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I.

INTRODUCTION

Patient S.S. is 46-year old female residing at Prk. Pepsi zone 2, Bacolod city. She is a
Filipino and a Catholic. She is currently staying at National Center for Mental Health. She has
been staying in the facility for almost 2 years and was brought by BJNP last November 23, 2013.
She is a college commerce graduate but did not practice because she lacked confidence. She has
a history of 2 miscarriages because she accidentally slipped. She lives with her father and
siblings. She provides for her family by working as a Labandera and manning their Sari-sari
store. The patients daily food intake consisted of rice, fish, vegetables and whatever was being
served in the facility. Her favorite food is tocino and energen. Sometimes, she would walk
around the ward as a form of exercise. She gets about 8 hours of sleep and takes naps during
morning or afternoon. Patient doesnt smoke, drink or use drugs. When asked how she felt,
patient said that she was happy. One of the problem that bothers her is when there are
emergencies back home which she cant resolve because she is unable to leave the facility.
21 years (1994) prior to admission, she was diagnosed with schizophrenia and was given
medications. 9 months prior to admission, the patient was not compliant with taking the
medications because of financial problems. 6 months prior to admission, patient was arrested for
murdering an 8-month baby which was known to be the patients nephew. According to her she
accidentally killed the baby by stabbing the back of the head with a bolo knife or a machete
twice. Afterwards, she laughed and members of her family saw her. During the Nurse-Patient
Interaction, Patient S.S. verbalized that she was out of her mind and heard auditory
hallucinations. She was sent to jail with a case of murder. After a few months of her stay in the
jail, the moderator noticed that patient S.S. was sleepless and was talking to herself. She was
then borught o NCMH by ship and was assessed. She was diagnosed with Schizophrenia and was
transferred to Pavillion 35 (Forensic Area) According to the patient, family problems triggered
her condition.
Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement, and
behavior. It cannot be defined as a single illness; rather thought as a syndrome or disease process
with many different varieties and symptoms. It is usually diagnosed in late adolescence or early
adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of
age for men and 25 to 35 years of age for women. (Videbeck, 2011)

II. NURSING PHYSICAL ASSESSMENT


Due to the patients condition, the student nurses were not given the chance to conduct a
thorough head to toe assessment.
Vital signs:
BP 110/70
Analysis:
Thebloodpressureiswithinthenormalrange.
On-going assessment:
Activity - Thepatientisambulatoryanddoesnotneededassistanceindailyactivities.
HygieneThepatientreceivesoralcare,powderandcologneinthemorning.
Nutrition - Patient eats three times a day. Patient has Good appetite able to consume 100% of
meal.
Elimination - The patient is able to void freely. The patient has regular bowel elimination.
Vascular Access - Not applicable
Safety - No suicide precaution.
Skin breakdown/Braden Scale - Not applicable.
Neurological - The patient is alert, oriented and has clear speech. Pupils were equally round and
reactive accommodation and light, no unusual threat on the right eye. Patients extremities are
strong.
Cardiovascular - The patient has regular heart rhythm. Has pink skin and warm. The patient has
brisk capillary refill. Radial pulse is present.
Respiratory - Thepatienthasnorespiratorydistress,lungsclearbilaterally.
Genitourinary - Not applicable
Psychological - Thepatienthasflataffect,slowthoughtprocessandunderstandshospitalization.
Analysis:
Aboveshowsnormalassessmentofthepatientexceptforthepsychologicalassessment.
ThepatienthasflataffectandslowthoughtprocessduetoherSchizophrenia.

III. ACTUAL MANAGEMENT AND RELATED TREATMENTS


Actual Management

Significance of Management

Ideal Management

On November 13, 20113 the


patient was brought to NCMH.
The patient was assessed for 2
weeks which was the hospitals
protocol. Physical assessment
and History was done. Lab tests
were ordered by the doctor (such
as
hematology,
chemistry,
urinalysis). The doctor also
ordered
for
chest
x-ray
procedure.
Medication
was
prescribed. Patient was admitted
to Pavillion 35 which is the
forensic area. Patients blood
pressure is checked everyday.
Medications is given on time
everyday.
Prescribed Medications:
Resperidone
2 mg
HS

Schizophrenia is associated
with a wide variety of abnormal
behaviors;
therefore,
assessment
findings
is
important to know proper
treatment. Medications are
given
everyday
because
continuity of care seems to be a
significant factor in psychiatric
nurse care as documented by
research studies (Backrush,
1981).

