NORTHEASTERN COLLEGE

COLLEGE OF NURSING
Villasis, Santiago City

PARKINSON’S DISEASE

A CASE STUDY

SUBMITTED BY:

BSN 3B – GROUP 2

Asingal, Kristine
Austriaco, Julyanne
Blanza, Arlene
Capinig, Jayvee
De Guzman, Jingkie
Dingle, Justine
Garzota, Princess Jhoanna
Gupuchon, Disiryl
Mabbayad, John Claro
Sarmiento, Johana Vie

MS. SHEINEL VICENTE, PHRN, SGRN.

Clinical Instructor
DECEMBER 11, 2023
OBJECTIVES

GENERAL OBJECTIVES

- This study aims to define Parkinson’s Disease (PD), Recognise the

motor symptoms, List the pharmacological and non pharmacological
strategies utilized in the treatment of PD, and evaluate the prognostic
value of the non-motor symptoms of this disease.

SPECIFIC OBJECTIVES

- To appreciates some diseases that are common in

provinces/hospital

- To educate patients about the diseases for them to be aware and

learn how to prevent and manage the disease.

- To provide necessary actions suitable to the patient’s problem.

- To have an opportunity to learn and apply our knowledge, skills,

and attitudes in giving services to different individuals with their
different diseases as well as to acquire more learning from such
diseases.

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Parkinson disease (PD) is a chronic, progressive, neurological disorder that results
from the loss of the neurotransmitter dopamine in a group of brain structures that
control movements. Its major manifestations are variable but can include hand
tremor, slowness of movements, limb stiffness, and difficulties with gait and balance.

When PD occurs, degenerative changes are found in an area of the brain known
as the substantia nigra, which produces dopamine, a chemical substance that
enables people to move normally and smoothly.

STAGES OF PARKINSON DISEASE

Stage 1: Initial Stage
Stage 2: Mild Stage
Stage 3: Moderate Disease
Stage 4: Severe Disability
- Unilateral limb movement, minimal
weakness, hand and arm trembling
- Bilateral limb involvement, mask-like
face, slow shuffling gait
- Postural instability, increased gait
disturbance
- Akinesia, Rigidity

Stage 5: Complete ADL

Dependance

Symptoms

Symptoms of Parkinson disease get worse over time. They can greatly reduce well-
being and quality of life.

CARDINAL FEATURES: OTHER FEATURES:

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- Tremors Craniofacial:

- Rigidity - Dysphagia, Hypophonia, Hypomimia

- Bradykinesia Visual:

- Postural Instability - Blurred Vision, Eyelid opening Apraxia

Gait:

- Shuffling, Freezing, Short hesitant

steps, Difficulty stopping quickly

Non-motor symptoms:

 Cognitive impairment
 Mental health disorders
 Dementia
 sleep disorders
 pain
 sensory disturbances.

Autonomic dysfunction:

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  Orthostatic hypotension
 Excessive perspiration
 Oily skin
 Flushing
 Changes in skin texture
 Eyelid spasm

Involuntary movements (dyskinesias) and painful muscle contractions (dystonias)

can cause problems speaking and moving. These symptoms lead to high rates of
disability and the need for care. Many people with PD also develop dementia during
the course of their disease.

RISK FACTORS:

 Age- biggest risk factor is advancing age, the average of onset is 60.

 Gender- Men are more likely to develop PD than women.

 Genetics- individuals with a parent or sibling who is affected have two times
the change to develop this disease.

 Environmental causes: exposure to farming chemicals like pesticides and

herbicides.

 Head trauma- a traumatic brain injury can damage neural tissue and induce
the release of cellular breakdown products from damaged cells in the
surrounding area.

