Comprehensive Study

of

Paranoid Schizophrenia

Submitted by:

Lazarte, Mary Rose

Libarnes, Noemibelle

Lim, Ludivina

Lingad, Patricia Shane

Lingad, Diovi Alyssa

Ludovico, Aira Joy

Macalinao, Rence Maricon

Macalinao, May Ann

Macaraeg, May

Martinez, Sheila Mae

Venturina, Lloribel

Magallanes, Mc Charles

Malanum, Jeffry

Malanum, Sergio Paolo

1

Group P

Submitted to:

Nemia de Leon-Calimbas, RN MAN

Clinical Instructor

Acknowledgement

We would like to extend our deepest gratitude to all those who made this

Comprehensive Case Study possible.

First and foremost, to our almighty God, for the spiritual guidance and blessing

given to us for the whole exposure to the institution. Every task and conflict faced is

treated with gratitude as it strengthen our faith and self-concept.

Second, to our beloved and hardworking parents, for the financial needs and

unconditional love. The continuous support and encouragement given served as

inspirations and motivation directed towards achieving the goals and objectives to the

exposure.

Third, to our very energetic and enthusiastic Clinical Instructors, Ma’am Nemia

D. Calimbas, Sir Ronald Tyron dela Rosa and Sir Irish Flores. Thank you for knowledge,

guidance, enthusiasm and patience you have given during our duty at Mariveles Mental

Hospital.

Fourth, to all the staffs of Mariveles Mental Ward, for the warm welcome and

accommodation during our duty. We thank the institute for allowing the group to

maximize their facilities.

Lastly, to our patients especially Mr. A.C.T. for cooperating with us while we

were having a daily conversation to get all the necessary data we needed on our case

study.

Thank you very much and God bless!!!

Dedication

We would like to dedicate this Comprehensive Case Study to our energetic,

bubbly, enthusiastic, and smart Clinical Instructor Ma’am Nemia D. Calimbas, RN,MAN

for her willingness to impart her knowledge to us .To Sir Ronald Tyron dela

Rosa,RN,MAN for his humor, workmanship and simple jokes that made us enjoy and

learn so much. To Sir Irish Flores, RN who supervised us in our duty at Mariveles Mental

Ward. We will owe you a lot for this and we will never forget our mentors who broaden

our knowledge in psychiatric nursing and inspired us to become successful registered

nurses in the near future.

TABLE OF CONTENTS

Acknowledgement

Dedication

Table of Contents

UNIT 1 …………………………………………………………….

Introduction

Personal Data

Chief Complaints

History of present Illness

Past Personal History

Family History

UNIT 2 ……………………………………………………………

Mental Status Assessment/ Analysis and Interpretation

UNIT 3 …………………………………………………………….

Psychopathology

Related Literature and Studies

UNIT 4 …………………………………………………………….

Nursing Care Plans

Pharmacology

UNIT 5 ……………………………………………………………

Psychotherapy

UNIT 6 ……………………………………………………………

Glossary

UNIT 7 ……………………………………………………………

References

UNIT 8 …………………………………………………………….

Documentation

UNIT 1

Introduction

Paranoid schizophrenia is the most common type of schizophrenia in most parts

of the world. The clinical picture is dominated by relatively stable, often paranoid,

delusions, usually accompanied by hallucinations, particularly of the auditory variety,

and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic

symptoms, are not prominent.

With paranoid schizophrenia, your ability to think and function in daily life may

be better than with other types of schizophrenia. You may not have as many problems

with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious,

lifelong condition that can lead to many complications, including suicidal behavior.

(http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862)

Patients who have paranoid schizophrenia that has thought disorder may be

obvious in acute states, but if so it does not prevent the typical delusions or hallucinations

from being described clearly. 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 course of paranoid schizophrenia may be episodic, with partial or complete

remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is

difficult to distinguish discrete episodes. The onset tends to be later than in the

hebephrenic and catatonic forms. (http://www.schizophrenia.com/szparanoid.htm)

According to the World Health Organization, It describes statistics about mental

disorders of year (2008). Schizophrenia is a severe form of mental illness affecting about

7 per thousand of the adult population, mostly in the age group 15-35 years. Though the

incidence is low (3-10,000), the prevalence is high due to chronicity. According to the

facts it reveals Schizophrenia affects about 24 million people worldwide. Schizophrenia

is a treatable disorder, treatment being more effective in its initial stages. More than 50%

of persons with schizophrenia are not receiving appropriate care.90% of people with

untreated schizophrenia are in developing countries. Care of persons with schizophrenia

can be provided at community level, with active family and community involvement.

