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Chapter 7

Unit 2: Nursing care of clients with neurosensory disorders

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!