HLT51612 - Diploma of Nursing Case Study Assessment Answer

Nursing Case Study Assignment

Case Study Assignment

John Magill, 75 years of age, has been admitted to hospital after having a fall at home. John was diagnosed with Parkinson’s disease five years ago. On arrival at the emergency department he was noted to have a generalised tremor and decreased mobility. John is a little confused and complaining of hip and back discomfort. He is very worried about his medications which are due to be taken.

On assessment:

Restless, agitated and at times teary. Xrays reveal no fractures to John’s lower limbs however he has sustained significant generalised bruising especially to his hips and buttocks and a skin tear to his right hip. Nursing staff noted that John started to cough after being given a drink of water.

Introduction

Parkinson’s disease is among the major age-related neurodegenerative infections and is second in frequency of Alzheimer's disease. It affects approximately 1% of persons older than 60 years of age and causes disability that can only be slowed down through treatment (Das et al., 2016). This paper presents a detailed discussion of the disease regarding its causes/risk factors, clinical manifestations and key physical assessments, and medical management. It also examines a holistic nursing care diagnosis, plan, and intervention as well as a discharge plan for the Mr. John, a patient in a case study of the disease.

Risk factors related to the health condition

As much as the cause of Parkinson’s disease remains obscure, there are many factors that are associated with the increase or decrease in the infection. For instance, demographic factors such as gender, racial origin, and age are associated with an increase in the level of infection of the disease. Many epidemiological studies indicate family history as a major risk factor for Parkinson’s disease while estimated the prevalence of positive family history tends to range from 10% to 40% according to Benjamin et al. (2011). While emotional stress, head injury, and premorbid personality also link to Parkinson’s disease in many reports, the associations between the disease and these factors are very controversial as a result of diagnostic accuracy, the time duration between injury and the onset of the disease, and recall bias.

In his study, Haerer (2015) also reports that lifestyle factors such as farming activity, rural living, or even drinking from a well-water source may also act as risk factors for the disease. Also, Chiu (2016) points out that some infectious agents such as HIV, coxackie B, herpes simplex, mumps, measles, croup, rheumatic fever, and diphtheria are as well linked to postinfectious parkinsonism either as a long-term or acute complication. The same study reports that influenza virus exposure in the fetus or childhood can also predispose one to Parkinson’s disease in the adulthood.

Clinical manifestations and key physical assessment

The initial clinical manifestations of the infection include tremor, soft voice, decreased facial expression, sleep disturbances, a subtle decrease in dexterity, decreased the sense of smell, and slowness in thinking. Severe cases indicate behavior disorders and rapid eye movement, loss of the normal atom during sleep, and automatic dysfunction. These tend to be coupled with constipation, seborrheic dermatitis, and a general feeling of lassitude, weakness, and malaise (Tanner & Thelen, 2014).

The onset of motor signs includes postural instability, progressively flexed axial posture, progressive rigidity, bradykinesia, and gait difficulty as was experienced by Mr. John. Concerning the symptoms above, the key physical assessment of Parkinson’s disease does not involve any laboratory tests, routine magnetic resonance, or computed tomography scans. The clinical diagnosis requires the recognition of two or three of the cardinal signs, i.e. rigidity, bradykinesia, and resting tremor (Schlick et al., 216).

Nursing diagnosis

The diagnosis of Parkinson’s disease is not primarily dependent on computed tomographic scans, routine magnetic resonance, or laboratory tests. The process involves the examination and analysis of the physical signs such as automatic dysfunction, normal atom of the body while at rest, voice, facial expression, sleep disturbances, dexterity, sense of smell, and the rate or level of thinking. In other words, the clinical diagnosis of the disease is majorly dependent on the recognition of the resting tremor, rigidity of the body, and bradykinesia of the patient as supported by Haerer (2015).

Medical management, including medications

The goal of managing the disease is to provide control of the symptoms and signs as long as possible while the adverse effects are minimized. The symptomatic drug therapy involves providing good control of motor signs for four to six years as well as the use of levodopa as the goal standard of symptomatic treatment. Monoamine oxidase inhibitors can also be used for initial treatment at the early stages of the disease. Second-line drugs for tremor such as benztropine and trihexyphenidyl can also be used as they are anticholinergic agents (Shi et al., 2016).

