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BULACAN STATE UNIVERSITY
Mojon, City of Malolos, Bulacan
COLLEGE OF NURSING
A Case Study of Ms. Sue with a diagnosis of Manic
Disorder with Pyschotic Feature (monosocial); to
consider Paranoidal SchizophreniaSubmitted By:
Group 2
De Leon, Charmaine P.
De Leon, Lara Erika B
De Leon, Mardielyn Rose M.
dela Cruz, Albert S.
dela Cruz, Jennelyn Y.
Dungca, Rhenee Anne G.
Eusebio, Omar
Hilario, Ma. Antonette A.
Iguban, Mickael John O.Leano, Gianina Marie P.
Group 3
Lumba, Christine Joy O.
Lumba, Eries L.
Martin, Claire Rochelle Erika A.
Nepomuceno, Anna Mhelysa F.
Pagal, Mylene
Perez, Ma. Cristina S.
Pescador, John Robert A.
Pingol, Criselle L.
Placides, Marrose Arra R.
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In Partial Fulfillment of the Requirements in NCM 105 B RLE
Mariveles Mental Hospital
Mariveles, Bataan
(February 14, 2013)
Submitted to:
3rd Level Clinical Instructors
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I. INTRODUCTION
This is a case of MS. SUE, 55 years old, that was admitted at Mariveles Mental hospital last August 31, 2012 and was diagnosed of Bipolar Manic Disorder
with Psychotic features. The patient was admitted at the female ward due to the complaints of the informants that the client escaped from home, refused to take
medications, refused to eat meals except for fruits and was talking and singing aloud.
Mood disorders, also called affective disorders, are pervasive alterations in emotions that are manifested by depression, mania, or both. There are two major
classifications of mood disorder. The Major Depressive Disorder, which is characterized by occurrence of one or more depressive episodes and absence of manic,
mixed and hypomanic episodes, and the Bipolar Disorder.
Bipolar disorder or BipolarAffective Disorder, historically known as manicdepressive disorder, is apsychiatric diagnosis
, defined by the presence of one or
more episodes of abnormally elevated energy levels, cognition
, andmood accompanied by abnormal behaviour with one or more depressive episodes. The elevated
moods are clinically referred to as mania or, if milder, hypomania. They also experience depressive episodes, or symptoms, or a mixed state in which features of
both mania and depression are present at the same time. These events are usually separated by periods of "normal"mood; but, in some individuals, depression and
mania may rapidly alternate, which is called rapid cycling. Severe manic episodes can sometimes lead to suchpsychotic symptoms as delusions.
People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or
overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of
both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode. Bipolar disorder
symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness
can lead full and productive lives. For the purpose of medical diagnosis, Bipolar Disorder can are described as Bipolar I disorderone or more manic or mixed
episodes usually accompanied by major depressive episodes; Bipolar II disorderone or more major depressive episode accompanied by at least one hypomanic
episode. In short, in type 1, manic episodes are more prevalent while vice versa.
Various theories for the etiology of mood disorders exist. Most recent research focuses on chemical biologic imbalances as the cause. Nevertheless
psychosocial stressors and interpersonal events appear to trigger certain physiologic and chemical changes in the brain, which significantly alter the balance of
neurotransmitters (Gabbard, 2000). Bipolar I disorder with psychotic features is a mood disorder characterized by unusually euphoric or agitated moods, along with
depression or a mix of high and low moods. Psychotic symptoms are also part of this disorder, which can severely impact a person's ability to function. An accuratediagnosis and appropriate treatment plan are vital to the successful management of bipolar I disorder with psychotic features.
http://en.wikipedia.org/wiki/Affect_(psychology)http://en.wikipedia.org/wiki/Classification_of_mental_disordershttp://en.wikipedia.org/wiki/Cognitionhttp://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Major_depressive_episodehttp://en.wikipedia.org/wiki/Mixed_state_(psychiatry)http://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Rapid_cyclinghttp://en.wikipedia.org/wiki/Rapid_cyclinghttp://en.wikipedia.org/wiki/Psychotichttp://en.wikipedia.org/wiki/Delusionshttp://en.wikipedia.org/wiki/Delusionshttp://en.wikipedia.org/wiki/Classification_of_mental_disordershttp://en.wikipedia.org/wiki/Cognitionhttp://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Major_depressive_episodehttp://en.wikipedia.org/wiki/Mixed_state_(psychiatry)http://en.wikipedia.org/wiki/Mood_(psychology)http://en.wikipedia.org/wiki/Rapid_cyclinghttp://en.wikipedia.org/wiki/Psychotichttp://en.wikipedia.org/wiki/Delusionshttp://en.wikipedia.org/wiki/Affect_(psychology)7/30/2019 Case Pres. Psyche
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According to PubMed-US National Library of Medicine National Institutes of Health, the Prevalence of Bipolar 1 Disorder in the World Mental Health
Survey Initiative, the aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I). In United States, Bipolar Disorder has an incidence of
approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. The median age of onset for bipolar disorder is 25
years, although the illness can start in early childhood or as late as the 40s and 50s.An equal number of men and women develop bipolar illness and it is found in
all ages, races, ethnic groups and social classes. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar
major depression, indicating that the disease has a heritable component. Locally, according to the record of Mariveles Mental Hospital as of 2012, there are 1030 patients
who are admitted and only 50 or 4.85% of the total number of patients are diagnosed having Bipolar Manic Disorder. Among them, 62% (31) are Male while the remaining 38%
(19) are female.
References:
http://www.ncbi.nlm.nih.gov/pubmed/21383262
Videbeck 4th ed.
http://www.ncbi.nlm.nih.gov/pubmed/21383262http://www.ncbi.nlm.nih.gov/pubmed/213832627/30/2019 Case Pres. Psyche
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II. OBJECTIVES
General Objectives
The study aims to supply knowledge about its definition, manifestation, sign and symptoms, complications and treatment to students and to the patientsregarding Bipolar Disorders. This study also aspires to enhance the skills of the student nurses in handling and caring for psychiatric nurses especially those with
Bipolar Disorders. Another aim that this study wants to achieve is to inculcate or instill virtues such as patients understanding, kindness, devotion and dedication in
the heart of nursing students.
Client Centered
To improve condition by reorienting our client into reality.
To express and explore clients thoughts and feelings.
To sustain an interactive conversation without or with decrease level of anxiety.
Student Centered
To gain knowledge about Bipolar Manic Disorder, Schizophrenia and Pyschosis
To improve therapeutic communication skills of the student nurse.
To gain and develop trust with client through self-awareness.
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III. NURSING ASSESSMENT
A. Biographic Data
NAME: Ms. SueAGE: 55 y/o
GENDER: Female
ADDRESS: Mariveles, Bataan
DATE OF BIRTH: December 17, 1957
PLACE OF BIRTH: Estancia, Iloilo
NATIONALITY: Filipino
CIVIL STATUS: Single
RELIGION: Born Again Christian
HIGHEST EDUCATIONAL ATTAINMENT: College Graduate
DIAGNOSIS: Bipolar Manic Disorder with Pyschotic Feature (monosocial), To consider Paranoidal Schizophrenia
DATE ADMITTED: August 31, 2012
TIME ADMITTED: 10:35am
TYPE OF ADMISSION: Old (3x)
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CHIEF COMPLAINT (recent admission):
Escaped from Home
Refused to take Medications
Poor Sleep
Talking Singing Aloud
Refuse to eat meal except for fruits
- source: Ms. VM (friend)
B. History Illness
Prior to Admission During Institutionalization Upon HandlingIn 1999, before being brought to a Mental
Institution, she was first brought to Bautista HomeCare Facility because she was eliciting
manifestations of mental illnesses. She was releasedin 2000 and is attending OPD check-ups on Juneand July(unknown institution) and was diagnosed
with Bipolar Manic and Psychotic Features; shestopped her medications August of that year..
Patient had several confinements at MMH. Her firstadmission was on November 05, 2010, with
complains of stopping her medications, being very
noisy and difficulty sleeping. She was diagnosedagain with Bipolar Manic and Psychotic Features.Her 2nd Admission was on October 06, 2011, with
At August 31, 2012, ACIS, she was seen by the
psychiatrist and she was described as being hostile,very noisy and uncooperative. According to the
records, she was verbalizing Ang aking kaharian,singing loudly lalalalala and she called herphysician as Dr. Quack-Quack.
