This is Sarah with RegisteredNurseRN.com and in this video I'm going to be going over Parkinson's disease and this video is part of an NCLEX review series over the neuro system and as always at the end of this YouTube video you can access the free quiz that will test you on this condition. So let's get started. First let's start out talking about what is Parkinson's disease. It is a neuro disease that affects movement.
So whenever you're studying Parkinson's remember that it is a movement disorder disease and a lot of your signs and symptoms are going to deal with movements now why is this happening why is their movement being affected well these dopaminergic neurons start to die that are located in the substantia nigra now where is the substantia nigra located if you were to look at the side of the brain here where the red square is you would see where the substantia nigra would be located and this area is part of the basal ganglia Which is part of the midbrain that controls our movement so if you look deeper and you took a section of the midbrain you could find the Substantia nigra and here where these arrows are pointing you will see that it's black Hence why its last part of its name is Niagara, which means black and here the dopaminergic neurons are dying and what do dopaminergic neurons release? They release the neurotransmitter dopamine. So if they are dying, this leads to less dopamine being produced. Now what is the significance of this?
Why is this an issue? Well, because dopamine provides us with accuracy with our movements. So if we are losing this, not having a lot of it, we're going to have problems. So over here we have a normal dopaminergic neuron.
It's nice and healthy. So it's releasing the neurotransmitter dopamine and those receptors are gladly accepting that and we're getting normal movement. However, over here to contrast it, we have a dopaminergic neuron that is dying.
It's not very healthy. So because of that it can't release a lot of dopamine. So those receptors are fine. They're there, they're wanting to take that dopamine which makes it a little bit different than these other neuro diseases that we've talked about.
The receptors are fine, it's just the issue with the neurotransmitter. So we're getting abnormal movement. Now let's talk about the relationship between acetylcholine and dopamine.
In the nervous system there's always this balance between acetylcholine and dopamine. Now acetylcholine Dopamine is an excitatory neurotransmitter and it causes cholinergic activity. We talked a lot about what cholinergic activity does in our sympathetic vs. parasympathetic video. If you're not familiar with it, be sure to check out that video.
Dopamine, on the other hand, has inhibitory properties. It's an inhibitory neurotransmitter. What's happening in Parkinson's, like we've just talked about, there's less dopamine. The neurotransmitter dopamine hangs around the brain. hanging out at those receptor sites.
So that throws off the balance between acetylcholine and dopamine. So because acetylcholine is an excitatory neurotransmitter, it's going to cause overstimulation of those neurons. And so that's why you're going to see a lot of those signs and symptoms like tremors, rigidity, etc. which we're going to go into detail here in a second. And another thing I want to point out is one of the treatments like medications for Parkinson's is toot. administer anticholinergic medications to slow down this cholinergic activity that's going on.
And typically it's prescribed for patients who are younger who have Parkinson's disease rather than the older adults because of the side effects of the anticholinergic. And these younger patients usually are experiencing extreme tremors. So we can give them these medications and help with that. Now let's talk about some key points of this disease along with the signs and symptoms it can cause.
Okay Parkinson's disease is a disease that can be caused by a person who has Parkinson's. Parkinson's disease tends to usually affect the older adult population, like 60 plus. However, it can affect young people. For instance, a well-known actor, his name is Michael J. Fox, was diagnosed with Parkinson's disease at the age of 29. So young people can get this disease. Currently there is no cure for Parkinson's.
However, medications can be prescribed, which can decrease the signs and symptoms, and we're going to go over them a little bit later. And the cause of... of Parkinson's is not fully understood. They think maybe it could be genetic or an environmental issue.
Now let's talk about the signs and the symptoms. Okay, at first in the early stages of Parkinson's disease the signs and symptoms Symptoms tend to be subtle. So the patient or people around them will not notice the signs and symptoms.
However, as time goes on, the signs and symptoms will become worse and the patient will notice them because it will affect their mobility along with the people around them. them will see them as well and the signs and symptoms tend to vary every patient will be different with what they experience so remember that also with Parkinson's a sign and symptom can start out in one extremity or just just one side of the body in those early stages, and then as time goes on, it will progress throughout the whole body. So what is a common sign and symptom experienced in Parkinson's disease?
