Question

CLINICAL SCENARIO: NEUROLOGICAL SYSTEM

Mr. A.G. is a 76-year -old widower being seen in your outpatient clinic for a medication refill for his Parkinson’s disease. He is a retired railroad engineer who derives great pleasures from collecting railroad memorabilia and taking walks with his dog around the vicinity of his neighborhood.

Mr. A.G. was diagnosed with moderate (Stage III) Parkinson’s Disease 2 years ago. He does not smoke tobacco nor drink alcohol. His PMH includes a femur fx at age 22, a cholecystectomy at age 47, and a transurethral resection of the prostate (TURP) at age 72.

Activity

1. Because of the interference of normal muscle tone and control of smooth muscle, patients with Parkinson’s disease exhibit a classic triad of syndromes. Name them.

2. Parkinson’s is primarily a disease affecting older adults with symptoms usually first noted in 60 to 70 -year-olds. List two reasons why we are seeing a growing number of people with Parkinson’s disease.

3. Symptoms vary and are highly individualized. List eight symptoms associated with Parkinson’s. Medical Management of the patient with Parkinson’s is usually directed toward control of symptoms with drug therapy, supportive therapy, physiotherapy and possible psychotherapy. Pharmacotherapy can be fairly complex in these patients because there are several types of antiparkinson drugs with different mechanism of actions.

4. Why can we not just give oral dopamine as replacement therapy? What medication do we give instead?

5. Levodopa is always given in combination with carbidopa. Why?

6. What are five nursing interventions to decrease the number or severity of side effects of antiparkinson medication?

7. What advice will you give Mr. A.G. about his diet?

8. Mr. A.G. asks you to explain ‘Parkinsonian Crisis.” Describe it in a way he can understand and describe what someone can do about it once it occurs.

9. List six things that you would assess to determine whether Mr. A.G.’s care can be managed in his home.

10. How might Mr. A.G. PMH affects his symptoms?

Answer 1

1-

• Tremor-A tremor, or shaking, usually begins in a limb, often your hand or fingers.
• Slowed movement (bradykinesia/akinesia)-Over time, Parkinson's disease may slow movement, making simple tasks difficult and time-consuming.
• Rigidity-Increased and persistent resistance to passive joint movement that is independent of speed of movement

2-

• Heredity- Having a close relative with Parkinson's disease increases the chances that you'll develop the disease. Familial history (various genes) → in approximately 10–15% of cases
• Environmental factors- (e.g., exposure to manganese and other substances

3-

• Tremor
• Depressive moods

• Small Handwriting

• Loss of Smell

• Trouble Sleeping

• Trouble Moving or Walking

• Masked Face

• Dizziness or Fainting

• Constipation

4-

• People with Parkinson's disease have low brain dopamine concentrations. However, dopamine can't be given directly, as it can't enter your brain.
• Levodopa is the drug of choice for the symptomatic therapy of Parkinson disease
• In the early phase of levodopa treatment, patients may experience a "honeymoon period" with relief of symptoms.

5- Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside your brain. This prevents or lessens side effects such as nausea.

6-

• Adjust drug dose

• take medication on time

• Change the timing

• Try another treatment- if there is severe side effects

• Levodopa is combined with carbidopa (Lodosyn).This prevents or lessens side effects such as nausea.

7-

• In order to maintaingood health most people living with Parkinson's disease should eat a variety of whole grains, vegetables, fruits, milk and dairy products, and protein-rich foods such as meat and beans
• Proteins for improving parkinsonism symtoms
• Antioxidants to reduce“oxidative stress' that aggravates Parkinson’s and similar conditions
• omega-3 fatty acids, which might improve cognitive function. Eg-salmon, halibut, oysters, soybeans, flax seed, and kidney beans
• For constipation caused by Parkinson's, try seasoning your food with turmeric or yellow mustard to encourage bowel movements.

8-Acute akinesia (Parkinson's crisis)

• A rare but life-threatening complication of Parkinson's disease, with a sudden worsening of motor symptoms and severe akinesia.
• Triggers include infections, surgery, gastrointestinal disease and changes in medication.
• Acute akinesia is difficult to treat and often needs hospital admission.

9-

• Physiotherapy
• Speech and language therapy
• Occupational therapy
• Support groups
• Stay physically active
• Create a safe environment

10- Parkinson's disease patients are at increased risk of falls and osteoporosis. There may be increase risk for rigidity, akinesia or slow movement with past medical history of femur fixation.