Submitted by: Gallano, Charmaine HAmoy, Hazel Ruth Ghan, Elaine Roa, Mel Titus Torres, Daniel John MAbelin, Aryan Ricci, Gloriefe Manduriao, Tristan Jan
Submitted to: Mrs. Ma. Dolores Mercado, RN,MN, MAN Clinical Instructor
TABLE OF CONTENTS
I. INTRODUCTION A. Overview B. Objective and Purpose of the study C. Scope and Limitation D. Spot Map E. Patients Profile II. ANAMNESIS A. Maternal and Paternal Lineage B. Parents C. Subjects III. COURSE IN THE HOSPITAL A. Mental Status Examination B. Progress Notes IV. Psychodynamics A. Tabular Presentation B. Schematic Presentation V. Laboratory Exam AND Results of Psychological Test A. Neuropsychological test B. Laboratory test if any VI. DIAGNOSIS\ VII. MULTI- AXIAL DIAGNOSIS VIII. NURSING MANAGEMENT IX. MEDICAL MANAGEMENT X. PROGNOSIS AND RECOMMENDATION XI. BIBLIOGRAPHY XII. DOCUMENTATION
I. Introduction A. Overview The term schizophrenia was coined in 1908 by the Swiss psychiatrist Eugen Bleuler. The word was derived from the Greek skhizo (split) and phren (mind). Over the years, much debate has surrounded the concept of schizophrenia. Various definitions of the disorder have evolved, and numerous treatment strategies have been proposed, but none have proved to be uniformly effective or sufficient. Although the controversy lingers, two general factors appear to be gaining acceptance among clinicians. The first is that schizophrenia is probably not a homogeneous disease entity with a single cause, but results from a variable combination of genetic predisposition, biochemical dysfunction, physiological factors, and psychosocial stress. The second factor is that there is not now and probably never will be a single treatment that cures the disorder. Instead, effective treatment requires a comprehensive, multidisciplinary effort, including pharmacotherapy and various forms of psychosocial care, such as living skills and social skills training,rehabilitation, and family therapy. Of all the mental illnesses that cause suffering in society, schizophrenia probably is responsible for lengthier hospitalizations, greater chaos in family life, more exorbitant costs to individuals and governments, and more fears than any other. Because it is such an enormous threat to life and happiness and because its causes are an unsolved puzzle, it has probably been studied more than any other mental disorder. Potential for suicide is a major concern among patients with schizophrenia. Schizophrenia may be the most devastating mental illness that humans can experience. Its onset is typically during adolescence or early adulthood, a period when individuals are just beginning to achieve a firm sense of self, to establish enduring relationships, and to make productive contributions to society. Unlike those with illnesses such as Alzheimers disease, cancer, and heart disease, patients with schizophrenia usually are unable to point to decades of health predating the onset of illness. A large majority of patients with the illness are unable to maintain independent living or gainful employment for any significant period in their lives after the onset of the illness. The public health effects of schizophrenia are staggering. Although the prevalence of the illness is approximately 1% in the United States, patients with schizophrenia occupy 25% of all inpatient hospital beds and represent 50% of all inpatient admissions. The overall cost of schizophrenia in the U.S. in 2002 was estimated to be $62.7 billion. Schizophrenia is one of the top 10 causes of disability-adjusted life years. (pp. 407408). This case study explored schizophrenia residual type disorder. This was focused on CB, a 32-year old patient who is afflicted with schizophrenia in which she was observed for impairments or alterations in thinking, memory, judgment, sensation, motivation, emotions, sleep, mood, attention, learning, movement, cognition, communication, behavior, and personality which are hallmarks of schizophrenia (Ignatavicius& Workman, 2002). They are of concern to health workers since they are major public burdens. Many of those afflicted with the said disorder do not seek care since they feel ostracized due to stigma. In order to put together the puzzles of CBs life and determine the exact cause of her schizophrenia residual type, CB was monitored and cared for by the group for 3 days. CB and the group worked through the Orientation and Working Phases and her problems, difficulties, fears; and anxieties were explored, and her adaptive and maladaptive coping mechanisms were identified and coined. Members in the family especially the mother were interviewed. The neighbours were also asked. Using subjective and objective cues noted by the group on site at the patients residence, CBs psychiatric disorder was finally identified as schizophrenia residual type based from the criteria established by Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM IV-TR). She was positive for restlessness, inability to sleep, panic, anxiety, murmurs and is always preoccupied. Schizophrenia is properly managed through a combination of pharmacological treatments using antipsychotic medications with the commitment and proper treatment regimen. Patient education and assistance with social problems including but not limited to unemployment or domestic violence by referral to appropriate agencies, and most importantly, the building of social support networks (Patel, Vikram et al, 2005).
