Full care plan for a patient with Parkinson’s disease

A patient care plan will help not only nurses and doctors, but will also be useful to everyone who cares for a seriously ill person in the hospital and at home.

The first stage of care is general hygiene

This stage includes basic routines such as washing, brushing teeth, toileting, feeding, bowel movements and positioning. If the patient is able to perform these activities independently, it is necessary to determine whether assistance is required. It is important to indicate the nature of this assistance, whether it is support with holding a cup or assistance in maintaining position while brushing teeth.

It is necessary to clearly determine whether the patient requires partial or complete assistance. For example, one patient may stay in bed all the time and require all procedures to be performed for him, while another may go to the sink and wash himself, requiring only supervision. Sometimes patients suffering from Parkinson’s disease may refuse to maintain hygiene. In such cases, it is important to have a conversation with them, explain the situation, offer support and assistance.

It is recommended to create an action plan that determines the frequency of washing your head and body, caring for your private parts and brushing your teeth. It is not necessary to describe each step of the algorithm in detail. If the patient does not have problems swallowing, then only assistance with feeding, such as spooning or using an adaptive utensil, may be required, as well as learning to eat with the other hand. The main thing is to clearly describe the problem that has arisen and the help needed.

Patients often require assistance with bowel movements. It is also important to monitor body position, especially in stages 3 and 4 of Parkinson’s disease, when independent movement becomes impossible. The goal is to prevent the occurrence of bedsores and contractures.

Second stage – risk prevention

Prevention of contractures is an integral part of patient care. Regular exercise, including 10 movements in each joint, as well as passive gymnastics, will help maintain mobility and flexibility. If contractures are already present and the patient cannot control their movements, it is important to position them correctly to prevent their worsening.

Preventing dehydration is equally important. People often forget about the need to drink water. Assist the patient by providing convenient drinking aids, such as a sippy cup, and ensure that he drinks at least a liter of water per day.

Prevention of thrombosis and bedsores requires daily attention. Regular hygiene, examinations, maintaining physiologically correct posture and periodic changes of position will help avoid these complications. It is important to correctly describe the positions in which you place the patient, taking into account his individual characteristics, possible discomfort and the presence of drains. To prevent thrombosis, it is also important to monitor fluid intake, ask relatives to provide compression garments and bandage the patient’s legs.

Third stage – specific problems of patients with Parkinson’s disease

Respiratory problems

Respiratory problems may occur in people with Parkinson’s disease. Nasal crusts, nasal congestion, infections, and difficulty coughing up mucus are all common symptoms. These patients have difficulty breathing deeply, leading to poor ventilation and shortness of breath. What can you do?

1. It is important to assess the depth of breathing and observe when a person is experiencing difficulty. Often patients take medications that temporarily relieve their condition, but their effect wears off over time. Therefore, it is important to combine all activities with taking medications.
2. You should also pay attention to the color of the skin and nails, their pallor or cyanosis, which may indicate oxygen starvation. Control the cough and help the patient get into a comfortable position to clear mucus.
3. Encourage the patient to be active while the medications are on, encouraging deep breathing and twisting to massage the lungs. If there is difficulty clearing mucus, assist the patient using a suction device to ensure normal breathing.

Thought disorder

A person with Parkinson’s disease may experience a variety of cognitive problems, including distractibility, inappropriate behavior, and difficulty with memory and concentration. It is important to take certain steps to help such people:

1. Assess the patient’s level of depression and presence of suicidal ideation. Pay attention to his emotional state and clarify what feelings he is experiencing.
   2. Carefully review the list of medications the patient is taking. Some of them can cause drowsiness and immobility, which can worsen his condition.
   3. If the patient spends most of their time in bed, check regularly every 4 hours to ensure comfort and prevent complications.
   4. Provide the patient with support and understanding, helping him cope with the difficulties that arise and easing his emotional state.
   5. It is important to remember to provide practical assistance and adapt the environment to the patient’s needs to ensure comfort and independence in everyday life.

Speech disorder

Speech problems are common in patients suffering from Parkinson’s disease. Stiff muscles can make it difficult for them to pronounce words, and they may stutter or lose the ability to speak altogether. Emotional expressiveness also suffers due to difficulty controlling facial muscles, making smiling a challenge.

Articulation changes, speech becomes monotonous and slow, patients have difficulty concentrating and remembering the names of objects. They may miss words or syllables, or, conversely, speak too quickly and unintelligibly.

It is important to provide support and understanding to these patients, and to help them cope with difficulties in everyday communication.

To help a patient with Parkinson’s disease, several measures should be taken:

1. Check whether the patient understands you and whether he is able to confirm this with a nod of his head.
2. If the patient is able to speak, have a conversation with him, even if his speech is slow and with pauses.
3. Use short sentences, pause, and observe the patient’s reaction.
4. If the patient shows signs of anxiety, such as speaking rapidly, crying, or facial distortion, find out if the patient is in pain. If you experience pain, discuss this with your doctor.
5. Maintain your gaze on the patient and reduce surrounding noise to provide a comfortable environment for conversation.
6. Do not rush the patient, give him time to think and concentrate, remain calm and adapt to his pace of communication.

Movement coordination disorders

Mobility problems are common in patients with Parkinson’s disease. They have difficulty standing up quickly, gait disturbances, problems with balance and coordination, and slow reaction times. This can lead to falls, and movements become small and jerky, and the gait becomes unsteady and “shallow.”

