SCHIZOPHRENIA

Psychiatric Nursing Clinical Case

Presentation

Presented by:
Group 1: AFABLE | ARELLANO | BALCOS |
BARRACA | BERMAS | CALUAG
Psychiatric Nursing History

General Data

Client’s initials: JV
Date Admitted: 09/09/14
Age: 15 yrs. old
Sex: M
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic (Converted)
Educational Attainment: Grade 6
Occupation:Undergrad Student (Grade 7)
 Psychiatric Nursing History
Chief Complaint/s:
● The patient verbalized “Binubulungan po ako,
nagsasabi na saktan mo, patayin mo, batuhin
mo. Kaya everytime na may nagbubully sa akin,
nananakit at lumalaban din po ako.May
naririnig ako na nagdidikta sa aking isipan
kaya po ako ay nakakapag-laslas sa aking
kamay. Pati na nga po ang sarili ko ay
sinasaktan ko. Kapag inaapi po ako, parang
gumagana po yung adrenaline rush ko. Tapos
parang gusto ko pong gantihan yung mga nag-
aapi sa akin. Tapos minsan po kapag inaapi
ako, yung mga tao po na dahilan ng trauma ko,
ay nakikita ko po sa taong nang-aapi sa akin.
Parang nag-iiba po yung mukha.”
Duration of illness:
a. The patient started to manifest symptoms such as auditory
and visual hallucinations, delusions, and disorganized
behaviors, when he was in Grade 1.
b. About 7 years after, the patient has learned ways to refrain
from responding to hallucinations. He mentioned that he is
now a lot more in control of his own mind.
Pre-morbid personality:
a. The patient was friendly, but at times he avoids
crowded places due to the fear of harming them.
As verbalized by the patient: “Palakaibigan
naman po pero may mga time na ayaw ko po
sumama sa mga crowded na area.” Although he
also socializes and has friends.
b. Patient was very active in terms of hobbies and
resourceful enough to be productive at the time
he was in House of Sarang. Patient verbalized:
“Naglilinis po, nagdodrawing, naghahanap po ako
ng mapaglilibangan.” As of now he is currently in
the hobby of cooking.
Psychiatric Nursing History

History of Present Illness:

● The patient has a long history of abandonment and neglect. Patient could
not recall his early childhood when he was abandoned.
● At 6 years old, he was in custody at DSWD. He has no clear recollection
of his past and his family. He was moved & admitted in the House of
Sarang, an orphanage in Taguig City, on September 9, 2014. He was
provided with the programs and services of the center.
● The patient started to manifest symptoms such as auditory hallucinations,
delusions, and disorganized behaviors, when he was in Grade 1. At that
time he claims that someone or something in his head is talking or telling
him to do things. He tried not to pay any attention to these “voices” but
sometimes his body would unconsciously do what the voices were telling
him to do.
Psychiatric Nursing History

History of Present Illness:

● In July 2019, the child was diagnosed with
intermittent explosive behavior.
● Patient said that he was bullied by older kids in
the adoption center. His experiences of bullying
precipitate the development of his paranoid
thinking. He has this constant fear that other
people are pursuing and intending to harm
him.
History of Present Illness: (CON’T)
● The patient was not diagnosed with insomnia however
the patient mentions that he cannot sleep well at night
and he had non-stop nightmares about getting killed.
Whenever he thinks that someone is a threat, his first
reaction is to defend himself by all means.

● There are times when people in the institution saw

him carrying sharp object/s. Consequently, when
anger occurs, JV do not not know how to effectively
control those emotions, resulting in strong anger
impulses and destructive behaviors.
● Since then, the child is given medication and he is
regularly consulting a psychiatrist, however the
child’s behavior is observed getting worse, he is now
harming himself and harming other people. The
center’s program and services are no longer
appropriate for his developmental needs, thus
transferring him in Sunrise.
 Family History:
● No appropriate data found.
● As interviewed the patient fails to recall in detail
Past Medical History:
● (+) Insomnia & (+) Uncontrollable of his bilogical family. However he states to only
movements remember him and his father on the mountains,
● At UST hospital, for a check-up. He had a nothing else. “Ang naaalala ko lang po ay yung
hard time sleeping, insufficient sleep and nasa bundok kami ng tatay.” He also claims that
irregular sleeping pattern. Another reason he his family has no history of his present illness.
said that he does not know what he was doing, “Wala po sila ganito.”
involuntary actions were recognized. He said
that he cannot control himself. As verbalized
by the patient: “Chinecheck up po ako kase
hindi ako makatulog. Wala po akong maayos
na tulog. Tapos kung ano ano po yung
ginagawa ko, hindi ko po macontrol yung
sarili ko.”
● Fractured left arm due in injury in
playing basketball- La Salle (2018)
Family Genogram:

● No Appropriate Data; Patient only knows he has a mother and a father

 Review of Systems
Patient is fairly groomed, with appropriate clothing. Calm
General (-) weakness (-) fever

Integument (+) Facial rashes (+) hyperpigmentation

Head and Neck (-) stiffness (-) swelling (-) headache

Left eye seems swollen, and has a small red mark below
Eyes (-) discharge (-) corrective lens

Ears (-) difficulty in hearing (+) tinnitus

Patient is fairly groomed, with appropriate clothing. Calm

Nose (-) weakness (-) fever
Review of Systems (CONT’D)
Patient is wearing a mask at all times
Mouth and Throat
(-) hoarseness (-) dysphagia

Respiratory (-) cough (-) dyspnea (-) chest pain

CVS (-) chest pain

GIT (-) anorexia (-) nausea (-) vomiting

Extremities No data

Nervous System No data

 Personal and Social History

Patient is currently 15 years old, he has also a long history of being

neglected due to his circumstance as being an orphan, patient experienced
bullying at a young age. At 6 years old patient was abandoned by his
parents and was placed in the custody of the DSWD, patient also
verbalized that he has no recollection of his family this could be related to
his trauma and/or being abandoned at a young age, due to his upbringing
during his time at DSWD, he lacked the basic moral values in which
resulted to his highly expressive behavior. Patient mentioned being bullied
by a specific individual who in return impacted his trauma in terms of
hearing voices of that same individual. The signs/symptoms above
warrants the patient’s manic episodes. In addition, as time in the DSWD
went on, the presence of this psychotic feature also mentioned that the
patient’s condition was getting severe. To the point that was a danger many
and to himself and thus was moved to a rehabilitation facility.
 Anamnesis

Informant (patient) cannot recall much about his biological family and
early childhood. At the age of 6, the patient is already in custody at DSWD.
He mentioned that he likes keeping himself busy by doing several
recreational activities like drawing, cooking, and playing basketball. After
showing clear manifestations of impaired behavioral patterns, the patient
was admitted to the House of Sarang in order to receive proper psychiatric
aid. He mentioned that he was often bullied and beaten by other kids. The
patient’s condition aggravated as he started showing signs of
hallucinations, delusions, and disorganized behavior and speech. He was
unable to sleep as he was always having nightmares. He also mentioned
throwing up his food everytime he eats, due to his fear of being poisoned
and feelings of being threatened. He was given an appropriate treatment
plan and receives psychotherapy regularly. He has not mentioned any
medication allergies, but has stated that he experiences side effects like
lethargy. The patient mentioned that he is feeling a lot better and stated
that the medication and therapy were really effective.
Mental Status Examination
The patient was sitting down with a slightly slouched posture. The client was seen well-
groomed, with his hair fixed. He was also wearing a decent shirt. He had a blank effect
throughout the interview. On the first day of the interview, he occasionally hesitates but can
answer the questions. But for the following days, he was cooperative with the interviewer.
Speech is loud, has a normal pace, and answers concisely when given a question. Although,
he was cooperative in terms of telling his past till present story. He tries to recall some of
the details that were being asked of him. He was in a light mood and ready to take in some
questions. He was also able to add some information beyond the questions. The
conversation between him and the interviewer was in a good flow. He kept track of all the
questions and stayed on topic. He claims to have auditory and visual hallucinations. The
patient has both auditory and visual hallucinations, delusions, disorganized speech, and
involuntary movements. As verbalized by the patient, he strongly believes that he might
harm other people at the same time he might get hurt or harmed by other people that lead to
him cutting himself. He shows an increase in goal-directed activity. He is certain enough to
say that he is not getting those hallucinations anymore and that he is well. The patient is
somewhat oriented. Past memory is slightly disorganized, he cannot recall every memory
when he was younger. Immediate recall for memory is good.
 Physical Examination

