3.

3 Level of Growth and Development

3.3.1 Normal development of a young adult (Potter

and Perry)
Young adulthood is the period between the late teens and the mid
to late 30s (Edelman and Mandle, 2010). In recent years young adults
between the ages of 18 and 29 have been referred to as part of the millennial
generation. In 2009 young adults made up approximately 33% of the
population (U.S. Census Bureau, 2009). According to the Pew Research
Center (2010), todays young adults are historys first always connected
generation, with digital technology and social media major aspects of their
lives. They adapt well to new experiences, are more ethnically and racially
diverse than previous generations, and are the least overtly religious
American generation in modern times. Young adults increasingly move away
from their families of origin, establish career goals, and decide whether to
marry or remain single and whether to begin families; however, often these
goals may be delayed (e.g., because of the economic recession of recent
years).

Physical Development
The young adult usually completes physical growth by the age of
20. An exception to this is the pregnant or lactating woman. The physical,
cognitive, and psychosocial changes and the health concerns of the pregnant
woman and the childbearing family are extensive. Young adults are usually
quite active, experience severe illnesses commonly than older age-groups,
tend to ignore physical symptoms, and often postpone seeking health care.
Physical characteristics of young adults begin to change as middle age
approaches.
Unless patients have illnesses, assessment findings are generally
within normal limits.

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 Psychosocial Development
The emotional health of the young adult is related to the individuals
ability to address and resolve personal and social tasks. The young adult
is often caught between wanting to prolong the irresponsibility of
adolescence and assume adult commitments. However, certain patterns
or trends are relatively predictable. Between the ages of 23 and 28, the
person refines self-perception and ability for intimacy. From 29 to 34 the
person directs enormous energy toward achievement and mastery of the
surrounding world. The years from 35 to 43 are a time of vigorous
examination of life goals and relationships. People make changes in
personal, social, and occupational areas. Often the stresses of this re-
examination results in a midlife crisis in which marital partner, lifestyle,
and occupation change.

Cognitive Development
Critical thinking habits increase steadily through the young-
and middle-adult years. Formal and informal educational experiences,
general life experiences, and occupational opportunities dramatically
increase the individuals conceptual, problem-solving, and motor skills.
Identifying an occupational direction is a major task of young adults. When
people know their skills, talents, and personality characteristics,
educational preparation and occupational choices are easier and more
satisfying. A bachelors or associates degree is the most significant
source of postsecondary education for 12 of the 20 fastest-growing
occupations. An understanding of how adults learn helps you to develop
patient education plans. Adults enter the teaching learning situation with a
background of unique life experiences, including illness. Therefore always
view adults as individuals. Their adherence to regimens such as
medications, treatments, or lifestyle changes such as smoking cessation

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involves decision-making processes. When determining the amount of
information that an individual needs to make decisions about the
prescribed course of therapy, consider factors that possibly affect the
individuals adherence to the regimen, including educational level,
socioeconomic factors, and motivation and desire to learn. Because young
adults are continually evolving and adjusting to changes in the home,
workplace, and personal lives, their decision making processes need to be
flexible. The more secure young adults are in their roles, the more flexible
and open they are to change. Insecure persons tend to be more rigid in
making decisions.

Moral Development

Kohlberg stated that the stage of moral development at age

of 26 is at level of conventional, the stage in which the person is
concerned with maintaining expectations and rules of the family, group,
nation, or society. A sense of guilt has developed and affects behavior.
The person values conformity, loyalty, and active maintenance of social
order and control. Conformity means good behavior or what pleases or
helps another and is approved. He/she lives according to principles of law-
and-order orientation that the person wants established rules from
authorities, and he reason for decisions and behavior is that social and
sexual rules and traditions demand the purpose

Spiritual Development
According to Fowler, it is ideal that a person reach stage IV
in their early to mid-twenties, it is evident that many adults never reach it.
If it happens in the thirties or forties, Fowler says, it is much harder for the
person to adapt. It is called the Individuative-Reflective Stage.

This is the tough stage, often begun in young adulthood,

when people start seeing outside the box and realizing that there are other

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"boxes". They begin to critically examine their beliefs on their own and
often become disillusioned with their former faith. Ironically, the Stage 3
people usually think that Stage 4 people have become "backsliders" when
in reality they have actually moved forward.

3.3.2 The ill person at a particular stage of Patient

Many young adults remain healthy; however risk of
developing a health problem is lower than that of the middle adult. Health
risk factors for a young adult originate in the community, lifestyle patterns,
and family history. The lifestyle habits that activate the stress response
increase the risk of illness. Smoking is a well-documented risk factor for
pulmonary, cardiac, and vascular diseases in smokers and the individuals
who receive second-hand smoke. Inhaled cigarette pollutants increase the
risk of lung cancer, emphysema, and chronic bronchitis.
A family history of a disease puts a young adult at risk for
developing it in the middle or older adult years. For example, a young man
whose father and paternal grandfather had myocardial infarctions (heart
attacks) in their 50s has a risk for a future myocardial infarction. The
presence of certain chronic illnesses such as diabetes mellitus in the
family increases the family members risk of developing a disease.
Regular physical examinations and screening are necessary at this stage
of development.
As in all age-groups, personal hygiene habits in the young
adult are risk factors. Sharing eating utensils with a person who has a
contagious illness increases the risk of illness. Poor dental hygiene
increases the risk of periodontal disease. Individuals avoid gingivitis
(inflammation of the gums) and periodontitis (loss of tooth support)
through oral hygiene.
Violence is a common cause of mortality and morbidity in the
young-adult population. Factors that predispose individuals to violence,

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injury, or death include poverty, family breakdown, child abuse and
neglect, drug involvement (dealing or illegal use), repeated exposure to
violence, and ready access to guns. It is important for the nurse to perform
a thorough psychosocial assessment, including such factors as behaviour
patterns, history of physical and substance abuse, education, work history,
and social support systems to detect personal and environmental risk
factors for violence. Death and injury occur from physical assaults, motor
vehicle or other accidents, and suicide attempts. In 2007, homicides
occurred at a higher rate among men and people ages 20 to 24 years than
other violent deaths (USDHHS, CDC, 2010)

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4. Pathophysiology and Rationale
4.1 Anatomy and physiology of the organ / system affected

FIGURE 1. View of the external surface of the brain showing lobes, cerebellum,
and brain stem.
Source: Brunner and Suddarths Textbook of Medical-Surgical Nursing 10 th Edition

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 Anatomy of the Nervous System

Three basic functions are performed by nervous systems:

1. Receive sensory input from internal and external environments

2. Integrate the input

3. Respond to stimuli

Sensory Input

Receptors are parts of the nervous system that sense changes in the internal or
external environments. Sensory input can be in many forms, including pressure, taste,
sound, light, blood pH, or hormone levels that are converted to a signal and sent to the
brain or spinal cord.

