Promoting Health In Extended Care: Priorities Of Care For Parkinson’s Disease Patient

Medical Assessment and Management

Discuss about the Promoting Health in Extended Care.

This essay aims to discuss the identified priorities of care in the given case scenario. Out of the five priorities of care, the two selected care priorities are- increased risk of social isolation and medication assessment and management. The discussion regarding the care of the patient in the given case scenario will be based on the processes that will be identified in in the Levett-Jones Clinical Reasoning Cycle or Framework. It will utilize Miller’s Functional Consequences Theory of Healthy Ageing will as a theoretical scaffold. The confirmation regarding how the patient’s dignity is maintained through the planning of care and process of provision will be discussed. Additionally, the client’s cultural background will be taken into consideration.

In the given case scenario, the patient is a 77-year-old widower, named Johann Silvermann. He is suffering from  Parkinson’s disease and hypothyroidism four years back. His hypothyroidism is now controlled on medication. The patient resides alone in his home having two-storeys and his wife is no more. The couple did not have any children; hence, he lives alone. A brother of the patient lives with his family nearby. The patient does not wish to bother them in his daily life. He has limited sources of income, which can only cover his expenses. The patient felt a minor tremor in his hands, which is aggravating. He is not able to perform the daily tasks difficult for him. He is worried regarding his disease and wonders how he will face the uncertainties in the future. His current medications comprise Entacapone 200 mg q8h., Thyroxine 100 micrograms daily and Carbidopa/Levadopa 25/100 q8h.

In the given case scenario, the patient is suffering from Parkinson’s disease, in which the nerve cells of the brain become impaired as well as gets degenerated (Liao et al., 2013). The pathogenesis of this disease is unknown. It is chronic and in nature and is progressive, but it does not affect the individuals in the similar way (Peretz et al., 2014).  A number of patients become disabled and others experience minor disturbances in motor functions. The physical symptoms of this disease include tremor, bradykinesia, rigidity, postural instability. The non-motor symptoms of this disease include depression, dysphagia, emotional changes, dysarthria, fragmented sleep, skin problems, constipation or urinary problems (Weerkamp et al., 2014).

The discussion of care of the patient will revolve around two care priorities. The first one is Medical assessment and management. In the given case scenario, it utilize the processes recognized in the Levett-Jones Clinical Reasoning Cycle or Framework (Levett-Jones, 2013). The work of clinicians and nurses involves collection of cues, processing the information, and come to an understanding regarding the situation or problem of the patient, plan and implementing interventions, evaluate the outcomes, reflect on and learn from the process. Considering the situation of the patient, he is an elderly individual, who has been diagnosed with Parkinson’s disease four years back. The patient was also diagnosed with hypothyroidism, four years back, which is now under control now. In order to collect the cues, the current symptoms of the patient will be observed in which his present symptoms of the disease will be taken into consideration. The minor tremor in his hands is aggravating. He is not able to perform the daily tasks. He has no one to look after him as his wife has expired 12 years back and he has no children. The planning and implementing of the interventions will be based on symptomatic and neuroprotective therapy (Magennis, Lynch & Corry, 2014). Its goal is to provide a control associated with the signs and symptoms of this disease for as long as possible whilst reducing the adverse effects (Shin & Habermann, 2016).  A number of studies have reported that the quality of a patient’s life deteriorates, if he/she is not provided with an appropriate treatment after the diagnosis (Birren et al., 2013).

Symptomatic therapy for Parkinson’s disease

For the treatment of Parkinson disease, the pharmacologic treatment can be divided into neuroprotective and symptomatic therapy. At present, there is no confirmed treatment disease modifying or neuroprotective therapy (Holwerda et al., 2012). For symptomatic treatment, Levodopa, coupled with Carbidopa, which is a peripheral decarboxylase inhibitor, is the gold standard (Magennis, Lynch & Corry, 2014).  It slows down the decarboxylation of levadopa to dopamine in the systemic circulation and allows for the greater distribution of Levadopa into the central nervous system (Weerkamp et al., 2014). For the motor signs and symptoms, it provides the greatest antiparkinsonian advantage for the motor signs and symptoms, with the smallest number of undesirable consequences in the short term; though, its long-standing utilization is associated with the progression of dyskinesias and motor functions (Eliopoulos, 2013).  If dyskinesis and fluctuations become problematic, then it is difficult for resolving. The inhibitors of Monoamine oxidase can be considered for preliminary treatment of early disease. The nurse who is given the work of addressing the needs of the patients with Parkinson’s disease is a specialist having an expert knowledge regarding the symptoms and treatment of Parkinson’s disease (Vikström et al., 2015). The experience of this disease is necessary for providing person-centered care, enabling the patient for identifying the and quickly responding to the symptoms that are changing. This minimizes the risks to the patients and families, and assists in preventing emergency admissions (David et al., 2015).

The individuals suffering from Parkinson’s disease along with their families’ value the nurses of Parkinson’s because the patients understand the condition or situation (Weerkamp et al., 2014). The nurses understand the complex ways in which Parkinson’s affects the individuals (Kogan, Wilber & Mosqueda, 2016).  The nurses try to make sure that patient’s dignity is maintained in the course of planning of care and provision. Additionally, they consider the cultural background of the patients. In the working lives of the nurses and other healthcare professionals, they come across a few number of individuals with Parkinson’s disease (Steptoe et al., 2013).

The nurses play a significant role in providing education to the patients regarding the condition and how the individuals are affected by it and minimizing the risks to the individuals with this condition. The nurses are placed ideally for providing education to the individuals suffering from Parkinson’s disease together with their care providers and families (Holwerda et al., 2012). This approach facilitates the individuals in understanding their condition and treatment. It enables self-management and making shared decisions. The nurses come across a variety of settings together with clinics, healthcare centers, hospitals, care homes and the own home of the individuals. An expert support is provided by them and makes sure the continuity of care throughout the journey of the patient from diagnosis to death (Vikström et al., 2015).

