Description
Parkinsonâs Disease Case Study Details:
Background
Doug and his wife Maria have three adult children, all of whom are married with young children of their own. Doug works as a regional sales representative for a chemical company that produces plastics, chemicals, and agricultural products. He has been in the position for 15 years, having moved into this job after leaving a different company doing similar work. The job requires him to travel to give demonstrations of the products across a six-state region. This requires him to fly and drive in unfamiliar areas. Maria works as a junior high school principal. Doug and Maria are financially set for retirement at age 65. Overall, they are in good health. At the age of 60, Doug received a diagnosis of Parkinsonâs Disease (PD).
Early phase
In the year before his diagnosis, Doug had three minor car accidents while he was traveling in unfamiliar territory. Maria was suspicious that the accidents were related to his PD and, after consulting with the neurologist and Doug, they decided he should no longer travel alone out of his immediate area. After a few months of traveling with a colleague, he reluctantly stepped down to a district sales representative position to stay closer to home. Within the next year, Doug started experiencing exacerbated (worsened) symptoms related to fine motor coordination, changes in speech, as well as anger, anxiety, and depression. The neurologist placed Doug on short-term disability at the age of 61. After six months on short-term disability, the law mandates that the individual must apply for Social Security Disability. Therefore, due to Dougâs health continuing to decline and his inability to return to work, Maria had to file for long-term disability for Doug. At first, Maria attempted to work with Doug to complete the disability paperwork. Doug was easily frustrated with formulating the responses to the questions on the forms; he did not know how to answer the questions nor where to find the information within their household records, so Maria hired a lawyer to complete the paperwork.
Three months after submitting the application, Doug was approved for Social Security Disability Income (SSDI). This was a significant drop in income. Dougâs employment income was twice that of Mariaâs; he was bringing home $7500 per month. His SSDI income is $2788 per month. Since Doug left his full-time job, he was no longer eligible for health benefits from his employer. He is not eligible for Medicare under the disability guidelines until two years after payments begin. Maria completed the paperwork to add him to the health insurance through her job, which doubled her monthly contribution to health insurance. The decrease in household income required them to utilize their retirement funds earlier than planned. In addition, Maria knows, as the disease progresses, she may have to make decisions about her own full-time work as a principal, which will further strain their financial situation.
Middle phase
Doug and Maria enjoyed playing Scrabble with their friends Susan and Bob, who lived nearby. The two couples would get together every Saturday for some friendly competition along with dessert and lively discussion. A year after his diagnosis, Doug was exhibiting stooped posture and changes in his speech, which made it difficult to understand what he said. These were clear signs the disease was progressing. In some aspects of his life, he appeared to function well enough, such as easily performing most activities of daily living, but it became clear he struggled with activities in the game of Scrabble. For example, he was having a difficult time creating words from the tiles he chose, where to place them on the board, and he could no longer add up his points correctly. In addition, Doug was embarrassed because he continually knocked tiles out of place on the board, struggled to communicate clearly and interact with friends in a social situation. Doug felt a great deal of shame due to the changes and told Maria that he no longer wanted to participate in the weekly game night. This meant that Doug and Maria had less interaction in their own community and became more socially isolated, which is not uncommon for families with a chronically ill member.
Late phase
Doug was in charge of managing his own medications, which he needs four times a day. One day, about four years after his diagnosis, Maria was away from home at noon when Doug called her to ask what he was supposed to do with the noon pills. âIâm supposed to throw them out, right?â That was an early sign of dementia. It was a signal for Maria that Doug could no longer control his own medications and that he probably shouldnât be left alone for very long. The incident marked the start of a steep decline in Dougâs cognitive and emotional abilities, and the coupleâs relationship changed from one of partners to one of patient and caregiver. Maria relied on their children and other family members to help with Dougâs care, and she began looking for support groups to help her figure out how to handle the deteriorating situation. Even though she had a rotation of helpers, most of the work of Dougâs care was Mariaâs responsibility.
