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SCHIZOPRE NIA A Case Study In Fulfillment of Requirements In Related Learning Experience 105 For the Bachelor of Science in Nursing
Rivera, Anne Mayelle E. Villanueva, Deborah V. Villas, Joyceline S.
Submitted to: Dr. Michael B. Espinosa Clinical Instructor
CHAPTER 1 INTRODUCTION
Schizophrenia is an extremely complex mental disorder: in fact it is probably many illnesses masquerading as one. A biochemical imbalance in the brain is believed to cause symptoms. Recent research reveals that schizophrenia may be a result of faulty neuronal development in the fetal brain, which develops into full-blown illness in late adolescence or early adulthood. Schizop Schizophre hrenia nia causes causes distorte distorted d and bizarre bizarre thought thoughts, s, percept perceptions ions emotions emotions
CHAPTER II CLINICAL SUMMARY A. GENERAL DATA Name: Marlene Millebo A.K.A. “UW” Marlene Gender: Female Age: 28 years old Address: B19, L3, Phase 5, Bagong Silang, Kalookan City
Case of “UW” Marlyn , female, referred by Social Worker of NCMH Camarin Extension in Caloocan City on March 28, 2011. The patient came in escorted as she was noted loitering in Camarin extension for a month now. She was being fed during mealtime, she established involuntary attempts were due to locate her family but to no avail. Until 1 week PTA, she became descriptive with shouting spells. She ruled on the street and tried to hunt herself. She was apprehended/resumed and was brought to a center.
D. PAST MEDICAL HISTORY Unknown E. FAMILIAL HISTORY Unknown F. SOURCE OF RELIABILITY OF INFORMATION The major source of information was the patient. Further information was obtained from the patient’s record. Other was based on short and simple assessment done by the student nurses. G. REASON FOR SEEKING CARE The patient was admitted at the National Center for Mental Health with Chief
HEAD - shape
Inspection and palpation
HAIR -color -oiliness •
EYES -eyebrows eyelashes
-symmetrical round -smooth control movements -hard -black
-eyebrows are symmetric in shape -eyelashes are contributed and curled outward
-round -IRIS AND PUPIL -black -shape -color of iris EARS Inspection and -normal shape -external ears -skin, smooth and -lesions and palpation no lesion discoloration MOUTH Inspection -red -lips
FUNCTIONAL HEALTH PROBLEM
Health perception health management pattern
Nutritional and Metabolic Pattern
PRIOR TO HOSPITALIZATION
DURING HOSPITALIZATION (Pre-operative)
ANALYSIS & INTERPRETATION
The patient sees her health pattern as normal as she suffered from no serious illness before. Whenever she feels pain or something uncommon, she usually takes drugs and consults a physician.
The patient denied that she has illness.
Prior and during hospitalization, the client sees herself as a healthy person.
The patient stated that she eats 3 times a day and is also fond of eating sweet foods. She likes having meat, fish and vegetables on her meals and she claimed that she has no allergies on foods and drugs. She also stated that she has a good appetite and was able to eat foods that are being served at
The patient stated that she eats all foods that are being served to them. She also stated that she can consume 23 cups of rice per meal and eats 3 times a day with merienda given by
Prior to hospitalization, the patient seems to have a good appetite but have a high amount of sweet food intake . During hospitalization, there were inadequacy on her nutritional and metabolic pattern due to the limited
given by the student nurses.
Sleep and Rest pattern
Self Perceptual/Self -Concern Pattern
The patient stated that she usually wakes up at 7:00 am and sleeps at 9:00 pm.
The patient stated that she has adapted her sleeping pattern to the activities in the hospital. She usually wakes up at 5:00 am to wash clothes and clean their hallway and sleeps at 8:00 pm.
The patient had changes in her sleeping pattern during hospitalization.
The patient stated that she has a good vision, hearing and she was able to smell, taste and touch. She also claimed that she can communicate appropriately.
The patient claimed that she understands what the nurses and doctors are asking of her to do.
During hospitalization, though there is no alteration on patient’s five senses and she felt nothing has changed.
The patient perceives her self as a believer of God but didn’t recall any feelings toward her family.
Patient claims that she still a believer of God and now misses her family.
Prior and during hospitalization, the patient’s perception regarding her self changed and missing her family caused her anxiety.
Coping/Stress Tolerance Pattern
The patient claimed that she doesn’t have problems in dealing with stress.
The patient stated that she is a Roman Catholic. She has a strong faith in God and their whole family usually goes to church during Sundays.
The patient verbalized that she copes up with the situation. Still, she exclaimed that she is sometimes feeling anxious about her family’s whereabouts
The patient stated that she knows God and sometimes Priest visits them and that’s the only time they were able to attend mass.
J. LABORATORY AND DIAGNOSTIC EXAM December 22, 2011 Urinalysis Protein RBC
Positive (++) 2-4/hpf
The patient claims she has a good stress coping pattern but experiences anxiety about her family.
Prior and during hospitalization, the patient knows God and still practices praying when asked by the situation like every before meal.
Sodium, Potassium and Lithium are all normal
April 11, 2011 Blood Chemistry Examination Glucose, BUN, Creatinine, Uric Acid , SGPT (ALT), SGOT are all normal
January 09, 2012 Urinalysis Color Transparency Specific Gravity Ph Protein Sugar
of visceral efferent and afferent nerve fibers as well as autonomic and sensory ganglia. B. The brain is covered by three membranes. 1. The dura matter is a fibrous, connective tissue structure containing several blood vessels. 2. The arachnoid membrane is a delicate serous membrane. 3. The pia matter is a vascular membrane. C. The spinal cord extends from the medulla oblongata to the lower border of the first lumbar vertebrae. It contains millions of nerve fibers, and it consists of 31 nerves – 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral. D. Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia matter. It flows through the foramen of Monro into to the third ventricle, then through the aqueduct of Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen of Magendie and the two foramens of Luska. It then flows into the cistema magna, and finally it circulates to the subarachnoid space of the spinal cord, bathing both the brain and the spinal cord. Fluid is absorbed by the arachnoid membrane.
