NUR2300 Evidence Based Nursing Practice

Parkinson is a neurodegenerative disease that affects the central nervous system and individuals lost control over the movement of the limbs and other body parts (Connolly& Lang, 2014). Parkinson’s is a unique disease that has different signs and symptoms and every individual experience different kinds of symptoms. Sometimes, the individual often experiences uncontrollable tremor, and 80% of dopamine-producing cells are lost in this disease (Poewe et al., 2017). However, different countries worldwide show a varying degree of variability in Parkinson’s along concerning gender, age and race. Therefore, this report will focus on the incidence of Parkinson in Australia compared to others, neurological and sensory motor assessment and management in following paragraphs based on the chosen case study.

Discussion:

Prevalence of Parkinson’s disease in Australia as compared to China:

The pieces of evidence and statistical surveys that accumulated from institutions of neuroscience worldwide stated that approximately, there are 10 million individuals or more than that has Parkinson disease. Statistics may differ from actually raw data since a significant number of individuals experiences such as loss of control over anatomical movement without being diagnosed. The prime reason behind undiagnosed Parkinson is that majority of the individuals neglect signs and symptoms; few other are ignorant about Parkinson disease and medical conditions. In Australia, the second most neurological disease prevailed is Parkinson’s after dementia. From the last six year, the prevalence of Parkinson’s disease increased by 17%, and frequency of experiencing Parkinson’s disease observed mostly in male than female (Gangadharan et al.,2017). Parkinson can occur in any age but the first case found in an infant of 3 years, very common with individual age more than 50 as in this case study.Mr. Patrick Drew is 74 who were diagnosed with Parkinson disease. In Australia approximately, 20% of the under 50 individuals suffering from this disease and only 10% of the under 40 % of individuals are diagnosed with Parkinson’s (Garcia et al., 2014). The different quantitative study reported that the incidence of Parkinson’s disease over the ten years is approximately 84% (Leung et al., 2015). A significant number of individual experience sudden tremors since they are unaware of the signs and symptoms of the Parkinson’s. No specific test for detecting Parkinson’s disease efficiently has been found. Therefore, the massive number of individual losing the anatomical movements followed by severe depression. On the other hand, China, one of the technologically advanced country, experiences the highest number of Parkinson’s disease worldwide. Approximately, more than 1 million the total population in China suffered from Parkinson’s disease. Prevalence mainly observed in the age group of 65years (Zhou, Yin & Yang, 2015). A variety of environmental factors, genetics and immunological issue are the predominant cause of Parkinson’s observed in China.  Every year, out of 100,000 individual in the population 1663 experience this neurological disorder (De Lau & Breteler, 2014). The frequency and severity mostly concentrated in the age group of individual more than 50 years old, the specifically older male of 80 years suffers from such neurogenerative disorder. A publication from Chinese journal it is quite evident that gender difference is huge in case of Parkinson’s disease. Approximately, 797 incidences of Parkinson’s disease are observed in the neurological department of China (Zhu et al.,2014). Lack of accurate diagnosis method hindered the actual treatment to prevent such disease.

Neurological, sensory and motor assessment of Parkinson’s disease:

In the above scenario, Mr.patrick Drew demonstrated with Parkinson’s disease. In the evaluation, bradykinesia was detected with gaze limitation. In Parkinson’s disease, slow movement occu that is called bradykinesia. The probable reason is not know, but one study suggested that this slow movement occurs due to the basal ganglia failure (Calabresi et al., 2014). Other symptoms also observed unilateral tremor in right hands. In Parkinson’s majority of the nerve cells gradually broken down or die. However, symptoms might be different for every individual (Del & Braak, 2016). In most of the scenario, due to loss of all neuronal cells the dopamine level of the brain decreases slowly over the time in basal ganglia that leads to the motor deficits (Piray et al., 2014). When dopamine level depleted in mind, motor nerves are unable to control the movement and coordination between different nerves of anatomy. Subsequently, the abnormality of the brain activity observed such as Parkinsonian gait. Most of the nerve cells that produce dopamine give rise lost and give rise to abnormal symptoms of motor nerve. Motor and non-motor abnormal symptoms are most common in the Parkinson’s disease. Over the time, The primary two symptoms observed in the patient were cogwheel rigidity in limb and lead pipe rigidity in the wrist, two most unusual symptoms that confirm the occurrence of disease. Lead pipe rigidity defined as the muscular rigidity where passive movement of body observed in the joints without any fluctuation of it whereas cogwheel rigidity defined as a sudden jerk of muscle then stiffness, fatigue and weakness was found along with severe tremor. He also had increased frequency in coughing and choking during consumption of food as secondary symptoms of Parkinson’s disease. Due to an abnormality in the movement, he had facial bruising and had a periorbital hematoma, which is common in eyes where abnormal high pressure detected in the eye and turned to the black. Over the time, his frequency of falling gradually increases. Over the years, researchers able to identify the single gene mutation that leads to Parkinson’s disease. Radiographic images of the patient suggested non-specific decline (atrophy) with large ventricles in the brain. The large ventricles observed because of the low pressure of the fluid in the brain due to a head injury he has experienced. Om the other hand, MRI report of the patient suggested that the decrease or degeneration of parc compacta of the substania nigra in midbrain. Since, parc compact formed by nerve cells that releases the dopamine, the decreased with confirms the low availability of dopamine in the brain (Shams et al., 2017). Subsequently, the function of the substantia nigra gradually decreases.