Integration and Output

In the sensory centers of the brain or in the spinal cord, the barrage of input is
integrated and a response is generated. The response, a motor output, is a signal
transmitted to organs than can convert the signal into some form of action, such as
movement, changes in heart rate, release of hormones, etc.

Divisions of the Nervous System

The nervous system monitors and controls almost every organ system through a
series of positive and negative feedback loops. The Central Nervous System (CNS)

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includes the brain and spinal cord. The Peripheral Nervous System (PNS) connects the
CNS to other parts of the body, and is composed of nerves (bundles of neurons).

CENTRAL NERVOUS SYSTEM

The brain is divided into three major areas: the cerebrum, the brain stem, and the
cerebellum. The cerebrum is composed of two hemispheres, the thalamus, the
hypothalamus, and the basal ganglia. Additionally, connections for the olfactory (cranial
nerve I) and optic (cranial nerve III) nerves are found in the cerebrum.
The brain stem includes the midbrain, pons, medulla, and connections for cranial
nerves II and IV through XII. The cerebellum is located under the cerebrum and behind
the brain stem. The brain accounts for approximately 2% of the total body weight; it
weighs approximately 1,400 g in an average young adult (Hickey, 2003). In the elderly,
the average brain weighs approximately 1,200 g.

Cerebrum
The cerebrum consists of two hemispheres that are incompletely separated by
the great longitudinal fissure. This sulcus separates the cerebrum into the right and left
hemispheres. The two hemispheres are joined at the lower portion of the fissure by the
corpus callosum. The outside surface of the hemispheres has a wrinkled appearance
that is the result of many folded layers or convolutions called gyri, which increase the
surface area of the brain, accounting for the high level of activity carried out by such a
small-appearing organ. The external or outer portion of the cerebrum (the cerebral
cortex) is made up of gray matter approximately 2 to 5 mm in depth; it contains billions
of neurons/cell bodies, giving it a gray appearance. White matter makes up the
innermost layer and is composed of nerve fibers and neuroglia (support tissue) that
form tracts or pathways connecting various parts of the brain with one another
(transverse and association pathways) and the cortex to lower portions of the brain and
spinal cord (projection fibers). The cerebral hemispheres are divided into pairs of frontal,
parietal, temporal, and occipital lobes. The four lobes are as follows:

a. Frontalthe largest lobe. The major functions of this lobe are concentration,
abstract thought, information storage or memory, and motor function. It also

27 | P a g e
 contains Brocas area, critical for motor control of speech. The frontal lobe is also
responsible in large part for an individuals affect, judgment, personality, and
inhibitions.
b. Parietala predominantly sensory lobe. The primary sensory cortex, which
analyzes sensory information and relays the interpretation of this information to
the thalamus and other cortical areas, is located in the parietal lobe. It is also
essential to an individuals awareness of the body in space, as well as orientation
in space and spatial relations.

c. Temporalcontains the auditory receptive areas. Contains a vital area called

the interpretive area that provides integration of somatization, visual, and
auditory areas and plays the most dominant role of any area of the cortex in
cerebration.
d. Occipitalthe posterior lobe of the cerebral hemisphere is responsible for visual
interpretation.

Corpus Callosum

The corpus callosum is a thick collection of nerve fibers that connects the two
hemispheres of the brain and is responsible for the transmission of information from one
side of the brain to the other. Information transferred includes sensation, memory, and
learned discrimination. Right-handed people and some left-handed people have
cerebral dominance on the left side of the brain for verbal, linguistic, arithmetical,
calculating, and analytic functions. The nondominant hemisphere is responsible for
geometric, spatial, visual, pattern, and musical functions.

Basal Ganglia
The basal ganglia are masses of nuclei located deep in the cerebral hemispheres
that are responsible for control of fine motor movements, including those of the hands
and lower extremities.

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Thalamus
The thalamus lies on either side of the third ventricle and acts primarily as a relay
station for all sensation except smell. All memory, sensation, and pain impulses also
pass through this section of the brain.

Hypothalamus
The hypothalamus is located anterior and inferior to the thalamus. The
hypothalamus lies immediately beneath and lateral to the lower portion of the wall of the
third ventricle. It includes the optic chiasm (the point at which the two optic tracts cross)
and the mammillary bodies (involved in olfactory reflexes and emotional response to
odors). The infundibulum of the hypothalamus connects it to the posterior pituitary
gland. The hypothalamus plays an important role in the endocrine system because it
regulates the pituitary secretion of hormones that influence metabolism, reproduction,
stress response, and urine production. It works with the pituitary to maintain fluid
balance and maintains temperature regulation by promoting vasoconstriction or
vasodilatation. The hypothalamus is the site of the hunger center and is involved in
appetite control. It contains centers that regulate the sleepwake cycle, blood pressure,
aggressive and sexual behavior, and emotional responses (blushing, rage, depression,
panic, and fear). The hypothalamus also controls and regulates the autonomic nervous
system.

Pituitary Gland
The pituitary gland is located in the sella turcica at the base of the brain and is
connected to the hypothalamus. The pituitary is a common site for brain tumors in
adults; frequently they are detected by physical signs and symptoms that can be traced
to the pituitary, such as hormonal imbalance or visual disturbances secondary to
pressure on the optic chiasm Nerve fibers from all portions of the cortex converge in
each hemisphere and exit in the form of a tight bundle of nerve fibers known as the
internal capsule. Having entered the pons and the medulla, each bundle crosses to the
corresponding bundle from the opposite side. Some of these axons make connections
with axons from the cerebellum, basal ganglia, thalamus, and hypothalamus; some
connect with the cranial nerve cells. Other fibers from the cortex and the subcortical

29 | P a g e
centers are channeled through the pons and the medulla into the spinal cord. Although
the various cells in the cerebral cortex are quite similar in appearance, their functions
vary widely, depending on location. The topography of the cortex in relation to certain of
its functions. The posterior portion of each hemisphere (the occipital lobe) is devoted to
all aspects of visual perception. The lateral region, or temporal lobe, incorporates the
auditory center. The mid-central zone, or parietal zone, posterior to the fissure of
Rolando, is concerned with sensation; the anterior portion is concerned with voluntary
muscle movements. The large area behind the forehead (ie, the frontal lobes) contains
the association pathways that determine emotional attitudes and responses and
contribute to the formation of thought processes. Damage to the frontal lobes as a result
of trauma or disease is by no means incapacitating from the standpoint of muscular
control or coordination, but it affects a persons personality, as reflected by basic
attitudes, sense of humor and propriety, self-restraint, and motivations.

