Manliclic, Eden DC.

BSN 4C1-7 Group 106 October 7, 2009

DATA OF THE CLIENT
Name: Vivian Manson
Age: 40 yrs. Old
Add: Marikina City
Nurse Response
Client’ s Response Analysis Evaluation

➢ Good afternoon ➢ Ako si Vivian ➢ Giving recognition.

ma’am Manson.Ahmm.. ➢ The client is
Ako po si Eden Eden..magandang responsive and now
student nurse ng Our hapon din. oriented as the
Lady of Fatima discussion and
University, kayo po
questions ask with
si?
➢ Bale 40 na ko. ➢ Very responsive. her. She clearly
➢ Ma’am ilang taon na answers all the
po kayo? questions and the
family who let her
➢ (7) Pang six ako confine in that
➢ Ilan po kayo sunod ako kay Ate ➢ In denial with her institution will be
magkakapatid? Lucy yung present illness. the one to decide if
nagpasok saken they want the client
dito hindi ko nga to go home.
alam kung bakit
ako pinasok dito
hindi naman ako
baliw.

Nurse-Patient Interaction
General Objective: As a nursing student I want to be broader minded when it comes with understanding the
situation or illness of the client in Metro psyche Facility.
Specific Objective: >To analyze the perception of the client about their illness.
>To know what behavior should be the nurse will show towards the client.
> To consider the client’s probable responses to potential therapeutic intervention.
➢ Ilang months na po ➢ Mag tu two months ➢ Very responsive.
kayo dito sa MPF? na sa 25.

➢ Sa tingin ninyo po ➢ Yung kapatid ko ➢ Very cooperative.

bakit kayo nandito galing din kasi dito
sa MPF? two months ago.
Tapos ng paglabas
niya ako naman
pinadala ng
kapatid ko dito.

➢ Oriented.
➢ Kelan po yung ➢ Matagal na. Si Ate
huling bisita ng Lucy and Ate
mga kamag-anak Nancy lang naman
ninyo dito? nagpupunta dito
kasi busy sila ➢ Very cooperative.
lahat.
➢ Kamusta naman
po kayo dito? ➢ Okay lang naman
kaya lang may
nang baback fight
saken dito pero
hindi ko siya
pinapansin kasi
matanda nay un.
Katulad kanina
pinapagalitan nia
ko kasi daw punta
ko ng punta dun sa
may lagayan ng ➢ Very responsive
toothbrush hindi
➢ Anong pong ko na lang
madalas ninyong pinansin kasi baka
gawin ditong mag away lang
activity para kami.
malibang kayo?
➢ Madami pero
madami din ako
kaibigan dito
marami ako
kausap .
➢ Yung mga staff po ➢ Mababait sila lahat ➢ Oriented.
kamusta? simula nung
pinainom nila ko
ng gamut
nakakatulog na ko
ng maayos tapos
wala na yung
boses ng mga
kapatid kong
➢ Ano naman po bumubulong. ➢ Very responsive.
sisabi sa inyo nung
bumubulong sa ➢ Sabi nila tulungan
inyo? ko daw sila kasi
hirap na hirap na
sila samantalang
ako daw nakahiga
lang. Gumawa daw ➢ Now admits the
➢ Ano- ano pong ako ng paraan. she has the illness.
gamot ung
pinapainom ➢ Pampatulog daw
sainyo? At ano daw yun tsaka para
po yung epekto? mawala ung mga ➢ Very responsive.
bumubulong saken
➢ Ano daw po sabi na wala naman
ng doctor sainyo? talaga.

➢ Ah..sabi ng Doctor
sila Ate Lucy daw
magdedesisyon ➢ Oriented.
kung ilalabas na
➢ Pano po nila ko dito kasi
magpapaalam na sila nagpasok
po kami sana pos a saken dito.
susunod png mga
araw mas maging ➢ Walang anuman.
maganda na Ikaw Si Eden di ba?
kalusugan ninyo. Oo nga iuuwi na ko
Manliclic, Eden DC. BSN 4C1-7 Group 106 October 7, 2009

Topic: -- from the Greek roots skhizein ("to split") and phrēn, phren- ("mind") is a psychiatric diagnosis that describes a mental disorder
characterized by abnormalities in the perception or expression of reality. Distortions in perception may affect all five senses, including
sight, hearing, taste, smell and touch, but most commonly manifest as auditory hallucinations, paranoid or bizarre delusions, or
disorganized speech and thinking with significant social or occupational dysfunction.

