A Case Study On

“UNDIFFERENTIATED SCHIZOPHRENIA”
In Partial Fulfillment of the Requirements in NCM- RLE (Psychiatric Exposure)

Submitted to: Ms. Marie Lyn Al Bayouk, RN Ms. Evelyn Alba, RN Ms. Maria Elsie Callueng, RN, MAN Ms. Mary Jane Guiang, RN Ms. Maria Delma Mausisa, RN, MAN Ms. Cecilia Grace Acuña, RN Clinical Instructors

Submitted by:
ANQUE, Joanna Grace Ruby BACARON, Loumelyn Rose BAUTISTA, Ericka BUTT, Kanval CLAVANO, Rock DALHOG, Aaron GARLIT, Irish GONZAGA, Kimberly Anne MAGSIPOC, Rubnie Jhum OBANDO, Sherilyn PUERTO, Angelee REPITO, Desiree ROSALIN, Jeffrey SANTOS, Amifaith SENARILLOS, Mary Rose SUCALDITO, April May Anne UNTALAN, Benjamin Alejandro

BSN – 4B Male Ward Group

Date Submitted: October 22, 2010

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TABLE OF CONTENTS

Table of Contents……………………………………………………………

I. Introduction A. B.
Overview……………………………………………………………… Objective B.1 General Objective……………………………………………… B.2 Specific Objectives……………………………………………………. II. Anamnesis………………………………………………………………………… A. Informants……………………………………………………………………. B. Maternal and Paternal Lineage………………………………………………….. C. Parents……………………………………………………………………………. D. Siblings……………………………………………………………………… III. Personal History……………………………………………………………………. IV. Course in the Hospital……………………………………………………………..

A.

Mental Status Examination……………………………………………….

V. Progress Notes………………………………………………………………. VI. Psychopathophysiology…………………………………………………….. VII. Psychodynamics………………………………………………… A. Tabular Presentation of the Predisposing Factors and Rationale…………………

B.

Schematic Diagram………………………………………………………….

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VIII. Differential Diagnosis……………………………………………………………. IX. Multi-Axial Diagnosis DSM-IV TR…………………………………………….. X. Summary………………………………………………………………………….. XI. Nursing Care Plan………………………………………………………………... XII. Medical Managements………………………………………………………… A. Doctor’s

Order…………………………………………………………………..

B.
.

Psychopharmacotherapy…………………………………………………….

XIII. Prognosis and Recommendation……………………………………………… XIV. Discharge Planning…………………………………………………………… XV. Bibliography…………………………………………………………………… Appendices

A.
B.

Spot Map……………………………………………………… Genogram……………………………………………………

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INTRODUCTION

OVERVIEW
How human brain works is the most complex toil in the human body. A serious damage in it can change lives. A change can be on a person’s thoughts, perceptions, behaviors, movements and emotions. These changes can possibly harm a person’s family or worst the community he lives in. Schizophrenia is not a terribly common disease but it can be a serious and chronic one. The appearance of its manifestations differs among patients and the duration of the disorder. The disorder usually begins before the age of 25 and continues throughout life time. Both patients and their families often suffer from poor care and social barring. Early Greek physicians described delusions of grandeur, paranoia, and deterioration in cognitive functions and personality. It was not until the 19th century, however that schizophrenia emerged as a medical condition worthy of study and treatment. Emil Kraepelin (1856 -1926) and Eugene Bleuler (1857 -1939) are the two major figures in psychiatry and neurology who studied schizophrenia. Kraepelin first named the disorder as dementia precox, a term that emphasized the change in cognition and

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was diagnosed with undifferentiated schizophrenia.543 out of 86. 697. Patient X.697 of Filipinos or approximately 0. undifferentiated.8% are suffering from schizophrenia . Symptoms of schizophrenia appear earlier in males. Dr. More than 1/2 of all male schizophrenic patients and 1/3 of all female patients are first admitted to psychiatric hospitals before 25. Padilla said that the Davao Mental Hospital receives an average of eight to 10 patients a day suffering from schizophrenia. Male and female equally affected.early onset of the disorder. 5 . It is considered to be one of the top ten causes of long-term disability worldwide.5 million people will be diagnosed with schizophrenia this year around the world. About 1.A study in 1988-1989 in a barrio in San Jose Del Monte Bulacan. Here in Davao. It was Bleuler who coined the term schizophrenia. According to study done. ). admitted in the Crisis Intervention Unit (CIU) of the Davao Mental Hospital. and residual. Worldwide about 1 percent of the population is diagnosed with schizophrenia. DSM – IV – TR (Diagnostic and Statistical Manual on Mental Disorders 4th Text Revised) classifies the subtypes of schizophrenia as paranoid. a study conducted in three primary health centers situated in an urban slum in Manila. The said disorder is hoped to be discussed thoroughly in this study. In the Philippines. About 90% of schizophrenic patients seek treatment between 18-55 years old. depression and bi-polar illnesses. showed that 17% of adults and 16% of children had mental disorders. which replaced dementia precox in the literature.241. catatonic. based predominantly on clinical presentation. showed the prevalence of adult schizophrenia to be 12 cases per 1000 persons.

8. 6. SPECIFIC OBJECTIVE: 1. Render health teaching to the patient. family. 5. Establish a trusting and therapeutic relationship with Patient X and his family. Trace the psychopathophysiology of the condition. 4.OBJECTIVE GENERAL OBJECTIVE: This study aims to discuss the causes and factors that will contribute to the onset of the condition of the patient. 2. Identify precipitating and predisposing factors that are possibly involved in the development of the presented disorder. Determine the family history related to the condition of the patient that is relevant to the study. 6 . 7. To learn drug actions. 3. Gather pertinent data from the patient. and other informants regarding patient’s condition. family and community. Formulate Nursing Care Plan suited to the patient’s condition. and side effects of medication given to the patient.

The interviewers gathered significant information which is helpful in knowing the present condition of the patient. The information comprised the familial history and the patient’s life. 2010. 2010. neighbors. undifferentiated and was admitted at Davao Mental Hospital last September 29. The group gathered ten informants including his relatives.P Laurel Avenue. The patient was diagnosed to have Schizophrenia. 2010 and discharged from CIU last October 4. 7 . This case study focused on a certain patient living at Panabo City. friends. and family members. Davao City last September 28 to October 15.SCOPE AND LIMITATION This study was accomplished during the Psychiatric Nursing exposure at the Davao Mental Hospital located at the J.

Phase I. Cagangohan. 1987 Civil Status: Single Nationality: Filipino Religion: Roman Catholic Ordinal Position: 5th Child 8 . Laurel Avenue. Bajada. Davao City Patient’s Name: Patient X Ward/Room/Bed Service:Crisis Intervention Unit Address: Guava St. Panabo City Age: 22 Gender: Male Birth date: January 9.PATIENT’S PROFILE Name of Hospital: Davao Mental Hospital Address: J. Brgy.P.

Sayon Type of Admission: New Principal Diagnosis: Schizophrenia. 2010 Time of Admission: 10:00 am Date Discharged: October 4. of Days Admitted: 5 days Admitting Physician: Dr. A Occupation: Fruit Vendor Date of Admission: September 29. (Deceased) Occupation: Citizenship Advancement Training Mother’s Name: Mrs. undifferentiated 9 . A Sr. 2010 No.Educational Attainment: 3rd Year High School Father’s Name: Mr.

