BACHELOR OF SCIENCE IN NURSING:
INTENSIVE NURSING PRACTICUM
RLE MODULE RLE UNIT WEEK
3 11 11
Geriatric Nursing - Parkinson’s Disease
ü Read course and laboratory unit objectives
ü Read study guide prior to class attendance
ü Read required learning resources
ü Participate in weekly discussion board (Canvas)
ü Answer and submit course unit tasks
At the end of this unit, the students are expected to:
General Objective:
To help future nurses to further understand and sharpen knowledge, attitude and nursing skills
needed in handling with a case of 'Parkinson's disease' and the complications that may follow.
Specific Objectives:
1. To discuss about Parkinson’s disease and its possible complications or imbalances.
2. To recognize the structures and functions in the body system that is mainly affected by the
illness.
3. To explain physiological processes or mechanisms whereby such condition develops and
progresses
4. To understand results of the laboratory examinations and diagnostic procedures undergone by
the patient.
5. To know more about the medications including its dosage, indications, side effects, nursing
considerations that was administered.
6. To create a nursing care plan suited for the patient’s condition as well as the recommendation.
Hinkle, J. L., & Cheever, K. H. (2017). Brunner & Suddarth's textbook of medical-surgical nursing
(Edition 14.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Geriatric Nursing
Gerontology, or geriatric, nursing is a specialty focused on the care of older adults. Like other
nursing specialties, a profession in gerontological nursing requires an understanding of anatomical
and physiological changes with aging, keen assessment and monitoring skills, vast knowledge
about disease and conditions, and ongoing education related to recommended treatment options.
Gerontological nurse practitioners are certified nurse practitioners who provide care to elderly
patients. They work in a variety of settings. They are primary care providers who are trained to treat
and prevent acute and chronic health concerns of aging adults.
Gerontological nurse practitioners diagnose and treat physical, emotional, cognitive, and social
needs of geriatric patients. They are adult nurse practitioners with advanced education regarding
the needs of elders.
Anatomy and Physiology
The brain is one of the most complex and magnificent organs in the human body. Our brain gives
us awareness of ourselves and of our environment, processing a constant stream of sensory data.
It controls our muscle movements, the secretions of our glands, and even our breathing and
internal temperature. Every creative thought, feeling, and plan is developed by our brain. The
brain's neurons record the memory of every event in our lives.
o Brain
o Brain stem - medulla, pons, midbrain
o Diencephalon – thalamus & hypothalamus
o Cerebellum
o Cerebrum
Basal ganglia
l Group of nuclei (cluster of neurons) in the brain that are located beneath the cerebral cortex
which are involved in the control of voluntary muscle movements.
l It specializes in processing information on movement and in-fine tuning the activity of the brain
circuits.
l It is a large masses of gray matter located within the central core of white matter of cerebral
hemispheres.
The Basal ganglia is composed of:
- Corpus striatum
--- Uses and stores the neurotransmitter dopamine (Caudate nucleus and Putamen)
- Caudate nucleus
- Putamen
- Globus pallidus
1. Caudate nucleus- these C-shaped pair nuclei are located primarily in the frontal lobe region of
the brain. It is involved in memory storage, associative anc procedural learning, inhibitory control,
decision making, and planning.
2. Putamen- lies just under behind the front of the caudate. It appears to be involved in voluntary
and imvoluntary motor control.
3. Globus pallidus- located near the caudate nucleus and putamen. It sendds information from
basal ganglia nuclei to the thalamus.
Subthalamic nucleus- located just below the thalamus. It receives excitatory inputs from the
cerebral cortex and has excitatory connections to the globus pallidus and substantia nigra. It is also
involved in associative learning and limbic functions.
Substantia nigra- is a region of dark melanin-containing neurons that is ivolved in the inhibition of
movement. It is composed of Pars reticulata and Pars compacta.
-Pars reticulata segment forms one of the major inhibitory outputs of basal ganglia and assists in
regulation of the eye.
-Pars compacta segment contains pigmented nerve cells that produces dopamine.
Degeneration of the substantia nigra leads to a loss of motor control known as Parkinson's disease.
Parkinson's Disease
Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking,
balance, and coordination. Parkinson's symptoms usually begin gradually and get worse over time.
As the disease progresses, people may have difficulty walking and talking. They may also have
mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue. Both
men and women can have Parkinson’s disease. However, the disease affects about 50 percent
more men than women.
One clear risk factor for Parkinson's is age. Although most people with Parkinson’s first develop the
disease at about age 60, about 5 to 10 percent of people with Parkinson's have "early-onset"
disease, which begins before the age of 50. Early-onset forms of Parkinson's are often, but not
always, inherited, and some forms have been linked to specific gene mutations.
What Causes Parkinson's Disease?
Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain that controls
movement become impaired and/or die. Normally, these neurons produce an important brain
chemical known as dopamine. When the neurons die or become impaired, they produce less
dopamine, which causes the movement problems of Parkinson's. Scientists still do not know what
causes cells that produce dopamine to die.
