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HLT54115 Diploma Of Nursing Question: Discuss about the Parkinsons Disease and its Treatment for Medication.   Answer: Introduction Mr. Ratin Bhai is an octogenerian widower, is diagnosed with both the Parkinsons disease and hypothyroidism four years back. He is under the medication for both the diseases and uses thyroxin, cabidopa/levodopa combination drugs and entacapone. He lives alone as his wife died a year ago and has no children. Recently, he observed to be suffering from a slight tremor and is facing problems in carrying out the daily household choirs. Parkinson’s disease is a chronic neurodegenerative disease, affecting mainly the older people that have no treatments as such but the patients suffering from it should be taken great care of (Rodriguez et al., 2015). The symptoms and the treatment procedures vary greatly with different patients depending on the extent of the disease they acquire.   The identification of the disease, the history of the patient, the goals of the treatment and the various interventions that may be taken are the topic of discussion. The outcome of the actions taken in order to cure the patient is also discussed here in this report along with the lesson one might get from it.   Discussion Scenario 1 outlines the social and physical condition of an eighty seven years old widower. He has been diagnosed with Parkinson’s disease and hypothyroidism. He uses different medications in order to control his hypothyroidism. Recently, Mr. Ratin Bhai is observing that his hands are tremoring slightly and this problem is increasing gradually (Thenganatt & Jankovic, 2016). He is under the medication like thyroxin, carbidopa/levodopa and entacapone. Neurodegeneration is the outcome of the aging process and this leads to the development of the Parkinson’s disease in some cases. Hypothyroidism, another disease that Mr. Ratin Bhai is suffering from is also the result of the aging process. Hypothyroidism is a genetic problem and is one of the risk factors followed by any autoimmune disease like type 1 diabetes or rheumatoid arthritis (Cappola, 2016). The anti-thyroid medications if taken can be another risk factor. Parkinson’s disease has many risk factors which include aging, genetic factors, low levels of vitamin B foliate and exposure to toxic substances. Parkinson’s disease makes the daily activities challenging. He is feeling weak and faces trouble in motility.    Mr. Ratin Bhai have been suffering from hypothyroidism for four years and takes medications in order to control it. He is under the medication of thyroxine for hypothyroidism, carbidopa/levodopa combination drugs and entacapone combination drugs for the treatment of Parkinson’s disease (Rascol, 2013). He is experiencing slight tremor in his hands and this is only becoming worse gradually. He is also facing problem in mobility, in his daily activities and his restricted mobility prevents him from going anywhere. The slight tremor that Mr. Ratin Bhai is experiencing may be drug-induced tremor. Parkinson’s disease is accompanied by tremor, which also occur in the hypothyroidism (Hallett, 2014). The tremor spreads to both sides of the body rather than on just one side of the body and it is one of the most important symptom of Parkinson’s disease. Slow limited movement being another important sign and is experienced by Mr. Ratin Bhai and makes it difficult for him to move. Parkinson’s disease is a non-fatal, degenerative disorder and progresses until it enfeebles the patient (Pringsheim et al., 2014). It is benign in some cases and severe in some with shorter life span. The other serious complications that may arise due to the Parkinson’s Disease are pneumonia, choking, falls that may lead to serious injury and sometimes death also. It also causes severity in movements to the persons suffering from Parkinson’s Disease. The symptoms and response to the medications varies with different patients. Hypothyroidism on the other hand also has other severe health outcomes. Body metabolism, altered mental functions and fatigue can occur as a result of hypothyroidism (Carlé et al., 2014). Joint pain, myxodema, a condition of unconsciousness and obesity may also contribute to the symptoms associated with hypothyroidism.   