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1. De Ocampo Memorial College
College of Nursing
NATIONAL CENTER FOR MENTAL HEALTH
In partial fulfillment for the requirements on psychiatric nursing
Undifferentiated Schizophrenia
Joeyneil Kenneth M. Licardo
BSN IV – 1
Group 2
Ms. Laarne Dumag
-Clinical Instructor-

2. Introduction
Mental Health and Mental Illness are states of human existence having precise
definitions. Mental Health is astate of emotional, psychological and social wellness evidenced by
interpersonal relationships, effective behavior coping, positive self-concept and emotional stability.
While mental illness is a clinically significant behavioral or psychological syndrome or
patterns that occurs in an individual and that is associated with present distress, associated
with present distress, increased risk of suffering, death, disability and loss of freedom such
disorders are defined by a combination of affective, behavioral, cognitive or perceptual
components, which may be associated with particular functions or regions of the brain
or nervous system, often in a social context. The recognition and understanding of
mental health conditions have changed over time and across cultures, and there are still
variations in definition, assessment and classification, although standard guideline
criteria are widely used. Over a third of people in most countries report problems at
some time in their life which meet criteria for diagnosis of one or more of the common
types of mental disorder.
In our exposure in National Center for Mental Heath in the Philippines (NCMH),
being a student nurse for mental health was great lifetime experience, it fulfills our
career as a health provider; benefit us and our resident to give best nursing care.
Handling a mentally challenged person was difficult task to do, but with our
determination to cope with this situation, we have support system including our
knowledge, skills and our clinical instructor, to provide us to face the behavior and
stressful events inside the institution. One of the leading mentally disorder is
Undifferentiated Schizophrenia. Residents in this condition have the characteristic of
positive and negative symptoms of schizophrenia but do not meet the specific criteria
for the paranoid, disorganized, or catatonic subtypes.

3. Objectives:
Main Goal
 To be able to utilize appropriate psychiatric management in order to lessen
the sign and symptoms, and to decrease in the secondary illnesses in the
existing condition.
Specific Objectives
 To be able to establish therapeutic nurse-patient interaction to collect data
and history about the resident, and will contribute to the nurse and to the
resident.
 To be able to apply the nursing process to the fullest extent of their
capabilities.
 To establish problem-solving approach to develop nursing care plan.
 To be able to apply the support system, including individuals, families and
community groups are assisted to achieve satisfying and productive patterns
of living through health teaching.
 To be able to participate in environmental structure to establish and maintain
a therapeutic milieu.
1. Resident Identification
a. Age: 47 yrs old
b. Ethnicity: Pilipino
c. Gender: Female

4. 2. Medical History
a. Chief Complaint: “Nahilo ako dahil sa gutom nuong naglalakad ako sa
harap ng hotel tapos ay umupo ako saglit tapos nakita ako ng tanod na
inaatake ako ng epilepsy” as verbalized by the resident. October 31, 1997,
the resident stated false statement, she was brought by Lita Merino of
Bulacan, a barangay health worker due to disturb behavior.
b. History of present illness: the resident was brought by a barangay health
worker named Lita Merino of Bulacan, due to disturbed behavior. She
stated that she was hungry and tired, and then she suffered epilepsy. One
day prior to confinement, she hacked her daughter on the neck that
motivates the barangay health worker to report the resident in the police
station, and referred to the national center for mental health due to
disturbed mental condition.
c. Past Medical/Psychiatric History: the resident stated that when she was 8
yrs old she already suffers epilepsy but did not consult and take
medications. But she remembered that her father gave her sambong after
the epilepsy occurred. When she drink sambong juice, her headache was
reduced the effect.
d. Family Medical History: Denies any family history of the disease.

