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) |