Pathophysiology: Loss of dopamine and a break down of the dopaminergic pathway causes the motor activity to be underactive and uncontrolled. With the lack of dopamine, the nerves fire signals out of control and causes uncoordinated movements.
- Degenerative neurological disorder
- Atrophy of substantia nigra → depletion of dopamine
- Less and less capable of controlled movement
- Slow, progressive disease
- No cure
- Progressively debilitated and self-care dependent
- Classic Signs:
- Pill rolling – tremors in hands (as if rolling a pill between fingers)
- Shuffling Gait
- Lip Smacking
- Bradykinesia – slow movements due to muscle rigidity
- Resting tremor
- Akinesia – loss of voluntary movement
- Blank facial expression
- Stooped stance
- Medication therapy
- Dopamine agonists
- Goal is to increase the levels of available dopamine in the CNS
- Eventually drugs become ineffective
- Functional Ability
- Assistive devices
- Physical and Occupational Therapy
- Use rocking movement to initiate movement
- Encourage client to ambulate multiple times a day
- Participate in active and passive range of motion activities
- Avoid foods high in Vitamin B6 (blocks effects of antiparkinsonian drugs)
- Small, frequent, nutrient dense food
- Speech Therapy
- Monitor diet to insure proper caloric intake
- Increase fluid intake
- High protein
- High fiber
- Assess ability to swallow prior to anything by mouth
- Encourage expression of feelings
- Provide resources for support groups
- Encourage independence as long as possible
- Best methods for optimizing nutrition
- Activity and energy conservation options
- Proper use of assistive devices
- Medication Instructions
In this lesson, we’re going to talk about Parkinson’s disease.
Parkinson’s disease is a slow, progressive, degenerative disorder of the nervous system. It primarily affects a structure in the midbrain known as the substantia nigra. You can see here is the substantia nigra in a normal midbrain. What happens in Parkinson’s disease is that this structure is atrophied, meaning it shrinks or get smaller. This substantia nigra is the structure in our brain that is primarily responsible for secreting dopamine. When it atrophies we see a decrease in our available dopamine in the brain. If you remember from the impulse transmission lesson, dopamine is a neurotransmitter that helps to send signals throughout the nervous system. It has many functions, but one of those functions is to help regulate and coordinate muscle movements to make them more controlled. What we see in Parkinson’s disease is that because of this depletion of dopamine, patients are less and less capable of controlled muscle movements.
The signs that will see in patients with Parkinson’s disease will all relate to the fact that they are unable to control their muscle movements. The classic signs of Parkinson’s disease that you will see listed on tests and on your NCLEX are shuffling gait, bradykinesia, and pill rolling. Bradykinesia means slow movements – it’s almost like they’re trudging through mud or quicksand. They shuffle their feet because they struggle to lift their feet up off the ground. We will also see muscle rigidity and significant tremors even at rest. One of those types of tremors is called pill-rolling. It’s a tremor within the hands that makes them look like they’re rolling a pill between their fingers. Patients with Parkinson’s disease will also lose control of muscles within their face, so we will see blank or inappropriate facial expressions. They also have trouble controlling their secretions and often will drool or have difficulty swallowing, which is called dysphagia. Many times patients will begin to lose weight because they find it much more difficult to prepare and eat food in addition to having trouble swallowing it. So nutrition will become a priority.
Every patient’s experience with Parkinson’s is different. One patient described it this way: “I feel like gravity changed and I’m dragging myself through sand now.” Ultimately those slow movements and inability to control them will become more and more of a burden.
Unfortunately, at this point there is no cure for Parkinson’s Disease. You may know two of the most famous people who have Parkinson’s disease, that is the late Muhammad Ali, and Michael J. Fox. Michael J. Fox actually has his own Foundation dedicated to Parkinson’s research and they hope to have a cure within the next few decades. Either way the ongoing research is helping to provide more and more treatment options. Our current therapies are aimed at increasing dopamine levels in the central nervous system. This includes dopaminergic medications, dopamine agonists, as well as anticholinergics. If you remember from the blood-brain barrier lesson, one of the problems with medications aimed at the central nervous system is that many of them cannot cross the blood-brain barrier. The dopamine agonist that we use for Parkinson’s, called levodopa, cannot cross the blood-brain barrier by itself. So they’ve added Carbidopa to it – that helps to carry levodopa across the blood-brain barrier to help to elevate dopamine levels in the CNS. Because Parkinson’s is a progressive disease, we will find that eventually these medications are no longer as effective. As muscle contraction gets less and less controlled, patients will lose their ability to do basic functions like eat and breathe.
Priority nursing concepts for a patient with Parkinson’s disease include functional ability, nutrition, and coping. We need to help them learn how to perform activities of daily living, and use assistive devices to get around if necessary so that they can maintain their independence as long as possible. As I said before, sometimes nutrition becomes a problem because preparing and eating meals is difficult. So we encourage small, frequent, nutrient-dense meals to make sure they’re still getting the calories they need. In the hospital, we want to make sure they are able to swallow safely before we feed them or give them anything by mouth. And finally because this is a progressive disease, some patients will need extra help with coping strategies and ways to make the best of the time they have left.
So remember that the core problem in Parkinson’s disease is a depletion of dopamine levels in the central nervous system that makes the patient less and less capable of controlled muscle movements. Classic signs of Parkinson’s are bradykinesia, shuffling gait, and pill rolling tremors. Parkinson’s disease is progressive, and the patients will slowly become more and more dependent on others for self-care. We want to encourage their activity and help them maintain their functional independence as long as possible.
Make sure you check out the care plan and other resources attached to this lesson to learn more about caring for patients with Parkinson’s disease. Now go out and be your best self today. And, as always, happy nursing!