Brain Stem

The brain stem consists of the midbrain, pons, and medulla oblongata The
midbrain connects the pons and the cerebellum with the cerebral hemispheres; it
contains sensory and motor pathways and serves as the center for auditory and visual
reflexes. Cranial nerves III and IV originate in the midbrain. The pons is situated in front
of the cerebellum between the midbrain and the medulla and is a bridge between the
two halves of the cerebellum, and between the medulla and the cerebrum. Cranial
nerves V through VIII connect to the brain in the pons. The pons contains motor and
sensory pathways. Portions of the pons also control the heart, respiration, and blood
pressure. The medulla oblongata contains motor fibers from the brain to the spinal cord
and sensory fibers from the spinal cord to the brain. Most of these fibers cross, or
decussate, at this level. Cranial nerves IX through XII connect to the brain in the
medulla

Cerebellum

The cerebellum is separated from the cerebral hemispheres by a fold of dura

mater, the tentorium cerebelli. The cerebellum has both excitatory and inhibitory actions

30 | P a g e
and is largely responsible for coordination of movement. It also controls fine movement,
balance, position sense (awareness of where each part of the body is), and integration
of sensory input.
NEUROTRANSMITTERS

Neurotransmitters are chemicals which transmit signals from a neuron to a target

cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered
beneath the membrane on the presynaptic side of a synapse, and are released into the
synaptic cleft, where they bind to receptors in the membrane on the postsynaptic side of
the synapse.

ACETYLCHOLINE
Found in the brain, spinal cord and PNS.
Can be inhibitory and excitatory
Synthesized from dietary choline found in red meat and vegetables
Affects sleep- wake cycle and to signal muscles to become active

DOPAMINE

Essential to the functioning of CNS

Excitatory
Involved in emotions, moods and regulation of motor control.
Dopamine forms from a precursor molecule called dopa- manufactured
from liver from amino acid tyrosine.

NOREPINEPHRINE & EPINEPHRINE (ADRENALIN)

Most prevalent neurotransmitter in nervous system.

Excitatory
Has limited distribution in brain but controls fight or flight in PNS
Play a role in attention, learning & memory, sleep and wakefulness and
mood regulation.

SEROTONIN

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 Its function is mostly inhibitory that includes induction of sleep and
wakefulness, pain control, temperature regulation, control of mood,
memory, and sexual behavior.
Inhibitory
Serotonin is produced in brain from amino acid tryptophan- derived from
foods high in CHON.

HISTAMINE

Involved in emotions, regulation of body temperature and water balance.

Neuromodulators

GLUTAMATE

Excitatory amino acid that at high levels that can have major
neurotoxic effects.

GABA

Most abundant neurotransmitters within the CNS and in cerebral

cortex.

Largely responsible for such higher brain functions as thought and

interpreting sensations.

Major inhibitory neurotransmitter in the brain

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4.2.1 Schematic diagram showing the Pathophysiology of the disease

Non-modifiable factors:
-Genetic (1000 % risk)
-Abnormalities in brain structure
and of certain brain circuits Modifiable factors:
-Alterations to mitochondria and -Trauma and or abusive
sodium ATPase pump experiences during childhood
-Hereditary Neuroendocrine -Acquired Neuroendocrine
disorders disorders

Cause:
UNKNOWN and UNCLEAR

Abnormality in the brain

and regulation of
neurotransmitters

Disturbed Neurotransmitter
Level of:
-Norepinephrine
-Serotonin
-Dopamine
-Gamma Aminobutyric Acid
-Glutamate
-Acetylcholine

Depression as manifested Mania as manifested as:

as: -Grandiosity
-Depressed mood -Decreased need for sleep
-Diminished behaviour -Flight of Ideas
-Insomnia -Easy distractibility
-Feeling of worthlessness -Psychomotor agitation
-Auditory Hallucination

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 4.2.2 Disease process and its effect to the organ system
involved

The exact psychopathology of this condition is yet to be determined but several

theories suggest that it arises from a complex interaction of genetic disposition,
neurochemical influences, anatomical variations, substance abuse, and stressful
perinatal and childhood experiences.

I. Biologic Theories:

Genetic theories

Genetic studies implicate the transmission of major depressive first-degree

relatives, who have twice the risk of developing depression compared with the general
population. First-degree relatives of people with bipolar disorder have a 3% to 8% risk of
developing bipolar disorder compared with a 1% risk in the general population. For all
mood disorders, monozygotic (identical twins have a concordance rate (both twins
having the disorder) two to four times higher than that of dizygotic (fraternal) twins.
Although heredity is a significant factor, the concordance rate for monozygotic twins is
not 100%, so genetics alone does not account for all mood disorders (kelsoe,2005)

Markowitz and Milrod (2005) discussed indications of a genetic overlap between

early-onset bipolar disorder and early onset-alcoholism. They noted that people with
cycling, poorer response to lithium, slower rate of recovery, and more hospital
admissions. Mania displayed by these clients involves more agitation than elation;
clients may respond better to anticonvulsants than to lithium.

II. Neurochemical Theories

Neurochemical influences of neurotransmitters (chemical messengers) focus on

serotonin and norepinephrine as the two major biogenic amines implicated in mood
disorders. Serotonin has many roles in behaviour: mood, activity, aggressiveness and
irritability, cognition, pain, biorhythms, and neuroendocrine process. Deficits of
serotonin, its precursor tryptophan, or a metabolite of serotonin found in the blood or

34 | P a g e
cerebrospinal fluid occurs in people with depression. Positron emission tomographies
demonstrate reduced metabolism in the prefrontal cortex, which may promote
depression.

Norepinephrine levels may be deficient in depression and increased in mania.

This catecholamine energizes the body to mobilize during stress and inhibits kindling.
Kindling is the process by which seizure activity in a specific area of the brain is initially
stimulated by reaching a threshold of the cumulative effects of stress, low amounts of
electric impulses, or chemicals such as cocaine that sensitize nerve cells and pathways.
These highly sensitized pathways respond by no longer needing a stimulus to induce
seizure activity, which now occurs spontaneously. It is theorized that kindling may
underlie the cycling of mood disorders as well as addiction. Anticonvulsants inhibit
kindling; This may explain their efficacy in the treatment of bipolar disorder.

Dysregulation of acetylcholine and dopamine also are being studied in relation to

mood disorders. Cholinergic drugs alter mood, sleep, neuroendocrine function, and the
electroencephalographic pattern; therefore, acetylcholine seems to be implicated in
depression and mania. The neurotransmitter problem may not be as simple as
underproduction or depletion through overuse during stress. Changes in the sensitivity
as well as the number of receptors are being evaluated for their roles in mood disorders.

Neuroendocrine influences

Hormonal fluctuations are being studied in relation to depression. Mood

disturbances have been documented in people with endocrine disorders such as those
of thyroid, adrenal, parathyroid, and pituitary. Elevated glucocorticoid activity is
associated with the stress response, and evidence of increase cortisol secretion is
apparent in about 40% if clients with depression, with the highest rates found among
older clients

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 4.3 Comparative Chart showing the classical and clinical signs
and symptoms of the disease and rationale

Classical Clinical Rationale

Inflated self-esteem Manifested
or grandiosity
Decreased need for Manifested
sleep
More talkative than Not
usual or pressure to Manifested
keep talking
Manic State
Clients with mania have exaggerated self-esteem.
They believe they can accomplish anything. They
rarely discuss their self-concept realistically
Clients with mania can go days without sleep or food
and not even realize they are hungry or tired.
Clients experiencing manic episode think move and
talk fast.

