Parkinson’s Disease

Parkinson’s Disease Nursing Care Plans Diagnosis and Interventions

Parkinson’s Disease NCLEX Review Care Plans

Nursing Study Guide on Parkinson’s Disease

Parkinson’s Disease (PD) 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 Parkinson’s disease.

Parkinson’s 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 Alzheimer’s disease.

Signs and Symptoms of Parkinson’s Disease

  • Tremor. The presence of tremors is one of the triad symptoms of Parkinson’s disease. Tremors usually start in the limbs, most commonly in the hands and fingers. They are likely to occur when the body is at rest and relaxed. Pill-rolling tremors are common in Parkinson’s disease patients. It is characterized by the rubbing of thumb and forefinger back and forth.
  • Bradykinesia. One other main symptom of PD is slow movements or bradykinesia. Individuals with PD display a distinctive slow and shuffling gait. Slowness in movements often make it more difficult for people with PD to complete activities of daily living.
  • Rigidity (rigid muscles). Muscle stiffness is also a common sign of PD. It may occur in any part of the body and may lead to dystonia or uncontrolled painful muscle cramps.
  • Impaired posture and balance. Most people with PD often have a stooped posture.
  • Loss of automatic movements. Unconscious movements such as blinking, smiling, and swinging of hands when walking may be reduced in people with Parkinson’s disease.
  • Anosmia. Loss of the sense of smell may occur even years before the diagnosis of PD.
  • Speech changes. Changes in speech may also be noted in people with PD. Their speech may become soft, fast, slur, and their tone may become monotonous.

Causes of Parkinson’s Disease

Parkinson’s disease is an idiopathic illness, which means that its cause is unknown.

The signs and symptoms it present are caused by the loss of nerve cells in the part of the brain called substantia nigra.

This part of the brain is responsible for the production of dopamine, a neurotransmitter that links the brain and nervous system to coordinate body movements.

Loss of dopamine results in uncoordinated body movements, thereby producing the signs and symptoms of the disease.

Though the exact cause of Parkinson’s disease is still unknown, there are possible explanations that may be responsible for the condition, such as:

  • Genetics. Studies have shown that a minority of cases of PD have genetic involvement.
  • Environmental factors. Exposure to pesticides, herbicides, and industrial pollution is now being looked at as a possible cause of PD. However, the results are still inconclusive.
  • Presence of Lewy bodies. Lewy bodies are clumps of substances in the brain cells. These are often seen in people with Parkinson’s disease. The studies about them are still inconclusive, but researchers believe that these substances hold useful information to what causes PD. Researchers are also focusing into alpha-synuclein (a-synuclein) found in the Lewy bodies.

The following are the associated risk factors in developing Parkinson’s disease:

  • Age. People 60 years and older are at higher risk of PD. Parkinson’s disease rarely occurs in younger individuals.
  • Heredity. Family history of PD increases the chance of it developing later in life.
  • Sex. Prevalence of PD is higher in men than women.
  • Exposure to toxins. As research suggests, exposure to pesticide, herbicides, and pollution can increase the risk of developing PD.

Complications of Parkinson’s Disease

  1. Speech problems. Speech is often affected in PD patients. Issues relaying messages is a common problem and often a cause for disappointment in individuals suffering from the disease.
  2. Difficulty chewing and swallowing. Changes in movements related to PD typically affects the ability to chew and swallow as well. This often leads to malnutrition; therefore, options for nutritional support will need to be discussed with the patients too.
  3. Depression and Anxiety. Due to the complexity and progressiveness of the disease, people with PD often suffer from depression and anxiety.
  4. Sexual dysfunction. Reduced sex drive is typical in PD. It may be due to other symptoms like fatigue, pain, and depression.
  5. Sleep disorders. Sleep problems may arise even before the diagnosis of PD. Common complaints related to sleep are Apnea, restless leg syndrome, and difficulty falling asleep.
  6. Urinary problems. Controlling the bladder may be challenging for people with PD.
  7. Constipation. Constipation is another symptom associated with PD that may become apparent even before the diagnosis.
  8. Dementia. Parkinson’s disease is closely related to dementia. The changes in the nervous system often lead to Parkinson’s dementia.
  9. Pain. This is a common symptom of PD. About 60% of PD patients experience pain.
  10. Changes in blood pressure and sense of smell. Changes in blood pressure may occur in PD due to the involvement of the autonomic nervous system that also controls blood flow. The impact on the nervous system also causes the loss of the sense of smell. This is a common symptom that is reported in 95% of cases.

