BULACAN STATE UNIVERSITY COLLEGE OF NURSING

A Case Study of a 54 years old female With Undifferentiated Schizophrenia

SUBMITTED BY: BSN 3D - GROUP 2 LEADER: Dela Cruz, Mary Grace C. MEMBERS: De Vera, Paula Marie E. Diaz, Elisha Rose C. Federis, Nerissa Joy E. Flores, Marjelene G. Junio, Ma. Jaecelyn S. Llano, Joanna Marie

SUBMITTED TO: Maria Ongleo, RN, MAN Clinical Instructor

I.INTRODUCTION

Our patient Mrs. M.J is a 54 years old woman residing at Cambio, San Miguel, Bulacan which was diagnosed with Undifferentiated Schizophrenia. She was admitted on October 16, 2008.

Undifferentiated Schizophrenia manifests an insidious and gradual reduction in external relations and interests. The patients emotions lack depth and ideations is simple and refers to concrete things. There are a relative absence of mental activity, a progressive lessening in the use of inner resource and a retreat to simpler or stereotyped forms of behavior.

Schizophrenia causes two groups of symptoms: Negative symptoms and Positive Symptoms. Negative symptoms generally include lack of motivation, self neglect (such as not bathing) and reduce or inappropriate emotion such as (becoming angry with strangers). A negative symptom usually appears first and maybe confused with depression. Positive symptoms which generally appear later, includes symptoms such as hallucinations, delusions and disorganized or confusing thoughts or speech.

This condition meets the general diagnostic criteria for schizophrenia (characterized in general by fundamental and characteristic distortions of thinking and perception and by inappropriate or blunted affect), but not conforming to any of the subtypes (paranoid, disorganized or catatonic), or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics. This rubric should be used only for psychotic conditions and after an attempt has been made to classify the condition into one of the three preceding categories.

Schizophrenia usually diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15-25 years old for men and 25-35 years old for women (American Psychiatric Association, 2010). The prevalence of Schizophrenia is estimated at about 1% of the total population. In the United States that translates to nearly 3million people who are have been or will be affected by the disease. The incidence and lifetime prevalence are roughly the same throughout the world.

Mrs. MJ was diagnosed to have Undifferentiated Schizophrenia since she was 50 years old.

II.

THEORETICAL FRAMEWORK

According to Sigmund Freud (1856-1939), he believed that the human personality functions at three level of awareness, conscious, preconscious and unconscious. The unconscious is the realm of the thought and feelings that motivate a person even though he or she is totally unaware of them. This realm includes most defense mechanisms and some instinctual drives or motivations. In the case of Mrs. M.J, she believed that According to Harry Stack Sullivan (1892-1949), interpersonal relationships are significant in the theory of personality development. He believed that ones personality involves more than individual characteristics, particularly how one interacts with others. Sullivan thought that inadequate or non-satisfying relationships produce anxiety, which he saw as the basis for all environmental problems. On our client, Mrs. MJ states that the past relationships with her husband were not successful. She was left by her husband because of another woman and has his own family right now, and her two siblings have their own too. Our client feels neglected and this may have triggered her condition. Sullivan established 5 life stages of development Infancy, childhood, juvenile, preadolescence and adolescence, each focusing on various interpersonal relationships. He also described 3 developmental Cognitive Models of experience and believed that mental disorders are related to the persistence of one of the early modes. The prototaxic mode, characteristics of infancy and childhood, involves brief unconnected experiences that have no

relationship to one another. Adults with Schizophrenia exhibit persistent prototaxic experiences. Our client was seen talking, being noisy without any connection, and sleepless which is an example of prototaxic experiences. According to Carl Rogers (1902-1987), stated in his client centered theory that clients are the key to healing process, within a supportive and nurturing client therapist relationship, they can cure themselves. Clients are in the best position to know their own experiences and make sense of them to regain their self-esteem and to progress to self-actualization. The patient in this case study cooperates well with the health team of the hospital, because she wants in her own motivation to get well from her present condition. In Abraham Maslows Hierarchy of needs , the basic drives on needs that motivate people were arranged in a pyramid. Even though the patient has the most basic needs (food, water, shelter, etc.) still patient do not have good sleep which we all know that sleep is one of the physiologic needs. She was also lacking in love and belongingness that she needs from her family because she doesnt have visitors at all since Mrs. MJ was admitted here in Mariveles, Mental Hospital.

