Nursing Care and Pathophysiology for Parkinsons

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Included In This Lesson

Study Tools For Nursing Care and Pathophysiology for Parkinsons

Common Signs of Parkinson’s (Mnemonic)
Parkinsons Pathochart (Cheatsheet)
Parkinsons Man (Image)
Parkinsons MJF and MA (Image)
Parkinsons Pathophysiology (Image)
Parkinson’s Disease Interventions (Picmonic)
Parkinson’s Disease Assessment (Picmonic)
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Outline

Pathophysiology: Loss of dopamine and a break down of the dopaminergic pathway causes the motor activity to be underactive and uncontrolled. With the lack of dopamine, the nerves fire signals out of control and causes uncoordinated movements.

 


Overview
  1. Degenerative neurological disorder
  2. Atrophy of substantia nigra → depletion of dopamine
    1. Less and less capable of controlled movement

Nursing Points

General

  1. Slow, progressive disease
  2. No cure
  3. Progressively debilitated and self-care dependent

Assessment

  1. Classic Signs:
    1. Pill rolling – tremors in hands (as if rolling a pill between fingers)
    2. Shuffling Gait
    3. Lip Smacking
    4. Bradykinesia – slow movements due to muscle rigidity
  2. Resting tremor
  3. Akinesia – loss of voluntary movement
  4. Blank facial expression
  5. Stooped stance
  6. Drooling
  7. Dysphagia

Therapeutic Management

  1. Medication therapy
    1. Dopaminergics
    2. Dopamine agonists
      1. Levodopa-Carbidopa
    3. Anticholinergics
  2. Goal is to increase the levels of available dopamine in the CNS
  3. Eventually drugs become ineffective

Nursing Concepts

  1. Functional Ability
    1. Assistive devices
    2. Physical and Occupational Therapy
    3. Use rocking movement to initiate movement
    4. Encourage client to ambulate multiple times a day
    5. Participate in active and passive range of motion activities
  2. Nutrition
    1. Avoid foods high in Vitamin B6 (blocks effects of antiparkinsonian drugs)
    2. Small, frequent, nutrient dense food
    3. Speech Therapy
    4. Monitor diet to insure proper caloric intake
      1. Increase fluid intake
      2. High protein
      3. High fiber
    5. Assess ability to swallow prior to anything by mouth
  3. Coping
    1. Encourage expression of feelings
    2. Provide resources for support groups
    3. Encourage independence as long as possible

Patient Education

  1. Best methods for optimizing nutrition
  2. Activity and energy conservation options
  3. Proper use of assistive devices
  4. Medication Instructions

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Transcript

In this lesson, we’re going to talk about Parkinson’s disease.

Parkinson’s disease is a slow, progressive, degenerative disorder of the nervous system. It primarily affects a structure in the midbrain known as the substantia nigra. You can see here is the substantia nigra in a normal midbrain. What happens in Parkinson’s disease is that this structure is atrophied, meaning it shrinks or get smaller. This substantia nigra is the structure in our brain that is primarily responsible for secreting dopamine. When it atrophies we see a decrease in our available dopamine in the brain. If you remember from the impulse transmission lesson, dopamine is a neurotransmitter that helps to send signals throughout the nervous system. It has many functions, but one of those functions is to help regulate and coordinate muscle movements to make them more controlled. What we see in Parkinson’s disease is that because of this depletion of dopamine, patients are less and less capable of controlled muscle movements.

The signs that will see in patients with Parkinson’s disease will all relate to the fact that they are unable to control their muscle movements. The classic signs of Parkinson’s disease that you will see listed on tests and on your NCLEX are shuffling gait, bradykinesia, and pill rolling. Bradykinesia means slow movements – it’s almost like they’re trudging through mud or quicksand. They shuffle their feet because they struggle to lift their feet up off the ground. We will also see muscle rigidity and significant tremors even at rest. One of those types of tremors is called pill-rolling. It’s a tremor within the hands that makes them look like they’re rolling a pill between their fingers. Patients with Parkinson’s disease will also lose control of muscles within their face, so we will see blank or inappropriate facial expressions. They also have trouble controlling their secretions and often will drool or have difficulty swallowing, which is called dysphagia. Many times patients will begin to lose weight because they find it much more difficult to prepare and eat food in addition to having trouble swallowing it. So nutrition will become a priority.