To help the patient cope with these difficulties, the following steps can be taken:

1. Train a person to stand up with a rocking motion using the “one, two, three” principle.
2. Explain the need to move to the edge of the seat first before standing.
3. Instruct the patient to stand up slowly to avoid sudden changes in blood pressure and loss of consciousness.
4. Teach the patient to focus on gait by conducting marching and striding exercises with arms raised to the sides.
5. To prevent the legs from getting caught in each other, teach the patient to step slightly to the side.
6. Do regular exercises to maintain muscle flexibility, which will only take 10-15 minutes daily.
7. Discuss with your doctor the possibility of using relaxing treatments, such as warm baths or applying a hot towel to the back of the head and forehead, to help the patient feel relief and relaxation.

Swallowing problems

Swallowing problems are common in people with Parkinson’s disease. They may have difficulty swallowing, chewing, and choking frequently. Here are some ways to help:

1. Observe the swallowing process carefully and perform a three-swallow test to assess the condition. You can use video instructions to complete this procedure.
2. Ensure that the patient’s head is positioned correctly when eating to avoid tilting back, which could result in food being inhaled.
3. Feed the patient only in a sitting position to prevent choking.
4. Before eating, have the patient chew gum or suck on a lozenge to stimulate salivation.
5. Maintain variety in the diet and ask relatives to bring something tasty to the patient.
6. While eating, communicate with the patient and instruct him in each step: tilt your head forward, place food on your tongue, close your mouth and begin chewing. Remind them that it takes effort to swallow.
7. Massage your neck before meals to make the muscles more mobile and improve the swallowing process.

Fall prevention

Fall prevention plays an important role in the care of patients with Parkinson’s disease. Here are some measures you can take:

1. Carefully examine the patient’s walking patterns and the routes they take, especially when going to the toilet. Assess your shoes and the environment underfoot to ensure safety.
2. Before going to bed, make sure the patient knows that when they wake up they must call the nurse and remember where the call button is. Turn on a night light for extra illumination, and remove slippers and rugs to avoid potential falls.
3. Remind the patient to remember to contact you when they wake up, especially if they need to go to the toilet. It is important to remember that the patient may forget how to stand up correctly, which can lead to falling out of bed.

Emotional problems

Emotional problems are common in people with Parkinson’s disease. They find it difficult to accept their diagnosis, especially in the early stages of the disease. This causes a huge feeling of heaviness and anxiety. At the same time, they realize their inadequacy and loss of control over their own lives. What can be done in this situation?

1. Strive to maintain stability in the person’s environment so that he feels confident. Avoid frequent changes of departing staff, preferably changing shifts every 12 hours.
2. Have daily conversations with the patient, even for a short time, so that he feels that he is being listened to carefully. This may be his only source of communication, so this is very important.
3. Help only when necessary, encouraging his independence. This will help him feel more confident and in control of the situation.
4. Do not take any action without his consent and explanation. It is important that he feels like the master of his life and does not depend on the help of others.
5. Take his wishes into account and strive to implement them. For him, this is an important moment of communication and self-expression.
6. Identify his strengths and achievements, focusing on them. This will help him feel valued and boost his self-esteem.
7. Use community resources such as forums and online communities where he can connect with people facing similar problems. Browse YouTube stories of inspiration with him to help him feel part of a larger community and not feel alone.

Lack of knowledge about the disease

Very often, people with Parkinson’s disease do not know the specifics of their disease, do not understand what is happening to them and why. Please tell the patient about Parkinson’s – what kind of disease it is, how it differs from others, what its symptoms are, what you will do about it.

1. Tell the person what he needs to do daily: exercise, hygiene. Remind him of this, he may forget;
2. Plan the patient’s day hourly: taking medications, procedures, physical exercise. Adjust the schedule if necessary. Try to ensure that the activity is at the peak of the effect of the drugs;
3. Be sure to explain to the patient why his daily routine is structured this way, what medications he takes and what they are needed for.

Problems with bowel movements

Typically, patients with Parkinson’s disease experience constipation – the person eats little and drinks little water. Some drugs can also slow down peristalsis, which can cause anal fissures and hemorrhoids. The person himself is afraid to push, afraid of pain. To avoid such problems:

1. Regulate the issue of nutrition before problems with bowel movements arise;
2. Monitor bowel movements, note when and how many times a person goes to the toilet;
3. Discuss with your doctor the possibility of using microenemas to induce bowel movements.

Sleep disorders

Sleep disorders can be a serious problem for people with Parkinson’s disease. Here are some ways to deal with this problem:

1. If a person tends to fall or slide out of bed while sleeping, it is recommended to place an additional mattress or bumper next to the bed for safety.
2. If the patient suffers from insomnia, encourage activity during the day to improve sleep quality at night.
3. Create a dark, quiet environment in the patient’s room to promote better sleep.
4. Make sure the patient is not exposed to unnecessary noise while sleeping. Encourage him to use earplugs or other sound-proofing devices to ensure a quiet resting environment.

At our Clinic we strive to improve the quality of life of patients with this disease. With our treatment, we aim to minimize symptoms and make everyday life easier for our patients. Find out more about our procedures by visiting alternativeparkinson.com, calling +34 963 516 680 or emailing info@weracu.org.