III. NURSING HEALTH HISTORY

Our client was a 54 year old woman lived in Cambio, San Miguel, Bulacan. She was born at February 5, 1958 in Camiling, Tarlac. Mrs. MJ was the eldest among the three siblings. She was an elementary graduate and not able to continue her studies because of financial problem. She worked as a housemaid to help her parents to earn some money for their everyday needs. She spent her life working for her family. According to Mrs. MJ, her parents separated when she was only 15 years old. She got married at the age of 19 years old and has 3

children. But after several years, the husband left her because of another woman. She continues working as a waitress for 4 years, and then she met her current partner and decided to live in together. They have 3 children.

Mrs. MJ was directly admitted in Female Ward 1 because of being aggressive and uncooperative. After several therapies, she was seen to be improved on her condition and transferred to Female Ward 4 up to present.

IV. CHIEF COMPLAINT

According to the informant which is the Barangay Captain of Cambio, San Miguel, Bulacan, Mrs. MJ was reported to be aggressive, throwing stones to the neighbors car, saying bad words and usually roaming around their Baranngay.

V. HISTORY OF PRESENT ILLNESS

This unknown woman has been seen roaming around at San Miguel, Bulacan since August 2008. The Barangay Captain allowed this woman to roam around while concern citizen were contributing food for her everyday needs. She was reported to have shown signs of emission by September 2008 but became sleepless, irritable and disruptive by October 2008 hence the Barangay Captain opted to bring her one.

VI.

PREVIOUS ILLNESS

Mrs. MJ was admitted to Marieles Mental Hospital accompanied by the Barangay Captain. She was found roaming aroung in San Miguel, Bulacan since August 2008. She was reported to have slow signs of emission by September but became sleepless, irritable and disruptive by October 2008.

VII.

PAST PERSONAL HISTORY

A. EARLY CHILDHOOD Our client didnt remember about her past history or experienced during this year. B. MIDDLE CHILDHOOD Our client states that she knows household activities. C. ADOLESCENT PERIOD Our client states that after she graduated in grade school, she started to work as housemaid to help their parents in earning money for everyday needs. D. SOCIAL HISTORY According to our client, she does not mingle with friends or even neighbor. She was not friendly to others and wants to be on her own. E. SCHOOL HISTORY Mrs. MJ was an elementary graduate. She states that she doesnt have friends since then.

F. OCCUPATIONAL HISTORY She worked first as a housemaid after she graduated at elementary. Then she got married and worked as waitress for 4 years.

G. SOCIAL ACTIVITIES According to her she was not friendly and dont want to talk with others. She just want stay in their house all day long.

VIII. FAMILY HISTORY According to our client her first husband has already his own family now and since then they do not have any communication. She has 3 children on her first husband. After that separation, she worked as waitress for 4 years and there she met her 2nd husband. They also have 3 children, but a few years later her husband died. Her husband was murdered by their neighbor. All of her children have already their own family and no ones visiting her since she was admitted last October 2008.

IX. PHYSICAL ASSESSMENT NAME OF THE PATIENT: Mrs. MJ AGE: 54 years old MEDICAL DIAGNOSIS: Undifferentiated Schizophrenia DATE OF ASSESSMENT: February 28, 2013 Vital Signs BP: 120/90mmHg TEMPERATURE: 37.3 C PULSE RATE: 72bpm

RESPIRATORY RATE: 19cpm

AREAS TO BE ASSESSED GENERAL SURVEY Body built, height and weight in relation to clients age, lifestyle and health. Clients posture and gait, standing, Sitting and walking

