Foundation University

COLLEGE OF NURSING
Dumaguete City

Behavioral Analysis
In Partial Fulfillment of the Requirements

In NCM 105

Submitted to:

Mr. Mark Andrie G. Largo, RN

Submitted by:

Annalee V. Ambos

Jamie Lee Anne A. Bueno

Anita T. Credo

Neyla D. Knapp

Ronnah Mhae Q. Sotomayor

June 08, 2021

1|Page
 FOUNDATION UNIVERSITY MISSION, VISION & LIFE PURPOSE

Mission

To enhance ad promote a climate of excellence relevant to he challenges of the times, where individuals are comitted to the pursuit of new knowledge and life-long
learning in serviceof society.

Vision

To be a dynamic, progressive school that cultivates effective learnig, generates creative idaes, responds to societal needs and offers equal oppurtunity for all.

Life purpose

To educate and develop individuals to become productive, craetive, useful and responsible citizens of societty.

Core Values

 Excellence

 Commitment

 Integrity

 Service

2|Page
June 07, 2021

Mark Andrie G. Largo

Clinical Instructor
Foundation University College of nursing
Dumaguete City

Dear Sir Largo,

Good Day!

We, Annalee V. Ambos, Jamie Lee Anne A. Bueno, Anita T. Credo, Neyla D. Knapp, Ronnah Mhae Q.Sotomayor are Level -IV nursing student of Foundation
Univeristy. We would like to apply a behavioral analysis for our patient Ms. M.D.C. 37 years old that was admitted at NOPH-BC (Negros Oriental Provincial
hospital–Behavioral Care Center) and was diagnosed with Schizophrenia. This behavioral analysis will serve as a partial fulfilment of the course NCM105. We
assure you that all the information gathered in this study are kept confidential and will help us to develop our critical thinking skills and comprehension. We are
hoping for your approval.

Thank you very much and God bless.

Sincerely,

Annalee V. Ambos
Jamie Lee Anne A. Bueno
Anita T. Credo
Neyla D. Knapp
Ronnah Mhae Q. Sotomayor

3|Page
 ACKNOWLEDGEMENT

We would like to express our heartfelt gratitude to Our Almighty Father, for all the blessings and guidance all throughout our psychiatric rotation. He gave
us strength to face whatever struggles we have encountered along the way.

To our clinical instructor, Mr. Mark Andrie Largo who imparted his knowledge and expertise to us. He was there to guide us and extended a helping hand.

To the staff of Negros Oriental Provincial Hospital Behavioral Care Center, who welcomed us warmly and allowed us to handle the real case scenarios.

To our client and her SO, whose willingness to participate was beyond immeasurable. The SO, the client’s mother was always there to answer all our
queries.

To our parents and family members who support us not only financially but also emotionally and morally. They gave us enough courage to continue and
strive hard to meet our goals.

4|Page
 TABLE OF CONTENTS

BEHAVIORAL ANALYSIS CONTENT PAGES

Cover Page 1

Mission, Vision, Life Purposes, Core Values 2

Application Letter 3

Acknowledgement 4

Introduction 7

Demographic Data 8

Genogram 9

Developmental Milestones 10-12

Psychosexual

Psychosocial

Cognitive

Morality

Five Domains 13

Physical

Intellectual

Emotional

5|Page
 Social

Spiritual

Observational Checklist 14-19

Psychodynamics 20-22

Psychopharmacology 23-28

Nursing Care Plan 29-33

Summary of NCP and other Diagnosis 34

Synthesis 35

Journal Readings 36

Reference and Bibliography 37

6|Page
 INTRODUCTION

This is a case of 37 years old female patient from Cabanlotan, Bais City, Negros Oriental, whom was diagnosed with mental illness related to schizophrenia

and was admitted in the Psychiatric Ward of Negros Oriental Provincial Hospital Behavioral Care Center (NOPH-BCC). The patient was admitted on the ward

around the year of 2004. According to her mother’s story, she noticed the change of mental state and behavior of her daughter after experiencing a traumatic

experience around the year 2000. At first, the patient was exhibiting paranoia and fear and later showing signs delirium and hallucinations. The patient first visited

the institution on the year of 2000. The patient was still manageable during the first 4 years after the diagnosis. But around 2004, the illness has become more

profound and attacks are more frequent. The patient has more frequent tendency of violence and aggressive behaviors and out of desperation and fear of both their

safety and welfare, their family has finally decided to admit the patient in the ward. The patient has one of the longest records of admittance in the ward and one of

the oldest patients in terms of years of stay in the facility, almost about 17 years straight already and counting. The patient still continues to take her therapies in the

ward and conditions for her release are still not clear up to this time. The patient’s mental condition at this time is still unbound to the realms of the norms.

