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z_MS1_Neuro Study > GF9: Neuro Parkinson’s Disease > Flashcards

GF9: Neuro Parkinson’s Disease Flashcards

1
Q

What is Parkinson’s Disease?

A

Progressive neurodegenerative disease causing muscle rigidity, akinesia and involuntary tremor.

A movement disorder with the progressive death of dopaminergic neurons in the substantia nigra resulting in Low dopamine & HIGH acetylcholine

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2
Q

What is the physical manifestation of low dopamine?

A

Low dopamine = low movement

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3
Q

What is the physical manifestation of high acetylcholine?

A

High acetylcholine = high secretions (drooling, etc)

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4
Q

What is the significance of dopaminergic neurons being affected in the substantia nigra?

A

This area is part of the basal ganglia which is part of the midbrain that controls movements.

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5
Q

What is the role of these dopaminergic neurons?

A

They release the neurotransmitter dopamine, which allows us to have accuracy with movement.

If they are dying this will lower the amounts of dopamine available to our body for normal movement

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6
Q

Why is there the signs and symptoms of tremors, rigidity etc.?

A

Normally in the nervous system there is a balance between acetylcholine (an excitatory neurotransmitter) and dopamine (an inhibitory neurotransmitter).

The loss of dopamine leads to more acetylcholine being able to produce more excitatory affects to the neurons in the basal ganglia and this leads to overstimulation…..tremors, rigidity (increased cholinergic activity)

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7
Q

What is the Patho of Parkinson’s Disease?

A
  • Cause is unknown, possibly genetic and environmental factors
  • Degeneration of dopamine-producing neurons in the substantia nigra causes decrease in dopamine and increase in acetylcholine at synapse
  • This causes a dysfunction of the extrapyramidal system inducing involuntary movement disorders
  • It also causes disruption of basal nuclei (basal ganglia) producing excess stimulation that affects movement and posture
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8
Q

What are the four key s/s of Parkinson’s

A
  • Resting tremors
  • Akinesia/bradykinesia
  • Shuffling gait and decreased arm swing
  • Pill rolling
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9
Q

What is bradykinesia?

A

slowness of movement

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10
Q

What is akinesia?

A

absence of movement

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11
Q

What is hypokinesia?

A

Decreased range of movement

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12
Q

Akinesia, hypokinesia and bradykinesia are cardinal signs of _______ disease.

A

Extrapyramidal

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13
Q

What are four other common s/s of Parkinson’s?

A
  • Dysphagia
  • Drooling
  • Muscle rigidity
  • Mask like (emotionless) expression
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14
Q

What are the dx tests for Parkinson’s?

A
  • CT of brain
  • Cerebral atrophy wasting away or destruction of brain tissue
  • Decreased motility in upper GI tract
  • Positive response to low dose carbidopa levodopa
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15
Q

Tx medications for Parkinson’s?

A
  • Increase Dopamine
  • Decrease acetylcholine
  • Levodopa/Carbidopa (combo drug)
  • Benztropine: for resting tumors
  • Pramipexole: dopamine agonists, stimulates more dopamine
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16
Q

What key diet information must be taught with Levodopa/Carbidopa administration?

A

Avoid protein because it interferes with how the body can absorb the medication (makes medication less effective

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17
Q

Due to elevated acetylcholine in Parkinson’s, what is the number one nursing intervention? List nursing actions to assist with it.

A
  • Maintain patent airway
  • Keep suction at bedside (due to excess drooling and risk of aspiration)
  • HOB elevated
  • Give a pureed or small bite sized pieces that are easy to swallow
  • Tissues readily available while eating
  • Add thickening agents to fluids
  • Monitor swallowing
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18
Q

Outside of food measures, what other safety and self-care nursing care for Parkinson’s should be done?

A
  • Encourage ROM and exercise
  • Assist w/ ADL’s
  • Implement fall precautions
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19
Q

What is dopamine?

A

Neurotransmitter

Primarily affects motor function and gross subconscious movements of the skeletal muscles

20
Q

True or False

With a Parkinson’s pt, tremors decrease when attention is diverted by activity.

A

True

21
Q

Which of the following is not a s/s of Parkinson’s:

  • Propulsive shuffling gait
  • Drooling of saliva
  • Intentional tremors
  • Decreased arm swing
A

Ans: intentional tremors

22
Q

What is the main care goal for a Parkinson’s patient?