Vital Signs: NOT TESTED

Skin: NOT TESTED
HEENT: NOT TESTED
Chest/Lungs: NOT TESTED
Heart: NOT TESTED
Abdomen: NOT TESTED
Extremities: NOT TESTED
Cranial Nerves: NOT TESTED
 Psychiatric Assessment
To diagnose Paranoid Schizophrenia, CGI-SCH scale is a valid reliable instrument for
evaluating severity and treatment response in schizophrenia. However due to inadequate time &
limited interaction for only twice. We managed to encounter the patient only twice. Lack
appropriate date to determine what subtype.
As noted,the patient was having persecutory delusions, auditory hallucinations and
negative symptoms that had lasted for at six years. Patient also verbally admits to do so.
During the orientation phase, patients is well orientated is usually intact (ie, patients know
who and where they are and what time it is). However the as the conversation, take quite longer,
in few accounts, patient show mild thought blocking, in which long pauses occur before he
answers a question Patient’s speech at times is circumstantial (ie, the patient takes a long time
and uses many words in answering a question).
Upon assessment & during interview, the patient did not show visible restlessness or
distress of hallucinations or respond to auditory or visual stimuli that are not apparent to the
examiner. The patient often has a flat affect (ie, little range of expressed emotion).
 Review of Records

Pertinent Data from the Doctor’s Order

Aside from the medications prescribed to the patient,

he has also undergone psychotherapy or talk therapy.
This therapy session helps eliminate or control
troubling symptoms so that the patient can function
better and can increase well-being and healing.
Significant Diagnostic Tests
 Date Laboratory Normal
Results Significance of the Result Nursing Responsibilities
Performed Test Value

Male: 4.35-5.65 trillion cells/L* (4.35-

Explain test procedure and that
5.65 million cells/mcL**) CBC is important to evaluate blood cells
slight discomfort may be felt when
March 20, 2014 CBC Normal and provide information on infection
skin is punctured. Explain also that
Female: 3.92-5.13 trillion cells/L and inflammation.
fasting is not necessary.
(3.92-5.13 million cells/mcL)

A urinalysis is used to detect and

Instruct the patient to void directly
manage a wide range of disorders, such
into a clean, dry container. Sterile,
The average value for urine pH is 6.0, as urinary tract infections, kidney
disposable containers are
but it can range from 4.5 to 8.0. Urine disease and diabetes. A urinalysis
Not stated Urinalysis Normal recommended. Women should
under 5.0 is acidic, and urine higher involves checking the appearance,
always have a clean-catch specimen
than 8.0 is alkaline, or basic. concentration and content of urine.
if a microscopic examination is
Abnormal urinalysis results may point to
ordered.
a disease or illness.

A fasting blood glucose test can be

A fasting blood sugar level less than
100 mg/dL (5.6 mmol/L) is normal. A
fasting blood sugar level from 100 to
Fasting
Not stated Normal 125 mg/dL (5.6 to 6.9 mmol/L) is
Glucose
considered prediabetes. If it's 126
mg/dL (7 mmol/L) or higher on two
separate tests, you have diabetes.
Apply direct pressure to the
useful to see how well the body is able
venipuncture site until bleeding
to manage blood sugar levels in the
stops.
absence of food. When we do not eat for
Provide a balanced meal or a snack.
several hours, the body will release
Instruct the patient that he may
glucose into the blood via the liver and,
resume his usual medications that
following this, the body's insulin should
were stopped before the test.
help to stabilise blood glucose levels.
 Date Laboratory Normal
Results Significance of the Result Nursing Responsibilities
Performed Test Value

The SGOT test is a blood test. It helps (1) It is a nursing responsibility to

The normal range of an SGOT
to determine how well the liver is ensure that the patient has had the
test is generally between 8 and
functioning by measuring levels of appropriate preparation. For
45 units per liter of serum. In
aspartate aminotransferase in the example: a special diet or fasting.
general, men may naturally
Not stated SGOT Normal have higher amounts of AST in
blood. Too much of this enzyme can (2) It is a nursing responsibility to
indicate a problem, such as liver be aware of the normal and
the blood. A score above 50 for
damage. Aspartate aminotransferase abnormal ranges of blood tests, in
men and 45 for women is high
(AST) is an enzyme primarily found in order to understand the
and may indicate damage.
the liver and heart. significance of the test results.

Proteins called enzymes help the

SGPT exists predominantly in
the liver and leaks into the
bloodstream when produced in
Not stated SGPT Normal excess. The SGPT normal range
is about 7 to 56 units per liter of
blood serum.
These enzymes can be indicative
liver build and break down
of liver disease. However, as stated
proteins. ALT (or SGPT, which
earlier in this text, these enzymes
stands for serum glutamic-pyruvic
are also found in other body
transaminase) is one of these
enzymes. It's found in particularly
tissues such as bone, heart, kidney,
etc. Isoenzyme tests usually must
large amounts in the liver and
be performed in order to isolate
plays an important role in
the isoenzyme that is elevated and
metabolism, the process that
if the source is the liver.
converts food into energy.
Other Diagnostic
Examinations
 Date Laboratory Normal
Results Significance of the Result Nursing Responsibilities
Performed Test Value

Bony structures absorb the most
radiation and appear white on the film.
Hollow structures containing mostly
air, such as the lungs, normally appear
March 20, 2014 Chest x-ray Normal
dark. In a normal chest X-ray, the
chest cavity is outlined on each side
by the white bony structures that
represent the ribs of the chest wall.
A chest x-ray can help rule out other
health conditions that may be behind the
asthma-like symptoms. Asthma may
cause a small increase in the size of the Remove all metallic objects. Provide
lungs (called hyperinflation), A chest X- appropriate clothing.
ray can also make sure you don't have
pneumonia or lung cancer, particularly
in smokers.

Assess the client's medical record

An ECG (electrocardiogram) records the
for information regarding the needs
electrical activity of your heart at rest. It
Normal ECG values for waves and for an ECG. Assess the client's heart
provides information about your heart
intervals are as follows: rate, heart sounds, and blood
rate and rhythm, and shows if there is
Not stated ECG Normal RR interval: 0.6-1.2 seconds. pressure. Assess the client's chest for
enlargement of the heart due to high
P wave: 80 milliseconds. areas of irritation, skin breakdown,
blood pressure (hypertension) or
PR interval: 120-200 milliseconds. or excessive hair growth that may
evidence of a previous heart attack
interfere with the electrode
(myocardial infarction).
placement.
 Psychiatric Assessments DSM 5 or ICD 10

Psychiatric Assessment:
To diagnose Paranoid Schizophrenia, CGI-SCH scale is a valid reliable instrument for
evaluating severity and treatment response in schizophrenia. However due to inadequate time
& limited interaction for only twice. We managed to encounter the patient only twice . Lack
appropriate date to determine what subtype.
As noted,the patient was having persecurtory delusions, auditory hallucinations and
negative symptoms that had lasted for at six years. Patient also verbally admits to do so.
During the orientation phase, patients is well orientated is usually intact (ie, patients know
who and where they are and what time it is). However the as the conversation, take quite
longer, in few accounts, patient show mild thought blocking, in which long pauses occur before
he answers a question Patient’s speech at times is circumstantial (ie, the patient takes a long
time and uses many words in answering a question).
Upon assessment & during interview, the patient did not show visible restlessness or
distress of hallucinations or respond to auditory or visual stimuli that are not apparent to the
examiner. The patient often has a flat affect (ie, little range of expressed emotion).
 Treatment Plan

Treatment plan
1. Resperidon 2 mg tablet, once a day, in the morning
2. levomepromazine 25 mg tablet, at night
3. Biperiden 2mg, one tablet, at night
4. Haloperidol 5 mg , 1 amp, IM (injection) - October 3, 2020
5. Psychotherapy
 Data from Textbook
Schizophrenia - a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia
may seem like they have lost touch with reality, which causes significant distress for the individual, their family members,
and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling.

