CASE STUDY The 64-year-old male patient presented

CASE STUDY The 64-year-old male patient presented with a seven-year history of Parkinson’s disease and symptoms of bilateral resting tremors, Parkinsonian gait, difficulty initiating movement and emotional lability. He had difficulty moving and hence became very introverted, stopped socialising and even lacked confidence spending time with his family and grandchildren. He felt like he was a burden to his wife and children and was disappointed that he would not be able to dance at his daughter’s upcoming wedding. Physical Examination- On physical examination the patient’s posture was stooped and he had difficulty initiating movement, he demonstrated a shuffling gait and had a resting tremor in his hands. The patient had elevated blood pressure bilaterally, optikokinetic reflex was dysmetric from right to left and fatigued bilaterally, Romberg’s test was positive also causing an increase in his resting tremor. There was a severe intention tremor bilaterally with finger to nose testing, bilateral dysmetria, worse on the left with heel to shin testing and rapid alternating movements at the shoulder and elbow were dysdiadochokinetic with an increased tremor. The upper and lower limb neurological examination demonstrated an increased tone in the right upper limb and 2-3 beats of clonus in the lower limb; muscle strength was reduced on the left side of the body, vibration sense was reduced in the left lower limb; the left upper body reflexes where increased and the Achilles reflex was reduced bilaterally. On cranial nerve examination the pupillary light reflex fatigued immediately, there was right ptosis, bilateral diplopia and left hypertropia, a mild jaw jerk reflex. Webber’s test lateralized to the left, left paresis of palatal action was seen and tongue fasciculation was noted. Give the following based on the case study CASE STUDY The 64-year-old male patient presented with a seven-year history of Parkinson’s disease and symptoms of bilateral resting tremors, Parkinsonian gait, difficulty initiating movement and emotional lability. He had difficulty moving and hence became very introverted, stopped socialising and even lacked confidence spending time with his family and grandchildren. He felt like he was a burden to his wife and children and was disappointed that he would not be able to dance at his daughter’s upcoming wedding. Physical Examination- On physical examination the patient’s posture was stooped and he had difficulty initiating movement, he demonstrated a shuffling gait and had a resting tremor in his hands. The patient had elevated blood pressure bilaterally, optikokinetic reflex was dysmetric from right to left and fatigued bilaterally, Romberg’s test was positive also causing an increase in his resting tremor. There was a severe intention tremor bilaterally with finger to nose testing, bilateral dysmetria, worse on the left with heel to shin testing and rapid alternating movements at the shoulder and elbow were dysdiadochokinetic with an increased tremor. The upper and lower limb neurological examination demonstrated an increased tone in the right upper limb and 2-3 beats of clonus in the lower limb; muscle strength was reduced on the left side of the body, vibration sense was reduced in the left lower limb; the left upper body reflexes where increased and the Achilles reflex was reduced bilaterally. On cranial nerve examination the pupillary light reflex fatigued immediately, there was right ptosis, bilateral diplopia and left hypertropia, a mild jaw jerk reflex. Webber’s test lateralized to the left, left paresis of palatal action was seen and tongue fasciculation was noted. Nursing Process: Give the 3rd priority based on the case study 1 nursing diagnosis 1 goal (short and long term) 3 nursing interventions 3 rationale ng nursing intervention PS: maybe the 3rd priority is Ineffective coping since the scenario is “He felt like he was burden..”

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