Bipolar 1 Case Presentation

POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC
MacArthur Highway, Digos City
BIPOLAR DISORDER I WITH PSYCHOTIC FEATURES
In Partial Fulfillment of the Requirements in RLE 105 (Psychiatric Nursing)
A Requirement Presented to the Faculty of the Nursing Department of

Polytechnic College of Davao Del Sur, Inc
Submitted by:
Alba, Jhensczy Hazel Maye
Colita, Pryll John
Dagpin, Aileen Claire
Daligdig, Jea
Padilla, Mary Shan
Palamos, Noelby Jay
March 2017
ACKNOWLEDGEMENT
A journey is easier when travelled together. Interdependence is certainly more valuable

than independence. The researchers would never have succeeded in completing this task without
the cooperation, encouragement and help provided by various personalities.
First and foremost, to the Almighty Father who bestowed self-confidence, wisdom,
ability and strength in them in order to complete this study. Without His grace this would never
have been a reality.
To Mrs. Jennifer Ybanez RN MAN, Dean of the Nursing Department for allowing them
to conduct their clinical exposure in Southern Philippines Medical Center Institute of Psychiatry
and Behavioral Medicine.
With deep sense of gratitude, they express their sincere thanks to the esteemed and
worthy Clinical Instructor, Sir Roberto Osol RN MAN for his valuable guidance and support in
carrying out this case under his effective supervision, encouragement, enlightenment, and
teachings.
They would also like to thank patient Chippy and his family for allowing them to use her
case as the subject of this study. The researchers are delighted for their enthusiasm and
cooperation throughout the interaction process.
To the SPMC IPBM staff, who allowed them to conduct their clinical exposure with their
cooperation and who had been always patient and helpful.
To the beloved parents, who gave them financial and moral support.
And to classmates and friends who have always been there for them.
TABLE OF CONTENTS
Title Page
Acknowledgement
Chapter I – INTRODUCTION
Chapter II – OBJECTIVES OF THE STUDY
Chapter III – PATIENT’S PROFILE
Chapter IV – ANAMNESIS
A. Genogram
B. Informants
C. Family History
C.1 Grand Maternal & Paternal Lineage
C.2 Father
C.3 Mother
C.4 Siblings
D. Personal History
D.1 Prenatal
D.2 Birth
D.3 Infancy and Childhood
D.4 Psychosexual History
Play Life
D.5 School History
D.6 Religious and Social Adaptability
D.7 Occupational History
D.8 Onset of Illness
Chapter V – PSYCHODYNAMICS
A. Tabular Presentation of Etiologic Factors

(Precipitating/Predisposing Factors)
B. Schematic Diagram of Psychodynamics
Chapter VI – MEDICAL MANAGEMENT
A. Differential Diagnosis
Actual Medical Management (Doctor’s Order)
B. Drug Study
Chapter VII – NURSING MANAGEMENT
A. Initial/Final Mental Status Exam

B. Nursing Care Plan
C. Health Teaching
Chapter VIII – PROGNOSIS
Chapter IX – EVALUATION
Chapter X – RECOMMENDATION
REFERENCES: Books/Internet Sources
APPENDIX
A. Transmittal Letter
Dean Of Nursing
Clinical Coordinator
B. Location Map/Spot Map
C. Home Visit Documentation
D. Curriculum Vitae
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INTRODUCTION
Mental health is a level of psychological well-being, or an absence of mental illness. It is

the "psychological state of someone who is functioning at a satisfactory level of emotional and
behavioral adjustment". From the perspective of positive psychology or holism, mental health
may include an individual's ability to enjoy life, and create a balance between life activities and
efforts to achieve psychological resilience. According to the World Health Organization (WHO),
mental health includes subjective well-being, perceived self-efficacy, autonomy, competence,
inter-generational dependence, and self-actualization of one's intellectual and emotional
potential, among others.
Bipolar 1 disorder, once known as manic depression, is a mental illness that involves
vast, out-of-control mood swings from depressed to elevated moods. Bipolar 1 is the type most
easily diagnosed as it contains the most pronounced elevated mood, called mania. A person with
bipolar 1 (also noted as bipolar i) has episodes of both mania and depression. The presence of
these episodes are the hallmark symptoms of bipolar I. (American Psychiatric Association)
If the client is under mania, the common signs and symptoms includes feeling that are
unusually high, optimistic and very irritable, unrealistic, grandiose belief about one’s abilities or
powers, sleeping less but feeling extremely energetic, talking so rapidly, racing thoughts,
jumping quickly from one idea to the next, highly distractible, impaired judgement and
impulsiveness, acting recklessly without thinking about the consequences and lastly in severe
cases, delusions and hallucinations may appear.
If the client is under depression, the common signs and symptoms are decreased energy,
easy fatigability, lethargic, has diminished activities, insomnia or even hypersomnia, usually loss
of interest in pleasurable activities and lastly social withdrawal.
According to the American Psychiatric Association, about 6 million people, or 2.5% of
the U.S. population, suffer from bipolar disorder. About 1% of the people in the U.S. are thought
to have bipolar 1 disorder. As of the year 2013, about 120 every 100,000 people in the
Philippines has bipolar disorder and about 642 people in Davao City and the surrounding regions
suffer the illness as stated by the DOH. According to PhilStar, out of 10 people affected by this
illness, 8 had suicidal ideations and 3 successfully committed suicide.
With the data shown above, it is a must that the group should choose this particular case.
Bipolar disorder if left untreated can result to self-harm and ultimately death. And as part of the
group’s psychiatric exposure, this study will further broaden their knowledge on such an illness.
Patient Chippy was found to be in the manic stage when the group interviewed him. Although
showing some mannerisms and hyperactivity, he was cooperative to the group. What makes
Patient Chippy more interesting is that he was readmitted for 4 times. This allows the group to
further examine the history of Patient Chippy and understand what might really cause and further
worsen his condition.
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OBJECTIVES
Generally, this study aims to present how mental and behavioral disturbances would
occur and how it can be managed.
Specifically, this study aims:
1. To be able to know and identify the common factors that may contribute or precipitate in
the occurrence of bipolar I disorder.
2. To be able to apply various modalities and nursing management in assessing or
determining the client’s current mental health condition and the extent of his condition.
3. To be able to determine and apply appropriate therapeutic nursing communication skills
in the attempt to gather pertinent data and information regarding the client’s previous and
present mental condition.
4. To be able to formulate and present psychodynamic graphical trace of the various
personal and psychological trace which is relevant or significant in the occurrence of the
client’s mental condition.
5. To be able to present the correlations of various biophysical, psychological, emotional,
and holistic factors which may have the direct cause or effect to the client’s mental status.
6. To be able to present both ideal and actual medical management in dealing with the
patient who is diagnosed with bipolar I disorder.
7. To be able to identify personality disorders present for a patient with bipolar I disorder.
8. To be able to formulate appropriate nursing diagnosis to address the identified mental
health abnormalities.
9. To be able to formulate and present appropriate nursing care plans of management to
address the identified mental health disturbance.

10. To be able to present and discuss various pharmacological therapies used to a patient with
bipolar I disorder and its common side effects and how to deal with it.
11. To be able to present actual prognosis of the client’s mental health disturbance.
12. To be able to come up with a strong recommendation points for the family, community,
and the whole environment which will be beneficial or helpful for the speedy recovery of
the patient.
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PERSONAL PROFILE
Name: aka “Chippy”
Address: People’s Village, Maa, Davao City
Gender: Male
Age: 23
Birth Date: October 18, 1993
Birthplace: Poblacion Arakan, Cotabato
Civil Status: Single
Occupation: None
Religion: Roman Catholic
Type of Community: Rural
Nationality: Filipino
Educational Attainment: Grade III
Ordinal Rank: Second
Father’s Name: Boy Bawang
Age: 37 (Deceased)
Occupation: Previously worked as a carpenter, construction worker
Mother’s Name: Happy
Age: 49
Occupation: Housemaid
Admitting Diagnosis: Bipolar I Disorder MRE Manic with psychotic features
Chief Complaint: Decreased sleep and appetite
Admitting physician: Dr. Aisa Katrina V. Francisco
Date of Time of Reason of Admitting Final Diagnosis Date of

Admission Admission Admission Diagnosis Discharge
1. 11/16/2013 8:45 pm Decreased Brief Psychotic Brief Psychotic 11/21/2013
sleep Disorder Disorder
2. 12/30/2013 6:00 am Laceration Major Depressive Cannabis 1/10/2014
on left wrist Disorder Induced
Psychosis
3. 1/24/2014 6:15 pm Difficulty in Major Depressive Major Depressive 1/31/2014
sleeping Disorder with Disorder with
Psychotic Psychotic
Features Features
4. 1/23/2016 7:00 pm Suicidal Major Depressive Major Depressive 2/13/2016
behavior Disorder Disorder with
Psychotic
Features
5. Feb. 20, 6:00 am Decreased Bipolar I
2017 sleep and Disorder MRE
appetite manic with
psychotic
features
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ANAMNESIS
Elizabeth
Age: 49
Relationship with the patient: Mother
Length of the time known to patient: 23 years
Address: People's Village, Maa Davao City
Apparent Understanding about the Patient's Present Illness:
“Dili man gud na siya mutarong og kaon dili pa jud magpatoo. Dili pa jud mutuo og Ginoo. Bad
Spirit jud ng naa sa iya”
 She is concerned and worried about her son.
Jomer
Age: 27
Relationship with the patient: Brother
“Usahay tarong mana siya. Usahay dili masabtan. Madepress siya kanang di siya kakaya og
problema. Pag-uli niya gikan Cotabato naguol siya nga buntis iyang manghod.”
 Worry was noted in the tone of his voice. He is concerned with the condition of his
brother.
Mario
Age: 52 years old
Relationship with the patient: Uncle
Address: Dafudel St. People's Village, Maa Davao City
Length of time known to patient: 23 years
Apparent Understanding of the Patient's Present Illness:
"Nagabisyo man gud na siya, didto siya nadaot sukad naga gamit siya ug shabu ug marijuana.
Maayo baya unta na siya, nalain lang iyang kinaiya sukad nag bisyo-bisyo. Manakit na bisag
babae kulatahon na niya."
 He was very accommodating, very cooperative and shares information about the patient
honestly.
Marcelino
Age: 45
Relationship with the patient: Uncle
"Buotan mana nga bata si Chippy. Sukad ng bisyo na siya, wala njud siyay ensaktong
panghunahuna. Usahay mukalit rag dagan dagan ky naa daw siya'y makita nga mga taong itom
tanan. Di man gud na siya mu inum sa iyang tambal ba ky wala daw siya'y sakit."
 The informant was very participative and cooperative.
Evon
Age: 36
Relationship with the patient: Neighbor
“Buotan mana si Chippy labina sa mga bata maayu kayu na siya hangtud natingala nalang mi
naglaslas siya”
 The informant was amazed of the patient but we can see that she was sad telling us the
last part of the story.
Melodina
Age: 39
“Pagabot niya dire kay naga dagan dagan na siya. Matukaran rana siya basta di maatiman ang
kaon. Pero mayo manang bataa, buotan kaayo. Duol kayo na siyag mga bata, iyaha panang
hatagan ug pagkaon unya mag duladula na sila”
 She was attentive and honest in answering the questions.
Rudeena
Age: 42
Relationship with the patient: Aunt
“Naga balik balik na iyang sakit kay di man gud na niya gina take iyang tambal gud. Okay na
man unta na siya, pero pagbalik niya dadto sa Cotabato, naga inom naman sad siya unya di nasa
tama nga oras siya mukaon mao siguro nga balik napud siya ana iyang sakit.”
 She was cooperative and answered the question honestly.
Mercidita
Age: 54
Relationship with the patient: Aunt
“Murag na siya ni balik og pag kabata kay iya mga kauban puros bata”
 She was cooperative and shared information about the patient honestly.
Fe
Age: 29
“Maayo mana siya pagabot namo dire. Nalain lang na siya ug sugod katong di na siya mukaon.
Pero buotan jud na siya sa mga bata.”
 She was very kind and cooperative.
Fortuna
Age: 33
"Wala najud koy laing ikasulti kana si Chippy maayu gyod kayu na sa mga bata".
 She was kind and direct in answering the question.
FAMILY HISTORY
GRAND MATERNAL AND PATERNAL LINEAGE
Chippy’s father is the youngest of 5 siblings. All of his siblings are alcoholic and
cigarette smoker. Their family was dubbed as the “dako-dako” in their area. His paternal
grandfather was fond of participating in vices such as cockfight, “tong-its” and the like. He was
also described as aggressive and violent that’s why when he was alive he frequently encountered
fights with his playmates. Eventually, he was killed due to a stabbing incident during these
fights. His paternal grandmother however died due to hypertension. She was a loving mother but
was too loving that she spoiled her children especially Chippy’s father even after he became
married.
On the maternal side, dingdong’s mother is the 4th daughter of 9 siblings. His maternal
grandfather died due to hypertension while his maternal grandmother is alive and well. They
were strict in terms of house rules but they were described as loving parents. They never hit their
children; they will just scold them and reprimand them on their mistakes.
FATHER
Chippy’s father was a disciplinarian type of person. He only finished high school. He was
hardworking as a father. When he was alive, he worked as a construction worker, carpenter,
plumber, and the like. He was also described as short-tempered, aggressive and frequently
drinks and smokes. He would go home drunk and would sometimes physically abuse his wife
and children. There was a time when he went home drunk, and he thought their chicken wasn’t
fed by Chippy. Chippy was already sleeping, he slapped him in the face hard and Chippy woke
up and was startled. The mother verbalized that he would tell his husband “ayaw anaa ang bata
ba kay makuyawan na..” When one of his children came home crying because they got into
trouble with other children, he would storm out right away and provoke a fight with those
children’s fathers. He died because he was stabbed to death during a drinking session with his
buddies when Chippy was 12 years old.
MOTHER
His mother is still alive and well at the age of 49 and is currently working as a stay-in
housemaid in a certain subdivision in El Rio. She graduated high school and is now presently
living at Maa Davao City along with her brothers and two children. She earns P3500 every
month to sustain her family’s needs. She is a permissive type of person. She disciplines her
children by just reprimanding them. She would reprimand her husband when he gets too abusive.
When her husband died, after a few years she had met someone and they lived together
for around 2 years. They eventually broke up because he was assigned to a different area away
from their home and she verbalized that he also never offered financial assistance to her and her
family.
After Chippy’s first admission, she decided to conduct Bible Studies in their own
community with teenagers and adolescence. She said they would often make fun of her but she
still continues to do it because she wants to spread the word of the Lord to everyone especially
with the youth. She would offer snacks to her listeners as well.
SIBLINGS
Chippy is the 2nd of 4 siblings. He has an elder brother who currently assists their uncle in
their own tailoring shop in Maa. His younger sister is now living with her husband and their 3
month old baby while their youngest brother is in Grade 6.Whenever their mother is away
working as a housemaid, they are left under the care of their maternal uncles and grandmother.
His brother and sister just finished high school and they started working afterwards to assist their
mother.
Chippy was good to his siblings. After his father died, he would help in taking care of
them and looking after them. He was protective as a brother.
PERSONAL HISTORY
PRENATAL
The couple planned to have a second pregnancy. She only had pre-natal check-up in their
local health center and she said she wasn’t given vitamins. She usually ate vegetables, fruits and
fish during her pregnancy. At this time she just managed their sari-sari store and took care of
their eldest child while her husband continued working.
BIRTH
Chippy was delivered full-term through normal spontaneous vaginal delivery last October
18, 1993 at their house in Arakan with the aid of a “mananabang”. She had no reports of
complication during and after the delivery. “Himsog jud si Chippy pag-gawas niya” said by
Happy.
INFANCY and CHILDHOOD

