INTRODUCTION

Schizophrenia comes from Greek words meaning, “Split mind.”It causes distorted and bizarre thoughts, perceptions, movements, emotions and behaviors. It cannot be defined as a single illness; rather schizophrenia is thought of as syndrome or disease process with many different varieties and symptoms. It is usually diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women.

Symptoms of Schizophrenia:

Positive or Hard Symptoms Negative or Soft SymptomsAmbivalence

Associate loosenessDelusions

EchopraxiaFlight of ideasHallucinations

Ideas of referencePerseveration

AlogiaAnhedonia

ApathyBlunted affect

CatatoniaFlat affect

Lack of volition

The types of Schizophrenia according to DSM-IV-TR;

Undifferentiated Type: demonstrates delusions, hallucinations, disorganized speech, disorganized behavior, and does not demonstrate behaviors usually observed in paranoid, disorganized or catatonic types.

Catatonic Type: features marked psychomotor disturbance that may involve motor immobility (waxy flexibility), excessive motor activity, extreme negativism, mutism, posturing, echolalia or echopraxia.

Disorganized Type: uses disorganized speech and behavior and exhibits flat or inappropriate behavior: does not exhibit catatonic behaviors (psychomotor or language mimic).

Paranoid Type: uses delusions of persecutory or grandiosity, or both, less often noted are delusional themes of jealousy, religiosity, or somatization.

Residual Type: criteria for schizophrenia and subtypes listed above are not met; there is continuing evidence of negative symptoms and two or more of these characteristic symptoms (delusions, hallucinations, disorganized speech, and gross disorganization).

Although there is no cure for schizophrenia, effective treatment exist that can improve the long term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms. Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotics medications are prescribed primarily for their efficacy in decreasing psychotic symptoms. They do not cure schizophrenia; they are used to manage the symptoms of the disease. The drugs reduce or eliminate psychotic symptoms such as hallucinations and delusions. The

medications can also help prevent these symptoms from returning. Common antipsychotic drugs include respiridone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridaxine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and trifluoperazine (Stelazine).

Because many patients with schizophrenia continue to experience difficulties despite taking medication, psychological and social rehabilitation is often necessary. A variety of methods can be effective.Behavioral training methods can also help them learn self-care skills such as personal hygiene, money management, and proper nutrition.In addition, cognitive-behavioral therapy, a type of psychotherapy, can help reduce persistent symptoms such as hallucinations, delusions, and social withdrawal.

a. Individual and group therapy: It is supportive in nature, giving the client an opportunity for social contact and meaning relationships. Groups that focus on topics of concern such as medication management, use of community supports and family concerns.

b. Family therapy: Family intervention programs can also benefit people with schizophrenia. These programs focus on helping family members understand the nature and treatment of schizophrenia, how to monitor the illness, and how to help the patient make progress toward personal goals and greater independence. They can also lower the stress experienced by everyone in the family and help prevent the patient relapsing or being re hospitalized.

c. Social skills training: Social skills training helps people with schizophrenia learn specific behaviors for functioning in society, such as making friends, purchasing items at a store, or initiating conversations.

According to the record of CVMC psychiatry department as of Jan. - Dec. of 2009 there were 95 male patients admitted in the psychiatric and among those patients there were 36 cases of schizophrenia and its prognosis is much higher as of today’s because as of now from Jan. - July of 2010 there were 71 patients admitted and among them there were 53 cases of schizophrenia. And its prognosis is increasing in number. In female ward as of Jan. – Dec. of 2009, there were 38 patients admitted and among those patients, there were 21 cases of schizophrenia. From Jan. – July of 2010, there were 43 patients admitted in female ward, and among those patients there were 26 cases of schizophrenia. There are 697,543 cases of schizophrenia in the Philippines, 75% are males and the rest are females. And 51 million people worldwide suffer from schizophrenia in which males have the most number of percent.

This statistics shows that males have the greater risk to develop psychiatric disorder such as schizophrenia because of their lifestyle and keeping their emotions.

