Create a concept map for the patient with Parkinson's Disease or Encephalitis or Meningitis.
Medications:
Risk Factors:
 Start of S/S between 40-70 y/o
 Male
 Genetic; family history
 Environmental exposure to toxins and
chemicals
 Chronic use of antipsychotic meds.
Lab Test:
 No definitive Dx procedures
 Dx based on S/S, progression and ruling out
other disease.
Therapeutic Procedures:
• Stereotactic pallidotomy or thalamotomy
• Deep brain stimulation
5 stages of PD:
 STAGE I: Initial Stage
• Unilateral shaking or tremor
• Mild weakness
 STAGE II: Mild Stage
• Bilateral limb shaking or tremor
• Walking and balance dysfunction
• Slow, shuffling gait
• Masklike face
 STAGE III: Moderate Stage
• Unstable balance
• Increased gait instability; walking
problems
 STAGE IV: Severe Stage
• Akinesia
• Rigidity
• ↓ Tremors
 STAGE V: Complete ADL dependence
• Unable to stand or walk
• Possible dementia
S/S:
• Dopaminergic: levodopa/Carbidopa
• Dopamine agonists: bromocriptine,
ropinirole, pramipexole
• Anticholinergics: benztropine,
trihexyphenidyl
• Catechol O-methyltransferase (COMT)
inhibitors: entacapone
• MAO-B inhibitors: selegiline, rasagiline
• Antivirals: amantadine
PARKINSON’S DISEASE
• Progressive neurodegenerative disease that
affects mobility.
• Caused by degeneration of substantia nigra.
• Results in ↓ dopamine.
• Results in ↑ acetylcholine.
• Has 4 main symptoms caused by
overstimulation of acetylcholine to basal
ganglia:
 Muscle rigidity
 Tremor
 Bradykinesia (slow movement)
 Postural instability
Complications:
 Aspiration pneumonia
o Swallowing precautions
o Individualized diet plan
o Encourage pt. to eat and chew
slowly in upright position
 Altered cognition: memory loss or
dementia
 Stooped posture
 Slow, monotonous speech
 Slow, shuffling, and propulsive gait
 Tremors or pill-rolling tremor of fingers
 Muscle rigidity
 Bradykinesia or akinesia
 Masklike face expression
 Autonomic symptoms
• Orthostatic hypotension
• Flushing
• diaphoresis
 Chewing or swallowing difficulties
• Drooling
• Dysarthria (slurred speech)
• Mood swings
• Difficulty with ADL’s
• Cognitive impairment (dementia)
Nursing Care:
 Administer meds as prescribed.
• Monitor side effects, effectiveness
 Monitor swallowing.
 Maintain adequate nutrition and weight.
Consult with dietician.
• Keep intake log for diet and fluids
• Encourage fluids
• Give smaller, frequent meals
• Keep upright during drinking or
eating
• Need high calorie/protein diet
 Consult speech and language therapist
 Encourage/maintain mobility as long as
patient can.
 Encourage to communicate if possible
• Speak slowly and pause
• Use alternate forms of
communication
 Monitor cognitive and mental status
• Check for depression or dementia
• Provide safe environment
• Refer to social worker or case
manager
Real life scenario

I encountered a patient diagnosed with Parkinson’s at the SNF. I noticed that the patient has tremors and unsteady gait. They have poor coordination,
looks fatigued, and has a stooped posture. In addition, the patient was on swallow precaution due to risk for aspiration, and the patient seem to have short term
memory loss. However, I do remember that the patient still has a good sense of humor and was overall good natured. I heard that his family visits him often and
that family support I think makes a whole lot of difference.