Schizophrenia

1. Prepared by:
Gagarin, Rovigail
Magsumbol, Jessica
Siman, Venn Jou
Ylagan, Jose Gabriel

2. Schizophrenia was vastly misunderstood by the
public for decades. People often attach violent
outbursts and wild disturbances with this condition.
It is not an illness, but a syndrome resulted from
varieties of causes and presenting different sets of
symptoms. This leads to bizarre thoughts,
movements, emotions, perceptions and behavior
(Videbeck,2008).

6. Name: Patient X
Age: 49 years old
Gender: Female
Status: Single
Nationality: Filipino
Religion: Roman Catholic
Place of Admission: Cavite Center for
Mental Health
Principal Diagnosis: Schizophrenia

8. a. Chief Complaint: sleeplessness, self-
talking, systemic pain and loss of appetite
b. Perceived Impact: The patient was thinking
that she was weak due to her condition. She
felt tired and helpless especially that no one is
capable and available to help her during those
times.

9. The patient seen talking to herself appear tired
and restless, and found dancing and dancing
in the street. The patient is not sleeping for
days and so become weak and restless. The
patient inflicted danger to her mother and the
people around her. The bishops found her and
decided to bring her at the Cavite Center for
Mental Health where the patient is being
treated with medications and order
management procedures.

10. The patient doesn’t have any allergies
and had completed vaccine. She never
experienced being hospitalized due to medical
condition even if she suffered from asthma
before and fell from a tree resulting to back
ache and fever lasted for four days. She often
got cough and cold and resolve these through
drinking plenty of water.

11. The patient’s mother suffered from
Schizophrenia going in and out of Cavite Center
for Mental Health.
LEGEND:
Patient
De ceased
HF,36 SCZD,7 Male
1 Female
HF Heart Failure
SCZ,49 SCZD Schizophrenia

12. General Assessments:
The patient was awake, conscious and
coherent.
Often stare blankly and seldom directly look
in the eyes.
Seemed tired without energy to talk.

13. Body parts Technique Actual Interpre-
examined performed findings tations
Integumentary Inspection Color: fair The patient
Palpation Temperature: may
36.5 degree
experience
celsius
Texture: rough dehydration as
and dry evidenced by a
Turgor: poor rough, dry skin
Rashes: none and a poor skin
Lesions: none turgor upon
assessment.

14. Body parts Technique Actual findings Interpre-
examined performed tations
HAIR INSPECTION Texture: Dry and The Patient’s hair
PALPATION frizzy is normal. Dry and
Loss of hair: None frizzy hair is a
Head lice: None normal finding in a
Lesions: None hot environment.
Distribution: Even
HEAD INSPECTION Shape: Round and The patient’s head
PALPATION symmetrical is normal. There
Masses: None are no masses or
Lesions: None any lesions
present upon
assessment.

15. Body parts Technique Actual Interpre-
examined performed findings tations
NAILS INSPECTION Shape: Round The patient’s nail
PALPATION Clubbing: None upon assessment
Capillary refill: 1-3
is normal. There is
seconds.
a trace amount of
dirt/soil in the
patient’s nails.
NECK PALPATION The patient’s neck
Masses: None
Mobility: Normal is normal upon
Stiffness: None assessment

16. Body parts Technique Actual Interpre-
examined performed findings tations
EYES INSPECTION Pupil Color: Black The patient’s
Symmetry: eyes are normal
symmetrical but with minimal
Pupil equally signs of stress. No
round responsive astigmatism
to light and noted.
accommodation.
Eye bags noted.
EARS INSPECTION Symmetrical: Size, The patient’s Ears
PALPATION location and are clean an
shape are all normal. Auditory
equal. abilities are good
Ear wax: Traces upon assessment.
Tenderness: None

17. Body parts Technique Actual Interpre
examined performed findings Tations
INSPECTION NOSE The patient’s teeth
NOSE
PALPATION Symmetry: is at poor
MOUTH
THROAT Symmetrical condition upon
Discharges: None assessment.
Blood: None
Puss: None
Mouth And Throat
Teeth: Decayed,
Spaces in
between,
yellowish.
Dentures: None

