Tremor Tomas — Parkinson's Disease
Resting tremor, rigidity, bradykinesia — time levodopa exactly, never abruptly stop it
Tomas's hand trembles at rest but calms when he reaches for his coffee cup. His steps have become short and shuffling, and he struggles to start walking through a doorway.
Tomas has too little dopamine in his basal ganglia, producing the classic triad: resting 'pill-rolling' tremor, cogwheel rigidity, and bradykinesia, plus a shuffling, festinating gait and stooped posture. Levodopa-carbidopa replaces what his brain is missing, but timing matters — doses are given on a strict schedule, apart from high-protein meals which compete for absorption, and the drug must never be stopped abruptly.
Read Tremor Tomas's full story →The story arc
The setup
Dopamine-producing neurons in Tomas's substantia nigra gradually die off, though he doesn't notice until his handwriting shrinks and his face looks less expressive.
The turn
A resting tremor appears in his right hand — worse when relaxed, better with purposeful movement — along with cogwheel rigidity in his wrist.
The crisis
Tomas freezes mid-stride in a doorway, shuffles with tiny steps, and falls when he tries to turn around too quickly.
The save
The nurse schedules levodopa-carbidopa at the same times daily, separates dosing from high-protein meals, teaches Tomas to rock side to side before stepping off to break a freeze, and never allows the medication to be stopped abruptly.
NCLEX study section — Parkinson's Disease
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.