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Putting it All Together

Case One

Based on the symptoms that the client is presenting as well as thehistory, the medical diagnosis made by the nurse practitioner is thatthe client has schizophrenia. Monique’s disorder is associatedwith risk factors such a family history of schizophrenia. It is thecase with the client since her father had also been presentingbizarre behavior. The subjective symptoms presented by client includethe suicidal thoughts, stress intolerance as well as the disturbancesin the perception of reality. The objective symptoms presented by theclient included the hostility and aggression, auditory hallucinationsand impaired relationship with the reality. The client hadinteractions with someone or something which was not seen or heard bythe average person. The client is presenting agitation and increasedanxiety in regards to her family. The NANDA nursing diagnosisappropriate for the client would be schizophrenia due to thecontributing factors that are defined by the alterations in behaviorand perceptions of reality (Ackley &amp Ladwig, 2013).

Based on the diagnosis of schizophrenia, the short-term outcomesappropriate for Monique include adequate rest and safe activity withsufficient nutrition while being kept in a safe environment whichwould then be conducive for the therapeutic community. Establishingcommunication and trust with the client is crucial. Medication woulddecrease delusions, hallucinations, and other psychotic symptomspresented. The long-term outcomes include the establishment of abetter self-image thus increasing the self-esteem. The client shouldmaintain standards of operation. The client should be able to acceptthe long-term nature of her disease and the manner in which sheshould take care of herself. Assertive community treatment is apsychological treatment that can be used to treat the client.Antipsychotics that include olanzapine, clozapine, haloperidol orchlorpromazine can be utilized for Monique’s treatment ofschizophrenia. The nursing interventions include providinggoal-directed structure and establishing a daily routine andincreasing the self-worth and esteem of the client. The nurse has towork to orient her in reality and prevent the self-destructivetendencies. To determine the success of the interventions, questionsshould be asked in regards to the objectives, and realisticexpectations daily.

Case Two

Jack is suffering from progressive memory loss (dementia) which isassociated with the Alzheimer’s disease. The definingcharacteristics include the decline in cognitive abilities,alterations in the moods or personality, the disorientation, aphasia,and inappropriate and bizarre behavioral changes. The MRI scansreveal the brain’s anatomic structure and the differences in thescans will be crucial in diagnosis. Jack’s scans would show loss ofbrain mass in the hippocampus and cortex regions. Atrophy would haveoccurred. The two mental status examinations showed the decline inJack’s cognitive and behavioral functioning. It is an indication ofprogressive dementia and confusion as the disease advances to theAlzheimer’s disease (Jack, Knopman, Jagust, Petersen, Weiner,Aisen, &amp Lesnick, 2013). The statement is a sign of theprogression of memory loss. There is no short-term memory functionwith only the long-term memory being retained.

Both pharmaceutical agents and non-pharmaceutical treatments can beused in the lessening the progression of the disease. The drugs thatcan be employed include those for memory loss, behavioral and sleepchanges that occur. They include cholinesterase inhibitors,memantine, antidepressants, and antipsychotics. His symptoms includedementia, aphasia, loss of appetite, mood changes, confusion, andloss of interest and social withdrawal. The NANDA nursing diagnosiswould be Alzheimer’s disease regarding the altered thought processdue to irreversible neuronal degeneration. The outcomes expectedinclude creating a calm environment which will not have anytriggering situations. The ideal situation is for the caregiver tocope well with the patient. Nursing interventions include avoidingany confrontational situations and if, in such a situation, aredirection of the attention is required. A calm environment thatensures adequate rest and security should be established. Questionsthat gauge the success of the interventions include: asking aboutthey personal comfort and the reasons behind any action the patientundertakes.


Ackley, B. J., &amp Ladwig, G. B. (2013). Nursing diagnosishandbook: an evidence-based guide to planning care. ElsevierHealth Sciences.

Jack, C. R., Knopman, D. S., Jagust, W. J., Petersen, R. C., Weiner,M. W., Aisen, P. S., … &amp Lesnick, T. G. (2013). Trackingpathophysiological processes in Alzheimer`s disease: an updatedhypothetical model of dynamic biomarkers. The Lancet Neurology,12(2), 207-216.