18. Body parts Technique Actual Interpre
examined performed findings Tations
LUNGS AND INSPECTION Shape of chest: The patient’s
THORAX PALPATION Symmetrical respiratory status
AUSCULTATION Use of accessory is normal upon
PERCUSSION muscles: None
assessment. No
Retractions: None
Lung sounds: tumors or masses
None was palpated and
Chest pain: None noted. Respiratory
rate 18 breaths
per minute from
the normal range
of 12-20 breaths
per minute.

19. Body parts Technique Actual Interpre
examined performed findings Tations
CARDIO- INSPECTION Pulse: The patient’s
VASCULAR PALPATION Nomocardic (90 Cardiovascular status
AUSCULTATION beats per minute) is poor as evidenced
Chest pain: None by a varicose veins
Distended leg on the left leg.
veins
Paleness: None
ABDOMEN INSPECTION Shape: Bulging The patient’s
PALPATION abdomen. abdomen is slightly
AUSCULTATION Presence of bowel bulged. The patient
sounds. can be constipated
upon assessment.

20. Body parts Technique Actual Interpre-
examined performed findings tations
EXTREMITIES INSPECTION Amputations: The patient’s
( UPPER AND PALPATION None
LOWER) extremities are
Edema: None
normal and are
Deformities:
None movable
Swellings: without pain or
None any discomfort
Mobility: mentioned.
Normal

21. DIFFERENT PREVIOUS CURRENT
PATTERNS
Health Perception- The patient believed that Upon being admitted in
Health Management she was fine and nothing’s CCMH and taking
wrong with her. antipsychotics, she
understands that she is
suffering from mental illness.
The patient loss her
Nutritional and Although she still appears
appetite because of too
metabolic pattern weak due to poor muscle
much depression making
tone, she is starting to
her pale and thin. She
regain her appetite.
became too weak unable
to perform daily activities.

22. DIFFERENT PREVIOUS CURRENT
PATTERNS
Elimination Pattern The patient has no There is no problem in terms
problems with urinating of patient’s elimination.
and defecating.
The patient seemed tardy The patient is now an active
Activity-Exercise of doing tasks assigned to helper in the ward and is
Pattern her maybe because of also serves in the nurse’s
weak feeling. home.
Sleep-Rest Pattern The patient was unable to
There were few nights that
continuously sleep or the patient cannot sleep very
experienced prolonged well but not as intense or as
time without sleeping long with the previous
resulting to deprivation. sleeping pattern problems.

23. DIFFERENT PREVIOUS CURRENT
PATTERNS
Cognitive- The patient strongly The patient is still delusional
Perceptual Pattern believed that she has a regarding her husband and
husband and children even children she keeps on
if she really have not. talking about.
Self-Perception/ The patient belittled herself The patient sees herself as
Self- Concept and kept saying that she a productive, helpful and
Pattern was unable to finish her industrious helper capable
studies attending only the of doing household chores,
first grade.
family.

24. DIFFERENT PREVIOUS CURRENT
PATTERNS
Role-Relationship She’s not close with The patient found a family
Pattern anyone of her family, figure in the person who
making her feel that she adopted her thus creating a
was almost abandoned. harmonious relationship with
them.
Coping-Stress The patient tells her problem
Whenever she
Tolerance Pattern to the person who adopted her
experienced family
and treated her as one true
problem, she just cried or
member of their family.
walked out because of
vulnerable attitude to face
those problems.

26.  The pathophysiology of schizophrenia has long
remained a mystery and still today, even with
various hypotheses, remains somewhat uncertain:
there are too many variants; not enough consistency
in findings; and, despite research, a lack of
documented proof. The most well-known and
respected hypothesis with regards to the
pathophysiology of schizophrenia began in the
1990s and consisted primarily of the notion there is
a problem with the dopamine levels in the brain of
schizophrenics.

