NRSG 259 Case Study: Parkinson's Disease Nursing Care Plan

This case study focuses on the nursing care of an 87-year-old man diagnosed with Parkinson's disease, highlighting the application of Miller's functional consequences theory and Levett-Jones' critical thinking model. The patient, Mr. Ratin, presents with tremors, limitations in daily activities, and hypothyroidism, requiring a comprehensive nursing approach. The essay details the collection of information, processing of data, identification of specific problems (motor and non-motor symptoms), establishment of goals (tremor control, reduced anxiety), action plan (medication monitoring), and evaluation of outcomes. The nursing priorities include managing motor symptoms through levodopa-based medication, controlling non-motor symptoms, and providing emotional support. The case study emphasizes the importance of critical thinking, individualized care, and the nurse's role in monitoring medication efficacy and patient well-being. The reflection section highlights the significance of empathy and proactive planning in geriatric nursing care for patients with Parkinson's disease. The essay concludes with a discussion of the practical application of the Levett-Jones theory to simplify and address patient needs.

NRSG 259 – Case Study
Nursing care priorities for a patient with Parkinson’s disease
The primary goal of this essay is to identify the nursing care needs of a particular patient and
discussing the priorities of nursing care for that patient. The essay has a background of two
important functional theories: The Miller’s functional consequences theory that helps in the
identification of the various factors that impact the elderly patient and theeffect of these
influencing factors. Additionally, the essay explores the eight steps of reasoning and critical
thinking in nursing using the Levett-Jones’ theory of clinical reasoning.
Part A:
Geriatric nursing involves several considerations that include the social and the lifestyle
concerns of the patient (Hunter, 2016). Critical thinking and logical approach to nursing in older
patients are essential in order to maintain the dignity and the interest of the patient (McMahon
&Fleury, 2012). Wellness of the patients is regarded a primary consideration in nursing.
Specifically, in cases of Parkinson’s disease, where limitations are imposed upon the daily life
activities of the elderly patient, the protection of patient wellness is of critical importance
(McMahon & Fleury, 2012).
The Miller’s theory of functional consequences provides an essential framework for the
understanding of promotion of wellness in older adults. This theory provides a basic framework
for nurses for the identification of the potential of an individual for the growth of the person
and the utilisation of diagnoses in nursing in order to provide the sense of value and protect the
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dignity of the older individual(Levett-Jones, 2013). In patients with limiting chronic illnesses like
Parkinson’s, Alzheimer’s, or dementia, the sense of dignity and integrity are critical since the
patient experiences limitations in handling the social presence and everyday life. The theory of
functional consequences provides guidance for geriatric nurses to adapt a holistic approach and
function with inter-related functionality of spirit, thoughts, and mind whilst handling older
adults. The Miller’s theory of functional consequences essentially addresses the concern of
cultural and dignity-related issues for the patient (Hunter, 2016). In the case of Mr. Ratin, his
cultural background reflects that he is originally from India and has immigrated in 1946. His
personal values and beliefs may have a cultural dilemma and since he is a widower, he may
have implications of loneliness. Additionally, he is a financially independent individual and
despite his bare-minimum earnings, he wishes to refrain from depending on his brother, who is
Niraj and his family. Thus, it becomes the primary concern of the nurse to enable Mr. Ratin to
manage his daily life without much dependence on a carer.The nursing priority is that the
patient is given complete independence (Nackaerts et al., 2016).
The current article follows the Levett-Jones’ model of critical thinking in nursing in order to
adequately divide the scenario into the various steps of logical nursing approach (Levett-Jones
et al., 2013).
Considerations of the patient:
The current essay discusses the case of Mr. Ratin Bhai, an 87-year-old man diagnosed with
Parkinson’s disease, four years before he presented to the hospital. He presents with the
diagnosis of hypothyroidism, controlled with the help of medication that was diagnosed
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alongside Parkinson’s. He is an independent patient with reduced mobility. He also has slight
tremor in both his hands which is increasing with time. He has limitations in performing
activities of daily life, including doing up his shoe laces or buttons, pouring water, or making
coffee.
