PSYCHIATRIC CASE STUDY FORMAT

PSYCHIATRIC NURSING CASE ANALYSIS RECORD (PNCAR)-INITIAL

INTRODUCTION (Narrative overview of patient’s diagnosis based on book view)

OBJECTIVES

Within 72 hours . . .

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KNOWLEDGE:
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________
4._________________________________________________________________________
5._________________________________________________________________________

SKILLS:
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________
4._________________________________________________________________________
5._________________________________________________________________________

ATTITUDE:
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________
4._________________________________________________________________________
5._________________________________________________________________________

CASE ANALYSIS PROPER

I. ADMISSION INFORMATION

General Admission Information

Client’s initials _______________ Age _________ Gender _________ Marital status
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Name of significant other _____________________________ Contact number
______________
Residential address
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Pavilion-Unit
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Date & time of admission
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Initials of Attending Physician
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Conditions of Admission
Check one (1) only: Voluntary ( ) Involuntary ( )
Accompanied by (family, friend, police, other)
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Route of admission (ambulatory, wheelchair, trolley)
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Admitted from (home, other facility, street, OPD section)
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Other Significant Information upon Admission
Vital signs: Pulse ___________ BP _________ Respiration __________ Temperature
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Height ________ Weight ________ Race ____________ Dominant Language
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Orientation (person, place, time, situation)
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Discharge to: (home, facility, other) ____________________ Estimated length of stay
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Diagnosis: Upon admission
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Current
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Chief Complaint/s (as verbalized by patients or significant others/informant)
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II. BIOPSYCHOSOCIAL HISTORY ASSESSMENT

Predisposing Factors
I. Genetic/biologic influences (related to mental and other illnesses)
Structural assessment of the family:
Use a genogram as applicable: Family of origin/culture extended and present
family/significant persons. (Refer to prescribed format of genogram)
 Family of origin:

Present family (if married):

Family History
Family members (indicate if mental illness has affected other members from family of
origin; specify name of disorder)
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II. Family dynamics (describe significant relationships among family members)

Family living arrangement
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Type of neighborhood
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III. Health Care History

General health care
Regular medical check-up with a general practitioner or specialist (if so, frequency of visits &
date of last examination
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Cardiac /Renal/hepato-problems (Childhood illness such as: rheumatic fever, AGN etc., history
of heart attacks, strokes, or hypertension and liver disease)
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Diabetes and endocrine disturbances (Thyroid and adrenal function)

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Allergies, immunizations, Chest x-ray & ECG, & TB test

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History of Hospitalizations (When, why indicated, treatments, and outcome)

TYPE OF WHE REASONS FOR TREATMENT/ OUTCOM
HOSPITALIZATIO N HOSPITALIZATIO DIAGNOSTIC TEST E
N N TAKEN
A. MEDICAL

B. SURGICAL

C. OTHERS

Neurologic impairment (diagnosed brain problem, head trauma, details of accidents or periods
of unconsciousness for any reasons: blows to the head, electrical shocks, high fevers, seizures,
fainting, dizziness, headaches, falls and
others)_______________________________________________________________________
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Cancer (full history, any metastases: lung, breast, G.I. tract, kidney; results of treatments)
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Lung problems (Condition or event that restricts the flow of air to the lungs for more than 2
minutes or adversely affects oxygen absorption: COPD, near drowning, near strangulation, or
resuscitation events)
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Female:
Menstrual history
Age of menarche________Last menstrual Period______ Regularity and duration of
period_________
Presence of premenstrual syndrome: YES________NO_______

Impact on
Lifestyle:_____________________________________________________________________
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Concerns about sexuality:

Describe feelings about being a man or woman _____________________________________
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To whom is the client more attracted to? (Male or female)
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Reproductive history (Number of pregnancies, births, children & their ages; assess birth control
methods used if any) T (Term) P (Preterm) A (Abortion) L (Living Children)
Type of Use of Family Planning Remarks
Name Age
Delivery Methods (TPAL)

