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Module 4 (MedSurg 2) > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What celebrities are known to have Parkinson’s

A

Muhammad ALI
Michael J Fox

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2
Q

Parkinson’s

A

Chronic, progressive neurodegenerative disease of the CNS

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3
Q

Parkinson’s manifestations primarily in

A

motor dysfunction

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4
Q

Origin in Parkinson’s

A

idiopathic
result of environmental factors and genetic makeup
Family = 15%
risk higher in well water, pesticides, herbicides, chemicals, and rural residences

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5
Q

Parkinson’s is Common

A

males 1.5-2x
begins 40-70 y/o (more comorbidities)

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6
Q

Does Parkinson’s have a cure?

A

no, only manage s/s

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7
Q

Secondary/atypical PD caused by

A

exposure to chemicals
drug-induced (Rx AND illicit)
if removed, then fixed

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8
Q

Parkinson’s is known as the shaking disease but what does not shake

A

their heads

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9
Q

Patho of PD

A

lack of dopamine
Degeneration of dopamine-producing neurons in substantia nigra of midbrain
Disrupts dopamine-acetylcholine balance in basal ganglia
Essential for normal functioning of extrapyramidal motor system

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10
Q

PD have what percentage of neuron loss and what percentage of dopamine decrease

A

60%
80%

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11
Q

Deficit in PD is an imbalance between

A

dopamine and excitatory neurotransmitter Acetylcholine

disturbed tremor and rigidity

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12
Q

Dopamine helps with the functioning of

A

posture
support
voluntary muscles

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13
Q

Onset of PD

A

gradual and insidious with ongoing progression

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14
Q

S/S of PD

A

TRAP**
Tremor resting
Rigidity
Akinesia and/or bradykinesia
Postural instability

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15
Q

Beginning stages of PD s/s

A

mild resting tremor
slight limp
decrease arm swing

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16
Q

Later stages of PD s/s

A

shuffling
propulsive gait with arm flexed
loss of posture

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17
Q

90% of PD pts experience

A

hypokinetic dysarthria (speech abnormality)

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18
Q

What is usually the first sign of PB

A

TREMOR RESTING
minimal
prominent at rest
aggravated by stress and more concentration

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19
Q

PD affects facial muscles causing

A

drooling and risk of aspiration later in the disease

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20
Q

What type of tremors do PD pts have in their hands?

A

pill-rolling

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21
Q

Tremors can extend to

A

diaphragm tongue
lips jaw

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22
Q

What tremor is not associated with PD?

A

essential
- voluntary, rapid frequency, fmailial

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23
Q

Rigidity

A

increase Resistance to passive motion when limbs are moved through their ROM
-cogwheel
contraction
slowness

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24
Q

Cogwheel rigidity

A

Jerky quality**
Like intermittent catches in passive movement of a joint

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25
Q

Sustained muscle contracture

A

Complaints of soreness
Feeling tired and achy
Pain in the head, upper body, spine, or legs

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26
Q

What chair do we want a PD pt to sit in?

A

hard with arms
so they don’t slide out

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27
Q

Akinesia

A

Absence or loss of control of voluntary muscle movements

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28
Q

Bradykinesia

A

Slowness** of movement
Particularly evident in the loss of automatic movements

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29
Q

Loss of automatic movements occur subconsciously and result these classic characteristics of a person with PD

A

stooped posture
masked face
drooling
festination (shuffling gait)

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30
Q

Nonmotor S/S of PD

A

Depression** and anxiety
Apathy
Fatigue
Pain
Urinary retention and constipation** - LOSS OF VOLUNTARY MUSCLE
Erectile dysfunction
Memory changes

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31
Q

What sleep problems do PD pts have?

A

**Difficulty staying asleep
Restless sleep
Nightmares
Drowsiness during the day
REM behavior disorder
Violent dreams
Potentially dangerous motor activity during sleep

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32
Q

PD Complications

A

Motor symptoms
DYSPHASIA = malnutrition and aspiration
Orthostatic hypotension (high for falls)
Weakness
Akinesia
Neurologic problems
Neuropsychiatric problems
dementia

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33
Q

General debilitation of PD may lead to

A

pneumonia
UTIs
skin breakdown

34
Q

If PD pt is going home, then what needs to be done to their house?

A

declutter/scatter rugs, lower fluids at night to decrease getting up at night and increase fluids in the day, shower chair and hand rails, loose clothes with no buttons, slip on shoes with close toed, hard chair with arm rests

35
Q

Parkinson’s is dx by

A

2/4 symptoms
and Positive response to antiparkinsonian drugs

36
Q

PD pts need to think about how to do ordinary things such as

A

swallowing and blinking

37
Q

Dx PD

A

No definitive diagnostic procedures
H&P, med hx, neuro exam
and Positive response to antiparkinsonian drugs
TRAP 2/4

38
Q

PD Goal

A

correcting imbalances of neurotransmitters within the CNS
improves pt’s ability to carry out ADLs

39
Q

Antiparkisonian Drug do either

A

Enhance or release supply of dopamine
Antagonize or block the effects of overactive cholinergic neurons in the striatum
**Dopaminergic or anticholinergic

40
Q

Drug selection and dosages are determined by the

A

extent to which PD interferes with work, dressing, eating, bathing, and other ADLs

41
Q

Dopaminergic

A

increase dopamine
most common in PD
Levodopa

42
Q

Anticholinergic

A

Prevent activation of cholinergic receptors
Benztropine (Cogentin)

43
Q

Levodopa

A

effective, but benefits diminish overtime
PO
rapid absorption

44
Q

Levodopa administered

A

w/o food
Delays absorption
not with proteins as the same time as medication is active
Neutral amino acids

45
Q

Levodopa/carbidopa (Sinemet)

A

Levodopa is converted to dopamine in the CNS.
Carbidopa prevents peripheral destruction of levodopa

46
Q

Levodopa/carbidopa (Sinemet) adverse effects

A

N/V, dyskinesias, postural hypotension, dysrhythmias, psychosis, impulse control, darkened sweat & urine, loss of effect

47
Q

What levels need to be checked for Levo/Carb?