COMPLICATIONS:

 Thinking difficulties- patient’s with PD may experience cognitive problem,

such as dementia and thinking difficulties. This occur in the later stages.
 Depression and emotional changes - this occur in early stages. Receiving
treatment for this can make it easier to handle the other symptoms.
 Swallowing problems- may develop difficulties in swallowing as the condition
progresses.
 Chewing and Eating problems- late stage of PD affects the muscles in the
mouth, making chewing difficult. This can lead to choking and precautions.
 Sleep problems- often experience sleep problems including waking up
frequently through the night and waking up early or falling asleep during the
day.
 Bladder and Elimination problem- patient’s with PD often experience bladder
and elimination problems, including being unable to control urine or having
difficulty in urinating and constipation due to a slower digestive tract.
 Smell Dysfunction- may experience problems with sense of smell, trouble
identifying certain odors or difference between odors.
 Fatigue- often lose energy and experience fatigue, the cause is unknown.
 Pain - some people with PD experience pain, either in specific areas o their
bodies or throughout their bodies.
 Sexual dysfunction- decrease in sexual desire or performance.

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DIAGNOSTICS:

 Imaging tests- such as an MRI, ultrasound of the brain and PET scans — also
may be used to help rule out other disorders. Imaging tests aren't particularly
helpful for diagnosing Parkinson's disease.
 Single-photon emission computerized tomography (SPECT) scan, this is
called dopamine transporter (DAT) scan. This can help the suspicion of
Parkinson disease, it is the neurological exam and symptoms that determine
the correct diagnosis. Most people do not require a DAT scan.
 Blood tests (CBC)- to rule out other conditions that causing some of the
symptoms

TREATMENT:

There is no cure for Parkinson disease, but therapies including medicines,

surgery and rehabilitation can reduce symptoms.

MEDICAL MANAGEMENT:

Drug Therapy

 Dopamine Agonists- mimic dopamine by stimulating dopamine receptors in

the brain. Typically effective during the first 3 to 5 years of use.

 Catechol O-methyltransferases (COMTs)- are enzymes that inactive

dopamine.

 Monoamine oxidase type B (MAO-B) inhibitor (MAOIs)- are the most popular
for use in patient with early or mild symptoms of PD

 Anticholinergic- these medicines were used for many years to help control the
tremor associated with Parkinson's disease.

 Amantadine- is antiviral drug that has anti-Parkinson benefits, it may be given

to reduce symptoms especially dyskinesias.

Rehabilitation including physiotherapy

 Strength training
 Gait and balance training
 Hydrotherapy.

SURGICAL MANAGEMENT:

 Stereotactic Pallidotomy- opening into the pallidum within the corpus striatum,
this is effective in controlling the symptoms associated with PD.
 Thalamotomy- alternative of stereotactic pallidotomy, this procedure is
opening into the thalamus of the brain for stimulation — this is for treatment of

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 tremor through thermocoagulation (high frequency currents to destroy the
tissue) of brain cells.
 Deep Brain Stimulation- electrodes are implanted into the brain connected to
small electrical device called a pulse generator that delivers electrical current.
 Fetal Tissue Transplantation- is an experimental and highly controversial
ethical and political treatment.

Many medications and surgical resources are not accessible, available or affordable
everywhere, particularly low- and middle-income countries.

PREVENTION:
 Physical activity (aerobic activity, strength training, balance training, functional
activities)
 Eating healthy and balanced diet

NURSING MANAGEMENT:

 Allow the patient extra time to respond to questions.

 Administer medications promptly on schedule to maintain continuous
therapeutic drug levels
 Provide medication for pain, tingling in limbs, as needed and as prescribed by
the physician.
 Monitor for the side effects of medications, especially orthostatic hypotension,
hallucinations, and acute confusional state
 Implement interventions to prevent complications of immobility, such as
constipation, pressure ulcers, and contractures.
 Allow the patient time to perform ADLs and mobility skill.
 Teach the patient to speak slowly and clearly. Use alternative communication
methods, such as communication board.
 Monitor the patient’s ability to eat and swallow, and actual food and fluid
intake.
 Provide high protein , high calorie foods to maintain weight. Recognize that
Parkinson’s disease affects body image, focus on patient’s strengths.
 Assess for anxiety and depression.
 Assess for sleeplessness.

STATISTICS:

Parkinson’s disease develops most often in people in their 60’s, although it can
strike much younger people as well. It occurs worldwide, about 1% of people older
than 50 of age have Parkinson’s disease.