B. Objectives and Purpose of the Study This study was conducted keeping in mind the general purpose of which w as that at the end of atleast 3visitations, the nursing students will be able to gain knowledge about the different Psychiatric problems learned from Psychiatric Nursing, develop skills in assessment and problem identification in actual setting and enhance supportive role and attitude to psychiatric patients that needs guidance and impart health teaching for the benefit of individuals with mental disorders. Through the formulation of daily and weekly plans of activities the group will be able to meet the following goals: initially, to establish rapport with the patient and her family; to conduct a complete and thorough nursing assessments on the patient as well as to obtain her medical and nursing history using both primary and secondary sources of information; to use therapeutic communication skills especially during Nurse-Patient Interactions so as to gain patients trust and confidence and impart genuine interest, empathy, acceptance and positive regard; to identify maladaptive behaviours through the assessments done; to plan courses of action and to perform nursing interventions in bringing comfort and safety to patient with health teachings.
C.Scope and Limitation The group had chosen this specific case in order to better understand the factors that contribute to the development of mental illness specifically schizophrenia, and how they affect all the aspects of an individuals personality, keeping in mind the application of the nursing process as well as nursing management of the signs and symptoms of the disease. This case focused on CB who was home managed for years already. 3 visitations were spent for the Nurse-Patient Interaction phases. The feelings, emotions, thoughts, behaviours, and actions were all taken into account. Pertinent data were obtained from relatives and neighbours of the individual under study. The study was patient-centered. The patient may not manifest all of the signs and symptoms that are expected from schizophrenia. The scope of the study are as follows: 1. Must be a resident of Cagayan de Oro City 2. Mother must be healthy and is able to give information 3. And patient is of sound mind in the course of interview.
D.Spot Map In going to our patients house which is at Gusa, Villa Ernesto phase 2, we start in school by riding a Jeepney (C2 or R1) with a fare of php 6.00 for students and php 7.00 as regular fare. Then will stop at the loading zone by Centrio and more or less 1km from the school. From this point you will ride again another Jeep going to gusa (RC cugman or RD gusa) The fare for this ride caused a bit more, php 7.00 for students and php 8.00 for regular fare and more or less 4 Km from centrio mall which was our last stop.
E.Patients Profile NAME: Miss CB ADDRESS: Purok 2B, Gusa, Cagayan de Oro City AGE: 32 yrs. old SEX: Female RELIGION: Roman Catholic MARITAL STATUS: Single DATE OF BIRTH: February 18, 1982 NATIONALITY: Filipino BIRTH PLACE: Cagayan de Oro City HEIGHT: 5 feet, 2 inches WEIGHT: 55kg NUMBER OF SIBLINGS: 2 BIRTH RANK: 2 nd from the eldest EDUCATIONAL ATTAINMENT: Elementary: Gusa Elementary School (1989-1995) Secondary: MOGCHS College: None Post Graduate Studies: None ARREST, COURT DATES, PROBATION: None VITAL SIGNS: BP: 100/60mmHg TEMP: 36.7 0 C RR: 24cpm HR: 90bpm FOOD AND DRUG ALLERGY: Allergic to dried fish and clams USE OF STREET DRUGS: (specify amount, when & how it started, history of blackouts) Use of street drugs when she was in 3rd year high school
II. ANAMNESIS Name: N.B Primary Care provider: AB (mother) Date of Birth:February 18, 1982 Age: 32 years old Sex: Female Race: Filipino Ethnicity: Filipino Marital Status: Single no. of marriages: none If married/divorce/separated, how long?: N/a Occupation: none Highest Educational Attainment: 3 rd year high school Religious affiliation: Roman Catholic City of Residence: Cagayan de Oro City Primary dialect/language spoken: Vernacular/ bisaya Accompanied by: Mother Admitted from: N/A Previous psychiatric hospitalizations (#): Lumbia (facility not known) Chief Complaints: DSM-IV TR Diagnosis: Schizophrenia Residual Type
A. Maternal and Paternal Lineage According to the interview to the mother , there family has a good relationship with one another but when her husband died, everything was torn apart. Her mother told us upon interview that they have no history of mental illness and also her husbands side. But when we interview her, there are signs that she also have a mental illness on the way she answers us. B. Parents Father CBs father died last last February 2, 1996 because of his heart enlargement. According to the mother, CBs father was kind and good to all of them. He was very responsible and when her their father died they experienced financial problems. Mother The mother of the patient clearly shows signs of mental problem. She does not show enough care to herself neither to her family. Upon interview the mother of CB always stressed to us that she loved her daughters so much and she dont want them to be hurt but according to CB her mother is so strict and she pays more attention to her youngest sibling who is mentally retarted and tend to neglect CB and her older sister. Siblings CB has 2 siblings. The older sister lives now in Samar, Leyte and has a family of her own. And CBs younger sister is 29 years old and is mentally retarted. Her younger sibling needs more attention because of her condition.
