Question

A 40 year old complains of slow gait and a hand tremor of a few months duration. HPI. His wife also describes postural instability, drooling of saliva and generalized rigidity. PE. "Mask-like facies; mild involuntary pill-rolling tremor at rest; gait-shortstepped and shuffling. Deep tendon reflex is normal. Plantar responses bilaterally flexed. On gross pathology, there is absence pigment in the substantia nigra. Micro pathology shows presence of Lewy bodies with decreased neurons in the substantia nigra )

Please provide long term care plan for this patient by explaining the rationale behind your protocol

Answer 1

Long term care plan for substantia nigra pigment absence patient:

Assess neurological status.

Provide high-calorie, high-protien, high-fiber soft diet with small, frequent feedings.

Increase fluid intake to 2000 mL/day.

Promote physical therapy and rehabilitation.

Administer anticholinergic medications as prescribed to treat tremors and rigidity and to inhibit the action of acetylcholine.

Promote independence along with safety measures.

Avoid rushing the client with activities.

Assist with ambulation and provide assistive devices.

Encourage the client to lift feet when walking and avoid prolonged sitting.

Provide a firm mattress, and position the client prone, without a pillow, to facilitate proper posture.

Instruct in proper posture by teaching the client to hold the hands behind the back to keep the spine and neck erect.