Final Cs Psychia

SAN PEDRO COLLEGE Criteria:
Format 5%
12 C. de Guzman St., Davao City Introduction 5%
Anamnesis 20%
Psychodynamics 15%
Medical Mgt 10%
NCP 20%
Prognosis 5%
A CASE STUDY ON Discharge Plan 15%
Bibliography 5%
100%
BIPOLAR 1
In Partial Fulfillment of the Requirements in

NCM – RLE 102
Submitted to:
Prof. Samuel F. Migallos, RN, MAN
Clinical Instructor
Jeune Elaine Saavedra, St. N.

Jemmil Carlo Samonte, St. N.
Practicing Clinical Instructors
Submitted by:
Franco Nico Baynosa, St. N.
Aaronzar Castor, St. N.
Brian Vale De Jesus, St. N.
Gem Ivan Dela Cruz, St. N.
Victoria Angelica Lim, St. N.
Daphne Bianca T. Luis, St. N.
Chenny Manahan, St. N.
Riza Mejorada, St. N.
Stephanie Anne Moncano, St. N.
Janelle Anne P. Morales, St. N.
Ferdauseeyah Nawal, St. N.
Justine Romica Omandac, St. N.
Margarette Therese G. Rabaria, St. N.
Joanie Faith Tinagan, St. N.
Rovianne Uy, St. N.
BSN – 3C; Group 2
Date Submitted:
February 1, 2010
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Table of Contents
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
II. Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
III. Anamnesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
IV. Course in the Hospital
A. Mental Status Examination. . . . . . . . . . . . . . . . . . . .. .20
B. Progress Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
V. Psychodynamics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
VI. Laboratory Examinations and Results of Psychological Testing
A. Neuropsychological Test. . . . . . . . . . . . . . . . . . . . . . . 55
B. Laboratory Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
C. Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
D. Medical Management. . . . . . . . . . . . . . . . . . . . . . . . . . 65
E. Nursing Care Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . .78
F. Prognosis and Recommendation. . . . . . . . . . . . . . . 125
Discharge Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
VII. Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
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I. Introduction
“My recovery from manic depression has been an evolution, not a sudden miracle.” -
PATTY DUKE
Bipolar disorder or manic–depressive disorder (also referred to a bipolarism or manic
depression) is a psychiatric diagnosis that describes a category of mood disorders defined by
the presence of one or more episodes of abnormally elevated mood clinically referred to as
mania or, if milder, hypomania. Individuals who experience manic episodes also commonly
experience depressive episodes or symptoms, or mixed episodes in which features of both
mania and depression are present at the same time.
Our client is classified as having Bipolar Type 1 disorder. In Bipolar I disorder, an
individual has experienced one or more manic episodes with or without major depressive
episodes. For a diagnosis of Bipolar I disorder according to the DSM-IV-TR, one or more manic
or mixed episodes are required. A depressive episode is not required for the diagnosis of
Bipolar I but it frequently occurs.
Some limited long-term studies indicate that children who later receive a diagnosis of
bipolar disorder may show subtle early traits such as subthreshold cyclical mood abnormalities,
full major depressive episodes, and possibly ADHD with mood fluctuation. There may be
hypersensitivity and irritability. There is some disagreement whether the experiences are
necessarily fluctuating or may be chronic. There have been repeated findings that between a
third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in
childhood, which is associated on average with earlier onset, a worse course, and more co-
occurring disorders such as PTSD. Early experiences of adversity and conflict are likely to make
subsequent developmental challenges in adolescence more difficult, and are likely a
potentiating factor in those at risk of developing bipolar disorder.
For bipolar disorder, the lifetime prevalence varies between 0.4% and 1.6% in diverse
community studies [DSM-IV]. This means that in the United States, about 2 million adults
(roughly 1% of the adult population) suffer from some form of bipolar disorder. According to
several studies, a significant proportion of the approximately 3.4 million children and
adolescents with depression in the United States may actually be experiencing the early onset
of adolescent bipolar disorder, but have not yet experienced the manic phase of the illness. It is
suspected that a significant number of children diagnosed in the United States with attention-
deficit disorder with hyperactivity (ADHD) actually have early-onset bipolar disorder instead of or
along side of ADHD. For example, an elementary school age child who seems difficult to settle
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in a classroom and cannot concentrate or refuses to do so might actually be showing the first
adolsecent bipolar disorder signs.
In the Philippines, Bipolar diorder has a lifetime prevalence of 15% and this may go as
high as 25% for females. In simpler terms, one out of five individuals will eventually experience
a bipolar episode during their lifetime. In half of these people, there will be more than one
episode. The incidence of bipolar disorder is also higher in medical in and out patients, ranging
from 10 to 15%.
II. Objectives
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General Objective:
At the end of our four week duty and exposure at the new day recovery center
(NDRC), we the BSN – 3C Group 2 students of San Pedro College, aims to make a
comprehensive nursing case study. We believe that, this could help us to apply the
theories learned in our Psychiatric – Mental Health Nursing concept and help us
improve our skills, broaden our understanding and practice right attitude towards Quality
Nurse– Client Relationship with regard to our chosen case.
Specific Objective:
Specifically, the group aims to:
• present an introduction and overview of the case and actual condition of the
client;
• device specific, measurable, attainable, realistic and time-bounded objectives;
• explicate the acquired essential and pertinent data which includes the patient’s
personal data;
• discuss comprehensively the anamnesis, the medical history of the patient
especially the one’s which the patient stated, which contains the interviewed
verbalizations of the informants of their observations concerning the client’s past
and present behavior and psychological conditions as well as the family tree
either in Maternal and Paternal Lineage;
• trace the family tree either in Paternal and Maternal Lineage through
constructing a genogram which reflects corresponding legends that would show
the diseases including mental illness, disorders and conditions of the patient and
his family;
• reassess for physical, psychological and behavioral changes observed from the
client by conducting a Mental Status Examination upon our initial interaction and
during the termination phase;
• discuss the client’s progress notes and other observations on the succeeding
interactions;
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• present in a tabular and schematic diagram of the different predisposing and
precipitating factors which contributes to the present psychological condition of
our client;
• evaluate the patient’s developmental task based on the theories proposed by
Erik Erikson and Robert Havighurst;
• identify the diagnostic or laboratory examinations undergone by the client, its
results and interpretation;
• formulate a differential diagnosis with respect to the gathered data as well as
the criteria presented in DSM – IV ;
• enumerate the medical management rendered to our client and identify its
rationale;
• discriminate four actual and a potential problem of our client;
• devise worthwhile Nursing Care Plans addressed to the five discriminated
problems of our client;
• identify the drugs prescribed to our client and discuss its importance, purpose,
manner and reason why it is given with the equivalent nursing responsibilities;
• render proper nursing care and valuable health teachings needed for the
improvement of our client’s mental health;
• identify the quality of prognosis whether complete recovery is achieved based on
the given criteria; and
• compile the different sources and references used for the completion of the
study.
III. Anamnesis
Personal Data
NAME: Rovelyn Espina Verano
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NICKNAME: Lyn-Lyn
AGE: 29
SEX: Female
CIVIL STATUS: Single
CITIZENSHIP: Filipino
RELIGION: Roman Catholic
ADDRESS: Km 7 Lizada Village, Lanang Beach Club, Davao City
BIRTHDATE: February 16, 1979
BIRTHPLACE: Km 7 Lizada Village, Lanang Beach Club, Davao City
OCCUPATION: Unemployed
ORDINAL RANK: 4th of 5 siblings
OCCUPATION:
MOTHER: Eufema Verano Housewife
FATHER: Ulysses Verano Fisherman
SIBLINGS: Ramil Verano Alcantara employee
Rowena V. Deligero Housewife
Russie V. Adriano Housewife
Ronnie Verano Jobless
Clinical Data
RESPONSIBLE PARTY: Eufemia Verano
RELATIONSHIP: Mother
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CATEGORY: Re-admission (6th)
DATE OF ADMISSION AND DISCHARGE:
1st Admission: October 15, 2003 Discharge: Not indicated in her chart.
2nd Admission: December 12, 2005 Discharge: December 16, 2005
3rd Admission: February 01, 2006 Discharge: March 14, 2006
4th Admission: June 19, 2007 Discharge: September 04, 2007
5th Admission: November 13, 2007 Discharge: November 07, 2008
6th Admission: November 27, 2008 Discharge: February 07, 2009
7th Admission: April 09, 2009
ADMITTING STAFF: Em-em Lingop
HOW ADMITTED: Walk-in
CHIEF COMPLAINT: “Gilaay ko sa balay.”
COMPANION’S WORDS: “Gilaay siya sa balay kay daghan problema.”
PERSONALITY: Ambivent
AGENCY: New Day Recovery Center
RELIABILITY: Good
A. Informants
Informant I
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NAME: Eufemia Verano
AGE: 62
ADDRESS: Km 7 Lizada Village, Lanang Beach Club, Davao City
RELATIONSHIP TO THE PATIENT: Mother
LENGTH OF TIME KNOWN TO THE PATIENT: Since birth
APPARENT UNDERSTANDING OF PRESENT ILLNESS OF THE PATIENT:
The mother is aware of the patient’s current condition. She believed that the
illness of her daughter was due to her child’s secretiveness. She said that her daughter
always keeps her emotions, feelings and problems on her own. As much as possible
she tries to hide it form other people. As she verbalized “ Dili mana siya naga sulti ug
problema sa amoa”.
OTHER CHARACTERISTICS AND ATTITUDES OF THE INFORMANT:
The mother, as our first informant is only fairly reliable source of information
despite the fact that she is the mother of the client. She couldn’t really pinpoint the exact
cause of her daughter’s illness. There were some things she didn’t know about her
daughter. Moreover, during the interview she was cooperative.
Informant II
NAME: May Ann I. Calderero
AGE: 27
ADDRESS: Ladislawa Village, Buhangin, Davao City
RELATIONSHIP TO THE PATIENT: Staff Nurse
LENGTH OF TIME KNOWN TO THE PATIENT: 2 years
May Ann I. Calderero, a staff nurse in New Day Recovery Center is aware of our
client’s current condition. Having known Rovelyn Verano for almost two years somehow
she is able to interact with and see the changes that are happening to our client.
According to her own understanding and on how she perceives the present illness of
the patient which is bipolar 1, a condition in which the patient has difficulty controlling
her mood. However, at present the Rovelyn is in remission. Meaning the patient doesn’t
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show any signs and symptoms of her condition. As of now the patient is currently in
hypomanic state.
We can say that our informant is a reliable source of information. Being a staff
nurse in the same institution where Rovelyn Verano is admitted makes her
knowledgeable about the condition of the client. During our interview she was very
accommodating and she answers every question we asked her regarding our clients
condition.
Informant III
NAME: Rodrigo Manalo
AGE: 62 years old
ADDRESS: Lanang, Davao City
RELATIONSHIP TO THE PATIENT: Neighbor
According to our informant, Mr. Manalo, the main cause of Len’s illness is due to
over thinking. This was manifested when she graduated in elementary, she was
answering questions in English and was observed to be laughing on her own. He also
said the reason why she was admitted because she can’t be controlled of her vices of
going out too often.
He described Len as a person with high expectations she easily gets frustrated if
things will not go according to her plan. She usually sweeps the entire neighborhood,
and gets angry if the people around her don’t help in cleaning their yard. She also seeks
attention; she rolls on the floor and cries, if not reciprocated. If she earns a little amount
of money, she gives it to her mother.
Mr. Manalo also verbalized that he hadn’t heard anything about the father
battering her. He also stated that, as per observation, she usually stays and hides on
their house if she is in the normal state.
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Mr. Manalo is quite fairly reliable source of information. This is because he
doesn’t have first-hand information about Len and he relies only about observation
made by him. He answers every question without hesitation and doesn’t seem to hide
anything.
Informant IV
NAME: Mary Cris Sevilla
AGE: 27 years old
ADDRESS: Lanang, Davao City
RELATIONSHIP TO THE PATIENT: cousin
According to the informant, Len’s illness may be due to trauma. She had stated
that her uncle (Len’s father) is authoritative and has undesirable attitude, though she
cannot explain thoroughly and give details about this. She said that her father and Len’s
father had somewhat of a conflict due to changes in religion.
Mrs. Sevilla was in denial when asked about Len. We hadn’t felt being welcomed
by her, she indirectly persuaded us to go and ask questions in their immediate family or
in their neighborhood. She said that there family is not very close with them and doesn’t
know in details about Len.
Informant V
NAME: Laurence Braza
AGE: 25 years
ADDRESS: Agdao, Davao City
RELATIONSHIP TO THE PATIENT: Head nurse of New Day Recovery Center
LENGTH OF TIME KNOWN TO THE PATIENT: 1 year 6 months
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Mr. Braza stated that the cause of relapse of Len’s illness is due to
noncompliance of her drugs. He said that Len doesn’t want to take any of her drugs
because it affects her activities; it makes her dizzy and weak. He also stated that she
was caught hoarding drugs. They had only known it when Len had confessed about it
and had shown the canister full of Lithium tablets. Another reason of her relapse is due
to her non-established termination phase to a nurse of NDRC who she had been close.
He stated that Len was molested by her special friend. Also, he said that Len’s father is
considered a stressor, she was abused physically. He is also one of the primary
reasons of her relapse. There was a time when Len was in relapse, she attempted to
strip her clothes off in front of others. She was isolated, and in that time, she attempted
to strip again and used it as an excuse to be free from isolation.
Mr. Braza is a reliable informant. We can sense the passion of him being a nurse
to care for Len. He is also very knowledgeable in every sense about Len. He was able
to state comprehensively Len’s history and his assessment to Len. He answers our
questions without any hesitation.
Informant VI
NAME: Titus Ray P. Galgo
AGE: 27
ADDRESS: Malvar St., Davao City
RELATIONSHIP TO THE PATIENT: Case Manager/ Staff Nurse
LENGTH OF TIME KNOWN TO THE PATIENT: 1 year and 10 months
According to him, our client was in her remission stage now. He said Lyn, our
client was diagnosed as Bipolar I. In his understanding, bipolar I patients have seasons.
They are sometimes hypermanic or depressed. When patients undergo their depressed
stage that’s the time they will be able to tell all their feelings, recall the events which
may cause trauma to them and the persons that may be their stressor. In times of
hypermanic, patients are unable to sleep or difficult to stay asleep. They will have a lot
of plans which are not realistic and attainable. They will also do strenuous physical
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activities to divert energy, because they feel they have unlimited energy even if they
appear stressed out.
Sir Titus was very cooperative, warm and spontaneous during our interview with
him. Every time we ask questions to him he answers us immediately and adds some
information. He also shares to us his experiences with Lyn.
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TRINIDAD
KABOG FERJENTINO
VERANO JOSE ESPINA CRISANTA
SESCOL
NENITA ENRIKITA EUFEMI

RENE PEDRO HAMILO CORINCHO
TUMULA ESCOBIS A
VERANO ESPINA ESPINA ESPINA
K ESPINA
62y.o.
ULYSSES
VERANO EVELYN VIVIENCIO CONCHIT ARSEÑIA
NAVALEZ ESPINA A UÑEZ SY
62 y.o.
RUSSIE ROWENA
RAMIL ROVELYN RONNIE
ADRIANO DELIGRO VERANO
VERANO VERANO
32y.o. 30y.o. 29y.o.
36y.o. 27y.o.
LEGEND:
-alcoholic - gambler - submissive to husband - hypertension

-use verbal abuse - drug addict - house manager - female
- deceased - use physical abuse - fisherman - male
- smoker - ambivert - no work - client

