Presentation of Case Study
Luis is a 72-year-old Hispanic man with Parkinson disease (PD). He came onto hospice having recently moved into the home of his son's family.
Luis had been diagnosed 13 years before with PD. He has mask-like facies and a soft voice and is confused. He will stand with assistance to transfer to a bedside commode. Because of increasing rigidity, poor balance, and an exhausted caregiver, he will eventually become bedbound and dependent for all activities of daily living.
Luis has an intermittent, resting tremor of his left arm. It is becoming increasingly difficult for him to feed himself and swallow. Finger foods in a preferred high-protein diet became easier to manage than utensils. Thickened liquids are recommended, but he does not like the taste. With more difficulty in swallowing, a lidded cup is effective to slow down his efforts to swallow and manage independent intake of fluids.
Robert, the patient's son, reports Luis's history of prolonged time on the commode, with extraordinary time straining and very large hard stools. In addition, Robert reports that the stools are so large and hard that the plunging of the commode and frequent backup of stool contents occurs about 2 times a week. Luis has a firm abdomen, and it has been at least 4 days since his last bowel movement.
On admission, the medications included Carbidopa/Levodopa 25/100 immediate release 5 times daily. Carbidopa/Levodopa extended release 25/100 one-half tablet is given twice a day. Amantadine 100 mg is given 2 times daily and Amantadine 50 mg is given once daily. Entacapone 200 mg is given 5 times daily. Other medications are Escitalopram for depression and clonazepam for sleep. Docusate dosage is 50 mg once per day. Patient is also taking Ferrex (iron supplement) 150 mg daily.
Luis would increasingly have more intense hallucinations, for which Quetiapine fumarate was added to the schedule. Ativan was also available as part of a comfort kit in the home for anxiety. Because of falls, this patient would need increased supervision with 24-hour caregiving by his spouse.