DIAGNOSIS PARKINSONS DISEASE a slowly progressing neurologic movement disorder that eventually leads to disability.

. The degenerative or idiopathic form is the most common; there is also a secondary form or suspected cause. It is the fourth most common neurodegenerative disease. It is associated with decreased levels of dopamine due to the destruction of pigmented cells in the substantia nigra in the basal ganglia of the brain. The nuclei of the substantia nigra project fibers or neuronal pathways to the corpus striatum, where neurotransmitters are key to control of complex body movements. Through the neurotransmitters acetylcholine and dopamine, striatal neurons relay messages to the higher motor centers that control and refine motor movements. The loss of dopamine stores in this area of the brain results in more excitatory neurotransmitters than inhibitory neurotransmitters, leading to an imbalance that affects voluntary movement. Etiology Although the cause of most cases is unknown, research suggests several causative factors, including genetics, atherosclerosis, and excessive accumulation of oxygen free radicals, viral infections, head trauma, chronic antipsychotic medication use and some

ASSESSMENT Tremors Slow unilateral resting tremor is present in 70% of patients at the time of diagnosis.

DIAGNOSTIC TEST . PET scanning Used to evaluate levadopa (precurso r of dopamin e) uptake & conversio n of to dopamin e in the corpus striatum. The disease is diagnose d clinically from pts hx & the presence of 2 or 3 cardinal manifesta tions : Tremor Muscle rigidity bradykine sia

MANAGEMENT PHARMACOLOGIC MANAGEMENT: Antiparkinsonian medications levodopa is the most effective agent and mainstay of treatments. Because levodopa is thought to precipitate oxidation, which further damages the substantia nigra and eventually speeds disease progression, physicians delay the prescribing the medication. Anticholinergic therapy- ex. Biperiden, benzotropine, procyclidine, are effective in controlling tremor and rigidity. Antiviral therapy amantadine hydrochloride is an antiviral agent used in Parkinsons treatment to reduce rigidity, tremor and bradykinesia. Dopamine Agonists - are useful in postponing the initiation of carbidopa or levodopa therapy. MAOI - inhibits the breakdown of dopamine and is thought to slowdown the progression of the disease. Catechol-0-methyltransferase (COMT) inhibitors - can increase the duration of action of levodopa when given in combination Antidepressants - to alleviate depression common in Parkinsons disease Antihistamines - have mild central anticholinergic and sedative effects and may reduce tremors SURGICAL MANAGEMENT: Stereotactic Procedures - thalamotomy and pallidotomy are effective in relieveing

ANTICIPATED NURSING INTERVENTION Encourage client to undergone a progressive program of daily exercise that can increase muscle strength, improve coordination and dexterity; reduce muscular rigidity and present contractures that occur when muscles are not used. Monitor clients weight on a weekly basis to assess if the clients caloric intake is adequate Make sure the client has an intake of moderate fiber to avoid constipation Implement semisolid foods to help ease the client in swallowing Encourage the assistive devices use of

Resting

characteristically disappears with purposeful movement but is evident when the extremities are motionless. The tremor may present as a rhythmic, slow turning motion of the forearm and the hand and a motion of the thumb against the fingers as if rolling a pill. Tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious.

tremor

Rigidity Resistance to passive limb movements characterizes muscle rigidity. Passive movement of an extremity may cause the limb to move in jerky increments referred to as cog wheeling. Stiffness of the neck, trunk and shoulders is common. Early in the disease , the patient may complain of shoulder pain.

Advise patient to speak in short sentences and take a few deep breaths before speaking Assist and encourage patient to set achievable goals like improving mobility Plan a program of activity throughout the day to prevent too much daytime sleeping as well as disinterest and apathy Provide information about

environmental exposures. Incidence Usually first appear in the fifth decade of life; however cases have been diagnosed at the age of 30 yrs. Parkinsons disease affects more men than women and nearly 1% of the population older than 60 yrs of age. Bradykinesia

One of the most common features of Parkinsons disease.

Patients take longer to complete most activities and have difficulty initiating movement. Hypokinesia is also common and may appear after the tremor. The freezing phenomenon is a transient inability to perform active movement and is thought to be an extreme form of bradykinesia. Micrographia and dysphonia develops as the symptoms progresses. The patient commonly develops postural and gait problems. There is a loss of postural reflexes and the patient stand with the head bent forward and moves with a propulsive gait.

many of the symptoms of Parkinsons disease. The intent of thalamotomy and pallidotomy is to interrupt the nerve pathways and thereby alleviate tremor or rigidity. In thalamotomy, a stereotactic electrical stimulator destroys part of the ventrolateral portion of the thalamus in an attempt to reduce tremors; the most common complications is hemiparesis and ataxia. Pallidotomy involves destroying part of the ventral aspect of the medial globus pallidus through electrical stimulation in patients with advanced disease. Neural transplantation surgical implantation of adrenal medullary tissue into the corpus striatum is performed in an effort to reestablish normal dopamine release. Deep brain transplant - recently approved by the FDA, pacemaker- like brain implants show promising results in relieving tremors. Electrode is placed in the thalamus and connected to a pulse generator implanted in a subcutaneous subclavicular or abdominal pouch. The battery powered pulse generator sends high frequency impulses through a wire placed under the skin to a lead anchored to the skull

the treatment Address health promotion needs such as screening for hypertension and stroke risk assessments in this predominantly elderly population