Medical Surgical Parkinson’s Disease PD #5

Question

A client with Parkinson’s disease is observed coughing numerous times while eating breakfast. Which priority action may help with the coughing while eating?

Answers

  1. Offer thickened liquids with each meal.
    • Rationale:

      This answer is correct because the risk of aspiration is higher with thin liquids than it is with thickened liquids. Since clients with PD have swallowing difficulties, offering thickened liquids with each meal will reduce the risk for aspiration.

  2. Offer a clear liquid diet until coughing subsides.
    • Rationale:

      This answer is not correct because a liquid diet can worsen coughing and symptoms of aspiration. The risk of aspiration is higher with thin liquids than it is with thickened liquids.

  3. Administer a cough suppressant if cough is unproductive.
    • Rationale:

      This answer is not correct because the client’s coughing is not related to a cold, virus, sinus drainage, or other viral illness. The coughing is an aspiration symptom. Offering thickened liquids with each meal will reduce the risk for aspiration.

  4. Explain that swallowing difficulty is a part of the disease and to eat with chin to chest.
    • Rationale:

      This answer is not correct because the chin should be only slightly tucked to facilitate swallowing and not all the way to the chest. The swallowing difficulty is certainly a problem with Parkinson’s; however, the most important is thickened fluids. Offering thickened liquids with each meal will reduce the risk for aspiration.

Overview

A feature of Parkinson’s disease (PD) is swallowing difficulty with aspiration risks. The risk of aspiration is higher with thin liquids than it is with thickened liquids.

Explanation

Learning Outcomes

Parkinson’s disease (PD) is a neurological disorder that affects the central nervous system. Neurons (nerve cells) are damaged due to the decreased level of dopamine in the brain. This causes various movement problems, including weakness, stiffness, balance issues, tremors, and slow movement (bradykinesia). Another feature of PD is swallowing difficulty. The client is at risk for aspiration. Aspiration can occur when stomach contents enter the client’s lungs. This can cause airway obstruction, coughing, choking, decreased oxygenation, and can lead to aspiration pneumonia. The risk of aspiration is higher with thin liquids than it is with thickened liquids.

Test Taking Tip

Coughing can be a symptom of many things but when associated with swallowing, the nurse should be alert to the risk of aspiration. This is an “airway” issue and is a priority finding that must be addressed properly (with thickened liquids.

Video Rationale