NORMAL FINDINGS

ACTUAL FINDINGS

ANALYSIS

Proportionate, lifestyle

varies

with

Proportionate and varies with lifestyle

Normal Normal

Relaxed, erected, coordinated movement

Our client was relaxed and has coordinated movement

Clients overall grooming, Vital sign Temperature Pulse rate Respiratory rate Blood pressure BEHAVIOR

hygiene

and

clean, neat

Our client looks untidy

Deviation from Normal

36.5-37.5 C 60-100 bpm 12-20 cpm 120/80 mmHg

37.3 C 72bpm 19cpm 120/90mmHg

Normal

Signs of distress, in posture or facial expression

No distress noted

No distress noted

Normal

Signs of health or illness Clients attitude

Healthy appearance

She looks weak

Deviation from Normal Normal Normal Normal

Cooperative, able to follow She is very cooperative and was instructions able to follow instructions Appropriate to situation Has clear tone and understandable

Clients affect/mood; Appropriate to situation Appropriateness of clients response Quantity of speech, quality Understandable, moderate phase; clear tone and in flexion; exhibit thought association of Logical sequence; makes sense; has sense of reality

Relevance thoughts

and

Organization

She can give relevant answer to our question and has an organized thoughts

Normal

2. INTEGUMENTARY A. SKIN Color and uniformity of color Varies from light to deep Her skin is uniform in color brown; ruddy pink to light except to areas exposed to sun pink; from yellow overtones to olive Generally uniform except in areas exposed to the sun; areas of darker pigmentation in dark-skinned people No edema No edema noted Normal

Presence of edema Skin moisture

Normal Normal

Moisture in skin folds and Moist skin axillae(varies with environmental temperature

and humidity and activity) Skin temperature Uniform; within normal ranges Her skin temperature is warm and uniform band within normal range back to Normal

Skin turgor B. NAILS

Skin springs back to previous Her skin springs state) has a good skin turgor previous state

Normal

Finger nails shape, curvature and Convex curvature; angle of Her nail has convex curvature angle nail blade about 160 approximately 160 Fingernail and toenail texture Tissues surrounding nails Blanch Test of capillary refill 3. HEAD A. SKULL Size, shape and symmetry Rounded(Normocephalic); Smooth Skull contour Her skull is rounded and has a smooth contour No visible lines and cracks Smooth texture smooth texture Intact epidermis Has an intact epidermis

Normal Normal Normal Normal

Prompt return of pink or usual Pinkish color of the nail beds color; delayed 1-3 seconds return within 3 seconds

Normal Normal

Presence of nodules, masses and Smooth, Uniform consistency; She has no nodules and masses depressions Absence of nodules and masses B. SCALP Color and appearance Usually white but it also Her scalp is white and has a

Normal

depends people Areas of tenderness C. HAIR

on

dark-skinned smooth surface There are tenderness no areas of Normal

No tenderness

Evenness of growth, thickness and Evenly distributed thick hair thinness Texture Color D. FACE Facial features, symmetry of facial Symmetrical facial movements and movements 4. EYES Inspect the eyes for edemas and No edema hollowness A. EYEBROWS Smooth texture Black

She hasa thick hair and it is evenly disturbed Has smooth texture She has stands of white hairs

Normal normal Normal

features She has symmetrical features and movements

facial

Normal

No edema

Normal

Evenness of hair distribution, Hair evenly distributed, She has evenly distributed hair alignment and movement eyebrows symmetrically in her eyebrow and they are aligned and equal in size aligned with equal movement B. EYELASHES Evenness of direction of curl distribution and Equally distributed; slightly outward curls Her eyelashes are evenly distributed and curled outward

Normal

Normal

C. EYELIDS Surface characteristics, position in Skin intact; no discharge or relation to the cornea, ability to discoloration; lids closed blink and frequency of blinking symmetrically approximately 15-20 involuntary blinks per minute D. SCLERA Color and clarity 5. EARS A. AURICLES Color, symmetry of size and position Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye about 10 vertical Texture, elasticity tenderness 6. NOSE Deviation in shape, size or color and Symmetric and straight; no Her nose is symmetrical; no flaring or discharge discharge or flaring; uniform discharge or flaring; uniform in in color color Nasal septum between the nasal Nasal septum intact and in Nasal septum chambers middle line midline Patency of both nasal cavities intact and in Normal and areas Her ears color is same as surrounding skin and both are symmetrical; the auricles are aligned in the outer canthus of each eye. Normal Sclera appears white Her sclera appears white Normal Skin is intact, and has no discharge or discoloration; lids closed symmetrically approximately 15-20 involuntary blinks per minute. Normal

of Mobile, firm and not tender Her auricles are firm and not pinna recoils after being tender; his pinna recoils when folded folded

