hi guys it's me Professor de welcome back to my YouTube channel on this video we're doing another cahoot and we're going to be come I can't speak we're going to be covering Parkinson's disease and I know it's been a while since you've seen me I've seen the comments the emails the DMS so those who are new to my channel I take the Summers off June July August I am not working I'm not really producing content because I'm trying to be outside living my best life with my family so anything that I produce is just considered a bonus because I really try not to do too much during the summer I'm really trying to execute self-care because that brain needs to be intact during all the other months so I can produce quality content for you so we're going to be going over Parkinson's uh disease be sure to check out my website Nexus nursing institute.com there you'll find audio lessons if you're a current student and you're really struggling you got to do really really well on your next exam I've got audio lessons available for you you can also book for uh next year generation enlex review a one-on-one toing session or even a consultation session um now like I said I'm on vacay until September but you can book for September or um onwards you can find me across all the other social media platforms Tik Tok Instagram Facebook and of course YouTube my handle is the same everywhere Nexus nursing so be be sure to check it out and without any further Ado guys let's get started Parkinson's disease first question type in your answer guys Parkinson's disease is a degenerative disease caused by depletion of what lack of what causes Parkinson's disease type in your answers if you were not able to join the live you go ahead and just I mean let me back up if you were not able to join us on the cahoot just type in your answers on the live you guys are doing great what's your answer dopamine dopamine is the correct answer so depletion of dopamine that's what causes this degenerative Progressive disorder that we know as Parkinson's disease let me see what answers you guys had up here iron brain cells vitamin D milin uh milin you're thinking of multiple sclerosis uh lack of nerves oxygen okay all right let's keep going all right order the symptoms of Parkinson's disease from earliest to late latest put it in order guys so with your mouse go ahead and put these symptoms in order what's the first symptom that the patient is expected to experience versus vasis uh symptom now while you're putting this this in order I'm going to remind you because I know you already know I'm just going to remind you what Parkinson's disease is so yes it's a depletion of dopamine it's um an imbalance imbalance of dopamine and acetycholine but what happens is it causes these neuromuscular um deficiencies in the patient okay and safety is a very big uh issue when it comes to the patient with Parkinson's disease all right you guys on the live I see you know your stuff most of you are right order of symptoms from earliest to late only 25 of you guys got this correct so let's talk about it on the live most of you guys got it correct Tremors the first symptom we expect the patient to experience is Tremors and so what happens the first person to usually notice the Tremors is going to be the patient themselves not someone else right so they'll have the Tremors and then from Tremors rigidity rigidity uh of muscle movement and then Brady kesia kesia means movement Brady means slow so slow movement and then remember I told you this disorder is Progressive the word Progressive that means as time goes on it only gets worse so when I say progressive in the uh medically speaking that's what I'm talking about as time goes on it gets worse so they'll go from slow movement to a kinesia when you see a in front of a word a means without kinesia means movement so they'll go from slow or sluggish movement to no movement like basically they're frozen in place all right again what's mostly caused by that lack of dopamine and so the patient will have trap symptoms I saw this on the live whoever typed that great job trap TR r a p t stands for Tremors the patients will have Tremors R rigidity muscle rigidity a ainia p postural instability and that postural instability is one of the many reasons that this patient's at risk for Falls and they're going to be a safety patient you're you're going to be very concerned about safety why is a patient with Parkinson's disease a fall risk is it because they have a fast gate is it because they have a slow gate is it because they have a broad-based gate or is it because they have a shuffling gate when it comes to Parkinson's what makes them the fall risk very good 79% of you got this correct they have a classic shuffling gate that shuffling gate and not only are they shuffling they're shuffling their back is stooped over and the feet is very close to each other so they're shuffling like this while they're looking down have you ever watched a race when people are running where where their eyes their eyes are looking ahead they're never looking down the minute you look down you lose your sense of balance not only are they looking down because remember I told you they're kind of hunched over right their po their postures kind of like this not only are they looking down which will mess with your sense of balance because of the shuffling gate and because the