Introduction Parkinson’s disease (PD) is a life changing diagnosis. It is a progressive, neurodegenerative disease that is the third most common neurological disorder of older adults (Ignatavicius & Workman, Medical Surgical Nursing Patient Centered Collaborative Care 6th edition, 2010, p. 965). Parkinson’s disease progresses to a debilitating disease and affects motor movement ability and has four main symptoms: rigidity, tremor, slow movement and instability in posture. As a result of these symptoms, a person would have trouble walking and swallowing and living life in general. Pathophysiology.
PD causes motor activity as a result of integrating the actions of the cerebellum, basal ganglia, and cerebral cortex. The basal ganglia are a group of neurons located within the cerebrum at the base of the brain near the ventricles. When the basal ganglia is stimulated, muscle tone in the body in inhibited and voluntary movements are refined. The secretions of two major neurotransmitters make this process happen. These two neurotransmitters are acetylcholine and dopamine. (Ignatavicius & Workman, Medical Surgical Nursing Clinical Companion 6th edition, 2010, p. 965). Acetylcholine is produced and secreted by the basal ganglia.
Dopamine is produced and secreted by the substantia nigra and the adrenal glands (Ignatavicius & Workman, Medical Surgical Nursing Patient Centered Collaborative Care 6th edition, 2010, p. 965). Acetylcholine transmits excitatory messages throughout the basal ganglia. Dopamine inhibits these neurons and can allow control over the voluntary movements.
Parkinson’s Disease 3 Widespread degeneration of the substansia nigra leads to a decrease in the amount of dopamine in the brain. When a person loses the ability to refine voluntary motor movement it is due to this decrease in dopamine leaving a large amount of excitatory acetylcholine secreting neurons thus causing the involuntary motor movements (Ignatavicius & Workman, Medical Surgical Nursing Clinical Companion 6th edition, 2010, p. 965).
This also prevents a person from controlling their movements. Besides the loss of dopamine in the brain, it also can reduce the sympathetic nervous system which can influence the blood vessels and the heart function. This is why orthostatic hypotension is seen in PD patients. (Ignatavicius & Workman, Medical Surgical Nursing Clinical Companion 6th edition, 2010, p. 965).
Risk Factors and Etiology Rarely do young adults experience PD. Mostly it is seen in middle to older populations, and the risk increases with age. Men are usually more likely to experience this disease. Ongoing exposure to herbicides and pesticides puts people at a slight increased risk. Having a close family relative with PD can also put someone at a slight increase for risk. Reduced estrogen levels are a known risk factor (Ignatavicius & Workman, Medical Surgical Nursing Patient Centered Collaborative Care 6th edition, 2010, p. 965). The exact cause remains unknown.
Diagnostic and Lab Tests Unfortunately, there are no definitive tests to diagnose PD. Tests such as MRI’s and brain scans would be ordered by your doctor to rule out other neurological diseases. The Parkinson’s Disease 4 diagnosis is most generally made by ruling out all other diseases and then doing a thorough medical history and neurological exam (Mayo Clinic, 2011). A diagnoses is usually made when a patient has •at least two of the three cardinal symptoms as mentioned above •onset of symptoms on only one side of the body •improvement with drug therapy like carbidopa/levodopa.
•a tremor that is more pronounced at rest. (Roberts, 2009) Focused Nursing Assessment Assessment would include obtaining patient information regarding family history, timing and progression of symptoms. Assessment of rigidity, which is present early and progresses as the disease progresses, should be noted. Stooped or flexed posture and gait should be documented. Patients with PD often have a shuffling, slow gate when walking. They have short steps and difficulty stopping. Speech is usually soft, low pitched with automatic repetition of what another people say.
Usually they will repeat sentences that they may hear. Assessment of tremors and the “pill-rolling” movements are noted. PD patients usually have a masklike faces with difficulty chewing and swallowing with excessive drooling mostly at night. A nurse would notice little arm movement when walking this patient. Autonomic dysfunction is apparent by orthostatic hypotension. Psychosocially, the patient will normally have depression and mood swings and sometimes cognitive impairment. (Ignatavicius & Workman, Medical Surgical Nursing Clinical Companion 6th edition, 2010) Parkinson’s Disease 5.