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Narrative Genogram
Paternal Lineage
The Verano Family started when Ferjentino Verano (grandfather) was married to
Trinidad Kabog (grandmother). They were fortunately endowed with four children, two
were sons and two were daughter. Nenita Tumulak was the eldest followed by Ulysses
Verano who happens to be the father of our client. He works as a fisherman. He was
before a gambler, a smoker and an alcoholic drinker before they got married with our
mother’s client. He also uses unkind words when he talks to our client as verbalized by
the mother of our client but the mo no concrete example of unkind word. Next was
Rene Verano followed by Evelyn Navalez,the youngest of the siblings.
Maternal Lineage
Rovelyn’s grandparents in her mother’s side were Jose Espina and Crisanta
Sescol. They were blessed with eight kids. Crisanta Sescol has a hypertension. The
eldest was Pedro Espina next was Vivviencio Espina followed by Enrikita Escobido,
Conchita Uñez, Hamilo Espina, Arsenia Sy, Corincho Espinaand the youngest was
Eufemia Espina. Eufemia Espino was the mother of our client. Her mother was a house
manager. She was submissive to her husband. She allows her husband to discipline
their children.
Immediate Family
The father of our client was an authoritative type. He decides for the family. He is
not receptive in the comments of the family member. He stopped doing his vices when
they lived-in together with Eufemia. Our client has an either extrovert or introvert
personality. She was sometimes verbally abused by her father and oldest brother. Her
oldest brother was a drug addict (marijuana) before.
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Family History
1. Maternal and Paternal Grand Lineage

Trinidad Kabug and Ferjentino Verano are the grandparents of Rovelyn on the
paternal side, both are now deceased. They were blessed with 4 children namely
Nenita, Ulysess, Rene and Evelyn. Ulysess is alcoholic, chain smoker, and gambler and
is a verbal abuser to his children. It was reported that only Ulysses was the sickly child
in their family. However, there were no reports of mental illness that runs in the family.
In the maternal side, Jose Espina and Crisanta Sescol are the grandparents of her.
They were endowed with 8 wonderful children namely Pedro, Vivencio, Enrikita,
Conchita, Hamilo, Arsenia, Corincho, Eufemia. Crisenta Sescol is the only hypertensive.
2. Father
According to his wife, her husband Ulysses acts as a father to his children by
trying to provide the needs of his family. In terms of their upbringing of their children, he
is an authoritative type of parent. Most of the time, he is the one who discipline his
children through verbal way. He believes that being the head of the family he is the one
to be followed in every decision-making. It was said that the father is an alcohol abuser
and at the same time a chain smoker. Occasionally he would indulge in gambling
activities such as playing “tong-its” with his friends in the neighborhood.
3. Mother
She is very protective to her husband and children. She always defends her
husband, and she is submissive to her husband. Before, she works as a laundry woman
which adds to their family income. Currently, she no longer works and only stays at
home. She disciplines her children through reprimanding them verbally. She doesn’t use
physical means in disciplining her children. According to the mother, she has a
harmonious relationship with her husband as well as with other family members.
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4. Sibling
She has 2 brothers namely Ramil Verano(36 years old) and Ronnie Verano(27
years old) and 2 sisters namely Rowena Verano(30 years old) and Russie Verano-
Adriano (32 years old). The siblings are in good terms with each other as well as to
other members of the family. They respect each other and get along well especially
when they were younger. She said that her eldest brother, Ramil, was taking drugs
before, specifically amphetamine.
Personality History
1. Prenatal and birth
The mother of Rovelyn considers conceiving a child a blessing even though it
was not planned. During the duration of her pregnancy she was not able to complete
her prenatal check-up. She did not mention the reason behind her incomplete prenatal
check-up. In relation to her nourishment, according to her, she was able to consume
enough food to sustain the nutritional needs of her body and the growing child in her
womb. During her pregnancy there were no unusualities observed by the mother such
as change in moods and feelings. All children were born full term. Rovelyn was born on
February 16, 1979.There were no unusual incidents that transpired during the course of
delivering the baby. The mother reported that she did not experienced difficulty in giving
birth. All children were born at home via Normal Spontaneous Vaginal Delivery. The
children were all born and attended by a “manghihilot”.
2. Infancy and Childhood characteristics

As reported by the mother during the first few months, she breastfeeds her baby.
However, later on she switches into bottle feeding. The mother abruptly introduced
bottle feeding. The brand of the formulated milk is Bear Brand. She feeds her child
whenever the child is hungry. All the children was taken care by the mother herself.
Rovelyn started to talk and walk at the age of 2. Eruption of temporary teeth was also
observed at this age. Rovelyn was not taught by her mother in toilet-training. She only
let her children to urinate and defecate beside the house anytime they want.
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3. Psychosexual History
Her mother told us that at an early age, Rovelyn, was already aware of the
subject matter which is sex. According to her mother, Rovelyn had her menarche at the
age of 14 years old. She has a normal menstrual period every month. Rovelyn was not
surprised when she discovered that she had her first menstruation. She already knew
what to do since she has older sister that will help her.
4. Play Life History

Rovelyn prefers to play boyish games such as “jolen-jolen” and basketball. Most
of the time, she choose to play with the opposite sex both old and young. Rovelyn told
us that she is a shy type person who favors to be just a mere follower in games. She
plays near their house and sometimes would play in other neighborhood. Playing boy
games and playing with the opposite sex may have contributed to her identity crisis.
She did not abandon homework or any school work for the sake of playing games.
5. School history
Our client started schooling when she was 7 years old at Bangoy Elementary
school. She was only an average student. When she was in first year high school she
continued studying at the same school. She has a good relationship with her teachers.
She attends class regularly and on time. She allots time in making her homework and
studies her lessons on time. During her early elementary years, she seems to be
interested in schooling. Her grades were somewhat able to pass. She stopped
schooling when she was in 1st year high school because changes in her behavior were
noted. According to her mother, Rovelyn’s favorite subject is Filipino.
6. Religious and Social Adaptability

She has a lot of friends, from both sexes but her male friends are more dominant.
Most of her friends are older than her. Her friends are the friendly type. Her family had
converted their religion to “Ang Dating Daan” but she had remained a Roman Catholic.
Rovelyn doesn’t want to lose, she had a competitive spirit, and she prefers to be
successful in every aspect as much as possible.
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7. Occupational History
Before, Rovelyn doesn’t have any permanent job. However, she has an income
generating activity, such as diving for loose iron in the sea near their house. She has no
permanent job because she easily gets bored. She doesn’t have a fixed amount of
salary or savings since the generated income depends upon the amount worth of the
iron sold. She works on her own. There were no measures employed by the client to
increase production because it depends only on her will to work.
Onset of Present Illness

During her elementary years, Rovelyn was a shy type person. However during
grade 6 years and through first year high school, she became overfriendly.
1993- At the age of 14, Rovelyn was admitted in the Davao Mental Hospital, for
just one day and one night only. It was due to nervous breakdown, because of the
trauma she suffered from the rape/molestation incident. According to her own
verbalization, she experienced depression as well as suicidal ideation. She was
discharged from the institution because of the nurse on duty’s opinion that her stay
there might aggravate it. During that time, she became silent and withdrawn from
others. She became introvert and doesn’t want to mingle with others and isolates
herself from others.
During the next few years, according to her mother, Rovelyn is functional and is
able to help at home.
October 15, 2003- In her 20’s, she was admitted at the New Day Recovery
Center because the family observed that unusual behaviors have recurred. At first she
was very hesitant to have herself admitted because she is very close to her mother and
doesn’t want to be separated from her family. As time went by, she eventually opened
up to the staff nurses and it is in this period wherein she voiced out the incidence of
rape/molestation by her cousin.
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One time – during the same year – she witnessed her brother battering her
niece. This had a negative impact on her. According to her, she easily gets affected by
the events/situation that is occurring in her surroundings. During this time, she also
started to experience difficulty falling asleep.
Through the following years she was in and out then in the NDRC. For the
reason that, when her condition is stable, she goes home, however when she feels that
she’s out of control or becoming hyper manic, she herself will go to New Day Recovery
Center and admit herself. Another reason, there is no proper compliance to her
treatment regimen.
February 17, 2009- This was the patients last discharge from New Day Recovery
Center with home meds, Lithium ½ tab twice a day and Levomepromazine 100mg ½ tab
hour of sleep.
After the patient’s last discharge, the patient is functional according to her
mother. She helps her mother in washing their clothes. The patient wants to be
readmitted in this institution to get rid of her older brother who used to drink alcohol and
to prevent any commotion with her brother because the patient used to advice her
brother to avoid or limit, if not stop, drinking alcohol, as verbalized by her mother.
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IV. Course in the Hospital
A. Mental Status Examination
INITIAL
NAME: Rovelyn Espina Verano Date: January 23, 2010
I. Preexaminarion
Ms. Rovelyn Espina Verano was admitted in the institution last November 28,
2008 at 9:00 am. Ms. Verano was admitted due to difficulty of falling asleep and due to
hyperactivity. She was attentive, talkative, and was having a mannerism of jerky hand
movements. Responsible party for admission was her mother, Eufemia Verano. Ms.
Verano is under the mood/affective disorder- Bipolar type I.
A. General Appearance
Rovelyn Verano was sitting in the chair wearing a blue shirt, black shorts, and
slippers. She was short and had an ectomorphic body built. She was tidy and was
properly groomed. She had no body and breath odor. Her fingernails, as well as her
toenails were short. Rovelyn is 29 years old but she looked, acted and talked younger
that her age. She was able to maintain fair eye contact. She wasn’t able to give her full
attention during our conversation. Rovelyn seemed not to have a mental problem. She
appeared relaxed and not so cooperative at times. There were no signs of distress
noted in her posture and facial expression.
B. General Mobility
1. Posture and Gait
Rovelyn was relaxed and had an erect posture. She had no problem in
standing, walking, and sitting. She could maintain balance and had
coordinated movements.
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2. Activity
She was normoactive and joined in some activities that were
conducted. She had some difficulties in performing the tasks and in
participating in the games.
3. Facial Expression
Rovelyn showed appropriate facial expressions. She was smiling yet
shy during our conversations.
C. Behavior
Rovelyn was friendly, someone who was open and easy to deal with. She was
accommodating to us during our activities.
D. Nurse – Patient Interaction

She was sometimes cooperative during the interview and answered questions
appropriately. She was not that talkative and limits her answers to the question given.
She told us about the things that had happened to her before she entered the institution.
She was not that open to us.
II. Stream of Talk

A. Character
When Rovelyn was being asked with questions, she was spontaneous in
answering even in the start of our conversation. It was organized, flowed freely, and
was logically sequenced. She was not that comfortable in answering yet and she was
able to express what she feels and what she thinks. It was also deliberate in which it
was goal – directed and proceeds at a normal pace.
B. Organization of Talk
22
She was able to answer the questions appropriately and relevantly. Her answers
were congruent to the questions asked. She answered directly to the point. She also
answered immediately and also asked questions to us.
C. Accessibility
Accessibility was good and she was open to the questions that were asked. She
expanded her answers and elaborated it.
III. Emotional State and Reactions

A. Mood
Rovelyn’s mood was euthymic. She did not appear depressed or euphoric. Her
mood was appropriate to the situation. As verbalized by Rovelyn, “Dili man ko hyper
karon. Wala na nag tukar”.
B. Affect
Her affect was appropriate to the situation and was congruent with her mood.
Regarding the quality, it was still normal.
C. Depersonalization and Derealization

Both were evidently absent. She was aware where she was and how long she
had been admitted, and she knew that everything around her was real.
D. Suicidal Potential
Suicidal potential was absent. Rovelyn was very eager to have a new life. In fact,
Dr. Babista allowed her to go out of the institution, but she insisted to stay. She told us
that it was more stressful if she went home because her father was battering her
mother. There were no verbalizations of wanting to die and no SHEP (Suicidal,
Homicidal, and Escape Precaution) noted.
IV. Thought Control
23
A. Perception
Rovelyn did not manifest any signs of having any hallucinations.
B. Delusions
Delusions were evidently absent in her.
C. Ideas of Reference
Ideas of Reference were not noted.
D. Preoccupation and Ruminations

There was nothing that makes her preoccupied and ruminations were also
absent.
E. Déjà vu and Jamais Vu

Rovelyn verbally reported that she had not experiences such as incidences
before.
V. Neurovegatative Dysfuction
A. Sleep
She was insomniac before but was already treated. Rovelyn verbalized that she
had no difficulty in sleeping now and was able to sleep well at night. She usually sleeps
at 9:00 pm and wakes up at 5:00 am. Upon waking up, she felt rested and refreshed
with satisfaction.
B. Appetite
She had a good appetite. She had a lot of favorite food and kept on mentioning
that she liked chicken and kakanin very much.
C. Diurnal Variation
24
Rovelyn didn’t seem to have problems with her mood after being awaken from
sleep and after being fed. But as verbalized by Rovelyn,”Mutukar jud ang akong pagka-
hyper pag nay makapatrigger, kanang palaguton gani ko. Pero last September pa man
tong last nako. Dili na man ko naga-tukar karon.”
D. Weight
We were not able to get and record her weight but according to the chart, her
weight did not increase nor decrease. Rovelyn had an ectomorphic body built.
E. Libido
She seemed to be energetic during the time of activities and exercises. She
performed dance exercise movements in a constant manner and followed how fast it
was done. She participated in the activities and games prepared by the student nurses
and she was eager to win in every activity. There were no signs of the patient being
sexually occupied all throughout the day. She was able to have a homosexual
relationship with her co-resident. But she kept it secret from the nurses.
VI. General Sensorium and Intellectual Status

A. Orientation
Rovelyn was well oriented with the time, place, and persons around her. We
asked her these questions:
N: Lyn, kabalo ka unsang adlaw karon?
C: Thursday, January 14, 2010
N: Lyn, asa man ka karon?
C: Naa ko sa NDRC activity room
N: Nag-unsa man ta karon Lyn?
C: Nag-activity ta karon
B. Memory
25
Rovelyn was able to remember remote, recent, and immediate activities of her
life. She was able to tell us about what happened to her when she was still 14 years old.
She told us that she was raped by her cousin, which was true. She was able to
remember the motto and theme for the day, too. And lastly, she was also able to
remember the meals served to her early this morning and the medicine she took.
C. Attention Span
Rovelyn’s attention span was good. She maintained her concentration during the
activities, listened to us attentively, and participated in sharing of thoughts. She also had
a fair eye contact in every conversation. She was not easily distracted by the things and
people around her.
D. General Information
Rovelyn gave her accurate information about herself when she was asked to.
Her names, age, address, and other information coincides with what was written in the
chart. When asked to name three examples of places in Mindanao, she was able to
mention three correctly, Davao, General Santos City and Cagayan de Oro.
E. Abstract Thinking Ability

Rovelyn was able to explain the motto for the day. She was able to comprehend
the meaning and essence of it. She explained it with a deep meaning.
F. Judgement and Reasoning

Rovelyn’s judgement and reasoning was not impaired. She was able to
comprehend the positive and negative propositions about something. We asked her
why she’s confined in this institution, she answered that she’s just staying here at
NDRC to continue her treatment and medicine.
VIII. Insight
26
Rovelyn’s insight was not impaired. She was aware why she was admitted to this
institution. She knew her condition and was willing to modify and bring about change to
it.
VIII. Summary of Mental Status Examination

