parkinson's disease

Question 1

incidence of PD

Answer 1

increases with age with peak onset in 70s

More common in men (3:2 ratio)

Question 2

risk factors

Answer 2

Family history

Hydrocephalus, hypoxia, infections, stroke, tumor, trauma and certain drugs/chemical intoxications

Question 3

role of dopamine

Answer 3

• Inhibitory neurotransmitter involved in mood and the normal functions of the extrapyramidal motor system, including posture, support and voluntary motion
• Loss of dopamine activity in some portions of the brain leads to the muscular rigidity

Question 4

role of acetylcholine

Answer 4

• Excitatory neurotransmitter that makes cells more excitable
• Governs muscle contractions and causes glans to secrete hormones

Question 5

what is PD

Answer 5

Loss of dopamine in the substantia nigra, which results in an imbalance between dopamine and acetylcholine

Question 6

hallmark features

Answer 6

tremor
rigidity
bradykinesia
postural instability

Question 7

tremor

Answer 7

“resting tremor” more common at rest, aggravated by stress

1. “Pill rolling”
2. Jaw, may affect the feet

Question 8

rigidity

Answer 8

increased resistance to passive motion

1. “Cogwheel rigidity” (i.e. intermittent or “jerky” motions)
2. Results in slowness of movement and muscle soreness from sustained muscle contractions

Question 9

bradykinesia

Answer 9

• lack of spontaneous autonomic, involuntary movements

- Results in: masked face, drooling, shuffling, stooped posture

Question 10

additional clinical manifestations

Answer 10

1. Depression
2. Apathy or anxiety
3. Fatigue
4. Pain
5. Constipation r/t immobility, difficulty swallowing
6. Short-term memory impairment
7. Dementia
8. Sleep disorders

Question 11

PD diagnostics

Answer 11

1. No specific tests for Parkinson’s

2. Dx made on clinical presentation (two or three hallmark characteristics)

Question 12

pharmacologic management

Answer 12

dopaminergic
anticholinergic
sinemet
dopamine receptor agonists

Question 13

dopaminergic

Answer 13

enhance release or supply of dopamine

Question 14

anticholinergic

Answer 14

block the effect of cholinergic neurons

Question 15

sinemet

Answer 15

Levodopa is a precursor of dopamine, crosses blood brain barrier
Carbidopa: inhibits the enzyme which breaks down levodopa before it reaches the brain
May become less effective over time

Question 16

dopamine receptor agonist

Answer 16

Bromocriptine (Parlodel)

Question 17

surgical interventions

Answer 17

Reserved for those unresponsive to drug therapy or those with severe motor complications
ablation surgery
deep brain stimulation

Question 18

ablation surgery

Answer 18

“destroy” stereotactic ablation of involved areas; non-reversible

Question 19

deep brain stimulation

Answer 19

places an electode in area and connects to a generator in the upper chest which delivers a specific current decreasing neuronal activity produced by dopamine depletion
-Allows for adjustments to be made

Question 20

PD nursing diagnoses/problems and interventions

Answer 20

impaired physical mobility
self care deficits 
constipation
risk for aspiration/impaired swallowing
imbalanced nutrition
impaired Verbal Communication
Risk for Falls r/t postural instability 
Knowledge Deficit
Impaired Social Interactions
Activity Intolerance
Risk for Injury

Question 21

impaired physical mobility

Answer 21

Squeeze a small rubber ball or hold change in pocket
Use both hands to accomplish tasks
Rationale: voluntary movements can stop or reduce tremors
Encouraging morning exercise
Encourage client to avoid soft, deep chairs and soft mattresses
Rationale: firmer chairs and mattresses are easier for the client to get up from and out of

Question 22

self care deficits

Answer 22

assistive devices: Velcro, elasticized clothing, etc. (allow extra time)

Question 23

imbalanced nutrition

Answer 23

Swallow saliva often 
Keep head upright
Chew hard; move food around with tongue
Finish one bite before another
Rest periods during meals 
East slowly, taking small bites

Question 24

prognosis/cure

Answer 24

• No cure
• Not fatal, but there is no cure
• Progresses more quickly in older than younger patients
• Can seriously impair the QoL in any age group
• Treatment advances are increasingly effective in alleviating sx and slowing disease progression
• May lead to severe incapacity within 10 to 20 years
• Older patients also experience freezing and greater decline in mental function and daily functioning