Finalist

ST.
PAUL UNIVERSITY DUMAGUETE

COLLEGE OF NURSING
A.Y. 2022-2023, 2ND SEMESTER
Negros Oriental Provincial Hospital: Talay Rehabilitation and

Psychiatric Center
In Partial Fulfillment for the Requirements in NCM 117 Care of Client

with Maladaptive Patterns of Behavior (Acute and Chronic) - RLE
A Case Study on:
Schizophrenia Manifesting Religious Delusion and Grandiose Delusion
Submitted by:
Abing, Samantha G.
Ambo, Krizha Jane C.
Lariosa, Josh Remil
Mancao, Joanamarica
Oyco, Joshbie Aira
Palongpalong, Kaye
Rabanal, Jether C.
Rosanto, Ashley Ann Fatima
Villaluz, Kate Stefan
Submitted to:
Mr. Eugene Moises Palarpalar, RN
May 19, 2023

ST. PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING
TABLE OF CONTENTS
TABLE OF CONTENTS .................................................... 2

ACKNOWLEDGMENTS ...................................................... 3
ABSTRACT ............................................................. 4
CHAPTER I
CASE OVERVIEW ........................................................ 5
Introduction ....................................................... 5
Objectives ......................................................... 6
Scope .............................................................. 7
Limitation ......................................................... 7
CHAPTER II
CASE DATA AND INFORMATION ............................................ 8
Chief Complaint .................................................... 8
History of Present Illness ......................................... 9
Past Health History ................................................ 9
Family Genogram ................................................... 10
Functional Health Patterns ........................................ 10
General Condition and Focused Assessment .......................... 16
Mental Status Assessment/MSE ...................................... 16
Psychodynamic (Theory) ............................................ 18
CHAPTER III LITERATURE REVIEW ....................................... 20
Normal Anatomy and Physiology ..................................... 20
Theoretical Background ............................................ 32
CHAPTER IV
CASE ANALYSIS AND INTERVENTIONS ..................................... 39
Psycho-Pathophysiology ............................................ 39
Medical Management ................................................ 40
Pharmacologic Management .......................................... 42
Psychotherapy ..................................................... 60
Progress Notes .................................................... 66
Discharge Plan .................................................... 71
CHAPTER V
CONCLUSIONS AND RECOMMENDATIONS ..................................... 74
Conclusions ....................................................... 74
Recommendations ................................................... 74
REFERENCES .......................................................... 76
APPENDICES .......................................................... 79
Curriculum Vitae .................................................. 79
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ACKNOWLEDGMENTS
The student nurses would like to express their deepest gratitude
to the following for their assistance and support throughout the
entire study period. First and foremost, we want to give gratitude and
praise to the Almighty Father for leading us throughout our clinical
duty in the hospital and the process of successfully finishing our
Clinical paper.
We would like to express our sincere gratitude to Sir Eugene
Moises Palarpalar, RN for giving us the opportunity to do a case study
and providing invaluable guidance throughout this case study. His
desire, genuineness, and passion have greatly motivated us. He
instructed the students on how to conduct case studies and present
their findings as carefully as feasible. Working and studying under
his guidance was an enormous privilege and honor.
Additionally, we would like to express our gratitude to the staff

members of Negros Oriental Provincial Hospital: Talay Rehabilitation and
Psychiatric Center for enabling us to participate in a valuable clinical
rotation that was very beneficial to us. We would like to express our
gratitude for their patience, acceptance, and trust of all student
nurses.
Lastly, to the parents of the student nurses, Mr. and Mrs. Enriquito
Ambo Jr. and Mr. and Mrs. Lumbo for their unending love, prayers, care
and sacrifices for educating and preparing the student nurses for their
future professions.
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ABSTRACT
A case study of a 49-year-old male from Mabinay, Negros Oriental was the
focus this clinical paper. Patient N.A.A. was diagnosed with
Schizophrenia and was admitted in Negros Oriental Provincial Hospital:
Talay Rehabilitation and Psychiatric Center in the year 2004. But on
April 25,2023, patient N.A.A. was re-admitted due to several fever as
he was also experiencing visual hallucinations, command hallucinations,
religious delusions and grandiose delusions. During his stay at the
Rehabilitation Facility, the patient received different types of
psychotherapy to address his behaviors and health concerns including art
therapy, occupational therapy, psychoeducation, play therapy, music
therapy and dance therapy. Patient had been provided antipsychotic
medications and an anticholinergic drug specifically fluphenazine
decanoate, clozapine and biperiden. Patient had no past and recent
surgery carried out on the patient upon admission. Upon assessment of
the patient, patient exhibited disorganized thinking and speech which
makes him express it in a coherent way. Nursing management done to manage
the symptoms and improve his quality of life include: Student Nurses had
ensured that the patient adheres to the prescribed medications ordered
by the physician and observe for any adverse reactions, student nurses
had been able to identify the symptoms and manifestations of
schizophrenia and had provided nursing interventions to manage it,
student nurses had implemented appropriate measures to ensure the safety
of the patient and others and provided an education about the benefits
of maintaining a healthy lifestyle. In summary, the patient was able to
receive comprehensive treatment and support.
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CHAPTER I
CASE OVERVIEW
Introduction
Schizophrenia is a chronic mental disorder that makes it difficult

for a person to distinguish between real and false perceptions and
beliefs. Symptoms can be so severe and limiting that everyday activities
can be difficult to complete. There are five (5) subtypes, catatonic
subtypes, paranoid subtypes, residual subtypes and the simple or
undifferentiated subtypes of schizophrenia. Diagnosing any type of
schizophrenia, a person must exhibit at least two of the following
symptom types, with at least one of the symptoms being delusions,
hallucinations or disorganized speech (Cagliostro, D. 2020). Mental
illness has become the third most common disability in the Philippines,
wherein six million Filipinos live with depression and anxiety. As a
result, the nation in the Western Pacific has the third-highest rate of
mental problems (Martinez et al., 2020). Additionally, 3.6 million
Filipinos are estimated to be affected by at least one type of mental,
neurological, or substance use illness, according to the World Health
Organization (WHO) Special Initiative for Mental Health conducted in
2020 (Department of Health, 2020). According to the WHO, 15.3 million
Filipinos have substance use disorders, 1 million have schizophrenia,
and 154 million have depression (Department of Health, 2018).
Additionally, 877,000 people commit suicide each year. Therefore, mental
illnesses may have a significant impact on employment and educational
levels, particularly for people between the ages of 25 and 52 (Hakulinen
et al., 2019).
This paper introduces a case study of a 49-year-old male who was

an in and out patient of NOPH Psychiatric Extension Ward in Talay
Behavioral Care Center. Client A.N.A a resident of Barangay. Kapanun-an
Mabinay Negros Oriental who experienced his first symptoms of mentall
illness in 2004, 12 years ago. April 12, 2004, at the age 43 client
A.N.A was diagnosed schizophreniform. At that time he was experiencing
delusions, visual hallucinations and command hallucinations. He was
given chlorpromazine 100 mg BID, Haloperidol 1 amp through IM and
Akinetone 2 mg BID. On April 20, 2023 client returned with a chief
complaint of several fever with the following positive behavioral
manifestations. According to the nurse on duty, he was brought to the
behavioral center by their barangay captain because he was aggressive.
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The group chose this case to further dig up the innermost reason
why schizophrenia exists. This also serves as a good way to enhance
knowledge and to supplement an individual's mind as the practice of
nursing profession exists.
Objectives
The case of patient N.A.A offers an learning avenue for the student
nurses to gain and supplement their knowledge about schizophrenia and
its related concepts. This case study aims to achieve the following
objectives:
Cognitive:
1. Student nurses will be able to describe and discuss the positive
and negative symptoms of schizophrenia.
2. Student nurses will outline a functional and mental state
examination for a client with schizophrenia.
3. Student nurses will show a higher understanding of and familiarity
with their client's illness, schizophrenia.
4. Nursing students will be able to name a variety of ethical nursing
interventions that might improve the client's condition.
5. Five nursing diagnoses will be recognizable by student nurses, who
will be able to create them based on the patient's current needs
and safety.
Affective:
1. The effectiveness of antipsychotic medications for people with
schizophrenia will be evaluated by nursing students.
2. Student nurses will be able to put up appropriate evaluation
processes for a patient with schizophrenia that will help determine
the necessity for therapy.
3. In order to demonstrate their breadth of knowledge, nursing
students will be able to assemble data on the causes of
schizophrenia.
Psychomotor:
1. Nursing students will be able to inform patients, family, and other
community members about the mental illness schizophrenia in the
following exposure.
2. This clinical report can be completed by nursing students in order
to investigate the potential causes of this mental disease.
3. Nursing students will talk about the need for supportive and
rehabilitative needs of clients with schizophrenia.
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Scope
This clinical paper focuses on a 49-year-old client who has been

diagnosed with a mental disorder and is showing active signs of both
positive signs of schizophrenia. The material reported in this clinical
paper research was acquired from the client's chart, and the client
himself. These data were collected by 3rd year student nurses from St.
Paul University Dumaguete during their 2 weeks of engagement with the
client during their clinical duty in Negros Oriental Provincial Hospital
- Talay Rehabilitation and Psychiatric Center from May 9, 2023 to May
20, 2023.
Limitation
This clinical paper focuses on a 49-year-old client who has been

diagnosed with a mental disorder and is showing active signs of positive
symptoms of schizophrenia and is limited to what was gained and
discovered during their 2 weeks of nurse-patient interaction with the
client. This study also focuses on the general facts surrounding the
client's medical state, as well as ways in which the mental disorder
schizophrenia is managed, the functional and physical evaluation, and
the outcomes of the interventions performed. The data provided in this
study is likewise confined to what is on the chart, and what information
the patient has given since he has no significant others to verify the
data and gather more reliable information.
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CHAPTER II
CASE DATA AND INFORMATION
Biographical Data
Patient’s Name : N.A.A
Address : Kapanun-an Mabinay : Kapanun-

an,Mabinay Negros Oriental
Contact Number : N/A
Age : 49 years old
Birthdate : October 6, 1973
Place of Birth : Mabinay Negros Oriental
Sex : Male
Citizenship : Filipino
Race/Ethnicity : Asian
Marital Status : Single
Religion : Roman Catholic
Educational : Elementary Graduate

Attainment
Occupation : Farmer
Contact Person :None
Occupation : N/A
Contact Number : None
Date of Admission : April 25, 2022
Healthcare : N/A
Financing
Physician : Dr. A.J.V.A
Admitting Diagnosis : Schizophrenia
Source of Information
a. S.O : 0%
b. Client : 60%
c. Chart : 40%
Chief Complaint
Admitted due to several fever and manifesting positive signs of

Schizophrenia.
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History of Present Illness
Patient A.N.A a 49 years old male single (never married,no

children)grew up in Mabinay Negros Oriental who experienced his first
symptoms of mental illness in 2004, last 12 years ago. According to the
patient he experienced visual hallucinations, command hallucinations and
was very aggressive.He also expressed that he nearly killed his father
because someone is whispering to him to do so. He experienced a recurrent
fever for a week Last April 20, 2022 and didn’t go for a check up in the
nearest hospital. During nurse patient interaction student nurses asked
patient A.N.A about his current mental health situation and he stated
“Na paakan man gud ko ug iro maam, wala ko naka pa bakuna dayun maong
na ing ani ko”. During the entire assessment with the client, the patient
exhibited delusion and hallucinations. Examples of his delusion included
the following: (1) Grandiose, (2) Religious Delusion and occasionally
experiencing visual hallucinations. His chart also revealed that he was
a heavy drinker and stopped smoking (year not specified).
Past Health History

Childhood Illness: The client claimed that he does not have any serious
childhood illness/illness. He also claimed he experienced mumps and
chicken pox during his childhood.
Hospitalization: Client has no history and previous hospitalization.
Surgeries: Client does not have any previous surgical procedure/s.
Immunization: Client was only immunized with anti-tetanus vaccine and
given COVID vaccine once.
Laboratory Examination: Client has no previous laboratory examinations.
Medications: The client claimed that he doesn't use any illicit
substances. He would only take ibuprofen, paracetamol, and oregano as
herbal remedies to treat his body aches.
Allergies: Client stated that he has no any allergies to food.
Travel History: No travel history
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Family Genogram
Interpretation: The family history of the patient represented by the

diagram above showed that there were no genetic factors in play as to
the development of the patient’s schizophrenia. However, this
information was gathered from the patient himself, there was no other
way to verify his family history since he did not have any significant
others with him during his stay inside the Talay Rehabilitation and
Psychiatric Center.
Functional Health Patterns
Functional Prior to During Justification

Health Pattern Admission Hospitalization
Health Patient A.N.A Client was not Client’s

Perception and viewed health as showing any perceived
Health a state in which aggression and Compliance with
Management he can perform seemed to be medication
his work daily calm and alert regimen and well
as a farmer and when asked upon being is
with the absence visitation but managed.
of illness and he was put in
disease. Buys cell last May
and takes over 12, 2023 due to
the counter inappropriate
drugs such as behavior and
solmux, neozep, delusions. He
biogesic and was prescribed
ibuprofen. He 100 mg of
rarely visits a chlorpromazine.
doctor to have a Upon the
check-up and observation of
seek medical the student
assistance, he nurses by May
also uses herbal 13, 2023 the
medicine such as patient was
guava and experiencing
oregano to heal delusion and
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his wounds. visual