IV. Lifestyle
Eating (Unusual or unsupervised diets, appetite, weight changes, cravings, and caffeine
intake)
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Drug history assessment
Use of Prescribed Drugs: Current

Name Dosage Prescribed For Results/Effects

Use of Over-the-counter /Non-prescription Drugs

Name Dose/Amount Used Reason for Use Results/Effects

Use of herbal and/or alternative medicines

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Toxins (Overcome by automobile exhaust or natural gas; exposure to lead, mercury,
insecticides, solvents, cleaning agents, & garden chemicals)
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Occupational hazards (Current/past; chemicals in the workplace: farming pesticides,
paint solvents; work-related accidents; military experiences; stressful job circumstances)
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Injury (Contact sports & sports-related injuries; exposure to violence or abuse; rape or
molestation; risk for falls or skin breakdown)
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Impairment/Disability (Blind, deaf, missing extremities, & etc.)
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Use of assistive devices (Eyeglasses, hearing aids, dentures, canes, etc.)
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V. Socio-cultural History
Financial factors relevant to current adaptation (e.g. loss of income, poverty or
bankruptcy)
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Other significant environmental factors (describe)
Health beliefs and practices (describe)
Personal responsibility for health &
wellness:_____________________________________________________________________
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Ritualistic behavior/practices
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Religious/Spiritual values
Religious/spiritual values, beliefs & practices (describe)
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Educational history/background
Highest level of education attained
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Reasons for dropping out, transfer or quitting school (if applicable)
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Achievements during school days (curricular & extra-curricular)
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Occupational background
Current occupation:
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Other job interests:
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Previous jobs, work or
employment:__________________________________________________________________
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VI. Alcohol and Substance Use History

Explore possible client use of alcohol and drugs (to ascertain co-morbidity); history of
nicotine and caffeine should also be explored since these are aggravating factors of symptoms.
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History of Present Illness/Current episode or Precipitating Events

 Describe the situation or events that precipitated this illness/hospitalization which may
be negative (e.g., job loss) or positive (e.g., job promotion); include development of symptoms
from onset & duration until admission; changes in somatic functioning (sleep pattern, appetite,
cognitive ability, sexual functioning) should be noted.
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History of Psychopathology
Information concerning client’s past psychiatric illness which may be a single event,
chronic, or intermittent; indicate if there is improvement or deterioration in relation to current
episode.
Client
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III. PHYSICAL ASSESSMENT

Review of Physiological systems. Indicate with a () mark OR give a specific description.
Skin: Warm _____ Dry _____ Moist _____ Cool _____ Clammy_____ Pink _____
Cyanotic _____ Poor turgor _____ Edematous _____ Evidence of Rash _____
Bruising _____ Needle Tracks _____
Hair and scalp: Hirsutism _____ Loss of hair _____
Nails: (condition) ____________________________________________________________
Eyes: Glasses ___ Contacts ___ Swelling ___ Discharge ___ Itching ___ Blurring ___
Double Vision ___ Other observations
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Ears: Pain ___ Drainage ___ Hearing Difficulty ___ Hearing Aid ___ Tinnitus___
Nose: (discharge)
________________________________________________________________ Mouth:
(lesions) _________________________________________________________________
Neck: (lumps)
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Respiration: Normal _______ Labored _______ Rate ______ Rhythm ___________________
Breast: Pain/Tenderness
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Swelling ______________________________ Discharge
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Lumps _____________________________ Dimpling ________________________
 Practice self -breast examination? __________ Frequency
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Cardiovascular status:
Blood Pressure (usual) ______ Pulse (usual) ______
History of: (Check all that apply)
Hypertension ___ Palpitations ___ Heart Murmur ___ Chest Pains ______________________
Shortness of breath ____ Pain in legs___ Phlebitis ___ Ankle/leg edema
______________ Numbness/Tingling in extremities _________________Varicose veins
________________
Other significant observations
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Gastrointestinal status:
Usual diet pattern _____________________________________________________________
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Food allergies
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Dentures: Upper: ___ Lower ___ Problem with chewing/swallowing ____________________

