Prepared by: Gagarin, RovigailMagsumbol, Jessica Siman, Venn JouYlagan, Jose Gabriel
Schizophrenia was vastly misunderstood by thepublic for decades. People often attach violentoutbursts and wild disturbances with this condition. It is not an illness, but a syndrome resulted fromvarieties of causes and presenting different sets ofsymptoms. This leads to bizarre thoughts,movements, emotions, perceptions and behavior(Videbeck,2008).
Name: Patient XAge: 49 years oldGender: FemaleStatus: SingleNationality: FilipinoReligion: Roman CatholicPlace of Admission: Cavite Center forMental HealthPrincipal Diagnosis: Schizophrenia
a. Chief Complaint: sleeplessness, self- talking, systemic pain and loss of appetiteb. Perceived Impact: The patient was thinkingthat she was weak due to her condition. Shefelt tired and helpless especially that no one iscapable and available to help her during thosetimes.
The patient seen talking to herself appear tiredand restless, and found dancing and dancingin the street. The patient is not sleeping fordays and so become weak and restless. Thepatient inflicted danger to her mother and thepeople around her. The bishops found her anddecided to bring her at the Cavite Center forMental Health where the patient is beingtreated with medications and ordermanagement procedures.
The patient doesn’t have any allergiesand had completed vaccine. She neverexperienced being hospitalized due to medicalcondition even if she suffered from asthmabefore and fell from a tree resulting to backache and fever lasted for four days. She oftengot cough and cold and resolve these throughdrinking plenty of water.
The patient’s mother suffered fromSchizophrenia going in and out of Cavite Centerfor Mental Health. LEGEND: Patient De ceased HF,36 SCZD,7 Male 1 Female HF Heart Failure SCZ,49 SCZD Schizophrenia
General Assessments: The patient was awake, conscious andcoherent. Often stare blankly and seldom directly lookin the eyes. Seemed tired without energy to talk.
Body parts Technique Actual Interpre- examined performed findings tationsIntegumentary 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.
Body parts Technique Actual findings Interpre- examined performed tationsHAIR 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: EvenHEAD 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.
Body parts Technique Actual Interpre- examined performed findings tationsNAILS 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
Body parts Technique Actual Interpre- examined performed findings tationsEYES 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
Body parts Technique Actual Interpre examined performed findings Tations INSPECTION NOSE The patient’s teeth NOSE PALPATION Symmetry: is at poorMOUTHTHROAT Symmetrical condition upon Discharges: None assessment. Blood: None Puss: None Mouth And Throat Teeth: Decayed, Spaces in between, yellowish. Dentures: None
Body parts Technique Actual Interpre examined performed findings Tations LUNGS AND INSPECTION Shape of chest: The patient’sTHORAX 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.
Body parts Technique Actual Interpre examined performed findings TationsCARDIO- INSPECTION Pulse: The patient’sVASCULAR 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: NoneABDOMEN INSPECTION Shape: Bulging The patient’s PALPATION abdomen. abdomen is slightly AUSCULTATION Presence of bowel bulged. The patient sounds. can be constipated upon assessment.
Body parts Technique Actual Interpre- examined performed findings tationsEXTREMITIES INSPECTION Amputations: The patient’s( UPPER AND PALPATION NoneLOWER) extremities are Edema: None normal and are Deformities: None movable Swellings: without pain or None any discomfort Mobility: mentioned. Normal
DIFFERENT PREVIOUS CURRENT PATTERNSHealth Perception- The patient believed that Upon being admitted inHealth 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 herNutritional and Although she still appears appetite because of toometabolic 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.
DIFFERENT PREVIOUS CURRENT PATTERNSElimination 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 activeActivity-Exercise of doing tasks assigned to helper in the ward and isPattern 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.
DIFFERENT PREVIOUS CURRENT PATTERNSCognitive- The patient strongly The patient is still delusionalPerceptual 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 asSelf- Concept and kept saying that she a productive, helpful andPattern was unable to finish her industrious helper capable studies attending only the of doing household chores, first grade. family.
DIFFERENT PREVIOUS CURRENT PATTERNSRole-Relationship She’s not close with The patient found a familyPattern 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 sheTolerance 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.
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.
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.
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.
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.
NURSING PROBLEMS JUSTIFICATIONAltered 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
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.
ASSESSMENT NURSING PLANNING EVALUATION DIAGNOSISObjective: Imbalanced Long term goal: After a week ofPoor muscle tone nutrition less than After a week of nursing interventionPoor skin turgor body requirements nursing the patient was ableWeakness 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
INTERVENTIONS RATIONALEINDEPENDENT:1. Determine client’s ability to chew, 1. All factors that can affect ingestionswallow, and taste food. and/or digestion of nutrients.2. Ascertain understanding of 2. To determine informational needs ofindividual nutritional needs. client/SO3. Evaluate the impact of 3. These factors may affect foodcultural/ethnic/religious desires and choicesinfluences.4. Note occurrence of Amenorrhea, 4. These factors affect the patient’stooth decay, swollen salivary ability to eat.glands, an constant sore throat.DEPENDENT:5. Administer pharmaceutical 5. To prevent the complications ofagents, as indicated. E.g., malnutrition.Multivitamins, digestive enzymes.
