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Whatever happened to Rizal’s famous quote “The youth is the hope of the nation” when a large percentage of the youth today are into intoxicating drugs and substances? These “future leaders” have indulged themselves into vices that are slowly killing them and destroying their bright future, the country’s bright future. Through sniffing and injecting cocaine the enjoyed a few minutes of ecstasy but unknowingly they have let in a poison run through their veins destroying them from the inside. By the time they realize (if ever they do) what’s happening, it is usually too late to repair the damage done. This is a case of twenty-three year old Ms. Esmeralda Gabinete, a resident of Toledo City, Cebu. who, like the youths mentioned above, got herself into an addictive vice like sniffing cocaine and injecting it into her own vein. She’s been using it for nearly five years, realized last June that it wasn’t really doing her any good, stopped, made a narrow escape from the cocaine’s deadly consequences but otherwise suffered from its common withdrawal effect: psychosis. A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs including alcohol, medications and toxin. Psychotic symptoms can result from intoxication on alcohol, amphetamines, cocaine and inhalants or as a result of withdrawal from the mentioned substances.
2 The disorder is categorized in two ways. First, it is subtyped based on whether the prominent feature is delusion or hallucination. Hallucinations are seeing, hearing, feeling, tasting or smelling things that are not there and delusions are fixed, false beliefs. Second, it is subtyped based on whether it began during intoxication on a substance or during withdrawal from a substance. A substance-induced psychotic disorder that begins during substance use can last as long as the drug is used while a psychosis that begins during withdrawal may first manifest up to four weeks after an individual stops using the drug. April Mechelle Tecson’s case is an interesting and controversial one.
Interesting in a sense that the student nurse is about the client’s age and it brings up the possibility of finding an answer to the question: What could possibly have lead those youths to bring about their own destruction? Controversial in a way because it involves a prominent issue such as drug addiction and gives rise to questions such as: What is the government doing to control these stuff and why are drug dens ( Kamputhaw is a famous one), even though everybody knows where they are, still impregnable to authorities? This case study aims to shed light on, as much as possible, all of the factors that have lead to April Mechelle Tecson’s current state of health. As her student nurse and as someone who has sentiments over a co-youth who have gone astray, the author seeks to delve more on here case and find means to help her and her significant others deal with the disorder substance-induced psychosis.
3 II. Objectives
General Objectives: This case study aims to help the student nurse in effectively providing holistic caring care for a patient suffering from bipolar I disorder. It also aims to aid the patient in coping with life situations, and incorporating it into her reorientation to reality and activities of daily living for her optimum level of functioning.
Specific objectives: After 2 weeks of providing holistic caring care and facilitating student nurse-patient interaction, the student will be able to: 1. perform a thorough assessment of an adolescent in her present
condition, and discuss the physical, social and cognitive characteristics of an adolescent, 2. establish rapport and interact with the patient at the patient’s own
level and taking into consideration her present condition 3. identify the signs and symptoms presented by the patient in
relation to the disease process 4. implement a comprehensive plan of care for the patient with
substance-induced psychotic disorder, and 5. Evaluate the interventions provided in the given span of time for
efficiency and effectiveness.
the client and her significant others will be able to: 1. and terminate the therapeutic student nurse-client interaction at the end of the given span of time . and participating in student nurse-client interaction. 5. manifest signs of reorientation to reality. participate with the student nurse in activities aimed at the patient’s holistic well being. establish trust towards the student nurse cooperate in procedures performed to the client for management treatment. 2.4 After 2 weeks of receiving holistic caring care. 4. such s in art therapy and morning stretching exercises. and 3. such as adhering to the medication regimen.
20010.5 III. April Mechelle Marson 23 years old Female Married Roman Catholic Date of admission: June 8. Nursing Assessment 1. Client belongs to a low socioeconomic class family and is the eldest among three siblings. 9:00 pm Room No. most recent episode manic with psychotic features Physician: Dr. nga iyang patyon”.2 Family and Individual information. 1. social and health history April Mechelle Tecson. She is a known alcoholic .: XII Complaint: “nang hagis sa iyang bana. Ariel Tecson at Vicente Sotto Memorial Medical Center Psychiatry ward at around nine in the evening. Yazar 1. 20-year old and single. as verbalized by mother-in-law Impression/Diagnosis: Bipolar I disorder. was admitted by her father.1 Personal History Patient’s profile Name: Age: Sex: Civil status: Religion: Tecson.
client responded angrily saying: “Ako man hinuoy praning! Di ko praning! Basin ikaw!”. According to her mother. Tecson gave birth with . Her mother expressed that it was probably due to the fact that April was delivered not in the hospital but in their house. Her father’s sister have had postpartum psychosis last 1989 which was known to be recurrent. Rosalie Tecson.6 and cocaine abuser and a cigarette smoker. Her mother’s brother was also addicted to marijuana and was admitted at VSMMC Psychiatry ward last 1980. Factors thought to have influenced remission include the fact that she was a battered wife and her husband was always abroad and she was left with the responsibility of taking care of their only son who has cerebral palsy. Client’s family has a history of addiction and psychosis. client was noticed to have stopped taking the said the said drug last June and that’s when she started exhibiting the positive symptoms such as talking and laughing by herself. Hours prior to admission. Client’s medical history showed that client was admitted at Southern Island when she was still days old and was diagnosed to have had meningitis. Client was formerly enrolled at Abellana High School but stopped when she reached second year high school. When confronted that she was acting weird. Mrs. Mrs. She already got well but the condition returned last 1994. She was known to have started using “shabu” injectables when she was fifteen years old. client was seen running after a pregnant neighbor with a knife in her hand.
has an intact short and long term memory. person and place oriented. Upon admission. 1 tab OD and chlorpromazine 100 mg. with poor concentration and exhibited circumstantiality. She is currently prescribed Haloperidol 20 mg. Mrs. However. Biperiden 2 mg. According to her mother. Her name was “Ilang” and April shares with her all her problems. Since then. Client is for homicidal and suicidal precaution. Ilang got married and transferred residence so April lost contact with her. April Mechelle has only one bestfriend that she knows of. 1 tab OD at hour of sleep. She was diagnosed to have uterine laceration.3 Level of Growth and Development 1.7 the aide of a “manghihilot/mananabang” who follows certain beliefs/odd beliefs like having the baby taste her first feces as a form of “sumpa” against evil spirits. When April Mechelle was fourteen years old. Rosalie Tecson was not able to get information regarding the goings on in her daughter’s life because April seldom talks to her about her feelings and concerns. ½ tab OD. she was admitted by her boyfriend at North General Hospital due to massive bleeding. Ilang was close to April’s mother so she can tell her what was going on with April. client was time.1 Normal Development at stage of adolescence (12-20 years old) . 1.3.
alteration in distribution of muscle and fat increased growth rate of skeleton. Physiologic Development Physical changes occur rapidly in adolescence. while a young adult is twenty to forty years old.8 The rate of a person’s growth and development is highly individual. 20 years old. cognitive. An adolescent’s self concept changes with biologic development. Gowth and development are commonly thought of as having five major components: physiologic. Ms. Significant others should assist adolescents to develop their coping behaviors. especially in the face of conflicts. is on the stage of adolescence. She is specifically in the middle of being an adolescent and a young adult because according to Fundamentals of Nursing by Barbara Kozier. Values are tested. width 3. April Mechelle Tecson. moral and spiritual. the sequence of growth and development is predictable. 2. psychosocial. however. and adolescent’s age ranges from twelve up to twenty years old. Four main focuses of the physical changes are: 1. On this case. muscle and viscera sex-specific changes. the client. Sexual maturation occurs with the development of primary and secondary sexual characteristics. such as changes in shoulder and hip . physical growth accelerates and stress increases.
