Topic 11: Parkinsons

Question 1

Parkinson’s disease

Answer 1

chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increases muscle tone (rigidity), tremor at rest, and gait changes

Question 2

PD patho

Answer 2

Degeneration of the DA-producing neurons in the substantia nigra of the midbrain, LOW dopamine, HIGH acetylcholine

Question 3

unusual clumps of protein found in the brains of patient with PD

Answer 3

LEWY BODIES

Question 4

clinical manifestations of PD

Answer 4

· Tremor (often first sign) MORE PROMINENT AT REST
· “Pill rolling”
· Rigidity “cogwheel rigidity” (increased resistance to passive motion when limbs are moved through their ROM)
· Akinesia (absence or loss of control of voluntary muscle movement)
· Bradykinesia (slowness of movement)
· Stooped posture
· Shuffling gait (festination) and appearing unable to stop
· Decreased arm swing
· Masked face
· Drooling of saliva
· Speech problem: hypokinetic dysarthria

Question 5

diagnostic assessment of PD

Answer 5

· No specific diagnostic tests exist for PD
· TRAP (tremor, rigidity, akinesia, postural instability)
· Positive response to antiparkinsonian drugs (levodopa or DA agonist)
· MRI
Rule out SE of phenothiazines, reserpine, benzos, and haloperidol

Question 6

TRAP

Answer 6

tremor, rigidity, akinesia, postural instability

Question 7

nuring implementation for PD

Answer 7

· Promote physical exercise and well-balanced diet
· PT to design a personal exercise program to strengthen and stretch certain muscles
· PREVENT FALLS
· Assess psychological well-being (patient may struggle with depression and anxiety

Question 8

preventing fall interventions

Answer 8

o Remove rugs and excess furniture, elevated toilet seat
o Tell client to consciously think about stepping over an imaginary object while walking
o Rock side to side before stepping forwards
o Walk to a beat
o Try to swing both arms front to back
o Take 1 step back and 2 steps forward

Question 9

Surgical therapy for PD

Answer 9

· Deep brain stimulation (DBS)
· Ablation (destruction area of brain affected by PD)
· Transplantation (provides DA-producing cells)

Question 10

nutritional therapy for PD

Answer 10

· Food should be easy to chew and swallow because of dysphagia
· Cut food into bite-size pieces
· Fiber and fruit to reduce constipation
· 6 small meals may be less tiring than 3 large meals a day

Question 11

what can impair the absorption of levodopa

Answer 11

Protein and vitamin B6 can impair the absorption of levodopa; LIMIT PROTEIN INTAKE AT EVENING MEAL

Question 12

mediation for Parkinson’s

Answer 12

Levodopa with carbidopa (Sinemet)

Question 13

Levodopa with carbidopa (Sinemet) converts…

Answer 13

Converts to dopamine in basal ganglia