Parkinson's Disease

Question 1

Parkinson’s Disease
What disease is classified as… chronic or acute?
progressive or stable? insidious or sudden? neurodegenerative disease or not?

Answer 1

chronic
progressive
insidious
neurodegenerative

Question 2

What is the pathology of Parkinson’s Disease?

Answer 2

Not enough dopamine.

Question 3

What is the relation of dopamine to acetylcholine in PD?

Answer 3

Not enough Dopamine. Normal balance of Acetylcholine.

Question 4

4 cardinal features of PD?

Answer 4

1. Tremor
2. Muscle rigidity
3. Bradykinesia
4. Postural Instability (later)

Question 5

Difference between PD tremors and essential tremors.

Answer 5

PD tremors are “rest tremors” or, pill-rolling, when the pt. is not engaged in activity. Essential tremors occur w/ movement.

Question 6

PD tremor initial presentation unilateral or bilateral?

Answer 6

Unilateral

Question 7

Define muscle rigidity.

Answer 7

Increased resistance to PROM (jerky quality).

Question 8

Muscle rigidity initial presentation unilateral or bilateral?

Answer 8

Unilateral

Question 9

What is the major cause of disability in pts. w/ PD?
1. Tremor
2. Muscle rigidity
3. Bradykinesia
4. Postural Instability (later)

Answer 9

Bradykinesia

Question 10

Define bradykinesia.

Answer 10

Generalized slowness in movement.

Question 11

(3)
How do pts. describe bradykinesia?

Answer 11

“Weakness, incoordination, and tiredness”

Question 12

Why are tremors the least debilitating of PD cardinal symptoms?

Answer 12

B/c they improve with purposeful activity.

Question 13

What happens in patients w/ postural instability?

Answer 13

They lose their balance. FALL RISK.

Question 14

Non-motor/ neuropsychiatric manifestations in PD?

Answer 14

Cognitive disfunction & dementia.
Psychoses & hallucinations
Mood disorders
Olfactory dysfunction
Sleep disturbances
Autonomic dysfunction
Pain/sensory disorders

Question 15

What is the physical appearance of a patient with PD?

Answer 15

Flat affect
Tilting forward
Soft, slow, monotonous speech. Dysarthria (slurred speech)
Tremors
Shuffling gait

Question 16

What is micrographia?

Answer 16

Progressive shrinking of hand-writing associated w/ PD

Question 17

What is the ultimate confirmation of PD?

Positive response to ______

Answer 17

Positive response to antiparkinsonian drugs.

Question 18

What is the goal of drug therapy in pts. w/ PD?

Answer 18

Relief of symptoms. No cure.

Question 19

What is the most effective drug at treating symptoms of PD?

Answer 19

Levodopa

Question 20

Nursing implications w/ Levodopa?

Answer 20

Only effective for a certain period of time. Wears off w/in several years. Monitor s/s on-off phenomenon.

Question 21

Difference between on and off in PD.

Answer 21

(med is) On=mobile
(med is) Off=immobile

Question 22

List 3 interventions for pts. experiencing on-off phenomenon?

Answer 22

Reduce inter-dose intervals.
Controlled-release meds.
Avoid high-protein meals.

Question 23

What is the most common surgical procedure for pts. w/ advance PD?

Answer 23

Deep brain stimulation (DBS)

Question 24

What happens in DBS?

Answer 24

Electrodes are surgically placed in the brain and connected to a neurostimulator (pacemaker device).

Question 25

Is DBS life-long or reversible?

Answer 25

It is reversible.

Question 26

What will cause a patient to freeze while walking?
1. Tremor
2. Muscle rigidity
3. Bradykinesia
4. Postural Instability (later)

Answer 26

Shuffled gate and bradykinesia associated with PD.

Question 27

List nursing interventions for a PD patient who freezes while walking.

Answer 27

1. Consciously think about stepping over imaginary or real lines on the floor.
2. Drop rice kernels and step over them.
3. Rock from side to side.
4. Lift toes when stepping.
5. Take one step backward and two steps forward.
6. Remove rugs and other tripping hazards in the home.