A. Disturbances
Rovelyn did not experience any disturbances in the presentation, stream of talk,
thought control, insight, neurovegetative dysfunction, general sensorium and intellectual
status, and in the emotional state and reaction.
B. Diagnosis Category
Rovelyn belonged to functional since she could still perform her activities of daily
living such as taking a bath, brushing her teeth, trimming her nails, cleaning her ears,
and alike on her own. She could also help do the dishwashing and sweeping. She also
evidently showed that she was willing to participate in all of our activities.
C. DSM – IV Diagnosis
Axis I – Bipolar I (in remission)
Axis II – No information gathered
Axis III – Client has no current medical condition that may be relevant
Axis IV – Sexual: No boyfriend since birth
Axis V – GAF: 81–90
Absent or minimal symptoms, good functioning in all areas,
interested and involved in a wide range of activities, socially
effective, generally satisfied with life, no more than everyday
problems or concerns.
TERMINATION
27
NAME: Rovelyn Espina Verano Date: January 30, 2010
I. Preexaminarion
Ms. Rovelyn Espina Verano was admitted in the institution last November 28,
2008 at 9:00 am. Ms. Verano was admitted due to difficulty of falling asleep and due to
hyperactivity. She was attentive, talkative, and was having a mannerism of jerky hand
movements. Responsible party for admission was her mother, Eufemia Verano. Ms.
Verano is under the mood/affective disorder- Bipolar type I.
A. General Appearance
Rovelyn Verano was wearing a blue shirt, black shorts, and a pair of slippers.
She was short and has an ectomorphic body built. She was tidy and was properly
groomed. She had no body and breath odor. Her fingernails, as well as her toenails
were short. Rovelyn is 29 years old but she looked, acted and talked younger that her
age. She was able to maintain good eye contact and full attention during our
conversation. Rovelyn seemed not to have a mental problem. She appeared relaxed
and very cooperative. There were no signs of distress noted in her posture and facial
expression.
B. General Mobility
1. Posture and Gait
Rovelyn was relaxed and had an erect posture. She had no problem in
standing, walking, and sitting. She can maintain balance and had coordinated
movements.
2. Activity
She was normoactive and joined in all activities that were conducted.
She did not have any difficulty in performing the tasks and in participating in
the games.
3. Facial Expression
28
Rovelyn showed appropriate facial expressions. She was smiling and
happy during our conversations.
C. Behavior
Rovelyn was friendly, someone who was very open and easy to deal with. She
was very accommodating to us during our activities.
D. Nurse – Patient Interaction

She was cooperative all throughout the interview and answered all the questions
appropriately. She was talkative and liked to talk about many things, especially about
past experiences. She even told us about the things that had happened to her before
she entered the institution. She was very open to us and very warm.
II. Stream of Talk

A. Character
When Rovelyn was being asked, she was spontaneous in answering even in the
start of our conversation. It was organized, flowed freely, and was logically sequenced.
She was comfortable in answering and she was able to express what she felt and what
she thought. It was also deliberate in which it was goal – directed and proceeds at a
normal pace.
B. Organization of Talk
She was able to answer the questions appropriately and relevantly. Her answers
were congruent to the questions asked. She answered directly to the point. She
answered immediately and also asked questions to us.
C. Accessibility
Accessibility was good and she was open to the questions that were being
asked. She even expanded her answers and elaborated it without hesitations.
III. Emotional State and Reactions
29
A. Mood
Rovelyn’s mood was euthymic. She did not appear depressed or euphoric. Her
mood was appropriate to the situation. As verbalized by Rovelyn, “Okay na man ko. Dili
na ko depressed or hyper.”
B. Affect
Her affect was appropriate to the situation and was congruent with her mood.
Regarding the quality, it was still normal.
C. Depersonalization and Derealization

Both were evidently absent. She was aware where she was and how long she
had been admitted, and she knew that everything around her was real.
D. Suicidal Potential
Suicidal potential was absent. Rovelyn was very eager to have a new life. In fact,
Dr. Babista allowed her to go once every week. She told us that she already wanted to
go home because she missed her family. It was also because her father gave up
smoking and drinking. His scolding also lessened. There were no verbalizations of
wanting to die and no SHEP (Suicidal, Homicidal, and Escape Precaution) noted.
IV. Thought Control

A. Perception
Rovelyn did not manifest any signs of having any hallucinations.
B. Delusions
Delusions were evidently absent in her.
C. Ideas of Reference
Ideas of Reference were not noted.
D. Preoccupation and Ruminations
30
There was nothing that made her preoccupied and ruminations were also absent.
E. Déjà vu and Jamais Vu

Rovelyn verbally reported that she had not experience such as incidences
before.
V. Neurovegatative Dysfuction
A. Sleep
She was insomniac before but it was already treated. Rovelyn verbalized that
she had no difficulty in sleeping now and was able to sleep well at night. She usually
sleeps at 9:00 pm and wakes up at 5:00 am. Upon waking up, she felt rested and
refreshed with satisfaction.
B. Appetite
She had a good appetite. She ate all food we served and she had no complaints
of the food served. She also had a lot of favorite food and kept on mentioning that she
liked chicken and “kakanin” very much.
C. Diurnal Variation
Rovelyn didn’t seem to have problems with her mood after being awaken from
sleep and after being fed. But as verbalized by Rovelyn,”Mutukar jud ang akong pagka-
hyper pag nay makapatrigger, kanang palaguton gani ko. Pero last September pa man
tong last nako. Dili na man ko naga-tukar karon.”
D. Weight
We were not able to get and record her weight but according to the chart, her
weight did not increase nor decrease. Rovelyn had an ectomorphic body built.
E. Libido
31
She seemed to be energetic during the time of activities and exercises. She
performed dance exercise movements in a constant manner and followed how fast it is
done. She participated in the activities and games prepared by the student nurses and
she was very eager to win in every activity. There were no signs of the patient being
sexually occupied all throughout the day. She was able to have a homosexual
relationship with her co-resident. But she kept it secret from the nurses.
VI. General Sensorium and Intellectual Status

A. Orientation
Rovelyn was well oriented with the time, place, and persons around her. We
asked her these questions:
N: Lyn, kabalo ka unsang adlaw karon?
C: Saturday. January 30, 2010
N: Lyn, asa man ka karon?
C: Naa ko sa Barcelona. Activity room sa NDRC
N: Nag-unsa man ta karon Lyn?
C: Nag-activity ta karon
B. Memory
Rovelyn was able to remember remote, recent, and immediate activities of her
life. She was able to tell us about what happened to her when she was still 14 years old.
She told us that she was raped by her cousin, which was true. She was able to
remember the motto and theme for the day, too. And lastly, she was also able to
remember the meals served to her early this morning and the medicine she took.
C. Attention Span
Rovelyn’s attention span was good. She maintained her concentration during the
activities, listened to us attentively, and participated well in sharing of thoughts. She
also had a good eye contact in every conversation. She wasn’t easily distracted by the
things and people around her.
D. General Information
32
Rovelyn gave her accurate information about herself when she was asked to.
Her name, age, address, and other information coincides with what was written in the
chart. When asked who the last 3 presidents of the Philippines were, she was able to
mention the 3 correctly.
E. Abstract Thinking Ability

Rovelyn was able to explain the motto for the day. She was able to comprehend
the meaning and essence of it. She explained it with a deep meaning.
F. Judgement and Reasoning

Rovelyn’s judgement and reasoning was not impaired. She was able to
comprehend the positive and negative propositions about something. We asked her
why she’s confined in this institution, she answered that she’s just staying here at
NDRC to continue her treatment and medicine.
VIII. Insight
Rovelyn’s insight was not impaired. She was aware why she was admitted to this
institution. She knew her condition and was willing to modify and bring about change to
it.
VIII. Summary of Mental Status Examination

A. Disturbances
Rovelyn did not experience any disturbances in the presentation, stream of talk,
thought control, insight, neurovegetative dysfunction, general sensorium and intellectual
status, and in the emotional state and reaction.
B. Diagnosis Category
Rovelyn belonged to functional since she could still perform her activities of daily
living such as taking a bath, brushing her teeth, trimming her nails, cleaning her ears,
and alike on her own. She could also help do the dishwashing and sweeping. She also
evidently showed that she was willing to participate in all of our activities.
33
C. DSM – IV Diagnosis
Axis I – Bipolar I (in remission)
Axis II – No information gathered
Axis III – Client has no current medical condition that may be relevant
Axis IV – Sexual: No boyfriend since birth
Axis V – Global Assessment Finding: 81–90
Absent or minimal symptoms, good functioning in all areas,
interested and involved in a wide range of activities, socially
effective, generally satisfied with life, no more than everyday
problems or concerns.
B. Progress Notes
34
January 14, 2010
This was our first meeting with our client, Rovelyn Verano. As we approached
her, she was still shy but she managed to smile. At that time, she was wearing a yellow
shirt, floral-printed shorts, and a pair of white slippers. During the vital signs taking, we
observed that she appeared tidy and properly groomed and there was no presence of
foul smelling body and breath odor. Her fingernails, as well as her toenails were short.
Rovelyn is 29 years old but she looks, acts and talks younger than her age. She has a
mannerism of jerky hand movements, though she was able to maintain fair eye contact
and full attention during our conversation. Rovelyn seems not to have a mental problem.
She appeared relaxed and very cooperative. There were no signs of distress noted in
her posture and facial expression.
The group noticed that she remained silent in her seat, observant, behaved and
responsive only when asked. She only answered the questions that were asked and
didn’t open up any subject in relation to the questions. The client was participative in
some of the prepared activities for the day. She remained normoactive. The client has a
low self-esteem which causes impairment on social interaction. During the course of our
activity, the client seldom showed pleasant facial expression. With regards to her level
of awareness on her condition, she told us chronologically what happened to her. She
believed that she was confined because she has the tendency to be hyperactive. She
showed independence during self care activities.
January 15, 2010

Rovelyn Verano was wearing an orange sleeveless shirt, maong short pants and
a pair of white slippers. She was clean and well-groomed. She was still silent at times,
but unlike the previous day, she was able to expound on the answers. She was able to
better express her thoughts and feelings during the conversation. When she had some
questions, she did not hesitate to approach the student nurses assigned to her. She
remained silent and observant during the program. Furthermore, she could answer the
questions being asked by the emcees. During this day, she smiled and laughed during
appropriate situations. Her appetite was good. In fact, she commented that the chiffon
she ate was delicious.
35
During the art therapy, she was able to mold her favorite vegetables – a carrot
and a squash. She was shy at first. She even hesitated to join with the group because
she told us that she does not have any talent in clay molding. But she was able to
explain in front on why she chose the above mentioned vegetables. The activity that
followed was “Paint me a Picture”. She was able to cooperate well with her co-residents
and other student nurses. The last game was “The Boat is Sinking”. She was energetic
this time and she even managed to win the game together with Jupiter.
January 16, 2010

Rovelyn was wearing a white printed shirt, a pair of black shorts, and a pair of
black slippers. She was in a good mood. She always responded with a smile whenever
someone talked to her or when someone greeted her. During this day, Lyn acted
appropriately to the situation. Her appetite was good.
Our first therapy was “Origami Making”. During the therapy, she was able to
follow the step-by-step instructions given by the facilitator. When she finished the frog
origami making, she hurriedly tried it. She was very excited to test if the frog she made
will hop. She exploded with laughter upon seeing her frog doing a somersault instead of
hopping. The next therapy was recreational. They played charade wherein they were
grouped into two. Rovelyn was very participative. In fact, she was the one who initiated
in answering for their group. We also had a statue dance game. Only the residents
participated in this game. Lyn was very shy at first. She doesn’t want to stand in front of
the crowd and be the center of attention. What she did was to dance even if the music
has already stopped for her to be eliminated from the game. The last game we had was
“Hep Hep Hooray!”. All the residents, including three student nurses, played this game.
Rovelyn was able to reach the semi-final round. She was asked to share her talent to
the group. At first, she was hesitant but after encouraging her, she opted to sing a song
for the group. Unfortunately, she still lost the game.
January 21, 2010
36
Rovelyn was not present during this day because she was not feeling well. She
had a cough and cold, which causes her head to ache. The staff nurses and our clinical
instructor allowed her not to join with the activities we had planned for them. She just
stayed and rested in her room the whole afternoon.
January 22, 2010

Upon endorsement, she was wearing a green shirt, a pair of black shorts, and a
pair of slippers. She appeared sick and gloomy maybe because she was still not feeling
well and the weather was cold. But as we took her vital signs, the results were within
normal range. Her appetite was still good even though she was not feeling well.
Rovelyn gave her full attention to our psychodrama therapy. Two of the student
nurses portrayed “The Starfish Story”. It was about how to make a difference in simple
ways. She reflected with the story and verbalized, “Dapat maka buhat jud ko ug
something sa akong sarili baskin gamay lang man para maka gawas na ko diri.” She
took the story positively and was motivated to make a difference. The next activity was
poetry therapy. It was entitled “Don’t Give Up”. After listening intently to the poem, there
was a sudden change in her mood. She was greatly affected by the poem because she
recalled certain experiences from her past that could be related to it. As verbalized by
the client, “Gusto na jud ko mu uli sa amo para atubangon na nako akong papa.
Namroblema man jud gud ko ani bah. Wala na me naga storya sa akong papa. Karon
new year na man, gusto nko na mag storya na me ug atubangon na nako akong
problema. Dili na dapat ko mahadlok.” The next activity was recreational therapy. We
had two games, namely “Blow the Cup” and “Pyramid”. She was very cooperative in
both games.
January 23, 2010

We were not able to meet her in the endorsement because she was interviewed
by the students of Prof. Samuel Migallos in his masteral class. Rovelyn was also the
subject of their case study. Rovelyn arrived during snack time. She was wearing a
yellow shirt, a pair of maong shorts and a pair of slippers. She was now more open to
37
us and was able to express her thoughts and feelings more during the conversation.
Her appetite was good.
Our first activity was pillow making. The theme was all about family. Instead of
drawing a picture of a family, she drew a heart with an “I Love My Family” inside it
because she told us that she doesn’t have a talent in drawing. The next activity was
“Calamansi Relay”. At first she doubted that they will win the game but fortunately, they
did win the game. The last game they played was the “Trip to Jerusalem”. She enjoyed
the game even though she did not win.
January 28, 2010

Rovelyn was wearing a gray shirt, a pair of maong shorts, and a pair of slippers.
She was smiling as we approached her during endorsement. During this day, Lyn acted
appropriately to the situation. Her appetite was good.
The first activity was the “Mega Relay”. She really enjoyed the game since it
requires psychomotor skills, speed, and coordination. She was frustrated at first
because she found it hard to shoot the hoops but she increased her speed to make up
the lost time. She planted the rice and found the candy with her spoon in no time. After
that she participated in the game “Pabitin”. All her group mates were taller than her but
she still managed to participate and got three from it. We had an occupational therapy,
which is the shirt tie dye making. She was confident with this activity because she has
done it a couple of times. She told us that she was an expert with this activity.
January 29, 2010

Upon endorsement, she was wearing a black shirt with a “Lyn” word printed on it,
a pair of black shorts, and a pair of slippers. She appeared happy and energetic. As we
took her vital signs, the results were within the normal range. Her appetite was good.
Instead of having the usual snack time after the opening salvo, we let them
dance in a “Rico Mambo” tune. She was very good with this activity because this is her
favorite. At first, she was shy but in the end, she’s the only resident who was able to
follow with the steps spontaneously. After the snack time, we had our art therapy, which
was the mask making. She painted her mask black at the upper half portion then white
38
at the lower half portion. She called it “Jabbawockeez”. She’s a fan of this group
because she was amazed of how they dance. The next activity was poem making. She
was asked to write a poem about happiness. The thought of the poem was “a happy
person has a lot of friends”. She really put her heart and mind in the poem. She always
shares to us the importance of having friends whom you can treasure. The next activity
was the recreational therapy. She played “Habulin Mo Ako”. She told us that it was a
thrill – exciting – heart racing activity. The next game was “Pass the Ball”. She did not
enjoy the game because she noticed that we manipulated the game in order for the
residents to win and not the student nurses.
January 30, 2010