27.  Dopamine is both a hormone and a
neurotransmitter, which means that it activates five
different receptors in the brain, aptly named
D1, D2, D3, D4, and D5. That said, it may not be the
only neurotransmitter involved in the pathophysiology
of schizophrenia. Glutamate and Serotonin have also
been implicated.
 Contributing to this hypothesis is the fact that drugs
administered to aid dopaminergic activity bring on
schizophrenic characteristics such as psychosis, in a
patient, whereas drugs administered to block them
help reduce, or eliminate symptoms of schizophrenia
altogether.

28.  Additional studies affecting the pathophysiology of
schizophrenia include suggestions that maternal
factors such as infection, malnutrition, location of
birth, season of birth, and delivery, may play a
significant part in the formation and subsequent
appearance of schizophrenia. Studies have shown
that the worldwide rate of births affected with
schizophrenia is up to 8% higher when occurring in
spring or winter, though no explanation for this can
be offered.

29.  Another aspect of the pathophysiology of
schizophrenia that has been explored in relative detail is
that of genetics, and their relation to the likelihood of
immediate relatives being born with the disease.
Shockingly, it has been found that 10% of all immediate
family members of an infected person will be struck down
with the disease. This is specifically in relation to parents,
siblings, and children. With regards to twins or other
multiple births, the chances they will share the disease is
50%. Genetic reports suggest that it is the X
chromosome which determines whether or not a person
is infected with schizophrenia, specifically, chromosomes
1, 3, 5, and 11, however further studies are needed in
order to prove this theory.

31. NURSING PROBLEMS JUSTIFICATION
Altered nutrition less than body This will be our top priority because
requirements physiologic alteration may directly
impaired an individual’s functioning
which affects everyday living.
Chronic sorrow Several complications may follow
due to extreme and pervasive
sadness. Although chronic sorrow
might be difficult to manage and
eliminate, better resolve this right
after altered nutrition since this is the
root of all the patient’s
manifestations,
Disturbed thought process Because of repetitive thinking of the
loss of her loved one, the patient
experienced disturbed thought

32. NURSING PROBLEMS JUSTIFICATION
Sleep Deprivation Because of intermittent presence of
disruption in cognitive operations the
client was unable to rest and even
sleeping hours are compromised.
Impaired socialization Socialization may be attained and
desired if and only an individual has
the energy to do so. A patient with
altered nutrition, chronic sorrow,
disturbed thinking and compromised
sleep will definitely has impaired
socialization. Correcting the above
nursing problems first makes
impaired socialization least priority.

34. ASSESSMENT NURSING PLANNING EVALUATION
DIAGNOSIS
Objective: Imbalanced Long term goal: After a week of
Poor muscle tone nutrition less than After a week of nursing intervention
Poor skin turgor body requirements nursing the patient was able
Weakness related to intervention the to be free of signs
depressed mood as patient will be of malnutrition.
evidenced by poor free of signs of Goal met if attained
muscle tone, poor malnutrition. at least 2 of the
skin turgor and following nursing
weakness outcomes:
Normal skin turgor
Energetic
Normal muscle tone
Well hydrated

35. INTERVENTIONS RATIONALE
INDEPENDENT:
1. Determine client’s ability to chew, 1. All factors that can affect ingestion
swallow, and taste food. and/or digestion of nutrients.
2. Ascertain understanding of 2. To determine informational needs of
individual nutritional needs. client/SO
3. Evaluate the impact of 3. These factors may affect food
cultural/ethnic/religious desires and choices
influences.
4. Note occurrence of Amenorrhea, 4. These factors affect the patient’s
tooth decay, swollen salivary ability to eat.
glands, an constant sore throat.
DEPENDENT:
5. Administer pharmaceutical 5. To prevent the complications of
agents, as indicated. E.g., malnutrition.
Multivitamins, digestive enzymes.

