IHUMAN CASE STUDY: DARRELL JOHNSON – PRIMARY
CONCERNS, ASSESSMENTS, AND INTERVENTIONS FOR A 64-
YEAR-OLD MALE WITH WORSENING PARKINSON'S DISEASE
PART 1: PATIENT BIO DATA & INITIAL DATA GATHERING
Category Details
Name Darrell Johnson
Age 64 years old
Gender Male
Admission Type Direct admission from neurologist's office
Reason for
Worsening symptoms of Parkinson's disease
Admission
Source Patient (self) and neurologist's referral
Limited due to cognitive impairment (MMSE 22/30); neurologist provides collate
Reliability
history
Allergies No Known Drug Allergies (NKDA)
PART 2: PAST MEDICAL HISTORY (PMH)
, Condition Details
Parkinson's Disease Diagnosed several years ago; progressively worsening
Duration of PD Not specified; likely chronic
Previous PD Symptoms Tremors, rigidity, bradykinesia, gait disturbance
Other Medical Conditions Not specified in available records
Key History Points:
Memory loss noted (associated with disease progression)
Increase in tremors recently
Issues with swallowing reported
Muscle weakness present
PART 3: PAST SURGICAL HISTORY (PSH)
Surgery Details
None reported No surgical history documented
PART 4: MEDICATIONS
Anticipated Home Medications
Medication Class Purpose
First-line treatment for Parkinson's
Carbidopa-Levodopa (Sinemet) Dopamine precursor
replaces dopamine
Dopamine Agonists (e.g., Dopamine receptor
Mimic dopamine effects in brain
Pramipexole, Ropinirole) agonists
, Medication Class Purpose
MAO-B Inhibitors (e.g., Selegiline, Monoamine oxidase B
Prevent breakdown of brain dopam
Rasagiline) inhibitors
How Dopamine Works in the Brain
Dopamine is a neurotransmitter produced in the substantia nigra
It facilitates smooth, controlled movements
In Parkinson's disease, dopamine-producing neurons degenerate
Dopamine deficiency leads to:
o Tremors at rest
o Muscle rigidity
o Bradykinesia (slowness of movement)
o Postural instability
Hospital Medications (Anticipated)
Medication Route Rationale
Enteral (via feeding tube Continue Parkinson's treatment
Carbidopa-Levodopa
if needed) critical for mobility
Antiemetics (non-dopaminergic, e.g., For nausea without blocking
IV/PO
Ondansetron) dopamine
Bowel Regimen (Docusate, Senna, Prevent constipation (common
PO/PR
Polyethylene glycol) PD)
IV Fluids IV Hydration if dysphagia present
PART 5: FAMILY HISTORY
, Relative Details
Family history Not specified in available records
PART 6: SOCIAL HISTORY
Factor Details
Living Situation Lives at home (needs case management assessment for safety)
Occupation Not specified
Tobacco Not specified
Alcohol Not specified
Support System Requires evaluation by case management for home safety
PART 7: HISTORY OF PRESENT ILLNESS (HPI)
Using OLD-CARTS Format
Component Finding
Onset Progressive worsening of Parkinson's symptoms; timing not specified
Location Neurological (brain) affecting motor function throughout body
Duration Chronic with acute worsening prompting admission
Character Worsening tremors, muscle weakness, difficulty swallowing, memory loss
Aggravating Factors Disease progression; possible medication timing issues
CONCERNS, ASSESSMENTS, AND INTERVENTIONS FOR A 64-
YEAR-OLD MALE WITH WORSENING PARKINSON'S DISEASE
PART 1: PATIENT BIO DATA & INITIAL DATA GATHERING
Category Details
Name Darrell Johnson
Age 64 years old
Gender Male
Admission Type Direct admission from neurologist's office
Reason for
Worsening symptoms of Parkinson's disease
Admission
Source Patient (self) and neurologist's referral
Limited due to cognitive impairment (MMSE 22/30); neurologist provides collate
Reliability
history
Allergies No Known Drug Allergies (NKDA)
PART 2: PAST MEDICAL HISTORY (PMH)
, Condition Details
Parkinson's Disease Diagnosed several years ago; progressively worsening
Duration of PD Not specified; likely chronic
Previous PD Symptoms Tremors, rigidity, bradykinesia, gait disturbance
Other Medical Conditions Not specified in available records
Key History Points:
Memory loss noted (associated with disease progression)
Increase in tremors recently
Issues with swallowing reported
Muscle weakness present
PART 3: PAST SURGICAL HISTORY (PSH)
Surgery Details
None reported No surgical history documented
PART 4: MEDICATIONS
Anticipated Home Medications
Medication Class Purpose
First-line treatment for Parkinson's
Carbidopa-Levodopa (Sinemet) Dopamine precursor
replaces dopamine
Dopamine Agonists (e.g., Dopamine receptor
Mimic dopamine effects in brain
Pramipexole, Ropinirole) agonists
, Medication Class Purpose
MAO-B Inhibitors (e.g., Selegiline, Monoamine oxidase B
Prevent breakdown of brain dopam
Rasagiline) inhibitors
How Dopamine Works in the Brain
Dopamine is a neurotransmitter produced in the substantia nigra
It facilitates smooth, controlled movements
In Parkinson's disease, dopamine-producing neurons degenerate
Dopamine deficiency leads to:
o Tremors at rest
o Muscle rigidity
o Bradykinesia (slowness of movement)
o Postural instability
Hospital Medications (Anticipated)
Medication Route Rationale
Enteral (via feeding tube Continue Parkinson's treatment
Carbidopa-Levodopa
if needed) critical for mobility
Antiemetics (non-dopaminergic, e.g., For nausea without blocking
IV/PO
Ondansetron) dopamine
Bowel Regimen (Docusate, Senna, Prevent constipation (common
PO/PR
Polyethylene glycol) PD)
IV Fluids IV Hydration if dysphagia present
PART 5: FAMILY HISTORY
, Relative Details
Family history Not specified in available records
PART 6: SOCIAL HISTORY
Factor Details
Living Situation Lives at home (needs case management assessment for safety)
Occupation Not specified
Tobacco Not specified
Alcohol Not specified
Support System Requires evaluation by case management for home safety
PART 7: HISTORY OF PRESENT ILLNESS (HPI)
Using OLD-CARTS Format
Component Finding
Onset Progressive worsening of Parkinson's symptoms; timing not specified
Location Neurological (brain) affecting motor function throughout body
Duration Chronic with acute worsening prompting admission
Character Worsening tremors, muscle weakness, difficulty swallowing, memory loss
Aggravating Factors Disease progression; possible medication timing issues
