196150292 casetudy-ncmh-doc

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Table of Contents
I. Introduction
-------------------------------------------------------------------------------------------------2
A. Background of the Study -----------------------------------------------------------------------------2
B. Significance of the Study -----------------------------------------------------------------------------3
II. Psychiatric Nursing Assessment
--------------------------------------------------------------------4
A. Patient’s Profile -----------------------------------------------------------------------------------------4
B. Chief Complaint -----------------------------------------------------------------------------------------4
C. History of Present Illness -----------------------------------------------------------------------------4
D. Past Medical History -----------------------------------------------------------------------------------4
E. Past Psychiatric History ------------------------------------------------------------------------------4
F. Familial History -----------------------------------------------------------------------------------------4
1

G. Personal History ----------------------------------------------------------------------------------------4
H. Mental Status Examination --------------------------------------------------------------------------5
I. Impression/Diagnosis ---------------------------------------------------------------------------------7
III. Clinical Discussion of the
Disease-------------------------------------------------------------------8
A. Psychodynamics ---------------------------------------------------------------------------------------8
B. Psychopathophysiology-------------------------------------------------------------------------------9
C. Laboratory and Diagnostic Examination --------------------------------------------------------10
D. Drug Study ---------------------------------------------------------------------------------------------12
IV. Nursing Care Plan
---------------------------------------------------------------------------------------14
A. Problem List ---------------------------------------------------------------------------------------14
B. Nursing Care Plan -------------------------------------------------------------------------------15
V. Process Recording
--------------------------------------------------------------------------------------17
VI. Psychotherapies
-----------------------------------------------------------------------------------------38
VII. Bibliography
-----------------------------------------------------------------------------------------------41
APPENDICES ---------------------------------------------------------------------------------------------------42
Mental Status Examination ---------------------------------------------------------------------------------A
2

Process Recording --------------------------------------------------------------------------------------------B
Reflection ---------------------------------------------------------------------------------------------------------C
I. INTRODUCTION
A. Background of the Study
Schizophrenia is a psychiatric diagnosis that describes a mental disorder
characterized by abnormalities in the perception or expression of reality. It most
commonly manifests as auditory hallucinations, paranoid or bizarre delusions or
disorganized speech and thinking in the context of significant social or occupational
dysfunction. Onset of symptoms typically occurs in young adulthood. Diagnosis is based
on the patient's self-reported experiences and observed behavior. No laboratory test for
schizophrenia currently exists.
The symptoms of schizophrenia are categorized into two major categories, the
positive or hard symptoms which include delusion, hallucinations, and grossly
disorganized thinking, speech, and behavior, and negative or soft symptoms as flat
affect, lack of volition, and social withdrawal or discomfort. There are 5 categories of
schizophrenia: Catatonic, Disorganized, Paranoid, Residual, and Undifferentiated.
Catatonic schizophrenia involves a disturbance in movement, voluntary movement for
prolonged periods of time. Disorganized schizophrenia involves, a disorganized
thought process – emotionally, mentally and verbally. Paranoid schizophrenia is
primarily characterized by hallucinations and delusions (perhaps about persecution or
conspiracies directed against the sufferer). Residual schizophrenia is diagnosed when
the patient isn't really displaying significant symptoms. The person is no longer in an
acute schizophrenic phase, but may experience symptoms that are either less frequent
or less severe than they were during the peak of the disorder. Undifferentiated
schizophrenia is characterized by mixed schizophrenic symptoms (of other types) along
with disturbances of thought, affect, and behavior. It is diagnosed when one doesn't
have the full symptoms of one of the other subtypes. In this study, undifferentiated
schizophrenia will be used for the case analysis.
Worldwide about 1 percent of the population is diagnosed with schizophrenia. About
1.5 million people will be diagnosed with schizophrenia this year around the world.
(mentalhelp.net). Ninety-five percent (95%) suffer a lifetime; thirty-three percent (33%)
3

of all homeless Americans suffer from schizophrenia; fifty percent (50%) experience
serious side effects from medications; and ten percent (10%) kill themselves (Keltner,
2007). According to study done 697,543 out of 86,241,697 of Filipinos or approximately
0.8% are suffering from schizophrenia (cureresearch.com).
 Undifferentiated Schizophrenia is manifested by pronounced delusions,
hallucinations, and disorganized thought processes and behavior. The undifferentiated
subtype is diagnosed when people have symptoms of schizophrenia that are not
sufficiently formed or specific enough to permit classification of the illness into one of
the other subtypes.
 Patients in this category have the characteristics of positive and negative symptoms
of schizophrenia but do not meet the specific criteria for the paranoid, disorganized or
catatonic subtypes. Onset of symptoms typically occurs in young adulthood with around
1.5% prevalence of the population affected. The disorder is thought to mainly affect
cognition, but it also usually contributes to chronic problems with behavior and emotion
 Undifferentiated schizophrenia is a difficult diagnosis to make with any confidence
because it depends on establishing the slowly progressive development of the
characteristic “negative” symptoms of schizophrenia without any history of
hallucinations, delusions, or other manifestations of an earlier psychotic episode, and
with significant changes in personal behavior, manifest as a marked loss of interest,
idleness, and social withdrawal. It can be also based on the self-reported experiences of
the person, and abnormalities in behavior reported by family members, friends, or co-
workers, followed by a clinical assessment by a mental health professional. Diagnosis of
undifferentiated subtype may best describe the mixed clinical syndrome.
B. Significance of the Study
General Objective: The main objective of this case study is to be able to present an
extensive and comprehensive case study of the chosen client that would present a
comprehensive discussion of Schizophrenia, Undifferentiated to yield important
information for this case analysis.
Specific Objective: In order to meet the general objective, the group aims to:
• Assess and interpret the pertinent data gathered from the patient
• Determine the etiology factors (precipitating and predisposing) of the mental
disorder
4

• Evaluate the presence or absence of signs and symptoms seen in the patient in
relation to the mental disorder
• Formulate effective, specific, measurable, attainable, realistic and time-bounded
nursing care plans base on identified actual and potential nursing problems
• Provide appropriate nursing care directed towards not only to the client’s
psychological but also his physical well-being
II. PSYCHIATRIC NURSING ASSESSMENT
A. Patient’s Profile
Sir J is a 47 year old, male, Filipino and Roman Catholic. He is single and was
born on April 4, 1963 in Occidental Mindoro. He lives at San Miguel Heights, Valenzuela
City. His educational attainment is Vocational. The date of his admission is December 4,
2006 (Re-admission) with an admitting Diagnosis of F20.3 Undifferentiated
Schizophrenia, unstable.
B. Chief Complaint
According to his sister in law, “Di natutulog, ayaw uminom ng gamot, nagwawala
at mainitin and ulo.”
C. History of Present Illness
The patient has been mentally ill since 1990. He was readmitted on December 4,
2006 in National Center for Mental Health with the same diagnosis. He had an irregular
check-up until his significant others noticed that he doesn’t sleeps, doesn’t want to take
medicines, became short tempered and showed irrational behavior.
D. Past Medical History
He has no history of seizure. Prior to admission, the patient was non-diabetic,
non-hypertensive, non-asthmatic.
E. Past Psychiatric History
He was mentally ill since the onset of attention of crisis during 1990’s. He had an
irregular check-up until he was observed to become non-functional at home and
became distracted. Hence, his family readmits him in the same institution.
F. Familial History
5

His father is deceased. There were no histories of diabetes mellitus, or suicide
attempts in the both side of his family. There is no trace of any mental disorders in the
client’s family.
G. Personal History
The patient is a vocational graduate. He smokes cigarette and drinks alcoholic
beverage but with no use of illegal drugs. He has no suicidal and homicidal tendencies.
According to the patient, he studied for 2 years and work as a seaman, radio operator,
guard, imprinting shirts and a magtatabako”. He was self-supporting student and he
said that his family is famous in their place though he is poor and he is ill.
H. Mental Status Examination
H.1 General Appearance and Behavior
The patient is tall and thin in terms of muscularity, with fair brown complexion, and
has short black hair with strands of white. He has wounds and lesions on right and left
elbow and has diabetic feet. On the first day of the nurse-patient interaction, he had his
clothes kept not that clean and pleasant. However on the second day, he had taken a
bath and his uniform was neatly pressed. He also shaved his beard. He has a hoarse,
husky and rough voice and intonation. He walks slowly with a shuffling gait. He sits with
his legs crossed and taps his one foot at times. When he hears his name, he looks to
his side and see who is calling. At times, he leans forward while talking, still maintaining
good and straight eye contact throughout the interaction. His eyes are dilated at times
but respond to light.
H.2 Affect
The patient displayed a blunted or restricted affect during the first minutes of the
interaction, and once in a while, showed generally appropriate affect. In an objective
manner, he appears to be serious but he was able to smile for a second especially if he
feels that way.
H.3 Mood
6

