Nursing Diagnosis and Nursing Care Plan for Parkinson’s Disease

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by the loss of dopamine-producing neurons in the brain. This dopamine deficiency disrupts the delicate balance of neurotransmitters, leading to an impaired ability to control movement. The resulting malfunction of the extrapyramidal system manifests in a range of motor and non-motor symptoms that significantly impact a patient’s quality of life. As a chronic and debilitating condition, Parkinson’s disease progresses over time, potentially leading to complications such as falls, self-care deficits, dysfunction in various body systems, and depression.

Understanding Parkinson’s Disease: An Overview for Nursing Care

While the precise cause of Parkinson’s disease remains idiopathic, several factors are recognized as contributing to its development:

• Advancing Age: The risk of Parkinson’s increases significantly with age.
• Genetic Predisposition: Family history and genetic factors play a role in susceptibility.
• Male Gender: Men are statistically more likely to develop Parkinson’s than women.
• Environmental Exposures: Exposure to certain environmental toxins, such as herbicides and pesticides, has been linked to an increased risk.

Parkinson’s disease typically presents with a gradual onset of symptoms, often subtle and easily overlooked in the early stages. While tremors are a hallmark symptom, the disease can also manifest as stiffness and slowness of movement.

Common signs and symptoms of Parkinson’s disease include:

• Bradykinesia: Characterized by abnormally slow movement and sluggish physical and mental responses, making everyday tasks challenging.
• Akinesia: Refers to the difficulty or inability to initiate voluntary muscle movement, leading to a feeling of being “frozen” or stuck.
• Micrographia: Progressively smaller handwriting is a noticeable early sign, reflecting fine motor skill impairment.
• Resting Tremors: Tremors in the hands and fingers, often described as “pill-rolling,” are most prominent when the limb is at rest.
• Fatigue-Exacerbated Tremors: Tremors tend to worsen with fatigue and stress.
• Activity/Sleep-Reduced Tremors: Purposeful activity and sleep can temporarily lessen tremor severity.
• Rigidity: Muscle stiffness and resistance to passive movement, often described as “cogwheel rigidity” due to jerky movements during examination.
• Masked Facies: A reduction in facial expression, leading to a mask-like appearance due to decreased facial muscle movement.
• Speech Changes: Drooling, monotonous speech, and reduced voice volume are common due to muscle control issues affecting speech.
• Dysphagia and Dysarthria: Difficulty swallowing (dysphagia) and difficulty articulating speech (dysarthria) arise from impaired muscle coordination in the mouth and throat.
• Balance and Coordination Loss: Impaired balance and coordination contribute to gait disturbances and increased fall risk.
• Gait Disturbances: Shuffling steps, a stooped posture, and a propulsive gait (festination, or involuntary acceleration) are typical walking pattern changes.
• Cognitive Changes: Difficulties with memory and concentration can occur as Parkinson’s progresses.

The Nursing Process in Parkinson’s Disease Management

Currently, there is no cure for Parkinson’s disease. The primary goals of treatment are to manage symptoms, slow disease progression, and improve the patient’s quality of life. Nurses play a crucial role in the multidisciplinary care team, providing holistic support to patients and their families from the initial diagnosis through palliative care and end-of-life stages. This support encompasses patient education about disease progression, symptom management strategies, medication considerations (including side effects), and necessary lifestyle adjustments.

Nurses are instrumental in:

• Emotional Support: Providing compassionate emotional support to patients and families coping with the physical, emotional, and social challenges of Parkinson’s.
• Education: Educating patients and caregivers about all aspects of Parkinson’s disease, empowering them to actively participate in their care.
• Symptom Management: Implementing and monitoring interventions to alleviate motor and non-motor symptoms and improve daily functioning.
• Medication Management: Administering medications, educating about drug actions and side effects, and monitoring for therapeutic effectiveness.
• Lifestyle Modifications: Guiding patients in adopting lifestyle changes that can enhance well-being and manage symptoms, such as exercise, nutrition, and stress reduction techniques.

