Medical Surgical Nursing

1. Parkinson's Disease
N u r s i n g E d u c a t i o n
Presented by; , M.Sc. Nursing, 1st

2. Contents
0 1 . D E F I N I T I O N
0 2 . I N C I D E N C E
0 3 . E T I O L O G Y
0 4 . P A T H O P H Y S I O L O G Y
0 5 . C L I N I C A L M A N I F E S T A T I O N
0 6 . D I A G N O S T I C E V A L U A T I O N
0 7 . M A N A G E M E N T
0 8 . C O M P L I C A T I O N S

3. DEFINITION
01
Parkinson's disease is a chronic, progressive neurode-
generative disorder characterized by slowness in the initiation and
execution of movement (bradykynesia), increased muscle tone
(rigidity), tremor at rest and gait disturbance.

4. 02 INCIDENCE
The incidence of Parkinson's disease in India is
1% in adults 65years or older and 5% in more than
80years. India has about 7million people living with
Parkinson's disease. Incidence of Parkinson's disease
increases with age, but an estimated 4% of people with
Parkinson's disease are diagnosed before 50years of age.
Parkinson's disease is more common in men by a ratio of
3:2.
5%
4%
1%
Adults in age of more
than 80 years
Adults diagnosed
before age of 50 years
7million
Adults in age of 65
years or more
People lived with PD

5. Genes
Specific genetic mutations that can
cause Parkinson's disease. But these
are uncommon except in rare cases
with many family members affected
by Relatively small risk of Parkinson's
disease for each of these genetic
markers.
Environmental Triggers
Exposure to certain toxins or
environmental factors may increase
the risk of later Parkinson's disease
The presence of Lewy bodies
Clumps of specific substances within
brain cells are microscopic markers of
Parkinson's disease. These are called
Lewy bodies, and researchers believe
these Lewy bodies hold an important
clue to the cause of Parkinson's
disease.
Alpha-synuclein found
within Lewy bodies
The natural and widespread protein
called alpha-synuclein (a-synuclein).
It's found in all Lewy bodies in a
clumped form that cells can't break
down. This is currently an important
focus among Parkinson's disease
A
B
D
C
A
B
C
D
ETIOLOGY
03

6. Cont....
The other risks of Parkinson's disease by
exposure to herbicides, pesticides, industrial chemicals
and wood pulp mills, rural residence.
Secondary factors are due to
exposure to the variety of chemicals include
carbon monoxide and mangenese. Also the
drug induced parkinsonism are
metoclopramide, reserpine, methyldopa,
lithium, haloperidol.

7. PATHOPHYSIOLOGY
04

8. 1.Tremor
A tremor, or shaking, usually
begins in a limb, often your
hand or fingers.
4.Impaired posture and
balance
Posture may become stooped,
or may have balance problems.
5.Loss of automatic
movements
Decreased ability to perform unconscious
movements, including blinking, smiling or
swinging your arms when you walk.
6.Speech & Writing
changes
Speaks softly, quickly, slur or hesitate
before talking & hard to write, and
your writing may appear small
3.Rigid muscles
Muscle stiffness may occur in
any part of the body. The stiff
muscles can be painful and
limits range of motion
2.Slowed movement
(bradykinesia)
Parkinson's disease may slow
your movement, making simple
tasks difficult and time-
consuming.
CLINICAL
MANIFESTATION
05

9. Cont.....

10. Cont....
Nostalgia took me to the depths of past.

11. DIAGNOSTIC EVALUATION
Single-photon emission
computerized tomography
(SPECT) scan.
MRI
Ultrasounds of brain
PET Scans
06
No specific test exists to diagnose Parkinson's disease. Diagnostic evaluation of
Parkinson's disease based on medical history, a review of your signs and symptoms, and a
neurological and physical examination.

12. Cont....
ADD YOUR TITLE

13. MEDICAL MANAGEMENT
07
MANAGEMENT
Medications may helps to manage problems with
walking, movement and tremor. These medications increase
or substitute for dopamine. People with Parkinson's disease
have low brain dopamine concentrations. However, dopamine
can't be given directly, as it can't enters the brain. Patients
may have significant improvement of your symptoms after
beginning Parkinson's disease treatment. Over time, however,
the benefits of drugs frequently diminish or become less
consistent.

14. Cont....
Carbidopa-
levodopa
Entacapone (Comtan) is
the primary medication
mildly prolongs the
effect of levodopa
therapy by blocking an
enzyme that breaks
down dopamine
It is a natural
chemical that
passes into your
brain and is
converted to
dopamine
It help control the
tremor associated
with Parkinson's
disease. Several
anticholinergic
medications like
benztropine
(Cogentin) or
trihexyphenidyl.
Amantadine alone to
provide short-term
relief of symptoms of
mild, early-stage
Parkinson's disease. It
given with carbidopa-
levodopa therapy
during the later stages
to control involuntary
movements (dyskinesia)
Catechol O-
methyltransfe
rase (COMT)
inhibitors
Anticholinergics Amantadine

15. SURGICAL MANAGEMENT
Deep Brain
Stimulation
In deep brain stimulation (DBS), surgeons implant electrodes into a
specific part of your brain. The electrodes are connected to a generator
implanted in your chest near your collarbone that sends electrical pulses to your
brain and may reduce your Parkinson's disease symptoms.
Deep brain stimulation is most often offered to people with advanced
Parkinson's disease who have unstable medication (levodopa) responses. DBS can
stabilize medication fluctuations, reduce or halt involuntary movements
(dyskinesia), reduce tremor, reduce rigidity, and improve slowing of movement.

16. Cont....
It involves in locating, targeting and destroying an
area/tissues of the brain affected PD. i.e., Thalamotomy,
pallidotomy & subthalamic nucleotomy.
Transplantation of fetal neural tissue into the basal ganglia is designed
to provide DA-producing cells in brain of patient.
Ablation Surgery
Transplantation

17. DIET AND EXCERCISES
1) Eating foods high in fiber and
drinking an adequate amount of fluids
can help prevent constipation that is
common in Parkinson's disease.
2) Exercising may increase your
muscle strength, flexibility and
balance. Try not to move too quickly.
Aim for your heel to strike the floor
first when you're walking.
3) Daily living activities — such as
dressing, eating, bathing and writing
— can be difficult for people with
Parkinson's disease. Helps to do their
activities.
4) Massage therapy can reduce muscle
tension and promote relaxatio. Yoga,
gentle stretching movements and
poses may increase your flexibility
and balance.

18. NURSING DIAGNOSIS
Impaired physical mobility
related to rigidity,
bradykinesia, akinesia and
postural instability.
Imbalanced nutrition less
than body requirements
related to inability to ingest
food.
Impaired swallowing
related to neuromuscular
impairment.
Impaired verbal
communication related to
dysarthria, tremor &
bradykinesia.

19. Promotion of physical
excercises & well
balanced diet Taught with excercises
to improve speaking &
swallowing
Improves self care
ability including
eating & dressing
Avoid complications
such as contractures &
fails
Maintanence of good
health & encourage
independence.
NURSING IMPLEMENTATION

20. COMPLICATIONS
Bladder
problems
Fatigue Pain
Constipation
08
Thinking difficulties
Depression &
emotional changes
Sleep disorders Smell
dysfunction
Chewing &
eating
problems
Swallowing
problems