36. INTERVENTIONS RATIONALE
COLLABORATIVE:
6. Consult 6. To implement inter
dietician/nutritional team, as disciplinary team management.
indicated.
7. Consult with dietician/ 7. For long term needs.
nutritional support team, as
necessary
8. Refer to social 8. For possible assistance with
services/other community client’s limitations in
resources buying/preparing food.

37. ASSESSMENT NURSING PLANNING EVALUATION
DIAGNOSIS
Subjective: Chronic sorrow Short term goal: After the
“Iniisip ko kung related to death of shift the patient
baket hindi ako loved one as After the was able to
manifested by shift the patient demonstrate
pinag-aral ng
frustration. will be able progress in
tatay ko.” demonstrate dealing with grief.
Objective: progress in
-Anger dealing with grief.
-Confusion
-Low self esteem
-Express feeling
of sadness
-frustration

38. INTERVENTIONS RATIONALE
1.Determine conditions contributing to 1. To assess causative/
client state of mind. contributing factors.
2. Encourage verbalization about 2. To assist client to move
situation. Active-listen feelings and be through sorrow.
available for support.
3. Acknowledge reality of feelings of 3. When feelings
guilt including hospitality toward spiritual are validated, client is free to
power. take steps toward acceptance.
4. Discuss use of medication when 4. Client may be benefit from the
depression is interfering with ability to short term use of an
manage life. antidepressant medication to help
with dealing with situation.
5. Discuss healthy way of dealing with 5. To promote wellness.
difficulty situations.

39. INTERVENTIONS RATIONALE
6. Encourage involvement in usual 6. Maintaining usual activities
activities, exercise and socialization may keep individuals from
within limits of physical and deepening sorrow/depression.
psychosocial state.
7. Chronic sorrow has a cyclical
7.Look for cues of sadness(e.g., effect, ranging from times of
sighing, faraway look, unkempt deepening sorrow to times of
appearance, inattention to feeling somewhat better.
conversation).
8. To assist client to move
8. Discuss ways individual has dealt through sorrow.
with previous losses. Reinforce use of
previously effective copping skills

40. ASSESSMENT NURSING PLANNING EVALUATION
DIAGNOSIS
SUBJECTIVE: Disturbed thought Short term goal: After 6 hours of
“May dalwa akong processes r/t After 6 hours of nursing
anak, 21 ang psychological nursing interventions, the
panganay at 15 conflicts a.m.b. interventions, the client will:
ang bunso”, as nonrealistic-based client will: -be free from
verbalized by the thinking. -be free from delusions or
patient. delusions or demonstrate the
demonstrate the ability to function
OBJECTIVE: ability to function without responding
without responding to persistent
-inappropriate/ to persistent delusional thoughts
nonrealistic-based delusional thoughts. as evidenced by;
thinking. - recalling the past of
her life.
-verbalization of
acceptance of
reality.

41. INTERVENTION RATIONALE
1. Be sincere and honest when 1.Delusional client are extremely sensitive
communicating with the client. Avoid about others and can recognize sincerity.
vague or evasive remarks. Evasive comments or hesitation reinforces
mistrust or delusions.
2. Be consistent in setting expectations, 2.Clear, consistent limits provide a secure
enforcing rules and so forth. structure for the client.
3. Encourage the client to talk, but do 3. Probing increases the client’s suspicion
not pry for information. and interferes with the therapeutic
relationship.
4. Give positive feedback for the client 4.Positive feedback for genuine success
successes. enhances the client’s sense of well-being and
helps to make nondelusional reality a more
positive situation for the client.
5. Initially, do not argue with the client or 5.Logical argument does not dispel
try to convince the client that the delusional ideas and can interfere with the
delusions are false or unreal. development of trust.

42. INTERVENTION RATIONALE
6. Interact with the client on the 6.Interacting about reality is healthy for
basis of real things; do not dwell the client.
on the delusional materials.
7. Do not be judgmental or belittle 7. The client’s delusions and feelings
or joke about the client’s beliefs. are not funny to him or her. The client
may not understand or may feel
rejected by attempts at humor.
8. Never convey to the client that 8. Indicating belief in the delusions
you accept the delusional as reinforces the client’s illness.
reality.