Schizophrenia affects men and women with equal frequency. Schizophrenia often

first appears in men in their late teens or early twenties. In contrast, women are generally

affected in their twenties or early thirties.

In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical

Manual of Mental Disorders, fourth edition (DSM-IV).

(http://www.howstuffworks.com/framed.htm?parent=schizophrenia.htm&url=http://

www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-

america.shtml)

In the Philippine setting, the disability survey done in 2000 by the National

Statistics Office (NSO) found out that mental illness was the 3rd most common form of

disability in the country. The prevalence rate of mental disorders was 88 cases per

100,000 population and was highest among the elderly group. This finding was supported

by a more recent data from the Social Weather Station Survey commissioned by DOH in

2004. It reveals that 0.7 percent of the total households have a family member afflicted

with mental disability. The Baseline Survey for the National Objectives for Health in

2000 stated that the more frequently reported symptoms of an underlying mental health

problem were sadness, confusion, forgetfulness, no control over the use of cigarettes and

alcohol, and delusions.

The most recent study on the prevalence of mental health problems was

conducted by the National Epidemiology Center (DOH-NEC) in 2006 which showed

revealing results though the target population was limited only to government employees

from the 20 national agencies in Metro Manila. Among 327 respondents, 32 percent were

found to have experienced a mental health problem at least once in their lifetime. The

three most prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%),

depression and schizophrenia (6%). Mental health problems were significantly associated

with the following respondent characteristics: ages 20-29 years, those who have big

families, and those who had low educational attainment. The prevalence rate generated

from the survey was much higher than those that were previously reported by 17 percent

(www.doh.gov.ph).

Currently, there is no method for preventing schizophrenia and there is no cure.

Minimizing the impact of disease depends mainly on early diagnosis and, appropriate

pharmacological and psycho-social treatments. Hospitalization may be required to

stabilize ill persons during an acute episode. The need for hospitalization will depend on

the severity of the episode. Mild or moderate episodes may be appropriately addressed by

intense outpatient treatment. A person with schizophrenia should leave the hospital or

outpatient facility with a treatment plan that will minimize symptoms and maximize

quality of life.

This introduced psychiatric case was chosen primarily because it is the most

interesting amongst the cases that were encountered by the group members. It posts

relevant manifestations that are psychiatric in nature and the entire case is highly possible

to be studied comprehensively within the limited time available.

Personal Data

Name : Mr. A. T.

Address : Arayat, Pampanga

Civil Status : Single

Birth Date : December 24, 1956

Father : Gonzalo Tungol (deceased)

Mother : Lourdes Tungol

Highest Educational Attainment : Second year high school

Admission : October 19, 2009

Physician Attended : Dr. Reyes

Date Furnished by : Merlinda Bernandino

Chief Complaints

Sleepless

Talkative

Refused Medication

Broke glasses and plates

Health History

a. Past Health History

Client was discharged from MMH last January 2009. He refused to report

for check up and refused to the medicines. He threw his medications but this was

tolerated by his family.

By March 5, 2009, his elderly mother passed away due to medical

condition of heart disease which was blamed to patient’s condition. Patient’s

condition worsens and he was noted to talked aloud and speak as is talking to

someone. He was also noted to become irritable and potentially harmful. He was

placed in jail and referred here at MMH for evaluation and management. He had 5

previous admissions at MMH. The last time was from May 20-August 25, 2009.

Two days after his discharge, he was noted to have shallow sleep and was caught

hoarding the medication.

b. Present Health History

Based from client’s chart, he smoked heavily and would harm his siblings

who refused to give him cigarette. He refused to have followed up check-ups at

JBL.

He walked aimlessly even at night and was tolerated as the family are

afraid at him. One week, he rushed stairs at neighbors prompting the family to

bring him for evaluation in management.

On the first day of handling our client he looked depressed but it doesn’t

show because he always smiled at us and seemed to be ok. He didn’t show signs

and symptoms of mental illness but when we talked to him you’ll see that there’s

a problem with him. Based on his statements, he always utter events that are

impossible to happen such “Uulan ng apoy sa Pebrero 21 taong 2030”,

“Mabubuhay ulit ang mga magulang ko makalipas ang 2 taon”, “May nakikita

akong mga taong nakatira sa araw”.