Diagnostic Criteria are as follows:

a. The presence of one (or more) delusions with a duration of 1 month or longer.
b. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related
to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).
c. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is
not obviously bizarre or odd.
d. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional
periods.
e. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not
better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder
Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality)
disorder. They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized
thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms.

● Delusions - fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of
themes; Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not
derive from ordinary life experiences.
● Hallucinations - perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force
and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but auditory
hallucinations are the most common in schizophrenia and related disorders.
● Negative Symptoms - Negative symptoms account for a substantial portion of the morbidity associated with schizophrenia but
are less prominent in other psychotic disorders. Two negative symptoms are particularly prominent in schizophrenia: diminished
emotional expression and avolition. Diminished emotional expression includes reductions in the expression of emotions in the
face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional
emphasis to speech.
● Disorganized thinking - (formal thought disorder) is typically inferred from the individual's speech. The individual may switch
from one topic to another {derailment or loose associations). Answers to questions may be obliquely related or completely
unrelated (tangentiality). Rarely, speech may be so severely disorganized that it is nearly incomprehensible and resembles
receptive aphasia in its linguistic disorganization {incoherence or "word salad").
● Grossly disorganized or abnormal motor behavior - may manifest itself in a variety of ways, ranging from childlike
"silliness" to unpredictable agitation. Problems may be noted in any form of goal-directed behavior, leading to difficulties in
performing activities of daily living.
PARADIGM OF THE PSYCHO- PATHOPHYSIOLOGY
PARADIGM OF THE PSYCHO- PATHOPHYSIOLOGY
PARADIGM OF THE PSYCHO- PATHOPHYSIOLOGY
PARADIGM OF THE PSYCHO- PATHOPHYSIOLOGY
PARADIGM OF THE PSYCHO- PATHOPHYSIOLOGY
PARADIGM OF THE PSYCHO- PATHOPHYSIOLOGY
 Signs and Symptoms

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

POSITIVE SYMPTOMS

Hallucinations Hallucinations: Dopamine Hypothesis:

● Auditory Auditory The mesolimbic pathway,
● Visual ● “Binubulungan po ako, nagsasabi na saktan mo, patayin mo, batuhin mo. extending from the ventral
May naririnig ako na nagdidikta sa aking isipan kaya po ako ay
● Olfactory nakakapag-laslas sa aking kamay” tegmental area (VTA) to the
● Tactile Visual nucleus accumbens in the
● Gustatory ● “nakakakita po ako ng mga letters, gumagalaw po.” limbic system, plays a role in
● Command ● “minsan po kapag naaapi ako, yung mga tao po na dahilan ng trauma ko, the positive symptoms of
● Illusions ay nakikita ko po sa taong nang-aapi sa akin. Parang nag-iiba po yung schizophrenia in the presence
mukha.”
● “Nakakakita po ako ng mga malalaking tao dati” of excess dopamine.
Olfactory and gustatory
● “Naghahallucinate po ako sa panglasa pati pang-amoy po”
 Signs and Symptoms (CONT’D)

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

POSITIVE SYMPTOMS

Delusions Delusions: Dopamine Hypothesis:

● Ideas of Persecution (paranoia) The mesolimbic pathway,
preference ● “Hirap na hirap na po ako kase, palaging parang ako yung pinapatay o extending from the ventral
kaya ay may papatay saakin, kaya po naiisip ko na palaging may
● Persecution nagmomonitor sa akin. Kaya pag nami-meet ko yung ibang tao, pinag- tegmental area (VTA) to the
(paranoia) iisipan ko na ako ay sasaktan, naiimagine ko po iyon.” nucleus accumbens in the
● Grandiosity Control limbic system, plays a role in
● Nihilistic ● “Pag inuutusan po ako [ng mga bumubulong sakin], nagugulat po ako the positive symptoms of
● Somatic sensations dati kase gumagalaw po ng kusa yung katawan ko” schizophrenia in the presence
● Jealousy of excess dopamine.
● Erotomanic
● Control
 Signs and
Signs and Symptoms
Symptoms (CONT’D)
(CONT’D)

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

POSITIVE SYMPTOMS

Disorganized speech Disorganized speech: Dopamine Hypothesis:

● Flight of ideas Neologisms The mesolimbic pathway,
● Neologisms ● “Ako po ay half-muslim and catholic” extending from the ventral
● Echolalia tegmental area (VTA) to the
● Circumstantiality nucleus accumbens in the
● Tangentiality limbic system, plays a role in
● Symbolic Speech the positive symptoms of
● Clang associations schizophrenia in the presence
● Word salad of excess dopamine.
 Signs and
Signs and Symptoms
Symptoms (CONT’D)
(CONT’D)

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

POSITIVE SYMPTOMS
Bizarre behavior Bizarre behavior: Dopamine Hypothesis:
● Catatonia Impaired impulse control The mesolimbic pathway,
● Motor retardation
● Motor agitation ● “Nasaksak ko po kase yung mukha ng nag-aalga saakin.” extending from the ventral
● Stereotyped behaviors tegmental area (VTA) to the
● Waxy flexibility nucleus accumbens in the
● Echopraxia limbic system, plays a role in
● Negativism the positive symptoms of
● Impaired impulse
control schizophrenia in the presence
● Gesturing or of excess dopamine.
posturing
● Boundary impairment
 Signs and Symptoms (CONT’D)

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

NEGATIVE SYMPTOMS
● Anhedonia (inability to Asociality Dopamine Hypothesis:
experience pleasure or
joy)
● “may mga time na ayaw ko po sumama sa mga crowded na area” Decreased dopamine in the
● Avolition (loss of mesocortical projection to the
motivation) Blunted affect dorsolateral prefrontal cortex
● Asociality (lack of ● The patient lack emotional expression when speaking
involvement in social is postulated to be
relationships of various responsible for negative
kinds) symptoms of schizophrenia.
● Blunted affect
(diminished facial and
emotional expression)
● Apathy (lack of emotion
or interest)
● Alogia (poverty of
thought)
 Signs and Symptoms (CONT’D)

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

COGNITIVE SYMPTOMS

● Inattention, easily Impaired memory Dopamine Hypothesis:

distracted ● “Hindi ko na po maalala kung may mga kapatid po ako eh. Due to prefrontal cortex D1
● Impaired memory Hindi ko po alam.” receptor hypostimulation
● Poor problem ● “Ang naaalala ko lang po ay yung nasa bundok kami ng tatay caused by reduced
solving skills ko”
● Poor decision ● “Hindi ko na po alam ang mukha ng nanay ko” mesocortical dopamine
making skills projections to the
● Illogical thinking dorsolateral prefrontal
● Impaired cortex.
judgement
 Signs and Symptoms (CONT’D)

Signs and symptoms

Signs and symptoms manifested by the client Rationale
found in the book

AFFECTIVE SYMPTOMS

● Dysphoria Dysphoria Dopamine Hypothesis:

