N ’S

I NS O
AR K E
P E AS
D IS
OBJECTIVES
Within a maximum of 2 hours of Case Sharing, the audience
will be able to:
 Compare the age of onset, clinical manifestations, and

pathologic mechanisms of Parkinson’s Disease.

 Explain & discuss the causes of the clinical manifestations

of Parkinson’s Disease
 Identify risk factors of Parkinson’s Disease.

 Identify clients who are at risk for Parkinson’s Disease.

 Enumerate the different management applied to patients

having Parkinson’s Disease.

 Identify and enumerate the nursing plan and action

applicable to patients having Parkinson’s Disease.

 IO N
CT
DU
O
IN TR
Parkinson disease (PD), also referred to as paralysis agitans,
is a disabling, progressive condition that is predominantly
thought of as a movement disorder. PD has a large
economic impact in the form of direct medical costs, as well
as indirect costs, such as lost wages and decreased
productivity. In 1817, when James Parkinson originally
described the "shaking palsy," he stated that cognitive
changes are not evident until the later stages of the disease
but that the disorder is often complicated by a spectrum of
cognitive deficits that range from isolated cognitive
impairment to severe dementia. Parkinson's disease (PD)
belongs to a group of conditions called motor system
disorders, parkinson's results from the degeneration of
nuclei in a number of dopamine-producing nerve cells in the
brainstem. Dopamine is a neurotransmitter that stimulates
motor neurons, which are nerve cells that control the
muscles.
When dopamine production is depleted, the motor
system nerves are unable to control movement
and coordination. Parkinson's disease patients
have lost 80% or more of their dopamine-
producing cells by the time symptoms appear.
The four primary symptoms of PD are tremor, or
trembling in hands, arms, legs, jaw, and face;
rigidity, or stiffness of the limbs and trunk;
bradykinesia, or slowness of movement; and
postural instability, or impaired balance and
coordination. As these symptoms become more
pronounced, patients may have difficulty walking,
talking, or completing other simple tasks.
PD usually affects people over the age of 50.
The primary symptoms are the results of
decreased stimulation of the motor cortex
 by the basal ganglia, normally caused by
the insufficient formation and action of 
dopamine, which is produced in the 
dopaminergic neurons of the brain
(specifically the substantia nigra).
Secondary symptoms may include high
level cognitive dysfunction and subtle
language problems.
Signs and Symptoms
 
Motor
Four motor symptoms are considered cardinal in PD: tremor,
rigidity, bradykinesia and postural instability Tremor is the
most apparent and well-known symptom. It is most commonly
a rest tremor: maximal when the limb is at rest and
disappearing with voluntary movement and sleep. It affects to
a greater extent the most distal part of the extremity and is
typically unilateral at onset. Though around 30% of PD
sufferers do not have tremor at disease onset most of them
would develop it along the course of the disease. Rigidity is
due to joint stiffness and increased muscle tone, which
combined with a resting tremor produce a ratchety, "cogwheel
 rigidity" when the limb is passively moved. Rigidity may be
associated with joint pain, such pain being a frequent initial
manifestation of the disease.
Bradykinesia (slowness of movement) is the most
characteristic clinical feature of PD and it produces
difficulties not only with the execution of a movement
but also with its planning and initiation. The
performance of sequential and simultaneous
movements is also hindered. In the late stages of the
disease postural instability is typical, which leads to 
impaired balance and falls.
PD motor symptomatology is not limited to these four
symptoms. Gait and posture disturbances such as
decreased arm swing, a forward-flexed posture and
the use of small steps when walking; speech and
swallowing disturbances; and a small handwriting are
only examples of the ample range of common motor
problems that can appear with the disease.
Other
In addition to cognitive and motor symptoms PD can impair other
body functions. Sleep problems can be worsened by
medications for PD, but they are a core feature of the
disease. They can manifest as excessive daytime somnolence
, disturbances in REM sleep or insomnia. The 
autonomic system is altered which can lead for example to 
orthostatic hypotension, oily skin and seborrheic dermatitis,
excessive sweating, urinary incontinence and altered sexual
function. Constipation and gastric dysmotility can be severe
enough to endanger comfort and health. PD is also related to
different ophthalmological abnormalities such as decreased 
blink rate and alteration in the tear film, leading to irritation of
the eye surface, abnormalities in ocular pursuit and 
saccadic movements and limitations in the upward
gaze. Changes in perception include reduced sense of smell
 and sensation of pain and paresthesias.
 
PD is separated into stages according to the symptoms and degree of
disability:
Stage 1: Initial Stage
Unilateral limb involvement
Minimal weakness
Hand and arm trembling
Stage 2: Mild Stage
Bilateral limb involvement
Masklike faces
Slow, shuffling gait
Stage 3: Moderate Disease
Increased gait disturbance
Stage 4: Severe Disability
Akinesia
Rigidity
Stage 5: Complete Dependence
The overall incidence of cognitive impairment in
Parkinson disease increases with age from
2.7% per year at age 55-64 years to 13.7%
per year in the 70-79 year age group.1 The
prevalence of dementia in Parkinson disease
ranges from 20-40%, with the disease
conferring a 2- to 6-fold increased risk
compared with control populations.2 In the
affected age group, comorbiditywith other
neurodegenerative disorders, particularly 
Alzheimer disease (Alzheimer's disease, AD)
and cerebrovascular disease, is common.
 PHYSICAL
ASSESSMENT AND
REVIEW OF SYSTEMS
 T IC
OS
G N
I A
D TS
T E S
 Diagnostic Normal Value Result Interpretation Significance Nursing
Test Responsibilities

Magnetic The Structural Early diagnosis To aid in the Preparation:

Resonance appearance changes that of multiple diagnosis of Make sure the
Imaging of of the brain increase sclerosis intracranial patient has
the and spinal tissue water revealed by and spinal signed an
Neurologic cord content detection of lesions appropriate
system structures is suggest sclerotic To aid in the consent form.
defined and possible plaques as diagnosis of Note and report
distinct cerebral small as 3 to 4 soft tissue all allergies
edema, mm in diameter abnormalities Screen for
demylinating surgically
disease, and implanted
pontine and joints, pins,
cerebral clips, valves,
tumor. pumps or
pacemakers
containing
metal.
Areas of To detect Remove all
demyelination small tumors metallic objects
(curdlike gray and from the patient.
or gray white hemorrhages Because of
areas). Around and cerebral powerful
the edges of infarction magnetic fields,
ventricles than possible magnetic
suggest with resonance
multiple computed imaging (MRI) is
sclerosis lesions tomography contraindicated
or may suggest scanning in patients with
a disease   pacemakers,
Changes in intracranial
normal clips, ferrous
anatomy metal implants,
suggest possible or gunshot
tumors. wounds to the
head.
Metallic or
computer based
equipment (for
example,
ventilators and
IV pumps) must
not enter the
MRI area.
Explain that MRI
is painless and
involves no
exposure to
radiation.
Explain the need
to remain still for
the entire
procedure.
A claustrophobic
patient may require
sedation or an open
MRI to reduce
anxiety.
Warn the patient
that he will hear
clicking, whirring
and thumping
sounds during the
procedure, and that
he may wear
earplugs.
Provide reassurance
to the patient that
he’ll be able to
communicate with
the technician at all
times.
Explain that the test
takes up to 90
minutes.
Implementation:
The patient is
placed in the
supine position on
a narrow table.
The table is
moved to the
desired position
inside scanner.
Radiofrequency
energy is directed
at the head or
spine.
Resulting images
or displayed on a
monitor.
Images are
recorded on film
or magnetic tape.
Patient Care:
Instruct the
patient to
resume his
normal
activity.
Monitor vital
signs
Compute Brain matter Enlarged Brain To diagnose Preparatio
d appears in ventricles matter intracranial n:
Tomogra shades of with large appears in lesions and Make sure
phy of the gray. sulci shades of abnormalitie the patient
Brain Ventricular suggest gray. s has signed
and cerebral Ventricular To monitor an
subarachnoid atrophy. and the effects of appropriat
cerebrospinal Areas of subarachoi surgery, e consent
fluid appears marked d radiotherapy, form
black generalized cerebrospin or Note and
lucency al fluid chemotherap report
suggest appears y in allergies.
cerebral black. treatment of
edema intracranial
tumors
Cerebral vessels To guide Inform the client
appearing with cranial that the head is
slightly increased surgery placed in a
density suggest To assess stabilized holder
possible focal with the face
arteriovenous neurologic uncovered and
malformation. abnormaliti that the holder is
Areas of altered es then placed in a
density or To evaluate frame that
displaced suspected revolves
vasculature or head injury around the head
other structures such as while the
may indicate subdural pictures are
intracranial hematoma. taken
tumors, Inform the client
intracranial that the study
hematoma, takes 30 minutes
cerebral atrophy, to 1 hour.
infarction,
edema, and
congenital
anomalies such as
hydrocephalus.
Obtain baseline vital
signs and
neurological
Checks for later

comparisons.
Obtain a history and
assessment of the
neurological system,
known or suspected
neurological
disorders, and
results of associated
laboratory Tests and
other diagnostic
procedures.
Implementation:
The patient is
assisted into a
supine position on a
radiographic table.
The patient’s head is
immobilized with
straps and he asked
to lie still.
The head of the
head is moved into
the scanner, which
rotates around the
patient’s head,
taking radiographs.
When the initial
series of
radiographs is
complete, the
contrast
enhancement is
given ordered.
Usually, 50 to 100
ml of contrast
medium is
injected by IV
bolus or infusion.
The patient is
observed for
hypersensitivity
reactions.
Another series of
scan is taken
Selected views
are taken for
further study.
Patient Care:
If the patient
received a
contrast
medium, watch
for delayed
adverse
reactions.
Have him
assume his usual
diet and
medications
unless otherwise
ordered.
NOR
MA L
AND ANA
PHY TOM
SIOL Y
OGY
The nervous system is one of the regulating systems.
Electrochemical impulses of the nervous system make it
possible to obtain information about the external or internal
environment and do whatever is necessary to maintain
homeostasis. Some of this activity is conscious, but much of it
happens without our awareness.
 