On September 07, 2012, she was seen again by thephysician and was described as wearing appropriate
clothes, barefoot and was holding a water bottlewhile being interviewed. She was exhibiting
Delusion of Grandeur, saying that she was the
product manager in Malacanang since Marcosregime. She claimed that the people who arewatching her are unknown to her, but later said
February 07, 2013, signals the start of
our Nurse Patient Interaction (NPI). Wemet our client Ms. Sue and she can be
described as a cooperative patient,polite and well behaved. She was veryconscious with her hygiene. We have
also observed that the client is reallyconscious when it comes to time. She
does not like being late as observedwhen we were grooming her. She
appears to be calm and easily
controlled during our NPI. Sheparticipated on all of the activities andreally showed enthusiasm in all of
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complains of difficulty sleeping then she wasdiagnosed again like the previous. Before her
present admission, she obediently attends to herfollow-up check-up at the OPD until June 2012.
Last July 2012, the client started to refuse takingmedications for her psychiatric condition and
Medications for Liver, Kidney and DiabetesMellitus. She stated that she stopped because she
listened to an advice (unknown informant) that themedications are the one causing her Robot-like
movements or feeling. She stated that she compliedto it because she is actually experiencing the
manifestations that the informant told her. ByAugust 05, 2012, she escaped from the house of the
informant by climbing down a guava tree near theinformants fence, then she went to Baesa, QuezonCity where her friend lost contact from her. On
August 8, 2012 (before the date of admission), the
informant learned that she was placed at a barangaystation (unknown location) due to complains fromthe supermarket employees who she had a quarrel
with. Non Smoker.
huwag kang maniniwala, singungaling yan!.On the following day, September 08, 2012, she was
seen again by the physician and was described ashaving a well-kept appearance and behaviour,
severely cheerful, dated, good mood, talkative,argumentative but polite, speaks in English with
mood disturbances while speaking. She admittedthat she is dancing and singing. When asked why,
she answered Syempre, Masaya!!. She was alsoexhibiting Referential Delusion verbalizing
nagbebenta ako ng imported giveaways, admitsthat she was called by the king of the Department
of Budget and Managament. She was alsoexhibiting Persecutory delusions, verbalizing,
maraming galit sa akin, pinapatay nila ako, dikoalam kung bakit (she was pertaining to Dela CruzFamily). She was also suspicious saying Yung
gamot na binibigay nyo, Tranquilizer that is
SHABU!. She claims that she wants to live alone,verbalizing Ayaw kong minamahal ako odinodomina ako, she accuses her guardian saying
ikaw ba talagang tapat sa akin? Sagutin mo ako!!,she was also observed with having poor insight
saying Magaling na ako eh, di ko na kailanganggamot.
them. During our last day handling her,she was being visited by her friend. We
were surprised to see a new side of heras she is demonstrating hostility as she
was begging her friend to take herhome already. This was the first time
that we have seen her like that. She wasstill mentioning that once she comes
out from the facility, she wouldimmediately get her salary from her
company and start her life anew. Sheeven demonstrated delusion of
grandeur as she verbalized that shewould help us financially when she gets
out of the facility to reward us fortaking good care of her.
C. Previous Illnesses
The client was also diagnosed with Type 2 Diabetes Mellitus 2 years ago and was prescribed to take Hypoglycemic Agents like Metformin. She took
the medications for one year and then she refused to take the said medications. The client also recalled having cough and cold prior to admission. She also
remembered having chickenpox when she was 12 years old.
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D. Past Personal History
The earliest event that the client remembered was playing with her siblings and friends at Iloilo City. She told us she was average student and has
never had a serious problem at school. During her high school years, she used to hang out with her friends especially with her bestfriend. She did not finish her
studies as she took up nursing at Central Philippines University due to financial problems.
The client worked as an attendant at the Bataan Hilltop Hotel during her younger years in which she recalled seeing many of the famous artists like
FPJ, Alma Moreno and Rudy Fernandez. She is not married and she never had boyfriend even when she was young because according to her, her focus was to finish
her studies and being able to help her family first.
E. Family History
According to her, before she was diagnosed, she had a good relationship with her family. She used to hang out with her siblings and spend every
Christmas together. But recently, she is very angry at her siblings after they brought her to 3 different Mental Health Institutions and refused to take responsibility of
her. According to the client, there is no previous history of mental illness within the family but her mother was diagnosed with heart condition.
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IV. Mental Status Examination
LEVEL OF CONSCIOUSNESS Day1 Day2 Day3 Day4 Day5
Alert * * * * *
Drowsy
Cooperative * * * * *
Eye contact * * * * *
AFFECT
Flat
Blunted
Inappropriate
MOOD
Appropriate * * * * *
Anxious
Agitated
Elated *
Depressed
DRESS
Appropriate * * * * *
Neat * * * * *
HYGIENE
Good * * * * *
PoorORIENTATION
Time * * * * *
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Place * * * * *
Person * * * * *
Situation * * * * *
MEMORY
Recent (Dinner/Breakfast * * * * *
Recent (Current Events) * * * * *
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Immediate (Short Term)
Remote ( Long Term) * * * * *
DEFENSE MECHANISM
Displacement
Denial * * * * *
Intellectualization
Introjection
Projection * *
RationalizationReaction Formation
Regression
Repression
Sublimation
Suppression
Identification
Isolation
Others:
EXTRA PYRAMIDAL
SYMPTOMS
PSEUDOPARKINSONISMAkinesia
Mask-like face
No swinging of arms
Hesitancy of Speech
Decrease muscle strengths
Shuffling gait
Drooling
Fine intention tremors * * * * *
ACUTE DYSTONIC
REACTION
Muscle spasm of the jaw, neck, tongue,eyes
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Laryngeal spasm
Akathesia
Restlessness
Tenseness *
Inability to sit still
Rocking back and forth of feet
Crossing legs frequently
Inability to relax
TARDIVE DYSKINESIA
Involuntary movement of mouth,
tongue ,face, and may extend to
finger arms and trunk
THINKING
COMMUNICATIONS
Loose Association
Neologism
Word Salad Echolalia
Echopraxia
Clang Association
Illogical thinking
Alogia
Concrete Thinking * * * *
Lack of Insight * * * * *
PERCEIVING AND INTERPRETING
Delusions
Reference
Persecution
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External influences
Somatic
Grandiose *
Hallucination
Cinesthetics
VisualOlfactory
Gustatory
Auditory
Tactile
SUMMARY OF MENTAL STATUS EXAMINATION:
During the five days of assessing the Mental State of the patient, she shows alertness, cooperativeness, and eye contact. Her mood is appropriate and
is oriented to time, place, person and situation. She was dressed appropriately and neatly, and her hygiene is good. She still remembers recent events and has long
term memory. She exhibits some extra pyramidal symptoms like fine intention tremors and tenseness.
While conducting a Nurse- Patient Interaction, the patient shows defense mechanism characterized as Denial and Projection. She denied her
condition because she has poor judgement which leads to the lack of knowledge about her mental condition. She exhibits Projection as a defense mechanism
because she believes that she doesnt have mental illness, she hates her family for bringing her to the Mental Institution, the reason why she wants them to
experience her affliction inside the ward.
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V. THEORETICAL FRAMEWORK
A. GROWTH AND DEVELOPMENT
Name: SCB
Age: 55 years
THEORY PSYCHOSOCIAL(Erik Erikson)
COGNITIVE(Jean Piaget)
PSYCHOSEXUAL(Sigmund Freud)
MORAL(Lawrence Kohlberg)
STAGE Intimacy vs. Isolation
( 18 -25 yrs. old)
Formal Operational
(12- Adulthood)
Genital Stage
(12 - Adulthood)
Post - Conventional: Universal
Ethical Principle Oriented
DEFINITION This stage covers the periodof early adulthood when
people are exploringpersonal relationships.
Erikson believed it wasvital that people develop
close, committedrelationships with otherpeople. Those who are
successful at this step willform relationships that are
committed and secure.
The formal operational stagebegins at approximately age
twelve to and lasts intoadulthood. During this time,
people develop the ability tothink about abstract concepts.
Skills such as logical thought,deductive reasoning, andsystematic planning also
emerge during this stage.
During the final stage of
psychosexual development,the individual develops astrong sexual interest in the
opposite sex. This stage beginsduring puberty but last
throughout the rest of aperson's life.
Where in earlier stages the
focus was solely on individualneeds, interest in the welfare
of others grows during this
stage. If the other stages havebeen completed successfully,the individual should now be
Kolhbergs final level of moralreasoning is based upon
universal ethical principles andabstract reasoning. At this
stage, people follow theseinternalized principles of
justice, even if they conflictwith laws and rules.
