Parkinson’s Disease

1. Parkinson’s Disease
JAMES KATEREGGA

2. Parkinson’s Disease
• A degenerative disease caused by the depletion of dopamine, which
interferes with the inhibition of excitatory impulses, resulting in a
dysfunction of the extrapyramidal system.
• It is a slow, progressive disease that results in a crippling disability.
• The debilitation can result in falls, self-care deficits, failure of body
systems, and depression.
• Mental deterioration occurs late in the disease

3. Assessment: Signs and symptoms
• Bradykinesia, abnormal slowness of movement, and sluggishness of physical and
mental responses
• Akinesia
• Monotonous speech
• Handwriting that becomes progressively smaller
• Tremors in hands and fingers at rest (pill rolling)
• Tremors increasing when fatigued and decreasing with purposeful activity or
sleep
• Rigidity with jerky movements
• Restlessness and pacing
• Blank facial expression; masklike faces
• Drooling
• Difficulty swallowing and speaking
• Loss of coordination and balance
• Shuffling steps, stooped position, and propulsive gait

4. Interventions
• Assess neurological status.
• Assess ability to swallow and chew.
• Provide high-calorie, high-protein, high-fiber soft diet with small,
frequent feedings.
• Increase fluid intake to 2000 mL/day.
• Monitor for constipation.
• Promote independence along with safety measures.
• Avoid rushing the client with activities.
• Assist with ambulation and provide assistive devices.
• Instruct the client to rock back and forth to initiate movement
• Instruct the client to wear low-heeled shoes.

5. Intervention cont’d
• Encourage the client to lift the feet when walking and to avoid
prolonged sitting.
• Provide a firm mattress and position the client prone, without a
pillow, to facilitate proper posture.
• Instruct in proper posture by teaching the client to hold the hands
behind the back to keep the spine and neck erect.
• Promote physical therapy and rehabilitation.
• Administer antiparkinsonian medications to increase the level of
dopamine in the CNS.
• Instruct the client to avoid foods high in vitamin B6 because they
block the effects of antiparkinsonian medications.
• Avoid the use of monoamine oxidase inhibitors because they will
precipitate hypertensive crisis.

6. Antiparkinsonian Medications
• Antiparkinsonian medications restore the balance of the
neurotransmitters acetylcholine and dopamine in the central nervous
system (CNS), decreasing the signs and symptoms of Parkinson’s
disease to maximize the client’s functional abilities.
• These medications include:
• The dopaminergics, which stimulate the dopamine receptors;
• The anticholinergics, which block the cholinergic receptors; and
• The catechol-O-methyltransferase inhibitors, which inhibit the
metabolism of dopamine in the periphery.

8. Dopaminergic medications
• Dopaminergic medications stimulate the dopamine receptors and
increase the amount of dopamine available in the CNS or enhance
neurotransmission of dopamine.
• They are contraindicated in clients with cardiac, renal, or psychiatric
disorders.
• NB: Carbidopa-levodopa taken with a monoamine oxidase inhibitor
antidepressant can cause a hypertensive crisis

9. Side and adverse effects
• Dyskinesia
• Involuntary body movements
• Chest pain
• Nausea and vomiting
• Urinary retention
• Constipation
• Sleep disturbances, insomnia, or periods of sedation
• Orthostatic hypotension and dizziness
• Confusion
• Mood changes, especially depression
• Hallucinations
• Dry mouth

10. Interventions in management of side effects
of dopaminergic medications
• Assess vital signs.
• Assess for risk of injury.
• Instruct the client to take the medication with food if nausea or vomiting
occurs.
• Assess for signs and symptoms of parkinsonism such as rigidity, tremors,
akinesia, bradykinesia, a stooped forward posture, shuffling gait, and
masked facies.
• Monitor for signs of dyskinesia.
• Instruct the client to report side and adverse effects and symptoms of
dyskinesia.
• Monitor the client for improvement in signs and symptoms of
parkinsonism.
• Instruct the client to change positions slowly to minimize orthostatic
hypotension.

11. Cont’d
• Instruct the client not to discontinue the medication abruptly.
• Instruct the client to avoid alcohol.
• Inform the client that urine or perspiration may be discolored and
that this is harmless, but may stain the clothing.
• Advise the client with diabetes mellitus that glucose testing should
not be done by urine testing because the results will not be reliable.
• Instruct the client taking carbidopa-levodopa to divide the total daily
prescribed protein intake among all meals of the day; high-protein
diets interfere with medication availability to the CNS.
• When administering carbidopa-levodopa, instruct the client to avoid
excessive vitamin B6 intake to prevent medication reactions

12. Anticholinergic medications
• Anticholinergic medications block the cholinergic receptors in the
CNS, thereby suppressing acetylcholine activity.
• They reduce the tremors and drooling but have a minimal effect on
the bradykinesia, rigidity, and balance abnormalities.
• They are contraindicated in clients with glaucoma.
• The client with chronic obstructive lung disease can develop dry, thick
mucous secretions

13. Side and adverse effects
• Blurred vision
• Dryness of the nose, mouth, throat, and respiratory secretions
• Increased pulse rate, palpitations, and dysrhythmias
• Constipation
• Urinary retention
• Restlessness, confusion, depression, and hallucinations
• Photophobia

14. Interventions
• Monitor vital signs.
• Assess for risk of injury.
• Monitor the client for improvement in signs and symptoms.
• Assess the client’s bowel and urinary function and monitor for urinary
retention, constipation, and paralytic ileus.
• Monitor for involuntary movements.
• Encourage the client to avoid alcohol, smoking, caffeine, and
acetylsalicylic acid to decrease gastric acidity.
• Instruct the client to consult with a health care provider (HCP) before
taking any non-prescription medications.

15. Interventions cont’d
• Instruct the client to minimize dry mouth by increasing fluid intake
and using ice chips, hard candy, or gum.
• Instruct the client to prevent constipation by increasing fluids and
fiber in the diet.
• Instruct the client to use sunglasses in direct sunlight because of
possible photophobia.
• Instruct the client to have routine eye examinations to assess
intraocular pressure.
NB: If an anticholinergic medication is discontinued abruptly, the signs
and symptoms of parkinsonism, such as rigidity, tremors, akinesia,
bradykinesia, stooped forward posture, shuffling gait, and masked
facies, may be intensified