PSYCHIATRIC- MENTAL HEALTH NURSING

A Case Presentation on Schizophrenia

Presented to the Faculty of the School of Nuring

Adventist Medical Center College
Brgy. San Miguel, Iligan City

In Partial Fulfillment
Of the Requirement for the Degree
BACHELOR OF SCIENCE IN NURSING

Abdullah, Asniah
Amano, Amirah
Bughaw, Alvin Miko
Bulado, Annielyn
Chinchuntic, Joan
Cornell, Nur Mohammad
Espera, Leslie
Medina, Robelynn
Pagasian, Lady Bee
Rangiris, Johainah
Sabdula, Norhaide

Professor:
Lecciones, Evalyn M. MAN, PhD, RN
 TABLE OF CONTENTS
PAGES
I. TITLE PAGE i
II. TABLE OF CONTENTS ii-iii
III. LIST OF TABLES iv
IV. LIST OF FIGURES v
V. OBJECTIVES 1

VI. INTRODUCTION 2-4

VII. CHAPTER1: ASSESSMENT

A. Psychiatric Nursing History

a. Vital Information 5-6
b. Informants 7-9
c. Chief Complaints 10
d. Personal Identifications 10
e. History of Present Illness 10-11
f. History of Past Illness 11
g. Allergies 11
h. Family History 11
i. Personality’ 11
j. Psychosexual History 12
k. Current Social Situation 12
l. Assets 12
m. Dreams, Fantasies and Value System 12

B. Anamnesis 13-21
C. Genogram 22
D. Mini- Mental Status Examination 23-34
E. Comprehensive Mental Status Examination 35-39

F. Spiritual/ Cultural Assessment 40-42

G. Diagnostic Studies 43-44
H.Nurse Progress Notes 45-50

ii
VIII. CHAPER 2: ANALYSIS AND DIAGNOSIS
Psychodynamics
a. Psychodynamics Concept Map 51- 53

b. Life Chart 54

IX. CHAPTER 3: PLANNING AND IMPLEMENTATION

a. Nursing Care Plan 55-77

b. Psychotherapies 78-81

c. Nurse Process Recording (NPI) 82-108

X. CHAPTER 4: PSYCHOPHARMACOLOGY 110-114

XI. CHAPTER 5: DISHARGE PLAN 109-117

XII. CHAPTER 6: EVALUTION

a. Prognosis and Recommendation 118-120

b. References 123
 iii
LIST OF TABLES
PAGES
1 ANAMNESIS 13-21
2 MINI- MENTAL STATUS EXAM 23-34
3 DIAGNOSTIC STUDIES 43-44
4 NURSE PROGRESS NOTES 45-50
5 NURSING CARE PLAN 55-77
6 NURSE PROCESS RECORDING 82-108
7 PSYCHOPHARMACOLOGY 110-114
8 PROGNOSIS
 iv

LIST OF FIGURES
PAGES
1 GENOGRAM 22
2 PSYCHODYNAMIC CONCEPT MAP 53
3 LIFE CHART 54
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