Parkinson Disease case study #1

1. What is the pathogenesis of Parkinson disease?

Parkinson's disease is a progressive neurodegenerative disorder that primarily affects dopamine-

producing neurons in the substantia nigra of the midbrain. Although Parkinson's disease is not yet fully

understood, genetics and the environment may play a role. Parkinson's disease is characterized by

abnormal protein deposits called Lewy bodies accumulating in the brain cells of individuals suffering

from the disease. Alpha-synuclein, which normally plays a role in regulating dopamine release, is

abnormally present in these Lewy bodies. Dopamine-producing neurons in the brain of individuals with

Parkinson's disease are believed to be affected by Lewy bodies, causing them to gradually die and later

decrease in dopamine levels. As a result of this reduction in dopamine levels, Parkinson's disease

symptoms such as tremors, rigidity, and difficulty moving can occur. A person does not show signs of

Parkinson's disease until they lose 80% of their neurons in the substantia nigra of the midbrain.

2. What is the likely explanation for the progression of Mr. Dufresne’s condition?

Parkinson's disease happens when certain cells in the brain die, which can cause problems with

movement like shaking, stiffness, and slowness. Mr. Dufresne has had Parkinson's for three years, and

his symptoms have been getting worse. One reason for this could be the medicine (Levodopa) he's

taking, which can have side effects like involuntary movements, changes in how well it works, and times

when it stops working between doses. This might be happening to Mr. Dufresne and making his

symptoms worse. Also, Parkinson's disease can cause other problems that aren't related to movement,

like trouble with thinking and digestion, and these can get worse over time and make other symptoms

worse too. It's important for Mr. Dufresne to talk to his doctor about his symptoms and medicines so

they can decide what to do next.

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3. What teaching plan should be developed for Mr. Dufresne's

Educate Mr. Dufresne’s on Parkinson's Disease causes, symptoms, and progression. Management of his

medication that includes the purpose of each med. Dose frequency as well as side effect. Due to loss of

weight and 2 weeks constipation it will be important to teach him to maintain a healthy diet rich in fiber

and stay hydrated. Regular exercise and physical therapy can help maintain mobility and balance, reduce

falls. Refer to a speech therapist to address his difficulty with speech and swallowing. Emotion support

can be something to talk about to because Living with Parkinson's disease can be challenging and

stressful, and it is normal for individuals to experience feelings of anxiety, depression, and frustration.

4. what are the priority nursing intervention for Mr. Dufresne

1. Assess and monitor vital signs as well as change in his condition.

2. Monitor and maintain adequate nutrition and hydration due to excessive weight loss

3. Assess bowel function and work with Mr. Dufresne and find a plan that will promote regular bowel

movements by increasing fiber intake, giving fluids, and if necessary, administering laxatives

4. Medication adherence as prescribe

5. Safety measures to prevent falls

6. Refer Mr. Dufresne to a speech therapist due to swallowing and speech difficulties

5. What are the priority nursing diagnoses based on the assessment data presented for Mr. Dufresne

1. Impaired Swallowing related to PD and decreased dietary intake as evidenced by difficulty with

speech and swallowing and decreased dietary intake.

2. Imbalanced Nutrition: Less Than Body Requirements related to decreased dietary intake and weight

loss as evidenced by a 5 kg weight loss in one month.

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3. Constipation is related to decreased fluid and fiber intake and immobility as evidenced by reports of

being constipated for two weeks.

4. Impaired Verbal Communication related to Parkinson's disease and difficulty with speech as

evidenced by reports of increasing difficulty with speech and swallowing.

5. Risk for Falls related to PD, shuffling gait, and propulsive quality as evidenced by a mild shuffling and

propulsive gait.

Diabetes Mellitus case study #2

1. Describe the factors placing T.A. at an increased risk of infection?

T.A. is susceptible to infection due to several factors. Among them are:

The first Type 2 diabetes mellitus: People with diabetes have weakened immune systems, making them

more susceptible to infections. Furthermore, high blood glucose levels impair wound healing, causing

the body to have a harder time fighting infections.

