Adult Medical-Surgical Nursing Neurology Module: Parkinson’s Disease

Parkinson’s Disease: Description An upper motor neurone disorder A progressive, degenerative neurological disease leading to disability Progressive destruction of the substantia nigra cells of the basal ganglia of the brain

Parkinson’s Disease: Aetiology Incidence is more in males than females and increases with age (mostly >50 years) Genetic predisposition Atherosclerosis Environmental hazards, viral infection Anti-psychotic drugs Cause unknown in many cases

Control of Motor Function Motor function is maintained in fine balance through the excitatory neurotransmitter, Acetylcholine (↑ activity) and the inhibitory neurotransmitter, Dopamine controlling (↓) activity

Parkinson’s Disease: Pathophysiology Progressive destruction of the substantia nigra cells of the basal ganglia leads to ↓ Dopamine secretion Since Dopamine has an inhibitory effect on motor function, imbalance leads to increased excitability of muscles

Parkinson’s Disease: Clinical Manifestations Tremor of extremities at rest (reduces with purposeful movement). “Pill-rolling” action Rigidity of muscles (resistance to passive movement). Stiff trunk, neck, shoulders Bradykinasia: slow, shuffling movements, difficulty in initiating movement (slow/ stop) Postural and balance disturbance: altered line of gravity

Parkinson’s Disease: Clinical Manifestations (cont) Difficulty with fine motor function Soft monotone voice, dysphagia, drooling Weakness, muscle fatigue: drooping limbs Mask-like expressionless face Cognitive impairment: dementia may occur and hallucinations. Sleep disturbance Sweating Prone to urinary retention/ constipation

Parkinson’s Disease: Complications High risk of injury from falling (rigidity, poor balance, muscle weakness) Respiratory infection/aspiration pneumonia (immobility, dysphagia, weak cough) Skin breakdown/ pressure sores (sweating, immobility, rigidity) Urinary tract infection

Parkinson’s Disease: Diagnosis Patient and family history Clinical picture

Parkinson’s Disease: Medical Management Levodopa (precursor of Dopamine): converts to Dopamine (↓ effect longterm) Bromocriptine (Dopamine agonist: increases receptors for Dopamine) Neostigmine (anti-cholinergic): reduces rigidity and tremor(↓effect of acetylcholine) MAOI drugs (↑ impulses at synapses) and Antiviral drugs may slow disease progress

Parkinson’s Disease: Stem Cell Research It is hoped that in the future Parkinson’s Disease may be cured by transplant into the basal ganglia of healthy stem cells produced from cord blood or controversially from cloned embryos

Parkinson’s Disease: Nursing Considerations Safe surroundings and support Adequate help when moving to avoid injury as rigid. Air mattress, cushioned cot sides if accepted by the patient Physiotherapy to correct gait and promote balance. Speech therapy Patient assistance with meals, soft food, weight chart Manage bladder and bowel control

Parkinson’s Disease: Nursing Considerations (cont) *TLC = tender loving care* Much psychological and emotional support to patient and family Monitor and encourage coping ability