Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Neurology Module:Neurology Module:

Parkinson’s DiseaseParkinson’s Disease

Parkinson’s Disease: DescriptionParkinson’s Disease: Description

An upper motor neurone disorderAn upper motor neurone disorder

A progressive, degenerative neurological A progressive, degenerative neurological disease leading to disabilitydisease leading to disability

Progressive destruction of the substantia Progressive destruction of the substantia nigra cells of the basal ganglia of the brainnigra cells of the basal ganglia of the brain

Parkinson’s Disease: AetiologyParkinson’s Disease: Aetiology

Incidence is more in males than females Incidence is more in males than females and increases with age (mostly >50 years)and increases with age (mostly >50 years)

Genetic predispositionGenetic predisposition

AtherosclerosisAtherosclerosis

Environmental hazards, viral infectionEnvironmental hazards, viral infection

Anti-psychotic drugsAnti-psychotic drugs

Cause unknown in many casesCause unknown in many cases

Control of Motor FunctionControl of Motor Function

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

Parkinson’s Disease: Parkinson’s Disease: PathophysiologyPathophysiology

Progressive destruction of the substantia Progressive destruction of the substantia nigra cells of the basal ganglia leads to ↓ nigra cells of the basal ganglia leads to ↓ Dopamine secretionDopamine secretion

Since Dopamine has an inhibitory effect Since Dopamine has an inhibitory effect on motor function, imbalance leads to on motor function, imbalance leads to increased excitability of musclesincreased excitability of muscles

Parkinson’s Disease: Parkinson’s Disease: Clinical ManifestationsClinical Manifestations

Tremor of extremities at rest (reduces with Tremor of extremities at rest (reduces with purposeful movement). “Pill-rolling” actionpurposeful movement). “Pill-rolling” action

Rigidity of muscles (resistance to passive Rigidity of muscles (resistance to passive movement). Stiff trunk, neck, shouldersmovement). Stiff trunk, neck, shoulders

Bradykinasia: slow, shuffling movements, Bradykinasia: slow, shuffling movements, difficulty in initiating movement (slow/ stop)difficulty in initiating movement (slow/ stop)

Postural and balance disturbance: altered Postural and balance disturbance: altered line of gravityline of gravity

Parkinson’s Disease: Parkinson’s Disease: Clinical Manifestations (cont)Clinical Manifestations (cont)

Difficulty with fine motor functionDifficulty with fine motor functionSoft monotone voice, dysphagia, droolingSoft monotone voice, dysphagia, droolingWeakness, muscle fatigue: drooping limbsWeakness, muscle fatigue: drooping limbsMask-like expressionless faceMask-like expressionless faceCognitive impairment: dementia Cognitive impairment: dementia maymay occur occur and hallucinations. Sleep disturbanceand hallucinations. Sleep disturbanceSweatingSweatingProne to urinary retention/ constipationProne to urinary retention/ constipation

Parkinson’s Disease: Parkinson’s Disease: ComplicationsComplications

High risk of injury from falling (rigidity, poor High risk of injury from falling (rigidity, poor balance, muscle weakness)balance, muscle weakness)

Respiratory infection/aspiration pneumonia Respiratory infection/aspiration pneumonia (immobility, dysphagia, weak cough) (immobility, dysphagia, weak cough)

Skin breakdown/ pressure sores Skin breakdown/ pressure sores (sweating, immobility, rigidity)(sweating, immobility, rigidity)

Urinary tract infectionUrinary tract infection

Parkinson’s Disease: DiagnosisParkinson’s Disease: Diagnosis

Patient and family historyPatient and family history

Clinical pictureClinical picture

Parkinson’s Disease: Parkinson’s Disease: Medical ManagementMedical Management

Levodopa (precursor of Dopamine): Levodopa (precursor of Dopamine): converts to Dopamine (↓ effect longterm)converts to Dopamine (↓ effect longterm)

Bromocriptine (Dopamine agonist: Bromocriptine (Dopamine agonist: increases receptors for Dopamine)increases receptors for Dopamine)

Neostigmine (anti-cholinergic): reduces Neostigmine (anti-cholinergic): reduces rigidity and tremor(↓effect of acetylcholine)rigidity and tremor(↓effect of acetylcholine)

MAOI drugs (↑ impulses at synapses) andMAOI drugs (↑ impulses at synapses) and

Antiviral drugs may slow disease progress Antiviral drugs may slow disease progress

Parkinson’s Disease: Parkinson’s Disease: Stem Cell ResearchStem Cell Research

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

Parkinson’s Disease: Parkinson’s Disease: Nursing ConsiderationsNursing Considerations

Safe surroundings and supportSafe surroundings and support

Adequate help when moving to avoid injury Adequate help when moving to avoid injury as rigid. Air mattress, cushioned cot sides as rigid. Air mattress, cushioned cot sides ifif accepted by the patientaccepted by the patient

Physiotherapy to correct gait and promote Physiotherapy to correct gait and promote balance. Speech therapybalance. Speech therapy

Patient assistance with meals, soft food, Patient assistance with meals, soft food, weight chartweight chart

Manage bladder and bowel controlManage bladder and bowel control

Parkinson’s Disease: Parkinson’s Disease: Nursing Considerations (cont)Nursing Considerations (cont)

*TLC = tender loving care**TLC = tender loving care*

Much psychological and emotional support Much psychological and emotional support to patient and familyto patient and family

Monitor and encourage coping abilityMonitor and encourage coping ability