Parkinson’s Disease

• Is a progressive neurologic disease affecting the brain centers responsible for control and regulation of movement.
• A deficiency of dopamine due to degenerative changes in the substantia nigra produces tremor, bradykinesia, rigidity, and autonomic dysfunction.
• The cause is not known.
• Complications of Parkinson’s disease include dementia, aspiration, and injury from falls.
• The incidence of Parkinson’s disease increases with age; approximately 1% of the population older than age 60 has this disorder.

Assessment

1. Characteristic resting tremor of the extremities (may be worse on one side), and possibly affecting the head and neck.
2. Bradykinesia (slowness of movement).
3. Muscle rigidity in performing all movements, as well as rest.
4. Verbal fluency may be impaired.
5. Signs of autonomic dysfunction (sleeplessness, salivation, sweating, orthostatic hypotension).
6. Depression, dementia.
7. Masklike facies.
8. Poor balance, gait disturbances, speech problems.

Diagnostic Evaluation

1. Diagnosis is based on observation of clinical symptoms and consideration of patient’s age and history, confirmed by favorable response to levodopa therapy.
2. CT scanning and MRI may be performed to rule out other disorder.

Pharmacologic Interventions

1. Various drugs can be used, often in combination to prolong effectiveness because tolerance develops.
   • Anticholinergics to reduce activation of cholinergic pathways, which are thought to be overactive in dopamine deficiency.
   • Amantadine, which may improve dopamine release in the brain.
   • Levodopa, a dopamine precursor, combined with carbidopa, a decarboxylase inhibitor, to inhibit destruction of L-dopa in the bloodstream, making more available to the brain.
   • Bromocriptine, a dopaminergic agonist that activates dopamine receptors in the brain.
   • Monoamine oxidase inhibitors as adjunct to levodopa therapy.
   • Catecholamine-O-methyltransferase (COMT) inhibitors, as adjunct therapy in combination with levodopa therapy; COMT is an enzyme that eliminates dopamine from the brain.

Surgical Interventions

1. Medical pallidotomy to improve dyskinesia, rigidity, and tremor.
2. Chronic deep brain stimulation through electrodes implanted into the thalamus or globus pallidus to decrease tremor.
3. Brain tissue transplants through the use of stem cells and genetically engineered animal cells are a promising area of research.

Nursing Intervention

1. Monitor drug treatment to note adverse reactions and allow for dosage adjustments. Monitor for liver function changes and anemia during drug therapy.
2. Monitor the patient’s nutritional intake and check weight regularly.
3. Monitor the patient’s ability to perform activities of daily living.
4. To improve mobility, encourage the patient to participate in daily exercise, such as walking, riding stationary bike, swimming, or gardening.
5. Advise the patient to perform stretching and postural exercises as outlined by a physical therapist.
6. Teach the patient walking techniques to offset parkinsonian shuffling gait and tendency to lean forward.
7. Encourage the patient to take warm baths and massage muscles to help relax muscles.
8. Instruct the patient to rest often to avoid fatigue and frustration.
9. To improve the patient’s nutritional status, teach the patient to think through the sequence of swallowing.
10. Urge the patient to make a conscious effort to control accumulation of saliva (drooling) by holding head upright and swallowing periodically. Be alert for aspiration hazard.
11. Have the patient use secure, stabilized dishes and eating utensils.
12. Suggest the patient eat smaller meals and additional snacks.
13. To prevent constipation, encourage patient to consume foods containing moderate fiber content (whole grains, fruits, and vegetables), and to increase his or her water intake.
14. Obtained a raised toilet seat to help the patient sit and stand.
15. Teach the patient facial exercises and breathing methods to obtain appropriate pronunciation, volume, and intonation.
16. Teach the patient about the medication regimen and adverse reaction.

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