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Module 4 (MedSurg 2) > Parkinson's > Flashcards

Parkinson's Flashcards

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1
Q

What celebrities are known to have Parkinson’s

A

Muhammad ALI
Michael J Fox

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2
Q

Parkinson’s

A

Chronic, progressive neurodegenerative disease of the CNS

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3
Q

Parkinson’s manifestations primarily in

A

motor dysfunction

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4
Q

Origin in Parkinson’s

A

idiopathic
result of environmental factors and genetic makeup
Family = 15%
risk higher in well water, pesticides, herbicides, chemicals, and rural residences

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5
Q

Parkinson’s is Common

A

males 1.5-2x
begins 40-70 y/o (more comorbidities)

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6
Q

Does Parkinson’s have a cure?

A

no, only manage s/s

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7
Q

Secondary/atypical PD caused by

A

exposure to chemicals
drug-induced (Rx AND illicit)
if removed, then fixed

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8
Q

Parkinson’s is known as the shaking disease but what does not shake

A

their heads

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9
Q

Patho of PD

A

lack of dopamine
Degeneration of dopamine-producing neurons in substantia nigra of midbrain
Disrupts dopamine-acetylcholine balance in basal ganglia
Essential for normal functioning of extrapyramidal motor system

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10
Q

PD have what percentage of neuron loss and what percentage of dopamine decrease

A

60%
80%

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11
Q

Deficit in PD is an imbalance between

A

dopamine and excitatory neurotransmitter Acetylcholine

disturbed tremor and rigidity

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12
Q

Dopamine helps with the functioning of

A

posture
support
voluntary muscles

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13
Q

Onset of PD

A

gradual and insidious with ongoing progression

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14
Q

S/S of PD

A

TRAP**
Tremor resting
Rigidity
Akinesia and/or bradykinesia
Postural instability

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15
Q

Beginning stages of PD s/s

A

mild resting tremor
slight limp
decrease arm swing

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16
Q

Later stages of PD s/s

A

shuffling
propulsive gait with arm flexed
loss of posture

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17
Q

90% of PD pts experience

A

hypokinetic dysarthria (speech abnormality)

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18
Q

What is usually the first sign of PB

A

TREMOR RESTING
minimal
prominent at rest
aggravated by stress and more concentration

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19
Q

PD affects facial muscles causing

A

drooling and risk of aspiration later in the disease

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20
Q

What type of tremors do PD pts have in their hands?

A

pill-rolling

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21
Q

Tremors can extend to

A

diaphragm tongue
lips jaw

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22
Q

What tremor is not associated with PD?

A

essential
- voluntary, rapid frequency, fmailial

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23
Q

Rigidity

A

increase Resistance to passive motion when limbs are moved through their ROM
-cogwheel
contraction
slowness

