Parkinson’s Diagnosis Pathophysiology
Parkinson’s disease (PD) is a central nervous system ailment that is chronic and neurodegenerative. It results from the lapse of dopaminergic the substantia nigra neurons, a part of the brain that regulates movement. Dopamine, a neurotransmitter that controls motor control, is thus depleted, causing motor symptoms typical of Parkinson’s disease (PD).
PD can significantly disrupt one’s quality of life with symptoms like tremors, stiffness, bradykinesia (slow movement), and postural instability affecting daily tasks (Schrag, 2018). Moreover, PD can result in non-motor symptoms such as melancholy, anxiety, restlessness, and cognitive decline. Various methods can be used to treat PD, such as prescription drugs, deep brain stimulation, and physical therapy.
One concept impacted by PD is motor function caused by the reduction of dopaminergic the substantia nigra neurons. Consequently, it accelerates the decrease in dopamine, a neurotransmitter vital to motor function. Another concept impacted is cognition, whereby PD patients commonly exhibit cognitive impairment, notably in executive function and memory, which can affect their everyday lives (Peball et al., 2020). Additionally, it leads to sleep disruptions, where up to 60% of individuals with PD report having insomnia (Wallace et al., 2020). Finally, emotional and psychological well-being are typically compromised, with depression and anxiety common in PD patients.
PD can have a considerable effect on a patient’s quality of life, causing a broad array of motor and non-motor symptoms. Tremors, rigidity, slowness of movement, and troubles with coordination and balance are examples of motor symptoms, while non-motor symptoms include stress, anxiety, sleep disruption, and memory problems. These problems can have a massive effect on an individual’s lifestyle because they interfere with everyday activities and social interactions.
Medications for treating Parkinson’s disease (PD) include monoamine oxidase-B (MAO-B) inhibitors, dopamine agonists, and levodopa. Dopamine agonists imitate the actions of dopamine in the brain, whereas levodopa is a dopamine precursor that can be turned into dopamine in the brain (Stocker & Barker, 2020). MAO-B inhibitors increase dopamine availability in the brain because they prevent dopamine breakdown. These drugs can lessen their motor symptoms and overall quality of life for persons with PD.
Furthermore, COMT inhibitors are drugs that inhibit the function of an enzyme termed catechol-O-methyltransferase, which is responsible for the breakdown of levodopa in the body. By inhibiting this enzyme, COMT inhibitors can help extend the influence of levodopa and improve muscle symptoms. Finally, anticholinergics are remedies that inhibit the activity of acetylcholine, a neurotransmitter in the brain. They can help with tremors and stiffness but can also cause a dry throat, constipation, and confusion.
Other treatment options for Parkinson’s disease can include physiotherapy, occupational therapy, and talk therapy. Physical therapy may improve a person’s maneuverability and balance by focusing on workouts that boost muscles and enhance motion range. Occupational therapy can assist a person with Parkinson’s disease in maintaining their autonomy by teaching them new methods for carrying out routine duties and adjusting to the changes (Welsby et al., 2019). Speech therapy may improve a person’s capacity to speak and communicate. These treatments may assist with both motor symptoms and non-motor symptoms like depression and anxiety.
Correlation between Rheumatoid Arthritis and PD
Both PD and Rheumatoid Arthritis (RA) can impair maneuverability, comfort, cognition, emotional well-being, and sleep. PD causes symptoms like tremors and impaired mobility, cognition, psychological well-being, and sleep disruption. RA is an autoimmune illness that mainly impacts the joints, causing damage and inflammation.
This damage can cause pain, stiffness, and a reduction in range of motion and induce inflammatory reactions, disrupting sleep and negatively impacting emotional well-being, resulting in anxiety and fatigue. There is no decisive correlation between the two diagnoses, but inflammation may contribute to the progression of PD (Tansey et al., 2022). Since RA is a chronic inflammatory disease, there could be some commonality in the inflammatory responses involved in both illnesses.
Plan for the Day
0700- If the patient reports pain, administer PRN morphine.
0730- Sarah’s breakfast
0800- Check patient’s BG level and administer FSG if necessary.
0900-Provide routine medicines (methotrexate, naproxen, duloxetine).
1000- Assist the patient with exercises or walking as tolerated; recommend a PT/OT consult.
1100- Monitor the patient’s oxygen saturation and encourage deep breathing as an incentive to reduce dyspnea.
1200- Encourage relaxation-promoting measures like warm baths.
1230- Sarah’s lunch.
1300- If necessary, give hydroxyzine PRN for sleep.
1400- Assist the patient with ADLs as needed.
1500- Check the patient’s temperature.
1600- If necessary, administer PRN morphine for pain.
1700- Monitor the patient’s blood oxygen and encourage deep breathing/spirometer incentive to reduce dyspnea.
1800- Dinner will be served.
1900- If necessary, give hydroxyzine PRN for sleep.
Patient History
Sarah Jones, a 35-year-old woman with a history of rheumatoid arthritis (RA), was admitted to the hospital with a flare-up of her RA. She arrived at the emergency department complaining of severe pain, dyspnea, fatigue, a slightly elevated temperature, and reduced mobility. Vitals: blood pressure: 132/80 mmHg, pulse rate: 102 beats per minute, temperature: 99.7°F, respiratory rate: 12 beats per minute, oxygen saturation: 97. Lab Results: CBC, CXR, CRP, SR- pending. Imaging: None. Medical History: RA, PD diagnosed 10 years back. Surgical History: None.
