A.G. is a 76-year-old man who was exposed to several chemicals during his farming career. For the last 7 years, he has walked with his arms flexed, leaning forward with his head bowed. Recently, he has had difficulty rising from a chair and balancing himself when he walks. He fell twice when doing odd jobs around the house. He started making a “to-do list” because he has difficulty remembering. He goes to the store for three items but returns with only two. His wife noticed that he has a slight tremor in his hand when he eats and often rolls his forefinger and thumb together in a circular motion.
1. Use deductive reasoning to identify A.G.’s possible diagnosis.
2. With these symptoms, what diagnostic tests may the doctor order?
A.G. shared his symptoms with his family physician. After some tests were completed and results of referrals to specialists were returned, the physician told A.G. he suspected a diagnosis of Parkinson’s disease (PD). A.G. said, “Tell me about Parkinson’s disease.”
3. Relate what a nurse could teach A.G. about PD.
4. List subjective and objective data needed to make an appropriate and thorough assessment on A.G.
5. List etiological causes of PD. What possible etiological factors does A.G. have?
6. Explain the action of dopamine, a neurotransmitter. How does dopamine affect the symptoms displayed in a client with PD.
7. List drugs that interfere in the synthesis and storage of dopamine.
8. List the signs and symptoms of PD. Think of a client with PD, and relate his or her symptoms to the textbook symptoms.
9. Develop a patho-flow map or concept map relating the pathophysiology of PD to the systems that could be affected and the typical symptoms of that system.
10. List drugs that A.G. may receive to control symptoms of PD. List the symptoms and side effects that need monitoring with each of the drugs listed.
A.G. is becoming more rigid, having difficulty swallowing food, falling frequently, reaching for items to assist in ambulating, experiencing frequent incontinence, reporting that his eyes itch, and having severe memory loss. His voice has become soft, and his speech is slurred.
11. List A.G.’s autonomic symptoms.
12. Develop diet instructions for A.G. and his wife.
13. What possible surgical procedures could be done to relieve A.G.’s symptoms?
14. Develop a nursing care plan for A.G. listing nursing diagnoses, goals, and nursing interventions to address each symptom.
15. Using the Internet, research new therapies for PD, and share them with other students.
After a year, A.G. is unable to walk and is lifted from his bed to his wheelchair. He is unable to verbally communicate. He no longer has bladder control. When he was fed his lunch, he started coughing and perhaps aspirated some food.
16. List appropriate subjective and objective data needed in a nursing assessment.
17. Reevaluate the previously developed nursing care plan and revise appropriately.