According to the hallucinations
patient's chart yet seemed to be
he was a heavy calm and able to
drinker and respond to
smoker. Patient questions
A.N.A cannot directly when
recall if he is asked. There are
fully immunized times when the
and was given student nurses
COVID 19 vaccine were observing
once. According him from afar,
to the patient he manifested
when his signs of
symptoms of religious
mental disorder delusion and
showed, he was agitation, yet
aggressive and no inappropriate
he experienced affect was
command noted. He also
hallucinations verbalized
“Pamatya na “Sauna rako maka
sila” as kita anang
verbalized by babayi na puti
the patient. tanan ug iya ko
hunghungan pero
sukad ga tumar
kog tambal wala
na”.
Nutrition and The client During Client was able

Metabolism verbalized that admission, the to consume food
their diet in client was able 3 times per day
the family was to express that and was able to
mostly corn and he is able to maintain
crops from their eat 3 times a hydration.
farm like green day, especially Client reveals
and leafy when there are good skin turgor
vegetables. He student nurses and body build
prefers to eat visiting Talay was appropriate
“ginaling na and enjoys to his age.
mais” rather delicious
than white rice. snacks. As
They rarely student nurses
consume meat and observed his
fish because eating
they are far behaviors, he
from the city to was able to
buy it. But in finish all the
our client’s meals that were
state, it was given to him and
proven that he he was not
was not eating hesitant in
properly on a accepting them.
day to day basis The client’s
due to excessive meal during the
work as admission was
“tapasero”, he vegetables,
only eats once meat, fish and
or twice a day processed foods.
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COLLEGE OF NURSING
and sometimes
not. Also termed
it as “pasmo”
which might be
one of the
factors why the
patient had a
mental illness.
Elimination Regarding the Client has been There was no

client’s eating properly change in the
elimination during frequency of the
pattern he admission, he stool and the
regularly was able to urine.
defecated in a express that his
day and he eliminating
maintained his patterns were
hydration. improved. From
the orientation
phase the
patient stated
that he was able
to defecate
twice and able
to urinate more
than three times
a day.
Activity and He states that Client was not During patient's

Exercise his only able to do such confinement,
activity and heavy activity there are quite
exercise was to and his only changes in his
work 24/7 in the exercise was activities and
sugar mill and walking around, has quite a
in their farm. cleaning the restriction of
“Sukad ga 6 comfort rooms his action.
years old ko and sweeping the
maam kay ga floor and
tapas nako ug sometimes his
tubo” as activities were
verbalized by restricted.
the client. When
the student
nurses asked the
client about
having to go for
a walk or do
some stretching
he stated that
he was not able
to do such
activity ever
since and his
only exercise
was working the
sugar mill.
Cognitive- The patient was Client was able Visual

Perceptual oriented to to answer the hallucination is
people, time and student nurse’s still noticed
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place responses questions alert when he is

to stimuli and placed inside
verbally and appropriately, the cell. There
physically. He but there are is an
can speak and some areas improvement in
understand wherein he loses the level of his
Tagalog and his focus and thinking since
bisaya. He is an jumps into based on
elementary another topic. patient's
graduate and he While progress note
is able to read, interviewing the last February 9,
write and solve client, he 2023 he was
simple randomly sees a oriented to
mathematical dog and he place but not to
equations. Prior states “Naa man time and date
to admission, he koy alaga na iro and unable to
had auditory and diri maam alas count backward.
visual dosi sa gabie
hallucinations siya nako gina
as stated by the pa kaon naa diha
client. sa taas color
orange”. When
asked to state
the letters in
the alphabet,
count numbers
from 1-100 and
ask the current
president he was
able to answer
it correctly.
Sleep and Rest The client Client stated Patient appears

stated that his earliest well-rested and
although he time to go to free from
generally goes sleep is at 8:00 suicidal
to bed at ten pm and he wakes ideation.
o'clock, he at 12 midnight
likes to watch to offer a
action movies in prayer and up
the hours at 4:00 am.
before. He then Sometimes he
gets up at five takes a nap at 3
in the morning pm for a short
to prepare for period of time.
his job at the Upon observing
sugar mill. his behavior,
According to the the client
patient, taking seemed relaxed
a nap while at and no visible
work would take dark circles in
too much time. his under eye.
He experienced He has no visual
visual or auditory
hallucinations hallucinations
during night during the night
time. especially when
he is able to
intake his
medicines.
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Self-perception The client was He was quite Patient able to

and Self-concept able to ambitious, and maintain eye
communicate his that came up in contact during
feelings about some of the the
his situation, interactions conversation. He
saying "Na with the student verbalized “Okay
paakan ko ug iro and the patient. raman, dli nako
mao na ing ani He claimed to be agresibo ron di
ko". The client an attorney, lay parehas sauna
could recognize clergyman, and naay mo hunghung
his value and landowner. He nako pamatyon
was content with further asserted nako ang mga
his life and that his tawo didto sa
work. He is siblings are amo”. Grandiose
content to see entrepreneurs delusion is
the love, and that they still evident
support, and own a business. during nurse
concern of his patient
family. His interaction.
primary sources
of stress were
money issues
brought on by
work and
occasionally by
his financial
situation.
Roles and Client plays the “Akoa trabaho Since he was

Relationship role of as the sauna mo tapas admitted last
breadwinner and ug tubo, unya ni year, the client
although he is adto mi ni inday has no
the 4th among Josephine sa significant
his siblings but manila para other on whom he
he act as the magpa maid ug may rely.
eldest who spent ako tig deliver
a short time anang mga puthaw
with his family sa Tarlac,
due to overtime Pampang ug
at the sugar Iloilo” as
mill but they verbalized by
maintain a good the client. When
communication, the student
there are no nurses asked
conflicts among about his
them as he previous
stated that he relationship he
love all of verbalized “ Naa
siblings and ko na ibogan
even work as didto sa amoa
“tapasero” at an bahalag na pa
early age just angkan to siya
to help his akoa to
family pakaslan”.
sustaining there
everyday food.
Sexuality and Verbalized that Client Sexuality and

Reproduction he is male and verbalized that reproductive
does want to he fell in love patterns are
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COLLEGE OF NURSING
have children with Melanie the affected by the

someday. When he mother prince. changes that
was 5 years old, He also claimed take place in a
he had his that he is in a patient's body
circumcision relationship and personal
with the use of with Morabel and life.
“palpal” Joyce and that
performed by the he had 100
locals. Client children.
has no known Doesn’t have an
sexual partner active sexual
ever since and life.
he wanted to
marry his
neighbor when he
will be out in
the
rehabilitation
and plans to
have children.
He does not have
any history of
genital or
sexually
transmitted
disease/illnesse
s.
Coping and Client stated When student The client's

Stress Tolerance that when it nurses asked him typical coping
comes to stress on how to manage mechanism for
management he his problems he stress has not
only prays. verbalized “mag changed.
ampo rako sige
maam”.
Values and Client religious The patient Client values

Beliefs affiliation is never blamed God religious
Roman Catholic, for his practices. After
he loves to go condition; what happened
to church every instead he the patient is
Sunday despite worshiped and still seeking
his busy never forgot to medical
schedule. He pray before assistance.
allotted time eating his meal. Religious effort
to pray and He kissed the is still part of
loves reading floor and raised a patient's
the bible. He his hands during life.
also believes in prayer time and
Quack Doctors. after praying
the patient
verbalized
“Amen, Praise
the Lord,
Hallelujah, Yes
Lord”. The
patient;s
relationship
with God
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remained
unchanged and
deepened.
General Condition and Focused Assessment
Patient appears 158 cm in length, with a dark complexion, black

and uneven haircut, tone and an age appropriate physical build. Changed
his clothes everyday and dress appropriately yet has poor hygiene,
discolored teeth, and dirty nails. Patient warm to touch no lesion nor
open wounds noted. Has good capillary refill and good skin turgor. The
patient walks and stands normally with mild tremors on hands on our first
nurse patient interaction. Eye contact was maintained and inappropriate
expressions were occasionally displayed. The patient’s positive symptoms
include visual hallucinations, grandiose and religious delusions, flight
of ideas, neologism, word salad and illusions. Patient’s negative
symptoms include alogia, flat affect, blunted affect and inattention.
Appearance and behavior was alert, awake, cooperative. Patient’s speech
and language was fluent with normal tone and volume of speech. Mood and
affect, patient’s occasionally display flat affect and usually good mood
and congruent.Patient is aware why he is here and oriented to place,
time and date able to count, recognize the current President and Vice
President and able to solve simple math problems.
Mental Status Assessment/MSE
History
Due to his hostile behavior, the client was taken to Talay
Rehabilitation Center on April 12, 2004, and later released on April 19,
2004. The patient claims that his barangay captain brought him because
of his violent behavior towards others. According to the patient's chart
last April 20, 2023 the patient has no subjective complaints and denies
that he hears voices or is having hallucinations or delusions.
General appearance and motor behavior
Client grooming was fair after morning care. He changed his clothes
everyday yet the presence of body odor is still there. Most of the time
he exhibited inappropriate facial expressions and appropriate posture
during interactions and can maintain good eye contacts. Throughout the
entire days of duty the patient can do personal care, handwriting,
running and walking. No repeated purposeless behavior of anxiety such
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COLLEGE OF NURSING
as drumming of fingers, twisting of locks of hair or tapping of foot.

No other motor behavior presented.
Mood and Affect
During the first week of nurse patient interaction with the

patient, we asked about how he felt that day and he responded to our
question without being anxious or hesitant. He answered with an
appropriate facial expression but in some questions displayed blunted
affect, flat or inappropriate affect. Throughout our interaction with
him, he was participative and very responsive most of the time.
Thought Process & Content
The patient has no problem speaking. He usually speaks normally.

But in some instances, he tends to speak about religious belief, the
saints and God (Delusion). In some instances he stated that he has a
color orange dog in the rehabilitation but there’s no dog there, only
cats and chicken (Hallucination). His thought process commonly manifests
flight of ideas, word salad, neologism, looseness of association.
Sensorium & Intellectual Processes
Client is oriented to time and place and upon assessing his focus,
there was no delay of speech and process of thinking. He was able to
verbalize his full name, birthdate and address. He was able to recite
the letters in the alphabet and count numbers from 1 to 100. He also
knows the current President and vice president in the Philippines. He
can now recognize the name of his student nurses. Client’s memory is
good.
Judgment & Insight
Client’s judgment and insight was good, he was able to distinguish

the objects and the color of it. When the student nurses asked the client
“Ug ma konsehal naka sir unsa man sad imong mga balaod?” and he replied
“sininaan nako ang mga pobre ug atopan ang mga kugon nga balay”. The
client was aware that he was having hallucinations before admission.
Self Concept
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Patient was asked to describe himself, he said that he was a

construction worker who also delivers metals around the Philippines. But
when we asked him again about his previous work he said he is a sugarcane
worker which is more accurate.
Roles and Relationship
The patient is the 4th son of their family. He said that all of
his siblings have families of their own already.
Psychodynamic (Theory)
Age/Stage Task Patient Implication
Views the world Patient grew up The patient

Trust vs as safe and in Mabinay feels protected
reliable, Negros Oriental and cared for by
Mistrust
nurturing, he has 6 2 girls his family at
(0-12 months) stable and and 4 boys, he this time.
dependable is the 4th child
relationship among them.
According to the
patient, he had
a good
relationship
with his
siblings and
parents.
Autonomy vs. Achieving a The patient is The patient is

Shame and Doubt sense of control able to act capable, feels
(1-3 years) and freewill independently in control, and
and make has free choice,
decisions. He but occasionally
can eat and take needs to be
his medications watched over and
on his own, led.
among other
basic tasks.
Initiative vs. Beginning Patient was able Patient is very

Guilt (3-6 development of a to participate friendly and
years) conscience, during one-on- loves to
Learns to manage one interact with
conflict and interactions. other patients.
anxiety When he is He is very
facing stress he active in
will pray. participating
during
psychotherapy.
Industry vs. Confidence in During Patient was very

Inferiority (6- own abilities, psychotherapies confident and
12 years) taking pleasure the patient trusted his own
in independently capabilities.
accomplishment made his own
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work and was

very cooperative
during therapy.
He verbalized
that he is happy
ever after
therapy.
Formulating a Patient loves Patient loves

Identity vs. sense of self being with every interacting and
and belonging patient. He making friends
Role Confusion
interacted with even with the
(12-18 years) everyone. new people he
According to encounters.
some SO
patients, they
love to
communicate and
help other
patients.
Adult loving Upon the Patient shows

Intimacy vs. relationship and interview, the interest in
meaningful patient intimate
Isolation (18-25
attachments to verbalized that relationships.
years) others he never had a
girlfriend. But
he once fell in
love with a
neighbor that
even though she
was a single mom
he is willingly
marrying her.
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CHAPTER III
LITERATURE REVIEW
Normal Anatomy and Physiology

