I.

Introduction

Schizophrenia is a chronic brain disorder that affects less than one percent of the
U.S. population. When schizophrenia is active, symptoms can include delusions,
hallucinations, disorganized speech, trouble with thinking and lack of motivation
(American Psychiatric Association, 2021). According to the latest report from Johnson &
Johnson's Philippine Health Information System on mental health conditions (PHIS-MH)
with data gathered from 10 government hospitals and four private hospitals,
schizophrenia is the top brain disorder in the Philippines, affecting at least 42 percent of
patients who seek psychological consult (Coronel, 2018).
Schizophrenia is a chronic mental disorder that usually starts between the ages of
16 to 30. Its symptoms make it one of the more severe and debilitating disorders: they are
classified as positive (psychotic behaviors not generally seen in healthy people, e.g.
hallucinations, delusions, bodily agitation), negative (disruptions to normal emotions and
behaviors, e.g. reduced facial expressions, emotions, speaking), and cognitive (problems
with memory, attention and executive function) (CNN, 2018).
Paranoid schizophrenia is characterized by predominantly positive symptoms of
schizophrenia, including delusions and hallucinations. These debilitating symptoms blur
the line between what is real and what isn't, making it difficult for the person to lead a
typical life (Cagliostro, 2020).

Objectives:
a. General objective

This case study aims to determine the students’ familiarization towards Schizophrenia,
Paranoid Type. To apply theories into practice and to help the patient about her mental health
through the application of Nursing Skills. We would have to identify nursing problems and
the corresponding nursing considerations and managements involved for promotion and
maintenance of the patient's mental health.
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 b. Specific objectives

Knowledge:

 Be familiar in the necessary assessments for the patient with Schizophrenia, Paranoid
Type.
 Be able to acquire the necessary knowledge with regards to the Patient’s medication and
understand the importance of complying with it.
 To recall topics that were discuss related to Schizophrenia, Paranoid Type
 Efficiently present the drugs including their own mechanisms of action, indications,
contraindications, adverse reactions, side effects, nursing responsibilities, and its
importance to the client’s condition;
 Efficiently provide appropriate and proper nursing diagnosis in line with the client’s
medical condition and skillfully formulate nursing care plan for the problem identified.

Skills:

 Render the necessary nursing care in the hospital needs for the client.
 Administer properly the medications for the client.
 Apply skills learned from school to hospital settings.

Attitude:

 Build confidence in case when handling similar case in the future.

 Observe and understand the behavior of the client.
 Show respect to the morals and beliefs of the patients and the employees in the hospital;
 Observe politeness and courteousness during the clinical exposure;
 Integrate the LaSallian core values and LaSallian 5C’s in the clinical duty.

2
Definition of Terms

1. Delusion. It is a false belief that is based on an incorrect

interpretation of reality. Delusions, like all psychotic symptoms,
can occur as part of many different psychiatric disorders (Harvard
Health, 2019).

2. Electroconvulsive therapy (ECT). According to American

Phychiatric Association, it is a medical treatment most commonly
used in patients with severe major depression or bipolar disorder
that has not responded to other treatments. ECT involves a brief
electrical stimulation of the brain while the patient is under
anesthesia. It is typically administered by a team of trained medical
professionals that includes a psychiatrist, an anesthesiologist, and a
nurse or physician assistant.

3. Hallucinations. These are sensory experiences that appear real but

are created by your mind. They can affect all five of your senses.
For example, you might hear a voice that no one else in the room
can hear or see an image that isn’t real (healthline.com).

4. Paranoid Schizophrenia. According to the Diagnostic and

Statistical Manual of Mental Disorders-5, or DSM-5, a person
suffering from the disorder is typically dominated by relatively
stable, often paranoid, fixed beliefs that are either false, over-
imaginative or unrealistic, and usually accompanied by
experiences of seemingly real perception of something not actually
present. Further signs are marked particularly by auditory and
perceptional disturbances, a lack of motivation for life, and mild
clinical depression.

5. Psychotherapy. It is a general term that is used to describe the

process of treating psychological disorders and mental distress

3
 through the use of verbal and psychological techniques. During
this process, a trained psychotherapist helps the client tackle
specific or general problems such as a particular mental illness or a
source of life stress (mayoclinic.org).

