Neuro

Parkinson’s Disease Epidemiology

• Males > females

  • 1.5x more than

  • ages 4070

  • progressive is faster with later diagnosis

Parkinson’s Disease

• Loss of dopamine-producing brain cells

• Decreased dopamine in the brain → inhibits acetylcholine

Parkinson’s Disease Clinical Manifestations

• Resting tremors (mostly in hands. seen in asymmetrical motion)

• Muscle rigidity

• Slowness of movement (bradykinesia) or loss of movement (akinesia)

• Postural instability (impaired balance and frequent falls)

• Mask like face: not a lot of animation

• Stooped postureL curve to shoulders

• Slow, shuffling gait, defragmented turns

Parkinson’s Disease Diagnosis

• Two or more cardinal symptoms with asymmetrical presentations\

• No diagnostic test yet

Parkinson’s Disease Medications

• Anticholinergics: “dried you up”, helping with oral secretion/drooling, helps decrease risk of aspiration

• Dopamine-receptor agonists: 1st line treatment, Side effects: drowsiness, nausea

Parkinson’s Disease Nursing Diagnosis

• Risk for falls

• Fisk for constipation (bc of anticholinergic)

• Powerlessness (loss of control, difficult to process)

Parkinson’s Disease Assessments

• Tremors, rigidity, bradykinesia

• Gag and swallow → risk for aspiration, speech therapist for further evaluation

• Mobility (PT helps)

• Bowel and bladder function (decrease in muscle control=incontinence)

Parkinson’s Disease Actions

• Administer medications

• Implement safety precautions (falls)

• Facilitate nutritional intake (prevent aspirations: on a puree diet)

• Elevate HOB: Helps with oral secretion to prevent aspiration

• Suction equipment as bedside (“yanker/yonker”)

• Encourage patients to participate in self-car activities

• Facilitate interprofessional collaboration (nutritionalist PT, speech therapist)

• Communication strategies (for late stages, not being able to talk anymore)

Parkinson’s Disease Teaching

• Medication compliance: involve family/care givers. might not be able to take their own medications.

• Safety precautions

• Psychosocial support

Parkinson’s Disease Evaluating Care Outcomes

• Prevention of falls

• Can’t stop disease but can slow it down

• Encourage independent living

Alzheimer’s Epidemiology

• 7.0 million Americans

• 7.4 million older than 65

• Women > Men

• Black, Hispanic populations

Dementia

• Progressive cognitive decline that affects a person’s social and occupational functioning

• Most common is Alzheimer’s dementia

• Parkinson’s is a cause of dementia

Alzheimer’s Risk Factors

• Family history

Alzheimer’s

• No proven cause (think it is dying nerve cells accumulating in brain)

• Decrease in neurotransmitters

• No diagnosis test

• Autopsy is the only definite confirmation

Alzheimer’s Clinical Manifestations

• Forgetfulness: short term memory loss

• Difficulty with language

• Agnosia: inability to process sensory information

• Emotional lability

• Personality changes: typically opposite from before diagnosis

• Loss of cognitive skills

• Loss in ability to complete task

• Difficultly problem solving

Alzheimer’s Diagnosis

• No diagnostic test

• History and physical

• Neuro Exam: test cognitive function and physical exam

• Dementia screening for 65+

• Cerebral spinal fluid

• MRI and CT

Alzheimer’s Treatment

• Symptom management

• Physical and emotional support

• Donepezil, Rivastigmine, Galantamine, Memantine: increase AcH inhibiting Acetylcholinesterase

Alzheimer’s Nursing Diagnoses

• Acute confusion

• Caregiver role strain

• Ineffective coping

Alzheimer’s Assessments

• Weight (may forget to eat or drink)

• Intake and Output

• Bowel and bladder function (incontinence)

• Skin: Pericare after bathroom

• ADLs

• Environment and safety: cooking and flight risks

• Coping

Alzheimer’s Actions

• Encourage/assist with feeding

• Implement safety measures

• Implement routine toileting practices

• Provide clock and calendar

• Speak calmly

• Provide diversionary activites

• Provide emotional support

Alzheimer’s Teaching

• Teach families how to provide care

• Label dangerous substances

• Monitoring systems

• Referral assistance

Alzheimer’s Evaluating Care Outcomes

• Enhanced quality of life

• Preparation for end of life