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Parkinsion.
Parkinson's disease is a progressive neurodegenerative disorder that affects movement. It is caused by the loss of dopamine-producing neurons in the brain. The main symptoms are tremors, rigidity, bradykinesia, and impaired balance and coordination. There is no cure for Parkinson's, but treatment aims to manage symptoms through medication and sometimes surgery. Nursing management focuses on maintaining mobility and self-care abilities, addressing complications, ensuring adequate nutrition, and supporting coping.
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Parkinsion.
- 1. PRAGYANSHREE NANDA M.SC NURSING1ST YR MED-SURG SPECIALITY KIIT UNIVERSITY
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- 6. INTRODUCTION •Parkinson’s disease isslowely progressing neurologic movement disorder that eventually leads to disability. •It is the 4th most neurodegenerative disorder. •The disease affects men more often then women.
- 7. DEFINITION •Parkinson’s disease isa neurodegenerative condition which affect the basal ganglia and which presents with differing combinations of slownees of movement ,increased tone,tremor and loss postural reflexes. (Devidson’s medicine)
- 8. INCIDENCE •50,000 new casesare repoted each year • in children, teenagers its vary rare. •In young adult (19-40):- its rare. •In adult & old age people (41+) its common. •Parkinson’s affect 1-2 per 1000 population •Prevalance is increseing with age & PD affect 1% of papulation above 60yr age.
- 10. CAUSES:- •Idopathic •Genetic •Atherosclerosis •Excessive accumulation ofoxygen free radicals •Viral infection •Head truma •Chroni use of anti psychotic medication Enevormental exposure
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- 13. Due to etiologicalfactor affects the substantia nigra destruction of dopamine producing neurons within the basal ganglia reduces the amount of available straital dopamine(inhibitory affect) there is increase in Acetylcholine (excitatory effects) excitatory activity of Ach is inadequatelt balanced difficulty in controlling and initiating voluntary movements.
- 14. CLINICAL MANIFESTATION •Tremor •Rigidity •Bradykinesia •Impaired posturalreflex •Expressionless face •Slow to start walking •Impaired balance turning
- 15. COMPLICATIONS:- •Uncontrolled sweating •Paroxysmal flushing •Orthostatichypertension •Dementia •Urinary retention •Memory defect •Micrographia •Dysphonia
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- 17. •MRI •PET •SPECT (single photonemission computed tomography)
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- 20. MEDICAL MANAGEMENT •Anti-cholinergic agents Benztropinemesylate:- its controls the tremor & rigidity •Anti viral agents Amantadine hydrochloride :-reduce rigidity,tremor,bradykinesia,&postural changes in early parkinson’s •Dopamine agonists Bromocriptine mesylate & pramipexole :- its given to pt in early stage of parkinson’s disease to reduce the effectiveness. •Monoamine oxidase inhibitor Selegiline & rasagiline :-inhibit dopamine breakdown •Anti depressants Fluoxetine hydrochloride & bupropion hydrochloride •Antihistamines Benadryl & bnaflex :-may reduce tremors
- 21. SURGICAL MANAGEMENT Stereotactic Peocedure •Thalamotomyand pallidotomy are effective in reliving many of the sympotoms of parkinson’s disease. •The patients eligible for this these procedures are pts. With idiopathic parknison’s disease who are taking maximum doses of anti-parkinson’s medication •The procedure is effective in reducing rigidity,bradykinesis,thus improving motor function and ALDs in the immediate postoperative course. •Complications include Hemiparesis and stroke as well as cognitive,speech,swellowing & visual changes. •A CT scan ,X-ray ,MRI scan, angiogram is used to localize the appropriate surgical site in the brain.
- 22. NEURAL TRANSPLANTATION Ongoing researchis exploring transplation of porcine neuronal cells,human fetal cells,and cells. DEEP BRAIN STIMULATION:- •Pacemaker like brain implants are used to relieve tremors •The stimulation can be bilateral or unilateral.
- 24. NURSING MANAGEMENT ASSESSMENT •Assessment focuseon how the disease has affected the patient’s ADLs functional ability . •The patient is observed for degree of disability and functional changes. •The following questions may be useful to assess alterations:- •Do you have leg or arm stiffness ? •Have you experienced any irregular jerking of your arms or legs? •Have you ever been “frozen ” or rooted to the spot and unable to move ? •Does your mouth water excessive? Etc
- 25. During this assessment,the nurse observes, the patient for quality of speech,loss of facial expression, swellowing deficits(drooling ,poor head control,coughing),tremors,slowness of movement , weakness, confusion
- 26. NURSING DIAGNOSIS •Impaired physicalmobility related to muscle rigidity and motor weaknes. •Self-care deficits (feeding ,dressing ,hygiene, and toileting ) related to tremor & motor disturbance •Constipation R/T medication & reduce activity. •Imbalanced nutrition ,less than body requirements,R/T tremor,slowness in eating , difficulty in chewing and swallowing. •Impaired verbal communication related to decreased speech volume ,slowness of speech ,inability to move facial muscles. •Ineffective coping related to depression and dysfunction due to disease progression.
- 27. PLANNING & GOALS:- •Thegoles for the patient may include improveing functional mobility,maintaining independence in ALDs achiving adequate bowel elimination,attaining and maintaining acceptable nutritional status, achieving effective communication,and developing positive coping mechanisms.
- 28. NURSING INTERVENTIONS •Improving mobility •Enhancingself-care activities •Improving bowel elimination •Improving nutrition •Enhancing swallowing •Encouraging the use of assistive devices •improving communication •supporting coping abilities
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- 32. BIBLIOGRAPHY:- •Suddarth & brunner’s,A text book of medical-surgical nursing,volume-1 , wolter kluwer publication, 12th edition 2010, page no-1986-1992 •Ralston.H & walker.R.brian,davidson’s principles & practice of medicine,elsevier,21st edition,2010, page no:-1199-1202 •Wilson & ross, a text book of anatomy & physiology ,elsevier,10th edition,2006.,page no-150-154 •www.ncbi.nlm.nih.gov/pubmed.
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