The client’s height is 5’1’’ and weight is 120 lbs. The client’s build is within the normal range. Developmental Task Theories According to Robert Havighurst. Girls tend to begin their physical changes earlier than boys. The final 20 % to 25% of adult height and 50% of adult weight is gained during this time period. April have had her menses at the age of 11. The growth spurt for girls generally begins between 8-14 years of age. each associated with 6-10 tasks to be learned. development of the reproductive system and secondary sex characteristics Wide variation exists in the timing of physical changes associated with puberty between sexes and within the same sex. growth and development occurs during 6 stages. April is in the stage of adolescence and the tasks are as follows: adults achieving assurance of economic independence selecting and preparing for an occupation preparing for marriage and family life achieving emotional independence from parents and other . Height increases 2-6 inches and weight increases by 15-55 pounds. Height and weight increases usually occur during the prepubertal growth spurt.9 4.
partial or unsuccessful. achievement of independence and decision making are encouraged.) with a central task identity vs. According to Roger Gould . The resolution of the task can either be complete. Separation from parents. role confusion.10 developing intellectual skills and concepts necessary for civic competence behavior Psychosocial According to Sigmund Freud Client is at genital stage wherein energy is directed towards full sexual maturity and function and development of skills needed to cope with the environment. desiring and achieving socially responsible behavior acquiring a set of values and ethical system as a guide to According to Erik Erickson Erickson envisions life as a sequence of levels of achievement.o. Each stage signals a task that must be achieved. April is at the adolescence stage ( 12-20 y. A coherent sense of self and plans to actualize one’s abilities are indicators of a positive resolution for this stage.
They feel they could be pulled back into their families. group. sequential process in which a variety of new experiences must exist before intellectual abilities can develop. her current condition does not enable the student nurse to assess fully her cognitive abilities at the absence of her psychosis.11 Gould believes that transformation is a central theme during adulthood. at this stage. Moral Development According to Laurence Kohlberg There are three levels and six stages. 20’s is the time when a person assumes new roles. April is at stage 2 ( 18-22 y. There is a sense of guilt that affects behavior. based on her age.o. or society. She is at the stage 3: Interpersonal Concordance . April is at the conventional stage where the person is concerned with maintaining expectations and rules of the family. they feel it is in jeopardy. Cognitive According to Jean Piaget Cognitive development for Piaget is an orderly. According to Gould. although the individuals have established autonomy. However. There are five major phases and April. nation. is supposed to be at the formal operations phase where rational thinking and deductive and futuristic reasoning is expected.).
2 The ill person at particular stage of patient . based on her significant other’s account. 1. April is at the synthetic-conventional is structured by the expectations and judgment of other.3. Stage 3: caring for self and others prevailed. Ideally. At this stage. interpersonal focus. was at this stage when her addiction developed and is still at the stage now. the person wants others’ approval or a reward. Spiritual Development According to James Fowler James Fowler describes the development of faith as a force that gives meaning to a person’s life. According to Wersterhoff April is at the experience faith stage which is a stage not normally for young adult based on Westerhoff’s theory. April.12 Orientation where decisions and behavior are based on concerns about other’s reactions. client experiences faith through interaction with others who are living particular faith tradition. The concept of responsibility now involves responsibility for self and others. According to Carol Gilligan The student nurse has difficulty pinpointing at what specific stage the client is due to the limited time of contact with the client.
Even though April has gone emotionally distant from her parents. Psychosocial development . It is just another way diverting her emotional needs and conflicts because she couldn’t reach them. Values and ethical system are vague yet and self-awareness and value clarification are ought to be realized. There has been no assurance of economic independence all throughout her childhood and adolescent years because the family is struggling financially. Selecting and preparing for an occupation and married life wasn’t on her list of priorities for the past years because she got hooked with an illegal substance and all she could think of were means of supporting her vices. April stopped going to school at the age of 15 and didn’t go through any livelihood trainings or seminars so skills and concepts necessary for civic competence weren’t met either. April has failed to achieve the last 7 tasks. it is not a sign of being emotionally mature and independent. A socially responsible behavior isn’t observable considering that what she had done and what she had gotten herself hooked to is a menace to the society and one of the major reasons why the crime rate is rapidly escalating.13 Developmental Task theory Based on the student nurse’s assessment on the client. starting from achieving emotional independence from the parent and other adults.
her coping skills are underdeveloped. She has not developed a sense of competence and perseverance which lead to her withdrawal from school. client seemed to . Her mother mentioned about difficulty providing her5 eldest daughter with the appropriate nutrition whenever she cries for feeding at times due to financial restraints. Client is making no effort to actualize her abilities.She is indecisive and has antisocial tendencies. inferiority task during her school age years. This could be one of the factors involved in the client’s smoking vice. According Roger Gould Client has not matured enough and based on her actions. client was found out to be orally fixated. Based on observation. biting or always puting objects into her mouth such as a pen or a pencil. According to Erik Erickson Client was unsuccessful in her industry vs. like withdrawing from her significant others and getting involved in illegal activities. she has difficulty progressing through the adolescent central task of identity vs. role confusion.Client is now at Genital stage. however. Due to this failure. has not tried to assume a new adult role. People who are orally fixated exhibit signs such as sucking thumb beyond toddlerhood.14 According to Sigmund Freud Based on the account of the client’s significant other.
one of the factors that lead to the client’s condition was her peers. the student nurse faces a great challenge on how to do health teaching effectively. “Gipasuway man ko nila.15 exhibit regression. Aside from being genetically predisposed. specifically cocaine. Moral Development According to Laurence Kohlberg Conventional stage and Interpersonal concordance orientation basically speaks of societal pressure. client seemed to be anxious that she’ll get separated from her mother. she got mixed up with a bad crowd and started using drugs due to peer pressure. Due to this fact. At 15. According Carol Gilligan . During the whole student nurse-client interaction. Cognitive Development According to Jean Piaget Rational thinking and deductive and futuristic reasoning of the formal operations phse has not been observed by the student nurse from the client.” as verbalized by the client when asked regarding the start of her vice. Priamary reason for this is the client’s current state: psychosis due to substance abuse.
whenever she has extra food. she would tell her mother to save it for her siblings. These behaviors gave the student nurse clues as to the client’s sense of responsibility.16 There was a time when the student nurse touched the topic about the client’s siblings. During her stay in the ward. . the client exhibited circumstantiality. She tried to avoid the topic. Before that. the client answered the student nurse’s questions sensibly. Her mother said that the client is deeply concerned when it comes to her siblings. Spiritual The spiritual development has proved to be difficult to assess in a person like April who is suffering from a substance abuse psychosis and who refuses to answer when it comes to questions such as: do you think what you are into now is a punishment from God? Her mother stated that she goes to church and prays with the family whenever her mother makes an enough effort to encourage her. She’s concerned not only on her own welfare but also that of her siblings’. however. when asked how were her siblings at home and whether she missed them or not.
She has dry skin and on it are four genuine tattoos found on her left ring finger. . and on her right lower extremity. that was during the student nurse-client interaction. She was not wearing any make-up. another one on her forearm(dorsal part). Affect Client’s facial expression does not convey emotion most of the time. The only accessory she had on was a multi-colored bracelet in her left arm. Mental Status Exam A. It remained constant all through out the conversation. Client is thwenty years old and looks her age. on her scapular region which was shaped like a cross. with a brown step-in sandals to match.17 2. Appearance Client was seen wearing a red shirt and maong pants. B.
D. she seemed to prefer sitting beside her mother. threatening. She responded only when questioned and spoke with a loud voice. and violent behavior.18 C. E. F. She just sat on a bench. No evidence of unusual mannerisms or motor activity. Client appeared to be evasive as evidenced by her short statements and stands up whenever the student nurse sits beside her. when asked about her family. client appeared to be personoriented. Client did not exhibit neologism nor verbigeration. place-oriented and time-oriented. Communication and Social Skills Client spoke coherently and enunciated clearly. . Content of Thought Client claimed to have not experienced any delusions nor any kind of hallucinations. No outward signs of compulsion and obsessions. She has a normal gait and posture.Orientation During the two interactions that took place. she displayed circumstantiality. cross-legged. client did not exhibit any strange. When asked. Attitude and Coping Patterns During the whole interaction. Behavior. however. client could say her name in full. stating unnecessary details irrelevant to what was being asked. During interviews.
client could recall certain fragments about her childhood and high school life.”Dili ko praning kay wa ko gagamit. subtraction. Sexuality . When asked if she can recall student nurse’s name. H. K. multiplication and division but has difficulty counting backwards. Spirituality Client is a Roman Catholic. client discretely glanced at the student nurse’s name plate which indicates that she can read.She was able to tell the student nurse what happened hours prior to her admission to the psychiatric ward. I. J. Insight Regarding Illness or Condition Client was in denial of her condition. Intellectual Ability Client can use facts comprehensively. Does not respond when asked about her spiritual values.19 G.” as verbalized by the client referring to her state.Client can do simple mathematical equations such as addition.Memory When asked.
despite their current condition. Neurovegetative Changes Client claimed to have no difficulty falling and staying asleep at night. It weighs a little over three pounds. Her mother stated that the client seldom eats at home.1 Normal Anatomy and Physiology of Organ and System Affected The Brain The adult brain’s unimpressive appearance gives few hints of its remarkable abilities. Client defecates regularly. especially when she’s “tama”. 3. Psychopathology and Rationale 3. she did not have any boyfriend since she was sixteen years old. According to her mother. When April was fourteen years old. and with the texture of cold oatmeal. Client’s appetite has improved according to her mother.20 Client haven’t express any concerns regarding sexual identity and function . she was admitted by her boyfriend at North General Hospital due to massive bleeding. wrinkled like a walnut. It is about two good fistfalls of pinkish gray tissue. She was diagnosed to have had uterine laceration. according to her mother. They currently sleep on a bench in the Psychiatric ward common room. Because the brain is the largest and most . L.
