Nursing Care Plan (NCP) for Parkinson’s Disease
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Lesson Objective for Nursing Care Plan (NCP) on Parkinson’s Disease
- Understanding Parkinson’s Disease (PD):
- Objective: Develop a comprehensive understanding of Parkinson’s Disease, including its etiology, pathophysiology, and the impact on the individual’s motor and non-motor functions.
- Methods: Study medical literature, consult with healthcare providers, and engage in educational resources to gain insights into the complexities of PD.
- Assessment of Individual Needs:
- Objective: Perform a thorough assessment of the specific needs and challenges faced by the individual with Parkinson’s Disease.
- Methods: Conduct a comprehensive nursing assessment, including a detailed medical history, physical examination, and collaboration with the healthcare team to identify both motor and non-motor symptoms affecting the patient.
- Developing a Person-Centered Care Plan:
- Objective: Formulate a person-centered care plan tailored to address the unique needs, goals, and preferences of the individual with Parkinson’s Disease.
- Methods: Collaborate with the patient, their family, and interdisciplinary healthcare professionals to create a holistic care plan that considers both pharmacological and non-pharmacological interventions.
- Implementation of Multidisciplinary Interventions:
- Objective: Implement a multidisciplinary approach to managing Parkinson’s Disease, incorporating medications, physical therapy, occupational therapy, and psychosocial support.
- Methods: Coordinate with various healthcare professionals, such as neurologists, physical therapists, and social workers, to ensure a comprehensive and coordinated approach to care.
- Ongoing Evaluation and Adaptation:
- Objective: Continuously evaluate the effectiveness of the care plan and make necessary adaptations to address evolving needs and optimize the individual’s quality of life.
- Methods: Regularly assess motor and non-motor symptoms, monitor medication responses, and engage in open communication with the patient and their support system to gather feedback on the impact of interventions.
Pathophysiology of Parkinson’s Disease
- Dopaminergic Neuron Degeneration:
- Primary Feature: Parkinson’s Disease is characterized by the progressive degeneration of dopaminergic neurons in the substantia nigra, a region of the brain involved in movement control.
- Consequence: Loss of dopamine-producing neurons leads to a deficiency of dopamine, a neurotransmitter critical for coordinating smooth and controlled movements.
- Formation of Lewy Bodies:
- Pathological Inclusions: Lewy bodies, abnormal protein aggregates primarily consisting of alpha-synuclein, accumulate within neurons.
- Impact: Lewy bodies disrupt normal cellular function and are associated with the death of dopaminergic neurons, contributing to the development of motor symptoms.
- Striatal Dopamine Deficiency:
- Resultant Effect: With the progressive loss of dopaminergic input, there is a significant reduction in dopamine levels within the striatum, a brain region responsible for regulating voluntary movements.
- Motor Impairments: Striatal dopamine deficiency leads to motor impairments, including tremors, rigidity, bradykinesia (slowness of movement), and postural instability.
- Neurotransmitter Imbalance:
- Dopamine-Acetylcholine Imbalance: The imbalance between dopamine and acetylcholine, another neurotransmitter, disrupts the normal signaling in the basal ganglia, influencing motor control and coordination.
- Non-Motor Symptoms: Neurotransmitter dysregulation contributes to non-motor symptoms, such as cognitive impairment and psychiatric disturbances.
- Spread of Pathology to Other Brain Regions:
- Progressive Nature: The pathology of Parkinson’s Disease can extend beyond the substantia nigra, affecting other brain regions.
- Non-Motor Manifestations: In addition to motor symptoms, PD can involve non-motor manifestations, including autonomic dysfunction, sleep disturbances, and mood disorders, reflecting the widespread impact of neurodegeneration.
Etiology of Parkinson’s Disease
- Idiopathic Nature:
- Primary Cause: The majority of Parkinson’s Disease cases are idiopathic, meaning the exact cause is unknown.
- Complex Interaction: Genetic and environmental factors likely interact in a complex manner, contributing to the development of the condition.
- Genetic Factors:
- Familial Links: Some cases of PD have a familial component, suggesting a genetic predisposition.
