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Med Surg 2 > 58 - Parkinson > Flashcards

58 - Parkinson Flashcards

1
Q

parkinson’s

A

chronic, progressive NEURODEGENERATIVE DISORDER

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2
Q

pakinson’s is characterized by

A
  • bradykinesia
  • rigidity
  • tremor at rest
  • gait changes
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3
Q

bradykinesia

A

slowness in intitiatn + executn of mvmt

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4
Q

rigidity

A

incr muscle tone

  • resistance to passive motin when limps are moved thru ROM
  • jerky quality
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5
Q

PD age + sex of onset

A
  • incr w age
  • only 4% diagnosed before 50 y.o
  • men>women
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6
Q

is PD heredetary?

A

NO but genetic + environmental factors could be a cause

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7
Q

exposure to ____ may incr risk

A
  • well water
  • pesticides
  • herbicides
  • industrl chemcl
  • wood pulp mills
  • rural residence
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8
Q

drug-inducing parkinsonism

A
  • haloperidol
  • chlorpromazine
  • metoclopramide
  • reserpine
  • methyldopa
  • lithium
  • illicit drugs like meth
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9
Q

pathological process of PD

A

low dopamine fr degeneratn of neurons that produce DA> imbalance bw DA + ACh> unusual clumps of lewy bodies in brain

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10
Q

Dopamine [DA] is important for…

A

normal functiong of extrapyramidal motor system

  • control of posture
  • support
  • voluntary motion
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11
Q

PD onset of sympt

A
  • gradual + ongoing progression

- 1 side of body may be involved at first

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12
Q

classic manifestation of PD

A 
TRAP
Tremor
Rigidity
Akinesia
Postural Instability
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13
Q

early manifestations

A
  • mild tremor
  • slight limp
  • decr arm swing
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14
Q

later signs

A
  • shuffling gait
  • arms flexed
  • postural reflex seem lost
  • speech problems
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15
Q

parkinsonian tremor is more prominent…

A

at rest

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16
Q

tremors can affect…

A
  • diaphragm
  • tongue
  • lips
  • jaw
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17
Q

essential termor

A

occurs during voluntary mvmt + has more frequency than parkinsonian
-more familial

18
Q

akinesia

A

absence/loss of coluntary muscle mvmt

-stoop posure, masked face, drooling, shiffling gate

19
Q

Pull Test

A

assessment of postural stability

  • stand behind pt + tug backwards on their shoulder
  • pt will fall backward
20
Q

nonmotor symptoms

A

-depression
-memory changes
-sleep problems
fatigue
-pain
-urinary retentn

21
Q

PD complications

A
  • dyskinesia
  • weakness
  • neurologic (dementia)
  • dysphagia
  • malnutrition
  • aspiration
  • PNA
  • UTI
  • skin breakdown
  • ortho hypotension
22
Q

dyskinesia

A

spontaneous INVOLUNTARY mvmt

23
Q

dysphagia

A

difficulty swallowing

24
Q

diagnosis

A

based on history + clinical features (TRAP_

25
Q

confirmation of PD is….

A

a positive response to ANTIparkinsonian drugs like levadopa or DA agonsit

26
Q

MRI + CT for PD

A
  • not helpful

- mostly used to rule out stroke or tumors

27
Q

PD treatment

A

no cure

-aimed at correcting imbalance of neurotransmitters

28
Q

antiparkinsonian drugs either _____ or ______

A
  • enhance release/supply of DA (dopaminergic)

- block effects of overactive cholinergic neurons (anticholinergic)

29
Q

primary tx of PD are…

A

levadopa + carbidopa

30
Q

levadopa + carbidopa

nursing alert

A
  • monitor for signs of dyskinesia
  • monitor short term a/e (n/v, light headed)
  • onset may take months
  • report signs of EPS
  • DO NOT give w food
31
Q

dont give levadopa + carbidopa w food bc…

A

protein reduces absorption

32
Q

DA agonist drug name

A

pramipexole

-directly stim DA receptors

33
Q

pramipexole

drug alert

A
  • take w food to decr nausea

- notify HCP if uncontrollable urses, confusn, rigidity, excess urinatn, SOB, vision changes

34
Q

anticholinergic drug names + action

A

trihexyphenidyl + benztropine + diphenhydramine

-decr activity of ACh to balance bw cholinergic + dopanergic actions

35
Q

anticholinergic drugs may be used to manage…

A

tremors

36
Q

MAO inhibitors drug name + action

A

selegiline

-inhibits the enzyme that degrades DA

37
Q

list of antiparkinsonian drug types

A
  • DA agonist
  • anticholinergic
  • mao inhibitor
  • DA precursor
38
Q

w/in 3-5 yrs, pt have episodes of…

A

hypomobility

-inability to raise fr chair, speak, or walk

39
Q

PD mgmt

A
  • antiparkinsonian drugs
  • surgical therapy
  • deep brain stim
  • ablation
  • phys therapy
  • occptnl therapy
40
Q

3 categories of surgical therapy

A

1 deep brain stim
2 ablation
3 transplantation

41
Q

DBS is preferred over ablation bs…

A

reversible + programable

42
Q

to prevent “freezes” while walking

A

imagine walking over an imaginary object on floor

  • rock fr side to side before stepping
  • walk to beat
  • swing both arms
  • 1 step back 2 forward

Med Surg 2 (13 decks)

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