His mother is his primary caregiver at this time but his grandmother sometimes assists
her from time to time. He was breastfed since birth until 1 year old and 6 months and weaned
after. He was given porridge at the age of 9 months and above. At the age of 1 year and 2 months
he started making audible words such as “mama”. He can stand alone by himself at the age of 1
year old and 3 months. At 1 year and 6 months he started walking but with assistance and after 3
months he can tolerate to walk on his own. He learned to urinate and defecate on his own at 2
years and 6 months. Happy said that they never toilet trained Chippy. They just left him to learn
on his own because she was busy with their poultry business.
Chippy never had any serious illness during infancy except for some mild fever, cough
and cold and was never hospitalized. He also had received complete vaccination.
PSYCHOSEXUAL HISTORY
During the age of 14, Chippy was able to identify his sexuality and was able to start
masturbating by watching porn videos with his friends. He verbalized that he would masturbate
up to 3x a day. He would have many crushes and textmates, but they rejected him. Before his
first admission when he was 19 years old, he met his first girlfriend in Kidapawan and they
lasted for only around 6 months because of Chippy’s unusual behavior. He had his first sexual
intercourse at the age of 20 with a prostitute because he was brought by his employer in a certain
barhouse in Calinan.
PLAY LIFE
Happy gave Chippy the freedom to play everywhere in the place within their community
with different playmates. He played whatever toys are available because he wasn’t provided with
toys back then due to financial difficulties. He had lots of friends back then. They usually play
“taksi”, marbles, and “dakpanay” as their favorite game with his playmates. He was always the
leader of the group. They would end up playing when the time each of her playmates are called
by their parents and sometimes it’s already night.
SCHOOL HISTORY
Chippy started school at the age of 6. He was “bugoy-bugoy” in the school. He usually
finds trouble by making fun of his classmates. He was looked up as someone who is dominant
and “isog” that’s why when there is a brawl in school, his classmates would ask for Chippy’s
help. He would often come home with blood on his uniform and bruises on his arms and face. He
had poor school performance and low grades. His mother verbalized “wala jud siyay study
study” and “palaaway na siya nga bata”. He stopped schooling when he was in grade 3.
RELIGIOUS and SOCIAL ADAPTATION

Happy and Boy Bawang are Catholic and Chippy and his siblings are baptized as
Catholic as well. When his father was alive, they don’t go to church very often because Boy
Bawang would have duties during weekends. His mother changed her religion to Baptist for 10
years now. She would always encourage Chippy to go with her to go to Church but Chippy
would refuse, stating many excuses. Happy would also conduct bible studies in their own home
with her siblings. Sometimes Chippy would join them whenever they insist him but he would not
take it seriously and often makes fun throughout the session. So his mother would not encourage
him anymore saying that “tungod man gud na sa iyang bad spirit na naa sa iya” and “dli na siya
mutuo og Ginoo.”
He has lot of friends and was known in their place because he was friendly. At age 15
when he started to work and moved out to live with his employer, he was influenced to drink
alcohol and used shabu. At age 19, his paternal uncle encouraged him to use marijuana. Chippy
verbalized that marijuana is very common in Arakan that almost all people there used marijuana.
He also frequently goes to ktv bars. He was noted to become aggressive everytime he is in the
spirit of alcohol. After he was discharged from his first admission, he stayed in Davao for a few
months with his siblings and maternal uncles. He was fond of playing with children there.
OCCUPATIONAL HISTORY
At a very young age of 12, he started working as “tigbantay” in a billiard place owned by
his maternal grandmother. As a salary, he would be given clothes, shoes, and slippers and a small
amount of money. After 6 months, he found a job in their terminal as a carwash boy. He then
worked as a bus conductor at age 13 in Prince Bus travelling from Arakan to Kidapawan. At 13
years old he moved out of their home and lived with his employer and continued to work as a
conductor in a jeep. After his third admission, he went back to work in Arakan with his former
employer and there he resumed his reckless activities. After his fourth admission, he went back
again to Arakan but this time he worked as a “kargador” of corn in a certain farm. He verbalized
that he was having a hard time during this days because his workmates think that his illness is
communicable.
MARITAL HISTORY
Chippy was fond of having textmates before but none took him seriously. It was when he
was 19 years old when he first met his girlfriend, Juliet, while they were having their trip to
Kidapawan. He asked for her number and they frequently texted even when he goes back to
Arakan. In the course of 6 months, Juliet noticed a change in Chippy behavior. Chippy told her
over the phone that he doesn’t feel right about himself. He doesn’t understand himself anymore.
Juliet ended their relationship and encouraged him to seek treatment. After that, Chippy didn’t
have any more girlfriends.
ONSET OF PRESENT ILLNESS

One year prior to first admission, Chippy was noted to become aggressive every time he
is in the spirit of alcohol. No hallucinations and delusions were reported at this time. Patient was
in tolerable condition until the 16th day prior to consultation when the patient took their pigs
outside their home which he hardly did before. He began talking to himself and attempted to hurt
his brother. He started saying “nagpakita akoa tatay nako.” Patient was brought to a private clinic
in Arakan by his mother and was given with unrecalled medications. 5 days prior to
confinement, patient was brought back to the clinic for follow up check-up. Patient was thought
to be well and so the medications were stopped. 3 days prior to confinement, the signs and
symptoms returned. He started to climb a tree, became more hostile, and had difficulty initiating
and maintaining sleep. Few hours prior to confinement, he was restrained by his brother and
uncles because he tried to escape and leave the house and choked his brother. They then brought
him to SPMC-IPBM and was confined in the CIU. He was discharged after 5 days.
After his first discharge, he was given home medications. He was compliant at first but
did not follow up. He stopped his medication altogether 25 days prior to 2 nd admission. 2 weeks
prior to second admission, his symptoms started to recur such as unable to sleep, poor appetite,
blank stares, pacing around/wandering. Patient was also noted to have intake of coffee and
smoked cigarettes. Still no consultation was done, and no medications were given. Patient did
not have good sleep for 7 days as claimed until the night prior to admission, the patient was not
able to sleep. Few hours prior to admission, patient slashed his right wrist with scissors hence
patient was brought back to CIU. He was discharged after 11 days.
9 hours prior to third confinement, patient became restless and wanted to get out of the
house. He then became aggressive and kept on talking and accused his family members of doing
things against him. Later on, he started attacking the people around him, strangling his mother
around the neck. He also hit his head several times on the wall and throws away things that he
could reach. This prompted his family to bring him to SPMC-IPBM back again and was
discharged after 7 days.
One week prior to fourth admission, patient was noncompliant to his medication
because he thinks that he is already well. He was also noted to have depressed mood, anhedonia
and poor appetite. 5 hours prior to confinement, the patient was alone when he suddenly grabbed
a knife and cut his wrist. According to him, he did it because his mother was forcing him to eat.
Patient was noted to be depressed, silent and doesn’t talk anymore. Persistence of symptoms
prompted admission. He was admitted in the CIU for 14 days and was then transferred to male
ward. He was discharged after the 3rd week.
One month prior to fifth admission, patient had decreased need for sleep and appetite.
Condition was associated with manic episode characterized as washing plates from the cabinet. 1
week prior to admission, patient was noted to have hallucinating gestures characterized as talking
and laughing to himself. Condition persisted hence was brought back again to the SPMC-IPBM
last February 20, 2017.
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PSYCHODYNAMICS
Predisposing Factors
Predisposing Factors Actual Description Rationale

Genetic Predisposition (-) The patient has no family Bipolar disorder appears to run in
history of any mental health families. More than 2/3 of people with
disturbance. bipolar disorder have at least one close
relative with the disorder or with
unipolar major depression, indicating
that the disease has a heritable
component. Bipolar disorder is
considered to be a result of complex
interactions between genes and
environment. (Sacks, Baldacsamo,
Truman, Guille, 2004)
Age (+) Patient was first Bipolar disorder can begin in late
admitted when he was 20 childhood or early adolescence, but
years old. onset usually occurs between ages 20
and 30. (Sarah Yuan, Handbook of
Diseases 3rd edition)
Gender Pt. is a male. It affects both sexes equally although in
different ways. Men are more likely to
suffer from early onset while women
have higher rates of rapid cycling mixed
states. (http://webmd.com//
Previous attacks (+) Pt was admitted with a Over 95% of people with bipolar
diagnosis of brief psychotic disorder have recurrent episodes of
disorder and major depression and mania throughout their
depressive disorder lives. The probability of experiencing
consecutively last 2013 and new episodes of depression or mania
2014. increases with each subsequent episode
despite treatment. (Deborah Anti-otong,
Psychiatric Nursing Biological and
Behavioral Concepts, 2003)
Stress (+) Patient verbalized “hago Stress, particularly severe or chronic
jud to akoa trabaho sauna” stress, is one environmental factor that
as a bus and jeep conductor increases the risk of developing bipolar
travelling from Arakan to disorder. In fact, it can trigger a
Kidapawan back and forth depressive episode or a manic episode
every day. in an individual predisposed to bipolar
disorder. Stress can also prolong a
bipolar mood episode. (Smeltzer and
Brunner, Medical-Surgical Nursing,
2006)
Family Environment (+) Patient expressed The family place a central role, it is
concern with the disunity of within the families that individual are
his family. nurtured attain as sense of well-being
cultivates belief and values about life,
and progress through life’s
developmental stages. Educating
families have been shown to
individual’s resiliency adaptation and
adjustment to life’s stressor. (Friedman
1998)
Precipitating Factors
Precipitating Factors Actual Description Rationale

Substance abuse (+) Patient is alcoholic and Substance abuse can bring on the manic
admits to have used or depressive episodes and worsens the
marijuana and shabu. course of the disease. It is believe to
alter neurotransmitter process and
impulses, thus precipitating the
development of an altered process.
(Sadock & Sadock, 2003)
Poor compliance to (+) Patient would stop Relapsed among patient with mental
medication taking the medication once disturbances often experience relapse as
he feels that he is already a result of non-compliance to home
well. therapy management. (Lippincott,
Mental Health, 2007)
SCHEMATIC PRESENTATION
Preconception
Mother Father
Hardworking
but alcoholic
Decided to get married

after 2 months of dating
Planned pregnancy to
have Chippy
Mother has regular prenatal check-up in barangay

health center but was not given with vitamins
Received immunization of tetanus toxoid
Diet of vegetables, fruits and fish throughout pregnancy
Mother experienced no sickness and complication
Chippy was delivered full-term last Oct. 18, 1993 via

NSVD assisted by manghihilot with no complication
Preconception
Chippy’s coming into being was planned. Mother had regular check-up in their barangay
health center. She didn’t take any vitamins because she said she want not provided with it and
she didn’t experience any difficulty during pregnancy and delivery. She usually ate fruits,
vegetables and fish because fruits and vegetables are readily accessible around their
neighborhood. She is just a high school graduate and doesn’t have any work at this time but
decided on having a sari-sari store.
The father was a hardworking and has all-around job. Also a high school graduate, he
was at first a quiet person during their marriage, but he was alcoholic. He earns a meager salary
and was able to provide for the family’s basic needs. They were all happy to hear about the
pregnancy.
Infancy (0-18months)
Trust vs. Mistrust (0-1 yr old)
Oral Stage
Birth of Chippy
Mother is a housewife and Father still works all-

managed their sari-sari around (carpenter,
store construction worker)
Mother left at home to take A heavy drinker and

care of 2 year old son and smokes
Dingdong
Introduced porridge at 9 months
Breastfed until 1 year and 6 months
He was breastfed every 2 hours
When mother is sometimes away, maternal

grandmother would take care of children.
Mother has time cuddling and hugging the baby
ORAL GRATIFICATION
Toddler (1-3SATISFIED
years old)
TRUST
Trust vs. Mistrust (0-1 yr old)
Oral Stage
According to Erik Erikson, during this stage, the infant is uncertain about the world in
which they live. To resolve these feelings of uncertainty, the infant looks towards their primary
caregiver, the mother, for stability and consistency of care.
If the care the infant receives is consistent, predictable and reliable, they will develop a
sense of trust which will carry with them to other relationships, and they will be able to feel
secure even when threatened.
According to Sigmund Freud, during this stage, the mouth is the pleasure center for
development. Freud believed this is why infants are born with a sucking reflex and desire their
mother's breast. If a child's oral needs are not met during infancy, he or she may develop
negative habits such as nail biting or thumb sucking to meet this basic need.
In the case of the Chippy, his mother was the primary caregiver although the
grandmother would sometimes assist her. Happy said that Chippy always get hungry that’s why
she would breastfeed him every 2 hours. This resulted to a mother-child bonding. The infant will
develop a sense of trust and will have confidence in the world around them or in their abilities to
influence events. The infant can have hope that as new crises arise, there is a real possibility that
other people will be there as a source of support. His oral gratification was also satisfied which is
evidenced by the patient being a non-cigarette smoker.
Toddler (1-3 yrs)
Autonomy vs. Shame & Doubt
Anal Stage
Mother at this time is Father is still working
busy with their poultry and often drinks and
business smokes
Is usually away and left Comes home late at

the children under their night and drunk
relatives care
Mother & Father did not

participate in toilet training
They left Chippy to learn to toilet train on his own under the care of relatives
His first word was “Mama” at the age of 1 year and 2 months
At 1 year and 3 months he was able to stand on his own
At 1 yr and 6 months he was able to walk with assistance and

he was able to walk on his own after 3 months
He was able to urinate and defecate on his own at 2

yrs and 6 months
Father often scold Chippy whenever the former gets home drunk
ANAL STAGE NOT SATISFIED
SHAME & DOUBT