Normal

Normal Normal

Air moves freely as the client Air moves freely as the client

breathes through the nares 7. MOUTH A. LIPS Symmetry of texture contour color

breathes through the nares

and Uniform pink color, soft, moist Her lips are uniform in color, smooth texture, symmetry of soft, moist and smooth in contour, ability to purse lips texture, and has ability to purse lips

Normal

B. TEETH Color 8. NECK A. THYROID GLAND Symmetry and visible masses 9. THORAX A. POSTERIOR Spinal alignment Chest for vocal fremitus Spine vertically aligned Her spine is vertically aligned Normal Normal Not visible on inspection Non visible Normal Smooth, white and shiny tooth She only has 8 tooth which is enamel slightly white in color Deviation from normal

Bilateral symmetry of vocal Has bilateral symmetry of vocal fremitus; fremitus mostly fremitus; fremitus mostly heard heard at the apex of the lungs at the apex of the lungs

B. ANTERIOR Breathing patterns Quiet, rhythmic and effortless Has quiet, rhythmic respiration effortless respiration and Normal

Bronchovesicular vesicular breath sounds Auscultate the carotid arteries 10. JUGULAR VEINS Presence of veins 11. ABDOMEN Abdominal movements 12. MUSCULOSKELETAL A. MUSCLES Veins not visible No sounds heard

and There are sounds heard Normal

No visible veins

Normal

Symmetric movements Has symmetric movements caused by respiration caused by respiration

Normal

Sizes, comparison on one side to Equal size on both side of the Has equal size on both side of other side body the body contractures Fasciculation and tremors B. BONES Normal structure and deformities C. JOINTS Swelling Joint range of motion No swelling No swelling No deformities Has no deformities No contractures No tremors She has no contractures Has no tremors

Normal Normal Normal

Normal

Normal Normal

Varies to some degree in Limited movement because of accordinance with persons her age genetic makeup and degree of

physical ability

X.

MENTAL STATUS EXAMINATION

Orientation DAYS Time Place Person Situation 1 2 3

Memory DAYS 1 2 3

Recent(dinner/brea kfast) Recent past (current events) Immediate short term Immediate recall Remote (Long term)

Defense Mechanism DAYS Displacement Denial Intellectualization Projection Rationalization Reaction formation Regression 1 2 3

Sublimation Suppression Identification Isolation Dissociation

Extrapramidal Symptoms DAYS Pseudoparkinmso nism Mask-like face No swinging of arms Hesitancy of speech Decreased muscle strength Shuffling Gait Drooling 1 2 3

Fine intention tremors Acute Dystonia Muscle spasms of jaw, tongue, neck, and eyes Larygeal spasm Akathisia Restlessness Tenseness Inability to sit still Rocking back and forth Crossing legs frequently Inability to relax Tardive Dyskinea Involuntary movements of mouth, tongue, face, and may extend to fingers,

arms, and trunk

Thinking and Communication DAYS Loose Association Neologism Word salad Echolaia Echopraxia Clang association Logical thinking Alogia Concrete thinking Lack of insight 1 2 3

Perceiving and Interpreting DAYS Delusions 1 2 3

Reference Persecution External Influences Somatic Grandiose Hallucination Visual Olfactory Auditory Gustatory Tactile ILLusions Depersonilization Attending to irrelevant stimuli Poor reality testing

Behaving and Interacting DAYS 1 2 3

Withdrawal Motor hyperactivity Motor hypoactivity Ambivalence Anhedonia Avulition INTERPRETATION: Our client Mrs. MJ was seen alert and cooperative response appropriately to situations. She has eye to eye contact when talking to the students, has little facial expressions, has mood appropriate for the situation. She was dressed appropriately but sometimes looks untidy. She was also oriented about the place, date and time. She can also recall recent event like breakfast and other meals. She has decrease muscle strength and short term memory. Sometimes, she experienced flight of ideas.

