parkinsons disease.pptx

Presented By:
Maria Kousar (Trainee Teacher)
Senior Electives (Clinical Education)
POST RN BSN session 2021 - 2022
2nd year Semester IV
Parkinson’s disease (PD) 0

By the end of this presentation learners will be able:
 To Define Parkinson’s disease
 To develop knowledge about stages of Parkinson's disease
 To explain causes and clinical manifestation of Parkinson's disease
 To enlist risk factors and etiology of Parkinson's disease
 To describe diagnostic evaluation of Parkinson's disease
 To elaborate Medical management of PD
 To explain nursing management of PD

Parkinson's disease is a degenerative and
slowly progressive disease that affects the
nervous system and the parts of the body
which controlled by nerves.
Parkinson's disease is caused by a loss of
nerve cells in the part of the brain called
the substantia nigra. Nerve cells in this
part of the brain are responsible for
producing a chemical called dopamine

 Genetics
 Environmental factors
 Drug induced (anti psychotic drugs)
 Cerebrovascular disease (Its attack damage the brain cells)
 The presence of Lewy bodies (Clumps of specific substances within brain cells)
 Head trauma
 Advancing of age
 Gender

Destruction of dopmenergic neuronal cells in the
substantia nigra in the basal ganglia
Neuronal cells loss and depigmentation
Degeneration of dopmenergic activity
Depletion of dopamine store
Imbalance between acetylcholine and
dopamine neurotransmitter
Etiological Factors
Environmental factors
Genetics
Brain Trauma
Sign and symptoms
Tremors
Rigidity
Akinesia
Postural instability
Impairment of extrapyramidal tract
controlling body movements

Tremors (pill rolling
usually during rest)
Rigidity (stiffness
of muscles)
Bradykinesia (slow and small
movements)
Postural changes
(imbalance, falls)

 Resting tremor
 Mask like facial expressions
 Stiff or achy limbs
 Rigidity
 Stooped posture (shuffle walk)
 Impaired posture and balance
 Loss of automatic movements
 Speech changes (low or soft voice)
 Trouble getting out from chair

 Patient history
 Detailed physical examination
 Complete neurological examination
 PET scan (positron emission topography)
 MRI (Magnetic resonance imaging)

 Dopamine agonists
 MAO B inhibitors
 Antiparkinson: drugs such as Levodopa (L-dopa); carbidopa-levodopa (Sinemet) is used to
control tremors and rigidity; converted to dopamine in the basal ganglia.
 Antiviral drugs: such as Amantadine hydrochloride (Symmetrel) is used to control tremor and
rigidity by increasing the release of dopamine to the basal ganglia.
 Anticholinergics: such as Trihexyphenidyl (Artane); benztropine mesylate (Cogentin) is used to
block acetylcholine stimulated nerves that lead to tremors.
 Other Drugs: Antihistamines are sometimes prescribed with the anticholinergics to inhibit
dopamine uptake; bromocriptine mesylate, a dopamine antagonist, is ordered to stimulate
dopaminergic receptors.

 Deep Brain Stimulation:
In deep brain stimulation (DBS),
surgeons implant electrodes into a
specific part of the 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.

 Assess neurological status.
 Assess ability to swallow and chew.
 Provide high-calorie, high-protien, 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 wear low-heeled shoes.
 Encourage the client to lift feet when walking and 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 anticholinergic medications as prescribed to treat tremors and
rigidity and to inhibit the action of acetylcholine.

 Imbalanced nutrition less than body requirements related to
parkinsonism changes in musculature and facial rigidity as
evidenced by weight lose.
 Impaired Physical Mobility related to Parkinson’s disease as
evidenced by immobility and weakness.
 Impaired Verbal Communication related to rigidity of facial
muscles evidenced by inability to speak
 Constipation related to diminished motor function and
inactivity.

 Assess patient’s ability to eat to provide information regarding factors
associated with reduced intake of nutrients.
 Weight patient daily, on the same scale and same time if possible Provides
information about weight loss or gain.
 Instruct patient with techniques that initiate movement change from side to
side helps to start the leg movement.
 Provide warm baths and massages helps relax muscles and relieve painful
muscle spasms that accompany rigidity.
 Assess the patient’s ability to speak, language deficit, cognitive or sensory
impairment his helps identify problem areas and speech patterns to help
establish a plan of care.

 Use simple, direct questions requiring one-word answers promotes self-
confidence of the patient who is able to achieve some degree of speech or
communication.
 Instruct patient to perform daily exercise that will increase muscle strength
and exercise prevent contractures.
 Refer patient to a physical therapist to be helpful in developing an
individualized exercise program and can provide instruction to the patient and
caregiver on exercising safely.
 When communicating with patient, face patient and maintain eye contact
Clarity, brevity, and time provided for responses promotes the opportunity for
successful speech

 To assist in maintaining balance, concentrate on taking larger steps with feet
apart, keeping back straight and swinging the arms.
 To overcome Akinesia, tape the “frozen” leg to initiate movement.
 To reduce tremors, hold objects (coins, keys, or purse) in the hand.
 To obtain partial control of tremors when seated, grasp chair arms.
 To reduce rigidity before exercise, take a warm bath.
 Teach the patient to eliminate loose carpeting, install grab bars, and elevate the
toilet seat.

 Assist with ambulation and provide
assistive devices.
 Assist during meals
 Maintain fluid balance
 Emotional support
 Provide physiotherapy services to
the patient .
Encephalitis
In olders above
60y of age
 Tremors
 Rigidity
 Bradykinesia
 Postural changes
 MAO B
 Dopamine Agonist
 Antiparkinson’s
 Anticholinergics
 I/v fluid therapy
Definition
Pharmacological
Treatment
4 cardinal
S & S
Diagnostic criteria
N-Management
PD is a slowly
progressive and
degenerative disease of
the brain
 Health history
 Complete physical
examination
 Complete neurological
examination
 CT- scan
 MRI
Most
commonly in
males

1)The slowly progressive and degenerative disease of the
brain is called..
a) Meningitis
b) Encephalitis
c) Parkinson's disease
d) Brain abscess
2) There are how many cardinal symptoms ..
a) 3
b) 4
c) 6
d) 5

3) Parkinson's is disease most common in..
a) Males
b) Females
c) Both
d) None of above
4) Which of the following is recognized as an initial cardinal
sign present early in Parkinson disease?
a) Bradykinesia
b) Balance impairment
c) Hyperkinesia
d) Dysarthriass

• Jankovic, J. (2008). Parkinson’s disease: clinical features and
diagnosis. Journal of neurology, neurosurgery &
psychiatry, 79(4), 368-376.
• Dauer, W., & Przedborski, S. (2003). Parkinson's disease:
mechanisms and models. Neuron, 39(6), 889-909.
• Lotharius, J., & Brundin, P. (2002). Pathogenesis of
Parkinson's disease: dopamine, vesicles and α-
synuclein. Nature Reviews Neuroscience, 3(12), 932-942.
• https://youtu.be/AZRq15AD4yA

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