They lived at Panabo province (please refer to the spot map) for 11 years. When he was nineteen years old he became drug dependent. The 10 . At 21 years old. his uncle brought him in Baringot Agusan to work. Patient A starts working as “konductor” at the age of 16 at Tres Marias. A Age: 55 years old Relationship: Mother VISAYAN VERSION: According to the informant her son was born in Minda Carmen. He keeps on saying to his mother that there are lots of cigarettes.ANAMNESIS INFORMANTS INFORMANT #1 Name: Mrs. 2010 his father died. Last May 27. At the age of 18 he was brought to Dela Rosa Rehabilitation Center. the burial last for fifteen days. They found out that he was using marijuana and prohibited drug like shabu. At that time he cannot fell to sleep and he kept on hugging his father’s coffin. He only reached 3rd year high school because he joined gang and was terminated at school. He was taking 100mg of Seroquel as maintenance rather 200mg.

Patient A started walking at 8 months old. The informant has spotting of blood while she’s pregnant with Patient A. His favorite subject was mathematics. CHARACTERICTICS AND ATTITUDES OF THE INFORMANT Mrs. When Patient A was still at the elementary level he really wanted to study. She responded accordingly to the interviewer’s questions. He also received a grade of 76 in English. She always went in their house and Patient A loves her child.informant has 7 children and all of them were delivered via normal spontaneous vaginal delivery. The informant went to the doctor for checkup and the result was normal. The informant also has cough during the pregnancy. A is very cooperative in interactive and very accommodating. He started schooling at the age of five. Patient A loves his siblings so much and he has close relationship to his father. He had a lot of girlfriends before but few are in serious relationship. Patient A was breastfed during his infancy. Patient A has complete immunization and prenatal check up according to his mother. according to the informant. She shared information about his son’s life. He stays at home before he was admitted in this hospital. He goes to church once or twice a month. He had a lot of friends both male and female. He started speaking at the age of 13 months. One of the girls that he loved went to Dubai and it gave him the reason to breakup. The woman was widower and has a child. According to the informant. She was well groomed and her speech was spontaneous. The informant was smoking during her third pregnancy. They don’t usually cuddle Patient A. 11 . They left him at school during school hours because he already knows how to go home. But when he reached high school level he didn’t want to study anymore.

fruit vending was the source of our income. He became a “konduktor” while he lived with his friend.” as verbalized by the informant. He plays basketball when he was a kid. he smoked but stopped when he was 45 years old.Informant #2 Name: Mr. his relationship to his co-workers was good. He worked at miners as a chef for 2 weeks. He has hypertension. We didn’t know that he was using cannabis and methamphetamine. naa pud si tatay ginatumar na tambal” as told by the informant. He had a girlfriend but I don’t know her name. My father is a social drinker. second to the eldest “Sometimes he became angry right after he left home. JB Age: 34 years old Relationship: brother. After a few months when my father died he took drugs again. 12 . Now my mother supports us financially. pagkapila ka adlaw na ing-ana naman sya (pagkatopak). After my father’s death. “stroke man to iyang dahilan pagkamatay. he even plays with other children. The informant said “Pag-uli nya sa balay hilomon naman siya. He had a friend and co-worker named Ton-ton. Sometimes my mother experiences shortness of breath. “pormal man siya na pagkatao” according to the informant. Right after he went home he talked often. He also becomes wild in our aunt’s house.

13 . He responded accordingly to the interviewer’s questions. Naga-videoke. Buotan. Informant #3 Name: Mr. He was well groomed and his speech was spontaneous.Characteristics and Attitudes of the Informant: Upon interviewing the informant we have observed that he was answering in all questions according to his cognitive knowledge although he was in a hurry because he had work to do. musogot suguon. KS Age: 18 years old Relationship: Close friend VISAYAN VERSION: Ok mana sya kaistorya ug kalit lang muistorya ug lahi “lahi ang tubag”. Dili siya ( Anthony) hilig magsugal aga-tan-aw lang na siya. sige dula ug basketball. dali istoryahon. Usahay lang naga-inom ug sigarilyo. daghan amigo.

papalita ko ug redhorse isa ka case kay mag-inom mi sa akong barkada. Bago na siya na-admit gidakop na siya kay nag-wild ug gi-kulata pud siya sa pulis.Iraq. Human wala nako ganahi mamasahero kay gihold-up nako niya. May sinsilyo ka 25 sa Milyon na gold?” ka yang gibayaran ko niya 25 sentavos. Pagkapatay sa iyang papa kay na-depressed siya. Nag-istorya siya sa tindahan Tindera: “ Dong asa man ka gikan? Anthony: “ Nag-adto ko Baghdad. INFORMANT #4 Name: Mr. known him for years 14 . CHARACTERICTICS AND ATTITUDES OF THE INFORMANT Upon interview we can observed that he is speaking fluently and it is based upon his knowledge. Wala siya pili na barkada kung baga “lovable”. Naa tong panahon na nagtan-aw mi ug basketball human gi-ayo niya ang sound system. Kadtong naa siya gitulis gi-ingnan niya iyang barkada na ihatag n amino ang imong kwarta sa akoa kay itumba ko na imong motor.Naay sya barkada sa prutasan kauban niya sa paghit-hit. He had a lot of stories to tell because he was a close friend to Anthony. Kadtong naay vigil sa amo gi-ingnan nya ang mga bisita na mulingkod sa ka manigarilyo ug mangape. RD Age: 39 years old Relationship: Friend. Nag-ingon siya sa usa ka tindera “Te.

Kadtong ulahing tukar niya kay nanghasi siya sa pulis. Nagakondoktor siya ug jeep human nikalit lang na torereng kay napasmohan. Palapansin sa iyang mga amigo pero sa kalaban masuko. Kadtong buhi pa iyang papa close sila. Ang iyang mama kay nahadlok sa iyang batasan human nidagan sa pikas balay. Kung mulakaw murag robot. CHARACTERICTICS AND ATTITUDES OF THE INFORMANT 15 . Nahibal-an na turiring kay ni-ingon na hayag inyong suga pero walay andar ang suga. when he walked he seems like a robot. His mother fear him because of his behavior he ran off to the other house. last occurrence of his untamed behavior he robbed a police man. Didto sya nagpuyo pila ka simana.VISAYAN VERSION: Dugay name nagkaila. When his father was still alive they were so bonded.he used to be jolly in his friends but easily gets angry with his enemy. He used to be conductor in a jeepney then suddenly something is ringing in his ear “natorereng” due to some eating pattern disturbance. there was one instance that his brother jailed him because he robbed one of his friends. his mother stayed there for a couple of time. ENGLISH VERSION: I’ve known him for a long time. ang iyang mga igsoon gikulong siya kay giholdap niya iyang barkada. we only knew that he is not in the right condition of his mind when he thought that our light is bright there is no light switch on.

Maayo man siya na amigo pero pagmabikil siya kay suko jud siya. ENGLISH VERSION: Anthony and I became friend in this area. PC Age: 58 years old Relationship: Friend. Ang iyang mga amigo parepareha lang ug edad nga puro mga lalaki. Dili man siya dalo na pagkatao. He used to be generous.As we have our interview with him. There was one time that he became wild at at one event of his friend. Dili kayo nako kaila iyang mama. his father was a foreman he has children this include Anthny they were behave children. mayo na siya na bata pinangga kayo na siya. naa toy usa na nabantayan nako siya na naghit-hit. a birthday celebration in a 16 . Ang iyang papa kay foreman human naa siya mga buotan na anak. apil na didto si Anthony. Mukalit-kalit lang baya siya. INFORMANT #5 Name: Mr. we sense that he willingly shared all his knowledge with our patient because he knew him so well. Naa toy usa na pagkataon na nag-wild siya sa birthday sa anak sa sarhento nya amigo pajud nya. known him for 13 years VISAYAN VERSION: Nagkasuod mi ani diri na sa lugar.

informant said “But-an. CHARACTERICTICS AND ATTITUDES OF THE INFORMANT Our informant known him for more than 10 years. In terms of cigarette smoking. He was loved by many. He was a good companion and a friend but a fearful one to his enemy. Informant observed that the patient had friends of the same age and same sex. I don’t really knew his mom.” When asked about his most memorable violent incident with the patient. When informant was asked about the patient’s father. He has the same peers almost all of it is boys. Informant observed that the patient is his parents’ favorite child. pero pag mabikil… kusgan jud ng bata na na. he said he died because of hypertension and that he was very strict. Informant #6 Name: Mr. He suddenly gets irritated. P Relation: Neighbor/ Friend of patient’s father Known patient since 1997. There was one time that I saw him using drugs.sergeant’s house. he speaks fluently and confidently. When asked about the patient. he said that the mother was always not home because she had to go to the market to sell fruits. He goes to church. The last incident that happened between the informant and 17 . Patient used to bring food to his family after work. but not with the whole family. When asked about the patient’s mother.” Informant attested that patient used cannabis in his home. informant said “kalit kalit magbunal bato sa video karera. patient used to smoke 1 pack of cigarettes per day.

