Economic Burden of Parkinson Disease Order Instructions: Thank you very much for helping me with this assignment. Actually, this assignment is the second part of the given case study.
The first part of this assignment, we have to make a concept map and discussion in a group of 6 students in 500 words. It was 20% and we didn’t do well and we fail that assignment. I attached the concept map and discussion for your general idea but it is not good. You have made your own ideas for Assessment task 2
I am attaching another concept map of another group ( who passed the assignment) to have a look and get the idea what we have to cover. It is in PDF format. My group’s concept map is in word format.
I attached the unit outline for your kind information to know what they looking into the assessment and you can find some useful references
In Assessment task 2 (it is individual assignment) it worth 40% 1750 words (referencing excluded)
• Students are required to discuss the assessment and care provision identified through the concept map in assessment task 1. A significant focus of this assessment is in demonstrating how the dignity of the client/patient can be maintained through the provision and evaluation of nursing care. This is to be integrated through the assessment.
• The purpose of this assessment is to promote both problems solving and care provision, including prioritizing within a clinical scenario.
• The student must use Miller’s functional consequence theory of healthy aging as a theoretical framework. I already attached it with your material.
• Please follow the reference rubric for this assessment task.
• I need at least 25 references between 2008 to 2015 in APA style. I am in Australia, so please try to use Australian and New Zeeland study material for reference. I need genuine referencing too.
• I need high distinction in this assessment to pass this subject, so help me, please.
• If you need any other information please give me an email
This is the message from the teacher about Assignment task 2 requirements
GENERAL SUGGESTIONS:
• -Be sure to discuss not only the primary issues but also their impact on each other (secondary issues), their assessment, care and the strategies you would use to evaluate the care.
• -Your assessment, care provision, and careful evaluation should demonstrate ethical and person-centered approach and the use of Miller’s theory as well as a clinical decision-making tool. You could use the Lovett-Jones clinical decision-making tool provided on LEO or any other you are comfortable with and will help you to achieve what is being asked in this assignment.
• -Make sure you analyze the complexity of the patient’s health issues and are- providing evidence of consideration of the patient’s issues from multiple perspectives.
• -Also, don’t forget the effects of the patient’s medication and perhaps conclude each of your paragraphs with a link sentence as a conclusion to lead nicely on to your discussion of issues in the next domains (like what you did on your concept map).
• -Group members from each group could all use the same references you submitted with your care priority discussion. You are not limited to that only but can change or add some more to it.
• -Remember that a significant focus of this assessment is in demonstrating how the dignity of the client/patient can be maintained. You do not need a separate paragraph but integrate that through the provision and evaluation of nursing care.
• -Most importantly, please stay within the wordage allowance to avoid any penalties.
• -I will strongly encourage you to use both the assignment 2 guide and the rubric as your guide to write and to achieve the requirements of the essay.
Economic Burden of Parkinson Disease Sample Answer
Introduction
Mr. Johann Silverman is a diagnosed with Parkinson disease. He is 77 years old and a widower. He has no sibling and his small income which covers his medication expenses. His condition is worsening making him get concerned on how he will manage his condition in the future. As a nurse, it is our duty to take care of elderly persons, to assess their disease progress, provide care; and simultaneously maintain the elderly patient dignity. Approximately, 1 in every 350 people in Australia live with Parkinson; with the highest affected group being those above 65 years of age. It is a major burden to the family and the care giver.
Neurological disorders among the elderly are the biggest threat to Australia public health. In fact, Parkinson’s disease prevalence in Australia is ranked as the leading cause of death amongst the elderly. This neurodegenerative disorder prevalence has been on the rise (17%) since the last five years; implying that there are 30 new cases of Parkinson disease reported every day (Axelrod Et al., 2010). Research finding’s indicates that the increase in number of elderly people living with Parkinson disease have resulted to poor quality of life due to straining on care providers. This impact of Parkinson disease on care providers has heightened and need to be addressed in effective clinical management of the disease (Hutchinson Et al., 2013; Zhao Et al., 2012).
Comprehensive Assessment
Parkinson disease is a neurological disorder that affects the movement and the response. There are two main hypothesis used to describe the disease pathophysiology. Free radical hypothesis- explains that dopamine undergoes enzymatic oxidation causing damage on the nigrostriatal neurons. Human body has protective mechanism to protect the body from oxidation process from oxygen radicals from other metabolic reaction; however, this mechanism seems to fail at an advanced age. The second hypothesis is the neurotoxin hypothesis. This hypothesis argues that the body has more kinds of neurotoxins which affect the basal ganglia – part of the brain responsible for integrating movement and rectification of any errors occurring during movement (Hellqvist & Bertera, 2015). This called for comprehensive assessment and it also explains the reasons why Mr. Johann musco-skeletal assessment indicated that he was experiencing slow movements (bradykinesia), uncontrolled movements and increased tremors. The neurological assessment indicated that Mr. Johann sweats a lot; sleeping pattern is disturbed and has hypertension- all indicators of possibility of developing mental disorders such as depression. The patient also complains of memory loss and fatigue (Hooker & Everett, 2011).