6. Schizophrenia. It is a serious mental disorder in which people

interpret reality abnormally. Schizophrenia may result in some
combination of hallucinations, delusions, and extremely disordered
thinking and behavior that impairs daily functioning, and can be
disabling (psychiatry.org).

III. Biographical data

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 Name : L.V.D.
Address : Panit an, Capiz
Age : 24 years old
Date of Birth : November 25, 1997
Birthplace : Roxas City
Gender : Female
Marital Status: Single
Religion : Roman Catholic
Educational Level: College Graduate
Occupation : Unemployed
Mother’s name: Deceased
Father’s name: P.D
Nationality :Filipino
Date of admission : December 13, 2008
Attending Physician : Dr. S
Chief complaints : Blank stares, inability to sleep, delusions, (+) auditory hallucinations,
disoriented
Admitting Diagnosis : Schizophrenia, Paranoid Type

Sources: Primary : Patient

Secondary : Aunt and Chart, Father, Sister In Law
NURSING HEALTH HISTORY
A. REASONS FOR SEEKING CARE/CHIEF COMPLAINT/S:
On December 13, 2008, L.V.D.’s mother took her to the Clinic. She manifestedB. H
blank stares, inability to sleep, delusions (+) auditory hallucinations, and dizziness are the I
most common symptoms. L.V.D. reported that a man named Bimbo injected her with S
heroin and raped her while she was sleeping. She had the impression that things were not T
as they appeared. O
RY OF PRESENT ILLNESS

5
 The patient visited the clinic on July 25, 2019 for a follow-up checkup. The following
vital signs were observed: BP 90/60 mm/Hg, Weight 38.4 kg. The patient was in a good
mood, had chewing motions, a good night sleep, and a decent appetite. L.V.D. was highly
conversant and had strong eye contact throughout the chat. She was instructed to continue
using her Clozapine 25 mg and Akineton 2mg/tab once daily meds and to return for
additional treatment and monitoring on February 23, 2018.

PAST HEALTH HISTORY

The patient arrived from Manila on December 4, 2008, with blank stares, an inability to
sleep, and the illusion that she was being observed by her elder brother "Gintakdan ako
monitor." She overheard others talking about her and calling her "BUANG." She said that a
man named "BIMBO" injected her with heroin and raped her while she was sleeping.
She had sexual relations with her ex-boyfriend, despite the fact that she said she was no
longer with him. After arriving at Roxas City through RoRo, the patient felt disoriented. She
felt, thought, and appeared differently.
She was working as a waiter at a Japanese restaurant and earning extra tips since
everyone liked her. She was then promoted to travel to Japan, but she did not get the position,
which caused her to become agitated and difficult.
Her Aunt arrived on August 27, 2009 since the patient had become ill again since August
24, 2009 and had refused to come in for a checkup.
The patient arrived with her aunt on September 6, 2010. For one week, she reported no
medication compliance, auditory hallucinations, suspiciousness, destructiveness, chaotic
thinking, and concern with "BAD SPIRITS," as well as sleeplessness. She has been working
in Boracay, Aklan since February 2010 and has been talking to herself, gazing blankly, and
becoming socially isolated due to her hallucinations.

The patient arrived on July 27, 2013, with her elder brother and two female relatives. She
was hospitalized at WESTERN VISAYAS MEDICAL CENTER (WVMC) a year ago for
one month and purportedly improved after release but did not comply with oral meds.

6
 The patient was purportedly allowed to work as a tourist guide and hotel employee at
Boracay Mansion for a year. She exhibited aggressive and destructive conduct. Her injectable
medicine was started on August 14, 2013.
NOTE: older brother who was also psychotic always argues with Patient’s father causing
anxiety for the patient.
Patient had destroyed and vandalized the house of a teacher in their community.
On August 14, 2013, the patient presented with her aunt, complaining of periodic
dizziness and sleeplessness; she denied anger and assaultive conduct but tested positive for
auditory hallucinations.
The patient arrived on August 28, 2013, accompanied by her sister-in-law. She had
uncommon, brief auditory hallucinations and became anxious when she heard loud sounds.
She wanted to take oral meds so she could work, but her family is concerned about her
adherence to the prescription.
The patient developed akathisia ("marching") on January 6, 2014. Fluphenazine was
injected into her right deltoid arm. She demonstrated a decline in marching action on March
10, 2014.
From March to November 2016, she displayed the same symptom as experiencing some
auditory hallucinations, although she was functioning at home.
On February 24, 2017, the patient experienced uncontrollable jaw movement. She was
observed leaping around in the rain and marveling at the sun in May 2017.
On October 20, 2017, the patient stated, "May nabatian man ko japun Doc," referring to
her lack of akidin compliance for one month, which was accompanied by an increase in jaw
movement.