Based on the chart:

General appearance, behavior and attitude: Adult, male

Mood and Affect: Congruent, poor grooming

Stream of Talk: Congruent

Content of thought: Responsive to irrelevant ideas

Assessment: Paranoid Schizophrenia

c. Family History

According to him, the client belongs to low socio economic status. They

have no any properties but lives through plowing vegetables such as eggplant,

carrots and etc.

According to his sister, they have a history of mental illnesses and five of

his siblings are also suffering from the said condition.

d. Social History

a. Childhood

The client is the eldest from the eleven siblings of Mr. Gonzalo

Tungol and Mrs. Lourdes Tungol. Since he was a child he is fond of

plowing vegetables, and seems to be contented with what they have. On

his elementary days, he was an active student in their class. He always

participates in class activities.

b. Adolescence

According to him, he started smoking and drinking emperador in

his teen age life. He verbalized that he always treats his friends when they

go outside for fun. There came a time that his friends left him because his

friends envied him.

c. Adulthood

According to him, he worked at Manila as a helper and then he was

lucky to have an opportunity to work abroad at the age of 22 at Saudi

Arabia for 3 years. Upon his return he managed to buy a karaoke for his

girlfriend and tricycle for his family also a 45 days chicken for his mother.

He also verbalized that he was hit by a jeep and he blamed his cousin for

this incident.

e. Sexual History

Upon interview, the client verbalized that he feels disappointed of

not having family but then he got contented for taking care of his nephews

but if he will be given a chance to have a family, he will be prefer to have

a small family with a loving wife. For him having a wealthy family is not

important but for him what important is having a happy and loving family.

UNIT III

Psychopathophysiology of Paranoid Schizophrenia

Death of a Loved One

Denial and depression

Need for love and belongingness

Grieving

Disruption of Self-Concept and Physiologic Functioning

In relation to Dorothy Johnson’s Behavioral System Model, individuals maintain

stability and balance through adjustments and adaptation to the forces that interferes

them. Death is an inevitable part of life. But those left behind undergoes a long and

complex process of grieving and coping. In the process of grieving, the individual needs

love and belongingness primarily from the family and friends who will support and guide

him. And if unmet, denial and depression will develop and prevent the individual from

dealing with the loss. Instead of acceptance and full recovery to physiologic function, the

self-concept of the individual is disrupted leading to different physiologic, social,

emotional and even mental conditions. It is by these coping mechanisms that the

individual may go back to normal functioning and without these; one may not be able to

accept the loss, move on and go back to reality.

In line with this, Nancy Roper, WW. Logan and A.J. Tierney’s Model for Nursing

based on a model of living explains that most individuals experience significant life

events which can affect activities of living causing actual and potential problems. Similar

to the case of the client, he experienced death of a loved one which primarily caused his

readmission to the institute. The event affected his independence towards living. The

individual became reliant to family and friends. And when his needs were unmet, his

activities of living were malformed thus disrupting his self-concept. Here is where the

nursing profession comes in, nursing helps to maintain the individuality of person by

preventing potential problems, solving actual problems and helping to cope.

Psychopathophysiology of Paranoid Schizophrenia

Separation from Family

Need for love and belongingness

Unsuccessful relationship with the opposite sex

Seeking for secondary sources

Development of depression and feeling of not wanted

Denial, confusion and self-pity

Psychopathophysiology of Paranoid Schizophrenia

Death of a Loved One

Family placed blame on client

Denial and depression

Having hallucinations of talking to someone

Withdrawal and detachment to society

Psychopathophysiology of Paranoid Schizophrenia

Maslow's hierarchy of needs is predetermined in order of importance. It is often

depicted as a pyramid consisting of five levels: the first lower level is being associated

with physiological needs, while the top levels are termed growth needs associated with

psychological needs. Deficiency needs must be met first. Once these are met, seeking to

satisfy growth needs drives personal growth. The higher needs in this hierarchy only

come into focus when the lower needs in the pyramid are met. Once an individual has

moved upwards to the next level, needs in the lower level will no longer be prioritized. If

Low-Socioeconomic Status

Deficiency in meeting sufficient needs and maintaining health

Limited access to health care

Disruption of health status

Alteration in physiologic function

Ineffective coping mechanisms

a lower set of needs is no longer being met, the individual will temporarily re-prioritize

those needs by focusing attention on the unfulfilled needs, but will not permanently

regress to the lower level.

