Nursing Assignment: Early Onset Parkinson's Disease, Safety, Referral

This nursing assignment report examines a case study of a 66-year-old patient, Patrick, diagnosed with early-onset Parkinson's disease. The report delves into the relevance of the disease, focusing on symptoms such as tremors, sleep disturbances, and decreased sense of smell. It outlines primary healthcare nursing interventions for each symptom, including advising on arm stabilization, recording tremor severity, and providing medication adherence guidance. Evidence-based practice rationales are provided, supported by recent studies, alongside recommendations for referrals to physiotherapists, counselors, and yoga trainers. Safety considerations, such as fall prevention and medication management, are discussed. The report emphasizes maintaining the patient's dignity throughout the treatment process, offering a holistic approach to patient care.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author’s Note

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Table of Contents
Introduction................................................................................................................................2
Discussion:.............................................................................................................................2
Relevance of the issue................................................................................................................2
Primary healthcare nursing interventions...................................................................................3
Evidence based practice rationale..............................................................................................4
Referral.......................................................................................................................................5
Safety considerations for Patrick...............................................................................................6
Maintaining Patrick’s dignity...................................................................................................10
Conclusion................................................................................................................................12
References................................................................................................................................13

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Introduction
Parkinson’s disease is a long-term neurodegenerative disorder that results in the
progressive loss of dopaminergic neurons and formation of lewy bodies (Zaltieri et al., 2015).
Pre symptoms of this disease includes slowness in movement, trembling, tremors at rest,
rigidity and stiffness in body and walking problems. In the given case study, Patrick who is
66 years old, has diagnosed by his neurologist that he is suffering from early onset
Parkinson’s disease. He is on medication and runs 5 Km on each day. This essay will focus
on the impact of this incurable Parkinson’s disease, some safety attentionsfor this stage of the
disease route, healthcare interventions and lastly on some referral made to the service
available in community.
Discussion:
Relevance of the issue
Parkinson’s disease is a chronic neurodegenerative disorder that targets motor neurons
and hampers the mobility of an individual. Patrick, who is 66 years old is suffering from the
same disease and experiences slight tremor in the right hand, reduction in quality of sleep and
decrease in the perception of smell for two weeks. His neurologist diagnosed this as the early
onset of Parkinson’s disease. He currently works as a primary school teacher and lives with
his supportive husband. He is fit enough, runs 5 km per day and is not regular in taking
medications, but now, due the diagnosis of Parkinson’s disease in commencing Levodopa 50
mg for three times a day and 0.5mg Clonazepam. All these issues are quite relevant to
Pratrick. Due to tremor experienced in right hand, he will no longer be able to continue his
normal household activities, his reduction in the quality of sleep will hamper his regular
activities of enjoyment like running 5 km per day. Moreover, this adequate quality of sleep
will further exacerbate his capability to take part in social activities and will decrease

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appetite. Establishment of skills and understanding of person-centered care should include
the identification of strength and power of the older adult in order to increase their
independence and to reduce the impact of disease and disability(Moyle, Parker& Bramble,
(2014).The community based supports and strategies should be promoted to increase the
holistic wellbeing of the patient.
Primary healthcare nursing interventions
Patrick is suffering from symptoms like tremor in right hand, decreased smell
sensation and sleep quality. The first issue is tremor at rest. The first intervention that is to be
done by registered nurse includes advising patient to maintain the arm close to the body since
stability that is more proximal will minimize the constant tremor while performing various
functional activities. A registered nurse can also advice the patient to stabilize the arms on a
surface while working as this will also help him to manage tremors.The second intervention
includes keeping a record of patient’s tremor that will enable registered nurse to track the
time and severity of occurrence of tremor. Registered nurse should instruct patient to
complete his daily activities in daytime when there is less severity of tremor present. The
third intervention that can be done is to check whether patient is taking proper medication on
scheduled time as prescribed by the doctor. Patient should manage anxiety, stress, fatigue and
frustration since this can worsen the tremor condition more. He should take deep breath while
feeling stressed, that may manage the tremor effectively. The fourth intervention includes
nurses should supply adaptive equipment like rocker knives and button hooks to improve
motor skills.
The second issue is that the patient is suffering from decreased sense of smell that is a
nonmotor symptom observed in Parkinson’s disease (El Rassi et al., 2016). The first
intervention to be taken to assess this symptoms is to perform the brief smell identification
test (BSIT) that is used to evaluate the olfactory function (Shrestha et al., 2017). The second