A. CNS 1. Brain a The cerebrum is the center for consciousness, thought, memory, sensory input, and motor activity; it consists of two hemispheres (left and right) and four lobes, each with specific functions. i The frontal lob controls voluntar
nts and contains
iii The parietal lobe coordinates and interprets sensory information from the opposite side of the body. iv The occipital lobe interprets visual stimuli. b The thalamus further organizes cerebral function by transmitting impulses to and from the cerebrum. It also is responsible for primitive emotional responses, such as fear, and for distinguishing between pleasant and unpleasant stimuli. c Lying beneath the thalamus, the hypothalamus is an automatic center that regulates blood pressure, temperature, libido, appetite, breathing, sleeping patterns, and peripheral nerve discharges associated with certain behavior and emotional expression. It also helps control pituitary secretion and stress reactions. d The cerebellum or hindbrain, controls smooth muscle movements, coordinates sensory impulses with muscle activity, and maintains muscle tone and equilibrium.
C. The ANS regulates body functions such as digestion, respiration, and cardiovascular function. Supervised chiefly by the hypothalamus, the ANS contains two divisions. 1. The sympathetic nervous system serves as an emergency preparedness system, the “flight-for-fight” response. Sympathetic impulses increase greatly when the body is under physical or emotional stress causing bronchiole dilation, dilation of the heart and voluntary muscle blood vessels, stronger and faster heart contractions, peripheral blood vessel constriction, decreased peristalsis, and increased perspiration. Sympathetic stimuli are mediated by norepinephrine. 2. The parasympathetic nervous system is the dominant controller for most visceral effectors for most of the time. Parasympathetic impulses are mediated by acetylcholine. III. Differences in nervous system response . The nervous system is one of the first systems to form in utero, but one of the last systems to develop during childhood. A. Accuracy and completeness of the neurologic assessment is limited by the child’s development. B. The child’s brain constantly undergoes organization in function and myelinization. Therefore, the full impact of insult may not be immediately apparent and may take years to manifest. C. The peripheral nerves are not fully myelinated at birth. As myelinization
D. Discharge Planning
Inform the family of the patient to always orient the patient to time, place, date and current events
Inform the family of the patient to use therapeutic communication while talking to the patient
Inform the family of the patient to do different therapeutic activity like occupational, remotivational, movie analysis and health teaching.
Inform the family of the client that good communication is a big contributing factor for the recovery of the patient.
Out-patient follow up
Inform the family of the client that the appointment or follow up with the psychiatrist is very much needed for the patient with schizophrenia to promote continues recovery
Advise the family of the client to go back to hospital If they observe any unnecessary action of the patient aside from the one explained by the psychiatrist.
B. Drug Study drug halope ridol
dosage 10 mg
action -Alters the effects of dopamine in the CNS -Also has anticholinergic and alphaadrenergic blocking activity. -Diminished signs and symptoms of psychoses
Nursing responsibilities • Assess mental status prior to and periodically during therapy. • Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May cause QT interval changes on ECG. • Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded. •Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration. • Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control. Report symptoms immediately. May also cause leukocytosis, elevated liver function tests, elevated CPK. • Advise patient to take medication as directed. Take missed doses as soon as remembered, witih remaining doses evenly spaced through out the day. May require several weeks to obtain desired effects. Do not increase dose or discontinue medication without consulting health care
professional. Abrupt withdrawal may cause dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled movements of mouth, tongue or jaw.
drug Bi pe riden
dosage 2 mg
classification Anticholinegic drug
action Synthetic anticholinergic drug, blocks cholinergic responses in the CNS.
indication Parkinsonian syndrome especially to counteract muscular rigidity and tremor; extrapyramidal symptoms.
contraindication Untreated narrow angle glaucoma, intestinal stenosis or obstruction, mega colon, prostatic hypertrophy, life threatening tachycardia.
Nursing responsibilities -Assess for Parkinsonism, EPS. -Assess for mental Status . -Assess patient response if anticholinergics are given. -Assess for tolerance over long term therapy, dosage may have to be increased or changed . -Avoid activities that require alertness, may cause dizziness, drowsiness and blurring of vision.
dosage 50 mg
Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine
parkinsonism or druginduced extrapyramidal effects
contraindication -cardiac disease or hypertension -glaucoma - gastric or duodenal ulcers
Nursing responsibilities • Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness. • Tell the client to take the medication with food to decrease GI upset. • Explain to the client that arising quickly form a lying or sitting position may cause orthostatic hypotension. • When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored. • Adverse effects of these drugs occur more commonly in elderly clients. • Explain to the client that use of these drugs in warm weather may increase the likelihood of heatstroke.
dosage 100 mg
action •-Block dopamine receptors in the brain; also alter dopamine release and turnover. -Prevention of seizures
-Acute and chronic psychoses, particularly when accompanied by increased psychomotor activity. Nausea and vomiting.
-Also used in the treatment of intractable hiccups
-Cross-sensitivity may exist among phenothiazines. Should not be used in narrowangle glaucoma. -Should not be used in patients who have CNS depression.
Nursing responsibilities • Assess mental status prior to and periodically during therapy. • Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May cause QT interval changes on ECG. • Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded. •Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration. • Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control. Report