NERVOUS SYSTEM DIVISIONS
The nervous system has two divisions. The central nervous
system (CNS) consists of the brain and spinal cord. The
peripheral nervous system (PNS) consists of cranial nerves
and spinal nerves. The PNS includes the autonomic nervous
system (ANS).
The peripheral nervous system relays information to and from
the central nervous system, and the brain is the center of
activity that integrates this information, initiates responses,
and makes us the individuals we are.
NERVE TISSUE
Nerve cells are called neurons, or nerve fibers. Whatever their
specific functions, all neurons have the same physical parts. The
cell body contains the nucleus and is essential for the
continued life of the neuron.
Dendrites are processes (extensions) that transmit impulses
toward the cell body. The one axon of a neuron transmits
impulses away from the cell body. It is the cell membrane of the
dendrites, cell body, and axon that carries the electrical nerve
impulse.
In the peripheral nervous system, axons and dendrites are
“wrapped” in specialized cells called Schwann cells During
embryonic development, Schwann cells grow to surround the
neuron processes, enclosing them in several layers of Schwann
cell membrane. These layers are the myelin sheath; myelin is a
phospholipid that electrically insulates neurons from one
another. Without the myelin sheath, neurons would short-circuit,
just as electrical wires would if they were not insulated.
The nuclei and cytoplasm of the Schwann cells are wrapped
around the outside of the myelin sheath and are called the
neurolemma, which becomes very important if nerves are
damaged. If a peripheral nerve is severed and reattached
precisely by microsurgery, the axons and dendrites may
regenerate through the tunnels formed by the neurolemmas.
The Schwann cells are also believed to produce a chemical
growth factor that stimulates regeneration.
In the central nervous system, the myelin sheaths are formed
by oligodendrocytes, one of the neuroglia (glial cells), the
specialized cells found only in the brain and spinal cord.
Because no Schwann cells are present, however, there is no
neurolemma, and regeneration of neurons does not occur.
This is why severing of the spinal cord, for example, results
in permanent loss of function. Another kind of neuroglia are
microglia,which are constantly moving, phagocytizing
cellular debris, damaged cells, and pathogens.
Yet another type of glial cell is the astrocyte (literally, “star
cell”). In the embryo, these cells provide a framework for
the migrating neurons that will form the brain.
Thereafter, the extensions of astrocytes are wrapped
around brain capillaries and contribute to the blood–
brain barrier, which prevents potentially harmful waste
products in the blood from diffusing out into brain tissue.
These waste products are normal in the blood and
tissue fluid, but brain tissue is much more sensitive to
even low levels of them than are other tissues such as
muscle tissue or connective tissue. The capillaries of the
brain also contribute to this barrier, because they are
less permeable than are other capillaries. A
disadvantage of the blood–brain barrier is that some
useful medications cannot cross it, and the antibodies
produced by lymphocytes cross only with difficulty.
SYNAPSES
Neurons that transmit impulses to other neurons do not
actually touch one another. The small gap or space between
the axon of one neuron and the dendrites or cell body of the
next neuron is called the synapse.Within the synaptic knob
(terminal end) of the presynapticsaxon is a chemical
neurotransmitter that is released into the synapse by the
arrival of an electrical nerve impulse. The neurotransmitter
diffuses across the synapse, combines with specific receptor
sites on the cell membrane of the postsynaptic neuron, and
there generates an electrical impulse that is, in turn, carried
by this neuron’s axon to the next synapse, and so forth. A
chemical inactivator at the cell body or dendrite of the
postsynaptic neuron quickly inactivates the neurotransmitter.
This prevents unwanted, continuous impulses, unless a new
impulse from the first neuron releases more
neurotransmitter.
Many synapses are termed excitatory, because the
neurotransmitter causes the postsynaptic neuron to
depolarize (become more negative outside as Na_ ions
enter the cell) and transmit an electrical impulse to
another neuron, muscle cell, or gland. Some synapses,
however, are inhibitory, meaning that the neurotransmitter
causes the postsynaptic neuron to hyperpolarize (become
even more positive outside as K_ ions leave the cell or
Cl_ ions enter the cell) and therefore not transmit an
electrical impulse. Such inhibitory synapses are important,
for example, for slowing the heart rate, and for balancing
the excitatory impulses transmitted to skeletal muscles.
With respect to the skeletal muscles, this inhibition
prevents excessive contraction and is important for
coordination.
 
One important consequence of the presence of synapses is that
they ensure one-way transmission of impulses in a living person.
A nerve impulse cannot go backward across a synapse because
there is no neurotransmitter released by the dendrites or cell body.
Neurotransmitters can be released only by a neuron’s axon, which
does not have receptor sites for it, as does the postsynaptic
membrane.
An example of a neurotransmitter is acetylcholine, which is found
at neuromuscular junctions, in the CNS, and in much of the
peripheral nervous system. Acetylcholine usually makes a
postsynaptic membrane more permeable to Na_ ions, which
brings about depolarization of the postsynaptic neuron.
Cholinesterase is the inactivator of acetylcholine. Each of these
neurotransmitters has its own chemical inactivator. Some
neurotransmitters are reabsorbed into the neurons that secreted
them; this process is called reuptake and also terminates the
effect of the transmitter.
The complexity and variety of synapses make them frequent
targets of medications. For example, drugs that alter mood or
behavior often act on specific neurotransmitters in the brain,
and antihypertensive drugs affect synapse transmission at the
smooth muscle of blood vessels.
 
TYPES OF NEURONS
Neurons may be classified into three groups: sensory
neurons, motor neurons, and interneurons (Fig. 8–3).
Sensory neurons (or afferent neurons) carry impulses from
receptors to the central nervous system. Receptors detect
external or internal changes and send the information to the
CNS in the form of impulses by way of the afferent neurons.
The central nervous system interprets these impulses as a
sensation. Sensory neurons from receptors in skin, skeletal
muscles, and joints are called somatic; those from receptors
in internal organs are called visceral sensory neurons.
Motor neurons (or efferent neurons) carry impulses from
the central nervous system to effectors. The two types of
effectors are muscles and glands. In response to
impulses, muscles contract or relax and glands secrete.
Motor neurons linked to skeletal muscle are called
somatic; those to smooth muscle, cardiac muscle, and
glands are called visceral.
Sensory and motor neurons make up the peripheral
nervous system. Visceral motor neurons form the
autonomic nervous system, a specialized subdivision of
the PNS that will be discussed later in this chapter.
Interneurons are found entirely within the central
nervous system. They are arranged so as to carry only
sensory or motor impulses, or to integrate these
functions. Some interneurons in the brain are concerned
with thinking, learning, and memory.
A neuron carries impulses in only one direction. This is the result
of the neuron’s structure and location, as well as its physical
arrangement with other neurons and the resulting pattern of
synapses. The functioning nervous system, therefore, is an
enormous network of “one-way streets,” and there is no danger
of impulses running into and canceling one another out.
 
NERVES AND NERVE TRACTS
A nerve is a group of axons and/or dendrites of many neurons,
with blood vessels and connective tissue. Sensory nerves are
made only of sensory neurons. The optic nerves for vision and
olfactory nerves for smell are examples of nerves with a purely
sensory function. Motor nerves are made only of motor
neurons; autonomic nerves are motor nerves. A mixed nerve
contains both sensory and motor neurons. Most of our
peripheral nerves, such as the sciatic nerves in the legs, are
mixed nerves.
THE NERVE IMPULSE
The events of an electrical nerve impulse are the same as those of
the electrical impulse generated in muscle fibers. Stated simply, a
neuron not carrying an impulse is in a state of polarization, with
Na_ ions more abundant outside the cell, and K_ ions and negative
ions more abundant inside the cell. The neuron has a positive
charge on the outside of the cell membrane and a relative negative
charge inside. A stimulus (such as a neurotransmitter) makes the
membrane very permeable to Na_ ions, which rush into the cell.
This brings about depolarization, a reversal of charges on the
membrane. The outside now has a negative charge, and the inside
has a positive charge. As soon as depolarization takes place, the
neuron membrane becomes very permeable to K_ ions, which rush
out of the cell. This restores the positive charge outside and the
negative charge inside, and is called repolarization. (The term
action potential refers to depolarization followed by repolarization.)
Then the sodium and potassium pumps return Na_ ions outside and
K_ ions inside, and the neuron is ready to respond to another
stimulus and transmit another impulse.
An action potential in response to a stimulus takes place
very rapidly and is measured in milliseconds. An
individual neuron is capable of Transmission of
electrical impulses is very rapid. The presence of an
insulating myelin sheath increases the velocity of
impulses, since only the nodes of Ranvier depolarize.
This is called saltatory conduction. Many of our
neurons are capable of transmitting impulses at a speed
of many meters per second. Imagine a person 6 feet
(about 2 meters) tall who stubs his toe; sensory
impulses travel from the toe to the brain in less than a
second (crossing a few synapses along the way). You
can see how the nervous system can communicate so
rapidly with all parts of the body, and why it is such an
important regulatory system. transmitting hundreds of
action potentials (impulses) each second.
THE SPINAL CORD
The spinal cord transmits impulses to and from the brain and is the
integrating center for the spinal cord reflexes. Although this statement of
functions is very brief and sounds very simple, the spinal cord is of great
importance to the nervous system and to the body as a whole.
Enclosed within the vertebral canal and the meninges, the spinal cord is
well protected from mechanical injury. In length, the spinal cord extends
from the foramen magnum of the occipital bone to the disc between the
first and second lumbar vertebrae.