ADL assessment was conducted to evaluate his ability to undertake activities of daily living. The disease progress recorded poor ADL functionality. This is alarming because it indicates that the patient cannot quality take care of himself in terms of nutrition, medication, hygiene and overall personal care (My aged care, 2014). Fall risk assessment was done to evaluate the patient’s safety. His muscle rigidity, tremor and poor sight indicated that he had high fall risk. MMSE assessment was conducted to evaluate the patient’s mental state. This assessment was done to examine presence of cognitive impairment. From the assessment, the patient cognitive function were generally under stable condition but the patient indicated that he was beginning to have immediate memory lapse (Macpherson, 2013).
During home assessment, the occupational therapy, it was noted that Mr. Johann uses the furniture for support as he moves around. He told the therapist that he no longer feels confident moving around and he is afraid of experiencing falls. The room had a lot of furniture that were not necessary, making the room look congested and poor light. The house floor is made of wooden increasing the chances for falls due to slips. The toilet and bathroom lacks supporting materials. The Kitchen shelves are high for him to reach. This home condition calls for modification of the environment to suit his condition. The smoke detectors needed to be fixed. The house needs at least one phone located at a specific location. The handrails need to be installed along the stairwells (Kirton Et al., 2011).
Nurse’s intervention
Putting into considerations the complexity of Parkinson disease, there is need for the healthcare providers to deliver quality care in the midst of the dynamic healthcare environment. This will require adequate thoughts and reasoning prior to making clinical decisions. Clinical reasoning refers to the methods which nurse collect cues, process the patient information, understands the patient needs comprehensively, plans actions, implements the actions, evaluates the outcomes and reflects on the entire process (Henderson Et al., 2013). In this context, the healthcare provider has assessed the patient Parkinson condition and has evaluated the complexity of issues. The healthcare provider has to put the clinical reasoning into practice so as to establish the safest approach to provide quality care to Mr. Johann.
Some aspects of our lives are inevitable such as aging. Complications which come with aging are often assumed by the public as normal. These includes myths that age person is supposed to be frail, depressed, confused and dependent. Such myths are harmful in the society because they make elderly people feel hopeless, pessimism and considerably reduce their dignity (Parkinson’s Australia, 2011). Fortunately, recent findings has brought forth new perception of ageism which has enlightened the healthcare providers so that they can adequately differentiate between changes due to age related and are inevitable from the risk factors which can be used to address the issues and prevent the complications (McCabe, Roberts & Firth, 2008).
The functional consequences theory for promoting wellness in elderly framework will be used to guide the concepts of nurse’s core concepts in nursing elderly patients. This framework was developed by C.A. Miller in 1980’s and has been effectively applied in nursing care for the elderly (Hunter, 2012). This theory is chosen for this purpose because of its core premises. This includes its emphasis on patient centered nursing care; which will ensure that the healthcare does not focus on disease symptoms but also the body-mind and spirit- because they encompass person’s physiological functioning. The model suggests that the problems affecting the elderly are attributable to risk factors (Suzuki Et al., 2008). The aged related changes interact with risk factors making the elderly person experience negative functioning consequences. In this context, interventions should focus on modification or removal of these negative function consequences. Consequently, the elderly person health and wellbeing is improved dramatically. Eventually, the interventions results to wellness outcomes which is characterized by high functioning of the elderly person irrespective of their age-linked changes or presence of risk factors (Sav Et al., 2013).
In this framework, the nurse should provide nursing care that is patient centered. This implies putting the elderly person at the center of their care. This enables the nurse identify the needs of the patient. The nurse then addresses each need one by one with the patient; explaining the alternative and implication of each alternative on their health. This empowers the patient, and the sharing of the information helps them in making an informed decision. This concept is achieved through nursing assessments (Oishi & Murtagh, 2014). Through clinical reasoning and Millers functional consequence theory of aging model, the nurse identifies the following risk factors which needs to be addressed including; a) reduced cognitive function; b) financial instability; c) Mental complications; d) reduced mobility and e) reduced personal care and hygiene (environment) (Aged Care Network, 2013).