Dougâs condition progressed to the point of needing full-time care in a skilled nursing facility a little more than a year later, after he lost the ability to stand up, even with help. He always needed two people to help him, and that just wasnât possible at home. In addition to the tremendous emotional stress on the family, moving Doug to a skilled nursing facility further increased the financial burden. Maria made the decision to sell the house and move to a small apartment by herself. She had to spend the proceeds from their home to pay for Dougâs nursing home care before Medicaid would help pay for his care, due to the Medicaid eligibility spend-down requirements. Doug passed away five months after moving to the skilled nursing facility. Maria was still paying for his care out of the proceeds from the sale of their home, so she never received Medicaid assistance for Dougâs care.
*Briefly define Parkinsonâs Disease.
-What physical changes occur related to the onset of the disease?
-What are the possible psychological changes with PD?
-What system(s) are affected?
-What are the treatments and therapies?
*The case study shared details that indicate Doug is no longer able to identify and resolve problems.
-Identify two examples in the study that indicate Doug is losing this ability.
-Provide two other examples that may arise as the disease progresses that are related to
identifying and resolving problems.
*Discuss possible feelings and stressors Doug may be experiencing as the disease progresses and he must rely on caregivers more.
-Refer to the required reading list for the topics related to this assignment for ideas.
*Discuss the effects of the diagnosis of PD and its progression can have on a spouse and family (micro-level).
-Refer to the chapter and required readings regarding caregiving and caregiver burden (e.g.,
employment, psychological effects, financial stressors, role in the marriage, etc.).
*Locate two services in your own community that offer assistance to people with PD and their caregivers (meso-level).
-Describe the services available, cost, and eligibility requirements.
-In your opinion, are Doug and Maria eligible for the services? Explain your answer based on your
findings and the knowledge of Doug and Maria.
*At the macro-level, research the state and federal programs, legislation and initiatives that affect chronic illnesses. Discuss the pros and cons of two of the following items as they affect patients and caregivers.
-Legislation and lobbying efforts (e.g., changes to the Affordable Care Act [ACA], stem-cell
research, etc.)
-Requirements to qualify for Social Security Disability Income (SSDI)
-Requirements to take advantage of the Family and Medical Leave Act (FMLA)
-Requirements to qualify for Medicaid/Medicare.
- What are the requirements of these programs in terms of paying for skilled nursing for
Doug? Do Doug and Maria qualify for assistance through these programs? Why or why
not?
-Americans with Disabilities Act (ADA).
-A program, legislation, or initiative of your finding.
Sample Solution
The Owl and the Pussy-Cat In this paper I will dissect Edward Lear’s sonnet ‘The Owl and the Pussy-Cat’ (Appendix 1), first giving a specialized expressive investigation focusing on sound designing, furthermore finding its place in the historical backdrop of verse for youngsters, and thirdly how the lyric conceives youth. Written in December 1867 for the girl of a dear companion of Lear, it was first distributed in a compilation by Lear entitled Nonsense Songs, Stor Parkinson’s Disease Case Study ies, Botany, and Alphabets (1871). From that point forward it has been distributed, represented, made an interpretation of, and set up with a good soundtrack ordinarily. In 2001 it was casted a ballot Britain’s preferred sonnet. Lear utilizes basic, however imaginative language to recount to the captivating story of the voyaging sweethearts; the indistinguishable winged animal and feline. Including three stanzas, every eleven lines in length, it comprises of twin number quatrains and a three-line hold back, formed in a particular versifying meter. The rhyme plan is ‘abcbdefe’ switching back and forth somewhere in the range of four and three focused on syllables for every line, trailed by the hold back ‘eee’ comprising of two lines with only one focused on syllable, and a last line with three. This uniform rhyme plot gives the sonnet melodic structure, yet in addition adheres the altogether different pieces of the story. The musical parallelism of the holds back, in which every one of the three lines end with the equivalent focused on word, is an exacting example in itself and frontal areas this piece of the sonnet as it takes on an incantatory feel. Despite the fact that the holds back are not the predominant structure of the sonnet, they do include melodic support. The customary metrical example is