Patient’s Profile

 Demographic Profile
a. Age: 38 years old
b. Sex: Female
c. City Address: Mandaluyong City
d. Educational attainment: College Undergraduate (A.B. Nursing) 
e. Occupation: Unemployed
f. Civil status: Single
 Chief Complaint (According to relatives)
a. History of being confined at veteran’s hospital twice 
b. Anger problems
c. Inability to sleep for 3 days
d. Restlessness 
 Admitting Diagnosis/Case: Bipolar Affective Disorder
 Working Diagnosis: Bipolar Affective Disorder

History
 Present Illness: Diagnosed with Bipolar Affective Disorder
 Past Illness: Seizures, Hypertension, Cardiac Problems, and Diabetes Mellitus 
 Family Illness (3 generations)

The patient disclosed that there were no known mental illnesses from the
relatives. 
  Sociocultural History
a. History of smoking
b. History of drinking

 Reason for admission: Her family had noticed the major difference in her attitude which
led to her confinement in the facility. 

Assessment
 General Survey
o Behavior
 The patient answers the questions being asked to him. However, he
abruptly ends the topic when he does not want to share further
information. He also seems to be argumentative at times. 
o Odor
 The student nurses were not able to observe this criterion as the
interaction was done online. 
o Gait
 She appears to be able to walk independently with no observed difficulty. 
o Hygiene
 The patient appears clean and well-groomed. 
o Level of distress/discomfort
 The patient has a strong desire to leave the facility and live her own life.
However, this only slightly affects her from living her daily life inside the
nursing home and is able to function well.  
 Physical Assessment
o Head-to-toe Assessment
 Integument
o Skin: The skin is uniform in color and unblemished. No ulceration
was present. 
 o Hair: The hair is shoulder length, thick, wavy, and evenly
distributed.
 Head
o Head: The head is rounded and symmetrical. 
o Face: The face appeared smooth and has uniform consistency
and with no presence of nodules or masses.
 Eyes and Vision
o Eyebrows: Hair is evenly distributed. The client’s eyebrows
appeared symmetrical and showed equal movement when asked
to raise or lower eyebrows.
o Eyes: The pupils appeared black, equal and round. The patient
had no need for visual aids.
 Ears and Hearing
o Ears: The ears are appeared symmetrical.
 Nose and Sinus
o Nose: The nose is symmetrical and uniform in color with no
presence of discharge or flaring.
o Mouth: The lips are pink with brown edges; moist, symmetric, and
seemed to have a smooth texture.
 Extremities
o The extremities are symmetrical in size and length.
o Remarkable findings - The patient has no remarkable findings. Moreover, further
assessments were not performed since the interaction was done online.  

 Gordon’s Functional Health Patterns

o Health Perception - Health Management Pattern
 Client reports using drugs and alcohol in the past and verbalized
“Nasubukan ko yan lahat. Yung mga iba’t ibang klase ng drugs tulad ng
ecstasy, shabu, at heroine lahat yan nasubukan ko. Madalas din ako
uminom dati at manigarilyo. Pero matagal ko narin naman yan itinigil”.
The client verbalized that he feels he is not healthy due to his age as he
said “kapag nag-zuzumba kasi mabilis na ako hingalin matanda na din
ako pero dahil din yun siguro kasi hindi ako gaano nag-eexercise kaya
 mabilis na ako mapagod.” The client is also not compliant on his
medications as he verbalize being sleepy and prefers taking his
medications at home. 
o Nutritional-Metabolic Pattern
 Client reports not having any food restrictions and eats all the food served
in the synergy but he also stated that he is not eating pig’s blood. 
o Elimination Pattern
 Client reports waking up in the middle of the night to eliminate urine. 
o Activity Exercise Pattern
 Client ambulates within the facility but does not have any exercise routine
saying “Yan ang pinaka ayokong activity”
o Sleep-Rest Pattern
 Client has a good sleep but wakes up in the middle of the night to urinate
and stated that “Pag umiinom ako ng gamot ng 7PM, 8PM tulog na ako.
Ang gising ko na kapag breakfast na mga 5:30 or 6"
o Cognitive Perceptual Pattern
 Client’s speech is clear without stuttering. Examines ideas clearly and
concisely. Responds to stimuli verbally and physically. During the
interview, he was able to recall past events without difficulty, orientated to
time, place, and person.
o Self-Perception and Self-Concept Pattern
 Client has poor perception about himself and verbalized “Parang nagiging
cycle lang. Pag naging ayos ako dito, lalabas na ako tapos pag
nagkaroon ng problema babalik ulit ako.”
o Role-Relationship Pattern
 The client is well supported by his family as they often send him food and
clothes. 
o Sexuality-Reproductive
 Client shared his dream of having multiple partners and verbalized “Sa
susunod yung gusto ko na is 5 Russian models.”
o Coping Stress Tolerance Pattern
  Client verbalized meditating and talking as  method of coping “Nag-
memeditate ako tapos minsan naghahanap ako ng matinong
makakausap”
o Value-Belief Pattern
 Client does not have any religion or beliefs as he verbalized “Wala akong
specific na religion parang yung pinagsama sama lang. Binasa ko yung
books ni Anthony Robbins. Try niyong isearch. Awaken the Giant Within
and Unlimited Power. Yung mga learnings ko dun, yun yung ginagamit
ko. You can say na more on knowledge.”

