Mindanao State University

VICENTE SOTTO MEMORIAL MEDICAL

CENTER
College of Health Sciences
Marawi City

PSYCHODYNAMICS

Presented to
PROF NASSEFAH-ALI RASOL
Faculty of College of Health Sciences
Mindanao State University – Marawi

In partial Fulfillment of the Requirements in

NSG 127.4 – PSYCHIATRIC DUTY
EXPOSURE
2nd Semester, S.Y 2023-2024

Submitted by
SECTION G2
Gayongan, Arlynne Moira M.

Manahan, Roldan Jay

Molama, Lizbeth Diahn

Murillo, Maria Katherine D.

Nicolas, Kyle Ritchell P.

Palaganas, Angeline L.

Panganiban, Estephanie C.

Saari, Casandra H.

Sahibol, Mersia A.

July 2024
 TABLE OF CONTENTS

I. PATIENT’S PROFILE

II. INFORMANTS

III. INTRODUCTION

IV. SUMMARY OF PSYCHIATRIC HISTORY

A. History of Present Illness

B. History of Past Illness

C. Family History

D. Personal History

IV. OUTLINE OF MENTAL STATUS EXAMINATION

A. GENERAL EXAMINATION

a. Appearance

b. Behavior/Movements

c. Communication: Speech and Language

d. Mood and Affect

B. EXPERIENCE

a. Perception

C. THINKING

a. Thought Content

b. Thought Process

c. Judgments

d. Insights
 D. SENSORIUM AND COGNITION

a. Orientation

b. Memory

c. Attention and Concentration

d. Information and Intelligence

E. MINI MENTAL STATE EXAMINATION

V. DSM of Mental Disorder

VI. PSYCHO ANATOMY AND PHYSIOLOGY

VII. PSYCHOPATHOPHYSIOLOGY

VIII. PSYCHOPHARMACOLOGY

IX. PSYCHOTHERAPY

X. NURSING CARE PLAN

XII. OBJECTIVES: PHASES OF ORIENTATION

XIII. PROGNOSIS
 PATIENT’S PROFILE

Name: Patient X

Admission Date: September 25, 1981

Hospital Number: 2349362011

Age Upon Admission: 34 years old

Diagnosis: Schizophrenia, undifferentiated

Age: 42 years old

Sex: Male

Marital Status: Single

Occupation: N/A

Race and Ethnicity: Visayan

Level of Education: High school Level

Income: N/A

Nationality: Filipino

Religion: Catholic

Household Composition and Size (before admission): 4

Address: Misamis Oriental

 INFORMANTS

Name: Jose Gimang

Age: N/A

Relationship with the Patient: Brother

Informant has Known the Patient: Since birth of the patient.

Apparent Understanding of Patient’s Illness:

“Maguba siya unya manapat na saako pagomangkon”

"He'll break down then blame it on my nephew."

“Dili na mutingog, maghinugto ug mukatawa na siya ra mag istorya storya sa

kaugalingon.”

"He won't listen anymore, he'll just sigh and laugh while talking to himself."

“Masuko siya ug badlungon namo, ug dapata niya akong pag-umangkon”

"He'll get angry and curse us, and he should take care of my nephew."

“Mulakaw na siya sa kadlawan unya buntag na mubalik, hangtod sa mubalik kulang ani

siya sa katulog”

"He'll walk away at dawn and come back in the morning, until he lacks sleep."

“Malibang ug mangihi sa kwarto unya maglakaw lakaw ra siya nga hubo tanan”.

"He'll urinate and defecate inside his room then he'll just walk around naked."

Chief Complaint:

“Magguba siya unya manapat sa akong pag-umangkon.” As verbalized by the brother.

 INTRODUCTION

Schizophrenia is a severe and chronic mental disorder that affects approximately 1% of the

population worldwide. It is characterized by profound disruptions in thinking, affecting language,

perception, and sense of self. Among the various subtypes of schizophrenia, undifferentiated

schizophrenia is a form that does not fit neatly into the specific categories of paranoid,

disorganized, or catatonic schizophrenia. Instead, it encompasses a mix of symptoms that do not

dominate in any particular pattern (American Psychiatric Association, 2013).

Historically, undifferentiated schizophrenia was categorized separately under the DSM-IV;

however, the DSM-5 has shifted towards a dimensional approach, eliminating specific subtypes and

focusing on the spectrum of symptoms and their severity (Tandon, Nasrallah, & Keshavan, 2009).

Despite these changes, individuals with undifferentiated schizophrenia continue to present a

significant clinical challenge due to the varied and unpredictable nature of their symptoms.

Undifferentiated schizophrenia is diagnosed when a patient exhibits symptoms that are

prominent in schizophrenia but do not meet the specific criteria for the other subtypes. The

symptoms may include delusions, hallucinations, disorganized speech, grossly disorganized or

catatonic behavior, and negative symptoms such as affective flattening, alogia, or avolition. This

subtype underscores the heterogeneity of schizophrenia, reflecting the complexity and variability of

the disorder (Tandon, Nasrallah, & Keshavan, 2009).

According to the DSM-5, a diagnosis of schizophrenia requires the presence of at least two

of the following symptoms, each persisting for a significant portion of time during a one-month

period (or less if successfully treated). At least one of these symptoms must be from the first three:

• Delusions (false beliefs not based in reality)

• Hallucinations (seeing or hearing things that are not there)

• Disorganized speech (incoherent or nonsensical talk)

• Grossly disorganized or catatonic behavior

 • Negative symptoms (such as reduced emotional expression or lack of motivation)

Based on the study of National Institute of Mental Health (2021), The treatment of

schizophrenia is multifaceted, aiming to alleviate symptoms, improve functioning, and enhance the

quality of life for individuals affected by this chronic mental disorder. Effective treatment typically

involves a combination of pharmacological and psychosocial interventions, tailored to meet the

unique needs of each patient. Understanding these treatment modalities is crucial for developing

comprehensive care plans that address both the biological and psychosocial aspects of

schizophrenia.

In addition, treating schizophrenia involves a combination of medications and therapy to

manage symptoms and improve daily functioning. Medications, mainly antipsychotics, help control

symptoms like hallucinations and delusions. Therapy and support programs assist patients in

coping with their condition, improving social skills, and achieving a better quality of life. National

Institute of Mental Health. (2021).

 SUMMARY OF PSYCHIATRIC HISTORY

a. History of Present Illness

A case of a 42-year-old male, Roman Catholic residing at Misamis Oriental, was admitted for

the first time at Vicente Sotto Memorial Medical Center, Center for Behavioral Science on

October 14, 2015, 7:33AM.

2 years prior to admission, the patient’s brother noted behavioral changes such as “not

listening”, and “talking and laughing to himself”. He has negative hallucination and negative

delusion. The patient had no consult done and no medications given/taken.

A year prior to admission, condition persisted, but patient was noted to get easily agitated.

Patient also had symptom of wandering outside their home, urinate and defecate inside his room,

and naked around the home, However, the family still tolerated the patient’s condition, but

persistence of symptoms prompted his brother “Jose Gimang” to seek consult at VSMMC-CBS

thus the patient was admitted.

b. History of Past Illness

The patient's chart lacks sufficient data regarding his past illnesses, but it notes no history

of major illnesses. Before his first admission to Vicente Sotto Memorial Medical Center – Center

for Behavioral Sciences, he had no previous hospitalizations, surgeries, or injuries, and had no

known allergies to food or drugs.

c. Family History

In terms of family history, there is a prevalent incidence of hypertension on his maternal

side, but no reported mental illnesses within the family. Jeffrey's family history includes his father's

mysterious death and his mother's passing at 56 due to ovarian cancer.

d. Social History

The patient leads a relatively typical life and had many friends during his earlier years. He

remains well-regarded in his community and is considered a good friend. He has had typical life

experiences, including a past relationship with one girlfriend. However, he also has a history of
engaging in risky behaviors, such as smoking and alcohol consumption.
 OUTLINE OF MENTAL STATUS EXAMINATION

GENERAL EXAMINATION

● General Appearance

The 42-year-old male patient from Misamis Oriental presented with a complex picture upon

initial assessment and follow-up. He was initially found seated, neatly dressed in a green shirt

and pink shorts, suggesting good personal hygiene. While maintaining eye contact during

communication, he paced, indicating possible restlessness or agitation. His footwear was well-

maintained, free of any unpleasant odor, further supporting his attention to hygiene. However,

his facial expression was flat, revealing a lack of emotional responsiveness.