During the interview, he stated that he knows he has a problem and he is ill.
He was worried about his feet and kept repeating that he needs “bayabas”. He is used
to touch his head part and sometimes, his face. Objectively, he appears to be concern
on his situation while looking at his feet. Once in a while, he smiles especially if the topic
is worth smiling for.
H.4 Thought Processes
The patient speaks in a loud and spontaneous manner. He speaks Filipino all the
time. His speech is sometimes unclear and there are words that are poorly articulated
making it difficult to understand. His thoughts are generally logical, and answer the
questions being asked to him by the student nurse. He also manifests looseness of
association but he still manages to answer some questions. Sometimes, he also
manifest blocking but returns to function immediately. He is quite circumstantial,
answers questions but includes unnecessary details and skips one topic from another
having flight of ideas, looseness of association, perseveration and tangential thinking.
H.5 Thought Content
The client believes that his family is famous and well known by other people.
Moreover, he is also preoccupied with thought that he is infertile and he is not good on
making love, that’s why his past girlfriends left her. In addition, he feels unworthy of
himself especially regarding the condition of his feet. He likewise said that his father is
in Guam, when in fact his father already died. Furthermore, he is inconsistent in
remembering real situations that happened to him. (About his occupation: he graduated
7

on a vocational course). Other than that, there were no noted signs of hallucination or
any illusion.
H.6 Cognitive Evaluation
The patient is fully awake and alert throughout the interview and is oriented to
time, place where he is, person who is with him, and date of the interaction. He was
able to: spell the word Japan and Salamat, count 1 to 10 and count it backwards, and
recite the alphabet completely from A to Z. On the first day, the meaning of Konnichiwa
is interpreted to him. And on the second day, he was asked about its meaning again
and he was able to remember it. Patient has a recent memory intact for 2/3 words
(Langit, lupa, puno) given to him during the first minutes of interview. He forgot the last
word for two consecutive times. When he was asked about his favorite song, he said
that he loves many songs but was unable to enumerate even one. He is also able to
answer simple mathematical calculations such as addition. He was able to recite a
poem entitled “Tutubi” and interpret a proverb in accordance to his understanding. And
when he was already on his room, he was shouting the 3 words (Langit, lupa, puno)
correctly and in sequence. In addition, he was not able to recall 4 historical events and
forgot 1 past president in the Philippines.
H.7 Insight
Patient knows that he has problem that is why he was admitted at the hospital.
He also thinks that the reason why he is not allowed to leave the hospital and go home
is because the doctors there are studying him especially the condition of his feet.
According to him, he always asks the nurse to give him bayabas so that it will heal
immediately but he said that they always refuse. He knows that his wound is treated
with the use of medicine instead of herbal. He also made mentioned that he is more like
of a prisoner because he was in the hospital for 24 years already unlike the prisoner
8

who suffers only on the jail for 10 years. He is already tired of complying with his
medicines but he said that he needs to take his drugs everyday so that he can already
go home. He is also able to identify the reason why he was admitted in the institution by
saying “Nambabastos daw ako sabi ng hipag ko kaya pinasok nila ako dito”. He was
able to cope up in his stay in the hospital but still desire to be with his family.
H.8 Judgment
The patient has fair and sound decisions regarding his everyday activities in the
hospital. He cooperates well with the therapies he is engaging too. He is ready to
answer questions asked by the student nurse. He said that when he will be able to go
back in his home, he will just take a rest and have fun.
I. Admitting Diagnosis: F20.3 Undifferentiated Schizophrenia, unstable
III. CLINICAL DISCUSSION OF THE DISEASE
A. Psychodynamics
 Psychodynamics evolved from the work of Bleuler and Freud. Their works
indicate that schizophrenia developed because of the psychic alterations that
occurred within a person. In addition, these alterations are contingent on the poor
caregiving that is provided within the child’s environment. However, they believed
that the psychic alterations are somehow tied to the genetic or physiological
changes that develop within the child’s environment.
DIATHESIS STRESS THEORY in Patients with Schizophrenia:
Individuals develop Schizophrenia based on the interactions of a number of
factors. Like in the case of our patient who was diagnosed to have Undifferentiated
Schizophrenia, unstable. He was a known to be a smoker and an alcohol drinker.
9

According to him, he started smoking during his younger years and use of alcohol
but in a moderate amount. This is under the environmental factor that may contribute
to the development of Schizophrenia. Another factor is his interpersonal relationship.
The client was not able to form a strong support system which is very essential in
maintaining an individual’s mental health. It’s a fact that a weak support system
could result to trigger behaviors or psychological disorders. All these predisposition
factors are in conjunction with the presence of stressors.
This model suggests that mental disorders are the result of an interaction between
nature and nurture. As for our patient another possible contributory factor is the
lower socio economic status that can create an environment susceptible to stress
formation leading to psychological dysfunction.
First, comprehensive measures of life stress give more precise information about the
particular stressful circumstances hypothesized to interact with diatheses. Second,
the influence of the diathesis on a person's life is typically ignored, which results in
several types of possible bias in the assessment of life stress. Finally, information is
available on diatheses and stress for specific disorders to provide a foundation for
more empirically based hypotheses about diathesis-stress interactions.
B. Psychopathophysiology
10
Decompensatory Factors:
• Lower socio economic status
• Environmental Stressors
• Lifestyle: Alcohol beverage drinker
and cigarette smoker
• Symptom triggers: Low self-
concept
Compensatory Factors:
• Age (20 year old-
onset)
• Gender (Male)

C. Laboratory results
Diagnostic Exam Normal Values Significant Findings Analysis/Interpretation
FBS 3.5 to 5.5 mmol/L 4.37 Normal
Cholesterol < less than 5.2 mmol/L 6.98 Increased due to congested in
the liver
Triglycerides < 2.21 mmol/L 1.21 Normal
BUN 2.80 – 6.40 mmol/L 4.37 Normal
*** Caligayahan Medical Clinic and Laboratory (February 19, 2010)
Cholesterol < less than 5.2 mmol/L 2.9 Normal
Triglycerides 90-150 mol/dL 81.6 Decreased due to metabolic
syndrome characterized by
excess adipose or fatty tissues.
*** NCMH (August 13, 2007)
11

FBS 3.5 to 5.5 mmol/L 4.21 Normal
Cholesterol < less than 5.2 mmol/L 7.04 Normal
Triglycerides 90-150 mol/dL 150.0 Normal
*** NCMH (February 9, 2007)
BUN 2.80 – 6.40 mmol/L 5.35 Normal
Uric acid 155.00 – 428.00 umol/L 356.9 umol/L Normal
Sodium 136.00 – 145. 00 mmol/L 139.2 mmol/L Normal
Potassium 3.50 – 5.10 mmol/L 4.8 mmol/L Normal
Hemoglobin M: 135 – 160 g/L 132 Decreased due to
abnormality or disease.
Erythrocytes M: 4.5 – 5.0 4.48 Decreased due to enriched
cholesterol
Total WBC 5.0 – 10.0 10^ 9/L 17.2 Increased due to infection
Monocytes 0.02 – 0.06 10^ 9/L 0.02 Normal
Eosinophiles 0.01 – 0.050 10^ 9/L 0.04 Normal
***NCMH (June 11, 2010)
Alkaline
Phosphate
20-140 IU/L 26.6 Normal
SGOT 10-34 IU/L 18.2 Normal
SGPT 5-35 IU/L 15.3 Normal
Bilirubin, Total 0.2-1.3 mg/dL 1.8 Increased due to blockage of the
bile ducts
Bilirubin, Direct <0.3 mg/dL 0.15 Increased due to blockage of the
bile ducts
*** NCMH (December 6, 2006)
Skin Craping done on April 2, 2008 in NCMH:
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ROH (Preparation): (+) Fungal Elements
DIAGNOSTIC EXAMS:
Radiological: (January 7, 2008)
CHEST:
Consider pulmonary arterial hypertension
Pulmonary emphysema bilateral
Fibriocalcific scarrings, bilateral old rib fracture
(July 26, 2007)
ECG:
Non-specific ST wave changes
(February 8, 2007)
D. Drug Study
13

