{ "name": "Parkinson's Disease", "slug": "parkinsons-disease", "url": "https://nursingplex.com/care-plans/parkinsons-disease", "category": "Neurological", "summary": "Progressive movement disorder; medication timing, fall prevention and swallowing safety.", "nursing_diagnoses": [ "Impaired physical mobility", "Risk for aspiration", "Self-care deficit" ], "overview": [ "Parkinson's disease is a progressive degeneration of dopamine-producing neurons in the substantia nigra. As dopamine falls, the balance between dopamine and acetylcholine in the basal ganglia is lost, and voluntary movement becomes slow, rigid and poorly initiated. Symptoms usually appear only after a majority of these neurons are already lost, which is why the disease presents insidiously in midlife or later.", "The cardinal features are tremor at rest, rigidity, bradykinesia and postural instability. The tremor is typically a pill-rolling motion of the hand that appears at rest and lessens with purposeful movement. Rigidity is often cogwheel in quality. Bradykinesia produces the masked face, soft monotone voice, small cramped handwriting and shuffling festinating gait.", "Non-motor problems drive much of the disability and are frequently missed: constipation, orthostatic hypotension, urinary urgency, drooling and swallowing difficulty, sleep disturbance, depression and, later, dementia. Nursing care focuses on maintaining function and safety, timing medication precisely, protecting nutrition and airway, and supporting communication and dignity across a course measured in years." ], "key_facts": [ { "label": "Cardinal signs", "text": "Resting tremor, cogwheel rigidity, bradykinesia and postural instability — remember TRAP." }, { "label": "Underlying imbalance", "text": "Dopamine deficiency with relative acetylcholine excess in the basal ganglia." }, { "label": "Main drug", "text": "Carbidopa-levodopa; carbidopa prevents peripheral breakdown so more levodopa reaches the brain." }, { "label": "Timing matters", "text": "Doses must be given on time to the minute; late doses produce 'off' periods with sudden freezing and immobility." }, { "label": "Biggest safety risks", "text": "Falls from postural instability and aspiration from impaired swallowing." } ], "nursing_priorities": [ "Preserve mobility and prevent falls.", "Maintain safe swallowing and adequate nutrition and hydration.", "Give antiparkinson medication precisely on schedule and manage side effects.", "Support communication as speech becomes soft and slurred.", "Prevent constipation, orthostatic hypotension and skin breakdown.", "Promote independence in self-care with adaptive strategies.", "Address depression, sleep disturbance and caregiver strain." ], "assessment": { "subjective": [ "Shaking of a hand at rest that improves when reaching for something", "Feeling stiff, slow or 'stuck' when starting to walk", "Difficulty turning in bed or rising from a chair", "Handwriting getting smaller; voice becoming quiet", "Choking or coughing while eating or drinking; drooling", "Constipation, urinary urgency, dizziness on standing", "Sadness, loss of interest, poor sleep and vivid dreams" ], "objective": [ "Pill-rolling resting tremor, decreased with intentional movement and absent in sleep", "Cogwheel rigidity on passive range of motion", "Bradykinesia with masked, expressionless facies and reduced blinking", "Stooped posture, shuffling festinating gait, reduced arm swing, freezing at doorways", "Positive pull test showing postural instability; falls history", "Soft, monotone, rapid or hesitant speech; micrographia", "Drooling, delayed swallow, weight loss", "Orthostatic blood pressure drop; decreased bowel sounds and hard stool" ], "related_factors": [ "Progressive loss of dopaminergic neurons in the substantia nigra", "Neurotransmitter imbalance producing rigidity and bradykinesia", "Autonomic dysfunction causing orthostasis, constipation and bladder symptoms", "Impaired oropharyngeal coordination affecting speech and swallowing", "Medication side effects including dyskinesia, hallucinations and hypotension", "Deconditioning, fatigue and depression reducing activity further" ] }, "goals": [ "The client will remain free of falls and injury throughout the care period.", "The client will maintain mobility with the safest assistive device and participate in a daily exercise routine.", "The client will swallow safely without choking and maintain weight within an agreed range.", "The client will receive antiparkinson medication within the ordered time window at every dose.", "The client will maintain a regular bowel pattern without straining.", "The client will communicate needs effectively using taught speech techniques or aids.", "The client and caregiver will describe the medication schedule, fall precautions and available community resources." ], "interventions": [ { "title": "1. Mobility, gait training and fall prevention", "points": [ "Assess gait, balance and freezing episodes; note which situations trigger freezing, such as doorways, turns and crowded spaces.", "Teach specific cueing strategies for freezing: rocking side to side, marching in place, stepping over an imaginary line or counting a rhythm to start movement.", "Instruct the patient to deliberately lift the feet, widen the stance, and swing the arms; a conscious exaggerated gait counteracts the shuffle.", "Discourage carrying objects while walking so the arms are free for balance, and teach turning in a wide arc rather than pivoting.", "Remove throw rugs and clutter, secure cords, improve lighting, install grab bars and raised toilet seats, and use a firm chair with arms.", "Encourage daily range of motion, stretching, and walking; regular