Download Family Assessment Still Alice Movie Cristen Moore Westminster

FAMILY ASSESSMENT PROCESS PAPER
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Family Assessment Still Alice Movie
Cristen Moore
Westminster College of Nursing
Carrie Huntsman-Jones, Carol Ross, & Diane Van Os
Community Nursing
September 26, 2016
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FAMILY ASSESSMENT PROCESS PAPER
Cristen Moore
Still Alice
Family members
 Alice Howland
 John Howland/husband
 Tom Howland/son
 Charlie Jones/son in law
 Anna Howland-Jones/daughter
 Lydia Howland/daughter
50
Early 50s
Mid 20s
Early 30s
Later 20s
Early 20s
Still Alice is a movie in which Alice receives news of early onset Alzheimer’s
disease. Alice is a 50-year-old white female with 3 children 1 male and 2 females.
She is a professor and her husband John does research. Currently all 3 children live
away from home. Lydia the youngest lives in LA seeking a career in acting. Tom the
middle child is going to college. Anna the oldest is married to Charlie Jones and by
the end of the movie they have twins, a boy and a girl. Alice’s father died of cirrhosis
due to alcohol in 1999. Alcoholic or Laennec’s cirrhosis is the end result of alcoholic
liver disease (Lemone, P., & Burke, K. (2014), p. 736). When asked about his overall
health Alice indicated that her father was incontinent and incoherent in the end
stage of his life. When pressed for further health Hx. on her father she indicated that
they weren’t very close. Alice’s mother and only sister died in a car crash when Alice
was 18. Later in the movie it is believed that the genetic component of Alzheimer’s is
from her father.
HEALTH-PERCEPTION--HEALTH MANAGEMENT PATTERN
Alice runs on a regular basis, takes vitamins and supplements (iron, calcium,
multi vitamin, and flax seed oil), she claims to be in menopause (last menses in
February and September), takes sleeping pills occasionally while traveling, reports
no head injuries or undue stress at this time, and eats a regular balanced diet. At this
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time Alice is reporting getting lost while running and forgetting words and names.
Overall Alice reports her health management as well maintained over the past few
years. All three children Tom, Lydia, Anna, and Charlie (son in law) report their
health as well maintained with regular exercise and a regular balanced diet over the
past year. Diet and exercise important to all family members. John reports little to
no exercise due to a busy work schedule and eats high calorie low nutrient meals
when not at home. John has also expressed concern that he is 20-30 pounds
overweight. All family members report no smoking and moderate alcohol use.
Immunizations are current for all family members. No other health problems
reported by family members.
Objective:
Family home was clean, free of clutter and trash, no family pets, and did not
have any foul odors. Alice, Tom, Charlie, Anna, and Lydia all looked healthy, well
nourished and fit. John looked to be about 30 lbs. overweight and well nourished. All
members of family looked well groomed and dressed appropriately for weather. No
rashes, acne, wounds, or open sores present.
Diagnosis:

Knowledge deficit R/T information misinterpretation about Alzheimer’s
signs and symptoms, treatments. AEB caregiver burnout, not listening to
physician during visits, forgetting things, delusions, anxiety and depression,
language problems, etc. This relates to all family members.

Risk for 1-falls, 2-poisoning, 3-injury, etc. R/T Alzheimer’s signs and
symptoms, memory problems, cognitive problems, sleepiness (Doenges,
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Moorhouse & Murr, 2013, p. 362-368), not recognizing surroundings,
directional loss, etc. This relates to Alice.
Later Stage Diagnosis

Impaired home maintenance R/T Alzheimer’s symptoms. AEB memory
problems, cognitive problems, sleepiness (Doenges, Moorhouse & Murr,
2013, p. 362-368), not recognizing surroundings, directional loss, forgetting
household routine, etc. This relates to Alice.

Risk for violence/combativeness R/T not recognizing self, others,
surroundings, not recognizing things, places, loosing the ability to
understand what is going on, and the feeling of helplessness. This relates to
Alice.

