Nursing Report: Patient Care Plan for Parkinson's Disease Management

This nursing report details the care of a 76-year-old male patient, Mr. Charles Williamsone, diagnosed with Parkinson's disease. The report covers his admission for respite care following a fall and skin tear. It explores the pathophysiology of Parkinson's disease, identifies nursing problems like fall risk and swallowing difficulties, and outlines nursing management strategies. The report emphasizes the role of registered nurses in medication management and highlights the importance of rehabilitation and discharge planning to address challenges such as fall prevention and home care support. The report provides insights into multidisciplinary approaches to improve patient outcomes and quality of life, emphasizing exercise, medication adherence, and home safety measures.

NURSING
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Table of Contents
Introduction......................................................................................................................................3
Primary admission..................................................................................................................3
Pathophysiology.....................................................................................................................3
Nursing problem..............................................................................................................................4
Nursing management.......................................................................................................................5
Nursing problem 1: Lack of proper care with treatment is one of the nursing issues...........5
Nursing problem 2: Lack of physical exercise.......................................................................6
Rationale to use this method...................................................................................................6
Discharge planning..........................................................................................................................6
Summary..........................................................................................................................................8
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Introduction
According to the given case scenario, Mr, Charles, Williamsone was 76 years old man
who admitted for ward care. He was diagnosed with Parkinson’s disease (PD) 10 years ago. His
primary career taker was her wife Elsie. Further, mother of Charles died because of pneumonia
at the age of 78 who also suffer from the PD since from 22 years. PD symptoms of Charles can
be managed with the Sinemet. At the time of assessment, Charles has a masked life and he speak
in a monotonous voice. Physical exam shows that his blood pressure is normal and heart rate is
76 with a regular rhythm. He can easily stand from a chair without pushing off with hands and
there is a noticeable scuffing on the right foot. Due to recent fall at home, he suffers from skin
tear in his right lateral lower leg. Then he was admitted to the ward for 5 days and provided a
specific nursing intervention for managing respite care successfully. The present report will
cover nursing problem which can arise because of primary diagnosis. Along with this, nursing
interventions and the role of the Registered Nurse (RN) related to medication management will
be explained.
Primary admission
Charles was admitted to the hospital for respite care. Recently he falls at home and suffer
from skin tear to his right lateral lower leg. Along with this, it is also identified that he started
coughing after drinking water. He also complains regarding constipation and a lack of appetite.
Further, at the time when medication effects wear off then it unable to control itself alternates
between states of immobility.
Pathophysiology
Parkinson infection is for the most part connected with the progressive loss of cells in the
substantia nigral of the mind. The capacity of this area is in charge of the creation of dopamine
which is the compound delivery person that transmits a flag between two areas of the mind for
facilitate action. Because of insufficiency of Dopamine in nerve cell of the cerebrum than an
individual unfit to direct or control developments. It is considered as an early symptom of
Parkinson diseases (Bastide, Meissner and Fisone, 2015). When the illness began spreading
different zones of the mind and sensory system create and prompt reason more significant
development. There is some hereditary and ecological factor that reason Parkinson sickness.
There are numerous qualities are distinguished which are identified with Parkinson ailments.
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Parkinson's is seen at an early age in people with changes in qualities for parkin, PINK1,
LRRK2, DJ-1, and glucocerebrosidase, among others. One of another factor is natural poison
which causes Parkinson infection.
Manifestation support can be provided to Charles to control of sign and symptoms for as
long as possible to overcome its adverse effects (Prakash, Nadkarni and Tan, 2016). Here below
are provided way to control adverse effects
Symptomatic drug therapy
It helps in providing control of motor sign of Parkinson diseases for 6 years. Along with
this deep brain stimulation that help in avoiding the destruction of brain tissue. A symptomatic
treatment need to be provided such as levodopa.
