2023 HPI Tony is a 69 year old Caucasian male with a history of a right hand tremor for several

HPI: Tony is a 69-year-old Caucasian male with a history of a right-hand tremor for several years. He is accompanied by his wife today to the clinic who is very concerned because Tony is having difficulty with balance and walking, which is becoming slower. 

You suspect Parkinson’s disease (PD). 

-Briefly describe the etiology of PD.

PE: 

-What will you examine in the neurological examination of Tony? 

-Describe at least three neurological examinations you will perform. 

Diagnostics: You know that PD is primarily a clinical diagnosis, but there are several diagnostic tests that can be useful in making the diagnosis. 

-Describe at least two diagnostic tests that may be helpful in the diagnosis of PD.

Diagnosis: You diagnose Tony with early-stage PD. 

-What are some of the key principles of treatment? List at least two principles of treatment.

Plan/Referrals:

As the NP you decide that Tony does not require medication treatment at this time, but you will make the following referrals. 

-Describe at least three referrals and the rationale for each.

Follow-up: You will want to see Tony in 3 months.

– What are some of the things you will want to follow in addition to his neurological status? 

-List at least three questions you will explore.

-List tow differential diagnosis for Parkinson’s (i.e. Normal-pressure hydrocephalus: Gait apraxia, urinary incontinence, and dementia are present. And, Striatal nigra degeneration: Autonomic dysfunction and dystonia are present.) -List a minimum of three differential diagnoses. Your primary (parkinsons) or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines.  

P (plan) 

Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.