A Clinical Scenario: Parkinson’s Disease Case
Instructions:-
A Clinical Scenario: Parkinson’s Disease Case
This assessment is designed to measure your ability to identify and prioritise the most important nursing care issues for a client.
Two theoretical frameworks underpin your assignment: Miller’s Functional Consequences Theory to identify the influences impacting on the older person and their level of function and Levett-Jones’ Clinical Reasoning Cycle as the tool to drive the process of identifying and assessing, implementing and evaluating care. In addition students need to demonstrate how the dignity of the older person is maintained and how the cultural background of the older person is considered, throughout the process of assessment and care provision
Students are required to deconstruct a provided scenario and identify and describe three nursing care priorities with rationale. Then select the top priority (one) to be discussed in further detail .The 50% of the assignment body is to be dedicated to the indepth discussion of the identified care priority.
Solution
A Clinical Scenario: Parkinson’s Disease Case
Introduction
Parkinson’s disease is a mental disorder whose symptoms worsen over time. The illness has no cure and its cause has not been discovered. Its symptoms include fatigues, resting tremor, muscle rigidity, stooping posture and slow movements (“Symptoms of Parkinson’s disease”, 2017). In essence, the only treatment option available is the management of the symptom. The ailment causes the death of nerve cells in the brain, including the death of the cells that release dopamine. Dopamine is a chemical that controls the part of the brain that is responsible for movement and coordination. The purpose of this paper is to demonstrate the ability of a nurse to identify the prime care issue for a patient. It aims at promoting problem-solving in nursing and healthcare.
A scenario is provided and the student is required to identify care priorities with rationale and choose a top priority care issue. The paper is supported by Miller’s Functional Consequences Theory which evaluates factors that affect old people’s functionality (Hunter, 2012). It is also supported by Levett-Jones’ Clinical Reasoning Cycle, which is useful in identifying, evaluating, implementing and evaluating care provided to patients (Levett-Jones, 2013). The paper requires students to consider the patient’s age and cultural background while demonstrating the health care that should be given to them.
Part A
Mr. Ratin Bhai is an 87-year-old man who suffers from hand tremors that seem to be getting worse, and slow movement due to the rigidity of his limbs and impaired balance. He is a widower and lives alone in a two-storey house since he has no children. His only source of income is his superannuation; he manages his funds well such that he is able to pay his expenses and go on a holiday once a year. However, with the deteriorating health and impaired mobility, he has not gone on holiday this year. Holidays are the only way Ratin can interact with other people. Therefore, his inability to go on holiday signifies a high risk of Ratin being socially isolated and suffering from depression. The tremor in his hands makes it difficult for him to perform basic duties such as cooking, wearing clothes and tying up shoe laces. Ratin is concerned about his future since he perceives his condition to be aggravating.
Ratin has a history of Parkinson’s disease (PD) that was diagnosed 4 years ago. He also suffers from hypothyroidism that was diagnosed four years ago. He has slight tremors in both hands that are worsening and his mobility is impaired. Some of the symptoms that Ratin shows are attributed to the Parkinson’s disease. For instance, a Parkinson’s disease patient experiences hand resting tremor. Another symptom is the altered movement which may be characterized by short steps and dragging of the feet when walking. Rigid muscles are also symptoms of the condition and may impair automatic movements such as swinging of the arms when one is walking (Sellbach & Silburn, 2012). Rigidity results in a stooped posture and may damage body balance. If the symptoms aggravate, one’s ability to move and perform tasks becomes impaired.
Thyroid gland undergoes functional and changes as one ages. For that reason, the prevalence of hypothyroidism increases with age with patients showing symptoms such as fatigue, Fatigue, dry skin, weight gain, pain in the joints, depression and slowed heart rates (Cooper, McDermott & Wartofsky, 2004). If a patient is treated, these symptoms begin to disappear after two weeks of medication. Ratin, therefore, does not exhibit any of the symptoms because he uses Thyroxine medicine that reverses the symptoms.
He is currently using Thyroxine 100 micrograms daily, Carbidopa/Levodopa 25/100 q8h and Entacapone 200 mg q8h. Thyroxine is a synthetic thyroid hormone that is taken daily to reverse symptoms of an underactive thyroid. Since there is no specific cure for Parkinsonism, these drugs only help in managing its symptoms. Ratin should keep track of his medications and maintain a schedule, for the drugs to work effectively. Carbidopa/Levodopa 25/100 q8h is used in the treatment of Parkinson’s disease symptoms in advanced stages of illness (“Parkinson’s disease”, 2017). Entacapone is a medication that is taken alongside Levodopa in the treatment of Parkinson’s disease. It belongs to the COMT inhibitors class and works by blocking the COMT enzyme in the body. COMT enzyme catalyzes the breakdown of Levodopa causing it to wear off between doses and consequently worsen the disease’s symptoms (Sellbach & Silburn, 2012). By blocking the release of the enzyme, Entacapone reduces the rate at which Levodopa is broken down causing it to last longer in the body.
Ratin is faced with various challenges that include hand trembling. The trembling has made him unable to carry out certain tasks such as buttoning up his clothes, tying his shoe lace and cooking. Parkinsonism has also caused negative impacts on his mobility preventing him from going on holidays. Another challenge he is faced with is hyperthyroidism which is attributed to his old age. Hypothyroidism is a complex condition that requires lifelong use of medication to manage (Tarsy, 2012). It is a condition where the thyroid gland produces insufficient hormones. Blood tests such as Thyroid Stimulating Hormone level tests are used in diagnosing the condition.
