Nursing Case Study Comprehensive Nursing Care for Parkinsons Disease

Question: Discuss about theNursing Case Studyfor Comprehensive Nursing Care for Parkinson's Disease. Answer: Introduction Parkinson's disease is the disease of clinical diagnosis in which diagnosis mainly performed based on the observations by clinician. However, there is no definitive diagnostic test available for Parkinson's disease. Initial symptoms of Mrs. Downs include depression, stopped posture, fatigue, problem in walking, tremors and difficulty in arm swing. However, exhibition and progression of these symptoms varies from patient to patient. In such scenario, it would be difficult to make conclusive diagnosis. These symptoms appearing in the intimal stage of the disease and these are subtle, also these symptoms can be attributed to other conditions. In the age of Mrs. Downs these symptoms can be considered as age related conditions. Patients with Parkinson's disease are often expressionless and these patients are mistaken for depression. Long term consumption of Sinemet leads to dyskinesia, which is difficulty in movement. It reflects in Mrs. Downs through slow movement. Phenothiazine exaggera tes symptoms of Parkinson's disease, also it interferes with the action of dopamine. In case of Mrs. Downs, she is taking Sinemet which is a combination of levodopa and carbidopa. Sinemet acts through dopaminergic pathway. In past studies, it is evident that phenothiazine interferes with dopaminergic pathway. Hence, in case of Mrs. Downs phenothiazine interferes with action of Sinemet and there was less cure for the symptoms of Parkinson's disease in Mrs. Downs (Mocko et al., 2010; Pahwa Lyons, 2013)). In patients with Parkinson's disease there is the occurrence of the depression, lack of interest in doing things, anhedonia and anxiety. These patients exhibits lack of enjoyment in the activities which are enjoyable like watching movies, playing, music and sexual activities. Parkinson's disease patients are always worried about something which is irrelevant most of the time. Due to Parkinson's disease, family members of the patient also get affected. Family members feel burdened and stressed due the patient. Family members of the patient should assist in the daily activities of the patient. Patients with Parkinson's disease feel isolated form The society. This social isolation may also further exaggerate depressive behavior in the patient. Social isolation also leads to less movement in the patients. This less movement in patients with Parkinson's disease exaggerates other symptoms. Patients with Parkinson's disease are associated with cognitive problem and communication problem. Th ese things also lead to the isolation from the society (Rosenbaum, 2006). Proper diagnosis of the Parkinsons disease is very important. Because symptoms of the Parkinsons disease interfere with common symptoms of other diseases. Nurse should observe very closely patient, evaluate patients physical and psychological behavior and conclude on the diagnosis. By observing depression nurse should not make diagnosis as solely depression. Nurse should correlate different symptoms observed in the patient and make proper conclusion. Nurse should also consult experts from other fields like psychology experts and physiotherapist for making conclusive diagnosis. Nurse should refer to the previous case studies with the similar type of symptoms for making accurate diagnosis. Nurse should plan for the proper treatment for Parkinsons disease patient. Parkinsons disease treatment is mainly medication dependent. Nurse should select dose of the drug very carefully and dose should be in narrow range. Nurse should administer patient with dopaminergic drugs because these are the most effective drugs available for the treatment of Parkinsons treatment. If these drugs administered in less quantity, it would not produce desired effect. On the other hand, if these drugs administered in more quantity, it would produce physical and psychological disturbances like mental disturbance, disturbance in the sleep pattern and stiffness and rigidity. Nurse should also take into account administration of other drugs concomitantly along with dopaminergic drugs because vitamin B complex and phenothiazine affects action of dopaminergic drugs (Bunting-Perry Vernon, 2007). Palliative care should be provided to Mrs. Downs because she is suffering through Parkinsons disease. This disease is