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
Impaired Physical Mobility
Impaired physical mobility is a common symptom of Parkinson disease due to the degeneration of neurons that control movement. This can lead to bradykinesia, tremors, rigidity, and postural instability, which can make it difficult for clients to perform activities of daily living, maintain balance, and walk without assistance. It is well known that physical inactivity impairs the clinical and functional domains of PD, reduces the quality of life, and increases the risk of falls (Pinto et al., 2019).
May be related to
- Parkinson disease
- Inability to bear weight
- Poor nutrition
- Perceptual impairment
- Cognitive impairment
Possibly evidenced by
- Inability to move at will
- Inability to bear weight
- Gait disturbances
- Balance and coordination deficits
- Difficulty turning
- Decreased fine and gross motor movement
- Decreased reaction time
- Jerky movement
- Postural disturbances
- Small, shuffling gait
- The client will maintain functional mobility as long as possible within the limitations of the disease process.
- The client will have few if any, complications related to immobility.
Nursing Assessment and Rationales
1. Assess for the presence of rigidity and bradykinesia.
Rigidity is usually tested by flexing and extending the client’s relaxed wrist and can be made more obvious by having the client perform voluntary movements, such as tapping, with the contralateral limb. Bradykinesia may be assessed by asking the client to tap the toes of each foot as big and fast as possible. Then, the client should be asked to arise from a seated position with the arms crossed to assess the ability to arise from a chair (Hauser & Benbadis, 2020).
2. Observe for gait abnormalities.
In the early stage of PD, the gait of clients slows and step length shortens, compared with those of age-matched healthy adults. Reduced amplitude of arm swing and smoothness of locomotion and increased interlimb asymmetry are more specific to PD and often are the first motor symptoms. Another approach to assessing gait includes using the Unified Parkinson’s Disease Rating Scale, the most commonly used rating scale for symptoms of PD, and a more detailed observational and quantitative assessment of different aspects of gait associated with functional limitations (Mirelman et al., 2019).
3. Assess the client for postural stability.
Postural stability is typically assessed by having clients stand with their eyes open and then pulling their shoulders back toward the examiner. The client is told to be ready for the displacement and to regain their balance as quickly as possible. Taking one or two steps backward to regain balance is considered normal. The examiner should be ready to catch the client if they are unable to regain balance (Hauser & Benbadis, 2020).
4. Monitor the client’s blood pressure, especially, before and after staying in a prolonged sitting or lying position.
Orthostatic hypotension should be actively screened at the bedside by measuring the BP and heart rate supine and after three minutes upon standing. Orthostatic hypotension is diagnosed in case of a systolic BP fall >20 mm Hg and/or diastolic >10 mm Hg (Fanciulli et al., 2020),
Nursing Interventions and Rationales
1. Instruct the client with techniques that initiate movement.
Rocking from side to side helps to start the leg movement. Bradykinesia refers to the slowness of movement but also includes reduced spontaneous movements and decreased amplitude of movement. In addition to this, postural instability or the imbalance and loss of righting reflexes may also be experienced by the client (Hauser & Benbadis, 2020).
2. Instruct the client to get out of the chair by moving to the edge of the seat, placing hands on arm supports, bending forward, and then rocking to a standing position.
Parkinson disease causes rigidity tremors, and bradykinesia and may result in difficulty getting out of a chair. Rigidity refers to an increase in resistance to passive movement about a joint. The resistance can either be smooth or oscillating. Additionally, orthostatic hypotension may put the client at risk for falls, if they stand up from a seating position immediately (Hauser & Benbadis, 2020).
3. Teach the client to concentrate on walking erect and use a wide-based gait.
Balance may be adversely affected because of the rigidity of the arms that prevents them from swinging when walking normally. A special walking technique must be learned to offset the shuffling gait and the tendency to lean forward. A conscious effort must be made to swing the arms, raise the feet while walking, and use a heel-toe placement of the feet with long strides.
