Parkisons Disease Flashcards
what is Parkinson’s disease?
a progressive, neurodegenerative disorder of the CNS (basal ganglia) characterised by slowing down in the initiation and execution of movements (bradykinesia) and increase muscle tone (rigidity), tremor at rest and impaired postural reflexed
-more common in men
causes of Parkinson’s?
- unknown
- 15% of cases have family history
pathophysiology of Parkinson’s?
involves the degeneration of the dopamine-producing neurons in the substantia nigra of the midbrain responsible for controlling voluntary movements
what does the degeneration disrupt?
- it disrupts the normal balance between dopamine and acetylcholine in the basal ganglia
- this is important because dopamine allows us to move normally
- decreased dopamine = abnormal movements
when do symptoms of PD occur?
symptoms dont occur until 80% of the neurons in teh substantia nigra are lost or damaged
clinical manifestations of PD?
- usually manifest unilaterally (on one side) with mild symtoms, eventually progressing bilaterally
- beginning stages of PD include mild tremor, a slight limp or decreased arm swing
- later on: pt may have difficult shuffling, propulsive gait with arms flexed and loss of postural reflexes
first symptom?
changes in hand writing
-tremors increase with increased concentration
what is the classical triad of symptoms?
tremor
rigidity
bradykinesia
what is a tremor?
often the first sign
more prominent at rest and aggravated by emotional stress
what is rigidity?
is the increased resistance to passive motion when the limbs are moved through thier ROM, is caused by sustained muscle contraction
what is bradykinesia?
the evident loss of automatic movement including decreased and slow blinking of the eyelids, swinging of the arms while walking, swallowing of saliva, self-expression with facial and hand movements
Complications of PD?
- depression, anxiety, apathy, pain, fatigue, constipation, impotence, and short term memory impairment
- dementia occurs in 1 in 5 ppl with PD
- general debilitation may lead to pneumonia, UTI, and skin breakdown
as swallowing becomes more difficult in PD, what happens?
malnutrition or aspiration may result
what do antiparkinsonian drugs do?
either enhance the release of supply of dopamine
or antagonise or block the effects of the overactive cholinergic neurons in the striatum (anticholinergic)
-the drugs are very effective for the first few years, but as disease progresses the effectiveness wears off
what are often the first drugs used?
Levodopa with cabidopa (Sinemet)
- levodopa is a pre-curser of dopamine
- it crosses the BBB and converted to dopamine in the basal ganglia
- receptors think the drug is dopamine, therefore improving muscle movement
- not a cure
what are pts often given early in the disease course?
cabidopa (Sinemet)
why is nutrition important in a PD pt?
-because malnutrition and constipation can be serious consequences of inadequate nutrition
nutritional therapy for PD?
- pts who have dysphagia and bradykinesia need appetizing foods that are easily chewed and swallowed
- food should be cut into bite-sized pieces before it is served
- ample time should be planned to avoid frustration and encourage independence
Overall goals?
- experiance a lower intensity and frequency of distressing symptoms
- maximize the neurological function
- maintain independence in activities of daily living for as long as possible
- optimize psychological well-being
what are the benifits of excersise for PD pts?
- nurses should promote excersise for PD pts
- excercise can limit the consequence of decreased mobility such as muscle atrophy, contractures and constipation
- although it will not halt the disease process, it will enhance the pts functional ability