Generic/
Brand/
Mechanism
of Action
Indication Contra-
indication
Side Effects Nursing
Responsibilities
14
Generic/
Brand/
Dosage/
Classification
Mechanism
of Action
Indication Contra-
indication
Side Effects Nursing
Responsibilities
Haloperidol
(Haldol)
10 g HS
- antipsychotic
Blocks
dopamine
receptors in
brain
especially in
limbic
system/
block post
synaptic D2
dopamine
Acute and
chronic
psychotic
disorders
including:
schizophrenia,
drug-induced
psychoses.
Also useful in
managing
aggressive or
agitated
patients.
Hyper-
sensitivity
Narrow
glaucoma
Bone marrow
depression
CNS
depression
Seizures
Extrapyramidal
reactions
Confusion
Drowsiness
Restlessness
Constipation
Dry mouth
-Assess mental
status (orientation,
mood, behavior)
prior to and
periodically during
therapy
-Monitor for
tardive dyskinesia
(uncontrolled
rhythmic
movement of
mouth, face, and
extremities; lip
smacking or
puckering, puffing
of cheeks;
uncontrolled
chewing, rapid or
worm-like
movements of
tongue). Report
immediately; may
be irreversible.
-Report increase in
temperature,
hypotension,
muscle rigidity
(NMS symptoms)
-Ask patient to rise
slowly to avoid
orthostatic
hypotension.

Dosage/
Classification
Amlodipine
5 mg
Calcium
Channel
Blocker
Inhibits influx
of calcium ion
across cell
membranes to
produce
relaxation of
coronary
vascular smooth
muscle
Hyper-tension;
chronic stable
angina;
vasospastic
angina.
Sick sinus
syndrome; 2nd
or
3rd
degree atrio-
ventricular block,
except with a
functioning
pacemaker.
Palpitations,
tachycardia,
headache,
dizziness,
fatigue
Assess cardiorespiratory
status: angina pain, B/P,
pulse, respiration, ECG.
Advise client to avoid
getting up too fast from a
sitting or lying position.
Get up slowly and steady
yourself to prevent a fall.
Losartan
Anti-
hypertensive
Selectively
blocks the
binding of
angiotensin II to
receptor sites in
many tissues,
especially the
vascular smooth
muscles and
adrenal glands.
Reduction in
the risk of
cardio
vascular
morbidity and
mortality in
hyper-tensive
patients
Patients who are
hypersensitive to
other
sulfonamide-
derived drugs.
Dizziness and
dose-related
orthostatic
hypertension.
Assess patient’s BP before
starting therapy and
regularly thereafter.
Assess B/P and pulse.
Monitor for adverse
reactions.
Aspirin
80 mg
Analgesic
Anti-
inflammatory
Relieves pain
and reduces
inflammation
by inhibition of
peripheral
prostaglandin
synthesis.
Treatment of
mild-to-
moderate pain.
Hyper-sensitivity
to salicylates or
NSAIDS;
hemophilia.
EENT:
dizziness;
tinnitus. GI:
nausea;
heartburn.
Assess pain: character,
location, intensity, ROM
before and 1 hour after
administration.
Give with meals or after
meal to avoid GI irritance.
Ferrous
sulphate 1 tab
TID
Iron
Preparation
Provides/
replaces
elemental iron,
an essential 1
component in
formation of
hemoglobin in
red blood cell
development
Dietary
supplement of
iron.
Prevention and
treatment of
iron deficiency
anemia.
Hyper-sensitivity
to any ingredient,
hemosiderosis,
hemolytic
anemia.
GI irritation,
anorexia,
nausea,
vomiting,
diarrhea.
Monitor for adverse
reaction: GI: nausea,
epigastric pain,
constipation, diarrhea,
black stools, anorexia.
Others: temporary teeth
staining
Caution patient to make
position changes slowly to
minimize orthostatic
hypotension.
IV. NURSING CARE PLAN
A. LIST OF PRIORITIZED PSYCHIATRIC NURSING DIAGNOSIS
Cues Diagnosis Justification
15

“ Bakit ako kinuhanan
noon? (BP and weight).
May kaso ako?” as
verbalized by the patient.
“Buwan-buwan ako
dinadalaw. Mga alas
kwatro ng hapon. Sabi ng
kapatid ko petition for
Guam ang nanay ko.
Ganoon din ang tatay,
petition for Guam.” as
verbalized by the patient.
Disturbed Thought
Processes related to
disruption in cognitive
and psychological
process as manifested
by ideas of delusions,
altered attention span
and disordered thought
sequencing
There was an obvious
manifestation of the psychological
problem of the patient that needs
to be resolved for a progress in
the rehabilitation of the client.
According to him, his father is for
petition in Guam, when in fact his
father already died. In addition, he
said that he was being visited
monthly but the last time was still
in the year of 2007.
“24 years na akong
ganito. Tingnan mo ang
mga paa ko. Naluluto na.
Makati siya, kinakamot
ko na minsan. Naluluto
na ang paa ko. Gusto ko
ng bayabas para sa paa
ko.” as verbalized by the
patient.
Impaired skin integrity
related to presence of
wounds on lower
extremities as manifested
by redness, numbness of
affected area and
presence of itching and
pain at times.
The client was noted to have
presence of a diabetic feet and
this is a concern since it may
possibly result to a further
complication or infection.
Rendering nursing interventions to
the client is important to achieve
timely wound healing.
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
Subjective cues:
“24 years na
akong ganito.
Tingnan mo ang
mga paa ko.
Naluluto na.
Makati siya,
Impaired skin
integrity related
to presence of
wounds on
lower
extremities as
manifested by
redness,
Short term:
After 1 day of
nursing
interventions,
the patient will
verbalize the
willingness and
Independent:
Note changes in skin
color, texture and
turgor.
Palpate skin lesions
for the size, shape,
To provide
baseline data
Assessment
purposes to
Short term:
After 1 day of
nursing
interventions,
the patient
verbalized the
willingness and
16

kinakamot ko na
minsan.
Naluluto na ang
paa ko. Gusto
ko ng bayabas
para sa paa ko.”
as verbalized by
the patient.
Objective cues:
>diabetic feet
>numbness of
affected area
>presence of
itching and pain
at times
>decreased self
esteem
numbness of
affected area
and presence
of itching and
pain at times.
ability to manage
situation of
cleaning his
wounds.
Long term:
After weeks of
nursing
interventions,
the patient will
display timely
healing of skin
lesion/wounds
pressure sores
without
complication.
consistency and
temperature and
hydration.
Inspect surrounding
skin for erythema,
induration and
maceration.
Keep the area clean/
dry, carefully clean
the wounds with
antiseptic solution.
Encourage client to
verbalize feelings
and discuss how to
manage wound
cleaning on his own.
Develop
repositioning of the
client and encourage
early ambulation.
Use appropriate
padding devices
Dependent:
Administer antibiotic
for prophylaxis as
prescribed by the
physician
determine
severity of skin
integrity
To prevent
infection
To increase
independence
and concern on
his condition
Promotes
circulation
To reduce
pressure and
enhance
circulation
To prevent
infection
ability to
manage
situation of
cleaning his
wounds.
Long term:
After weeks of
nursing
interventions,
the patient still
manifested
presence of
itching and
redness on the
affected area.
Appearance of
wound was still
noted.
Capitol Medical Center Colleges
#4 Sto. Domingo Ave., Quezon City
V. PROCESS RECORDING
17