Flight of ideas Manifested Cognitive ability is confused and jumbled with thoughts
racing one after the other. Clients cannot connect
concepts and jump from one subject to another
Distractibility Manifested The ability to concentrate or pay attention is grossly
impaired because the persons attention span is brief
Psychomotor Manifested Clients with mania experience psychomotor agitation
agitation and seem to be in perpetual motion. Sitting still is
difficult.
Excessive Not Excessive involvement in pleasurable activities that
involvement in Manifested Have high potential for painful consequences
pleasurable
activities that
Have high potential
for painful
consequences

Depressed State
Depressed mood Manifested Clients with depression describe themselves as
hopeless, helpless, down, or anxious

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Diminished interest Manifested They experience anhedonia, losing any sense of
or pleasure in all or pleasure from activities they formerly enjoyed.
most activities

Significant weight Not Clients in the depressive phase manifest weight loss
loss Manifested from lack of appetite or disinterest in eating.

Insomnia Manifested Sleep disturbances are common: either clients cannot

sleep or the feel exhausted and unrefreshed no matter
how much time they spend in bed.
Fatigue Not Because of the lack of food and inactivity, clients feel
Manifested exhausted and unrefreshed.

Feeling of Manifested Clients with depression may describe themselves as

worthlessness hopeless, helpless, down, or anxious. They also may
say they are a burden on others or are a failure to life
Diminished ability to Not Clients with depression experience slowed thinking
think Manifested process. They may not respond verbally to questions

Recurring thoughts Not Often clients with depression have thoughts of dying or
of death Manifested committing suicide.

5. Nursing Intervention

5.1 Care Guide of patient with Bipolar 1 Disorder

Depressive state

Try to sit beside and be in the clients space often people who are
depressed do not like to make demands on others but they appreciate

37 | P a g e
 company. Likewise, you will need to do the talking rather than expecting
the person to do so.

Keep up good levels of communication even when not reciprocated e.g.

Let the client know where you are going even if there is no response.

Provide for the safety of the client and others.

Begin a therapeutic relationship by spending non-demanding time with the

client.

Promote completion of activities of daily living by assisting the client only

as necessary

Establish adequate nutrition and hydration.

Promote sleep and rest.

Engage the client in activities.

Encourage the client to verbalize and describe the emotion.

Set realistic tasks and have realistic expectations.

Be aware of suicide risk. Ask the appropriate questions and communicate

with treating team about this issue. This issue may be a reason for
hospitalization.

If the client expresses unexpected happiness and begins to give

possessions away, seek assistance immediately.

Avoid placing unrealistic demands on the client.

Be patient.

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Manic state

Be calm.

Do not participate in the escalation of excitement.

Use simple, clear communications, and make sure the message has been
understood.

Make sure that you move away from potential conflictual situations. Use
their distract ability to come back again.

Do not make too many demands.

Reduce stimulation and loud noises.

Avoid conflict.

Keep the clients real level of expertise in mind. Do not allow yourself to be
overly influenced by their persuasive presentation of advice.

This is very tiring so make sure that you get some space, which you will
need to regulate for yourself the other client may not recognize your
need.

When you want space, try to manage your emotional state as the
individual will pick up on your distress and you may have to defend
yourself, as the client will not see themselves as unreasonable.

Be genuine, try not to turn off. When something is funny enjoy it.

39 | P a g e
 Be conscious of the safety factor. The danger of physical complications
may be one of the trigger factors to indicate the need for hospitalization.

Remember it is very easy for this client to end up with disturbed sleep
patterns, sleep late and spend half the evening ringing people.

In hot weather, fluid replacement is important, particularly when the client

is on lithium. Clients can become so dehydrated that the blood
concentration of lithium increases to such an extent that the person can go
into a hepatic coma. Lithium also increases sensitivity to sun

Encourage the client to drink small amounts regularly. Consider what the
client likes to drink and make it easily available. Address nutrition in the
same way, thinking of high-energy food.

Encourage the client to have a bath or a shower

Some client suggest warm drinks, but not coffee or tea. This helps the
person feel looked after.

Be assertive about your own boundaries in a friendly manner

Reduce access to dangerous situations.

40 | P a g e
 5.2.1 Nursing Care Plan

Cues Nursing Scientific Objectives Intervention Rationale Evaluation

Diagnosis basis
Subjective Ineffective Inability to General :
report of coping form a valid After 5 days of GOAL UNMET:
worry related to appraisal of holistic nursing client still
mingaw na impaired the stressors, care, the pt will unable to
gud kung adaptive inadequate be able to reach assess current
MAMA Bro behaviour choices with Optimum Level of situation
ba. Wala syay practiced Functioning accurately
kauban sa responses, Specific : 1.Determined 1.to determine
balay as and/or After 8 hrs of individual stressors degree of
verbalized by inability to nurse-pt impairment
the patient use available interaction, the pt 2. Evaluated ability 2.to determine
resources. will be able to to understand degree of
Objective- assess current events and provide impairment
Looks worried situation realistic appraisal to
accurately the situaion
3. Ascertained 3. to assess
clients coping abilities
Source : understanding of and skills
Doenges, current situation and

41 | P a g e
Moorhouse, its impact on life
Murr Nurses 4.Called client by 4. using clients
Pocket name. Ascertain name enhances
Guide12th how clients prefer to sense of self
edition be addressed and promotes
individuality and
self-esteem
5. Used reality 5. to assist
orientation client deal with
current situation
6. Assisted client in 6. to assist
use of diversion and client deal with
recreation current situation
techniques
7.Encouraged 7.to provide for
verbalization of meeting
feelings and fears psychological
needs
8. administered 8.to aid
prescribed pharmacological
medication ly

42 | P a g e
 Cues Nursing Scientific Objectives Intervention Rationale Evaluation
Diagnosis basis
Subjective - Deficient Decreased General : GOAL MET:
laay kaau ari diversional stimulation After 5days of the client
oy. Maaug activity from holistic nursing participated
muinit kay related recreational care, the pt will in the
makagawas lack of or leisure be able to reach activity/s
mi pero lay environme activities. Optimum Level intervened
ghapun oy. ntal of Functioning.
Objective: stimulation Source : Specific:
-Disinterested Doenges, After 8 hrs of
in the Moorhouse, nurse-pt 1. Assessed clients 1. validates
environment Murr Nurses interaction, the physical, cognitive, reality of
-lethargic Pocket pt will be able to emotional, and environmental
noted Guide12th engage in environmental status deprivation when
edition satisfying 2. Acknowledged the it exists
activities within reality of situation 2. to establish
personal and feelings therapeutic
limitations. relationship and
support helpful
3. Provided change emotions
of scenery 3. to provide
positive sensory