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well-balanced, warm and
caring. The goal of this stageis to establish a balance
between the various life areas.
REMARKS/ANALYSIS Client was not able to satisfy
this stage because she did nothave her own family. Instead,
she supported her family to thefullest. Client is isolated due to
the fact that she is separatedfrom her relatives and loved
ones.
Client developed a formal
cognitive perception asevidenced by observed clients
ability to reason out answer tological questions.
Client did not pass through
this stage completely becauseclient did not satisfy her sexual
desires as well as a need forfamily even though her
reproductive system isfunctioning normal.
Before, client was able to
identify ethical principles suchas a persons right and rules of
the state but now she is unableto differentiate right from
wrong. Also her decisionmaking is somewhat affected
due to her psychologicalproblem. This is evidenced by
wrong judgement when asked
about situational problems.
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B. Theoretical Frameworks
Theory Theorist Description Application of the Theory to thePatient
Self-Care Theory Dorothea Orem The provision of self-care which istherapeutic in sustaining life andhealth, in recovering from disease
or injury, or coping with theireffects.
Nursing promotes the goal ofpatient self-care.
a. SELF-CARE
- comprises those activitiesperformed independently by an
individual to promote and maintain
personal well-being throughoutlife.
b. SELF-CARE DEFICITresults when the Self-care Agency
(patient) cant meet her/his self-care needs or administer self-care
Orem focused on a specific need ofperson, which is self care. This canbe defined as being able to maintain
health with the help of oneself. But ifone is psychologically incapacitated,
he/she might not be able to do suchtask. This theory serves as a guide
for us student nurses to act in helpingout clients take care of themselves
again or achieve maximum level ofwellness as possible.
Nightingales Environmental Theory Florence Nightingale Defined Nursing:The act ofutilizing the environment of the
patient to assist him in his
recovery.
Focuses on changing and
manipulating the environment in
We used this theory to determine thefactors that will affect clients health
as well as in choosing appropriateinterventions for our clients.
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order to put the patient in the bestpossible conditions for nature to
act.
Identified 5 environmental factors
NECK AND LYMPH
NODES
Symmetry and visible
mass of thyroid gland
Presence of tenderness or
nodules in the lymph
nodes
Placement of trachea
Smoothness and areas of
enlargement, masses or
nodules in the thyroid
gland
SKIN
Inspection
Palpation
Palpation
Palpation
Asking the client
to lower the chinslightly
Glands ascends during
swallowing but is not visible
Not palpable
Central placement in themidline of neck; spaces are
equal on both sides
Lobes may not be palpable
No visible masses
No nodules or tenderness
In midline of neck
No areas of enlargement
Normal
Normal
Normal
Normal
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Inspect for color anduniformity
Inspect for the presence
of edema
Inspect and palpate for
skin lesions according to
location distribution,
color, configuration, size,
shape, type or structure
Observe and palpate skin
moisture
Note skin temperature
Note for skin turgor
NAILS
Inspection
Inspection andPalpation
Inspection and
Palpation
Inspection andPalpation
Palpation
Inspection
Varies from light to deepbrown, ruddy pink to light
pink, yellow overtones to olive;generally uniform except in
areas exposed to the sun, areasof lighter pigmentation in dark-
skinned people
No edema and inflammation
Freckles, some birthmarks,
some flat and raised nevi; noabrasions or other lesions
Moisture in the skin folds andaxillae
Uniform, within normal range
Skin springs back to previousstate; may be slower in elders
There are no observablepatches in the clients face
and skin
(-) edema
There are noticeable scratch
marks all over the body ofthe client. Prominent onboth legs.
The patient has dry skin.
Skin temperature is within
normal range
Skin springs back slowly
Normal
Normal
Deviation from normal due to itchiness
Deviation from normal due to poor sanitation
Normal
Due to poor hydration and aging
Normal
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Inspect fingernail shape
to determine its curvature
and angle
Inspect fingernail and
toenail texture
Inspect fingernail and
toenail bed color
Inspect tissues
surrounding nails
Perform blanch test or
capillary refill
THORAX
Inspection
InspectionInspection
Inspection
Inspection
Convex curvature, angle of nail
plate about 160
Smooth textureHighly vascular and pink inlight skinned clients; dark
skinned clients may havebrown or black pigmentation in
longitudinal streaks
Intact epidermis
Prompt return of pink or usualcolor
No signs of early clubbing
Smooth texturePink in color
No presence of lesions
Skin return to its normal
color; pinkish
Normal
Normal
Normal
Normal
ANTERIOR THORAX
1. Breathing patterns Inspection Quiet, rhythmic, and effortless
respirations
Normal rhythmic breathing Normal
2. Temperature,
tenderness, masses
Palpation Skin intact; uniform
temperature; chest wall intact;
Has an intact skin; has equal
warmth on both sides. No
Normal
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no tenderness; no masses masses.
3. Anterior thorax
auscultation
Auscultation Bronchovesicular and vesicular
breath sounds
No crackles sounds on the
upper thorax & lower
thorax
Normal
POSTERIOR
THORAX
1. Shape, symmetry, and
comparison of
anteroposterior thorax to
transverse diameter
Inspection
Palpation
Anteroposterior to transverse
diameter in ratio 1:2; Chest
symmetric
Has a anteroposterior to
transverse diameter ratio of
1:2, elliptical in shape and
symmetrical chest
Normal
2. Spinal alignment Inspection Spine vertically aligned Has a vertical alignment Normal
3. Temperature,
tenderness, and masses
Palpation Skin intact; uniform
temperature; chest wall intact;
no tenderness; no masses
No masses nor tenderness;
has equal warmth on each
side
Normal
7. Posterior thorax
auscultation
Auscultation Vesicular and bronchovesicular
breath sounds
No crackles, heard on the
anterior and middle part of
right and left lungs.
Normal
CARDIOVASCULAR
AORTIC andPULMONIC AREAS Auscultation No pulsations No pulsations felt Normal
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TRICUSPID AREA Auscultation No pulsations; no lift or heave No pulsations of lifts Normal
APICAL AREA Auscultation Pulsations visible in 50% of
adults and palpable in most
PMI in fifth LICS at or medial
to MCL
Has full pulsation Normal
EPIGASTRIC AREA Auscultation Aortic pulsations Has pulsation Normal
CARDIOVASCULAR
AREAS
AUSCULTATION
Auscultation S1: Usually heard at all sites
Usually louder at the apical
area
S2: Usually heard at all sites
Usually louder at the base of
heart
Systole: silent interval; slightly
shorter duration than diastole atnormal heart rate (60 to 90
beats/min)
Diastole: silent interval;
slightly longer duration than
systole at normal heart rates
S3: in children and young
adults
S4: in many older adults
Has full and rapid pulsation.
Sounds on the aortic and
pulmonic areas; has a lub
sound on the apex and dub
sounds on the tricuspid area.
Normal
Normal
Normal
CAROTID ARTERIES
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1. Carotid artery
palpation
Palpation Symmetric pulse volumes; full
pulsations, thrusting quality;
quality remains same when the
client breathes, turns head, and
changes from sitting to supine
position; elastic arterial wall
Normal pulsation.
Symmetrical pulse.
Normal
AXILLAE
1. Axillary, subclavicular,
and supraclavicular
lymph nodes
Inspection No tenderness, masses, or
nodules
Have no masses and
nodules.
Normal
ABDOMEN
1. Skin integrity Inspection Unblemished skin; uniform
color
Uniform color and has no
blemishes
Normal
2. Abdominal contour Inspection Flat, rounded(convex), or
scaphoid(concave)
Has a concave abdomen. Normal
3. Enlargement of liver or
spleen
Inspection No evidence of enlargement of
liver or spleen
No enlargement of the
spleen and liver seen
Normal
4.Symmetry of contour Inspection Symmetric contour Has a symmetrical
abdominal contour
Normal
5. Abdominal movements
associated with
respirations, peristalsis or
aortic pulsations
Inspection Symmetric movements caused
by respiration; visible
peristalsis in very lean people;
aortic pulsations in thinpersons at epigastric area
Abdominal movements
noted when inhaling.
Normal
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6. Vascular pattern Inspection No visible vascular pattern Has no blood vessels visible Normal
MUSCULOSKELETAL
SYSTEM
MUSCLES
1. Muscle size and
comparison on the other
side
Inspection Proportionate to the body; even
in both sides
Proportionate to the body;
even in both sides
Normal
2. Fasciculation and
tremors in the muscles
Inspection No fasciculation and tremors Has tremors Deviation from normal due to the side effects of
medications.
