Hi guys, it's me Professor D and welcome back to my YouTube channel. On this video, we're going to be going over Parkinson's disease and myasthenia gravis. Now before we get started, I have to address something.
I've been getting a lot of DMs and a lot of emails and a lot of comments all saying the same thing and I didn't realize this, but I have a lot of new viewers, a lot of new subscribers. So if you're new to my channel, first and foremost, welcome. Secondly, I want you to know I don't work during the summer, at least I try not to.
All right, so June, July, August, you really won't see too many new videos because I just don't make them. For those three months, I want to take a break and relax and travel with my family and see the world. I'm trying to be outside and do the most, okay? So those are the three months that I kind of just kind of rejuvenate, right? So I can come back and give you the best of me.
Every here and there, I'll make a video or I may make a post, but it's not going to be consistent. So I'm so sorry to anyone who's new to my channel and didn't know. Now you do. Self-care is very important.
Now, with that out of the way, I want to remind you to please check out my website, NexusNursingInstitute.com. I've got lots of resources there. I've got resources for students.
who have graduated and want to take boards and, you know, they want to review or they want a private tutoring session or they want a consultation session. I'm not available right now. However, right.
You can start booking for September or on. So you can check that if you're a current nursing student in the program. I have audio lessons available.
So be sure to check that out as well. There was something else I want to say to you. Oh, don't forget, you can find me across my other social media platforms, just TikTok, Instagram, Facebook. My handle is still the same everywhere, Nexus Nursing.
Now, before we get started, I want to start off with a quick prayer. If you're not into that, that's fine. Just go ahead and fast forward.
And if you are not operating heavy machinery, go ahead, close your eyes, bow your head. Father God, thank you, Lord. Thank you, Jesus, for all you've done.
Thank you for watching over us and protecting us, Father God. Lord, I tell you, thank you. uh for another day on this earth for the breath of life in our bodies for our health father god thank you for every single person that's listening or watching right now for whatever reason they came to this channel lord i ask that you please help them seek what they found i ask that you please bless them help them understand this information father god i want to say a special prayer for those who are currently in a domestic um violence relationship um Whatever it is that's happening and they're trying to get away, Father God, but they don't have the means and they've tried many times, but they just haven't been able to do that, Lord.
And they're seeing this license as a way to earn money, to get away. Father God, I'm asking that you please help these people who are listening or watching right now, those who are in those situations. Lord, I ask that you please open up a path for them, Father God, and help them to escape that reality that they're living in right now.
Lord, I ask that you please help them, help their children, help the people. who are under their care, Lord. And I ask that you please bless them, Lord. And I ask that you please use me as a means, Lord, to help them to get that license, Father God.
And I ask that you continue to bless them. And when they get that license, let them pay it forward. Let them be a blessing to somebody else in their own way.
Father God, thank you. Thank you for putting me in this position where I am able to share knowledge and teach in the way that the students seem to grasp, seem to understand. Thank you for that.
And I ask that you please continue to help me to help other students. Thank you for all you've done, God, and all you will continue to in Jesus Christ we pray. Amen. All right, guys, let's get started. First question.
It says, which nursing approach is most helpful to a client with Parkinson's disease who's experiencing a freezing of gait with difficulty initiating movement? One, pull the client forward to initiate walking. Two, instruct the client to use a wheelchair.
Three, have the client remain still. Or four, tell the client to march in place. And guys, the correct answer is four. Have the client march in place.
Something else that you can do to help them initiate that movement, you can help tell them to walk over either imaginary lines or real lines, or you can tell them to take a step forward and then take... two steps back or take two steps forward or one step back. Any of those choices will help them to basically initiate a movement.
Okay. So that's the correct answer. Now let's look at the wrong answer choices.
One, if you don't stop, where's my stop? I literally can't even with that answer choice. Are you kidding me?
Pull the client forward to initiate walking. Well, I mean, if that isn't a disaster to have your patient fall, I don't know what is. We're talking about Parkinson's disease here, right?
In Parkinson's disease, the patient has decreased. ...dopamine and that decreased dopamine causes musculoskeletal dysfunction, right? Patient has TRAP symptoms. T-R-A-P.