the thing that gives the lyric its rising cadence (anapests) and sing melody structure and there is little to upset the progression of the mood, or the story. The point at that point is effortlessness and redundancy; undoubtedly the primary case of reiteration happens in the opening line, which highlights the sonnet’s title words accordingly reaffirming the focal point of the ballad. Yet, in the primary stanza, the most discernible sound example is the convergence of/p/sounds; a phonological parallelism that reaches out over the content with the words ‘Pussy’, ‘pea’, ‘bounty’ and ‘pound’ just as happening in ‘wrapped’ and ‘up’. The repeat of this plosive consonant copies the culling of guitar strings, which upgrades the musicality as well as the enhanced visualization of the serenading owl. While the plosive/p/in ‘Pussy’ combined with the/b/in ‘wonderful’ isn’t exactly alliterative, it is resonating and enticing of music, mirroring the profundity and enthusiasm of the owl’s charms. Note that Lear likewise utilizes accentuation to stress meaning; the outcry marks toward the finish of lines ten and eleven signify a statement of the owl’s sentiments recommending that the relationship is surely something other than kinship. Notwithstanding reiteration and similar sounding word usage, Lear utilizes solid full rhyme Parkinson’s Disease Case Study s to fortify sound, which means and beat, and they have a functioning influence in the state of mind and motivation behind this ballad. Flawless end rhymes are the most discernible, yet there are additionally solid inward rhymes, to be specific happening in each third line of every stanza, yet in addition in the fifth line in the second and third ones. This blend of one and two syllable rhymes go about as a sub-abstain bringing the tune sound ‘all around’ again to our ears while the content turns out to be increasingly capricious. Sound and musicality are additionally drawn out into the open by the tolling end rhyme among ‘sing’ and ‘ring’ in lines thirteen and fifteen. The words are splendid and short, similar to the vowel sound, yet pursued by the consonant/ng/the sound is broadened, and the redundancy of ‘ring’ in the hold back mimickes the ringing of a chime where we may hear the onomatopoeic reverberation of ‘bong’ (from ‘bong-tree’). The third stanza comes full circle in a centralization of inner and harmonious rhymes which invoke a visual and aural gala to coordinate the wedding dinner itself, with the last lines inspiring the who-o-o, who-o-o of an owl through the long vowel/oo/in ‘moon’. Every one of the characteristics of tune are available: delight, simplicity of reiteration, memorability, cadence, rhyme and abstains. The clear suddenness of these components rise up out of customary standards and Lear’s clever association. Other than musicality, the other fundamental element of the lyric is ‘word-play’ with Lear fusing intermittent created words: ‘ Parkinson’s Disease Case Study bong-tree’, ‘Piggy-wig’ and the babble descriptor ‘runcible’. Just as having a comical impact, they present components of unconstrained dream that accentuate the dreamlike adventure of the anthropomorphised creatures. In spite of the fact that these words seem made-up regardless they stay, just, inside our typical desires for English. Nonetheless, the way that they do veer off from the ballad’s encompassing basic language implies they are foregrounded, in this manner, the peruser/audience gives especially consideration to them since they are fulfilling to state without fundamentally appearing well and good. Despite the fact that ‘runcible’ has no genuine importance (in spite of the fact that it has since been famously characterized as a three-pronged fork bended like a spoon) it has a phonological fun loving nature with the moving of the ‘r’ in ‘run’ trailed by the two syllables in ‘cible’. The hyphenation of ‘Piggy-wig’ really fuses the phonemes and implications of two words, ‘pig’ and ‘wig’, managng to prevail as an interior rhyme. While the consideration of these words doesn’t generally add anything to the significance of the expression, they do at any rate continue, and perhaps fortify the musicality. It isn’t until the last stanza that the mood is upset somewhat by the ‘running over’ of line twenty-three into twenty-four immediately. The impact of this enjambment is that we are rushed on to a vital stage in the story, the time when an exchange happens. The caesura at the word ‘ring’ makes a delay, yet additionally a short strain as we anticipate the pig’s answer. Note that the immediate discourse in these lines references conventional marriage promises strengthened by the weight on the words ‘willing’ and ‘will’. Moreover, this exchange likewise brings the ‘genuine’ world closer to the surface. Without a ring the marriage can’t occur. Just when the ‘bargain’ has been done can the