On the second day, the patient was observed standing, appearing clean and freshly dressed,

now in a white shirt and grey shorts. While displaying rapid shifts in thought during

conversations, he remained responsive to questions but appeared lethargic. He walked with a

normal gait and maintained an approachable demeanor. The lack of emotional expression and

signs of underweight persisted. These observations highlight the need for attentive and

empathetic care. He also reported a non-productive cough.

Physically, the patient has short, evenly distributed black hair and fair skin. His nails were

well-trimmed, but he demonstrated poor oral hygiene, with visible tooth decay, tartar, and bad

breath. There were no abnormal discharges or lesions on his eyes, nose, or ears.

● Behavior

The patient demonstrates consistent appropriate behavior, maintaining calm demeanor in

interactions. However, notable delusions are evidenced by his self-identification as Batman, the

superhero. Despite this, he maintains hygienic habits and prefers solitude over peer interactions.

Additionally, he engages in gesticulations and pacing behavior, showing no signs of fatigue.

 Further assessments indicate a calmer demeanor, with the patient participating in activities

but experiencing periods of stillness after engagement. Delayed responses to questions are

observed, and he tends to withdraw from activities without direct prompting or encouragement.

Notably, he maintains a dual identity, identifying himself as both Toby McGrath, an engineer, and

Batman, blending reality and fantasy.

Throughout interactions, the patient remains cooperative and non-aggressive, readily

complying with instructions. He exhibits no combative or argumentative behaviors.

● Communication

During communication, the patient exhibits disorganized thoughts, leading to disjointed

responses. Despite speaking slowly and softly, his articulation is clear. Loose associations are

present, as the patient frequently diverges from the topic without directly answering questions.

Notably, paranoia or suspicion is absent during the initial contact. The patient shows reading

comprehension, indicating cognitive functioning.

Consistently, the patient's speech is sluggish, quiet, and characterized by disorganized

thinking. Neologisms and loose associations suggest continued difficulties in communication and

thought organization.

Despite these challenges, the patient remains verbally interactive. He possess a high school

education and understand Cebuano, Tagalog, and English. He engage in conversations, respond

to questions, and often demonstrate a grasp of reality while exhibiting flight of ideas. His voice is

usually audible but can occasionally become a whisper, making their statements slightly

ambiguous. Nevertheless, he maintain appropriate speech spacing and word usage, ensuring

understanding.
 ● Mood and Affect

The patient typically presents as calm and cooperative, but experiences noticeable swings

in their emotional expression. He often exhibit periods of blunted affect, characterized by

slow speech, limited responsiveness, and a decrease in his usual level of engagement. These

periods are punctuated by moments of appropriate interest, especially when discussing topics

like Batman and mathematics, where the patient displays engagement and emotional

response. However, the overall presence of blunted affect significantly impacts the patient's

emotional expressiveness and responsiveness throughout interactions.

EXPERIENCE

● Perception

The patient exhibits significant long-term memory impairment, with fragmented and

distorted recollections of the past. While he can access certain basic details, like his birthplace

and schooling in Iligan City, he struggles to recall crucial familial information, such as his

parents' names. This disconnection from reality is further evidenced by his frequent identification

with fictional characters like Batman and Spiderman.

Despite these memory deficits, the patient shows intermittent moments of clarity, such as

remembering the boat trip from Iligan City to VSMMC with a companion. However, his

participation in activities is often limited, with withdrawal after brief interactions potentially

stemming from his disorganized perception of the environment. He also demonstrates a strong

interest and aptitude in mathematics, readily engaging in related discussions.

The patient's disorganized perception extends to his communication, characterized by

incoherent speech, including word salad, loose associations, and tangential thinking. These

symptoms collectively point to significant cognitive impairment, demanding comprehensive

evaluation and support to address both his memory deficits and disorganized thinking.
THINKING

• Thought Content

The patient presents with a multifaceted mental health condition, characterized by

significant cognitive and behavioral alterations. He struggles to maintain a consistent train of

thought, exhibiting disorganized thinking that jumps erratically between unrelated topics,

making his speech incoherent and difficult to follow. This disorganization is further

highlighted by the presence of delusions, primarily grandiose beliefs, such as a conviction of

possessing extraordinary abilities like Batman. The fluctuating nature of his thought

processes is pronounced, with periods of relative coherence abruptly shifting to episodes of

withdrawal and nonsensical speech.

• Thought Process and Insight

Cognitive disturbances manifest in patients with disorganized perception, evidenced by

distorted interpretations of sensory experiences. His thought patterns are disjointed, rendering

it arduous for him to sustain logical sequences. Frequent verbal jumbling and impaired

language comprehension hinder his ability to convey thoughts coherently.

• Judgment

The patient exhibits impaired judgment due to the difficulty in differentiating between

reality and delusion. This cognitive distortion significantly affects his decision-making process,

leading to irrational choices. Furthermore, disorganized thinking hinders his ability to make

logical and reasoned judgments independently. The patient's lack of insight compounds these

challenges, impeding their ability to recognize and address his impaired judgment. This

constellation of symptoms underscores the significant impact of their condition on their capacity

to make sound decisions.

• Insight

The patient demonstrates a moderate understanding of his condition. He consistently follows

his treatment plan, including medication adherence and therapy participation. However, he has
not explicitly verbalized a comprehensive understanding of his condition.
SENSORIUM AND COGNITIVE

• Orientation

The patient is alert and oriented to the present, demonstrating an understanding of

his current surroundings and circumstances. However, the patient exhibits anterograde

amnesia, characterized by difficulty recalling specific events or individuals from the

recent past. While the patient can respond to inquiries about his present location and year,

he have difficulty recalling time-related information, specific dates, and aspects of his

personal history.

• Memory

The patient's memory was assessed across three domains: immediate, recent, and

remote recall. While the patient demonstrated intact immediate and recent memory, as

evidenced by the ability to remember and repeat information, there were notable deficits

in his remote memory. Specifically, the patient struggled to recall past experiences and

events from his life. This suggests a discrepancy in the patient's overall memory function,

with strong immediate and recent recall capabilities but a significant impairment in

accessing long-term memories.

• Attention and Concentration

The patient struggles with significant concentration difficulties. He frequently

appears disengaged during conversations, making it challenging for him to maintain

focus and participate in sustained interactions. He also exhibits delusions of grandeur,

comparing himself to a fictional superhero.

Despite these challenges, the patient demonstrates some cognitive abilities. He

can successfully solve simple mathematical problems that align with his intellectual level.

He expresses a strong interest in both mathematics and engineering.

• Information and Intelligence

The patient's communication abilities fluctuate, alternating between periods of

coherent and precise responses to moments of inconsistency, especially when discussing

family details. Certain responses contradict medical records, such as the claim that family

members reside in Iligan City.

Regarding intelligence, the patient's highest recorded educational level is second-

year high school, yet they display sufficient proficiency in essential skills like reading,

writing, and arithmetic. They can communicate effectively in Cebuano, Filipino, and

English. Despite some inconsistencies, the patient demonstrates comprehension and can

follow specific instructions, indicating adequate cognitive function. Notably, the patient

possesses strong reading and legible handwriting skills.

 FOLSTEIN’S MINI MENTAL
EXAMINATION

This is a brief 30-point questionnaire test that is used to screen for cognitive impairment.

It is also used to estimate the severity of cognitive impairment at a given point of time and to

follow the course of cognitive changes in an individual overtime, thus making it an effective way

to document individual’s response to treatment.

A score of 25 out of 30 are considered normal; 18-24 indicate mild to moderate

impairment; and scores of 17 or less indicate severe impairment.

