Professional Documents
Culture Documents
BGHMC
PREPARED BY:
GLYNN I. PASIGON
HEAD NURSE:
HANEE GRACE KIMMOT
DECEMBER 2014
INTRODUCTION
Patient JB is diagnosed with paranoid schizophrenia, 24 years old, male. He
was from La union, Pangasinan.
The present condition of the client started when he was 19 years old. Due to
some circumstances, the client become hostile and showed untoward
behaviors and even hurting his neighbors. He was readmitted on December
9.2014 with a diagnosis of Schizophrenia undifferentiated type, Chronic and
unstable. He has a regular check-up and taking the medications religiously
but his condition worsened when he saw his nieces rapist.
The clients condition now was already stable and manageable.
Pathophysiology
According to Freud, schizophrenia is a form of regression, back to the oral
stage of development. The oral stage is the first stage of psychosexual
development.
A baby is born a bundle of id; ID is self-indulgent and concerned only with a
satisfaction of his/her needs. There is a need to gratify these impulses but
their experiences in the real world result in conflict. People with
schizophrenia are overwhelmed by anxiety because their egos are not strong
enough to cope with id impulses. In schizophrenia, this can lead to selfindulgent symptoms such as delusions of grandeur, Jesus Christ.
As the patient is still living in the real world, this may result in further
DELUSIONS such as hearing voices which may have an ultimate authority
such as God. This explanation suggests that schizophrenia has a
psychosomatic cause the origin is solely in the mind.
At best it could only be a partial explanation of some symptoms, e.g.
delusions. In reality, Freud is denying the very experience of patients with
schizophrenia. Its unscientific and extremely difficult to test. Concepts such
as repression are difficult to observe and measure, although this difficulty
does not invalidate the theory. The theory is based on unrepresentative
samples, case studies, from which it is difficult to generalize.
And it involves poor methodology. The theory fails to account for gender
differences - the onset for males is around 20 years, and for females 30
years. Nor does the theory explain why, prior to diagnosis, their behavior has
Objective data
Subjective data
Expected Outcomes
SHORT TERM GOAL
Interventions
Interventions
Rationale
Ongoing Assessment
A thorough
Determine if JB has
understanding of
trouble falling
he goes to bed,
sleep cycle is
asleep or if he
ability to fall to
important to develop
wakes up in the
sleep, waking up in
improve sleep
night.
hygiene.
Increase activities by
Increasing activities
attending day
treatment program
daily. Encourage JB
cycle.
center.
to resist urge to
sleep during the day.
Establish a daily
routine for getting
up and going to bed.
Plan with patient how
to increase physical
exercise.
Regular physical
Determine if JB is
exercise improves
willing to exercise
sleep hygiene.
Evaluation
1. JB slept 2 hours within the shift
2. JB was able to describe factors
that prevent or inhibit sleep.
Objective data
Subjective data
Irritable
Does not talk with others
Outcomes
SHORT TERM GOAL
socialization.
Interventions
Interventions
Rationale
Ongoing Assessment
Initiate a nurse-
Through a nurse-
Determine whether or
patient relationship
patient relationship,
a relationship.
strengths and
support him as he
limitations.
his disorder.
Provide supportive
group therapy to
focus on the hereand-now, establish
group norms that
discourage
inappropriate social
behavior, and
encourage testing of
new social behavior.
interact in the
group.
schizophrenia can
make it difficult to
automatically recall
appropriate social
behavior.
Reinforcing
appropriate
behavior in a group
can help the patient
add new skills to a
limited repertoire of
Role-play certain
accepted social
behaviors.
Through practicing
Assess JBs willingness
behaviors. Foster
social interaction,
development of
to participate with
relationships among
become
group members
comfortable in
availability of people
through self-
social situations.
disclosure and
have similar
genuineness.
interests.
Encourage members
to validate their
perception with
others.
Monitor adherence to
medication regimen.
Encourage JB to
attend medication
group. Ask patient
about specific side
effects and symptom
exacerbations.
Encourage JB to
attend the evening
symptom
management group.
Identify the
environment in
which social
interactions are
impaired (living,
learning, working,
specifically asking
about symptoms
and medication side
effects, patients
can focus on
specific experiences
that represent
symptomatology.
Different social skills
are needed in
different situations.
leisure).
Role-play aspects of
social interactions
such as
initiating/terminating
a conversation,
refusing a request,
asking for
something,
interviewing for a
job, asking someone
to participate in an
activity (going to a
By practicing specific
skills, patients will
be able to use them
in specific
situations. It is then
possible to assign a
patient to practice a
specific social skill.
Too much feedback
adds confusion and
increases anxiety.
feedback. Focus on
no more than three
behavioral
connections at a
time.
Assist family and
community
members in
understanding and
main source of
providing support.
develop an alliance
support in dealing
Encourage them to
attend a support
group.
Evaluation
JB was able to establish a
therapeutic relationship with
one of the nurses. Through the
relationship and the group, JB
identified barriers in his
interpersonal relationships.
JB was able to practice various
communication strategies and
eventually was able to
Assess family
interaction.
NURSE
MODIFICATIONS
INFERENCES
Giving facts
or relevant
information
would help
facilitate
establish
rapport and
therapeutic
communicat
ion
Greeting the
patient
would
let
patient
identify she
is part of
the
interaction.
P- he nods and
looked at the
floor
The patient
serious and
looks
irritated
N- kumusta kayo
ngay met sir?
P- mayat met
N- kayat yo ba ti
danum?
Recognizing
the feelings
of
the
patient
Patient
shows
cooperation
but
Shows
initiative to
address to
patients
needs
Helps
the
patient
to
identify
solutions to
problems
P- haanen uray
mandamdaman
maturog ak pay
Conversant
to
the
student
nurses
Nocge
po,
agibaga
kayo
lang
nu
kailangan yo ti
danum.
Pocge(nods
head)
N- apay ayna
gayam ti ayan yo
tadta sir?
Shows
initiative to
address to
patients
needs
Shows
willingness
to
accept
suggestions
Trying
to
orient
the
patient with
her location.
Helps
the
patient
to
recall where
he is.
Pditoy
psychiatric
ti
BGHMC
The patient
shows he is
oriented
with reality
and ha sa
good
retention
and recall
N- apay ayana ti
nagapuan yo sir?
P- La union
N- anya ngai me
ti kayat yo nga
pasauan
tayo
tadta?
Trying
to
explore the
origin of the
patient and
to let the
patient
recall
his
origin
to
present
reality
The patient
is is able to
answer
question
Giving
opportunity
to patient to
open topics
she
might
to
talk
about
P- dakayo ah nu
anya ti kayat yo
nga
maamuan(yawns
and
appears
sleepy)
Shows he is
willing
to
talk
some
things
about
his
but is not
able
to
start
N- sir ibaga yo
lang
ah
nu
makaturturog
kayo
P- wen kayat ko
nga maturog
Allowing the
patient
to
take some
time to rest
he
addresses
biological
needs
Informing
the patient
about when
to return.
Builds
a
more
trusting
relationship
with
the
patient.
P- ocge salamat!
Nwen sir
salamat met!
Looking
forward
that
the
students
will return.
Ensuring
the patient.
EVALUATION:
Objectives of the first nurse patient interaction were met. The
student nurse was able to establish rapport. Therapeutic communication also
was achieved. And lastly, we established mode of communication acceptable
to both the patient and the student nurse by talking in either Ilocano.