Parkinson’s Disease 1

Parkinson’s Disease

Healing 200

June 3, 2010
 Parkinson’s Disease 2

Table of Contents

Introduction.......................................................................................... 3
Research............................................................................................. 4
Etiology of Disease......................................................................................4-5

Disease Diagnosis/Prognosis......................................................................... 6

Effects of Disease on well being....................................................................7

Signs and Symptoms.......................................................................................8

Treatment of disease........................................................................................9

Practical Nurse’s Role.....................................................................................10

Nursing Process.......................................................10-12

Care Plan...............................................................................13-14
Conclusion............................................................................................15
References............................................................................................16
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Introduction:

Parkinson’s disease, or PD, “is one of the most common neurological disorders, affecting 1

percent of adults over the age of sixty-five.” (Grimes, 2004, p.2). Although there is no direct

cause of this disease, there are secondary factors which attribute to this chronic progressive

condition. Despite how debilitating this disease can impact a person’s life, “In truth, this disease

is one that you can live with, surrender to, or fight with everything you’ve got.” (Tagliati, Guten

& Horne, 2007, p.11). It is imperative that as caregivers, one must truly comprehend the

specifics of this disease, such that, they will be able to provide safe and effective care.

Throughout this research paper, there will be an in depth analysis of this illness; also included is

a sample care plan that is focused towards the management of this debilitating disease.
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Research

Etiology of Parkinson’s Disease

Parkinson’s disease is a neurological disorder where it affects the client’s movement, such that, it

“results in an eventual loss of coordination and control over involuntary motor movement.”

(Linton, 2007, p.446). Because Parkinson’s disease is considered idiopathic, which means

“arising spontaneously from an unknown cause.” (Tagliati et al., 2007, p.10), there is no clear

and concise factor that directly causes this disease. Although there is no primary cause in PD,

(Tagliati et al., 2007) research found the following:

Dopamine (a neurotransmitter in the brain) relays signals from the substantia nigra to

those regions (putamen, caudate and globus pallidus-collectively named the basal ganglia

-in the striatum) that control movement, balance, and coordination. In the brain of people

of People With Parkinson’s (PWP), cells that produce this essential substance die earlier

than normal. (p.10)

Despite the fact that Parkinson’s disease is quite common in older adults 65 years of age or older,

there are other types of this disease that affect the younger age groups. (Grimes, 2004, p.2) stated

that “5 to 10 percent of people with Parkinson’s develop symptoms before the age of forty; this

is called young-onset Parkinson’s.” The only difference between the older onset and the young-

onset is that the signs and symptoms are more gradual, motor and memory characteristics appear

earlier due to medications. Although “several neurological conditions may appear to be

idiopathic (without known cause) PD at first, but they eventually trace back to known causes,
 Parkinson’s Disease 5

progress differently, and respond differently to therapy.” (Tagliati et al., 2007, p.12). It is vital to

understand that there are other diseases that look like PD, such as essential tremor, Parkinson’s-

plus syndromes, secondary parkinsonism, pseudoparkinsonism and drug/toxin induced

parkinsonism; therefore, it is mandatory that a client undergoes diagnostic tests in order to rule

out these similar diseases, as Parkinson’s disease can not be determined with diagnostic

procedures.
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Disease Diagnosis/Prognosis

According to (Weiner, Shulman and Lang, 2007, p.102), “Unfortunately, there is no diagnostic

test that can confirm Parkinson’s disease.” Despite this, physicians have alternative techniques in

which can find if a client shows the signs and symptoms of this degenerative disease. A

neurologic examination can be performed, wherein the “neurologist observes aspects of the

patient’s movement, coordination, and balance.” (Weiner et al., 2007, p.102). Positron Emission

Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) scans are

other diagnostic tests used to “assess the dopamine system in the brain.” (Weiner et al., 2007,

p.103). Unfortunately, these kinds of diagnostic procedures are not easily accessible for a Person

