Parkinsons

Question 1

what is Parkinsons?

Answer 1

chronic progressive neurodegenerative dz od CNS

Question 2

primary manifestation is in

Answer 2

motor dysfunction

Question 3

more common in which gender

Answer 3

males

Question 4

cause?
might be related to

Answer 4

unknown
environmental factors/genetics

Question 5

secondary/atypical parkinsons

Answer 5

-exposed to chemicals
-drug induced (prescribed, illicit)

Question 6

lack of dopamine

Answer 6

-essential for normal functioning
-disrupts dopamine-acetylcholine balance in basal ganglia
-symptoms appear with 60% neuron loss and 80% dopamine decrease

Question 7

clinical manifestations

Answer 7

TRAP
tremor
rigidity
akinesia / bradykinesia
postural instability

Question 8

beginning stages symptoms

Answer 8

mild tremor, slight limp, decreased arm swing

Question 9

what kind of tremor?

Answer 9

resting tremor

Question 10

later stages symptoms

Answer 10

shuffling, propulsive gait w arms flexed, loss of postural reflexes

Question 11

tremor

Answer 11

-often 1st sign
-initially minimal
-more prominent at rest
-aggravated by : emotional stress, increased concentration

Question 12

tremor is also called

Answer 12

pill rolling hand tremor

Question 13

tremor will eventually effect

Answer 13

diaphragm, tongue, lips, jaw

Question 14

rigidity is

Answer 14

increased resistance to passive motion when limbs are moved through ROM

cogwheel rigidity

Question 15

akinesia

Answer 15

absence or loss of control of voluntary muscle movements

Question 16

bradykinesia

Answer 16

slowness of movement
particularly evident in loss of automatic movements

Question 17

loss of automatic movements

Answer 17

-stooped posture
-masked face
-drooling
-festination (shuffling gait)

Question 18

nonmotor symptoms

Answer 18

-depression/anxiety
-apathy
-fatigue
-pain
-urinary retention and constipation
-ED
-memory changes

Question 19

________ problems are common

Answer 19

sleep

Question 20

T or F ; pt can get “parkinsons dementia”

Answer 20

true

Question 21

complications ________ as dz ________

Answer 21

progress
progress

Question 22

dysphagia may result in

Answer 22

malnutrition/aspiration

Question 22

debilitation may lead to

Answer 22

pneumonia, UTI, skin breakdown

Question 23

is pt at risk for falls and injuries? why?

Answer 23

yes, orthostatic hypotension is a complication

Question 24

is there a definitive diagnostic procedure?

Answer 24

NO

Question 25

how do we diagnose?

Answer 25

-pt history, clinical features -2+ TRAP -medical hx, symptoms, neuro exam -postive response to antiparkinsonian drug

Question 26

drug therapy is aimed at

Answer 26

correcting imbalances of neurotransmitters within CNS

Question 27

antiparkinsonian drugs either

Answer 27

-enhance or release dopamine -antagonize or block effects of overactive cholinergic neurons

Question 28

most commonly used drugs for PD are

Answer 28

dopaminergic agents

Question 29

dopaminergic agent- most common

Answer 29

levodopa

Question 30

anticholinergic agent

Answer 30

benztropine

Question 31

levodopa is _____________, but benefits ______ over time

Answer 31

highly effective diminish

Question 32

what form is levodopa

Answer 32

PO - absorbed in intestine

Question 33

does food delay absorption of levodopa? which food reduce therapeutic effects?

Answer 33

yes - high protein

Question 34

levodopa/carbidopa what does carbidopa do?

Answer 34

help levodopa cross BBB

Question 35

dopamine agonists are first choice for

Answer 35

mild or moderate symptoms

Question 36

dopamine agonists do not compete with

Answer 36

dietary protein

Question 37

pramipexole is used alone in _________ and with ______ in advance PD

Answer 37

early PD levodopa

Question 38

pramipexole alone can cause

Answer 38

sleep attacks

Question 39

anticholinergic meds

Answer 39

trihexiphenidyl and benztropine

Question 40

MOA of trihexiphenidyl and benztropine

Answer 40

decreases activity of ACh

Question 41

never stop med abruptly, why?

Answer 41

can have rebound effect

Question 42

COMT inhibitors inhibit

Answer 42

metabolism of levodopa in periphery (cross BBB)

Question 43

COMT inhibitors

Answer 43

entacapone tolcapone

Question 44

entacapone is used with because?

Answer 44

levodopa - inhibits breakdown of levodopa in periphery

Question 45

tolcapone use with helps

Answer 45

levodopa extend effects of levodopa up to 3 hrs a day

Question 46

MAO-B inhibitors are considered can be given with

Answer 46

first line drugs for PD levodopa - reduces wearing off effect

Question 47

MAO-B inhibitors

Answer 47

-selegiline -rasagiline

Question 48

selegiline can be given early on as ________ or later with ________

Answer 48

mono therapy levodopa

Question 49

parkinsons pt will have multiple

Answer 49

changes or adds of medicines

Question 50

rasagiline is used for _______ therapy and for combined use with ______

Answer 50

initial levodopa

Question 51

other things used to manage PD

Answer 51

-antihistamines : tremors -antiviral agent amantadine -amorphine : hypo mobility

Question 52

surgery (last resort)

Answer 52

-deep brain stimulation : most common -ablation -tranplantation (stem cell - not approved)

Question 53

care for PD

Answer 53

nutrition (malnutrition, constipation) (dysphagia, bradykinesia) (adequate fiber) (more numerous small meals)

Question 54

nursing diagnoses

Answer 54

-self care deficity -chronic confusion -impaired physical mobility -impaired verbal communication -impaired swallowing -risk for imbalanced nutrition

Question 55

nursing management

Answer 55

-maximize neuro function -maintain ADL -optimize psychosocial well being -administer meds -nutrition -PT, OT, SpeechT