Sunday, March 24, 2024

Parkinson’s Disease Nursing Diagnosis

Difficulties With Activities Of Daily Living

Parkinson’s Disease Symptoms, Treatment, Nursing Care, Pathophysiology NCLEX Review

ADLs refer to basic personal care tasks including bathing, dressing, eating, mobilizing, and toileting.

Individuals with Parkinsons disease may have problems with mobilizing, freezing in place, bathing, grooming, toileting, dressing, eating, driving, travelling, as well as safety at home. A person has more difficulty performing these ADLs as the disease progresses due to increased muscle and cognitive impairment.

It can be hard to for individuals to adjust to these changes but there are ways to provide support and to promote as much independence and quality of life as possible.

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Transdermal And Duodenal Drug Administration

Some medications may be delivered transdermally or by enteral duodenal infusion. A transdermal patch delivers a dopamine agonist around the clock to decrease off time its used in combination with L-dopa. Duodenal infusion avoids gastric emptying problems. It can be used short-term through a nasogastric tube and long-term through a percutaneous endoscopic gastrostomy tube that extends into the duodenum. These methods are still under review.

What Causes Parkinsons Disease

The most prominent signs and symptoms of Parkinsons disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems associated with the disease. Scientists still do not know what causes the neurons to die.

People with Parkinsons disease also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinsons, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying position.

Many brain cells of people with Parkinsons disease contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons andLewy body dementia.

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Home Care Plan For Stage One

At this early stage of the disease, the best thing to do isget as much information as possible. Speak to loved ones about organisingpotential care, or, if you are helping a loved one to come to terms withdiagnosis and early symptoms, seek advice. You may also want to begin thinkingabout the later stages by planning for mobility aids or home care.

Here are some helpful resources:

Nursing Care Plan For Parkinsons Disease 3

parkinson

Nursing Diagnosis: Fatigue related to disease process of Parkinsons disease as evidenced by generalized weakness, tremors, muscular rigidity, and verbalization of overwhelming tiredness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

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Is Early Diagnosis Possible

Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.

Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.

For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.

How Is Parkinsons Treated

Parkinsons disease can also be broken down into four stages: diagnosis, maintenance, complex and palliative. In the early stages of Parkinsons disease, medication treatment can be very effective. However as the disease progresses into the complex and palliative stages, the individual may become more restricted despite an ideal medication therapy regime.

There is no ideal medicinal treatment for Parkinsons. Therapy will be tailored to the individual, their symptoms, disease progression, lifestyle and physical tolerance. However most medication prescribed to someone with Parkinsons will fit into one of these categories:

  • Levodopa dopamine replacement therapy
  • Dopamine agonists mimic the action of dopamine
  • COMT inhibitors these are used in conjunction with Levodopa and blocks the COMT enzyme to prevent levodopa breaking down in the intestine so more of it will reach the brain
  • Anticholinergic block the effect of acetylcholine to rebalance its levels with dopamine
  • Amantadine has anticholinergic properties and improves dopamine transmission
  • MAO type B inhibitors prevent the metabolism of dopamine within the brain

As the disease progresses, medication management for the individual will need to change. However one important factor which must be taken into consideration regarding medications is time. These medications need to be taken on time: if they are taken late, they can severely impair the movements of the person with Parkinsons.

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Box : Further Assessment Of Depression In Patients With A Chronic Physical Health Problem6

If a patient with a chronic physical health problem answers yes to either of the depression identification questions , a practitioner who is competent to perform a mental health assessment should:

  • ask three further questions to improve the accuracy of the assessment of depression, specifically:
  • during the last month, have you often been bothered by feelings of worthlessness?
  • during the last month, have you often been bothered by poor concentration?
  • during the last month, have you often been bothered by thoughts of death?
  • review the patients mental state and associated functional, interpersonal and social difficulties
  • consider the role of both the chronic physical health problem and any prescribed medication in the development or maintenance of the depression
  • ascertain that the optimal treatment for the physical health problem is being provided and adhered to, seeking specialist advice if necessary.
  • © NICE 2009. Depression in adults with a chronic physical health problem: recognition and management. Available from www.nice.org.uk/cg91 All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

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    Pathogenesis Of Parkinsons Disease

    Parkinson’s Disease: New Diagnosis Workshop with Nurse Practitioner Joanna Davis

    A number of mechanisms have been implicated in PD pathogenesis, with -synuclein aggregation central to the development of the disease. Multiple other processes are thought to be involved, with several studies suggesting that abnormal protein clearance, mitochondrial dysfunction, and neuroinflammation play a role in the onset and progression of PD. However, the relationship between these pathways remains unclear.

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    Signs And Symptoms Of Dehydration

    The signs and symptoms of dehydration are related to how much water is lost. They can be mild, moderate, to severe and usually start with thirst and dark-colored urine.

    The signs and symptoms of dehydration can also differ in children and adults.

