully.

VIII. REFERENCE


and Wilkins


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UNIT IV

B) PSYCHOPHARMACOLOGY

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NAME OF DRUG ACTION

INDICATION

CONTRAINDICATION SIDE EFFECTS

NSG. RESPONSIBIL

ITIESBrand name: Haldol

Generic name:Apo-Haloperidol

Classification:Anti psychotics

Dosage & route: 5mg 1m3-4 doses

Use to help control the symptoms of psychosis and may help the patient became more receptive to psycho therapy

Modifies thought disorder, blunted affect (deadend emotions and apathy) and abnormal behavior associated w/ psycho motor and mental retardationthought disorder, blunted affect (deadend emotions and apathy) and abnormal behavior associated w/ psycho motor and mental retardation

Psychotic disorder

Contraindicated in CNS depression or coma and in patient with parkinsonism

Extra pyramidal symptoms, especially akathisia and dystomas, occurs more frequently than with phenothiazines

Sedation

Hypothension

Do not confuse Hal dol with Medrol , a corticosteroids

Watch for signs and symptoms of parkinsonism and tardive dyskinesia

Avoid exposing client to activities that require mental alertness until drug effects are realized

Monitor BP

Report muscle weakness/stiffness.

Change position slowly to avoid sudden drop of BP.

Avoid over exposure to sun

Avoid abrupt withdrawal of this med.

NAME OF ACTION INDICATIO CONTRAINDI SIDE EFFECTS NSG.

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DRUG N CATION RESPONSIBILITIES

Generic name:Fluphenazine HCL

Brand name:Flupentixol

ClassificationPhenothiazine,Anti-psychotic

High incidence of extrapyramidal symptoms and a low incidence of sedation, anticholinergic effects, anti-emetic effects and orthostatic hypotension

Psychotic disorders

schizophernia

Clients with phenothiazine that sensitivity may cause undue reactions

sedation

tardive dyskinesia

EENT – dry eyes blurred vision

Begin the therapy with hydrochloride before giving deconocate

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NAME OF DRUG

ACTION INDICATION

CONTRAINDICATION

SIDE EFFECTS NSG. RESPONSIBIL

ITIES

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Generic name:ChlorpromazineHCL

Brand name:Morazine

ClassificationAnti psychotic

Dosage 10mg

Has significant anti-emetic, hypotensive, and sedative effect, moderate anticholinergic and extrapyramidal effects

senizophenia

pt with known hyper sensitivity to phenothizines and related compoundspt with blood dyscarias and bone marrow depression because chlorpromazine may induce agranucocytosis

sedation

tardive dyskinesia

EENT – dry eyes blurred vision

CV – hypotension

GI – constipation, dry mouth

GU – urinary retention

Skin – rashes

Blood – agranulo cytosis

Do not confuse chlorpromazine with chlopropamide (oral diabetic) chlorothiazide (thiazide diuretics)

With food administer or milk to prevent GI upset

Avoid performing activity that requires mental acconity.

Assess for symptoms of possible side effect.

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UNIT V

PSYCHOTHERAPY

COMIC READING THERAPY

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DEFINITION

Comic reading therapy helps the client to assess how their reading skills work in

terms of reading a comic. How they relate scripted words in their everyday life, this is used

to test how they can read comprehensively and make their mind work.

GOALS

1. To let the client understand and verbalize words.

2. To develop their comprehensive ability.

3. To promote thorough process.

4. To understand the level of ability in terms of reading.

PROCEDURES

1. The facilitator orients the client about the therapy and how it should be done.

2. The client allows reading.

3. After reading, they were asked a few questions about the content by their student

nurse.

4. All the clients were asking to state their thought regarding the therapy.

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ANALYSIS & INTERPRETATION

Once were started the therapy, we noticed that Mr. A.M has eagerness in reading.

He read the comic story entitled “Gigimik ba si Gilmer?”

During the interaction, we asked him to tells us and interpret the story to us again.

And he do that. The client perceived the right thought implied by the story. Mr. A.M related

himself to the story by means of remembering those times that he was in a peer pressure &

did not mind to follow his parent’s advises for him. The client realized that the things led

done before a wrong. He also stated that if he had only followed his parents, maybe his life

during his adulthood would be on the right way. I think that the client develop his

comprehensive ability during the therapy.

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PHOTO LANGUAGE THERAPY

DEFINITION

Photo Language Therapy helps the client to verbalized and state the level of their

thinking by formulating an idea on the photos they picked, this is used to test thinking skills

of the client and make their mind work.

