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  1. What is Parkinson's disease?
    • Progressive neurodegenerative disease
    • Affects motor ability
  2. Cardinal symptoms
    • Tremor
    • Rigidity
    • Bradykinesia or Akinesia
    • Postural instability
  3. Primary vs Secondary
    • Most people have primary or idiopathic
    • Secondary symptoms form brain tumors or certain anti-psychotic drugs
  4. Stages of PD
    • I: initial stage-unilateral limb involvement, minimal weakness, hand/arm trembling
    • II: mild stage- Bilateral limb, masklike face, slow shuffling gait
    • III: moderate disease- Postural instability, gait disturbances
    • IV: severe disability- Akinesia, rigidity
    • V: complete ADL dependence
  5. Patho
    • Widespread degeneration of the substantia nigra leads to a decrease in dopamine. ACh remains active, creating an imbalance btwn excitatory/inhibitory activity
    • PD not only interferes c mvmnt, also reduces SNS influence on the heart & blood vessels resulting in orthostatic hypotension
  6. Rigidity classifications
    • Cogwheel: rhythmic interruption of muscle mvmnt
    • Plastic: mildly restrictive mvmnt
    • Lead pipe: total resistance to mvmnt
  7. Masklike expression
    • Wide open, fixed, staring eyes caused by rigidity of facial muscles
    • Difficulty chewing/swallowing esp if pharyngeal muscles are involved
  8. Diagnosis
    • Made on basis of clinical findings p neurological diseases are eliminated
    • No specific tests
  9. Diet
    • High-protein or high-calorie foods or supplements to maintain weight
    • Monitor pt ability to eat/swallow
    • Small frequent meals/liquid thickeners for difficulty swallowing
    • Elevate head to prevent aspiration
  10. Nonsurgical management
    • Dopamine agonists mimic dopamine by stimulating dopamine receptors in the brain
    • Most effective first 3-5yrs of use
    • Fewer incidents of dyskinesia and "wearing off" phenomenon-loss of response to drug
  11. Dopamine agonists
    • Apomorphine (Apokyn)
    • Pramiexole (Mirapex)
    • Ropinirole (Requip)
    • Ritigotine (Neupro)

    Side effects-orthostatic hypotension, hallucinations, sleepiness/drowsiness
  12. Drug therapy
    • *Sinement-improve motor function
    • COMT inhibitors
    • MAO-B
    • Dopamine receptor agonist
    • Antiviral
    • Anticholinergic
  13. Treatment drug toxicity/tolerance
    • Reduction in drug dosage
    • Change of drug/frequency of admin
    • Drug holiday- 10 days no PD meds
  14. Nonsurgical interventions
    • Exercise/ambulation-yoga, tai chi,ROM, stretching
    • Self management- encourage pt participation in ADL's
    • Injury prevention- monitor sleeping patterns (naps)
  15. Surgical management
    • Stereotactic pallidotomy
    • Thalamotomy
    • Fetal tissue transplantation
    • Deep brain stimulation
  16. What is a stereotactic pallidotomy?
    • Target area id'd by CT or MRI
    • Head frame palced on pt
    • Burr hole made into cranium into the pallidum within the corpus striatum
    • Electrode placed-recieves mild shock
    • When probe in correct spot, permanent lesion made to destroy tissue
    • Monitor pt in PACU for 1hr
  17. What is a thalamotomy?
    • Opening into thalamus for thermocoagulation
    • Only unilateral surgery done to prevent complications
  18. What is fetal tissue transplantation?
    • Experimental/highly controversial
    • Fetal substantia nigra tissue is transplanted into caudate nucleus of brain
  19. What is deep brain stimulation?
    Thin electrode is implanted in thalamus or subthalamus and connected to pacemaker that delivers an electric current
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