PARKINSON’S DISEASE

 Parkinson's Disease is a chronic, progressive, degenerative neurological disorder of the nerve cells in the basal ganglia (Substantia Nigra)that affects extrapyramidal system.

✏Note: It is characterized by difficulty in control and regulation of movement.

 CAUSES:

Note✏:The cause is idiopathic(unknown) but it can be attributed to different factors(predisposing factors).These factors include

👉Viral infection 

👉Chemical toxicity(e.g. Manganese, CO,dust)

👉CVA

👉Effects of drugs .e.g. Major tranquilizers 

👉Genetics/Heredity.

PATHOPHYSIOLOGY!!!

👉Parkinson's Disease is a chronic, progressive, degenerative neurological disorder of the nerve cells in the basal ganglia (Substantia Nigra) that affects extrapyramidal system.

👉Dopamine is an inhibitory NT responsible for the normal functioning of the EPS(Substantia Nigra, Globus pallidum, corpus striatum).

👉The Substantia Nigra is connected to the Corpus Striatum by a Dopamine releasing pathway known as BASAL GANGLIA.

👉Due to a depletion of dopamine in the Brain, there is deficiency of dopamine in the Basal Ganglia leading to a depletion of dopamine in the Corpus Striatum. 

👉This deficiency would lead to an increase in excitatory NT which is ACH in the Brain cells of the CNS and the individual experiences the symptoms seen in Parkinson's.

SIGNS AND SYMPTOMS 

➡️ TREMOR

➡️ BRADYKINESIA

➡️ RIGIDITY

➡️ POSTURAL ABNORMALITIES. 

👉If not managed properly, it can lead to complications such as Injuries from fall, UTI, Dementia. e.t.c.

 CLINICAL MANIFESTATIONS .

👠Tremors in hands and fingers (Pill rolling).

Note: that the tremor is usually a resting tremor.i .e occurs when the patient is at rest.

👠Akinesia

👠Bradykinesia(slow activity )

👠Shuffling gait and steps.

👠Restlessness 

👠Monotony(Impaired speech)

👠Muscle rigidity 

👠Fatigue

👠Oily skin

👠Increased perspiration

👠Insomnia 

👠Mood Swing(Depression and withdrawal)

👠Dysphagia

👠Drooling 

👠Muscle cramps

👠Constipation.

 DIAGNOSTIC EVALUATION . 

🔬History taking (Signs and Symptoms)

🔬Physical examination 

🔬CT Scan and MRI (to rule out other neurological disorders).

🔬Favourable response to a single Dose of levodopa.

 MANAGEMENT. 

As usual, we would group these into 2 (Medical and Nursing Management).

MEDICAL MGT:

Note✏It comprises of pharmacotherapy (drugs),Surgical therapy and Physiotherapy.

1)Pharmacotherapy using drugs called ANTIPARKINSONIA AGENTS .e.g. cholinergic medications (anticholinesterase).

They help relieve the muscle weakness and block ACH breakdown.

💊Pyridostigmine(mestinon)

💊Neostigmine(prostigmine)

💊Edrophonium chloride(Tensilon)

💊Dopaminergics.e.g. Levodopa(Dopamine replacement).

💊Bromocryptine (activates dopamine in the Brain)

💊Amantidin (Antiviral agent used in early txt to reduce rigidity, Akinesia, tremor).

2)Physiotherapy :Helps to maintain the patient's normal muscle tone and function. It includes both active and passive ROM exercises, routine daily activities, walking and bath,massage to help relax muscles. 

3)Neurosurgery(Surgical):This is used to destroy ventrolateral nucleus of the thalamus to prevent involuntary mvt.

 NURSING MGT:

💉Promote measures to maintain adequate airway.e.g. positioning, suctioning.e.t.c.

💉Encourage pt to engage in daily exercise. E.g.walking and postural exercise to off set shuffling gait.

💉Massages and warm bath to relax muscles.

💉Promote methods to ease difficulty in swallowing. E.g.chew slowly, conscious effort to control accumulation of saliva, feeding in upright position. 

💉Use stabilized, secure dishes and eating utensils.

💉Suggest smaller meals.

💉 Encourage intake of high fibre diet and water to prevent constipation. 

💉Monitor weight.

💉Teach facial exercises and breathing methods to obtain appropriate pronunciation, volume and intonation. E.g. deep breathing before speaking increases volume.

💉Encourage use of raised toilets to promote normal posture.

💉Provide emotional support and encourage verbalization of feelings. 

💉Allow pt to take active role in activity planning and evaluation of txt plan to reduce depression. 

💉Assess and encourage safety in environ to reduce risk for falls at home.

💉Instruct pt and family to adhere to medication regimen and report advers effects,as well as maintain follow-up care and monitoring. 

💉Encourage good personal hygiene. 

💉Assist pt to set realistic goals.

 Complications. 

😭Aspiration

😭Dementia 

😭Injuries from fall

😭Skin breakdown 

😭UTI.