Parkinson's Disease and Nursing Care

This assignment covers various aspects of Parkinson's disease, including its non-motor features, management strategies, and related nursing care plans. It draws from a range of sources, including peer-reviewed articles and research papers, to provide a comprehensive overview of the topic. The selected sources highlight the importance of understanding the disease beyond its motor symptoms, as well as the role of nursing care in managing Parkinson's disease patients. This assignment is relevant for students and professionals interested in neurology, nursing, and healthcare management.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author note

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Cases study- Phillip
Primary care for chronic illness is very complicated as it is multifactorial in nature. The
patient’s health may be affected by different factors. To provide high quality and safe care the
nurse must consider the patient and associated clinical needs (Helgeson & Zajdel, 2017). The
essay deals with the case study of Philip, 67 years old male, with primary diagnosis of
Parkinson’s disease. The case study will be analysed to identify the two priorities of care. The
aim of the essay is to develop comprehensive care plan for him applying the clinical reasoning
cycle. It is the tool for nurses to develop the goal driven nursing care, considering the spiral of
series of linked clinical encounters (Dalton, Gee & Levett-Jones, 2015). It will help in
prioritisation of care while integrating different aspects of the Philip’s clinical condition.
Prioritisation and care plan involves use of clinical reasoning and decision making skills
(Papastavrou, Andreou & Efstathiou, 2014).
To understand the patient’s health status it is necessary to consider the present situation
(Dalton, Gee & Levett-Jones, 2015). In the given case study, Philips 67-years old male is
presented to the medical ward after losing balance and fall. After two weeks he was diagnosed
with Parkinson’s disease. His symptoms were numbness in his hands and difficult speech. He
feels everything is spinning around. Further, process may involve collection of cues and
information from the patient’s health history, previous assessment and further assessment
(Dalton, Gee & Levett-Jones, 2015). The patient history shows presence of high cholesterol. He
has surgical history of Left knee arthoplasty. As a child he had tonsillectomy and
adenoidectomy. The discharge history shows patient under variety of medication for Parkinson’s
disease. At the time of admission he had upper limb tremor that was more pronounced on right
side. The patient experiences drooling, fatigue and sleepy episodes during the day time. The

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patient’s history also highlights the feelings of blue and fluctuations of mood, global
bradykinesia, and increasing hypoponia. The cumulative effect of these may have manifested as
difficulty in working with hot water or making tea. His occuputational history showed him as
semi-retired worker. He worked part time at tea store. It may be associated with serious financial
implications. His social life is poor. He is separated from his wife and his children do not support
enough. It may be related to emotional issues if unaddressed. These conditions if untreated may
lead to other comorbidities such as hypertension, diabetes, paralysis, chronic pulmonary disease
and others (Lubomski et al., 2014).
It is necessary to process this information, to prioritize the care. It involves use of critical
thinking and relation of information to clinical knowledge (Dalton, Gee & Levett-Jones, 2015).
Philips fails to coordinate at work may be due to lack of dopamine. The loss of neurons and cells
from the substantia nigra of the brain leads to decreased dopamine secretion. Dopamine is
responsible for impairing the basal ganglia in low levels, thereby affecting movement and
coordination of activity (Schulz-Schaeffer, 2015). Gait is the most telling signal of Parkinson’s
disease. In normal condition the patient can walk from head to toe but in Parkinson disease the
patient does not lift the feet at all. As the gait shuffling becomes more pronounced, the patient
suffers from fall. It is known as freezing of gait (Reichmann et al., 2016). Falls may be due to
failure in sustaining the waking velocity as in normal condition for longer distances (Schulz-
Schaeffer, 2015). Parkinson’s disease results in deteriorating rhythm control, bilateral
coordination of gait, Sleep scaling, gait symmetry, and decrease the dynamic postural control. It
may be the rationale for motor symptoms, upper limb tremor, and bradykinesia and sleepy
episodes. It is manifested as drooling, confusion, and dropping of equipments at work (Schulz-
Schaeffer, 2015).

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Fatigue presented by Philips is the insidious symptom of Parkinson’s disease. It is also
known as Parkinson’s apathy where the individual fails to initiate projects or follow complex
interactions and have short term memory loss. Even simple daily life activities like walking,
results in energy drain, causing fatigue (Serrano-Dueñas et al., 2018). The pathophysiology is
however not very clear. The absence of dopamine in the Parkinson’s prevents protection of
cochlea and result in hearing loss (Lai et al., 2014). Philips is thus experiencing increasing
hypoponia. The slurred speech in Philips may be due to dysarthria that is impairment of muscles
required for speaking. It may have caused by hypoponia that result in weakening of muscles and
weak voice (Rusz et al., 2015).
Parkinson’s has profound impact on the emotional and the psychological wellbeing. The
out of proportion emotional reactions in Philips may be due to biochemical changes wrought by
the disease. Depression and denial of the reality of the situation are the adverse outcomes. It in
turn starts a chain of reaction that manifests as spiral effect. Starting with sleep disorder, to
concentration issues, the apathy increases (Reichmann et al., 2016). Therefore, the mood swings
in Philips may be the cause of cumulative effect of emotional impact as well as motor function
decline. Depression also causes the memory impairment and slow response (Schrag et al., 2015).
High cholesterol in the patient is risk factor for hypertension and other comorbidities (Mark &
Somers, 2016).
In order to prioritise the care the main health issues of the client must be identified.
Based on the above analysis and from the synthesis of fact, it can be concluded that the main
health issues are impaired physical mobility and speech and hearing impairment. The other
symptoms such as gait, balance, tremors, fatigue, slow response are all interrelated to this main
health issues. Sequentially, it is hampering the activities of daily life of Philips as well as social