The internal gray matter is shaped like the letter H; gray matter consists of
the cell bodies of motor neurons and interneurons. The external white
matter is made of myelinated axons and dendrites of interneurons. These
nerve fibers are grouped into nerve tracts based on their functions.
Ascending tracts (such as the dorsal columns and spinothalamic tracts)
carry sensory impulses to the brain. Descending tracts (such as the
corticospinal and rubrospinal tracts) carry motor impulses away from the
brain. Lastly, find the central canal; this contains cerebrospinal fluid and
is continuous with cavities in the brain called ventricles.
SPINAL NERVES
There are 31 pairs of spinal nerves, those that emerge from
the spinal cord. The nerves are named according to their
respective vertebrae: 8 cervical pairs, 12 thoracic pairs, 5
lumbar pairs, 5 sacral pairs, and 1 very small coccygeal pair.
These are shown in Fig. 8–4; notice that each nerve is
designated by a letter and a number. The 8th cervical nerve
is C8, the 1st thoracic nerve is T1, and so on.
In general, the cervical nerves supply the back of the head,
neck, shoulders, arms, and diaphragm (the phrenic nerves).
The first thoracic nerve also contributes to nerves in the
arms. The remaining thoracic nerves supply the trunk of the
body. The lumbar and sacral nerves supply the hips, pelvic
cavity, and legs. Notice that the lumbar and sacral nerves
hang below the end of the spinal cord (in order to reach their
proper openings to exit from the vertebral canal); this is
called the cauda equina, literally, the “horse’s tail.”
Each spinal nerve has two roots, which are neurons
entering or leaving the spinal cord (see Fig. 8–3). The
dorsal root is made of sensory neurons that carry
impulses into the spinal cord. The dorsal root ganglion
is an enlarged part of the dorsal root that contains the
cell bodies of the sensory neurons. The term ganglion
means a group of cell bodies outside the CNS. These
cell bodies are within the vertebral canal and are
thereby protected from injury.
The ventral root is the motor root; it is made of the axons
of motor neurons carrying impulses from the spinal cord
to muscles or glands. The cell bodies of these motor
neurons, as mentioned previously, are in the gray
matter of the spinal cord. When the two nerve roots
merge, the spinal nerve thus formed is a mixed nerve.
SPINAL CORD REFLEXES
Spinal cord reflexes are those that do not depend directly on the brain,
although the brain may inhibit or enhance them. We do not have to think about
these reflexes, which is very important, as you will see.
 
Reflex Arc
A reflex arc is the pathway that nerve impulses travel when a reflex is elicited,
and there are five essential parts:
1. Receptors—detect a change (the stimulus) and generate impulses.
2. Sensory neurons—transmit impulses from receptors to the CNS.
3. Central nervous system—contains one or more synapses (interneurons may
be part of the pathway).
4. Motor neurons—transmit impulses from the CNS to the effector.
5. Effector—performs its characteristic action. Let us now look at the reflex arc
of a specific reflex, the patellar (or knee-jerk) reflex, with which you are
probably familiar. In this reflex, a tap on the patellar tendon just below the
kneecap causes extension of the lower leg. This is a stretch reflex, which
means that a muscle that is stretched will automatically contract.
 
THE BRAIN
The brain consists of many parts that function as an integrated whole. The major
parts are the medulla, pons, and midbrain (collectively called the brain stem), the
cerebellum, the hypothalamus, the thalamus, and the cerebrum.
 
VENTRICLES
The ventricles are four cavities within the brain: two lateral ventricles, the third
ventricle, and the fourth ventricle. Each ventricle contains a capillary network
called a choroid plexus, which forms cerebrospinal fluid (CSF) from blood
plasma. Cerebrospinal fluid is the tissue fluid of the central nervous system; its
circulation and functions will be discussed in the section on meninges.
 
MEDULLA
The medulla extends from the spinal cord to the pons and is anterior to the
cerebellum. Its functions are those we think of as vital (as in “vital signs”). The
medulla contains cardiac centers that regulate heart rate, vasomotor centers that
regulate the diameter of blood vessels and, thereby, blood pressure, and
respiratory centers that regulate breathing. Also in the medulla are reflex centers
for coughing, sneezing, swallowing, and vomiting.
 
PONS
The pons bulges anteriorly from the upper part of the medulla. Within
the pons are two respiratory centers that work with those in the
medulla to produce a normal breathing rhythm. The many other
neurons in the pons ( pons is from the Latin for “bridge”) connect the
medulla with other parts of the brain.
 
MIDBRAIN
The midbrain extends from the pons to the hypothalamus and
encloses the cerebral aqueduct, a tunnel that connects the third and
fourth ventricles. Several different kinds of reflexes are integrated in
the midbrain, including visual and auditory reflexes. If you see a wasp
flying toward you, you automatically duck or twist away; this is a
visual reflex, as is the coordinated movement of the eyeballs. Turning
your head (ear) to a sound is an example of an auditory reflex. The
midbrain is also concerned with what are called righting reflexes,
those that keep the head upright and maintain balance or equilibrium.
CEREBELLUM
The cerebellum is separated from the medulla and pons by the fourth ventricle
and is inferior to the occipital lobes of the cerebrum. As you already know,
many of the functions of the cerebellum are concerned with movement. These
include coordination, regulation of muscle tone, the appropriate trajectory and
endpoint of movements, and the maintenance of posture and equilibrium.
Notice that these are all involuntary; that is, the cerebellum functions below the
To regulate equilibrium, the cerebellum (and midbrain) uses information about
gravity and movement provided by receptors in the inner ears.
 
 
HYPOTHALAMUS
Located superior to the pituitary gland and inferior to the thalamus, the
hypothalamus is a small area of thebrain with many diverse functions:
 
1.Production of antidiuretic hormone (ADH) and oxytocin
 
2.The hypothalamus produces growth hormone releasing hormone (GHRH),
which stimulates the anterior pituitary gland to secrete growth hormone (GH).
3. Regulation of body temperature by promoting responses such as sweating in a
warm environment or shivering in a cold environment.
4. Regulation of food intake
5. autonomic nervous system, which in turn regulates the activity of organs such
as the heart, blood vessels, and intestines.
6. Stimulation of visceral responses during emotional situations. When we are
angry, heart rate usually increases. Most of us, when embarrassed, will blush,
which is vasodilation in the skin of the face. These responses are brought
about by the autonomic nervous system when the hypothalamus perceives a
change in emotional state
7. Regulation of body rhythms such as secretion of hormones, sleep cycles,
changes in mood, or mental alertness. This is often referred to as our biological
clock, the rhythms as circadian rhythms, meaning “about a day.” If you have
ever had to stay awake for 24 hours, you know how disorienting it can be,
until the hypothalamic biological clock has been reset.
 
THALAMUS
The thalamus is superior to the hypothalamus and inferior to
the cerebrum. The third ventricle is a narrow cavity that passes
through both the thalamus and hypothalamus. Many of the
functions of the thalamus are concerned with sensation. Sensory
impulses to the
brain (except those for the sense of smell) follow neuron pathways
that first enter the thalamus, which groups the impulses before
relaying them to the cerebrum, where sensations are felt. For
example, holding a cup of hot coffee generates impulses for
heat, touch and texture, and the shape of the cup (muscle sense),
but we do not experience these as separate sensations. The
thalamus integrates the impulses from the cutaneous receptors
and from the cerebellum, that is, puts them together in a sort of
electrochemical package, so that the cerebrum feels the whole
and is able to interpret the sensation quickly.
CEREBRUM
The largest part of the human brain is the
cerebrum, which consists of two hemispheres
separated by the longitudinal fissure. At the base
of this deep groove is the corpus callosum, a band
of 200 million neurons that connects the right and
left hemispheres. Within each hemisphere is a
lateral ventricle.
Frontal Lobes
Within the frontal lobes are the motor areas that
generate the impulses for voluntary movement. The
largest portions are for movement of the hands and face,
those areas with many muscles capable of very fine or
precise movements. It is the large size of the motor area
devoted to them that gives these muscles their precision.
The left motor area controls movement on the right side of
the body, and the right motor area controls the left side of
the body. This is why a patient who has had a
cerebrovascular accident, or stroke, in the right frontal
lobe will have paralysis of muscles on the left side.
Anterior to the motor areas are the premotor areas, which
are concerned with learned motor skills that require a
sequence of movements.
The parts of the frontal lobes just behind the eyes are
the prefrontal or orbitofrontal cortex. This area is
concerned with things such as keeping emotional
responses appropriate to the situation, realizing that
there are standards of behavior (laws or rules of a
game or simple courtesy) and following them, and
anticipating and planning for the future. The
prefrontal cortex is very important for social behavior,
and greatly contributes to what makes us human.
Also in the frontal lobe, usually only the left lobe for
most right-handed people, is Broca’s motor speech
area, which controls the movements of the mouth
involved in speaking.
 
Parietal Lobes
The general sensory areas in the parietal lobes
receive impulses from receptors in the skin and feel and
interpret the cutaneous sensations. The left area is for
the right side of the body and vice versa. These areas
also receive impulses from stretch receptors in muscles
for conscious muscle sense. The largest portions of
these areas are for sensation in the hands and face,
those parts of the body with the most cutaneous
receptors and the most muscle receptors. The taste
areas, which overlap the parietal and temporal lobes,
receive impulses from taste buds on the tongue and
elsewhere in the oral cavity.
 