Problem with:
Indigestion/Heartburn______________________________ (If yes, relieved by)
______________
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Nausea/Vomiting _______________________________ (If yes, relieved by) _____________
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Loss of appetite ________________________________ (Measures taken) _______________
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History of Ulcers
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Usual bowel pattern
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Constipation ___ Diarrhea ___ Type of self-care assistance provided for either of these
problems:
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Genitourinary/Reproductive status:
Usual voiding pattern
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Frequency ______________ Urinary hesitancy _____ Nocturia _____ Pain/burning _____
Incontinence ____________________________________________________________
Any Genital lesions_____________________________________________________________
Discharge____________________________ Odor _______________________________

Musculoskeletal status:
Weaknesses ___ Tremors ___ Describe ____________________________________________
Degree of range of motion (describe limitations, if applicable) _______________________
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Pain (describe) ______________________________________________________________
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Coordination (describe limitations, if applicable)
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Skeletal Deformities (describe, if applicable)
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Medication side effects (What symptom(s) is/are the client experiencing that may be attributed
to current medication usage?
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Altered laboratory test values and possible significance (If applicable)
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Activity/rest patterns
Exercise (type, frequency, duration)
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Leisure activities
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Pattern of sleep:
Number of hours per night _____
Use of sleeping aids (music, etc.)_________________________
Insomnia ________________________Hypersomnia _________________________________
Reversal of sleep pattern
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Patterns of awaking during the night
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Feel rested upon awaking?
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Personal hygiene/activities of daily living (ADL):
Patterns of self-care:
Independent___________________________________________________
Requires assistance with:
Mobility ____________________________ Feeding ________________________________
Hygiene ____________________________ Dressing _______________________________
Toileting ___________________________ Other __________________________________
Refusal to eat ______________ Reason __________________________________________
Statement describing personal hygiene and general appearance:
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Other pertinent physical assessment not previously mentioned
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IV. MENTAL STATUS EXAMINATION
Underline as many criteria under each category as applicable to the client
General Appearance
Cooperative Uncooperative Bored
Angry
Unkempt Well-groomed Heavily made-up
Younger looking than age
Older looking than age Tense posture Relaxed Underweight Overweight

Bizarre behavior observed (Describe postures or psychomotor activity)

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Emotions: Mood/Affect
Happy Sad Anxious Frightened
Angry Elated
Euphoric Apathy Flat Blunted
Inappropriate Labile Depressed

Congruity of mood/affect (Describe how manifested)

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Speech
Clear Coherent Slurred Speech Incoherent
Neologisms
Loose association Flight of ideas Aphasic Perseveration Verbigeration
Rumination Tangential Circumstantial Slow
Impoverished Speech logorrhea

Describe the speech

pattern_______________________________________________________________________
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Speech Impediment (Describe if applicable)

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Other observations
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Thought Content
Delusional Obsessive Homicidal
Suicidal
Suspicious

Describe and support the underlined thought

content_______________________________________________________________________
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Thought Process
Clear Logical Illogical Easy to follow

Relevant Confused Blocking Rapid flow of thought

Loose association Circumstantial Concrete thought
process Capable of abstract thought
Describe and support the underlined thought process
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Perceptual Disturbances
Illusions Hallucinations Depersonalization
Derealization
Describe and support the underlined perceptual disturbances
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Impulse Control
Describe client’s ability to delay, modulate, or inhibit the expression of behaviors and feelings
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Cognition and Sensorium
Level of consciousness
Conscious ______________ alert and awake___________
Stuporous _________
Drowsy ________________ confused_________________ lethargic
___________ Responds to external stimuli________

Memory

Immediate: ___ Loss ___ Intact Remote: ___Loss ___ Intact Recent: ___ Loss ___ Intact

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Focus/Concentration
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Orientation Encircle Y or N (Yes or No).

Oriented to a. Time: Y N b. Person: Y N c. Place: Y N d. Situation: Y N

Describe other significant observations

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Knowledge and Judgment
Describe client’s answer to a hypothetical question (What will you do if you find a fifty
peso bill while going around SM?)
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Insight

Client’s perception of illness and expectations of hospitalizations.