NPI # 1 (Orientation Phase)
Date: August 17, 2010; Tuesday
Time: 12:45-1:10 pm
Setting: Hallway
Name: Sir J
Age: 47 years old
Educational Attainment: Vocational
Date of Admission: December 4, 2006
Diagnosis: F20.3 Undifferentiated Diagnosis Unstable
Description of patient:
The client is a tall and thin man, wearing his uniform, not that neatly pressed. He is fully awake,
conscious, alert and cooperative. He has a fair brown complexion. Hair is short and color black with
strands of white hair. He has a mustache. His eyes are color black and have a good eye contact. He sits
with legs crossed and taps his foot. There was no untoward behavior experienced during the nursing-
patient interaction.
Description of environment:
Sir J is in the pavilion 21. During the first minutes, the NPI happened at the hallway outside the
ward because there was no space inside due to other affiliated school’s activity. It was a rainy and windy
day. The surrounding is slightly noisy because there are other students who are present outside the area.
Objectives:
1. To establish rapport and trust
2. To orient the client
3. To form contract with the client
4. To assess client’s strengths and weaknesses
5. To help the client communicate
NURSE Therapeutic
Technique
Patient Analysis
Magandang hapon Joven.
Ako si Diana Ortiz, student
nurse ng Capitol Medical
Center. Ako ang magiging
nurse mo ngayong araw,
bukas at next week, Lunes
at Martes. Ano ang gusto
mong itawag ko sayo?
Establish
rapport
Giving
information
Joven. Hoven. The patient answered
the question of the
student nurse.
Joven. Nagagalak akong
makilala ka. Ako ang
makakasama mo hanggang
Acknowleding Gusto ko malaman ang
pagaaral.
The patient chose a
topic of conversation.
18

mamaya 3 pm. May mga
inihanda kaming activities
para sa inyo. Ano ang gusto
mong pagusapan natin
ngayon?
Providing
general leads
Pag-aaral. Kaninong pag-
aaral?
Seeking
clarification
Syempre sayo.
Pagaaral mo,
The client was able to
clarify what he wants to
talk about.
Ah. Gusto mong malaman
ang pagaaral ko?
Oo.
Fourth Year na ako. Ikaw
naman ang gusto kong
makilala. Ano nga pala ang
nagdala sa iyo dito?
Use of open-
ended question
Dinala ako ng kapatid
kong babae dito noong
2006.
He had remembered
the date when he was
brought to the institution
but it was not his sister
who accompanied him.
Ano ang nangyari? Sabe hindi daw ako
makausap ng maayos
at ayaw ko daw
uminom ng gamot.
Nagwawala din ako
minsan.
He still knew why he
was brought to the
hospital.
Ang ibig mong sabihin hindi
ka umiinom ng gamot?
Seeking
clarification
Oo. Nagsawa na ako.
24 years na akong
umiinom ng gamot.
Pero wala naming
nangyayari, Nandito na
ako noong 1994 tapos
umalis ulit tapos
bumalik nitong 2006
lang.
He verbalized his
feelings about the
situation.
He manifested
circumstantiality.
Silence
Pabalik-balik na lang
ako lage. 47 years old
na ako. Ganoon pa din.
May sakit pa din ako.
He continued
verbalization of what he
feels and stating how
old he is.
Ano ang ibig mong sabihin
na may sakit ka?
Providing
general leads
May sakit ako, sabi ng
doctor, baog daw ako
eh. Hindi daw ako ibig. Self-depreciation
Ibig? Iibig. Baog daw ako
sabe ng mga doctor.
Hindi daw ako
marunong makipag
19

Seeking
clarification
sex.
Sinabi nila iyon? Oo. Ganoon siguro
talaga pag dukha. At
pinagkaitan ng
Maykapal.
Self-depreciation
Ano ang nararamdaman mo
ngayon?
Providing
general leads
Okay naman. (Silence)
Ang mga doctor dito
pinagaaralan nila ang
mga tao. Ayaw ko na
nga uminom ng gamot
eh pero kailangan para
uwi na.
Flight of Ideas
Parang hindi ka naniniwala
sa mga doctor na tumitingin
sayo?
Focusing 24 years na akong
ganito. Tingnan mo ang
mga paa ko, naluluto
na. Naluluto na. Makati
siya. Kinakamot ko na
minsan. Naluluto na
ang paa ko. Gusto ko
ng bayabas para sa
paa ko.
From his words, it only
showed that he was
anxious about his feet.
Nakikita ko na masyadong
kang nag-aalala sa iyong
kalagayan.
Being tentative
rather than
absolute
Oo. May problema kasi
talaga ako. Di daw kasi
ako marunong mag-sex
eh. Sabi din naman ng
mga naging girlfriend
ko. Ilan taon ka na ba?
Looseness of
Association
19 years old. Mamaya pala
Joven may mga activities
tayo na inaasahan ko na
magiging cooperative ka.
Tara doon tayo sa loob
magpatuloy mag-usap. Use of open-
ended question
Ah ganoon. Oo.
Anong pinagkakaabalahan
mo bago ka nagpunta dito?
Nag-aral ako dati. 2
years. Self- supporting
ako, naging radio
operator sa La Union.
Nag-imprinta ng damit.
Nag stay din ako sa
Oriental Mindoro.
Seaman, dati interland,
ngayon international.
Katulad ng tatay ko
Somatic delusion
20

pero patay na siya
ngayon.
Lahat ng binanggit mo ay
naging trabaho mo?
Seeking
clarification
Oo.
Silence Silence
Nga pala, may alam ka bang
ibang salita?
Meron. Arigato. He was able to
remember the true
meaning of the word
taught to him.
Ano ibig sabihin nun? Seeking
clarification
Salamat.
May isa pa akong alam.
Konnichiwa.
Giving
information
Ano yun?
Konnichiwa. Ibig sabihin,
magandang hapon.
Ah. Magandang hapon
pala.
He accepted new
information from the
student-nurse.
Kanina ay nabanggit mo
yung tungkol sa tatay mo.
Nasaan naman ang nanay
mo?
Providing
general leads
Di ko alam. Wala na
akong balita sa kanya
eh. Sabi ng kapatid
kong babae, hindi daw
niya alam. Kaya gusto
ko talaga kamustahin.
He was able to answer
the question.
Kailan ka ba huling dinalaw
ng kapatid mo?
Closed-ended
question
Buwan-buwan ako
dinadalaw. Mga alas
kwatro ng hapon. Sabi
ng kapatid ko petition
for Guam ang nanay
ko. Ganoon din ang
tatay, petition for
Guam. Teka lang, iihi
muna ako.
He was inconsistent
about what he knows
about his father.
(Tatayo sana ako para
samahan siya)
Diyan ka na lang.
Maupo ka na. Ako na
lang mag-isa pupunta
ng banyo.
He showed a
manipulative behavior.
Hindi sasamahan na lang
kita. Kahit dyan lang bago
lumabas.
Offering Self Sige.
Malapit na tayo magsimula
sa mga activities. Madami
Summarizing
and Planning
Sige, Diana. The client accepted the
notion about what the
21

na din tayong napagusapan
sa kalahating oras. Bukas
naman ay mas palalawakin
pa natin ang mga topic natin
ha? Upo ka na. Salamat.
student nurse told him.
Evaluation and remarks:
The student nurse was able to establish rapport in order to gain the trust
of the client. After introducing, orienting and forming contract, the student nurse
was able to gather some information about the client especially how was he
feeling by that time. He was ready to answer the questions though there is some
inconsistency in his thoughts. He manifested circumstantiality, flight of ideas,
looseness of association and self-depreciation. There is no evidence of other
thought disorders. The goals are met.
NPI # 2 (Working Phase)
Date: August 18, 2010; Wednesday
Time: 11:05-11:35 am
Setting: Under the tree; and beside the ward, under the roof
Name: Sir J
22

