Biological Needs Of Parkinson’s Patient

A 73-year-old Caribbean female having Parkinson’s ailment is the subject of this case analysis. The client’s identity would be disguised due to privacy and in accordance with NMC (2018). Throughout this circumstance, the name Eve would be used. Eve was admitted to the hospital after being seen and evaluated throughout the Accident and Emergency (A&E) section owing to the swollen leg. Eve had hallucinations, roaming, extreme spontaneous trembling of both fingers and hands, sleeping issues, and hypotension when she was admitted. Eve was held on Section 5(2) and subsequently Section 2 of the Mental Health Act (MHA) after being assessed in the A&E unit and transferred to the facility. For analysis, both provisions of the MHA (2007) are used. Eve was advised of the entitlements both orally and in writing, as provided in MHA Part 132 (Gupta et al., 2021). Eve declined to take medication, claiming she didn’t need antipsychotics. She was told that if she didn’t take the medicine, a depot injection would be administered for the benefit because Eve was a danger to herself and others.

Hence, this paper is going to analyse her needs of Eve using the biopsychosocial model, and how it is related to her presented conditions. Also, this paper is going to discuss the intervention and multi-professional approaches to improve her conditions.  Biopsychosocial Analysis Of Parkinson’s Patient Essay Paper

The biopsychosocial framework is the inter-disciplinary paradigm, which examines how biology, psychological, as well as socio-environmental elements are linked. The design looks at how these factors are related in a variety of areas, including healthcare and sickness, as well as human progress (Kusnanto et al., 2018). According to this model, Eve has several biological, psychological and social needs.

1. Swollen feet
2. A tremor in hands and fingers
3. Sleeping difficulties
4. Hypotension
5. Hallucination

According to this model, Eve has five biological needs. The chief problem for which she gets admitted into the hospital is swollen feet. However, the exact reason for her swollen feet is unknown. Feet can get swollen due to several reasons; however, the most common reason is the cardiovascular problem, which can cause increased fluid accumulation inside the legs. Also, this is an indication of a heart attack, where the pumping action of the heart gets diminished. Hence, this problem needs to be managed urgently (Lewis et al., 2018). Moreover, hypotension and tremor can also occur due to ineffective cardiac function. Due to hypotension, the brain and other vital organs may receive less oxygenated blood and may fail to function properly. This situation can lead to the development of hypoxia condition, ultimately causing shut down of the vital organs. Also, hallucination and sleeping problem suggests Eve might have developed some neurological complication due to Parkinson’s disease (Ball et al., 2019).

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1. Mental depression
2. Detention

According to the presented condition, Eve has developed depressive symptoms. Hence, to improve her condition antipsychotic drug is given. Also, to reduce the chance of self-injury and injury to other people, she was being detained according to the MCA. However, this can increase the chance of developing stress that can affect the psychological condition of the patient aversively (Ball et al., 2019).

1. Separation from her daughter.
2. Caribbean background
3. Financial difficulty

It was mentioned that her daughter lives outside of London, and the relationship between Eve and her daughter is unknown. This might suggest they may not have a good relationship. As a result, additional support and assistance are needed from her daughter to improve Eve’s condition. Also, Caribbean people face high racism in the United Kingdom (UK), and this can increase the chance of social stress (Hackett et al., 2020). Additionally, Eve is dependent upon the tenant for her finance. Hence, she might fail to properly take care of her property due to this condition.

Psychological And Social Needs Of Parkinson’s Patient

Biological intervention

To manage her Parkinson’s disease and other neurological complications, administration of antipsychotic drugs Co-careldopa and Quetiapine are necessary. Also, to manage her hypotension administration of fluid and electrolytes are necessary. Also, to manage her swollen leg, administration of a diuretic drug and compression are necessary. As the case study suggests, Eve has developed hallucinations. There have been at least 3 chemical methods for causing hallucinations: (1) psychostimulants activate dopamine D2 receptors (D2Rs), (2) psychedelics activate serotonin 5HT2A receptors (HT2ARs), as well as (3) dissociative anaesthetics inhibit glutamate NMDA receptors (NMDARs) (Cassidy et al., 2018). Dopamine seems to be a neurotransmitter, meaning it sends and receives messages in the brain. Hence, blocking this dopamine receptor is necessary to reduce the chance of hallucinations. The majority of antipsychotic medications are believed to disrupt dopamine channels within the brain. This slows the stream of these signals that might help the patient feel less psychotic (Chokhawala and Stevens, 2021). Quetiapine works by interacting with multiple neurotransmitter receptors, including the serotonin as well as dopamine sites, to alleviate the positive as well as negative complications of schizophrenia and severe depression (Maan et al., 2021). Additionally, fluid and electrolytes administration is necessary to improve blood pressure. In healthy people, a 30-minute i.v. administration of 20–30 ml/kg saline solution increased pulmonary capillary intravascular volume and heart rate by 12 per cent, with a 7-mmHg rise in systolic blood pressure (Lewis et al., 2018). However, as Eve has developed swollen leg, the administration of fluids needs to be closely monitored. Moreover, administration of diuretics may be necessary to manage the edema in her leg. Also, leg raise and the use of compression can help in this situation (lewis et al., 2018).

