PARKINSON’S DISEASE

Raymund Christopher R. Dela Peña, MAN, RN, RM

Assistant Professor II, College of Nursing
University of Northern Philippines
Parkinson’s Disease
 A progressively degenerative neurological
disorder affecting the brain centers

 Occurs in 1% of pop.

 Over 50, affects men > women

 Parkinson’s Disease
PATHOPHYSIOLOGY

 depletion
of dopamine levels in the
basal ganglia of the mid brain

Dopamine depletion  impairment of

the extrapyramidal tracts with loss of
movement coordination
Parkinson’s Disease
ETIOLOGY
 Cause: unknown
Some heredity causes

Secondary iatrogenic PD – is drug or

chemical related
Dopamine depleting drugs:
Reserpine. Phenothiazine,
Metoclopromide, Butyrophenones
(Droperidol & Haloperidol)
Parkinson’s Disease
CLINICAL MANIFESTATIONS
Parkinson’s Disease
DIAGNOSTIC EVALUATION
 No specific tests

 History: progresses thru stages

 Mild unilateral dysfunction
 Mild bilateral dysfunction, expressionless face &
gait changes
 Dysfunction w/ walking, initiating movements, and
maintaining equilibrium
 Severe disability- difficulty in walking, & maintaining
balance & steady propulsion, rigidity
 Parkinson’s Disease
Nursing Diagnosis
 Impaired physical mobility related to the
stiffness and muscle weakness.
 Self care deficit related to neuromuscular
weakness, decline in strength, loss of
muscle control / coordination.
 Impaired Verbal Communication related
to the decline in speech and facial muscle
stiffness
 Parkinson’s Disease
Drug therapy
 Goal: enhance dopamine transmission

 Dopaminergics (Levodopa)
a synthetic metabolic precursor to dopamine
 given in combination with Sinemet (Carbidopa)
 to allow more Levodopa to reach the brain
 prevents peripheral metabolism of levodopa
 beneficial first few years
 on & off reactions
Parkinson’s Disease
Drug therapy
 Dopaminergics (cont.)
Sinemet
most common drug (carbidopa-
levodopa)
SE: Orthostatic hypotension, nausea,
hallucinations, dyskinesia
Nursing Considerations:
Monitor B/P
Use TED hose to  venous return
Monitor for urinary retention
Parkinson’s Disease
Drug therapy
 Dopaminergics (cont.)
Symmetrel (Amantadine)
Action: causes release of dopamine in
CNS
Indications: rigidity, bradykinesia
SE:
dizziness, ataxia, insomnia, leg
edema
Nursing Considerations:
Monitor for postural hypotension
Do not administer at bed time
Parkinson’s Disease
Drug therapy
 Anticholinergic
 toblock the release of acetylcholine (balance
between dopamine & acetylcholine)

 to block the excitatory effects of the cholinergic

system

 Examples:

 Artane (trihexphenidyl)
 Cogentin (benztropine)
 Parsidol (ethopropazine)
Parkinson’s Disease
Drug therapy
 Anticholinergic
 Indications: tremor, rigidity, drooling
 SE:
dry mouth, constipation, blurred vision,
confusion, hallucination
 Nursing Considerations:
 Usually
contraindicated in acute-angle
glaucoma, & tachycardia
 Monitor pulse & B/P during dosage adjustments
 Administer w/ meals
 Do not withdraw meds suddenly
Parkinson’s Disease
Drug therapy
 Antihistamines
Benadryl
Indications: tremor, rigidity, insomnia
SE: dry mouth, lethargy, confusion
Nursing Considerations:
Use w caution in pts with seizures,
hypertension, hyperthyroidism,
renal disease, diabetes
Administer w meals or antacids.
 Parkinson’s Disease
Drug therapy
 Dopamine agonists

Parlodel (Bromocriptine)
Action: activates dopamine receptor in
the CNS, helpful for treatment of on-off
reactions
Indications: fluctuation of manifestations,
dyskinesia, dystonia
SE: hallucinations, orthostatic
hypotension, confusion
Nursing considerations:
 monitor B/P & mental status
Parkinson’s Disease
Drug therapy
 COMT inhibitors [catechol-O-
methyltransferase}
 Tolcapone
Action: enhance effect of dopamine
Indications: adjuvant treatment
SE: diarrhea
Nursing Considerations:
Monitor liver enzymes
 Parkinson’s Disease
Drug therapy
 MAO (Monoamine Oxydase) inhibitors
 Deprenyl (Selegiline)
 Action:inhibit monoamine oxidase B, an enzyme
that converts chemical byproducts in the brain
into neurotoxins that prevent substantia nigra
cell death
 Indications: adjuvant treatment
 SE:
nausea, dizziness, confusion, hallucinations,
dry mouth
 Nursing considerations:
 Monitor for levodopa side effects
Parkinsonian Crisis
 Sudden or inadvertent withdrawal of anti-PK
drugs or emotional trauma

 Severe exacerbation of tremor, rigidity and

bradykinesia, along w/ acute anxiety,
sweating, tachycardia.

 Interventions: respiratory & cardiac support,

subdued lighting, mild barbiturates, anti PK
drugs
 Parkinson’s Disease
NURSING MANAGEMENT
 Improve mobility
• Exercise & stretch regularly (first thing in morning)
 Encourage daily ROM to avoid rigidity &
contractures

• Enhance walking – walk erect, watch horizon, wide-

based gait, heel-toe gait, long strides.

• Use cane or walker  prevent falls

 Parkinson’s Disease
NURSING MANAGEMENT
 Improve hydration & nutrition
• Maintain fluid intake 2 L/24 hrs

• Monitor weight & ability to chew & swallow

 Upright
position to chew & swallow, offer small
freq. meals, soft foods & thick cold foods 
supplemental puddings
 Preventaspiration  think thru the steps of
swallowing, keep lips closed, keep teeth together,
chew, finish one bite before another
 Parkinson’s Disease
NURSING MANAGEMENT
 Improve bowel elimination
Stool softeners, mild laxatives, regular
routine,  fiber, raised toilet seat

 Improve communication
Speech therapy: speak slowly, use
board, mechanical voice synthesizer
Parkinson’s Disease
NURSING MANAGEMENT
 Enhance self-care
 Extra time needed to perform ADL’s, use of
side rails, overhead trapeze.

 Reinforce occupational & physical therapy

 Sleep on firm mattress, prevent neck

contractures
Parkinson’s Disease
NURSING MANAGEMENT
 Support coping abilities
 Feel embarrassed, depressed, lonely, bored,
more muscle rigidity & unresponsive to verbal
stimuli
treat w/ dignity
do not ignore clients
 Client to be active participant
 Explore feelings
 Nursing Management

P-rovide extra time for activities such as dressing, bathing & eating
A-nticholinergic & antiparkinson drugs
R-ange of motion exercises
K-nowledge or techniques to enhance voluntary movements
I-ncrease fluid & fiber intake
N-o pillow when resting
S-wallowing & chewing ability should be checked before feeding
O-ffer a high calorie & protein, soft diet w/ small frequent feedings
N-o loose carpeting
S-afety is a priority
 Parkinson’s Disease
Evaluation
 The client is able to perform
physical activity according to
ability.
 The client is able to perform self
care
 The client is able to maximize
the ability to communicate.