CNS DEGENERATIVE Parkinson Updated 3102013

7/27/2019 CNS DEGENERATIVE Parkinson Updated 3102013

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TOPIC: C.N.S DEGENERATIVE PARKINSONS DISEASE

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LEARNING OUTCOMES.

At the end of the topic, the students must be able to:

1) Define Parkinsons disease.2) State the etiology of Parkinson Disease.3)

State clinical manifestations for patient with Parkinsons disease4) List the common diagnostic test ordered to confirm the diagnosis

5) Identify the treatment available for patient with Parkinsons Disease6) Identify 3 nursing diagnosis for client with Parkinsons disease.7) Explain nursing intervention in caring for client with Parkinsons disease.

Definition It is characterized by progressive loss of muscle control, which leads totrembling of the limbs and head while at rest, stiffness, slowness, and

impaired balance.

As symptoms worsen, it may become difficult to walk, talk, and complete

simple tasks.


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Most individuals who develop Parkinson's disease are 60 years of age or older

Parkinson's disease was named after the British doctor James Parkinson, who

in 1817 first described the disorder in great detail as "shaking palsy."

Etiology Lack of dopamine causes the motor symptoms of Parkinson's disease. A substance called dopamine acts as a messenger between two brain

areas - the substantia nigra and the corpus striatum - to produce

smooth, controlled movements

When the amount of dopamine is too low, communication between thesubstantia nigra and corpus striatum becomes ineffective, andmovement becomes impaired; the greater the loss of dopamine, the

worse the movement-related symptoms

Other causes: dysfunctional cellular processes, Inflammation stress

At risk: A small number of individuals are at increased risk because of a

family history of the disorder. Head trauma, illness, or exposure to environmental toxins such as

pesticides and herbicides may be a risk factor.

Clinical

ManifestationsTremors:

Trembling in fingers, hands, arms, feet, legs, jaw, or head.


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Often occur while the individual is resting, but not while involved in atask.

May worsen when an individual is excited, tired, or stressed.

Rigidity: Stiffness of the limbs and trunk, which may increase during

movement. may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting

(micrographia) and may make eating difficult.

Bradykinesia: Slowness of voluntary movement. Over time, it may become difficult

to initiate movement and to complete movement. Bradykinesia together with stiffness can also affect the facial muscles

and result in an expressionless, "mask-like" appearance.

Postural instability:

Impaired or lost reflexes can make it difficult to adjust posture tomaintain balance.

Postural instability may lead to falls.


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Nursing

Management:

1)Maintain independent

help client to identify optimal activity level Teach client to balance rest & activity Encourage client to use of devices to assist with function

2)Prevent compl icati ons: assist client in diet selection: to avoid constipation & maintain

nutritional status

help client & family member be alert to skin care needs: to preventskin breakdown

encourage range of motion exercise & deep breathing exercise: forprevention of muscle waste & pulmonary infections

3) Provide appropriate care & guideli nes in all setting long term facility = at home obtain physiotherapist


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over something to take the first step. It may also help to take several

steps in place before starting to walk.

Self-Care Deficit Related to Reduced Mobility.The most common setting for treatment of the patient with Parkinsons

disease is the home. Encourage the patient to participate in ADLs as much as possible. Theoccupational therapist can assist with devices and strategies for

maintaining independence.

Patients have usually developed their own coping strategies, such aswearing clothing without buttons or shoes with adherent fasteners. As

self-care abilities further decline, caregivers provide more assistance

with ADLs.

Imbalanced Nutrition Related to Dysphagia and Reduced Mobility.

Assist patients to open packages and prepare meals, so they can feedthemselves if at all possible.

If the patient has a severe tremor, a spoon may be safer than a fork forself-feeding.

Finger foods may also be helpful. A cup with a lid and spout can help minimize spilling. Patients in the advanced stages of Parkinsons disease are at high risk

for aspiration because they have difficulty swallowing.

Adding thickening agents to liquids and assisting the patient to a chairor high Fowlers position for meals may help prevent aspiration.

Meals that are high in fiber help prevent constipation. Small, frequentmeals may be less overwhelming to the patient who must eat slowly.


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Disturbed Thought Processes Related to Effects of Disease and

Medication.

Memory impairment is one of the most distressing symptoms that patients

with Parkinsons disease experience. Many patients state that memory

impairment and loss of social outlets are more troublesome than the physical

impairments.

Assist the patient to devise coping methods, such as written dailyschedules, calendars, and reminders to take medications. If the patient

becomes confused, frequent reorientation may be helpful.

Caregiver Role Strain Related to Demands of Caring for Patient.

The significant others and caregivers of the patient with Parkinsons

Disease should be included in the plan of care. Encourage caregivers to utilize all community, personal, and

governmental support systems available. Caregivers may need to be

reminded that if they neglect their own health, both physical andmental, it will have a negative impact on the patient as well.

Some caregivers may only need an hour or two away on an occasionalbasis. Others may require a more extended break. Options for relieffrom caregiving range from having a friend or neighbor visit to

employing a home health aide or utilizing adult day care on a part-

time or full-time basis. Some skilled care facilities offer respite care, in which the patient is

admitted for a short time. This may be a viable option for caregivers

who must be hospitalized for their own health care. A social worker

may be able to assist with identification of resources.

Risk for Injury Related to Reduced Mobility and Balance.

The patient is at risk for injury from falls related to problems with mobility. If the patient is in the hospital or extended care facility, keep the call

light within reach at all times. The bed should be kept in the low position, with side rails raised. Restraints should be avoided, but alarm systems are available that alert

the staff that the patient is getting up.

The environment should be kept free from clutter, throw rugs, or otheritems that may cause a patient to trip.

Remind the patient to request assistance with ambulation. Walkers andother assistive devices may be helpful.

REFERENCES William, L. S & Hopper, P. D (2003) Understanding Medical SurgicalNursing. 3rd. edition. Davis Plus. Philadelphia.

Lemone P. & Burke K. (2004) Medical Surgical Nursing. CriticalThinking in Client Care. 3rd. edition. Pearson Prentice Hall.


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CNS DEGENERATIVE Parkinson Updated 3102013

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