Care for a Parkinson’s Disease Patient

This clinical case report discusses the care for a Parkinson’s Disease patient. It includes information about the patient's diagnosis, nursing problems, nursing management, and discharge planning. The report provides insights into Parkinson’s Disease and its impact on patients.

CLINICAL CASE REPORT 1
Care for a Parkinson’s Disease Patient
Student Name
Institution
Course
Date

CLINICAL CASE REPORT 2
Care of a Parkinson’s Disease Patient
Introduction
My report involves Jessica, a 79-year-old woman who lives in South Australia’s rural
area. She lives with her husband, Frank who is 60 years old. She has been admitted to my ward
at the Crystal Brook for respite care and was diagnosed with Parkinson’s disease 15 years ago.
Her mother had the same ailment and died of pneumonia aged 80 years. She takes Sinemet CR
tablets every four hours and a daily dose of Pramipexole 1.5 mg to control her PD symptoms.
Her husband is the primary caregiver. The purpose of this report is to act as the tool to plan and
evaluate care to the patient (Cereda et al. 2011, p. 2620). The record will act as the means to
communicate in detail to other parties who may be involved in rendering care to the patient. The
report includes the primary admission diagnosis where the client’s pathophysiology is described
in detail. The report also has the nursing problems sections where the manifestations and
pathophysiology presented in the admission section are applied to identify the nursing problems
that arise. The final section is the nursing management where the above nursing problems are
addressed. The nursing assessment, interventions and the role of the registered nurse involved in
this medication are also stated.
The Primary Admission Diagnosis
Mrs. Jessica George has a tremor in her upper limbs. It was also noted that her face
looked mask-like and she spoke in a hoarse voice which was also monotonous rather than the
normal inflections. The patient also has a drag in her left foot. This is because the muscles are
rigid and happen to limit her motion range. The patient also displays slowed movement also
known as bradykinesia. This makes even the tasks which were simple seem difficult and

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consume a lot of time. For example, the walking steps are shorter and it may be difficult to get
out from a sitting position. She also has impaired posture and body balance. Even though she
could walk without any aid, her balance appears unstable. She had recently fallen while at home
and sustained a bruise and a skin tear in her lateral lower leg. She complains of a lack of appetite
and constipation. She also starts coughing whenever she takes a drink of water. She is very
anxious. This shows that she has emotional complications which may result in even depressions.
She is also very particular in timely medications and she believes that the effectiveness of
levodopa therapy starts to diminish after a period of four hours. She states that she has a little
good time due to her immobility and her need for assistance in all the activities of daily living.
This shows that she is sad and lacks motivation and thinks of her life like the one that purely
relies on the medication that she gets (Hirsch and Hunot 2009, p. 397). She also displays a state
of excessive and uncontrolled movements in the times that the medication is in effect. Her limb
Nursing Problems
The nursing problems that I noticed include impaired physical mobility. From the
diagnosis, it was clear that Jessica had difficulties in movements, which in most cases was very
slow. There was also some weakness in the lower limbs which are attributable to the recent
accidental fall while she was at home. Her unstable balance made her unable to bear much
weight. She was also mostly immobile where she only stays in one place as even rising up from
her seat is difficult. It is also clear that she has balance and muscle coordination deficits that
further hinder movement. She clearly states of her desire to move from one place to another and
do her daily activities all on her own. She says that she has a little good time due to her
immobility and uncontrolled movement at the time the medication is in effect. This muscle
rigidity also affects her capability to do such small tasks. This is because movement in a human

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is solely attributed to the flexibility of the joints and muscles (Tomlinson et al., 2010, p. 2600).
The PD also affects her body balance. This brings an injury risk due to the accidental falls. The
tremors and loss of body postural adjustment cause these accidents. It can also be related to poor
judgment where the strides are poorly estimated in line with the coordination capability of the
limbs. The patient is therefore forced to remain at a sitting position most of the time (Soldner et
al. 2009, p. 970).
The other problem that I noted is the disturbed thought process. Mrs. Jessica experiences
a disruption in the cognitive operations. The patient has had some lifestyle since the disease
struck. She is reported to be very anxious of late. She entirely believes in effectivity of the
medical attention that she receives. She is also unable to conduct the normal daily activities on
her own to the point that she has to rely on her caregiver (Deuschl et al 2009, p. 899). She is at
times sorrowful and in some cases. She laments that of late her good times are reduced due to her
inability to move. She is reported to be very alert in some cases.
Nursing Management
As the registered nurse in charge of Jessica, my role is to intervene while looking out for
any possible depressive behaviors. After discharge, there are regular visits to the hospital where
she meets the nurse. Considering the possibility of thought complications my role patient to the
reality. The patient ought to be made aware of her own self as well as the surroundings because
the ailment greatly drains their memory and level of judgment (Rayner et al 2011, p. 25). The
nurse is also expected not to have a judgmental attitude towards the patient and also pay attention
to her feelings. I’m supposed to establish a trustworthy relationship with the patient. She can
discuss topics that will help the patient deal with her concerns in most appropriate ways. Most of
the time the PD patients feel embarrassed, lonely and bored. This is brought about by their

