Mrs. Downs is 55 years old when she was diagnosed with PD (Parkinson’s disease). Her initial symptoms were depression, stooped posture, loss of energy, dragging leg, difficulty walking, tremors, and a...

Mrs. Downs is 55 years old when she was diagnosed with PD (Parkinson’s disease). Her initial symptoms were depression, stooped posture, loss of energy, dragging leg, difficulty walking, tremors, and a loss in her arm swing. Her physician started her on Sinemet® (levodopa-carbidopa combination). While discussing her medication history with her, you find out that she takes a B-complex multivitamin that contains B6. She also tells you that her wife has told her to take some of her phenothiazine (an antipsychotic) since she thinks it may “lift her out of her depressed mood”.

A year has passed, and when you see Mrs. Downs again her symptoms have worsened. She is feeling muscle rigidity, fixed facial expressions, slowed movement, arm numbness, and cognitive difficulty. Her physician has changed her Sinemet® to Stalevo® (levodopa-carbidop-entacopone); he has also added a dopamine agonist (such as pramipexole) and an antidepressant for her mood disorders.


PART 1: Questions
1.    What is the likely explanation for the progression of Mrs. Downs condition?




2.    Explain some of the emotional and psychological issues the patient and the family of the patient may experience.




3.    What are the two initial nursing interventions that you would focus on? Explain your answer.





4.    Should palliative care be provided to Mrs. Downs at this stage? Why or why not?




5.    Mrs. Downs’s wife states, “I read somewhere that using stem cells may help to improve the condition of a person with Parkinson’s disease. Is it true?” How will you respond to Mrs. Downs wife?  Explain your answer.



6.    Mrs. Downs asks if she can continue taking her multivitamin while taking Sinemet®. What can you tell her about taking the multivitamin while taking a medication containing levodopa?