Parkinson’s
Disease
JESTHER B. BAUTISTA, RN, RTRP
LORMA College of Nursing
(Idiopathic)
Parkinson’s
• degenerative disease caused by the depletion
of dopamine, which interferes with the
inhibition of excitatory impulses, resulting in
a dysfunction of the extrapyramidal system
• a slow, progressive disease that results in a
crippling disability
Secondary Parkinson’s
• Atherosclerosis • toxicity from pesticides, herbicides,
• excessive accumulation of methyl-phenyl-tetrahydropyridine, or
oxygen free radicals welding fumes
• may be related to a virus • repeated head injuries
• genetic susceptibility • chronic use of antipsychotic medications
Effects
• Falls
• self-care deficits
• failure of body systems
• Depression
• Mental deterioration occurs late in the disease
Cardinal Signs
•Tremor
•Rigidity
•Bradykinesia
•Postural instability
Other
Manifestations
• Sluggishness of physical and mental
responses
• Monotonous speech
• Handwriting that becomes
progressively smaller (micrographia)
Manifestations
•Tremors increasing when fatigued and decreasing with purposeful
activity or sleep
•Rigidity with jerky movements
•Restlessness and pacing
•Blank facial expression; mask-like facies
Manifestations
•Drooling
•Difficulty swallowing and speaking
•Loss of coordination and balance
•Shuffling steps, stooped position, and propulsive gait
Diagnosis
• History and presentation (at
least 2 of 4 cardinal signs)
• Early diagnosis can be difficult
• Response to Levodopa
confirms diagnosis
Medical
Management
• Antiparkinsonian medications
• Levodopa (Larodopa) is the most effective
agent and the mainstay of treatment
• Stereotactic procedures
• Thalamotomy
• Pallidotomy
• Neural transplantation
• Deep brain stimulation (Pacemakerlike brain
implants)
Other medications
•Anticholinergics trihexyphenidyl, benztropine, and procyclidine) to reduce
transmission of cholinergic pathways; most effective in controlling tremor but are
known to cause confusion and hallucinations
•Amantadine, prevents dopamine reuptake
•Dopaminergic agonists (Bromocriptine, pramipexole, and ropinirole)
•Monoamine oxidase inhibitor (MAOIs) to boost the effect of Levodopa
01 02 03 04 05
Improving Mobility Optimizing Maximizing Preventing Strengthening Coping
and Reducing Risk of Nutritional Status Communication Constipation Ability
Falls Ability
Nursing Interventions
Multiple
Sclerosis
Definition
• chronic, frequently progressive neurologic
disease of the CNS of unknown etiology and
uncertain trajectory
• characterized by the occurrence of small patches
of demyelination of the white matter of the
optic nerve, brain, and spinal cord
• (+) exacerbations and remissions of symptoms
over the course of the illness
Risk
Factors
•autoimmune dysfunction
•genetic susceptibility
•infectious process
•Caucasians
Clinical Forms
• Relapsing remitting (RR) – [acute attacks + partial recovery]
• Secondary progressive (SP) – [increasing relapse rate, with a steady deterioration]
• Primary progressive (PP) – [steady progression without exacerbations and remissions]
• Progressive relapsing (PR) – [steadily progressive + acute exacerbations]
Clinical Manifestations
• Fatigue and weakness.
• Abnormal reflexes—absent or exaggerated.
• Vision disturbances—impaired and double vision, nystagmus.
• Motor dysfunction—weakness, tremor, incoordination.
• Sensory disturbances—paresthesias, impaired deep sensation,
impaired vibratory and position sense.
Clinical
Manifestations
• Impaired speech—slurring, scanning (dysarthria).
• Urinary dysfunction—hesitancy, frequency, urgency,
retention, incontinence; upper UTI
• Neurobehavioral syndromes—depression, cognitive
impairment, emotional lability.