multifactorial disease and in this disease there is the physical and psychological disturbance in the patient. These conditions lead to the emotional, social and behavioral impact on the patient and family members of the patient. Palliative care is the multidisciplinary approach of managing chronic illness in elderly patients. Palliative care provides relief from symptoms, painful condition, physical and mental stress irrespective of the diagnosis. In case of Parkinsons disease also diagnosis is difficult and hence implementation of therapeutic strategy is difficult. In such scenario palliative care would be the optimum therapeutic approach for Mrs. Downs. Moreover, curative management of the Parkinsons disease is not available, hence management of Parkinsons disease remains pallitative. Due to Parkinsons disease, Mrs. Downs became disabled and dependent. Physical dis abilities in Mrs. Downs lead to the exaggeration of cognitive impairment and depression (Bunting-Perry Vernon, 2007). Stem cells are regenerating type of tissues, which can be converted into different type of tissues in the body. These newly formed tissues have the potential to maintain and repair tissues responsible for the disease conditions. This would prominently affect the development of the Parkinsons disease. Parkinsons disease is the neurodegenerative disease in which there is deficiency of dopamine. Currently available medications for the treatment of Parkinsons disease are dopamine agonist. These medications are helpful in the improvement in the early symptoms. However, long term use of the medications lead to the loss of dopaminergic neurons and after certain period of treatment these drugs become ineffective in Parkinsons disease patients. Treatment with stem cells proved useful in the improvement in Parkinsons disease symptoms and increase in dopamine level in the brain. Intracranial administration of stem cells in patients with Parkinsons disease provide neurotropic support and replace s dying dopaminergic neurons of the Parkinsons disease patient. Moreover, this stem cell therapy doesnt cause adverse effects like dyskinesia. Stem cell can release different chemical mediators like cytokines which can be useful in the differentiation of stem cells into the dopamine releasing neurons. Treatment with stem cells is proved to be beneficial in patients with Parkinsons disease. Parkinsons disease can be treated with stem cell transplantation. These stem cells are already in the phase 3 clinical trials. It reflects these stem cells exhibited effectiveness in both preclinical and clinical Parkinsons disease. Also, these stem cells exhibited safety profile in different toxicology models (Ambasudhan et al., 2016). Patients taking levodopa should not consume vitamin B complex concomitantly because vitamin B complex contains vitamin B6. Vitamin B6 potentiates transformation of levodopa to dopamine. Levodopa is the precursor of the neurotransmitter dopamine. This potentiating effect of vitamin B6 on levodopa may lessen effect of levodopa in patients with Parkinsons disease. Also, vitamin B6 stops the absorption of levodopa and it reduces its effect in Parkinsons disease. Mrs. Downs can take vitamin B complex along with levodopa however, its dose should be optimized. Vitamin B6 dose should not interfere with effectiveness of levodopa in Mrs. Downs. It has been well established that different doses vitamin B complex along with Sinemet exhibited different effects in Parkinsons disease (Prasad, 2016). References: Ambasudhan, R., Dolatabadi, N., Nutter, A., Masliah, E., Mckercher, S.R., Lipton SA. (2014). Potential for cell therapy in Parkinson's disease using genetically programmed human embryonic stem cell-derived neural progenitor cells. Journal of Comparative Neurology, 522(12), 2845-56. Bunting-Perry, L. K., Vernon, G. M. (2007). Comprehensive Nursing Care for Parkinson's Disease. Springer Publishing Company Mocko, J.B., Kern, A., Moosmann, B., Behl, C., Hajieva, P. (2010). Phenothiazines interfere with dopaminergic neurodegeneration in Caenorhabditis elegans models of Parkinson's disease. Neurobiology of Disease, 40(1), 120-9. Pahwa, R., Lyons, K. E. (2013). Handbook of Parkinson's Disease. CRC Press. Prasad, K. N., (2016). Fight Parkinson's and Huntington's with Vitamins and Antioxidants. Inner Traditions Bear Co. Rosenbaum, R. B. (2006). Understanding Parkinson's Disease: A Personal and Professional View. Greenwood Publishing Group.