A

plasma for effectiveness

48
Q

Dopamine Agonists is the 1st choice for

A

Mild or moderate symptoms only

49
Q

Dopamine Agonists

A

direct activation of receptors
**less effective than levodopa
not dependent
not compete with proteins
lower incidence of response failure
less likely to cause dyskinesia

50
Q

Pramipexole (Mirapex) used in

A

used alone in early PD
with LEVODOPA in Later PD

51
Q

Pramipexole (Mirapex)
adverse effects with monotherapy

A

sleep attacks worse than narcolepsy
nausea, dizziness, daytime somnolence, insomnia, constipation, weakness, hallucinations

52
Q

Micrographia

A

small handwriting

53
Q

Pramipexole (Mirapex)
adverse effects with combined therapy

A

orthostatic hypotension, dyskinesia, increased hallucinations

54
Q

Anticholinergic

A

Trihexiphenidyl & Benztropine

55
Q

Anticholinergic

A

decrease ACh activity
never stop abruptly

56
Q

Anticholinergic adverse effects

A

dry mouth, urinary retention, tachycardia, blurred vision, constipation, photophobia, confusion, hallucinations
drink water and chew gum for effects

57
Q

COMT Inhibitors

A

inhibit metabolism of levodopa in the periphery
no direct effects of own

58
Q

COMT Inhibitors

A

Entacapone (Comtan)
Tolcapone (Tasmar)

59
Q

Entacapone (Comtan)

A

w/ levodopa
inhibit breakdown of levodopa

60
Q

Entacapone (Comtan) adverse effects

A

dyskinesia, orthostatic hypotension, N/V/D, hallucinations, sleep disturbances, impulse control disorders, & yellow-orange discoloration of urine

61
Q

Tolcapone (Tasmar)

A

only if safer agents are ineffective

62
Q

Tolcapone (Tasmar)
adverse effects

A

lasts for 2-3 hours
Liver failure, dyskinesia, orthostatic hypotension, nausea, hallucinations, sleep disturbances, & yellow-orange urine

63
Q

MAO-B Inhibitors

A

1st line drug for PD
benefits modest
combo with levodopa reduces wear off

64
Q

Selegiline
Rasagiline
are what type of drug

A

MAO-B Inhibitors

65
Q

Selegiline (Eldepryl) MOA

A

inhibit the breakdown of dopamine
benefits decline with 2-4 months
constant change in meds
given breakfast and lunch
not later can cause insomnia

66
Q

Selegiline (Eldepryl) adverse effects

A

insomnia, dry mouth, orthostatic hypotension, dizziness, hypertensive crisis, & GI symptoms

67
Q

Rasagiline (Azilect)

A

initial and with levo
preserve dopamine

68
Q

Rasagiline (Azilect) PD pts need to avoid

A

processed foods high in Tyramine
or can cause a hypertensive crisis

69
Q

Rasagiline (Azilect) adverse effects

A

insomnia, orthostatic hypotension, irritation of buccal mucosa, hypertensive crisis

70
Q

Other drugs to help with PD

A

An antihistamine with anticholinergic to manage tremors
antiviral
apomorphine for hypomobility

71
Q

A pt taking levo/carb for PD experiences requires “on-off” (i.e. abrupt loss of effect). Which action by the nurse is best?
Administer med when pt has an empty stomach
Instruct pt to avoid high-protein foods
Have the pt increase the intake of vitamin B6
D/C the drug for 10 days

A

Instruct pt to avoid high-protein foods

72
Q

Nurse is caring for a pt who us receiving pramipexole. The nurse is most concerned if the pt makes which statement?
Take even when I feel good
Sometimes I just fall asleep w/o warning
The pills make me sleepy, so they take in the afternoon
Causes constipation

A

Sometimes I just fall asleep w/o warning

73
Q

What type of surgical therapy can be used for PD

A

only if unresponsive to drug therapy
Deep Brain Stimulation
Ablation (Destruction)
Thalamotomy - removing part of the thalamus
Pallidotomy
Subthalamic nucleosome
Transplantation

74
Q

Does Levodopa break down easily?

A

yes
That is why combo drugs are given to increase the effects

75
Q

Deep Brain Stimulation

A

reversible and programmable
most common
pacemaker for the brain
decrease neuron activity produced by DA depletion
improve motor function
reduces dyskinesia and meds

76
Q

Ablation surgery

A

Locate, target, destroy area of brain affected by PD**
Destroys tissue that produces abnormal chemical or electrical impulses leading to tremors or other symptoms

77
Q

Transplantation

A

fetal neural tissue into the basil ganglia
- DA producing cells into the brain
still ongoing

78
Q

Nutritional Therapy for PD

A

Malnutrition and constipation (FIBER)
with dysphagia and bradykinesia need food that is easily chewed & swallowed
Numerous and small meals with ample time

79
Q

Nursing Dx of PD

A

Self-care deficit
Parkinson’s dementia
Abradykinesia
Impaired verbal communication
Impaired swallowing
Max neuro function.
Maintain independence in activities of daily living (ADLs) for as long as possible. - ROM
psychosocial well-being. - groups
Administer medications as prescribed
Facilitate nutritional intake
Interdisciplinary collaboration: PT, OT, Speech

80
Q

B vitamins are high in

A

proteins

Module 4 (MedSurg 2) (36 decks)

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