We have chosen this case for the reason that we want to gain more knowledge about the disorder and also to enhance the knowledge we learned in Psychiatry Nursing in relation to it’s application in actual setting.

MENTAL STATUS EXAMINATION ANDPSYCHIATRIC NURSING ASSESSMENT

A. Appearance The patient dressed neatly and appropriately for his age but not with the

weather. He sees to it that he is clean, has taken a bath, changed his clothes and brushed his teeth before going out Nurse-Client interaction. He seems always alert and maintains eye contact whenever possible. He maintains a good posture and steady gait. He experienced shaking of legs as a side effect of haloperidol. Generally he is well-nourished. He appears to be his stated age.

B. Speech He talks in moderate and loud, his words are clear but sometimes stuttered.

He skips from 1 topic to another, when he answered the question “marunong kang magsulat kuya?” he answered “opo ma’am, kumakanta at sumasayaw pa ako ma’am ah.” He talks non-stop, his responses are not minimal by yes or no, and rather he elaborates answers to questions asked. Most of the time the content of his words is relevant. He doesn’t manifest neologism.

C. Level of Consciousness He is responsive and not confused. He was able to sustain attention but

sometimes distracted with other patients when they talk very loud. He answers questions accurately and can follow simple instructions such as to sit down and carry the chair.

D. Emotional Status Most of the time he is happy but sometimes he cries in silent because he

always remember her sister E. he verbalized that “sana andito siya, para kunin na niya ako dito.”

E. Cognitive Functioning He is oriented with person, place and time. He knows his full name, and his

sister’s name. He is aware of the present day, month and year. He knows his birthday. He was able to spell children, can count 1-100 and can name days of the week and months of the year correctly. And also do simple calculation.

F. Abstract Thinking When he was asked to interpret the common proverb “Kung mayroong

itinago, May madudukot” he provides a little explanation which is “Nu indulin mu ti kwarta, adda maalam.” He also explained “Aanhin pa ang damo kung patay na ang kabayo” with “Awanen a ma’am, natay met diay kabayo nga mangan kuma.”

During the working phase we also asked him to explain the massage of the song “ kanlungan”, he answered” Para sa akin po, ang ibig sabihin ng kantang yan ay, isang buhay lang ang meron tayo at dapat nating pahalagahan ito dahil kapag tayo’y namatay, mga ala-ala nalang ang maiiwan”.He can’t interpret the meaning thus concrete thinking is present.

G. Insight and Judgment

When we asked “Nu adda ti mapidut mu nga pera anya ti aramidam?” He answered “isublik a ma’am ngem nu singko haanen panggatung ku latta ti sigarilyo kun”. While in the ward, he still engages in smoking and even exchanges his things with cigarette. Hence, he has a poor judgment.

He manifests good insight since he accepts the responsibility for his actions. He verbalized “Napabarkada kasi ako noon ma’am, naninigarilyo ako at umii,om ako ng hard liquor un bang gin ma’am. He also verbalized “Behave na ako ma’am, kapag nakalabas na ako ma’am di na ako maninigarilyo at iinom ng alak.”

H. Memory Recent: when he said “nagluto ako ng nilagang saging noon ma’am, nung si

ma’am Alona pa ang student nurse ko eh”. Immediate: when he immediate knew his student nurse’s name, he stated

that “si ma’am Alona Foronda ang student nurse ko ma’am”. Remote: when he said “ naalala ko ma’am nung natanggal si Estrada bilang

Pangulo, naimpitch pa nga siya eh, ang pumalit si GMA pero nandaya naman siya dahil dun sa Hello Garsi!”

I. Physiologic and Self Care Considerations The patient stated that he eats 3 times a day with 2 snacks, takes a bath

everyday, changes his clothes daily and brushes his teeth thrice a day. He usually sleeps for 8 hours and takes a nap at daytime as a side effect of the drug. He takes his medicine at morning and night. The patient knows proper hygiene and complies with the medications.

