Establishing appropriate nursing diagnoses for Jack

Jack and Margaret have had the same family physician through the last 22 years of their marriage, ever since they moved to Santa Fe, where Jack is an artist.

“We came here so Jack could pursue his painting,” Margaret says. “He’s a wonderful artist, and for years he was a wonderful dad. When our youngest child finally left the nest, we decided it was time for an adventure. We moved to Santa Fe, set Jack up in a studio in our new home, and I began teaching music in our home as well. It’s been a wonderful ride.”

Now, however, their physician has referred Jack and Margaret to the mental health wellness clinic where you work.

“Jack has been undergoing some changes,” Margaret says. She looks at Jack.

“In other words,” Jack says. “I can’t remember ‘jack.’” He smiles at his little joke, but his eyes are sad and a little confused. “That’s the one thing I’m still aware of,” he says. “I still remember that I don’t always remember.”

Margaret explains that they both noticed at first that he had trouble remembering recent events.

“One day he went into his studio to work on a painting he had in progress of one of the Rio Grande Aztec pueblo ruins. He’d been working on it for days, but one day he went into his studio, and I was just setting up for my first music student, when Jack shouted. I knew something was wrong, and I went running in there, and he said, ‘Who did this? Who’s using my pipes?’”

“‘What pipes?’ I said.

“‘My, you know, my pipes!’ he said. ‘Look at this desecration on the ramp! Who did this?’

“It took me awhile,” Margaret says, “but I finally figured out three things: By ‘pipes,’ he meant ‘brushes’, and by ‘ramp,’ he meant ‘easel.’ He had no recognition of his own painting, and he wondered who had been using his studio to paint a strange painting.”

She has tears in her eyes, but Jack just blinks at you.

“Another time,” Margaret says, “I went to call Jack to come to dinner, and he was just rocking idly in his studio, looking around and looking lost. So I thought it would help if I gave him something concrete to do. I said, ‘Jack, honey, you should clean your brushes so they don’t get stiff, then come on in for dinner.’”

“He nodded, so I turned to leave, but then stayed to watch. He just looked at me.”

“‘Your brushes, Jack. Better clean them, all right?’ He nodded and walked to his easel, but he didn’t pick them up. I walked back over to him and put them in his hand. I thought holding them might help. ‘Clean your brushes, and then we’ll eat.’”

“And I’ll never forget this. He just looked down at the brushes, then thumped them hard on the floor and left them there.”

Jack’s physician has recorded a preliminary diagnosis of Alzheimer’s disease.

1. In this scenario, we see that Jack forgets the names of familiar objects at first; he also forgets that he is the one who created the painting of the ancient pueblos. Later, he seems to have also forgotten what very familiar objects to him (his brushes) are for, and what he’s supposed to do with them. How many dementia symptoms is Jack displaying in this description, and what are they?

2. In establishing appropriate nursing diagnoses for Jack, what specific changes can Jack and Margaret anticipate in the area of Jack’s current agnosia and apraxia?

Note: Please use this source if you can lay your hands on it.

Varcarolis, E. M. (2016). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care, 3rd Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9780323389655