Nursing Management of Parkinson's Disease: A Case Study

This report discusses the nursing management of Parkinson's disease through a case study of Mr. Charles Williamson, including his diagnosis, nursing problems, interventions, and discharge planning. Parkinson's disease contributes to symptoms such as impaired physical immobility, impaired verbal communication, and imbalance in nutrients.

Introduction
Mr. Charles Williamson is a 76 year old man who has been admitted to the respite care for 5
days, following a recent fall at home. He has sustained bruises and a skin tear in his right lateral
leg. In regards to his medical history, he was diagnosed with Parkinson disease 10 years ago for
which he is taking Sinemet CR (200/50mg tablets) every 4 hours during the day. However, Mr.
Williamson thinks the effectiveness of Levodopa therapy starts to wear off after 4 hours and then he
fails to control his movement.
Regarding Mr. Williamsons past history, his mother died of pneumonia at the age of 78. She
also had Parkinson’s disease for 22 years. His primary carer is his wife Elise at the moment.
On general appearance, Mr Williamson was alert and orientated. However, he was slightly
anxious with noticeable tremor in his upper limb. During the assessment, he had a ‘mask like’ face.
He was speaking in hoarse and monotonous voice. His physical assessment revealed a normal blood
pressure (120/72) in siting position and his heart rate was 76 with rhythm. Mr. Williamson was able
to rise from the chair without pushing off with his hands, but a drag /scuffing of the right foot was
heard. His movements are slow and rigid and his balance appeared to be unstable. As a result, he
needs assistance in ADL (activity of daily living). He also complained of constipation and lack of
appetite, and started coughing when a drink of water was given.
Primary admission diagnosis
Mr. Williamson is admitted to the hospital following a fall at home where he sustained
bruising. A skin tear in his right lateral lower leg was also observed. He has been diagnosed with
Parkinson’s disease 10 years ago. Parkinson’s disease is a movement disorder associated with
dopamine deficiency in the brain.
Dopamine is a chemical messenger that transmits signals between two regions of the brain
to coordinate activity. For example, it connects the substantia nigra and the corpus striatum to
regulate muscle activity (Mandal 2018).Dopamine is mainly produced by special cells deep inside the
brain. It is these cells that die and causes Parkinson’s disease. The dopamine is used by many areas
of the brain but it is particularly important in controlling movement. Because of this impact on
movement, Parkinson's disorder is classified as a movement disorder (Annon2018). Some of the
clinical manifestations of Parkinson disease include shuffling gait, mask like face expression, and
muscle weakness affecting writing, speaking, eating, chewing and swallowing (Annon 2018). Some of
the risk factors of Parkinson disease are, age, genetic and gender .The older a person gets the
greater the risk they develop. If a person who has a close relative (brother, sister, mother, and
father) with Parkinson disease, he or she has a slightly higher risk of developing it himself compared
to others. Males are slightly more likely to develop Parkinson’s disease compared to females. (Dr
Ananya Mandal 2018). The aim of medical management of Parkinson disease is to provide control of
signs and symptoms for as long as possible while reducing adverse effects. Patients will be given
medication, such as carbidopa-levodopa (for example, Sinemet) that will increase the dopamine in
the brain (Upfal2016, p.471). Carbidopa prevent destruction of levodopa elsewhere in body,
allowing a much greater portion of the drug to reach the brain (Upfal2016, p.472) There are some