The Limbic System The limbic system sets the emotional tone of the mind. controls appetite and sleep cycles. the hypothalamus which is an important part of the limbic system and the epithalamus which has the pineal gland and choroids plexus. interpretation of sensation and voluntary movement. Logical and emotional response. it is commonly discussed in terms of its four major regions. brain stem and cerebellum. The Blood-Brain barrier . directly processes the sense of smell. diencephalons. are all functions of cerebral cortex neurons. modulates motivation. memory. The major structures of the diencephalon are the thalamus.cerebral hemispheres. promotes bonding. stores highly charged emotional memories. wherein reflex centers for vision and hearing are found. and modulates libido. the pons which is involved in the control of breathing and the medulla oblongata which regulate vital visceral activities. as well as consciousness. which encloses the shallow third ventricle of the brain. Speech. filters external events through internal states( emotional coloring).21 complex mass of nervous tissue in the body. Structures of the brain stem are the midbrain. tags events as internally important.
First. uncontrolled neural activity might resultremember that certain ions (Na and K) are involved in initiating nerve impulses. cocaine and anesthetics can affect the brain. people may overdose on recreational drugs .2 Psychopathology A large number of toxic or psychoactive substances can cause psychotic reactions. only water. Alternatively.The blood brain barrier is virtually useless against fats. either because they don’t know any better or by mistake. particularly after eating or exercising. Other body tissues can withstand the rather small fluctuations in the concentrations of hormones. and some amino acids serve as neurotransmitters. composed of the least permeable capillaries in the whole body. Such substance-induced psychosis can occur in multiple ways. Finally. neurons are kept separated from blood borne substances by a so-called blood brain-barrier.22 No other body organ is so absolutely dependent on a constant internal environment as is the brain. If the brain were exposed to such chemical changes. medicines may interact in unforeseen ways or doctors may miscalculate the effects of medicines they prescribe. 3.This explains why blood-borne alcohol. glucose and essential amino acids pass easilty throught he walls of these capillaries.Of water soluble substances. respiratory gases and other fat-soluble molecules that diffuse easily through all plasma membranes. ions and nutrients that continually occur. people may take too much of a legitimately prescribed medicine. nicotine. people may inadvertently ingest toxic substances by accident. Consequently.
This is basically what happened to April Michelle Tecson. Erythroxylon coca. Sigmund Freud proposed cocaine for the treatment of depression. The Diagnostic and Statistical Manual of Mental Disorders notes that a diagnosis is made only when the psychotic symptoms are above and beyond what would be expected during intoxication or withdrawal and when psychotic symptoms are severe. In 1885. In the late 19th century. the Harrison Narcotics Act banned all nonprescription use of cocaine. In 1914. The following are the criteria necessary for diagnosis: cessation or reduction in previously heavy or prolonged cocaine use The patient also must have a dysphoric mood associated with 2 of the following 5 physiological changes: -Fatigue -Vivid unpleasant dreams -Insomnia or hypersomnia -Increased appetite • • . or become dependent on drugs or alcohol and experience psychotic symptoms while in withdrawal from those substances. Finally.23 they commonly use ( such as cocaine). and asthma. cachexia. It later became prescribed for almost any illness and could be found in numerous tonics. Cocaine is a naturally occurring alkaloid found within the leaves of a shrub. John Styth Pemberton registered a cocaine-containing drink in the United States. in 1970. This drink was later named Coca-Cola. except for limited medical uses. the Controlled Substances Act prohibited the possession of cocaine in the United States..
slowed-down patient who complains of depressed mood and has a restricted affect. They may express suicidal ideation. • Mental status examination may show a sleepy. The patient may experience significant depressed mood with suicidal ideation. norepinephrine. and serotonin reuptake blockade) . 1 Schematic Diagram of Psychopathology of the illness Predisposing Factors Biological -genetics -brain damage From previous disease: meningitis Psychological -unresolved self-conflicts -failed developmental tasks Environmental -deficiency of vitamin B complex -viral infection Spiritual -financial status -relationship with members of the community Precipitating Stressors financial constraints personal inadequacies peer pressure Blockade of catecholamine reuptake occuring in both the central and peripheral nervous systems (ie. dopamine.24 -Psychomotor agitation or retardation • These signs or symptoms result in significant distress in the patient clinically and may impair the patient's social or occupational areas of functioning. Fig.
alogia. encourage verbalization of problems and assist in art therapy and remotivation therapy 3.25 Signs and Symptoms Delusions.hallucination Medical Management -stabilize psychotic symptoms with medications Nursing Management -eliminate alcohol and substance abuse. promote healthy relationship. monitor for suicidality and homicidality.3 Disease Process and its Effect on the Different organ/system Phase1(crash) 9hrs.-4days Phase2(withdrawal) 1-10 weeks Cocaine Binge Early dysphoriadepression.anxiety and agitation Middle Fatigue Depression No cocainecraving Insomnia with increased need for sleep Late Exhaustion Hypersomnolence Hyperphagia No cocaine craving Early Sleep normalized Euthymic mood Low cocaine craving Low anxiety Middle&Late Anhedonia Anergia Anxiety High cocaine craving Conditioned cues exacerbate craving craving Phase3(extinction) indefinite . decrease environmental stress. flight of ideas.
26 Normal hedonic response Euthymic mood Episodic craving Conditioned cues triggering craving
Fig. 2 Pattern of Cocaine Use
Cocaine has a number of pharmacologic effects on the human body. Neuronal fast sodium channel blockade produces a local anesthetic effect that continues to be used in medicine today. During myocardial fast sodium channel blockade, cocaine blocks fast cardiac sodium channels, which results in type I antidysrhythmic activity. This may lead to prolongation of the QRS complex and contribute to the induction of the dysrhythmias associated with cocaine use. Blockade of catecholamine reuptake (ie, norepinephrine, dopamine, and serotonin reuptake blockade) occurs in both the central and peripheral nervous systems. Blockade of reuptake of norepinephrine leads to the sympathomimetic syndrome associated with cocaine use. This syndrome consists of tachycardia, hypertension, tachypnea, mydriasis, diaphoresis, and agitation. Inhibition of dopamine reuptake in the CNS synapses, such as in the
27 nucleus accumbens, contributes to the euphoria associated with cocaine. Norepinephrine release augments norepinephrine reuptake blockade effects. Cocaine abuse is associated with numerous detrimental health effects. All organ systems can be adversely affected by its use. Cocaine-related psychiatric disorders have been well-documented in the literature. Ten cocaine-induced psychiatric disorders are described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSMIV-TR).Some of them are cocaine withdrawal, cocaine-induced psychotic disorder with delusions and Cocaine-induced psychotic disorder with hallucinations. 3.4 Classical and Clinical Symptoms
Classical Symptoms Delusion, fixed but false beliefs -false sense of grandeur also called cocainomania
Clinical Symptoms Client did not exhibit delusions of grandeur
Rationale An excess of dopamine affecting the cortical areas of the brain.This gives the client perceptions which are not based on reality Source:Psychiatric-Mental Health Ng. by Shives
Flight of ideas
When client talks she sometimes jumps from one
An excess of dopamine which results in the firing of
28 topic to another.(refer to process recording no.5) neurons with varied different and multiple impulses to the brain Source: Psychiatric-Mental Health Ng. by Shives
Alogia, poverty of content
Client often speaks very little or conveys little substance of meaning
Organic functional changes in the brain and cerebral atrophy from imbalances in neurotransmitter levels in the brain.This decreases the speed and how much information is processed in the brain. Source: Psychiatric-Mental Health Ng. by Shives
Hallucinations, most commonly tactile and olfactory
Client laughs by herself
The excess of dopamine in the cortical areas of the brain gives the client perceptions which are not based on reality Source: Psychiatric-Mental
or organic functional changes that the client’s brain may have undergone. cerebral atrophy . by Shives Client does not engage in Anergia( lack of energy) activities that used to be fun for her . This is caused by an inadequate amount of dopamine. by Shives Client gets anxious Anxiety whenever her mother is not beside her. A negative symptom caused by an inadequate amount of dopamine.This is according to her mother. by Shives Anhedonia (loss of pleasure or interest) Client rarely interacts with her siblings anymore and A negative symptom caused by an inadequate amount of does not engage in activities dopamine. Source: Psychiatric-Mental Health Ng.29 Health Ng. cerebral atrophy or organic functional changes that the client’s brain may have undergone. Source: Psychiatric-Mental Health Ng.This is according to her mother. cerebral atrophy that used to be fun for her .
