58 - Parkinson Flashcards
parkinson’s
chronic, progressive NEURODEGENERATIVE DISORDER
pakinson’s is characterized by
- bradykinesia
- rigidity
- tremor at rest
- gait changes
bradykinesia
slowness in intitiatn + executn of mvmt
rigidity
incr muscle tone
- resistance to passive motin when limps are moved thru ROM
- jerky quality
PD age + sex of onset
- incr w age
- only 4% diagnosed before 50 y.o
- men>women
is PD heredetary?
NO but genetic + environmental factors could be a cause
exposure to ____ may incr risk
- well water
- pesticides
- herbicides
- industrl chemcl
- wood pulp mills
- rural residence
drug-inducing parkinsonism
- haloperidol
- chlorpromazine
- metoclopramide
- reserpine
- methyldopa
- lithium
- illicit drugs like meth
pathological process of PD
low dopamine fr degeneratn of neurons that produce DA> imbalance bw DA + ACh> unusual clumps of lewy bodies in brain
Dopamine [DA] is important for…
normal functiong of extrapyramidal motor system
- control of posture
- support
- voluntary motion
PD onset of sympt
- gradual + ongoing progression
- 1 side of body may be involved at first
classic manifestation of PD
TRAP Tremor Rigidity Akinesia Postural Instability
early manifestations
- mild tremor
- slight limp
- decr arm swing
later signs
- shuffling gait
- arms flexed
- postural reflex seem lost
- speech problems
parkinsonian tremor is more prominent…
at rest
tremors can affect…
- diaphragm
- tongue
- lips
- jaw
essential termor
occurs during voluntary mvmt + has more frequency than parkinsonian
-more familial
akinesia
absence/loss of coluntary muscle mvmt
-stoop posure, masked face, drooling, shiffling gate
Pull Test
assessment of postural stability
- stand behind pt + tug backwards on their shoulder
- pt will fall backward
nonmotor symptoms
-depression
-memory changes
-sleep problems
fatigue
-pain
-urinary retentn
PD complications
- dyskinesia
- weakness
- neurologic (dementia)
- dysphagia
- malnutrition
- aspiration
- PNA
- UTI
- skin breakdown
- ortho hypotension
dyskinesia
spontaneous INVOLUNTARY mvmt
dysphagia
difficulty swallowing
diagnosis
based on history + clinical features (TRAP_
confirmation of PD is….
a positive response to ANTIparkinsonian drugs like levadopa or DA agonsit
MRI + CT for PD
- not helpful
- mostly used to rule out stroke or tumors
PD treatment
no cure
-aimed at correcting imbalance of neurotransmitters
antiparkinsonian drugs either _____ or ______
- enhance release/supply of DA (dopaminergic)
- block effects of overactive cholinergic neurons (anticholinergic)
primary tx of PD are…
levadopa + carbidopa
levadopa + carbidopa
nursing alert
- 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
dont give levadopa + carbidopa w food bc…
protein reduces absorption
DA agonist drug name
pramipexole
-directly stim DA receptors
pramipexole
drug alert
- take w food to decr nausea
- notify HCP if uncontrollable urses, confusn, rigidity, excess urinatn, SOB, vision changes
anticholinergic drug names + action
trihexyphenidyl + benztropine + diphenhydramine
-decr activity of ACh to balance bw cholinergic + dopanergic actions
anticholinergic drugs may be used to manage…
tremors
MAO inhibitors drug name + action
selegiline
-inhibits the enzyme that degrades DA
list of antiparkinsonian drug types
- DA agonist
- anticholinergic
- mao inhibitor
- DA precursor
w/in 3-5 yrs, pt have episodes of…
hypomobility
-inability to raise fr chair, speak, or walk
PD mgmt
- antiparkinsonian drugs
- surgical therapy
- deep brain stim
- ablation
- phys therapy
- occptnl therapy
3 categories of surgical therapy
1 deep brain stim
2 ablation
3 transplantation
DBS is preferred over ablation bs…
reversible + programable
to prevent “freezes” while walking
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