Let's see if I can remember what TRAP stands for. Here I am mentioning TRAP symptoms. Let me see if I can remember.
So T is for tremors. R, rigidity. They'll have muscle rigidity, difficulty initiating movement.
A. It stands for something. I'll come back to A. But P, postural instability.
So safety is an issue. A, akinesia. Okay, not moving.
Okay, kinesia means movement, right? A, kinesia. A means without.
So the patient will have these trapped symptoms and safety is a big issue. Falling is a big issue. Why would we pull this patient forward? That makes absolutely no sense.
So we're not going to choose that. Two, instruct the client to use a wheelchair. Why would we do that?
We always want patients to use the most, no, that's not good English, the highest level of functionality as possible. So why? Why would we tell them to use a wheelchair? No, we want them to use their muscles as much as they can because we want to maintain movement.
Three, have the client remain still. Again, no, we want them moving around. Four, telling them to march in place.
That's perfect. Again, you can tell them to march in place. If you're on the sidewalk and there are lines, you can tell them to step over the lines.
We want them practicing stepping over the lines. If there's no lines, tell them there's an imaginary line and you want them to step. What are you asking them to do?
You want them to lift. their leg and actually you know put one foot in front of the other to move so number four is the correct answer choice by the way when you think of dopamine again dopamine when you think of uh parkinson's i want you to think of decreased dopamine that's really what's causing all the issues or most of the issues i should say a healthcare provider has prescribed a carbidopa levodopa four times a day for a client with parkinson's disease the client wants to end it all now that the parkinson's disease has progressed what should a nurse do? Select all that apply. All right. How do we treat select all that apply?
We treat it as true or false. Let's go. One, explain that the new prescription for carbidopa levodopa will treat the depression. No, it won't.
It treats Parkinson's disease. It's an anti-Parkinsonian medication, right? If you want something to treat depression, you give them what? An anti-depressant agent with an order, of course.
Choice two, encourage your client to discuss feelings as the carbidopa levodopa is being administered. Look how true. tricky that question is. You would not do that.
The first part of the answer is beautiful, right? We always want to encourage the patient to express themselves. We want to know what they're thinking, right? But look at the rest of it. After it says, encourage the client to express feelings as the carbidopa levodopa is being administered.
Not yet. Let me tell you something about this medication. It treats Parkinson's disease.
It's a great med. But an adverse effect is if this patient already has depression, it may cause them to have suicidal ideations. So do you think this is a good drug to give the patient, especially after they said they should end it all?
Absolutely not. Absolutely not. choice three um contact the health care provider before administering the carbidopa levodopa absolutely because um we suspect this patient is probably having depression if they talk about they want to end it all this medication um Not in everyone, but it has shown to cause depression in some patients. So you have to be very careful.
If the patient already has depression, they can get suicidal ideations. Next, determine if the client is on MAOIs. True.
Why is this? MAOIs is a type of antidepressant agent. But if a patient is on an MAOI, and this medication, it can cause hypertensive crisis. MAOIs are so dangerous. Let me tell you something.
Even though they are, yes, antidepressants, they're like the last class of antidepressants that we would ever give a patient. Like a patient would have to go through the SSRIs and the TCAs, they'd have to go through everything and nothing else works. And our last line of defense when it comes to antidepressants are the MAOIs because there are so many drug-drug and drug-food interactions, it's ridiculous, right? And one of the biggest concerns it comes to maois is a hypertensive crisis and the carbidopa levodopa with maois can cause a hypertensive crisis so um four is absolutely true and then five determine if the client's at risk for suicide absolutely not only is that a correct answer choice that is a priority That is a priority.
Whenever you suspect that a patient is suicidal, the priority is always, one, ask them directly. Are you having thoughts of harming yourself or others? People tend to think if you ask the patient if they're suicidal that you planted the idea in their head. No. As a nurse, if you suspect it, you ask them directly because what happens is many patients that are suicidal, they really don't want to kill themselves.
They really want help, but no one's ever asked them directly. right? You ask them directly. And then if they say yes, they're having thoughts, they want to harm themselves.
