Discussion
Discusss about the Parkinso Disease Long Term Neurodegenerative Disorder.
Parkinson’s disease is a long-term neurodegenerative disorder that results in the progressive loss of dopaminergic neurons and formation of lewy bodies (Zaltieri et al., 2015). Pre symptoms of this disease includes slowness in movement, trembling, tremors at rest, rigidity and stiffness in body and walking problems. In the given case study, Patrick who is 66 years old, has diagnosed by his neurologist that he is suffering from early onset Parkinson’s disease. He is on medication and runs 5 Km on each day. This essay will focus on the impact of this incurable Parkinson’s disease, some safety attentionsfor this stage of the disease route, healthcare interventions and lastly on some referral made to the service available in community.
Parkinson’s disease is a chronic neurodegenerative disorder that targets motor neurons and hampers the mobility of an individual. Patrick, who is 66 years old is suffering from the same disease and experiences slight tremor in the right hand, reduction in quality of sleep and decrease in the perception of smell for two weeks. His neurologist diagnosed this as the early onset of Parkinson’s disease. He currently works as a primary school teacher and lives with his supportive husband. He is fit enough, runs 5 km per day and is not regular in taking medications, but now, due the diagnosis of Parkinson’s disease in commencing Levodopa 50 mg for three times a day and 0.5mg Clonazepam. All these issues are quite relevant to Pratrick. Due to tremor experienced in right hand, he will no longer be able to continue his normal household activities, his reduction in the quality of sleep will hamper his regular activities of enjoyment like running 5 km per day. Moreover, this adequate quality of sleep will further exacerbate his capability to take part in social activities and will decrease appetite. Establishment of skills and understanding of person-centered care should include the identification of strength and power of the older adult in order to increase their independence and to reduce the impact of disease and disability(Moyle, Parker& Bramble, (2014).The community based supports and strategies should be promoted to increase the holistic wellbeing of the patient.
Patrick is suffering from symptoms like tremor in right hand, decreased smell sensation and sleep quality. The first issue is tremor at rest. The first intervention that is to be done by registered nurse includes advising patient to maintain the arm close to the body since stability that is more proximal will minimize the constant tremor while performing various functional activities. A registered nurse can also advice the patient to stabilize the arms on a surface while working as this will also help him to manage tremors.The second intervention includes keeping a record of patient’s tremor that will enable registered nurse to track the time and severity of occurrence of tremor. Registered nurse should instruct patient to complete his daily activities in daytime when there is less severity of tremor present. The third intervention that can be done is to check whether patient is taking proper medication on scheduled time as prescribed by the doctor. Patient should manage anxiety, stress, fatigue and frustration since this can worsen the tremor condition more. He should take deep breath while feeling stressed, that may manage the tremor effectively. The fourth intervention includes nurses should supply adaptive equipment like rocker knives and button hooks to improve motor skills.
Primary healthcare nursing interventions
The second issue is that the patient is suffering from decreased sense of smell that is a nonmotor symptom observed in Parkinson’s disease (El Rassi et al., 2016). The first intervention to be taken to assess this symptoms is to perform the brief smell identification test (BSIT) that is used to evaluate the olfactory function (Shrestha et al., 2017). The second intervention that is to be taken by registered nurse includes proper counselling of patient that may improve the condition of smell dysfunction (Kalogjera& Dzepina, 2012). Third intervention includes registered nurse should enrich patient’s diet with foods that are rich in vitamin A, B6, B12 since the deficiency of this factor are responsible for impairment of smell. Fourth intervention that a registered nurse can do is to check whether the patient is taking correct medications for smell disorder like tropical corticosteroids as prescribed by the doctor (Wu et al., 2015).
The third issue that he is suffering from is decreased quality of sleep. The first intervention includes the registered nurse should assess the pattern of sleep disturbances that is caused due to the environment since this disturbances in sleep may reduce the recovery rate of the disease. A generator with soothing sound like sounds of ocean, rainfall and waterfall can be used that may induce sleep. The second intervention includes taking feedback from the patient about the daily bedtime routine, for how many hours the patient is sleeping and the usual sleep pattern. Third intervention includes caring patient without waking him up. Registered nurse should provide care when the patient is awake. They can provide an efficient back massage to patient that can increase the quality of sleep as suggested by researchers (Pinar& Afsar, 2015).The fourth intervention includes the reduction in daytime napping during late afternoon. Patient should limit his sleep to short interval in daytime.
Patrick is suffering from tremor at rest and this can be reduced if he stabilizes his arm on the surface while working. Recent studies suggested that involuntary control can be controlled by placing the wrist attached to an apparatus that will lock the movement of the arm (Murnaghan et al., 2016). Patrick is also suffering from decreased sensation of smell and this can be cured by giving Vitamin B supplements to patient. According toHåglin et al., ( 2017), a low level of thiamin and folate density is linked with olfactory dysfunction in patient suffering from Parkinson’s disease. The last issue that the patient is suffering from is reduced quality of sleep. This can be improved by increasing the amount of physical activity and decreasing the amount of sleep in daytime (Wu et al., 2105). Research evidences suggested that an intervention of back massage for 15 minutes in a week, which is a non-pharmaceutical therapy, is effective in increasing the quality of sleep.