Second smoking: Smoking damages the respiratory system and increases the risk of respiratory

infections such as pneumonia. Current illness of pneumonia: Pneumonia is an infection of the lungs, and

people with pneumonia are at an increased risk of further infections.

Lastly, elevated blood glucose levels: T.A.'s blood glucose level is high, which can impair immune

function and make him more susceptible to infections.

2. What further assessment do you need to perform?

As a nurse, further assessment that needs to be performed for T.A. includes: 1. Obtain a detailed

medical history, including any recent travel or exposure to sick individuals, and a thorough assessment

of his lung function, including oxygen saturation levels, respiratory rate, and breath sounds. 2. Monitor

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vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, frequently to

detect any changes or deterioration in his condition. 3. Assess T.A.'s blood glucose levels regularly to

monitor for hyperglycemia and to ensure insulin sliding scale doses are appropriate. 4. Assess T.A.'s pain

level regularly, including location, intensity, and duration of the pain, as well as factors that may relieve

or exacerbate the pain. 5. Monitor T.A.'s response to treatment, including antibiotics, insulin, and

oxygen therapy, to ensure that the treatment is effective and to identify any adverse reaction s.

3. what are the nursing priority nursing intervention in caring for T.A.

Administer antibiotics such as levofloxacin to treat pneumonia. 2. monitor T.A. Vital signs, including

blood pressure, heart rate, respiratory rate and oxygen saturation to detect changes or deterioration in

your condition. 3. Administering supplemental oxygen via a nasal cannula to maintain adequate oxygen

saturation. 4. Administer insulin as directed to control blood glucose levels. 5. Monitor T.A. regularly and

adjust insulin dose as needed. 6Encourage and assist with deep breathing exercises and coughing to

facilitate the removal of secretions from the lungs. 7. Pain relief is needed for chest pain and discomfort.

4. T.A. asks why he is taking insulin here in the hospital when he does not take it at home. How

would you respond.

When T.A. When he asks you why he is taking insulin in the hospital when he doesn't take it at home,

you can explain to him that insulin therapy is often used in hospitals to manage blood glucose levels,

especially during times of illness or stress, for diabetics. When you are in the hospital, your blood

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glucose levels may fluctuate more than you do at home, so insulin therapy can be helpful to keep your

blood sugar levels under control.

It is also important for T.A. to be aware that his healthcare provider will closely monitor his blood

glucose levels and adjust his insulin therapy as needed. His treatment plan in the hospital will include

insulin therapy, which can help improve his health and recovery overall.

If he has further questions or concerns about his insulin therapy or his treatment plan, you can

encourage him to discuss them with his healthcare provider, who can provide more specific information

and address any individual concerns he may have.

5. As you assess T.A. you note that he has bilateral paresthesia in his lower legs and a 2.5cm

reddened area of the skin on the top of his right foot indicating the presence of neuropathy.

Outline what you would teach him regarding proper foot care

It's important to provide education to patients with diabetes who have neuropathy to prevent further

complications in regarding to T.A. proper foot care It's important for T.A. Inspect his feet's daily for any

signs of redness, swelling, blisters, or sores. T.A. should wash his feet every day with warm water and

soap, dry his feet, well, especially between the toes. T.A. should wear shoes that fit well, Trim toenails

properly Applying lotion to his feet can prevent dryness and cracking, but avoid applying lotion between

his toes

6. Describe addition teaching you should provide T.A. before discharge

Addition teaching provided to T.A. will be Medication management, diabetic diet, exercises, smoke

cessation, maintain healthy weight and proper foot care as well as regular follow up with his health care

provider to monitor his blood sugar (diabetes) T.A. should understand the sing and symptoms of hyper.

and hypoglycemia.

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Hypertension HTN case study #3

1. What is the nurse’s priority at this health screening

Based on objective data collected above, patient blood pressure is significantly high 182/104 can lead to

a stroke or MI the nurse's priority is to Controle J.G blood pressure it is above the normal limit. Which

has led to an increase in his respiration. The nurse should ensure that J.G.'s blood pressure is accurately

measured, documented and that appropriate interventions are initiated to lower his blood pressure.

