Combined Na Tanan!

Introduction
Paranoid schizophrenia is one of several types of schizophrenia, a mental illness

in which tends to experience persecutory or grandiose delusions and auditory
hallucination and also may exhibit behavioral changes such as anger, hostility or violent
behavior. Ability to think and function in daily life may be better in paranoid
schizophrenia compare to other type of schizophrenia. Still, it’s a serious lifelong
condition that can lead to many complications, including suicidal behavior.
Affect is usually less blunted than in other varieties of schizophrenia, but a minor
degree of incongruity is common, as are mood disturbances such as irritability, sudden
anger, fearfulness, and suspicion. "Negative" symptoms such as blunting of affect and
impaired volition are often present but do not dominate the clinical picture.
The onset of schizophrenia in men is usually in the teens or 20s. The onset in
women is usually in the 20’s or early 30’s. Paranoid schizophrenia tends to appear toward
the the later end of this range. (Another life Foundation, Colorado Springs, Colorado,
(719)).
Some scientists believe p aranoia may be a reaction to high levels of life stress.
Leading support to this opinion is the evidence that paranoia is more prevalent among
immigrants, prisonersof war and other undergoing severe stress.
(www.nexusbooks.net/health/paranoia3).
Its is believed to be widespread with world life prevalence rates estimated to be at

0.2% to 1.5% of the general population, meaning approximately 1% of the population
develop schizophrenia during their lives, with men and women being equally affected
(Jablensky, 1995). Clients with schizophrenia are at high risk for suicide. Approximately
10-15% of those with schizophrenia commit suicide: 50% attempt suide at least once.
These suicides rates can be compared to the general population, which is somewhere
around 0.01%. Approximately 20-30% of clients with schizophrenia, however, can lead
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somewhat normal lives. Another 20-30% continue to have moderate symptoms where as
the illness significantly impairs 40-60%.
The Philippines is one of the world’s most heavily populated countries. A high
level of poverty still exists and malnutrition and communicable diseases continue to be
the main cause of morbidity. The public health impact of mental illness lays in the fact
that it can cause disability for prolonged periods. In a disability survey by the National
Statistics Office in 2000, it was found that rate of Schizophrenia in the Philippines was 88
cases per 100,000 population in 2000. The region with the highest prevalence rate of
schizophrenia is Southern Tagalog at 132.9 cases per 100,000 population, followed by
NCR at 130.8 per 100,000 population and Central Luzon at 88.2 per 100,000 population.
In choosing this Case Study, a criterion was made with some defining points to
meet. One of which would be the consent or the willingness of the patient as well as the
patient’s family which would facilitate collaborative efforts of the group and patient.
Second would be the accessibility of the informants as well as their validity and
residence of the patient, the cooperation of these informants would prove to be of utmost
help for the reason that there statements would be taken into account for the researchers
to make a comprehensive picture of the course of the patients illness.
The patient’s age would constitute part of the criteria for which the consideration
of the patient’s development stage would be anchored on for us to envision what the
patient’s life was before the onset of the disorder.
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OBJECTIVES OF THE STUDY
GENERAL:
The Primary goal of this Case Study is to achieve deeper understanding about the
nature of the case, to help the readers and future researchers know regarding the
medical and nursing management of patients with schizophrenia, paranoid type.
SPECIFIC OBJECTIVES:
•Extended our deepest appreciation on those people who contributed in the

completion of this case presentation.
•We will make an introductory statement about the schizophrenia paranoid type
and the case study.
•We will define the various terms used in the case study.
•We will gather necessary information about the patient from her immediate
family, friends and neighbors;
•We will conduct and present the mental status examination of the patient as well
as his capacity to relate and communicate with student nurses;
•We will identify the predisposing and precipitating factors that contribute to the
condition of the patient;
•We will be able to trace the psychodynamics of the case and relate it with Erik
Erikson’s theory of growth and development;
•We will define in our case presentation the psychiatric management needed by
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the patient;
•We will present a drug study on all medications given to our patient in the case
study;
•We will formulate the appropriate and effective nursing care plans on the
identified problems experience by the patient;
•We will justify the possible prognosis of the patient on the case;
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DEFINITION OF TERMS
Schizophrenia - a disease affecting the brain that causes distorted and bizarre thoughts,
perceptions, emotions, movements, and behavior.
Hallucinations- false sensory perceptions or perceptual experiences that do not exist in
reality.
Delusions- fixed false beliefs no basis in reality.
Apathy- feelings of indifference toward people, activities, events.
Affect-a person’s mood, feelings, or tone observable as an outward manifestation. Often
referred to as emotion. Affect may be referred to as inappropriate, flat or blunted.
Flat Affect- absence of any facial expression that would indicate emotions bsence of any
facial expression that would indicate emotions or mood.
Blunted Affect - restricted range of emotional feeling tone,or mood.
Inappropriate affect- inconsistency between expression and mood.
Flight of ideas- continuous flow of verbalization in which the person jumps rapidly from
one topic to another.
Associative looseness- fragmented or poorly related thoughts or ideas.
Denial- unconscious refusal to face thoughts,feelings,wishes,needs,or reality factors that
are consciously intolerable.
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Depression- a mood state characterized by a feeling of
sadness,dejection,despair,discouragement,or hopelessness.
Psychosis-is a disorder in which a person displays more positive signs of
delusions,hallucinations,
Mananabang – a person who is not licensed and has no formal education who aids in
giving birth to a mother
Mananguete – a person who makes vinegar out from coconut juice and disordered
thinking.
Mania - is a severe medical condition characterized by extremely elevated mood, energy,
unusual thought patterns and sometimes psychosis.
Paranoia - is a thought process characterized by excessive anxiety or fear, often to the
point of irrationalityS and delusion.
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IDENTIFICATION OF THE CASE
Patient’s Code Name: Ruby
Age: 42 years old
Sex: Female
Birth date: February 27, 1968
Birth Place: Island Garden City of Samal
Address: Talamo, Davao City
Nationality: Filipino
Civil Status: Single
Occupation: None
First Admission: 1997 at a Psychiatric institution in Mandaluyong due to
change in behavior
Second Admission: 1997 at Davao Mental Hospital due to her violent act
towards others
Third Admission: 2000 at Davao Mental Hospital due to her violent act
towards her mother
Fourth Admission: 2003 at Davao Mental Hospital due to violent act towards
others
Fifth Admission: July 20, 2010
Reason of Admission: Threat to the community
Date of Discharge: July 23, 2010
Admitting Diagnosis: Schizophrenia Paranoid Type
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Final Diagnosis: None
Attending Physician: Paulo Woodruff A. Gonzales, MD
Date Study Begun: July 21, 2010
Date Study Ended: July 23, 2010
Time Spent in Actual Nursing Care: 3 hours
Time Spent in Home Visit: 2 hours
Source of Information / Informant: Primary source: Ruby
Patient’s Chart
Secondary Sources: Mother
Brother
Neighbors
Previous Co-workers
Previous employer
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ANAMNESIS
Informant # 1
Name: Mother Lily
Age: 68 years old
Address: Talomo, Davao City
Relationship to the patient: Mother
Length of time known to patient: 42years
Personal Background of Informant and Apparent understanding of present illness of
patient:
Mother Lily was 68 years old, widowed for about 8 years and is the one who took care of
her children, 6 boys and two girls. She was from Samar City where Mr. M and she met. She
worked at Stanfilco when Ruby was working in Manila, but now she is a plain housewife.
On July 23, 2010, Mother Lily verbalized “ Buotan man siya pagkabata, permi niya
kadula iyang manghud na babae. Bright pud na siya, pag abot sa balay human kaon magstudy
dayon na siya. Makakuha pud na siya ug award or honor gikan sa elementary hantod highschool.
Katong nag second year highschool na siya, 15 years old siya ato, wala na siya ganahi
magskwela kay gina sungog na siya sa iyang mga classmate kay tungod nag cratches na siya ato
kay nabaril man iyang tuo na tiil. Ginasaway siya sa iyang mga classmate ug “piang”. Sukad ato
niadto ug Manila. Pag adto niya ug Manila, nagtrabaho siya didto as katabang tapos gipaskwela
9
pud siya sa iyang amo pero wala siya ka human. Taga bulan naga padala siya ug kwarta. Isa ka
adlaw, nakabalo si Ruby na ang iyang ginapadala na kwarta kay ang silingan makadawat tapos
ang mahatag na kwarta sa iyang pamilya kay gamay na lang. Sukad ato, nakita na lang siya sa
iyang amo na nga yaw-yaw ug istorya sa iyang sarili. Tapos gi admit siya sa Mandaluyong
Hospital.
Other characteristics and attitude of the informant:
Mother Lily was an accommodating person, she welcome us warmly. She is attentive and
responsive during the interaction. She showed enthusiasm and willingness to share her
daughter’s information despite the sensitivity of the issue being discussed and allowed us to
conduct an interview.
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Informant # 2
Name: Silver
Age: 29 years old
Relationship to the patient: Brother
Length of time known to patient: 29 years
patient:
Silver is the youngest among the 8 children. He was 29 years old and single. He is
working as a tricycle driver and the bread winner of the family in replace of Ruby. He provided
their basic needs as well as the medications of Ruby. According to him, “Nagtawag iyang amo
diri ingon lahi na daw siya didto ug batasan mao gipauli siya, gisundo namo siya sa airport siya
lang man isa nag-uli. Sukad ato dili siya ganahan na walay ginauhat sa balay mao nang nangita
siya ug pama-agi na maka-kwarta. Nagtrabaho siya sa factory sa Mango juice sa Toril, 4 months
lang siya didto kay naglahi naman pud daw iyang batasan. Katong mga niaging adlaw, boutan pa
man to siya ginatabangan pa man gain niya si mama pero karon awayon na niya. Nigrabe na pud
iyang batasan kay wala naman siya ka inom ug tambal.
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He is approachable and responds attentively to the questions that were asked. He also
provides whatever information related to his sister.
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Informant # 3
Name: Gold
Age: 32 years old
Relationship to the patient: Brother
patient:
Gold is 32 years old, single and do not have work. He is the one who accompanied and
took good care of Ruby inside the CIU. According to him, “Katong gisundo namo siya ni Silver
sa Airport, ok pa man siya ato. Maistorya pa man siya. Tapos niagi ang isa ki simana natingala
nalang mi na nag bag-o na siya. Mag yaw-yaw nalang siya ug kalit tapos manakit napud siya.
Didto na pud nag sugod na naga pangluwa siya. Naay time na nag prepare ug pagkaon ako mama
tapos iyang gipang luwaan ang pagkaon. Siya na ang nag prepare sa iyang sariling pagkaon. Naa
pud time na napasakitan nako siya kay sobra na kayo iya ginapanghimo”.
13
He is approachable, talkative and responsive. He is also very defensive and secretive. He
shows willingness in answering the questions.
Informant # 4
Name: Sugar
Age: 26 years old
Relationship to the patient: Neighbor
Personal background of the informant and apparent understanding of the patient’s present
illness:
On July 23, 2010 Sugar verbalized, “Pag abot nako diri ing-ana na siya, sige siya ug yaw-
yaw bahin sa kwarta. Gikuha man to siya sa 911, mga pagka human ug paniudto buntis kay wala
siya gipasakay sa jeep na gina driban sa bana sa buntis. Unya sige pa jud daw ug katawa mao to
g atangan siya pag pauli gikan nag pa prenatal.
Other Characteristics and attitude of the informant:
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She was attentive and responsive during conducting an interview, she was willing to
impart the things she knew about the patient.
Informant # 5
Name: Honey bee
Age: 21 years old
illness:
On July 23, 2010 Honeybee verbalized,” Sukad adtong nag kabo-ut ko naa na siya gamay
(exhibits behavioral changes) pero dili pa ing ana ka grabe, mastorya pa siya ug tarong pero dili
jud na siya gapangamigo ug lalake sukad sukad. Katong gikan siya ug manila na lahi na man siya
labi na ang iya batasan, naa gani to siya gi luwa-an na engineer sa amo kalsada. Tapos gapang
gukod na siya, mag lakaw lakaw tapos sige ug sulti na gi baboy daw siya sa mga lalake”.
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He was cooperative and willing to answer questions that were asked.
Informant # 6
Name: Milky
Age: 45 years old
illness:
On July 23, 2010 Milky verbalized, “ Sukad pag ka bata boutan mana siya wala jud na
siya libog na pag ka tao pero di jud pud na siya gadoul- duol ug lalake. Pirmi ra na siya naa sa
ila balay gapanglimpyo sa silong ug sige ug tabang sa iya mama. Daghan mana siya ug
pangandoy sauna tungod pud siguro sa amo kalisud diri. Kanang ilang balay mas okey na na
karon kay sa sauna kay katumpagon jud na ba. Pero katong ga sugod na siya ug kalahi ang
batasan na gapangaway na, ginakulata mana siya sa iya mga igsoon na lalake labaw na si Gold
mao na siguro na samot ug ka boang si Ruby. Mahadlok mana siya sa iya mga igsoon nga lalake.
pag naa gani makita si Ruby nga galingkud dira dapit sa ilang payag-payag iya jud nang yab-an
ug tubig. Galakaw lakaw na siya gadala ug kutsilyo sa iya kilid tapos naa pa gani to panahon na
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iya gi dunggab si Silver sa may kilid. Pero mayo mana siya ba pag maka inum o makapa
injection siya sa iya tambal. Malouy man ko sa ila kay halos wala gani na sila pang palit ug
pagkaon mao nang nabuang pud siguro na si Ruby, pampalit pa kaha ug tambal? Mao na sige ug
balik-balik iya sakit.
She felt sorry for what happen to the patient, she was helpful with the cooperation she has
given during the acquiring of information about the patient and her past experiences.
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Name Age Address Relation Length of time Apparent understanding of Characteristics of the
to patient known to patient the present illness informant
Mother 68 Talomo, Mother 42 years Informant: “Sukad niadto The informant was an
Lily years Davao City
siya ug Manila, nagtrabaho accommodating person,
old
siya didto as katabang tapos she welcome us warmly.
gipaskwela pud siya sa iyang She is attentive and
amo pero wala siya ka responsive during the
human. Taga bulan naga interaction. She showed
padala siya ug kwarta. Isa ka enthusiasm and
adlaw, nakabalo si Ruby na willingness to share her
ang iyang ginapadala na daughter’s information
kwarta kay ang silingan despite the sensitivity of
makadawat tapos ang the issue being discussed
mahatag na kwarta sa iyang and allowed us to
pamilya kay gamay na lang. conduct an interview.
Sukad ato, nakita na lang
siya sa iyang amo na nga
yaw-yaw ug istorya sa iyang
sarili. Tapos gi admit siya sa
Mandaluyong Hospital.
INFORMANTS DATA
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Name Age Address Relation Length of time Apparent understanding of Characteristics of the
to patient known to patient the present illness informant
Silver 29 Talomo, Brother 29 years Informant: “Nagtawag iyang The informant is
years Davao City
amo diri ingon lahi na daw siya approachable and responds
old
didto ug batasan mao gipauli attentively to the questions
siya, gisundo namo siya sa that were asked. He also
airport siya lang man isa nag- provides whatever
uli. Sukad ato dili siya ganahan information related to his
na walay ginauhat sa balay sister.
mao nang nangita siya ug
pama-agi na maka-kwarta.
Nagtrabaho siya sa factory sa
Mango juice sa Toril, 4 months
lang siya didto kay naglahi
naman pud daw iyang batasan.
Katong mga niaging adlaw,
boutan pa man to siya
ginatabangan pa man gain niya
si mama pero karon awayon na
niya. Nigrabe na pud iyang
batasan kay wala naman siya
ka inom ug tambal.
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Name Age AddressR Relation Length of time Apparent understanding of Characteristic of the
to Patient known to patient the present illness Informant
Gold 32 Talomo, Brother 32 years Informant: “Katong gisundo The informant is
years Davao City
namo siya ni Silver sa Airport, approachable, talkative and
old
ok pa man siya ato. Maistorya responsive. He is also very
pa man siya. Tapos niagi ang defensive and secretive. He
isa ki simana natingala nalang shows willingness in
mi na nag bag-o na siya. Mag answering the questions.
yaw-yaw nalang siya ug kalit
tapos manakit napud siya.
Didto na pud nag sugod na
naga pangluwa siya. Naay time
na nag prepare ug pagkaon ako
mama tapos iyang gipang
luwaan ang pagkaon. Siya na
ang nag prepare sa iyang
sariling pagkaon. Naa pud time
na napasakitan nako siya kay
sobra na kayo iya
ginapanghimo”.
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Name Age Address Relation to Length of time Apparent understanding Characteristics
patient known to Patient of the illness of the
informant
Sugar 26 years Talomo, Davao Neighbor 2 years Informant verbalized, The informant
old “Pag abot nako diri ing-
City was attentive and
ana na siya, sige siya ug
responsive
yaw-yaw bahin sa kwarta.
Gikuha man to siya sa during
911, mga pagka human ug
conducting an
paniudto kay gigukod niya
interview, she
ang among silingan na
buntis kay wala siya was willing to
gipasakay sa jeep na gina
impart the things
driban sa bana sa buntis.
she knew about
Unya sige pa jud daw ug
katawa mao to g atangan the patient.
siya pag pauli gikan nag
pa prenatal”.
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Name Age Address Relation to Length of time Apparent understanding Characteristics
patient known to of the illness of the
Patient informant
Honeybee 21 years Talomo, Davao Neighbor 15 years Informant verbalized,” The informant
old Sukad adtong nag kabo-ut
City was cooperative
ko naa na siya gamay
and willing to
(exhibits behavioral
changes) pero dili pa ing answer questions
ana ka grabe, mastorya pa
that were asked.
siya ug tarong pero dili jud
na siya gapangamigo ug
lalake sukad sukad. Katong
gikan siya ug manila na
lahi na man siya labi na ang
iya batasan, naa gani to
siya gi luwa-an na engineer
sa amo kalsada. Tapos
gapang gukod na siya, mag
lakaw lakaw tapos sige ug
sulti na gi baboy daw siya
sa mga lalake”.
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23
Name Age Address Relation to Length of time Apparent Characteristics of
patient known to understanding the informant
Patient of the illness
Milky 45 years old Talomo, Davao City Neighbor 42 years Informant The informant felt
verbalized, “… sorry for what
katong ga sugod
happen to the
na siya ug kalahi
patient, she was
ang batasan na
gapangaway na, helpful with the
ginakulata mana cooperation she
siya sa iya mga has given during
igsoon na lalake
the acquiring of
labaw na si -----
mao na siguro na information about
samot ug ka the patient and
boang si Ruby. her past
Mahadlok mana
experiences.
siya sa iya mga
igsoon nga
lalake. pag naa
gani makita si
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Ruby nga
galingkud dira
dapit sa ilang
payag-payag iya
jud nang yab-an
ug tubig.
Galakaw lakaw
na siya gadala ug
kutsilyo sa iya
kilid tapos naa
pa gani to
panahon na iya
gi dunggab
si------ sa may
kilid. Pero mayo
mana siya ba pag
maka inum o
makapa injection
siya sa iya
tambal…”
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GENOGRAM
PATERNAL Cristine MATERNAL