    Dehydration in Infants and Children

    • Dry mouth, lips, and tongue
    • Absence of tears when crying
    • Dry diapers for three hours or more
    • Sunken eyes and cheeks

    The Role Of Nurses In Parkinsons Disease

    Research has shown increasing specialization among nurses who care for patients with PD thus, knowledge of the pathophysiology of this disease is arguably an important starting point for vocational training . Based on this, we sought to hierarchically organize the major motor and nonmotor symptoms of PD using evidence gathered from the literature .

    Figure 1.

    Classification of the main motor and nonmotor symptoms in Parkinsons disease.

    The symptoms of PD are divided into motor and nonmotor each of these classifications contains various other signs and symptoms related to both the neurodegenerative disease process itself as well as multifactorial causes. Thus, hierarchical organization of symptoms is not an easy task, and various descriptions have been proposed to facilitate understanding of the pathophysiology of the disease however, none of them have structured the symptoms into an organizational chart.

    Our research on nursing diagnoses, outcomes, and interventions was based on this chart.

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    Questions To Ask A Skilled Nursing Living Facility

    Refer to the questions on the following pages for guidance. Try to make a second, unannounced visit in the evening or on a weekend. You may learn additional information that adds to your overall opinion of the facility. If you have specific questions about this process, contact our Helpline at 1-800-4PD-INFO .

    *Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both to stay best informed on the Foundations work and the latest in PD news.

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    Causes And Risk Factors Of Dehydration

    Pin by Nursing on Parkinsons disease

    Dehydration occurs due to two main mechanisms: inadequate fluid intake and losing fluid more than what is taken. However, there can be different factors as to why these mechanisms occur. These may include:

    • Illness most illnesses can cause increased fluid loss due to the increased metabolic demands. However, some illnesses have a higher rate of fluid loss such as diarrhea and vomiting. These two conditions are the most common causes of dehydration in infants and children.
    • Sweating extensive sweating after an episode of fever, exercise, or manual labor especially in hot weather can cause dehydration. Children and teens are more prone to dehydration from sweating as they are likely to ignore the symptoms such as thirst.
    • Alcohol Alcohol is a diuretic and therefore can increase the frequency of urination. The headache that comes after a hangover is a symptom of dehydration.
    • Increased urination several conditions and medications can cause increased urinary frequency. One of the most common medical conditions that can cause dehydration is diabetes. The body compensates for the high blood sugar level by producing more urine to excrete the excess sugar in the bloodstream. on the other hand, certain drugs can also cause dehydration such as diuretics and antihypertensive drugs.

    Complications of Dehydration

  • Heat injury. One of the functions of fluids in the body is thermoregulation. Dehydration can cause mild to severe heat injuries including life-threatening heatstroke.
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    Purposes Of Nursing Diagnosis

    The purpose of the nursing diagnosis is as follows:

    • Helps identify nursing priorities and helps direct nursing interventions based on identified priorities.
    • Helps the formulation of expected outcomes for quality assurance requirements of third-party payers.
    • Nursing diagnoses help identify how a client or group responds to actual or potential health and life processes and knowing their available resources of strengths that can be drawn upon to prevent or resolve problems.
    • Provides a common language and forms a basis for communication and understanding between nursing professionals and the healthcare team.
    • Provides a basis of evaluation to determine if nursing care was beneficial to the client and cost-effective.
    • For nursing students, nursing diagnoses are an effective teaching tool to help sharpen their problem-solving and critical thinking skills.

    Depression In Parkinsons Disease

    Depression is a common non-motor symptom in PD and is thought to occur in over 50% of people.2 Depression in PD can occur for various reasons but is generally considered a consequence of a chemical depletion in the brain and a response to living with the challenges of the condition.3 It is widely accepted that people with depression, regardless of whether they have PD or not, have an increased risk of suicide than those who do not have depression.4 A recent review of literature suggests that people with PD are much more likely to experience suicidal thinking than the general population, but it remains unclear if the risk of suicide is increased. The review concluded that there was often conflicting evidence on suicide and suicidal ideation in the Parkinsons population and that more studies were needed. However, it does state that the evidence suggests aggressive management of depression is the best approach.5

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    Advice For Nursing Care

    People with Parkinsons have specific needs and care requirements. Most important is that they receive their medication on time, every time. Nurses should also be aware of the on/off nature of the condition.

    Some patients say they are on when their drugs are working and symptoms are mostly under control. If they go off, their symptoms are not under control and it becomes harder for them to move some may stop moving altogether. Patients might change from on to off very quickly, like a switch.

    The way in which Parkinsons affects patients can vary from hour to hour and day to day, and it also varies widely between individual patients. The amount of help and support they need also varies. Nurses should therefore listen to patients and their families about how the condition affects them.

    It is important to ensure that patients have access to a varied and balanced diet nurses should take account of any swallowing or movement problems that could lead to malnutrition. It is also important to remember to give patients time to answer when talking to them. It may take them time to respond, but this does not mean they are not listening or do not understand.

    Parkinsons Disease Nursing Care Plans Diagnosis And Interventions

    Parkinson’s, Alzheimer’s, and Huntington’s Disease – Medical-Surgical – Nervous System -@Level Up RN

    Parkinsons Disease NCLEX Review and Nursing Care Plans

    Parkinsons Disease is a common neurodegenerative disease characterized by changes in movement and posture.