The second thing you have to do is find out if they have a plan so you can know the lethality of their ideation. Do you have a plan? What do you plan on doing?
And then the third one, do they have access to the weapon, right? That tells you how lethal that plan is. So remember those three things when it comes to suicide, I've totally gone on a tangent. Let's go back to Parkinson's. Anyway.
What was I talking about? Oh yes, suicide. So anyway, that's going to be a priority if you suspect the patient's suicidal. So three, four, and five. Next question.
Which is an initial sign of Parkinson's disease? Rigidity, tremor, bradykinesia, or akinesia? And the correct answer is two, tremor.
So that's the earliest sign. And usually the patient notices it before anyone else because it's their body, right? So they'll notice the tremor. And then from the tremor, the second one is the rigidity, that muscle rigidity.
Then the third one would be the bradykinesia. They start having that slow movement, right? And then lastly, as it progresses, because remember, Parkinson's is a progressive disorder. That means as time goes on, it only gets worse.
As it progresses, it goes from bradykinesia to akinesia. Basically, no movement. That's when that patient's frozen in space. They're not moving, right? So the akinesia, that's the later stage.
So number one is tremor. The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease. Which topic is most important to include in the plan?
One, maintaining balanced nutritional diet. Two, enhancing the immune system. Three, maintaining a safe environment.
Or four, engaging in diversional activity. And the correct answer is three, maintaining a safe environment. That goes back to Maslow's hierarchy of needs, right?
What is our priority? Number one, keeping the patient alive, right? Anything that falls under physiological integrity that will keep our patient alive. I'm talking about vital signs, airway, breathing, circulation, fluid and electrolytes. circulatory status, right?
Prevention of dehydration, prevention of shock, anything that physically keeps your patient alive. But immediately after that, after you make sure your patient's alive, what's the second priority? To make sure they're safe, right?
Look at our other choices. It can't be anything else. One, maintaining a balanced nutrition.
Who cares about that if the patient's not even safe? Two, enhancing the immune system. Who cares about that if your patient's not even safe?
And then four, engaging in diversional activity. Oh my gosh, that's all the way in the top of the pyramid for Maslow's hierarchy of needs. Throw that out, right?
We need to make sure the patient's safe. Three is the correct answer. Nothing else matters if our patient is not alive and safe.
The nurse observes that when a client with Parkinson's disease unbuttons a shirt, the upper arm tremors disappear. Which statement best guides the nurse's analysis of this observation about the client's tremors? One, the tremors are probably psychological and can be controlled at will.
Two, the tremors sometimes disappear with purposeful and voluntary movements. Three, the tremors disappear when the client's attention is diverted by some activity. Or four, there's no explanation for the observation.
It is a chance occurrence. What do you guys think? And guys, the correct answer is two.
The tremors sometimes disappear with purposeful and voluntary movements. So when the patient has a voluntary movement, they're moving on purpose. Sometimes it does disappear, but this is only temporary. It doesn't last. Okay.
And something I want to remind you, the reason that we're even seeing these tremors happen in the first place is that imbalance between the dopamine. Again, is the dopamine high or is it low? It's low. Okay. We're seeing an imbalance between the dopamine and acetylcholine, and that's what causes the tremors in the first place.
At what time of day should the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? 1. Early morning when the client's energy level is high. 2. To coincide with the peak action of drug therapy.
With drug therapy. So we want to make sure the peak time, that's when the drug action is the highest. That's when the patient is doing what may possibly be most fatiguing or most demanding. They're going to need that energy.
And again, it's going to be treated, that patient not being able to move around the way they normally do is treated with hypokinesia. meds. So we have to make sure that they're doing this action during the time that the effect is at its peak at the highest level. Excuse me.
Which goal is the most realistic for a client diagnosed with Parkinson's disease? One, to cure the disease. Two, to stop the progression of the disease. Three, to begin preparations for terminal care.
Or four, to maintain optimal body function. And I kind of gave you this answer in another question, so everyone should get it correct. And the correct answer is... Where was I? Oh, here it is.
Four, to maintain optimal body function. Remember... This disorder is progressive.