Upon endorsement, she was wearing a blue shirt, a pair of black shorts, and a
pair of slippers. She was late during endorsement because she was asked by the staff
nurses to wash the glasses that were used earlier that day. As we took her vital signs,
all the results were within normal range. Her appetite was good.
The first activity that they had was dance therapy. They reviewed the steps of
“Rico Mambo”. The purpose of this is because they will perform this dance during the
culmination. She was able to perform it well. When we appreciated her dancing skills,
she denies that she is a good dancer. After dancing, we had an occupational/art
therapy. She was very focused in painting her fan. She designed it with a flower at the
middle with a black border. After that we had a recreational therapy. The first game was
“Arrange Mo, Cup Mo”. She was quick in stacking the cups and returning them to their
previous state. And because of this their group won the game. The second game was
“Shoot the Ball”. She was the first player in their group since she is the only girl and the
shortest player among them. She liked the game because she loved to play basketball.
Because of this she was able to perform well and won the game.
V. Psychodynamics
39
Predisposing and Precipitating Factors
A. Predisposing
FACTORS PRESENT RATIONALE
• Sex Bipolar disorder develops in men and
women in about equal numbers, but
there are gender differences in the
ways that the illness manifests itself.
Women with the disorder tend to have
more depressive and fewer manic
episodes than men do. The typical
bipolar woman will start with a
depressive episode, whereas a man
will usually get a manic episode first,
according to Michael First, M.D.,
professor of clinical psychiatry at
Columbia University and editor of the
latest edition of the Diagnostic and
Statistical Manual of Mental Disorders,
the American Psychiatric Association's
diagnostic guidelines.
• Heredity/ Usually, those families with history of
Genetics mental illness will likely to develop one.
As long as the same chromosome
carries the disease gene in different
families. The genetic predisposition
theory suggests that risk of inheriting a
mental illness is 10% in those who
have one immediate family member
with the disease and approximately
40% if the disease affects both parents
40
and an identical twin. So genes are one
of the factors of having this disease,
and large percentage of it if the one
who have the disease is a immediate
family member.
She doesn’t have any family member
either
immediate or distant having a mental
illness. But as we all know, we are all
candidates for having a mental illness.
• Age Manic disorders can affect all age
groups, it often occurs in younger
people. Psychosis caused by a
psychiatric disorder such as
schizophrenia or manic depression
usually starts during the teen years or
in early adulthood. In young people,
psychosis can be mistaken for normal
teenage rebellion, or can be associated
with drug and alcohol use. Depression
—related psychosis typically begins
after adolescence, and may appear
during the second or third decade.
Approximately 10%-15% of
adolescents with recurrent Major
Depressive Episodes will go on to
develop Bipolar I Disorder. Mixed
Episodes appear to be more likely in
adolescents and young adults than in
older adults. Since this condition
affects all age groups, she is also a
41
candidate for having this illness.
• Family Bipolar disorder affects more than the
Dynamics individual who has it. It affects
everyone it touches, especially family
members, and can in turn be affected
by the words and behaviors of others.
It was reported by the staff nurses that
she considers his father as her primary
stressor, for the reason that his strict
rules and regulations for Lyn is not
acceptable. Also, her parents don’t
listen to her complaints and problems
most of the time especially when she
told them about the incident of her
being sexually molested by her cousin.
She had verbalized that she minimally
interacts with their eldest brother
because she doesn’t like her brother
using illegal drugs.
B. Precipitating
FACTORS PRESENT RATIONALE
• Stressful life Stressful life events are thought to be
events. the main element in the development of
bipolar disorder. These can range from
a death in the family to the loss of a
42
job, from the birth of a child to a move.
One person's stress may be another
person's piece of cake.
With that in mind, research has found
that stressful life events can lead to the
onset of symptoms in bipolar disorder.
However, once the disorder is triggered
and progresses. Once the cycle
begins, psychological and/or biological
processes take over and keep the
illness active. Durand and Barlow
define this model as a theory "that both
an inherited tendency and specific
stressful conditions are required to
produce a disorder."
In the case of our client, it was reported
that she was sexually molested when
she was 5 years old by her 10 years
old neighbor. Then it happened again
by her 34 years old cousin when she
was 14 years old. At grade three, she
was also accused by her classmates
that she stole a bag of her classmate.
She was always scolded by her
parents and the involvement of usage
of illegal drug by her elder brother.
• Interpersonal She was often neglected by her
relationship. classmate or peer because of her
identity crisis. Since she was admitted
in a mental institute, she is
embarrassed to go out of their house
43
because people might get the wrong
idea since they have a different
understanding of mental illness. Every
time symptoms of her disorder
manifests, she doesn’t show any signs
of being shy towards others, but as the
symptoms subside, she again feels
aloof towards others.
• Substance Several categories of medications have
abused. been implicated in the onset of drug-
induced depression or mania.
Hypotheses regarding the etiology of
drug-induced mood disorders are
based on the known properties of these
medications and their potential
correlation with current
neurophysiologic models of affective
disorders. Notably, drug-induced mood
disorder is more likely to occur in
individuals with risk factors for major
depressive disorder (MDD), dysthymia,
or bipolar disorder.
She doesn’t have any history of using
drugs that may alter her levels of
neurotransmitters which can contribute
to her present mental ilness.
• Non- According to Keltner, non-compliance
compliance with medications is the leading cause
with of the return of symptoms and a
medication. leading cause of re-admission.
In our client’s case, she was already
been admitted for 7 times. Every time
44
she will be discharged she cannot take
her maintenance drug, Lithium,
because of financial constraints
according her mother. During her stay
in NDRC, there were reports by staff
nurses about Lyn hoarding her
medications especially Lithium. It
makes her feel weak.She hides her
medications in dentures. According to
Lyn she doesn’t like her Levo
Promazine because it makes her feel
weak and she also drools when taking
it.
B. Schematic Diagram
Father Mother
Ulysses Verano Eufemia Verano
-Fisherman -House manager
-Authoritative, strict -Passionate

disciplinarian disciplinarian
-Financially responsible -Submissive to husband

and supportive
45
Courtship and Marriage
Mr. Ulysses Verano was from Masbate and Ms. Eufemia Espina was
from Butuan. They meet here in Davao; both came here to meet their own
siblings, and coincidently lived in the same place. They became friends and
then eventually Ulysses starts to send letters to Euefemia as a start of his
courtship. Ulysses asks permission to the family of Eufemia but the family was
not that in favor of Ulysses because of his vices. Mr. Ulysses court her for
more than a year and after years of having a relationship, they decided to live
in the same house. They live normally as a husband and wife, Mr. Ulysses
worked as a fisherman and Ms. Eufemia as a house manager. They are
blessed with five children, having two boys and three girls. And after they aged
50, they successfully get married in “Kasalan ng Bayan”.
Prenatal
She did not complete her pre-natal check-up because they thought it is
not needed. She did not also complete her tetanus toxoid immunization as she
remembers. In terms of her exercise, she considered doing household chores
as a form of exercise. She did not experience having craving for something
while she was bearing Lyn. She did not notice any alteration in mood during her
pregnancy. She told us that it was not planned pregnancy, but they perceive it
as a blessing.
46
Natal
Rovelyn was born on February 16, 1979; she was delivered via normal
spontaneous vaginal delivery in their own house, with the help of “manghihilot”
without complication. According to her mother she was delivered full term. She
was baptized as Roman Catholic.
Infancy
(Birth-18 months)
Sigmund Freud: Oral Stage
Erik Erikson: Trust vs. Mistrust
Task Learned: Love and be loved
Significant Person: Mother
Rovelyn was breastfed for 6 months. At 6 months old, she was started to
Toddlerhood
be fed with porridge. She did (1-3her
not complete years old)
immunization; she only received
one dose of BCG and OPV.Sigmund
After fewFreud:
days,Anal
she was admitted at Davao Medical
Stage
Center for 1 week due to high grade fever and convulsion. At 1 year old, she
Erik Erikson: Autonomy vs. Shame & Doubt
started to mumble simple words like “mama” and started to learn how to walk.
Task Learned: Independence
The primary person who took good care of her and attended to her needs was
Significant
her mother. She was the main person person: Mother
who played a significant role as she was
growingRovelyn
up. Rovelyn
was was
not well loved
strictly andtrained.
toilet cared byHer
her mother
family. would allow her to
Conclusion:
urinate and Trust was in
defecate fully achieved
their because
backyard. She she
was was
not breastfed
peeing onand
herweaned
pants but
properly
sometimesandshe
shown
peesnoinoral
his fixation
bed. She in has
her adult
temperyears. Whenever
tantrums if she she
did was
not get her
thrown
desires.up in the
She air she
suffered smiles
from this issickness
common according to cough
like her mother. This but
and colds is ashe
means
didn’t
to assess if the
experience child had developed
convulsions. her trust
Rovelyn also to persons
experienced outsidepox
chicken herself.
and mumps.
She often liked playing with her brothers and sisters and would engage in active
games and energetic activities like running around. She was learning how to do
simple things for herself like dressing up although she could not do it perfectly at
this time.
47
Conclusion: Partially achieved Autonomy because she achieved most of the
tasks essential during this stage, but there are adult manifestations such as
dependence on others, and self-doubt.
Preschool (3-6 years old)
Sigmund Freud: Phallic or Oedipal Stage
Erik Erikson: Initiative vs. Guilt
Task learned: How to do things
Significant persons: Family
Rovelyn played games like balay-balay, hide and seek, cops and robbers,
and the like. She played with his siblings and children around their
neighbourhood. She got along well with her playmates. She didn’t get into fights.
She goes to preparatory school for two years. Her speaking abilities have
developed according to her age. She knew how to choose and wear her own
clothes. She started to help in doing simple household chores such as sweeping
the floor and watering the plants. Whenever she commits mistake her mother
reprimand her. 48
Conclusion: Initiative was achieved because she undergone all the tasks that
need to be experienced.
School Age (6-12 years old)
Sigmund Freud: Latency Stage
Erik Erikson: Industry vs. Inferiority
Task learned: Competence
Significant persons: Neighborhood and school acquaintances
Rovelyn was enrolled grade 1 at Bangoy Elementary School when she

was seven years old. When she was in grade 2, she experienced trauma
because she was accused of stealing a bag. She was a studious pupil. She liked
Filipino subject, because during that time she really want to speak in tagalong.
Although she was not an achiever, still she was eager to go to school and do
some physical activities that can enhance her strength and be able to socialize
with friends. Her parents were supportive in her studies.
Conclusion: Industry was met because she now creates friendship towards 49
others and develops a sense of competence during performing physical activities
with her friends.
Adolescence (12-18 years old)
Sigmund Freud: Genital Stage
Erik Erikson: Role identity vs. Role confusion
Task Learned: Self-awareness
Significant persons: Peers
She enrolled for high school at Bangoy National High School. When she
was in first year high school, at the age of 13, she quit schooling due nervous
breakdown. At the age of 14 was her menarche and she also was molested by
her cousin in her father side. Her attitudes towards studying have changed. She
was not anymore motivated in going to school. She was aloof in interacting with
other people for almost a year. After it she started going out with her peer groups
in attending basketball in different places. She was repeatedly reprimand by her
parents because she always come home late. She has a gender identity disorder
and during this stage also she started engaging in girl-girl relationship.
50
Conclusion: Because her peers are now her significant others, she was now
always tempted to go out and want to be in her friends all the time. She also has
an antisocial behavior after she was molested by her cousin.
Young Adulthood (18-30 years old)
Erik Erikson: Intimacy vs. isolation
Task Learned: Affiliation and love
Significant persons: Partner or friend
She’d been into many works and able to attend in just a week, because
she always complain to be tired. She did not able to commit herself to someone
special except to her friends. When she was 24 years old, she had her first
admission at NDRC due to insomnia. During this stage she was diagnosed to
have Bipolar I – most recent episode hypo manic, she was admitted seven times
because she did not able to take her medication, so she always re-admitted for
proper management and observation. It was also reported that during this stage
she meet a lot of friends because of being to NDRC which she can always
interact to others during her stay there. She smokes and drinks wine
occasionally. She was also fond of going parties before she got mentally illed.
She had no boyfriend but had 5 girlfriends.
Conclusion: Intimacy was partially met since she didn’t have an intimate
51
relationship to others but was able to gain friends during staying in NDRC. She
was also get herself to work, but was not able to stay long because she always
complains of being tired.
Admission
1st Admission: October 15, 2003
Discharge: Not indicated in her chart.
She was brought by her mother in NDRC due to nervous breakdown. This was
causedPredisposing
by a traumaFactors
that leads to insomnia. She was discharged
Precipitating because she
Factor
was then stable and functional.
• Sex • Stressful life events
• Heredity • Interpersonal
2nd Admission: December 12, 2005 relationship
• Age Discharge: December

• 16, 2005
Substance abused
She was admitted for the second time due to noncompliance of taking
medications. She was then again discharged •of the
• Culture Non-compliance with
facility because she became
stable and functional.
3rd Admission: February 01, 2006
Discharge: March 14, 2006
She was again admitted due to noncompliance of taking her medications. The
relapse was due to non-compliance of taking of medications.
4th Admission: June 19, 2007
Discharged: September 04, 2007
52
She was admitted for the fourth time due to noncompliance of taking
medications. She was then again discharged of the facility because she became
stable and functional.
5th Admission: November 13, 2007
Discharge: November 07, 2008
Patient was discharged from this institution functional and responsive with take
home medications. On November 14, 2008, she worked at NDRC canteen and
noticed to be functional, cooperative and responsible. At home she helped her
mother in doing their household chores.
6th Admission: November 27, 2008
Discharge: February 07, 2009
Patient’s mother was alarmed of the patient’s behavioural changes thus this
results to her re-admission. Her mother thought that the patient was taking her
meds at NDRC because she was not taking her meds at home. She was again
discharged because the institution sees her as stable and functional.
7th Admission: April 09, 2009
She was again admitted in the same institution for the same reason of not taking
53
her medications in home. It was due to financial constraints and the side effects
of the meds which the patient doesn’t like.
Good Prognosis Bad Prognosis
IF TREATED: IF NOT TREATED:
Psychotherapeutic Management Relapse of illness.

Art and music therapy
Recurrence of the signs and
Recreational therapy symptoms of Bipolar I disorder
Occupational therapy
Compliance of Medications
54
VI. Laboratory Examinations and Results of Psychological Testing
A. Neuropsychological Tests
Psychological Test Evaluation

Name: Rovelyn Verano Date: December 17, 2008
Age: 29 years old
Civil status: Single
Educational attainment: 1st year high school
I. Reason for Referral
55
Psychological assessment as part of a comprehensive case study meant to
provide the basis of a full clinical diagnosis and therapeutic intervention
II. Psychological Test Administered

Raven’s Progressive Matrices Test Dec. 1, 2008
House – tree – Person Test -do-
Draw a Person Test -do-
SACHS Sentence Completion Test -do-
Basic Personality Inventory -do-
III. Test Results

A. Intellectual Functioning
Raven’s SPM 25th percentile Below Average
B. Personality Dynamics
1. Results to the Projective Measures;
DAP
• Inadequacy, dependency; emotional immaturity; egocentricity; oral
dependency
• Feelings of immobility, lack of autonomy
• Power strivings; intellectual strivings
• Acting out tendency; tendency toward immediate, frank and
emotional satisfaction of motives
• Demand for love and attention; ambitious, striving for success
• Self-absorb; introversive
• Forced congeniality
• Shrunk ego
HTP
• Regression; inadequacy, immaturity, anxiety
• Withdrawal; social sensitivity
56
• Exercise of tact is minimal
• Need for emotional satisfaction
• Pride self of sexual strength
2. Results to the SACHS
• Issues toward father…
• Unfavorable treatment from family…
• Issues on respect and gender… her past…
3. Test to the BPI
RAW
SCALES T-SCORE PC-Equiv. T-SCORE LEVEL
SCORE
Hypochondriasis
10 67 96 Very high
(Hyp)
Depression
12 80 99 Very high
(Dep)
Denial (Den) 12 63 90 Very high
Interpersonal
12 62 88 High
Problems (IPs)
Alienation (Aln) 13 81 99 Very high
Persecutory
11 78 99 Very high
Ideas (PId)
Anxiety (Axy) 12 71 98 Very high
Thinking
8 76 99 Very high
Disorder (ThD)
Impulse
Expression 12 71 98 Very high
(ImE)
Social
Introversion 11 67 96 Very high
(Sol)
Self 7 75 99 Very high
Depreciation
57
(SDp)
Deviation (Dev) 11 94 99 Very high
IV. Overall Test Results and Interpretation

