This paper will briefly discuss the pathophysiology that causes the Parkinsons disease (PD) patients to have impaired mobility. It will then describe the nursing care required during the course of the disease focusing on helping PD patients live a relatively normal life span and maintain independence for years.
PD disease is a chronic, progressive, neuro-degenerative loss of neurons and the neuro transmitter dopamine. Patients exhibit many of the following characteristics that include combinations of tremors, rigidity, slowing of movement and postural instability that are all motor symptoms. However, non-motor symptoms also accompany Parkinson’s disease. They include: psychiatric, sensory, autonomic, sleep, gastrointestinal, sight and smell dysfunction. (Shulman, L.M.,Taback, R.L., Rabinstein, A. A., & Weiner, W.J. (2002))
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Clinicians often use a five-stage system for describing the progress of Parkinson’s disease. This system does not make a prediction regarding the advancement of the disease, it only shows where in the disease process the patients are at the current time. The five stages can be defined as follows:
Stage One: Patients usual have mild symptoms that manifest in the shaking of one of the limbs. This may cause minor inconveniences in day-to-day tasks that have been completed easily in the past.
Stage Two: PD symptoms advance affecting the left and right sides of the body and limbs. This could lead to problems in walking and with balance. Completing normal physical tasks becomes a struggle.
Stage Three: Patient symptoms can be mild to moderate with observed slowing of physical movements, difficulty with walking (deteriorating balance) and other mobility issues
Stage Four: In this stage of the disease, severe symptoms can become apparent. Walking is often limited and rigidity and slowness of movement are visible. At this stage, PD patients are not able to complete normal daily tasks, and usually should not live by themselves. The shaking that was prevalent during the earlier stages may be reduced or even stop for unexplained reasons in stage four. Patients require considerable assistance.
Stage Five: In the final stage of PD patients physical movements are reduced to a state where mobility is non-existent. The patients are usually not capable of taking care of themselves and might not be able to stand or walk. Patients are usually confined to a wheel chair or bed, with a feeding tube and tracheostomy. They require full time care.
(http://www.stagesofparkinsonsdisease.com, Stages of Parkinson’s disease)
Nursing is recognized as “the diagnosis and treatment of human responses to actual and potential health problems” (American Nursing Association, (2003). Nursing plays a vital role in wide-ranging care of patients with PD. Each case of PD can present with a different symptoms, making each nursing care plan unique to the individual and family. The care is determined by symptoms that are affecting independence and self-worth of PD patients.
Now I will discuss nursing intervention for each stage of PD. Nurses are often the primary contact and the central coordinator of a PD patient’s care. They take on an advisory role during the early stages of the disease by assisting the caregiver and patient on the various symptoms of the disease and get more involved in the later stages with direct patient contact. The goal of nursing care is to help individuals manage their illness and improve their quality of life.
In PD stage one, after the clinician does the initial assessment based on the patient’s symptoms, nurses often act as translators, interpreters, assessors of symptoms and educators who help explain the diagnosis to the patients and their families, as they all develop their own understanding of PD as a disease.
Parkinson’s symptoms require the attention of a specially educated nurse who can recognize, assess, treat and make the correct recommendations within the multidisciplinary team. The nurse must know the role of each member of the team and his/her role to give shared, patient-centered care.
It would also be beneficial to discuss the living environment as well as activities that the PD patients will experience on a daily basis. By doing this assessment, the nurse can identify potential problem areas that may affect the life experience of the patients. In addition, nurses may assist the patients and their families in identifying potential caregivers and the impact of the disease on the social well being of the patients and their families and relatives.
In PD stage two, motor skill problems spread to both sides of the patient’s body. The disease may start presenting with the following symptoms:
Posture may start showing a slight tilt forward and facial masking
Mild shuffling gait
Becoming easily fatigued
The above signs usually begin to make an appearance and are usually mild and balance is still intact. (Backer, J. H. (2006)) Nursing interventions at this stage would center on getting referrals for patients to start speech therapy, helping with speech exercises and even instructing caregivers to make conscientious efforts to encourage the patient to slowdown their speech patterns and to avoid completing sentences for the patient. Physical as well as occupational therapy can be suggested and arranged by the nurse to give the patient and caregivers a way of insuring patient activity to maintain strength and mobility. The nurse can help adjust the patient’s activity levels to meet changing energy levels and insure that there are regular rest periods. It is also important to help reduce the level of stress that the patient feels because stress has been proven to influence the well-being of the PD patient. (MacMahon, D. G., & Thomas, S. (1998)) Again, it is important to keep the patient as well as the caregiver informed on available treatments and potential symptoms the disease will manifest during this stage and in further stages.
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In PD stage three, the symptoms can be mild to moderate and balance is impaired, but the person can still function independently. The nurse should involve the patient into decision-making processes such as participating in various activities, and so on. Offer suggestions for patient to have opportunities to socialize in the community, keep the education and communication process going and be calm and offer reassurance if the patient becomes fearful and promote restful sleep-wake cycles. Nurses should include exercise plans as a part of daily activity. This will keep patients mobile, flexible, balanced and strong. Many local exercise facilities such as the YMCA have different types of activities for older adults with limited mobility.
PD stage four, this is the stage of the disease accompanied by severe symptoms of Parkinson’s. The PD patient will be able to walk for short distances but some stiffness and slower motions are often visible. At this stage, most patients will not be able to complete daily tasks, and usually will need a caregiver or family member to help them live. The tremors and shakiness that was visible during the earlier stages may lessen or completely stop for unknown reasons during this time. The nurse should educate patients and their families about the benefits and possible side effects of PD medications. Medication compliance is an important part of the patient’s care and the medications should be given on a rigorous schedule. The nurse should provide the link between health care professionals, the patients and caregivers. This would include all aspects of patient care including scheduling the patient for hospital or clinic visits to see their doctor or to attend therapist sessions. Again, the nurse would also be responsible for educating and communicating with the family, caregiver and the patient. (Bunting-Perry, L. K. & Vernon, G.M. (2007)
PD stage 5: In last or final stage of PD, the disease usually takes control of the patient’s physical movements. The patients are usually unable to take care of themselves and may not be able to stand or walk. Patients usually need constant one-on-one caregiver attention that includes:
Dressing and undressing the patient
Helping the patient with normal bodily functions
Turning the patient
Insuring some type of physical therapy program
When the caregivers can no longer provide emotional or physical care required for PD patients, the nurse may suggest hospice care, nursing home, or assisted living facilities for end of life care.
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