Temporal Lobes
The olfactory areas in the temporal lobes receive
impulses from receptors in the nasal cavities for the sense
of smell. The olfactory association area learns the meaning
of odors such as the smell of sour milk, or fire, or brownies
baking in the oven, and enables the thinking The auditory
areas, as their name suggests, receive impulses from
receptors in the inner ear for hearing. The auditory
association area is quite large. Part of it is concerned with
the meanings of words we hear, that is, with speech. Other
parts are for the interpretation of sounds such as thunder
during a storm, an ambulance siren, or a baby crying.
Without proper interpretation, we would hear the sound but
would not know what it meant, and could not respond
appropriately.
Occipital Lobes
Impulses from the retinas of the eyes travel along the optic
nerves to the visual areas in the occipital lobes. These
areas “see.” The visual association areas interpret what is
seen, and enable the thinking cerebrum to use the
information. Imagine looking at a clock. Seeing the clock is
far different from being able to interpret it. At one time we
learned to interpret the clock face and hands, and now we
do not have to consciously decide what time the clock is
reading. We can simply use that information, such as
hurrying a bit so as not to be late to class. Other parts of the
occipital lobes are concerned with spatial relationships;
things such as judging distance and seeing in three
dimensions, or the ability to read a map and relate it to the
physical world.
Basal Ganglia
The basal ganglia are paired masses of gray matter within the
white matter of the cerebral hemispheres (see Fig. 8–6). Their
functions are certain subconscious aspects of voluntary
movement, and they work with the cerebellum. The basal ganglia
help regulate muscle tone, and they coordinate accessory
movements such as swinging the arms when walking or gesturing
while speaking. The basal ganglia consist of several structures of
subcortal gray matter buried deep in the cerebral hemispheres.
These structures include the caudate nucleus,putamen, globules
palliuds, substansia nigra, and suthalamic nucleus. The basal
ganglia serves as processing stations that link the cerebral cortex
and the spinal cord travel through the white matter pathways near
the caudate nucleus and putamen ganglia. These pathways are
known as the internal capsule. The basal ganglia, along with the
corticospinal tract, are important in controlling complex motor
activity.
Corpus Callosum
As mentioned previously, the corpus callosum is a
band of nerve fibers that connects the left and right
cerebral hemispheres. This enables each hemisphere
to know of the activity of the other. This is
especially important for people because for most of
us, the left hemisphere contains speech areas and the
right hemisphere does not. The corpus callosum,
therefore, lets the left hemisphere know what the
right hemisphere is thinking about, and the right
hemisphere know what the left hemisphere is
thinking and talking about.
 
MENINGES AND CEREBROSPINAL FLUID
The connective tissue membranes that cover the brain
and spinal cord are called meninges; the three layers
are illustrated in Fig. 8–9. The thick outermost layer,
made of fibrous connective tissue, is the dura mater
(Latin for “tough mother”), which lines the skull and
vertebral canal. The middle arachnoid membrane
(arachnids are spiders) is made of web-like strands of
connective tissue. The innermost pia mater (Latin for
“gentle mother”) is a very thin membrane on the
surface of the spinal cord and brain. Between the
arachnoid and the pia mater is the subarachnoid
space, which contains cerebrospinal fluid (CSF), the
tissue fluid of the central nervous system.
CRANIAL NERVES
The 12 pairs of cranial nerves emerge from the brain
stem or other parts of the brain. The name cranial
indicates their origin, and many of them do carry
impulses for functions involving the head. Some,
however, have more far-reaching destinations.
The impulses for the senses of smell, taste, sight, hearing,
and equilibrium are all carried by cranial nerves to their
respective sensory areas in the brain. Some cranial nerves
carry motor impulses to muscles of the face and eyes or
to the salivary glands. The vagus nerves (vagus means
“wanderer”) branch extensively to the larynx, heart,
stomach and intestines, and bronchial tubes. The
functions of the cranial nerves are summarized:
 Function Functional Test
Classification

I Olfactory Sense of smell Sensory Subject is asked to

sniff and identify
aromatic substances,
such as oil of cloves
or vanilla

II Optic Sense of sight Sensory Vision and visual field

are tested with an
eye chart and by
testing the point at
which the subject first
sees an object
(finger) moving into
the visual field; eye
interior is viewed with
an opthalmoscope
III Oculomotor Movement of Mixed Pupils are
the eyeball; examined for size,
constriction shape, and size
of pupil in equality; papillary
bright light or reflex is tested
for near with a penlight
vision (pupils should
constrict when
illuminated); eye
convergence is
tested, as is the
ability to follow
moving objects

IV Trochlear Movement of Motor Tested in common

eyeball with cranial nerve
III for the ability to
follow moving
objects
V Trigeminal Sensation in face, Mixed Sensation of pain, touch and
scalp, and teeth; temperature are tested with a
contraction of safety pin and hot and cold
chewing muscles objects; corneal reflex tested with a
wisp of cotton; motor branch
tested by asking the subject to
open mouth against resistance and
move jaw from side to side

VI Abducens Movement of the Motor Tested in common with cranial nerve

eyeball III for the ability to move each eye
laterally

VII Facial Sense of taste; Mixed Anterior two- thirds of tongue is tested
contraction of for ability to taste sweet, salty, sour,
facial muscles; and bitter substances; subject is
secretion of saliva asked to close eyes, smile, whistle,
etc., tearing is tested with ammonia
fumes
VIII Vestibulocochlear Sense of Sensory Hearing is checked by air and bone
hearing; sense conduction, using a tuning fork
of equilibrium

IX Glossopharyngeal Mixed Gag and swallowing reflexes are checked;

posterior tongue may be tested for taste

X Vagus Sensory in Mixed Tested in common with cranial nerve IX

cardiac, because they both serve muscles of the
respiratory, and throat
blood pressure
reflexes; sensory
and motor to
larynx (speaking);
decreases heart
rate; contraction
of alimentary tube
(peristalsis);
increases
digestive
secretions
XII Assessory Contraction of Motor Sternocleidomastoid and trapezius
neck and muscles are checked for strength by
shoulder asking the subject to rotate head and
muscles; motor to shrug shoulders against resistance
larynx (speaking)
XII Hypoglossal Movement of the Motor Subject is asked to stick out tongue, and
tongue any position abnormalities are noted
THE AUTONOMIC NERVOUS SYSTEM
 
The autonomic nervous system (ANS) is actually part of the
peripheral nervous system in that it consists of motor portions
of some cranial and spinal nerves.
Because its functioning is so specialized, however, the
autonomic nervous system is usually discussed as a separate
entity, as we will do here. Making up the autonomic nervous
system are visceral motor neurons to smooth muscle, cardiac
muscle, and glands. These are the visceral effectors; muscle
will either contract or relax, and glands will either increase or
decrease their secretions. The ANS has two divisions:
sympathetic and parasympathetic. Often, they function in
opposition to each other, as you will see. The activity of both
divisions is integrated by the hypothalamus, which ensures
that the visceral effectors will respond appropriately to the
situation.
AUTONOMIC PATHWAYS
An autonomic nerve pathway from the central
nervous system to a visceral effector consists of two
motor neurons that synapse in a ganglion outside the
CNS. The first neuron is called the preganglionic
neuron, from the CNS to the ganglion. The second
neuron is called the postganglionic neuron, from
the ganglion to the visceral effector. The ganglia are
actually the cell bodies of the postganglionic
neurons.
SYMPATHETIC DIVISION
Another name for the sympathetic division is thoracolumbar division.
The sympathetic division is dominant in stressful situations, which
include anger, fear, or anxiety, as well as exercise. For our
prehistoric ancestors, stressful situations often involved the need for
intense physical activity—the “fight or flight response.” Our
nervous systems haven’t changed very much in 50,000 years. The
heart rate increases, vasodilation in skeletal muscles supplies them
with more oxygen, the bronchioles dilate to take in more air, and the
liver changes glycogen to glucose to supply energy. At the same
time, digestive secretions decrease and peristalsis slows; these are
not important in a stress situation. Vasoconstriction in the skin and
viscera shunts blood to more vital organs such as the heart, muscles,
and brain. All of these responses enabled our ancestors to stay and
fight or to get away from potential danger. Even though we may not
always be in life-threatening situations during stress (such as
figuring out our income taxes), our bodies are prepared for just that.
 
PARASYMPATHETIC DIVISION
The other name for the parasympathetic division is the
craniosacral division. The cell bodies of parasympathetic
preganglionic neurons are in the brain stem and the sacral
segments of the spinal cord. Their axons are in cranial
nerve pairs 3, 7, 9, and 10 and in some sacral nerves and
extend to the parasympathetic ganglia. These ganglia are
very close to or actually in the visceral effector and
contain the postganglionic cell bodies, with very short
axons to the cells of the effector.
The parasympathetic division dominates in relaxed (non-
stress) situations to promote normal functioning of several
organ systems. Digestion will be efficient, with increased
secretions and peristalsis; defecation and urination may
occur; and the heart will beat at a normal resting rate.
 
NEUROTRANSMITTERS
Recall that neurotransmitters enable nerve impulses to
cross synapses. In autonomic pathways there are two
synapses: one between preganglionic and postganglionic
neurons, and the second between postganglionic neurons
and visceral effectors. Acetylcholine is the transmitter
released by all preganglionic neurons, both sympathetic
and parasympathetic; it is inactivated by cholinesterase
in postganglionic neurons. Parasympathetic
postganglionic neurons all release acetylcholine at the
synapses with their visceral effectors. Most sympathetic
postganglionic neurons release the transmitter
norepinephrine at the synapses with the effector cells.
Norepinephrine is inactivated by either catechol-Omethyl
transferase (COMT) or monoamine oxidase (MAO), or it
may be removed from the synapse by reuptake.
Acetylcholine
Acetylcholine has many functions:  It is responsible for much of the
stimulation of muscles, including the muscles of the gastro-intestinal
system.  It is also found in sensory neurons and in the autonomic
nervous system, and has a part in scheduling REM (dream) sleep.
Norepinephrine
Norepinephrine is strongly associated with bringing our nervous
systems into "high alert."  It is prevalent in the sympathetic nervous
system, and it increases our heart rate and our blood pressure.  Our
adrenal glands release it into the blood stream, along with its close
relative epinephrine (aka adrenalin).  It is also important for forming
memories.
Dopamine
It is an inhibitory neurotransmitter that is naturally produced in the
body. It is present in the regions of the brain that regulate movement,
emotion, motivation and the feeling of pleasure. Dopamine stabilizes
the brain activity, regulated flow of information to other parts of the
brain and controls movement.
GABA
It is also usually an inhibitory neurotransmitter.  GABA acts like a
brake to the excitatory neurotransmitters that lead to anxiety.  People
with too little GABA tend to suffer from anxiety disorders, and drugs
like Valium work by enhancing the effects of GABA.  Lots of other
drugs influence GABA receptors, including alcohol and barbituates. 
If GABA is lacking in certain parts of the brain, epilepsy results.
Glutamate
Glutamate is an excitatory relative of GABA.  It is the most common
neurotransmitter in the central nervous system -as much as half of all
neurons in the brain and is especially important in regards to
memory.  Curiously, glutamate is actually toxic to neurons, and an
excess will kill them.  Sometimes brain damage or a stroke will lead
to an excess and end with many more brain cells dying than from the
original trauma.  ALS, more commonly known as Lou Gehrig's
disease, results from excessive glutamate production.  Many believe
it may also be responsible for quite a variety of diseases of the
nervous system, and are looking for ways to minimize its effects
Serotonin
Serotonin is an inhibitory neurotransmitter that has been found to be
intimately involved in emotion and mood.  Too little serotonin has
been shown to lead to depression, problems with anger control,
obsessive-compulsive disorder, and suicide.  Too little also leads to an
increased appetite for carbohydrates (starchy foods) and trouble
sleeping, which are also associated with depression and other
emotional disorders.  It has also been tied to migraines, irritable
bowel syndrome, and fibromyalgia. 
Endorphin
Endorphin is short for "endogenous morphine."  It is structurally very
similar to the opioids (opium, morphine, heroin, etc.) and has similar
functions:  Inhibitory, it is involved in pain reduction and pleasure,
and the opioid drugs work by attaching to endorphin's receptor sites. 
It is also the neurotransmitter that allows bears and other animals to
hibernate.  Consider:  Heroin slows heart-rate, respiration, and
metabolism in general - exactly what you would need to hibernate. 
Of course, sometimes heroin slows it all down to nothing:  Permanent
hibernation.
 Neurotransmitter Location Function

