PATIENT PROFILE

Name: Patient “Lala” Age: 30 years old

Date of Birth: July 5, 1999 Sex: Female
Nationality: Filipino
Address: Pampanga
Date of Admission: February 16, 2021 Attending Psychiatrist: Dr. Myra Dee Lopez-Roces Chief Complaint: “relapse” gala ng gala, san san
nakakarating

HEALTH HISTORY

FORMER HISTORY
Patient Lala's clinical trajectory within the institution commenced on February 16, 2021, prompted by her admission with a presenting complaint
of relapse, characterized by erratic behavior and aimless wandering (gala ng gala, kung san san nakakarating). Diagnosed with schizophrenia,
Patient Lala exhibited a protracted history of instability spanning several years. Upon admission, she manifested symptoms of agitation,
disorganized ideation, and behavior consistent with responses to internal stimuli and paranoid ideation.

A comprehensive diagnostic evaluation confirmed the presence of symptoms aligning with schizophrenia, meeting the requisite criteria in terms of
symptoms and duration. Schizophrenia, a multifaceted neurobiological disorder typified by hallucinations, delusions, disorganized speech, and
negative symptoms, was formally delineated as F20 schizophrenia, paranoid type, thus delineating Patient Lala as an individual living with
psychosocial disability.

During her tenure within the facility, Patient Lala displayed a spectrum of behaviors indicative of her clinical presentation. Frequently observed in
a state of repose (“nakaupo at nakatingin lang sa kasama”), she demonstrated idiosyncrasies (unusual activities) such as bathing without requisite
toiletries and lingering in proximity to doorways (“nakamasid lang sa pinto”), ostensibly observing her environment. Despite these tendencies,
she is in consistent adherence to established meal schedules, maintaining a good appetite and adhering to postprandial protocols.

Intermittently, Patient Lala engaged in activities such as movement of her lower extremities while laying down on bed with eyes closed, and
maintaining a vigilant observance of her surroundings. Granted privileges, inclusive of telecommunication access on May 6, 2021, and supervised
out-on-pass on November 9, 2022, and April 18, 2023, she did so without untoward incident.
However, on September 27, 2023, a perceptible deviation in Patient Lala's demeanor was observed. She presented with restlessness, tangential
speech patterns, and instances of somnolence during clinical rounds. Despite these emergent developments, she remained compliant with her
prescribed pharmacotherapy regimen, warranting the implementation of targeted interventions to manage emerging challenges.

PRESENT HISTORY
1 month prior to admission, after death of her mother, patient Lala’s relative noted changes in behavior, talking to self, walking on the street most
of the time. Relative decided to admit the patient to prevent worsening of signs and symptoms. Patient Lala is advised to take long term care
maintenance medications to control her symptoms and long-term care in the facility. In the present, Patient Lala has been stable and compliant
with her medications, she was also reported to have good appetite, and she communicates with nurses on duty and her roommates.
 PSYCHOPATHOPHYSIOLOGY

Genetics vulnerability neurobiology Environmental triggers

-e.g. Mother’s death (grief, sadness,
depression)

Dopamine hyperactivity
Legend:
Seen in Patient Lala
Frontal and temporal lobe deficits

Positive symptoms: Negative symptoms

- Hallucinations - Avolition
- Delusions - Alogia
- Thought process disorders - Anhedonia
- Affective flattening

Cognitive Symptoms
- Impaired attention
- Impaired memory
- Poor functioning

SCHIZOPHRENIA
Clinical Observations
- Agitation
- Disorganized ideation
- Tangential speech
- somnolence
 LABORATORIES

Drug Test (Methamphetamine + (-) Rapid & PCR Test (-)

Cannabinoid)