According to Sister Callista Roy’s Adaptation Model, an individual is a

biopsychosocial adaptive system within an environment. In the client’s case, the need for

love and belongingness is not achieved, so he resorted to seek for alternative resources

such as having a relationship with the opposite sex. Whenever a need is unmet, an

individual adapts to the deprived environment so as to meet the needs in other means.

The client needs to have a positive self-concept and self-awareness in order to be fully

functional and productive.

Psychopathophysiology of Paranoid Schizophrenia

Low Educational Attainment

Minimal exposure to society(peers and student body)

Limited development of physiologic capability, problem solving skills and social skills

Ineffective coping strategies and maladaptation

Alteration to Self-Concept

Self-Inferiority

Neuman sees health as being equated with wellness. She defines health/wellness

as "the condition in which all parts and subparts (variables) are in harmony with the

whole of the client (Neuman, 1995)". As the person is in a constant interaction with the

environment, the state of wellness (and by implication any other state) is in dynamic

equilibrium, rather than in any kind of steady state. Neuman proposes a wellness-illness

continuum, with the person's position on that continuum being influenced by their

interaction with the variables and the stressors they encounter. The client system moves

toward illness and death when more energy is needed than is available. The client system

moves toward wellness when more energy is available than is needed. Since the client

has minimal exposure to the society, using Neuman’s theory, this could explain why the

client has become ill.

According to Roy’s Adaptation Model, adaptive responses promotes integrity in

terms of the goals of the human system, that is, survival, growth, reproduction, mastery,

and personal and environmental transformation. In this case, if the client would adapt

physically, emotionally, psychologically and socially, then there is a possibility that the

client would attain wellness.

Related Literatures and Studies

Perspectives of Mental Illness Vary With Cultural Backgrounds?

Recently, treatment of mental illness has shifted toward a collaborative effort

between patient and practitioner. As a result, the understanding of a patient's perspective

on his or her illness is essential to treatment. The study attempts to understand the

different cultural backgrounds of patients and how they influence their unique

perspectives of their illnesses. The goal is to aid the treatment of mental illness through a

deeper understanding of patients and their diverse cultural backgrounds.

I agree to this study because it is vital to understand the client as an individual, a

member of the society and a rational human being. There are different predisposing

factors towards development of any mental illness, paranoid schizophrenia for example.

In order to maintain and control an illness, the risk factors and stimulus must be removed

the system to allow rehabilitation and development of self-concept and function.

It is important to have this kind of studies in order to correct, support and provide

information from the previous studies. Also, this improvement in the recent studies

proves that there are other ways to treat and evaluate mental illnesses.

Schizophrenia Risk Genes Affect Even Healthy Individuals

Dr. Stefanis, explaining the importance of this study, comments that "these

findings support the notion that even at the general population level, the genetic liability

to psychosis may be expressed as minute and 'undetected to the naked eye' alterations in

brain information processing capacity and behavior." Dr. Krystal adds, "Consistent with a

growing body of evidence, this study suggests that there may be subtle cognitive

impairments that are present when these common risk gene variants are present in the

general population." Clearly, these findings will have an important impact on the future

genetic work in this area.

I agree to this study since heredity and genetics served as primary risk factors.

There are conditions like mental illnesses that occur physiologically. This study is

important in order to assess and estimate the number of population at risk of developing

the said condition. Also, there has been past studies proving the relation of genetics to the

development of the illness and this study would prove it, increasing the chance of

developing managements and treatment even prevention of acquiring the condition which

is a huge help to the nursing profession whereas, prevention of illnesses and promotion of

health is the main goal.

Schizophrenia

Schizophrenia is a chronic, severe and disabling brain disease. Approximately 1

percent of the population develops the condition during their lifetime. People with

schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard

by others, or believing that other people are reading their minds, controlling their

thoughts, or plotting to harm them. These symptoms may leave them fearful and

withdrawn. Their speech and behaviour can be so disorganized that they may be

incomprehensible or frightening to others. This is a time of hope for people with

schizophrenia and their families.

In my opinion, many studies have been done to uplift the treatment and the

process of rehabilitation. However, the individual with schizophrenia on continuous or

recurring pattern of illness often does not fully recover normal function and typically

requires long-term treatment, generally including medication, to control the symptoms.

