The Pathophysiology and Clinical Manifestation associated with Parkinson's Disease - Case Study Example

Parkinson's Disease: Michael J. Fox

Normal body functions require that all body processes perform their required purposes with utmost accuracy. However, it is not always the case considering that natural processes are prone to environmental ‘disturbances’. These disturbances are commonly referred to as pathophysiological conditions, and are commonly associated with diseases or syndromes. As such, by understanding the pathophysiology of various diseases, it is possible to develop effective intervention approaches. For this reason, professionals within the medical and allied sectors continually invest in research concerning many pathophysiological condition and hence the development of modern care technologies that have improved patient outcomes significantly. In this regard, the following discussion will delve into Parkinson's Disease as a physiology and how it can be managed in regard to Michael J. Fox’s condition.

The Case

Born in June 9, 1961, Michael J. Fox has undertaken many roles that have made him to feature in the international lime light. Precisely, Michael J. Fox is Canadian citizen who has undertaken various roles as an actor, author, producer, and activist over the years (IDMb, n.d). Some of the major films in which he as featured in the earlier mentioned roles include: Back to the Future trilogy and Family Ties. Being a film and television star has also made Michael J. Fox to receive various awards, such as Emmy Awards, Golden Globe Awards and Screen Actors Guild Awards, all of which have boosted the growth of his career (IDMb, n.d).

Unfortunately, Michael J. Fox was forced to reduce his active involvement in the film industry after he was diagnosed with Parkinson's Disease in 1991. Although he did not make it public in the same year, he was forced to retire in the year 2000, a time when the symptoms associated with the disease overwhelmed him. It is after his retirement when he formed the Michael J. Fox Foundation, an organization which focused on addressing issues associated with Parkinson's Disease (Michael J. Fox Foundation, n.d). It is noteworthy pointing out that choice of Michael J. Fox’s condition in this case study was inspired by the fact that he has championed significantly in the research and development of effective strategies for management of Parkinson's Disease.

Parkinson's Disease (PD) is associated with a complex processes that alter the normal body physiology in diseased state. According to Schapira (2010), PD is a neurodegenerative condition that has been shown to affect certain cells within the brain area. Precisely, the disease affects the normal functioning of cells within the substantia nigra, which are tasked with the production of dopamine, a hormone that is involved in the coordination of body movements (Parkinson's Disease Foundation, 2016). Considering that PD is a progressive conditions, more cells are affected and hence the reduction in the levels of dopamine within the body and subsequent loss of movement coordination among the victims.

The pathophysiology and clinical manifestation associated with PD are quite distinctive. In particular, PD is associated with characteristics such as uncoordinated movements, behavioral changes, difficulties in learning, and emotional instability (Rodriguez-Oroz et al., 2009). Some of these characteristics are evident in our case because Michael J. Fox demonstrated emotional instability in 1991, when he started to consume alcohol heavily (IDMb, n.d). These manifestations can be explained by the fact that PD causes damage to brain cell that are responsible for the production of dopamine, a substance that communicates to brain areas that are responsible for body coordination (Rodriguez-Oroz et al., 2009).

The altered physiology in PD can cause effects on multiple body systems. Studies on patients who have suffered from PD reveal that decreased dopamine has, in many cases, resulted into slowness of movement, tremor in body parts such as hands and legs, rigidity and postural instability (Schapira, 2010). Of more significance, it has been revealed that PD results into the accumulation of Lewy Bodies in the mid brain, brain stem and the olfactory bulb, resulting into non motor effects, such as the uncontrolled emotions.

History of Selected Case

Historical variations of PD can be identified from various individuals who have suffered from the disease. Although Michael J. Fox did not show the “conventional symptoms” of the PD, just before being diagnosed with the onset of the disease, he had started to drink heavily, a characteristic associated with emotional instability. However, other symptoms such as tremor appeared later but were managed immediately after the diagnosis. Other people who have suffered from PD include Maurice White, who encountered body tremors, Estelle Getty, who presented symptoms of uncoordinated movements, and Charles Schultz, who showed some degree of emotional instability.

On the other hand, several physiological stressors associated with PD can be pointed out. One of the most pointed out stressors is the environmental toxicity. It is undeniable that there are certain toxin, such as manganese, carbon monoxide, carbon disulfide, and some pesticides, that can destroy human cells. In this case, the toxins are believed to destroy brain cells that are responsible for the production of dopamine (Schapira, 2010). Similarly, the formation of free radicals within the brain is also considered a physiological stress associated with PD. In particular, the radicals also lead to the destruction of brain cells and hence reduced production of dopamine.

Just like in other diseased conditions, the body mounts adaptive physiological mechanisms against PD. In particular, it has been shown that the body reacts through mitochondrial defects, formation of oxygen radicals, protein aggregation, and neuroinflammation (Blandini, 2013). It is noteworthy pointing out that although these physiological responses are initiated with the aim of restoring normalcy, in most cases, they lead to the progression of PD. according to Blandini (2013), these adaptive physiological mechanisms lead to increased cell death and hence continued decline in the amount of dopamine produced within the brain cells.

It is undisputed that modern technological advancements have improved health outcomes of many patients, including the ones suffering from PD. considering the nature of clinical effects associated with PD, many technological applications, such as Lee Silverman Voice Treatment Companion, which help patients in speech related problems, have been developed (Halpern et al., 2012). More importantly, technologies such as APDM Opal, advanced objective analytics and mobile communications have helped the researchers to collaborate effectively with the patients and hence develop a better understanding of the disease. Because of these technologies, it has been possible to support people living with PD to have a quality life.