30 or organic functional changes that the client’s brain may have undergone. Taber’s Cyclopedic Medical Dictionary .A. such as in the nucleus accumbens. by Shives High cocaine craving Not exhibited by the client. Source: Davis. Inhibition of dopamine reuptake in the CNS synapses. F. contributes to the euphoria associated with cocaine which in turn triggers intense craving. Source: Psychiatric-Mental Health Ng.
But of course. Care Guide of Patient with Substance-induced Psychosis a. which may also include vocational training and other features.31 IV.A client typically spends six to twelve months in such programs. Treatment Settings Residential programs/ therapeutic communities may be helpful. b. Nursing Intervention 1. Dr. the client’s financial status and ability to cover treatment is also an issue that affects the patient’s access to treatment. Yazar have recommended that April be transferred to a drug rehabilitation center but April’s mom still has difficulty finding a rehabilitation center that they can afford. Psychotherapy Contingeny management rewards drug abstinence( confirmed by urine testing) with point or vouchers which patients can exchange for such .
plans. If a plan and intent to act is present. Supportive therapy helps patients to modify their behavior by preventing relapse by taking actions such as staying away from drug-using friends and from neighborhoods or situations where cocaine is abundant. Not only may the patient require voluntary or involuntary psychiatric hospitalization. Behavioral therapies have been designed to prevent relapse in patients addicted to cocaine. This also may mandate further inpatient care. but one also may have a duty to warn an intended victim. Another example is behavioral therapy such as contingency management. psychiatric hospitalization is almost always warranted. in which vouchers are provided and are redeemable for goods or services contingent on performance of . For example. a relapse prevention strategy may include minimizing the free cash the cocaine addict has available to buy drugs. Also. Clients in similar situation with April should also be assessed for risk of harm to self or to others. Cognitive behavioral therapy help users learn to recognize and avoid situations most likely to lead to cocaine use and to develop healthier ways to cope with stressful situations most likely to lead to cocaine use and to develop healthier ways to cope with stressful situations. These therapies help minimize exposure to drug cues and help modify patients' responses to cues they encounter.32 things as an evening out or membership in a gym. and plan is critical. and level of intent to act on such ideation is crucial. even if requiring involuntary commitment. intent. assessing homicidal ideation. Careful assessment for suicidal ideation.
Medications There are numerous medications have been studied for the treatment of cocaine addiction. mints. Topiramate. an anticonvulsant. . With the help of the dietitian or nutritionist.33 desired behaviors. and many show promise. vegetables and bran products. The use of low calories or sugarless hard candy. Constipation is a common side effect of the drugs given to April. Nausea and vomiting or irritation may present as a transient side effect so medication must be taken with food. Baclofen and tiagabine. d. April can be given a more holistic care. c. as well as modafinil have also shown promise in reducing cocaine use. Disulfiram may increase the aversive effects of cocaine and reduce its use. shows some promise for cocaine-dependent patients. Diet and Nutrition The student nurse should promote adequate fluid intake ( 2. Other recent work has suggested that a cocaine vaccine may induce the formation of sufficient antibodies to reduce cocaine use. gum or beverages is encouraged if the client experiences dry mouth as a side effect. These are precautionary measures to lessen the side effect of psychotropic drugs given .5003000 cc/ day) and promote intake of fresh fruits.
Haloperidol is an antipsychotic nonphenothiazine while chlorpromazine is also an anti-psychotic but that of the phenothiazine type. Biperiden. is given as a prevention of the extrapyramidal side effects that accompany phenothiazine therapy. . an antiparkinsonian. Chlorpromazine and Biperiden.34 As of now. April has been given Haloperidol.
Yazar Nursing Care Plan Needs/Problem Cues I. XII Date: 09/17/07 Physician: Dr. gain 1. the client will be able to establish trust. Actual Patient Care: 2.35 2. Impaired verbal communication Impaired verbal communicat ion: Cues: incomprehe nsible Cocaine produces pleasurable effects through its action on structures deep nurse-client interaction. attempt to decode incomprehensible communication patterns 1. Psychologic deficit: Nursing Diagnosis Goal: After 2 weeks of student A. gain rapport.reveal how the client is being perceived by others while the responsibility of understanding the client is I.1 Nursing Care Plan Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Hospital No. 6184112 Ward No. improve the quality of verbal communication Scientific Basis Objectives of Care Nursing Actions Rationale Measures to: .
285-286. A cocaine binge (repeated use with increase amount) may insight of reason of admission and show adaptive attitude towards stressful situations 2. of student nurse-client interaction.Ng. responds in a loud voice -client usually responds in short statements and sometimes statements related to looseness of association within the brain-most notably.Ng. by Townsend .285-286. possible resultant min. by Townsend cause increasing After 30-45 irritability.client is silent most of the time but when talked to.This approach conveys empathy and may encourage client to disclose painful issues-pg. a region called the ventral segmental area. seek validation and clarification on ambiguous statements accepted by the student nurse pg. by Townsend 2.facilitate trust and understanding by maintaining staff assignments as possible Psych.285-286. the client will be able to: 3.prevents making assumptions and genuinely attempts to understand client-pg. Psych. restlessness and paranoia.36 -client’s statements are often incomprehensi ble . Psych.Ng. Specific Objectives: 3.
Straight A’s in Psychiatric Mental Health Nursing. loss of touch of reality and auditory hallucinations. by Townsend B.” as verbalized by the client fullblown paranoid psychosis. Pg.285-286.Client’s safety and comfort are nursing priorities-pg.Ng. by Townsend 5.37 does not respond at all -“Tan-aw nila ug praning na ko. Impaired Impaired The deep limbic 2. as efvidenced by an interaction wherein her responses can be understood by the student nurse 4. effectively II.Ng. Lippincott Williams & Wilkins 1. 293.285-286. These facilitate restoration of functional communication patterns of client-pg. Psych. anticipate and care for client’s needs until functional communication pattern returns 4.express herself effectively . Psych. promote social . orient client to reality by name and validate those aspects of communication that help differentiate between what is real and what’s not 5.
the ability to connect with 2. 483. to keep a baseline data .Nursing Care Plan by Doenges Cues: -client has difficulty maintaining eye contact -client has a “glazed look” -client answers curtly in short statements most of the time -“Excuse sa te maintaining eye contact related to client’s withdrawal from society limbic system is damaged due to several factors such as trauma and chemical hzzards. anxiety. When the deep with the student nurse as evidenced by maintenance of eye contact and improved responses to student nurse’s questions interaction 1. Nursing Care Plan by Doenges 3. determine the use of coping skills and defense mechanisms 2. powerlessness. encourage client to verbalize problems and perceptions of reasons of problems 1.actively listen to note indications of hopeless ness. grief and hatepg. encourage client to keep a 3.38 social interaction social interaction: difficulty system/structure communicate s are also intimately involved with bonding and social connectedness.481. It affects the ability to be involved in social interactions-pg.
pg. 1953-1956. and interaction. Davis Doenges 4.pg. to reorient the client to reality while not yet fully exposing her to full social . to slowly reorient client positive social skills through to the reality of social practice of skills in real social situations accompanied by a support person. listening to news and remotivation therapy 5. 483. assist the client to develop 4. encourage reading.” as verbalized by the client other people on a social level is affected. Nursing Care Plan by -pg. Taber’s Encyclopedic Medical Dictionary by F. Nursing Care Plan by Doenges 5. 483.A. improvements or exacerbations. daily journal of social interactions for changes/.39 ha.
