- Impaired Verbal Communication Related to Inability to control face, throat, mouth, and vocal cord muscles and extrapyramidal system dysfunction as evidenced by Alteration in voice (hoarseness) and change in verbal fluency (stammering, stuttering, or slurring of words)
- Impaired Walking/Risk for Falls related to damage to the substantia nigra in the brain and inhibition of excitatory impulses as evidenced by Rigidity with jerky movements and Activity reluctance
- Impaired Swallowing Related to inability to control throat and mouth muscles and degeneration of nerve cells as evidenced by Clearing of the throat while eating or drinking and A feeling of food stuck in the throat during feeding
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Expresses inability to vocalize Objective Data: -Difficulty in comprehension -Change in verbal fluency (stammering, stuttering, or slurring of words) -Presence of speech pauses -Difficulty with memory or concentration -Slow speech -Soft-spoken or monotone voice | Impaired Verbal Communication Related to Inability to control face, throat, mouth, and vocal cord muscles and extrapyramidal system dysfunction as evidenced by Alteration in voice (hoarseness) and Change in verbal fluency (stammering, stuttering, or slurring of words) | Patient will demonstrate an improvement in dysarthria resulting in improved enunciation and slurred speech. Patient will be able to establish different methods of communication. Patient will be able to use verbal and nonverbal communication congruently. | 1. Establish a trusting relationship with the patient. Build a rapport with the patient to encourage communication of feelings and assessment cues that will help in managing PD. PD symptoms can be embarrassing for some patients and cause isolation so it’s important to build trust. 2. Allow time for the patient to communicate and express themself. Both the patient and the listeners may become frustrated with the sluggish and stuttering speech of patients with PD. Allow plenty of time for the patient to respond before continuing to speak. 3. Provide as many communication skills and methods as possible. Teach energy-saving practices such as how to communicate nonverbally or with short phrases as this can prevent frustration and confusion between the patient and the care provider. 4. Introduce communication aids. Patients with PD often have soft speech and hoarseness. Amplifiers can increase loudness and prevent voice straining. Text-to-speech devices can also help the patient communicate since tremors can make handwriting illegible. 5. Refer to speech-language pathologists. SLPs can assist the patient with PD in improving cognitive functioning, comprehension, and memory, and teaching oral exercises to improve speech and voice. | Patient demonstrated an improvement in dysarthria resulting in improved enunciation and slurred speech. Patient established different methods of communication. Patient used verbal and nonverbal communication congruently. |
| Subjective data: Inability to control muscles Objective Data: -Rigidity with jerky movements -Restlessness -Pacing -Shuffling steps -Stooped position -Propulsive gait -Diminished independence -Loss of quality of life -Social isolation -Activity reluctance | Impaired Walking/Risk for Falls related to damage to the substantia nigra in the brain and inhibition of excitatory impulses as evidenced by Rigidity with jerky movements and Activity reluctance | Patient will be able to walk around the facility independently with minimum assistance. Patient will be able to use an assistive device while walking. Patient will be able to participate actively in physical therapy and rehabilitation. Patient will not experience falls. | 1. Encourage independence with safety precautions. Parkinson’s disease treatment aims to lessen symptoms and keep functionality intact for as long as possible. Allow the patient to participate in self care as much as possible. PD causes slow movements so the patient will require patience to complete tasks. 2. Assist with ambulation. Patients with PD may move slowly with tremors and stiff muscles. Continuous ambulation will prevent muscle atrophy and improve quality of life. Assisting in ambulation will allow the patient to move independently while providing safety. 3. Provide assistive devices. Most people with gait and stability issues use assistive ambulatory devices as their primary form of adjunctive care. Provide walkers, canes, and wheelchairs as needed. 4. Instruct the patient on how to walk safely. Ask the patient to start moving by rocking back and forth. Remind them to pick their feet up to prevent shuffling. Encourage the patient to wear flat-heeled footwear. 5. Teach proper posture. Teach the patient to hold their hands behind their backs to maintain an upright spine and neck to establish appropriate posture. 6. Administer antiparkinsonian medications as ordered. Antiparkinsonian medications increase the level of dopamine in the CNS to control symptoms (tremors and muscle weakness/rigidity) and slow the progression of PD. 7. Refer to physical therapy and rehabilitation. To improve patients’ health, well-being, and quality of life, physical therapy and rehabilitation will help restore, maintain, and improve movements, activities, and functioning. 8. Encourage tai chi and exercise. Exercise reduces the risk of falls. Tai chi is a highly recommended form of exercise for those with PD to improve balance. | Patient walked around the facility independently with minimum assistance. Patient used an assistive device while walking. Patient participated actively in physical therapy and rehabilitation. Patient will not experience falls. |
Subjective data: expresses inability to control throat and mouth muscles Objective Data: -Dysarthria -Weight loss -Increased incidence of pneumonia -Coughing while eating or drinking -Clearing of the throat while eating or drinking -A feeling of food stuck in the throat during feeding | Impaired Swallowing Related to inability to control throat and mouth muscles and degeneration of nerve cells as evidenced by Clearing of the throat while eating or drinking and A feeling of food stuck in the throat during feeding | Patient will demonstrate appropriate swallowing without coughing/gagging, drooling, or pocketing food. Patient will be able to maintain an acceptable weight for their height and gender. Patient will not develop aspiration pneumonia. | 1. Assist with meals. The nurse can prevent aspiration by assisting with feeding at mealtimes. This includes offering small bites, reminding to chew completely and coaching to swallow, and monitoring for signs of impaired swallowing. 2. Place the patient in an upright position during feeding. Choking and aspiration risks can be reduced by eating while sitting upright. This allows the food to enter the stomach with the help of gravity. Allow the patient to remain upright for 30 minutes after eating to prevent reflux. 3. Promote aspiration precautions. Thickener may be added to liquids to slow the liquid flow and decrease the risk of liquid entering the airway which can cause aspiration. Diet modifications may be required such as soft or pureed diets. 4. Administer antiparkinsonian medications between meals. Medication administration frequency will depend on the physician’s orders but attempt to administer between meals. Levodopa is not absorbed as well when taken with high-protein meals which can reduce its efficacy. 5. Consult with a speech therapist. Speech therapists can assist with evaluating dysphagia and teaching patients and families how to improve swallowing. | Patient demonstrated appropriate swallowing without coughing/gagging, drooling, or pocketing food. Patient maintained an acceptable weight for their height and gender. Patient developed aspiration pneumonia. |