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Parkinson Disease (PD)
Terms in this set (40)
Parkinson Disease (PD)
This decrease quality of life by immobilization...unable to do ADLs, losing independence.
This leads to frustration and depression
This is a disease of basal ganglia characterized by
-Slowing down in the initiation and execution of movement
-↑ muscle tone
-Tremor at rest***
What effects do tremors have on a patient's life?
dopamine doesn't cross the BBB at the rate we want it to cause a therapeutic effect
It's a progressive disease that will occur due to depleted dopamine
No...high risk for depression
Men that are increased in age (50-60)
Athletes who sustain head injury
What is a term for slowing down of muscle movement
What is the challenge in treating PD with drugs?
Why are p/ts with PD functional in initial dx then get worse?
Does it affect cognitive function?
Who are high risk?
a neurotransmitter essential for normal functioning of the extrapyramidal motor system, including control of posture, support, and voluntary motion.
Manifestations of PD do not occur until 80% of neurons in the substantia nigra are lost.
PD occurs due to a lack of dopamine in the substantia nigra of the midbrain. what is dopamine?
What other neurotransmitter does dopamine need to balance with?
When do the manifestations of PD occur?
Risk for fall due to excessive tremors
Risk for aspiration due to the affect to the epiglottis
Risk for dehydration/malnourishment b/c family is scardd to give them liquids in fear of chocking
What nursing diagnosis are appropriate for patients with PD?
What are the classic triad s/s of PD
The s/s of PD onset is gradual and insidious with ongoing progression
The Beginning stages may involve only mild tremor, slight limp, or ↓ arm swing.
Later stages may have shuffling, propulsive gait with arms flexed, and loss of postural reflexes.
Some have slight speech changes...They'll speak in a _______ voice because they lose the ability to project their voice
This is often the first s/s of PD
it's More prominent at rest and is aggravated by emotional stress or ↑ concentration
This term is used to describe the tremor b/c the thumb and forefinger appear to move in rotary fashion
Hand tremor is most common; tremor can involve the diaphragm, tongue, lips, and jaw but rarely causes shaking of the head.
Increased resistance to passive motion when limbs are moved through ROM
Rigidity is classified by a jerky quality when the joint is moved.
What is rigidity characterized by
This is the Slowing down in initiation and execution of movement. As well as loss of autonomic movement
-Patients will have a mask like face
-accounts for the stooped posture, masked face (deadpan expression), drooling of saliva, and shuffling gait (festination) that are characteristic of a person with this disease.
Swinging of arms while walking
Swallowing of saliva
Self-expression with facial movements
What actions will be affected IF there is a loss of autonomic movements?
(Usually put on antidepressent)
(Could become short tempered b/c excessive tremors makes them tired)
Short-term memory loss
Impotence in men
Short-term memory impairment
Nonmotor symptoms of PD would include:
-Dyskinesias [spontaneous, involuntary movements],
-Akinesia [total immobility]
-They increase as the disease progresses
-What would a few complications of PD be?
Aspiration and malnutrition due to dysphagia.
number one priority is to auscultate the lungs/check pulse ox
Pneumonia due to their hunched stature
What is the number one complication of PD?
What infection are patients with PD most likely to get and why?
Why are PD patients at risk for getting a UTI?
There are no diagnostic tools; dx is based solely on symptoms
Firm diagnosis can be made when at least two of three characteristics of the classic triad (tremor, rigidity, and bradykinesia) are present.
How is PD diagnosed?
-Physical: gross motor abilities
-Occupational: fine motor abilities (ADLs)
What's the difference between physical and Occupational therapy?
manage quality of life and decrease symptoms
What's the goal for providing care for p/ts with PD?
Is there a cure?
-Enhance or release supply of DA
-Antagonize or block the effects of overactive cholinergic neurons in the striatum
Drugs for PD is aimed at correcting imbalances of neurotransmitters within the CNS
What two actions could PD drugs do to have a therapeutic effect?
Levodopa with carbidopa (Sinemet)
This is the first drug to give to a pt with PD
It's a precursor of dopamine (DA) and crosses the blood-brain barrier. It will then be converted to DA in the basal ganglia
more levodopa reaches the brain, and therefore less drug is needed.
Carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain.
Prolonged use can often result in dyskinesias and "off/on" periods when the medication will unpredictably start or stop working.
