Hesi Case Study: Parkinson's Disease
Nancy asks the home health nurse what "other people" do who have family members with Parkinson's. She states, "I feel so alone in this." The home health nurse recommends that Nancy attend a support group sponsored by the National Parkinson Foundation. Nancy attends a support group, where the nurse leader begins by explaining the disease. Which statement by the nurse leader best describes Parkinson's disease? There is premature death of cells in the part of the brain called the basal ganglia. A chemical imbalance in the brain leads to movement and coordination problems. There is increased dopamine in the substantia nigra due to hypertrophy of cells. Parkinson's is a chronic muscle disorder that causes wasting of skeletal muscles.
A chemical imbalance in the brain leads to movement and coordination problems. Parkinson's disease is caused by decreased levels of dopamine in the brain that lead to resting tremors, rigidity, bradykinesia, and a shuffling gait.
Nancy calls the local hospice agency and requests information about hospice care. Which statement by Nancy indicates to the nurse that Nancy understands the role of hospice care in the home? "Someone will be with us 24 hours a day so that Leo can die peacefully at home." "If necessary, hospice will help us find a way to end all of Leo's suffering." "Whatever is needed to keep Leo alive will be provided right in our home." "The hospice nurses and staff will help keep Leo comfortable at home until he dies."
"The hospice nurses and staff will help keep Leo comfortable at home until he dies." The intent of hospice is to provide palliative care for terminally ill persons. Hospice is a coordinated program of interdisciplinary services provided by professional caregivers and trained volunteers to clients with serious, progressive illnesses that are not responsive to a cure.
Leo's condition is deteriorating daily. He tells Nancy that he wants to die at home. Nancy tells the nurse about Leo's request and tearfully says, "Someone told me that hospice care will allow me to take him home to die. Can Leo be on hospice care?" What is the best response by the nurse? "To be eligible for hospice care, Leo must have fewer than 6 months to live." "You need to talk to Leo's healthcare provider about prescribing hospice care." "Leo is worried that he is going to die in the nursing home." "Please don't cry. I don't think Leo realizes what he is saying."
"To be eligible for hospice care, Leo must have fewer than 6 months to live." The nurse should provide factual information to Nancy about hospice care.
"Ask the director of nursing for the names and phone numbers of persons willing to serve as references for the facility." Talking to family members and the persons who agree to serve as references for the facility will provide Nancy with information about all aspects of the nursing home and may help Nancy make the right decision for Leo. How should the home health nurse respond? "You may want to visit at different times, rather than following a routine visiting schedule." "You don't need to worry about Leo. He is in a nursing home that will take very good care of him." "What makes you think that Leo will not get good care in this nursing home?" "They won't care for him as well as you did at home, but Leo will be just fine."
"You may want to visit at different times, rather than following a routine visiting schedule." By visiting at different times, Nancy will be able to observe the quality of care throughout the day.
Two weeks later, Leo falls while walking from the living room to the bathroom, hitting his head on a coffee table. He is transported to the medical center and admitted to the medical floor for head injury observation and possible transient ischemic attack (TIA). Nancy calls the home health nurse to report what happened. When the home health nurse visits them in the hospital the next day, Nancy is crying and tells the nurse that she just can't take care of Leo at home anymore. How should the home health nurse respond first? Discuss possible long-term care placement. Allow Nancy to cry and discuss her feelings. Encourage Nancy to notify Leo's children. Request that the hospital chaplain speak with Nancy.
Allow Nancy to cry and discuss her feelings. Nancy is grieving and needs comfort and emotional support. The nurse should provide a therapeutic environment, offering presence and support that allows Nancy to cry and discuss her feelings.
