Case Study
Movement Disorder with Fall Injury
Gary Jansek is a 70-year-old who has lived with Parkinson’s disease for decades.
He was a well-respected bank president when diagnosed at the age of 45. When
diagnosed, it was expected that Gary would require full-time care within 10 years.
After the prognosis and months of depression, his lifestyle changed. He retired
early and focused on staying active. He and his wife moved to the community near
his adult children. They were able to golf and swim every day, socialize with other
couples, eat healthier, and focus on each other. The relaxing lifestyle slowed the
progression of his symptoms. Gary and Judy believe that this lifestyle is why Gary
is still able to function somewhat independently.
1. How did Gary’s lifestyle changes slow the progression of symptoms? Select
all that apply.
a. Healthier eating allows for better absorption of medications.
b. Physical activity builds muscle strength and coordination.
c. Socialization improves depression.
d. The reduction of stress decreases the need for dopamine.
e. Retiring provides for financial stability.
, Gary is beginning to fall several times a week. He sometimes feels that his feet
“stick to the floor” and when he cannot get moving he falls forward. At other
times he becomes very dizzy when standing and loses his balance. He and Judy
make an appointment with the provider to discuss their concerns.
2. The nurse completes and assessment, which finding is most concerning?
a. Large hematoma on the right hip.
b. Tremors of the fingers and hands, right worse than left.
c. Hunched stature.
d. Shuffling gait.
3. The nurse is unfamiliar with Gary’ medication and accesses resources to
learn more. Highlight the areas of the information that is most concerning
to his current situation.
Levodopa/Carbidopa Selegiline Benztropine
Classification: Dopamine agonist, Classification: Classification: Anticholinergic,
Antiparkinsonian agent. Monoamine Oxidase Antiparkinsonian agent.
Dose and Administration: 25 mg Type B Inhibitor (MAOI), Dose and Administration: 1-2
carbidopa/100 mg levodopa 3 Antiparkinsonian agent. mg/day in 1-2 divided doses
times a day; may increase till Dose and Side Effects: Confusion,
effect is achieved (max – 8 Administration: 5 mg depression, dizziness,
tables/day) twice a day with food. arrhythmias, hypotension,
Side Effects: involuntary Side Effects: Confusion, constipation, dry mouth, urinary
movements, dizziness, blurred dizziness, fainting, retention. Precautions:
vision, mydriasis, nausea dry melanoma, nausea, dry Contradicted in angle-closure
mouth, melanoma, anemia, mouth. glaucoma and with tardive
leukopenia. Precautions: Do not give dyskinesias. Use cautiously with
Precautions: Contraindicated in with meperidine, opioid cardia dysrhythmias.
glaucoma, MAOI therapy. Use analgesics, SSRIs or Assessment: Parkinsonian and
cautiously with a history of tricyclic antidepressants. extrapyramidal symptoms, bowel
cardiac, psychiatric or ulcer The side effect can be function, monitor constipation,
disease. life-threatening. measure intake and output,
Assessment: Parkinsonian and Assessment: orthostatic hypotension.
extrapyramidal symptoms, lab Parkinsonian symptoms,
abnormalities, blood pressure blood pressure.
monitoring during dose change.
Movement Disorder with Fall Injury
Gary Jansek is a 70-year-old who has lived with Parkinson’s disease for decades.
He was a well-respected bank president when diagnosed at the age of 45. When
diagnosed, it was expected that Gary would require full-time care within 10 years.
After the prognosis and months of depression, his lifestyle changed. He retired
early and focused on staying active. He and his wife moved to the community near
his adult children. They were able to golf and swim every day, socialize with other
couples, eat healthier, and focus on each other. The relaxing lifestyle slowed the
progression of his symptoms. Gary and Judy believe that this lifestyle is why Gary
is still able to function somewhat independently.
1. How did Gary’s lifestyle changes slow the progression of symptoms? Select
all that apply.
a. Healthier eating allows for better absorption of medications.
b. Physical activity builds muscle strength and coordination.
c. Socialization improves depression.
d. The reduction of stress decreases the need for dopamine.
e. Retiring provides for financial stability.
, Gary is beginning to fall several times a week. He sometimes feels that his feet
“stick to the floor” and when he cannot get moving he falls forward. At other
times he becomes very dizzy when standing and loses his balance. He and Judy
make an appointment with the provider to discuss their concerns.
2. The nurse completes and assessment, which finding is most concerning?
a. Large hematoma on the right hip.
b. Tremors of the fingers and hands, right worse than left.
c. Hunched stature.
d. Shuffling gait.
3. The nurse is unfamiliar with Gary’ medication and accesses resources to
learn more. Highlight the areas of the information that is most concerning
to his current situation.
Levodopa/Carbidopa Selegiline Benztropine
Classification: Dopamine agonist, Classification: Classification: Anticholinergic,
Antiparkinsonian agent. Monoamine Oxidase Antiparkinsonian agent.
Dose and Administration: 25 mg Type B Inhibitor (MAOI), Dose and Administration: 1-2
carbidopa/100 mg levodopa 3 Antiparkinsonian agent. mg/day in 1-2 divided doses
times a day; may increase till Dose and Side Effects: Confusion,
effect is achieved (max – 8 Administration: 5 mg depression, dizziness,
tables/day) twice a day with food. arrhythmias, hypotension,
Side Effects: involuntary Side Effects: Confusion, constipation, dry mouth, urinary
movements, dizziness, blurred dizziness, fainting, retention. Precautions:
vision, mydriasis, nausea dry melanoma, nausea, dry Contradicted in angle-closure
mouth, melanoma, anemia, mouth. glaucoma and with tardive
leukopenia. Precautions: Do not give dyskinesias. Use cautiously with
Precautions: Contraindicated in with meperidine, opioid cardia dysrhythmias.
glaucoma, MAOI therapy. Use analgesics, SSRIs or Assessment: Parkinsonian and
cautiously with a history of tricyclic antidepressants. extrapyramidal symptoms, bowel
cardiac, psychiatric or ulcer The side effect can be function, monitor constipation,
disease. life-threatening. measure intake and output,
Assessment: Parkinsonian and Assessment: orthostatic hypotension.
extrapyramidal symptoms, lab Parkinsonian symptoms,
abnormalities, blood pressure blood pressure.
monitoring during dose change.