Autonomy vs. Shame & Doubt
Anal Stage
Between the ages of 18 months and three, children begin to assert their independence, by
walking away from their mother, picking which toy to play with, and making choices about what
they like to wear, to eat, etc. Such skills illustrate the child's growing sense of independence and
autonomy. Erikson states it is critical that parents allow their children to explore the limits of
their abilities within an encouraging environment which is tolerant of failure.
During this stage, toddlers and preschool-aged children begin to experiment with urine and
feces. The control they learn to exert over their bodily functions is manifested in toilet-training.
Improper resolution of this stage, such as parents toilet training their children too early, can
result in a child who is uptight and overly obsessed with order.
Chippy wasn’t toilet trained by any of his parents. They didn’t think that the child would
need this much of this attention. They just left him to learn on his own. They also didn’t
frequently talk with him because they are mostly away. But whenever the father comes home
drunk, he would scold at his children and wife and find faults about them. This would result to a
tendency for the child to feel inadequate in their ability to survive, and may then become overly
dependent upon others, lack self-esteem, and feel a sense of shame or doubt in their abilities.
Pre-school (3-5 years old)
Initiative vs. Guilt
Phallic Stage
Mother is still mostly Father still worked as an all

away because of their around helper, construction
business worker, carpenter
She is permissive Continued with his

as a parent drinking and smoking
habits
Would hit his wife and

children whenever drunk
Lets Chippy play outside

with neighbors
Mostly the leader of the group
Was able to initiate activities with playmates
He would be scolded by his father when he

makes a mistake
PHALLIC STAGE NOT SATISFIED
INITIATIVE
Initiative vs. Guilt
Phallic Stage
During this period the primary feature involves the child regularly interacting with other
children at school. Central to this stage is play, as it provides children with the opportunity to
explore their interpersonal skills through initiating activities. If given this opportunity, children
develop a sense of initiative and feel secure in their ability to lead others and make decisions
According to Freud, the child would also begin to struggle with sexual desires toward the
opposite sex parent (boys to mothers and girls to fathers). For boys, this is called the Oedipus
complex, involving a boy's desire for his mother and his urge to replace his father who is seen as
a rival for the mother’s attention. This is resolved through the process of identification, which
involves the child adopting the characteristics of the same sex parent.
Chippy at this time was often left around to play with other children. He was fond of
playing with his neighbors and his mother just let him be. He was mostly the leader of the group.
He wasn’t provided with toys but he plays whatever is available. He was able to initiate activities
with his friends. Because of this, Chippy will develop a sense of initiative and feel secure in his
ability to lead others and make decisions. Chippy was also described as a quiet child. When he
makes mistakes, his mother would just calmly reprimand him but his father would scold him. His
mother verbalized “ginapasagdan lang man nako na sila sauna ako ra sturyahan. Iyaha papa ang
grabe mangasaba og mandapat.”
School Age (6-12 years old)
Industry vs. Inferiority
Latency Stage
Mother was always away to Father is still working but

look for a source of living usually used his salary for
drinking and other vices
Would always get into fight whenever drunk
Stabbed to death while drinking beer

when Chippy was 12 yrs old
Chippy started pre-school

when he was 6 years old.
Had lots of friends at school and was the leader

and “bugoy-bugoy” of the group
Often plays with friends but cheats in the games
Often gets into fight.
Started to work after

father died
LATENCY STAGE NOT MET
INDUSTRY
Industry vs. Inferiority
Latency Stage
Industry versus inferiority is the fourth stage of Erik Erikson's theory of psychosocial
development. It is at this stage that the child’s peer group will gain greater significance and will
become a major source of the child’s self-esteem. Teachers begin to take an important role in the
child’s life as they teach the child specific skills.
According to Freud’s psychosexual theory, the latent period is a time of exploration in

which the sexual energy is still present, but it is directed into other areas such as intellectual
pursuits and social interactions. This stage is important in the development of social and
communication skills and self-confidence. Children begin to behave in morally acceptable ways
and adopt the values of their parents and other important adults. Much of the child's energy is
channeled into developing new skills and acquiring new knowledge and play becomes largely
confined to other children of the same gender.
Chippy started school at age 6 but stopped when he was in Grade 3. He never showed
interest in his studies and always gets in trouble in school. He was described as “bugoy-bugoy”
and would always get into fights. His classmate would look up to him as verbalized by the
mother as “magpalaban dayon na sila kay Chippy kung naa pud silay kaaway.” Even so, Chippy
has lots of friends and was always with them playing “taksi”, “jolen”, and they would also climb
trees to get fruits. Sometimes he would cheat in their game that’s why he would get into fights
again. When his father would know about this, the father would right away confront the rival and
would eventually get into fight with their fathers. The mother would again and again reprimand
Chippy to stop getting into fights but Chippy was hard headed. At the age of 12 his father died. It
was also in this stage that he started to work as a “tigbantay” at his Lola’s billiard place to help
family earn a living. In the end Chippy tried to use his skill to do something productive such as
getting a job. This makes him feel industrious and feel confident in his ability to achieve goals.
Adolescence (13-18 years old)
Identity vs. Role Confusion
Genital Stage
Wants to be independent
Chippy moved out of

their home
He worked as a bus/jeep
conductor
At age 14 he started to
masturbate
At 15 he started
drinking alcohol and
used shabu
He keeps going out with his

friends and goes to beerhouses
Frequent use of shabu
Low sense of morality

from right or wrong
GENITAL STAGE MET
ROLE CONFUSION
Identity vs. Role Confusion
Genital Stage
Up until this fifth stage, development depends on what is done to a person. At this point,
development now depends primarily upon what a person does. An adolescent must struggle to
discover and find his or her own identity, while negotiating and struggling with social
interactions and “fitting in”, and developing a sense of morality and right from wrong.
During this genital stage, sexual impulses reemerge. If other stages have been
successfully met, adolescents engage in appropriate sexual behavior, which may lead to marriage
and childbirth.
Chippy started to move out of their home to live with his employer and be independent
when he was 13 years old. He started to masturbate when he was 14 by watching porn videos
with friends. He then became influenced with alcohol at the age of 15 and the use of shabu. He
also frequently goes to beerhouses with friends. At the same time, he was working as a bus
conductor and eventually a jeep conductor. He didn’t have any girlfriend at this time although he
has lots of textmates and crushes.
Young Adulthood (18-35 years old)
Intimacy vs. Isolation
Genital Stage
Used marijuana at 19
yrs old
Continued to work as
conductor
Met his first girlfriend while

travelling to Kidapawan
They were in a long distance relationship but

maintained communication through texting
After 6 months they broke up because the girl

noticed something unusual about his behavior
He had his first sexual

intercourse with a prostitute
Continues to drink and use

marijuana
Became aggressive when in

the spirit of alcohol
Noticeable changed in behavior;

had difficulty sleeping
Sought consult in a private

hospital in Arakan
Was given unrecalled medication
Medications were stopped

after follow up check-up
Symptoms returned; became

more hostile
Prompted admission in SPMC-IPBM CIU last Nov. 16,

2013 @8:45pm and was discharged after 5 days
Was given home medications but was non compliant
Intake of prohibited foods such as

coffee, cigarette smoking
Symptoms recurred; slashed

his wrist with a scissor
Prompted 2nd admission last Dec.

30, 2013 @6am in CIU for 11 days
Non-compliance to medication
Became aggressive and restless;

tried to strangle his mother
Prompted 3rd admission last Jan. 24, 2014

@6:15pm and was discharged after 7 days
After he was discharged, he
went back to Arakan to work
Had poor sleeping and eating habits
Stopped taking his medications
Became suicidal; symptoms

persisted
4th admission last Jan. 23, 2016 @7pm and

was discharged the next month February 23
Went back to Arakan and worked as kargador
Became stressed with work
Had difficulty sleeping and

poor appetite
Unusual behaviors such as

talking to himself recur
Admitted once again for the 5th time last

Feb. 20. 2017 @6am with a diagnosis of
Bipolar Disorder 1 with Psychotic Features
GENITAL STAGE MET
ISOLATION
Intimacy vs. Isolation
Genital Stage
At the young adult stage, people tend to seek companionship and love. Some also begin
to “settle down” and start families, although seems to have been pushed back farther in recent
years. Young adults seek deep intimacy and satisfying relationships, but if unsuccessful,
isolation may occur. Significant relationships at this stage are with marital partners and friends.
This is the last stage of Freud's psychosexual theory of personality development and
begins in puberty. It is a time of adolescent sexual experimentation, the successful resolution of
which is settling down in a loving one-to-one relationship with another person in our 20's.
Sexual instinct is directed to heterosexual pleasure, rather than self pleasure like during the
phallic stage.
Chippy was influenced by his uncle to use marijuana when he was 19. He had his first
girlfriend when he was 20 yrs old. They were together for around 6 months and maintained
communication through texting. They broke up eventually because chippy verbalized that he
didn’t understand himself anymore. He continued to have textmates and crushes. There was one
time that he was brought to a barhouse by his employer. His employer paid a prostitute for him
there. He had his first sexual intercourse with the prostitute but he said that he wasn’t able to
come. He had not experience any more sexual encounters until now. He continued to use
marijuana. He continued to use marijuana but denies it when confronted by his mother. He still
drinks a lot in beerhouses.
Over time he became aggressive and not himself anymore everytime he gets drunk. He
found it hard to sleep and people noticed a change in his behavior. This prompted his mother to
consult in a private clinic in Arakan. He was given unrecalled medications but was stopped after
his follow up check-up, thinking he is already well. His symptoms recurred that prompted
consult in SPMC-IPBM.
After he was discharged from his first and second admission, he stayed in Maa, Davao
with his family. He was then able to spend time with them. He became fond of the little children
in their neighborhood too. Over time he became uneasy for not being able to provide for his
family that’s why after his 3rd admission he went back to Arakan to work. There he became too
busy with his work especially when their jeep broke off in the middle of the road. He usually
skips meal during his work because he was too busy. His mother encouraged him to go back in
Davao for follow up check up but he didn’t go. He had a relapsed that’s why he was admitted
again for the 4th time. After he was discharged from his fourth admission, he went back to
Arakan again to help his family. He becomes worried everytime his family will encounter a
financial difficulty such as a notice for disconnection in their electric bill that’s why he wants to
go back to work. But this time, he worked as a “kargador” in a corn farm. He had a hard time
working there because people thought that his illness is communicable. After a few months he
went back to Davao to stay with his family.
C
H
A
P 6
T
E
R
MEDICAL MANAGEMENT
Differential Diagnosis
1. Schizophrenia Paranoid
1. Suspiciousness (/) ()
2. With delusion of persecution and grandiose (/ ) ()
3. Preoccupied with unrealistic thinking (/) ()
4. Irritable, discontent and unpredictable (/) ()
5. Hallucination (auditory) (/) ()
6. Onset is often abrupt and usually in adult life (/) ()
7. Defense mechanism: projection () (x)
8. Excessive religiosity () (x)
9. Hostile and aggressive behavior () (x)
10. Conducts quite well socially (/) ()
Percentage: 7/10 = 70%
2. Catatonic Schizophrenia
1. Marked decrease in reactivity to environment or reduction of spontaneous movement
and activity () (x)
2. Becomes immobile, incommunicative, negativistic () (x)
and automatic in their response to physical suggestion
3. Lacks verbal responses to peers, has never been () (x)
completely understood
4. Maintenance of inappropriate or bizarre posture () (x)
5. Waxy flexibility () (x)
6. Acute stupor () (x)
7. Negativism: rigidity and mutism () (x)
8. Defense mechanism: repression (/) ()
9. Exhaustion leading to malnutrition () (x)
10. Hypupyrexia & self inflicted injury () (x)
11. Motionless () (x)
12. Echolalia/echoproxia () (x)
Percentage: 1/12 = 8.33%
3. Disorganized Schizophrenia
1. Little verbal communication with other people (/) ()
2. Delusion are often fragmentary of bizarre (/) ()
3. Inability to initiate plan (/) ()
4. Incoherent, unintelligible, bubbling speech () (x)
5. Grimace, mannerism, hypochondrial complains and extreme () (x)
social withdraw
6. Inappropriate or silly affect () (x)
7. Severe impairment in social and occupational functioning () (x)
8. Defense mechanism: regression (/) ()
9. Loose associations () (x)
10. Extremely disorganized behavior () (x)
4. Schizophrenia Undifferentiated
1. Apathy () (x)
2. Ideas if reference () (x)
3. Prominent delusion () (x)
4. Negativistic behavior () (x)
5. Hallucination (/) ()
6. Perplexity () (x)
7. Incoherent communication () (x)
8. Grossly disorganized behavior () (x)
9. Socially afferent behavior () (x)
10. Impoverished relationship with the family and neighbors (/) ()
5. Residual
1. History of at least one previous episodes of brief psychotic (/) ()
disorder with prominent psychotic symptoms
2. With residual symptoms such as eccentric behavior, bizarre, (/) ()
ideation, blunted and vague speech
3. Appears to be shallow individual who becomes easily () (x)
irritated
4. Social withdrawal () (x)
5. Flat affect () (x)
6. Looseness of association () (x)
6. Bipolar disorder
Manic depression
1. Elevated mode, elated (/) ()
2. Controlling and manipulating (/) ()
3. Increased activity pressured speech, increase energy (/) ()
4. Flight of ideas (/) ()
5. Typically distractive, poor judgment (/) ()
6. Limited need for sleep (/) ()
7. Lability (/) ()
8. Projection () (x)
9. Risk for violence directed at others (/) ()
10. Exaggerated self-esteem (/) ()
7. Depressive Type
1. With obsession () (x)
2. Looseness zest for living (/) ()
3. Melancholia personality (/) ()
4. Lack of confidence itself (/) ()
5. Feel inadequate (/) ()
6. Psychomotor retardation () (x)
7. Sad/looks ill () (x )
8. Introjection () (x)
9. Risk for violence: self-directed (/) ()
10. Latency of response () (x)
8. Involuntary Melancholia
1. Agitated depression (/) ()
2. Delusion (/) ()
3. Depression Affect (/) ()
4. Paranoid mentation () (x)
5. Early morning awakening (/) ()
6. Rumination () (x)
8. Sexual dysfunction: diminished interest in sexual activity (/) ()
inability to experience pleasure
9. Brief Psychotic Disorder

1. Rapid onset, following major stressor (/) ()
2. Hallmark is emotional turnevil, mood, lability and confusion () (x)
3. At least one positive symptoms of psychosis, from the (/) ()
following symptoms: Delusion, hallucination in grossly
disorganized which is strange, peculiar difficult to comprehend
(peculiar speech), disorganized (bizarre or child like) behavior
bizarreprimitive behaviors; or catatonic behavior
4. Limited duration (time limited). The psychotic symptoms have (/) ()
occurred for at least one day but less than one month. There is
an eventual return to normal level of function
5. Polymorphic, rapidly changing and variable state () (x)
6. The symptoms are not biologically influenced as attribute () (x)
to another disorder. The symptoms cannot be occurring as part
of mood disorder.
10. Schizo affective disorder