FAMILY GENOGRAM

PERSONAL HISTORY

PRE MORBID HISTORY

ANATOMY & PHYSIOLOGY

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 People with schizophrenia suffer from
hallucinations and delusions, among
other things. Hallucinations involve
hearing or seeing things that aren’t
real, such as hearing voices in your
head. Delusions are false beliefs that
don’t go away, even with evidence that
they aren’t true. No one knows the
cause of schizophrenia, but scientists
have found some information on the
symptoms of schizophrenia by studying the brains of schizophrenic patients.

Prefrontal Cortex- the very front top of the brain covering the front part of the frontal lobe. It
helps people think logically and organize their thoughts. It is implicated in a variety of complex
behaviors, including planning, and greatly contributes to personality development.

Basal Ganglia- located deep inside the brain, and it involves movement and thinking skills. The
function includes control of voluntary motor movements, cognition, and emotion.

Visual and Auditory Cortices- areas of the brain process vision and sound information from the
eyes and the ears. Visual Cortices is highly specialized for processing information about static
and moving objects and is excellent in pattern recognition. Auditory Cortices’ function is for
performing basic higher functions in hearing, such as possible relations to language switching.

Amygdala- part of the brain that is responsible for basic feelings, like fear, lust and hunger. A
neutral network that mediates many aspects of emotion and memory. 

PSYCHOPHYSIOLOGY

PHYSICAL ASSESSMENT

CLINICAL REPORT

ASSESSMENT DATA

8
Problem List
 Blank stares
  Difficulty of sleeping 
 Delusions
 Auditory hallucinations
 Disoriented
 Assaultive and destructive behavior
 Increase involuntary jaw movements

NURSING IMPRESSION

 Ineffective coping mechanism

 Disturb sensory
 Risk for self and other directed violence related to delusional thinking and hallucinatory
experiences.

HEALTH TEACHING/ DISCHARGE PLANNING

Medication  Exercise Treatment Hygiene Return to Diet Spiritual 

clinic 
Encourage Enough Encourage the Since Instruct the Instruct Encourag
the patient rest is patient to there is an patient folks the e the
to continue important actively alteration to monitor the patient’s patient to
taking to the participate in of in the condition of folks to continue
medication patient the treatment mental the patient.  prepare going to
s to avoid however; process.  functionin foods church
recurrence physical g of the Noncomplian that are and never
of activities Instruct the patient, ce to referrals, healthy forget to
psychotic such as patient to reminding therapies and for the pray
features.  walking, actively attend her the medications patient.  every
jogging to follow-up importanc prescribed day.
All the and other consultation e of of may trigger Teach Spiritual

9
medication light and referral by hygiene the recurrence the nursing
s and exercises his primary could be of acute patient actions
treatment are highly health care beneficial. psychotic eat help
prescribed encourage provider. features, if nutritiou clients
by the d. Teach her this will s and meet their
primary Follow the the basics manifest to healthy spiritual
health care Active and referral made of proper the patient, foods or needs
provider regular by his health hygiene bring her to to have include:
must be exercise care provider such as the a
-
strictly promotes that may taking a psychiatric balance
Providing
adhered proper and include to bath every facility. d diet. 
presence
and should good cognitive- day, tooth
not be circulation behavioral brushing, Immediately -
discontinue all therapy, group hand bring her to Supportin
d to unless throughout therapy, etc.  washing the facility if g
ordered. the body and he will religious
including Emphasize personal impose practices
Inform the the brain that grooming.  danger not
-Assisting
patient of thus, compliance to   just to herself,
client’s
the side promotes pharmacologic but also to the
guardians
effects of optimum al treatment public safety.
with
the level of may promote
prayer
medication functionin optimum level
s g. of health.
prescribed
to her.
Advice her
to report to
primary
physician
any

10
adverse
reaction
and
undesired
effects of
the
medication
s.
 

