1. What is the title of the movie?

• The movie is entitled The Notebook. This romantic drama film was directed by
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. their love story was narrated from the present day by James
Garner to his fellow nursing home resident, played by Gena Rowlands.

2. Who is the character?

• 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 observed signs and symptoms?

• The signs and symptoms observed were memory loss, changes in 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 evidenced by finding herself lost
in familiar surroundings like the nursing care home.
• She exhibited signs of difficulties performing familiar and routine tasks that
require sequential steps.
• She experienced personality changes. This was clearly shown when she was with
Noah during their dinner together when she suddenly had her mood swings as
evidenced by her, not trusting or even knowing who Noah was.
• She also showed signs like aimless wandering, decreased interest in usual
activities, and contentment in sitting and watching others.
• She also was suspicious or fearful of people just like when the nurses in the
nursing home care tried to care for her but she refused to be taken cared of.
• She also had sudden angry outbursts during their dinner when she had another
attacks of Alzheimer’s.
• She also lacked interest of mealtimes, denied having been hungry, was dependent
on the nurses to meet her basic hygiene needs
• Has progressive loss of remote memory and doesn’t want to engage in social
conversations.
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?

• 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, but 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
disease. Any decision regarding the use of HRT should be made in consultation
with a physician.
• Your risk of developing Alzheimer's appears to be slightly higher if a first-degree
relative — parent, sister or brother — has the disease. Although the genetic
mechanisms of Alzheimer's among families remain largely unexplained,
researchers have identified several genetic mutations that greatly increase risk in
some families.
• People who have mild cognitive impairment have memory problems that are
worse than what might be expected for people of their age, yet not bad enough to
be classified as dementia. Many of those who have this condition go on to
develop Alzheimer's disease.
• The same factors that put you at risk of heart disease may also increase the
likelihood that you'll develop Alzheimer's disease. Examples include: High blood
pressure, High cholesterol and Poorly controlled diabetes
6. What are the priority nursing problems?
NURSING PROBLEM RANK
Disturbed Thought
Processes
related to
Organic mental disorder
specifically primary
degenerative disease
(Alzheimer’s disease)
as manifested by altered
1 withdrawn from the environment that
perceptions of surrounding
stimuli,
confusion, disorientation,
inappropriate social
behavior, and altered mood
states.
Self Care Deficit
related to
cognitive impairment
as evidenced by inattention
and inability to complete
2 the physiological needs of a person
activities of daily living
(ADLs).
Impaired social interaction 3 This is the third prioritized problem
related to communication
barrier secondary to
Alzheimer’s Disease as
evidenced by discomfort in
social situations and
inability to receive a
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
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
problem. And according to the Maslow’s
Hierarchy of needs, this is included in
which are given the most priority among
all the needs. This is also ranked second
because if the client’s thought processes
will be solved, her inability to care for
herself will also be solved.
because this is not life-threatening. If the
problem regarding thought process will
be solved, and if the client has calmed
and become oriented with his
surroundings, this problem regarding her
interaction with other people will be
 solved.
satisfying sense of social
engagement.

Risk for Violence: Self-

directed related to cognitive
impairment as evidenced by
suspicion and inability to
4 This is not an actual problem.

recognize people or places.

Risk for Injury related to

psychological factors such
as orientation and affect as
evidenced by wandering
behavior and mood changes
5 This is not an actual problem.

such as sudden outbursts of

anger.
 7. Make a nursing care plan of one of the identified problems.

