The evaluation of a 70-year-old male who presents with complaints of headaches and sore throat
Assignment Details: The evaluation of a 70-year-old male who presents with complaints of headaches and sore throat and who is known to have Parkinson’s disease (PD) necessitates a comprehensive approach. Before addressing the complaints of headache and sore throat, it is essential to conduct a thorough clinical evaluation to rule out infectious causes or other pathologies. Around 90% of headaches are primary, like tension, migraine, or cluster headaches, while secondary headaches stem from other illnesses or injuries (Dunphy et al., 2023). Acute sore throats are frequently caused by viral infections, with bacteria like streptococci present in only 20.2%-34% of cases. Other possible causes include smoking, acid reflux, vocal stress, and medication adverse effects (Krüger et al., 2021). Considering the patient’s age and history of PD, it is essential to rule out any possibility that his symptoms are due to something other than the disease or any of his medications. Additionally, older people may be more prone to infections due to weakened immune systems. So, it is crucial to rule out bacterial, viral, and fungal infections as potential triggers of his symptoms.
The patient’s current medication regimen, which includes Sinemet (carbidopa/levodopa), warrants careful evaluation because of the potential side effects it may have for the patient. Carbidopa/levodopa is a well-recognized treatment for Parkinson’s disease (PD), but like many other medications, it carries the risk of undesirable side effects. Headaches and sore throats are two possible adverse effects of levodopa and carbidopa (National Library of Medicine, n.d.). Considering the patient’s symptoms, this association is noteworthy. Assessing the medication’s dosage, timing, and link between the onset of symptoms and medication intake might offer valuable insights into the underlying contributing factors.
Regarding health promotion, Dunphy et al. (2023) mentioned that patients with Parkinson’s disease (PD) should be educated on their disease, treatments, risks, and outcomes. Regular exercise and physical therapy are essential, mainly because swallowing difficulties and other physical and psychological challenges can affect nutrition and dietary habits. It is essential to address speech and swallowing issues, continue regular health screenings, educate about fall risks, stress the significance of immunizations, and consider referring patients and caregivers to support groups.
Parkinson’s disease is managed primarily through symptom management, as no treatment can prevent its progression, necessitating individualized approaches due to varied patient symptoms and medication responses (Dunphy et al., 2023). Evaluating whether Parkinson’s disease (PD) is well-controlled involves assessing motor and non-motor symptoms. According to Kanellos et al. (2023), recent treatment methods involve periodic, short outpatient clinic visits during which neurologists assess disease progression utilizing standard rating scales or patient feedback. During these visits, the globally utilized MDS-UPDRS scale functions as a standard reference for evaluating both motor and non-motor symptoms of Parkinson’s patients.
The Beers Criteria recommends medication that should be used cautiously or avoided when treating elderly patients. The Beers Criteria should be consulted before prescribing or reviewing medications for the elderly to ensure that the drugs are not classified as potentially dangerous or pose a risk of interactions or side effects in this age range. Based on the revised Beers criteria by the American Geriatrics Society (2023), carbidopa/levodopa is not among the antiparkinsonian drugs listed as having potentially significant drug-drug interactions that should be avoided in the elderly population. However, it is vital to ensure that any additional medications prescribed for the patient do not interact adversely with Sinemet or are not discouraged by the Beers Criteria.
Reference:
American Geriatrics Society. (2023). 2023 updated AGS beers criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372
Dunphy, L. M., Winland-Brown, J. E., Porter, B., & Thomas, D. (2023). Primary care: The art and science of advanced practice nursing – An interprofessional approach (6th ed.). F A Davis.
Kanellos, F. S., Tsamis, K. I., Rigas, G., Simos, Y. V., Katsenos, A. P., Kartsakalis, G., Fotiadis, D. I., Vezyraki, P., Peschos, D., & Konitsiotis, S. (2023). Clinical evaluation in parkinson’s disease: Is the golden standard shiny enough? Sensors, 23(8), 3807. https://doi.org/10.3390/s23083807
Krüger, K., Töpfner, N., Berner, R., Windfuhr, J., & Oltrogge, J. (2021). Sore throat. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.m2021.0121
National Library of Medicine. (n.d.). Levodopa and carbidopa: Medlineplus drug information. MedlinePlus. Retrieved September 24, 2023, from https://medlineplus.gov/druginfo/meds/a601068.html
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