1750: Parkinson's Disease

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1750: Parkinson's Disease
2015-05-16 17:10:57

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  1. What is PD?

    What is the pathophysiology of PD?
    Decrease of dopamine NT (inhibitor).

    • When dopamine & ACh are in
    • balance = controlled voluntary muscle movements.

    • Decreased production of Dopamine (no change in acetylcholine) = uncontrolled
    • movements
  2. Of dopamine and Ach, which is inhibitory and which is excitatory NT?
    dopamine: inhibitory NT

    Ach: excitation NT

    Ach causes excitation action of involuntary muscle contraction.
  3. What are some categorical sx of PD?

    ANS dysfunctions: dermatologic problems, sleep disturbances.

    Sensory sx

    Cognitive & Psychological sx
  4. Focus of nursing assessment? (movement)

    What muscles may be effected beyond skeletal muscles?
    • speed/coordination
    • posture
    • tremors?
    • pain w/ stiffness
    • Hx of falls
    • use of mobility equipment
    • tongue, dysphagia
  5. What are 4 cardinal signs of PD? 
    (starts with..

    What is "pill rolling"??

    (Pt must have at least half of the signs)
    Tremor: unitlateral "pill-rolling" to bilateral.

    Rigidity: resistance/passive movements

    Bradykinesia: slow movements

    Postural Changes: (4 s's) slow, shaky, stiff, stooped
  6. What are some ADDITIONAL S/sx of PD?
    Facial mask: "frozen" features (scowl expression).

    Speech & swallowing problems d/t inability of "gag reflex".
  7. What INTERVENTION can you teach the Pt when walking?
    Rock side-to-side when walking, lift toes when stepping.
  8. Additional data.

    H&P. What is done additionally to Dx PD?
    Micrographia=early change

    Presence of cardinal signs

    Response to antiparkinson’s drugs (levodopa challenge)
  9. What are the "goals" to PD Tx?

    If on medications, what must be emphasized about the frequency of use?
    • management of Sx
    • decrease rigidity
    • improve swallowing
    • manage SFX of med by use of “Drug holidays” (off and back on meds)
  10. Why are "drug holidays" used to treat PD?
    • Long-term use of Levodopa may cause dyskinesia—uncontrollable abnormal
    • facial movements, and grimacing.
  11. What is the first line drug for PD & what is it?

    Why is Carbidopa combined w/ this drug?
    Levodopa: precursor of dopamine NT.

    Carbidopa, a decarboxylate inhibitor (converter), is added to Levodopa so that it does not convert Levodopa to dopamine before entering the BBB.

    The two must cross the BBB. Then, Levodopa is decarboxylated into dopamine by carbomide and dopamine can act on the CNS.

    Carbidopa also prevents the peripheral metabolism of levodopa, therefore, less levodopa is needed and SFX are diminished.
  12. What are some goals & collaborative goals of a Pt w/ PD?
    functional mobility

    I in ADL's

    Bowel mgmt


    Effective communication

    Avoid injury

    Develop positive coping mechanisms