Nursing management of patient with PARKINSONS DISEASE

Parkinson’s disease is a chronic, progressive neurodegenerative condition resulting from the loss of the dopamine-containing cells of the substantia nigra, and its prevalence increases with age. It is a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves.
Symptoms start slowly. Causes can be Genetics ,Environmental factors - Exposure to pesticides, herbicides, and industrial pollution is now being looked at as a possible cause of PD.
Presence of Lewy bodies -Lewy bodies are clumps of substances in the brain cells. These are often seen in people with Parkinson’s disease.
Age - People 60 years and older are at higher risk of PD. Parkinson’s disease rarely occurs in younger individuals.
Heredity - Family history of PD increases the chance of it developing later in life.
Gender - Prevalence of PD is higher in men than women.
Exposure to toxins- As research suggests, exposure to pesticide, herbicides, and pollution can increase the risk of developing PD.
Management includes
Physiotherapy can be helpful in relieving muscle stiffness and joint pain. It may improve gait and movement.

Occupational therapy- This therapy may help with the performance of activities of daily living. It helps promote independence and helps people make sure that their environment is conducive for their condition.

Speech and Language therapy- Speech and language therapy helps individuals to cope with this issue.

Medications are commonly used to manage symptoms of PD. However, close, and regular monitoring is needed to watch out for side effects.
Central nervous system agents such as levodopa –Levodopa works by being converted into dopamine in the brain.
Decarboxylase inhibitors such as carbidopa – these drugs assist the levodopa by preventing its breakdown before it reaches the brain; there are PD medications that have levodopa and carbidopa in combination.

Dopamine agonists – work by mimicking the action of dopamine in the brain.
Mao-B inhibitors – act by blocking in the chemicals in the brain that promote the breakdown of dopamine.
Anticholinergics – work by restoring the balance between dopamine and acetylcholine; they help reduce tremors and muscular rigidity.

Deep Brain Stimulation (DBS)�
Stereotactic thalamotomy – produces small incision the ventro lateral nucleus of the thalamus to alleviate contralateral tremor and rigidity.
Neuro transplantation – Experimental treatment in which dopamine producing cells of the adrenal medulla are transplanted into the caudate nucleus.

NURSING MANAGEMENT
Assessment
Initial symptoms, weak men, tendency to tremble, slowness of affected limb, loss of facial expression, difficulties in speech and flexed elbows.
Assess for tremors, in lips, jaws, facial muscles and limb muscles.
Assess for posture and rigidity- shuffling gait without arm swings and hyperactivity.
Assess the facial changes like masklike face and decreased eye blink.

1. Parkinson’s disease PREPARED BY :- PROF.BLESSY THOMAS ,MSc (N) NEUROSCIENCE NURSING DISEASE OF NERVOUS SYSTEM

2. INTRODUCTION Parkinson’s disease is a chronic, progressive neurodegenerative condition resulting from the loss of the dopamine-containing cells of the substantia nigra, and its prevalence increases with age. It is a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves. Symptoms start slowly.

3. DEFINITION Parkinson’s Disease (PD) is a common neurodegenerative disease characterized by changes in movement and posture. Parkinson’s disease is a chronic progressive degeneration of the brain dopamine neuronal systems characterized by the clinical systems of mask-like face, trunk forward flexion, muscle weakness and rigidity, shuffling gate, resting tremors, finger pill rolling and bradykinesia.

4. INCIDENCE 130/1000 population. Common in individuals under 40 years. Occurs through out the world in all racial and ethnic groups.

5. CAUSES AND RISK FACTORS Genetics Environmental factors - Exposure to pesticides, herbicides, and industrial pollution is now being looked at as a possible cause of PD. Presence of Lewy bodies -Lewy bodies are clumps of substances in the brain cells. These are often seen in people with Parkinson’s disease. Age - People 60 years and older are at higher risk of PD. Parkinson’s disease rarely occurs in younger individuals.

6. Heredity - Family history of PD increases the chance of it developing later in life. Gender - Prevalence of PD is higher in men than women. Exposure to toxins- As research suggests, exposure to pesticide, herbicides, and pollution can increase the risk of developing PD.

7. CLASSIFICATION

8. STAGE I – Unilateral involvement only STAGE II – Bilateral involvement STAGE III –Impaired postural and rightness reflex as mild to moderate disability. STAGE IV -Fully developed severe diseases, manned disability. STAGE V -Confinement to bed/ wheel chair.

9. PATHOPHYSIOLOGY Due to etiological factors Destruction of dopaminergic neuronal cells in the substantia nigra in the basal ganglia. Destruction of dopamine producing neuron within the basal ganglia. Reduces the amount of available striatal dopamine (inhibitory effects) There is an increase in Acetylcholine (excitatory effects) Excitatory activities of Ach are inadequately balanced Difficulty in contributing and initiating voluntary movement.

10. SIGNS AND SYMPTOMS OF PARKINSON’S DISEASE Motor manifestations Muscle rigidity Associated with slower of voluntary movement The muscle feels stiff and require more effort to move.