Age: 47 years old
The patient has a shuffling gait. He is alert and cooperative. His complexion is brown. He has a
good hygiene this time. His clothes are well-kept. He has shaved his mustache and his hair was short. His
eyes are color black and have a good eye contact. Nails are short and clean. He sits with legs crossed
and taps his foot. Once in a while, he leans forward while talking. He sometimes scratches his head and
crumples his face.
The working phase of the nurse-patient interaction happened under the tree after doing the
different therapies. Drops of rain are felt that made us transfer to another area where a roof can protect us
from the scattered rain shower. The area was conducive.
Objectives:
1. Promote positive self-concept
2. Realistic goal-setting
3. Encourage client to verbalize feelings and explore self
4. Develop positive coping behaviors
5. Take action to meet the goals set with the client
NURSE Therapeutic
Technique
Patient Analysis
Magandang araw sayo
Joven!
Establish
rapport by
greetings
Oh. Oo.
Ang galing mo kanina sa
mga activities natin.
Nakita kong
nagparticipate ka talaga.
Acknowledging
Oo. Talaga.
Bago ang lahat, may
ibibigay akong 3 salita
tapos tandaan mo ito,
mamaya ipapaulit ko
muli sayo.
MSE
Component
Sige. Ano yun? He agreed to what the
student nurse asked
him to do.
Langit, Lupa, Puno.
Ulitin mo nga.
Langit, Lupa, Puno. Langit,
Lupa, Puno
He was able to repeat
the 3 words given to
him.
Magaling.
Magkwentuhan ulit tayo.
Ano nga ulit yung
natapos mong kurso?
Being specific Radio operator. Nag-aral ako
sa Samson. Sa Recto. Sa
Maynila. 2 taon akong nag-
aral.
He had answered the
question with details
about his school days.
23

Ah. At pagkatapos,
anong pinasukan mong
trabaho?
Validating data
from previous
conversation.
Seaman, sa dagat.
Nagtatabako. Nag-iimprinta ng
damit. Guard.
He had a false belief
about his work of
being a seaman.
Lahat yan naging
trabaho mo?
Seeking
clarification
Oo, madami akong
pinagkaabalahan noon.
Ano ginagawa mo
noong bata ka pa?
Using open-
ended
question
Nung bata ako, mahilig akong
maglaro ng kard. Pusoy dos.
Baraha. At nagjojolen din ako
kasama ng aking mga
kaibigan.
He was able to
answer the question.
Naging masaya ba
childhood days mo?
Close-ended
question
Oo. Kasama ko mga kapatid ko
at mga pinsan na naglalaro.
Sino ang mga kasama
niyo sa bahay?
Using open-
ended
question
Mga kapatid ko. 7 kaming
magkakapatid lahat. Nasa
Guam ang 4 kong kapatid. Si
Ilinoy, Dalisay, Angelito at
Anastacio. Yung 3, sina Danilo,
at A, Joven. Dito sa Maynila.
He stated the names
of his siblings and
where they reside.
Pang ilan ka ba sa
magkakapatid?
Clarifying
relationship
status
Pang-apat.
Ano yung masasayang
araw or memories mo
na kasama mo sila?
Using open-
ended
question
Kapag may patay.
Ha? Ang ibig mong
sabihin ay masaya ka
kapag may patay?
Perception
seeking/
Restating
Hindi! Syempre kumpleto
kaming pamilya. Lahat kami
kumpleto pag bumibisita.
He was able to clarify
his feelings.
Anong nagagawa ng
pakiramdam mong yan
sa iyo?
Using open-
ended
question to
explore
feelings
Masaya nga. He did not further
elaborate his
response.
Joven, ano nga pala
date ngayon?
Evaluating if
the client is
oriented to
date.
August 18. He was able to
answer the question
correctly.
2000 ano? 2010.
He was able to
answer the question
correctly showing that
Eh anong araw? Miyerkules.
Saan ka nga pala
pinanganak?
Mindoro.
24

Exploring
client’s
important
thoughts about
his life
he’s aware and
capable to remember
events in his life. He is
comprehensible.
Kailan pala birthday mo? April 4, 1963. 47 na ako.
Saan ka nakatira? Maynila.
Anong mga pagkain
yung paborito mo?
Hotdog. Longganisa. Hotdog.
Longganisa. Longganisa.
He stated his favorite
foods.
Anong kanta naman
yung gusto mo?
Madami akong gusto.
Katulad ng? Basta madami. He was not able to
enumerate the title of
some of his favorite
songs.
Ilan na nga ulit naging
girlfriend mo?
Close-ended
question
Madami na pero lahat sila
iniwan ako dahil nga hindi daw
ako marunong makipag sex.
He verbalized his
feelings about his
relationship with other
his past girlfriends.
Ah. Joven, umaambon.
Lipat tayo dun sa may
bubong. Showing
Concern
Ah. Ganoon.
Ayan. Di na tayo
mauulanan.
Oo.
Sabihin mo nga ulit yung
pangalan ko.
Diana.
Nakita mo ata sa name
plate ko eh!
Testing Oo nabasa ko.
Laugh Smile
Joven sabihin mo nga
ulit yung 3 salita na
sinabi ko sayo kanina. MSE
Component
Langit. Lupa. (pause) Bundok. He forgot the last
word given to him.
Langit, lupa, puno. Langit, lupa, puno. He repeated the same
words given to him.
Kailan ka pala napunta
dito?
Evaluating if
he still
remembers
when he was
brought to the
hospital
August 3, 1987 ako una
nandito. Tapos umalis. Tapos
bumalik ulit. Noong 2006.
December 6, 2006. 2010 na
ngayon diba?
He had a false belief
of the date when he
was first admitted in
the institution. It was
1990 and it was
December 4, 2006 for
his readmission.
25

Oo. Bakit? Probing 24 years na pala no. Tagal ko
ng nandito.
Ano bang nanyari at
bumalik ka dito?
Using open-
ended
question
Nambabastos daw ako sabi ng
hipag ko. Nanggugulo.
Nakikipag away.
He was able to recall
the reason why he
was admitted and who
brought him to the
hospital.
Silence Naninigarilyo din ako bata pa
lang.
He remembered his
lifestyle when it
comes to vices.
Eh alak? Exploring Alak onti lang. Pag dumadaan
ako sa may sa amin, bigyan
nila ako ng 1shot. Isa lang
talaga tapos uwi na ko.
Ganoon ba. Anong
pangalan ng hipag mo?
Exploring
client’s
important
thoughts about
his life
Si Tess nga.
Ah. Kailan ka huling
dinalaw ng mahal mo sa
buhay?
Noong katapusan. Dinalaw ako
ng pamangkin ko.
Misperception of
when he was visited
by his loved one. The
last visitation was
2007 by his brother.
Ganon. Mahal mo ba
mga magulang mo?
Exploring
client’s ideas
and thoughts
Oo.
Nasaan magulang mo
ngayon?
Nasa Guam sila.
May kakaiba ka bang
naririnig o nakikita dati
at ngayon?
Wala naman.
Nasaan ka ba ngayon? Sa Mental. He knew where he
was.
Sino mga kaibigan mo
dito?
Lahat sila. Madami.
Ano ginagawa mo dito
sa ward?
Wala. Sabe hindi daw pwede
umalis kaya di ako makauwi.
Tumutulong ka ba? Oo.
Joven, tawag tayo sa
loob. Kuhanan ka daw
ng BP.
Silence.
Silence. May kaso ba ako?
Aso? Seeking Ba’t ako kinuhanan nun?
26

clarification (pertaining to BP and weight)
May kaso ako?
He thought that he
had done something
wrong that’s why his
BP and height was
obtained.
Ah. Kaso. (Laugh).
Wala. Tiningnan lang
natin BP at timbang mo
para makita kung
mataas ba ang presyon
mo sa dugo at kung ano
timbang mo.
Giving
information
Ah. Akala ko kasi meron akong
kaso. Sabi kasi nila may kaso
daw ako.
Ano daw kaso mo? Seeking
clarification
Hindi ko alam. Sabi kasi ni Elsi
kalimutan ko na lang at wag
isipin kaya di ko alam kaso ko.
Ganoon? Oo nga wag
mo na lang gaano isipin.
Agreeing Oo, wag daw isipin eh.
Kalimutan na lang.
Ano nangyari diyan sa
paa mo?
Using open
ended
question
Dahil sa swimming, trabaho ko.
Ano ginagawa mo para
gumaling?
Gamot. May binibigay na
gamot.
He was aware that he
has medicine for his
feet to be healed.
Anong gamot ginagamit
mo?
Gamot eh. Gusto ko nga
bayabas para gumaling na.
Ayaw naman ako bigyan.
He used to believe in
herbal medicine to
restore his feet.
Sinabi mo ba sa doctor
na gusto mo bayabas
ang gamitin?
Oo. Pero pinagaaralan nila ang
paa ko. Ayaw ata pagalingin.
Pero alam ko gagaling pa yung
paa ko.
He thought that
doctors don’t want
him to be healed
because he was being
studied.
Yan ang paniniwala mo? Oo.
Alam mo ba na ang mga
doctor, ginagamot nila
ang mga may sakit. At
ang mga nurse
tinutulungan nila ang
doctor sa mga gawain
nito at syempre
tinutulungan din nila ang
may sakit.
Presenting
reality
Giving
information
Ah ganoon pala yon. He agreed to what the
student nurse
explained.
Oo. Namimiss mo na ba
ang pamilya mo?
Close ended
question
Oo.
Alam mo ba sikat ang pamilya
ko sa amin. Ang mga
He believes that his
family is famous and
27