NCP
Assessment  Diagnosi Rational Planning  Intervention  Rationale  Evaluati
s  e  on
Subjective Risk for At risk Short Independent: Independent:  Short
data: self-/othe for term:   Observe  May term: 
“gintakdan r behavior After 3 and listen indicate Goal was
ako directed in which days of for early possibility partially
monitor” as violence an nursing cues of of loss of met,
verbalized related to individua intervent distress or control after 3
by the delusion l ion, the increasing and days of
patient. al demonstr patient anxiety interventi nursing
thinking ates the will on at this intervent
The patient and he or she acknowl point can ion, the
claimed of hallucina can be edge prevent a patient
hearing tory physicall realities blow up. acknowl
voices experien y, of edge
telling her ces. emotiona situation. realities
she is lly   of
 Identify
‘buang’ and/or Long conditions  These situation.
sexually term: such as physical
“may harmful After 1 acute or conditions Long
nabatian to self week of chronic may term:
man ko nursing brain interfere Goal was
japun Doc” intervent syndrome, with partially
as ion, the panic state, ability to met after
verbalized patient hormonal control 1 week
by the will imbalance, own of
patient. express drug behavior nursing
realistic induced, and will intervent
self- postanesthes need ion, the
Objective evaluatio ia/post specific patient
data: n and interventi express
11
 Had increased seizure ons to realistic
assaultiv sense of confusion, manage. self-
e and self- traumatic evaluatio
destructi esteem.  brain injury. n and
ve increased
behavior sense of
 (+)  self
 Childr esteem. 
auditory
 Note en who
hallucin
family grow up
ations
history of in homes
suicidal or where
VS homicidal violence is
BP: behavior. accepted
90/60mmHg tend to
Weight: grow up
38.4kg to use
violence
as a
means of
solving
problems.

 Maintai
n  To
straightforw avoid
ard reinforcin
communicat g
ion. manipulati
ve
behavior.
Dependent: 
 Provide
client with a Dependent: 
sense that  To
caregiver is provide
in control of feeling of
the situation safety.
 Adminis
ter
prescribed
medications,  The
taking care chemistry
not to of the
oversedate brain is
client. changed

12
 by early
violence
and has
been
shown to
respond 
to
serotonin,
as well as
related
neurotrans
Collaborative:  mitter
 Identify systems,
support which
systems play a role
in
restraining
aggressive
impulses.

Collaborative: 
 In
addition to
the client,
those
around
him or her
need to
learn how
to be
positive
role
models
and
display a
broader
array of
skills for
resolving
problems.

Drug Study
Name of Dosage, Mech. of Indication Adverse Nursing

13
Drug Route, Action Reactions Responsibilitie
Freq., s
Timing
Generic: Dosage: Interferes Primary indications CNS: seizures, Assessment
cloZAPine 25 mg with for clozapine neuroleptic
• Assess
(Rx) dopamine include schizophren malignant
mental status:
Route: receptor ia or schizoaffective syndrome s
orientation,
Brand: oral binding disorder partially or
HEMA: mood,
with lack fully resistant to
Leukopenia, behavior,
Clozaril of EPS treatment with
Freque neutropenia, presence of
and other antipsychotic
ncy: agranulocytosis hallucinations,
tardive drugs, or
, eosinophilia and type
dyskinesi schizophrenia/schiz
q.d before initial
a; also oaffective SYST: Death
administration
acts as an accompanied by in geriatric
and monthly;
Timing: adrenergi persistent suicidal patients with
this product
Every 8 c, or self-injurious dementia
should
a.m cholinergi behavior.
Source: significantly
c,
reduce
histamine
Skidmore- psychotic
rgic,
Roth, Linda. behavior
serotonine
(11th Edition).
rgic
Mosby's drug • Check for
antagonist
guide for swallowing of
.
nurses. Elsevier PO
publisher. medication;
check for
Classificatio Contraindications: Side Effects:
hoarding or
n:
Functional:  Hypersensiti  weight giving of

