Primary Nursing Diagnosis

Self-care deficit related to rigidity and tremors

OUTCOMES. Self-care: Activities of daily living—Bathing, Hygiene, Dressing, Grooming, Eating; Anxiety control; Endurance; Comfort level; Mood equilibrium; Energy conservation; Muscle function; Mobility level

INTERVENTIONS. Exercise therapy: Ambulation, Balance, Joint mobility, Muscle control; Environmental management, Self-care assistance; Exercise promotion; Energy management; Body image enhancement

700 Parkinson's Disease

^ PLANNING AND IMPLEMENTATION Collaborative

To control tremor and rigidity, pharmacologic management is the treatment of choice. Long-term levodopa therapy can result in drug tolerance or drug toxicity. Symptoms of drug toxicity are confusion, hallucinations, and decreased drug effectiveness. Treatment for drug tolerance and toxicity is either a change in drug dosage or a drug holiday. Autologous transplantation of small portions of the adrenal gland into the brain's caudate nucleus of Parkinson's disease patients is offered on an experimental basis in some medical centers as a palliative treatment. In addition, if medications are ineffective, a thalamotomy or stereotaxic neurosurgery may be done to treat intractable tremor.

Physical and occupational therapy consultation is helpful to plan a program to reduce flexion contractures and to maximize functions for the activities of daily living. To prevent impaired physical mobility, perform passive and active range-of-motion exercises and muscle-stretching exercises. In addition, include exercises for muscles of the face and tongue to facilitate speech and swallowing. Use of a cane or walker promotes ambulation and prevents falls.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Antiparkinson

Varies with drug

Levodopa (L-dopa); car-

Controls tremor and rigid

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