Catatonic schizophrenia -is one of several types of schizophrenia, a chronic mental illness in which reality is interpreted abnormally
(psychosis). Catatonic schizophrenia includes extremes of behavior. At one extreme of catatonic schizophrenia, you're unable to speak, move or
respond. At the other, you have overexcited or hyperactive motion and you may involuntarily imitate sounds or movements of others.

Signs and symptoms of catatonic schizophrenia fall into several categories of catatonic behaviors, including:
• Physical immobility. You may be completely unable to move or speak, or you may stare, hold your body in a rigid position and seem to be
unaware of your surroundings (catatonic stupor). You also may have a form of immobility known as waxy flexibility. For example, if your
arm is moved into a certain position, it will stay in that position for hours.
• Excessive mobility. Rather than being unable to move, you may move in an excited manner that appears to have no purpose. You may pace
in a frenzy, turn in circles, flail your arms or make loud noises.
• Extreme resistance. You may not respond to instructions, may resist any attempt to be moved or may not speak at all.
• Peculiar movements. You may have inappropriate or unusual postures, grimace for long periods or adopt unusual mannerisms. You may
also have habits known as stereotyped behaviors, which can include repeating words, obsessively following a routine, or always arranging
objects exactly the same way.
• Mimicking speech or movement. You may repeatedly say a word just spoken by someone else (echolalia) or repeatedly copy a gesture or
movement made by someone else (echopraxia).
Other signs and symptoms of catatonic schizophrenia
Although the main symptoms of catatonic schizophrenia are catatonic behaviors, you may also have some of the other common signs and
symptoms of schizophrenia, such as:
• Having beliefs not based on reality (delusions)
• Seeing or hearing things that don't exist (hallucinations), especially voices
• Incoherent speech
• Neglect of personal hygiene
 • Lack of emotions
• Emotions inappropriate to the situation
• Angry outbursts
• Trouble functioning at school or work
• Social isolation
• Clumsy, uncoordinated movements
PATHOPHYSIOLOGY
To determine whether patients with catatonic schizophrenia have specific alterations in brain morphology, internal
(ventricles) and external (frontal, temporal, parieto-occipital) components of the cerebrospinal fluid (CSF) spaces were
examined morphometrically. Planimetric measurements of computed tomographic (CT) scans from 37 patients with
catatonic schizophrenia, 28 patients with hebephrenic schizophrenia, and 39 patients with paranoid schizophrenia, all
diagnosed according to DSM-III-R criteria, were compared with separate age- and sex-matched non-psychiatric control
groups, respectively. The areas of the frontal sulci, the parieto-occipital sulci, the inter-hemispheric fissure, and the
lateral and third ventricles were measured separately for the right and left hemispheres. Catatonic patients showed
significant enlargements in almost all CSF spaces, especially in the left fronto-temporal area which, in addition, correlated
significantly with illness duraton. Catatonic schizophrenia, the most severe sub-type with regard to clinical
symptomatology and brain pathology, showed fronto-parietal cortical alterations.

MEDICATION
Medications are one of the cornerstones of catatonic schizophrenia treatment. Those most commonly prescribed for catatonic schizophrenia
include:
• Benzodiazepines. These medications, also called anti-anxiety medications, are sedatives. They are generally the medication of choice to
treat catatonic schizophrenia. Benzodiazepines, which may be injected in a vein — especially if you're in a state of catatonia — are typically
fast acting, helping relieve catatonic symptoms quickly. They may cause dependency with long-term use. These medications may also help
if you have anxiety along with catatonic schizophrenia. You may need to take benzodiazepines for a period of days or weeks to relieve your
catatonic symptoms.
• Barbiturates. These medications also are sedatives and have a similar effect as benzodiazepines, quickly relieving catatonic symptoms.
They, too, may be habit-forming with long-term use. They're generally not routinely used to treat catatonic schizophrenia.
• Other medications. It's common to have other mental health issues along with catatonic schizophrenia. Antidepressants can be helpful if
you have symptoms of depression. And mood-stabilizing medications may help with aggression or hostility.
• Antipsychotic medications. These are generally the medication of choice for schizophrenia. However, they aren't used as often for the
catatonic type of schizophrenia because they can actually worsen catatonic symptoms.