● Suicidality ● “Dati po hindi ako makatulog kapag gabi dahil nag Decreased dopamine in the
● Hopelessness hahallucinate po ako” mesocortical projection to the
● “Dati po everytime na kakain po ako ay sinusuka ko yung ventromedial prefrontal
kinain ko.” cortex is postulated to be
● “Dati po puro negative po ang naiisip ko” responsible for affective
symptoms of schizophrenia.
Suicidality
● “May naririnig ako na nagdidikta sa aking isipan kaya po
ako ay nakakapag-laslas sa aking kamay.”
 Problem List
Nursing Diagnoses
Disturbed sensory perception related to biochemical alterations in the
brain of certain neurotransmitters as evidenced by auditory and visual
hallucinations

Disturbed thought process related to overwhelming stressful life events as

evidenced by delusions

Impaired social interaction related to feeling threatened in social situations

as evidenced by verbalized discomfort in social situations and spending time
alone

Impaired verbal communication related to biochemical alterations in the

brain of certain neurotransmitters as evidenced by difficulty in discerning
and maintaining the usual communication pattern

Risk for self-directed or other-directed violence related to impulse

control and command hallucinations
Psychiatric Nursing Care Plan
 Nursing Diagnosis
Disturbed sensory perception related
to biochemical alterations in the
brain of certain neurotransmitters as
evidenced by auditory and visual
hallucinations
Subjective cues:
The patient verbalized:
- “Binubulungan po ako,
nagsasabi na saktan mo, patayin
mo, batuhin mo. May naririnig
ako na nagdidikta sa aking
isipan kaya po ako ay
nakakapag-laslas sa aking
kamay”
- “Nakakakita po ako ng mga
letters, gumagalaw po.”
- “minsan po kapag inaapi ako,
yung mga tao po na dahilan ng
trauma ko, ay nakikita ko po sa
taong nang-aapi sa akin. Parang
nag-iiba po yung mukha.”
- “Nakakakita po ako ng mga
malalaking tao dati”
Goals/Objective
Short term goal:
After 8 hours of nursing
intervention, the client will:
Maintain orientation to
time, place, person, and
circumstances for a
specified period of time.
Divert attention away from
hallucinations
Identify activities that
would help keep attention
away from hallucinations
Long-term goal:
Within each day, the client
will:
Be oriented with time,
place, person, and
circumstances for a
specified amount of time.
Decrease or cease
recurrence of hallucination
Manage self through
activities that would divert
attention away from
hallucinations.
Nursing Intervention Rationale
Independent 1. Decrease the potential
1. Decrease the amount of stimuli in for anxiety that might
the client's environment (e.g., low trigger hallucinations.
noise level, few people, simple Helps calm the client.
decor). 2. Validating that your
2. Accept the fact that the voices are reality does not include
real to the client, but explain that voices can help client
you do not hear the voices. Refer to cast “doubt” on the
the voices as “your voices” or validity of his voice.
“voices that you hear”. 3. Maintain reality
3. Maintain reality through through reorientation
reorientation and focus on real and focus on real
situations and people. situations and people.
4. Stay with clients when they are 4. The client can
starting to hallucinate, and direct sometimes learn to push
them to tell the “voices they hear” to voices aside when given
go away. Repeat often in a matter- repeated instructions.
of-fact manner. especially within the
framework of a trusting
relationship.
Evaluation
Short term goal: Met
After 8 hours of nursing
intervention, the client
was able to::
a. Maintain
orientation to time,
place, person, and
circumstances for a
specified period of
time.
b. Divert attention
away from
hallucinations
c. Identify activities
that would help
keep attention
away from
hallucinations
Nursing Diagnosis Goals/Objective Nursing Intervention Rationale
5. Work with the client to find which 1. If clients’ stress triggers
activities help reduce anxiety and hallucinatory activity,
distract the client from a they might be more
hallucinatory material. Practice new motivated to find ways
skills with the client. to remove themselves
6. Engage client in reality-based from a stressful
activities such as card playing, environment or try
writing, drawing, doing simple arts distraction techniques.
and crafts or listening to music. 2. Redirecting the client’s
energies to acceptable
Dependent: activities can decrease
7. Intervene with one-on-one, the possibility of acting
seclusion, or PRN medication (As on hallucinations and
ordered) when appropriate. help distract from
voices.
Dependent:
3. Intervene before anxiety
begins to escalate. If the
client is already out of
control, use chemical or
physical restraints
following unit protocols.
Evaluation
Long-term goal: Met
Within each day, the client
was able to::
a. Be oriented with time,
place, person, and
circumstances for a
specified amount of
time.
b. Decrease or cease
recurrence of
hallucination
c. Manage self through
activities that would
divert attention away
from hallucinations.
 Nursing Diagnosis
Disturbed thought process
related to overwhelming
stressful life events as
evidenced by delusions
Subjective Data:
“Parang nagagalit ako”
ayan ang mga sinasabi nya.
“May naririnig ako na
nagdidikta sa aking isipan
kaya po ako ay nakakapag-
laslas saaking kamay.
Sobrang galit ko po at
naririnig ko ang boses ni
Mario, sya po ang aking
kagalit. Hinahampas ako ng
cabinet. Kaya everytime na
may nagbubullly sa akin,
nananakit o lumalaban din
po ako. Pati na nga po ang
sarili ko ay sinasaktan ko”
Goals/Objective Nursing Intervention Rationale Evaluation
After the nursing intervention Independent: 1. Important clues to After following the
the patient will be able to: 1. Attempt to understand the underlying fears nursing intervention the
1. demonstrate decreased significance of these beliefs and issues can be patient was able to:
anxiety level. to the patient at the time of found in the
2. Will refrain from acting their presentation. patient’s seemingly 1. Demonstrate
on delusional thinking. 2. Recognizes the patient’s illogical fantasies. decreased anxiety levels
3. will develop trust in at delusions as the patient’s 2. Recognizing the 2. Patient refrain from
least one staff member perception of the patient’s perception acting on delusional
within 1 week. environment. can help you thinking
4. Will be able to talk 3. Interact with the patient on understand the 3. Patient is able to talk
about concrete the basis of things in the feelings he or she is about concrete
happenings in the environment, try to distract experiencing. happenings in the
environment without the patient from their 3. When thinking is environment without
talking about delusions delusions by engaging in focused on reality- talking about delusions
for 5 minutes. reality-based activities (e.g., based activities, the for 5 minutes
5. Will be able to card games, simple arts and patient is free of 4. Was able to
demonstrate two crafts projects etc). delusional thinking demonstrate two
effective coping skills during that time. effective coping
that minimize Helps focus mechanism that
delusional thoughts. attention externally. minimizes delusional
thinking
5. Patient is able to trust
1 staff member the day
Nursing Diagnosis Goals/Objective Nursing Intervention
4. Do not touch the client; use
gestures carefully.
5. Initially do not argue with
the client’s beliefs or try to
convince the client that the
delusions are false and unreal.
Rationale Evaluation
4. Suspicious clients
might misinterpret touch
as either aggressive or
sexual in nature and
might interpret it as a
threatening gesture.
People who are psychotic
need a lot of personal
space.
5. Arguing will only
increases the patient’s
defensive position,
thereby reinforcing false
beliefs. This will result in
the client feeling even
more isolated and
misunderstood.
 Nursing Diagnosis
Impaired social interaction related to
feeling threatened in social situations
as evidenced by verbalized
discomfort in social situations and
spending time alone
Subjective cues:
The patient verbalized:
- “May mga time na ayaw ko
po sumama sa mga crowded
na area.”
- “Takot po kasi akong
masaktan ko sila.”
- “Binubulungan po ako
(from auditory
hallucination). Sinasabi po
na pataying mo… Saktan
mo, batuhin mo (pertaining
to the people around him)”
- “Kapag naaapi po ako,
parang gumagana po yung
adrenaline rush ko. Tapos
parang gusto ko pong
gantihan yung mga nag-
aapi sa akin.”
Goals/Objective
After following appropriate
nursing interventions, the
patient will be able to:
a. attend one structured
group
activity within 5-7 days
b. seek out supportive social