C. Subject Prenatal During the prenatal period, the mother mentioned that she completed the visitations in her pre natal in the Health Center and no problems happened on the course of her pregnancy. Birth NB is a full term baby and delivered through normal spontaneous vaginal delivery in their home and she was referred to Northern Mindanao Medical Center. INFANCY AND CHILDHOOD CHARACTERISTICS The mother was breastfeeding NB when she was still a baby. The patient had a good development during her childhood days. The patient started to walk when she was still 9 month old and after a year, she begun to speak a few words such as mama and papa. CBs mother said that no problems were seen during CBs growing up years and only minor sickness such as colds, cough and minor fevers are felt by CB as a child. PSYCHOSEXUAL FACTORS According to CB she had her first sexual intercourse when she 17 and she got pregnant when she was 21 and then her second pregnancy was when she was 23. He relationship with men was not successful because she said that they are all jealous and she cant understand them. PLAY LIFE During her childhood days, CB has problems when it comes mingling with other people and she was shy because when she was young her mother always restricts her to play with other kids in their neighbourhood. Religious Life CB is a Roman Catholic and she told us that they always go to church on a Sunday and in every special occasion. They also pray when they are having their meals and their religious beliefs are evident because there are saints in their house.
INTERVIEW WITH NEIGHBOURS:
Informant 1 Name: Mrs.AB Address: Purok 2B Gusa, Carmen CDO City Relationship to client :Neighbor Length of time known to client: 32 years Aparrent Understanding to the cleints Illness: Nagsugod ng sakit ni CB tong high school pana sya. Kay ana ang iya mama napasmuhan daw n sya busa ingon ana na sya karun.
Informant 2: Name: Mr P. Address: Purok 2B Gusa, CDO City Relationship to client : Neighbor Length of time known to client: 25 years Aparrent Understanding to the cleints Illness mag lakaw lakaw na sya sa dalan sauna nga ga panty rah mao ng naburusan na sya. Ga ato manang high school pana sya sa MOGCHS. Kana pud ang iya mama sauna kay ga yaw yaw pd na sya ug sya rah usa. Kaliwat na guro na nila
Informant 3: Name: Mrs. LO Address: Purok 2B Gusa. Carmen CDO City Relationship to client :Neighbor Length of time known to client: 27 years Aparrent Understanding to the cleints Illness sauna kay napasmuhan na sya tong high school pa sya. Muadto rana sya sa skwelahan nga walay kaon. III.COURSE IN THE HOSPITAL
Mental Status Exam DAY 1
DAY 2 DAY 3 DATE OF VISIT
A. GENERAL APPEARANCE
Improper dressed Properly dressed Properly dressed B. BEHAVIORS
Shy Friendly and Approachable Friendly and Approachable C. GENERAL MOBILITY
Mannerism noted Mannerism noted Mannerism noted D. NPI
Cooperative Cooperative Cooperative
A1 SPEECH DAY 1
DAY 2 DAY 3 SOFT
LOUD
HESITANT
SLURRED
SUPERIOR
HUMOR
FRIGHTENED
A2 DOES HER STYLE AND VOCABULARY CONVEY?
