Answer Happy

History of Present Problem J.D. is a 68 yo man who presents with his caregiver to the neurology clinic for his routine three-month evaluation. His caregiver states "His medicine for Parkinson's doesn't seem to be working well anymore." He reports that he has more "bad days" than "good days." He complains of "feeling more wooden" recently and often times awakening with a painful cramp in his left foot. His appetite has decreased and he states that he is "just not interested in food." His caregiver says that she has to tap his brow lightly because he forgets to blink for long periods of time occasionally. His caregiver reported that last week he fell sideways out of his chair when reaching for a potato chip that fell to the floor, but was not injured. His caregiver stated "he seems clumsier in the evenings." Personal/Social History J.D. lives alone and has caregivers that are in and out on a daily basis. His caregiver states "he is not interested in wood-working anymore and sits and stares at the television for hours, often not moving." She reports that he is always happy to see his children, even smiles when they are visiting. She also reports that he enjoys playing dominos with his grandchildren but they get impatient with him, he is slow to place his dice when it is his turn. 1. What questions would the nurse ask to explore and identify potential problems in this case? Past Medical History Diabetes Mellitus type 2 x 23 years Parkinson's Disease x 5 years GERD x 2 years Hyperlipidemia x 2 years . Family History Father died from hypertension-related cerebral hemorrhage at age 64 Mother died from renal failure secondary to Diabetes Mellitus at age 73 One brother alive and well Two daughters alive and well Social History (-) for alcohol, tobacco, and illicit drug abuse; drinks 2 cups caffeinated coffee each morning Retired farmer (31 years) Married 42 years, wife passed away 3 years ago Relocated after his wife's death to be near his daughters Enjoys playing games Family recently constructed a ramp at his home
2. What information from the above is relevant that must be recognized as clinically significant? RELEVANT DATA RATIONALE 2. What is the relationship of the patient's past medical history and home meds listed below? Complete the table below. History/PMH Home Meds Expected Outcomes Pharm. Classification Omeprazole 20mg po QD x 2 years Glyburide 6mg po QD x 1 year Carbidopa/levodopa 25/100 1 tablet @ 08:30 AM, 12:30 PM, 4:30PM, and 8:30PM (started 2 years ago with multiple doses changes since that time) Entacapone 200mg po @ 08:30AM, 12:30PM, 4:30PM, and 8:30 PM X 3 weeks
Simvastatin 20mg po HS X 1 year Metformin 850mg po BID x 8 months Allergies PCN (hives and edema of face and tongue) Review of Systems The patient has no complaints other than those noted. He denies nausea, vomiting, sweating, heartburn, tearing, paresthesia's, blurry vision, constipation, and dizziness. He also reports no problems with chewing, swallowing, and urination. He is sleeping "OK" at night and often takes a short afternoon nap. . > Physical Assessment and Lab Tests General Appearance: Elderly, overweight white male who appears his stated age. Well groomed, cleanly shaven, and his overall hygiene seems to be very good. Shuffling gait noted. Voice is soft and monotone and is cognizant of all that is going on around him. Vital Signs: T 98.4 F, P 73, BP 130/80, RR 14, HT 5'9" WT 2051b Skin: Normal turgor Erythema and dry, white scales on forehead, and in naral folds Mild dandruff on scalp, within and behind ears No bruises noted HEENT: Speaks only in short, simple phrases Mask-like facial expression Eye blinking, approximately 1/minute PERRLA EOMI TMs intact Oropharynx without redness, exudate, or lesions Mucous membranes moist Wears dentures Neck Flexion of head and neck prominent No masses, bruits, or JVD Normal thyroid Lungs/Thorax/Heart Respiration even, unlabored Bilateral anterior, posterior, and lateral lung fields clear .
Parkinson Disease Case Study . Localized kyphosis with exaggerated lordosis of the lumbar spine Normal sinus rhythm without murmurs Abdomen Soft, non-distended, non-tender Liver and spleen not palpable No palpable masses BS positive x4 Genitourinary/Rectal Prostate moderately enlarged but no nodules palpated No rectal polyps or hemorrhoids Musculoskeletal/Extremities Resting tremor, bilateral, LR Resistance to movement Difficulties with balancing and getting up from chair Poor fine motor coordination Peripheral pulses moderately subnormal DTRs 2+ Muscle strength 4/5 throughout Left foot with normal sensation and vibration Neurological CNs intact Unified Parkinson Rating Scale- Scored 11/16 (O=no disability, 16=total disability) 20% on Schwab and England ADL-can do nothing alone, can help slightly with some chores, severe invalid Stage 4 of Hoehn Yahr Staging of PD, severe symptoms, rigidity, and bradykinesia, should no longer live alone, (cachexia not present yet) 3. Identify indications of the cardinal signs of Parkinson disease in this case. List any other relevant assessment findings. . . .