The tremor that is associated with paralysis agitans is usually caused by low levels of dopamine chemical in the brain (Chen, Hopfner, Becktepe & Deuschl, 2017). Medication is used to control muscle rigidity which, in turn, reduces the trembling. However, the trembling may get worse over the years even if the patient continues to use the drugs. It should be noted that hand shakiness may be a symptom conditions other than Parkinson’s, hence a need to do a thorough clinical screening to identify the cause. Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are tests that can be used on a patient suffering from tremor to identify the disease; the tests can detect the levels of dopamine in the brain (Pamela, Britta & John, 2003). Slow movement in Parkinson’s disease is caused by the rigidity of the muscles. Impaired mobility can also be a symptom of other conditions like the Progressive supranuclear palsy, a brain disorder that impairs body balance and walking. For that reason, a nurse should conduct a careful review patient’s history and perform neurological examinations which include mental ability assessment to avoid misdiagnosis.
Part B
The hand’s tremor should be the top priority of care to the patient. The trembling prevents the patient from preparing food and putting on clothes. The nursing care plans include the following: The severity of the shakiness will be reduced to a level where the patient can carry out the fundamental tasks within one week. The patient’s anxiety about his future will be reduced by promoting independence along with safety (“Parkinson disease”, 2014). The nursing interventions will include monitoring of the patient to assess the severity of the trembling (Vera, 2016). This will also include observing the patient as he cooks and eats to determine how the tremor affects these activities. To suppress tremors, the patient is encouraged to squeeze or roll a small ball in his hands. Patient’s anxiety state will also be assessed by letting the patient describe how he feels about his future health and inability to work (Marsh, 2013). The patient will be encouraged to take deep breaths and relax the nervous system (“Parkinson’s Disease Nursing Care Plan & Management – RNpedia”, 2017). Adaptive equipment like rock knives and button hooks will be introduced to the patient to enhance fine motor skills and promote independence.
After one week, the hand tremors have reduced and occasionally stop after a few squeezes of the ball. The patient has gained self-confidence and can face the uncertainty of the future because the adaptive equipment has improved his self-reliance (Karceski, 2007). Through this patient’s case, I have learned that tremors associated with the condition worsen with time and can prevent a patient from performing light duties like holding items and preparing food. I have also learned that Parkinson’s disease can reduce a patient’s level of independence and consequently cause depression and uncertainty about the future. I have understood the role of Entacapone drugs in reducing the rate at which Levodopa is absorbed in the body. This case has also made me understand that the symptoms of Parkinson’s disease cannot be reversed, but can be managed.
Conclusion
Paralysis
agitans is a disease that is caused by low levels of dopamine in the brain. The disease progresses slowly and
results in failure of body systems and eventually depression.
Tremors are one of the symptoms that are associated with the disease. Tests
like Positron emission tomography (PET) and single photon emission computed
tomography (SPECT) can be performed by nurses to confirm the illness. The
disease does not have a specific cure but its symptoms can be controlled by use
of medicine such as Levodopa and Entacapone. For the medicine to be effective,
patients should follow a strict schedule when taking them to avoid missing
doses. It is worth stating that long-term
use of these drugs results in drug tolerance and severity in the symptoms. Massages and Training exercises like muscle
stretching may also reduce muscle rigidity thus suppressing the symptoms. A
patient can also control hand tremors by squeezing a ball or shifting it
between hands. If the tremors are severe, adaptive appliances may be introduced
to help a patient in performing certain tasks. The equipment helps in assures the patient of their
independence hence lowering their chances of getting depressed.
References
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Chen, W., Hopfner, F., Becktepe, J., & Deuschl, G. (2017). Rest tremor revisited: Parkinson’s disease and other disorders. BioMed Central. Retrieved 7 September 2017, from https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-017-0086-4
Cooper, D., McDermott, M., & Wartofsky, L. (2004). Hypothyroidism. The Journal Of Clinical Endocrinology & Metabolism, 89(11), 0-0. http://dx.doi.org/10.1210/jcem.89.11.9990
Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters Kluwer/Lippincott, Williams and Wilkins.
Karceski, S. (2007). Early Parkinson disease and depression. Neurology, 69(4), E2-E3. http://dx.doi.org/10.1212/01.wnl.0000277528.52407.c0
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Marsh, L. (2013). Depression and Parkinson’s Disease: Current Knowledge. Current Neurology And Neuroscience Reports, 13(12). http://dx.doi.org/10.1007/s11910-013-0409-5
Pamela, B., Britta, J., & John, V. (2003). Positron Emission Tomography (PET) and Single Photon… : Journal of Neuro-Ophthalmology. LWW. Retrieved 7 September 2017, from http://journals.lww.com/jneuro-ophthalmology/Abstract/2003/03000/Positron_Emission_Tomography__PET__and_Single.9.aspx
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Sellbach, A., & Silburn, P. (2012). Management of Parkinson’s disease. NPS MedicineWise. Retrieved 7 September 2017, from https://www.nps.org.au/australian-prescriber/articles/management-of-parkinson-s-disease
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Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Tarsy, D. (2012). Treatment of Parkinson Disease. JAMA, 307(21), 2305. http://dx.doi.org/10.1001/jama.2012.4829
Vera, M. (2016). 9 Parkinson’s Disease Nursing Care Plans. Nurseslabs. Retrieved 7 September 2017, from https://nurseslabs.com/parkinsons-disease-nursing-care-plans/
