Parkinson's Disease: Prepared by Bhawana Shrestha

Parkinsons Disease
Prepared by Bhawana Shrestha
Definition
Parkinsons disease is a slowly progressive degenerative neurologic disorder characterized by tremor, rigidity and bradykinesia (abnormally slow movements). It affects the brain centers that are responsible for control and regulation of movement.
The degenerative and idiopathic form of parkinsons disease is the most common ; there is also a secondary form with a known or suspected cause. The cause of disease is mostly unknown. The disease usually first appears in the fifth decade of life and is the fourth most common neurodegenerative disease.
Clinical features
The three cardinal signs are: tremor, rigidity and bradykinesia. Impaired movement: bradykinesia, muscle weakness Resting tremors: a slow, unilateral turning of the forearm and hand and a tremor of rest, increasing with concentration and anxiety. Hypokinesia ( abnormally diminished movement), gait disturbances, flexed posture and postural instability (loss of postural reflexes, and the freezing phenomenon)
Clinical features contd.

Dysphonia ( soft, slurred, low-pitched, and less audible speech) Loss of postural reflexes: patient stands with head bent forward and walks with propulsive gait( shuffling gait); Depression and psychiatric manifestations (personality changes, psychosis, dementia and confusion)
Diagnosis
Patients history Presence of two of the three cardinal manifestations: tremor, rigidity and bradykinesia. Positron emission tomography (PET) scanning: it is a computer based nuclear imaging technique that produces images of actual organ functioning Neurological examination
Management
Medical management:
Levodopa therapy (converts to dopamine): Most effective agent to relieve symptoms Antidepressant drugs Budipine is a non-dopaminergic, antiparkinson medication that significantly reduces akinesia, rigidity and tremor Antidistamine drugs to allay tremors Dopamine agonist (eg: pergolide) are used to postpone the initiation of levodopa therapy Monoamine oxidase inhibitors (MAOIs) to inhibit dopamine breakdown
Surgical management
Surgery to destroy part of thalamus ( stereotactic thalamotomy and pallidotomy) to interrupt nerve pathway and alleviate tremor or rigidity. Transplantation of neural cells from fetal tissue of human or animal source to reestablish normal dopamine release.
Nursing management
1. Improving mobility:
Help patient plan progressive program of daily exercise to increase muscle strength, improve coordination and dexterity, reduce muscular rigidity and prevent contractures. Encourage exercises for joint mobility. Encourage postural exercises to counter the tendency of the head and neck to be drawn forward and down. Teach the patient to walk erect, watch the horizon, use a wide based gait, swing arms with walking , walk heel - toe, and practice marching to music. Encourage breathing exercise s while walking and frequent rest periods to prevent fatigue or frustration.
2. Enhancing self care and using assitive devices

Encourage, teach and support patient during activities of daily living Enlist assistance of an occupational therapist as indicated Obtain special devices/ equipment as needed to assist patient
3. Improving swallowing and nutrition

Promote swallowing and prevent aspiration by having patient sit in upright position during meals. Provide semisolid diet with thick liquids that are easier to swallow. Monitor patient;s weight on a weekly basis.
4. Improving communication
Remind patient to face the listerner, speak slowly and deliberately, nad exaggerate pronunciation of words. Instruct patient to speak in short sentences and take a few breaths before speaking. Enlist a speech therapist to assist the patient.
Some nursing diagnoses

Impaired physical mobility relate to muscle rigidity and muscle weakness Self care deficits/eating, drinking, dressing, hygiene and toileting) related to tremor and motor disturbance Imbalance nutrition less than body requirements related to tremor, slowness in eating, difficulty in chewing and swallowing Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles. Ineffective coping related to depression and dysfunction due to disease progression.

Parkinson's Disease: Prepared by Bhawana Shrestha

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Parkinson's Disease: Prepared by Bhawana Shrestha

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Parkinsons Disease

Prepared by Bhawana Shrestha

Clinical features contd.

2. Enhancing self care and using assitive devices

3. Improving swallowing and nutrition

Some nursing diagnoses

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