contacts
c. improve social interaction
with people that surrounds
him
d. use appropriate social
skills in interactions
e. engage in one activity
with a nurse by the end of
the day
f. demonstrate interest to
start coping skills training
when ready for learning
g. state that he is
comfortable in at least 3
structured activities that are
goal directed
h. use appropriate skills to
initiate and maintain an
interaction
Nursing Intervention
Independent:
1. Identify with client,
symptoms he experiences
when he begins to feel
anxious around others.
2. Keep the client in an
environment as free of stimuli
(loud noises, crowding) as
possible.
3. Structure times each day to
include planned times for
brief interactions and
activities with the client on
one-on-one basis.
4. If the client is found to be
very paranoid, solitary
activities that require
concentration are
appropriate. If the client is
delusional/hallucinating,
provide very simple concrete
activities with the client.
Rationale Evaluation
1. Increased anxiety can Goals/objectives: Met
intensify agitation, After following appropriate
aggressiveness, and nursing interventions, the
suspiciousness. patient will be able to:
2. The client might
respond to noises and a. attend one structured
crowding with agitation, group
anxiety, and increased activity within 5-7 days
inability to concentrate b. seek out supportive social
on outside events. contacts
3. Helps the client to c. improve social interaction
develop a sense of safety with people that surrounds
in a non-threatening him
environment. d. use appropriate social
4. The client is free to skills in interactions
choose his level of e. engage in one activity
interaction. However, with a nurse by the end of
concentration can help the day
minimize distressing f. demonstrate interest to
paranoid thoughts or start coping skills training
voice, while simple when ready for learning
activities help draw the g. state that he is
client away from comfortable in at least 3
delusional thinking into structures activities that are
reality. goal directed
h. use appropriate skills to
initiate and maintain an
interaction
Nursing Diagnosis Goals/Objective Nursing Intervention
5. Teach the client to remove himself
briefly when feeling agitated and work
on some anxiety relief exercises.
6. As the client progresses, provide the
client with graded activities according
to the level of tolerance.
Dependent:
7. Administer Risperidon 2 mg tablet,
once a day, in the morning, as
prescribed.
8. Administer haloperidol 5 mg , 1 amp,
IM (injection), as prescribed.
Rationale Evaluation
5. Teaching the client skills
in dealing with anxiety,
increases a sense of control.
6. Gradually, the client
learns to feel safe and
competent with increased
social demands
7. This medication, used to
treat schizophrenia, can
help the patient think
clearly and take part in
everyday life.
8. This medication is used
to treat a range of
disruptive disorders and
behavior problems.
 Nursing Diagnosis
Impaired verbal
communication related to
biochemical alterations in the
brain of certain
neurotransmitters as evidenced
by difficulty in discerning and
maintaining the usual
communication pattern
Subjective data:
“Kapag naaapi po ako, parang
gumagana po yung adrenaline
rush ko . Tapos parang gusto ko
pong gantihan yung mga nag-
aapi sa akin. Tapos minsan po
kapag naaapi ako, yung mga tao
po na dahilan ng trauma ko, ay
nakikita ko po sa taong nang-
aapi saakin. Parang nag-iiba po
yung mukha.”
“Palakaibigan naman po pero
may mga time na ayaw ko po
sumama sa mga crowded na
area.”
Goals/Objective Nursing Intervention Rationale Evaluation
After the nursing intervention, the 1. Assess if incoherence in speech is 1. Establishing a baseline Goals/Objectives: Met
patient will be able to: chronic or if it is more sudden, as in facilitates the establishment
1. Express thoughts and an exacerbation of symptoms. of realistic goals, the After the nursing
foundation for planning
feelings in a coherent, 2. Identify the duration of the interventions, the patient
effective care.
logical, goal-directed psychotic medication of the client. 2. Therapeutic levels of an was able to:
manner. 3. Keep voice in a low manner and antipsychotic aids clear
2. Demonstrate reality-based speak slowly as much as possible. thinking and diminishes 1. Express his thoughts and
thought processes in 4. Keep the environment calm, derailment or looseness of feelings in a coherent,
verbal communication. quiet and as free of stimuli as association. logical, goal-directed
3. Communicate in a manner possible. 3. A high-pitched/loud tone manner.
that can be understood by 5. Plan short, frequent periods with of voice can elevate anxiety
levels while slow speaking
others with the help of a client throughout the day. 2. Demonstrated reality-
aids understanding.
medication and attentive 6. Use clear or simple words, and 4. Keep anxiety from based thought processes in
listening by the time of keep directions simple as well. escalating and increasing verbal communication.
discharge. 7. Use simple, concrete, and literal confusion and
4. Learn one or two explanations. hallucinations/delusions 3. Communicated in a
diversionary tactics that 5. Short periods are less manner that can be
work for him/her to stressful, and periodic understood by others with
decrease anxiety, hence meetings give a client a the help of medication and
chance to develop familiarity
improving the ability to attentive listening by the
and safety.
think clearly and speak 6. The client might have time of discharge.
more logically. difficulty processing even
simple sentences. 4. Learned one or two
7. Minimizes diversionary tactics that
misunderstanding and/or work for him/her to
incorporating those decrease anxiety, hence
misunderstandings into improving the ability to
delusional systems.
think clearly and speak
more logically.
 Nursing Diagnosis
Risk for self-directed or
other-directed violence maybe
related to impulse control and
command hallucinations
Goals/Objective
After nursing interventions, the
client will be able to:
a. Patient will verbalize control of
feelings
b.Demonstrate self-control
c. Express realistic self-evaluation
and increased sense of self-esteem
d. Patient will seek help when
experiencing aggressive impulses.
e. Patient will refrain from verbal
threats and loud, profane
language toward others.
f. Patient will be safe and free
from injury.
Nursing Intervention
Independent:
1. Develop therapeutic nurse-
client relationships. Provide a
consistent caregiver when
possible.
2. Decrease environmental
stimuli (e.g., by providing a
calming environment or
assigning a private room)
3. Frequently assess client’s
behavior for signs of increased
agitation and hyperactivity.
4. Help client identify more
appropriate solutions or
behaviors (e.g., motor activities,
exercise)
5. Give the client as much control
as possible within the constraints
of the individual situation.
Rationale
1. Promotes a sense of trust,
allowing client to discuss
feelings openly.
2. Helps decrease escalation
of anxiety and manic
symptoms.
3. Early detection and
intervention of escalating
mania will prevent the
possibility of harm to self or
others, and decrease the
need for seclusions.
4. To lessen sense of anxiety
and associated physical
manifestation.
5. Enhances self-esteem,
promotes confidence in
ability to change behavior.
Evaluation
Goals/Objectives: Met
After nursing
interventions, patient
was able to:
a. verbalized control of
feelings
b. demonstrate self-
control as evidenced by
relaxed posture,
nonviolent behavior.
c. convey self-control
and enhance their sense
of self-esteem.
d. patient willingly asks
help when experiencing
aggressive impulses
e. withhold from verbal
threats and loud,
profane language,
toward others.
f. safe and free from
injury.
Nursing Diagnosis Goals/Objective Nursing Intervention
. 6. Assist the individual to understand
that angry, vengeful feelings are
appropriate in the situation but needed
to be expressed and not acted on.
7. Discuss reasons for client’s behavior
with significant others. Determine
desire and commitment of involved
parties to sustain current relationships.
Rationale Evaluation
6. Helps the client accept
feelings as natural and
begin to learn effective
coping skills and promotes
a sense of control over
situations.
7. Family
members/guardians may
believe an individual is
purposefully behaving in
angry ways, and
understanding underlying
reasons for behavior can
defuse feelings of anger on
their part, leading to
willingness to resolve
problems.
DRUG STUDY
 Classification/Act
Drug Indication Side-effect Nursing Responsibilities
ion