OBJECTIVES

GENERAL OBJECTIVES:

At the end of the case presentation, we the presenters aim to share to our audience the knowledge that we have gained about schizophrenia, the skills required to manage the patient and the attitude that we must obtain to become an effective and efficient nurse to the patient that we may encounter in the future.

SPECIFIC OBJECTIVES:

Specifically, we aim to:

Define what is schizophrenia disorder Enumerate the different types and the signs and symptoms manifested in the

disorder. Determine the patient ‘s psychiatric health history Discuss the patient’s mental status Review the Anatomy and physiology of the disorder Trace the psychopathology of the disorder Interpret the laboratory result of the patient Formulate Nursing care Plan utilizing the nursing process Discuss the medication of the patient Interplay the nurse patient interaction

PSYCHIATRIC NURSING HISTORY

A. GENERAL INFORMATION

Patient’s initial: A.DG

Age: 39 years old

Gender: Male

Marital Status: Single

Address: Magapit, Lallo Cagayan

Birthday: October 16, 1969

Birthplace: Lallo, Cagayan

Religion: Roman Catholic

Dialect: Tagalong, Iloko, English

Educational Attainment: High School Graduate

Occupation: Vendor

Date of Admission: March 9, 2009

Chief complaints: He claimed that “sinira ko yung parlor ng ate ko, sa pagwawala ko,pinagpapatay ko ang manok namin, ‘di ako makatulog ng ilang araw”. And “lagi syang nagsasalita mag-isa” as been added by his sister w/c is his companion when he was admitted.

Final Diagnosis: Schizophrenia UT, In relapse

Attending physician: Dr. Jerry Sagabaen

Dr. Leonara Juliana

Source of information: Patient, Patient’s chart and Staff

B. PSYCHIATRIC HEALTH HISTORY

1. PSYCHIATRIC HISTORY

Patient ADG stated that he had experienced episodes of depression when their parents left them and he was still in elementary level. He stated that “ may balak akong magbigti, uminom ng acetone, maglaslas at magpasagasa sa dami ng iniisip kong problema. Pero hindi ko nagawa ang mga yun dahil sa ate ko, sobra kasi ang pag aalaga nya samin.” He also stated that “ may time na nagbabago ang ugali ko hindi ako nambubugbog pero pumapatay ako ng manok kung saan saan ko tinatapon, minsan sinusunog ko na lang, minsan tumawa ako mag isa, nagsasalita ako mag isa”.

A week before patient ADG was admitted he claims that “sinira ko yung parlor ng ate ko sa pag wa wala ko, pinagpapatay ko ang manok namin, at ‘di ako makatulog ng ilang araw”.and his sister added “ lagi syang nagsasalita mag isa”, in w/c his companion when he was admitted.

MEDICAL HISTORY

According to patient ADG when was still a child he experienced colds, cough and fever. He stated that “ kwento ng ate ko, naglalagay ang nanay ko ng dahon ng oregano sa noo ko noon, pati yung dahon ng saging sa may tiyan ko pag may lagnat ako eh. Pero pag malalana ang sakit ko gamot nlang ang binibigay nila sa akin gaya ng Biogesic”. He added that he had not incurred any type of surgery. He only sustained superficial wound on the temporal area of his face and his left and right eyebrow after he made his co- patients (R.P., S. V., M. F., and R. F.) get mad because of his being talkative.

2. PERSONAL AND SOCIOECOMIC HISTORY

According to patient ADG, he only finished secondary level with the age of 20. He stated that “ mabarkada kasi ako noon. Naninigarilyo ako( Malboro and Philip 3sticks/day) at umiinom ako ng alak (Gin) pag may occasion lalo na pag birthday ng barkada ko”. He also said that he had been in live-in relationship with Ms. P for 5 yrs. and Ms. L for 3 yrs. He stated that “ ayaw na ayaw kong magpakasal, mas gusto kong ibahay nalang ang babae.”