TES ANSWER RESULTS

TS
1. Orientation

What is the year? 1813 0

What season? Tag-init 0

What month? August 0

What day of the week? Silence 0

What date? Bente 0

Total: 0/5

2. Where are we? Diri 0

What country? USA 0

What town or city? Canada 0

What hospital? No response 0

What floor? 3rd floor 0

Total: 0/5

3. Registration

Name three (3) objects slowly and Relo, t-shirt, face 3

clearly then ask patient to repeat mask
them

Total: 3/3
4. Attention and Calculation

Ask to spell the word WORLD D-L-R-O-W 5

backwards

Total: 5/5

5. Recall

Ask the patient to recall the Relo, t-shirt, face 3

objects mentioned above. mask

Total: 3/3

6. Language

Can you tell me what these things No response 0

are?

Total: 0/2

7. Repetition

Say these words “no ifs, ands, or Patient was able

buts” to repeat the
1
words
spontaneously
without any
difficulty in
speech.
8. Complex Compounds

Give the patient a plain piece of Patient took the 3

paper and say “Take this paper in paper using her
your right hand, fold it in half, and right hand, fold it
put it on the floor” in half and then
place it on the
floor.
Patient had no
difficulty in
doing the
procedure.
Total: 4/4

9. Tell the patient to read and obey Upon seeing the

what’s written on the paper you will instruction in the
show him. paper, patient
quickly closed 1
Give the patient a piece of paper her eyes.
with “CLOSE YOUR EYES”
printed on it.
 Total: 1/1

11. Give patient a paper and pencil Patient wrote “I 1

and ask the patient to write a am listening”
sentence.

Total: 1/1

12. Draw pair of intersecting Patient was able 1

pentagons onto a piece of paper to imitate what
and ask the patient to copy it. the student nurse
had drawn.

Total: 1/1

Total Score

The patient’s MMSE score is 18, thus, the patient is having a mild to mild cognitive

impairment. As the examination was being conducted, the patient was unable to answer some the

questions accurately as well as, unable to perform some of the commands accordingly and

correctly.
 DSM-V - TR

UNDIFFERENTIATED SCHIZOPHRENIA

Diagnostic Features

Undifferentiated schizophrenia is characterized by the presence of prominent psychotic

symptoms such as delusions, hallucinations, disorganized thinking (speech), grossly disorganized

or catatonic behavior, and negative symptoms (e.g., diminished emotional expression or

avolition). These symptoms persist for a significant portion of time during a one-month period,

with some level of impairment in social or occupational functioning.

Subtypes

Undifferentiated schizophrenia is considered a subtype of schizophrenia in which the

specific symptoms do not clearly fit into any of the other defined subtypes (paranoid,

disorganized, catatonic, or residual).

Associated Features Supporting Diagnosis

Associated features may include social withdrawal, impaired cognition, mood disturbances

(such as depression or anxiety), and disturbances in sleep and appetite.

Prevalence

The prevalence of undifferentiated schizophrenia is estimated to be similar to that of other

subtypes of schizophrenia, affecting approximately 1% of the population worldwide.

Development and Course

Undifferentiated schizophrenia typically manifests in late adolescence or early adulthood,

although onset can occur at any age. The course of the disorder varies, with some individuals

experiencing chronic symptoms and others having periods of remission and relapse.

Risk and Prognostic Factors

 Genetic and physiological elements. Genetic factors play a significant role in the

development of schizophrenia, including the undifferentiated subtype. Physiological factors such

as neurotransmitter imbalances, abnormalities in brain structure or function, and prenatal or

perinatal complications may also contribute to risk.

Culture-Related Diagnostic Issues

Cultural factors can influence the expression and interpretation of symptoms, affecting

diagnosis and treatment. Cultural beliefs about mental illness, stigma, and access to care may

impact the presentation and course of undifferentiated schizophrenia.

Suicide Risk

Individuals with undifferentiated schizophrenia have an elevated risk of suicide compared

to the general population, particularly during periods of acute psychotic symptoms or depressive

episodes.

Functional Consequences of Undifferentiated Schizophrenia

Undifferentiated schizophrenia can lead to significant impairments in various domains of

functioning, including social relationships, work or academic performance, and self-care

abilities.

Differential Diagnosis

Undifferentiated schizophrenia must be differentiated from other psychotic disorders

(such as schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder) as

well as mood disorders with psychotic features, substance-induced psychotic disorder, and other

medical conditions presenting with similar symptoms.

Comorbidity

Comorbid conditions commonly associated with undifferentiated schizophrenia include

substance use disorders, mood disorders (particularly depression), anxiety disorders, and

personality disorders. Co-occurring medical conditions and psychosocial stressors may also be
present and impact the course and treatment of the disorder.
 ASSESSMENT MEASURES

Cross-Cutting Symptom Measures

Level 1 Cross-Cutting Symptom Measure

The DSM-5 Level 1 Cross-Cutting Symptom Measure is a tool for assessing various

mental health domains that are relevant across different psychiatric diagnoses. It consists of

23 questions for adults and 25 questions for children, covering areas such as depression,

anxiety, psychosis, and substance use. These questions are meant to help clinicians identify

additional areas of concern, track changes in symptoms over time, and inform treatment

decisions. If individuals are unable to complete the measure themselves, a knowledgeable

informant can provide the information.

 Scoring and Interpretation:

The scoring and interpretation of the DSM-5 Level 1 Cross-Cutting Measures involve rating

each item on a 5-point scale: 0 (none or not at all), 1 (slight or rare), 2 (mild), 3 (moderate),

and 4 (severe). Here's how to interpret the scores: Review each item within a domain should

be reviewed individually.

● Mild or Greater Rating: A rating of mild (2) or greater on any item within a

domain, except for substance use, suicidal ideation, and psychosis, suggests the need

for additional inquiry and follow-up. This may involve a more detailed assessment,

potentially including the Level 2 cross-cutting symptom assessment for that domain.

● Substance Use, Suicidal Ideation, and Psychosis: For these specific domains, a

rating of slight (1) or greater on any item indicates the need for additional inquiry

and follow-up. This may involve further assessment to determine if a more detailed

evaluation is necessary.

● Highest Domain Score: The highest score within a domain should be indicated in

the "Highest domain score" column, which helps prioritize areas for further

assessment or intervention.
 PSYCHOANATOMY AND PHYSIOLOGY

CENTRAL NERVOUS SYSTEM

The central nervous system (CNS) is a complex network of nerves and cells that transmit and
process information throughout the body. This controls thought, movement, and emotion, as well
as breathing, heart rate, hormones, and body temperature. It is consist of the brain and spinal
cord.

The brain is the central control module of the body and coordinates activity. It is an organ of
nervous tissue that is responsible for responses, sensation, movement, emotions, communication,
thought processing, and memory. Structurally, the brain is divided into the cerebrum,
cerebellum, brain stem, and limbic

CEREBRUM

It is the largest and most prominent part of the brain, occupying the uppermost portion of the
skull. It is responsible for higher cognitive functions such as thinking, reasoning, memory, and
voluntary movement. It also contains the cerebral cortex, a highly convoluted outer layer
composed of gray matter, which is crucial for processing sensory information and initiating
motor responses. There is a large separation between the two sides of the cerebrum called the
longitudinal fissure. It separates the cerebrum into two distinct halves, a right and left cerebral
hemisphere.

● Left hemisphere – controls the right side of the body and is the center for logical
reasoning and analytic functions such as reading, writing, and mathematical tasks.
● Right hemisphere – controls the left side of the body and is the center for creative
thinking, intuition, and artistic abilities.

The corpus callosum is a thick band of nerve fibers located deep within the brain, connecting
the left and right cerebral hemispheres. It serves as the primary communication pathway between
the two hemispheres, allowing them to exchange information and coordinate their activities. The
cerebral hemispheres are each divided into four lobes:

● Frontal lobe – located at the front of the brain and is primarily responsible for functions
such as decision-making, planning, voluntary movement, and personality expression.
When damaged it will be difficult to gather information, remember previous experiences,
and make decisions based on this input.
● Temporal lobe – located at the sides of the brain, and is involved in auditory processing,
memory formation, language comprehension, and aspects of emotion regulation.
 ● Parietal lobe – located near the top and back of the brain, and is responsible for
processing sensory information from the body, including touch, pain, temperature, and
spatial awareness.
● Occipital lobe – located at the back of the brain and is primarily dedicated to visual
processing, including the interpretation of visual stimuli, object recognition, and the
perception of color, shape, and motion.