Doenges A.pg. as evidenced by the client sharing one past experience and can be understood by the student nurse. possible resultant fullblown paranoid psychosis.inappropriate answers to questions -usually responds in circumstanti ality 3. III. Doenges Cues: . decrease erratic thinking processes: 1.Doenges II. exhibit a coherent train of thoughts. reorient the client to the time.to provide stimulation 2. to clarify and simplify 3. give simple activities for the client-pg.531. Psychologic overload: Impaired thought processes: A cocaine binge may cause increasingly irritability. Nurse’s Pocket Guide. Nurse’s Pocket Guide.531. loss of touch of reality and auditory 3.40 interaction. place and day 1. 483. Nursing Plan. . schedule structured activities and rest periods without undue fatiguepg. to promote reality based interaction-pg. restlessness and paranoia. Impaired thought processes inappropriat e answers to questions related to 2.
Nurse’s Pocket Guide. Nurse’s Pocket Guide. the quality of verbal Date: 09/17/07 I. I. Doenges 4.encouraged client to keep a daily journal of social interactions . decrease pattern returnspositive B. –pg. to refocus conversation in one topic-pg. clarify and refocus if client exhibits circumstantialit 2. -usually by the client time inappropriate answers to questionstoeffectivelytrust.-client usually responds in shorteye contact Psychologic overload: -reoriented the situations accompanied by athose aspects -client has difficulty maintaining skills in real social that help differentiate between what is support person. of real and what’s not verbal student -client answers curtly in na questions Impairedof theGoal:Aftercommunication: nurse-client interaction. promote social interaction statements .2 Brunswick Lens Model Name of Client: April Mechelle Tecson Age: 20 years old Hospital No. gain insight related society looseness able -do not respond directly -“Excuse sa te ha. listening to news and remotivation therapy -client has a -“Tan-aw nila ug answersshort statements mostImpaired After 30-45 difficulty -gave simple questions the client will be able . social interaction: min.” as verbalized by the clientcircumstantialityof of associationshow adaptive attitude towards of reason can be understood by the student nurse related to Nursing responses admission and Of patient’s Actual state condition Cues Diagnoses Nursing Actions Desired Outcome stressful situations . 5. 532. to refocus conversation in one topic-pg. Nurse’s Pocket Guide.41 short statements -do not respond directly hallucinations.express .attempted to decode incomprehensible communication patterns Diagnosis: Substance-induced psychosis Sex: Female Ward No. place and day validate II. XII Physician: Dr.encouraged client to verbalize problems and perceptions of reasons of A. improve 6184112 communication Measures to: .clarified and refocus if client exhibits circumstantiality withdrawal fromtoclient will beherself establish . questions 532. the 2 weeks of III processes: verbalized responds in short statements Impaired eye contact related to client’s asked leading questions maintaining thoughtto: incomprehensible statements student nurse-client interaction.evidenced by an interaction wherein her 1. Impaired thought processes Specific Objectives:-encouraged reading.determined and use of coping skills and defense mechanisms incomprehensible . Psychologic deficit: II.anticipated the care for client’s needs until functional . ask leading questions Lippincott Williams Doenges 5. as gain rapport. Impaired verbal communication -facilitated trust and understanding by maintaining staff problems as possible -statements are often assignments . -assisted the clientreality by name and social skills through practice of to develop -oriented client toclient to the time. Yazar . and of -scheduled structured activities and rest periods communication statements “glazed look” A.inappropriate praning to ko.sought validation and clarification on ambiguous I. 532.293. 4.” as II.Impaired social interaction silent most of the time communicationerratic thinking processes: III. Straight A’s in Psychiatric Nursing.
PO. Provides a symptomatic control for the client by blocking the activity of disorders control of tics in Tourette’s syndrome behavioral absorption and client to effectiveness reality advise client by not to avoid being in direct encourag ing problems in children with combative. “Muinom ra pud biya siya.3 Drug Therapeutic Record Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Date: 09/17/07 Ward No. Yazar Drug Therapeutic Record Drug/Route/Do sage/ Timing Classification/ Mechanism of action Indication/Contrain dication/ Adverse effects Principles of Care Treatment Evaluation Haloperidol.42 2. nonphenothia zine I: nt of manifestations of psychotic manageme do not allow encour client to crush or chew medication to prevent decrease in age client to join in therapies orient Client’s blood pressure was taken before she was given the medication.hype good oral . sunlight for an distorted extended time perceptio ns of explosive. MOA: Mechanism not fully understood. Dili ra pugsunon”. as verbalized by the client’s significant other. ½ tab. OD 8am Typical antipsychotic . 20mg. XII Physician: Dr.
which has the potential to produce psychotic thinking. Too much dopamine causes nerve impulses in the brain stem to be transmitted faster than normal. constipation dermatitis photosensitivity early signs of discour extrapyramida age use l side effects of alcohol and other additive drugs GI distress weight gain . Also has anti-emetic property. rexcitability. resulting in strange thoughts and hallucinations . assist in mood lability C/I: CBC monitoring hypersensitivity monitor for Parkinson’s disease liver damage A/E: anticholinergic effects: dry mouth.drowsines s.43 dopamine.sh ort-term treatment hygiene should be encouraged to avoid mouth infections reality encour age complian ce of taking medicati ons on time for children with excessive motor activity. nasal congestion.
44 extrapyramidal side effects source: pg. PsychiatricMental Health Ng. 235. by Shives .
Drug/Route/Do sage/ Timing Classification/ Mechanism of action Indication/Contrain dication/ Adverse effects Principles of Care Treatment Evaluation
Chlorpromaz ine hydrochlorid e,PO, 100mg, I tab, OD at hour of sleep
Typical , antipsychotic, phenothiazine
I: nt of manifestations manageme do not allow encour client to crush or chew medication to prevent decrease in age client to join in therapies orient Client’s blood pressure was taken before she was given the medication. “Muinom ra pud biya siya. Dili ra pugsunon”, as verbalized by the client’s significant other.
MOA: Not fully understood. Blocks postsynaptic dopamine receptors in the brain. Depresses those parts of the brain involved with wakefulness and emesis; anticholinergi c, antihistaminic
of psychotic disorders relief of
preoperative restlessness; control of manicdepressive illness adjunct
absorption and client to effectiveness reality
advise client by not to avoid being in direct encourag ing
sunlight for an distorted extended time good oral hygiene should be encouraged to avoid mouth infections perceptio ns of reality encour age complian ce of taking
treatment of tetanus for combativeness, hyperactivity therapy
control of assist in
46 and alphaadrenergic blocking nausea and vomiting C/I:
CBC monitoring monitor for
medicati ons on time
early signs of discour extrapyramida age use l side effects of alcohol and other additive drugs
source: pg. 235, PsychiatricMental Health Ng. by Shives
Parkinson’s disease Coma Bone marrow depression A/E: anticholinergic effects dermatitis
GI distress extrapyramidal side effects
Drug/Rout e/Dosage/ Timing Classification/ Mechanism of action Indication/Contrain dication/ Adverse effects Principles of Care Treatment Evaluation
Biperiden hydrochl oride, PO, 2mg, 1 tab, OD
I: adjunct drug should be tapered gradually to prevent withdrawl symptoms advise client to avoid the use of encourag e client to take antipsycho tic medication s exactly as prescribed do health teaching to Client’s blood pressure was taken before she was given the medicatio n. “Muinom ra pud biya siya. Dili ra pugsunon” , as verbalized by the client’s significant other.