According to him, he had been a vendor of ‘mani’ and juices like buko juice for 4 yrs infort of the schools. This is to help his sister E to earn money. He stated that “ pagmay sobra sa binebenta ko yung hindi nabili binibigay ko lahat sa mga pamangkin ko at mga apo”.

According to him, they were left by his parents when he was in elementary level. He stated that “ mas malapit ako sa ate ko kasi siya na ang nag alaga samin, kaya ayaw na ayaw ko siyang saktan, kung pwede lang gagawin ko ang lahat para sa kanya”.

3. HISTORY OF PRESENT ILLNESS

According to patient ADG one week before he was admitted, he stated that “ nasira ko ang parlor ng ate ko sa pagwawala ko, hindi rin ako makatulog siguro mga limang araw na,pinag papatay ko din ang mga manok, tinatapon ko pa nga ang mga yun ,minsan sinusunog ko na lang at nagsasalita ako mag isa kung anu ano pinagsasabi ko”. He added that “mas lagi ko itong ginagawa simula noong binagbintangan akong nirape ko ang anak ng ka live-in ko noon, hindi nila alam na wala akong ginawa dahil tinuring ko din naman tunay na anak yun”.

According to him, maybe because of these things and concern his sister E accompanied him to be admitted in CVMV Psychiatric ward. In there, he was admitted last March 9, 2009 with a diagnosis of Schizophrenia, UT In relapse.

4. DEVELOPMENTAL HISTORY According to patient ADG, his sister told him that when he was an infant he was

been breastfed, he also stated that “ kung anu ano daw ang sinusubo ko noon.” He learned how to walk before he reaches his first year of life. He also added that “marunong na daw akong mag hawak ng kutsara at tinidor kaso nagkakalat naman ang mga pagkain ko kaya yun lagi akong pinapagalitan daw ni nanay, yun ang sabi ni ate E____.

When he was 3 yr. Old, he was trained to urinate with the use of “arenola”. But when he defecate, he just defecate anywhere at their backyard at daytime and use “arenola” during night time, he said that “ang sabi ni ate noong nagkekwento siya, ginigising ko ang nanay pagnatatae ako ng gabi noon, umiiyak pa daw ako ng malakas pag ‘di nila ako pinapansin”.

When he was 5 yr. old, he said that “ tinutiruan akong magbilang noon gamit ang tingting at mais,nagdodrawing ako ng linya noon, mga bahay tapos kinukulayan ko, kahit ABC tinuturo sa akin.” He also added that “namimili daw ako ng kalaro ko noon, mas gusto ko daw na kalaro ang mga lalake noon,yun ang sabi nila, bihira pa nga daw akong magshort noon kaya yun nilalaro ang ari ko noon.”

During his elementary life, he said that “sumasali nak ti sala ken kinnantaan nu adda ti program ti iskwela mi”. He also added that “ nagkaroon ako ng puppy love, mas matanda sa akin. Naalala ko pa nga noon inaabangan ko siya lagi, nagbibigay ako ng sulat”.

During his High school life, he stated that “ nagkaroon na ako ng Girlfriend pero nagbreak din kami kasi palaaway ako noon. Dito ako natutong manigarilyo, uminom ng alak at bumarkada. Nagtagal ako sa high school pero dahil sa ate ko tinuloy kong mag aral at mabuti na lang nakatapos parin ako”. According to him, he was circumsized during his high school life. He also added that when he was in high school, he had his first sex at the age of 18. He has never had homosexual experiences.

At the age of 26, he stated that “ nagkaroon ako ng ka live-in noon si P_____ at si L___ may mga dati na silang asawa. Si P_____ mahigit limang taon na kami pero mas gusto nyang maglagi at magtrabaho sa manila kaya yun iniwan niya ako. Tapos si L__ mahigit tatlong ataon kami noon, may dalawa siyang anak tinuring ko na din mga anak yun kahit hindi galing skin, nagkahiwalay lang kami noong pinagbintanagan akong rereypin ko ang ank niya na saktong nadatnan niyang naghuhubad sa harap ko”. He also added that “ nagtitinda ako ng mani at mga juice sa harap ng skul noon, yung hindi ko nabenta pinamimigay ko sa mga pamangkin at apo ko”.

