Parkinson's Disease

Parkinson's Disease

1. Risk factors

2. Nursing Care plan

3. Pathophysiology

   • Disease of basal ganglia
     • Characterised by:
       • Slowness in the initiation and execution of movement,
       • Increased muscle tone
       • Tremor at rest
       • Impaired postural reflexes
   • Neurons that supply dopamine to the striatum degenerates.
     • When there is defects of dopamine, the excitatory effects of acetylcholine go unopposed resulting in disturbed movements.

4. Signs and symptoms

   • Tremor
     • Hand
       • Pill rolling
     • diaphragm, tongue, lips and jaw
     • Can rarely cause shaking of the head
   • Rigidity
     • Increased resistance to passive motion when limbs go through their range of motion
     • Caused by sustained muscle contractions
     • Can cause pain and slowness in movement
   • Bradykinesia/Akinesia (Immobility)
     • Loss of automatic movements
       • Blinking of the eyelids
       • Swinging of the arms while walking
       • Swallowing of saliva
       • Self-expression with facial and hand movements
     • Primary evidence is the physical and chemical alteration of the basal ganglia and related structures in the extrapyramidal portion of the CNS
   • Posturing
     • Shuffling gait with short steps
       • Parkinsonian Gait
       • Festination
     • Postral instability is common
     • Forward tilt of the trunk
     • Propulsion and Retropulsion
       • Forward bending and backwards bending

5. Medications

   • Anticholinergic
   • Dopaminergic
     • Levodopa with carbidopa
       • Also called sinemet
       • Precursor of DA and crosses blood-brain barrier
       • Converted to DA in the basal ganglia
       • Carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain.
   • Antihistamine
   • monoamine oxidase inhibitor
   • Catechol-O-methyl transferase (COMT) inhibitor

6. Complications