Charice Iyaz
Jericho
Mr. M Yuri Leah Jeny Nina Mother Lily
Yen
Bruno Mae
Carlo
GARNET AMETHYST GEM GOLD
DIAMOND TOPAZ SILVER

RUBY
LEGEND:
Male Arthritis
Female Mental Illness
Deceased 26
FAMILY HISTORY
Paternal Grand Lineage
The group was not able to get the information about the patient’s grandfather
because the family could not remember any information with regards to their grandfather
because they had have not seen their grandfather even before. Additionally, the patient’s
family mentioned that there was no mental disorder in relation to their grandfathers’ side.
Maternal Grand Lineage
Mother Lily came from a broken family and was the only child of White and
Peach. Mother lily also claimed that her parents had other children with different
partners. In addition, mother lily said that her mother –in –law (violet) had a history of
mental illness. Other than that, there is no history of delinquency, addiction, suicide,
dependency, chronic unemployment and other traits on inefficiency in their family,
according to Mother Lily.
Father
According to his wife, Mother Lily, Mr. M had a live-in partner before they met
each other. Nevertheless, they separated so he went to Samar for vacation. Mother Lily’s
cousin stayed at Mr. M’s house. Mr. M was 21 years old then, and Mother Lily was still
14 years old. Mr. M had not courted her, but instead, he went to her parents and asked
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them to let her marry him. Mr. M married her and after two years, they were blessed with
a baby boy and were blessed with seven more after succeeding years. In addition, Mr. M
was born on January 07, 1937, as he was described by his wife, Mother Lily, he was a
responsible husband and a womanizer but still able to provide what his family’s basic
needs. He is also a disciplinarian father and got along with his friends and he would
socialize through alcohol drinking. When it comes to his educational attainment, Mr. M
only reached grade 6 due to financial constraint. He worked as a carpenter and a
“mananguete” as his source of income and earns enough money to suffice their basic
needs. Furthermore, Mr. M died at the age of 65 years old due to complications that they
cannot specify. As Mother Lily had verbalized, her daughter ruby was not able to accept
her father’s death.
Mother
Mother Lily is 68 years old and was born at Davao City and reached only 2 nd year
high school. She came from a socially – deprived community and they were 3 siblings
in the family, one girl and two boys. Accroding to her, she had cared for her children
since they were young until they grew up. She did not let anyone attend to her children
but herself. She never laid a hand over her children instead she just talked to them when
committing any mistakes. Before she worked in Stanfilco a factory that processes banana
products but now she is a plain housewife and dependent to the income of her daughter.
She also said that she had a good relationship with her husband and children; whenever
thay had a conflict she would just keep quiet and never argue with them.
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Siblings
They were 8 siblings in the family. The eldest is Garnet, male, 44 years old.
Currently living in Mati, Davao Oriental. Second is Ruby, 42 years old, attained 1 st year
high school only at Andres Bonifacio Talomo, Davao City. Third is Amethyst, male, 40
years old. Fourth is Diamond, female, 38 years old. Fifth is Gem, male, 36 years old.
Sixth is Topaz, male, 34 years old, he was a Pastor. Seventh is Gold, male, single, 32
years old. And lastly is Silver, male, single, 29 years old, he is a tricycle driver.
According to Mother Lily, when they were young, Ruby was much closed to her
younger sister Diamond. There were also times that Ruby and her brother had a conflict
but settled afterwards.
At present, Ruby is the bread winner in the family. She was able to sustain the
financial needs of her family by working as a housekeeper in Manila. According to Ruby,
her siblings were her inspirations in life to strive more because she wanted them to finish
their studies, according to Silver. However, due to high aspiration in life, she was
pressured because of her small minimum wage by that she can’t able to continue
supporting her family. When it comes to social aspect, she is a non-smoker, non-alcoholic
drinker. Furthermore, the siblings had good relationship with each other. Each of them
helped one another to provide their needs and during times of problem.
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PERSONAL HISTORY
Pre-natal
Mother Lily said that she did not think of her pregnancy with Ruby as a problem.
During the prenatal period, Mother Lily was not able to have a medical prenatal check up
throughout her pregnancy but instead she went to “binisaya” or quack doctors because of
their tradition and beliefs. During her first and second pregnancy, the only foods that she
usually eats are; egg, meat, dried fish and canned goods. Sometimes, she rather prefers
biscuit and soda as her breakfast. She denied that those unhealthy eating habits might
have influenced the growing fetus. In addition, she only stayed at home during pregnancy
and never went anywhere. According to her, she has no history of fall and accidents
during pregnancy.
Birth
Mother Lily gave birth to Ruby on February 27, 1968; full term cephalic
presentation via Normal Spontaneous Vaginal Delivery (NSVD) and was attended by her
father who was a “mananabang” at their house. She claimed that she had no difficulty in
labor. And her father took good care of her after delivery.
Infancy
As she was described by her mother, from birth to one month Ruby could lift her
head slightly off the bed. She was provided with hanging toys. She would cry to express
30
discontentment, and smiles when contented. Complete immunizations such as BCG,
OPV, DPT, Hepa B, and measles vaccines were received, as verbalized by mother Lily.
Ruby was breastfed since birth until she reached two years old.
At 6 months, eruption of teeth begins, during teething Ruby manifested fever and
managed by giving paracetamol specifically Tempra.
At the age of one year old, Ruby was able to utter only one to two words such as
“mama” and “papa.” She began to grasp objects and played games such as “peek-a-boo.”
At the age of two years old, Mother Lily weaned Ruby by way of applying
bronchorub ointment or Vicks on her nipples. During weaning, gradual introduction of
solid foods begins such as cereal usually rice. At this age, Ruby begins to thumb sucked.
In addition, Mother Lily said that Ruby was experienced bed wetting and stops when she
reached two years old. Toilet training was emphasized; Ruby was trained to defecate
beside their house.
Childhood
At three years old, her vocabulary increased and she showed proper use of
pronouns such as “ako” (me) and “ikaw” (you). She walked downstairs using alternate
feet. Night time bladder control developed. At this stage, toilet training was completed.
At this age, common health problems were experienced by Ruby like dental caries and
chicken pox.
And at the age of 6 years old, Ruby was able to dress and feed self with less
assistance from her parents.
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At this age also, she was sent to primary school at Andres Bonifacio Talomo, Davao City.
Ruby was able to write and read. She already had a circle of friends and was reported
that Ruby has gained high grades.
Adolescent
At this age, Ruby had developed a sense of competence by way of maintaining
good grades at school. She also developed her self identity and self esteem by having
friends. She didn’t have any difficulty adapting to puberty. She is always determined in
achieving what she wants and she never bends her own principles just to please others.
At the age of 15 years old, Ruby was accidentally shot at her right leg when she
was sleeping at around 9pm; and began teasing by her classmates as verbalized by her
Mother.
At the age of 16, Ruby gained independence. She went to manila to work as a
Housekeeper and a Nanny for about 10 years.
Play Life
She enjoyed imitative and dramatic play such as dressing up and doll houses. She
also acts a leader and only plays only with her younger sister Diamond and follows any
play that her younger sister wants to. Ruby preferred to have a female playmate rather
than a male because she is not comfortable when she plays with an opposite sex.
Moreover, as verbalized by her mother, Ruby always plays with her younger sister near
from their house and sometimes thay had a quarrel whenever they had misunderstandings
but settled thereafter.
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School History
Ruby was sent to school at the age of 6 years old at at Andres Bonifacio Talomo,
Davao City.. “Wala na siya niagi og kinder, diretso na Grade 1.” As verbalized by
Mother Lily. She was able to write when she was 2 years old. She only finished her 1 st
year high school at Andres Bonifascio Talomo, Davao City. She was kind, silent type and
responsible student. She spends an hour for studying and wasn’t forced to go to school.
She has no enemies in school and has a good relationship with her teachers. She was
good at school, quiet, and responsible from elementary up to high school. She also
maintained good grades at school. She even got 3 rd honors and 2nd honors during her
elementary years. Ruby’s favorite subject was Mathematics, English and Science.
According to Mother Lily, Ruby’s highest grade was 85-87 % and the lowest was 83%.
When she reached 2nd year high school at the age of 15 years old, she was teased by her
classmates because she was using crutches due to gunshot wound at her right leg because
of that she decided to stop going to school.
Psychosexual History
Ruby never talked about liking someone according to her mother. When she
reached high school, she just focused on her studies. Mother Lily said that she and her
husband did not forbid her to get involved in relationships but Ruby just decided not to.
She had her menarche at the age of 12 years old, since then she had her regular monthly
period and only lasts for 3 days.
33
Religious and Social Adaptability
Ruby is a Roman Catholic. She goes to church every Sunday to attend mass but
she did not involve herself in other religious activities such as seminars and youth
organization activities because she is not interested to join to. Moreover, she also didn’t
involve herself in community activities whenever their community celebrated fiesta,
contests, or etc.
Since she came back from Manila, between the year 1997 and 2010 she stopped
going to church according to her mother because she already manifesting such behavioral
changes. She has few friends and most of them are females. She was not that friendly to
her neighbors.
Occupational History
At the age of 16, Ruby went to Manila with her friend to work and did not ask
permission to her parents. She just wrote a letter to her family after arriving in Manila
saying she did it because she wanted to help her family.
She worked as a househelper in Makati, Manila for 10 years. She left several
employers and found new ones for reasons of finding a better salary. After 10 years of
working, she went back here to Davao City in 1994 and stayed home for several months.
She left for Makati again to continue working as a househelper with another employer. In
the year 1997, one of her employers called her family to inform them that she would be
sent back because she was mentally ill and was being put at one of the Mental Hospitals
in Mandaluyong.
34
When she arrived at Davao City in the same year, she stayed at their home for
several months and worked as a factory worker for 4 months at one of the juice factories
in the city. Between the year 1997 and 2010, she worked several jobs within the City. In
January 2010, Ruby was 42 years old that time; she worked as a bakery helper for several
months. She was pulled out from her work since she was not understood by her co-
workers.
Before she was brought to DMH, she recently worked as a laundry girl. She was
paid from 150 – 200 pesos. Her salary from her previous work was not known by her
family. Aside from their lot, no savings have been reported.
Marital History/Relationship History
According to Mother Lily, she and her husband (Mr. M) did not forbid her to get
involved in relationships but Ruby just decided not to. Ruby was not married. She had
never been involved in a relationship as she reported.
Onset of Present Illness
Mother Lily as well as other family members could not specify what precipitated
her condition. All they know is that after working in Makati, a sudden change in her
behavior occurred such as talking to oneself. Mother Lily reported that her employer had
noticed her to be talking to herself as if someone was with her though her employer does
not see any one. She was noted to have lost her appetite and often out stares out blankly.
Also, she became unresponsive to questions. Her employer brought her to a Mental
35
Hospital in Mandaluyong in 1997, and she was confined for a week for a treatment and
