Ella and (Husband) had always been inseparable, but when David landed an exciting job overseas, their

worlds shifted. Despite her love for him, Ella encouraged him to seize the opportunity. Months after his
departure, Ella fell seriously ill and found herself in the hospital, missing (Husband) deeply.

 Explain the procedure: So, today ma’am I will going to assess you and interview you, all you
need to do po is makicooperate and answer my questions promptly po. I’ll make sure na lahat po
ng information na makukuha ko from you will going to be confidential to which tayong dalawa
lang ang makakaalam and I promise po na you can trust me, okay lang po ba?
 What do you like me to call you?

A. GENERAL INFORMATION
1. May I know your full name?
2. How old are you po?
3. When is your birthday?
4. Your address?
5. Your marital status po?
6. Chief Complaint
- May I know po, what brings you here today ma’am? Andami kong iniisip, nagooverthink ako
that’s why most of the times I’m not able to get enough sleep and napapansin ko na nababawasan
yung appetite ko ever since nawala yung asawa ko kasi nangibang bansa siya para magwork po.
 Ah okay po, so clarify ko lang, this was just started since nangibang bansa yung mister mo? Opo,
kasi may longiness ako, sobra ko siyang namimiss to the point na minsan nagooverthink na ako,
what if ipagpalit niya ako.
 Can you remember po yung dati niyong kilo in contrast sa present weight mo po? Nasa 55 po ako
dati ngayon 48 nalang po

B. PSYCHIATRIC NURSING HISTORY

1. Medical/Psychiatric History
 Do you have any family member that consult to psychiatrist before? Wala naman po
2. Social Functioning?
 How was your interaction to other people? Madalas mas gusto ko ng mapag-isa which is dati
hindi naman
3. History of Present Illness?

 How did you start feeling this way?

 Do you stare into nothing?
 Do you feel alone?

4. DEVELOPMENTAL HISTORY
 Do you remember what happened to you when you were a child?
a. Prenatal history
 How was your mother when she was pregnant with you? did she have any problems or
complications? Wala naman po, normal naman daw po ako nun at walang kahit na anong
komplikasyon.
 Did they plan when she got pregnant with you or was it just unexpected that they thought it
should be next year but suddenly you came with a blessing? According to my mother, yes po nag
family planning daw po sila ng papa ko.
b. Toddler or early childhood
Eating Problems:
• How about your mother's feeding habits when you were a baby, is it breast feed or bottle feed?
Nag breast feed daw po siya sakin for 2 years.

Early Development
• Did you ever have eating problems when you were a child? You don't want to eat even fruit?
Wala po magaling akong kumain nung bata ako, kahit ano daw pong ipasaubo sakin dati gusto ko
• How old were you when you started walking? Nasa 1 year old po
• When did your teeth start growing? Diko na po masyadong maalala pero ang nakwento ng
nanay ko nasa mga 6 months ako nun, nung nagsisimula na akong kumain

Language Development
• How about in talking, when did you start saying words? Nasa mga 1 year and 6 months po

Motor Development:
 When did you start to hold things? Diko na po maalala
 When did you start crawling? Hindi ko na po maalala

Sign of unmet needs:

 Do you feel unwanted? Unloved?

Sleep Pattern:
Are you a morning person or a night person? Hindi ko na po madetermine kasi di na din po ako
nakakatulog kakaisip

Object Constancy:
If your mother or father leave you, do you still feel that she is still your mother? Oo naman po

Strange Anxiety:
Are you afraid of other people or someone that is not close to you? Opo lalo na sa mga bigla
bigla nalang kakalbit

Symptoms of behaviour problems:

 •When you were young, did you like to thumb suck? Yes po
 •When you didn't get the toy you wanted, did you get angry and cry when you were a child?
Hindi po, kasi dinisiplina ako ng mga magulang ko na kung ano lang ang meron dapat matuto
kaming i-appreciate yon
 Do you experience ticking and head banging? Hindi din po
 Do you have any fear? Itong nararamdaman ko po ngayon takot po akong mapalitan
 Did you experience bed soiling?
Personality as a child

 • How was your personality when you were young; are you overactive, shy or restless?
Medyo mahiyain po
 • Did you often dream when you were a child? Opo

