1. What What is the the titl titlee of the the mov movie ie? ? •
Notebook. This romantic drama film was directed by The movie is entitled The Notebook. Nick Cassavetes based on the novel of the same title by Nicholas Sparks. It starred Ryan Gosling and Rachel McAdams as young couple who fell in love during the 1940s. 1940s. their love love story was narrated narrated from from the present present day by James Garner to his fellow nursing home resident, played by Gena Rowlands.
2. Wh Who o is is the the char charac acte ter? r? •
I have chosen the character played by Gena Rowlands and Rachel McAdams which was Allie Hamilton, a free-spirited and wonderful woman who fell in love with Noah Calhoun until fate decided to take its own course.
3. What are the the obser observed ved signs signs and and symptom symptoms? s? •
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The The signs signs and and symp sympto toms ms obser observe ved d were were memo memory ry loss loss,, chang changes es in mood mood or behavior like restlessness, irritability and lethargy with short attention span. Increasing and persistent forgetfulness, especially of recent events or simple directions, what begins as mild forgetfulness persists and worsens. These weren’t shown in the movie but are stated in the novel. Allie had difficulty finding the right word to express her thoughts or even follow conversations. She displayed disorientation to time and dates as ev idenced by finding herself lost in familiar surroundings like the nursing care home.
4. What do you think is the diagnosis? •
According to the novel and based form the client’s exhibited signs and symptoms, the diagnosis would be Alzheimer’s disease.
5. What predisposes the client’s condition? •
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Age is the most important risk factor. As we age, our body's ability to repair itself becomes less efficient. The extent by which the self-repair of our brains diminishes varies from person to person and these differences contribute to an individual's susceptibility to Alzheimer's disease as they age. As well, many of the other known risk factors for the disease tend to increase with age (such as elevated cholesterol and being overweight). The older you become the higher the risk. Alzheimer's usually affects people older than 65, bu t can, rarely, affect those younger than 40. Less than 5 percent of people between 65 and 74 have Alzheimer's. For people 85 and older, that number jumps to nearly 50 percent. Twice as many women get Alzheimer's disease than men. Many believe that it is in a large part a result of the changes to women's hormones at menopause, in particular the decline of the important hormone estrogen. In the past estrogen was often prescribed to relieve symptoms of menopause and to reduce the risk of developing Alzheimer's disease. However, a fairly recent large-scale clinical study recommended discontinuation of Hormone Replacement Therapy (HRT) because of potentially dangerous side effects. A number of clinical researchers regard HRT as worthy of further study especially in the context of Alzheimer's
6. What are the priority nursing problems? NURSING PROBLEM
Disturbed Thought Processes related to Organic mental disorder specifically primary degenerative disease (Alzheimer’s disease) as manifested by altered perceptions of surrounding stimuli, confusion, disorientation, inappropriate social behavior, and altered mood states.
Self Care Deficit
RANK
1
JUSTIFICATION
This is an actual problem and is considered as a health-threatening one. The problem ranked first since the client cannot function well as a normal and healthy adult. The mental disorder she acquired caused her to be somewhat withdrawn from the environment that surrounds her. This problem needs to be solved so that the client can function well and be able to perform her roles as an individual such as maintenance of personal hygiene, proper nutrition, etc.
This is the second prioritized nursing problem, because this is an actual
solved.
satisfying sense of social engagement. Risk for Violence: Selfdirected related to cognitive impairment as evidenced by suspicion and inability to recognize people or places.
4
This is not an actual problem.
Risk for Injury related to psychological factors such as orientation and affect as evidenced by wandering behavior and mood changes such as sudden outbursts of anger.
5
This is not an actual problem.
7. Make a nursing care plan of one of the identified problems.
CUES
Subjective:
“go away from me!” “ I don’t who you are! What are you gonna do with me!” as verbalized by the client.
