Parkinsons Disease Flashcards
CLINICAL MANIFESTATIONS
OF
EMOTIONAL CHANGES
(3)
- DEPRESSION
- FEAR, ANXIETY, PANIC ATTACK
- INABILITY TO COPE
“3” things affected by Parkinson’s Disease
1) Voluntary Movement 2) Cognitive Changes 3) Emotional changes
“4” classic motor symptoms associated
with Parkinson’s Disease
“TRAP”
Tremors
Rigidity
Akinesia
Postural Instability
Clients with Bradykinesia, tremors & rigidity that DO NOT RESPOND to Dopaminergic drugs are typically said to have ____________________
PARKINSONISM instead of Parkinsons Disease
CLINICAL MANIFESTATIONS
associated with TREMORS
(5)
- Early sign–typicallys begins with 1 hand, foot, etc.
- more prominent when pt is at rest (declines with movement)
- “PILL ROLLING”
- Exacerbated by Stress /Anxiety
- Progressive Difficulty with ADL’s
bradykinesia
slow movements
DIAGNOSTIC TESTING
for
PARKINSON DISEASE
(6)
- Presenting symptoms
- neurological exam
- response to medication (favorable outcome to levodopa / carbidopa)
- DaT Scan
- MRI
- Client w/PD will have normal exam from MRI and/or CT scan
- This will rule out other causes
- 2 of 4 TRAP CRITERIA
DaT Scan
**identifies lack of dopamine receptors in the brain
- Binds to dopamine transporters
- *clients w/degeneration of dopamine will show less uptake**thyroid needsblocked before injection of radioactive dye to prevent thyroid accumulation*
IT CAN: DIFFERENTIATE BETWEEN ESSENTIAL TREMORS & TREMORS R/T PARKINSONIAN SYNDROME.
IT CAN NOT:differentiate between parkinson disease and other dopamine degenerative disorders
“5” stages of Parkinson’s Disease
STAGE 1: Shaking/tremor in 1 extremity STAGE 2: Bilateral extremities affected Walking/Balance Poor STAGE 3: Slowed Physical Movement Walking more affected STAGE 4: Akinesia & rigidity make ADL’s difficult STAGE 5: Unable to stand/Walk Dependent for all care
What is
DEEP BRAIN STIMULATION?
**Electrode implanted in Thalmus
-Current delivered by small pulse generator implanted under the skin of upper chest
- Decreases Tremors
- Reduces rigidity
- Improved Akinesia
- Allows for decreased dose of Levodopa
Define Dysarthria
Slurred or Slowed speech
Difficult to understand
NON-MOTOR SYMPTOMS
(7))
- FATIGUE
- LOSS OF SMELL
- DEMEN TIA\
- DEPRESSION
- SLEEP DISORDERS
- CONSTIPATION
- URINARYFREQUEMCY / RETENTION
WHAT IS PARKINSONISM?
Causes???
(3)
- **individuals w/the combination of motor symptoms typically seen in Pakinson Disease.*
- <strong>**not everyone that has parkinsonism has PD.</strong>*
CAUSES:
- MEDICATIONS
- HEAD TRAUMA
- NEURODEGENERATIVE DISORDERS
RISK FACTORS (2)
1) AGE (Primary Risk Factor)—average age onset between 40-70 2) GENDER —Males at increased risk
Typically, Dopamine must be decreased by __________ before the patient begins to exhibit signs and/or symptoms
70%
CLINICAL MANIFESTATIONS
OF
SLEEP PROBLEMS
(4)
- daytime sleep attacks
- restless leg syndrome
- insomnia
- parasomnia
DEFINE
“BRADYKINESIA”
ABNORMALLY SLOW MOVEMENTS
This medication is converted directly to dopamine in the brain
LEVODOPA
The medications used to treat Parkinson’s Disease do 1 of 2 things
- prevent breakdown of dopamine
- replicate action of dopamine
When given orally, medication such as LEVODOPA are converted to ______ in the brainn, increasing dopamine levels in the _______ _________.
DOPAMINE
BASAL GANGLIA
Levodopa is a ______________
(class of medication)
DOPAMINERGIC
Dopamingerics may be combined with ________________ to descrease peripheral metabolism of Levodopa.
Carbidopa
“2” Nursing considerations for Dopaminergic medications
- monitor for “weaning off” phenomenon
- Dyskinesias…….(which can indicate the need to adjust the dosage or time of administration)
Dopamine
brain neurotransmitter that is needed for voluntary movement
Potential Nursing Diagnoses
for Parkinsons Disease
(7)
- Risk for Falls
- Impaired Physical Mobility
- Impaired verbal communication
- Risk for Aspiration
- Self-Care Deficit
- Impaired urinary elimination
- Constipation
Define “RIGIDITY”
Resistance to Movement
CLINICAL MANIFESTATIONS
AKINESIA
VOLUNTARY (1) AUTOMATIC MOVEMENTS (4)
VOLUNTARY
1) progressive difficulty w/ADL’s
AUTOMATIC MOVEMENTS
- 1) Excessive Drooling*
- 2) Difficulty Chewing / swallowing*
- 3) Slow / slurred speech <strong>(dysarthria)</strong>*
- 4) Hypophonia (<strong>low volume)</strong>*
CLINICAL MANIFESTATIONS
OF
RIGIDITY
(3)
- MUSCLE CONTRACTION
- LIMITED ROM
- “COGWHEEL RIGIDITY”
This medications’ “therapeutic” effectiveness diminishes with increasing doses and long term exposure
Levodopa (Dopaminergic)
DEFINE
“AKINESIA”
ABSENCE OF MOVEMENT
Clinical Manifestations
of
COGNITIVE PROBLEMS
(4)
- SLOWED THINKING
- MEMORY LOSS
- DEMENTIA (*later in disease progression)
- CONFUSION
Dopaminergics may be combined with ___________ to decrease peripheral metabolism leading to less medication needed to gain a therapeautic effect
Carbidopa
Carbidopa and
Levidopa together are known
as ____________ (Name of drug)
Sinemet
CAUSES of Parkinson’s Disease (3)
1) Idiopathic mostly 2) Genetic Predisposition 3) Exposure to environmental toxins/chemicals
CLINICAL MANIFESTATIONS
OF
POSTURAL INSTABILITY
(4)
- Stooped Posture
- Retropulsion (tendancy to topple backward)
- Parkinson Gait (shuffling gait-small steps) with FESTINATION = involuntary quickening of gait
- Freezing of Gait—pt feels like they are stuck to the floor—–>increased risk of falling