Intellectually, subject is found to be functioning in the Below Average level
on the Raven’s Standard Progressive Matrices test. She appears to possess a relatively
poor capacity for meeting the demands of day-to day life, for learning and problem
solving, for analyzing and reasoning through facts and events, and for planning ahead
and responding effectively to the continuing call for adaptation in a changing
environment.
Results to projective drawings indicate Subject’s shrunken ego. There are
indices of power and intellectual striving, egocentric attitudes and acting out tendency
as compensatory mechanism for feelings of inadequacy, insecurity, immaturity,
dependency, anxiety and sensitivity.
Subject’s BPI profile conversely point out elevated scores on all of the scales
namely Self-Depreciation, Social Introversion, Deviation, Hypochondriasis, Depression,
Alienation, Impulse Expression, Persecutory Ideas, Anxiety and Thinking disorder.
Concern with physical complaints and weaknesses, she tends to interpret normal
sensations as signs of sickness. However, if there is no medical history of disease and
physical ailment, this could mean the person is internalizing the problem and that he
prefers to discuss the physical symptom rather than the psychological condition itself.
With negative self-concept and unfavorable image that she has of herself, the person’s
social attitude and behavior towards the world and towards people is also threatened.
Thus, appears to be uncomfortable when around with other people. Seemingly cautious
and anxious, she has beliefs that certain people are trying to make her life difficult and
unpleasant. She also expressed attitudes which are different from common social codes
alongside the negative attitude toward supervision, direction and authority figures. With
a quite limited impulse control, the person is inclined to undertake risky and reckless
action. Relatively unresponsive emotionally; she seems to lack insight into her feelings
and into the causes of her own behavior. Overall pattern of scores may be accurate in
58
general, but elevations would have been greater and more pronounced had the person
been more open and less defensive in responding to the test questions.
V. Diagnostic Impression:
Subject is disturbed. There are evidences maladjustment and
psychopathology characterized by poor self-perception and sociability, depression,
limited impulse control, interpersonal problems, strong persecutory ideas with schizoid
trends.
Prognosis however seems unfavorable with her low I.Q.
Prepared By:
Katherine D. Pantaleon
Psychometrician
Noted by:
Aneze M. Babista, MD
Psychia
B. Laboratory Test
Lithium Exam
Patient’s name: Rovelyn Verano Physician: Dr. A. Babista
Sex: Female Age: 29 y.o
Test Initial Date: January 8, 2009 Fluid: Serum
Report print date: January 8, 2009 Priority: Routine
Analyzer: Vitros 250
Test Result Normal Range
Lithium Low 0.5 mmol/L 0.6 – 1.2 mmol/L
59
C. Diagnosis
DSM-IV Criteria for 296.40 Bipolar I Disorder, Most Recent Episode Present
Hypomanic
A. Currently (or most recently) in a Hypomanic Episode... √
B. There has previously been at least one Manic Episode...or Mixed

√
Episode...
C. The mood symptoms cause clinically significant distress or impairment

in social, occupational, or other important areas of functioning.
D. The mood episodes in Criteria A and B are not better accounted for
by Schizoaffective Disorder and are not superimposed on Schizophrenia,
60
√
Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder
Not Otherwise Specified.
DSM-IV-TR Criteria for a Hypomanic Episode Present

1. A distinct period of persistently elevated, expansive, or irritable
mood, lasting throughout at least 4 days, that is clearly different √
from the usual non depressed mood.
2. During the period of mood disturbance, three (or more) of the
following symptoms have persisted (four if the mood is only
irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3
hours of sleep)
3. more talkative than usual or pressure to keep talking √
4. flight of ideas or subjective experience that thoughts are √
racing
5. distractibility (i.e., attention too easily drawn to unimportant
or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation √
7. excessive involvement in pleasurable activities that have a
high potential for painful consequences (e.g., the person
engages in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)
3. The episode is associated with an unequivocal change in
functioning that is uncharacteristic of the person when not
symptomatic.
4. The disturbance in mood and the change in functioning are √
observable by others.
5. The episode is not severe enough to cause marked impairment in
61
social or occupational functioning, or to necessitate √
hospitalization, and there are no psychotic features.
6. The symptoms are not due to the direct physiological effects of a

substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Bipolar disorder (also known as "manic depression") is often not recognized by

the patient, relatives, friends, or even physicians. An early sign of manic-depressive
illness may be hypomania -- a state in which the person shows a high level of energy,
excessive moodiness or irritability, and impulsive or reckless behavior. Hypomania may
feel good to the person who experiences it. Thus, even when family and friends learn to
recognize the mood swings, the individual often will deny that anything is wrong.
Based on the resident’s verbalization, the latest episode of marked mood

deviation was last September 2009. The resident reported to have hyperactivity marked
by insomnia, being excessively talkative, and engaging in household chores even at the
dead of the night. Prior to this, the patient was noted to have a major manic episode on
December 2008 necessitating isolation. According to the informant, the hypomanic
episode lasted for around a week. Although the resident was uncomplaining of doing
household chores during the state of lucidity, there was marked increase during the
hypomanic episode.
BIPOLAR 1
Bipolar 1 disorder also known as manic-depressive disorder or manic depression

is a form of mental illness. A person affected by Bipolar 1 disorder has had at least one
manic episode in his life. A manic episode is a period of abnormally elevated mood,
accompanied by abnormal behavior that disrupts life. Most people with Bipolar disorder
also suffer from episodes of depression. Often, there is a cycling between mania and
depression.
62
Mohr, Wanda. Johnson’s Psychiatric Mental Health Nursing. 5th edition. Lippincott
Williams and Wilkins.Philadelphia.2003.
Bipolar 1 disorder is characterized by periods of both manic episodes and major

depressive episodes, and occurs equally in both sexes. There is no evidence of
variation in the incidence of Bipolar disorder in different racial and ethnic groups, but
some practitioners are concerned that the disorder is under-diagnosed in certain
groups.
O’ Brien, Patricia. Psychiatric Mental Health Nursing. Jones and Barlett Publishers.
London.2008.
Bipolar 1 disorder is characterized by one or more manic episodes, usually

alternating with major depressive disorder. The episodes are not the direct result of a
substance or other medical condition.
Antai-otong, Deborah. Psychiatric Nursing: Biological and Behavioral Concept. 2nd
edition. Thomson Delmar. Canada. 2008.
A mood disorder sometimes called manic-depressive illness or manic-depression

that characteristically involves cycles of depression and elation or mania. Sometimes
the mood switches from high to low and back again are dramatic and rapid, but more
often they are gradual and slow, and intervals of normal mood may occur between the
high (manic) and low (depressive) phases of the condition. The symptoms of both the
depressive and manic cycles may be severe and often lead to impaired functioning.
http://www.medterms.com/script/main/art.asp?articlekey=2468
The essential feature of Bipolar I Disorder is a clinical course that is

characterized by the occurrence of one or more Manic Episodes...or Mixed Episodes...
Often individuals have also had one or more Major Depressive Episodes...Episodes of
Substance-Induced Mood Disorder (due to the direct effects of a medication, other
somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood
63
Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar
I Disorder.
http://www.mental-health-today.com/bp/bi1.htm
HYPOMANIA
Is a period of abnormally and persistently elevated, expansive, or irritable mood
lasting 4 days and including three or four of the additional symptoms ;changes in
appetite or weight, sleep, or psychomotor activity, decreased energy, feelings of
worthlessness or guilt, difficulty thinking, concentrating or making decisions, or recurrent
thoughts of death or suicidal ideation, plans or attempts. The difference is that
hypomanic episodes do not impair the person’s ability to function(he or she may be
quite productive) and there are no psychotic features (delusions and hallucinations.)
Videbeck, Shiela. Psychiatric Mental Health Nursing. 2nd edition.Lippincott Williams and
Wilkins.Philadelphia.2004.
Is a subcategory of mania and is slightly less severe. It does not have the
psychotic features or severely impaired functioning that would require hospitalization,
such as those thatoccur in manic states.
Mohr, Wanda. Johnson’s Psychiatric Mental Health Nursing. 5th edition. Lippincott
Williams and Wilkins.Philadelphia.2003.
A clinical syndrome that indicate an elated mood state similar but less severe
than that describes by the team mania, or manic episodes; it generally does not cause
social or occupational impairment.
Antai-otong, Deborah. Psychiatric Nursing: Biological and Behavioral Concept. 2nd
edition. Thomson Delmar. Canada. 2008
A condition similar to mania but less severe. The symptoms are similar with
elevated mood, increased activity, decreased need for sleep, grandiosity, racing
thoughts, and the like. However, hypomanic episodes differ in that they do not cause
64
significant distress or impair one's work, family, or social life in an obvious way while
manic episodes do.
http://www.medterms.com/script/main/art.asp?articlekey=30745
A mild degree of mania, often preceding a full manic episode. Hypomania differs
from mania in that it is not severe enough to significantly interfere with the person's day-
to-day life. This may make hypomania difficult to diagnose because the patient feels
happy and energetic without experiencing many negative effects, and thus doesn't
recognize that there is a problem.
http://depression.about.com/od/glossary/g/hypomania.htm
D. Medical Management
MILIEU MANAGEMENT AND POSSIBLE THERAPIES
Personal Therapy and CBT (Cognitive Behavioral Therapy)

Personal Therapy is a psychosocial intervention designed to help patients with bipolar
recognize and respond appropriately to arousing stimuli improves function and reduces relapse.
Personal therapy, as it is called, aims to create a therapeutic umbrella to protect the patients
from undue personal stress.
Music Therapy
Music therapy is a type of psychotherapy in which the patient is encouraged to utilize
music to improve interpersonal and communication skills in ways that regular dialogue is limited.
Forms of music therapy generally are based around cognitive/behavioral, humanistic or
psychoanalytic frameworks or a mixture of approaches. There are usually both active and
receptive parts of the therapy, meaning that at times music is listened to and at other times
there is the use of musical improvisation or creation.
Occupational Therapy
65
The aim of the occupational therapy is to develop independence in performance of
activities of daily living. Focus is on rehabilitation and vocational training in which clients learn to
be productive, thereby enhancing self-esteem, creative activities and therapeutic relationship.
Recreational Therapy
This includes recreational activities to promote clients to redirect their thinking or to
rechannel destructive energy in an appropriate manner. Clients learn skills that can be used
during leisure time and during times of stress following discharge from treatment.
Art Therapy
It uses the clients’ creative abilities to encourage expression of emotions and feelings
through artwork. It helps clients to analyze their own work in an effort to recognize and resolve
underlying conflict.
Remotivational Therapy
It is a skill that draws the client into a situation that will stimulate the motivating life
experiences that are mentally pleasurable and emotionally uplifting.
Dance Therapy
This involves the use of movement (kinetics) to express emotions, work out tensions,
develop improved body image, and achieve body awareness and social interactions through
rhythmic exercises and responses to music
Psychodrama Therapy
Intense emotional release and insight are achieved through acting out intrapersonal and
interpersonal conflicts. Helps patients to improvise their roles in specific situations or a
script/play can be used. Support and discussion after the drama are provided by the therapist,
nurse and other patients.
Possible Diagnostic Exam
Electroencephalography
66
Electrodes attached to areas of the patient’s scalp record the brain’s electrical activity
and transmit this information to an electroencephalograph, which records the resulting brain
waves on recording paper. This will help determine the presence and type of seizure disorder
and to evaluate the brain’s electrical activity in metabolic disease, cerebral ischemia, head
injury, meningitis, encephalitis, mental retardation, psychological disorder and drugs.
Blood Test
Use to measure the concentration of the blood markers that varies depending on the
severity of the depression or mania the individual experiences. Molecular changes in the
brain are reflected in the blood producing biomarkers whose levels correlated with the severity
of the symptoms.
Positron Emission Tomography

Measure the metabolic activity of specific areas of the brain and may reveal low
metabolic activity in the frontal lobes, especially in the prefrontal area of the cerebral cortex.
Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is used to assess anatomic structures, organs, and
soft tissue, including visualization of any pathologic condition that is present. It is used for
patient with bipolar disorder to measure a part of the brain that regulates emotions, the ventral
prefrontal cortex that lies above the eyes. MRI is also use to explore differences in brain
structure, assessing in particular for reduced brain tissue that might account for enlarging
ventricles. Data suggest temporal lobe volume reduces in bipolar patients.
Computed Tomography
The computed tomography (CT) scan provides precise visualizations of the structure,
size, shape, and density of the soft tissue, bone, major blood vessels, and organs of the head
and torso. Enlarged ventricles in particular have been a common finding seen in unipolar,
bipolar and schizophrenic patients. Ventricles are enlarged because the brain tissue which
previously occupied this space has been somehow reduced. However, the tissue loss that might
account for such a finding has not been explored using the CT method due to its relatively poor
resolution.
67
DRUG STUDIY
Brand Name: Lithium Bicarbonate

Generic Name: Carbolith, Durlith, Eskalith
Pregnancy risk category: D
Classification: Central Nervous System Drugs
Interaction:
Drug-drug: ACE Inhibitors: May increase lithium level. Monitor lithium level; adjust
lithium level dosage, as needed.
Calcium Channel Blockers: May decrease Lithium levels and may increase risk
of neurotoxicity.
Neuromuscular blockers: May cause prolonged paralysis or weaknesses. Monitor
patient closely.
Action:
Alters cation transport in nerve muscle. May also influence reuptake of
neurotransmitters.
Indication:
To prevent or control mania; bipolar affective disorders
Contraindications:
68
• Contraindicated if therapy can’t be closely monitored.
• Avoid using in pregnant patient unless benefits outweigh risks.
• Use with caution in patients receiving neuromuscular blockers and diuretics; in
elderly or debilitated patients; and in patients with thyroid disease, seizure
disorder, infection, renal or CV disease, severe debilitation or dehydration, or
sodium depletion.
Adverse Effects
• CNS: fatigue, lethargy, coma, tremors, epileptiform seizures, headache,
dizziness, psychomotor retardation, blackouts, impaired speech, ataxia,
incoordination
• CV: hypotension, arrhythmias, bradycardia
• EENT: tinnitus, blurred vision
• GI: vomiting, anorexia, diarrhea, metallic taste, abdominal pain, indigestion.
• GU: polyuria, glycosoria, albuminuria
• Hematologic: leucocytosis with leukocyte of 14000 to 18000/mm3
• Metabolic: Transient hyperglycemia, goiter, hyperthyroidism, hyponatremia
• Musculoskeletal: muscle weakness
Nursing Responsibilities
• Monitor baseline ECG, thyroid studies, renal studies and electrolyte levels.
• Weigh patient daily; check foe edema or sudden weight gain.
• Tell patient to take drug with plenty of water and after meals to minimize
GI upset.
• Explain the importance of having regular blood tests to determine drug
levels; even slightly high values can be dangerous.
• Warn patient to expect transient nausea, large amounts of urine, thirst,
and discomfort during first few days of therapy and to watch for evidence
of toxicity.
• Instruct patient to withhold one dose and call prescriber if signs and
symptoms of toxicity appear, but not to stop the drug abruptly.
• Tell patients not to switch brands or take other prescription or OTC drugs
69
without prescriber guidance.
• Tell patient to wear or carry medical identification at all times.
• Monitor closely the fluid and electrolyte levels.
• Instruct patient to report blurring of vision.
Brand Name: Levomepromazine

Generic Name: Nozinan
Pregnancy risk category: C
Classification: Antipsychotics
Interaction:
Drug-drug: Increased risk of extrapyramidal effects with metochlopromide,
acetylcholinesterase inhibitors. Additive hypotensive effects with antihypertensive
agents, Trazadone. Additive sedative effects with CNS depressants. May alter
levels/effects of CYP2D6 substrates and pro drug substrates. Reduced pressor effects
of epinephrine. Reduced effects of Bromocriptine, Guanethidine, Guanadrel, and
Levedopa. Reduced serum levels with phenytoin or increased phenytoin toxicity.
Increased serum concentrations with propranolol, sulfadoxine-pyrimethamine.
Increased serum levels of valproic acid. Reduced absorption with aluminium salts.
Reduced effects of amphetamines or increased risk of psychotic symptoms. Reduced
effects and excessive anticholinergic effects with benztropine, Trihexyphenidyl,
Biperiden.
Action:
Levomepromazine is a phenothiazine with CNS depressant, α-adrenergic-
blocking, antimuscarinic, antihistaminic and analgesic activity. It acts by blocking
dopamine receptors in the mesolimbic dopaminergic system.
70
Indication:
Schizophrenia, nausea and vomiting,
Contraindications:
• Comatose state
• severe CNS depression
• phaeochromocytoma
• blood dyscrasia
Adverse Effects
• CNS: extrapyramidal effects, dizziness, seizure, headache, drowsiness.
• CV:Hypotension, orthostatic hypotension, tachycardia, QT prolongation.