Collection of information:
Ratin is found to have slight tremors in both hands and has limitations in cooking, making
coffee, pouring water, or doing up laces and buttons. He has a history of hypothyroidism which
has been controlled by medication. His medication history includes thyroxine at 100 mg every
day, levodopa and carbidopa, and entacapone. He has to be monitored for managing his every
day medication. The primary reason for this includes the principle behind the formulation of
levodopa and entacapone to increase the bioavailability of levodopa. With the constant
monitoring of the medication, the conversion of levodopa to dopamine may be monitored to
check for medication efficacy. The interference of thyroxine with
levodopa/carbidopa/entacapone has to be eliminated with the help of regular monitoring of
effects of thyroxine on the control of symptoms of hypothyroidism. The absence of symptoms
of hypothyroidism acts as an indicator for efficacy of thyroxine. The primary adverse effects of
thyroxine in older adults such as angina or cardiac functionality compromise with regular ECG
monitoring to check for palpitations is essential. Additionally, the effects of
levodopa/carbidopa/entacapone formulations with the thyroxine drug needs to be monitored
with regular recording of related presentations in the patient. The gradual stabilisation of hand
shivers and improved dexterity act as key indicators of drug efficacy.
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Processing the obtained information:
The patient is receiving levothyroxine treatment for hypothyroidism. The drug has a half-life of
about 7 days with dosage on a daily basis (Costa, Rosso, &Maultasch, 2012). In the elderly, the
dosage requirements of levothyroxine decrease. The primary reason for this is the decline in
the degradation of levothyroxine that occurs with age. High dosages of thyroxine in the elderly
may lead to the catalysis of myocardial infarction and angina in the older patients (Lambrinou,
Kalogirou,Lamnisos,&Sourtzi,2012). Several dietary supplements and medications can adversely
affect or cause interference to the action of levothyroxine. Supplements of iron, aluminium,
cholestyramine, and calcium can intervene with the effects of thyroxine.
Additionally, in the elderly who take levothyroxine treatments, there can be the presence of
interference with the activities of daily life.The dosage of thyroxine has to be significantly
reduced in older adults (Nackaerts et al., 2016). Mr. Ratin presents with tremors and due to
this, he has several limitations in performing activities of daily life such as cooking and similar
activities (Nackaerts et al., 2016). Thyroxine can have adverse effects on the tremors and can
lead to the enhancement of the tremors (Kong, Qin, Zhou, Mou, & Gao, 2014).
Identification of the specific problems:
In order to specifically identify the problems that Mr. Ratin has, it is essential to reflect upon
the issues presented in literature about Parkinson’s disease and the current approach of
treatment of the disease.Parkinson’s disease is typically characterised by chronic and
progressive neurodegenerative events (Tolosa et al., 2014). Parkinson’s disease is traditionally
perceived as a disease of motor functions and results in cardinal symptoms and leads to
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tremors in hands, bradykinesia, and rigidity. Recently, symptoms of a non-motor origin such as
fatigue, mood swings, anxiety, apathy, sleep deficiency, and impairment in the quality of life of
the patients have been identified(Tolosa et al., 2014).
The treatment therapy for Parkinson’s disease is a combination of therapy involving
replacement of dopamine, treatment of issues of non-motor origin including dementia,
dysfunction of the autonomic system, depression etc. (Tolosa et al., 2014). The administration
of levodopa is an essential aspect in the treatment of Parkinson’s disease. It is one of the most
popularly chosen treatment options for Parkinson (Armstrong, Peterson, & Rayner, 2012).
Levodopa is an improvement to the traditional method of treatment involving only
anticholinergic agents. Levodopa has demonstrated a considerable level of efficacy in the
treatment of Parkinson. However, there are certain limitations in the prescription of levodopa.
The primary reason for this is the emergence of complications of the motor system. The motor
neuronal complications are even known to be more complex than the benefits of the treatment
(Iranfar, Iranfar, &Mohammadi, 2012). In the case of Mr. Ratin, due to the presence of motor
complication of tremors, it is advisable to closely monitor the effects of levodopa (Tolosa et al.,
2014).
Therefore, the three specific nursing priorities whilst dealing with Mr. Ratin include the control
of motor symptoms of Parkinson’s disease, control of non-motor symptoms such as anxiety,
mood swings, and depression, providing adequate emotional and knowledge-based support to
Mr. Ratin.
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Establishment of goals:
The treatment of Mr. Ratin is fairly straightforward due to the medication being non-
complicated and controlled in dosage. Therefore, the primary approach for the treatment of
the disease would include the monitoring of the dosages of levodopa, thyroxine, carbidopa, and
entacapone(Nackaerts et al, 2016). Since levodopa has several limitations, Mr. Ratin is being
given the formulation of levodopa, entacapone, and carbidopa. It has optimal pharmacokinetic
characteristics. This formulation is capable of limiting the primary functional pathways of
levodopa (El-Gilany, &Abusaad, 2013).
The primary goal or the nursing priority of the highest degree would be to control the motor
symptoms experienced by Mr. Ratin.