side effects of Sinemet , such as loss of appetite and constipation(Upfal2016, p.473),which Mr
Williamson stated during assessment.
Nursing Problems
The first identified nursing diagnosis was Mr Williamson’s impaired verbal communication;
He was speaking in hoarse and monotonous voice. When the Parkinson diseases progress the
cognitive ability diminishes. The patients with Parkinson disease may have slurred speech as a result
of dysarthria (Gulanick& Myers 2007,p.618). Dysarthria follows when the patient has problems
expressing certain sounds or words and they poorly pronounce speech (such as slurring). The
rhythm or speed of speech is changed (Dysarthria –symptom and causes 2018).Since dysarthria can
make it harder to move lips, tongue, and jaw; it can also make it tougher for the patient to chew and
swallow. Hence, trouble in swallowing can cause the patient to drool. In Mr Williamson’s case, it was
noticed that while giving him a drink, he started coughing. Untreated speech disorders may cause a
person to experience a great deal of anxiety and over time, this anxiety can elicit anxiety disorders or
a phobia of speaking in public(Speech Disorders: Causes, Signs, and Diagnosis 2018).
The second identified nursing diagnosis was Mr Williamson’s impaired physical mobility. He
was dragging his right foot while moving and his movement was slow and rigid. His balance
appeared to be unstable. Patients with Parkinson disease have difficulties initiating movement or
changing direction of movement. This results from poor coordination of the muscle groups. Thus the
patient’s movements become slow and hesitant (Sietske and Heyn 2018). Mobility is important for
an older patient to maintain their independent living. Restricted movement affects the performance
of most activities of daily living (ADLs). Mr Williamson requested for assistance with activities of
daily living (ADL) since he is restricted with his mobility due to uncontrolled movement. Impaired
physical mobility means unsteady gait which can causes increased risk for falls and dependence
regarding everyday activities. It also means to have lack of physical conditions, such as reduction of
muscle strength, activity intolerance, musculoskeletal and neuromuscular impairment (Impaired
physical mobility of Parkinson disease 2018)

Nursing Management
Verbal communication is used to inform others of our needs or to share knowledge. When
verbal communication becomes impaired, it becomes hard for individuals to express the words
(Lucus 2018).The task for nurses is to encounter the patient and find out the reason of the
communication becoming ineffective. They need to use strategies to improve transmission of
information (Gulanick& Myers 2007,pg.622).Some of the nursing interventions and rationalecould
be maintaining eye contact when speaking with patient. This promotes patient to focus(Gulanick and
Myers 2007,pg.622).The nurse should give patient some time to express themselves as they may be
discouraged and give up if rushed. They need time to organize thoughts before they speak
(Gulanick& Myers 2007,pg.623). Nurses needs to encourage patients to do face and tongue exercise.
Regular exercise can reduce rigidity and facilitate muscle relaxation (Gulanick& Myers 2007,pg.622).
The patient should also be encouraged to practice reading aloud. This activity will help patient with
muscle control. The health organization should provide alternative communication aids, such as
picture or word boards. These aids communication and reduces frustration. A speech therapist
should be contacted if indicated; the speech therapist can evaluate the patient’s need of adaptive
device such as voice synthesizers or computers (Parkinson's Disease & Speech Therapy | Cleveland
Clinic 2018). In Mr Williamson’s case, during the assessment the nurse should maintain eye contact
when communicating, so that he can concentrate and respond to the nurse. In addition, the nurse
should allow Mr Williamson some time to direct his speech; this will give him time to bring together
his thoughts before speaking, and the nurse should avoid using medical jargon, technical
terminology used by health care providers. This is because it can sound foreign language to patient
and family.
Mobility is also related to body changes from aging such as loss of muscle mass, reduction in
muscle strength and function. Gait changes also affect balance as that can significantly compromise
the mobility of older patients (Gulanick& Myers 2007,pg.618).Impaired physical mobility restricts
movements. Hence, it affects the ability to perform most of the ADLs (activities of daily living). In Mr
Williamson’s case, he was affected by impaired physical movement and he requested for assistance
with his ADLs. The nurse intervention and rationale would be to encourage patient to perform
exercise daily, since exercise reduce muscle rigidity ,maintain joint mobility and prevents muscle
weakening. The nurse can explain the progressive activity to the patient and help the patient or
caregivers establish reasonable and obtainable goals. This is because information promotes
awareness of the treatment plan and help in setting small attainable goals. This helps to increase
self-confidence and promotes adherence. The nurse should allow the patient to perform tasks at
their own rate and encourage independency with safety. Mostly caregivers are often in hurry and
do more than needed, and thereby it slows patient’s recovery and reduces their self-esteem . In Mr
Williamson’s case, the nurse should provide tips for getting in and out of chair, using high-seated
chair with arms. The high seated chair provides more support and reduces risk of falls with change in
position .Also they should encourage him to lift his feet and take large steps while walking. This is
because a broad based gait helps to improve balance and reduce shuffling. The registered nurse
should administer medication as appropriate like an antispasmodic medication that may reduce
muscle spasms that interfere with mobility.
The administration of medicines is an activity of registered nurses. To promote safe care and
competent practice, professionals must administer medicines to individuals who are unable to self-