ACETYLCHOLINE Junction with motor Excitatory or inhibitory;

effectors (muscle, involved in memory
glands); many parts of
brain
AMINES
Serotonin Several regions of the Mostly inhibitory;
CNS involved in moods and
emotions, sleep

Histamine Brain Mostly excitatory;

involved in moods and
emotions and regulation
of body temperature and
water balance

Dopamine Brain; autonomic system Mostly inhibitory;

involved in emotions/
moods and in regulating
motor control
Epinephrine Several areas of the Excitatory or inhibitory;
CNS and in the acts as a hormone
sympathetic division of when secreted by
ANS sympathetic neurons of
the adrenal gland

Norepinephrine Several areas of the CNS Excitatory or inhibitory;

and in the sympathetic regulates sympathetic
division of ANS effectors; in brain,
involved in emotional
response

AMINO ACID
Glutamate (glutamic CNS Excitatory; most common
acid) excitatory
neurotransmitter in CNS
Gamma- aminobutyric Brain Inhibitory; most common
acid inhibitory
neurotransmitter in CNS
Glycine Spinal Cord Inhibitory; most common
inhibitory
neurotransmitter in CNS
NEUROPEPTIDES

Vasoactive intestinal Brain; some ANS and Function in nervous

peptide sensory fibers; retina; system uncertain
gastrointestinal tract

Cholecystokinin Brain; retina Function in nervous

system uncertain

Substance P Brain, spinal cord, Mostly excitatory;

sensory pain pathways; transmits pain
gastrointestinal tract information

Enkephalins Several regions of CNS; Mostly inhibitory; act like

retina; intestinal tract opiates to block pain

Endorphins Several regions of CNS; Mostly inhibitory; act like

retina; intestinal tract opiates to block pain
RISK FACTORS AND
PATHOPHYSIOLOGY
NURSING CARE
PLANS
 HE A
EDU LT H
CAT
ION
PL A
N
OBJECTIVES:
After 30 minutes of nursing intervention, the patient will be
able to:
 Identify healthy lifestyle changes and behaviors.

 State optimal health guidelines by following and

maintaining the appropriate diet.

 Express feelings on how to live his life after the treatment of

the disease
 Verbalize how to avoid further complications that may arise.

Materials Needed:
 Cartolina

 Pictures

 Marker
General
Health Specific Teachings
Teachings
 Encourage patient that a registered dietitian should evaluate his/her food intake.
DIET  Encourage patient to maintain weight through a proper balance of exercise and food.
 Instruct patient to include high-fiber foods such as vegetables, cooked dried peas and
beans (legumes), whole-grain foods, bran, cereals, pasta, rice, and fresh fruit in his diet.
 Encourage patient to choose foods low in saturated fat and cholesterol, try to limit
sugars and moderate the use of salt.
 Encourage patient to drink eight 8 oz. glasses of water per day.
 Since swallowing difficulties are common in parkinson’s disease, the following health
teachings should be followed to enhance swallowing:
a. Patient should sit in an upright position during mealtime.
b. Eat smaller, more frequent meals throughout the day.
c. A semi-fluid diet with thick liquids is easier to swallow than solids: thin liquids
should be avoided.
d. Take a drink after each bite of food to moisten your mouth and to help you swallow.
e. Teach the client to place the food on the tongue up and then back, and swallow.
f. Encourage the patient to hew first on one side of the mouth and then on the other.
g. To control the buildup of saliva, remind the patient to hold the head upright and
make a conscious effort to swallow.
h. Massaging the facial and neck muscles before meals may be beneficial.
EXERCISE TEN BASIC EXERCISES FOR THE PARKINSON PATIENT
1. Bring the toes up with every step you take. In Parkinson's
disease, "you never make a move", without lifting the toes.
2. Spread the legs (10 inches) when walking or turning, to provide
a wide base, a better stance, and to prevent falling. It may not look
"beautiful," but neither does falling.
3. For greater safety in turning, use small steps, with feet widely
separated. Never cross one leg over the other when turning.
Practice walking a few yards and turn. Walk in the opposite
direction and turn. Do so fifteen minutes a day.
4. Practice walking into tight corners of a room, to overcome fear
of close places.
5. To insure good body balance, practice rapid excursions of the
body. Backward, forward and to the right and left, five minutes,
several times a day. Don't look for a wall when you think you are
falling. It may not be there. Your body will always be there to
protect you, if you will practice balance daily.
6. When the legs feel frozen or "glued" to the floor, a lift of the
toes eliminates muscle spasm and the fear of falling. You are free
to walk again.
7. Swing the arms freely when walking. It helps to take body
weight off the legs, lessens fatigue, and loosens the arms and
shoulders.
8. If getting out of a chair is difficult, rise with "lightning
speed," to overcome the "pull of gravity." Sitting down should
be done slow, with body bent sharply forward, until one touches
the seat. Practice this at least a dozen times a day.
9. If the body lists to one side, carry a shopping bag loaded with
books or other weights in the opposite hand to decrease the
bend.
10. Any task that is difficult, such as buttoning a shirt. or getting
out of bed, if practiced 20 times it day, becomes easier the 21st
time.
FOR TIGHT MUSCLES AND POOR POSTURE STANDING
1. Stand in front of a wall, facing it about 8" away. Raise arms
and reach as high as possible toward the top of the wall. Lean
toward the wall and stretch.
2. With your back to the wall, alternate raising legs as high as
possible by bending the knee as if marching in place.
3. Holding on to something secure, squat down as far as possible,
bending knees; then come up.
SITTING
1. Sitting in straight-back chair, place your arms behind the chair
and bring your shoulders back as far as possible; raise your head
up and look at the ceiling.
2. Sitting In the same chair, grip the ends of a broom or mop stick
with both hands, try to raise it over your head until you get it
behind your head. Keep head and shoulders as erect as possible.
3. Sitting in same chair, place one leg at a time on another chair
and press the knee straight. Keep it there 15 minutes. Try both
legs together.
4. Sitting in a chair, raise legs up from the knee alternately, as if
stamping your feet.
LYING ON A FIRM BED OR FLOOR
1. Lie on the floor or bed, flat on your back; try to press your body
to the floor as flat as possible. Move your head from right to left as
far as possible. Make sure your head, shoulders, back, and knees
touch the surface.
2. Lie on the floor or bed on your abdomen. Do the following one by
one:
Put your hands behind back and look up to ceiling, trying to raise
your chest off the floor.
Kick your legs alternately, as if swimming.
Turn your head from right to left.
FOR BETTER BALANCE
1. Stand with hands on hips, feet spread apart:
Practice marching in place
Practice raising leg straight out to the rear.
Practice raising leg out to the side.
Practice drawing a circle with the leg.
2. Standing with hands at side, feet spread apart:
Lean forward and back
Lean to both sides
Lean in a circular motion and reverse the motion
FOR WALKING
1. When walking, REMEMBER:
Take as large a step as possible
Raise your toes as you step forward, hitting ground with your heels
Keep legs apart and posture straight
Swing arms and look straight ahead - your feet know where the floor is
located.
2. Collect a dozen magazines; lay them out in a straight line. Space them so
that you can take as long a step as possible. Practice walking over these
magazines without stepping on them.
3. For a better swing to arms, walk holding a rolled magazine in each hand;
keep elbows straight.
4. Practice walking sideways, backwards, and take big steps.
FOR TURNING
1. When practicing turning:
Keep feet spread-apart and head high
Use small steps; rock front side to side
Raise legs from the knees
2. If you feel glued to the floor:
Raise your head, relax back on your heels and raise your toes
Rock from side to side, bend knees slightly and straighten up and lift your
toes
It sometimes helps if the arms are raised in a sudden short motion
FOR GETTING IN AND OUT OF A CHAIR
1. If you become glued a few steps before you reach the chair, try
this: Don't aim for the chair but some object past it. Pass the chair as
closely as possible and as you go by it sit down.
2. To sit down, bend forward as far as possible and sit down slowly.
Get close to the chair. Do not fall into the chair.
3. To get up, move to the edge of the chair, bend forward and push
up vigorously using your arms; try to count 1 2 3 GO! If you have a
favorite armchair, raise the back legs with 4" blocks. This will help
you to get up easily. Don't let people drag you up by your arms, but
help you by pulling you under your arms, or with a slight push on
your back.
FOR GETTING OUT OF BED
1. Place blocks under the legs of the head of the bed. This will elevate
the head of the bed, & make it easier for you to sit up and swing the
legs off the bed.
2. A knotted rope tied to the foot of the bed can help you to pull
yourself up.
3. To get to a sitting position, shift the body down and rock yourself
by vigorously, throwing your arms and legs toward the side of the
bed.
FOR USING YOUR ARMS AND HANDS
1. Practice buttoning and unbuttoning your clothes; practice cutting
food and writing. Squeeze a ball or work with "Silly Putty." Keep
your fingers busy many times a day. Tear paper; take coins out of the
pocket; play the piano.
2. Always try to dress yourself completely. Use shoehorns, elastic laces,
or extra-long shoelaces to get a better grip. Dress in the most relaxed
and comfortable position, sitting or standing, but make sure you are in
a safe position.
3. To keep elbows straight and shoulders loose, install a pulley in door
way, place a chair under it or slightly in front. Stretch your arms and
shoulders in all directions. By working the pulley when seated, you
can get a more vigorous pull.
FOR GREATER SAFETY IN BATHTUB AND TOILET
If it is difficult to sit down in a bathtub, try the following:
1. Place a bench, stool or chair inside the tub; have the legs sawed off
to tub height. Sit on the chair and soap yourself. Use shower to rinse,
or rubber shower extension.
2. Bathtub grab bars are available. Purchase only those that attach
securely.
3. Raised toilet seats are commercially available.
4. Toilet armrest for getting on and off the toilet are available.
FOR SPEECH, FACE AND CHEWING DIFFICULTIES
1. Practice singing and reading aloud with forceful lip movements. Talk
into a tape recorder, if one is available.
2. Practice making faces in front of a mirror. Recite the alphabet and count
numbers with exaggerated facial motions. Massage your face with vigor
when washing and bathing.
3. When chewing food, chew hard and move the food around; avoid
swallowing large lumps.
IMPROVING Encourage patient to make a conscious effort to speak
COMMUNICATIO slowly, with deliberate attention to what they are saying.
N Remind patient to face the listener, exaggerate the
pronunciation of words, speak in short sentence, and take
a few deep breaths before speaking.
Instruct the patient to organize his or her thoughts before
speaking and is encourage to use facial expression and
gestures, if possible, to assist in communication.
A speech therapist may be helpful in designing speech
improvement exercises and assisting the family and health
care personnel to develop and use a method of
communication that meet the patient’s needs.
A small electronic amplifier is helpful if the patient has
difficulty being heard
Unnecessary environmental noise should be eliminated to
maximize the listener’s ability to hear and understand the
client.
DENTAL Encourage patient to use proper toothpaste to
CARE cater for the sensitivity of the inner lining of the
mouth using a mouth rinse or flossing may not
be easy for Parkinson’s patients in the end stages
and may need to be skipped altogether.
Encourage patient to do regular brushing,
frequent visits to a dentist and even simple
measures like wiping the inside of the mouth and
tongue with glycerin in order to maintain
healthy teeth and gums.
WOUND CARE Patient who is bedridden should be turned regularly and
allowed to move around with the aid of a wheelchair.
The bed sore should be treated with an antimicrobial topical
solution to prevent a bacterial or fungal infection.