References:

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Workman, et al.,Medical-Surgical Nursing, Patient-Centered Collaborative Care, 8 th
edition, P985-987.
Hawks, et al., Medical-Surgical Nursing, Clinical Management for Positive
Outcomes, 8th edition

COURSE IN THE WARD

DATE AND DOCTOR’S ORDER INTERPRETATION
TIME
12/01/23 -TO ER-NOD/ROD
5:00 PM
-Secure consent Securing consent in a patient is a must, this is
essential to patient's autonomy.
TPR every shift and Vital signs monitoring will help to indicate any further
record complications. This also may use as baseline data in
patient’s health progression.
Low salt and low fat This diet will help to manage medical conditions
diet related to patient’s illness.
5:14 PM IVF: D5NM 1L X 10 Indicated for parenteral maintenance of routine daily
HRS fluid and electrolytes requirements with minimal
carbohydrates calories from dextrose.
5:30 PM REQUEST:

- CBC - This tests is usually done to rule out patient’s illness,

this is helpful to know other complications related to
admitting diagnosis.
- RBS
- This is to check if the patient’s blood sugar if
elevated or within normal range

- SERUM Na - Serum Na is essential for checking electrolytes

imbalances that may cause further complications,
and to know suitable intervention.

- Potassium - Potassium is essential for checking electrolytes

imbalances that may cause further complications,
and to know suitable intervention.

- Magnesium - Aside from hospital standard procedure, patient is

experiencing weakness as chief complaint and
twitching, this may indicate a low magnesium.

- One of the patient’s chief complaint is slurred

- ECG
speech, this can show if there’s an irregular
heartbeat that may have cause another complication
such as stroke.

- Aside from hospital standard procedure, chest

- Chest X-Ray radiograph produces images of heart, lungs, airways

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 and bones of chest and spine. This is helpful to detect
another illness that may cause further complications.

- NIH guidelines recommend that RAT be used as an

- RAT initial diagnostic tool of SARS-CoV-2 before
admission.

- LIPID PROFILE - This is to measure 4 different cholesterol

measurements and a measurement of triglycerides.
This will also help to plan suitable interventions
depending on the result.

- BUN - This test is use to check whether the urea nitrogen

levels are higher than normal, this indicates if the
kidneys may not be working properly.

- CREATININE - This test is done to measure the level of creatinine

in the blood, this is use to check if the kidneys are
properly working.
- BUA - This measures the amount of uric acid in a sample
of the blood or urine (pee), to check if the patient is
at risk of gout.
- SGPT
- Typically used to detect any kind of disease or injury
to the kidney or liver, or possible metastasis in the
liver.

10:45 PM D5050, 50cc IV NOW Patient’s RBS result is low 116.23 mg/dL, this is used
to correct the blood sugar to avoid severe
BP- hypoglycemia resulting for another complications
130/80mmHg
Start Urinorm 80mg /1 The patient’s BUA result is (8.16) which is high, so the
tab OD physician ordered urinorm to treat and prevent gout
Refer for ECG NOW
12/02/23
MEDS:
10:24 AM Cerebrolysin 10mg + Patient is suspected of having stroke, because of
10 ml slow IV q8 slurred speech as chief complaint.
Cholinerv 1gm IV q12 This medication is indicated for patient with PD.
Vessel due F, 1 amp Patient’s LDL result is (133.04 mg/dL), this is higher
q12 than the normal range, this medication is capable to
normalize altered blood viscosity and lower the levels
of cholesterol.
ORAL:
Akidin 2mg 1/2 tab, TID Patient’s experiencing involuntary movement and
hand tremors as chief complaint, this medication
indicated to patient with Parkinson’s disease (anti-
Parkinson), by improving muscle control and

