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29 terms

NCLEX - Parkinson disease

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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