was sent back to Davao.
And Ruby was brought to DMH with her brother by 911 last July 20, 2010 due to
assaulting a pregnant neighbor. It began when she was not allowed by a jeepney driver to
ride in his jeepney since she was known not to pay for her fare. The said jeepney driver
was her neighbor and who happened to be the husband of the victim. So, she directed her
anger to the driver’s wife and followed her on the street but her siblings stopped her from
such an act. The injured party suggested to Silver to confine Ruby at the Davao Mental
Hospital for her and everybody’s safety in the community.
On July 23, 2010, she was instructed by her Doctor that she may go home and
continue to comply with her medication.
NURSING ASSESSMENT TOOL
Date: July 23, 2010
HISTORY OF PRESENT ILLNESS
She was admitted lately for attempting to assault her pregnant neighbor. It began
when she was not allowed by a jeepney driver to ride in his jeepney since she was known
not to pay for her fare. The said jeepney driver was her neighbor and who happened to be
36
the victim’s husband. So, she directed her anger to the driver’s wife and followed her on
the street but her siblings stopped her from such an act. The victim suggested to Silver to
confine Ruby at the Davao Mental Hospital for her and everybodys safety in the
community.
PAST MEDICAL HSTORY
She was first admitted at a psychiatric institution in Mandaluyong for one week in
1997 by her employer due to a change in behavior. In the same year, she was admitted at
Davao Mental Hospital for several days by her family after her violent act towards others.
Her third admission at the Davao Mental Hospital was in 2000 for four days due to her
violent act towards her mother. In the year 2003, she was again admitted at the Davao
Mental Hospital for three days due to violent act towards others. She is currently
admitted at the Davao Mental Hospital for she was a threat to the community.
FAMILY HISTORY OF ILLNESS
There is no known family history of asthma, hypertension, diabetes and other
family history of illness on both sides of the family.
PHYSICAL ASSESSMENT
General Survey
Patient noted to be in euthymic mood with broad affect and good eye contact. She
is wearing a white t-shirt and a gray short. Fingernails and toenails are well-trimmed.
37
Upright posture was noted. With Vital Signs of T: 36 degree Celsius, P: 86bpm, R:
20cpm, BP: 100/80 mm Hg
Skin
Skin has fair complexion, generally uniform in color with good skin turgor and
mobility. She has a temperature of 36 oC. Hair is black, dry and evenly distributed. Nail
surface is slightly curved. Nail edge ridges are smooth and clean. A Capillary refill result
of less than 2 seconds. Scar noted at right upper leg 3 inches long and 1 inch wide and at
right lower leg3 inches long and 4 inches wide.
Eyes
Eyelashes are evenly distributed along the lid margins and curve outward.
Eyeballs are aligned in their sockets. Pupils are equally round, reactive to light and
accommodation. No masses, tenderness and lesions were noted. Extra ocular muscles
were coordinated. She is able read newsprints without any difficulty at a distance of
3feet.
Ears
Ears are of equal size with the same color to facial skin and feel firm. Pinna
recoils back. No discharges were noted. No masses, tenderness and lesions were noted.
She has no difficulty in hearing the ticking sound of the watch when placed near her ears.
Nose
38
Nose is symmetric, placed midline and proportion to facial features. No
discharges were noted. No masses, tenderness and lesions noted.
Mouth
Lips are pink and dry. Inner surface is also pink . Dental carries and tartar can be
noted. Patient’s teeth are twelve, eight in the upper area and four in the lower part. Gums
appear pink. Tongue is placed in the midline and able to move freely. Tonsils are visible.
Uvula rises in midline on phonation. No masses, tenderness and lesions noted.
Respiratory System
Chest is symmetrical. Scapula is also placed symmetrically. When inhaling, her
diaphragm descends and ascends when exhaling. Respiratory excursions are symmetrical.
She has a respiratory rate of 20 cycles per minute. No accessory muscles were used upon
breathing. No masses, tenderness and lesions were noted. No abnormal breath sounds
noted on both lung fields upon auscultation. Vibration felt upon performing tactile
fremitus
Circulatory System
A capillary refill result of less than 2 seconds. No jugular vein distension. Carotid
pulse can be felt symmetrically. Pulses are palpable on both upper and lower extremities.
When radial and ulnar arteries were depressed, blood flow returns via ulnar artery within
less than 2 seconds. No jugular vein distention. She has a blood pressure of 100/80
mmHg and a pulse rate 86 beats per minute.
39
Abdomen
Skin has fair complexion all throughout the abdomen with good skin turgor.
Abdomen is round. Patient has decreased appetite. Snacks served was not consumed.
There were no masses and tenderness noted.
Genitourinary System
Patient can void freely. She had not experienced any pain when urinating. There
were no reports of hematuria or urinary incontinence.
Elimination
She is able to defecate without pain daily. No reports of melena or hemtochezia
Musculoskeletal System
Patient moves with good coordination. Upright posture noted whether he is
standing or in a sitting position. She is able to move her joints smoothly.
Speech
The stream of talking is at an even pace. However, she formulates words that it is
difficult to understand. Sometimes, the questions being asked to her were not properly
answered.
40
Sleep
She has intervals of sleep. During day time and night time, patient wakes up late
at night because she feels she’s not at home. She sleeps every 10 in the evening and
wakes at 5:30 in the morning.
Activities of Daily Living
She is able to feed and bathe herself. Since the activities of daily are not strictly
implemented in the center, hygiene is fair.
Habit
The patient does not drink and smoke.
Present Behavior
She was sitting in an upright posture. She’s cooperative and talkative during the
interaction.
REVIEW OF SYSTEMS
General Survey
She feels comfortable, with no muscle weakness, fatigue or fever. She claims to
be in a good health condition.
41
Skin
The patient has no known allergies to food and drugs. She applies lotion after
bathing. She reported scars in her right upper thigh and right lower leg due to gunshot
wound. She reported occurrences of minimal hair fall when bathing. She cuts her nails
every week and she does not like putting any polish on it.
Head
Patient claims to be confined in this institution due to some problems in her brain
which she termed as migraine. However, she had no history of any head injury and had
not experienced dizziness. When she is mad, she can feel headaches.
Eyes
Client claimed to be diagnosed with astigmatism when she was 30 years old. She
does not use any devices to aid her vision.
Ears
The patient has no known history of hearing problems. She cleansed her ears with
the use of cotton buds thrice a week. She does not use any hearing aids.
Nose
The patient did not experience problems in smelling. During cold season, she
easily acquires colds.
42
Mouth and Throat
The patient has no known history of difficulty of swallowing and eating problems.
She can eat well in any forms of food. However, she claims to have decreased appetite
upon staying at the institution due to unpalatable food. She could not recall the last time
she had a dental check-up. She did not experienced any instances of gum bleeding.
Respiratory System
The patient has reported no history of asthma or any other chronic or acute
respiratory problems, and that she does not smoke.
Circulatory System
No known history of hypertension or any cardiovascular problems, as claimed by
the patient.
Gastrointestinal
The patient reported abdominal discomfort whenever she drinks a cup of coffee.
She has no history of hemorrhoids and had not experienced constipation or diarrhea.
Genitourinary
Patient reported no difficulty upon urinating, with characteristics of yellow
colored urine in moderate amount. No history of hematuria or dysuria.
43
Musculoskeletal
Patient reported that she was hit by a bullet on the right lower leg when she was
13 years old. Client also reported that she did not use any assistive device.
Neurological System
She did not experienced fainting, seizures or weakness on upper and lower
extremities as claimed by the patient.
Elimination
She claims to be defecating every other day. She did not complain of any
difficulty in elimination such as constipation or diarrhea. However, she verbalized
discomfort in defecating at the institution due to poor toilet facilities.
Sleep
According to the patient, she wakes up late at night because she feels she is not at
home.
Psychiatric
Whenever she is mad, she feels nervous and tensioned. She did not noticed any
changes in her mood and behavior since she left to work at Manila, as verbalized.
44
Sometimes, she feels homesick whenever she remembers birthdays of one of her family
members whenever she is away from home, as she reports.
MENTAL STATUS EXAMINATION
Orientation Phase
45
PERSONAL DATA
Name: Ruby ` Date: July 22, 2010
Address: Talomo, Davao City Time: 1:40 pm
Age: 42 Sex: F Civil Status: Single Occupation: None
Nationality: Filipino Religion: Catholic
Date of Admission: July 20, 2010
Reason for Admission: Assaulting a pregnant women
Medical Diagnosis: Schizophrenia, Paranoid Type
Attending Physician: Dr. Dova M. Sayon, M.D.
I.GENERAL DESCRIPTION
General Appearance
Ruby appeared to be happy. She was dressed in a white t-shirt and a gray short, Her face
appeared to be cleaned. Her hair is short and pony tailed, she wore rubber slippers. Her
fingernails and toenails were well trimmed. She appeared properly groomed and has no
foul smelling odors.
Behavior & Psychomotor Activity
A. General Mobility
a. Posture & Gait
46
(√ )Normal ( )Inappropriate
Justification: She has an upright position when sitting and standing. She has a
well coordinated gait. She ambulates without assistance.
b. Actions & Gestures
(√) Normal ( ) Inappropriate
Justification: Ruby’s actions and gestures were appropriate. She was able to
follow instructions like raising her hand to the right and left.
Reaction:
(√)Normoactive ( )Psychomotor retardation
( )Rigidity ( )Agitated
Justification: Ruby was just sitting. She has upright position when sitting and
standing. She has a well coordinated gait. She can walk without assistance.
c. Facial Expression
( √ )Smiling ( )Worried ( )Sad
( )Ecstatic ( )Tense ( )Tearful
( √ )Happy ( )Frightened ( )Distant
( )Angry ( )Suspicious
Justification: Ruby’s facial expression was appropriate. She laughs and smile
when she shares her happy moments.
B. Behavior
47
( √ )Friendly ( )Impulsive ( )Angry
( )Embarrassed ( )Negativistic ( )Seductive
( )Indifferent ( )Withdrawn ( )Manic
Justification: Ruby greeted all the student nurses. She was comfortable in
talking with student nurses. She participates in the interaction and mingles to the student
nurses.
Student Nurse:’’Maayong Hapon Ruby”
Ruby:”Maayong hapon pud. (smiling)
Student Nurse:”kumusta man ka?”
Ruby:”Maayo man, nag paycheck up ra man ko diri.”
C. NURSE PATIENT INTERACTION
a. Attention
(√) Cooperative ( ) Uncooperative ( √ ) Allthroughout
( ) Initially ( ) Lately
Justification: Ruby was cooperative and participates all throughout the

interview, she pays attention to every question and answered the questions
appropriately.
Student Nurse:’’Kanus.a ra ka di admit diri?”
Ruby:”ganina lang buntag, ana si Silver mag pa check up lang man mi”.
48
Student Nurse:”unsa may ingon sa doctor nimu?”
Ruby:”gipa inom man ko nya ug tambal, tapos diri sad aw ko.”
b. Quality
(√)Warm ( )Distant ( )Dependent
( )Hostile ( )Suspicious ( √ )Talkative
Justification: Ruby was warm. She openly expresses her thoughts and feelings
without hesitation and hostility as an indication that she developed trust.
Student Nurse:’’karon, kumusta man imung paminaw?”
Ruby:”Okay lang man pag human nako ug inum ug tambal, kamu musta man
mo? Graduating nab a mo?”
Student Nurse:”okay lang ,man mi Ruby, o, graduating na.”
Ruby:”Maayo kay mu graduate na jud mo.”
I. EMOTIONAL STATE & REACTION MOOD

a. Mood
( ) Depressed ( ) Angry ( )Frightened
( ) Anxious ( ) Suspicious ( √ )Talkative
Justification: Ruby was in the mood for interview there was no indication of
depression, anger and anxiety. She was able to express her thoughts happily.
Student Nurse:’’Pila mo ka mag igsuon Ruby?”
Ruby:”walo mi kabuok, ika duha ko, tapos Akong magulang tua karon sa mati.”
Student Nurse:”unsa pud trabaho sa imung ma ug papa?”
49
Ruby:”akong papa kay boksengero dati, unya akong mama kay naga laba lang
sa mga silingan namu. Unya naa man koy yaya dati”
b. Affect
( √ )Appropriate ( ) Inappropriate
Justification: Ruby’s emotion was congruent with her accompanying ideas

and thoughts.
c. Quality
( )Flat ( )Blunted Others: (√) Euthymic
Justification:
Ruby has normal quality of affect from its mood. She laughs when something is
funny or her emotions is appropriate with the environment.
II. N1EUROVEGETATIVE FUNCTION

