Case Study on

Presented by:
Group 2: Erardo, Erguiza, Eribal, Esguerra, Esmero, Español,
Española, Estacio M., Estacio, P., Estepa, Estrada &
Evangelista

PRESENTED TO:
Mrs. Joanie C. Andaya, RN
Group 2 Clinical Instructor
 COLLEGE OF NURSING

A Case Study on

Residual Schizophrenia
Presented to the College of Nursing
University of Perpetual Help System DALTA

In Partial Fulfillment of the

Subject Requirement in
Related Learning Experience (NCM 104)

Presented by:
ERARDO, Darius Daniel Gonzales
ERGUIZA, Mianne Nicole Empalmado
ERIBAL, Charmaine delos Reyes
ESGUERRA, Jose Mari Filipinas
ESMERO, Jimmel Obejas
ESPAÑOL, Nikko Jan Tristan Respicio
ESPAÑOLA, Alberto Miguel Moscoso
ESTACIO, Mary Grace Natividad
ESTACIO, Precious Ann Sernande
ESTEPA, Kevin Marlo Alonzo
ESTRADA, Ralph Edison Clemente
EVANGELISTA, Lorna Tabudlong
BSN 4G – Group 2

Presented to:
Mrs. Joanie C. Andaya, RN
 ACKNOWLEDGEMENT

This Case Study would not have been possible without the help of many people. We,
the Group 2 of BSN 4G would like to extend our warmest gratitude to the following people who
made an effort to help in different ways:

To our Family, for their continuous support and encouragement and for being our
inspiration in every task that we are doing;

We would like also to convey our thanks to the Staff of Cavite Center for Mental
Health for allowing us in borrowing the case of their patients for our case study.

To our Clinical Instructor, Mrs. Joanie C. Andaya, we whole heartedly thank you for
your efforts and suggestions; we really appreciate your kindness and patience to help us in many
ways for us to have courage to pursue this task.

To our Patient, Mr. R.M, we really appreciate your participation in our case study.
Thank you for allowing us to have an interview with you.

And lastly, to our God Almighty for the gift of wisdom and skills for us to accomplish
this task, we offer you these for being our source if encouragement and determination.
CHAPTER 1: Overview of the Disease

DEFINITION

Schizophrenia is an extremely complex mental disorder: in fact it is probably many illnesses

masquerading as one. A biochemical imbalance in the brain is believed to cause symptoms. Recent
research reveals that schizophrenia may be a result of faulty neuronal development in the fetal
brain, which develops into full-blown illness in late adolescence or early adulthood.

Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement, and
behavior. It cannot be defined as a single illness; rather thought as a syndrome or disease process
with many different varieties and symptoms. It is usually diagnosed in late adolescence or early
adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age
for men and 25 to 35 years of age for women.

TYPES

• Schizophrenia, paranoid type is characterized by persecutory (feeling victimized or spied

on) or grandiose delusions, hallucinations, and occasionally, excessively religiosity
(delusional focus) or hostile and aggressive behavior.

• Schizophrenia, disorganized type is characterized by grossly inappropriate or flat affect,

incoherence, loose associations, and extremely disorganized behavior.

• Schizophrenia, catatonic type is characterized by marked psychomotor disturbance, either

motionless or excessive motor activity. Motor immobility may be manifested by catalepsy
(waxy flexibility) or stupor.
 • Schizophrenia, undifferentiated type is characterized by mixed schizophrenic symptoms
(of other types) along with disturbances of thought, affect, and behavior.

• Schizophrenia, residual type is characterized by at least one previous, though not a

current, episode, social withdrawal, flat affect and looseness of associations.

SYMPTOMS

The symptoms of schizophrenia are categorized into two major categories, the positive or
hard symptoms which include delusion, hallucinations, and grossly disorganized thinking,
speech, and behavior, and negative or soft symptoms as flat affect, lack of volition, and social
withdrawal or discomfort. Medication treatment can control the positive symptoms but frequently
the negative symptoms persist after positive symptoms have abated. The persistence of these
negative symptoms over time presents a major barrier to recovery and improved the functioning of
client’s daily life.

