The nurse is caring for a patient with Parkinson’s disease. While writing the care plan for this patient what would be an appropriate nursing diagnosis?

A) Reducing some of the tremors: Benztropine (Cogentin) is an anticholinergic medication commonly used in the treatment of Parkinson's disease to help manage symptoms. It works by blocking the effects of acetylcholine, which can help to restore the balance between acetylcholine and dopamine in the brain. This helps reduce symptoms like tremors and rigidity, which are common in Parkinson’s disease. Although it may not completely eliminate these symptoms, it can significantly reduce tremors, making this the most accurate effect of the drug.

B) Improving mental function: Benztropine is not intended to improve mental function. In fact, anticholinergic medications like benztropine can sometimes cause cognitive side effects, including memory problems or confusion, particularly in older patients. While the drug is effective in reducing motor symptoms, it is not used to enhance cognitive abilities in Parkinson’s disease.

C) Helping the patient to walk faster: Benztropine does not directly improve gait speed or help a patient walk faster. The drug primarily targets motor symptoms like tremors and rigidity rather than improving bradykinesia (slowness of movement), which is often the cause of walking difficulty in Parkinson’s patients. Medications such as levodopa or dopamine agonists are typically used to address issues related to bradykinesia and movement speed.

D) Minimizing symptoms of bradykinesia: While benztropine can help manage tremors and rigidity, it is not particularly effective for bradykinesia, which is the hallmark symptom of Parkinson’s disease. Bradykinesia is best addressed with dopaminergic medications like levodopa or dopamine agonists. Therefore, benztropine would not be the first choice for minimizing bradykinesia symptoms.

A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.

B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.

C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.

D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.