Case Senario: Johann Silvermann is a 77 year old widower diagnosed with Parkinson’s disease four years ago. He was also diagnosed with hypothyroidism four years ago – this is now controlled on medication.The Silvermanns moved from Germany in 1946. Johann lives in his own two-storey home where he has lived with his wife, Gertrude, until she died twelve years ago. Johann has remained independent since then. Gertrude and Johann did not have children, thus Johann has no immediate family. However, he has a brother, Hugo and his family, living close by. Johann does not want to involve them in his daily life as he does not want to be a bother to them. Johann has a small income from his self-managed superannuation and is careful with his money. This allows him some measure of financial independence, however, because of reduced investment returns; finances are now only just covering his expenses. He tries to go on a holiday once a year, but was unable to this year due to his altered mobility.Johann has a slight tremor in both hands which is becoming worse. This is making tasks such as cooking, making a cup of tea and doing up buttons and shoe laces difficult. Because Johann perceives that his disease process is worsening, he is starting to wonder how he can face the uncertainty of his future. Current Medications
• Thyroxine 100 micrograms daily
• Carbidopa/Levodopa 25/100 q8h
• Entacapone 200 mg q8h
Johann’s GP has referred him to the community health centre where you work and you are the community nurse assigned to manage Johann’s care in his home.

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