According to the client, he never has any weight problems or any inferiority problems.

ANATOMY AND PHYSIOLOGY

LABORATORY AND OTHER DISGNOSTIC EXAMS

RADIOLOGIC EXAMINATION

04-11-09

Interpretation:

Chest (PA)

Both lungs fields are clear and with normal vascular pattern. Heart and great vessels are normal in size and configuration. Other chest structures are unremarkable.

Impression:

No radiographic abnormality within the chest.

LABORATORY RESULT

RESULT

TEST RESULT NORMAL RESULT INTERPRETATION

Glucose 4.6 mmol/L 4.1-5.9 NORMAL

Cholesterol 5.2 1-5.2 NORMAL

Triglyceride 1.8 0-1.69 NORMAL

Direct HDLC 1.1 0-1.6 NORMAL

LDL 3.36 0-3.35 NORMAL

HDL .82 0-.91 NORMAL

UNIVERSITY OF CAGAYAN VALLEY

COLLEGE OF HEALTH

TUGUEGARAO CITY

Grand case Presentation

On

Schizophrenia, UT In relapseIn partial fulfillment of the requirements in NCM 104

Related Learning Experience

Presented by:Cloyd P. Sagundo

Bong-bong A. TaguinodJelanie T. Calimag

Karelle Kilgerinn Q. DiscipuloAlona Jane T. Foronda

Angelica M. MoralesAngelie M. De Polonia

Jenevie C. SabbanGroup D; Cluster A

Presented to:Mr. Lourish B. Conag RN, MSN

Clinical CoordinatorCollege of Health

Nurse-Patient Interaction

Nurse’s Verbalization Patient’s ResponseInsights/Observations

Therapeutic Communication

Techniques And Rationale

ORIENTATION PHASE

Magandang hapon po Kuya Bubut, mukhang Masaya po kayo ah? (Smiles)

Halina po kayo, upo po tayo doon. (leading to a place where NPI could take place)

Kuya ako nga po pala si Alona Jane Foronda, estudyante po ng UCV, taga Isabela po, at ako po ay makakasama nyo ngayon Lunes hanggang Miyerkules at hanggang sa susunod na linggo po mula Lunes po ulit hanggang Miyerkules po ng ganitong oras po alas dos ng hapon hanggang ala sais. (Smiles)

Ano pong gusto nyong itawag ko sa inyo? (Smile)

Narito po ako para po kahit sa simpleng paraan na aking magagawa ay mapasaya ko po kayo at matulungan. (Smile)

Ano pong nararamdaman nyo kapag nakikita nyo po

Magandang hapon din po Ma’am! Syempre naman ma’am, ngayon lang po ulit ako nailabas eh. (Smiles back)

Sige po ma’am.(Followed the instruction).

Opo Ma’am Alona.(Smiles back)

Bubut na lang po Ma’am, un naman po tawag nila sakin dito. (Smile back)

Salamat po Ma’am. (Smile back)

Masaya po kasi nakakalabas kami kahit

Greeting the client by name or noting efforts the client has made all show that the SN recognizes the client as a person/individual.

Suggesting Collaboration. The SN seeks to offer a relationship which the client can identify problems and this improves ability to form satisfactory relationship.

Giving information. Informing the client of facts increases his knowledge about a topic or lets the client know what to expect. Establishing specific of the relationship time, date, place and duration of meeting.

Seeking information. Asking the client what she wants to be called is one way of letting the client feel that the SN is interested in him.

Offering one’s self could lessen up the anxiety level of the client. With our knowledge that the client we are handling have certain points in their lives wherein there ego was weak and their self esteem were low. With this, we should offer ourselves and devote some of our time to them for them to feel that somebody supports them and that people are ready to guide them when they need guidance.

kami? ( smile)

Nalulungkot po ba kayo sa loob kaya nasabi nyo po na masaya kayo pag nailalabas namin kayo?