43. ASSESSMENT NURSING PLANNING EVALUATION
DIAGNOSIS
SUBJECTIVE Sleep deprivation Long term goal: After 2 days of
“Hindi ako related to Nursing
makatulog.iniisip prolonged After 2 days of Interventions, the
ko kung baket psychological nursing patient
hindi ako pinag discomfort as interventions, the report
aral ng tatay ko.” manifested by patient will report feeling rested and
OBJECTIVE: restlessness and improvement in show
restlessness irritability his sleep/rest improvement in
noted pattern. sleep/rest
dark circles pattern.
under eyes
irritability noted
frequent
change of affect
noted

44. INTERVENTIONS RATIONALE
INDEPENDENT
1. Assess past patterns of sleep in 1. Sleep patterns are unique to
normal environment: amount, bedtime each individual.
rituals, depth, length, positions, aids,
and interfering agents.
2. Document nursing or caregiver 2. Often, the patient’s perception of
observations of sleeping and wakeful the problem may differ from
behaviors. Record number of sleep objective evaluation.
hours. Note physical (e.g., noise, pain
or discomfort, urinary frequency)
and/or psychological (e.g., fear,
anxiety) circumstances that interrupt 3. To assess causative/ contributing
sleep. factors.
3. Note medical diagnoses that affect
sleep(e.g., brain injury, depression.). 4. Enhances expenditure of
4. Promote adequate physical exercise energy/release of tension so that
activity during the day clients feels ready for sleep/rest.

45. INTERVENTIONS RATIONALE
5. Provide calm, quite environment, and 5. To reduce need for reducing
manage controllable sleep-disrupting during prime sleep hour.
factor. 6. This promotes regulation of the
6. Instruct patient to follow as consistent a circadian rhythm, and reduces the
daily schedule for retiring and arising energy required for adaptation to
as possible. changes.
7. Avoid including in the meal alcohol or 7. Gastric digestion and
caffeine as well as heavy meal stimulation from caffeine and
8. Increase daytime physical activities as nicotine can disturb sleep.
indicated. 8. This reduces stress and
9. Recommend an environment promotes sleep.
conducive to sleep or rest (e.g., quiet, 9.To promote sleep
comfortable temperature, ventilation, 10.Different drugs
darkness, closed door). are prescribed depending on
COLLABORATIVE whether the patient has
10. Administer sedatives as ordered. trouble falling
asleep or staying asleep.

46. ASSESSMENT NURSING PLANNING EVALUATION
DIAGNOSIS
Objective: Impaired social Short term Goal: After 8 hours of
Use of interaction related After 8 hours of nursing
unsuccessful to therapeutic nursing intervention the
social interaction isolation as intervention the patient was able
behaviors manifested by patient will be to identify feelings
Blunted affect unsatisfied social able to identify that lead to poor
Absence of interaction and feelings that lead social interaction.
specific others relationships to to poor social Goal met if
Specific Others. interaction attained at least 2
of the following
nursing
outcomes:
Low self esteem
Depression
Anxiety

47. INTERVENTIONS RATIONALE
INDEPENDENT
1. Ascertain ethnic/ Cultural or religious 1. These impact choice of behaviors/ may
implications for the client. even script interactions with others.
2. To note prevalent interaction patterns.
2. Observe client while relating to family/SO(s).
3. Affects ability to be involved in social
3.Determine client’s use of coping skills and situations.
defense mechanisms.
4. Have client list behaviors that cause 4. Once recognized, client can choose to
discomfort. change as he or she learns to listen and
5. Role play changes and discuss impact. communicate in socially acceptable ways
Include family/ So(s) as indicated. 5. Enhances comfort with new behaviors.
COLLABORATIVE:
6. These social behaviors and interpersonal
6. Refer for family therapy, as indicated.
relationships involve more than the
7. Refer for occasional follow up. individual.
8. Refer to/involve Psychiatric clinical nurse 8. For reinforcement of positive behaviors
specialist for additional assistance when after professional relationship has ended.
indicated. To improve patient’s condition and wellness.