Risk for injury R/T combativeness of patient, caregiver burnout, not being
able to lift and restrain patient, etc. This relates to family members of Alice.
NUTRITIONAL-METABOLIC PATTERN
Overall Alice reports her nutritional status as well maintained. Alice reports
taking vitamins and supplements (iron, calcium, multi vitamin, and flax seed oil), All
three children Tom, Lydia, Anna, and Charlie (son in law) report having a regular
balanced diet which includes fruits, vegetables, healthy carbohydrates, plenty of
water and little to no alcohol use. Alice drinks a lot of tea and John prefers coffee.
John reports little to no exercise due to a busy work schedule and eats high calorie
low nutrient meals when not at home. John has also expressed concern that he is 2030 pounds overweight. No rashes, acne, wounds, or open sores present for any
family members.
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Alice may start to exhibit malnutrition and loss of weight. This would be due
to not knowing when, what foods to eat, and how to cook food and use utensils. Also,
she may not recognize her caregivers and/or herself. It is not uncommon for
patients to become combative during end stage Alzheimer’s.
Alice and family members may be at risk for imbalanced nutrition less than
body weight requirements or more than body weight requirements. Each of us
handles stress in our own way. Some of us eat more or don’t eat due to stress.
Individuals over exercise or stop exercising due to stress and anxiety.
Subjective:
When asked about taking pills, supplements, medications, Alice replies with “I take a
multi vitamin, flaxseed oil, calcium, iron.” When asked about dental problems Alice
stated, “No, none of us have problems with our mouths except John”. Alice said,
“John has a couple of crowns, he likes the sweets”.
Objective:
Alice, Tom, Charlie, Anna, and Lydia all looked healthy, well nourished and fit.
John looked to be about 30 lbs. overweight and well nourished. All family members
observed having a healthy appetite. I observed Alice brushing her teeth on a regular
basis.
The family eats well-balanced home cooked meals with occasionally eating
out. Meals include fruits, vegetables, meat, and very few desserts. Alice, Tom,
Charlie, Anna, and Lydia all looked healthy, well nourished and fit. John looked to be
about 30 lbs. overweight and well nourished.
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Diagnosis:

Risk of rotting teeth R/T to Alzheimer’s symptoms of cognitive impairment,
memory loss, forgetfulness, not recognizing household items, not
remembering teeth brushing routine, etc. This relates to Alice.

Risk of infection R/T to Alzheimer’s symptoms of cognitive impairment,
memory loss, forgetfulness, not recognizing surroundings etc. Causing
patient to not take vitamins, stop cooking, forget to eat, forget what is food
and what isn’t food, etc.
Later Stage Diagnosis

Impaired nutrition less than body requirements R/T cognitive problems
from Alzheimer’s. AEB not recognizing self, not recognizing the need to eat
and what food is, others, surroundings, not recognizing things, places, loosing
the ability to understand what is going on, dysphagia problems, due to loss of
regular homeostatic mechanisms (Alice). R/T mother/wife diagnosis with
Alzheimer’s. AEB stress and anxiety, caregiver burnout, lack of appetite, extra
burden on a busy schedule, etc. (family).

Impaired nutrition more than body requirements R/T mother/wife diagnosis
with Alzheimer’s. AEB over eating due to stress and anxiety, caregiver
burnout, extra burden on a busy schedule and eating high calorie low
nutritional meals, eating most meals out due to Alice not cooking, etc.
(family).
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Elimination
OBJECTIVE:
Family home was clean, free of clutter and trash, no family pets, and did not
have any foul odors. No bugs or rodents observed to be on premises of home. Alice
is observed putting trash (from food) in garbage on several occasions.
In the beginning family members report having regular bowel and bladder
movements without problems. Alice’s overall bladder control changes as the
Alzheimer’s progresses. Alice goes inside beach home before she and her husband
go running to go pee. However when she gets inside she opens many doors and
cannot find the bathroom. When her husband finds her she has urinated all over
herself. As time goes by Alice increasingly forgets where bathrooms are and that she
needs to go to the restroom.
Diagnosis:

Impaired urinary elimination R/T cognitive problems due to Alzheimer’s.
AEB forgetting to go to restroom when feeling urge (later stage), not
remembering where the restroom is, wetting self at home and in public. This
relates to Alice.

Risk for impaired skin integrity R/T cognitive problems (not understanding
when to go to restroom and where they are) and incontinence due to
Alzheimer’s. AEB patient forgetting where bathroom at home is, not
understanding the urge to go to the restroom in public, area around buttocks
and genitals red and warm to touch, incontinent due to unrecognized UTI, pt.
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is incontinent of bladder, leading to excessive moisture of skin. This relates to
Alice.

Risk for garbage build up in home R/T cognitive problems from Alzheimer’s,
forgetfulness, memory problems, and lack of sleep.