Objective:
Observed disorientation time, person, place, and situation. Altered behavioral patterns (regression, poor impulse control) Altered mood states
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NURSING DIAGNOSIS Disturbed Thought Processes related to Organic mental disorder specifically primary degenerative disease (Alzheimer’s disease) as manifested by altered perceptions of surrounding stimuli, confusion, disorientation, inappropriate social behavior, and altered mood states. .
ANALYSIS
GOAL
Alzheimer’s disease (AD) is a degenerative disorder of the brain that is manifested by dementia and progressive physiological impairment. It is the most common cause of dementia in the elderly but is not a normal part of aging. Dementia involves progressive decline in two or more of the following areas of cognition: memory, language, calculation, visual-spatial perception, judgment, abstraction, and behavior.
After nursing interventions, the client will be able to demonstrate reality-based perceptions, as evidenced by decreased verbalizations of hallucinations and delusions and decreased threats to self and others.
NURSING INTERVENTIONS
Assess and observe patient’s ability to verbalize own needs and trust those around him or her.
RATIONALE
EVALUATION
1.
Dementia of the Alzheimer’s type (DAT) accounts for approximately half of all dementias. The
2. Assess patient’s communication patterns. Observe for the presence of delusions and/or hallucinations.
1.
Determines the ability to participate in planning or executing care.
2.
Determines patient agitation and response level.
3.
Client may respond with anxious or aggressive behaviors if startled or overstimulated.
4.
Validation of patient’s needs, thoughts, and perceptions will encourage trust and openness.
3. Maintain a pleasant, quiet environment and approach client in a slow, calm manner. 4. Encourage patient to communicate own thoughts and perceptions with
After nursing interventions, the client was able to demonstrate reality-based perceptions, as evidenced by decreased verbalizations of hallucinations and delusions
and decreased threats to self and others.
(hostility, irritability, inappropriate affect) Impaired ability to perform selfmaintenance activities (grooming, hygiene, food and fluid intake) Altered sleep patterns
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Altered perceptions of surrounding stimuli
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average time from onset of symptoms to death is 8 to 10 years. The pathophysiological changes that occur in DAT include the following: (1)Presence of neurofibrillary tangles, neuritic plaques, and amyloid angiopathy; ( 2) Accumulation of lipofuscin granules and granulovacuolar organelles in the cytoplasm of the neurons; (3) Structural changes in the dendrites of the neurons and in the cell bodies; (4) Predominant neuronal degeneration in the cortical association areas of the basal ganglia; (5) Gross cortical atrophy and widening of the sulci;
significant others in the environment 5. Clarify patient’s misperceptions of events and situations that may result from memory impairment. Orient to time, place, person, and situation as needed
5.
6.
The patient’s ability to orient himself or herself may be impaired by memory loss.
7.
Anxiety may impair patient’s ability to communicate, problem solve, and reason.
8.
The patient’s safety is a priority. The patient may be unable to accurately assess potentially dangerous items and situations such as wet floors, electrical appliances, and
6.
7.
Minimize situations that provoke anxiety.
8. Provide protective supervision
Clarification is necessary and more easily accepted when offered in a respectful manner.
verbal threats from other patients as a result of severe impairment in judgment.
(6) Enlargement of the ventricles; and (7) Decrease in neurotransmitters (acetylcholine, dopamine, norepinephrine, serotonin), somatostatin, and neuropeptide substance P.
9.
If patient is experiencing delusional thinking, assist him or her in recognizing the delusions. Acknowledge the delusions without agreeing to the content of the delusions.
9.
10. Identify and remove potentially dangerous items in the environment.
Delusions can be anxiety provoking and distressing for patient. It is important to acknowledge this distress but to convey that one does not accept the delusions as real
10. Interview
clients in a private area while maintaining staff safety. Nursing staff should sit closest to the door 11. A
quiet environment
11. Stay with clients if they are agitated and likely to be injured.
with the presence of another person can calm an agitated client. One-on-one contact from staff to patient is the first step is successful deescalation 12. Client may feel
threatened and may withdraw or rebel.
12. Refrain form forcing activities and communications.