magulang ko. Ang tito ko, sikat
sa probinsiya.
known by many
people in their
province.
Silence Silence
Mas grabe pa ako sa
nakakulong. Sawa na ko dito.
24 years na. He verbalized his
feelings of being tired
staying in the hospital
comparing it to people
who are in jail. He
likewise said that he’s
more of a prisoner, no
freedom.
Ano ang ibig mong
sabihin?
Seeking
clarification
Di ba ang mga nakakulong 10
taon lang sila sa kulungan pero
ako, sobra pa sa 10 taon ako
nandito. Hindi pwede lumabas.
Nakakulong din ako. Walang
Kalayaan.
Sa pagkakaalam ko
kasi, depende sa kaso
na nagawa ng isang tao
kung gaano siya
makukulong eh.
Presenting
reality
Giving
information
Ah ganoon pala. Depende sa
kaso.
Agreeing to the
student nurse
Oo. Kung grabe ang
nagawa ng isang tao,
katulad na lang kung
nakapatay siya na
sinasadya at planado,
pwede siyang makulong
habang buhay.
Ah. Ganoon pala yun.
Joven, banggitin mo nga
ulit yung 3 salita na
sinabi ko sayo kanina.
MSE
Component
Langit, lupa, dagat. He still forgot the last
word given to him a
while ago.
Langit, lupa, puno. Langit, lupa, puno.
Ayan. Recite mo naman
un letters ng alphabet.
A-B-C-D-E-F-G-H-I-J-K-L-M-N-
O-P-Q-R-S-T-U-V-W-X-Y-Z
He was able to
answer the questions
correctly to evaluate
his cognitive ability.
Galing! Ngayon,
magbilang ka naman
mula 1 to 10. 1-2-3- 4-5-6-7-8-9-10
Tama! Spell mo nga
yung word na Japan.
J-A-P-A-N
Eh un tagalog word na
salamat.
S-A-L-A-M-A-T
Hmm. 6+3? 9
28

MSE
Component
7+6? 13
2+5? 7
Magaling! Naaalala mo
pa ba kahapon yung
tinuro ko sayong salita?
Ano dun?
Yung Konnichiwa.
Anong ibig sabihin nun?
Magandang Hapon. He remembered the
meaning of the word
given to him
yesterday.
Tama. Kapag pinayagan
ka ng umalis dito, anong
gagawin mo pag nasa
labas ka na?
Exploring
ideas
Magpapahinga ako paglabas,
enjoy. Punta ko sa look. Dun
ako magpapahinga.
Verbalization of
feelings.
Ah talaga? Anong oras na ba? He asked about the
time and requesting
that he will already go
inside.
11:30. Bakit? Tapos na ba interview? Pasok
na tayo. 11:30 na pala.
Ganoon ba. Sige. Joven,
magkita tayo ulit next
week ha. Sa Martes na
Socialization day natin.
Tara, pasok na tayo.
Summarizing
and Planning
Ah ganon. Sige.
Evaluation and Remarks:
The client was able to answer the questions being asked to him though in some
cases there were still some inconsistencies in his ideas/thoughts and misperception of
the real situation. Some of his answers are different from his answers during the
orientation phase. He had manifested circumstantiality and looseness of association.
There is no evidence of hallucination or illusion. He had also difficulty in remembering
the 3 words given to him to evaluate his short term memory. He was cooperative during
the nurse-patient interaction. He had maintained a good eye contact and showed no
untoward behavior. The goals are met.
29

NPI # 3 (continuation of Working Phase)
Date: August 23, 2010; Monday
Time: 1:10-1:30 pm
Setting: Tree house
Name: Sir J
Age: 47 years old
The patient has a shuffling gait. He is alert and cooperative. His complexion is brown. His eyes are color
black and have a good eye contact. He sits with legs crossed and taps his foot. Once in a while, he leans
forward while talking. He sometimes scratches his head and crumples his face.
30

The continuation of the working phase of the nurse-patient interaction happened in the tree house in the
afternoon after he had eaten his lunch. The environment was conducive, quiet and comfortable.
Objectives:
1. Promote positive self-concept
2. Encourage client to verbalize feelings and explore self
3. Develop positive coping behaviors
4. Take action to meet the goals set with the client
NURSE Therapeutic
Technique
Patient Analysis
Hi. Kamusta Joven? Establish
rapport
Using open-
ended
question
Mabuti naman. Ano gagawin
naten? Magdadrawing?
He asked about the
activity.
Hindi. Mag NPI tayo at
pagkatapos mag games.
Pinoy Henyo.
Giving
information
Ah ganoon ba.
Oo. Last day na naming
ngayon. Bukas
socialization na natin. O
anong gusto mong food
natin?
Using open-
ended
question
Kahit ano.
He was able to
answer the question
of the student nurse.
Ah. Anong kinain mo sa
tanghalian?
Baboy. Paksiw.
Masarap ba? Oo.
Describe mo naman sa
akin famly mo. Nasaan
magulang mo?
Nasa Guam nanay at tatay ko.
Petition for United States. Sa
London din. Andon din mga
kapatid ko.
He manifested
delusion. His father
already died.
Anong dahilan bakit
hindi mo sila kasama?
Focusing and
Using open-
ended
Nasa US sila. Tatay ko patay
na. Nanay ko Petition.
Inconsistent thought.
Anong dahilan bakit
hindi mo sila kasama?
Andito ko sa loob eh. Paano
ako sasama?
He was able to
verbalize his thoughts.
Ano ba rason bakit
andito ka?
Nakikipag-away nga. Tsaka
sabi ng nanay at kapatid ko
nagsasalita daw ako ng walang
kausap. Mabilis daw ako
magsalita. Walang kausap.
Kaya dinala nila ako ditto.
31

question Noong una, sila. Tapos yung
hipag ko nagdala sa akin.
Sino ba kinakausap mo? Wala nga. Mental nga diba.
Ano.. Kailan ka huling
dinalaw dito?
Noong katapusan. Ng kapatid
ko.
He manifested
delusion. He was last
visited 2007.
Anong nararamdaman
mo noong pinasok ka
nila dito?
Ayoko na dito.
He was able to
verbalize his feelings.
He doesn’t want to
take his medicines
anymore but still, he
complies to take it. He
is concerned about
his health.
Joven, iinom ka daw ulit
ng gamot.
Gamot ulit. Lagi na lang gamot.
Nagsasawa na ako.
*He took his medicine.
Buti at ininom mo pa din
ang gamot mo.
Ayoko na. Sawa na ako. 24
years na ako umiinom ng
gamot. Hindi naman ako
gumagaling. Sawa na ako.
Kailangan mo pa din
uminom ng gamot mo
para gumaling ka.
Ang tagal-tagal na eh. Dito na
ako sa mental matagal. May
sakit ako. Kaya nga pinasok
ako dito eh. May kapansanan
ako.
Anong kapansanan mo? May kapansanan ako. Kaya
nandito ako. Kaya nga nasa
Crossings eh. Sa
Mandaluyong.
He manifested
tangential thinking,
circumstantiality.
Crossings? Seeking
clarification
Oo mental nga. Ano ba naman
ito.
Ah. Crossings sa
Mandaluyong. Pasensya
Oo.
Saan ka nga ulit
nakatira?
Validation of
the
congruency of
his past
answers to
present
Sa Mindoro nga. Ano ba
naman ito.
He was slightly
annoyed of repeated
question asked.
Saan sa Mindoro? Look.
He was able to
answer the question
Probinsya yon? Oo. Taga Maynila ka ba?
Oo. Bakit? Nag stay din ako sa Maynila.
Grade 3 pa lang ako.
32