- Genes Involved: Mutations in specific genes, such as SNCA (alpha-synuclein), LRRK2, and PARKIN, have been implicated in familial forms of the disease.
- Environmental Factors:
- Pesticide Exposure: Long-term exposure to certain pesticides and herbicides has been associated with an increased risk of developing PD.
- Toxin Exposure: Exposure to environmental toxins, including heavy metals like manganese and certain industrial chemicals, may contribute to the risk.
- Age as a Risk Factor:
- Prevalence with Age: The incidence of Parkinson’s Disease increases with age, with the majority of cases diagnosed in individuals over the age of 60.
- Age-Related Changes: Aging processes and cumulative cellular damage may contribute to the vulnerability of dopaminergic neurons.
- Inflammatory and Neurodegenerative Processes:
- Role of Inflammation: Chronic neuroinflammation and immune system dysfunction may play a role in the development and progression of PD.
- Neurodegenerative Cascade: The interplay of inflammatory responses and neurodegenerative processes contributes to the selective loss of dopaminergic neurons.
Desired Outcome for Parkinson’s Disease
- Improved Motor Function:
- Reduced Tremors: Aim for a significant reduction in tremors, allowing for improved motor control and coordination.
- Enhanced Mobility: Increase the ability to perform daily activities, such as walking and reaching, with greater ease.
- Enhanced Quality of Life:
- Improved Independence: Foster independence in daily living activities, minimizing reliance on caregivers or assistive devices.
- Emotional Well-being: Promote emotional and psychological well-being, addressing any mood disturbances and enhancing overall quality of life.
- Optimized Medication Management:
- Balanced Medication Effects: Achieve a balance in medication management to control symptoms effectively while minimizing side effects.
- Consistent Symptom Control: Maintain a stable control of Parkinson’s symptoms, preventing fluctuations in motor function.
- Cognitive and Emotional Stability:
- Preserved Cognitive Function: Aim to preserve cognitive abilities and slow the progression of cognitive decline often associated with PD.
- Emotional Stability: Address and manage emotional aspects, such as depression and anxiety, contributing to an overall stable mental state.
- Patient and Caregiver Education:
- Empowered Patients: Educate individuals with PD and their caregivers about the condition, empowering them to actively participate in their care.
- Adaptive Strategies: Provide strategies and resources for adapting to the evolving challenges of living with Parkinson’s Disease.
Parkinson’s Disease Nursing Care Plan
Subjective Data:
- Weakness
- Fatigue
- Feeling “heavy”
- Feeling “stiff”
- Difficulty swallowing
Objective Data:
- Pill-rolling tremor
- Shuffling gait
- Lip smacking
- Bradykinesia – slow movements
- Akinesia – loss of voluntary movement
- Blank facial expression
- Drooling
- Dysphagia
Nursing Assessment for Parkinson’s Disease
- Motor Function:
- Observation of Tremors: Assess the presence, severity, and characteristics of tremors in various parts of the body.
- Gait and Balance: Evaluate gait patterns and balance to identify any abnormalities or difficulties in walking.
- Activities of Daily Living (ADLs):
- Functional Independence: Assess the patient’s ability to perform ADLs independently, including dressing, grooming, and eating.
- Fine Motor Skills: Evaluate fine motor skills, such as writing and handling small objects.
- Medication Management:
- Review of Medication Regimen: Assess the patient’s understanding and adherence to the prescribed medication regimen.
- Identification of Side Effects: Monitor for any side effects or adverse reactions related to Parkinson’s medications.
- Cognitive Function:
- Memory and Cognitive Assessment: Evaluate memory, attention, and other cognitive functions to identify any signs of cognitive decline.
- Mood and Emotional State: Assess the patient’s emotional well-being, including the presence of depression, anxiety, or mood swings.
- Speech and Swallowing:
- Speech Patterns: Evaluate speech patterns, looking for changes such as slurred speech or a softening of voice.
- Swallowing Function: Assess swallowing function to identify any difficulties or risk of aspiration.
