Parkisons Disease

Question 1

what is Parkinson’s disease?

Answer 1

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

Question 2

causes of Parkinson’s?

Answer 2

• unknown

- 15% of cases have family history

Question 3

pathophysiology of Parkinson’s?

Answer 3

involves the degeneration of the dopamine-producing neurons in the substantia nigra of the midbrain responsible for controlling voluntary movements

Question 4

what does the degeneration disrupt?

Answer 4

• 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

Question 5

when do symptoms of PD occur?

Answer 5

symptoms dont occur until 80% of the neurons in teh substantia nigra are lost or damaged

Question 6

clinical manifestations of PD?

Answer 6

• 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

Question 7

first symptom?

Answer 7

changes in hand writing

-tremors increase with increased concentration

Question 8

what is the classical triad of symptoms?

Answer 8

tremor
rigidity
bradykinesia

Question 9

what is a tremor?

Answer 9

often the first sign

more prominent at rest and aggravated by emotional stress

Question 10

what is rigidity?

Answer 10

is the increased resistance to passive motion when the limbs are moved through thier ROM, is caused by sustained muscle contraction

Question 11

what is bradykinesia?

Answer 11

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

Question 12

Complications of PD?

Answer 12

• 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

Question 13

as swallowing becomes more difficult in PD, what happens?

Answer 13

malnutrition or aspiration may result

Question 14

what do antiparkinsonian drugs do?

Answer 14

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

Question 15

what are often the first drugs used?

Answer 15

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

Question 16

what are pts often given early in the disease course?

Answer 16

cabidopa (Sinemet)

Question 17

why is nutrition important in a PD pt?

Answer 17

-because malnutrition and constipation can be serious consequences of inadequate nutrition

Question 18

nutritional therapy for PD?

Answer 18

• 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

Question 19

Overall goals?

Answer 19

• 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

Question 20

what are the benifits of excersise for PD pts?

Answer 20

• 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