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V. PSYCHOLOGICAL TESTS
Document results of psychological tests that were administered to the client (If any).
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VI. COPING AND ADAPTATION RESPONSES

Current resources
Growth and stages of development (Based on Freud’s, Erickson’s, Sullivan’s Theories-
whichever is/are applicable)
Theoretical explanation
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Actual behavior
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A. Previous patterns of coping with grief and stress

Significant losses / changes /grief responses. (Generally, how does the client respond to
loss of significant persons, opportunities, relationships, & etc?)

Consider the following elements:

• How does the client solve his/her problems?
• Classify each into Adaptive, Palliative, Maladaptive, or Dysfunctional
Mark with a () and Identify: (may be several)
Pattern of Coping with Stress Classification
____ Fight or flight _________________
____ Dependence on other’s decision _________________
____ Acceptance of fate or destiny _________________
____ Use of physical illness _________________
____ Blaming others/self _________________
____ Use of problem-solving coping skills _________________
B. Situations where and how patterns of coping were applied
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Support systems (before and during admission)
Family
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Friends
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Community
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Economic security (sources of family income, assistance from relatives)
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Role contributions and responsibility for others (family, job, community)
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Adaptation responses
A. Psychosocial responses
1. Level of anxiety (Underline particular level and the behaviors that apply to it)

MILD MODERATE SEVERE PANIC

Calm Friendly Passive Perceives environment
correctly Cooperative Impaired attention “Jittery” Unable to concentrate
Hypervigilant Tremors Rapid speech Depersonalization
Disoriented Fearful Confused Hyperventilating

Obsessions Compulsions Alert Withdrawn

Misinterpreting the environment (hallucinations/delusions) Somatic complaints
Excessive hyperactivity

Other behaviors (Describe):

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2. Ego defense mechanism (Underline as many as applicable)

Projection Suppression Undoing Displacement

Intellectualization Denial Rationalization Repression
Reaction formation Fantasy Religiosity Sublimation
Compensation Symbolization Introjection Regression
Conversion Denial Fixation Identification
Substitution Isolation Splitting (Dissociation)
Describe how the identified responses are used by the client
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3. Level of self-esteem: (Underline one) LOW MODERATE HIGH
Characteristics that the client likes about self
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Characteristics that the client would want to change about self

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Objective assessment of self-esteem

Eye contact ______________________________
General Appearance ____________________________________________________________
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Participation in group activities and interaction with others (in general)

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4. Stage and manifestation of grief over life changes (impaired psychosocial functioning)
Underline one (1) only.

DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE

Describe client’s behaviors that are associated with this stage of grieving in response to
loss or change
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B. Physiologic responses
Psychosomatic manifestation
Describe any somatic complaint that may be stress-related; e.g., pain: chest pain,
headache, other anatomical pain or discomfort, etc. (onset, location, quality, intensity, origin;
scale of 1-10: 1-3, mild; 4-6, moderate; 7-10, severe); relieved by/worsened by use of
prescribed/over-the counter drugs)
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VII. DIAGNOSES AND INTERVENTIONS
Integrating Nursing Diagnosis and Interventions with DSM-IV-TR Diagnosis

A. Nursing Diagnosis
Actual Nursing Problem
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Potential Problem
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B. Formulate Nursing Care Plan (from the identified nursing diagnosis, please use separate
sheet)

C. Formulate Discharge Plan (Use separate sheet)

VIII. EVALUATION OF PSYCHOTHERAPEUTIC AND OTHER INTERVENTION Evaluation of NPR (Initial,

Working, Termination Phases)
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Responses of Client to Different Therapeutic Activities
Music and Art Therapy through Art Appreciation
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Remotivation Therapy
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Occupational Therapy /Arts and Craft

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Play Activity
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Other Activities
Food Preparation
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Dance Therapy
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Newspaper Reading
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Community Singing
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Calisthenics
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References: (Use APA format)