7|Page
 DEMOGRAPHIC DATA

Name: “MDC” Sex: Female Birthday: December 27, 1983

Age: 37 years old Civil Status: Single Religion: Roman Catholic

Educational Attainment: Second Year High School Occupation: None Nationality: Filipino

Home Address: Cabanlotan, Bais City, Negros Oriental Date of Admission: June 27, 2004

Room/Ward: Female Ward

Source of Information: Client, Patient’s chart Date of NPI: May 24-June 08, 2021

Chief Complaint(s): Delirium, Hallucination (Visual and Auditory Form), Disturbance of Affect, Depression, Flight of Ideas and Sleeplessness

History of present illness:

The client has previous admission at NOPH Negros Oriental Provincial Hospital last June 27, 2004. According to DSWD, the client had behavioral changes
which started last February 2000 after the rape incident. Client is experiencing depression and had hallucinations and illusions.

General Impression of the client (appearance upon first contact on January 18, 2012):

The client/patient was sitting on a bench with some other patients. She was well groomed and fingernails were relatively clean. She was smiling and and
shows excitement about the upcoming culmination. She had good eye contact but has short attention span, while in conversation we observed combing her hair has
her mannerism. She was verbally responsive and approachable but sometimes manipulative. May 25, 2021, the client was sitting and smiling. She had
overabundance of thoughts. She gave false statement about her siblings and family but she tells lot of everything about her past. She has hallucinations and illusions
and she was not oriented to time and place.

Medications: Clozapine 100mg I tab q hs, Risperidone 2mg I tab PRN for EPS, Fluphenazine Decanoate IM

8|Page
 GENOGRAM

9|Page
 DEVELOPMENTAL MILESTONES

PSYCHOSEXUAL

Genital stage

The genital stage is the last stage of Freud's psychosexual theory of personality development, and begins in puberty.  It is a time of adolescent sexual
experimentation, the successful resolution of which is settling down in a loving one-to-one relationship with another person in our 20's.

The person’s ego becomes fully developed during this stage, and they are subsequently seeking their independence. Their ability to create meaningful and lasting
relationships is concrete, and their sexual desires and activity are healthy and consensual. If a child or young adult experiences dysfunction during this period, they
will be unable to develop meaningful healthy relationships. (Lantz, 2020)

Correlation:

Patient MDC is 37 years old female. Based on the patient’s chart it shows information that she was sexually abused at the aged of 16. It clarifies a strong relation
between her symptoms and the psychoanalytical literature, explaining that sexual abuse in her teenager stage may result in physical, emotional, behavioral
and social difficulties in adulthood. As a conclusion, when considering the psychosexual constitution, sexual abuse is probably the main cause of her mental
disorder.

PSYCHOSOCIAL

Stage 6: Intimacy vs. Isolation

Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.
This stage covers the period of early adulthood when people are exploring personal relationships.

Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will form relationships that
are enduring and secure. (Susman, 2020)

10 | P a g e
Correlation:

Patient MDC is 37 years old female and single. During her teenage life she had experienced a series of negative events. In correlation with Erik Erikson's Stages of
Psychosocial Development (Intimacy vs. Isolation) patient wasn’t able to experience an intimate relationship but rather she was sexually abuse. That led her to
avoid opening herself up to others. In turn, that may cause loneliness — even eventual social isolation and depression.

COGNITIVE

The Formal Operational Stage

The final stage of Piaget's theory involves an increase in logic, the ability to use deductive reasoning, and an understanding of abstract ideas.

At this point, people become capable of seeing multiple potential solutions to problems and think more scientifically about the world around them.

The ability to thinking about abstract ideas and situations is the key hallmark of the formal operational stage of cognitive development. The ability to systematically
plan for the future and reason about hypothetical situations are also critical abilities that emerge during this stage. (Gans, 2020)

Correlation:

Patient is experiencing schizophrenia. She is currently admitted at Provincial Hospital-Behavioral Care Center located in Barangay Talay, Dumaguete City, Negros
Oriental. In correlation with Piaget’s stages of development theory the patient’s behavioral changes has affected her ability to think about abstract ideas and
situations. A wide range of cognitive functions are affected; particularly memory, attention, motor skills, executive function, and intelligence. Cognitive deficits in
various domains have been consistently replicated in patients with schizophrenia. In patients with schizophrenia, delusions and hallucinations could arise as a result
of deficits in cognitive functions.

11 | P a g e
 MORALITY

Conventional level

This conventional is the Second level Kohlberg’s stages of moral development in which conformity to social rules remains important to the individual. However, the
emphasis shifts from self-interest to relationships with other people and social systems. The individual strives to support rules that are set forth by others such as
parents, peers, and the government in order to win their approval or to maintain social order (Sanders, 2006).