Interprofessional care and management of the  Parkinson’s:

Parkinson’s is a common neurological disorder that mostly observed in older individuals especially most abundant in males with the age group of more than 50 years. One of the most significant impairments in the Parkinson’s diseases is the stiffness in the muscle and gaze limitation. Over the years when the majority of the dopamine cells decreases, individual lost all the control over the anatomical movement. Therefore, patients who have Parkinson’s disease require the assistance of health expertise for regular changes. Parkinson’s patients also shows the forgetfulness, dementia and slow thought processes. When a person with Parkinson’s disease admitted in the hospital, nurses are the person that is able to communicate with the patient. They are the person that is able to observe the progress and issues of the patient more closely.

There are specific ways of managing patients with Parkinson’s to ease the uncomfortableness and prevent occurrence of physical injury and mental issues. The management of the Parkinson’s is following:

•    Since patient suffering from Parkinson’s disease experiences muscle stiffness and loss of words, nurses should display patience and communication with the patient’s family to understand the critical issues of Parkinson’s.
•    Due to physical impairment, they need the assistance of nurses. Nurses should give the support to the patient for walking or moving in limbs.
•    Caregivers should monitor any difficulties and the improvement regarding this difficulties.
•    Nurses should take care of the meal of the patients, in the case of liquids such as soups and water straw should be used to reduce the challenges.
•    Nurses should provide foods which are free from caffeine and provide an exact dose of the medicine for avoiding any kinds of side effects (Shin et al., 2017).
•    It should be recommended to the nurses that they should communicate with patient’s family about the disease, take medical histories from the patients and provide the information about treatment procedure of the Parkinson’s disease along with few protocols that needs to follow for proceeding with the treatment procedure.
•    Nurses should give the patient a psychological comfort to ease the mental severe conditions, and if any severe condition needs to address, then they should inform the medical experts about the problem of individuals.
•    Nurses should provide unique activities for overcoming the mental issues they are facing.

Activities such as dancing, any physical exercise for improving movement of the limbs such as yoga, physiotherapy should be encouraged by nurses.

•    It should be recommended to the nurses to communicate with the patient through writing if patient unable to talk due to impairment of facial nerve.

Conclusion:

Thus, it can be concluded that Parkinson is a severe neurodegenerative disease that was predominately effecting population worldwide.  Frequency mostly observed with male population than female. Muscle stiffness due to loss of half of the neuronal cells and subsequent loss of dopamine detected in individuals having Parkinson’s disease. Most patient experience massive loss of dopamine and subsequently, loss motor movement. Main rigidity such as cogwheel rigidity and lead pipe rigidity confirms the occurrence of the Parkinson’s disease. However, Parkinson’s disease is incurable but can be reduced by proper care from healthcare expertise and adequate treatment procedure.

References:

1Calabresi, P., Picconi, B., Tozzi, A., Ghiglieri, V., & Di Filippo, M. (2014). Direct and indirect pathways of basal ganglia: a critical reappraisal. Nature neuroscience, 17(8), 1022.

8De Lau, L. M., & Breteler, M. M. (2014). Epidemiology of Parkinson’s disease. The Lancet Neurology, 5(6), 525-535.

Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. Jama, 311(16), 1670-1683.

Del Tredici, K., & Braak, H. (2016). Sporadic Parkinson’s disease: development and distribution of α?synuclein pathology. Neuropathology and applied neurobiology, 42(1), 33-50.

Gangadharan, S., Chen, S., Cross, E., Chamberlain, T., & Tampiyappa, A. (2017). Prevalence and severity of non-motor symptoms (NMS) of Parkinson’s disease (PD) among patients attending a PD rehabilitation service in rural Queensland, Australia. Journal of the Neurological Sciences, 381, 226-227.

Garcia-Ruiz, P. J., Castrillo, J. C. M., Alonso-Canovas, A., Barcenas, A. H., Vela, L., Alonso, P. S., … & Fernandez, I. M. (2014). Impulse control disorder in patients with Parkinson’s disease under dopamine agonist therapy: a multicentre study. J Neurol Neurosurg Psychiatry, jnnp-2013.

Leung, I. H., Walton, C. C., Hallock, H., Lewis, S. J., Valenzuela, M., & Lampit, A. (2015). Cognitive training in Parkinson disease A systematic review and meta-analysis. Neurology, 10-1212.

Piray, P., Zeighami, Y., Bahrami, F., Eissa, A. M., Hewedi, D. H., & Moustafa, A. A. (2014). Impulse control disorders in Parkinson’s disease are associated with dysfunction in stimulus valuation but not action valuation. Journal of Neuroscience, 34(23), 7814-7824.

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.

Shams, S., Fällmar, D., Schwarz, S., Wahlund, L. O., Van Westen, D., Hansson, O., … & Haller, S. (2017). MRI of the Swallow Tail Sign: A Useful Marker in the Diagnosis of Lewy Body Dementia?. American Journal of Neuroradiology.

Shin, J. Y., & Habermann, B. (2017). Nursing research in Parkinson’s disease from 2006 to 2015: a systematic review. Clinical nursing research, 26(2), 142-156.

Zhou, J., Yin, T., Gao, Q., & Yang, X. C. (2015). A Meta-Analysis on the Efficacy of Tai Chi in Patients with Parkinson’s Disease between 2008 and 2014. Evidence-Based Complementary and Alternative Medicine, 2015.

Zhu, X. L., Chan, D. T., Lau, C. K., Poon, W. S., Mok, V. C., Chan, A. Y., … & Wong, R. K. (2014). Cost-effectiveness of subthalmic nucleus deep brain stimulation for the treatment of advanced Parkinson disease in Hong Kong: a prospective study. World neurosurgery, 82(6), 987-993.