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Pathophysiology and Nursing Essay Assignment
This Pathophysiology Nursing Essay Assignment is case based written assessment, requires Clinical Reasoning Cycle Guide, Health assessment, clinical Findings and nursing care strategies.
Brief overview of pathophysiology and risk factors
Parkinson’s disease is a chronic disorder which impacts the central nervous system and has a direct impact on the motor system of a human. Shaking of the body, rigidity, slow movement and eventually increasing dependency on others for basic life activities with growing age.
Causes of Parkinson’s disease are still not completely known to the medical science but it is generally accepted in medical fraternity that genetic and environmental factors do play a role in prevalence rate of disease. It is often observed that Parkinson’s disease runs in the family and members of the family have a higher prevalence probability. Some of the studies also find out that people who have a higher exposure to pesticides tend to have higher chances of developing Parkinson’s disease at a later stage of life. Some studies have also identified factors like tobacco smoking, tea and coffee drinking which can reduce the risk of Parkinson’s disease development among people. People with prior history of head injuries and infections which impacted the brain in any way like Herpes etc have a higher probability of developing parkinson’s as well (Aarsland et al. 2009).
Substantia Nigra is the primary area of Brian where cell death occurs because of parkinson’s disease and this area controls a large number of motor activities in the musculskeletal system of human body. Death of brain cells occurs in this region of mid brain because of lack of dopamine caused by Parkinson’s disease. According to the data released by WHO approximately 53 million people globally are suffered by Parkinson’s disease and it is causing death of 103000 deaths on annual basis. Parkinson’s disease is mostly precipitated in age range of 60 years and above where approximately 1 percent of total global population is suffering from some stage of parkinson’s disease. It is also found in the studies that males are more prone towards developing Parkinson’s as compared to females and in some part of population it is also seen at an early age of 40-50 years, it is called early onset Parkinsonism.
There are five major pathways in Brain which all gets affected by the Parkinson’s disease and gets their activity disrupted. This is the reason why so many motor activities and functional movement and learning activities get affected in this disease at once. The conceptual framework model of pathophysiology of Parkinson’s disease which is accepted even with its limitations states that the Basal Ganglia of the brain provides the necessary inhibition of CNS to ensure that motor activities only get active when it is appropriate. When this inhibition is reduced the required motor system gets activated sufficient enough to do the job and then again it goes back to inhibited stage. Dopamine is the prime facilitator chemical which ensures release of inhibition and with its absence the level of inhibition for the motor neurons gets reduced. This also means a greater effort and exertion would be required for any activity when the inhibition is reduced. It is commonly observed in Parkinson’s patient that they get tired easily, their breathing gets heavy and everything requires a lot of their efforts (Dickson, 2007).
Specific assessment data
When a patient presents himself or herself with the symptoms hinting towards a possible diagnosis of Parkinson’s disease the diagnosis physician would require different set of data to come to a firm diagnosis and severity of the situation. This data would be as follows.
HISTORY OF A PATIENT
UK PARKINSON’S SOCIETY CRITERIA DATA
First and foremost information sought from the patient would be any past history of neurological disorder, mental disorder, injury on the brain would be recorded and duly analyzed for possible precipitation of late onset problems like Parkinson’s disease. Patient who would provide a positive data of above mentioned situations would be more likely to develop Parkinson’s as compared to those who have no such history.
family history of the patient with previously known cases of Parkinson’s disease would be helpful in getting the required data for diagnosis. If there is a previous family history of diagnosed disease or if there is a family member who has shown similar symptoms but never got diagnosed then also it might be considered as a positive family history and needs further investigation. It has been proved in many studies that Parkinson’s have family history as a precipitating factor
This set of data required would not be helping in detecting the disease but it would be more helpful in ruling out other disorders which could mimic the symptoms similar to Parkinson’s and disrupt the final diagnosis. A PET scan of the brain, data collected from MRI or CT scan are known to have been helpful in identifying if there is any other neurological disorder patient is suffering from which might look like Parkinson’s. There are no lab tests which can identify or detect Parkinson’ thus ruling out other disorders is a good way to confirm the diagnosis (Yao, et al. 2013).
Periodic review data is also considered as important in diagnosing the Parkinson’s disease. The progress of the disease reveal if the diagnosis is Parkinson’s or not thus it is recommended to review the progress after every 6 months by the UK Parkinson’s disease society they have identified criteria which needs to be checked and confirmed and criteria developed by UK PD is used globally for diagnosis. There are other disease like Alzhimer’s, multiple cerebral infraction and drug effects induced damage which can mimic the symptom of Parkinson’s but their progress pattern and growth rate would be different. This time line data helps in identifying that.
The UK PD society have also decided and created criteria which is called as PD brain bank criteria to ease and standardize the process of diagnosis of the disease and to also identify in which stage the progression of the disease has reached in a patient. Data regarding Bradykinesia, tremor frequency, postural instability, unilateral onset, progression timing and symmetry or asymmetry of tremors are some of the primary criteria which are identified by the PD society as the required data for identifying the disease and its progression. It is found by the post mortem data from the diseased patient that accuracy of criteria fixated by UK PD society is close to 75-90 percent a case which is a fairly good level for a disease which cannot have a proper diagnosis through medical examinations.