Clinical Manifestations The characteristics of PD include tremors which include movement at resting state. Nurses will see the rubbing of thumb and forefinger commonly known as the “pill-rolling” movement. PD may reduce patient’s ability to initiate voluntary movement. This makes the simplest tasks time consuming and difficult. Muscle stiffness can occur in any part of the body. Impaired posture and balance are also symptoms. Speech changes and dementia can be seen in the late stages of PD (Ignatavicius & Workman, Medical Surgical Nursing Clinical Companion 6th edition, 2010).
Medical Care Medical care is mostly directed towards treatment of symptoms. A lot of research has gone into experimentation with different drug therapy. Some doctors see good results with prescribing anticholinergics to help manage tremors but these medications often give patients side effects of dry mouth and constipation (Ignatavicius & Workman, Medical Surgical Nursing Patient Centered Collaborative Care 6th edition, 2010). Some patients have seen good results from antiviral drugs like Amantadine.
This drug increases the release of dopamine and decreases its reuptake, increasing dopamine levels (Roberts, 2009). Carbidopa/levodopa is the only approved antiparkinson drug available. Dosages and timing of directions may need to be experimented with to find the correct dosage for the patient. Therapeutic effect may require 2-3 weeks of therapy but may require up to 6 months (Deglin & Vallerand, 2009). Patients who take this medication for several years may experience a decrease in the effectiveness of this drug (Deglin & Vallerand, 2009) Parkinson’s Disease 6.
Nursing Care Nursing Diagnosis for a patient with PD could be deficient knowledge related to unfamiliarity with resources of information (Sparks & Taylor, 2008). Nurses could assess for verbalization of the problem and the patient’s ability of following instructions. Nursing interventions may include teaching the patient a new skill each day, and continually reminding the patient to discuss progression towards goal. Nurses would want to establish an environment of respect and trust to enhance the learning environment.
Social isolation related to an altered state of wellness could be seen in patients with PD (Sparks & Taylor, 2008). Assessment should be made regarding preoccupation of thoughts related to the disease. Lack of friendships and loneliness can be seen. Sometimes patients are insecure in public environments and can express sadness. Interventions may be to identify support groups or to make referrals to support groups. Time should be spent letting the patient discuss feelings each day. Divisional activities may also seem helpful.
Some patients may experience grieving related to potential losses. (Sparks & Taylor, 2008). Assessments can be made regarding anger, decreased sleeping patterns, increased sorrow and even signs of denial. These patients should be encouraged to express their feelings and know that grief and anger are both normal feelings. Potential Complications One of the biggest complications of PD is imbalanced nutrition. When a patient suffers from tremors and movements that he cannot control they may burn an undesirable amount of Parkinson’s Disease 7 calories.
Then they have difficulty swallowing and chewing which then contributes to malnourishment and constipation. Healthy eating is an important way to control these potential complications. Patients should be taught to eat a balanced diet that contains plenty of fruits, vegetables and whole grains. A balanced diet can also provide nutrients, such as omega 3 fatty acids, that may be beneficial for people with PD. Patients must also modify consistency of foods as needed for safe swallowing (Mayo Clinic, 2011) Conclusion Living with a chronic illness like PD can be very difficult.
PD can be frustrating due to the problems such as walking, dressing and eating and just enjoying life. The understanding of loved ones would be top priority for these types of patients because the family and friends would be expected to be the patient’s biggest support. A person with PD would absolutely have to have a very strong support system in place in order to live happily for the remainder of their life. Works Cited Deglin, J. , & Vallerand, A. (2009). Davis’s Drug Guide for Nurses 11th edition. Philiadelphia: F. A. Davis Company. Ignatavicius, D. , & Workman, L. (2010).
Medical Surgical Nursing Clinical Companion 6th edition. St Louis: Saunders Elsevier. Ignatavicius, D. , & Workman, L. (2010). Medical Surgical Nursing Patient Centered Collaborative Care 6th edition. St Louis: Saunders Elsevier. Mayo Clinic. (2011, September 28). Parkinson’s disease. Retrieved September 28, 2011, from Mayoclinic: http://www. mayoclinic. com. health/parkinsons-disease Roberts, B. (2009, July 1). Parkinson disease. Nursing 2009 , pp. 58-64. Sparks, S. , & Taylor, C. (2008). Nursing Diagnosis Reference Manual 7th edition. Ambler: Lippincott Williams & Wilkins.