• Skin: photosensitivity, rash.
• GI: constipation, nausea, vomiting, ileus, jaundice, hepatotoxicity .
• Neuro: neuroleptic malignant syndrome, interference with temperature regulation.
• GU: urinary retention, incontinence, polyuria, priapism.
• Hematologic: blood dyscrasias.
• Other: gynaecomastia, wt gain, irregular menstruation, changes in libido,
ejaculatory disorders.
Nursing Responsibilities
• Tell patient to watch for dizziness upon standing quickly. Advise her to
change positions slowly.
• Warn patient to avoid activities that requires alertness until effects of drug
are known.
• Instruct patient to use sunblock and to wear protective clothing outdoors.
• Have patient to report signs of urine retention and constipation.
• Warn patient to avoid hazardous tasks until full effects of drug are known.
• Drug may be taken without food.
• Instruct client to report when experiencing difficulty in peristalsis.
• Advice client to report immediately when experiencing any urinary
retention.
71
• Assess client for signs of jaundice.
• Instruct client to take ice chips to relieve nausea.
Doctor’s Order
Date Doctors Order Rationale
11/27/08
12:05pm Admit to psychiatric ward under Initial VS will serve as
FAAP status. baseline data in order to
Take VS initially then as needed. determine any unusuality on
On DAT. the physiologic status in the
For picture. body of the patient.
For neuropsychological test, Neuropsychological test
For selected routine labs. is used to measure or
Highly SHEP. assess neurological function
Monitor behavior and sleep. associated with certain
Refer accordingly. behaviors. They are used in
diagnosing brain
dysfunction or damage and
central nervous system
sdisorders or injury.
Client is monitored for her
behavior and sleeping
pattern since she was
identified as SHEP patient.
12:30pm Into isolation temporarily. Client is temporarily

Refer accordingly. isolated to punish them due
Chlorpromazine 100mg 1tab TID. to their inappropriate acts
Lithium ½ tab BID like running naked and to
Refer accordingly. provide safety not just to the
client but also to the nurses
and residents
Chlorpromazine is given
to patient with acute or
chronic psychoses. It alters
72
the effect of dopamine in the
CNS which can diminish
signs/symptoms of
psychosis.
Lithium is given to
patient to prevent or control
mania. It alters the cat ion
transport in nerve muscle.
May also influence of
neurotransmitters.
12/2/08 Increase chlorpromazine mg ½-1/2- Dosage is increased to

1tab. client who is on her highest
Into isolation temporarily. peak of being bipolar.
Isolation is one way of
preventing client from
harming herself and others.
12/14/08 Biperidin 200g itab now. Use for patient

11:00am Refer accordingly. manifesting
parkinsonism’s disease. It
Blocks cholinergic activity
in the CNS, which is
partially responsible for
the symptoms of
Parkinson’s disease.
Restores the natural
balance of
neurotransmitters in the
CNS. Thus, it reduces
rigidity and tremors.
Orfiril is an anti-
12/15/08 Natrilvalproas (Orfiril) 500mg 1 convulsant and mood
sachet OD. stabilizing drug. It is for
Into isolation. treatment of epilepsy,
bipolar depression and
schizophrenia.
12/26/08 d/c chlorpromazine. Levomepromazine is
Telephone order Levomepromazine 100 mg ¼ am given to patient who
1/4nn ½ 9am manifests restlessness,
Refer accordingly. anxiety, agitation, emotional
disturbances and manic
phase of bipolar disorder. It
acts by blocking dopamine
receptors and has
73
prominent sedative effects.
12/26/08 Ceterizine 10mg 1tab OD Cetirizine is a non-

@bedtime sedating antihistamine. It is
Paracetamol 500mg 1tab q4 for used for the symptomatic
fever. relief of allergic reaction like
rhinitis.
Given as antipyretic to
reduce fever by acting
directly to hypothalamic
heat-regulating center to
cause vasodilation and
sweating, which helps
dissipates heat.
12/30/08 Into isolation.

Refer accordingly. Orfiril is an anti-convulsant
Increase Orfiril 1000mg ½ sachet and mood stabilizing drug. It
BID is for treatment of epilepsy,
Az Lithium deta on 1-5-09 bipolar depression and
Out from Isolation. schizophrenia. Dosage is
increased to client who is in
her highest peak of being
manic.
1/18/09 Decrease Levomepromazine to Decreased dosage of

10mg ½tab. drugs is given to patient
who had already shows
signs of remission of the
condition.
1/24/09 To consume 1 B/C Orfiril 1000mg ½ Orfiril is an anti-

sachet. convulsant and mood
Non-behavior. stabilizing drug. It is for
Refer accordingly. treatment of epilepsy,
bipolar depression and
schizophrenia.
1/29/09 Resume Orfiril 1000mg ½ sachet
BID.
2/2/09 Contact parents ASAP to see

undersigned. Parents should sign the
document and see whose
other signatures appears on
74
2/4/09 C/T Orfiril 1000mg ½ sachet BID. the document.
Refer accordingly.
2/5/09 Mother care for health teachings.

NO OOP privileges.
Family may visit her on her birthday To facilitate successful
2/16/09. recovery.
2/13/09 APO-DIVALPROEX 500mg 1tab at

HS.
An anticonvulsant used
to manage and control of
certain types of seizures.
2/16/09 Discharge to mother.
Continue meds. Meds should be taken
Check-up 1week after discharge. continuously to prevent
client from relapsing.
2/17/09 Hold Divalproex sodium.

Resume orfiril. Divalproex sodium is
Refer accordingly. used to treat seizures, and it
can be used with other
seizure medication.
Divalproex is hold to resume
use of orfiril which is also an
anticonvulsant drug.
4/9/09 Readmit to psych ward-FAAP.

Take VS initially as needed. Initial VS will serve as
On-DAT. baseline data in order to
For pict. determine any unusuality on
On highly SHEP. the physiologic status in the
Continue meds. body of the patient.
-levopromazine 100mg ½ tab HS. DAT is a particular diet
-Apo-divalproex 250mg 1tab hours that is only given when
of sleep. client can now tolerate any
-Lithium CO3 450mg ½ tab BID food she desires that is
Monitor sleep and Bed rest. nutritious, if this will not lead
Report Accordingly. to any complications and if
the client needs further
monitoring for lab test.
Client’s sleep must be
monitored to make sure that
she’s getting the proper
amount of sleep since client
was given anti-mania and
anticonvulsant which has
side effect of muscle
weakness, tremors or
restlessness.
75
4/11/09 Hold levomepromazine.
Verbal Order D/C Apo-divalproex Levomepromazine and
Continue Lithium carbonate 450mg Apo-divalproex were stop to
½ tab BID. continue Li CO3 which may
Monitor Sleep/bed rest prevent or control mania.
Refer accordingly.
6/6/09 Out on Pass by herself.

Client’s stability at the
7/10/09 In from out of pass. moment had given her the
privileges to go out and go
7/17/09 Out on pass by herself. back from the institution.
Self awareness of the
7/18/09 In from out on pass. client’s condition may
promote successful
recovery.
8/1/09 In from out on pass.

Refer accordingly.

Verbal order
9/06/09 Increase Levomepromazine

(Nazinar) to 100mg 1 tab HS Increase dosage of
medication indicates the
severity of the condition of
the client.
9/06/09 Decrease levomepromazine 100mg
to ½ tab HS. Decreased dosage of
Refer accordingly. drugs is given to patient
who had already shows
9/15/09 Out on Pass by herself. signs of remission of the
condition.
9/26/09 Out on Pass with mother.
76
to ¼ tab HS.
Monitor sleep.
Refer accordingly.

Decrease levomepromazine 100mg
to 1/8 tab HS.
Monitor sleep.
Refer accordingly.

In from out on pass.
10/07/09 Lithium carbonate 450mg 1 tab BID.

It is given to patients to
treat mania. It alters
intraneuronal metabolism of
catecholamines and sodium
transport in neurons and
muscle cells.
10/08/09 Levomepromazine 100mg 1 tab HS.
Refer accordingly. Used to treat and control
symptoms of schizophrenia,
10/26/09 Haloperidol 5mg 1 amp given IM. delirium, hyperactivity,
Monitor for EPS. aggression, and manic
Refer accordingly. phase in bipolar disorder.
Extrapyramidal
symptoms are the various
movement disorders such
as tardive dyskinesia,
akathisia as a result of
taking antipsychotic drugs.

Verbal orders to ½ tab prn for DFA. Risperidone is an
Start Risperidone 4mg ¼ tab BID. antipsychotic drug that
Monitor sleep and behavior. blocks dopamine and 5HT2
Refer accordingly. receptors in the brain. It is
given to delay relapse in
schizophrenia therapy
lasting 1 to 2 yaears.
11/7/09 Discontinue Risperidone.

Refer accordingly.
11/12/09 Out on Pass.
77
11/18/09 Decrease Lithium bicarbonate

450mg 1 tab HS. Decreasing of drugs may
indicate that client’s shows
remission on it.
11/22/09 Monitor sleep and behavior.
Refer accordingly. Client’s sleep must be
monitored to make sure that
she’s getting the proper
amount of sleep since client
was given anti-mania.
Client’s stability at the
11/28/09 In from out on pass. moment had given her the
12/9/09 Out on Pass by herself. back from the institution.
Self awareness of the
12/10/09 In from out on pass. client’s condition may
promote successful
12/13/09 Out on Pass by herself. recovery.
Refer accordingly.
12/15/09
Telephone order In from out on pass.
Out on Pass with mother.
1/13/10 For trial home visit.

Continue meds: Li CO3 450 mg 1 Client must continuously
tab HS. be monitored to be assured
Levomepromazine 100mg ¼ tab prn that medicine is constantly
for DFA. being taken.
To come back 1 month post
discharge.
1/18/10 In from trial home visit.

Continue meds: Li CO3 450 mg 1 Client was given
tab HS. Levomepromazine due to
Levomepromazine 100mg ¼ tab prn difficulty of falling asleep. It
for DFA. has sedative effects.
Refer accordingly.

Refer accordingly. Client’s stability at the
moment had given her the
back from the institution.
78
79
E. Nursing Care Plans
1. Low self-esteem related to doubt concerning self-worth and abilities secondary to sexual abuse.
Date and Cues Need Nursing Diagnosis Objectives of Nursing Interventions Evaluation
Time Care
January Subjective: Low self-esteem That within our 1. Convey that you January
14, - “Murag wala S related to doubt 2 weeks span care about the client 23,
2010 na man koy E concerning self- of care, our and that you believe 2010
nabuhat na L worth and abilities client will be the client is a
@ tama uie. “ F secondary to able to gain worthwhile human @
- “Gi malas - sexual abuse. self-esteem as being;
2:00pm man ko sa P evidenced by: ®Often, feedback 4:30 pm
akong E ® Sexual abuse received by clients in
kinabuhi R occurs when a. verbalization abusive situations is “Goal Met”
karon.” C adults use children of appropriate negative and
- “Maulaw gani E and realistic demeaning; the client At the end of
for sexual
ko sa uban P evaluation of may not have our 2 weeks
tao kay ilang T gratification or own; experienced span of care,
tan-aw sa ako I expose them to acceptance of herself. our client was
kay buang O sexual activities. b. able to gain
ko.” N Sexual abuse may demonstration 2. Encourage the self-esteem
- “Dili na ata ko - begin with kissing of behavior client to express as evidenced
maka asawa S or fondling and consistent with feelings; convey your by:
kay murag E increased self- acceptance of the
progress to more
wala nay L esteem, such client’s feelings; a. “Maka
magka gusto F intrusive sexual as good eye ®Expressing feelings sabay na jud
sa ako.” - acts, such as oral contact, can help the client to ko sa ubang
C sex and vaginal or audible voice identify, accept, and pasyente diri.
Objective: O anal penetration. tone, and etc.; work through them, Ug dili na
- Poor eye N even if they are painful nako
contact C Victims of sexual c. identification or uncomfortable. ginakaulawan
- Soft voice E abuse are of feelings and Feelings are not na nasulod ko
80
- Ruminates P traumatized and it methods for inherently bad or good. diri sa mental.
and repeats T becomes evident coping with Naa gihapon
statements to them that it has underlying 3. Persuade the client koy mabuhat
about negative to become involved kung maka
disturbed their
negative P perception of with staff and other gawas na ko
situations and A growth and self; and clients in the milieu diri.”, as
experiences T development through interactions verbalized by
(sexually T process and their d. ability to and activities; Rovelyn.
abused twice, E self esteem. express ® When the client can
being blamed R satisfaction on focus on other people b.
for stealing N The person with one’s own or interactions, demonstrated
classmate’s low self-esteem capabilities. negative thoughts are behaviors
bag, family thinks, feels, and interrupted. showing
won’t believe behaves as if increased
in her) unworthy and 4. Give the client self-esteem,
- Displays incapable of positive feedback for such as good
shyness achieving or completing eye contact,
- Rejects performing at a responsibilities and audible voice
positive level consistent interacting with others; tone, and
comments with own ®Positive feedback pleasant facial
from others expectations or increases the expression;
- Demonstrate those of others. likelihood that the and
inability to Clients with low client will continue the
make self-esteem have behavior. c. “Kelangan
decisions derived it from jud nako
- Fear in trying negative, 5. In interacting with ipagawas
new things unrealistic values the client, point out akong mga
that the individual and give support for problema.
ascribe to self- her efforts in decision Dapat
concept. This may making, seeking atubangon na
be due to trauma, assistance, expressing nako akong
idea, belief, or strengths, solving papa ani para
mental image of a problems, interactions, magawas
81
person, based on and achieving nako tanan.
perceived successes; Dili na nako
strengths, ®The client may not dapat
weaknesses, and see her strengths and daganan
status. may have suffered akong
abuse when displaying problema.
Fortinash, strengths in the past. Pag magawas
Katherine, et al. Positive support may na nako ni,
Psychiatric help reinforce the wala nay
Nursing Care client’s efforts and maka pa-
Plans; 4th edition. promote self-esteem. down sa
St. Louis, Missouri; ako.”, as
Mosby, Inc. © 6. If negativism verbalized by
2003. dominates the client’s Rovelyn.
conversations, it may
Keltner, Norman. help to structure the d. “Naa pud
Psychiatric content of interactions, koy mabuhat
Nursing. 5th ed. example, by making an maskin
Singapore; agreement to listen to ginagmay
Mosby,Inc. © 10 minutes of lang. Kaya
2003. “negative” interaction, pud nako
after which the client buhaton ang
will interact on a mga
positive topic; ginabuhat sa
®The client will feel uban tao. Naa
you are acknowledging pud koy
her feelings yet will akong sariling
begin practicing the talent na
conscious interruption maingon na
of negativistic thought special pud
and feeling patterns. ko.”, as
verbalized by
7. Explore with the Rovelyn.
82
client her personal
strengths;
®While you can help
the client discover her
strengths, it will not be
useful for you to list the
client’s strengths. The
client needs to identify
them but may benefit
from your supportive
expectation that she
will do so.
8. Involve the client in

activities that are
pleasant or
recreational as a break
from self-examination;
®The client needs to
experience
pleasurable activities
that are not related to
self and problems.
9. It may be necessary
to stress to the client
that she should begin
doing things to feel
better, rather than
waiting to feel better
before doing things;
®The client will have
the opportunity to
83
recognize her own
achievements and will
receive positive
feedback. Without this
stimulus, the client
may lack motivation to
attempt activities.
10. Give the client