HYGIENE Bathing
Bathtubs and shower stalls should have at least two handrails to
hold on to as you get in and out. It is the best to get advice from a
physical or occupational therapist before installing handrails for
proper and safe placement. Handrails should be professionally
installed when possible. Never use the towel bar, soap dish, or
faucet as a handrail.
Replace the door on tub/ shower combinations with two shower
curtains to make transferring easier. One curtain can be placed
inside the tub, and other outside the tub. Cut slots on the side
curtain to accommodate the tub transfer bench. This helps to
prevent slipping by keeping your floor dryer.
If you sit on a tub transfer bench or shower chair
while showering, use a hand held shower head. This
will allow you to sit first and then hold the shower
head to direct the water away from you so you can
adjust the temperature safely.
All bathtubs and shower stalls should have a non-skid
rubber bath mat.. All bath rugs should have a rubber
backing. Try kitchen rugs instead of bath rugs. They
tend to be thinner.
Don’t use bar soap. It is slippery and hard to fold. If
you drop the bar, it leaves a slippery film on the floor.
Try pump soaps or soap-on—rope. If you do use a bar
soap, try this tip to make safer to use; Cut one leg off
of a pair of nylons, drop the soap into the leg and tie
the other hand to the handrail.
Grooming
Use an electric razor
Use an electric toothbrush (if applicable)
Use a hand-free hairdryer that can be mounted on a
vanity
If shoulder tire, prop your elbows on the vanity or
sink when you shave, comb your hair, or use a
hairdryer.
Toileting
Try a regular schedule for going to the bathroom. For
example try going to the bathroom every two hours
Avoid caffeinated drinks such as coffee, tea and cola
which may worsen urinary problems.
If getting up at night to use the bathroom is a
problem limit evening fluids 2 hours before bedtime.
Frequency or urgency with burning pain are
symptoms of a urinary tract infection. If you
experience these symptoms, call your health care
provider.
STRESS Provide psychosocial support to the pt. & his
MANAGEMEN family. Calmness & competency are extremely
T reassuring.
 
Provide an opportunity for the client & family to
explore their concerns & to identify alternative
methods of coping as necessary.
 
Promote a positive attitude & active participation
of the client & the family.
 
Promote stress management technique such as
bonding with family, watching movies, listening
music.
ACTIVITY Rest and Sleep
AND REST Discuss trouble in getting in and out of the bed, or
turning over in bed, with your health care
provider. You may need to have your medication
adjusted.
A satin sheet or piece of satin material tucked
across the middle of the bed can make it easier to
turn over
Flannel sheets and heavy blankets can make it
more difficult to turn over
Make sure the pathway from the bed to the
bathroom is well-lit. A nightlight or a closet door
left open with the light on works well
Tips for getting into bed
Slowly lower yourself to a seated position on bed,
using your arms to control descent.
Lean your forearm while you allow your trunk to
lean down to side.
As your trunk goes down, the legs will want to go up,
like a see-saw
Tips for getting out of bed
Bend knees up, flat on the bed
Roll onto your side toward the edge of the bed by
letting the knees fall to that side. Reaching across
with the top arm. Turn your head and look in the
direction you are rolling.
Lower feet from the bed as you push with your arms
into a sitting position
 Types of rolling or turning over the bed
Bend your knees up with fleet flat
Allow knees to fall to one side as you begin to roll
Turn your head in the direction you are rolling and
reach top arm across the body

PSYCHOSOCI Patient should not be forced into situation in which

AL SUPORT they feel ashamed in their appearance.
They should be encouraged to undertake activities that
do not require small muscle dexterity, such as light,
aerobic exercise
Assist the client with grooming and hygiene to
maintain positive image.
SPIRITUA Encourage client to perform meditation.
L CARE  
Encourage client to pray always, read bible,
inspiring messages and any devotional
books because God is the only savior, friend,
and the owner of everything.
DISCHA
R GE P L A
N
 MEDICATIONS
MEDICATIONS ROUTE AND DOSAGE NURSING CONSIDERATION