Parkinson’s Disease Nursing Care Plans: Addressing Key Nursing Diagnoses

Once a nurse has identified relevant nursing diagnoses for a patient with Parkinson’s disease, nursing care plans become essential tools for prioritizing assessments and interventions. These plans guide nursing care to achieve both short-term and long-term patient-centered goals. The following sections provide examples of nursing care plans for common nursing diagnoses associated with Parkinson’s disease.

Impaired Verbal Communication

Nursing Diagnosis: Impaired Verbal Communication

Impaired verbal communication in Parkinson’s disease arises from the disease’s impact on muscle control. PD can affect the muscles of the face, throat, mouth, and vocal cords, leading to difficulties in articulation and speech production. Furthermore, neurodegeneration in brain areas responsible for speech regulation and comprehension can also contribute to communication challenges.

Related Factors:

• Inability to control muscles of the face, throat, mouth, and vocal cords due to neurological impact of PD.
• Degeneration of nerve cells affecting motor pathways and speech centers.
• Dopamine depletion disrupting neurotransmission essential for motor control.
• Inhibition of excitatory impulses impacting muscle activation for speech.
• Extrapyramidal system dysfunction leading to movement disorders affecting speech muscles.

Evidenced by:

• Drooling due to impaired oral motor control.
• Alteration in voice quality, such as hoarseness or breathiness.
• Difficulty in speech articulation (dysarthria), characterized by slurred or unclear speech.
• Difficulty in comprehension of spoken language.
• Changes in verbal fluency, including stammering, stuttering, or slurring of words.
• Presence of speech pauses or hesitations.
• Difficulties with memory or concentration impacting communication effectiveness.
• Slow rate of speech.
• Soft-spoken or monotone voice lacking inflection and volume.

Expected Outcomes:

• The patient will demonstrate measurable improvement in dysarthria, evidenced by clearer enunciation and reduced slurring of speech within a specified timeframe.
• The patient will effectively utilize alternative methods of communication to express needs and ideas.
• The patient will demonstrate congruent use of verbal and nonverbal communication strategies, enhancing overall communication effectiveness.

Nursing Assessments:

1. Determine the patient’s current ability and preferred methods of communication.
   Rationale: Understanding the patient’s communication baseline is crucial for tailoring interventions and preventing confusion. It also ensures that the nurse can effectively receive and understand information from the patient.

2. Assess the patient’s comprehension of communication.
   Rationale: Parkinson’s disease can affect cognitive processing, potentially leading to aphasia or difficulties in understanding communication. Assessing comprehension ensures effective information exchange and patient safety by ensuring they understand instructions and explanations. Observe the patient’s ability to respond to questions and follow simple commands.

3. Determine the patient’s attention span, focus, and concentration levels.
   Rationale: Adequate attention and concentration are essential for effective communication. Evaluating these cognitive functions helps to optimize communication strategies and ensure the patient can fully participate in conversations and understand healthcare information.

Nursing Interventions:

1. Establish a trusting and supportive relationship with the patient.
   Rationale: Building rapport and trust encourages the patient to communicate their feelings and concerns openly. This is especially important in Parkinson’s disease, as symptoms like speech difficulties can be emotionally challenging and lead to social isolation. A trusting relationship facilitates better assessment and management of the patient’s condition.

2. Allow ample time for the patient to communicate and express themselves.
   Rationale: Bradykinesia affects speech, causing slow and sometimes hesitant speech patterns. Rushing the patient can lead to frustration for both the patient and the listener. Providing sufficient time and patience shows respect and encourages the patient to communicate fully, improving the accuracy of information received.

3. Provide and encourage the use of diverse communication skills and methods.
   Rationale: Teaching energy-saving communication strategies, such as nonverbal cues (gestures, facial expressions), short phrases, or written communication, can reduce frustration and improve communication efficiency. This also empowers the patient to communicate effectively even when verbal communication is challenging.

4. Introduce and facilitate the use of communication aids as appropriate.
   Rationale: For patients with soft speech or hoarseness, voice amplifiers can increase volume and reduce vocal strain. Text-to-speech devices can be invaluable for patients whose handwriting is affected by tremors, enabling them to communicate in writing. These aids can significantly improve communication effectiveness and independence.

