Case study of a man with parkinsons disease

Case study of a man with parkinsons diseaseMr Henderson has arrived in hospital after a history of locomote at home and has comely commenced a new medicinal medicine regime.It is very achievable that he whitethorn be anxious, unhappy, frightened as a essence of falling at home which also whitethorn result in loss of agency. He may also be apprehensive ab bug out his new medication regime. Having been diagnosed with Parkinsons for 5 years, he more than likely knowns the greatness of getting his medications on meter, in reducing the symptoms allowing him to maximise his independence. However, it is not for the think of to presume this and she/he must sit drop, talk to him, allowing him time to talk and express his worried and anxieties. This was suffice to establish a relationship and Mr Henderson depart understand that you argon at that place to support him throughout his journal of c be. The hold in should also fall in sure that all members of the multidisciplinary team atomic number 18 aw are of Mr Hendersons condition and if they are not aware of the importance of getting medication on time out with normal drug rounds then they should be informed of its importance and understand the signifi asst consequences resulting from not getting the drugs on time much(prenominal) as lopd independence and prolonged hospital stay. As medications are a large part in maximise independence and mobility and it may be suggested that Mr Henderson receives his medications before getting out of shaft in the morning time. This leave alone allow time for the drugs to domesticate and therefore enabling him to get out of bed more easily.Freezing, a symptom of Parkinsons disease after part be distressing for patients. It affects gait initiation, turning and moving through small spaces, such(prenominal) a doors and busy areas. Anxiety whoremaster exacerbate remedyzing and it is vital that the look can firstly recognise anxiety, this may be chance on through potent communication and listening skills and secondly developing strategies to reduce anxiety levels such as allowing him time to talk, listening and victorious on board his expressions allowing for a trusting relationship to be developed, attentioning him to ramp up in confidence and preparing him psychologically for going home. Various strategies have been suggested to serve well with freezing. Alexander, Fawcett and Runicnan (2006) suggest cognitive techniques in prisonbreak down movement. They suggest breaking down the task of getting out of bed in the morning and describe that patients should bend their knees so that feet are flat on the mattress and they the patient should swing knees in the direction that he wants to turn. The next stage involves clasping some(prenominal) hands and lifting them straight up, straightening the elbows, then turning the head and swinging the munition in the same direction as the legs. Finally the patient can grip the edge of the mattress and adjust his position until comfortable. When Mr Henderson is mobilising then it is important that he does not have any distractions and the nurse or other members of provide should not disturb or interrupt if at all possible as this could lead to freezing. The Parkinsons Disease Society describe cueing strategies as outside meaning visual, auditory or preprioceptive or internal meaning cognitive. opthalmic cues could be stepping over a cue in the floor, for theoretical account show can be placed on the floor in strips to help initiate in confined spaces when freezing has taken place. Tape can also be placed on the edges of stairs. Mr Henderson may also scram utilitarian to imagine he is taking steps up stairs and this may prompt movement. The nurse should ensure that the area is clutter free and this can exacerbate freezing. Auditory cues as the name suggests would indicate labored utilized to enhance movement. Metronomes have been described as a useful tool in su pport gait initiation. Counting out rhythms or singing and walking in time to this can be beneficial. proprioceptive cues which means taking a step back before starting to walk rocking gently from side to side or marching on the stop before stepping.The nurse should ask Mr Henderson if he has experienced falls in the past year and frequency, obtaining as much information as possible nearly the falls, this can form part of the patients assessment viz. a Falls Risk Assessment. Nice (2004) provides clinical guidance on falls risk assessment and suitable referrals should be initiated to the physiotherapist who go forth help to improve balance and the occupational therapist can help to make Mr Hendersons home safer place to live by attending a home visit and suggesting suitable aids that can improve safety, maximising independence. One of the most devastating consequences of falling in older mint is a fractured neck of femur which can have earthshaking jar on independence and qual ity of life. The nurse may suggest to Mr Henderson about wearing a hip protector, this again can improve confidence and also help to protect the hip if her were to fall. A full exposition as to why this is being suggested should be provided allowing for informed choice.Falls can be as a result of loss of balance and posture, freezing, further being able to take small steps, or dyskinesia and it is