honest praise for
accomplishing small
responsibilities by
acknowledging how
difficult it can be for the
client to perform these
tasks; and
®Clients with low self-
esteem do not benefit
from flattery praise.
Positive feedback
provides reinforcement
for the client’s growth
and can enhance self-
esteem.
11. Teach the client

problem-solving and
coping skills. Support
the client’s efforts at
decision-making; do
not make decisions for
the client and give
advice.
84
®The client needs to
learn effective skills in
making her own
decisions. When the
client makes a
decision, she can
enjoy a successful
outcome or learn that
she can survive a
mistake and identify
alternatives.
2. Impaired social interaction related to history of traumatic event secondary to sexual abuse.
Date Cues Need Nursing Objectives of Care Nursing Interventions Evaluation

and Diagnosis
Time
85
January Subjective Cues: R Impaired Social That within our 2 1. Initially, January 23,
14, 2010 O Interaction weeks span of interact with the 2010
 “Maulaw L related to nursing care, our client on one-to-
@ man gud E history of client will be able one basis. Then, @
ko”. - traumatic event to improve her gradually
2:00 pm  “Stricto man R secondary to social interaction facilitate social 4:30 pm
gud ako E sexual abuse. as evidenced by: interactions
papa. Dili L between the “GOAL
jud mi A ® Sexual abuse a) initia client and other PARTIALLY
magkasinab T occurs when tion of social client, small MET”
ot”. I adults use interaction groups, and
 “Gihilabtan O with co- larger groups; After our 2
children for
man ko sa N residents and ® Your social weeks span of
S sexual student behaviour provides nursing care, our
ako ig-agaw
tong 14 pa H gratification or nurses; a role model for the client was able
ko”. I expose them to b) sho client. Gradually to improve her
 Gihilabtan P sexual activities. w comfort increasing the social interaction
pud ko tong Sexual abuse and scope of the client’s as evidenced by;
mga 5 years P may begin with enjoyment social interactions
old pako sa A during will help the client a) “M
kissing or
ako T interaction build confidence in apildi na jud
T fondling and like good social skills. ta ani
silingan.
E progress to eye contact; 2. Actively Janelle. Si
 Hilomon
man ko tong R more intrusive c) parti listen, observe, Jupiter jud
naa ko sa N sexual acts, cipation in and respond to ang una?
elementary. such as oral sex group the client’s Ako na lang
 Wala man and vaginal or therapies verbal and beh” as
ni tuo akong actively. nonverbal verbalized
anal
mama og expressions; the client.
penetration. ® Active listening But Rovelyn
papa na gi
hilabtan ko lets the clients still doesn’t
Victims of
sa ako ig- know they are initiate
sexual abuse
86
agaw are traumatized worthwhile and interaction
and it becomes respected. The with her co-
evident to them client will be residents;
Objective Cues: encouraged to b) sh
that it has
continue seeking owed
disturbed their out others. comfort and
 Comments
of Raul growth and 3. Initiate enjoyment
during the development brief, frequent during the
program, process and conversation interaction
“sana their self with the client as
maging mag esteem. Feeling throughout the manifested
kaibigan day; my good
of
kami”. ® Frequent contact eye contact
depersonalizatio tells the client that and
 Most
residents n, regression, she is an important pleasant
verbalized impaired social part of the milieu facial
that they interaction and and encourages the expression;
want to be withdrawal are client to participate. c)participat
her friend common. 4. Initially ed in group
 Unstable job comment on therapies
 Poor eye Keltner, neutral topics or such as
contact Norman. subjects of recreational
 Direct to the common therapy
Psychiatric
point when interest; (blow the
Nursing. 5th ed. ® Social cup, paint
answering
Singapore; conversation me a
questions
Mosby,Inc. initially helps picture, and
 Displays
establish rapport. the boat is
shyness
5. Remain sinking),
 Teases
with the client poem
other
even if she does therapy
residents
not engage in (don’t quit),
 Has only conversation, and
one close
87
friend and offer brief, psychodra
 Doesn’t accepting ma therapy
participates comments; (The
in group 6. Avoid Starfish
activity( duri becoming the Story).
ng Jingle only one the
making) client can talk to
 Prefers about her
individual feelings and
activities problems;
rather than ® It inhibits the
group client’s ability to
activities form relationship
with others.
7. Give
attention and
positive
feedback for
acceptable or
positive
behaviour;
® Desirable
behaviours
increases when
they are positively
reinforced.
8. Help the
client in
identifying more
effective
methods of
dealing with
stress;
88
® The client may
need to learn new
skills and
behaviours.
9. Encoura
ge client to
identify
supportive
people outside
the institution
and to develop
these
relationships.
® Increasing the
client’s support
system may help
decrease future
social isolation.
10. Encoura
ge the clients to
pursue personal
interests,
hobbies and
recreational
activities;
® Recreational
activities can help
the client’s social
interactions and
provide enjoyment.
11. Help the
client identify
and implement
89
ways of
expressing
emotions and
communicating
with others;
12. Assist
client in
identifying
personal
behaviours or
problem areas
in her life
situation.
® The client must
identify what
behaviours or
problems need
modification or
change before
change can occur.
3. Loneliness related to separation from family secondary to bipolar type 1
90
DATE/ NURSING
TIME CUES NEED DIAGNOSIS GOAL OF CARE INTERVENTION EVALUATION

Subjective: S Loneliness After 2 weeks of care, 1. Establish rapport January 23, 2010
related to the patient will be able with the client. @ 4:00pm
J - “Gimingaw nako E
separation to reduce loneliness as
sa akong
A L from family evidenced by:
pamilya. Gusto
secondary to ® In GOAL MET
N na gani ko F
Bipolar type 1 psychotherapy,
muuli.”
U - a. Identification of rapport between
individual the therapist and After 2 weeks of
A P
- “Lain kayo difficulties such the patient implies care, the patient
R dugay pako E as mutual feeling of was able to reduce
® Loneliness
mugawas sa -minimal social comfort, loneliness as
Y R is an
April pa, kauliun participation acceptance, evidenced by:
emotional
nakayo ko kay C understanding,
state of -lack of trust
la-ay man gud confidence and
14 E dissatisfaction towards other
kayo diri.” warmth. a. Identified
with the people and self
P individual
quality or
and ways to difficulties
2010 - “feel nako wala T quantity of
address them 2. Build a trusting such as
nay relationships.
I such as: relationship with -minimal
magkagusto sa Clients who
the client. social
@ ako kay nasulod O have - diversional
participatio
ko sa mental ug psychiatric activities such
91
isa pa, wala pud N problems may as playing n
koy balak mag- experience sports
2:00 ® The client may -lack of
asawa..” loneliness as
PM -communicating be cautious or wary trust
S a result of
her feelings to of a new towards
their
Objective Cues: E staff nurses relationship. The other
psychiatric
client may have people and
- Normoactive L illness.
had many self
- lack of energy
F b. Report relationships with
- has been in the and ways
involvement in health care
institution for six - Bibliography: to address
interactions providers in the
years them such
C Schultz, client views as past and may have
as:
Judith. meaningful. suffered grief and
O
Lippincott’s loneliness when - diverted
N Manual of those relationships. attention by

Psychiatric playing
C
Nursing Care badminton
E Plans. 3. Spend a part of

-confided
Pennsylvania: each contact with
P her feelings
Lippincott the client
to staff
T Williams and addressing the
nurses
Wilkins, 2002: client’s general well-
16 being and
conveying interest
P a. Reported
in the client as a
92
A person. Inquire involvemen
about the client’s t in
T
feelings, interactions
T perceptions, and client views
sense of progress as
E
toward hi/her goals. meaningful.
R Use interactions like
this to model
N
appropriate
behavior.
® The client can

benefit from
perceiving that you
are interested in
him or her as a
person and in his
well-being, not only
in compliance and
participation in the
treatment program.
The client’s
relationship with
93
you and other
providers may be
the client’s primary
relationships.
4. Teach the client

about the
therapeutic
relationship,
including the
purposes and
boundaries of such
relationships.
® The client needs

to know that this is
not a social
relationship, that
the goals include
eventual
termination of the
relationship and so
on.
94
5. Teach the client,
caregivers, and
other support
people about
loneliness, and
help them develop
in which to interact
to help the client.
® The client may

not know how to
ask for help or may
have felt unheard in
the past.
6. Encourage the
client to express
feelings, regarding
loneliness and
other emotions that
may be difficult for
95
the client.
® Expressing
feelings verbally or
non-verbally can
help the client work
through emotions
that are difficult or
painful.
7. Encourage the
client to identify
strategies to use
when feeling lonely,
including things
that have alleviated
these feelings in
the past.
® Activities like
these may be
96
effective in
alleviating the
client’s feeling of
loneliness. If the
client has a number
of activities from
which to choose,
he or she can learn
to anticipate and
prevent feelings of
loneliness.
8. Help the client

identify resources
in the institution
that can provide
social functions,
offers social
support, and meet
needs for
interpersonal
activity.
97
® Some institutions
have resources that
can meet these
kinds of needs. The
structure of these
activities can help
the client’s daily
routine and form a
framework within
which to develop
relationships.
9. Explore with the

client his or her
interests or hobbies.
Help the client
identify activities
related to these
interests to do in the
client’s leisure time.
98
® Clients often
complain of
loneliness or feeling
worse when they
are alone and have
nothing to do.
Planning and
participating in
activities can help
prevent feelings of
loneliness and give
the client something
to look forward to.
10. Teach the client

about basic matters
and social skills,
including socially
appropriate
conversation topics,
how to engage
someone in a
conversation,
99
listening skills, steps
in building
relationships, how
to say no to
unwanted attention
or relationships,
handling rejection
by others, and so
forth. Use role
modeling and group
sessions to help the
client learn and
practice these skills.
® The client may

have never learned
basic manners or
skills in interacting
or building
relationships, or
these may have
been adversely
affected by the
100
client’s illness.
Social skills can
help the client
develop more
satisfying
relationships and
alleviate loneliness.
The client may also
be vulnerable to
people who would
take advantage of
him, especially if his
judgment is
impaired by illness.
11. Give the client

positive feedback
for
accomplishments
for participating in
small activities, for
making efforts, and
improving social
101
skills and so fort. Be
honest in your
feedback; do not
use flattery.
® Positive feedback
can reinforce
desired behaviors
and can help the
client’s self-esteem.
Flattery and
insincerity are not
helpful and can
undermine the trust
relationship.
12. At the end of

each visit or contact
with the client,
review with the
client what his plans
are for the time until
102
your next contact.
® Reviewing the
client’s plans helps
to remind him of
how to use the time
between contacts
with the nurse, and
can diminish the
client’s anxiety if he
relies heavily on
contacts with the
nurse for support.
103
4. Risk for violence towards others related to emotional difficulties secondary to bipolar type 1
DATE/ NURSING
TIME
GOAL OF INTERVENTION
CUES NEED DIAGNOSIS EVALUATION
CARE
Subjective: R Risk for 1. Establish rapport. January 23,
violence ® To gain the trust and 2010
J O After the end
towards cooperation of the patient.
“ kung masuko ko masuko of our rotation, @ 4:00 pm
A L others related
jud ko.” the patient will
to emotional
N E be able to
difficulties 2. Introduce self to client
reduce risk for GOAL MET
U Objective: - secondary to and call by name
violence as
bipolar type I ® Conditions that make
A R evidenced by:
people feel anonymous
• Hyperactive After the end of
R E facilitate aggressive
• Violent our rotation, the
® A state in
104
Y behavior noted L which an a.) freedom behavior. patient will be
in the past individual from injury of able to reduce
A
• (+) negativistic experiences people risk for violence
14 behavior T behaviors around; 3. Answer questions in an as evidenced
that can be open, direct manner. by:
I
physically ® Promotes the developing
2010 O harmful either b.)participation of a trusting relationship
to self or in the activities and promotes consistency a.) freedom
N
others. A during the in interventions. from injury of
@ S person who is program people around;
not able to
H
control his 4. Observe client’s use of
2:00 I behavior may physical space, and do b.)participated
PM intensify his not invade client’s in the activities
P behavior personal space. during the
making him ® Encroachment on the program
combative. client’s personal space may
P
be perceived as a threat.
Bibliography:
A Doenges,
Marilynn,
T
5. If it is necessary to
Nurse’s
T have physical contact
Pocket
with the client, explain
Guide:
E this need to the client in
Nursing
105
R Diagnosis brief, simple terms
with before approaching.
N
Interventions, ® Clarifies role of staff to
rd
3 edition. client so that the intent of
F.A. Davis these interaction can be
Company. framed in a positive
USA. 1991. manner.
pp. 511
6. Talk with the client in a

calm, reassuring voice.
Do not make sudden
moves. Do not assume
physical postures that
are perceived as
threatening the client.
® This can attempt the
client to have violent
behavior.
7. Maintain eye contact,

but do not stare; be
aware of the client’s
106
position and posture.
® The client might perceive
staring as intrusive or
challenging. If preparing to
strike out, the client will
glance quickly to check for
a clear path.
8. Tell the client that you

will help him maintain
control that you are
aware of his concern
about losing control.
® By acknowledging the
client’s possible fear of
losing control, the nurse
can help put those feelings
into perspective.
9. In an accepting,
nonthreatening manner,
encourage the client to
107
verbalize feelings and
perceptions.
® By encouraging the client
to express unacceptable
feelings, the nurse can help
put those feelings into
perspective.
10. Decrease
environmental stimuli,
avoiding exposure to
areas or situations of
predictable high
stimulation and
removing stimulation
from area if client
becomes agitated.
® Client may be unable to
focus attention on only
relevant stimuli and will be
reacting/responding
relevant stimuli and will be
reacting/responding.
108
11. Continually reevaluate
client’s ability to tolerate
frustration and/or
individual situations.
® Facilitates early
intervention and assists
client to manage situation
independently, if possible.
12. Provide safe

environment,
removing objects and
rearranging room to
prevent
accidental/purposeful
injury to self or
others.
® Grandiose thinking (e.g.,

“I am Superman”) and
hyperactive behavior can
lead to destructive actions
109
such as trying to run
through the wall/into others.
13. Avoid arguing when

client verbalizes
unrealistic or
grandiose ideas or
“put-downs.”
® Prevents triggering
agitation in predictably
touchy areas.
14. Ignore/minimize
attention given to
undesired behaviors
(e.g., bizarre dress,
use of profanity),
while setting limits on
destructive actions.
® Avoids giving
reinforcement to these
110
behaviors, while
providing control for
potentially dangerous
activities.
15. Encourage client,

during calm moments,
to recognize
antecedents/precipitant
s to agitation.
® Promotes early
recognition of developing
problem, allowing client
to plan for alternative
responses and intervene
in a timely fashion.
111
5. Risk for poisoning, lithium toxicity related to lack of proper precaution (unsafe habits) secondary to bipolar
type 1
DATE/ NURSING
CUES NEED DIAGNOSIS GOAL OF CARE EVALUATION
TIME INTERVENTION
Subjective: After 2 weeks of care, the 1.Observe January 23, 2010

patient will be able to for/review signs of
J “Pagmaguli H Risk for @ 4:00 pm
reduce risk of lithium impending drug
ko wala na poisoning,
A E toxicity as evidenced by: toxicity (e.g.,
anko gina lithium
blurred vision,
N inom akong A toxicity GOAL PARTIALLY
ataxia, tinnitus,
tambal, abi related to MET
U L a. Identification of persistent
man sa lack of proper
dangers of nausea/vomiting,
A akong T precaution
poisoning such and severe
mama nga (unsafe After 2 weeks of care,
R H as: diarrhea).
didto ko habits) the patient will be able
-shut down of Differentiate from
Y naga inom secondary to to reduce risk of lithium
organs common side
ug tambal sa bipolar type I toxicity as evidenced
P effects (e.g., mild
NDRC.” -death by:
nausea, loose
14 E stools,
b. Demonstration of
®
R necessary thirst/polyuria,
“naga inom Accentuated a. Identification of
actions/lifestyle metallic taste,
2010 pud ko iced C risk of dangers of
changes to headache, tremor).
tea pag mag accidental poisoning such
promote safe
uli ko sa exposure to,
112
among E or ingestion environment such ® As there is a very as:
balay.” of, drugs or as: narrow margin between -shut down of
@ P
dangerous -proper interval of therapeutic and toxic organs
T products in drug intake levels, toxicity can occur
-death
Objectives: doses quickly and requires
2:00 I -avoid substances
sufficient to immediate intervention. b. Demonstration
PM that could lead to
O cause The common side effect of necessary
untoward side
Lithium poisoning or of tremor may be actions/lifestyle
N effects of lithium
bicarbonate the adverse lessened by use of low changes to
such as caffeine
intake as effects of doses of propranolol promote safe
medication prescribed (Inderal) or atenolol environment
A
medication/ (Tenormin). such as:
N drug use. -avoid

substances that
D
2.Assess current could lead to
understanding, untoward side
perceptions about effects of lithium
H medications. such as caffeine
E Evaluate ability to
self-administer
A medication However,
correctly. proper drug
L
intervals were
T not done
113
H ® Identifies because of the
misinformation/ lack of funds of
misconceptions about the family to