Levodopa 0.5 to 1g PO daily, Should be taken with food to minimize GI

increase by no more than upset, but tell him high-protein meals can
impair absorption and reduce
0.75g daily q 3 to 7 days
effectiveness
Advice patient and caregivers that multi-
vitamin preparations, fortified cereals, and
certain OTC drugs may contain pyridoxine
(vitamin B6), which can block the effects
of levodopa by enhancing its peripheral
metabolism
Tell patient to protect drug from heat, light,
and moisture. If preparation darkens, it
has lost potency; tell him to discard it.
Warn patient about possible dizziness
upon standing quickly
Sinemet 25-100 mg 4x daily Do not stop taking Sinemet suddenly, as a
serious group of side effects, known as
neuroleptic malignant syndrome (NMS),
may occur
The medication may cause you to fall
asleep during the day, sometimes without
warning. This can be especially dangerous
if you are driving a car or operating heavy
machinery.
Sinemet can cause dark (red, brown, or
black) saliva, sweat, or urine. Although this
is not dangerous, it can be quite
bothersome.
Cogentin(ben Parkinsonism
ztropine Adults :PO 1 to 2 mg/day; range,
mesylate)
0.5 to 6 mg. Individualize
dosage.
Idiopathic Parkinsonism
Adults :PO Initially 0.5 to 1 mg
at bedtime; 4 to 6 mg/day may
be required.
Postencephalitic Parkinsonism
Adults :PO 2 mg/day in 1 or
more doses; some patients may
require initial dose of 0.5 mg.
Drug-Induced Extrapyramidal
Disorders
Adults :1 to 4 mg every day or
twice daily.
Acute Dystonic Reactions
Adults :PO / IM / IV Initial dose
is IM / IV 1 to 2 mg; then PO 1 to
2 mg twice daily.
Explain that full effectiveness of drug may
not occur for 2 to 3 days after initiation of
drug therapy. Explain that doses will be
tapered gradually before stopping.
Advise patient that increasing fluid intake
will help decrease dry mouth and
constipation.
Instruct patient to take sips of water
frequently, suck on ice chips or sugarless
hard candy, or chew sugarless gum if dry
mouth occurs.
Warn patient to pay particular attention to
dental hygiene because of problems
associated with decreased salivation.
Tell patient that vision may be blurry during
the first 2 to 3 wk of treatment.
Advise patient to avoid intake of alcoholic
beverages or other CNS depressants.
Eldepryl Adults—At first, Do not take selegiline if you have used meperidine
(selegiline) 1.25 milligrams (e.g., Demerol®) or an MAO inhibitor (MAOI) (e.g.,
(mg) once a day isocarboxazid, phenelzine, tranylcypromine,
for at least 6 Marplan®, Nardil®, or Parnate®) within the past 14
weeks. After 6 days. If you do, you may develop agitation,
weeks, your confusion, restlessness, stomach or intestinal
doctor may symptoms, sudden high body temperature,
increase your extremely high blood pressure, or severe
dose to 2.5 mg convulsions.
once a day.
Dizziness, lightheadedness, or fainting may occur,
Children—Use especially when you get up from a lying or sitting
and dose must position. Getting up slowly may help. If the
be determined by problem continues or gets worse, check with your
your doctor. doctor.
Do not stop taking this medicine without first
checking with your doctor. Your doctor may want
you to reduce gradually the amount you are taking
before stopping completely.
Comtan(en Adults—200 mg with Do not stop taking entacapone
tacapone) each without first checking with your
doctor. Your doctor may want you to
levodopa/carbidopa
gradually reduce the amount you are
(Sinemet) dose. taking before stopping completely.
Entacapone may be Nausea may occur, especially when
taken up to 8 times a you first start taking this medicine.
day, but the total daily Also, an increase in body movements
dose is usually not and twitching, twisting, or
more than 1600 mg.. uncontrolled movements of the
tongue, lips, face, arms or legs may
Children— Use and occur. Your doctor may need to
dose must be adjust your dose of
determined by your levodopa/carbidopa if these
doctor. movements occur.
Entacapone may cause your urine to
turn brownish orange. This effect is
harmless and will go away after you
stop taking the medicine.
Amitriptyline 50 to 100 mg The possibility of suicide in depressed
per day patients remains until significant
remission occurs. Potentially suicidal
patients should not have access to large
quantities of this drug. Prescriptions
should be written for the smallest amount
feasible.
Concurrent administration of Amitriptyline
hydrochloride and electroshock therapy
may increase the hazards associated with
such therapy. Such treatment should be
limited to patients for whom it is essential.
When possible, the drug should be
discontinued several days before elective
surgery.
Benadryl(diphenhydr 1tablet Once a day Should be taken after meals or with food or milk
amine hydrochloride) PO 25 to 50 mg to decrease GI effects; limit caffeine; increase
every 4 to 6 h (max, dietary intake of pyridoxine, vitamin C, vitamin D,
300 mg/day). IV/IM folate, calcium, and phosphorus.
10 to 50 mg IV at a Do not administer acetate or tebutate salt I.V.
rate not exceeding Monitor patient for dizziness and excessive
25 mg/min or 100 drowsiness. If noted hold therapy. Use caution
mg deep IM if when administering diphenhydramine by
required (max, 400 injection. Inadvertent intradermal or
mg/day). subcutaneous administration may cause tissue
necrosis.
Advise patient that medication may cause
drowsiness or dizziness and not to drive or
perform other activities requiring mental
alertness until tolerance is determined.
Caution patient that alcohol and other CNS
depressants (eg, sedatives) will have additional
sedative effects if taken with diphenhydramine.
If patient is to have allergy skin testing, advise
patient not to take the medication for at least 4
days before the skin testing.
Symmetrel 100 mg Gradually increase physical activity as the
(amantadine twice a symptoms of Parkinson’s disease improve.
hydrochloride Avoid excessive alcohol usage, since it may
day
increase the potential for CNS effects such as
dizziness, confusion, lightheadedness and
orthostatic hypotension.
Avoid getting up suddenly from a sitting or
lying position. If dizziness or lightheadedness
occurs, notify physician.
Seek medical attention immediately if it is
suspected that an overdose of medication
has been taken.
Patients should inform their physician if they
experience new or increased gambling urges,
increased sexual urges or other intense urges
while taking Symmetrel. Physicians should
consider dose reduction or stopping the
medication if a patient develops such urges
while taking Symmetrel.
Parlodel ½ of a 2½ mg Patients being treated with Parlodel
(bromocripti SnapTabs tablet and presenting with somnolence
ne mesylate) and/or sudden sleep episodes must
twice daily with
be advised not to drive or engage in
meals. activities where impaired alertness
may put themselves or others at risk
of serious injury or death (e.g.,
operating machines) until such
recurrent episodes and somnolence
have resolved.

Mirapex 0.375 mg given once Mirapex ER tablets can be taken with or

(pramipexole) per day
without food.  If patients develop
nausea, advise that taking Mirapex ER
tablets with food may reduce the
occurrence of nausea.
Mirapex ER tablets should be swallowed
whole. They should not be chewed,
crushed, or divided [see Dosage and
Administration (2.1)].
Dostinex 0.25 Patients should be instructed to
(cabergoline) mg notify their physician if they suspect
twice a they are pregnant, become
pregnant, or intend to become
week pregnant during therapy. A
pregnancy test should be done if
there is any suspicion of pregnancy
and continuation of treatment
should be discussed with their
physician.
Patients should notify their
physician if they develop shortness
of breath, persistent cough,
difficulty with breathing when lying
down, or swelling in their
extremities.
EXERCISE
Nontraditional exercise programs such as Yoga and tai chi, may help elevate
mood as well as improve mobility in the early stage of the disease.
 
To avoid rigidity and the development of contractures:
 Exercise and stretch regularly
 Exercise first thing in the morning, when energy levels are highest
 Exercise in bed if getting to the floor is difficult
 Get out on chair by bending over slowly so that the head is over the toes:
avoid soft, deep chairs

For bradykinesia:
 Rock back and forth to get going
 Imagining of stepping over an imaginary line when walking
 Throw small objects (e.g. small scraps of paper) in front to practice fine
motor movements
 Count while walking
 Visualize intended movement
For tremor:
 Hold change in pocket or squeeze a small rubber ball
 Use both hands to accomplish tasks
 Lie face down on the floor and relax the entire body

THERAPY

WATER THERAPY
 Instruct patient to drink plenty of fluids to prevent
constipation
 About 8-10 glasses of water a day
 Liquids will keep the patient from becoming
dehydrated and help soften the stool.
DRUG THERAPY
 Medications are prescribed to treat the symptoms of PD with the goal of
maximizing the client’s functional abilities
 
SPEECH THERAPY
 To strengthen muscles used for breathing, speech, and swallowing
 The client is instructed to speak slowly and clearly and to pause and take
deep breaths at appropriate intervals during each sentence

HEALTH TEACHING:
 Instruct SO or clients with PD to take medications promptly on schedule
to maintain continuous therapeutic drug levels

If trouble getting dressed:

 Dress and undress in front of a mirror
 Use adaptive devices such as long-handled shoehorns and button
fasteners
 Buy clothes with self-fasteners (e.g Velcro) and slide-locking buckles
To ensure safety:
 Wear good, sturdy shoes
 Use a cane or walker
 Concentrate on standing upright
 Consciously pick up your feet to take steps
 Remove all throw rugs, electrical cords, and clutter from the floor
 Make sure that clients have adequate lighting
 Arrange essential items so that they are within easy reach
 Use a bath chair and a hand-held shower nozzle
 Have grab bars installed in the bathroom
 Have a raised toilet seat installed

To ensure good communication:

 Pause between every few words
 Exaggerate the pronunciation of words
 Finish saying the final consonant of a word before starting to say the next word
 Express ideas in short, concise phrases
 Plan what to say
 Face the listener
To ensure adequate swallowing and prevent aspiration:
 Think through the steps of swallowing
 Keep your lips closed
 Keep your teeth together
 Put food on tongue
 Lift tongue up and back
 Swallow
 Eat slowly, taking small bites
 Chew hard and move food around with the tongue
 Finish one bite before taking another

To keep saliva from building up in mouth:

 Make a conscious effort to swallow saliva often
 Keep head in an upright position so saliva will collect in the
back of the throat and stimulate automatic swallowing
 Swallow excess saliva before attempting to speak
OPD VISITS/REFERRAL
 Instruct patient to return check up every week.
 Instruct patient to return to check up if there is any worsening of the condition
or if symptoms are unmanageable. .
 
DIET
”SOFT DIET, HIGH-FIBER, HIGH-CALORIE DIET”
SAMPLE MENU
Breakfast
 1 big slice papaya
 1 cup oatmeal w/ 2 tbsps milk
 1 cup soymilk

Lunch
 2 cups champorado with milk
 1 big mango

Supper
 1 serving watermelon triangle
 1 glass coconut juice
 2 slice wheat bread
SPIRITUAL CARE
 Encourage client to pray, and not to lose hope,
because god is always at our side to help us in our
problems.
 Encourage patient to verbalize feelings.
 Tell family to be always at patient’s side.
 Encourage client to read God’s word always.

 
 MED
MAN I CAL
AGE
MEN
T
 Generic Drug Indications Mechanism Route/Frequ Adverse Drug-to- Nursing
Name and Classifica of Action ency/Dosage Reactions/Si Drug, Food- Consideratio
Trade tion de Effects to-Drug ns/ Patient
Name
Interaction Teaching

Oral CNS:
Levodopa Anti- Idiopathic converted to Route aggressive DRUG-DRUG: Monitor V/S,
(Larodopa, parkinso parkinson’s, post- dopamine in behavior, Acetaminoph especially
Dopar) n’s encephalic the basal en/propoxyp while
parkinsonism, Dosage, head
Carbidopa(Si ganglia, hene adjusting
and symptomatic Tablet movements, Food-to-drug:
nemet) parkinsonism producing ADULT and tremor, Food high in dosage.
after carbon symptom CHILDREN: ataxia, protein: May Report
monoxide or relief - Age 12 fatigue, decrease changes.
manganese or older. severe Levodopa ALERT: Watch
intoxication or - O.5 to 1 depression, absorption. for muscle
with cerebral Discourage twitching and
arteriosclerosis. g P.O seizures,
use together. blepharospas
daily. suicidal
Using alcohol m, which
tendencies.
or tobacco maybe early
CV:
with certain
HPN, signs of drug
medicines overdose;
phlebitis,
may also report
orthostatic.
cause immediately.
EENT:
interactions .
Blurred vision
to occur.
 Generic Drug Indications Mechanism of Route/Frequenc Adverse Drug-to-Drug, Nursing
Name and Classification Action y/Dosage Reactions/Side Food-to-Drug Considerations
Trade Effects Interaction / Patient
Name
Teaching

