Nursing care for Parkinson’s disease帕金森患者疾病护理
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tomography (SPECT), or a positron emission tomography (PET) to rule out other CNS disorders.
DIAGNOSTIC TESTS
Tremor (resting) usually starts in a finger or hand in a "pill-rolling" manner.
WHAT IS PARKINSON’S DISEASE?
Substantia nigra highlighted in red in the basal ganglia
PATHOPHYSIOLOGY OF PARKINSON’S DISEASE
Most people have primary, or idiopathic PD(familial tendency).
Use the nursing process as a framework for care of patients with Parkinson’s disease.
,
Parkinson's disease is a degenerative disorder of the nervous system that causes a gradual loss of muscle control.
QUESTION:
IS THE FOLLOWING STATEMENT TRUE OR FALSE?
Parkinson’s disease is a slowly progressing neurologic movement disorder that eventually leads to disability.
exposure to pesticides, herbicides, and industrial chemicals and metals and drinking well water, >40 years, and ↓estrogen levels
PD CAN BE A FRIGHTENING & DEBILITATING DIAGNOSIS.
sentences Hypophonia (soft voice), change in voice volume or articulation Autonomic dysfunction: ➢ Orthostatic hypotension ➢ Excessive perspiration ➢ Oily skin ➢ Seborrhea ➢ Flushing ➢ Changes in skin texture ➢ Eyelid spasm ➢ GI & GU problems
Associated with decreased levels of dopamine caused by destruction of cells in the substantia nigra in the basal ganglia affecting the neurotransmission of impulses
Define and describe each of the cardinal manifestations of Parkinson’s disease.
Detail the medical management of this disease, especially the drugs used for this disorder.
3)
FACTS
5 STAGES OF PD
Stage 1: Initial Stage
• Unilateral limb involvement • Minimal weakness • Hand and arm trembling
Stage 2: Mild Stage
• Bilateral limb involvement • Masklike face • Slow, shuffling gait
NURSING CARE OF THE PATIENT WITH PARKINSON DISEASE
• Schedule appointments and activities late in the morning to prevent rushing the patient, or schedule them at the time of the patient's optimal level of functioning.
What are the causes?
In its early stages, nearly 40% of people with PD may not be diagnosed, and as many as 25% are misdiagnosed.
PD patients’ life expectancy about the same as the general population
There are no specific diagnostic tests. Analysis of cerebrospinal fluid (CSF) may show a
decrease in dopamine levels. MRI, single-photon emission computed
Bradykinesia – The body suddenly stops or "freezes“ . Also shuffling gait and "mask-like" face
Stooped posture, with drooping shoulders and their head jutted forward Reduced arm swinging on one side of the body when walking Balance problem – at risk for fall Difficulty getting into and out of bed Muscular rigidity: Cogwheel, Plastic, or Lead Pipe Difficulty chewing and swallowing Uncontrolled drooling, especially at night Fatigue
• Teach the patient to speak slowly and clearly. Use alternative communication methods, such as a communication board.
• Monitor the patient's ability to eat and swallow. Monitor actual food and fluid intake. Collaborate with the dietitian.
Manifestations: tremor, rigidity, bradykinesia/akinesia, postural instability, depression and other psychiatric changes, dementia, autonomic symptoms, sleep disturbances
PSYCHOSOCIAL ASSESSMENT
• Allow the patient extra time to respond to questions. • Administer medications promptly on schedule to maintain continuous therapeutic drug levels. • Provide medication for pain, tingling in limbs, as needed. • Monitor for side effects of medications, especially orthostatic hypotension, hallucinations, and acute confusion(delirium). • Collaborate with other disciplines to keep the patient as mobile and as independent as possible in ADLs. • Allow the patient time to perform ADLs and mobility skills. • Implement interventions to prevent complications of immobility, such as constipation, pressure ulcers, and contractures.
About 50% more men than women currently have the disease.
About 5-10% of cases occur before age 50.
Symptoms evolve slowly over time. How does the disease progress? Time spent at each stage varies May skip stages (e.g. from Stage 1 to
Stage 3: Moderate Disease
• Postural instability • Increased gait disturbances Stage 4: Severe Disability
• Akinesia • Rigidity
Stage 5: Complete ADL Dependence
ASSESSMENT
Speech: Soft, low-pitched voice Dysarthria (slurred speech) Echolalia (automatic repetition of what another person says) and repetition of
NURSING CARE OF PATIENTS WITH PARKINSON’S DISEASE
LEARNING OBJECTIVES
Describe the pathophysiology responsible for the manifestations of Parkinson’s Disease.
A few patients have secondary PD due to conditions such as brain tumors and certain anti-psychotic drugs.
Exact cause remains unknown.
wenku.baidu.com(environmental and genetic factors)
• Provide high-protein, high-calorie foods or supplements to maintain weight.
• Recognize that Parkinson disease affects the patient's body image. Focus on strengthening self-esteem.
ASSESSMENT (SYMPTOMS BEYOND MOVEMENT)
➢ Emotionally labile ➢ Depressed ➢ Paranoid ➢ Easily upset ➢ Rapid mood swings ➢ Impaired cognition (i.e., dementia or delirium) ➢ Delayed reaction time ➢ Sleep disturbances
DIAGNOSTIC TESTS
Tremor (resting) usually starts in a finger or hand in a "pill-rolling" manner.