1. Has strong elements of either depression or euphoric affect (/) ()
2. Maybe depressed, retarded, suicidal (/) ()
3. Expressed absurd delusion of persecution, complains of being (/) ()
controlled by outside forces.
4. Substantial loss of occupational and social functioning (/) ()
5. Positive and negative symptoms (/) ()
6. Uninterrupted period of illness () (x)
11. Substance dependece

1. Tolerance (/) ()
2. Withdrawal () (x)
3. Substance often taken in a longer period that was intended (/) ()
4. Persistent desire or unsuccessful efforts to cut down or control use (/) ()
5. Much time spent in activities necessary to obtain the substance (/) ()
or use it
6. Reduction or cessation of important social occupation or (/) ()
recreation activities
7. Used continue despite knowledge of having problem or recurrent (/) ()
physical or psychological problem likely to have been caused or
exacerbated by the substance
12. Substance abuse
1. Recurrent resulting in failure to fulfill major role obligation at (/) ()
work, school or home
2. Recurrent use in situation that is physically hazardous (/) ()
3. Recurrent substance-related legal problems (/) ()
4. Continued despite feelings persistent of recurrent effect of the (/) ()
substance
SUMMARY OF THE DIFFERENTIAL DIAGNOSIS
1. Substance abuse 100%

2. Bipolar disorder 90%
3. Substance dependence 85.71%
4. Schizo affective disorder 85.71%
5. Involuntary melancholia 75%
6. Depressive type 50%
7. Schizophrenia paranoid 70%
8. Brief psychotic disorder 50%
9. Disorganized schizophrenia 40%
10. Residual 33.33%
11. Schizophrenia undifferentiated 20%
12. Catatonic schizophrenia 8.33%
PERSONALITY DISORDER
Cluster A: Odd/Eccentric
A. PARANOID PERSONALITY TYPE DISORDER
1. Suspects without sufficient basis that are exploiting harming or deceiving +
him/her
2. Is preoccupied with unjustified doubts about the loyalty of the +
trustworthiness of friends or associates
3. Is reluctant to confide in others/aloof -
4. Reads demining or threatening meaning into benign remarks or event -
5. Persistently bears grudges +
6. Perceives attack on his/her character or reputation that are not apparent to +
others and is quick to react angering to counter attack.
7. Has a recurrent suspicious, without justification regarding fidelity of -
spouse or sexual partner
8. Pervasive mistrust to others -
9. Guarded/hyper vigilant -
10. Restricted affect and unable to demonstrate warm or emphatic emotional -
response.
4/10= 40%
B. SCHIZOID PERSONALITY DISORDER

1. Neither desire nor enjoys close relationship including being part of a +
family
2. Almost always chooses solitary activities -
3. Has a little, if an interest in having sexual experiences with another +
person.
4. Takes pleasure in few, if any activities +
5. Lacks line friends or confidents other than first-degree relatives -
6. Shows emotional coldness, detachment, or flattered affectivity -
7. Appears indifferent to the praise word or criticism of others. -
8. Avoids treatment +
9. Aloof and indifferent -
10. Rich fantasy life -
4/10= 40%
C. SCHIZOTYPAL PERSONALITY DISORDER

1. Ideas of reference +
2. Odd belief or magical thinking that influences behaviour +
3. Unusal perceptual experiences -
4. Odd thinking and speech -
5. Suspicious and paranoid ideation -
6. Inappropriate or constricted affect -
7. Odd eccentric or peculiar behavior or appearance -
8. Lack of close friends or confidents other than first-degree relatives -
9. Excessive social anxiety that does not with familiarity and tense -
associated with paranoid face rather than judgment about self.
10. Loose, vague speech -
2/10= 20%
Cluster B: Bad and Erratic

A. ANTISOCIAL PERSONALITY DISORDER
1. Failure to confirm social norms with respect to lawful behavior or -
indicated by repeated performing acts that are ground for rest
2. Deceitfulness as indicated by repeating lying, for personal profit or -
pleasure
3. Impulsivity of failure to plan ahead +
4. Aggressiveness -
5. Reckless disregard for safety of self or other -
6. Consistent irresponsibility -
7. Lack of remorse +
8. Individual is at least 18 years old +
9. Manipulative -
10. Disregards and violates others rights -
3/10= 30%
B. BORDERLINE PERSONALITY DISORDER
1. Frantic efforts to avoid real or imagined abandonment -

2. A pattern of unstable and intense interpersonal relationship characterized -
by alternating between extreme ideation and evaluation
3. Identify disturbances -
4. Impulsivity in at least two areas that is partially self-damaging -
5. Recurrent suicidal behavior, gesture or threats, or self-motivation +
behaviour
6. Affective instability due to marked reactivity of mood -
7. Chronic feeling of emptiness +
8. Inappropriate intense anger or difficulty controlling anger -
9. Transient stress-related paranoid ideation -
10. Impulsivity/self-mutilation/intense unstable relationship +
3/10= 30%
C. HISTRIONIC PERSONALITY
1. Pervasive pattern of excessive emotionally attention-seeking -
2. Exaggerates the closeness of the relationships -
3. Dramatize relatively minor occurrences -
4. Speech is full of superlative adjectives, yet description are vague and -
lacks of details.
5. Overall appearances is normal, although client is over dress -
6. Presence of flirtation behavior in social, occupational and professional -
settings/seductive
7. Emotionally expressive, gregarious -
8. Experience rapid shifts in mood and emotions +
9. Self absorbed and focus most of their time on themselves -
10. Attention seeker. -
1/10= 10%
D. NARCISSISTIC PERSONALITY DISORDER

1. Pervasive pattern of grandiosity -
2. Need for admiration/ self love/ self grandiosity -
3. Lack of empathy -
4. Displays arrogant or naughty -
5. Expresses envy and beg rude to other individual’s social status because -
of the belief that it belongs to them.
6. Disparage, be little or discounts the feelings of others -
7. Preoccupied with fantasies or unlimited success, power, brilliance hearty -
or ideal love
8. Sense of superiority -
9. Insight is limited or poor +
10. Hypersensitivity to criticism -
1/10= 10%
CLUSTER C
A. AVOIDANT
1. Pattern of social discomfort -

2. Low self-esteem +
3. Hypersensitive to negative evaluation -
4. Anxious/sad +
5. Fidgets -
6. Poor eye contact with the nurse -
7. Reluctant to ask questions make request -
8. Social withrdrawal -
9. Fearful of criticism and rejection -
10. Fearful, convinced that they will make a mistake -
2/10= 20%
B. DEPENDENT
1. Excesive need to be taken cared of -

2. Submissive and clinging behaviour -
3. Fears of separation -
4. Runs in family and occurs commonly in youngest child -
5. Frequently anxious and uncomfortable -
6. Pessimistic and self-critical +
7. Excessively preoccupied with unrealistic fears of being left alone to care -
for themselves
8. Have difficulty making decisions +
9. Passive/ submissive, increase need to be taken care of -
10. Feeling unhappy +
3/10= 30%
C. OBSESSIVE-COMPULSIVE
1. Preoccupied with perfections -

2. Demeanor is formal and serious -
3. Feeling the indeed to be perfect -
4. Have difficulty expressing emotions -
5. Emotion range is constricted -
6. Stubborn and reluctant to relinquish control -
7. Affect is restricted usually appears anxious and fretful or stiff and -
reluctant
8. Preoccupied with orderliness/meticulous -
9. Absorbed to their own perceptive and do not listen to other persons -
10. Have problems with judgment and decision making +
1/10= 10%
SUMMARY OF PERSONALITY DISORDER

1. Paranoid personality type disorder 40%
2. Schizoid personality disorder 40%
3. Antisocial personality disorder 30%
4. Borderline personality disorder 30%
5. Dependent 30%
6. Schizotypal personality disorder 20%
7. Avoidant 20%
8. Histrionic personality 10%
9. Narcissistic personality disorder 10%
10. Obsessive compulsive 10%
Actual Medical Management (Doctor’s Order)
Date & Time Orders Justification

Ordered
February 20, Please admit patient to CIU The patient needs to be
2017 @ monitored closely
6:00 PM Secure consent to care Pt. must give permission before
receiving any type of medical
treatment
DAT, VSq4 & record The patient can have anything for
intake and to establish baseline
data
Labs Patient’s laboratory result must
1. CBC with PC be monitored to identify possible
2. U/A complication.
3. SGPT/SGOT
4. BUN, Crea
5. Serum Na, K
6. CXR-PA
7. ECG 12 leads
Meds:
1. Olanzapine 10 mg/ODT, 1
Olanzapine is a drug to control
ODT
psychosis
2. Na Divalproex 500mg/tab, 1
tab OD Na Divalproex acts as a mood
stabilizer
For suicidal, homicidal, assault, & To prevent possible self-harm
escape precautions
February 21, Increase olanzapine 10 mg/ODT to To increase antipsychotic effect
2017 @ because of pertinent
½ am, 1ODT @ HS
9:00 AM hallucinations.
February 22, Continue medications To continue therapeutic regimen
2017 @
12:04 PM
February 23, For NPT once amenable For further mental evaluation
2017 @
11:50 AM
February 24, Olanzapine 10 mg/ODT, 1 ODT Olanzapine is a drug to control
2017 @ psychosis
1:24 PM BID
February 25, Still for NPT on Monday For further mental evaluation
2017 @
12:40 PM
February 26, Refer to Psychiatric Social Worker
2017 @
for corroborative interview
11:40 AM
February 28, Increase Na Valproate &valproic To increase mood stabilizing
2017 @ effect
acid 500 mg/tab, 1 tab BID
11:37 AM
March 1-3, Continue medications To continue therapeutic regimen
2017
March 4,5, transfer to Male Ward on Monday The patient’s condition slowly
2017 stabilized but still needs further
monitoring.
March 6, transfer to male ward today The patient’s condition slowly
2017 @ stabilized but still needs further
10:07 am monitoring.
March 7, Received pt. from CIU
2017 @
Seen and examined pt.
2:10 am
Meds:
Olanzapine 10 mg/ODT, 1 ODT Olanzapine is a drug to control
psychosis
BID
Na Valproate &valproic acid 500 Na Valproate &valproic acid acts
mg/tab 1 tab BID as a mood stabilizer
For family counselling The patient’s family needs further

Inform Psychiatric Social Worker knowledge about the patient’s
condition.
to contact relatives for family
counselling from Monday to
Friday between 10 AM to 3 PM
Noted unremarkable chest findings There are no problems on the
chest area.
Laboratory Findings
HEMATOLOGY
Date Received: Feb. 21, 2017 @ 9:35 AM
Date Reported: Feb. 21, 2017 @ 11:33 AM
TEST REFERENCE RESULT INTERPRETATION
RANGE
OPD Hematology
Complete Blood Count
 WBC count 5.0-10.0 9.73 Within normal range

 Hemoglobin 135.0-175.0 147.0 Within normal range
 Hematocrit 0.4-0.52 0.45 Within normal range
 RBC count 4.2-6.1 5.25 Within normal range
Differential Count
 Neutrophils 55-75 58 Within normal range
 Lymphocytes 20-35 27 Within normal range
 Monocytes 2-10 6.0 Within normal range
 Eosinophils 1-8 8.0 Within normal range
 Basophils 0-1 1 Within normal range
Platelet Count 150.0-400.0 475 H Platelet count increased is
found among people with
Bipolar disorder, especially
for people who take
medicationlike
Zyprexa,Lamictal,
Clonazepam, Lithium
carbonate and Lamotrigine
and have Depression.
Source: eHealthMe
 MCV 79.0-92.2 85.0 Within normal range
(mean
corpuscular
volume)
 MCH 25.7-32.3 28.00 Within normal range

(mean
corpuscular
hemoglobin)
 MCHC 32.3-36.5 33.00 Within normal range

(mean
corpuscular
hemoglobin
concentration)
OPD Chemistry
 Creatinine 39.0-113.0 92.36 Within normal range
CHEMISTRY

DateReported: Feb. 21, 2017 @ 11:33 AM
RANGE
SGPT (ALT) 14.0-63.0 29.4 U/L Within normal range
Sodium 136.00-144.00 141.51 mmol/L Within normal range
SGOT (AST) 15.00-41.00 27.04 U/L Within normal range
Blood urea nitrogen 2.9-7.1 6.42 mmol/L Within normal range
Potassium 3.6-5.1 4.13 mmol/L Within normal range
CLINICAL MICROSCOPY

Date Reported: Feb. 21, 2017 @ 12:48 PM
RANGE
OPD clinic
Urine Examination
Physical Exam
 Appearance Clear Normal
 Color Yellow Normal
Urine Chemistry
 Protein Negative Normal
 pH 6.5 Normal
 Specific 1.016 Normal
Gravity
 Glucose Negative Normal
Urine bilirubin 0-16 Negative Normal
Urine urobilinogen 3.4-17.0 3.4 umol/L Normal
Nitrite Negative Negative Normal
Leukocyte esterase 0-9.14 Negative Normal
Urine ketone 0-0.4 Negative Normal

Date Reported: Feb. 21,2017 @ 12:48 PM
RANGE
RBC 0.0-28.0 / uL 6.00 /uL Within normal range
WBC 0.0-27.0 / uL 27 /uL Within normal range
Epithelial Cells 0.0-7.0 / uL 0.0 /uL Within normal range
Cast 0.0-2.0 / uL 0.0 /uL Within normal range
Bacteria 0.0-111.0 / uL 0.0 /uL Within normal range
CRYSTALS
Amorphous crystals 0.0 Normal
Calcium Oxalates 0.0 Normal
Uric Acid 0.0 Normal
Others
Mucus Threads 8.0 Normal
*/uL
ROENTGENOLOGICAL REPORT
OFFICIAL READING
Date & Time of exam: March 2, 2017 @ 9:16 AM
Chest PA (Adult)
Findings:
The lungs are clear. Tracheal air column is at the midline. The heart is not enlarged. Both
hemidiaphragms and costophrenic sulci are intact. The rest of the included structures are
unremarakable.
Impressions:
Unremarkable chest findings
ECG OFFICIAL RESULT

Date: March 2, 2017
Rhythm: Sinus Axis:90 Arterial Rate: 100 BPM Ventricular Rate: 100 BPM
PR Interval: 0.12 sec. QRS: 0.04 sec. QT: 0.28 sec
SUMMARY, SERIAL & IMPLICATIONS