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 reducing stiffness.
Neuropat 1 tab, TID This vitamin helps to improve the brain and nerves,
this indicated to prevent dementia as complications
to patient with PD.
Duxaril 1 tab, BID Indicated to treat symptoms inability to concentrate
and memory loss in patient with PD
Tocovid 200mg/ 1 cap, This vitamin E is indicated to patient with PD, this
OD helps to improve the dopamine levels, this also
reduced neurodegeneration and alleviation of motor
deficits.
10:58 AM Hold Tocovid and Will shift to Pronerv 1 tab, OD.
Neuropat
Shift to Pronerv 1 tab, Pronerv is still a vitamin B, this lowers the
OD progression of parkinson’s disease.
FF up result of all lab This are hospital standard procedures, follow up of
exam lab exam and results is crucial health indicator to
every patient.
Refer accordingly

12/02/2023 Follow up official MRI Patient has history of colon cancer and undergone
3:30 PM result surgery and chemotherapy, physician ordered MRI
because of suspected metastasis in the brain, this
diagnostic test also helps to detect existing
Parkinson’s disease.
GCS-15/15 To consume
cerebrolysin
Start edaravone 1 vial Patient is still experiencing involuntary movement
in 50 cc PNSS for 1-2 and body weakness. Edavarone is used to treat
hrs q12 condition in which the nerves that control muscle
movement slowly die, causing the muscle to
weakens.
Start Clopidogrel 75mg/ Patient is suspected of having stroke, because of
tab OD now then after slurred speech as chief complaint.
lunch
Give Risperidone Patient’s with PD often experiencing hallucinations,
2g/tab, OD in pm this medication is indicated to treat hallucinations
and delusions associated with PD.
TF: PNSS 1LX 12hrs Indicated to patient as sources of hydration and
electrolyte imbalances
12/03/23
11:00 AM TF: PNSS 1LX 12hrs Indicated to patient as sources of hydration and
electrolyte imbalances
Continue management Continuity of care, this helps the patient to recover
faster.
Refer

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DIAGNOSTICS AND LABARATORY TESTS RESULTS
DATE: 12/01/23
TIME: 5:31 PM

PARAMETERS RESULTS NORMAL VALUES INTERPRETATION

Hemoglobin 14.8 14.000-18.000g/dL NORMAL
Hematocrit 44.8 42.000-51.000% NORMAL
WBC 8.20 5.000- NORMAL
10.000x10^9cells/L
Segmenters 47.80 (L) 50.000-80.000% Patient underwent 2
sessions of
chemotherapy, low
segmenters is
common in patient
with cancer.
Lymphocytes 34.40 25.000-50.000% NORMAL
Eosinophils 9.40 (H) 0.000-5.000% High because patient
has history of colon
cancer t/c brain
metastasis
Monocytes 7.80 2.000-10.000% NORMAL
Basophils 0.60 0.000-2.000% NORMAL
Platelet count 333.00 150.00-450.00 mm^3 NORMAL
MCV 85.2 80.000-97.000 um^3 NORMAL
MCH 28.1 26.000-32.000 pg NORMAL
MCHC 33.0 31.000-36.000g/dL NORMAL
RDW-CV 13.80 10.000-16.000% NORMAL

DATE/TIME: 12/01/23 (6:40 PM)

BLOOD SUGAR 116.23 (L) 120-180 mg/dL Low, because

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 (RBS)
BLOOD URIC ACID 8.16 (H) 3.400-7.000 mg/dL High, this can be an
indication that patient
is at risk of having
gout
BLOOD UREA 18.52 <65Y: 50 : >60 : NORMAL
NITROGEN <=71mg/dL
ALT (SGPT) 22.87 F: <=33 : M:<=40 U/L NORMAL
IONIZED CALCIUM 1.23 1.120-1.320 mmol/L NORMAL
SODIUM 141 137.000-145.000 NORMAL
mmol/L
POTASSIUM 3.6 3.600-5.500 mmol/L NORMAL
MAGNESSIUM 0.78 0.70-1.05 mmol/L NORMAL

DATE/TIME: 12/02/23 (10:11 AM)

CHOLESTEROL 171.51 <200mg/dL NORMAL

TRIGLYCERIDES 86.93 <200mg/dL NORMAL
LDL 133.04 <100mg/dL Patient’s LDL is high,
CHOLESTEROL and HDL is low, this
will increased risk of
heart disease
HDL 37.50 (L) M: >55 F: >65 mg/dL Patient’s LDL is high,
CHOLESTEROL and HDL is low, this
will increased risk of
heart disease