With Parkinson’s (PWP), because they are used in research, and are not readily available to the

public. Although these diagnostics have a chance of determining this illness,

(Weiner et al., 2007) stated:

The results of diagnostic test, then are more likely either to point to a diagnosis other than

Parkinson’s disease or to be inconclusive- they do not show any abnormal results that can

be identified as due to a specific process. (p.103)

The prognosis of this disease is quite unfortunate as it is considered a chronic and degenerative

disease where the only treatment is managing this debilitating illness. Although the outcome of

this disease is terrifying, is must not hinder them in their daily lives. The following topic will

discuss the effects of holistic well being of the client who is persevering through this ordeal
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Effects of disease on holistic wellbeing

As nurses, it is vital that we look at our client holistically, and not just focus on the diagnosis

itself. For a client with Parkinson’s, each dimension of (SPICES) is affected differently in each

person. Therefore, it is important the health care providers be very cognizant when caring for a

client entirely, as every client has different needs. Parkinson ’s disease affects a client socially,

wherein they can’t involve themselves in activities that were once possible prior to this disease,

as they are ashamed of how they will be viewed by their friends and family. As such, it may lead

them to social isolation due to their physical appearance. This disease will affect a client

physically as this disease is a movement disorder. Therefore, a PWP will find it difficult to

perform the simplest of movements, such as walking, because there is a lack of dopamine, which

is a neurotransmitter in the brain which is necessary for motor function. When it comes to their

intellect and cognition, “about 45 percent of those with Parkinson’s will have some impairment

of their cognitive function.” (Grimes, 2004, p.36). Because this is a substantial amount,

caregivers must be all the more cognizant when caring for a client that is affected mentally and

physically. Emotionally, a client diagnosed with this illness will feel depressed, which could lead

to an emotional downfall as they might not be able to cope with this illness. This disease can

affect them spiritually in a sense that they will be hindered from their religious practices due to

their physical disability. Although this disease has an immense impact on a client’s holistic

wellbeing, it is important that nurses are completely involved in the client’s needs so that they

will be able to manage this illness, while being able to lead their lives to its fullest extent.
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Signs and Symptoms

The primary symptoms of PD are indicated by these four symptoms, as stated by

(Tagliati et al., 2007):

Tremor at rest (trembling in the hands, arms, feet, legs, or face when that body part isn’t

engaged in activity), Rigidity (stiffness in the limbs and trunk), Akinesia or bradykinesia

(lack of movement or slowness of movement). (p.14)

In addition to those primary symptoms, (Eliopoulos, 2010, p.326) states that “Secondary

symptoms include depression, sleep disturbances, dementia, forced eyelid closure, drooling,

dysphagia, constipation, shortness of breath, urinary hesitancy, urgency, and reduced interest in

sex.” Other signs and symptoms of PD include: cognitive impairment which “45 percent of those

with Parkinson’s will have some impairment of their cognitive function.” (Grimes, 2004, p.36).

Emotional problems, mainly depression also arise due to the client being unable to cope with

their illness. Fatigue is a “common symptom in Parkinson’s.” (Grimes, 2004, p.36); sleep

problems, internal tremor, shoulder pain due to lack of arm swing and shoulder movement, foot

pain, falls, scoliosis, edema in the lower extremities, digestive problems, drooling, dry mouth

(Xerostomia), dysphagia and changes in handwriting are just some of the many symptoms that

can manifest from this debilitating disease. Despite this progressive disease, there are treatments

available to PWP to help them manage these taxing symptoms.