Risperidon 2 mg Therapeutic class: Treatment for schizophrenia (in - nausea 1. Obtain baseline BP measurements
tablet, once a day, in Antipsychotics adults and children aged 13 and - vomiting before starting therapy, and monitor
the morning up), bipolar I acute manic or - diarrhea BP regularly. Watch for orthostatic
Pharmacologic class: mixed episodes as monotherapy - constipation hypotension, especially during first
risperiDONE Benzisoxazole derivatives (in adults and children aged 10 - heartburn dosage adjustment.
(Risperidal, and up), bipolar I acute manic or - dry mouth 2. Monitor patients for tardive
Risperidal Consta, Action: mixed episodes adjunctive with - increased saliva dyskinesia, which may occur after
Risperidal M- TAB) Blocks dopamine, 5-HT lithium or valproate (in adults), - increased appetite prolonged use. It may not appear
(hydroxytryptamine)2, and autism-associated irritability - weight gain until months or years later and may
alpha1, and alpha2 (in children aged 5 and up). - stomach pain disappear until months or years later
adrenergic, and H1 - anxiety and may disappear spontaneously or
histaminergic receptors It is also known as a second - agitation persist for life, despite stopping drug.
in the brain. generation antipsychotic (SGA) or - restlessness ● Watch for evidence of NMS
atypical antipsychotic. - dreaming more than usual (Extrapyramidal effects,
Risperidone rebalances dopamine - difficulty falling asleep or staying hyperthermia, autonomic
and serotonin to improve asleep disturbance), which is rare
thinking, mood, and behavior. - breast enlargement or discharge but can be fatal
- late or missed menstrual periods 3. Life-threatening hyperglycemia
- decreased sexual ability may occur in patients taking atypical
- vision problems antipsychotics. Monitor patients with
- muscle or joint pain diabetes regularly.
dry or discolored skin ● Monitor patient for
- difficulty urinating symptoms of metabolic
- dizziness, feeling unsteady, or syndrome (significant weight
having trouble keeping your gain and increased BMI,
balance HTN, hypertriglyceridemia)
 Classification/Acti
Drug Indication Side-effect Nursing Responsibilities
on

4. Periodically evaluate drug’s risks and

benefits, especially during prolonged use.
5. Patients experiencing persistent
somnolence may benefit from administering
half the daily P.O., dose b.i.d.
6. Monitor patient weight gain
7. Complete fall risk assessments when
initiating treatment and recurrently for
patients on long-term therapy, especially for
elderly patients and patients with diseases,
conditions, or whose are taking other drugs
that could increase fall risk.
P.O.
- Give drug without regard for meals
- Oral solutions aren't compatible with cola
or tea.
- Open package for ODT’s immediately
before giving by peeling off foil backing with
dry hands. Don’t push tablets through the
foil. ODT’s can be swallowed with or
without liquid.
 Drug Classification/Action Indication Side-effect Nursing Responsibilities

Levomepromazine Therapeutic Class: Antipsychotic
25 mg tablet, at agent
night
Pharmacologic Class: Phenothiazine
(Nozinan,
Levoprome, Levomepromazine is a
Detenler, Hirnamin, phenothiazine and typical
Levotomin and antipsychotic agent, with
Neurocil) sedative/hypnotic, anxiolytic,
antiemetic, analgesic and
antipsychotic activities. Although
the exact mechanism of action of
levomepromazine is not fully known,
upon administration, this agent
appears to act as an antagonist for a
variety of receptors in the central
nervous system (CNS), including
adrenergic, dopamine, histamine,
cholinergic and serotonin (5-
hydroxytryptamine; 5-HT)
receptors. Blocking these receptors
results in levomepromazine's
pharmacologic effects.
Levomepromazine is a - difficulty breathing or
phenothiazine used swallowing,
widely in palliative care - swelling of the face, lips, tongue
to treat intractable or throat
nausea or vomiting, and - severe itching of the skin, with a
for severe red rash or raised lumps.
delirium/agitation in the - sleepiness
last days of life. - dry mouth
- weakness
Levomepromazine is - low blood pressure, especially in
comparable to elderly patients
chlorpromazine in its heat stroke
efficacy and caused less alteration of heart rhythm
extrapyramidal side - stiffness,
effects compared with - shaking (tremor) or slow
haloperidol and movements
chlorpromazine, you have a fit (seizure)
clinicians could consider - blood abnormalities
it as another drug - constipation, which may become
available for the severe and stop food moving
treatment of through the bowel
schizophrenia. - heart palpitations (usually rapid
or irregular heartbeats)
- jaundice (yellowing of the skin
and eyes)
1. Carefully supervise ambulation for
at least 6 h, but preferably 12 h.
Orthostatic hypotension with faintness,
weakness, and dizziness may occur
within 10–20 min after drug
administration and may last 4–6 h and
occasionally as long as 12 h. Tolerance
to effects usually develops with
successive doses.
2. Excessive sedation and amnesia also
occur commonly during early drug
therapy.
3. Assess BP and pulse frequently until
dosage requirements and response are
stabilized. 4. Monitor older adult and
debilitated patients closely.
5. Methotrimeprazine injection
contains a bisulfite, an allergen for
some patients.
6. Do not treat severe hypotension with
epinephrine; it is specifically
contraindicated.
 Nursing
Drug Classification/Action Indication Side-effect
Responsibilities

Biperidon Therapeutic class: Antipsychotics Biperiden is also used Biperiden: Instruct patient to
(Akineton) to control severe Incidence not known
report other
Pharmacologic Class: - Anxiety
muscle reactions and - chest pain or discomfort bothersome side
anticholinergic agent other side effects from - chills effects, including
Action:
certain medicines that - cold sweats
severe or prolonged
are used to treat - confusion
- confusion about identity, place, and time headache, vision
severe nausea or
Parkinsonism is thought to result nervous, mental, or
- decrease in frequency of urination problems, decreased
decrease in urine volume
from an imbalance between the emotional conditions - difficulty in passing urine (dribbling)
sweating, urinary
excitatory (cholinergic) and - disturbed behavior problems (hesitancy,
inhibitory (dopaminergic) systems dizziness, faintness, or lightheadedness when retention), or GI
in the corpus striatum. The getting up from a lying or sitting position
mechanism of action of centrally - dry mouth
problems (nausea,
active anticholinergic drugs such - false or unusual sense of well-being constipation, dry
as biperiden is considered to relate - hyperventilation mouth).
to competitive antagonism of - irregular heartbeats
acetylcholine at cholinergic - irregular, twisting uncontrolled movement
receptors in the corpus striatum, of the face, hands, arms, or legs
- irritability
which then restores the balance. - nervousness
- painful urination
- restlessness
- shaking
- shortness of breath
- slow or irregular heartbeat
- trouble sleeping
- unusual tiredness
 Classification/Ac
Drug Indication Side-effect Nursing Responsibilities
tion

haloperidol 5 mg Therapeutic class: Use of haloperidol is for
, 1 amp, IM Antipsychotics schizophrenia, Tourette
(injection) syndrome (control of tics
Pharmacologic Class: and vocal utterances in
(Haloperidol Butyrophenone adults and children),
decanoate & derivatives hyperactivity (which may
haloperidol present as impulsivity,
lactate) Action: difficulty maintaining
A butyrophenone that attention, severe
probably exerts aggressivity, mood
antipsychotic effects instability, and frustration
by blocking intolerance), severe
postsynaptic childhood behavioral
dopamine receptors in problems (such as
the brain. combative, explosive
hyperexcitability),
intractable hiccups. It is a
typical antipsychotic
because it works on positive
symptoms of schizophrenia,
such as hallucinations and
delusions.
Extrapyramidal symptoms:
- Acute Dystonia: (Develops within
hours to days of initiation. Maybe
presented as muscle spasm, stiffness,
oculogyric crisis)
-Akathisia: (Develops within days to
months of use of haloperidol -
characterized by restlessness.)
- Neuroleptic malignant syndrome:
(NMS; infrequent but severe
condition. May present as High fever,
muscle rigidity)
-Parkinsonism: (Develops after days
to month use of haloperidol)
- Tardive dyskinesia: (Develops after
years. Presents as chore especially
orofacial region)
1. Monitor patients for tardive
dyskinesia, which may occur after
prolonged use. It may not appear
until months or years later and may
disappear spontaneously or persist
for life, despite ending drug.
● Watch for signs and
symptoms of NMS
(extrapyramidal effects,
hyperthermia, autoimmune
disturbance), which is rare
but commonly fatal.
2. Don’t withdraw drug abruptly
unless required by severe adverse
reactions.
3. Complete fall risk assessments at
start of antipsychotic treatment and
recurrently for patients on-long
term therapy, especially those at
increased risk for falls.
 Classification/Act
Drug Indication Side-effect Nursing Responsibilities
ion