Panu po ninyo nasasabi na nalulungkot kayo sa loob?

Gusto nyo na po bang makauwi sa inyo?

Maaari pa po ba kayong magkwento pa tungkol sa pamilya niyo?

(Nodding while listening)

Paano nyo po nasabing pati mga kapatid nyo ay nawalan ng tiwala sa inyo?.

papaano, may natututunan po kami sa inyo, at higit sa lahat masaya kasi kahit ganito kami ay andiyan kayo para damayan kami. (Smile)

Opo Ma’am.

Limitado lang po kasi ang galaw namin, at tsaka man hindi ako nakaklanghap ng sariwang hangin dun kaya Masaya ako pag nilalabas ninyo ako.(smile)

Gustung –gusto ko na po Ma’am kasi gusto ko na talagang makita at makasama mga kapatid ko.

Opo ma’am, bale po yung nanay at tatay ko di ko na alam kung buhay pa sila. Mga kapatid ko lang po kasi dumadalaw sakin dito, wala naman po kasi akong asawa at anak. May kinakasama po ako noon at mahal na mahal ko yun pati mga anak nya sa unang asawa nya pero siya pa itong sumira sakin, pinalabas nyang gusto kong gahasain ung anak nya at hanggang pati mga kapatid ko nawalan ng tiwala sakin at inisip nilang nasisiraan na ako ng bait.

Kasi po sila pa itong nakiusap sakin na kailangan ko raw pong pumasok dito para magpagaling.

Encouraging description of perceptions helps the SN to understand the client. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and she might be less likely to take action on ideas that are harmful or frightening.

Reflecting and consensual validation. Restating lets the client know that she communicated the idea effectively or if the client has been understood, he can clarify his thoughts

Seeking clarification.

Verbalization of client’s

feelings is always

important thing to consider

for the patient to recognize

his personal feelings.

Exploring helps in examining the real issue and gathering more information. Any concern of the patient can be better understood if exploring in depth.

Nodding while the client is talking would let the client feel that the SN is listening attentively and agreeing what she says.

Seeking clarification. Encouraging description of perceptions helps the SN to understand the client. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and she

Ah ganun po ba?

Ano po yung mga hilig nyong Gawain? (Smile)

Wow eh di magaling po kayong kumanta at sumyaw kuya? (Smile)

Bale po next week maalalro tayo ng binggo.marunong po ba kayong maglaro ng ganun? At sa susunod po na miyerkules magkakaroon po tayo ng socialization.(smile)

So dapat po bago naming kayo kukunin sa susunod na lunes po dapat nakaligo na kayo, nakatoothbrush, nakapalit ng damit at nakainom na po kayo ng gamot nyo. Malinaw po ba yun? (Smile)

Sige po kuya Bubut, ihahatid ko napo kayo sa loob. Magpahinga po kayo ng mabuti po para po masigla pa rin kayo sa bukas, ok po bay un? Maraming salamat po kuya Bubut. (Smile)

Opo Ma’am.

Mahilig po akong kumanta at sumayaw. (Smiles back)

Medyo lang po ma’am. (Smiles back)

Opo Ma’am. Sige po,masaya po yun. (Smiles back)

Opo Ma’am. (Smiles back)

Sige po Ma’am asahan ko po ulit kayo mam ha. Salamat din (Smiles back)

might be less likely to take action on ideas that are harmful or frightening.

Giving the client time to organize things direct the topic of interaction or focus on issues that are more important.

Seeking clarification. We must consider what the patient wants for us not to let him indulge into activities wherein he would be discouraged if he would not succeed in a certain activities where he was involved.

Giving information. Giving the patient the necessary information would let the patient to ask particular questions if there are any for him to lessen anxiety and to particularly feel him the information on what to expect.

