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• 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.
• I have chosen the character played by Sydney Lassick which was Charlie
Cheswick, one of the so-called “friends” the central character, McMurphy, had.
• 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.
• 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?
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.
NURSING NURSING
CUES ANALYSIS GOAL RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS
13. Involve
client in short
activities.