1 Notre Dame University

GRADUATE SCHOOL
Cotabato City

A Written Report in Advanced Psychiatric Nursing

A Case Study Presented to

The Faculty of the Graduate School

Of Notre Dame University, Cotabato City

In Partial Fulfillment

Of the Requirement for the Degree

Masters of Arts in Nursing

Submitted to:

Agripino N. Agulo Jr., RN, MAN

Submitted by:

Dave C. del Rosario, RN

 CASE STUDY #1

Jovan was one of the newly recruited members of the bodyguards of one
of the most influential politicians in Mindanao. One night, he was asked by his
commander to accompany them in a business meeting for the politician. When
they were in the site, which is peculiarly remote, he saw two men bound in ropes,
bleeding and pleading for their lives. They were surrounded by paramilitias like
him. The commander ordered him to kill the captives. Fearing for his own life,
he executed the order of the commander.
His life went by without any incident. He removed that horrifying
experience from his mind and went on with his life. He was able to marry and
open a small store. He planned to have a big family someday.
One night, he noticed a commotion outside his house and heard gun fire.
Everything came back to him at once. He was found by his wife trembling and
crying. Nightmares and flashbacks keep hounding him each day. He became very
agitated and he verbalized his anger and the loss of his will to live. Fearing for
what might happen to her husband, his wife sought the help of a professional
and her husband was diagnosed to have PTSD.
 TREATMENT PLAN

POST-TRAUMATIC STRESS DISORDER

Post-traumatic stress disorder (PTSD) is a mental health condition that's

triggered by a terrifying event, either experiencing it or witnessing it. Symptoms
may include flashbacks, nightmares and severe anxiety, as well as
uncontrollable thoughts about the event.
Most people who go through traumatic events may have temporary
difficulty adjusting and coping, but with time and good self-care, they usually
get better. If the symptoms get worse, last for months or even years, and interfere
with your day-to-day functioning, you may have PTSD.

Signs and Symptoms (as manifested by the patient)

 Trembling
 Crying
 Nightmares
 Flashbacks (Reliving the traumatic event as if it were happening again)
 Very agitated
 Verbalized anger
 Loss of his will to live
 Severe emotional distress or physical reactions
Long-term Goals

 Helping you think better about yourself, others and the world

 Learning ways to cope if any symptoms arise again

 Treating other problems often related to traumatic experiences, such as

depression, anxiety, or misuse of alcohol or drugs

 Develop stress management skills to help you better handle stressful

situations and cope with stress in your life.

 Restore your self-esteem

 Use relaxation and anger-control skills

 Help identify and deal with guilt, shame, and other feelings about the
event

Short-term Goals

 Reduce stress and worry

 Break up large tasks into small ones, set some priorities and do what you
can as you can
 Spend time with other people
 Seek out comforting situations, places and people
 Provide tips for better sleep, diet and exercise habits
Short term Goals and objectives Interventions
1. Increased understanding of  Help them to identify cues and
PTSD (psycho-education) symptoms that he is experiencing
 Develop a short-term action plan for
dealing PTSD
2. Identify issues of PTSD from the  Exposure therapy to address current
past and resolve or let go symptoms (intrusive thoughts,
flashbacks and nightmares
 Coping skills (sleep disturbances)
 Cognitive restructuring ( irritability,
angry outbursts)
3. Correct irrational thinking  Help them to identify and address
which leads to PTSD and specific areas of cognitive distortion
interpersonal problems  Challenge irrational thoughts with
reality
 Use positive thinking and self-talk for
dealing with anticipated problems or
when confronting stressors
4. Effectively manage anxiety and  Help learn coping techniques to reduce
stress PTSD and prepare to handle future
stressful situations.
 Help reduce risk of accidental
exposure to specific triggers and
stressors.
 CASE STUDY #2
Bill Waters was a 48-year-old house painter. He was an alcoholic and,
although he was not as productive as he had been in years past, he still made a
good living until recently. In the last 6 months, his alcoholism began to have
more of an effect on his work. He lost one important job because he was unable
to meet the deadlines he had established. His home life had been dysfunctional
for years. Weekends were only a blur, because he drank beer continuously and
watched television. His wife Wanda made sure that the bills were paid and took
care of all the children’s needs. Bill never interfered but would occasionally spend
money on alcohol before Wanda was able to pay a bill.

In recent years however, Wanda had caught on to all of Bill’s tricks and he
rarely had an opportunity to spend household money. When Bill was too
hangover to go to work. Wanda called and made up the excuses. Wanda covered
for Bill at church and in other situations in which his heavy drinking would be
an embarrassment. Wanda alternated between protecting Bill and blaming him.
Her life now revolved around Bill and his problems. After Bill lost an important
painting contract. Wanda insisted on treatment. Bill attended a 6-week inpatient
treatment program. On his return, Bill was ready to re-establish himself as the
husband and father, but Wanda was not ready to trust him in essence, what
happened, and what happens in many families such as these, is that Wanda had
to take over responsibilities of making decisions, and she was not willing to give
them up without long-term proof of Bill’s sobriety and responsibilities. He had
promised to stay sober many times before and failed. Bill, on the other hand,
had a clear head for a change and wanted to be the “man of the house” again’.
Although neither Bill nor Wanda was able to articulate the new problems with
which they were struggling, they did recognize emotions that they were unable
to control. Bill and Wanda soon divorced. A marriage that was able to withstand
alcoholism was not able to withstand recovery.
 TREATMENT PLAN

ALCOHOLISM

Abusers are typically heavy drinkers who continue drinking regardless of

the results.
Alcohol can be an addictive substance. Not everyone who consumes
alcohol will become addicted. However, certain people may be more susceptible
to addiction.
It should be noted that alcohol addiction and abuse are not the same. It's
important to understand the facts on alcohol abuse. Alcohol addiction refers to
a psychological dependence on alcohol that involves continued, compulsive
drinking that does not stop despite adverse consequences.2 Individuals who
suffer from alcohol addiction also become physically dependent on the
substance and experience severe, sometimes life-threatening, withdrawal
symptoms upon quitting.

Signs and Symptoms (as manifested by the patient)

 Neglecting personal/family responsibilities

 Conflicts with loved ones (wife)
 Failing in attempts to stop drinking
 Declining academic or professional performance
 Inability to control drinking.
Long-term Goals

 Helps an individual, especially someone in addiction recovery,

understand that he or she is good enough and strong enough to fight
and overcome addiction.
 Self-confidence leads to laying a solid foundation that those in recovery
can grow and build upon.

 Goals keep those in addiction recovery on track to remain focused on

what they want out of life.

Short-term Goals

 Restore positive relationships.

 Commit to one positive action each day
 Reducing intake of alcohol per day (detoxification)
 Try new things (Being willing and open to trying new things will help you
find a new hobby – or reignite passion for an old one)
Short term Goals and objectives
1. Encourage a reduction or
cessation of alcohol intake
2. Enhance patient engagement,
including approaches to
overcome alcohol abuse
3. Develop healthy habits
4. Begin to resolve family conflict
Interventions
 Empower family and close friends to
reduce availability of alcohol and to
encourage further engagement with
clinicians able to help with
 Engage psychosocial supports (‘meals
on wheels’, welfare, employment
support, community and religious
networks, financial or relationship
counselling) to reduce personal
 Regular physical activity, managing
stress more effectively and eating well
all can make it easier for you to
recover from alcohol use disorder.
 Motivational interviewing and cbt;
assist client with expanding social
support that includes non using
friends.