Evidence based practice rationale
For the issue of tremor, Patrick and Michael should consult a physiotherapist (WHO). Research evidence suggested that physiotherapist enable patient to maintain their mobility at maximum level (Tomlinson et al., 2012). This therapy will enrich Patrick’s confidence to continue his regular activities with ease (WHY). Patrick is suffering from early onset of Parkinson’s disease, so, it will be better if he starts taking physiotherapy at the earliest. His immediate action is required to maximize his mobility level and will be effective if he starts this therapy within one week (WHEN).Health care should provide one trained physiotherapist and is a free program. Patrick and Michael should avail this facility for the physical well being of Patrick (HOW). For the issue of smell dysfunction, they should consult a counselor who can help Patrick to increase his perception of smell by proper counseling. A dietician can also help him making a proper diet plan that includes foods rich in Vitamin B (WHO). Proper counseling and a diet plan that include Vitamin B can help Patrick to overcome his problem of smell dysfunction that mainly results due to Vitamin B deficiency( WHY). This should be done by Patrick immediately since he is suffering from early onset of the disease (WHEN). A well-trained counselor and dietician will be arranged by health care services that are free of cost (HOW). The last issue that he is facing is deprivation of sleep. For increasing the quality of sleep, they must take help from a skilled yoga trainer who can train him in performing meditation (WHO). Research suggested that a mindfulness meditation in effective in increasing the quality of sleep (Black et al., 2015). This increased quality of sleep will enable him to cope the disease efficiently (WHY). Patrick is suffering from decreased quality of sleep and his immediate action may give a positive result to overcome his problem (WHEN).Health care will arrange one mindful awareness practice program and a sleep hygiene education for Patrick that will be free of cost in order to prevent the progression of his disease (HOW).
|
Diagnosis |
PHC Nursing 1X |
Evidence based practice rationale |
Referral |
|
Tremors in the right hand |
To reduces the chances of fall in the patient due to loss of grip |
Due to loss of effective holding capacity the patient may face difficulty in holding onto railings while climbing stairs resulting a bad fall in the patient |
WHO: the patient could be provided support and care services form community based nurses who could help the patient with the activities of daily living |
|
To reduce the chances of disability or paralysis due to losing grip of the right hand |
The patient should be restricted from picking and lifting of heavy objects as it may cause further stress upon the nerve and muscles |
WHY: lifting heavy objects could trigger further shaking in the hands by sensitizing the nerves further. |
|
|
Restricted or less movements due to inability to hold objects |
The patient could be suggested physiotherapy on a regular basis to check the progression of the Parkinson’s disease |
WHEN: the therapy could be started as soon as possible as the patient is still in the early stage |
|
|
NA |
HOW: the patient could be referred to a community based health care center where the physiotherapist appointed for the patient could be sent to the home of the patient directly to give the treatment. |
|
Diagnosis |
PHC Nursing 1X |
Evidence based practice rationale |
Referral |
|
Decreased sense of smell |
Reduced appetite |
The decrease smell could diminish the desire to eat in the patient (Poewe et al., 2017) |
WHO: the patient could be referred to a neurologist for providing with a long term care plan |
|
Lessen the response to surroundings |
The patient would not be able to sense foul or nice smell which could impair the responses to the surroundings |
WHY: the patient was suffering from progressive parkinson’s therefore immediate care was needed. |
|
|
Increase tendency to nausea in the patient |
The inability to decipher a proper smell could initiate reactions within the patient such as nausea (Fox et al., 2018) |
WHEN: the treatment could be followed up on a monthly basis initially in order to stabilize the condition of the patient |
|
|
Loss of function of taste buds |
With the inability to decipher smell the taste buds may be less responsive |
HOW: the patient could be referred to by the community nurse to the clinic. |
|
Diagnosis |
PHC Nursing 1X |
Evidence based practice rationale |
Referral |
|
Poor quality of sleep |
Risk of cerebral stroke |
As the patient had developed Parkinson’s; sleep serves as a medicine which could relax the nerves. The lack of sleep increases the chances of cerebral stroke |
WHO: the patient could be referred to a counselor who could help initiate sleep within the patient with the help of therapeutic approaches |
|
Risk of cardiac stroke |
Less sleep could affect cardiac health of the patient enhancing the chances of stroke (Tarazi, Sahli, Wolny & Mousa, 2014) |
WHY: this is because the holistic approaches have long term effect compared to the strictly pharmacological interventions |
|
|
Inability to perform activities of daily living |
The fatigue due to lack of sleep may prevent Patrick from performing the activities of daily living effectively |
WHEN: the counseling sessions could be organized within the community centers only alongside the pharmacological treatment |
|
|
Reduced thinking power |