Diagnosis of Parkinson’s Disease

There is no specific diagnostic procedure to diagnose PD. However, the following are helpful to come up with the diagnosis:

  • Medical History Taking
  • Physical Examination
  • Single Photon Emission CT scan -this form of imaging shows the blood flow to tissues and organs
  • Dopamine transporter scan (DaTscan) – this imaging is often used to confirm the diagnosis of PD. It is not typically requested as medical history and physical examination are often conclusive.

Treatment of Parkinson’s Disease

Currently, Parkinson’s disease has no cure. However, treatments are extremely helpful in managing its signs and symptoms.

  1. Supportive therapies, such as physiotherapy.
    • Physiotherapy can be helpful in relieving muscle stiffness and joint pain. It may improve gait and movement.
    • Occupational therapy. This therapy may help with the performance of activities of daily living. It helps promote independence and helps people make sure that their environment is conducive for their condition.
    • Speech and Language therapy. Speech is often affected in PD. Speech and language therapy helps individuals to cope with this issue.
  2. Medication. Medications are commonly used to manage symptoms of PD. However, close, and regular monitoring is needed to watch out for side effects.
  3. Central nervous system agents such as levodopa – commonly prescribed for PD patients. Levodopa works by being converted into dopamine in the brain
  4. Decarboxylase inhibitors such as carbidopa – these drugs assist the levodopa by preventing its breakdown before it reaches the brain; there are PD medications that have levodopa and carbidopa in combination
  5. Dopamine agonists – work by mimicking the action of dopamine in the brain
  6. Mao-B inhibitors – act by blocking the chemicals in the brain that promote the breakdown of dopamine
  7. Anticholinergics – work by restoring the balance between dopamine and acetylcholine; they help reduce tremors and muscular rigidity
  8. Surgery in some cases. A surgical procedure called Deep Brain Stimulation (DBS) can be performed. This procedure involves risks for complications; hence it will need to be discussed thoroughly.

Nursing Care Plan for Parkinson’s Disease

Nursing Care Plan 1

Ineffective Airway Clearance related to Parkinson’s disease as evidenced by shortness of breath, SpO2 level of 89%, cough, use of accessory muscles, increased mucus production, difficulty to expectorate phlegm

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within target range (usually above 94%), and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess breath sounds via auscultation.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Suction secretions.To help clear thick phlegm that the patient is unable to expectorate.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed medications (e.g. bronchodilators).Bronchodilators: To dilate or relax the muscles on the airways.  
Elevate the head of the bed and assist the patient to assume high or semi-Fowler’s position as tolerated. Turn the patient every 2 hours.Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively. Turning the patient every 2 hours promotes drainage of lung secretions.
Encourage oral fluid intake of at least 2L per day.To help thin out secretions and make them easier to expectorate.

Nursing Care Plan 2

Impaired physical mobility related to disease process of Parkinson’s disease as evidenced by bradykinesia, cognitive impairment, inability to bear weight, rigidity, tremors, generalized weakness, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness

Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.

InterventionsRationales
Assess the patient’s level of functional mobility and ability to perform ADLs.To assist in creating an accurate diagnosis and monitor effectiveness of  treatment and therapy.
Assist the patient during exercises and when performing activities of daily living.To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach.To maintain patient safety and reduce the risk of falls.      
Encourage the patient to perform range of motion (ROM) exercises in all extremities.To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.
Refer to the physiotherapy and occupational therapy team.To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.

Nursing Care Plan 3

Nursing Diagnosis: Fatigue related to disease process of Parkinson’s 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.

InterventionsRationales
Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep.    Encourage enough rest and sleep, and provide comfort measures.To help the patient balance his/her physical activity and rest periods.   To reserve energy levels and provide optimal comfort and relaxation.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.

Other nursing diagnoses:

  • Disturbed Thought Process
  • Impaired Verbal Communication
  • Risk for Aspiration

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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