CEREBELLUM

Located below the temporal and occipital lobes, it coordinates voluntary movement, balance,
posture, and muscle tone. It receives and integrates information from the cerebral cortex, muscles,
joints, and inner ear.
BRAIN STEM

The brainstem is the lower part of the brain that connects the cerebral hemispheres with the
spinal cord. It serves as a pathway for nerve fibers traveling between the brain and the rest of the
body, facilitating sensory and motor signals. It consists of three main regions: the medulla
oblongata, the pons, and the midbrain.

● Medulla - where the brain meets the spinal cord, contains vital centers that regulate many
bodily activities, including heart rhythm, breathing, blood flow, and oxygen and carbon
dioxide levels. It produces reflexive activities such as sneezing, vomiting, coughing and
swallowing.
● Pons - above the medulla is the pons, bridges the gap both structurally and functionally,
serving as the primary motor pathway.
● Midbrain - facilitates various functions, from hearing and movement to calculating
responses and environmental changes.

Also located in the brainstem is the reticular formation, a diffusely arranged group of neurons
and their axons that extend from the medulla to the thalamus and hypothalamus. The functions of
the reticular formation include relaying sensory information, influencing excitatory and
inhibitory control of spinal motor neurons, and controlling vasomotor and respiratory activity.

The reticular activating system (RAS) is a complex system that requires communication among
the brainstem, reticular formation, and cerebral cortex. The RAS is responsible for regulating
arousal and sleep-wake transitions.

The extrapyramidal system also originated in the brainstem, carrying motor fibers to the spinal
cord. They are responsible for the unconscious, reflexive or responsive control of musculature,
e.g., muscle tone, balance, posture and locomotion.
LIMBIC SYSTEM

Limbic system, group of structures in the brain that governs emotions, motivation, olfaction
(sense of smell), and behavior. The limbic system is also involved in the formation of long-term
memory. The limbic system consists of several interconnected components, including the:

● Thalamus - known as "relay center" of the brain and is responsible for relaying sensory
and motor signals to the cerebral cortex. It also regulates consciousness, sleep, and
alertness. Damage can cause motor impairments, tremors, insomnia, memory loss,
attention problems, vision loss or light sensitivity.
● Hypothalamus - located just below the thalamus. Its most basic function is in
homeostasis. It controls autonomic functions such as hunger, thirst, body temperature,
blood pressure, and heart rate. It is the interface between the nervous and endocrine
systems and regulates sexual activity. The hypothalamus also controls the body’s
response to stress. Damage to the hypothalamus can lead to aggression, acute stress,
hypothermia, hyperthermia, fatigue, weight gain or loss, and a high or low sex drive.
● Basal ganglia – This is a group of nuclei deep within the brain that is primarily involved
in the control of voluntary motor movements, procedural learning, habit formation,
emotion, and cognition. Disorders of the basal ganglia can lead to movement disorders
such as Parkinson's disease and Huntington's disease.
● Hippocampus - the region of the brain associated with memory. It's heavily involved in
the consolidation of short-term memory to long-term memory and plays a key role in
episodic memory. Damage to this part of the brain can prevent people from building new
memories, though they can still remember events from the past.
● Amygdala - plays a key role in mediating many aspects of emotional learning and
behavior. It helps evaluate the emotional valence of situations, recognize threats, and
prepare the body for fight-or-flight reactions. Due to its close proximity to the
hippocampus, the amygdala helps modulate memory storage, especially of memories
associated with strong emotions. Damage to the amygdala can result in higher levels of
aggression, irritability, poor emotional control, and an inability to recognize emotions.

SPINAL CORD

The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends
from the brainstem down the vertebral column. It serves as a vital link between the brain and the
rest of the body, transmitting signals between the brain and peripheral nervous system.

Functions of the spinal cord include:

 ● Transmission of sensory information: Sensory neurons convey signals from the body's
periphery (such as touch, temperature, pain, and proprioception) to the spinal cord, which
then relays these signals to the brain for processing and interpretation.
● Transmission of motor commands: Motor neurons in the spinal cord convey signals
from the brain to muscles and glands, enabling voluntary and involuntary movements and
actions.
● Reflex actions: Can initiate rapid, involuntary responses to certain stimuli through reflex
arcs. In these instances, sensory information is transmitted directly to motor neurons
within the spinal cord, bypassing the brain. This allows for swift reactions to potentially
harmful stimuli, such as withdrawing a hand from a hot surface.
● Coordination of certain reflexes: While the brain plays a crucial role in higher-order
processing and coordination of movements, the spinal cord can independently coordinate
certain reflexive movements, particularly those that are essential for survival and occur
rapidly.

NEUROTRANSMITTERS

Neurotransmitters are chemical messengers that transmit signals across synapses, the tiny gaps
between neurons, allowing for communication within the nervous system. They either excite or
stimulate an action in the cells (excitatory) or inhibit or stop an action (inhibitory). (Lewis,
2000). They enable the brain to provide a variety of functions, through the process of chemical
synaptic transmission.

● Norepinephrine and Epinephrine

o Norepinephrine (NE): Regulates attention, arousal, mood, and activates the
sympathetic nervous system to prepare the body for action during stress.
o Epinephrine (Adrenaline): Initiates the "fight or flight" response, increasing
heart rate, blood pressure, and energy availability in response to stress or danger.
● Dopamine - a neurotransmitter located primarily in the brain stem, has been found to be
involved in the control of complex movements, motivation, cognition, and regulation of
emotional responses. Dopamine is generally excitatory and is synthesized from tyrosine,
a dietary amino acid. An increase dopamine may indicate schizophrenia and Parkinson’s
diseases when decreased.
● Glutamate - is the primary excitatory neurotransmitter in the brain. It's involved in
learning, memory, synaptic plasticity, and various cognitive functions. However,
excessive glutamate activity can lead to excitotoxicity, which is implicated in
neurodegenerative diseases like Alzheimer's and Parkinson's.
● Acetylcholine - it can be an excitatory or inhibitory neurotransmitter. It is synthesized
from dietary choline found in red meat and vegetables and has been found to affect the
sleep/wake cycle and to signal muscles to become active.
● Gamma-aminobutyric acid (GABA) - it is the primary inhibitory neurotransmitter in
the central nervous system. It helps regulate neuronal excitability and plays a role in
reducing anxiety, promoting relaxation, and preventing over-excitation.
● Serotonin - is a neurotransmitter, found only in the brain. It is derived from tryptophan, a
 dietary amino acid. The function of serotonin is mostly inhibitory, and is involved in
mood regulation, sleep, appetite, and social behavior. Imbalances in serotonin levels are
linked to mood disorders such as depression and anxiety. It has been found to contribute
to the delusions, hallucinations, and withdrawn behavior seen in schizophrenia.
● Histamine - is involved in peripheral allergic responses, control of gastric secretions,
cardiac stimulation, and alertness.
 PSYCHOPATHOPHYSIOLOGY

PREDISPOSING FACTORS

Neurochemical

Excessive dopaminergic activity in cortical areas is responsible for the acute positive

symptoms of schizophrenia. This may be due to increase release or turnover of dopamine or

increase in number of dopamine receptors. Imbalances in neurotransmitters, particularly

dopamine, glutamate, and serotonin, are thought to play a role. Dopamine dysregulation is

implicated in the positive symptoms while glutamate abnormalities may contribute to cognitive

deficits.

Finding: No dopamine determination done to the patient.

