Mental Status Examination I. General Description Mr. Jim Racoma, a 32 year old Filipino, male. Mr.

Racoma appears to be well and healthy and whenever he is sick he prefers to stay up on bed when he is awake. He appears to be at his stated age. Mr. Racoma is appropriately dressed and groomed for his age, sex and the situation. He is neat in appearance and no bad odor is noted. During the interview with him there was constant eye contact with the interviewers and he can express his feelings appropriately. He can also speak out the things or his ideas but not at all times answering the questions being asked. He usually jumps from one idea to another but he can be approached easily. He also responds easily and cooperative. During the interview he has also no unusual habit. Mr. Racoma appears and acts alert and oriented to person, place and situation since he was able to identify who is the interviewer, where he is and what he is doing there, he also know how long he have been in rehab. He knows how to deal with his surroundings. His speech is clear, normal in volume, speak at a normal rate but able to speak so many ideas which are unrelated. He is also spontaneous in answering. Mr. Racoma sits slightly leaning forward and his gait is steady and strong. His general motor activity is on average and with good motor coordination. Emotional Status Affect: Appropriate Mood: Happy, with good disposition. He is not anxious and shows no guilt when hes stating that he has killed many people. With no anger but is quite aggressive when triggered. Subjective aspect of the patients emotional reactions: The patient had religious, grandiose and paranoid delusions. Objective aspects of the patients emotional reactions: He seems very happy when he talks about his brother and other relatives. He maintains eye to eye contact because every time someone asks, he usually looks at to the one asking. He seems not hesitant in sharing his ideas and experiences because he is continuously sharing his different ideas and experiences. Subjective aspect of patients emotional reactions: He verbalized that haan kayo unay agsasao ket mabannug nak nukwa. III. Thought content, Processes and Experiences Symptomatology involving thoughts: Delusion

II.

a. Religious- The patient said that he is related to Jesus and gave iodine to Him. b. Grandiose- The patient said that he is Father of Mathematician, he is Neil Armstrong and he is also an Olympian. c. Paranoid- The patient said that he feels weak because he thinks that they are poisoning him in the rehab. Neologism- The patient named his tattoo as Omega Esclerabo Omega. Loose association- The patient said that Ilocos Norte, Ilocos Sur, Boundary, Security guard. Tangential- The patient verbalized for his meryenda Confidential, Astronaut has vitamins and laklak lipovitan. Circumstantial- The patient verbalized on his judgment, Five million naassemble na computerpangnegosyo at I-share ko. Yung piso na papel nakopya sa computer madami. Flight of Ideas- During the conversation, he had many fragmented and unrelated ideas. When he was asked if who he was, he verbalized Im Incredible Hulk, a giant. Then he continued by saying, In Mactan airport, there are 852 passengers, 140 ang namatay at isa ang namatay na stewardess. Somatic pre-occupations: Symptomatology affecting the perception: Illusion- The patient perceives that there are eight (8) suns in Malaysia.

Hallucination Visual- The patient claims that he sees a man at the topmost part of the wall watching them. Tactile- The patient claims that he has a bomb in his leg and once he stands up it might explode Sensorium and Cognition Level of orientation: Person- The patient is oriented to person and was able to identify the name of the examiner. Place- The patient is oriented to place since he was able to identify where he is which is at Pavilion 18 in NCMH Time- The patient is oriented to time because he was able to identify the date of the interview which was February 14, 2013. Attention and Concentration: a. Digit span test a.1. Digits forward- the patient was able to repeat a series of digits forward read to him by the examiner which was 3.8.9.1.7.4. a.2. Digits backward- at the first trial the patient was able to repeat a series of digits forward read to him by the examiner which was 4.1.6.2.7. a.3. Serial 7s test- The examiner asked the patient to subtract 7 from 100 in serial function. The patient was able to subtract it but some has an interval of 3-4 sec.

IV.

