Parkinson’s Disease

BY ,ANUPAMA.VARGHESE
 PARKINSON’S DISEASE
Parkinson’s disease (PD) is a chronic progressive disease of the nervous
system characterized by the cardinal features of rigidity, bradykinesia ,
tremor and postural instability.
 ETIOLOGY
Refers to a group of disorders that produce abnormalities of basal
ganglia (BG) function.
PARKINSON’S DISEASE or IDIOPATHIC PARKINSONISM is the most
common form.
SECONDARY PARKINSONISM results from number of identifiable
causes, including virus, toxins, drugs, tumors.
 ETIOLOGY
• PARKINSONISM-PLUS SYNDROMES: refer to those conditions that
mimic PD in some respects, but the symptoms are caused by some
other neurodegenerative disorders.
• Genetic factors
• Family history
• Atherosclerosis
• Deficiency of dopamine in substantia nigra of brain
• Environmental factors such as heavy metals and pesticides
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Tremors:
• Although symptoms are variable, a slow, unilateral resting tremor is
present in the majority of patients at the time of diagnosis. Resting
tremors characteristically disappears with purposeful movements and
during sleep but is evident when the extremities are motionless or at
rest. Trembling in fingers, hands, arms, feet, legs, jaw or head.
Rigidity:
• Passive movement of an extremity may cause the limb to move in
jerky increments, referred to as lead- pipe or cogwheel movements.
Involuntary stiffness of the passive extremity increases when another
extremity is engaged in voluntary active movement. Stiffness of the
arms, legs, face, and posture are common. Early in the disease, the
patient my complain of shoulder pain due to rigidity.
Bradykinesia:
• Slowness of voluntary movements. Overtime it may become difficult
to initiate movement and to complete movement. Bradykinesia
together with stiffness can also effect the facial muscles and result in
an expressionless, MASK LIKE appearance. Postural Instability:
Impaired or lost reflexes can make it difficult to adjust posture to
maintain balance. Postural instability may lead to falls.
Parkinsonian gait:
• Individuals with more progressive Parkinson’s disease developed a
distinctive SHUFFLING walk with a stopped position and a diminished
or absent arm swing. It may become difficult to start walking and to
make turns, Individuals may freeze in mid-stride and appear to fall
forward while walking.
Other Manifestations :
• Excessive and uncontrolled sweating
• Paroxysmal flushing
• Orthostatic hypotension
• Urinary retention
• Sexual dysfunction
• Depression, Anxiety, Dementia, delirium, hallucination
Other Manifestations :
• Hypokinesia (Abnormal diminished movement)
• Micrographia (Small handwriting )
• Dysphonia (voice impairment or altered voice production) •
Dysphagia, Begins to drool, Choking and aspiration MICROGRAPHIA
Assessment and Diagnostic finding:
Medical history or present with two or more cardinal symptoms. 
Position emission tomographic (PET)
 Neurological examination
Response to pharmacologic management. (Positive response to a
levodopa)
Management Pharmacologic Therapy:
Antiparkinsonian drug: Levodopa is the most effective agent and the
mainstay of treatment. Levodopa is converted to dopamine in the
basal ganglia, producing symptom relief. Sometimes Levodopa +
Carbidopa is administered to avoid the metabolism of levodopa
before it can reach the brain.
Anticholinergic: Trihexyphenidyl hydrochloride and Benztropine
mesylate (To control the tremors and rigidity.)
Antiviral agent: Amantadine (Reduce rigidity, tremors, bradykinesia,
and postural changes in early Parkinson's disease.)
Dopamine agonists: (Bromocriptine mesylate) activates the dopamine
receptors.
 Monoamine oxidase inhibitors: Selegiline, Rasagiline, (Prevent the
dopamine breakdown.)
Catechol-o-Methyltransferase inhibitors: Increase the duration of
levodopa[a or carbidopa.
 Antidepressant: Bupropion hydrochloride
 Antihistamine : Diphenhydramine hydrochloride (May help in reduce
the tremors.)
Surgical Management
Thalamotomy and Pallidotomy are ablative procedures that were
formally used to relieve symptoms of disease. However, these
procedures permanently destroy brain tissue.
 Deep Brain Stimulator (DBS) involves the surgical implantation of an
electrodes into the brain either in pallidus and subthalamic nucleus.
Stimulation of these areas may increase dopamine release or
anticholinergic release, there by improving the tremors and rigidity.
• Neural Transplantation: Ongoing research is exploring transplantation
of porcine neuronal cells, human fetal cells, and stem cells to replace
degenerated striatal cells. Legal, ethical, and political concerns
surrounding the use of fetal brain cells and steam cells have limited
the exploration of these procedures.
NURSING MANAGEMENT
 THEORY OF SELF CARE

• Self care – practice of activities that individual initiates and perform

on their own behalf in maintaining life ,health and well being
• Self care agency – is a human ability which is "the ability for engaging
in self care" -conditioned by age developmental state, life experience
sociocultural orientation health and available resources
• Therapeutic self care demand – "totality of self care actions to be
performed for some duration in order to meet self care requisites by
using valid methods and related sets of operations and actions"
 NURSING DIAGNOSIS
1. Impaired physical mobility related to muscle rigidity and postural
impairment
2. Self care deficits(feeding, dressing, hygiene, and toileting,) related to
tremors and muscle rigidity.
3. constipation related to medication and reduced activity.
4. Impaired verbal communication related to decrease speech volume,
slowness of speech, inability to move facial muscles.
5. ineffective coping related to depression and dysfunction due to
disease progression.