Chapter 58 Parkinson’s Disease Case Study
Chapter 58 Parkinson’s Disease Case Study
Please complete the following case study: Chapter 58a :: Patient With Parkinson’s Disease and Hip Fracture and submit your assignment here by the due date.
Answer each objectives in your own words, you will receive a zero for copy and pasting.
Cite all references. References must be from a Medical Surgical Nursing Textbook.
Please reply by evaluating 1 other students’ post; what you learned or add additional relative information. This must be a substantive reply. You did a great job etc. will not be acceptable. Include you peer reply at the bottom of your case study before you submit it.
Overview of Parkinson’s Disease
Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait disturbance. It is the most common form of parkinsonism (a syndrome characterized by similar symptoms). The pathologic process of PD involves degeneration of the dopamine-producing neurons in the substantia nigra of the midbrain, which in turn disrupts the normal balance between dopamine (DA) and acetylcholine (Ach) in the basal ganglia. DA is essential for normal functioning of the extrapyramidal motor system, including control of posture, support, and voluntary motion.
There is no cure for Parkinson’s disease. Management is aimed at relieving symptoms with anti-parkinsonian drugs that either enhance the release or supply of DA (dopaminergic drugs), or antagonize or block the effects of the overactive cholinergic neurons in the striatum (anticholinergic drugs). Surgical therapy is used for those unresponsive to drug therapy or who have developed severe motor complications.
Overview of Hip Fracture
A fracture of the hip refers to a fracture of the proximal (upper) third of the femur, which extends to 5 cm below the lesser trochanter. Fractures that occur within the hip joint are called intracapsular fractures and are further identified by location as capital (fracture of the head of the femur), subcapital (fracture just below the head of the femur), and transcervical (fracture of the neck of the femur). These fractures are often associated with osteoporosis and minor trauma. Extracapsular fractures occur outside the joint capsule and are termed intertrochanteric (if they occur in a region between the greater and the lesser trochanter) or subtrochanteric (if they occur in the region below the trochanter). Extracapsular fractures are usually caused by severe direct trauma or a fall. In adults over age 65, hip fractures occur more frequently in women than in men because of osteoporosis.
Surgical treatment of hip fractures permits early mobilization of the patient and decreases the risk of major complications. The type of surgery depends on the location of the fracture, severity of the fracture, and the person’s age. Surgical options include repair with internal fixation devices (e.g., hip compression screw, intramedullary devices), replacement of part of femur with a prosthesis (partial hip replacement), and total hip replacement (involves both the femur and acetabulum).
Objectives
Evaluate the nursing management of a patient with Parkinson’s disease (PD) who sustains a hip fracture and undergoes mental status changes.
Identify relevant assessment data for a patient with PD and a hip fracture.
Differentiate clinical manifestations and characteristics of PD.
Describe the interprofessional care of a patient with PD.
Appropriately delegate nursing care of a patient with Buck’s traction.
Prioritize nursing care of a patient with a hip fracture.
Develop an appropriate plan of care for a patient following a hip arthroplasty.
Develop an individualized teaching plan for a patient with a hip arthroplasty.
Case Study
F.A. is a 76-year-old widow who is brought to the emergency department by ambulance after she was found by a neighbor lying on the bathroom floor complaining of pain in her left hip. F.A. lives alone, but she and her older neighbor check on each other daily because they both have grown children who live out of state. F.A. reports that she fell the night before when preparing for bed and was not able to move because of the pain in her hip. She tells you that she has had PD for 10 years. She takes levodopa-carbidopa (Sinemet) and selegiline (Eldepryl), but she has noticed that her symptoms are worse lately. She also has a history of hypertension and osteoporosis for which she takes verapamil (Calan SR) and alendronate (Fosamax).
Upon examination, you find that her left hip is shortened with external rotation and there is a large amount of swelling at the hip and upper thigh. She is oriented to person and place but is confused about the time. Her vital signs are as follows: BP 94/60 mm Hg, heart rate (HR) 98 beats/minute, respiratory rate (RR) 22 breaths/minute, temperature 96.8°F (36.0°C), SpO2 88% on room air. As she tries to sign the admission form, you note that she has a tremor of her hands and her signature is illegible. She is taken to x-ray, which confirms a diagnosis of a transcervical intracapsular fracture of the hip, and an orthopedic consult is requested. While waiting for an available bed on the orthopedic unit, F.A. becomes more disoriented, asking where she is and where her daughter is. The neighbor tells you that normally F.A. has difficulty moving but usually is very alert.
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