Nursing 22: Oncology – Exam 3 (Parkinson’s Disease)

Parkinson’s Disease
This is a progressive neurologic disorder that affects the brain center responsible for control and regulation of movement. It occurs in a person’s middle to late years and it effects men and women equally.

Signs and Symptoms of Parkinson’s (Cardinal Ones)
These signs and symptoms can sometimes occur on one side. They start slowly, you usually cannot pinpoint when they started. The 4 cardinal one’s are:
– Tremors
– Rigidity
– Akinesia
– Postural Instability
The patients intellectual function usually remains intact, however, they can appear with decreased tears, constipation and incontinence

Cardinal Symptom: Tremors
This symptom of Parkinson’s is manifested as:
– Pin rolling: Thumb against forefinger
This symptom will be triggered if the patient is anxious or in deep concentration. It will vary in intensity and can be reduced or abolished by voluntary movement.

Cardinal Symptoms: Rigidity
This symptom of Parkinson’s is manifested as:
– Stiffness in extremities
The patient becomes *Wax-Like* and sometimes drools because they have difficulty swallowing. Their head is forward, and they have a slow-shuffled gait.

Cardinal Symptoms: Akinesia
This symptom of Parkinson’s is manifested as:
– No movement
– on and off response
The patient will be active and moving (ON), then suddenly will be frozen in place for 1-2 minutes (OFF)
There is a rapid fluctuation of these symptoms.

Speech During Cardinal Symptoms
This is manifested as:
– Slow, monotone, low pitch

Cardinal Symptoms: Postural Instability
With this Parkinson’s symptom, there is a loss of postural reflex’s, causing an instability in the patients gait.

Diagnostics for Parkinson’s
These include:
– Change in handwriting
– A good patient history
– Neuro Exam
– Decreased dopamine in the urine

Early Clue to Parkinson’s Diagnosis
This is indicated by a change in handwriting.

Parkinson’s Medications
These inlcude:
– Levadopa (Precursor to Dopamine)
– Sinemet (carbidopa/levadopa)

Sinmet
This Parkinson’s medication is considered more common and better for motor issues.
Therapeutic control of symptoms: quicker, lower dose, fewer s/e
– This medication is given orally before meals to increase absorption.
– No vitamin B-6
– With this medication, you start with a low dose, and then increase. The therapeutic level of this is determined when symptoms disappear.

Vitamin B-6
This reveres the effects of L-dopa, do not give a Parkinson’s patient this.

Side Effects of Sinmet
These include:
– Swelling of the mouth and lips (Watch ABC’s)
– Thick secretions
– Red, Brown, Black urine, sweat, and saliva

Sinmet Wearing off Phenomenon
This is a loss of responsiveness to this medication. The patient will present with:
– Frequent episodes of freezing in place
Drug Holiday (In the Hospital)
– Decrease the patients medication, the symptoms reappear, then restart the medication.

Surgery for Parkinson’s
This treatment includes deep brain stimulation and fetal tissue transplant.

Activity for Parkison’s patients
With this, do ROM, and maintain ADL’s as best as possible. Teach the patient to take a deep breath in the middle of a sentence to improve speech.
For constipation, give colace.
For nutrition – make sure they have a proper gag reflex (If not-Aspiration Pneumonia)
For Saftey, use a raised toilet, no rugs, cane, walker, etc.

Nursing Diagnosis for Parkinson’s (#1)
Risk for injury/falls – SAFTEY

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