Nursing: Clinical Case Report

This clinical case report analyzes the medical assessment of a patient with Parkinson Disease and provides nursing interventions and management strategies.

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NURSING: CLINICAL CASE REPORT
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Nursing 2.
Introduction
The case report provides a medial assessment analysis of Mrs. Jessica George who is 79 years
old patient. She is married to Frank (60 years) her husband who also serves as her primary
caregiver. According to her health status assessment she was diagnosed with Parkinson Disease
(PD) in the last 15 years and she has been receiving treatment from both the Critical Brook and
District Hospitals for Respite care. Based on her medical she does not show any other medical
history however her mother died of Pneumonia at the age of 80 years and had suffered from PD
for 30 years. Her case, therefore, requires some nursing intervention based on the findings from
the assessment report based on her medical history, her general appearance assessment; her
medical believe and clinical assessment by providing pathophysiological patient-centered
nursing care. The purpose of this report will, therefore, be to provide an effective
pathophysiological nursing intervention that will help to solve the identified nursing problems in
the patient case. The structure of the report will involve the analysis of the primary admission
diagnosis of the patient, identification of nursing problems based on the assessment report,
nursing management and development of a discharge plan as well as a summary of the
significant findings of the report.
Primary Admission Diagnosis
Mrs. Jessica was diagnosed with Parkinson Disease (PD) 15 years ago which is the reason why
she has been admitted to the hospital for treatment. This disease refers to a neurodegenerative
disorder, which affects an individual motor function through a progressive deterioration as a
result of the loss of dopamine-producing brain cells. It is, therefore, the second most common
neurodegenerative disorder as well as the most common movement disorder in individuals which
is usually detected at the ages of 60 years and above (Postuma 2016, 196). Pathophysiology

Nursing 3.
refers to the functional changes that accompany a particular syndrome or a disease and therefore
based on the assessment report of the patient; this report will be able to analyze the common
nursing problem facing the patient and the necessary nursing management practice towards an
effective patient-centered nursing care approach. These symptoms will, therefore, help us
understand if the patient has been receiving the appropriate medical attention towards the
treatment of Parkinson Disease which is a neurodegenerative disorder.
The primary patient diagnosis revealed that she was becoming more alert and anxious with a
noticeable tremor in her upper limp. She was also speaking in a horse and monotonous voice and
that she also complain of constipation. The assessment also revealed that the patient she could
cough whenever she is given some water to drink, but she believed that the effectiveness of the
levodopa therapy started to wear off after 4 hours. The clinical assessment also revealed that she
had normal blood pressure (120/72) with a regular respiratory rate of 16 and a heart rate of 82
with a regular rhythm. It was also noted from her physical assessment that she was able to arise
from a chair without pushing off with her hand. However, her movements were slow and rigid,
and drag or scuffing was noted on her left foot. The clinical assessment was able to reveal that
she had a recent fall at home and therefore she was able to sustain bruises and a skin tear to her
left lateral lower leg. Therefore the findings from the assessments and observation have been
able to demonstrate various symptoms which support the previous diagnosis that the patient has
Parkinson Disease. This is because the assessment results were able to present some of the
primary and secondary symptoms of the diagnosed disease such as increased anxiety, tremors,
postural instability, bradykinesia, constipation as well as dementia and skin problems.

Nursing 4.
Nursing Problems
Based on the patient’s assessment report and symptoms we can identify the cardiac problem as
well as psychological nursing problems. The cardinal problems result from the manifestation of
bradykinesia which is the slowness of voluntary movement as well as resting tremor and muscle
rigidity. The psychological problems are backed by the presence of psychological manifestation
such as increased anxiety (Sveinbjornsdottir 2016, 322). Fear, dementia. However, the patients
lack some other aspect of psychological problems such as memory loss as she was able to follow
her medical prescription timetable, depression, lack of sleep as well as memory loss. This could
be an indication that the disease is in its primary states more of primary than secondary
symptoms of the disease are observable (Pagonabarraga, Kulisevsky, Strafella & Krack 2015,
522). The cardinal problems such as bradykinesia can be attributed to the side effects of certain
drugs such as antipsychotics. The patient has been taking Sinemet CR (200/0 mg tablets) every
four hours during the day as well as pramipexole 1.5 mg daily to manage the disease symptoms.
These drugs are antipsychotics and could be the leading cause of the cardinal problems
experienced by the patient (Ascherio & Schwarzschild 2016, 1260). The psychological problems
result from the environment in which the patient is taken care of which may be stressful and
therefore increasing the rate of depression for the patient, anxiety as well as other stress-related
disorders.
Nursing Management
Nurses play a critical role in the management of the patient’s health conditions for PD. Therefore
it is their responsibility to assess the patient nursing problem, develop an intervention strategy
and a medication management strategy (Tysnes & Storstein 2017, 903). In this case, it is
essential for the nurses to understand that PD is not cured or cannot be cured, but treatment is

