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Parkinson's Disease

Samantha Banal & Dawn Collins-Emerick

Parkinson's Disease

A progressive nervous system disease that affects movement. Symptoms gradually occur when an usual noticeable tremor of the hands. Tremors are common, however, the disorder is consisted of symptoms such as stiffness and the slowing of movement.

Medical Diagnosis:

Parkinson's

Disease

Pathophysiology

Parkinson's disease is increasingly seen as a complex neurodegenerative disease with a sequence of progression. This disease process first affects the dorsal motor nucleus of the vagus nerve and the olfactory bulbs and the nucleus, then the locus coeruleus, and eventually the subtansia nigra. Cortical areas of the brain are affected at a later stage. Damage to these various neuronal systems account for the multi-faceted pathophysiologic changes that results in impairments not just to the motor system, but also to the cognitive and neuropsychological systems.

Pathophysiology

Signs & Symptoms

  • Tremors
  • Bradykinesia
  • Rigid muscles
  • Impaired balance and posture
  • Loss of automatic movement
  • Speech changes
  • Loss of fine motor movements

Signs

&

Symptoms

Risk Factors

- Advancing of Age

- Gender

- Genetics

- Environmental Factors

- Head Traumas

Risk Factors

Complications

  • Thinking difficulties
  • Depression and emotional changes
  • Swallowing and chewing problems
  • Sleep disorders
  • Incontinence
  • Constipation

Diagnostic & Labs

There is no lab or imaging test for definitive Parkinson's disease. However, in 2011, The US Food and Drug Administration had approved and imaging scan called DaTscan. This technique allowed medical physicians to view detailed images of the brain's dopamine system.

Diagnostics

&

Labs

Medications

Medications & Procedures

  • Levadopa
  • Sinemet
  • Safinamide
  • Mao-B inhibitors
  • Safinamide
  • COMT inhibitors
  • Deep Brain Stimulation

Levadopa (side effects)

Dizziness

Loss of Appetite

Diarrhea

Xerostomia

Pain in the mouth and throat

Constipation

Altered sense of taste

Confusion/Memory Loss

Sinemet (side effects)

Numbness

Insomnia

Parasomnia (strange dreams)

Itching/skin rash

Dizziness

Drowsiness

Headaches

Blurred Vision

Nausea

Vomiting

Xerostomia

Loss of Appetite

Heartburn

Diarrhea

Constipation

Sneezing/Stuffy Nose

Cough/Cold symptoms

Muscle Pain

Safinamide (side effects)

Involuntary muscle movements

Hypertension

ALT or AST increseased to greater than ULN

Falls

Orthostatic Hypotension

Nausea

Insomnia

Anxiety

Monoamine Oxidase Type B (MAO-B inhibitor) (side effects)

Mild Nausea

Xerostomia

Lightheadedness

Constipation

Confusion (older PD patients)

Hallucinations (older PD patients)

Catechol-O-Methyl Transferase (COMT inhibitors (side effects)

May exaggerate some Levadopa-related side effects (Dyskinesia)

Confusion

Hallucinations

Discoloration of urine (reddish-brown, rust-colored)

Diarrhea

Deep-Brain Stimulation

Seizure

Susceptible to Infections

Headache

Confusion

Concentration Difficulties

Stroke

Temporary Pain and Swelling at the implantation site

Hardware complications (eroded lead wire)

Patient Teaching

Patient

Teachings

Risk for Falls

Speech Therapy

Diet & Exercise

Side Effects of Medications

Nursing Diagnosis

Nursing Diagnosis #1 with Intervention

Impaired verbal communication r/t decreased volume, slowness of speech, impaired facial muscles as evidence by the neurological and musculoskeletal effects of Parkinson's disease.

Listen to the patient carefully. Validate verbal and nonverbal cues or expressions particular when dealing with pain and use appropriate scale for pain.

Nursing Diagnosis #2 with Intervention

Risk for injuries r/t alteration in cognitive and psychomotor functioning as evidenced by the risks factors of tremors, slow reactions and altered gait.

Provide a safe environment for patient. Assess patient's surroundings when entering the patient's room. Orient the patient in their room. (Orientation of the patient's personal belongings and space can provide them a sense of control towards their surrounding especially geriatric patients.

Nursing Diagnosis #3 with Intervention

Chronic sorrow r/t loss of physical capacity as evidenced by the denial of their current health status.

Determine the client's degree of sorrow; Assess the patient's eight mood states: grief, shock, anger, hopelessness, sadness, disbelief, fear and guilt.

CITATIONS

References

March 8, Editorial Team, and 2017. “What Are Common Risk Factors for Parkinson’s?” ParkinsonsDisease.net, Mar. 2018, parkinsonsdisease.net/basics/risk-factors-causes.

Mayo Clinic. “Parkinson’s Disease - Diagnosis and Treatment - Mayo Clinic.” Mayoclinic.org, 2018, www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062.

“Parkinson’s Disease - Symptoms and Causes.” Mayo Clinic, 8 Dec. 2020, www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055.

O’Maley, Karen, et al. “Teaching People with Parkinson’s Disease about Their Medication.” Nursing Older People, vol. 17, no. 1, Mar. 2005, pp. 14–20, 10.7748/nop2005.03.17.1.14.c2357.

Gulanick, M., & Myers, J. L. (2011). Nursing care plans: Diagnoses, interventions, and outcomes. Elsevier Mosby.

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