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2010-03-25 15:39:37

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  1. chronic degenerative disorder of the basal ganglia
  2. Parkinson's results in..
    • dec levels of dopamine (neurotransmitter) which is needed for voluntary movement
    • impairment of extrapyramidal (pathways) tracks which control and regulate movement
  3. cause of Parkinson's
    • really unknown
    • some cases caused by toxins:
    • -Manganese-a metal (helps with bone metabolism, in bran, beets, peas)
    • -carbon monoxide
  4. Parkinson's
    course of illness
    • slowly progressive and debilitating
    • does not led to paralysis
    • intellect, sight, and hearing are intact
  5. sxs of Parkinson's
    • three cardinal sx
    • rigidity (stiffness in extremities)
    • -cogweel-jerky, slow movement, requires more effort
    • -handwriting becomes jerky

    • bradykinesia
    • -one of the most common features
    • -slower voluntary movements
    • -longer to complete activities
    • -difficulty initiating movement such s rising from a sitting position or turning in bed

    • resting tremors
    • -tremors when they aren't doing anything
    • -rolling motion with fingers
  6. other sxs of Parkinson's
    • mask-like facial expressions (hypomimia) with associated:
    • -difficulty chewing, dysphagia (swallowing), dysarthria (speaking)
    • -drooling esp. at night

    • posture and gait impairment
    • -stooped posture, semi-flexed forearms (don't swing while walking)-loose balance
    • -slow shuffling gait-lean forward and shuffle
    • -difficulty maintaining balance

    • weakness/fatigue
    • -fatigue with ADLs
    • -weak monotone, low volume voice=dec in dopamine

    • other
    • -flat affect, they often have depression
    • -excessive sweating on face and neck
    • -constipation from inc in GI motility and immobility
    • -urinary frequency and hesitancy
    • -dementia-usually with older pts who do not respond well to Levodopa therapy-depends on loss of neurons, not everyone will get
    • -orthostatic hypotension-impaired vascular smooth muscle response
  7. diagnosis of Parkinson's
    • on to SXS, HX, no tests
    • fir dx when person has at least 2 of the 3 cardinal sx and if positive response to drugs seen, then dx made
  8. surgery for Parkinson's
    • used for ppl that are unresponsive to drug therapy or have developed severe motor complications
    • destroy tissue that causes tremors
  9. ablation
    destruction of areas in the thalamus by stereotactic procedures (freezing, electric)
  10. DBS-deep brain stimulation
    electrode in the thalamus or other areas and connect it to a generator in the upper chest (like pacer)-delivers current to the targeted brain location-adjust to control sx and can be removed
  11. transplantation
    • transplant fetal neural tissue in to the basal ganglia, hopefully this tissue grows and produce cells that produce the needed dopamine
    • -legal, ethical issues
  12. cogentin
    • anticholinergic
    • up to 6 mg/day

    reduces cholinergic activity, dec involuntary movements

    • adverse reactions:
    • inc P
    • postural LBP
    • HA
    • dizzy
    • dry mouth
    • constipation
    • urinary retention

    • nsg care:
    • glacoma, urinary obstruction? with glacoma, can inc intraocular pressure
    • -avoid rapid position changes, extreme heat-can perspire
    • -gum hard candy, frequent mouth care
    • -fluids, bulk needed
  13. dopamine replacements
    • dopar-8 g/day
    • Sinemet

    stimulates dopamine production or increases sensitivity of dopamine receptors, replaces dopamine

    • adverse reactions:
    • -involuntary movements
    • -N/V
    • -hallucinations
    • -dec BP

    • nsg care:
    • -drugs may take months to achieve desired effects
    • -take with food
    • -warn to avoid sudden position changes
    • -avoid foods high in vit B6 like pork, tuna, liver, milk, eggs, cheese, dried beans, and nuts
    • -insomnia
    • -sleep attacks
    • -risk taking-gambling, sex
  14. dopamine replacements
    • antiviral
    • Symmetrel-400 mg/day

    • dec rigidity and tremors
    • stimulates dopamine production or inc sensitivity of dopamine receptors

