The present report is based on clinical scenario of Charles Williamson who was suffering from Parkinson’s disease and this was non curable thus respite care had to be offered to him.
- Provide brief of the clinical case related to Charles
- Critical evaluation of primary diagnosis for Charles and ways of supporting client primary diagnosis.
- Identify nursing problem that as a result of primary diagnosis.
- Reflect on nursing management.
It is the clinical scenario of Charles Williamson, who is a 76 year old man. He has been admitted to the ward of respite care. 10 years ago, he was diagnosed with Parkinson’s disease. His mother also died due to Parkinson’s disease after suffering from it for 22 years. His wife, Elsie, is the primary carer of Charles. No other medical history has been noticed during primary diagnosis. As a treatment of Parkinson’s disease, Charles is indulged in consuming Sinemet CR tablet, in every four hours during the day.
The present report discuses regarding Parkinson’s disease which is considered to be non-curable. However, its symptoms on human body can be reduced through exercise and medications. Primary admission diagnosis of Charles will be discussed in the report so as to understand the condition of patient in most effective manner. The report will then make comprehensive discussion on the two nursing issues that are being faced by Charles are, possessing ineffective motor and verbal communication skills (Kelly, Eusterbrock and Shumway-Cook, 2012). He has been brought to respite care so that actions regarding his involuntary falling due to lack of motor movement can be assessed by the nurses. In the end, a discharge plan for Charles will also be discussed so as to ascertain treatment and medication to him during respite care process.
Primary Admission Diagnosis
Physical examination of Charles stated normal blood pressure, that is 120/72 without any presence of orthostasis. A regular rhythm of heart rate was noticed with 76. Drag in the right foot was noticed with slow and rigid movements in the body. His balance also appeared to be unstable. He also experienced fall at home leading to certain cuts and bruises at right lateral lower leg. Other issues faced by him includes constipation and lack of appetite (King and et.al., 2012). He generally starts to cough when he drink water. Charles is quite alert, oriented though a bit anxious with noticeable tremors
He has been noticed quite regular and particular for his Parkinson’s disease medication. He tends to requires assistance with activities of daily life (ADL) when the impact of medicines reduces. He also notices the episodes of excessive and uncontrolled movements in his hands and legs (Kordower and et.al., 2013).
Parkinson’s disease is a central nervous system disorder that can have a direct impact on motor skills of the individual. The same is the scenario of Charles which is genetically being transferred to him by his mother. Since, he is already being suffering from the disease for past 10 years. Nursing interventions that are required to be planned by the nurses must be inclusive of it. The key information that is required to be considered by the nurses while planning any type of care for Charles are, Parkinson’s disease, ineffective limb movements, cuts and bruises due to recent fall at home and issue of constipation and loss of appetite that he facing these days (Litvan and et.al., 2012). It has also being noticed in the case of Charles that while communicating he was making a mask like face and was speaking in a hoarse and monotonous voice.
Pathophysiology of Parkinson’s disease is related to gradual loss of cells which is responsible for production of Dopamine. This chemical in the brain is primarily responsible for coordination and regulation of muscle activity (Postuma and et.al., 2015). It is generally transmitted genetically. However, other issues that are related to development of Parkinson’s disease include, aging, environmental factors, such as, manganese dust, carbon disulphide and severe poisoning of carbon mono oxide. Clinical manifestation of disease states that it is not yet possible to cure the disease, but consumption of certain medications can help in reducing the symptoms in an individual’s body. The cardinal features of Parkinson’s include, tremors, bradykinesia and rigidity in limbs. It is considered to be primary diagnosis criteria of the patient.
According to the views of Pringsheim and et.al., (2014) there are various issues that are generally faced by the patient due to Parkinson’s being non curable in nature. The symptoms tend to progress as and when the patient tend to reach to older age. Advancement in the severity can be noticed through rigidity in the limbs and ineffective motor skills. The movements of the body tends to slow down at an unreasonable pace that ultimately increases the tendency and probability of falling and getting injured. It is due to this reason, the patients are generally brought to respite care for primary diagnosis and treatments. At the later stage of Parkinson’s disease, the patient may constantly require care which can help him in daily necessary activities of life. He may be left bedridden as he is not able to walk and stand. He may also face certain episodes of hallucinations and delusional activities. However, in comparison to this, as per the views of Bloem, de Vries and Ebersbach (2015) there are higher chances of the patient to fall due to restrictive body movement. Certain involutory movements and loss of postural adjustments can also be the issues that are generally faced by the patient. It helps in assessing that whether a continuous care is required by the patient or not (Diagnosis, 2015). Loss of balance, tremors and rigidity in muscles can also be the reason for falling down of the individual. Hence, in such cases, it generates the requirements of developing a nursing interventions that can prevent the patient from falling. In care of Charles, these can be the main reason of falling at home which ultimately resulted in some cuts and bruises.
