Case Study 2: Evaluating Nursing Interventions for Parkinson's Disease

This case study focuses on a 67-year-old semi-retired man, Philip, diagnosed with Parkinson's disease, detailing his symptoms, including tremors, bradykinesia, and emotional lability. The assignment emphasizes two key nursing priorities: addressing mobility issues, including fall risks and physical limitations, and managing emotional instability and depression. The community nurse's role involves setting goals, implementing interventions like exercise and fall prevention strategies, and ensuring patient autonomy and dignity. The study highlights the importance of assessing fall risks, providing mobility aids, and educating the patient about their condition. The clinical reasoning cycle is applied to assess, plan, implement, and evaluate care, with a focus on improving the patient's quality of life through physical and emotional support, and by arranging for occupational and physical therapy. The assignment underscores the need for regular assessment of physical and mental health outcomes, and the importance of reflection for improved future care. The community nurse should also assess the risks of falls in the house and should accordingly develop his home to make him free from fall risks. She should prepare to provide him with bed rails and also handles in bathroom so that he can get assistance while trying to mobilize. Moreover, she should also take initiatives to remove the environmental barriers like heaped up carpets, heaps of different substances on the floor and many others.

Running head: CASE STUDY 2
CASE STUDY 2
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Clinical reasoning can be defined as the process by which nursing professionals can
collect cues and thereby process the information that have been collected. The nursing
professional hence comes to an understanding of the problem or the situation of the patient that is
very helpful in planning as well as implementing interventions (Connolly & Lang, 2014). The
nursing professionals can thereby evaluate the outcomes after implementing the interventions,
thereby reflect on, and learn from the entire procedures. This is called the critical thinking
process and this is entirely dependent upon the critical thinking disposition. Researchers are of
the opinion that this skill of an individual is entirely influenced by his or her attitude,
preconceptions, knowledge and philosophical perspectives. This ensures safe practices of the
patients ensuring best outcomes (Sarrafchi et al., 2016). This assignment will mainly be based on
the application of this cycle in a case study where the patient is suffering from Parkinson’s
disease. These will also show two important nursing priorities that the community nurses should
take to ensure best health of the patient.
Philip is a 67 years old man who is semi-retired and is separated from his wife Klara. He
has three children who have their own young families and lives on other cities. He works in a
local specialty tea store. Recently, he had been admitted to the healthcare center in the
emergency ward and was later reviewed by a neurologist who confirmed Parkinson’s disease. He
was admitted to the healthcare center with increasing tremor in the upper limb that as more
pronounced in the right side. He was also going through a phase of global bradykinesia,
increasing hypophonia. He was losing balance and felt numbness in his hands. He was feeling
sleepy, tired during the day, and often seen to stand throughout the day to prevent himself from
sleeping. After admission to the healthcare center, the professional clinically examined him and
transferred him to the neurology department where the experts stated that he is diagnosed with

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Parkinson’s diseases. CT and Pet scan was conducted to conduct differential diagnosis where no
abnormalities were found. Hence, Parkinson’s disease was confirmed.
From the entire observation and analysis of the situations, two important priorities
had been identified in case of Phillip. He had two episodes of falling. He is also having problems
with maintaining balance. Moreover, he is also having issues with holding things and is therefore
dropping things more often. Right hand tremor is more common when sitting down on bed. All
these may create accidents if care is not taken to help him overcome such situations, therefore
one nursing priority would be to help him overcome this symptoms. Another issue that he is also
facing is his emotional labiality. He is going through situations where he is being out of
proportion while emotionally reacting to small incidents. He is also feeling “blue” and sad as he
is not having an emotionally stable and happy life for his both physical disorder and emotional
and mental situations due to his personal relationship tensions. Therefore, the nursing priority
would be also to provide interventions to him by whom he would be emotionally stable and
thereby lead a happy and emotionally stable life.
The community nurse needs to decide what goals are to be set for the patient and
accordingly they need to set interventions by which the goals would be achieved. These would
ensure proper management of the disorder and helping the patients to lead a quality life.
Therefore, the community nurses should introduce interventions which would help him in
maintaining is functional mobility and effective control of emotions.
The community nurse should have clear ideas about how loss of mobility of the patient
can affect him in his regular lives resulting him to lead a poor quality life. As he has become less
mobile, there is a high chance of the patient gaining weight. Therefore, the community nurse