A.Sleep
( √ ) Normal ( ) Hypersomnia ( ) Mixed Insomnia
( ) Early Insomnia ( )Late Insomnia
Justification: She verbalized that she can sleep well at the DMH. No signs
of fatigue during the entire interview.
B. Appetite
50
( √ )Normal ( )Increased ( )Decreased
Justification: Ruby’s appetite was normal. She eats three times a day. She
take a snacks in between meals.
Student Nurse: ”Naa ba ka gana mukaon?”
Ruby:” Oo, nikaon man gani ko ganina, salamat diay aning mirienda, kaunon
ko ni unya.”
C. Weight
( ) Increased ( )Decreased ( )No Changes

Justification:
Unable to assess weight.
D. Diurnal Variation: Absent
Justification: There was no diurnal variation noted. She maintained the same
mood throughout our interaction. She was attentive and responsive during interaction.
E. Libido
Justification: Ruby participated well on the interaction. Most of the time, she
will do all the talking and we where only listening. Ruby doesn’t show any
interest to men.
IV. Speech and Stream of Talk
A. Character
(√)Spontaneous ( )Deliberate ( )Loud ( √ )Talkative
( )Whispered ( )Mumbled ( ) Hesitant ( )Pressured
51
Justification: Ruby answers questions appropriately and the pacing of speech
is normal.
Student Nurse:’’Ruby, unsa diay imung trabaho dati?”
Ruby:”katong 16 pa ko, nag adto ko ug manila para mag trabaho, katabang ug

yaya, tapos ginapadalhan nako akong mga igsuon para makaskwela sila.”
Student Nurse:”unya, pila man pud ka katuig nag trabaho didto?.”
Ruby:”10 years ko didto, lain lain akong amo, mubalhin lang ko ug amo pag
gamay ang sweldo nako.”
B. Accessibility
( √ )Good ( )Defensive ( )Fair ( )Mute
Justification: Ruby expresses her thoughts and feelings in a clear

understandable manner. She was able to talk with no doubt and hesitation.
Student Nurse:’’nganong nag uli diay ka ug Davao Ruby?”
Ruby:”Kuan, pag graduate atong alaga nako, didto nako nag decide na muuli,
gihatod paman gani ko sa akong amo, buutan pud tong amo nako bah.”
C. Organization of Thoughts
(√) Relevant () Irrelevant ( ) Circumstantial
Justification: Ruby was able to verbalized relevant information when asked.

She doesn’t show any thought disturbance.
52
V. Perception
( )Present ( √ )Absent
Justification: Ruby does not manifest any signs of hallucinations.
VI. Thoughts
A. Delusion
( )Present (√ )Absent
Justification: Ruby doesn’t show any delusions, or hallucinations during the interview.
B.Suicidal Potential
Justification:No evidence of suicidal potential
Student Nurse:”Ruby, usahay ba makahuna huna ka na pasakitan imung

sarili?”
Ruby:”aw, dili ui, dili jud nako na mabuhat sa akong sarili.”
C. Homicidal Potential
( √ )Present ( ) Absent
Justification: Shows potential in committing homicide.
Ruby:”musulod ko sa military, magbuhat ko ug bomba, unya didto nako pa

butuhon sa akong mga yawa na silingan na nag baligaya sa akong yuta.”
53
VII. Sensorium & Cognition
A.,Orientation
( ) Time
Justification: ( )Impaired ( √ )Unimpaired
Ruby was oriented to time
Student Nurse: ”Unsang adlaw karon uby ug unsang oras na sa tan-
aw nimu?’’
Ruby:”July 23, 2010, alas 2 sa hapon na.”
( ) Place
Justification: ( )Impaired ( √ ) Unimpaired

Ruby was oriented to place
Student Nurse:”Kabalo ka asa ka karun?”
Ruby:”Sa Davao Mental Hospital, nagpa check-up lang ko..”
( ) Person

Ruby was oriented to person
Student Nurse:”Unsa pangalan sa imung kauban karun?”
Ruby:”Si Silver.”
B. Memory
( ) Remote
Justification: ( )Impaired (√ ) Unimpaired
Student Nurse:”Asa ka nagraduate?”
Ruby:”Sa Andres Bonifacio Talomo.”
54
( ) Recent
Student Nurse:”Asa ka last nagtrabaho,Ruby?”
Ruby:”Kompanya sa factory na mango juice sa Toril Lizada.”
( ) Recent Past
Student Nurse: ”Unsa man pangalan sa imung amo didto sa imung
gitrabahuan sa kompanya?”
Ruby:”Incorporate man gud to,daghan tag-iya.”
( ) Immediate

Student Nurse: ”Unsa imung gikaon ganinang buntag ruby?”
Ruby: ” odong na naay tinapa, unya kan-on.”
C.Attention Span
( √) Good ( ) Fair ( ) Poor

Justification :Ruby was responsive and listened to our questions all
throughout our interactions.
A. Calculation
Justification:Ruby was able to answer correctly the calculation.
SN:”100-7=?”
Ruby:”93.”
SN:”93-7=?”
Ruby:”86.”
55
E.Spelling
Justification:When asked to spell her name,she answered it correctly

but wasn’t able to spell it backward.
SN:”i-spell daw imung pangalan?”
Ruby:”Ruby= R-U-B-Y”
A. Abstract Thinking Ability
I. A.Judgement
( ) Impaired ( √ ) Unimpaired
Justification: Ruby has no impairment in judgement..
SN:”Kung nahulog akong pitaka na wala ko kabalo,unsay may
buhaton
nimo?”
Ruby:”Akong iuli sa imuha.”
B.Insight
Justification:
SN:”Unsay pasabot nimu niani, kung may tiyaga may nilaga?”
Ruby:”Kung maningkamot nay pagkaon.”
Summary of Mental Status
Disturbances in:
( ) General Description
( ) Emotional State & Reaction Mood
( ) Neurovegetative Function
56
( ) Speech & Stream of Talk
( ) Perception
(/) Thought
( ) Sensorium & Cognition
(/) Judgement & Insights
Diagnostic Category
(/) Psychotic ( ) Non-Psychotic
Justification:
Patient’s thought processes seemed become disrupted, she exhibited Delusion of
Grandeur and of Persecution towards her neighbors. Also, patient was able to display
poor judgment. However, symptoms of psychotic disorder are minimal.
DSM IV Diagnosis
Axis I – Schizophrenia Paranoid
Axis II – Narcissistic Personality Disorder
Axis III – none
Axis IV - Traumatic experience (shot by a bullet at her right leg)
Social Problems (withdrawn from peers)
Possible traumatic experienced (Patient claims to be raped)
Axis V - 51 – 60: moderate symptoms or moderate difficulty in social,
occupational or school functioning.
57
MENTAL STATUS EXAMINATION
Termination Phase
PERSONAL DATA
Name: Ruby ` Date: July 23, 2010
Address: Talomo, Davao City Time: 2:30 pm
Age: 42 Sex: F Civil Status: Single Occupation: None
Nationality: Filipino Religion: Catholic
Date of Admission: July 20, 2010 Reason for Admission:
Medical Diagnosis: Schizophrenia, Paranoid Type
Attending Physician: Dr. Dova M. Sayon, M.D.
I.GENERAL DESCRIPTION
General Appearance
Ruby appeared to be happy. She was dressed in a light green t-shirt and a gray short, Her
face appeared to be cleaned. Her hair is short and not properly combed, she wore rubber
slippers. Her fingernails and toenails were well trimmed. She appeared properly groomed
and has no foul smelling odors.
Behavior & Psychomotor Activity
A.General Mobility
a.Posture & Gait
58
(√ )Normal ( )Inappropriate
Justification: She has an upright position when sitting and standing. She has a
well coordinated gait. She ambulates without assistance.
b.Actions & Gestures
(√) Normal ( ) Inappropriate
Justification: Ruby’s actions and gestures were appropriate. She was able to
follow instructions like raising her hand to the right and left.
Reaction:
(√)Normoactive ( )Psychomotor retardation
( )Rigidity ( )Agitated
Justification: Ruby was just sitting. She has upright position when sitting and
standing. She has a well coordinated gait. She ambulates without assistance.
c.Facial Expression
( √ )Smiling ( )Worried ( )Sad
( )Ecstatic ( )Tense ( )Tearful
( √ )Happy ( )Frightened ( )Distant
( )Angry ( )Suspicious
Justification: Ruby’s facial expression was appropriate. She laughs and smile
when she shares her happy moments.
B.Behavior
59
( √ )Friendly ( )Impulsive ( )Angry
( )Embarrassed ( )Negativistic ( )Seductive
( )Indifferent ( )Withdrawn ( )Manic
Justification: Ruby greeted all the student nurses. She was comfortable in
talking with student nurses.She participates in the interaction and mingles to other
people.
Student Nurse:’’Maayong Hapon Ruby”
Ruby:”Maayong hapon,sa inyo gikan tong grocery Maam?
Student Nurse:”OO”
Ruby:”Ali Maam.” (smiling face)
C.NURSE PATIENT INTERACTION
a.Attention
(√) Cooperative ( ) Uncooperative ( √ ) Allthroughout
( ) Initially ( ) Lately
Justification: Ruby was cooperative and participate all throughout the

interview, she pays attention to every question and answered the questions
appropriately.
b.Quality
(√)Warm ( )Distant ( )Dependent
( )Hostile ( )Suspicious ( √ )Talkative
60
Justification:Ruby was warm. She openly expresses her thoughts and feelings
without hesitation and hostility as an indication that she developed trust.
III. EMOTIONAL STATE & REACTION MOOD

a.Mood
( )Deppressed ( ) Angry ( )Frightened
( ) Anxious ( ) Suspicious ( √ )Talkative
Justification:Ruby was in the mood for interview there was no indication of

depression,anger and anxiety.
b.Affect
( √ )Appropriate ( ) Inappropriate
Justification: Ruby’s emotion was congruent with her accompanying ideas

and thoughts.
c.Quality
( )Flat ( )Blunted Others: (√) Euthymic
Justification:
Ruby has normal quality of affect from its mood. She laughs when something is
funny or her emotions is appropriate with the environment.
IV. N1EUROVEGETATIVE FUNCTION
61
A.Sleep
( ) Normal ( ) Hypersomnia ( ) Mixed Insomnia
( ) Early Insomnia ( )Late Insomnia
Justification:
B. Appetite
( √ )Normal ( )Increased ( )Decreased
Justification:Ruby’s appetite was normal. She eats three times a day. She
take a snacks in between meals.
Student Nurse:”Naa ba ka gana mukaon?”
Ruby:” Oo ,kakaonon gani ko run…kung sa amuang balay,daghan kaayo ko
makaon..”
C.Weight
( ) Increased ( )Decreased ( )No Changes

Justification:
Unable to assess weight.
D.Diurnal Variation: Absent
Justification: There was no diurnal variation noted. She maintained the same
mood throughout our interaction. She was attentive and responsive during interaction.
E.Libido
Justification: Ruby participated well on the interaction.
62
IV.Speech and Stream of Talk
A.Character
(√)Spontaneous ( )Deliberate ( )Loud ( √ )Talkative
( )Whispered ( )Mumbled ( ) Hesitant ( )Pressured
Justification: Ruby answers questions appropriately and the pacing of speech

is normal.
B.Accessibility
( √ )Good ( )Defensive ( )Fair ( )Mute
Justification: Ruby expresses her thoughts and feelings in a clear

understandable manner. She was able to talk with no doubt and hesitation.
C. Organization of Thoughts
( ) Relevant (√) Irrelevant ( ) Circumstantial
Justification:
Ruby: “Ma’am mga kristyano mo no, dli man gud ko katulugon sa inyu di
pareha atong nag-interbyu sa ako ganina.”
SN:
V.Perception
Justification:Ruby does not manifest any signs of hallucinations.

Student Nurse:”Naa ba ka makit-an o madunggan bisan ikaw lang isa.?”
63
Ruby:”Wala.”
VI.Thoughts
A.Delusion
( √ )Present ( )Absent
Justification:
Ruby: Ma’am/sir, naa moy dugong H?
SN: “unsa man nang dugong H ruby?
Ruby: “dugong Hero ba..kanang dugong sundalo gud.”
Ruby exhibits disturbance in thinking specifically neologism.
B.Suicidal Potential
Justification:No evidence of suicidal potential
Nurse:”Nakahuna-huna ba ka na pasakitan imu sarili?”
Ruby:”Dili oi,nganu saktan man naku akong sarili,sakit man na.”
C. Homicidal Potential
( )Present ( √ ) Absent
Justification:
Student Nurse:”Nakahuna huna ba ka na pasakitan ang imung mga kauban

diri sa sulod?”
Ruby:”Wala pud,kay religious ako.”
64
VII. Sensorium & Cognition
A.,Orientation
( ) Time
Ruby was oriented to time
Student Nurse:”Unsa orasa na karun,Ruby?’’
Ruby:”2:30 sa hapon.”
( ) Place

Ruby was oriented to place
Student Nurse:”Kabalo ka asa ka karun?”
Ruby:”Sa Mental.”
( ) Person

Ruby was oriented to person
Student Nurse:”Unsa pangalan sa imung kauban karun?”
Ruby:”Si bing2x.”
Student Nurse:”Unsa tinuod pangalan ni bing2x?”
Ruby:”Rey.”
B. Memory
( ) Remote
Student Nurse:”Asa ka nagraduate?”
Ruby:”Sa Andres Bonifacio Talomo.”
( ) Recent
65
Student Nurse:”Asa ka last nagtrabaho,Ruby?”
Ruby:”Kompanya sa factory na mango juice sa Toril Lozada.”
( ) Recent Past
Student Nurse:”Unsa man pangalan sa imung amo didto sa imung
gitrabahuan sa kompanya?”
Ruby:”Incorporate man gud to,daghan tag-iya.”
( ) Immediate

Student Nurse:”Unsa imung gikaon ganinang buntag ruby?”
Ruby:”Breakfast,odong na naay tinapa.”
C.Attention Span
( √) Good ( ) Fair ( ) Poor

