9 Parkinson’s Disease Nursing Care Plans

April 13, 2016

Parkinson’s disease, or paralysis agitans,is a progressing neurologic movement disorder that eventually leads to disability. It occurs after the age of 50 and increases in incidence with age. The disease affects more men than women and it’s the fourth most common neurodegenerative disease, with 50,000 new cases reported each year in the United States.

Parkinson’s disease is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia region of the brain. Neuronal pathways project from the substantia nigra to the corpus striatum, where neurotransmitters are key to the control of complex body movements. The loss of dopamine stores in areas of the brain results in more excitatory neurotransmitters than inhibitory neurotransmitters, leading to an imbalance that affects voluntary movement.

Nursing Care Plans

The nursing goals for patients with Parkinson’s Disease include improving functional mobility, maintaining independence in performing ADLs, achieving optimal bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms.

Here are nine (9) nursing care plans (NCP) and nursing diagnosis for Parkinson’s Disease:

Ineffective Airway Clearance

Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.

May be related to

parkinsonian changes in musculature
tracheobronchial obstruction
aspiration
infection
truncal rigidity
bronchospasm
fatigue
increased work of breathing
increased mucus production
thick secretions

Possibly evidenced by

dyspnea
tachypnea
bradypnea
bronchospasms
increased breathing effort
use of accessory muscles
increased mucus production
cough with or without productivity
adventitious breath sounds
abnormal arterial blood gases

Desired Outcomes

Patient will achieve the normalization and ability to maintain patent airways and respiratory status.
Patient will achieve and maintain a patent airway.
Patient will have clear breath sounds to auscultation and will have respiratory status parameters with optimal air exchange.
Patient will be able to cough up secretions and perform coughing and deep breathing exercises.

Nursing Interventions	Rationale
Observe patient and assess energy level and endurance, and how these affect respiratory status.	Energy ability decreases with age and chronic disease like PD.
Assess respiratory status for rate, depth, ease, use of accessory muscles, and work of breathing.	For baseline data.
Auscultate the lung fields for the presence of wheezes, crackles, rhonchi, or decreased breath sounds.	Wheezing results from squeezing of air past the narrowed airways during expiration which is caused by bronchospasms, edema, and obstructive secretions. Crackles result from consolidation of leukocytes and fibrin in the lung causing an infection or by fluid accumulation in the lungs. Decreased breath sounds may indicate alveolar collapse with little to no air exchange in the lung area being auscultated and usually results in poor ventilation.
Administer oxygen as ordered. Monitor oxygen saturation by pulse oximetry.	Provide supplemental oxygen to benefit patient.
Assess patient for pallor or cyanosis in nail beds and/or around the mouth.	May indicate hypoxemia.
Monitor patient for cough and production of sputum, noting amount, color, character, and patient’s ability to expectorate secretions and patient’s ability to cough.	Mucus color from yellow to green may indicate the presence of infection. Tenacious, thick secretions require more effort and energy to cough up and remove and may cause obstruction and stasis that may lead to infection.
Position patient in high Fowler’s or semi-Fowler’s position, if possible.	Promotes maximal lung expansion.
Turn the patient every 2 hours.	Repositioning promotes drainage of pulmonary secretions and enhances ventilation to decrease the potential for atelectasis.
Administer bronchodilators as ordered.	Promotes relaxation of bronchial smooth muscles to decrease spasm, dilates airways to improve ventilation, and maximizes air exchange.
Encourage an increase in intake of fluids up to 3-4 L/day.	Provides hydration and helps to thin secretions for easier mobilization and removal.
Perform postural drainage and percussion as ordered.	Postural drainage utilizes gravity to help raise secretions and clear sputum. Percussion may assist in the movement of secretions away from bronchial walls and enable patient to cough them up and increase the force of expiration. Some positions done may be contraindicated in elderly patients.
Encourage deep breathing and coughing exercises every 2 hours.	Assist in lung expansion and helps in dislodgement of secretions for easier expectoration.
Suction patient if warranted.	The patient may be too weak or fatigued to expel own secretions.
Instruct patient to seek help and stop smoking of patient is a smoker.	Smoking causes increased mucus, vasoconstriction, and increased blood pressure.