During the initial assessment of Mr. Thompson, which intervention should the nurse prioritize to help manage his mild resting tremor?

A) Encourage the use of weighted utensils during meals

B) Advise taking frequent naps throughout the day

C) Suggest avoiding all physical activities to prevent fatigue

D) Recommend limiting social interactions to reduce stress

Which intervention should the nurse prioritize to help Mr. Thompson manage his mild resting tremor?

A) Encourage the use of weighted utensils during meals

B) Suggest reducing physical activity to prevent fatigue

C) Recommend a high-protein diet to maintain muscle strength

D) Advise taking frequent naps throughout the day

What is an appropriate nursing intervention to help Mr. Thompson manage occasional fatigue associated with Parkinson's disease?

B) Advise Mr. Thompson to take frequent rest periods throughout the day

A) Encourage Mr. Thompson to engage in high-intensity workouts

B) Advise Mr. Thompson to take frequent rest periods throughout the day

C) Suggest Mr. Thompson increases his daily caffeine intake

D) Recommend Mr. Thompson eliminate all physical activities to conserve energy

What is the primary goal of nursing interventions for a patient with Parkinson's disease?

B) Alleviate symptoms and improve quality of life

C) Prevent disease transmission

What is the primary purpose of balance exercises for Mr. Thompson, who has exhibited mild difficulty with balance?

D) To improve respiratory function

What is the most appropriate initial intervention for Mr. Thompson to address his new symptom of mild difficulty with balance?

B) Recommend Mr. Thompson start a home exercise program focusing on balance

A) Encourage Mr. Thompson to take more frequent rest breaks during the day

B) Recommend Mr. Thompson start a home exercise program focusing on balance

C) Suggest Mr. Thompson increase his medication dosage

D) Advise Mr. Thompson to use a wheelchair to prevent falls

What is the primary reason the nurse suggests Mr. Thompson might benefit from occupational therapy?

B) To address his daily activities and enhance home safety

A) To improve his balance through specialized exercises

B) To address his daily activities and enhance home safety

C) To increase his cardiovascular fitness

D) To manage his medication regimen more effectively

What is the primary reason the nurse suggests Mr. Thompson consider using a cane?

B) To improve cardiovascular health

D) To increase his respiratory capacity

What is the most appropriate nursing intervention to help Mr. Thompson manage orthostatic hypotension?

C) Instruct Mr. Thompson to rise slowly from a seated position.

A) Encourage Mr. Thompson to drink more fluids.

B) Advise Mr. Thompson to stand up quickly to overcome dizziness.

C) Instruct Mr. Thompson to rise slowly from a seated position.

D) Recommend Mr. Thompson avoid using a cane.

When educating a patient with early-stage Parkinson's disease about reducing dizziness when standing up, what is the most appropriate instruction the nurse should give?

C) Rise slowly from a seated position.

A) Stand up quickly to get used to the movement.

B) Use a cane to push yourself up quickly.

C) Rise slowly from a seated position.

D) Avoid sitting down for long periods.

parkinsons disease - Nursing Case Study

Pathophysiology

• Primary mechanism: Parkinson's disease is mainly caused by the degeneration of dopamine-producing neurons in the substantia nigra, a brain region crucial for controlling movement. This dopamine loss leads to the movement difficulties seen in patients.

• Secondary mechanism: The imbalance between dopamine and another neurotransmitter, acetylcholine, in the brain further disrupts motor control, contributing to symptoms like tremors and muscle rigidity.

• Key complication: The lack of dopamine affects not just movement but also other brain functions, which can lead to non-motor symptoms such as mood changes and cognitive impairments.

Patient Profile

Demographics:

65-year-old male, retired teacher

History:

• Key past medical history: Hypertension, mild osteoarthritis

• Current medications: Amlodipine 5 mg daily, Levodopa/Carbidopa 100/25 mg twice daily

• Allergies: None

Current Presentation:

• Chief complaint: Mild tremor in right hand

• Key symptoms: Resting tremor in right hand, slight stiffness in right arm, no significant impact on daily activities

• Vital signs: Blood pressure 130/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During the assessment, Mr. Thompson presents with a mild resting tremor in his right hand, noticeable when his hand is at rest and subsiding with voluntary movement. The tremor is described as rhythmic and consistent but not yet interfering with his daily activities. Upon examination, there is slight rigidity noted in his right arm, particularly noticeable during passive range of motion exercises. Mr. Thompson reports occasional stiffness, which is more pronounced in the mornings but improves as the day progresses with movement and activity. He denies any falls or balance issues, and his gait appears normal for his age.

Mr. Thompson's cognitive function is assessed using the Mini-Mental State Examination (MMSE), and he scores 28 out of 30, indicating normal cognitive function with no evident signs of dementia or significant cognitive decline. He expresses mild concern about his ability to write legibly due to the tremor, though he has not experienced any significant issues with daily tasks or hobbies. No mood disturbances such as depression or anxiety are reported, although he acknowledges feeling slightly frustrated with his symptoms.

The nursing assessment prioritizes monitoring for any progression of his symptoms, educating Mr. Thompson on lifestyle modifications to manage his condition, and reinforcing the importance of medication adherence. The nurse also advises on strategies to manage the tremor, such as using weighted utensils during meals and practicing regular physical activity to maintain mobility. These foundational interventions are aimed at supporting Mr. Thompson's independence and quality of life while addressing his current symptoms and concerns.

Section 2

Response to Interventions:

After implementing the nursing interventions, Mr. Thompson returns for a follow-up appointment three months later. He reports diligently practicing the recommended lifestyle modifications, including using weighted utensils, engaging in regular physical exercise, and adhering to his medication regimen as prescribed. Mr. Thompson notes a slight improvement in managing his tremor, particularly during meals, and expresses satisfaction with his current routine. He continues to write with mild difficulty, but his frustration has been alleviated by using adaptive tools and maintaining an optimistic outlook.

