OBJECTIVES

At the end of 60 minutes presentation, the presenters will be able to:

Knowledge

1. Identify the main leading or causing factors of Schizophrenia.

2. Trace and determine the major triggering, precipitating, and predisposing factors

of Schizophrenia.

3. Discuss the psychological and social interventions designed for people with

Schizophrenia.

Skills

1. Formulate care plans for client who is experiencing Schizophrenia.

2. Do a structural health to the audience.

3. Transport the knowledge the researchers gained to the audience.

Attitude

1. Listen attentively to the presentation and reflect from it.

2. Reflect the role of the nurse in caring for a client with Schizophrenia.

3. Maintain confidentiality of the patients data.

 Chapter 1

INTRODUCTION

Is the world a safe place or it is full of unpredictable events and accidents waiting

to happen? There are about 1 in 100 people who experience schizophrenia in their

lifetime, many of them continuing to lead normal lives. Schizophrenia is a mental

disorder often characterized by abnormal social behavior and failure to recognize what

is real. Schizophrenia is a chronic, severe, and disabling brain disorder that has affected

people throughout history. They tend to hear voices or see things that other people dont

hear or see. They believe other people are reading their minds, controlling their thoughts,

or planning to harm them. This can terrify people with the illness and make them

withdrawn or extremely agitated.

Families and society are affected by schizophrenia too. Many people with

schizophrenia have difficulty holding a job or caring for them, so they rely on others for

help. People withdraw their self from people who are mentally ill making them become

more isolated from the real world. Many scientists say according to their research that

schizophrenia runs in families.

Scientists have long known that schizophrenia runs in families. The illness occurs

in 1 percent of the general population, but it occurs in 10 percent of people who have a

first-degree relative with the disorder, such as a parent, brother, or sister. People who

have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease

also develop schizophrenia more often than the general population. The risk is highest for
an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance

of developing the disorder.

We the researchers choose this case because we want to gain more knowledge

about this illness since most of the people tend to develop this illness. We would like to

gain awareness and share to other people our learning about this disease so that when this

illness strike this homes and families they will be able to manage and cope with this

illness and proper interventions will be given.

 Psychiatric History

I. Demographic Data

Name: Miss Paasa

Address: Sigma, Capiz

Age: 19 years old

Birth date: July 26, 1996

Gender: Female

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Date of Admission: March 22, 2016

Time of Admission: 4:00 PM

Attending Physician: Dr. Villanueva

Admission Diagnosis: Schizophrenia

II. Chief Complaint: behavioral changes

III. History of Present Illness

During the September 15, 2015 there was an incident when she was

unable to get out of her bed, damu-damo daw siya kamot kag mga shadows

makita sa sulod balay nga daw kwaon siya, as verbalized by the mother. Miss
 Paasa also complains of headache and experienced fainting sometimes, her

mother brings her to quackery and had tried different remedies but her

condition wasnt cured. Her mother also brings her to a health center but the

doctor didnt tell them the diagnosis and just give them medication to take. Her

condition was not cured. On the next month, October 26, 2015, her mother

decided to bring her to PMHU. Miss Paasa was discharged on November 10,

2015, but she stopped taking her medications, nag untat siya inom bulong kay

daw lain na iya gihu kag panumduman, dawg a buang siya, as stated by the

mother of Miss Paasa. After a few days when she started on not taking her

medications, she manifested nervousness and starring spells and doesnt want

to go outside of the house. So the mother decided to bring her again to PMHU

to have her admitted the second time, she was brought on March 22, 2016.

IV. Past History

On 2013, the patient found out that she had a benign cyst on her breast.

She was able to undergo x-ray and biopsy on San Anthonio, Roxas. She

undergoes an operation on her breast at Manduriao Western Ilo-Ilo to prevent

the cyst from getting worse.

V. Family History

Father of the patient died of CVD when she was 3 years old.
VI. Past Personal History

A. Prenatal data:

- Her mother was 46 years old when she was born.

- Previous deliveries are all normal and delivered at home.

B. First Year of Life (0-1 years):

- The patient was normally delivered at home with assistance of paltera.

- The patient is breastfeed by her mother until 3 years old. The child was

cuddled during feeding.

- Mother stays with the child most of the time.

- There was no nailbitting as verbalize by the mother. But she does thumb

sucking until the age of 8 months.

- The patient started talking when she was 2 years old. First word is mama

as verbalized by the mother.

