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

Nursing Interventions and Rationales

• Assess swallow prior to giving anything by mouth – involve Speech Therapy as appropriate

• Encourage PT/OT and the use of assistive devices for ambulation multiple times a day

• Educate patient on activity and energy conservation options

• Use rocking motion to initiate movement, especially from sit to stand

• Encourage small, frequent, nutrient-dense meals to get proper caloric intake
  • Increase fluid intake
  • High protein
  • High fiber
  • Avoid foods high in Vit B6

• Administer medications
  • Dopaminergics
  • Dopamine agonists
    • Levodopa-Carbidopa
  • Anticholinergics

• Encourage independence as long as possible

• Provide resources for community support (i.e. groups)

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

• https://emedicine.medscape.com/article/1831191-overview
• https://www.michaeljfox.org/