Parkinson's disease is a progressive neurological disorder caused by the loss of dopamine-producing neurons in the brain. It is characterized by tremors, rigidity, slowness of movement, and impaired balance and coordination. There is no cure for Parkinson's, but treatment aims to manage symptoms through medications like levodopa and deep brain stimulation surgery. Nurses play an important role in assessing patients, educating on medication management, and supporting overall care and quality of life.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking.
Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from sudden excessive discharge from cerebral neurons.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking.
Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from sudden excessive discharge from cerebral neurons.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
parkinson's disease by me ..........prakash mahala p.g. medical surgical nursing at himalayan college of nursing dehradun.......prakashjpmmahala@gmail.com
Parkinson's Disease, SYMPTOMS OF PARKINSONISM, STAGES OF PARKINSONISM, ETIOLOGY OF PARKINSONISM, PATHOPHYSIOLOGY OF PARKINSONISM, TREATMENT OF PARKINSONISM.
During my 1st &2nd year of residency period , i used to teach Anatomy and Orthopaedics for foreign undergraduate medical students. At last year i taught Neurology for one batch. so i posted some of my collections for competely educational purpose coz i believe in knowledge ...inseted of deleting these ppts , they may me useful for others so i shared it ....
Advances in Management of Parkinson's DiseaseSultana Shaikh
Parkinson's disease [PD] is one of the most common neurodegenerative disorders. There have been significant recent advances in the understanding of the pathogenesis of the disease. There has also been a greater realization that the disorder may be associated with significant non-motor disturbances in addition to the more commonly recognized motor complications. There are many drugs like levodopa and carbidopa, ropinirole, pramipexole, rotigotine etc. and some MAO-B INHIBITOR like selegiline and rasagiline which are used in treatment of Parkinson’s disease. Some COMT INHIBITOR
and others drugs are also available and some herbs like turmeric, ginger, garlic etc. provides temporary relief from Parkinson’s disease. There are two vaccines which are under development for the treatment of Parkinson’s disease.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
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AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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2 Case Reports of Gastric Ultrasound
3. INTRODUCTION:
Parkinson disease is a slowly progressive , chronic
neurological disease that effects a small area of nerve cells in
an area of the brain known as the substantia nigra.
This cells normally produces dopamine, a chemical
(neurotransmission) that transmits signal between areas in the
brain that when working normally coordinates smooth and
balanced muscle movement .
Parkinson’s disease cause this nerve cells to die and as a result
body movement are effected.
4. HISTORYOF PD:
In 1817, a detailed medical essay was published on the
subject by London doctor, Dr. James Parkinson.
Jean Martin Charcot was the first to truly recognize the
importance of Dr. James Parkinson’s and renamed the
disease after him as ‘’Parkinson’s disease’’ which was
formerly named paralysis agitation (shaking palsy).
5. EPIDEMIOLOGY:
Parkinson disease occurs worldwide and is present in all races.
Males are more affected than females.
Prevention of Parkinson disease increase with increasing age of 1% of person
from age 60.
YOPD starts between 21 -40 years of age affecting 5 to 10% of Parkinson
disease patients.
China is the country world largest prevalence of Parkinson disease.
The incidence and prevalence of Parkinson disease in India is lesser as
compared to other country, Rural population had a higher prevalence than
urban population 41:14.
6. DEFINITION:
Parkinson disease is characterized by
tremor at rest, rigidity and slowness
or difficulty in initiating and
executing movement (Akinesis or
Bradykinesis). This combination of
clinical features is collectively known
as Parkinsonism.
Parkinsonism is a syndrome with
numerous cause of which Parkinson
disease is the most common.
8. The substantia nirga is a nucleus in the mid brain which is part of the Basal
Ganglia.
The substantia nigra is made up of two automatically and functionally distinct
portion :
Substantia nigra pars compacta –more darkened
Substantia Nigra pars reticulata –less darken.
Most of the dopamine neuron of the brain originate in the midbrain and are
found in either the substantia Nigra.
The Dopamine neurons in the substantia Nigra express high level of pigment
called Neuromelanin which accounts for thin dark colour .
The substantia Nigra par compacta contain more dopamine neurons while pars
Reticulate contains more GABA neurons .
9. CLINICAL SIGNIFICANCE:
Parkinson disease is associated with the
death of dopamine Neuron in the
substantia Nigra pars compacta which is
due to neuro-degeneration .
when a significant number of this neuron
have died, the individual will likely to
start to experienced movement –related
problems like tremors, rigidity, slowness
of movement and postural instability –
which are the hall mark symptoms of
Parkinson disease.
10. ETIOLOGY/RISK FACTORS:
Advancing age : Above 60 years mostly seen while young onset Parkinson disease
is called a patients develop Parkinson disease between 21-40 years.
Sex: male are more likely to get than female.
Family History: Having one or more close relatives with the disease increase the
rise of getting.
