Parkinson’s disease


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Parkinson’s disease

  1. 1. Parkinson’s Disease
  2. 2. Pathophysiology• Chronic progressive of CNS• Neurodegenerative disease• Deterioration of dopaminergic neurons (depleting dopamine)• Age 60 and older• Men than women• Muscle tremors• Bradykinesia• Rigidity w/muscle weakness• Position instability (posture & equilibrium
  3. 3. Symptoms• Orthostatic hypotension• Nocturnal sleep disturbances• Daytime somnolence• Depression• Progressive dementia
  4. 4. Parkinson’s Types• Primary or idiopathic – caused by a reduction in dopamine producing cell• Secondary – caused by head trauma, intracranial infections, tumors & drug exposure• Motor symptoms start insidiously• Usually begin on one side of the body• Eventually have postural & gait alterations• Non-motor – depression, anxiety, apathy, chronic fatigue
  5. 5. Drug Therapy• Minimizing the symptoms• Non-pharmacologic therapy – support services, exercise, nutrition• Pharmacology to relieve the symptoms & restore dopaminergic activity
  6. 6. Nursing Process: Assessment• Unified Parkinson’s Disease Rating Scale• History• Obtain data to classify Stages I-V• Motor function• Facial Appearance• Nutrition• Salivation• Psychological• Stress• Safety & Self-care• Family Resources
  7. 7. Unified Parkinson’s Disease Rating Scale• UPDRS• Baseline symptoms• Monitor changes in symptoms• Evaluates• Mentation, behavior, mood• ADL’s• Motor examination• Complication of therapy• Modified Hoehn and Yahr staging• Schwab and England ADL scale
  8. 8. UPDRS• Stage I –one limbs, slight tremor or change in speech, facial expression, posture change or movement, mild disease• Stage II –two limbs, early postural changes, social withdrawal, depression• Stage III –significant gait disturbances & moderate generalized disability• Stage IV –akinesia, rigidity & severe diability; still able to walk or stand unassisted• Stage V –unable to stand or walk, perform all ADL’s, wheelchair-bound or bedridden unless aided
  9. 9. Motor function• Tremors• Dyskinesia• Bradykinesia• Rigidity• Postural instability
  10. 10. Nursing Process: Diagnoses• Risk for Constipation• Deficient knowledge• Risk for injury• Ineffective Self-Health Management• Bathing Self-Care Deficit• Dressing Self-Care Deficit• Feeding Self-Care Deficit• Toileting Self-Care Deficit• Imbalanced Nutrition: Less Than Body Requirements
  11. 11. Nursing Process: Planning• History-abilities, mental status schedule a meeting to plan baseline before initiating therapy• Safety-obtain anti-slip pad, perform safety check• Care needs-other departments, periodic evaluations, family, provide information & resources• Medication-vital signs routinely especially BP
  12. 12. Nursing Process: Implementation• Monitor & record vitals signs – BP**• Degree of therapeutic response & adverse effects• Monitor bowel function & prevent constipation• Support effort to remain mobile –removing clutter & throw rugs, correct equipment & supportive devices• Minimize deformities- erect posturing, joint mobility (ROM)• Reinforce principles for gait training• Nutritional needs• Encourage self maintenance & social involvement• Provide restful environment & reduce stressors• Monitor mood and affect- depression1• Ambulating safely