Parkinsons dis.pdf

Parkinson’s Disease (PD) Parkinson’s Disease - Progressive neurodegenerative condition Pathology: ○ Degeneration of the substantia nigra leads to a decrease in dopamine in the brain. Substantia nigra - brain region that produces dopamine ○ If dopamine decreases by 20-30% symptoms occur Patients can’...

Parkinson’s Disease (PD) Parkinson’s Disease - Progressive neurodegenerative condition Pathology: ○ Degeneration of the substantia nigra leads to a decrease in dopamine in the brain. Substantia nigra - brain region that produces dopamine ○ If dopamine decreases by 20-30% symptoms occur Patients can’t refine voluntary movement. Risk Factors: W FAM ○ Worked with pesticides ○ Family history = Familial Parkinson’s Disease ○ Age ○ More common in men Signs and Symptoms: RM BP | TSSL | SIDD ○ Classic Signs: RM BP (room blood pressure) Resting tremor Muscle rigidity Bradykinesia (slow movement) / Akinesia (absence of movement) Postural instability - unable to stand up straight TSSL (tassel) ○ Early Signs: Tremors on one side of body Slower movements Some rigidity/freezing Loss of balance SIDD (that one snitch) ○ Late Signs: Shuffling gait / eventually unable to walk Impaired cognition Difficulty swallowing Difficulty speaking Stages of Parkinson’s Disease ○ Stage 1 - Early PD Symptoms of PD are mild and only seen on one side of the body (unilateral involvement) Symptoms: Tremor of one hand Rigidity Clumsy leg One side of the face may be affected, impacting the expression ○ Stage 2 - Early PD Symptoms of PD are mild and on both sides of the body (bilateral involvement) or at the midline. Symptoms: Loss of facial expression on both sides Decreased blinking Speech abnormalities Rigidity of the muscles in the trunk ○ Stage 3 - Mid-stage PD Symptoms of PD are Moderate and characterized by a loss of balance and slowness of movement. Symptoms: Balance is compromised Inability to make the rapid, automatic and involuntary adjustments All oter symptoms of PD are present ○ Stage 4 - Advanced PD Symptoms of PD are severely disabling. Symptoms: Patients may be able to walk and stand unassisted, but they are noticeably incapacitated. Patient is unable to live an independent life and needs assistance. ○ Stage 5 - Advanced PD Symptoms of PD are severe and are characterized by an inability to rise. Symptoms: Patients fall when standing or turning May freeze or stumble when walking Hallucinations or delusions Interventions: CT, SPECT, CSF ○ Subjective questions to ask: Describe the tremor → Does it happen when you are doing an intentional action or is it resting? Medical history → Exposure to head trauma/chemicals? Family history Stress → emotional and or physical Has he fallen recently? How is your balance? Can I see you walk? ○ Secondary Prevention: (inspect MineCrafts) = N SPECT MCs Neuro exam/history Medication trial CT scan → used to r/o tumors SPECT (Single photon emission computed tomography) - can detect loss of dopamine producing neurons. CSF - May show decrease in dopamine levels. ○ Tertiary Prevention: MF 2 PDs Meds Medication management Fall Prevention Home assessment, use of canes, walkers, elevated toilet seat Physical Therapy/Exercise Speech Therapy Dysphagia Management Stereotactic pallidotomy - destroys portion of globus pallidus in the brain to decrease muscle rigidity Deep brain stimulation - making small holes in the skull to implant the electrodes into brain tissue. Electrodes in brain decrease impulses decreasing tremors Psychosocial Support ○ YM/YWCA Delay the Disease (in most communities) ○ Michael J Fox Foundation, Parkinson’s Foundation Medications for Parkinson’s Disease ○ Carbidopa-Levodopa [Sinemet] - dopamine promoter ○ Levodopa - increases dopamine in the brain to help control muscle movements. ○ Carbidopa - prevents levodopa from being broken down before it gets into the brain. Enables a lower dose of levodopa. ○ Side Effects: NV, LLL, SCD Nausea and vomiting Loss of appetite Lightheadedness Lowered blood pressure Sleepiness Confusion Dyskinesia (usually develops within 5-10 years) ○ Nursing Implications: Assess pulse and B/P Talk to patient/significant other about fall risk Monitor hepatic/renal function Assess for signs of toxicity: BITS Behavioral changes Involuntary muscle twitching Tardive dyskinesia - lip smacking, tongue protrusion, facial grimacing Spasmodic eye winking Ensure the patient doesn’t take large amounts of iron or Vitamin B6. Large amounts of B6 (pyridoxine) and iron may interfere with the action of levodopa. Should not be taken within 1.5 hours of a protein meal/large amount of B6 ○ ○ If a patient complains of sleepiness → suggest to the doctor to take an enhancer (Selegiline) to lessen the amount of Sinemet. Selegiline - MAOI (antidepressant) that can also treat Parkinson's. If patient is having an off day and needs to do PT or be active, suggest Inbrija (takes 10 minutes to work/ works for 50 minutes) INBRIJA - an inhaled prescription of levodopa medicine used to treat the return of Parkinson's symptoms (known as OFF episodes) in people with Parkinson's disease who are treated with carbidopa-levodopa medicines. Doesn’t replace the regular carbidopa-levodopa medicines. Since it goes directly into the bloodstream when inhaling, you don’t need carbidopa. Works well if you have a high protein meal because it’s inhaled