Mr. Ratin Bhai has been diagnosed with Parkinson’s Disease and hypothyroidism four years back. He is also detected with slight tremor recently that is proceeding to worse. The slight tremor that Mr. Bhai has started to suffer from is the mere outcome of the Parkinson’s Disease. Mr. Bhai is not able to perform his regular activities as his strength is decreased due to the onset of the tremor. Bradykinesia and poor balance may be observed in him (Bank et al., 2016). Mr. Bhai has gradually developed tremor, a most noticed symptom of Parkinson’s Disease. Inspite of being under the medication of carbidopa and levodopa combination, Mr Bhai’s tremor is proceeding to worsen the situation. The anxiety that he is suffering as a result of the increased tremor may only worsen his condition (Lin et al., 2015). He is gradually losing control on his muscle and coordination. The weakness or intolerance and in the activity can be diagnosed in a patient with hypothyroidism. The most significant problem that he is now suffering is the Parkinson’s Disease and the tremor in his limbs. This problem has been discussed with priority. The dopamine producing neurons in the brain is degenerated slowly which results in the disability to produce dopamine and as a result the ability to move (Robbins & Cools, 2014). Parkinsonian tremor is a major problem faced by the patients. So the goals should be established keeping this fact in mind. The primary goal in the treatment of the Parkinson’s disease is to keep the person busy in regular activities and allow themselves to be independent as long as they can. The goals for the treatment can be set according to the needs of the patients and varies with them. The treatment of the motor symptoms such as tremor and trouble in movement of the Parkinson’s disease should be treated and is established as another goal for its treatment (Connolly & Lang, 2014). Non-motor systems like depression and anxiety would also get the priority in setting the goal of the treatment. Moreover, the nurses should be trained and their knowledge about this disease must be taught. The nurse should gain the confidence in treating and caring the patient with this disease. Parkinson’s disease is the problem associated with the nerves present in brain any disorder in these nerves may eventually lead to the loss of the ability to move and parkinsonian tremor.   There are few interventions that can be adopted by the nurses in order to provide support to these patients. The nurses must administer the medicines properly maintaining the schedule and the drug levels. They should encourage the patients suffering from this disease to work independently and perform all the daily choirs as much as they can (Sturkenboom et al., 2014).  They should be given rest between each work they perform on their own. This would make them to feel less weak and prevent them from facing any accident. A frequent warm bath and physiotherapy should be carried out on them which would help in relaxing the muscle and prevent any chance of muscle cramp. The parkinsonian tremor may sometime result in the fall and as a result the patient may get seriously injured. The nurse should protect the patient from facing any such injuries (Canning, Paul & Nieuwboer, 2014). They should be provided with semi-solid foods which is easier to swallow and make him sit upright while eating. The drugs that is used to treat the disease should be monitored and any kind of adverse situation, if occur should be reported immediately. The weight of the patients should be regularly monitored and evaluate the patients nutrition. Mr. Bhai would gradually gain the ability to perform his daily household choirs independently and would gain confidence and doing so. The rest that is provided would make him less weak and he would be capable to do work with more confidence. He should be given frequent warm bath and physiotherapy that may help in the improvement of the parkinsonian treatment (Tomlinson et al., 2014). This may cure the tremor that Mr. Bhai is experiencing to some extent and he would not find any difficulty to move. The improved motility would prevent him from falling and reduce the risk of facing any accident that lead to any severe injury or even death. Mr. Bhai would also be provided with semi-solid food. The semi-solid food helps him to swallow the food without difficulty. The various interventions that are adopted to provide neuroprotective benefits to the patients are capable of changing the disease course.  