Review of Parkinson's Disease (Nursing)

by Prof. Lawes

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      Slides 11-05 Parkinsons Overview.pdf
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      Review Sheet Parkinson Disease Nursing.pdf
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    00:01 Hi! Welcome to our video on Parkinson’s medication.

    00:05 I’m gonna kinda give you an overview of the medications we use to treat Parkinson’s.

    00:09 Now this is a pretty good graphic of what it looks like for someone with an advanced case of Parkinson’s, so we've got a drawing therefore you kinda get a feel for what we’re talking about.

    00:21 Parkinson’s is a progressive nervous system disorder, that means when you first start noticing symptoms it progressively gets more difficult so it affects a person’s ability to control movements.

    00:34 Now that sounds difficult but I wanna break it down for you even more so you can just a little bit of a feel of what our patients who have Parkinson’s disease have to face every day.

    00:44 Now PD, we will use that to be short for Parkinson’s disease, it also negatively impacts how a person feels, how they think, how they sleep and how they talk, so it is a wide range of areas in their life that is impacted by this disease.

    01:01 It’s progressive, it’s basically a motor movement problem but it also impacts how they feel, think, sleep, and talk.

    01:11 So, the common symptoms that someone with Parkinson’s disease has includes a tremor and they have bradykinesia, so let’s break that word down because you know we love to teach you medical terminology as we're going through our courses.

    01:25 So brady means slow, thereby bradycardia that means slow heart - cardia means heart.

    01:32 Bradykinesia, kinesia means movement so this is slow movement.

    01:37 So they have kind of a tremor, they move very slowly, they have stiff muscles so they can’t move them as easily as you or I could.

    01:47 I have that stooped posture so you got a tremor they can move really slow, their muscles are real stiff, they have changes to their speech so they could be kind of difficult to understand.

    02:01 They lose fine motor control so if they were trying to button their shirt or if they're trying to sign their name on a check or to write a letter, it’s very difficult for them because Parkinson’s interferes with your ability to work, to dress yourself, to feed yourself and just all your basic activities of daily living.

    02:22 I want you to stop for a minute and think about your day this morning.

    02:26 When your alarm clock went off you easily reach over and turn that sucker off, didn’t you? Wouldn’t be as easy to do if you're a patient with Parkinson’s disease.

    02:34 What about getting out of bed? Well, remember they’re stiff, they move slow, they have a hard time getting up.

    02:42 So getting up and just going to the bathroom something that we don’t even think about in the morning and usually our brains don’t even really work on yet, could take extreme effort for somebody with advanced Parkinson’s disease.

    02:53 Now picking out what to wear sometimes is complex, right? I’m amazed at how I can have a closet full of clothes and still have absolutely nothing to wear.

    03:03 Well, Parkinson’s patient is gonna pick clothing that doesn’t have very many complicated buttons or closures or things.

    03:10 They’re gonna look for things that pull on and easier to dress themselves with.

    03:14 Think about eating, if you have a tremor just trying to feed yourself cereal or breakfast in the morning is gonna be a problem.

    03:21 But they’ve got this super cool spoon that also vibrate, it kinda help the patient - I mean give them ability to feed themselves.

    03:28 So I just want you to get a little picture of what it’s like with advanced Parkinson’s disease.

    03:34 It doesn’t start out that way but it can progress to be that difficult.

    03:37 Now first what I wanna introduce you to neurotransmitters because this is at the heart of what Parkinson’s disease is.

    03:44 We've got a graphic for you there and I look at that you’ve got a presynaptic neuron, we've got the axon terminal, don’t let this scare you, this is pretty cool how this works.

    03:53 What I want you to circle right now are neurotransmitters, kind of dead center, in the middle of our slide there, so I want you just to pay attention mostly to those.

    04:03 We’re talking about neurons, right, so when you said the synaptic cleft, that’s the middles space in-between and the neurotransmitters are what kinda communicate back and forth there.

    04:12 So we’re looking at neurons, we’re looking at the axons, we’re looking at the gap in between and the neurotransmitters, so you can see they’ve taken over on the left, they show you what it looks like all stretched out and it showed you a tiny piece of it, maybe enlarged it on the right.

    04:27 Okay, so I asked you to circle neurotransmitters, you see those right there, because they are chemical messengers and they transmits signals across the synapses.

    04:37 Synapsis is a gap, right, from one neuron to another neuron.

    04:41 So, make sure you write in your own words under neurotransmitter that space right there is a synapse.

    04:46 You can see in the right we have synaptic cleft written.

    04:49 So, how do these neurons communicate with each other? Well, through these chemical messengers called neurotransmitters.

    04:57 You see one is releasing it and it’s received by the other one, that’s how they communicate.

    05:02 That’s the problem in Parkinson’s diseases.

    05:06 We've got these pathways in our brains - dopamine and serotonin are neurotransmitters, right and it’s represented by those little tiny balls you saw in that previous drawing.

    05:16 Now dopamine in our brain, we have that pathway.

    05:20 These are the things that we feel when dopamine is functioning effectively - it’s reward, it’s pleasure, it’s euphoria, it’s motor function it’s also compulsion and preservation so that you can keep going.

    05:34 Okay, now we have an imbalanced of dopamine in our brain with Parkinson’s.

