parkinson's - 405

Question 1

Parkinson’s disease

Answer 1

a chronic, progressive, insidious neurodegenerative disease characterized by not enough dopamine causing an imbalance between dopamine & acetylcholine

Question 2

PD cardinal features

Answer 2

1) tremors: “pill rolling” and most noticeable at rest & improves w/ activity
2) muscle rigidity
3) bradykineasia: generalized slowness in movement & the major disability in PD
4) postural instability (later in disease process)
5) flat affect, slow slurred speech, forward tilt, short shuffling gait, micrographia

Question 3

PD non motor & neuropsychiatric features

Answer 3

-cognitive dysfunction & dementia
-psychoses & hallucinations
-mood disorders
-olfactory dysfunction (may precede motor sx)
-sleep disturbances
-autonomic dysfunction
-pain & sensory disorders

Question 4

what is meant by autonomic dysfunction

Answer 4

orthostasis, constipation, dysphagia, diaphoresis, urinary difficulties & sexual dysfunction

Question 5

dx of PD

Answer 5

-no specific test so H&P
-at least 2 or 3 signs of classic triad present
-ultimate confirmation: positive response to antiparkinsonian drugs

Question 6

drug therapy

Answer 6

aimed at correcting neurotransmitter imbalance
-levodopa is most affective drug but lots of SE & becomes less effective over time (on off phenomenon)
-also dopamine agonists & anticholinergics

Question 7

on-off phenomenon

Answer 7

invariable consequence of long term levodopa administration
-on means mobile
-off means immobile
initially wearing off begins at the end of the dosing interval but eventually becomes more unpredictable

Question 8

what to do in regards to the on off phenomenon

Answer 8

-reduce inter dose intervals (make intervals shorter)
-give controlled release meds
-avoid high protein meals

Question 9

PD surgical procedures

Answer 9

deep brain stimulation: for advanced, adjust to control sx, is reversible
-electrodes are surgically placed in brain adn connected to a neurostimulator in the chest

Question 10

care of pt w/ PD

Answer 10

-allow extra time to respond to questions
-allow plenty of time for ADL’s & collaborate w/ PT&OT
-provide listening ear
-meds
-implement interventions to prevent complications of immobility (constipation, contractures & skin breakdown)
-collaborate w/ speech path d/t dysphagia & hypophonia
-collaborate w/ dietitian: balanced diet, high kcal, high fiber, increased fluid intake, small pieces of food, SFM
-assess for depression, anxiety & insomia

Question 11

what to teach pt who freezes while walking

Answer 11

-consciously think about stepping over imaginary or real line on the floor
-drop something on floor and have them step over
-rock from side to side
-life toes when stepping
-1 step back, 2 steps forward
remove tripping hazards at home