Correlation

Patient MDC is 37 years old female, who develop mental disorder at the age of 16 due to sexually abuse. In this information the patient have lost interest in herself
that she may want to end it. As a conclusion, an individual’s sense of morality is tied to personal and societal relationships. Patient MDC continue to accept the rules
of authority figures, but this is now because they believe that this is necessary to ensure positive relationships and societal order.

12 | P a g e
 FIVE DOMAINS

 Physical: Client is dependent to her mother. She is often unable to cope with everyday tasks, such as personal hygiene and household chores.

 Intellectual: Client was not oriented on date, time, place and reality. She has cognitive deficits particularly memory, attention, motor skills, executive
function, and intelligence.

 Emotional: Client was happy and excited yet there still sadness and gloomy on her face. She sometimes experience hallunation and delusions.

 Social: Client has the tendency to withdraw from others and exhibit inappropriate mood behaviors can make relationships difficult.

 Spritual: Patient views religion as an important aspect to her life because she believes that God is there to protect her. Prior to her admission she often goes
to church with her mother. She believes that being faithful to God will help her.

13 | P a g e
 OBSERVATIONAL CHECKLIST

Notation symbols to use Abbreviation Explanations

/= Dtermination made M or R= Marked or Repeated

ND= No data and cannot be S or O = Slight or Occasional
Inferred NP= Not Present
Hx= History

NP S O M R

APPEARANCE 1. Physically unkempt, unclean 🗸

2. Clothing disheveled, dirty 🗸

3. Clothing atypical, unusual, bizarre 🗸

4. Unusual physical characteristics 🗸

Comments re: Appearance

During our interaction, our patient appears clean and neat. She has taken a bath and changed her clothes. Her hair was wet and combed.

POSTURE 5. Slumped 🗸

6. Rigid, tense 🗸

7. Atypical, inappropriate 🗸

8. Anxiety, fear, apprehension 🗸

14 | P a g e
 Facial Expression Suggests 9. Depression, sadness 🗸

10. Anger, hostility 🗸

11. Decreased variability of expression 🗸

12. Bizarreness, inappropriateness 🗸

Comments re: Behavior

Our client was sitting on a bench during our nurse-patient interaction. Occasionally, she will stand-up, yell, call a person’s name and ask for something and also
she will lean toward us just out of curiosity to see what’s’ going on.

General movements 13. Accelerated, increased speed 🗸

14. Decreased, slowed 🗸

15. Atypical, peculiar, inappropriate 🗸

16. Restlessness, fidgety 🗸

Quality of Speech 17. Increase, loud 🗸

18. Decreased, slowed 🗸

19. Atypical qualitym slurring 🗸

Comments re: Speech

Occasionally, she will speak so fast and sometimes she will speak slowly. She sometimes do not understand what she was trying to say and so, we ask her to repeat
the word in order for us to understand.

15 | P a g e
 Interviewer-Patient Relationship 20. Domineering 🗸

21. Submissive, overly compliant 🗸

22. Provocative 🗸

23. Suspicious 🗸

24. Uncooperative 🗸

Comments re: Behavior

Her behavior was appropriate during the nurse-patient interaction, but sometimes our client sounded like she is the boss and she will tell us to get this and that.

25. Inappropriate to thought content 🗸

26. Increased liability of affect 🗸

27. Blunted, absent, unvarying 🗸

Feeling (Affect/Mood) PREDOMINANT MOOD IS

28. Euphoria 🗸

29. Anger, hostility 🗸

30. Fear, anxiety, apprehension 🗸

31. Depression, sadness 🗸

Comments re: Feeling

16 | P a g e
During the nurse-patient interview. We, notice that she was happy and yet there still sadness and gloomy on her face.

Perception 32. Illusions 🗸

33. Auditory hallucinations 🗸

34. Visual hallucinations 🗸

35. Other type of hallucination 🗸

Comments re: Perception

She was okay at first during the nurse-patient interview but then all of the sudden she will have an auditory and visual hallucination and she will say this and that
then she will stop.

Intellectual Functioning 36. Impaired level of consciousness 🗸

37. Impaired attention span/concentration 🗸

38. Impaired abstract thinking 🗸

39. Impaired calculation ability 🗸

40. Impaired intelligence 🗸

Orientation 41. Disoriented to person 🗸

42. Disoriented to place 🗸

43. Disoriented to time 🗸

Comments re: Thinking

17 | P a g e
She is somewhat disoriented to place, year, month and time during the nurse-patient interaction. She is easily distracted to people who pass by and sometimes start
yelling or calling a person’s name.

Insight 44. Difficulty in acknowledging the presence of psychological problems 🗸

45. Mostly blames others or circumstances for problems 🗸

Judgement 46. Impaired ability to manage daily living activities 🗸

47. Impaired ability to make reasonable-like decisions 🗸

Memory 48. Impaired immediate recall 🗸

49. Impaired recent recall memory 🗸

50. Impaired remote recall memory 🗸

51. Obsessions 🗸

Comments re: Memory

She has difficulty of recalling her passed memory, although she’s almost there but then again she will deviate other words and frequently changes topic and not
consistent.

