Parkinson's Disease
UNFOLDING Reasoning
Lillian "Lilly" Marie Jones, 76 years old
Primary Concept
Nutrition
Interrelated Concepts (In order of emphasis)
• Collaboration
• Patient Education
• Communication
• Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
• Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15%
• Health Promotion and Maintenance 6-12% ✓
• Psychosocial Integrity 6-12% ✓
• Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
1
, • Physiological Adaptation 11-17% ✓
History of Present Problem:
Lillian "Lilly" Jones is a 76-year-old female with a history of hypertension, gastro esophageal reflux disease (GERD) and
Parkinson's disease. Ms. Jones was hospitalized three months ago due to a urinary tract infection and dehydration. She is
now a resident of Sunnyside Health Care Center, a local long-term care facility because her Parkinson's disease has
progressed and her son, Jack, is no longer able to care for her at home. Lilly has lost ten pounds (4.5 kg) in the past
month. She is 5 feet-6 inches (167.6 cm) weighs 110 pounds (49.9 kg) and has a BMI of 17.8. After one week of residing
at Sunnyside, Jack visits and is saddened when he finds his mother in her room alone. Jack approaches the nursing station
and states, "My mother is so thin and losing weight and sits just staring into space. I thought having her here was going to
help her get better!”
Personal/Social History:
Lilly was married to John for 54 years before he passed away two years ago. She has one son, Jack, who lives 30 minutes
away. Jack has a medical power of attorney for Lilly's healthcare decisions. Lilly was a homemaker and an active
participant in her community. Her hobbies include knitting, playing the piano and reading. Lilly reluctantly has agreed to
go to Sunnyside Health Care Center after her son accepted a job that required him to travel.
1. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• Hx of Hypertension • Hx of hypertension is significant this is a risk factor for
• Hx of Gerd several potential problems; also, antihypertensive drugs
• Hx of PD have side effects and nursing interventions that must be
• Recent hospitalization for UTI addressed.
and Dehydration • GERD is significant because this can cause esophageal
• Low BMI at 17.8 distress, decreased eating, and other side effects and risk
• Losing weight factors.
• PD is a disease that will cause many problems, such as
tremors, abnormal and uncontrollable movements, and
decreased eating.
• Recent hospitalization indicate potential problems that may
present again in the future.
• Normal BMI should be 18.5-25; underweight indicates
poor nutritional intake
• The elderly should not lose weight (in this situation)
because at their age they rely on that fat tissue to keep
them warm and full of nutrients; loss of weight can
indicate poor nutritional intake which can be caused from
her PD, GERD, or possibly depressional and loneliness she
could be feeling
RELEVANT Data from Social History: Clinical Significance:
• Son has medical power attorney • Son has control and the power to decide all of the patient’s
• Widow medical decisions
• Living in an assisted living • She is a widow, living in a new place with strangers, and
• One son who lives 30 mins away her son lives 30 mins away and travels a lot; this puts her
and job that requires travel at risk for loneliness and depression
2
, Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 98.4 F/36.9 C (oral) Provoking/Palliative: "Better when walking a while."
P: 90 (regular) Quality: "ache"
R: 14 (regular) Region/Radiation: "Knees"
BP: 112/70 Severity: "3/10"
O2 sat: 98% room air Timing: "When I wake up."
2. What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
• BP slightly • Could be caused from medication; also, can be an indication of dehydration
lower • Pulse is WNL, but on the higher end of normal and can be a sign of potential
• HR 90 dehydration
• 3/10 pain • Pain 3/10 is a mild pain when waking up in her knees, she admits gets better
with movement; continue to monitor for worsening pain; joint pain can also
be a sign of dehydration
Current Assessment:
GENERAL SURVEY: Alert, flat affect and slow to respond to questions in a soft tone (hypophonia). Oriented
and in no acute distress, dress appropriate for the season, hygiene and grooming normal
for age and gender. Sitting with a forward leaning posture.
NEUROLOGICAL: Alert & oriented to person, place, time, and situation (x4); muscle strength 4/5 in both
upper and lower extremities bilaterally. Tremors noted at rest in hands.
HEENT: Head normocephalic with the symmetry of all facial features, but tremor noted.
PERRLA, sclera white bilaterally, conjunctival sac pink bilaterally. Lips, tongue, and oral
mucosa pink and tacky dry.
RESPIRATORY: Breath sounds clear with equal aeration on inspiration and expiration in all lobes
anteriorly, posteriorly, and laterally, nonlabored respiratory effort on room air.
CARDIAC: Pink, warm & dry, no edema, heart sounds regular, pulses strong, equal with palpation at
radial/pedal/post-tibial landmarks, brisk cap refill. Heart tones audible and regular, S1
and S2, noted over A-P-E-T-M cardiac landmarks with no abnormal beats or murmurs.
No JVD noted at 30-45 degrees.
ABDOMEN: Abdomen round, soft, and nontender. BS hypoactive in all four quadrants.
GU: Urinary Incontinent episode x1, urine yellow
INTEGUMENTARY: Skin oily but warm with normal color for ethnicity. No clubbing of nails, cap refill <3
seconds, Hair soft, distribution normal for age and gender. Skin integrity intact, skin
turgor elastic, tenting present.