Social intervention

To address her social needs, it is important to incorporate her ex-partner into the care plan. Jazieh et al (2018) suggest incorporating a close person in the care plan can help to improve the chance of a positive outcome. In this case, her next of kin is her ex-partner. Hence, the nurse must need informed consent from him to provide effective care to Eve. This will help to feel the patient that they are taking proper care. Also, such intervention can help to customise the care plan for the patient. This can help to improve patient satisfaction. Moreover, in this case, providing culturally orientated care is important. As Eve belongs to a culturally diverse group, she might have some cultural differences. Fekete (2020) suggests cultural racism against the Caribbean people in the UK is high. However, such experience can lead to poor clinical outcomes; also it can increase the chance of mental stress. Hence, it is important to understand the cultural background of Eve and provide care accordingly. To do so the nurse needs to engage in therapeutic communication with the patient and must value her decision.

Psychological intervention

According to the case study, Eve has several psychological needs. She is experiencing hallucinations and wandering into the wards. Also, she has developed depression. Therefore, to improve her condition cognitive behavioural therapy (CBT) can be implemented. Reynolds et al (2020) mention although clinical manifestations are the hallmark of Parkinson’s disease (PD), nonmotor problems could have a substantial impact on everyday functional ability. Anxiety is common and severe in Parkinson’s disease, yet it is underexplored and inadequately treated. In Parkinson’s disease, much emotional study focused on depression instead of anxiety. However, finding from the author suggests weekly CBT intervention may be an effective tool to manage PD (Mulders et al., 2018). This can help to lower the prevalence of depression and anxiety, with skill-building, and improving the self-esteem of the patient. Most of the Patients with PD who finished the research revealed that cluster CBT had been a successful therapy for sadness and anxiety. CBT also lessened the intensity of non-movement problems, like lethargy, in patients. Hence, CBT can be given to Eve to improve his mental condition. Also, CBT can help to improve the cognitive function of the patient, thus improving their health literacy (Moonen et al., 2021).

Intervention And Multi-Professional Approaches

Using quetiapine increases the chance of metabolic problems, especially in people who have a lot of additional cardiovascular risk in their lives. Therefore, as Eve has developed swollen leg, which may be due to a cardiovascular problem; increased monitoring is required while administering the quetiapine (Maan et al., 2021). Moreover, this drug cans other side effects such as vomiting, constipation, weakness and dizziness. Hence, it is important to monitor the dosage while giving this drug. The nurse needs to properly administer the correct amount of dosage at the correct time to reduce the chance of adverse reactions. However, in case of an adverse reaction, the nurse needs to contact the physician to reduce the amount of dosage (Maan et al., 2021). As a result, frequent patient monitoring, and documentation is necessary.

To manage Eve’s condition involvement of a registered nurse (RN), physician, psychotherapist, and a cardiac specialist is necessary. A psychotherapist can help Eve with CBT and with her overall mental condition; a nurse can help with documentation, medicine administration and providing patient education (Lewis et al., 2018). A cardiac specialist can help to determine the exact reason for her swollen feet and overall cardiac condition and a physician can monitor the overall progress made by the patient. However, a nurse needs to effectively communicate with all of these professionals and uphold the rights of the patient (Lewis et al., 2018).

Eve did not want to take her medication, as a result, she was advised to have a depot injection. However, following the interventions, her condition started to improve. Nevertheless, it was found out that she still experiencing lucid dreaming and sometimes she also experiences hallucinations. However, the overall frequency of the hallucination was reduced; indicating the medication and the treatment plan were working properly. Also, it was stated that his mental condition is started to improve. Therefore, she has fewer depressive symptoms and anxiety. However, the indication of Parkinson’s disease is still evident. Hence, the goal of managing her Parkinson’s disease is not met. Due to the prevalence of this disease, she is exposed to the risk of having memory difficulties, mood swings, sleeping problems and tremors (Balestrino and Schapira, 2020). However, her blood pressure is well managed. She has developed a normal blood pressure and the medicine administration was closely monitored to reduce the chance of negative outcomes.

