UNIT 2- PARKINSON'S DISEASE Flashcards
What is Parkinson’s disease?
It is a chronic progressive neurodegenerative disease of the CNS manifesting primarily in motor dysfunction
What is the typical age range for Parkinson’s disease dx?
40-70 years of age
What causes PD?
1.Exact cause is unknown
2. Possibly a result between environmental factors and a person genetic make up
3. Risk also increases by well water, pesticides, herbicides, industrial chemicals, wood pulp mills, Rual residence
What is atypical PD? and what are possible causes?
- Atypical PD is caused by various factors causing PD like s/s however once factors are treated or removed than the s/s improve and it deemed atypical PD. In true PD the s/s would not reside.
Possible causes include
1. Exposure to chemicals
2. Drug induced
3. Others
True or false: In PD patients will shake their heads as part of the tremors?
False- In PD people don’t shake their heads.
What is the patho of PD?
- Degeneration of dopamine producing neurons in substantia nigria of midbrain.
- Disrupts dopamine-acetylcholine balance in basal ganglia
- Essential for normal functioning of extrapyramidal motor system
When do clinical symptoms appear in PD?
Clinical symptoms appear with 60% neuron loss and 80% dopamine decrease
What are the clinical manifestations of PD? Think TRAP
T- Tremors (resting)
R- Rigidity
A- Akinesia/Bradykinesia
P- postural instability
What is the onset of symptoms like in PD?
Gradual and insidious w/ongoing progression
What are beginning stages of PD s/s?
- Mild tremor (resting),
2.slight limp,
3.decreased arm swing
What are the later stage s/s of PD?
- Shuffling
- Propulsive gait with arms fixed
- Loss of postural reflexes
Which increases drooling, aspiration risk, mask like facial feature
What should we know about PD tremors?
- Resting tremor/pill rolling hand tremor
- Often 1st sign of PD
- More prominent at rest
- Aggravated by emotional stress and increased concentration
What other areas can PD tremors effect in later stages?
- Diaphragm
- Tongue
- Lips
- Jaw may be involved
What should we know about rigidity in PD?
- Increased resistance to passive motion when limbs are moved through ROM
- Sustained muscle contraction
-Complaints of muscle soreness
-Feeling achy or tired
-pain in the head, upper body , spine or legs. - Slowness of movment
What is cogwheel rigidity?
Jerky quality- like intermittent catches in passive movement of a join
What is akinesia?
Absence or loss of control of voluntary muscle movements
What is bradykinesia?
Slowness of movement, particularly evident in the loss of automatic movements
What are classic s/s of PD?
- Stooped posture
- Masked face
- Drooling
- Festination (shuffling gate)
What are some non-motor manufacturers of PD?
- Depression and anxiety
- Apathy
- Fatigue
- Pain
- Urinary retention and constipation (bladder/bowel retraining)
- erectile dysfunction
- Memory changes (dementia)
What are sleep manifestations of PD?
Sleep problems are common
1. Difficulty staying asleep
2. Restless sleep
3. Nightmares
4. Drowsiness during the day
5. REM behavior disorder
-Violent dreams
-Potentially dangerous motor activity during sleep.
What are some complications of PD?
- Motor symptoms
- Weakness
- Akinesia
- Neurologic problems
- Neuropsychiatric problems
Complications INCREASE as the disease progresses
What sets Parkinson’s disease apart from other neurodegenerative diseases?
- Parkinsonian Dementia
True or False: Dysphagia is not common in PD?
- False- Dysphagia can happen with PD and increases the likelihood of malnutrition or aspiration
General debilitation in PD may lead to?
- Pneumonia, UTI’s, skin breakdown
True or false: Orthostatic hypotension is common in PD?
- True which in turn increases risk of falls and injuries.
What is definitive diagnostic test for PD?
- There is not one
What dx studies can be done for an official dx of PD?
- Presence of 2 or more cardinal manifestations of TRAP.
- Medical history, presenting symptoms, neurologic exam
- Positive response to antiparkinsonian drugs!!!
What is the therapeutic goals of PD drug therapy?
- Aimed at correcting imbalances of neurotransmitters within the CNS
- Improve the patient’s ability to carry out the activates of daily life
What is the MOA of antiparkinsonian drugs?
- Enhance or release supply of dopamine
- Antagonizes or blocks the effects of overactive cholinergic neurons in the striatum
Does the ideal treatment of PD exist?
No, the ideal treatment that reverses neuronal degeneration or prevents further degeneration does not exist.
How is the drugs/dosages chosen for a PD patient?
- Drug selection and dosages are determined by the extent to which PD interefers w/work, dressing, eating, bathing, and other ADLS
How do we known when a patient is ready to move forward with surgical management of PD?
- Surgical therapy is used in patients unresponsive to drug therapy and have developed severe motor complications.
What are the different types of surgical management for PD?
- Deep brain stimulation
- Ablation
- Transplantation
What do we need to know about DBS (deep brain stimulation)
- Most common surgical treatment
- Reversible and programmable- basically like a pacemaker for the brain
- Improves motor function
- Reduces dyskinesia and medications needs
What do we need to know about ablation surgery?
- Ablation is used to locate, target and destroy area of brain affected by PD
- Destroys tissue that produces abnormal chemical or electrical impulses leading to tremors or other symptoms.
PD patients with dysphagia and bradykinesia need food that is…..
1.Easily chewed and swallowed to decrease risk of aspiration..
Should PD pts eat large meals?
No, they should eat more numerous small meals to avoid getting to tired while eating.
important to provide ample time.
True or false: Malnutrition and constipation can be serious complications of PD?
- True
What are some nursing dx for PD patients?
- Self-care deficit
- Chronic confusion (dementia/meds)
- Impaired physical mobility (Rigidity, akinesia/bradykinesia)
- Impaired verbal communication
- Impaired swallowing
- Risk for imbalance nutrition: less than body requires
What are some nursing management considerations?
- Maximize neurologic functions
- Maintain independence in activities of daily living as long as possible
- Optimize psychosocial well-being
- Administer medications as prescribed
- Facilitate nutritional intake
- Interdisciplinary collab w/PT, OT, Speech
