parkinsons and alzheimers

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parkinsons and alzheimers
2012-04-23 21:44:58

parkinsons and alzheimers
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  1. A nerurogegenerative disease that is progressive
  2. Pathophysiology of parkinsons
    • involvement of basal ganglia, primarily substantia nigra, and globus pallidus
    • Depletion of CNS dopamine -dopamine controls movement
    • Imbalanced cholinergic/dopaminergic transmission
  3. How is parkinsons diagnosed
    • Symptomatically
    • No specifict tes
    • history and physical
    • symptom development with correltation to medications taking- if symptoms improve with meds they diagnosed
    • neurological exam
    • mri ,ct, eef- rule out other things
  4. Symptoms of parkinsons (I)
    • primarily of upper extremities aka "pill rolling tremors"
    • rhythmic interruption of movement - cant stop, faceplant
    • slow shuffling walk, unsteady gait
    • stooped posture
    • con lead to akinesia ( can't walk)
    • impaired blinking, smiling, swinging arms, fixed staring eyes
  5. Symptoms of parkinsons (II)
    • monotoned dysarthria (slurred speech) ecolalia ( repeat words- echo)
    • tube feedings
    • othrostatic hypotension- severe w/ meds
    • changes in skin texture
    • flushing
    • causes facial mask-like expression
    • difficulty in moving out of bed, chair
    • changes in handwriting
  6. Stages of parkinsons
    • early- mo functional impairment
    • mild- honeymoon peirod
    • mod-mulitple drugs, occcupational and social activities affected
    • severe- side effects from drugs, resistant to therapym reduced quality of life
    • Late- totally dependent in adl, wheelchair, or bed bound
  7. Medical mediation with parkinsons
    physical, occupational, and speech therapy
  8. Steriotactic pallidotomy
    electrical stimulation
    intrathecal drugs
    • parkinsons
    • sp-take brain tissue away
    • es- pacemaker for brain, movement part
    • id- cf fluid
  9. Diet for parkinsons
    • high protien
    • high calorie foods
    • soft to ease chewing problems- thickened liquids
  10. complications of parkinsons
    • aspiration pneumonia
    • fractures due to falls
    • infections
    • bowel and bladder complications
    • drug toxicity -monitor drug levels
    • malnutrition
    • drpression suicidal behaviors
    • airway obstruction
  11. The brains of people that have ad has an abundance of what 2 abnormal structure?
    • Beta-amyloid plaques- which are dense depositis of protein and cellular material that accumulates outside and around nerve cells
    • Neurofibrillary tangles, wharch ar twisted fibers that build up inside the nerve cell
  12. What is the precurser to amyloid of plaque?
    Amyloid precursor protein (APP)
  13. Clinical manafestations of early AD
    • Forgetfulness beyond what is seen in a normal person
    • Short-term memory impairment, especially for new learning
    • Difficulty recognizing what numbers mean
    • Loss of initiative and interests
    • decreased judgement
    • Geographic disorientation
    • Short attention span
    • decreased performance when stressed
  14. Clinical manifestations for moderate ad
    • Imparied ability to recognize close family or friends
    • agitation
    • wandering, getting lost
    • loss of remote memory
    • confusion
    • impaired comprehension
    • forgets how to do simple tasks
    • apraxia
    • receptive or expressive aphasia
    • insomnia
    • delusions
    • illusions, hallucinations
    • behavioral problems
  15. Clinical manifestations for severe (late) ad
    • Little memory, unable to process new information
    • Connot understand words
    • difficulty eating, swallowing
    • Repetitios words or sounds
    • unable to perform self-care activities
    • immobility
    • incontinence
    • •weight loss
    • • seizures,
    • • skin infections,
    • •groaning, moaning, or grunting,
    • • increased sleeping, loss of bladder and bowel control. •Death from aspiration pneumonia or other infections.
  16. AD diagnostics
    • •a detailed patient history
    • •information from family and friends
    • •physical and neurological exams and lab tests
    • •neuropsychological tests
    • •imaging tools such as CT scan, or magnetic resonance imaging (MRI). PET scans are used primarily for research purposes
  17. When you have a patient with AD..
    • •Stay calm and be understanding.
    • •Be patient and flexible. Don’t argue or try to convince
    • .•Acknowledge requests and respond to them.
    • •Try not to take behaviors personally. Remember: it’s the disease talking, not your loved one.
  18. AD medications
    Memory Loss
    • Aricept
    • Namenda
  19. Drug therapy
    • Zoloft
    • Celexa
  20. Drug therpy
    Behavioral problems
    • Neuroleptics: Seroquel
    • Benzo: Ativan, Serax
    • Antipsycotics: Risperidol, haldol
  21. Possible AD Nursing Diagnoses
    • oSelf care deficit
    • oImpaired verbal communication
    • oImbalanced nutrition
    • oRisk for infection
    • oImpaired physical mobility
    • oCompromised family coping
    • oDisturbed sleep pattern
  22. Nursing interventions AD
    • oCognitive stimulation: promote awareness to environment
    • oPresent change slowly and repeat changes
    • oUse therapeutic touch
    • oStimulate memory by repeating requests
    • oImplement memory techniques: name tags, visual clues, using computers, rehearsing activity of daily living
    • oMonitor drug therapy for effectiveness
    • oEncourage to participate in group activities
    • oSafety is the most important
  23. Possible factors to cause seizures
    • Stress
    • Fatique
    • Alcohol
    • Caffeine
    • Increased physical activity
  24. Tonic seizures:
    abrupt increase in muscle tone, loss of consciousness and loss of autonomic functions lasting 30 sec to minutes
  25. Clonic seizure:
    muscle contraction and relaxation. Lasts typically several minutes
  26. Seizure drug therapy
    • barbiturates: (phentobarbital or luminol, mysoline) increase seizure threshold, may require high doses to raise the threshold: can be used for all seizures except absence.
    • Side effects: many including vertigo, drowsy, N&V, night terrors, stevens-johnson syndrome (rash, fever, joint pains, resp infection and vomiting. Do not stop medication without weaning and without MD orders
  27. watch dilantin and valium interaction must keep separate
  28. Parkinsons medication
    • Dopamine agonists (bromocriptine, pergolide, pramipexole, ropinirole).
    • Levodopa and carbidopa.
    • COMT inhibitors (entacapone, tolcapone).
    • Anticholinergic agents (benztropine, trihexyphenidyl). Selegiline (MAO-B inhibitor). Amantadine.