Treatment for non-motor symptom
Modafinil: For excessive daytime somnolence
Polyethylene glycol: For constipation
Deep brain simulation
For Parkinson diseases surgical procedure can be used
It does not involve destruction of brain tissue
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Figure 1: Parkinson disease
Nursing problem
According to the given case, Charles is suffering from Parkinson diseases and recently he
falls at home. He takes all its medicines on time, but still he is facing issues due to Parkinson
disease, such as lack of appetite uncontrolled movement when the medication is in effect
(Schulz-Schaeffer, 2015). Charles was provided medical treatment but no one is there to provide
him proper care at home. The first nursing problem which is identified is related to the risk from
fall due to which his health concern increases. (Schrag, Horsfall, Walters and Petersen, 2015).
He used to take medicines on time but not provide proper care which is required to strength the
muscles and live a normal life. One of another problem which is identified is swallowing due to
which he falls at home and suffer from skin tear to his right lateral lower leg. Due to weakness
in muscles and other problem he was unable to stand properly. The treatment Levodopa which is
provided to Charles is effective for 5 to 6 years and now additional care is needed to be provided
so that he can overcome his health issues.
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Nursing management
Nursing problem 1: Risk for fall
Method of nursing assessment that is need to perform related to the ongoing nursing
managemen..
Rehabilitation is one of the effective method that be consider with the ongoing nursing
management problem. In order to improve risk from fall it is important to provide nutritional
food which can reduce the chances of fall (Song, Guo and Shang, 2014).
Fall is known as the major sources of morbidity and disability in Parkinson diseases. The
chances falls increases at the tie when patient is suffering from Parkinson disease. Some of the
consequence of falling are fractures, head trauma, hip fracture etc. Along with this it also lead to
increase fear if new falls. To prevent fall is become one of the most essential unmet needs. There
are various strategies which can be adopted in order to prevent fall.
Intervention is designed for reducing the risk of fall with Parkinson diseases. It includes exercise,
movement strategy. It is noted that physical therapy and exercise is proven to be effective for
Charles which can be -perform in ongoing nursing management. Aerobic and learning based
exercises can be effective for neuroprotective in an aging individual. Therefore, for Charles
facilitated exercise program will help in improving health
Physiotherapy can be seen to reduce disability and regular exercise which provide lots of benefits
to the Charles such as reducing muscles cramping, improved coordination, flexibility, improved
poster, enhance muscles strengthen, and control over gross body movement. Therefore,
rehabilitation program helps in making sure that the person with Parkinson received holistic care
with its regular treatment in a supportive environment. With the treatment rehabilitation help
Charles in controlling its movement and immobility (van Uem, Marinus and Maetzler, 2016).
The reason behind using this method is that the effects of denigrative neurological are
widespread for the person. Therefore, it is important to provide care to the Charles with
treatment. It will help in strengthening the muscles and minimize the changes of muscle
cramping.
Role of registered nurses in the medication management related to the ongoing nursing
management
At the time when Charles is admitted in the hospital it is important for nurses to ensure
proper care is provided to client or not. They need to observe the patient’s level of function
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throughout the day and help them with the implementation of strategies in respect to improve
health problem of the Charles. Apart from this, nurse also required to display patients and keep
understanding with them. This will not have required longer time for completing daily activities
and it lead to change their function level and bring improvement (Pickrell, and Youle, 2015).
Nursing problem 2: Swallowing
Mostly people who suffer from Parkinson diseases face issues relate to swallowing as because
they lose control of their mouth and throat muscles. Due to this reason it become difficult for
them to chewing and manage solid foods. Swallowing can be occur at any stage of Parkinson
disease and it can be treated.
Method of nursing assessment is need to perform related to the ongoing nursing
management of the above provided nursing problem.
Swallowing management, through the utilisation of methods. It is important to be stay focused
while eating and drinking. Food should be swallow two to three times per bite. Along with this
Charles should drink plenty of fluids.
(Sauerbier, Jenner and Chaudhuri, 2016). Along with this, they can promote good biomechanics,
trunk rotation, good posture and symmetric movements which are best. Time for exercise in
relation to medication is accurate when mobility is best. At the time when Charles take
medication for Parkinson diseases the best level of function occurs after taking first. Due to
swallowing it become difficult for Charles to stay healthy (King, Boyd and Raphael, 2018).
