Nursing care of patient with NEUROLOGICAL Problems

1. PARKINSONISM
MR.VEERABHADRA.B.B
ASST PROFESSOR
DEPT OF MEDICAL SURGICAL NSG
.

2. .Definition:
Parkinsonism is a clinical syndrome consisting of 4
cardinal features:
1) Bradykinesia (slowness of movement) and, in
extreme cases, a loss of physical movement (akinesia)
2) Muscular rigidity.
3) Resting tremor (which usually disappears during
voluntary movement)
4) Impairment of postural balance leading to
disturbances of gait and falling

3. .Causes of parkinsonism:
1) Idiopathic PD:
- Progressive loss of dopamine-containing
neurons is a feature of normal aging
- Death frequently results from complications
of immobility, including aspiration pneumonia or
pulmonary embolism
2) Secondary PD:
Following stroke, and intoxication with
dopamine-receptor antagonists as antipsychotics.

4. .
Destruction of dopaminergic neuronal cells in the substantia nigra in
the basal ganglia
Depletion of dopamine stores
Degeneration of the dopaminergic nigrostriatal pathway
Imbalance of acetylcholine and dopamine neurotransmitters in the
corpus striatum
Impairment of extrapyramidal tracts controlling complex body
movements
Tremors ,Rigidity ,Bradykinesia , Postural changes

5. CLINICAL MANISFESTATION
 .

6. CONTINUED……
 the disease affects the jaw, tongue, and larynx;
speech is slurred; and chewing and swallowing
become difficult.
 Rigidity can lead to contractures.
 Salivation increases, accompanied by drooling.
 In a small percentage of clients, the eyes roll
upward or downward and stay there involuntarily
(oculogyric crises) for several hours or even a few
days

7. MANAGEMENT
 Dopaminergics such as
• *Levodopa (Larodopa)
• *Levodopacarbidopa
• *Amantadine
 Dopamine agonists such as
 *Bromocriptine (Parlodel);
 *Apomorphine
 Anticholinergics such as
 Benztropine

8. MANAGEMENT CONTINUED…..
Rehabilitation measures, such as
 Physical therapy,
 Occupational therapy,
 Client and family education, and
 Counseling, are used concurrently with drug
therapy.

9. SURGICAL MANAGEMENT
 Stereotaxic pallidotomy is a surgical
procedure performed in selected cases. The
procedure destroys a part of the globus pallidus
to eliminate or reduce tremor, stooped posture,
shuffling gait, and stiff movement.

10. .
Deep Brain Stimulation (DBS).
 DBS involves the implantation of a neuro stimulator
that works like a pacemaker for the brain.
 The electrical stimulus blocks (65%) abnormal
nerve signals that cause the parkinsonian tremor.

11. NURSING MANAGEMENT
(1) The nurse must administer the drugs closely to the
schedule the client previously established at home.
(2) Self-care deficit related to rigidity and tremors
 Exercise therapy
 Ambulation, Balance,
 Joint mobility, Muscle control;
 Environmental management,
 Self-care assistance;

12. CONTINUED……
 Imbalanced Nutritional .
 Risk for fall / injury.
 Knowledge deficit.