Personal/Social/Cultural History: Sarah has a 7-pack-year smoking history, and she reports that she is “trying to quit,” but she smokes to cope with the fatigue caused by her arthritis. Home Medications: Methotrexate 7.5 mg IM once weekly (immunosuppressant), Naproxen 250 mg PO BID (NSAID for pain), Hydroxyzine 25 mg PO q6h PRN for sleep (antihistamine), Nicotine 21 mg transdermal patch qd (smoking cessation aid), Morphine 4 mg IV q4h PRN for pain (opioid analgesic), Duloxetine 60 mg PO qd (SNRI antidepressant).
Hospital Order: Levodopa 84 mg inhaler up to 5x/day prn for Parkinson’s symptoms (dopamine precursor). Add prednisone if the patient’s symptoms do not improve. Clinical Significance of Labs: The CBC, CXR, CRP, and ESR are pending, and there is no information on their clinical significance related to the admission diagnosis.
Assessment of Data
Sarah Jones was admitted due to RA exacerbation that caused severe pain, dyspnea, fatigue, a mildly higher temperature, and decreased mobility. Sarah has swollen and deformed joints on both sides and rates joint pain as a 7 out of 10. She is severely exhausted and in pain, with dyspnea, a mildly higher heart rate, anorexia, and decreased mobility in her upper and lower extremities. None of the findings deviate significantly from what is expected in a patient with RA and Parkinson’s disease. Sarah, on the other hand, has a 7-pack-year smoking history and continues to use nicotine patches to deal with her fatigue.
Planning
The ideal result for the patient is well-managed pain, adequate water and food intake, and proper wound care. The nursing priority is to manage the patient’s pain level through interventions such as pain medication administration, non-pharmacologic pain management techniques, and regular pain assessment. The priority of holistic care is to guarantee the patient’s comfort and well-being. Interventions like offering psychological assistance, adequate nutrition, and preserving a clean environment can be implemented to accomplish this. Interventions that can be delegated include aiding with hygiene, eating, and mobility and tracking any changes in the patient’s disease to the nurse.
Complications and Reassessment Findings
Septic arthritis, an infection in the joint, is a complication that occurred during the shift. Sarah was re-examined for symptoms and signs of septic arthritis, such as muscle aches, inflammation, redness, warmth, rigidity in the affected joint, and fever. I then administered 12 mg of vancomycin intravenously (IV) twice in an 8-hour interval as per the doctor’s instructions, which resulted in a lowering of the infection.
Evaluation
The specific decisions include prioritizing Sarah’s respiration by delivering oxygen and suctioning as needed, giving medication for pain control, and monitoring the side effects. What might have to be done differently is to document all interventions and assessments more thoroughly and accurately.I learned from this experience how to communicate effectively with health providers and multidisciplinary teams.My future learning will be applied to providing patient-centered care, including thorough documentation and enhanced communication with health professionals.
Patient Education
For medical diagnosis, RA will be described as an illness that causes joint pain, stiffness, and swelling. The medications prescribed, such as NSAIDs, will help reduce joint pain, inflammation, and swelling. Rheumatoid arthritis is commonly treated with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs (DMARDs).
Exercise, physical therapy, and occupational therapy will all help to manage the symptoms. An RA exacerbation can increase joint pain, stiffness, and swelling. It is critical to take care of oneself by getting enough rest, eating well, and exercising regularly. Follow-up appointments are advised to modify the treatment plan and communicate the patient’s progress.
References
Peball, M., Krismer, F., Knaus, H., Djamshidian, A., Werkmann, M., Carbone, F., Ellmerer, P., Heim, B., Marini, K., Valent, D., Goebel, G., Ulmer, H., Stockner, H., Wenning, G. K., Stolz, R., Krejcy, K., Poewe, W., & Seppi, K. (2020). Non‐motor symptoms in Parkinson’s disease are reduced by Nabilone. Annals of Neurology, 88(4), 712-722. Web.
Schrag, A. (2018). Testing the MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders, 33(10), 1518-1520. Web.
Stocker, T. B., & Barker, R. A. (2020). Recent developments in the treatment of Parkinson’s Disease. PubMed. Web.
Tansey, M. G., Wallings, R. L., Houser, M. C., Herrick, M. K., Keating, C. E., & Joers, V. (2022). Inflammation and immune dysfunction in Parkinson’s disease. Nature Reviews Immunology, 1-17. Web.
Wallace, D. M., Wohlgemuth, W. K., Trotti, L. M., Amara, A. W., Malaty, I. A., Factor, S. A., Nallu, S., Wittine, L., & Hauser, R. A. (2020). Practical Evaluation and Management of Insomnia in Parkinson’s Disease: A Review. Movement Disorders Clinical Practice, 7(3), 250–266. Web.
Welsby, E., Berrigan, S., & Laver, K. (2019). Effectiveness of occupational therapy intervention for people with Parkinson’s disease: systematic review. Australian Occupational Therapy Journal, 66(6), 731-738. Web.