43 | P a g e
 stimulation,
reduce sense of
boredom,
improve sense of
4.Involved normalcy and
recreational, play, control
music therapy as 4. to provide
appropriate positive sensory
stimulation,
reduce sense of
boredom,
5. determined actual improve sense of
ability to participate normalcy and
and interest in control
available activities, 5. presence of
noting attention acute illness,
span, physical depression or
limitations and sensory
tolerance, level of deprivation may
interest or desire and interfere with
safety needs. desired activity
6. administered

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 prescribed
medication
6.to aid
pharmacologicall
y

Cues Nursing Scientific Objectives Intervention Rationale

Diagnosis basis Evaluation

45 | P a g e
Subjective - Risk for self- At risk for General :
directed behaviors in After 5 days of GOAL MET:
Objective- violence which an holistic nursing the client
-psychiatric and or other individual care, the pt will does not
diagnosis of directed demonstrate be able to reach demonstrate
bipolar 1 violence s that Optimum Level of any
disorder related to he/she can Functioning 1. Determined the 1. to assess violent
-living with mental be Specific : underlying dynamics causative or behavior
people with health physically, After 8 hrs of of etiology contributing
co-mental problem and emotionally, nurse-pt factors
health environment and or interaction, the pt 2. Ascertainn clients 2. to assess
problems in al risk sexually will be able to perception of self and causative or
an harmful to demonstrate self- situation contributing
environment self and or control as factors
which had others evidenced by 3. Observed and 3.may indicate
risk for nonviolent listened for early possibility of loss
violent In manic behaviors cues of distress and of control and to
behaviors phase or increasing anxiety intervene at this
-history of negative, point to prevent a
aggressiven uncontrolled blow-up
ess and thoughts Source : 4 to assess
violence feeling and -Doenges, 4.Determine causative or

46 | P a g e
toward behavior Moorhouse, Murr availability of contributing
others pose a Nurses Pocket homicidal and or factors to prevent
A risk threat or Guide12th suicidal means violence against
diagnosis is danger to edition self and or others
not harm self or -Sheila L. 5.to promote
evidenced by other. They Videbeck 2011 5. Developed SN- sense of trust
signs and are Psychiatric- cleint relationship allowing to
symptoms, aggressive, Mental Health discuss feelings
as the hostile and Nursing 5th openly
problem has cannot Edtion 6.to set
not occurred; evaluate the 6.remain calm and boundaries on
rather consequenc state limits on clients behavior
nursing e of their inappropriate
interventions behavior. behavior in a firm
are directed manner 7. to aid
at prevention 7.administered pharmacologicall
prescribed y
medication

5.2.1 Drug Therapeutic Record

Drug Classification/ Indication Contraindication / Side Effect Nursing Responsibility

Action
Name : Classification : -psychotic disorder Contraindication : Before

47 | P a g e
haloperidol Dopaminergic- -tourettes syndrome -hypersensitivity Educated for possible side effects.
Dose :20 mg blocking agent -behavioral problem -coma During

Route : PO Antipsychotic in children -severe CNS depression - Ensured that the patient took the

Frequency : once a -hyperactive -Parkinsons disease medicine

day Action: children -liver damage After

Mechanism not fully Avoided activities that require

understood, Side Effect: alertness

Avoided alcohol during treatment
antipsychotic blocks -Dry mouth
Avoided prolonged exposure to
post synaptic -nausea and vomiting
sunlight
dopamine receptors in -seating Educated not to withdraw dug
the brain, depress the -drowsiness abruptly unless prescribed
RAS, including those -headache Educated the importance of

parts of the brain that -vertigo compliance to therapeutic regimen

Monitored for signs and symptoms of
are involved with -extrapyramidal syndrome
Side Effects
wakefulness and
emesis.
Source : Lippincott 2013 Nursing Drug
Guide
12th edition

Drug Classification/ Indication Contraindication / Side Effect Nursing Responsibility

Action

48 | P a g e
Name : Classification : - Schizophrenia Contraindication Before
- Manic Bipolar 1
olanzapine Therapeutic Class: -Hypersensitive to drug Educated for possible side effects
disorder -Sedation incluiming coma Informed patient that he may gain
Dose :10 mg Antipsychotic
- Agitation caused by -Caution in patients with heart
Route : PO Pharmacologic Class: weight
Schizophrenia disease, cerebrovascular During
Frequency : once a Dibenzapine
and Bipolar 1 disease, conditions that - Ensured that the patient took the
day derivative
disorder predispose patient to hypotension medicine
- Depressive
and hepatic impairment. After
Action: episodes of Side Effect
- CNS: somnolence, insomnia, Avoided activities that require
May block dopamine Bipolar 1
parkinsonism, dizziness, alertness
and 5-HT2 receptors disorder Avoided alcohol during treatment
- Obsessive- neuroleptic malignant syndrome,
Avoided prolonged exposure to
Compulsive suicide attempt, abnormal gait,
sunlight
Disorder asthenia, personality disorder, Informed patient to rise slowly to
- Tourette Syndrome
akathisia, tremor, articulation avoid dizziness upon standing up
impaitment, tardive dyskinesia, quickly
fever Educated not to withdraw dug
- CV: orthostatic hypotension, abruptly unless prescribed
tachycardia, chest pain Educated the importance of
hypertension, ecchymosis, compliance to therapeutic regimen
Monitored for signs and symptoms of
peripheral edema, hypotension
- EENT: Amblyopia, rhinitis, Side Effects
pharyngitis, conjuctivitis
- GI: constipation, dry mouth,
dyspepsia, increased
appetite,increased salivation
vomiting, thirst
- GU- hematuria, metrorrhagia,
urinary incontinence, UTI,
- Hematologic : leucopenia

49 | P a g e
 - Metabolic: htperglycemia, weight
gain
- Musktal: joint pain extremity pain,
back pain, neck rigidity,
twitching hypertonia
- Respir: increased cough, dyspnea
- Skin: sweating
Other: flulikesyndrome, injury.