It is also known Common: 4. Esophageal dysmotility and aspiration

-Anticholinergic effects: (Elevated can occur. Use cautiously in patients at
as a first temperature, dry mouth, drowsiness or risk for aspiration (those with
sedation, constipation, urinary pneumonia and/or alzheimer disease)
generation retention) 5. Advise the patient to report all adverse
antipsychotic Sedation reactions
- Weight gain 6. Although drugs are the least sedating
(FGA) or typical - Erectile dysfunction in male of the antipsychotics, warn patients to
antipsychotic. -Oligomenorrhea or amenorrhea in avoid activities that require alertness
female and good coordination until effects of the
Haloperidol drug are known. Drowsiness and
rebalances dizziness usually subside after a few
weeks.
dopamine to 7. Advise the patient that the drug may
improve cause somnolence, orthostatic
hypotension, and motor and sensory
thinking, mood, instability, which may lead to falls.
8. Warn patient to avoid alcohol during
and behavior. therapy.
Health Teaching Guide
● Medication
● Treatment
● Diet
● Spiritual Care
● Follow-up Check up/Referrals
 Topic: Pharmacotherapy
Objectives
To assess the level of understanding &
awareness of the patient in compliance of
pharmaco-therapeutic care
Describes the intention to follow
prescribed regimen..
Content
- Assess the patient’s knowledge regarding his
prescribed medications.
- Identify patient’s understanding of common
medical terminology, such as “empty
stomach,” “emesis,” and “palpation.”
- Discuss the importance of patient education
in the safe and efficient administration of
drugs (e.g., prescription drugs, over-the-
counter drugs, herbal preparations, dietary
supplements).
-Educate the patient on 3 risks and 3 benefits
of adhering to the medication regime.
-Discuss how the patient’s medications work
& why should it be taken
on a desired time.
-Explain the side effects of the medications.
Teaching Strategy Evaluation
Q&A Respond to questions regarding
Discussion with reading & writing compliane of pharmacotherapy.
materials.
Be sure that written and verbal
instructions are available in the
language that the patient prefer.
For the adolescent, be sure to Patient performed return demonstration
provide clear and simple directions of medication inventory.
for each medication, including
clarification of information that
may well be misinterpreted.

Objectives
Describes or demonstrates required
competencies
Identifies appropriate resources.
Topic: Pharmacotherapy
Content
-Provide a checklist for medications
-Perform drug inventory with the patient &
make the patient preform a return
demonstration.
-Discuss the effect proper nutrition, diet &
lifestyle in taking medications
-Provide important key pointers on what food
& drink can alter the effect of the medication
prescribed.
-Advise the patient to observe physical
changes from the medication & encourage to
notify the physician or care taker when felt
worsened.
Teaching Strategy Evaluation
Discussion with Nanda & Patient states at least 5 about the desired
Small hand carry white board. time, date & some foods to avoid in
Use readability tools in the
taking medications.
development of patient education
materials if you are involved in this
process. Several tools are available,
such as the SMOG (Simple Measure
of Gobbledygook) readability
measure and the Fry readability
formula. It is important to know
that evidenced-based measures
State contact person & physician’s
contact or name to obtain assistance
when the patient will experience altered
physical changes that can hinder his
daily lifestyle.
 Topic: Treatment Health Teaching
Objectives
Vocational rehabilitation to help
individuals with schizophrenia obtain
work
Increase client’s compliance to treatment
and nursing plan
Content
The key to effective communication is to keep
your statements focused on reality. Do not
agree or disagree with the hallucination or
delusion. Rather than probing for
information about the delusion or
hallucination, it’s important to reinforce
anything that is grounded in reality. You
should state what your reality is in a non-
confrontational manner while respecting the
individual’s feelings.
- Establish trust and rapport. Don’t 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.
- Promote compliance and monitor drug therapy.
Administer prescribed drugs and encourage the
patient to comply. Ensure that the patient is really
taking the drug.
- Observe for manifestations that warrant
hypersensitivity reactions and toxicity.
Teaching Strategy
One-on-one communication. For
example, “I don’t see the snakes,
John. Do they frighten you?” Be
sure to speak slowly and calmly in a
non-judgmental manner. Avoid
quick movements and touching and
always have the exit easily
accessible so you can’t get cornered
by an angry patient having a
psychotic episode.
Going through the nursing plan as
well as the treatment plan with the
patient. Other treatments include
compliance promotion programs,
psychosocial treatment and
rehabilitation, vocational
counseling, supportive
psychotherapy, and appropriate use
of community resources.
Evaluation
The following are to be documented in
the patient’s chart:
Document the assessed presenting signs
and symptoms (e.g., positive and
negative signs).
In instituting suicide precaution,
document behavior and your
precautions.
In instituting homicide precaution,
document the patient's comment and
who was notified. Be sure to notify the
doctor and the potential victim.
Evaluate effectiveness of drug therapy
(absence of acute episodes and psychotic
symptoms).
Evaluate compliance to health
instructions (taking medications on time,
showing independence in activities,
involvement of family).
Level of patient’s functioning (ability to
engage in social interactions).
Patient’s mental status (oriented to
reality).
 Topic: Diet Health Teaching
Objectives
The patient will understand the
importance of having a proper diet as
bad eating habits often lead to other
health problems.
The patient will be able to list which
foods to eat and are considered healthy
and beneficial.
The patient will be able to list which
foods to avoid and are bad for his health.
Limit and reduce intake of the following:
Content Teaching Strategy Evaluation
● What consists of a healthy and ● Discussion with question and After the health teaching, the patient was
proper diet answer able to understand the importance of
● How diet affects the patient’s ● Pictures of foods as visual aids having a proper diet as bad eating habits
condition often lead to other health problems.
● Health problems and
complications related to bad
eating habits
● Fiber-rich diet and its benefits ● Discussion with question and After the health teaching, the patient was
● Low fat and calorie diet and its answer able to list which foods to eat and are
benefits ● Pictures of foods as visual aids considered healthy and beneficial.
● Heart-healthy diet and its
benefits
● A healthy body weight
● Adequate polyunsaturated
fatty acid levels
● Vitamin supplementation
● Health risks: blood sugar ● Discussion with question and After the health teaching, the patient was
problems and diabetes answer able to list which foods to avoid and are
● Pictures of foods as visual aids bad for his health.
● Refined sugars
● Refined carbohydrates
● Caffeine and stimulant drugs
 Topic: Spiritual Care Health Teaching
Objectives
The patient should be able to
verbalize their thoughts and share
their feelings on their situation.
The patient verbalized increase of
connectedness and hope for future
Demonstrate ability to help self and
participate in care
Content
1. Conducting a Spiritual History:
This is a more in-depth tool that
assesses the religious/spiritual
background of the patient and
determines what type of support is
potentially most helpful.
2. Observe clients for self-esteem,
self-worth, feelings of futility, or
hopelessness.
3. Monitor client’s support systems.
Teaching Strategy Evaluation
Discussion with the client and if Client responds to activities given
possible with family members.
Client verbalized increased sense of
Plan and schedule with the client and connectedness and hope for future.
with the family or guardian.
Clients participate in activities with
others and actively seek
relationships.