Cogentin ANTICHOLINERGIC PARKINSONISM May block ADULT: CNS: DRUG-DRUG: Monitor V/S
(benztropine central O.5 to 6 mg Memory Cholinergics carefully.
mesylate) cholinergic P.O/I.M daily. impairement, (donepezil, Watch for
receptors, nervousness, galantamine, intermittent
tacrine) may
helping to depression, antagonize the constipation
balance disorientation, therapeutic and abdominal
cholinergic hallucinations, effects of this distention and
activity in the toxic psychosis. drugs. If used pain, which
basal ganglia. CV: together, may indicate
This may also Tachycardia monitor patient onset of
counteract the EENT: for therapeutic paralytic ileus.
effect.
action of the Dilated pupils, Monitor closely
neurotransmi blurred vision elderly patients
tter GI: as they are
acetylcholine. Drymouth, more prone to
constipation, severe adverse
N/V, paralytic effects.
ileus. Tell patient to
GU: relieve dry
Urine retention mouth with
and dysuria. cold drinks,
SKIN: sugarless gum
Decreased or hard candy.
sweating.
 Generic Name Drug Indications Mechanism of Route/Frequency Adverse Drug-to-Drug, Nursing
and Trade Classification Action /Dosage Reactions/Side Food-to-Drug Considerations/
Name Effects Interaction Patient Teaching

 Cogentin ANTICHOLINERGI PARKINSONISM May block ADULT: CNS: DRUG-DRUG: Monitor V/S
(benztropine C central O.5 to 6 mg Memory Cholinergics carefully.
cholinergic P.O/I.M daily. impairement, (donepezil, Watch for
mesylate) galantamine,
receptors, nervousness, intermittent
tacrine) may
helping to depression, antagonize the constipation and
balance disorientation, therapeutic abdominal
cholinergic hallucinations, effects of this distention and
activity in the toxic psychosis. drugs. If used pain, which may
basal ganglia. CV: together, indicate onset of
This may also Tachycardia monitor patient paralytic ileus.
counteract the EENT: for therapeutic Monitor closely
effect.
action of the Dilated pupils, elderly patients
neurotransmitter blurred vision as they are more
acetylcholine. GI: prone to severe
Drymouth, adverse effects.
constipation, Tell patient to
N/V, paralytic relieve dry
ileus. mouth with cold
GU: drinks, sugarless
Urine retention gum or hard
and dysuria. candy.
SKIN: Advise patient to
Decreased limit hot weather
sweating. activities because
drug-induced
lack of sweating
may cause
overheating.
Generic Name Drug Indications Mechanism of Route/Frequen Adverse Drug-to-Drug, Nursing
and Trade Classification Action cy/Dosage Reactions/Side Food-to-Drug Considerations
Name Effects Interaction / Patient
Teaching

Parlodel ANTIPARKINSO Parkinson’s dse. Inhibit ORAL CNS: DRUG-DRUG: Adverse

(bromocriptine N’s/ secretion of ADULT: Dizziness, Antihypertensiv reaction maybe
mesylate) DOPAMINE prolactin and 1.25 mg P.O, headache, e minimized if
Levodopa
AGONIST acts as a b.i.d with fatigue, mania, erythromycin drugs is given in
dopamine meals. stroke, seizure. the evening
receptor CV: with food.
agonist by Hypotension, Baseline and
activating post acute MI. periodic
synaptic EENT: evaluations of
dopamine Nasal cardiac,
receptors. congestion, hepatic, renal,
blurred vision. and
GI: hematopoietic
N/V, anorexia, function are
diarrhea, recommended
constipation during prolong
GU: therapy.
Urine retention, Instruct patient
urinary to take drug
frequency. with meals.
SKIN:
Coolness, pallor
of fingers and
toes.
Generic Name Drug Indications Mechanism of Route/Frequen Adverse Drug-to-Drug, Nursing
and Trade Classification Action cy/Dosage Reactions/Side Food-to-Drug Considerations/
Name Effects Interaction Patient Teaching

Eldepryl MONOAMINE Adjunctive May directly ORAL ROUTE CNS: DRUG-DRUG: ALERT:
(selegiline) OXIDASE treatment with increase ADULT: Dizziness, Tramadol Drug may increase
INHIBITORS levodopa and dopaminergic - 10 mg P.O depression, Venlafaxine the risk of suicidal
(MAO) carbidopa in activity by daily hallucination, thinking in
managing signs decreasing the divided as insomnia. children and
and symptoms reuptake of 5 mg at CV: HPN. adolescence. Drug
of parkinson’s dopamine into breakfast GI: is not approve for
dse. nerve cells. and 5 mg Diarrhea, use in children.
at lunch. drymouth, Monitor patient
abdominal pain. with major
depressive
disorder by
worsening of
symptoms and of
suicidal behavior,
especially during
the first few
weeks of
treatment and
during dosage
changes.
Advice patient not
to take drugs in
the evening
because doing so
may cause
insomnia.
 Generic Drug Indications Mechanism of Route/Frequenc Adverse Drug-to-Drug, Nursing
Name and Classification Action y/Dosage Reactions/Side Food-to-Drug Considerations/
Trade Effects Interaction Patient Teaching
Name

Eldepryl MONOAMINE Adjunctive May directly ORAL ROUTE CNS: DRUG-DRUG: ALERT:
(selegiline) OXIDASE treatment with increase ADULT: Dizziness, Tramadol Drug may increase
INHIBITORS levodopa and dopaminergic - 10 mg P.O depression, Venlafaxine the risk of suicidal
(MAO) carbidopa in activity by daily hallucination, thinking in
managing signs decreasing the divided as 5 insomnia. children and
and symptoms reuptake of mg at CV: HPN. adolescence. Drug
of parkinson’s dopamine into breakfast GI: is not approve for
dse. nerve cells. and 5 mg at Diarrhea, use in children.
lunch. drymouth, Monitor patient
abdominal pain. with major
depressive
disorder by
worsening of
symptoms and of
suicidal behavior,
especially during
the first few
weeks of
treatment and
during dosage
changes.
 Generic Drug Indications Mechanism of Route/Frequenc Adverse Drug-to-Drug, Nursing
Name and Classification Action y/Dosage Reactions/Side Food-to-Drug Considerations/
Trade Effects Interaction Patient Teaching
Name

Comtan CATECHOL-O- Adjunct to May reversibly ORAL CNS: DRUG-DRUG: Monitor patient
(entacapone) METHYLTRANS Levodopa an inhibit COMT ADULT: Sleep disorder, CNS for orthostatic
FERASE Carbidopa for when given 100mg , t.i.d dizziness, fever, depressants hypotension.
Give first dose of
INHIBITORS signs and with Levodopa tremor, speech warfarin the day with first
(COMT) symptoms of and disorder. daily dose of
idiopathic Carbidopa, CV: Levodopa and
parkinson’s dse increasing Chest pain, Carbidopa.
in patients who Levodopa palpitations, Advice patient to
have symptom bioavailability. hypotension. take drug exactly
fluctuation or This causes a EENT: as prescribed.
Advice patient to
haven’t more constant Pharyngitis, avoid hazardous
responded to dopaminergic sinus activities until CNS
other adjunctive stimulation in congestion. affects of drugs
treatment. the brain. GI: are known.
N/V, dry mouth, Inform patient
constipation, that hallucinations
may occur.
anorexia.
RESPIRATORY:
URTI,
bronchitis.
SKIN:
Increase
sweating, rash.
Generic Name Drug Indications Mechanism of Route/Frequen Adverse Drug-to-Drug, Nursing
and Trade Classification Action cy/Dosage Reactions/Side Food-to-Drug Considerations
Name Effects Interaction / Patient
Teaching

Comtan CATECHOL-O- Adjunct to May reversibly ORAL CNS: DRUG-DRUG: Monitor patient
(entacapone) METHYLTRANSF Levodopa an inhibit COMT ADULT: Sleep disorder, CNS for orthostatic
ERASE Carbidopa for when given 100mg , t.i.d dizziness, fever, depressants hypotension.
Give first dose
INHIBITORS signs and with Levodopa tremor, speech warfarin of the day with
(COMT) symptoms of and Carbidopa, disorder. first daily dose
idiopathic increasing CV: of Levodopa
parkinson’s dse Levodopa Chest pain, and Carbidopa.
in patients who bioavailability. palpitations, Advice patient
have symptom This causes a hypotension. to take drug
fluctuation or more constant EENT: exactly as
prescribed.
haven’t dopaminergic Pharyngitis, Advice patient
responded to stimulation in sinus to avoid
other the brain. congestion. hazardous
adjunctive GI: activities until
treatment. N/V, dry mouth, CNS affects of
constipation, drugs are
known.
anorexia. Inform patient
RESPIRATORY: that
URTI, hallucinations
bronchitis. may occur.
SKIN:
Increase
sweating, rash.
 Generic Drug Indications Mechanism of Route/Freq Adverse Drug-to-Drug, Nursing
Name Classification Action uency/Dosa Reactions/Si Food-to-Drug Considerations
and Trade ge de Effects Interaction / Patient
Name
Teaching

Tachycardia, DRUG-DRUG:
 Nortri ANTIDEPRESS Depression It inhibits the Oral slows May antanise May be taken
ptyline ANT activity of such ADULT: 75- conduction, hyptensive with or without
(Pamelor) TCA’s as diverse 100 mg daily food.
in 3-4 and effects of Warn patient to
agents as divided prolongation guanethidine avoid activities
histamine, 5- doses, of PR and similar that require
hydroxytrypta increased interval, compounds, alertness and
mine, and gradually up lowers clonidine and good
acetylcholine. to 150 mg seizure rauwolfia coordination.
Studies daily in threshold, alkaloids. May Recommend
suggest that severe use of sugarless
depression. peripheral cause additive candy to relieve
nortriptyline CHILD: neuropathy, CNS dry mouth.
hydrochloride adolescent: dry mouth, depression Warn patient of
interferes with 30-50 mg constipation, with CNS morning
the transport, daily in urinary depressants dizziness when
release and divided hesitancy, (e.g/ opoiods, waking up.
storage of doses. Tell patient to
ELDERLY: 30- confusion alchohol, avoid alcohol
catecholamine 35mg daily and blurred sedatives and while taking
s. in divided vision, hypnotics). drug.
doses. Nausea.
 SUR
MA GIC
NA A
GE M L
ENT
 Pallidotomy

 Thalamotomy
 Deep brain stimulation
 Neural transplantation
 SI S
N O
O G
PR