DAY 1 DAY 2 DAY 3 COYNESS
SUSPICIOUSNESS
ARROGANCE
SECRECY
SUPERIORITY
HUMOR
FEAR
A3 STREAM OF TALK
DAY 1 DAY 2 DAY 3 SPONTANEOUS
DELIBERATE
PRESSURED
A4 ORGANIZATION OF TALK
DAY 1 DAY 2 DAY 3 RELEVANT
IRRELEVANT
INCOHERENT
LOOSE ASSOCIATION
FLIGHT OF IDEAS
TANGENTIALITY
CIRCUMSTANTIALITY
PERSEVERATION
CLANG ASSOCIATION
NEOLOGISM
ECHOLALIA
ECHOPRAXIA
A5 MOOD AND AFFECT
DAY 1 DAY 2 DAY 3 1. MOOD
EUTHYMIC
DEPRESSED
EUPHORIC
2. AFFECT
FLAT
BLUNT
ANGRY
ELATED
ANXIOUS
FEARFUL
A6 RANGE OF AFFECTIVE EXPRESSION
DAY 1 DAY 2 DAY 3 CONSISTENT
LABILE
ANHEDONIC
APPROPRIATE TO THE SITUATION AND FEELINGS VERBALIZED
A7 PERCEPTION DAY 1 DAY 2 DAY 3 HALLUCINATION AUDITORY VISUAL OLFACTORY GUSTATORY TACTILE DELUSION GRANDEUR PERSECUTORY REFERENCE ILLUSION DEREALIZATION DEPERSONALIZATION IDENTIFICATION THOUGHT BROADCASTING
Dj vu JAMAIS VU
A8 ORIENTATION AND MEMORY
DAY 1 DAY 2 DAY 3 1. IDENTIFIES DATE CORRECTLY
2. ESTIMATES TIME OF THE DAY
3. KNOWS WHERE SHE IS
4. KNOWS THE EXAMINER
5. RECALLS EVENTS PRIOR TO ADMISSION
6. RECALLS ACTIVITIES DONE WITHIN 24 HOURS
7. RECALLS ACTIVITIES
DONE WITHIN 1 WEEK
A9 NEURO-VEGATATIVE FUNCTIONING
DAY 1 DAY 2 DAY 3 SLEEP AND REST PATTERN
NORMAL SLEEP
EARLY MORNING AWAKENING
MIDDLE NIGHT AWAKENING
HYPER INSOMNIA
DIFFICULTY FALLING ASLEEP
INTERRUPTED SLEEP
A10 ELIMINATION DAY 1 DAY 2 DAY 3 BOWEL 2 1 1 BLADDER 5 6 6
A11 ABSTRACT THINKING ABILITY DAY 1 DAY 2 DAY 3 Good Fair Good
A12 JUDGMENT DAY 1 DAY 2 DAY 3 Good Good Good
PROGRESS NOTES GENERAL OBJECTIVE: At the end of 3 days visit to CB, we will be able to gain knowledge and information about patient CB and correlate the information gathered with the development of mental illness from which CB is diagnosed.
February 15, 2014 SPECIFIC OBJECTIVE: At the end of our first visit, we will be able to establish rapport to patient CB and make a contract.
On our first visit to CB, we are all new to her except our one classmate because she has her 1 st interaction to CB before us. On our way to their house, we can see that she is very interested and she likes students. She is accommodating and she always smile. We told her about the contract and she agreed on it. Our planned activity was to play badminton and she told us that she loved badminton also. After playing badminton, we asked her several questions and upon our interview, there are times that she tend to change the topic and its as if all that she is saying is shes not that sure. Her mother is not in their house upon our visit. We then bid farewell to her and promised that we would go back on her birthday.
February 18, 2014 2 nd visit
On our 2 nd visit, it was on her birthday and we had brought some food and gifts for her. She was so happy and she cant really put into words the happiness that she feels because on the event that we sang happy birthday, she was very very happy. We had gift giving and she thanked all of us for the gifts that we had given her. Her mother and her sister are in their house but we were not able to talk to them because they are inside their room. CB was so happy and she told us that she had her children being adopted and she dont know who adopted them. Some informations were gathered and we bid then goodbye again to her. April 28, 2014 3 rd visit On our 3 rd and last visit, CB was not on their house because she was on their neighbours house taking care of an old woman. It is good to know that she can take care of somebody on her condition and that proves that she is of sound mind now. On our last visit, we had told her about the end of the contract and we had an activity with a sport again of badminton and she was so happy also. Their are times that she keeps on asking when are we coming back and we told her that its the end of our contract but some of our classmates are coming back to visit her again.
