Nursing jobs process composition

The customer is a 75 year old, Caucasian male who may be a retired siding jeweler from Riverside, IA, who may have an extensive background with Paralysis agitans (Parkinson’s disease). The consumer was first confessed to the longer term care facility in December 2012. The client explained that this individual came to be only at that facility after “already staying in two places just like this. Having been removed/discharged in the last long-term care service for being what he known as “disruptive. The client described the staff at the last facility since not very kind to the residents.

There was a great incident where the drugs that had been prescribed for the client made him hallucinate and he became disobedient with the personnel and was restrained and taken to the hospital for analysis. He was then simply transferred to this kind of long term care center. Wanting to gather the client’s health record, an interview was scheduled.

In starting the interview together with the client, having been asked if he would be comfortable with being asked a lot of questions and was informed that he did not need to answer virtually any questions that he was unpleasant with.

Due to the client’s paralysis agitans and his muscle mass weakness he can primarily in a wheelchair. The consumer was asked if there was clearly anything that he needed before beginning and if he’d prefer the door be shut down or the drape be sketched for level of privacy, he explained that was not necessary. It absolutely was observed that the client got tremors in his right side and provide. A few minutes following sitting down, your customer asked for support moving his hand that was sleeping on the foundation to the equip of his wheelchair; by doing this it appeared to help quiet the tremors. When talking to the client, he’s of appear mind and has a spontaneity.

This indicates which the client’s paralysis agitans has not affected the region in the proper hemisphere with the brain that controls individuality. The client mentioned that having been in respectable physical well being until 1996. He then described that inside the spring of 1996, when he was running he suffered from a TIA (Transient Ischemic Attack). Your customer sought out professional answers coming from 5 professionals and was diagnosed with Paralysis agitans. The consumer conveyed it was a concern he had because his father also had Paralysis agitans. The client describes which the Paralysis agitans hasprogressively turn into worse over the past 18 years. It was noticed that his speech was slow and monotonous. Your customer spoke in a low and discreet quantity. A lack of face expressions was also discovered. The client can easily walk together with the assistance of a walker yet is generally in a wheelchair.

Identity of Medication

Dosage

Route

Time

Related to

Carbidopa-Levo twenty-five

90 tab

Orally

TID

Paralysis agitans

Comtan

200 mg tablet

Orally

TID

Paralysis agitans

Seroquel XR

60 mg tablet

Orally

Inside the afternoon

Nonorganic psychosis

He is prescribed 3 tablets to be taken orally 3 times each day Carbidopa-Levodopa 25-100 (25 mg of Carbidopa and 75 mg of Levodopa) intended for paralysis agitans. He is likewise prescribed 200 mg of Comtan that must be taken orally three times a day pertaining to paralysis agitans. These prescription drugs raise the degree of dopamine inside the brain. A side effect of having elevated amounts of dopamine inside the brain is psychosis. The client is also given 60 mg of Seroquel XR orally inside the afternoon to ease his non-organic psychosis. It truly is documented inside the client’s graph that there are indications of sleep apnea. The moment asked, the client stated that he was unacquainted with having that condition. The client will not use a ongoing positive respiratory tract pressure (CPAP) machinewhile sleeping at night.

When ever talking even more in depth regarding sleep habits and concerns the client explained that he gets roughly 8 several hours a sleeping a night, this is certainly without any help from rest aids. The moment speaking of his bedtime traditions he stated that he does have two sodas, back to back, through the night right before bed time, while watching tv. He does not have difficulty falling asleep but performed claim that he sometimes includes a hard time remaining asleep through the night. When asked about choosing occasional naps throughout the day this individual stated “depends on in the event that I’ve been up all night. The client in that case explained that it must be the sound level at the long term care facility that will bring him awake.

When asking about the client’s family members he stated that this individual has been committed for twenty four years and has two children, a kid who is forty-four years old and a child that is 39 years old. The client also has seven grandchildren. Once asked what he wants to do in the spare time he replied that he loves spending time with his wife and children. This individual stated that before visiting this long term care facility he enjoyed playing card and gambling. This individual now takes on computer games for fun, when his wife will there be to help him. The client explained that he has a “little bit an excellent source of blood pressure and it was observed in his graph that he can given an 81MG Acetylsalicylsäure daily pertaining to atrial fibrillation.

Aspirin

81 mg

Orally

o. m.

A-fib

Acetaminophen

325 mg

Orally

Every 6th hour

Pain

He has no history of heart surgeries or surgeries of any sort. The client reported that this individual has never acquired rheumatic fever. When mentioned blood clots, the client reacted that this individual believes that his TIA in 1996 was a result of arterial emboli. The client statements that occasionally he provides numbness in his legs fantastic hamstrings tense up and it can be painful. He mentioned that he will ask for his prescribed 650 MG of acetaminophen for the discomfort.

When talking about everyday challenges with the consumer, he mentioned that this individual doesn’t have a whole lot of tension but gets irritated once that personnel turn on the lights every single morning in 6: 30 am. Once asked in the event there was whatever he does when he realises that he could be stressed, your customer mentioned that whenever he was younger he would go Vedic Town in Grand rapids and practice with the Maharishi meditating. He admits that that meditating has been beneficial in his mature life. The client also mentioned that this individual liked to adhere to the Maharishi lifestyle and eat simply organic foods but it is not possible to adhere to that when residing at a long term care service. Other things that he does to problems are take a look at his pictures that he has on his shelf in his room. One which helps him the most is known as a black and white-colored picture of him in a airplane along with his flight instructor standing on the wing. The consumer use to pilot planes if he was younger.

When the consumer was asked if having been religious and he described that he’s Methodist nevertheless hasn’t been to church in about a few years. This individual did state that he truly does pray sometimes. The client explained that is not scared of dying yet he is scared of falling. That’s exactly what joked that maybe is actually not so much the falling but maybe it’s the landing. When determining the patient’s vitals it had been noted that he provides slightly enhanced blood pressure of 129/84 and could be cause of concern of pre-hypertension.

Metoprolol tartrate

25 mg

Orally

BID

Hypertension

It is noted in his data that the customer is given a 25 mg tablet of metoprolol tartrate orally two times a day pertaining to hypertension. His respirations had been within regular range at 18 respirations per minute. SaO2 was at 86%. The patient’s temperature was taken orally and was 97. 6th F. The consumer is 6 feet and 1 in . tall and weighs 257 lbs. The consumer has a BMI of 33. 9. The customer received a vaccination pertaining to influenza upon 10/16/13. The clients chart states that he requires assistance with a large number of daily activities. He is dependent on assistance with dressing, and bathing. When ever asked, your customer stated that it can be challenging to get outfitted and undressed due to the rigidity in his legs and arms.

The client is definitely on a regular diet plan and declares that hedoesn’t have any kind of difficulty ingesting foods and doesn’t require help with feeding. When mentioned appetite he said that occasionally he doesn’t have much of a great appetite nevertheless he feels that is because of the medications that he is choosing. The client explains that he can not aware of having any meals allergies. This individual also explained that after consuming he does not experience sensations of nausea/vomiting, but really does encounter heartburn/indigestion occasionally, which in turn he takes 30 ml an antacid suspension. He could be also provided one multivitamin pill orally daily for dietary supplement.

Antacid Postponement, interruption

30 milliliters

Orally

Just about every 6 hours

Supplement heartburn

Multivitamin

1 tablet

Orally

um. d.

Health supplement

When the customer was asked about dentures this individual stated that he will not have false teeth even though false teeth were known in his chart. He claims he demands aid in transferring from pickup bed to a chair and with toileting. When asked about the smoothness of his stools he explained that both uniformity and color were normal. The client likewise stated that he doesn’t need the help of laxatives. Noted in the client’s graph and or chart he is given a 100 mg tablet of Docusate sodium orally 2 times a day to help with constipation.

Docusate sodium

75 mg supplement

Orally

BET

Constipation

The customer does not possess any history of kidney or perhaps bladder disease. He claims which the frequency, sum and color of his urine are typical. He also claims that he does not have any kind of difficulty voiding and there is no pain or burning when urinating. According to the CNA, the client is able to stand, holding the hand bed rails, while peeing. It is noted in the clients care plan that he’s urinary énurétique which is linked to impaired range of motion and PRN straight catheter needed for sporadic retention extra to BPH. The client has one zero. 4 magnesium of Tamsulosin HCL orally a day to get BPH (benign prostatic hyperplasia).

Tamsulosin HCL

0. some mh

Orally

o. d.

BPH

The client needs assistance with bathing as well. The client even offers a DNR order.

Parkinson’s disease (paralysis agitans) is a progressive disorder of the nervous system that affects types mobility. According to Hubert and VanMeter, Parkinson’s disease is a “dysfunction of the extrapyramidal motor system that occurs as a result of progressive pathological changes in the principal nuclei, principally in the substantia nigra. (UMMC, 2012) The substantia nigra is the major area of the human brain that is afflicted with Parkinson’s disease (PD). (UMMC, 2012) The substantia nigra is made up of a specific pair of neurons that send chemical signals, referred to as dopamine.

Dopamine then moves to the striatum, responsible for balance, control of motions, and going for walks, by means of long fibers named axons. (Okun, 2013) These regular human body movements happen to be controlled by the process of dopamine about these axons. With PD the neurons in the substantia nigra break up and perish causing the loss of dopamine, which often causes the nerve skin cells in the striatum to result in excessively. The excessive shooting of neurons makes it extremely hard for one to control their moves, a sign of Parkinson’s disease. (Okun, 2013) According to the Parkinson’s disease Basis (2014):

As many as one million People in america live with Parkinson’s disease, which is more than the mixed number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease. Also roughly 60, 500 Americans are diagnosed with Parkinson’s disease every year, and this quantity does not reflect the 1000s of cases that go undiscovered. An estimatedseven to 15 million persons worldwide live with Parkinson’s disease. Prevalence of Parkinson’s increases with age, but an estimated 4 percent of folks with PD are clinically diagnosed before the regarding 50 and men happen to be one and a half times more likely to have Parkinson’s than females. (p 1) Since PD is a gradually degenerative disease the signs and symptoms change after some time and range from person to person. A widely used scientific rating level is the Hoehn and Yahr scale (HY); this helps to distinguish signs and symptoms inside the various phases of Parkinson’s disease. (MGH, 2005)

Initial phases, like HY’s stage 1, of Parkinson’s disease the symptoms are usually mild and appear unilateral. There might be changes in facial expressions, position and locomotion; these symptoms are usually untimely and annoying but not circumventing. As the disease progresses, in to stage two of the HY scale, it could begin to impact ambulation and be noticeable bilaterally with little disability. (MGH, 2005) While symptoms intensify, as in stage three of the HY range, there is substantial slowing of body motions, early disability of balance with walking and standing up and generalized dysfunction that may be moderately severe. The Hoehn and Yahr scale’s level four clarifies that signs and symptoms are severe but the person can still walk to a limited extent. (MGH, 2005) Rigidity and bradykinesia become elements in mobility. In level five anybody is unable to walk or stand so is bedridden or perhaps confined to a wheelchair. This kind of stage is known as the “cachectic stage. Frequent nursing attention is required in stage five (Costa and Quelhas, 2009). There are many problems that are connected with PD; you can be difficulty swallowing (dysphagia), likely due to the loss of control of muscles in the throat. (UMMC, 2012)

Drooling can occur as saliva might accrue on the teeth due to dysphagia. Difficulty swallowing can also lead to malnourishment, although also postures a risk for aspiration pneumonia (Leopold and Kagel, 1997). Constipation could be another problem as to the decreasing of the digestive system. Parkinson’s disease can also cause urinary preservation and urinary incontinence. Dementia and difficulty considering comes in later stages of PD. (University of Maryland Medical Center, 2012) Depression is extremely common in patients with Parkinson’s. The illness process on its own causes changes in chemicals in the brain that affect mood and wellbeing. Anxiety is likewise very common and may even be present along with major depression (University of Maryland Medical Center, 2012).

Rest problemsand sleep problems are also associated with PD, with this comes fatigue. A lot of patients may possibly experience feeling light headed when standing due to the drop in blood pressure (orthostatic hypotension). Pain may also be another indication related to Parkinson’s disease (Okun, 2013). There isn’t yet get rid of Parkinson’s disease but you will find treatments that will help alleviate the symptoms. One of the most commonly used is definitely drug therapy. Medications can help with difficulty with movement, strolling and controlling tremors simply by increasing the brains quantity of dopamine. (University of Maryland Medical Center, 2012) The most common and most successful Parkinson’s disease drug is definitely Levodopa. This can be a natural chemical that goes into your brain and is converted to dopamine (Okun, 2013). There is surgical procedures available, deep mind stimulation. With this procedure the surgeon enhancements electrodes to a specific site in the patient’s brain. A generator is usually implanted in the patient’s breasts, which is mounted on the electrodes.

This generator sends electric powered impulses towards the patient’s human brain, which may lessen the indications of Parkinson’s disease. (University of Maryland Medical Center, 2012) Other ways that support control the effects of PD is a healthy diet. Obstipation is a complications associated with PD, so a diet that is well balanced with fiber rich foods, fruits and vegetables helps to manage this kind of complication. Harmony, coordination, versatility and muscle tissue strength deteriorate with PD so , exercise is encouraged. Exercise also helps with decreasing anxiety and major depression. The client displays many of the reviewed signs and symptoms of Parkinson’s disease. The client encounters resting tremors, bradykinesia, hide like deal with (hypomimic), slowed down speech and is in a wheelchair. He scores very terribly according to the Hoehn and Yahr scale. The consumer is on medications to help diminish the signs and symptoms of Parkinson’s disease. Impaired physical mobility level 3, linked to bradykinesia, akinesia, neuromuscular impairment motor weak point, pain and tremors. (Berman & Snyder, 2012)

Evidenced by insufficient decisive motion within physical environment, which includes movement in bed, transfers, and ambulation. Limited range of motion (ROM). Decreased muscle tissue stamina, durability and control. Limitation in independent, purposeful physical motion of the body system and impairment unilaterally around the right part. Due to the buff and neuromuscular weakness relevant to Parkinson’s disease, evidenced because of it being tough for the sufferer to ambulate. The client includes a defect of extrapyramidal tract, in

the essentiel ganglia, with loss of the neurotransmitter dopamine. (Berman & Snyder, 2012) Classic triad of symptoms: tremor, solidity, bradykinesia (Jarvis, 2012). Tremors associated with paralysis agitans generate it difficult control. Tremors discontinue with non-reflex movement and during sleep (VanMeter and Hubert, 2014). Immobility is a great expected human response to Parkinson’s disease. The client’s immobility puts him at risk for thrombophlebitis, pores and skin breakdown, pneumonia and depression. Immobility impedes circulation and diminishes the provision of nutrition to certain areas. As a result, skin malfunction and development of pressure (decubitus) ulcer can occur (Berman and Snyder, 2012).

Immobility also encourages clot development. Self-care failures related to neuromuscular impairment, immobility, decreased power, and lack of muscle control and insufficient coordination, ridgity and tremors. Self-care failures, dressing, cleanliness and toileting, evidenced by tremors and motor hindrance. The client does not have the ability to purify his human body, comb his hair, comb his teeth is to do skin care.. The customer is also not able to dress him self satisfactory. This individual does not are capable to fasten his clothes. The patient is helped with ADL’s. Patient is usually incapable to wash, dress or perhaps brush tooth without aid. Patient occasionally needs help with feeding. Assistance is also needed with toileting. Aid is required with ADL’s because of the insufficient coordination and then for safety. This nursing medical diagnosis is important because it ensures health, improves standard of living, and helps bring about dignity, self-worth, independence and freedom. Exposure to possible falls linked to decreased flexibility, and unsteady gait second to sedentary lifestyle and Parkinson’s disease. Patient works on the wheelchair and ambulates with a walker. People gait is definitely impaired because of Parkinson’s disease. Festination, or maybe a propulsive walking (short, shuffled steps with increasing acceleration), occurs because postural reflexes are disadvantaged, leading to declines (VanMeter and Hubert, 2014).

Falls also result in psychological implications to get the patient having a decrease in self-esteem and a fear of even more falls. This kind of contributes to a decrease in mobility and culminates in a significant reduction in standard of living (Jarvis, 2012). Impaired intestinal elimination/constipation linked to medication , physical disability and decreased activity. Evidenced by the client not passing stools daily. Medications prescribed to patient to get Parkinson’s disease attribute to constipation. The patients experience of immobility is likewise acontributing component for constipation. This medical diagnosis is very important because it enables nursing staff to keep an eye on the patient’s bowel movements and avoid fecal impaction. Unbalanced nutrition lower than body requirements related to tremors, slowing the procedure for eating, problems chewing and swallowing. Evidenced by the client occasionally requiring assistance with consuming.

Pressure sores develop quicker in people with a health deficit. Right nutrition also provides necessary energy to get participating in an exercise or a healing program. The goal should be to optimize the client’s nutritional status. Damaged verbal conversation related to lowered speech volume, decreased ability to speak, stiff facial muscle groups, delayed presentation, and inability to move cosmetic muscles. Confirmed by insufficient expression around the client’s confront, client’s impeded speech. Decrease of dopamine can impact the face muscles, which makes them stiff and slow and resulting in a attribute lack of phrase. Speech disability is referred to as dysarthria and is typically characterized while weak, slower, or uncoordinated speaking which could affect amount and message. Difficulty speaking and composing because of tremors, hypophonia, and “freeze occurrences. This is an expected consequence of Parkinson’s disease.

Breastfeeding Care Plan- Alteration in impaired physical mobility- Parkinson’s disease Linked to:

Goals

Involvement

Bradykinsia

Customer will use a walker to go to breakfast in the mornings rather than need help with transfers. Customer will be able to conduct all lively ROM simply by 3 months

Look at current freedom and statement of an embrace damage. Carry out exercise program to boost muscle strength.

Perform passive or effective assistive RANGE OF MOTION exercises and muscle flexibility exercises to all muscles. To promote increased venous come back, prevent stiffness, and maintain muscle mass strength and endurance. Devoid of movement, the collagen tissue at the joint become ankylosed (permanently immobile) (Berman & Synder, 2012)

Akinesia

Customer will gain power of voluntary movements.

Joint contractures will not arise.

Assess the possibility of profound brain stimulation.

Make reference to physical therapy.

When the muscle mass fibers are not able to shorten and lengthen, ultimately a contracture forms, constraining joint range of motion (Berman & Synder, 2012)

Tremors

Client’s tremors will decrease.

Motivate deep breathing, images techniques and meditation. Inspire holding an object in hand

Suggest keeping the equip of the seat.

Revitalizing the brain by simply concentrating on breathing may stop tremors. (www.theparkinsonhub.com)

Pain

Client is not going to experience discomfort >4 on a size of 0-10

Prior to activity see for and, if possible, handle pain.

Assess patient’s willingness or perhaps ability to explore a range of techniques geared towards controlling soreness. Administer pain medication per physician instructions.

Encourage/assist to reposition frequently to put of comfort and ease. Pain limits mobility which is often exacerbated by movements.

(www.ptnow.org)

Nursing Care Plan- Alteration in Epidermis Integrity, Disadvantaged: Risk for ” Pressure Sores; Pressure Ulcers, Bed Sores; Decubitus Care Related to:

Goal

Interventions

Rationale

Neuromuscular impairment

Client will be free of virtually any pressure ulcers for length of long term stay. Monitor web page of pores and skin impairment at least one time a day pertaining to color adjustments, redness, puffiness, warmth, soreness or any additional signs of disease. Pay work to risky areas and have client questions to determine whether he is going through loss of experience. Apply hurdle cream to peri area/ buttocks since needed.

Make use of ROHO safety net on wheelchair.

Checking skin daily will ensure that skin keeps intact. (Jarvis, 2012)

Immobility

Client should be able to express stainless steel of impaired skin.

Teach pores and skin and wound assessment and ways to keep an eye on for stainless steel of contamination, complications and healing. Use prophylactic antipressure devices because appropriate

Early on assessment and interventions may help complications by developing. To avoid tissue malfunction.

(Jarvis, 2012)

Medical Care Plan- Self Care Deficits

Related to:

Goal

Intervention

Rationale

Immobility

Consumer will assist with bathing, grooming, dressing, oral care and eating daily. Assist client with bathing, grooming, shower, oral proper care and eating daily. Work with high backside wheelchair.

The effectiveness of the bowel or perhaps bladder plan will be increased if the organic and personal patterns of the individual are respected. Loss of muscle tissue control and lack of dexterity

Consumer will improve muscle control and coordination in every extremities intended for the length of long term stay. Consumer will walk to living area and in hallways- 5 a few minutes a day 5 days a week. Use consistent routines and let adequate moment for patient to complete responsibilities. Assist client with ambulation.

This helps sufferer organize your self-care abilities.

Tremors

Customer will be able to help with dressing.

Provide suitable assistive products for shower as evaluated by doctor and occupational therapist. Inspire use of clothes one size larger.

Teach and support the consumer during the patient’s activities

Apply exts on fractures with ball grips

The use of a press button hook or perhaps of trap and heap closures about clothes could make it feasible for a patient to continue independence through this self-care activity. Ensures simpler dressing and comfort.

Grips will probably be easier to understand with tremors.

Neuromuscular impairment

Client will be clean, dressed, well mown daily to promote dignity and psychosocial wellbeing. Assist with shower as necessary.

Assist with daily hygiene, grooming, dressing, oral attention, and ingesting as needed. This promotes dignity and psychosocial health.

Nursing Proper care Plan- Falls, risk for

Related to:

Goal

Intervention

Rationale

Lowered muscle sculpt

Customer will express an understanding with the factors associated with possible injury. Educate the customer about what makes them at risk for falls.

Bed should be in cheapest position.

Provide assistance to transfer as needed.

Reinforce the advantages of call light.

If the client can be educated and shows an understanding of the factors involved with is catagorized, they are less likely to fall. Prevent fall.

Nursing Attention Plan- Reduced Bowel elimination/constipation

Related to:

Goal

Involvement

Reason

A sedentary lifestyle, immobility

Client will have soft produced stool alternate day that are exceeded without difficulty. Encourage physical activity and regular exercise.

Adjust toileting times in order to meet client’s requirements.

Record changes in epidermis integrity community forum during daily care

Ambulation and/or abdominal exercises improve abdominal muscles that facilitate defecation. low-fiber diet plan

Evaluate normal dietary practices, eating habits, consuming schedule, and liquid intake. Initiate additional high-protein feedings as suitable.

Change in nourishment, type of foodstuff, disruption of usual plan, and stress can lead to congestion. Proper nutrition is required to preserve adequate degree of energy.

Diminished muscle tone

Inspire isometric stomach and gluteal exercise

Apply epidermis moisturizers/barrier lotions as necessary

To strengthen muscle tissues needed for evacuation unless contraindicated. (http://www.gutsense.org)

Medications

Inspire liquid the consumption of 2000 to 3000 milliliters per day

To enhance hydration position and prevent stiffing of stool

(VanMeter & Hubert, 2014)

My own thinking about my personal resident offers definitely improved since the first day when I conducted a health background assessment about him. I knew that initially day that I was going to value getting to know this resident as a result of how efficiently the dialogue flowed. This kind of resident experienced some amazing stories to share with. I absolutely enjoy that fact that he and his wife had been married intended for 48 years. I loved listening to him remember what life was like before getting diagnosed with Parkinson’s disease, that appeared to brighten his nature. I feel very fortunate to obtain been given a chance to care for this kind of a genuine heart and soul. My complete clinical experience was a great one. I actually realized that merely lacked the ability about a particular task to request help.

We liked the simple fact that clinicals was on the job and that My spouse and i gained knowledge in a long-term health care center. Another thing that the clinical rotationtaught me was that it takes a great type of person to go into geriatric medical. Probably the single most important thing that I’m going to take away from this clinical experience is the total importance of pride. I too will be older someday and I applied the golden guideline to this encounter. I treated others?nternet site want to someday, and hopefully, will probably be treated. Exactly what a university fantastic learning experience.

Recommendations:

Berman, A., & Snyder, S. (2012). Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice. Top Saddle Riv: Pearson Education. Coleman, T., (September 1, 2013) Yoga & Mitigating Parkinson’s Symptoms. Retrieved coming from http://www.theparkinsonhub.com/your-quality-of-life/article/meditation”mitigating-parkinsons-symptoms.html Playa, M. & Quelhas, 3rd there’s r. (2009). Stress, Depression, and Quality of Life in Parkinson’s Disease. The Log of Neuropsychiatry and Medical Neurosciences 2009; 21: 413-419. Jarvis, C. (2012). Physical Examination & Health Evaluation. St . Paillette: Elsevier Kegelmeyer, D., (July 1, 2013) Functional Restriction Reporting (FLR) Under Medicare health insurance: Tests and Measures for High-Volume Circumstances. Retrieved by http://www.ptnow.org/FunctionalLimitationReporting/TestsMeasures/Default.aspx Leopold N., Kagel M. (1997). Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia 1997; 12: 11″18 Massachusetts General Hospital (MGH) (May, 2005) Hoehn and Yahr Staging of Parkinson’s Disease, Unified Parkinson Disease Ranking Scale (UPDRS), and Schwab and Great britain Activities of Daily Living. Massachusetts General Clinic. Retrieved March 2, 2014, from http://neurosurgery.mgh.harvard.edu/functional/pdstages.htm#HoehnandYahr Okun, M. (2013). Parkinson’s Treatment: 12 Secrets to a Happier Life. CreateSpace 3rd party Publishing Michael jordan S. Okun M. D. Parkinson’s disease Foundation (2014, March) Understanding Parkinson’s. Parkinson’s Disease Groundwork. Retrieved March 2, 2014, from http://www.pdf.org/en/understanding_pd University of Maryland Medical Center (2012, September) Parkinson’s disease. University of Maryland The hospital. Retrieved Mar 2, 2014, from http://umm.edu/health/medical/reports/articles/parkinsons-disease#ixzz2upFLCggw VanMeter, E. C., & Hubert, 3rd there’s r. J. (2014). Gould’s Pathophysiology for the

Wellness Professions. St Louis: Elsevier.

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