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S DEGENERATIVE – PARKINSON’S DISEASE
LEARNING OUTCOMES. At the end of the topic, the students must be able to: 1) Define Parkinson’s disease. 2) State the etiology of Parkinson Disease. 3) State clinical manifestations for patient with Parkinson’s disease 4) List the common diagnostic test ordered to confirm the diagnosis 5) Identify the treatment available for patient with Parkinson’s Disease 6) Identify 3 nursing diagnosis for client with Parkinson’s disease. 7) Explain nursing intervention in caring for client with Parkinson’s disease.
It is characterized by progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance.
As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.
controlled movements When the amount of dopamine is too low. or exposure to environmental toxins such as pesticides and herbicides may be a risk factor. •Head trauma.TOPIC: C. or head. and movement becomes impaired. Inflammation stress At risk: •A small number of individuals are at increased risk because of a family history of the disorder. A substance called dopamine acts as a messenger between two brain areas ." Etiology Lack of dopamine causes the motor symptoms of Parkinson's disease.to produce smooth. jaw.S DEGENERATIVE – PARKINSON’S DISEASE Most individuals who develop Parkinson's disease are 60 years of age or older Parkinson's disease was named after the British doctor James Parkinson. the worse the movement-related symptoms Other causes: dysfunctional cellular processes. communication between the substantia nigra and corpus striatum becomes ineffective. the greater the loss of dopamine. illness. arms.the substantia nigra and the corpus striatum .N. hands. feet. legs. who in 1817 first described the disorder in great detail as "shaking palsy. 2 . Clinical Manifestations Tremors: Trembling in fingers.
Postural instability may lead to falls.TOPIC: C. Over time. Rigidity: Stiffness of the limbs and trunk.S DEGENERATIVE – PARKINSON’S DISEASE Often occur while the individual is resting. May worsen when an individual is excited. which may increase during movement. 3 . but not while involved in a task. "mask-like" appearance. tired.N. Bradykinesia together with stiffness can also affect the facial muscles and result in an expressionless. it may become difficult to initiate movement and to complete movement. Bradykinesia: Slowness of voluntary movement. or stressed. may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult. Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance.
progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These vary in severity. and monotone voice 4 . quieter speech. Individuals may freeze in mid-stride and appear to fall forward while walking.TOPIC: C. and stress confusion. and dementia (more common in elderly individuals) constipation Depression difficulty swallowing and excessive salivation diminished sense of smell increased sweating male erectile dysfunction skin problems slowed. memory loss. insecurity.N.S DEGENERATIVE – PARKINSON’S DISEASE Parkinsonian gait: Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing. It may become difficult to start walking and to make turns. and not every individual will experience all of them. Some of the secondary symptoms include: anxiety. The main symptoms of Parkinson's disease are movement-related.
dizziness. specific areas in the brain that cause Parkinson's symptoms are destroyed. what types of medication have been or are being taken. In another type of surgery. walking. Unpleasant side effects of these preparations are quite common.N. constipation. which is converted to dopamine in the brain. including swelling caused by fluid accumulation in body tissues. and fine motor tasks involving the hands Management Medical: The most effective therapy for Parkinson's disease is levodopa (Sinemet). long-term treatment with levodopa can lead to unpleasant side effects (a shortened response to each dose. and involuntary movements) Levodopa is frequently prescribed together with carbidopa (Sinemet). 5 . and nausea. The surgeon implants electrodes to stimulate areas of the brain involved in movement. hallucinations. Surgical: Deep brain stimulation (DBS). and whether there was exposure to toxins or repeated head trauma in the past Neurological exam: may include an evaluation of coordination.S DEGENERATIVE – PARKINSON’S DISEASE urinary frequency/urgency Investigation /Diagnostic Test An initial assessment Medical history: important to know whether other family members have Parkinson's disease.TOPIC: C. drowsiness. painful cramps.
N.TOPIC: C.S DEGENERATIVE – PARKINSON’S DISEASE Nursing Management: 1)Maintain independent help client to identify optimal activity level Teach client to balance rest & activity Encourage client to use of devices to assist with function 2)Prevent complications: assist client in diet selection: to avoid constipation & maintain nutritional status help client & family member be alert to skin care needs: to prevent skin breakdown encourage range of motion exercise & deep breathing exercise: for prevention of muscle waste & pulmonary infections 3) Provide appropriate care & guidelines in all setting long term facility = at home obtain physiotherapist 6 .
2) Observe ability to move. 4) Ineffective coping by the client & family member related to deteriorating health status Assessment. 5) Psychosocial assessment includes the patient’s and caregiver’s response to the disease. Impaired Physical Mobility Related to Muscle Stiffness and Tremor. Patients often plan their daily activities based on anticipated response to their medications. 1) Encourage patients to determine their own best schedule for activities that require mobility patients in skilled nursing facilities. and support systems. 2) Body image disturbance related to changes in bodily function & inability to perform function independently. plan leisure activities around the patient’s most active times. 1) Assess the patient for symptoms of Parkinson’s disease and their effect on level of functioning. Determine risk for injury related to immobility or falls.TOPIC: C. Teach patients who have difﬁculty initiating walking to pick up their foot as though attempting to step 7 Nursing Process: The Patient with Parkinson’s Disease . coping strategies. 4) Identify presence of confusion and side effects of medications. 3) Impaired home maintenance management related to weakness & immobility. and perform ADLs.S DEGENERATIVE – PARKINSON’S DISEASE Nursing Diagnosis 1) Self care deficit related to physical mobility impairment & weakness. Provide assistance with range-of-motion exercises. 2) Physical and occupational therapy can help maintain mobility.N. 3) Assess nutritional status and condition of skin. This allows them to be as active as possible within the restrictions of the medication schedule. provide assistive devices. and provide divisional activities. walk.
Patients have usually developed their own coping strategies. Imbalanced Nutrition Related to Dysphagia and Reduced Mobility.N. Adding thickening agents to liquids and assisting the patient to a chair or high Fowler’s position for meals may help prevent aspiration. caregivers provide more assistance with ADLs. a spoon may be safer than a fork for self-feeding. If the patient has a severe tremor. so they can feed themselves if at all possible. A cup with a lid and spout can help minimize spilling. Encourage the patient to participate in ADLs as much as possible. It may also help to take several steps in place before starting to walk. The most common setting for treatment of the patient with Parkinson’s disease is the home. 8 . frequent meals may be less overwhelming to the patient who must eat slowly.TOPIC: C. Self-Care Deﬁcit Related to Reduced Mobility. As self-care abilities further decline. The occupational therapist can assist with devices and strategies for maintaining independence. Meals that are high in ﬁber help prevent constipation. Assist patients to open packages and prepare meals. such as wearing clothing without buttons or shoes with adherent fasteners. Finger foods may also be helpful. Patients in the advanced stages of Parkinson’s disease are at high risk for aspiration because they have difﬁculty swallowing.S DEGENERATIVE – PARKINSON’S DISEASE over something to take the ﬁrst step. Small.
The patient is at risk for injury from falls related to problems with mobility. edition. Risk for Injury Related to Reduced Mobility and Balance.N. Pearson Prentice Hall. Philadelphia. throw rugs. P. Assist the patient to devise coping methods. 9 . L. but alarm systems are available that alert the staff that the patient is getting up. Encourage caregivers to utilize all community. Caregivers may need to be reminded that if they neglect their own health.S DEGENERATIVE – PARKINSON’S DISEASE Disturbed Thought Processes Related to Effects of Disease and Medication. Others may require a more extended break. such as written daily schedules. Caregiver Role Strain Related to Demands of Caring for Patient. The bed should be kept in the low position. (2004) Medical Surgical Nursing. S & Hopper.TOPIC: C. and reminders to take medications. Remind the patient to request assistance with ambulation. 3rd. A social worker may be able to assist with identiﬁcation of resources. with side rails raised. Options for relief from caregiving range from having a friend or neighbor visit to employing a home health aide or utilizing adult day care on a parttime or full-time basis. Lemone P. frequent reorientation may be helpful. or other items that may cause a patient to trip. The environment should be kept free from clutter. REFERENCES William. Many patients state that memory impairment and loss of social outlets are more troublesome than the physical impairments. 3rd. If the patient becomes confused. Davis Plus. keep the call light within reach at all times. Some caregivers may only need an hour or two away on an occasional basis. and governmental support systems available. edition. D (2003) Understanding Medical Surgical Nursing. personal. Restraints should be avoided. in which the patient is admitted for a short time. it will have a negative impact on the patient as well. Critical Thinking in Client Care. Walkers and other assistive devices may be helpful. both physical and mental. This may be a viable option for caregivers who must be hospitalized for their own health care. calendars. If the patient is in the hospital or extended care facility. Memory impairment is one of the most distressing symptoms that patients with Parkinson’s disease experience. & Burke K. Some skilled care facilities offer respite care. The signiﬁcant others and caregivers of the patient with Parkinson’s Disease should be included in the plan of care.
TOPIC: C.N.S DEGENERATIVE – PARKINSON’S DISEASE 10 .
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