Thought content 52. Compulsions 🗸

53. Phobias 🗸

54. Suicidal Ideations 🗸

55. Homicidal Ideations 🗸

56. Derealization/ Depersonalization 🗸

18 | P a g e
 57. Delusions 🗸

Thinking 58. Ideas of reference 🗸

59. Ideas of influence 🗸

Stream of Thought 60. Associated disturbance 🗸

61. Thought flow decreased, slow 🗸

62. Thought flow increased 🗸

Comments re: Thinking

On our day 2 nurse-patient interaction the client relayed to us that she was dreaming of snake and that she was afraid of it. She has her own core beliefs that causes
negative thoughts and that she believe in her own self.

MENTAL STATUS EXAM COMPLETED IN 24 HOURS OF ASSESSMENT

Name: M.D.C.

Date: May 27-28, 2021

Time: 9:00-10:30am

COPING RESOURCES

COGNITIVE
19 | P a g e The higher the degree of learning, the greater is the ability of the
person to effectively develop and use problem-solving skills.

AFFECTIVE
Attitude, feelings, and values are essential elements to support and
 APPRAISAL OF STRESSORS

BIOLOGICAL
Biological Theories in schizophrenia involves genetics,
neuroanatomy and neurodevelopment through brain
CONTRIBUTING FACTORS imaging studies. It also involves the neurochemical factors
specifically on neurotransmitter dysregulation.
BIOLOGICAL
 Genetics
 Brain Development PSYCHOLOGICAL
Stress diathesis model described in a classic work by
 Neurotransmitters
Lieberman and colleagues states that schizophrenic
symptoms develop based on the relationship between the
PSYCHOLOGICAL amount of stressor that a person experiences and an
 Life-Changing Events internal stress tolerance threshold.
 Stress related to:
 Physical abuse
 Sexual abuse SOCIO-CULTURAL & ENVIRONMENT
 Emotional abuse Some theories proposed that poverty, society, and cultural
disharmony could cause schizophrenia or that people
SOCIO-CULTURAL & chose to become schizophrenic to cope with the insanity
of the modern world. Others proposed that schizophrenia
ENVIRONMENT
was caused by living in the city or living in isolation in the
 Unfavorable neighborhood  country.

PSYCHODYNAMIC 1

of
SCHIZOPHRENIA
COPING RESOURCES

COGNITIVE
20 | P a g e  The patient has finished secondary education.
 The patient understands Visayan and Filipino language.
 The patient understands a couple of English words.
 The patient knows how to read and write.
 COPING MECHANISMS

Suppression: Conscious exclusion of unacceptable thoughts and

feelings from conscious awareness.
 She was hesitant at first to share information regarding her
experiences in the past and she was resistant and evaded some
of our questions.

Repression: This occurs when a threatening idea, thought or

emotion enters consciousness; this defense mechanism causes
suppression of threatening material or intrusive thoughts.
 Everytime we asked a question related to her experience, she
1 either say different things or answer us with unrelated things.

Regression: Returning into an earlier level of development.

 Most of our interaction with her, she usually sits like that of a
child wherein both of her feet are placed under the bench with
her arms folded on his knees.

CONSTRUCTIVE BEHAVIOR:
 Taking a Nap
 Medication Adherence
 Joins therapy
 Exercising

DESTRUCTIVE
 Depression
 Manic
 Irritability
 Profanity
 Aggression
 Withdrawing Self from Peers.

MALADAPTIVE RESPONSES

 Sleep Disturbances
 Delusions (Grandiose and Religious) 2
THOUGHT DISTURBANCES
21 | P a g e Hallucinations (Visual and Auditory)  Disorganize speech
 Disorganized Speech  Derailment
 Flight of Ideas  Tangentiality
 Bipolar  Illogicality
2

SCHIZOPHRENI
A
SCHIZOAFFECTIVE TYPE

Nursing Interventions
 Establish a therapeutic nurse-

PSYCHOSIS client relationship.

 Providing for Safety
 Using Therapeutic
Communication
 The nurse should be calm when
talking to the patient.
PSYCHOTIC  Never reinforce hallucinations
and delusions.
SYMPTOMS  Encourage client to participate in
appropriate
therapies/activities/exercise
program.
 Allow verbalizations of feelings.
PSYCHOPHARMACOLOGY  Managing Medications.

 Clozapine
 Fluphenazine Decanoate
 Respiridone

PSYCHOPHARMACOLOGY

22 | P a g e
Generic Name: clozapine Drug Order: 100mg Tablet given before bedtime.
Brand Name: Clozaril
Classification: Central Nervous System (CNS) Agent; Psychotherapeutic Agent; Antipsychotic; Atypical

Actions: Mechanism is not defined. Interferes with binding of dopamine to D 1 and D2 receptors in the limbic region of brain. It binds primarily to nondopaminergic
sites (e.g., alpha-adrenergic, serotonergic, and cholinergic receptors).