Neurostructural

People with schizophrenia have relatively less brain tissue and cerebrospinal fluid. This

could represent a failure in the development or a subsequent loss of tissue. Computed

tomography scans have shown enlarged ventricles in the brain and cortical atrophy. Positron

emission tomography studies suggest that glucose metabolism and oxygen are diminished in the

frontal cortical structures of the brain. The research consistently shows decreased brain volume

and abnormal brain function in the frontal and temporal areas of persons with schizophrenia.

Finding: Client did not undergo any diagnostic examination to trace the presence of the current

disease.

Genetics

Schizophrenia has a significant genetic component, with heritability estimated to be

around 80%. Genome-wide association studies (GWAS) have identified numerous genetic risk

variants associated with the disorder, many of which are involved in synaptic transmission,

neurodevelopment, and immune function. A mix of genetic changes can interact with
environmental factors and other risk factors. About 10% of people with a parent or sibling with

schizophrenia develop the condition.

Finding: Client does not have a heredo-familial history of mental disorders.

Immunological Dysfunction

There is growing evidence implicating immune dysfunction, including

neuroinflammation and autoimmune processes, in the pathogenesis of schizophrenia. Aberrant

immune activation and cytokine signaling may contribute to neurodevelopmental abnormalities

and synaptic dysfunction.

Finding:

Age/Sex

The nodal age at onset for men is between 18 and 25; while for women is between 25 and

mid-30s.

Finding: Client had manifested the signs and symptoms of schizophrenia affective disorder at the

age of 29, two years prior to admission.

PRECIPITATING FACTORS

Environmental Factors

Prenatal and perinatal factors such as maternal infection, malnutrition, and obstetric

complications have been linked to an increased risk of schizophrenia. Psychosocial stressors,

substance abuse, and urban upbringing are also associated with higher rates of the disorder;

include familial, unfavorable living conditions, poverty, and environmental effects.

Finding: Patient is a cigarette smoker and is alcoholic PTA.

These components contribute to the patient's rising stress levels, resulting in an inability

to cope and the emergence of coping methods such as denial, agitation and acting out. Inadequate
coping strategies cause emotional instability, and as this condition persists, the patient becomes

increasingly disconnected from reality.

Undifferentiated schizophrenia can be caused by both psychological factors, such as high

"expressed emotion" environments with extensive negative comments about the patient, which

increases the risk of relapse in people who have previously had schizophrenia, and anatomical

anomalies, such as decreased brain tissue and cerebrospinal fluid (CSF), ventricular enlargement,

cortical atrophy, and impaired glucose metabolism in the frontal cortex.

Despite the fact that schizophrenia has no known origin, research indicates that changes

in neurotransmitters play an important role. A decrease in dopaminergic activity in the

mesocortical projection, a neural pathway within the cerebral cortex that primarily affects the

prefrontal cortex, which is responsible for cognitive functions such as reasoning, decision-

making, language production and mood, results in an abnormal dopamine transmission to cause

negative symptoms of schizophrenia such as decreased emotional expression, affective

flattening, poor speech (alogia), and decreased motivation (avolition), diminution of thoughts

and asociality.

Increased dopaminergic transmission in the mesolimbic projection, which projects to

various limbic system regions such as the amygdala and hippocampus responsible for regulating

behavior and emotions, causes positive symptoms or psychotic manifestations such as

hallucinations (sensory perceptions without external stimuli). The disorder is also distinguished

by erratic speech and cognitive patterns, such as tangentiality and word salad, as well as

catatonia, which prevents deliberate physical activity.

 PSYCHOTHERAPY

Psychotherapy (also called talk therapy) refers to a variety of treatments that aim to help

a person identify and change troubling emotions, thoughts, and behaviors. Most psychotherapy

takes place one-on-one with a licensed mental health professional or with other patients in a

group setting. The goals of psychotherapy are to gain relief from symptoms, maintain or enhance

daily functioning and improve quality of life.

Psychotherapy is also a process of interaction between the therapist and the patient

aimed at dispelling distress arising through disorders of emotion, thinking, and behavior.

Psychotherapy can be an effective treatment for many mental disorders. Some forms of

psychotherapy try to help people resolve their internal, unconscious conflicts, and other forms

teach people skills to correct their abnormal behavior.

IDEAL PSYCHOTHERAPY FOR SCHIZOPHRENIA

Psychotherapy and psychoeducation offer invaluable support to individuals grappling with

schizophrenia, addressing various aspects of their condition to foster understanding,

empowerment, and healing. Psychoeducation equips patients with essential knowledge about

their mental health condition, including symptoms, triggers, and available treatments. This

understanding not only reduces stigma but also enables individuals to make informed decisions

about their care and actively participate in their treatment journey. Moreover, psychoeducation

imparts practical skills for symptom management, stress reduction, and crisis prevention,

empowering patients to navigate their challenges with resilience and confidence.

1. Cognitive Behavioral Therapy (CBT)

- CBT is a structured form of therapy that helps individuals identify and challenge

unhelpful beliefs and thought patterns associated with psychosis. It aims to reduce

distressing symptoms, improve insight, and enhance coping skills.

 2. Family Therapy
Schizophrenia can have a significant impact on family dynamics and relationships.

Family therapy involves working with the individual with schizophrenia and their

family members to improve communication, resolve conflicts, and develop

strategies for supporting each other.

3. Supportive Psychotherapy

- This type of therapy focuses on providing emotional support, empathy, and

encouragement to individuals with schizophrenia. It can help individuals cope

with the challenges of living with the disorder and foster a sense of hope and

resilience.

4. Psychotherapy and counseling

- Building a trusting relationship in therapy can help people with schizoaffective

disorder better understand their condition and feel hopeful about their future.

Effective sessions focus on real-life plans, problems, and relationships. New skills

and behaviors specific to settings such as the home or workplace may also be

introduced.

● ACTUAL PSYCHOTHERAPY

The following are the conducted psychotherapies that were used by the group:

I. MORNING EXERCISE

The use of morning exercise can be highly beneficial for individuals with

schizophrenia, offering a variety of advantages such as helping the mood elevate,

reduce feelings of depression, and decrease anxiety, improves cognitive function,

helps mitigate cardiovascular disease and diabetes by improving cardiovascular

health, aiding in weight management and overall enhancing physical well-being and

can reduce stress which can help manage schizophrenia symptoms more effectively.

General Objective: Within 20-30 minutes of Morning exercise at VSMMC – Center for

Behavioral Sciences (Male Ward), patients will be able to boost mood and emotional resilience,

fostering a positive outlook and greater emotional stability throughout the day.
 Specific Objectives:

● To help regulate the mood.

● Facilitate patients in engaging in morning exercise routines.

● To help improve cognitive function,

● To help patients express their feelings through morning exercise.

● Promote emotional well-being through engaging morning exercise routines.

Evaluation: Patient was able to participate and able to verbalize feeling of joy after the morning

exercise.

II. DANCE THERAPY

Dance therapy, also known as dance movement therapy (DMT), is a form of

psychotherapy that uses movement and dance as a therapeutic tool to support

emotional, cognitive, physical, and social integration. It is based on the premise that

movement and expression of emotions through dance can contribute to psychological

healing and well-being.

Dance therapy offers numerous benefits through movement and exercise.

Patients can improve cardiovascular fitness, muscle strength, flexibility, and

coordination through participation in dance-based activities. This physical aspect of

dance therapy not only contributes to improved physical health but also enhances

overall well-being and self-esteem through the experience of mastery and

achievement. Furthermore, dance therapy serves as a powerful intervention for

mentally ill patients, addressing emotional, social, physical, and cognitive needs

through the transformative power of movement and dance. By providing a holistic

approach to healing, dance therapy offers individuals schizophrenia a pathway to self-

discovery, empowerment, and resilience as they navigate the complexities of their

condition and embark on a journey of recovery and well-being.

General Objectives: Within 20-30 minutes of Morning exercise at VSMMC – Center for

Behavioral Sciences (Male Ward), patient will be able to reduce stress and anxiety, promoting

relaxation and emotional well-being.

Specific Objectives:

● Distraction from problem-oriented thinking and worries.

● To help patients express their feelings through dance.

● Encourage patients to participate actively in dance therapy sessions to enhance

physical movement.

● To encourage emotional expression and understanding through dance therapy.