feet so close together instead of being far apart they kind of lose their center of gravity so that increases their risk for Falls this is something very important to know when it comes to the patient with Parkinson's disease the code to get in is 383 7944 all right next question what should the nurse teach the patient about maintaining Mobility here are your choices they should sit in a soft deep chair they should exercise before going to bed they should buy clothes with many buttons or they should Rock back and forth to start movement out of these options what should the nurse be teaching the patient about maintaining uh Mobility we want them moving around we want them to be active because one of the things we deal with is what rigidity right very good rock back and forth to start movement because one of the issues the patient will have will even starting movement they'll have Brave kinesia aesia where they have that sluggish slow movement to the point that they're not moving at all they're frozen in place where we want that patient to maintain Mobility we want to maintain that flexibility of the joints so we want them moving about so a couple things you can teach a patient this is one of the examples teach them to rock back and forth to kind of get that momentum to start moving you're going to teach a patient to let's say you're outside walking the patient you're on a sidewalk in their lines you're going to teach them you're going to tell them to lift their leg over lift their foot over that line in order to walk or if there's no line tell them to pretend there's a line pretend that there's a line that they need to step over to make them lift up their leg one in front of the other right very good all right select all that applies which are clinical manifestations of Parkinson's disease select all that apply clinical manifestations of of Parkinson's disease when I say clinical manifestations I'm talking about signs and symptoms and don't forget how do you treat select all that applies you treat them as true or false what do you guys think Nar thank you for sharing the live thank you our choices I'm sorry I didn't read to Brady kesia monotone speech aesia mask like facial appearance Tremors drooling those are the options Brady kesia monotone speech aesia mask-like facial appearance Tremors drooling very good all of these are clinical signs and symptoms of the patient with Parkinson's disease that slow movement that progresses to no movement where they frozen place so you have the Brady kinesia you have the ainia Tremors remember that's the first symptom that's manifested monotone speech and Faith likee appearance you won't be able to tell by the words coming out of their mouth or the way they say their words or their facial appearance if they're happy if they're sad if they're entertained because the voice is monotone and the face is masslike and drui another very big safety issue when it comes to the patient with Parkinson's disease besides Falls we're also concerned about aspiration we don't want them choking on their own saliva because remember I told you muscle rigidity well you have M uh muscles in your throat when you swallow right it may even be hard for the patient to swallow and they may aspirate so aspiration is a huge safety concern as well true or false the patient with Parkinson's disease should be on a low calorie low protein low fiber diet true or false very good it's false I want to address the 11 of you that chose true okay I'm going to give you some tips when you're taking a test and you're not sure let's say you have a question like this is true or false and they give you more than one one um subject that's actually better for you and here's why it's better for you you see how you have three subjects I give you low calorie low protein low fiber only one out of those three has to be wrong for the whole thing to be wrong guys listen to me please believe me when I say this to you if one tiny portion of your option is incorrect the whole thing is incorrect throw it away I don't care how beautiful that option looks if one thing is incorrect the whole thing is incorrect now I'm going to explain to you why at the end of the day you got to remember you're testing to get your license the state wants to see if you are safe if you're going to go out there and kill the test Riders Grandma ma Auntie Uncle cousin whatever so they don't want the nurse that's gonna say oh well you know only the dosage is wrong everything else is right that's fine no they want the type of nurse that sees if one tiny little thing is wrong uhuh they're pumping the breaks that's the type of nurse the state wants to see and that's how you're supposed to think now as a student let's say I wasn't sure about low calorie let's say I wasn't sure about low protein any student nurse even if you are in the first semester in Fundamentals of Nursing one of the first things that you learn is that we love fiber right there are very few disorders that the patient is going to be on a low fiber diet I mean unless this patient has uh crazy diarrhea or something like that we're not going to put them on a low fiber diet we love fiber because fiber gets rid of all that crap in your GI stream right and it really helps get the cholesterol down it helps you move your bounds bowels we love fiber so there are too many conditions where patients going