Parkinson disease: Nursing process (ADPIE)

Michael Desante is a 67 year old male with a history of Parkinson disease. His daughter has been his primary caregiver since his diagnosis, however, as Michael’s disease progressed, Michael moved into a long-term care center for further support.

Parkinson disease, or PD for short, is a progressive neurological disease that affects movement. Most often, the cause of PD is unknown, but there are some factors that can increase the risk.

Non-modifiable risk factors include increasing age, with a mean age of onset of 57 years; as well as male sex; and having a family history of PD.

On the other hand, modifiable risk factors include exposure to toxins like pesticides, and a history of head trauma. Now, in PD there’s degeneration of the dopamine-producing neurons in the substantia nigra of the basal ganglia.

Normally, the substantia nigra helps initiate movements, but also fine tunes the way that movements happen. When these neurons die, the first symptom is a resting tremor, which is an involuntary shaking that presents at rest and decreases with movement.

Most often, resting tremor affects the hands, which is called a “pill-rolling” tremor because it looks like someone is rolling a pill between their thumb and index finger.

Over time, resting tremor can also involve the feet, tongue, and jaw. In addition, the client can experience bradykinesia, or slowness of voluntary movement.

A more severe form of bradykinesia is akinesia, which is when they become unable to initiate a voluntary movement. For instance, the client may feel like their legs freeze up when trying to walk.

Another typical symptom is “cogwheel” rigidity, which is a type of stiffness characterized by a series of catches or stalls as a person’s arms or legs are passively moved by someone else.

And because of rigidity of facial muscles, some clients with PD may have a mask-like facial expression, as well as difficulty speaking, chewing, and swallowing.

As a result, food, fluid, or saliva may enter the lungs, causing aspiration pneumonia. Decreased intake can put the client at risk for nutritional problems.