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Australia is well known as a multicultural society with many diverse cultures being represented. As an Enrolled Nurse, there will be many occasions where it is vital to have an understanding of a co-worker / patient’s culture. Culturally inclusive care begins with an understanding of, and respect for, cultural diversity and can lead to nursing practices / interventions / care that are culturally sensitive and appropriate for a specific patient or co-worker.
You will conduct research; then answer the following questions about migration to Australia; the differing needs in relation to health; the importance of identifying culturally sensitive and appropriate nursing care / practices; and the available resources for the particular culture you have chosen.
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The paper is based on the case study of John Magil, who is a 75 years old man. He had suffered a fall at home and was brought to the hospital. The medical records of John, informs that he is the suffering from Parkinson’s disease. Medical records also inform that he had impaired physical mobility, and suffer generalized tremors. The reason behind decreased mobility and tremors is his disease. Generalized bruising and right hip skin tearing on John’s body is due to the fall he had at home. This paper will discuss the causes and risks associated with Parkinson’s disease, the clinical manifestations, key physical assessment, medication and holistic nursing care plan for the patient suffering with Parkinson’s disease.
Causes and Risks associated with Parkinson’s disease
Parkinson’s disease is a progressive neurodegenerative disease. This disease makes its progress slowly, and it is caused when small clusters of dopaminergic neurons die in the mid brain. The gradual decrease in these neurons results in the decrease of a significant neurotransmitter, which is known as dopamine. This is the chemical, which helps in transmitting the message from the brain to the body parts for the muscle coordination. It is also believed that genetic and environmental factors also affect that condition of the patient. Primary causes of this disease are yet to be identified. The major risk associated with Parkinson’s disease is age. The older the person, the higher is the risk of getting affected by this disease. John is also 75 years old and, and risk of co-morbidities and injuries in his case is high. The family history of the disease also increases the risk factor to some level. Long-term exposure to chemicals, pesticides, and un-clean water also increases the risk of this disease.
Clinical Manifestations and Key Physical Assessment
Parkinson’s disease is considered as a chronic and progressive neurologic disease (Bunting-Perry, 2006). The motor manifestations presented by it are tremors, rigidity, postural instability and bradykinesia (or slowing of movement). Not all the signs are initially seen in all the patients. They may initially complain about one motor weakness (Rodriguez-Oroz et al., 2009). The clinical diagnosis of the disease is made on the basis of neurologic examination and medical history. However, there is no lab test yet found that could correctly diagnose this diseases. Cognitive and Psychiatric manifestations are also seen. Due to the loss of Dopamine the parallel circuits within basal ganglia are also affected. These dysfunctions include dementia, and depression (Mandir, & Vaughan, 2000). The signs of hallucinations, anxiety, apathy, irritability, and delusion have also been reported.
The motor signs in the PD are considered as typically asymmetric, where the most common initial physical assessment is based on the resting tremors. Gradually, patient also starts complaining about bradykinesia, rigidity, and gait difficulty. The first affected arm would not be able to swing completely while walking. Also the foot on the same side may seem to scrap the floor. Over the time, axial posture is changed and the strides become smaller. Some of the non motor functions are also noticed in patients of PD. In the physical assessment it has been noticed that olfactory function substantially reduce by the time other motor signs are visible. Other symptoms are rapid eye movement (REM) and rapid behavior disorder (RBD) (Mandir, & Vaughan, 2000). Some of the other symptoms could be excessive saliva, constipation, forgetfulness, urinary urgency, soft speech and sleep disturbances. It is also noticed that facial expressions are reduced or the person remains in the same position for long time. The patients also find difficulty in holding the utensils and with shaky hands reading a newspaper becomes very difficult.
Medication is the most common therapy for the Parkinson’s disease. The main aim behind medication is to correct the shortage of dopamine. Due to this deficiency, all the symptoms are caused. Medication should be given according to patient’s age, symptoms and response towards specific medicines. Thus, finding the best combination of the drugs become difficult sometimes. Levodopa is considered as the most effective medicine for PD(Goldenberg, 2008, p. 594). It absorbs in the body rapidly, and by the process of decarboxylation, it is converted to dopamine within the presynaptic terminals (Goldenberg, 2008, p. 594). The therapeutic effectiveness of the drug depends on the production of dopamine. This medicine provides dramatic effect on the signs and symptoms of Parkinson’s disease. In the early period of the disease, the improvement in the rigidity, tremors and bradykinesia by this medicine is nearly complete.
