Mr. Anil has Parkinson's disease and he finds the resting tremor he is experiencing in his right hand very frustrating. The nurse advises him to?

1. A

   Take a warm bath

2. B

   Hold an object

3. C

   Take a warm bath

4. D

   Practice deep breathing

Appeared in: HPSSC - 2015

Explanation

• The tremor in Parkinson's disease is a 'resting tremor', meaning it is most prominent when the affected body part is not engaged in a voluntary action.
• Engaging the hand in a purposeful or voluntary movement, such as holding an object, activates different neural pathways that override or dampen the signals causing the tremor.
• This is a simple, non-pharmacological strategy that empowers the patient to manage a frustrating symptom and improve function in daily activities.
• This principle is a key differentiator from other types of tremors, like essential tremor, which worsen with action.

Why Other Options Were Wrong

• Option A: Taking a warm bath primarily addresses muscle rigidity and stiffness, which are also symptoms of Parkinson's disease, but it has little to no direct effect on the resting tremor itself.
• Option C: This is a duplicate option. Taking a warm bath primarily addresses muscle rigidity and stiffness, not the resting tremor.
• Option D: Deep breathing is a relaxation technique aimed at reducing stress and anxiety. While stress can exacerbate tremors, this method does not directly suppress the underlying neurological mechanism of the tremor.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Non-pharmacological management of resting tremor in Parkinson's disease helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses play a vital role in educating patients about non-pharmacological strategies to manage symptoms of Parkinson's disease, which can improve quality of life and a sense of control.
• Encouraging patients to keep the affected hand active (e.g., by carrying a light bag or object) can help reduce the noticeability and frustration of resting tremors during the day.
• Referral to an Occupational Therapist (OT) is crucial. An OT can recommend adaptive devices like weighted utensils or pen grips that use the principle of purposeful action to reduce tremors during activities like eating and writing.

How to Approach the Question

• First, identify the key elements in the question: the diagnosis is 'Parkinson's disease' and the specific symptom is 'resting tremor'.
• Recall the pathophysiology of a Parkinsonian tremor. The defining characteristic is that it occurs at rest and diminishes with voluntary movement.
• Analyze each option based on this characteristic.
• Option A/C (warm bath) relates to rigidity, not tremor.
• Option D (deep breathing) relates to stress, a secondary trigger, not the primary mechanism.
• Option B (hold an object) is a direct application of the principle of using voluntary movement to suppress a resting tremor.

Concept Tested & Keywords

• Concept Tested: Non-pharmacological management of resting tremor in Parkinson's disease.
• Stem keywords: Parkinson's disease, resting tremor, frustrating, right hand
• Lead-in keywords: advises him to
• Clinical cues: The patient has a known diagnosis of Parkinson's disease, and the symptom is a resting tremor, which is a classic sign.

Question ID

Qt8eTONWWq6sD5T21B9_A5

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 p. 1411-1413

E6 Medicine Davidson Principles Practice 24e p. 1135-1137