The forms are signed, and then are witnessed by Leo's next door neighbor. The forms are placed in Nancy's desk at home. Copies are sent to Leo's children, Leo's healthcare provider, and to the local medical center to be placed in Leo's records. The home health nurse visits Leo and Nancy's home weekly. One week after the initial visit, Leo shares with the nurse that he has not had a bowel movement in 3 days. Which independent nursing action should be implemented first? Administer Leo's PRN laxative. Instruct Leo to drink at least 3,000 mL of water daily. Assess Leo's bowel sounds and check his abdomen for distention. Encourage Nancy to increase the fiber in Leo's diet.
Assess Leo's bowel sounds and check his abdomen for distention. The nurse should assess the client prior to taking any further action.
After the nurse administers the medications, Leo has a large liquid stool. While the nurse and the UAP are changing the bed linens, Leo complains of cramps in his legs. Which action should the nurse take next? Offer to massage Leo's legs. Stop the tube feeding immediately. Check Leo for a fecal impaction. Assess Leo's serum potassium level.
Assess Leo's serum potassium level. Diarrhea, especially in an elderly client, can lead to hypokalemia. Since leg cramps are a symptom of low potassium, the nurse should assess Leo's potassium level.
The PEG tube is inserted without any complications. Leo is brought back to his room where Nancy is waiting at his bedside. Upon Leo's return to his room, which intervention should the nurse implement? Obtain a stat chest x-ray to confirm tube placement. Initiate tube feedings at 30 mL an hour via pump. Assess the insertion site for signs of bleeding. Elevate the head of Leo's bed to a 90-degree angle.
Assess the insertion site for signs of bleeding. The nurse must assess any incision site for bleeding in the immediate postoperative period.
The client was prescribed the antiparkinsonian medication carbidopa-levodopa shortly after being diagnosed with Parkinson's disease. Before starting the medication, the nurse in the healthcare provider's office explained the action of carbidopa-levodopa as part of medication teaching. Which statement explains the mechanism of action of carbidopa-levodopa in the treatment of Parkinson's disease?
Carbidopa-levodopa is converted to dopamine and provides an exogenous form of dopamine replacement.
Leo has been back at the nursing home for 3 weeks. He is becoming progressively weaker and has had several episodes of diarrhea, but he has not had any weight loss. The primary nurse is preparing to administer an intermittent enteral tube feeding of 480 mL over the next 6 hours. Which intervention should the nurse implement first? Flush tubing with 20 mL water. Ask the client if he is experiencing a feeling of fullness. Check the residual volume. Monitor Leo's intake and output.
Check the residual volume . The nurse must aspirate for gastric contents (residual volume) prior to giving the feeding. Residual amounts greater than 50 to 100 mL (depending on agency policy) indicate the need to hold the feeding since this amount is an indication that the formula is not being digested and further feedings could lead to aspiration
The nurse is administering Leo's 9:00 a.m. medications via the PEG tube. Leo's medications include carbidopa-levodopa (Sinemet) scored tablet, benztropine mesylate (Cogentin) elixir, and a baby aspirin/Which intervention(s) should the nurse implement regarding the administration of these medications? Select all that apply Which intervention(s) should the nurse implement regarding the administration of these medications? Crush each tablet individually, dissolve each in warm water, and administer separately via the PEG tube. Withhold the carbidopa and baby aspirin and notify the healthcare provider. Flush tube with water before medication administration, in-between each medication, and after medication administration. Flush the tubing with 20 mL of cranberry juice prior to administering the medications. Put the medication in pudding and place in the back of Leo's mouth.
Crush each tablet individually, dissolve each in warm water, and administer separately via the PEG tube. Flush tube with water before medication administration, in-between each medication, and after medication administration.
Because Leo walks with a shuffling gait and tends to lean forward when walking, the home health nurse discusses Leo's continued weakness, mobility concerns, and safety issues with Nancy. In providing client teaching related to ambulation, which instruction should the nurse include? Demonstrate how to walk with a wide-based stance. Advise Leo to look at his feet when walking. Explain the need for Leo to keep his arms at his sides. Discuss how to use a toe-heel placement of the feet.