Justification:Ruby was responsive and listened to our questions all
throughout our interactions.
B. Calculation
Justification:Ruby was able to answer correctly the calculation.
SN:”100-7=?”
Ruby:”93.”
SN:”93-7=?”
Ruby:”86.”
E.Spelling
66
Justification:When asked to spell her name,she answered it correctly
but wasn’t able to spell it backward.
SN:”i-spell daw imung pangalan?”
Ruby:”Elenita=E-L-E-N-I-T-A=
B. Abstract Thinking Ability
II. A.Judgement
Justification: Ruby has no impairment in judgement..
SN:”Kung nahulog akong pitaka na wala ko kabalo,unsay may
buhaton
nimo?”
Ruby:”Akong iuli sa imuha.”
B.Insight
Justification:
SN:”Unsay pasabot nimu niani, kung may tiyaga may nilaga?”
Ruby:”Kung maningkamot nay pagkaon
III. Summary of Mental Status

A. Disturbances in:
( ) General Description
( ) Emotional State & Reaction Mood
( ) Neurovegetative Function
67
( ) Speech & Stream of Talk
( ) Perception
( √ ) Thought
( ) Sensorium & Cognition
( ) Judgment & Insights
Diagnostics Category
( ) Psychotic ( √ ) Non-Psychotic
B. DSM IV Diagnosis
Axis I Schizophrenia Paranoid
Axis II Narcissistic Personality Disorder
Axis III None
Axis IV Traumatic Experience (shot by a bullet at her right leg)
Social Problems (withdrawn from peers)
Possible traumatic experienced (Patient claims to be raped)
Axis V 51 – 60: moderate symptoms or moderate difficulty in
social, occupational or school functioning.
68
NURSE PATIENT INTERACTION
ORIENTATION PHASE
Name of Patient: Ruby Age: 42 years old Status:

Single
Date and Time of Assessment: July 22, 2010 2:00PM
Phase Interaction: Orientation Phase
Goal of Interaction:
 To continue establishing rapport.
 To maintain therapeutic communication.
 To encourage verbalization of feelings.
Objectives:
1. To introduce self;
2. To orient patient about the purpose of interaction;
3. To enable patient to share information about herself; and
Environment:
During our conversation we are sitting on the hammock. It was quite and
peaceful. And we are comfortably interacting.
General Appearance:
Patient was dressed in yellow-green color shirt and short pants appears tidy. Her
face appeared to be clean. She has bent and slouched posture. Her fingernails and toenails
were well trimmed. Patient appeared groomed and she has no foul smelling odor.
69
NURSE PATIENT ANALSIS/INTERPRETATION
“Maayong hapon “Mayong hapon” (smiles a little) Giving Recognition

Ruby” (smiles and
looks at the patient in Greeting the patient by name indicates
the eye using a gentle recognition of the individual as a
voice). person regardless of the formality or
length of the relationship, each nurse
actively encourages patient to feel
comfortable in the relationship.
Patient responds appropriately and
gives a sign of good start.
“Ruby kami diay ang “ duha lang diay mo ka oras” Giving information
mga student nurse sa
Brokenashire college. Making available of the facts the
Kami imung client needs. It builds trust with the
makauban karon ug client and introducing oneself is the
hangtud unyang alas initial step in social interaction and
dos” (speaks in a establishing rapport. The nurse should
gentle voice.) established roles, the purpose of
meeting and parameters of subsequent
meeting that clarifies expectations.
The patients response emphasizes that
she understand the information given.
“OO, hangtud alas “okay Sir” Giving information and

dos lang, tapos balik encouraging
na pud mi ugma. Naa
lang koy mga Allowing the patient to know specific
pangutana bahin sa information with regards to his
imung kinabuhi. participation providing
Storya lang kung psychotherapeutic activities. The
unsa tong mga kaagi patients way of answering the
nimu dati.” question initiates acceptance and
understanding of the information
provided.
“Unsa imung tibuok “Ruby ” Seeking information

na pangalan?” (Look
at the patient and
70
smiled)
“Ang edad nimu?” “42 na ko.”
“Pangalan sa imung
Mama ug edad?”
“Si Antonia, 62.”
“Imung Papa? Unsa
iyang pangalan ug
pila ang edad?”
“Luciano, 77, patay na sya.”
“Unsa iyang gi- “Arthritis man to” Seeking Information

kamatyan Ruby?”
The student nurse is assessing whether
“unsa pud ang the patient knows how to spell.
trabaho sa imung “Wala, sa balay lang man to sya, kay
mama?” sukad atong nag trabaho ko sa
maynila, ako na naga supporta sa
akong manghod.”
“Imung papa, unsa “Boxer to sya sa una, mga 20 pa

iyang trabaho sa una? iyang edad nag sugod, tapos ang last
nyang nakalaban kay si flash elorde.”
“mananggiti.”
“tapos, unsa man ang
iyang sunod na
trabaho katong nag
retire na sya?”
“asa pud ka nag “sa talomo highschool, honor student Seeking Information and
skwela tong ko, unya valedictorian ko atong Clarification
highschool ka?” elementary ko. Pirmi ko top one sa
highschool.” As the student nurse we should seek
for clarification throughout the
interactions with the patient. Doing so
“wow, kugihan jud can help us to avoid making
diay ka.” assumptions that understanding has
occurred when it has not.
The patient responses show that she is

aware of himself and the ability to
71
spell is not impaired.
“Ruby, pila mo “walo mi kabuok, duha ang babae.” Seeking information

kabuok mag-
igsuon?” Helps the patient articulate thoughts,
feelings and ideas more clearly by
“mapanganlan ba “O, si Danilo 44, tapos ako, edito 40, asking the patient to compute, patient
nimu tong walo nimu Vilma 38, Alan 36, Rolando 34, Rey was logically active and yet
ka igsuon?” 32, ug si Luciano Jr. 30.” participative and can compute w/out
using calculator just by his mental
ability.
“naunsa diay nang “Na-igo ni sya ug bala tong 15 pa Seeking information and giving
paa nimu Ruby, dako akong edad, natulog ko ato na information
lagi na peklat?” nakasandig ang tiil sa bintana.”
The student nurse is seeking
“Pag human?” “Human ato, gidala ko sa Regional, information regarding the patient's
November 14, 1983 man to, unya ability in remembering. What was the
nag-gawas ko sa hospital December date of going to manila.
24, 1983.”
”Pila imung edad na ni- “kuan ko ato, 16, ni-adto na Using open ended question
adto kag manila?” kog manila para mag trabaho
ug katabang sa Quezon, tapos Asking broad questions that leads or invite the
nagbalhin ko ug amo kay client to explore. Patient seems to be interested.
gamay ang sweldo, sa
Marikina.”
“tapos?”
“ako na ang naga pa eskwela
“unya unsa kang tuiga sa akong lima ka manghud.”
ning balik sa Davao?”
“naga uli-uli man ko, katong

“unsa to syang tuiga pag-graduate sa akong alaga
Ruby?” sa manila, didto nako ning-
uli.”
“2001 to.”
“Tapos, pagbalik nimu
diri, unsa napud imung
72
gi-applyan?” “Nanglabada, nag trabaho ko
diha sa may factory sa Toril,
human nag trabaho pud ko
diha sa Bakery sa may Ulas.”
“katong naga trabaho “wala man, mga buutan man Using open ended question
pa ka didto sa manila, ang Amo, ginahatag among
ginapasakitan ba ka sa 13th month pay.” Asking broad questions that leads or invite the
imung amo?” client to explore. Patient seems to be interested.
“katong bata pa ka, “Manika,usahay syatong.” Seeking information

unsa imung gina
dulaan?” As the patient responded, he gives us the idea
that he wants it secretly.Patient seems to be
Kinsa man pud imung “Ako lang mang mga aware of his condition, during interaction.
mga kadula?” manghud ang kadula nako” Patient responds in a good mood and can
establish relationship by expressing his true
feelings without hesitation. She answers
“Ruby, napasakitan nab “wala man…ay, kaisa.” questions
a sa imung papa tong
bata pa ka?”
“nakabuak man yata ko ato,

Unsa diay ang nahitabo tapos gibunalan ko atong 1x1
nganong gibunalan na kahoy
ka?”
“katong high school pa “BSEd” Offering self

ka, unsa unta imung
kuhaon na kurso?” Suggesting one's presence interest or wish to
understand the client without making any
demands or attaching conditions that the client
must comply. Patient responds by nodding his
“Ruby, kailangan na head. It feels like it needs more convincing
namu manglakaw, 2 “ah okay, sige, okay ra sa words to feel comfortable when having
hours lang baya to si ako..” interraction.
kinsa man?”
73
“Salamat sa imung oras “La man, wala pud koy Seeking Information
ruby ha?” madungog.
Asking her the information about what
“Uist! Kanang, pwede ato-ato happened to his eyes, the possible cause and
lang tong gi-istoryahan? Dili the treatment used.
man nako apilun ang school.”
Patient responds with imaginary words like he
“kita-kita lang ang “okay, salamat kayo ha.” is hallucinating.
nakabalo ato Ruby, sa
ato lang to magtuyok?” Patient's awareness of the medication gives us
an idea that he has a good memory and can
“ familiarize the medication being used to her
EVALUATION:
Patient was able to:
1. Be orient about the purpose of interaction
2. Share information about herself; and
3. Reveal and express views, feelings and memory.
Student Nurse was able to:
1. Establish rapport to the patient;
2. Obtain information needed from the patient; and
3. Assess mental status of the patient.
74
NURSE PATIENT INTERACTION
Name of Patient: Ruby Age: 42 years old Status:Single
Date and Time of Assessment: July 23,2010 2:00PM
Phase Interaction: Working Phase
Goal of Interaction:
 To continue establishing rapport.
 To maintain therapeutic communication.
 To encourage verbalization of feelings.
Environment:
During our conversation we are sitting on the hammock. It was quite and
peaceful. And we are comfortably interacting.
General Appearance:
Patient was dressed in blue color shirt and gray short pants appears tidy. Her face
appeared to be clean with properly shaven facial hair. She has bent and slouched posture.
Handcuffed noted and his fingernails and toenails were well trimmed. Patient appeared
groomed and she has no foul smelling odor.
Nursing goals and objectives for this interaction:
1. To explore and understand thoughts and feeling;
2. To have a much deeper interaction with the patient;
3. To do necessary action and aid the patient plan a program of action to meet pre-
established goals.
75
NURSE PATIENT ANALSIS/INTERPRETATI
ON
“Maayong hapon Ruby” “Mayong hapon” (smiles a little) Giving Recognition

(smiles and looks at the
patient in the eye using a Greeting the patient by name
gentle voice). indicates recognition of the
individual as a person
regardless of the formality or
length of the relationship, each
nurse actively encourages
patient to feel comfortable in
the relationship. Patient
responds appropriately and
gives a sign of good start.
“Kumusta imu tulog “Nindot ako pagtulog”. (still looking Seeking information and
Ruby” (maintains eye to the student nurse with a little smile) Clarification
contact to the patient)
Maintaining eye contact while
asking the patient. Patient
“Nakadungog ka sa helicopter? Kusog responds appropriately and has
kayo noh?” sign of good sleep with good
facial expression and also
patient begins to experience
“Hehehe..bugol man ka sir oi.” auditory hallucination bys
asking the student nurse on
“Asa gud?”
what he had heard it gave ideas
that still the patient has
hallucination.
“Ruby kaila pa ka sa “Kaila pako” Seeking Information

ako?”
“Lami kayo.” Helps the patient articulate
“Ruby lami ang snack?” thoughts and feelings and ideas
“Baby Bear”. more clearly. Based on the pt’s
“Unsa pangalan sa imong response it is appropriate to the
igsoon r?” situation. Pt gave ideas that he
feels better and nice while he
76
was asked by the student nurse
and it is a sign of good heart.
“Kinsa gani ko Ruby?” “Si Jude, sudent nurse nako”. Seeking Information
Helps the patient articulate

thoughts, feelings, and ideas
“Ruby asa man ang nurse “Tua ra oh!” (Pointing to the nurse more clearly.(Psychiatric
station?” station) Nursing by Keltner)
The nurse asked questions to

“Very good”. assesst the patient’s awareness
of her.
The patient shows

consciousness and awareness
of oneself and also the
environment she stayed in.
“Ah mayo Ruby. Ahh “Uhmmm kabalo man”. Seeking Information

sige, kabalo ka og
spelling?” The student nurse is assessing
whether the patient knows how
to spell.
“Spell daw akoa name?” “Ahhh.. J-U-D-E Seeking Information and