GOALS

1. To let the client to verbalized his/her insights, thoughts and feelings about the

picture.

2. To develop client’s cooperation.

3. To promote thought process and verbalization of the client.

4. To let the client participate and socialize in a group discussion.

PROCEDURE

1. The facilitator orients the clients about the therapy and give instructors.

2. The client was asking to pick two photos they like.

3. After a minute of looking of the photos, they were asked to speak out the idea they

made about the photo and asked why did they picked that pictures

4. All the clients were asking to state their thought regarding the photos.

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Once we have started the therapy, we noticed that MR. A.M had high enthusiasm on

choosing an image for the therapy. When he saw the picture of a guitar, he picked it up.

Then he also chooses the picture of amazing house, and when he saw a picture of food, he

picked it up. Then he asked him what had like the most on the 3 pictures, he choose the

picture of a guitar and the house. When he asked him why he chooses, the guitar he says

that he remembered the times that are playing a guitar with his friends. Then, when we

asked him why he chooses the house, he says that it is for his future family for his wife and

children to be. Because when he can go home, he wants to have his own family.

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PUZZLE THERAPY

DEFINITION

A puzzle is a problem or enigma that tests the ingenuity of the solver. Puzzle therapy

is purposely to evaluate the client’s cognitive and problem-solving ability. Puzzle was

created to advance development this instilling aptness on the part of the client.

GOALS

1. To access the client’s memory, cognition and problem-solving ability.

2. To augment their thinking abilities and independence.

3. To imbibe self-esteem and fulfillment on the client.

PROCEDURE

1. The facilitator commences the assigned activity of that day, explaining its nature,

description and how it will be done.

2. Give the necessary materials for the activity, 2 simple and 2 complex puzzles.

3. Let the client choose 1 simple and 1 complex.

4. Start with the simple puzzle. Give sufficient amount of time for the client to scan and

see what the puzzle look like.

5. Record the duration of the first puzzle building.

6. Present the next puzzle, the complex. Again, give sufficient amount of time for the

client to scan and see what the puzzle look like.

7. Record the duration of the second puzzle building.

8. Evaluate the outcomes of the activity with the client.

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The client was able to differentiate the simple puzzle from the complex one. He

solved the simple puzzle for about 1 minute & the complex for 4 minutes. Mr. A.M. started

to form the puzzle at the side of the frame. He did the simple puzzle by his self, but in the

complex, he needed our assistance.

Mr.A.M. found the simple puzzle easier to form than the complex because of the

fewer number of puzzle pieces on it. He was able to do the therapy well & it tested his

problem solving ability.

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PLAY THERAPY

DEFINITION

Play therapy refers to social recreation activity that requires strategies & physical

strength. There 2 kinds of play therapy, first is the indoor games, which are played inside

the house example of this are snake & ladders, chess, damath, etc. ; the other one is

outdoor games, this are played outside the house examples are basketball, volleyball,

badminton & etc.

This therapy is used to help to interact & for socialization purposes and, to

encourage them to be competitive in any type of game. It is a tool to encourage client to

have their exercise them forget their boredom.

GOALS

1. To help the client to socialize & other people.

2. To help the client to be competitive & to trust their planned strategies.

3. To encourage their client to conceptualized ideas on how to win.

4. To give client new information outside the hospital.

PROCEDURE

Prepare the necessary equipment needed for indoor games (chess, snakes, &

ladders, puzzles) outdoor (Badminton, Basketball, Volleyball).

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ANALYSIS & INTERPRETATION Mr. AM participated actively in both games. We did first the outdoor game, wherein

he practiced sportsmanship after losing the game. He behaved well although he did not win.

While in the indoor game (Chess), he is very happy winning 3 rounds of the game.

However, the client did not boast it.

Mr. AM showed good mood & behavior, right affect & appropriate actions during the

play.

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BIBLIO THERAPY

DEFINITION

It cultivates & enhances the client’s memory capacities as well as reasoning & learning

ability in recalling the title. The character & the values regarding the story play which is

based from the Bible. It also served as a means of instruments in recognizing good manners

& values since the story was based from the bible.

GOALS

1. To enhance the client’s intellectual & memory capacity in recalling the important

facts & details to the therapeutic activities and retain this to his mind in order to use

it for future goals.

2. To provide a means of the entertainment & enjoyment in order to provide a lively &

active working environment to the client.

3. To enhance the client thought about good manners & values and be able to apply it

to his relationship with others.

4. To assess the client feelings and thoughts regarding his view about the story and its

relationship to her experiences in life in order to explore the feelings of the client

even more.