M support
drug therapy and
medications of
A establishes learning
the patient.
needs and likelihood
N
of successful
A medication routine.
E 3.Provide
information
M regarding lithium,
E using a structured
format and
N informational
handout.
T
® Structured client
P education is more
A effective. Handout
provides a memory
T
prompt.
114
T
E 4.Frame
adherence to
R
medication and
N follow-up
treatment, attention
to lifestyle as ways
of assuming
personal control.
® Linking follow-up
treatment to the
client’s goals for self-
control may enhance
feelings of self-esteem
and continued
participation in care.
5.Draw parallel to
other kinds of
chronic illness
(e.g.,diabetes,
115
epilepsy).
® Supports the need

for ongoing care and
normalcy of lifelong
medication.
6.Stress
importance of
adequate sodium
and fluid in diet.
® Sodium and fluid are

required for
appropriate lithium
excretion, which is
necessary to the
prevention of toxicity.
Discuss use of
nonsteroidal, anti-
116
inflammatory drugs
(e.g., ibuprofen
[Motrin, Advil, Nuprin])
or thiazide diuretics.
® Use of NSAIDs and

some diuretics can
alter renal clearance of
lithium, increasing
blood levels and risk of
toxicity. Note:
Potassium-sparing
diuretics (e.g.,
amiloride [Midamon] or
triamterene
[Dyrenium]) appear to
have a higher level of
safety in combination
with lithium therapy.
7. Encourag
117
e involvement of
family in regimen/
monitoring.
® Enhances
understanding of
reason for/importance
of drug therapy.
8. Provide
opportunity for
client to
demonstrate
learning after
initial class and at
least once again
before discharge.
Clarify
misconceptions,
confusion about
drug use/follow-up
care.
118
® Determines success
of client
education/additional
needs and helps to
plan appropriate
follow-up.
9. Document
information that
has been given
and how
client/family
demonstrate
learning.
® Provides continuity,
communicates to other
providers the level of
client’s/family’s
knowledge.
10. Monitor
119
serum lithium levels
at least twice a
week upon initiation
of drug therapy until
serum levels are
stable, then weekly
to bimonthly, as
indicated.
® Narrow therapeutic
range increases risk of
developing toxicity.
Early detection and
prompt intervention
may prevent serious
complications.
11. Provide a
schedule for regular
laboratory testing
and follow-up
appointments at
discharge.
120
® Assists client to stay
on medication and
maintain
improved state.
121
F. Prognosis and Recommendations
Criteria Poor Fair Good Justification
(1) (2) (3)
1. Onset of We rated the onset as fair since upon

Illness the manifestation of the initial signs
and symptoms of depression they
didn’t seek professional help

immediately. Instead, they sought the
help of a quack doctor. They still had
√
further observations and decided to
seek professional help upon the
worsening of the manifestations.
2. Duration of We rated it as fair since she has been

Illness manifesting the first signs and
symptoms since she was 15 years
√ old.
3. Precipitating We scored it as poor since out of the

Factor three precipitating factors
enumerated, all of the factors
√ contributed to her present condition.
4. Attitude and We rated this as good because she

willingness to herself complies with the treatment
take and medication being prescribed to
medication √ her and because she wanted to get
well to hasten her recovery she also
avails to the therapies that the facility
offers her.
5. Mood and We rated it as good because

affect throughout our interaction with her in
both the orientation and working
122
√ phase she has been very cooperative
in all of our activities. She displays
appropriate affect and is generally a
smiling and happy person.
6. Any We rated it as good because she

Depressive does not manifest or imply through
√
Features speech any depressive behavior.
7. Family We rated it as fair because even

though the family does not fully
support
recognize and understand her current
condition they still encourage her to
continue the therapies and take her
√
medications to hasten her recovery.
Scoring: SCORING RATING

Poor 1*2=2
Poor=6 0-1.6
Fair 2*2=4
Fair=0 1.7-2.3 Good 3*3=9
Good=1 2.3-3 Mean: 2+1+1+3+3+3+2=
14 / 7 = 2
General Prognosis
Based on the criteria above mentioned, the client has fair prognosis. She was
admitted twice. Her second admission was because of relapse due to poor compliance.
The onset of illness was fair since it was later on that they seek for medical help but was
123
not too late. They sent her first to a quack doctor yet, they were able to realize that
professional help could be more helpful in her condition. The duration of her illness was
not that long and her readmission was only due to poor medical compliance. In her
precipitating factors, 3 out of 4 factors were identified to be present. During her stay
under our care, she was able to exhibit correct affect but sometimes, she fails to
manifest such. She is coherent and oriented. She is very much active but there were
also moments that she becomes quiet. The family is also supportive although they don’t
have enough knowledge in maintaining the compliance of medication.
Recommendation
Individual
We recommend that our client will:
• eat a healthy diet
• have a daily exercise
124
• follow the treatment regimen
• practice proper hygiene especially in taking a bath
• maintain interaction with others
• participate in the activities to enhance skills and to increase self-esteem
• practice healthy ways of expressing feelings
• open to the professional counselling to develop an insight about the illness
• maintain a good sleep pattern, elimination pattern and hydration
• continue sessions of counselling and psychotherapy to facilitate recovery process
Family
We recommend that the family will:
• Join therapy that would teach them on how to deal with client’s condition.
• exhibits awareness of the signs and problems the qualifications
• Must create an atmosphere of understanding, love, openness and acceptance.
• This could help in the recovery of the client.
• Learn to adjust in some changes in lifestyle of the client.
• Collaborate with the health care team in providing the best the client.
• be aware of the importance of showing affection, love, support, understanding and
feelings of importance
• Develop an open communication with its members.
Community
We recommend that the community will:
• respect the family’s privacy
• Offer support to the client than giving judgmental attitude towards the client.
• Promote acceptance and understanding which are important to build trust and self-
esteem in part of the client.
G. Discharge Plan
Medication
1. Instruct the resident as well as the care takers to comply with the treatment.
® To prevent occurrence of resistance and for fast recovery
2. Emphasize the importance of taking drug according to the schedule and doses.
125
® To ensure effectiveness of drug
3. Explain to the client about the therapeutic effects of the drugs and its possible side
effects.
® To give information about the medication that the client is taking
4. Encourage client to take prescribed medication with full glass of water or with food
® To facilitate easy absorption and prevent gastric irritation
5. Advice client to report any side effects noted and signs and symptoms such as such as
fatigue, lethargy, coma, tremors, epileptiform seizures, headache, dizziness,
psychomotor retardation, blackouts, impaired speech, ataxia, incoordination
hypotension, arrhythmias and bradycardia.
® These suggest toxicity level of Lithium and needs to be taken cared of and to monitor
the drug effects to the client
6. Avoid abrupt withdrawal of medications.
® Extrapyramidal symptoms can or may occur
7. Emphasize to the family the importance of continuous drug and treatment compliance.
® To ensure that the client’ family will support the drug and treatment regimen of the
client
8. Encourage client to complete the entire course of the therapy.
® Completion of the therapy is a must to achieve maximum level of wellness
9. Tell the resident to as much as possible avoid alcohol while taking the medication
® To avoid drug interactions such as drug toxicity
10. Instruct the family to monitor the resident’s intake of medication
® Family should make sure that the resident takes the drugs regularly at right doses and
time
11. Explain to the resident and his family about the drug-drug interaction as well as drug-
food interaction
® To avoid decreased effect or adverse effect of the medication.
12. Assess mental status frequently and monitor mood changes.
® Confusion, agitation, and hallucinations may occur during initiation of the therapy and
may require dosage reduction.
13. Instruct the resident and family about the foods contraindicated if taking neuroleptic
drugs such as cheese, chocolate, aged wine, alcoholic beverages, caffeinated drinks, and
avocadoes.
® To avoid toxicity
126
Exercise
1. Encourage the client to have a daily exercise as tolerated
® To relieve muscle spasm and have a good blood circulation
2. Implement safe, structured activities such as occupational therapy
® To improve general performance and to obtain essential skills of living
3. Explain to the resident the effects of exercise to the body.
® To let the client know significance of having exercise daily
4. Suggest some safety precautions for the resident, beginning an exercise program.
These are:
a. Exercising or walking in safe, well lighted areas.
b. Being aware of adverse symptoms of exercise, such as dizziness, shortness of
breath or irregular heartbeat.
c. Beginning any exercise program slowly to allow the body time to adjust
5. Advise the client to have rest periods during exercise.
® To increase the client’s tolerance to the exercise activity
Treatment
1. Encourage the client to participate in the psychotherapy activities.
® To promote compliance in the treatment regimen.
2. Encourage the client’s family to visit the client.
® To provide moral and emotional support from the family
3. Inform the family about the nature of the mental illness, its treatment course and its
duration.
® This will provide the family basic education about the disease process and anticipate
what to expect from the treatment program.
4. Instruct the client and the family to refer immediately any unusualties observed.
® It supports continuity of care and lessens critical conditions because early treatment
can be done
5. Instruct the family to report to the doctor and constantly comply with the appointments.
® To ensure continuity of care
Hygiene
1. Encourage the client to take a bath, do oral care and change clothing every day.
127
® To promote cleanliness and comfort
2. Tell the client the importance of personal cleanliness
® To motivate the client to do personal hygiene
3. Tell the resident that ears should be clean every other day, fingernails and toenails
should be trimmed and hair should be shampoo every day.
® Microorganism can spread and invade the body and temporarily defeat the body’s
defences causing infections
Out-patient
1. Encourage to have adequate rest and sleep.
® To increase strength and tolerance from activities
2. Encourage patient to still comply treatment regimen.
® To prevent relapse and facilitate fast recovery
3. Encourage client to have daily check-ups.
® For the Physician to have awareness and to be updated to client’s condition
4. Encourage the family and the community to support the client and avoid provoking the
client. Give emotional support to the client.
® It will prevent the client from having mood swings and avoiding the client to be
provoked and be violent.
5. Remind significant others to provide safety precaution.
® To avoid harm to the patient
Diet
1. Instruct the client to eat nutritious food such as fresh fruits and vegetables and eat on
time.
® To ensure that the client is receiving well balanced diet
2. Advise client not to skip meals
® This will aggravate his condition
3. Instruct the patient that chocolate, chocolate-containing food, caffeinated food and
cheese are contraindicated.
® Foods listed above are food that can have an effect during the course of
pharmacological treatment.
128
VII. Bibliography
Boyd, Mary Ann. Psychiatric Nursing: Contemporary Practice. Philadelphia: Lippincott

Williams & Wilkins © 2005.
Doenges, Marilynn E., et. al. Nurse's Pocket Guide: Diagnoses, Interventions, and
Rationales; 8th edition. Philadelphia: F.A. Davis Company © 2002.
Doenges, Marilynn E., et. al. Nurse's Pocket Guide: Diagnoses, Prioritized
129
Interventions, and Rationales; 10th edition. Philadelphia: F.A. Davis Company ©
2006.
Doenges, Marilynn E., et. al. Nursing Care Plans: Guidelines for Individualizing Client
Care Across the Life Span; 7th edition. Pennsylvania: F.A. Davis Company ©
2006.
Karch, Amy M. 2007 Lippincott's Nursing Drug Guide. Philadelphia: Lippincott Williams
& Wilkins © 2007.
Keltner, Norman L., et. al. Psychiatric Nursing; 4th edition. Singapore: Mosby, Inc.
© 2007.
Keltner, Norman L., et. Al. Psychiatric Nursing; 3rd edition. © 1999 by Mosby Inc.
Louise Rebraca Shives, Basic Concepts of Psychiatric – mental health nursing, 6th
edition © 2005
Schultz, Judith M., and Sheila L. Videbeck. Lippincott’s Manual of Psychiatric Nursing
Care Plan; 7th edition. Philidephia: Lippincott Williams & Wilkins © 2005.
Townsend, Mary C. Psychiatric Mental Health Nursing: Concepts of Care; 4th edition.
Philidelphia: F.A. Davis Company © 2003.
Venable, Samantha. Springhouse Nurse’s Drug Guide 2007. Philidephia: Lippincott
Williams & Wilkins © 2007.
Videbeck, Sheila L. Psychiatric Mental Health Nursing; 2nd edition. Philadelphia:
Lippincott Williams & Wilkins © 2004.
Videbeck, Sheila L. Psychiatric Mental Health Nursing; 3rd edition. Philadelphia:
Lippincott Williams & Wilkins © 2006.
130

Final Cs Psychia

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Final Cs Psychia

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SAN PEDRO COLLEGE Criteria:

In Partial Fulfillment of the Requirements in

Jeune Elaine Saavedra, St. N.

APPARENT UNDERSTANDING OF PRESENT ILLNESS OF THE PATIENT:

NENITA ENRIKITA EUFEMI

-alcoholic - gambler - submissive to husband - hypertension

- deceased - use physical abuse - fisherman - male

- smoker - ambivert - no work - client

1. Maternal and Paternal Grand Lineage

2. Infancy and Childhood characteristics

4. Play Life History

6. Religious and Social Adaptability

Onset of Present Illness

A. Mental Status Examination

D. Nurse – Patient Interaction

II. Stream of Talk

III. Emotional State and Reactions

C. Depersonalization and Derealization

IV. Thought Control

D. Preoccupation and Ruminations

E. Déjà vu and Jamais Vu

VI. General Sensorium and Intellectual Status

E. Abstract Thinking Ability

F. Judgement and Reasoning

VIII. Summary of Mental Status Examination

D. Nurse – Patient Interaction

II. Stream of Talk

III. Emotional State and Reactions

C. Depersonalization and Derealization

IV. Thought Control

D. Preoccupation and Ruminations

E. Déjà vu and Jamais Vu

VI. General Sensorium and Intellectual Status

E. Abstract Thinking Ability

F. Judgement and Reasoning

VIII. Summary of Mental Status Examination

January 15, 2010

January 16, 2010

January 21, 2010

January 22, 2010

January 23, 2010

January 28, 2010

January 29, 2010

January 30, 2010

Ulysses Verano Eufemia Verano

-Fisherman -House manager

-Authoritative, strict -Passionate

-Financially responsible -Submissive to husband

Sigmund Freud: Oral Stage

Erik Erikson: Trust vs. Mistrust

Task Learned: Love and be loved

Significant Person: Mother

Sigmund Freud: Phallic or Oedipal Stage

Erik Erikson: Initiative vs. Guilt

Task learned: How to do things

Significant persons: Family

Sigmund Freud: Latency Stage

Erik Erikson: Industry vs. Inferiority

Task learned: Competence

Significant persons: Neighborhood and school acquaintances

Rovelyn was enrolled grade 1 at Bangoy Elementary School when she

Sigmund Freud: Genital Stage

Erik Erikson: Role identity vs. Role confusion