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Understanding and Managing
Parkinson's Disease
Parkinson's Disease
Parkinson's disease is a progressive, neurodegenerative disorder characterized by a deficiency of dopamine in the brain, resulting from the loss of dopamine-producing cells. Dopamine is a neurotransmitter crucial for regulating movement.
Etiology
The causes of Parkinson's disease are multifactorial, involving both environmental and genetic components. Risk factors include exposure to certain chemicals and metals, age over 40, and genetic predisposition, which accounts for approximately 10% of cases.
Cardinal Symptoms
The four primary motor symptoms of Parkinson's disease are tremor, muscle rigidity, bradykinesia/akinesia (slowness or absence of movement), and postural instability.
Assessment
Assessment involves gathering the patient's history, including the onset of symptoms, and conducting a physical examination. Non-motor symptoms may manifest several years before motor symptoms. Physical findings may include resting tremors in the upper extremities, rigidity (assessed by decreased arm swing or leg drag during walking), facial masking (reduced facial expression), and a wide, slow, shuffling gait. Emotional and speech changes, such as soft speech (hypophonia), and bowel and bladder changes may also be present. Micrographia (small handwriting) is another possible finding.
Non-Motor Symptoms
Non-motor symptoms encompass a range of issues, including depression, anxiety, apathy (loss of motivation), psychosis (hallucinations and delusions), and impulse control disorders (compulsive gambling, sexual behaviors, shopping, eating, punding). Other non-motor symptoms include constipation, overactive bladder and incontinence, sexual dysfunction, excessive salivation (drooling), excessive sweating, pain, sleep disturbances (REM sleep behavior disorder), fatigue, and neurogenic orthostatic hypotension (nOH). REM sleep behavior disorder is characterized by acting out vivid dreams.
Motor Symptoms
Motor symptoms include tremors (pill-rolling, resting, action, and internal), rigidity, bradykinesia (slowness of movement), postural instability (poor balance and coordination), and dystonia (involuntary muscle contraction).
Labs and Imaging
The text does not specify particular labs and imaging techniques used in the diagnosis of Parkinson's Disease.
Nursing Interventions
Nursing interventions include allowing extra time for patients to answer questions, administering medications on schedule, providing pain medication as needed, monitoring for drug side effects, implementing fall precautions, providing physical and occupational therapy, assisting with activities of daily living while allowing the patient sufficient time, preventing complications such as constipation, contractures, and skin breakdown, scheduling appointments later in the day, teaching the patient to speak slowly and clearly, monitoring swallowing and eating, providing high-protein, high-calorie supplements, building self-esteem by focusing on strengths, and assessing for depression, anxiety, impaired cognition, and insomnia.
Drug Therapy
Pharmacological treatments include carbidopa/levodopa, which increases dopamine levels in the brain. Side effects include nausea and light- headedness. Dopamine agonists, such as pramipexole, ropinirole, and apomorphine, improve movement but can cause hallucinations, daytime sleepiness, sleep attacks, impulse control disorders, and dyskinesia. MAO-B inhibitors, such as selegiline and rasagiline, block the enzyme that breaks down dopamine. Pimavanserin (Nuplazid) is specifically used to treat Parkinson's disease-related hallucinations and delusions.
Surgical Management
Surgical options include stereotactic pallidotomy and deep brain stimulation (DBS), both aimed at improving tremors and overall movement.
Deep Brain Stimulation (DBS)
DBS involves implanting electrodes in the brain to produce electrical impulses that regulate abnormal brain activity. Risks include bleeding or stroke, infection, lead breakage, lead movement, failure to improve, and adverse side effects of stimulation. Special precautions with a DBS device include turning it off prior to MRI, EKG, or EEG.
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Safety Concerns
Safety concerns in Parkinson's disease include falls (due to rigidity, postural instability, freezing, and bradykinesia), aspiration pneumonia (due to dysphagia), incontinence (due to rigidity and bradykinesia), skin breakdown (due to immobility), and emotional distress (due to feelings of helplessness, frustration, anxiety, fear, depression, and embarrassment).