Self-Care Deficit-Toileting R/T cognitive problems from Alzheimer’s. AEB
forgetting where restroom is, not recognizing urge to go to restroom,
inability to manipulate clothing, inability to recognize UTI, forgetting the
routine one does in the restroom, etc.
ACTIVITY-EXERCISE PATTERN
Alice runs on a regular basis, all three children report regular exercise, and
John reports very little exercise due to hectic work schedule as a researcher. Lydia
reports, doing a lot of walking while on the hunt for acting jobs. During later stage
Alzheimer’s Alice forgets to exercise on a regular basis and stops exercising all
together due to getting lost. Lydia and Anna report an increase in exercise to deal
with the stress. Tom reports stopping exercise and Jon reports no change in exercise
with the Alice’s diagnosis.
Objective:
Alice is seen running on several occasions during the beginning of the film.
Later on in Alice’s diagnosis she is seen walking with a companion/husband and
daughter Lydia. Alice and her three children all look healthy and look appropriate
weight for size and height. John looks to be overweight for his size and height. Home
looks to be well furnished with healthy choices for food. Kitchen is kept orderly and
clean.
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Diagnosis:

Risk for sedentary life style R/T cognitive problems from Alzheimer’s
diagnosis. AEB decreased running, walking instead of running, stopping
exercise due to confusion and loss of memory, getting lost, not knowing who
she/Alice is, her surroundings, and what she is supposed to do.

Risk for increased anxiety R/T Alice’s diagnosis of Alzheimer’s. AEB
increased family stressors, caregiver responsibilities, knowledge deficient
about Alzheimer’s etc.
SLEEP-REST PATTERN
Subjective:
In the beginning of the movie states “It’s fine like 7 hours a night” and “I occasionally
take a sleeping pill when I travel” when asked about her sleeping habits. All 3 of her
children vocalize problems with sleeping during the course of Alice’s Alzheimer’s.
Objective:
In the beginning of the movie all family members look well rested without bags under
their eyes. Each family member has their own room except married couple who share
rooms. They live in a quiet comfortable neighborhood. Family members enjoy spending
relaxing time together and by themselves. Before Alice’s diagnosis sleeping doesn’t seem
to be a problem for the family. Alice starts to have trouble sleeping after speaking with
the neurologist the 2nd time. Alice is observed taking a pill after not being able to go to
sleep the first time in the movie. The sleeplessness only increases.
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Diagnosis:

Sleep pattern disturbance R/T diagnosis of Alice’s Alzheimer’s. AEB trouble
going to sleep, not being able to go to sleep even after taking a pill, tossing and
turning, patient’s stating trouble sleeping after diagnosis. This can relate to all
family members.

Risk for fatigue R/T sleep deprivation due to Alice’s Alzheimer’s diagnosis. AEB
trouble going to sleep, not being able to go to sleep even after taking a pill,
tossing and turning, patient’s stating trouble sleeping after diagnosis, increased
stress intolerance of Alice’s family members, moodiness of Alice’s family
members. This can relate to all family members.

Insomnia R/T anxiety from Alice’s diagnosis of Alzheimer’s. AEB Alice’s
inability to sleep through the night, difficulty falling asleep, nightmares. This can
relate to all family members.
COGINITIVE-PERCEPTUAL PATTERN
Family exhibits no visual or hearing problems. Tom is currently in college.
Lydia has a high school education however she has an extensive vocabulary due to
being around a formally well-educated family.
Family has a lot of big decisions to make about how to care for Alice and what
their roles are in this care. John, Alice, and Anna all hold Master’s degrees or higher.
Alice avoids telling her husband about what is happening in the beginning and then
John avoids telling their children. All 3 children face the decision of getting a genetic
screening to find out if they are carriers. Anna and her husband Charlie decide to
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have children and get rid of embryos carrying the gene. Lydia decides to not get
tested and Tom is not a carrier. John is offered a job and decides to take it. Lydia
eventually decides to move home and take care of her mother when her father
moves.
Diagnosis:

Anxiety R/T how care for Alice will be impacted by John’s decision to take a
new job out of state. AEB him avoiding Alice’s comment about him not
wanting to stay and deal with the disease progression, Anna Tom and John’s
bickering about him leaving, and John’s decision to not tell his wife about his
new job.