People with Parkinson's also lose the nerve endings that produce norepinephrine, the main
chemical messenger of the sympathetic nervous system, which controls many automatic functions
of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain
some of the non-movement features of Parkinson's, such as fatigue, irregular blood pressure,
decreased movement of food through the digestive tract, and sudden drop in blood pressure when
a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson's contain Lewy bodies, unusual clumps of the protein
alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of
alpha-synuclein and its relationship to genetic mutations that impact Parkinson’s disease and Lewy
body dementia.
Although some cases of Parkinson's appear to be hereditary, and a few can be traced to specific
genetic mutations, in most cases the disease occurs randomly and does not seem to run in families.
Many researchers now believe that Parkinson's disease results from a combination of genetic
factors and environmental factors such as exposure to toxins.
Symptoms of Parkinson’s Disease
Parkinson's disease has four main symptoms:
l Tremor (trembling) in hands, arms, legs, jaw, or head
l Stiffness of the limbs and trunk
l Slowness of movement
l Impaired balance and coordination, sometimes leading to falls
l Other symptoms may include depression and other emotional changes; difficulty swallowing,
chewing, and speaking; urinary problems or constipation; skin problems; and sleep
disruptions.
Symptoms of Parkinson’s and the rate of progression differ among individuals. Sometimes people
dismiss early symptoms of Parkinson's as the effects of normal aging. In most cases, there are no
medical tests to definitively detect the disease, so it can be difficult to diagnose accurately. Early
symptoms of Parkinson's disease are subtle and occur gradually.
For example, affected people may feel mild tremors or have difficulty getting out of a chair. They
may notice that they speak too softly, or that their handwriting is slow and looks cramped or small.
Friends or family members may be the first to notice changes in someone with early Parkinson's.
They may see that the person's face lacks expression and animation, or that the person does not
move an arm or leg normally.
People with Parkinson's often develop a parkinsonian gait that includes a tendency to lean forward,
small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have
trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the
disease progresses, it eventually affects both sides. However, the symptoms may still be more
severe on one side than on the other.
Many people with Parkinson’s note that prior to experiencing stiffness and tremor, they had sleep
problems, constipation, decreased ability to smell, and restless legs.
Diagnosis of Parkinson’s Disease
A number of disorders can cause symptoms similar to those of Parkinson's disease. People with
Parkinson's-like symptoms that result from other causes are sometimes said to have parkinsonism.
While these disorders initially may be misdiagnosed as Parkinson's, certain medical tests, as well
as response to drug treatment, may help to distinguish them from Parkinson's. Since many other
diseases have similar features but require different treatments, it is important to make an exact
diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinson's
disease. Diagnosis is based on a person's medical history and a neurological examination.
Improvement after initiating medication is another important hallmark of Parkinson's disease.
CLINICAL SCENARIO:
NURSING HEALTH HISTORY
A. Patient’s Profile
Name: Patient CD
Birthday: January 30, 1950
Age: 67 years old
Sex: Male
Nationality: Filipino
Religion: Roman Catholic
Marital Status: Single
Address: Caloocan City
Case Background:
A 67-year-old male was admitted last April 16. 2015 accompanied by the institution of Barangay
volunteer. Accordingly, the client is living alone in an abandoned area at their Barangay. The client
is not disclosing any of his personal information, thus background data is not well documented.
Being an old age, weak, sick and unsheltered and having no family, hence referred at EMMAUS
Apostolate wherein his needs will be provided.
Family History
(+) Hypertension
(-) Diabetes
(-) Asthma
(-) Cancer
Personal and Social History
He is single and living as a worker in a window glass store. He doesn’t smoke and drinks alcohol
occasionally.
Physical Assessment Date: August 29, 2020
General Survey Patient received patient awake on bed
Responds to question slowly
Vital signs as of 9 am:
BP: 110/80 T:36.4 PR:88 RR:15
Integumentary Skin coloris brown, warm, rough to touch and
dry
Hair is dry and white in color
Nails are long and dirty
Heent Anicteric sclera, pink palpebral conjunctiva
Nostrils are patent
Chest and Lungs Symmetrical chest expansion, no retractions,
no lagging, vesicular breath sounds
Heart Adynamic precordium; normal rate regular
rhythm, no murmur
Abdomen Abdomen is soft, non tender upon light and
deep palpation
Extremities Assymetric tremor of the hands (right hand), no
cyanosis, no edema
Cranial Nerve Assessment Date: August 29, 2020
Olfactory Hyposmia
Optic Blurred vision
Occulomotor Grossly Normal
Troclear Grossly Normal
Trigeminal Decreased level of the sense of touch
Abducens Grossly Normal
Facial (+) Mask face, hypogeusia
Vestibulocochlear Decreased level of the sense of hearing
Glossopharyngeal Intact gag reflex
Vagus Can swallow food
Accesory Decreased in strength
Hypoglossal Can push the tongue against resistance
Course in the Ward
DAY 1
One group of senior students of OLFU attended the mass conducted at Emmaus Chapel. After
that, general orientation which includes the following: tour of the wards, introduction of oneself to
designated client as well as to the volunteers found in each ward was done. The remaining time
was utilized to build nurse-patient relationship and talk to the volunteers for us to familiarize their
daily routines. Upon meeting all clients, they discussed their potential patient for this case study.