• often unpredictable, varying from person to person
and from time to time in the same person
Diagnostic Evaluation
• often difficult, with much uncertainty concerning prognosis once the
diagnosis is made
• Serial brain MRI
• Magnetic resonance spectroscopy
• Electrophoresis study of CSF shows abnormal IgG antibody
• Clinical assessment (Visual, auditory, and somatosensory evoked potentials—
slowed conduction is evidence of demyelination)
Management
•no cure exists for MS, the goals of treatment are to
delay the progression of the disease, manage
chronic symptoms, and treat acute exacerbations
Management
• Pharmacotherapy
• Corticosteroids or adrenocorticotropic hormone are used to decrease inflammation and shorten
duration of relapse or exacerbation.
• Methyprednisolone IV
• Interferon beta-1a (Rebif) and interferon beta-1b (Betaseron) – both SQ
• Glatiramer acetate (Copaxone) - SQ
• Mitoxantrone (Novantrone) – IV infusion q 3 months, a chemotherapeutic agent
Chronic Symptom
Management
•Spasticity:
• Pharmacotherapy: Baclofen, Dantrolene,
Diazepam
• Physical therapy
• Nerve blocks and surgical intervention
Chronic Symptom Management
• Control of fatigue with Amantadine (Symmetrel), pemoline (Cylert), or fluoxetine
(Prozac)
• Treatment of depression with antidepressant drugs and counseling.
• Bladder management with anticholinergics, intermittent catheterization for drainage,
prophylactic antibiotics.
• Bowel management with stool softeners, bulk laxative, suppositories.
Chronic Symptom Management
•Multidisciplinary rehabilitation management
•physical therapy, occupational therapy, speech therapy, cognitive
therapy, vocational rehabilitation, and complementary and
alternative medicine
•Control of dystonia with carbamazepine.
Nursing Interventions
• Promoting Motor Function
• Minimizing Fatigue
• Preventing Injury
• Managing Dysphagia
• Maintaining Urinary Elimination
• Normalizing Family Processes
• Promoting Sexual Function
Promoting Motor Function
• muscle-stretching and muscle-strengthening exercises daily
• ice packs before stretching
• frequent rest periods
• encourage walking and activity
• teach how to use such devices as braces, canes, and walkers, when
necessary
• avoid sudden changes in position
• walk with a wide-based gait
• encourage frequent change in position while immobilize
Minimizing Fatigue
• Help the patient and family understand that fatigue is an integral part of MS.
• Plan ahead and prioritize activities. Take brief rest periods throughout the day.
• Avoid overheating, overexertion, and infection.
• energy-conservation techniques
• healthy lifestyle with balanced diet, rest, exercise, and relaxation
Preventing Injury
• Suggest use of an eye patch or frosted lens (alternate eyes) for patients with double vision.
• Encourage regular ophthalmologic consultation
• Safe environment
• Orient to environment; be consistent with arrangement of furniture and personal articles
• Floor is free from obstacles, loose rugs, or slippery areas
• Teach the use of all senses to maintain awareness of environment
Managing Dysphagia
• Initiate referrals to speech/language pathologist and dietician for evaluation and
treatment of swallowing problems.
• Ensure that the patient is alert and distractions are minimized at mealtimes: provide
supervision, as indicated.
• Use safe swallowing practices, including proper positioning, double swallow, and chin
tuck.
• Monitor the patient for signs and symptoms of choking or aspiration; use suctioning as
indicated.
• Educate and counsel patients and care partners about feeding options as disease
progresses.
Maintaining Urinary Elimination
• Ensure adequate fluid intake to help prevent infection and stone formation (q 2 hrs)
• Assess for urine retention and catheterize for residual urine, as indicated.
• Teach the patient to report signs of UTI immediately.
• Set up bladder-training program to reduce incontinence.
• Restrict fluid volume and salty foods 1 to 2 hours before bedtime.
Normalizing Family Processes
• Encourage verbalization of feelings of each family member.
• Encourage counseling and use of church or community resources.
• Suggest dividing up household duties and childcare responsibilities to prevent strain on one person.
• Explore adaptation of some roles so the patient can still function in family unit.
• Expand treatment efforts to include the whole family.
• Support mothers with MS who often face fatigue and episodic exacerbations during their childrearing
years.
Promoting Sexual Function
•Encourage open communication between partners.
•Discuss birth control options, if appropriate.
•Suggest sexual activity when the patient is most rested.
•Suggest consultation with sexual therapist to help obtain greater sexual
satisfaction.