Middle childhood

 How is your feelings towards going to school? Okay naman po, actually honor student po
ako dati
 How do you feel about your gender po, are you happy and contented po ba? Oo naman po
 How do you deal with a thing if you did something wrong? Makokonsensya po ako
hihingi po ako ng sorry
 • How were you disciplined when you were a child, did your parents punish you as a way
of disciplining you? Yes po, pinapa face the wall po ako, but hindi naman ganon katagal
maybe 15 minutes lang ganon po
 How are your friends treating you? Syempre hindi naman maiwasan yung pang jujudge
sa isa’t isa, pero so far ok naman ako sakanila.
 Did you ever experience po to have nightmares? Hindi naman po, wala
 How about phobias, do you have fear of animals po, heaights, needles? Yes may phobia
ako sa rats and snakes
 Ilang taon ka po nung natuto ka ng umihi sa cr, yung kahit sa gabi nagigising ka to go to
cr kasi di kana nagddiapers? I think nung mga 3 years old po ako kasi di na ako umiihi sa
higaan namin eh even though wala akong diapers
 Do you like pets? Yes super, I have a lot of pets in our house mostly mga aso

Later Adulthood

 How about in your social relationships po, such as bonding with friends? Okay naman po, I
hang out with my friends before pero madalas ngayon parang mas gusto ko nalang yung
napag- iisa ako gaya nga ng sabi ko kanina. I don’t even know why.
 Do you have siblings po? Yes po , dalawa
 How’s your relationship towards them? We are all good naman, lahat kami nagkakasundo
 If you rate, how many do you think are your close friends? Ahm.. nasa 8 or 10 po yung mga
talagang close friends ko
 In your own opinion po, what is your ideal popularity? For me to dati ha, pero ngayon I’m
not interested na with popularity siguro ganon talaga noh, as we grew older wala na sa isip
natin yang mga yan. Pero btw, before, para sakin I want to be popular in a way na
nakakasabay ako sa mga trends, and kapag madaming nakakilala sayo not just in personal but
also sa social medias mo.
 Do you participate in any group activities po? Nope, hinde
 • Is there a time when you become aggressive, in a way that you lose your temper, especially
when you miss your husband? Hindi naman po, umiiyak lang ako pero di ako nagwawala
  • How about anxiety, have you experienced it? The feeling that you are very exhausted and
then you always panic every time you do something? Yes po lagi, kaya di ako
nakakapagfocus sa mga gawaing bahay
 With regards to your studies before Ms. , how is your relationship with your teachers or
classmates? We’ll as I’ve said, I’m a consistent honor student in my elementary and
highschool before, and there is no problem with regards to my teachers kasi lahat naman sila
mababait same with my classmates.
 Do you engage in any extracurricular activities before? Oo nung elementary ako. Badminton

Adolescent problems:

 When you were a teenager, did you often get a guidance counselor? Yes one time
 May I know po what’s the reason if it is? Yes sure. I have this friend of mine kase and then
may hindi kami pagkakaintindihan that’s why napunta sa awayan until napaguidance
counsellor kami. But that was just one time, hindi na naulit.
 Do you have any vices? Such as smoking and drinking alcohol? Hindi siya bisyo, umiinom
lang ako ng alak kappag may special occasions.
 When you were an adolescent, how was your appetite? Malusog ako dati, “chubby” ika nga
nila. Pero as I grew older medyo pumayat ako and then mas lumalala this past few months
kasi kung ano-ano iniisip ko, ayun tuloy nawawalan ako ganang kumain.
 How about sa self perception niyo po, are you contented of what you are right now? Yes po, I
don’t have any insecurities in myself. Sobrang kontento ako sa kung anong binigay ng diyos
sakin.

