Parkinsons Disease

Benita Nwokolo, MSN, RN

Introduction

A debilitating disease affecting motor ability. Has a large on medical cost, lost wages, and decreased productivity. The third most common neurologic disorder of older adults. Onset is often after age 40. Men are affected more than women

Pathophysiology and Etiology

Neurotransmitters (acetylcholine and dopamine) in the basal ganglia of the brain coordinate voluntary body movements. Widespread degeneration of the substanitia nigra leads to a decrease in the amount of dopamine Virus; genetic; toxicity from pesticides, herbicides; repeated head injury; or unknown

Clinical manifestations

Three cardinal signs:

Tremor Rigidity bradykinesia

Other symptoms

Stages of Parkinson

Stage 1: Initial Stage

Unilateral limb involvement Minimal weakness Hand and arm trembling

Bilateral limb involvement Masklike facies Slow shuffling gait Postural instability Increased gait disturbance Akinesia Rigidity

Stage 2: Mild Stage

Stage 3: Moderate Disease

Stage 4: Severe Disability

Stage 5: Complete ADL Dependence

Diagnosis

Made from history and presence of two of the cardinal signs.

Pharmacologic Therapy

carbidopa-levodopa (Sinemet); Paracopa

Take with food Use caution with activity or position changes Effects may be delayed Do not stop abruptly Instruct to report any uncontrolled movements; palpitations; severe n/v; difficulty urinating

Dopamine agonist bromocriptine (Parlodel); ropinirole (Requip) stimulate DA receptors

Adverse effectsNotify MD immediately with severe h/a

Anti-cholinergics- benztropine (Cogentin) manage tremors

Surgical Management

Stereotactic pallidotomy mild electrical stimulation applied to target area to reduce tremors & rigidity Deep Brain Stimulation (DBS) used when meds no longer effective

Nursing care

Improving mobility

Postural exercises

Broad-based gait Make conscious effort to swing arms, raise feet while walking, & increase width of stride Practice walking to marching music

Nursing care

Optimizing nutritional intake

Think through swallowing

Close lips with teeth together Lift tongue with food on it Move tongue back and swallow while tilting head forward

Nursing care

Maximizing communication ability Preventing constipation Strengthening coping ability

Establish realistic goals Provide emotional support and encouragement Encourage open communication Active role in treatment plan Observe for changes in depression

Home Care Education

It is important for both the client and the family to maintain independence and self care as long as possible. Educate about the disease process and management of disease to help to delay disability. Educate about medications and side effects. Provide community resources.

Test Your Knowledge

A 79-year-old male was diagnosed with Parkinsons disease two years ago. In spite of his condition, he is able to live independently with his partner of 59 years. He takes levodopa with carbidopa to control his disease. The couple has two grown children who live nearby to offer assistance when needed. Due to a recent episode of pneumonia, the patient is receiving home health visits. 1. If the patient has classic Parkinsons disease, what three signs and symptoms can the nurse expect the client to be exhibiting?
2.

Why is the patient at increased risk for the development of pneumonia?