A 70-year old client is confined to her bed due to advanced Parkinson's disease. Which nursing diagnosis takes the highest priority for a client with Parkinson's crisis?

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

The ABC (Airway, Breathing, Circulation) framework dictates that maintaining a patent airway is the highest priority in any clinical emergency.
A Parkinson's crisis is characterized by severe muscle rigidity and akinesia, which directly impacts the muscles used for swallowing and coughing.
This leads to an inability to manage oral secretions, posing an immediate risk of aspiration, airway obstruction, and respiratory failure.
Therefore, 'Ineffective airway clearance' is the most critical and life-threatening issue that must be addressed first.

Option A: Postural hypotension relates to circulation ('C' in ABCs). While it is a serious risk that can cause falls, it is not as immediately life-threatening as a compromised airway ('A').
Option C: Urinary problems are common in Parkinson's disease but do not pose an immediate threat to life. This is a lower-priority issue compared to airway compromise.
Option D: Risk of injury is a significant long-term concern. However, in an acute crisis, the immediate physiological threat to the airway takes precedence over potential safety risks, especially since the client is already confined to bed.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prioritization of nursing diagnoses in an acute neurological crisis to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in monitoring the respiratory status of a patient in Parkinson's crisis, including respiratory rate, effort, and oxygen saturation.
Essential bedside equipment includes a suction machine to clear oral secretions and prevent aspiration. The nurse must be prepared to use it immediately.
Positioning the client in an upright or side-lying position can facilitate drainage of secretions and reduce the risk of aspiration.

How to Approach the Question

First, identify the keywords in the question: 'advanced Parkinson's disease', 'Parkinson's crisis', and 'highest priority'. This tells you it's a prioritization question in an acute setting.
Recall standard prioritization frameworks taught in nursing, primarily the ABCs (Airway, Breathing, Circulation).
Evaluate each option based on the ABC framework.
Option A (Postural hypotension) relates to 'C' (Circulation).
Option B (Ineffective airway clearance) relates to 'A' (Airway).
Option C (Ineffective urinary elimination) and Option D (Risk of injury) are lower-priority needs in this acute context.

Concept Tested & Keywords

Concept Tested: Prioritization of nursing diagnoses in an acute neurological crisis.
Stem keywords: Parkinson's disease, Parkinson's crisis, highest priority, nursing diagnosis
Lead-in keywords: highest priority
Clinical cues: Advanced Parkinson's disease suggests severe symptoms.
Clinical cues: Confined to bed indicates significant immobility.

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E6 Nursing Fundamentals Potter Perry 12e Part 2 p. 22-24

E6 Pharmacology Nursing Lilley 11e Part 1 p. 262-264

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Attempt every question from this paper in a timed mock, then review the full solution for each one.