INTERVENTIONS RATIONALECOLLABORATIVE:6. Consult 6. To implement interdietician/nutritional team, as disciplinary team management.indicated.7. Consult with dietician/ 7. For long term needs.nutritional support team, asnecessary8. Refer to social 8. For possible assistance withservices/other community client’s limitations inresources buying/preparing food.
ASSESSMENT NURSING PLANNING EVALUATION DIAGNOSISSubjective: Chronic sorrow Short term goal: After the“Iniisip ko kung related to death of shift the patientbaket hindi ako loved one as After the was able to manifested by shift the patient demonstratepinag-aral ng frustration. will be able progress intatay ko.” demonstrate dealing with grief.Objective: progress in-Anger dealing with grief.-Confusion-Low self esteem-Express feelingof sadness-frustration
INTERVENTIONS RATIONALE1.Determine conditions contributing to 1. To assess causative/client state of mind. contributing factors.2. Encourage verbalization about 2. To assist client to movesituation. Active-listen feelings and be through sorrow.available for support.3. Acknowledge reality of feelings of 3. When feelingsguilt including hospitality toward spiritual are validated, client is free topower. take steps toward acceptance.4. Discuss use of medication when 4. Client may be benefit from thedepression is interfering with ability to short term use of anmanage life. antidepressant medication to help with dealing with situation.5. Discuss healthy way of dealing with 5. To promote wellness.difficulty situations.
INTERVENTIONS RATIONALE6. Encourage involvement in usual 6. Maintaining usual activitiesactivities, exercise and socialization may keep individuals fromwithin limits of physical and deepening sorrow/depression.psychosocial state. 7. Chronic sorrow has a cyclical7.Look for cues of sadness(e.g., effect, ranging from times ofsighing, faraway look, unkempt deepening sorrow to times ofappearance, inattention to feeling somewhat better.conversation). 8. To assist client to move8. Discuss ways individual has dealt through sorrow.with previous losses. Reinforce use ofpreviously effective copping skills
ASSESSMENT NURSING PLANNING EVALUATION DIAGNOSISSUBJECTIVE: Disturbed thought Short term goal: After 6 hours of“May dalwa akong processes r/t After 6 hours of nursinganak, 21 ang psychological nursing interventions, thepanganay at 15 conflicts a.m.b. interventions, the client will:ang bunso”, as nonrealistic-based client will: -be free fromverbalized by the thinking. -be free from delusions orpatient. delusions or demonstrate the demonstrate the ability to functionOBJECTIVE: ability to function without responding without responding to persistent-inappropriate/ to persistent delusional thoughtsnonrealistic-based delusional thoughts. as evidenced by;thinking. - recalling the past of her life. -verbalization of acceptance of reality.
INTERVENTION RATIONALE1. Be sincere and honest when 1.Delusional client are extremely sensitivecommunicating 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 secureenforcing rules and so forth. structure for the client.3. Encourage the client to talk, but do 3. Probing increases the client’s suspicionnot pry for information. and interferes with the therapeutic relationship.4. Give positive feedback for the client 4.Positive feedback for genuine successsuccesses. 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 dispeltry to convince the client that the delusional ideas and can interfere with thedelusions are false or unreal. development of trust.
INTERVENTION RATIONALE6. Interact with the client on the 6.Interacting about reality is healthy forbasis 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 feelingsor 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 delusionsyou accept the delusional as reinforces the client’s illness.reality.
ASSESSMENT NURSING PLANNING EVALUATION DIAGNOSISSUBJECTIVE Sleep deprivation Long term goal: After 2 days of“Hindi ako related to Nursingmakatulog.iniisip prolonged After 2 days of Interventions, theko kung baket psychological nursing patienthindi ako pinag discomfort as interventions, the reportaral ng tatay ko.” manifested by patient will report feeling rested andOBJECTIVE: 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
INTERVENTIONS RATIONALEINDEPENDENT1. 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 of4. Promote adequate physical exercise energy/release of tension so that activity during the day clients feels ready for sleep/rest.
INTERVENTIONS RATIONALE5. 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 the6. 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 and8. Increase daytime physical activities as nicotine can disturb sleep. indicated. 8. This reduces stress and9. 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 onCOLLABORATIVE whether the patient has10. Administer sedatives as ordered. trouble falling asleep or staying asleep.