Overdose Signs and Symptoms:

Agitation, aggressiveness,
dysarthria, tachycardia, EPS,
reduced level of consciousness, Source : Lippincott 2013 Nursing Drug
CP arrest, cardiac arrhythmias, Guide
delirium, NMS, respi depression, 12th edition
seizures, HPN, hpn

Drug Classification/ Indication Contraindication / Side Effect Nursing Responsibility

Action

50 | P a g e
Name : Classification : Parkinsonism Contraindication Before
Biperidine Anticholinergic -relief of symptoms -use cautiously with tachycardia, Educated for possible side effects
Dose :2mg Action: of extrapyramidal pregnancy and lactation During

Route : PO Anticholinergic disorder -reduce dosage in hot weather - Ensured that the patient took the

Frequency : twice a Activity in the CNS Contraindications: -discontinue or reduce dosage if dry medicine

day that is believed to -hypersensitivity mouth makes speaking or After

normalize -close-angle swallowing difficult Avoided activities that require

The hypothesized glaucoma Side Effect alertness

Avoided alcohol during treatment
imbalance of -peptic ulcers disorientation
Avoided prolonged exposure to
cholinergic and -confusion
sunlight
dopaminergic -nervousness Informed patient to rise slowly to
neurotransmission in -light headedness avoid dizziness upon standing up
the basal ganglia in -dizziness quickly
the brain. -dry mouth Educated not to withdraw dug

. -blurred vision abruptly unless prescribed

Educated the importance of
compliance to therapeutic regimen
Monitored for signs and symptoms of
Side Effects

Source : Lippincott 2013 Nursing Drug

Guide
12th edition

51 | P a g e
 Orientation Phase

1. Objectives

After 8 hours of student nurse-patient interaction, the

patient will be able to:

I. identify the student nurses name;

II. gain information on the purpose of student
nurses duty;
III. acquire a sense of trust to the student nurse as
evidenced by a voluntary conversation with the
student nurse.

2. Description

Before interaction, the patient was having some

conversation with other patients. He is wearing a red colored
jacket, blue shorts and red slippers. The patient looks
interested for the conversation.

52 | P a g e
3. Illustration

Legend
Doors Long Table Beds Nurses Station Urinary Area
Supply Area Bathing Area Isolation Area Student-Nurse Patient

Actual Interaction

53 | P a g e
Date : January 18, 2017 Time: 11:00 am
Setting and Student Nurse Verbalization Patients Students thoughts Communication
Appearance of the Verbalization and feelings technique used and
patient concerning the rationale
interaction
The patient is musta naman ang imu okey raman I was quite nervous Encouraging
wearing a red paminaw Churchill and fearful on what expression
colored jacket, may happen next asking the client to
shorts and slippers. appraise the quality of
The patient looks his or her experiences
interested for the
conversation.
ako diay si Jack imung ah. Di diay mo Giving information
Student-Nurse. Gkan diay mi kadtong making available
sa Leyte. Tga-Naval State tagaBOHOL? the facts that the
University mi ug naa mi client needs
kutob sa sabado, January
21, 2017. Naa mi ari sugod
alas sais (6) sa buntag kutob
alas 2 sa hapun
lahi man to sila nga school. ah Giving information
Taga-Bohol State University making available
to cla ug kutob rato sila sa the facts that the
alas 10 sa buntag client needs

54 | P a g e
 okey ra mangutana ko nimu okey ra man I was delighted that Asking consent
C******l? the patient accept allows client to
my invitation for my cooperate with his/her
queries own will
taga-asa diay ka taga-Carcar man Exploring
CHURCHILL? ko. delving further into
a subject or an idea
ah. Kahinumdum ka nganu di man ko buang. Acceptingindicating
miabut k ngari C******l? Nahadlok man gud reception
akong Mama Exploring
maTOKHANG ko delving further into
a subject or an idea
matokhang? Giunsa man Gagamit man gud My nervousness Seeking information
nimu pagkasulti nga ko ug bawal kadtong was replaced with seeking to make
iTokHang ka C******l? una pero dugay interest clear that which is not
naman to kaau meaningful or that
which is vague
unsa man sad nga bawal sama gud sa droga, Seeking information
imu gigamit diay? rugby nya syrup seeking to make
pud clear that which is not
meaningful or that
which is vague
The patient looks ah. Nahadlok imu mama? hadlok man cla nga I was sad also but I Acceptingindicating
sad and Giunsa man nimu mapareha ko didnt show it to the reception

55 | P a g e
derpressed. pagkaingun nga nahadlok kanang sa TV gud. patient. I showed Encouraging
imu mama diay C*******l? Kanang mapatay lag empathy rather than expression
kalit ba. Mao na sympathy. asking the client to
ilang kahadlokan. appraise the quality of
Mao gidala ko sa his or her experiences
aku Mama ug
maguwang ari
cgue pa diay kag gamit dugay na oy. Kadtu I wasnt nervous Exploring
atong bawal diay last year pa. sugod anymore cause I delving further into
sa birthday naku. sensed that the a subject or an idea
patient was not
violent as I think.
kanus-a man to imu oh gad. Dec 30, Exploring
Birthday C******l? 1991 delving further into
kadumdum ka? a subject or an idea
The patient ah. So pipila palang diay ka Kadto pa last year I was amazed how Acceptingindicating
suddenly looks and kaadlaw diay gaundang man. Suwatan natog he shift suddenly reception
acts as energetic. kanta imu notebook from one topic to Exploring
bi. another. delving further into
a subject or an idea
kanta? Unsa man sad nga bisaya ni. Ako ra Seeking information
kanta imu isulat sad? nagsuwat ani ganue. seeking to make
Title ani kay clear that which is not
tambag meaningful or that

56 | P a g e
 which is vague
wala man koy lapis ari kanang ballpen
C*****l nalang

pagamiton tikag ballpen oh gad, pagsuwat

basta di ni gamiton para lang ang ballpen
makipag-away hap! Ang
ballpen para pagsuwat
lamang.
dia ra C******l oh. (he wrote the song
he mentioned
above)
unsa mani nga kanta about na sa atoa. Exploring
C*****l? puedi ko nimu Cause we are all delving further into
sultian kung para asa mani Son of GOD, in the a subject or an idea
nga kanta? name of Jesus
Christ
cgue daw palhug ko ug (he sang the song) I was amazed and
kanta ani C******* mesmerize by his
ability to sing.
maayu man diay ka doctor mo bro? Giving recognition
mukanta C******l acknowledging,
indicating awareness
student-nurses mi C*****l. ah. Nagskuwela Giving information

57 | P a g e
 nagskuwela mi ug nursing man sad ko, 3rd year making available
nga course nko. the facts that the
client needs
unsa man imu course Bachelor of Arts in Exploring
C******l diay? English ko. delving further into
a subject or an idea
imu course kay Bachelor of Magprform mi Exploring
Arts in English? Mag-unsa anah. Im a total delving further into
man diay mo ana C******l? performer, Im a a subject or an idea
judge and a
performer.
You mean performer and Gajudge man ko ug I didnt believe on Seeking information
judge ka? Giunsa man nimu mga perormances what he said seeking to make
pagsulti nga performer ug nya kabalo sad ko instead I assume it clear that which is not
judge ka? mukanta ug a feeling of meaningful or that
maggitara, drums, grandiosity only. which is vague
baho. Exploring
delving further into
a subject or an idea
Pedro approaches
and shouts 1+1?
Mukanta? Puedi mngayug two, ayg samuk dha I assume it as a Seeking information
sample nimu C****l? Bro. May banda pa manifestation of seeking to make
ganue ko (2) duha being easily clear that which is not

