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
Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. True or False
True
What is an anticholinergic medication used to treat Parkinson disease?
A.Benztropine mesylate (Cogentin)
B.Diphenhydramine hydrochloride (Benadryl)
C.Orphenadrine citrate (Banflex)
D.Phenindamine hydrochloride (Neo-Synephrine)
A (should be A & B 🤔)
MS
- effects CNS
- causes fatique
- 4 types
— most common type: relapsing & remitting
— know different types - symptom treating
— fatique: provigil & motifinal?
— spasms: baclofin & sodium - warm packs
- stretching
- diplopia
- speech problems
- contractures
- exacerbation meds: corticosteroids
- thought/ memory issues: post its/ alarms
GB
- peripheral
- virus: do a history
- ascending/ progressive
— cant walk: assess - crawling skin
- 3 phases
— different interventions - MEDs:
— symptom based; supportive
MG
- Autoimmune
- blocking of Ach receptors by antibodies
- weakness
- myasthenia crisis: poor breathing
— meds: neostigmine/ pyridiostigmine
—-too much med can cause bradycardia; cholinergic crisis
BP
- cranial nerve 7
- antiviral, corticosteroids
TN
- cranial nerve 5
- carbomazipine (tegrelol)
ALS
- ensure Advanced directive is in place