Pregnancy Test (-) ECG normal

Flag Value Unit Reference Range

WBC 4.73 uL 3.98-10.4

RBC 4.60 uL 3.93-5.22

Hgb 13.8 g/dL 11.2-15.7

Hct 43.0 % 34.1 - 44.9

MCV 93.5 L 79.4 - 94.8

MCH 30.0 pg 26-32

MCHC L 32.1 g/dL 32.2 - 35.5

RDW-CV 14.1 % 11.7 - 14.4

Platelet 208 uL 150-450

Neutrophils 47 % 34-67

Lymphocytes 34 % 19-52

Monocytes 06 % 5-13

Eosinophils H 12 % 0-6

Basophils 01 % 0-1
 DRUG STUDY

Drug Indication Nursing Consideration Literature

Clozapine Clozapine is indicated for the - Prior to initiating Saunders Nursing Drug
treatment of schizophrenia in clozapine therapy, it is Handbook (2021). Philadelphia,
● Brand Name: Clozaril patients who have not responded essential to perform a PA: Elsevier.
● Generic Name: Clozapine adequately to standard comprehensive baseline
● Classification: Atypical antipsychotic treatments. It is also assessment including a
antipsychotic used to reduce the risk of thorough medical history,
● Dosage: 100 mg ½ tab recurrent suicidal behavior in physical examination, and
● Frequency: BID patients with schizophrenia or assessment of baseline
schizoaffective disorder who are
psychiatric symptoms.
judged to be at chronic risk for re-
- Close monitoring of
experiencing suicidal behavior.
patients receiving
clozapine is essential due
to the risk of serious
adverse effects such as
agranulocytosis,
myocarditis, and seizures.
- Educate patients about
the signs and symptoms
of agranulocytosis (e.g.,
fever, sore throat,
malaise) and instruct
them to seek immediate
medical attention if these
symptoms occur.
- Clozapine lowers the
seizure threshold, so
precautions should be
taken to minimize the risk
of seizures. Advise
patients to avoid activities
 that may increase the risk
of seizures, such as
excessive alcohol
consumption and
exposure to bright
flashing lights.
- Clozapine is associated
with metabolic side
effects such as weight
gain, dyslipidemia, and
diabetes mellitus.
Monitor patients for
changes in weight, lipid
levels, and glucose levels
regularly.
- Caution should be
exercised when
prescribing clozapine
with other medications
that can prolong the QT
interval or lower the
seizure threshold.
 Drug Indication Nursing Consideration Literature
Aripiprazole Abilify (Aripiprazole) is indicated - Assess the patient's Saunders Nursing Drug
for the treatment of psychiatric condition, Handbook (2021). Philadelphia,
● Brand Name: Abilify schizophrenia, bipolar disorder including mood, PA: Elsevier.
● Generic Name: aripiprazole (manic and mixed episodes), behavior, and thoughts,
● Classification: atypical major depressive disorder (as an prior to initiating therapy
antipsychotic adjunctive treatment), irritability with Abilify.
● Dosage: 10 mg associated with autistic disorder, - Monitor vital signs,
● Frequency: OD ½ tab and Tourette's disorder. particularly blood
pressure and heart rate,
before and during
treatment, as Abilify may
cause orthostatic
hypotension and
tachycardia.
- Administer Abilify orally
once daily as prescribed,
preferably with or
without food.
- Instruct the patient not to
chew, crush, or break the
tablet, as this may alter
the drug's controlled-
release properties.
- Monitor the patient for
the emergence of adverse
reactions such as
extrapyramidal symptoms
(e.g., tremor, rigidity,
akathisia), weight gain,
hyperglycemia, and
dyslipidemia.
 NURSING CARE PLAN

ACTUAL

Assessment Diagnosis Outcome Identification Intervention Evaluation

Impaired Verbal Independent:

Short Term:
Communication related to - Establish therapeutic
- After nursing
disorganized thought Short Term: rapport with Patient interventions, Patient
Subjective: processes and After nursing Lala to facilitate trust demonstrated
- Patient Lala presents hallucinations secondary interventions, Patient will and open improved
with a history of to schizophrenia as
demonstrate improved communication communication skills
erratic behavior and evidenced by tangential
communication skills - Promote adequate within one week,
aimless wandering, speech patterns and
within one week, as physical exercises engaging in coherent
indicating a relapse of responses to internal
evidenced by coherent during the day. verbal interactions
schizophrenia. stimuli.
verbal interactions with - Provide a structured during therapy
- She exhibits sessions.
symptoms of healthcare providers.. environment with
agitation, disorganized consistent routines to
reduce anxiety and Long Term:
ideation, and Long Term:
disorganization. - After nursing
responses to internal After nursing
interventions, Patient
stimuli. interventions, Patient will Dependent
actively participated
- Patient Lala's behavior participate in group - Facilitate participation
in group therapy
includes idiosyncratic therapy sessions aimed at in group therapy
sessions for three
activities such as enhancing communication sessions focused on
months,
bathing without skills and coping communication skills
demonstrating
toiletries and lingering strategies for and coping strategies.
improved
near doorways. schizophrenia for three - Administer
communication and
months. medications as
coping strategies.
prescribed

Objective: Collaborative:
- Patient Lala was - Coordinate with social
diagnosed with services to explore
schizophrenia, paranoid community resources
type, characterized by and support networks
hallucinations, for Patient Lala's
delusions, and continued care post-
disorganized speech. discharge.
- She adheres to - Involve family
established meal members or caregivers
schedules, maintains a in therapy sessions to
good appetite, and enhance understanding
follows postprandial and support for Patient
protocols. Lala's condition.
- Patient Lala has a
history of supervised
out-on-pass privileges
without incident.
- Recent observations
show restlessness,
tangential speech
patterns, and
somnolence during
clinical rounds.

POTENTIAL
 Assessment Diagnosis Outcome Identification Intervention Evaluation

Objective: Risk for Injury related to Short Term: Independent: Short Term:
- Patient Lala has to altered mental status After nursing - Assess Patient Lala's After nursing
exhibited idiosyncratic and disorientation interventions, Patient will environment for interventions, patient
behaviors such as secondary to remain free from physical potential hazards and remained free from
bathing without schizophrenia. injury during her stay implement safety physical injury during her
toiletries and lingering within the healthcare measures such as stay within the healthcare
near doorways. facility. removing sharp facility, with no reported
- She occasionally objects, securing incidents of falls or self-
engages in movement Long Term: furniture, and ensuring harm.
of her lower After nursing adequate lighting. Long Term:
extremities while lying interventions, Patient will - Encourage Patient Lala After nursing
down and maintains actively participate in to communicate any interventions, Patient
vigilance of her ongoing safety feelings of consistently engaged in
surroundings. assessments and disorientation or safety assessments and
- Recent observations interventions within the discomfort promptly to interventions within the
show restlessness, healthcare facility to healthcare providers. healthcare facility,
tangential speech minimize the risk of injury Dependent: demonstrating proactive
patterns, and throughout her continued - Administer participation in
somnolence during stay. medications as minimizing the risk of
clinical rounds. prescribed by the injury throughout her
Subjective: doctor. continued stay.
- Patient Lala has a
history of Collaborative:
schizophrenia with - Collaborate with the
periods of relapse and interdisciplinary team
stability. to monitor Patient
- She presents with Lala's mental status and
recent symptoms of adjust
restlessness, tangential pharmacotherapy as
speech patterns, and needed to minimize
somnolence. symptoms and reduce
- Patient Lala remains the risk of injury.
compliant with her
 prescribed
pharmacotherapy
regimen despite recent
changes in demeanor.

References:

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. FA Davis.
he