XI.

NURSE-PATIENT INTERACTION Initial of the Patient: Mrs. MJ Date: February 21 and 26, 2013 Site of Interaction: within the hospitals vicinity Description of setting: Calm and quiet therapeutic environment Phase: Orientation Phase to Termination Phase Goals of NPI:

To To To To To

introduce self and role definition establish trust and rapport test orientation to reality define responsibility of the client and the nurse establish contact purposes that were mutually agreed

LEGEND: N1 Joanna Marie Llano N2 Elisha Rose Diaz Pt. Mrs. MJ NURSE PATIENT INTERACTION February 21, 2013 N1: Good morning Im Joanna your student nurse for today from Bulacan State University N2: And Im Elisha Pt: (smiling) hello din N1; what is your name? Pt: Milagros Javinas N2: How old are you? Pt: 52 N1: When was your birthday? Pt: February 5 Seeking information Seeking information Seeking information THERAPEUTIC COMMUNICATION Giving information Seeking Information DEFENSE MECHANISM

N1: where do you live? Pt: Camiling, Tarlac N1: How long do you stayed here in the hospital? Pt: Dalawang taon na N2: Do you have a family? Pt: Meron N2: Do you have a child? Pt: Meron N1: How many? Pt: Anim N2: Who are they? Pt: Yung asawa ko hiwalay na kame N2: What is the reason of being separated? Pt: (No response) N2: What age did you got married? Pt: Disinuwebe N1: Can you tell us more about your life? Pt: Pagkatapos naming maghiwalay,nag-asawa ulit

Seeking information

Seeking information

Seeking information Seeking information

Seeking information

Seeking information Dissociation Seeking information

Seeking information Exploring

ako, kaya lang namatay siya N1: What is the reason your husband died? Pt: Binaril siya kasi may nakaaway siya N2: Then what happened? Pt: Dahil dun kaya ako na depressed N1: Do you think depression is the reason that you are here? Pt: Oo N1: What happened to those people who killed your husband? Pt: Nakulong N2: Do you have a child in your second husband? Pt: Oo N2: Who are they? Pt: William N1: Where is he? Pt: Nasa nanay ko N1: Where is your mother? Seeking Information Seeking Information Seeking Information Seeking Information Reflection General Leads Exploring

Seeking Information Seeking Information

Pt: (No response) N2: Did William visit you here? Pt: Hindi N1: How about your relatives? Pt: Walang dumadalaw sakin ditto N1: Since you were here? Pt: Oo N1: Before you send here, what are the things you do? Pt: Nagsasalita mag-isa February 26, 2013 N1: Good morning Milagros. Did you still remember us? Pt: Nodding N1: Im Joanna N2: How about me? Did you still remember? Pt: Nodding N2: Im Elisha Giving Information Offering self Giving Recognition Giving Information Giving Information Exploring Seeking Information Restating Seeking Information

N1: Lets go with us and we will start the general grooming Pt: Smiling N2: Did you miss us? Pt: Smiling N1: You told us last week you have a bag with you before you send here in the hospital. What inside your bag? Pt: Pantalon, damit, pantaas N2: What else? Pt: Wala na N2: What is the reason that you always bring that bag with you? Pt: Pamalit lang N2: Can you tell us about your love life? Pt: Oo N1: Where did you meet your first husband? Pt: di ko na matandaan N2: Are you married with him? Exploring Seeking Information Seeking Information Exploring Exploring Summarizing

General Leads

Pt: Oo N1: What is your job when you were together? Pt: Waitress N1: For how long? Pt: Dalawang taon N2: What is the reason you resign? Pt: Kasi nagara ang bar na pinapasukan ko N2: What happened to your husband? Pt: Nag-asawa ng iba N2: How about your second husband, where did you meet him? Pt: Sa Bambang nung nagtrabaho ulit akong waitress N2: For how long? Pt: Dalawang aton din N1: What is your schedule? Pt: Hapon ng 3:00 hanggang 12 ng gabi N2: Who is your favourite actress? Seeking Information Seeking Information Seeking Information Seeking Information Seeking Information Exploring Seeking Information Exploring