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life. Interventions are required to minimise the risk associated with these health issues. The main
risks associated this health issue is risk of injury (Lubomski, Rushworth & Tisch, 2014).
Addressing these issues will help Philip manage his daily life activities. Therefore, the nursing
care priorities applying the clinical reasoning for Philips are- 1 improvement in functional
mobility within the limitations of disease and 2 prevent risk of injury. Hence, to fulfil the two
priorities of care comprehensive nursing care plan will be developed based on evidence.
An action plan is required to fulfil the priorities of care to yield positive health outcomes
(Dalton et al., 2015). The action plan for maintaining functional mobility and reducing the
complications may involve patient education on safe techniques of movement. For instance,
rocking from sideways may help in leg movement. Bradykinesia and tremors may increase
difficulty in getting out of chair. The patient may be instructed to move to edge of seat, take arm
support followed by standing position (via rocking). To decrease muscle rigidity, the patient
may be provided with warm bath and messages (Van der Eijk et al., 2013). To prevent the risk
of injury it is necessary to assess ambulation and movement to plan appropriate patient centered
interventions. During ambulation, the patient may be recommended to swing arms and lift heels.
It will assist in gait and prevent falls (Van der Eijk et al., 2013).The patient may be instructed to
maintain an upright posture to maintain functional mobility. Philips may be requested to look up
while walking. It will prohibit the patient to have the stoped posture and prevent collision with
objects while walking. In order to improve balance, a wide base gait may be instructed
(Tomlinson et al., 2012).
To prevent injury, patient education may involve teaching Philips to turn in wide arcs. It
will prevent crossing of legs over one another and falls. Further, teach range of motion exercises.
The patient may be referred to physical therapist for safe exercise program. Philips will be

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trained to use facial muscle for exercises for effective communication of needs. He may be
assisted to perform daily stretching activities. This intervention is effective in improving
strength, flexibility and balance (Van der Eijk et al., 2013). The patient may be educated to
undertake rehab services instead of staying at house. To integrate the Philips’ needs the patient
may be monitored for non verbal messages and ensure calm and relaxed communication as
speech and hearing is weakened. Positive body language and soft tone of voice will be used
communicate care needs and prevent Philips’s anxiety (Gulanick & Myers, 2013). The patient
will be educated to talk slowly in short phrases and provide him with hearing aid, for addressing
care needs (Van der Eijk et al., 2013). Pharmaceutical interventions may include use of
dopamine agonists or levadopa for motor symptoms. Cholinesterase inhibitors may improve
depression (Connolly & Lang, 2014).
Evaluating the nursing action plan is mandatory to ensure effectiveness of interventions
and modify in case of adverse outcomes (Dalton, Gee & Levett-Jones, 2015). The evaluation
may involve ensuring that home environment is free of barriers. The patient must be safe from
environmental hazards. Philips to be monitored during exercises for adherence to guidelines. He
will be monitored for speech and hearing cooping. Assess about knowledge of potential hazards
and its elimination. Client will be assessd to show willingness to join rehabilitation service. On
reflection it appears that the patient may have challenges in adhering to treatment. The patient
may be evaluated for anxiety and aggression during treatment. He may be referred to cognitive
behavioural therapist for controlling irrational thoughts and behaviours. It will also reduce
depression (Troeung, Egan & Gasson, 2014).
In conclusion, the essay helped to understand the process of prioritising the care for
chronic illness, applying the clinical reasoning cycle. It is an effective method to rationalise the

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illness symptoms and identify the main health issue. In case of Philips, the mobility impairment
and weak speech and hearing are the main health issues. Both increases risk of fall and injury.
Therefore, nursing interventions are developed for maintaining functional mobility and reducing
risk of injury. The interventions are based on evidence and will yield positive health outcomes.

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References
Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a
review. Jama, 311(16), 1670-1683.
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
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Gulanick, M., & Myers, J. L. (2013). Nursing Care Plans-E-Book: Nursing Diagnosis and
Intervention. Elsevier Health Sciences.
Helgeson, V. S., & Zajdel, M. (2017). Adjusting to chronic health conditions. Annual review of
psychology, 68, 545-571.
Lai, S. W., Liao, K. F., Lin, C. L., Lin, C. C., & Sung, F. C. (2014). Hearing loss may be a non ‐
motor feature of Parkinson's disease in older people in Taiwan. European journal of
neurology, 21(5), 752-757.
Lubomski, M., Rushworth, R. L., & Tisch, S. (2014). Hospitalisation and comorbidities in
Parkinson's disease: a large Australian retrospective study. J Neurol Neurosurg
Psychiatry, jnnp-2014.
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insights and therapeutic implications. Hypertension, 68(1), 24-26.
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patient outcomes: a systematic review of quantitative studies. The International journal
of health planning and management, 29(1), 3-25.

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Reichmann, H., Brandt, M. D., & Klingelhoefer, L. (2016). The nonmotor features of Parkinson's
disease: pathophysiology and management advances. Current opinion in
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Rusz, J., Bonnet, C., Klempíř, J., Tykalová, T., Baborová, E., Novotný, M., ... & Růžička, E.
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Van der Eijk, M., Nijhuis, F. A., Faber, M. J., & Bloem, B. R. (2013). Moving from physician-
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