ASSESSMENT NURSING PLANNING EVALUATION DIAGNOSISObjective: Impaired social Short term Goal: After 8 hours ofUse of interaction related After 8 hours of nursingunsuccessful to therapeutic nursing intervention thesocial interaction isolation as intervention the patient was ablebehaviors manifested by patient will be to identify feelingsBlunted affect unsatisfied social able to identify that lead to poorAbsence 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
INTERVENTIONS RATIONALEINDEPENDENT1. Ascertain ethnic/ Cultural or religious 1. These impact choice of behaviors/ mayimplications 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 social3.Determine client’s use of coping skills and situations.defense mechanisms.4. Have client list behaviors that cause 4. Once recognized, client can choose todiscomfort. change as he or she learns to listen and5. Role play changes and discuss impact. communicate in socially acceptable waysInclude family/ So(s) as indicated. 5. Enhances comfort with new behaviors.COLLABORATIVE: 6. These social behaviors and interpersonal6. Refer for family therapy, as indicated. relationships involve more than the7. Refer for occasional follow up. individual.8. Refer to/involve Psychiatric clinical nurse 8. For reinforcement of positive behaviorsspecialist for additional assistance when after professional relationship has ended.indicated. To improve patient’s condition and wellness.
DRUG DOSAGE INDICATION CONTRA INDICATIONchlorpromazine 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.
SIDE EFFECTS ADVERSE REACTIONSDrowsiness, blank facial expression, Drowsiness, jaundice,shuffling walk, restlessness, agitation, postural hypotension,nervousness, unusual, slowed, or extrapyramidal effects.uncontrollable movements of any part Persistent abnormalof the body, difficulty falling asleep or movement, cerebralstaying asleep, increased appetite, edema, hematologicweight gain, breast milk production, disorders.breast enlargement, missed menstrualperiods, 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)
NURSING CONSIDERATIONS1.Assess for mental status: delusions, hallucinations, disorganized speech,disorganized or catatonic behavior, and negative symptoms; before initial therapyand monthly thereafter.2.Assess any potentially reversible cause of behavior problems .3.Check for swallowing of oral administration medication; check for giving ofmedication to other patient.4. Monitor input-output ratio; palpate bladder if low urinary output occurs.5.Assess affect, orientation, LOC, reflexes, gait, coordination, sleep patterndisturbances.6. Monitor BP with patient sitting, standing, and lying; take pulse and RR every fourhours during initial treatment.7.Check dizziness, faintness, palpitations, tachycardia on rising; severe orthostatichypotension is common.8. Identify for NMS; hyperpyrexia, muscle rigidity; increased CPK, altered mentalstatus: should discontinue drug.9. Assess EPS including akathisia, tardive dyskinesia, pseudoparkinsonism; anantiparkinsonian drug should be prescribed.10. assess for constipation, urinary retention daily; if these occur, increased bulk andwater in diet.
DRUG DOSAGE INDICATION CONTRAINDICATIONfluphenizine 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 Parkinsons disease, liver No more than hostility. damage, cerebral 40 mg/d arteriosclerosis, coronary disease, severe hypotension or hypertension; pregnancy.
SIDE EFFECTS ADVERSE REACTIONSUpset stomach, Hypotension, orthostaticdrowsiness, weakness hypotensionor tiredness, excitementor anxiety, insomnia,nightmares, dry mouth,skin more sensitive tosunlight than usual,changes in appetite orweight
NURSING CONSIDERATIONS1.Arrange for discontinuation of drug if serum creatinine, BUN becomeabnormal or if WBC count is depressed.2.Monitor elderly patients for dehydration, institute remedial measurespromptly. Sedation and decreased sensation of thirst related to CNS effectscan lead to severe dehydration.3.Report physician regarding appropriate warning of patient or patientsguardian about tardive dyskinesias.4.Consult physician about dosage reduction, use of anticholinergicantiparkinsonian drugs (controversial) if extrapyramidal effects occur.5. Administer drug exactly as prescribed.6. Maintain fluid intake, and use precautions against heatstroke in hotweather.7.Report sore throat, fever, unusual bleeding or bruising, rash, weakness,tremors, impaired vision, dark urine (pink or reddish brown urine isexpected), pale stools, yellowing of skin or eyes.
Categories ResultGeneral appearance Patient X was well- The patient dressed appropriately toand 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.
Categories ResultMood 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 disorganizedand 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.
Sensorium and Orientation: The patient is Orientation: x3Intellectual oriented with time, place and Memory: Good. Patient X is able toProcesses 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.
Abstract Thinking andIntellectual Ability: Thepatient’s abstract thinkingabilities were intact as evidencedby her interpretation of theproverb “Kapag may isinuksok,may madudukot” as “Kapag angtao marunong mag ipon, magtabing perang kanyang kinita,mayroon syang magagamit saoras na kailanganin nya ngpera”. She even answeredMathematical equation correctlyas 20 divided by 5 equals 4.
Categories ResultSensory- The patient does not There is no problem or alterationPerceptual experience any in patient’s sensory perceptions.Alterations hallucination involving the five sensesJudgment and Patient X cannot justify Judgment and insight are poorInsight 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.”
Categories ResultSelf- 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 herRelationships 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.