Nursing Process: The Patient With Parkinson Disease PDF

10/24/23, 3:18 PM Realizeit for Student NURSING PROCESS The Patient With Parkinson Disease Assessment The nurse gathers information focusing on how the disease has affected the patient’s ADLs and functional abilities. The patient is observed for degree of disability and functional changes that occ...

10/24/23, 3:18 PM Realizeit for Student NURSING PROCESS The Patient With Parkinson Disease Assessment The nurse gathers information focusing on how the disease has affected the patient’s ADLs and functional abilities. The patient is observed for degree of disability and functional changes that occur throughout the day, such as responses to medication. Almost every patient with a movement disorder has some functional alteration and may have some type of behavioral dysfunction. The following questions may be useful to assess alterations: Do you have leg or arm stiffness? Have you experienced any irregular jerking of your arms or legs? Have you ever been “frozen” or rooted to the spot and unable to move? Does your mouth water excessively? Have you (or others) noticed yourself grimacing or making faces or chewing movements? What specific activities do you have difficulty doing? Have you had any recent falls? During this assessment, the nurse observes the patient for quality of speech, loss of facial expression, swallowing deficits (drooling, poor head control, coughing), tremors, slowness of movement, weakness, forward posture, rigidity, evidence of mental slowness, and confusion. PD symptoms, as well as side effects of medications, put these patients at high risk for falls; therefore, a fall risk assessment should be conducted (Hickey & Strayer, 2020). Nursing Interventions IMPROVING MOBILITY A progressive program of daily exercise will increase muscle strength, improve coordination and dexterity, reduce muscular rigidity, and prevent contractures that occur when muscles are not used (Hickey & Strayer, 2020). Walking, riding a stationary bicycle, swimming, and gardening are all exercises that help maintain joint mobility. Stretching (stretch–hold–relax) and range-of-motion exercises promote joint flexibility. Postural exercises are important to counter the tendency of the head and neck to be drawn forward and down. A physical therapist may be helpful in developing an individualized exercise program and can provide instruction to the patient and caregiver on exercising safely. Faithful adherence to an exercise and walking program helps delay the progress of the disease. Warm baths and massage, in addition to passive and active exercises, help relax muscles and relieve painful muscle spasms that accompany rigidity. Balance may be adversely affected because of the rigidity of the arms (arm swinging is necessary in normal walking). Special walking techniques must be learned to offset the shuffling gait and the tendency to lean forward. The patient is educated to concentrate on walking erect, to watch the horizon, and to use a wide-based gait (i.e., walking with the feet separated). A conscious effort must be made to swing https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 1/3 10/24/23, 3:18 PM Realizeit for Student the arms, raise the feet while walking, and use a heel–toe placement of the feet with long strides. The patient is advised to practice walking to marching music or to the sound of a ticking metronome, because this provides sensory reinforcement. Performing breathing exercises while walking provides additional movement of the ribcage and aerates larger parts of the lungs. Frequent rest periods aid in preventing frustration and fatigue. ENHANCING SELF-CARE ACTIVITIES Encouraging, educating, and supporting the patient during ADLs promote self-care (Hickey & Strayer, 2020). Environmental modifications are necessary to compensate for functional disability. Patients may have severe mobility problems that make normal activities impossible. Adaptive or assistive devices may be useful. A hospital bed at home with bedside rails, an over-bed frame with a trapeze, or a rope tied to the foot of the bed can provide assistance in pulling up without help. An occupational therapist can evaluate the patient’s needs in the home, make recommendations regarding adaptive devices, and educate the patient and caregiver how to improvise. IMPROVING NUTRITION Patients may have difficulty maintaining their weight. Eating becomes a very slow process, requiring concentration due to a dry mouth from medications and difficulty chewing and swallowing. These patients are at risk for aspiration because of impaired swallowing and the accumulation of saliva. They may be unaware that they are aspirating; subsequently, pneumonia may develop (Aslam, Simpson, Baugh, et al., 2019). Monitoring weight on a weekly basis indicates whether caloric intake is adequate. Supplemental feedings increase caloric intake. As the disease progresses, a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube may be necessary to maintain adequate nutrition. A consultation with dietitian may be indicated. IMPROVING COMMUNICATION Speech disorders are present in most patients with PD. The low-pitched, monotonous, soft speech of patients requires that they make a conscious effort to speak slowly, with deliberate attention to what they are saying. The patient is reminded to face the listener, exaggerate the pronunciation of words, speak in short sentences, and take a few deep breaths before speaking. A speech therapist may be helpful in designing speech improvement exercises and assisting the family and health care personnel to develop and use a method of communication that meets the patient’s needs. A small electronic amplifier is helpful if the patient has difficulty being heard. SUPPORTING COPING ABILITIES https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 2/3 10/24/23, 3:18 PM Realizeit for Student Support can be given by encouraging the patient and pointing out that activities will be maintained through active participation. Patients with PD can become socially and emotionally withdrawn. It is best if patients are active participants in their therapeutic program, including social and recreational events. Patients often feel embarrassed, apathetic, inadequate, bored, and lonely. In part, these feelings may result from physical slowness and the great effort that even small tasks require. The patient is assisted and encouraged to set achievable goals (e.g., improvement of mobility). Every effort should be made to encourage patients to carry out the tasks involved in meeting their own daily needs and to remain independent. Doing things for the patient merely to save time undermines the basic goal of improving coping abilities and promoting a positive self-concept. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 3/3