and he verbalized his
thoughts and feelings.
Ibig mong sabihin grade
3 ka pa lang, nag-aral ka
na dito sa Maynila?
Paraphrasing Hindi. Namamasyal lang ako
sa Maynila.
Sino kasama mo?
Focusing and
Using open
ended
question
Edi pamilya ko.Magulang. Mga
kapatid.
Anong ginagawa niyo
pag nandito kayo sa
Maynila?
Namamasya. Nagpupunta sa
mga kapitbahay. Kung saan-
saan,. Pero ayoko dito sa
Maynila.
Sa anong dahilan? Ayoko dito sa Maynila.
He manifested
perseveration.
May mga naging
karanasan ka ba habang
nasa Maynila ka pa?
Wala.
Kamusta naman
pagkabinata mo?
Okay lang. May sakit pa din.
Ayoko na ng gamot.
Naaalala mo si Kaye? Oo. Ayoko ng gamot.
Mukhang ayaw mo at
nagsasawa ka na talaga
uminom ng gamot ha.
Pero kailangan mong
uminom ng gamot mo.
Para sa ikabubuti mo din
yan.
Focusing
Ang tagal-tagal na eh. 24 years
na.
Sino ba ang doctor mo?
Using open
ended
question
Si Dr. Tamayo. Si Dr. Ho. Si
Dr. Kaligayahan.
He manifested
delusion.
Kailan ka huling
chineck-up?
Matagal na.
May mga bisyo ka ba? Oo. Nagyoyosi. Kanina yosi.
Ano? Nagyoyosi ka? Clarifying Hindi bawal. Walang batas.
Nagyosi.
Saan mo nakuha yung
yosi mo?
Focusing and
Using open
ended
question
Dito din sa mga kasama ko.
Bigay.
Sinong kasama? Sila. Binibigay lang.
Wala daw batas na
bawal mag yosi dito?
Walang batas. Pwede.
Nagyoyosi.
Masama iyan sa
kalusugan mo.
Hindi. Yosi lang.
33

May peklat ka ba diyan
sa ulo mo?
Wala. Wala no.
Ganoon ba. Magbigay
ka nga Joven ng 5
naging presidente ng
Pilipinas.
MSE
Component
Manuel Roxas. Manuel
Quezon. Ninoy Aquino.
Corazon Aquino. (pause)
Manuel Quezon.
He repeated Manuel
Quezon.
5 mga mahahalagang
nangyari naman sa
Pilipinas. Yung naaalala
mo sa history?
(pause) Wala. Wala akong
alam. (pause) Noong dumating
ang mga kastila. Yon lang.
He was not able to
recall historical events
in the Philippines.
Ah. Explain mo naman
sa akin yung salawikain
na “Ang palay ay hindi
kusang lalapit sa
manok.”
Ang biyaya. Ang biyaya ay
hindi dadating pag hindi
pinaghihirapan. Dapat
maghirap para magkaroon ng
biyaya.
He interpreted the
proverbs given to him.
Magaling. O Joven,
magsimula na daw ang
Pinoy Henyo. Sali ka ah.
Planning
Oo.
Babye Joven. Bukas ulit
ha. Socialization na.
Huling araw na natin.
Ganoon ba. Dalhan mo ako
Alaska. Code.
Anong Code? Alaska. Code. Basta. Yung
Pulbo.
He demanded
something for
tomorrow’s
Socialization day and
termination phase.
Ah. Yung powder? Oo.
Sige. Damihan mo ha. Kaw na
bahala.
Sige Joven. Babye ulit. Sige Diana.
For the continuation of the Working Phase, still, the client was able to
answer the questions being asked to him though in some cases there were still
some inconsistencies in his ideas/thoughts and misperception of the real
situation. Some of his answers are different from his answers during the
orientation and first part of the working phase. He had manifested delusion,
circumstantiality, looseness of association, perseveration and tangential thinking.
34

There is no evidence of hallucination or illusion. He had also difficulty in
remembering historical events in the Philippines and was not able to complete 5
Past Presidents of our country for his cognitive evaluation. He was cooperative
during the nurse-patient interaction. He had maintained a good eye contact and
showed no untoward behavior. The goals are met.
NPI # 4 (Termination Phase)
Date: August 24, 2010; Tuesday
Time: 12:45-12:55 pm
Setting: Outdoor, under the tree
Name: Sir J
Age: 47 years old
The patient is happy and excited upon seeing the token of appreciation. He is alert and cooperative. He is
relaxed and feels comfortable. Still, he maintains a good eye contact. He leans forward while talking.
The termination phase of the nurse-patient interaction happened under the tree immediately after the
socialization day. The environment was in high spirit and comfortable. Other patients and student-nurses
are beside us.
Objectives:
1. Promote self-care
2. Recognize increasing anxiety
35

3. Increase independence
4. Demonstrate emotional stability
5. Evaluate goals achieved by the patient
NURSE Therapeutic
Technique
Patient Analysis
Hi. Kamusta ka Joven? Establish
rapport
Using open-
ended
question
Okay naman.
Client was able to
interpret and verbalize
his feelings and
thoughts about the
situation.
Salamat sayo kanina ha.
Nagparticipate ka talaga
sa mga inihanda namin.
Acknowledging
Providing
general lead
Dapat magparticipate.
Tapos na socialization
day natin. Ano
pakiramdam mo
ngayon?
Enjoy. Masaya ako.
Talaga? Buti naman.
Kasi ako nag-enjoy din
ako. Eto pala yung
pinapabili mo sa akin.
Request mo.
Ayun. Salamat. Madami ha.
Salamat. Nakauniform ako,
Sorry. Naka uniform eh.
Welcome. Okay lang
yun na naka uniform ka.
Yun naman talaga dapat
suotin dito diba. Naging
Masaya ako na
nakasama ko kayo.
Presenting
reality
Verbalization
of feeling
Ah. Masaya. Mayaman ka ba?
Client was asking the
student nurse and
verbalized his
observations.
Ha? Hindi ah. Wag ka
maniwala sa kanya.
Hindi ako mayaman.
Sabi niya, mayaman ka daw
eh. Mayaman ka pala.
Hindi Joven, hindi ako
mayaman.
Edi may shoe mart kayo?
Market? Clarifying Shoemart.
Ah, shoemart. Wala ha.
Di ako mayaman.
Ah, iibigin ka no?
36

Ako? Hindi ko alam.
Haha.
Oo iibigin ka eh.
Hindi naman. O ikaw,
ano bago sayo?
Using open-
ended
question
Lalabas na ako eh.
He thought the he will
already leave the
institution.
Talaga? Saan ka
pupunta?
Aalis na. Lalabas na daw ako
eh.
Kailan? Sa katapusan. Aalis na ako.
Sino nag sabi sayo? Aalis na nga ako.
Ah, ganoon ba. Aalis na
din ako mamaya. Huling
araw na namin ngayon
diba?
Reminds client
that
termination is
near
Ah ganoon ba. Oo.
Gusto ko magpasalamat
sayo kasi dami ko
natutunan sayo eh.
Ako din. Dapat magparticipate
talaga tayo. Para Masaya.
He recognized his
responsibility.
He thanked the
student nurse.
Nashare mo din sa akin
mga experiences and
mga nararamdaman mo
diba? And sana
natulungan din kita kahit
papaano. Salamat ha.
Evaluate goal
achievement
Oo. Salamat din.
*Silence.
He recognized his
responsibility.
He gave some
reminders to the
student nurse.
He thanked the
student nurse.
O tawag na tayo sa
loob. O ingatan mo sarili
mo habang nandito ka
ah. Pakabait ka sa
susunod na
makakasama mo dito.
Tell him
responsibility
for his care;
Achieve
smooth
transition to
other
caregiver;
Expresses
thought about
termination
phase
Oo. Iingat ako.
Ikaw din Diana. Kumain ka ng
masusustansyang pagkain.
Oo naman. Ikaw din
dapat.
Oo, Uminom ka din ng gatas
gabi-gabi para lumusog ka.
Hehe. Sige. Ikaw din ha,
yung gatas na binigay
ko sayo, gamitin mo.
Oo. Gamitin ko yan.
Ingat ka Joven. Mag-ingat ka din.
Oo. Salamat sa mga Sige Diana. Babye. Salamat
37

