Parkinson's Disease: Constipation and Adequate Nutrition (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now this one is more personal, right? Because patients may be hesitant to talk to you about this.

    00:07 But a patient with Parkinson's is at an increased risk for constipation.

    00:11 So, these are the things that anyone can do who's at risk for constipation, but these are particularly important for someone with Parkinson's.

    00:18 So you want them to have consistent fluids and intake up to about 2,000 milliliters a day.

    00:24 All right, so that's the equivalent of what we'd call a two liter of Pop.

    00:27 Now we're not recommending that they drink Pop.

    00:29 I just wanted you to have kind of a feel for how much volume that is.

    00:34 Now if the patient has renal disease or congestive heart failure, we want to make sure that you work closely with the healthcare provider to make sure that the amount of volume is appropriate for that patient's body.

    00:45 Now, if they'll increase their intake of dietary fiber, the best way to do this is to eat fresh vegetables, right? Look for the foods that naturally have fiber.

    00:56 Beans, legumes, fresh fruits, or vegetables.

    00:59 Those within the limits that they have any other special dietary needs.

    01:03 It's one of the best ways to increase fiber.

    01:05 We also have some medications that you get.

    01:07 Psyllium capsule fiber, that's one way to take it.

    01:10 But it's always best if you can to get dietary in its natural form.

    01:16 Now there's also stool softeners or mild laxatives.

    01:19 Those work in different ways, but predominantly, they'll draw more water or fluid into the waste and make it easier for the patient to pass.

    01:28 Now, if we have to, we can use bowel training techniques because you just have to set and establish a regular time for bowel movements.

    01:35 Usually about 30 to 40 minutes after a meal, you have that gastrocolic reflex, and it's an appropriate time for the patient to teach themselves to go to the bathroom in that time frame.

    01:46 But you have to individualize each one of their training programs, but you'll find the right method.

    01:52 The most important thing is consistency.

    01:54 So you teach that gut to empty at approximately the same time every day.

    01:59 Remember, everything requires extra time including if someone's working on bowel and bladder, so they need to go maybe even before they feel that urgency, so they have plenty of time to make it to the restroom.

    02:16 Now we look at nutrition.

    02:18 Everyone needs a healthy diet, right? but patients with Parkinson's are going to need longer to eat.

    02:24 So we want them to take smaller bites because they might be at risk for choking.

    02:29 So when you go out to dinner, you may consider slowing down your own eating speed and taking smaller bites.

    02:37 That's good advice for anybody.

    02:39 That's gonna help your "Hey, I'm full signals in your brain.

    02:43 Register for you more effectively if you slow down and take slower bites." Then the patient with Parkinson's also doesn't feel so self-conscious about being the absolute last person at the table to finish eating.

    02:58 We talked about the adaptive silverware.

    03:00 That's pretty cool to help them with the tremors and the grip.

    03:03 You want to make sure that you're assessing the patient for any difficulties or complaints or problems with swallowing when you are the nurse, and educate the patient and family that they really need to let us know if they start experiencing that after they go home.

    03:18 Now if you've watched our other videos, you know I hate this next option, but it really is helpful.

    03:24 You can use thickeners or Thick-It with liquids if the patient needs that.

    03:29 A problem for me is I'm a real texture person when it comes to food.

    03:33 And so you can take something like iced tea and put Thick-It in it.

    03:37 And my brain just can't get over the concept of drinking iced tea that's thick.

    03:42 It seems like it's just rotten or nasty.

    03:45 But if it's the only way I could ingest that, I'd have to figure out how to adjust.

    03:50 So be prepared.

    03:52 If your patients are like me, they might be a little hesitant to try that.

    03:57 But you'll find a balance in what they're willing to tolerate in order to eat or drink the food and beverages that they really enjoy.

    04:04 Be sure to be gentle about this with your patient and remind them about the high protein in levodopa medications.

    04:13 Now, why I say be gentle with this is, you don't want to overload your patient with a lot of dos and don'ts, but consistently remind them that if they're taking levodopa, a form of medication that treats Parkinson's, you don't want them to have a high-protein meal with the levodopa.

    04:32 You want to make sure there's time in between that.

    04:34 Because what ends up happening is the medication is more-- is less effective.

    04:38 So it's more ineffective or less effective because that protein in the food if it's high protein is going to compete with receptors, and so really messes up the effectiveness of the levodopa.

    04:50 So just remind them of that that we can work with the timing in them of the medication and their meals.

    04:57 Nurses always have a responsibility in helping a patient understand their medication plan.

    05:04 But in Parkinson's, it's particularly problematic, because this can be a complex plan or progress because one drug will work and then it stops, might have to consider a drug holiday under medical supervision, switch medications.

    05:19 It can really be complex.

    05:21 The earlier problems are identified, the more effective a plan we can develop.

    05:26 So, first of all, it's our job as nurses to assess the patient and the caregiver how much do they know about their prescribed medications, are there any gaps, and where are those gaps, because this is critically important.

    05:40 The adjustments that need to be made in a Parkinson's patient's medication plan involve the patient and caregiver giving us lots of feedback about their symptoms and how things are progressing.

    05:53 So the patient and family need to clearly understand how the medication works, and know what needs to be communicated to the healthcare team.

    06:01 So it's all about consistency.

    06:04 You just don't go in at the discharge of the patient and throw up all this information on them, or worse, hand them a stack of papers with medical knowledge on it.

    06:14 That's not the way to educate the patient.

    06:17 You want to be consistent about it.

    06:19 Give them information and small, but consistent.

    06:21 And we keep using that word.

    06:23 Because that's the way we all learn best.

    06:26 Small pieces over a period of time to address the gaps and the patient's knowledge that you find is appropriate.

    06:33 That's what a nurse's job is.

    06:35 You don't do it in one shift.

    06:37 You do it every shift with all of your patients.

    06:41 It will be much more effective for them.

    About the Lecture

    The lecture Parkinson's Disease: Constipation and Adequate Nutrition (Nursing) by Rhonda Lawes, PhD, RN is from the course Chronic Neurological Disorders (Nursing). It contains the following chapters:

    • Constipation
    • Adequate Nutrition

    Included Quiz Questions

    1. Encourage consistent fluid intake.
    2. Increase dietary fiber.
    3. Utilize bowel training techniques.
    4. Use suppositories and enemas regularly.
    5. Increase dietary caffeine and sodium intake.
    1. Use thickeners with liquids as appropriate.
    2. Eat quickly to limit fatigue.
    3. Encourage the client to work through noted problems with swallowing.
    4. Encourage the client to raise the chin when swallowing.
    1. Assessing the client's knowledge about their prescribed medications
    2. Reviewing the client's chart and making medication adjustments
    3. Watching the client take their medications
    4. Adding more medications to supplement their current regimen

    Author of lecture Parkinson's Disease: Constipation and Adequate Nutrition (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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