story, and therefore the sonnet, proceed as in the past. When the customary musicality resumes it drives the story ahead, finishing with cat and fowl moving ‘connected at the hip, on the edge of the sand⦠by the light of the moon’. Symbolism made by the evening glow (generally summoned as being sentimental) implies the charm of the scene moves on with the dream sweethearts and is the place the peruser/audience needs to leave them. Despite the offbeat story and word-play the sonnet is firmly tied down by the solid versifying ‘walk’ woven through the conventional melody type of tetrameter and trimeter. The rising rhythms move the ballad along while being constrained by the full and stable rhymes, making it fulfilling. Lear’s ability originally came around in A Book of Nonsense (1846) containing a gathering of his limericks and interesting representations which demonstrated a prompt accomplishment with perusers and faultfinders. Lear’s work, alongside that of Lewis Carroll, created and promoted rubbish writing, particularly with respect to their utilization of ‘babble’ words, in this manner, it is regularly observed as an unmistakably ‘Victorian classification’. Be that as it may, abstract rubbish existed some time before this and, as Styles calls attention to in her exposition about the historical backdrop of verse for youngsters, can be followed back to the ‘ferocity of the nursery rhyme’ (Styles, p. 211). These old and customary rhymes from the oral convention, naturally known as ‘Mother Goose’ rhymes, are an accumulation of sections, bedtime songs, rhymes and tunes offering silliness, redundancy and narrating, albeit few were initially made or planned for kids. Eighteenth century verse considered reasonable for Parkinson’s Disease Case Studykids was generally instructional or moralistic, and frequently dastardly. Its main points were worried about sparing the spirit and making great character and, as other youngsters’ writing, generally mirrored the thoughts that grown-ups held about what kids ought to be keen on. Be that as it may, as Puritanism wound down and new thoughts regarding adolescence rose, beautiful accumulations composed explicitly for kids started to show up. Tommy Thumb’s Song Book (1744) was the main endeavor to put nursery rhymes from the oral custom into print, and two accumulations from William Blake in 1789 and 1794, despite the fact that not explicitly composed for kids, captured the quintessence of adolescence. Different volumes of tyke focused verse showed up in the early piece of the nineteenth century, and despite the fact that writers as of now kept on following in the equivalent moralistic custom there was a developing enthusiasm for kids’ feelings and encounters. The mid and late nineteenth century delivered Stanzaan bounty of verse for kids, including that of Lear, which harmonized with the changing perspectives on youth. Despite the fact that the foundations of babble refrain are sooner than the nineteenth century, this is the period the most celebrated and remarkable models show up. Lear’s limericks and rubbish rhymes were delighted in by youngsters, yet additionally by grown-ups, who discovered them an appreciated help from the prohibitive lessons of the Church and Victorian culture when all is said in done. These clever and comical rhymes were enjoyable to peruse so anyone might hear and simple to recollect. Be that as it may, Lear’s work isn’t simply recognized by his se Parkinson’s Disease Case Study mantic play; it additionally included unusual and funny illust Parkinson’s Disease Case Study rations. In spite of the fact that his representations for ‘The Owl and the Pussy-Cat’ are to some degree preservationist in that the creatures are delineated reasonably and seem blank, they do offer an interp Parkinson’s Disease Case Study retative impact and would have incredibly improved the impression of the lyric at the season of distribution. On the other hand, the single delineation in 100 Best Poems for Children (P>
The Owl and the Pussy-Cat In this paper I will dissect Edward Lear’s sonnet ‘The Owl and the Pussy-Cat’ (Appendix 1), first giving a specialized expressive investigation focusing on sound designing, furthermore finding its place in the historical backdrop of verse for youngsters, and thirdly how the lyric conceives youth. Written in December 1867 for the girl of a dear companion of Lear, it was first distributed in a compilation by Lear entitled Nonsense Songs, Stories, Botany, and Alphabets (1871). From that point forward it has been distributed, represented, made an interpretation of, and set up with a good soundtrack ordinarily. In 2001 it was casted a ballot Britain’s preferred sonnet. Lear utilizes basic, however imaginative language to recount to the captivating story of the voyaging sweethearts; the indistinguishable winged animal and feline. Including three