● To facilitate the development of physical skills and coordination through

movement.

Evaluation: Patients were able to follow the instructions, enjoy the activity, express their

feelings, and socialize with others.

 OBJECTIVES: PHASES OF
INTERACTION

PRE- INTERACTION/ PRE- ORIENTATION PHASE

Objectives:

1. To perform self- introspection

2. To familiarize the work area.

3. To observe the overall behavior of my patient.

4. To formulate future nursing care plans.

Activities:

1. Performed self- awareness.

2. Checked the patient’s chart and record.

Evaluation:

● SN has identified his patient’s profile, history, medications, and diagnosis.

ORIENTATION PHASE
Objectives:

1. To establish mutual trust and rapport with the client.

2. To explain the purpose and duration of stay.

3. To establish mutually agreed goals.

4. To build a working relationship with the client.

5. To be able to identify and prioritize client’s problems and feelings.

6. To perform mental status examinations and give psychological support.

7. To formulate nursing diagnosis.

Activities:

1. Introduced self and other members of the group.

 2. Established rapport and a contract by explaining to the patient about the duration of the

meeting.

3. Assessed and observed the patient's condition, appearance, behavior, and communication.

Evaluation

● Therapeutic communication was performed, and rapport was established as evidenced by

cooperation of the client, with himself answering the questions that were being asked.

WORKING PHASE

Objectives:

1. To help the client become aware of the current time, date, identity, and location.

2. To conduct psychotherapeutic interventions.

3. To plan and execute a comprehensive care strategy.

4. To promote the use of healthy coping mechanisms.

5. To evaluate the client's emotions and assist in expressing their thoughts and feelings.

Activities:

1. Encourage the patient to articulate and express their emotions.

2. Motivate the patient to maintain proper hygiene and perform basic tasks independently.

3. Collect additional information regarding the patient's behaviors.

4. Evaluate and identify the patient's problems and address their needs.

Evaluation:

1. The student nurse (SN) successfully assessed the patient's emotions and behavior, creating

a supportive environment that encouraged the patient to express themselves openly.

Consequently, the patient met the established objectives.

TERMINATION PHASE

Objectives:

1. To evaluate the nurse-client relationship.

2. To determine if the client's problems have been identified and addressed with appropriate

interventions.

3. To assess whether the mutually agreed upon goals have been achieved.

4. To gauge the client's feelings regarding the termination of the relationship.

5. To explain to the client the reasons for ending the relationship to prevent separation

anxiety.

Activities:

1. To explain to the client the reasons for ending the relationship to prevent separation

anxiety.

2. Evaluate the effectiveness of the nurse-patient relationship.

3. Assess the patient's emotional stability.

4. Conclude the therapeutic relationship with the patient.

Evaluation:

1. The student nurse (SN) successfully concluded the therapeutic relationship with the patient

in a formal manner. The interaction between the client and the group ended positively, with

no signs of separation anxiety observed.

 PROGNOSIS

The outlook for individuals with schizophrenia differs widely and presents substantial

social and economic challenges. Generally, those affected have a life expectancy shortened by

12–15 years due to factors such as obesity, sedentary lifestyle, smoking, and increased suicide

rates. Even with improved healthcare access, the life expectancy disparity between individuals

with schizoaffective disorder and the general population has widened over time.

Schizophrenia is one of the top causes of disability, with psychotic episodes being highly

debilitating, even more so than paraplegia and blindness. While about three-quarters of those with

schizophrenia continue to experience disability, some achieve full recovery or lead functional

lives.

Many individuals with schizophrenia can live independently with community support.

Long-term outcomes following the first psychotic episode vary, with around 42% achieving

favorable outcomes, 35% experiencing intermediate outcomes, and 27% facing poor outcomes.

Notably, outcomes tend to be better in developing countries, although this has been debated.

The disorder is associated with a high suicide risk, estimated at 4.9%, with most suicides

occurring shortly after diagnosis or initial hospitalization, and there is a high rate of suicide

attempts among those with schizophrenia. Various factors contribute to this risk, underscoring the

importance of personalized interventions and support systems for affected individuals.

 FACTS ABOUT UNDIFFERENTIATED
SCHIZOPHRENIA

Historical Context

Undifferentiated schizophrenia was first recognized in the DSM-III (1980) and continued

to be included as a subtype in subsequent editions of the DSM until the DSM-5 (2013), where

the subtypes of schizophrenia were eliminated in favor of a dimensional approach.

Diagnostic Stability

The diagnosis of undifferentiated schizophrenia may be less stable over time compared to

other subtypes of schizophrenia, as symptoms may evolve and change, leading to reclassification

into a different subtype or diagnosis.

Treatment Challenges

Undifferentiated schizophrenia poses unique challenges in treatment planning, as

individuals may present with a diverse range of symptoms that do not neatly fit into a specific

subtype. Treatment often involves a combination of antipsychotic medications, psychosocial

interventions, and supportive services tailored to the individual’s needs.

Prognosis

The prognosis for undifferentiated schizophrenia varies widely among individuals. Some

may experience significant improvement with treatment and achieve periods of remission, while

others may have a more chronic and disabling course of illness.

Impact on Families and Caregivers

Undifferentiated schizophrenia can have profound effects on families and caregivers,

who may struggle to understand and cope with the individual’s symptoms and behaviors.

Support and education for families are crucial components of comprehensive treatment

approaches.

Stigma and Discrimination

 Like other forms of schizophrenia, individuals with undifferentiated schizophrenia may

face stigma and discrimination due to misunderstandings about the nature of the disorder.

Advocacy efforts aimed at reducing stigma and promoting mental health awareness are important

for improving outcomes and quality of life for affected individuals.

Research Directions

Ongoing research is focused on elucidating the underlying neurobiological mechanisms

of undifferentiated schizophrenia, identifying biomarkers for early detection and intervention,

and developing more effective and personalized treatment strategies tailored to the individual's

symptom profile and genetic makeup.

NURSE PATIENT THERAPEUTIC
COMMUNICAT RATIONALE/ANALYSIS
VERBAL NONVERBAL VERB NONVERBAL ION
AL TECHNIǪUE
“Maayong buntag, Jeffry. “Silence” Informing the identity of the
● Facing the patient ● Facing down ⮚ Giving information
Ako diay si student nurse student nurse.
Liz, isa ko sa mga student
● Eye contact ● Arms-crossed
nurse gikan sa MSU-main
campus, CHS.”

“Karon kay adlaw sa martes, silence Informing the patient about the
● facing the patient ● Facing down ⮚ Giving information
Hulyo dos, tuig dosmil bente current date and time.
kwatro, oras nato karon kay ● eye contact ● Arms-crossed
alas nuebe sa buntag.”
“Bago ta magsugod, Jeffry “Oo, naa ta lagda Giving information to the patient
● Eye contact ● Laughs and ⮚ Giving information
naa tay mga lagda sundon. parehas ganiha about the role of student nurse and
Una, mas maayo nga sa exercise.” start pacing the patient.
nakaligo, nakakaon, ug
nakainom na kita sa atoang
tambal. Ikaduha, ako ang
imong student nurse, ug ikaw
akoa participant, mas maayo
na mananghid ug
magbinootan kita. Ikatolo,
kita kay malipayon sa matag-
adlaw ug magpasalamat sa
Ginoo sa matag-adlaw.
Nasabtan ba ni Jeffry?”
“Maayo kay naminaw si “Oo, lipay.” Recognizing the effort of the
● Smiles ● Stares ⮚ Giving recognition
Jeffry. Niapil ba si Jeffry sa patient helps boost their
exercise? Unsa man ang confidence.
imoang gibati?”
kumusta ang imong gibati, “maayo” To start a conversation by
● Eye contact ● smiles ⮚ Broad opening
jeffrey? encouraging the pt to reflect on
their experience and reflect on
● scratches head what was done.
“Maayo man. nakaligo ka “Oo. Ganina” To extract information from the
● Eye contact ● Laughs and ⮚ Asking question
na?” patient.
starts
pacing
“Unsa man ang imoang “palmolive” To extract information from the
● smiles ● smiles ⮚ Asking question
sabon ug shampoo?” patient.
● scratches head
“nakatoothbrush ra ka? Pila “dalawa” To extract information from the
● smiles ● smiles ⮚ Asking
ka beses magtoothbrush si patient.
jeffrey” question
● eye contact ● pacing
“Jeffrey, magpauli nako a, “okira” Giving information about the end
● smiles ● smiles ⮚ Giving
mubalik lang ako ugma sa of today's interaction and the
information schedule of the next interaction.
alas sais sa buntag. okay ● eye contact ● scratches
raba?” head
NURSE PATIENT THERAPEUTIC
COMMUNICATI RATIONALE/ANALYSIS
ON TECHNIQUE
VERBAL NONVERBAL VERBAL NONVERBAL
“Maayong buntag, Jeffrey! “Maayong buntag” To enhance and encourage pt to
● Facing the patient ● Smiles ⮚ Giving
Okay raka?” participate.
recognition
● Eye contact
“Kumusta naka?” “Oki ra” To start a conversation by
● Facing the patient ● eye ⮚ Broad opening
encouraging the pt to reflect on
contact their experience and reflect on
● Eye contact
what was done.