- Orthostatic Hypotension:
- Blood Pressure Monitoring: Monitor blood pressure in various positions to detect orthostatic hypotension, a common issue in Parkinson’s patients.
- Sleep Patterns:
- Sleep Quality: Assess the patient’s sleep patterns, including the presence of insomnia or disruptions in sleep.
- Support System:
- Family and Caregiver Involvement: Evaluate the level of support from family and caregivers and assess their understanding of the patient’s needs.
Implementation for Parkinson’s Disease
- Medication Administration:
- Timely Administration: Ensure that Parkinson’s medications are administered on time as prescribed to maintain consistent symptom control.
- Monitoring Effects: Regularly assess the patient for medication effectiveness and potential side effects, adjusting dosages as needed in collaboration with the healthcare team.
- Mobility and Exercise:
- Physical Therapy Referral: Collaborate with physical therapists to develop and implement exercise programs focused on maintaining and improving mobility and balance.
- Assistive Devices: Provide and educate the patient on the use of assistive devices such as canes or walkers to enhance stability and prevent falls.
- Speech and Swallowing Therapy:
- Speech Therapy Referral: Facilitate referral to a speech therapist for exercises and strategies to improve speech clarity and swallowing function.
- Dietary Modifications: Collaborate with a dietitian to modify the diet based on swallowing difficulties and nutritional needs.
- Psychosocial Support:
- Support Groups: Encourage participation in Parkinson’s support groups to provide emotional support, share experiences, and learn coping strategies.
- Individual Counseling: Offer individual counseling services for patients experiencing emotional challenges, anxiety, or depression.
- Fall Prevention Measures:
- Home Safety Assessment: Conduct a home safety assessment to identify and address potential hazards that could contribute to falls.
- Educate on Fall Prevention: Provide education to the patient and caregivers on strategies to prevent falls, including environmental modifications.
Nursing Interventions and Rationales
- Assess swallow prior to giving anything by mouth – involve Speech Therapy as appropriate
Due to muscle weakness, patients may experience difficulty swallowing. It may be appropriate to have ST assess for appropriate interventions to prevent aspiration.
- Encourage PT/OT and the use of assistive devices for ambulation multiple times a day
Improving range of motion and muscle strength can help patient to maintain independence. If they do not participate in these activities, muscle atrophy is likely.
- Educate patient on activity and energy conservation options
Patients fatigue easily. Teach to cluster care and provide for periods of rest.
- Use rocking motion to initiate movement, especially from sit to stand
This momentum can help assist with initiating movements when weakness is present.
- Encourage small, frequent, nutrient-dense meals to get proper caloric intake
- Increase fluid intake
- High protein
- High fiber
- Avoid foods high in Vit B6
As the disease progresses, weakness and dysphagia make preparing and eating meals more difficult. Smaller meals can be easier to consume before getting fatigued. Encourage nutrient dense foods.
Vitamin B6 can interfere with antiparkinsonian drugs.
- Administer medications
- Dopaminergics
- Dopamine agonists
- Levodopa-Carbidopa
- Anticholinergics
The goal is to increase the levels of available dopamine within the central nervous system.
Anticholinergics are given to decrease drooling and secretions.
- Encourage independence as long as possible
As the disease progresses, patients will lose their independence. Encourage them to remain an active participant in their care as long as possible.
- Provide resources for community support (i.e. groups)
Progressive, degenerative diseases can take their toll on patients and their families emotionally. Having community support is helpful.
Evaluation for Parkinson’s Disease
- Medication Efficacy:
- Symptom Control: Assess the degree of symptom control achieved with prescribed medications, considering improvements in motor and non-motor symptoms.
- Adverse Effects: Evaluate for any adverse effects or complications related to Parkinson’s medications.
- Mobility and Functional Status:
- Mobility Assessment: Measure changes in mobility, gait, and balance to determine the impact of interventions on the patient’s functional status.
- Activity Levels: Assess the patient’s ability to perform activities of daily living independently and any changes in their overall activity levels.
- Speech and Swallowing Function:
- Speech Clarity: Evaluate improvements in speech clarity through follow-up assessments with a speech therapist.