exercise slows functional decline more reliably than any comfort measure.", "Coordinate physical therapy for gait training and occupational therapy for adaptive equipment early rather than at crisis point." ] }, { "title": "2. Medication timing and management", "points": [ "Give carbidopa-levodopa exactly on schedule; even 30 minutes late can produce an 'off' period with sudden immobility, and hospital routine dosing times are a frequent cause of avoidable deterioration.", "Take levodopa on an empty stomach when tolerated, since high-protein meals compete with its absorption; if nausea requires food, use a low-protein snack.", "Watch for dyskinesia — involuntary writhing movements indicating too much dopaminergic effect — and report the pattern rather than simply the presence.", "Monitor for orthostatic hypotension, nausea, vivid dreams, hallucinations, confusion and impulse-control behaviors with dopamine agonists.", "Explain that urine and sweat may darken harmlessly on levodopa.", "Never stop antiparkinson drugs abruptly; withdrawal can cause a severe rigidity crisis.", "Avoid dopamine-blocking antiemetics and antipsychotics such as metoclopramide and haloperidol, which markedly worsen symptoms.", "Understand adjunct classes: MAO-B inhibitors and COMT inhibitors extend levodopa effect, amantadine reduces dyskinesia, and anticholinergics help tremor but cause confusion, dry mouth and retention in older adults." ] }, { "title": "3. Swallowing, nutrition and aspiration prevention", "points": [ "Screen swallowing before any oral intake in the hospital and refer to speech-language pathology for a formal evaluation.", "Seat the patient fully upright, use a chin-tuck posture as advised, and allow unhurried meals with small bites and full attention.", "Provide soft, moist foods and thickened liquids if recommended; encourage a conscious, deliberate swallow and a second dry swallow.", "Keep suction available, avoid straws when they increase aspiration risk, and remain with the patient during meals when risk is high.", "Weigh weekly, monitor intake, and offer small frequent high-calorie meals; eating is slow work and fatigue limits intake.", "Manage drooling by cueing the patient to swallow saliva periodically and to hold the head upright.", "Schedule the largest meal at the time of best medication effect." ] }, { "title": "4. Communication", "points": [ "Allow ample time and never finish sentences for the patient; comprehension is intact even when speech is slow.", "Teach the patient to face the listener, take a breath before speaking, exaggerate articulation and speak in short phrases.", "Refer for intensive voice therapy, which measurably improves loudness.", "Provide a communication board, writing aids or a voice amplifier when speech becomes unintelligible.", "Reduce background noise and use yes/no questions when fatigue is high." ] }, { "title": "5. Autonomic and elimination problems", "points": [ "Prevent constipation with fluids, fiber, activity and scheduled toileting; constipation is nearly universal and often precedes motor symptoms.", "Teach slow position changes, use of compression stockings and adequate hydration and salt as approved to reduce orthostatic dizziness.", "Check orthostatic blood pressures, particularly after medication changes.", "Assess for urinary urgency and retention, and establish a toileting schedule with a bedside commode at night.", "Address excessive daytime sleepiness and REM sleep behavior disorder; ensure the sleep environment is safe." ] }, { "title": "6. Self-care and independence", "points": [ "Allow extra time and avoid taking over tasks the patient can still perform; independence maintains function and self-worth.", "Provide adaptive equipment: built-up utensil handles, plate guards, non-slip mats, elastic waistbands, slip-on shoes, button hooks and Velcro closures.", "Use a firm mattress and satin sheets or a bed rail to make turning in bed easier.", "Break complex tasks into single steps and give one instruction at a time.", "Schedule demanding activities during peak medication effect." ] }, { "title": "7. Mood, cognition and caregiver support", "points": [ "Screen routinely for depression and anxiety, which affect a large share of patients and are treatable; do not dismiss flat affect as merely a masked face.", "Monitor for hallucinations and evolving dementia in later disease and report them, since medications may need adjustment.", "Encourage social contact and meaningful activity; withdrawal accelerates decline.", "Assess caregiver strain directly, arrange respite and refer to Parkinson's support organizations and local groups.", "Discuss advance care planning while communication is still effective." ] } ], "patient_teaching": [ "Take every dose of your Parkinson's medication exactly on time — set alarms and bring your own schedule to the hospital.", "Never stop the medication suddenly, and check with the prescriber before any new drug, especially antinausea or psychiatric medications.", "Avoid taking levodopa with a high-protein meal; a small low-protein snack is acceptable if nausea occurs.", "Exercise daily — walking, stretching, and balance work slow the loss of function.", "Use the freezing tricks you have practiced: rock, count, march, or step over a line to get moving again.", "Sit fully upright to eat, take small bites, and report any coughing or choking during meals.", "Rise slowly from bed or chair to avoid dizziness, and keep pathways clear of rugs and clutter.", "Report new confusion, hallucinations, uncontrollable movements, marked mood change, or repeated falls.", "Connect with a Parkinson's support group and arrange caregiver respite before exhaustion sets in." ] }