Building contracts to the client such as good grooming could help both SN and the client on the next meeting activities for more cooperation, good dealing and effective communication.

Consistent approach and appraisal should be expressed by SN for the client to feel that he is worthy and that he makes someone life happy being with him. Extending thanks is a sign of recognition.

WORKING PHASE

Magandang hapon po kuya Bubut, kumusta na po? (Smile)

Halina po kayo, upo po tayo dun. (Leading to a place where NPI could take place)

Nakakapagpahinga naman po ba kayo kuya ng maigi?

Ano naman po napanaginipan nyo?

Ganun po ba? (Silence)

Activity: singing the song “kanlungan”

Kuya sa sarili nyo pong pananaw, ano po ibig ipahiwatig na kantang yan?

Wow ang galing po ah. (Smile)

Activity: playing touching ball…

Ang galing nyong maglaro kuya ah, napagod po ba kayo? (Smile)

Sa lunes po ulit bago naming kayo kukunin sa susunod na lunes po dapat nakaligo na kayo, nakatoothbrush, nakapalit ng damit at nakainom na po kayo ng gamot nyo. Malinaw po ba yun? (Smile)

Magandang hapon din po Ma’am ok lang naman po ako. (Smiles back)

(Just followed the instruction given)

Opo Ma’am. Mahimbing nga po ang tulog ko. Nanaginip nga po ako eh.

Nakauwi na raw po ako at kasama ko na raw po mga kapatid ko.

Opo. (Silence)

Para sa akin po, ang ibig sabihin ng kantang yan ay, isang buhay lang ang meron tayo at dapat nating pahalagahan ito dahil kapag tayo’y namatay, mga ala-ala nlang maiiwan.

Just smiles back.

Hindi naman po ma’am. (Smiles back)

Opo Ma’am. (Smiles back)

Greeting the client indicates that she is being recognized by the SN as a person.

Suggesting collaboration. The SN seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally and improve ability to form satisfactory relationships.

Showing concern by asking the clients condition would let the client feel that he is being cared about.

Exploring helps in examining the real issue and gathering more information. Any concern of the patient can be better understood if exploring in depth.

Silence gives the client time to organize thing direct the topic of interaction or focus on issues that are more important.

Encouraging description of perceptions helps the SN to understand the client. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and he might be less likely to take action on ideas that are harmful or frightening.

Giving recognition gives self-confidence to the client.

Giving recognition gives self-confidence to the client.

Building contracts to the client such as good grooming could help both SN and the client on the next meeting activities for more cooperation, good dealing and

Sige po kuya Bubut, ihahatid ko napo kayo sa loob. Sa lunes po ulit? Maraming salamat po kuya Bubut, sa oras. (Smile)

Second week activity: playing binggo

Diba po kuya Bubut napag usapan natin nung isang lingo na ngayon tayo maglalaro ng bingo.

Bale po ang larong ito ay may nakalaan na premyo kung sino man ang mananalo.

After the game:

Marami kayong nakuhang premyo kuya ah?

Bale po magkakaroon po tayo ng socialization sa miyerkules, ano pong nararamdaman nyo pay may mga ganitong activities?

Mahilig po ba kayong makisali sa mga palaro tuwing may socialization?

Wow galing po mabuti naman po kung ganun.

So dapat po paghandaan natin para sa ganun manalo po tayo ulit sa mga palaro.

So kuya Bubut napag-usapan na nga po natin na magkakaroon nga tayo ng socialization at marami po tayong activities na gagawin, aasahan ko po na talagang

Sige po Ma’am asahan ko po ulit kayo mam ha. Salamat din (Smiles back)

Opo Ma’am.

Opo mam, masaya po kung ganun.( smiling)

Hindi naman gaano marami ma’am.(smiling)

Opo.Masaya, excited na nga po ako eh, bukas na lang po sabado na. Kakanta po ako tapos sasayaw. (laugh)

Opo ma’am, palagi nga po akong nanalo eh.