IV. PSYCHODYNAMICS
RATIONALE PRESENT FACTORS
Predisposition to mental illness is genetically transmitted and inherited.
The client's mother has a history of mental illness
A. Hereditary
People with a younger age of onset have poorer outcomes and less effective coping skills, than those people with a late age of onset. A possible reason is that younger clients have not had enough experiences of successful independent living and have less well developed sense of personal identity than older clients (Buchaman and Carpenter, 2000).
The client was 16 years old during the onset of her illness
B. Age
Abnormally high dopaminergic transmission has been and psychosis linked to schizophrenia (Dr AnanyaMandal, MD)
Alteration in the neurotransmitter system of the brain
C. Biochemical
Deficits in information processing may leave people vulnerable to the behaviors typically seen as symptoms
Client manifested flight of ideas and irrelevance.o
D. Cognitive
V. LABORATORY EXAM AND RESULTS OF PSYCHOLOGICAL TEST a. Neuropsychological test The patient has no neurological test b. Laboratory test The patient has no laboratory test
VI. DIAGNOSIS DSM-IV Diagnosis: Schizophrenia, Residual Type; ICD-9 CM Code ICD-9 CM Name 295.65 Schizophrenic disorders, residual type ICD-10 CM Code ICD-10 Name F20.5 Residual Schizophrenia
VII. MULTI-AXIAL DIAGNOSIS Axis Code Description Justification Axis I Is for identifying all major psychiatric disorders except mental retardation and personality disorders.
295.60 T/C Schizophrenia (Residual Type) The essential feature of schizophrenia are a mixture of characteristics signs and symptoms (both positive and negative) that have been present for a significant portion of time during a 1 month period with some signs of the disorder persisting for at least 6 months. This falls into criterion A, wherein there is presence of delusion, hallucinations, and disorganized speech. The client displayed signs and symptoms of schizophrenia residual type that includes delusions, anxiety, anger, disorganized speech and difficulty making decisions. Axis II Is for reporting mental retardation and personality disorders as well as prominent maladaptive personality features and defense mechanisms. Devaluation The individual deals with emotional conflict or internal or external stressors by attributing exaggerated negative qualities to self or others. Axis III Is for reporting current medical conditions that are potentially relevant to understanding or managing the persons mental disorder as well as medical conditions that might contribute to understanding none None the person. Axis IV Is for reporting the psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders. V15.81
V61.20 Non-Compliance with treatment
Parent-Child Relational Problem
Patient often disregard medication administration due to the side effect of sinusitis. She doesnt see the consequence of non-adherence to medication to regimen.
Her mother is more concerned of CBs sister and she tends to neglect CB and lets CB work but her mother also goes with her whenever she have check-ups Axis V Presents a Global Assessment of Functioning, which rates the persons overall psychological functioning on a scale of 0 to 100. 81-70 (current) Some mild symptoms or some difficulty in social, occupational, or school functioning but generally functioning pretty well has some meaningful interpersonal relationships. CB exhibits mild anxiety as evidenced by tapping her fingers and swiping her hands in the table
VIII. NURSING MANAGEMENT
S Usahay dili ko ganahan muinom ug tambal as verbalized by the client O
-rejected offered medications -high toned voice
A Ineffective health maintenance Related to Deficient knowledge regarding treatment and control of psychological condition P At the end of 2 nd our visit, the patient will be able to describe positive health maintenance behaviour such as keeping scheduled appointments (home visitation), improving home environment and following her medication regimen.
I 1. Provided client information on home health services to help her choose one that will work for her. 2. Encouraged client to make appointment with home health before leaving the hospital to ensure: a) she doesnt forget. b) she has access to a healthcare team to answer questions she may have. 3. Involved clients father in conversations about home health and lifestyle changes to create a support system for her. 4. Offered suggestions on lifestyle changes that may be may include diet and exercise that can easily be worked into her current routine to help her become willing to make changes. 5. Made a reminder card for client to keep with her to remind her to make healthful choices daily.