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intervention that is to be taken by registered nurse includes proper counselling of patient that
may improve the condition of smell dysfunction (Kalogjera& Dzepina, 2012). Third
intervention includes registered nurse should enrich patient’s diet with foods that are rich in
vitamin A, B6, B12 since the deficiency of this factor are responsible for impairment of
smell. Fourth intervention that a registered nurse can do is to check whether the patient is
taking correct medications for smell disorder like tropical corticosteroids as prescribed by the
doctor (Wu et al., 2015).
The third issue that he is suffering from is decreased quality of sleep. The first
intervention includes the registered nurse should assess the pattern of sleep disturbances that
is caused due to the environment since this disturbances in sleep may reduce the recovery rate
of the disease. A generator with soothing sound like sounds of ocean, rainfall and waterfall
can be used that may induce sleep. The second intervention includes taking feedback from the
patient about the daily bedtime routine, for how many hours the patient is sleeping and the
usual sleep pattern. Third intervention includes caring patient without waking him up.
Registered nurse should provide care when the patient is awake. They can provide an
efficient back massage to patient that can increase the quality of sleep as suggested by
researchers (Pinar& Afsar, 2015).The fourth intervention includes the reduction in daytime
napping during late afternoon. Patient should limit his sleep to short interval in daytime.
Evidence based practice rationale
Patrick is suffering from tremor at rest and this can be reduced if he stabilizes his arm
on the surface while working. Recent studies suggested that involuntary control can be
controlled by placing the wrist attached to an apparatus that will lock the movement of the
arm (Murnaghan et al., 2016). Patrick is also suffering from decreased sensation of smell and
this can be cured by giving Vitamin B supplements to patient. According toHåglin et al.,
( 2017), a low level of thiamin and folate density is linked with olfactory dysfunction in

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patient suffering from Parkinson’s disease. The last issue that the patient is suffering from is
reduced quality of sleep. This can be improved by increasing the amount of physical activity
and decreasing the amount of sleep in daytime (Wu et al., 2105). Research evidences
suggested that an intervention of back massage for 15 minutes in a week, which is a non-
pharmaceutical therapy, is effective in increasing the quality of sleep.
Referral
For the issue of tremor, Patrick and Michael should consult a physiotherapist (WHO).
Research evidence suggested that physiotherapist enable patient to maintain their mobility at
maximum level (Tomlinson et al., 2012). This therapy will enrich Patrick’s confidence to
continue his regular activities with ease (WHY). Patrick is suffering from early onset of
Parkinson’s disease, so, it will be better if he starts taking physiotherapy at the earliest. His
immediate action is required to maximize his mobility level and will be effective if he starts
this therapy within one week (WHEN).Health care should provide one trained physiotherapist
and is a free program. Patrick and Michael should avail this facility for the physical well
being of Patrick (HOW). For the issue of smell dysfunction, they should consult a counselor
who can help Patrick to increase his perception of smell by proper counseling. A dietician can
also help him making a proper diet plan that includes foods rich in Vitamin B (WHO). Proper
counseling and a diet plan that include Vitamin B can help Patrick to overcome his problem
of smell dysfunction that mainly results due to Vitamin B deficiency( WHY). This should be
done by Patrick immediately since he is suffering from early onset of the disease (WHEN). A
well-trained counselor and dietician will be arranged by health care services that are free of
cost (HOW). The last issue that he is facing is deprivation of sleep. For increasing the quality
of sleep, they must take help from a skilled yoga trainer who can train him in performing
meditation (WHO). Research suggested that a mindfulness meditation in effective in
increasing the quality of sleep (Black et al., 2015). This increased quality of sleep will enable