stanzas, every eleven lines in length, it comprises of twin number quatrains and a three-line hold back, formed in a particular versifying meter. The rhyme plan is ‘abcbdefe’ switching back and forth somewhere in the range of four and three focused on syllables for every line, trailed by the hold back ‘eee’ comprising of two lines with only one focused on syllable, and a last line with three. This uniform rhyme plot gives the sonnet melodic structure, yet in addition adheres the altogether different pieces of the story. The musical parallelism of the holds back Parkinson’s Disease Case Study , in which every one of the three lines end with the equivalent focused on word, is an exacting example in itself and frontal areas this piece of the sonnet as it takes on an incantatory feel. Despite the fact that the holds back are not the predominant structure of the sonnet, they do include melodic support. The customary metrical example is the thing that gives the lyric its rising cadence (anapests) and sing melody structure and there is little to upset the progression of the mood, or the story. The point at that point is effortlessness and redundancy; undoubtedly the primary case of reiteration happens in the opening line, which highlights the sonnet’s title words accordingly reaffirming the focal point of the ballad. Yet, in the primary stanza, the most discerni Parkinson’s Disease Case Study ble sound example is the convergence of/p/sounds; a phonological parallelism that reaches out over the content with the words ‘Pussy’, ‘pea’, ‘bounty’ and ‘pound’ just as happening in ‘wrapped’ and ‘up’. The repeat of this plosive consonant copies the culling of guitar strings, which upgrades the musicality as well as the enhanced visualization of the serenading owl. While the plosive/p/in ‘Pussy’ combined with the/b/in ‘wonderful’ isn’t exactly alliterative, it is resonating and enticing of music, mirroring the profundity and enthusiasm of the owl’s charms. Note that Lear likewise utilizes accentuation to stress meaning; the outcry marks toward the finish of lines ten and eleven signify a statement of the owl’s sentiments recommending that the relationship is surely something other than kinship. Notwithstanding reiteration and similar sounding word usage, Lear utilizes solid full rhymes to fortify sound, which means and beat, and they have a functioning influence in the state of mind and motivation behind this ballad. Flawless end rhymes are the most discernible, yet there are additionally solid inward rhymes, to be specific happening in each third line of every stanza, yet in addition in the fifth line in the second and third ones. This blend of one and two syllable rhymes go about as a sub-abstain bringing the tune sound ‘all around’ again to our ears while the content turns out to be increasingly capricious. Sound and musicality are additionally drawn out into the open by the tolling end rhyme among ‘sing’ and ‘ring’ in lines thirteen and fifteen. The words are splendid and short, similar to the vowel sound, yet pursued by the consonant/ng/the so Parkinson’s Disease Case Study und is broadened, and the redundancy of ‘ring’ in the hold back mimickes the ringing of a chime where we may hear the onomatopoeic reverberation of ‘bong’ (from ‘bong-tree’). The third stanza comes full circle in a centralization of inner and harmonious rhymes which invoke a visual and aural gala to coordinate the wedding dinner itself, with the last lines inspiring the who-o-o, who-o-o of an owl through the long vowel/oo/in ‘moon’. Every one of the characteristics of tune are available: delight, simplicity of reiteration, memorability, cadence, rhyme and abstains. The clear suddenness of these components rise up out of customary st Parkinson’s Disease Case Studyandards and Lear’s clever association. Other than musicality, the other fundamental element of the lyric is ‘word-play’ with Lear fusing intermittent created words: ‘bong-tree’, ‘Piggy-wig’ and the babble descriptor ‘runcible’. Just as having a comical impact, they present components of unconstrained dream that accentuate the dreamlike adventure of the anthropomorphised creatures. In spite of the fact that these words seem made-up regardless they stay, just, inside our typical desires for English. Nonetheless, the way that they do veer off from the ballad’s encompassing basic language implies they are foregrounded, in this manner, the peruser/audience gives especially consideration to them since they are fulfilling to state without fundamentally appearing well and good. Despite the fact that ‘runcible’ has no genuine importance (in spite of the fact that it has since been famously characterized as a three-pronged fork bended like a spoon) it has a phonological fun loving nature with the moving of the ‘r’ in ‘run’ trailed by the two syllables in ‘cible’. The hyphenation of ‘Piggy-wig’ really