Overview
The brain is an amazing three-pound organ that controls all functions
of the body, interprets information from the outside world, and embodies
the essence of the mind and soul. Intelligence, creativity, emotion, and
memory are a few things the brain governs. Protected within the skull,
the brain is composed of the cerebrum, cerebellum, and brainstem.The
brain receives information through our five senses: sight, smell, touch,
taste, and hearing - often many at one time. It assembles the messages
in a way that has meaning for us and can store that information in our
memory. The brain controls our thoughts, memory, and speech, movement
of the arms and legs, and the function of many organs within our body.The
central nervous system (CNS) is composed of the brain and spinal cord.
The peripheral nervous system (PNS) is composed of spinal nerves that
branch from the spinal cord and cranial nerves that branch from the
brain. (Maldonado, K. A.,2023)
Brain
The brain is composed of the cerebrum, cerebellum, and brainstem
The brain has three main

parts: the cerebrum,
cerebellum, and brainstem.
Cerebrum is the largest
part of the brain and is
composed of right and left
hemispheres. It performs
higher functions like
interpreting touch,
vision, and hearing, as
well as speech, reasoning, emotions, learning, and fine control of
movement.
Cerebellum is located under the cerebrum. Its function is to
coordinate muscle movements and maintain posture, and balance.
Brainstem acts as a relay center connecting the cerebrum and
cerebellum to the spinal cord. It performs many automatic functions
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such as breathing, heart rate, body temperature, wake and sleep

cycles, digestion, sneezing, coughing, vomiting, and swallowing.
Right brain – Left Brain

The cerebrum is divided into two halves: the right and left
hemispheres. They are joined by a bundle of fibers called the corpus
callosum that transmits messages from one side to the other. Each
hemisphere controls the opposite side of the body. If a stroke occurs
on the right side of the brain, your left arm or leg may be weak or
paralyzed.
Not all functions of the hemispheres are shared. In general, the left
hemisphere controls speech, comprehension, arithmetic, and writing.
The right hemisphere controls creativity, spatial ability, artistic,
and musical skills. The left hemisphere is dominant in hand use and
language in about 92% of people.
The cerebrum is divided into

left and right hemispheres. The
two sides are connected by the
nerve fibers corpus callosum.
Lobes of the brain

The cerebral hemispheres have
distinct fissures, which divide
the brain into lobes. Each hemisphere has 4 lobes: frontal, temporal,
parietal, and occipital. Each lobe may be divided, once again, into
areas that serve very specific functions. It’s important to understand
that each lobe of the brain does not function alone. There are very
complex relationships between the lobes of the brain and between the
right and left hemispheres.
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The cerebrum is divided into four lobes: frontal, parietal, occipital

and temporal.
Frontal Lobe
• Personality, behavior, emotions
• Judgment, planning, problem-solving
• Speech: speaking and writing (Broca’s area)
• Body movement (motor strip)
• Intelligence, concentration, self-awareness
• Interprets language, words.
• Sense of touch, pain, temperature (sensory strip)
Parietal Lobe
• Interprets signals from vision, hearing, motor, sensory and memory.
• Spatial and visual perception
Occipital Lobe
• Interprets vision (color, light, movement)
Temporal Lobe
• Understanding language (Wernicke’s area)
• Memory
• Hearing
• Sequencing and organization
Language
In general, the left hemisphere of the brain is responsible for language
and speech and is called the "dominant" hemisphere. The right hemisphere
plays a large part in interpreting visual information and spatial
processing. In about one-third of people who are left-handed, speech
function may be located on the right side of the brain. Left-handed
people may need special testing to determine if their speech center is
on the left or right side prior to any surgery in that area.
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Aphasia is a disturbance of language affecting speech production,

comprehension, reading or writing, due to brain injury – most commonly
from stroke or trauma. The type of aphasia depends on the brain area
damaged.
Broca’s area lies in the left frontal lobe. If this area is damaged, one
may have difficulty moving the tongue or facial muscles to produce the
sounds of speech. The person can still read and understand the spoken
language but has difficulty in speaking and writing (i.e., forming
letters and words, doesn't write within lines) – called Broca's aphasia.
Wernicke's area lies in the left temporal lobe. Damage to this area
causes Wernicke's aphasia. The individual may speak in long sentences
that have no meaning, add unnecessary words, and even create new words.
They can make speech sounds however, they have difficulty understanding
speech and are therefore unaware of their mistakes.
Cortex
The surface of the cerebrum is called the cortex. It has a folded
appearance with hills and valleys. The cortex contains 16 billion neurons
(the cerebellum has 70 billion = 86 billion total) that are arranged in
specific layers. The nerve cell bodies color the cortex grey-brown giving
it its name – gray matter. Beneath the cortex are long nerve fibers
(axons) that connect brain areas to each other — called white matter.
The cortex contains neurons (grey matter), which are interconnected to

other brain areas by axons (white matter). The cortex has a folded
appearance. A fold is called a gyrus and the valley between is a sulcus.
The folding of the cortex increases the brain’s surface area allowing
more neurons to fit inside the skull and enabling higher functions. Each
fold is called a gyrus, and each groove between folds is called a sulcus.
There are names for the folds and grooves that help define specific brain
regions.
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Pathways called white matter tracts connect areas of the cortex to each
other. Messages can travel from one gyrus to another, from one lobe to
another, from one side of the brain to the other, and to structures deep
in the brain (Fig. 5).
Figure 5. Coronal cross-section showing the basal ganglia.

Hypothalamus: is in the floor of the third ventricle and is the master
control of the autonomic system. It plays a role in controlling behaviors
such as hunger, thirst, sleep, and sexual response. It also regulates
body temperature, blood pressure, emotions, and secretion of hormones.
Pituitary gland: lies in a small pocket of bone at the skull base called
the Sella turcica. The pituitary gland is connected to the hypothalamus
of the brain by the pituitary stalk. Known as the “master gland,” it
controls other endocrine glands in the body. It secretes hormones that
control sexual development, promote bone, and muscle growth, and respond
to stress.
Pineal gland: is located behind the third ventricle. It helps regulate
the body’s internal clock and circadian rhythms by secreting melatonin.
It has some role in sexual development.
Thalamus: serves as a relay station for almost all information that comes
and goes to the cortex. It plays a role in pain sensation, attention,
alertness, and memory.
Basal ganglia: includes the caudate, putamen and globus pallidus. These
nuclei work with the cerebellum to coordinate fine motions, such as
fingertip movements.
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Limbic system: is the center of our emotions, learning, and memory.

Included in this system are the cingulate gyri, hypothalamus, amygdala
(emotional reactions), and hippocampus (memory).
Memory
Memory is a complex process that includes three phases: encoding
(deciding what information is important), storing, and recalling.
Different areas of the brain are involved in different types of memory
(Fig. 6). Your brain must pay attention and rehearse in order for an
event to move from short-term to long-term memory – called encoding.
Structures of the limbic system involved in memory formation. The

prefrontal cortex holds recent events briefly in short-term memory. The
hippocampus is responsible for encoding long-term memory.
• Short-term memory, also called working memory, occurs in the
prefrontal cortex. It stores information for about one minute and its
capacity is limited to about 7 items. For example, it enables you to
dial a phone number someone just told you. It also intervenes during
reading, to memorize the sentence you have just read so that the next
one makes sense.
• Long-term memory is processed in the hippocampus of the temporal

lobe and is activated when you want to memorize something for a longer
time. This memory has unlimited content and duration capacity. It
contains personal memories as well as facts and figures.
• Skill memory is processed in the cerebellum, which relays

information to the basal ganglia. It stores automatically learned
memories like tying a shoe, playing an instrument, or riding a bike.
Ventricles and Cerebrospinal fluid
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The brain has hollow fluid-filled cavities called ventricles (Fig. 7).
Inside the ventricles is a ribbon-like structure called the choroid
plexus that makes clear colorless cerebrospinal fluid (CSF). CSF flows
within and around the brain and spinal cord to help cushion it from
injury. This circulating fluid is constantly being absorbed and
replenished.
CSF is produced inside the ventricles deep within the brain. CSF fluid
circulates inside the brain and spinal cord and then outside to the
subarachnoid space. Common sites of obstruction: 1) foramen of Monro,
2) aqueduct of Sylvius, and 3) obex.
There are two ventricles deep within the cerebral hemispheres called the
lateral ventricles. They both connect with the third ventricle through
a separate opening called the foramen of Monro. The third ventricle
connects with the fourth ventricle through a long narrow tube called the
aqueduct of Sylvius. From the fourth ventricle, CSF flows into the
subarachnoid space where it bathes and cushions the brain. CSF is
recycled (or absorbed) by special structures in the superior sagittal
sinus called arachnoid villi.
A balance is maintained between the amount of CSF that is absorbed and
the amount that is produced. A disruption or blockage in the system can
cause a build-up of CSF, which can cause enlargement of the ventricles
(hydrocephalus) or cause a collection of fluid in the spinal cord
(syringomyelia).
Skull
The purpose of the bony skull is to protect the brain from injury. The
skull is formed from 8 bones that fuse together along suture lines. These
bones include the frontal, parietal (2), temporal (2), sphenoid,
occipital and ethmoid (Fig. 8). The face is formed from 14 paired bones
including the maxilla, zygoma, nasal, palatine, lacrimal, inferior nasal
conchae, mandible, and vomer.
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The brain is protected inside the skull. The skull is formed from eight
bones. Inside the skull are three distinct areas: anterior fossa, middle
fossa, and posterior fossa. Doctors sometimes refer to a tumor’s location
by these terms, e.g., middle fossa meningioma.
A view of the cranial nerves at the base of the skull with the brain
removed. Cranial nerves originate from the brainstem, exit the skull
through holes called foramina, and travel to the parts of the body they
innervate. The brainstem exits the skull through the foramen magnum. The
base of the skull is divided into 3 regions: anterior, middle, and
posterior fossa.Like cables coming out the back of a computer, all the
arteries, veins and nerves exit the base of the skull through holes,
called foramina. The big hole in the middle (foramen magnum) is where
the spinal cord exits.
Cranial nerve
The brain communicates with the body through the spinal cord and twelve
pairs of cranial nerves. Ten of the twelve pairs of cranial nerves
control hearing, eye movement, facial sensations, taste, swallowing, and
movement of the face, neck, shoulder, and tongue muscles that originate
in the brainstem. The cranial nerves for smell and vision originate in
the cerebrum.
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Meninges
The brain and spinal cord are covered and protected by three layers of
tissue called meninges. From the outermost layer inward, they are the
dura mater, arachnoid mater, and pia mater.
Dura mater is a strong, thick membrane that closely lines the inside of
the skull; its two layers, the periosteal and meningeal dura, are fused
and separate only to form venous sinuses. The dura creates little folds
or compartments. There are two special dural folds, the falx, and the
tentorium. The falx separates the right and left hemispheres of the
brain, and the tentorium separates the cerebrum from the cerebellum.
Arachnoid mater is a thin, web-like membrane that covers the entire

brain. The arachnoid is made of elastic tissue. The space between the
dura and arachnoid membranes is called the subdural space.
Pia mater hugs the surface of the brain following its folds and grooves.
The pia mater has many blood vessels that reach deep into the brain. The
space between the arachnoid and pia is called the subarachnoid space.
It is here where the cerebrospinal fluid bathes and cushions the brain.
Blood supply
Blood is carried to the brain by two paired arteries, the internal
carotid arteries, and the vertebral arteries (Fig. 10). The internal
carotid arteries supply most of the cerebrum.
The common carotid artery courses up the neck and divides into the
internal and external carotid arteries. The brain’s anterior circulation
is fed by the internal carotid arteries (ICA) and the posterior
circulation is fed by the vertebral arteries (VA). The two systems
connect at the Circle of Willis (green circle).
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The vertebral arteries supply the cerebellum, brainstem, and the

underside of the cerebrum. After passing through the skull, the right
and left vertebral arteries join together to form the basilar artery.
The basilar artery and the internal carotid arteries “communicate” with
each other at the base of the brain called the Circle of Willis (Fig.
11). The communication between the internal carotid and vertebral-
basilar systems is an important safety feature of the brain. If one of
the major vessels becomes blocked, it is possible for collateral blood
flow to come across the Circle of Willis and prevent brain damage.
Figure 11. Top view of the Circle of Willis. The internal carotid and
vertebral-basilar systems are joined by the anterior communicating
(Acom) and posterior communicating (Pcom) arteries.
The venous circulation of the brain is very different from that of the
rest of the body. Usually arteries and veins run together as they supply
and drain specific areas of the body. So one would think there would be
a pair of vertebral veins and internal carotid veins. However, this is
not the case in the brain. The major vein collectors are integrated into
the dura to form venous sinuses — not to be confused with the air sinuses
in the face and nasal region. The venous sinuses collect the blood from
the brain and pass it to the internal jugular veins. The superior and
inferior sagittal sinuses drain the cerebrum, the cavernous sinuses
drains the anterior skull base. All sinuses eventually drain to the
sigmoid sinuses, which exit the skull and form the jugular veins. These
two jugular veins are essentially the only drainage of the brain.
Cell of the Brain