Opo. (laugh)

Opo ma’am.

Opo, siyempre ma’am (Smile)

effective communication.

Consistent approach and appraisal should be expressed by SN for the client to feel that he is worthy and that he makes someone life happy being with her.

Recapitulation would refresh the client’s mind about the recent conversations that has transpired the last meeting.

Giving the patient the necessary information would let the patient to ask particular questions if there are any for her to lessen anxiety and to particularly feed him the information on what to expect.

Giving recognition gives self-confidence to the client.

Encouraging description of perceptions helps the SN to understand the client. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and she might be less likely to take action on ideas that are harmful or frightening.

Seeking information regarding one’s strengths would let the patient recognize the good part in him.

Giving recognition gives self-confidence to the patient.

Suggesting collaboration. The SN seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally and improve ability to form satisfactory relationships.

At the end of every NPI, we

makikilahok ka ha. Sige po kuya Bubut hanggang

bukas po ulit. (Smile)

must some up what has transpired for the patient to recognize that what has been talked about were all relevant.

TERMINATION PHASE

Hello po kumusta na po kayo? (Smile)

Wow, ang ganda po ng damit mo ah, talagang pinaghandaan nyo po ang socialization natin ah.

Hali na po kayo ate, doon po tayo. (Leading to the socialization area.

Kuya galingan nyo po mamaya sa mga palaro natin ah, tutulungan ko po kayo. (Smile)

Ano pong ipapakita ninyong talent po para sa program natin.

Gusto nyo po bang dalawa tayong sasayaw at kakanta.

Ok lang po Ma’am. (Smile back)

Siyempre naman po ma’am.

Just followed instruction given.

Opo ma’am.

Kakanta po ako tapos sasayaw ma’am.

Opo ma’am para po mas masaya. (laugh)

Greeting the client indicates that she is being recognized by the SN as a person.

Noting the efforts the client has made all show that the SN recognizes the client as a person/individual thus the client gives a feeling of self-confidence.

Suggesting collaboration. The SN seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally and improve ability to form satisfactory relationships.

Offering one’s self could lessen up the anxiety level of the client. With our knowledge that the client we are handling have certain points in their lives wherein there ego was weak and their self-esteem were low. With this, we should offer our selves and devote some of our time to them for them to feel that people are ready to guide them when they need guidance.

Seeking information regarding one’s strength would let the patient recognize the good part in him.

Suggesting collaboration. The SN seeks to offer a relationship in which the

***During the socialization, I continually observed my patient actively participating with the games that our group has prepared.

Kuya Bubut ito na po ang huling araw na makasama mo ako bilang ma’am mo, ano pong nararamdaman nyo?

Pagkatapos po namin ay may ibang grupo na naman po kayong makakasama kaya magiging masaya po ulit kayo, diba po? (Smile)

So sana po kuya may natutunan po kayo sa amin kahit papaano po maraming salamat din po na naging parte po kayo ng buhay ko. At marami po akong natutunan po mula sa inyo. Maraming salamat po kuya Bubut. (Smile)

Masaya po kasi marami na akong premyo, pero malungkot din kasi aalis na kayo.

Mabuti naman po kung ganun ma’am. Para makalabas po ulit kami. (Smiles back)

Maraming salamat din po ma’am. (Smile back)

client can identify problems in living with others, grow emotionally and improve ability to form satisfactory relationships.

We should also consider nonverbal cues the patient shows for this would help us determine the congruency of data that the patient gives us. Observing also the reactions of the patient to a certain stimuli would let us determine if he responds appropriately or not.

Encouraging expression. The SN asks the client to consider people and events in light of his own values. Doing so encourages the client to make his own appraisal rather accepting the opinion of others.

Giving the patient the necessary information would let the patient to ask particular questions if there are any for him to lessen anxiety and to particularly feed him the information on what to expect.

Consistent approach and appraisal of positive results should be expressed for the client to feel worthy and to gain cooperation in the succeeding interactions.