important to use techniques such as cues to minimise the risk of falls. Also physiotherapy commentary will help with exercise, improving balance and posture. Multidisciplinary collaborating is essential in proving effective care. The nurse can find out what strategies are being taught to Mr Henderson and the nurse can encourage continuation of these exercises indoors the ward environment. It is important to delay to communicate with Mr Henderson allowing for evaluation in care and under stand up what strategies are work and ones that are not. Once evaluated alternative strategies may be considered.Postural hypotension should be monitored/assessed for patients with Parkinsons as this increases the risk of falls as a result of silliness or fainting in the drop in blood pressure. The patient should be supine for at least 10 minutes before taking a supine blood pressure variation. Then another reading should be taken within 3minutes of him standing up from the supine position. The nurse should be aware the dizziness the patient may experience when standing up should be standing next to him when she does the reading. If there is a significant fall in systolic blood pressure, by 20mmHg or goes under 90mmHg then this would indicate that the person has postural hypotension.Strategies can be adopted to improve the deficit before considering pharmacological methods such as recommending piecemeal compression stockings to improve venous return and therefore blood pressure. For them to work efficiently they much be measured and fitted to ensure the correct pressure is applied to the legs and ensuring that Mr Henderson is achieving recommended fluid wasting disease of 1500-2000ml per day.If Mr Henderson is in a bay of beds for example 6 beds, then his location within the room should be considered in relation to the toilet. The bed should be relatively close to the toilet, if his fluid intake perhaps is being increased then frequency to micturate will potentially be increased. Mr Henderson is experiencing reduced mobility then bed position should be definitely considered to minimise the risk of unnecessary bowel or vesica incontinence. A commode may be considered and placed discretely closer to his bed for the evening or provision of urine bottles and buzzer placed in a position that is easily available.Appropriate footwear should be consider, the nurse should ensure that the are well fitted and not falling off increase the risk of falls. The nurse should also check his feet or ensure there are no problems such as ingrown toe nails or blisters. T he nurse should also ensure that Mr Hendersons vision is examined or glasses should be worn at all times if required as this could result in unnecessary falls.1299 wordsParkinsons Disease Question 2bWithin the substantia coon and radical ganglia there is progressive degeneration of cells which produce the neurotransmitter dopamine. The substantia nigra is a strip of dark pigmented cells located in the mid spirit and the basal ganglia are collections of nerve cells located in near the base of the cerebrum. When motor impluses are initiated in the motor cortex, they need to be modified by the basal ganglia and substantia nigra by modifying motor activity, posture and making fine adjustments to movement. This is contained within the extrapyramid motor system and within the system there is normally a fine balance of neurotransmitters dopamine and acytylcholine.Dopamine is inhabitory and acytylcholine is excitatory. Due to the reduction in dopamine there is excess of the excitory neurot ransmitter acytlecholine resulting in excitable muscle stair and the symptoms associated with Parkinsons disease.Mr Hendersons has begun a new medication regime using co-careldopa used to acquire and maintain the balance between dopamine and acytlecholine.Dopamine cannot be attached on its own as it will fail to cross the blood-brain roadblock (BBB). The BBB is a physiological barrier that prevents substances from getting across from the blood watercourse and into the brain. Instead of dopamine, the drug levadopa is used which can cross the blood brain barrier and is then converted into dopamine. The dopamine then acts on dopamine receptors in the extrapyraminal motor system to maintain the neurotransmitter balance and therefore control the Parkinsons disease symptoms.When levadopa is administered it is broken down in the gut and liver by an enzyme called dopa decarboxylase, therefore combined with levadopa is a drug that inhibits the enzyme from breaking down levadopa is used w hich will lengthen the effects of levadopa meaning that less drug is required. This drug is called dopa decarboxylase inhibitor (cardidopa)This combination of levadopa can be provided as a preparation of one drug called co-careldopa or Sinemet (the brand name)There may be side effect such as nausea and vomiting, postural fall in blood pressure, constipation, and red stained urine. Mr Henderson must be made made aware of these side-effects and should inform the nurses when he is experiencing them. Domperidone can be used as an anti-emetic to stop the side-effects of nausea and vomitting. Blood pressure should be monitored for signs of postural hypotension and if required a medication review may be required, the nurse may ask the patient not to sit up or stand up too quickly.Parkinsons Disease 2c