According to Bloem, de Vries and Ebersbach (2015) another nursing issue that can be faced by the patient due to Parkinson’s disease is related to impaired verbal communication. A decreased, delayed, absent ability to receive, process and transmit can be noticed in the individual due to increased symptoms of Parkinson’s disease in the patient. It may be related to medications, psychological barrier, rigidity in facial muscles of the patient, decreased circulation of brain activity and lack of stimuli. It can be prevailing due to increased age of the patient as well which automatically reduce development of dopamine in the brain. However, in contrast to this, in the opinion of Brown and et.al. (2017) there are various method based on which ineffective verbal communication aspect can be ascertained in Parkinson’s patient. Some factors are, restlessness, confusion and anxiety, fight with the ideas and inability to speak long sentences and difficult words. Patient may also face issues in comprehending communication which can lead to slow and monotonous speeches. Facial muscle rigidity can also be the other factor of Parkinson’s disease which can lead the patient to impaired verbal communication skills (Parkinson Disease, 2018).
Based upon the nursing issues faced by the patient, it becomes important to have appropriate set of activities that can be performed by the nurse so as to deal with the issues that are cropping up. In such cases, the first important aspect is to identify the issues faced by the patient.
The first issue that requires nursing intervention is rigid and involuntary movement in the body in the patients with Parkinson’s disease. It is important for the nurse to assess ambulation and movement and rigidity in the body and limbs. Keeping them in respite care will help in preventing episodes of falling and Charles can be kept safe from any kind of environmental hazard that may take place due to involuntary and rigid movement of limbs of Parkinson’s patient. Reminding patients to keep and maintain an upright posture is another aspect. It is important for the patient to be aware of various products kept at different places and mark the steps being taken by them. So that it can help in minimizing the episodes of falling (Cummings and et.al., 2014). Nurses can also indulge in teaching them motion exercises and certain stretching that can be performed by them daily so as to minimize rigidity and involuntary motions in the limbs. It can help in improving balance that is quite required while walking or moving. It can also help in improving overall flexibility of the body that can ultimately help in improving balance of the body.
Another issue that is generally faced by Parkinson’s patient and so by Charles is impaired verbal speech and thereby facing issues in communication. The desired outcome of nurse is to ensure effective speech and understanding of communication in the patients. Nursing interventions can also help in understanding communication aspects that can help in minimizing anxiety and frustration with the speech attempts of the patients. It can also help ion developing adequate amount of confidence by developing and using non-verbal methods attempting to support communication aspects of the patient as well (Deane and et.al., 2014). Nursing intervention for this aspect include, addressing areas of issues and speech pattern that can further help in addressing the same in care plan. Instructing patients to make a conscious efforts to speak slowly with deliberate attention helps in developing clear method of communication. Nurses can also analyse patient’s non verbal communication skills such as, pointing, crying, facial grimacing, smiling and so forth that can help in encouraging use of speech to the maximum possible extent rather opting for non verbal communication methods (Sharp and Hewitt, 2014). Use of direct and simple questions can also help in reducing the ongoing issue of verbal impairment. Controlling lengthy phrases and over articulated words can help in promoting effective speech. In such cases, nurses plays a substantial role during respite care of Parkinson’s disease patient (Ngoga and et.al., 2014).
From the above report, it can be concluded that, Charles is a patient who has been suffering from Parkinson’s disease since last 10 years. Since, this disease is not curable, though, adoption of right medications can bring adequate amount of changes in the lifestyle can help in reducing the impact of its symptoms of individual. The two major nursing issues that are faced by Charles are, involuntary falling due to inappropriate movement of limbs and experiencing ineffective verbal communication. The nursing interventions for the same has been planned for the stated patient condition. Ineffective verbal communication may be related to medications, psychological barrier, rigidity in facial muscles of the patient, decreased circulation of brain activity and lack of stimuli.
Keeping Charles in respite care will help in preventing episodes of falling and Charles can be kept safe from any kind of environmental hazard that may take place due to involuntary and rigid movement of limbs of Parkinson’s patient. Moreover, it can also help in developing motor sand verbal skills for the patient with the help of training and exercise. In the end, it can be stated that discharge helps in understating the overall issue faced by the patient and treatment and medication being extended to Charles.