Antipsychot vity gain medication to

ic other patients
 severe  dizzines

14
 granulocyto s • Check for
penia (WBC  tremor dizziness,
,3500/mm3 faintness,
Chemical:  fast
before palpitations,
Tricyclic heart
therapy) tachycardia on
dibenzodiaz rate
 coma rising
epine  headach
derivative e • Assess for

 drowsin neuroleptic
ess malignant
syndrome:
 nausea
hyperpyrexia,
 constipa
muscle rigidity,
tion
increased CPK,
 dry altered mental
mouth, status; product
or should be
increase discontinued
d
salivati • Assess for EPS
on including
akathisia
 vision
(inability to sit
problem
still, no pattern
to movements),
 Fever tardive
 Increase dyskinesia
d (bizarre
sweatin movements of
g. the jaw, mouth,
tongue,
extremities),

15
 pseudoparkinson
ism (rigidity,
tremors, pill
rolling, shuffling
gate)

• Assess for
constipation,
urinary retention
daily; if these
occur, increase
bulk, water in
diet

Patient/family
education

• Teach patient
to use good oral
hygiene;
frequent rinsing
of mouth,
sugarless gum
for dry mouth

• Caution
patient to avoid
hazardous
activities until
product response
is determined

• Inform patient

16
 that orthostatic
hypotension
occurs often and
to rise from
sitting or lying
position
gradually

• Caution
patient to avoid
hot tubs, hot
showers, tub
baths, since
hypotension
may occur

• Teach patient
to avoid OTC
preparations
(cough, hay
fever, cold)
unless approved
by prescriber,
since serious
product
interactions may
occur; avoid use
with alcohol,
CNS
depressants;
increased
drowsiness may

17
 occur

• Teach patient
about EPS and
necessity of
meticulous oral
hygiene, since
oral candidiasis
may occur

18
 Name of Drug Dosage, Mech. of Indication Adverse Nursing
Route, Action Reactions Responsibiliti
Freq., es
Timing
Generic: Dosage: Depresses Fluphenazine is CNS:
fluPHENAZine 10mg ( cerebral indicated Assessment
seizures,
hydrochloride 1 tab) cortex, to treat certain
neuroleptic • Assess
(Rx) hypothalam mental/mood
malignant mental status:
Brand: Route: us, limbic problems
syndrome orientation,
Oral system, (chronic
mood,
Prolixin which schizophrenia). CV: cardiac
behavior,
control arrest,tachyc
Freque presence and
activity and ardia
ncy: type of
aggression;
blocks GI: paralytic hallucinations
BID ileus, before initial
neurotransm
hepatitis administratio
Timing ission
n and
: produced by
HEMA: monthly; this
Every 8 dopamine at leukopenia, product
hours synapse;
leukocytosis, should
exhibits
agranulocyto significantly
strong a-
sis, aplastic reduce
adrenergic
anemia, psychotic
and
thrombocyto behavior.
anticholiner
penia
gic blocking • Assess
action; RESP: affect,
mechanism Laryngospas orientation,
for m, LOC,
antipsychoti respiratory reflexes, gait,
c effects is depression. coordination,

19
 unclear Source: sleep pattern
disturbances
Skidmore-
Roth, Linda. • Monitor
(11th B/P with
Edition). patient sitting,
Mosby's standing, and
drug guide lying down;
for nurses. take pulse and
Elsevier respirations
publisher. q4hr during
initial
Classification: Contraindicatio Side Effects:
treatment;
ns:
Functional:  Hyperse  upset establish
Antipsychotic/ne nsitivity stom baseline
uroleptic  blood ach. before

dyscrasi starting
 weak
as treatment;
ness
Chemical:
 Coma report drops
or
Phenothiazine,
 bone of 30 mm Hg;
tiredn
piperazine
marrow obtain
ess.
depressi baseline
 excit
on ECG, Q-wave
emen
and T-wave
 closed- t or
changes
angle anxie
glaucom ty. • Check for
a dizziness,
 inso
mnia. faintness,

 night palpitations,
tachycardia
mare
on rising;
s.

