What is the key information from the case scenario that would be relevant for the plan of care for this client?
Mr Charles Williamson, a 76 year old man, has been admitted to your ward for respite care. He was diagnosed with Parkinson’s disease (PD) 10 years ago. His wife, Elsie, is his primary carer. Charles’ mother died of pneumonia at the age of 78, having had PD for 22 years. He has nil other significant medical history. Charles’ PD symptoms are being managed with Sinemet CR ® (200/50 mg tablets) every 4 hours during the day.
On general appearance, Charles is alert, oriented, but appears slightly anxious with a noticeable tremor in his upper limbs. During the assessment, he has a ‘mask-like’ face and speaks in a hoarse, monotonous voice. Charles’ physical exam reveals a normal blood pressure (120/72) without orthostasis. Heart rate is 76 with a regular rhythm. Charles is able to arise from a chair without pushing off with hands and there is a noticeable ‘drag/scuffing’ of the right foot, heard better than seen. His movements are slow and rigid and his balance appears to be unstable. He has had a recent fall at home sustaining bruising and a skin tear to his right lateral lower leg. He complains of constipation and a lack of appetite. It is also noted that he starts to cough when given a drink of water.
Elsie informs you that Charles is ‘very particular’ about taking his PD medications ‘on-time’. Charles thinks that the effectiveness of his levodopa therapy starts to wear off after 4 hours. He says that he has relatively little ‘good time’ and he alternates between a state of immobility, requiring assistance with activities of daily living (ADL), when the effect of the medication wears ‘off’, and a state of excessive, uncontrolled movements when the medication is in effect.
Charles will be admitted to the ward for 5 days and will require specific nursing interventions to successfully manage his respite care.
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