DAY 2
They chose the patient with Parkinson's disease that caught their interest. They went to their
respective wards and physical assessment was done during the nurse-patient interaction and the
patient said 'Ma'am Gusto ko na po maligo pero hindi ko kayang gawin mag-isa' and his
verbalization was supported by dry skin, dirty fingernails, dirty clothes, thick mustache and
presence of body odor. After assessing, they come up to their first plan of care and started taking
actions based on the patient's condition. At 7: they bathed, dressed, provide oral hygiene, applied
lotion, changed patient's diaper, cutted nails and shaved the mustache and beard. At 8:00 a.m.
breakfast was served and medication was given like Multivitamins 1 capsule OD, Norvase 5mg OD
and Pardopa 1/2 tab OD. After that, Vital signs were taken as follows: BP: 110/80 T: 36.4 PR: 88
RR: 15. Gordon's Functional Assessment was done and found out the patient's concern as he
verbalized that he has a difficulty of sleeping at night and we anticipated that he is at risk for injury.
By 12:00 noon lunch was given to the client.
DAY 3
At 6:00 a.m. received patient on his bed and asleep. At 6:30 a.m. the patient was transferred from
bed to wheelchair to listen to the ceremonial mass. Monitored and recorded vital signs as follows:
BP: 110/80 T: 36.7 PR: 73 RR: 14 and morning care was done. By 9:00 a.m. breakfast was served.
Medication was given like Multivitamins 1 capsule OD, Norvase 5mg OD and Pardopa 1/2 tab OD.
Patient has requested a music and by 12:00 noon lunch was given to the client.
DAY 4
At 6:00 patient received awake on bed. He was asked about his sleep. and the patient answered
"mabilis ako nakatulog gabi. The patient was transferred from bed to wheelchair to provide the
morning care. Subsequently, bathing and oral hygiene was done. Monitored vital signs as follows:
BP: 120/70 T: 36.7 PR: 77 RR: 15. Aided patient in sitting on a stable chair. Placed the client on a
stable position and by a.m. breakfast was served. Medication was given like Multivitamins 1
capsule OD, Norvasc 5mg OD and Pardopa 1/2 tab OD. Companionship was rendered like we
played music, watch a television show, massage the patient and do some exercises and by 12:00
noon lunch was given to the client.
DAY 5
The patient was in bed. The patient was transferred from bed to wheelchair to provide the morning
care. Bathing and oral care was done. Vitals signs taken and recorded as follows: BP: 110/80 T:
36.6 PR: 81 RR: 15. By 8:00 a.m. breakfast were served. Medications was given such as
Multivitamins 1 capsule OD, Norvasc 5mg OD and Pardopa 1/2 tab OD. The patient requested to
watch a television. Companionship was rendered like we played music, watch a television show,
massage the patient and do some exercises and by 12:00 noon lunch was served to the client.
DAY 6
As they age, time spent socializing can strengthen your sense that life has meaning and purpose.
On their last day of duty at Emmaus House of Apostolate. They prepared a grand socialization for
the Lolo's and Lola's. They prepared some games as well as prizes. At 7:00 a.m. The patient was
cooperative. Thereupon, personal hygiene such as bathing and oral care was done. Vital signs
were taken as follows: BP: 110/70 T: 36.5 PR: 77 RR: 18 and morning care was done. At 8:00am
breakfast was served and medication was administered like Multivitamins 1 capsule OD, Norvasc
5mg OD and Pardopa 1/2 tab OD. By 9:00 a.m. the program has started. They can feel the
enthusiasm and happiness in their hearts. By 12:00 noon lunch was given to the client and
companionship was rendered.
Laboratory Results
URINALYSIS
Color Yellow
Glucose Negative
Bilirubin Negative
Ketone Negative
Sp. Gravity 1.010
Ph 5.5
Protein Negative
Leukocytes Negative
RBC 0.1
WBC 0.1
Amorphous urates Rare
Epithelial Cell Rare
Bacteria Rare
Mucous threads few
Chest X-ray
Clear lungs, Pulmonary Hyper aeration
True cardiac size cannot be ascertain
Atheromatous aorta
COURSE TASKS:
1. Conceptualize the pathophysiological alterations distinct to the case.
ü Trace the pathophysiological changes and highlight problems that are
experienced by the client.
ü Connect the pertinent nursing care and medical – surgical management to the various
signs and symptoms presented by the client.
ü Interpret the laboratory results obtained from the patient.
2. Make a drug study with first column with generic, brand name, dosage, frequency, route
and classification; second column with mechanism of action, third column with rationale why
giving the drug, fourth column with common side effects of the drugs and last column
with nursing considerations while taking the drug.
3. Make at least two nursing care plan based on your assessment that needs to prioritize.
Date Completed:
Date Submitted:
Hinkle, J. L., & Cheever, K. H. (2017). Brunner & Suddarth's textbook of medical-surgical nursing
(Edition 14.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