5. e. Physical Assessment
General Survey
 Resident is active, coherent, ready to participate and approachable.
General Appearance
 Resident is not in distress
 Relax
 Coordinated
 Attentive
Vital Signs
Temperature: 36.2 Respiratory rate: 21bpm
Pulse Rate: 80bpm Blood Pressure: 110/70
Body Parts Inspection Actual Findings Normal Findings Analysis
Skin:
 General
Color
 Texture
 Moisture
Head:
 Size,
Shape and
Symmetry
Hair:
 Distribution
 Color
 Texture
Inspection
and
Palpation
oLight to dark
brown skin color,
and feels warm,
(+) lesions,
rashes and scars
oRough and Soft
oSkin is dry and
has flakes
oface is
symmetrical,
centered-head
position
oEqual distribution
of hair
oBlack color
oSmooth
oBrown and
uniform skin color
with no lesions.
oSmooth and Soft
oNo signs of
dryness and
flaking.
oface is
symmetrical,
centered-head
position
oEqual distribution
of hair
oBlack color
oSmooth

6. Eyes:
 Pupil
 Eye lids
 Sclera
 Iris
Ears:
 Outer Ears
 Inner Ears
Nose:
 Color
 Appearance
 Internal
Nose
Mouth:
 Lips
 Buccal
Mucosa
Inspection
Inspection
Inspection
Inspection
opupil is equally
round
and reactivated
to
light
accommodation
opinkish dark color
osemi dark color
osmooth and
moist
osymmetrically
appearance and
equally in size
ono discharge,
clear ear canal,
no obstructed
object
o same color of
the face
osymmetrically
appearance
ono redness in
nasal mucosa
odarkish pink in
color, no flakes,
no lesions.
oMoist with no
lesions
opupil is equally
round
and reactivated to
light
accommodation
opinkish color
owhite in color
osmooth and moist
osymmetrically
appearance and
equally in size
ono discharge,
clear ear canal,
no obstructed
object
osame color of the
face
osymmetrically
appearance
ono redness in
nasal mucosa
opink in color, no
flakes, no lesions.
oMoist with no
lesions

7.  Gums
 Teeth
Neck:
 Active
Range of
Motion
 Color, Size
 Thyroid
Extremities:
 Upper
Extremities
 Nails
 Palms
 Arms
Inspection
and
Palpation
Inspection
and
Palpation
odarkish pink in
color, no
bleeding
o4 remaining
teeth, no cavity,
no dentures
oSome of teeth
were yellowish in
color
ocan move flexion,
extension, tilt and
lateral rotation
obrownish color,
no lesions
onon- palpable, no
pain when
palpate
ono cyanosis, no
clubbing, pinkish
in color, 2
seconds capillary
refill
opinkish in color,
feels warm,
rough, (+)
tremors, no
lesions.
oDominant in right
arm, weak at left
arm (5/10 muscle
force)
opink in color, no
bleeding
o32 complete teeth
no cavity, no
dentures
oWhitish color of
Teeth
ocan move flexion,
extension, tilt and
lateral rotation.
obrownish color, no
lesions
onon-palpable, no
pain when palpate
ono cyanosis, no
clubbing, pinkish
in color, 2
seconds capillary
refill
opinkish in color,
feels warm,
rough, no lesions.
o10/10 muscle
force, no muscle
weakness

8.  Lower
Extremities
 Nails
 Feet
 Leg
oBilateral pulses
are strong, and
equal(radial
pulse)
o(+) lesions,
scars, and
rashes.
oSymmetrical in
size
ono cyanosis, no
clubbing, pinkish
in color, 2
seconds capillary
refill
opinkish dark color
on the palm of
the feet, no
lesions
oDominant in right
leg, no muscle
weakness
o(+) lesions,
scars, and
rashes.
oSymmetrical in
size
oBilateral pulses
are strong, and
equal(radial
pulse)
oNo lesions, scars,
and rashes.
oSymmetrical in
size
ono cyanosis, no
clubbing, pinkish
in color, 2
seconds capillary
refill
opinkish color on
the palm of the
feet, no lesions
ono muscle
weakness
ono lesions, scars,
and rashes.
oSymmetrical in
size