paalala mo sa akin.
Babye Joven.
sayo ha. Sige pasok na.
Salamat.
During the termination phase, He had manifested circumstantiality,
looseness of association, delusion. There is no evidence of hallucination or
illusion. He was alert and cooperative during the nurse-patient interaction. He
had maintained a good eye contact and showed no untoward behavior. He
seemed to be happy and contented with the token of appreciated he had. He
even gave reminders to the student-nurse. There was no increase anxiety level
on the part of the client during the termination phase. The goals are met.
VI. PSYCHOTHERAPIES
THERAPY DEFINITION PURPOSE TECHNIQUE ANALYSIS
Calisthenic/
Exercise
therapy
A free body
exercise
performed
with varying
degrees of
intensity &
rhythm,
employ
motions
To energize the
client and to
revitalizes the
patient’s
interest & helps
him to be
relaxed & be
refreshed
Use of different
motions such
bending, stretching,
jumping, hand
shaking, head and
ankle rotation with
a background
sound of Solo and
Eye of the Tiger
Sir J was able to do simple
steps like hand shaking, head
rotation and stretching.
However, he has a slower
movement when it comes to
jumping and ankle rotation.
Probably he takes extra effort
in handling his lower
extremities due to his diabetic
feet.
Play therapy It is a
treatment
modality as an
energizer and
enable patient
to enjoy.
Provides a
change from
the patient’s
usual routine
and enable
patient to
experience
intense
emotion in a
safe
environment
Asked the patients
to make a cheer
prior to game.
Employed different
questions that
enhanced their
memory.
(Sa Bughaw, Sa
Dilaw)
The client was able to actively
participate in the games,
raising the colored card to
answer questions. He was
asked to enumerate 3 kinds of
food that has a soup, he
itemize the ff: Sinigang na
baboy, Sinigang na isda and
Sinigang na baka.
38

Singing therapy It is a
recreational
therapy that
allow patient
to sing and
read lyrics
with rhythm
To learn a new
song that will
revitalizes
patient’s
interest & helps
him to be
relaxed & be
refreshed
With the use of
manila paper, the
client sang Won’t
last a day without
you and Umagang
Kay Ganda
The client was able to follow
the lyrics of the songs that
were taught to the group. He
was focusing on the reading
rather on singing.
Music & Arts
(Fast & Slow
Instrumental
Song )
(Music)
Use of unique
properties &
potential of
music in a
therapeutic
situation.
(Arts)
A Creative/
Expressive art
therapy that
encourages a
person to
express &
understand
emotions
through artistic
expression &
through
creative
process.
(Music)
To change
human
behavior so
that the
individual
affected will be
able to function
as worthwhile
person.
(Arts)
Use of music to
aid relaxation.
Helps in
reconciling
emotional
conflicts as well
as promoting
self-awareness
& growth.
The client was
given a bond
paper. He wrote his
name above it and
while playing the
background music,
he was asked to
draw what is in his
mind. The student
nurse let him
choose the color he
wants to use. The
fast music was
played first followed
by the slow
instrumental song.
For the fast song, he had
drawn a circle with trees
around it. He used a brown
color in outlining the circle and
green for trees. On the right
side, he draw 3 candles using
an orange color and wrote on
the center, “corona”. Based on
his interpretation, he said that
Halloween is near that’s why
he drawn candles symbolizing
his family members who
already died and left him. The
corona signifies the gift he is
offering to his deceased loved
ones. And in addition, he said
that when it is near to
Christmas, he will draw a
different thing again.
For the slow song, he has
drawn a stick man playing
inside a basketball court using
only one color, green. He said
that he was playing those
younger years.
The drawing for the fast song
showed that he thinks more of
the occasions he experiences
yearly specifically the times
when he and his family
reunites during visitation of the
deceased members of his
family while for the slow song,
it can be interpreted that he
misses the times when he was
able to play basketball during
the years when he was outside
the hospital.
Biblio-therapy
(Story Telling)
Use of printed
words in
modifying or
stimulating
emotions and
awareness
To improve the
attention span
of the individual
with power of
concentration,
and to
The story was
entitled “Ang
Tipaklong at ang
Langgam”. It was
presented with the
use of puppets, art
After the story telling, when the
patient was asked what he
understood of the story, he
was able to verbalize that
“Dapat nag-iipon ng pagkain
para hindi magugutom”.
39

stimulate the
imagination &
ideas of the
patient
works, drawing &
voice dubbing while
the student nurses
are behind the
cloth.
It shows that he was
attentively listening to the story
presented and he understands
that the ant became cautious
in gathering his food so that it
will not get hungry in the
future.
Biblio-therapy
(Proverbs
Interpretation)
Use of printed
picture to
identify
characters in
the story that
will modify or
stimulate
emotions and
under-
standing.
Reading may
help lift a
depressed
patient.
To facilitate
expression
Sir J was asked to
read the proverb
written on a bond
paper, “Sa
Panahon ng
Kagipitan,
makikilala ang
Tunay na
Kaibigan”.
He explained that “Kapag
magkaibigan, dapat
nagtutulungan. Halimbawa sa
paggawa ng bahay, dapat
madaming tao ang gumawa
para mas matibay at maganda
ang maging bahay.”
He had expressed his
understanding of what he read.
According to him, friends
should help one another to
make work easier though the
real meaning of the proverb is
one will be able to recognize
his true friends in times of
downfall.
Remotivation
therapy
Technique of
a simple group
therapy that
uses a poem
and a drawing
which aims to
bridge the
fantasy world
of the
psychotics to
the real world.
To stimulate
patients to be
fellow explorer
of the real
world.
To develop
their ability to
communicate &
share ideas &
experiences
with the other
people.
To promote
group harmony
& identification.
.
Patient is seated in
a U-formation. The
facilitator provided
a poem and a
picture about a
mountain. The
student-nurse
asked stimulating
questions leading
to the topic and
asked to relate it in
his experiences in
life.
Patient was able to cooperate
in the group therapy though he
goes to the comfort room twice
during the therapy. When he
was asked about the relation
of the mountain to his
experiences, he said,
“Kumukuha kami noon ng
iba’t-ibang prutas sa bundok.
May okra, kopra, apple,
orange, patatas. Namimitas
kami dati sa bundok.” When
asked about the message of
the poem, he said, “Dapat
natin pangalagaan ang
kalikasan, bundok. Bigay ito sa
atin ng Panginoon. Dapat
alagaan at ingatan.”
Occupational
Therapy
( Banana Split )
Treatment of
physical and
psychiatric
conditions by
encouraging
patients to
undertake
specific
selected
Help clients to
reach their
maximum level
of function and
independence
in all aspects of
daily life.
The clients are
provided with the
materials and
ingredients needed
for making a
banana split.
Student nurses are
beside them to
assist and help
The client’s response to the
activity is good. He
appreciated the occupational
therapy done. He was
participative while the
facilitator explains the
procedure.
40

activities them while doing
the therapy. Steps
are written in a
manila paper while
the facilitator
explains the
procedure.
VII. BIBLIOGRAPHY
• Psychiatric Nursing Biological and Behavioral Concepts. Second Edition.
Deborah Antai-Otong. 2008
• Nurse’s Pocket Guide 11th
Edition by Doenges, etc.
• http://psychcentral.com/lib/2006/undifferentiated-schizophrenia/. Retrieved
August 07, 2010
• www.wikipedia.com
• http://psychcentral.com/lib/2006/undifferentiated-schizophrenia/
• http://aids.about.com/od/nutrition/qt/choltri.htm
• http://www.scribd.com/doc/27589683/Undifferentiated-Schizophrenia
41

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