MEDICAL MANAGEMENT

Currently, there is no method for preventing schizophrenia and there is no cure. Minimizing the
impact of disease depends mainly on early diagnosis and, appropriate pharmacological and
psycho-social treatments. Hospitalization may be required to stabilize ill persons during an acute
episode. The need for hospitalization will depend on the severity of the episode. Mild or moderate
episodes may be appropriately addressed by intense outpatient treatment. A person with
schizophrenia should leave the hospital or outpatient facility with a treatment plan that will
minimize symptoms and maximize quality of life.

A comprehensive treatment program can include:

• Antipsychotic medication
• Education & support, for both ill individuals and families
• Social skills training
 • Rehabilitation to improve activities of daily living
• Vocational and recreational support
• Cognitive therapy

Medication is one of the cornerstones of treatment. Once the acute stage of a psychotic
episode has passed, most people with schizophrenia will need to take medicine indefinitely. This is
because vulnerability to psychosis doesn’t go away, even though some or all of the symptoms do. In
North America, atypical or second generation antipsychotic medications are the most widely used.
However, there are many first-generation antipsychotic medications available that may still be
prescribed. A doctor will prescribe the medication that is the most effective for the ill individual

Another important part of treatment is psychosocial programs and initiatives. Combined with
medication, they can help ill individuals effectively manage their disorder. Talking with your
treatment team will ensure you are aware of all available programs and medications.

In addition, persons living with schizophrenia may have access to or qualify for income support
programs/initiatives, supportive housing, and/or skills development programs, designed to
promote integration and recovery.

NURSING INTERVENTIONS

Strengthening differentiation

• Provide patient with honest and consistent feedback in a non threatening

manner.
• Avoid challenging the content of patient’s behavior
• Focus interactions on patient’s behavior.
• Administer drugs as prescribed while monitoring and documenting patient’s
response to drug regimen.
• Use simple and clear language when speaking with the patient.
• Explain all procedures, test and activities to patient before starting them
Promoting socialization

• Encourage patient to talk about feelings in the context of a trusting, supportive

relationship.
• Allow patient to reveal delusions to you without engaging in power struggle
over the content or the entire reality of the delusions.
• Use supportive, emphatic approach to focus on patient’s feelings about
troubling events or conflicts.
• Provide opportunities for socialization and encourage participation in group
activities.
• Be aware of personal space and use touch judiciously.
• Help patient to identify behaviors that alienate significant others and family
members.

Ensuring safety:

• Monitor patient for behaviors that indicate increased anxiety and agitation.
• Collaborate patient to identify anxious behaviors as well as causes.
• Establish consistent limits on patient’s behavior and clearly communicate
these limits to patients, family member, and health care providers.
• Secure all potential weapons and articles from patient’s room and the unit
environment that could be used to inflict injury.
• Determine the need for external control, including seclusion or restraints.
Communicate the decision to patient and put plan into action.
• Frequently monitor the patient within guidelines of facility’s policy on
restrictive devices and assess the patients level of agitation.
• When patient’s level of agitation begins to decrease and self control regained,
establish a behavioral agreement that identifies specific behaviors that indicate self
control against are escalation agitation.
CHAPTER 2: Patient’s Profile

Demographic Data:

Name: R.M

Age: 35 years old

Gender: Male

Address: Maragondon Cavite

Date of Birth: December 27, 1975

Place of Birth: Cavite

Occupation: Home buddy

Nationality: Filipino

Civil Status: Single

Religion: Roman Catholic

Chief Complaint: (Nananakot)

Diagnosis: Residual Schizophrenia

Date Admitted: November 4, 1999

Source of Information: Patient, Patient’s Chart and Patient’s Relatives

NURSING HISTORY

A. Chief Complaint

The Patient was admitted by his relatives at Cavite Center for Mental Health last
November 4, 1999 due to personality disorder such as scaring them and did different behaviors.

