Name of Patient: Mr.

Anabieza, Mateo Age: 30 years old

Room/ Ward No.: Male Psychiatric Ward - VSMMC Sex: Male
Impression: “Gusto na siya magpakamatay, magpapugot siya ug ulo. Dili na mokaon, sige og lakaw” as verbalized
by SO

BRUNSWICK LENS MODEL

Measures to:
A. Looseness of Association
Objective cues: improve verbal communication
- Client is talkative at times 1. establish a working relationship with patient through continuity of
- easily laughs care.
2. communicate with patient as if he could comprehend what you are
- slurred speech saying.
A Case of Mr. Mateo - linking things that are unrelated 3. structure communications to reflect consideration of client’s
Anabieza, 30 years - easily distracted. socioeconomic, educational, and cultural history/values.
old, Male, who lives in - disordered thought sequencing. 4. reinforce congruent thinking. Present reality and demonstrate
Subjective cues: motivation to understand client.
Mandaue City with 5. praise patient’s accomplishments and acknowledge his
“Muse? Meuzep tambal sa sip-on! Haha”
Chief complaints of as verbalized by patient. frustrations.
“Gusto na siya 6. acknowledge attention span/ distractictibility and ability to make
-Patient verbalized that SN was the one he decisions or solve problem.
magpakamatay, imprisoned 7.reorient patient to time/place/person, as needed.
magpapugot siya ug when asked by SN what his work was. 8. schedule structured activity and rest periods.
9. maintain a pleasant, quiet environment and approach in a slow, 80-90%
ulo. Dili na mokaon,
calm manner. Resolution of
sige og lakaw” as
Physiologic &
verbalized by SO,
Psychologic
diagnosed with remain injury-free
B. Risk for Violence: Self-Directed Needs
Undifferentiated 1. monitor the client for behaviors that indicate increased anxiety.
Objective cues: 2. maintain low level of
Schizophrenia was - history of physical abuse stimuli in client’s environment.
admitted in the year - poor concentration 3. encourage the client to verbalize feelings and perception in an
1998, conscious but it - change in usual communication patterns accepting, non threatening manner.
is hard for him to - difficulty in organizing information 4. remove all other clients and unnecessary spectators from the
- slouched position with arms crossed. environment.
focus on a single 5. speak in a quiet, slow, self-assured manner, using clear, concise
conversation, feels Subjective cues: language.
“Maayo pag mamatay ko.hehe” as 6. provide a quiet, peaceful environment.
agitated and
verbalized by patient 7. ensure the client with adequate interpersonal space, taking care
withdrawn. not to enter that space without warning.

improve Circulation
1. instruct patient to avoid activities that cause venous stasis.
2. promote increase of fluid intake.
3. remind patient about changing of positions frequently.
4. tell patient toelevate legs when they are tired.
C. Physiologic Overload: Venous 5. encourage moderate amount of walking or graded extremity exercise.
stasis 6. maintain warm temperatures and avoid chilling.
Objective Cues: 7. caution patient to avoid scratching or vigorous rubbing.
-dull aches -muscle 8. initiate passive and active exercise.
9. promote wearing of properly fitting clothing and
cramps footwear.
-varicosities on legs -ankle edema
-pigmentation
Subjective Cues:
Actual statement Cues Nursing Diagnosis Nursing Actions Desired Outcome
After 4 hours of SN-pt interaction, the pt will be able to:
of the problem demonstrate ability to concentrate on one topic during conversation. After 10 days of SN-pt interaction, the patient
remain injury-free.
demonstrate behavioral changes to improve circulation. will be able to attain optimum level of
functioning.