In case study, Phillip, a semi-retired active person was working in a tea store as part-time worker. He had several mishaps at workplace with respect to his health including unsteady gait and slight tremors in right hand. He has been dropping stock and equipments at work more frequently. He has been not able to handle hot water to make tea at work. His level of confusion and drooling is increasing and he was not able to hear properly. After complete diagnosis, Phillip was found to be suffered from Parkinson’s disorder. He was recently separated from his wife and living alone.
Parkinson’s disorder comes under neurodegenerative disorder leading to deterioration of motor functions progressively due to insufficiency of brain cells which produces dopamine. However, the cause for the disorder is unknown; environment and genetic factors are associated with the disorder. Slowness, Impaired balance, tremor, shuffling gait and stiffness are some of the primary symptoms. Depression, anxiety and dementia are the secondary symptoms associated with Parkinson’s disorder. Progression and degree of impairment of disorder may vary from individual to individual. Several individuals can live productive lives followed by Parkinson’s disorder whereas some get disable more quickly. Premature death can occur due to several complications such as pneumonia or falling-related injuries (T Pringsheim, 2014). Quality of life is reduced significantly in Parkinson’s disorder which has motor and non-motor symptoms. Pharmaceutical as well as non-pharmaceutical approaches are available for the treatment of this disorder. A significant non-pharmaceutical treatment approach is neurorehabilitation in which behavioural adaptation training was done which can help the patients to handle the motor and non-motor symptoms effectively. A personalized and tailor-made approach is required for the optimal delivery of neurorehabilitation. A real impact can be done to improve the quality of life of the individuals who are suffering from Parkinson’s disorder (Merel S. Ekker, 2016). There is need to impart suitable and appropriate care to Phillip in the case study. Care priorities which must be given in the case of Phillip are discussed and elaborated in later sections.
Individualized nursing care in accordance with the needs of patient suffering from Parkinson’s disease is required to improve the quality of life and provide optimum symptom control. It is recommended that integrated palliative care approach must be followed in all life-threatening disorders including Parkinson’s disorder. However, it has been observed from the studies that individuals suffering from Parkinson’s disorder were not able to obtain palliative care needs. Palliative care is a care approach which can improve the quality of life of patient and family members who are facing concerns linked with life-threatening disorders such as Parkinson’s disorder. It involves the prevention and relief from suffering through early identification and evaluation and treatment of pain and other associated psychosocial and physical symptoms. Parkinson’s disorder is a neurodegenerative life-limiting disorder which has symptomatic treatment (Janis M. Miyasaki, 2015).
The perception of healthcare workers was explored for the palliative care of individuals suffering with Parkinson’s disorder along with the identification of associated facilitators and barriers. Several barriers were identifies which were evident with the previous studies for unmet palliative care needs. Carers and patients were not possessing adequate information regarding how to take palliative care. There were no or few communication amongst the patients and palliative care specialists resulting in obstruction of imparting individual and specialized care. Similarly, the time to initiate palliative care is also a significant parameter because it must be introduced at the early detection stage to prevent the severe consequences. Parkinson’s disorder is associated with high burden of non-motor symptoms such as fatigue, pain which are difficult to handle, increased mortality rate, more utilization of medical services and high stress for the caregiver. Palliative care can assist in enhancing the delivery of care, recognize and address unmet requirements and evade the interventions and hospitalizations which can be helpful for the patient as well as their family members (Siobhan Fox, 2016).
Individuals suffering from Parkinson’s disorder get benefited through generalized palliative care approach utilized by health care workers who are practicing it as core skills or trained and possessed experience in palliative care. There are specialist palliative care services in which palliative care is being given to the individuals who has demanding and complex care needs. It has been confirmed from several studies that individuals suffering with Parkinson’s disorder gets the benefits from palliative care. Studies conducted by specialist palliative neurology in UK observed that better and improved outcomes were obtained in the patients suffering from neurological disorders specially Parkinson’s disorder. However, palliative care is not being followed in all health care centres. Imparting palliative care to Phillip must be the first care priority after the complete study of his case study and family situation. Palliative care can be effective for his health and prevents further health deterioration (Janis M. Miyasaki, 2015).
