Parkinson's Disease

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Author:
japanice27
ID:
306263
Filename:
Parkinson's Disease
Updated:
2015-08-11 07:49:53
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parkinsonsdisease
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neuro
Description:
review about parkinson's disease
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  1. Parkinson's disease:
    • -degenerative disease caused by depletion of dopamine, which interferes with the inhibition of excitatory impulses, resulting in a dysfunction the of extrapyramidal system
    • -slow, progressive dse that can result in a crippling disability
    • -mental deterioration occurs late in the dse
  2. Assessment: PD
    • 1. Bradykinesia- abn slowness of movt, and sluggishness of physical and mental responses
    • 2. Akinesia- loss or impairment of the power of voluntary movement.
    • 3. Monotonous speech
    • 4. Handwriting that becomes progressively smaller
    • 5. Tremors in hands and fingers at rest (pill rolling); increased when fatigue and decreases with purposeful activity or sleep
    • 6. Rigidity with jerky movt
    • 7. Blank facial expression; masklike faces
    • 8. Drooling
    • 9. Diff swallowing and speaking
    • 10. Loss of coordination and balance
    • 11. Shuffling steps, stooped position, and propulsive gait.
  3. INT: PD
    • ☑ Ability to swallow and chew
    • ☑ Neurologic status
    • ☑ High-caloric, high-protein, high-fiber, soft diet with small, frequent feedings
    • ☑ OFI: 2000ml/day
    • ☑ Monitor for constipation
    • ☑ Avoid rushing pt with activities
    • ☑ Pt: rock back and forth to initiate movement
    • ☑ Wear low-heeled shoes
    • ☑ Lift feet when walking and to avoid prolonged sitting
    • ☑ Firm mattress and position pt PRONE, without a pillow (proper posture)
    • ☑ Proper posture: hold hands behind the back to keep the spine and neck erect
    • ☑ Give antiparkinsonian meds
    • ☑ AVOID: MAOI's (precipitate hypertensive crisis)
  4. Medical management: PD
    • ANTIPARKINSONIAN MEDS:
    • -restore the balance of the neurotransmitter Act and dopamine in the CNS.
    • -DECREASE s/sx of Parkinson's dse
    • -these meds include: dopamine receptors, anticholinergics (BLOCK cholinergic receptores) and catechol-O-methyltransferase inhibitor (inhibit the metabolism of dopamine in the periphery)

    • DOPAMINE MEDS:
    • -stimulate dopamine receptors and increase amt of dopamine available in the CNS or enhance neurotransmission of dopamine in the periphery
  5. Medications to tx Parkinson's dse:
    • MEDICATIONS AFFECTING THE AMT OF DOPAMINE:
    • Amantadine
    • Apomorphine (Apokyn)
    • Bromocriptine (Parlodel)
    • Carbidopa; levodopa (Sinemet)
    • Levodopa (Larodopa)
    • Pramipexole (Mirapex)
    • Ropinirole (Requip)
    • Selegiline hydrochloride (Eldepryl)

    • ANTICHOLINERGICS:
    • Benztropine mesylate (Cogentin)
    • Biperiden hydrochloride (Akineton)
    • Trihexyphenidyl Hydrochloride
  6. S/E or A/E of Dopaminergic meds:
    • Dyskinesia
    • Involuntary body movt
    • Chest pain
    • N&V
    • Urinary retention
    • Constipation
    • Sleep dist, insomnia or periods of sedation
    • Orthostatic hypotension, dizziness
    • Confusion
    • Mood changes, esp depression
    • Hallucinations
    • Dry mouth

    • INT:
    • ☑ v/s
    • ☑ assess risk for injury
    • ☑ take meds with food if nausea and vomiting occurs
    • ☑ assess for s/sx of PARKINSONISM: rigidity, tremors, akinesia, bradykinesia, a stooped forward posture, a shuffling gait and masked facies.
    • ☑ monitor for signs of dyskinesia
    • ☑ monitor for signs of improvement
    • ☑ change positions SLOWLY to px orthostatic hypotension.
    • ☑ DO NOT STOP the meds abruptly
    • ☑ perspirations and urine may be discolored (harmless, but may stain the clothes)
    • ☒ ALCOHOL
    • ☑ (+)DM urine testing should NOT be done when checking glucose bec this is not reliable
    • ☑ LEVODOPA- avoid excessive vit B12 to px medication reactions
    • ☑ SINEMET- divide total daily prescribed protein because this may interfere with medication availability in the CNS.
  7. ANTICHOLINERGIC MEDS:
    • -blocks the cholinergic response in the CNS thereby suppressing Act activity.
    • -reduce tremors and drooling
    • -(+) GLAUCOMA- contraindicated
    • -(+) COPD- cause dry, thick mucous secretions

    • S/E; A/E:
    • Blurred vision
    • Dryness of the nose, mouth, throat and resp secretions
    • ↥ PR, palpitations and dysrhythmias
    • Constipation
    • Urinary retention
    • Restlessness, confusion, depression and hallucinations
    • Photophobia

    • INT:
    • ☑ V/S
    • ☑ assess risk for injury
    • ☑ monitor: signs of improvement
    • ☑ assess: bowel and bladder function
    • ☑ monitor for urinary retention, constipation and paralytic ileus
    • ☑ monitor for involuntary movements
    • ☒ ALCOHOL, SMOKING, CAFFEINE and ASPIRIN (decrease gastric acidity)
    • ☑ consult to HCP first before taking any OTC drugs
    • ☑ dry mouth- increase OFI, use of ice chips, hard candy or gum
    • ☑ increase fiber
    • ☑ use sunglasses (photophobia)
    • ☑ routine eye exam to monitor IOP.

    **stopped ABRUPTLY-intensified sx of Parkinson's 

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