Every patient’s experience with Parkinson’s is different. One patient described it this way: “I feel like gravity changed and I’m dragging myself through sand now.” Ultimately those slow movements and inability to control them will become more and more of a burden.

Unfortunately, at this point there is no cure for Parkinson’s Disease. You may know two of the most famous people who have Parkinson’s disease, that is the late Muhammad Ali, and Michael J. Fox. Michael J. Fox actually has his own Foundation dedicated to Parkinson’s research and they hope to have a cure within the next few decades. Either way the ongoing research is helping to provide more and more treatment options. Our current therapies are aimed at increasing dopamine levels in the central nervous system. This includes dopaminergic medications, dopamine agonists, as well as anticholinergics. If you remember from the blood-brain barrier lesson, one of the problems with medications aimed at the central nervous system is that many of them cannot cross the blood-brain barrier. The dopamine agonist that we use for Parkinson’s, called levodopa, cannot cross the blood-brain barrier by itself. So they’ve added Carbidopa to it – that helps to carry levodopa across the blood-brain barrier to help to elevate dopamine levels in the CNS. Because Parkinson’s is a progressive disease, we will find that eventually these medications are no longer as effective. As muscle contraction gets less and less controlled, patients will lose their ability to do basic functions like eat and breathe.

Priority nursing concepts for a patient with Parkinson’s disease include functional ability, nutrition, and coping. We need to help them learn how to perform activities of daily living, and use assistive devices to get around if necessary so that they can maintain their independence as long as possible. As I said before, sometimes nutrition becomes a problem because preparing and eating meals is difficult. So we encourage small, frequent, nutrient-dense meals to make sure they’re still getting the calories they need. In the hospital, we want to make sure they are able to swallow safely before we feed them or give them anything by mouth. And finally because this is a progressive disease, some patients will need extra help with coping strategies and ways to make the best of the time they have left.

So remember that the core problem in Parkinson’s disease is a depletion of dopamine levels in the central nervous system that makes the patient less and less capable of controlled muscle movements. Classic signs of Parkinson’s are bradykinesia, shuffling gait, and pill rolling tremors. Parkinson’s disease is progressive, and the patients will slowly become more and more dependent on others for self-care. We want to encourage their activity and help them maintain their functional independence as long as possible.

Make sure you check out the care plan and other resources attached to this lesson to learn more about caring for patients with Parkinson’s disease. Now go out and be your best self today. And, as always, happy nursing!

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Concepts Covered:

  • Basics of Sociology
  • Statistics
  • Communication
  • Fundamentals of Emergency Nursing
  • Musculoskeletal Disorders
  • Cardiac Disorders
  • Emergency Care of the Cardiac Patient
  • Medication Administration
  • Gastrointestinal Disorders
  • Pregnancy Risks
  • Labor Complications
  • Factors Influencing Community Health
  • Respiratory Disorders
  • Emergency Care of the Neurological Patient
  • EENT Disorders
  • Newborn Complications
  • Documentation and Communication
  • Preoperative Nursing
  • Legal and Ethical Issues
  • Adult
  • Substance Abuse Disorders
  • Hematologic Disorders
  • Musculoskeletal Trauma
  • Intraoperative Nursing
  • Microbiology
  • Disorders of Pancreas
  • Oncology Disorders
  • Anxiety Disorders
  • Neurologic and Cognitive Disorders
  • Personality Disorders
  • Basics of NCLEX
  • Studying
  • Newborn Care
  • Basics of Mathematics
  • Note Taking
  • Integumentary Disorders
  • Emergency Care of the Trauma Patient
  • Respiratory Emergencies
  • Developmental Considerations
  • Digestive System
  • Lower GI Disorders
  • Central Nervous System Disorders – Brain
  • Postpartum Care
  • Basic
  • Infectious Respiratory Disorder
  • Integumentary Disorders
  • Eating Disorders
  • Circulatory System
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  • Test Taking Strategies
  • Musculoskeletal Disorders
  • EENT Disorders
  • Postoperative Nursing
  • Neurological Emergencies
  • Cognitive Disorders
  • Concepts of Population Health
  • Community Health Overview
  • Noninfectious Respiratory Disorder
  • Delegation
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  • Terminology
  • Postpartum Complications
  • Vascular Disorders
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  • Developmental Theories
  • Fetal Development
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  • Prenatal Concepts
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  • Female Reproductive Disorders
  • Acute & Chronic Renal Disorders
  • Prioritization
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  • Pediatric
  • Perioperative Nursing Roles
  • Concepts of Pharmacology
  • Psychotic Disorders
  • Concepts of Mental Health
  • Neurological Trauma
  • Health & Stress
  • Respiratory System

