Case Study 63 Parkinson

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Rochester Community Technical College *

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MISC

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Health Science

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Feb 20, 2024

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docx

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Uploaded by PresidentRockRaven42

Case Study 63 Parkinson’s disease Scenario L.C. is a 78-year-old white man with a 4-year history of Parkinson’s disease (PD). He is a retired engineer, is married, and lives with his wife in a small farming community. He has 4 adult children who live close by. He is taking carbidopa-levodopa, pergolide, and amantadine. L.C. reports that overall he is doing “about the same” as he was at his last clinic visit 6 months ago. He reports that his tremor is about the same, his gait is perhaps a little more unsteady, and his fatigue is slightly more noticeable. L.C. is also concerned about increased drooling. The patient and his wife report that he is taking carbidopa-levodopa 25/100 mg (Sinemet), 1 tablet an hour before breakfast and 1 tablet 2 hours after lunch, and carbidopa-levodopa 50/200 mg (Sinemet CR), 1 tablet at bedtime. On the previous visit they were encouraged to try taking the carbidopa-levodopa (Sinemet) more times throughout the day, but they report that he became very somnolent with that dosing regimen. He also reports that his dyskinetic movements appear to be worse just after taking his carbidopa-levodopa. 1. What is Parkinsonism? 2. What is PD? 3. What are the clinical manifestations of PD? Place a start next to the symptoms L.C. has mentioned. Mask-like face with blank facial expression Inability to blink: “stare” Drooling, decreased gag reflex, inability to chew or swallow* Unintentional tremor, “pill rolling,” which stops with intentional movements* General weakness and muscle fatigue* Restlessness, compelling need to ambulate Loss of postural reflexes: stooped, shuffling gait (called a Parkinsonian gait) Autonomic manifestations, diaphoresis, seborrhea, postural hypotension, decreased libido, GI hypomotility, urinary retention High-pitched, monotone voice

4. L.C’s wife asks you, “How do the doctors know L.C. has Parkinson’s disease? They never did a lot of tests on him.” How is the diagnosis of PD made? 5. L.C.’s wife comments “I don’t even know which one of his medicines he takes for his Parkinson’s.” What medications are used for PD? 6. L.C. asks, “If I don’t have enough dopamine, then why don’t they give me a dopamine pill?” Why can’t oral DA be given as replacement therapy? 7. Levodopa is always given in combination with carbidopa. Why? 8. What is the current recommended nutritional management for PD?

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