Mobility: Parkinson's Disease

dx of PD

2 out of 3 (tremors, rigidity, bradykinesia) -postural instability later in progression of disease -motor s/s begin unilaterally, progress to bilat

A nurse is providing care for a client with Parkinson disease. When assessing the​ client's current​ condition, about which items should the nurse​ ask?

Bowel changes Cognitive deficits Response to medication -It is important to ask the client about responses to​ medication, especially any​ "on-off" or​ "wearing off" effects that indicate that medication is losing its effectiveness. The client will also have cognitive deficits such as memory​ loss, slowed​ thinking, and​ confusion, which eventually progress to dementia. The client with Parkinson disease​ (PD) has problems with peristalsis. This contributes to​ constipation, as does poor nutrition caused by tremors and dysphagia. Clients with PD have difficult falling and staying asleep rather than​ too-deep sleep. Postural hypotension is common in Parkinson​ disease, resulting in blood pressure that drops when the client stands​ up, not sits down. Dizziness is a symptom of postural hypotension.

A nurse is assessing a client with Parkinson disease. The nurse monitors the client for which potential complications of Parkinson​ disease?

Choking Falls Impaired memory Pressure ulcers

diagnostics

DaTscan: binds to dopamine transporters (DaT), shows less uptake; distinguishes between essential tremor and stuff d/t parkinsonisms; won't distinguish between PD and other dopamine degenerative disorders MRI/CT: Rule out other causes of symptoms (PD-normal results) blood tests: to rule out

A​ client, newly diagnosed with Parkinson​ disease, asks the nurse what dopamine does in the brain. What is the appropriate response by the​ nurse?

Dopamine helps maintain coordinated motor​ movement -Dopamine is responsible for coordination. It balances the neurotransmitter​ acetylcholine, which stimulates the neurons. Dopamine prevents this stimulation from becoming excessive. Dopamine provides regulation rather than stimulation. Dopamine regulates motor neuron impulses and balances acetylcholine. Dopamine only works on certain brain neurons located in the basal​ ganglia, not the spinal cord. Dopamine minimizes and balances the effects of​ acetylcholine, not enhances it.

A nurse is preparing a presentation on Parkinson disease for a health fair at a local community center. What would the nurse include in this​ presentation?

Parkinson disease usually affects people older than the age of 60 years. Parkinson disease affects at least​ 500,000 individuals in the United States. -Parkinson disease affects at least​ 500,000 individuals in the United States​ alone, with​ 50,000 new cases in the United States each year. Parkinson disease is more common in people older than the age of 60 years. Parkinson disease can also occur in younger​ people, but this is less common. Parkinson disease affects men more than women. The cause of Parkinson disease is not known. It is inherited in only​ 15-25% of cases. There is no evidence of an infection that causes Parkinson disease.

A client is taking​ carbidopa-levodopa (Sinemet) to help control the manifestations of Parkinson disease. The client is experiencing brief periods of sudden onset of manifestations followed by a return to improved function. What is causing this sudden change in​ manifestations?

Sinemet can cause episodes of manifestations followed by return to improved​ function, also known as the​ on-off phenomenon. These episodes can last from minutes to hours. This can sometimes be prevented by increasing the number of doses per day. Medication withdrawal can cause severe muscle​ rigidity, tremor, and mental changes. The manifestations do not improve until the drug is administered and enters the client​'s blood stream. Insufficient blood levels cause poorly controlled manifestations. The manifestations do not improve until medication is administered. Adverse effects of Sinemet include involuntary​ movement, suicidal thoughts and euphoria. These manifestations do not improve until the medication is stopped.

A nurse has completed teaching for an older adult male client and his wife about placement of a deep brain stimulator. Which statement by the wife indicates a need for further​ instruction?

This device means my husband won​'t have to take medication​ anymore -The statement​ "This device means my husband won​'t have to take medication​ anymore" indicates that the wife needs further instruction concerning the brain stimulator. Clients who have a deep brain stimulator placed may still need low doses of medication. The stimulator does not completely control the​ manifestations, such as tremors. The statement​ "The device does not cure Parkinson​ disease" indicates that the wife understands the procedure and does not need further instruction. The stimulator does not cure Parkinson disease. It will help control tremors in clients who are not receiving sufficient control with medications. The statement​ "The device makes electrical impulses to stimulate his​ brain" indicates that the wife understands how the stimulator works. The deep brain stimulator creates electrical impulses that stimulate the brain in specific areas. The impulses block the effects of acetylcholine that cause the tremors. The statement​ "This device helps block a chemical in my husband​'s ​brain" indicates that the wife understands the stimulator will act to block the chemical​ acetylcholine, which is causing the client​'s tremors.

Risk factors:

age: onset at 60 (increases with age) gender: M (50%+) environment: rural areas, working in certain professions genetic: 15-25% have a relative (moreso if onset is early or juvenile)

non-motor S/S of PD

cognitive deficits: slowed thinking, confusion, memory loss, (later) Parkinson dementia emotional changes: depression, fear, anxiety, panic attacks, social withdrawal, apathy sleep problems: insomnia, daytime sleep attacks, Restless leg, parasomnias, rapid-eye movement constipation, bladder probs sexual dysfunction skin probs (seborrhea- dandruff; hyperhidrosis- excess sweating) anosmia- decreased ability to smell orthostatic hypotension pain/discomfort

Parkinsonism

combo of motor symptoms seen in PD - not all have actual PD -meds, head trauma, other neurodegenerative disorders -s/s have NOT improved with meds- parkinsonism dx

surgery

deep brain stimulation: decrease s/s, lower meds pallidotomy: destroys basal ganglia; improves motor thalamotomy: destroys thalamus; reduce tremor

prevention:

hi diet in fruits and veggies avoid herbicides and pesticides mod amts of green tea and caffeine Vit C, D, E Co-Q10 Creatine Stilbenes

PT

lower body improves walking prevent contractures and falls improves transfers edu in assistive devices- walker, cane

Clinical Manifestations

mild at first, worsen over time Tremor: trembling at rest; "pill-rolling" Rigidity: cog-wheel Bradykinesia: drooling, speech issues, lengthy pauses during speech, hypophonia (lower voice vol) Postural Instability: stooped posture can lead to instability and falls (retropulsion-tendancy to topple over), festination (rapid steps), Parkinsonian gait (small, shuffling steps), freezing micrographia- small cramped writing dystonia- twisting, repetitive movements oculogyric crisis- eyes stayed rolled up in head (like OD)

ST

speech and swallowing communication/nutrition assistive- magic slate, pen grips

OT

upper extremities- finger fxn independent ADLs assistive- button hooks, electric razors