Parkinsons disease

Question 1

Stage 1 parkinsons

Answer 1

unilateral shaking or tremor of limb

Question 2

stage 2 parkinsons

Answer 2

bilateral limb involvement occurs, making walking and balance difficult

Question 3

stage 3 parkinsons

Answer 3

physical movements slow down significantly affecting walking more

Question 4

stage 4 parkinsons

Answer 4

tremors can decrease but akinesia and rigidity make day to day taks difficult

Question 5

stage 5 parkinsons

Answer 5

client unable to stand or walk and is dependent for all care and might exhibit dementia

Question 6

four characteristics of parkinson’s disease

Answer 6

1. tremor
2. muscle rigidity
3. bradykinesia
4. postural instability

Question 7

why do these symptoms occur:?

Answer 7

overstimulation of the basal ganglia by acetylcholine

Question 8

What does the treatment of PD focus on?

Answer 8

increasing the amount of dopamine or decreasing the amount of acetylcholine in the clients brain

Question 9

Risk factors of PD?

Answer 9

• onset of symptoms between age 40-70
• more common in men
• genetic predisposition
• exposure to environmental toxins and chemical solvents
• chronic use of antipsychotics medication

Question 10

Expected findings

Answer 10

report fatigue

report decreased ability to perform tasks

Question 11

Physical assessment finding of PD (9)

Answer 11

• stooped posyure
• slow gait
• slow speech
• bradykinesia/akinesia
• tremors
• muscle rigidity
• masklike expression
• autonomic symptoms(ortho HTN, flushing, diaphoresis)
• dysphagia

Question 12

Dopaminergics

Answer 12

Levodopa

orally this medication is converted to dopamine in the brain, increasing dopamine levels in the basal ganglia

Question 13

Dopamine agonists are used to do what?

Answer 13

activate release of dopamine

Question 14

dopamine agonist examples

Answer 14

bromocriptine, ropinirole, pamipexole

Question 15

Nursing considerations for dopamine agonists

Answer 15

orthostatic hypotension
dyskinesia
hallucinations

Question 16

What are anticholinergics used for?

Answer 16

anticholinergics are used to block the transmission of acetylcholine in the synapse. In PD it is used to help control tremors and muscle rigidity

Question 17

what kind of drugs are benzotropine and trihexyphenidyl and what do they do?

Answer 17

anticholinergic

Question 18

nursing considerations for anticholinergics

Answer 18

• dry mouth
• constipation
• urinary retention
• acute confusion

Question 19

what is a Catechol O-methyltrandferase (COMT) inhibitor used for?

Answer 19

decreases the breakdown of levodopa, making more available to the brain as dopamine

Question 20

what kind of medication is entacapone?

Answer 20

COMT

Question 21

nursing considerations for COMT

Answer 21

• monitor or dyskinesia/hyperkinesia when used with levodopa
• assess for diarrhea
• dark urine is an expected finding

Question 22

what does Monoamine oxidase- type B inhibitors do?

Answer 22

inhibits monamine oxidase type B activity and increase dopamine levels

Question 23

selegiline and rasagiline are what type of medication?

Answer 23

MOA-B

Question 24

Nursing considerations for MOA-B…

Answer 24

• avoid food with tyramine, which can cause hypertensive crisis
• severe reactions can occur if administered with sympathomimetic, meperidine, and fluoxetine

Question 25

Antivirals such as amantadine do what?

Answer 25

stimulate the release of dopamine and prevent its reuptake

Question 26

Nursing considerations for amantadine?

Answer 26

- monitor for discoloration of the skin that subsides when amantadine is discontinued - client might experience anxiety, confusion, and anticholinergic effects

Question 27

what is deep brain stimulation?

Answer 27

an electrode is implanted in the thalamus. electrical stimulation from the DBS impulses decreases tremors and involuntary movements and can decrease medications required used to control PD.