B. History of Present Illness

Started 2 weeks prior to consultation when patient showing violent attitude towards
his relatives.

Relapsed Schizophrenia (2007)

Residual Schizophrenia

C. Past Medical History

(+) Tuberculosis
(+) Schizophrenia

D. Medical Status Coordination

Prior admission the patient is:

- unkept
- uncooperative
- incoherent
- (+) visual & auditory hallucination
- disoriented
- poor memory & judgment
CHAPTER 3: Anatomy of the Brain

CEREBRAL CORTEX
Function:

The outermost layer of the cerebral hemisphere which is composed

of gray matter. Cortices are asymmetrical. Both hemispheres are
able to analyze sensory data, perform memory functions, learn new
information, form thoughts and make decisions.

Left Hemisphere
Function:
Sequential Analysis: systematic, logical interpretation of information. Interpretation and
production of symbolic information: language, mathematics, abstraction and reasoning. Memory
stored in a language format.

Right Hemisphere
Function:
Holistic Functioning: processing multi-sensory input simultaneously to provide "holistic" picture of
one's environment. Visual spatial skills. Holistic functions such as dancing and gymnastics are
coordinated by the right hemisphere. Memory is stored in auditory, visual and spatial modalities.

CORPUS CALLOSUM
Function:
Connects right and left hemisphere to allow for communication
between the hemispheres. Forms roof of the lateral and third
ventricles.

Associated Signs and Symptoms:

Damage to the Corpus Callosum may result in "Split Brain" syndrome.

FRONTAL LOBE
Function:
Cognition and memory.

Prefrontal area: The ability to concentrate and attend, elaboration of

thought. The "Gatekeeper"; (judgment, inhibition). Personality and

emotional traits.

Movement: Motor Cortex (Brodman's): voluntary motor activity.

Premotor Cortex: storage of motor patterns and voluntary activities.

Language: motor speech

Associated Symptoms:

• Impairment of recent memory, inattentiveness, inability to concentrate, behavior disorders,

difficulty in learning new information. Lack of inhibition (inappropriate social and/or sexual
behavior). Emotional lability. "Flat" affect.
• Contralateral plegia, paresis.
• Expressive/motor aphasia

PARIETAL LOBE

Function:

Processing of sensory input, sensory discrimination

Body orientation

Primary/ secondary somatic area

Associated Symptoms:

• Inability to discriminate between sensory stimuli.

• Inability to locate and recognize parts of the body (Neglect).
• Severe Injury: Inability to recognize self.
• Disorientation of environment space.
• Inability to write
OCCIPITAL LOBE

Function:

Primary visual reception area.

Primary visual association area: Allows for visual interpretation.

Associated Symptoms:

• Primary Visual Cortex: loss of vision opposite field.

• Visual Association Cortex: loss of ability to recognize object seen in opposite field of vision,
"flash of light", "stars".

TEMPORAL LOBE

Function:

Auditory receptive area and association areas.

Expressed behavior.

Language: Receptive speech.

Memory: Information retrieval.

Associated Symptoms:

• Hearing deficits.
• Agitation, irritability, childish behavior.
• Receptive/ sensory aphasia

LIMBIC SYSTEM
Functions:

Olfactory pathways:

Amygdala and their different pathways.

Hippocampi and their different pathways.

Limbic lobes: Sex, rage, fear; emotions. Integration of recent memory, biological rhythms.

Hypothalamus.

Associated Symptoms:

• Loss of sense of smell.

• Agitation, loss of control of emotion. Loss of recent memory.

BASAL GANGLIA

Functions:

Subcortical gray matter nuclei. Processing link between thalamus

and motor cortex. Initiation and direction of voluntary

movement. Balance (inhibitory), Postural reflexes.

Part of extrapyramidal system: regulation of automatic movement.