- She learns to stand at the age of 1 year and 3 months.

- She learns to walk at the age of 1 year.

C. Toilet training: Anal Phase (1-3 years)

- She was 4 years old when she started going to toilet on her own.

D. Secondary socialization: Oedipal phase (3-6 years)

- Admitted that mahuloyaon ko.

 - According to her mother her child preferred to be accompanied by the

same sex. But the child verbalizes she likes to be accompanied by

opposite sex.

E. School History

- She started schooling at the age of 6 years old.

- She graduated from high school and en1rol 1st semester of her 1 year in

college but didnt finish the semester.

F. Home Environment

- There family is like the typical family we all can see. The patient

verbalized "wala man ga favoritism si mama nakon, halos tanan man kami gina

treat niya nga equal." Her mother is so understanding and very supportive to

whatever activities she has. She gets punishment when she commits wrong things

but her mother doesnt usually hit them. The family has still a happy atmosphere

and very close with each other.

G. Interests, hobbies, habit

- She likes listening to music, and she do household chores. She and her

friends go out and drinks alcoholic beverages and she try smoking. She doesnt

tell her problem to anyone.

VIII. Current Social Situation and Home Environment

Miss paasa lives with her mother, brother and nephew at their house. She is close

to her family but she doesnt tell them about her problem.
 Mental Status Examination

1.) General Appearance and Behaviour:

A. Physical appearance: fairly kempt, appropriately dressed, hair neatly combed

and always attends to her daily hygiene.

B. Behaviours during the interview: answers questions when asked but some

answers have gaps. Laughs when she doesnt want to answer the question, noted to

engage herself in deep thought at times when ask with a personal questions.

C. Social skills: friendly to nurse and to other patients. Tends to socialize with

other patients, but sometimes prefer to be alone. She attends the activities and participates

but hesitant to go in front when asked.

D. Amount and type of motor activity: joins in recreational activities such as

gardening and other therapies. Walk within the compound; sits with other patient in the

kubo.

E. Speech pattern: speaks in low tone of voice, readily answers when asked with

some questions only but do not respond right away if question is personal.

F. Degree of concentration and attention span.

Attention span: tend to scratch the back of her neck when irritated and patient verbalized

damo pa kamo pamangkot?

G. orientation: oriented to time, place and person.

H. memory: able to recall high school memory and some happy memories.

Suppressed painful memory.

 I. Intellectual functioning: finish elementary with satisfactory grade. Graduate

high school ranking top ten and was able to enrol in HRM for only one year. Can speak

English but not fluent.

J. Mood and affect: blunted and inappropriate affect, unable to show right affect

to her mood. She speaks in a happy voice when she is depressed. She expresses

inappropriate mood from what she is talking about.

K. Content of thought: The patient doesnt have any hallucinations during the

course of the interview.

L. Insight and judgment: The patient was asked by a series of question. The

student nurse asked first question kun mag lubog ang barko ano imo himu-on? the

patient answered ma lumpat ko kag malangoy kabalu man ko mag langoy. The student

asked another question kun masunog ang istaran, ano himu-on mo? the patient

answered ma gwa sa balay kag mangayo tabang. The patient verbalized na tingala

man ko gane ngaari ko di. Daw normal man ko.

 Psychopathology

Precipitating: Predisposing
- trauma experience
-gender
-Home environmental?
- age
-stress on emotional upset,
-race
medication, exercise
-boyfriend

Neurodevelopmental abnormalities and

target features.

Improper balance of chemical, increase and

decrease of serotonin and dopamine.

Behavioral changes (altered).

Signs and symptoms (two or more

are present) hallucination,
disorganize speech grossly,
disorganize or catatonic behavior.
Positive Negative

Delusion Alogia *
Hallucination Adhedonia *
Anergia Avolition *
Asocial behavior *
Passive social withdrawal *

Schizophrenia

Hallucination Delusion Stress Depression

Nervous Anxiety

Clozapine Insomnia Irritability

w
Constructive
 Psychodynamic Formulation

According to Erikson, the ego develops as it successfully resolves crises that are

distinctly social in nature. These involve establishing a sense of trust in others,

developing a sense of identity in society, and helping the next generation prepare for the

future. Erik Erikson maintained that personality develops in a predetermined order, and

builds upon each previous stage. This is called the epigenic principle.