2. What additional history information will the nurse want to obtain?

Obtaining a family history about hypertension, heart disease and cardiovascular disease. his lifestyle

than my contribute to HTN (exercises level, stress and how he copes with it) any OTC medication taking

now.

3. What classification of hypertension does J.G. have?

J.G. is classified as stage 2 hypertension with blood pressure at 182/104.

4. What are J.G.’s risk factors for developing hypertension?

The risk factors may include the sedentary lifestyle (truck drive), obesity, unhealth diet (high sodium and

fat) and smoking.

5. What lifestyle modifications are indicated?

Lifestyle changes include exercising regularly, eating a healthy diet, reducing weight, smoking cessation

and managing stress in a positive way.

6. J.G. is prescribed medication to manage his hypertension. What is the common side effects of

many blood pressure medications to advise him about and what instructions should you give

him to manage this side effect?

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A common side effect of many blood pressure medications is orthostatic hypotension, which is a sudden

drop in blood pressure when changing positions, such as standing up from a seated or lying position.

This can cause dizziness, lightheadedness, or even fainting. should advise him to stand slowly from a

seated or lying position, taking his time to allow his body to adjust to the change in position as well as to

stay hydrated.

7. Outline topics to include in a teaching plan for J.G.

Teacher patient about blood pressure and it causes. How to monitor and manage his blood pressure by

medication, lifestyle changes, smoke cessation, diet changes, complications associated with high blood

pressure and follow up with health care provider.

8. J.G. asks you if he “does all this” if he will be able to stop taking the medication for his blood

pressure. How would you respond?

It is important for J.G. to understand that high blood pressure is a long-term condition that requires

ongoing management, including regular medication use and lifestyle changes. The nurse can work with

J.G. to develop a personalized plan that includes both medication and lifestyle changes and to monitor

his progression over time.

Stroke case study #4

1. Why was the first CT scan negative? What implication did this have on B.W.’s care?

B.W. had a stroke and the first test (CT scan) did not show it because it was done too soon. This delayed

the diagnosis of her stroke and the start of treatment. The second CT scan, done later, showed the

stroke. The delay in diagnosis may have made her outcome worse.

2. What is the difference between an ischemic and a hemorrhagic stroke?

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An ischemic stroke is when a blood clot blocks a blood vessel that supplies oxygen and nutrients to the

brain, while a hemorrhagic stroke is when a blood vessel in the brain bursts and bleeds occure in the

cranial cavity.

3. What are the different manifestations of right-sided versus left-sided stroke?

In a left-sided stroke, the right side of the body can be weakened or paralyzed, while in a right-sided

stroke, the left side of the body can be weakened or paralyzed. This is because the left side of the brain

controls the right side of the body, and the right side of the brain controls the left side of the body.

4. Why was the barium swallow study ordered

The barium swallow study was ordered to check if B.W. could swallow properly after her stroke. Stroke

can affect the muscles used for swallowing, which can make it difficult to swallow safely and may cause

food or liquid to enter the airway. By drinking a liquid with barium, doctors can see how she swallows

through X-rays and detect any problems. Depending on the results, they can recommend treatments to

prevent complications like pneumonia caused by inhaling food or liquid.

5. Based on B.W.’s assessment findings, what are the priority nursing diagnoses?

The priority nursing diagnoses for B.W. after the assessment provided above may include impaired

physical mobility due to left-sided hemiparesis, risk for impaired skin integrity due to decreased mobility

and sensation on the left upper and lower extremity, risk for aspiration due to left-sided weakness and

facial droop, impaired verbal communication due to slurred speech, and risk for falls due to decreased

strength and sensation on the left side.

6. Outline a fall risk reduction plan to reduce B.W.’s risk of falling

To reduce the risk of B.W. falling, nurses should take precautions to prevent falls, by assist her with

mobility (working program). Use a bed alarm, chair, alarm, hip protect pants to refer her OT, PT By

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following these steps, they can reduce B.W.'s risk of falling and provide her with safe care while she is in

the hospital.

