Case Study: Parkinson's Disease - Patient Diagnosis and Treatment

This case study presents a 64-year-old semi-retired science teacher, Diana, diagnosed with Parkinson's Disease. The case explores her symptoms, including tremors, gait issues, and emotional distress, following a Christmas period. It details the diagnostic process, including neurological assessments and scans. The analysis focuses on identifying care needs, particularly fall risks and psychosocial issues. Treatment strategies, including medication and physiotherapy, are discussed, along with the importance of emotional support and encouragement. The study highlights the complex care priorities, goals to minimize fall risk and improve emotional well-being, and the evaluation of the patient's progress. The conclusion emphasizes the importance of addressing both physical and emotional aspects of Parkinson's Disease to improve the patient's quality of life, even though the disease is not curable. The study also references several research papers and online resources to support the findings.

CASE STUDY

PARKINSON'S DISEASE
INTRODUCTION
A 64 year old women, Diana is a semi-retired science teacher. She is married and have
three children. She was identified with Parkinson. She was quite active in various outdoor
activities with her husband such as gardening, bush walking and playing cryptic crosswords.
After returning for relief from Christmas period, she noticed some shaking in her right hand
and she was also unable to walk properly. On that night only, vibrations in her hand were getting
worse than ever. She was very tired after Christmas activities. She was feeling awkward and her
awkwardness made it more noticeable. After discussing the issues with her husband, he
considered this as a reason of her stressful schedule during Christmas period. Diana asked for
an appointment to her general practitioner.
Analysing the Case scenario
1. Considering the patient situation analysis
A medical officer analysed her and referred to a neurologist. After spending three weeks
in the hospital, she was diagnosed with Parkinson. To check whether there are any further
neurological conditions, an MRI and PET scan was conducted. The outputs of both the scans
came positive. Idiopathic Parkinson's disease was identified after the neurological physical exam.
She was discharged after three months and had taken a leave for two months in her school.
She was so tired throughout the day that it was very difficult for her to work. Her
Bradykinesia level was also 6/12. It is considered as a diseases which comes under the cardinal
manifestation of the Parkinson's disease (Mure and Eidelberg, 2011). She was afraid that during
her science class, she might drop things here and there and she was also observing vibrations in
her hand. The level of vibration was 6/12 which meant she was better than before but still was
facing some sort of vibrations. Diana was out bursting emotionally as she was not able to
manage the things. She was trying hard to forget things and dropping the items at home as well
as at workplace. There was also an abnormality in her walking. She was sometimes tripping here
and there without any reason. These symptoms of Parkinson might have affected her physical
and mental condition (Dias, Junn and Mouradian, 2013). Her emotional outbursts became a
reason for less social interaction of her. Providing her the physiological and mental support can
also be considered as a complex care priority. Providing her proper medications was also
essential. Patients of Parkinson often suffer from improper and inappropriate diet. She was
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facing tiredness in her activities and was not even able to walk properly. It was becoming
difficult for her to sit in classroom for teaching. Her body was shaking and her hand was
vibrating enough so she started feeling awkward.
Identification of the care needs
2. Gathering information
Before diagnosis with Parkinson's diseases, she was an active semi retired school teacher.
After Christmas event happened, she started feeling vibration in her hand. That time her body
was shaking and she was not even able to walk properly. When she sat down for taking some rest
in the night, she was feeling more awkward because of these vibrations which went worse that
time. After discussing all the issues with her husband, he felt of her having a stroke. Although
the symptoms of stroke are dizziness, blurred vision, facing paralysis and weakness in any part
of the body. Memory loss can also be considered as a symptom. Oliver also considered that the
main cause of her condition can be the stressful schedule of the whole Christmas process. She
even spent Christmas event with all her children along with the grandchildren also. After that
only, she had an appointment with her general practitioner (GP) in which she was about to
discuss about the odd symptoms she was facing.
3. Process Information
In her medical history, she had high levels of cholesterol present. While from her surgical
history, it was found that she had given birth in 1980 and that too was caesarean. She was
having tonsils as well and had gone through tonsillectomy when she was a child. While
examining her other factors, it was found that she had a record of fit and healthy body excepting
these issues. When she was diagnosed with Parkinson's disease, her neurological,
musculoskeletal and cardiovascular assessment was done. A CT and a PET scan was done whose
results were positive. Cholesterol levels that are less than 200 mg per decilitre is considered
within the normal levels of a human body (Olanow and Brundin, 2013). Diagnosis of Parkinson's
diseases was that her lipitor level was 25 mg mane . On an average, the starting dose of Lipitor
comes with 10 mg/day and the usual range of it comes between 10 – 20 mg once in a day.
There are no specific care for Parkinson's diseases but few methods are there to provide
some relief to the people suffering from it. Some examples of it can be medications, surgeries
and supportive theories. Diana can apply any one of them to get some sort of relief from various
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symptoms of the diseases. Physiotherapy can help a lot as these exercises can make stiff the
