Parkinson’s Disease Flashcards
Parkinson’s Disease Pathophysiology:
- PD is a chronic, progressive neurodegenerative disease of the CNS that is characterized by lack of the chemical messenger, dopamine
- The disease is slowly progressive often ending in disability and total dependence for care needs
- PD is seen mostly in men and diagnosis occurs as age increases
- Widespread degeneration of the substantia nigra
- Leads to decrease in dopamine in the brain.
— With decreased dopamine, a person loses the ability to refine voluntary movements - It belongs to a group of conditions called movement disorders
- Patho break down:
— Destruction of dopaminergic neuronal cells in the substantia nigra in the basal ganglia=
— Depletion of dopamine stores=
— Degeneration of the dopaminergic nigrostriatal pathway=
— Imbalance of excitatory (acetylcholine) and inhibiting (dopamine) neurotransmitters in the corpus striatum=
— Impairment of extra pyramidal tracts controlling complex body movements=
—- Tremors
—- Rigidity
—- Bradykinesia
—- Postal changes
Normal Motor Function
- Substantia nigra neurons produce dopamine
- Dopamine communicates with Acetylcholine (excitatory neurotransmitter)
- Produces smooth movement
Parkinsons Motor Function
- Dopamine is decreased while Acetylcholine remains constant.
- Causing a loss in the ability to initiate smooth, controlled body movement
Parkinson’s Disease Risk factors/ causes:
- Age: over 60
- Hereditary: genetic links
- Environment
- Sex: greater occurrence in males
Parkinson’s Disease S/S:
- Onset is slow and gradual
- Early symptoms include an expressionless face, cramped handwriting, a little shakiness
- Lack of arm swing
- The main features of PD are gross slowness in starting and executing movement along with resting tremors and gait disturbances
- Tremors (pill rolling): hands, legs, arms, jaw
- Rigidity
- Bradykinesia (slow movement)
- Postal changes/instability: fall risk
- Classic stooped posture
- Shuffling gait
- balance issues: worse when they have to stop abruptly
- Vision
- Monotone
- Fatigue
- ANS (hypotension)
- Perspiration
- Constipation
- Mask like/ blank facial expression
- Decreased blinking
- Shuffling, propulsive gait
Parkinson’s Disease nursing Assessments:
- Assess client’s gait, may observe shuffling
- Assess movement, will see bradykinesia and may find akinesia
- Examine client’s stance, will find a stooped posture
- Assess for tremors that increase at rest and decrease when hands are active
- Observe facial expression, may see a masklike expression
- Assess muscle strength, may find muscle weakness
- Assess for rigidity that can appear to have jerkiness (called cogwheel rigidity)
- Assess for bowel and bladder incontinence
- Observe for difficulty swallowing, may see dysphagia.
- Assess for drooling
- Assess for psychological complications, may see depression
- Assess for cognitive impairment, may see dementia
Parkinson’s Disease Laboratory/ Diagnostic Tests:
- Diagnosis based on medical history and neuro exam
- Early signs often dismissed as effects of normal aging
- CT/MRI brain scans usually appear normal
- Positive response to Levodopa trial
- Response to antiparkinsonian drug test, improvement in symptoms when this drug is given is a positive response and confirms the diagnosis
Nursing Process: The Care of the Patient With Parkinson’s Disease—Diagnoses
- Impaired physical mobility and risk for activity intolerance
- Disturbed thought processes
- Self-care deficits
- Imbalanced nutrition
- Constipation
- Impaired verbal communication
- Ineffective coping and compromised family coping
- Deficient knowledge
- Risk for injury
Nursing Process: The Care of the Patient With Parkinson’s Disease—Planning
Major goals may include:
- Improved functional ability
- Maintaining independence in ADLs
- Achieving adequate bowel elimination
- Attaining and maintaining acceptable nutritional status
- Achieving effective communication
- Developing positive individual and family coping skills
Parkinson’s Disease Nursing Interventions:
- Administer antiparkinsonian drugs on time
- Provide assistive device to help with ambulation
- Have client use strategies to minimize risk of falls
- Plan activities around times when client’s muscle strength is optimal
- Balance activity and rest to prevent fatigue
- Provide rest between interventions
- Provide foods that are easy to chew and swallow to decrease risk of aspiration
- Monitor ability to eat/swallow – Aspiration precautions
- Small meals that are easy to chew
- Provide foods that are high in calories
- Monitor constipation, provide high fiber in diet and increase fluids (unless contraindicated)
- Initiate consultation with physical therapy to prevent contractures and muscle wasting
- Maintain movement-keep patient as mobile and independent as possible
- Administer meds on time/ monitor side effects
- Fall risk
- Psychosocial (anxiety/depression)
Parkinson’s Disease Medical Management
- Restore balance of dopamine and Ach
- Increase Dopamine
- Block Action of Ach
— Levadopa
Parkinson’s Disease Medications:
Dopaminergic/ dopamine agonist
- Levodopa
- (Levodopa+carbidopa) Sinemet (helps med get to brain)
— *Dopaminergic/Antiparkinsonian agent
may cause dyskinesia (involuntary and uncontrolled movement)
— GI side effects
— Orthostatic hypotension
— Confusion
— “On-off syndrome”
— Drug interactions
— Patient education
—- Don’t stop abruptly
—- have to take a long time to get into system - (6 months)
—- Take on an empty stomach, reduce protein intake (cant take with protein)
Stimulates domapine receptors:
- Ropinirole (Requip)
— *Dopamine receptor agonist
— May cause drowsiness
- Parlodel (brocriptine)
- Mirapex (pramipexole)
Parkinson’s disease MEDs that extend action of dopamine:
- COMT Inhibitors
— Comtan (entacapone) - MAO Inhibitors
— Selegiline (eldapryl) - delays break down of dopamine
- ## no smoked meats/ smoked cheeses
Parkinson’s Disease Medications: Anticholinergics
- block Ach in the striatum to decrease tremor and rigidity
- Benztropine mesylate (Cogentin)
— *Anticholinergic drug
— May cause urinary retention
— Contraindicated in patient’s with narrow-angle glaucoma - Benedryl (diphenhydramine)
- Artane (trihexyphenidyl)
Parkinson’s Disease Surgical Intervention:
- Deep Brain Stimulation involves the surgical implantation of an electrode into the brain
— stimulation may increase dopamine release or block anticholinergic release
— Improves tremor - Pallidotomy
- Fetal cells
