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Psychiatric Gordon's

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The human brain is the most complex, most sophisticated body organ which makes us superior among other living creatures. It is the vessel of the greatest power ever invented. Since it is a treasure not any pleasure could ever equal it is encapsulated on a hard mass of bone to keep its treasure.

The human brain can be divided into four major divisions: The cerebrum, the diencephalon, the cerebellum and the midbrain.

The first division is further subdivided into four parts. The frontal lobe, the parietal lobe and the occipital lobe.

In the frontal lobe, the precentral gyrus (motor cortex) controls voluntary motor activity. The Broca’s area coordinates the complex muscular activity of the mouth, tongue, and larynx and makes expressive motor speech possible. The frontal area also controls attention and concentration, motivation, ability to formulate goals, the ability to plan, the ability to initiate and maintain action, ability to self monitor and the ability to use feedback (executive functions). These areas contribute to reasoning, problem solving and emotional stability.

The parietal lobes interpret temperature, touch and pleasure. Concept formation and abstraction happens and are formulated in this area. The parietal lobes form two sides; the left parietal lobe and the right parietal lobe. The left parietal lobe assists with right and left orientation and mathematics, while the right parietal lobe is used for awareness, as to shape (steriognosis) and size as well as body position (proprioception).

The occipital lobe is responsible for usual interpretation and association.

The temporal lobe is responsible for hearing and smell sensation as well as storage for some complex memories.

The second major division of the brain is the Diencephalon which is responsible for some of the basic human function. It is further divided into three subdivisions: the Thalamus, hypothalamus and the epithalamus.

The Thalamus detects wether the message sent by the hypothalamusare pleasant or unpleasant. The hypothalamus functions along with the Endocrine System which controls ANS functions such as: heart rate, blood pressure, water and electrolyte balance, stomach and intestinal motility, glandular activity, body temperature hunger, body weight and sleep and wakefulness. And majorly regulates some of the activities of the pituitary gland. The epithalamus- houses the pineal body which then regulates the CSF production on the roof of the diencephalon.

The next major part of the brain is the Cerebellum. It integrates informationrelated to the position of body parts, coordinates skeletal movement and regulates muscle tention which is necessary for balance and posture. It also maintains reflex, tone and body coordination.

The last major part or division of the brain is the brain stem. It is composed of the mid-brain, pons and the medulla oblongata. The midbrain contain some parts of the Substantia negra at the basal ganglia which is responsible for movement and coordination.This is the most commonly affected part with patients taking antipsychotic drugs. Which is also responsible for manifsting Extra Piramidal Symptoms. The Pons act as bridges that connects the midbrain and the medulla oblongota, it majorly controls breathing and its patern. The medulla oblongata regulates major body functions essential for normal functioning. It controls the heart rate, breathing pattern, rate and depth, it assists in swollowing, nausea, vomiting and the activity of the RAS-which is responsible for sleep and wake cycle.