    • adverse reactions:
    • involuntary movements
    • -N/V

    • nursing care
    • -avoid foods high in vit B6
    • -drowsiness
    • -take with food
  15. dopamine replacements
    dopamine releasing agonists
    • parlodel
    • permax
    • requip and mirapex-newer

    newer drugs require lower dosage;enhance response; minimize adverse reactions

    • adverse reactions
    • -involuntary movements
    • -N/V
    • -hallucinations
    • -dec BP

    • nursing care:
    • drowsiness
    • take with food
    • sleep attacks
    • risk taking:gambling, sex
  16. monoamine oxidase
    type B inhibitor
    inhibits enzyme that breaks down L-dopa, thus expands its action

    • adverse reactions
    • -hallucinations
  17. eldepryl
    use with dopamine agonists if sxs not responding

    • adverse reactions
    • -confusion
    • -dizziness
    • -nausea
    • -dry mouth
    • -insomnia

    • nursing care:
    • not an option if on antidepressants
    • causes hallucinations in elderly
  18. generic names

    *parlodel-bromocriptoine mesylate








  19. teaching for Parkinson's drugs
    • takes months to see changes
    • avoid foods high in vit B6
    • -breaks down L-dopa
    • -foods high in vit B6-pork, tuns, liver, milk, eggs, cheese, dried beans, nuts

    • may cause insomnia-take in the morning or earlier like at supper, before bed, limit caffeine, stimulants
    • may initially cause drowsiness, no driving until under control
    • cause dark urine and sweat
    • on-off phenomenon
    • -may suddenly not work and then start to work again
    • -drug holiday-be off certain drug for awhile, then may be restarted or add another combination
    • -eventually drugs do not work

    • most pts will develop dyskinesia w/i 5-10 yrs
    • -made naturally in the body, used by cells to produce energy and as an antioxidant
    • -1200 mg/day helps to decrease deterioration in feeding, dressing, bathing, walking-helps prolong ADLs

    • Parkinson's crisis
    • -rapid withdrawal of meds
    • -sxs: tremors, rigidity, akinesia, inc P, anxiety
    • -treat-:cardiac/resp support, quiet room, subdued lights
  20. impaired physical mobility r/t muscle weakness/rigidity
    goal-improve mobility-very important, safe environment

    • interventions-ROM bid-qid
    • -encourage finger exercises-tearing paper, jingling coins, playing piano, typing

    • gait training
    • -wide base-helps balance better, "goose step"
    • -pick up feet and walk side to side
    • -swing arms when walking
    • -get up quickly from char but sit down slowly-move in one motion, if low BP can't do-prevents freezing
    • -assistive devices
    • -safety precautions at home-perform most strenuous activity when drug action peaks
    • -ambulate qid, do not do prolonged rest periods
  21. altered nutrition:LTBR r/t muscle weakness, tremors, dysphagia
    • goal-improve nutrition
    • interventions:
    • small feedings-semisolids, soft, pureed-add thick it
    • 6 small meals
    • fiber/fruit-maintain bowel function
    • high calorie foods or supplements to maintain weight
    • may need to limit PRO, B6 if on Levodopa
    • precautions when eating-may aspirate
    • sit up concentrate on swallowing-risk of aspiration, give time to eat
    • allow pt to feed self until tired-then feed pt
    • watch hot foods/liquids, can burn self
    • bite size
    • suction available
    • quiet environment
  22. constipation r/t dec activity, medication
    • goal-improve bowel function, have regular BMs
    • 2-3 L fluid
    • high fiber
    • stool fibers
    • raise toilet seat
    • establish regular bathroom schedule
  23. impaired verbal communication r/t dec speech volume, inability to move facial muscles
    • goal-improve communication
    • facial exercises to maintain facial tone
    • -make faces, sing, read
    • allow time, don't rush
    • alternative communication
    • speech consult
    • yes/no questions
  24. self-care deficits (ADL) r/t tremors, motor disturbance
    • goal-enhance self-care activities
    • bathe in morning and night to relax muscles
    • -warm not too hot, at night-helps them sleep
    • encourage to do what able to do, after meds
    • velcro not buttons, slip on shoes
    • SAFETY
  25. impaired home maintenance mgmt
    • schedule appointments/activities late morning so not rushed
    • OR schedule for peak activity of medication

    **remember to bring in other departments-OT, PT, speech, whatever you need for their help and assistance

    HESI hints-NCLEX questions often focus on features of the disease: tremors, rigidity, hypertonicity, stooped posture and safety