The outcome of this 'maturation timetable' is a wide and integrated set of life

skills and abilities that function together within the autonomous individual. However,

instead of focusing on sexual development (like Freud), he was interested in how children

socialize and how this affects their sense of self. Erikson assumes that a crisis occurs at

each stage of development. For Erikson (1963), these crises are of a psychosocial nature

because they involve psychological needs of the individual (i.e. psycho) conflicting with

the needs of society (i.e. social). (McLeod, S. A. (2013). Erik Erikson. Retrieved from

www.simplypsychology.org/Erik-Erikson.html)

According to the theory, successful completion of each stage results in a healthy

personality and the acquisition of basic virtues. Basic virtues are characteristic strengths

which the ego can use to resolve subsequent crises.

Failure to successfully complete a stage can result in a reduced ability to complete

further stages and therefore a more unhealthy personality and sense of self. These stages,

however, can be resolved successfully at a later time

Trust vs. Mistrust:

During this stage the infant is uncertain about the world in which they live. To

resolve these feelings of uncertainty the infant looks towards their primary caregiver for

stability and consistency of care.

the object of gratification is the lips.

If the care the infant receives is consistent, predictable and reliable, they will

develop a sense of trust which will carry with them to other relationships, and they will

be able to feel secure even when threatened. The patient was fully satisfied and develop

trust among caregivers as it is provided. During this stage the patient was able to gain

trust other people especially to her mother who take all the time taking care of her.

Autonomy vs. shame and doubt

The child derives great pleasure from defecating. The child is now aware that

they are a person in their own right and that their wishes can bring them into conflict with

the demands of the outside world (i.e. their ego has developed). Freud believed that this

type of conflict tends to come to a head in potty training, in which adults impose

restrictions on when and where the child can defecate. The patient started her toilet

training at the age of 3 years old. She was able to go to their comfort room and defecate

or pee. She was not able to play with her feces. Also her mother is very strict when it

comes to cleanliness in their home. No bedwetting happened except when she is very

tired.
Initiative vs. Guilt

During this period the primary feature involves the child regularly interacting

with other children at school. Central o this stage is play, as it provides children with

opportunity to explore their interpersonal skills through initiating activities. The patient

was able to gain friends during this period of time. She also become more curios and tend

to ask many question to the mother. She went out and play with some kids but she spend

more time in their home. A healthy balance between initiative and guilt is important.

Success in this stage will lead to the virtue of purpose.

Industry vs inferiority

Children are at the stage where they will be learning to read and write, to do sums,

to make things on their own. Teachers begin to take an important role in the child's life as

they teach the child specific skills. it is at this stage that the child's peer group will gain

greater significance and will become a major source of the child self esteem. She gain

friends but she is more close with her brothers rather than with her friends.

Identity vs. Role Confusion

During Adolescence, the transition from adulthood is most important. Children

are becoming more independent, and begin to look at future terms of career,

relationships, families, housing, etc. The individuals want to belong to a society and fit

in. During this period of time she tend to go out with her friends and join with them with

their vices. She was also able to gain some textmates. She was also much more close to

guys rather than girls. During this period, they explore possibilities and begin to form

their own identity based upon the outcome of their explorations.

Intimacy vs. Isolation

Exploring relationships leading toward longer term commitments with someone

other than a family member. During this stage the patient trust so much to her boyfriend,

believing she will have a better future with her boyfriend. She trusted so much that

person but in the end she was left leaving her pregnant. But she verbalized "saguron ko

