Case Study 2

History:
Ester is a 75-year-old female who is not active.

Presentation and Examination

The patient presents with Parkinson’s disease (PD). She was diagnosed at the age of 35. This
was considered early for her age range. She first saw signs when she was tripping on small
cracks. Parkinson’s disease is a neurodegenerative (loss of neutrons in brain cell) disorder
affecting the motor skill of a person. Which can then affect a person's physical, functional and
mental activity. With age, Parkinson’s disease will later take over the body. The patient is now
in stage 5.

However, symptoms are bradykinesia, rigidity, hyperkinesia and resting tremor (Mestre, 2010). 
Tremor is looking at the patient fingers. Rigidity is looking at the limb movement in a jerking
increment, and looking if the neck is stiff or trunk. Bradykinesia when a patient takes longer to
complete most activities such as, rising from a sitting position or turning in bed. Hyperkinesia
causes abnormally diminished movement. At a later stage patient suffering from PD have a
higher chance of falling, less control of motor function, dementia and a loss of autonomy. My
client is in the last stage. In my experience usually, they are very stiff from their head to there
entire body. Her face is mask-like and expressionless. Her speech is soft, slurred and less
audible. The patient has problems with muscle and joint function. She develops dysphagia
because she drools, and is at risk for choking or aspiration. I have to do everything for her. That
is why I'm here to assist them with everything she needs help with. But it takes a lot of work
doing it by myself. So usually I have another aid to assist me. She has an issue with
hypertension. Taking care of an elderly with Parkinson's takes a lot of work, it is usually not
easy to hold them up by yourself, she can not walk anymore and we need a wheelchair to move
her around. Even though I am tired and sometimes impatient, I remember that the best part of
my day is knowing I did everything for my patients. Sometimes seeing my patient sick, I feel
bad, but I try forgetting that so I can help them become healthy person. I strive to help them live
and enjoy the next day.

Diagnosis:
Diagnostic for Parkinson’s disease is PET scanning which is used in evaluating levodopa uptake
and conversion to dopamine in the corpus striatum. The doctors will look at patient history and
their daily activities. The doctor can do a neurologic examination.

Treatment and Outcomes:

There are no medical or surgical approaches that prevent PD.  They are ways to slow down the
progression of the disease. There is pharmacologic therapy such as she is taking dopamine
agonists (immediate release, controlled release, and patch).  She is being treated with
levodopa-carbidopa 100/25 mg. Also, one and a half pills q.i.d., and non-ergot derivative of
ropinirole. She also takes benztropine which is acetylcholine blocking drugs. The patient had
surgical interventions which they implanted a pacemaker. It's like a brain implant showing
promising results in relieving tremors. She had physical therapy 2 times a week. Sometimes she
went to swimming therapy to help her balance.

Cite:

Hayes, L. “Early Onset Parkinson’s Disease. Part 1: The Patient’s Story.” Canadian Family
Physician 40 (1994): 506–508. Print.

Mestre, Tiago, and Joaquim J Ferreira. “Pharmacotherapy in Parkinson's disease: case

studies.” Therapeutic advances in neurological disorders vol. 3,2 (2010): 117-26.
doi:10.1177/1756285609352366