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Treatment of disease:

Unfortunately, there is no cure for this chronic, progressive disease, but there are some

medications that can temporarily halt the symptoms of Parkinson's’ Disease. First are Levodopas

which “produce more dopamine, the neurotransmitter that PD reduces.” (Tagliati et al., 2007,

p.116). Dopamine agonists such as Bromocriptine “imitate the characteristics of dopamine. “

(Tagliati et al., 2007, p.118). Monoamine oxidase inhibitors (MAOI) are a class of drugs

“interact with monoamines...that transmit messages between nerve cells.” (Tagliati et al., 2007,

p.118). Anticholinergics are used in PWP because there is an offset between dopamine and

acetylcholine. Anticholinergics are used to “block the action of acetylcholine, and this improves

the balance between acetylcholine and dopamine.” (Grimes, 2004, p.167). Besides medicinal

treatments, there are also surgical procedures that can drastically improve a person’s life,

although “it does not affect the natural progression of the disease.” (Grimes, 2004, p.171). There

is a procedure known as Deep Brain Stimulation (DBS) where a trained surgeon implants a

“neurotransmitter (a battery-operated device similar to a pacemaker) to send electrical

stimulation to those areas of the brain that control movement.” (Tagliati et al., 2007 p.129).

Another surgical procedure involves lesioning procedures, which destroy a part of the brain “to

diminish the excessive activity that is causing the unwanted symptoms.” (Grimes 2004, p.172).

The two kinds of lesioning procedures are Pallidotomy and Thalamotomy, where the globus

pallidus and the thalamus are lesioned, respectively. Lastly, CAM (Complementary and

Alternative Medicines), diet, and exercise therapies can also be used in conjunction with

traditional medicinal treatments to augment the signs and symptoms of PD.

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Practical Nurse’s Role

It is important to realize as a nurse, that this job requires one to be conscious of their actions as

any mistake can result in death or serious injury to the client, which will lead to severe

ramifications towards the caregiver. As an LPN, they are bound to rules and regulations that

encompass their occupation. It is stated that “Both Standards of Practice and Code of Ethics are

essential for all self-regulating professions, to reflect the values and beliefs of the profession and

clarify what the profession expects of its members.” (College of Licensed Practical Nurses of

British Columbia [CLPNBC], 2005, p.2). In addition to the two documents listed above, the

Baseline Competencies “reflect the minimum standards required to ensure nurses provide the

public with safe, competent, and ethical care.” (CLPNBC baseline competencies, 2009, p.3).

Nursing Process

Assessment:

For a client with Parkinson’s disease, it is important to perform a thorough head to toe

assessment, so that the nurse will be able to provide effective care without any consequences. As

a nurse, the first step in my assessment would be to perform a thorough head to toe assessment to

see if there are any physiological changes that have deviated from the previous assessments. If

there are any changes, I must make note of them, as they could possibly worsen the client’s

condition if left unattended. For the client with Parkinson’s, I need to assess their motor strength,

as it is the area affected by this disease. Next, I need to check their cognitive function to see if

the disease has progressed. This assessment is vital, because it is stated in my research that 45

percent of clients with Parkinson’s are likely to have some cognitive impairment. I would have to
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assess these clients during the start of my shift, before and after any procedure and prior to

finishing the shift.

Planning:

As I have stated in this research that this disease is both chronic and progressive, it is highly

unlikely that this patient with Parkinson’s is going to recover fully. Despite that, I plan on

improving this client’s health, so that they may be able to manage this debilitating illness. It is

important this I have a plan prior to carrying out my interventions, so that I may be able to

anticipate any changes while carrying out the interventions.

Implementation:

For a client with Parkinson’s disease, their motor functions are the epicentre of this disease. As

such, I will need to assure that their environment is free of any obstacles, to prevent them from

falling, which could lead to further complications. Because they are prone to tripping due to their

gait imbalance, I may need to provide some device that will keep them ambulatory, such as a

walker, or a cane. Because of their symptoms, I will need to assist them with ROM exercises if

they are not capable, to prevent atrophy of the muscles. I will also assist them in eating as they

could suffer from tremors, which prevents them from keeping their hand stable, thus spilling the

contents from the eating utensils. I may need to assist them with their ADLs if they can’t perform

them, because this disease will continue to progress, thus hindering them from doing this

activities with full capacity. I will also need to administer medications as ordered from the

physician to temporarily control their symptoms. I should also educate them on this disease;

client teaching is a huge part in caring for our clients, therefore, it is imperative that the client be

educated on their diagnosis, so that they will be prepared in living with this condition as they are

discharged from the hospital.