SPECIAL PROCEDURE
Electroconvulsive therapy (ECT) for catatonic schizophrenia
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your brain to trigger a brief seizure. This seems to
cause changes in brain chemistry that can reduce symptoms of certain mental illnesses, such as catatonic schizophrenia. ECT may be an option for
you if your symptoms are severe or if medications haven't helped relieve a catatonic episode. Deciding whether electroconvulsive therapy is a good
option for you can be extremely difficult. If possible, make sure you or your guardian understand all the pros and cons.
Hospitalization for catatonic schizophrenia
During crisis periods or times of severe catatonic symptoms, hospitalization may be necessary. This can help ensure your own safety and that of
others, and make sure that you're getting proper treatment, nutrition, sleep and hygiene. Partial hospitalization and residential care also may be
options.
Psychotherapy for catatonic schizophrenia
Although medications are the cornerstone of catatonic schizophrenia treatment, psychotherapy also is important. Psychotherapy may not be
appropriate for everyone, though, especially if symptoms are too severe to engage in a therapeutic process that requires two-way communication.
Psychotherapy may include:
• Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life
challenges brought on by having a chronic mental illness like catatonic schizophrenia. Therapy can help improve communication skills,
relationships, your ability to work and your motivation to stick to your treatment plan. Learning about catatonic schizophrenia can help you
understand it better, cope with lingering symptoms, and understand the importance of taking your medications. Therapy also can help you
cope with stigma surrounding catatonic schizophrenia.
• Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have
a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse,
and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and
understand family conflicts. Family therapy also can help family members cope and reduce their distress about your condition.
Social and vocational skills training for catatonic schizophrenia
Training in social and vocational skills to live independently is an important part of recovery from catatonic schizophrenia. With the help of a
therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help you with
jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctors about getting
one.
Treatment challenges in catatonic schizophrenia
When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in
daily activities. But be prepared for challenges that can interfere with treatment.
For one thing, you, like many others with schizophrenia, may find it hard to follow your treatment plan. You may believe that you don't need
medications or other treatment. Also, if you're not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk
to your doctors about tips to stick to your treatment plan. Even with good treatment, you may have a relapse. Have a plan in place to deal with a
relapse.
Smoking, and often heavy smoking, is common when you have schizophrenia. Some evidence suggests that smoking improves thinking and
concentration in schizophrenia. But smoking can interfere with certain medications. Be honest with your doctors about your smoking habits. And
be sure you understand the serious health risks of smoking.
Similarly, using alcohol and drugs can make catatonic schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you
may benefit from treatment programs that include care for both schizophrenia and substance abuse.
 NURSING INTERVENTIONS RATIONALE

Be sincere and honest when communicating with the client. Avoid Delusional clients are extremely sensitive about others and can
vague or evasive remarks. recognize insincerity. Evasive comments or hesitation reinforces
mistrust or delusions.

Be consistent in setting expectations, enforcing rules, and so forth. Clear, consistent limits provide a secure structure for the client.

Do not make promises that you cannot keep. Broken promises reinforce the client’s mistrust of others.

Encourage the client to talk with you, but do not pry for Probing increases the client’s suspicion and interferes with the
information. therapeutic relationship.

Explain procedures, and try to be sure the client understands the When the client has full knowledge of procedures, he or she is less
procedures before carrying them out. likely to feel tricked by the staff.

Give positive feedback for the client’s successes. Positive feedback for genuine success enhances the client’s sense of
well-being and helps make non-delusional reality a more positive
situation for the client.

Recognize the client’s delusions as the client’s perception of the Recognizing the client’s perceptions can help you understand the
environment. feelings he or she is experiencing.

Initially, do not argue with the client or try to convince the client Logical argument does not dispel delusional ideas and can interfere
that the delusions are false or unreal. with the development of trust.

Interact with the client on the basis of real things; do not dwell on Interacting about reality is healthy for the client.
the delusional material.

Engage the client in one-to-one activities at first, then activities in A distrustful client can best deal with one person initially. Gradual
small groups, and gradually activities in larger groups introduction of others when the client can tolerates is less
threatening.

Recognize and support the client’s accomplishments (projects Recognizing the client’s accomplishments can lessen anxiety and the
Evalutation:

There's no sure way to prevent catatonic schizophrenia. Evidence shows that some signs of schizophrenia may be present from
early childhood or even infancy. Early identification and treatment for people at risk of schizophrenia, perhaps starting in
childhood, may help get symptoms under control before serious complications develop and may help improve the long-term
outlook. Also, sticking with your treatment plan can help prevent relapses or worsening of catatonic schizophrenia symptoms.