Neuro Case Studies Parkinson’s Case Study You

Neuro Case Studies Parkinson’s Case Study You are a student nurse currently working as in an outpatient neurology clinic. Mr. Fraser, a 44-year-old male, is in the office today with his wife after being referred to a neurologist by his primary care physician. The patient reports having a resting tremor in his right hand and some stiffness in the right arm for over a year now. He thought the tremors were related to nerves and would eventually resolve on its’ own. He also doesn’t like going to the doctor and his wife finally convinced him to go. On inspection you notice a pill-rolling movement in his right hand at rest that resolves with active movement of the hand. On further inspection by the MD, relative slowness of fine rapid movements of the right hand are noted along with rigidity to right arm. Based on the patient’s history and physical findings, the neurologist’s diagnosis is early-stage Parkinson’s disease. ANSWER THE FOLLOWING QUESTION ((Please specific and short answers) 1. List 3 other symptoms that may occur at any stage of Parkinson’s disease. 2. The patient and his wife are confused about what Parkinson’s disease is and how the treatment will help him. Avoiding medical jargon, please describe to the patient and his wife the pathophysiology of Parkinson’s disease and what benefits the patient will expect to see. 3. Current drug therapy cures Parkinson’s disease. T F 4. In Parkinson’s disease, the goal of drug therapy from a pharmacologic perspective is to restore the functional balance between dopamine and ACH (Acetylcholine). T F 5. The neurologist orders a dopamine agonist, pramipexole (Mirapex) for Mr. Fraser. A. A dopamine agonist is recommended to be second-line therapy for most patients with Parkinson’s disease. T F B. Dopamine agonists work by activating dopamine receptors in the striatum. T F C. What are two advantages of using a dopamine agonist over Levodopa? D. What are two disadvantages of using a dopamine agonist over Levodopa? Mr. Fraser’s symptoms of Parkinson’s are well-controlled with pramipexole (Mirapex) for a few years. However, on a follow-up visit he reports his symptoms are no longer controlled with pramipexole and he has tremors and stiffness in all 4 extremities. The neurologist considers whether to add Levodopa or Sinemet (Levodopa + Carbidopa) to Mr. Fraser’s treatment plan. 1. What is the likely explanation for the progression of Parkinson’s dx? 2. can you support Mr. Fraser and his family including coping strategies? 3. What are the two nursing interventions that you would focus in? Explain your answer. 4. Dopamine is decreased in Parkinson’s disease. Therefore, should dopamine administration also be considered as part of his treatment plan? Why or Why not? 5. Patients who are receiving Levodopa may need to be placed on a “drug holiday.” What is a drug holiday? And when might this be necessary? 6. Acute loss of effect may occur in patients on Levodopa and can present in two patterns: gradual loss and abrupt loss. What is the difference between these two patterns? Give one intervention for how to minimize each pattern. 7. How does Carbidopa enhance the benefits and reduce the side effects of Levodopa?

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