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Flashcards in parkinson's disease Deck (24):
1

incidence of PD

increases with age with peak onset in 70s
More common in men (3:2 ratio)

2

risk factors

Family history
Hydrocephalus, hypoxia, infections, stroke, tumor, trauma and certain drugs/chemical intoxications

3

role of dopamine

-Inhibitory neurotransmitter involved in mood and the normal functions of the extrapyramidal motor system, including posture, support and voluntary motion
-Loss of dopamine activity in some portions of the brain leads to the muscular rigidity

4

role of acetylcholine

-Excitatory neurotransmitter that makes cells more excitable
-Governs muscle contractions and causes glans to secrete hormones

5

what is PD

Loss of dopamine in the substantia nigra, which results in an imbalance between dopamine and acetylcholine

6

hallmark features

tremor
rigidity
bradykinesia
postural instability

7

tremor

“resting tremor” more common at rest, aggravated by stress
1. “Pill rolling”
2. Jaw, may affect the feet

8

rigidity

increased resistance to passive motion
1. “Cogwheel rigidity” (i.e. intermittent or “jerky” motions)
2. Results in slowness of movement and muscle soreness from sustained muscle contractions

9

bradykinesia

-lack of spontaneous autonomic, involuntary movements
-Results in: masked face, drooling, shuffling, stooped posture

10

additional clinical manifestations

1. Depression
2. Apathy or anxiety
3. Fatigue
4. Pain
5. Constipation r/t immobility, difficulty swallowing
6. Short-term memory impairment
7. Dementia
8. Sleep disorders

11

PD diagnostics

1. No specific tests for Parkinson’s
2. Dx made on clinical presentation (two or three hallmark characteristics)

12

pharmacologic management

dopaminergic
anticholinergic
sinemet
dopamine receptor agonists

13

dopaminergic

enhance release or supply of dopamine

14

anticholinergic

block the effect of cholinergic neurons

15

sinemet

Levodopa is a precursor of dopamine, crosses blood brain barrier
Carbidopa: inhibits the enzyme which breaks down levodopa before it reaches the brain
May become less effective over time

16

dopamine receptor agonist

Bromocriptine (Parlodel)

17

surgical interventions

Reserved for those unresponsive to drug therapy or those with severe motor complications
ablation surgery
deep brain stimulation

18

ablation surgery

“destroy” stereotactic ablation of involved areas; non-reversible

19

deep brain stimulation

places an electode in area and connects to a generator in the upper chest which delivers a specific current decreasing neuronal activity produced by dopamine depletion
-Allows for adjustments to be made

20

PD nursing diagnoses/problems and interventions

impaired physical mobility
self care deficits
constipation
risk for aspiration/impaired swallowing
imbalanced nutrition
impaired Verbal Communication
Risk for Falls r/t postural instability
Knowledge Deficit
Impaired Social Interactions
Activity Intolerance
Risk for Injury

21

impaired physical mobility

Squeeze a small rubber ball or hold change in pocket
Use both hands to accomplish tasks
Rationale: voluntary movements can stop or reduce tremors
Encouraging morning exercise
Encourage client to avoid soft, deep chairs and soft mattresses
Rationale: firmer chairs and mattresses are easier for the client to get up from and out of

22

self care deficits

assistive devices: Velcro, elasticized clothing, etc. (allow extra time)

23

imbalanced nutrition

Swallow saliva often
Keep head upright
Chew hard; move food around with tongue
Finish one bite before another
Rest periods during meals
East slowly, taking small bites

24

prognosis/cure

-No cure
-Not fatal, but there is no cure
-Progresses more quickly in older than younger patients
-Can seriously impair the QoL in any age group
-Treatment advances are increasingly effective in alleviating sx and slowing disease progression
-May lead to severe incapacity within 10 to 20 years
-Older patients also experience freezing and greater decline in mental function and daily functioning