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Question:

Discuss about the Parkinson’s Disease.
 
 

Answer:

Parkinson’s disease is one of the most common diseases that affect the nervous system of an individual usually in the old age. It is responsible for development of chronic and progressive movement disorder. The symptoms are found to worsen order time as the disease progresses (Safarpour et al., 2015). The patient is the case study has already been affected by Parkinson’s disease about five hundred years ago and can be assumed to be in the advanced stage of the diseases. He has faced an accident where he had fallen sue to the occurrence of tremor. The fall has affected him badly as he had faced tears in his right hip and developed pain and bruises in hips and buttocks. The report will mainly contain a detailed analysis of the case study and will develop nursing interventions for the patient so that he can experience better quality life.

Parkinson disease mainly occurs due to the progressive impairment of the neurons or the nerve cells that remain located in particular region of the brain called the substantia niagra. Under normal condition, the neurons in this part of the brain release a chemical known as the dopamine which is responsible for continuing a smooth communication between substantia niagra and corpus striatum of the brain. This in turn is responsible for the maintenance of the coordination among different smooth and balanced muscle movement (Weekeramp et al., 2014). When the impairment of neuron takes pace, it results in death of neurons and as a result dopamine gets reduced affecting the nerve functioning. Therefore an individual loses the ability to control his body movements and experiences uncontrolled body movements.

 


Age is one of the most crucial risk factors. Studies suggest that young individuals have very less chances of development of the disease. It usually affects individuals in the late or middle age and the condition gradually worsens as age of the individual progresses. This disease mainly affects individuals at around the age of sixty. Moreover heredity is yet another risk factor that exposes an individual towards the risk of developing the disease. Having a close relative with Parkinson disease automatically increases the chance of an individual being affected by the disorder. Often the sex of an individual possesses a threat to the development of the disease. This is said so because researches have shown men to be more vulnerable towards the development of the disorder than women. Researchers also say that exposure to toxin in any part of the life, increases the risk of developing the disorder in the individual (Fox et al., 2016). Exposure to herbicides and pesticides are thought to increase the risk of the individuals by a slightly higher degree.

Tremor is one of the most important symptoms that can be observed in patient with Parkinson disease. Tremors or shaking mainly develops in limbs, hands or fingers making people vulnerable to fall. The patient also suffered a fall in the case study due to the occurrence of tremors. Besides, slowed movement called bradykinesia accompanies patients with the disorder. It often results in reducing the ability of the patient to move, it also slower the movement of individuals making simple tasks like daily activities difficult. Muscle rigidness also takes place causing stiffness in muscles that not only limits the range of motion but also develops pain in the individual. Other important clinical manifestations include loss of automatic movements along with impaired posture and balance. Although the patient of the case study has not developed but many cases also show changes in speech and writing in individuals who develops this disorder (vanderMarck et al., 2014).

 


In order to conduct full physical assessment of the disorder, the healthcare professional should first a full neurobiological examination and rule out the chances of other conditions before the diagnosis of Parkinson diseases is conducted. Cranial nerves analysis can be done by checking the presence of impaired vertical eye movements, hyposmia, masked face, mumbled or fast speech and others. Motor examination will reveal presence of tremor, bradykinesia, rigidity of muscles, diminished gesturing, micrographia and others. Sensory examination, coordination examination and deep tendon reflexes will also help the healthcare professional also help to develop the idea whether the patient is suffering from the disease or not. Gait and balance are also analysed. Another very important examination that can be done is the testing of the presence of melanoma. Patients with Parkinson are more likely to develop melanoma and therefore healthcare professionals look for the presence of melanoma as a symptom of the presence of Parkinson (Ahlskog, 2014). The patient is also suffering from melanoma and his fall from tremors easily portrays the patient’s advancing stage of Parkinson.

It is usually found that patients with Parkinson disorders develop depression and therefore serotonin selective reuptake inhibitors called SSRI are provided to manage depression. Citalopram is one such example and is given to the patient to manage his depression as he was often getting teary. Kinson is also provided and is mixture of right doses of levodopa and carbidopa.  Levodopa is provided as it results in greater anti-parkinsonian benefit for different sign and symptoms of the motor nerves and has very few adverse effects. Carbidopa is especially helpful in inhibition of the decarboxylation of levodopa to dopamine in the systemic circulation. This causes the greater distribution of levodopa into the central nervous system (Kowal et al., 2013). Madopar is used in Parkinson also as it contains two medicines including levodopa and benserazide. It causes changes of levodopa to dopamine in the brain important for conducting proper muscular movements. Monoamine oxidase (MAO)-B inhibitors and Dopamine agonists (ropinirole, pramipexole) are also used.

 


The nursing diagnosis would contain the proper caring plan for developing the impaired physical mobility of the patient due to the muscle weakness and rigidity that occurs in advanced stage of Parkinson (vanRumumnd et al., 2014). The second nursing diagnosis would be the self care deficit. This has resulted in developing his dependency on his wife Fran. This has mainly occurred due to the development of neuromuscular weakness along with decline in the strength and loss of control over muscle. The third diagnosis would be the severe bruises and tears he had developed in his buttocks and thighs due to the fall which create discomfort and take much time to heal due to his old age.

