Question

CASE STUDY PARKINSON’S DISEASE

Miss Rose is a 74 year old female, who is a retired widow and lives with her son for the past five years. Both enjoy planting seedlings and own a community agriculture store. She does not suffer with hypertension or diabetes and has an active lifestyle. She is also not known to have any psychiatric illnesses. Over the past six months Miss Rose’s son and herself noticed physical changes and decided to visit her General Practitioner. At her visit she mentioned to the doctor that she was having difficulty rising up from a sitting position after grooming her plants or turning from one table to another when she has customers. Documentation on her clinic file noted that she previously complained of difficulty walking and falling when coming out of bed. She was sent for an X-ray but there were no clinical findings. The physician asked her to describe what happened when she fell. Miss Rose verbalized that when she got up from bed and starting walking she started moving forward and backward then stooped forward with small fast steps and then she fell. Her son mentioned to the doctor that he has noticed that when she is pruning her plants she has abnormal rhythmic movement of the upper and lower limbs. She occasionally has a slight limp and her handwriting has become smaller over the past months. This has stopped her from doing her daily yoga exercises and she has been very disturbed about it. Miss Rose then further explained that the movement started on the distal part of both upper limbs at the same time. She also expressed that during rest she noticed the movement in her limbs and as she started her tasks the movements became more aggravated. Urinary incontinence is also a problem for Miss Rose and she is having difficulty in her swift movements to her bathroom. The patient was later diagnosed with Parkinson’s disease. After the assessment and interview of Miss Rose the Physician documented the following: Physical Assessment Vital Signs: BP- 130/74 mmHg Temperature - 36.7 C, Pulse- 78 bpm regular and bounding Respiration- 20 bpm Height- 5ft 7 in Weight- 70 kg Facial expression- Masklike Gait- Shuffling gait with tendency to fall forward and backward CNS Examination Alert and oriented to time, person and place Level of consciousness GCS- 15/15 Sleeping patterns- normal Swallowing gag reflex- normal Cogwheel rigidity present Tremor present Bradykinesia present Dysphonia present

Instructions:Answer the question below.

a) Discuss the nursing management of the patient using a care plan. Three actual and two (2) potential

Answer 1

Let's see the important Assessment findings.

• Tremor
• History of fall
• Occasionally has a slight limp
• Stopped doing yoga
• Increased tremor while doing any task
• Urinary incontinence
• Bradykinasia
• Dysphonia
• Swift movement
• Cogwheel rigidity
• Mask like facial expressions
• Shuffling gait with tendency to fall forward and backwards

Prioritize findings according to the patient need ,

?‍⚕So we can write?

1.NURSING DIAGNOSIS

Impaired physical mobility related to disease progression as evidenced by Shuffling/balance and co-ordination deficit/gait disturbances/bradykinesia/difficulty turning/tremors/cogwheel rigidity /instability while standing.

INTERVENTIONS

• Assess the functional ability for mobility.
• Assist patient with walking , it prevents the risk of injuries as well as the chance of developing immobility.
• Provide and encourage active range of motion exercises , it helps in prevention of muscle atrophy and joint contractures.
• Provide walkers and canes only after assessing the cognitive abilities, because , in patient with cognitive impairment the potential for injury is high.

2.NURSING DIAGNOSIS

Selfcare deficit related to swift movements /bradykinesia as evidenced by verbal reports of stopped yoga exercise / previous history of fall

INTERVENTIONS

• Assess the appearance and grooming
• Ensure all needed items are present in bathroom before the arrival of patient. Make sure that the water temperature is proper. It helps to reduce the risk of injury .
• Instruct the patient in activity with short step by step method, do not rush patient.
• Establish urinary and bowel care programme if patient is unable to complete toileting.

3. NURSING DIAGNOSIS

Altered bladder elimination pattern related to abnormal bladder contraction due to Parkinson's disease as evidenced by verbal reports of urge incontinence.

INTERVENTIONS

• Assess the voiding frequency of the client.
• Promote access to toilet facilities , instruct patient to keep scheduled bladder elimination.
• Administer medications as per orders.
• Health educate the client regarding the importance of avoiding alcohol and caffeine intake.
• Aid the patient in bladder training programmes.
• Educate and ecourage patient to do KEGELS EXERCISE.

4. NURSING DIAGNOSIS

Risk for injury related to bradykinasia/tremor

INTERVENTIONS

• Assess ambulation and movement

Assist the patient while doing activities of daily living.

• Teach patient to turn in wide arcarcs.
• Instruct patient to maintain an upright posture .
• Instruct to take wide based gait.
• Teach range of motion exercises.

5.NURSING DIAGNOSIS

Risk for ineffective verbal communication related to hypertonicity/psychological barriersbarriers as evidenced by dysphonia.

INTERVENTIONS

• Assess the ability to speak.
• Attempt to anticipate the needs
• While communicating with patient, face the patient, maintain eye contact, speak slowly in a moderate or low pitched tone.

​​