Associated Symptoms:

• Movement disorders: chorea, tremors at rest and with initiation of movement, abnormal
increase in muscle tone, difficulty initiating movement.
• Parkinson’s

THALAMUS
Functions:

Processing center of the cerebral cortex. Coordinates and

regulates all functional activity of the cortex via the

integration of the afferent input to the cortex (except olfaction).

Contributes to effectual expression.

Associated Symptoms:

• Altered level of consciousness.

• Loss of perception.
• Thalamic syndrome - spontaneous pain opposite side of body.

HYPOTHALAMUS

Functions:

Integration center of Autonomic Nervous System (ANS):

Regulation of body temperature and endocrine function.

Anterior Hypothalamus: parasympathetic activity (maintenance function).

Posterior Hypothalamus: sympathetic activity ("Fight" or "Flight", stress response).

Behavioral patterns: Physical expression of behavior.

Appestat: Feeding center. Pleasure center.

Associated Symptoms:

• Hormonal imbalances.
• Malignant hypothermia.
• Inability to control temperature.
INTERNAL CAPSULE

Functions:
Motor Tracts

Associated Symptoms:
Contralateral plegia (Paralysis of the opposite side of the body)

RETICULAR ACTIVATING SYSTEM (RAS)

Functions:
Responsible for arousal from sleep, wakefulness, attention.

Associated Symptoms:
Altered level of consciousness.

CEREBELLUM

Functions:
Coordination and control of voluntary movement.

Associated Symptoms:

• Tremors.
• Nystagmus (Involuntary movement of the eye).
• Ataxia, lack of coordination.
MIDBRAIN

Functions:

Nerve pathway of cerebral hemispheres.

Auditory and Visual reflex centers.

Cranial Nerves:

 CN III - Oculomotor (Related to eye movement), [motor].

 CN IV - Trochlear (Superior oblique muscle of the eye

which rotates the eye down and out), [motor].

Associated Symptoms:

• Weber's: CN III palsy and ptosis (drooping) ipsalateral (same side of body).
• Pupils:

Size: Midposition to dilated.

Reactivity: Sluggish to fixed.

• LOC (Loss of consciousness): Varies

• Movement: Abnormal extensor ( muscle that extends a part).
• Respiratory: Hyperventilating.
• CN (Cranial Nerve) Deficits: CN III, CN IV.

PONS
Functions:

Respiratory Center.

Cranial Nerves:

 CN V - Trigeminal (Skin of face, tongue, teeth; muscle of mastication), [motor and sensory].

 CN VI - Abducens (Lateral rectus muscle of eye which rotates eye outward), [motor].

 CN VII - Facial (Muscles of expression), [motor and sensory].

 CN VIII - Acoustic (Internal auditory passage), [sensory].

Associated Symptoms:

• Pupils:

Size: Pinpoint

• LOC:

Semi-coma

"Akinetic Mute".

"Locked In" Syndrome.

• Movement:

Abnormal extensor.

Withdrawal.

• Respiratory:

Apneustic (Abnormal respiration marked by sustained inhalation).

Hyperventilation.

• CN Deficits: CN VI, CN VII.

MEDULLA OBLONGATA
Functions:

Crossing of motor tracts.

Cardiac Center.

Respiratory Center.

Vasomotor (nerves having muscular control of the blood vessel walls) Center

Centers for cough, gag, swallow, and vomit.

Cranial Nerves:

 CN IX - Glossopharyneal (Muscles and mucous membranes of pharynx, the constricted

openings from the mouth and the oral pharynx and the posterior third of tongue.), [mixed].

 CN X - Vagus (Pharynx, larynx, heart, lungs, stomach), [mixed].

 CN XI - Accessory (Rotation of the head and shoulder), [motor].

 CN XII - Hypoglossal (Intrinsic muscles of the tongue), [motor].

Associated Symptoms:

• Movement: Ipsilateral (same side) plegia (paralysis).

• Pupils:

Size: Dilated.

Reactivity: Fixed.

