Parkinson's disease Flashcards
What is parkinson’s disease?
PD = neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.
Describe the on and off stage of PD
On stage: when the patient is medicated and symptoms are controlled as there are adequate dopamine within the system
Off stage: when the patient is under-medicated and symptoms are not controlled as there is a lack of dopamine within the system.
What is Dyskinsia?
Dyskinsia: Uncontrolled involuntary muscle movement when the patient is over medicated due to an overlap of effect from medications administrated
Motor Symptoms of PD?
- speech
- facial expressions
- tremors
- rigidity
- bradykinesia and akinesia
- GAIT disturbance
- Freezing of GIAT
Speech
Explain and nursing intervention
- Reduced tone and volume
- Slurring speech
- Results in reduced engagement in social conversations
Intervention
- Need to be prompted to speak slowly and loudly
- Wait for patient to complete sentence
Explain and nursing intervention
Facial expressions
- Reduced facial expressions (hypomimia)
- Result in feelings of neglect and reduced social interactions
Interventions
- Engage the patient in discussion and conversation despite them appearing ‘disengaged’
- Talk with patient at eye level
Explain and nursing intervention
Tremors
- Usually occurs resting position
- Can also occur on posture and action
- Latency on change of position
Intervention
- Be careful of spillage during meals
- Assist in fine motor tasks
Explain and nursing intervention
Rigidity
- Stiffness in limbs
- ‘Cog-wheeling’ or ‘lead pipe’
- Not velocity dependant -
Medicate patient prior to performing ADL’s
Explain and nursing intervention
Bradykinesia and akinesia
- Bradykinesia – slowness in movement
- Akinesia – difficulty initiating movement
- Impaired amplitude, velocity, decrements, blocking, early fatiguing -
Ensure medications administered in a timely fashion
Explain and nursing intervention
GAIT disturbance
- Slow, short shuffling steps
- Reduced arm swing
- Reduced step height and stride
- Ensure medications administered in a timely fashion
- Increased risk of falls Remove clutter around patient area
Explain and nursing intervention
Freezing of GIAT
- Sudden freeze during walking
- Can occur on initiation, straight walking, doorways,
- reaching destination, most commonly on turning
- Worsened with mental distraction
- Ensure medications administered in a timely fashion
- Increased risk of falls
- Provide prompts (cues) to initiate movement Visual – Lines / Target on the floor, laser pointers Auditory – Music, metronomes, beats - i.e. getting out of a chair, taking the first step
Non motor symptoms of PD?
- sleep disturbance
- autonomic dysfunction
- mood disturbance
- neuropsychiatric
- cognitive impairment
- dysphagia
Explain and nursing intervention
Sleep disturbance
- Insomnia, daytime somnolence, RLS, RBD
- RLS – restless leg syndrome
- Improve sleep hygiene – restrict day time naps to short periods
- Ensure a PD medication close by bedside
- Medications may be introduced – Clonazepam or Melatonin
- Ensure safety of patients (i.e. bed rails, soft padding, etc)
Explain and nursing intervention
Autonomic dysfunction
- Urinary Dysfunction, Constipation, Orthostatic Hypotension
- Increase risk of falls
- Constipation – may affect medication absorption
- May become severe obstruction
- Increase risk of falls
- Encourage regular toileting
- Timing of anti-diuretics – i.e. coffee, tea and/or medications
- Redistribution of fluid intake/ bowel charts
- Toileting equipment close to bed side
- Incontinence pads in appropriate situations
- Probiotic and fibre in diet
Explain and nursing intervention
mood disturbance
- Depression, Anxiety -
Ensure medications given on time
- Provide PRN rescue / rapid release medications in a timely fashion
Explain and nursing intervention
neuropsychiatric
- Psychosis, Hallucinations, Delusions, ICD
- Anti-psychotics may be used with care – many with dopamine blocking effects
Explain and nursing intervention
Cognitive impaiment
- Difficulties with concentration, memory, thinking
- Cognitive dysfunction will occur in 83% patients at some stage of their disease
- Provide prompts for patients
- Be wary of patient provided history
- Learning to perform cognitive screens
Explain and nursing intervention
Dysphagia
- Difficulty swallowing
- Generally off period
- Ensure medications administered in a timely fashion (i.e. preferably before meals)
- Position upright during meals (preferably sit out of bed)
Common treatments for parkinsons disease pharmacological
Categories:
- Dopaminergic Replacement
- Enzyme Inhibitors
- Dopamine Agonists
- Anti-Viral
Side effects of parkinsons medications
- Nausea and vomiting
- Orthostatic hypotension
- Light-headedness
- Hallucinations
- Motor fluctuations / Dyskinesia
Common treatments for parkinsons disease non pharmacological
Device assisted therapy for Parkinson’s disease
Complementary therapies
Alternative therapies
Discuss the need of carers of patient with PD?
- Stress/ frustration
o Reinforced it is part of the condition and disuse process - Physical stress
o Physiotherapy/nurses advice on transfer techniques
o Massage or other therapies - Sleep deprivation and exhaustion
o Respite care
o Counselling
o Manage own physical and psychological health - Financial stress
- Social embarrassment
Nurses: identify care burden, early intervention, prioritise in reliving primary symptoms
