Nursing Interventions for Respite Care: A Case Study of Mrs. Jessica George

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
The following assignment is based on the case study of Mrs Jessica George, a 79-year
old lady who is suffering from Parkinson's disease (PD) for the past 15 years. Her primary
care giver is her husband, Frank who is 60-year old. She is admitted in the District Hospital
for respite care. Hr vital signs are normal upon admission however she experiences noticeable
tremor in her upper limbs along with "drag/scuffing on the left foot. She is also suffering
from constipation, lack of appetite, difficulty in drinking liquid and prone to accidental fall.
Jessica requires assistance in conducting her daily living activities however, very particular in
taking her PD medications on time.
The following paper will highlight the specific nursing interventions for Jessica in
order to manage her respite care successfully. The assignment will initiate with the primary
diagnosis for Jessica followed by identification of two main clinical priorities that will
require immediate nursing interventions. The nursing management will deal with framing of
proper nursing assessment for the identified nursing problems followed by subsequent
intervention to manage the problem and role of registered nurse (RN) in medication
management. The assignment will sum up with a detailed discharge planning with a focus on
multidisciplinary management.
Primary admission diagnosis
The client is admitted to hospital for respite care. Respite care is given in order to
provide short-time relief for the primary care givers for example the family member. It can be
arranged for a day or for a week. In this case Jessica is admitted for respite care for 5-day.
Respite care is important from the perspective of Jessica’s husband who is 60-years old.
According to Bartolomei et al. (2018), though there is no direct correlation with the patient's

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sleep quality and depression upon the quality of life of the care givers but patient's motor
disability hampers the mental health and well-being of the care givers leading to the
generation of compassion fatigue. As per the case study, Jessica has severe motor disability
which hampers her daily living activities and thus heightening the compassion fatigue of her
husband. Krishnan et al. (2017) reported that in order to cope with the caregiver’s burnout for
PD, respite care could be treated as an important option.
PD is a neurodegenerative disease that affects the dorsal motor nucleus of the vagus
nerves along with the olfactory bulbs and nucleus followed by the locus coeruleus and
substantia nigra. Cortical areas of the brain are also affects but in the later stages of the
disease. this damage in the neuronal system leads to the development of multifaceted
pathophysiological changes leading to impairments in the motor system followed by
cognitive impairments and neuropsychological systems (Gratwicke, Jahanshahi & Foltynie
2015). The progressive loss of dopamine, the neurotransmitter in PD is the main reason
behind the motor problems of problems. Jessica also has motor problems as exhibited by
tremor in upper limbs and stiffness in left foot. the problem in the motor neurons leads to loss
of control of the throat muscles leading to difficulty in swallowing of dysphagia. The same is
reflected in Jessica as she faces problems in drinking water. Masked faces or hypomimia as
exhibited by Jessica is also an outcome of the progressive loss of motor neurons than
hampers extending or relaxing of the facial muscles (Gratwicke, Jahanshahi & Foltynie
2015).
Nursing Problems
Nursing Problem 1: Unstable body balance
Postural instability is a major component of PD that results in the generation of the
accidental falls among the older adults, hampering their quality of life. Balance is control of

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body's center of mass (CoM) in order to achieve the postural equilibrium. It requires active
brain processes that integrate the information from diverse level of the nervous and
musculoskeletal system during both standing (static) and moving (dynamic) posture. The
basal ganglion is the main pathologic structure in PD. It is involved in controlling of the body
balance by thalamic cortical spinal loops and through brainstem pseudo-ncculopontine
nucleus and reticulospinal system. In PD, the neuronal signaling of the basal ganglia is
hampered leading to problems in maintaining body balance (Park, Kang & Horak 2015).
Nursing Problem 2: Constipation
The neurological problems of PD are not solely associated with the motor neurons.
The pathology of PD also depends on the location of the alpha-synuclein immunopositive
Lewy bodies that lead to the generation of the non-motor symptoms like autonomic
dysfunction and abnormal sensation. Constipation is one of the frequent non-motor symptoms
of PD that comes under the autonomic system and gastrointestinal complications of PD (Yu
et al. 2018).
Nearly 50 to 70% of the PD patients who are suffering from PD for over 20 years
exacerbate constipation. Jessica is diagnosed with PD for the past 15 years and thus
exacerbation of constipation for her is natural. It is regarded as prodromal symptoms of PD
(Yu et al. 2018). Cersosimo et al. (2018) are of the opinion that the enteric nervous system
dorsal nucleus of the vagus is closely associated with constipation. Constipation in turn
decreases the sense of appetite in PD individuals. Jessica also complains about lack of
appetite. The lack of appetite in turn leads to massive weight loss leading to the generation of
fatigue.