Research has shown increasing specialization among nurses who care for patients with PD [–]; thus, knowledge of the pathophysiology of this disease is arguably an important starting point for vocational training []. Based on this, we sought to hierarchically organize the major motor and nonmotor symptoms of PD using evidence gathered from the literature (). Show The symptoms of PD are divided into motor and nonmotor; each of these classifications contains various other signs and symptoms related to both the neurodegenerative disease process itself as well as multifactorial causes. Thus, hierarchical organization of symptoms is not an easy task, and various descriptions have been proposed to facilitate understanding of the pathophysiology of the disease [–]; however, none of them have structured the symptoms into an organizational chart. Our research on nursing diagnoses, outcomes, and interventions was based on this chart. 2.2. Nursing protocols for patients with Parkinson's diseaseAccurate identification of nursing diagnoses is essential for clinical practice since it enables proper planning of care, implementation of interventions, and efficient evaluation of the results. Therefore, it is necessary to use diagnostic support tools prepared in accordance with institutional settings and the complexity of patient's conditions. These tools should still be based on the best clinical evidence and recommendations described in the scientific literature. This subchapter presents several nursing assessment protocols in the context of the activities of daily living, gastrointestinal and genitourinary function, sleep disorders, hypotension, and medication adherence. Nursing assessment for daily life activities in patients with Parkinson's disease Date: _____/_____/_______ Personal dataName: _________________ Age: ___ Sex: ( ) Female ( ) Male Family/Caregiver:________________Date of onset of symptoms of Parkinson's disease: _________________________________________Concomitant diseases: ______________ Daily medications: __________________________________Housing conditions and family support( ) Own residence ( ) Rented residence ( ) Residence of relatives/friends ( ) Institutionalized( ) House with a single level ( ) House with multiple levels ( ) Stairs with unilateral handrail ( ) Stairs with bilateral handrail ( ) Stairs without handrail ( ) No stairs ( ) Apartment with elevator ( ) Apartment with no elevatorAdaptation at residence? ( ) yes ( ) no Where?__________________________________________( ) Live alone ( ) Live with whom? _______________________ Family/caregiver support? ( ) Yes ( ) NoRoutineDescribe your routine before the Parkinson's disease diagnosis:_________________________________________________________________________________________________________________Describe your current routine:__________________________________________________________ __________________________________________________________________________________Schwab and England activities of daily living []100%-Completely independent. Able to do all chores without slowness, difficulty, or impairment. Essentially normal. Unaware of any difficulty.90%-Completely independent. Able to do all chores with some degree of slowness, difficulty, and impairment. Might take twice as long. Beginning to be aware of difficulty.80%-Completely independent in most chores. Takes twice as long. Conscious of difficulty and slowness.70%-Not completely independent. More difficulty with some chores. Three to four times as long in some. Must spend a large part of the day with chores.60%-Some dependency. Can do most chores but exceedingly slowly and with much effort. Errors; some impossible.50%-More dependent. Help with half, slower, et cetera. Difficulty with everything.40%-Very dependent. Can assist with all chores, but few alone.30%-With effort, now and then does a few chores alone or begins alone. Much help needed.20%-Nothing alone. Can be a slight help with some chores. Severe invalid.10%-Total dependent, helpless. Complete invalid.0%-Vegetative functions such as swallowing, bladder, and bowel functions are not functioning. Bed-ridden.MDS-UPDRS Part II scale can be appliedNursing diagnosesNursing interventions Evaluation of patient's ability to perform activities of daily life is complex because it involves environmental aspects (usually related to the accessibility of the house), family support or caregivers, and commitment to the routine. The assessment