CXR-PA

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DATE: 12/01/23

IMPRESSION:

ATHEROSCLEROTIC AORTA

DATE/TIME: 12/01/23 (05:09 PM)

INTERPRETATION: SINUS RHYTHM WITHIN NORMAL LIMITS

DATE: 12/01/2023

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 IMPRESSION:
- Periventricular white matter ischemic changes.
- Small right intraparietal arachnoid cyst vs prominent subarachnoid space
- Cerebrocerebellar atrophy with ex-vacuo ventricular dilatation.
Physical Assessment

Date/Time of Assessment: November 13, 2023 at 3:59PM

General Survey: The patient is on sitting position wearing gray shirt and khaki
shorts.Patient is eating sandwich and dipping it on his coffee. He is awake and alert,
coherent to time and place, cooperative to our questions but experiencing hand
tremors and slight involuntary movement in left arm and right leg.
Vital Signs:
BP: 140/90 mmHg
Temp: 36.2°c
HR: 60 bpm
RR: 20 cpm
O2: 99%

AREAS TECHNIQUE FINDINGS INTERPRETATION

SKIN INSPECTION
-No sign of jaundice, oily Oily skin is one of the
skin, no lesions and rashes manifestation in
parkinson’s disease.

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 HEAD INSPECTION -Symmetrical and rounded
in shape
Normal

-Head is normocephalic in
shape and symmetrical, no
visible lesions, no
lacerations and scar

HAIR AND INSPECTION -Slightly thin, black and Due to old age
SCALP white colored hair evenly
distributed.

-Slightly oily and no Normal

PALPATION presence of tenderness
and masses upon
palpation

FACE Inspection - Face is symmetric Normal

- It takes time to do Mask-face is an early

different facial expressions. symptom of PD.

- No tenderness, and
Palpation massess palpated

EYES Inspection -The patient has blurry - Due to old age

vision but doesn’t wear any
glasses.

-Both eyes are able to - Eyelids spasm is an

move but sometimes he’s involuntary movement, it
experiencing eyelids is one of the common
spasms symptom of PD

-The patient's eye can

move and follow the
objects

- No presence of stye in
both eyes

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 -Bulbar conjunctiva - Normal
transparent; no swelling

-Palpebral conjunctiva -
pink and moist; no
swelling, no lesions

- the pupil are equally

round and reactive to the
light and accommodation

EARS Inspection - Ears are equal in size and Normal

same color as face, there’s
presence of earwax, no
presence of ear discharge
and bleeding has seen

- not using hearing aid but

experiencing difficulty in -Hearing difficulties
hearing caused by aging

NOSE Inspection -Symmetrical in midline Normal

-No breathing difficulty in -Reduction of smell is

the nose, no deviated
septum, no sign of any
infection, cannot smell that
much but can differentiate
the smell after few mins.
MOUTH Inspection -He has 18 teeth and
yellow in color.
-Presence of tooth decay
at the tip of the tooth.
one of the early symptom
of PD
- may indicate poor
hygiene, yellow teeth
because the patients
loves coffee.

-Patient was able to move Normal

tongue in different
directions

-Slowly chewing and has - Parkinson disease can

difficult of swallowing. cause the muscle in jaw
to be less efficient
NECK Inspection -Symmetrical with head in
central position

Palpation - No scars, and visible Normal

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 masses, thyroid slides
upward when swallowing,
trachea is in the midline

CHEST AND Inspection -Side to side symmetric

THORAX chest shape

-No presence of lesions,

rashes, moles, and masses
is seen in the chest area.

-Normal rate and rhythm of

respirations

-equal chest expansion, Normal

Palpation equal and moderate
vibrations are noticed
during speech (Tactile
Fremitus), no palpable
masses, and lumps.