Nursing 5.
administered to slow disease progression as well as reduce disability while minimizing further
complications.
For the Cardinal problems such as muscle rigidity, bradykinesia the nurses are required to
develop appropriate intervention strategies. Based on the patient manifestation of muscle rigidity
and slow movements it is critical that the nurse administer appropriate drugs as well as physical
therapies (Lill 2016, 390). The physical therapies can increase the ability of the patients to move
and as well as gain increased stability in their movements. It is therefore the responsibility of the
nurse to ensure that proper drug is administered to the patient and that they are familiar with the
mechanisms of action of PD drugs as well as the importance of taking the drugs as scheduled in
which the patient has been compliant in her past clinical experiences (Hirsch, Jette, Frolkis,
Steeves & Pringsheim 2016, 296). To treat the patient anxiety, the nurses should prescribe SSRI
or bupropion which are effective anxiety and stress relievers for the patients. Most important it is
the responsibility of the nurses to discuss with the patient the importance of physical exercise.
Bastide (2015) provides that, the patient suffers from speech and language depression and
therefore the nurse through speech and language therapies can help the patients strengthen their
volume and solve the problem of hoarse and monotonous voice so that the patients can
effectively participate in conversation as well as help her feel comfortable in social situations.
For the psychological problems facing the patient, a patient-centered care approach can be
administered to ensure that the nurses have a clear understanding of both the medical and
psychological experiences of the patients. This will help them take the necessary interventions to
help them minimize risk and exposure to stressful conditions (Braak & Del 2017, 76). It is,
therefore, the responsibility of the nurses to educate the patients and their families who are the
caregiver on the importance of avoiding stressful environments in the treatment process. The

Nursing 6.
help of occupational therapist can be beneficial in coping with the effects of the disease on their
daily routine and activities of the day to day (Salat, Noyce, Schrag & Tolosa 2016, 646). The PD
has different facets or stages and therefore it is the responsibility of the nurses to recognize and
address all the aspects of the disease as well as understand the importance of changing patients
prescribed therapies and drugs or medications as the disease progresses.
Discharge Planning
The discharge planning process for a patient aims at improving the coordination of services after
the patient is discharged from the hospital in response to the respective community needs (Hara,
Kalia & Kalia 2018, 236). The discharge process should, therefore, involve efforts of the health
professionals, the patient’s family, social services as well as the patient. In this case, therefore,
the patient discharge planning will ensure that the staff who participated in the treatment process
are involved (Magrinelli 2016, 640). It will also ensure that the patient family is involved in this
case Mr. Frank who is the primary caregiver of Jessica should be involved in the discharge
process as well as involve the patient in terms of getting his views and opinions regarding the
place of residence after the discharge from hospital and who would be involved in her primary
care at home.
The discharge process calls for the involvement of every person which includes the health care
professionals, family and the patient. At this point it is necessary for the nurses to prepare the
discharge documentation and define the effect of the transfer of care (Miyasaki 2016, 1112). The
discharge documentation will involve all the treatment documents for the patient and any other
requirements she might need as well as the instructions to the patient and the caregivers in
handling the patient and providing a supportive environment for improved treatment outcomes
(Rusz 2015, 996). This is because the ongoing patient needs must be considered before she