4. Instruct the client to perform a daily exercise that will increase muscle strength: walking, riding a stationary bike, swimming, and gardening are helpful.
Exercise prevents contractures that occur when muscles are not used, improves coordination and dexterity, and reduces muscular rigidity. Adherence to exercise and walking programs helps delay the progress of the disease. Exercise can also improve gait through various mechanisms, some specific to central aspects of gait control and some indirect via improved fitness, strength, and balance (Mirelman et al., 2019).
5. Teach the client to sit in chairs with backs and armrests; use elevated toilet seats or sidebars in the bathroom.
This helps with rising from a sitting position and prevents falls. Seats, either fixed or free-standing, and boards can be added into showers and baths as a simple, first-line option for helping client who struggles with transfers or standing for prolonged periods to manage their self-care. For those who struggle with getting off the toilet, raised toilet seats with or without frames and handles can be useful. This makes standing easier if positioned at the correct height, and they can be easily removed and replaced (Jackson, 2019).
6. Provide warm baths and massages.
This helps relax muscles and relieve painful muscle spasms that accompany rigidity. Some clients may describe stiffness in the limbs, but this may reflect bradykinesia more than rigidity. Occasionally, individuals may describe a feeling of ratchety stiffness when moving a limb, which may be a manifestation of cogwheel rigidity (Hauser & Benbadis, 2020).
7. Instruct the client to raise the head of the bed and make position changes slowly. Teach the client to dangle their legs a few minutes before standing.
These measures reduce orthostatic hypotension. Orthostatic hypotension manifests with syncope, unexplained falls, lightheadedness, cognitive impairment, blurred vision, dyspnea, fatigue, and shoulder, neck, or low-back pain, which develop upon standing and recover by lying down. Instruct the client to stand up slowly, especially after resting supine for a long time; in this case, the client may pause in the sitting position before standing up (Fanciulli et al., 2020).
8. Refer the client to a physical therapist.
This may be helpful in developing an individualized exercise program and can provide instruction to the client and caregiver on exercising safely. A systematic review of 33 randomized trials involving 1515 clients evaluated various physiotherapy interventions, including general physiotherapy, exercise, treadmill training, cueing, dance, and martial arts. There were significant improvements in walking speed, walking endurance and step length, mobility, and balance (Hauser & Benbadis, 2020).
9. Promote increased fluid intake and maintain adequate dietary salt.
Increasing water (up to 2.5 L/day) and salt intake (6 to 10 g/day) represents a key nonpharmacological measure to combat orthostatic hypotension. Drinking a bolus of water of 500 mL significantly raises BP in the following 30 to 90 minutes. Caution in water and salt intake should be used in clients with known heart, kidney, or liver failure (Fanciulli et al., 2020).
10. Promote the use of mobility aids and other assistive devices.
Walking sticks and frames can improve balance- these are good if there are concerns about the client falling. Fixed frames without wheels are the most supportive and help maintain a good upright position. A wheeled walker is preferable for use outside and over longer distances, and many have the advantage of coming with a storage bag or tray, so the client can transport items without having to carry them. Wheeled walkers with brakes are the safest option, as they can reduce the risk of falling if the frame gets too far ahead (Jackson, 2019).
11. Ensure that the client’s bed height is adjusted to the most optimal position.
The stiffness and difficulty with turning that is commonly experienced by people with PD can make getting in and out of bed very problematic. The first thing to consider is the height of the ebd. As with a chair, a suitable height bed allows the client’s legs to be at a 90-degree angle before they attempt to stand (Jackson, 2019).
12. Encourage the client to participate in dance practice exercises.
Recently, many researchers have been demonstrating that dance practice associated with musical stimuli seems to increase the reward system, once there is dopamine release via the ventral tegmental area. Thai implies improvements in the mood state and cognition of clients, and consequently an improvement in the quality of life. Results in studies found that dance practice induces better responses in motor symptoms and in functional mobility in individuals with PD (Delabary et al., 2018).
5 thoughts on “9 Parkinson’s Disease Nursing Care Plans”
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.