- Resonance is heard while

Percussion percussing the chest

-S1 and S2 was heard, no

crackles, no wheezes, no
Auscultation murmurs were heard upon
auscultation

ABDOMEN Inspection - Scar between umbilicus

and symphisis pubis.
-The patient had past
colectomy surgery.
- Patient has colostomy A reduction in the
bag attached at the LLQ regularity of sounds when
ausculting the bowel
sound is because of
surgery
Auscultation
- 4 bowel sound heard in
3min( Hypoactive)

UPPER Inspection -Patient has slight

EXTREMETIES involuntary movement on
his hand and hand tremors
- cardinal symptoms of

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 -Slight weakness in both PD
hands

-Presence of scars in left

arm - because of patient’s
former job (farming)

-Patient was able to shrug Normal

his shoulders and turn his
head from one side to the
other

- Patient’s with PD
Muscle strength- 4/5 usually experience body
Palpation and muscle weakness

Normal

-There is no presence of
deformities, edema and
lesions
LOWER Inspection - involuntary movement in
EXTREMETIES right leg, sudden twitching - cardinal symptoms of
and tremors while resting. PD

-Minimal scar are present

in the right knee - because of patient’s
former job (farming)
- Presence of callus in feet,
some lesions and yellowish
nails.

-Slightly passive ROM, can

walk but slow - Patient’s with PD
usually experience body
and muscle weakness,
-Pain in both side hips and because of the
when standing, patient has abnormal gait
stooped posture (PS: 5/10)

- Pain was reported during

assessment because of the
sudden stiffness in his right

18
 leg

Muscle strength- 3/5

Palpation -No tenderness or Normal

deformity upon palpation

-No presence of edema

ANATOMY AND PHYSIOLOGY

19
20
21
 11 FUNCTIONAL BEFORE HOSPITALIZATION DURING HOSPITALIZATION
HEALTH PATTERN
HEALTH He stated that health is the most The patient is oriented, conscious
PERCEPTION/HEALTH important thing in his life. He used and coherent. He showed interest
MANAGEMENT herbal remedies like paragis, which to recover easily and fast. He
are believed to be good for cancer. always pray to God.
According to the hearsay he heard, he
mixed it with guyabano and atis leaves
and consumed it with his 1 cup of
coffee, taking it 3 times a day. He
underwent surgery and he stated that
they removed an anastomosis and
had a permanent cholostomy.
According to patient, he only did 2
sessions of chemotherapy because he
cannot handle it, The significant other
stated that patient AR is taking
medication for chemo radiation and
pain reliever but can’t remember the
name. Patient AR said that he cannot
remember the date of his
immunization but his covid vaccine is
pfizer, He does not have any allergies
to food, drugs and environment.
NUTRITIONAL – The patient stands 162 cm tall, weighs In the morning he drinks coffee
METABOLIC 60 kg, and has a body mass index of with skyflakes, then rice with
22.86 kg/m². He mentioned that before vegetables with moderate intake,
hospitalization, he usually consumes according to him, he lost his
coffee 3x a day. He drinks alcohol and appetite upon admission.
smokes occasionally.
Morning meal: 2 cups of rice, DIET:
vegetables and 3 glass of water. - Low fat, Low salt
Lunch: 2 cups of rice, 1 small plate of
kilawin, and 3 glass of water.
Dinner: 1-2 cups of rice, different pork
dish, 2-3 glasses of water.
Patient experienced difficulty of
swallowing prior to admission.
ELIMINATION BLADDER BLADDER
The patient stated he typically urinates There is no changes to his
1-2times a day, with urine that is urination.
typically yellow in color.

BOWEL
The patient stool output is watery, no
solid pieces it's entirely liquid. He
often change his colostomy bag (2-3x
per day)
BOWEL
The patient stool output is watery,
no solid pieces it's entirely liquid
and brownish in color seen on its
colostomy bag.

ACTIVITY EXERCISE The patient's typical daily activities During hospitalization, the patient's
include waking up early in the morning usual activity is sitting, lying down
to prepare his breakfast and get ready on the bed, and resting.

22
 to go to his farm. He usually walks 800
meters to get to the farm. He also
stated that after he gets home, he
usually plays with his grandchildren.

