Parkinson's Disease Lecture Notes

Introduction

• Presenter: Sarah from RegisteredNurseRN.com
• Part of NCLEX review series focusing on the neuro system.
• Free quiz available at the end of the video.

What is Parkinson's Disease?

• A neurodegenerative disease affecting movement.
• Primarily a movement disorder.
• Caused by the death of dopaminergic neurons in the substantia nigra.
• Substantia nigra is part of the basal ganglia in the midbrain that controls movement.

Dopamine and Movement

• Dopaminergic neurons produce dopamine, which is essential for movement accuracy.
• Loss of dopamine leads to abnormal movement.
• Neurotransmitter Balance:
  • Acetylcholine (excitatory) vs. Dopamine (inhibitory).
  • Imbalance causes overstimulation, leading to symptoms like tremors and rigidity.

Key Points of Parkinson's Disease

• Primarily affects older adults (60+), but can occur in younger individuals (e.g., Michael J. Fox diagnosed at 29).
• No cure; medications can alleviate symptoms.
• Cause is not fully understood (possible genetic/environmental factors).

Signs and Symptoms

Early Stages

• Subtle symptoms that worsen over time.
• Can start on one side of the body.

Common Symptoms

• Tremors:
  • Occur at rest, especially in hands (pill rolling).
  • Improve with purposeful movement.
• Stiffness:
  • Leads to abnormal gait (arms not swinging).
• Akinesia:
  • Loss of voluntary movement; freeze-ups.
• Bradykinesia:
  • Slow movements affecting swallowing, chewing, and expression (mask-like face).
• Cogwheel Rigidity:
  • Jerky resistance when moving limbs passively.

Non-Motor Symptoms

• Loss of smell, constipation, and depression.

Nursing Interventions

Safety

• Teach use of assistive devices (canes, walkers).
• Educate on changing positions slowly to prevent falls.
• Footwear: Low heel shoes with a smooth sole.

Freeze-up Management

• Change direction, use laser-point canes, and consciously raise legs while walking.

Psychosocial Support

• Encourage autonomy with adaptive utensils and clothing.
• Suggest support groups to avoid isolation.
• Avoid causing stress which may exacerbate symptoms.

Nutrition and Digestion

• Soft diet for easy swallowing and chewing.
• High fiber diet with adequate hydration to prevent constipation.
• Educate on timing of protein intake with medications to avoid interactions.

Medications for Parkinson's Disease

Carbidopa/Levodopa (Sinemet)

• Increases dopamine in the brain.
• Side effects: nausea, involuntary movements.
• Important education points:
  • Effects may take up to 3 weeks.
  • Body fluids may turn dark.
  • Avoid high-protein meals around dosing times.

Ropinirole (Requip)

• Dopamine agonist; may cause drowsiness.

Amantadine

• Stimulates dopaminergic activity; also an antiviral.

Anticholinergics (e.g., Benztropine)

• Decreases cholinergic activity; assess for glaucoma.
• Side effects: dry mouth.

Monoamine Oxidase Inhibitors (e.g., Rasagiline)

• Increases dopamine by blocking monoamine oxidase.
• Avoid foods high in tyramine.

COMT Inhibitors (e.g., Entacapone)

• Used with Carbidopa/Levodopa to extend effectiveness.

Conclusion

• Parkinson's disease is complex with various symptoms and management strategies.
• Emphasize patient education on medications, safety, and nutrition.
• Encourage usage of resources like quizzes and further materials for NCLEX preparation.