Pt: Nora Aunor N2: What is your favourite movie? Pt: Golden voice N1: Who is your favourite actor? Pt: Tirso Cruz III N2: what is your favourite song? Pt: Isang linggong pag-ibig at Once there was a love N2: Who sung Isang linggong pag-ibig? Pt: Imelda Papin N1: Who sung once there was a love? Pt: Victor Wood N2: Who send you here? Pt: Ambulansiya N2: Can you tell more about your childhood days? Pt: Bata pa lang ako hiwalay na ang magulang ko N2: How old are you when they got separated? Pt: Siyam n taong gulang

Seeking Information

Seeking Information Exploring

Seeking Information Seeking Information

Exploring

Exploring Exploring

General Leads

N2: What is your educational attainment? Pt: Grade 6 lang ang natapos ko N1: Then after grade 6, what did you do? Pt: Di na ko nag_aral, huminto na ako kasi din a kaya ng magulang ko N1: Then after you stop schooling. What did you do? Pt: Nagtrabaho na ko N2: Like what? Pt: Naglalaba, naglilinis ng bahay N2: Do you have a friend there? Pt: Hindi ako masyadong nakikipag-usap N2: How about here do you have a friend? Pt: Hindi ako nakikipag-usap N1: You need to communicate with other patients.so you can have a lot of friends. Pt: Smiling N2: We prepared some activities for you like song and dance, art and play therapy, are you excited? Seeking Information Seeking Information Giving Information Advising Seeking Information Seeking Information General Leads General Leads

Pt: Oo N2: Can you dance? Pt: Oo N1: Can you sing? Pt: Oo N1: Can you give us some sample? Pt: Singing N1 and N2: Clapping! N1: I think you are ready for the activities, so lets start the activity. Pt: Smiling

Giving recognition Giving recognition Offering Self

XII.

NURSING CARE PLAN DIAGNOSIS PLANNING Short Term Goal Disturbed thought process related to mental disorder as manifested by disordered thought sequencing. After 2-3 days of nursing intervention the client will be able to: Recognize changes in thinking behavior. Demonstrate behavior to minimize changes in mentation. IMPLEMENTATIO N To create therapeutic milieu and assist client to develop coping strategies: Maintain pleasant quiet environment and approach in a slow and calm manner. RATIONALE EVALUATION After 2-3 days of nursing intervention the client was be able to: Recognized changes in thinking behavior. Demonstrated behavior to minimize changes in mentation.

ASSESSMENT SUBJECTIVE : February 21, 2013 Naghiwalay ang magulang ko noong 9 pa lang ako as verbalized by the client. February 28,2013 Naghiwalay sila noong 15 years old akoas verbalized by the client.

Client may respond with anxious or aggressive behaviors if startle or over stimulated.

OBJECTIVE: Inaccurate information given

Listen with regard.

To convey interest and worth individual.

by the patient Allow more time for the client to respond to questions and make simple decision. Promote Wellness To allow client to give information correctly and accurately. Sources : Nurses Pocket Guide Ninth Edition. Pg. 529532

ASSESSMENT

DIAGNOSIS

PLANNING

IMPLEMENTATIO N

RATIONALE

EVALUATION

SUBJECTIVE: OBJECTIVE: Observed avoidance towards sharing past experiences. Observed discomfort in social situations.

Impaired social interaction related to Communication Barriers .

