HLTEN513B : Nursing - Parkinson’s Disease - Case Study Assessment Answer

Nursing Case Study Assignment

John Magill, 75 years of age, has been admitted to hospital after having a fall athome. John was diagnosed with Parkinson’s disease five years ago. On arrival at theemergency department he was noted to have a generalised tremor and decreasedmobility. John is a little confused and complaining of hip and back discomfort. He isvery worried about his medications which are due to be taken.

Assignment Task

1) Introduction

2) Possible causes / risks factors related to the health condition

3) Discuss clinical manifestations of Parkinson’s disease and key physical assessment

4) Discuss medical management including medications

5) Develop holistic nursing care plans using NANDA in order of priority. It should consist of

a) Three nursing diagnosis

b) A goal for each nursing diagnosis

c) Three nursing interventions d) Three rationales for each

d) An evaluation for each diagnosis

6) Make a discharge plan for John, focusing on the health education and any referrals to allied health professionals you think John and his wife may need

7) Referencing

8) Presentation

9) Grammar, spelling and punctuation

Introduction

Parkinson’s disease is known as a progressive disease, which is related to the nervous system of the humans. People affected by this disease are mainly those, who are in middle age or old age. This disease is often related to the age of an affected individual. The disease is market by muscular rigidity, tremors, imprecise and slow physical movements. Studies have associated disease with deficiency of neurotransmitter dopamine and degeneration of the basal ganglia inside the human brain. This paper will present the case study of John Magil, a 75 years old man. John is admitted to the hospital as he had a fall at home. According to the medical examination and past reports he is suffering from Parkinson’s disease (PD). John’s mobility has been decreased and he also has generalized tremors. This paper will discuss the risks and causes linked with Parkinson’s disease. Paper will also provide discussion over clinical manifestations, medication, key physical assessment, and holistic nursing care plan for the patients, who suffer from Parkinson’s disease.

Parkinson’s disease: Causes and Risks

Parkinson’s disease is a disorder linked to nervous system. The disease makes slow progress and it occurs due to the malfunction or the death of essential nerve cells inside the middle brain. These nerve cells are called as neurons. The decrease in the neurons results in further decrease of the essential neurotransmitter. This neurotransmitter is called as dopamine, which is a chemical responsible for transmitting the brain messages to different parts of the human body and aids in muscle coordination. There are others factors also, which are responsible for the condition of the patient. These involve genetic and environment factors. However, primary causes of the Parkinson’s disease have not been identified yet. One of the vital reasons associated with this disease is age. The risk of the disease increases with the age. If the patient has the family history of the disease then the risk of the Parkinson’s disease also increases to some level. This disease can also occur by long term exposure to pesticides, un-clean water, and chemicals.

Clinical Manifestations and Key Physical Assessment

Parkinson’s disease (PD) is a chronic neurologic disease (Bunting-Perry, 2006). All the signs associated could not be detected on the initial stage of the disease. Patient may complain about any one of the motor weakness. The main clinical diagnosis of Parkinson’s disease is done on the basis of medical history and neurological examination of the patient’s condition (Rodriguez-Oroz et al., 2009). But, there is no specified lab test that has been found for the correct diagnosis.

The motor manifestations associated with this disease includes rigidity, tremors, bradykinesia (or slow physical movements) and postural instability. The disease also displays Psychiatric and cognitive manifestations. The parallel circuits present within the basal ganglia are also affected due to the loss of Dopamine. The dysfunctions associated with this are depression and dementia (Mandir, & Vaughan, 2000). The other signs of anxiety, delusion, hallucination, apathy, irritability have also been reported in some of the cases (Bunting-Perry, 2006).

The motor manifestations detected in Parkinson’s disease (PD) are also typically asymmetric, under which the first and common physical assessment is based on the detection of resting tremors. In some cases, patients also start complaining about rigidity, gait difficulty and bradykinesia. The patient may also face problem in swinging the first affected arm. The same side foot may have muscular rigidity and could be difficult to move. Over the period of time, while being suffering from the disease, the axial posture of the patient may change the strides become smaller. Problem in some of the non-motor functions is also noticed in patient. Also in the physical assessment of the patients, it is noticed that olfactory function is significantly reduced; meanwhile the other motor functions are visible. Other symbols also include rapid behavior disorder (RBD) and rapid eye movement (REM); urinary urgency, constipation, excessive saliva, sleeps disturbances, soft speech, and forgetfulness. The facial expressions of the patients are reduced and the patient tends to stay in same posture in for long time. Holding something in hands could also be a difficult task for the patients, as they have shaky hands. So, patients might feel difficulty in holding utensils and reading newspapers.

