Test 3 Parkinson Disease (CNS, Brain) Flashcards
What is the pathophysiology of Parkinson’s Disease?
- Degeneration of the substantia nigra results on decreased production of dopamine
- Overstimulation of the basal ganglia by acetylcholine
- Progressive disease!
What are the risk factors for Parkinson’s Disease?
Age 40 to 70 Gender: men Genetic predisposition Exposure to environmental toxins Chronic use of antipsychotic medication
What are the 4 primary symptoms of Parkinson’s Disease?
What causes these symptoms to occur?
What is the expression that is typical of these patients?
4 Primary Symptoms of Parkinson’s Disease:
- Tremor
- Muscle rigidity
- Bradykinesia (Slow Movement)
- Postural instability
- The overstimulation of the basal ganglia by acetycholine occurs because degeneration of the substantia nigra results in decreased dopamine production. This allows acetylecholine to dominate, making smooth, controlled movements difficult.
- Mask-like facial expression is typical
What is stage 1 of the 5 stages of Parkinson’s Disease?
-Stage 1 : Unilateral shaking or tremor of one limb (Independent)
What is stage 5 of the 5 stages of Parkinson’s Disease?
Stage 5: Patient unable to walk or stand, in dependent for all care, and may exhibit dementia.
** COMPLETE ADL DEPENDENCE
What are some autonomic symptoms that occur with Parkinson’s Disease?
How is the patient cognitively? Mood?
Autonomic symptoms:
- Orthostatic hypotension
- Flushing
- Diaphoresis
-Emotionally labile, cognitive impairment (dementia), depressed, paranoid
What is the nursing care for Parkinson’s Disease patient?
-Mobility? Nutrition? Psychological? etc.
Collaborative:
Mobility:
-Encourage mobility for as long as possible
-Fall Risk!
- Teach patient to stop occasionally when walking and slow down to reduce risk for falls.
-Pace activities by providing rest periods.
-Assist with ADLs as needed
-Encourage exercise (Yoga)
Nutrition
- May need assistance with eating (have tremors)
- May need special tools
- Monitor swallowing
Psychological
- Age 40 early onset –> Need psychological support to deal with the look of their life.
- Observe for signs of depression, dementia
Speech therapy
-Will have difficulty with speech
Drug therapy:
What are some drug therapy teaching points and considerations?
- MOST EFFECTIVE in FIRST 3-5 years of use.
- May take several weeks of use before improvement of symptoms are seen.
- Maintenance of therapeutic medication levels is necessary for adequate control.
- Drug toxicity interventions
- Drug holiday
What is the priority care and management of Parkinson’s Disease?
No Cure, just treating symptoms.
Parkinson’s Medications:
What are the medications for Parkinson’s Disease?
-Dopaminergics
**Dopamine agonists
**Anticholinergics
**Catechol O-methyltransferase inhibitors
-Antivirals
Name a dopaminergic?
How does it work?
What can it be combined with and why?
Nursing considerations?
Dopaminergics:
levodopa - converted to dopamine in the brain, increasing dopamine levels in basal ganglia
Levodopa combined with carbidopa to decrease peripheral metabolism of levodopa requiring a smaller dose to make the same amount available to the brain. Less side effects.
Nursing considerations:
- Adjust regimen to avoid periods of poor mobility
- Monitor for the wearing off effect (dyskinesias–> problems with movement) and consider medication holiday
Name dopamine agonists?
How does it work?
What can it be combined with and why?
Nursing considerations?
Dopamine agonists:
**ROPINIROLE, BROMOCRIPTINE, pramipexole
These active the release of dopamine and may be used in conjunction with a dopaminergic for better results.
Nursing considerations:
-Monitor for ORTHOSTATIC HYPOTENSION, dyskinesias, hallucinations
Name anticholinegics?
How does it work?
What can it be combined with and why?
Nursing considerations
Anticholinergics:
benzotropin (Cogentin) and trihexyphenidyl
These help to control tremors and rigidity.
Nursing considerations:
-Monitor for anticholinergic effects (dry mouth, constipation, urinary retention, acute confusion)
Name a Catechol O-methyltransferase (COMT) inhibitor?
How does it work?
What can it be combined with and why?
Nursing considerations?
Catechol O-methyltransferase (COMT) inhibitor:
entacapone - Decreases the breakdown of levodopa making it more available to the brain as dopamine.
Can be used in conjunction with dopaminergic and dopamine agonist for better results.
Nursing considerations:
- Monitor for dyskinesia/hyperkinesia when using levodopa
- Assess for diarrhea
- Dark urine is a normal finding
Name an antiviral?
How does it work?
Nursing considerations?
Antivirals:
amantadine - Stimulates the release of dopamine and prevents its reuptake
Nursing considerations:
- Monitor for swollen ankles and discoloration of skin.
- Client may experience atropine-like effects.