3. Muscle tonicity Palpation Even and firm muscle tone Even and firm muscle tone Normal
4. Muscle strength Palpation Has equal muscular strength on
both sides
Has equal muscular strength
on both sides
Normal
JOINTS
1. Joint swelling Inspection No swelling, no warmth, no
redness, no pain, no crepitus
No swelling, no warmth, no
redness, no pain, no crepitus Normal
EXTREMETIES Inspection,
Palpation
No swelling, no warmth, no
redness, no pain.
No swelling, no warmth, no
redness, no pain. Normal
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PHYSICAL ASSESSMENT SUMMARY
GENERAL: The patient is a nourished female; alert and oriented.
VITAL SIGNS: Temperature: 36C, PR: 82 bpm, RR: 28 cpm, BP: 110/80 mmHg
HEENT: Head is normocephalic and atraumatic; Patches of alopecia are present, with thin hair, dry and flaky scalp; lice and lesions are present in the head.
Presence of cerumen and wounds on both ears (pinna); Presence of mouth sores; Extraocular muscles are intact.
NECK: No carotid bruits. No lymphadenopathy or thyromegaly.
LUNGS: No crackles heard on the anterior and middle part of right and left lungs.
HEART: Regular rate and rhythm without murmur.
ABDOMEN: Soft, not tender, and not distended. No Hepatosplenomegaly.
MUSCLE: Has tremors.
SKIN: There are noticeable scratch marks all over the body of the client; presence of lesions on both legs; skin springs back slowly and with dry skin.
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VIII. LABORATORY
Laboratory
Procedure
Date Ordered.
Date of Result
Indication/
Purposes
Normal Values Actual Values Analysis/
Interpretation
Nursing
Responsibilities
Blood Chemistry
- FBS- Cholesterol
- Triglycerides
Ordered:
December 20
Result:January 24, 2013
A test to assess a
wide range of
conditions andthe function oforgan.
60-110.9 mg/dl0-200 mg/dl
97-190.3 mg/dl
65.4 mg/dl186.9 mg/dl
132.6 mg/dl
NormalNormal
Normal
Prior:
- Define and
explain thetest.
- State the
specificpurpose of the
test.- Explain the
procedure.- Discuss test
preparation,procedure, and
post test care.
During:
- Ensure that the
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specimen issecured in a
sterilecontainer.
After:
- Apply manual
pressure anddressings overpuncture site.
- Monitor thepuncture site
for hematomaformation.
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IX. Medical Management (Pharamacologic Treatments)
DRUG NAME MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDE/ ADVERSEEFFECT
NURSINGCONSIDERATIONS
Generic Name:Clonazepam
Classification:Anti-convulsant
Anxiolytics
Route/Dosage:2mg tab PO HS then
PRN tab
Probably acts byfacilitating the effects ofthe inhibitory
neurotransmitter GABA
Atypical absenceseizures
Akinetic and
myoclonicseizures
Panic disorder
Acute manic
episodes of
bipolar disorder
Contraindicated inpatients
hypersensitive tobenzodiazepine.
Use cautiously in
patients with mixedtype seizurebecause drug may
cause tonic-clonicseizures
Drowsiness
Agitation
Ataxia
Slurred speech
Tremor
Confusion
Behavioral
Disturbance
Closely monitorall patients for
changes inbehavior that
may indicateworsening of
suicidal thoughtsor behavior or
depression/.
Dont stop drug
abruptly
Assess elderlypatients responseclosely. Elderly
patients are moresensitive to CNS
drug effects.
Monitor CBC
and liver functiontests.
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DRUG NAME MECHANISM OFACTION
INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSEEFFECTS
NURSINGCONSIDERATIONS
Generic Name:
Divalproex Sodium
Classification:Anti-convulsant
Route/Dosage:250mg PO OD
Probably facilitates the
effects of the inhibitoryneurotransmitter GABA.
Simple and
complex absenceseizures
Complex partial
seizures
Mania associated
with bipolar
disorder
Prevent migraine
headache.
Contraindicated in
patientshypersensitive to
drug and in thosewith hepatic
disease.
Dizziness
Headache
Blurred vision
Back and neck
pain
Give drugs with
food to avoid toreduce adverse
GI effects.
Advise patient to
immediately
report malaise,weakness,
lethargy, appetiteloss, vomiting, or
yellowing of skinor eyes. It can bea symptom of
hepaticdysfunction.
Dont stop drug
abruptly.
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DRUG NAME MECHANISM OFACTION
INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSEEFFECTS
NURSINGCONSIDERATIONS
Generic Name:Quetiapine
Classification:Antipsychotics
Route/Dosage:
300 mg HS
Blocks dopamine andserotonin receptors. Itsaction may be mediated
through thisanatagonism.
Schizophrenia
Adjunct therapy
with Lithium or
Divalproex forthe short term
treatment of acutemanic episodes
associated withbipolar disorder.
Depression
associated with
bipolar disorder.
Contraindicated in
patients withhypersensitive to
drug or itsingredients.
Use cautiously in
patients with
conditions that canpredispose
hypotension andconditions in
which core bodytemperature maybe elevated.
Orthostatic
hypotension
Flulike syndrome
Dizziness
Headache
Somnolence
Skin Rash
Wight gain
Hyperglycemia
Dont break or crus
tablets
Give drug without
regard for food
Watch out for
evidence of
neuroleptic malignasyndrome
(extrapyramidaleffects, hypertherm
autonomicdisturbance) which
rare but deadly. Monitor patient for
Tardive Dyskinesia
which may occurafter prolonged use
of drug.
Monitor for
metabolic syndromwt. gain,
hyperglycemia,hypercholesterolem
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DRUG NAME MECHANISM OF
ACTION
INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSE
EFFECTS
NURSING
CONSIDERATIONS
Generic Name:Dipenhydramine
Classification:
Anti-histamine; Anti-parkinsonian
Route/Dosage:
50 mg PO HS
Competes withhistamine for H1-
receptor sites. Prevents,but doesnt reverse,
histamine-mediatedresponses, particularly
those of the bronchialtubes, GI tract, uterus
and blood vessels.
Rhinitis andallergy symptoms
Parkinsons
disease
Sedation
Nighttime sleep
aid
Non-productive
Cough
Contraindicated inpatients
hypersensitive todrug.
Avoid use in
patients with
asthma.
Contraindicated in
patients taking
MAO inhibitors.
Hypotension Tremor
Vertigo
Headache
Dry mouth
Thickening of
bronchial
secretions.
Give drug with fooor milk to reduce G
distress.
Caution the client
that the medicationcan cause
drowsiness.
Explain to the patie
that arising quickly
from a lying orsitting position may
cause orthostatic
hypotension. Inform patient that
sugarless gum orhard candy may
relieve dry mouth.
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DRUG NAME MECHANISM OFACTION
INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSEEFFECTS
NURSINGCONSIDERATIONS
Generic Name:Risperidone
Classification:Atypical Antipsychotic
Route/Dosage:
4mg tab
Blocks Dopamine and5-HT receptors in thebrain
Schizophrenia
Combination
therapy with
Lithium orvalproate for 3
week treatment ofacute manic or
mixed episodesfrom bipolar I
disorder.
Contraindicated in
patientshypersensitive to
drugs
Use cautiously in
patients with CVdisease.
Akathisia
Somnolence
Dystonia
Insomia
Agitation
Parkinsonism
Hallucination
Tremor
Abnormal
Thinking
Decreased libido Hypertension
Hyperglycemia
Tell patient that
he/she can takedrug with or
without food.
Obtain baseline
blood pressuremeasurements
before therapy.Watch out for
orthostatichypotension.
Monitor patientfor tardive
dyskinesia, whichmay occur after
prolonged use.
Life-threatening
hyperglycemia
may occur.Monitor patients
with Diabetes.
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DRUG NAME MECHANISM OFACTION
INDICATIONS CONTRAINDICATIONS SIDE/ ADVERSEEFFECTS
NURSINGCONSIDERATIONS
Generic Name:Chlorpromazine
Classification:Typical anti-psychotic
Route/Dosage:
100 mg HS
Block dopaminereceptors in the brain;also alter dopamine
release and turnover.
Psychosis
Mania
Behavioral
disorders;hyperactivity
Contraindicated in
patientshypersensitive to
drug.
Contraindicated in
those with CNSdepression.
Use cautiously in
patients with
severe CV disease(may suddenly
decrease bloodpressure)
Extrapyramidal
reactions
Sedation
Tardive dyskinesia
Pseudo
parkinsonism
Ocular changes
Advise patient
not to crush,chew or break
tablet.