Appropriate nutrition care especially diet can be beneficial for the patients suffering from Parkinson’s disorder. However, very few evidences are available in the studies regarding the eating habits of individuals suffering from Parkinson’s disorder and their association with the disorder features. A large case-control study was conducted with 66 consecutive patients with Parkinson’s disorder who were receiving systemic nutritional care along with 600 healthy controls. The association among features of Parkinson’s disorder such as energy balance, body weight, constipation, levodopa therapy, and dietary habits were studied. It was observed that patients suffering from Parkinson’s disorder had higher food intake and lower BMI in comparison to control individuals (Michela Barichella, 2017). There was inversely proportional relationship between severity, disease duration and BMI. However, positive relationship was observed between these variables and energy intake. A mean increase in levodopa dose was seen with an increase in protein uptake resulting into constipation. Levodopa-related motor complications were influenced with the protein intake. Thus, constipation treatment and intake of protein must be managed properly in the patients suffering from Parkinson’s disorder. Energy intake must also be monitored properly which further leads to nutritional status maintenance, regularization of levodopa-therapy and reduction in its associated complications. Thus, providing appropriate nutrition through diet and managing the protein intake must be the second care priority for Phillip. He can be given proper diet chart which must be followed by him properly (M Aiello, 2015).
There are several other care requirements which must be done for the patients suffering from Parkinson’s disorder. Some of them includes keeping the doctor appointment track, provide medications on time and regular exercise. Appropriate support and love must be given to the patients in order to motivate the patient to handle the challenges associated with the disorder. Patients must be allowed to perform their daily activities on their own. Accurate medication on accurate time should be given to the patients. Debilitating symptoms such as tremors and muscle rigidity can occur due to even few minutes delay in taking the Parkinson’s medication. There are chances where a patient suffering from Parkinson’s disorder is taking medications for other disorders such as sleeplessness and depression as well along with Parkinson’s medication. A slight change in time to take the medications can leads to re-emerge of symptoms. Thus, an effective plan including the time schedule of each medication can be helpful for the patients suffering from Parkinson’s (T Pringsheim, 2014).
According to the recent research studies, exercise seems to be effective as medications for the patients with Parkinson’s disorder. Neurological health can be promoted by regular exercise which keeps joints and muscles limber. Along with exercise, physical therapy is also found to be efficient for the patients to stay them independent for long time. Apart from taking regular medication, monitoring of symptoms is also very important. If there will be an increase in the severity or the number of symptoms in spite of taking regular medication on time, then there is an urgent requirement to consult with the physician. There may be a chance where the prescribed dose needs to be increased or change in medication is required. Symptoms such as rigidity in which patient is not able to move limbs and tremors such as uncontrollable shaking must be observed very carefully. Physician must also be consulted if the patient is feeling difficulty in memorizing information, walking, swallowing or talking (GO Reynolds, 2016).
About half of the Parkinson’s patients are also suffering from Depression which might be a disorder symptom according to doctors. Stress, anxiety and denial are the other concerns suffered by the patients. Thus, mood of patient must be taken into consideration during his/her care. Counselling or antidepressant medication can assist in providing relief to patient. Sleep is the other concern faced by Parkinson’s patients. Patients often feel drowsy during daytime due to medication of Parkinson and thus kept awake all night resulting in loss of focus and more fatigue. A regular routine for bedtime and stay awake during daytime can assist in promoting quality sleep (J Pagonabarraga, 2015).
It can be concluded that imparting palliative care and maintenance of diet and protein intake must be first two care priorities for Phillip in case study. Apart from these two care priorities, regular exercise, routine medication on time, monitoring of symptoms and bedtime routine are the other care priorities which must be followed in the case study.
GO Reynolds, M. O. (2016). The therapeutic potential of exercise to improve mood, cognition, and sleep in Parkinson's disease. Movement Disorders , 31 (1), 23-38.
J Pagonabarraga, J. K. (2015). Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment. The Lancet Neurology , 14 (5), 518-531.
Janis M. Miyasaki, B. K. (2015). Palliative Care for Parkinson’s Disease: Has the Time Come? Current Neurology and Neuroscience Reports , 15 (26).
M Aiello, R. E. (2015). Body weight and food intake in Parkinson's disease. A review of the association to non-motor symptoms. Appetite , 84, 204-211.
Merel S. Ekker, S. J. (2016). Neurorehabilitation for Parkinson's disease: Future perspectives for behavioural adaptation. Parkinsonism and Related Disorders , 22 (1), S73–S77.
Michela Barichella, E. C. (2017). Dietary habits and neurological features of Parkinson's disease patients: Implications for practice. Clinical Nutrition , 36 (4), 1054-1061.
Siobhan Fox, A. C. (2016). Interviews with Irish healthcare workers from different disciplines about palliative care for people with Parkinson’s disease: a definite role but uncertainty around terminology and timing. BMC Palliative Care , 15 (15).
T Pringsheim, N. J. (2014). The prevalence of Parkinson's disease: A systematic review and meta‐analysis. Movement Disorders , 29 (13), 1583–1590.
W Jiang, C. J. (2014). Dairy foods intake and risk of Parkinson's disease: a dose–response meta-analysis of prospective cohort studies. European Journal of Epidemiology , 29 (9), 613-619.
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