5. To enhance the clients understanding & reminding regarding the thought of the

topic & be able to express the opinion.

PROCEDURE

1. Prepare all the necessary equipment/ materials.

2. Make a television image the put curtains around it.

3. Present the improvised television together with the puppets handled by the student

nurses behind the blanket.

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4. Allow the clients to watch the whole play & ask them if they recall the important

details regarding the story on a group dynamics as wells as one on one interview

with the client.

Si Noe at ang Dakilang baha

Narrator: Si Noe ay isang lalaking sumasamba sa Diyos. Ang bawat isa ay galit at suwail sa Diyos.

Isang araw, nagsabi ang Diyos ng mga ilang bagay na katakut- takot.

Diyos: Noe, makinig ka! Sisirain ko ang mga masasama sa mundo. Ang iyong sambahayan at ikaw lamang ang makakaligtas.

Noe: Panginoon, ano po ang dapat kong gawin?

Diyos: Magkakaroon ng malaking baha ng tubig sa ibabaw ng mundo. Gagawa ka ng daong na kahoy, malaking sasakyan para sa iyong sambahayan at maraming mga hayupan.

Narrator: Minanduhan ng Diyos si Noe. Binigyan si Noe ng tumpak na utos. Si Noe ay kumilos agad. Kinutya si Noe ng mga tao habang nagpapaliwanag kungbakit gumagawa ng daong o arko. Sinabi niya sa mga tao ang tungkol sa baha ngunit walng nakinig sa kanya.

Mga tao: Kalokohan! Paano babaha dito at ni minsan ay hindi pa naulan. Niloloko mo lamang kami. Hindi kami naniniwala sayo. Sinungaling!

Noe: Malaki ang tiwala ko sa Panginoon. Naniniwala ako sa kanyang pahayag kahit hindi pa naulan kahit kalian.

Narrator: Kaya’t sinunod ni Noe ang ipinag- utos ng Diyos. Gumawa siya ng malaking arko. Nang matapos na ito ay handa ng lagyan ng mga pangkailangan. Ngayon dumating ang iba’t ibang uri ng hayop. May mga ibon, may mga malalakin hayop, maliliit, at matatangkad. Ang lahat ng ito ay pumasok sa arko.

Pinagtawanan ng mga tao si Noe.

Mga tao: Ha ha ha ha ha! Ha haha haha haha! Ha ha!

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Narrator: Hindi sila naniniwala tungkol sa mlakimg pagbaha kaya’t sila ay walang takot at pinagpatuloy ang kanilang masasamang Gawain. Ngayon lahat ng mga hayop at mga iboon ay nasa daong na, gayundin ang pamilya ni Noe. Si Noe, ang kanyang asawa, ang 3 anak na lalaki at ang kanilang mga asawa ay nagsipasok na sa arko. Sinara ng Diyos ang pintuan!

Pagkatapos ay biglang dumating ang ulan. Malakas na malakas ang ulan na bumaha ng bumaha sa ibabaw ng lupa. Nalunod ang mga taong hindi naniniwala kay Noe. Gusto man nilang pumasok sa arko ngunit huli na ang lahat. Bumaha sa lahat ng lungsod at nayon.

Mga Tao: Tulong! Tulungan niyo kami. Nagsisisi na kami sa mga nagawa naming kasalanan. Noe! Papasukin mo kami. Patawarin mo kami. Maawa na kayo. Tulong!

Narrator: Nang huminto ang ulan, ang mga kabundukan ay inapawan ng tubig. Habang palalim ang bahang tubig, lumutang ang daong sa ibabaw. Ang daong ang nakaligtas kay Noe at kanyang sambahayan sa malaking baha.

Nang matapos ang limang buwang baha, nagpadala ang Diyos ng pangtuyong hangin. Dahan- dahan, ang daong ay huminto sa ibabaw ng Bundok Ararat. Pinalabas ni Noe ang isang kalapati.

Noe: Humayo ka at humanap ng tuyong lupa upang ating pagdaungan.

Narrator: Hindi ito nakakita ng tuyong lupa kaya’t nagbalik ang kalapati. Nang dumaan ang 1 linggo, pinalabas muli ni Noe ang kalapati. Bumalik ito na may dalang dahon ng olibo sa kanyang tuka.

Noe: Kung gayon ay mayroong tuyong lupa! Salamat Panginoon!

Diyos: Ito na ang takdang panahon. Oras na upang umalis kayong lahat sa daong. Pagpalain ka Noe dahil sa iyong pagsunod at pagtitiwala sa akin.

