week 3 prt 2 Flashcards
Parkinson’s is:
A progressive, degenerative neurologic disease characterized by tremor at rest, muscle rigidity and akinesia.
People with PD are faced with multiple problems involving independence in ADLs, emotional well-being, financial security, and relationships with caregivers.
Pathophysiology Review
A disturbed balance b/w excitatory and inhibitory neurotransmitters causes disorders of voluntary motor function
In PD:
Neurons in the cerebral cortex atrophy & are lost
Dopaminergic nigrostriatal pathway degenerates.
# of specific dopamine receptors in basal ganglia decreases
Cause decrease in Dopamine (helps regulate nerve impulses involved in motor function)
Usual balance of dopamine (inhibitory neurotransmitter) and acetylcholine (excitatory neurotransmitter) in brain is disrupted & dopamine no longer inhibits acetylcholine
Cardinal Symptoms
Tremor: Involuntary trembling of the limbs at a rate of 4-6 beats per second
Rigidity: Stiffness of the muscles
Akinesia: Lack of movement or slowness in initiating and maintaining movement
Postural changes: Characteristic bending or flexion of the body, associated with difficulty in balance and disturbances in gait
Manifestations
Urinary problems or constipation.
improper functioning of ANS (regulates smooth muscle) – incontinent or trouble urinating. Constipation gut slows, poor diet, drinking too little fluid, medications
Skin problems
Face very oily, dandruff, or very dry, +++diaphoresis.
Sleep problems
difficulty staying asleep at night, restless sleep, nightmares & emotional dreams, and drowsiness or sudden sleep onset during the day
Dementia or other cognitive problems.
may develop memory problems & slow thinking
cognitive problems become more severe, leading to a condition called Parkinson’s dementia late in the course of the disease (approx 30%)
Orthostatic hypotension
Muscle cramps and dystonia
rigidity and lack of normal movement often causes muscle cramps, especially in the legs and toes.
Dystonia— sustained muscle contractions that cause forced or twisted positions, often caused by fluctuations in the body’s level of dopamine
**side effect of too much Levodopa
Anosmia
diminished or loss of sense of smell *early symptom
Pain
aching muscles and joints d/t rigidity & abnormal postures
Treatment and exercises may help
Fatigue and loss of energy
especially late in the day
Associated with depression or sleep disorders, muscle stress, overexertion when well, akinesia
Sexual dysfunction
Erectile dysfunction
Anosmia
diminished or loss of sense of smell *early symptom
Dystonia—
sustained muscle contractions that cause forced or twisted positions, often caused by fluctuations in the body’s level of dopamine
Stages of involvement FIVE STAGES:
Five main stages Initial Stage Mild Stage Moderate Severe Disability Complete Dependence
Level 1
No difficulties with day-to-day activities
Level 2
Mild difficulties with day-to-day activities
L 3
Moderate difficulties with day-to-day activities
Without some help, have increased difficulty with simple activities such as rising from a chair, washing, dressing, shopping, housework.
May have some difficulties walking and may require assistance.
Difficulties with recreational activities or the ability to drive a car.
L4
Severe or high levels or interference in activities of daily living
Require much more assistance with activities of daily living such as washing, dressing, housework or feeding.
L5
Extreme difficulties with day-to-day activities/ total dependency
Diagnosis
History
Physical exam
No specific diagnostic tests in common use*
Principles of Treatment
- Utilize nonpharmacologic therapies
Regular exercise, sound nutrition, & patient & caregiver education are essential for optimal treatment. - Individualize medication regimens
Must individualize due to wide variation in the presentation of symptoms between individuals
Based on:
the patient’s age and cognitive status
the hours when the need for mobility is greatest
other underlying medical problems
consider cost of medications ($$$) and the patient’s ability to pay - Recognize Symptom Responsiveness
Medications are most effective at improving mobility, particularly larger limb and body movements
Tremor may not respond well or at all to any medication regimen
Impaired sense of balance generally is not correctable
speech and swallowing symptoms respond poorly or not at all to medications. - Recognize Potential Side Effects.
Almost without exception, the meds used to treat PD can cause symptoms that are more troubling than the disease itself.