” Patient brings food to family.the patient was when the patient went to his home. G Address: Relationship: Aunt Length of time known to patient: 23 years Apparent Understanding of Present Illness to the Patient: 18 . When asked what she can say about the patient. Informant #7 Name: Mrs. she said “Maayo man siya. Informant also shared another incident with the patient. unable to recognize him as a close family friend. He also has lots of friends. Informant # 8 Name: Mrs. M Relation: Neighbor Known patient since 1995. When asked about his most memorable violent incident with the patient. He once brought a lot of orchids from his mother’s garden to his neighbors houses without his mother’s permission. pero pag mabikil magalit. informant said that the patient once threw a stone that broke their window.

G is willing to share information regarding her nephew’s condition. Murag na pasmuhan man gud na siya unya katong nag konduktor na siya nakasaksi na siya nga nay gibaril sa iyang atubangan mao tong na shock siya didto na nagsugod iya sakit unya namatay iyahang papa nisamut iyahang sakit. bright gane na siya naundang lang na siya ug eskwela mao to nag konduktor na siya jeep pa davao. “ ay sa barkada-barkada mana siya basig na impluwensiyahan na siya mag take ug bawal na gamut. bugoy man gud na iya mga barkada. Pero dili ko sure ana 19 . Sa side pud sa mama ni Anthony naa siya pagumangkon nga naa sakit sa utok. G verbalized. E Address: Relationship: Neighbor Length of time known to patient: 2 years Apparent Understanding of Present Illness to the Patient: Mrs. pero step sister lang man to sa mama ni Anthony basin dili pud to konektado sa Iyahang sakit. Informant # 9 Name: Mrs. napasmuhan pud to siya sa bukid man to nahitabu kay nag-uma man to siya didto.Mrs. she response accordingly to our question. E verbalized.” Characteristics and Attitude of the Informant: Mrs. “ buotan mana na bata si Anthony.

Mahadluk lang mi sa iyaha kay lain man gud na siya mutan-aw mao na naga pan lock me sa gate namu. ” Characteristics and Attitude of the Informant: As we interview Mrs. Informant # 10 Name: Mrs. F is hesitant to give information due to the fear that the patient will be agitated and harm their family.kay bag-o lng pud baya me dire unya mahadluk jud ko ana niya kay mututok man na siya sa balay. she was very sociable and readily answers our question regarding the patient’s condition.last week lang gani to sya nag-wild. 20 .” Characteristics and Attitude of the Informant: Mrs. E. F Address: Relationship: neighbor Length of time known to patient: 1 year Apparent Understanding of Present Illness to the Patient: Mrs. F verbalized. “ ang pagkabalu nako bag-o lang na siya na kagawas ug mental pero wala jud ko kabalo sa iyahang sakit.

In the family. The late Mr. She had a good relationship with her husband but 21 . He is an employee at a private company for 6 years then he became a commandant for the high school subject CAT (Citizenship Advancement Training) at Panabo National High School. the patient was his favorite. A also grew up in Panabo City. Mr. A Seniors activities includes singing in a videoke machine and occassional drinking session of alcoholic beverage with his colleagues. In terms of religious practices. he seldom attends mass. Among his children.MATERNAL AND PATERNAL LINEAGE PARENTS Father Mr. A believed that discipline is a key to have a harmonious relationship among each family member. In terms of discipline. She was described by the informants to be a good and kindhearted person. She was a fruit vendor at the public market. Mother Mrs. A Senior grew up in Panabo City. He wass a good provider to his family and was generally described as a good person. an informant told the interviewers that he witnessed the mother spanking her kids whenever they did something wrong. he was known to be a strict disciplinarian.

22 .was said that she was a very busy person that sometimes she lacks time to spend with her family.

SIBLINGS Joe. Fred. is the fourth in the family. 27 years old. He was described as a simple guy and a very thrifty person. Currently. Vidi. is the eldest in the family. He was already married for 7years with two daughters. 30years old. is the second in the family. He is single and is currently working as a waiter at a local restaurant nearby their residence. He was also married for 5 years with 2 kids. 36 years old. He was able to finish first year high school and stopped then after. Anthony is the fifth in the family. He was able to graduate in High School. he resides at Panabo City and is working at TADECO Company. He was described as a silent type of person before his sickness but his behavior drastically changed right after he was admitted. 23 . Jov. This was due to his extreme attachment to his friends and vices. He also graduated in High School. He was described as a silent and shy type of person. He is 23 years of age. He is still single and is currently working at the Panabo Port. He was also a shy type of person and only opens up to those who are very close to him. He was not able to finish schooling due to financial constraints. is the third in the family. He was described as a very sociable person in the entire family. He reached 3rd year High School and was not able to pursue his education due to his vices and recurrent admission to the psychiatric institution. He was the only one in the siblings who was able to reach first year college level. 29 years old.

He is a high school graduate. Currently. He is still single and helps in the family’s finances especially now that their father is gone. He is currently helping his mother in selling fruits and vegetables in the market. He was known to be a good person in their community.He became aggressive and anxious most of the time but he calms down when his mother starts to threat him that she will call the police officers. He is the sixth in the family and is working as a school janitor. he is still staying in their residence and is still under observation for possible recurrence of aggression that he exhibits a week prior to admission. He was also known to be a member of a gang who was said to be involved in some violent activities. 24 . Vani age 22 is a high school graduate. He was described by the neighbor informants to be “budotsbudots” (quirky clothing style) due to his fashion statement. Anthony starts working at 18 years old when he became a konduktor (helper) in the jeepney that travels from Panabo City to Davao City. Vens age 18 is the youngest in the family.

The two younger siblings were delivered at the hospital. As for Anthony. The patient was toilet trained at 3years old. At 4 years old an unexpected incident occurred wherein he fell down 3steps in the stairs and resulted to few bruises and lesions but there were no any neurologic deficit noted. She verbalized that she took paracetamol when she have headache or fever when she was pregnant. She doesn’t have any supplements and she rarely eats nutritious foods. At 8 months. PSYCHOSEXUAL HISTORY 25 . A has a poor prenatal check up. The first five children were delivered at home wherein a midwife facilitated the delivery. INFANCY AND CHILDHOOD Anthony was breastfed for 9months. 1987 and there were no complications noted upon delivery. he was able to take his first steps. BIRTH She delivered all her children via normal spontaneous vaginal delivery. She also lacks exercise. He was able to baby talk at 1year and 1month. he was born on January 9.PERSONAL HISTORY Mrs. His eruption of teeth occurred at around 4months.