administer or unable to take responsibility for decisions about when to take medicines and when not
to take medicines (Bryce, J & Foley, 2013).
Discharge planning
Mr Williamson was admitted to respite care following a fall at home sustaining bruising and skin tear
to his right lateral leg. During the assessment, he was found to be unstable on his leg and he spoke in
a hoarse and monotonous voice. Mr Williamson was diagnosed with Parkinson disease and this
contributes to his disorders. The first challenge for MrWilliamson is his impaired physical mobility;
he needs to be educated regarding hazards of immobility. Importantly he needs to know, how to
change his leg position and the significance of exercise. Good information enables the patient to
develop some control over the rehabilitation process (Armitage et al. 2009). In addition, the
environmental barriers should be removed in home before he is discharged to maintain his safety
and prevent any fall (Armitage et al. 2009).Mr Williamson should be consulted with physical and
occupational therapists about aids to facilitate ADLs, safe ambulation and to promote muscle
strengthening. Aids can increase mobility and allow the patient some control over the environment.
Mr Williamson also complained of constipation, so he should be given stool softeners for
constipation. He should be also encouraged to eat food items that are high in fibre and drink
adequate water to prevent constipation. Immobility promotes constipation and therefore care
should be taken to help him overcome this symptom..
The second challenge for Mr Williamson is to develop his verbal communication. His voice
was hoarse during the assessment. Clear information should be given to him about how to do
undertake speech exercise and the nurses should convey the importance of it before he is
discharged. This may include different face and tongue exercise that can reduce rigidity and ease
muscle relaxation. Mr Williamson should be provided with an appointment with speech therapist. A
speech therapist can estimate the patient’s need and can provide him with adaptive devices such as
voice synthesizers. In addition, the nurse can offer alternative communication aids such as, picture
or word boards. These aids can reduce communication frustration.
It appears that Mr Williamson’s medication for Parkinson disease(Sinemet200/50mg tablets)
wear off after 4 hours. Hence, the dosage needs to be increased. A doctor needs to review him
before his discharge. A community nurse can be also appointed to help Mr Williamson with his ADLs
and his medications.

Summary
This report clearly states that Parkinson disease contributes to symptoms such as impaired
physical immobility, impaired verbal communication , imbalance in nutrients and many more.
Parkinson disease cannot be cured (Sietske N. Heyn 2018). However, many treatments are available
that can allow a person with Parkinson’s to lead a fulfilling and productive life. Treatments can assist
in managing the symptoms and providing a high quality of life for many years to come. Parkinson
disease can be managed by medications and doing exercises that are allocated by physio and speech
therapist(Sietske N. Heyn 2018).Educating the patient and the family to manage Parkinson disease is
very important, such as educating about medication, diet, and exercise, using safe measures during
walking and the ways to use walking aids safely (Parkinson Disease 2018). Currently, there is no
known cause or understanding of why a person develops Parkinson’s disease. However, there are
many theories for the occurrence of the disorders. It is generally thought that multiple factors are
responsible, such as genetic changes, environmental factors, oxidative stress or a combination of
these (Parkinson Disease 2018). A patient should always be given good information and support
from caregivers and families. A good support at all times encourages patients to achieve a goal and
maintain their life style.

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