The brain is made up of two types of cells: nerve cells (neurons) and
glia cells.
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Nerve cell
There are many sizes and shapes of neurons, but all consist of a cell
body, dendrites and an axon. The neuron conveys information through
electrical and chemical signals. Try to picture electrical wiring in
your home. An electrical circuit is made up of numerous wires connected
in such a way that when a light switch is turned on, a light bulb will
beam. A neuron that is excited will transmit its energy to neurons within
its vicinity.
Neurons transmit their energy, or “talk”, to each other across a tiny
gap called a synapse (Fig. 12). A neuron has many arms called dendrites,
which act like antennae picking up messages from other nerve cells. These
messages are passed to the cell body, which determines if the message
should be passed along. Important messages are passed to the end of the
axon where sacs containing neurotransmitters open into the synapse. The
neurotransmitter molecules cross the synapse and fit into special
receptors on the receiving nerve cell, which stimulates that cell to
pass on the message.
Nerve cells consist of a cell body, dendrites, and axons. Neurons

communicate with each other by exchanging neurotransmitters across a
tiny gap called a synapse.
Nerve cells consist of a cell body, dendrites, and axon. Neurons
communicate with each other by exchanging neurotransmitters across a
tiny gap called a synapse.
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Glia cell
Glia (Greek word meaning glue) are the cells of the brain that provide
neurons with nourishment, protection, and structural support. There are
about 10 to 50 times more glia than nerve cells and are the most common
type of cells involved in brain tumors.
• Astroglia or astrocytes are the caretakers — they regulate the
blood-brain barrier, allowing nutrients and molecules to interact with
neurons. They control homeostasis, neuronal defense and repair, scar
formation, and affect electrical impulses.
• Oligodendroglia cells create a fatty substance called myelin that

insulates axons – allowing electrical messages to travel faster.
• Ependymal cells line the ventricles and secrete cerebrospinal fluid

(CSF).
• Microglia are the brain’s immune cells, protecting it from invaders

and cleaning up debris. They also prune synapses.(Hines, 2018)
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Theoretical Background
Definition
Schizophrenia refers to a condition and to a spectrum of disorders
that all involve a disconnection from reality, including hallucinations
and delusions. It also affects a person’s ability to recognize the
symptoms they have of this condition. It’s a severe condition, but is
treatable, and many people with it can still live happy, fulfilling
lives. These are conditions where a person experiences some form of
“disconnection” from reality. Those disconnections can take several
different forms (Cleveland Clinic, n.d.).
Etiology
Schizophrenia can have a range of causes. There is a lot that
researchers still don't know and it is likely to be caused by a
combination of genetic, personal and environmental factors. These
factors will be different for everybody but may include stressful life
events, drug and alcohol use, genetic inheritance and differences in
brain chemistry.
Highly stressful or life-changing events may sometimes trigger

schizophrenia. These can include: being abused or harassed, losing
someone close to you, being out of work, feeling lonely or isolated,
having money problems, becoming homeless (Mental Health and
Schizophrenia, 2022).
Clinical Manifestations
According to the DSM-5, a schizophrenia diagnosis requires the
following clinical manifestation: Firstly, the patient has to have at
least two of five main symptoms. These symptoms are delusions,
hallucinations, disorganized or incoherent speaking, disorganized or
unusual movements and negative symptoms. Secondly, Duration of symptoms
and effects. The key symptoms you have must last for at least one month.
The condition’s effects (whether or not they meet the full criteria for
the symptoms) must also last for at least six months. Lastly, Social or
occupational dysfunction. This means the condition disrupts either your
ability to work or your relationships (friendly, romantic, professional
or otherwise). (Cleveland Clinic, n.d.).
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Management
Medical Management
In most cases, the combination of right medication and
psychotherapy is implemented for managing schizophrenia therapeutically.
Antipsychotic Medications
Schizophrenia is mostly treated with antipsychotic drugs.
Hallucinations, delusions, and disorganized thinking are among the most
common of the symptoms of schizophrenia that medication can help
alleviate or get rid of. Antipsychotic drugs are also known as
neuroleptics. This class of drug is primarily used to treat psychosis,
schizophrenia and many other range of psychotic disorders. There are two
types of antipsychotic drugs which are included as typical and atypical
antipsychotic drugs. Typical antipsychotics primarily affect the
dopamine system. However, atypical medications also affect the
neurotransmission of serotonin (5-HT), norepinephrine, and/or histamine.
These drugs are known as serotonin-dopamine antagonists because they
have more effects to dopamine receptor blockade. Knowing that atypical
antipsychotics were effective not only against the positive but also
against the negative symptoms of schizophrenia. Furthermore, they are
less likely to cause extrapyramidal motor side effects. Typical
antipsychotic drugs reduce dopamine transmission and decrease the
concentration of dopamine. Also blocks acetylcholine, histamine, and
norepinephrine(Chokhawala & Stevens, 2023).
Psychotherapy
Talking with a therapist, psychiatrist, or other mental health
professional during psychotherapy is a method for addressing mental
health problems. It is often referred to as counseling, psychosocial
treatment, talk therapy, or just therapy. Psychosocial therapies can
also be helpful in the management of schizophrenia by changing their
thought patterns and behaviors. Psychotherapies may involve
psychoeducation, art therapy, recreational therapy, play therapy, dance
therapy and music therapy.
Psychoeducation
The process of educating patients about psychological or mental
health problems, including their causes, symptoms, and possible
treatments, is known as psychoeducation. Increased knowledge and
understanding of a specific mental health issue or condition is the aim
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of psychoeducation, which also aims to assist people in learning skills

and coping mechanisms to help them manage their symptoms or enhance their
general well-being. Various topics may be covered in psychoeducation,
including the warning signs and symptoms of various mental health issues,
the impact of stress on mental health, the advantages of self-care and
healthy living practices, and techniques for controlling negative
emotions and thoughts. It may also contain details on various therapies
and how to get hold of mental health services (Xia et al., 2011).
Art Therapy
Art therapy is a method of using creative techniques to treat
psychological illnesses and improve mental wellness. The concept of art
therapy is based on the theory that artistic expression can promote
recovery and mental health. With patients that range from young children
to older adults, a specialist in art therapy can use a number of artistic
techniques, such as collage, painting, sculpting, and drawing. Patients
who have experienced emotional trauma, physical violence, domestic
abuse, anxiety, depression, and other psychological issues can benefit
from expressing themselves creatively.(Cherry, 2022)
Occupational/Recreational Therapy
Occupational therapy is a type of health care that helps to solve
the problems that interfere with a person’s ability to do the things
that are important to everyday things like leisure activities, self-
care, and being productive. It involves the use of assessment and
intervention to develop, recover, or maintain the meaningful activities,
or occupations, of individuals, groups, or communities. The primary goal
of occupational therapy is to enable people to participate in the
activities of everyday life (WFOT, 2012).
Play Therapy
Play therapy is a method of therapy that uses play to uncover and
deal with psychological issues. Play therapy can also encourage use of
language or improve fine and gross motor skills. Play therapy can be
used to observe and gain insights into a person’s problems. This can
then help the individual explore emotions and deal with unresolved
trauma. Through play, individuals can learn new coping mechanisms and
how to redirect inappropriate behaviors. Play isn’t just for kids, and
neither is play therapy. Teenagers and adults can also have a difficult
time expressing their innermost feelings in words. Adults who may benefit
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from play therapy include those affected by intellectual disabilities,

dementia, chronic illness, trauma and physical abuse and anger management
issues (West, 2022).
Music Therapy
Music Therapy is the clinical & evidence-based use of music
interventions to accomplish individualized goals within a therapeutic
relationship by a credentialed professional who has completed an approved
music therapy program. Music therapy interventions can address a variety
of healthcare & educational goals as it promotes wellness, manage stress,
alleviate pain, express feelings, enhance memory, improve communication,
promote physical rehabilitation and many more. It is an evidence-based
therapy well-established in the health community. Music therapy
experiences may include listening, singing, playing instruments, or
composing music. Research has shown that music therapy can improve
memory, attention and cognitive function. It can help increase core
executive functions, self-awareness, inhibition, non-verbal and verbal
working memory, emotional self-regulation, self-motivation, planning and
problem solving and lastly it helps increase memory and attention (Wong,
2023).
Dance Therapy
Dance/movement therapy, usually referred to simply as dance therapy
or DMT, is a type of therapy that uses movement to help individuals
achieve emotional, cognitive, physical, and social integration. Movement
is a language, our first language. Movement can be functional,
communicative, developmental, and expressive. It is an assessment tool
and a primary mode of intervention which is beneficial for both physical
and mental health, dance therapy can be used for stress reduction,
disease prevention, and mood management. This therapy is a holistic
approach to healing, based on the empirically supported assertion that
mind, body, and spirit are inseparable and interconnected; changes in
the body reflect changes in the mind and vice versa (West, 2022).
Surgical Management
Schizophrenia is a chronic and severe mental disorder that affects
how a person thinks, feels, and behaves. While there is no cure for
schizophrenia, it can be treated with a combination of medications and
therapies. Surgical management of schizophrenia, also known as
psychosurgery or neurosurgery for mental disorders, is a type of brain
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surgery that is performed to alleviate severe and treatment-resistant

symptoms of schizophrenia. This type of surgery is considered a last
resort and is only used in extreme cases where all other treatment
options have failed. The most common type of psychosurgery for
schizophrenia is called a prefrontal lobotomy, which involves cutting
or destroying the connections between the prefrontal cortex and the rest
of the brain. This surgery was popular in the early 20th century but is
now rarely performed due to its high risk of complications and negative
side effects, such as personality changes, cognitive impairment, and
emotional blunting (Soares et al., 2013).
These techniques are being replaced by stereotactic gamma-knife

surgery. Modern stereotactic psychosurgery depends upon the following
procedures:
Cingulotomy
Cingulotomy is a neurosurgical procedure in which doctors use
specialized tools to inactivate brain tissue in areas that are associated
with a variety of debilitating diseases, including chronic pain and
obsessive-compulsive disorder (OCD). It was first developed in the 1960s
and has been studied extensively since that time. Over the past decades,
advances in technology have made this procedure minimally invasive,
improving safety and recovery time.
Chronic pain patients who benefit from this treatment report an improved
quality of life and less preoccupation with their pain. Cingulotomy
targets the "bothersome" aspect of pain (Soares et al., 2013).
Subcaudate Tractotomy
Stereotactic subcaudate tractotomy is a surgical procedure
performed for the alleviation of intractable affective disorders. It
involves the destruction of bifrontal pathways located beneath and in
front of the head of the caudate nucleus. Subcaudate tractotomy was the
most commonly used form of psychosurgery in the UK from the 1960s to the
1990s. It targets the lower medial quadrant of the frontal lobes,
severing connections between the limbic system and supra-orbital part
of the frontal lobe (Thomas, 2018).
Limbic Leucotomy
Limbic leucotomy is a combination of subcaudate tractotomy and
anterior cingulotomy.It targets the lower medial quadrant of the frontal
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lobes, severing connections between the limbic system and supra-orbital

part of the frontal lobe.Limbic leucotomy was described in 1973 by Kelly
and Richardson. In this stereotactic technique, cingulotomy is paired
with SCT to make use of the effects on the autonomic nervous system and
the patient’s responses. The improvement was seen in up to 80% of
patients (Thomas, 2018). Today, newer and less invasive forms of
psychosurgery are being researched and developed, such as deep brain
stimulation (DBS) and transcranial magnetic stimulation (TMS). DBS
involves implanting electrodes in specific areas of the brain and
delivering electrical impulses to modulate brain activity, while TMS
uses magnetic fields to stimulate nerve cells in the brain.
However, it's important to note that while these newer forms of

psychosurgery show promise in treating schizophrenia, they are still
considered experimental and are not yet widely available as a treatment
option. Additionally, they still carry risks and potential side effects
that need to be carefully weighed against the potential benefits for
each individual patient.
Nursing Management
Nursing management of schizophrenia involves a comprehensive

approach that aims to address the various physical, psychological, and
social needs of patients with the condition. Some of the key aspects of
nursing management of schizophrenia include the following:
1. Medication management: The nurse plays a crucial role in ensuring

that the patient adheres to the prescribed medication regimen. This
involves monitoring the patient for any adverse effects or
medication interactions and providing education on the benefits
and risks of the medication.
2. Symptom management: The nurse should be able to identify the
symptoms of schizophrenia and provide interventions to manage them.
This may involve providing cognitive-behavioral therapy,
supportive therapy, or other interventions to help the patient cope
with their symptoms.
3. Safety management: The nurse should be aware of any potential
safety risks associated with the patient's condition, such as self-
harm or aggression towards others. The nurse should implement
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appropriate measures to ensure the safety of the patient and

others.
4. Health promotion: The nurse should provide education on the
importance of maintaining a healthy lifestyle, including regular
exercise, healthy eating, and avoiding substance abuse.
5. Family and social support: The nurse should work with the patient's
family and support system to provide emotional support and
education on how to care for the patient.
6. Community resources: The nurse should be aware of the various
community resources available to patients with schizophrenia, such
as support groups, vocational training programs, and housing
services. The nurse should help the patient navigate these
resources and access the appropriate services.
In summary, nursing management of schizophrenia involves a holistic