    It is a progressive illness with symptoms starting from barely noticeable to obvious signs and symptoms.

    Tremors, rigidity, and bradykinesia are the triad of symptoms of Parkinsons disease.

    Parkinsons disease has a prevalence rate of 0.5-1% in the 65-69 years old population. Its occurrence rises as the age progresses and its incidence is second to Alzheimers disease.

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    Pharmacological Treatment Of Parkinsons Disease

    There is currently no proven disease-modifying or neuroprotective therapy for PD. A summary of previous neuroprotection trials is given in a recent review article. Current evidence-based treatment for PD is symptomatic and mainly based around dopaminergic replacement or modulation . The evidence base is summarised in recent guidelines from the National Institute for Health and Care Excellence and the International Parkinson and Movement Disorder Society. Levodopa, dopamine agonists and monoamine oxidase B inhibitors are all licensed for use as initial therapy in PD. Anticholinergics are no longer routinely used due to the risk of cognitive decompensation.

    Pharmacological therapies currently used for initial and adjunctive treatment of motor symptoms in Parkinsons disease

    • Selegiline hydrochloride
    • Rasagiline mesylate

    The enzyme monoamine oxidase B breaks down dopamine in the brain. MAO-B inhibitors prevent this breakdown, thus increasing the amount of dopamine in the brain and reducing the motor symptoms of Parkinsons disease.

    MAO-B inhibitors to treat the symptoms of PD can either be used alone or with levodopa. In early PD, they can delay the need for starting levodopa. Later in the disease, they can be given with levodopa, to enhance and prolong the effects to levodopa, thus reducing the wearing off phenomenon. When taken in combination with levodopa, it may allow the dose of levodopa to be reduced.

    Caring For Patients With Parkinsons Disease In General Hospital Settings

    Vicky Queen Parkinsons disease nurse specialist, Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay, England

    Parkinsons disease is a common progressive neurological condition. There are 127,000 people with the disease in the UK, that is, one in every 500 of the population. In 2014-15 there were 14,000 hospital admissions of people with PD in England. However, PD is often not the primary cause of admission. Urinary tract infections and pneumonia, for example, are frequent causes of hospital admission for people with PD. Therefore, nurses on general medical and surgical wards will often care for people with PD. This article aims to provide an update on PD and explore the nurses role in assessment and provision of safe and effective care for patients with PD in acute hospital settings.

    Nursing Older People.29, 5, 30-37. doi: 10.7748/nop.2017.e861

    Correspondence

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    Impaired Swallowing Care Plan

    Impaired swallowing associated with Parkinsons disease is caused by the inability to control throat and mouth muscles resulting in difficulty chewing and swallowing food. This can lead to aspiration pneumonia, which is the leading cause of death in PD.

    Nursing Diagnosis: Impaired Swallowing

    • Inability to control throat and mouth muscles
    • Degeneration of nerve cells
    • Blank facial expression
    • Coughing while eating or drinking
    • Clearing of the throat while eating or drinking
    • A feeling of food stuck in the throat during feeding

    Expected outcomes:

    • Patient will demonstrate appropriate swallowing without coughing/gagging, drooling, or pocketing food
    • Patient will be able to maintain an acceptable weight for their height and gender
    • Patient will not develop aspiration pneumonia

    Impaired Swallowing Assessment

    1. Assess the patients ability to swallow and chew.The muscles in the throat that regulate food passage can stiffen or become slow-moving, which may leave residue in the throat. The patient may complain of food stuck in the throat. The nurse can perform a bedside swallow assessment by giving the patient a teaspoon of water and ensuring the patient can swallow without gagging or coughing.

    2. Monitor the patients weight.Weight and nutritional status must be consistently monitored. Impaired swallowing is associated with weight loss in PD.

    3. Assess for signs of aspiration pneumonia.Fever, dyspnea, chest pain, coughing, and lethargy are signs of possible aspiration pneumonia.

    Data Collection And Management

    So helpful! Great for #caregivers

    Patients will be given a unique personal identification code not containing any information that refers back to the individual. The key file connecting personal identification codes to the individual patient will be stored on a secure Radboudumc data server. Only the research team has access to this key. The key file will be stored on a different server from the one with acquired study data for 5 years, allowing the research team to contact patients after they have finished the study. After 5 years, the key file will be destroyed.

    Data from all paper-based case report forms completed by the researcher will be entered manually into an online certified data management system . Online CRFs will automatically be recorded in Castor EDC. When patients or caregivers are not able to complete questionnaires online, they also have the opportunity to do this on paper. We will send out the questionnaires by post, and patients can return the completed questionnaires using a self-addressed envelope. These questionnaires will be entered manually into Castor EDC. Both online and paper-based CRFs only contain the personal identification code.

    Clinical notes taken by the PDNS in the online study report will also not contain any information that refers back to the individual. PDNSs are instructed to make notes according to a predefined structured format without mentioning personal information that traces back to an individual patient. The study report will be completed in Castor EDC.

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