Medical Management

The most common therapy used for the management of Parkinson’s disease is medication. The purpose of medication is not to cure the disease, but to aid in shortage of dopamine. Due to deficiency of the dopamine the problem occurs, and thus medication improves the shortage of this element in the brain. All symptoms seen are due to the shortage of dopamine. Medication is given to the patients according to their symptoms, age, and response towards medications. It is important to find some best combination of medicines. One of the best medications used to treat patients of Parkinson’s disease is Levodopa. “Levodopa itself is largely inert; both its therapeutic and adverse effects result from decarboxylation of levodopa to dopamine” (Goldenberg, 2008, p. 594). The absorption of the medicine is very rapid inside the body and it is “converted to dopamine by decarboxylation primarily within the presynaptic terminals of dopaminergic neurons in the striatum” (Goldenberg, 2008, p. 594).

Thus, the curative efficacy of the drug is highly dependent on the creation of dopamine. The dramatic effect in the signs and symptoms are seen, due to this medication. In the early stage of medication, there is almost complete recovery in tremors, bradykinesia and rigidity. Another medication used for the patients of Parkinson’s disease is Carbidopa. This medicine is given as a combination with Levodopa. In some cases, Levodopa can result in the feeling of wearing-off at the end, thus Carbidopa helps to reduce the feeling of wearing-off, and thus results in reducing the side effects. Carbidopa is also responsible for increasing the time till which Levodopa remains active inside the brain. According to the given case study, the combination of Levodopa and Carbidopa are given to the patient. Another drug prescribed to the patient Citalopram 20mgms. This medicine is prescribed so that the level of energy in the patient could be improved. The balance of serotonin (natural substance) is also stored with this medication.

Nursing Care Plan for Patient

NANDA provides the most effective and holistic nursing care plans for Parkinson’s disease patients. The main aim of a nursing care plan is to improve quality of life and health outcomes of patients.

NANDA Nursing Diagnosis for Parkinson’s disease

• Physical mobility is the first thing, which should be diagnosed by the nurse, body weakness and stiffness could be related to physical mobility.
• It is important to diagnose if the patient is self-care deficit. This helps in understanding the neuromuscular weakness. This diagnosis is also important to understand the muscle strength, and muscle coordination in patients.
• Diagnosis of the sleeping pattern is another important diagnosis, as Nurses must diagnose the sleeping pattern in the patient, as patient suffering from PD face sleep disturbances and also Insomnia.

All these three diagnosis are very important. The goal impaired physical mobility dignosis is to detect the physical mobility of the patient and to arrange physical training programs and assessments.

The goal behind self-care deficit diagnosis is to understand the patient’s capability to take self-care. The goal of sleeping pattern diagnosis is to improve the quality and length of sleeping patients.

Three Nursing Interventions

Diagnosis of the patient’s impaired physical mobility

• Essential to secure the patient from falls.
• Falls can have adverse on the patient’s health and can result in deactivation of the brain stimulators.
• This diagnosis is also important to save patient from other physical harms and to encourage them to take part in physical training programs.

Encouraging Independence

• Encouraging patients to become independent will make them feel comfortable.
• Walking with assistive devices will also aid to physical exercise.
• Mobility of the patient would increase.

Sleeping Pattern

• For improving the sleeping pattern of patient, dim lights and environment without any kind of noise is helpful. It provides suitable environment for sleeping.
• Sleeping pattern can be improved by ignoring caffeine, increasing exercise and avoiding day time sleep.
• Environment should be maintained for sleep, like soft and gentle music may help patient in sleeping. Gentle music is good for creating environment better for sleep.

Evaluation of Diagnoses

Impaired Physical Mobility: The current mobility of the patient is must be evaluated, so that any kind of damage to the muscles can be diagnosed. The diagnosis also helps the healthcare professionals to conduct physical training programs for the patients, as it is important strengthening body muscles. This diagnosis can also encourage patient for massages and war bath to loosen the muscles. This intervention helps the nurse’s to understand the need of taking assistance from the physiotherapists for physical exercise (Rodriguez-Oroz et al., 2009).

Self-Care: Self-care ability is important to be analyzed in the case of Parkinson’s disease. This diagnosis is also important to encourage independence in patients, and develop self-confidence. This diagnosis is also important to support patients in different physical activities.

Diagnosis of Sleeping Pattern: Diagnosis of the sleeping pattern is important. It allows the nurses to prepare the nursing plan according to patient’s needs. Patient can be assisted having a better sleep by educating them about important sleeping pattern and creating favorable environment for sleep.

Discharge Plan for the patient

• Medication should not be discontinued without consulting with doctor.
• Store medicines away from the reach of young children.
• Patient must do regular exercise in order to strengthen muscles.
• Patient should be provided with safe environment at home. Patient should be kept waya from wires, cords and uneven flooring.
• More liquids should be added to the diet of the patient, and patient should avoid talking while eating food.

Doctor must be contacted immediately if any changes in the symptoms are detected. At the time of falls, bladder infection or chocking, patient should be immediately brought to hospital. (American Parkinson Disease Association, 2015).