The neurological care should be provided to Mr. Bhai would save his life. The encouragement of performing various daily works increases his physical activity and in turn helps to prevent the deterioration in the quality of the life. Parkinson’s Disease is the neurodegenerative disorder and the patients suffering from this needs a good care from the nurses and the care givers. I feel that Mr. Bhai should be allowed to be independent so that he would gain the confidence to work in his own and overcome his fear. I believe that by doing this, Mr. Bhai would not suffer from anxiety as it can cause more harm to them by increasing the Parkinsonian tremor. I believe that he should undergo a speech and swallow therapy from the very beginning so that he would not lose the ability to swallow when the muscle coordination would get disturbed. According to me, a regular physiotherapeutical approach may help to cure the Parkinsonian tremor to a certain extent and increase his life span. I should have asked Mr. Bhai to use antichollnergic agents as these agents are mainly used by the patients who is suffering from restricted motility due to the tremor. I believe that the medical management is an important for the cure of this disease and from the next time onwards I would adopt this method as one of the steps for treatment.   Conclusion Parkinson’s disease being the fatal and incurable neurodegenerative disease occurs frequently among the older people.  The people suffering from this disease require extra care as the disease progresses to worsen the condition. The symptoms and the responses to different medications and treatments vary greatly with the patient and the extent of the disease. Parkinsonian tremor is one of the important symptoms associated with it. A combination drug is used for the treatment of the Parkinson’s Disease. The patient should be allowed to work independently and physiotherapic treatment is carried out to the patient as a part of the treatment.  The patient is given rest in between the works that he performs daily. It can be concluded from the above discussion that by adopting various steps the patient with Parkinson’s Disease can be treated to a certain extent. The above discussion makes us to conclude that the patient must also be made to overcome his fear and anxiety and help him to gain confidence to work on his own and take his medications accordingly.    References Bank, P., Marinus, J., de Groot, J. H., Meskers, C., & van Hilten, J. J. (2016). Objective, unobtrusive assessment of bradykinesia in Parkinson’s disease. Movement Disorders, 31, S505. Canning, C. G., Paul, S. S., & Nieuwboer, A. (2014). Prevention of falls in Parkinson’s disease: a review of fall risk factors and the role of physical interventions. Cappola, A. R. (2016). Hypothyroidism in the Elderly. In 2016 Meet-The-Professor: Endocrine Case Management (pp. 355-358). The Endocrine Society. Carlé, A., Pedersen, I. B., Knudsen, N., Perrild, H., Ovesen, L., & Laurberg, P. (2014). Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case–control study. European journal of endocrinology, 171(5), 593-602. Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. Jama, 311(16), 1670-1683. Hallett, M. (2014). Tremor: pathophysiology. Parkinsonism & related disorders, 20, S118-S122. Lin, C. H., Lin, J. W., Liu, Y. C., Chang, C. H., & Wu, R. M. (2015). Risk of Parkinson’s disease following anxiety disorders: a nationwide population?based cohort study. European journal of neurology, 22(9), 1280-1287. Pringsheim, T., Jette, N., Frolkis, A., & Steeves, T. D. (2014). The prevalence of Parkinson’s disease: A systematic review and meta?analysis. Movement disorders, 29(13), 1583-1590. Rascol, O. (2013). Extended-release carbidopa-levodopa in Parkinson’s disease. The Lancet Neurology, 12(4), 325-326. Robbins, T. W., & Cools, R. (2014). Cognitive deficits in Parkinson’s disease: a cognitive neuroscience perspective. Movement Disorders, 29(5), 597-607. Rodriguez, M., Rodriguez?Sabate, C., Morales, I., Sanchez, A., & Sabate, M. (2015). Parkinson’s disease as a result of aging. Aging cell, 14(3), 293-308. Sturkenboom, I. H., Graff, M. J., Hendriks, J. C., Veenhuizen, Y., Munneke, M., Bloem, B. R., … & OTiP Study Group. (2014). Efficacy of occupational therapy for patients with Parkinson’s disease: a randomised controlled trial. The Lancet Neurology, 13(6), 557-566. Thenganatt, M. A., & Jankovic, J. (2016). The relationship between essential tremor and Parkinson’s disease. Parkinsonism & related disorders, 22, S162-S165. Tomlinson, C. L., Herd, C. P., Clarke, C. E., Meek, C., Patel, S., Stowe, R., … & Ives, N. (2014). Physiotherapy for Parkinson’s disease: a comparison of techniques. The Cochrane Library.

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