TOPIC: C.N.

S DEGENERATIVE PARKINSONS DISEASE

LEARNING OUTCOMES. At the end of the topic, the students must be able to: 1) Define Parkinsons disease. 2) State the etiology of Parkinson Disease. 3) State clinical manifestations for patient with Parkinsons disease 4) List the common diagnostic test ordered to confirm the diagnosis 5) Identify the treatment available for patient with Parkinsons Disease 6) Identify 3 nursing diagnosis for client with Parkinsons disease. 7) Explain nursing intervention in caring for client with Parkinsons disease.

Definition

It is characterized by progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance.

As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.
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TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

Most individuals who develop Parkinson's disease are 60 years of age or older Parkinson's disease was named after the British doctor James Parkinson, who in 1817 first described the disorder in great detail as "shaking palsy." Etiology Lack of dopamine causes the motor symptoms of Parkinson's disease. A substance called dopamine acts as a messenger between two brain areas - the substantia nigra and the corpus striatum - to produce smooth, controlled movements

When the amount of dopamine is too low, communication between the substantia nigra and corpus striatum becomes ineffective, and movement becomes impaired; the greater the loss of dopamine, the worse the movement-related symptoms

Other causes: dysfunctional cellular processes, Inflammation stress At risk: A small number of individuals are at increased risk because of a family history of the disorder. Head trauma, illness, or exposure to environmental toxins such as pesticides and herbicides may be a risk factor. Clinical Manifestations Tremors: Trembling in fingers, hands, arms, feet, legs, jaw, or head.
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TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

Often occur while the individual is resting, but not while involved in a task. May worsen when an individual is excited, tired, or stressed.

Rigidity: Stiffness of the limbs and trunk, which may increase during movement. may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult. Bradykinesia: Slowness of voluntary movement. Over time, it may become difficult to initiate movement and to complete movement. Bradykinesia together with stiffness can also affect the facial muscles and result in an expressionless, "mask-like" appearance.

Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls.

TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

Parkinsonian gait: Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing. It may become difficult to start walking and to make turns. Individuals may freeze in mid-stride and appear to fall forward while walking.

The main symptoms of Parkinson's disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These vary in severity, and not every individual will experience all of them. Some of the secondary symptoms include: anxiety, insecurity, and stress confusion, memory loss, and dementia (more common in elderly individuals) constipation Depression difficulty swallowing and excessive salivation diminished sense of smell increased sweating male erectile dysfunction skin problems slowed, quieter speech, and monotone voice
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TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

urinary frequency/urgency

Investigation /Diagnostic Test

An initial assessment Medical history: important to know whether other family members have Parkinson's disease, what types of medication have been or are being taken, and whether there was exposure to toxins or repeated head trauma in the past Neurological exam: may include an evaluation of coordination, walking, and fine motor tasks involving the hands

Management

Medical: The most effective therapy for Parkinson's disease is levodopa (Sinemet), which is converted to dopamine in the brain. long-term treatment with levodopa can lead to unpleasant side effects (a shortened response to each dose, painful cramps, and involuntary movements) Levodopa is frequently prescribed together with carbidopa (Sinemet), Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, constipation, dizziness, hallucinations, and nausea. Surgical: Deep brain stimulation (DBS), The surgeon implants electrodes to stimulate areas of the brain involved in movement. In another type of surgery, specific areas in the brain that cause Parkinson's symptoms are destroyed.

TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

Nursing Management:

1)Maintain independent help client to identify optimal activity level Teach client to balance rest & activity Encourage client to use of devices to assist with function

2)Prevent complications: assist client in diet selection: to avoid constipation & maintain nutritional status help client & family member be alert to skin care needs: to prevent skin breakdown encourage range of motion exercise & deep breathing exercise: for prevention of muscle waste & pulmonary infections 3) Provide appropriate care & guidelines in all setting long term facility = at home obtain physiotherapist

TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

Nursing Diagnosis

1) Self care deficit related to physical mobility impairment & weakness. 2) Body image disturbance related to changes in bodily function & inability to perform function independently. 3) Impaired home maintenance management related to weakness & immobility. 4) Ineffective coping by the client & family member related to deteriorating health status Assessment. 1) Assess the patient for symptoms of Parkinsons disease and their effect on level of functioning. 2) Observe ability to move, walk, and perform ADLs. Determine risk for injury related to immobility or falls. 3) Assess nutritional status and condition of skin. 4) Identify presence of confusion and side effects of medications. 5) Psychosocial assessment includes the patients and caregivers response to the disease, coping strategies, and support systems. Impaired Physical Mobility Related to Muscle Stiffness and Tremor. Patients often plan their daily activities based on anticipated response to their medications. This allows them to be as active as possible within the restrictions of the medication schedule. 1) Encourage patients to determine their own best schedule for activities that require mobility patients in skilled nursing facilities, plan leisure activities around the patients most active times. 2) Physical and occupational therapy can help maintain mobility, provide assistive devices, and provide divisional activities. Provide assistance with range-of-motion exercises. Teach patients who have difculty initiating walking to pick up their foot as though attempting to step
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Nursing Process: The Patient with Parkinsons Disease

TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

over something to take the rst step. It may also help to take several steps in place before starting to walk. Self-Care Decit Related to Reduced Mobility. The most common setting for treatment of the patient with Parkinsons disease is the home. Encourage the patient to participate in ADLs as much as possible. The occupational therapist can assist with devices and strategies for maintaining independence. Patients have usually developed their own coping strategies, such as wearing clothing without buttons or shoes with adherent fasteners. As self-care abilities further decline, caregivers provide more assistance with ADLs.

Imbalanced Nutrition Related to Dysphagia and Reduced Mobility. Assist patients to open packages and prepare meals, so they can feed themselves if at all possible. If the patient has a severe tremor, a spoon may be safer than a fork for self-feeding. Finger foods may also be helpful. A cup with a lid and spout can help minimize spilling. Patients in the advanced stages of Parkinsons disease are at high risk for aspiration because they have difculty swallowing. Adding thickening agents to liquids and assisting the patient to a chair or high Fowlers position for meals may help prevent aspiration. Meals that are high in ber help prevent constipation. Small, frequent meals may be less overwhelming to the patient who must eat slowly.

TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

Disturbed Thought Processes Related to Effects of Disease and Medication. Memory impairment is one of the most distressing symptoms that patients with Parkinsons disease experience. Many patients state that memory impairment and loss of social outlets are more troublesome than the physical impairments. Assist the patient to devise coping methods, such as written daily schedules, calendars, and reminders to take medications. If the patient becomes confused, frequent reorientation may be helpful. Caregiver Role Strain Related to Demands of Caring for Patient. The signicant others and caregivers of the patient with Parkinsons Disease should be included in the plan of care. Encourage caregivers to utilize all community, personal, and governmental support systems available. Caregivers may need to be reminded that if they neglect their own health, both physical and mental, it will have a negative impact on the patient as well. Some caregivers may only need an hour or two away on an occasional basis. Others may require a more extended break. Options for relief from caregiving range from having a friend or neighbor visit to employing a home health aide or utilizing adult day care on a parttime or full-time basis. Some skilled care facilities offer respite care, in which the patient is admitted for a short time. This may be a viable option for caregivers who must be hospitalized for their own health care. A social worker may be able to assist with identication of resources. Risk for Injury Related to Reduced Mobility and Balance. The patient is at risk for injury from falls related to problems with mobility. If the patient is in the hospital or extended care facility, keep the call light within reach at all times. The bed should be kept in the low position, with side rails raised. Restraints should be avoided, but alarm systems are available that alert the staff that the patient is getting up. The environment should be kept free from clutter, throw rugs, or other items that may cause a patient to trip. Remind the patient to request assistance with ambulation. Walkers and other assistive devices may be helpful. REFERENCES William, L. S & Hopper, P. D (2003) Understanding Medical Surgical Nursing. 3rd. edition. Davis Plus. Philadelphia. Lemone P. & Burke K. (2004) Medical Surgical Nursing. Critical Thinking in Client Care. 3rd. edition. Pearson Prentice Hall.
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TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

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