Week 7 - Parkinson's Disease

Question 1

what is parkinsons disease

Answer 1

• chronic, progressive, degenerative disease of the CNS

Question 2

what is the classic triad of parkinsons

Answer 2

• bradykinesia = slowed initiation and execution of movement
• rigidity = increased muscle tone
• tremor at rest

Question 3

describe the onset of parkinsons (4)

Answer 3

• insidious
• gradual progression
• prolonged course
• usually begins unilaterally with mild symptoms and progresses to bilat

Question 4

the tremor associated w PD is more pronounced when?

Answer 4

• at rest

- aggravated by emotional stress & concentration

Question 5

what can the tremor associated w PD impact (5)

Answer 5

• hand = pill rolling
• diaphragm
• tongue
• lips
• jaw

rare to cause shaking of the head

Question 6

how is the rigidity in PD often descibred as

Answer 6

“cogwheel rigidity”

- intermittent catches in the movement

Question 7

what symptoms does the bradykinesia in PD cause (7)

Answer 7

• stooped posture
• mask like affect
• drooling of salivia
• shuffling gait
• difficulty initiating movement (freeze)
• decreased blinking
• decreased swinging of arms when walking

Question 8

the rigidity associated w PD can lead to (4)

Answer 8

• muscle soreness
• fatigue
• aches
• pain

Question 9

what impact does PD have on bowel function

Answer 9

• can cause constipation

Question 10

what are nonmotor signs of PD (7)

Answer 10

• depression
• anxiety
• fatigue
• pain
• constipation
• impotence
• short term memory impairment

Question 11

what are some complications of PD (9)

Answer 11

• dysphagia –> malnutrition & aspiration
• neuro problems –> dementia
• dyskinesias = spontaneous, involuntary mvmts
• weakness
• akinesia = total immobility
• UTIs
• skin breakdown
• pneumonia
• sleep disorders

Question 12

how is PD diagnosed (2)

Answer 12

no specific diagnostic test

• history
• S&S –> 2/3 of classic triad

Question 13

what is included in collaborative care for PD (3)

Answer 13

• meds
• surgical therapy
• nutritional therapy

Question 14

what is the goal of drug therapy for PD

Answer 14

• correct the imbalance of neurotransmitters in the CNS ( too much acetylcholine, not enough dopamine)

Question 15

what classes of meds are used for PD (4)

Answer 15

• dopaminergic
• antichlinergic
• antihistamines w anticholinergic properties
• beta blockers

Question 16

what are two types of dopaminergic meds for PD

Answer 16

• levodopa

- carbidopa (sinemet)

Question 17

what is a type of beta blockers used for treatment of PD

Answer 17

• propanolol (inderal)

Question 18

why is propanolol used for PD

Answer 18

• manage tremors & rigidity

Question 19

what is imp to note with admin of propanolol

Answer 19

• titrate dose to effect, start low and slow

Question 20

when and why is surgical therapy used for PD

Answer 20

• aimed at relieving symptoms of PD

- for pts who are unresponsive to drug therapy or have severe motor comp

Question 21

what 3 categories of surgical procedures are used for PD

Answer 21

• ablation (destruction)
• deep brain stimulation
• transplantation

Question 22

why is diet imp for a pt with PD (2)

Answer 22

• malnutrition r/t physphagia

- risk of constipation

Question 23

describe diet for a pt with PD (5)

Answer 23

• 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)

Question 24

collaborative care for PD is focused on?

Answer 24

• no cure = focused on symptom mngmt

Question 25

describe the importance/implementation of exercise for a pt with PD (4)

Answer 25

- 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

Question 26

do pts with PD experience exacerbations

Answer 26

noo

Question 27

why might OT be consulted for a pt with PD

Answer 27

- assist pt with strategies to increase self-care such as eating and dressing

Question 28

what should be included in pt teaching for a pt with PD (5)

Answer 28

- maintenance of good health - diet - med teaching - encourage independence - avoidance of complications (like contractures, constipation)

Question 29

nursing care for a pt with PD is focused on (4)

Answer 29

- managing issues of mobility - communication - nutrition - adapting activities to increase independence

Question 30

a nursing diagnosis r/t to PD is impaired physical mobility. what nursing interventions can be done for this (4)

Answer 30

- assist w ambulation for safety - promote stretching and ROM exercises - consult PT and OT for assistive devices - teach techniques to assist w mobility

Question 31

what are some techniques to assist w mobility & the freezing associated w PD (4)

Answer 31

- 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

Question 32

a nursing diagnosis r/t PD is impaired verbal communication. what nursing interventions can be done for that (5)

Answer 32

- allow sufficient time for communication - encourage deep breaths before speaking - consult speech therapist - provide alternative communication techniques - massage pts facial and neck muscles

Question 33

a nursing diagnosis r/t PD is imbalanced nutrition that is less than body requirements. what nursing interventions can be done for this (6)

Answer 33

- 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

Question 34

a nursing diagnosis r/t PD is deficient diversional activity. what nursing interventions can be done for this (5)

Answer 34

- 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