1. If yes consider the following
Anticipatory Care Management of an acute deterioration in Parkinson’s symptoms- professionals
Is the Person with Parkinson’s (PwP) experiencing e.g increased tremor, slowness of movement, rigidity, or a change in cognition, confusion, hallucinations, falls ? (deterioration in the last 2/3 weeks)
If yes consider the following
Is infection present?
NB: PwP do not always display signs of infections therefore consider carrying out the tests /observations below:
Urinalysis if positive send to microbiology.
Blood tests for infection, delirium, falls inc: FBC, U&E’s CRP, TFT’s, B12 folate, LFT, calcium, random glucose.
Examine chest-risk of aspiration refer to SALT for swallow assessment.
Any wounds, infected rashes.
Falls- with or without infection;
check Lying & Standing BP after 1 & 3 minutes to rule out postural hypotension. Complete multifactorial falls assessment.
Is the PwP constipated?
Have their bowels opened within the last 2/3 days or consistent with the patient’s normal bowel habit.
Has the PwP taken or been given any new medications within the last month?
Check the medications to see if it is one to avoid / contraindicated in Parkinson’s (see list overleaf & BNF for further information).
Assess the PwP for any medication side effects.
Is the PwP taking their medication correctly as prescribed?
Consider;
correct patient, time,
dose, route, medication.
Yes
Yes
Yes No
Positive infection screen
If requiring treatment the PwP should generally return to their normal level of functioning.
Constipation present
Suggest an increase in dietary fibre and fluid intake. If unsuccessful treat accordingly. Macrogols (Laxido) can be effective in Parkinson’s but choice depends on the individual.
Medication Compliance
Consider a patient medication management system/aid e.g. dossette box, pill timer etc.
For those PwP with complex, frequent & timely dosing regimes, speak to the Parkinson’s Specialist to see if it is possible to simplify the Parkinson’s medication regime (with patient consent).
 If PwP has symptomatic postural hypotension
Check the PwP is drinking adequate fluids & review other medications e.g anti-hypertensive’s.
Consider compression hosiery if not contra-indicated to other conditions e.g vascular /arterial.
Refer to Specialist Nurse to discuss the Parkinson’s medication regime to see if requires adjustment.
Refer to the their Specialist Parkinson’s Consultant for discussion as to whether anti-hypotensive medication indicated and appropriate for the patient.
Authors
Kay Baggley, Kathryn Prout,
Parkinson’s Nurse Specialists.
Adapted from Barnes, L,PDNS, Peninsula Community Health
01/17Review date 01/19
Increase in PwP Social Care Needs /Carer Stress
Consider referral to Care Direct
Carers Centre
South Gloucester shire Social Services
Tel No:
Options for support -Community Pharmacist, GP, Parkinson’s Consultant or Parkinson’s Nurse Specialist
Kay Baggley PNS South, Inner city & East Bristol
Sally –Anne Wherry PNS North & West Bristol –
Kathryn Prout PNS , South Glos