Medical Dx FSCC Clinical Tool: Medical Diagnosis

Student_________________ Clients Initials_______ Clinical Week_______

Pathology of Disease: Describe the pathology related to your patients medical diagnosis. Include textbook signs and symptoms

Parkinsons disease is a chronic degenerative movement disorder of the central nervous system. Eventually the disease affects a persons
cognition and mood. Parkinsons disease is more commonly found in people over the age of 65, and affects more than one million people.
The underlying cause is not known, but the disease does often cluster in families, whether this is the result of genetics or exposure to
environmental toxins or virus is uncertain. There presently is no known cure, but there are treatment options such as medication and
surgery to help aid with the effects of the disease. Parkinsons disease occurs when a group of brain cells called the substantia nigra begin
to malfunction and die. The substantia nigra are responsible for the production of dopamine, a neurotransmitter, that sends messages to the
brain to control movement and coordination. As the dopamine-producing cells start to die, the messages from the brain affecting body
movement are delivered at a slower rate, leaving the person incapable of initiating and controlling movements normally.
The common characteristics of Parkinsons disease are: tremor of the hands, arms, legs, jaw, and face; Rigidity or stiffness of the limbs and
trunk, loss of facial expression, bradykinesia, gait disturbances, causing difficulty in initiating forward movements.
Symptoms include: a gradual feeling of general malaise, fatigue, aching, followed by a tremor in a resting hand, or in another extremity;
trouble rising from a chair or turning over in bed; a stooped posture and shuffling gait, increasing the risks for falling; vocal quality and
facial expression diminishes; handwriting becomes smaller, with a cramped, often illegible script.

Sources: Parkinsons Disease Foundation, Inc.; http://www.pdf.org ; Davis, F. A., Tabers Cyclopedic Medical Dictionary, 20th Edition,

Textbook Picture Client Presentation

Signs and Symptoms: The common signs Signs and Symptoms: The most obvious sign for my patient are the tremors affecting her
of Parkinsons disease are: tremor of the hands and neck. She had difficulty feeding herself, due to her trembling hands.
hands, arms, legs, jaw, and face; Rigidity or
stiffness of the limbs and trunk, loss of
facial expression, bradykinesia, gait
disturbances, causing difficulty in initiating
forward movements.
Symptoms include: a gradual feeling of Medical Management including medications, diagnostic tests & surgery: The patient is
general malaise, fatigue, aching, followed currently taking Sinemet for the current symptoms.
by a tremor in a resting hand, or in another
extremity; trouble rising from a chair or
turning over in bed; a stooped posture and
shuffling gait, increasing the risks for
falling; vocal quality and facial expression Prognosis: Since there is no cure for Parkinsons disease at this time, the patient will
diminishes; handwriting becomes smaller, continue to take Sinemet to control her symptoms.
with a cramped, often illegible script.

Medical Management including

medications, diagnostic tests & surgery:
Medical treatments include
levodopa/carbidopa (Sinemet); dopamine
agonists (e.g. APOKYN injection,
bromocriptine, pergolide, pramipexole,
ropinirole); and monoamine oxidase-B
inhibitors (e.g.deprenyl.)
Surgery options are minimal and performed
at very few hospitals; involve the
transplantation of dopamine-secreting cells
into affected areas of the brain, or insertion
of electrical brain stimulators onto the
subthalamic nucleus, globus pallidus
internus, or ventral intermediate nucleus.
Prognosis: There is not a cure for
Parkinsons disease at this time.

Nursing Care: Monitor the patients drug
therapy, and tolerance, especially with
other drug interactions, if a new drug is
introduced.
Patient and family need safety instruction
to prevent the risk for falls as the disease
progresses.
Patient should be monitored while eating,
due to the increased risk of dysphasia.
Try to encourage the patient to exercise, to
prevent contractures and muscle atrophy.
Nursing Care: The patient is given Sinemet daily for her Parkinsons symptoms.
She is also encouraged to feed herself, even though she loses some of her food from the plate
to her mouth.
The patient is able to rise from the bed and sit in her wheelchair, and vice versa, but she is
recognized by the facility as a fall risk.
She did not want to participate in exercise class the day I was with her, due to having a
headache.

How does your client compare to what is considered usual medical/nursing interventions?
My client is given the prescribed Sinemet daily to control the symptoms of Parkinsons disease. She is encouraged to feed herself and
stay as mobile as possible. The facility has her posted as a fall risk, and has her on a turning schedule, if she is not able to do it herself.