|AREA |PHYSICAL EXAM |REVIEW OF SYSTEM |
|GENERAL APPEARANCE |>Conscious, coherent, oriented to place, time and person, | |
| |expressive mood, talkative, appropriate affect, fairly | |
| |groomed, wearing a red shirts and blue shorts, responds in | |
| |a well understood voice, fast rate and good eye to eye | |
| |contact, good judgment and abstract reasoning, afebrile. | |
| | | |
| |HT= 5’2 ft | |
| |WT= 70 kg | |
| |BMI= 28 | |
|VITAL SIGNS |BP= 100/80 mmHg | |
| |HR= 81 bpm | |
| |RR= 22 cpm | |
| |T= 36.4 ⁰C | |
|INTEGUMENTARY |SKIN: |“ Wala ko’y samad ug dili man ko katlan sa |
| |INSPECTION: |akong lawas ky maligo man ko kada adlaw”, as |
| |> Dark brown, dry skin, freckles in face, no cyanosis, |verbalized by the patient. |
| |rashes, itching, edema and bruises | |
| |> has warts on neck | |
| | | |
| |PALPATION: | |
| |> warm to touch | |
| |HAIR AND SCALP | |
| |INSPECTION: | |
| |> evenly distributed, black, fine hair, “semi kalbo” | |
| | | |
| |PALPATION: | |
| |> no scalp masses, nodules, and tenderness | |
| |NAILS | |
| |INSPECTION: | |
| |> Well- trimmed | |
| |> Nails- round, thick | |
| |>Nailbed- smooth, firm, pink | |
| |> with an angle of 160⁰ | |
| | | |
| |PALPATION: | |
| |> Capillary refill: 2 sec. | |
|RESPIRATORY |THORAX |“Wala man ko’ygibatinga lain saakongpaghinga”, |
| |INSPECTION: |as verbalized by the client. |
| |> Chest symmetry equal | |
| |>Anteroposterior to transverse dm in ratio of 1:2 | |
| |> Spine vertically aligned | |
| |> Chest wall intact | |
| |> Respiration pattern: even, 22 cpm/min. , unlabored | |
| | | |
| |PALPATION: Refused | |
| | | |
| |AUSCULTATION: | |
| |> Lungs clear to auscultation on inspiration and | |
| |expiration | |
|CARDIOVASCULAR |HEART |Has no complain |
| |PALPATION AND AUSCULTATION: | |
| |> Rate and rhythm- 81 bpm, regular | |
|GI |ABDOMEN | Has no complain |
| |INSPECTION: | |
| |> Umbilicus centrally located | |
| |> No rashes, no lesions | |
| |> Round, symmetrical abdomen | |
| | | |
| |AUSCULTATION | |
| |> High pitched bowel sound noted equally in all four | |
| |quadrants | |
| | | |
| |PALPATION and PERCUSSION: | |
| |> refused | |
|GU | INSPECTION: | |
| |> refused | |
| | | |
| |PALPATION: | |
| |> refused | |
|MUSCULOSKELETAL |EXTREMITIES: (UPPER) |Has no complain |
| |INSPECTION: | |
| |> Full Range of Motion | |
| |> Bilaterally symmetrical | |
| |> Full and equal pulses | |
| | | |
| |(LOWER) | |
| |>Bilaterally symmetrical and equal | |
| |> Full Range of Motion | |
| |> without edema, bruising or lesions | |
| | | |
| |PALPATION: | |
| |> warm, non-tender | |
|NEUROLOGIC |LOC: alert, awake, responds appropriately |> Client loves to sing in front of the student |
| | |nurses to get their attention. |
| |APPEARANCE and MOVEMENT: |> Client has the habit preaching important |
| |Sometimes agitated, sometimes relaxed; coordinated |biblical phrases to the student nurses. |
| |movements, hyperactivity, neat and well-groomed |> Shared the I-S-D-A pneumonics to the student |
| |MOOD: |nurses. “I” stands for IDEA, S= Study, |
| |Responds appropriately to topic discussed. |D=decision and A= action. Explains that if one |
| | |has an idea in mind, she would study it first |
| |THOUGHTS PROCESS AND PERCEPTIONS: |before making important decisions and before |
| |Repetition and expression of illogical thoughts. |taking actions. |
| | | |
| |COGNITIVE ABILITIES: | |
| |Aware of self, others, place and time; sometimes doesn’t | |
| |listen attentively, correctly answers questions about | |
| |current day activities, recalls significant pat events. | |
| | | |
| |CRANIAL NERVE ASSESSMENT: | |
| |CN I (OLFACTORY): | |
| |Identifies scent correctly with each nostril | |
| | | |
| |CN II (OPTIC): | |
| |> Near vision: reads print at 14 in. without difficulty | |
| |>Peripheral vision: sees objects as it approaches from the | |
| |periphery | |
| | | |
| |CN III ( OCULOMOTOR), CN IV (TROCHLEAR) | |
| | | |
| |CN VI (ABDUCENS) | |
| |> Both eyes move in a smooth coordinated manner in all | |
| |directions, pupils equally round and reactive to light and | |
| |accommodation | |
| | | |
| |CN V (TRIGEMINAL) | |
| |> Identifies light touch; smiles, frowns, shows teeth, | |
| |blows out cheeks, raises eyes rows as instructed, facial | |
| |movements are symmetrical | |
| | | |
| |CN VIII (AUDITORY) | |
| |> gross hearing ability: | |
| |Can hear whispered words from 1 ft. and hear watch tic from| |
| |2 in. | |
| |Lateralization of Sound (WEBER TEST);vibrations heard | |
| |equally in both ears (RINNE TEST) AC>BC; | |
| |ROMBERG TEST: stands straight with minimal swaying | |
| | | |
| |CN IX (GLOSSOPHARYNGEAL) | |
| |Gag reflex present | |
| | | |
| |CN X (VAGUS) | |
| |Bilateral, symmetrical rise of soft palate and uvula, gag | |
| |reflex present | |
| | | |
| |CN XI (SPINAL ACCESSORY) | |
| |Symmetrical, strong contraction of sternocleidomastoid | |
| |muscle and trapezius muscles on opposite side that head is | |
| |turned. | |
| | | |
| |CN XII (HYPOGLOSSAL) | |
| |Symmetrical tongue with bilateral strength. | |