During the follow-up assessment, Mr. Thompson's vital signs remain stable: blood pressure is 128/78 mmHg, heart rate is 72 beats per minute, respiratory rate is 16 breaths per minute, and his temperature is 98.6°F. A repeated examination of his motor symptoms shows no significant progression of the tremor or rigidity; however, Mr. Thompson mentions experiencing occasional fatigue after prolonged activities. The nurse reassures him that this is common in Parkinson's disease and emphasizes the importance of pacing activities and allowing for rest periods throughout the day.

Encouraged by his positive response to interventions, Mr. Thompson is eager to continue his proactive approach to managing his Parkinson's disease. The nurse reinforces the importance of routine follow-up appointments to monitor any changes in symptoms and to adjust his care plan as necessary. Mr. Thompson is provided with additional resources and support groups to connect with others experiencing similar challenges, promoting a sense of community and shared experience. The nurse's ongoing support and education aim to empower Mr. Thompson to maintain his independence and quality of life as he navigates his condition.

Section 3

Three months later, Mr. Thompson returns for another follow-up appointment. He reports maintaining his lifestyle modifications and medication regimen but has noticed a new symptom: mild difficulty with balance, particularly when transitioning from sitting to standing. Despite this, he has not experienced any falls. Mr. Thompson also mentions experiencing more frequent episodes of fatigue, especially in the late afternoon.

During the assessment, Mr. Thompson's vital signs remain stable: blood pressure is 130/80 mmHg, heart rate is 74 beats per minute, respiratory rate is 18 breaths per minute, and his temperature is 98.4°F. Neurological examination confirms the slight increase in postural instability, but motor symptoms such as tremor and rigidity have not significantly progressed. The nurse conducts a timed up-and-go test, which shows a slight increase in time compared to previous visits, suggesting a minor decline in mobility.

Recognizing the early signs of balance issues, the nurse discusses the importance of incorporating balance exercises into Mr. Thompson's routine. She provides simple exercises that can be done at home to improve his stability and recommends consulting with a physical therapist for a tailored exercise program. Additionally, the nurse emphasizes the importance of safety measures at home, such as removing trip hazards and using assistive devices if necessary. Mr. Thompson is advised to maintain regular follow-up appointments to monitor his symptoms closely and is reminded of the support groups available for encouragement and shared experiences.

Section 4

Three months after his last appointment, Mr. Thompson returns for another follow-up. He reports that he has been diligently performing the balance exercises recommended by the nurse and has begun attending sessions with a physical therapist. He feels more confident in his movements but still notices occasional unsteadiness, particularly when fatigued. Despite these efforts, Mr. Thompson has experienced two minor near-falls at home, prompting his visit today. He has implemented some home safety modifications, such as removing loose rugs, as advised.

During the assessment, Mr. Thompson's vital signs remain stable: blood pressure is 128/78 mmHg, heart rate is 72 beats per minute, respiratory rate is 18 breaths per minute, and his temperature is 98.2°F. Notably, the nurse observes a slight worsening in Mr. Thompson's balance through a repeat timed up-and-go test, which takes longer than the previous visit. However, his motor symptoms remain largely unchanged, with no significant increase in tremor or rigidity. Mr. Thompson also reports ongoing episodes of fatigue, particularly in the late afternoon, which the nurse attributes to both his condition and possible side effects of his medication regimen.

In response to these findings, the nurse reinforces the importance of ongoing physical therapy and suggests that Mr. Thompson might benefit from occupational therapy to address his daily activities and further enhance safety. She discusses with him the potential need for assistive devices, such as a cane, to improve his confidence and stability. The nurse also reviews his medication schedule, considering adjustments to better manage his fatigue. Mr. Thompson is encouraged to maintain an active role in his care, with regular follow-ups to monitor his progress and any new symptoms.

Section 5

Two weeks later, Mr. Thompson returns to the clinic for a follow-up appointment, as scheduled by the nurse. During this visit, the nurse conducts a thorough assessment and notes that Mr. Thompson has started using a cane, which he finds helpful in maintaining his balance, especially during periods of fatigue. He reports feeling more secure while walking, which has reduced his anxiety about potential falls. Mr. Thompson shares that he has recently begun occupational therapy sessions, which have been particularly beneficial in teaching him strategies to perform daily tasks more safely and efficiently.

Upon examination, Mr. Thompson's vital signs remain stable: blood pressure is 126/80 mmHg, heart rate is 70 beats per minute, respiratory rate is 18 breaths per minute, and his temperature is 98.0°F. The nurse observes an improvement in his timed up-and-go test, suggesting that the combination of physical and occupational therapy is positively impacting his mobility. However, Mr. Thompson mentions experiencing mild dizziness occasionally when rising from a seated position. The nurse considers this a possible side effect of his current medication and discusses with Mr. Thompson the importance of rising slowly to prevent orthostatic hypotension.

To address the issue of dizziness and fatigue, the nurse collaborates with the healthcare team to review Mr. Thompson's medication regimen. Adjustments are made to the timing of his doses, aiming to minimize these side effects while maintaining optimal control of his motor symptoms. Mr. Thompson is advised to monitor his symptoms closely and report any significant changes. The nurse schedules another follow-up appointment to evaluate the effectiveness of these interventions and ensure Mr. Thompson's continued safety and well-being. This ongoing assessment and tailored care plan exemplify the proactive approach needed to manage early-stage Parkinson's disease effectively.