NRSG366 Partnerships In Chronicity

Patients with chronic condition have various needs particular to the disease they are suffering. Their needs are identified to accord them the customized care they need. This essay is a discussion of the care needs of Parkinson’s disease. It highlights the health challenges they face and the appropriate interventions that will help the patient cope. It makes references to a case study of Diana who has developed Parkinson’s disease (Martínez-Ramírez & Maraies—Brioeño, 2014). Her needs and the method of intervention to cater for her needs have been discussed. Her history has been reviewed and discussed to detail.

Parkinson’s disease is neuron degenerative disorder whose incidence increases with age in human beings. It affects all sexes although a higher number of incidences have been recorded in males than in females. This disease is associated with a decrease in the levels of dopamine in the neurons in the substantia nigra of the basal ganglia of the brain. This affects the neural pathway in which the neurons project to the corpus striatum (Blesa et al., 2012). Dopamine is the major excitatory neurotransmitter in these neurons. It is involved in regulation of movement and emotional responses. A degenerative change in the neurons in substantia nigra is the major cause or Parkinson’s disease. Low dopamine levels can also result from damage of the neurons that may result from viruses, chemicals such as some herbicides or even repeated head injury. This disease is accompanied by many signs and symptoms that are confirmative of its presence. Tremor is often the most striking one of all. It affects mainly the limbs. Bradykinesia, rigidity in the performance of tasks, for instance, turning around, and poor balance. They experience fatigue and this makes them have general body weakness. Patients often have a gait disorder, which is characterized by shuffling of feet. Patients with Parkinson’s disease require an elaborate nursing plan to manage this condition. Both psychological and medical interventions are important to ensure the well-being of the individuals (Ramanan & Saykin, 2013).

In the case scenario, Diana has care needs that require a nurse’s intervention in order to live a healthy life. She has some mobility problems. She was examined to having gait problems. She stumbled and tripped with no any obvious reason. She was also diagnosed with bradykinesia.  All these symptoms are consistent with impaired mobility which therefore requires nursing interventions. She needs techniques that would initiate movement.in this case rocking from side to side will help to start leg movements. This will be essential in offsetting the stumbling and tripping tendency and consequently improve the movement (Earhart et al., 2012). Parkinson’s disease causes rigidity and tremors as she had initially experienced rendering her unable to move from her sitting position. Balance is affected by the rigidity of the arms and this prevents her from swinging them from side to side. This is evident due to her inability to pick up things when preparing for her science lesson. Due to this problem, she is most likely going to adopt a walking style which will include the shuffling of feet. To offset this; the nurse should teach her to concentrate on assuming an erect gait and using a wide based gait. The nurse should ask her to make a conscious effort to swing her arms and raise the feet while walking and use a heel-toe placement of the feet. Diana is in need of constant exercise. Having regular exercise will prevent contractures that mostly occur when muscles are not used. Diana although has been given a leave from her job, the nurse should ensure she exercises daily. This will improve the coordination and dexterity and therefore offset muscular rigidity (Bertram, 2015). She should be encouraged to carry on with her hobbies. Bushwalking and gardening and participating in outdoor activities with her husband would suit her well as she loves them. This will be an individualized and well-customized exercise program that she is more likely to adhere to. Adherence to exercise help delay the progress of the disease. She requires assistance on how to rise from a sitting position without falling back as it had initially happened while she was watching the television. She should be taught to sit in chairs with backs and arms rest to support themselves when standing. Diana should have warm baths and massages. This will play an important role in relaxing the muscles and relieving the very painful muscle spasms that accompany rigidity (Poryazova et al., 2013).

Her diet should also be a major concern. This is important in achieving functional mobility, achieving optimal bowel elimination and maintaining the required nutritional status. This is crucial in helping the patient cope. The nutritional imbalance may be triggered by changes in musculature, usage of antiparkinsonian drugs, decreased level of consciousness or inability to absorb nutrients because of biologic or psychological factors that accompany aging. Diana is likely to be faced with this condition due to either of the factors. This imbalance may be evidenced by inadequate food intake and decreased muscle mass and decreased peristalsis (Weiner, Shulman & Lang, 2013). To ensure the proper nutritional status is maintained, the patient’s ability to eat should be examined and factors that would affect it analyzed. For instance, low food intake may be associated to the levodopa. Her medication should be reviewed in this case. Her dose of maxolon may not be effective in preventing nausea. An appropriate dose should be prescribed or a different drug prescribed altogether. Her weight should be measured daily to provide information about weight loss or gain and take the appropriate steps if it’s a loss. She should be advised to take her time when taking meals. Eating may become very slow and would consequently require a deliberate effort to focus all the concentration on eating this will help in easing the work of digesting food for the digestive system, which fails with age. Her weight should be measured on a weekly basis. This is to assess whether they meet the average requirement (Fernandez, 2012).

In Diana’s case, the two complex care priorities are fatigue and emotional outburst that she is experiencing. Fatigue is a very common and disabling symptom of Parkinson’s disease. The pathophysiology of fatigue can be explained by some hypothesized mechanisms. One of the mechanisms points out that an imbalance between some neurotransmitters in the brain, that is, dopamine and serotonin. Dopamine deficiency is attributed to fatigue since the communication between the striatum and prefrontal cortex is reliant on dopamine, which is a modulatory neurotransmitter. Fatigue can be classified into two; central and peripheral. Central fatigue refers to reduced central drive from the motor cortex that results from increased inhibitory interneuron input that is influenced by the peripheral system (Pedrosa & Timmermann, 2013).