Low Estrogen Level: most menopausal women who don’t use hormone
replacement therapy are more risk of getting the disease.
Agricultural work: exposure to environmental toxin such as pesticide ,herbicides
,inhabits dopamine production and promote free radical damage. these involved
in farming and are exposed to such toxins have a greater risk of getting the
disease.
Low level of vitamins: researchers de was found that people with low level of
vitamin B develop severe Parkinson symptoms.
Head Trauma: Trauma to the head ,neck and upper cervical spine increase the
chance of getting Parkinson’s.
11. Genetic Mutation: people who have both young onset Parkinson’s disease and a
strong family history of the disease are more likely carry genes linked to
Parkinson’s disease which includes;
Alpha Synuclein: Autosomal dominant.
LRRK2(leucine rich repeat kinesis2): Autosomal.
PINK1/PARKIN/DJ-1: Autosomal recessive
GBA(Glucocerebrocidase): Autosomal recessive
Alpha synuclein and LRRK2 gene mutation is linked with Young onset Parkinson
Disease.
12. Other causes:
Secondary Parkinson’s: which are caused by other disorders such as
Neoplasm, multiple cerebral infarction and infection of the brain.
Drug induces Parkinsonism: which are irreversible. causative drugs
include : Neuroleptics – haloperidol ,risperidone, olanzapine.
Antiemetic- metachlopramine, prochlorperazine.
Parkinson’s disease caused by Degenerative disease in which
symptoms of Parkinson’s disease are combines with neurologic deficit
yet patients fail to response to Anti-Parkinson drugs therapy . These
disorders include
Multiple system atrophy (MSA).
Alzheimer’s Disease -often accompanied with mild signs of
Parkinsonism.
13. PATHOPHYSIOLOGY:
Etiological Factors:
Environmental
factors
Gene mutation
Degenerative
disease
Destruction of Dopaminergic neuronal cells in the substantia nigra in the
basal Ganglia
Neuronal cells loss and depigmentation
Degeneration of dopaminergic activity particularly in the nigro-striatal
pathway
Depletion of dopamine store
Imbalance between excitatory (Acetylcholine) and inhibiting
(dopamine) neurotransmitter in the corpus striation
Impairment of extrapyramidal tract controlling
complex body movement
Tremors
Rigidity
Akinesis
Postural instability
14. SIGNS AND SYMPTOMS:
Four cardinal sign:
Resting tremor
Rigidity
Akinesia
Postural instability
Cog-wheeling
AKINESIA:
Bradykinesia
Hypokinesia
Hypophonia
Micrographia
DYSAUTONOMIA: it includes
sweats,facial flushing.
Dyspnea, urinary frequency, urgency.
GI dysfunction-constipation.
Dysphagia
Orthostatic hypotension and sexual
dysfunction
Cognitive And psychiatric disturbance:
Anxiety, Apathy, mental, irritability,
impaired executive function, depression
psychosis (delusions and Italicization)
dementia
POSTURAL DISTURBANCE:
Stooped or fixed positive
Disequilibrium or postural
instability
Retropulsion –backward
motion
Propulsion – forward motion
Sleep disturbance:
Frequent awakening
Daytimes sleepiness’
Sensory impairment:
pain, restlessness and
Akathisia.
15. STAGES OF PARKINSON’s DISEASE
Parkinson’s disease is typically classified by the worsenng of clinical
manifestation. The modified Hoehn and yohr and scale is one method use to
rate the severity of Parkinson’s disease.
STAGE 0: No evidence of Parkinson’s disease.
Stage 1: Unilateral involvement .
Stage 1.5: Unilateral and Axial involvement .
Stage 2: Bilateral involvement, balance in contact .
Stage 2.5: Bilateral involvement, recovery on pull test .
Stage 3: Mild to moderate impairment with postural instability .
Stage 4: Severe impairment but still able to stand or walk un assisted.
Stages 5: Confinement to a wheel chair or bed .
16. DIAGNOSTIC EVALUATION:
Laboratory test and imaging studies are not helpful in the diagnosis of
Parkinson’s disease.
Criteria for making diagnosis of Parkinson’s disease include the
following
1. Through patients’ history and performed complete neurological
examination.
2. CT scan or MRI of head to rule out secondary cause.
3. PET-scan to evaluate levodopa uptake and conversion to Dopamine in
the corpus Striatum .
4. Present of two or more cardinal features (resting tremors, rigidity,
Akinesia, postural instability).
5.Final diagnosis usually made by the pressure of heavy bodies in the
brain during Autopsy.
17. MANAGEMENT:
There are complete cure for Parkinson’s disease.
Treatment is directed at controlling symptoms and maintaining
functional independence.
There are no medical or surgical approaches that prevent
disease progression.
Care is individualized for each patients based on preventing
symptoms and social occupational and social needs.
Pharmacologic management is the main stay of treatment.