Make sure the
medication istaken.
Obtain baseline
blood pressure
measurementsbefore therapy.
Watch out fororthostatic
hypotension.
Monitor patient
for tardive
dyskinesia, whichmay occur after
prolonged use.
Dont stop drug
abruptly.
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X. PROCESS RECORDING
CONVERSATION DEFENSE MECHANISM with ANALYSIS THERAPEUTIC COMMUNICATIONTECHNIQUES USED
FIRST DAY OF INTERACTION
N1: Good morning po. Ano po pangalan nyo?
P: Good morning, kayo ba magiging nurse ko? Akosi S.B.
N2: Opo, ako po si Chelle, siya nman po si Criselleat ito naman po si Eries.
P: Hello Nurse Chelle, Nurse Criselle at Nurse Eries.N3: Sana po maging masaya kayo kasama kame.
P: Mukha naming mag eenjoy ako sa inyo at
mababait naman kayo. Maliligo ba ako?N1: Hindi po, magtutooth brush ka muna po atmaghihilamos po kayo. Tutulungan po naming
kayong gawin iyon.P: Osige. Salamat ha.
(AFTER THE SAID GROOMIING)
N2: May mga sugat po ba kayo?P: Oo, dito sa may ulo, dahil ito sa balikubak e, angtapang kse ng ginagamit naming sabon, Perla.
N3: Ganoon po ba? Osge po, gagamutin po natin angmga sugat nyo. Sabihin nyo po kung masakit at
mahapdi ha.P: Osige. Salamat ha.
RATIONALIZATION
EXPLORING
GIVING INFORMATION OR INFORMING
OFFERING SELF
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(NURSE DOES THE WOUND CARING)
N1: okay na po. Yan lang po ba ang sugat nyo? Walanap o sa katawan?
P: Wala na e. ano na ang susunod nating gagawin?
N3: pupunta po tayo sa area kung saan tayo gagawang mga activities. Tara po, lakarin napo natin.P: Osige.
(WHILE WALKING)N3: Alam nyo po ba kung anong araw ngayon?
P: oo, Thursday. February 7. Db?N2: Opo. Bali makakasama nyo po kami hanggang
sa susunod na byernes, bale pitong araw po tayongmagkakasama at may mga activities na gagawin. Salipo kayo ha, dapat po manalo lagi ang grupo natin.
P: Oo naman sige.(AT THE ACTIVITY AREA)
N1: Upo po tayo maam, magkwentuhan tayo.N3: ilang taon napo kayo?
P: 55 years old. 3rd year nursing student na din bakayo?
N3: opo.N2: ilang taon na po kayong nakaconfine dito?
P: mga aanim na buwan palangg. Pero ito na angpangatlong beses kong napasok dito. Gusto ko na
ngang umuwi e.N3: taga saan po ba kayo?
P: Taga Ilo-ilo talaga ako, kaya lang nanirahan akosa QC dahil sa Malacanan ako nagtatrabaho noon.
N1: sino po bang nagpadala dito sa inyo?P: yung mga kapatid ko. May nangyari kasi sa akin
COMPENSATION
GIVING INFORMATION OR INFORMING
GIVING INFORMATION OF INFORMING
OFFERING SELF
EXPLORING
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at ayaw nila akong paniwalaan, hindi nila akoiniintindi.
N3: ano po ba iyon?P; mahabang kwento e, at baka hindi nyo ako
paniwalaan.N1: makikinig po kami sa inyo, asahan nyo po iyon.
P: talaga? Yung mga kapatid ko kasi hindi ito
pinaniniwalaan at sabi nila sira ulo daw ako, e hindinaman ako sira ulo e.N2: ano po bang nangyari?
P: august 25, 1995 may nangyari sa akin. Galing akosa trabaho nun eh, mga alas nyebe ng gabi,
nagpaphinga ako sa terrace ng bahay ko. Tapospumasok na ako sa kwarto ko, may bigla akong
naramdaman na kuryente na nagsimula sa bumbunanko pababa sa buong katawan ko. Itong mga mata ko,napakasakit dahil hinugot ito pababa sa baba pa ng
lupa at nakita ko ang palasyo ng kadiliman, angnamamahala ditto ay si Satanas. Si Satanas ang
pumasok sa katawan ko, at inaalog alog pa nila angkatawan ko para magkasya pa ang napakarami
niyang kamppon. Dahil malapit na daw angpaghuhukom at kailangan nilang pagtago sa katawan
ko dahil ako ay ligtas sa paghuhukom, ang tawagnila sa akin ay Ang Batang Walang Malay. Kapag
daw sila ay pumasok sa katawan ko, magiging ligtasna sila. Nakikita ko ang sila, pumapasok dito sa
bumbunan ko, ito kasi ay malambot, napakasakit.N1: ano pa po ang nakita nyo? Naramdaman?
P: may mga uod na kumakain sa laman ko.N2: pano po yon natapos?
P: napakasakit sa katawan at napakabigat sapakiramdam. Madaming mga diablo at si Satanas ay
DENIAL
CONVERSION
OFFERING SELF
EXPLORING
ENCOURAGING DESCRIPTION OF
PERCEPTIONS
EXPLORING
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pumasok sa katawan ko. Alam nyo ba, nakakausapko din ang Panginoon.
N3: Ano po ang pinag-uusapan nyo?P: ang sabi niya tatagan ko ang loob ko laban kay
Satanas at may binigay syang misyon sa akin.N1: ano po ang misyon na iyon?
P: ang patayin si satanas at puksain ang kasamaan
nito.N3: hanggang ngayon po ba nakakausap nyo sila?P: Oo, nakakausap ko sila, at unti unti nang
nababawasan ang nasa loob ng katawan ko.N2: ano po ang nararamdaman nyo pag ganon?
P: maaliwalas sa pakiramdam. Ngunit ayaw parinakong paniwalaan ng kapatid ko tungkol doon at
dinala nila ako dito. Gustong gusto ko nang umuwi,nakakainip pa dito.N3: ano po ba ang mga pang araw araw na ginagawa
nyo dito?P: wala. Dun lang kame sa ward, kakain, matutulog.
N1: kamusta naman po ang mga kasama nyo?P: okay naman, mabuti nga at walang nakikipag
away doon sa ward naming e.N2: napaaway na po ba kayo dati?
P: Oo, sa ibang ward pa ako non, ayoko sanangpatulan pero pag hindi ako lalaban lalo nila akong
sasaktan.N3: e ang pagkain nyo naman po, kamusta?
P: naku, lutong baboy. Pero wala na akong magawakung hindi kainin to, kung hindi magugutom ako.
N2: pano po kayo sa pagligo?P: araw araw, alas kwatro ng madaling araw, sabay
sabay kami, walang damit lahat.N1: osge po, maam, may gagawin po tayong activity
PROJECTION
ENCOURAGING EVALUATION OR
EVALUATING
EXPLORING
EXPLORING
ASKING QUESTION
EXPLORING
GIVING INFORMATION OR INFORMING
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ha.P: osge.
(ALL PATIENTS PERFORMEDACTIVITY/THERAPY, CLIENT SB
PARTICIPATES WELL. AFTER THE ACTIVITYPATIENTS ATE MIRYENDA AND TOOK THEM
AGAIN IN THEIR RESPECTIVE WARDS)
(while walking back to the clients ward)N2: sana po ay nag enjoy kayo.P: Oo nmana. Salamat ha.
N3: magkikita pa po tayo ulit bukas ha. Salamat po.Mag iingat po kayo.
P: mag ingat din kayo. Salamat.
SECOND DAY OF INTERACTION
P: Hello. Good morning po.N1: Hi. Good morning din po.
N2: Hello Susan. Good morning!N3: Good morning. Natatandaan mo pa ba ang mga
pangalan namin?P: Oo naman po.
N2: Sige nga po. Sino ako?P: Ikaw si Nurse Chelle.
N3: Eh ako naman po sino?P: Nurse Criselle at siya si Nurse Eries.
N1: Wow Susan. Matandain ka pala.N2: Oo nga. Tara, grooming na tayo.
P: Sige po.
(GROOMING AREA)
Seeking Clarification
Seeking Clarification
Seeking Clarification
Giving Recognition
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N3: Magtoothbrush ka muna bago magshampoo parahindi mabasa damit mo.
P: Sige po.N2: Eto na po ang toothbrush mo.
P: Tapos na po.N1: Sige magshampoo ka naman.
