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1. What is the title of the movie?

• The movie is entitled One Flew Over the Cuckoo’s Nest. It was directed by Milos
Forman and was the 1975 adaptation of the novel by Ken Kessey with the same
title. This movie is actually one of those great films in American Cinema to have
won all five major Academy Awards including Best Picture. It was filmed at
Oregon State Hospital in Salem, Oregon.

2. Who is the character?

• I have chosen the character played by Sydney Lassick which was Charlie
Cheswick, one of the so-called “friends” the central character, McMurphy, had.

3. What are the observed signs and symptoms?

• The signs and symptoms observed were elevated, expansive or irritable moods
especially when Cheswick was asking for his pack of cigarettes from Nurse
Mildred Ratched during their meeting.
• Another was the client’s racing thoughts. This happens when a manic person is
actually excessively distracted by objectively unimportant stimuli. Just like in the
case of Cheswick where he was distracted by his want for his cigarette. This
experience created an absentmindedness where his thoughts totally preoccupied
him making him unable to keep track of time or be aware of anything that was
happening around him besides his flow of thoughts.
• The client also experienced pressured speech as evidenced by his rapid and
excessive speech.
• Other signs and symptoms observed were outbursts of anger and rage,
impulsiveness, talkativeness and internal pressure to keep talking as shown by
Cheswick’s over-explanation.

4. What do you think is the diagnosis?

• The character was said to have a Manic Disorder as evidenced by having fits of
tantrum and the signs and symptoms stated above. This manic disorder is actually
associated with Bipolar Disorder or Manic Depression Disorder.
5. What predisposes the client’s condition?

• The closer the familial relationship, the greater the susceptibility. A child with one
affected parent has a 25% chance of developing bipolar disorder; a child with two
affected parents, a 50% chance. The incidence of this illness in siblings is 20% to
25%; in identical twins, the incidence is 66% to 96%. Recent studies have shown
that postpartum women are also at particular risk for bipolar disorder through
postpartum psychosis.
• Although certain biochemical changes accompany mood swings, it isn't clear
whether these changes cause the mood swings or result from them. In both mania
and depression, intracellular sodium concentration increases during illness and
returns to normal with recovery.
• Patients with mood disorders have a defect in the way the brain handles certain
neurotransmitters - chemical messengers that shuttle nerve impulses between
neurons. Low levels of the chemicals dopamine and norepinephrine. for example,
have been linked to depression, whereas excessively high levels of these
chemicals are associated with mania. Changes in the concentration of
acetylcholine and serotonin may also play a role. Although neurobiologists have
yet to prove that these chemical shifts cause bipolar disorder, it's widely assumed
that most antidepressant medications work by modifying these neurotransmitter
systems. In addition, new data suggest that changes in the circadian rhythms that
control hormone secretion, body temperature, and appetite may contribute to the
development of bipolar disorder.
• Emotional or physical trauma, such as bereavement, disruption of an important
relationship, or a serious accidental injury, may precede the onset of bipolar
disorder. However, bipolar disorder commonly appears without identifiable
predisposing factors. Manic episodes may follow a stressful event, but they're also
associated with antidepressant therapy and childbirth. Chronic physical illness,
psychoactive drug dependence, psychosocial stressors, and childbirth may
predpitate major depressive episodes.
• Other familial influences - especially the early loss of a parent, parental
depression, incest, or abuse - may predispose a person to depressive illness.
6. What are the priority nursing problems?

NURSING PROBLEM RANK JUSTIFICATION

This is the first priority nursing problem


because it is life threatening. If this is
not solved, this could lead to a more
dangerous matter like if the client
Disturbed Thought
continuously experiences these kinds of
Processes related to
disturbances without proper
mental disorder (Bipolar

1
intervention, this could harm him as well
Disorder) as evidenced
as the people that surround him. Since
by increased
the client has exhibited symptoms
distractibility, agitation,
mainly related to how he perceives his
anxiety, disorientation
environment and how he reacts to the
and poor concentration.
stimuli associated to his condition, these
problems need to be solved. And if this
will be solved, the other identified
problems will also be solved.

Impaired social This is the second prioritized problem


interaction related to because this is not life-threatening. If the
communication barrier problem regarding thought process will
(presence of Bipolar
disorder in manic state)
as evidenced by
2 be solved, and if the client has calmed
and become oriented with his
surroundings, this problem regarding his
excessive and constant interaction with other people will be
physical activity. solved.

