SCENARIO OVERVIEW:
Charles Peterson (pronouns: he/him/his) is a patient admitted for a fall and suspected closed head
injury. Mr.Peterson has a history of Parkinson’s Disease and reports losing his balance while
walking. He states he hit his head on the floor and denies loss of consciousness. He is a retired
farmer and lives with his wife on the family farm. His wife reports changes in Charles’ ability to
complete activities of daily living. The scenario starts as the patient arrives to the unit from the
Emergency Department.
1. What neurological assessment findings would you anticipate for a patient who has
Parkinson’s Disease?
Anticipated Neurological Assessment Findings in Parkinson’s Disease
Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting motor
control due to dopamine deficiency in the basal ganglia.
Expected Neurological Assessment Findings:
• Resting tremor (often unilateral, “pill-rolling” tremor of hands)
• Bradykinesia (slowness of movement, difficulty initiating movement)
• Muscle rigidity (cogwheel or lead-pipe rigidity)
• Postural instability and impaired balance
• Shuffling gait with reduced arm swing
• Masked facies (reduced facial expression)
• Monotone, soft speech (hypophonia)
• Micrographia (small, cramped handwriting)
• Delayed reaction time
• Possible cognitive slowing or mild confusion, especially under stress or acute illness
Given Mr. Peterson’s fall and suspected closed head injury, the nurse should also closely
monitor for:
• Changes in level of consciousness
• Headache, nausea, vomiting
• New or worsening confusion
• Unequal pupils or abnormal pupillary response
2. What neurological assessment findings would you anticipate for a patient who has
Parkinson’s Disease? Your patient has Parkinson’s Disease, and was admitted for a fall
and possible closed head injury. Home Medications: Carbidopa/Levodopa 25/100 mg PO
TID For each medication, describe the following: • Mechanism of action • Safe dose
range • Expected half-life • Side effects.
, Medication Review: Carbidopa/Levodopa (25/100 mg PO TID)
Medication: Carbidopa/Levodopa
Indication: Management of Parkinson’s disease symptoms
Mechanism of Action
Levodopa is a dopamine precursor that crosses the blood–brain barrier and is converted
into dopamine in the brain, improving motor symptoms.
Carbidopa inhibits peripheral conversion of levodopa to dopamine, increasing availability
in the brain and reducing peripheral side effects.
Safe Dose Range
Typical levodopa dosage range: 300–1,200 mg/day in divided doses
Carbidopa dosage should be ≥75 mg/day to effectively inhibit peripheral metabolism
Mr. Peterson’s dose (25/100 mg TID = 300 mg levodopa/day) is within a safe and
common starting range
Expected Half-Life
Levodopa: Approximately 1–2 hours
Short half-life contributes to “wearing-off” effects and fluctuating symptom control
Common Side Effects
Orthostatic hypotension
Nausea and vomiting
Dyskinesias (involuntary movements)
Confusion or hallucinations (more common in older adults)
Dizziness
Sleep disturbances
Charles Peterson (pronouns: he/him/his) is a patient admitted for a fall and suspected closed head
injury. Mr.Peterson has a history of Parkinson’s Disease and reports losing his balance while
walking. He states he hit his head on the floor and denies loss of consciousness. He is a retired
farmer and lives with his wife on the family farm. His wife reports changes in Charles’ ability to
complete activities of daily living. The scenario starts as the patient arrives to the unit from the
Emergency Department.
1. What neurological assessment findings would you anticipate for a patient who has
Parkinson’s Disease?
Anticipated Neurological Assessment Findings in Parkinson’s Disease
Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting motor
control due to dopamine deficiency in the basal ganglia.
Expected Neurological Assessment Findings:
• Resting tremor (often unilateral, “pill-rolling” tremor of hands)
• Bradykinesia (slowness of movement, difficulty initiating movement)
• Muscle rigidity (cogwheel or lead-pipe rigidity)
• Postural instability and impaired balance
• Shuffling gait with reduced arm swing
• Masked facies (reduced facial expression)
• Monotone, soft speech (hypophonia)
• Micrographia (small, cramped handwriting)
• Delayed reaction time
• Possible cognitive slowing or mild confusion, especially under stress or acute illness
Given Mr. Peterson’s fall and suspected closed head injury, the nurse should also closely
monitor for:
• Changes in level of consciousness
• Headache, nausea, vomiting
• New or worsening confusion
• Unequal pupils or abnormal pupillary response
2. What neurological assessment findings would you anticipate for a patient who has
Parkinson’s Disease? Your patient has Parkinson’s Disease, and was admitted for a fall
and possible closed head injury. Home Medications: Carbidopa/Levodopa 25/100 mg PO
TID For each medication, describe the following: • Mechanism of action • Safe dose
range • Expected half-life • Side effects.
, Medication Review: Carbidopa/Levodopa (25/100 mg PO TID)
Medication: Carbidopa/Levodopa
Indication: Management of Parkinson’s disease symptoms
Mechanism of Action
Levodopa is a dopamine precursor that crosses the blood–brain barrier and is converted
into dopamine in the brain, improving motor symptoms.
Carbidopa inhibits peripheral conversion of levodopa to dopamine, increasing availability
in the brain and reducing peripheral side effects.
Safe Dose Range
Typical levodopa dosage range: 300–1,200 mg/day in divided doses
Carbidopa dosage should be ≥75 mg/day to effectively inhibit peripheral metabolism
Mr. Peterson’s dose (25/100 mg TID = 300 mg levodopa/day) is within a safe and
common starting range
Expected Half-Life
Levodopa: Approximately 1–2 hours
Short half-life contributes to “wearing-off” effects and fluctuating symptom control
Common Side Effects
Orthostatic hypotension
Nausea and vomiting
Dyskinesias (involuntary movements)
Confusion or hallucinations (more common in older adults)
Dizziness
Sleep disturbances