P: Sige po.
N2: Eto ang sabon oh. Maghilamos ka naman. Etorin ang face towel. Magpunas ka rin.P: Sige po.
P: Tapos na po. Lalaban ko na rin po tong face towelpara malinis.
N3: Ay sige po. Ang bait mo naman.N1: Oh eto po ang cotton buds. Linis ka muna ng
tenga mo. Tapos maglotion ka rin saka naminglagyan ng betadine yung sugat mo sa ulo.P: Sige po pero sabi ni Maam 15minutes lang daw.
May 15minutes na ba?N2: Ay, ok lang po yun. Ang mahalaga malinis at
magamot naming yung sugat mo. At sakamaglalakad lakad din tayo para may exercise ka.
N3: Ayan okay na. Tara na po lakad lakad muna tayobago magpunta dun sa pinuntahan natin kahapon.
(WHILE WALKING)
N3: Kumusta naman po kayo? Maayos ba ang
naging tulog niyo?P: Ayos naman po ako. Puro ako na lang ang
kinukumusta nyo, kayo po ba kumusta?N2: Ay, ayos lang din naman po kami. Salamat sa
pagtatanong.N1: May activity po ulit tayo ngayon ha.
Giving Recognition
Broad Opening
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P: Talaga po? Anong gagawin natin?N2: Newspaper reading po ang gagawin.
P: Ah. Sige po.N1: Ayan malapit na tayo sa students area.
(STUDENTS AREA)
N2: Upo ka na Susan.P: Salamat po.N1: Bale Susan, Friday ngayon. Hindi tayo
magkikita bukas at sa Sunday ha. Monday na ulittayo magkikita.
P: Ah. Uuwi na ulit kayong Bulacan?N3: Oo, kaya hindi muna tayo magkikita ng
dalawang araw.P: Okay po.N2: Tara, magsimula na tayo sa pagbabasa.
(AFTER NEWSPAPER READING)
N3: Ano po ang masasabi mo?
P: Mataas na yung P125 na umento. Bihira silamagtaas ng ganon sa sweldo. Siguro sa mahal na rin
ng mga bilihin.N1: Nung panahon niyo po ba madalas magtaas ng
sweldo?P: Nako, hindi. Kaya nga maswerte ang mga
nagtatrabaho ngayon kasi mataas na yung P125 naumento.
N2: Doon naman po sa pagiging hydrated? Malakaska po bang uminom ng tubig?
P: Hindi po ako gaano umiinom ng tubig dito.N1: Anong dahilan at hindi ka umiinom?
GIVING INFORMATION OR INFORMING
GIVING INFORMATION OR INFORMING
GIVING INFORMATION OR INFORMING
Presenting Reality
Broad Opening
Exploring
Exploring
Exploring
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P: Malakas akong uminom ng water noong wala paako dito. Kasi mineral water ang inumin naming sa
bahay. Dito kasi sa gripo lang.N3: Pwede naman pong inumin yung nasa gripo.
Hindi naman po nila ipapainom sa inyo yun kunghindi pwede.
P: Malinis naman. Kaya lang minsan may mga
lumalabas na uod at maliliit na ahas. Kaya bihiralang akong uminom ng tubig.N2: Ay, ganon po ba? Hindi po kayo nanghihingi ng
mineral water?P: Sa payward lang sila nagpapainom ng mineral
water.N1: Ganon po ba? Nakahingi na po ba kayo minsan
ng mineral water sa nurse?P: Pag nauuhaw ako at may dumaan na nursenanghihingi ako.
N3: Ah. Okay po.N1: Teka lang po ha. Ayusin ko po yung meryenda
niyo.N3: Tulong na po ako sa kanya.
P: Sige po.P: Nurse Chelle, natanong mo na po ba kay Maam
kung pwede akong gumawa ng sulat para sa ate ko?N2: Di ba po gumawa na kayo ng sulat kahapon?
Para pa nga po sa kanilang lahat yun eh.P: Hindi, iba pa yung kay ate lang. Gusto ko na kasi
talagang makalabas dito eh.N2: Sige po tatanong ko mamaya kay Maam.
P: Salamat Nurse Chelle.N2: Walang anoman po. Kumusta naman po ang
mga kapatid niyo? Lahat po ba sila nasa I lo-ilo?P: Tatlo lang yung nasa Ilo-ilo. Dalawa kaming
Presenting Reality
Exploring
Exploring
Broad Opening
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nandito sa Bataan at yung dalawa naman eh nasaDubai.
N2: Wow. Dubai. Ano naman po ang trabaho niladoon?
P: Isang civil engineer at isang accountant angnandoon.
N2: Ay. Ang galing naman po nila.
P: Isa lang ang hindi nakagraduate sa amin. Nagsisisinga siya kung bakit hindi siya nagpatuloy sa pag-aaral. Gusto nga sana niyang mag-aral ulit kaya lang
matanda na siya.N2: Eh ano naman po ang trabaho niya ngayon?
P: Mangingisda siya ngayon. Pero nag-aaral namanlahat ng anak niya.
N2: Ayon naman po pala eh. Sana makatapos polahat ng anak niya at sila naman ang tumulong satatay nila.
P: Sana nga. Kaya kayo tapusin niyo yang pag-aaralniyo. Sayang lang talaga at hindi ko natapos ang
pagnanurse ko.N2: Oo nga po eh. Ano po ba ang nangyari at hindi
niyo natapos ang kursong nursing?P: Nagkaroon kasi ng ibang babae ang tatay ko.
Kaya lahat kami naging working student.N2: Ang galing niyo naman po palang
magkakapatid.P: Ganon talaga. Gusto kasi naming mga magsipag-
aral.N2: Eh may kapatid po ba kayo sa tatay niyo? Ilan
po sila?P: Oo meron. Tatlo sila.
N2: Close naman po ba kayo sa kanila?P: Ay hindi. Hindi kami mga nag-uusap.
Exploring
Giving Recognition
Exploring
Exploring
Giving Recognition
Exploring
Exploring
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N2: Nasaan po ba sila?P: Nasa Ilo-ilo rin sila. Huli kaming mga nagkita at
nagkausap nung patay si tatay. After noon wala ngcommunication.
N2: Ah, ganon po pala. Ayan po. Meryenda na munapo kayo.
P: Kayo po, kain tayo.
N1: Sige po tapos na po kami kanina sa dorm.
(AFTER MERYENDA)
N3: Ayan. Nabusog po ba kayo?
P: Opo. Salamat po sa meryenda.N1: Dun naman po tayo sa may activity center.
Practice po tayo ng power clap at cheering natin.P: Sige po masaya yun.N2: Tara po.
(AFTER POWER CLAP AND CHEERING
PRACTICE @ ACTIVITY CENTER)
N2: Napagod po ba kayo?P: Hindi naman gaano.
N1: Masaya po ba?P: Opo masaya. Nag-enjoy po ako.
N3: Mabuti naman po kung ganon.N2: Paano Susan kailangan na naming umalis. Mag-
aayos pa kami ng iba naming gamit bago umuwi saBulacan.
P: Sige po. See you next week. Ingat kayo sa biyaheniyo ha.
N1: Ingat ka rin po dito. Hanggang sa muli.P: Bye bye Nurse Chelle, Nurse Criselle and Nurse
Exploring
GIVING INFORMATION OR INFORMING
Presenting Reality
7/30/2019 Case Pres. Psyche
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Eries. Salamat sa inyo.N1, N2 and N3: Bye bye Susan.
3rd day Interaction
N1: Hello. Good morning.P: Hi, good morning po.
N2: Kamusta ka naman po?
P: Ok lang naman ako. Kayo po ba?N3: Ayus lang din naman kami. Kumusta weekendsmo?
P: Ayus naman, walang bago.N2: Tara po, mag-grooming na tayo.
P: sige po.N3: Kumusta naman po ang mga sugat nyo sa ulo?
Gumagamit parin po ba kayo ng Perla?P: Ok naman, hindi na ako gumamit ng perla
kaninang umaga e.N3: Ganon po ba, osige po, mag sha-shampoo ka
ngayon.
N2: Mauna na po tayo sa pagtotoothbrush nyo.P: Sige, salamat ha.
(AFTER TOOTHBRUSH, SHAMPOO, etc.)
N3: gagamutin na po natin ngayon ang mga sugatnyo sa ulo ha.
P: sige.N1: mahapdi po ba pag nilalagyan namin ng gamot?
P: medyo, pero ok lang. Gusto ko nga yung mahapdieh.