49. DRUG DOSAGE INDICATION CONTRA
INDICATION
chlorpromazine HANDBOOK Management of Comatose states,
BASE: manifestations of presence of large
Severe psychotic disorders, amounts of CNS
behavior to control nausea depressants,
disorder or and vomiting, relief presence of bone
psychotic restlessness. marrow depression.
conditions, Control Hypersensitivity.
higher manifestations of
dosages 50- manic type of manic
100 daily. depressive illness,
relief of intractable
hiccups.

50. SIDE EFFECTS ADVERSE REACTIONS
Drowsiness, blank facial expression, Drowsiness, jaundice,
shuffling walk, restlessness, agitation, postural hypotension,
nervousness, unusual, slowed, or extrapyramidal effects.
uncontrollable movements of any part Persistent abnormal
of the body, difficulty falling asleep or movement, cerebral
staying asleep, increased appetite, edema, hematologic
weight gain, breast milk production, disorders.
breast enlargement, missed menstrual
periods, decreased sexual ability,
changes in skin color, dry mouth,
stuffed nose, difficulty urinating,
widening or narrowing of the pupils
(black circles in the middle of the eyes)

51. NURSING CONSIDERATIONS
1.Assess for mental status: delusions, hallucinations, disorganized speech,
disorganized or catatonic behavior, and negative symptoms; before initial therapy
and monthly thereafter.
2.Assess any potentially reversible cause of behavior problems .
3.Check for swallowing of oral administration medication; check for giving of
medication to other patient.
4. Monitor input-output ratio; palpate bladder if low urinary output occurs.
5.Assess affect, orientation, LOC, reflexes, gait, coordination, sleep pattern
disturbances.
6. Monitor BP with patient sitting, standing, and lying; take pulse and RR every four
hours during initial treatment.
7.Check dizziness, faintness, palpitations, tachycardia on rising; severe orthostatic
hypotension is common.
8. Identify for NMS; hyperpyrexia, muscle rigidity; increased CPK, altered mental
status: should discontinue drug.
9. Assess EPS including akathisia, tardive dyskinesia, pseudoparkinsonism; an
antiparkinsonian drug should be prescribed.
10. assess for constipation, urinary retention daily; if these occur, increased bulk and
water in diet.

52. DRUG DOSAGE INDICATION CONTRAINDICATION
fluphenizine Initial 2.5-10
Used to treat Coma or severe CNS
mg/d div q6- schizophrenia depression, bone marrow
8hr PO and psychotic depression, blood dyscrasia,
Maint: 1-5 symptoms such circulatory collapse,
mg PO/IM as hallucinations, subcortical brain damage,
q6-8hr delusions, and Parkinson's disease, liver
No more than hostility. damage, cerebral
40 mg/d arteriosclerosis, coronary
disease, severe hypotension
or hypertension; pregnancy.

53. SIDE EFFECTS ADVERSE REACTIONS
Upset stomach, Hypotension, orthostatic
drowsiness, weakness hypotension
or tiredness, excitement
or anxiety, insomnia,
nightmares, dry mouth,
skin more sensitive to
sunlight than usual,
changes in appetite or
weight

54. NURSING CONSIDERATIONS
1.Arrange for discontinuation of drug if serum creatinine, BUN become
abnormal or if WBC count is depressed.
2.Monitor elderly patients for dehydration, institute remedial measures
promptly. Sedation and decreased sensation of thirst related to CNS effects
can lead to severe dehydration.
3.Report physician regarding appropriate warning of patient or patient's
guardian about tardive dyskinesias.
4.Consult physician about dosage reduction, use of anticholinergic
antiparkinsonian drugs (controversial) if extrapyramidal effects occur.
5. Administer drug exactly as prescribed.
6. Maintain fluid intake, and use precautions against heatstroke in hot
weather.
7.Report sore throat, fever, unusual bleeding or bruising, rash, weakness,
tremors, impaired vision, dark urine (pink or reddish brown urine is
expected), pale stools, yellowing of skin or eyes.