Significant goal of nursing care
The three problem which are identified in patient suffering from Parkinson’s disease are
Motor disorder (tremor, rigidity etc)-
Nursing Goal:-To control the motor instability through medications like Levadopa.
In case of Parkinson’s disease a daily intake of levadopa would be very helpful for the patient to keep the inhibition in mid brain in place and control the discharge from motor neurons. This goal can only be achieved if nurses ensure that patient takes daily dosage of levadopa for a long period of time. It has often observed that after a period of time patient starts becoming complacent and neglect taking daily dosage of levadopa because they feel better. A nurse is required to educate the patient and make them aware about importance of taking medication without fail. A nurse is also helpful in educating the patient about disease and its progression, symptoms and the role played by levadopa in their body. If this goal is achieved then it would be much easier for physicians to improvise the quality of life for the patient (Cooper, 2008).
Neuropsychiatric disorder (mood swings, behaviour modifications and cognitive disorder)-
health care service goal is to monitor and evaluate the psychological condition of the patient and report any significant changes in patient to the attending physician. A nurse if the medical professional who spends the most time with patient and have a close connect with the day to day activities of the patient. It is much easier for a nurse who is well aware of patient from earlier days of diagnosis to identify if there is any change in the behavior of patient in general, development of signs and symptoms reflecting psychiatric problems or mood swings etc. these developments help a physician in understanding the progression of disease, any gap in current treatment plan, family and living environment and the way patient is able to cope up with changing functionality of his body.
Nursing Goal:-nursing goal is to make sure that patient remembers basic memories like name, address, medications, telephone numbers and emergency contact information etc.
Dementia is another problem which is found in patient suffering from Parkinson’s disease and it is found in association with the Lewy bodies present in Mid brain section of the patient. It is termed as DLB or Dementia with Lewy bodies in a patient and it causes them to even remember most basic memories like name of family members and address of their home etc. This goal is very important because in advanced stages it is risky for a patient to go out of home if they are suffering from dementia. By achieving this goal basic safety of the patient the patient can be ensured when they are on their own. There are various tricks which a nurse can teach a patient to remember things like using mnemonics, using photographs, wearing bracelets and pendants with important number engraved on it etc (Aarsland et al. 2009).
Nursing care strategies and evidence
- Levadopa medication:- According to the study conducted by Barichella, et al in 2009 it was found that nutritional deficiency is the primary causative factor behind development and progression of Parkinson’s disease. Lack of proper nourishment in the patient lead towards less formation of dopamine in the brain. When a nurse ensures that proper supplements are taken by the patient on a periodic and repetitive basis then its production would get boosted and patient would have a sufficient quantity for the entire day. Data released by Global Burden of disease Index in 2013 reveals that 30 percent of complexity in the patient suffering from Parkinson’s disease happens because of lack of awareness and non compliance of patient. Non compliance will lead towards severity of disease where management would be complex, expensive and with poor prognosis. Nurse has strategies like education, increasing awareness and she can also use an early intervention with the help of families and friends of the patient. They can also associate their daily medication intake with the any other daily routine activity like evening walks or exercise etc which will help them not to forget medication (Global Burden of Disease, 2015).
- Psychiatric evaluation:- A nurse who is handling the patient suffering from Parkinson’s disease would have access to the patient’s medical records and history and she can study them carefully to understand if there are changing patterns of behavior or previous frequent outbreaks of mood swings. She has the data to do a comparative evaluation and if she can observe any rise in the frequency then she can alert the doctors at an early stage. She can also use various basic tests like a psychometric analysis to assess the current mental status of the patient on a periodic basis. She can also keep a chart of the patient outbreak so that even in future if another medical professional is giving service to the patient they can continue with the assessment of patient and monitoring. Sometimes nurses can take help of family members to keep a track on patient’s movement and daily activities and they would also encourage them be active socially with the support of family which will help in improving mental status of the patient.
- Dementia:- Dementia is a problem where Nurses would use strategy of providing cues and memory instigator to make sure that patient has a habit of remembering names, faces and addresses etc. nurses would use strategies like practicing games where names and places would be first mismatched and then patient would be asked to rematch them. These strategies would keep the mental facilities of the patient well exercised and also enable them to learn the trick of associating cues with the names and other attributes. On this reasoning only mnemonics are created for the patients (Lorenzl, et al. 2013).
Global Burden of Disease Study 2013, Collaborators (2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet (London, England) 386 (9995): 743–800
Barichella M, Cereda E, Pezzoli G (2009). "Major nutritional issues in the management of Parkinson's disease". Mov. Disord. 24 (13): 1881–92
Aarsland D, Londos E, Ballard C (2009). "Parkinson's disease dementia and dementia with Lewy bodies: different aspects of one entity". Int. Psychogeriatr. 21 (2): 216–219.
Lorenzl S, Nübling G, Perrar KM, Voltz R (2013). "Palliative treatment of chronic neurologic disorders". Handb Clin Neurol. Handbook of Clinical Neurology 118: 133–9.
Dickson DV (2007). "Neuropathology of movement disorders". In Tolosa E, Jankovic JJ. Parkinson's disease and movement disorders. Hagerstown, MD: Lippincott Williams & Wilkins. pp. 271–83.