Therapeutic Effects: Utilized for treatment of schizophrenia uncontrolled by other agents.

Uses: Indicated only in the management of severely ill schizophrenic patients who have failed to respond to other neuroleptic agents.

Unlabeled Uses: Schizo-affective disorder, severe obsessive-compulsive disorder, bipolar disorder, dementia-related behavioral disorders.

Contraindications: Severe CNS depression, blood dyscrasia, history of bone marrow depression; patients with myeloproliferative disorders, uncontrolled epilepsy;
clozapine-induced agranulocytosis, severe granulocytosis, chemotherapy, coma, leukemia, leukopenia, neutropenia, myocarditis, concurrent administration of
benzodiazepines or other psychotropic drugs; renal failure, dialysis, hepatitis, jaundice; infants, lactation.

Cautious Use: Arrhythmias, GI disorders, narrow-angle glaucoma, hepatic and renal impairment, prostatic hypertrophy, history of seizures; patients with
cardiovascular and/or pulmonary disease; cerebrovascular disease, cardiac arrhythmias, tachycardia, dehydration, neurological disease, tardive dyskinesia, previous
history of agranulocytosis; surgery, glaucoma, infection, pregnancy (category B); older adults. Safety and efficacy in children have not been established.

Adverse Effects ( 1%): CV: Orthostatic hypotension, tachycardia, ECG changes, increased risk of myocarditis especially during first month of therapy,
pericarditis, pericardial effusion, cardiomyopathy, heart failure, MI, mitral insufficiency. GI: Nausea, dry mouth, constipation,
hypersalivation. Hematologic :Agranulocytosis. CNS: Seizures, transient fever, sedation, neuroleptic malignant syndrome (rare), dystonic reactions
(rare). Metabolic: Hyperglycemia, diabetes mellitus. Urogenital: Urinary retention. Other: Increased mortality from severe hematologic, cardiovascular, and
respiratory adverse effects.

23 | P a g e
Nursing Implications Assessment & Drug Effects

 Lab tests: Baseline WBC and absolute neutrophil count must be made before initial treatment, every week for first 6 mo, then every 2 wk for next 6 mo, then
every 4 wk, and weekly for 4 wk after the drug is discontinued. Periodically monitor blood glucose.
 Monitor diabetics for loss of glycemic control.
 Monitor for seizure activity; seizure potential increases at the higher dose level.
 Closely monitor for recurrence of psychotic symptoms if the drug is being discontinued.
 Monitor cardiovascular and respiratory status, especially during the first month of therapy. Report promptly S&S of CHF and other potential cardiac
problems.
 Monitor for development of tachycardia or hypotension, which may pose a serious risk for patients with compromised cardiovascular function.
 Monitor daily temperature and report fever. Transient elevation above 38° C (100.4° F), with peak incidence during first 3 wk of drug therapy, may occur.

Patient & Family Education

 Carefully monitor blood glucose levels if diabetic.

 Do not engage in any hazardous activity until response to the drug is known. Drowsiness and sedation are common adverse effects.
 Due to the risk of agranulocytosis (see Appendix F) it is important to comply with blood test regimen. Report flulike symptoms, fever, sore throat, lethargy,
malaise, or other signs of infection.
 Rise slowly to avoid orthostatic hypotension.
 Report immediately any of the following: unexplained fatigue, especially with activity; shortness of breath, sudden weight gain or edema of the lower
extremities.
 Take drug exactly as ordered.
 Do not use OTC drugs or alcohol without permission of physician.
 Do not breast feed while taking clozapine.

24 | P a g e
Generic Name: fluphenazine decanoate Drug Order: 1 ml IM Injection
Brand Name: Prolixin
Classification: Central Nervous System Agent; Psychotherapeutic; Antipsychotic; Phenothiazine

Actions: Potent phenothiazine, antipsychotic agent. Blocks postsynaptic dopamine receptors in the brain. Similar to other phenothiazines with the following
exceptions: more potent per weight, higher incidence of extrapyramidal complications, and lower frequency of sedative, hypotensive, and antiemetic effects.

Therapeutic Effects: Effective for treatment of antipsychotic symptoms including schizophrenia

Uses: Management of manifestations of psychotic disorders.

Unlabeled Uses: As antineuralgia adjunct.

Contraindications: Known hypersensitivity to phenothiazines; subcortical brain damage, comatose or severely depressed states, blood dyscrasias, renal or hepatic
disease. Safety during pregnancy (category C) or lactation is not established. Parenteral form not recommended for children <12 y.