E At the end our visit, the patient was be able to described positive health maintenance behaviour such as keeping scheduled appointments (home visitation), improving home environment and following her medication regimen.
S nah pag mutukar na sya dretso na sya mudagan sa dalan maski naa sakyanan as verbalized by the mother
O - Not mindful of what she is doing - Absent minded
A Risk for Injury related to mental illness P At the end of our 3 rd visit, the patient will be able to demonstrate and understand ways on how to reduce injury I -approached the client in a non-threatening manner -discussed the importance of self-monitoring of conditions that contributes to the occurrence of the injury
-demonstrated use of relaxation techniques such as deep breathing exercise
-encouraged use of assertive type of communication and positive self-image E At the end of our 3 rd visit, patient was able to understand and demonstrate proper ways to prevent injury and demonstrated the techniques being taught
IX. MEDICAL MANAGEMENT
GENERI C NAME OF ORDERE D DRUG BRAND NAME CLASSIFIC ATION DOSE/ FREQUE NCY/ ROUTE MECHA NISM OF ACTION SPECIFI C INDICATI ON CONTRAI NDICATIO N SIDE EFFECTS/ TOXIC EFFECTS NURSING PRECAUTION chlorpro mazine Thorazin e antipsychotic 100mg/O D Antipsych otic drugs block the postsyna ptic dopamin e receptors in the brain: depress those part of the brain involved with wakefuln ess and emesis Manage ment of manifesta tion of psychotic disorders Contraindic ated with hypersensi tivity to chlorproma zine, parkinsons disease, severe hypotensio n or hypertensi on >drowsines s >weakness >nasal congestion >dyspnea >fever >sweating 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 dehydration.
GENERI C NAME OF ORDERE D DRUG BRAND NAME CLASSIFIC ATION DOSE/ FREQUE NCY/ ROUTE MECHA NISM OF ACTION SPECIFI C INDICATI ON CONTRAI NDICATIO N SIDE EFFECTS/ TOXIC EFFECTS NURSING PRECAUTION Flupentix ol antipsychotic 100mg/O D Antipsych otic drugs block the postsyna ptic dopamin e receptors in the brain: depress those part of the brain involved with wakefuln ess and emesis Manage ment of manifesta tion of psychotic disorders Contraindic ated with hypersensi tivity to chlorproma zine, parkinsons disease, severe hypotensio n or hypertensi on -dry mouth - constipatio n - hypersaliva tion -blurred vision -nausea -dizziness
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 dehydration.
X.PROGNOSIS AND RECOMMENDATION
Multiple factors appear to influence prognosis (disease outcome) in schizophrenia. Family history of schizophrenia is relevant. Multiple relatives who share schizophrenia outcomes is a bad sign. Other good signs include good social and professional adjustment prior to the onset of symptoms, and awareness and insight of symptoms as signs of a problem (rather than just reaction to symptoms without insight); patients demonstrating both of these signs may sometimes recover completely. Chances for recovery are improved if the disease comes on suddenly, as opposed to when it comes on slowly. If schizophrenia is treated quickly and consistently with good response to treatment, the prognosis is usually very good. A short amount of time that people suffer with severe symptoms and a lack of symptoms reported during periods between severe psychotic episodes is also good indicators of recovery potential. A personal history or family history of mood disorders may help a person to move through a schizophrenic phase quickly because their primary condition may be some other affliction. Since schizophrenia is a brain disorder, a CRITERIA OF DATA POOR GOOD Onset of Illness X Duration of Illness X Precipitating Factors X Mood and Affect X Attitude Toward Taking Medication and Treatment X Any Depressive Features X Family Support X good outcome is predicted when the brain has a normal structure and function as indicated by a brain scan.
Recommendation In order for our patient Ms. CB. to gain her maximum recovery as possible, it would be helpful if she and her significant others or her family members should take into consideration the following recommendations. 1. Indulge into other activities that promote physical, emotional, and spiritual healing by participating activities in the community. 2. Continue to provide emotional support by accepting and understanding client's current condition, providing continuous medication and observing compliance as ordered. 3. Provide client with teachings that promote health and wellness both physical, emotional and as well as spiritual healing. 4. It is also important that the client be provided that they will eat three times a day and the importance of good health and exercise for better recovery. 5. Allow patient to verbalize feelings of hopelessness
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