man gyapon akon bata maskin wala na siya papa nga kilalahon."
 Nursing Care Plan

Assessment Nursing diagnosis Plan Nursing Rationale Evaluation

intervention
S- The patient After 7 days of
verbalized Disturbed thought SHORT TERM -Assess level of -For baseline nursing interaction
"budlayan ko mag processes related to After 4 hours of anxiety of patient purposes. the patient was able
share sa akon inability to trust as nursing interaction to:
problema kay wala evidence by the patient will be -Assess coping -For baseline
ko ga salig sa iban Inappropriate use of able to: mechanism of purposes. -verbalized her
nga taho" defense patient problems and the
mechanisms. Build rapport with To obtain accurate things that bother
O- the client and be -Build a strong information. her.
- Denial able to discuss her rapport with client
- Suppression of problem To maintain trust - verbalized that she
events -Be honest and keep and good nurse will coped on
- deep thought LONG TERM all promises. patient relationship. whatever problems
she will encounter
After 7 days of To gain needed in life in the present.
nursing interaction - Use a creative information.
the patient will be approach to let
able to: patient talk her
problems.
Demonstrate use if To obtain right and
more adaptive - Encourage client accurate data.
coping skills, as to verbalize true
evidenced by feelings.
appropriateness of To prevent client
interaction and -Educate client the from being depress.
willingness to importance of
 participate in the verbalizing her
therapeutic problems.
community.
Assessment Nursing diagnosis Plan Nursing Rationale Evaluation
intervention
S- patient verbalizes After 5 hours of After 5 hours of
" akig ko sa mego Ineffective coping nursing interaction -Assess patient - To determine the nursing interaction
ko kay gin bayaan related to inability the patient will be response to problem depth of patients the patient was able
niya ko kag ka to form a valid able to: coping pattern. to:
busong pa ako." appraisal of the
stressors Engage in reality- -Build rapport with -To obtain an Verbalized partly of
O- based interactions the client. accurate her problem.
-Suppression of information.
happenings -Encourage client to
- deep thought Express feelings verbalize her -To determine
- positive pregnancy feelings and her appropriate measure
test. Understand that problems. in helping patient.
despair can be
overcome. -Engage patient in -To express her
illustrative therapy. feelings.

-Educate patient the -To express her

importance of fee;ings and be able
socializing her to cope
problems.
 Psychopharmacology

Generic name/ Classification Indication Dosage/Time Mechanism of Nursing Rationale

Drug Name Action Consideration

Clozapine Antipsychotic; Management of 100 mg 1 tab Interferes with Do not abruptly To avoid drug

(clorazil) Dopaminergic severely ill OD HS 7pm binding of discontinue long resistance.

blocker schizophrenic dopamine at term drug

pts who are dopamine therapy.

unresponsive to receptor sites;

standard binds primarily Avoid alcohol, To prevent/

antipsychotic at non-dopamine caffeine. avoid contra

drugs. Treatment receptor sites. acting with the

of recurrent Clozapine drug.

suicidal produces fewer -Weekly Blood

behavior. extrapyramidal tests will be -to ensure safe

side effects than taken dosage in the

other -Educate patient blood

antipsychotics. on serious -To educate the

agranulocytosis. client about

-Follow possible low

guidelines for blood

discontinuation components.

or reinstitution -to have fewer

of the drug side effects that

can lead to

withdrawal

syndrome
 Discharge Plan

Nursing Goals Orders Rationale

Upon the Discharge, the patient will be able to:

Medication Verbalize compliance to prescribe medication Instruct patient & S.O. to take note the To help patient not to be confused of her
regimen for the recovery, administer at the right time, prescribed medication. Instruct patient or medications and also none will be miss.
route and dosage as ordered by physician. S.O. if they can buy medicine cabinet sort Taking of the drug to the prescribed date
the medication needed for the would help patient avoid drug resistance.
corresponding day.

Exercise Provide good blood circulation and promote healthy Encourage patient to have a light exercise, To help improve body functions and to
living and establish mind and body circulation at least 15 minutes walking with a regular improve health.
pace.

Therapy Encourage active cooperation on occupational Continue to perform therapies such as To aid client's maximum wellness.
therapy such as dance therapy, constructive therapy, dance therapies, constructive therapies, and
and expressive therapy. expressive therapies.

Hygiene To maintain proper hygiene, cleanliness to the Instruct patient to take a bath regularly & Avoid infection from invading the body.
patient, practice normal ADL and to avoid more wash hands before and after eating.
infection and diseases.

Patient should have an update of what is happening to Follow-up checkup should be done after To note the progression of healing of the
OPD her mental status. discharge. patient.
\

Diet Patient will maintain good health and good body Encouraged patient to eat healthy food. To promote the health and wellness of the
condition. patient.
Spiritual To promote a closer bond with God and to ease more Emphasize the importance of God to our To bring spiritual growth with the client and
the feelings of the client about her condition. lives. becomes much closer with God.
 Recommendations

This case study is viewed to be of esteemed value to the following groups:

CPAC Faculty can utilize baseline information from this study as a guide in

making more advanced related studies to this specific disease.

Nursing Students can utilize the findings of this study as basis for design and

conduct of other researchers related to schizophrenia and will provide rich information

regarding diagnosed diseased. In addition to, it will serve as a medium in which nurses

can improve their care with this kind of patients.

CPAC Students can utilize the findings of this study to provide awareness with

regards to the specified case study and also to gain more information to enhance the

knowledge of the students to this specific disease.