N1, N2 and N3: (Silence)
Broad Opening
Exploring
Exploring
Exploring
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(AFTER WOUND CARE)
P: pwede ba akong humingi ng cotton buds? Lilinisinko yung tenga ko e, may mga sugat nga e.
N1: patingin nga po.N2: Oo nga, teka po, kuha ako panlinis ha.
P: osige. Maraming salamat sa inyo.
(AFTER WOUND CARE)P: Naku, nahuli na tayo sa kanila.N3: ok lang po iyan.
P: tara na, ready na ako.N2: Tara po, lakad na tayo.
N3: Ang unang activity natin ngayon ay phototherapy, alam nyo po ba iyon?
P: ah, yung ipapaliwanag yung mga larawan.N1: opo, yun po ang gagawin natin ngayon,magparticipate ka po ha.
P: oo naman sige.
(CLIENT PARTICIPATED WELL)(AFTER THE ACTIVITY)
N1: nag-enjoy po ba kayo?
P: ok lang,N3: magmiryenda na po kayo. Eto po.
P: salamat, kayo ba? Kain na din kayo.N2: sige lang po, mamaya na po kami.
P: napakabait nyo sa akin. Kayo kapag nakalabas naako dito tutulungan ko kayo, sana kung ano man
yung mabibigay kong mga tulong sa inyo tanggapinnyo ha.
N2: oo naman po.P: pag nakalabas na ako dito aayusin ko na ang
GIVING INFORMATION OR INFORMING
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buhay ko.N1: maari po ba naming malaman kung pano nyo
uupisahan ayusin ang buhay nyo kung sakalingmakalabas na kayo dito?
P: tapos na ang pinakaunang misyon ko eh, wala nasi Satanas, kaya wala nang babagabag sa loob ko.
Ang natitirang misyon ko nalang ay puksain angkasamahan ni satanas, yung mga taong criminal, at
makasalanan, kailangan na nilang mawala.Napanuod nyo na ba yung movie na The Monster?
N1, n2, n3: hindi po e. ano po ba iyon?P: totoo yung movie na iyon, ang monster yun ay
Pugita, yun si Satanas at ang mga Galamay nungpugita ay ang mismong mga galamay din ni satanas.
Ngayon ay nasa Karagat na sila ng apoy at lugar ngwalang katapusang kaparusahan, at yung end of theworld, totoo yun, sinabi ng panginoon sa akin yun.
N2: sinabi po ba niya kung kelan iyon?P: Oo, ngayon na iyon, dahil sa satanas ay
pinaparusahan na at susunod na ang mga taonggumagawa ng mga gawa niya.
N3: ano pong mangyayari sa mga tao nun?P: mapaprusahan sila, kaya kayo dapat ay ang mga
itinuri lang ng Panginoon ang gawin nyo, wagmasasamang bagay.
N2: opo.P: kaya nga may galit ako sa mga kapatid ko, dahil
hindi nila ako inintindi.N1: kung makikita niyo po sila ngayon, ano po ang
sasabihin niyo sa kanila?P: ilabas na nila ako dito, gusto ko maranasan din
nila ang hirap na naranasan ko dito sa mental, labisnila akong pinarusahan, hindi na nga ako nakapag-
Broad Opening
Exploring
Exploring
Exploring
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asawa dahil sa kanila, dahil sa kakatrabaho sapagkatsila ang priority ko, tapos ito pa ang iginanti nila sa
akin. Nagagalit ako sa kanila.N3: hindi nyo na po ba sila mapapatawad?
P: ewan ko, basta gusto ko maranasan nila angnaranasan ko dito, ang hirap.
N1: sana po ay gumaan ang pakiramdam nyo saating pag-uusap ngayon. Pasensya na po, pero oras
na para kayo ay ibalik sa ward. Marami pa namantayong pag-uusapan bukas.
P: osige, bukas ulit ha.N2: tara po, hated na namin kayo.
P: salamat.N1, n2, n3: salamat din po. ingat po.
Projection
4th day Interaction
N1, N2, N3: good morning po.
P: goodmorning din po.N1: kumusta po kayo? Kumusta pagtulog nyo?P: Ok naman po. Kayo po?
N2: Ok naman po. Malamig po ngayon no, ok langpo ba kayo?
P: Oo malamig nga, presko, pero ok lang ako saganyang panahon.
N3: naligo po ba kayo kaninang madaling araw?P: Oo, napakalamig, ngunit wala naman akong
magagawa.N1: Oo nga po. Tara, grooming na po tayo, tsaka po
natin lilinisin mga sugat nyo sa ulo.
P: Oo sige.(AFTER GROOMING AND WOUND CARE)
Broad Opening
EXPLORING
OFFERING SELF
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N2: Dun po tayo sa Activity Center.P: Ano ang activity natin na gagawin ngayong araw?
N3: Maglalaro po tayo, tas kakanta at sasayaw, atpag kaya po ng oras manunuod po tayo ng palabas.
P: Ah, yung tugtog sa laptop?N2: Opo.
N3: Gusto nyo po ba iyon?P: Oo,
N1: Sali po tayo sa lahat ah. Ready po ba kayo?P: Oo naman, enjoy nga yun e.
(AFTER THE ACTIVITIES)
N2: Kain na po kayo.
P: Sige, kayo ba? Kain na din kayo, sabay na kayosakin.N3: Nag-almusal po kame kanina, sige lang po kain
na kayo.P: pagkatapos kong kumain pwede bang hingi ako ng
papel at ballpen, susulatan ko yung kapatid ko.N1: osige po. Hindi na po ba kayo galit sa kapatid
nyo?P: Galit pa, dahil nga dinala nila ako dito.
N2: hanggang ngayon po ba?P: Oo
N3: paano po kung makalabas na kayo dito? Galitparin po ba kayo sa kanila?
P: Basta iuna ko muna ang paglabas ko dito bagonamin pag-usapan ang tungkol sa galit ko sa kanila.
N1: Paano po ba kayo magalit?P: yung pinapagalitan ko sila.
N3: sa sarili nyo po? Hindi nyo naman po sinasaktansarili nyo?
Projection
GIVING INFORMATION OR INFORMING
Exploring
EXPLORING
Exploring
Exploring
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P: Hindi naman. Hindi ko naman sinasaktan sarili kopag galit ako.
(AFTER THE CLIENT INTERPRETED MESSAGEFOR HER SISTERS LETTER)
P: Ipadala nyo sa kapatid ko ha, kailangan ko natalagang makalabas dito dahil napakahirap dito.
Kailangan ko nadin iayos sa tama at magsimula ulitsa buhay ko.
N2: ipapadala po natin, ang CI na po ang bahala.N3: tara na po, ihahatid na po namin kayo sa ward
nyo.P: salamat ha. Bukas ulit.
N1: sana po nag-enjoy kayo. Salamat.
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XI. Therapys done
Bulacan State University
Malolos, Bulacan
College of Nursing
THERAPY PLANNING
Title of
Therapy
Descriptions Learning Contents Learning
Objectives
Mechanics Resources Expected
Outcome
Family
Therapy
Family therapy is a type
of
psychotherapy
thatinvolves all members of
Family therapy involves
multiple therapy sessions,usually lasting at least
After 15minutes of the
therapy the client willbe able to:
After the music and
art therapy, thefacilitator
Manpower:
Student
Nurse and
After 15minutes of
the therapy, theclient were able to:
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a nuclear familyor stepfamily and, in
some cases, members ofthe extended family
(e.g., grandparents). Atherapist or team of
therapists conducts
multiple sessions to helpfamilies deal withimportant issues that
may interfere with thefunctioning of the
family and the homeenvironment.
one hour each, conductedat regular intervals (for
example, once weekly)for several months.
Typically, family therapyis initiated to address a
specific problem, such as
an adolescent witha psychologicaldisorderor adjustment to
a death in the family.
Use their
cognitive skillsto recall their
family
Express their
feelings while
rememberingmemories witheach of the
familymember
instructed thepatient as well as
the student nurseassisted them
throughencouraging to
think their loved
ones and write itdown on the tree
Facilitator:Albert dela Cruz
the patient
Materials:
Bond paper
Crayons
Used their
cognitiveskills o recall
their family
Expressed
their feelings
whilerememberingmemories
with each ofthe family
member
Title ofTherapy
Descriptions Learning Contents LearningObjectives
Mechanics Resources ExpectedOutcome
Photo
Therapy
Use of photograph ina therapeutic
encounter. It may usethe clients own family
album or personalsnapshot.
