NSG 326 Adult Health IParkinson’s Disease [PD]Etiology and PathophysiologyParkinson’s DiseaseClinical ManifestationsSlide 6Clinical ManifestationsSlide 8Slide 9Nursing AssessmentAppearance of Patient with PDComplications of Parkinson’s DiseaseComplicationsDrug ToxicityManagement of Parkinson’s DiseaseManagement of Parkinson’s DiseaseNursing Management and Nursing AssessmentSlide 18Nursing Management and Nursing DiagnosesNursing Management and PlanningNursing ImplementationSlide 22Slide 23Multiple SclerosisSlide 25Slide 26Multiple SclerosisMultiple Sclerosis Etiology and PathophysiologySlide 29Major Types of Multiple SclerosisCommon Physical AssessmentDiagnostic StudiesManagementNursing DiagnosesPlanningSlide 36Slide 37Alzheimer’s DiseaseStructural Changes in the BrainSlide 40Chemical Changes in the BrainManifestationsInterventions in Alzheimer’s DiseaseInterventionsInterventionsRisk for InjurySlide 47Compromised Family CopingDisturbed Sleep PatternSlide 50Slide 51Slide 52Slide 53Prepared by Dr. K. A. EnnenNSG 326 Adult Health ISpring 2011Alterations in Perception & Sensation2Parkinson’s Disease [PD]Debilitating disease affecting motor ability characterized by slowing down in the initiation and execution of movement, ↑ muscle tone, impaired postural reflexes, tremor at rest, rigidity, akinesia, and postural instabilityDiagnosis increases with age, with peak onset being in the sixth decadeMore common in men, ratio of 3:2Exact cause unknown, possibly involving environmental and genetic factors3Etiology and PathophysiologyPathologic process of PD involves degeneration of dopamine-producing neurons in substantia nigra of the midbrainDisrupts dopamine-acetylcholine balance in basal ganglia Symptoms of the disease Do not occur until 80% of neurons in the substantia nigra are lostParkinson’s Disease Fig. 59-5Fig. 59-55Clinical Manifestations Onset is gradual and insidiousClassic triad of PDTremorRigidityBradykinesiaDiagnosis based solely on history and clinical features Firm diagnosis can be made when at least 2 of 3 characteristics of the classic triad (tremor, rigidity, and bradykinesia) are present Ultimate confirmation of the disease is a positive response to antiparkinsonian drugs6Clinical Manifestations Progression may involve only one side of the body initiallyBeginning stages may involve only mild tremor, slight limp, or ↓ arm swingLater stages may have shuffling, propulsive gait with arms flexed, and loss of postural reflexes7Clinical ManifestationsTremorSo minimal initially that only the patient may notice itMore prominent at rest and is aggravated by emotional stress or ↑ concentration Described as pill rolling because thumb and forefinger appear in move in rotary fashionTremor can involve diaphragm, tongue, lips, and jawBenign essential tremor, which occurs during voluntary movement, has been misdiagnosed as Parkinson’s disease (PD)8Clinical ManifestationsRigidity Increased resistance to passive motion when limbs are moved through ROMRigidity is typified by a jerky quality when the joint is moved Rigidity is similar to intermittent catches in the movement of a cogwheel Caused by sustained muscle contraction and consequently elicits the followingComplaint of sorenessFeeling tired and achyPain in the head, upper body, spine, or legsInhibits the alternating contraction and relaxation in opposite muscle groups, thus slowing movement9Clinical ManifestationsBradykinesia Slowing down in initiation and execution of movement Evident in loss of autonomic movementsBlinkingSwinging of arms while walkingSwallowing of saliva Self-expression with facial movements10Nursing Assessment Fatigue, slight tremor, problems with manual dexterityRigidity, changes in facial expression, uncontrolled drooling, dementia, changes in voluntary movement, excessive perspiration, orthostatic hypotensionNo specific diagnostic testsAppearance of Patient with PDFig 59-8Fig 59-812Complications of Parkinson’s DiseaseNonmotor symptomsDepressionAnxietyApathyFatiguePainConstipationImpotence Short-term memory impairment13Complications As disease progresses, complications increaseMotor symptomsWeaknessAkinesia (motionless)Neurologic problemsNeuropsychiatric problemsDementia occurs in 40% of patientsDysphagia may result in malnutrition and aspirationGeneral debilitation may lead to pneumonia, UTIs, and skin breakdownOrthostatic hypotension may occur Could result in falls and injuriesSleep disorders are common and potentially severeEffective management of sleep disturbances can greatly improve quality of life14Drug Toxicity Long-term drug therapy regimens often cause delirium, cognitive impairment, decreased effectiveness of the drug, or hallucinations.Reduce medication dose.Change medications or frequency of administration.Take “drug holiday,” especially in the use of levodopa therapy.15Management of Parkinson’s DiseaseSelf-careInjury preventionNutrition - Malnutrition and constipation can be serious consequences Patients with dysphagia and bradykinesia need food that is easily chewed and swallowed Exercise and ambulation Adequate roughage Food should be cut into bite-sized piecesSeveral small meals to prevent fatigueProvide ample time to avoid frustrationLevodopa can be impaired by protein ingestion16Management of Parkinson’s Disease CommunicationPsychosocial supportSurgical management includes:Stereotactic pallidotomyDeep brain stimulationFetal tissue transplantation17Nursing Management and Nursing AssessmentHealth historyCNS traumaCerebrovascular disordersExposure to metals and CO2Encephalitis Excessive salivationDysphagiaWeight lossDifficulty initiating movements, falls, loss of dexterityConstipationIncontinenceDiffuse pain in head, shoulders, neck, back, legs, and hipsDepressionMood swingsHallucinations18Nursing Management and Nursing AssessmentObjective dataBlank faces, infrequent blinkingSeborrheaDandruffAnkle edemaPostural hypotensionTremor at rest“Pill rolling” Poor coordinationSubtle dementia Cogwheel rigidityDysarthriaBradykinesiaContractures19Nursing Management and Nursing DiagnosesImpaired physical mobilityImbalanced nutrition: Less than body requirementsImpaired verbal communicationDeficient diversional activity20Nursing Management and PlanningMaximize neurologic