Case study of a man with parkinsons disease

Mr Henderson has arrived in hospital after a history of falls at home and has just commenced a new medication regime.

It is very possible that he may be anxious, worried, frightened as a result of falling at home which also may result in loss of confidence. He may also be apprehensive about his new medication regime. Having been diagnosed with Parkinson’s for 5 years, he more than likely knowns the importance of getting his medications on time, in reducing the symptoms allowing him to maximise his independence. However, it is not for the nurse to presume this and she/he must sit down, talk to him, allowing him time to talk and express his worried and anxieties. This was help to establish a relationship and Mr Henderson will understand that you are there to support him throughout his journal of care. The nurse should also make sure that all members of the multidisciplinary team are aware of Mr Henderson’s condition and if they are not aware of the importance of getting medication on time out with ‘normal’ drug rounds then they should be informed of its importance and understand the significant consequences resulting from not getting the drugs on time such as reduced independence and prolonged hospital stay. As medications are a large part in maximising independence and mobility and it may be suggested that Mr Henderson receives his medications before getting out of bed in the morning. This will allow time for the drugs to work and therefore enabling him to get out of bed more easily.

‘Freezing’, a symptom of Parkinson’s’ disease can be distressing for patients. It affects gait initiation, turning and moving through small spaces, such a doors and busy areas. Anxiety can exacerbate freezing and it is vital that the nurse can firstly recognise anxiety, this may be achieve through effective communication and listening skills and secondly developing strategies to reduce anxiety levels such as allowing him time to talk, listening and taking on board his expressions allowing for a trusting relationship to be developed, helping him to build in confidence and preparing him psychologically for going home. Various strategies have been suggested to assist with ‘freezing’. Alexander, Fawcett and Runicnan (2006) suggest cognitive techniques in breaking down movement. They suggest breaking down the task of getting out of bed in the morning and describe that patients should bend their knees so that feet are flat on the mattress and they the patient should swing knees in the direction that he wants to turn. The next stage involves clasping both hands and lifting them straight up, straightening the elbows, then turning the head and swinging the arms in the same direction as the legs. Finally the patient can grip the edge of the mattress and adjust his position until comfortable. When Mr Henderson is mobilising then it is important that he does not have any distractions and the nurse or other members of staff should not disturb or interrupt if at all possible as this could lead to ‘freezing’. The Parkinson’s Disease Society describe cueing strategies as external meaning visual, auditory or preprioceptive or internal meaning cognitive.

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