Planning for Care for the Selected Case

Having a patient-specific care plan for patients suffering from PD is an integral part towards the achievement of improved health outcomes. In particular, having care plans has been shown to be associated with several benefits including: continuity of care even with the changing of nursing staff, catering for individual patient needs and documentation purposes (Ackley and Ladwig, 2014).

Based on the selected case, several goals for care plan can be pointed out based on the various nursing concerns associated with PD. To start with, Michael J. Fox, to extend experienced impairment on the physical mobility. This has also been pointed out in many patients suffering from PD. This problem is mainly evidenced by one or more of the following characteristics: body weakness, gait disturbances, challenges in maintaining balance and coordination, and postural challenges. Based on the identified patient need, the following goals will direct the care plan:

Short Term Goal: the patient will be able to maintain functional mobility to the level best within the confines of disease progression.

Long Term Goal: the patient will be able to overcome challenges associated mobility to an extent that few or no visible characteristics can be detected.

Another nursing concern that can be pointed out from the case is the emotional stress associated with PD. In particular, Michael J. Fox was associated with heavy drinking of alcohol, indicating that he had some level of emotional/thought disturbances. This is because there was a significant change in his life style considering that he had never been associated with the drinking behavior before the onset of PD. Other evidences that can be used to point out this problem include one or several of the following: insomnia, sorrow and memory impairment. Similarly, based on the identified patient need, the following goals will direct the care plan:

Short Term Goal: the patient will be able to identify the sources of depression that lead to the emotional/though disturbances.

Long Term Goal: the patient will adhere to the prescribed regimen and regain full control of the emotional/thought process.

Several patient care technologies can be used to manage the clinical problems identified above to facilitate better health outcomes among PD patients. For instance, one of the technologies that have received an increased attention among healthcare providers dealing with PD patients is the use of exercise technologies that are in line with the standard physical therapy. Many companies have developed technologies that enable people to accomplish particular exercises, which target specific objectives. Some of these technologies, such as GymPact and Cody, have been presented as applications that are even compatible with smart phones. According to NINDS (2016), the use of technologies in promoting exercises has shown benefits such as improved mobility and flexibility, and emotional well-being among patients.

Intervention

Considering that the PD results from depletion of dopamine, the first intervention would be to provide dopaminergic drugs to the patient. This class of drugs mimics the effects of dopamine and hence increases the body responsiveness. Other commonly used classes of drugs include: Levodopa, Amantadine, Anticholinergics, COMT Inhibitors and MAO-B Inhibitors. Another intervention for this case would be to encourage the patient to become active by rocking to a standing position. Considering that PD causes rigidity tremors (Ackley& Ladwig, 2014), it is highly likely that the patient experiences physical mobility, such as getting out of the chair. In this case, by getting support from firm objects, such as the arms of a chair, the patient can be able to overcome the challenge. The third intervention would be to encourage, and teach the patient to use a wide-based gait in order to improve on balancing. According to Sanders and Gillig (2010), the shuffling gait and the tendency to lean forward can be overcome through conscious effort to learn a walking technique that involves swing of arms, raising of feet and use of long strides.

In addition, the patient should be given massage, in order to relax muscles, and referred to a physical therapist in order to undertake additional, but guided exercises. In this case, one of the many exercise applications can be adopted to guide the instructor to assist the patient to complete exercises aimed at reducing the rigidity. This way, the patient will be able to maintain functional mobility to the level best within few months or the intervention. Of more significance, with continued therapy, the patient will overcome the challenges associated mobility to an extent that few or no visible characteristics can be detected.

On the other hand, monitoring of stressors that cause emotional instability to the patient will be used as an intervention. By identifying the events that cause depression, it is possible to tailor the care plan by orienting the patient to the reality. As such, the patient becomes aware of the surroundings and is able to make decisions that help to overcome the issue. In addition, there is need to monitor current medications used by the patient as some medications, such as amantadine, are associated with emotional changes (Schapira, 2010).

Evaluation

During evaluation stage, regular cognitive evaluations will be conducted in intervals of about two weeks. In particular, interviews with the patient can help to establish changes in memory, behavior, and mood (U.S. Department of Health & Human Services, 2016). By examining the changes in life style for the patient, it is possible to point out whether the given intervention is effective. In the same note, evaluation for the interventions on mobility challenges will be conducted by recording the patient’s ability to tolerate activity. Similarly, other parameters, such as mobility on bed, pain, pulse, blood pressure, breathing and skin color will be monitored in order to evaluate the efficacy of intervention.

There are several reasons that can be given to indicate the higher chances of success in this care plan. To start with, there is vast evidence that suggests that physical therapy intervention approach is effective in overcoming functional mobility challenges. According to Ackley and Ladwig (2014), physical exercises help to tone muscles and also stimulate the usage ‘rigid’ muscles through motions. Similarly, exercises have been shown to also help in improving emotional well-being of the participants, therefore, alleviating the emotional disturbances. Moreover, the use of dopaminergic drugs will help to improve neurologic responses and hence the overall well-being of the patient. Based on the above statements, it can argued that the plan will be a success.