It is tremors, tremors that will occur at rest. And they can occur in the hands, the arms, the legs, and even the lips and the tongue. Now, when the patient experiences tremors of the fingers and the hand, we call this pill rolling and just as the name says the hand and the fingers will tremor and it looks just like the patient is rolling a pill in between their fingers so remember this term and its definition and as I go throughout the lecture if you see something that has a unique nickname remember that because it's probably going to be on your exam and one thing to remember about these trimmers is that they tend to improve with purposeful movement and they're worse when they're resting. Another thing they can experience is stiffness of the extremities. And this can lead to the patient, whenever they walk, instead of their arms swinging at their side, their arms will just be still at their side.
So they'll have an abnormal looking gait. Also they can experience what's called akinesia. And this is where they lose the ability to actually do movements voluntarily.
And for instance, they can be walk. walking, and all of a sudden they freeze up, their legs freeze up and it feels like their feet are just stuck to the ground and can't move. This is termed freeze ups in Parkinson's disease. In our nursing interventions, we're going to talk about some education pieces you can provide to the patient on how to deal with these freeze ups because that is definitely a safety issue for them. Also this stiffness is going to lead to them having a shuffling gait where they really don't pick their feet up very well.
as they walk and their posture is going to be bent forward as they walk. And because of this stiffness, they can have what's called cogwheel rigidity, one of those fancy little nicknames I would remember. And this is where whenever you passively move their arms, for instance, toward their body, that the arms will just jerk back like this as you move them. And that's called cogwheel rigidity.
Another thing a patient can experience is called bradykinesia. and this is where their movements are slow so just look at the word if you were on exam and you don't know what this word means just try to dissect it Brady means slow like Bradycardia no it's slow heart rate and kinesia is dealing with movement so they have slow movements and this can affect a lot of things for instance they're swallowing because whenever we are swallowing we're doing a lot of movement and we need dopamine to help us with that so we don't have a lot of available They're going to slow down and be sluggish so they can have difficulty swallowing food and they can experience Drooling because all that saliva is just staying in their mouth and it can pull outward because another thing they're going to have like this expressionless face and it can be mask like from again where their movements in their face if they're going to smile Make some type of expressions really not going to happen because those movements are so slow They can have chewing issues issues, and they can have speech issues where their voice is really soft or slurred. Another thing they can have is problems with coordination. So from a nursing standpoint, they are definitely at risk for safety issues like falls and hurting themselves. And again, we talked about this a little bit earlier, to compensate for that because they're afraid of falling, they'll stoop forward.
To compensate for that, to make themselves feel like they have better control. standing. Now some non-motor signs and symptoms they can experience is like loss of smell.
They're not for sure why that happens but many times Parkinson's patients tend to say I've lost my sense of smell. They can also have constipation and again that's dealing with the GI tract, the movement of those intestines that's slowed down so they can deal have issues with that and depression. So to help us understand why a patient let's say with late stage Parkinson's disease would look like let's look at this illustration okay right off the bat we can see as this patient is standing it's illustrating him with movement he is bent forward and if you take a closer look at his face his face is expressionless he even has a little bit of drooping in his face from where the movements are very slow so it gives him that like mask like appearance his hand has a trimmer And then down at the bottom, his feet don't really raise off the ground as he walks.
He has like a shuffled type gait. Now let's switch gears and talk about nursing interventions. Okay, based on all that material we just learned, we should be pulling from our nursing knowledge and be thinking of some certain areas that we want to be intervening in. And these areas include safety because these patients are going to have balance coordination problems because again, this is a movement disorder.
So we've got to watch them with that because we don't want them to fall. Also, they can experience freeze-ups where once a freeze-up happens, they're going to be able to move around. So freeze-up is over they increase the risk of injury so we want to be providing education about that another thing is psychosocial these patients one of the signs and symptoms is depression also they're going to be losing the ability as the disease progresses to take care of themselves so they're gonna lose their autonomy and this can make them feel very isolated so we want to concentrate on that another thing is digestion and nutrition they're gonna have constipation issues and due to the difficulty chewing and swallowing, there's some things we can help them do with improving that so they make sure that they're getting as many calories as they need to maintain and sustain life, along with educating them about medication side effects and the education pieces that go with that.
Because as you're gonna see, some of these medications that they're prescribed to treat their Parkinson's has requirements of certain foods that they need to limit or avoid. So as I'm going over that, pay attention to those points. So first, let's talk about safety.
