Parkinson’s Disease Nursing Diagnosis and Nursing Care Plan

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 Diagnosis for Parkinson’s Disease

Nursing Care Plan for Parkinson’s Disease 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.

Nursing Interventions for Parkinson’s Disease	Rationales
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 for Parkinson’s Disease 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.

Nursing Interventions for Parkinson’s Disease	Rationales
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 for Parkinson’s Disease 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.

Nursing Interventions for Parkinson’s Disease	Rationales
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.

Nursing Care Plan for Parkinson’s Disease 4

Disturbed Thought Process

Nursing Diagnosis: Disturbed Thought Process related to psychological causes, parkinsonian medications, chronic illness, and depression, secondary to Parkinson’s disease as evidenced by memory impairment, distractibility, inability to perform activities, abnormal lab studies, and insomnia.

Desired Outcomes:

• The patient will be able to express understanding of the factors that may produce depressive reactions.
• The patient will use different techniques that will effectively decrease the amount and frequency of depressive reactions.
• The patient will show compliance to the different therapeutic regimens.

Nursing Interventions for Parkinson’s Disease	Rationale
1. Check for the presence of depressive behaviors, and causative events. Help the patient to familiarize the reality as warranted.	Patients with Parkinson’s disease often experience depression, it may be a reaction to the disorder or may be related to biochemical abnormality.  Identify the specific problem of the patient to establish a proper plan of care. Orienting the patient to reality will help the patient to be aware of himself/herself and the surroundings.
2. Monitor the patient’s vital signs every four hours as well as the patient’s lab studies as needed.	Changes in the patient’s vital signs and lab results that may happen to patients with Parkinson’s disease should be monitored to help prevent complications.
3. Assist and encourage the patient in every effort that is possible to carry out different tasks which involve meeting the patient’s own daily needs to remain independent.	Advise the patient about the need and importance of doing the different tasks that may be needed by the patient to gain independence to manage his or her life. Allow the patient to have more time to speak his or her thoughts.
4. Let the patient have adequate time to ponder and frame responses and use plain and concrete language when talking to the patient.	Patients with Parkinson’s disease may experience delayed thinking and may have trouble understanding. The patient should be given more time to consider a response.
5. Check the patient’s thought process and determine the patient’s attention span and alignment to a location, or time.	It is important to assess the patient’s thought process to determine the degree of sensory integration interference. Sensory integration is important because it is the process in which the patient senses the world around him or her.
6.  Assess and take note of any possible changes in the patient’s behavior.	Checking for any changes in the patient’s behavior is important to reveal if the patient is restless, excessively sensitive, and hyper-vigilant.
7. Measure the patient’s level of anxiety because of the condition.	The patient’s cognitive processes may be changed because of anxiety. Patients with Parkinson’s disease may experience anxiety that may affect the patient’s thought processes. Determining the patient’s level of anxiety will help in managing the patient’s thoughts.
8. Keep a peaceful environment for the patient, which includes reduced stimuli, cold room, dark lighting, and restriction of personnel entering the patient’s room is advised.	Hyperactivity or reflexes and CNS irritability may be reduced if the external stimulus was suppressed and avoided.
9. Check the medications that the patient is currently taking which may affect the patient’s thought process.	Identifying the medications that the patent is currently using for Parkinson’s disease is needed. Identify any misuse of the medications and the side effects that may cause depressive symptoms in the patient. Discuss with the physician the side effects that the patient might be experiencing because of the current medications. The physician may decrease or change the medication if necessary.
10. Practice a non-judgmental attitude towards the patient and actively listen to the patient’s feelings and concerns.	A trusting relationship with the patient should be established to allow the patient to discuss topics that may help him or her to deal with the situation in appropriate ways. Patients with Parkinson’s disease often feel embarrassed, bored, and lonely because of the physical slowness and the great effort that requires even small tasks.

Nursing Care Plan for Parkinson’s Disease 5

Impaired Verbal Communication

Nursing Diagnosis: Impaired Verbal Communication related to the rigidity of facial muscles, lack of stimuli, decreased circulation to the brain, and psychological barriers secondary to Parkinson’s disease as evidenced by stuttering, inability to name words, inability to identify objects, inappropriate verbalization, and facial muscle rigidity.

Desired Outcomes:

• The patient will be able to use other methods to communicate and make his or her needs known. 
• The patient will be able to use techniques and other assistive devices that will help him or her to improve the patient’s ability to communicate.
• The patient will be capable of speaking in an understandable way as much as possible.
• The patient will be able to comprehend communication and will be able to exhibit minimal frustration and anxiety with speech attempts.

