Nursing Care Priorities For A Patient With Parkinson’s Disease

Question: Discuss About The Nursing Care Priorities For A Patient With Parkinsons Disease? Answer: Introducation The primary goal of this essay is to identify the nursing care needs of a particular patient and discussing the priorities of nursing care for that patient. The essay has a background of two important functional theories: The Millers functional consequences theory that helps in the identification of the various factors that impact the elderly patient and theeffect of these influencing factors. Additionally, the essay explores the eight steps of reasoning and critical thinking in nursing using the Levett-Jones theory of clinical reasoning. Geriatric nursing involves several considerations that include the social and the lifestyle concerns of the patient (Hunter, 2016). Critical thinking and logical approach to nursing in older patients are essential in order to maintain the dignity and the interest of the patient (McMahon Fleury, 2012). Wellness of the patients is regarded a primary consideration in nursing. Specifically, in cases of Parkinsons disease, where limitations are imposed upon the daily life activities of the elderly patient, the protection of patient wellness is of critical importance (McMahon Fleury, 2012). The Millers theory of functional consequences provides an essential framework for the understanding of promotion of wellness in older adults. This theory provides a basic framework for nurses for the identification of the potential of an individual for the growth of the person and the utilisation of diagnoses in nursing in order to provide the sense of value and protect the dignity of the older individual(Levett-Jones, 2013). In patients with limiting chronic illnesses like Parkinsons, Alzheimers, or dementia, the sense of dignity and integrity are critical since the patient experiences limitations in handling the social presence and everyday life. The theory of functional consequences provides guidance for geriatric nurses to adapt a holistic approach and function with inter-related functionality of spirit, thoughts, and mind whilst handling older adults. The Millers theory of functional consequences essentially addresses the concern of cultural and dignity-related issues for the pa tient (Hunter, 2016). In the case of Mr. Ratin, his cultural background reflects that he is originally from India and has immigrated in 1946. His personal values and beliefs may have a cultural dilemma and since he is a widower, he may have implications of loneliness. Additionally, he is a financially independent individual and despite his bare-minimum earnings, he wishes to refrain from depending on his brother, who is Niraj and his family. Thus, it becomes the primary concern of the nurse to enable Mr. Ratin to manage his daily life without much dependence on a carer.The nursing priority is that the patient is given complete independence (Nackaerts et al., 2016). The current article follows the Levett-Jones model of critical thinking in nursing in order to adequately divide the scenario into the various steps of logical nursing approach (Levett-Jones et al., 2013). Considerations of the patient: The current essay discusses the case of Mr. Ratin Bhai, an 87-year-old man diagnosed with Parkinsons disease, four years before he presented to the hospital. He presents with the diagnosis of hypothyroidism, controlled with the help of medication that was diagnosed alongside Parkinsons. He is an independent patient with reduced mobility. He also has slight tremor in both his hands which is increasing with time. He has limitations in performing activities of daily life, including doing up his shoe laces or buttons, pouring water, or making coffee. Collection of information: Ratin is found to have slight tremors in both hands and has limitations in cooking, making coffee, pouring water, or doing up laces and buttons. He has a history of hypothyroidism which has been controlled by medication. His medication history includes thyroxine at 100 mg every day, levodopa and carbidopa, and entacapone. He has to be monitored for managing his every day medication. The primary reason for this includes the principle behind the formulation of levodopa and entacapone to increase the bioavailability of levodopa. With the constant monitoring of the medication, the conversion of levodopa to dopamine may be monitored to check for medication efficacy. The interference of thyroxine with levodopa/carbidopa/entacapone has to be eliminated with the help of regular monitoring of effects of thyroxine on the control of symptoms of hypothyroidism. The absence of symptoms of hypothyroidism acts as an indicator for efficacy of thyroxine. The primary adverse effects of thyroxine in ol der adults such as angina or cardiac functionality compromise with regular ECG monitoring to check for palpitations