Scenario – B Roy Rogers is a 67-year-old man transferred to your rehabilitation facility from the local public hospital. He has spent the last 24 hours being observed in the emergency department...

Scenario – B
    Roy Rogers is a 67-year-old man transfe
ed to your rehabilitation facility from the local public hospital. He has spent the last 24 hours being observed in the emergency department following a fall at home.
Admission History
Roy was diagnosed with Parkinson's Disease 5 years ago. He stood up very quickly from his kitchen chair & almost immediately fell backward, hitting the back of his head on the tiled floor. His wife, June, witnessed the incident and stated that he did not lose consciousness but was dazed for several minutes. Roy cannot recall the incident. He does not want to be in your facility but states, "I wasn't given any choice."
On admission to the rehab ward, Roy demonstrated the following:
· Pronounced tremors of upper extremities
· Laceration of his posterior scalp with four sutures in situ
· Extreme fatigue and weakness
· BP – 110/62, P- 62, R- 20.
· O2 sats are 98% on room ai
· Anxiety and signs of distress
· Joint stiffness & pain on movement from stretcher to bed
· Large, reddened scaly lesions on arms & chest
Investigations
· MRI revealed no abnormalities
· An X-ray revealed no fractures
· All blood work is within normal range
Physical History
Roy was first diagnosed with PD 5 years ago after seeking advice about increasing unsteadiness on his feet. He was not expecting this diagnosis, and it hit him hard. Roy retired from his job as an accountant almost immediately. The gait distu
ance has been getting progressively worse over the last year & he is beginning to give up hope. Roy also suffers from eczema, which he has experienced in many exace
ations since his teens: "it goes away for a while & then comes back twice as nasty. It has gotten worse since the PD diagnosis". He was also diagnosed with osteoarthritis of both hips & the L knee. Roy had been scheduled for a L hip arthroplasty, but that plan ended with the diagnosis of PD. Roy states that: "I don't know which is worse – arthritis or Parkinson's. It's a miracle I'm not already in a wheelchair".
Psychosocial/Cultural History
Roy is ma
ied to June, who is his primary career. She gave up work as a primary school teacher to care for him. They have two children who live close by but whom they seldom see. Roy & June are stoic in explaining that both boys live busy lives, but Roy also points out that the visits ceased when they could no longer look after the grandchildren. He is a smoker & a drinker: "what else am I gonna do"? Roy can't identify any cultural issues that might impact his treatment.
Questions to Answer by the student:
1. List and describe eight signs and symptoms that you would expect Roy to evidence and provide an explanation of the pathophysiological process of Parkinson's disease relevant to each.
    The following are the signs and symptoms of Parkinson’s disease:
· Tremor: A tremor, or trembling, generally starts in one of Roy's limbs, most often his hand or fingers. A pill-rolling tremor occurs when Roy rubs his thumb and fingers back and forth. When Roy's hand is at rest, it may quiver.
· Slowed movement (
adykinesia): Parkinson's disease can slow down a person's mobility over time, making basic tasks complex and time-consuming. When Roy walks, his steps may get shorter. Getting out of a chair can be difficult. Roy's feet may drag as he tries to walk.
· Rigid muscles: Muscle stiffness might strike at any time and in any region of his body. His range of motion is limited by tight muscles, which can be uncomfortable.
· Impaired posture and balance: Roy's posture may stoop, or he may experience balance issues as a result of Parkinson's disease.
· Loss of automatic movements: Roy's capacity to make unconscious motions, such as blinking, smiling, or swinging his arms as he walks, may be impaired.
· Speech changes: Roy has a tendency to speak quietly, rapidly, slur, or pause before speaking. Roy's voice may have a monotonous quality to it rather than the typical inflections.
· Writing changes: It is possible that writing may become difficult, and Roy's writing will seem tiny.
2. Identify two priority nursing interventions based on Roy's cu
ent presentation.
    Firstly, Rogers will require stiches for the laceration on his head and secondly, he needs sedatives to calm his nerves so he can rest as he is very weak and fatigued due to the fall.
3. Develop a problem-based care plan for Roy based on his primary diagnosis of PD. Include an evaluation of your interventions and how you would assess their effectiveness.
    Nursing Diagnosis: Impaired physical mobility
    Nursing Interventions
    Rationale
    Instruct the patient on movement-initiating strategies.
    Starting the leg action by rocking from side to side might assist.
    Instruct the patient to get out of the chair by going to the seat's edge, resting their hands on the armrests, leaning forwards, and then swaying to a standing posture.
    Rigidity tremors,
adykinesia, and trouble getting out of a chair are all symptoms of Parkinson's disease.
    Teach the patient to walk with a wide-based gait and to walk upright.
    The stiffness of the arms, which prevents them from swinging when walking properly, may have a detrimental effect on balance. To compensate for the shuffling pace and inclination to lean forwards, a unique walking style must be developed. Swinging the arms, raising the feet while walking, and using a heel-toe placement of the feet with lengthy strides all need deliberate effort.
    Instruct the patient to engage in a daily muscle-strengthening activity such as walking, riding a stationary bike, swimming, or gardening.
    Exercise decreases muscular stiffness and prevents contractures that form when muscles are not utilised. It also improves coordination and dexterity. Following a regular exercise and walking regimen can help slow the progression of the illness.
    Teach the patient to sit in chairs with backs and armrests; in the bathroom, use raised toilet seats or sidebars.
    Assist in getting up from a seated position and avoiding falls.
    Recommend scheduling sexual relations for when the medicine is in effect.
    Parkinson's disease produces
adykinesia, which can make intimacy difficult.
    Instruct the patient to slowly lift the head of the bed and shift positions. Before standing, teach the patient to dangle his legs for a few minutes. Maintain enough dietary salt to avoid dehydration.
    These steps help to alleviate orthostatic hypotension.
4. Roy's osteoarthritis is compounding his difficulty in moving. How could you assist him in increasing his mobility?
    Roger may have some discomfort when he initially starts moving since his knees and joints are inflamed. In this situation, walking may be the best medication. It may be difficult at first, but as he begins walking, it should become easier. This is the path I would advise Roy to take in order to improve his mobility.
5. Roy describes his atopic dermatitis (eczema) as "driving me crazy." He describes the itching as all-consuming, and he can't think of anything else. Roy got significant relief in the past by soaking in a bath of Aveeno but now can't get in & out of the tub even with assistance.
List & describe three alternative interventions that may decrease Roy's distress.
    Conventional therapies, in addition to stringent skin-care practises, may include:
· Nonsteroidal anti-inflammatories and topical steroids
· Immunosuppressants, either oral or injectable
· Antibiotics are used to treat skin infections.
Complementary and alternative treatments, on the other hand, have gained in popularity in recent years for a variety of ailments. According...