7. You acknowledge her daughter’s distress and the difficulties that problems with speech can

pose of B.W. and her. Describe nursing interventions to assist B.W. impaired communication

Nurses should work with B.W. and her family to find way for her to communicate can small white board,

picture words ect.., practicing active listening, using simple language, providing extra time for

communication, refer her to a speech therapist. These interventions can help to improve B.W.'s

communication abilities and reduce her frustrations.

Spinal Cord Injury case study #5

1. Based on the assessment data, what are the nursing priorities for M.P.at this time

The nursing priorities for M.P. are managing his impaired physical mobility due to T5 spinal injury,

preventing skin breakdown due to impaired circulation and immobility, promoting regular bowel

movements, preventing urinary tract infections, and providing emotional support to help him cope with

his new condition. Providing information about his new condition, prognose and treatment, the nursing

team should work collaboratively with other healthcare professionals to develop a comprehensive plan

of care that addresses M.P.'s individual needs and goals.

2. What actions do you need to take based on these priorities?

Nurses should work with M.P and the interdisciplinary team OT, PT, rehabilitation team and psychiatrist

to elaborate a comprehensive care plan that will meet M.P.'s needs and recovery. Assist him with his

ADL’s, encourage fiber and fluid intake, check skin integrity and apply skin barrier as needed, monitor his

urine output and ensure good catheter care to prevent infection, provide social support and monitor

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patient Edima elevate his leg. Another is to prevent complications like pressure ulcers, blood clots, and

autonomic dysreflexia by taking measures like turning and repositioning every q2h.

3. What is the rationale for the lower extremity elastic compression stockings and abdominal

binder?

The compression stockings seen in M. P’s physical examination are likely used to prevent DVT by

improving blood flow and reducing the risk of blood clots in his legs. The use of lower extremity elastic

compression stockings and an abdominal binder can help prevent pooling of blood in the lower

extremities and abdomen, which can improve the tone of blood vessels and reduce the risk of blood

clots forming in the veins (DVT) and pulmonary embolism. This is because the compression from the

stockings and abdominal binder helps to support the abdominal muscles and reduces the risk of

abdominal distention, which can lead to breathing difficulties and increase the risk of aspiration. This is

important for patients with spinal cord injury, as abdominal distention can be a complication of

immobility and reduced muscle tone.

4. What are M.P.’s priority nursing diagnoses while in rehabilitation?

1. Impaired physical mobility related to spinal cord injury as evident by M.P.'s complete paralysis of his

lower body and legs.

2. Risk for impaired skin integrity related to immobility Due to M.P.'s paralysis and decreased mobility,

he is at risk for developing pressure injury.

3. Risk for impaired bowel and bladder function related to spinal cord injury M.P.'s spinal cord injury

evident by no bowel movement for the past 2 days and urinary catheter in place

4. Risk for impaired respiratory function related to spinal cord injury evident by abdominal binder was

put in place

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5. Risk for depression related to spinal cord injury as patient stated he is depressed

5. Because of the complexity of M.P.’s care, you are coordinating care among many members of the

healthcare team. Who might be participating in M.P.’s rehabilitation?

- Rehabilitation team, Physiatrist, Physical therapist, Occupational therapist, Psychologist and Social

worker

6. List three potential adverse conditions to continue to monitor M.P for throughout his stay.

1. Deep vein thrombosis (DVT)

2. pressure injury

3. Respiratory complications

7. Rehabilitation care includes initiating a bowel retraining program. Outline the components of a

program for M.P.

Establish a bowel routine, Encourage M.P to exercise, fiber intake, as well as adequate fluid to improve

bowel function. Medications may be necessary, M.P. as stool softeners or laxatives as needed to manage

constipation. Performing digital rectal stimulation or manual evacuation to assist with bowel

movements as needed. Monitoring bowel sounds and signs of fecal impaction or bowel obstruction.

8 List 3 physical rehabilitation goals that M.P. can achieve

1. Increased upper body strength M.P. This can help him become more independent with ADL’s and the

use of transfer board if needed.

2. Improved sitting balance M.P. this can help prevent falls and increase his ability to reaching and grasp.

3. increase the range of motion on the upper body.

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