PARKINSON’S DISEASE

PARKINSON’S
• A chronic (long term) progressive degenerative neurological disorder affecting the brain
centers that are responsible for control and regulation of movement

PATHOPHYSIOLOGY
• Coordination problems
• Degeneration of substanita nigra (pigmented neurons) leads to depletion of Dopamine
causing decreased and slowed voluntary movements, rigidity and tremors
• With the Decrease in Dopamine(Inhibits excitability) you have an increase in
Acytlcholyene( excitability). That’s why you have the tremors, rigidity, and slow
movements

INCIDENCE
• Begins most often in 5th decade of life
• Affects men and women equally – whites more than blacks
• Not a familial disease

ETIOLOGY
• May Follow
o Acute encephalitis (viral infection ) – RARE
o Carbon monoxide, metallic or other poisoning
o Sometimes associated with arteriosclerosis
• Cause is unknown

DIAGNOSIS
• Clinical Manifestations form history
• Must have 2 of the 3 cardinal symptoms
• No Conclusive lab work
• Handwriting changes may be first clue
• May take a while to diagnose

PROGNOSIS
• Symptoms come on rapid in first year and then level off
• Advance of symptoms most often extended over several decades
CLINICAL MANIFESTATIONS
• Resting tremors - Pill-rolling tremors
o Disappears with purposeful movement
o Intentional Tremor – Piggyback – hold hand
• Muscle rigidity (cogwheel rigidity) – prevents from doing normal activity
o Jerky PROM
• Akinesia / Bradykinesia
o Absence of movement / Slow movement
• Mask-like facial expression
o Have a stare and eyes may not blink
• Moist oily skin
• Monotonous, low pitched, slow poorly articulated speech
• Drooling
o Due to problems swallowing secondary to muscle problems R/F Aspiration
• Heat intolerance
• Intellect is not affected – Do not treat them as if it is affected
• Characteristic Propulsion Gait
o Forward stoop, with a tendency to get going too fast where they are unable to stop
o Shuffling gait, walk on toes, take tiny steps, and do not have normal movement with hands
and arms = potential safety problems HRF Injury
• Appetite increased but can’t eat much because of drooling and difficulty swallowing resulting in
weight loss.
• Impaired handwriting
o First sign although not a cardinal symptom
o Handwriting gets small and shaky looking
• Deficits in judgment and emotional instability
• Intention tremors
o When attempting to do something like pick up a glass
• Depression – Common
• Decreased cerebral blood flow = dementia
• All signs and symptoms increase with fatigue, excitement, and frustrations
o As a nurse you would: Not let them get too tired, excited, or frustrated
• Complications form immobility (Pneumonia, UTI) and the consequences of falls and accidents are
major causes of death

MEDICAL MANAGEMENT
• There is no known treatment

• Drug therapy
o Anticholinergic drugs – Causes constipation in elderly
o These drugs are either used to Dopamine supply or  Achytocholine response
 Congentin – Control tremor and rigidity
 Artaine – Same as Congentin
 Levadopa – Replaces or converts to Dopamine in basal ganglia; usually given
with Sinemet to allow increased levels of Dopamine
 Symmetrel – Antiviral –  rigidity, tremors, and bradykenisa
 Sinemet –  3 main symptoms

• Surgical Treatment
o Destroy part of brain tissue in thalamus - Thalamectomy
 o Effective for younger people
o Surgery not used often on elderly, usually use the meds instead – Levadopa

NURSING MANAGEMENT
• Physical Therapy / Gait training
o Teach to use wide gait and look ahead which forces them to keep the head up
• Teach patient to exercise for posture and prevent deformities
o Keep neck straight and prevent contractures
o Can lead to respiratory problems
o No pillows under the neck causes flexion of the neck
• Weigh periodically – Intake problems
• Rest and eating appropriately
• Speech Exercises – May need voice amplifier
• Constipation problems – possibly due to drooling
• Weakness of the muscles needed to defecate
• Do oral care and protect skin around the mouth – drooling
• May have problem eating – getting food to mouth and chewing – have suction available
• Lassitude (exhaustion)
• Tremor control – Hold on to chair or hold one hand in the other
• General health measures
• Patient and/or family education
o Medications – SE
o Exercise and walking
o Well-balanced diet – Usually regular diet
o Small frequent feedings
o Warming plate for food
o Over the counter meds must be Ok’d by MD
o Cannot have Vitamin B6: Fortified breads and cereals may have  B6

PARKINSON’S CRISIS
• Medical Emergency
• See sudden severe exacerbation of classic symptoms – call for immediate attention – not
able to swallow, walk, sweating, tachycardia, etc.
• Results form sudden withdrawal of anti-parkinsonian medications or some severe
emotional trauma
• Can die from this – quiet environment may give sedative-hypnotic, anticonvulsants and
antiparkinson’s meds IV
• First calm patient and be sure patient is breathing
• Provide respiratory and cardiac support
• May be given an injection of Phenobarbital