Parkinson's

Parkinson's

• dec levels of dopamine (neurotransmitter) which is needed for voluntary movement
• impairment of extrapyramidal (pathways) tracks which control and regulate movement

• really unknown
• some cases caused by toxins:
• -Manganese-a metal (helps with bone metabolism, in bran, beets, peas)
• -carbon monoxide

• slowly progressive and debilitating
• does not led to paralysis
• intellect, sight, and hearing are intact

• three cardinal sx
• rigidity (stiffness in extremities)
• -cogweel-jerky, slow movement, requires more effort
• -handwriting becomes jerky

• bradykinesia
• -one of the most common features
• -slower voluntary movements
• -longer to complete activities
• -difficulty initiating movement such s rising from a sitting position or turning in bed

• resting tremors
• -tremors when they aren't doing anything
• -rolling motion with fingers

• mask-like facial expressions (hypomimia) with associated:
• -difficulty chewing, dysphagia (swallowing), dysarthria (speaking)
• -drooling esp. at night

• posture and gait impairment
• -stooped posture, semi-flexed forearms (don't swing while walking)-loose balance
• -slow shuffling gait-lean forward and shuffle
• -difficulty maintaining balance

• weakness/fatigue
• -fatigue with ADLs
• -weak monotone, low volume voice=dec in dopamine

• other
• -flat affect, they often have depression
• -excessive sweating on face and neck
• -constipation from inc in GI motility and immobility
• -urinary frequency and hesitancy
• -dementia-usually with older pts who do not respond well to Levodopa therapy-depends on loss of neurons, not everyone will get
• -orthostatic hypotension-impaired vascular smooth muscle response

• on to SXS, HX, no tests
• fir dx when person has at least 2 of the 3 cardinal sx and if positive response to drugs seen, then dx made

• used for ppl that are unresponsive to drug therapy or have developed severe motor complications
• destroy tissue that causes tremors

destruction of areas in the thalamus by stereotactic procedures (freezing, electric)

electrode in the thalamus or other areas and connect it to a generator in the upper chest (like pacer)-delivers current to the targeted brain location-adjust to control sx and can be removed

• transplant fetal neural tissue in to the basal ganglia, hopefully this tissue grows and produce cells that produce the needed dopamine
• -legal, ethical issues

• anticholinergic
• up to 6 mg/day

reduces cholinergic activity, dec involuntary movements

• adverse reactions:
• inc P
• postural LBP
• HA
• dizzy
• dry mouth
• constipation
• urinary retention

• nsg care:
• glacoma, urinary obstruction? with glacoma, can inc intraocular pressure
• -avoid rapid position changes, extreme heat-can perspire
• -gum hard candy, frequent mouth care
• -fluids, bulk needed

• dopar-8 g/day
• Sinemet

stimulates dopamine production or increases sensitivity of dopamine receptors, replaces dopamine

• adverse reactions:
• -involuntary movements
• -N/V
• -hallucinations
• -dec BP

• nsg care:
• -drugs may take months to achieve desired effects
• -take with food
• -warn to avoid sudden position changes
• -avoid foods high in vit B6 like pork, tuna, liver, milk, eggs, cheese, dried beans, and nuts
• -insomnia
• -sleep attacks
• -risk taking-gambling, sex

• antiviral
• Symmetrel-400 mg/day

• dec rigidity and tremors
• stimulates dopamine production or inc sensitivity of dopamine receptors

• adverse reactions:
• involuntary movements
• -N/V

• nursing care
• -avoid foods high in vit B6
• -drowsiness
• -take with food

• parlodel
• permax
• requip and mirapex-newer

newer drugs require lower dosage;enhance response; minimize adverse reactions

• adverse reactions
• -involuntary movements
• -N/V
• -hallucinations
• -dec BP

• nursing care:
• drowsiness
• take with food
• sleep attacks
• risk taking:gambling, sex

inhibits enzyme that breaks down L-dopa, thus expands its action

• adverse reactions
• -hallucinations

use with dopamine agonists if sxs not responding

• adverse reactions
• -confusion
• -dizziness
• -nausea
• -dry mouth
• -insomnia

• nursing care:
• not an option if on antidepressants
• causes hallucinations in elderly

*dopar-levodopa

*parlodel-bromocriptoine mesylate


permax-pergolide


eldepryl-selegiline


symmetrel-amantadine


cogentin-benztropine


*sinemet-carbidopa/levodopa


requip-ropinirole


mirapex-pramipexole


artane-trihexyphenidyl

• takes months to see changes
• avoid foods high in vit B6
• -breaks down L-dopa
• -foods high in vit B6-pork, tuns, liver, milk, eggs, cheese, dried beans, nuts

• may cause insomnia-take in the morning or earlier like at supper, before bed, limit caffeine, stimulants
• may initially cause drowsiness, no driving until under control
• cause dark urine and sweat
• on-off phenomenon
• -may suddenly not work and then start to work again
• -drug holiday-be off certain drug for awhile, then may be restarted or add another combination
• -eventually drugs do not work

• most pts will develop dyskinesia w/i 5-10 yrs
• -made naturally in the body, used by cells to produce energy and as an antioxidant
• -1200 mg/day helps to decrease deterioration in feeding, dressing, bathing, walking-helps prolong ADLs

• Parkinson's crisis
• -rapid withdrawal of meds
• -sxs: tremors, rigidity, akinesia, inc P, anxiety
• -treat-:cardiac/resp support, quiet room, subdued lights

goal-improve mobility-very important, safe environment

• interventions-ROM bid-qid
• -encourage finger exercises-tearing paper, jingling coins, playing piano, typing

• gait training
• -wide base-helps balance better, "goose step"
• -pick up feet and walk side to side
• -swing arms when walking
• -get up quickly from char but sit down slowly-move in one motion, if low BP can't do-prevents freezing
• -assistive devices
• -safety precautions at home-perform most strenuous activity when drug action peaks
• -ambulate qid, do not do prolonged rest periods

• goal-improve nutrition
• interventions:
• small feedings-semisolids, soft, pureed-add thick it
• 6 small meals
• fiber/fruit-maintain bowel function
• high calorie foods or supplements to maintain weight
• may need to limit PRO, B6 if on Levodopa
• precautions when eating-may aspirate
• sit up concentrate on swallowing-risk of aspiration, give time to eat
• allow pt to feed self until tired-then feed pt
• watch hot foods/liquids, can burn self
• bite size
• suction available
• quiet environment

• goal-improve bowel function, have regular BMs
• 2-3 L fluid
• high fiber
• stool fibers
• raise toilet seat
• establish regular bathroom schedule

• goal-improve communication
• facial exercises to maintain facial tone
• -make faces, sing, read
• allow time, don't rush
• alternative communication
• speech consult
• yes/no questions

• goal-enhance self-care activities
• bathe in morning and night to relax muscles
• -warm not too hot, at night-helps them sleep
• encourage to do what able to do, after meds
• velcro not buttons, slip on shoes
• SAFETY

• schedule appointments/activities late morning so not rushed
• OR schedule for peak activity of medication

**remember to bring in other departments-OT, PT, speech, whatever you need for their help and assistance

HESI hints-NCLEX questions often focus on features of the disease: tremors, rigidity, hypertonicity, stooped posture and safety