20
  dry severe
mout orthostatic
h. hypotension is

 skin common

more
• Assess for
sensit
EPS including
ive to
akathisia
sunli
(inability to sit
ght
still, no pattern
than
to movements),
usual.
tardive
 chan dyskinesia
ges in (bizarre
appet movements of
ite or the jaw, mouth,
weig tongue,
ht. extremities),
pseudoparkinso
nism (rigidity,
tremors, pill
rolling,
shuffling gait);
an
antiparkinson
product should
be prescribed

• Assess for
constipation,
urinary
retention daily;

21
 if these occur,
increase bulk,
water in diet
Patient/family
education

• Caution
patient to avoid
hazardous
activities until
product
response is
determined;
dizziness,
blurred vision
may occur.

• Inform patient
that orthostatic
hypotension
occurs often
and to rise from
sitting or lying
position
gradually; tell
patient to avoid
hot tubs, hot
showers, tub
baths because
hypotension
may occur; tell
patient that in

22
 hot weather,
heat stroke may
occur; extra
precautions are
necessary to
stay cool

• Instruct
patient to avoid
abrupt
withdrawal of
this product, or
EPS may result;
product should
be withdrawn
slowly

• Teach patient
to avoid OTC
preparations
(cough, hay
fever, cold)
unless approved
by physician
because serious
product
interactions
may occur;
avoid use with
alcohol, CNS
depressants;
increased

23
 drowsiness may
occur

• Teach patient
about EPS and
necessity of
meticulous oral
hygiene

XII. Significance of the study

The significance of this study is to broaden the knowledge, promote skills, and
comprehend attitude to the patient and especially to the nursing students who might have handled
cases or will handle with this kind of case. The findings will be beneficial to the Society and
Science and Technology considering that it focuses on the Care of Clients with Maladaptive
behaviour and provides the necessary nursing care and proper intervention for the wellness of
patient having Schizophrenia, Paranoid Type .

The results of the study may be beneficial to the following:

24
  Family members – this may be helpful for the family member to serve as a knowledge
and prevention for the family and how to manage the said disease whenever the disease
occur.
 Individuals – it serve as an awareness for them to be able to avoid this disease.
 Health department – this may serve as a helpful guide to provide interventions, basic
needs and support from the health department.
 Future researchers – this may be beneficial to future researchers as it can be used for
future
references.

XIII: ACCOMPLISHMENT REPORT

Our group tackled things to work out this case presentation and each of us think critically to
provide the proper nursing process which includes the assessment, diagnosis, planning,
intervention and evaluation. In line with this, we were able to carry out everything that we,
students nurses needs to do.

As a nursing student who's new to embracing the new normal of learning amidst to the
covid 19 pandemic outbreak, we would say that this is such a challenging one. Considering the
factors and challenges like technical issues, distractions and time management, staying
motivated, understanding course expectations and lack of in-person interaction. However, we,
students continue our education through online learning and via video calls with our dear
teachers and clinical instructors. We were able to learn and gradually adjust to this kind of
system wherein we were also able to catch up and comply the things needed.

25
 As for our skills laboratory, despite of being not expose to the clinical setting, truly and
deeply we were able to learn and gain the knowledge we need to acquire in order for us to be
more fully equipped as we gather and do our clinical duties once the pandemic is over and safe to
do so. What matters the most is the safetyness we have right now and the opportunity to
continuously learn regardless of the hindrances of learning.

It is quite difficult to write an accomplishment report in these trying times. We don’t have a
face to face interaction with our CI’s and classmates. We can’t compare notes and we have to do
group work not having seen each other, yet we managed to carry out the assigned tasks the best
way we can. We are assigned a case work without actually seeing a live person whom we can
interview. If being exposed to hospital setting is stressful but much easier because you are in an
actual setting. Ours now is very much stressful, however, we can say that despite the adversities
we still have learned a lot. We learned things by a theory that was lectured to us online. Yet,
despite the difficulties it is exhilarating to feel that we were able to pull off those situations that
we think was impossible to do.

In General, this new normal was a training ground for us to be a better nursing student
because it provides discipline, proper judgment, flexibility, initiative and an independent health
care provider.

26