58 | P a g e
 kabouk. distracted. meaningful or that
which is vague
Astiga gud anah C****l Black Damp ang isa Exploring
Unsa man sad ngalan sa nya ang isa delving further into
imu banda C****l? jelvaniers a subject or an idea
Black Damp? Palhug daw B L A C K nya Seeking information
ko ug spell out C*****l? space D A M P seeking to make
clear that which is not
meaningful or that
which is vague
Ah. Nya ung isa? J E L V A N I E R S, Acceptingindicating
mao na nag ako is reception
aka banda Seeking information
seeking to make
clear that which is not
meaningful or that
which is vague
Exploring
delving further into
a subject or an idea
As he replied, he Ah. Musta naman imu Okey raman to, nay I sensed that what Acceptingindicating
suddenly looks sad Banda karun C*****l? bag-o na cla lead he claimed is true. reception
and depressed. singer. Ang kadto Exploring
asawa sa aku uyab delving further into

59 | P a g e
 dati. a subject or an idea
Uyab nimu dati? OO, uyab mi ato six Seeking information
(6) years pero seeking to make
gibiyaan ko niya. clear that which is not
Sakitan ko Bro oy meaningful or that
which is vague
Puedi ko nimu sultian Okey raman mi ato Exploring
nganuj gabulag mo nya gisultian nlang delving further into
C*******l? ko saku kabanda a subject or an idea
sad nga gi-okoy ang
aku uyab ni Richie
sakitan ko Bro
oy
All of the patients Kaon sang ko Bro
Cgue-cgue
were called for their
lunch. Our
conversation ended.

60 | P a g e
61 | P a g e
 Working Phase

1. Objectives

After 8 hours of student nurse-patient interaction, the

patient will be able to:

I. recognize the assigned student nurse;

II. acquire a sense of trust to the student nurse as
evidenced by a voluntary conversation with the
student nurse.;
III. share his thoughts and feelings;

2. Description

Before interaction, the patient was having some

conversation with other patients while combing his hair. His
mood seemed to be not the same as yesterday. He was
wearing a black colored jacket, red shorts and black slippers.

62 | P a g e
3. Illustration

Actual Interaction
Date: January 19, 2017 Time: 1:00 pm
The Musta naman ka C*****l? Okey raman, Encouraging expression
patient is mingaw lague kong asking the client to appraise
wearing a Mama Bro oy. Wala the quality of his or her
black syay kauban sa experiences
colored balay?
jacket,
red shorts
and black
slippers.
As he Mingaw ka sa imu Mama? Miari man to siya I felt sad as well but Seeking information
replied, Kanus-a man diay sad to last kadtong Sabado I didnt show it. seeking to make clear that
he gabisita nimu C******l? pero gaingun man to which is not meaningful or that
suddenly sya nga mubalik sya which is vague
looks sad karun pero wala
and paman
depresse
d.

63 | P a g e
Bdaw nangita pato ug mingaw na kaayu oi
kwarta C****l. . Mao lague sad
pero di man ko
kailangan presohon
ari kay presohan
mani sa mga buang.
Di man ko buang.
Ang mga buang
ayuhon, ang mga
ayu buangun.
giunsa man nimu pag-ingun Kitaa ra gud na cla. Seeking information
nga buangun ang mga ayu Naay gahubo, seeking to make clear that
ari C*****l? glakaw-lakaw nya which is not meaningful or that
gatuyok-tuyok. Kinsa which is vague
ba pud kaha di Exploring
mabuang ana delving further into a subject or
kauban. an idea
Wala man ko kabalo ana Ganahan na kaayu
C*******l nganu gdala ka ari ko mugawas ba.
pero ang mga Doktor man
ang gakita nimu nya may
nakita sila nga dili maayu sa
imu karun. Di mana sila

64 | P a g e
 magdala ari kung okey imu
paminaw.
Ang imu mabuhat karun Mao mana aku
C*****l para mapadali imu gbuhat. Maminaw
paggawas kay mutumar ka man ko niya di sad
sa imu mga tambal nimu ug pabalong.
tumanun ang mga tambag
sa mga Doktor, Nurse o
bisan Student-Nurse.

Legend
Doors Long Table Beds Nurses Station Urinary Area
Supply Area Bathing Area Isolation Area Student-Nurse Patient

65 | P a g e
66 | P a g e
 Termination Phase

1. Objectives

After 8 hours of student nurse-patient interaction, the

patient will be able to:

I. recognize the assigned student nurse;

II. acquire a sense of trust to the student nurse as
evidenced by a voluntary conversation with the
student nurse.;
III. share his thoughts and feelings;
IV. accept the termination phase.

2. Description

Before interaction, he was holding the wall rails while

waiting for her mother. He looked happy and seems just got woke
up. He was a wearing a black colored polo shirt with prints, red
shorts and black slippers.

67 | P a g e
 3. Illustration

Legend
Doors Long Table Beds Nurses Station Urinary Area
Supply Area Bathing Area Isolation Area Student-Nurse Patient

Actual Interaction
Date: January 21, 2017 Time: 1:30 pm

68 | P a g e
He was Musta naman imu paminaw Okey lang man Bro. Encouraging expression
holding the Bro? Naa naman si asking the client to appraise
wall rails Mama. the quality of his or her
while waiting experiences
for her
mothers
arrival. He is
wearing white
polo shirt with
prints, shorts
and slippers.
The patient
looks just got
wake up and
seems happy.
Naa na imu Mama? Oo Bro, tua pa sa I was delighted and Seeking information
gawa. gapalit pa ug happy. seeking to make clear that
tinapay. which is not meaningful or that
which is vague
Ahh, maayu. Kuan diay Bro, Aww, oo. Sabado Acceptingindicating reception
manguli nami karun. Last man diay karun.
day nani namu karun Cgue Bro, ayo-ayo.
Tarung ug skwela.

