OA Parkinson's Flashcards
Parkinson’s Disease
- neurodegenerative disease
- largely unknown cause
- no diagnostic test
- no prevention, no cure
- debilitating
- progressive with complications
Parkinson’s increases with…
age
age of onset for Parkinson’s
50s-60s
peak onset for Parkinson’s
70s
What gender is Parkinson’s more common?
men
What type of degeneration results in Parkinson’s?
-degeneration of dopamine-producing neurons in substantia nigra of the midbrain
What does the degeneration of dopamine producing neurons in the midbrain disrupt?
it disrupts dopamine-acetylcholine balance in basal ganglia
The increase of acetylcholine results in…
clinical manifestations
Motor clinical manifestations of Parkinson’s
- bradykinesia
- rigidity
- resting tremors
- impaired postural reflexes
**at least 2 of 4 for diagnosis
bradykinesia
slowing of initiation and execution of movement
rigidity due to…
- increased muscle tone
- involuntary muscle contractions
resting tremors
- HANDS, arms, legs, jaw, face
- “pill-rolling”
what type of impaired postural reflexes are typical for Parkinson’s
late response
Non-motor clinical manifestations
- cognitive changes
- sleep abnormalities
- emotional changes
Stages of Progression
- PD symptoms affect only one side of body
- symptoms both sides, balance intact
- mild to moderate symptoms, balance impaired, still functions independently
- severely disabled, but can still walk or stand without assistance
- wheelchair-bound or bedridden
The “classic” Parkinson’s Patient
- stooped posture
- masked faces
- drooling
- shuffling gait
- “frozen” in place
- difficulty controlling posture
Complications that result from Parkinson’s
- dysphagia
- urinary incontinence
- lack of mobility
- orthostatic hypotension
- depression
- dementia
dysphagia
- difficulty or discomfort swallowing
- leads to malnutrition
- aspiration/pneumonia
urinary incontinence leads to…
UTIs
skin breakdown
lack of mobility leads to..
- constipation
- ankle edema
- contractures
orthostatic hypotension leads to..
falls and other injuries
How to diagnosis
- no specific tests
- based on hx and clinical features
- at least 2 of 4 motor characteristics
- positive response to meds
Pharm therapy for PD
- main treatment for PD
- corrects imbalance of neurotransmitters
- enhances or releases supply of dopamine
- antagonize/block effects of overactive cholinergic neurons
- can have difficult side effects
- may have “wearing off” time
Levodopa/Carbidopa
Sinemet
- increases dopamine effect
- converted to dopamine in the basal ganglia and peripheral tissue
- carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain
Dopamine receptor agonists
- postpone the use of Levodopa/Carbodopa
- mimic dopamine
- less likely to cause dyskinesias
Dopamine receptor agonist medications
- Pramipexole
- Ropinirole
- Pergolide
Monoamine Oxidase (MAO) inhibitors
- preserves existing dopamine
- modest in preventing symptoms
- interacts with antidepressants, narcotic painkillers, and decongestants
- Selegillne
Catechol-O-Methyl Tranferase Inhibitors
- preserves and prolongs the effects of Levodopa
- Entocaparone
Entocaparone
- interacts with MAO-inhibitors
- may cause abdominal and back pain
Anticholinergics
- decreases activity of acetylcholine, tremors, rigidity
- helps with “wearing off”
Anticholinergic medications
- Benztropine
- Trihexyphenidyl
**helps with wearing off
Antihistamines
-decreases activity of acetylcholine, decreases tremors
Antihistamine medications
- Diphenhydramine
- Orphandarine
Possible side effects of meds
- dyskinesias
- hallucinations
- orthostatic hypotension
- weakness
- akinesia
Surgical Therapy for PD
- Stereotactic Ablation
- Deep brain stimulation
-fetal neural tissue
transplantation
-stem cell therapy
Stereotactic Ablation
- thalamotomy
- pallidotomy
Supportive therapies
- nutritional
- PT
- OT
- Speech
- Psych
Nutritional Therapy
- prevent/correct malnutrition
- easy to chew and swallow foods
- several small meals to prevent fatigue
- provide ample time to decrease frustration
- encourage high fiber and increased fluids to help with constipation
Physical Therapy
- help maintain mobility of joints, muscle tone, and function
- maintain self care
- increase safety
Nursing Diagnoses
- Impaired physical mobility r/t rigidity, bradykinesia AMB difficulty in initiating voluntary movements
- Impaired verbal communication r/t dysarthria, tremor AMB decreased communication, slow and slurred speech
- Impaired swallowing r/t….AMB….
- Constipation r/t….AMB….
- Imbalanced nutrition: less than body requirements r/t….AMB….
- Powerlessness r/t….AMB….
Nursing Goals/Interventions
- safe ambulation
- maintenance of joint mobility
- prevent aspiration
- maintain satisfactory weight
Safe ambulation/maintenance of joint mobility
- assist with ambulation
- ROM exercises
- PT/OT consults
- Teach techniques to assist with mobility
Maintain satisfactory weight
- assess swallowing ability
- consult dietician and speech therapy
- upright position to eat
- have suction available
- soft, solid and thick, liquid diets depending on individual
