12.2 Neurological and Neuromuscular Disorders

Question 1

Parkinson’s Disease

Answer 1

• Progressive CNS disorder “shaking palsy” that impairs motor skills, speech, and movement (tremors and slow/freezing movements)
• No cure for motor symptoms but drugs can maintain functional mobility for years.

Risk Factors
- Pesticide Exposure
- Rural Living
- Farming as an occupation
- Drinking well water

• Dopamine producing neurons in the midbrain degenerate which alters levels of dopamine and acetylcholine in basal ganglia.
• Decreased dopamine causes extrapyramidal symptoms such as posture, support, and motion.

Diagnosis
- Autopsy (definitive)
- Neurological exam
- Positive response to dopaminergic medications
- CT/MRI to rule out other causes

Question 2

Parkinson’s Disease Manifestations

Answer 2

• TREMORS
• MUSCLE RIGIDITY
• BRADYKINESIA (slow movement)

Other symptoms
- Difficulty changing positions, walking, speaking, and swallowing
- Postural instability
- Shuffling gait
- Lack of swing in arms
- MASK LIKE FACE
- Akinesia (absence of movement)
- Cognitive dysfunction
- Language problems

Can be caused by the following drugs
- Antiemetics (Compazine and Metoclopramide)
- Neuroleptics (Haldol and Thorazine)
- Avoid these drugs in PD patients and these are reversible symptoms.

Question 3

Medical Treatment Parkinson’s

Answer 3

Surgery
- Deep Brain Stimulation (DBS) with cell transplantation to improve motor function and reduce dyskinesia (involuntary movements)
- This is done with a pulse generator surgically implanted into the area beneath the clavicle which blocks nerve pathways to the thalamus associated with tremors.

NUTRITION
- FIBER AND FRUIT (to prevent constipation)
- Mechanically Soft Diet (Easy to chew)
- SIX SMALL MEALS

Question 4

Nursing Care Parkinson’s

Answer 4

• Medication compliance
• Safety of home environment (rugs and equipment)
• Assist with ADL’s
• Help maintain lifestyle
• Identify caregivers