Nursing 7.
leaves the hospital. The nurses or the health professionals concerned should arrange for
appropriate follow-ups, ensure patient daily drug treatment is followed as well as ensure that the
patient will receive adequate support at home (Rizek, Kumar & Jog, 1162). However, it is also
important to understand that effective discharge planning requires multidisciplinary teamwork
which can be difficult and therefore it is essential to establish an active communication network
for the people involved in the primary care for the patient.
Summary of the clinical report
From the above report, it has been established that in indeed Jessica is suffering from PD as
previously diagnosed. However, her medical condition is still under primary stages which can
still be managed through appropriate treatment. It has also been established that PD cannot be
cured but can be treated to reduce the progression rate of the diseases as well as minimize further
complications to the patients. The report has also been able to identify cardiac and psychological
problems as the main PD problems facing the patient based on the manifestations and assessment
of the patient’s symptoms before admission. However, these problems can be treated through
effective nursing intervention strategy that entails providing the effective drug administration to
the patient as well as prescribing physical therapy, occupational therapies as well as speech and
language therapies which are critical in solving these nursing problems. The report has also been
able to highlight the importance of developing an effective discharge plan for the patient that
comprises of the efforts of the patient family, the patient as well as the healthcare professionals
while on the other hand developing an active communication channel to ensure proper
coordination of the prescribed care in the discharge documentation.

Nursing 8.
List of references
Ascherio, A. and Schwarzschild, M.A., 2016. The epidemiology of Parkinson's disease: risk
factors and prevention. The Lancet Neurology, 15(12), pp.1257-1272.
Bastide, M.F. 2015. Pathophysiology of L-dopa-induced motor and non-motor complications in
Parkinson's disease. Progress in neurobiology, 132, pp.96-168.
Braak, H. and Del Tredici, K., 2017. Neuropathological staging of brain pathology in sporadic
Parkinson’s disease: separating the wheat from the chaff. Journal of Parkinson's disease, 7(s1),
pp.S71-S85.
Hirsch, L., Jette, N., Frolkis, A., Steeves, T. and Pringsheim, T., 2016. The incidence of
Parkinson's disease: a systematic review and meta-analysis. Neuroepidemiology, 46(4), pp.292-
300.
Lill, C.M., 2016. Genetics of Parkinson's disease. Molecular and Cellular Probes, 30(6), pp.386-
396.
Magrinelli, F., Picelli, A., Tocco, P., Federico, A., Roncari, L., Smania, N., Zanette, G. and
Tamburin, S., 2016. Pathophysiology of motor dysfunction in Parkinson’s disease as the
rationale for drug treatment and rehabilitation. Parkinson’s disease, 2016. 640.
Postuma, R.B. 2016. The clinical symptoms of Parkinson's disease. Journal of neurochemistry,
139, pp.318-324. isorders, 30(12), pp.1591-1601.
Rusz, J. 2015. Speech disorders reflect differing pathophysiology in Parkinson’s disease,
progressive supranuclear palsy and multiple system atrophy. Journal of neurology, 262(4),
pp.992-1001.

Nursing 9.
Salat, D., Noyce, A.J., Schrag, A. and Tolosa, E., 2016. Challenges of modifying disease
progression in prediagnostic Parkinson's disease. The Lancet Neurology, 15(6), pp.637-648.
Tysnes, O.B. and Storstein, A., 2017. Epidemiology of Parkinson’s disease. Journal of Neural
Transmission, 124(8), pp.901-905.
Sveinbjornsdottir, S., 2016. The clinical symptoms of Parkinson's disease. Journal of
neurochemistry, 139, pp.318-324.
Hara, D.M.O., Kalia, S.K. and Kalia, L.V., 2018. Emerging Disease-Modifying Strategies
Targeting α-Synuclein for the Treatment of Parkinson Disease. British journal of
pharmacology.230-246.
Rizek, P., Kumar, N. and Jog, M.S., 2016. An update on the diagnosis and treatment of
Parkinson disease. Cmaj, 188(16), pp.1157-1165.
Pagonabarraga, J., Kulisevsky, J., Strafella, A.P. and Krack, P., 2015. Apathy in Parkinson's
disease: clinical features, neural substrates, diagnosis, and treatment. The Lancet Neurology,
14(5), pp.518-531.
Miyasaki, J.M., 2016. Treatment of advanced Parkinson disease and related disorders.
CONTINUUM: Lifelong Learning in Neurology, 22(4, Movement Disorders), pp.1104-1116.