18. ANTI-PARKINSONISM MEDICATION:
1. LEVEDOPA (L-Dopa): it is the most effective agents and the mainstay of treatment, for
controlling the symptoms particularly Bradykinesia and rigidity.
SINEMET: it is made up of Levodopa and carbidopa .Levodopa enters the brain and is
converted to Dopamine while carbidopa increase its effectiveness and prevents the side
effects of levodopa such as nausea, vomiting.
2. DOPAMINE RECEPTOR AGONISTS: this are the drugs that activate or stimulate the
dopamine receptors . They mimic or copy the function of Dopamine in the brain. Dopamine
agonists can be taken alone or in combination with Levodopa/carbidopa. Most commonly
drugs used are
Ergot derivatives : Bromocriptine or pergolite.
Non-ergot Derivatives: Ropinirole ,pramipexole.
3. MONOAMINE OXIDIZED INHIBITORS: It blocks an enzymes that caused premature of
levodopa and are used primarily to treat motors fluctuation associated with levodopa
treatment .most commonly drugs used are
Seligiline
Rosagiline.
19. AMANTADINE : it is the most commonly used medication for early onset Parkinson’s
disease to tract tremor .It reduce dyskinesia’s that occur with Levodopa.
COMT INHIBITORS(Catechol-o-methyl-transferase): such is Tolcapone and entacapone
response the newest class of Parkinson’s drugs .
It does not have direct effect on Parkinson’s disease symptoms
it prolong the effect of levodopa by blocking its metabolism.
ANTI-CHOLINERGIC: it is helpful in controlling tremors and rigidity.
It decrease the activity of acetylcholine, a neurotransmitter that regulates
movement ,most commonly used are:
Benzotropine mesylate
Trihexyphenidyl HCL
ANTI-DEPRESSANT :
Amitriptyline is typically prescribe because of its Anticholinergic and
Antidepressant effect.
Serotonins reuptake inhibitors; Fluoxetine Hydrochloride and Bupropion
hydrochloride.
Effective for treating depression in patients with Parkinson’s disease.
20. SURGICAL MANAGEMENT:
THALATOMY:
It involves destruction of part of the Thalamus,
generally the ventral’s intermediates (VIM) to
relieve tremor.
The VIM nucleus is considered the best target for
tremor suppression with excellent short and long
term tremor suppression in 80-90% of patients
with Parkinson’s diseases.
When rigidity and Akinesia are prominent other
targets ,deep brain stimulation of both Globus
pallidus interna (Gpi) and subthalami nucleus
(STN)are preferred.
21. PALLIDOTOMY:
Pallidotomy is a neurosurgical
procedure whereby a tiny electrical
probe is placed in the globes pallidus,
which is then heated to 800C for 60
sec, to destroy a small area of brain
cells.
It is effective for treating in
voluntary movements known as
Dyskinesia, motor symptoms
presented with Parkinson’s Disease.
22. DEEP BRAIN STIMULATION:
Deep brain stimulation is a neurological procedure
which was first approved in 1997 to treat Parkinson’s
diseases tremor, then in 2002 for treatment of
advanced Parkinson’s diseases symptoms.
More recently in 2016 DBS surgery was approved for
the earlier stages of Parkinson’s for those with at least
four years disease duration with motors complication
that are not controlled with medications.
Deep brain stimulation involves the implantation of
permanents thin electrodes into selected deep parts
of the brain .
The targets area of the brain depends on the
presenting symptoms, the most common targets area
are thalamus, subthalamic nucleus(STN)and Globus
pallidus in terna(Gpi).
23. NURSING MANAGEMENT:
Nursing Assessment:
Obtain a history of symptoms and their effect on functioning,
mobility, feeding, communication, and self-care difficulties.
Assess cranial nerves, cerebellar function (co-ordination) and
motor function.
Observe gait and performance of activities
Assess speech for clarity and space
Assess for sign of depression
Assess family supports and access to social service.
24. Nursing Diagnosis:
1. Impaired physical mobility related to Bradykinesia,
rigidity and tremors
2. Imbalance nutrition less than body requirement related
to motor difficulties with feeding, chewing and swallowing
3. Impaired verbal communication related to decreased
speech volume
4. Constipation related to diminished motor function and
inactivity
5. Ineffective coping related to physical limitation and loss
of independence.
25.
26. CONCLUSION:
Parkinson’s disease is a chronic, progressive neurologic disorders that results
from the loss of the neurotransmitter dopamine in a group of brain structures
that controls movement.
The cardinal symptoms are resting tremors, rigidity, Akinesia and postural
instability.
The goal of management is to control the manifestation such as motor and
non-motor symptoms with the lowest possible dose of medication in order to
avoid side effects.
Medication selection and dosage depend on the manifestation, age of the
client and presence of other medical condition.
Nursing care should focus on the health assessment, medication instruction
and monitoring, liaison with other members of the health care team, and
family members and family education.