Untitled Quiz

Parkinson's Disease Overview

• Parkinson's disease is associated with decreased dopamine levels due to cell destruction in the substantia nigra.
• This affects neurotransmission of nerve impulses.
• Symptoms include tremor, rigidity, bradykinesia, postural instability, depression, psychiatric changes, dementia, autonomic symptoms, and sleep disturbances.

Pathophysiology

• Dopaminergic neurons in the substantia nigra are destroyed.
• Dopamine stores in the basal ganglia are depleted.
• An imbalance occurs between excitatory (acetylcholine) and inhibitory (dopamine) neurotransmitters in the corpus striatum.
• Extrapyramidal tracts, controlling complex body movements, are impaired.
• This results in about an 80% reduction in dopamine production, leading to symptoms.

Symptoms

• Tremor: Muscular twitches at rest, head shakes.
• Rigidity: Resistance to passive movement.
• Bradykinesia: Slowness, shuffling gait, mask-like facial expression, and uncontrolled drooling.
• Postural Instability: Posture/gait problems.

Other Symptoms

• Physical: personality changes.
• Psychiatric: depression, dementia, and delirium.
• Cognitive: perceptual and memory deficits, impacting up to 75% of patients.
• Hypokinesia: reduced movement.
• Dexterity decline: mask-like appearance and drooling.
• Gait and balance issues: shuffling gait.

Diagnosis

• No definitive tests exist.
• Trial levodopa (a dopamine precursor).
• MRI or PET scans can show brain function.

Treatment - Pharmacology

• Levodopa/Carbidopa: Levodopa is converted to dopamine in the basal ganglia, while carbidopa prevents levodopa activation in the body.
• Effectiveness can decrease over time.
• Side effects include hallucinations, confusion, depression, and sleep disruptions.
• Can cause dyskinesia (involuntary movements) after long-term use.
• ON-OFF phenomenon: fluctuation between mobility and immobility.
• Must be taken on an empty stomach.

Treatment - Other

• Dopamine agonists: May be given before levodopa or as an adjunct.
• MAOIs (Monoamine oxidase inhibitors): May slow disease progression by inhibiting dopamine breakdown.
• Anticholinergic agents: Counteract the effects of acetylcholine.
• Surgical procedures: Stereotactic procedures like thalamotomy or pallidotomy, and deep brain stimulation.
• Stem cell treatment: Research ongoing.

Nursing Process

• Assessment: Assess ADLs, IADLs, cognitive function, medication responses, emotional/family coping.
• Diagnosis: Possible diagnoses like impaired physical mobility, self-care deficits, imbalanced nutrition, constipation, ineffective coping, knowledge deficits, and risk of injury.
• Planning: Major goals include improved functional ability, independence in ADLs, adequate bowel and nutrition, effective communication, and positive coping mechanisms.
• Interventions: Examples include exercise programs, ROM exercises, postural exercises, assistive/adaptive devices, consultation with therapists, and support for coping mechanisms.

Review Questions (Examples):

• Which of the following is not a cardinal sign of Parkinson's disease: Tremor, Dementia, Bradykinesia, Rigidity?
• When is the best time to assess for tremor in a suspected Parkinson's patient?
• What side effects might a patient taking Levodopa/Carbidopa experience?
• What are the main aspects of the nursing process related to Parkinson's Disease?