Parkinsons Disease and Diagnosing by Symptoms - Essay Example

Patient Education Session Parkinson disease affects the nervous system and gets worse as the time progress. So it may be defined as a “disorder that affects nerve cells, or neurons, in a part of the brain that controls muscle movement.” (Parkinson’s Disease. 2007). Some of the symptoms of Parkinson disease are “slowness and difficulty of movement. These are usually the first symptoms. The patient will be asked to walk and to get out of a chair, preferably a deep one. Early gait disturbance, however, often indicates a disease other than Parkinsons disease. A tremor when their limb is relaxed and symptoms on one side of the body.” (Parkinson’s Disease. Diagnosing by Symptoms. 2006). At present, though there is no cure for Parkinson disease, it can be treated. Some of the goals of the treatment are minimize disability, assist the patient to maintain a high quality of life and reduce the possible side effects of drug therapy. A surgery is often recommended if the condition of the patient is severe. Generally, three types of surgeries i.e. pallidotomy, thalamotomy and deep brain stimulation are used to treat Parkinson’s disease. “A thalamotomy is the removal of the thalamus region of the brain. Although this type of surgery is rarely performed, it can be a last resort for patients who have disabling tremors in the hand or arm.” (Treatment Options. Parkinson’s Disease. 2007). Mrs. Jan Williams suffers from muscular rigidity which is identified “when the limb is bent and the examiner moves the limb back and forth. In doing so, it seems to catch at regular points throughout its range of motion, much like that of a second hand on a clock.” (Butler, Nancy. G). She also suffers from ‘bradyknesia’ due to which she is not able to make any spontaneous movement. She finds it difficult to change positions and accomplish motor activity. She has also developed tremor. Generally, it is observed in hands but incase of Mrs. Jane Williams it is also seen in the jaw and lower extremities. Some other features of Parkinson’s diseases such as difficulties in speech, chewing, swallowing, stooped posture, the presence of drooling shuffling gait, loss of balance, blank staring facial expression, slow and low pitched monotone voice are also observed in her. Parkinson’s disease is a disease, which gradually destroys the nerve cells in the part of the brain that controls muscle movement. Since brain is the center of all mental and psychological activities, its damage through Parkinson’s disease creates certain psychological characteristics in the patients. Severe depression is also seen in Mrs. Jan. This may be because of the lack of dopamine in certain brain areas where pleasure and mood are regulated. Dopamine is a chemical that helps in the transmission and reception of nerve signals in brain. (Garkavenko, V. V., Bachinskaya, N. Y., Karaban, I. N. 2000). She also suffers from Dementia. It may occur as a consequence of some of the medications used to treat the disorder. Parkinson’s disease also affects her motivation. (Pluck, G. C., & Brown, R, G. 2002). She also suffers from Dementia. It may occur as a consequence of some of the medications used to treat the disorder. Mrs. Jan Williams got Parkinson’s disease at a younger age. She has been taking medicines for the last 10 years. She has developed a personality which is called ‘novelty-seeking’ probably due to the side effects of medication. She has been taking dopamine agonists, which is a medication used for the treatment of Parkinson’s disease. She has developed a habit of compulsive shopping, binge eating and pathological gambling. “Behaviours associated with impulse control including compulsive shopping, hyper sexuality, binge eating and pathological gambling have been associated with dopamine agonists, medications used to treat Parkinsons disease.” (Characteristics of Patients at Increased Risk for Compulsive Gambling Associated with Taking Parkinson’s Meds. 2007). As regards Mrs. Jan Williams’s educational qualification, she is a qualified teacher. Since teaching is her profession, it is easier for a nurse to explain and educate about Parkinson’s disease. But her physical and mental conditions are not normal. Moreover, she suffers from depression which makes the task all the more difficult. Preoperative care for Thalamotomy: Special care for a patient who is suffering from Parkinson’s disease can be taken through several steps. Some of the steps include reviewing of diagnostic findings, surgical procedure and expectations with the patient. Presurgical shampoo with an antimicrobial agent may be ordered. The patient should be prepared for the use of intra-operative antibiotics to reduce risk of infection and urinary catherization to assess volume of urine during the operative period. Some times patients are very reluctant to use antibiotics due to its harmful side effects. But a nurse should educate Jan about the need for it. Antibiotics are very essential in reducing infection. Cerebral edema intra-operative or postoperative osmotic diuretics or corticosteroids may also be