In this context, the nurse must evaluate how the environment increases the elderly risk factors, how it affects the patient’s quality of life. The nurse should ensure that environment is not only comfortable but also safe (Kim Et al., 2012). To manage the activities for daily living activities, the patient can use dressings chosen specifically for the patient. This includes clothes with large buttons, pullover tops and those with easy fasteners. The patient can wear elastic shoes and those that are non-tie. For hygiene, tooth brushes with long brushes and spinning brushes would be effective. When bathing, the patient can use adapted bathing tools such as long handle scrubber, transferring devices or tub chair. This also refers to the toileting aids e.g. use of stationary toilet chair and use of toilet back and grab bars can be installed. In bedroom, installing more lighting, use of transfer boards and bedsides commodes can be effective. The kitchen sector needs modification such as lowering the shelves to the place where the patient can reach. Use of rocker lives for cutting and use of easy to grip utensils made of solver. For mobility’s aids, the best type for this patient is the motorized wheel chair. This is because the patient is a weakling and needs less physical exertions, thus helping the patient maneuver with ease and safely (Zhao Et al., 2010).
For reduced personal care and hygiene can be explored using other alternatives includes HACC program which is funded by the Australian Government to help elderly who are able but not so completely able to cope on their own. The program is effective as it helps in domestic care which is needed by Mr, Johann, but in the future he should consider palliative care (Meier & McCormick, 2015). This is because it will allow him to avoid hospitalization but ensure that he is cared for adequately. For promoting independence, the patient can be use community services such as domestic support to help in showering, cooking and other services such as shopping. Aged care assessment team helps the elderly by referring the community care services that will help increase their own home. As the disease progresses, ACATs increases the care package such as Community Aged Care Package (CACP ) and Extended Aged Care Package (EACH); programs sponsored by the Australian government to offer coordinated home care for the elderly (Roberts Et al., 2009).
There is no cure for the disease, but it can be managed by increasing dopamine supply in the brain. Some of the medication includes Carbipoda –Levodopa which is converted into the dopamine in the brain. Other medication Dopamine agonists which mimic dopamine effects can be used to manage the disease. This includes Mirapex and Neuprol. MAO-B inhibitors, Catechol-O methyltransferase inhibitors, Anticholinergics and Amantadine Using nursing services are other alternative therapies for Parkinson disease (Nishtala Et al., 2010). . To manage the medication, the patient can be referred to District Nursing Services. The nurse works closely with social workers and occupational therapists. The nurses will ensure that Johann health is promoted and medication is administered appropriately (Meier & McCormick, 2015).
Other alternatives medication includes surgical procedures such as Deep brain stimulation. This method has been found to be effective in controlling dyskinesias and tremor; however, this procedure has many risks including developing stroke or even hemorrhage. Health dietary that consists of plenty of fruits and whole grains is encouraged. Taking a lot of water will help manage constipation which is common secondary effects. The patient should increase exercise to improve patient, mobility through enhanced muscle strength and balance. It also reduces depression and anxiety (Meier & McCormick, 2015). The patient should be encouraged to look in front while walking, and he notices that he is shuffling; he should stop and check his posture again. Alternative medicine includes Coenyzmes Q10 has been found to be effective medication during the first stages of Parkinson disease. Massages have been shown to reduce muscle tension and simultaneously promote relaxation. Acupuncture, Yoga, Tai chi, music therapy and pet therapy has been found to increase emotional health, but it is not evidence based practice (Wong Et al., 2014).
Conclusion
The disease symptoms include bradykinesia, muscle rigidity and tremors. The disease progression is inherently slow and often strikes at elderly people from 50 years to 60 years. There has been no connection on the disease genetic cause and the medication available only manages the disease symptom but does not cure it. To manage the disease among the elderly, nurses should provide quality care to these individuals; including the moral support.
Economic Burden of Parkinson Disease References
Aged Care Network (2013). Parkinson’s disease service model of care. Retrieved from http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Parkinsons_Disease_Model_of_Care.pdf
Axelrod, L., Gage, H., Kaye, J., Bryan, K., Trend, P. and Wade, D. (2010). Workloads of Parkinson€™s specialist nurses: implications for implementing national service guidelines in England. Journal of Clinical Nursing, 19(23-24), pp.3575-3580.
Cowan, M. and Cardy, C. (2011). Nurse-led palliative care clinic: optimizing choice for patients. BUM Supportive & Palliative Care, 1(2), pp. 218-218.
Edwards, K., Duff, J. and Walker, K. (2014). What really matters? A multi-view perspective of one patient€™s hospital experience. Contemporary Nurse, 49(1), pp. 122-136.