The second priority of care is increased risk of social isolation. Since the patient lives and he does not have a family, there is an increased possibility that his symptoms may deteriorate. In addition, he does not want to bother his brother and his family for carrying out his daily activities. The patient is having an increased risk of being lonely or socially isolated. He is near to his 80’s and is a widower. He manages everything on his own, as he does not have any child, who can take care of him. A number of researchers have examined the effect of social isolation on the health consequences (Steptoe et al., 2013). According to their findings, the lack of social contacts poses a strong factor of risk for mortality. In addition, the older adults who live lonely and do not want to have any social contact have an enhanced risk of dying more rapidly. They also are more probable to experience reduced mobility in comparison to the older adults who live with their families and have social contacts (Hunter, 2012).

Role of Nurses in providing care for Parkinson’s disease patient

Social relationships or associations are essential for the well-being of the humans and are significantly involved in health maintenance. In the older adults, social isolation is a particular problem when reducing economic resources and impairment in the mobility work together to limit societal contacts (Holwerda et al., 2012). The older individuals who are socially isolated possess an increased risk for developing cardiovascular disease, cognitive impairment, infectious illness and mortality. It has also been related with elevated blood pressure and some other associated problems (Rodin, 2014).

For the patient in the provided case scenario, Miller’s Functional Consequences Theory of Healthy Ageing will be utilized as a theoretical scaffold. This theory draws from the other theories, which are relevant to the adults, holistic nursing and ageing (Hunter, 2012). The concepts of nursing domain of the individuals, health, environment, and nursing are associated with the exclusively with respect to the older adults (Eliopoulos, 2013). Functional consequences are the apparent effects of events, changes associated with age and risk factors that persuade the quality of life of activities of the adults on a daily basis. The factors of risk can originate in the surroundings or can arise from psychosocial and physiologic influences (Holwerda et al., 2012).When the functional consequences interfere with the quality of life or level of function of an individual, then they are said to be negative. On the other hand, when thy assist the utmost level of performance together with the smallest amount of dependence, then they are said to be positive. The negative functional consequences characteristically occur due to the combination of alterations that are associated with changes and the factors of risk. They may also result due to the interventions, in the cases, where the interventions become the factor of risk (Rodin, 2014).

To conclude, the patient in given case scenario needs to be provided with an appropriate care regarding his Parkinson’s disease and his increased risk of social isolation. The nurses should understand the complex ways by which Parkinson’s affects the individuals. The nurses should try to make sure that the patient’s dignity is maintained in the course of the process of care planning and provision For the treatment of Parkinson disease, the planning and implementation of the interventions will be based on symptomatic and neuroprotective therapy. The goal should be to provide a control associated with the signs and symptoms of Parkinson’s disease for as long as possible whilst reducing the adverse effects.  For dealing with his increased risk of social isolation, the patient should be encouraged to socialize with the other individuals because it will help him to overcome his loneliness and will make him strong in dealing with the situations of life in an efficient manner.

References

Birren, J. E., Cohen, G. D., Sloane, R. B., Lebowitz, B. D., Deutchman, D. E., Wykle, M., & Hooyman, N. R. (Eds.). (2013). Handbook of mental health and aging. Academic Press.

Davidson, L., Tondora, J., Miller, R., & O’Connell, M. J. (2015). Person-centered care.

Eliopoulos, C. (2013). Gerontological nursing. Lippincott Williams & Wilkins.

Holwerda, T. J., Beekman, A. T., Deeg, D. J., Stek, M. L., van Tilburg, T. G., Visser, P. J., … & Schoevers, R. A. (2012). Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL). Psychological medicine, 42(04), 843-853.

Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters Kluwer/Lippincott, Williams and Wilkins

Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Personâ€ÂCentered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review. Journal of the American Geriatrics Society,64(1), e1-e7.

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.

Liao, Y. C., Wu, Y. R., Tsao, L. I., & Lin, H. R. (2013). The experiences of Taiwanese older individuals at different stages of Parkinson disease. Journal of Neuroscience Nursing, 45(6), 370-377.

Magennis, B., Lynch, T., & Corry, M. (2014). Current trends in the medical management of Parkinson’s disease: implications for nursing practice.British Journal of Neuroscience Nursing, 10(2).

Peretz, C., Chillag-Talmor, O., Linn, S., Gurevich, T., El-Ad, B., Silverman, B., … & Giladi, N. (2014). Parkinson’s disease patients first treated at age 75 years or older: A comparative study. Parkinsonism & related disorders,20(1), 69-74.

Rodin, J. (2014). Health, control, and aging. Aging and the Psychology of Control, 139-165.

Shin, J. Y., & Habermann, B. (2016). Nursing Research in Parkinson’s Disease From 2006 to 2015 A Systematic Review. Clinical nursing research, 1054773816634912.

Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women.Proceedings of the National Academy of Sciences, 110(15), 5797-5801.

Vikström, S., Sandman, P. O., Stenwall, E., Boström, A. M., Saarnio, L., Kindblom, K., … & Borell, L. (2015). A model for implementing guidelines for person-centered care in a nursing home setting. International Psychogeriatrics, 27(01), 49-59.

Weerkamp, N. J., Tissingh, G., Poels, P. J., Zuidema, S. U., Munneke, M., Koopmans, R. T., & Bloem, B. R. (2014). Parkinson disease in long term care facilities: a review of the literature. Journal of the American Medical Directors Association, 15(2), 90-94.