ordered for reducing risk of infection and urinary catherization to assess volume of urine during the operative period treatment. Neurological assessment should be performed to evaluate and record the patient’s neurological baseline and vital signs for postoperative comparison. Postoperative care A nurse can educate Jan and her husband several things about the post operative care. Post operative care is taken by assessing respiratory status and also by monitoring the rate, depth and pattern of respiration. Vital signs and neurological status should be monitored using GCS (Glasgow Coma Scale) and findings should be documented. Pharmacological agents may be prescribed to control increased ICP (Intra cranial Pressure). Incisional and headache pain may be controlled with mild analgesics (codeine and acetaminophen) or low dose of opiods (morphine sulphate or fentnyl) as prescribed. Monitor response to medication. Position the head of the bed 15 to 30 degree or preclinical status of the patient, to promote venous drainage. So that there could be sufficient supply of blood to brain. This point must be emphasised while educating Jan and her husband. Another point, while educating Jan and her husband, is the importance of turning side to side every 2 hours. It is very helpful in the smooth flow of blood and the prevention of bed sore. CT scan of the brain of the patient should be done if the condition of the patient deteriorates. Signs of infection should be monitored by checking the site of thalamotomy. Monitor for complications of thalamotomy like: weakness, loss of sensation, or loss of voluntary movement (paralysis) temporary confusion, stroke caused by bleeding in the brain, which sometimes can lead to death. As regards Jan’s second thought on thalamotomy, it is very clear that without consent, thalamotomy can not performed on a patient. Consent is the client’s approval to have his or her body touched by a specific individual. Legally, the client must be mentally competent to give consent for procedures. Prior to granting consent, the client must be fully informed regarding treatment, tests, surgery and so on, and must understand both the intended outcome and the potentially harmful results. Consent must be obtained by the physician, surgeon or other medical practioner performing the treatment or procedure. In most states, when a nurse is involved in the informed consent process, she is only witnessing the signature of the client on the informed consent form. An informed consent can be waived for urgent medical or surgical intervention as long as institutional policy so indicates. A client has the right to refuse information and waive the informed consent and undergo treatment, but this decision must be documented in the medical record. Nurse’s Role: The nurse is not responsible for explaining the procedure but for witnessing the client’s signature on the form. The nurse’s signature confirms three things: 1. Client gave consent voluntarily 2. Signature is authentic 3. Client appeared competent to give consent In this particular case, a nurse should try to convince Jan that thalamotomy is must. The right of consent also involves the right of refusal. Inform clients that they can change their minds and cancel the procedure at any time because the right to refuse continues even after signing the consent. Similar to informed consent, it is important to verify that the client is aware of the pros and cons of refusal and is making an informed decision. The nurse needs to notify the health provider of the client’s refusal and document the refusal in the chart. Documentation is an important aspect to informed consent. A client’s concerns or questions must be documented along with the notification of the health care provider. Works Cited Parkinson’s Disease. (2007). Health Topics. Retrieved May 20, 2007, from http://www.nlm.nih.gov/medlineplus/parkinsonsdisease.html Parkinson’s Disease. Diagnosing by Symptoms. (2006). University of Maryland Medical Centre. Retrieved May 20, 2007, from http://www.umm.edu/patiented/articles/what_will_confirm_diagnosis_of_parkinsons_disease_000051_5.htm Treatment Options. Parkinson’s Disease. (2007). Express Scripts. Retrieved May 20, 2007, from http://www.drugdigest.org/DD/HC/Treatment/0,4047,550186,00.html Butler, Nancy. G. Parkinson’s Disease: An Overview. Tongue Tips. Retrieved May 20, 2007, from http://arapaho.nsuok.edu/~slpgrads/ Garkavenko, V. V., Bachinskaya, N. Y., & Karaban, I. N. (2000). Interrelations between EEG Parameters and Personality Characteristics in Parkinson’s Patients. Neurophysiology. Vol 32, No 6. Ingenta connect. Retrieved May 20, 2007, from http://www.ingentaconnect.com/content/klu/neph/2000/00000032/00000006/00341636?crawler=true Pluck, G. C., & Brown, R, G. (2002). Apathy in Parkinson’s Disease. The BMJ publishing group Ltd. Retrieved May 20, 2007, from http://jnnp.bmj.com/cgi/content/abstract/73/6/636 Characteristics of Patients at Increased Risk for Compulsive Gambling Associated with Taking Parkinson’s Meds. (2007). Retrieved May 20, 2007, from http://www.medicalnewstoday.com/medicalnews.php?newsid=63332 Read More