PARKINSONS DISEASE Progressive, degenerative neurological disorder of basal ganglia Signs & Symptoms: o Tremor (shaking) at rest, affecting

ng hands, feet, head, neck face, lips & tongue, jaw. Tremor disappears on movement or sleep. Starts unilateral progresses to bilateral. Progressive impairment on movements needing fine motor skills & dexterity- writing & eating o Muscle rigidity & Bradykinesia (slowness of movement)-Rigidity from involuntary contraction of all skeletal muscles makes active & passive ROM difficult. Bradykinesia experienced as difficulty starting, continuing or coordinating movement is the most common & crippling effects (experiences jerky movement called cogwheel rigidity). All striated muscles are affected-walking, chewing, swallowing, and speaking. Affects eyes, mouth & voice causing masklike face & softened or muffled voice o Postural instability- involuntary flexion of head & shoulders means cannot maintain upright position of trunk when sitting or standing resulting in a stooped leaning forward position risk for falls from disorders of equilibrium with inability to correct when leaning forward or backward takes small shuffling steps to try and maintain upright position when walking. o Mood & Cognition- depression & dementia are associated. Experiences- confusion, disorientation, memory loss, distractibility, & changes in abstraction & judgement. Bradyphrenia may occur-slow thinking & ability to form thoughts, to plan & make decisions. o Sleep disturbances Complications:- Paranoia, falls, infections from immobility, malnutrition from swallowing problems, altered sleep patterns, skin breakdown & pressure ulcers, depression & isolation Medication- Levadopa:o Teaching- takes weeks to take effect, do not alter dosage- take as recommended, protein intake should be equally distributed throughout day-avoid food in pyridoxinepork, beef, ham, avocado, beans & oatmeal, change positions slowly-orthostatic hypotension, fluids & exercise to prevent constipation, watch for on-off phenomena Nursing Care: o Diagnoses:- Ineffective coping, Powerlessness, Disturbed body image, Risk for falls, Impaired physical mobility, Risk for constipation, Dysphagia, Risk for impaired skin integrity, Altered nutritional intake o Interventions-: Physical mobility- physiotherapist developed individualized exercise plan, ROM2x/day focusing on trunk, neck, arms, legs & hips, Ambulate 4x/day, Recommend & emphasize use of assistive/safety devices- walkers, raised toilet seats, lift chairs, non-skid shoes

Communication- develop methods of communication- flash cards, magic slate, refer to speech language for oral exercises & interventions to help with speech, cue to speak louder Nutrition- prepare food with right consistency, weight weekly, diet in fibre & fluids Sleep- limit naps in day, avoid napping & strenuous physical activity in evenings, limit caffeine & alcohol, glass of milk before bed, modify environment- darken room & reduce noise