What can we do to keep our patients safe? Well, first we want to teach them how to use assistive devices, anywhere from canes and walkers to handrails in the bathroom, keeping rugs off the floor that can cause them to slip along with making sure if they have pets that those pets don't get around their feet and cause them to trip. Because these patients have... balance issues and to help them with these balance issues you can tell them that whenever they go to change positions they need to do this slowly and say that they lose their balance a lot while they're walking.
They can use a rubber tip cane at a single point to help with maintaining stability. Also shoe wear is very important. They want to wear a low heel shoe without that rubber sole because those rubber soles tend to grip to the floor and this can lead to them tripping. So something other than that, that's smooth but not slick.
So now let's look at some education pieces about those freeze-ups that patients can experience. And again, this is where, for instance, say that the patient's walking and in their walk all of a sudden their legs freeze up, they can't move. A lot of patients describe it as feeling like their feet are stuck to the ground and they can't move.
And And after that freeze up, there's an increased risk of injury or fall. So what can you educate the patient to do to help prevent that from happening? One thing is that while they're walking, if the freeze up occurs, they can try to change direction of movement. So say they were walking forward, freeze up happens, they could try to change their direction by maybe stepping to the side.
Another thing is that they can use a cane or a walker. that has a laser point to it. So if they're using this device, as they use it, a laser line will appear on the ground and as they walk and a freeze up occurs, they will know where to move their leg after that freeze up is over. So it gives them some coordination about where they should move their foot.
Another thing is, is as they walk, they need to consciously make the effort to raise their legs as they walk, like they were marching or. stepping over something instead of having that shuffling type gait. And it's important that the patient doesn't try to push through those freeze-ups. Instead, just try to bear with it, but don't push through it and use either the laser point cane, which can help them know where to step or just try to stand still until the freeze-up is over. Now let's look at the psychosocial Part okay with these patients we want to help them feel as autonomous as possible So it's important that they are able to feed themselves and do those basic activities of daily living So it feels like they have a sense control over their life and one way we can do that is educate them and show them where they can get special cookware and utensils to help them be able to still cook and feed themselves because forks and spoons and knives they're made in a different way for patients who have Parkinson's disease where they can still feed themselves.
Also dressing, it's best if they put on shirts that don't have buttons or zippers which are hard to maneuver when you're experiencing the tremors and instead that they velcro so it's easily to put on or it's just like a sweatshirt that you slide over the head. Also the patient wants to have shoes that they don't have to tie they're like velcroed. and to help prevent isolation there are local support groups with other people who are experiencing Parkinson's disease where these people get together share their stories and help encourage one another with this disease so provide your patient with that it's important to exercise as much as possible and another thing that you want to educate the patient's family members and people who are going to help provide care to these patients is not to stress them out with trying to rush them through their activities or with getting ready or presenting something stressful to them because it actually makes their signs and symptoms worse and we don't want to do that and another thing if the patient's going to have a busy day they have a lot of things going on it's best for them to do these activities when their medications which we're going to talk about here in a moment are in their peak now moving on to digestion and nutrition because Remember these patients are probably going to experience constipation and they're going to have issues swallowing and chewing.
One thing is that they can have a soft diet of soft foods that don't require a lot of chewing that's really easy to swallow. On an exam, if you see which options are best for a patient with Parkinson's disease, always pick the food that's easiest to chew and swallow. Don't pick some big steak or a taco or something like that.
A lot of these patients... are going to be evaluated by a speech language pathologist which will look at their swallowing and chewing abilities may recommend their liquids become thickened with nectar honey thick liquids and it's important that you educate them about a high fiber diet with lots of fresh fruits and vegetables and to drink at least two liters of fluid per day unless contraindicated that helps prevent constipation and per md order they can take a stool softener to keep those stools soft and As a nurse, you want to be asking, when was your last bowel movement? If it was a week ago, that's not good.
You want to look at the abdomen, listen to the belly sounds, palpate on it, make sure you don't feel any hard masses. An education piece, which we're really going to go over here in a second when we talk about meds, is that they want to watch their protein intake. They need protein, so they need to incorporate that in their diet, but they don't want to eat a protein-rich meal when they take their... medication because they're anti-parkinson medication because some of these medications compete with protein in the small intestine which will decrease the absorption of that parkinson parkinson medication now let's talk about medications used to treat parkinson's disease now remember these drugs do not cure the disease but will help decrease those motor signs and symptoms so the first drug i want to talk about is called carpadopa with levodopa so it's a combination drug and its brand name is called cinnamon and what it does is it adds more dopamine in the brain which is what we need because we're low on it and how it works is it's pretty interesting is that the carpa dobo after the patient ingests it will prevent the levodopa from breaking down in the blood so more of it can cross over into the brain and whenever the levodopa crosses over it will turn into dopamine and help decrease those signs and symptoms.