Demonstrate how to walk with a wide-based stance. Leo should be instructed to walk erectly, watch the horizon, use a wide-based stance (feet separated), and swing his arms. This walking technique will help offset the shuffling gait.
The primary nurse on the 7-3 shift is caring for six clients in addition to Leo. Which nursing task(s) can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply
Empty Foley catheter and report output for a client with a urinary track infection. Help the client ambulate down the hall to the shower area.
Leo tells the nurse that he is starting to have difficulty eating and chokes when swallowing food. How should the nurse respond? Instruct Leo to chew more slowly to help prevent choking. Encourage Nancy to provide a soft diet with mainly thick liquids. Advise Leo to sit in a semi-Fowler's position when eating meals. Explain the importance of drinking water prior to all meals.
Encourage Nancy to provide a soft diet with mainly thick liquids. Swallowing disorders can be due to poor head control, tongue tremor, or difficulty shaping food in the mouth. A soft diet with thickened liquids is easier to swallow.
Four days after being admitted to the long-term care facility, Leo experiences a choking incident during lunch that requires his transfer to the medical center. After evaluation by the healthcare provider and the speech therapist, a percutaneous endoscopic gastrostomy (PEG) tube for enteral formula feedings is recommended. Which nursing intervention must be implemented prior to inserting the PEG tube? Request an endoscopy kit from central supply and place at Leo's bedside. Ensure that an informed consent for the PEG tube placement has been signed. Cleanse Leo's gastrointestinal tract by administering a stimulant laxative. Determine if Leo is allergic to iodine or any type of shellfish.
Ensure that an informed consent for the PEG tube placement has been signed. This is an invasive procedure that requires informed consent.
At the end of the meeting, Nancy shares that she is angry because this is happening to her, and she feels guilty thinking about having to put her husband in a long-term care facility. Many of the group members share that they had to go through the same thing, and one woman shared that she put her husband in a facility just last week. After the meeting is adjourned, Nancy goes out for coffee with 3 of the group members. The nurse and social worker at the hospital discuss possible long-term care facilities with Nancy and Leo. Leo wants to be near home so Nancy can visit often. The social worker provides Nancy with the names of several nursing homes close to their home. Nancy expresses concern about how they will pay for the nursing home care. How should the social worker respond? You are worried about how you will pay for Leo's nursing home care. If you and Leo are financially qualified, Medicaid will pay for the home. Why don't you ask Leo's children to pay for the care of their father? Medicare will pay for everything Leo needs while in the nursing home
If you and Leo are financially qualified, Medicaid will pay for the home. When an individual has less than $2,000.00 and/or all financial sources are exhausted as a result of prolonged nursing home care, the family, the institution, or both may apply for Medicaid reimbursement.
The UAP assigned to assist Leo with personal hygiene gets frustrated because Leo is not moving as quickly as the UAP thinks he should. The primary nurse observes the UAP yelling at Leo that he needs to hurry up or he won't be allowed to take a shower. What action should the primary nurse take? Instruct the UAP to go to the nurse's station. Report the incident to Adult Protective Services (APS). Reprimand the UAP in front of Leo for this behavior. Terminate the UAP immediately for this behavior.
Instruct the UAP to go to the nurse's station. The nurse needs to remove the UAP from the situation and then address the issue of verbal client abuse.
Leo is alert and oriented enough to realize that he is going home. A hospital bed and bedside commode are delivered to the home, and the hospice nurse is waiting there to meet the ambulance when Leo arrives. The hospice nurse tells Nancy and Leo that they need to discuss an Out-of-Hospital Do-Not-Resuscitate Order (DNR). Which statement accurately describes the rationale for an Out-of-Hospital Do-Not-Resuscitate Order? The order informs the hospital that Leo has a DNR request in his medical records. It is an order that will prevent paramedics from starting cardiopulmonary resuscitation. This helps the healthcare providers know what the client's Advance Directive states. This allows the home health nurse to pronounce death in the home if needed.