Study Plan Lessons

Lab Panels – The Basics and What YOU Need to Know 2 – Live Tutoring Archive
Fundamentals Course Introduction
Legal & Ethical Issues in ER
Nursing Care and Pathophysiology of Osteoporosis
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
6 Rights of Medication Administration
Abdomen (Abdominal) Assessment
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placentae (Placental abruption)
Abuse
Access to Care
ACE (angiotensin-converting enzyme) Inhibitors
Acute Bronchitis
Acute Confusion
Acute Otitis Media (AOM)
Addicted Newborn
Admissions, Discharges, and Transfers
Advance Directives
Advanced Cardiovascular Life Support (ACLS)
Aggressive & Violent Patients
Airway Suctioning
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alkylating Agents
Alveoli & Atelectasis
Ammonia (NH3) Lab Values
Amputation
Amputation Concept Map
Anemia in Pregnancy
Anesthetic Agents
Aneurysm & Dissection
Angiotensin Receptor Blockers
Antepartum Testing
Anti Tumor Antibiotics
Anti-Infective – Aminoglycosides
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Antidiabetic Agents
Antimetabolites
Antineoplastics
Anxiety
Appendicitis
Applying for Jobs
Artificial Airways
Asthma
Asthma Concept Map
Attention Deficit Hyperactivity Disorder (ADHD)
Atypical Antipsychotics
Autism Spectrum Disorders
Avoiding Alarm Fatigue
Babies by Term
Barriers to Health Assessment
Base Excess & Deficit
Basic Operations
Be a Mix Tape (Rewind and Fast-Forward)
Bed Bath
Benzodiazepines
Betamethasone and Dexamethasone
Betamethasone and Dexamethasone in Pregnancy
Bladder Cancer
Blood Cultures
Blood Transfusions (Administration)
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Blunt Thoracic Trauma
Body Image Changes Throughout Development
Body System Assessments
Bone Cancer (Osteosarcoma, Chondrosarcoma, and Ewing Sarcoma)
Bowel Elimination
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Brain Death v. Comatose
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Bronchiolitis and Respiratory Syncytial Virus (RSV)
Bronchoscopy
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Can You Draw It
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Community Health Nursing Theories
Congenital Heart Defects (CHD)
Congestive Heart Failure Concept Map
Conjunctivitis
Connections
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Continuous Renal Replacement Therapy (CRRT, dialysis)
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Day in the Life of a Postpartum Nurse
Day in the Life of an Operating Room Nurse
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Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Degree Restrictions in Career Growth
Delegation
Depression
Depression Concept Map
Developmental Considerations for the Hospitalized Individual
Diabetes Management
Different Dressings
Digestive Terminology
Diploma vs ADN vs BSN vs Bridge
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Dissociative Disorders
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Documentation Basics
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Erikson’s Theory of Psychosocial Development
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Hemoglobin (Hbg) Lab Values
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Histamine 1 Receptor Blockers
How to Write a Nursing Care Plan
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IM Injections
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Insulin
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Integumentary (Skin) Assessment
Interventional Radiology
Intracranial Hemorrhage
Intraoperative Positioning
Introduction to CCMM
Intubation in the OR
Iron Deficiency Anemia
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Legalities of Charting
Leopold Maneuvers
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Magnesium Sulfate in Pregnancy
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Meds for PPH (postpartum hemorrhage)
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Moderate Sedation
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Nephrotic Syndrome
Neuro Assessment
Newborn Physical Exam
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NG (Nasogastric)Tube Management
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Normal Sinus Rhythm
Nuclear Medicine
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Appendicitis
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Chlamydia (STI)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care and Pathophysiology for Gonorrhea (STI)
Nursing Care and Pathophysiology for Gout
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hemorrhoids
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Lyme Disease
