neuro 2

Parkinson's Disease Overview

• Definition: Slowly progressing neurologic movement disorder leading to disability.

• Prevalence: Affects about 1 million patients in the U.S. annually; more common in men than women; typically diagnosed around age 50.

• Cause: Unknown, possibly due to environmental or genetic factors.

Pathophysiology

• Dopamine Loss:

  • Loss of dopamine production and storage cells in the substantia nigra leads to insufficient dopamine, affecting movement control.

  • Dopamine is inhibitory (slows movement), while acetylcholine is excitatory (promotes movement).

  • Lack of dopamine contributes to hallmark symptoms.

Symptoms of Parkinson's Disease

• Progression:

  • Symptoms start small and worsen over time; chronic prolonged course.

  • Four cardinal symptoms: tremor, rigidity, bradykinesia or akinesia, and postural instability.

• Subtypes:

  • Tremor-Dominant: Predominance of tremor with fewer other symptoms.

  • Nontremor Dominant: Focus on akinetic rigidity and postural instability.

• Hallmark Symptoms Detail:

  • Tremor: Unilateral resting tremor, often resembling a pill-rolling motion.

  • Rigidity: Resistance to passive limb movement characterized by lead pipe or cogwheel movements.

  • Bradykinesia: Characterized by slowness of movement; crucial in diagnosis.

  • Postural Instability: Balance problems leading to gait issues, such as shuffling and propulsive gait.

Additional Symptoms

• Autonomic Symptoms: Include excessive sweating, drooling, orthostatic hypotension, gastric and urinary retention, and sexual dysfunction.

• Psychiatric Symptoms: Commonly depression and anxiety; may progress to dementia and hallucinations.

• Masked Facial Expression: Reduced ability to express facial emotions due to muscle rigidity.

Stages of Parkinson's Disease

• Overall Progression: Documented in stages, with videos illustrating differences in symptom severity.

• Fall Precautions: High fall risk due to postural instability; interventions include modifying the home environment.

Complications of Parkinson's Disease

• Swallowing Difficulties: Increase risk of aspiration and pneumonia; recommend an upright position during meals and semi-solid diets.

• Increased Fall Risk: Encourage use of assistive devices and implement safety precautions.

• Cognition Monitoring: Depression and cognitive impairment need regular assessments; psychotherapeutic interventions possible.

Treatment Approaches

• Medications:

  • Dopaminergics: Levodopa and carbidopa as primary treatment; manage symptoms by increasing dopamine availability.

  • Adverse Effects: Long-term use may lead to dyskinesias, involuntary movements that interfere with daily living.

  • Other Drug Classes: Include dopamine agonists, anticholinergics, COMT inhibitors, MAOIs, and antivirals.

• Surgical Procedures:

  • Deep Brain Stimulation (DBS): Implanting electrodes to stimulate dopamine production areas; may allow reduction of medication doses.

  • Ablative Procedures: Thalamotomy and pallidotomy less common due to risks.

Nursing Interventions

• Medication Administration: Regular dosages tailored to patient response.

• Monitoring and Support: Assess swallowing, nutrition, mobility, and mental status; work closely with speech and occupational therapy.

• Dietary Needs: Encourage small, frequent meals and high-calorie foods to combat weight loss due to difficulties in eating.

• Mobility Enhancement: Regular exercise and physical therapy to stimulate muscle strength and balance.

• Communication Strategies: Remind patients to speak clearly and face listeners, utilize speech therapy for specific exercises.

Multiple Sclerosis Overview

• Definition: Chronic autoimmune disorder affecting the central nervous system (CNS).

• Pathophysiology: Demyelination leads to impaired nerve transmission; plaques observed in MRIs.

• Prevalence: More common in women (ages 20-40) and in northern regions, with known risk factors including obesity and low vitamin D exposure.

Types of Multiple Sclerosis

• Relapsing-Remitting (RRMS): Most common type; fluctuating periods of symptoms.

• Secondary Progressive: Progresses from RRMS to a steady decline without clear remissions.

• Primary Progressive: Constant symptoms without relapse and remission phases.

• Progressive Relapsing: A continuous decline with intermittent exacerbations.

Symptoms of Multiple Sclerosis

• Common Symptoms: Fatigue, muscle weakness, ataxia, vision changes, pain, and cognitive/psychological issues.

• Fatigue: Considered the most debilitating symptom; management through treating underlying causes.

• Visual Changes: Such as blurred vision and diplopia.

• Motor Symptoms: May lead to complications like pressure injuries and osteoporosis due to immobility.

Diagnosis of Multiple Sclerosis

• MRI Findings: Identification of plaques in CNS.

• Cerebrospinal Fluid Analysis: Detects oligoclonal banding, indicating an immune response.

Treatment Approaches for Multiple Sclerosis

• Disease-Modifying Drugs: Aim to reduce relapses and plaques, primarily for non-primary progressive types.

• Symptomatic Treatments: Include medications for fatigue, pain, and spasticity, as well as therapies for improving function and mobility.

Nursing Interventions for Multiple Sclerosis

• Promote Mobility: Regular physical therapy and support with assistive devices.

• Nutrition Management: Address weight gain or loss; educate families on meal preparation suitable for patients.

• Fatigue Management: Advocate for proper sleep hygiene and energy conservation techniques.

• Definition: Slowly progressing neurologic movement disorder leading to disability.