(Maintains eye contact) Clarification
As the student nurse we should

seek for clarification
“very good Ruby! Sige ha,
“T-U-E-S-D-A-Y” throughout the interactions
spell Tuesday?”
with the patient. Doing so can
help us to avoid making
assumptions that understanding
“A-U-G-U-S-T”
“Spell August?” has occurred when it has not.
The patient responses show that

she is aware of himself and the
ability to spell is not impaired.
“ Ahh. Very good. Oh sige “Uhmmm eighteen po” (maintains Seeking information
math na pod ta. One eye contact, then responds correctly)
hundred minus eighty two, Helps the patient articulate
pila man?” thoughts, feelings and ideas
more clearly by asking the
77
patient to compute, patient was
logically active and yet
participative and can compute
w/out using calculator just by
his mental ability.
“Wow! Ang galing” “Four hundred fourty po” (maintains Seeking information and
eye contact and smiling while bowing giving information
“One hundred eighty six his head)
plus two hundred sixty, The student nurse is seeking
pila man?” information regarding the
patient's ability in mathematics.
“Ay Ruby, time na. Balik (Nods) Thanks you po! (with eye In multiplication, division,
lang mi ugma ha. Thank contact) subtraction and addition.
you! (maintaining eye Patient responds directly to the
contact) question.
Evaluation:
The student nurse was able:
1. To explore and understand thoughts and feeling;
2. To have a much deeper interaction with the patient ; and
3. To do necessary action and aid the patient plan a program of action to
meet pre-established goals.
78
PSYCHODYNAMICS
PREDISPOSING PRENATAL:
FACTORS:
 Doesn’t visit clinics for prenatal check-up but instead
 Dysfunctional consult to “quackdoctors”.
family relationship
 Planned/expected pregnancy
 Gender
 Family history  usually eat egg, meat, dried fish and canned goods
 Age
BIRTH:
 Mother Lily gave birth to Ruby on February 27, 1968; full term via Normal
Spontaneous Vaginal Delivery (NSVD).
 Was attended by her father who was a “mananabang” at their house.
 No history of fall and accidents during pregnancy as verbalized by Mother
Lily.
INFANCY TRUST
(Birth -18 months)
Trust was
TRUST VS MISTRUST
developed because her
 Cuddled during breastfeeding
needs were all attended.
 Ruby was left under the care of her mother since birth
 Mother lily applies bronchorub ointment or vicks on her nipples in weaning her child. She was nurtured by her
 After weaning, Ruby had experienced thumbsucking mother properly and she
 Ruby had experienced childhood disease like chickenpox and consulted a doctor and was advised simply gains good
to avoid taking a bath for 5 days.
 Ruby was breastfed for 2 years and mother lily claimed that she doesn’t use any formula milk. relationship with other
 At 1 ½ years of age, ruby was already able to walk, talk and manifested fever during teething. She individuals. Mother
79 is the
began her toilet training also about this age wherein she was trained to defecate beside their house.
 Child is comforted when crying.
TODDLER AUTONOMY
(18 months to 3 years old)
Ruby developed autonomy because she was able to verbalize her toilet needs. Developed self-control without loss of se
AUTONOMY VS SHAME & DOUBT
Mother lily claimed that her daughter also experienced bed wetting and stopped when she reached the age of 2years.
At the age of two years old, Mother Lily weaned Ruby by way of applying bronchorub ointment or Vicks on her nipples.
She doesn’t have playmates and only wants to play with her younger sister.
Follower in the game.
Develops cooperativeness and the ability to delay gratification of needs.
PRESCHOOL INITIATIVE
(3 years old to 6 years
Rubyold)
was able to learn the degree to which assertiveness and purpose influence the environment and
INITIATIVE VS GUILT
cabulary increased and she showed proper use of pronouns such as “mama” (mother) and “papa” (father).
ool at age of 6. “Wala na siya niagi og kinder, diretso na Grade 1.” As verbalized by Mother Lily and was able to write when she was 2 years old.
mother on the first day of school and eventually learned to go to school alone.
stay inside the house.
80
SCHOOLAGE INDUSTRY
(6 years old to Ruby
12 years
begins
old)to create, develop, and manipulate and developed sense of competence and perseverance and
INDUSTRY VS INFERIORITY
Ruby loved playing during her early days such as dolls.

She is confident in doing task like household chores
Ruby’s favorite subjects are mathematics, English and science.
She has no enemies in school and has good relationship with her teachers.
Excelled academically at school, received honors.
ADOLESCENCE ROLE CONFUSION

(12 years old to 20 years old)
IDENTITY VS ROLE CONFUSION
The patient developed
 She didn’t have any difficulty adapting to puberty feelings of Confusion,
 She had her menarche at the age of 12 years old and only lasts for 3 days.
indecisiveness and anti social
 She only finished 1st year high school
 She was teased by her classmates because she was using crutches shedue to gunshot wound at her behavior manifested by running
right leg. away from home.
 She was kind, silent type and responsible student. She spends an hour for studying and wasn’t
forced to go to school.
 According to mother Lily Ruby’s highest grade was 85-87 % and the lowest was 83%.
 She is always determined in achieving what she wants and she never bends her own principles
just to please others. Ruby values hard work and responsibility
 At the age of 16, she went to manila to work as a Housekeeper and a Nanny for about 10 years. 81
YOUNG ADULT ISOLATION
Precipitating Factors (20 years old -40 years old)
INTIMACY VS ISOLATION Ruby develops
 Stress
avoidance of relationships,
 Frustrations  Unable to develop lasting relationships with other people. She
 Traumatic career, and commitments.
hated boys. And doesn’t have many friends.
event The patient never got
 Non-  Lacks emotional maturity and exhibits possessiveness and
compliance married and she doesn’t
suspiciousness instead. She was kick out of her job because of her
with have any plans of building a
medications behavioral changes.
family of her own.
 Develops a sense of mistrust in building permanent intimate
relationship due to immaturity handling it.
 Since then the patient was not able to form significant relationship,
declined making new friend and did not feel safe and secure with
her surroundings.
ADULTHOOD STAGNATION
(40 years old to 65 years old)
GENERATIVITY VS STAGNATION Ruby developed self-
 Develops sense of stagnation because she doesn’t care about her family indulgence and lack of interests.
members including her mother, brother and sisters, not politically active And was in the institution which
sometimes she doesn’t recognized her brothers and sister but instead always prevented her from doing things a
insisting that they are fake family members and her true family lived on
woman of her age does. She has
Manila.
difficulty in applying for a job she
prefers due to her mental illness.
82
ADMISSION:
 Brought to DMH with her brother by 911 (July 20, 2010) due to uncontrolled
behavior.
 She was admitted at Davao Mental Hospital and confined at CIU for
observation.
 On July 23, 2010, she was instructed by her Doctor that she may go home.
Schizophrenia Paranoid type
If treated: If not treated:
 Control symptoms  Progression of symptoms
 Able to perform Activities of Daily  Dependent in others in performing

Living ADL
 Unable to function in the society
 Able to function in society
83
Stage Age Central task Indicators of positive Indicators of negative Actual task Indication
resolution resolution
Infancy Birth to 18 Trust vs.  Shows strong  Shows  Ruby was born
According To Erik
Months Mistrust affectional avoidant or Feb 27, 1968 via
tie and resistant Erikson the baby
exhibits attachment Normal
will develop trust to
attachments towards Spontaneous
behaviors parents. The the person who
toward her child has Delivery full term
takes care of him,
mother.The delayed at their house.
child have physical, the mother is the
good motor motor and  Breastfed for 2
major person whom
ad social social years and mother
development. development. the trust may be
 Parents show claimed that she
developed.
affection and doesn’t use any
love while  Parents have
showed anger formula milk. In this age the
handling the
child. or have fought,  Cuddled during needs of the infant
 Parents allow while handling
the child. breastfed must be provided so
infants to
satisfy his  After weaning that trust will be
oral needs
and respond ruby experienced developed.
to infants thumb sucking.
signal in a
well-timed,  At 1 year of age,
 Parents cannot
appropriate
interpret ruby was already If she fulfils this
fashion.
infants signals able to walk and task she will have
and the ability to relate
84
discourages talk. well with others
thumbsucking
 Child is comforted and share her
at this stage.
when crying. thoughts and
concern.
She will feel safe

and secure to give
affection and expect
the same affection
in return.
Build trust and

confidence in her
self and others.
85
 Self-control Children take pride
without loss
Learns to become in new
Toddler 18 months Autonomy vs. of self-  Lack of self 
to 3 years shame and esteem confidence, accomplishments
independent in
doubt pessimism,
and want to do
fear of wrong performing simple
doing. everything
activities or task
independently. If
 Develops
parents recognize
cooperativeness
toddlers need to do
and the ability to
what they are
delay gratification
capable of doing at
of needs
their own pace and
 Parents allow the
in their own time
child try new
then children
things and
develop a sense of
discover the world
being able to
around her.
control their
 Also experienced
muscles and
bed wetting and
impulses during this
stopped when she
time. If children
reached the age of
leave this stage
2years.
with last autonomy
than shame or
86
doubt, they can be
disabled in their
attempts to achieve
independence and
may lack
confidence in their
abilities to achieve
well into
adolescence and
adulthood.
Erikson defines
developmental task
87
 Develops a of the preschool
Preschool 3 to 6 years Initiative vs. positive  Her parents allow period as learning
Guilt response to initiative vs. guilt.
her to play near
the world’s Learning initiative
their house, but
challenges. is learning how to
she will refuse to
Has the do things. Children
play outside their
confidence to can initiate motor
house. She would
try activities of various
always like to stay
something sorts on their own
inside the house.
that he has and no longer
 She entered school
not done merely respond to
at the age of 6
before. Child or imitate the
years old. She
is exposed to actions of other
accompanied by
a wide children or of their
her mother on the
variety of parents. Whether
first day of school
experiences children leave this
and eventually
and play stage with a sense
learned to go to
materials of initiative
school alone.
outweighing a sense
of guilt depends
largely on hoe
parents respond to
88
self-initiated
activities.
School age children

 Loved playing develop a sense of
89
Beginning to create, during her early industry by
School age 6 to 12 Industry vs. develop and days such as working, being
years Inferiority manipulate. manika, luto-luto confident, and
and balay-balay. feeling of
accomplishment.
 She is confident in
Developing sense of
doing task like
competence and
household chores
perseverance
 Good follower in
the game
 favorite subject are
Mathematics
English and
science
 Excelled
academically at
school, received
honors.
According to
 Knows herself and Erikson
 Coherent how she fits to the adolescence must
90
Sense of self. rest of society. She bring together
Adolescence 12-20 years Identity Vs. is always everything they

old Role Confusion determined in have learned about
 Plans to
achieving what she them selves as son
actualize
wants and she or daughter.
ones
never bends her Erikson also
abilities.
own principles just believed the new
to please others. interpersonal
Ruby values hard dimension that
work and emerges during
responsibility adolescence in the
sense of identity
versus role
 Accepts and adjust
confusion.
changes in body
image. She didn’t In ruby’s case she
have any difficulty developed identity
adapting to rather than Role
puberty. confusion.
According to her
mother she had her
menarche at the
age of 12.
91
 Unable to develop Intimacy is the
lasting ability to relate well
relationships with with other people,
92
other people. She not only with
hated boys. And members of
Young Adult 18-25 years Intimacy Vs.  Impersonal
Isolation doesn’t have many opposite sex but
relationship
friends. also with one’s own
 Avoidance of
 Lacks emotional sex from one
relationship
maturity and lasting friendship.
career or
exhibits
lifestyle In Ruby’s case she
possessiveness and
commitments developed Isolation
suspiciousness
because she cannot
instead. She was
develop lasting
kick out of her job
relationship with
because of her
others, and doesn’t
behavioral
trust anyone and for
changes.
the reason also that
 Develops a sense
she didn’t feel safe
of mistrust in
and secure with her
building
environment.
permanent
intimate
relationship due to
immaturity
handling it.
93
 Since then the
patient was not
able to form
significant
relationship,
declined making
new friend and did
not feel safe and
secure with her
surroundings.
 Develops sense of
stagnation because
she doesn’t care
about her family
members including
her mother,brother
and sisters,not
politicallyactive
sometimes she
doesn’t recognized
her brothers and
94
sister but instead
always insisting
that they are fake
family members
and her true family
lived on Manila.
According to
Erikson people with
95
sense of
generativity are self
Adulthood 25-65 years Generativity  Self
Vs. Stagnation confident and better
indulgence,
able to juggle their
self concern
various lives.
lack of interest
People without
and
sense become
commitments
stagnated and self
absorbed. In Ruby’s
case she developed
Stagnation because
she doesn’t care
about people
around her.
96
DOCTOR’S ORDER
7/20/2010 >Please admit patient to CIU with watcher
2pm > on DAT with AP
>Monitor vsq4 and record please
> Meds:
Fluopentixol dec 20g IM now
Haloperidol 5mg IM nows
Biperidine HCL 2mg 1 tab BID prn
>Suicidal, Homicidal, Escape precaution
>Remove any safety hazards prior to entry to CIU
>Secure consent for admission
>Refer
Dova M. Sayon, M.D.
7/21/2010 >Meds:
Shift haloperidol IM to Haloperidol 5mg per tab, 1 tab BID
Start Lithium Carbonate 450mg per tab, 1 Tab BID
Dr. Oligario
7/22/2010 >Increase Haloperidol to 20mg/tab, ½ Tab BID
10:30am >Continue Meds
Dr. Gonzaga
07/23/2010 > MGH
10:15 am >Continue Home Meds
Dr. Gonzaga
97
DRUG STUDY
Generic Brand Classificatio Mechanism of Route and Indication Contraindicatio Adverse Nursing
name name n action Dosage n reaction responsibilities
A 20 mg/tab >Psychotic Contraindicated >Tardaive >assess severity of

H H A butyrophenone ½ tab disorders in patients dyskinesia symptoms
A A N that probably BID hypersensitive >assist in ambulation
L L T exerts >chronic to drug and in >Sedation and provide safety
O D I antipsychotic psychosis those with >advice to rest and
P O P effects by requiring Parkinsonism, >Drowsiness avoid alcoholic
E L S blocking post- prolonged coma, or CNS beverages
R Y synaptic therapy depression >Lethargy >assist in activities
I C dopamine of daily living
D H receptors in >Toirette Use cautiously >Headache >note serum levels
O O the brain syndrome in elderly and for any abnormalities
L T debilitated >Insomnia especially creatinine
I patients, in levels
C patients with >Confusion >caution when
seizures, or engaging in activities
EEG >Blurred requiring alertness or
abnormalities, vision clear vision
severe CV >encourage to
disorders, >Dry mouth increase OFI
allergies and >advise to eat
glaucoma >Anorexia nutritious food and
monitor weight daily
>Nausea and >give small frequent
vomiting feedings
>advise to apply
>Diaphoresis lotion
98
DRUG STUDY
Generic Brand Classificatio Mechanism of Route and Indication Contraindicatio Adverse Nursing
name name n action Dosage n reaction responsibilities
Weak 20 mg/tab > control of Contraindicated >Drowsiness >instruct the patient