He had his first girlfriend at age 15. He was circumcised at age 8. Grabeh jud nah siya makadula. In elementary years.Anthony verbalized that he was already oriented on his sex as a male since he was a child. His mother verbalized. He had 2 succeeding relationships thereafter. “Ay. He received an award at the end of the school year as a fifth with honors. PLAYLIFE The patient was given toys appropriate for his age.” SCHOOL HISTORY At 6years old. 26 . He verbalized that he had a serious relationship with a woman and he got her impregnated but the woman decided to abort the child and that made him devastated because he wanted a child. Daghan pud nah siya ug amigo. MARITAL HISTORY Patient is still single. Anthony was really eager to excel in school but when he reached high school he became too involved with his friends and was influenced with their bad habits that’s why he flanked his English subject.wala jud nay problema nang bata-a nah. he started schooling as a kindergarten student.

He was then placed by his mother and his siblings on restrain because he could no longer control his anger. Last May 2010. This prompted the family to seek consult at DMH (Davao Mental Hospital). 27 . He was rehabilitated three times at De La Rosa rehabilitation Center yet he still continued his vices after discharge. The work was very tedious and he skips meals often. He also became influenced to take illegal drugs and he became addicted to it.ONSET OF PRESENT ILLNESS Upon stopping school at age 16 he became a “konduktor” (helper) of the jeep. his father died which precipitated his aggression towards other people which includes his robbery case.

Panabo City CIU Visit September 30. Cagangohan. General Appearance: Fairly Groomed with Good eye contact. Activity ( )Normoactive ( ) Psychomotor Retardation (√) Restless 28 . Presentation A.COURSE IN THE HOPITAL MENTAL STATUS EXAMINATION Patient’s Name: Patient A Age: 23 years old Address: Niceville Subdivision. General Mobility: 1. akathesia noted B. 2010 I. Posture and Gait: (√) Appropriate ( ) Inappropriate Describe: Normal_____________________________________ 2.

Patient Interaction (√)Cooperative ( ) Initially Only E. Nurse. Behavior: Restless and anxious D. Facial Expression (√) Appropriate Quality: (√)Smiling (√)Happy ( ) Ecstatic ( ) Tearful (√) Worried ( ) Tensed ( ) Sad ( ) Distant ( ) Inappropriate ( ) Angry ( ) Suspicious ( ) Frightened C. Quality ( ) Warm (√)Talkative ( ) Distant ( ) Hostile ( ) Suspicious ( ) Others:_________ ( ) Uncooperative (√) Throughout interview 29 .( ) Agitated 3.

II. Organizational of Talk ( ) Relevant (√) Circumstantial ( ) Tangential (√) Spontaneous ( ) Deliberate ( ) Irrelevant ( ) Incoherent ( ) Looseness of Association (√) Flight of Ideas ( ) Others:___________________________________________________ III.Emotional State and Reactions A. Character of Talk B. Mood (√) Euthymic ( ) Depression ( ) Euphoria ( ) Others:_____________________________________________ 30 . STREAM OF TALK A.

Thought A. Homicidal Potential ( ) Present (√) Absent IV. Suicidal Potential ( ) Present (√) Absent E.B. Delusion Type: auditory 31 . Depersonalization and Derealization ( ) Present (√) Absent D. Affect: (√) Appropriate ( ) Inappropriate Quality: ( ) Flat ( ) Blunted ( ) Hostile ( ) Labile ( ) Elated C.

Activity (√) Normoactive ( ) Psychomotor Retardation ( ) Restless ( ) Agitated 3. Facial Expression (√) Appropriate Quality: (√)Smiling (√)Happy ( ) Ecstatic ( ) Tearful ( ) Worried ( ) Tensed ( ) Sad ( ) Distant ( ) Inappropriate ( ) Angry ( ) Suspicious ( ) Frightened 32 . Posture and Gait: (√) Appropriate Description: Normal_______ ( ) Inappropriate 2. hurried speech B. General Appearance: Clean clothing.Presentation A. General Mobility: 1. 2010 I. good eye contact.First Home Visit October 06.

Organizational of Talk (√) Relevant ( ) Circumstantial ( ) Tangential (√) Spontaneous ( ) Deliberate ( ) Irrelevant ( ) Incoherent ( ) Looseness of Association ( ) Flight of Ideas ( ) Others:___________________________________________________ III. STREAM OF TALK ( ) Distant ( ) Hostile ( )Suspicious ( )Others:_________ ( ) Uncooperative (√)Throughout interview A. Quality ( ) Warm (√)Talkative II.C. Mood (√) Euthymic ( ) Depression ( )Euphoria ( ) Others:_____________________________________________ 33 . Nurse. Behavior: Normal D.Patient Interaction (√)Cooperative ( ) Initially Only E. Character of Talk B.Emotional State and Reactions A.

B. Delusion Type: absent 34 .Thought A. Homicidal Potential ( ) Present (√)Absent IV. Suicidal Potential ( ) Present (√)Absent E. Depersonalization and Derealization ( ) Present (√)Absent D. Affect: (√) Appropriate ( ) Inappropriate Quality: ( ) Flat ( ) Blunted ( )Hostile ( )Labile ( )Elated C.

Presentation A. Facial Expression (√) Appropriate Quality: (√)Smiling (√)Happy ( ) Ecstatic ( ) Tearful ( ) Worried ( ) Tensed ( ) Sad ( ) Distant ( ) Inappropriate ( ) Angry ( ) Suspicious ( ) Frightened 35 . Activity (√) Normoactive ( ) Psychomotor Retardation ( ) Restless ( ) Agitated 3. General Mobility: 1.Second Home Visit October 06. 2010 I. hurried speech B. Posture and Gait: (√) Appropriate Description: Normal_______ ( ) Inappropriate 2. good eye contact. General Appearance: Clean clothing.

Mood (√) Euthymic ( ) Depression ( ) Euphoric ( ) Others:_____________________________________________ 36 .Patient Interaction (√)Cooperative ( ) Initially Only E. Nurse. STREAM OF TALK ( ) Distant ( ) Hostile ( ) Suspicious ( ) Others:_________ ( ) Uncooperative (√) Throughout interview A. Behavior: Normal D. Quality ( ) Warm (√)Talkative II.C. Organizational of Talk (√) Relevant ( ) Circumstantial ( ) Tangential (√) Spontaneous ( ) Deliberate ( ) Irrelevant ( ) Incoherent ( ) Looseness of Association ( ) Flight of Ideas ( ) Others:___________________________________________________ III.Emotional State and Reactions A. Character of Talk B.

B. Affect:

(√) Appropriate

( ) Inappropriate

Quality: ( ) Flat

( ) Blunted

( )Hostile

( )Labile

( )Elated

C. Depersonalization and Derealization

( ) Present

(√)Absent

D. Suicidal Potential

( ) Present

(√)Absent

E. Homicidal Potential

( ) Present

(√)Absent

IV- Thought A. Delusion Type: absent

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PROGRESS NOTES
Progress Notes
Admission Date: October 6, 2010  Oriented on time and place  poor sleep  poorly groomed  conversant with good eye contact  positive audiovisual hallucination  Analysis: Undifferentiated Schizophrenia Planning: For Discharge Brief History: September of 2005 patient was caught taking drugs and was admitted to Dela Rosa for rehabilitation, he lasted there for 1 month. On October of the same year he was admitted again, on the second day of his stay he tried to escape but was captured, he was rehabilitated for 6 months. on 2006 mid year the patient took drugs again, became violent and often goes amok. the patient was again admitted at Dela rossa for 7 months. 2007-2010 before the death of his father his mother claimed that he was normal. after the death of his father he took drugs again and was admitted at 38

Davao Mental Hospital after he stole money from his friend including previous violent behaviour in their community. Admitting Impression: Undifferentiated Schizophrenia Medication:  Fluphenazine  Trifluoperazine  Chlorpromazine  Perphenazine  Thioridazine

Procedure: CBC Recommendations: Continue Meds

39

PSYCHOPATHOPHYSIOLOGY

40

Peak incidence of onset is 15-25 years of age for men and 25-35 years of age for women. 297. Schizophrenia is usually diagnosed in late adolescence or early adulthood.PSYCHODYNAMICS TABULAR PRESENTATION OF THE PREDISPOSING FACTORS AND RATIONALE Predisposing factors Factors Sex Present The patient is male. 2nd edition) Genetics/Hereditary The patient’s first The genetic or 41 . (Videbeck p. Age The patient is 23 years old. Rationale Schizophrenia affects both male and female with equal frequency.

