Parkinsons Disease Case Study PDF

Preview

Summary

Parkinson's disease case study + answers ...

Description

Parkinson’s Disease Case Study Presenting HistoryPat is an 80-year-old woman with Parkinson’s disease. She lives in an Aged Care facility and was referred to the dietitian by the medical officer for dietetic review and education as she is to be discharged from hospital following a recent fall where she sustained a fracture to her left arm. Pat receives a pension and lives in a one-bedroom apartment with her husband who also receives a pension. Her health affects her day to day functions as she does not feel that sturdy on her feet anymore and sometimes her muscles feel weak and stiff. She also feels less confident now to move around after her recent fall. Pat and her husband loved to go for an early morning walk most days of the week before her fall. She has never seen a dietitian before. Medical history Parkinson’s diagnosed 6 years ago. Type 2 diabetes mellitus, hypertension Biochemistry and tests Serum Albumin = 38g/L Serum Sodium = 140mmol/l Serum Potassium = 4.1 mmol/l HbA1c = 8%BP: 132/82 mmHg Medication Levodopa (Parkinson management)Metformin (Biguanide) Methyl-dopa (Anti-hypertensive) Anthropometry Height: 168cm Current Weight: 70 kg Weight on admission 71 kg (weight was 73 kg 6 months ago, she weighed 73kg for a few years) Physical Findings Pat struggles to get out of the chair without support. She mentions her clothes feels looser around her waist. Diet History (usually intake at home) Breakfast: 2 x Weetbix, 200mls Full cream milk, 1 tspn sugar Morning tea: 1 cup tea, black with 1 tspn sugar, 1 glass cordial Lunch: 1/2 cup fresh fruit + 200gms (1 tub) Full fat flavoured yoghurt + 1 glass cordial Afternoon tea: 1 slice of processed cheese on 2 Sao biscuits (No butter or margarine) + 1 glass cordial Dinner: Small meal of 1 (60g) lamb chump chop (grilled), 1 medium potato, 1⁄4 cup peas (sometimes too tired to eat) + 1 glass cordial Supper: 1 small chocolate bar with black coffee, no sugar. She reports of liking most foods except she can’t make the same dishes she used to. Pat complains she sometimes struggle to chew tough foods. She has noticed her food intake reduce over the last 6 months.

Question 1: What conclusions can you draw from your patient’s nutrition assessment information?

An 80-yr-old woman with Parkinson’s disease has sustained a fracture to her left arm likely due to reduced physical function which is part of the progression of Parkinson’s disease. She currently has a healthy weight but has experienced 4% unintentional weight loss over the past 6/12 which places her at an increased risk of malnutrition. She potentially has reduced muscle strength but a full SGA needs to be conducted to identify whether this is related to malnutrition or her disease progression. She also has a medical history of type 2 diabetes and hypertension. Her blood glucose levels do not seem to be well controlled as her HbA1c is above the recommended 7% target. She is receiving Metformin but her diet seems to be high in refined carbohydrates which will impact her long-term blood glucose control. Her blood pressure is normal, she takes an anti-hypertensive which seems to manage this well. Her usual diet shows she is meeting her energy needs but is not having all of her recommended food serves, thus her requirements may lean towards the higher range of the recommendations. She has also recently lost weight which supports this conclusion. Her protein intake is inadequate and may be linked to her finding it hard to chew tough foods like meat. The inadequate protein intake may play a role in her reduced physical function. She states she is experiencing problems with her cooking ability and mobility, this may impact her food intake. Lastly, she and her husband are pensioners which may impact food choice and availability. Question 2: Considering your patient’s underlying nutrition concerns, what are the key nutrition problems and why? Inadequate protein-energy intake (NI-5.7.1) due to lack of knowledge regarding requirements as evidence by meeting 33% of protein requirements and 4% unintentional weight loss. I want to make sure she receives adequate oral intake to prevent or improve malnutrition risk. Patients with Parkinson’s disease can have increased requirements and may need to increase intakes above normal requirements to prevent weight loss or achieve weight maintenance. Predicted suboptimal intake (NI-1.4) due to reduced physical ability 20 to Parkinson’s disease as evidence by report that she feels less confident to move around, reduced cooking and chewing ability. I’m concerned that her intake will decline once she is discharged as she has reduced physical function and her disease has impacted her ability to cook and chew. These are all risk factors related to reduced oral intake which can quickly result in further weight reduction. Further unintentional weight loss will result in malnutrition. Malnutrition is linked with reduced QoL, increased hospital stay (thus longer recovery time) and increased health care costs Intake of types of carbohydrate inconsistent with needs (refined CHO) (NI-5.8.3) due to lack of knowledge on healthy food choices to manage T2DM as evidenced by HbA1c of 8% and having 4 glasses cordial/day. Refer to Diabetes outpatient clinic to address this in follow-up. Good glycaemic control will be a future goal for her as uncontrolled diabetes can increase her risk of other comorbidities and longterm health consequences. Additionally, it can delay recovery and increase her susceptibility to infection and illness. Question 3: Can you explain how your nutrition intervention plan has considered the patient’s individual situation and needs? To address the key nutrition problems I’ve set the following goals and objectives: Goals: • Weight maintenance • Adequate energy and protein intake • Provide nutrition education on meeting her needs • Promote euglycemia (Long-term goal) Objectives: • Protein intake of >56 – 98g and energy intake of 1000kJ above current intake • Weight maintenance at 70 kg • HbA1c...