It is an order that will prevent paramedics from starting cardiopulmonary resuscitation. In the event paramedics are called to treat Leo and he dies, the paramedics must legally start CPR unless he has an "Out-of-Hospital DNR."
Leo chooses to complete a Living Will, along with the Durable Power of Attorney for Health Care. The home health nurse obtains the needed documents. To complete the forms, Leo asks the home health nurse to serve as the witness while he signs them. What should the home health nurse do?
Make a copy to scan in the client's medical record.
Leo is concerned because he is having difficulty eating and bathing independently. He tells the nurse that he is worried about Nancy having to do everything for him and that he does not want to be a burden to her. Which member of the interdisciplinary team can best assist Leo in his desire to maintain independence when performing his ADLs? Physical therapist. Home healthcare aide. Social worker. Occupational therapist.
Occupational therapist. After evaluating Leo's needs in the home, the occupational therapist can make recommendations regarding adaptive devices and teach Leo and Nancy how to improvise so that Leo can perform his ADLs.
The next morning Leo is started on a continuous enteral feeding at 25 mL/hr via a pump. Leo is placed in a semi-Fowler's position. Which statement correctly explains the rationale for this positioning? A semi-Fowler's position helps aid in the digestion of formula. Placing Leo in a semi-Fowler's position helps prevent aspiration of the tube feeding. This is the typical position of comfort during feedings. Elevating the head of the bed allows Leo to breathe more easily.
Placing Leo in a semi-Fowler's position helps prevent aspiration of the tube feeding. The most common life-threatening complication of tube feedings is aspiration. Risk of this complication can be reduced by elevating the head of the bed.
Leo shares with the home health nurse that he fears he may become unable to make decisions for himself. He states that he wants Nancy to be able to make decisions for him. He is worried that his children will try to decide what is best for him and states that he does not want them making any decisions about his health care./Which action should the nurse implement? Which action should the nurse implement? Recommend that Leo and Nancy hire an attorney to make the needed arrangements. Provide Leo with information about a Durable Power of Attorney for Health Care. Help Leo complete a Living Will and notify his healthcare provider. Encourage Nancy to contact Leo's children and discuss his concerns with them.
Provide Leo with information about a Durable Power of Attorney for Health Care. This document authorizes a designated person (Nancy) to act in specific outlined circumstances on behalf of the signer (Leo).
Nancy shares with the home health nurse that it is getting harder and harder to understand what Leo is trying to say, even when allowing more time. This is increasing the frustration level for both Leo and Nancy. Which intervention will the nurse recommend to Nancy to address this problem? Speak to Leo using a slow, exaggerated voice. Stand directly in front of Leo when he is speaking. Do not become frustrated with Leo because it will only make things worse. Use an erase slate so that Leo can write everything.
Stand directly in front of Leo when he is speaking. The soft, low-pitched, monotonous speech of a client with Parkinson's requires the client to make a conscious effort to speak slowly, with deliberate attention to word pronunciation. The client should face the listener, take a few deep breaths before speaking, speak in short sentences, and exaggerate the pronunciation of words.
A visitor in the support group asks the nurse leader, "How does someone get Parkinson's disease?" What is the best response by the nurse leader? It occurs mostly in men who have a history of seizure activity. Smoking cigarettes over a long period of time may cause Parkinson's. There is really no known specific cause for Parkinson's disease. It is hereditary and usually passed to the male son by the mother.
There is really no known specific cause for Parkinson's disease. The cause of Parkinson's is unknown, but research suggests several causative factors, including genetics, atherosclerosis, excessive accumulation of oxygen free radicals, viral infections, head trauma, chronic antipsychotic medication, and some environmental exposures.
Later in the day, the primary nurse enters the room and observes Nancy sitting in the chair looking worried. Nancy shares with the nurse that she has no idea how to pick a nursing home for her husband. What is the best response by the nurse? "I recommend going to visit the homes during meal times." "Ask for a tour of the nursing home by the director of nurses." "Find out what activities are provided by the nursing home." "Ask the director of nursing for the names and phone numbers of persons willing to serve as references for the facility."
