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:
Parkinson's disease PD will continue to worsen; it is important to assess constantly
Urinary tract infection and to adapt to new challenges.
dehydration UTI can be a complication of PD because of the patient’s
Lilly has lost ten pounds in the past inability to fully empty their bladder. Certain medications for
month. has a BMI of 17.8. PD can increase the risk of dehydration.
She may be suffering from dysphagia and is underweight
RELEVANT Data from Social History: Clinical Significance:
Widowed The loss of a spouse can cause depression, but she is at
One son that lives 30 away increased risk for depression due to PD. Depression is a
Reluctantly agreed to go to a long- complication associated with PD.
term care facility She is at risk for isolation due to being widowed and her only
child living 30 min away.
Loss of independence can be another risk factor for depression.
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?
2
, (Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
Resting pulse is tachycardic and could be due to dehydration.
P: 90 Pain could be a complication of PD and could be the reason she is tachycardic as
Pain well, even though her pain level is not high.
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. What assessment data is RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion & Maintenance)
RELEVANT Assessment Data: Clinical Significance:
Flat affect Depression can cause her to have a flat affect.
Tremors at rest in hands Can cause difficulties for her to perform her ADL’s.
Tremor noted in face Tremors in face can make it hard for her to eat or drink.
Lips, tongue, and oral mucosa Indicates dehydration
pink and tacky dry. Can indicate constipation, consistent with dehydration.
BS hypoactive in all four Incontinence could indicate a problem getting to the bathroom in
quadrants time. Patients with PD may have a hard time getting anywhere
Urinary incontinence fast.
Skin tenting Indicates dehydration.
Lab Results-On Admission:
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:
Parkinson's disease PD will continue to worsen; it is important to assess constantly
Urinary tract infection and to adapt to new challenges.
dehydration UTI can be a complication of PD because of the patient’s
Lilly has lost ten pounds in the past inability to fully empty their bladder. Certain medications for
month. has a BMI of 17.8. PD can increase the risk of dehydration.
She may be suffering from dysphagia and is underweight
RELEVANT Data from Social History: Clinical Significance:
Widowed The loss of a spouse can cause depression, but she is at
One son that lives 30 away increased risk for depression due to PD. Depression is a
Reluctantly agreed to go to a long- complication associated with PD.
term care facility She is at risk for isolation due to being widowed and her only
child living 30 min away.
Loss of independence can be another risk factor for depression.
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?
2
, (Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
Resting pulse is tachycardic and could be due to dehydration.
P: 90 Pain could be a complication of PD and could be the reason she is tachycardic as
Pain well, even though her pain level is not high.
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. What assessment data is RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion & Maintenance)
RELEVANT Assessment Data: Clinical Significance:
Flat affect Depression can cause her to have a flat affect.
Tremors at rest in hands Can cause difficulties for her to perform her ADL’s.
Tremor noted in face Tremors in face can make it hard for her to eat or drink.
Lips, tongue, and oral mucosa Indicates dehydration
pink and tacky dry. Can indicate constipation, consistent with dehydration.
BS hypoactive in all four Incontinence could indicate a problem getting to the bathroom in
quadrants time. Patients with PD may have a hard time getting anywhere
Urinary incontinence fast.
Skin tenting Indicates dehydration.
Lab Results-On Admission:
3