MOA: Blocks the action of acetylcholine in the brain and peripheral nervous system in attempt to correct an imbalance between a deficiency of dopamine and abundance of acetylcholine.
therapy of parkinsonism relief of
extrapyramidal side effects that accompany phenothiazine therapy C/I:
glaucoma myasthenia gravis prostatic hypertrophy
alcohol,sedat the client’s ive and over the counter drugs advise against staying long under the sun significant other regarding the early signs of extra pyramidal side
source: pg. 235, PsychiatricMental Health Ng. by Shives
A/E: psychosis depression
4 Health Teaching Plan .48 insomnia irritability effects encourage complianc e of taking medication on time 2.
the client wil be able to acquire adequate knowledge. the client will be able to: Content Methodology Evaluation . XII Physician: Dr. Specific: Within 45 min. attitude and skills regarding the use of coping skills whnever the need arises. Yazar Health Teaching Plan Objectives General: Within 2 weeks of student nurse-client interaction.49 Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Date: 09/17/07 Ward No. of student nurse-client interaction.
state the importan ce of using coping mechanis m 1. She easily gets distracted by the events around her. . Hazards of not being able to use proper coping mechanisms 2. identify health hazards of not being able to use -person would turn to vices like smoking. However. at the end of the health teaching she stated the that she prefers writing on a journal as a means of coping.50 1. drinking. drugs -aggravates mental illness 3.Importance of using a coping mechanism -reduces stress and lightens up your mood -reduces anxiety -enables a person to still function in work despite current crisis 2. enumerate coping Informal discussion Informal discussion Informal discussion Client was barely listening.
mechanis mechanism she is ms available comfortable with 5. client’s verbalization of willingness to use the coping mechanism .. Client stated that she preferred writing on a journal as a means of coping. enumerat ed coping other relaxation classes 4.51 coping mechanisms mechanis available ms dcuring stressful situation s -talking to a bestfriend or significant other about problems -putting troubling thoughts in a journal Informal discussion -drawing -listening to music -playing sports -joining in yoga and 3.. choose a coping Informal discussion “Gahanan ko magsuwat.” as verbalized by the client.
52 4. choose a coping mechanis m she is comforta ble with 5.5 SOAPIE and Process Recording . verbalize willingne ss to try to use the coping mechanis m 2.
instead. scheduled structured activities and rest periods. asked leading questions. gave simple questions.2 S. Yazar SOAPIE No. Name of Client: April Mechelle Tecson Age: 20 years old Date: 09/17/07 . usually responds in short statements and when asked about her siblings. XII Physician: Dr. she does not respond correctly. exhibits circumstantiality A-Impaired thought processes: inappropriate answers to questions related to circumstantiality P- to decrease erratic thinking process I.“Maayong buntag. place and day.reoriented the client to the time. Rhia Marie B. clarified and refocused if client exhibits circumstantiality E.” as verbalized by the client O.client was still not ready to openly discuss her troubled past Student nurse: Casinillo.client is still silent most of the time but responds with a loud voice when talk to.53 Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Date: 09/17/07 Ward No.
” as verbalized by the client O-client has difficulty maintaining eye contact. encouraged client to keep a daily journal of social interactions. client answers curtly in short statements most of the time A- Impaired social interaction: difficulty maintaining eye contact related to client’s withdrawal from society PI- to promote social interaction . assisted the client to develop positive social skills through practice of skills in real social situations accompanied by a support person. determined the use of coping skills and defense mechanisms.client still answered in short statements but was able to stay with the student nurse for approximately 5 minutes without the presence of her mother Student nurse: Casinillo. Name of Client: April Mechelle Tecson Age: 20 years old Date: 09/17/07 . and encouraged reading. encouraged client to verbalize problems and perceptions of reasons of problems. client has a “glazed look”.54 Diagnosis: Substance-induced psychosis Sex: Female Ward No. XII Physician: Dr. Rhia Marie B.“Excuse sa te ha. Yazar SOAPIE No. listening to news and remotivation therapy E.3 S.
Specific Objectives: After 30-45 min.1 maintaining eye contact during interaction 1. b. agree to date. establish trust on the student nurse-client interaction.55 Diagnosis: Substance-induced psychosis Sex: Female Ward No. abide by the “lagda” or contract set by the student nurse and agency 3.2 asking questions 2. time and place of the next interaction . gain insight of reason of admission and show adaptive attitude towards stressful situations. XII Physician: Dr. the client will be able to: 1. General Objective: After 2 weeks of student nurse-client interaction. Yazar Process Recording No. verbalize feelings and concerns as regarding present situation 5. of student nurse-client interaction. gain rapport. show essential details that lead to client admission 4. the client will be able to establish trust. 1 I. Objectives a. the client will be able to: 1.
2007. jumping from topics unrelated to the current topic of discussion and inability to concentrate. Date: September11. Setting a. Place: Vicente Sotto Memorial Health Center Psychiatric Ward. communicates but in short statements only. She was well taken care of by her mother who was with her since her admission to the center. which was last September 8. IV.56 II. She was wearing a relatively clean black shirt and pink pants. 2007 b. She was silent most of the time. He rhair was neatly combed. Client communicates in a loud voice. V. Her belongings were packed in a bag. Time: 11:00 am to 11:30 am c.bench in the common room III. She maintains eye contact when talked to. nor of pressured speech but exhibit flight of ideas. She does not mingle with other patients and preferred sitting with her mother. . Behavior The client was cooperative. Appearance The client was seen sitting on a bench in the common room. Communication The client did not exhibit neologisms.
Client’s verbal/ Communication non-verbal communication technique used Client’s Defense Mechanism Analysis “Ako diay si Rhia.T. Interaction Student nurse’s verbal/ non-verbal communication “Maayong buntag A. . imong student nurse na gikan sa Cebu Doctors’ University” “Estudyante sa Cebu Doc?” Giving information -none used- This action helps facilitate trust and build rapport by giving information about self or one’s self to the client.57 VI.” Client nods and stares at the student nurse Giving recognition -none usedThe nurse calls the client by name to boost the client’s selfesteem and promote reorientation to her identity.
Makahatag ka sa eksaktong oras karon?” “Dili wala koy orasan” Exploring -none used- The nurse delves deeper to further assess the client’s orientation to reality and ensure that client is not just guessing. to assess the client’s orientation.58 “Makahatag ka sa eksaktong adlaw. Setyembre 11. . petsa ug oras? Ug kung asa ta?” “Gidala ko nila Papa kay praning daw ko. Gidala ko dire sa Sotto atong Sabado” Client pauses and stares at student nurse. Asking direct question -none used- The nurse asks a question by interaction. “Murag Martes ta karon” “Sakto na Martes ta karun. 2007.
59 Nurse provides “Alas onsi kapin Client nods ta karun sa buntag. Evaluation . VII. No answer. “Unsa man ang rason na nakaingon ka ana?” Client lies down on her mother’s lap.” Asking direct open endedquestion -none usedan open ended question to facilitate expression of feelings through continued communication. The nurse asks “Kumusta man ang imo pamati karun?” “Ganahan na ko muoli. Exploring -regression- Nurse delves deeper to get further information.” Giving information -none usedinformation to orient client to reality.
Yazar Process Recording No. of student nurse-client interaction.60 Client was not very cooperative and appeared to be uncomfortable when the student nurse talked to her and asked her questions. Specific Objectives: After 30-45 min. She exhibited regression when she felt uncomfortable. the client will be able to: . Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Date: 09/17/07 Ward No. 2 I. XII Physician: Dr.
Setting a. recall the name of the student nurse 2. state the present date. . Client can maintain eye contact for quite sometime but her eyes wander off constantly when asked about her family. She was always standing up to check the activities going on outside.. time and place of the current interaction 3. She was wearing a red shirt with maong pants. set the date. Time: 10:45 am to 11:15 am c.61 1. Appearance The client was seen sitting on a bench in the common room.verbalize feelings about the client’s present condition 4. as evidenced by a neat and tidy appearance. IV. time and place of the next interaction II. Date: September 12. Behavior The client was constantly glancing outside the window. The client was able to perform activities of daily living.bench in the common room III. identify the reason for current hospitalization 5. 2007 b. Place: Vicente Sotto Memorial Health Center Psychiatric Ward.
62 V. giving much unnecessary details that delay meeting a goal or stating a point. nor of pressured speech but exhibit circumstantiality.” Client’s verbal/ Communication non-verbal communication technique used Client’s Defense Mechanism Analysis “Maayong buntag” Client nods Giving recognition -none used- The nurse calls the client by name to boost the client’s self-esteem and promotes reorientation to her identity. Interaction Student nurse’s verbal/ nonverbal communication “Maayong buntag A. “Nakahinumdum Client looks at Asking direct -none used- The nurse . Communication The client did not exhibit neologisms. VI.T.