to be on a low fiber diet so as a nursing student even if I wasn't sure about the protein or the calorie I should have said low fiber diet uhuh I'm not going to take the chances false now let's talk about why the patient is going to be on this type of diet um they're going to be on low everything's actually going to be high high calorie why what what do calories give you energy when a patient is sick I don't care what the disorder is if you have to guess go with high calorie don't go with low calorie because calories give you energy you need energy to fight the disorder you need energy and the patient who has Parkinson's disease remember I told you they'll go from Brady kinesia slow sluggish moving to ainia not moving at all don't you think that type of patient would need energy of course so they're going to be a high calorie diet why would they be high protein think about it remember I told you the Trap symptoms what one of them's what rigidity muscle rigidity the muscle issue that's a big problem what does uh protein do bu uh uh build muscle remember this is a degenerative Disorder so everything that happens is going down the drain so aren't we going to try to preserve what little muscle we have left of course we are so they're going to be on the high high protein diet and why high fiber let me tell you something anything that causes a patient to be guys I'm sorry I'm on vacation and I have complete vacation brain I have to put myself back in teacher brain uh what's that word when a patient what's the word when a patient like they're bed bound they can't move they're uh um immobile thank you okay so when you have a patient that's either immobile or their mo mobility is very low you're going to have constipation issues the more that you move the more that your peristalsis increases the more that things move through your bowels but the slower that you are your your peristalsis slows down and your GI tract just isn't moving the way it normally does and so the patient tends to be get constipated so any patient such as a a patient with Parkinson's disease they're going to need lots of fiber lots of fluid and lots of UL ambulation we want them walking around and moving so they're going to be on a high calorie high protein high fiber diet all right which drug would you expect to give to treat Tremors and rigidity while stopping the action of atic choline remember guys I told you that one of the issues with um Parkinson's is that uh dopamine and acetycholine imbalance so which drug would you expect to treat the Tremors and rigidity because of this here are your choices anticholinergics beta blockers antibiotics or anti-depressants which drug class would you expect to give that's right anticholinergics look at the other choices you have beta blockers beta blockers are adrenergic anti right slows down the blood pressure slows down heart rate what does that have to do with the Parkinson's disease antibiotic they kill bacteria they help with infections and of course anti-depressants they treat depression but when it comes to the the rigidity and the Tremors that's caused by the action of acid Coline you're going to expect to give anticholinergics all right which class of anti-depressants would you never ever expect to give a Parkinson's patient ssris tcas maois or skeletal muscle relaxing matter of fact if you're caring for a patient that has Parkinson's disease and they also have depression or let's say you're just caring for a patient with Parkinson's disease what medication if that doctor ordered it you would question it you would not give that medication you would pick up the phone and call the healthc care provider and ask them if they lost their minds tell them to come give that that M cuz you're not doing it what drug very good maois I almost gave you the answer at when I was trying to give you an example and I said depression but yeah maois why okay patients with Parkinson's disease very often they'll also have depression because they'll be depressed about this disease remember I told you it's Progressive there's no cure it only gets worse right right so very often they're going to be on anti-depressants but let me tell you something about maois maois are the very last drug class of anti-depressants that we're going to give not only a patient with Parkinson's disease but honestly anybody when it comes to maois those are our last drug of defense for depression we're going to try everything else first why maois have so many drug drug interactions so many um drug food interactions we just we give maois when nothing else has worked so let's look at our first option ssris ssris are actually the first class of anti-depressants that are usually given when a patient's depressed why because it's so effective with the least amount of adverse effects right so let's say the patient gets ssris they've been on it for a long time it's no longer working we got to try something else the next class of drugs you most likely see the healthcare Prov provider are going to be your TCA TCA are tricyclic anti-depressants right patients's been on that now it's no longer working we've tried all the different drug classes finally maois but the problem with maois is that um well there are many problems many problems but one of the biggest reasons we're definitely not going to give an MAOI with a patient that's on with a patient that has