9. f. Review of Systems
General:
(+) Fever
Skin:
(+) Itching
(+) Scabies
(+) Dryness
(+) Rashes
(+) Change Color
Head:
(+) Headache
(+) Head Injury
Eyes:
(+) Nearsighted
Mouth:
(+) Dry Mouth
(+) Four Teeth
Respiratory:
(+) Cough
Gastrointestinal:
(+) Diarrhea
Vascular:
(+) Varicose Veins
Neurologic:
(+) Seizures
(+) Tremors
Psychiatric:
(+) Depressed Mood
(+) Stress
(+) Disturbing thoughts
(+) Memory Loss

10. g. Mental Status Examination
1. General Description
 Appearance- the resident was well groomed, she combed her hair
carefully and she applies face powder, in stooping position.
 Behavior and Psychomotor activity- She had good eye contact
whenever she answered a question and sometimes she looking in other
patient when she asked to answer a question. She had a short attention
span while in conversation. She had a mannerism of scratching her finger.
 Attitude toward examiner- the resident was approachable and
cooperative and able to do anything that was asked her to do. She acts
what she say when she tells her story.
2. Mood and Affect
 Mood- the resident looks depressed when she was alone, and no one
calling her attention. When she asked about her daughter she feels
depressed because of the past event, that her husband kills her daughter
after she gave birth.
 Affect- the resident has an appropriate response affect about the topic of
the conversation. Sometimes she has no emotion when talked about her
father.
 Appropriateness- the resident can answer the questions, but some were
false statement.
3. Speech- the resident was quite, if she asked a question then that’s the time she
talk and continue to give a data.
4. Perceptual Disturbance- the resident had a memory loss because of the
existing mental disorder that she pretends that her husband kills her daughter but
truth was she hacked her daughter seen by the barangay health worker.

11. 5. Thought
a. Process or Form of thought- the resident had overabundance of
thoughts. She gave a false data about her daughter but she tells a lot of
everything about her past.
b. Context of Thought- denies any hallucination and illusions, also
homicidal ideation.
6. Sensorium or Cognition
a. Alertness and level of consciousness- The resident was alert and
attentive.
b. Orientation- The resident was oriented to time, date, place and names of
person around her.
c. Memory- Recent – she remembers what they eat and what household
she do in the morning, Immediate- she can’t remember 3 words/items that
she asked to memorized, in every 5 minutes, Remote- when she was still
a child she remembers when her father got drunk, her father hurt her
mother, Recent Past Memory- she can’t remember the recent president,
and she always saying that Pacquio was the recent president
d. Concentration and Attention- the resident had difficulty in subtracting 3
from 100, but she can count up to 1000.
e. Capacity to read and write- she can read more on tagalog words, and
had difficulty in English word. In her writing, it quite understandable, and
can copy the word that was written in a piece of sheet, and can write one
sentence more on tagalog but can’t write in English word.
f. Visuospatial Ability- the resident can draw the images that asked to her,
and she can copy an image by herself.
g. Abstract Thinking- She can’t identify the similarities of 2 objects given to
her.
h. Fund of Information and Intelligence- She knows what year and her
age when she confined in the institution but she don’t know when she had
a incident report five times in the isolation room, but if it was told to her
she remembers the incident.

12. 7. Judgment and Insight- The resident was asked what she will do, if she saw a
mother and a child, and the mother was choking her child, she said that, she will
go to the mother then asked what was happening, then she will try to help to
solve the problem about the mother and the child. She was aware that she had a
mental disorder.
3. Psychosocial History
a. Personal History
i. Marital and relationship history- the resident claimed that she’s
only 13 years old when her father sell her to a “magjuejueteng” a 28
years old to become her husband. After 1 year, they were
separated but not married because of a family problem. When she
was 18 years old, she met a 30 years old guy who works in the
bakery with two kids and widow, and then they have a relationship
for one year and not married. According to the resident, she had a
daughter in her second husband but apparently her husband kill the
baby after she gave birth and they were separated by the family of
her husband because she did not finish her high school.
ii. Sexual History and Preference- according to the resident when
her first husband came from work and drunk, her husband abuse
her but did not report to the authority. After she was confined in the
mental institution she had no longer sexually active.
iii. Educational History- she was under graduate, she finished up to
grade III elementary.
iv. Occupational History- when she was a child she stop going to
school, because she want to help her mother to earn money, she
sells “kakanin” in Manila. When she was 10 years old, she travelled
to Manila from Quezon to find a job, she said that she was excellent
in doing household chores, and apply as a maid.
v. Socioeconomic Status- she claimed that they are in middle class.
Her father was a fisherman and her mother sells “kakanin”.