IMPRESSIONS
Normal sinus rhythm
DRUG STUDY
DATE/ BRAND ACTION INDICATION ROUTE/ DRUG ADVERSE PRECAUTION NURSING

TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICA RESPONSIBILITES
ORDERED TIME TIONS
INTERVAL
Feb. 20, Zyprexa Unknown: Treatment 10 Increased CNS: Contraindicate  Do not dispense
2017 may of acute mg/ODT, olanzapine Somnolence, dwith allergy more than 1-wk
@ 6:00 mediate mixedor 1 ODT clearance w/ dizziness, toolanzapine, supply at a time.
PM antipsychoti manicepisod CYP1A2 inducers nervousness, myeloproliferat
c activity by esassociated (e.g. headache, ive  Peel back foil on
both with bipolar carbamazepine, akathisia, disorders,sever blister pack of
disintegrating
dopamine 1disorder omeprazole). personality e
tablets; do not push
GENERIC and andmainten HALF LIFE disorders, CNSdepression through foil; use dry
NAME serotonin ance of Inhibits metabolism tardive ,comatose hands to remove
type 2 (5- bipolar 30-38 hrs w/ CYP1A2 dyskinesia, states,and tablet and place in
olanzapine hydroxytryp 1disorder inhibitors (e.g. neuroleptic lactation. mouth.
tamine asmonother fluvoxamine). malignant
[HT]2) apyor syndrome  Monitor for the
antagonism; combinedwi May antagonise many possible drug
also, may th lithiumor effects of levodopa CV: interactions before
antagonize valproate and dopamine Orthostatic beginning therapy.
muscarinic agonists. hypotension,
receptors, peripheral  Encourage patient to
histaminic Reduced edema, void before taking
(H1)- and bioavailability w/ tachycardia the drug to help
decrease
alpha- activated charcoal.
adrenergic. Additive effect w/ GI: anticholinergic
centrally acting effects of urinary
drugs or drugs Constipation, retention.
known to increase abdominal
QT interval. pain  Monitor for
elevations of
CLASSIFI- ABSORPTI EXCRETION temperature and
CATION ON Respiratory:
differentiate between
Via urine (approx Cough, infection and
Antipsych Well 57%) mainly as pharyngitis neuroleptic
otic absorbed metabolites and malignant syndrome.
Dopamine from the faeces (approx Other:
rgic GI tract 30%) Fever,  Monitor for
blocker weight gain, orthostatic
joint pain hypotension and
provide appropriate
safety measures as
needed.
ORDERED TIME TIONS
INTERVAL
Feb. 20, Depakote Increases Acute 500mg/tab Decreased protein- The most Contraindicate  Monitor blood studies:
2017 ER level of manic or , 1 tab OD binding& inhibits frequent d to patients Hct
@ 6:00 gamma- mixed the metabolism of adverse with known
PM aminobutyri episodes valproate w/ effects are hypersensitivit  Monitor liver function
c associated aspirin. gastro- y to the drug, studies: AST, ALT,
acid(GABA w/ bipolar intestinal patients with bilirubin, creatinine,
) in brain, disorder w/ Increased clearance disturbances, pre-existing failure
GENERIC HALF LIFE
NAME which or w/o w/ rifampin. particularly liver disease or
decreases psychosis. on initiation a family  Monitor blood levels:
9-16 hrs therapeutic level 50-
Sodium seizure Mono- & Increased trough of theraphy. history of
100 mcg/mL
divalproex activity. adjunctive plasma levels w/ severe hepatic
therapy of chlorpromazine. Less dysfunction  Assess mentral status:
complex common: and patients mood, sensorium,
partial Decreased plasma Increased with known affect, memory (long,
seizures that clearance of appetite and urea cycle short)
occur either amitriptyline/nortri weight gain, disorders.
in isolation ptyline. edema,  Assess respiratory
or in headache, dysfunction: respiratory
CLASSIFI- association ABSORPTI EXCRETION reversible depression, character,
CATION w/ other ON prolongation rate, rhythm; hold drug
seizure Excreted of bleeding if respirations
Anticonvu types & Well unchanged in urine time, and are<12/min or if pupils
lsant multiple absorbed thrombocyto are dilated.
seizure from the penia.
GI tract  Warn patient not to stop
types the drug abruptly.
including Neurologic:  Instruct patient to avoid
absence Ataxia, activities that require
seizures. tremor, alertness.
Migraine sedation,
prophylaxis lethargy,  Advise patient to report
in adults. confusion visual disturbance, rash,
diarrhea, light-colored
and more
stools, jaundice,
rarely protracted vomiting to
encephalopat physician.
hy and coma.
Aggression,
hyperactivity,
behavioural
disturbances,
transient hair
loss,
sometimes
with
regrowth of
curly hair,
amenorrhea,
gynecomastia
, hepatic
failure and
pancreatitis.
ORDERED TIME TIONS
INTERVAL
Mar. 7, Depacon Mechanism Treatment 500mg/tab Increased serum The most Contraindicate  Assess mental status.
2017 of action of acute , 1 tab phenobarbital, frequent d to patients
@ 2:10 not manic or BID primidone, adverse with known  Assess hepatic and
PM understood: mixed ethosuximide, effects are hypersensitivit hematologic status.
antiepileptic episodes diazepam, gastro- y to the drug,
activity may associated zidovudine levels intestinal patients with  Advise patient to report
be related to with bipolar disturbances, pre-existing drug induced adverse
GENERIC HALF LIFE reactions.
NAME the disorder, Complex particularly liver disease or
metabolism with or 6-16 hrs interactions with on initiation a family
Na of the without phenytoin; of theraphy. history of  Give drug with food if
GI upset occurs;
valproate inhibitory psychotic breakthrough severe hepatic
substitution of the
neurotransm features seizures have Less dysfunction enteric-coated
itter, occurred with the common: and patients formulation also may
GABA; combination of Increased with known be of benefit;
divalproex valproic acid and appetite and urea cycle
sodium is a phenytoin weight gain, disorders.  Have patient swallow
compound edema, the tablet whole; do not
containing Increased serum headache, cut, crush, or chew.
equal levels and toxicity reversible
proportions with salicylates, prolongation  Discontinue if there is
of valproic cimetidine, of bleeding evidence of
acid and chlorpromazine, time, and hemorrhage, bruising,
sodium erythromycin, thrombocyto or disorder of
valproate. felbamate penia. hemostasis.
Decreased effects Neurologic:  Monitor ammonia
with Ataxia, levels, and discontinue
carbamazepine, tremor, if there is clinically
rifampin, sedation, significant elevation in
lamotrigine lethargy, level.
confusion
Decreased serum and more  Monitor serum levels of
valproic acid and other
levels with rarely
antiepileptic drugs
charcoal encephalopat given concomitantly,
hy and coma. especially during the
Increased sedation first few weeks of
with alcohol, other Aggression, therapy. Adjust dosage
CNS depressants hyperactivity, on the basis of these
CLASSIFI- ABSORPTI EXCRETION behavioural data and clinical
CATION ON disturbances, response.
urine transient hair
Antiepilep Well loss,
tic absorbed sometimes
from the with
GI tract regrowth of
curly hair,
amenorrhea,
gynecomastia
, hepatic
failure and
pancreatitis.
ORDERED TIME TIONS
INTERVAL
Mar. 7, Depakene Mechanism Treatment 500mg/tab Increased serum The most Contraindicate  Assess mental status.
2017 of action of acute , 1 tab phenobarbital, frequent d to patients
@ 2:10 not manic or BID primidone, adverse with known  Assess hepatic and
PM understood: mixed ethosuximide, effects are hypersensitivit hematologic status.
antiepileptic episodes diazepam, gastro- y to the drug,
activity may associated zidovudine levels intestinal patients with  Advise patient to report
be related to with bipolar disturbances, pre-existing drug induced adverse
GENERIC HALF LIFE reactions.
NAME the disorder, Complex particularly liver disease or
metabolism with or 6-16 hrs interactions with on initiation a family
valproic of the without phenytoin; of theraphy. history of  Give drug with food if
GI upset occurs;
acid inhibitory psychotic breakthrough severe hepatic
substitution of the
neurotransm features seizures have Less dysfunction enteric-coated
itter, occurred with the common: and patients formulation also may
GABA; combination of Increased with known be of benefit;
divalproex valproic acid and appetite and urea cycle
sodium is a phenytoin weight gain, disorders.  Have patient swallow
compound edema, the tablet whole; do not
containing Increased serum headache, cut, crush, or chew.
equal levels and toxicity reversible
proportions with salicylates, prolongation  Discontinue if there is
of valproic cimetidine, of bleeding evidence of
acid and chlorpromazine, time, and hemorrhage, bruising,
sodium erythromycin, thrombocyto or disorder of
valproate. felbamate penia. hemostasis.
Decreased effects Neurologic:  Monitor ammonia

levels, and discontinue
with Ataxia,
if there is clinically
carbamazepine, tremor, significant elevation in
rifampin, sedation, level.
lamotrigine lethargy,
confusion
Decreased serum and more  Monitor serum levels of
levels with rarely valproic acid and other
charcoal encephalopat antiepileptic drugs
hy and coma. given concomitantly,
Increased sedation especially during the
first few weeks of
with alcohol, other Aggression,
therapy. Adjust dosage
CNS depressants hyperactivity, on the basis of these
CLASSIFI- ABSORPTI EXCRETION behavioural data and clinical
CATION ON disturbances, response.
urine transient hair
Antiepilep Well loss,
tic absorbed sometimes
from the with
GI tract regrowth of
curly hair,
amenorrhea,
gynecomastia
, hepatic
failure and
pancreatitis.
C
H
A
P 7
T
E
R
Mental Status Examination
INITIAL FINAL
Date: March 09, 2017 Date: March 16, 2017
1. PRESENTATION 1. PRESENTATION
A. A. General Appearance A. General Appearance
B.
Reveals a well-nourished, well-developed male who
Patient was 23 years old, appropriately dressed wearing
looks his stated age. He is dressed in a slightly faded
a blue t-shirt and also color blue pants with sleepers.
gray pashirt and pants and wears slippers. Hygiene
and grooming are adequate. He was of an average
height and build. He is he is alert, attentive, and
accessible to examination. His mood is euthymic
with congruent affect. Denies any suicidal or
B. GENERAL MOBILITY
homicidal ideations. Denies hallucinations. Trend of
1. Posture and Gait
thought showed delusion of persecution.
(√) Normal ( ) Appropriate ( ) Inappropriate
Describe:
C. GENERAL MOBILITY
1. Posture and Gait The client can able to walk normal.
(√) Normal ( ) Appropriate ( ) Inappropriate
Describe: 2. ACTIVITY
The client can able to walk normal. ( ) Normoactive (√) Hyperactive
( ) Psychomotor retardation ( ) Agitated
2. ACTIVITY Describe:
( ) Normoactive (√) Hyperactive
( ) Psychomotor retardation ( ) Agitated The posture of the client and gait is normal and
Describe: with coordination action.
The client is hyperactive to the question willing to
accommodate. 3. FACIAL EXPRESSION
3. FACIAL EXPRESSION Quantity:
Quantity:
(√) Smiling ( ) Worried ( ) Happy ( ) Tense
(√) Smiling ( ) Worried ( ) Happy ( ) Tense ( ) Ecstatic ( ) Sad ( ) Fearful ( ) Anger
( ) Ecstatic ( ) Sad ( ) Fearful ( ) Anger ( ) Suspicious ( ) frightened ( ) distant
( ) Suspicious ( ) frightened ( ) distant Describe:
Describe:
The client was always smiling
The client is smiling when having interview
from the start to the end of our interview.
C. BEHAVOIR
D. BEHAVOIR The client was very cooperative and responsive to the
The client was very cooperative and responsive to the group question.
group question.
D. NURSE-PATIENT INTERACTION
E. NURSE-PATIENT INTERACTION (√) Cooperative ( ) Initially only
(√) Cooperative ( ) Initially only ( ) Uncooperative ( ) Throughout interview
( ) Uncooperative ( ) Throughout interview
QUALITY:
QUALITY: (√) Warm ( ) Distant ( ) Suspicious
(√) Warm ( ) Distant ( ) Suspicious (√) Talkative ( ) Hostile ( ) others:
(√) Talkative ( ) Hostile ( ) others:
II. STREAM OF TALK
II. STREAM OF TALK
A. CHARACTER OF TALK
A. CHARACTER OF TALK (√) Spontaneous ( ) Deliberate
(√) Spontaneous ( ) Deliberate
B. ORGANIZATION OF TALK
B. ORGANIZATION OF TALK (√) Relevant ( ) Tangential ( ) Flight of ideas
(√) Relevant ( ) Tangential ( ) Flight of ideas ( ) Irrelevant ( ) Incoherent
( ) Irrelevant ( ) Incoherent ( ) Loose association ( ) others:
( ) Loose association ( ) others:
C. ACCESSIBILITY
C. ACCESSIBILITY (√) Good ( ) Poor ( ) Self-absorbed ( ) Fair
(√) Good ( ) Poor ( ) Self-absorbed ( ) Fair ( ) Inaccessible ( ) Mute ( ) Defensive
( ) Inaccessible ( ) Mute ( ) Defensive Describe:
Describe:
The client is able to understand comprehended the
The client is able to understand comprehended group question.
the group question.
III. EMOTIONAL STATE AND REACTION

III. EMOTIONAL STATE AND REACTION
A. MOOD
A. MOOD (√) Euthymic ( ) Depression ( ) Euphoria
(√) Euthymic ( ) Depression ( ) Euphoria ( ) Others:
( ) Others: Describe:
Describe:
The client was approachable and responsive to the
The client was approachable and responsive to group question.
the group question.
B. AFFECT
B. AFFECT (√) Appropriate ( ) Inappropriate
(√) Appropriate ( ) Inappropriate
QUALITY:
QUALITY: ( ) Flat ( ) Blunted ( ) Labile
( ) Flat ( ) Blunted ( ) Labile ( ) Hostile (√) Elated ( ) Others:
( ) Hostile (√) Elated ( ) Others: Describe:
Describe:
The client is happy and enjoys having interaction to
The client is happy and enjoys having interaction the group.
to the group.
C. DEPERSONALIZATION AND
C. DEPERSONALIZATION AND DEREALIZATION
DEREALIZATION ( ) Present (√) Absent
( ) Present (√) Absent D. SUICIDAL POTENTIAL
D. SUICIDAL POTENTIAL ( ) Present (√) Absent
(√) Present ( ) Absent E. Homicidal
E. Homicidal ( ) Present (√) Absent
( ) Present (√) Absent
IV. THOUGHT CONTROL