5. Refer the patient to a speech-language pathologist (SLP).
   Rationale: SLPs are specialists in communication disorders. They can provide comprehensive assessment and therapy to improve cognitive functioning, comprehension, and memory, all of which can impact communication in Parkinson’s disease. SLPs can also teach specific oral exercises to strengthen speech muscles and improve articulation and voice quality.

Impaired Walking / Risk for Falls

Nursing Diagnosis: Impaired Walking / Risk for Falls

Impaired walking and increased risk of falls in Parkinson’s disease are primarily due to the neurological impact of the disease on motor control. Parkinson’s affects both neuromuscular (muscle weakness, tremors, bradykinesia) and musculoskeletal systems (joint rigidity). Damage to the brain regions that regulate movement further exacerbates these issues.

Related Factors:

• Inability to control muscles due to dopamine deficiency and neurological dysfunction.
• Damage to the substantia nigra in the brain, the primary site of dopamine production.
• Degeneration of nerve cells disrupting motor pathways and coordination.
• Depletion of dopamine leading to motor control deficits.
• Inhibition of excitatory impulses affecting muscle activation and movement initiation.
• Extrapyramidal system dysfunction resulting in movement disorders.

Evidenced by:

• Bradykinesia: Slowness of movement impacting gait speed and fluidity.
• Akinesia: Difficulty initiating movement, including walking, leading to hesitancy and freezing.
• Tremors: Involuntary shaking that can affect balance and coordination while walking.
• Rigidity with jerky movements: Muscle stiffness and resistance affecting flexibility and gait.
• Restlessness and involuntary movements that can disrupt balance.
• Pacing or aimless wandering due to motor restlessness and difficulty staying still.
• Shuffling steps: Short, quick steps with reduced foot clearance, increasing fall risk.
• Stooped posture: Forward leaning posture shifting the center of gravity and affecting balance.
• Propulsive gait: Festination, or involuntary acceleration, making it difficult to stop walking.
• Diminished independence in mobility and daily activities.
• Loss of quality of life due to mobility limitations and fear of falling.
• Social isolation resulting from reduced mobility and fear of going out.
• Activity reluctance and avoidance of physical activity due to fear of falls.

Expected Outcomes:

• The patient will ambulate within the healthcare facility or home environment with minimal assistance and maintain safe mobility.
• The patient will appropriately and consistently utilize assistive devices (e.g., walker, cane) to enhance walking safety and stability.
• The patient will actively participate in prescribed physical therapy and rehabilitation programs to improve gait, balance, and strength.
• The patient will remain free from falls and fall-related injuries.

Nursing Assessments:

1. Assess the patient’s neurological status, focusing on motor function and balance.
   Rationale: Parkinson’s disease is a progressive condition that increasingly affects both the neurological and musculoskeletal systems, directly impacting balance and muscle control. Neurological assessments, such as grip strength testing and coordination tests, help quantify the extent of motor impairment and guide intervention planning.

2. Assess and document the patient’s specific Parkinson’s movement symptoms.
   Rationale: Understanding the specific motor symptoms, such as rigidity, tremors, bradykinesia, and freezing episodes, is crucial for tailoring interventions. Patients in mid-stage to advanced PD may experience “freezing” or the sensation of their feet being stuck to the floor, as well as characteristic short, shuffling steps. Detailed assessment informs targeted interventions.

3. Determine the patient’s current ability to move independently and safely.
   Rationale: Assessing the patient’s level of independence in mobility helps identify specific needs for assistance and assistive devices. Encouraging continuous, safe movement is important because regular physical activity can help reduce Parkinson’s symptoms, improve confidence, and maintain independence while minimizing fall risks.

4. Observe and document the patient’s body posture and gait pattern.
   Rationale: Stooped posture, a common feature of Parkinson’s, can lead to musculoskeletal pain and postural instability. Postural instability is a significant fall risk factor. Assessing gait pattern (e.g., shuffling steps, festination) helps identify specific gait deviations that require targeted interventions like gait training.

