parkinson's disease Flashcards
incidence of PD
increases with age with peak onset in 70s
More common in men (3:2 ratio)
risk factors
Family history
Hydrocephalus, hypoxia, infections, stroke, tumor, trauma and certain drugs/chemical intoxications
role of dopamine
- 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
role of acetylcholine
- Excitatory neurotransmitter that makes cells more excitable
- Governs muscle contractions and causes glans to secrete hormones
what is PD
Loss of dopamine in the substantia nigra, which results in an imbalance between dopamine and acetylcholine
hallmark features
tremor
rigidity
bradykinesia
postural instability
tremor
“resting tremor” more common at rest, aggravated by stress
- “Pill rolling”
- Jaw, may affect the feet
rigidity
increased resistance to passive motion
- “Cogwheel rigidity” (i.e. intermittent or “jerky” motions)
- Results in slowness of movement and muscle soreness from sustained muscle contractions
bradykinesia
- lack of spontaneous autonomic, involuntary movements
- Results in: masked face, drooling, shuffling, stooped posture
additional clinical manifestations
- Depression
- Apathy or anxiety
- Fatigue
- Pain
- Constipation r/t immobility, difficulty swallowing
- Short-term memory impairment
- Dementia
- Sleep disorders
PD diagnostics
- No specific tests for Parkinson’s
2. Dx made on clinical presentation (two or three hallmark characteristics)
pharmacologic management
dopaminergic
anticholinergic
sinemet
dopamine receptor agonists
dopaminergic
enhance release or supply of dopamine
anticholinergic
block the effect of cholinergic neurons
sinemet
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
dopamine receptor agonist
Bromocriptine (Parlodel)
surgical interventions
Reserved for those unresponsive to drug therapy or those with severe motor complications
ablation surgery
deep brain stimulation
ablation surgery
“destroy” stereotactic ablation of involved areas; non-reversible
deep brain stimulation
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
PD nursing diagnoses/problems and interventions
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
impaired physical mobility
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
self care deficits
assistive devices: Velcro, elasticized clothing, etc. (allow extra time)
imbalanced nutrition
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
prognosis/cure
- 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