Nursing Interventions for Parkinson’s Disease	Rationale
1. Check the patient’s ability to speak, presence of language deficit, cognitive impairment, presence of aphasia, dysarthria, aphonia, dyslalia, or apraxia.	Patients with Parkinson’s disease may experience speech disorders and problems. It is important to identify and assess the patient’s ability and deficits of the patient to speak. This will help in identifying the problems and the speech patterns that will help the nurse to establish a plan of care.
2. Encourage the patient to have a conscious effort to speak slowly. Encourage the patient to face the listener and exaggerate the pronunciation of words, and take a few breaths before speaking.	This method will help in establishing clear communication and speaking to the patient.
3. Assess the patient’s nonverbal communication which includes the patient’s facial grimaces, smiling, pointing, and crying.	Nonverbal communication indicates the patient’s feelings or needs which are expressed when speech is impaired.  Nonverbal cues may be the only method left for the patient to be able to express his or her discomfort.
4. Maintain eye contact, speak slowly and enunciate clearly in a low-pitched tone when communicating with the patient. Give directions and explanations that are simple as possible and use clear and plain words when interacting with the patient.	Allowing the patient to have time to receive and process information, and providing clarity, and brevity, will help in promoting opportunities for a successful speech. It is important to provide simple and clear instructions to avoid misunderstanding because the patient may have difficulty understanding even basic statements.
5.  Avoid and remove stimuli to the patient’s environment and provide a calm and unhurried atmosphere when communicating with the patient.	Reducing unnecessary noise and distractions to the patient’s environment is important to decrease the patient’s frustrations.
6. Repeat questions if needed and use simple and direct questions that require one-word answers.	This will help in promoting the patient’s self-confidence in achieving the degree of speech and communication.
7. Advise the patient to control the length and rate of the phrases, over the articulated words and encourage the patient to separate syllables and emphasize consonants.	This will help the patient to promote speech when dysarthria is present. Dysarthria is the difficulty of the patient to speak due to brain damage that results from the patient’s inability to control the muscles that are used in speech.
8. Allow the patient to express his or her feelings and thoughts without rushing the patient when the patient is speaking.	If the patient is feeling despair, isolated, depressed, and frustrated impaired verbal communication may happen. Therapeutic communication and a sense of trust between the nurse and the patient are important for continuing communication.
9. Encourage the patient, family, and significant others the need to use glasses, hearing aids, and dentures.	Using glasses, hearing aids and dentures will help in promoting communication with patients experiencing sensory and other deficits.
10. Teach the patient, family, and significant others about the facial muscle exercises, such as smiling, and frowning.	Facial expressions are used to communicate by increasing muscle coordination and tone.
11. Teach the patient about therapeutic techniques that will help him or her in dealing with anxiety. These techniques include deep breathing exercises, and speaking with a family member or significant other that will help the patient cope with struggling.	It is important to teach the patient the use of therapeutic techniques and anxiety-relieving techniques to improve the patient’s verbal communication.

Nursing Care Plan for Parkinson’s Disease 6

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of knowledge about Parkinson’s disease, difficulty understanding the disease process, lack of coping skills, and cognitive impairment secondary to Parkinson’s disease as evidenced by verbalization of questions and incorrect information from the patient and family, presence of preventable complications, and inappropriate behavior.

Desired Outcomes:

• The patient and the patient’s family will be able to express an accurate understanding of the disease process, medication regimen, and treatment plan of care for Parkinson’s disease.
• The patient will be able to fulfill the medication regimen and will notify the physician if the patient experiences unusual side effects.
• The patient will be able to prevent injury by demonstrating safety precautions.
• The patient and the family members will identify the need for long-term goals and the potential for end-of-life decisions to be done.

Nursing Interventions for Parkinson’s Disease	Rationale
1. Ask the patient about his or her understanding of the disease process and consider the older patient’s life experiences.	This will provide baseline information about the patient’s understanding to establish and make a plan of care.
2. Teach the patient, family, and significant others about Parkinson’s disease, its signs, and symptoms, treatments, and prevention of complications. Teaching sessions should be limited and should be done in a quiet and productive environment for each session.	Elderly patients may not be aware of the old information and the stigma about Parkinson’s disease that will require the teaching of additional information about the current treatments. An environment with reduced extraneous stimuli will help in learning and will increase the patient’s ability to process new information without distractions. Doing short sessions will allow the patient to learn at his or her speed and will avoid information overload.
3. Instruct the patient and significant others about the medications and the need for compliance with the dosage and schedule. Instruct about the possible side effects of the medication and when to notify the physician.	This will provide knowledge to the patient and the significant others that will help in facilitating compliance with the treatment regimen. Serious adverse effects from the medication will be identified as soon as possible to prevent complications.
4. Allow the patient and the family to ask questions and voice out concerns. Answer the questions honestly and correctly.	Providing correct information is important for the family and the patient. Adequate knowledge about the condition will help the patient once he or she is discharged from the hospital.
5. Involve the patient and the family when creating the teaching plan for the condition. Begin with the establishment of objectives and goals that will help in learning before the session.	Goals should be set first to allow the patient to know what will be discussed and what they can expect during the session.
6. Ask and consider what is important to the patient.	The most significant content should be identified first to make the teaching effective.
7. Evaluate the patient’s and the family’s reactions and feelings about the condition and the changes.	Assessing the patient and family’s reaction to the condition will help the nurse know how the patient and the family may respond to the information that will possibly affect the success of the intervention.
8.  Provide information using media such as visual aids, diagrams, pictures, videotapes, and audiotapes.	The patient and the family may understand information through these aids more easily. Check the availability of the aids and supplies that may be used when teaching.
9. When teaching the patient and the family starts with the basic, familiar, simple, and concrete information with less familiar complex ones. Focus the teaching of the patient on a single idea or concept.	This method will help the patient understand teaching more easily and will focus more on concepts that should be first discussed.
10. Teach the patient and the family about the need for long-term planning for the patient.	Explain to the patient and his or her family that the disease is chronic and the patient may be severely impaired and there may be issues that may occur in the future.  This information should be discussed to help the family and the patient to make informed choices while the patient is still capable of understanding the severity of the condition.

More Parkinson’s Disease Nursing Diagnosis

• Risk for Aspiration

Nursing References

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. (2022). 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. (2020). 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

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