Ch 7 Parkinsons Disease Flashcards
How is PD characterized?
It is characterized by 4 primary symptoms;
Tremor, muscle rigidity, bradykinesia (slow movement) and postural instability.
what is PARKINSON’S DISEASE?
Parkinson’s disease (PD) is a progressively debilitating disease that grossly affects motor function!
Why does symptoms of PD occur?
These symptoms occur due to OVER STIMULATION of the BASAL GANGLIA by ACETYLCHOLINE!
What does the secretion of DOPAMINE and ACETYLCHOLINE do in the body?
The secretion of acetylcholine and dopamine in the body produce inhibitory and excitatory effects on the muscles respectively
How does overstimulation of acetylcholine to the basal ganglia occur?
Overstimulation of the basal ganglia by acetylcholine occurs because DEGENERATION of the substantia Nigra results in decreased dopamine production. This allows acetylcholine to dominate, making smooth, controlled movements difficult!
What does tx of PD focus on?
Tx of PD focuses on increasing the amt of DOPAMINE or decreasing the amt of acetylcholine in a clients brain.
How many stages of PD is their?
As PD is a progressive disease; there are 5 stages of involvement.
What are the 5 stages of PD?
Stage 1- unilateral shaking or tremor of one limb
Stage 2- bilateral limb involvement occurs, making walking & balance difficult.
Stage 3- physical movements slow down significantly, affecting walking more.
Stage 4- tremors may decrease but akinesia & rigidity make day to day tasks difficult
Stage 5-client is unable to stand or walk, is dependent of all care & may exhibit dementia.
What are the risk factors for developing PD?
Onset of symptoms between 40-70 yrs old More common in men Genetic predisposition Exposure to environmental toxins and chemical solvents Chronic use of antipsychotic medication
What types of subjective data might a client report regarding PD?
Report of fatigue
Report of decreased manual dexterity over time
What are physical assessment findings of a person with PD?
Stooped posture Drooling
Slow shuffling, & propulsive gait. Dysarthria
Slow, monotonous speech. Mood swings
Tremors/ pin rolling tremor of the fingers
Muscle rigidity ( rhythmic interruption, midly restrictive, or total resistance to movement)
Bradykinesia/akinesthia. Cognitive impairment
Mask like expression. Progressive difficulty with ADL’s
Autonomic symptoms ( orthostatic hypotension, flushing, diaphoresis)
Difficulty chewing & swallowing
How often should a person with PD weight be documented?
At least weekly Keep a dietary intake log Encourage fluids and document intake Provide smaller & more frequent meals Provide supplements as prescribed Add commercial thickeners to food
What is a nursing action for a pt. with PD?
Monitor client mobility for as long as possible!
( encourage exercise, use of assistive devises, ROM)
Teach client to stop occasionally when walking to slow down speed & reduce risk for injury.
Pace activities by providing rest periods
Promote communication for as long as possible
*teach client facial strengthening exercises
Encourage client to speak slowly and to pause frequently
Use alternate forms of communication as appropriate
Refer client to speech language pathologist are nursing interventions of a client with PD promoting what?
These interventions promote client communication for as long as possible.
While observing a PD clients mental status for mental and cognitive status; what is a nursing intervention?
Observe for signs of depression and dementia
Provide a safe environment(no throw rug, electric razors etc…)
Assess personal & family coping
Provide a list of community resources( support groups for client,family)
Refer client to a social worker or case manager as condition advances
When taking MEDS for PD what should a nurse inform the client about?
The meds may take several weeks before improvement of symptoms occur.
While the client is taking a combination of meds, maintenance of therapeutic med levels is necessary for adequate control
Dopaminergics are used for what?
PD
Whe given orally, meds such as levodopa (Dopar), are converted to dopamine in the Brain, increasing dopamine levels in the BASAL GANGLIA.
dopaminergics may be combined with carbidopa (Sinemet) to decrease peripheral metabolism of levodopa requiring a smaller dose to make the same amt available to the brain. Side effects are subsequently less.
Due to medication tolerance and metabolism, the clients dosage, form of medication and administration times must be adjusted to avoid periods of poor mobility.
What are nursing considerations when administering Dopaminergics?