(Psychiatric Mental Health Nursing.263). hereditary predisposition theory suggests that the risk of inheriting Schizophrenia is 10% in those who have one immediate family member with the disease. 5th edition. Characteristics/Personality Stressed Depressed An interpersonal approach to the etiology of schizophrenia is based on the theory that there exist a pre-disposition of the personality under high level of stress.cousin from the mother side has a psychiatric problem brought by starvation. p. Precipitating Factors Factors Present Rationale 42 . By Shrives.

Keltner). The patient’s father died early this year. According Horrocks and Benirnoff. one of many other factors. His mother spends most of her time in the market where she works. The patient and his siblings are always left at home to tend to themselves. Lack of loving and nurturing caregivers. Teenagers tend to have vices due to peer pressure. Family The father and his brothers are occasional drinkers. Cannabis and shabu increases 43 . (psychiatric nursing 3rd edition. the peer group is the adolescence’s real world. is thought to be responsible for mental problems in later life. providing a stage upon to which to try himself and others.Peer Influence The patient started using marijuana and shabu when he worked as a bus conductor at the age of 16. The patient also uses cannabis and shabu. Vices The patient is a smoker and alcoholic drinker.

died early this year.dopamine levels in the brain. Before that. An increase in dopamine level in the brain is possibly linked to schizophrenia. the breadwinner. and economic reverses. Emotional Trouble The patient was depressed when he broke up with his girlfriend. He claims to have fallen over heels for her. deprivations. rejections. the patient Social causation hypothesis proposes that stresses experienced by members of low socioeconomic group contribute to the 44 . inferiorities. Loch. marital difficulties. drives may be expressed in an individual’s behavior reaction to everyday incidents such as disappointments. According to Manfreda and Krapmitz. Low Socio-Economic Status The patient now belongs to a low income family because his father. failure in one ambition.

but was still prompted to work as a bus conductor. development of Schizophrenia. 462) 45 .lived an easier life. (Synopsis of Psychiatry by Kapplan. p.

limiting time with the patient Bottle-fed with mother’s milk Patient Limited attention and care Limited feelings of security and belongingness Attachment to the mother not very well developed Task Achieved: Mistrust 46 . thus.SCHEMATIC DIAGRAM Trust vs. 0 to 18 months) Father Rarely have time with the patient due to work conflicts Mother Experienced vaginal spotting during pregnancy for 2 months bit was able to continue pregnancy until full term Optimal care was not given due to lack of attention because she still had 4 older children to take care of Needed to attend family business in the market. Mistrust (Infants.

Autonomy vs.able to go to the bathroom when has the urge to urinate or defecate • If unable to go the bathroom on time. Shame & Doubt (Toddlers. 18 months to 3 years) Mother Doesn’t personally supervised the patient’s activities Had 4 other children at home Allows her children to play with others Able to toilet train the patient Father Preoccupied with his work as an employee at TADECO (private company) Toilet Train • Age 3. mother punishes patient through spanking Patient • Loves to play logical games with different colors and shapes Task Achieved: Autonomy 47 .

4 to 6 years) Siblings Initiate play with younger brother Father Disciplinarian father Mother Had another baby boy Has limited time to her other children Patient Loves to play outside with friends Plays shatong. nanny) Task Achieved: Initiative 48 . tumba lata.g. etc.Initiative vs. Guilt (Preschool. Shy type but energetic as well as thoughtful child Inadequate maternal support and guidance But developed sense of initiative through the people surrounding him (e.

patient was his favorite Patient Age 9. 7 to 12 years) Mother Arrived home late and sometimes never slept in their house due to work conflicts Less time spent with her family Father Very strict and implements discipline within the family Among his children.started smoking Age 10. as verbalized by the patient Awarded “Athlete of the Year” Task Achieved: Industry 49 .Industry vs.started drinking alcoholic beverages Became a varsity player in running. Inferiority (Childhood. “1 km dash”.

Patient • Heavy drinker • Had a girlfriend for the first time but for a short period • Joined in different fraternities for comfort and security • Age17.Identity vs. Role Confusion (Adolescents. marijuana. etc. Task Achieved: Identity 50 .influenced to take prohibited drugs such as marijuana. shabu. 13 to 18 years) Mother Less supervision Preoccupied with her work Father Worked as a CAT Commandant at Panabo National High School Spent less time with the family Friends Influenced patient to join fraternities Most were males Interested in girls Influenced patient to take prohibited drugs such as shabu. etc.

hallucinations. delusions Task Achieved: Isolation 51 . Isolation (Young Adults. etc. 19 to 34 years) Mother Out of house to work Father Very strict when at home Seldom spends time with his family Siblings Not supportive with his lovelife Social drinkers Busy with their own relatioonship Miss Wa Last girlfriend of the patient Impregnated by the patient but aborted the child Broke up with the patient because of the involvement of a third party Patient Deeply in love with Miss Wa Wanted to have a baby Impregnated with Miss Wa but was disappointed for the child has been aborted Broke up with Miss Wa Depressed because of his father’s death Took prohibited drugs (shabu.)leads to being hostile. marijuana.Intimacy vs.

With such a blurred line between the real and the imaginary. thought disorders. delusions). et. Psychiatric Nursing (p. It is a diagnostic term used by mental health professional to describe a major psychotic disorder. and by deterioration in psychosocial functioning. It is characterized by disturbances in thought and sensory perception (hallucinations. mental or physical. and sees the world. Schizophrenia is a brain disorder that affects the way a person acts.DIAGNOSIS COMPLETE DEFINITION OF DIAGNOSIS Definition of the complete Diagnosis Schizophrenia Schizophrenia is one of the most common causes of psychosis. Simply. 351). or feel like they’re being constantly watched. thinks.3rd Edition (1999) Philippines: C&E Publishing Inc. schizophrenia is one of the most profoundly disabling illnesses. It is not characterized by a changing personality. speak in strange or confusing ways. often a significant loss of contact with reality. believe that others are trying to harm them. People with schizophrenia have an altered perception of reality. Source: Keltner. al. They may see or hear things that don’t exist. it is characterized by a deteriorating personality. 52 .

delusions. Phils. flat affect. 2000. disorganization. Source: Maria Loreto Evangelist-Sia. Quezon City. Persons experiencing an earlier onset of schizophrenia usually have more problems with movement from adolescence into adulthood and development of inappropriate social relationships and interactions. 1998). In response. Psychiatric Nursing: Biological and behavioural concepts (p. including hallucinations. and avolition (APA. Source: Deborah Antai-Otong. people with schizophrenia may withdraw from the outside world or act out in confusion and fear. RMSIA Publishing. NY: Thomson/ Delmar Learning (2003). (2004) 53 . Source: Maria Loreto Evangelist-Sia. 231).The course of the disease may be different for each person. 347). alogia. 1950). Bleuler. RMSIA Publishing. Phils. 231). depending on when the disorder manifests itself and if symptoms of the schizophrenia are compounded by a person’s use of alcohol or other substance (Brunette and Drake. Clifton Park.schizophrenia makes it difficult—even frightening—to negotiate the activities of daily life. disorganized speech. (2004) Schizophrenia is a disorder associated with a variety of a complex combination of symptoms. Psychiatric Nursing: A Textbook and A Reviewer (p. Australia. Quezon City. Undifferentiated This type is characterized by some symptoms seen in all of the other types but not enough of any one of them to define it a particular type of schizophrenia. Psychiatric Nursing: A Textbook and A Reviewer (p.