approach that addresses the physical, psychological, and social needs
of the patient. The nurse plays a critical role in coordinating care and
ensuring that the patient receives comprehensive treatment and support
(Dodi, 2011).
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CHAPTER IV
CASE ANALYSIS AND INTERVENTIONS
Psycho-Pathophysiology
Figure 4.1. Pathophysiology of Schizophrenia
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Interpretation: In schizophrenia, the following factors have been

considered to be part of its etiology. The focus in terms of genetic
factors is on identical twins which pose a 50% risk for the development
schizophrenia. Fraternal twins only have 15% of the risk. However, the
patient does not have a twin as per his verbalization. He also does not
have any significant others with him inside the facility to verify this
information (Frankenburg, 2021). Neurochemical factor is focused on the
neurotransmitter dopamine. When there is increased transmission of
dopamine positive signs would manifest. When there is a decrease in the
dopamine transmission, negative signs would manifest. The positive signs
manifested by the patients include religious, flight of ideas, word
salad, and neologism. These positive signs became the basis in
identifying the nursing diagnosis for the case of patient N.A.A.
Medical Management
Schizophrenia treatment will center on managing symptoms. Patient
may need to stay on medication for a long time, possibly even for life.
Psychotherapy, a kind of talk therapy, will likely also be a big part
of the plan to help understand and manage the symptoms. The right
treatments, along with practical and emotional support from loved ones,
will go a long way to help the patient navigate life. Medical management
for schizophrenia typically involves a combination of pharmacological
interventions and psychotherapy.
Antipsychotic medications
These medications are often used to manage the psychotic symptoms

of schizophrenia, such as hallucinations and delusions. Some commonly
prescribed antipsychotics include risperidone, olanzapine, and
quetiapine. However, medication selection is individualized, and the
choice of antipsychotic may depend on a number of factors such as side
effect profile, effectiveness, and patient preference.(Videbeck, S. L.
(2023))
Nursing Responsibilities:
1. Educate patient about the side effects that may occur while on
antipsychotic meds.
2. Educate patient to not discontinue the medication when experiencing
side effects. But instead it should be reported to the physician.
40
COLLEGE OF NURSING
3. Encourage patient to drink sugar free beverage and candies to ease

dry mouth.
4. Educate patient on managing or avoiding unpleasant side effects.
5. Encourage patient to use sunscreen or avoid sun exposure because
photosensitivity is one of the side effects of this medications.
6. Educate patient to monitor the amount of sleep or drowsiness they
feel.
7. Instruct patient to avoid driving.
8. Encourage patient to use pillbox or record the dose to avoid missed
dose.
9. Educate patient to take missed dose if it’s late for only 3 to 4 hours
and omit the forgotten dose if it exceeds 4 hours
Mood stabilizers
Mood stabilizers such as lithium, valproic acid, and carbamazepine

may be used to manage mood symptoms, particularly when there is a history
of bipolar disorder. These medications can help regulate mood and prevent
episodes of mania or depression. (Videbeck, S. L. (2023))
1. Monitor blood levels periodically.

2. Take medications with meals.
3. Educate patient to avoid driving.
Antidepressant medications
Antidepressants may be used to manage depression or anxiety

symptoms in individuals with s. However, their schizophrenia can be
controversial as some studies suggest they may worsen symptoms or
increase the risk of manic episodes. (Videbeck, S. L. (2023))
1. Educate patient to take SSRIs first thing in the morning unless

sedation is a problem.
2. Educate patient if he missed a dose, they can take it up to 8 hours
after the missed dose.
3. Educate patient on how to minimize the side effects of the medication.
4. Encourage patient to take precaution when performing activities that
nrequires sharp and alert reflexes.
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COLLEGE OF NURSING
5. Educate patient when taking MAOIs to observe dietary restrictions to

avoid life threatening hyperadrenergic blocker.
6. Give the client a list of food to avoid.
Psychotherapy
Psychotherapy is a treatment of any psychological disorders and

mental distress through verbal ang psychological techniques that allows
expression and understanding of one’s mood, feelings, thoughts and
behaviors. (Evans, O. (2023, May 10))
1. Encourage patient to participate on the therapy.
2. Guide patient during the therapy.
3. Promote independence.
Pharmacologic Management
Generic name: Clozapine
Brand name: Clozaril, Fazaclo, Versacloz
Classification: Atypical Antipsychotics
Indications: Treatment of severely ill patient with Schizophrenia who

fail to respond adequately to standard antipsychotic treatment.
Because of the risk of severe neutropenia and of seizure associated
with its use, Clozapine should be used only in patients who have
failed to respond adequately to standard antipsychotic treatment.
Clozapine is also indicated for reducing the risk of recurrent
suicidal behavior in patients with Schizophrenia or schizoaffective
disorder who are judged to be at chronic risk for re-experiencing
suicidal behavior, based on history and recent clinical state.
Suicidal behavior refers to actions by a patient that put him/herself
at risk for death.
Dosage: 200mg
Route: Oral
Frequency: Twice a day
Mechanism of Action: The mechanism of action of clozapine is unknown.

However, it has been proposed that the therapeutic efficacy of clozapine
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COLLEGE OF NURSING
in schizophrenia is mediated through antagonism of the dopamine type 2

(D2) and the serotonin type 2A (5-HT2A) receptors. Clozapine also acts
as an antagonist at adrenergic, cholinergic, histaminergic, and other
dopaminergic and serotonergic receptors. Clozapine demonstrated binding
affinity to the following receptors: histamine H1 (Ki 1.1 nM), adrenergic
α1A (Ki 1.6 nM), serotonin 5-HT6 (Ki 4 nM), serotonin 5-HT2A (Ki 5.4
nM), muscarinic M1 (Ki 6.2 nM), serotonin 5-HT7 (Ki 6.3 nM), serotonin
5-HT2C (Ki 9.4 nM), dopamine D4 (Ki 24 nM), adrenergic α2A (Ki 90 nM),
serotonin 5-HT3 (Ki 95 nM), serotonin 5-HT1A (Ki 120 nM), dopamine D2
(Ki 160 nM), dopamine D1 (Ki 270 nM), dopamine D5 (Ki 454 nM), and
dopamine D3 (Ki 555 nM). Clozapine acts as an antagonist at other
receptors, but with lower potency. Antagonism at receptors other than
dopamine and 5HT2 with similar receptor affinities may explain some of
the other therapeutic and side effects of clozapine. Clozapine's
antagonism of muscarinic M1-5 receptors may explain its anticholinergic
effects. Clozapine's antagonism of histamine H1 receptors may explain
the somnolence observed with this drug. Clozapine's antagonism of
adrenergic α1 receptors may explain the orthostatic hypotension observed
with this drug.
Adverse Effects: The common adverse events associated with clozapine

overdose are hypersalivation, tachycardia, hypotension, sedation,
delirium, coma, respiratory depression, or failure. There are few reports
of cardiac arrhythmias, aspiration pneumonia, and seizure.
Nursing Responsibilities: Monitor patient regularly for signs and

symptoms of diabetes mellitus. Encourage voiding before taking drug to
decrease anticholinergic effects of urinary retention. Follow guidelines
for discontinuation or reinstitution of the drug. Educate patient on
seriousness of potential agranulocytosis.
Generic name: Biperiden
Brand name: Akineton HCL
Classification: Anticholinergic Antiparkinson Agents
Indications: Biperiden reduces the effects of certain naturally

occurring chemicals in your body that may become unbalanced as a result
of disease (such as Parkinson's disease), drug therapy, or other causes.
Biperiden is used to treat the stiffness, tremors, spasms, and poor
43
COLLEGE OF NURSING
muscle control of Parkinson's disease. It is also used to treat and

prevent these same muscular conditions when they are caused by drugs
such as chlorpromazine (Thorazine), fluphenazine (Prolixin),
perphenazine (Trilafon), and others.
Dosage: 2mg 1 tab (PO) as needed for ExtraPyramidal syndrome
Route: Oral
Frequency: 1 tab, Three times a day
Mechanism of Action: Blocks cholinergic activity in the CNS, which is

partially responsible for the symptoms of Parkinson's disease. Restores
the natural balance of neurotransmitters in the CNS. Therapeutic Effects:
Reduction of rigidity and tremors.
Adverse effects: If you experience any of the following serious side

effects, stop taking biperiden and seek emergency medical attention:
1. An allergic reaction (difficulty breathing; closing of your throat;

swelling of your lips, tongue, or face; or hives);
2. Unusual fever;
3. Fast or irregular heartbeat;
4. Anxiety, hallucinations, confusion, agitation, hyperactivity, or loss
of consciousness;
5. Seizures;
6. A rash; or
7. Eye pain.
1. Monitor BP and pulse after IV administration. Advise patient to make

position changes slowly and in stages, particularly from recumbent to
upright position.
2. Monitor for and report immediately: Mental confusion, drowsiness,
dizziness, agitation, hematuria, and decrease in urinary flow.
3. Assess for and report blurred vision.
4. Monitor I&O ratio and pattern.
Generic Name: Fluphenazine Decanoate
Brand Name: Psycosin
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COLLEGE OF NURSING
Route: (I.M.)
Classification: Antipsychotic
Indications: For treatment of a variety of psychiatric disorders

including Schizophrenia, Mania, Severe Anxiety, and Behavioral
disturbances.
Dosage: 0.5mL every month intramuscularly. The optimal amount of the

drug and frequency of administration must be determined for each patient,
since dosage requirement have been found to vary with clinical
circumstances as well as with individual response to the drug. Or as
prescribed by the physician.
Adverse Effects: The side effects most frequently reported with

Phenothiazine compounds are extrapyramidal symptoms including pseudo
parkinsonism, dystonia, dyskinesia, akathisia, oculogyric crises,
opisthotonos, and hyperreflexia. Muscle rigidity sometimes accompanied
by hyperthermia has been reported following use of Fluphenazine
decanoate.
Nursing Responsibilities
1. Monitor signs of allergic reactions, including pulmonary symptoms

(laryngeal edema, wheezing, dyspnea) or skin reactions (rash,
pruritus, urticaria).
2. Notify physician or nursing staff immediately if these reactions
occur.
3. Assess BP and compare to normal values
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COLLEGE OF NURSING
Nursing Care Management
The following are the identified nursing problem according to

prioritizations:
1. Risk for self-directed injury related to mental health disorder

2. Risk for infection related to poor personal and environmental
sanitation
3. Impaired verbal communication related to cognitive impairment as
evidenced by frequent movement from place to place
4. Continuous wandering related to cognitive impairment as evidenced by
frequent movement from place to place
5. Disturbed sleep patterns secondary to religious delusions as evidenced
frequent awakenings at midnight and dawn
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COLLEGE OF NURSING
Nursing Care Plans

NURSING CARE PLAN
Patient’s Name (Initials): N.A.A Diagnosis: Schizophrenia

Age: 49 years old Sex: Male Physician: Dr. A.J.A
Room No.: Male Ward
Nursing Diagnosis: Disturbed sleep pattern secondary to religious

delusions as evidenced by frequent awakenings.
Definition: Time-limited awakenings due to external factors
Reference: Doenges, M.E., Moorhouse, M.F.,& Murr, A.C. (2019)Nurse’s

Pocket Guide Diagnoses, Prioritized Interventions, and Rationales. F.
A. Davis Company
Scientific Analysis: On sleep disruptions in schizophrenia patients
during actively psychotic states, during at-risk stages, and during
remission, there is a lengthy and vast body of literature.The
management of sleep issues in this illness is increasingly being
given substantial consideration. Because of the substantial
connection between the two conditions, research on schizophrenia is
extremely applicable to delusional disorders. The degree of paranoid
ideation, aggression and violence, poor quality of life, memory
functions, physical activity, and dopamine signaling have all been
linked to poor sleep quality in schizophrenia.
Reference: Rodriguez, A. G., Labad, J., Seeman, M. V. (2020). Sleep

Disturbances in Patients with Persistent Delusions: Prevalence,
Clinical Associations, and Therapeutic Strategies. National Center
for Biotechnology Information, 2(4), 399-415. https://doi.org/
10.3390/clockssleep2040030
Subjective: Objective:
“Matulog ko alas otso, mumata ko Presence of religious delusions
ug alas dose kay mangadye dayun
pagka alas tres na pd ug alas 4”,
as verbalized by the patient.
Goal:
Short Term
After 5 hours of nursing intervention, that patient will be able to:
1. Identify interventions that promote sleep
2. Identify ways that increase sense of well-being and feeling
rested
Long Term
After 1 week of nursing intervention, the patient will be able to:
3. Improve sleep
Intervention Rationale
Independent
1. Assess client’s usual sleep
patterns and compare with 1. To ascertain intensity and
current sleep disturbance, duration of problems
relying on client report of
problem
2. Listen to reports of sleep

quality and response of lack of 2. Helps clarify client’s
good sleep perception of sleep quantity and
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COLLEGE OF NURSING
quality and response to inadequate

sleep
3. Teach patient on proper food 3. Helps patients understand

and fluid intake, avoid caffeine, the impact of these substances on
alcohol and smoking their sleep and overall well-
being, enabling them to make
necessary changes for better sleep
quality.
4. Large meals eaten so close