B A A peripheral anti 1 tab PRN extra in patients to get up slowly
I K N cholinergic for EPS pyramidal hypersensitivity >Insomnia when rising from
P I T agent with disorders to biperiden sitting or lying
E N I nicotinolytic secondary to >Blurred position
R E C activity, neuroleptic Narrow angle vision >avoid alcoholic
I T H inhibition of drug therapy glaucoma beverages, schedule
D O O striatal >Dry mouth rest and activity
E N L cholinergic >as an Bowel periods
N I receptors adjunct in the obstruction >muscle and >advise not to take
N therapy of all joint pain naps in the morning
E forms of >increase oral fluid
R Parkinsonism >Dizziness intake
G >advise to use
I >Increased mouthcare
C saliva >Advise to practice
good oral hygiene
>caution when
engaging in
activities requiring
alertness or clear
vision
>provide hot
compress
>advise to rest and
teach how to do
passive ROM
exercises.
99
DRUG STUDY
Generic Brand Classification Mechanism Route Indication Contraindicati Adverse reaction Nursing
name name of action and on responsibilities
Dosage
F A Specifically 20 >Depression Extreme >Restlessness >Monitor patient
L N antagonizes mg/amp involving excitability >insomnia condition before and
U T D1 and D2 1 amp IM anxiety, lack of and >extrapyramidal therapy.
P I dopamine initiative. overactive syndrome >assess for any heart
E P receptors(as >Chronic patients, >sedation problems, liver,
N S well as neuroses with acute >antimuscarinic kidney, breathing
T Y serotonin) anxiety, barbiturate, effects may also problems, jaundice,
I C depression and alcohol and occur, tardive and postural
X H inactivity opiate dyskinesia hypotension.
O O >Psychosomatic poisoning; >assess if patient is
L T disorders with pregnancy, pregnant, trying for a
I asthenic patients with baby or
C reactions. bone marrow breastfeeding.
>Anxiety and depression >Should be
tension states. and comatose monitored carefully
>Schizophrenia states in patients on long
and allied term therapy.
psychoses >Can be taken with
especially with or without meal.
symptoms; eg.
Hallucination,
paranoid
delusions and
thought
disturbances
with apathy,
energy and
withdrawal.
100
Nursing Care Plan
Name of Patient: Ruby
Age: 42 years old
Date and time of admission: 07- 20 – 2010 : 2 PM
Date and time of assessment: July 22, 2010 @ 1 – 2 PM Date and time of evaluation: July 23, 2010 @ 1 – 2 PM
Cues & evidences NURSING NURSING

EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION RATIONALE
Risk for other That at the end 4 hours .> Establish rapport >To promote cooperation. Goal Met:
Within 2 hours of
Subjective: violence related of nursing care, patient with the client.
care, patient was able
“Musulod ko ug to auditory will decreased number to:
airforce kay hallucination. of violent responses as >Observed client’s >Close observation is
>Show control of
magbuhat ko ug manifested by: behavior frequently. required so that intervention behavior with
assistance from
bomba, didto Rationale: Do this through can occur if required to
other.
nako pabuthon  Showing control routine activities and ensure clients ( and others
>absence
sakong mga Violence is a of individual interactions; avoid safety.)
manifestations of
silingan” as state in which behavior with appearing watchful desire to inflict pain
to others.
verbalized. an individual assistant care from and suspicious.
101
experience other. .> To avoid feelings of
Objectives: behaviors that >Maintain person’s entrapment on the part of the
can be  Absence of personal space. Avoid individual.
 History physically manifestations of being too touchy to the
Of suicidal harmful either desire to inflict client. >The client may act on what
Potential. to self or to pain to others such she “hears. Your early
others. Since as threats, uttering >Remain aware of response to cues indicating
 History of patient has of illicit language cues indicating that active hallucinations
Homicidal schizophrenia, and facial the client is decreases the chance of
Potential. and he is expressions. hallucinating (intent acting out or aggressive
paranoid type, listening for no behavior.
 Depress paranoia may  Demonstrate apparent reason,
Ion noted. occur and may satisfying talking to someone

provoke her to relationship with when no one is >With decreased anxiety the
 Impulsive Become others. present, muttering to client will be able to solve
Behavior violent. self, inappropriate problems, learn new
noted. facial expression.) behaviors and establish

relationship with others.
>Help the client
Bibliography: identify and practice
Videbeck, ways to relieve
Sheila, anxiety such as deep
102
Lippincotts breathing, listening to
Manual of music, and relaxation.
Psychiatric
Nursing.
Seventh
Edition.
Lippincott,
Williams and
Wilkins,
Walter kluwers
Company.
Phiulad.
Copyright @
2008
Pg. 187
NURSING CARE PLAN
103
Age: 42 years old
Cues & NURSING NURSING

evidences DIAGNOSIS OBJECTIVES INTERVENTION RATIONALE EVALUATION
Non – compliance Within 4 hours span of  Develop  To promote trust, Goal Met:
S/O: to medication care, patient will be able therapeutic nurse – provides atmosphere in
related to to : patient which the patient can After 4 hours of
“Mutukar na ang financial aspect. a.) Verbalize relationship. freely express views and care, patient was
iyang sakit, kung accurate concerns. able to:
dili siya Rationale: knowledge and  Explore client  To be able to follow
makainum ug Maintaining the understanding of involvement in or through the goals she  Verbalize the
tambal tungod medication treatment lack of mutual participated in importance of
kay wala kwarta regimen is vital to regimen. goal setting. developing. complying
pampalit, “as the successful b.) Verbalize the  Contract with the  To enhance commitment with
verbalized by her outcome for importance of patient for the to follow through. medication
brother (Silver) clients with complying to participation in and
schizophrenia. medication. care. understanding
Failure to take  Accept the  To maintain open about
104
medications as patient’s choice / communication. treatment
prescribed is one point of view even regimen.
of the most if it appears to be
frequent reasons self – destructive,
for recurrence of avoid
psychotic confrontation
symptoms and regarding beliefs.
hospital  Encourage the  In order for the patient
admission. importance of not to manifest behaviors
(Psychiatric complying with or occurrence of illness.
Mental Health medication.
Nursing by Sheila
L Videbeck, page
318)
With regards to
our patient’s
condition, she
demonstrated
occurrence of
schizophrenia due
to failure in
105
taking or
complying
medical regimen.
NURSING CARE PLAN
Age: 42 years old
106
Cues & evidences NURSING NURSING

DIAGNOSIS OBJECTIVES INTERVENTION RATIONALE EVALUATION
Within 4 hours span of  Assess the level of  To identify the alteration Goal Met:
S/O: Disturbed
care, patient will be thinking of the in cognitive functioning
“Sir, naa ka’y thinking process
able to: patient with of the patient. After 4 hours of
dugong “H”?, kana related to
a.) Respond to regards to time, care, patient was able
gud dugong Hero,” mental
reality – based place, and person. to:
as verbalized by disorders
interactions  Orient the patient  To provide information
the patient. secondary to
initiated by the to time, place and and present reality.  Respond to
schizophrenia.
student nurse. person. reality – based
- Has
 Approach the  A clam approach helps interactions
delusional Rationale:
patient is a slow, the patient to avoid initiated by the
thinking Disruption in
calm way when distorting the client’s student nurse.
( neologism) cognitive
communicating. sensory field which
- Inappropriate operations
 Avoid making could promote disturbed
or non – affects the
promises that you thoughts.
reality based physical,
cannot keep.  Because broken promises
thinking. mental,
 Avoid of being reinforce the patient’s
- Confabulation psychological
judgmental or mistrust of others.
and spiritual
making jokes  The patient’s delusions
107
function of a about the patient’s and feelings are not
person beliefs. funny to her. The patient
experiencing may not understand or
this kind of  Give positive may feel rejected by
mental disorder. feedback for the attempts of humor.
patient’s success  Positive feedback for the
or when the patient’s genuine success
patient begins to enhances the patient’s
show or sense of well being and
differentiate helps not to make non-
reality – based and delusional reality.
non – reality based
thoughts and
behaviors.
 Distract the patient
from the delusion
by engaging the  Dwelling on delusional
patient in a less content may increase the
threatening or patient’s anxiety or other
more comforting dysfunctional behavior.
topic.
 Do not argue with
108
the patient or
trying to convince  Because delusional
the patient that the arguments could or
delusions are false might lead to
or unreal. misunderstanding or
interfere with the
development of trust.
109
PROGNOSIS
Criteria Poor Fair Good Ideal Actual

Onset of illness  Onset may be abrupt or The patient was
insidious, but most manifesting behavioral
clients slowly and changes since she was
gradually develop signs working in Manila at the
and symptoms such as age of 29. She is admitted
social withdrawal and first at Mandaluyong and
unusual behavior. Those with unknown diagnosis.
who develop the illness Lasts July 20, 2010 ; 2:00
earlier show worse pm she was admitted at
outcomes than those Davao Mental Hospital
who develop it later. due to violence
(Videbeck, Psychiatric specifically able to fight
Mental Health Nursing, against her neighbor due
2004) to land property and was
diagnosed with
schizophrenia, paranoid.
Duration of  Those that experience a The patient’s duration of

illness gradual onset of the illness is considered poor
disease tend to have since she manifested the
poorer and immediate signs and symptoms of
long term course than schizophrenia such as
those that experience an delusions hallucinations,
acute sudden episode hostility and paranoia
( Psychiatric Mental were observed by her
Health Nursing, 4th employer while working
edition, Chapter 14 by in Makati, Manila at the
Shiela Videbeck, 2008) said age of 29 though had
sought for medical help;.
110
Patient noted to be hostile
able to fight against her
Increasing presence of
neighbor due to land
schizophrenic symptoms
property and became
was presumed to be a
violent. Her brother
poor prognosis (Kaeplan
decides to put Ruby in a
and Saddocks synopsis
rehabilitation center on
of Psychiatry)
July 20, 2010 at Davao
Mental Hospital. After 3
days she was discharged
and functional.
Environment  Based on environmental Ruby together with her

or cultural theory, family lived in a
theorist believe that community housing in
persons who come from Talomo, Davao City The
low socio – economic community was also
areas or single – parent aware of patient’s
homes in deprived areas condition including their
do not have the chance neighbors and friends, and
to experience thus she is considered as a
achievements. (Shives, threat to public safety in
Louise Rebecca the neighborhood. At
Psychiatric Mental present, Ruby is confined
Health Nursing, Page in Davao Mental Hospital
264) where medications are
available. Additionally,
the said institution is a
training ground for student
nurses who offer social
interaction that may
prevent isolation and self
111
– preoccupied. There were
also a proper approach in
giving care and having a
proper guidance in
patients.
Attitude toward  Maintaining the During her admission at

medication and medication regimen is Davao Mental Hospital,
treatment vital to a successful she has good compliance
outcome for client in taking her medications
having schizophrenia. and treatment. After she
Failing to take the was discharged, prescribed
medication regimen is medication was given. In
one of the frequent addition, family support
reasons of the recurrence when it comes to financial
of the illness and aspect is also important to
hospital admission. be emphasized in order for
(Psychiatric Mental the patient to continue to
Health Nursing, 4th comply with medications,
edition, Chapter 14 page because non-compliance
288 by Shiela L. with medications may
Videbeck, 2008). endanger the patient for
relapses.
Antipsychotics are
valuable medications,
but they do not cure
schizophrenia.
(Psychiatric Mental
Health Nursing 3rd
edition, Chapter 13 page
243 by Noreen Cavan
Frisch, 2006)
112
Mood and Affect  Patients with On the course of our
schizophrenia report and exposure at Davao Mental
demonstrate wide Hospital, patient is
variances in mood and attentive and responsive
affect. (Psychiatric during the interaction.
Mental Health Nursing,
4th Edition, Chapter 14
by Shiela Videbeck,
2008)
Family Support  Family is a source of When it comes to financial

social support and also aspect, it is poor because
be a key factor to the they can’t able to sustain
recovery of the patient the medication for the
with the psychiatric patient. But when it comes
illnesses although family to emotional aspect, a
members are not always family member provides
positive resource in enough emotional support
mental health. They by way of visiting her at
often play the most Davao Mental Hospital,
important part. and showing concern and
(Psychiatric Mental acceptance towards the
Health, 4th edition, patient’s condition.
Chapter 14 by Shiela
L.Videbeck, 2008)
Criteria:
Onset of illness - Poor
Duration of illness - Poor
113
Environment - Good
Attitude toward medication and treatment - Good
Mood and Affect - Good
Family Support – Fair
Total:
Poor : 2/6 = 0.33 % x 100 = 33 %
Fair : 1/6 = 0.17 % x 100 = 17 %
Good : 3/6 = 0.5% x 100 = 50 %
In general, having ( 2 ) points for poor prognosis with a percentage of 33 %; ( 1 ) point
for fair prognosis with a percentage of 17% and ( 3 ) points for good prognosis with a
percentage of 50%. Having 50 % as the highest value of good prognosis this means that Ruby is
an indicative of a good outcome for recovery. On the course of our exposure in Davao Mental
Hospital, patient Ruby is complying with medications. Emotional and family support was given.
Additionally, Ruby was responsive and attentive during the interaction. At present, Ruby is
already discharged on July, 23, 2010 with a prescribed medication given.
RECOMMENDATION
114
For the family
1. They must seek education about schizophrenia and undergo counseling.
2. The family members must know how to prevent and manage relapse.
3. They must know the importance of medication in managing symptoms and preventing
recurrence.
4. Family members need ongoing support and evaluation, including reassurance that they
are not the cause of schizophrenia.
5. They must be aware of community support system and self-help groups.
6. They should get involved with group programs pertaining schizophrenia such as
seminars.
7. The family must help client regain with reality by gently introducing conversation or
activities.
8. The family must maintain patient’s medication compliance and following scheduled
check ups.
9. They must know how to formulate realistic goals for the client.
10. The family members should minimize stimulating the patient by avoiding presentations
of stressors.
11. The family members must maintain adequate nutrition and fluids of the client for
physical and emotional wellbeing.
For the community
1. A case manager maybe assigned to the patient to provide assistance in handing the wide
variety of challenges to the patient in community setting
2. Depending on the funding, the patient maybe referred to a social worker or may directly
refer patient to case management services.
115
 Includes assistance with housing and transportation.
 Nursing management.
 Socialization and recreation.
3. Community support program assess the patient’s quality of life to continue monitoring
for planning of care.
For the Patient
1. Watching TV, listening to music, writing are useful to divert her attention from
distressing thoughts.
2. Involve patient to reality-based activity such as playing cards, participating in

