Download Parkinson`s

Adult Health II
Neurological Diseases
Jerry Carley RN, MSN, MA, CNE
Summer, 2010
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Concept Map: Selected Topics in Neurological Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
Diagnostic Testing
PATHOPHYSIOLOGY
PHARMACOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Huntington’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
--Decrease ICP
--Disease /
Condition
Specific Meds
A-D-O-P-I-E
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D O_P_I_E
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary
 Progressive
 Grossly
affects motor function
 Symptoms
of Parkinson's disease may appear
at any age, but the average age of onset is 60
 Rare
in people younger than 30, but 5% - 10%
of pts experience symptoms before the age of
40
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 Normally
Dopamine & Ach neurotransmitters
work together to enable motor neurons to
refine voluntary movement
 Parkinson's
results from the degeneration of
dopamine-producing nerve cells in the
brain, specifically in the substantia nigra and
locus coeruleus
 Clients
have lost 80% or more of their
dopamine-producing cells by the time
symptoms appear
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1)
Tremors (at rest)
2)
Muscle Rigidity (may produce muscle pain, expressionless,
mask-like face, difficulty chewing)
3)
Bradykinesia (slow movement)
4)
Cognitive impairment (mood swings…dementia)
5)
Postural instability:
- Falls are common
- Poor balance
- Stooped posture
- Difficulty walking (slow, shuffling, propulsive gait)
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 Based
on symptoms and ruling out other
disorders that produce similar symptoms
 Must
have two or more of the primary
symptoms, one of which is a resting tremor or
bradykinesia
 Often
diagnosis is made after observing that
symptoms have developed and become
established over a period of time
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 There
is no cure for Parkinson's disease
 Treatment
centers on relieving symptoms
 meds
 surgery or surgically implanted device
that lessens tremors
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Dopamine Replacement / Agonists

Levodopa (DOPAR)
- can become ineffective over time
- abnormal movements (dyskinesias)

Levodopa and carbidopa combined (Sinemet®) is
the mainstay of Parkinson's therapy

Side effects: gastrointestinal distress, especially
early in treatment, hypotension, and dyskinesias

Slow dosage adjustment and taking medication with
food can reduce these effects and using lowest
effective dose may prevent or delay appearance of
motor dysfunction
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Dopamine Agonists
 Parlodel
 Mirapex
(pramipexole)
 Side
effects: hypotension
and hallucinations
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
Dopamine Agonists
Dopamine agonists mimic dopamine's function in the brain. They are used primarily as adjuncts to
levodopa/carbidopa therapy. They can be used as monotherapy but are generally less effective in
controlling symptoms with Side effects similar to those produced by levodopa
- Bromocriptine (Parlodel®)
- Pergolide (Permax®)
- Pramipexole (Mirapex®)
- Ropinirole (Requip®)


MAO-B Inhibitors
Dopamine is oxidized by monoamine oxidase B (MAO-B). Selegiline (Carbex®) inhibits MAO-B,
increasing the amount of available dopamine in the brain. MAO-B inhibitors boost the effects of
levodopa
Anticholinergics reduce the relative overactivity of the neurotransmitter acetylcholine to balance
the diminished dopamine activity. This class of drugs is most effective in the control of tremor, and
they are used as adjuncts to levodopa. Side effects associated with anticholinergic drugs include dry
mouth, blurred vision, constipation, and urinary retention
- Benztropine mesylate (Cogentine®)
- Biperiden (Akineton®)
- Diphenhydramine (Benadryl®)
- Trihyxyphenidyl (Artane®)

COMT (catechol-O-methyl transferase) Inhibitors
These new class of Parkinson's medications augment levodopa therapy by inhibiting the COMT
enzyme, which metabolizes levodopa before it reaches the brain. Inhibiting COMT increases the
amount of levodopa that enters the brain. These drugs are only effective when used with levodopa
- Entacapone (Comtan®)
- Tolcapone (Tasmar®)
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 It
is imperative that patients inform their
physician of any over-the-counter
medications, herbs, or other supplements
that they use on a regular basis, because
they may interact with medication and
because drug dosages may need to be
adjusted
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 Surgery
may control symptoms and
improve quality of life when medication
ceases to be effective or when medication
side effects, such as jerking and
dyskinesias, become intolerable
 Only
about 10% of Parkinson's patients are
estimated to be suitable candidates
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• Ablative Surgery
- This procedure locates, targets, and then destroys (ablates) a clearly
defined area of the brain affected by Parkinson's
- The object is to destroy tissue that produces abnormal chemical or
electrical impulses that produce tremors and dyskinesias
- This type of surgery involves either pallidotomy or thalamotomy
- A related procedure, cryothalamotomy, uses a supercooled probe
that is inserted into the thalamus to freeze and destroy areas that
produce tremors
• Deep Brain Stimulation (DBS)
- DBS targets the subthalamic nucleus, which is located below the
thalamus and is difficult to reach, the globus pallidus, or the thalamus
- Targeted region is inactivated, not destroyed, by an implanted
electrode
• Transplantation or Restorative Surgery
- In transplantation, or restorative, surgery dopamine-producing cells are
implanted into the striatum
- The cells used for transplantation may come from one of several
sources: the patient's body, human embryos, pig embryos
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

Goal = help relieve symptoms & improve quality of life
Physical therapy can help strengthen and tone underused muscles, and
give rigid muscles a better range of motion. The goal is to help build
body strength, improve balance, overcome gait problems, and improve
speaking and swallowing

Simple physical activity such as walking, gardening, and swimming can
improves one's sense of well-being

Gentle, soothing massage techniques may provide relief from muscle
rigidity and may have some neuromuscular benefit as well

The slow flowing movements of Tai Chi help maintain flexibility, balance,
and relaxation


Support groups provide a caring supportive environment in which
patients and their loved ones can ask questions about Parkinson's,
expressing their frustrations, and obtain advice about coping with and
treating symptoms from people who share the same problem
Parkinson's appears to progress more slowly in those who remain
involved in activities that they enjoyed before the onset of symptoms and
in those who engage in new interests
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