4. Teach patients to avoid to bedtime can have an impact on
having heavy meals before bed digestion and sleep quality.
Dependent 5. Ensuring efficacy and

5. Administer prescribed reducing negative side effects.
medication
6. For specific interventions

Collaborative and/or therapies, including
6. Refer to physician or sleep medications, biofeedback
specialist as indicated
Evaluation:
Short Term
Goals are partially met, patient was able to:
1. Practice appropriate behavior that promote sleep
2. Demonstrate ways that increase sense of well-being and feeling
rested
Long term:
Goals are partially met, patient was able to:
After 1 week of nursing intervention, the patient will be able to:
3. Report improved sleep
NURSING CARE PLAN

Room No.: Male Ward
Nursing Diagnosis:
Continuous wandering related to cognitive impairment as evidenced by
frequent movement from place to place
Definition:
Meandering, aimless, or repetitive locomotion that exposes the
individual to harm; frequently incongruent with boundaries, limits,
or obstacles
Reference:
Doenges, M.E., Moorhouse, M.F.,& Murr, A.C. (2019)Nurse’s Pocket
Guide Diagnoses, Prioritized Interventions, and Rationales. F. A.
Davis Company
Scientific Analysis:
Schizophrenia, brief psychosis, depressive illness and dissociative
48
COLLEGE OF NURSING
disorders were the common psychiatric disorders associated with the

condition. The common preceding factor of wandering behavior was
relapse of psychiatric illness.
Reference:
Price JD, Hermans DG, Grimbley Evans J. Subjective barriers to prevent
wandering of cognitively impaired people. Cochrane Database Syst Rev
2000; 4: CD001932
Moving from various places throughout

“Adto sa ko didto Ma’am ha” the facility
“Mangihi sa ko”
Goal:
Short Term:
After 5 hours of nursing intervention, the patient will be able to:
1. Be free of injury, ot unplanned exits
Long Term
After 2 days of nursing intervention, the patient will be able to:
1. Modify environment, as indicated, to enhance safety
2. Provide for maximal independence of client
3. Improve coping abilities with the patient's cognitive
condition, risk of wandering, and care demands.
49
COLLEGE OF NURSING
Interventions Rationale
Independent
1. Evaluate client’s
mental status during 1. Can reveal circumstances under
daytime and nighttime, which client is likely to wander
noting when the
client’s confusion is
most pronounced and
when client sleeps
2. Client may demonstrate searching

2. Identify client’s behavior (e.g. looking for lost item)
reason for wandering, if or be experiencing sensations without
possible ability to express the actual need
3. To determine necessary changes

to environment
3. Ascertain if client has

delusions due to shadows,
lights and noises 4. To accommodate safe wandering
4. Provide a safe place

for client to wander, away 5. To help identify likelihood of
from safety hazards wandering
5. Evaluate client’s past

history 6. It may increase agitation,
sensory deprivation, and falls;
contribute to wandering behavior
6. Avoid using physical or

chemical restraints to
control wandering behavior 7. This technique seeks to refocus
the patient’s attention so that he can
prevent wandering. In patients at risk
of wandering, redirecting one’s energy
to another meaningful activity is
beneficial.
7. Redirect the patient’s
pacing or restless behavior
into productive activities or
exercise.
8. An atypical antipsychotic
medication that is primarily used to
treat schizophrenia but may indirectly
reduce symptoms that can interfere with
daily activities
Dependent
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COLLEGE OF NURSING
9. To promote wellness and a sense

8. Administer prescribed of belongingness to the community
medications as directed to
manage symptoms of
schizophrenia and reduce the
patient's risk for injury
Collaborative
9. Refer to community
resources, such as day-care
program and support groups
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COLLEGE OF NURSING
Evaluation:
Short term
GOAL MET
After 5 hours of nursing intervention, the patient was able to:

1. Know how to be safe from injury and properly time exits
Long term
GOAL MET
After 2 days of nursing intervention, the patient was able to:

1. Modify the environment and know precautionary measures to
maintain safety
2. Improve sense of independence in doing tasks
3. Develop safe coping mechanisms to deal with the patient’s
cognitive condition and wandering
NURSING CARE PLAN

Room No.: Male Ward
Nursing Diagnosis: Risk for self-directed injury related to mental

health disorder
Definition: At risk for behaviors in which an individual demonstrates

that he or she can be physically, emotionally, and/or sexually
harmful to self
Reference:
Doenges, M.E., Moorhouse, M.F.,& Murr, A.C. (2019)Nurse’s Pocket
Guide Diagnoses, Prioritized Interventions, and Rationales. F. A.
Davis Company
Scientific Analysis: The likelihood of self-injury increases when one
has a high level of self-criticism and has difficulty solving
problems. Additionally, there is a strong correlation between self-
harm and a number of mental health disorders, including eating
disorders, post-traumatic stress disorder, depression, anxiety
disorders, and borderline personality disorder.
Reference: Mayo Clinic (n.d.). Self-injury/cutting - Symptoms and

causes, Retrieved April 6, 2023 from
https://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-
causes/syc-20350950#:
“Ako gi habwa ang akong basura kay Risk Factors:
nangita ko sa akong sudlay”, as History of alcoholism
verbalized by the patient. Age 45 years old and over
Goal:
Short Term:
After 5 hours of nursing intervention, the patient will be able to:
1. Identify factors that contribute to the possibility to the
injury
2. Identify appropriate behavior and lifestyle changes that would
reduce the risk factors and protect self from injury
52
COLLEGE OF NURSING
Long Term
After 2 days of nursing intervention, the patient will be able to:
1. Modify environment as indicated to enhance safety
Independent
1. Establish rapport
1. To gain the trust of the
patient
2. Note the client’s age,

gender, developmental age, 2. These affect the client’s
decision making ability, and level ability to protect self and
of cognition/ competence influence choice of interventions
and teaching
3. Assess mood, coping ability

and personality styles
3. That may result in

carelessness or increased risk
taking without considerations of
consequences
4. Evaluate the individual’s
emotional and behavioral response
to violence in environmental 4. This may affect the
surroundings client’s view of and regard for
own/others’ safety
5. Ascertain knowledge of
safety needs and injury
prevention 5. Information may reveal
areas of misinformation, lack of
Dependent knowledge, need for teaching
6. Check doctor’s order
Collaborative 6. To provide dependent based

7. Refer to other professional care
resources, as indicated (e.g.
counseling, psychotherapy)
7. For collaborative care and

8. Encourage participation in to provide furthermore
self-help programs, such as intervention
assertiveness training, positive
self image
8. To enhance self-esteem and

sense of self worth
Evaluation:
Short term:
Goals are partially met, the patient was able to:
1. Verbalize understanding of individual factors that contribute
to possibility of injury
2. Demonstrate behaviors, lifestyle changes to reduce risk factors
and protect self from injury
Long term:
Goals are partially met, the patient was able to:
1. Be free of injury
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COLLEGE OF NURSING
NURSING CARE PLAN

Room No.: Male Ward
Nursing Diagnosis: Risk for infection related to poor personal

hygiene and environmental sanitation
Definition: At risk for being invaded by pathogenic organisms
Reference: Doenges, M.E., Moorhouse, M.F.,& Murr, A.C. (2019)Nurse’s

Pocket Guide Diagnoses, Prioritized Interventions, and Rationales. F.
A. Davis Company
Poor sanitation is associated with the spread of typhoid, cholera,
dysentery, intestinal worm infections, and polio, all of which are
diarrheal illnesses. Stunting is made worse, and antimicrobial
resistance spreads as a result. Risk for infection can be heightened
by anything that interferes with the body’s ability to fight off
pathogenic invasions.
Reference:
World Health Organization: WHO. (2022). Sanitation. www.who.int.
https://www.who.int/news-room/fact-sheets/detail/sanitation
Risk factors:
• Kissing the floor associated
with his religious delusion
• Poor food hygiene by eating
• Unclean water bottle
Goal:
Short Term
After 5 hours of nursing interventions, the client will be able to:
1. Verbalize understanding of individual causative or risk
factor(s).
2. Patient will demonstrate a meticulous hand washing
technique.
Long Term
After 1 week of nursing interventions, the client will be able to:
1. Demonstrate techniques, lifestyle changes to promote safe
environment
2. Identify interventions to prevent or reduce risk of
infection.
Independent
1. Emphasize constant and 1. This is a first-line defense

proper hand hygiene by all against healthcare-
caregivers between associated infections (HAIs)
therapies and clients.
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COLLEGE OF NURSING
Instruct client/SO/
visitors to wash hands, as
indicated.
2. This may be accidental or

2. Environmental exposure intentional. Exposure occurs in
different ways, such as use of
specific microorganisms.
Accidental exposures can result
from exposures to contaminants
arising from commonplace processes
(e.g. wastewater recycling and
animal contact)
3. Personal habits or living

situations such as persons sharing
close quarters and or equipment
3. Identify the lifestyle
of client
4. Proper nutrition and a

balanced diet support the immune
systems’ responsiveness and
enhance the health of all the
4. Encourage intake of body’s tissues
protein-rich and calorie-rich
foods and encourage a balanced
diet
5. Explain to the client how
infections can be transmitted from
sharing personal items.
5. Instruct the client not to

share personal care items (e.g., 6. Adequate sleep is an
toothbrush, towels, etc.) essential modulator of immune
responses. A lack of sleep can
weaken immunity and increase
susceptibility to infection.
6. Encourage sleep and rest
7. Other people can spread

infections or colds to a
susceptible patient (e.g.,
immunocompromised) through direct
contact, contaminated objects, or
air currents.
7. Teach the importance of
avoiding contact with individuals
who have infections or colds.
Teach the importance of physical
distancing.
8. To determine effectiveness
of therapy or presence of side
Dependent effects
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COLLEGE OF NURSING
8. Administer/monitor
medication regimen and note the
client’s response
9. Knowledge of ways to reduce
or eliminate germs reduces the
Collaborative likelihood of transmission.
9. Educate clients and SO

(significant other) about
appropriate cleaning,
disinfecting, and sterilizing
items.
Evaluation:
Short Term
GOAL PARTIALLY MET
After 5 hours of nursing interventions, the client was able to:

1. Verbalize risk factors but continued doing it
2. Demonstrate hand washing technique by performing a very care and
precise way of handwashing
Long Term
GOAL NOT MET
After 1 week of nursing interventions, the client was not able to

identify interventions to prevent or reduce risk of infection by
continuously kissing the floor after prayer and showing poor
sanitation in eating
NURSING CARE PLAN

Room No.: Male Ward
Nursing Diagnosis: Impaired verbal communication related to altered
perceptions as evidenced by speech disturbances
Definition:
Impaired verbal communication is a common nursing diagnosis for

individuals with schizophrenia, as they may experience difficulty
expressing their thoughts and ideas in a coherent and logical manner,
leading to inappropriate responses and altered social interaction. The
altered social interaction is a result of the impaired verbal
communication and the cognitive and emotional changes associated with
schizophrenia. Patients with schizophrenia may struggle with engaging
in conversations, initiating interactions, or following social cues
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COLLEGE OF NURSING
and norms, leading to social isolation and difficulties in forming and

maintaining relationships.
Reference: Cassata, C. (2021, July 30). How to Communicate with

Someone Living with Schizophrenia. Retrieved from psychcentral.com:
https://psychcentral.com/schizophrenia/how-to-communicate-with-
someone-with-schizophrenia
Due to a variety of causes, including disordered thinking, trouble

concentrating, and auditory hallucinations, clients with schizophrenia
frequently have verbal communication impairment. It may be difficult
for the client to communicate consistently and clearly as a result of
these symptoms, making meaningful communication difficult.
Disorganized speech is a hallmark of schizophrenia that is reliably
linked to subpar performance on cognitive tasks. Communication
impairment, also known as communication failures in speech, is
characterized by a phrase or passage of speech whose meaning is
sufficiently ambiguous as to undermine the passage's overall meaning.
Reference: Merrill, et al (2017).

https://nurseslabs.com/schizophrenia-nursing-care-plans/
“Okay ra. Nalipay ko sa akong gi Difficulty comprehending and

gama kay nay budget food” as maintaining conversation
verbalized by the client when
asked how he was doing.
Alogia, there is poverty in the
“Nag volleyball mi gahapon syete content of answers.
sentos mi kabuok na bola amoa gi
dula nya nay pastor gikan cebu ni Difficulty forming sentences or
misa” as verbalized by the words
patient when he was asked what he
was doing yesterday. Word salad, there are unconnected
words.
“Oh, A,B,C, D, E , F, G, H, I ,J
,K , L, M, N, O, P, Q, R, S, T,U, Neologism, making of new words.
V, W, X,Y,Z boys and girrss sing
with me nenenegralalalala naw ay Loose association, poorly related
no may ABC” as verbalized by the thoughts and ideas.
patient when asked if he knows
how to sing ABC Thought blocking, patient
experiencing stopping of thought
in the middle of the sentence.
57
COLLEGE OF NURSING
Goal: After the two weeks of care, the patient will be able to:
Short Term: After 5 days of nursing interventions, the client will be

able to:
1.The client will be able to communicate in a manner that can

be understood by others with the help of medication and
attentive listening by the time of discharge.
2.The client will spend time with one or two other people on
structured activity-neutral topics.
3.The client will learn one or two diversionary tactics that
work for him/her to decrease anxiety, hence improving the
ability to think clearly and speak more logically.
Long Term: After 2 weeks of nursing interventions, the client will be

able to:
1.The client will express thoughts and feelings in a coherent,

logical, goal-directed manner.
2.The client will demonstrate reality-based thought processes
in verbal communication.
3.The client will spend two to three five-minute sessions with
the nurse sharing observations in the environment within three
days.
Independent
● Establish rapport with ● Helps establish a trusting

client, smile and initiate relationship with the client,
eye contact, address by demonstrating care about the
preferred name, engage in client as a person.
brief social interaction if ● Client will more likely feel
appropriate by asking simple at ease, leading to improved
questions. communication and
● Kefrain from shouting when understanding.
directing speech to a ● To increase the likelihood of
confused client being understood.
● Keep communication simple, ● To promote better
and speak slowly and comprehension and maintain
clearly, in short sentences. communication.
● Reduce environmental noise ● An atypical antipsychotic
that can interfere with medication that is primarily
comprehension. used to treat schizophrenia
but may indirectly improve
Dependent impaired verbal
communication by reducing
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COLLEGE OF NURSING
● Administer prescribed symptoms that can interfere

medications with communication.
● Clozapine 200mg BID (PO) ● To provide specialized
● Biperiden HCL 2mg 1 tab (PO) interventions that can help
PRN for ExtraPyramidal the client improve
Syndrome communication
● Fluphenazine Decanoate 1 cc
IM
Collaborative
● Refer to appropriate
resources such as a speech
therapist if the condition
worsens.
Evaluation:
Client partially met the goal by:
- Verbalizing in a more understandable manner.