fuses the phonemes and implications of two words, ‘pig’ and ‘wig’, managng to prevail as an interior rhyme. While the consideration of these words doesn’t generally add anything to the significance of the expression, they do at any rate continue, and perhaps fortify the musicality. It isn’t until the last stanza that the mood is upset somewhat by the ‘running over’ of line twenty-three into twenty-four immediately. The impact of this enjambment is that we are rushed on to a vital stage in the story, the time when an exchange happens. The caesura at the word ‘ring’ makes a delay, yet additionally a short strain as we anticipate the pig’s answer. Note that the immediate discourse in these lines references conventional marriage promises strengthened by the weight on the words ‘willing’ and ‘will’. Moreover, this exchange likewise brings the ‘genuine’ world closer to the surface. Without a ring the marriage can’t occur. Just when the ‘bargain’ has been done can the story, and therefore the sonnet, proceed as in the past. When the customary musicality resumes it drives the story ahead, finishing with cat and fowl moving ‘connected at the hip, on the edge of the sand⦠by the light of the moon’. Symbolism made by the evening glow (generally summoned as being sentimental) implies the charm of the scene moves on with the dream sweethearts and is the place the peruser/audience needs to leave them. Despite the offbeat story and word-play the sonnet is firmly tied down by the solid versifying ‘walk’ woven through the conventional melody type of tetrameter and trimeter. The rising rhythms move the ballad along while being constrained by the full and stable rhymes, making it fulfilling. Lear’s ability originally came around in A Book of Nonsense (1846) containing a Parkinson’s Disease Case Study gathering of his limericks and interesting representations which demonstrated a prompt accomplishment with perusers and faultfinders. Lear’s work, alongside that of Lewis Carroll, created and promoted rubbish writing, particularly with respect to their utilization of ‘babble’ words, in this manner, it is regularly observed as an unmistakably ‘Victorian classification’. Be that as it may, abstract rubbish existed some time before this and, as Styles calls attention to in her exposition about the historical backdrop of verse for youngsters, can be followed back to the ‘ferocity of the nursery rhyme’ (Styles, p. 211). These old and customary rhymes from the oral convention, naturally known as ‘Mother Goose’ rhymes, are an accumulation of sections, bedtime songs, rhymes and tunes offering silliness, redundancy and narrating, albeit few were initially made or planned for kids. Eighteenth century verse considered reasonable for kids was generally instructional or moralistic, and frequently dastardly. Its main points were worried about sparing the spirit and making great character and, as other youngsters’ writing, generally mirrored the thoughts that grown-ups held about what kids ought to be keen on. Be that as it may, as Puritanism wound down and new thoughts regarding adolescence rose, beautiful accumulations composed explicitly for kids started to show up. Tommy Thumb’s Song Book (1744) was the main endeavor to put nursery rhymes from the oral custom into print, and two accumulations from William Blake in 1789 and 1794, despite the fact that not explicitly composed for kids, captured the quintessence of adolescence. Different volumes of tyke focused verse showed up in the early piece of the nineteenth century, and despite the fact that writers as of now kept on following in the equivalent moralistic custom there was a developing enthusiasm for kids’ feelings and encounters. The mid and late nineteenth century delivered Stanzaan bounty of verse for kids, including that of Lear, which harmonized with the changing perspectives on youth. Despite the fact that the foundations of babble refrain are sooner than the nineteenth century, this is the period the most celebrated and remarkable models show up. Lear’s limericks and rubbish rhymes were delighted in by youngsters, yet additionally by grown-ups, who discovered them an appreciated help from the prohibitive lessons of the Church and Victorian culture when all is said in done. These clever and comical rhymes were enjoyable to peruse so anyone might hear and simple to recollect. Be that as it may, Lear’s work isn’t simply recognized by his semantic play; it additionally included unusual and funny illustrations. In spite of the fact that his representations for ‘The Owl and the Pussy-Cat’ are to some degree preservationist in that the creatures are delineated reasonably and seem blank, they do offer an interpretative impact and would have incredibly improved the impression of the lyric at the season of distribution. On the other hand, the single delineation in 100 Best Poems for Children (P>