Other medication is Carbidopa. This is given in combination with Levodopa. The main purpose of this medication is to reduce the experience of wearing-off at the end of the dose. Thus, Cabidopa reduces the side effects of Levodopa (Lynn, 2012). It also increases the time by which Levodopa remains active in the brain. As per the given case study, patient is also given the combination of these two medications. Other drug given to patient is Citalopram 20mgms daily. It is an antidepressant. This medicine also improves the energy level in the patients. It is also helpful in restoring the balance of serotonin, which is a natural substance.
Holistic Nursing Care Plan
The nursing care plans based on NANDA are very effective. The main aim of the nursing care plan is to improve the health outcomes for the patients.
NANDA Nursing Diagnosis for Parkinson’s disease
Three Nursing Interventions
|For Ineffective airway clearance, patient will be observed for the respiratory status and energy level.||Energy level is very significant for physical mobility and effective respiration.||The major aim of this intervention is to keep the respiratory status normal. Collecting cough evidences are important for saving patient from severe problem and help him to have optimal gas exchange (Skelly, Lindop & Johnson, 2012).|
|Intervention will include monitoring patient for coughing. Mr. John has also started coughing after being given a drink.||Observation of cough and mucus is important as it can provide evidence about some problems like dyspnea, tachypnea, infection, fatigue, aspiration and tracheobronchial obstruction (Tosin et al, 2016).|
|Respiratory status of patient will be accessed to monitor breathing patter.||Collection of the baseline data is important for the patient. It is also important for evaluating REM sleep (Sleep and Parkinson’s Disease, 2011).|
|Second intervention to access and encouraging the physical mobility of the patient. Due to tremors and muscle stiffness patient may lose physical mobility and may become self-care deficit (Skelly, Lindop & Johnson, 2012).||Encouraging Independence will make them feel comfortable and independent. This will in turn improve the quality of life.||The goal behind intervention for monitoring and encouraging physical mobility is to empower patient, increase independence, and to promote confidence (Borrione et al, 2014).|
|Encouraging the use of assistive devices, to help patient in walking and improving motor skills.||With the help of appropriate assistive devices like walkers and canes, patient will have improved physical mobility.|
|Increasing patient’s participation in physical exercise programs, exercise sessions and Treadmill exercise.||Encouraging physical mobility will also increase the patient’s participation in physical exercise programs.|
|Sleeping Pattern can be altered in patients suffering with Parkinson’s disease, thus this intervention will focus on improving sleep. (Sleep and Parkinson’s Disease, 2011).||Sleeping is very important for patient, thus nurses should provide noise free environment with dim lights.||The goal behind diagnosis of the sleeping pattern is to examine if patient is getting enough sleep or not, as sleeplessness can result into Insomnia.|
|In case of Mr. John, he will be helped with the sleep therapies and increasing physical exertion. Improving sleeping routine and reducing depressive symptoms are also important||No caffeine should be given to patient, and should be encouraged for more physical exercise (Sleep and Parkinson’s Disease, 2011). Patients should also avoid naps in day time will help to improve sleeping routine..|
|Mr. John will be provided with comfortable and pleasurable environment.||For creating the favorable environment for sleeping, mild and gentle music can be used.|
Evaluation of Diagnoses
Ineffective Airway Clearance: For evaluating ineffective airway clearance in the case of Mr. John, the color and quality of the mucus will be evaluated. Thick mucus secretion can be associated with more efforts in coughing and can also obstruct the respiration in patient. In the case of Mr. John, the improvement was seen in reduced coughing and stable respiratory rate.
Physical mobility: The purpose evaluating physical mobility in the patient with Parkinsosn’s disease to promote independence and confidence in them. Mr. John was encouraged for exercising sessions, daily routine of walks and taking part in exercising and cognitive sessions (Borrione et al, 2014). The results of all these practices were evaluated. The result of these practices informed about the improvements in patient’s condition. He has started taking small walks independently, and has also showing improvement in cognitive and motor skills..
Sleeping Pattern or Insomnia: This kind of diagnosis is very important, as sleeping pattern opf people changes with age. In old age sleep can be reduced and may also result in Insomnia, which is not good for PD patients. Thus, suitable sleeping environments should be promoted that can help patient to take more and sound sleep. In case of Mr. John, sleeping patter was improved through therapies and other interventions. Physical activities and increased physical mobility also improved sleep.
Discharge Plan for John
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