13. vi. Religious Affiliations- she said that she is Roman Catholic but not
able to go to church to pray because of her status but she always
pray at night before she sleep.
vii. Place of Birth- the resident claimed that she is from Caluag,
Quezon, but her chart showed that she is from Sitio Katulad Pulong
Sampaloc Dona Remedious Trinidad Bulacan.
viii. Legal History- she had a record on police before she referred to
the mental institution.

14. 4.Medical Management
Name of Drug
(Classification)
Dosage Action Indication Side-effect Interpretation
Nursing
Consideration
Haloperidol
(Haldol)
-Antipsychotics
10 mg.
OD
Started:
4/18/99
Ended:
6/30/08
• Alters the
effects of
dopamine in
the CNS
• Also has
anticholiner
gic and
alpha-
adrenergic
blocking
activity.
•
Diminished
signs and
symptoms
of
psychoses
•Organic
Psychoses
• acute
psychotic
symptoms
• Relieve
hallucination
s, delusions,
disorganized
thinking
• severe
anxiety
• seizures
•CNS: extrapyramidal
symptom such as
muscle rigidity or
spasm, shuffling gait,
posture leaning
forward, drooling,
masklike facial
appearance,
dysphagia, akathisia,
tardive dyskinesia,
headache, seizures.
•CV: tachycardia,
arrhythmias,
hypertension,
orthostatic
hypertension.
•EENT: blurred vision,
glaucoma
• GI: dry mouth,
anorexia, nausea,
vomiting, constipation,
diarrhea, weight gain.
• GU: urinary
frequency, urine
retention, impotence,
enuresis, amenorrhea,
gynecomastia
• Assess mental
status prior to and
periodically during
therapy.
• Monitor BP and
pulse prior to and
frequently during
the period of
dosage adjustment.
May cause QT
interval changes on
ECG.
• Observe patient
carefully when
administering
medication, to
ensure that
medication is
actually taken and
not hoarded.
•Monitor I&O ratios
and daily eight.
Assess patient for
signs and
symptoms of

15. • Hematologic: anemia,
leucopenia,
agranulocytosis
• Skin: rash, dermatitis,
phtosensitivity
dehydration.
• Monitor for
development of
neuroleptic
malignant
syndrome (fever,
respiratory distress,
tachycardia,
seizures,
diaphoresis,
hypertension or
hypotension, pallor,
tiredness, severe
muscle stiffness,
loss of bladder
control. Report
symptoms
immediately. May
also cause
leukocytosis,
elevated liver
function tests,
elevated CPK.
• Advice patient to
take medication as
directed. Take
missed doses as
soon as
remembered, within
remaining doses

16. evenly spaced
throughout the day.
May require several
weeks to obtain
desired effects. Do
not increase dose
or discontinue
medication without
consulting health
care professional.
Abrupt withdrawal
may cause
dizziness, nausea
and vomiting, GI
upset, trembling, or
uncontrolled
movements of
mouth, tongue or
jaw.
Dilantin
(Phenytoin)
100mg  Phenytoin
is used to
prevent
and control
seizures
(also called
an
anticonvuls
ant or
antiepilepti
c drug). It
works by
reducing
the spread
 Phenytoin
is indicated
for use as
an
anticonvulsa
nt drug in
people of all
ages.
Evidence
supporting
efficacy of
phenytoin as
an
anticonvulsa
 Headache, nausea,
vomiting, constipation,
dizziness,
drowsiness, trouble
sleeping, or
nervousness may
occur. If any of these
effects persist or
worsen, notify your
doctor or pharmacist
promptly.Phenytoin
may cause swelling
and bleeding of the
gums.
 Take this drug
exactly as
prescribed, with
food to enhance
absorption and
reduce GI upset,
or without food—
but maintain
consistency in the
manner in which
you take it; be
especially careful
not to miss a dose
if you are on