After 2-3 days of nursing intervention the client will be able to:

To assist client to recognize changes in impaired social and interpersonal interactions:

After 2-3 days of nursing intervention the client was be able to: Verbalized awareness of factors causing impaired social interaction. Identified feelings that

Encourages Verbalize Provide positive continuation of awareness of reinforcement desired factors causing for improvement behaviors/efforts impaired social in social for change interaction. behaviors and interaction. Identify feelings Because they that lead to poor Work with the often impede

social client to alleviate interaction. underlying self concept. Express desire in achieving Establish positive changes therapeutic in social relationship behaviors and using positive interpersonal regard for the relationship. person active listening and Give self providing safe positive environment for reinforcement self disclosure. for changes that are achieved. ASSESSMENT SUBJECTIVE : Wala pang dumadalaw sa akin dito, wala kasing nakakaalam na nandito ako as verbalized by the client. DIAGNOSIS Ineffective coping related to inadequate support system. PLANNING After 1 and a half hour of nursing intervention the client will be able to: Identify support system inside the hospital IMPLEMENTATIO N To provide for meeting psychologic needs: Encourage communication with student nurses Treat the client with courtesy and respect. Converse at clients level, providing

positive social interactions. To improve social life SOURCE: Nurses Pocket Guide Ninth Edition Pg. 482-483

lead to poor social interaction. Expressed desire in achieving positive changes in social behaviors and interpersonal relationship. Gave self positive reinforcement for changes that are achieved. EVALUATION After 1 and a half hour of nursing intervention the client wasl be able to: Identified support system inside the hospital

RATIONALE

To compensate with the longingness for her family. Enhances therapeutic relationship

meaningful conversation while performing For the client to care. freely express Allow client to her feelings and react in own way emotion without comfortably with judgment by the staff. staffs/student nurses

XIII. GENERIC NAME

DRUG STUDY BRAND NAME CLASSIFICATIO N ACTION DOSAGE ADVERSE REACTION NURSING CONSIDERATION

Biperiden

Akineton

Central Nervous System Drug or Anticholinergic Drugs

Synthetic Anticholinergic drug, It blocks cholinergic responses in

2mg tab OD

Central Nervous System and peripheral effects, skin rashes, dyskinesia, ataxia,

Assess for parkinsonism, EPS. Monitor I and O Assess mental status.

Central Nervous Sytem.

twitching, impaired speech, confusion, anxiety

Monitor for abdominal distention. Increase fluid intake. Increase fiber diet. NURSING CONSIDERATION Monitor patients response. Take medications as prescribed. Avoid excessive dosage. Monitor the patient for hallucinations. Use ice chops to relieve dry mouth. Observe for signs of sedation. Medication was to be given or of needed.

GENERIC NAME

BRAND NAME

CLASSIFICATIO N

ACTION

DOSAGE

ADVERSE REACTION

Dipenhydra mine

Benadryl

Antihistamine

This drug blocks the effects of histamine at H1 receptor sites. It has atropine-like, anti-pruritic and sedative effects.

50mg HS X PRN for sleeplessn ess

Drowsiness Sedation Dizziness

Extrapyramidal Syndrome (EPS)

XIV. Title of Therapy

PLAN OF ACTIVITY Descriptions Learning Contents Learning Objectives Mechanics Resources Expected Outcome

Play Therapy

Play Therapy has been recognized as an effective approach for children and adults including those with developmental disabilities, comorbid mental health disorders, and/or arrested emotional developmental stages.

It allow adults to access their innerselves and work through childhood trauma using range of materials. Clarify their self-concept and build healthy relationship. Helps to control their emotions properly.

After 1 hour of Nurse vs. Patient Play Therapy, the Theres a ball client should be each team and able to: the member will Express their run 3-4 meters emotions while the ball freely. was place in the Learn to underarm. As manage their soon as they emotions appropriately. reach the chair Allow the they will roam patient to around the chair the first process and and understand team to return to trauma on their proper his/her own places wins. tense. Regain his/her confidence and selfexpression.

Manpower 2 Chairs 4 balls Face towel money

After 1 hour of Play Therapy, the client was able to: Express their emotions freely. Learn to manage their emotions appropriately. Allow the patient to process and understand trauma on his/her own tense. Regain his/her confidence and selfexpression.

Title of Therapy

Descriptions

Learning Contents

Learning Objectives

Mechanics rces

Resou

Expected Outcome

Art Therapy

Art Therapy is used to help people manage their physical and emotional problems by using creative activities to express emotions. It provides a way for people to come to terms with emotional conflicts, increase self-awareness and express unspoken and often unconscious concerns about their illness and their lives.

