Nursing process

Assessment
• Assess the patient’s hepatic and biliary function before starting
therapy.
• Monitor the patient’s blood pressure closely. Watch for orthostatic
hypotension.
• Monitor the patient for hallucinations.
• Evaluate the patient’s and family’s knowledge of drug therapy

Key nursing diagnoses

• Impaired physical mobility related to presence of parkinsonism
• Disturbed sensory perception (visual) related to drug-induced
adverse reactions
• Deficient knowledge related to drug therapy

Planning outcome goals

• The patient’s physical mobility will improve.
• The patient will be alert and able to verbalize orientation
adequately.
• The patient and his family will verbalize an understanding of drug
therapy.

Implementation
• Give the drug with immediate or sustained-release
carbidopalevodopa as ordered, with or without food.
• Check to see that the drug is used only with carbidopalevodopa; no
antiparkinsonian effects will occur when the drug is given as
monotherapy.
• Keep in mind that carbidopa-levodopa dosage requirements are
usually lower when given with entacapone; the carbidopalevodopa
dosage should be lowered or the dosing interval should be
increased to avoid adverse effects.
• Keep in mind that the drug may cause or worsen dyskinesia
despite a reduced levodopa dosage.
• Watch the patient for onset of diarrhea, which usually begins 4 to
12 weeks after therapy starts but may begin as early as the first
week or as late as many months.
• Keep in mind that rapid withdrawal or abrupt reduction in the
dosage could lead to signs and symptoms of Parkinson’s disease; it
may also lead to hyperpyrexia and confusion, a symptom complex
resembling neuroleptic malignant syndrome.

Discontinue the drug slowly and monitor the patient closely. Adjust other
dopaminergic treatments.
• Observe for urine discoloration.
• Watch for signs of rhabdomyolysis, which can rarely occur with
drug use.

Evaluation
• Patient exhibits improved physical mobility.
• Patient maintains normal thought processes.
• Patient and his family state an understanding of drug therapy