17. ofseizure a
ctivity in
the
brain.OTH
ER This
section
contains
uses of this
drug that
are not
listed in the
approved
professiona
l labeling
for the drug
but that
may be
prescribed
by your
health care
professiona
l. Use this
drug for a
condition
that is
listed in
this section
only if it
has been
so
prescribed
by your
health care
nt was
derived from
active drug-
controlled
studies that
enrolled
patients with
the following
seizure
types:
 Partial
seizures
 Primary
generalized
tonic-clonic
seizures
(grand mal)
 Phenytoin
is best
used for
partial-
onset
seizures. It
generally is
not
effective
against
generalized
-onset
absence
seizures or
infantile
Immediately if any of
these unlikely but
serious side effects
occur: unusual eye
movements, loss of
coordination, slurred
speech, confusion,
muscle twitching,
double or blurred
vision, tingling of the
hands/feet, facial
changes (e.g., swollen
lips, butterfly-
shapedrash around
the nose/cheeks),
excessive hair growth,
increased thirst or
urination, unusual
tiredness, bone or
joint pain, easily
broken bones.A small
number of people who
take anticonvulsants
for any condition
(such as
seizure, bipolar
disorder, pain) may
experience depressio
n, suicidal
thoughts/attempts, or
other mental/mood
problems.
once-a-day
therapy.
 Do not
discontinue this
drug abruptly or
change dosage,
except on the
advice of
your prescriber.
 Maintain good oral
hygiene (regular
brushing and
flossing) to
prevent gum
disease; arrange
frequent dental
checkups to
prevent serious
gum disease.
 Arrange for
frequent checkups
to monitor your
response to this
drug.
 Monitor your
blood or urine
sugar regularly,
and report any
abnormality to

18. professiona
l.This drug
may also
be used to
treat
certain
types of
irregular
heartbeats.
spasms.
 Phenytoin
has limited
value in
clonic,
myoclonic,
and atonic
seizures
and in the
Lennox-
Gastaut
syndrome.
It may
control the
tonic-clonic
component
of the
syndrome.
your health care
provider if you
have diabetes.
 This drug is not
recommended for
use during
pregnancy. It is
advisable to use
some form of
contraception
other than
hormonal
contraceptives.
 Wear a medical
alert tag so that
any emergency
medical personnel
will know that you
have epilepsy and
are taking
antiepileptic
medication.
Chlorpromazine
(Thorazine)
-Antipsychotic
100g  Block
dopamine
receptors in
the brain;
also alter
dopamine
release and
turnover.
 Acute and
chronic
psychoses,
particularly
when
accompanie
d by
increased
CNS: neuroleptic
malignant syndrome,
sedation,
extrapyramidal
reactions, tardive
dyskinesia
CV: hypotension
(increased with IM, IV)
 Assess mental
status prior to and
periodically during
therapy.
 Monitor BP and
pulse prior to and
frequently during

19.  Prevention
of seizures
psychomoto
r activity.
Nausea
and vomiting
.
 Also used
in the
treatment of
intractable
hiccups.
EENT: blurred vision,
dry eyes, lens
opacities
 GI: constipation, dry
mouth, anorexia,
hepatitis, ileus
GU: urinary retention
 Hematologic:
agranulocytosis,
leucopenia
Skin: photosensitivity,
pigment changes,
rashes
the period of
dosage
adjustment. May
cause QT interval
changes on ECG.
 Observe patient
carefully when
administering
medication, to
ensure that
medication is
actually taken and
not hoarded.
 Monitor I&O ratios
and daily eight.
Assess patient for
signs and
symptoms of
dehydration.
 Monitor for
development of
neuroleptic
malignant
syndrome (fever,
respiratory
distress,
tachycardia,
seizures,
diaphoresis,

20. hypertension or
hypotension,
pallor, tiredness,
severe muscle
stiffness, loss of
bladder control.
Report symptoms
immediately. May
also cause
leukocytosis,
elevated liver
function tests,
elevated CPK.

