As a nurse, understanding the nursing diagnosis of Parkinson disease is crucial for providing effective care to clients. In this article, we will explore the common nursing diagnosis, nursing interventions, and nursing considerations for Parkinson disease.
What is Parkinson Disease?
Parkinson disease, or paralysis agitans, is a progressing neurological 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 disease is associated with decreased levels of dopamine resulting from the 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.
Initial clinical symptoms of Parkinson disease include tremors, subtle decrease in dexterity, decreased arm swing on the first-involved side, soft voice, decreased facial expression, sleep disturbances, rapid eye movement behavior disorder, decreased sense of smell, malaise, anhedonia, slowness in thinking (Hauser & Benbadis, 2020).
There are four cardinal signs of Parkinson disease, with two of the first three required to make the clinical diagnosis. These are resting tremors, rigidity, bradykinesia, and postural instability. With the introduction of levodopa, the mortality rate dropped by approximately 50%, and longevity was extended by many years (Hauser & Benbadis, 2020).
Nursing Care Plans
The nursing goals for clients with Parkinson disease include improving functional mobility, maintaining independence in performing ADLs, promoting safety and preventing falls, achieving optimal bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, developing positive coping mechanisms, and educating the client and their family on the disease process and self-care strategies to manage symptoms and improve the overall quality of life.
Here are nine (9) nursing care plans (NCP) and nursing diagnoses for Parkinson Disease:
- Ineffective Airway Clearance
- Disturbed Thought Process
- Impaired Verbal Communication
- Impaired Physical Mobility
- Imbalanced Nutrition: Less Than Body Requirements
- Impaired Swallowing
- Risk for Injury
- Ineffective Coping
- Deficient Knowledge
- Other Nursing Care Plans
Ineffective Airway Clearance
In Parkinson disease, there is a risk of ineffective airway clearance due to the weakening of the muscles responsible for breathing and coughing. Additionally, clients with Parkinson disease may have impaired swallowing function, which can increase the risk of aspiration and further compromise the airway. Pooling of secretions, decreased sensation, and aspiration are also characterizations of the Parkinson disease larynx (Hauser & Benbadis, 2020).
May be related to
- Parkinsonian changes in musculature
- Tracheobronchial obstruction
- Impaired swallowing function
Possibly evidenced by
- Dyspnea
- Tachypnea
- Bradypnea
- Bronchospasms
- Increased breathing effort
- Thick secretions
- Use of accessory muscles
- Increased mucus production
- Cough with or without productivity
- Adventitious breath sounds
- Abnormal arterial blood gases
Desired Outcomes
- The client will achieve the normalization and ability to maintain patent airways and respiratory status.
- The client will achieve and maintain a patent airway.
- The client will have clear breath sounds to auscultation and will have respiratory status parameters with optimal air exchange.
- The client will be able to cough up secretions and perform coughing and deep breathing exercises.
Nursing Assessment and Rationales
1. Observe the client and assess energy level and endurance, and how these affect respiratory status.
Energy ability decreases with age and chronic diseases like PD. Pulmonary function impairment has been studied in PD, the most common type of Parkinsonism whereby the cause is unknown. Pulmonary dysfunction has been known as an autonomic disorder equated to non-motor symptoms of PD. abnormalities involving obstructive, restrictive, and mixed-type pulmonary dysfunction increase disability in PD clients (Post et al., 2019).
2. Assess respiratory status for rate, depth, ease, use of accessory muscles, and work of breathing.
Clients with early idiopathic PD had significantly lower respiratory muscle strength and higher central respiratory drive than those in age-matched healthy controls, according to a study. Abnormalities of peak expiratory and inspiratory flows were found in clients with relatively severe PD and without clinical signs or symptoms of respiratory problems. These changes can be explained by “muscle weakness” and hypokinesia, two symptoms intrinsic to PD. The main reasons for the upper airway dysfunction and restrictive pattern may be due to poor coordination, or rigidity of respiratory muscles (Post et al., 2019).
3. Auscultate the lung fields for the presence of wheezes, crackles, rhonchi, or decreased breath sounds.
Wheezing results from the squeezing of air past the narrowed airways during expiration which is caused by bronchospasms, edema, and obstructive secretions. Crackles result from the consolidation of leukocytes and fibrin in the lung causing an infection or 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.
4. Assess the client for pallor or cyanosis in nail beds and/or around the mouth.
This may indicate hypoxemia. Several studies have reported the preponderance of upper airway obstruction among Parkinson disease clients, resulting in chronic airflow limitation and, consequently, weakness, bradykinesia, or dysfunctional contraction of the striated musculature in the region of the upper airway, which has been considered to be major factors contributing to the development of secretion retention, atelectasis, and aspiration pneumonia (Axelerad et al., 2021).
