Wk. 12 - Chronic Neurological Disorders

What is bradykinesia?

Slowness in the initiation and execution of movement; a hallmark motor symptom of Parkinson’s disease.

What is dyskinesia?

Involuntary, uncontrolled movements (writhing, fidgeting, body swaying) often occurring with long-term levodopa use.

What is dystonia?

A sustained muscle contraction causing abnormal posturing; can be painful and occurs in Parkinson’s disease.

What is chorea?

Involuntary, rapid, irregular, jerking movements seen in Huntington’s disease.

What is clonus?

Rhythmic, involuntary muscle contractions often associated with upper motor neuron lesions (e.g., ALS spasticity).

What is akinesia?

Absence or difficulty initiating voluntary movement; common in later Parkinson’s disease.

What is "freezing" in Parkinson’s disease?

A sudden inability to move or step forward, often triggered by stress or narrowing spaces.

What is REM sleep behavior disorder?

Acting out dreams due to loss of normal muscle atonia during REM; an early sign of Parkinson’s disease.

What causes the motor symptoms in Parkinson’s disease?

Progressive loss of dopamine-producing neurons in the substantia nigra → impaired basal ganglia motor control.

Why does tremor, rigidity, and bradykinesia occur in PD?

Dopamine loss leads to relative overactivity of acetylcholine in the basal ganglia.

What are very early symptoms of Parkinson's disease?

Hyposmia (loss of smell), constipation, REM sleep behavior disorder.

Describe the classic PD tremor.

Resting “pill-rolling” tremor that begins unilaterally and progresses to bilateral.

What non-motor symptoms may occur in PD?

Depression, anxiety, sleep disturbances, urinary issues, hallucinations, cognitive decline.

What is the mechanism of action of levodopa?

Converts into dopamine in the brain, improving motor function.

Why is carbidopa added to levodopa?

To prevent peripheral breakdown of levodopa, allowing more to reach the brain.

What foods interfere with levodopa absorption?

High-protein meals decrease absorption and efficacy.

What are common side effects of carbidopa-levodopa?

Nausea, orthostatic hypotension, somnolence, hallucinations, impulse-control disorders.

What long-term complications occur with levodopa therapy?

Dyskinesias and “on/off” motor fluctuations.

What nursing teaching is essential for levodopa timing?

MUST be given on time; delays of even minutes may cause immobility.

What is the mechanism of dopamine agonists?

They directly stimulate dopamine receptors in the brain.

What is a unique side effect of dopamine agonists?

Impulse-control disorders

What is “punding”?

Repetitive, purposeless activities such as sorting or collecting items.

What is the mechanism of COMT inhibitors?

They block COMT enzyme to prolong the action of levodopa.

What must COMT inhibitors always be taken with?

Levodopa—otherwise the medications have no therapeutic effect.

What is a characteristic side effect of COMT inhibitors?

Orange-colored urine.

How do MAO-B inhibitors work?

They inhibit the MAO-B enzyme, slowing dopamine breakdown in the CNS.

What is an important nursing consideration with MAO-B inhibitors?

They interact with many other medications; always consult pharmacy.

What is the nursing focus in Stage I PD?

Fall prevention teaching, exercise, managing constipation and sleep issues.

What is the nursing focus in Stage II PD?

Start PT/OT, initiate speech therapy if needed, teach strategies for rigidity.

What is the nursing focus in Stage III PD?

Gait training, assistive devices, home safety evaluation, monitor swallowing.

What is the nursing focus in Stage IV PD?

Assistance with ADLs, strict medication timing, caregiver support, mobility devices.

What is the nursing focus in Stage V PD?

Total care needs, aspiration prevention, pressure injury prevention, palliative care.

What causes the neurological deficits in MS?

Immune-mediated destruction of myelin, oligodendrocytes, and nerve fibers → impaired nerve conduction.

What early symptoms often occur in MS?

Numbness/tingling, optic neuritis, gait problems, spasms, fatigue.

What diagnostic test is most important for MS?

MRI showing lesions in different areas of the CNS occurring at different times.

What CSF findings support MS diagnosis?

Increased IgG and oligoclonal bands.

Name one disease-modifying therapy used in MS

Interferons, glatiramer, fingolimod, dimethyl fumarate, or ocrelizumab.

What causes muscle weakness in MG?

Autoimmune destruction or blocking of acetylcholine receptors at the neuromuscular junction.

What is the mechanism of pyridostigmine (Mestinon)?

Inhibits acetylcholinesterase → increases acetylcholine availability.

How do you differentiate myasthenic vs cholinergic crisis?

Myasthenic crisis: under-medication → severe weakness, respiratory failure → treat with more medication. Cholinergic crisis: over-medication → DUMBBELLS + weakness → treat with atropine.