There are many researches that are gradually leading to new and safer medication

and unravelling the complex causes of the disease. Methods of imaging the brain’s

structures and function hold the promise of new insights into the disorder. This is

important to the nurse’s profession in order to understand in detail the condition and be

able to give appropriate management towards rehabilitation.

Fish Oil as a Preventive Medication to Schizophrenia

The study is about the beneficial effects of Fish Oil to the prevention of the

condition in those at risk to mind altering disease. The study was a randomized control

trial conducted on Australia to those who had experienced brief hallucination/ delusions

between the ages of 15 and 25 years old. For three months period, one half of the group

received approximately 1.5 grams of a fish oil capsule while the remaining members

received placebo.

I do agree with the said research since upon researches and experiments done. It

finds out that fish oil have higher tendency of preventing mental illness specifically

schizophrenia. And fish oil has its medical effect rather than giving placebo effect

thereby inducing greater tendency of developing psychosis. As cited by the DOH,

“prevention is better than cure”. Early prevention can cure only this kind of illness early.

Fish oil have no known side effect and also proven healthy based from other researches

conducted.

As a nurse, this is important because alternative medication can be found in nature

and not purely chemically engineered medications. This can be offered in a lower cost

and can be easily acquired.

Schizophrenia and a Handful of medications forever

Schizophrenia is a scary and difficult chronic mental illness both for the person

and for the family who all have to live with the diagnosis. In most cases, antipsychotic

medications need to be taken forever to control the disturbing symptoms but rarely is

anyone told that these medication not only double the risk of sudden cardiac death but

also put the suffer at risk for several other chronic illnesses as well.

Personally, I disagree in a sense that I had to experience wherein I have seen the

patient that stayed in the mental institution for three years and was able to recover . when

I asked him about his condition right now, he said that he is okay and he is not suffering

from any fatal diseases in which this article talks about.

We as the health care providers, it will give us enough information about the

“real” effects of the medications that we are supposed to give to the clients. And this

article will enable us to be knowledgeable enough to any pharmaceutical products.

NAME OF DRUG MECHANISM

OF ACTION

INDICATIONS CONTRAINDICATIONS SIDE

EFFECTS

ADVERSE

EFFECTS

NURSING

CONSIDERATIONS

GENERIC NAME:

Clonazepam

BRAND NAME:

Clonapam

CLASSIFICATION

Anti-convulsant

DOSAGE:

0.5mg three times a

day

•Benzodiazepin

e derivative w/c

increasing

presynaptic

inhibition and

suppresses the

spread of

seizure activity.

•Some

effectiveness in

absence

seizures

resisters to

succinimide

therapy.

•Sensitivity to

benzodiazepine

•Severe liver disease,acute

narrow-angle glaucoma

•Pregnancy

•Sedation

•Weakness

•Headache

•Vomiting

•Muscle cramping

•Insomnia

•Do not confuse

Klonopin w/ clonidine

(anti-hypertensive)

•Assess drug effects

before performing

activities that require

mental alertness.

•Take as directed, report

any loss of seizure

control or adverse effect

NAME OF DRUG MECHANISM INDICATION CONTRAINDICATION SIDE ADVERSE NURSING

OF ACTION EFFECTS EFFECTS CONSIDERATIONS

GENERIC NAME:

Diphenhydramine

BRAND NAME:

Benadryl

CLASSIFICATION:

Anti-histamine

DOSAGE:

50mg three times a

day

•High

sedative ,antich

olinergic,and

antiemetic

effects.

•Diphenhydramin

e is used for the

relief of nasal and

non-nasal

symptoms of

various allergic

conditions such as

seasonal allergic

rhinitis. It is also

used to alleviate

cold symptoms

and chronic

urticaria (hives).

•Topically to treat

chickenpox

•Poison ivy or sunburn.

•Nausea

•Sleepiness

•Tirediness

•Hypertension

•Tremor

•Glaucoma

•Hyperthyroidism

•Do not confuse

diphenhydramine w/

pesipramine (anti-

depressant) or

dimenhydrinate(antihista

mine).

•Use sun protection;may

cause photosensitivity

reaction.

•Use sugarless

gum/candy to diminish

dry mouth effects.

NAME OF DRUG MECHANISM INDICATION CONTRAINDICATION SIDE ADVERSE NURSING

OF ACTION EFFECTS EFFECTS CONSIDERATIONS

GENERIC NAME:

Haloperidol

BRAND NAME:

Haldol

CLASSIFICATION:

Anti-psychotic

DOSAGE:

2mg two-three times

a day

•Competitively

blocks

dopamine

receptors in the

tuberoinfundibu

lar system to

cause sedation.

•Haloperidol is used

to treat symptoms of

certain types of

mental conditions

(e.g., schizophrenia);

to control movements

or effects of

Tourette's syndrome;

or to control severe

behavioral problems

in children.

•Use w/ extreme

caution,or not at all,in

clients w/ parkinsonism.

•Dry mouth

•Headache

•Nausea

•Drowsiness

•Dizzines

•Vomiting

•Do not confuse Haldol

w/ Medrol (a

corticosteroid)

•Use w/ caution in

elderly;they tend exhibit

toxicity more frequently.

•Assess

CBC,electrolytes,liver

and renal function.

UNIT IV

NURSING CARE PLANS

UNIT V

PSYCHOTHERAPY

UNIT VI

Glossary

Affect – the outward expression of the client’s emotional state

Agnosia – inability to recognize or name objects despite intact sensory abilities

Akathisia – intense need to move about; characterized by restless movement, pacing, inability to

remain still, and the client’s report of inner restlessness.

Anhedonia – having no pleasure or joy in life; losing any sense of pleasure from activities

formerly enjoyed.

Aphasia – deterioration of language function

Apraxia – impaired ability to execute motor functions despite intact motor abilities

Blunted Affect – showing little or a slow-to-respond facial expression; few observable facial

expression

Concrete Thinking – when the client continually gives literal translations; abstraction is

diminished or absent

Delusion – a fixed, false belief not based in reality

Denial – defense mechanism; clients may deny directly having any problems or may minimize

the extent of problems or actual substance use.

Dissociation –a subconscious defense mechanism that helps a person protect his or her

emotional self from recognizing the full effects of some horrific or traumatic event by allowing

the mind to forget or remove itself from the painful situation or memory

Echolalia – repetition or imitation of what someone else says; echoing what is heard

Echopraxia – imitation of the movements and gestures of someone an individual is observing

Extrapyramidal Side Effects –reversible movement disorders induced by antipsychotic or

neuroleptic medication

Fear – feeling afraid or threatened by a clearly, identifiable, external stimulus that represents

danger to the person

Flat Affect – showing no facial expression

Flight of Ideas –excessive amount and rate of speech composed of fragmented or unrelated

ideas; racing, often unrelated thoughts

Inappropriate Affect – displaying a facial expression that is incongruent with mood or

situation; often silly or giddy regardless of circumstances.

Labile – rapidly changing or fluctuating, such as someone’s mood or emotions

Neologisms – invented words that have meaning only for the client

Repressed Memories – memories that are buried deeply in the subconscious mind or repressed

because they are too painful for the victim to acknowledge; often relate to childhood abuse

Tardive Dyskinesia – a late-onset, irreversible neurologic side effect of antipsychotic

medications; characterized by abnormal, involuntary movements such as lip smacking, tongue

protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet.

Therapeutic Communication – an interpersonal interaction between the nurse and client during

which the nurse focuses on client’s specific needs to promote an effective exchange of

communication

Therapeutic Nurse-Client Relationship – professional, planned relationship between client and

nurse that focuses on client needs, feelings, problems and ideas; interaction designed to promote

client growth, discuss issues, and resolve problems; includes the three phases of orientation,

working and termination

Therapeutic Relationship – see nurse-client relationship

Word Salad – flow of unconnected words that convey no meaning to the listener

Working Phase – in the therapeutic , the phase where issues are addressed, problems identified,

solutions explored; nurse and client work to accomplish goals; contains Peplau’s phases of

problem identification and exploitation.

UNIT VII

References

Books

Videbeck, Sheila L., Psychiatric Mental Health Nursing, 3rd edition

Elizabeth, Manual of Psychiatric Nursing Care Plan

BPSU-CNM, NCM 103

Balita, Carl E., Ultimate Learning Guide to Nursing Review, 2008 ed.

Websites

www.mayoclinic.com

www.naturalnews.com

www.schizophrenia.com

www.howstuffworks.com

www.doh.gov.ph

UNIT VIII

DOCUMENTATION