21. CONCEPT MAPPING
Undifferentiated Schizophrenia
Disturbed Thought Processes
Risk for SuicidalRisk for Other-
Directed Violence
Disturbed Personal Identity

22. Name:Ms. L.Z. Age:48 yearsold Gender:Female
Religion:RomanCatholic Ethnicity:Pilipino
Diagnosis:UndifferentiatedSchizophrenia
PriorityNo.1
NursingDiagnosis:Riskforother-directedviolence
At riskfor behaviorsinwhichanindividual demonstratethatshe canbe physically,emotionallyand/orsexuallyharmful toothers.
Data Outcome Intervention Rationale Evaluation
Subjective:
“Kapag nag aawayang
mga engot(Mentally
Retarded) nagaawat
ako,pero nung
nasaktanako, sinaktan
ko na dinsila”as
verbalizedbythe
patient.
Objective:
 Historyof hitting
others:she had an 5
incidentreport
 Historyof Hitting
familymembers:she
hack herdaughter
 Historyof Childhood
abuse:whenshe got
marriedwiththe age
of 13 yearsold
 Historyof conflictual
familybackground:
Afterof 8 hoursof
duty,the residentwill
expressedherown
realisticevaluationand
demonstrate self-control.
 Developedtherapeutic
nurse-client
relationship.
 Observedforearlycues
of distress/increasing
anxiety
 Identifiedcondition
such as psychomotor
seizuresactivity
 Askeddirectlyif the
personwasthinkingof
actingon
thoughts/feelings
 Acceptedclient’sanger
withoutreactingon
emotionbasis.Give
permissiontoexpress
angry feelingin
acceptable waysandlet
 Promotessense of
trust,allowingclientto
discussfeelingopenly.
 To give appropriate
management.
 to control own
behavior
 to determine violent
intent
 to promotes
acceptance and sense
of safety
Afterof 8 hoursof
intervention,the resident
were expressedherown
realisticevaluationand
demonstratedself-control
as evidencedby:
 expressedcalmness
whensomeone hurt
him,and will tell to
the nurse on duty
 not joiningthe
argue,and stayedin
the conner.

23. herfatherhit them,
whenherfathergot
drunk.
clientknowthatstaff
will be availableto
assistinmaintaining
control.
 Helpedclientidentify
more approachable
solution/behavior
 to lessensense of
anxietyandassociated
physical manifestation

24. Name:Ms. L.Z. Age:48 yearsold Gender:Female
Religion:RomanCatholic Ethnicity:Pilipino
Diagnosis:UndifferentiatedSchizophrenia
PriorityNo.2
NursingDiagnosis:Diarrhea
Unformedstool
Data Outcome Intervention Rationale Evaluation
Subjective:
“Kapag lagi akong
kumakainngginiling
at nilagangbaboyay
sumasamaang tiyan
ko at nagnatatae ako ”
as verbalizedbythe
patient.
Objective:
 hyperactive bowel
sounds
 Historyof takingdrugs
for diarrhea
 three loose liquid
stoolsperday
Afterof 8 hoursof
duty,the residentwill
maintainnormal pattern
of bowel function.
 MonitoredVital signs
and intake andoutput.
 Auscultatedabdomen
 Restrictedsolidfood
intake asindicated
 Promoteduse of
relaxationtechnique
 Increasedoral fluid
intake and returnto
normal dietas
tolerated.
 Reviewedcausative
factors andappropriate
intervention.
 To knowthe baseline
data.
 To knowpresence,
location,and
characteristicsof bowel
sounds.
 To allowforbowel
rest/reducedintestinal
workload
 To decrease
stress/anxiety
 To prevent
dehydration.
 To preventrecurrence.
Afterof 8 hoursof
intervention,the resident
was maintainednormal
patternof bowel function.

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