Ang bahaghari na ito ay siyang sumisimbolo ng aking pangako. Hindi na muling magbabaha sa mundo upang parusahan ang mga may kasalanan.

Noe: Purihin ang Panginoon! Diyos na dakila sa lahat. Maraming salmat po at iniligtas ninyo kami sa kapahamakan.

Narrator: Gumawa si Noe ng altar at sumamba sa Diyos na nagligtas sa kanya at sa kanyanh sambahayan sa malaking baha ng tubig. Si Noe at ang kanyang pamilya ay nakahanap muli ng bagong pamumuhay pagkatapos ng dakilang baha.

TAPOS…

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Mr.AM watched & listened attentively to our puppet showed entitled “Si Noeh at

ang Dakilang baha”. He was able to tell the story again to us after watching. The client

got the moral lesson of the story. He remembered his grandfather on the part of the

story wherein Noeh build the ark, because it was his grandfather who made their house.

However suddenly, he opened the topic wherein he said that a diamond was placed

inside his head by his own uncle. The client was able to analyze the story &

comprehended well on it; but at the end of our interaction, he possessed flight of ideas,

telling stories unrelated to what we are really talking about.

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EXPRESSIVE ARTS THERAPY

DEFINITION

Expressive arts therapy is the use of the creative arts as a form of therapy. It is predicted on

the assumption that a client can heal through use of imagination and the various forms of

creative expression. It is also about reclaiming innate capacity as human beings for creative

expression of an individual and collective human experience its artistic form.

GOALS

1. To express his ideas and feelings.

2. To lessen the anxiety felt by the client in terms of entertainment.

3. To help the client to express his thoughts.

4. To assess the clients working attitudes.

5. To assess clients creativeness.

PROCEDURE

1. The facilitator commences the assigned activity of the day, explaining its nature,

description and how it is done.

2. Prepare the necessary materials needed (A4 paper, glue, and matches w/o the head

part).

3. Instruct the client to make us of the matchsticks by creating images/ figures that

comes into their mind and stick then with glue.

4. Allow them to finish their work and then interpret what image they create.

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Mr. A.M. formed the matchsticks into a house, tree, mountain & sunrays & he

pasted it in a bond paper. He did his art well, it appeared good and the best from other

finished products of the clients. As he said, he remembered his family in the art he did. The

sunrays symbolize hope for him. Then, Mr. A.M. appeared anxious, from the time, we

received him, and so we asked what is bothering him. He said that his uncle was talking to

him through the attachment string his uncle put inside his said. He started to become

blunted & have flight of ideas. At the end of our interaction, the client was able to do the

therapy but he is not that good when we evaluated and interpreted his work.

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SONG THERAPY

DEFINITION

Song therapy will motivate client to enhance their memory by memorizing lyrics of

song as well as the steps or interpretation of it. It will also develop their interpretation

about the meaning of the song on w/c they will easily understand the message of the song.

They will also have to energize their physical strength.

GOALS

1. To encourage client to express feelings by singing a song that is appropriate with

their emotions.

2. To enhance their memory by singing the song repetitively.

3. To enhance their physical strength by having exercised while dancing so that they

can use their strength in more progressive way.

4. To develop their talents about singing & dancing where in client will regain their self-

esteem.

5. To assess client capacity to follow instruction by copying steps from the steps from

the students nurses.

6. To enhance client social relationship w/ others by dancing & singing all together.

PROCEDURE

1. Find & select an aspiring song that is appropriate for the community song.

2. Write the lyrics in the Manila paper.

3. Practice the song until memorized.

4. Create steps threat will match the sentences from every stanzas.

5. Practice together with the patient. Teach them the song & steps.

6. Sing a loud & clear & play the steps gracefully.

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STAR NG PASKOKung kailan pinakamadilim

Ang mga tala ay mas nagniningningGaano man kakapal ang ulapSa likod nito ay may liwanag

Ang liwanag na itoNasa 'ting lahat

Mas sinag ang bawat pusong bukasSa init ng mga yakap

Maghihilom ang lahat ng sugat

Ang nagsindi nitong ilawWalang iba kundi ikawSalamat sa liwanag mo

Muling magkakakulay ang paskoSalamat sa liwanag mo

Muling magkakakulay ang pasko

Tayo ang ilaw sa madilim na daanPagkakapit bisig ngayon higpitanDumaan man sa malakas na alon

Lahat tayo's makakaahon

Ang liwanag na itoNasa 'ting lahat

Mas sinag ang bawat pusong bukasSa init ng mga yakap

Maghihilom ang lahat ng sugat


Muling magkakakulay ang paskoSalamat sa liwanag mo


Kikislap ang pag-asaKahit kanino man

Dahil ikaw Bro, dahil ikaw BroDahil ikaw Bro

Ang star ng pasko

Salamat sa liwanag moMuling magkakakulay ang pasko

Salamat sa liwanag moMuling magkakakulay ang pasko

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Dahil ikaw Bro, dahil ikaw BroDahil ikaw Bro

Ang star ng pasko!