The goals identified are:
Ratin should be able to gain a control of the tremors in both his hands. The activities such as
cooking, making his coffee, or doing up shoe laces and buttons, and other activities requiring
minimum coordination and dexterity must become simpler. There must be a reduction in the
fatigue and anxiety levels
The goals set for the nursing plan of Mr. Ratin indicate that the symptom-control may be
achieved by the appropriate administration of the drugs and medication at the appropriate
dosages and times. The appropriate medical treatment timeline can ensure the cure of the
specified symptoms.
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Action plan:
The highest nursing priority identified is the treatment of motor symptoms of Parkinson’s
disease. Ratin has been advised to take levodopa/carbidopa/entacapone formulation for the
treatment. However, it is the prerogative of the nurse to ensure the timely administration of
appropriate dosages and monitor the effects of the drugs continually (D'Amore, James,&
Mitchell, 2012). The regular and meticulous monitoring of the drug administration in the
patient must be carried out. The primary rationale for the identified priority is the plausible
effects of levodopa drug overdose. The formulation, although regarded safe, has certain
potential adverse effects in the elderly (Salat and Tolosa, 2013). The decarboxylation of
levodopa occurs rapidly in the tissues of the cerebrum and in the extracerebral areas when
ingested orally. The common adverse events include psychiatric anomalies and dyskinesias
(Salat and Tolosa, 2013). These interferences need to be monitored regularly and are thus an
important part of the action plan.
The action plan would include the recording of instances of weakness, fatigue, depression, or
anxiety in Ratin (D'Amore, James, & Mitchell, 2012).The rationale for this is that these
symptoms act as primary bioindicators for the development of levodopa overdose in the
patient. This can additionally lead to dyskinesias or even cardiac complications.Levodopa is
known to create fluctuations in response and thus, symptom control must be analysed
alongside any potential presence of fluctuations in the readings for the patient (Salat and
Tolosa, 2013).
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Evaluation of outcomes:
The action plan has resulted in the monitored evaluation of the effects of the medication. Ratin
is able to control the dosages of hypothyroidism. There is a significant improvement in the
mood stability and behavioural patterns of the patient. The dosages of levodopa, carbidopa and
entacaponeare well-monitored and he requires minimum assistance in the administration of
the drug. The tremors in both hands have significantly reduced. Mr. Ratin has improved
mobility and can perform his regular activities including walking, cooking, making coffee, and
writing.
Reflection of the case:
The current case has provided sufficient insight into the life of an elderly patient with
Parkinsonism. Mr. Ratin has been a fiercely independent and self-contained individual. I have
considerable satisfaction of the resources that I had for the nursing of Ratin. The next time,
whilst dealing with a patient with Parkinson’s disease, I wish to spend a higher amount of time
in the analysis and identification of specific concerns for that patient and try to anticipate the
needs of the patient in advance. The medication provided for Parkinsonism can have several
distressing and fatigue-inducing effects (Andreou, Papastavrou, &Merkouris, 2013). In the
elderly, especially, I will pay additional care to the empathy of mood swings and anxiety
resulting from pharmacological and non-motor symptoms of the patient. The current case has
taught me the importance of critical thinking and the implementation of the Levett-Jones
theory of critical thinking. It has led to the simplification and the identification of specific
concerns to address each of them adequately.
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Conclusion:
The current case has provided ample opportunity for the understanding of treatment protocols
and the concurrent notions and social complications associated with the care for a person living
with Parkinson’s. Ratin’s case has provided insight into the obligations, limitations, and the
helplessness experienced by persons living with Parkinson’s disease. The debilitating symptoms
of the disease are both compelling and limiting. The primary learning gained in this experience
is that the nursing care provided to the patient has a holistic and nurturing role in the health
and development of the patient in the social setup. The patient care in Parkinson’s disease is
associated with several steps that include recording patient history and medications of chronic
and long-term natures. Additionally, the observation of patient presentations at every stage
with both biomedical and clinical implications such as clinical symptoms observed during
patient care and the biomedical readings including ECG, EEG, etc is critical. These observations
act as indicators of health in the patient. The absence of symptoms such as tremors and
neurological symptoms need to be assessed alongside the biomedical observations. Along with
the physiological complications, it is crucial to provide logical and clinical reasoning for the
designing of care protocol in order to provide appropriate support. The establishment of
nursing goals for Ratin allows the nurse to give complete attention to all subsequent disease-
associated factors.
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References:
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nursing and midwifery students: a cross-sectional survey utilizing the Kolb Learning Style
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