NUR 149 2nd SEMESTER

A.Y. 2022-2023 PD
PARKINSON’S DISEASE

PARKINSON’S DISEASE Basal Ganglia Function

- a.k.a. Parkinson disease, Parkinson's, o VOLUNTARY MOVEMENTS; ROUTINE
Idiopathic parkinsonism, Primary parkinsonism, BEHAVIORS, COGNITION, LEARNING,
PD, or paralysis agitans EMOTION, etc.
- a degenerative disorder of the CNS
- a slowly progressing neurologic movement
disorder that eventually leads to disability
- associated with decreased levels of dopamine
- the degenerative or idiopathic form is the most
common

CAUSE
• Unknown for most cases (idiopathic)
• Dopamine - acetylcholine disequilibrium

RISK FACTORS BASAL GANGLIA

• Age is the largest risk factor (Older than 50-60
years of age) - is a collection of nuclei which has different parts:
• Men are affected about 1.5 to 2 times more
often than women. CAUDATE NUCLEUS, d/o:
• Genetics: A small number of individuals are at o overactive: OCD;
increased risk because of a family history of o huntington’s
the disorder o depression
• Head trauma & illness
PUTAMEN (perform automatic behaviors:
• Exposure to environmental toxins (pesticides
riding a bike, typing in the keyboard, driving)
& herbicides)
o d/o: TOURETTE’S SYNDROME

SUBSTANTIA NIGRA (black substance

from neuromelanin)
o necessary for smooth muscle
movement d/o: PARKINSON’S
DISEAES

MS LEC NEURO, TCGGUILLERMO

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CLINICAL MANIFESTATIONS
Early onset- the most obvious symptoms are
movement-related include:
o Shaking
o Rigidity
o slowness of movement
o difficulty with walking & gait.
Later
o Cognitive & behavioral problems
o Dementia; occurring in the advanced
stages of the disease
o Sensory, sleep & emotional problem
4 CARDINAL SIGNS OF PD
TREMOR
- A slow, unilateral resting, trembling in
fingers, hands, (TURNING MOTION),
arms, feet, legs, jaw, or head
- Occur when individual is resting, but not
while involved in a task
- Tremors worsen; when excited, tired, or
stressed
- May manifest a motion of the thumb
against the fingers as if rolling a pill
between the fingers.
BRADYKINESIA
- Slowness of voluntary movement
- Difficult to initiate/complete movement
- Bradykinesia together with stiffness affect
the facial muscles leading to
expressionless, "mask-like" appearance
- Initial manifestations- problems when
performing daily tasks which require fine
motor control: writing, sewing or getting
dressed.
- Severe form: FREEZING PHENOMENON
▪ transient inability to perform active
movement.
▪ Walking – “glued”
POSTURAL INSTABILITY
- Impaired or lost reflexes
- Postural & gait problems---” FALLS”
- The posture is caused by the forward
flexion of the neck, hips, knees & elbows
- The patient may walk faster & faster, trying
to move the feet forward under the body’s
center of gravity (shuffling gait)
- More progressive Parkinson's disease
develops a distinctive shuffling walk with a
stooped position & a diminished or absent
arm swing
- It may become difficult to start walking & to
make turns
- Individuals may freeze in mid-stride and
appear to fall forward while walking.

RIGIDITY
- Stiff & resistant limbs & trunk that increase
during movement
- Muscle aches & pain
- Handwriting (micrographia)/ eating
difficulty
- lead-pipe rigidity; cogwheel
Other Manifestations
- Asymmetrical in early stages (neck &
shoulder muscles prior to the muscles of PSYCHIATRIC CHANGES
the face & extremities) o Depression
- With progression, rigidity typically affects o Dementia (progressive mental
the whole body & reduces the ability to deterioration),
move. o Delirium,
o Hallucinations

MENTAL CHANGES
o Cognitive
o perceptual & memory deficits;
o intellect is not usually affected.

MS LEC NEURO, TCGGUILLERMO

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 Dysphonia (soft, slurred, low-pitched, less o Acting on neurotransmitter pathways
audible speech) other than the dopaminergic pathway
Dysphagia, begins to drool, & at risk for choking
& aspiration
Levodopa (Larodopa)/ Carbidopa with
AUTONOMIC SYMPTOMS levodopa (Sinemet)
o Hyperhidrosis o the most effective agent & the mainstay
o Orthostatic Hypotension treatment
o Gastric, Urinary Retention; Constipation o Converted to dopamine in the basal
o Sexual Dysfunction ganglia, producing symptom relief

COMPLICATIONS Avoid the following when on Levodopa

Patients are at risk for: o Tyramine rich foods (prevent hypertensive
• Respiratory problems
crisis)
• UTI
• Skin breakdown
o B6 (pyridoxine)
• Injury from falls

DIAGNOSTIC TESTS SURGICAL MANAGEMENT

✓ PET & Single Photon Emission Computed
Tomography (SPECT)
o Findings: nigrostriatal dysfunction
✓ EEG
✓ No tests are diagnostic of PD
✓ Most accepted: Pt’s history + at least 2 of 4
cardinal signs
MEDICAL MANAGEMENT
• Treatment is directed at controlling symptoms
& maintaining functional independence
• Care in individualized for each patient based
on presenting symptoms & social,
occupational, & emotional needs
• Patient are usually cared for at home & are
admitted to the hospital only for complications
or to initiate new treatments
❖ Surgery provides symptom relief in selected
patients
1. Stereotactic procedures:
- To interrupt the nerve pathways &
thereby alleviate tremors or rigidity
• Thalamotomy; a stereotactic
electrical stimulator destroys part of
the ventrolateral portion of the
thalamus in an attempt to reduce
tremor
• Pallidotomy; involves destruction
of part of the ventral aspect of the
medial globus pallidus through
electrical stimulation in patients
with advanced disease.
• Deep brain stimulator – insertion of
a pacemaker like device with
electrodes attached to thalamus to
relieve tremors

PHARMACOLOGIC THERAPY

Antiparkinsonian medications act by:

o Increasing striatal dopaminergic activity
o Restoring a balance between
dopaminergic & cholinergic activities

MS LEC NEURO, TCGGUILLERMO

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 NURSING DIAGNOSES
• Impaired physical mobility related to muscle
rigidity & motor weakness
• Self-care deficits related to tremor & motor
disturbance
• Constipation related to medication & reduced
activity
• Imbalanced nutrition
• Impaired verbal communication
• Ineffective coping

NURSING INTERVENTIONS

✓ Improving mobility (progressive program of

daily exercise)
✓ Enhancing self-care activities
(independence)
✓ Improving bowel elimination
✓ Improving nutrition (high residue, high
caloric, soft diet)
✓ Encouraging the use of assistive devices
Improving communication (refer to speech
therapy)
✓ Supporting coping abilities
✓ Promoting Home & community-based care

• SLEEPING: avoid pillows, use firm mattress,

prone position to minimize stooped posture

MS LEC NEURO, TCGGUILLERMO