Unit 1: Parkinson's Disease Flashcards
Parkinson’s Disease
a progressive, neurodegenerative disease of the CNS; in motor function
- idiopathic or
- environmental toxins (pesticides and herbicides) brain injury, brain tumors, use of anti-psychotic medication, and genetics
- progression is escalated in those diagnosed at later stages in life
Pathophysiology of Parkinson’s Disease
-loss of dopamine-producing brain cells
-decreased dopamine in the brain
>motor system disorder
>loss of dopamine-producing brain cells in the substantia nigra of the basal ganglia; decreasing amount of dopamine in the brain
>the basal ganglia consists of several brain structures or collections of neurons: the striatum, substantia nigra, and the subthalamic nucleus, all innervated by the dopaminergic system
>motor activity is the result of the release of dopamine and acetylcholine (ACh) and the integration of the basal ganglia, the cerebral cortex, and the cerebellum
>stimulation of the basal ganglia = muscle tone is inhibited, voluntary movement is coordinated and smoothly executed
>coordination of the excitatory messages from the production of ACh in the basal ganglia and the inhibitory messages from dopamine via transport from the substantia nigra to the basal ganglia allow for the control of steady, well-coordinated, fine movement
>deterioration of the substantia nigra decreases the amount of dopamine in the brain
>the excitatory ACh neurons continue to proliferate, remaining active
>a continued loss of dopamine and its inhibitory mechanism = loss of initiation and control on voluntary movement
4 Discernable/ Cardinal Symptoms of Parkinson’s Disease
- Resting Tremors
- Muscle rigidity (stiffness)
- Bradykinesia (slowed movement)
- Postural instability (impaired balance, frequent falls)
How is PD Diagnosed?
when two or more cardinal symptoms w/ asymmetrical presentation [bradykinesia (slow movement), resting tremor, rigidity, and postural instability], are observed in the absence of other causes
- no specific diagnostic test
- presence of progressive decline in motor function accompanied by tremors and rigidity is how diagnosis is made
Clinical Manifestations of Parkinson’s Disease
- Fatigue
- Drooling
- Mask like face
- Sexual dysfunction
- Constipation
- Urinary Dysfunction
- Orthostatic hypotension
- Widening gait
- Sleep disorders
- Pain
- Depression
- Anxiety
- Apathy
- Cognitive Impairment
Progressive Stages
- initial stage: unexplained unilateral weakness, upper-extremity tremors
- progresses: more pronounced physical disabilities; slow, shuffling gait, widening on gait, postural instability
- final stages: movements much slower; rigidity more pronounced
Medical Management of Parkinson’s Disease
> Pharmacological therapy is initiated when symptoms become difficult or disabling for the patient
- Anticholinergics: Benztropine
- Dopamine-receptor agonists: Ropinirole
- Dopaminergic: Levodopa-Carbidopa
Medications: Benztropine
anticholinergic
- reduces tremors and drooling
- reduction of rigidity
- generally not used in older adults b/c of side effects
- Side Effects: confusion, memory impairment, blurred vision, dry mouth, constipation, and urinary retention
Medications: Ropinirole (Requip)
- first-line treatment
- dopamine agonist
- stimulates dopamine receptors in the brain
- decreased tremor and rigidity
- Side Effects: sleep attacks, disorders of impulse control (gambling and hypersexuality), lower-extremity edema, orthostatic hypotension, nausea/vomiting, urinary frequency, drowsiness
Medications: Levodopa/carbidopa (Sinemet)
- dopamine replacement; dopaminergic
- compensates for the lack of dopamine
- treatment of bradykinesia, tremors, and rigidity
- Side effects: nausea/vomiting, orthostatic hypotension, constipation, arrhythmias, dyskinesias (uncontrolled, voluntary muscle movement), and dry mouth
Surgical Management
- Deep Brain Stimulation
- Stereotactic Pallidotomy
Surgical Management: Deep Brain Stimulation
surgical implantation of a pulse generator into the thalamus, subthalamic nucleus, or Globus pallidus area of the brain of a person w/ PD
-the electrical stimulation to the deep brain helps improve symptoms such as tremor, rigidity, stiffness, slowed movement, and gait
Surgical Management: Stereotactic Pallidotomy
- for control of clinical manifestations
- opening of the pallidum within the corpus striatum
- locating the site using CT of the head and the stereotactic head ring
- once location identified, a burr hole is performed for access and a cylindrical rod or electrode is implanted, allowing targeted area to receive mild electrical stimulation to reduce tremors and rigidity
- once probe is confirmed, in proper location, a permanent lesion is established in order to destroy the tissue and reduce tremors and rigidity
Nursing Management of PD: Assessment and Analysis
>Signs of PD: -Resting tremor -Muscle rigidity -Bradykinesia -Postural Instability >other: weakness, fatigue, mask-like face, shuffling gait, uncoordinated movements, widening gait, stooped posture, arms flexed at elbows and wrists, hips and knees slightly flexed
Nursing Diagnoses
- risk for falls r/t ataxia, muscular rigidity, and orthostatic hypotension
- risk for constipation r/t decreased mobility and side effects from medications
- powerlessness r/t diagnosis of a chronic progressive disorder