Cautious Use: With anticholinergic agents, other CNS depressants; older adults, previously diagnosed breast cancer; cardiovascular diseases; pheochromocytoma;
history of convulsive disorders; patients exposed to extreme heat or phosphorous insecticides; peptic ulcer; respiratory impairment.

Adverse Effects ( 1%): CNS: Extrapyramidal symptoms (resembling Parkinson's disease), tardive dyskinesia, sedation, drowsiness, dizziness, headache, mental
depression, catatonic-like state, impaired thermoregulation, grand mal seizures. CV: Tachycardia, hypertension, hypotension. GI: Dry mouth, nausea, epigastric
pain, constipation, fecal impaction, cholecystic jaundice. Urogenital: Urinary retention, polyuria, inhibition of ejaculation. Hematologic: Transient
leukopenia, agranulocytosis. Skin: Contact dermatitis. Body as a Whole: Peripheral edema. Special Senses: Nasal congestion, blurred vision, increased intraocular
pressure, photosensitivity. Endocrine: Hyperprolactinemia.

25 | P a g e
Nursing Implications Assessment & Drug Effects

 Report immediately onset of mental depression and extrapyramidal symptoms. Both occur frequently, particularly with long-acting forms (decanoate and
enanthate).
 Be alert for appearance of acute dystonia (see Appendix F). Symptoms can be controlled by reducing dosage or by adding an antiparkinsonism drug such as
benztropine.
 Be alert for red, dry, hot skin; full, bounding pulse, dilated pupils, dyspnea, mental confusion, elevated BP, temperature over 40.6° C (105° F). Inform
physician and institute measures to reduce body temperature rapidly. Extended exposure to high environmental temperature, to sun's rays, or to a high fever
places the patient taking this drug at risk for heat stroke.
 Lab tests: Monitor kidney function in patients on long-term treatment. Withhold drug and notify physician if BUN is elevated (normal BUN: 10–20 mg/dL).
Also perform WBC with differential, liver function tests, periodically.
 Monitor BP during early therapy. If systolic drop is more than 20 mm Hg, inform physician.
 Monitor I&O ratio and bowel elimination pattern. Check for abdominal distension and pain. Monitor for xerostomia and constipation.
 Note: Patients on large doses who undergo surgery and those with cerebrovascular, cardiac, or renal insufficiency are especially prone to hypotensive effects.

Patient & Family Education

 Do not drive or engage in potentially hazardous activities until response to drug is known.
 Do not alter dosage regimen or stop taking drug abruptly. Do not give drug to anyone else.
 Seek and obtain physician approval before taking any OTC drugs.
 Be alert for adverse effects, early detection is critical because both decanoate and enanthate have a long duration of action. Inform physician promptly if
following symptoms appear: Light-colored stools, changes in vision, sore throat, fever, cellulitis, rash, any interference with your willful (volitional)
movements.
 Make sure to eat and drink adequately in order to prevent constipation and dry mouth.
 Be aware that it may be difficult for you to adjust to extremes in temperature. Use caution because of this possible impaired thermoregulation.
 Avoid exposure to sun; wear protective clothing and cover exposed skin surfaces with sun screen lotion (SPF above 12).
 Avoid alcohol while on fluphenazine therapy.
 Note: Fluphenazine may discolor urine pink to red or reddish brown.
 Do not breast feed while taking this drug without consulting physician.
 Periodic ophthalmologic exams are recommended.

26 | P a g e
Generic Name: risperidone Drug Order: 2mg I tab PRN for EPS
Brand Name: Risperdal
Classification: Central Nervous System (Cns) Agent; Antipsychotic; Atypical

Actions: Mechanism is not well understood. Interferes with binding of dopamine to D2-interlimbic region of the brain, serotonin (5-HT2) receptors, and alpha-
adrenergic receptors in the occipital cortex. It has low to moderate affinity for the other serotonin (5-HT) receptors and no affinity to nondopaminergic sites (e.g.,
cholinergic, muscarinic, or beta-adrenergic receptors).

Therapeutic Effects: Effective in controlling symptoms of schizophrenia as well as other psychotic symptoms.

Uses: Reduction or elimination of psychotic symptoms in schizophrenia and related psychoses; treatment of bipolar disorder. Seems to improve negative symptoms
such as apathy, blunted affect, and emotional withdrawal.

Unlabeled Uses: Management of patients with dementia-related psychotic symptoms. Adjunctive treatment of behavioral disturbances in patients with mental
retardation.

Contraindications: Hypersensitivity to risperidone; elderly with dementia-related psychosis; QT prolongation, Reye's syndrome, brain tumor, severe CNS
depression, head trauma; suicidal ideation, tardive dyskinesia; sunlight (UV) exposure, tanning beds; pregnancy (category C), lactation, children <15 y.