Parkinson's disease is um the the chance of the risk of that patient getting hypertensive crisis right why that combination of MAOI with levodopa Carbidopa it just does not go together and the patient's going to be at risk for hypertensive crisis which is a medical emergency we want to avoid that at all costs maybe I should have done of this cahoot because I I'm on vacation brain I promise it's taking me a minute to to think guys forgive me all right foods high in blank must be a avoided because they block the effects of anti-parkinsonian drugs foods high in what must be avoided because they block the effects of the anti-parkinsonian drugs here's our options fiber sodium potassium or B6 fiber sodium potassium or vitamin B6 foods high in what have to be avoided in the patient that's taking anti parkinsonian meds all right let's talk about this I know why 28 of you guys chose potassium I know why so let me talk about the wrong answer first and then we're going to get to the right answer I'm G tell you why you saw pottassium and you know that high potassium pottassium being higher than five or low potassium pottassium being less than 3.5 can cause cardiac dis rhythmia and that is a huge problem that's a medical emergency that's true but is it answering your question it say it said foods high and blank must be avoided because I didn't say because it can cause cardiac dismas that's not what the question says it says because they block the effects of anti-parkinsonian meds so even though we don't want to give an a patient who has Parkinson's disease is taking anti-parkinsonian meds we don't want to give them um to many foods high in potassium we don't want to cause them to have cardiac dismas but the question's not asking about cardiac dismas they're asking about what is going to block the effects of anti- parkinsonian meds and let me tell you something as nursing students I see you guys make the same mistake all the time you'll choose an answer based on something you know but not what the question's asking answer the question so when it comes to types of food that can block the effects of the drugs we're giving to treat part Parkinson's disease the correct answer is vitamin B6 okay why I don't know I don't know like the chemical reaction I couldn't tell you I just have no clue but foods high in vitamin B6 such as organ meats you know liver um kidney um certain um high starch vegetables like potatoes they're high in vitamin B6 and they can actually block the effects of the anti- parkinsonian medication so you got to be careful with that are you guys doing on live okay you learn something new every day I love it okay last question select all that applies what are the adverse reactions of Carbidopa levodopa to be aware of and to assess for so your patient with Parkinson's is on carb levodopa what are the adverse reactions we're going to watch out for here are your options heart palpitations cardiac arrhythmias dizziness orthostatic hypotension fluctuations in Vital Signs increased liver enzymes now let me talk to you guys about adverse reactions while you're trying to figure out what your answer is there is a difference between adverse reaction and side effects some many books use it interchangeably but there is a difference side effect is something that may possibly happen you're going to warn the patient it can happen but we're not going to stop their meds right adverse effect is something that may possibly happen that we do not want to happen under any any circumstances and we warn the patient if it happens let us know right away because the healthare provider most likely is going to augment that medication they're going to change the dosage maybe they're going to completely change the medication we don't know but something's going to change so that's the difference between side effect and adverse effect but back to Lev dop Carbidopa levodopa adverse effects all of them patient may feel heart palpitations they need to report it cardiac arhythmia they need to reported dizziness that's a safety issue you having dizziness you can't drive you can't operate heavy machinery that needs to be reported orthostatic hypotension what are you going to do you're going to make sure the patient dangles on the side of the bed you're going to sit them up and get them to stand up slowly you're going to make sure that bed's in ly's position side rails up you're going to have the call Light Within Reach you're going to tell that patient if you got to get up for any reason press the call Bell because I want to assist you getting up you don't want that patient to fall on on your watch fluctuations and Vital Signs where you'll see maybe the heart rate or the blood pressure go up and down up and down and of course increase liver enzyme you're going to be checking the labs you're GNA be checking the liver function studies you're going to be looking at the alt a right yeah all right guys um that was it this was just uh 10 slides so I hope you found it to be helpful again those who are new to my channel I'm on vacation June July August that's why you're not seeing new material from me anything you do see between June July in August just take it as a bonus because I'm trying to be outside doing the most like I said I'm traveling with my family I just I need to rest my brain I got to rest my brain so uh let's see how you guys did on the cahoot