is essential. Additionally, the effects of levodopa/carbidopa/entacapone formulations with the thyroxine drug needs to be monitored with regular recording of related presentations in the patient. The gradual stabilisation of hand shivers and improved dexterity act as key indicators of drug efficacy. Processing the obtained information: The patient is receiving levothyroxine treatment for hypothyroidism. The drug has a half-life of about 7 days with dosage on a daily basis (Costa, Rosso, Maultasch, 2012). In the elderly, the dosage requirements of levothyroxine decrease. The primary reason for this is the decline in the degradation of levothyroxine that occurs with age. High dosages of thyroxine in the elderly may lead to the catalysis of myocardial infarction and angina in the older patients (Lambrinou, Kalogirou,Lamnisos,Sourtzi,2012). Several dietary supplements and medications can adversely affect or cause interference to the action of levothyroxine. Supplements of iron, aluminium, cholestyramine, and calcium can intervene with the effects of thyroxine. Additionally, in the elderly who take levothyroxine treatments, there can be the presence of interference with the activities of daily life.The dosage of thyroxine has to be significantly reduced in older audit (Nackaerts et al., 2016). Mr. Ratin presents with tremors and due to this, he has several limitations in performing activities of daily life such as cooking and similar activities (Nackaerts et al., 2016). Thyroxine can have adverse effects on the tremors and can lead to the enhancement of the tremors (Kong, Qin, Zhou, Mou, Gao, 2014). Identification of the specific problems: In order to specifically identify the problems that Mr. Ratin has, it is essential to reflect upon the issues presented in literature about Parkinsons disease and the current approach of treatment of the disease.Parkinsons disease is typically characterised by chronic and progressive neurodegenerative events (Tolosa et al., 2014). Parkinsons disease is traditionally perceived as a disease of motor functions and results in cardinal symptoms and leads to tremors in hands, bradykinesia, and rigidity. Recently, symptoms of a non-motor origin such as fatigue, mood swings, anxiety, apathy, sleep deficiency, and impairment in the quality of life of the patients have been identified(Tolosa et al., 2014). The treatment therapy for Parkinsons disease is a combination of therapy involving replacement of dopamine, treatment of issues of non-motor origin including dementia, dysfunction of the autonomic system, depression etc. (Tolosa et al., 2014). The administration of levodopa is an essential aspect in the treatment of Parkinsons disease. It is one of the most popularly chosen treatment options for Parkinson (Armstrong, Peterson, Rayner, 2012). Levodopa is an improvement to the traditional method of treatment involving only anticholinergic agents. Levodopa has demonstrated a considerable level of efficacy in the treatment of Parkinson. However, there are certain limitations in the prescription of levodopa. The primary reason for this is the emergence of complications of the motor system. The motor neuronal complications are even known to be more complex than the benefits of the treatment (Iranfar, Iranfar, Mohammadi, 2012). In the case of Mr. Ratin, due to the presence of motor complic ation of tremors, it is advisable to closely monitor the effects of levodopa (Tolosa et al., 2014). Therefore, the three specific nursing priorities whilst dealing with Mr. Ratin include the control of motor symptoms of Parkinsons disease, control of non-motor symptoms such as anxiety, mood swings, and depression, providing adequate emotional and knowledge-based support to Mr. Ratin. Establishment of goals: The treatment of Mr. Ratin is fairly straightforward due to the medication being non-complicated and controlled in dosage. Therefore, the primary approach for the treatment of the disease would include the monitoring of the dosages of levodopa, thyroxine, carbidopa, and entacapone(Nackaerts et al, 2016). Since levodopa has several limitations, Mr. Ratin is being given the formulation of levodopa, entacapone, and carbidopa. It has optimal pharmacokinetic characteristics. This formulation is capable of limiting the primary functional pathways of levodopa (El-Gilany, Abusaad, 2013). The primary goal or the nursing priority of the highest degree would be to control the motor symptoms experienced by Mr. Ratin. The goals identified are: Ratin should be able to gain a control of the tremors in both his hands. The activities such as cooking, making his coffee, or doing up shoe laces and buttons, and other activities requiring minimum coordination and dexterity must become simpler. There must be a reduction in the fatigue and anxiety levels The goals set for the nursing plan of Mr. Ratin indicate that the symptom-control may be