"Ask the director of nursing for the names and phone numbers of persons willing to serve as references for the facility." Talking to family members and the persons who agree to serve as references for the facility will provide Nancy with information about all aspects of the nursing home and may help Nancy make the right decision for Leo.
Leo is in a semi-private room with a man who is alert and sitting in a recliner reading. After saying, "Hello" to Leo's roommate, Nancy asks the admitting nurse, "What can I do to help make this transition easier on my husband?" How should the nurse respond? "You should come every day until he gets used to the new room." "It is usually best to ask his friends not to visit him for a few months." "Don't worry; your husband will be fine. It is you that I am worried about." "Bring some pictures and personal items from home and decorate the room."
"Bring some pictures and personal items from home and decorate the room." Bringing personal items will make the room feel more like home and may help Leo during this period of adjustment to his new living environment.
Nancy shares with the home health nurse that she doesn't understand why Leo is getting constipated when he doesn't eat very much. She tells the nurse that he is losing weight and his clothes are hanging off his body. The home health nurse tells Nancy that Leo's medications, as well as his inactivity can cause constipation, no matter how little he is eating. The home health nurse is concerned about Leo's constipation, lack of appetite, and weight loss. Which intervention should the nurse implement first to address Leo's weight loss? Encourage Nancy to get Leo clothes that fit and are easy to put on. Discuss providing supplemental feedings between meals. Explain that a feeding tube may be needed to prevent weight loss. Refer Leo to a registered dietician to evaluate his daily intake.
Discuss providing supplemental feedings between meals. Supplemental feedings will increase calorie intake which may help decrease any further weight loss.
Nancy brings Leo to the healthcare provider's office. After assessing Leo, the healthcare provider informs Nancy that Leo is going to get progressively worse. Nancy starts crying and tells the healthcare provider she just can't keep caring for Leo by herself. The healthcare provider writes a referral for home health care. During the initial visit with the home health nurse, Nancy expresses frustration, stating that it is getting harder for her to understand what Leo is saying, although he can still communicate if she gives him enough time. In addition, the nurse observes that Leo has a shuffling gait and has difficulty getting out of the chai
Impaired physical mobility related to muscle rigidity and motor weakness. Impaired physical mobility is a priority since it impacts every aspect of Leo's ability to function safely, and it places him at risk for numerous complications of immobility.
Nancy calls the healthcare provider's office and reports to the nurse that Leo has started seeing and talking to people that have been dead for many years. In addition, he has developed jerky movements of his head and has begun smacking his lips. How should the nurse respond? Suggest that Nancy contact a psychiatrist as soon as possible. Advise Nancy to administer an extra dose of levodopa. Explain that this is normal behavior as the disease progresses. Instruct Nancy to bring Leo to the healthcare provider's office now.
Instruct Nancy to bring Leo to the healthcare provider's office now. Hallucinations, delusions, and tardive dyskinesia are adverse effects of long-term levodopa therapy. Therefore, Leo needs to be assessed by the healthcare provider.
Nancy discusses Leo's wishes with his healthcare provider. Since the healthcare provider believes that Leo's prognosis is less than 6 months, a referral for hospice care is made. Leo is experiencing small strokes that are causing further deterioration, and he has signs of congestive heart failure. The hospice nurse comes to the nursing home to discuss the preparations for Leo's transfer home. Nancy expresses concern about how she will pay for hospice care. Which statement provides correct information about payment for hospice care? The client must have private insurance to pay for hospice care. Medicare Hospice Benefit will cover the cost for Medicare beneficiaries. The client must be eligible for Medicaid to receive hospice care. Volunteer donations pay for the cost of hospice care for all clients.
Medicare Hospice Benefit will cover the cost for Medicare beneficiaries. In 1983, the Medicare Hospice Benefit was implemented to cover hospice care for Medicare beneficiaries.