Course in the Ward

 Time table

Pathophysiology
 Etiology, Predisposing, Precipitating Factors
  Process
 Signs and Symptoms
 Nursing Diagnosis

Nursing Management
 Five Prioritized Nursing Diagnosis
 Nursing Care Plan

Medical and Surgical Management

 Drug Study
 Therapeutic Medical Procedures
 Surgical Management
 Diet Therapy
1. Eat more vegetables and fruits

Rationale: Fruits are best source of vitamins and fiber which helps lower bad cholesterol and
aids in digestion. Fiber-rich diets may lower your chance of some health problems that often are
associated with schizophrenia, like heart disease, diabetes, and obesity. vitamins, too.

     2. Improve blood sugar balance

Rationale: Eat a diet that will stabilise your blood sugar (known as a Low GL diet). This means
avoiding sugar and refined carbohydrates, eating at regular intervals, including protein with
every meal and snack. Avoid strong stimulants such as coffee, tea and energy drinks and drink
mild stimulants such as green tea only occasionally. Keep alcohol to a minimum, for example,
one unit per day, three to four times per week.

3. Up your intake of essential omega-3 and -6 fats

Rationale: This means eating fish at least twice a week, seeds on most days and
supplementing omega-3 oils. Omega-3 supplementation is more effective in reducing psychotic
symptom severity in young adults or adolescents in the prodromal phase of schizophrenia who
have low omega-3 baseline.

4. Balance your blood sugar and avoid stimulants

Rationale: Sugar intake, refined carbohydrates, caffeine, alcohol and cigarettes, as well as
stimulant drugs, all affect the ability to keep one’s blood sugar level balanced. Common
antipsychotic medication may also further disturb blood sugar control. Stimulant drugs, from
amphetamines to cocaine, can induce schizophrenia. The incidence of blood sugar problems and
diabetes is also much higher in those with schizophrenia. Therefore it is strongly advisable to
reduce, as much as possible, your intake of sugar, refined carbohydrates, caffeine and stimulant
drugs and eat a low glycemic load diet.

Discharge Planning
 Diagnosis: The patient was discharged against the medical advice of the psychiatrist. 
 Medications
 Environment
 Decrease environmental stimuli. Modify environment to minimize objects that can be
used as weapon. 
 Treatment
o Drug Therapy
 Schizophrenia is mainly treated by antipsychotics (neuroleptic) drugs.
These prevent relapse of acute symptoms.
o Other treatments
 Include compliance promotion programs, psychosocial treatment and
rehabilitation, vocational counseling, supportive psychotherapy, and
appropriate use of community resources.
 Health Education
o Establish trust and rapport. 
 Do not touch the client without telling him first what you are going to do.
Use an accepting, consistent approach; short, repeated contacts are best
until trust has been established. Language should be clear and
unambiguous. Maintain a sense of hope for possible improvement, and
convey this to the patient.
o Maximize level of functioning. 
  Avoid promoting dependence by doing only what the patient can’t do for
himself. Reward positive behavior and work with him to increase his
personal sense of responsibility in improving functioning.
o Promote social skills. 
 Provide support in assisting him to learn social skills.
o Ensure safety.
 Maintain a safe environment with minimal stimulation.
o Ensure adequate nutrition. 
 Monitor patient’s nutritional status and if the patient thinks his food is
poisoned, let him fix his own food if possible or offer him foods in closed
containers that he can open. Institute suicide and/or homicide precautions
as appropriate.
o Keep it real. 
 Engage patient in reality-oriented activities that involve human contact
(e.g., workshops, inpatient social skills training). Clarify private language,
autistic inventions, or neologisms.
o Deal with hallucinations by presenting reality. 
 Explore the content of hallucinations. Avoid arguing about the
hallucinations. Tell them you do not see, hear, smell, or feel it but explain
that you know that these hallucinations are real to him.
o Promote compliance and monitor drug therapy. 
 Administer prescribed drugs and encourage the patient to comply. Ensure
that patient is really taking the drug. Observe for manifestations that
warrant hypersensitivity reactions and toxicity.
o Encourage family involvement. 
 Involve family in patient treatment and teach members to recognize
impending relapse (e.g. nervousness, insomnia, decreased ability to
concentrate). Suggest ways how families can manage symptoms.
 OPD follow-up
o
 Diet
1. Reduce the intake of sugar 
 The incidence of blood sugar problems and diabetes is also much higher in those with
schizophrenia. Therefore it is strongly advisable to reduce, as much as possible, your
intake of sugar, refined carbohydrates, caffeine and stimulant drugs and eat a low
glycemic load diet.
2. Eat more fruits and vegetables
Fiber-rich diets may lower the chance of some health problems that often are associated
with schizophrenia, like heart disease, diabetes, and obesity. 
3. Increase essential fats
The breaking down, or stripping of essential fats from brain, membranes, is done by an
enzyme called phospholipase A2 (PLA2). This is often overactive in people with
schizophrenia, and this leads to a greater need for these fats, which are quickly lost from
the brain. at fish at least twice a week, seeds on most days and supplementing omega 3
fish oils.
4. Drink enough to keep your body well hydrated
Drink at least 1.5-2 liters of water daily. 

5. Try to get into the habit of having three regular meals each day
Breakfast is important as having a satisfying breakfast of high fibre cereal will leave you
feeling full until lunchtime and will deter you from snacking during the morning.

Spiritual: