John

Smith 67 Widowed Roman Catholic

Patient
“I have trouble walking by myself” Parkinson’s Disease

3/27/20 Maslow’s Hierarchy of Subjective: Risk for injury related to Within 8hrs of my nursing intervention, the Independent: NANDA 14th - Goal met
Needs: “I have trouble walking Parkinson’s disease as pt will be able to: - Assess ambulation and - Aids in planning of interventions. Edition
by myself” AVB pt evidenced by altered movement. - Within 8hrs of my
Physical Needs mobility and involuntary 1) remain safe from environmental hazards nursing intervention, the
Objective: movements. resulting from cognitive impairment. - Instruct pt to swing - Assists fait and prevents falls. pt was able to:
- altered mobility arms and lifts heels
- involuntary movements 2) have family ensure that safety during ambulation. 1) remain safe from
- loss of postural precautions are instituted and followed. environmental hazards
adjustment - Teach pt to turn in wide - To prevent the crossing of one leg resulting from cognitive
- loss of balance 3) remain in a safe environment with no arcs. over the other, which may cause a fall. impairment.
- shuffling gate complications or injuries obtained
- muscle rigidity - Remind pt to maintain - Stooped posture may cause the 2) have family ensure
4) have family identify and eliminate and upright posture and patient to collide with objects. that safety precautions
hazards in the patient’s environment. look up when walking. are instituted and
followed.
- Instruct a wide-based - To improve balance.
gait. 3) remain in a safe
environment with no
- Teach range of motion - To improve balance. complications or injuries
exercises and stretching obtained
to be performed daily.
4) have family identify
- Remove any hazardous - To ensure prevention of injuries. and eliminate hazards in
objects that may get in the patient’s
the way of patient environment.
mobilization.

- Raise side rails when pt - To prevent pt from falling in bed.
is in bed.


Collaborative:
- Educate the pt’s family - Having a strong family support system
members on how to with whom she is familiar with will
ambulate pt properly. help pt remember instructions nurse
has give them to prevent falls.

Alexa-Rae P. Zagado SNBC BSN-III 3/27/20

Ronald Ramo RN, MAN