Parkinson's Disease

What does tremor look like in PD?

"pill-rolling" tremor - thumb and forefinger appear to move in a rotary fashion as if rolling a pill

For the patient with Parkinson's disease who has difficulty swallowing, which intervention would the nurse initially include in the patient's plan of care? 1. Arrange for someone to feed the patient. 2. Provide the patient with semisolid or soft foods. 3. Encourage the patient to drink fluids with meals. 4. Place food into the unaffected side of the patient's mouth.

2 Rationale: - In Parkinson's disease, the patient may have poor control of the tongue, increasing the risk for aspiration. Semisolid food without lumps and thickened liquids stick together, allowing the tongue to direct the food bolus to the back of the mouth. Encourage the patient to self-feed to maintain independence and function. Clear fluids with meals at any time may present a risk of aspiration if there is difficulty swallowing. Parkinson's disease likely affects the tongue and entire mouth, so placing food into the unaffected side of the patient's mouth is not an appropriate choice.

Regarding the patient with Parkinson's disease (PD) who recently entered a long-term care facility, which action would the health care team implement to promote adequate nutrition for this patient? 1. Provide multivitamins with each meal. 2. Provide a diet low in complex carbohydrates and high in protein. 3. Provide small, frequent meals throughout the day that are easy to chew and swallow. 4. Provide the patient with minced or pureed diet, high in potassium and low in sodium.

3 Rationale: - Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal; and the patient's vitamin intake, along with protein intake, will be monitored to prevent contraindications with medications. It is premature to introduce a minced or pureed diet at this time, and a low-carbohydrate diet is not indicated.

The nurse is instructing a client with PD about preventing falls. Which client statement reflects a need for further teaching? 1. I can sit down to put on my pants and shoes 2. I try to exercise every day and rest when I'm tired 3. My son removed all loose rugs from my bedroom 4. I don't need to use my walker to get to the bathroom

4

When evaluating the presence of an initial symptom of Parkinson's disease, which clinical manifestation would the nurse evaluate? 1. Akinesia 2. Aspiration 3. Forgetfulness 4. Pill-rolling tremors

4 Rationale: - Early symptoms of Parkinson's disease include coarse resting tremors of the fingers and thumb, also known as pill-rolling movements. Akinesia (complete or partial loss of muscle movement), aspiration, and mental deterioration occur later in the disease process.

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

A Pt teaching: - It is PRIORITY to teach the patient to not take this medication when they be driving or operating machinery etc...to prevent injury.

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

A Rationale: - Anticholinergic medications are contraindicated in pts with glaucoma

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

A Rationale: - This option is the only one that is INCORRECT. Tremors in Parkinson's Disease tend to occurs at rest and will actually improve with movement.

True or False: Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease.* A. True B. False

B Rationale: - Parkinson's Disease most commonly affects patients in OLDER adulthood (60 or older), and there is currently no cure for the disease.

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

B, C, E, F, H Rationale: - These are all signs and symptoms experienced with PD (they vary among patients). There is NOT increased salivation (although drooling occurs...this is due to the decreased ability to swallow). There are tremors at REST (not purposeful movement) along with depression rather the euphoria.

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

B, D Rationale: - Constipation (not diarrhea) is a common symptom of Parkinson's Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods high in fiber like fruits/vegetables and drinking 2 L of fluid per day (unless contraindicated). In addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient should NOT take this medication with a protein-rich meal because levodopa competes with protein in the small intestine (hence decreasing its absorption).

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

C Rationale: - All the other options are CORRECT about this medication. However, the patient should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of this medication.

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this from happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

C Rationale: - Entacapone "Comtan" (is a catechol-O-methyltransferase inhibitor) and is used with levodopa/carbidopa to prevent the "wearing-off" of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.

What is levodopa action?

Converted to dopamine in the brain

What is the benefit of MRI and CT in diagnose PD?

It can rule out a stroke, brain injury, or brain tumor

What is the primary medication for tx of symptomatic clients?

Levodopa with carbidopa -> Sinemet

What is TRAP stands for?

Tremors Rigidity Akinesia Postural inability

Parkinson's disease is a degenerative disease caused by the depletion of what neurotransmitter?

dopamine

What is the purpose of carbidopa?

inhibits enzyme dopa-decarboxylase that breakdown levodopa before it reaches the brain

What teaching should nurse include in patients taking levodopa?

limit evening protein before dose and B6, which can interfere with absorption