Rnur 141 Parkinsons Disease

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Rnur 141 Parkinsons Disease
2012-04-23 17:57:56
Rnur 141

Rnur 141 Parkinsons Disease
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  1. Definition:
    slowly progressing neuro movement disorder that eventually leads to disability
  2. Two Types of Parkinson's Disease
    • Degenerative or idiopathic-most common
    • Secondary, known or suspected cause
  3. Pathophysiology
    • Decreased levels of dopamine
    • NTs--ACH (excitatory) and Dopamine (inhibitory) relay messages to higher motor centers that control and refine motor movement.
    • Loss of dopamine results in more excitatory NTs.
  4. Clinical Manifestations
    • Gradual onset
    • Symptoms progress slowly
    • Cardinal Signs: Tremor (pill rolling), Rigidity, Bradykinesia, Postural inability
    • Other: dementia, microphagia (small handwriting), dysphonia (slurr)
  5. Diagnostics
    • Hx
    • Presence of 2 of 4 cardinal signs
    • Family members often notice changes.
    • Neuro exam
    • Response to meds
  6. Medical Management is directed at controlling symptoms and maintaining functional independence.
    • 1) increase dopamine
    • 2) reduce excitatory cholinergic neurons
    • 3) act on NT pathways other than dopamine
  7. Pharmacological Treatments
    • Levodopa- most effective & mainstay treatment, converts to dopamine
    • Cogentin- controls tremor
    • Symmetrel- antiviral agent used early to reduce 4 cardinal signs
    • Parlodel & Permax: postpones the use of carbidopa or levodopa therapy
    • MAOIs: inhibits dopamine breakdown
    • Antidepressants: Elavil, Prozac, Wellbutrin
    • Antihistamines: Benadryl, reduces tremors
    • Requip & Mirapex: 1st line, dopamine agonists
  8. Surgical Treatment
    • Candidates: pts with disabling tremors, rigidity, etc.
    • Surgery does not alter the course, only provides relief.
    • Stereotactics (Thalamotomy/Pallidotomy): pts with max doses of meds
    • Neural Transplant: stem cells, fetal cells
    • Deep Brain stimulation- pacemaker like device
  9. Assessment:
    • Do you have arm/leg stiffness?
    • Have you experienced irregular arm/leg jerking?
    • Have you ever been "frozen" and unable to move?
    • Does your mouth water excessively?
    • Have you noticed yourself grimacing or making faces?
  10. Nursing Diagnoses
    • Fall risks
    • Impaired physical mobility
    • Self care deficit
    • Constipation r/t medication or reduced activity
    • Imbalanced nutrition
    • Impaired verbal communication
    • Ineffective coping