54 . The client may exhibit both positive and negative symptoms. hallucinations.c 2003. Australia. hallucinations. NY: Thomson/ Delmar Learning (2003). or disorganized schizophrenia. and incoherence may occur. Psychiatric Nursing: Biological and behavioural concepts (p. Source: Deborah Antai-Otong. delusions. Clifton Park. Odd behavior. Undifferentiated Schizophrenia usually is a characterized by atypical symptoms that do not meet the criteria for the subtypes of paranoid. 348). Prognosis is favorable if the onset of symptoms is acute or sudden. catatonic. and disorganized thought processes and behavior. Source: Psychiatric Nursing: biological & behavioural concepts (Deborah Antai-Drong)thomson/Delmar learning.Undifferentiated schizophrenia is manifested by pronounced delusions.

and violent behavior. Prognosis is more favorable for this subtype of schizophrenia than for the other subtypes of schizophrenia. Disorganized Type The client experiences a disintegration of personality and is withdrawn.DIFFERENTIAL DIAGNOSIS DSM IV TR identifies five subtypes of schizophrenia: paranoid. disorganized. rigidity. They also may exhibit behavioral changes such as anger. are the prominent feature of catatonic schizophrenia. undifferentiated. hostility. 2000). auditory hallucinations. Behavior is uninhabited. Patient exhibits grandiose delusion. anger. patient demonstates anxious movements of the hands and feet and was open to the student nurses during interview. Catatonic Type Psychomotor disturbances. Instead. Patient do not exhibit stupor. and residual (American Psychiatric Association. echolalia. Speech may be incoherent. Patient do not exhibit persecutory delusions. or violent behavior. rigidity. catatonic. excitement. Clients are at risk medically because of extreme withdrawal. and extreme withdrawal. or posturing. hostility. echopraxia. Prognosis is poor. 55 . such as stupor. Echolalia and echopraxia are also features of catatonic schizophrenia. Paranoid Type Clients exhibiting paranoid schizophrenia tend to experience persecutory or grandiose delusions and auditory hallucinations.

Patient do not exhibit social withdrawal and poor hygiene. Patient do not exhibit negative symptoms. Patient sometimes exhibit incoherent speech. 56 . Residual Type Residual schizophrenia is the subtype used to describe clients experiencing negative symptoms following at least one acute episode of schizophrenia.

[√ ] 57 .MULTI-AXIAL DIAGNOSIS DSM-IV TR CRITERIA FOR DIFFERENTIAL DIAGNOSIS Characteristic Symptoms: two or more of the following present for a significant portion of the time during a month period: 1. Delusions 2. Work. Hallucinations 3. Disorganized Speech 4. Social / Occupative Dysfunction: 1. or self – care is markedly below the Level [√ ] Achieved prior to onset. Negative Symptoms [√ ] [√ ] [√ ] [ X] [X ] A. Interpersonal Relations. Duration: Continuous signs of the disturbance persist for at least 6 months. Grossly Disorganized or Catatonic Behavior 5. 2.

Exclusion of substance abuse and general medical condition.55% 58 .3. Schizoaffective and mood disorder with Psychotic features have been ruled out. [ X] [ X] TOTAL: 5 / 9 X 100 = 55. 4.

33% NEGATIVE SYMPTOMS • Motor Retardation [ X] 59 .POSITIVE SYMPTOMS • • • • • • • • • • • • Anxiety Bizarre Behavior Delusions Hallucinations Agitation Aggressiveness Hostility Somatic Complaints Suspiciousness Cognitive Disorganization: Looseness Association and Tangentiality Speech Disturbances Inappropriate affect [ √] [ √] [ √] [ √] [ √] [ √] [ √] [ X] [ √] [ √] [ √] [ X] TOTAL: 10 / 12 X 100 = 83.

CATATONIC • • • • • Extreme Psychomotor Retardation and Posturing Catatonic Excitement Extreme Psychomotor Agitation Purposeless Movements which may harm self or others Negativism [ X] [ X] [ √] [ X] [ √] 60 .• • • • • • • • • Absence of Pleasure Intellectual Impairment Social Withdrawal and Isolation Depressed Mood Apathy and Disinterest Poor grooming and Self – Care Lack of Thoughts Lack of Goal Directed Behavior Blunted Affect [ X] [ X] [ X] [ X] [ X] [ X] [ X] [ X] [ X] TOTAL: 0 / 10 X 100 = 0% A.

PARANOID • • • Delusions Hostile Argumentative [ X] • • • Aggressive Hallucinations Suspicious [ X] [ √] [ √] 61 [ √] [ √] .• • • • • • • Waxy Flexibility Stupor Echolalia Echopraxia Delusions Extreme Withdrawal Selective Mutism [ X] [ X] [ X] [ X] [ √] [ X] [ X] TOTAL: 3 / 12 X 100 = 25% B.

DISORGANIZED • • • • • • • • Flat or inappropriate affect Bizarre Behavior Social impairment Flight of ideas Incoherent Speech Disintegration of personality Withdrawn Poor personal hygiene and grooming [ X] [ X] [ √] [ √] [ √] [ √] [ X] [ X] 62 .• • • • • Social Impairment Regression Behavior Anger Violent Behavior Threat to safety of self or others [ √] [ X] [ X] [ √] [ √] TOTAL: 7 / 11 X 100 = 63.63% C.

RESIDUAL • History of at least a previous episode of Schizoprenia with prominent psychotic symptoms • • • • • • Shy Easily Irritated Perceived as Peculiar Emotional blunting Illogical thinking Disorganized behavior [ √] [ X] [ √] [ X] [ X] [ √] [ √] 63 . UNDIFFERENTIATED • • • • Odd Behavior Delusions Hallucinations Incoherence [ √] [ √] [ √] [ √] TOTAL: 4 / 4 X 100 = 100% E.TOTAL: 4 / 8 X 100 = 50% D.

Anger. complains of being controlled by outside forces [ X] [ X] [ X] TOTAL: 0 / 3 X 100 = 0% II. MAJOR DEPRESSIVE DISORDER • • • • • • Sexual Disinterest Suicidal or Homicidal Ideations Affect. melancholy Self Destructive Behavior [ X] [ X] [ √] [ X] [ X] [ X] 64 . Sadness.• Absence of prominent delusions and hallucinations [ X] TOTAL: 4 / 8 X 100 = 50% I. Irritability Decrease in Personal hygiene Tearfulness. Retarded or Suicidal Expressed observed delusions of persecution. Crying. SCHIZOAFFECTIVE DISORDER • • • Has strong element of either Depression or Euphoria effect May be Depressed.

71% III. school or home Recurrent substance use in hazardous situations Recurrent substance related legal problems Continued substance use despite problems [ √] [ √] [ √] [ √] TOTAL: 4 / 4 X 100 = 100% 65 .SUBSTANCE ABUSE DISORDER • • • • Failure to fulfill major role obligations at work. Worthlessness.• • • • • • • • Difficulty Concentrating Loss of Energy or Restlessness Anhedonia ( Loss of Pleasure ) Gain or Loss of Weight Anger: Self Directed Psychomotor retardation or Agitation Insomnia or Hypersomnia Feeling of Hopelessness. Helplessness [ √] [ √] [ X] [ √] [ X] [ X] [ √] [ X] TOTAL: 5 / 14 X 100 = 35.

66 .