Gordon’s Typology of Health Patterns

A case of MissTambilina Tumbler, 39, Female, Single from Lapu-Lapu City, in for complaints of behavioural changes admitted due to Bipolar I Disorder Most Recent Episode Manic With Psychotic Features under Dr. Amaya

I. Health Perception health management Patern

In the rate of zero to ten, ten being the highest, patient rates her health at the rate of six since she experienced more fatigue before than she does now due to her work. The patient is aware of her condition and diagnosis, but is not certain about its specific cause. During her younger years she had hepatitis, she was only diagnosed but there was no admission to any health institution. The patient was addmitted to VCMC last 2005 for oophorectomy and was also a possible candidate for TAHBSO but was not initiated. Furthermore las 2006 she was admitted to the same institution for D and C since she experienced bleeding. She attributes her present condition due to her past lifestyle since she worked as a lady guard.

II. Nutritional-Metabolic Pattern

|PAST |PRESENT |
|According to the patient she was a “Frutarian”. She only used |According to the client she could no longer follow her previous|
|to eat bread, fruits and vegetable but also ate chicken. She |lifestyle since she is now admitted to VSMMC. Client’s choice |
|doesn’t eat rice, since it contains too much carbohydrates, |is limited and they are not given any option. They only eat |
|meat and fish. She used to have a garden that she tends to |food that is served for every meal. Their meals are usually |
|everyday after she wakes up in the morning. She also claims |composed of rice, mostly vegetables, and sometimes meat, chiken|
|that she had a make-shift fishpond on her backyard. She eats |or fish either sauteed, deep fried, boiled or with greated |
|three full meals a day. For breakfast she usually eats |coconut milk and drinks water as their beverage. The quantity |
|“kakanin” that she buys at the market. For lunch she eats |of water consumed now, is reduced to just five glasses each |
|vegetables and drinks water. For dinner she also eats |day. They seldom have snacks. If snacks are available, it is |
|vegetables, water and then drinks milk to help her sleep |usually served at in the morning since affiliating schools |
|whenever she has no work. She used to drink ten to fifteen |conduct their feeding programs during that time. But rarely |
|glasses of water each day, she usually drinks one bottle of |have them in the afternoon. |
|350 ml beer once a week. She doesn’t eat junk foods since it | |
|may only make you weak. | |

III. Elimination Pattern

|PAST |PRESENT |
|Client defecates once a day in regular intervals, she does not|Client defecates once a day, has no complaint of pain and any |
|complain about any difficulties in deficating and urinating. |difficulty in deficating, she also has no complaint of the |
|She urinates 6-8 times a day. And she does not sweat too much.|toilet facilities in the institution. She urinates 3-4 times a |
| |day with no complaints of discomfort. Client is in control of |
| |bladder and bowel movement |

IV. Activity-Exercise pattern

|PAST |PRESENT |
|Client claims to be an active person prior to admission. |According to the client as soon as she wakes up she takes a |
|According to her, as soon as she wakes up she usually eats |bath, have her exercise, clean the house and pray as a part of |
|breakfast, cleans the house, tend to her garden, and feed her |her daily routine. She usually acts as a facilitator and |
|fishes in the pond. Client has no other hobbies aside from |mediator among her co-patients. During the afternoon they watch|
|reading books and the Bible. She is a fan of biking, |the television on the mess hall, and spends siesta at around |
|marathons, and triathlons and performs these tasks alone. She |1pm-3pm. Has no complains of musculoskeletal impairment and |
|doesn’t play any ball games and other outdoor games. Client |shortness of breath. She participates in the morning strech and|
|has no complaint of muscle pain, doesn’t feel weak and |some other therapies |
|shortness of breath. And when she’s on work she usually stands| |
|during the entire 12 hour shift but takes short periods of | |
|rest. | |