11. PRIMARY MANIFESTATIONS Tremor- The presence of tremors is one of the triad symptoms of Parkinson’s disease. Tremors usually start in the limbs, most commonly in the hands and fingers. They are likely to occur when the body is at rest and relaxed. Pill rolling tremors - It is characterized by the rubbing of thumb and forefinger back and forth.

12. Has difficulty in rising from chair. Bradykinesia (slow movements )- Individuals with PD display a distinctive slow and shuffling gait. Slowness in movements often make it more difficult for people with PD to complete activities of daily living. Rigidity (rigid muscles) - Muscle stiffness is also a common sign of PD. It may occur in any part of the body and may lead to dystonia or uncontrolled painful muscle cramps. Impaired posture and balance - Most people with PD often have a stooped posture.

13. SECONDARY MANIFESTATIONS Loss of automatic movements - Unconscious movements such as blinking, smiling, and swinging of hands when walking may be reduced in people with Parkinson’s disease. Hand writing becomes progressively smaller, choppier and jerkier. Visual deficits – blurred vision upward and lateral rotation of the eyes become fixed. (oculogyric crisis) Mask like face – the patient appears to stare straight a head and assumes and expression less look on his face.

14. The eyes tend to blink frequently than normal 5-10 times rather than the normal 15-20 minutes. Anosmia - Loss of the sense of smell may occur even years before the diagnosis of PD. Speech changes- Their speech may become soft, fast, slur, and their tone may become monotonous.

15. COMMON AUTONOMIC MANIFESTATIONS Drooling of saliva. Seborrhoea Dysphagia Excessive perspiration Constipation Orthostatic hypotension Urinary hesitation and frequency

16. DIAGNOSIS History collection Physical Examination Single Photon Emission CT scan -this form of imaging shows the blood flow to tissues and organs Dopamine transporter scan– This imaging is often used to confirm the diagnosis of PD. EEG

17. MANAGEMENT Physiotherapy can be helpful in relieving muscle stiffness and joint pain. It may improve gait and movement. Occupational therapy- This therapy may help with the performance of activities of daily living. It helps promote independence and helps people make sure that their environment is conducive for their condition. Speech and Language therapy- Speech and language therapy helps individuals to cope with this issue.

18. Medications are commonly used to manage symptoms of PD. However, close, and regular monitoring is needed to watch out for side effects. Central nervous system agents such as levodopa –Levodopa works by being converted into dopamine in the brain. Decarboxylase inhibitors such as carbidopa – these drugs assist the levodopa by preventing its breakdown before it reaches the brain; there are PD medications that have levodopa and carbidopa in combination.

19. Dopamine agonists – work by mimicking the action of dopamine in the brain. Mao-B inhibitors – act by blocking in the chemicals in the brain that promote the breakdown of dopamine. Anticholinergics – work by restoring the balance between dopamine and acetylcholine; they help reduce tremors and muscular rigidity.

20. Deep Brain Stimulation (DBS) Deep brain stimulation (DBS) involves implanting electrodes within areas of the brain. The electrodes produce electrical impulses that affect brain activity to treat certain medical conditions. The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in the upper chest. A wire that travels under the skin connects this device to the electrodes in the brain .

21. Stereotactic thalamotomy – produces small incision the ventro lateral nucleus of the thalamus to alleviate contralateral tremor and rigidity. Neuro transplantation – Experimental treatment in which dopamine producing cells of the adrenal medulla are transplanted into the caudate nucleus.

22. NURSING MANAGEMENT Assessment Initial symptoms, weak men, tendency to tremble, slowness of affected limb, loss of facial expression, difficulties in speech and flexed elbows. Assess for tremors, in lips, jaws, facial muscles and limb muscles. Assess for posture and rigidity- shuffling gait without arm swings and hyperactivity. Assess the facial changes like masklike face and decreased eye blink. Assess the problems in speech.

23. NURSING DIAGNOSIS Impaired physical mobility related to muscle tremors, rigidity, tremors, gait disturbances and bradykinesia.

24. NURSING INTERVENTIONS Assess the muscle rigidity, gait disturbances and signs of bradykinesia. Administer prescribed medication in a timely manner, observe and document patients’ response. Provide for range of motion exercise to extremities four times a day. Evaluate the effectiveness of the drug program and adjust as necessary. Suggest a physical therapy referral to assist the patient’s mobility.

25. COMMON NURSING INTERVENTIONS Assess neurological status. Assess ability to swallow and chew. Provide high-calorie, high-protein, 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.

26. Instruct client to rock back and forth to initiate movement. 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.

27. Administer anticholinergic medications as prescribed to treat tremors and rigidity and to inhibit the action of acetylcholine. Administer antiparkinsonian medications to increase the level of dopamine in the CNS. Instruct the client to avoid foods high in vitamin B6 because they block the effects of antiparkinsonian medications. Instruct the client to avoid monoamine oxidase inhibitors because they will precipitate hypertensive crisis.

28. THANK YOU