Paranoid 25% 63. Major Depressive Disorder 8. Catatonic B. Positive Symptoms 4. Residual 6. Characteristic Symptoms shows Delusions. DSM IV Criteria for Schizophrenia Subtypes A. Undifferentiated E. Negative Symptoms 5. Schizoaffective Disorder 7.63% 30% 83.71% 100% 67 . Substance Abuse Disorder 50% 100% 50% 0% 35. Hallucinations and Disorganized Speech 2.SUMMARY Percentage: 1.33% 0% C. Disorganized D. Social / Occupative Dysfunction 3.

Anthony showed signs and symptoms of Schizophrenia. Using the DSM IV criteria.71% and Substance Abuse Disorder is 100%. based on the results of the DSM IV criteria. he manifests Undifferentiated Schizophrenia with the percentage of 100% that was related to his diagnosis. the group concluded that Anthony suffers from Undifferentiated Schizophrenia like his diagnosis. Major Depressive Disorder is 35. Schizoaffective Disorder is 0%. During our interview with Anthony. On the other Disorders. Therefore.This DSM IV criterion has been used by the group during the first interview of Anthony. We are able to communicate and interact with him. 68 .

NURSING CARE PLAN 69 .

burns.0 ↓ = anemia. RBCs transport oxygen bound to hemoglobin. CHF.0 – 6. ↑ = primary and secondary polycythemia. ERYTHROCYTES (RBCs) 4. FUNCTION/S TEST RESULT UNIT REFERENCE 70 .40 10^12/L 4.MEDICAL MANAGEMENTS DOCTOR’S ORDER Nursing/Pharmacological Diagnostic Examination H E M A T O L O G Y Name: Patient X Date: 09-22-10 Age: 23 yrs old Room: CIU Sex: Male HEMOGLOBIN 150 g/dL Male: 140-170 Female: 120150 ↓ = anemia. acute and chronic haemorrhage. COPD. liver and kidney disease. CLINICAL SIGNIFICANCE Hemoglobin is responsible for binding oxygen in the lungs and in transporting the bound oxygen throughout the body where it is used in aerobic metabolic pathways.

0 – 10.95 (H) 10^9 /L 5. and primary bone marrow disorders. detoxification of toxic proteins that may result from allergic reactions and cellular injury. Segmenters eg. and renal disease. aplastic. age.45 . ↑ = leukocytosis – acute infection (degree depends on the severity of infection.77 (H) % 0.0 ↓ = leucopenia – viral infections. 71 .65 ↓ = neutropenia – in acute bacterial infection. and immune system cells. and viruses. fungi. erythropoietin-secreting tumors. irradiation. and renal disorders LEUKOCYTES (WBCs) 10. number increases rapidly during short-term or acute infections. resistance. and presence of trauma. ↑ = neutrophilia – in acute localized Neutrophils are active phagocytes. Neutrophils . and pernicious anemia. blood. Leukocytes function as phagocytes of bacteria. some parasitic.leukemia. tissue necrosis or inflammation and haemorrhage) Differential Count also transports small amount of carbon dioxide.0. and chronic infection ↑ = primary and secondary polycythemia. bone marrow depression due to drugs. viral infection. anaphylactic shock.

one group (B cells) produces antibodies.13 (L) % 0. fighting tumors and viruses. acute hemorrhage.09 % 0.0.35 ↓= lymphocytopenia / lymphopenia – gastrointestinal tract and in aplastic anemia. and hemolysis of RBC’s. and activating B lymphocytes.02 – 0. myelogenous leukemia and tissue necrosis Lymphocytes .20 . ↑ = lymphocytosis – occurs in certain chronic diseases and during convalescence from acute infection Lymphocytes are part of immune system. and severe or debilitating disease of any kind. other group (T cells) involved in graft rejection.06 ↓= monocytopenia Monocytes are active 72 . gout and uremia.and general bacterial infections. immune system dysfunction. Monocytes .

polycythemia or hemoconcentratio n. hairy cell leukemia and overwhelming infection ↑ = monocytosis in monocytic and other leukemia.60 ↓ = anemia or hemodilution.4 Male: 0. 73 . myoproliferative disorders. ↑ = dehydration.4-0.(H) – occurs in HIV.38 (L) Female: 0. and other lymphomas. number increases rapidly during short-term or acute infections. Hematocrit is a measure of the proportion of blood volume that is occupied by RBC’s.38 -0. recovering state of acute infections phagocytes. HEMATOCRIT .

photosensitivity and agranulocytosis. Adverse reactions/Side effects: Extrapyramidal reactions. Narrow angle glaucoma. Cross sensitivity with other phenothiazines may exist. antihypertensive: additive hypotension. hypotension. Prolixin Decanoate. Interactions: Pimozide: may have additive adverse caridiovascular effects. Modecate Concentrate Indication: Acute and Chronic Psychoses Action: Alter the effects of Dopamine in the CNS. tardive dyskinesia. Contraindicated in: Hypersensitivity.PSYCHOPHARMACOTHERAPY Pharmacologic Studies Generic Name: Fluphenazine Brand Name: Modecate. Bone marrow depression. Possess anticholenergic and alphaadrenergic blocking activity. Severe liver or cardiovascular disease and Hypersensitivity to sesame oil. 74 . tachycardia. blurred vision. sedation.

• Inform patient of possible extrapyramidal symptoms and tardive dyskenesia. Route/dosage IM/ subcut (adults): 12.wave and T. Do not mix with caffeine products (coffee. MAO inhibitors. take after 1 hr or skip dose and return to regular schedule if taking 1 dose/day. behaviour) before and periodically throughout therapy. mood. may be repeated q 1-4 wk. 75 . carbonated beverages or fruit juices.5-25mg initially. Monitor VS especially BP and RR including ECG.25-18. general anesthetics and opioids: additive CNS depression Phenobarbital: may increase metabolism and decrease effectiveness. antihistamines. IM/subcut (Children): 6. Nursing Consideration: Assess patient’s mental status (orientation. or pectinates (apple juice).75mg initially. may be repeated q 1-3 wk. tannics (tea). milk. cola). • Instruct patient to take medication exactly as directed and not to skip doses or double up on missed doses.wave changes in ECG. May cause q. If a dose is missed. dosage may not exceed 100mg/dose. epinephrine and norepinephrine: decrease vasopressor response Amphetamines: decrease pharmacologic effects. Dilute concentrate just before administration in 100cc-240cc of water.CNS depressants.

• Inform patient that this drug may turn urine pink or reddish brown. 76 .

77 . antihypertensive and nitrates: additive hypotension effect. CNS depression: additive CNS depression Lithium: decrease blood levels and effectiveness of phenothiazides. Thioridazine (Mellaril. also alter dopamine release and turnover. Emetil plus). Should not be used on patients with CNS depression. Megatil. trilafon). Peripheral effects include anticholinergic properties and anti adrenergic blockade. Contraindications: Hypersensitivity. Interactions: Alcohol. Actions: Block dopamine receptors in the brain. Antacids: may decrease absorption Phenobarbital: increase metabolism and decrease effectiveness. Perphenazine (Siquil. Thioril).Phenothiazides Generic Names with Trade names: trifluoperazine (etrafon. Novoridazine. Chlorpromazine (Emetil. Indications: Treatment of acute and chronic psychosesparticularly when accompanied by increased psychomotor activity. Severe liver impairment. Orap. Neurap). Levodopa: decrease therapeutic response. Antithyroid agents: increase risk of agranulocytosis.

contact dermatitis. photosensitivity. drowsinesss. confusion. tachycardia. hypotension or hypertension. • • Monitor for tardive dyskenesia. hypotension. headache. tiredness. aplastic anemia. extrapyramidal effects. severe muscle stiffness and loss of bladder control. constipation. • • Administer PO with a full glass of water or milk to decrease gastric irritation. convulsions.Adverse Reactions: agranulocytosis. orthostatic hypotension. apnea. pulse and respiratory rate before and frequently during dosage adjustments • • Observe patient carefully to ensure that drugs are taken and not hoarded. dystonic reaction. diaphoresis. Nursing Consideration: • • Assess patient’s mental status during and throughout therapy Monitor BP. akathisia. 78 . sinus tachycardia. Monitor patient for onset of akathesia. tardive dyskinesia. dystonia and parkinsonianeffects. diaphoresis. ejaculation dysfunction. Monitor for Neuroleptic Malignant Syndrome. respiratory depression. hypothermia. neuroleptic malignant syndrome. visual impairment. pseudoparkinsonism.fever respiratory distress. Dilute most concentrate in 120ml of distilled or acidified water or fruit juice just before administration. dizziness. blurred vision. pallor.