Nursing Interventions:

1. Encourage patient independence in mobility and activities of daily living (ADLs) while ensuring safety precautions are in place.
   Rationale: The goal of Parkinson’s disease treatment is to manage symptoms and preserve functional abilities for as long as possible. Allowing patients to participate in self-care activities fosters a sense of control and independence. Parkinson’s causes slowed movements, so nurses must provide encouragement and patience to allow patients sufficient time to complete tasks safely.

2. Provide assistance with ambulation as needed, prioritizing patient safety.
   Rationale: Patients with Parkinson’s may move slowly, exhibit tremors, and experience muscle stiffness, making ambulation challenging and risky. Assisting with ambulation ensures patient safety while promoting physical activity, which is crucial for preventing muscle atrophy, maintaining mobility, and improving overall quality of life.

3. Provide and ensure the proper use of assistive devices for mobility.
   Rationale: Assistive ambulatory devices, such as walkers, canes, and wheelchairs, are essential for many individuals with Parkinson’s who experience gait and balance difficulties. Providing appropriate devices and ensuring patients are trained in their safe use significantly reduces the risk of falls and promotes independent mobility.

4. Instruct the patient on safe walking techniques and fall prevention strategies.
   Rationale: Teaching specific walking techniques, such as consciously initiating movement by rocking back and forth, lifting feet to avoid shuffling, and widening stance, can improve gait stability and reduce fall risk. Recommending flat-heeled footwear further enhances stability and reduces tripping hazards.

5. Teach and reinforce proper posture and body mechanics.
   Rationale: Instructing patients to consciously maintain an upright posture, such as holding hands behind their back to straighten the spine and neck, can improve posture and balance. Proper posture reduces strain on muscles and joints and improves stability, lowering the risk of falls.

6. Administer antiparkinsonian medications as prescribed and monitor for therapeutic effects and side effects.
   Rationale: Antiparkinsonian medications, such as levodopa, are crucial for increasing dopamine levels in the central nervous system (CNS). These medications help control motor symptoms (tremors, rigidity, bradykinesia) and slow disease progression. Monitoring medication effectiveness and managing potential side effects is essential for optimizing symptom control and patient well-being.

7. Refer the patient to physical therapy and rehabilitation services.
   Rationale: Physical therapy and rehabilitation are vital components of Parkinson’s care. These services help patients restore, maintain, and improve movement, physical function, and overall quality of life through tailored exercise programs, gait training, balance exercises, and other therapeutic interventions.

8. Encourage participation in beneficial exercises like Tai Chi and general physical activity.
   Rationale: Regular exercise is proven to reduce the risk of falls and improve overall motor function in Parkinson’s disease. Tai Chi, in particular, is highly recommended due to its focus on balance, coordination, and slow, controlled movements. Encouraging exercise promotes physical and mental well-being.

Impaired Swallowing

Nursing Diagnosis: Impaired Swallowing

Impaired swallowing (dysphagia) in Parkinson’s disease results from the disease’s impact on the muscles controlling the throat and mouth. PD-related muscle stiffness and slowness can make chewing and swallowing difficult, increasing the risk of aspiration. Aspiration pneumonia, a serious complication resulting from food or liquid entering the lungs, is a leading cause of mortality in Parkinson’s disease.

Related Factors:

• Inability to control throat and mouth muscles due to neurological effects of PD.
• Degeneration of nerve cells affecting motor pathways and muscle control.
• Depletion of dopamine disrupting neurotransmission essential for muscle function.
• Extrapyramidal system dysfunction affecting coordination of swallowing muscles.

Evidenced by:

• Blank facial expression (mask-like face) reducing facial muscle movement needed for chewing and swallowing.
• Drooling due to impaired oral motor control and swallowing reflex.
• Dysphagia: Reported or observed difficulty swallowing food or liquids.
• Dysarthria: Speech difficulties that can coexist with and exacerbate swallowing problems.
• Unexplained weight loss due to reduced food intake and swallowing difficulties.
• Increased incidence of pneumonia, particularly aspiration pneumonia.
• Coughing while eating or drinking, indicating potential aspiration.
• Clearing of the throat frequently while eating or drinking, another sign of swallowing difficulty.
• Patient reporting a sensation of food being “stuck” in the throat during feeding.