Cautious Use: Older adults; arrhythmias, hypotension, breast cancer, blood dyscrasia, cardiac disorders, cerebrovascular disease, hypotension, dehydration,
diabetes mellitus, diabetic ketoacidosis, hyperglycemia, hypokalemia, hypomagnesemia, hyponatremia, MI, obesity, orthostatic hypotension, mild or moderate CNS
depression, coma; GI obstruction, dysphagia; electrolyte imbalance, ethanol intoxication, heart failure, renal or hepatic dysfunction; seizure disorder, seizures,
stroke, Parkinson's disease.

Adverse Effects ( 1%): Body as a Whole: Orthostatic hypotension with initial doses, sweating, weakness, and fatigue. CNS: Sedation, drowsiness,
headache, transient blurred vision, insomnia, disinhibition, agitation, anxiety, increased dream activity, dizziness, catatonia, extrapyramidal symptoms (akathisia,
dystonia, pseudoparkinsonism), especially with doses >10 mg/d, neuroleptic malignant syndrome (rare), increased risk of stroke in elderly. CV: Prolonged QTc
interval, tachycardia. GI: Dry mouth, dyspepsia, nausea, vomiting, diarrhea, constipation, abdominal pain, elevated liver function tests (AST,
ALT). Endocrine: Galactorrhea. Metabolic: Hyperglycemia, diabetes mellitus. Respiratory: Rhinitis, cough, dyspnea. Skin: Photosensitivity. Urogenital: Urinary
retention, menorrhagia, decreased sexual desire, erectile dysfunction, sexual dysfunction male and female.

27 | P a g e
Nursing Implications Assessment & Drug Effects

 Monitor diabetics for loss of glycemic control.

 Reassess patients periodically and maintain on the lowest effective drug dose.
 Monitor closely neurologic status of older adults.
 Monitor cardiovascular status closely; assess for orthostatic hypotension, especially during initial dosage titration.
 Monitor closely those at risk for seizures.
 Assess degree of cognitive and motor impairment, and assess for environmental hazards.
 Lab tests: Monitor periodically blood glucose, serum electrolytes, liver function, and complete blood counts.

Patient & Family Education

 Carefully monitor blood glucose levels if diabetic.

 Do not engage in potentially hazardous activities until the response to drug is known.
 Be aware of the risk of orthostatic hypotension.
 Learn adverse effects and report to physician those that are bothersome.
 Wear sunscreen and protective clothing to avoid photosensitivity.
 Notify physician if you intend to or become pregnant.
 Do not breast feed while taking this drug.

28 | P a g e
 NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Self-care deficit related At the end of our two Independent: At the end of our two
to cognitive impairment and a half hour rotation, and a half hour rotation,
“Wala pa nako to naligo the patient will be able to the patient will be able to
kay nagpa injection improve hygiene as improved hygiene as
 Assess barriers in  Due to
paman” as verbalized by evidenced by: insufficient time evidenced by:
participation of
the patient’s mother regimen

 Demonstrate frequent  Determine mental  Demonstrated

bathing status  Affecting ability frequent bathing, (As
to participate in per Dorothea Orem’s
Objective: own care
 Wear clean and Self Care Deficit
 Offensive body odor appropriate clothing Theory, individuals
 Unkempt appearance will initiate and
 Offering assistance in  Promotes perform their own
 Unkempt hair bathing or in cleanliness
 Demonstrate kempt self-care activities on
 Untrimmed dirty grooming self
hair regular basis so that
nails
their overall health
and wellbeing can be
 Trim the nails  Praise client for
 Positive maximized).
attempts of self-care
reinforcement
 Wore clean and
appropriate clothing,
(As per Dorothea
Orem’s Self Care
Deficit Theory,
individuals will
initiate and perform
their own self-care
29 | P a g e
 activities on regular
basis so that their
overall health and
wellbeing can be
maximized).

 Demonstrated kempt
hair, (As per
Dorothea Orem’s
Self Care Deficit
Theory, individuals
will initiate and
perform their own
self-care activities on
regular basis so that
their overall health
and wellbeing can be
maximized).

 Well-trimmed nails,
(As per Dorothea
Orem’s Self Care
Deficit Theory,
individuals will
initiate and perform
their own self-care
activities on regular
basis so that their
overall health and
wellbeing can be
maximized).

30 | P a g e
 ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Acute pain related to At the end of our one Independent: At the end of our one
frequent nail biting hour care, the patient will hour care, the patient was
“Sakit akong kuko kay  Assess the  Allows to know
be able to report pain is able to report pain is
sige ka duot. Nao condition of the the severity of the
relieve as evidenced by: finger tips condition relieved as evidenced by:
nagpula oh”

 Identify the  To fully

 Eliminate facial  UNMET: Eliminate
aggravating understand
grimacing facial grimacing
factors client’s pain
 Eliminate redness
Objective: symptoms.
on the finger tips
 UNMET: Eliminate
Facial grimacing  Accept client’s
redness on the finger
description of  Pain is subjective
tips
Redness on the finger pain experience and
tips cannot be felt by
others.