V. Cognitive Pattern

The client is capable of reading and writing. She can respond well to any question, understands simple instructions and solves mathematical equations. Client is oriented to time, place and person. She responds appropriately to verbal and physical stimuli. Recent memory and remote memory are still intact. She manifests flight of ideas, delusions and thought process disturbance. This is manifested by the claims of the patient that she was a former manager, and that sharks invade her make-shift pond. She believes that she is a male. Abstract thinking and judgement is in good condition. The reason why she is bald is because of her belief that it is a sign of purity

VI. Sleep-rest pattern

|PAST |PRESENT |
| According to client she usually sleeps at around seven in the |Clientdoes not feel comfortable to sleep soundly since it is not |
|morning as soon as she gets home from work and sleeps until 5pm. |her home. She is bothered by the security of the place for the |
|She also believed in yoga and maditation as a form of having rest|gates might be open at any time. She also feels anxious of what |
|and relaxation. She doesn’t take any sleeping pill/s as a remedy |other patients might do to her. Client claims that she sleeps at |
|for sleeping difficulty that she apparently didn’t experience but|nine in the evening and wakes up at one in the morning. From |
|rather drinks milk or soya to help her fall asleep at times. Does|1am-3am, she claims to join the “Walk for Jesus crusade” From |
|drink energy giving beverage like Sting, Cobra, and Samurai and |three in the morning until five in the morning she prays to the |
|consumes a bottle of any during her work shift. |Holy Trinity, and after that, she then takes breakfast and attend|
| |to all of her other needs |

VII. Self-percetion-Self-concept Pattern

Despite of her condition the client stays positve just like before. During conversations she maitains good eye to eye contact, uses hand gestures to express her feelings and emotion. She perceives herself as simple, helpful, patriotic, and most of all God fearing and a unique creation of God. She is happy and thankful that she is at least still alive and is able to socialize with others despite her conditon.

VIII. Role-Relationship Pattern

|PAST: | PRESENT: |
|Client claims that she has problems with her parents as she |Now she acts as a facilitator in the psychiatric ward she |
|verbalized: “ako sila gi pa-uli dayon, Ug muadto sila sa |sometimes acts as a madiator. She helps in guarding the door and|
|akong balay.” She always stayed at home and lived her life |prevents other patients from picking with each other. Even up to|
|without her parents by the time she learned to be independent|this time she still not in good terms with her parents and |
|not even with the assistance of her brothers or any other |brothers, except for her brother Rogelio , whom she labeled “a |
|relative. She and her girlfriend broke-up with each othe last|white lamb of the family” as she was the “black sheep” She has a|
|August 2011. Her main issue was that she felt betrayed and |good relationship with her co-patients and the rest of the staff|
|used by her girlfriend. She used to help sustain with the |in the institution. |
|educational needs of her girlfriend’s children. She had a | |
|good and satisfying relatonship with her friends and | |
|colleagues. | |

IX. Sexuality-reproductive pattern

Client claims that she never had any sexual engagement with her girlfriend during their eight year relatonship. Due to her sexual preference she never had any sexual interaction with any male. She is no longer caple of bearing a child due to her previous opperations.

X. Coping-stress tolerance Pattern

|PAST |PRESENT |
|In times of stress and any difficult condition she used to |Being inside the mental institution she does not percieve it as|
|smoke cigarrette just to relive her feeling of anxiety. She |a stressor and thinks of it as an oppurtunity to help herself |
|also uses divertionary activities, rest recreation and |sometimes she would just feel weak but cracking jokes and |
|relaxation. She also used to read motivational books sometime |making fun of her self makes her feel better |
|during her break-up with her girlfriend. | |

XI. Value-Belief Pattern

The client verbalize of being God fearing and goes to churh occasionally on Sundays an a basis of two to three times a month since her work sometimes gets along in the way. She believes in one God, in Jesus Christ and the holy Trinity. She doesn’t pray before meals but prays before going to sleep. She doesn't believe in “tambalans” and never sought for their services.

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