muscles and treat the joint pain as well. A Physiotherapist can help Diana in moving easier and
also can be able to make her walk more comfortable and stiff. After the discharge period, she had
some improvement in her condition as her increased level of fatigue and shakiness was improved
to an extend that she was able to walk steadily. Before having medications, she was undergoing a
huge amount of stress from past 12 months.
Diana was ill so was in critical need of care priorities. Some care priorities that need to be
considered can be fall risks, psychosocial and emotional issues. As Diana was going through
various emotional outbursts. She was depressed of the fact that she has in a habit of dropping and
forgetting things at her home as well as in school. She was feeling awkward because of these
habits of her. Fall risks is also considered as an essential one which can help in reducing the risk
of falls along with the related complications. Mobility and safety are also considered as essential
care priorities that can help Diana in staying away from impact of the Parkinson's disease.
Although the disease is not curable, but one can stay quite relieved prevented from its impact by
considering the care priorities.
Complex Care Priorities
4.Identification of the issue
Diana has been admitted in the hospital via A&E having the disorders as pronounced
vibration in left hand and her condition worsened when she was sitting. Her body was
continuously shaking and was responding very slow to the signals and requests. The first
complex care priority can be considered as fall risk and the second complex care priority is
Psychosocial And Emotional Issues . As Parkinson is a type of disorder which directly attacks
the central nervous system. Thus, it further affects the body movements and includes various
vibrations too in the body. It was essential for Diana to undergo a medical treatment and this
diseases is not curable at all although it is termed as chronic which means that which can last for
years or for lifetime as well.
5. Goals
The goal is to minimise the fall risk and the related complications. Some assessments
regarding the walking of Diana can be made such as controlling feet, walking style, some small
exercises etc. The goal of improving her mental as well as emotional level is encouraging and
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motivating her. It is an other important thing to be taken care of. Failing to do so in Parkinson's
diseases can lead to mental stress which can even effect her health more badly. As when she was
ill, she had a habit of dropping and forgetting things here and there (Schuepbach and Falk, 2013).
Although the Parkinson's disease deals with the involvement of the central nervous system, it
also affects a person's physical and mental stability.
6. Action
These techniques can prove very helpful for Diana such that she can be able to walk
comfortably. She must be taught more effective techniques for a steady walk. She must do
proper exercises after which she can be able to walk properly in comfort. There are various
exercises which helps in expanding the muscles and tissues (Hirsch, Vyas and Hunot, 2012).
Diana's motivation level can also be encouraged and Oliver can motivate her. It can help her
staying happy and capable of dealing with the situation herself.
7. Evaluation
Diana should be encouraged by her husband and general practitioner for doing these
exercises which can help her in improving her muscle tone, balancing and flexibility. However,
she can also be referred to a physiotherapist which can help her in making a schedule for doing
these exercises for tissues and muscles. While analysing the psychosocial and emotional issues,
tiredness and depression can act as negative elements that can worse the actual quality of life.
These can make Diana internally more weaker that she was not even able to go to the school
because she felt that vibrations can occur at anytime in her hand and she must not be capable of
teaching the students in the school.
8. Reflection
If fall risk is not addressed as a complex care priority, then Diana along with her husband
may have to suffer from the same problems. However, the same way if psychosocial and
emotional issues are also not addresses as complex care priorities, Diana along with her family
may have to suffer from the problems for lifelong.
CONCLUSION
It has been concluded from the essay was Diana after considering few complex care
priorities had improvements in her health. Her issue of vibration was corrected to an extent.
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Psychosocial and emotional issues along with the fall risks are the main care priorities which
have been used for providing some sort of relief to Diana. Although the diseases is not curable
but various methods are there which can provide some relief to Diana.
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REFERENCES
Books and Journals
Dias, V., Junn, E., & Mouradian, M. M. (2013). The role of oxidative stress in Parkinson's
disease. Journal of Parkinson's disease. 3(4). 461-491.
Halliday, G. M., & McCann, H. (2010). The progression of pathology in Parkinson's disease.
Annals of the New York Academy of Sciences. 1184(1). 188-195.
Hirsch, E. C., Vyas, S., & Hunot, S. (2012). Neuroinflammation in Parkinson's disease.
Parkinsonism & related disorders. 18. S210-S212.
Mure, H., & Eidelberg, D. (2011). Parkinson's disease tremor-related metabolic network:
characterization, progression, and treatment effects. Neuroimage. 54(2). 1244-1253.
Olanow, C. W., & Brundin, P. (2013). Parkinson's Disease and Alpha Synuclein: Is Parkinson's
Disease a Prion‐Like Disorder?. Movement Disorders. 28(1). 31-40.
Postuma, R. B., & Halliday, G. (2015). MDS clinical diagnostic criteria for Parkinson's disease.
Movement Disorders. 30(12). 1591-1601.
Schuepbach, W. M. M., & Falk, D. (2013). Neurostimulation for Parkinson's disease with early
motor complications. New England Journal of Medicine. 368(7). 610-622.
Snijders, A. H., & Toni, I. (2010). Gait-related cerebral alterations in patients with Parkinson’s
disease with freezing of gait. Brain. 134(1). 59-72.
Online
What is Parkinson's disease? . (2017). [Online]. Available through:
<http://www.pdf.org/about_pd> . [Accessed on 30th August 2017].
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