Exam #6 Parkinson's Disease
Which statement best describes the pathophysiology of Parkinson disease?
Degeneration of the nigrostriatal dopamine system Parkinson disease presents with degenerative changes in the basal ganglia. Dopamine depletion results from degeneration in the nigrostriatal system. The cause of Parkinson disease is still unknown; it is widely believed that most cases are caused by an interaction of environmental and genetic factors.
A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client?
Imbalanced nutrition: less than body requirements The client's reports suggest that the client's intake of food and fluids may be altered, leading to problems with inadequate nutritional intake. Risk for injury would be more appropriate if the client was experiencing CNS effects. These symptoms are unlikely to affect the client's dentition or skin integrity.
The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem?
Increasing the functional ability of the underactive dopaminergic system Antiparkinson drugs act by increasing the functional ability of the underactive dopaminergic system. The cerebellar pathways, acetylcholine levels and axonal degradation are not components of the etiology of Parkinson disease.
A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease?
"It is characterized by abnormalities in movement and posture." Parkinson's disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and muscular rigidity, postural instability).
A client with Parkinson's disease has been prescribed diphenhydramine 25 mg IV. The nurse knows that the drug must be added to a 50 mL minibag of 0.9% NaCl and that diphenhydramine is available in single-use vials of 50 mg/1 mL. How many mL of diphenhydramine should the nurse add to the minibag?
0.5 mL The drug is available with a concentration of 50 mg/mL and the client requires 25 mg. 25 ÷ 50 = 0.5.
A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action?
Administer the medication as prescribed and monitor for therapeutic and adverse effects This prescription is within recommended parameters. The nurse should administer the medication and monitor the client.
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?
Amyotrophic lateral sclerosis Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.
What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy?
Blurred vision Blurred vision is considered a peripheral anticholinergic effect. Delirium, agitation, and memory loss are considered central effects affecting the CNS.
The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for:
falls Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.
A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect?
involuntary movements. Abnormal and involuntary movements are among the most common and serious adverse effects of carbidopa-levodopa therapy. Increased appetite, thirst, and perspiration are not common adverse effects, and increased mobility is a desired outcome of treatment.
A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies?
"Drugs do not cure these disorders; they instead enhance quality of life." It is most important that clients and their families know that Parkinson's disease as with other movement disorders are chronic, that there is no cure, and that drug therapy only serves to help decrease the severity of the symptoms. Symptoms are not normally eliminated completely. Culture must be considered because of catecholamine-O-methyltransferase (COMT), which affects the absorption of levodopa in the body. Some of the drugs used to treat movement disorders can pose a risk of causing renal or hepatic dysfunction, but not all.
A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine?
With amantadine, excretion is primarily via the kidneys. With amantadine, excretion is primarily via the kidneys, and the drug should be used with caution in clients with renal failure.
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?
Dopamine nigrostriatal system The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.
The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding?
Dysphonia Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.
Which action would be a priority for a client receiving apomorphine?
Monitoring cardiac status Apomorphine is associated with a risk for hypotension and a prolonged QT interval. Therefore, the priority would be to monitor the client's cardiac status closely. The drug is given by subcutaneous injection, not oral administration. Checking for skin lesions would be appropriate for a client receiving levodopa due to its association with melanoma. Palpating the bladder would be appropriate for any dopaminergic agent because of the risk for urinary retention. However, this would not be the priority.
A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply.
Rigidity Tremor Bradykinesia The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement). Tremor is the most visible manifestation of the disorder. The tremor affects the distal segments of the limbs, mainly the hands and feet; head, neck, face, lips, and tongue; or jaw.
For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated?
Levodopa Levodopa is contraindicated in clients with known hypersensitivity to the drug. Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma (because it increases intraocular pressure).
A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route?
Oral Trihexyphenidyl is available only in an oral form.
Entacapone has been recently added to the medication regimen of a client with Parkinson's disease. The nurse should recognize what likely rationale for this change in medication regimen?
The client's Sinemet was likely less effective than in the past Entacapone is an adjunctive agent used to treat Parkinson's disease. It is used with levodopa-carbidopa for clients who are experiencing "wearing off" of drug effects.
The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain?
Parkinson disease In some patients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.
Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding?
Paralysis Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) are characterized by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less-than-normal muscle tone. Hypertonia or spasticity is a condition of excessive tone. Paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.
A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following?
Central nervous system The symptoms of parkinsonism are caused by the depletion of dopamine in the central nervous system. Peripheral nervous system disorders can result from damage to or dysfunction of the cell body, myelin sheath, axons, or neuromuscular junction such as seen in neuropathy. Disorders of the smooth muscle seen affecting the esophagus is a condition called achalasia causing a failure to relax, usually referring to the smooth muscle fibers of the gastrointestinal (GI) tract; causing difficulty swallowing; and a feeling of fullness in the sternal region. Disorders of the skeletal muscle can cause twitching, spasms, and even slow movement called bradykinesia.
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following?
Dyskinesia Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. Bradykinesia refers to an overall slowing of active movement and is a manifestation of the disorder. Micrographia refers to the development of small handwriting as dexterity declines with Parkinson's disease. Dysphonia refers to soft, slurred, low-pitched, and less audible speech that occurs as the disorder progresses.
The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care?
Encourage the client to massage the facial and neck muscles before eating. The client is having difficulty swallowing, which is interfering with nutritional intake. Therefore, the nurse should encourage the client to massage the facial and neck muscles before meals, sit in an upright position during meals, consume a semisolid diet with thick rather than thin liquids (which are easier to swallow), and think through the swallowing sequence. Raising the head of the bed 30 degrees is not high enough. Using specialized utensils would be more appropriate for a nursing diagnosis of self-care deficit, feeding to foster a sense of greater independence and control with eating.
Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells?
Parkinson disease In some clients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.