WHAT IS PARKINSON’S DISEASE?
Substantia nigra highlighted in red in the basal ganglia
PATHOPHYSIOLOGY OF PARKINSON’S DISEASE
Most people have primary, or idiopathic PD(familial tendency).
Use the nursing process as a framework for care of patients with Parkinson’s disease.
,
Parkinson's disease is a degenerative disorder of the nervous system that causes a gradual loss of muscle control.
QUESTION:
IS THE FOLLOWING STATEMENT TRUE OR FALSE?
Parkinson’s disease is a slowly progressing neurologic movement disorder that eventually leads to disability.
exposure to pesticides, herbicides, and industrial chemicals and metals and drinking well water, >40 years, and ↓estrogen levels
PD CAN BE A FRIGHTENING & DEBILITATING DIAGNOSIS.
sentences Hypophonia (soft voice), change in voice volume or articulation Autonomic dysfunction: ➢ Orthostatic hypotension ➢ Excessive perspiration ➢ Oily skin ➢ Seborrhea ➢ Flushing ➢ Changes in skin texture ➢ Eyelid spasm ➢ GI & GU problems
Associated with decreased levels of dopamine caused by destruction of cells in the substantia nigra in the basal ganglia affecting the neurotransmission of impulses
Define and describe each of the cardinal manifestations of Parkinson’s disease.
Detail the medical management of this disease, especially the drugs used for this disorder.
3)
FACTS
5 STAGES OF PD
Stage 1: Initial Stage
• Unilateral limb involvement • Minimal weakness • Hand and arm trembling
Stage 2: Mild Stage
• Bilateral limb involvement • Masklike face • Slow, shuffling gait
NURSING CARE OF THE PATIENT WITH PARKINSON DISEASE
• Schedule appointments and activities late in the morning to prevent rushing the patient, or schedule them at the time of the patient's optimal level of functioning.
What are the causes?
In its early stages, nearly 40% of people with PD may not be diagnosed, and as many as 25% are misdiagnosed.
PD patients’ life expectancy about the same as the general population
There are no specific diagnostic tests. Analysis of cerebrospinal fluid (CSF) may show a
decrease in dopamine levels. MRI, single-photon emission computed
Bradykinesia – The body suddenly stops or "freezes“ . Also shuffling gait and "mask-like" face
Stooped posture, with drooping shoulders and their head jutted forward Reduced arm swinging on one side of the body when walking Balance problem – at risk for fall Difficulty getting into and out of bed Muscular rigidity: Cogwheel, Plastic, or Lead Pipe Difficulty chewing and swallowing Uncontrolled drooling, especially at night Fatigue
• Teach the patient to speak slowly and clearly. Use alternative communication methods, such as a communication board.
• Monitor the patient's ability to eat and swallow. Monitor actual food and fluid intake. Collaborate with the dietitian.
Manifestations: tremor, rigidity, bradykinesia/akinesia, postural instability, depression and other psychiatric changes, dementia, autonomic symptoms, sleep disturbances
PSYCHOSOCIAL ASSESSMENT
• Allow the patient extra time to respond to questions. • Administer medications promptly on schedule to maintain continuous therapeutic drug levels. • Provide medication for pain, tingling in limbs, as needed. • Monitor for side effects of medications, especially orthostatic hypotension, hallucinations, and acute confusion(delirium). • Collaborate with other disciplines to keep the patient as mobile and as independent as possible in ADLs. • Allow the patient time to perform ADLs and mobility skills. • Implement interventions to prevent complications of immobility, such as constipation, pressure ulcers, and contractures.
About 50% more men than women currently have the disease.
About 5-10% of cases occur before age 50.
Symptoms evolve slowly over time. How does the disease progress? Time spent at each stage varies May skip stages (e.g. from Stage 1 to
Stage 3: Moderate Disease
• Postural instability • Increased gait disturbances Stage 4: Severe Disability
• Akinesia • Rigidity
Stage 5: Complete ADL Dependence
ASSESSMENT
Speech: Soft, low-pitched voice Dysarthria (slurred speech) Echolalia (automatic repetition of what another person says) and repetition of
NURSING CARE OF PATIENTS WITH PARKINSON’S DISEASE
LEARNING OBJECTIVES
Describe the pathophysiology responsible for the manifestations of Parkinson’s Disease.
A few patients have secondary PD due to conditions such as brain tumors and certain anti-psychotic drugs.
Exact cause remains unknown.
wenku.baidu.com(environmental and genetic factors)
• Provide high-protein, high-calorie foods or supplements to maintain weight.
• Recognize that Parkinson disease affects the patient's body image. Focus on strengthening self-esteem.
ASSESSMENT (SYMPTOMS BEYOND MOVEMENT)
➢ Emotionally labile ➢ Depressed ➢ Paranoid ➢ Easily upset ➢ Rapid mood swings ➢ Impaired cognition (i.e., dementia or delirium) ➢ Delayed reaction time ➢ Sleep disturbances