This is the last prioritized problem


Risk for others-directed because it is only a risk problem. If the
Violence related to
mental health problem
(Bipolar Disorder).
3 above-mentioned problems will be
solved, this will also be solved. The
client and the nurse have enough
resources to answer this problem.
7. Make a nursing care plan of one of the identified problems.

NURSING NURSING
CUES ANALYSIS GOAL RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS

Subjective: Disturbed 1. Observe for causes 1. Differential After nursing


 sensory Thought Bipolar disorder, or After nursing of altered thought diagnosis is interventions, the
distortions Processes BD, is a psychiatric interventions, the processes important as client was able to
related to illness (formerly client will be demonstrate
physical and mental
known as manic- able to
Objective: mental disorder health problems, improved
depressive disorder) demonstrate
 Observed (Bipolar improved substance abuse, cognitive function
that causes a person to
exaggerated Disorder) as experience recurrent cognitive neoplasms and as evidenced by
emotional evidenced by episodes of elated and function as medication side decreased
responses increased depressed moods evidenced by effects may effect distractibility,
distractibility, separated by well- decreased cognitive. calmness,
 Anxious
agitation, spaced intervals of distractibility, decreased level of
 Irritability euthymia—normal calmness,
anxiety, 2. Monitor, record, 2. Assessing anxiety, and
 Poor mood. decreased level
disorientation of anxiety, and and report changes in cognitive, physical enhanced
concentration
and poor enhanced client's neurological and behavioral concentration.
 Impaired During manic
concentration. episodes, people concentration. status (level of symptoms help to
communicati
appear euphoric and consciousness, determine the
on
unusually cheerful and increased intracranial relationship
 Change in
display heightened pressure), mental between brain
behavior self-esteem and status (memory, anatomy,
pattern grandiosity that leads cognition, judgment, neurochemical
them to
concentration), vital systems, and
indiscriminately
undertake multiple signs, laboratory symptoms. A
sexual, occupational, results, and ability to mental status
political or religious follow commands. examination is a
activities with a sense recommended
of conviction and
procedure in
purpose but without
regard for the apparent assessing any
risks or need to cognitive
difficulties
complete them.
3. Complete a mental 3. Postoperative acute
This often is status examination of confusional state is
accompanied by client. a significant
restlessness, a problem among
decreased need for
older surgical
sleep, "pressured
speech" that is loud, clients; its
rapid and difficult to incidence is higher
interpret, and in orthopedic
increased sociability surgery than in
that is intrusive, general surgery
demanding and
domineering. When
4. Report any new 4. Basic interactions
rebuffed or frustrated,
however, irritability, onset or sudden provide the nurse
anger and rage are increase in confusion. with opportunity to
likely to ensue. assess patient
agitation and
response level

5. Adjust 5. Confused clients


communication style cannot accurately
to client. Assess pain report pain. Pain
and promptly provide control reduces
comfort measures. suffering and
adverse health
effects related to
pain.

6. Use soft restraints 6. Seclusion, restraint,


with discretion and and/or other
physician order. behavioral
management
interventions must
be used in
accordance to the
patient's plan of
care and regulatory
guidelines.

7. Provide validation 7. Validation seeks to


of thoughts and help the caregiver
feelings of client. understand the care
receiver,
encouraging
empathy

8. Stay with clients if 8. A quiet


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

9. Develop a 9. Approaching the


therapeutic alliance to client in a
increase trust with the nonjudgmental
client. manner,
acknowledging the
client's experience,
and not challenging
the client's reality
help develop a
therapeutic alliance
10. Routines promote
10. Establish feelings of security.
predictable care
routines and maintain
continuity of client's
nursing staff. 11. Excessive
environmental
11. Frequentl stimuli can
y check on client and adversely affect
have brief client's level of
interactions to orientation and
prevent sensory increase
deprivation. disorganization

12. Family members


may also have
12. Provide cognitive
support and education symptoms related
to family during to age or mental
client's period of illness (Wuerker,
cognitive change. 2000). Family
Involve family in involvement
current care and in promotes
planning of continuity of care.
postdischarge care,
recognizing the 13. Distraction is a
family members' positive coping
strengths and needs. skill.

13. Involve
client in short
activities.