3
UNFOLDING Reasoning
Lillian "Lilly" Marie Jones, 76 years old
Primary Concept
Nutrition
Interrelated Concepts (In order of emphasis)
• Collaboration
• Patient Education
• Communication
• Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
• Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15%
• Health Promotion and Maintenance 6-12% ✓
• Psychosocial Integrity 6-12% ✓
• Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
1
, • Physiological Adaptation 11-17% ✓
History of Present Problem:
Lillian "Lilly" Jones is a 76-year-old female with a history of hypertension, gastro esophageal reflux disease (GERD) and
Parkinson's disease. Ms. Jones was hospitalized three months ago due to a urinary tract infection and dehydration. She is
now a resident of Sunnyside Health Care Center, a local long-term care facility because her Parkinson's disease has
progressed and her son, Jack, is no longer able to care for her at home. Lilly has lost ten pounds (4.5 kg) in the past
month. She is 5 feet-6 inches (167.6 cm) weighs 110 pounds (49.9 kg) and has a BMI of 17.8. After one week of residing
at Sunnyside, Jack visits and is saddened when he finds his mother in her room alone. Jack approaches the nursing station
and states, "My mother is so thin and losing weight and sits just staring into space. I thought having her here was going to
help her get better!”
Personal/Social History:
Lilly was married to John for 54 years before he passed away two years ago. She has one son, Jack, who lives 30 minutes
away. Jack has a medical power of attorney for Lilly's healthcare decisions. Lilly was a homemaker and an active
participant in her community. Her hobbies include knitting, playing the piano and reading. Lilly reluctantly has agreed to
go to Sunnyside Health Care Center after her son accepted a job that required him to travel.
1. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• Hx of Hypertension • Hx of hypertension is significant this is a risk factor for
• Hx of Gerd several potential problems; also, antihypertensive drugs
• Hx of PD have side effects and nursing interventions that must be
• Recent hospitalization for UTI addressed.
and Dehydration • GERD is significant because this can cause esophageal
• Low BMI at 17.8 distress, decreased eating, and other side effects and risk
• Losing weight factors.
• PD is a disease that will cause many problems, such as
tremors, abnormal and uncontrollable movements, and
decreased eating.
• Recent hospitalization indicate potential problems that may
present again in the future.
• Normal BMI should be 18.5-25; underweight indicates
poor nutritional intake
• The elderly should not lose weight (in this situation)
because at their age they rely on that fat tissue to keep
them warm and full of nutrients; loss of weight can
indicate poor nutritional intake which can be caused from
her PD, GERD, or possibly depressional and loneliness she
could be feeling
RELEVANT Data from Social History: Clinical Significance:
• Son has medical power attorney • Son has control and the power to decide all of the patient’s
• Widow medical decisions
• Living in an assisted living • She is a widow, living in a new place with strangers, and
• One son who lives 30 mins away her son lives 30 mins away and travels a lot; this puts her
and job that requires travel at risk for loneliness and depression
2
, Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 98.4 F/36.9 C (oral) Provoking/Palliative: "Better when walking a while."
P: 90 (regular) Quality: "ache"
R: 14 (regular) Region/Radiation: "Knees"
BP: 112/70 Severity: "3/10"
O2 sat: 98% room air Timing: "When I wake up."
2. What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
• BP slightly • Could be caused from medication; also, can be an indication of dehydration
lower • Pulse is WNL, but on the higher end of normal and can be a sign of potential
• HR 90 dehydration
• 3/10 pain • Pain 3/10 is a mild pain when waking up in her knees, she admits gets better
with movement; continue to monitor for worsening pain; joint pain can also
be a sign of dehydration
Current Assessment:
GENERAL SURVEY: Alert, flat affect and slow to respond to questions in a soft tone (hypophonia). Oriented
and in no acute distress, dress appropriate for the season, hygiene and grooming normal
for age and gender. Sitting with a forward leaning posture.
NEUROLOGICAL: Alert & oriented to person, place, time, and situation (x4); muscle strength 4/5 in both
upper and lower extremities bilaterally. Tremors noted at rest in hands.
HEENT: Head normocephalic with the symmetry of all facial features, but tremor noted.
PERRLA, sclera white bilaterally, conjunctival sac pink bilaterally. Lips, tongue, and oral
mucosa pink and tacky dry.
RESPIRATORY: Breath sounds clear with equal aeration on inspiration and expiration in all lobes
anteriorly, posteriorly, and laterally, nonlabored respiratory effort on room air.
CARDIAC: Pink, warm & dry, no edema, heart sounds regular, pulses strong, equal with palpation at
radial/pedal/post-tibial landmarks, brisk cap refill. Heart tones audible and regular, S1
and S2, noted over A-P-E-T-M cardiac landmarks with no abnormal beats or murmurs.
No JVD noted at 30-45 degrees.
ABDOMEN: Abdomen round, soft, and nontender. BS hypoactive in all four quadrants.
GU: Urinary Incontinent episode x1, urine yellow
INTEGUMENTARY: Skin oily but warm with normal color for ethnicity. No clubbing of nails, cap refill <3
seconds, Hair soft, distribution normal for age and gender. Skin integrity intact, skin
turgor elastic, tenting present.
3
