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Parkinson's disease is a:

slow, progressive, degenerative disease caused by the depletion of dopamine resulting in the inhibition of excitory muscles

Parkinson's disease results in:

1. falls
2. self-care deficits
3. failure of body systems
4. depression
5. mental deterioration (late in the process)

Symptoms:

1. bradykinesia (slow motor movements)
2. sluggishness of physical/mental responses
3. akensia (absence/poverty of movement)
4. monotonous speach
5. tremors in hands/fingers (pill rolling)
6. drooling
7. aphasia/dysphagia
8. shuffling/stooped posture
9. restlessness/pacing
10. loss of coordination/balance

PD interventions:

assess neuro status
assess ability to swallow/chew
provide high-calorie/protein/fiber diet
provide soft diet w/small frequent feedings
increase fluids to 2000 ml/day
monitor for constipation
assist w/ambulation
provide assistive devices
instruct client to wear low healed shoes
avoid prolonged sitting

Anticholinergics block:

cholinergic receptors in CNS supressing acetylcholine activity

Anticholergenic Meds in PD are used to treat/reduce:

1. tremors/rigidity/drooling
2. inhibit the action of acetylcholine

Anticholinergic meds have a minimal effect on:

1. bradykensia
2. rigidity
3. balance abnormalities

Anticholergenic Meds for PD:

- Benotropine mesylate (Cogentin)
- Biperiden hydrocholride (Akeneton)
- Procyclidine hydrochloride (Kemadrin)
- Trihexyphenidyl hydrochloride (Artane)

Anticholinergic meds are contraindicated in pts w/:

- glaucoma
- COPD (can develop dry, thick mucous
secretions)

Monitor/assess pt taking anticholinergic meds:

- vital signs
- risk for injury
- signs of parkinson disease
- improvement
- bowel/urinary function/paralytic ileus
- involuntary movements breakthrough

Anticholinergic interventions:

- encourage avoidance of alcohol, smoking,
caffeine and aspirin
- call dr b4 taking OTC
- increase fluid/fiber intake
- wear shades (for possible photophobia)
- see eye dr to assess intraocular pressure

Anticholinergic side effects:

1. blurred vision
2. drying of secretions
3. >PR, palpitations, arrhythmias
4. constipation/urinary retention
5. restlessness/confusion
6. depression/halluncinations
7. photophobia

Antiparkinsonian meds are used to:

increase the lebel of dopamine in the CNS

client taking PD meds must:

avoid foods high in Vit B
- they block the efects of antiparkinsonian meds

PD meds affecting amount of dopamine:

- Levodopa (Laradopa, Dopar)
- Caribidopa-levodopa (Sinemet)
- Ropinirole (Requip)
- Bromocriptine (Parlodel)

Antiparkinsonial meds restore the balance of the neurotransmitters:

1. acetylcholine (in the CNS)
2. dopamine (in the CNS)

Parkinsonian Meds decrease:

the signs/symptoms of PD to maximize the clients functional ability

Parkinsonian Meds include:

1. dopaminergics
2. anticholinergics

Dopaminergics stimulate:

dopamine receptors

Dopaminergics increase:

amount of dopamine available in the CNS

Antiparkinsonian meds are used for:

1. drug-induced parkingson disease
2. parkinson disease

Antiparkinsonian meds - drug-induced parkinsonism where:

neuroleptic agents (antipsychotics) block dopamine receptors in the CNS leading to funtional loss of dopamine activity

Antiparkinsonian meds - for Parkinson Disease where:

dopamine-containing neurons in the basal ganglia are destroyed/deficient causing loss of fine motor control

Dopaminergic meds are contraindicated in clients w/:

1. cardiac
2. renal
3. psychiatric disorders
4. meds - levadopa taken w/

Dopaminergic meds are contraindicated when taking:

Levadopa w/a monoamine oxidate ihhibitor antidepressant (can cause hypertensive crisis)

Dopaminergic med side effects:

dyskinesia
involuntry movements
chest pain
n/v
urinary retention/constipation
insomnia/sedation
orthostatic hypotension/dizziness
confusion
mood changes/depression
hallucinations
dry mouth

Dopaminergic interventions:

take med w/food if n/v occur
assess for signs of PD
monitor for dyskinesia
do not discontinue abruptly
avoid alcohol
urine/perspiration may be discolored (harmless)
w/diabetes mellitus (no urine testing-unreliable)

If taking Levadopa (Sinemet) instruct the client to:

eat low-protein foods because high-protein foods interfere w/med transport to the CNS

When administering Levodopa instruct the client to avoid:

- excessive Vitamin B6 to avoid med reactions

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