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Criteria:

Situation, Date, Time


San Pedro College (5)
C. de Guzman St. Davao City NPI (50)
Objectives, Thoughts &
Feelings, Interpretation
Nurse-Patient Interaction (40)
Bibliography (5)
(Orientation Phase)

In Partial fulfilment
Of the Requirements
In NCM-102 RLE

Submitted to:
Expectacion Tapia-Datuin, RN, MAEd
Clinical Instructor

Theresa Babiera, St.N.


Practicing Clinical Instructor

Submitted by:
Jaeson Angelo Coronica
BSN 3J
Date Submitted:
February 17, 2010
I. Introductory Data

A. Personal Data
Name: Jolito Cuaton Dalugdog Address: Purok 4 Baybay II, Bislig City Surigao del Sur
Birth date: October 18, 2965 Occupation: Fisherman
Birthplace: Surigao del Sur Chief Complaint: murmurs, incomprehensive words
Nationality: Filipino Date of Interaction: February 15, 2010
Sex: Male Diagnosis: Psychotic disorder
Civil Status: Single Institution: New Day Recovery Center

B. Brief History
The patient was basically a friendly and generous person. He became shy after the condition was triggered.
In 1996, he was on a boat when a storm struck and he was stranded 3 weeks on a deserted island with no food source. He tried to
climb a coconut tree but failed in his attempt and fell to the ground. When he got back home he was already fond of wearing Cossack and
rosary beads. The family consulted a quack doctor but failed to treat him.
In 1997, he was admitted to DMH and was prescribed with Thorazine. After a week of treatment the patient became normal. He
indulged himself to vices such as drinking alcoholic beverages, smoking, and coffee. This triggered his condition.
In 2004, the family became non-compliant to the medicine because of lack of financial resource. The patient became more violent.
In 2008, his father died. This triggered his condition.
Last 2009, his mother died. This triggered his condition. He verbalized ‘patay na mama, wala na magpakaon sa ilaga’.
He was admitted to New Day Recovery Center on April 22, 2009 with a chief complaint of murmurs and incomprehensive words. His
brother, Wilfredo, was the one who brought him there and said it was to stabilize his thinking.

II. Nurse-Patient Interaction

SITUATION/ DATE/ NURSE PATIENT INTERACTION OBJECTIVE/ THOUGHT & FEELINGS/


TIME INTERPRETATION

February 15, 2010 Legend: SN - student nurse O – Objective T/F – Thoughts/Feelings


4:00-4:30 pm C- client I – Interpretation B - Bibliography
@ the Sydney Room
SN: Maayong hapon Sir! O: To establish a helpful trusting relationship.
My client & I were in C: Maayong hapon pud. T/F: This area is quite critical because it will be my first
the area during the SN: Sir, unsa imong pangalan? time to interact with the patient but knowing that my
snack time. I was C: Jolito. resident responds still, I am overwhelmed.
sitting beside him SN: unsa ang imong angga Jolito? I: The trust established between the nurse and client at
and we were both C: Joli. this point allows them to examine the problems and to
eating the food SN: Ok lang mao akong tawag sa imoha? work on them within the security of relationship.
prepared. He was C: Oo. B: Videbeck, Sheila L. Psychiatric Mental Health
wearing yellow shirt Nursing. 3rd Edition. Philadelphia: Lippincott Williams &
& shorts. Wilkins. © 2006, p. 97

SN: Jol dili kayo ka nagasturya no, unsa diay imong gibati karon? O: To encourage verbalization of feelings.
C: Maulaw man gud ko. T/F: As much as possible I wanted him to open up to me.
SN: Aw Jul ayaw lang ug kaulaw sa amo-a ha? Ayaw kabalaka dili Knowing that he felt awkward, I readily told him that he
man ka namo pabayaan. Ok ba na Jol? doesn’t have to feel that way.
C: Sige Jaeson. I: The client must believe that the nurse will
not turn away or be upset when the client reveals his
feelings or emotions.
B: Videbeck, Sheila L. Psychiatric Mental Health
Nursing. 3rd Edition. Philadelphia: Lippincott Williams &
Wilkins. © 2006, p. 97

SN: Salamat Jol. Ako diay si Jaeson, student nurse nimo. Alagaan ka O: To establish a helpful trusting relationship.
namo sir hangtud sa kami pa ang mag duty diri sa NDRC. T/F: As I remember this has to be stated to ensure that
C: Ok Jaeson. the client knows the span of time that they will be on our
SN: Gikan Monday to Wednesday taga-semana Jol kami ang care. I was hoping that it would be okay for him that we
assigned nga mag-alaga sa inyoha. Hangtud march 9 mi diri mag will be meeting every week. I was thankful that he
duty. Ok ba na sa imoha Jol. responded.
C: Ok lang. I: The trust established between the nurse and client at
this point allows them to examine the problems and to
work on them within the security of relationship.
B: Videbeck, Sheila L. Psychiatric Mental Health
Nursing. 3rd Edition. Philadelphia: Lippincott Williams &
Wilkins. © 2006, p. 97

SN: Jol taga aha diay ka? O: To gather pertinent information.


C: Taga Surigao. T/F: I felt the need to talk a bit more about basic
SN: Unsa pud imong ginabuhat didto sa una? information with him so that he can open up more and
C: Naga-trabaho man ko didto sa una. not feel awkward towards us students.
SN: Unsa imong trabaho Jol? I: Exploring ideas can help in understanding it better and

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