Parkinson's Disease: Definition and Nursing Diagnoses

by Rhonda Lawes, PhD, RN

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    00:00 Hi, welcome to our neurological series.

    00:03 In this video, we're going to take a look at Parkinson's disease, and what the health care team does to work together collaboratively to help them have the best, most effective and safe care.

    00:15 Parkinson's disease is a progressive nervous system disorder.

    00:20 Don't miss that word "progressive." Sadly, these symptoms develop, the patient gets treatment.

    00:27 But, eventually, this disease progresses with these nervous system problems, so it affects the patient's ability to control movement.

    00:36 It also affects a lot of other areas.

    00:38 But as a first step, let's just have that laid down.

    00:42 Parkinson's affects a person's ability to control movement.

    00:46 It can also impact how a person feels, how they think, how they sleep, and how they speak or talk.

    00:54 So, Parkinson's disease is progressive.

    00:58 It does affect a person's ability to control movement that involves walking, dressing themselves, all the activities of daily living, but it also affects their emotional feelings, thinking, sleeping, and talking, because Parkinson's is an imbalance.

    01:16 We've got a picture for you there of the brain.

    01:19 We've got a scale.

    01:21 It's helping you see that there is an imbalance in movement, it comes from an imbalance in dopamine and acetylcholine.

    01:28 So because we have this imbalance in the brain that ends up being an imbalance in the patient's ability to control their movement.

    01:35 So, we've got not enough dopamine and too much acetylcholine.

    01:40 That's the state of the imbalance in a patient's brain with Parkinson's disease.

    01:46 Now, sadly, there's no cure.

    01:47 We just have medications that treat the symptoms.

    01:50 And one of the most difficult things with Parkinson's is eventually the effectiveness of these medications wears off.

    01:57 So, initially, it will have a really good response, but sometimes as short as three to five years, the patient has returned to the level before medication.

    02:06 So, what's our goal? Let's talk about some good news.

    02:09 What are the things we can do for our patient? Well, number one, we want to maintain functional mobility and activities of daily living as long as possible.

    02:19 Everyone wants to be as independent as possible.

    02:22 And that's our goal as a health care team, help them remain functional in their daily life.

    02:27 We want to improve the quality of their life by helping them maintain their functional mobility.

    02:32 And so we're going to look to some medications.

    02:34 Now, these medications work in one of two ways.

    02:37 They can help us either increase the dopamine that's available or we can decrease the action of the acetylcholine.

    02:44 So, that's how we're gonna look to rebalance those scales, are we gonna make more dopamine available, or we're going to block the action of acetylcholine in the brain.

    02:55 Now, if you're thinking about, "Hey, what are some possible nursing diagnoses?" Now, stay with us.

    03:01 I know sometimes it's really difficult to deal with nursing diagnoses because you start thinking about care plans and grading.

    03:08 But let's think of this from the patient's perspective.

    03:10 What are the things they're going to be most on their mind? So, how can we help them solve these problems? Well, we know that Parkinson's gives the patients difficulty with mobility.

    03:22 That's because they become really rigid.

    03:23 They tend to walk really slow movements.

    03:27 Bradykinesia, slow movement.

    03:30 Akinesia, they can't make themselves move.

    03:34 They also have postural instability.

    03:38 Okay, so we know they're not going to be as safe and as effective at moving as they used to be.

    03:46 They're stiff, they're slow, and they're not really stable on their feet.

    03:51 So, we are going to watch them. They're definitely at a risk for falls.

    03:54 They might also have impaired swallowing because in the neuromuscular impairment.

    03:59 So, they might even have a decreased or absent gag reflex.

    04:04 Well, that gag reflex is what protects my airway from getting yucky unknown substances that are not supposed to be in my lungs, in my lungs.

    04:12 So, you're always on the lookout.

    04:15 Patient with Parkinson's disease might struggle with that gag reflex, might be decreased, not as effective, or completely absent in severe cases.

    04:25 So, swallowing is something that you consistently have to evaluate with a Parkinson's patient.

    04:30 Now, they can also have difficulty with verbal communications because the have a hard time controlling the muscles of speech.

    04:38 If you think about it, it's pretty complicated.

    04:42 You use your tongue to formulate sounds into words much more than we realize.

    04:47 Until you go to the dentist and they numb your tongue, then you have a pretty good idea of how important your tongue is.

    04:54 So, other problems related to communication include tremors and bradykinesia.

    05:00 So, Parkinson's is a cruel disease.

    05:03 It attacks every aspect of a patient's life.

    05:07 So, they can't control their movements. That's dyskinesia.

    05:11 We want to make sure you're familiar with that term.

    05:13 D-Y-S means difficult, kinesias means movement.

    05:17 And there's also non-motor symptoms.

    05:20 So, when I'm thinking of a Parkinson's patient, I know it's imbalance of two things: acetylcholine and dopamine with not enough dopamine, and the patient is going to have difficulty controlling movements, and there's also non-motor symptoms.

    05:34 So, there's two categories of the imbalance: acetylcholine and dopamine.

    05:39 And there's also two categories of problems: controlling movement and there's non-motor symptoms.

    About the Lecture

    The lecture Parkinson's Disease: Definition and Nursing Diagnoses by Rhonda Lawes, PhD, RN is from the course Chronic Neurological Disorders (Nursing). It contains the following chapters:

    • Parkinson's Disease
    • Plan of Care

    Included Quiz Questions

    1. It is a progressive nervous system disease.
    2. It can affect a person's ability to control muscle movement.
    3. It can have negative effects on how a person feels, thinks, sleeps, and talks.
    4. It can be cured with the right medications.
    5. All clients with this condition will have the same symptoms.
    1. There is an imbalance in the brain, with not enough dopamine and too much acetylcholine.
    2. There is an imbalance in the brain, with not enough acetylcholine and too much dopamine.
    3. The brain has a balance of dopamine and acetylcholine.
    4. There is not enough dopamine in the brain, but acetylcholine is unrelated to Parkinson's disease.
    1. Fall safety precautions
    2. Medication administration
    3. Emotional support
    4. Caloric intake for energy

    Author of lecture Parkinson's Disease: Definition and Nursing Diagnoses

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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