“Kumusta man ang imong buntag?” “Okay ra man. . ug unsang orasa na?” “Karun kay Setyembre 12.Alas dose na” Asking direct question -none used- The nurse asked a question by interaction. 2007.T. Alas 10:50 sa buntag” “Nakalimot ko. to assess the client’s memory and orientation “Unsa man tang adlawa kaun A.63 pa ka sa akong pangan?” student nurse’s name plate question asks a question by interaction.Gikan unta ko sa gawas pero nisud ko kay nay gaaway” Asking open ended question -none used- The nurse provided information to orient the client to reality. to “Okay” Giving information -none used- assess the client’s memory and orientation.
ang imo ganahan asked her buhaton karun?” mother to put oil on her back.64 “Nisud ka kay nahadlok ka sa gaaway?” Client nods Restating -none used- The nurse asked an open ended question to start a conversation. “Sakit ba ang imong likod kaun?” “Oo” Client closes her eyes. “Ganahan jud diay ka na ang Client’s mother answered for Asking direct question -none used- Nurse asked w the client is . “Panuhot” Seeking information -none used- The nurse asked an open ended question to continue conversation. “Nya unsa man “Wala” Client Asking direct open endedquestion -none used- The nurse restated the client’s statement for clarification.
Kagwapa nimo uy…ganahan jud ko nimo” Seeking information Negative attitude: Circumstantiality Client gave much unnecessary detail stating a point or to divert Student nurse’s attention from the unwanted topic. .. Lahi sa iyang mga igsoon” Client closes her eyes.65 imong mama maghilot nimo. feeling. sah?” her: “Sukad pa atong bata neh siya day ganahan na jud neh siya hiluton nako. “Kinsa man ang gabantay sa imong mga igsoon karun?” Client stares at a distant object. preventing formulation of assumption.
with no impairments in mobility. VII. . “Naa ra ko dire. O. Evaluation Client was cooperative.She watches television instead.” Giving information Student nurse and client agreed reading the next meeting time and place.66 Avoidance “Murag galibog ko sa imong tubag sa akong pangutana.Naa ra ka dire gihapon?” Client looks at the student nurse. sige. Seeking clarification The student nurse asked a question to clarify the client’s reply. alert and oriented.Unsa man ang imong pasabot?” -none used“Ganahan na ka mopahuway AT? Mubalik lang ko ugma ha sa pareho gihapong oras. She did not seem to want to talk about her family. answers questions but seemed distracted. Client does not look at the SN. She was awake. as evidenced by the circumstantiality she exhibited at the last part of the conversation.
and 5.67 Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Date: 09/17/07 Ward No. Setting a. state the present date. Specific Objectives: After 30-45 min.respond to the student nurse’s questions appropriately 4. maintain eye contact for at least 3 seconds. XII Physician: Dr. recognize the student nurse 2. of student nurse-client interaction. 3 I. 2007 . Date: September 13. agree with the student nurse regarding the date. time and place of the current interaction 3. Yazar Process Recording No. time and place of the next interaction II. the client will be able to: 1.
She has already brushed her teeth and attended to her personal needs. curt statement. She answered the student nurse’s questions. . and she was clean from her bath. Place: Vicente Sotto Memorial Health Center Psychiatric Ward. Shea was walking towards her mother. Her hair was neatly combed.She exhibited looseness of association as evidenced by inappropriate answers to student nurse’s questions. Time: 10:30 am to 11:00 am c. IV. after she was done eating her burger and fries. Every time the student nurse tries to sit beside her and start a conversation.. she tries to excuse herself and walks toward her mother. Client was wearing a brown halter top and pyjama pants. She became cooperative after a few minutes. Communication The client spoke in short. Behavior The client was uncommunicative at first. She participated in the student nurse’s drawing therapy. V. She did not exhibit any violent behavior. Appearance The client was seen walking away from the area of the culminating activity carrying with her a cellophane with food.bench in the common room III.She had no echolalias nor palilalias.68 b.
Interaction .69 VI.
and Asking direct question . Kahibaw kung unsa ang adlaw.T.Alas diyes kwarentay 10 minutes later…same setting Client nods Acknowledgement -none used- confidence and reorient her to reality. to assess the client’s memory and orientation To boost the client’s “Sakto na alas diyes ta karun. ug kung aha ta karun?” “Alas diyes. Naa ko sa gawas kay gaculminating.” Asking direct question -none useda question by interaction.petsa. The nurse asks “AT.” Client’s verbal/ non-verbal communication Communication technique used Client’s Defense Mechanism Analysis 70 Client nods Giving recognition -none used- The nurse calls the client by name to boost the client’s selfesteem and shows that the client is recognized as an individual.Student nurse’s verbal/ non-verbal communication “Maayong buntag A.
Her train of thought was coherent and intelligible. in her case. Name of Client: April Mechelle Tecson Age: 20 years old Date: 09/17/07 . Student nurse was able to get through the barrier of communication (e.71 VII. the client’s significant other . Evaluation The student nurse-client interaction was more productive this time because client was more cooperative and less avoidant compared with the previous conversations. Client was able to interact well with the individualized art therapy. because student nurse has difficulty communicating with the client whenever the significant other is around because client expects the significant other to answer for her).g.
state the present date. participate in the news therapy. Place: Vicente Sotto Memorial Health Center Psychiatric Ward. Date: September 14. 2007 b. Setting a.72 Diagnosis: Substance-induced psychosis Sex: Female Ward No. agree with the student nurse regarding the date. and 5. of student nurse-client interaction. time and place of the next interaction II.1 content of client’s auditory hallucinations 4. 4 I. Time: 10:30 am to 11:00 am c. XII Physician: Dr. respond to the student nurse’s questions appropriately as to 3. Yazar Process Recording No. recognize the student nurse 2. time and place of the current interaction 3.bench in the common room . the client will be able to: 1. Specific Objectives: After 30-45 min.
She exhibited signs of nervousness as evidenced by her frequent glancing at the stairs and at the physician’s clinic door. wearing a clean brown shirt with a clean maong pants. Apart form. date and time disorientation. Communication The client answered the student nurse’s questions regarding the content of her auditory hallucination. She has already taken a bath according to her significant other and has already done her activities of daily living like brushing her teeth. Yazar. Appearance The client was seen sitting at a bench in the OPD with her mother. Behavior The client was much more cooperative compared with the previous interactions. Interaction Student nurse’s verbal/ non-verbal communication Client’s verbal/ Communication non-verbal communication technique used Client’s Defense Mechanism Analysis .She was scheduled for a n interview with Dr. V. IV. Howver. Client was well-groomed. her hair wasn’t properly kempt. client was coherent all throughout the interaction and was able to answer appropriately. as if she just arouse from bed. VI.73 III.
Asking direct question -denialclient’s orientation to reality and current emotional status. Murag lipay lageh ka karun.T. Asking direct question -none used- Assessed the client’s .74 “Maayong buntag A. Assess the “Nakulbaan ka para sa interview?” Looks at the student nurse. “Okay ra man ko. “makasulti ka kung unsa tan a Looks at the stairs.Wa ra ko nakulbaan” Looks at the stairs and then the office door. Gaunsa man ka dinhi?” Client smiles “Interviewhon ko ni doctor para makauli na ko” Giving recognition -none used- The nurse calls the client by name to boost the client’s self-esteem and shows that the client is recognized as an individual.
Yazar” Client nods “Sakto. oras ug kung asa ta karun AT?” “Dominggo man ta karun.mao na siya. “Biyernes ta karun AT. Sakto” Giving information -none used- Giving information to orient the client to reality. “O. Yazar?” Client nods "O. Padung ko maginterview” orientation to reality. VII. Naa ta karun sa OPD para sa imong interview kang Dr.75 adlaw.” Asking direct question -none usedAssessed the client’s orientation to reality. Mao ban a siya si Dr. Evaluation . Setyembre 14. 2007.Alas diyes sa buntag. naa na imong Doctor AT.Excuse sa ha. Alas diyes. .
the client will be able to: 1. Student nurse was able to get through the barrier of communication. Specific Objectives: After 30-45 min. XII Physician: Dr. 5 I. Client was cooperative and less avoidant. state the present date. which in this case.recall the past experience with the student nurse for the past week 4.76 The student nurse-client interaction was brief but productive. Yazar Process Recording No. time and place of the current interaction 3. recognize the student nurse 2. of student nurse-client interaction. improve social interaction by joining the culminating activity . Name of Client: April Mechelle Tecson Diagnosis: Substance-induced psychosis Age: 20 years old Sex: Female Date: 09/17/07 Ward No. was her mother because the client does not usually talk to the student nurse whenever her mother isn’t by her side.