Expected Outcomes:

• The patient will demonstrate safe and effective swallowing without signs of coughing, gagging, drooling, or pocketing food in the mouth during and after meals.
• The patient will maintain a stable weight appropriate for their height and gender, indicating adequate nutritional intake.
• The patient will remain free from aspiration pneumonia and other respiratory complications related to swallowing difficulties.

Nursing Assessments:

1. Assess the patient’s ability to swallow and chew, noting any difficulties or signs of aspiration.
   Rationale: The muscles in the throat that regulate food passage can become stiff or slow-moving in Parkinson’s disease, leading to food residue in the throat and a sensation of food being “stuck.” A bedside swallow assessment, involving giving the patient a small amount of water (e.g., a teaspoon) and observing for coughing or gagging, can provide an initial indication of swallowing safety.

2. Monitor the patient’s weight regularly and assess nutritional status.
   Rationale: Weight loss is a significant concern in Parkinson’s disease, often directly linked to impaired swallowing and reduced food intake. Consistent monitoring of weight and nutritional status allows for early identification of nutritional deficits and prompt intervention to prevent malnutrition and related complications. Refer to a dietitian for comprehensive nutritional assessment and planning if needed.

3. Assess for signs and symptoms of aspiration pneumonia.
   Rationale: Aspiration pneumonia is a serious and potentially life-threatening complication of dysphagia. Early detection of aspiration pneumonia is crucial for prompt medical intervention. Assess for fever, dyspnea (shortness of breath), chest pain, coughing (especially after meals), and lethargy, which are all potential indicators of aspiration pneumonia. Auscultate lung sounds for adventitious sounds (crackles, wheezing) which may also suggest aspiration.

Nursing Interventions:

1. Assist the patient with meals, employing aspiration precautions to ensure safe feeding.
   Rationale: Direct assistance during mealtimes is crucial to prevent aspiration. This includes offering small, manageable bites, reminding the patient to chew thoroughly and swallow deliberately, and closely monitoring for any signs of swallowing difficulty (coughing, choking, wet voice).

2. Position the patient in an upright position (90 degrees) during feeding and maintain this position for at least 30-60 minutes after meals.
   Rationale: Eating in an upright position significantly reduces the risk of choking and aspiration by utilizing gravity to facilitate food passage into the stomach. Maintaining this position post-meal helps prevent reflux of stomach contents back into the esophagus and potential aspiration.

3. Implement aspiration precautions and dietary modifications as recommended by a speech therapist and dietitian.
   Rationale: Thickening liquids can slow down their flow rate, reducing the risk of liquid entering the airway and causing aspiration. Diet modifications, such as providing soft, pureed, or mechanically altered diets, may be necessary to ensure safe swallowing and adequate nutrition. Consult with a speech therapist and dietitian for individualized recommendations.

4. Administer antiparkinsonian medications as prescribed, ideally between meals, to optimize drug absorption.
   Rationale: Antiparkinsonian medications, particularly levodopa, are most effective when absorbed optimally. Administering these medications between meals, rather than with high-protein meals, can improve levodopa absorption, as high protein intake can interfere with its uptake in the gut. However, always follow physician’s orders regarding medication timing.

5. Consult with a speech therapist for a comprehensive dysphagia evaluation and individualized swallowing therapy.
   Rationale: Speech therapists are experts in dysphagia management. They can conduct thorough evaluations to identify the nature and severity of swallowing difficulties. They can also develop individualized swallowing therapy programs, teach compensatory swallowing strategies, and educate patients and families on safe swallowing techniques and dietary modifications to improve swallowing function and reduce aspiration risk.

Risk for Aspiration

Nursing Diagnosis: Risk for Aspiration

Parkinson’s disease-related nerve and muscle degeneration affects the swallowing process, leading to cough dysfunction (dystussia) and swallowing difficulties (dysphagia). These impairments significantly increase the patient’s risk of aspiration, which is the entry of food, fluids, or secretions into the airway and lungs.

Related Factors:

• Disease process of Parkinson’s leading to neurological and muscular impairments.
• Dysphagia: Difficulty swallowing due to muscle weakness and incoordination.
• Ineffective cough reflex (dystussia): Reduced ability to clear the airway of aspirated material.
• Poor muscle tone in the oropharyngeal and laryngeal muscles affecting swallowing mechanics.

