1
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%
✓ Physiological Adaptation 11-17%
, 2
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights reserved.
, 3
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.
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:
76-year-old female Physiological changes occur with aging in all organ systems.
Hx of hypertension, Hypertension increases the risk of heart disease, stroke, and other cardiovascular
disease
Hx of gastro esophageal reflux disease (GERD) GERD is a highly prevalent disease caused by the exposure of the esophagus to
refluxed gastric contents, PPIs are the mainstay of current treatment
Parkinson's disease The cardinal symptoms of Parkinson's disease are shaking, stiffness, and slowness
and poverty of movement. The condition leads to physical signs including tremor
at rest, rigidity on passive movement, slowness of movement (bradykinesia), and
poverty of movement (hypokinesia).
Lost ten pounds in the last month, 5 fett-6inches In patients with low body weight, the brain becomes starved and they can develop
weighs 110 lbs. and BMI of 17.8 symptoms that meet the criteria for depression. A BMI of 20-25 is ideal; 25-30 is
overweight and over 30 is obese. If the patient’s BMI is under 18.5, they
considered underweight
Son found his mother in her room alone staring into Chronic loneliness can have a significant impact on the overall health, including
space the mental health of the patient. Loneliness can increase the patient’s risk for
depression
RELEVANT Data from Social History: Clinical Significance:
Husband, John, passed away two years ago Coping with the death of a significant other isn’t easy. Grief can affect our body,
mind, emotions, and spirit.
Medical power of attorney, the son Jack, lives 30 A medical power of attorney is a legal document that names one person the health
minutes away care agent of another person. The agent has the ability to make health care
decisions and the responsibility to make sure doctors and other medical personnel
provide necessary and appropriate care according to the patient's wishes. Due to
the son living 30 mins away and at a new job it may be harder to get a hold of him
or take longer for him to get to the facility to make medical decisions for his
mother.
Was a homemaker, an active participant in her Knowing this can help show just how differently Lilly is acting now that she is at
community, and had many hobbies. She reluctantly Sunnyside Health Care Center. These changes in her behavior can be a sign of
agreed to go to Sunnyside Health Care Center after depression.
her son accepted a job that required him to travel.
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%
✓ Physiological Adaptation 11-17%
, 2
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights reserved.
, 3
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.
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:
76-year-old female Physiological changes occur with aging in all organ systems.
Hx of hypertension, Hypertension increases the risk of heart disease, stroke, and other cardiovascular
disease
Hx of gastro esophageal reflux disease (GERD) GERD is a highly prevalent disease caused by the exposure of the esophagus to
refluxed gastric contents, PPIs are the mainstay of current treatment
Parkinson's disease The cardinal symptoms of Parkinson's disease are shaking, stiffness, and slowness
and poverty of movement. The condition leads to physical signs including tremor
at rest, rigidity on passive movement, slowness of movement (bradykinesia), and
poverty of movement (hypokinesia).
Lost ten pounds in the last month, 5 fett-6inches In patients with low body weight, the brain becomes starved and they can develop
weighs 110 lbs. and BMI of 17.8 symptoms that meet the criteria for depression. A BMI of 20-25 is ideal; 25-30 is
overweight and over 30 is obese. If the patient’s BMI is under 18.5, they
considered underweight
Son found his mother in her room alone staring into Chronic loneliness can have a significant impact on the overall health, including
space the mental health of the patient. Loneliness can increase the patient’s risk for
depression
RELEVANT Data from Social History: Clinical Significance:
Husband, John, passed away two years ago Coping with the death of a significant other isn’t easy. Grief can affect our body,
mind, emotions, and spirit.
Medical power of attorney, the son Jack, lives 30 A medical power of attorney is a legal document that names one person the health
minutes away care agent of another person. The agent has the ability to make health care
decisions and the responsibility to make sure doctors and other medical personnel
provide necessary and appropriate care according to the patient's wishes. Due to
the son living 30 mins away and at a new job it may be harder to get a hold of him
or take longer for him to get to the facility to make medical decisions for his
mother.
Was a homemaker, an active participant in her Knowing this can help show just how differently Lilly is acting now that she is at
community, and had many hobbies. She reluctantly Sunnyside Health Care Center. These changes in her behavior can be a sign of
agreed to go to Sunnyside Health Care Center after depression.
her son accepted a job that required him to travel.