IV. THOUGHT CONTROL
A. PERCEPTION: HALLUCINATION
A. PERCEPTION: HALLUCINATION ( ) Present (√) Absent
(√) Present ( ) Absent Describe:
Describe:
The client has no sign of hallucination
The client able to see an image that attempts to B. DELUSION
kill her. ( ) Present (√) Absent
Describe:
B. DELUSION
(√ ) Present ( ) Absent The client have no sign of delusions
Describe:
The client feels anxious whenever someone is C. IDEAS OF REFERENCES

coming ( ) Present (√) Absent
TYPE:
C. IDEAS OF REFERENCES Describe:
( ) Present (√) Absent
TYPE: D. DEJAVU AND JAMAIS VU
Describe: ( ) Present (√) Absent
D. DEJAVU AND JAMAIS VU E. PREOCCUPATION AND HUMINATION
( ) Present (√) Absent ( ) Present (√) Absent
E. PREOCCUPATION AND HUMINATION

( ) Present (√) Absent V. NEUROVEGETATIVE DYSFUNCTIONS
A. SLEEP
V. NEUROVEGETATIVE DYSFUNCTIONS (√) Normal ( ) Hypersomnia
( ) Late insomnia ( ) Mixed
A. SLEEP
(√) Normal ( ) Hypersomnia B. APPETITE
( ) Late insomnia ( ) Mixed (√) Normal ( ) Increased ( ) Decreased
B. APPETITE C. WEIGHT: 63
(√) Normal ( ) Increased ( ) Decreased
D. DIURNAL VARIATION
C. WEIGHT: 61 ( ) Present (√) Absent
Describe:
D. DIURNAL VARIATION
( ) Present (√) Absent E. LIBIDO
Describe: ( ) Present (√) Absent
E. LIBIDO F. ATTENTION SPAN

( ) Present (√) Absent (√) Present ( ) Absent
Describe:
F. ATTENTION SPAN
(√) Present ( ) Absent Client has good interaction to the group.
Describe:
VI. GENERAL SENSORIUM AND
Client has good interaction to the group. INTELLECTUAL STATUS
VI. GENERAL SENSORIUM AND A. ORIENTATION
INTELLECTUAL STATUS (√) Time (√) Person (√) Place (√) Situation
Describe:
A. ORIENTATION
(√) Time (√) Person (√) Place (√) Situation Client was oriented with the four spheres
Describe:
B. MEMORY
Client was oriented with the four spheres ( ) Remote (√) Immediate ( ) Recent
( ) Impaired ( ) Situation
B. MEMORY
( ) Remote (√) Immediate ( ) Recent C. CALCULATION
( ) Impaired ( ) Situation Describe:
C. CALCULATION 100-7=93-7=86-7=79-7=72-7=65-7=58-8=50
Describe: The client are alert to answer the mathematical
question
100-7=93-7=86-7=79.
The client are alert to answer the mathematical D. GENERAL INFORMATION
question Describe:
D. GENERAL INFORMATION Student Nurse: kinsa man ang pangulo karon?

Describe: Client: Rodrigo Duterte.
Student Nurse: kinsa man ang pangulo karon? E. ABSTRACT INFORMATION

Client: Rodrigo Duterte. Describe:
E. ABSTRACT INFORMATION Student Nurse: Migo onsa ang imo pag sabot ani
Describe: migo.? aanihin pa ang kabayo kung wala nang
damo
Student Nurse: Migo onsa ang imo pag sabot ani Client: mamatay kay wala na man siya makaon.
migo.? aanihin pa ang kabayo kung wala nang mura rana og tubig mamatay ta kung walay tubig.
damo
Client: mamatay kay wala na man siya makaon. F. JUDGMENT AND REASONING
mura rana og tubig mamatay ta kung walay tubig. Describe:
F. JUDGMENT AND REASONING Impaired

Describe: Student Nurse: kung malunod imo gi sakyan na
barko onsa imo buhaton?
Impaired Client: mulangoy ko niya nag palutaw ko sa tubig.
Student Nurse: kung malunod imo gi sakyan na
barko onsa imo buhaton?
Client: mulangoy ko niya nag palutaw ko sa G. COMPREHENSION
tubig. Describe:
Client can able to read.

G. COMPREHENSION
Describe: VII. INSIGHT
Describe:
Client can able to read.
Client is aware on the place that he is in a mental
VII. INSIGHT hospital.
Describe:
Client is aware on the place that he is in a mental VIII. SUMMARY OF MENTAL STATUS
hospital. EXAMINATION
A. DISTURBANCES IN
VIII. SUMMARY OF MENTAL STATUS ( ) Presentation (√) Stream of talk
EXAMINATION (√) Emotional state and reaction
( ) General sensorium and intellectual status
A. DISTURBANCES IN ( ) Thought control
( ) Presentation (√) Stream of talk ( ) Neurovegetative dysfunction
(√) Emotional state and reaction
( ) General sensorium and intellectual status B. DIAGNOSTIC CATEGORY
( ) Thought control (√) Functional ( ) Psychotic ( ) Organic
( ) Neurovegetative dysfunction ( ) Non-psychotic ( ) Both functional and organic
B. DIAGNOSTIC CATEGORY
(√) Functional ( ) Psychotic ( ) Organic
( ) Non-psychotic ( ) Both functional and organic XI. DEVELOPMENTAL TASK ( IDEAL)
(DEVVELOPMENTAL STAGE AND
XI. DEVELOPMENTAL TASK ( IDEAL) DESCRIBLE THE IDEAL/EXPECTED TASK)
(DEVVELOPMENTAL STAGE AND
DESCRIBLE THE IDEAL/EXPECTED TASK) Sullivan- Preadolescences
Sullivan- Preadolescences He was capable of participating in genuine love

relationship with others
He was capable of participating in genuine love
relationship with others References:
Deborah antai – otong. Psychiatric nursing 2nd edition
References:
Deborah antai – otong. Psychiatric nursing 2nd edition DEVELOPMENTAL TASK (Actual)
Actual description based on the ideals accomplished?
DEVELOPMENTAL TASK (Actual) Or failure?
Actual description based on the ideals accomplished?
Or failure? References: See Sheila L. Videbeck- psychiatric
Mental Health Nursing
References: See Sheila L. Videbeck- psychiatric Diagnosis and statistical manual of mental disorder
Mental Health Nursing (DMS)
Diagnosis and statistical manual of mental
disorder (DMS)
AXIS I
BIPOLAR DISORDER I
AXIS I
BIPOLAR DISORDER I
AXIS II
NONE
AXIS II
NONE
AXIS III
NONE
AXIS III
NONE
AXIS IV
POOR EDUCATIONAL BACKGROUND
AXIS IV POOR FINANCIALSTATUS
POOR EDUCATIONAL BACKGROUND
POOR FINANCIAL STATUS AXIS V
AXIS V 51 – 60 Moderate symptoms
51 – 60 Moderate symptoms
Nurse Patient Interaction
NURSE PATIENT ANALYSIS DOCUMENTATION REFERENCE
Maayong udto Maayong udto pud The client was in Broad opening is Saunders manual of
migo sir/ ma’am good mood to helpful to begin psychiatric nursing care
accommodate therapeutic plan; diagnosis, clinical
question. communication. tool and
Onsa imo pangalan Chippy psychopharmacology 3rd
migo? edition 2007.
Kami diay Okey lang sir/ The client was Asking question
studyante sa ma’am basta sa responsive encourages the client to
Polytechnic kaayohan. respond and attain
College of Davao specific information.
del Sur, Inc. na a
me dire kay
psychiatric duty
namo. napili pud
ka namo ikaw
subject sa amo Videbeck, shiela
cases study migo psychiatric mental health
ding-dong. Nursing. 2nd edition.
Giving recognition is to 2004.
Musta man ka Okey lang ko oi. The client was identify client effort to
migo? remained participate in
responsive communication.
Ay gidala ko sa Client is in denial Asking question to

Ngano na a man ka ako angkol, igsoon about his status he validate client status
dire migo? og mama sila man pretend that he is able to understand
gud nag daot sa normal. specific situation.
ako
Saunders manual of
Ngano ka ingon Ila ko gidala dire Client pretend that Blaming towards other psychiatric nursing care
man ka na gi daot wala man ta ko he is mentally well person represent plans;
ka nila? problema grabe and did not accept manipulative client to Diagnosis, clinical tools,
kayo pangdaout sa he have a problem. obtained sympathy. and
ako. psychopharmacology
3rd edition
Kabalo baka asa Na a ko sa mental. Client was able to Broad opening is 2007
ka karon og kabalo wala man ko acknowledge the helpful to begin
baka sa imo gi bati problema sila ang question . therapeutic
karon? na a problema communication.
tong nag dala sa
ako dire.
Musta mo sa imo Dili okey oi kay Client toward Parent relationship is

mama o papa inyo pasagdan lang me relationship to his most importance to
relasyon migo walay pakaban parent are in not have a motivation.
ding-dong? sukad na matay si good. Saunders manual of
papa. psychiatric nursing care
plans;
Ngano daiy na Maoy man gud si Parent client not Parent act as a good Diagnosis, clinical tools,
onsa imo papa papa palahubog na value a good example to the children and
migo ding-dong? dungaban mao na model to them. psychopharmacology
matay siya. 3rd edition
Parent relationship is 2007
Tong wala pa Dili japon oi kay Client toward most importance to
namatay imo papa pag hubog si papa relationship to his have a motivation.
okey man ka mo sa kulatahon mi niya. parent are in not
imo parent? good
Child abuse is not
Ngano kulatahon Alangan hubog Client suffer a appropriate to children Psychiatric
man mo sa imo man ciya maoy pa physical abuse Mental Health Nursing
papa migo ding- jud mao magulata from his father. Abuse person suffer a by Sheila L Videbeck,
dong. siya. trauma from his past PhD, RN
that he remember.
Niya tong pag Wala oi gi Client did not
kamatay sa imo pasagdan me ato accept other person
papa musta man na a siya lain. ako on his life to have
mo sa imo mama? gani to siya gi father figure.
sultian na ma dili
ka mag dala og
laki dire sa balay Saunders manual of
kay maot na kong Superstitious believes psychiatric nursing care
mag dala paka dire are also one influences plan; diagnosis, clinical
usab ako sunogon our culture. tool and
Ngano sunogon ning balay Client believes psychopharmacology 3rd
man nimo migo older interpretation edition 2007.
ding-dong? Dili man gud na about bad luck in
mayo sa pag puyo life. Exploring into the
na mag dala ka og subject help examine
laki sa inyo balay the issues of the family
Naka eskuwela maot man gud na. Videbeck, shiela
baka migo ding- Client was psychiatric mental health
dong? Wala lagi ni cooperative to Nursing. 2nd edition.
undang ko ug answer questioned 2004.
eskuwela nag being asked
condoctor nalang k
okay gi pasagdan Asking question
Tong nag man me. The client was encourages the client to
eskuwela ka actibo remained respond and attained
baka sa Dili lagi kay sige responsive specific information Psychiatric
eskuwelahan migo lang ko og absent Mental Health Nursing
ding-dong? by Sheila L Videbeck,
PhD, RN
Onsa daiyka year Client was able to Asking question

ni ondang migo? First year ko ni accommodate and encourages the client to
undang nako og answer the respond and validate
eskuwela. questioned client status.
appropriate Saunders manual of
Na a kay rebon to psychiatric nursing care
ni graduate ka sa Na a most Client was still plan; diagnosis, clinical
grade six nimo cooperative lang responsive tool and
migo? psychopharmacology 3rd
edition 2007
Seeking information
Tong nag Dili oi pasagdan Client had the encourages the client to
eskuwela paka lang ko ato ni willingness to respond and attain
mahadlok ka biya mama. cooperate specific information.
an sa eskuwelahan
migo? Psychiatric
Mental Health Nursing
Migo tong nag Ka ayo badlugon by Sheila L Videbeck,
eskuwela pa ka kay ko sa una( The client was PhD, RN
sakit baka sa ulo sa smiling) responsive and
maistra? cooperative to
accommodate Seeking information
Tong nag questioned encourages the client to
eskuwela pa ka sa Ako permi bagsak respond and validate
un amigo musta tas kasab an pa jud client status of
man imo grado? ko ig uli nako sa orientation.
balay. Saunders manual of
psychiatric nursing care
Na a pud kay mga Exploring into the plan; diagnosis, clinical
amigo migo? O dag han sila Client was subject help examine tool and
responsive and yet the issue. psychopharmacology 3rd
Si kinsa mana sila able to remember edition 2007.
migo? Si bon bon 29 her friends
Jan,jan 32 Substances abuse one
Kapid 24 factor influence
Mao o na sila ako behavior of a person
ka uban tong nag Videbeck, shiela
bisyo ko Client have a good psychiatric mental health
Onsa pud inyo memory able to Nursing. 2nd edition.
bisyo migo? Imun lang pero recall past memory 2004.
sige sila hagad Asking questioned
sigarilyo pero dili encourages the client to
ko mu segarilyo Client are respond and validate
Ngano dili man ka substance abuse client status orientation.
mu segarilyo Dili lang ko imum due to fear
migo? lang ako jud to pressure on the Psychiatric
ako. environment Mental Health Nursing
by Sheila L Videbeck,
Client still was Seeking information PhD, RN
Kaning pag bisyo responsive encourages the client to
nimo migo kabalo Ambot wala guro respond and validate
imo mama o sila kabalo. client status of.
igsoon migo?
Pila ma idad nag Client was able to Saunders manual of

