Nursing Care for Parkinson's Disease: A Case Study

This case study focuses on the nursing care and management of a patient with Parkinson's disease. It discusses the primary diagnosis, nursing problems, interventions, and discharge planning. The goal is to provide effective and efficient nursing care to promote the patient's wellbeing and independence.

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INTRODUCTION
Mrs. Jessica George is an old adult (79 years) living with Parkinson’s disease (PD) for 15
years now. There is a case of PD diagnosed in her mother. The PD symptoms manifesting are
being managed through medication.
Jessica is alert, oriented, slightly anxious and with a noticeable tremor in her upper limbs.
(Bruno, and Sethares, 2015, p.149) After assessing her, it was noted she has a mask like-face, her
voice being hoarse and monotonous. The physical examination has shown her heart rate to be
normal, normal blood pressure and a healthy respiratory rate. She can arise from the chair
without the support of the hands. A drag is noticed on the lower left foot. Jessica moves slowly,
rigidly and in an unstable manner without aids. The left leg has a bruise and a tear on the skin
due to a fall. She has constipation, lack of appetite and cough when given water.
The overall objective is to give Jessica an effective and efficient optimal nursing care,
maximum level of wellbeing and independence. This is going to be attained through good
nursing practice which involves appropriate primary diagnosis, identification of the nursing
problem, formulation of the nursing assessment, intervention, medical management and a
discharge plan.
PRIMARY ADMISSION DIAGNOSIS
Primarily, Jessica was diagnosed with Parkinson’s disease. The disease is considered
highly idiopathic, though a few cases are proven to be genetically linked. It is a progressive
disease and causes a disorder in the nervous system. (Tysnes, and Storstein, 2017.p.903)
No cure has yet been found for this disorder, but medication would greatly help in managing the
symptoms (Bruno and Sethares, 2015, p.150). Parkinson’s disease is due to loss of dopamine.
This happens in the synapse. This affects the functioning of the nervous system since the
transmission of electrochemical signals in the Central Nervous System and the Peripheral
Nervous System is impaired. The symptoms are rigid muscles, tremor, bradykinesia, imbalance,
stooped posture and a monotone speech. (Sveinbjornsdottir,2016, P.399)
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Potentially, Jessica diagnosis with PD may be due to the genetic link with her mother.
Her manifestations are in total alignment with the symptoms of Parkinson’s disease. (Kalinderi,
Bostantjopoulou, and Fidani, 2016, p.319)
The objective manifestations of PD in Jessica include a noticeable tremor in her upper limb, a
hoarse monotonous speech, a rigid, slow and unstable movement with a scuff of the left foot. Her
face is mask-like displaying the very nature of PD to stiffen the facial muscles supplied by the
facial nerve. This limits the face from displaying facial expressions based on their emotions.
Some of the subjective manifestations are: Jessica fell at home which would be due to the
imbalance and her need for help when it comes to Activities of Daily Living (ADL). Jessica
claims relative less good time which may be due to muscle stiffness and rigidity. Muscle
stiffness is painful and hinders the patient from resting and limited movement. There is a
complaint from Jessica of constipation and loss of appetite; this can be anticipated to stiffened
muscle movement which slows bowel movements leading to indigestion and lack of appetite.
(Abbruzzese, Avanzino, and Pelosin, 2016, p.61)
NURSING PROBLEM
Impaired physical movement
This is an actual nursing problem denoted by the limitation of willful, independent and
purposeful movement of the body and its parts. (Wang, Jiang, and Yuan, p.1587)
Jessica has impaired physical movement which is related to (r/t) various factors as
denoted below: Impaired physical movement is related to bradykinesia. Bradykinesia is slowed
spontaneity and movement. It is also related to muscle rigidity as a result of Parkinson’s disease,
tremors on the limbs, perceptual impairments and cognitive impairments. (Moustafa, et al ,2016,
pp.732)
Cognitive impairments affect the accurate judgment of the affected person. It is also related to
poor nutrition which is caused by indigestion as a result of slowed muscle function of the
bowels.
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All the above is as evidenced by: It is as evidenced by the tremor in Jessica’s upper
limbs, the drag seen on her left foot and the slow and rigid movement with the instability in her
balance. It is noted that Jessica requires assistance with the activities of daily living (ADL).
The focus and desired results being that Jessica may attain maximal and operational
mobility despite the disease limitations. The focus would is to eliminate complications related to
mobility.
Imbalanced nutrition
It happens when one has less than the body nutritional requirements. It is a challenge for
people diagnosed with PD. Jessica has imbalanced nutrition which is related to (r/t) rigid bowel
muscles, indigestion, dehydration, and feeling weak as evidenced by (aeb) Jessica experiencing
constipation, coughing, the rigidity of facial muscles and the lack of appetite. (Martinez‐Martin,
2017.p.210)
The focus is geared towards ensuring that Jessica has a healthy balanced diet and as a
result balanced nutrition. The objective is to eliminate imbalanced nutrition-related
complications. This is to ensure no signs of malnutrition such as weight loss.
Impaired physical movement
Nursing assessment and rationale
Motor assessment: This entails assessment of arm and hand function, gait (walking),
posture and balance. This will help the RN assessment of activities of daily living. The RN will
use a rating scale like UPDRS and questionnaires to examine Jessica. She will question Jessica
on bradykinesia but using terms which Jessica will understand like do you feel dizzy when you
stand for too long?