55. Categories Result
General appearance Patient X was well- The patient dressed appropriately to
and Motor Behavior groomed and dressed location, weather and age thus
There were no signs of showing good appearance.
tremors. She was Motor behavior is not so good as
cooperative during shown by frequent eye movements
interview, however, unable and inability to sit straight.
to maintain direct eye Speech pattern is comprehensible
contact especially when although there are some pauses in
remembering the history between statements.
of her father’s death. The
patient seldom smiles and
was unable to sit still with
straight body. She
answered questions at
slow rate, soft voice with
observable pauses.

56. Categories Result
Mood and Affect The patient seldom smiles Patient X shows blunted affect or
and frowns. She usually few observable facial expressions.
stares blankly even when She appeared depressed and
talking and sharing stories. frustrated when talking about her
family.
Thought Process The patient seems like not The patient has disorganized
and Content preoccupied because she thought process and content as
was able to answer questions shown by delusions. She is
spontaneously. However, she consistent of saying that she has a
suddenly stops talking in the husband and two children, even
middle of the sentence and mentioned their ages.
remain silent for several
seconds when asked about
family background. When she
continues, there is a flight of
idea. She showed delusion
believing that she has a
husband and two kids where
in fact she she has not.

57. Sensorium and Orientation: The patient is Orientation: x3
Intellectual oriented with time, place and Memory: Good. Patient X is able to
Processes person. answer questions such as “Kailan ka
Memory: The patient is able to huling nagpunta kina Mommy
remember her last actions few Mherly?Anon’g ginawa mo
days ago and even several doon?”with “Nung isang lingo, nag-
years passed. Walter kame, namili”, and “Anon’g
Abstract Thinking and dahilan at nag away kayo ng nanay
Intellectual Ability: The patient mo nung 13 ka pa lang?” with “Ayaw
is able to explain given proverb kong maglaba, pinagalitan ako kaya
and solve given mathematical naglayas ako.”
problem even lack with formal
education.

58. Abstract Thinking and
Intellectual Ability: The
patient’s abstract thinking
abilities were intact as evidenced
by her interpretation of the
proverb “Kapag may isinuksok,
may madudukot” as “Kapag ang
tao marunong mag ipon, magtabi
ng perang kanyang kinita,
mayroon syang magagamit sa
oras na kailanganin nya ng
pera”. She even answered
Mathematical equation correctly
as 20 divided by 5 equals 4.

59. Categories Result
Sensory- The patient does not There is no problem or alteration
Perceptual experience any in patient’s sensory perceptions.
Alterations hallucination involving
the five senses
Judgment and Patient X cannot justify Judgment and insight are poor
Insight her answer when asked when the patient is asked “Ano
with situational problem ang gagawin mo kapag
requiring her to choose dumating si Nanay Diding
between two significant (relative) para kuhanin ka kay
people in her life. Mommy Mherly? Sasama ka
ba?” and she answered
“Sasama. Iiwan ko si Mommy
Mherly dahil gusto ko lang.
ganun lang.”

60. Categories Result
Self- Concept Patient X described The patient viewed herself
herself as poorly educated negatively especially in terms of
who attended only grade educational attainment.
one. Upon asking the She also showed weakness in
patient of what she would resolving problems thinking that she
do in times of problems cannot do anything to handle the
she always answered that situation.
she cries.
Roles and The patient is living away Her roles and relationship with her
Relationships from her family. She is not biological family is poor. But her
that close with her mother. current relationship with whom she
She does not have called Mommy Mherly seems
siblings, husband nor harmonious, helping and assisting
child.Almost abandoned each other in their own little ways.
by her own family but
fortunately adopted by
CCMH head nurse
Mommy Mherly.