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him to cope the disease efficiently (WHY). Patrick is suffering from decreased quality of
sleep and his immediate action may give a positive result to overcome his problem
(WHEN).Health care will arrange one mindful awareness practice program and a sleep
hygiene education for Patrick that will be free of cost in order to prevent the progression of
his disease (HOW).
Safety considerations for Patrick
Diagnosis PHC Nursing 1X Evidence based
practice rationale
Referral
Tremors in the right
hand
To reduces the
chances of fall in the
patient due to loss of
grip
Due to loss of effective
holding capacity the
patient may face
difficulty in holding
onto railings while
climbing stairs resulting
a bad fall in the patient
WHO: the patient could
be provided support and
care services form
community based
nurses who could help
the patient with the
activities of daily living
To reduce the chances
of disability or
paralysis due to losing
grip of the right hand
The patient should be
restricted from picking
and lifting of heavy
objects as it may cause
further stress upon the
nerve and muscles
WHY: lifting heavy
objects could trigger
further shaking in the
hands by sensitizing the
nerves further.
Restricted or less
movements due to
inability to hold objects
The patient could be
suggested physiotherapy
on a regular basis to
check the progression
of the Parkinson’s
WHEN: the therapy
could be started as soon
as possible as the
patient is still in the

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disease early stage
NA HOW: the patient could
be referred to a
community based health
care center where the
physiotherapist
appointed for the
patient could be sent to
the home of the patient
directly to give the
treatment.
Diagnosis PHC Nursing 1X Evidence based
practice rationale
Referral
Decreased sense of
smell
Reduced appetite The decrease smell
could diminish the
desire to eat in the
patient (Poewe et al.,
2017)
WHO: the patient
could be referred to a
neurologist for
providing with a long
term care plan
Lessen the response to
surroundings
The patient would not
be able to sense foul or
nice smell which could
impair the responses to
the surroundings
WHY: the patient was
suffering from
progressive parkinson’s
therefore immediate
care was needed.
Increase tendency to The inability to decipher WHEN: the treatment

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nausea in the patient a proper smell could
initiate reactions within
the patient such as
nausea (Fox et al.,
2018)
could be followed up on
a monthly basis initially
in order to stabilize the
condition of the patient
Loss of function of
taste buds
With the inability to
decipher smell the taste
buds may be less
responsive
HOW: the patient could
be referred to by the
community nurse to the
clinic.
Diagnosis PHC Nursing 1X Evidence based
practice rationale
Referral
Poor quality of sleep Risk of cerebral stroke As the patient had
developed Parkinson’s;
sleep serves as a
medicine which could
relax the nerves. The
lack of sleep increases
the chances of cerebral
stroke
WHO: the patient could
be referred to a
counselor who could
help initiate sleep
within the patient with
the help of therapeutic
approaches
Risk of cardiac stroke Less sleep could affect
cardiac health of the
patient enhancing the
chances of stroke
(Tarazi, Sahli, Wolny
WHY: this is because
the holistic approaches
have long term effect
compared to the strictly
pharmacological

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& Mousa, 2014) interventions
Inability to perform
activities of daily living
The fatigue due to lack
of sleep may prevent
Patrick from performing
the activities of daily
living effectively
WHEN: the counseling
sessions could be
organized within the
community centers only
alongside the
pharmacological
treatment
Reduced thinking
power
The less sleep and
fatigue may affect the
thinking and cognition
skills of the patient
(Grover, Somaiya,
Kumar & Avasthi,
2015)
HOW: the free program
could be organized for
Patrick by a call to the
director of the
community center b the
attending nurse

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Maintaining Patrick’s dignity
Diagnosis PHC Nursing 1X Evidence based
practice rationale
Referral
Maintaining the
dignity of the patient
Low self esteem in
the patient
The inability to lead a
normal life could to
development of self
resentment within the
patient
WHO: the patient
should be supported by
special care nurses who
are effectively trained
to deal with specific
areas. Additionally, the
gender of the patient
should be taken into
consideration during
recruitment of the
attending support care
as it may cause safety
as well as privacy
concerns (Miller &
O’Callaghan, 2015).
Less trust /conflict
with the care and
support providers
The patient may ask to
complete autonomy over
his daily life; however
the inability to move
effectively may cause
the support carers to
restrict the freedom of
the patient to move
WHY: Interaction with
a friendly and same
gender nursing
professional will also
help in providing
effective emotional
support which will help
in boosting the mental

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around freely health of the patient.
Social isolation;
development of
depression
The inability to move
like before can cause the
Patient shift into social
isolation
WHEN: the support
and care services
extending to personal
hygiene should only be
provided after the due
consent of the patient
and their respective
family members
Resignation from daily
life activities
The tremors in the right
hand may cause Patrick
scared to lift objects to
use his hands
otherwise; making him
dependent upon the
support carer fort basic
activities like bathing,
cleaning , which could
lead to privacy concerns
HOW: the service
could be asked for from
the local community
centers by direct
referral through GP.