• LOC: Comatose.
• Respiratory: Abnormal breathing patterns. Ataxic. Clustered. Hiccups.
Modifiable factors: Non-Modifiable
factors:
CHAPTER 4: Psychopathology
*Environmental factors *Gender - Male
- Low economic status / *Age – 24 years
poverty
-age range:
*Stress 15 – 25 years old
 Neuro Chemical Factor Neuro Anotomic Diminished
factor of glucose
metabolism
& oxygen
Complex senses of Decreased brain
biochemical event tissue and CSF

Increase activity of
dopamine & serotonin Increased activity
of glutamate, Enlarged ventricle and
acetylcholine & cortical atrophy
other
Increase dopamine neurotransmitters
and serotonin
Decreased brain volume
& brain function

Temporal dysfunction

Uncooperated
Incoherent
Disoriented
Poor mental judgement

RESIDUAL
SCHIZOPHRENIA
CHAPTER 5: Mental Status Examination

A. Appearance

- The Patient is family groomed, appropriately dressed

- Slightly Pale
- Maintain eye contact with interviewer
B. Speech

- Speech is sluggish
- Verbigeration present
- Rate is slow with low volume
- Good Articulation

C. Mood and Affect

- Patients claim that he feels happy but he misses his sister

- Affect is blunted

D. Thinking Process
- Patient’s answer occasionally relevant and organized.
- No hallucination, illusions, delusions and suicidal or homicidal intention.

E. Sensorium

Patient is alert, disoriented to 3 spheres, retrograde memory, no consideration.

F. Insight and Judgment

Good

CHAPTER 6: Problem List

PRIORITIZING PROBLEMS
 Ineffective Verbal Communication

Ineffective thought process

Disturbed personal identity

CHAPTER 7: List of Nursing Care Plan

Ineffective Verbal Communication
Assessment Diagnosis Planning Interventions Rationale Evaluation
Subjective: Ineffective At the end of - Establish rapport - to gain trust and At the end of
Verbal the rotation, to know the the rotation,
[No communicati the patient patient the patient
subjective on related to will be able - Assess - to prevent was able to
cues] psychotic to verbalize environmental environmental verbalize his
barriers sec. his ideas factors that may stressors that can ideas and
Objective: to residual effectively affect ability to affect thoughts
schizophreni and communicate communication effectively
Disoriented a as appropriatel abilities of the and
manifested y. patient appropriatel
(+) by positive - Maintain eye - to show interest y.
verbigeration verbigeratio contact when and sincerity in
n and communicating to communicating
Inappropriate inappropriat the patient with the patient
verbalization e
verbalization - Provide the - to construct his
Speaks in a patient sufficient thoughts
soft manner time to respond

- Keep - for them to

communication understand
simple, speaking phrases effectively
to short sentences, and appropriately
using appropriate
words, and using
all modes for
accessing
information

- Reduce - it can interfere /

environmental confuse patients
noise that can
interfere with
comprehension

- Provide - to improve their

therapeutic capacity to think
activities such as
art therapy

Ineffective thought process

Assessment Diagnosis Planning Interventions Rationale Evaluation
Subjective: Ineffective At the end of - Establish - to gain trust At the end of
“Gusto ko thought the rotation, therapeutic the rotation,
mag pa- process the client relationship the client
ospital, gusto related to will be able was able to
ko ng green, psychologica to - Redirect client - to avoid demonstrate
gusto ko ng l conflicts demonstrate away from confusion and organize
maliit” as sec. to organize problem situation stressors thinking
verbalized by residual thinking process
the patient schizophreni process - Provide the - to orient them in
a as patient sufficient reality
Objective: manifested time to respond
by
Inappropriate inappropriat - Provide - to construct their
verbalization e therapeutic thoughts
verbalization activities such as
Disoriented , disoriented, art therapy
short
Rarely attention - Maintain reality- - to improve their
engaged on span and oriented capacity to think
eye contact positive relationship and
verbigeratio environment
Short n
attention
span

