Case Study For Parkinson Disease: Causes, Symptoms, Medical Management, Nursing Care Plan, And Discharge Plan

Possible Causes/Risk Factors that lead to Parkinson’s Disease

Write about the Case Study for Parkinson Disease.

Parkinson disease is a neurological disorder that commonly affects about one percent of the individuals aged sixty years and above. There are two major neuropathologic findings regarding the Parkinson’s disease; the subsequential destruction of the brain neuron pigments located at the susbstancia nigra pars compacta (SNpc) and the occurrence of the Lewy bodies and neurites (Allen, Schwarzel, & Canning, 2013). In the case study, John aged seventy-five years, having diagnosed for Parkinson’s disease get admission to the emergency department. He has shown some signs of the disease such as tremor, decreased mobility, restlessness, and agitations. In the essay, I shall focus attention on the causes, risk factors, clinical manifestations of the Parkinson’s disease, physical assessment, management and medication for patients with the health condition and relate it to the case study for John. Finally, shall discuss the nursing care plan and discharge plan with relevance to John’s case study.

The etiological causes of the condition are quite unclear and still unknown. But, scientists have come up with hypotheses stating the most likely causes of the disease include both the genetic factors and the environmental factors. Presently, the genetic factors contribute to averagely ten percent of the population for the condition. Also, neuropathologic findings show that the loss of dopamine and presence of Lewy body and Lewy neurites causes Parkinson’s disease (Pringsheim, Jette, Frolkis, & Steeves, 2014).  Other risk factors which place an individual at higher chances of developing the disease include the age, gender, occupations, and race. Age is the major risk for developing the disease as in the case of John who is above 50 years. Scientists do believe that the functioning of the brain and dopamine starts to decline as the individual ages, making him more susceptible to the disease. Men are at higher risk to develop Parkinson’s disease than women. Research conducted show that some occupations put an individual in greater danger of developing the disease (Pagonbarraga, Kulisevsky, Strafella, & Krack, 2015). For instance, welding, agriculture and industrial work in which people get exposed to the toxic substances. Furthermore, some researchers have shown that Caucasians are more susceptible to develop the disease than Africans. Lastly, consumption of alcohols like in the case of John would have exposed him to high risk of developing the disease.

There are three cardinal indicators for the disease which include; general tremor, the bradykinesia and being rigid. Another sign is that of body imbalance. In the case study, John shows the signs of generalized tremor, decreased mobility and lack of body stability which results in a fall before admission to hospital. Tremor might occur while one is at rest, typically commencing at one of the hands, his leg and eventually the entire body parts (Szewczyk-krolikowski, et al., 2014). Generalized tremor noted in John acts as a hallmark of the disease thus giving a clue for the diagnosis of idiopathic Parkinson’s disease. John experiences rigidity and that is the reason as to why in the case study he complains of hip and back discomfort. John has the symptom of bradykinesia that is shown by the decreased mobility. Other symptoms in the john’s case include depression and anxiety about his medication, fatigue and problematic mental processes. Physical assessment of the patient’s condition involves the gross examination to evaluate the signs (Sawada, et al., 2013). For instance, an examiner would evaluate John’s tremor, rigidity, bradykinesia, and postural instability through just observation. Another physical assessment would involve the use of a scale device known as Unified Parkinson Disease Rating Scale which has the four subscales. Subscale 1 measures the mentation, behavior and the mood. Subscale 2 rates one’s daily activities. Subscale 3 rates the motor manifestations and subscale 4 examinations therapy complications. Finally, the assessment can be through the interviewing of the patient, John, on the presence or the absence of possible signs of Parkinson’s disease.

Signs and Symptoms of Parkinson’s Disease and the Key Physical Assessment

The objective of the medical management of the disease is to offer the control of the clinical manifestations as much as possible while minimizing the adverse effects. In the case study, John should be advised to undertake daily exercises so as to improve his mobility (Trinh & Farrer, 2013). He should do regular exercises that include, walking, strength training, or Tai Chi so as to improve and maintain mobility, balance, and coordination. Also, John should be advised on to take a balanced diet and stop consuming alcohol. John should be given medications for the motor symptoms diagnosed. Although Parkinson disease has no cure, there are several categories of drugs that are available to offer successful treatment of the motor signs and symptoms. Medications are available either in the generic form or via the special programs for affordability (Reeve, Simcox, & Turnbull, 2014). The medications include; citalopram (20mgms daily) also known as the Selective Serotonin Reuptake Inhibitor, used for depression treatment. It functions through restoring the balance of serotonin in the brain. Kinson acts as a dopamine precursor to treating the major signs of the disease. Madopar HBS 125 mg Nocte contain the levodopa and the benserazide active ingredients. It used to serve as a treatment agent for Parkinson disease, acting as an antiparkinsonian agent. Other medications for the condition include; dopamine agonists (Apokyn, Pramipexole, and Rotigotine) which imitate the activity of dopamine, COMT Inhibitors that are used together with Kinson, and the Selective MAO-B Inhibitors which blocks the MAO-B enzyme in the brain from breaking dopamine.

