Nursing Care Plan for Parkinson's Disease

Parkinson's Disease

Parkinson's disease is one of a larger group of neurological conditions called motor system disorders. Historians have found evidence of the disease as far back as 5000 B.C. It was first described as "the shaking palsy" in 1817 by British doctor James Parkinson. Because of Parkinson's early work in identifying symptoms, the disease came to bear his name.

In the normal brain, some nerve cells produce the chemical dopamine, which transmits signals within the brain to produce smooth movement of muscles. In Parkinson's patients, 80 percent or more of these dopamine-producing cells are damaged, dead, or otherwise degenerated. This causes the nerve cells to fire wildly, leaving patients unable to control their movements. Symptoms usually show up in one or more of four ways :

• tremor, or trembling in hands, arms, legs, jaw, and face
• rigidity, or stiffness of limbs and trunk
• bradykinesia, or slowness of movement
• postural instability or impaired balance and coordination.

Though full-blown Parkinson's can be crippling or disabling, experts say early symptoms of the disease may be so subtle and gradual that patients sometimes ignore them or attribute them to the effects of aging. At first, patients may feel overly tired, "down in the dumps," or a little shaky. Their speech may become soft and they may become irritable for no reason. Movements may be stiff, unsteady, or unusually slow.

Symptoms

Tremors- the most noticeable early symptom. It often begins very localised, such as in a finger of one hand. Over time it spreads throughout the whole arm. Tremors often occur when the limb is at rest or when held in a stiff, unsupported position. Tremors also may occur in the lips, feet or tongue.

Bradykinesia- slowness of motion. The individual's movements become increasingly slow and over time muscles may randomly "freeze".

Akinesia- muscle rigidity. Often begins in the legs and neck. These muscles become very stiff. When it affects the muscles of the face the individual adopts a mask like stare.

Digestion problems- the ability to process food slows down, resulting in low energy and constipation.

Depression- Parkinson's causes chemical changes in the brain that may result in depression. This can be an early warning sign, but as depression becomes more common in older adults, it is not often associated with the disease.

Low Blood Pressure- can result in light headedness and fainting.

Temperature sensitivity- perception of temperature can be affected, and may result in hot flashes and excessive sweating.

Leg discomfort- some patients report burning sensations and cramp in the legs.

Balance- There is a progressive loss of coordination and sense of balance, putting the individual at risk of falls.

Source : www.parkinsons.org

Nursing Care Plan for Parkinson's Disease

Nursing Assessment for Parkinson's Disease

1. Assess cranial nerves, cerebral function (coordination) and motor function.
2. Observation of gait and while doing the activity.
3. Review the history of symptoms and their effects on body functions.
4. Assess the clarity and speed of speech.
5. Review the signs of depression.

Nursing Diagnosis for Parkinson's Disease

1. Impaired physical mobility related to muscle stiffness and tremors are marked with :
   Subjective data: client said it was difficult to do activities
   Objective Data: tremors while on the move
2. Impaired compliance with nutrition: less than body requirements related to the difficulty: moving food, chewing, and swallowing, marked with
   Subjective data: client said it was difficult to eat, weight loss
   Objective Data: thin, weighing less than 20% ideal body weight, pale conjunctiva, and mucous membranes pale.
3. Verbal communication disorders related to decreased ability to speak and is characterized by facial muscle stiffness
   Subjective data: client / family say the difficulty in speaking
   Objective Data: elusive words, stony-faced.