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Evaluation:

It is important to evaluate, to determine whether or not your interventions are improving the

client's condition. If it is not aiding the client, then changes must be made to the care plan

immediately, so that, the client’s condition will not continue to worsen. It is important to check

the effectiveness of you interventions on a daily basis, so that the caregiver may be able to

determine a more appropriate intervention, if the current actions are not working. I need to

evaluate their motor function to see if they are capable of ambulating themselves; if they are not

able to move, despite the interventions that were carried, then I must revise the care plan in a

manner that will help them with motor functions. For all the other interventions, I must act

accordingly to each one if they are not effective in helping the clients conditions improve.
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Care Plan

Nurse: Eduardo Gamboa

Clients Name: J.D
Date: Jun 3, 2010
Age: 74

Assessment: Client states, “I tend to trip a lot due to my legs feeling stiff”
Diagnosis: Risk of falls due to muscle rigidity as manifested by Parkinson’s disease

Focus Area Planning (Goal) Implementation Evaluation

(Problem)
Educate client on Client is educated on
Muscle rigidity as Client’s muscle medications and its medications and its
manifested by rigidity to improve side effects to prevent side effects
Parkinson’s disease gradually ADR’s (Adverse Drug
Reaction)

Assist client with Client is actively

range of motion involved with ROM
(ROM) exercises to exercises
prevent atrophy of
muscles

Administer Client is following

medications as prescribed medication
prescribed by regimen
physician in order to
control S/S of disease

Refer client to Client is making

Physical Therapist regular visits of PT
(PT) in order to
improve clients gait
and balance

Provide ambulatory Client is maintaining

devices to prevent balance with
further falls ambulatory devices
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Encourage Client is actively

communication from involved in discussing
client in regards to their coping
coping mechanisms so mechanisms in
that they will be able regards to disease
to
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Conclusion

As mentioned throughout this paper, Parkinson’s disease is considered as idiopathic PD, where

there is no direct factor that contributes to this progressive illness. Despite the fact that this

illness is irreversible, there are treatments available in order to help the client live with this

debilitating disease. As with any disease, the clients’ wellbeing will be affected; it is important as

nurses that we care for our patient’s holistically, and not just focus on the disease itself, so that

the client will be able to recover more effectively. As a caregiver, it is important that we follow

the rules and regulations set by our governing body, so that we do not place ourselves and our

profession in jeopardy. When caring for our clients, we should follow the nursing process in

regards to the client’s condition. It is important to act accordingly if the nursing process is not

working in helping the client’s condition improve. In conclusion, as nurses, it is essential to be

dynamic in this profession in order for us to provide effective care for our clients.
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Works Cited

College of Licensed Practical Nurses of British Columbia. (2009). Baseline competences for

Licensed Practical Nurses’ Professional Practice

British Columbia, Canada

College of Licensed Practical Nurses of British Columbia. (2004). Code of Ethics for LPNs:

Companion Guide

British Columbia, Canada

College of Licensed Practical Nurses of British Columbia. (2005). Standards of Practice and

Entry-level competencies: Companion Guide

British Columbia, Canada

Eliopoulos, C. (2010). Gerontological Nursing (7th ed.)

Philadelphia, Pennsylvania: Lippincott Williams & Wilkins

Grimes, D.A. (2004). Parkinson’s: Stepping Forward

Ontario, Canada: Key Porter Books Limited

Linton, A.D. (2007). Introduction to medical-surgical nursing. (4th ed.)

St. Louis, Missouri: Saunders Elsevier

Tagliati, M., & Gluten, G.N., & Horne, J. (2007). Parkinsons disease for dummies

Indianapolis, Indiana: Wiley Publishing

Weiner, W.J., & Shulman, L.M., & Lang, A.E. (2007). Parkinsons disease (2nd ed.)

Baltimore, Maryland: The Johns Hopkins University Press