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slowness to accomplish their own tasks as it requires a great effort. She needs assistance and
training on how to accomplish these tasks so that they can regain their personal independence.
The nurse should also make sure that she takes the described dosage (Sidransky et al 2009, p.
1665). The depressive nature and forgetting nature of the patients may lead to unintentional drug
misuse. Upon discharge, the nurse should make sure that in the regular visits she follows the
prescription. In the unstable mental state, the patient might also have suicidal thoughts
(Wickremaratchi et al 2009, p 807). She needs to be taken care of every time she seems
depressed where therapy is also recommended. While in the hospital the vital signs should be
monitored regularly. Antidepressants, as well as other psychoactive medications, can be used to
prevent psychiatric disturbances.
The nurse should assess the current mobility of the patient. This will be by telling her to
try various movement techniques, for example, rocking from side to side (Sidransky et al., 2009,
1660). The patient can also be instructed to try and wake up from the edge of the seat, or try to
place the hands on the arms of the chair for support, or even try to bend forward so as to know
which the best waking up position they are comfortable with. It will improve their mobility and
also at least enable them to practice muscle flexibility in movement. The patient mobility can
also be assessed by their capability to walk while erect and also use a wide-based gait. It will
show to which extent the rigidity of the arm has advanced which may prevent them from walking
normally with reduced swinging. She can also be told to try to raise her feet while she is moving
so as to check on how fast she can successfully take strides. The patient can also engage in daily
exercises under an instructor so as to check on the current muscle strength. These include trying
to ride a stationary bike, swimming or even gardening.

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The other role of the nurse would be referring the patient to a therapist. This will help to
develop an exercising program an also give the patient professionally specialized instructions on
the safe exercise techniques (Willis et al 2011, p. 857).
Discharge Planning
The aim of the discharge planning is to ensure a smooth continuity of care to my patient
from the health care to the community (Follett et al 2010, p. 2090) It is the link between the care
that is given I the hospital to the patient to the care that the community is expected to render to
the patient. The other aim of the plan is to maintain the quality of care that the patient receives
from the community once she gets officially discharged. The importance of the discharge is to
reduce the period that a patient will stay in the hospital. It will make her get accustomed to life in
at home so as she can easily adapt to it. A good discharge plan will guarantee reduced chances of
unplanned hospital readmission (Tomlinson et al 2012, p. 345). It will also improve coordination
of services after the patient’s discharge. Each participant clearly understands their roles in the
care of the patient so as to avoid any inconveniences in the recovery process. Jessica requires
adequate attention considering that she has she cannot do most of the daily activities on her own.
During the regular hospital visits, the patients meet the assigned registered nurse
(Chaudhuri and Schapira 2009, p 473). The role of the nurse is with the assistance of the patient
and the caregiver, monitor the recovery activities that the patient is engaging in. The nurse is also
supposed to monitor the advancement of the disease and direct the patient to the relevant care
(Schrag et al 2015, p. 60) For example, in case of problems with communication and sensory due
to sight, hearing and dentures she should be directed to the areas where she should get glasses,
hearing aids or dental care. The nurse can also refer her to professional physical therapists so that

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she gets specialized guidelines on the best ways to carry out her exercises safely (Sanchez et al
2009, p. 1308)
Other than the nurses the caregiver who is her husband, with assistance from her wife is
supposed to make sure that all the doctor’s instructions are followed. She should maintain the
right dosage and feed on the prescribed diet. They are also in charge of her psychological state
and should make sure that she is never lonely. They should attend to her frequently, give her
stories and also assist her whenever she needs help. They should also give her walking so as to
try and strengthen her muscles. In the case of any unusual complication, they should contact the
hospital immediately. They should also make sure that she attends the planned hospital visits
precisely in the instructed durations and keep the information on the progress of the patient so
that it will be used in the assessment.
Summary
Parkinson’s disease mostly affects the aged people and greatly affects the brain cells.
These cells are in charge of nervous impulses and the muscle coordination that is responsible for
body motion. It causes the patient to have difficulties in motion as well as memory and thought
complication. In the severe cases, the patient is unable to conduct even simple tasks and is
entirely dependent on a caregiver. Jessica lives with her husband and has frequently been visiting
the hospital in seeking medical attention. As her nurse, I needed to apply effective management
techniques that will be of most use to her. One of these measures is determining the main nursing
problems that the disease caused to the patient as to determine the best way of dealing with it.
The patient had a movement problem and needed some aid to move and fulfillment of some of
her daily activities while in the ward. The disease also affects the mind of the patient and this
changes even her behavior. She is now very anxious and uncomfortable with the situation. She

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needs care from the nurse as well as the community which she lives in once she gets discharged
from the hospital.

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