Week 7 - Parkinson's Disease Flashcards
what is parkinsons disease
- chronic, progressive, degenerative disease of the CNS
what is the classic triad of parkinsons
- bradykinesia = slowed initiation and execution of movement
- rigidity = increased muscle tone
- tremor at rest
describe the onset of parkinsons (4)
- insidious
- gradual progression
- prolonged course
- usually begins unilaterally with mild symptoms and progresses to bilat
the tremor associated w PD is more pronounced when?
- at rest
- aggravated by emotional stress & concentration
what can the tremor associated w PD impact (5)
- hand = pill rolling
- diaphragm
- tongue
- lips
- jaw
rare to cause shaking of the head
how is the rigidity in PD often descibred as
“cogwheel rigidity”
- intermittent catches in the movement
what symptoms does the bradykinesia in PD cause (7)
- stooped posture
- mask like affect
- drooling of salivia
- shuffling gait
- difficulty initiating movement (freeze)
- decreased blinking
- decreased swinging of arms when walking
the rigidity associated w PD can lead to (4)
- muscle soreness
- fatigue
- aches
- pain
what impact does PD have on bowel function
- can cause constipation
what are nonmotor signs of PD (7)
- depression
- anxiety
- fatigue
- pain
- constipation
- impotence
- short term memory impairment
what are some complications of PD (9)
- dysphagia –> malnutrition & aspiration
- neuro problems –> dementia
- dyskinesias = spontaneous, involuntary mvmts
- weakness
- akinesia = total immobility
- UTIs
- skin breakdown
- pneumonia
- sleep disorders
how is PD diagnosed (2)
no specific diagnostic test
- history
- S&S –> 2/3 of classic triad
what is included in collaborative care for PD (3)
- meds
- surgical therapy
- nutritional therapy
what is the goal of drug therapy for PD
- correct the imbalance of neurotransmitters in the CNS ( too much acetylcholine, not enough dopamine)
what classes of meds are used for PD (4)
- dopaminergic
- antichlinergic
- antihistamines w anticholinergic properties
- beta blockers
what are two types of dopaminergic meds for PD
- levodopa
- carbidopa (sinemet)
what is a type of beta blockers used for treatment of PD
- propanolol (inderal)
why is propanolol used for PD
- manage tremors & rigidity
what is imp to note with admin of propanolol
- titrate dose to effect, start low and slow
when and why is surgical therapy used for PD
- aimed at relieving symptoms of PD
- for pts who are unresponsive to drug therapy or have severe motor comp
what 3 categories of surgical procedures are used for PD
- ablation (destruction)
- deep brain stimulation
- transplantation
why is diet imp for a pt with PD (2)
- malnutrition r/t physphagia
- risk of constipation
describe diet for a pt with PD (5)
- easily chewed and swalllowed food
- adequate roughage and fruit
- cut into bite sized pieces before served
- 6 small meals a day
- limit protein intake to evening meal (protein impacts levodopa absoprtion)
collaborative care for PD is focused on?
- no cure = focused on symptom mngmt
describe the importance/implementation of exercise for a pt with PD (4)
- limits consequences of decreased mobility (muscle atrophy, contractures, constipation)
- consult PT to create exercise program aimed at strengthening and stretching muscles
- exercise for muscles involved in talking and swallowing
- will enance functional ability
do pts with PD experience exacerbations
noo
why might OT be consulted for a pt with PD
- assist pt with strategies to increase self-care such as eating and dressing
what should be included in pt teaching for a pt with PD (5)
- maintenance of good health
- diet
- med teaching
- encourage independence
- avoidance of complications (like contractures, constipation)
nursing care for a pt with PD is focused on (4)
- managing issues of mobility
- communication
- nutrition
- adapting activities to increase independence
a nursing diagnosis r/t to PD is impaired physical mobility. what nursing interventions can be done for this (4)
- assist w ambulation for safety
- promote stretching and ROM exercises
- consult PT and OT for assistive devices
- teach techniques to assist w mobility
what are some techniques to assist w mobility & the freezing associated w PD (4)
- teach to imagine stepping over an imaginery line
- rock from side to side to initiate leg mvmts
- 1 step backwards, 2 forwards
- drop rice kernels and step over them
a nursing diagnosis r/t PD is impaired verbal communication. what nursing interventions can be done for that (5)
- allow sufficient time for communication
- encourage deep breaths before speaking
- consult speech therapist
- provide alternative communication techniques
- massage pts facial and neck muscles
a nursing diagnosis r/t PD is imbalanced nutrition that is less than body requirements. what nursing interventions can be done for this (6)
- carefully monitor swallowing ability
- provide soft-solid and thick-liquid diet
- maintain pt in upright position for all meals
- consult speech therapist and dietician
- have suction available
- ensure diet includes adequate fibre
a nursing diagnosis r/t PD is deficient diversional activity. what nursing interventions can be done for this (5)
- assess pts ability to determine their response to difficulties
- determine preferred diversional activities
- adapt difficult activities
- initiate new activities when pts capabilities can no longer perform
- encourage pt to discuss emotional response to decreasing capabilities
