Parkinson's Disease

Question 1

Parkinson’s Disease - Pathophysiology

Answer 1

• Loss of dopamine stores
• Results in more excitatory neurotransmitters
• Imbalance affects voluntary movement
• Males greater than women
• 15% early onset genetic mutation

Question 2

Parkinson’s Disease - CMs

Answer 2

• 4 Cardinal Signs
  > tremor
  > rigidity
  > bradykinesia/akinesia
  > postural instability
  tremor & rigidity typically show 1st
• Types:
  > tremor dominate
  > non-tremor dominate; a kinetic-rigid & postural instability

Question 3

Parkinson’s Disease - Stage 1

Answer 3

• Initial Stage
  > unilateral limb involvement
  > minimal weakness
  > hand & arm trembling

Question 4

Parkinson’s Disease - Stage 2

Answer 4

• Mild Stage
  > bilateral limb involvement
  > masklike face
  > slow, shuffling gait

Question 5

Parkinson’s Disease - Stage 3

Answer 5

• Moderate Disease
  > postural instability; not able to walk very well
  > incr gait disturbances

Question 6

Parkinson’s Disease - Stage 4

Answer 6

• Severe Disability
  > akinesia: loss of voluntary muscle movement
  > rigidity

Question 7

Parkinson’s Disease - Stage 5

Answer 7

• Complete ADL Dependence
  > in later stages, psychiatric components come into play
  > psychosis
  > hallucinations

Question 8

Parkinson’s Disease - Diagnostics

Answer 8

• Hx
• 4 cardinal signs (2 of 4)
• Diagnosis confirmed by a positive response to levodopa trial
• PET scan; rule out
• Single-photon emission CT; rule out

Question 9

Parkinson’s Disease - Medical Management

Answer 9

• Pharmacotherapy
  > Levodopa; most effective; converts to dopamine; relieves manis
• Surgical Treatment
  > deep brain stimulation (DBS)
  > electrode implanted/blocks anticholinergic release

Question 10

Parkinson’s Disease - Nursing Diagnosis

Answer 10

• Impaired physical mobility
• Self-care deficits
• Constipation; due to lack of mobility
• Impaired nutrition
• Risk for injury
• Impaired verbal communication
• Knowledge deficit; family & pt

Question 11

Parkinson’s Disease - Nursing Interventions

Answer 11

• Improve mobility (w/in safety)
• Enhancing self care activities
• Improved bowel elimination; mobility & stool softeners
• Improved nutrition; aspiration risk
• Enhanced swallowing
• Assistive devices
• Family/pt education; PT/OT/Speech