SLEEP REST The patient can sleep for 8-11 hours
due to fatigue. Patient stated his
earliest time for going to sleep is at
7pm after dinner, while his latest time
for waking up is at 5am.
Since the patient's hospitalization,
he usually watches on TV to get
his sleep, so he stated that he
sleeps at 1am and wakes up at
8am. With sleep interrupted due to
the administration of medication
and taking of vital signs.

SENSORY AND COGNITIVE:

COGNITIVE- The patient has finished the -Patient is having trouble
PERCEPTUAL secondary level. He is able to speak remembering things and other
Filipino, Ilocano, and he is able to informations
understand English.

SENSORY:
The patient has no sensory deficit. - Patient started to notice that he
Oriented to people,time, and place. can’t smell that much.
Responds to stimuli verbally and
physically.
SELF The patient is able to express his The patient stated and believes
PERCEPTION/SELF feelings about his condition. He is that admission will be helpful for
CONCEPT contented seeing his family, their adjusting to his needs and will
support, love, and care for him. alleviate the occurrence of his
condition.
ROLE RELATIONSHIP The patient currently lives with his Despite his condition, he still fulfills
children. He is kind yet strict in his role as a father. The patient is
disciplinary action wherein if he well supported by his family. He
whistles, his children must obey his receives positive reinforcement
orders. He stated that he is short- and it provides him comfort and
tempered and always gets mad when reassurance.
his orders are not done immediately.
He had a small argument with his
neighbors when they refused to lend
him cigarettes.
SEXUALITY – The patient is widowed, but he said The patient is widowed.
REPRODUCTIVE that during her married years, they do
not often engage in coitus, they are
not using any contraceptives, they
only use the withdrawal method.
COPING/STRESS The patient stated that his source of During hospitalization, he watched
TOLERANCE stress is his condition and children TV and also talked to his children
because they don't obey him. If he as coping mechanisms.
gets stressed, he always watches TV,
plays with his grandchildren, and
smokes cigarettes to relieve his
stress.
VALUES/BELIEF The patient is a Roman Catholic and The patient has a strong faith in
she regularly attends church. God and is confident that he will

23
 However, he doesn't believe in assist him in overcoming his
'albularyo'. present circumstances. The patient
relationship to God remained
unchanged

DISCHARGE PLANNING
- Encouraged the patient to take the RATIONALE:
medication as prescribed with the
right dose, and right route. Using medications correctly at the right
dosage and in the right way as prescribe
MEDICATION
-Advised the patient to take the by the doctor.
medications with meal to limit
gastric irritation

Patient’s meds according to

physician’s order:
-Akidin 2mg 1/2 tab, TID (6-
12-5)
-Neuropat 1 tab, TID (6-12-5)
-Duxaril 1 tab, TID (6-12-5)
-Tocovid 200mg/1 cap, OD
(6am)
-Urinorm 80mg/1 tab, OD
(6am)
-Instructed the patient to avoid salty RATIONALE:
and fatty foods
-Advised the patient to eat a variety Eating foods that are high in iodine will
DIET
of foods as recommended by the increase the production of thyroid gland,
physician to get a balanced intake eating nutritious food will help the body
of nutrients for faster recovery
-Limit the intake of fats, carbs and
sodium. Consume more protein.
RATIONALE:

- Encouraged the patient to

HEALTH TEACHING speak slowly and clearly. To emphasize the importance of
adhering to the treatment regimen

- Encouraged the client to get 5 and strictly following the do’s and

24
 mins walk everyday don’ts as ordered.
EXERCISE - Encouraged the patient to do RATIONALE:
atleast 10 minutes exercise of light For immediate recovery
slow walking in the morning

OUT-PATIENT -Encouraged the patient to visit the RATIONALE:

FOLLOW UP doctor at the given time

To monitor the progress of treatment.
-Encouraged the patient to call the
physician, for an ambulance or tell To help you address quickly if there’s a
the family members or friends to problem with your health.
take the patient to the nearest
hospital if there’s severe tremors in
hands and other painful twitching
and crampings
SPIRITUAL - Encouraged to continue to seek RATIONALE:
God’s and enlightenment
To have a closer relationship with God
- Emphasized the importance of
prayers in healing

- Encouraged to continue to have a

positive outlook in life

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