The therapy engagesconversation with theclient that might bestimulated by thephotographs as
memories emotionsideas and questionsraised by the images
After 30mins ofphototherapy, the
client will be able to:
think
abstractly
throughsharing their
ideas about the
picture showedto them
Express their
feelings afterthey see the
picture
The client areinstructed to look
at the pictures thenthe student nurses
will ask them toshare the ideas
regard to thepicture
Facilitator/s:
Manpower:
Student
Nurse andpatient
Resources:
Pictures
(home,
family and
nature)
After 30mins ofphototherapy, the
client were able to:
think
abstractlythrough
sharing theirideas about
the picture
showed tothem
Expressed
their feelingsafter they see
the picture
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Title ofTherapy DescriptionsLearning Contents
LearningObjectives Mechanics Resources ExpectedOutcome
Play
Therapy
Play therapy is a
treatment modality inwhich the therapist
engages in play with thechild and adults. Play
activities are used as theprimary basis for
communicationbetween the child and
the psychotherapist
It is used in identifying
and appreciatingchildhood mental
disorders and how theypull away from normal
functioning. This canaffect their home lives,
academic performances,as well as their play with
peers. Play therapy offers
a direct route to engagechildren/adult on theirterms, in their world.
After 30 minutes of
Play therapy thepatient will be able to:
to make clients
practice their
criticalthinking skills
andconcentration
alleviate their
anxiety practice their
social skills as
they enjoyplaying with
other patients
The facilitator will
explain theprocedure and
demonstrate howthe play will be
done. The studentnurses assist and
play with theirpatient.
Facilitator/s:
Manpower:
Student
Nurses and
Patient
Resources:
Electronic
devices (e.g
laptop,
speaker) Bond paper
Pentel pen
Cups
After 30 minutes of
Play therapy thepatient were able to:
to make
clients
practice theircritical
thinkingskills and
concentration
alleviatedtheir anxiety
practiced
their socialskills as they
enjoy playingwith other
patients
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Title ofTherapy
Descriptions Learning Contents LearningObjectives
Mechanics Resources ExpectedOutcome
Song and
Dance
Therapy
Song and Dance
therapy usesmovements to improve
mental and physicalwell being while
singing
It helps the patient to
reduce their stress,anxiety and depression.
Also increasescommunication skills
and develop positivebody image
After 30mins of Song
and dance therapy theclient will be able to:
Reduce their
anxiety, stress
and depression
Relax as they
sing and dance
Socialize withother patientsthrough
communications
The facilitator
will explain firstthe procedure
then the studentnurses will show
how it done andnext will teach
the patient to singand dance.
Lastly, to showthe talents to
others.
Facilator/s:
Manpower:
Student
Nurses andPatient
Resources:
Electronic
Devices (e.g
Laptop,
Speakers)
After 30mins of Song
and dance therapythe client will be able
to:
Reduced their
anxiety, stressand
depression
Relaxed as
they sing anddance
Socialized
with other
patientsthrough
communications
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Title of Descriptions Learning Contents Learning Mechanics Resources Expected
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Title of
Therapy
Descriptions Learning Contents Learning
Objectives
Mechanics Resources Expected
Outcome
Movie and
Cinema
Therapy
Cinema therapy is the
process of using moviesmade for the big screen
or television fortherapeutic purposes. It
allows us to gainawareness of our deeper
layers of consciousnessto help us move toward
new perspectives orbehavior as well as
healing and integrationof the total self.
Movie Therapy is amind therapy that
involves the clientviewing certain films
that under thesupervision of a
therapist in order to helptreat emotional and
mental conditions.
This therapy will help the
patient to change the waythey think and feel, and
ultimately deal with life'sups and downs.
After 30mins of
Movie and CinemaTherapy the client will
be able to:
watch films with
consciousawareness
explore theirminds and
feelings by thehelp of the
student nurses
inspire patients
through movies
help patients to
open upcommunications
to their studentnurses about their
thoughts andfeelings
Ask patients to
gather and sit infront of the
monitor. Tell themto watch carefully
and to reflect. Afterwatching their
student nurses mayask them to tell
something aboutthe videos they
watched.
Manpower:
Student
Nurse and thepatient
Resources: Electronic
devices
(projector,laptop,
speaker)
After 30mins of
Movie and CinemaTherapy the client
were able to:
watched films
with consciousawareness
explored theirminds and
feelings by thehelp of the
student nurses
inspired patients
through movies
helped patients
to open upcommunication
to their studentnurses about
their thoughtsand feelings
TITLE OF LEARNING LEARNING EXPE
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TITLE OF
THERAPYDESCRIPTIONS
LEARNING
CONTENTS
LEARNING
OBJECTIVESMECHANICS RESOURCES
EXPE
OUT
OCCUPATIONALTHERAPY
Occupational Therapy isdefined as The therapeutic
use of work, self-care, and
play activities to increasedevelopment and preventdisability. It may include
adaptation of task orenvironment to achieve
maximum independenceand to enhance the quality
of life."(AmericanOccupational Therapy
Association Executiveboard). One's occupationcan be defined as how we
spend our time; whetherpaid or unpaid, restful or
fun, obligation or choiceand that which fulfills us,
gives us purpose, andallows us to interact with,
be productive, and functionin the world around us to
the best of our ability.
This small bag or basketmaking as an Occupational
Therapy contributes to thedevelopment of mentally
challenged clientsespecially their motor
functions through making ahandmade basket or bag. It
is a good activity also to
combat the Extrapyramidalsymptoms of drug they are
taking.
At the end of 1 hour oftherapy, the client will
be able to increasehis/her development or
commit leisure bypracticing their function
through the use ofmaking small basket or
bag out of used
newspaper folded inthin sizes
The student nurse will
provide the materialsfor the client to make
a small basket or bagout of used
newspaper folded intothin sizes. After the
time given by thestudent nurse, the
clients must be done
making theirhandmade basket or
bag.
MANPOWER
-Student Nurse-Clients
MATERIALS
-Old Newspapers
-Glue
At the therapy
will bsomeho
his/her dor com
by pracfunctionuse of m
basket oused n
folded in
Title of Descriptions Learning Contents Learning Mechanics Resources Expected
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Title of
Therapy
Descriptions Learning Contents Learning
Objectives
Mechanics Resources Expected
Outcome
Storytelling It is an accessible andcreative form of
communicating and
reflecting uponexperience, both real
and imagined.
Storytelling involves
stories that use metaphorand imagery to change
the way they see theirlives and the world, it
helps the clients thinkand behave in new,
productive ways,offering healing and
growth to everyone.
After 15 minutes of
psychotherapy, theclient will be able to:
Reflect on the
story told and
express theirfeelings aboutthe story.
Determine the
connection of
the story ontheir lives and
Verbalize
having a better
and positiveoutlook in life.
The facilitators will
first explain theactivity to the
clients. A story willbe read by the
facilitators andafter the
storytelling, theclients will be
asked toverbalize/express
their feelings andopinions about the
story.
Facilitator/s:
Man power:
Student
nurse andthe patient
Materials: Book
Flash Cards
After 15 minutes of
psychotherapy, theclient have:
Reflected on
the story told
and had abetter outlookin life.
Determined the
connection of
the story ontheir lives and
Verbalized a
better and
positiveoutlook in life.
Title of Descriptions Learning Learning Mechanics Resources Expected
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Title of
Therapy
Descriptions Learning
Contents
Learning
Objectives
Mechanics Resources Expected
OutcomeNewspaperReading
Newspaper therapy isgiving information to
the clients about eventsand what is happening
outside. Newspaper
therapy is cuttingclippings fromnewspaper and sharing
this information to theclients and knowing
their feelings and ideasabout the information
given. Providing basicinformation about
places/events maymotivate the clients to
follow the medicalregimen to be well.
Reading can helpjumpstart the brain. It
encourages the patients toshow emotions and
reactions about the latest
news. It also encouragesthe patients to verbalizeideas regarding the topic.
*To be able to providethe clients an
information on what ishappening outside and
the current news.
*To be able tointroduce topics thatwill facilitate clients
participation inreading
*to be able to assessclients reading
comprehensionthrough asking
question about thenews.
1. Exercise2. Gather materials
needed3. explain the
concept of
newspaper reading4. newspaperreading(15-20
minutes)5. giving
comments/ideasabout the topic
*Newspaper
Venue:Mariveles Mental
Hospital
Duration:15-20 minutes
*Patients will beable to talk about
the news they readand how they
respond about it.
*patients will beable to provide
ideas/ suggestions/comments/
conclusions aboutthe topic
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