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Chapter 7
Unit 2: Nursing care of clients with neurosensory disorders
| Question | Answer |
|---|---|
| Parkinson's disease (Pg. 72) | Progressive, debilitating, grossly affects motor function (5 stages of development pg.72) |
| 4 Primary symptoms of Parkinson's | Tremors, muscle rigidity, bradykinesia & postural instability |
| What is bradykinesia? | Slow movement |
| Why do these 4 symptoms occur? -Over stimulation of what | Over stimulation of the basal ganglia by acetylcholine |
| Why does the over stimulation occur? | Degeneration of the substantia nigra = decreased dopamine production -Acetylcholine dominates -Smooth, controlled movements difficult |
| What does tx of PD focus on? | Increasing dopamine or decreasing acetylcholine in the client's brain |
| Risk factors: -Age, gender, environment or genetics? and what type of med | -40-70 onset of symptoms -More common in men -Genetics -Env't exposure to toxins/chemicals -Chronic use of antipsychotic medications |
| Signs/symptoms: (Pg. 73) -posture, gait, speech (describe) -Shaking, muscles - | -Fatigue, stooped posture, slow, shuffling gait, slow monotonous speech -Tremors, pill-rolling, finger tremors -Muscle rigidity -Bradykinesia/akinesia |
| Facial expression in PD | Mask-like expression |
| Autonomic symptoms: | Orthostatic hypotension, flushing, diaphoresis |
| Issues w/ the mouth in PD? | Difficulty chewing/swallowing, drooling, dysarthria |
| Mind issues w PD? | Mood swings, cognitive impairment (dementia). |
| Is there a definitive dx procedure? | No. Dx is based on symptoms, progression & ruling out other diseases |
| Nursing care.. Diet based | -Consult prn -Weekly wt -Intake log -Encourage fluids -Smaller, more frequent meals -Thicken liquids/foods |
| Nursing care.. Mobility | -Encourage exercise; yoga -Assistive devices, ROM exercises, rest periods, assist w ADLs |
| Nursing care.. Communication | -S/s depression/dementia -Safe env't -Support |
| Medication therapy for PD: -How long can it take for symptoms to go down | Several weeks |
| 1. Dopaminergics | Levodopa (Dopar); when oral, converted to dopamine in the brain -increases dopamine in the basal ganglia |
| Can combine dopaminergics with what? | Carbidopa (Sinemet) -decreases peripheral metabolism of levodopa = smaller dose can be taken |
| When on dopaminergics, monitor for? | "Wearing off" phenomena -dyskinesias (problems w movement) -May need to adjust dose |
| 2. Dopamine agonists | Ex. Bromocriptine (Parlodel), Ropinirole (Requip), Pramipexole (Mirapex) -Activate release of dopamine -Can be used in conjunction w dopaminergic |
| S/e of dopamine agonists | Orthostatic hypotension, dyskinesias & hallucinations |
| 3. Anticholinergics | Ex. Benztropine (Cogentin) & Trihexphenidyl (Artane) -Help control tremors & rigidity |
| S/e of anticholinergics | Dry mouth, constipation, urinary retention, acute confusion |
| 4. COMT inhibitors | Catechol O-Methyltransferase Ex. Entacapone (Comtan) decrease breakdown of levodopa making more available to the brain as dopamine |
| COMT inhibitors can be used in conjunction w/? | Dopaminergic and dopamine agonists -for better results |
| Monitor COMT s/e: | Dyskinesia/hyperkinesia when used w/ levodopa -diarrhea -dark urine is a normal finding |
| 5. Antivirals | Ex. Amantadine (Symmetrel) -Stimulate release of dopamine & prevent its reuptake |
| S/e of antivirals -ankles, skin | Swollen ankles Discoloration of the skin |
| Surgical interventions for PD: (2) | Stereotactic pallidotomy Deep brain stimulation |
| What is stereotactic pallidotomy? (Pg. 75) | Destruction of a small portion of the brain w/in the globus pallidus through the use of brain imaging and electrical stimulation -CT/MRI targets area -Client is assessed 4 a decrease in rigidity & tremors -If decreased, lesion is formed |
| What is deep brain stimulation? (Pg. 76) | Electrode implanted into the thalamus -Current delivered through an implanted pacemaker type of generator -GOAL: interfere w electrical conduction in tremor cells |
| Deep brain stimulation client education -Magnet, battery | Instruct on how to use magnet to adjust current Battery of magnet; replaced every few years |
| Complications of PD: -Aspiration pneumonia (1) | D/t swallowing/chewing difficulty -swallow precautions, diet, assist w/ eating/supervise, eat slow, suction nearby & feed upright |
| Complications of PD: -Altered cognition | -Dementia, memory deficits) |
Created by:
mary.scott260!
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