(+)
verbiigeration

Disturbed Personal Identity

Assessment Diagnosis Planning Interventions Rationale Evaluation
Subjective: Disturbed At the end of - Establish - to gain trust At the end of
“28 years old personal the rotation, therapeutic the rotation,
na ako” as identity the client communication the client
verbalized by related to will be able was able to
the patient poor ego to - Determine - to orient patient demonstrate
differentiatio demonstrate distortion of in 3 spheres improvemen
Objective: n as improvemen reality t on ego
manifested t on ego demonstrati
- disoriented by demonstrati - Encourage - to relieve stress on (such as,
disorientatio on (such as, patient to being
- confused n in 3 being appropriately oriented to 3
spheres oriented to 3 express his spheres)
- retrograde (time, spheres) feelings.
amnesia person &
place), and - Provide calm - to help client to
retrograde environment remain calm
amnesia
- Allow client to - to prevent stress
deal with situation overload
in small steps

CHAPTER 8: Drug Study

Drug & Indication & Mechanism of Adverse Nursing
Classification Contraindication Action Effect Responsibilities

Generic Indication Has aggressive • Instruct patient

Name: antipsychotic behavior, to take
Risperidone Schizophrenia effect, dizziness, prescribed dose
apparently headache, once or twice
Brand Name: Bipolar Mania caused by fatigue, daily as
Risperdal, dopamine- and anxiety, prescribed,
Risperdal Irritability serotonin- transient without regard
Consta symptoms of receptor ischemic to meals.
aggression toward blocking in attack, Advise patient
Anti - psychotic others, deliberate CNS. cerebrovascula to take with
self-injury, and r accident, food if GI upset
temper tantrums neuroleptic occurs.
associated with syndrome, • Instruct patient
autistic disorder Tachycardia, using oral
chest pain, solution to use
Contraindication bradycardia, calibrated
orthostatic pipette to
Hypersensitivity to hypotension, measure each
drug arrhythmia, dose. Advise
Rash, skin patient that
discoloration, solution may be
skin ulceration, mixed with 3 to
acne, dry skin, 4 oz of water,
seborrhea, coffee, orange
pruritus, juice, or low-fat
Rhinitis, milk (but not
abnormal with cola or
vision, tea) prior to
pharyngitis, administration.
conjunctivitis, • Caution patient
otitis media, using orally
blurred vision, disintegrating
earache. tablet not to
Vomiting open the blister
increased until ready to
salivation, take the dose.
constipation, • Advise patient
abdominal that dose will
pain. be started low
Dyspepsia, and then
nausea, dry increased until
mouth, max benefit is
anorexia. obtained.
• Instruct patient
not to stop
taking
risperidone
when feeling
better.
 • Tell patient to
immediately
report altered
mental status,
high fever,
irregular pulse,
muscle rigidity,
rash, seizures,
or sweating to
health care
provider.