The less sleep and fatigue may affect the thinking and cognition skills of the patient (Grover, Somaiya, Kumar & Avasthi, 2015) |
HOW: the free program could be organized for Patrick by a call to the director of the community center b the attending nurse |
|
Diagnosis |
PHC Nursing 1X |
Evidence based practice rationale |
Referral |
|
Maintaining the dignity of the patient |
Low self esteem in the patient |
The inability to lead a normal life could to development of self resentment within the patient |
WHO: the patient should be supported by special care nurses who are effectively trained to deal with specific areas. Additionally, the gender of the patient should be taken into consideration during recruitment of the attending support care as it may cause safety as well as privacy concerns (Miller & O’Callaghan, 2015). |
|
Less trust /conflict with the care and support providers |
The patient may ask to complete autonomy over his daily life; however the inability to move effectively may cause the support carers to restrict the freedom of the patient to move around freely |
WHY: Interaction with a friendly and same gender nursing professional will also help in providing effective emotional support which will help in boosting the mental health of the patient. |
|
|
Social isolation; development of depression |
The inability to move like before can cause the Patient shift into social isolation |
WHEN: the support and care services extending to personal hygiene should only be provided after the due consent of the patient and their respective family members |
|
|
Resignation from daily life activities |
The tremors in the right hand may cause Patrick scared to lift objects to use his hands otherwise; making him dependent upon the support carer fort basic activities like bathing, cleaning , which could lead to privacy concerns |
HOW: the service could be asked for from the local community centers by direct referral through GP. |
Conclusion
From the above discussion this can be deduced that though Patrick is suffering from early onset of Parkinson’s disease yet some changes in his lifestyle may help him to control the progression of the disease. This essay highlighted some non-pharmaceutical remedies apart from some biomedical remedies. Lastly, some referrals are also suggested that may help Patrick and his supportive husband to cope with the disease.
Referral
References
Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA internal medicine, 175(4), 494-501.
El Rassi, E., Mace, J. C., Steele, T. O., Alt, J. A., Soler, Z. M., Fu, R., & Smith, T. L. (2016, March). Sensitivity analysis and diagnostic accuracy of the Brief Smell Identification Test in patients with chronic rhinosinusitis. In International forum of allergy & rhinology (Vol. 6, No. 3, pp. 287-292).
Fox, S. H., Katzenschlager, R., Lim, S. Y., Barton, B., de Bie, R. M., Seppi, K., … & Movement Disorder Society Evidence?Based Medicine Committee. (2018). International Parkinson and movement disorder society evidence?based medicine review: Update on treatments for the motor symptoms of Parkinson’s disease. Movement Disorders.
Grover, S., Somaiya, M., Kumar, S., & Avasthi, A. (2015). Psychiatric aspects of Parkinson’s disease. Journal of neurosciences in rural practice, 6(1), 65.
Håglin, L., Johansson, I., Forsgren, L., & Bäckman, L. (2017). Intake of vitamin B before onset of Parkinson’s disease and atypical parkinsonism and olfactory function at the time of diagnosis. European journal of clinical nutrition, 71(1), 97.
Kalogjera, L., & Dzepina, D. (2012). Management of smell dysfunction. Current allergy and asthma reports, 12(2), 154-162.
Miller, D. B., & O’Callaghan, J. P. (2015). Biomarkers of Parkinson’s disease: present and future. Metabolism-Clinical and Experimental, 64(3), S40-S46.
Moyle, W., Parker, D., & Bramble, M. (2014). Care of older adults: A strengths-based approach. Cambridge University Press.
Murnaghan, C. D., Carpenter, M. G., Chua, R., & Inglis, J. T. (2016). Keeping still doesn’t “make sense”: examining a role for movement variability by stabilizing the arm during a postural control task. Journal of neurophysiology, 117(2), 846-852.
Pinar, R., & Afsar, F. (2015). Back massage to decrease state anxiety, cortisol level, blood pressure, heart rate and increase sleep quality in family caregivers of patients with cancer: a randomized controlled trial. Asian pacific journal of cancer prevention, 16(18), 8127-8133.
Poewe, W., Seppi, K., Tanner, C. M., Halliday, G. M., Brundin, P., Volkmann, J., … & Lang, A. E. (2017). Parkinson disease. Nature reviews Disease primers, 3, 17013.
Shrestha, S., Kamel, F., Umbach, D. M., Freeman, L. E. B., Koutros, S., Alavanja, M., … & Chen, H. (2017). Nonmotor symptoms and Parkinson disease in United States farmers and spouses. PloS one, 12(9), e0185510.
Tarazi, F. I., Sahli, Z. T., Wolny, M., & Mousa, S. A. (2014). Emerging therapies for Parkinson’s disease: From bench to bedside. Pharmacology & therapeutics, 144(2), 123-133.
Tomlinson, C. L., Patel, S., Meek, C., Clarke, C. E., Stowe, R., Shah, L., … & Ives, N. (2012). Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev, 8(8).
Wu, X., Tao, S., Zhang, Y., Zhang, S., & Tao, F. (2015). Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PloS one, 10(3), e0119607.
Zaltieri, M., Longhena, F., Pizzi, M., Missale, C., Spano, P., & Bellucci, A. (2015). Mitochondrial dysfunction and-synuclein synaptic pathology in Parkinson’s disease: who’s on first?. Parkinson’s Disease, 2015
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