• Parkinson’s disease or paralysis
agitants, is a neurologic
disorder that normally occurs
after the age of 50, and
increases in incidence with age,
Most occurences of the disease
are primary parkinsonism in
which the basal ganglia of the
modify the system that
controls voluntary motor
• Cell loss occurs in the
substantial Nigra which in turn
decreases the level of striatal
dopamine, and this results in
The disease is progressive and
characterized by slowing and
weakening of movements, tremors,
rigidity and continues to a state of
the patient’s complete dependence on
others for care.
Neuromuscular and motor function
changes eventually result in
respiratory mobility, elimination and
• A second form of parkinson’s
disease is a secondary
parkinsonism which occurs as a
result of other causes.
Causes of secondary parkinsonism
include viral encephalities,
methydopa,meperidine analog, carbon
hypothyroidism, basal ganglia brain
tumors, head trauma and dementia-
type illnesses. Striatal dopamine
• Death usually occurs from 7-10
years after the beginning of
neurologic symptoms and is a
result of dysrhythmia, sleep
apnea or pulmonary emboli.
Positron emission tomography Scan
• Ineffective airway clearance related to:
• Parkinsonian changes in Musculature,
Tracheobronchial Obstruction, Aspiration,
Infection, Truncal Rigidity, Bronchospasms
,Fatigue, Increase Work Breathing
• Dyspnea , Tachypnea, Bradypnea,
Bronchospasms, Increase work of
breathing, Use of accessory muscles,
Increased Mucos Production.
• Related to: use of parkinsonian
medications, psychological causes
depression .incorrect belief system,
chronic illness , misperceptions.
• Defining Characteristics:
• Inaccurate interpretation of environment,
changes in lifestyle, loss of significant
other, egocentricity, distractibility,
• Related to: Lack of knowledge about
Parkinson’s disease, stigma of
disease, difficulty understanding
about disease process, lack of coping
skills, cognitive impairment.
• Verbalization of questions,
verbalization of incorrect
information, Noncompliant behaviour,
Presence of Preventable
Complications, Inability to follow
• Patient/Family will be able to exhibit
understanding of disease process,
medication regimen , and treatment
plan of care.
• Assess patient’s understanding of
disease process. Consider the older
patient’s life experiences.
• Instruct Patient/Family regarding
medications and need for compliance
with dosages, scheduling and
• Provide time for questions and concerns
to be voiced and answer questions
honestly. if possible, give patient/family
written materials to refer later.
• Instruct patient /family regarding need
for long-term planning and potential for
end of life care decisions.