NRSG374 Principles of Nursing: A Palliative Approach:Parkinson Disease

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NRSG374 Principles of Nursing: A Palliative Approach

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Introduction

This case study will focus on patient centred care of Mr Nathan Rollins, a 64-year-old man with an extensive cardiac health history and a recent diagnosis of rapidly progressive Parkinson’s Disease (PD). Mr Rollins has been caring for his wife at home who has been recovering from a hip replacement surgery related to degenerative changes from Rheumatoid Arthritis (RA). Together the two of them had led an active life working hard to support each other after many years of work and enjoy their much-loved garden and home. Nathan’s wife Heather has noticed that he
has been experiencing increased pain and shortness of breath assisting her with her ADL’s, however, does not know how to get any help or if they are even eligible.

Case Study

Mr Nathan Rollins is a 64-year-old man who has been married to Heather for 42 years, they were never able to have children however both worked until recently and are now self-funded retirees. Nathan worked as a commercial industrial electrician, he was a heavy smoker up until 10 years ago when he had an ST Elevation Myocardial Infarction (STEMI) and required urgent Cardiac Arterial Bypass Graft Surgery (CABGS) surgery. Nathan with the help of Heather recovered well from his quadruple bypass, returning to work for another 9 years until Heather required a hip replacement related to degenerative changes from her Rheumatoid Arthritis (RA).

The two retired at this stage of their lives with Nathan becoming Heather’s carer, assisting his wife with her recovery and rehabilitation at home, including most ADL’s involving hygiene, dressing, and transferring. It was during this time that Heather noticed that Nathan was experiencing tremor’s, rigidity and drooling as he bent over to put on her shoes rarely verbalising pain but was exhibiting it. Nathan was reviewed by his general practitioner (GP) and after several tests and consultations with specialists he was diagnosed with rapidly progressing Parkinson’s Disease.

It is 0700 hours and you have been assigned to work on Nathan’s discharge from the medical ward that you have been allocated to during your final year clinical placement. The RN that you are buddied with has explained to you that Nathan is due for discharge this week however prior to this a referral to the regional community palliative care team needs to be attended to.

Nathan is continuing to experience fluctuating symptoms of his Parkinson’s Disease that have recently caused increasing musculoskeletal and nervous system pain. The Palliative Care Team have consulted during this admission providing useful advice for not only pain interventions but also his fatigue and mild cognitive changes including lack of concentration. It was decided in a family meeting that ongoing review from palliative services would be useful in supporting Nathan and Heather to remain at home and support each other.

Considerations for the palliative care referral

1. Consider some of the assessments that you can undertake on Nathan, how might this assist with your referral to community palliative care services?

2. What key criteria do you believe are important to convey to the community palliative care team?

3. Nathan and Heather have already been introduced to the Palliative Care Consultancy service within the hospital setting and have agreed to a
community referral

4. Consider the concept of Total Pain and how aspects of Physical, Spiritual, Psychological, and social needs can be addressed in this model of care.

5. Is an Advanced Care Directive (ACD) important to discuss and plan?

6. Has Nathan appointed a Medical Power of Attorney (MPOA)?

7. Is a home Occupational Therapy Ax required?

8. Is there any equipment that can be provided to support Nathan and Heather?

9. Is a FICA assessment needed? Will this assist in spirituality concerns?

10. Are there any side effects that may be impacting Nathan’s QoL from his medication?

11. Are there other community supports available if Nathan and Heather do not wish to “burden” their family?

12. Consider exercise / hydrotherapy supports could these improve quality of life and aid in non-pharmacological pain management and movement?

13. Strengthening exercises and physiotherapy can improve core strength, neck, and lower back pain. Consider discussing this for both Heather and Nathan to attend.

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