“Jeffrey, naa mi diri Facing the patient “Okay ra” smiling Providing Giving information about the
giandam nga mga Eye contact Eye contact information activity.
pangutana. Okay raba sa Smiles
imoha kung interbyuhin
taka.”

“Sige, sugdan na nato.” Facing the patient Silence

Eye contact Nodding Providing Giving information that the activity
information will start now.

‘Kasabut naka kung unsay Facing the patient “Oo, 1813” Smiling To explore the pt likes and
tuig nato karon? unsay Eye contact Asking questions dislikes and gain more
tuig nato karon?” Lean forward and exploration information.

“Karon kay 2024” facing the patient silence smiles Stating the reality To provide the correct
smiles information to the patient
“Unsay panahon nato facing the patient “Tag-init” eye contact Asking questions To explore the pt likes and
karon? taginit o tgaulan?” eye contact smiles and dislikes and gain more
exploration information.

“Unsay petsa ta karon?” facing the patient “bente” nodding Asking questions To explore the pt likes and
eye contact and dislikes and gain more
exploration information.

“Ang petsa ta karon kay smiles “tres” nodding Stating the reality To provide the correct
tres” eye contact information to the patient

“Unsa na ta ka bulan facing the patient “August” eye contact Asking questions To explore the pt likes and
karon?” eye contact smiling and dislikes and gain more
exploration information.

‘Karon kay July” smiles “July” smiles Stating the reality To provide the correct
eye contact scratches information to the patient
head

“Asa ta nga lugar karon?” facing the patient “USA, Canada” eye contact Asking questions To explore the pt likes and
eye contact smiles and dislikes and gain more
exploration information.
“karon kay diri ta sa smiles Silence smiles Stating the reality To provide the correct
Cebu” eye contact scratches information to the patient.
head

“asa ta nga floor karon? facing the patient “3rd floor” smiling Asking questions To explore the pt likes and
eye contact eye contact and dislikes and gain more
exploration information.

“Jeffrey, asa kita karon sa facing the patient Silence smiling Stating the reality To provide the correct
first floor sa CBS.” eye contact eye contact information to the patient

“Jeffrey, naa koy ingon facing the patient “kini, kini. wala ako sa smiling Asking questions To explore the pt likes and
nga tulo ka butang, unya eye contact facemask. kini eye contact and dislikes and gain more
kinahanglan nimo ni sya point the watch, face facemask” exploration information.
nga ma-ilhan ng matun-an mask, and t-shirt
kay pangutan-un tika
pagkahuman nako para
makabalo kung
kahinumduman pa ba ka
ug kung naminaw ka
nako. okay ba? so ang
butang kay relo, face
mask. t-shirt. Asa ang
relo? t-shirt? Face mask?
“kabalo ka og spelling? facing the patient “oo. DLROW. Unya” smiles Asking questions To explore the pt likes and
gusto tika makit-an nga i- eye contact eye contact and dislikes and gain more
spell nimo ang word nga nodding exploration information.
WORLD ug unya
pavaliktad.
“kabright gyud kaayo ni smiles silence nodding Giving recognizing the effort of the
Jeffrey ba” clapping smiling recognition patient

‘naa koy isulti nga word smiles “No ifs, and or buts” smiles To gain more information as
⮚ Exploring
human kay pagkahuman facing the patient eye contact well for the pt to sense that the
nakoy sulti kay ikaw nurse is interested to know more
nasad ha? ang words kay about
“No ifs, and or buts” him.
Mahimo ba nimo balikon
ang mga pulong nga
akong gisulti? ikaw bi”

“kabright gyud ni jeffrey smiles “silence” smiles Giving recognizing the effort of the
ba” facing the patient eye contact recognition patient

NPI continuation after activity THERAPEUTIC

COMMUNICATI RATIONALE/ANALYSIS
VERBAL NONVERBAL VERBAL NONVERBAL ON TECHNIQUE
Hello,Jeffry. Open gesture Bino, Laugh and walk away Asking question To test the memory recall pf the
Nakahinumdum ka nako? Eye contact B-I-N-O patient.
Bino
Karun, naa mi gi-andam na Eye contact O. Nods Obtaining feedback To ask permission and ensure the
mga pangutana para sa Scratches participation of patient
imoha. Okira ba? head
Jeffrey, unsa man imong full Maintain eye contact Toby McGrath Smiles Seeking information To evaluate patient’s awareness
name?

Kinsa man si Toby McGrath? Smiles Silence Smiles Stating reality To re-orient patient about the
Jeffrey Gimang man ang Scratch his reality.
imong ngalan. head
Ganahan ka maging si Toby Maintained eye contact Oo ug engineer ug si Nods Exploring To explore patient’s thoughts.
McGrath? Batman smiles

Unsa man ang rason nimo na Smiles Ako man si Batman, Smiles Exploring To gain more information.
mag-enginner ka? Maintained eye contact Superhero. Pacing

Kasabot ko nga gusto nimo

mahimong batman pero bisag Smiles Ah. Nods Stating the reality To re-orient patient about the
dili ka superhero makatabang Maintained eye contact reality.
ka gihapon sa ubang tawo.
Bag-o ta mahuman ganahan Facing the patient “Gamay ra” Smiling Asking question and To explore the pt likes and
ako na mahinumduman kung Eye contact Nodding exploration dislikes and gain more
nakaturog ka ba og ayos, information.
Jeffry?
Ganahan ka matulog Jeffry? Eye contact “…” Nods and sat in the chair Exploring To gain more information as
Maayo jud nang well for the pt to sense that the
makapahulay kita sa matag- nurse is interested to know more
adlaw. Maayo kana Jeffry.” about
him.
“Jeffry, mao ra sa ang atong Eye contact “Salamat.” Nods and wend inside Giving To foster rapport and for pt to be
istoryahan, mubalik ra ko sa recognition ready for departure.
Huwebes. Daghang salamat.”
NURSE PATIENT THERAPEUTIC
COMMUNICATI RATIONALE/ANALYSIS
VERBAL NONVERBAL VERBAL NONVERBAL ON TECHNIQUE
Maayong buntag, Jeffry. Open Okay ra Smiles Asking question To gather information of
Ako si Liz, ang student Eye contact the feelings and condition of
nurse atong niagi. Kamusta gesture the patient.
man? Eye contact
Karung adlaw sa Martes, naa Eye contact Silence Nods Obtaining feedback To ask permission and ensure the
tay pagkahimuon na activity. Scratches participation of patient
Okay ra nimo? head
Maayo. Naa kami inandam Smiles Oo Smiles Asking question To introduce the activity and the
nga akitibidad para sa tanan. walks away and fall in patient’s activity.
Ito ang ginatawag na line
morning exercise ug
diversional dance activity.
Ganahan ka muapil?
“Maayo Jeffrey kay smiles silence nods Giving To provide information that could
kinahanglan na maexercise boost the confidence of the patient
nati ang atong lawas para recognition, and to engage in the activity
malagsikon taka.” information
(After morning exercise) smiles “nalipay” nods Asking question To dig deeper about the patient’s
“unsa imong gibati experience through this activity.
pagkahuman sa atong
morning exercise, Jeffrey?”