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should take effective measure by which she can help the patient to maintain a diet that can result
in calorie deposition. Moreover, free hand exercises can be taught to him where he can keep
himself fit without straining much on his limbs. Researchers also state that loss of mobility and
physical activity result in constipation that may provide him a poor quality lives. Therefore, the
community nurse should have the duty to make proper treatment choices so that constipation
issues do not occur in future. She should ensure proper diet and fluids to the patient, proper
exercise and activity planning for him, effective home remedies and proper medications
(Sveinbjornsdottir, 2016). Again, loss of mobility may make him vulnerable to experience a
buildup of fluid in different part of the body. Researchers have also observed in different
experiments that people who gradually lose mobility becomes highly vulnerable to development
of more sensitive skin where they sit or lie in the same position for a considerable period
(Goldman & Weintraub, 2015). This may expose him to development of pressure ulcer in the
near future. Such patients also tend to lose muscle strength. Therefore, Phillip can find many of
the activities much more difficult as well as tiring in comparison to previous times. Therefore,
the community nurse should ensure that he does not take up activities that will strain him and
guide him to conduct activities in ways that will not affect him negatively. He may have
difficulty in conducting daily activities of life like bathing, eating, walking, dressing and many
others. He is highly subjected to fall and hence care needs to be taken so that he can get proper
assistance in each of the activities of daily life. Along with that, the community nurses also have
the duty to arrange for resources that would help him live in better ways. She should arrange for
occupational therapist, physiotherapist, experts helping him with mobility aids and equipments
can help him to adapt to the situations and be active as much as possible. One of the most
important aspects that the community nurse would be care of is to maintain antinomy and dignity

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of the patient. For long Phillip has been taking care of himself and did not take any help from
others regarding his healthcare. Therefore, this type of healthcare disorder not only affects him
physically but also affects him mentally as well. He may be depressed and may still want to not
take help from others. In such situations, he might also not like the interference of other
professionals in his daily care. In such situation, it might become difficult for the community
nurse to care for the patient. However, she should be very careful about the maintenance of
autonomy and dignity of the patient and should not conduct any practice that is against his wish
and informed consent (Eisele et al., 2015). She should first try to develop therapeutic patient
client relationship by which she establishes effective communication with the patient. She should
be gentle and compassionate in her approach so that he does not feel that the nurse is forcing her
interventions on her. Breaches in the ethics of dignity and autonomy of the patient may result in
addition of emotional turmoil to Phillip where he might feel that his decisions no longer count as
he had become helpless and weak. Therefore, in order to prevent him from feeling of depression
and going through emotional turmoil, the community nurse should educate him about his health
conditions and encourage him to align with the interventions so that he can develop better quality
life. Moreover, she should also assess the risks of falls in the house and should accordingly
develop his home to make him free from fall risks (Frazitta et al., 2015). She should prepare to
provide him with bed rails and also handles in bathroom so that he can get assistance while
trying to mobilize. Moreover, she should also take initiatives to remove the environmental
barriers like heaped up carpets, heaps of different substances on the floor and many others. Fall
risk assessment would help the community nurse to provide a safe environment to the patient
where his chances of falls would reduce.

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The patient would be instructed with techniques that would initiate movement (Chinchan
et al., 2015). This is mainly because rocking from side to side would help to start leg movement.
The community nurse would instruct the patient to get out of the chair by moving first to the
edge of the seat and then placing the hands on the arm supports. This would be followed by
bending forward and then rocking to a standing position (Eisele et al., 2015). This would help
him to get up from chair properly as such patients have huge problem when getting up from
sitting positions. The patient would be taught a special walking technique to offset the shuffling
gait as well as the tendency to lean forward. The patient would be taught the ways to take a
conscious effort by swinging his arms, raising the feet while walking, and using heel toe
placement of the feet with long strides. The patients should be also instructed to perform the
daily exercises that will in turn increase his strength of the muscle and walking, riding a
stationary bike, gardening, swimming and others (Sveinbjornsdottir, 2016). Exercises would
prevent contractures, which mainly takes place when muscles are not used. This would improve
coordination, dexterity and reduce muscular rigidity. It also results in delaying the progress of
the diseases.
The community nurse needs to assess the patient for depressive behaviors,
causative events as well as orient the patient to the reality as required. Depression and emotional
lability (changes in emotions and mood takes place in an exaggerated ways) are common among
patient. The nurses hold try to identify the triggering factors and should thereby try to develop
care plans that help in attending to these emotional outbursts (Frazitta et al., 2015). Many
researchers state that reality orientations also help patients like Phillip to be aware of his physical
and environmental condition thereby helping the patient to feel self aware of himself and
surrounding. The nurses should also use non-judgmental attitude towards the patient and thereby