- Responding to some questions appropriately.
59
COLLEGE OF NURSING
Psychotherapy
Art Therapy
Art therapy is the use of artistic means to treat psychological

disorders and improve mental health. It is a technique based on the idea
that creative expression can promote healing and mental well-being. It
encourages people to express and understand emotions through artistic
expression and through the creative process. This therapy technique aims
to help patients massage their inner self in a way that may provide the
patient with a deeper understanding of him or herself. This allows them
to explore their emotions, foster self-esteem, confidence, and self-
awareness.
Figure 4.2 Art Therapy
For the Nurse:
1. To provide a platform for patients to communicate their inner

thoughts and feelings to assess their mental status.
2. To assess the patient’s current mental state.
3. To communicate effectively in delivering instructions to
patients.
4. To build trust and improve the patient-nurse relationship
professionally.
5. To offer clear, concise, and appropriate instructions and
guidelines
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COLLEGE OF NURSING
For the Patient
1. To learn more about oneself or become more conscious by exploring

their own inner thoughts and feelings.
2. To recognize the conflict that is causing them distress.
3. To express emotions and thoughts through the use of art
specifically through drawing.
4. To enhance their sensorimotor abilities while using their innate
motor the brain and muscular impulses.
5. To improve their ability to interact with others and communicate
through their artistic feelings during, and after creating it.
6. To encourage self-worth and build emotional resilience.
Occupational Therapy
Psychotherapy using tie-dye towels is a unique therapeutic approach

that supports individuals with mental challenges. It combines
traditional therapy with tie-dyeing to promote self-expression and
personal growth. Tie-dye towels serve as a medium for individuals to
express their thoughts and feelings through various therapeutic
activities. The tie-dye process allows for self-reflection and emotional
release, with the colorful patterns representing different aspects of
their lives. Student nurses guide participants in exploring the symbolism
of their creations, fostering insight and understanding for healing and
growth.
Figure 4.3 Tie-Dye Handkerchief
61
COLLEGE OF NURSING
For the student nurse:
1. The student nurse will act as facilitators during the therapy to

avoid any confusion and chaos
2. The student nurse will be able to improve their knowledge about
creativeness
3. The student nurse will give importance to concepts of food
preparation and hygiene when making the food
4. The student nurse will guide the patient all throughout the
therapy.
5. To be patient when teaching on how to do the tie-dye
For the patient:
1. Promote, maintain and/or restore functional independence in daily

living skills
2. Facilitate learning of skills and function essential for adaptation
to the environment.
3. The patient will be equipped with knowledge with regards to tye
die
4. Patient will be knowledgeable about the activity therapy.
5. Patient will learn patience while doing the therapy
6. Patient will be able to behave appropriately while doing the
therapy.
Psycho Education
Psychoeducation is an evidence-based therapeutic intervention

involving therapists providing their clients with education and
information about certain illnesses. Patients and family members who
receive psychoeducation are taught problem-solving and communication
techniques in a caring and supportive environment (Better Help Editorial
Team, 2023). The purpose of psychoeducation therapy is to help
individuals better understand their condition and its effects on their
daily life, as well as to provide them with the skills and knowledge
they need to manage their symptoms more effectively (Sarkhel et al.,
2022).
62
COLLEGE OF NURSING
Figure 4.4 Psychoeducation
For the nurse:
1. Plan and implement appropriate interventions to improve sleep

hygiene.
2. Provide health teaching to the patients about sleep hygiene
practices.
3. Evaluate the patient's participation during the activity.
4. Explain the importance of sleep.
5. Identify the factors that disturb sleep.
6. Educating patients on the importance of good sleep hygiene
practices and providing guidance on how to implement them.
7. Demonstrate empathy and understanding towards patients
experiencing sleep disturbances.
8. Be open-minded in listening to their sharing.
9. Demonstrate the necessary skills and techniques in presenting
psycho-education.
For the patient:
1. Establish and maintain a consistent sleep schedule.

2. Use relaxation techniques to calm the mind and body before
bedtime.
3. Develop effective coping strategies to manage stress and anxiety
that may interfere with sleep.
4. Understand the importance of regular sleep patterns for overall
health.
63
COLLEGE OF NURSING
5. Recognize the factors that can interfere with sleep, such as

caffeine and alcohol consumption.
6. Acquire knowledge on sleep hygiene practices.
7. Take an active role in promoting good sleep hygiene practices.
8. Be open to trying new techniques or modifications to improve
sleep quality.
9. Prioritize sleep hygiene as an essential component of overall
health and wellness.
Play Therapy
Figure 4.5 Play Therapy
Contract/Rules:
1. The patient should be ready to participate to the games and pay

attention to the facilitators.
2. The patients should go to the comfort room prior to the activity
to prevent from being excused while the mechanics are given and
explained.
3. The patients should listen while the presenters are talking and
explaining the mechanics of each game.
4. Avoid talking with each other while the presenters are talking in
front.
5. Avoid unnecessary movements. The patients should be cooperative by
asking questions when they don't understand the mechanics or some
details of the games.
6. The patients were able to enjoy and participate well in the games.
7. The patients should be able to achieve the game's objectives.
64
COLLEGE OF NURSING
Music and Dance Therapy
Figure 4.6 Music and Dance Therapy
For the student nurse:
1. To help patients develop skills for effective coping.

2. To provide patients an escape from negative thoughts or cravings.
3. To help the patients identify and appropriately express their
emotions.
4. To facilitate patients' expression and communication with other
people.
5. To provide the patients a strategy to reduce stress and gain self-
confidence.
6. To help the patients increase body awareness and healthy self-
image.
For the patients:
1. Patient will be able to express and explore their emotions and

thoughts
2. Patient will be able to show positive self-impression and growth
3. Patient will be able to convey happiness and a positive mood.
65
COLLEGE OF NURSING
Progress Notes
DATE PROBLEM MEDICAL/SURGICAL NURSING OUTCOME

INTERVENTION INTERVENTION
May 9, Patient was Psychotherapy Establish Patient is

2023 diagnosed (Dialectical rapport with well oriented
with Behavioral Therapy) the patient. and answers
Schizophreni -Provide a questions
Medications
a last 2004 therapeutic without
● Chlorpromazine relationship hesitation.

100 mg -Gather
● Haloperidol 1 patient's
amp data -
● Akinetone 2 mg Monitor for

the
patient's
external
environment.
- Monitor
the client’s
behavior
May Patient Psychotherapy Provide a Patient has a

10, experiencing (Dialectical therapeutic sense of self
2023 blunted Behavioral Therapy) relationship awareness. She
affect. Organizing talks and
● Clozapine 100
Patient client’s shares a lot
mg
shows activities about what is
religious or let the happening.
delusion and client list Patient is
flight of down all she active and
ideas. wants to do. oriented.
Set limits
for clients
behaviors,
Assist the
client
safely in
66
COLLEGE OF NURSING
meeting
their needs.
Teaching the
client that
it is very
important to
think before
you act.
May 11, Patient was Psychotherapy Give Patient

2023 well groomed (Dialectical recognition maintained eye
and dressed Behavioral Therapy) to the contact.
decently patient and
● Clozapine 100 Dress
with visible remind him
mg appropriately
bids, to take a
necklace and bath
bracelet. everyday.
Respond to
Approached
questions
and
calmly and
communicated
maintain eye
with
contact.
patients
therapeutica
lly.
May 13, Received Psychotherapy Upon the The client is

2023 client (Dialectical first calm, and
standing Behavioral Therapy) interaction approachable
upright during the during the
● Clozapine 100
inside the orientation whole
mg
cell. phase the interaction.
Observed student
client for nurses
signs of assigned
visual utilized the
hallucinatio use of
n therapeutic
communicatio
n and
67
COLLEGE OF NURSING
intervention
s such as
broad
openings,
accepting.
-Encouraged
the patient
to join
occupational
therapy.
With the
following
vital signs
taken and
noted:
BP-110/70
mmHg
Temp- 36.6
°C
RR- 21 cpm
PR- 91 bpm
O2Sat- 99%
May 15, Received the Psychotherapy Encouraged The client

2023 client (Dialectical to join actively
sitting on a Behavioral Therapy) psychoeducat answers the
bench with ion therapy questions being
● Clozapine 100
clothes asked by the
mg With the
appropriatel student nurses.
following
y worn for
vital signs Client was able
the weather.
taken and to maintain
noted: composure all
throughout the
68
COLLEGE OF NURSING
BP-110/70 interview and

mmHg the program.
Temp- 36
RR- 23 cpm
PR- 97 bpm
O2Sat- 98%
May 16, Client is Psychotherapy Introduce Able to follow

2023 actively (Dialectical ourselves instructions
socializing/ Behavioral Therapy) and oriented
Patients can
talking with patient
● Clozapine 100 recall days of
other about our
mg the week and
clients in purpose
months of the
the area.
Assessed year but find
patient’s it difficult to
physical recall the
appearance months of the
and mental year backward.
status
Encouraged
participatio
n in play
therapy
May 17, Received Psychotherapy Encouraged Patient has no

20223 patient was (Dialectical client on subjective
well groomed Behavioral Therapy) the complaints.
and dressed importance Appears clean
● Clozapine 100
appropriatel of taking a and
mg
y. Calm and bath each appropriately
responsive. day and dressed.
69
COLLEGE OF NURSING
provide him
detergent
powder
Asked
patient to
state the
days in a
week and
months in a
year
70
COLLEGE OF NURSING
Discharge Plan
Medication
To effectively manage the symptoms of schizophrenia, the patient

must take their medications as prescribed to prevent further
complications. Schizophrenia is mainly treated by antipsychotics like
Clozapine 200mg that must be taken twice a day which is indicated to
treat severely ill patients with schizophrenia. Seizures may be triggered
by clozapine. If seizures occur, let the doctor know. While taking
clozapine, the patient avoids operating machinery, climbing, swimming,
or driving a car as you could cause harm to yourself or others if you
suddenly lose consciousness. Some medications are given through
injection, fluphenazine decanoate 0.5 ml which is injected
intramuscularly every month to treat psychiatric disorders including
schizophrenia and behavioral disturbances. Treatment for schizophrenia
must continue over time. Even if one starts to feel better, fluphenazine
decanoate is still a must have. This medication's withdrawal symptoms,
which include nausea, vomiting, dizziness, and shaking, can be brought
on by abruptly stopping it. If your doctor has not advised you to stop
taking this medication, do not.
Exercise/Activity
Physical exercise is beneficial for patients with schizophrenia,

with the potential to improve cognition, clinical symptoms, and quality
of life. The patient can have plenty of exercise everyday like going for
a walk or jog, ride their bike, or play sports. These exercises and
activities can help them stay fit. Some activities to consider are
drawing, reading, listening to music, or walking. These are "here-and-
now" activities. It is essential to keep the patient focused on reality-
based activities in order to assist them manage these symptoms. These
activities should be within the patient’s functional level.
Participating in activities can help reduce social isolation and
inappropriate behavior while also increasing motivation.
Treatment
Despite the widespread misconception that people with schizophrenia

have no chance of recovery or improvement, the reality is much more
hopeful. Schizophrenia currently has no known cure, but it is treatable
and manageable with medication, self-help techniques, and supportive
71
COLLEGE OF NURSING
therapies. Medications like antipsychotics and therapy for schizophrenia

