Parkinson’s Disease

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Parkinson’s Disease

Table of Contents

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Objectives

What is Parkinson Disease?

Diagnosis

Caring for the Client with PD

Quiz

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Parkinson’s Disease

Objectives

1. Describe Parkinson disease.

2. Identify signs and symptoms of Parkinson disease.

3. Communicating with the client with Parkinson.

4. Lists care guidelines for the client with Parkinson disease.

go to What is Parkinson's Disease

Parkinson's Disease

Parkinson disease (PD) was known for century as the shaking palsy before it was renamed in honor of the physician who described it.   Parkinson disease is a degenerative disease of the central nervous system, involving primarily certain nerve cells (neurons) in the deep recess of the brain stem called the substantia nigra.   These cells produce the neurochemical messenger dopamine, responsible for coordinating voluntary movement.   The absence or reduction of more than 80% of the dopamine affects the next circuit of nerves called the striatum, resulting in impairment of movements such as tremor, slowness of voluntary movement, shuffling gait, loss of balance, slurred speech and over time an increasing dependence on others.

Parkinson disease occurs in the same proportion of men as women, symptoms can manifest at any age. Symptoms of PD is uncommon in people under the age of 40, although some cases have been documented, in people under the age of 20, the majority of people affected by PD are over 50 years of age at the time of diagnosis.

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Parkinson's Disease

There are no specific tests that identify Parkinson disease at this time.   Diagnosis of the disease is based on comprehensive neurological exam and complete medical history to rule out other diseases.   The signs and symptoms that define PD are tremors, rigidity and bradykinesia (slow movement). The initial symptoms are difficult to diagnose and vary from client to client.   They generally appear as an uncertain feeling of weakness or fatigue of the voluntary muscles, thus affecting initiation and following through of active range of movement, such as getting in and out of a chair, a bath, or a car.   Symptoms appear unilateral (on one side of the body) and with time progress to the opposite side.

Parkinson is a chronic, progressive illness; the rate of progression varies from person to person, although many individuals share the same features of the disease process.   At this time, there is no cure for PD, however it is not a fatal disease. The medications given are for the management and control of symptoms.

go to Caring for the Client with PD

Alteration in the muscular-skeletal system can lead to shaking and trembling even at rest, changes in facial expression (the Parkinson mask), and difficulty initiating movement or walking may also be present.   Also seen in the early stages are drooling particularly at night and symptoms of depression.   In advanced cases altered mental status and dementia can be present.   Symptoms of the Parkinson disease can interfere with work or activity of daily living.   Increased stress or a stressful situation can exacerbate the symptoms.

Activity of daily living should be geared toward allowing the client to do, as much for himself as possible within the limits of his disabilities, this can be difficult due to the time constraints of the visit.

Exercise helps in promoting mobility and independence; an exercise program may or may not be in place.   The client will require assistance or verbal cueing during ambulating remind client to walk as erectly as possible, to look straight ahead and to use a broad based gait, balance may be off because of inability of the client to swing his arms as a result of rigidity. Client may experience a "freeze" where he is unable to initiate a movement.   This can happen after a long period of inactivity or during a transition in activity.   Should this occur during ambulation, the client needs to be instructed on how to proceed.   Ask the client to lift and step with his right or left foot. The goal is to get the client to think of performing a task in a different focus.

Nutritional status is another aspect of the disease process that must be monitored.   Clients with PD have difficulty maintaining their weight; the problem could be related to embarrassment of their untidiness or slowness while eating.   Also known as the "silent aspirators" they have problem swallowing and often foods or liquids pooled in the back of their throat without their realizing it.   Aspiration pneumonia is a major health risk for these clients.   To ensure patient’s safety, have patient sit upright, offer small bites of food, and small sips of liquids.   Encourage patient to swallow two times to make sure food has been completely swallowed.

Adequate well balanced nutritional meals are very important, helping the client to choose the right kinds of food will help in making eating easier, safer and more pleasurable.   Foods that do not require vigorous chewing and soft textured such as oatmeal, cream of wheat, soft casseroles or scrambled eggs, mashed potatoes, soft well-cooked vegetables rather than dry or crumbly foods are more preferable.   Offer the client small meals throughout the day instead of three large meals to avoid tiring. Nutritional supplements are sometimes added to the client’s diet to increase caloric intake.

Alteration in elimination like constipation is of major concern for the client with PD.   Changes in nutritional status and decreased activity as well as side effects of medications can cause constipation. Monitor bowel habits and report to the primary nurse no BM for three days and provide care in accordance with the care plan.

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