should be based on standardized scales, such as the Unified Parkinson's Disease Rating Scale (UPDRS) Part II and the Schwab and England activities of daily living scales widely used in research and clinical practice [–]. Nursing assessment of bowel status in patients with Parkinson's disease Date: _____/_____/_______  Evaluation of intestinal symptoms in patients with PD focuses on constipation, which is the main problem. However, it is important to assess other symptoms such as fecal incontinence and related factors that enhance intestinal symptoms such as changes in mobility/accessibility, swallowing, and cognitive function, among others. The Rome III criteria and the Bristol Stool Scale are recommended tools for evaluation of constipation [, ]. Genitourinary nursing assessment in patients with Parkinson's disease Date: _____/_____/_______ Personal dataName: ______________ Age: ___ Sex: ( ) Female ( ) Male Family/Caregiver:____________________Date of onset of symptoms of Parkinson's disease: __________________________________________Concomitant diseases: ________________________________________________________________Daily medications: ___________________________________________________________________Genitourinary, reproductive, and bowel functionsNumber of pregnancies and births: _________ ( ) Vaginal birth ( ) Caesarean ( ) Abortions: _________Main complaint: _____________________________________________________________________Onset of symptoms: _________________ Presence of symptoms before PD: ( ) Yes ( ) NoHistory of uro/gynaecology surgery: ( ) Yes ( ) No Which: ___________________________________Regular monitoring by urologist/gynaecologist: ( ) Yes ( ) NoSensation of bladder fullness ( ) Yes ( ) NoBladder control ( ) Yes ( ) No Urinary Urgency ( ) Yes ( ) No Urinary Loss ( ) Yes ( ) NoIntestinal function: ( ) Regular ( ) Irregular Frequency:______________________________________Do the bladder symptoms impact sexual capacity ( ) Yes ( ) No How? __________________________Storage symptoms Evaluation of bladder symptoms in patients with PD is complex because it involves investigation of urinary, gynecological/urological, cognitive/behavioral, and sleep symptoms, as well as mobility/accessibility and quality of life. Thus, nurse evaluations should focus on several aspects that may contribute to these changes in order to propose appropriate interventions. Some measurement scales may be used, including the Overactive Bladder questionnaire (OAB‐q) [], Questionnaire on Pelvic Organ Function [], and the Scale for Outcomes in Parkinson's disease (SCOPA‐AUT) []. Nursing assessment for sleep disorders in patients with Parkinson's disease Date: _____/_____/_______ Personal dataName: _______________ Age: ___ Sex: ( ) Female ( ) Male Family/Caregiver:___________________Date of onset of symptoms of Parkinson's disease: __________________________________________Concomitant diseases: ________________________________________________________________Daily medications: ___________________________________________________________________Sleep assessmentComplaint: _______________________________ Onset of symptoms of sleep disorder: ___________Use medication to sleep? ( ) yes ( ) no Impact on quality of life of the patient: ( ) yes ( ) noHas sleep routine? ( ) yes ( ) no Impact on quality of life of the family: ( ) yes ( ) noSleep disorders related to motor symptomsDifficulty with movement in bed: ( ) Yes ( ) NoMorning dystonia: ( ) Yes ( ) NoTremors that compromise the quality of sleep: ( ) Yes ( ) NoRestless leg syndrome: ( ) Yes ( ) NoSleep disorders related to nonmotor symptomsHallucinations: ( ) Yes ( ) NoMental confusion: ( ) Yes ( ) NoSleep apnoea/difficulty breathing: ( ) Yes ( ) NoPain: ( ) Yes ( ) NoNocturia: ( ) Yes ( ) NoSpecific symptoms of sleep disordersInitial insomnia: ( ) Yes ( ) NoSleep-talking: ( ) Yes ( ) NoTerminal insomnia: ( ) Yes ( ) NoNightmares: ( ) Yes ( ) NoNonrestorative sleep: ( ) Yes ( ) NoVivid dreams: ( ) Yes ( ) NoSpecific symptoms of daytime sleep disordersSleeping unexpectedly during the day: ( ) Yes ( ) NoSleep while talking: ( ) Yes ( ) NoSleeping while watching TV: ( ) Yes ( ) NoSleep while sitting: ( ) Yes ( ) NoDifficulty staying awake during the day: ( ) Yes ( ) NoNursing diagnosesNursing interventions Evaluations of symptoms that cause sleep disorders should be approached with care and cover various related aspects, including motor/nonmotor function and night/day sleep