Help the patient to process emotions and feelings that are struggling with so they begin to promote healing. Idea of self exploration. Help people improve their mental, emotional and even physical skills.

After 1 hour of Art Therapy, the client should be able to:

The patient are instructed to draw anything about their 3 wishes and they Express their are going to emotions interpret it one through art, by one. Learn that others have similar concerns and issues. Learn to manage their emotions properly.

Short bond paper Pencil Eraser Crayons Tables Chairs Manpowe r Money

After 1 hour of Art Therapy, the client was able to: Express their emotions through art, Learn that others have similar concerns and issues. Learn to manage their emotions properly.

Title of

Descriptions

Learning Contents

Learning Objectives

Mechanics

Resources

Expected Outcome

Therapy

Song and Dance Therapy

Song and Dance Therapy are the use of music by health care professionals to promote healing and enhance quality of life for their patients.

It can be used to encourage emotional expression. It promote social interaction. It may also relieve stress and provide an over-all well being. Used relaxation. for

After 1 hour of Song and Dance Therapy, the client should be able to: Alleviate tension anxiety. and

We play a song then the patient will sing and dance it together with the student nurse.

Laptop Speaker Manpowe r Face towel

After 1 hour of Song and Dance Therapy, the client was able to: Alleviate tension and anxiety. Aids pain control through distraction and relaxation. Promote relaxation.

Aids pain control through distraction and relaxation. Promote relaxation.

Title of Therapy Occupatio nal Therapy

Descriptions

Learning Contents It ensure that goals are being met and/or make changes to the intervention plan. It has positive effect on health and well-being. It creates structure and organizes time. It brings meaning to life, culturally and personality.

Learning Objectives After 1 hour of Occupational Therapy, the client should be able to: Improve their learning and working skills. Improve their ability to perform daily activities. Determine his/her own goals in life.

Mechanics

Resources

Expected Outcome

It helps the patient to perform diverse task and improve their learning and working skills. It also provides opportunity to a certain clients to develop their skills, and increases their level of selfconfidence through accomplishing a specific task.

Pour soap flakes in a container. Put 500ml water then stir until soap was dissolve. Next, pour additional 500ml and the iodized salt then stir it again until it dissolves. Put the glycerin and lemon oil in the mixture and continuously stir it until all mixture where blended well. Add the calamnsi fragrance and stir again. Lastly, put the finished product in a container then label it.

1 hour of A set of After ingredient Occupational Therapy, in making the client was able to: dishwashi ng liduid Improve their learning Tables and working skills. Chairs Improve their ability Container to perform daily Funnel activities. Measurin g cups Determine his/her Manpowe own goals in life. r money

INTERPRETATION OF PATIENT AND NURSE PLAY THERAPY The patient cooperates well in this activity. She enjoyed it a lot. Mrs. MJ was smiling all throughout the game.

ART THERAPY In this Activity, we asked the client to color a book. The color they will choose represents their feelings and emotions. Color red was the most dominant color on her work. Red color means hostility. We also ask them to draw their 3 wishes and interpret it afterwards. She drew first an apple, she said it was her favorite and the last time she ate it was on Christmas. Next thing she drew was a duck. According to her, they do have ducks before and she misses taking care of their ducks. Third thing she drew was a watermelon. She said it was also her favorite food. Her mother usually gave her watermelon when she was a child.

SONG AND DANCE THERAPY This activity helps the client to encourage them to express their emotions through music and body movements. Our client enjoyed this activity a lot. She likes to sing and she has beautiful voice. After that therapy, she told us her favorite song and singer. And it was nice to hear some stories from her.

PHOTOTHERAPY This activity helps the client to freely express their feelings about the photo. We asked them to looked at the photo and tell us what they feel about that. Mrs. MJ cooperates well, she even recognized those photos. She can also identified the use of those photos. This therapy help our client to redirect or orient her into reality.

MOVIE THERAPHY This activity helps the patient to express his/her feelings which may reflect their personal experiences. Our client enjoyed watching the film, they do not have television inside the hospital. She also stated that she misses her mother a lot when she saw the girl on the movie.