The answer is D: Motor ability.
Explanation for each option:
A. Nutrition: While patients with Parkinson's disease may experience challenges related to nutrition, such as difficulty swallowing or decreased appetite, these are not the primary expected outcomes of the disease.
B. Elimination: Parkinson's disease can affect the autonomic nervous system, leading to issues with bowel and bladder function. However, these are not the primary expected outcomes.
C. Effective communication: Communication difficulties can arise due to changes in speech and facial expression, but these are secondary to the primary motor symptoms.
D. Motor ability: Parkinson's disease is primarily characterized by progressive motor symptoms, including tremors, rigidity, bradykinesia (slowness of movement), and postural instability. These motor difficulties are the hallmark of the disease and the primary expected outcome as the disease progresses.
Summary: The primary expected outcome in a patient with Parkinson's disease is progressive difficulty with motor ability.