69 | P a g e
O gad Bro, kaw pud ari. Ganahan na sad ko
mouli Bro oy
Ganahan na kaau ka Mao lague Bro,
mouli? kapoy ari oy.
Basta tumanun nimu unsa Lague sad
gisulti sa Doktor, sa Nurses
unya dili magsiaw-siaw.
Cgue-cgue Bro

70 | P a g e
 5.2.4 FDAR Charting

Date Focus Data Action Response

-Assessed physical,
January Deficient Received Patient
cognitive, emotional and
18, 2017 diversiona patient participated in the
environmental factors
l activity lethargic and morning exercise
-informed the importance of
disinterested and verbalized
diversional activity (morning
in the the importance its
exercise)
environment importance
-encouraged to participate
into diversional activity
-encouraged verbalization of
feelings
-change of scenery provided
January Deficient Received -Assessed physical, Patient
19, 2017 diversiona patient cognitive, emotional and participated in the
l activity lethargic and environmental factors morning exercise
disinterested -informed the importance of and verbalized
in the diversional activity (dance the importance its
environment therapy) importance
-encouraged to participate
into diversional activity
-encouraged verbalization of
feelings
-change of scenery provided

71 | P a g e
5.2.5 Health Teaching Plan
Objective
General Objective
After 5 days of student
nurse-client and significant
others interaction the client
will be able to gain
knowledge, attitude, and
skills.
After 45 minutes of
student nurse-client
interaction the client will be
able to:
1.state the importance of
having proper hygiene
2.cite ways in maintaining
proper hygiene
3.enumerate ways on how
to cope with loneliness
Content Methodology
1.Importance of having good hygiene 1.Discussion
-best defense against diseases
-pleasing to look
- stress free person is not irritable
- proper blood circulation
-promotes optimum level of functioning
2. Ways in maintaining proper hygiene 2.Discussion
2.1 taking a bath
2.2 brushing teeth
2.3 changing clothes everyday
2.4 wearing slippers
2.5 keeping fingernails short
3.Ways to cope with loneliness 3.Discussion
3.1 listening to music
3.2 watching television
3.3 talking with other people
3.4 playing ball games
72 | P a g e
 3.5 playing cards with friends

4.demonstrate proper way 4.Proper way in taking a bath 4.Demonstrat

in taking a bath 4.1 wet your body ion and return
4.2 apply shampoo and massage demonstratio
your hair properly and rinse n
4.3 apply soap and rinse
4.4 wipe your body with a towel until
dry
4.5 change dirty clothes with clean
one
5.the family would be able 5.Preventive measures to prevent 5.Discussion
to discuss preventive relapse
measures of relapse 5.1.Encourage family to provide a
quiet ,calm, atmosphere.
5.2.Instruct the family members to
set limits on acting out behaviours of the
client and learn ways to express
emotions in an acceptable manner.
5.3.Encourage restful environment
where possible .
5.4.Advise the family or S.O. to help
the client in setting limits on acting out
behaviours and learn way to express
emotions in an acceptable manner.
5.5.Encourage structured or
controlled increase in physical activity.
5.6.Encourage client to avoid
strenuous activity.
`

73 | P a g e
5.2.6 Therapies
Dance and Music Therapy
Dance therapy is a type of psychotherapy that uses movement to further the
social, cognitive, emotional, and physical development of the individual. Dance
therapists work with people who have many kinds of emotional problems, intellectual
deficits, and life-threatening illnesses. They are employed in psychiatric hospitals, day
care centers, mental health centers, prisons, special schools, and private practice. They
work with people of all ages in both group and individual therapy. Dance therapy can be
helpful to a wide range of patientsfrom psychiatric patients to those with cancer to
lonely elderly people. Dance therapy is often an easy way for a person to express
emotions, even when his or her experience is so traumatic he or she can't talk about it.
It is frequently used with rape victims and survivors of sexual abuse and incest. It can
also help people with physical deficits improve their self-esteem and learn balance and
coordination.
Music therapy uses music to promote healing and enhance quality of life. It is a
complementary therapy that is used along with other cancer treatments to help patients
cope mentally and physically with their diagnosis. Music therapy may involve listening to
music, creating music, singing, and discussing music, in addition to guided imagery with
music. Music therapy can be incorporated into many different environments. People
listen to music alone or in groups. This can be done with trained therapists or without. It
can be as simple as someone listening to a CD. Specially selected music can be
broadcasted into hospital rooms.

Date of Activity: January 19, 2017

Participants: Male patients guided by their student nurses
Facilitator: BSN Group 1 of Naval State University

74 | P a g e
I. Objectives:

General Objectives:
After 8 hours of student nurse-patient interaction, the patients will
be able to express their thoughts and feelings through dance and music.
Specific Objectives:
a. To be able to encourage the patients to participate in the therapy

b. To create social needs and generate the good feeling that comes from
being with others

c. To enhnace cognitive skills, motivation and memory

d. To increase body movement, strength and tone

e. To improve circulation

f. To promote self-expression and provide relaxation

II. Materials Needed:

Laptop

Speaker

Name tags

III. Physical Arrangement

A. Location: Male Ward
B. Conceptual Presentation of the Participants Formations

Facilitator

Patient
IV. Flow of Therapy

1. Gathered the patients.

2. Oriented to time, place and activity

3. Explained the rules and regulations to be followed for the entire

therapy.

75 | P a g e
 4. Provided instructions on the conduct of the therapy.

5. Started the dance therapy.

6. Evaluated the patients feelings and expression about the therapy.

V. Precautions to be Observed

1. Maintained a safe environment by not using sharp objects such as

ballpen and other materials to be used for the therapy.

2. Monitor the patient during the entire therapy.

VI. Evaluation of the therapy

1. Documented to the patients chart.

ART THERAPY

Art therapy is defined by the American Art Therapy Association as a mental

health profession in which clients, facilitated by the art therapist, use art media, the
creative process, and the resulting artwork to explore their feelings, reconcile emotional
conflicts, foster self awareness, manage behavior and addictions, develop social skills,
improve reality orientation, reduce anxiety, and increase self-esteem. A goal in art
therapy is to improve or restore a clients functioning and his or her sense of personal
well-being. Individuals with mental illnesses may not always be verbally expressive;
however, they may display emotions through creative expressions such as music,
poetry, or art.
Date of Activity: January 21, 2017
Participants: Male patients guided by their student nurses
Facilitator: BSN Group 1 of Naval State University
I. Objectives:

General Objectives:

After 8 hours of student nurse-patient interaction, the patients will

be able to express their thoughts and feelings through arts.

Specific Objectives:

a. to help them reflect on their thoughts, desires, and challenges.

b. to explore their feelings

76 | P a g e
 c. to foster self awareness

d. to develop social skills,

e. to improve reality orientation,

f. to reduce anxiety, and

g. to increase self-esteem.

II. Materials Needed:

Laptop

Speaker

Name tags

Bond Paper

Crayons

III. Physical Arrangement

C. Location: Male Ward/Mess Hall
D. Conceptual Presentation of the Participants Formations

Facilitator

Patient

Bed

IV. Flow of Therapy

77 | P a g e
 7. Gathered the patients to the mess hall.

8. Oriented to time, place and activity

9. Explained the rules and regulations to be followed for the entire

therapy.

10. Provided instructions on the conduct of the therapy.

11. Started the art therapy.

12. Evaluated the patients feelings and expression about the therapy.

V. Questions asked

Ngano mao mana imo gi drawing?

Unsa imo gihuna huna pag drawing nimo ana?

Unsa man imong gibati kahuman nimog drawing?

VI. Precautions observed

1. Maintained a safe environment by not using sharp objects such as

ballpen and other materials to be used for the therapy.

2. Monitored the patient during the entire therapy.

VII. Evaluation of the therapy

1. documented to the patients chart.

78 | P a g e