Drug & Indication & Mechanism of Adverse Nursing

Classification Contraindication Action Effect Responsibilities
 Indication neuroleptic • Assess mental status
Generic • Block malignant prior to and
name: - Acute and chronic dopamine syndrome, periodically during
chlorpromazine psychoses, receptors in the sedation, therapy.
particularly when extrapyramidal
brain; also alter • Monitor BP and
Brand name: accompanied by dopamine reactions, pulse prior to and
Thorazine increased release and tardive frequently during the
psychomotor turnover. dyskinesia, period of dosage
activity. Nausea hypotension adjustment. May
and vomiting. • Prevention of (increased with cause QT interval
Anti - psychotic seizures IM, IV), changes on ECG.
- Also used in the blurred vision, • Observe patient
treatment of dry eyes, lens carefully when
intractable hiccups opacities, administering
constipation, medication, to ensure
Contraindication dry mouth, that medication is
anorexia, actually taken and not
• Hypersensitivity. hepatitis, ileus, hoarded.
agranulocytosis •Monitor I&O ratios
•Cross-sensitivity , leucopenia, and daily eight. Assess
may exist among photosensitivit patient for signs and
phenothiazines. y, pigment symptoms of
Should not be used changes, dehydration.
in narrow-angle rashes. • Monitor for
glaucoma. development of
•Should not be used neuroleptic malignant
in patients who syndrome (fever,
have CNS respiratory distress,
depression. tachycardia, seizures,
diaphoresis,
hypertension or
hypotension, pallor,
tiredness, severe
muscle stiffness, loss
of bladder control.
Report symptoms
immediately. May also
cause leukocytosis,
elevated liver function
tests, elevated CPK.
• Advice patient to
take medication as
directed. Take missed
doses as soon as
remembered, with
remaining doses
evenly spaced
throughout the day.
Drug & Indication & Mechanism of Adverse Nursing
Classification Contraindication Action Effect Responsibilities
 Generic Indication Parkinsonism is dilated and • Instruct patient to
name: thought to sluggish pupils, take it with food and
Biperiden HCL For use as an result from an warm, dry skin, avoid alcohol.
adjunct in the imbalance facial flushing, • Avoid the use of the
Other brand therapy of all forms between the decreased herb Kava as it
names of parkinsonism excitatory secretions of causes
containing and control of (cholinergic) the mouth, Parkinsonism.
Biperiden: extrapyramidal and inhibitory pharynx, nose, • Avoid driving, the
disorders (dopaminergic) and bronchi, drug cause blurred
Akineton; secondary to systems in the foul-smelling vision.
Akinophyl neuroleptic drug corpus striatum. breath, • Avoid vitamin B6 or
therapy. The mechanism elevated protein rich foods
of action of temperature, because it decreases
Anti - Contraindication centrally active tachycardia, the absorption of the
cholinergic anticholinergic cardiac drug.
drugs such as arrhythmias,
Hypersensitivity to biperiden is decreased
biperiden considered to bowel sounds,
relate to urinary
Narrow angle competitive retention,
glaucoma antagonism of delirium,
acetylcholine at disorientation,
Bowel obstruction cholinergic anxiety,
receptors in the hallucinations,
Megacolon corpus striatum, illusions,
which then confusion,
restores the incoherence,
balance. agitation,
hyperactivity,
ataxia, loss of
memory,
paranoia,
combativeness,
and seizures.

Drug & Indication & Mechanism of Adverse Nursing

Classification Contraindication Action Effect Responsibilities
 Generic Indication Unclear. May Seizures,anxiet • Encourage patient
Name: alter y,headache,ins for signs and
Fluphenazine A long-acting postsynaptic omnia,weaknes symptoms of
Decanoate parenteral mesolimbic s,tremor,fatigu depression. Assess
antipsychotic drug dopamine e,suicidal,ideati for suicidal ideation.
Brand Name: intended for use in receptors in on,dizziness. • Tell patient drug
Prolixin the management of brain and Chest may take 4 weeks or
Decanoate patients requiring reduce release pain,palpitatio longer to be fully
prolonged of hypothalamic ns,prolonged effective.
Anxiolytic & parenteral and QTc interval. • Caution patient to
Anti-psychotic neuroleptic therapy hypophyseal visual avoid driving and
(e.g., chronic hormones disturbances,st hazardous activities
schizophrenics). thought to uffy nose, until he knows how
depress sinusitis, drug affects
Contraindication reticular pharyngitis, concentration and
activating nausea,vomitin alertness.
system, thereby g,diarrhea,cons • Instruct patient to
- Hypersensitivity preventing tipation,dry minimize adverse GI
to drug psychotic mouth, effects by eating
symptoms. anorexia, frequent, small
- MAO inhibitor use urinary servings of healthy
within past 14 days frequency,sexu food, and drinking
al adequate fluids.
dysfunction,dy
• Advise patient to
smenorrhea,
discuss anti-itching
hypoglycaemia,
medicine with
hypocalcemia,
prescriber if rash
hyponatremia,
develops
hypouricemia,
joint, back or • Not allowed if the
muscle pain, patient is pregnant.
URTI, cough,
dyspnea,
respiratory
distress,
diaphoresis,pru
ritus, flushing,
rash.

