Question

CASE STUDY FOR GROWTH AND DEVELOPMENT CLASS

Topic: PARKINSON’S DISEASE

Miss Rose is a 74 year old female, who is a retired widow and lives with her son for the past five years. Both enjoy planting seedlings and own a community agriculture store. She does not suffer with hypertension or diabetes and has an active lifestyle. She is also not known to have any psychiatric illnesses. Over the past six months Miss Rose’s son and herself noticed physical changes and decided to visit her General Practitioner. At her visit she mentioned to the doctor that she was having difficulty rising up from a sitting position after grooming her plants or turning from one table to another when she has customers. Documentation on her clinic file noted that she previously complained of difficulty walking and falling when coming out of bed. She was sent for an X-ray but there were no clinical findings. The physician asked her to describe what happened when she fell. Miss Rose verbalized that when she got up from bed and starting walking she started moving forward and backward then stooped forward with small fast steps and then she fell. Her son mentioned to the doctor that he has noticed that when she is pruning her plants she has abnormal rhythmic movement of the upper and lower limbs. She occasionally has a slight limp and her handwriting has become smaller over the past months. This has stopped her from doing her daily yoga exercises and she has been very disturbed about it. Miss Rose then further explained that the movement started on the distal part of both upper limbs at the same time. She also expressed that during rest she noticed the movement in her limbs and as she started her tasks the movements became more aggravated. Urinary incontinence is also a problem for Miss Rose and she is having difficulty in her swift movements to her bathroom. The patient was later diagnosed with Parkinson’s disease. After the assessment and interview of Miss Rose the Physician documented the following: Physical Assessment Vital Signs: BP- 130/74 mmHg Temperature - 36.7 C, Pulse- 78 bpm regular and bounding Respiration- 20 bpm Height- 5ft 7 in Weight- 70 kg Facial expression- Masklike Gait- Shuffling gait with tendency to fall forward and backward CNS Examination Alert and oriented to time, person and place Level of consciousness GCS- 15/15 Sleeping patterns- normal Swallowing gag reflex- normal Cogwheel rigidity present Tremor present Bradykinesia present Dysphonia present

Instructions: Create a nursing care plan including the nursing management of the patient and three actual and two (2) potential problems.

Answer 1

Parkinsonism is a progressive neurologic disorder leading to movement problems and finally disability.

Nursing care plan:-Since she is unable to walk properly, so the main nursing intervention will be regarding her movement.

Nursing interventions:-a) The nurse can help her to initiate to move and teach her easy ways to move properly to prevent her from any future disability.

b) Teach the patient to walk erect. Balance is mainly adversely affected. To prevent this, teaching to walk erect is necessary.

c) Instruct patient to do some works regularly such as swimming, walking. This helps to prevent body from muscle contracture.

d) Provide warm baths to the patient.

Three actual problems are:-The patient usually gets depressed, face more difficulty in walking, have memory difficulties.

Potential problems:-may fall off if not taken care, difficulty in controlling or starting urination.