Upon administration, she started to wander into the unit. Also, it was mentioned that she has developed a hallucination problem and experiencing tremors. Therefore, such a condition can lead to a sudden fall of the patient, which can jeopardise the patient’s safety and may lead to additional harm. Moreover, due to her unstable mental condition, she might be a risk for her own and other people. Therefore, Eve was first imprisoned under Section 5(2) of the MHA, and later on Section 2 of the Act. For evaluation, both parts of the MHA – MHA (2007) are used. Eve was advised of her privileges both orally and in writing, as provided in MHA Section 132. However, detaining a patient comes with several ethical and legal issues. Chin (2019) mentions the main ethical issue is the patient’s autonomy. According to the concept of autonomy, it is important to respect the decision made by the patient. However, detaining a patient will go against the concept of autonomy. However, according to the concept of beneficence, a nurse must do the best to protect the safety of the patient and improve their health. Hence, if the nurse did not restrain her, she might cause damage to herself as well as others. Therefore, it will go against the concept of beneficence. Therefore, restraining a patient can cause a conflict between the patient’s autonomy and beneficence (Johnstone 2019). Also, Chin (2019) suggests detaining a patient can increase the guilt feeling for a nurse. Moreover, before restraining a patient it is important to discuss the issue with the patient and close relatives to avoid any ethical and legal complications.

Conclusion

Eve has several biological, psychological and social needs to improve her condition. As a result, the use of the MDT approach is necessary to improve her condition. In this case, the nurse needs to actively engage with other professionals to promote patient outcomes. Moreover, the nurse needs to provide culturally oriented care to the patient. The nurse needs to take proper informed consent from the patient to avoid any complications. Additionally, the nurse needs to closely monitor her Parkinson’s condition, as this problem has not yet been solved.

References

Balestrino, R. and Schapira, A.H.V., 2020. Parkinson disease. European journal of neurology, 27(1), pp.27-42.

Ball, N., Teo, W.P., Chandra, S. and Chapman, J., 2019. Parkinson’s disease and the environment. Frontiers in neurology, 10, p.218.

Cassidy, C.M., Balsam, P.D., Weinstein, J.J., Rosengard, R.J., Slifstein, M., Daw, N.D., Abi-Dargham, A. and Horga, G., 2018. A perceptual inference mechanism for hallucinations linked to striatal dopamine. Current Biology, 28(4), pp.503-514.

Chin, H.P., 2019. Detention, Capacity, and Treatment in the Mentally Ill—Ethical and Legal Challenges. Cambridge Quarterly of Healthcare Ethics, 28(4), pp.752-758.

Chokhawala, K. and Stevens, L., 2021. Antipsychotic medications. In StatPearls [Internet]. StatPearls Publishing.

Fekete, L., 2020. Reclaiming the fight against racism in the UK. Race & Class, 61(4), pp.87-95.

Gupta, S., Dinakaran, D. and Athanas, E., 2021. Mental Health of Black and Minority Ethnic Communities in the UK and the Utilization of the Mental Health Legislation. Mental Illness and Migration, p.513.

Hackett, R.A., Ronaldson, A., Bhui, K., Steptoe, A. and Jackson, S.E., 2020. Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC public health, 20(1), pp.1-13.

Jazieh, A.R., Volker, S. and Taher, S., 2018. Involving the family inpatient care: a culturally tailored communication model. Global Journal on Quality and Safety in Healthcare, 1(2), pp.33-37.

Johnstone, M.J., 2019. Bioethics: a nursing perspective. Elsevier Health Sciences.

Kusnanto, H., Agustian, D. and Hilmanto, D., 2018. The biopsychosocial model of illnesses in primary care: A hermeneutic literature review. Journal of family medicine and primary care, 7(3), p.497.

Lewis, S.L., Bucher, L., Heitkemper, M.M. and Harding, M.M., 2018. Medical-surgical nursing in Canada-E-Book. Elsevier Health Sciences.

Maan, J.S., Ershadi, M., Khan, I. and Saadabadi, A., 2021. Quetiapine. In StatPearls [Internet]. StatPearls Publishing.  Biopsychosocial Analysis Of Parkinson’s Patient Essay Paper