• Prevalence: Affects about 1 million patients in the U.S. annually; more common in men than women; typically diagnosed around age 50.

• Cause: Unknown, possibly due to environmental or genetic factors; some studies suggest exposure to pesticides or head injuries may increase risk.

Pathophysiology

• Dopamine Loss:

  • Loss of dopamine production and storage cells in the substantia nigra leads to insufficient dopamine, affecting movement control.

  • Dopamine is inhibitory (slows movement), while acetylcholine is excitatory (promotes movement).

  • Lack of dopamine contributes to hallmark symptoms.

  • Neuroinflammation may also play a role in the progression of the disease.

Symptoms of Parkinson's Disease

• Progression:

  • Symptoms start small and worsen over time; chronic prolonged course.

  • Four cardinal symptoms: tremor, rigidity, bradykinesia or akinesia, and postural instability.

• Subtypes:

  • Tremor-Dominant: Predominance of tremor with fewer other symptoms.

  • Nontremor Dominant: Focus on akinetic rigidity and postural instability.

• Hallmark Symptoms Detail:

  • Tremor: Unilateral resting tremor, often resembling a pill-rolling motion.

  • Rigidity: Resistance to passive limb movement characterized by lead pipe or cogwheel movements.

  • Bradykinesia: Characterized by slowness of movement; crucial in diagnosis.

  • Postural Instability: Balance problems leading to gait issues, such as shuffling and propulsive gait.

  • Additionally, loss of automatic movements such as blinking or arm swinging during walking may occur.

Additional Symptoms

• Autonomic Symptoms: Include excessive sweating, drooling, orthostatic hypotension, gastric and urinary retention, and sexual dysfunction.

• Psychiatric Symptoms: Commonly depression and anxiety; may progress to dementia and hallucinations.

• Masked Facial Expression: Reduced ability to express facial emotions due to muscle rigidity.

• Sleep Disturbances: Insomnia and changes in sleep architecture can exacerbate fatigue and cognitive issues.

Stages of Parkinson's Disease

• Overall Progression: Documented in stages, with videos illustrating differences in symptom severity.

• Fall Precautions: High fall risk due to postural instability; interventions include modifying the home environment; physical therapy can help improve balance and stability.

Complications of Parkinson's Disease

• Swallowing Difficulties: Increase risk of aspiration and pneumonia; recommend an upright position during meals and semi-solid diets.

• Increased Fall Risk: Encourage use of assistive devices and implement safety precautions.

• Cognition Monitoring: Depression and cognitive impairment need regular assessments; psychotherapeutic interventions possible.

• Parkinson’s Disease may lead to Parkinsonism, a syndrome that presents symptoms similar to Parkinson’s but can arise from other conditions.

Treatment Approaches

• Medications:

  • Dopaminergics: Levodopa and carbidopa as primary treatment; manage symptoms by increasing dopamine availability.

  • Adverse Effects: Long-term use may lead to dyskinesias, involuntary movements that interfere with daily living; this may necessitate periodic adjustments to medication dosage.

  • Other Drug Classes: Include dopamine agonists, anticholinergics, COMT inhibitors, MAOIs, and antivirals; each plays a role in symptom management.

• Surgical Procedures:

  • Deep Brain Stimulation (DBS): Implanting electrodes to stimulate dopamine production areas; may allow reduction of medication doses; effectiveness varies based on patient individuality.

  • Ablative Procedures: Thalamotomy and pallidotomy less common due to risks; used in specific cases where DBS is not an option.

Nursing Interventions

• Medication Administration: Regular dosages tailored to patient response; monitor for effectiveness and side effects.

• Monitoring and Support: Assess swallowing, nutrition, mobility, and mental status; work closely with speech and occupational therapy.

• Dietary Needs: Encourage small, frequent meals and high-calorie foods to combat weight loss due to difficulties in eating.

• Mobility Enhancement: Regular exercise and physical therapy to stimulate muscle strength and balance; adaptive equipment may be beneficial.

• Communication Strategies: Remind patients to speak clearly and face listeners, utilize speech therapy for specific exercises; consider communication aids if needed.

1. Parkinson's Disease:

   • Definition: Slowly progressing neurologic movement disorder leading to disability.

   • Prevalence: Affects about 1 million patients in the U.S. annually; more common in men than women; typically diagnosed around age 50.

   • Symptoms: Four cardinal symptoms include tremor, rigidity, bradykinesia/akinesia, and postural instability.

   • Complications: Monitor for swallowing difficulties, fall risk, and cognitive impairments.

   • Treatment: Understand medications like dopaminergics (e.g., levodopa/carbidopa), surgical procedures like Deep Brain Stimulation (DBS), and nursing interventions such as mobility enhancement and dietary needs.

2. Multiple Sclerosis:

   • Definition: Chronic autoimmune disorder affecting the CNS, with variable symptoms based on the type (Relapsing-Remitting, Primary Progressive, etc.).

   • Symptoms: Common symptoms include fatigue, ataxia, visual changes, and cognitive issues.

   • Diagnosis: MRI findings show plaques in the CNS, and cerebrospinal fluid analysis detects oligoclonal banding.

   • Treatment: Focus on disease-modifying drugs and symptomatic treatments; understand the importance of patient education on management.

3. Nursing Interventions:

   • Assess swallowing, nutrition, mobility, and mental status; work closely with rehabilitation services.

   • Emphasize patient education and support for daily activities, promoting independence while managing symptoms.