Parkinsons Disease

Question 1

CLINICAL MANIFESTATIONS

OF

EMOTIONAL CHANGES

(3)

Answer 1

1. DEPRESSION
2. FEAR, ANXIETY, PANIC ATTACK
3. INABILITY TO COPE

Question 2

“3” things affected by Parkinson’s Disease

Answer 2

1) Voluntary Movement 2) Cognitive Changes 3) Emotional changes

Question 3

“4” classic motor symptoms associated

with Parkinson’s Disease

Answer 3

“TRAP”

Tremors

Rigidity

Akinesia

Postural Instability

Question 5

Clients with Bradykinesia, tremors & rigidity that DO NOT RESPOND to Dopaminergic drugs are typically said to have ____________________

Answer 5

PARKINSONISM instead of Parkinsons Disease

Question 6

CLINICAL MANIFESTATIONS

associated with TREMORS

(5)

Answer 6

1. Early sign–typicallys begins with 1 hand, foot, etc.
2. more prominent when pt is at rest (declines with movement)
3. “PILL ROLLING”
4. Exacerbated by Stress /Anxiety
5. Progressive Difficulty with ADL’s

Question 7

bradykinesia

Answer 7

slow movements

Question 8

DIAGNOSTIC TESTING

for

PARKINSON DISEASE

(6)

Answer 8

• 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

Question 9

DaT Scan

Answer 9

**identifies lack of dopamine receptors in the brain

1. Binds to dopamine transporters
2. *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}

Question 10

“5” stages of Parkinson’s Disease

Answer 10

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

Question 11

What is

DEEP BRAIN STIMULATION?

Answer 11

**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

Question 12

Define Dysarthria

Answer 12

Slurred or Slowed speech

Difficult to understand

Question 13

NON-MOTOR SYMPTOMS

(7))

Answer 13

1. FATIGUE
2. LOSS OF SMELL
3. DEMEN TIA\
4. DEPRESSION
5. SLEEP DISORDERS
6. CONSTIPATION
7. URINARYFREQUEMCY / RETENTION

Question 14

WHAT IS PARKINSONISM?

Causes???

(3)

Answer 14

• ^{**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

Question 15

RISK FACTORS (2)

Answer 15

1) AGE (Primary Risk Factor)—average age onset between 40-70 2) GENDER —Males at increased risk

Question 16

Typically, Dopamine must be decreased by __________ before the patient begins to exhibit signs and/or symptoms

Answer 16

70%

Question 17

CLINICAL MANIFESTATIONS

OF

SLEEP PROBLEMS

(4)

Answer 17

1. daytime sleep attacks
2. restless leg syndrome
3. insomnia
4. parasomnia

Question 18

DEFINE

“BRADYKINESIA”

Answer 18

ABNORMALLY SLOW MOVEMENTS

Question 19

This medication is converted directly to dopamine in the brain

Answer 19

LEVODOPA

Question 20

The medications used to treat Parkinson’s Disease do 1 of 2 things

Answer 20

1. prevent breakdown of dopamine
2. replicate action of dopamine

Question 21

When given orally, medication such as LEVODOPA are converted to ______ in the brainn, increasing dopamine levels in the _______ _________.

Answer 21

DOPAMINE

BASAL GANGLIA

Question 22

Levodopa is a ______________

(class of medication)

Answer 22

DOPAMINERGIC

Question 23

Dopamingerics may be combined with ________________ to descrease peripheral metabolism of Levodopa.

Answer 23

Carbidopa

Question 24

“2” Nursing considerations for Dopaminergic medications

Answer 24

1. monitor for “weaning off” phenomenon
2. Dyskinesias…….^{(which can indicate the need to adjust the dosage or time of administration)}

Question 25

Dopamine

Answer 25

brain neurotransmitter that is needed for voluntary movement

Question 27

Potential Nursing Diagnoses

for Parkinsons Disease

(7)

Answer 27

• Risk for Falls
• Impaired Physical Mobility
• Impaired verbal communication
• Risk for Aspiration
• Self-Care Deficit
• Impaired urinary elimination
• Constipation

Question 28

Define “RIGIDITY”

Answer 28

Resistance to Movement

Question 29

CLINICAL MANIFESTATIONS

AKINESIA

VOLUNTARY (1) AUTOMATIC MOVEMENTS (4)

Answer 29

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>}*

Question 30

CLINICAL MANIFESTATIONS

OF

RIGIDITY

(3)

Answer 30

1. MUSCLE CONTRACTION
2. LIMITED ROM
3. “COGWHEEL RIGIDITY”

Question 31

This medications’ “therapeutic” effectiveness diminishes with increasing doses and long term exposure

Answer 31

Levodopa (Dopaminergic)

Question 32

DEFINE

“AKINESIA”

Answer 32

ABSENCE OF MOVEMENT

Question 33

Clinical Manifestations

of

COGNITIVE PROBLEMS

(4)

Answer 33

1. SLOWED THINKING
2. MEMORY LOSS
3. DEMENTIA (*later in disease progression)
4. CONFUSION

Question 34

Dopaminergics may be combined with ___________ to decrease peripheral metabolism leading to less medication needed to gain a therapeautic effect

Answer 34

Carbidopa

Question 35

Carbidopa and

Levidopa together are known

as ____________ (Name of drug)

Answer 35

Sinemet

Question 36

CAUSES of Parkinson’s Disease (3)

Answer 36

1) Idiopathic mostly 2) Genetic Predisposition 3) Exposure to environmental toxins/chemicals

Question 37

CLINICAL MANIFESTATIONS

OF

POSTURAL INSTABILITY

(4)

Answer 37

1. Stooped Posture
2. Retropulsion ^{(tendancy to topple backward)}
3. Parkinson Gait (shuffling gait-small steps) with FESTINATION = involuntary quickening of gait
4. Freezing of Gait—pt feels like they are stuck to the floor—–>increased risk of falling