A

To maintain optimal function within the client’s limitations

23
Q

Is there a cure for Parkinson’s Disease?

A

No

24
Q

Selegiline is actually a MAOI antidepressant. Why would a Parkinson’s pt be taking this?

A

It increases availability of dopamine and other neurotransmitters in the brain

25
Q

True or False

Whole grains and fruit should be included in the diet for a Parkinson’s pt.

A

True

26
Q

What is the purpose of levodopa and carbidopa?

A

To decrease acetylcholine and increase dopamine

27
Q

True or False

The child of a patient with Parkinson’s that taking levodopa carbodopa states:“I will buy lots of bone broth and soup for my parent with Parkinson’s”

A

False, bones have a lot of protein and are contraindicated for pts taking levodopa carbodopa

The soup will also need thickening agents to reduce risk of aspiration

28
Q

Why is benztropine prescribed for the Parkinson’s patient?

A

It is an anti-cholinergic used to reduce acetylcholine secretions and treat resting tremors

29
Q

Anticholinergics reduce _______. The result is you can’t pee, can’t see, can’t spit, can’t shit.

A

Secretions

30
Q

What is pramipexole?

A

A dopamine agonist used to stimulate acetylcholine receptor sites to trigger the release of more dopamine.

31
Q

What is the pt teaching for Parkinson’s pts taking levodopa?

A
  • Slow onset: 2-6 weeks to become effective
  • Slow position changes: orthostatic hypotension
  • Use may result in red/brown urine, sweat, saliva (expected outcome)
  • Minimize protein intake
  • It doesn’t eliminate tremors, only decreases
  • Never stop abruptly!
32
Q

True or False

Signs and symptoms may present on one side or one extremity and progress to the others overtime.

A

True

33
Q

What is “pill-rolling”?

A

tremors of the hands and fingers….looks like the patient is rolling a pill between fingers and hands

34
Q

What is Cogwheel rigidity?

A

When moving the patient’s arms passively toward the body they jerk or push back slightly

35
Q

What are the safety concerns for a patient with Parkinson’s?

A
  • Balance coordination
  • Swallowing
  • @ Risk for falls
36
Q

What are the psychosocial concerns for a patient with Parkinson’s?

A
  • Low self-esteem
  • Loses ability to care for self
  • Depression
  • Isolation
37
Q

Should a Parkinson’s pt where smooth or rubber soled shoes?

A

Smooth (not slick)

Rubber soles can stick to the floor and cause falls

38
Q

What is our pt education for a how to deal with freezing episodes for a Parkinson’s pt?

A
  • Try to change direction of movement….rather then continue going to the side go forward.
  • Use cane or walker with a laser…it provides a laser line on the floor that will help the patient find a landmark for when freezing episode happens and helps the patient coordinate their next step.
  • Consciously lift the legs (as in marching) with each step or pretend they are walking over an object.
  • DON’T push through the freeze up.
39
Q

Why is a Parkinson’s pt @risk for weight loss?

A

because of the struggle with swallowing, chewing, depression, and hard to feed self due to rigidity

40
Q

What do we encourage for a Parkinson’s pt to avoid constipation?

A

Drink at least 2 L fluids per day

High fiber foods

41
Q

What is another name for the levodopa carbodopa combo?

A

Sinemet

42
Q

A pt should not take levodopa carbodopa with MAO inhibitors as it can cause a…

A

Hypertensive crisis

43
Q

True or False

Vitamin B6 increases effectiveness of levodopa carbopa.

A

False, high amounts will decrease effectiveness

44
Q

Why are anticholinergics prescribed for pts with Parkinson’s?

A
  • acetylcholine (causes cholinergic activity) is exceeding dopamine, which is producing an excitatory affect on the neurons.
  • ANTIcholinergics can be prescribed to decrease these effects.
45
Q

If a pt with Parkinson’s has a dry mouth, what can you do?

A

Give sugarless candy to stimulate salivary glands

46
Q

What is the purpose of COMT Inhibitors (Entacapone “Comtan”) for the Parkinson’s pt?

A

used with levodopa/carbidopa to prevent the “wearing off” of the drug before the next dose is due

blocks COMT enzyme that will break down the levodopa in the blood to allow it to last longer

z_MS1_Neuro Study (30 decks)

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