4. Be physically present and

available to help clients determine
religious and spiritual needs.

5.Discuss client’s spiritual

commitment, beliefs, and values.
 Topic: Follow-up Check up/Referrals Health Teaching

Objectives Content Teaching Strategy Evaluation

At the end of the health Tell the patient to seek Direct teaching and guided After the health teaching, the
teaching, the patient and will immediate medical care if: approach patient was able to
be able to ● He is thinking a. verbalize at least
a. verbalize at least about suicide or are three signs and
three signs and threatening suicide. symptoms of when
symptoms of when ● He feels like hurting to seek immediate
to seek immediate yourself or someone medical care
medical care else.
● He hears voices.
● He thinks someone
is trying to harm
you.
● He cannot
concentrate or are
easily confused.
 References
● What is Psychotherapy? (2016). Psychiatry.org. https://www.psychiatry.org/patients-families/psychotherapy
● Schizophrenia | Nutrition Guide for Clinicians. (2013). Pcrm.org. https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342091/all/Schizophrenia
● ‌https://www.facebook.com/WebMD. (2019). What to Eat When You Have Schizophrenia. WebMD. https://www.webmd.com/schizophrenia/ss/slideshow-best-nutrition-for-schizophrenia
● ‌Schizophrenia and Psychosis - Food for the Brain. (2020, June 18). Food for the Brain. https://foodforthebrain.org/condition/schizophrenia-and-psychosis/#:~:text=The%20incidence%20of%20blood
%20sugar,a%20low%20glycemic%20load%20diet.
● McNeil, S. E. (2021, March 7). Risperidone. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459313/.
● U.S. National Library of Medicine. (n.d.). Risperidone: MedlinePlus Drug Information. MedlinePlus. https://medlineplus.gov/druginfo/meds/a694015.html.
● Nozinan 25 mg Tablets. Nozinan 25 mg Tablets - Patient Information Leaflet (PIL) - (emc). (n.d.). https://www.medicines.org.uk/emc/product/1429/pil#gref.  
● U.S. National Library of Medicine. (n.d.). Levomepromazine. National Center for Biotechnology Information. PubChem Compound Database.
https://pubchem.ncbi.nlm.nih.gov/compound/Levomepromazine#section=Names-and-Identifiers. 
● Availability. METHOTRIMEPRAZINE. (n.d.). http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/M047.html.  
● 6 Schizophrenia Nursing Care Plans. (2016, September 14). Nurseslabs. https://nurseslabs.com/schizophrenia-nursing-care-plans/2/
● ‌Rahman, S. (2021, February 19). Haloperidol. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560892/. 
● The Role of Nurses in Providing Spiritual Care to Patients: An Overview. The Role of Nurses in Providing Spiritual Care to Patients: An Overview | Journal of Nursing. Nursing Journals : American
Society of Registered Nurses. (n.d.). https://www.asrn.org/journal-nursing/1781-the-role-of-nurses-in-providing-spiritual-care-to-patients-an-overview.html#:~:text=(c)%20Providing%20a%20Range
%20of,spiritual%20care%20to%20the%20patient.&text=Sometimes%20patients%20ask%20the%20nurse%20to%20pray%20with%20them.
● Dilip V. J et al. (2013) Diagnostic and statistical manual of mental disorders, from https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf
● Woods, A. (2020). Nursing 2020: Drug Handbook (Vol. 1). Quezon City: C&E Publishing.
● Woods, A. (2020). Nursing 2020: Drug Handbook (Vol. 2). Quezon City: C&E Publishing.
● Risperidone (Risperdal). NAMI. (n.d.). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Risperidone-(Risperdal)#:~:text=Risperidone%20is
%20a%20medication%20that,thinking%2C%20mood%2C%20and%20behavior.
● Sivaraman, P., Rattehalli, R., & Jayaram, M. (2012, March). Levomepromazine for schizophrenia. Schizophrenia bulletin.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283151/#:~:text=Levomepromazine%20is%20comparable%20to%20chlorpromazine,for%20the%20treatment%20of%20schizophrenia.
● Haloperidol (Haldol). NAMI. (n.d.). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Haloperidol-(Haldol)#:~:text=Haloperidol%20is%20a
%20medication%20that,thinking%2C%20mood%2C%20and%20behavior.
● Mayo Foundation for Medical Education and Research. (2021, February 1). Biperiden (Oral Route) Description and Brand Names. Mayo Clinic. https://www.mayoclinic.org/drugs-
supplements/biperiden-oral-route/description/drg-20072620.
● Mayo Foundation for Medical Education and Research. (2021, February 1). Biperiden (Oral Route) Side Effects. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/biperiden-oral-route/side-
effects/drg-20072620.
● Biperiden. Biperiden | Davis's Drug Guide for Rehabilitation Professionals | F.A. Davis PT Collection | McGraw-Hill Medical. (n.d.). https://fadavispt.mhmedical.com/content.aspx?
bookid=1873§ionid=139003188#:~:text=Instruct%20patient%20to%20report%20other,%2C%20constipation%2C%20dry%20mouth).
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 01
A COMPLETE OVERVIEW
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INTRODUC
TION

Venus has a beautiful name and is the

second planet from the Sun. It’s terribly
hot—even hotter than Mercury—and its
atmosphere is extremely poisonous. It’s
the second-brightest natural object in the
night sky after the Moon
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WHAT IS
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ABOUT?
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say that it’s the closest planet to the
Sun and the smallest one in the
Solar System
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DEFINITION OF
CONCEPTS
MARS SATURN
Mars is actually a cold It’s composed mostly of
place hydrogen

MERCURY VENUS
Mercury is the closest Venus is has a beautiful
planet name
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FEATURES OF THE
TOPIC

mercury jupiter venus

Mercury is the closest It’s a gas giant and Venus is the second
planet to the Sun the biggest planet in planet from the Sun
the Solar System
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 9,200 km
Venus has a beautiful name

15 mm
Saturn is a gas giant and has rings

67,700
Despite being red, Mars is cold
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PRACTICAL USES

MERCURY VENUS MARS

It’s the smallest Venus has a Despite being red,
planet of them all beautiful name Mars is cold

JUPITER SATURN NEPTUNE

It’s the biggest planet It’s a gas giant and It’s the farthest one
of them all has rings from the Sun
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 Despite being red, Mars is
actually a cold place. It’s
full of iron oxide dust,
which gives the planet its
reddish cast

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 DID YOU KNOW THIS?

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important
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important
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 PROBLEM SOLUTION
Mercury is the smallest Jupiter is a gas giant, the
planet in the Solar biggest planet in the Solar
System. In fact, it’s only System and the fourth-
a bit larger than the brightest object in the sky
Moon
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PROCESS

STEP 1 STEP 2 STEP 3 STEP 4

Mercury is the Despite being red, Venus has a beautiful Jupiter is the biggest
smallest planet Mars is cold name planet
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A PICTURE IS
WORTH A
THOUSAND
WORDS
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A PICTURE
ALWAYS
REINFORCES
THE CONCEPT
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data, so remember: use an image
instead of long texts
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DIAGRAM
JUPITER

mercury venus mars

It’s the smallest Venus has a Despite being red,
planet of them all beautiful name Mars is cold
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4,498,300.000
Big numbers catch your audience’s attention
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OVERVIEW
VENUS
Venus has a beautiful
name and is the
second planet from the
Sun.

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follow the link, change the data and
paste the new graph here
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AREAS OF
ACTION mercury
Mercury is the closest
planet to the Sun

mars
Despite being red,
Mars is a cold place,
not hot
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EXERCISE
Does MERCURY’S
name
have anything to do
with the liquid metal?

+ +

No, the truth is that this planet

was named after the Roman messenger
god, Mercury
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ASSIGNME
NT mercury
Is Mercury the closest planet to the
Sun?

saturn
Which planet is a gas giant and has
several rings?

jupiter
Can you calculate the distance
between these two planets?
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