Antipsychotic
medication
Education & support,
for both ill individuals and
families
Social skills training
Rehabilitation to
improve activities of daily
living
Vocational and
recreational support
Cognitive therapy
Reference: (Vera, 2012)

Lab Results:

Lab results indicated normal


except for the following:

Chest radiography (6/5/14) &


Urinalysis (2/16/15) Normal
findings
Blood Chemistry (1/14/15) All
normal findings except for
Albumin. There is an increased
albumin

Antipsychotic. Used to treat


schizophrenia, bipolar mania
alone or combined with lithium
or valproate and for the
treatment
of
irritability
associated with autistic disorder
in children and adolescents

There is an increase in Albumin


because patient had edema
during this time. The test is
done to help determine the
cause of edema or abdomen or
of fluid collection in the lungs
that may cause shortness of
breath.

Nursing Responsibilities:
Monitor patient for
symptoms of
tardive dyskinesia,
it may occur after
prolonged use
Monitor for weight
gain
Monitor for
hyperglycemia
Monitor for EPS

Analysis:
Medication is one of the cornerstones of treatment. Once the acute stage of a psychotic
episode has passed, most people with schizophrenia will need to take medicine indefinitely. This
is because vulnerability to psychosis doesnt go away, even though some or all of the symptoms
do. In North America, atypical or second generation antipsychotic medications are the most
widely used. However, there are many first-generation antipsychotic medications available that
may still be prescribed. A doctor will prescribe the medication that is the most effective for the ill
individual
Another important part of treatment is psychosocial programs and initiatives. Combined
with medication, they can help ill individuals effectively manage their disorder. Talking with
your treatment team will ensure you are aware of all available programs and medications.
In addition, persons living with schizophrenia may have access to or qualify for income
support programs/initiatives, supportive housing, and/or skills development programs, designed
to promote integration and recovery. (Vera, 2012)

IV. PATHOPHYSIOLOGY
Schizophrenia
Patient S.S. (46 years old)

Precipitating factors:
Jail for a case of murder
Family Problems
History of miscarriages

Risk factors:
Genetic Predisposition
Environmental, Social, and
Psychological Factors

Neurodevelopmental
abnormalities and target features.

Brain dysfunctional
Improper balance of chemicals

Antipsychotic
Medications:
Resperidone

Schizophrenia

Positive:
Delusion
Hallucination
Ideas of reference
Flight of ideas

Reference: (Videbeck, 2011)

Negative:
Ambivalence
Anhedonia
Apathy
Thought blocking

V. NURSING CARE
Short-term goals

Anxiety
Altered thought processes

Long-term goals

Disabled family coping


Ineffective individual coping
Disturbed sensory perception
(Auditory)
Impaired verbal communication
Grooming self-care deficit
Ineffective role performance
Powerlessness
Risk for violence
Impaired Social Interaction
Compromised/Disabled Family
Coping

Reference:
(Doenges,

Moorhouse, & Murr, 2008) (NANDA, 2010)


VI. PRIOIRITIZATION
1st priority Altered thought process
2nd priority Disturbed sensory perception (Auditory)
3rd priority Ineffective individual coping
The first priority would be Altered thought process because a disruption in mental
processes which include reality orientation, comprehension, awareness, and judgment, may lead
to inaccurate interpretations of the environment and may result in an ability to evaluate reality
accurately.
The second priority problem is Impaired Social Interaction, state in which an individual
experiences a change in the amount or type of stimuli received, accompanied decrease towards
exaggeration or disorder of the response to such stimuli.

Lastly, the 3rd priority problem is Ineffective individual coping is Inability to form a valid
appraisal of stressors, inadequate choices of practiced responses, and/or inability to use available
resources Maladaptive coping can result in unnecessary distress for the person and others
associated with the person or stressful event. In nursing literature, effective and ineffective
coping are often differentiated. Effective coping results in adaptation, while ineffective coping
results in maladaptation.
VII. REFERENCE

Doenges, M. E., Moorhouse, M., & Murr, A. C. (2008). Nurse's Pocket Guide . Joanne Patzek
DaCunha.
NANDA. (2010). NCP for Schizophrenia. Retrieved from NANDA Nursing: http://nandanursing.blogspot.com/2010/10/nursing-care-plan-for-schizophrenia.html
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth's
textbook of medical-surgical nursing. Wolters Kluwer Health.
Vera, M. (2012, Feb 23). Schizophrenia Nursing Care & Management. Retrieved from
NursesLabs: http://nurseslabs.com/schizophrenia-case-study-types-diagnosis-interventionstreatment/
Videbeck, S. L. (2011). Psychiatric-Mental Health Nursing. Wolters Kluwer | Lippincott
Williams & Wilkins.