disorders. Measurement scales can be used for this assessment and may include those recommended by the Movement Disorders Society Task Force: the PD sleep scale (PDSS), Pittsburgh sleep quality index (PSQI), SCOPA‐sleep (SCOPA), and the Epworth sleepiness scale (ESS) []. We also emphasize that the PDSS scale has been revised and the PDSS‐2 version has been validated []. Nursing assessment for orthostatic hypotension in patients with Parkinson's disease Date: _____/_____/_______ __________________________________________________________Personal dataName: _________________ Age: ___ Sex: ( ) Female ( ) Male Family/Caregiver:________________Date of onset of symptoms of Parkinson's disease: _________________________________________Concomitant diseases: _____Daily medications: ___________________________________________________________________Autonomic scale for outcomes in Parkinson's disease (SCOPA-AUT): Hypotension sectionIn the past month, when standing up, have you had the feeling of either becoming light-headed, not seeing properly, or not thinking clearly?( ) Never ( ) Sometimes ( ) Regularly ( ) OftenIn the past month, did you become light-headed after standing for sometime?( ) Never ( ) Sometimes ( ) Regularly ( ) OftenHave you fainted in the past six months?( ) Never ( ) Sometimes ( ) Regularly ( ) OftenComposite Autonomic Symptom Scale (COMPASS 31): Hypotension section []1. In the past year, have you ever felt faint, dizzy, “goofy”, or had difficulty thinking soon after standing up from a sitting or lying position? (1) Yes (2) No2. When standing up, how frequently do you get these feelings or symptoms?(1) Rarely (2) Occasionally (3) Frequently (4) Almost Always3. How would you rate the severity of these feelings or symptoms?(1) Mild (2) Moderate (3) Severe4. In the past year, have these feelings or symptoms that you have experienced:(1) Gotten much worse (2) Gotten somewhat worse (3) Stayed about the same(4) Gotten somewhat better (5) Gotten much better (6) Completely gonePhysical ExaminationBlood pressure (BP) lying:_____X_____mmHg Evaluation of orthostatic hypotension in patients with PD should be part of nursing protocol. Different measurement scales can be used, including those recommended by the Movement Disorders Society Task Force []: SCOPA‐AUT and the Composite Autonomic Symptom Scale (COMPASS) []. Nursing care can be based on “Clinical Practice Guidelines: Patient Self‐Management of BP Instability in Multiple System Atrophy, Parkinson's Disease and Other Neurological Disorders” []. Nursing assessment for medication adherence in patients with Parkinson's disease Date: _____/_____/_______ Personal DataName: ________________ Age: ___ Sex: ( ) Female ( ) Male Family/Caregiver:_________________Date of onset of symptoms of Parkinson's disease: __________________________________________Daily medicationNumber of pills/time of ingestionNumber of pills/time of ingestionMedication action/Side effectsTime-action:_______________________ Evaluation of medication adherence should consider aspects related to medication (expected, adverse, and side effects; action time; costs; etc.), other symptoms of PD (dysphagia, cognitive/neuropsychiatric disorders), impact on the quality of life, and family support/caregiver for management of treatment. The scale most commonly used in research and clinical practice is the Morisky Medical Adherence Scale (MMAS) [–]. What are the 3 nursing interventions?There are typically three different categories for nursing interventions: independent, dependent and interdependent.
What are 3 treatments for Parkinson's disease?Specific treatment for a Parkinson's disease will be determined by your doctor based on: Your age, overall health, and medical history.. Lesion surgery (burning of tissue). ... . Deep brain stimulation (DBS). ... . Neural grafting or tissue transplants.. What is the intervention for Parkinson's disease?Most people with Parkinson's disease eventually need a medication called levodopa. Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement.
What are 3 nursing interventions you are likely to perform to help the client manage her blood pressure?Nursing Management. Monitor blood pressure frequently. ... . Administer antihypertensive medications as prescribed.. Have two large-bore IVs.. Provide oxygen f the saturations are low (less than 94%). Limit fluid intake if the patient is in heart failure.. Assess ECG to ensure the patient is not having a heart attack.. |