Decreased work performance for Alice R/T Alzheimer’s. AEB reduced
cognitive function, forgetting which lecture she is on, being late to lecture,
getting lost at school, etc.
SELF-PERCEPTION--SELF-CONCEPT PATTERN/ROLE RELATIONSHIP PATTERN
Family members appear to be happy and content in their relationships and
roles within the family. Normal sibling bickering occurs throughout movie. This
family is a traditional nuclear family. Income needs are met as shown through their
comfortable life style. After all family members become aware of the diagnosis their
stress levels, bickering amongst family members, and anxiety increase.
John exhibits denial behavior and eventually leaves out of state for a new job.
As a whole the family rallies together to support their mother. At the end stage
Lydia moves back home from LA when her father moves. The family finances seem
to be more than adequate due to house size, well furnished home, eating out, etc.
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John is assertive and at times aggressive in his opinions of Alice’s new
situation. Anna is passive, tries to avoid talking about the serious things, and tries to
support her mother as much as she knows how (lets her hold the baby). Lydia is
assertive and doesn’t shy away from talking to her mother about feelings and the
situation as a whole. Tom isn’t around that much due to attending college. When he
is around he is supportive to his mother. Charlie is on the offensive when Alice asks
to hold one of the babies after they are born.
Alice becomes part of the Alzheimer’s community and gives a speech at a
convention. Alice feels pain and sadness as she is required to leave her college
community due to student complaints and her employers becoming concerned with
her abilities after they found out about her diagnosis.
It is obvious that Alice is the glue that holds her family together. As her
Alzheimer’s increases her husband tries to take over but ends up giving up. Lydia
steps up to the plate and takes over the family home and becoming her mother’s
main caregiver. Anna and her husband Charlie are trying to have a family of their
own. Tom doesn’t know what to do other than show unconditional love and support
when he is available.
Originally Alice decides not to let her family know about what is going on
even though the neurologist keeps asking for her to bring a family member. Then
her husband John doesn’t want to tell the family. Once the family is aware each of
them try to support Alice in the only way they know how to. John eventually
succumbs to his denial and leaves the state for another job. Lydia asks imploring
questions to her mother and her contact increase eventually leading her to move
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back home to take care of her mother. This family is full of love for each other. Each
one rallies to support Alice and each other.
Objective:
This family is a traditional nuclear family. Alice the mother works, cooks, and
cleans. John makes Alice tea and does no other cooking. He goes to work and is the
main breadwinner of the family. All three children love each other and exhibit
normal family bickering.
Subjective:
When Alice finally tells her husband he tries to deny what she is telling him.
She responds with, “I know what I’m feeling, it feels like my brain is dyeing
everything in my entire life is going”. In the end John says to Lydia “You’re a better
man than me” when she moves back home to take care of her mother.
Diagnosis:

Anxiety R/T mother/wife diagnosis of Alzheimer’s. AEB increased bickering
amongst family members, John’s denial of situation eventually leading him to
move, family members crying throughout movie, “I don’t know what to do”
statements, etc. This relates to all family members.

Risk for family dysfunction R/T not being able to handle anxiety of
progression of Alice’s’ Alzheimer’s. This relates to all family members.

Compromised dignity R/T not being able to handle anxiety of Alice’s
Alzheimer’s. AEB Alice anxiety from UI, getting lost, forgetting names,
forgetting objects, etc. John’s denial and eventually moving away.
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SEXUALITY-REPRODUCTIVE PATTERN
At the beginning of the movie family members comfortable with their sex lives.
Except Lydia who doesn’t have a partner. As the movie goes on all family members
sexual lives are affected by the stress/anxiety of the situation
Diagnosis:

Ineffective child bearing process R/T unknown factors given in movie for
Anna and Charlie. AEB unable to have children on their own, seek medical
intervention, multiple visits to physician about infertility.

Risk for sexual dysfunction R/T increased stress/anxiety due to Alice’s
diagnosis of Alzheimer’s. AEB John moving to another state for a job,
sleeplessness, increased anxious behaviors, stating no desire, etc.
COPING-STRESS-TOLERANCE PATTERN/VALUE-BELIEF PATTERN
All family members exhibited stress throughout movie. Alice often grabbed
pendant on her necklace during stressful moments as well as having moments of
crying. John exhibited stress as using avoidance tactics. Right after meeting with the
neurologist (going over PET scan and further genetic testing) he repeatedly pushed
elevator button while swearing. At this time he also said “I don’t think we should tell
them, I would like to wait till the test results ” when he and Alice were speaking
about telling their children. During the visit with the neurologist husband kept
grasping for reasons why his wife didn’t have Alzheimer’s disease. He stated “I also
read that high amyloid is associated with other conditions other than Alzheimer’s?”
Lydia had tears in her eyes after her mother explained what it felt like having
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Alzheimer’s. Tom had tears in his eyes while listening to his mother’s speech on
Alzheimer’s.
Diagnosis:

Readiness for enhanced knowledge on how to cope with anxiety R/T family
dealing with Alice’s Alzheimer’s. As evidence by Alice researching her
condition, Alice finally telling her husband about her condition, when
condition is confirmed Alice tells her family of her condition, Alice saying “I
don’t know what to do now” after she wets herself at the beach. This relates
to all family members.

Risk for caregiver burnout R/T anxiety from caregiver duties for
mother/wife with Alzheimer’s. AEB exhaustion, “I don’t know what to do
statements”, not sleeping, etc. This is related to family members of Alice.

Ineffective coping R/T Alice/mother/wife having Alzheimer’s. AEB wringing
of hands while speaking with neurologist, Alice holding onto pendant while
speaking of stressful things, John/husband “I also read that high amyloid is
associated with other conditions other than Alzheimer’s?”, Alice and children
crying throughout film, husband pressing elevator button over and over and
saying “I don’t think we should tell them, I would like to wait till the test
results ” after speaking with neurologist about PET scan, etc. This relates to
whole family.
Healthy People 2020 Assessment
1. Family Planning- Improve pregnancy planning and spacing, and prevent
unintended pregnancy. One or more birth control option should be used by
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John and Alice to avoid any unintentional pregnancies. Because their children
have a 50% chance of getting. Also Alice cannot take care of herself let alone
a child. Affected children of John and Alice should also be using birth control
due to unintentional pregnancies and passing on the genes to their offspring.
2. Improve health and prevent harm through valid and useful genomic tools in
clinical and public health practices. All genetic family members should get
genetic testing done to see if they are carriers. Genetic counseling should be
used for family members carrying the gene so they understand the risks of
passing on the gene. Getting a genetic panel done will also let family
members know if they are carriers for cancers, heart disease, at risk for
stroke, carry X or Y linked abnormalities, etc.
3. Improve mental health through prevention and by ensuring access to
appropriate, quality mental health services. Having a healthy mental health is
important to continue living ones life style. When families deal with chronic
health issues their anxiety increases, which can lead to depression. Mental
health issues commonly lead to disabilities. Anxiety and depression can lead
to increase use of alcohol and drugs, which in turn can lead to abuse.
4. Reduce the morbidity and costs associated with, and maintain or enhance the
quality of life for persons with dementia, including Alzheimer’s disease. This
family is dealing with Alzheimer’s disease. Caregiver costs go up, loss of one
income, dehydration, anxiety costs go up for everyone, depression costs go
up, if someone has drinking problems they can increase or begin, medication
costs, etc. Every family member is at risk for increasing costs due to effects
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on them as individuals. Morbidity goes up for Alice and her daughter Anna
who both carry the gene. This can be related to accidents, increase in
susceptibility to infections, medication over dosing, etc.
5. Promote health and reduce chronic disease risk through the consumption of
healthful diets and achievement and maintenance of healthy body weights.
John is already impaired nutrition for body requirements. The rest of the
family is at risk due to anxiety. Alice is at risk for impaired nutrition for body
requirements less than body weight due to stress. All family members are at
risk for malnutrition because Alice isn’t cooking meals anymore which leads
to eating out. Eating out increases calories, bad carbohydrates, increased
sugar and low nutritional values.
6. Improve health, fitness and quality of life through daily physical activity. All
family members are at risk for decreased physical activity. Due to
Alzheimer’s Alice’s exercise decreases. Since family members are over
stressed they might stop exercising. Caregiving is time consuming and
exhausting. This could decrease families’ available time, energy, and
motivation to exercise. Lack of exercise will lead to an increase in
stress/anxiety and other health problems as a whole.
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References
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http://umm.edu/health/medical/altmed/herb/peppermint.
Stanhope, M. & Lancaster, J. (2016). Public Health Nursing: Population-Centered
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Health Care in the Community (9 ed.) St Louis, MO: Elsevier
Touhy, T.A. & Jett, K. (2012). Ebersole & Hess' Toward healthy aging:
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https://www.healthypeople.gov