Parkinson’s disease (PD) presents unique challenges for nursing care, requiring a comprehensive understanding of both motor and non-motor symptoms. This progressive neurodegenerative disorder affects approximately 1 million Americans, with 60,000 new cases diagnosed annually. As a nurse, your role in managing PD patients is crucial for maintaining quality of life and preventing complications.
Understanding Parkinson’s Disease
Parkinson’s disease occurs when dopamine-producing neurons in the substantia nigra degenerate, leading to decreased dopamine levels. This neurotransmitter deficiency results in characteristic motor symptoms and various systemic complications.
Risk Factors:
- Advanced age (typically onset after 60)
- Genetic predisposition
- Male gender
- Environmental exposures (pesticides, industrial chemicals)
- History of head trauma
Primary Clinical Manifestations:
- Cardinal motor symptoms (tremor, rigidity, bradykinesia, postural instability)
- Non-motor symptoms (cognitive changes, depression, sleep disorders)
- Autonomic dysfunction
- Speech and swallowing difficulties
Comprehensive Nursing Care Plans
1. Risk for Falls
Nursing Diagnosis: Risk for Falls related to impaired balance, postural instability, and altered gait pattern.
Related Factors:
- Muscle rigidity
- Bradykinesia
- Postural instability
- Freezing of gait
- Environmental hazards
Nursing Interventions and Rationales:
Conduct fall risk assessment using standardized tools
- Enables early identification of high-risk patients
Implement environmental safety measures
- Remove obstacles
- Ensure adequate lighting
- Install grab bars
Establish an exercise program focusing on balance
- Improves muscle strength and coordination
Monitor medication timing and effects
- Optimal medication management reduces fall risk
Educate about the proper use of assistive devices
- Promotes safe mobility and independence
Desired Outcomes:
- Patient maintains balance during activities
- Zero falls during hospitalization
- Demonstrates proper use of assistive devices
- Successfully navigates environment safely
2. Impaired Physical Mobility
Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular impairment and tremors.
Related Factors:
- Muscle rigidity
- Tremors
- Decreased strength
- Fear of falling
- Fatigue
Nursing Interventions and Rationales:
Assess mobility status regularly
- Tracks disease progression and intervention effectiveness
Implement a progressive mobility program
- Maintains muscle strength and joint flexibility
Coordinate physical therapy sessions
- Improves functional mobility and independence
Teach energy conservation techniques
- Reduces fatigue and maintains activity tolerance
Monitor for signs of skin breakdown
- Prevents complications from decreased mobility
Desired Outcomes:
- Maintains optimal level of mobility
- Participates in daily activities
- Demonstrates improved muscle strength
- Reports decreased fatigue levels
3. Self-Care Deficit
Nursing Diagnosis: Self-Care Deficit related to neuromuscular impairment and decreased motor function.
Related Factors:
- Tremors
- Muscle rigidity
- Fatigue
- Cognitive impairment
- Depression
Nursing Interventions and Rationales:
Assess self-care abilities using standardized tools
- Identifies specific areas needing assistance
Provide adaptive equipment
- Promotes independence in ADLs
Establish a consistent daily routine
- Reduces anxiety and improves task completion
Teach compensatory techniques
- Enables greater independence
Involve occupational therapy
- Develops specialized strategies for ADLs
Desired Outcomes:
- Demonstrates improved independence in ADLs
- Uses adaptive equipment effectively
- Maintains personal hygiene
- Reports satisfaction with self-care ability
4. Impaired Swallowing
Nursing Diagnosis: Impaired Swallowing related to neuromuscular impairment and decreased coordination.
Related Factors:
- Decreased muscle control
- Delayed swallowing reflex
- Cognitive impairment
- Medication side effects
Nursing Interventions and Rationales:
Perform swallowing assessment
- Identifies specific swallowing difficulties
Implement dysphagia precautions
- Prevents aspiration
Position patient upright during meals
- Facilitates safe swallowing
Modify food/fluid consistency
- Ensures safe oral intake
Coordinate with speech therapy
- Develop specialized swallowing strategies
Desired Outcomes:
- Maintains adequate nutrition
- Demonstrates safe swallowing techniques
- No episodes of aspiration
- Reports improved swallowing ability
5. Chronic Pain
Nursing Diagnosis: Chronic Pain related to muscle rigidity and postural changes.
Related Factors:
- Muscle rigidity
- Joint stiffness
- Postural deformities
- Decreased mobility
Nursing Interventions and Rationales:
Assess pain using appropriate scales
- Ensures accurate pain evaluation
Implement pain management strategies
- Reduces discomfort and improves function
Apply heat/cold therapy as appropriate
- Provides symptomatic relief
Teach relaxation techniques
- Reduces muscle tension
Monitor medication effectiveness
- Ensures optimal pain control
Desired Outcomes:
- Reports decreased pain levels
- Maintains functional mobility
- Demonstrates effective pain management strategies
- Improved quality of life
Evidence-Based Practice Recommendations
Current research emphasizes the importance of early intervention and comprehensive care planning. Regular assessment and modification of care plans ensure optimal outcomes for PD patients.
References
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- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Lum HD, Jordan SR, Brungardt A, Ayele R, Katz M, Miyasaki JM, Hall A, Jones J, Kluger B. Framing advance care planning in Parkinson disease: Patient and care partner perspectives. Neurology. 2019 May 28;92(22):e2571-e2579. doi: 10.1212/WNL.0000000000007552. Epub 2019 Apr 26. PMID: 31028124; PMCID: PMC6556088.
- Martello J, Shulman LM, Barr E, Gruber-Baldini A, Armstrong MJ. Assessment of Parkinson disease quality measures on 12-month patient outcomes. Neurol Clin Pract. 2020 Feb;10(1):58-64. doi: 10.1212/CPJ.0000000000000745. PMID: 32190421; PMCID: PMC7057067.
- Nunes SFL, Alvarez AM, Valcarenghi RV. Parkinson’s disease in primary health care and nursing care: a scoping review. Rev Esc Enferm USP. 2022 Mar 11;56:e20210367. doi: 10.1590/1980-220X-REEUSP-2021-0367. PMID: 35293943; PMCID: PMC10081600.
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