Hellqvist, C. and Bert era¶, C. (2015). Support supplied by Parkinson’s disease specialist nurses to Parkinson’s disease patients and their spouses. Applied Nursing Research, 28(2), pp. 86-91.
Henderson, E., Lord, S., Close, J., Lawrence, A., Whone, A. and Ben-Shlomo, Y. (2013). The Respond trial – rivastigmine to stabilize gait in Parkinson€™s disease a phase II, randomized, double-blind, placebo-controlled trial to evaluate the effect of rivastigmine on gait in patients with Parkinson€™s disease who have fallen. BMC Neurology, 13(1), p.188.
Hooker, R. and Everett, C. (2011). The contributions of physician assistants in primary care systems. Health & Social Care in the Community, 20(1), pp.20-31.
Hughes, C. (2008). Compliance with Medication in Nursing Homes for Older People. Drugs & Aging, 25(6), pp.445-454.
Hutchinson, A., Rasekaba, T., Graco, M., Berlowitz, D., Hawthorne, G. and Lim, W. (2013). The relationship between health-related quality of life, and acute care re-admissions and survival in older adults with chronic illness. Health and Quality of Life Outcomes, 11(1), p.136.
Hunter, S. (2012). Miller’s nursing for wellness in older adults. Lippincott Williams & Wilkins Pty Ltd. Sydney
Kim, S., Allen, N., Canning, C. and Fung, V. (2012). Postural Instability in Patients with Parkinson€™s Disease. CNS Drugs, 27(2), pp.97-112.
Kirton, J., Jack, B., O’Brien, M. and Roe, B. (2011). Care of patients with neurological conditions: the impact of a Generic Neurology Nursing Service development on patients and their carers. Journal of Clinical Nursing, 21(1-2), pp. 207-215.
Macpherson, P. (2013). Understanding patients with Parkinson’s disease. Dental Nursing, 9(7), pp. 376-382.
McCabe, M., Roberts, C. and Firth, L. (2008). Satisfaction with services among people with progressive neurological illnesses and their carers in Australia. Nursing & Health Sciences, 10(3), pp.209-215.
Meier, D.E., & McCormick, E., (2015). Benefits, services and models of subspecialty palliative care. Retrieved from http://www.uptodate.com/contents/benefits-services-and-models-of-subspecialty-palliative-care#H51425731
My agedcare(2014). Home and community care. Retrieved from http://www.myagedcare.gov.au/aged-care-services/home-and-community-care
Nishtala, P., McLachlan, A., Bell, J. and Chen, T. (2010). Determinants of antipsychotic medication use among older people living in aged care homes in Australia. International Journal of Geriatric Psychiatry, 25(5), pp. 449-457.
Oishi, A. and Murtagh, F. (2014). The challenges of uncertainty and inter-professional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals. Palliative Medicine, 28(9), pp. 1081-1098.
Parkinson’s Australia (2011). National Health & Hospital Reform Commission. Retrieved from http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/143/$FILE/143%20Parkinson%27s%20Australia%20Submission.pdf
Roberts, S., Webster, C., Valentine-Gray, D., Mew, C., Gow, G., Johnson, J., Lennon, E., Myers, M., Dearden, D., Kirwan, J. and Jamison, L. (2009). Developing a nurse-led holistic clinic and assessment pathway. Cancer Nursing Practice, 8(8), pp.34-36.
Sav, A., Kendall, E., McMillan, S., Kelly, F., Whitty, J., King, M. and Wheeler, A. (2013). ‘You say treatment, I say hard work’: treatment burden among people with chronic illness and their carers in Australia. Health Soc Care Community, p.n/a-n/a.
SUZUKI, W., OGURA, S. and IZUMIDA, N. (2008). BURDEN OF FAMILY CAREGIVERS AND THE RATIONING IN THE LONG-TERM CARE INSURANCE BENEFITS OF JAPAN. Singapore Econ. Rev., 53(01), pp.121-144.
Wong, J., Gott, M., Frey, R., and Jull, A. (2014). What is the incidence of patients with palliative care needs presenting to the Emergency Department? A critical review. Palliative Medicine, 28(10), pp.1197-1205.
Zhao, Y., Tan, L., Au, W., Heng, D., Soh, I., Li, S., Luo, N. and Wee, H. (2012). Estimating the lifetime economic burden of Parkinson’s disease in Singapore. European Journal of Neurology, 20(2), pp.368-374.
Zhao, Y., Tan, L., Li, S., Au, W., Seah, S., Lau, P., Luo, N. and Wee, H. (2010). Economic burden of Parkinson€™s disease in Singapore. European Journal of Neurology, 18(3), pp. 519-526.
