Nursing Care for Parkinson's Disease: A Case Study

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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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