sugod ka og 13 ko nag sugod think abstractly to Giving recognition is to psychiatric nursing care
trabaho migo? limyo lang ko og answer the identify client effort to plan; diagnosis, clinical
sakyanan questioned participate in tool and
Pila pud imo communication. psychopharmacology 3rd
sweldo ato migo? 25or 30 dako pa edition 2007.
mana gud sa una
makapalit nako.
Onsa pud imo Client had
paliton migo? Pag kaon pait ka attention to span
ayo segi lang and answer the
trabaho wala kaon questione.
kaon patay ta ana.
Tong buhi pa imo Broad opening is
papa migo onsa Tig buhat og The client was helpful to begin Saunders manual of
pud iya trabaho hallow bloc sa remained therapeutic psychiatric nursing care
migo? amo hawd man responsive communication plan; diagnosis, clinical
gud to mu buhat tool and
ako papa. psychopharmacology 3rd
Onsa pud oras mu edition 2007.
lakaw imo papa og 7:30 mulakaw na The client was able
uli gikan sa ciya niya muuli to acknowledge the Asking question
trabaho migo? 3:00 sa hapon. statement encourages the client to
usahay pag uli respond and validate
Diba na sulti nimo niya hubog pud. client status.
na matay imo papa
onsa ka bag ohan Ako mama na ay
sukad wala na siya lain ato niya kami
migo? sa ako mag igsoon The client was in
nag bulag bulag good mood to Exploring into the
pud kay sa trabaho accommodate subject help examine Videbeck, shiela
mag kita rami pag questioned the issue. psychiatric mental health
As man pud diay b-day. Nursing. 2nd edition.
ka nag trabaho 2004.
migo? Sa cotabato ko nag Exploring into the
trabaho byahe subject help examine
conductor ko tidto Client had the issue.
Layo a ba ngano attention span in
na a man ka tidto Na a man gud ko answering the
migo? angkol tidto niya questioned
tidto pud ko nag
sugod bisyo ka
uban me sa driver
of amo nako. Giving recognition is to
Asa man pud ka Identify client effort to Psychiatric
naga Sa balay sa ako Client are easily participate in Mental Health Nursing
ulian migo? amo na a man siya influences due to communication. by Sheila L Videbeck,
balay ka uban me the environment PhD, RN
sa driver
Onsa pud klase
bisyo n amigo? Gamit og shabo og Client are easily
mariwana influences due to Client manifested
Ngano naga gamit the environment withdrawal they want to
man pud mo ana Pang pa wala lang be aloft to everyone. Saunders manual of
sir gud sa kapoy niya psychiatric nursing care
naga gamit pud plan; diagnosis, clinical
ang driver niya tool and
amo pud nako Client manifested psychopharmacology 3rd
gamit nalang pud withdrawal they want to edition 2007.
Pila pud ka tuig ko. The client was in be aloft to everyone.
bago ka ni undang good mood to
gamit migo? Ambot kalimot accommodate the Client manifested
nako wala nako questioned withdrawal they want to
naga gamit at okay be aloft to everyone.
nag kasakit ko ato
nadal ko sa
Pila man imo edad hospital gi dala Asking questioned
na gi dala ka dire a pud ko nila dire Client is in encourages the client to
migo? ato. withdrawal stage respond and validate
they try to escape status of orientation Psychiatric
Ngano na dala 21 ko ato na gidala from the reality. Mental Health Nursing
man ka ato dire dire a. by Sheila L Videbeck,
migo? PhD, RN
Mahadlok ko sa Client are in Client manifested

tao ato. confused state withdrawal they want to
niya pag gabie nag about the situation be aloft to everyone.
laslas ko ato og happened
Ngnano gusto man gunting wala man
ka ato mamatay ko namatay. Asking question
migo? Client is in encourages the client to Saunders manual of
Ambot lagi ato withdrawal stage respond and validate psychiatric nursing care
ngano they try to escape client status. plan; diagnosis, clinical
Gi bantayan nako from the reality. tool and
Tong pag adto nila ato tulo sila Blaming towards other psychopharmacology 3rd
nimo dire asa ka gi nag bantay sa ako. person represent edition 2007.
dala? Client had the manipulative client to
Sa CIU lang ko ato willingness to obtained sympathy.
7 ka adlaw ko tidto cooperate
human nakagawas Blaming towards other
Niya sukad ato ko okey na man ko person represent Videbeck, shiela
wala naka kabalik ato. manipulative client to psychiatric mental health
ato dire a migo? obtained sympathy. Nursing. 2nd edition.
Mga 1 year na pud 2004.
Ngano man gi dala ato gibala na pud
ka nila og balik ato ko nila dire. Client is in Asking questioned
dire migo? withdrawal stage encourages the client to
Wala man koy they try to escape respond and validate
Ngano wala man kaon kaon ato og from the reality. client status orientation.
kay kaon kaon ato kan on. Psychiatric
migo? Mental Health Nursing
Client had by Sheila L Videbeck,
Paminaw man gud attention span in PhD, RN
Naga gamit pa nako busog ko answering the Other opinions can
japon ka og shabu mao wala ko ning questioned bring down their self
mariwana anang kaon. confident
panahona
Wala na ko nag Client pretend that Other opinions can
Sukad ato wala gamit ana kay na a he is mentally well bring down their self Saunders manual of
naka nada og balik nako ato dire sa and did not accept confident psychiatric nursing care
dire migo? davao. he have a problem. plan; diagnosis, clinical
tool and
Na dala ko ato og Client pretend that psychopharmacology 3rd
Ngano man na balik. he is mentally well edition 2007.
dala ka og balik and did not accept Seeking information
dire migo? he have a problem. encourages the client to
respond and validate
Nag stambay ko sa The client was client status of
maa sa ako angkol remained orientation
Ngano kaigon ka tong nag daot sa responsive
na gi daot ka mig? ako a Being Positive can
bring more energy and
happiness the client Saunders manual of
Iya man gud ko gi Client had the psychiatric nursing care
Wala naka dala dire siya ang willingness to plan; diagnosis, clinical
nagagamit ato daot dili ako. cooperate tool and
shabu mariwana Being Positive can psychopharmacology 3rd
migo? bring more energy and edition 2007.
Wala na kay ato Client are shy happiness the client
president si duterte about of his back
Niya kanang na man gud. ground due to his Diverting some topic
makagawas ka dire past illness means there something
a migo onsa man hiding feelings
imo buhatong? Magita og trabaho Client are shy
basta naka kuwarta about of his back
Niya naka trabaho ground due to his Seeking feeling
ka sukad tong past illness examine some of issues.
nakagaws ka dire a
migo? Wala oi kay Client was still Firm and stand strong Videbeck, shiela
ingnoon man ko responsive to the decision making psychiatric mental health
Bagong laya nila na bagong Nursing. 2nd edition.
migo? laya . Client was 2004.
responsive and
Mahadlok sila kay willingness to Broad opening is
bag o daw ko accommodate the helpful to being
Migo ni adot biya gawas sa mental. questioned therapeutic
mi sa inyo migo. communication.
O bati kayo amo
Okey rana oi basta balay sa ma-a no Clint have good
ang nag puto tidto sir. positive out look Giving recognition is to
ma ayong tao identify client effort to
kapiras nimo ma Mao jud sir participate in
ayo og gwapo ja (laughing ) communication Psychiatric
jud. Client in their Mental Health Nursing
community are by Sheila L Videbeck,
Nag istoryahay being so friendly PhD, RN
biya me sa imo
ankol migo? Ah nag
istoryahany diay client did not
mo tong tag iya og acknowledge the Restating lets client
Daghan ka ayo ka teloring shop question but diver know whether an
og kaila tidto no into other topic expressed statement has Saunders manual of
migo? or has been not psychiatric nursing care
O sir kay friendly understand plan; diagnosis, clinical
man gud ko sa client was able tool and
amo. respond in every psychopharmacology 3rd
Migo kong questioned Restating lets client edition 2007.
makagawas ka know whether an
migo mus simba client are being expressed statement has
jud ka? Ay sir mga doctor manipulative or has been not
o. understand
Ma ayong buntag
migo ding- dong?
the client was in Being Positive can
Musta man imo Ma ayong buntag good mood to bring more energy and
tulog migo ding- pud. accommodate happiness the client
dong?
Okey land japon.
Sir unya nata the client was

Ngano man? istorya sir hapon responsive
kalibangon ko niya
wala ckicks
Kong ako lang Lain kayo sir

daiy migo? lalaki lalaki lang
dapat na chick
para lingaw.
Musta manka dire Client was able to
migo ding-dong? O key man sir sa acknowledge the
lalaki pero gusto statement
Niya gi bisaita ka ko na ay chicks
sa imo mama migo
ding-dong? O key lang japon
Niya musta man Client was able to

mo sa imo mama? O gahapon ni acknowledge the
bisita siya statement
Ah okey lang ako

gani to sila gi
pasuya ako mga ka
uban dire na sweet Client was
Hantod hwebes me ne sa ako mama. remained
dire ding-dong responsive and
Hantod kanus a positive
mo dire sir?
Managhid sa me sa
imo doctor migo? Puwedi ko mu apil
sa inyo
Pag makagaws ka culmination day
onsa migo imo sir?
plano?
Pare pareha man
Sa imo diay mama me og doctor dire
ding-dong kay a sir.
mingawon sa imo?
Mu gawas ko dire
mu adto ko sa
cotabato.
Tid to lang ko sa
cotabato kay
lingaw man gud.
Date/ Cues Nee Nursing Scientific Goals Objectives Nursing Interventions Rationale Evaluation
Time ds diagnosis Basis Criteria
March Subjective: P Potential for Suicidal Within 2 weeks of 1. Establish rapport. 1. To gain cooperation. “PARTIALLY
9,2017 “Dili nako H injury tendency or the nursing 2. Determine level of 2. A high risk client will MET”
@ masabtan akong Y directed ability to project interventions, the suicide precautions need constant  Behavioral
1:00P kaugalingon ato S towards self pain towards self needed. manifestation
client will be able supervision and a safe
M maam” , as I related to are some of the For example the client : s of
verbalized by O Distorted common self- to: * Have suicide plan environment Reduces
 Behavioral stress and decreases depression
the patient L thought directed * Admit previous
O content mechanism of manifestations of suicide attempts muscle spasm are absent
Objective: G getting rid of depression are * Abuse Substance 3. Growing up in a  Demonstrate
 Previous I some unresolved absent * Have no friends family that did not alternative
C conflicts or 3. Note beliefs, cultural ways of
admitting  Demonstrate allow feelings to be
chief problem, chronic and religious practices dealing with
alternative ways expressed, individuals
mental illness, that may be involved in
complaint: of dealing with learn that feelings are negative
irrational choice of behavior.
Suicide thinking, negative feelings 4. Determine use or abuse bad or wrong. feelings and
attempt depression, and and emotional of addictive substances. 4. May be trying to resist emotional
such as exposure to stress. 5. 5. Encourage client to impulse to self injure b stress.
- Cutting violence.
 State that he
talk freely about turning to drugs.  Verbalization
his wrist feelings ( Anger, 5. Client can learn of desire to
wants to live. disappointments ) and
with a  Not harm self or alternative ways of live, “Gusto
help client plan
scissor ( others. alternative ways to dealing with pako mabuhi
2013) handle anger overwhelming ky wala
- Cutting frustrations. emotions and gain a pakoy liwat.”
his wrist 6. Close monitoring of the sense of control over  Not harm self
with a knife patient's non-verbal his life. or others.
( 2016) communication and
6. Constant monitoring of
behavioral cues.
- Doesn't the patient's behavior
7. Provide external
want to eat provides a strong cue
controls and limit
at all (
setting. guide that an uprising
2017)
8. Include client in episode for suicidal
development of plan of tendency is imminent
care. thus prevents the
9. Encourage client to
engage in active completion of such
diversional activities. contemplated plans.
10. Reinforce family 7. To decrease the need
support system.
to mutilate self.
11. Discuss and provide
information about the 8. Being involved in own
use of medication, as decisions can help
appropriate. reestablish ego
boundaries and
strengthen
commitment to goals
and participation in
therapy.
9. Providing diversional
activity to the patient
would lessen his focus
of completing the
contemplated suicidal
tendency.
10. Client's need a
network of resources
to help diminish
personal feelings of
worthlessness,
isolation, and
helplessness.
11. Antidepressant
medications may be
useful, but use needs to
be weighted againts
potential for
overdosing or side
effects.
Date/ Cues Nee Nursing Scientific Goals Objectives Nursing Interventions Rationale Evaluation
Time ds diagnosis Basis Criteria
March Subjective: H Risk for non- Some factors Within 2 weeks of 1. Establish rapport. 1. To gain cooperation. “PARTIALLY
9,2017 “ Di ko ganahan E compliance to may contribute nursing 2. Listen to clients 2. Helps to identify MET”
@ mu inum anang A medication to patient's non- interventions, the complains/comments. client's thinking  Verbalized
1:00P tambal nga L regimen or compliance or accurate
client will be able 3. Identify factors that about the treatment
M gereseta sa T treatment non-adherence to knowledge of
doktor kay H Related to medication to: interfere with taking regimen, side effects
 Verbalized medications or lead to of medications or condition and
makadaot na sa Denial of the regimen such as
utok. Wala man M problem denial of the accurate lack of adherence ( success of procedure understanding
kuy daot. Sige A problem, cost of knowledge of e.g., depression, drug 3. Forgetfulness is the of treatment
kog inum ana N the treatment, condition and use , lack of belief in most common reason regimen.
wala mn A difficulty of the understanding of treatment efficacy) given for not ’’Mu inom
gihapoy G regimen, the jud ky para
treatment 4. Note length of illness. complying with the
nahitabo .” As E unpleasant man daw
verbalized by M outcomes or regimen. 5. Be aware of treatment plan.
the patient E side-effects of  Make choices at nurses'/healthcare 4. Individual tend to maayo ko.
N the treatment, level of readiness providers' attitudes become passive and Masuko pud
Objective: T lack of trust, and based on accurate and behavior toward dependent in long ang nurse ug
 Mistrust of apathy. information. the client. term, debilatating dili nako
regimen P
 Verbalize 6. Develop therapeutic illnesses. imnon.’’
and/or A  Make choices
commitment to nurse-client 5. Some care providers
T
healthcare mutually agreed relationship. may be enabling at level of
T
personnel E upon goals and 7. Explore client client, whereas readiness
 Knowledge R treatment plan. involvement in or others' judgmental based on
deficit N  Access resources lack of mutual goal attitudes may impede accurate
about the appropriately. setting. treatment progress. information.
benefits of
 Demonstrate 8. Provide for 6. Promotes trust,  Verbalize
taking the continuity of care in provides atmosphere commitment
progress toward
medications health goals. and out of the in which client can to mutually
. hospital or care freely express views agree upon
setting, including and concerns. goals and
treatment
long range plans. 7. Client will be more plan. "
9. Give information in likely to follow- Makainum
manageably amounts, through on goals he jud ko kay
using verbal written, participated in naa man ko
and audiovisual developing. diri maam."
modes at level of 8. Supports trust,  Access
client's ability. facilitates progress resources
10. Have the client toward goals appropriately
paraphrase 9. Using client's style of  Demonstrate
instructions and learning facilitates progress
information heard. learning, enabling toward health
11. Suggest using a client to understand goals.
medication reminder diagnosis and
system. treatment regimen.
12. Provide family 10. Helps validate client's
support system. understanding and
reveals
misconceptions.
11. These have been
shown to improve
client adherence by a
significant
percentage.
12. To reinforce
negotiated behaviors.
DATE/ CUES NEEDS NURSING SCIENTIFIC GOALS NURSING RATIONALE EVALUATION
TIME DIAGNOSIS BASIS OBJECTIVES INTERVENTIONS
CRITERIA
March 7, Subj: C Disturbed Because of After 2 weeks of 1. Establish 1. To gain trust and “GOAL MET”
2017 “Ginadautan O thought neurological nursing rapport with cooperation
@ rako sa akong G processes changes and interventions, the client. 2. This lessens After 2 weeks of
8:00 am pamilya” as N related to chemical client will be 2. Identify anxiety. nursing
I
verbalized by neurologic imbalances able to lessen feelings related 3. This avoids interventions, the
T
the patient I changes as of the brain, delusions as to delusions reinforcing false patient was able to
V evidenced by an individual evidenced by: such as fear. beliefs. reduce delusions
Obj: E delusions may have 3. Do not argue or 4. A psychotic as evidenced by:
 frequent disturbed a. Avoiding try to correct person might
blinking P thought withdrawal false beliefs interpret touch a. Talking more
E processes. from family using facts. and gestures as with his
 reluctance R members 4. Do not touch aggressive mother
to C NANDA b. Stating that client. Use 5. When thinking is b. Absent
communica E the gestures focused on withdrawal
te with P
delusional carefully reality-based from family
T
family U thoughts are 5. Distract client activities, the members
 frowns A less intense from delusion client is free of c. “Murag wala
when L and less by engaging in delusional na man ko nila
frequent reality-based thinking. ginadautan” as
talking
P c. Communica activities such 6. This allows the verbalized by
about his A ting more as playing patient to be the patient.
family T with his cards. ready to do tasks
 withdrawal T mother 6. Teach client independently
E coping skills 7. This allows
from R
family that minimize further recovery.
N
delusional 8. To avoid drug
 persecutory
thoughts such interaction
delusion as talking to a 9. To prevent any
trusted friend. injuries
7. Maintain 10. To prevent
regular sleep relapse and
pattern. occurrence of
8. Restrict alcohol delusions
intake.
9. Maintain self-
care.
10. Maintain
medication
regimen
CRITERIA
3/7/16 Subj: C Ineffective An individual Within 2 weeks of 1. Establish 1. To gain trust “GOAL MET”
8:30 am “Maglisodkosa O coping may feel nursing rapport and
akongsitwasyo P related to uncomfortable interventions, the 2. Assess and cooperation After 2 weeks of
nkaronmurag di I lack of when they feel client will be able recognize early 2. Setting limits nursing
N
namakaya” as defense like the to attain coping signs of is an intervention,
G
verbalized by mechanism demands or skills as evidenced manipulative important step patient was able to
the patient S utilization pressures on by: behavior. in the attain coping skills
T them are more 3. Observe for intervention as evidenced by:
Obj: R than what they a. Absence of destructive of bipolar
-presence of E can cope with. delusion behavior clients. a. Absence of
delusions S Depending on b. Increased towards self or 3. Early delusion
-demanding S the coping problem others detection and b. Able to solve
behavior resources, an solving skills 4. Maintain a intervention problems
-Inability to T individual c. Decreased firm, calm, and can prevent independently
O
problem solve may have manipulative neutral harm to client c. Decreased
L
-Inability to ask E difficulty in behavior approach or others manipulative
for help R coping. 5. Avoid arguing 4. This prevents behavior
-manipulative A with the client escalation of
behavior N Kozier and 6. Avoid joking environmental
C Erb’s with the client stimulation
E Fundamentals 7. Administer and manic
on Nursing anti-manic activity.
P medication as 5. Arguing
A ordered provides
T
environmental
T
E stimuli to the
R patient
N 6. To prevent
manic activity
7. To control
manic activity
CRITERIA
3/7/16 Subj: R Impaired Due to After 2 weeks of 1. Establish 1. To gain trust “GOAL MET”
9:00 am “Grabena kayo O social disturbed nursing rapport. and
ko L interaction biochemical interventions, 2. Provide an cooperation. After 2 weeks of
kaistoryadorkar E related to disturbances, patient will be environment 2. Reduction in nursing
on. Maski asa biochemical an individual able to balance with minimum stimuli lessens interventions, the
R
rako makakitag E imbalances may exhibit an social interaction stimuli. distractability. patient was able to
amigo” as L and excessive impaired as evidenced by: 3. Encourage to 3. This balance social
verbalized by A hyperactivity social do solitary minimizes interaction as
the patient T and agitation interaction a. Satisfying activities with stimuli evidenced by:
I wherein there verbal staff. 4. This releases
Obj: O is an excessive exchanges 4. Encourage to tension a. Satisfying
-racing N quantity of b. Increased perform mild constructively verbal
thoughts S social attention span physical 5. Relieves communicatio
-frequent H exchange. c. Controlled activities. tension and ns
I
blinking of tone of voice 5. Involve patient decreases b. Increased
P
eyes Kozier and d. Absence of in gross motor manic levels. attention span
-elevated tone P Erb’s sudden verbal activities such 6. As mania c. Moderate tone
of voice A Fundamentals outbursts as walking subsides, of voice
-loud verbal T on Nursing 6. When less involvement d. Absence of
behavior T manic, let the in activities sudden verbal
-poor attention E client join one that provide a outbursts
span R or two other focus and
-sudden verbal N clients in quiet social contact
outbursts activities such becomes more
as drawing and appropriate.
board games. 7. Increases
7. Eventually feelings of
involve the self worth and
patient in group helps in
activities maintaining
social
interactions.
Health Teachings
PRIMARY
 Instruct the patient to follow treatment regimen.