Rationale to use this method
Reason behind using this method is that it has great impact on the minimising Parkinson
motor symptoms. Aerobic, Tai Chi exercise reduce the chances of fall and help in maintain
health issues (Mills, 2016).
Role of registered nurses in the medication management related to the ongoing nursing
management
Nurses who provide care to Charles need to start their care service with providing
vocational training. Along with this, they need to keep a record of patients who perform daily
exercise and help them in physical therapy (Cummings, Isaacson and Ballard, 2014). Along with
this, nurses need to ensure that patient do exercise on given time and in under supervision of
health care professional and nurses until they learn.
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Discharge planning
2 issues need to address for this client prior to discharge home
The first main issue which is identified while discharging Charles is that chances of falls
can be occur at home. In the hospital, doctor provides different types of medicine to in order to
provide respite care. A medicine which consumes at home may cause side effect which includes,
vomiting, hallucination, confusion and nausea (van Uem, Marinus and Maetzler, 2016).
However, some medicine leads to risky behavior such as gambling etc. Along with this if a
single dose is miss then it leads to cause problem for patient.
Second issue is related to providing care at home
Charles can face Swallowing problem again at home because no one there to provide
treatment and for taking proper care. It can become one of the challenges for nurses because if
the patient does not get proper care, who suffer from Parkinson diseases then symptoms can
become worse and impact patient negatively (Trenkwalder, Chaudhuri and Oksche, 2015).
Nurses ensure that patient takes proper diet on time and food which are not permitted should not
eaten by them. At home, it is not easy to follow the plan strictly as some time it swaps from the
mind of family members. However, sometimes issues arise when there is no family member at
home to provide care in such a condition it becomes difficult to plan discharge of the patient. For
providing care to Charles only his wife is at home. For her it is not easy to take proper care in
older age (Wolkowski and Carr, 2017).
Facilitate multidisciplinary discharge plan for Charles related to both challenges
Multidisciplinary discharge plan for Charles is as follows
Exercise daily can help in keeping balances and it is also good for all the health issues.
Along with this, exercise also help in providing better sleep and have regular bowel movements.
It is essential to remove things that can cause a trip such as loose wires, cords and throw rug.
Perform exercise on time help in reducing the chance of worsening the condition to get lower. In
respect to overcoming this issues, the nurse can make a proper schedule of consuming medicine
and diet plan so that individuals do not face issues at home (Dang, Tran and Le, 2018). Along
with this, Parkinson disease may cause an unsteady gain, resulting in trip and falls. It is
important for Charles wife to stay with her 24 hours and ensure that any problem does not arise.
Physical therapy can also perform at home under the guidance of care provider. Apart from this,
client should be taught to use facial exercise and breathing method for correcting the words,
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intonation and volume. In the case of Charles, there is some complication which is noticed that
are immobility, tremors and balance. Therefore, it is essential to meet the physical need of
services users (Tuck, Mann and Carter, 2016). Along with this regular going to the occupational
therapist help in teaching the skills to carry out daily activities. As occupational therapy helps in
selecting that equipment that helps to work at home and suggest to be away from home and
workplace safe (Lebcir, Demir. and Southern, 2017).
Summary
From the above report it is concluded that Parkinson patient can suffer from immobility,
tremors and balance. It is important to provide proper care to the patient so that condition do not
get worse. Parkinson diseases occur due to the loss of brain cells that produce dopamine. There
are some secondary symptoms of Parkinson disease that are depression, dementia etc. This
symptom can affect the quality life of individual. If this symptom become worsen then it become
difficult for an individual to carry out daily activities and then need to more time to complete it.
Further it is concluded that in most of the cases Parkinson diseases occur due to genetic factor.
There are approximately 15 to 20% people who suffer from this disease due to the close relative
who has Parkinson symptoms. There are some treatments available to cure Parkinson diseases.
Various therapies are available to delay the onset of motor symptoms and to ameliorate motor
symptom. This all are properly designed for increasing the amount of dopamine in the brain
through replacing it. One of the most effective therapy for Parkinson’s is levodopa which in
bran converted as Dopamine. Proper nursing care, physical therapy and rehabilitation can easily
overcome symptoms of Parkinson diseases.
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