# A nurse is assessing a 65-year-old male client with Parkinson's disease who was admitted to the medical unit. Which assessment finding would be most concerning and require immediate nursing intervention?

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## 문제

A nurse is assessing a 65-year-old male client with Parkinson's disease who was admitted to the medical unit. Which assessment finding would be most concerning and require immediate nursing intervention?

## 보기

1. Bradykinesia with slow, deliberate movements when walking to the bathroom
2. Pill-rolling tremor of the hands that decreases during purposeful activity
3. Muscle rigidity in the arms and legs with cogwheel resistance
4. Difficulty swallowing with frequent coughing during meals and drooling **✔ 정답**

**정답: 4**

## 해설

Dysphagia (difficulty swallowing) with frequent coughing and drooling indicates a high risk for aspiration pneumonia, which is a life-threatening complication requiring immediate intervention.

Parkinson's disease is a progressive neurodegenerative disorder characterized by the degeneration of dopamine-producing neurons in the basal ganglia, particularly the substantia nigra. This leads to the classic motor symptoms known as the "cardinal signs" of Parkinson's disease: tremor, rigidity, bradykinesia, and postural instability.

In this assessment scenario, the nurse must prioritize findings based on immediate safety concerns. While all options represent typical symptoms of Parkinson's disease, dysphagia (difficulty swallowing) with frequent coughing and drooling poses the most immediate threat to patient safety.

In Parkinson's disease, dysphagia results from impaired coordination of the muscles involved in swallowing, including the tongue, pharynx, and esophagus. Dopamine deficiency disrupts the smooth coordination of these muscles, leading to delayed initiation of swallowing, reduced tongue mobility, and impaired pharyngeal clearance. When frequent coughing during meals and drooling are present together, this indicates a high risk for aspiration pneumonia.

Aspiration pneumonia is a serious and potentially life-threatening complication that can develop rapidly in patients with Parkinson's disease. Frequent coughing during meals suggests that food or liquid may be entering the airway, while drooling indicates impaired oral motor control. This combination requires immediate nursing interventions, including consideration of NPO status, swallowing evaluation, and dietary consistency modifications.

The correct answer demonstrates the nurse's ability to prioritize assessment findings based on immediate safety concerns and recognize complications requiring urgent intervention in patients with progressive neurological disorders.

## 심화 해설

Clinical Reasoning and Priority Setting

This question requires you to apply clinical judgment to prioritize a client with Parkinson's disease. The key is to distinguish between expected, chronic manifestations of the disease and an acute complication that poses an immediate threat to the airway and breathing. Using the ABC (Airway, Breathing, Circulation) framework is essential for establishing priority.

Analysis of the Correct Answer

Option 4 is the most concerning finding. Difficulty swallowing (dysphagia) with frequent coughing during meals and drooling is a direct clinical indicator of aspiration. Aspiration is defined as the unintentional passage of material from the oropharynx into the larynx and lower respiratory tract [1]. In a client with Parkinson's disease, neurogenic dysphagia is a common and disabling symptom that compromises swallowing safety, directly increasing the risk of aspiration of food, liquids, or saliva [2][3]. The coughing during meals is a protective reflex, but its presence signals that the airway is already being compromised. Drooling (sialorrhea) further indicates poor oral motor control and an inability to manage secretions, which can also be aspirated. This situation can rapidly lead to airway obstruction, chemical pneumonitis, or bacterial aspiration pneumonia, representing an immediate threat to the airway and breathing [1].

Analysis of Incorrect Options

Option 1: Bradykinesia with slow, deliberate movements is a cardinal, expected motor symptom of Parkinson's disease. While it increases the client's risk for falls and requires safety interventions, it does not represent an immediate, life-threatening airway or breathing emergency. This is a chronic management issue.

Option 2: A pill-rolling tremor that decreases during purposeful activity is a classic, expected resting tremor in Parkinson's disease. It is a motor symptom that can be distressing and interfere with fine motor tasks, but it is not an immediate threat to physiological stability.

Option 3: Muscle rigidity with cogwheel resistance is another hallmark, expected finding in Parkinson's disease. It contributes to mobility issues, pain, and the characteristic stooped posture. While it requires nursing assessment and comfort measures, it does not take priority over a finding that indicates active airway compromise.

Pathophysiology and Clinical Connection

The underlying pathophysiology of Parkinson's disease involves the degeneration of dopamine-producing neurons in the substantia nigra. This dopamine deficiency affects not only the motor pathways controlling skeletal muscles but also the complex neuromuscular coordination required for swallowing. Neurogenic dysphagia in Parkinson's disease results from bradykinesia and rigidity affecting the oropharyngeal muscles, leading to delayed swallow reflex, reduced pharyngeal clearance, and poor airway protection [2][3]. When a client coughs during meals, it is a clinical sign that the swallow is unsafe and material has entered the laryngeal vestibule. This observation is a critical component of bedside dysphagia screening, similar to the clinical purpose of tools like the Meal Rounds Observation Form, which helps identify when a client's food texture is unsafe . The nurse's immediate intervention must be to stop the feeding, assess the client's respiratory status, and collaborate with the healthcare team for a formal swallowing evaluation to prevent the progression to aspiration pneumonia, a leading cause of death in this population [1][3].

References (research sources)

- [1]Aspiration RiskResearch articleHoecker RN, Schweiger J, Prunier J, Dua A. (2026)

- [2]Wearable sensors for monitoring neurogenic dysphagia: a scoping review.Research articleGasperini D, Pierotti F, Privitera L, Steele CM, Bandini A. (2026) · DOI: 10.1088/2516-1091/ae6d5d

- [3]Rehabilitation interventions for oropharyngeal dysphagia in people with Parkinson's disease.Research articleBattel I, Arienti C, Del Furia MJ, Lazzarini SG, Warnecke T, Walshe M. (2026) · DOI: 10.1002/14651858.cd015816.pub2

## 임상 시나리오

Parkinson's Disease: Dysphagia & Aspiration PrecautionsAirway protection is the priority over chronic motor symptoms
When assessing a client with Parkinson's disease, any sign of dysphagia such as coughing during meals or drooling signals a high risk for aspiration. This is an immediate threat to the airway per the ABC framework.

Immediate nursing actions include stopping the meal, sitting the client upright to 90 degrees, and assessing oxygen saturation. A formal swallow evaluation by a speech-language pathologist is required before resuming oral intake.

CautionDo not assume a lack of coughing means safe swallowing; silent aspiration is common in Parkinson's disease. Drooling is a red flag for impaired secretion management, not just a social concern.

## 핵심 개념

- **Dysphagia** — Difficulty swallowing, a common symptom in Parkinson's disease that significantly increases the risk of aspiration.
- **Aspiration** — Inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract, potentially causing pneumonitis or pneumonia.
- **Bradykinesia** — Slowness of movement, a cardinal motor symptom of Parkinson's disease.
- **Cogwheel rigidity** — A type of muscle rigidity where a limb responds with a jerky, ratchet-like movement during passive range of motion.
- **Sialorrhea** — Excessive drooling due to impaired swallowing of saliva, not overproduction.

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