 Provide supportive measures as indicated.
 Encourage to have enough rest and sleep.
 Instruct to increased oral fluid intake.
 Instruct the importance of proper hygiene.
 Instruct the importance of balance diet.
SECONDARY
 Instruct significant others to keep a safe environment to the patient.

 Instruct significant others to assist patient in doing activities of daily living until the patient
becomes independent.
 Teach patient and other family members how to perform exercises, skin inspection and
mobility regimen.
 Instruct significant others to encourage the patient to discuss feelings and concerns about the
current condition.
TERTIARY
 Consult the dietician to plan appealing, high-protein meals that provide sufficient fiber and
calories.
 Inform dietician about the foods that are prohibited to the clients.
 Instruct patient to report any unusualities to a physician.
 Encourage patient to follow drug regimen prescribed by the physician.
Discharge Plan
Medications
 Encourage patient to maintain compliance to medication regimen.
 Administer medication with food.
 Do not double dose if missed, take as soon as possible but not just before next dose.
 Instruct patient to report for any unusual bleeding, rash, pale stools and dark urine.
 Instruct client to increase oral fluid intake.
Exercise
 Make an exercise routine every morning
 Advice client to perform minimal activities to conserve energy.
 Exercise on a soft surface like grass or mats.
 Encourage family members to provide time for bonding moment with the client through
exercise activities.
Treatment
 Explain to the client the possible effects of taking the medication.
 Let the client understand any increment of dosage or adjustments in the pattern of his
drug regimen.
Hygiene
 Instruct client to take a bath daily.
 Encourage patient to hand washing before and after eating.
 Advice to change clothing every day.
 Encourage to maintain proper oral hygiene.
Out Patient Orders

 Encourage client to follow the doctor’s advices strictly to prevent recurrence of illness.
 Instruct the family members to always orient the client with reality and give positive
actions to avoid suspicions.
 Encourage client to avoid noisy environment as this could trigger aggression and tension.
Diet
 Teach client to eat meals regularly specially when taking his medications.
 Remind client about the foods that are prohibited such as chocolate, colas, cheese and etc.
Spiritual Aspects
 Encourage patient to attend mass every Sunday held at the solarium.
 Encourage patient and family to pray and trust God’s plan all the time.
C
H
A
P 8
T
E
R
Prognosis
GOOD PROGNOSIS POOR PROGNOSIS

Late Onset (x) Early Onset( /)
Obvious precipitating factors(/ ) No precipitating Factors(x )
Acute Onset(x) Insidious Onset(/)
Good premorbid social( /) Poor premorbid social sexual and
work history( x)
Affective symptoms especially Withdrawn, autistic behavior, single,
depression(/ ) married, divorced, widowed(x )
Family history of mood Family history of schizophrenia(x )
disorders(x )
Good support systems( /) Poor support system(x )
Positive symptoms(/ ) Negative symptoms(x )
No history of prenatal trauma History of prenatal trauma
( /) (x )
Undulating course symptoms have No remission in 3 years chronic(x )
present in less than a year(/)
Few relapses( x) Many relapses( /)
Not assaultive(x ) History of assaultiveness( /)
Paranoid/Catatonic( x) Undifferentiated/Disorganized( /)
Cooperative in Uncooperative in treatment regimen(/
treatment regimen( /) )
Without substance abuse Substance abuse present
( x) (/ )
Family with history of mental Family with no history of mental
illness( x) illness(/ )
With occupation Without occupation( x)
( /)
With parent( /) Lost a parent(/ )
/= 10 x=8 /=9 x=9
I. Onset of illness: Good

Patient’s behavioral changes were observed 1 week prior to admission.
II. Duration of illness: Good
After the family noticed the patient’s behavioral changes, they immediately decide to
admit the patient to SPMC-IPBM.
III. Precipitating Factors: Poor
There are factors that was considered that affects the client’s condition such as lack of
knowledge about the benefits of taking the medications.
IV. Mood and affect: Good
The patient’s mood and affect is appropriate to the patient’s feelings and appropriate
to what he is talking about.
V. Attitude and willingness to take medication: Poor
The patient believed that taking medications does not help him. He doesn’t want to
take it, but since he is admitted to SPMC-IPBM, he is forced to do so.
VI. Any depressive feature: Good
The patient already stated that he wants to live.
VII. Family support: Good
The patient has a supportive family member who are trying their best to provide all of
his needs including physical, moral, emotional , and spiritual needs.
Overall Prognosis:
Good: 5/7 x 100 = 71.42%
Poor: 2/7 x 100 = 28.57%
Based on the researcher’s observation, assessment and justifications, they were able to
come up with good prognosis. Which means that patient Chippy has a good and higher chance of
recovery.
C
H
A
P 9
T
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Evaluation
This study has brought us a mind opening experience. It has helped us further enhanced
our knowledge on how to care for a patient who is experiencing any form of mental disorder.
Psychiatric Nursing exposure and this case study helped us to see the reality of life which
is very significant tool as we continue our quest to become young professional nurses in the
future.
It has opened our eyes to appreciate life and being thankful to our parents, friends, and
clinical instructors who had helped us mold to what we are now and what we will be in the
future.
As we go along with our studies or this particular case,we had met the objectives which
enables us to think that this case study was mad successfully. We identified the patient's problem
which entailed us to do the nursing care plan specifically the interventions which are set in our
minds that we can have it for our future use. We had assessed the patient that we had, which we
had come up better understanding on his situation.
Truly, we were thankful for this wonderful experience. An experience worth nourishing
and will be printed in our minds till life-everlasting.
It has opened our eyes to appreciate life and being thankful to our parents , friends, and
clinical instructors who had helped us mold to become what we are now and what we will be in
the future.
C
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P 10
T
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Recommendation
As it thought that Bipolar I, is a mental disturbance which may be cause or triggered by

various physiologic, psychological and emotional factors, the authors would like to suggest the
following recommendations:
To the Client:
1. An adequate and nutritional dietary supplement should be provided for the patient. Encourage
small amount eaten frequently throughout the day.
2. Anticipating for possible high caloric finger foods, sandwiches, and crackers to supplement
diet in case the patient would not like the previously suggested food.
3. Help patient in personal hygiene as symptoms subside by encouraging him to assume

responsibility of self care.
4. Involve the patient in activities that requires gross motor movements , maintain a calm
environment , and protect him from over stimulation; suggest short day time naps to promote rest
and firmly encourage him from over exerting his self.
5. Provide diversional activities suited to a short period attention span.
6. Provide emotional support and set realistic goals for behavior.
7. In a calm, clear and confident manner establish limits for patient's demanding, hyperactive,
manipulative, and acting-out behavior.
To the Family:
1. It is important that the family of the patient would extend further effort to reach and
understand the patient's mental condition in order to provide a warm environment and healthy
enough for the patient to develop strong sense of belongingness.
2. The family should actively participate in the psychotherapy program of the patient in order to
fully understand course of management.
For the Community:
1. It is important that the community should have an accepting attitude towards the patient
regardless of the mental and behavioral disturbances the patient is experiencing. This would
make the patient feel accepted thus contribute in increasing the self-esteem of the patient.
2. The community should actively participate and assistive in helping the family raise the
necessary monetary value needed in procuring the medicines of the patient to ensure the
continuity of the medication of the patient for fast and better recovery.

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Bipolar 1 Case Presentation

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POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC

MacArthur Highway, Digos City

BIPOLAR DISORDER I WITH PSYCHOTIC FEATURES

In Partial Fulfillment of the Requirements in RLE 105 (Psychiatric Nursing)

A Requirement Presented to the Faculty of the Nursing Department of

A journey is easier when travelled together. Interdependence is certainly more valuable

Chapter II – OBJECTIVES OF THE STUDY

Chapter III – PATIENT’S PROFILE

A. Tabular Presentation of Etiologic Factors

Chapter VII – NURSING MANAGEMENT

A. Initial/Final Mental Status Exam

Chapter VIII – PROGNOSIS

REFERENCES: Books/Internet Sources

Mental health is a level of psychological well-being, or an absence of mental illness. It is

occur and how it can be managed.

Specifically, this study aims:

the occurrence of bipolar I disorder.

2. To be able to apply various modalities and nursing management in assessing or

3. To be able to determine and apply appropriate therapeutic nursing communication skills

present mental condition.

4. To be able to formulate and present psychodynamic graphical trace of the various

client’s mental condition.

5. To be able to present the correlations of various biophysical, psychological, emotional,

patient who is diagnosed with bipolar I disorder.

8. To be able to formulate appropriate nursing diagnosis to address the identified mental

9. To be able to formulate and present appropriate nursing care plans of management to

address the identified mental health disturbance.

Date of Time of Reason of Admitting Final Diagnosis Date of

INFANCY and CHILDHOOD

RELIGIOUS and SOCIAL ADAPTATION

ONSET OF PRESENT ILLNESS

Predisposing Factors Actual Description Rationale

Precipitating Factors Actual Description Rationale

Decided to get married

Mother has regular prenatal check-up in barangay

Received immunization of tetanus toxoid

Diet of vegetables, fruits and fish throughout pregnancy

Mother experienced no sickness and complication

Chippy was delivered full-term last Oct. 18, 1993 via

Mother is a housewife and Father still works all-

Mother left at home to take A heavy drinker and

Introduced porridge at 9 months

Breastfed until 1 year and 6 months

He was breastfed every 2 hours

When mother is sometimes away, maternal

Mother has time cuddling and hugging the baby

Is usually away and left Comes home late at

Mother & Father did not

At 1 year and 3 months he was able to stand on his own

At 1 yr and 6 months he was able to walk with assistance and

He was able to urinate and defecate on his own at 2

ANAL STAGE NOT SATISFIED

SHAME & DOUBT

Mother is still mostly Father still worked as an all

She is permissive Continued with his

Would hit his wife and

Lets Chippy play outside

Mostly the leader of the group

Was able to initiate activities with playmates

He would be scolded by his father when he

PHALLIC STAGE NOT SATISFIED

Mother was always away to Father is still working but

Would always get into fight whenever drunk

Stabbed to death while drinking beer