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24
Q

Cogwheel rigidity

A

Jerky quality**
Like intermittent catches in passive movement of a joint

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25
Sustained muscle contracture
Complaints of **soreness Feeling tired and achy** Pain in the head, upper body, spine, or legs
26
What chair do we want a PD pt to sit in?
hard with arms so they don't slide out
27
Akinesia
Absence or loss of control of voluntary muscle movements
28
Bradykinesia
Slowness** of movement Particularly evident in the loss of automatic movements
29
Loss of automatic movements occur subconsciously and result these classic characteristics of a person with PD
stooped posture masked face drooling festination (shuffling gait)
30
Nonmotor S/S of PD
Depression** and anxiety Apathy Fatigue Pain Urinary retention and constipation** - LOSS OF VOLUNTARY MUSCLE Erectile dysfunction Memory changes
31
What sleep problems do PD pts have?
**Difficulty staying asleep Restless sleep Nightmares Drowsiness during the day REM behavior disorder Violent dreams Potentially dangerous motor activity during sleep
32
PD Complications
Motor symptoms DYSPHASIA = malnutrition and aspiration Orthostatic hypotension (high for falls) Weakness Akinesia Neurologic problems Neuropsychiatric problems **dementia**
33
General debilitation of PD may lead to
pneumonia UTIs skin breakdown
34
If PD pt is going home, then what needs to be done to their house?
declutter/scatter rugs, lower fluids at night to decrease getting up at night and increase fluids in the day, shower chair and hand rails, loose clothes with no buttons, slip on shoes with close toed, hard chair with arm rests
35
Parkinson's is dx by
2/4 symptoms and Positive response to antiparkinsonian drugs
36
PD pts need to think about how to do ordinary things such as
swallowing and blinking
37
Dx PD
**No definitive diagnostic procedures** H&P, med hx, neuro exam and Positive response to antiparkinsonian drugs TRAP 2/4
38
PD Goal
correcting imbalances of neurotransmitters within the CNS improves pt's ability to carry out ADLs
39
Antiparkisonian Drug do either
**Enhance or release supply of dopamine** Antagonize or **block the effects of overactive cholinergic neurons** in the striatum **Dopaminergic or anticholinergic
40
Drug selection and dosages are determined by the
**extent to which PD interferes with work, dressing, eating, bathing, and other ADLs**
41
Dopaminergic
increase dopamine most common in PD **Levodopa**
42
Anticholinergic
Prevent activation of cholinergic receptors Benztropine (Cogentin)
43
Levodopa
effective, but benefits diminish overtime PO rapid absorption
44
Levodopa administered
w/o food Delays absorption not with proteins as the same time as medication is active **Neutral amino acids**
45
Levodopa/carbidopa (Sinemet)
Levodopa is converted to dopamine in the CNS. **Carbidopa prevents peripheral destruction of levodopa**
46
Levodopa/carbidopa (Sinemet) adverse effects
N/V, dyskinesias, postural hypotension, dysrhythmias, psychosis, impulse control, darkened sweat & urine, loss of effect
47
What levels need to be checked for Levo/Carb?
plasma for effectiveness
48
Dopamine Agonists is the 1st choice for
Mild or moderate symptoms only
49
Dopamine Agonists
direct activation of receptors **less effective than levodopa not dependent not compete with proteins lower incidence of response failure less likely to cause dyskinesia
50
Pramipexole (Mirapex) used in
used alone in early PD with LEVODOPA in Later PD
51
Pramipexole (Mirapex) adverse effects with monotherapy
**sleep attacks worse than narcolepsy** nausea, dizziness, daytime somnolence, insomnia, constipation, weakness, hallucinations
52
Micrographia
small handwriting
53
Pramipexole (Mirapex) adverse effects with combined therapy
orthostatic hypotension, dyskinesia, increased hallucinations
54
Anticholinergic
Trihexiphenidyl & Benztropine
55
Anticholinergic
decrease ACh activity *never stop abruptly*
56
Anticholinergic adverse effects
**dry mouth, urinary retention**, tachycardia, blurred vision, constipation, photophobia, confusion, hallucinations *drink water and chew gum for effects*
57
COMT Inhibitors
inhibit metabolism of levodopa in the periphery *no direct effects of own*
58
COMT Inhibitors
Entacapone (Comtan) Tolcapone (Tasmar)
59
Entacapone (Comtan)
w/ levodopa inhibit breakdown of levodopa
60
Entacapone (Comtan) adverse effects
dyskinesia, orthostatic hypotension, N/V/D, hallucinations, sleep disturbances, impulse control disorders, & yellow-orange discoloration of urine
61
Tolcapone (Tasmar)
only if safer agents are ineffective
62
Tolcapone (Tasmar) adverse effects
lasts for 2-3 hours Liver failure, dyskinesia, orthostatic hypotension, nausea, hallucinations, sleep disturbances, & yellow-orange urine
63
MAO-B Inhibitors
1st line drug for PD benefits modest combo with levodopa reduces wear off
64
Selegiline Rasagiline are what type of drug
MAO-B Inhibitors
65
Selegiline (Eldepryl) MOA
inhibit the breakdown of dopamine benefits decline with 2-4 months constant change in meds **given breakfast and lunch not later can cause insomnia**
66
Selegiline (Eldepryl) adverse effects
**insomnia**, dry mouth, orthostatic hypotension, dizziness, hypertensive crisis, & GI symptoms
67
Rasagiline (Azilect)
initial and with levo preserve dopamine
68
Rasagiline (Azilect) PD pts need to avoid
processed foods high in Tyramine or can cause a hypertensive crisis
69
Rasagiline (Azilect) adverse effects
insomnia, orthostatic hypotension, irritation of buccal mucosa, **hypertensive crisis**
70
Other drugs to help with PD
An antihistamine with anticholinergic to manage tremors antiviral apomorphine for hypomobility
71
A pt taking levo/carb for PD experiences requires “on-off” (i.e. abrupt loss of effect). Which action by the nurse is best? Administer med when pt has an empty stomach Instruct pt to avoid high-protein foods Have the pt increase the intake of vitamin B6 D/C the drug for 10 days
Instruct pt to avoid high-protein foods
72
Nurse is caring for a pt who us receiving pramipexole. The nurse is most concerned if the pt makes which statement? Take even when I feel good Sometimes I just fall asleep w/o warning The pills make me sleepy, so they take in the afternoon Causes constipation
Sometimes I just fall asleep w/o warning
73
What type of surgical therapy can be used for PD
**only if unresponsive to drug therapy** Deep Brain Stimulation Ablation (Destruction) Thalamotomy - removing part of the thalamus Pallidotomy Subthalamic nucleosome Transplantation
74
Does Levodopa break down easily?
yes That is why combo drugs are given to increase the effects
75
Deep Brain Stimulation
*reversible and programmable* most common pacemaker for the brain decrease neuron activity produced by DA depletion improve motor function reduces dyskinesia and meds
76
Ablation surgery
Locate, target, destroy area of brain affected by PD** Destroys tissue that produces abnormal chemical or electrical impulses leading to tremors or other symptoms
77
Transplantation
fetal neural tissue into the basil ganglia - DA producing cells into the brain still ongoing
78
Nutritional Therapy for PD
Malnutrition and constipation (FIBER) with dysphagia and bradykinesia need food that is easily chewed & swallowed **Numerous and small meals with ample time**
79
Nursing Dx of PD
Self-care deficit **Parkinson's dementia** Abradykinesia Impaired verbal communication Impaired swallowing Max neuro function. **Maintain independence** in activities of daily living (ADLs) for as long as possible. - ROM psychosocial well-being. - groups Administer medications as prescribed Facilitate nutritional intake **Interdisciplinary collaboration: PT, OT, Speech**
80
B vitamins are high in
proteins

Module 4 (MedSurg 2) (36 decks)

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