occupational therapy, or listening to music.
3. The patient must comply with her medication avoid relapse.
4. Patient must be exposed to opportunities where he can make her own decisions and
experience small successes.
116
Personalities Accurately Judged by Physical Appearance Alone
Science Daily (Dec. 11, 2009)
Observers were able to accurately judge some aspects of a stranger's personality from
looking at photographs, according to a study in the current issue of Personality and Social
Psychology Bulletin (PSBP), the official monthly journal of the Society for Personality and
Social Psychology. Self-esteem, ratings of extraversion and religiosity were correctly judged
from physical appearance
Researchers asked participants to assess the personalities of strangers based first on a
photograph posed to the researchers' specifications and then on a photograph posed the way the
subject chose. Those judgments were then compared with how the person and acquaintances
rated that individual's personality. They found that while both poses provided participants with
accurate cues about personality, the spontaneous pose showed more insight, including about the
subject's agreeableness, emotional stability, openness, likability, and loneliness.
The study suggested that physical appearance alone can send signals about their true
personality.
"As we predicted, physical appearance serves as a channel through which personality is
manifested," write authors Laura P. Naumann, University of California, Berkeley, Simine
Vazire, Washington University in St. Louis, Peter J. Rentfrow, University of Cambridge, Samuel
D. Gosling, University of Texas at Austin. "By using full-body photographs and examining a
broad range of traits, we identified domains of accuracy that have been overlooked, leading to
the conclusion that physical appearance may play a more important role in personality judgment
than previously thought."
117
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials
provided by SAGE Publications, via EurekAlert!, a service of AAAS.
SUMMARY:
The study suggested that Physical Appearance alone can send signals about their
personality. It shows that physical appearance has a basis of what kind of personality you have.
If you’re happy your picture will appear smiling, when you are lovely you appear sad. If you are
hungry your picture will become hostile. If you are eager you become aggressive that shows how
your personality evaluated by your appearance.
As we predicted, physical appearance serves as a chemical through which personality is
manifested. In conclusion physical appearance may play a more important role in personality
judgment than previously thought.
REACTION:
This article described that personality was determined by physical appearance it was a
basis of knowing what kind of personality a person herd. Ive agree about what the another
written on this journal reading because sometimes our facial expression with in show what kind
emotion we felt. And it is said in this article that physical appearance serves as a channel through
which personality is manifested. As a student nurse we should practice to used our clinical eye to
118
assess and to observed what kind of personality a person was experiencing and to know how
does she/he felt for the movement.
119
New Ways To Predict Violent Behavior?
Science Daily (February. 27, 2010)
In the future, diagnosing severe personality disorders, evaluating the childhood
environment, assessing alcohol consumption and the analysis of the MAOA genotype may
provide more accurate means for assessing risk among violent offenders, according to the
Finnish research carried out jointly at the University of Helsinki and the Helsinki University
Central Hospital Psychiatry Centre.
"The many negative effects of violence could be alleviated by improving the accuracy of
predicting violent behavior. Lack of knowledge about the root causes of violence is, however, an
impediment for such predictions," says Roope Tikkanen, MD, who has published his doctoral
dissertation on the subject.
Tikkanen analyzed the risk factors of violent reconvictions and mortality, using research
data collated by Professor Matti Virkkunen based on court-ordered mental status examinations
carried out in Finland during 1990-1998. The majority of the 242 men participating in the study
suffered from alcoholism and severe personality disorders. The control group comprised 1,210
Finnish males matched by sex, age and place of birth. Following a nine-year follow-up period,
the risk analyses were conducted based on criminal register (Legal Register Centre) and
mortality (Statistics Finland) data.
Risk variables used in the analyses were antisocial personality disorder (ASPD),
borderline personality disorder (BPD), the co morbidity of ASPD and BPD, childhood
adversities, alcohol consumption, age, and the monoamine oxidize A (MAOA) genotype. In
120
addition to these factors, the temperament dimensions were also assessed using the
Tridimensional Personality Questionnaire (TPQ).
The prevalence of recidivistic acts of violence (32%) and mortality (16%) was high among the
offenders. Severe personality disorders and childhood adversities increased the risk of recidivism
and mortality both among offenders and in comparison to the controls. Offenders with BPD and
a history of childhood maltreatment stood out as having a particularly poor prognosis.
The MAOA genotype was associated with the effects of alcohol consumption and aging on
recidivism. With high-activity MAOA (MAOA-H) offenders, alcohol consumption and age
affected the risk of violent reconvictions – alcohol increasing it and aging decreasing it – while
with low-activity MAOA (MAOA-L) offenders no such link existed.
The temperament dimensions of offenders included high novelty seeking, high harm avoidance,
and low reward dependence which correspond to the definition of an explosive personality.
"The risks of violent reconvictions and mortality accumulate in clear subgroups of violent
offenders. Diagnosing severe personality disorders, assessing childhood environments and long-
term alcohol consumption, and analyzing the MAOA genotype may be tools that can in the
future be employed in the prevention of recidivism and mortality and improving the accuracy of
risk assessment among offenders," says Tikkanen.
Story Source:
provided by University of Helsinki, via EurekAlert!, a service of AAAS.
121
SUMMARY:
This study reveals how to determine new ways to predict violent behavior one of it was
geno typing. Geno typing may provide more accurate means of assessing risk among violent
offenders. Childhood environment would also vary because child situation in the environment
during childhood will brought up in the future. If she live the kind of environment which is not
good example she will mostly adopt the bad traits. But if she lives in an environment that set
good example will help her to become a good example. The prevalence of recidivistic acts of
violence (32%) and (16%) was high among the offenders. Severe personality disorders and
childhood adversities increased the risk of recivism and morality both among offenders and in
comparison to the controls.
Diagnosing severe personality disorders, assessing childhood environment and long term
alcohol consumption and analyzing the genotype may be tool that can in the future be employed
in the prevention of recidivism and mortality and improving the accuracy of risk assessment
among offenders.
REACTION:
This journal reading shows new ways to predict violent behavior. Evaluating childhood
environment is on of the best factor in assessing violent behavior. In my own opinion what you
see is what you get if you live in good environment you will be good. If you live in unpeaceful
environment you will manifest inappropriate behavior. I also agree that continuation study to this
prediction of future violent behavior will help offenders to prevent and find ways how to prevent
122
it. As a student nurses we are bound to study keenly some personality disorder that will bring
violent to other people. We should render patience like this. Therefore, being violent is not good
that’s why certain studies will help to prevent some of these cases.
123
In Schizophrenia and Bipolar Disorder, Life Is Not Black and White
ScienceDaily (Feb. 23, 2010)
Schizophrenia and bipolar disorder affect tens of millions of individuals around
the world. These disorders have a typical onset in the early twenties and in most cases have a
chronic or recurring course. Neither disorder has an objective biological marker than can be used
to make diagnoses or to guide treatment. Findings in Biological Psychiatry, published by
Elsevier suggest that electroretinography (ERG), a specialized measure of retinal function might
be a useful biomarker of risk for these disorders, and retinal deficits may contribute to the
perceptual problems associated with schizophrenia and bipolar disorder.
Over the past several years, research has suggested that cognitive impairments in
schizophrenia might be linked to early stages of visual perception. This work is now drawing
attention to the function of the retina, the component of the eye that detects light. Within the
retina, rods are light sensors that respond to black and white, but not to color. Rods are
particularly important for maintaining vision under conditions of low light and for detecting
stimuli at the periphery of vision. Cones are light sensors that detect color and perceive stimuli at
the center of vision.
Using ERG, Canadian researchers Marc Hébert, Michel Maziade and their colleagues observed
that the ability of light to activate rods was significantly reduced in currently healthy individuals
who descended from multigenerational families that had members diagnosed with either
schizophrenia or bipolar disorder. In contrast, the response of their cones to light was normal.
"We take for granted that other people experience the world in the same way that we do. It is
important to appreciate that for schizophrenia and bipolar disorder, as for colorblindness or
selective hearing loss, people who appear to perceive the world normally may actually have
124
subtle but important problems with perception, which may contribute to other adaptive
impairments," comments Dr. John Krystal, Editor of Biological Psychiatry.
Scientists are still searching for a valid biomarker for the heritable risk for schizophrenia and
bipolar disorder. Although the current data are interesting, extensive testing is still needed before
the utility of this measure as a risk biomarker can be evaluated.
The article is by Marc Hébert, Anne-Marie Gagné, Marie-Eve Paradis, Valérie Jomphe, Marc-
André Roy, Chantal Mérette, and Michel Maziade. All authors are affiliated with Centre de
recherche Université Laval Robert-Giffard, Québec, Canada. The article appears in Biological
Psychiatry, Volume 67, Issue 3 (February 1, 2010), published by Elsevier.
Story Source:
provided by Elsevier, via EurekAlert!, a service of AAAS.
Journal Reference:
1. M. Hébert, A. Gagné, M. Paradis, V. Jomphe, M. Roy, C. Mérette, M. Maziade. Retinal
Response to Light in Young Nonaffected Offspring at High Genetic Risk of
Neuropsychiatric Brain Disorders. Biological Psychiatry
125
SUMMARY:
Schizophrenia and Bipolar disorder affects ten millions of individuals around the world.
(Elsevier Sluggurt that Eleetroretionography (ERG)). Specialized a measure of retinal function
might be useful biometer of risk for these disorder, and retinal deficits may contribute to the
perceptual problems associated with schizophrenia and Bipolar disorders.
In the past study research suggested that cognitive impairment in schizophrenia might be
linked to early stage of visual perception. It shows that Illusion can affect normal perception. It
alters the state of the mind. Retina plays important role in visual perception and illusion is one of
alteration in retinal function.
REACTION:
Our opinion in this article is lying Electroretinography will help as a biomater of risk for
disorder of perceptual problems such as schizophrenia and Bipolar disorder. Life is not black and
white indeed its just the alteration in perceptual impairment would be the factor for that matter.
126
EVALUATION
General:
The case study provided us a better understanding on schizophrenia, paranoid

type.
Specific: at the end of our case study, we were able to:
•Extended our deepest appreciation on those people who contributed in the completion of
this case presentation.
•We had made an introductory statement about the schizophrenia paranoid type and the
case study.
•We had defined the various terms used in the case study.
•We had gathered necessary information about the patient from her immediate family,
friends and neighbors;
•We had conducted and presented the mental status examination of the patient as well as
his capacity to relate and communicate with student nurses;
•We had identified the predisposing and precipitating factors that contributed to the
condition of the patient;
•We was able to trace the psychodynamics of the case and relate it with Erik Erikson’s
theory of growth and development;
•We had defined in our case presentation the psychiatric management needed by
the patient;
•We had presented a drug study on all medications given to our patient in the case study;
•We had formulated the an appropriate and effective nursing care plans on the identified
problems experience by the patient;
•We had justified the possible prognosis of the patient on the case;
127
BIBLIOGRAPHY
Videbeck, Shiela Psychiatric Mental Health Nursing, 2nd Edition, 2004
Keltner, et. al. Psychiatric Nursing, 3rd Edition, 2002
Cook, J. Sue and Fontaine, Karen Lee Essentials of Mental Health Nursing, 1987
Thompson, et. al. Mosby’s Clinical Nursing, 4TH Edition
Otong, Deborah Psychiatric Nursing Biological and Behavioral Concepts, Thomson Asian
Edition, 2003
Jarvis, C. Physical Examination and Health Assessment, 4th Edition, 2004
Doenges,M. Nursing Care Plans ,11th Edition
Kozier, B. Fundamentals of Nursing, 9th Edition
Saunders, Nursing Drug Handbook, 2007
INTERNET SOURCES:
www.encyclpoedia.com
www.wikipedia.com
www.sciencedaily.com
www.yahoo.com
www.google.com
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Introduction

Paranoid schizophrenia is one of several types of schizophrenia, a mental illness

Its is believed to be widespread with world life prevalence rates estimated to be at

•Extended our deepest appreciation on those people who contributed in the

perceptions, emotions, movements, and behavior.

Hallucinations- false sensory perceptions or perceptual experiences that do not exist in

Delusions- fixed false beliefs no basis in reality.

Apathy- feelings of indifference toward people, activities, events.

Affect-a person’s mood, feelings, or tone observable as an outward manifestation. Often

referred to as emotion. Affect may be referred to as inappropriate, flat or blunted.

facial expression that would indicate emotions or mood.

Blunted Affect - restricted range of emotional feeling tone,or mood.

Inappropriate affect- inconsistency between expression and mood.

one topic to another.

Associative looseness- fragmented or poorly related thoughts or ideas.

Denial- unconscious refusal to face thoughts,feelings,wishes,needs,or reality factors that

are consciously intolerable.

Psychosis-is a disorder in which a person displays more positive signs of

giving birth to a mother

Mania - is a severe medical condition characterized by extremely elevated mood, energy,

unusual thought patterns and sometimes psychosis.

Paranoia - is a thought process characterized by excessive anxiety or fear, often to the

point of irrationalityS and delusion.

Patient’s Code Name: Ruby

Age: 42 years old

Birth date: February 27, 1968

Birth Place: Island Garden City of Samal

Address: Talamo, Davao City

Civil Status: Single

First Admission: 1997 at a Psychiatric institution in Mandaluyong due to

towards her mother

Fifth Admission: July 20, 2010

Reason of Admission: Threat to the community

Date of Discharge: July 23, 2010

Admitting Diagnosis: Schizophrenia Paranoid Type

Attending Physician: Paulo Woodruff A. Gonzales, MD

Date Study Begun: July 21, 2010

Date Study Ended: July 23, 2010

Time Spent in Actual Nursing Care: 3 hours

Time Spent in Home Visit: 2 hours

Source of Information / Informant: Primary source: Ruby

Secondary Sources: Mother

Name: Mother Lily

Age: 68 years old

Address: Talomo, Davao City

Relationship to the patient: Mother

Length of time known to patient: 42years

Personal Background of Informant and Apparent understanding of present illness of

Other characteristics and attitude of the informant:

Age: 29 years old

Address: Talomo, Davao City

Relationship to the patient: Brother

Length of time known to patient: 29 years

Personal Background of Informant and Apparent understanding of present illness of

iyang batasan kay wala naman siya ka inom ug tambal.

provides whatever information related to his sister.

Age: 32 years old

Address: Talomo, Davao City

Relationship to the patient: Brother

Length of time known to patient: 32 years

Personal Background of Informant and Apparent understanding of present illness of

He is approachable, talkative and responsive. He is also very defensive and secretive. He

shows willingness in answering the questions.

Age: 26 years old