In fact. Client was wearing a white shirt and pyjamas. Setting Date: September 17.bench in the common room III. she was the one who initiated the conversation when the student nurse arrived at the common room. She was much more talkative during this interaction compared with the previous ones. Appearance The client was seen sitting on a bench in the common room with her mother. However.77 5. her hair wasn’t properly kempt probably due to her frequent scratching of her head. terminate the therapeutic student nurse-client interaction II.She was talking to her mother about her food and at the same time she was getting ready fo the morning stretch. 2007 Time: 8:30 am to 9:00 am Place: Vicente Sotto Memorial Health Center Psychiatric Ward. Behavior The client was cooperative but exhibited irritability at some points of the interaction. She got irritated when she was asked the second time regarding the current date and place. She had already taken a bath according to her mother. IV. .
Interaction Student nurse’s verbal/ non-verbal communicatio n Client smiles at student nurse. “Hi ate” Student nurse smile at AT.T. She easily gets distracted with ativities around her as evidenced by her frequent standing up and glancing outside while the conversation between the student nurse and client was going on. “Hi A.78 V. making it difficult for the student nurse to understand her statement.” Giving recognition The nurse calls the client by name to -none usedClient’s verbal/ non-verbal communication Communicatio n technique used Client’s Defense Mechanism Analysis . Communication The client was much more talkative this time and was observed to have exhibited flight of ideas. She often does not state her ideas coherently. VI.
. to assess the client’s orientation to About 15 minutes later… reality. Muapil ko ug exercise.” Asking direct question -none used- Assesed if client is aware of what is going on around her.Excuse sa ha. “Kumusta man ang morning stretch?” Client smiles and wipes sweat off her forehead. “Kumusta man ka karun?” “Okay ra. “Hangak ug kapoy uy.79 boost the client’s selfesteem and shows that the client is recognized as an individual.” Asking direct question -none used- The nurse asks a question by interaction.Mubalik lang ko inig human na.
”Lunes ta. gusto ka muapil AT?” “Di lang. petssa ug adlaw karun?” Client smiles “Alas nuwebe na daw ta. . mutanaw ra ko” Asking direct question -none usedThe nurse provided information to orient the client to reality and give the client a choice as a sign of respecting her dignity. makaingon ka kung unsa tan a oras . diba?” “O sakto ka na alas nuwebe ta karun. Pero Client’s face turned serious and her smile Giving information -none usedThe nurse provided information Asking direct question -none usedAssessed if client is oriented to time and date.AT. “Ah sige.80 “Naa pay music therapy taodtaod. Muag lunes ta karun.
“Setyembre 17. Maminaws na ta ha!” “O sige maminaw na ta” to orient the client to reality. none -none usednone After about 5 minutes .” ko magsuwatsuwat. tagaan tika. 2007.Suwatsuwat lang. After about 5 minutes “Ate naa kay suwaton? Pwede ako musuwat? Ganahan man gud “Wala pero naa koy papel ug crayon dire.” mother.81 kahibaw ka unsa na na petsa?” faded.
Mag focus sa ta karun sa ato topic bahin pagsuwat suwat” Client nods. mao neh akong buhaton sa bay” Client is busy writing “Sakto neh siya ate? Pailisdan nako akong Tshirt unya ha” “Unya na na huna hunaa AT.Mahilig diay ka magsuwat?” “O.sakto”. “Sakto. Refocusing -none usedThe student nurse reoriented the client to the present topic of conversation and shifted her attention to what is After about 5 minutes Giving recognition Negative communication Giving recognition boosts the client’s selfesteem. “AT naka dumdum pa ka -none used- .82 “Nindot ug agi nimo AT. : Flight of ideas presently discussed.
sa pareho gihapong lugar.83 sa akong gitudlo nimo ato niaging adlaw? Kato bahin sa mga buhaton nimo kung naa kay problema?” “O kanang mag suwat o magdrawing? Mas ganahan ko mag suwat Te kaysa sa magdrawing” Asking direct question This was to assess if the client was able to retain knowledge regarding coping mechanisms taught by the student nurse.Timan-an nako tanan” Giving information -None usedT o make the client aware of the upcoming activity and inable her to act . Timan-I tong akong gipangtudlo Client nods. “Ugma diay AT kay magsturya gihapon ta ha. “O sige te. Giving recognition -none usedThis boosts the client’s self confidence. “Maayo kay nakadumdum pa ka” Client nods and smiles.
84 nimo ha” appropriately . Lahi na Client smiles pud ang student nurse na makig amiga nimo. “Bye te” Giving information And expressing appreciation -none usedGiving information facilitates improve trust and expressing appreciation shows that client is . Hinaot unta na nakatabang ra ko nimo. Apil ta ug culmination karong Friday ha?” Client looks at the student nurse. Salamat sa tanan AT” Student nurse smiles at the back. "Dina ka mubalik te?” Giving information -none usedT o make the client aware of the upcoming activity and inable her to act appropriately “Di na mi mubalik sunod semana. “Last day na diay na mo ug ma AT.
because student nurse has difficulty communicating with the client whenever the significant other is around because client expects the significant other to answer for her). the client’s significant other . in her case.85 client. VII. . Client was able to interact well and was able to assess whether the client has learned something from the previous interactions. Evaluation The student nurse-client interaction was productive because client was more cooperative. being recognized as a person.g. Student nurse was able to get through the barrier of communication ( e. Client has improved a great deal since the first interaction as evidenced by more productive and fruitful conversations as time went by.
Evaluation and Implication of this Case Study to: Nursing Practice . An expensive rehabilitation center would further pull down the family’s already unstable financial status. the best recommendation in this case would be to follow Dr. April’s being a young adult at the time she was admitted is working to her advantage because it is during this time that a significant other or care giver can guide and support her with her chosen lifestyle.86 V. one of which is still going to school. Up to this point. it is much harder to convince her to change her lifestyle because she may have already chosen one for herself. Somehow. VI. Later than this stage. Yazar’s advice to transfer April to a drug rehabilitation center wher3e needs and therapies specific for her condition can be provided. Evaluation and Recommendation Many studies of short term out-patient treatment over a six-month to two-year period indicate that people addicted to cocaine have a better chance of recovering than people who are addicted to heroin. Given her economic status. One that will not cost the family too much since April has three siblings. an appropriate rehabilitation center should be chosen .
addictive or not. signs and symptoms of substance abuseinduced psychosis but the larger part of the condition lies largely unexplained. professions in the medical field are more prone to being a drug dependent due to the easy access to medications. The nurse should know how to recognize the signs and symptoms of drug dependence if ever they see one not only to promote the integrity of their profession but also for the benefit of their clients. Nursing Research The human mind is a subtle and mysterious part of the human body. Knowledge is important in order to effectively intervene in the management of signs and symptoms in collaboration with reorientation and pharmacotherapy. it is vital that with the increasing number of stressors in the environment and an easy access to drugs. it is important to learn and understand this condition in order to impart adequate and understandable information to them. Nursing Education Since most of the client’s significant others are directly affected with the effects and social repercussions of the condition.87 In the nursing practice. cannot be adequately fathomed by the human intellect. This nursing research aims to give us a peek of what it is like in April’s world not . Researchers may so much as theorize as to the factors. It differs from person to person and affects the society in varied ways.
Elaine. Bibliography Davis. Processes and Practice. et al. 2004 Marieb. California: 20th edition Kozier. Barbara. Philippines: Pearson Education South Asia Inc.. 2004 . Essentials of Human Anatomy and Physiology.A. F.. Philippines: Pearson Education South Asia Inc.88 only for a more holistic care but also to help prevent another innocent life wasted by illegal drugs. Fundamentals of Nursing: Concepts. Taber’s Cyclopedic Medical Dictionary. VII.
Philippines: Lippincott Williams and Wilkins. 2002 . Concepts of Psychiatric-Mental Health Nursing. Shiela. Philippines: Lippincott Williams ans Wilkins.89 Shives. Rebeccca. 2002 Videbeck. Psychiatric Mental Health Nursing.