As time goes on, it only gets worse. There is no cure. So the goal, the best thing we can do right now is maintain, keep what we have.
We don't want anything else to be lost. So one, cure? Nope. Two, stop the progression?
Nope. Three, begin preparations for terminal care. We have patients with Parkinson's disease that lives for years. So that'd be inappropriate. to have them start preparing for terminal care as if, you know, they're going to die tomorrow.
That's just not the case. Four is the correct answer. We want the quality of life that they have to be at the highest level.
Which of the goals is collaboratively established by the client with Parkinson's disease, nurse, and physical therapy? Oh, I didn't give you choices. Sorry, guys. Listen, guys, I'm on vacation, okay?
So the brain cells, okay, forgive me. Here's our choices. One, to maintain joint flexibility. Two, to build muscle strength. Three, to improve muscle endurance.
Four, to reduce ataxia. And the correct answer is one, to maintain joint flexibility. Again, we want to maintain, keep that joint flexibility, keep that endurance, keep that muscle function for as long as possible.
Okay. Look at the other choices. Two, to build muscle strength. That's unrealistic.
Again, this disease is progressive. Three, to improve muscle endurance. This disease is progressive.
Four, to reduce ataxia. PT is not going to do this. Okay.
Ataxia guys, that's, you know, when someone's walking, like they're drunk, like they're swaying, that's what ataxia is. And that ataxia is due to the decreased dopamine, but also the extrapermital side effects. and pt wouldn't help with that anyway so the only correct answer here guys is to maintain joint flexibility and we want to do that for as long as possible a client with parkinson's disease is prescribed a levodopa therapy improvement in which area indicates effective therapy one mood two muscle rigidity three appetite or four alertness and i hope you guys all chose to muscle Levodopa, that's what it helps with. It decreases the muscle rigidity. A client's being switched from levodopa to carbidopa levodopa.
The nurse should monitor for which possible complication during medication changes and dosage adjustment. One, euphoria. Two, jaundice.
Three, vital sign fluctuation. Four, signs and symptoms of diabetes. And number three is the correct answer, vital signs complications or fluctuations, I should say, not complications. Also, when you see the switch, you may also, patient may also experience orthostatic hypotension.
They may also experience palpitations where they feel like their heart's coming out of their chest. Dizziness, maybe a liver dysfunction. So you better be looking at the liver enzymes. None of the other choices, euphoria, jaundice. And symptoms of diabetes, no.
Now, if you were thinking of like the liver dysfunction, that still wouldn't cause the jaundice, right? It still won't cause jaundice. We don't expect to see a patient have jaundice, but maybe a liver dysfunction. So you'd be looking at those liver function studies. All right.
A client with Parkinson's disease needs a long time to complete morning care, but becomes annoyed when the nurse offers assistance and refuses all help. Which action is a nurse's best initial response in this situation? One, tell the client firmly that he or she needs assistance and help with the morning care.
Two, praise the client for the desire to be independent and give extra time and encouragement. Three, tell the client he or she's being unrealistic about abilities and must accept the fact that he or she needs help. Or four, suggest to the client to at least modify the morning care routine if he or she insists on self-care. And the correct answer is two.
Praise the client for the desire to be independent because we want the patient to do as much for themselves as possible and give them extra time and encouragement. You want the patient to maintain their dignity, right? All of the other choices are one, wrong. One, tell the client firmly. That's your first red flag.
Tell the client firmly that he or she needs to, excuse me, in nursing, we don't give advice. We don't give judgments, right? Choice three, tell the client that he or she's being unrealistic about their abilities.
That's not therapeutic. Choice four, suggest that they modify the morning care routine if they insist. That word insist should have been the red flag to you. If they insist on self-care. Self-care is good.
We want that patient to be independent. Why would we try to shame them for that? That's not therapeutic either.
So the only correct answer choice is two. When assessing the client with multiple sclerosis for potential complications of the disease, the nurse should assess the client for which of the following? Select all that apply. All right, guys, how do we treat select all that apply?
We treat them as true or false. Let's go. One, dehydration. No, that's not a risk.
