solved

solved. Question
Answered step-by-step
Asked by mosun4luv26

Discussion Board Post # 1: Parkinson’s Disease

 

 

History of Presenting Illness (HPI):

Lucille “Lou” McKinley is a 72-year-old female with a history of hypertension, atrial fibrillation and Parkinson’s disease. Ms. McKinley was hospitalized three months ago due to a urinary tract infection and dehydration. She is now a resident of a LTC facility because her Parkinson’s disease has progressed and her son, Michael, is no longer able to care for her at home. Lou has lost 12 pounds in the past month. She is 5 feet-6 inches (167.6 cm) weighs 110 pounds (49.9 kg) and has a BMI of 17.8. After one week of residing in LTC, Jack visits and is saddened when he finds his mother in her room alone. Michael approaches the nursing station and states, “My mother is so thin and losing weight and sits just staring into space. I thought having her here was going to help her get better!”

 

Personal/Social History:

Lou was married to Brian for 54 years before he passed away two years ago. She has one son, Michael, who lives 30 minutes away. Michael has a medical power of attorney for Lou’s healthcare decisions. Lou was a daycare teacher and an active participant in her community. Her hobbies include knitting, playing the piano and reading. Lou reluctantly has agreed to go to LTC after her son accepted a job that required him to travel.

 

Vital Signs:

T:36.9 C (oral)

P:94 (irregular)

R:14 (regular)

BP:102/70

O2sat: 98% room air

 

Assessment Data:

GENERAL SURVEY:

Alert, flataffect and slow to respond to questions in a soft tone (hypophonia). 

Dressed appropriate for the season, hygiene and grooming normal for age and gender. 

Sitting with a forward leaning posture.

NEUROLOGICAL:

Alert & oriented to person, place,time (x3) 

PERRLA

Muscle strength 4/5in both upper and lower extremities bilaterally. 

Tremors noted at rest in hands.

 

HEENT:

Head normocephalic with the symmetry of all facial features, but tremor noted. 

Lips, tongue, and oral mucosa pink and tacky dry.

 

RESPIRATORY:

Breath soundsclear with equalair entry on inspiration and expiration in all lobes.

nonlabored respiratory effort on room air.

 

CARDIAC:

Pink, warm &dry, no edema,heart sounds irregular, pulses strong, equalwith palpation at radial/pedal/post-tibial landmarks, brisk cap refill. 

No JVD noted at 30-45 degrees.

 

ABDOMEN:

Abdomen round,soft, and nontender. 

BS hypoactive in all fourquadrants.

 

GU:

Urinary Incontinent episode x1, urine concentrated yellow

INTEGUMENTARY:

Skin oilybut warm withnormal color for ethnicity. No clubbing of nails, cap refill <3 seconds, Hair soft, distribution normal for age and gender. Skin integrity intact, skin turgor elastic, tenting present.   Labs:   Sodium (Na)  Potassium (K) Creatinine (Cr) Current: 144 3.8 98 Last Month: 136 3.2 77   Physician's Orders (in no particular order of priority): Referral to a speech pathologist Referral to an occupational therapy Referral to physical therapy                 Weekly weights                                      Dietary consult Warfarin 2 mg Orthostatic VS Carbidopa-Levodopa 20-100 mg PO TID Repeat bloodwork    QUESTIONS:       What VS are relevant and interpreted as clinically significant by the nurse?   Provide 2 assessment data findings that are relevant and must be interpreted as clinically significant by the nurse?   What lab results are relevant and interpreted as clinically significant by the nurse?   What nursing priority will guide your plan of care? Include rationale and expected outcome.   Priority: Which orders do you implement first and provide rationale.   What body system(s) will you assess most thoroughly based on the primary/priority concern?   You are finished your shift. Provide an SBAR report to the nurse who will be caring for this patient.     SCIENCE HEALTH SCIENCE NURSING NURSING 305

solved