 Changes in the neuromuscular junction and the muscles attribute to peripheral fatigue. Many body processes are controlled by muscles. Breathing is one major function that is highly dependent on the muscles of breathing. Fatigue of these muscles can bring about difficulty and strains in breathing. It is, therefore, a major concern when it comes to making an effort to manage the fatigue. Managing fatigue is done in many ways as a nurse (Goetz & Pal, 2014). Firstly, establish and identify the body parts affected. Identify whether it is primary or secondary. Identify the treatable factors of the fatigue. The causes may be depression, anxiety, sleep alteration or orthostatic hypertension. In Diana’s case, she felt fatigued and was concerned that she would not go to class. Her inability to stand from a sitting position shows fatigue.in managing it as a nurse I would explain the nature of fatigue to Diana and her husband who is the caregiver. For physical fatigue, she should rest and enjoy the leave from school. This will also eliminate any mental fatigue that may be due to her concern that she would not teach. Mental fatigue can also be avoided by providing emotional support to avoid depression. Physical exercise would also be important in managing fatigue. The exercise should not be very strenuous but should be sufficient.pharmacological intervention would also contribute to the management. Emphasize on the adherence to the drug regimen prescribed by the doctor. Dopaminergic drugs like levodopa are important. Anti-depressants can be administered if the patient if she shows any signs of depression (Tanner, 2013).

The other complex care priority would be managing the emotional outburst. Psychological issues are a great concern in patients with chronic diseases. Diana is evidently having some emotional issues in relation to her health condition. She was having some emotional problems and she could not speak properly. This is most probably due to the things that she wasn’t able to do owing to the fact that she has the disease. The drastic changes that were happening to her might have been worrying and she may have been worried.in her patient history, she has been well for a long time without experiencing many health issues (Isaacson & Chaudhuri, 2013). At her age now, she has to come to terms with the fact that the disease she has is chronic and she is going to have it throughout her life. This information is very sensitive to take in. management of chronic diseases is highly dependent on the attitude of both the patient and the caregiver. A patient will have to be mentally in good health for it to be successful. She must be psychologically stable for there to be progress in treatment. She would need to adhere to the drugs prescribed and the daily exercise recommended. This will help in slowing down the course of disease progression. The caregiver should also be aware of the necessity of the help they are offering. They will spend most of the time with the patient hence their input is crucial. The caregiver should be advised on the best way to handle the patient (Tanner, 2013).

Parkinson’s disease patients need a well-customized treatment program that will be easy for them to adhere to.one that will be quickly integrated into their lifestyle. They need an enabling environment with supportive caregivers. Qualified professionals such as nurses should be present to oversee the progress of the patient and provide the necessary guidance.

References

Bertram, L. (2015). The role of TREM2 R47H as a risk factor for Alzheimer’s disease, frontotemporal lobar degeneration, amyotrophic lateral sclerosis, and Parkinson’s disease. Alzheimer’s & Dementia, 1, 10.

Blesa, J., Phani, S., Jackson-Lewis, V., & Przedborski, S. (2012). Classic and new animal models of Parkinson’s disease. BioMed Research International, 2012.

Earhart, G. M., Ellis, T., Nieuwboer, A., & Dibble, L. E. (2012). Rehabilitation and Parkinson’s disease. Parkinsons Dis, 2012, 371406.

Fernandez, H. H. (2012). Updates in the medical management of Parkinson disease. Cleve Clin J Med, 79(1), 28-35.

Goetz, C. G., & Pal, G. (2014). Initial management of Parkinson’s disease. women, 9, 11.

Isaacson, S. H., & Chaudhuri, K. R. (2013). Morning akinesia and the potential role of gastroparesis–managing delayed onset of first daily dose of oral levodopa in patients with Parkinson’s disease. Eur Neurol Rev, 8(2), 82-4.

Martínez-Ramírez, D., & Maraies—Brioeño, C. A. H. (2014). patients with Parkinson’s disease.

Pedrosa, D. J., & Timmermann, L. (2013). Review: management of Parkinson’s disease. Neuropsychiatr Dis Treat, 9(March), 321-340.

Poryazova, R., Oberholzer, M., Baumann, C. R., & Bassetti, C. L. (2013). REM sleep behavior disorder in Parkinson’s disease: a questionnaire-based survey. J Clin Sleep Med, 9(1), 55-9A.

Ramanan, V. K., & Saykin, A. J. (2013). Pathways to neurodegeneration: mechanistic insights from GWAS in Alzheimer’s disease, Parkinson’s disease, and related disorders. Am J Neurodegener Dis, 2(3), 145-75.

Tanner, C. M. (2013). A second honeymoon for Parkinson’s disease. N Engl J Med, 368(7), 675-6.

Weiner, W. J., Shulman, L. M., & Lang, A. E. (2013). Parkinson’s disease: A complete guide for patients and families. JHU Press.