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akinesia

a reduction or absence of psychomotor activity that results in a mask like facial expression and impaired postural reflexes. a classic characteristic of parkinson's disease.

bradykinesia

slowness of movement, related to Parkinson's disease .

chorea

a type of dyskinesia: condition characterized by involuntary, purposeless, rapid motions such as flexing and extending the fingers, raising or lowering the shoulders, or grimacing. In some forms the person is also irritable, emotionally unstable, weak, restless, and fretful.

dyskinesia

an impaired ability to execute voluntary movements.
1)tardive (effect of antipsychotic drugs), Akathisia (inner tremor or restlessness):

dystonia

a type of dyskinesia: impaired or distorted voluntary movement due to a disorder of muscle tone.

exogenous

a term describing any substance produced outside of the body that may be taken into the body

on-off phenomenon

a common experience of patients taking medications for parkinson's disease in which they experience periods of greater symptomatic control ("on" time) alternating with periods of lesser symptomatic control.

parkinson's disease

slowly progresive degeneration of nerves in the brain characterized by tremor, rigidity of muscles, and slow movements (bradykinesia), usually occurring later in life

postural instability

a decrease or change in motor and muscle movements that leads to unsteadiness and hesitation in movement and gait when the individual starts or stops walking, occurs in parkinson's disease.

presynaptic

drugs that exert their antiparkinsonian effects before the nerve synapse.

rigidity

resistance of the muscle t passive movement, leads to the "cogwheel" rigidity seen in parkinson's disease.

tremor

in parkinson's disease, shakiness of the extremities seen mostly at rest.

wearing off phenomenon

a gradual worsening of parkinsonian symptoms as a patient''s medications begin to lose their effectiveness, despite maximal dosing with a variety of medications.

Parkinson's Disease important points

-Symptoms initially occur when about 80% of the dopamine stored in the substantia nigra of the basal ganglia is depleted
-As long as there are functioning nerve terminals that can take up dopamine, symptoms can be partially controlled
-As disease progresses, the effectiveness of pharmacological therapy lessens
-In later stages of disease, PT, speech therapy, and OT are almost always needed

Classic Parkinsonian Symptoms

-Akinesia: Reduction in or absence of psychomotor activity resulting in masklike facial expression and impaired postural reflexes
-Bradykinesia: Slowness of movement
-Rigidity:"Cogwheel" rigidity, resistance to passive movement
-Tremor:Pill rolling: tremor of the thumb against the forefinger, seen mostly at rest, is less severe during voluntary activity; starts usually on one side then prograsses to the other; is the presenting sign in 70% of cases
-Postural instability:Unsteadiness that leads to danger of falling; hesitation in gait as patient starts or stops walking

Parkinson's Disease: Nursing Implications

-Teach patient to avoid foods high in vitamin B6
Pyridoxine (vitamin B6) in doses greater than 10 mg will reverse the effects of levodopa
Teach patients about what therapeutic and adverse effects to expect with antiparkinsonian drug therapy
Taking Levodopa with MAOIs may result in hypertensive crisis
Levodopa preparations may darken the patient's urine and sweat
Therapeutic effects of COMT inhibitors may be noticed within a few days; it may take weeks with other drugs
"Drug holidays"
Patients should be told not to skip antiparkinsonian drugs suddenly
-Encourage patient to force fluids to at least 3000 mL/day (unless contraindicated)

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