NURSING NURSING
CUES ANALYSIS GOAL RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS

Subjective: Disturbed 1. Assess and

 “go away Thought Alzheimer’s disease After nursing observe patient’s 1. Determines the After nursing
Processes (AD) is a degenerative interventions, ability to verbalize ability to interventions,
from me!”
disorder of the brain the client will be own needs and participate in the client was
 “ I don’t related to planning or
that is manifested by able to trust those around able to
who you Organic demonstrate executing care.
dementia and him or her. demonstrate
are! What mental progressive reality-based reality-based
are you disorder physiological perceptions, as perceptions, as
specifically impairment. It is the evidenced by 2. Assess 2. Determines evidenced by
gonna do
primary most common cause decreased patient’s patient agitation decreased
with me!” as
of dementia in the verbalizations of communication and response verbalizations of
verbalized degenerative
elderly but is not a hallucinations patterns. Observe level. hallucinations
by the client. disease
normal part of aging. and delusions for the presence of and delusions
(Alzheimer’s and decreased
Dementia involves delusions and/or and decreased
Objective: disease) progressive decline in threats to self hallucinations. threats to self
as manifested two or more of the and others. 3. Client may
and others.
•Observed by altered following areas of respond with
3. Maintain a
disorientation perceptions of cognition: memory, anxious or
pleasant, quiet aggressive
time, person, surrounding language, calculation,
environment and behaviors if
place, and stimuli, visual-spatial
perception, judgment,
approach client in startled or
situation.
confusion, a slow, calm overstimulated.
•Altered abstraction, and
behavioral disorientation, behavior. manner.
patterns inappropriate 4. Validation of
(regression, social Dementia of the 4. Encourage patient’s needs,
poor impulse behavior, and Alzheimer’s type patient to thoughts, and
control) (DAT) accounts for communicate own perceptions will
altered mood
•Altered mood approximately half of thoughts and encourage trust
states. and openness.
states all dementias. The perceptions with
.
 (hostility, significant others
irritability, average time from in the environment 5. Clarification is
inappropriate onset of symptoms to necessary and
affect) death is 8 to 10 years. 5. Clarify more easily
•Impaired The accepted when
patient’s
ability to pathophysiological offered in a
misperceptions of
perform self- changes that occur in respectful
maintenance events and manner.
DAT include the
activities following: situations that may
(grooming, result from
hygiene, food (1)Presence of memory 6. The patient’s
and fluid neurofibrillary tangles, impairment. ability to orient
intake) neuritic plaques, and himself or herself
•Altered sleep amyloid angiopathy; ( 6. Orient to may be impaired
patterns time, place, by memory loss.
2) Accumulation of person, and
•Altered lipofuscin granules situation as needed 7. Anxiety may
perceptions and granulovacuolar impair patient’s
of organelles in the ability to
surrounding cytoplasm of the communicate,
stimuli neurons; problem solve,
7. Minimize and reason.
situations that
(3) Structural changes provoke anxiety.
in the dendrites of the
neurons and in the cell 8. The patient’s
bodies; safety is a
priority. The
patient may be
(4) Predominant
8. Provide unable to
neuronal degeneration
protective accurately assess
in the cortical
supervision potentially
association areas of
dangerous items
the basal ganglia;
and situations
such as wet
(5) Gross cortical floors, electrical
atrophy and widening appliances, and
of the sulci;
 verbal threats
(6) Enlargement of the from other
ventricles; and patients as a
result of severe
(7) Decrease in impairment in
neurotransmitters judgment.
(acetylcholine,
dopamine,
norepinephrine, 9. Delusions can be
serotonin), anxiety-
somatostatin, and provoking and
neuropeptide distressing for
substance P. patient. It is
9. If patient is important to
experiencing acknowledge this
delusional distress but to
thinking, assist convey that one
does not accept
him or her in
the delusions as
recognizing the real
delusions.
Acknowledge the
delusions without 10. Interview
agreeing to the clients in a
content of the private area
delusions. while
maintaining
10. Identify and staff safety.
remove potentially Nursing staff
dangerous items in should sit
the environment. closest to the
door

11. A quiet
environment
 with the
presence of
another person
can calm an
11. Stay with clients agitated client.
if they are agitated One-on-one
and likely to be contact from
injured. staff to patient
is the first step
is successful de-
escalation

12.Client may feel

threatened and
may withdraw or
rebel.

12. Refrain form

forcing activities
and
communications.