HOWARD COMMUNITY COLLEGE

NURSING EDUCATION PROGRAM

NURSING CARE PLAN
Student Name: Shaleah McQueen
12/2/16_____________________
Patient Initials: C.B

Age/Sex

Date Submitted:
74

Medical Diagnosis

Parkinsons Disease

Complete using your nursing textbooks (cite references used). Underline the etiologies and clinical
manifestations that relate to your client.

I.

Pathophysiology:

The pathologic process of PD involves degeneration of the dopamine producing neurons in the
substanstia nigra of the midbrain, that interrupts the normal balance between DA and
Acetylcholine in the basal ganglia. PD manifestations occurs when 80% of neurons in the
substantia nigra are lost.
Dopamine is a neurotransmitter essential for normal functioning of the extrapyramidal motor
system. Including control of posture, support, and voluntary motion.
(Lewis, 2011) pg.1432

II.

Etiology:

The exact cause of PD is unknown, a complex interplay of environmental and genetic factors is
involved. 10%-15% of PD patients have a family history of the disease. Many autosomal
dominant and recessive genes have been linked to familial PD.
(Lewis, 2011) pg.1432

III.

Clinical Manifestations (Signs & Symptoms):

Gradual/insidious onset
Tremor

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IV.

Rigidity
Bradykinesia
Slight limp
Decreased arm swing
Dysphagia

Treatment and Nursing Management:

V.

Antiparkinsonian Drugs (Drug Therapy)- correcting the imbalance of neurotransmitters

within the CNS
Deep brain stimulation
Ablation surgery
Diagnostic Studies

VI.

There is no specific diagnostic test for PD

Diagnosis is based on clinical features
When at least two of the three signs of the triad (tremor, rigidity, and bradykinesia) are
present
PD is ultimately confirmed when the patient has a positive response to antiparkinsonian
drugs
MRI
Rule out the side effects of phenothiazine, reserpine, benzodiazepines, haloperidol.
Plan ample time for eating to avoid frustration( foods that are easily swallowed and
chewed/ fruits/ adequate roughage)
Discharge Planning and Client Teaching

Teaching and nursing care directed toward maintenance of health

Promote/teach about physical exercise that can limit the consequences of decreased motility
Consult a physical therapist
Consult an occupational therapist to assist patient with self-care strategies
Assist the patient by listening, providing coping strategies, challenging distorted thoughts, and
encouraging social interactions.
Encourage environmental changes such as removing rugs, excess furniture, and wearing easy slip on
shoes.

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VIII.

Growth & Development

According to Erikson: Stage: Late Adulthood______________ Crisis:
_Despair vs. Integrity_______________________
Tasks:

A.

Describe your patients ability to achieve their growth and developmental tasks.
How is this ability affected by the underlying disease process and/or the current
admission?

The patient has the ability to achieve their growth and developmental tasks. The past makes
engineering jokes referring to his old career and is in good spirits even when in pain. The patient
has accepted both of his diseases, but seems like he could be struggling to cope with both at the
same time.

B.

IX.

List nursing actions to assist your client in meeting their growth and
developmental needs.
Encourage the patient to join a support group with people going through similar things
Encourage the patient to do as much self-care as he can
Promote exercising to exercise

List in priority order all relevant nursing diagnoses for your patient. Include
NANDA diagnosis, etiology and supporting data.

Impaired physical mobility related to rigidity, bradykinesia, and akinesia and the patients
slowness of moment.
Imbalanced nutrition: less than body requirements related to inability to ingest food, the
patient having trouble swallowing (the patient stated a pill was stuck in his throat for 6
hours)
Impaired swallowing related to neuromuscular impairment (decreased gag reflex), the
patient being NPO with sips.

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Assessment Data

Nursing Diagnosis

Nursing Actions

Rationale

Evaluation

Identify all data that support the

priority nursing diagnosis.

According to NANDA

List in order of priority. Label

aspect of care.

State the rationale for each

nursing action. Cite reference
and page number.

Evaluate the patient response to

each nursing action providing
objective & subjective data.
Revise nursing actions as
necessary.

Subjective:
The patient stated last
night a pill was stuck in
his throat for 6 hours
The patient stated he had
a difficult time taking his
medication.

Objective:
NPO with sips with
medication, and hard
candy
Calcium- 7.9(decreased)
Magnesium
1.5(decreased)
HCT- 32.9%
Constipation: prescribed
laxatives and constipation
drugs

Imbalanced
nutrition: less than
body requirements
related to inability
to ingest food, the
patient having
trouble swallowing
(the patient stated a
pill was stuck in his
throat for 6 hours)

Expected Outcome:

Short Term Goal (STG):

The patient will
understand and explain
an adequate diet plan to
maintain nutrition at the
end of the shift/
Long Term Goal (LTG):
The patients IV therapy
will fix the electrolyte
imbalance and his I and
Os will be maintained by
discharge.

