Mr. Newton, age 65, is seen by the home health nurse after a new diagnosis of Parkinson’s disease. He has a history of hypertension, type 2 diabetes, and chronic obstructive pulmonary disease. He has a 65-pack year history of smoking; he quit smoking 10 years ago. He is 6′2″ tall and weighs 205 lb (BMI 26.32 kg/m²). On exam Mr. Newton has resting tremor bilateral upper extremities, his voice is soft with occasional slurring; his posture is stooped, and he takes short, shuffling steps that do not clear the floor and has minimal arm movement with ambulation. He has difficulty initiating movement. His gait is unsteady, and he uses a quad cane for assist. He must use the arms of the chair to stand, and it takes several attempts before he succeeds in standing. His partner of 15 years is present at the visit and states he now must assist Mr. Newton with dressing, as he can no longer button his shirts or grasp zippers. His medications include carbidopa/levodopa 10 mg/100 mg three times a day, metformin 500 mg twice a day, glipizide 5 mg twice a day, lisinopril/hydrochlorothiazide 10 mg/12.5 mg, and budesonide/formoterol 80 µg/4.5 µg 2 puffs twice a day.

Based on the client’s condition, the client’s priority needs will be to prevent which of the following? Select all that apply.

1. INJURY
2. EXCESSIVE INTESTINAL MOTILITY
3. DYSARTHRIA
4. DECREASED IMMUNITY
5. DECREASED MOBILITY
6. FALLS
7. FUNCTIONAL NEGLECT
8. COGNITIVE DECLINE

ANSWER

Mr. Newton’s new diagnosis of Parkinson’s disease and his existing medical history present complex challenges that require careful consideration of his priority needs. Based on his condition, the following priorities need to be addressed to ensure his well-being and quality of life:

FALLS: Mr. Newton’s presentation of resting tremors, shuffling gait, unsteadiness, and difficulty initiating movement significantly increases his risk of falls. His use of a quad cane and the need for assistance to stand and perform activities of daily living highlight his compromised mobility. Falls can lead to serious injuries, fractures, and subsequent decline in health. Preventing falls is crucial to maintaining his safety and independence.

INJURY: Related to the risk of falls, the potential for injury is a significant concern. The presence of a resting tremor, reduced arm movement, and the need to use his partner’s assistance for dressing all indicate his decreased motor function and coordination. These factors contribute to his susceptibility to accidental injuries, such as burns or cuts. Preventing injuries is paramount to ensuring his physical well-being.

DECREASED MOBILITY: Mr. Newton’s shuffling gait, difficulty initiating movement, and need for assistance to stand underscore his reduced mobility. Prolonged immobility can lead to muscle weakness, joint stiffness, and further impair his overall functional ability. Addressing his decreased mobility is vital to maintaining his independence and quality of life.

DYSARTHRIA: Dysarthria, characterized by slurred speech and reduced vocal volume, is already evident in Mr. Newton’s presentation. As his speech becomes less intelligible, communication barriers may develop, affecting his ability to convey his needs and interact with others effectively. Managing dysarthria and facilitating effective communication strategies are essential to enhance his overall well-being.

While other considerations such as cognitive decline, decreased immunity, and functional neglect are relevant to the care of patients with Parkinson’s disease, addressing the risk of falls, injury prevention, maintaining mobility, and managing dysarthria should take precedence in Mr. Newton’s care plan. A holistic approach that encompasses physical, emotional, and social well-being is necessary to ensure that Mr. Newton’s quality of life is maximized despite the challenges posed by his medical conditions.