Evidenced by:

Risk diagnoses are not evidenced by signs and symptoms because the problem has not yet occurred. Nursing interventions are focused on prevention.

Expected Outcomes:

• The patient will maintain a patent airway, free from obstruction, as evidenced by clear and equal breath sounds bilaterally and absence of respiratory distress.
• The patient will be able to eat and swallow food and liquids safely without coughing, gagging, or other signs of aspiration during and after meals.

Nursing Assessments:

1. Assess the patient’s ability to swallow, identifying any pre-existing swallowing difficulties.
   Rationale: Thoroughly evaluating the patient’s swallowing ability is the foundation for planning appropriate aspiration prevention strategies. Closely monitor for any signs of swallowing difficulty, such as excessive coughing, gagging, throat clearing, and drooling, which may indicate aspiration risk. Use a standardized dysphagia screening tool if available.

2. Monitor the patient’s respiratory status regularly, noting any changes that might indicate aspiration.
   Rationale: Respiratory changes are often the first signs of aspiration. Be vigilant for symptoms such as new onset cough, dyspnea, hoarseness, wheezing, and production of foul-smelling sputum, which may indicate aspiration or aspiration pneumonia.

3. Auscultate lung sounds before and after feeding to detect any adventitious sounds suggestive of aspiration.
   Rationale: Auscultating lung sounds provides valuable information about respiratory status. The new onset of crackles (rales) and wheezing, particularly after feeding, may be indicative of aspiration pneumonia or aspiration of food or liquid into the lungs. Compare pre- and post-feeding lung sounds to identify any changes.

Nursing Interventions:

1. Recommend a formal swallowing evaluation by a speech-language pathologist (SLP).
   Rationale: If swallowing difficulties are suspected or identified during nursing assessment, a referral to an SLP for a comprehensive swallowing evaluation is essential. SLPs can perform specialized tests, such as a modified barium swallow study or Fiberoptic Endoscopic Evaluation of Swallowing (FEES), to objectively assess swallowing mechanics and aspiration risk.

2. Implement specific measures to reduce the risk of aspiration during mealtimes.
   Rationale: Proactive implementation of aspiration precautions during feeding is critical to patient safety. Instruct and assist caregivers in consistently applying the following strategies:

   • Maintain an upright position (90 degrees) throughout the meal and for 30-60 minutes after eating.
   • Instruct the patient to consciously tuck their chin down towards their chest when swallowing. This chin tuck maneuver helps to protect the airway during swallowing.
   • Ensure the patient completely chews and swallows each bite of food before offering the next bite. Avoid “pacing” the patient.
   • Offer small sips of liquids between bites of solid food to help clear the bolus and maintain hydration.

3. Implement strategies to control drooling (sialorrhea).
   Rationale: Drooling is common in Parkinson’s disease due to impaired oral motor control and swallowing dysfunction. Excessive drooling can complicate swallowing and increase aspiration risk. Anticholinergic medications, such as glycopyrrolate or atropine eye drops (used sublingually under medical supervision), may be prescribed to reduce salivary secretions and manage drooling.

4. Encourage and facilitate swallowing exercises as prescribed by a speech therapist.
   Rationale: Swallowing exercises, prescribed and instructed by an SLP, are designed to strengthen the muscles of the neck, throat, and mouth involved in swallowing. Exercises like tongue thrusts and jaw exercises can improve swallowing function and reduce aspiration risk over time with consistent practice.

5. Select and offer foods with textures that are easy to swallow and less likely to cause aspiration.
   Rationale: Dietary modifications are a cornerstone of aspiration precautions. Offer foods that are moist, soft, and cohesive, and avoid foods that are dry, crumbly, stringy, or require extensive chewing. Examples of easy-to-swallow foods include oatmeal, scrambled eggs, yogurt, mashed potatoes, and pureed fruits and vegetables.

Risk for Injury

Nursing Diagnosis: Risk for Injury

Motor symptoms of Parkinson’s disease, including muscle rigidity or stiffness, postural changes (stooped posture, postural instability), and bradykinesia (slowness of movement), significantly increase the patient’s risk for falls and other injuries.

