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Outline
Pathophysiology
A degenerative neurological disorder characterized by a lack of controlled movement, caused by a depletion in circulating dopamine levels in the brain. Dopamine is a neurotransmitter responsible for controlled muscle movements.
Etiology
A genetic component is suspected, but the true cause is not entirely understood. The depletion of dopamine results from atrophy of the substantia nigra – the structure within the midbrain that is responsible for secretion of dopamine.
Desired Outcome
Optimize independence and ability for self-care as long as possible. Improve dopamine levels within the brain to minimize symptoms. There is no cure.
Parkinson’s Disease Nursing Care Plan
Subjective Data:
- Weakness
- Fatigue
- Feeling “heavy”
- Feeling “stiff”
- Difficulty swallowing
Objective Data:
- Pill-rolling tremor
- Shuffling gait
- Lip smacking
- Bradykinesia – slow movements
- Akinesia – loss of voluntary movement
- Blank facial expression
- Drooling
- Dysphagia
Nursing Interventions and Rationales
- Assess swallow prior to giving anything by mouth – involve Speech Therapy as appropriate
Due to muscle weakness, patients may experience difficulty swallowing. It may be appropriate to have ST assess for appropriate interventions to prevent aspiration.
- Encourage PT/OT and the use of assistive devices for ambulation multiple times a day
Improving range of motion and muscle strength can help patient to maintain independence. If they do not participate in these activities, muscle atrophy is likely.
- Educate patient on activity and energy conservation options
Patients fatigue easily. Teach to cluster care and provide for periods of rest.
- Use rocking motion to initiate movement, especially from sit to stand
This momentum can help assist with initiating movements when weakness is present.
- Encourage small, frequent, nutrient-dense meals to get proper caloric intake
- Increase fluid intake
- High protein
- High fiber
- Avoid foods high in Vit B6
As the disease progresses, weakness and dysphagia make preparing and eating meals more difficult. Smaller meals can be easier to consume before getting fatigued. Encourage nutrient dense foods.
Vitamin B6 can interfere with antiparkinsonian drugs.
- Administer medications
- Dopaminergics
- Dopamine agonists
- Levodopa-Carbidopa
- Anticholinergics
The goal is to increase the levels of available dopamine within the central nervous system.
Anticholinergics are given to decrease drooling and secretions.
- Encourage independence as long as possible
As the disease progresses, patients will lose their independence. Encourage them to remain an active participant in their care as long as possible.
- Provide resources for community support (i.e. groups)
Progressive, degenerative diseases can take their toll on patients and their families emotionally. Having community support is helpful.
References
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