ANALYSIS AND EVALUATION

The client back to the ward earlier because he’s formed a reaction after the first

therapy, so he didn’t attend the song therapy.

But on the performance of the song on the grand socialization day, he can follow the

song and the steps done by the student nurses and the other clients.

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UNIT VI

GLOSSARY

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GLOSSARY

Affect-is the outward expression of the client’s emotional state

Catatonic schizophrenia-characterized by marked psychomotor disturbance, either

motionless or excessive motor activity.

Ambivalence-presence of two opposing feelings.

Anhedonia-loss of interest in pleasurable things.

Aphasia-loss or impairment of the power to use or comprehend words.

Apraxia-inability to carry out purposeful motor activities.

Avolotion-lack of motivation.

Clang association-the sound of the words gives direction to the flow of thought.

Delusions-a fixed, false belief not based in the reality.

Denial-failure to acknowledge an intolerance thought, feeling, experience or reality.

Depersonalization-feeling of strangeness towards ones self.

Displacement-the redirection of feelings to a less threatening object.

Echolalia-pathological repetition of words of others.

Echopraxia-the pathological imitation of posture/ action of others.

Fantasy-conscious distortion of unconscious feelings or wishes.

Fixation-arrest of maturation at certain stages of development.

Flight of ideas-shifting of ideas from one subject to another in a somewhat related way.

Hallucination-false perceptions or perceptual experiences that do not really exist.

Intellectualization-over use of intellectual concepts by an individual to avoid expression of

feelings.

Introjections-symbolic assimilation or taking into one’s self a loved/ hated object.

Neologism-pathological coining of new words.

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Paranoid schizophrenia-characterized by persecutory (feeling victimized) or grandiose

delusions, hallucinations, and occasionally, excessive religiosity(delusional religious focus)or

hostile and aggressive behaviour.

Pharmacological treatments-curing and treating illness that deals in the science of nature

and action of drugs and medicines.

Phobia-an exaggerated and often disabling fear usually inexplicable to the subject and

having sometimes a logical but usu. an illogical or symbolic objects or situation.

Projection-attributing to others one’s unconscious wishes/ fear.

Rationalization-justifying one’s actions which are based on other motives.

Reaction formation-expression of feelings that is the direct opposite of one’s real feelings.

Regression-returning to an earlier level of development in the face of stress.

Repression-unconscious forgetting.

Schizophrenia-a form of mental illness in which there is a withdrawal from reality. It cannot

be defined as a single illness; rather, schizophrenia is thought of as a syndrome or disease

process with many different varieties and symptoms.

Sublimation-the rechanneling of unacceptable instinctual drive with one that is acceptable.

Substitution-replacing the desired unattainable goal with one that is attainable.

Suppression-“Conscious forgetting” a deliberate process of thought blocking.

Symbolism-less threatening object is used to represent another.

Undoing-an attempt to erase an act, thought, feeling or desire.

Word salad-incoherent mixture of words and phrases.

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UNIT VII

REFERENCES

Page | 161

Ann Isaacs,RN,MS,APRN-BC. “Mental Health and Psychiatric Nursing” Lippincotts

Review Series, 4th Series. Philippines, 2005

Shiela L. Videbeck. “Psychiatric Mental Health Nursing”, 2nd Edition. Philippines

2004

Marilynn E.D., et al. “Nurses Pocket Guide: Diagnosis, Prioritized Interventions and

Rationales” 10th Edition. F.A.Davis Company, Philadelphia, Pennsylvania, 2006

PPD’s, “Nursing Drug Guide” Malan Press Inc. Philippines, 2007

Merriam-Webster's Medical Dictionary, Merriam-Webster, Incorporated, United

States of America, 2006

Ray A. Gapuz et al. "Mosby's Essential Concepts for the Philippine Nurse Licensure

Exam" Philippines, 2010

Maria loreto evangelista-Sia."Psychiatric Nursing", RMSIA Publishing, Philippines,

2004

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UNIT VIII

DOCUMENTATION

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Documents

Comprehensive Case Study Paranoid Schizophrenia