Some side effects of this medication include nausea and involuntary movements. Now let's talk about the education pieces associated with Carpidopa Levodopa. I really want you to pay attention to these diet pieces down here because exams and NCLEX love to ask about that.
This medication, if your patient is newly prescribed it, let them know that it can take up to three weeks for them to notice a decrease in their signs and symptoms. So it's not that the medication is not working, it just takes some more time. while to take effect.
Also, their body fluids like saliva, sweat can turn a dark color so not to be alarmed by that. It happens with this drug. And this drug, if a patient takes it for long term use, they can start experiencing signs and symptoms that are really pronounced before their next scheduled dose of their Carpadova Levodopa because the drug has wore off.
What they can prescribe with this, which we're going to talk about here in a second, is a COMT inhibitor like Entacapone, also called Comitan, which will help decrease this wearing off from happening. This medication should not be taken with a monoamine inhibitor. It can lead to hypertensive crisis. The patient doesn't need to take or consume high amounts of foods or supplements containing vitamin B6. it can decrease the effectiveness of this medication along with not taking their scheduled dose of carpa dopa levodopa with a high protein rich meal like milk and meats and beans things that are super high in protein because protein and carpa dopa levodopa compete in the small intestines and the body will pick protein and it'll decrease absorption of this drug Another type of drug used to treat Parkinson's disease is called ropinerol, also known as Requip, and it is a dopamine agonist.
So it stimulates those dopamine receptors, which will help improve those signs and symptoms. It's also used to treat conditions like restless leg syndrome. And one thing I want to point out to you is that you really want to educate your patient that this can cause severe drowsiness, where they'll become so drowsy where they'll abruptly fall asleep. So they don't need to take this medication before operating machinery or driving or cooking or something like that Because they may fall asleep another type of drug used to treat Parkinson's is called a mantidine and it is a it's actually used as well as an antiviral in the treatment of influenza a but this drug they have found stimulates the dopaminergic Activity in the CNS which helps with those signs and symptoms Another category of drugs used to treat Parkinson's and we talked a little bit about this in the beginning when we were talking about the patho of Parkinson's is called anti cholinergic and One kind is called benztropine and its brand name is cogentin and what it does is it blocks the acetylcholine so you get decrease in that cholinergic activity because remember there's an imbalance between acetylcholine and dopamine and acetylcholine was that excitatory neurotransmitter and the dopamine was inhibitory neurotransmitter. So these neurons are becoming overstimulated and you can get those signs and symptoms.
So this will help decrease rigidity, also decrease the salivation which will help with that drooling and decrease signs and symptoms. However, this is not for patients who have glaucoma. So assess your patient's history, their eye health and make sure that they don't have glaucoma. And some other things is that they never want to just quit taking this abruptly.
It can cause worsening of signs and symptoms. They will experience dry mouth with this just because of what it's doing on the cholinergic side. So sugarless gum or candy can help with that.
And absolutely no alcohol while taking this medication. Some other drugs used to treat Parkinson's disease include monoamine oxidase inhibitors type B and a popular one is called risagilane. also known as azalex. And what this does is it increases dopamine by stopping monoamine oxidase activity.
So you're going to get improvement of those signs and symptoms. But there's some important teaching parts with this and I would definitely remember this. Okay, so whenever any type of monoamine oxidase inhibitor, you don't want the patient ingesting foods high in tyramine. And this would include foods like aged cheese, smoked cured meats, fermented foods, and beer.
So they would definitely want to limit those in their diet. And then last but not least are those COMT inhibitors that I talked about earlier in the lecture when we were talking about Carpidopa levodopa. And popular one is called Entacapone, also known as Comtam.
And the COMT stands for catechol-O-methyltransferase inhibitor. And this is used with what drug? The Carpidopa Levodopa, so the Sinemet. Now, how does this drug work? Because remember, it's used to decrease that wearing off phase that can happen with Carpidopa Levodopa when patients have been using it for long term because their signs and symptoms, they notice they're starting to become more pronounced before that next dose of their medication.
So what it'll do, it'll block that COMT enzyme, that will break down that levodopa in the blood which will make it last longer hence not have those signs and symptoms okay so that wraps up this NCLEX review over Parkinson's disease thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos