Parkinson’s Disease Flashcards
What is Parkinson’s Disease (PD)
Disease of basal ganglia
characterized by
Slowing down in the initiation and execution of movement
↑ muscle tone (rigidity)
Tremor at rest
Gait disturbance
Diagnosis increases with age.
Affects about 2% of people over age 60
As many as 15% of those diagnosed with PD are younger than age 50.
More common in men
Etiology and Pathophysiology
Exact cause of PD unknown
Possibly a result of a complex interplay between environmental factors and the person’s genetic makeup
Family history
Exposure to toxins may trigger disease.- CO2-
Drug-induced-meth-reglan-Haldol-lithium-psych meds
Other causes- infections, stoke, MS, HD, Trauma
Lack of dopamine in brain
Pathologic process involves degeneration of dopamine- producing neurons in substantia nigra of the midbrain.
Disrupts dopamine-acetylcholine balance in basal ganglia
Nigrostriatal Disorder in Parkinsonism
Clinical Manifestations
Onset is gradual and insidious with ongoing progression.
Classic triad of PD
Tremor- pill rolling tremors -
Rigidity
Bradykinesia- rock side to side to initiate movement
Beginning stages may involve only mild tremor, slight limp, or ↓ arm swing.
Later stages may have shuffling, propulsive gait with arms flexed, and loss of postural reflexes.
Some have slight speech changes.
Pull/fall test
Tremor
So minimal initially that only the patient may notice it
More prominent at rest and is aggravated by emotional stress or ↑ concentration
Rarely causes shaking of the head- this is usually a adverse effect of medications such as dyskinesia
Rigidity
Increased resistance to passive motion when limbs are moved through ROM
Caused by sustained muscle contraction
Bradykinesia
Slowing down in initiation and execution of movement
Evident in loss of autonomic movements
Blinking
Swinging of arms while walking
Swallowing of saliva
Self-expression with facial movements
Nonmotor symptoms
Depression
Anxiety
Fatigue
Pain
Constipation
Sleep problems
Short-term memory loss
Complications Nonmotor Symptoms
Impotence
Short-term memory impairment
Sleep problems
Difficulty staying asleep
Restless sleep
Nightmares
Drowsiness during the day
Complications ↑ as disease progresses
Motor symptoms
Weakness
Akinesia
Neurologic problems
Neuropsychiatric problems
Dementia occurs in 70% of patients.
Complications
Dysphagia may result in malnutrition and aspiration.
General debilitation may lead to pneumonia, UTIs, and skin breakdown.
Orthostatic hypotension may occur.
Could result in falls and injuries
Diagnostic Tests
No specific tests for PD
Diagnosis based solely on history and clinical features
Firm diagnosis can be made when at least two of three characteristics of the classic triad (tremor, rigidity, and bradykinesia) are present.
Collaborative Care
No cure for PD
Collaborative management is aimed at relieving symptoms.
Collaborative Care
Drug Therapy
Aimed at correcting imbalances of neurotransmitters within the CNS
Antiparkinsonian drugs either
Enhance or release supply of DA
Antagonize or block the effects of overactive cholinergic neurons in the striatum
Levodopa with carbidopa (Sinemet) is often the first drug used.- Carbidopa is there so levodopa can reach the brain more effectively
Precursor of DA and crosses blood-brain barrier
Converted to DA in the basal ganglia
Carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain.
Effectiveness of Sinemet could wear off after a few years of therapy.
Therefore some initiate therapy with a DA receptor agonist instead.
Sinemet is added when moderate to severe symptoms develop.
•These drugs directly stimulate DA receptor- bromocriptine (Parlodel)-lowers B/P by dilating the arteries and veins must monitor vitals, pergolide (Permax), ropinirole (Requip), and pramipexole (Mirapex).
MAO-B inhibitors, selegiline and rasagiline, may be combined with Sinemet.
Entacapone and tolcapone block the enzyme that breaks down levodopa in the peripheral circulation, prolonging the effects of Sinemet.
What happens after 3-5 years of therapy
patients experience episodes of hypomobility.
Treated with apomorphine (Apokyn)
SQ
Needs to be taken with an antiemetic drug
Do not give with Ondansetron- cause hypertension and loss of consciousness
Collaborative Care Nutritional Therapy
Food should be cut into bite-sized pieces.
Several small meals should be taken to prevent fatigue.
Provide ample time to avoid frustration.
Levodopa can be impaired by protein and vitamin B6 ingestion. What foods contain vitamin B6
Malnutrition and constipation can be serious consequences.
Patients with dysphagia and bradykinesia need food that is easily chewed and swallowed.
Adequate roughage
Collaborative Care Surgical Therapy
Procedures aimed at relieving symptoms
Used in patients who are usually unresponsive to drug therapy or have developed severe motor complications
Ablation Surgery
Has been used to treat PD for over 50 years
But has been recently replaced by deep brain stimulation (DBS)
Collaborative Care
Deep Brain Stimulation
Involves placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus
Connected to a generator placed in the upper chest
Device is programmed to deliver specific current to targeted brain location.
Nursing Management
Nursing Assessment
Health History
CNS trauma
Cerebrovascular disorders
Exposure to metals and CO2
Encephalitis
Medications
Tranquilizers
Reserpine
Methyldopa
Amphetamines
Fatigue
Excessive salivation
Dysphagia
Weight loss
Constipation
Incontinence
Difficulty initiating movements, falls
Loss of dexterity
Diffuse pain in head, shoulders, neck, back, legs, and hips
Insomnia
Depression
Mood swings
Nursing Management
Nursing Assessment Objective Data
Blank faces, infrequent blinking
Seborrhea
Dandruff
Ankle edema
Postural hypotension
Tremor at rest
“Pill rolling”
Poor coordination
Subtle dementia
Nursing Management
Planning
Maximize neurologic function.
Maintain independence in activities of daily living (ADLs) for as long as possible.
Optimize psychosocial well-being.
Nursing Management
Nursing Implementation
PD is a chronic degenerative disorder with no acute exacerbations.
Focus teaching and nursing care
Maintenance of good health
Encouragement of independence
Avoidance of complications such as contractures and falls
Promote physical exercise and
a well-balanced diet.
Limit the consequences from decreased mobility.
Specific exercises to strengthen muscles involved with speaking and swallowing