5. Monitor the client for cough and production of sputum, noting the amount, color, character, and client’s ability to expectorate secretions and the client’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. A significant number of Parkinson disease clients die due to pneumonia as compared with the general population (Axelerad et al., 2021).
Nursing Interventions and Rationales
1. Position the client in a high Fowler’s or semi-Fowler’s position, if possible.
This promotes maximal lung expansion. Dyspnea represents a prevalent symptom in the evolution of Parkinson disease, with approximately 40% prevalence in the symptomatology of clients as reported in a study. The presence of dyspnea correlates with the severity of the disease, decreased ventilatory function, motor fluctuations, dysphagia, and even neuropsychological symptoms such as anxiety and depression (Axelerad et al., 2021).
2. Turn the client in every two hours.
Repositioning promotes drainage of pulmonary secretions and enhances ventilation to decrease the potential for atelectasis. Dyspnea and subsequent ventilatory dysfunctions are considered to be symptoms of autonomic dysfunction. The obstructive and restrictive aspects, the potential drug effects, and abnormal central control of ventilation are partly responsible for the ventilatory dysfunction in Parkinson disease clients (Axelerad et al., 2021).
3. Encourage an increase in intake of fluids up to 3 to 4 L/day.
This provides hydration and helps to thin secretions for easier mobilization and removal. Parkinson disease can also lead to dysphagia, therefore, sufficient fluid intake can help with swallowing by moistening the throat and making it easier to swallow food and medications.
4. 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 the client to cough them up and increase the force of expiration. Some positions may be contraindicated for older adult clients. Airway clearance techniques, postural drainage, incentive spirometry, and breathing exercises may also be helpful (Saha et al., 2020).
5. Encourage deep breathing and coughing exercises every two hours.
This assists in lung expansion and helps in the dislodgement of secretions for easier expectoration. Deep breathing exercises can reduce the work of breathing by decreasing the respiratory rate and relaxing accessory muscles. Diaphragmatic breathing helps to ease the diaphragm, which reduces the activity of accessory muscles, hence reducing breathing difficulties. Apical, costal, and basal breathing helps to improve various segments of the lung (Saha et al., 2020).
6. Suction client if warranted.
The client may be too weak or fatigued to expel their own secretions. Respiratory complications in clients with PD is one of the most serious complication and a common cause of death. Evacuation of secretions must be performed by the nurse if the client cannot expel them effectively (Saha et al., 2020).
7. Administer oxygen as ordered. Monitor oxygen saturation by pulse oximetry.
This provides supplemental oxygen to benefit the client. Additionally, hyperbaric oxygen therapy (HBOT) has been suggested as a potential adjunctive therapy for PD. Research on the neuroprotective effects of HBOT has shown that hyperbaric oxygen can inhibit inflammation, reduce hypoxia, and improve nervous system microcirculation (Hsu et al., 2022).
8. Administer bronchodilators as ordered.
This promotes the relaxation of bronchial smooth muscles to decrease spasms, dilates airways to improve ventilation, and maximizes air exchange. The use of salbutamol and inhaled corticosteroids and their indications for asthma and COPd were each associated with a reduced risk of PD after adjustment for the use of care (Nielsen, 2018).
9. Instruct the client to seek help and stop smoking if the client is a smoker.
Smoking causes increased mucus, vasoconstriction, and increased blood pressure. A meta-analysis of observational studies revealed the inverse association between cigarette smoking and the risk of PD. Nicotine may also act as a stimulant to inhibit the action of the striatal dopamine transporter, increasing dopamine levels in the synaptic gap. In addition, cigarette smoking may be associated with cognitive impairment (Wang et al., 2022).
10. Assist the client in respiratory muscle training.
Given that reduced cough function is associated with decreased respiratory muscle strength, it may be possible to improve peak cough flow by exercising respiratory muscles. Respiratory muscle training programs have been utilized in clients with PD and other similar neurodegenerative disorders to improve pulmonary and swallowing function. Inspiratory muscle-training studies in clients with PD have reported improvements in inspiratory muscle strength and endurance (Reyes et al., 2018).
11. Provide information about chest PNF.
Chest PNF is an effective treatment tool and has established efficacy in respiratory conditions like COPD. it provides proprioceptive feedback to the respiratory muscles, which create reflex respiratory movement responses and improves the rate and depth of breathing. This also increases the activity of the diaphragm and abdominal muscles. The rigid chest wall muscles may get inhibited through autogenic inhibition and promote mobility to the chest wall (Saha et al., 2020).
Awesome stuff.
Feel like I have found a gold mine !! Very helpful.
Very nice and helpful
This website has helped me so much with nursing interventions and now is helping me come up with interventions and understanding why because of the rationale
Would be Important to add references. Apart from that is very good.