are traditional treatment options for people living with schizophrenia.
The patient must take the medicines as prescribed. However, medication
alone is not enough. Thought patterns may be normalized with
psychotherapies. In addition, developing coping mechanisms for stressful
situations and recognizing early indicators of relapse can help people
with schizophrenia manage their illnesses, as advised by their physician.
Health Teaching
The patient is encouraged to live a healthy lifestyle. This
includes not drinking alcohol, use of cannabis, and the use of illegal
drugs. Having a drug or alcohol problem makes treating schizophrenia
more difficult. Aside from that. A balanced diet is a must. The body
can deal with tension and stress better as a result. A balanced diet
includes whole grains, dairy products, fruits, vegetables, and protein.
Regular, wholesome meals can help prevent psychosis and other symptoms
of schizophrenia brought on by significant changes in blood sugar levels.
Reduced intake of sugar and refined carbohydrates, which can cause a
quick slump in mood and energy is also a must. Increase the amount of
omega-3 fatty acids you consume by eating more fatty fish, fish oil,
walnuts, and flaxseeds to help you focus better, stay awake longer, and
maintain a stable mood.
Follow-up care is a key part of their treatment and safety. It's

important to offer patients who have undergone hospitalization for any
mental illness—in particular, schizophrenia—regular follow-up therapy.
Be sure that the patient will make and go to all appointments. Lack of
follow-up treatment might lead to increased psychotic symptoms and raised
risk of relapse and rehospitalization.
Out-Patient
Families and significant others play an important role in assisting
those suffering from schizophrenia. We acknowledge that schizophrenia
is a demanding condition, and that family members and others must
frequently take on a lot more responsibility and make adjustments to
assist manage the illness and support someone with schizophrenia. People
can begin to express and lessen some of the problems they experience as
a result of the illness, learn about it, and get all of their questions
about schizophrenia answered through family therapy. Family therapy for
schizophrenia frequently includes structured problem solving, emotional
regulation, emotional processing, and stress reduction. Together, the
72
COLLEGE OF NURSING
group will advance their understanding of the illness and how to treat
it. This alters any unhelpful communication patterns and helps to foster
empathy and affective support. The patient is also encouraged to continue
his faith to God and to always ask for his guidance.
73
COLLEGE OF NURSING
CHAPTER V
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
The student nurses were able to gain knowledge and deep

understanding about schizophrenia which is a severe mental illness in
which reality is perceived by the patient abnormally. Schizophrenia may
cause hallucinations, delusions, and extremely irrational thinking and
behavior, which can make it difficult to go about daily activities and
be incapacitating.
The student nurses were able to understand the disease condition

and the positive and negative symptoms manifested by the patient and how
it was ruled out as schizophrenia. The student nurses were able to
identify that the positive symptoms manifested by the client during our
care were visual hallucinations, grandiose hallucination, and religious
hallucination. Negative symptoms were also observed and identified
during our care and those are alogia and blunted affect. Appropriate
nursing interventions were rendered to the patient taking into
consideration the nature of his disease and according to his needs.
Recommendations
The student nurses would like to address the following

recommendation for clinical practice and clinical purposes. The paper
will help them in further understanding the case of patient N.A.A and
his diagnosis which is schizophrenia and to further improve this study.
Psychiatric Personnel can further assess all the mental and

physical symptoms. They will provide psychological treatment and
administer and prescribe medications according to the client’s needs.
Nursing Educators will ensure basic knowledge and competence of

patients and will help provide insight into the illness. Nursing
educators will help nursing students by better understanding
schizophrenia and effectively recognizing the signs and symptoms related
to it, and may help people to find and access the care and support they
need.
Student Nurses will deepen the knowledge of schizophrenia and how

it affects a patient who has this disease. The students will gain ideas
on how to effectively provide treatment and therapy from learning from
the positive and negative symptoms/manifestations, etiology,
74
COLLEGE OF NURSING
pathophysiology, and the student/researchers will be guided to improve

their knowledge regarding the case of the patient.
75
COLLEGE OF NURSING
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Diabetes and Digestive and Kidney Diseases.
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ine%20is%20in%20a%20class,natural%20substances%20in%20the%20brain
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Cherry. (2022, November 8). How Art Therapy Works. Verywell Mind.
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Chokhawala, K., & Stevens, L. (2023, February 26). Antipsychotic

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78
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APPENDICES
Curriculum Vitae
SAMANTHA G. ABING, SN-SPUD
Candanay Sur, Siquijor, Siquijor 6225
abingsamantha13@gmail.com
Contact Number: 09553340065
PERSONAL INFORMATION
Sex: Female
Age: 21 years old
Birthdate: October 6, 2001
Birthplace: Siquijor Provincial Hospital
Father’s name: Claverito C Abing
Mother’s name: Elizabeth G Abing
Height: 165 cm
Weight: 55 kg
Educational Attainment:
School Year Graduated
Pre-School Assisi High School 2008- 2011
Elementary Siquijor Central Primary School 2011-2012
Assisi High School 2012-2014
Junior High Assisi High School 2014-2018
Senior High Siquijor State College 2018-2020
College Saint Paul University Dumaguete 2020-present
The information above is true and correct,
SAMANTHA G. ABING, SN
79
COLLEGE OF NURSING
KRIZHA JANE C. AMBO, SN-SPUD

Poblacion Basay Negros Oriental
krizhja@gmail.com
09491001050
Sex: Female
Age: 21 years old
Birthdate: August 19, 2001
Birthplace: Bayawan City Negros Oriental
Father’s name: Enriquito Ambo Jr.
Mother’s name: Kristine Joy C. Ambo
Height: 157 cm
Weight: 55 kg
EDUCATIONAL ATTAINMENT
Pre-school Basay Central School 2005-2007
Elementary Basay Central School 2007-2014
Junior High Basay National High School 2014-2018
Senior High Basay National High School 2018-2020
Krizha Jane C. Ambo, SN-SPUD
80
COLLEGE OF NURSING
Josh Remil G. Lariosa, SN-SPUD
Bagacay, Purok Gemelina, Dumaguete City
josh14.lariosa@gmail.com
+639976534639
Sex: Male
Age: 21 years old
Birthdate: April 30, 2002
Birthplace: Holy Child Dumagute City Hospital
Father’s name: Remil F. Lariosa
Mother’s name: Jenifer G. Lariosa
Height: 175 cm
Weight: 68 kg
EDUATIONAL ATTAINMENT
Pre-school Mission School 2005-2007
Elementary Silliman University 2007-2014
Junior High Silliman University 2014-2018
Senior High Science High School Dumaguete 2018-2020
College Saint Paul University Dumaguete 2020- present
Josh Remil G. Lariosa, SN-SPUD
81
COLLEGE OF NURSING
JOSHBIE AIRA P. OYCO, SN-SPUD

Highway Villa Amada, Dumaguete City
Joshbieoyco1@gmail.com
+639455117093
Sex: Female
Age: 21 years old
Birthplace: Federville Subdivision, Cotabato City
Father’s name: Rodel M. Oyco
Mother’s name: Alma P. Oyco
Height: 152 cm
Weight: 40 kg
Pre-school Cotabato City 2005-2007
Elementary Lyceum Cebu 2007-2014
Junior High Negros Oriental High School 2014-2018
Senior High Saint Paul University Dumaguete 2018-2020
82
COLLEGE OF NURSING
Joanamarica Mancao, SN-SPUD

Bayawan City Negros Oriental 6221
joanamaricamancao@gmail.com
+639354443194
Sex: Female
Age: 24 years old
Birthdate: February 12, 1999
Birthplace: Binan, Laguna
Father’s name: Joseph Norman L. Mancao
Mother’s name: Marjorie T. Mancao
Height: 149 cm
Weight: 48 kg
Pre-school NK Learning Center 2004-2005
Elementary Dolores Central School 2009-2012
Junior High Dawis National High School 2015-2016
Senior High Dawis National High School 2016-2018
Tertiary Saint Paul University Dumaguete 2020-present
83
COLLEGE OF NURSING
KAYE S. PALONGPALONG, SN-SPUD

Luna St. Catamboan, Lazi, Siquijor 6228
siongkaye07@gmail.com
+639618128500
Sex: Female
Age: 21 years old
Birthdate: November 14, 2001
Birthplace: Siquijor Provincial Hospital
Father’s name: Cyril B. Palongpalong
Mother’s name: Philna S. Palongpalong
Height: 167 cm
Weight: 80 kg
SCHOOL YEAR GRADUATED
Pre-school Lazi shepherd 2005-2007
Elementary Lazi Central School 2007-2014
Junior High Saint Isidore the Farmer Catholic School 2014-2018
Senior High Siquijor State College 2018-2020
Tertiary Saint Paul University Dumaguete 2020-present
84
COLLEGE OF NURSING
Jether C. Rabanal, SN-SPUD

Purok 2, Senora Ascion, San Jose, Neg. Or.
jethrabanal@gmail.com
+639509011369
Sex: Male
Age: 22 years old
Birthdate: July 30, 2000
Birthplace: Dumaguete city
Father’s name: Efren F. Rabanal
Mother’s name: Jacqueline C. Rabanal
Height: 163 cm
Weight: 60 kg
Pre-school Sra. Ascion Elementary School 2005-2007
Elementary Sra. Ascion Elementary School 2007-2014
Junior High Negros Oriental High School 2014-2018
Senior High Saint Paul University Dumaguete 2018-2020
JETHER RABANAL
85
COLLEGE OF NURSING
ASHLEY ANN FATIMA S. ROSANTO, SN-SPUD

Bais City Negros Oriental
rosantoashley56@gmail.com
09458612152
Sex: Female
Age: 21 years old
Birthdate: April 30,2002
Birthplace: Leyte, Tacloban
Father’s name: Nelson Rosanto
Mother’s name: Gemma Rosanto
Height: 5’0
Weight: 49 kg
Pre-school Sum-ag Pre-school 2005-2007
Elementary Bais City Pilot School 2007-2014
Junior High Bais City National High School 2014-2018
Senior High Bais City National High School 2018-2020
ASHLEY ANN FATIMA S. ROSANTO
86
COLLEGE OF NURSING
KATE STEFAN B. VILLALUZ, SN-SPUD

Bais City Negros Oriental
villaluzkit@gmail.com
+639059144516
Sex: Female
Age: 22 years old
Birthplace: Bais City
Father’s name: Stephen Villaluz
Mother’s name: Alma Villaluz
Height: 5’2
Weight: 55 kg
Pre-school Bais City Pilot School 2005-2007
Elementary Bais City Special Science School 2007-2014
Junior High La Consolacion Bais School 2014-2018
Senior High Bais City Special Science Class 2018-2020
KATE STEFAN B. VILLALUZ
87

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ST.

PAUL UNIVERSITY DUMAGUETE

Negros Oriental Provincial Hospital: Talay Rehabilitation and

In Partial Fulfillment for the Requirements in NCM 117 Care of Client

A Case Study on:

Schizophrenia Manifesting Religious Delusion and Grandiose Delusion

Ambo, Krizha Jane C.

Lariosa, Josh Remil

Oyco, Joshbie Aira

Rosanto, Ashley Ann Fatima

Villaluz, Kate Stefan

Mr. Eugene Moises Palarpalar, RN

May 19, 2023

TABLE OF CONTENTS .................................................... 2

Additionally, we would like to express our gratitude to the staff

Schizophrenia is a chronic mental disorder that makes it difficult

This paper introduces a case study of a 49-year-old male who was

This clinical paper focuses on a 49-year-old client who has been

This clinical paper focuses on a 49-year-old client who has been

Patient’s Name : N.A.A

Address : Kapanun-an Mabinay : Kapanun-

Contact Number : N/A

Age : 49 years old

Birthdate : October 6, 1973

Place of Birth : Mabinay Negros Oriental

Marital Status : Single

Religion : Roman Catholic

Educational : Elementary Graduate

Contact Person :None

Contact Number : None

Date of Admission : April 25, 2022

Physician : Dr. A.J.V.A

Admitting Diagnosis : Schizophrenia

Admitted due to several fever and manifesting positive signs of

History of Present Illness

Patient A.N.A a 49 years old male single (never married,no

Past Health History

Interpretation: The family history of the patient represented by the

Functional Health Patterns

Functional Prior to During Justification

Health Patient A.N.A Client was not Client’s

his wounds. visual

Nutrition and The client During Client was able

Elimination Regarding the Client has been There was no

Activity and He states that Client was not During patient's

Cognitive- The patient was Client was able Visual

place responses questions alert when he is

Sleep and Rest The client Client stated Patient appears

Self-perception The client was He was quite Patient able to

Roles and Client plays the “Akoa trabaho Since he was

Sexuality and Verbalized that Client Sexuality and

have children with Melanie the affected by the

Coping and Client stated When student The client's

Values and Client religious The patient Client values

General Condition and Focused Assessment

Patient appears 158 cm in length, with a dark complexion, black

Mental Status Assessment/MSE

General appearance and motor behavior

as drumming of fingers, twisting of locks of hair or tapping of foot.

Mood and Affect

During the first week of nurse patient interaction with the

Thought Process & Content

The patient has no problem speaking. He usually speaks normally.