Related Factors:

• Disease process of Parkinson’s causing motor and non-motor impairments.
• Muscle rigidity and stiffness limiting flexibility and increasing fall risk.
• Postural instability and impaired balance control predisposing to falls.
• Bradykinesia: Slowness of movement and reaction time increasing risk of accidents.
• Neurobehavioral manifestations: Cognitive changes, impulsivity, or impaired judgment contributing to unsafe behaviors.

Evidenced by:

Risk diagnoses are not evidenced by signs and symptoms because the problem has not yet occurred. Nursing interventions are focused on prevention.

Expected Outcomes:

• The patient will remain free from injuries throughout their care, as evidenced by the absence of falls, fractures, bruises, or other physical harm.
• The patient and/or caregiver will demonstrate understanding and consistent implementation of injury prevention interventions and safety measures in the home and healthcare environment.

Nursing Assessments:

1. Assess the severity and impact of the patient’s motor symptoms on mobility and safety.
   Rationale: Mobility impairments directly related to Parkinson’s motor symptoms are major contributors to injury risk. A thorough assessment of the degree of rigidity, balance deficits, freezing episodes, uneven gait, and slowed movements is essential to develop a tailored plan of care focused on symptom management and injury prevention.

2. Assess for specific ambulation, movement, and gait abnormalities that increase fall risk.
   Rationale: Parkinson’s disease commonly manifests in characteristic gait disturbances, such as a slow, shuffling gait, reduced arm swing, and decreased smoothness of movement. Identifying these specific gait abnormalities helps target interventions, such as gait training and assistive devices, to improve walking safety and reduce fall risk.

3. Monitor the patient’s blood pressure, especially when changing positions (orthostatic blood pressure).
   Rationale: Parkinson’s disease can affect the autonomic nervous system, leading to reduced levels of norepinephrine, a neurotransmitter that regulates blood pressure. This can result in orthostatic hypotension, a drop in blood pressure upon standing or changing positions. Orthostatic hypotension increases the risk of dizziness, lightheadedness, and falls, especially when transitioning from sitting or lying down to standing. Monitoring blood pressure in different positions is crucial for identifying and managing orthostatic hypotension and preventing falls.

Nursing Interventions:

1. Provide clear and concise instructions to the patient when assisting with ambulation.
   Rationale: When assisting patients with walking, providing specific instructions can improve gait safety and reduce fall risk. Instructing the patient to take deliberate, conscious steps, widen their stance for better balance, and lift their feet slightly to avoid shuffling can improve gait stability and reduce tripping hazards.

2. Encourage the patient to consciously maintain an upright posture while walking and engaging in activities.
   Rationale: Maintaining an upright posture improves stability and balance, directly reducing the risk of falls and injuries. The stooped posture common in Parkinson’s disease shifts the center of gravity forward, making patients less aware of their surroundings and increasing fall risk. Conscious effort to maintain an upright posture enhances stability and spatial awareness.

3. Instruct the patient and caregivers on the proper use of assistive devices for mobility and safety.
   Rationale: Walking aids, such as walkers and canes, provide external support and improve balance, promoting safer and more independent movement. Proper instruction on device selection, fitting, and safe usage is essential to maximize their effectiveness and prevent device-related injuries.

4. Encourage the patient to engage in regular exercise programs tailored to Parkinson’s disease.
   Rationale: Regular physical activity is crucial for maintaining balance, flexibility, and strength in Parkinson’s disease, all of which contribute to fall prevention. Recommend and encourage participation in exercises specifically beneficial for PD, such as Tai Chi, yoga, walking, and stationary cycling. These activities improve motor control, balance, and overall physical function, reducing injury risk.

References

1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
2. Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Wolters Kluwer India Pvt.
3. Rengifo, M. L., Jonasson, S. B., Ullén, S., Carlgren, N. M., & Nilsson, M. H. (2021, April 1). Perceived walking difficulties in Parkinson’s disease – predictors and changes over time. BioMed Central. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02113-0
4. Silvestri, L. A., Silvestri, A. E., & Grimm, J. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.