“naay laing kalihokan, smiles silence nods Asking question To dig deeper about the patient’s
pagkanta gusto ka muapil?” experience through this activity.
“Jeffrey, maayo ba pagkanta smiles silence nods Exploring To dig deeper about the patient’s
ni toto?” experience through this activity

“naa kay gibati? unsa man smiles silence looks away Asking question To dig deeper about the patient’s
imong gibati, Jeff? “ experience through this activity

“aw sige, naa ka ba gusto smiles silence looks away Asking questions To show engagement and interest.
isulti ka nako?”
“diri na lang ang pag-istorya smiles okira nods Giving recognition To foster rapport and for pt to be
nato Mupauli nako. Mobalik facing the patient ready for departure.
ko ugma ug magkita mi sa
alas sais sa buntag diri sa
male ward. okay ra ba?”
NURSE PATIENT THERAPEUTIC
COMMUNICATI RATIONALE/ANALYSIS
VERBAL NONVERBAL VERBAL NONVERBAL ON TECHNIQUE
Jeffrey karon na ang Silence Eye contact Giving information To provide information regarding
termination phase namo, Maintained eye the termination phase and
ibigsabihin ay karon na ang contact prevent the patient expect.
ato nga huli na pagkikita diri
sa CBS pero naa pay laing
nga mga student nurses nga
mag assist nimo.
Maaari ko bang malaman Silence Looks away Exploring To assess and evaluate the
kung nahidumduman pa nimo Smiles cognitive of the patient. To test
ang mga activity na ating the memory recall.
nahimo sa sulod sa mga
adlaw na magkauban tayo?
Unsa ni?
Sige, isulti ko nimo. Silence Looks away Summarizing To provide the previous
Nagexercise, nagsayaw, Nods information and to help the patient
nagkanta, naginterview, Maintained eye contact recall
nagspelling, nagdraw ka.
Nahinumduman nanimo?
Kumusta ra ka, Jeffrey? Silence Looks away Broad opening To start a conversation
Nalipay ka ba sa ilang Smiles
activity?
Sige Jeffrey, karon kay mag Silence Eye contact Giving To provide information and
pauli na ako. Di na ako Maintained eye contact Nodding information prevent expectations from the
mobalik ugma. Karon kay Wave hand student nurse.
ginapaambit ko ka nimo nga
ako ay nagpapasalamat sa
imoha sa pagpartisipar sa
atong nahuman na aktibidad
sa sulod sa mga adlaw na naa
me diri sa CBS male ward,
sige na.
 Generic name;
Brand name;
Classification;
prescribed dosage, Mechanism Indication Contraindication Adverse Nursing responsibilities
frequency, route of of action reaction
administration
Known Adverse Assess the patient's nutritional
MULTIVITA Each Prevention and hypersensitivity to reactions status, dietary habits, and
MINS vitamin treatment any component to potential risk factors for vitamin
BRAND NAME: and of vitamin and of the multivitamin multivitamins or mineral deficiencies.
Centrum mineral mineral formulation. are rare when
within the deficiencies. taken as
formulation Presence of directed. Always follows 10 rights of
Classification Support
plays of overall vitamin or mineral However, administration
Pharmacologic:
a specific excess, such as excessive intake
Water-soluble health and Educate patients about the
role in hypervitaminosis of certain
vitamins wellbeing, importance of a balanced diet
supporting g A or D. vitamins or
iron supplements especially in and the
physiological minerals may
Therapeutic: individuals role of multivitamins as
processes, Certain medical lead to adverse
Multivitamins with
such as conditions or effects such as: supplements, not substitutes, for
and mineral inadequate
energy medications that a healthy diet.
dietary intake Nausea,
metabolism, may interact with
Recommended: or vomiting,
immune specific vitamins Select appropriate multivitamin
300 mg-500 mg increase d or
function, or minerals in the formulation based on
cap PO nutrition al gastrointestinal
formulation. the patient’s age, gender, medical
Frequency: OD bone health, requirements discomfort.
Route: PO and cellular history, and specific nutritional
due to certain needs.
repair. medical Allergic
conditions, age, reactions to
or lifestyle specific
factors. ingredients.

Vitamin or
mineral toxicity
with prolonged
excessive intake.

BIPERIDINE
Parkinson' s Hypersensitivity CNS: Monitor for signs of
BRAND NAME: Blocks disease, to biperiden, Sedation, anticholinergic toxicity, such as
Akineton acetylcholine angle closure confusion, confusion and hallucinations.
extrapyramida glaucoma,
receptors, hallucinations,
primarily in l symptoms myasthenia
Classification: memory Assess vital signs regularly,
the striatum. induced by gravis, paralytic impairment
Anticholinergic ileus, prostatic especially heart rate and blood
antipsychotic
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE CUES: Impaired social After 4 hours of 1. Approach the 1. Building trust After 4 hours of
“Kahapon pa yan siya interaction related to nursing intervention patient with a is essential in nursing intervention
hindi makausap, hindi anxiety as evidenced the patient will be calm, non- creating a the goal is met as the
nagsasalita at by minimal eye contact able to demonstrate threatening therapeutic patient made an
nakikipagusap” as and limited verbal improved social demeanor. relationship. A increased eye contact
verbalized by SN. communication. interaction skills and Spend time calm and in a day and
reduced anxiety by with the consistent participated in group
OBJECTIVES CUES: the end of the care patient without presence can activities.
 Withdrawn plan period. demanding help reduce
behavior conversation, anxiety and
observed. offering make the
o signs “go presence and patient feel
away” support. more
o walks 2. Introduce the comfortable.
away patient to 2. Gradual
 Minimal eye social exposure to
contact interactions social
 Non verbal gradually, situations can
communication starting with help the
 Reduced one-on-one patient build
participation in interactions confidence and
activities. with trusted reduce anxiety.
staff members.
Facilitate
participation in
less demanding
group activities
such as art
therapy or
music therapy.
3. Teach the
patient 3. Teaching
relaxation coping
techniques strategies can
such as deep empower the
breathing patient to
exercises, manage their
progressive anxiety and
muscle improve their
relaxation or ability to
mindfulness interact with
meditation. others.
Provide
 education on
effective
communicatio
n skills.
4. Praise and
acknowledge 4. Positive
the patient for reinforcement
any attempt at can encourage
social the patient to
interaction no continue
matter how making efforts
small. in social
Reinforce interactions.
positive
behavior with
specific
feedback.
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE DATA: Disturbed sleeping Within 8 hours of 1. Assess the patient’s 1. Understanding the After 8 hours of nursing
The patient verbalizes pattern related to nursing interventions the sleep pattern and factors affecting the interventions the goal is
“Gamayan na akong environmental stressors patient will be able to: contributing patient’s sleep can help met as the patient was
tulog kay saba ug baho as evidenced by environmental factors. tailor interventions able to:
sa sulod.” verbalization of poor  Report effectively.  Report
sleep. improvement in 2. Create a favorable 2. A comfortable and improvement in
OBJECTIVE DATA: sleep quality sleep environment if quiet environment sleep quality.
 Dark circles within one week. applicable. promotes better sleep. “Nakatulog ako
under the eyes.  Patient will 3. Educate the patient on 3. Good sleep hygiene ug tarong” as
 Observed demonstrate sleep hygiene practices. practices can help verbalized by the
yawning during effective use of improve sleep quality. patient.
daytime. relaxation 4. Teach and encourage 4. Relaxation  Demonstrated
techniques relaxation techniques techniques can help effective use of
before bedtime. including deep breathing reduce anxiety and relaxation
 Experience exercises. promote sleep. techniques
fewer before bedtime.
awakenings  Reported fewer
during the night awakenings
within one week. during the night.
Patient
verbalizes
“Madalang na
lang ako
magmata sa
gabii.”