Np Psychiatric Nursing

IV. Content of Thought Client verbalized, “Pinasara ko yung sabungan sa amin kasi maraming mga di maganda nangyayari sa loob palagi. Galing sa uncle ko yung sabungan. Ngayon natatakot na ako kasi parang hinahabol na ako ng mga pulis dahil sa pangyayaring iyon.” Client suggested that he would be confined alone and away from the place of incident where the claimed “sabungan” is located. He is afraid of the policemen because he is thinking that he is being tracked down by them. Delusion of persecution is being experienced by the client. The actual case was that the policemen were the one who took charged of the raid of the claimed “sabungan” and not the client who had caused the raid. The client is having some altered thought processes and poor judgment during the incident according to the brother, “Palagi siyang nakikipag-usap sa sarili niya noon na nagkapagsisigaw. Parang nag-aamok ba na hindi maintindihan ang mga pinagsasabi. Kaya siguro naisipan niyang na siya ang dahilan ng pagsara ng sabungnan ni tito.” V. Perception According to the client as verbalized, “May naririnig ako kung minsan na parang hinahabol nga ako ng mga pulis. Pero sa mga ganoong mga pangyayari di ako naniniwala pero medyo natatakot naman ako kasi iniisip ko na baka totoo.” The client is hallucinating. The degree of hallucination is consequently followed by incidence of repeated wakefulness because of hyperarousal according to patient. “Kung minsan nakakatulog ako na parang ‘tulog-manok’ ba. Mabilis na magising at nahihirapan namang bumalik makatulog. Kung minsan din kahit sa konting mga ingay tulad ng may nahulog na bagay nagigising din ako kasi akala ko na baka may pumasok na mga pulis sa loob ng bahay naming.” VI. Sensorium functions Orientation: 1. 2. 3. 4.

Person – oriented to name of the student nurses, watcher and co-patients Time – oriented to time and stated exact time by looking at his watch Place – client knows the place but doesn’t know the exact address Situational orientation – he stated that the weather is cool, his co-patients is playing basketball that he wants to play basketball too when he was aksed what can he tell about his surroundings

Memory: 1. Role memory – he was able to sing Jack and Jill, but had a hard time multiplying table 4, 6, 7, 8 and 9 2. Recent memory – he knows what he did yesterday that they had a remotivation therapy, and stated what he ate sausage and rice for breakfast, fried chicken, tinola and rice for lunch and beef steak for dinner 3. Remote memory – He is able to give his brief life story during interaction 4. Immediate retention and recall – he is able to repeat 3 digits number 267 but was not able to repeat the 4 digits number 2871. Kahn’s 10 questions on mental status examination: 1. What is the name of this place – “ Pototan Mental….unit” 2. Where is it located – “Ahhh, basta sa Pototan pero di ko alam ang eksaktong address pero parang nabasa ko yan noon sa isang papel pero di ko na maalala.” 3. Whay day of the week is it? – “Martes”

4. What time of the day is it? – “Minus diyes bago mag alas quarto” 5. What is the year? – “2009” 6. How old are you? – “30” 7. When were you born? – “Setyembre” 8. When were you born? – “Ahhh. 1978” 9. Who is the President at present? – “Si Gloria” 10. Who is the President before her? – “Erap.” Attention and Concentration: Attention can be aroused but cannot be sustained because he is focusing at the basketball game his co-patients is doing. Able to subtract but answers incorrectly sometimes. Doesn’t know the adjacent provinces of Panay but is able to name 5 countries and 5 names of heroes. The client was asked by the student nurse, “Ano po yung gagawin ninyo kung may nakita kayong naiwang wallet sa daan?” The client verbalized, “Hahabulin ko ung nakaiwan o kaya’y ibabalik ko sa may nakakakilala sa may-ari.” C. Psychodynamic Formulation: Schizophrenia is a disease affecting the brain that causes distorted and bizarre thoughts, perceptions, emotions, movements and behavior. Schizophrenia cannot be defined as a single illness; rather, it is thought of a syndrome or disease process that includes many different varieties of cancer. (Videbeck, 2006). According to the brother of the client, “Di lang ako sigurado pero ang nahalata ko ay nakatikim siya noon ng Marijuana nang siya ay nagtatrabaho sa Mandaluyong.” The client has positive and negative symptoms being experienced. D. Psychopathology Whether schizophrenia is an organic disease with underlying physical brain pathology has been an important question for researchers and clinicians for as long as the illness has been studied. One popular theory suggested that schizophrenia resulted from an overly anxious, overly protective, or emotionally cold mother or a distant and controlling father. None of these interpersonal theories was proven, although newer scientific studies are finding answers in neurologic/neurochemical causes, many people still believe schizophrenia results from dysfunctional parenting or family dynamics. (Videbeck, 2006). The client claimed that he couldn’t sleep for almost 3 days and subsequently he experienced it every other day with severe wakefulness early in the morning. He also claimed that he has been drinking alcohol. He claimed that he is a heavy drinker of alcohol. His brother said that they doubt that the client has taken Marijuana. The client always verbalized that he misses his home and that he misses his mother who has been away for almost 4 years now. He claimed that he really loves his mother and that he never experienced any depression before his mother left.