Monitor for the “ wearing off” phenomenon and dyskinesias ( problems with movement) which can indicate the need to adjust the dosage or time of administration or the need for a medication holiday.
Name some Dopamine agonist medications.( used 4 PD clients)
bromocriptine ( Parlodel)
ropinirole ( Requip)
pramipexole ( Mirapex)
ALL ACTIVATE RELEASE OF DOPAMINE; MAY BE USED IN CONJUCTION WITH A DOPAMINERGIC FOR BETTER RESULTS!
What are nursing considerations for a client taking dopamine agonists?
Monitor for orthostatic hypotension, dyskinesias, and hallucinations
What do anticholinergics help control?
ANTICHOLINERGICs such as benztropine ( Cogentin) and trihexyphenidyl (Artane), help control tremors and rigidity.
What is Catechol O-methyltransferase ( COMT)inhibitors?
comt inhibitors, such as entacapone (Comtan), decrease the breakdown of levodopa making more available to,the brain as dopamine. Can be used in conjunction with a DOPAMINERGIC and dopamine agonist for better results.
What are nursing considerations to consider when administering COMT medications?
Monitor for dyskinesia/ hyperkinesis when used with LEVODOPA
Assess for diarrhea
Dark urine is a normal finding
How does antiviral medications help treat a person with PD?
Antivirals such as amantadine (Symmetrel), stimulate release of dopamine and PREVENT ITS REUPTAKE
What are nursing considerations for the administration of antivirals?
Monitor for swollen ankles and discoloration of the skin
Client may also experience atropine like effects
What are surgical interventions of a person with PD?
Stereotactic pallidotomy
Strict eligibility criteria generally includes those who have not responded well to other therapies
What is stereotactic pallidotomy?
It is the destruction of a small portion of the brain within the GLOBUS pallid us thru the use of brain imaging and electrical stimulation.
Target area is identified with a CT scan or a MRI
mild electrical stimulation is provided through a burr hole to a target area.
Client is assessed for a decrease in tremors and muscle rigidity.
When a decrease is elicited, a temporary lesion is formed & the client is reassessed.
Why is deep brain stimulation done?
It is done to treat Parkinson’s disease.
Deep brain stimulation
An electrode is implanted in the THALAMUS
a current is delivered through an implanted pacemaker type of generator
The goal of the current is to interfere with electrical conduction in tremor cells decreasing tremors
What are nursing actions of a person who receives DEEP BRAIN STIMULATION?
Monitor for infection, brain hemorrhage or stroke like symptoms!
Client education;
The client will need to be instructed on how to use a magnet to adjust the current
The battery to the magnet will need to be replaced every few years.
What are client outcomes for a person receiving deep brain stimulation for Parkinson’s disease?
The clients medication will be scheduled so the wearing off phenomenon does not occur.
The client will ambulated safely with through the use of assistive devices.
The client will maintain adequate hydration and nutrition via appropriate diet and thickened liquids
What are complications of Parkinson’s disease?
Aspiration pneumonia Altered cognition (dementia, memory deficits)
Aspiration pneumonia
As PD advances in severity; alterations in chewing and swallowing will worsen, increasing the risk for aspiration
A nurse is caring for a client who displays signs of stage 3 Parkinson’s disease. What actions should the nurse include in the plan of care?
Provide a walker for ambulation.
The client should use a walker in stage 3 of Parkinson’s disease because movement slows down significantly and gait disturbances occur.
A nurse is developing a plan of care for the nutritional needs of a client who has stage 4 Parkinson’s disease. What actions should the nurse include in the plan of care?
Record diet and fluid intake daily
Add thickeners to liquids
Offer nutritional supplements between meals.
A nurse is reinforcing teaching to a client who has Parkinson’s disease and has received a prescription for bromocriptine ( Parlodel). What instruction should the nurse include in the teaching?
Rise slowly when standing
Orthostatic hypotension is a common adverse effect of bromocriptine.
A nurse is caring for a client who,has Parkinson’s disease and displays signs of bradykinesia. What is an appropriate action of the nurse?
Assist with hygiene as needed
Bradykinesia is abnormally slow movement and is seen in clients who have PD. Therefore, the nurse should assist with hygiene as needed.