CHAPTER 9: Recommendation
 We would like to recommend this to the family of the patient to participate and act
accordingly to the following guidelines for the improvement and betterment of the patient
condition:

- Help the patient to recover from his condition by visiting them to the hospital.

- Encourage the family of the patient to comply well with the rules and
regulations of the hospital.

- Advise the family of the patient to actively participate the planned activities of
the hospital for the fast recovery of the patient.

- Instruct the family to initiate therapy for the patient’s recovery (e.g. music and
arts therapy.

- The patient’s family plays an important role in the patient’s illness and
recovery. Encourage the family to make their physically present so that the
patient would somehow feel their support and concern. They are encouraged
to be the patient’s source of strength and inspiration as she undergoes painful,
traumatic and harrowing procedures. In addition, it is of prime importance
that they are oriented and educated basic facts regarding the patient’s
condition so that they will understand her even better and assist him in his
daily activities.

CHAPTER 10: Evaluation

 Patient reported outcomes in Schizophrenia relate either to evaluate of illness or benefit
from treatment or to resilience of the self of the former, needs for care treatment satisfaction and
the therapeutic relationship are most common.

Less common are symptoms, insight, attitude towards medication and clinical
communication. Increasing expectations of treatment have led to new measures assessing
resilience of the self including empowerment, self-esteem & recovery. Scores of different patient
related outcomes, overlap, are influenced by a general tendency, largely influenced by mood for
more or less positive appraisal.

General appearance of the patient was able to sustain. Has a good hygiene during the period
of engagement.

Good grooming was sustained with careful attention on his clothes and looks.

Motor behavior, patients able to calm down and lessen anxiety during interaction as
manifested by ability to follow instructions and pays attention longer, indulge in muscle exercises
and other motivational activities and ability to set longer.

Speech of patient, presence of same manifestation of echolalia is observed. Rambling of

speech still observed exist tone of voice is kept intermittently between very soft to moderate. The
general tendencies of the patient is grossly dependent on patients mode of patient, remains flat
affect as significant identifier by the disease.

CHAPTER 11: Curriculum Vitae

ERARDO, Darius Daniel Gonzales

 “Darius”
September 13, 1987
22 years old
dde_stitched@yahoo.com

ERGUIZA, Mianne Nicole Empalmado

“Nicole”
August 13, 1990
20 years old
mianne_13@yahoo.com

ERIBAL, Charmaine delos Reyes

 “Maine”
November 21, 1990
19 years old
cemaine_08@yahoo.com.ph

ESGUERRA, Jose Mari Filipinas

“Joemari”
January 17, 1991
19 years old
jmf_esguerra@yahoo.com
 ESMERO, Jimmel Obejas

“Jim”
January 8, 1990
19 years old
swt_misery_08@yahoo.com

ESPAÑOL, Nikko Jan Tristan Respicio

“Nix”
November 27, 1989
20 years old
sereamo_nix@yahoo.com

ESPAÑOLA, Alberto Miguel Moscoso

 “Am”
April 26, 1986
24 years old
am_am2686@yahoo.com

ESTACIO, Mary Grace Natividad

“Grace”
July 14, 1980
30 years old
gianne_henson@yahoo.com
ESTACIO, Precious Ann Sernande
 “Precious; Prei”
December 19, 1990
19 years old
kettlecorn09@yahoo.com

ESTEPA, Kevin Marlo Alonzo

“Kevin; Kevs”
October 26, 1991
18 years old
k3vs2004@yahoo.com & suhr_alonzo14@yahoo.com
ESTRADA, Ralph Edison Clemente
 “Rap”
October 24, 1989
20 years old
bopols24@yahoo.com

EVANGELISTA, Lorna Tabudlong

“Lorna”
October 23, 1968
41 years old
lornaevangelista23@yahoo.com