The first nursing goal would thereby include proper development of physical mobility where the client would be able to perform physical activity according to his mobility. To fulfil the goal, interventions would include assessing the patient’s existing mobility along with the proper analysis of the increased damage. Besides, the nurse should conduct training program, encourage warm bath and massaging the muscle, help the client in Rom activities and also associate with physiotherapists for the best practices. The rationale would be to help the patient develop his muscle strength and can develop his capability in mobility (Marck et al., 2014).

The second nursing goal would be to develop her independence level so that he can conduct his self care activities. The interventions that the nurse should include will be assessing the patient’s capability and rating the decline of his ability is self care activities. This should be marked by scale of 0 to 4 in performing ADLS. The nurse should also avoid anything which cannot be done and also assist the client in case of necessities. The nurse should also teach and support the patients in cases of his different activities. Environmental modifications should be done to decrease the chances of fall. Occupational therapists can be summoned. These would lessen her dependency level on others and would help him to revive from depression as he would become independent and will have better quality of life (Deane et al., 2014).

 


The third goal would be to relieve the patient from his discomfort that he is facing in his buttocks and hips due to tears and bruises for falling down. The interventions would include proper management of wound care along with frequent cleaning and dressing the wounds. Moreover, as he lives a sedentary lifestyle due to his immobility, he might develop pressure sores for which frequent changing of his position should be done every two hours or air filled mattress can be provided. Care should b e also taken to manage his symptoms of depression through proper counselling and empowering him along with appropriate medication (Bloem & Munneke, 2014). This would help in curing his wounds and reducing his discomfort. This would also help him to recover from his depressions as well.

A complete evaluation is required by assessing the development in the mental and physical health of the patients. Neurological tests can be conducted to see the response of the neurons and the activity of the muscles accordingly. His discharge plan would contain the detailed document of the interventions and medication along with the education he requires and the advices provided for health development. Different healthcare professionals like occupational therapists, physical therapists, clinical trial coordinators, nutritionists, spiritual therapists can be consulted by patient and his wife. The nurse should advise the patient for proper planning periods of rest, conservation of energy, planning activities like mini exercises, recreational activities, performing physical activities within range and others (Tan, Williams & Kelly, 2014). Moreover fall prevention strategies should be mentioned by the nurse to prevent further accidents.

For treating patients with Parkinson diseases, the nurse should have detailed knowledge about the causes, risk factors and clinical manifestations associated with it. For making proper intervention, the nurses should make proper goals and should have proper rationale behind it. Moreover, it is extremely necessary for a nurse to provide a person centred approach according to the needs of the patients and develop her interventions accordingly. This will help the nurse to offer a quality life to the patient.

 

References:

Ahlskog, J. E. (2014, July). Parkinson disease treatment in hospitals and nursing facilities: avoiding pitfalls. In Mayo Clinic Proceedings (Vol. 89, No. 7, pp. 997-1003). Elsevier.

Bloem, B. R., & Munneke, M. (2014). Revolutionising management of chronic disease: the ParkinsonNet approach. BMJ, 348, g1838.

Deane, K. H., Flaherty, H., Daley, D. J., Pascoe, R., Penhale, B., Clarke, C. E., ... & Storey, S. (2014). Priority setting partnership to identify the top 10 research priorities for the management of Parkinson's disease. BMJ open, 4(12), e006434.

Fox, S., Cashell, A., Kernohan, W. G., Lynch, M., McGlade, C., O’Brien, T., ... & Timmons, S. (2016). Interviews with Irish healthcare workers from different disciplines about palliative care for people with Parkinson’s disease: a definite role but uncertainty around terminology and timing. BMC palliative care, 15(1), 15.

Kowal, S. L., Dall, T. M., Chakrabarti, R., Storm, M. V., & Jain, A. (2013). The current and projected economic burden of Parkinson's disease in the United States. Movement Disorders, 28(3), 311-318.

Marck, M. A., Bloem, B. R., Borm, G. F., Overeem, S., Munneke, M., & Guttman, M. (2013). Effectiveness of multidisciplinary care for Parkinson's disease: a randomized, controlled trial. Movement Disorders, 28(5), 605-611.

Safarpour, D., Thibault, D. P., DeSanto, C. L., Boyd, C. M., Dorsey, E. R., Racette, B. A., & Willis, A. W. (2015). Nursing home and end-of-life care in Parkinson disease. Neurology, 85(5), 413-419.

Tan, S. B., Williams, A. F., & Kelly, D. (2014). Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: A systematic review. International journal of nursing studies, 51(1), 166-174.

van der Marck, M. A., Klok, M. P. C., Okun, M. S., Giladi, N., Munneke, M., Bloem, B. R., & Force, N. F. T. (2014). Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. Parkinsonism & related disorders, 20(4), 360-369.

van Rumund, A., Weerkamp, N., Tissingh, G., Zuidema, S. U., Koopmans, R. T., Munneke, M., ... & Bloem, B. R. (2014). Perspectives on Parkinson Disease Care in Dutch Nursing Homes. Journal of the American Medical Directors Association, 15(10), 732-737.

Weerkamp, N. J., Tissingh, G., Poels, P. J., Zuidema, S. U., Munneke, M., Koopmans, R. T., & Bloem, B. R. (2014). Parkinson disease in long term care facilities: a review of the literature. Journal of the American Medical Directors Association, 15(2), 90-94.

Worth, P. F. (2013). How to treat Parkinson's disease in 2013. Clinical Medicine, 13(1), 93-96.

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