    05:40 Now we also put serotonin up there to just kinda remind you and keep you in focused that dopamine and serotonin are just both neurotransmitters in our brain, they have special pathways and serotonin controls mood and memory processing and your sleep and cognition.

    05:55 We’ll talk more about serotonin when we look at drugs for depression but for now I want you to focus on dopamine - reward, pleasure, euphoria, motor function is the one I want you to circle because that’s when we're gonna focus on the discussion for Parkinson’s.

    06:11 Remember with Parkinson’s a lot of different areas are impacted not just motor function but that’s what I want you to focus on for now.

    06:19 There’s a couple of other things I want you to notice in the brain.

    06:23 You see you got the frontal cortex there, it’s right there it’s were the decision making it’s a very important part of our brain.

    06:30 Well, all parts of our brain are important but we’re kinda gonna focus on the frontal cortex.

    06:35 We’ve also got some others areas in there, the striatum, hippocampus, the substantia nigra - let’s look at those a little closer because Parkinson’s disease is difficulty controlling movement, right? Dys means difficulty, kinesia means movement.

    06:50 You already know that because we’ve talked about bradykinesia, slow movement.

    06:54 Parkinson’s is also bradykinesia and dyskinesia.

    06:58 So it has the movements symptoms and it has the non-motors symptoms, so the difficulty with controlling movements some examples we’ve talked about tremor at rest - they're gonna be really stiff or rigidity.

    07:09 They got a posture instability so they're really at a risk for falls and they have that slower movement we know as bradykinesia.

    07:17 Now the striatum is the part of your brain, it’s where the neurons are that coordinate movement so it’s an important player in Parkinson’s disease because the striatum receives information from two sources, the neocortex and the substantia nigra.

    07:35 Okay, striatum. Let’s make sure we have -- so before we move on, that’s where the neurons are that coordinate movement in my body.

    07:43 The striatum gets its information from two places, the neocortex and the substantia nigra.

    07:49 Now underline substantia nigra because that’s what we’re gonna talk about next.

    07:53 The substantia nigra neurons are an important source of dopamine for the striatum - okay, cool.

    08:00 So you see that we got the amygdala, that’s just gonna give your frame of reference and then we’ve got the substantia nigra that tiny, tiny, tiny little organ and it is the one that’s responsible for getting dopamine delivering that to the striatum.

    08:13 In Parkinson’s disease, the neurons connecting the substantia nigra die, this cuts off the dopamine supply to the striatum so that’s what we’re looking at.

    08:25 The substantia nigra’s job is to deliver dopamine to the striatum.

    08:29 In Parkinson’s disease, the neurons connecting the substantia nigra die.

    08:34 Now exactly why that happens we’re not really clear but we just know that it does so now we don’t have the dopamine supply that what - right, that the striatum needs and remember that controls movement, that’s why we have a problem with movement in Parkinson’s disease.

    08:50 Now this is just a pretty cool visual for you to see, look how tiny that substantia nigra is.

    08:58 It’s just a tiny little spot in the middle of your brain and it’s very, very, deep in the brain.

    09:04 So, when you hear people talking about deep brains stimulations for Parkinson’s, this is what they mean, it’s way down deep in the middle of your brain.

    09:13 Now there was motor symptoms, we talked about those remember the striatum controls that and we depend on substantia nigra to supply dopamine to that, we have autonomic disturbances.

    09:24 Look at that list, okay.

    09:28 Dry eyes, loss of taste or smell, swallowing difficulties, drooling, excessive sweating, orthostatic hypotension, sensitivity to heat, to cold, bladder problems, sexual dysfunction, constipation and weight loss - really, what’s left, right? If someone experiences many of those symptoms can you imagine how difficult it would be in daily life? That’s not all, they're also prone to depression which often goes along with chronic diseases.

    09:56 They can lead to psychosis or dementia - now that’s a whole another level so these are the non-motor symptoms that people with Parkinson’s can also experience the autonomic disturbances that really lengthy list we have there: depression, psychosis and dementia; and they tend to have this flat affect, that means they just look like - they may be listening; they may know what's going on but their face just really doesn’t have much expression, that’s what flat affect means.

    About the Lecture

    The lecture Review of Parkinson's Disease (Nursing) by Prof. Lawes is from the course Central Nervous System (CNS) Medications (Nursing). It contains the following chapters:

    • Parkinson's Disease
    • Neurotransmitters
    • Dopamine and Serotonin Pathways
    • Motor Symptoms: Dyskinesias
    • Striatum
    • Substantia Nigra
    • Non-motor Symptoms

    Included Quiz Questions

    1. Muscle weakness
    2. Bradykinesia
    3. Changes in speech
    4. Loss of fine motor abilities
    1. Dopamine
    2. Serotonin
    3. Norepinephrine
    4. Acetylcholine
    1. The neurons connecting the substantia nigra die.
    2. The neurons of the striatum die.
    3. The dopamine is metabolized immediately to make it unavailable in the brain.
    4. Dopamine cannot cross the blood-brain barrier.
    1. Autonomic disturbances and depression
    2. Increased acuity in taste and smell
    3. Speech disturbances and bradykinesia
    4. Hypertension and constipation

    Author of lecture Review of Parkinson's Disease (Nursing)

     Prof. Lawes

    Prof. Lawes

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