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Nutritional: Teach the

patient about eating
several small meals a day
that contain roughage
and fruit.
Pharmacological: The
nurse will administer
constipation medication
Rehabilitation: The nurse
will promote exercising
and a well-balanced diet
Physiological: The nurse
will measure the patients
Is and Os to maintain
an equal balances of fluid
going in and come out.

1. The diet should

contain roughage
and fruit to avoid
constipation.
Eating 6 small
meals a day may
be less exhausting
than eating three
large meals a day
(Lewis,2011, pg.
1436)
2. Exercise can limit
the consequences
of decreased
mobility such as
muscle atrophy,
contractures, and
constipation.
(lewis,2011
pg.1437)
3.

Evaluate each expected

outcome:

Short Term Goal (STG):

Long Term Goal (LTG):

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Assessment Data

Nursing Diagnosis

Nursing Actions

Rationale

Evaluation

Identify all data that support the

priority nursing diagnosis.

According to NANDA

List in order of priority. Label

aspect of care.

State the rationale for each

nursing action. Cite reference
and page number.

Evaluate the patient response to

each nursing action providing
objective & subjective data.
Revise nursing actions as
necessary.

Expected Outcome:

Short Term Goal (STG):

Long Term Goal (LTG):

Evaluate each expected

outcome:

Short Term Goal (STG):

Long Term Goal (LTG):

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MEDICATION PREPARATION SHEET

Allergies:

No known allergies

Med as per MAR: acetaminophen

MD Order: Acetaminophen(Tylenol) tablet 650 mg
Time(s) Due: 1000
Generic/Trade Name: Tylenol
Normal Dosage: 325-650mg
Classification/Action: Inhibits synthesis of prostaglandins that may serve as mediators of
pain and fever, primarily in the CNS
Indication for Patient: Treatment of mild pain
Major Side Effects: anxiety, headache, fatigue
Parameters Checked: Pain level:2
Med as per MAR: calcium gluconate 1 g in sodium chloride 0.9% 100ml iVPB
MD Order: calcium gluconate 1 g in sodium chloride 0.9% 100ml iVPB
Time(s) Due: 845
Generic/Trade Name: Kalcinate
Normal Dosage: 0.5g-2g
Classification/Action: essential for nervous, muscular, and skeletal systems. Maintain cell
membrane and capillary permeability
Indication for Patient: Treatment and prevention of hypocalcemia
Major Side Effects: headache, tingling, syncope, Cardiac arrest
Parameters Checked: no parameters
Med as per MAR: docusate sodium(COLACE) capsule 100 mg
MD Order: docusate sodium(COLACE) capsule 100 mg
Time(s) Due: 1000
Generic/Trade Name: COLACE
Normal Dosage: 50-400mg
Classification/Action: promotes incorporation of water into stools
Indication for Patient: prevention of constipation
Major Side Effects: throat irritation, mild cramps, diarrhea
Parameters Checked: no parameters
Med as per MAR: magnesium sulfate 2g in 50 mL IVPB
MD Order: magnesium sulfate 2g in 50 mL IVPB
Time(s) Due: 845
Generic/Trade Name: magnesium sulfate
Normal Dosage: 2 grams
Classification/Action: essential for the activity of many enzymes. Neurotransmission and
muscular excitability

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Indication for Patient: treatment/prevention of hypomagnesemia

Major Side Effects: drowsiness, decreases respiratory rate
Parameters Checked: Low mg lab values(1.5)

Med as per MAR: rasagiline(AZILECT) tablet 1 mg

MD Order: rasagiline(AZILECT) tablet 1 mg
Time(s) Due: 1000
Generic/Trade Name:AZILECT
Normal Dosage:1mg
Classification/Action: inactivates monoamine oxidase by binding to it at type B to increase
dopamine available in CNS
Indication for Patient: History of Parkinsons disease
Major Side Effects: depression, dizziness
Parameters Checked: N/a
Med as per MAR: senna(SENOKOT) tablet 8.6 mg
MD Order: senna(SENOKOT) tablet 8.6 mg
Time(s) Due: 1000
Generic/Trade Name:SENOKOT
Normal Dosage: 2 tablets once daily
Classification/Action: acts as a local irritant on the colon stimulating peristalsis
Indication for Patient: treatment of constipation associated with dry hard stools
Major Side Effects: electrolyte imbalances, dehydration
Parameters Checked: n/a

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