Question

A. FP is a 66-year-old man hospitalized for surgical management of an enlarged prostate. His chart indicates that he has had Parkinson disease for 5 years prior to admission and has been managed with a dopamine precursor (levodopa/carbidopa). He also has a seizure history, having experienced a seizure about 20 years ago as a complication of a motor vehicle accident. He took an anticonvulsant medication for many years but stopped taking it about 3 years ago because he was “tired of taking it” and hadn’t had a seizure since the accident.

Discussion Questions

1. What types of motor difficulties would FP be expected to exhibit related to his Parkinson disease?

2. What is the rationale for managing Parkinson disease with a dopamine precursor?

3. What safety and activities-of-daily-living problems might FP have encountered while hospitalized?

4. If FP experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?

B. MG is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104 °F, lethargy, headache, and stiff neck. Laboratory analysis of a spinal tap demonstrates increased white blood cells in the cerebrospinal fluid (CSF).

Discussion Questions

1.What is the most likely cause of MG’s signs and symptoms?

2.What is the origin and pathogenesis?

3.What other laboratory findings would be consistent with this etiology?

4.What are common complications of this disorder, and how would one assess for their occurrence?

5.What is the usual treatment for this disorder?

Answer 1

1.The following motor symptoms can be exhibited by a patient who has Parkinson's disease

• Tremor usually begins with extremities
• Decrease in arm swing
• Rigidity of the muscles
• Decreased movement or bradykinesia
• Dystonia
• Abnormal gait while walking

2.Parkinson's disease happens due to alteration in dopamine level. Hence administration of dopamine is essential to control the symptoms.Here levodopa acts as a precursor and it forms dopamine which is responsible to control tremor.

3.Some of the safety and activities of daily living problems affected are

• Risk for fall due to loss of balances
• Unable to do activities by self like brushing,dressing,bathing ,walkingetc.,
• Needs help in toileting
• Patient will lack the sensory perception to smell son there are chance of food poison ,toxic gas attack etc.,

4.When there is a seizure attack the following has to be assessed

• Length of the seizure attack and any injury to tongue or other body parts
• Neurological assessment
• EEG,CT or MRI scan as per the order

The seizure can be managed by

• Removing any sharps around pay and preventing from tongue bite
• Anticonvulsant to prevent seizure episode
• Sedation in case of severe symptoms
• Provide all basic care to the patient.