achieved by the appropriate administration of the drugs and medication at the appropriate dosages and times. The appropriate medical treatment timeline can ensure the cure of the specified symptoms. Action plan: The highest nursing priority identified is the treatment of motor symptoms of Parkinsons disease. Ratin has been advised to take levodopa/carbidopa/entacapone formulation for the treatment. However, it is the prerogative of the nurse to ensure the timely administration of appropriate dosages and monitor the effects of the drugs continually (D'Amore, James, Mitchell, 2012). The regular and meticulous monitoring of the drug administration in the patient must be carried out. The primary rationale for the identified priority is the plausible effects of levodopa drug overdose. The formulation, although regarded safe, has certain potential adverse effects in the elderly (Salat and Tolosa, 2013). The decarboxylation of levodopa occurs rapidly in the tissues of the cerebrum and in the extracerebral areas when ingested orally. The common adverse events include psychiatric anomalies and dyskinesias (Salat and Tolosa, 2013). These interferences need to be monitored regularly and are thus an imp ortant part of the action plan. The action plan would include the recording of instances of weakness, fatigue, depression, or anxiety in Ratin (D'Amore, James, Mitchell, 2012).The rationale for this is that these symptoms act as primary bioindicators for the development of levodopa overdose in the patient. This can additionally lead to dyskinesias or even cardiac complications.Levodopa is known to create fluctuations in response and thus, symptom control must be analysed alongside any potential presence of fluctuations in the readings for the patient (Salat and Tolosa, 2013). Evaluation of outcomes: The action plan has resulted in the monitored evaluation of the effects of the medication. Ratin is able to control the dosages of hypothyroidism. There is a significant improvement in the mood stability and behavioural patterns of the patient. The dosages of levodopa, carbidopa and entacaponeare well-monitored and he requires minimum assistance in the administration of the drug. The tremors in both hands have significantly reduced. Mr. Ratin has improved mobility and can perform his regular activities including walking, cooking, making coffee, and writing. Reflection of the case: The current case has provided sufficient insight into the life of an elderly patient with Parkinsonism. Mr. Ratin has been a fiercely independent and self-contained individual. I have considerable satisfaction of the resources that I had for the nursing of Ratin. The next time, whilst dealing with a patient with Parkinsons disease, I wish to spend a higher amount of time in the analysis and identification of specific concerns for that patient and try to anticipate the needs of the patient in advance. The medication provided for Parkinsonism can have several distressing and fatigue-inducing effects (Andreou, Papastavrou, Merkouris, 2013). In the elderly, especially, I will pay additional care to the empathy of mood swings and anxiety resulting from pharmacological and non-motor symptoms of the patient. The current case has taught me the importance of critical thinking and the implementation of the Levett-Jones theory of critical thinking. It has led to the simplification and the ident ification of specific concerns to address each of them adequately. Conclusion: The current case has provided ample opportunity for the understanding of treatment protocols and the concurrent notions and social complications associated with the care for a person living with Parkinsons. Ratins case has provided insight into the obligations, limitations, and the helplessness experienced by persons living with Parkinsons disease. The debilitating symptoms of the disease are both compelling and limiting. The primary learning gained in this experience is that the nursing care provided to the patient has a holistic and nurturing role in the health and development of the patient in the social setup. The patient care in Parkinsons disease is associated with several steps that include recording patient history and medications of chronic and long-term natures. Additionally, the observation of patient presentations at every stage with both biomedical and clinical implications such as clinical symptoms observed during patient care and the biomedical readings including ECG, EEG, etc is critical. These observations act as indicators of health in the patient. The absence of symptoms such as tremors and neurological symptoms need to be assessed alongside the biomedical observations. Along with the physiological complications, it is crucial to provide logical and clinical reasoning for the designing of care protocol in order to provide appropriate support. 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