It is very effective for the management of akinetic symptoms
Why is Levodopa with carbidopa (Sinemet) given?
Why is carbidopa given with levodopa?
What's the function of Carbidopa?
What side effect does levodopa have on the p/t?
Which symptom does this drug effectively work for?
No. It enhance the effectiveness of the levodopa
Entacapone and tolcapone
MAO-B inhibitors (selegiline and rasagiline) may be combined with Sinemet.
TQ: Does selegline take the place of dopamine or increase the amount?
These 2 drugs block the enzyme that breaks down levodopa in the peripheral circulation, prolonging the effects of Sinemet
Antihistamines with anticholinergic or β-adrenergic blockers are used to manage tremors.
These drugs will decrease the activity of Ach? `
What drugs are given to manage the tremors?
This drug is an antiviral agent that is used for the flu and PD
Taking on drug is preffered because it produces less SE and the dosages are easier to adjust
Combination therapy is often required as disease progresses
Excessive dopaminergic drugs can lead to ?. The opposite of the drug's effect occurs. Results in aggravation rather than relief of symptoms.
can lead to very low blood pressure and loss of consciousness.
Subq injections only
Within 3 to 5 years of treatment, patients experience episodes of hypomobility...There's a build up of dopamine, resulting in the muscles becoming frozen like.
What is this term?
What drug is given to treat this?
What drugs should not be given with apomorphnie? Why?
How is apomorphine given?
Used in patients who are usually unresponsive to drug therapy or have developed severe motor complications
Surgical therapy for PD is goaled at ? not curing the disease
When is surgical therapy used?
Ablation, DBS, and transplantation of fetal neural tissue.
What 3 categories surgical procedures fall into?
There is the destroying of abnormal signals of the brain
dopamine making receptors could be damaged
What occurs during Ablation surgery?
What is a complication of this?
Deep Brain Stimulation
This procedure involves Involves placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus, connected to a generator placed in the upper chest
-Device is programmed to deliver specific current to targeted brain location.
-BENEFICIAL for ONLY motor tremors
Watch for injection (Incr. Temp) and do a neuro assessment
What is a major intervention for post op surgical repair of the brain?
This surgical procedure is the transplantation of fetal neural tissue into the basal ganglia provides DA-producing cells in the brains of patients.
Still in experimental stages
Malnutrition and constipation
food that is easily chewed and swallowed with adequate roughage
What are serious nutritional consequences of PD?
What type of foods do p/ts with dysphagia and bradykinesia need?
-Food should be cut into bite-sized pieces.
-Several small meals should be taken to prevent fatigue.
-Provide ample time to avoid frustration.
-Levodopa can be impaired by protein and vitamin B6 ingestion.
-Some patients are advised to limit their protein intake to the evening meal to decrease this problem and to consult with their health care provider regarding possible supplementation of vitamin B6 in their multivitamins and fortified cereals.
What med will be helpful for excessive salivation?
Nursing Dx of PD...tq
-Impaired physical mobility
-Imbalanced nutrition: less than body requirements
-Impaired verbal communication
We should plan to Maximize neurologic function. Maintain independence in activities of daily living (ADLs) for as long as possible. Optimize psychosocial well-being.
Focus teaching and nursing care on:
-Maintenance of good health
-Encouragement of independence
-Avoidance of complications such as contractures and falls
Promote physical exercise and a well-balanced diet.
-Limit the consequences from decreased mobility.
-Specific exercises to strengthen muscles involved with speaking and swallowing
-Get out of a chair by using arms and placing the back legs on small blocks.
-Remove rugs and excess furniture.
-Simplify clothing from buttons and hooks.
-Use elevated toilet seats.
-Use an ottoman to elevate legs to avoid dependent ankle edema
-Clothing can be simplified by the use of slip-on shoes and Velcro hook-and-loop fasteners or zippers on clothing, instead of buttons and hooks.
Assist patients as they make adjustments to their lifestyle to accommodate symptoms.
Caregivers may also experience stress associated with disease progression (i.e., dementia).
An appropriate nursing diagnosis for M.J. at this stage of advanced Parkinson's disease is:
a. risk for injury related to limited vision.
b. risk for aspiration related to impaired swallowing.
c. urge incontinence related to effects of drug therapy.
d. ineffective breathing pattern related to diaphragm fatigue.
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