 Perform health  To avoid

teaching to the recurrence of the
SO regarding the condition
avoidance of
frequent nail
biting

ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

31 | P a g e
 Altered comfort related At the end of our one Independent: At the end of our one
to treatment regimen hour care, the patient will hour care, the patient was
Subjective:  Determine the  Comfort scale
be able to report able to report pain is
type of can help the
“Galain akong paminaw” discomfort is relieve as discomfort the client identify the relieved as evidenced by:
evidenced by: client is focus of
experiencing discomfort
Objective:  UNMET: Eliminate
 Eliminate guarding guarding behavior
 Active-listen to  Helps to
 Guarding on the behavior determine the
identify
head client’s specific
underlying issues  UNMET: Eliminate
 Irritable needs.
 Eliminate irritability irritability
 Determine how
the client is  Lack of control
managing the may br related to
discomfort others issues.

SUMMARY OF NCP AND OTHER DIAGNOSIS

32 | P a g e
Three Nursing Care Priorities:

 Self-care deficit related to cognitive impairment

 Acute pain related to frequent nail biting

 Altered comfort related to treatment regimen

SYNTHESIS

33 | P a g e
 On our first day, it was Monday and schedule for monthly injection. Our client was injected with her monthly medication so she was a bit tired to talk with
us. We were only able to perform our contract setting together with the client and her Significant Other. We had asked the SO to sign the informed consent to
conduct the interview and for audio recording.

On the second day was our pre-interaction phase. We did another set of meet and greet with our client to have her familiarize our faces and physical
appearances as it was difficult to distinguish us as we were wearing face mask and face shield as per mandate due to the COVID-19 safety protocol.

First day on the second week of our exposure was our Interaction phase. We conducted our interview with audio recording. The patient demonstrated
irritability and sluggishness because she verbalized that she was not feeling well. Her mother said that she was not able to bathe her because she woke up late.

The next morning, the client was still irritable and showed to be reluctant to talk with us as she just wanted to watch TV or play table tennis. Due to the help
of her mother, we were able to spend time with her talking. We informed her regarding the upcoming culmination which she had been waiting since the day we’ve
met her. She got so excited that she finally had the stamina to talk with us.

During our termination phase, we emphasized our contract setting that it would be our last day talking with her and the next time we will be back would be
our culmination day. Our client said that she doesn’t want to be with the crowd.

June 10, 2021 was our culmination day that everyone got so excited. We prepared meals for all the clients inside the facility. There was an open intermission
segment to hype up the crowd.

JOURNAL READING

34 | P a g e
 According to Marco M PicchionI, 2007, Schizophrenia is one of the most serious and frightening of all mental illnesses. No other disorder arouses as much
anxiety in the general public, the media, and doctors. Effective treatments are available, yet patients and their families often find it hard to access good care. In the
United Kingdom, as in many parts of the world, this is often due to poor service provision, but sometimes it is simply down to misinformation. In this review, we
clarify the causes and presentation of schizophrenia, summarise the treatments that are available, and try to clear up a few myths. People with schizophrenia
typically hear voices (auditory hallucinations), which often criticise or abuse them. The voices may speak directly to the patient, comment on the patient's actions, or
discuss the patient among themselves. Not surprisingly, people who hear voices often try to make some sense of these hallucinations, and this can lead to the
development of strange beliefs or delusions.

Many patients also have thought disorder and negative symptoms. While negative symptoms may be less troubling to the patient, they can be very
distressing to relatives. Psychiatrists often classify schizophrenia into subtypes according to the balance of symptoms that a patient manifests

REFERENCES

BOOK:

35 | P a g e
  Stuart, G. & Laraia, M. (2001) Principles and practice of Psychiatric Nursing.7th ed. St. Louis, Missouri: Mosby

 Townsend, M.C. (2008). Essentials of Psychiatric Mental Health Nursing. 4th ed. Philadelphia: F.A. Davis Company.

WEBSITE:

 Schizophrenia. (14). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914490/

 Susman, PhD, D. (2020, June 26). Understanding Erikson's stages of psychosocial development. Verywell Mind. https://www.verywellmind.com/erik-
eriksons-stages-of-psychosocial-development-2795740

 Gans,MD, S. (2020, March 31). What are Piaget's four stages of development? Verywell Mind. https://www.verywellmind.com/piagets-stages-of-cognitive-
development-2795457

 Lantz, S. E. (2020, May 10). Freud developmental theory - StatPearls - NCBI bookshelf. National Center for Biotechnology Information.
https://www.ncbi.nlm.nih.gov/books/NBK557526/

36 | P a g e