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actively listen to the different feelings and concerns of the patient. This would help in
development of a trusting relationship with Phillip that would help Phillip to deal with emotions
in appropriate ways. Such patients feel embarrassed, lonely as well as bored because of the
physical slowness and the effort required completing easier tasks (Goldman & Weintraub, 2015).
Therefore, the patients should be encouraged and assisted in every effort possible so that they
can carry out their tasks independently and thereby remain independent. The community nurse
needs evaluate the outcomes of taken interventions and then reflect on the entire scenarios to
develop their knowledge and skills for future. The professional should use different tools on a
weekly basis to assess the physical mobility. The tools have certain framework that helps in
understanding the condition of the patient and hence this would help to know how the patient is
developing the physical mobility. Similarly, the professionals would also test his mental and
emotional stability through assessment tools that would help her to judge the present mental and
emotional state. Depending upon these tests, decisions would be taken. The nurse would then
conduct a reflection to learn from the experiences or take decisions of how to conduct such
interventions more effectively the next time.
Clinical reasoning cycle is indeed important in developing care plans as it helps the
professionals by developing sequential approach. With the help of this cycle, successful
healthcare properties of Phillip had been identified and proper interventions plans are prepared.

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References:
Brauer, R., Bhaskaran, K., Chaturvedi, N., Dexter, D. T., Smeeth, L., & Douglas, I. (2015).
Glitazone treatment and incidence of Parkinson’s disease among people with diabetes: a
retrospective cohort study. PLoS medicine, 12(7), e1001854.
Chin-Chan, M., Navarro-Yepes, J., & Quintanilla-Vega, B. (2015). Environmental pollutants as
risk factors for neurodegenerative disorders: Alzheimer and Parkinson diseases. Frontiers
in cellular neuroscience, 9, 124.
Coates, L. C., Kavanaugh, A., Mease, P. J., Soriano, E. R., Laura Acosta‐Felquer, M.,
Armstrong, A. W., ... & Espinoza, L. R. (2016). Group for research and assessment of
psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic
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Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a
review. Jama, 311(16), 1670-1683.
Eisele, Y. S., Monteiro, C., Fearns, C., Encalada, S. E., Wiseman, R. L., Powers, E. T., & Kelly,
J. W. (2015). Targeting protein aggregation for the treatment of degenerative
diseases. Nature reviews Drug discovery, 14(11), 759.

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Fahn, S. (2015). The medical treatment of Parkinson disease from James Parkinson to George
Cotzias. Movement Disorders, 30(1), 4-18.
Frazzitta, G., Maestri, R., Bertotti, G., Riboldazzi, G., Boveri, N., Perini, M., ... & Ghilardi, M.
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131.
Goldman, J. G., & Weintraub, D. (2015). Advances in the treatment of cognitive impairment in
Parkinson's disease. Movement Disorders, 30(11), 1471-1489.
Jin, H., Kanthasamy, A., Ghosh, A., Anantharam, V., Kalyanaraman, B., & Kanthasamy, A. G.
(2014). Mitochondria-targeted antioxidants for treatment of Parkinson's disease:
preclinical and clinical outcomes. Biochimica et Biophysica Acta (BBA)-Molecular Basis
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Pagonabarraga, J., Kulisevsky, J., Strafella, A. P., & Krack, P. (2015). Apathy in Parkinson's
disease: clinical features, neural substrates, diagnosis, and treatment. The Lancet
Neurology, 14(5), 518-531.
Sarrafchi, A., Bahmani, M., Shirzad, H., & Rafieian-Kopaei, M. (2016). Oxidative stress and
Parkinson’s disease: New hopes in treatment with herbal antioxidants. Current
pharmaceutical design, 22(2), 238-246.
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neurochemistry, 139(S1), 318-324.

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