Memory:

a. Immediate- The patient was asked what his duty in the ward for his snack and he answered it is confidential and he laklak lipovitan and astronaut has vitamin. And for the second time the patient was asked what he ate for his snack he said pancit luglog. This shows that at the second try his immediate memory is impaired. b. Recent- The patient was asked what was his course and he answered grafting, and added that he graduated but failed to find a job because he got sick with schizophrenia. c. Remote- The patient was asked what how long he had been in the ward and he answered that he has been in the ward since 2010 and he said that it would be three years now. Information and Vocabulary: The patient was asked How many days are there in a week? and he said I dont know maybe 28, 29. And in addition he also said that Marcos erase 31. --Since the patient was not able to provide the answer asked by the examiner. The examiner initiated to ask what the days of the week are but he was not able to name all the days of the week. He was only able to name Monday and Tuesday. The patient was asked What must you do to water to make it boil? and he answered boil, thermostat, pressure to kill insects. --The patient showed circumstantial thought process since he was able to answer the question but then he jumped to another idea. The patient was asked How many things are there in a dozen? and he answered 12 maybe. --The patient was able to answer the question but with hesitation.

The patient was asked How many months in a year? and he answered We hi-jack something, there are 72 letters in Philippine alphabet. And as a follow up question the examiner asked the patient to name the months in a year and he was able to name only January and February. --The patient showed tangential thought process because he was not able to answer the question.

The patient was asked How many pounds are there in a kilo? but he was not able to answer it correctly instead he said he had face transplant.

--The patient showed tangential thought process because he was not able to answer the question.

The patient was asked How many sun on earth? and he said there are 8 suns in Malaysia. --The patient showed illusion where he misinterpreted the stimuli which is the sun and perceives it to be eight (8).

Abstraction: The patient was asked what was his idea about Time is Gold. And he answered he saw gold when they found Yamashita Treasure in the year 1936-1945. And he also said that there is palatandaan which is mango and coconut. Then his ideas jumped to Death March where he said that he died during that time but he is still alive because a doctor treated him. --The patients abstract thinking is no longer intact since he was not able express what he understands about Time is Gold instead he answered other ideas which is quite related to the word gold. Judgment and comprehension:

The patient was asked what he will do if he sees a lot of money and the patient said that Five million na-assemble na computer. And the examiner again asked the patient what he will do with the money and he said pangnegosyo at I -share ko. Yung piso na papel nakopya sa computer madami. This shows that the patient is able to judge a situation. --The patients judgment is intact however the patient was not able to give the answer to the question immediately. Insight: The patient was asked what he feels in the rehab and he said that he feels weak and he says that he is masabsabidungan. --This shows that the patient is aware what is happening in his surroundings but perceives it differently. Perception and coordination: The patient was able to write his name on a sheet of blank paper. The patient was able to copy a simple circle drawn by the examiner. The patient was able to copy a simple cross drawn by the examiner. The patient was able to copy a square drawn by the examiner. --The patient was able to perform what was asked and it shows that the patients perceptual and visual functioning is still intact Drug Study 1. Generic Name: Risperidone Classification: Antipsychotics

Dosage, Route, Frequency: 0.5 mg tab, oral, BID Mechanism of Action: Interferes with binding of dopamine to D2 interlimbic region of the brain, serotoninreceptors, and alpha adregernic receptors in the occipital cortex. It has low to moderate affinity for the other serotonin receptors Indication: Acute manic episodes associated with bipolar disorder, long-term maintenance therapy of bipolar disorder, maintenance of schizophrenia Desired Effect: This is given to the patient to decrease manifestations of psychosis and stabilize his mood since he is experiencing Bipolar Disorder Depressed type and Schizoaffective disorder.

Nursing Responsibilities 1. Check the doctors order. 2. Check the availability and expiration date of the drug

Rationale To verify doctors prescription of the drug To make sure that the drug is available on the time of administration To know if the drug is safe to administer

3. Observe 10 Rs of drug administration. 4. Assess mental status (orientation, mood, behavior) before and periodically during therapy.

To avoid errors To know if there is a need for the drug to be withdrawn To know if there is a need for drug dose readjustment Because the drug causes hypostatic hypotension and tachycardia To ensure that medication is taken and not hoarded or cheeked. Because the drug may cause tardive dyskinesia and neuroleptic malignant syndrome

5. Monitor blood pressure, ECG, pulse and respiratory rate before and frequently during dose adjustment. 6. Observe patient carefully when administering medication 7.Monitor patient for adverse effects 8. Impart health teachings such as: a. Change position slowly b. Avoid driving or activities that needs alertness

To minimize orthostatic hypotension Because it causes drowsiness

c. Use sunscreen or protective clothing when exposed to sun 9. Do proper documentation

It impairs body temperature regulation

For legal purposes