Caution patient to avoid drinking or other activities requiring alertness until response to medication is known. As of now patient has withdrawn from peers and has been avoiding cigarette smoking. PROGNOSIS AND RECOMMENDATION Criteria Onset of illness Duration of illness Poor   Fair Good Justification chronic The patient has been in and out in the rehabilitation center for the past 5 years. socioeconomic status.• Instruct patient to take medication exactly as directed Instruct patient to slowly change position to prevent orthostatic hypotension. • Medications may cause drowsiness. and emotional problem. but there Mood and affect  is a risk of relapses. family. The patient had shown sign of Precipitating factors  improvement but has relapses. The precipitating factors include peer influences. Patient has labile mood at first encounter but he gradually improves by the time of second visit wherein he already had appropriate emotional 79 . vices.

especially the elder brother expresses that they are willing to give their emotional and financial support but as of now the family is economically depressed.response.   Computation: Poor 4 x 1 = 4 Fair 2 x 2 = 4 Good 0 x 3 = 0 Total: 8/6 = 1. The patient verbalized that he is willing to take the medication. The family.33% The prognosis of the patient is poor having the score of 1. The family of the patient is willing to support the patient but they lack 80 .33 based on the computation and justification. The patients have bouts of depression when the topics of love discussed. now he is comfortable with the treatment regimen as evidenced by Any Depressive features improved sleep. This just related to the break up with the formal girlfriend and the recent Family support death of his father.

Exercise 81 . ® To address patient apprehension and prevent underlying factors. Also there is possibility of relapses because of non adherence of the treatment regimen. ® To avoid drug resistance • Encourage patient to verbalize concerns regarding the drug and inform the physician if side effects are occurring. • Inform the patient about the effect of the drug ® To know what to expect when symptoms occur and to have knowledge about the drug. • Instruct the patient. DISCHARGE PLANNING Medication • Instruct the patient to comply the treatment regimen ® To conform to pharmacological regimen and to attain full coarse of prescribed treatment • Encourage and instruct the family members to always seek medication advice and prescription. ® To prevent further complication and for further information.of financial resources. do not discontinue the drug and avoid over the counter drug.

Treatment • Instructed the patient to comply the treatment regimen ®to achieve the effectiveness and expected outcome • Encouraged the patient to participate diligently in the treatment modalities advised to him by the physician. ®to promote comfort and prevent fatigue • Encourage deep breathing exercise.• Encourage the client to do daily exercise ®to practice range of motion and to enhance musculoskeletal strength • Encourage adequate rest and sleeping periods. ®An environment free from pollution may facilitate fast recovery and prevent recurrence of the disease influenced by unhealthy environment. 82 . ® To hasten the improvement of her health status • Encouraged the patient to verbalize honest information to the physician and other health care provider. ® This prevents over distention of the bladder and compromised blood supply to the bladder wall • Maintained good environment free from pollution and stress provoking environment. ®to enhance breathing pattern • Instructed to void every 2 to 3 hours during the day and completely empty the bladder.

® To strengthen the support system of the client • Treatment should be taken in a timely manner ® To ensure proper timing of treatment regimen Hygiene • Encourage daily bathing and use clean clothing ®to promote proper hygiene and promote proper circulation • Instruct patient to take care of wounds and do proper wound dressing. ®to prevent infection and prevent the spread of microorganism • Instruct the patient to do oral hygiene and use soft bristle brush ®to avoid bleeding of the oral mucosa • Encourage the patient to do the proper hand washing at all times.® To aid accurate detection of a disease and early medical intervention • Tell the family that they should take part on the treatment of the patient. ®to deter the spread of microorganism • Instruct the patient to do proper grooming and always trim nails ®to prevent harbor of microorganism in a certain area Outpatient • Emphasize to patient the importance of follow up check-up ®to assess the effectiveness of therapy given 83 .

84 . ®to ensure proper intake of fluids • Inform the patient to avoid alcohol and cigarette smoking ®to prevent occurrence of symptoms and to prevent alteration in the effectiveness of the drug • Inform patient to avoid eating food which is high in tyramine such as cheese and process meat.• Reiterated health teaching regarding diet and hygiene ®to provide health information and awareness • Sighted any symptoms other than the usual that may indicate infection and report it immediately to the physician. ®to enhance balance diet and avoid malnutrition • Encourage to drink at least 6-8 glasses of water a day. if there is wound. ®to avoid alteration in the effectiveness of the drug. ® To reduce bacterial colonization Diet • Encourage patient to eat nutritious food at the right time and right amount. ® To note any unusualities and address it promptly before complications occur • Instructed significant others to change wound dressing daily.

APPENDICES SPOT MAP 85 .

GENOGRAM 86 .

Whitehouse Station.. Chapter 194 In The Merck Manual of Diagnosis and Therapy. NJ: Prentice Hall. and Carolyn L. 2004.. "Schizophrenia and Related Disorders. • Wilson." Social Psychiatry and Psychiatric Epidemiology 39 (May 2004): 350-357. NJ: Merck Research Laboratories. editors. 2004. • Frankenburg. MD. MD.com/med/topic2072. Haasen. Mark H. and Robert Berkow.emedicine. C. Margaret T.. and C. revised. and Tolerability. N. Whitehouse Station." Clinical Therapeutics 26 (May 2004): 649-666. NJ: Merck Research Laboratories.. 2004. Frances R.. D." Section 15. A. • Hutchinson. editors." Section 15. L. Upper Saddle River. "Aripiprazole: A Comprehensive Review of Its Pharmacology. • Beers.. Crismon. "Schizophrenia. 87 . G. Washington." eMedicine June 17. and Robert Berkow.C. Patel. 2000. Stang.htm. http://www. Mark H.. MD. "Psychiatric Emergencies. Nurse's Drug Guide 2003. MD.: American Psychiatric Association. • DeLeon. Shannon. Chapter 193 In The Merck Manual of Diagnosis and Therapy.BIBLIOGRAPHY • American Psychiatric Association. MD.. and M. 2003. • Beers. Billie Ann. 4th ed. "Migration and Schizophrenia: The Challenges for European Psychiatry and Implications for the Future. Diagnostic and Statistical Manual of Mental Disorders. Clinical Efficacy.

P. Arvanitis. or Haloperidol. 2004): 2063-2072. • Yolken. R. J. L. • Mueser. K. D. et al.. H. Supplement 2 (June 2004): 83A-88A. McGurk. Risperidone. Czobor. Y." Journal of Clinical Psychopharmacology 24 (April 2004): 225228. Nolan. • Volavka. "Schizophrenia.• Meltzer. et al." Lancet 363 (June 19." American Journal of Psychiatry 161 (June 2004): 975-984. and S. "Viruses and Schizophrenia: A Focus on Herpes Simplex Virus. K. Bauer." Herpes 11. R. "Placebo-Controlled Evaluation of Four Novel Compounds for the Treatment of Schizophrenia and Schizoaffective Disorder. Olanzapine... "Overt Aggression and Psychotic Symptoms in Patients with Schizophrenia Treated with Clozapine. 88 . T.

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