Care of the Client With Parkinson’s Disease

CARE OF THE CLIENT WITH PARKINSON’S DISEASE Objectives ◦ Discuss the incidence of PD ◦ Highlight the symptoms that a client with PD may experience ◦ Discuss the nursing and medical management of PD ◦ Highlight the teaching points for the client with PD Parkinson’s ◦ Most common hypokinetic movement disorder ◦ Impacts over 1,000,000 clients who are hospitalized ◦ Can occur at any age, but most commonly diagnosed in the 5th or 6th decade of life ◦ Multiple origins including age, environment and genetics Parkinson’s Basics ◦ Defined as a complex, chronic, progressive, neurodegenerative illness resulting from the slow loss of the brain’s dopamine producing system ◦ Due to the degeneration of dopamine producing cells in the substantia nigra (part of the midbrain) ◦ Imbalance in dopamine and acetylcholine effects voluntary movement ◦ Tremors, Rigidity, Bradykinesia, Postural changes Clinical Manifestations ◦ Motor symptoms ◦ Tremor ◦ rigidity ◦ Non-motor symptoms ◦ Sweating, drooling (excessive) ◦ Urinary retention/ constipation ◦ dysphagia ◦ Neuro-psychiatric symptoms ◦ Anxiety ◦ Depression ◦ dementia Assessment/Diagnostics ◦ No specific diagnostic test ◦ Diagnosis made on basis of clinical symptoms –Medication trial ◦ Most experts agree that the patient must have two of the four cardinal symptoms of PD ◦ Tremor ◦ Rigidity ◦ Bradykinesia ◦ Postural changes ◦ Other associated systemic symptoms Treatment goals ◦ Variability of symptoms means that treatment must be individualized for the client. ◦ Current treatments manage the symptoms of the disease but do not alter the disease progression. ◦ As the disease progresses, use of combined drug therapies is often recommended. ◦ Medications are used to treat motor and non-motor symptoms Medical Management ◦ Levodopa: Converted to Dopamine which produces some symptom relief ◦ Carbidopa: Added to Levodopa to avoid early metabolism of levodopa ◦ Combination Levodopa/Carbidopa is available in the US as Sinemet ◦ Beneficial effect ◦ More pronounced over first two years ◦ Extended use-symptoms ◦ Within 5-10 years-symptoms of dyskinesia (grimacing, jerking, chewing, smacking) ◦ Side effects: Nausea, vomiting, confusion Medical Management ◦ Amantidine (Symmetrel) ◦ Often provides immediate benefit for most PD motor symptoms by reducing rigidity and tremors, but effect frequently wanes after a few weeks or months. ◦ Mechanism of action is not fully known, however it seems that it interacts with receptors in the brain. ◦ Must be used with caution in people with kidney problems. They may require lower doses. ◦ Side effects are: ◦ Nausea ◦ Light headedness ◦ Insomnia Medical Management ◦ ANTI-CHOLINERGIC DRUGS ◦ Examples: ◦ benzatropine (Cogentin) ◦ Trihexyphenidyl hydrochloride (Apo-Trihex) ◦ Method of action ◦ Block the action of acetylcholine in the CNS ◦ Helps to control tremors and rigidity ◦ side effects include: urinary retention and dry mouth, blurry vision, decreased short term memory Surgical Management ◦ Deep Brain Stimulation (Stereostactic procedure) ◦ Wire electrodes surgically placed in the brain ◦ Electrical stimulation to target areas in the brain (may increase dopamine release) ◦ May be used in addition to medication, when medication alone does not control symptoms ◦ Preferred method for treating advanced Parkinson’s Disease (after five years) Nursing goals ◦ Planning and goals: ◦ Improve mobility ◦ Daily workout program ◦ Relaxation techniques ◦ Mobility techniques ◦ Self care ◦ Modify home. Environment ◦ Encourage independence ADL’s and personal activities Nursing Management ◦ Bowel Elimination ◦ Bowel routine-encourage moderate fiber ◦ Encourage fluids ◦ Avoid laxatives ◦ Nutrition ◦ May be difficult to maintain weight-weekly monitoring ◦ May need supplements ◦ Assistive devices for ADL’s Nursing Management ◦ Nutrition (Cont.) ◦ Encourage upright posture ◦ May need thickened meal ◦ Swallowing techniques ◦ Outpatient ◦ Education ◦ Lifestyle modifications