The nonmotor symptoms, treatment involves the use of Viagra (sildenafil) for erectile dysfunction, modafinil for the treatment of excessive daytime somnolence, Methylphenidate for fatigue, and polyethylene glycol for constipation management (Tanner & Thelen, 2014). Benjamin et al. (2011) also note that deep brain stimulation can be treated through a surgical procedure that does not interfere with the brain tissues and can be adjusted as the disease advisements or progressions occur. As a result, the use of a bilateral procedure can be done as it results in little or no significant increase in the adverse effects of the patient according to Lindskov et al. (2016).

Holistic nursing care plan and intervention

Patients suffering from the disease such as Mr. John in the case study need proper nursing care to help in the control or management of the disease so as to prevent any adverse effect that may occur with the disease. The diagnosis process needs to identify three major symptoms which are;

• Rigidity- the goal of this diagnosis is to monitor or examine the postural stability of the patient
• Resting tremor- the goal is to examine the general feeling of lassitude, weakness, and malaise
• Bradykinesia- the goal of the intervention is to monitor the flexibility of the body towards movement

Intervention

The success of the above diagnostic procedures in the management of the disease requires different nursing intervention procedures to help in the management of the disease. According to Benjamin et al. (2016), such interventions include;

• Symptomatic therapy for advanced disease

The rationale for the symptomatic therapy is to provide moderate symptomatic benefits while delaying the progression of the disease. It is from this that the disability progression is monitored to understand the long-term motor complications that might occur. It is carried out in the early stages and adverse cases of the disease.

• Neuroprotective therapy

The intervention aims at slowing, blocking, or reversing the progression of the disease thus slows the underlying loss of dopamine neurons in the body.

• Exercise and physical therapy

Exercise will help the muscles stay strong, thus essential for helping the body to keep balance. Such an intervention is good for the heart and can help the patient sleep better with increased bowel movements.

Goals and rational of intervention of Parkinson’s disease

With the fact that it is a multisystem neurogeneric process resulting in both motor and nonmotor symptoms, the intervention process starts with the accurate and comprehensive assessment. The goal of the assessment and intervention plans involve the examination of the tremor, balance, stiffness or rigidity, and imperative slowness in movement. The process however requires a clear communication process with the family of the patient. The intervention process also aims at education of the patients to enable them patient to understand the medication considerations involved. It hence requires realistic expectations towards the possible side effects, mechanism of action, and dosing regimen (Tanner & Thelen, 2014).

Regular aerobic exercise is also necessary to help in the balance of motion, strength, and fitness. Regular monitoring of the patient is also necessary towards their moods and cognitive symptoms, olfactory dysfunctions, and possible sleep disorders. The rational for the various methods of intervention is dependent on the condition of the patient and the period the disease has taken. For instance, exercise contributes to neuro-restoration and neuroplasticity as it increases brain neurotropic factors, stimulates neurogenesis, angiogenesis and synaptic strength, as well as immune response and metabolism. These changes are beneficial in the improvement of the central pain processing as they activate the dopaminergic inhibitory pathways for the pain (Lindskov et al. 2016).

Discharge plan for Mr. John

Focusing on the health, education and qualified nurses referrals, Mr. John requires a continuous monitoring of his condition till he is stable and out of danger. John and his family require proper health education so as to understand how to manage the condition even while out of the hospital. The discharge plan thus involves health education, instructions on how to use the prescribed medication and the general management practices within the home environment.

While using the prescribed drugs, some of the safety measures necessary include avoiding things that may cause Mr. John to trip, good lightening, well-installed handrails in the shower, slip-proof mat in slippery areas, re-organized rooms where things are easy to reach out, etc. Regular exercise is also necessary to promote strong muscle growth and stability of the neurons in the body of the patient. In the case of any complexity, Fran should contact the doctor for assistance or further advice.

Conclusion

The etiology of the main cases of Parkinson’s disease, infections are still unknown with multi-factorial theories postulated about gene-environmental interactions. The incidences and prevalence of the infection increase exponentially with age and tend to be higher in men than in women. Many case studies on Parkinson’s disease cannot be compared as a result of different methods of diagnostic criteria, medical facilities, population age distribution, case ascertainment, and classification standards. It is because risk factors studies are limited by assessment difficulties on its exposure and appropriate control methods.