Two, falls. Absolutely, that's a risk. We're talking about multiple sclerosis. This is where there's destruction of the myelin sheath. You know, that protective layer or sheath that actually covers the nerves.
So absolutely, that patient's going to be at risk for falls because of the muscle weakness. True. Seizures.
No, they're not risk. Even though we do see nerve damage that it disrupts communication between the bones. Bones.
Oh my gosh, I cannot speak. Between the brain and the body, we don't see seizures. That's not a common clinical manifestation of multiple sclerosis. think at the beginning of the video, I told you I was doing Parkinson's and myasthenia gravis.
I'm not sure, but I apologize. If I said myasthenia gravis instead of multiple sclerosis, please forgive me. Vacation brain, forgive me, okay?
Choice three, skin breakdown. True. Why? Because of the incontinence of bladder and stool, right?
Those body fluids either from urine or feces, alcohol. cause breakdown, excoriation of the skin. True.
Five, fatigue. Absolutely. Why? Because of the musculoskeletal damage of the brain and spinal cord.
So falls, skin breakdown, and fatigue. Which is not a typical clinical manifestation of multiple sclerosis. Double vision, sudden burst of energy, weakness in extremities, or muscle tremors.
And two is the correct answer, sudden burst of energy. That's not something that we typically see. The patient may have bursts of euphoria or hyper excitability where they're happy, but not bursts of energy.
They're extremely fatigued, right? The body's not matching what the brain is. Okay. So, um, that number two, sudden bursts of energy. No, but double vision.
Yes. Muscle, uh, weakness in the extremities. Absolutely.
Um, muscle tremor. Yep, and that's due to loss of muscle tone. Next question.
A client with MS is receiving baclofen. The nurse determines that the drug is effective when it, one, induces sleep, two, stimulates the client's appetite, three, relieves muscular spasticity, or four, reduces the urine bacterial count. and three is the correct answer relieves muscular spasticity why this drugs a muscle relaxant and so um we expect it to decrease the muscle spasms right look at one induces sleep Even though this medication can cause drowsiness or induce sleep, that's an adverse effect. You're going to teach the patient. Let us know if you're experiencing this.
Why is that important? We want the patient to be active, number one. And number two, we don't want that patient. to be drowsy operating heavy machinery or driving a car. So it's an adverse effect.
It's not something that we'd see and say, oh, the drug's working. No. Choice two, stimulate the client's appetite. Does it do that? And four, reduces urine bacterial count.
No, it doesn't do that. It's not an antibiotic. So three is the correct answer choice.
And we're down to our last question, guys. A client has had MS for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of drugs that the client has used? 1. The client exhibits tolerance to many drugs.
And guys, the correct answer is two. The client experiences spontaneous remissions from time to time. Here's the thing.
The patient, for how long has the patient been taking? 15. So the patient's been taking different anti-Parkinsonian drugs for 15 years. 15 years.
This has been a long time that they've had this disease. So what happens is when the patients have this disease and it's been for a long time, we will see exacerbations and remissions, exacerbations and remissions, exacerbations and remissions. And the thing is, it's not predictable and we don't know why. So it's hard to tell, okay, is the patient getting better because of the drug? or are they getting better just because they're in a remission?
That makes it hard to tell. And so number two absolutely is the only correct answer choice here. And guys, that is the end for this video. I hope you guys enjoyed this video. And I would say, let me know if you want a part two.
But listen, it's going to be a couple of weeks before I get on here and do another video. Okay. So just enjoy this video.
But go ahead. Let me know in the comment section if you want a part two. When I get back, I'll make a part two for you.
I hope you found this video to be helpful. I hope everyone is enjoying. their summer even those who are still taking classes during the summer i hope you're enjoying your summer guys don't forget to check out my website nexusnursinginstitute.com um right under this video there's a button that says super thanks if you appreciate this video or you feel like i bring a value to what you're trying to learn go ahead and press that super thanks i appreciate you in advance for um any generosity thank you in advance guys um you Nexus Nursing across all my social media platforms you guys can find me so be sure to check it out guys thank you so much for watching this video you guys catch me on the next video