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  • Parkinson's disease is a progressive neurodegenerative disorder of the nervous system that affects movement (Mayo Clinic, 2016).
  • It is the third most common neurological disorder of older adults, and affects more men than women with onset typically between the ages of 40-70 (Adams & Urban (2013).
  • Tremor and shaking
  • Small handwriting
  • Loss of smell
  • Trouble sleeping, moving, walking
  • Mask-like face
  • Soft/low voice
  • Stooping or hunching over
  • Muscle rigidity
  • Dysarthria
  • Dysphagia

Doctors rely on Hoehn and Yahr five rating scale to classify severity of symptoms

Intervention 1: Incorporate safe & effective folk health care practices & beliefs into care whenever possible. Rationale: Incorporating folk health care beliefs & practices into pain management care increased compliance with the treatment plan.

Intervention 2: Apply the RICE method (rest, ice, compression, and elevation) to injured ankle. Rationale: After an injury, such as a knee or ankle sprain, you can relieve pain & swelling & promote healing & flexibility with RICE.

Intervention 3: Provide nutritional counseling about the elements of a well-balanced diet, dietary factors related to bone healing. Rationale: Patients are vegetarian due to religious belief. Well-planned, balanced vegetarian diets can supply the necessary nutrients to achieve an adequate nutritional status. Vitamin C (ascorbic acid) aids in tissue building & many metabolic reactions.

Case Study: Parkinson's Disease

Nursing Dx #2

Na Ha, Averee Mewborn, Liz Vining, Nicole Davis

Short Term Goal

Short Term Interventions

The patient will be free from any falls during hospitalization.

Risk for falls related to unsteady Parkinsonian gait as evidenced by

patient admission to the emergency room due to a fall at home & injured ankle.

Intervention 1: Complete a fall-risk assessment for older adults in acute care using a valid & reliable tool such as the Hendrich II Model. Rationale: The Hendrich II Fall Risk Model is quick to administer & provides a determination of risk for falling.

Intervention 2: The patient will wear a yellow fall risk bracelet & yellow nonskid socks so other nursing staff know that the patient is a risk fall. Rationale: The Institute for Healthcare Improvement (IHI) has recommended universal use of color yellow to identify patients at risk for falling.

Intervention 3: Thoroughly orient client to environment to reduce risk of harm. Rationale: Common physical hazards that result in falls include unfamiliar environments.

Pathophysiology

Nursing Dx #1

Long Term Goal

Long Term Interventions

Patient will make necessary physical changes in environment to ensure increased safety within first week of returning home.

Intervention 1: Provide patient with adaptive equipment, such as a cane or walker, for ambulation& instruct patient on how to use. Rationale: Saying active helps maintain strength & balance which can help reduce falls.

Intervention 2: Refer to exercise programs that target strength, balance, flexibility, or endurance. Rationale: Programs with at least two of these components have been shown to decrease the rate of falling & number of the people falling.

Intervention 3: Assess home environment for threats to safety including clutter, slippery falls, scatter rugs, & other potential hazards. Rationale: Clients suffering from impaired mobility, impaired visual acuity, & neurological dysfunction, including dementia & other cognitive functional deficits, are all at risk for injury from common hazards.

Short Term

Goal Interventions

Risk for grieving related to personal

vulnerability secondary to PD as

evidenced by continued loss of ADLs.

The patient will be able to identify & discuss the meaning of the loss in his life and its effects on the family dynamics.

  • Unknown cause, possibly genetic and/or environmental
  • Destruction of substantia nigra
  • Dopamine
  • Acetylcholine
  • Also involved: the striatum
  • Dysfunction of basal ganglia

Ignatavicius & Workman, 2013

Define the Disease

Intervention 1: Assess the patient's state of grieving using the Texas Revised Inventory of Grief (TRIG). Rationale: It is important to differentiate between depression & complicated grief because they can easily be confused.

Intervention 2: Provide time for the patient to express feelings about illness. Rationale: Active listening helps decrease feelings of

loneliness & isolation.

Intervention 3: Offer the option of referral to a spiritual counselor or Buddhist monk. Rationale: Spiritual beliefs often become stronger & occupy a larger place in the patient's life during times of grieving.

Long Term Goal

Long Term Goal Interventions

The patient will continue seeking emotional support by

discharge home as evidenced by patient's verbalization

& acceptance of assistance.

Intervention 1: Assist patient to make a specific plan for coping. Rationale: To enable the

patient to integrate loss of independence & adjust to new lifestyle.

Intervention 2: Help the family determine the best way & place to find social support.

Rationale: Social support has been shown to help individuals as they reconstruct

their lives & find new meaning in life.

Intervention 3: Encourage expression of grief in a support group for patients with the same

disease. Rationale: There is comfort in connection with others similar situations living with

the same illness & knowing that pain from grief is normal.

Nursing Dx #3

Medical Dx

Signs and Symptoms

Short Term Goal

Short Term Interventions

Risk for acute pain related to a fall as evidenced by patient stating his pain level is an 8/10 scale and observed warmth of right ankle.

The patient will be at or below acceptable pain score by the end of shift as evidenced by patient his pain is tolerable at 4/10.

Intervention 1: Use culturally relevant pain scales to assess pain in the client. Rationale: Clients from minority cultures may express pain differently than clients of the majority culture.

Intervention 2: Administer analgesic as ordered by the physician. Rationale: Opioids are indicated for treatment of moderate to severe pain.

Intervention 3: X-ray ankle for any signs of broken bones. Rationale: Radiography is commonly used to diagnose fractured bone, injuries & joint abnormalities.

Case Study

Long Term Goal

  • Dx is made by an internist, family physician, or neurologist

  • No standard diagnostic tests for Parkinson's - Doctors must rely on symptoms and whether medication will improve symptoms

  • DaTscans can help confirm a dx early on in the disease

Long Term Interventions

The patient will continue to be at a tolerable

pain level after discharge as evidenced by patient not returning

to the hospital with

increased pain.

  • Mr. M.F. is a 55 year old Chinese male from New York who was a past marathon runner.
  • He is a Buddhist with a history of Parkinson's Disease diagnosed in 1996 (20 years).
  • He was brought to the ED by his wife, who cited he had fallen down the flight of steps at their home.
  • Patient rates his pain 8/10 on his right ankle. Temperature 98.2° F 125/85 BP, 16 breaths per minute, SpO2 of 98%, and pulse rate of 88 beats/min.
  • The patient currently takes Sinemet for symptoms of Parkinson’s.
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