- Swallowing Ability: Monitor changes in swallowing function and adjustments to dietary modifications.
- Psychosocial Well-being:
- Emotional Well-being: Assess the patient’s emotional well-being, looking for improvements in mood, reduced anxiety, and overall psychological adjustment.
- Social Interaction: Evaluate the patient’s participation in support groups or counseling sessions and the impact on their social interactions.
- Fall Prevention Effectiveness:
- Fall Incidence: Track the occurrence of falls post-implementation of fall prevention measures and assess their effectiveness.
- Environmental Modifications: Evaluate the success of environmental modifications in reducing fall risks within the patient’s home.
References
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Transcript
Hey guys, in this care plan, we will explore Parkinson’s disease. In this Parkinson’s disease care plan, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales.
Parkinson’s disease is a degenerative neurological disorder that’s characterized by the loss of controlled movement. This is caused by the depletion of circulating dopamine levels in the brain. Dopamine is a neurotransmitter that’s responsible for controlled muscle movements. A genetic component is suspected, but the true cause is unknown. Depletion of the dopamine happens because of the atrophy of a substantia nigra, which is the structure in the midbrain that’s responsible for the situation of dopamine. The desired outcome is to optimize independence in the ability for the patient to care for themselves for as long as possible. We want to improve the dopamine levels in the brain to minimize symptoms. Unfortunately, there is no cure for this disease.
Let’s take a look at the care plan for Parkinson’s disease. Let’s start with the subjective data. So, the patient is going to be experiencing some weakness, fatigue, difficulty swallowing, they might feel heavy or really stiff and this is all due to the lack of controlled movement because of the lack of dopamine in the brain.
Now, let’s discuss the objective data. You might notice a pill rolling motion. It’s called a pill rolling tremor in the hands that looks like they’re really rolling pills between their thumb and their fingers. The patient with Parkinson’s, they look pretty stiff okay? They’re really stiff and when you get them up to walk, they kind of just shuffle. They don’t move their feet very much, so it’s really difficult for them, and it takes a long time to get them from point A to point B. They have really slowed movements or Brady Kenesha. They might have some lip-smacking, some drooling, a blank face, like a flat affect almost. These symptoms are all due to the loss of muscle control and they worsen as the disease progresses.
You will assess the patient’s ability to swallow before you give them anything by mouth to avoid aspiration, because remember, their muscles are weak and it causes a difficult time swallowing. Involve speech therapy as appropriate for interventions and assessments pertaining to the patient’s abilities or inabilities regarding swallowing different foods and drinks. Encourage your patient to work with the PTO team and use assistive devices for ambulation multiple times a day. You want to keep them moving. You want to help them improve their range of motion by working with them. You want to encourage them to maintain independence for as long as possible. If they don’t participate in these activities, muscle atrophy is going to occur, and this is not fun. I mean, then they can’t really do as much in the end, so you want to guide these patients to do as much as they can and you want to encourage independence. Educate your patient on activity and energy conservation options because these patients are going to fatigue easily. Teach them how to cluster care and allow for periods of rest. It’s super helpful to teach your patients to try to use that rocking motion. If they’re sitting in a chair and you want to get them up, just have them rock back and forth a few times. Getting that momentum is going to help assist with getting up when weakness is present.
You want to encourage small, frequent, nutrient dense meals. This is because you want to make sure they get the proper caloric intake. It’s harder for them to eat. They have weak muscles. It’s hard to chew and hard to swallow, so try to encourage high fluid intake. Encourage protein-rich foods and high fiber. They should avoid foods that are high in B6 because these can interfere with anti-Parkinsonian drugs. Administer medications as ordered by the doctor to help increase the levels of dopamine in the brain. Carbidopa levodopa is a super commonly used drug. Anticholinergics can also be used to decrease drooling and secretions.
You want to provide resources for the patient and family for community support. This is a tough time that they’re going to be going through right? Progressive degenerative diseases can really take a toll on the patients and their family. Having community support is very helpful for them.
We love you guys. Now, go out and be your best self today and as always, happy nursing!
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Nursing Clinical 360
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