The RN will do orthostatic hypotension examination and assessment of medication
adherence. The rational is to assess how advanced is the rigidity in order to determine how best
to administer intervention. (Mahlknecht, et al, 2016, p.1411)
Nursing intervention and rationale
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Physical therapy; The RN will help Jessica to concentrate on walking uprightly and using
a broad-based gait. The rationale is that due to the rigidity of muscles, imbalance might be
affected by the lack of shuffling of hands and there must be a conscious effort of walking
uprightly and swinging of hands. Within the 5 days, she will add to Jessica’s schedule activities
like riding a stationary bike and swimming. The rationale is to increase coordination within the
body which happens when the muscles are in use. The RN will instruct Jessica to have warm
baths and massages to relax muscles and relieve muscular pain. The rationale is that physical
exercise increases mobility and endurance by reducing the stiffness of muscles.
The role of the RN in the medication management
The RN will educate Jessica on the purpose of medication and clarify that the medication
therapy doesn’t cure rigidity rather it prevents severity and offers a better quality of life. She will
inform Jessica the side effects of the medication such as a dry mouth and dizziness. (Sullivan,
Schmitz, and Fulk, 2019.p.2). The RN will ensure that Sinemet CR (200/50 mg tablets) is
available and that Jessica takes them after every 4 hours together with Pramipexole (1.5mg)
which she shall take daily. She is not to engage in any activity that requires full alertness like
driving after medication.
Imbalanced nutrition
Nursing assessment and rationale
The RN will do genitourinary nursing assessment and assessment on bowel status by use
of Bristol stool scale. She will assess Jessica’s eating habits with the aim of counseling her on
poor eating habits consequences. She will question her whether she feels pain when chewing and
swallowing food.
Nursing interventions and rationale
The RN will do teaching intervention and measure Jessica’s weight daily on a scale with
the rationale of monitoring her weight and updating her on the progress. She will offer Jessica a
relaxing conducive environment to eat slowly with the rationale that eating for PD patients is a
difficult task.
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The role of the RN in the medication management
The RN will ensure a balanced diet for the 5 days she is in the ward. A balanced diet is
the best treatment of imbalanced nutrition. Dietary supplements may be harmful and should only
be administered when necessary. She will ensure the rights of medication administration are
observed; the right medication, right route, right time, right reason, right documentation, right
response, and right client.
DISCHARGE PLANNING
It is a process aimed at ensuring safe handling of patients from one level of care to
another. Discharge planning is important since it helps in the quick recovery of the patient,
administration of the medication correctly as prescribed and accessibility of the patient.
(Mahlknecht, et al, 2016 p.1410)
It will ensure that Jessica honors hospital appointment, ease of patient monitoring and
response to medication. It ensures better quality of life will have caregiver skilled to offer help in
activities of daily living. Discharge planning reduces possibilities of Jessica’s readmission into
the hospital and healthcare costs.
It is important to use a multidisciplinary approach when conducting a discharge plan
since it ensures involvement and boosts confidence in the discharge process. It is also
accommodative to the opinions of the caregiver and family based on the discharge.
It is the role of the RN in facilitating the multidisciplinary approach discharge plan. It is
the role of the RN to involve key personnel to form a discharge team. The RN has an obligation
of evaluating the client from the admission date. The RN engages in deliberate meaningful
discussions with the client and the client’s representatives on discharge plan to get their
feedback. The RN oversees and facilitates effectively the client’s homecoming or transfer to a
different care facility. This is to be done professionally with the client’s best interests at heart.
The RN is to arrange for caregiver training if necessary or where deemed fit. The training may
involve aspects such as how to administer medication to the client appropriately, activity and
safety of the client, dietary needs of the client and other lifestyle changes. The RN is to arrange
for follow up tests or appointments with the help of the team. (Abbruzzese, et al, 2016.p.S63)
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The members of the multidisciplinary team would involve the RN who would perform the
aforementioned roles, the primary medical practitioner (family doctor), the caregiver and the
family representative.
The caregiver (Frank) and the roles played in the multidisciplinary discharge process:
The caregiver gives his opinion on whether he is willing to offer person-centered care to
the client. It is also important for him to assess his ability and give a response to the discharge
panel. This is so since he is the one that would be involved in offering health care, supporting in
activities of daily living, emotional care, and personal care. (Boersma, Jones, and Kluger,
2017.p.936)
Primary Medical Practitioner
The medical practitioner is of the essence since he has good knowledge of the client’s
medical condition and history. Their opinion of whether the client should be discharged or when
and how would be very helpful in planning.
The family
Jessica’s family would be instrumental in ensuring home safety standards. The rationale
is that Jessica has a risk of fall and injury. The family knows her (Jessica) tendencies and
behaviors at home and is better position to rectify some such as poor dietary tendencies and
physical fitness issues.
SUMMARY
From the case report, it is evident that a multidisciplinary approach of discharge planning
is more effective when dealing with clients of chronic disorders. It is a contemporary method as
opposed to the discharge of clients from care centers without the knowledge of the primary
medical practitioners. That approach has been reported to lead to more clients discharged
prematurely and thus adverse medical conditions, with some leading to readmission or even loss
of life. From our client, it was fair that diagnosis of PD was done early leading to proper
symptom management. More research should be done to ensure that diagnosis of neurological
disorders specifically PD can be done early. (Domellöf, et al, 2017.p.46)
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It is scientifically proven that the signs and symptoms can only be seen after approximately after
7 years. More research should be done on using the smell/odor of the patient to detect PD just
like in Typhoid.
Scientists have discovered that individuals with particular genetic mutations are more
susceptible to Parkinson’s disease. (Kalinderi, Bostantjopoulou, and Fidani, 2016, p.318)
This is a discovery that can help speed up the invention of medication of the nervous disorder
through intense study. I recommend that intense and thorough research be done in this field.
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