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Critical Thinking ExercisesNursing Management of the Client with Parkinsons disease

Situation: The nurse is completing an admission assessment on Mr. Trixx, who states that hehad progressive symptoms of Parkinsons disease, which began when he was 64. He is now 70years old. The nurse notes that the patient has the triad of symptoms that areclassic in patients with Parkinsons disease.

Matching:Match the symptom to the observed manifestation.A. Resistance during passive range of motion ____TremorB. Masked face ____RigidityC. Initial sign ____Bradykinesia

D. DroolingE. Pill rollingF. Cogwheel movementG. Shuffling gait

During the assessment, the nurse observes Mr. Trixx for complications related

to Parkinsons disease.Select all that apply:

Which of the complications listed below are commonly found in a patient with Parkinsonsdisease?A. DepressionB. DiarrheaC. DyskinesiasD. DysphagiaE. Dementia

It is important to continue passive and active ROM exercises in these patients in

order to maintain functional ability. Mr. Trixxs chart states that he has bradykinesia.

Fill in the blanks:

What is bradykinesia and akinesia?

What is the cause of bradykinesia and akinesia?

The nurse teaches Mr. Trixx and his family how to deal with the problems that

are common in patients with Parkinsons disease.

List two nursing interventions that would be appropriate for each symptom that is listed below:Freeze when walking

1.2.Difficulty standing up from a sitting position1.2.Difficulty dressing1.2.

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The nurse is developing a plan of care for Mr. Trixx.

The nurse observes that the patient has decreased mobility of the tongue. The nursingdiagnosis would be:A. Ineffective airway clearance, related to retained secretions.

B. Impaired nutritionless than body requirements, related to dysphagia.C. Impaired physical mobility, related to bradykinesia.D. Impaired verbal communication, related to dental problems.

List the swallowing sequence technique indicated for a patient with Parkinson's diseasewho has dysphagia.1.2.3.

Which of the following nursing interventions will improve nutritional balance in a patientwith Parkinsons disease?

A. Drinking fluids after swallowing food.B. Cutting food into bite-sized pieces.C. Providing six small meals each day.D. Increasing time for eating meals.

Make a brief drug study of the following anti-parkinsonian drugs using a separate sheet of paper

(handwritten):

1. Carbidopa

2. Levodopa

3. Bromocriptine

4. Benztropine

5. Selegiline

Nursing Management for Client with Myasthenia Gravis

Situation: Mrs. Gomez is admitted to the inpatient unit with a myasthenic crisis. She has severemuscle weakness and is having difficulty speaking, swallowing, and breathing.

Fill in the blanks:Name the two assessments that would be done first.1.

2.

Aldee, the nurse, understands that there are many factors as well as medications

that cause an exacerbation of the disease.

Select all that apply:An exacerbation of myasthenia gravis can be precipitated by:A. Emotional stress

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B. Extremes of temperatureC. Acetaminophen (Tylenol)D. PregnancyE. Influenza

Aldee explains to the family that edrophonium (Tensilon) is a drug used for diagnostic

purposes and that it can also be helpful in evaluating the treatment plan. The patients familyagree to the test. When Tensilon is administered, the patient may have several reactions. Whichdisease process matches to the clinical manifestations?

Matching:Match the symptom to the disease.A. Sweating. ______Myasthenic crisisB. Muscle strength improves. ______Cholinergic crisis

C. Abdominal pain.D. Excessive salivation.E. Muscles become weaker.

Fill in the blanks:What medication should be readily available during the Tensilon test?

Why?

Mrs. Gomez has severe muscle weakness and is having difficulty speaking,swallowing, and breathing.

Name two methods that would help the patient to communicate.1.2.

Head Trauma

Situation: Mr. Bacar, having been robbed and hit in the head with a blunt instrument, wastaken to the ER. The exam identifies multiple bruises on his face and a depressed area ofthe skull. Mr. Bacar is making sounds but is unable to pronounce words. He is opening his

eyes and withdrawing his upper and lower extremities to painful stimuli. He is transferredto the neurology intensive care unit.

1. E =2. V =3. M =4. Total =

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Mr. Bacars level of sensorium has further decreased he has now a GCS of 5.

1. What signs should alert the nurse that the client is developing increased intracranial pressure

(ICP)?

2. How can the nurse be certain the client is experiencing increased ICP since he is

unconscious?

3. What are the drugs Mannitol and Decadron, and what is their primary benefit to clients with

increased ICP?

4. Why is increased ICP an important cause of mortality in head injured clients?