Nursing Care and Pathophysiology for Male Infertility
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Pulmonary Embolism
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Scleroderma
Nursing Care and Pathophysiology for Seizure
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for Syphilis (STI)
Nursing Care and Pathophysiology for Testicular Torsion
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoporosis
Nursing Care and Pathophysiology of Renal Calculi (Kidney Stones)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care Delivery Models
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Glaucoma
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Process – Assess
Nursing Process – Diagnose
Nursing Process – Evaluate
Nutrition (Diet) in Disease
Nutrition Assessments
Nutrition in Pregnancy
Obstetrical Procedures
Obstructive Heart (Cardiac) Defects
Omphalocele
Oncology Important Points
Opioid Analgesics
Opioid Analgesics in Pregnancy
Order of Lab Draws
Osteosarcoma
Outline Question Method (Note taking)
Ovarian Cancer
Pain and Nonpharmacological Comfort Measures
Paranoid Disorders
Parasympatholytics (Anticholinergics) Nursing Considerations
Patient Positioning
Pediatric Advanced Life Support (PALS)
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediculosis Capitis
Penetrating Abdominal Trauma
Penetrating Thoracic Trauma
Perioperative Nursing Roles
Peripheral Vascular Assessment
Peritoneal Dialysis (PD)
Personality Disorders
Pertussis – Whooping Cough
Pharmacology Course Introduction
Phenylketonuria
Phosphorus-Phos
Piaget’s Theory of Cognitive Development
Pill Crushing & Cutting
Pituitary Adenoma
Placenta Previa
Platelets (PLT) Lab Values
Pneumonia
Postpartum Discomforts
Postpartum Hematoma
Postpartum Hemorrhage (PPH)
Postpartum Physiological Maternal Changes
Potassium-K (Hyperkalemia, Hypokalemia)
PPE Donning & Doffing
Practice Settings
Precipitous Labor
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Preoperative (Preop) Nursing Priorities
Preoperative (Preop)Assessment
Pressure Line Management
Pressure Ulcers/Pressure injuries (Braden scale)
Preterm Labor
Prioritization
Prioritizing Assessments
Procedural Terminology
Process of Labor
Prostaglandins
Prostaglandins in Pregnancy
Provider Phone Calls
Psychiatry Terminology
Pulmonary Function Test
R – Real-Life
Radiation Cancer Treatment
Real-Life Experiences
Red Blood Cell (RBC) Lab Values
Renal (Kidney) Failure Labs
Reproductive Terminology
Resources for Lesson Creation
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Restraints
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Routine Neuro Assessments
Rubeola – Measles
Safety Checks
SBAR Communication
Schizophrenia
Scoliosis
Seizure Management in the ER
Selecting THE vein
Self Concept
Sensory Terminology
Sepsis Concept Map
Shift change and Patient handoff
Sickle Cell Anemia
Signs of Pregnancy (Presumptive, Probable, Positive)
Sinus Bradycardia
Sinus Tachycardia
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Spiking & Priming IV Bags
Spina Bifida – Neural Tube Defect (NTD)
Spinal Cord Injury
Spinal Precautions & Log Rolling
Start and End with the Linchpin
Sterile Gloves
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Stomach Cancer (Gastric Cancer)
Stress and Crisis
Stroke (CVA) Management in the ER
Stroke Concept Map
Stroke Nursing Care (CVA)
Subinvolution
SubQ Injections
Sudden Infant Death Syndrome (SIDS)
Suicidal Behavior
Surgical Incisions & Drain Sites
Surgical Prep
Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Systemic Lupus Erythematosus (SLE)
Tenet 2 Linchpins & Connections
Tenet 3 Why Behind the What
Tenet 4 Learner-Centered Talkabouts
Tension and Cluster Headaches
Testicular Cancer
The 5-Minute Assessment (Physical assessment)
The EKG (ECG) Graph
The Medical Team
Thinking Like a Nurse
Thoracentesis
Thorax and Lungs Assessment
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Thrombocytopenia
Thyroid Cancer
Time Management
Tocolytics
Tocolytics
Tonsillitis
Topical Medications
Total Bilirubin (T. Billi) Lab Values
Trach Care
Trach Suctioning
Transient Tachypnea of Newborn
Transition To Practice
Transition to Practice Course Introduction
Trauma Survey
Triage in the ER
Troponin I (cTNL) Lab Values
Types of Exercise
Types of Schizophrenia
Umbilical Hernia
Urinary Elimination
Using Aseptic Technique
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Varicella – Chickenpox
Varicocele
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms
Vitals (VS) and Assessment
Vomiting
What Guides Nurses Practice
What is CCMM?
White Blood Cell (WBC) Lab Values
Working night shift
Working with a Preceptor
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Selecting a Dressing
Wound Care – Wound Drains