Question

Neurology Case Study

George is a 74-year-old male with a diagnosis of Parkinson’s disease for more than 10 years. His primary caregiver is his wife of 52 years, who is in good health except for rheumatoid arthritis. The couple’s grown sons live in another state but visit the family once a year during the Christmas holiday. Recently Mr. R. has experienced a greater degree of twitching in his arms. He slurs his speech and is difficult to understand at times. He and his wife had enjoyed a wide range of activities such as bowling, going to the movies, and trying new restaurants. However, since his condition has deteriorated they rarely leave the house. Mr. R. has also experienced difficulty walking and getting up from the bed or chair. His wife must assist him in all activities of daily living.

What abnormalities would you expect to find on his neurological evaluation?

Formulate health promotion topics, risks, and nursing diagnoses for George and his wife.

Answer 1

Neurological examination :

• Tremor : in resting condition, asymmetric
• Bradykinesia : general slowness of movement and paucity of movement , check hand grip, finger tap ,toe tap, etc
• Look for progressive reduction in speed, slowness of initiation
• Undoing and doing up buttons of dress.
• Increased muscle tone or rigidity.
• Check patients ability to stand up from sitting position, make them walk up and down, assess gait like initiation, step length,posture, tremor.
• Postural instability by performing pull test.