Psychosexual History

 May I ask for your consent if it’s just alright to ask you about your psychosexual history? Yes,
we’re both matured naman na it’s no big deal.
 When do you think your puberty started, to which you feel arousal? I can’t remember na yung
exact eh, but nasa elementary palang ako that time before ako nagkaroon ng first menstrual
period.
 Since you have kids na po, may I ask if how is your attitude toward having sex with your
husband; are you being aggressive, shy or timid po? Nung una po nahihiya pa ako sa asawa ko
pero nung tumagal hindi na po. I’m not aggressive tho, I think we are both intimate about having
sexual intercourse
 Have you ever been in sexual contact sa kapwa mo po babae? NO, Hindi po
 How about po in sexual contact with more than one partner at the same time? Nope, hinde. Yung
asawa ko ang first ko.
 MENTAL STATUS EXAMINATION

 A. History
Has the client experienced similar difficulties in the past?

Has the client been admitted in the hospitals before? Reasons for confinement:

Is there a family history of alcoholism? ____________________________________________

Bipolar disorder:_______________________ Suicide attempts: ________________________

B. GENERAL APPERANCE AND MOTOR BEHAVIOR:

Is the properly dressed, unkept and disheveled? ___________________________________
Does the client appear to be his/her stated age? _____________________________________
Assess for automatisms: _________ waxy flexibility: ______________________________
Psychomotor retardation: ______________________________________________________

C. SPEECH
Is the client talk non- stop:________________________________________________________
Does the client perseverate: (Seem to be stuck on one topic and unable to move to another idea:

Are the responses ” yes or no” without elaboration? __________________________________

Is the rate of speech fast/ slow? __________________________________________________
Is the tone audible or loud: ______________________________________________________
Does the client use neologisms? _________________________________________________
Is there any lisping or stuttering in the speech? ______________________________________

D. MOOD AND AFFECT:

(Take note of the client’s gestures, tone of voice, facial expressions and posture)
Assess the client’s mood: happy? Sad? Presence of mood swings?_________________________
Is the client’s affect flat? Blunted? Inappropriate? Restricted? __________________________

E. THOUGHT PROCESS AND CONTENT:

(Check if any of these items are observed from the client)
_ Circumstantial thinking:
_ Delusions: (grandiosity, Persecution, Religious, Paranoid)
_ Flight of ideas
_ Ideas of reference
_ Loose associations
_ Tangential thinking
_ thought blocking
_ thought broadcasting
_ thought insertion
_ thought withdrawal
_ word salad
F. ASSESSMENT OF SUICIDE OR HARM TOWARDS OTHERS
Ask the client directly: Do you have thoughts of suicide?
If the client said yes, How do you plan to kill yourself?_________________________________

How would you carry out the plan? _______________________________________________

Where would you kill yourself? __________________________________________________
When? Day/ Time?______________________________________________________________

G. SENSORIUM AND INTELLECTUAL PROCESS:

1. MEMORY ( testing the client’s memory both recent and remote)

What did you do yesterday? _________________________________________________
What are the names of your parents? __________________________________________
What is your birthday? _____________________________________________________

2. ABILITY TO CONCENTRATE:
Make the client do the following:
a. Spell your name backwards
b. Begin counting from 30-1
c. What are the days of the week?

3. ABSTRACT AND INTELLECTUAL ABILITIES:

Ask the client to explain a proverb “ Kung ano ang puno ay cya ang bunga”
Is there evidence of abstract or concrete thinking?
Why? __________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

4. SENSORY/ PERCEPTUAL ALTERATIONS:

Hallucinations
Auditory_____
Visual _____
Olfactory __
Tactile ____
Gustatory _

5. JUDGMENT AND INSIGHT:

Ask the client what she will do if she found a wallet on the ground, what will be the next thing/s
she will do? _______________________________________________________
_______________________________________________________________________
Insights: What do you think about your illness? ________________________________
What do you think about your medications? ____________________________________
________________________________________________________________________

6. SELF CONCEPT:
Ask: What do you think of yourself? __________________________________________
_______________________________________________________________________

7. ROLES AND RELATIONSHIPS:

Do you feel close to the family? _____________________________________________
Do you have relationship or want to be with someone else? _______________________
_______________________________________________________________________
Can you meet your sexual needs satisfactorily? _________________________________
Have you been involved with abusive relationships before? _______________________
_______________________________________________________________________
Can you tell us what happened? _____________________________________________
_______________________________________________________________________

8. PHYSIOLOGIC AND HEALTH CARE

Can the client eat well? ___________________________________________________
Can he client sleep well? __________________________________________________
Grooming patterns? ______________________________________________________
Taking Medications? _____________________________________________________