The NANDA nursing diagnosis for John would involve the examination and evaluation of his reduced mobility, confusion, generalized tremor, bradykinesia, restless and agitation. The examination would be either through physical examination or use of x-rays. The goals relevant to the nursing diagnosis for John include patient, achieving his mobility, reduced pain on the lower limbs, reduced anxiety and no confusion, body stability and feeling restful (Cummings, et al., 2014). The following nursing interventions would be appropriate in the holistic care for John; observing and assessing his movement and body posture, assessing his mental processing speed, monitoring the coughing risk, administering the appropriate medications.

John’s movement slows with age and chronic disease. His body posture also bends as he ages. His mental processor also becomes slower as he ages. Hence, he takes long to think and give a response, the coughing upon sipping water decreases on using cough syrup administered at the hospital (Lees, et al., 2017). Finally, the benefit of medications emerges when the prescribed drugs are used appropriately as per the instructions.

Medical Management of Parkinson’s Disease Patients

John should be encouraged to exercise daily for two hours, increase intake of fluids up to 6-8 glasses per day and his movement and body stability monitored every day. His anxiety should get monitored after every six hours.

John would get discharged from the hospital upon regaining his normal health status and strength to walk unaided. He should get motivation to contribute actively in decision making concerning his health status. John and his wife should give pieces of information about his health status and the expected or current challenges (Gulanick & Myers, 2013). John and his wife should be referred to a social worker or a psychologist to receive the psychosocial support. Furthermore, John and wife should get guided on how to prevent falls. The couple should also be advised to disclose any additional information which may be essential in financial budgeting and planning, life assurance, application for the disability kit, and the admission into either a nursing center or an assisted living facility.

Conclusion

It is evident and clear that John is amongst the one percent people who are highly susceptible to Parkinson disease due to old age. His gender also contributes heavily to the susceptibility of the condition. Though neuropathologic findings show that Parkinson disease originates from two major factors, genetic and environmental factors, in John’s case there is no historical information to support these factors. John has the four major symptoms of Parkinson’s disease which include, generalized tremor, the rigidity, the bradykinesia and reduced mobility among others. Epidemiology holds that the incidence and prevalence of the condition increase with age. Clinical manifestations help in the nursing diagnosis of the patient. The NANDA holistic nursing is the caring of the patients. Finally, patient education at the point of patient discharge is important in encouraging the patient to participate in decision making regarding their health status. Also, patient education sheds light to the patient and caregivers on the understanding of the disease condition and offers referral to allied institutions or professionals for psychosocial support.

References

Allen, N. E., Schwarzel, A. K., & Canning, C. G. (2013). Recurrent falls in Parkinson’s disease: a systematic review. Parkinson’s Disease, 2013.

Pringsheim, T., Jette, N., Frolkis, A., & Steeves, T. D. (2014). The prevalence of Parkinson's disease: A systematic review and meta?analysis. Movement disorders, 29(13), 1583-1590.

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.

Szewczyk-Krolikowski, K., Tomlinson, P., Nithi, K., Wade-Martins, R., Talbot, K., Ben-Shlomo, Y., & Hu, M. T. (2014). The influence of age and gender on motor and non-motor features of early Parkinson's disease: initial findings from the Oxford Parkinson Disease Center (OPDC) discovery cohort. Parkinsonism & related disorders, 20(1), 99-105.

Trinh, J., & Farrer, M. (2013). Advances in the genetics of Parkinson disease. Nature Reviews Neurology, 9(8), 445-454.

Reeve, A., Simcox, E., & Turnbull, D. (2014). Ageing and Parkinson's disease: why is advancing age the biggest risk factor?. Ageing research reviews, 14, 19-30.

Sawada, H., Oeda, T., Yamamoto, K., Umemura, A., Tomita, S., Hayashi, R., ... & Kawamura, T. (2013). Trigger medications and patient-related risk factors for Parkinson disease psychosis requiring anti-psychotic drugs: a retrospective cohort study. BMC neurology, 13(1), 145.

Cummings, J., Isaacson, S., Mills, R., Williams, H., Chi-Burris, K., Corbett, A., ... & Ballard, C. (2014). Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial. The Lancet, 383(9916), 533-540.

Gulanick, M., & Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Lees, A. J., Ferreira, J., Rascol, O., Poewe, W., Rocha, J. F., McCrory, M., & Soares-da-Silva, P. (2017). Opicapone as adjunct to levodopa therapy in patients with Parkinson disease and motor fluctuations: A randomized clinical trial. Jama neurology, 74(2), 197-206.