Parkinson's Disease

Ideopathic (Primary)

Degeneration of Substantia Nigra

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Substantia Nigra produces dopamine and trasmits it to the basal ganglia.

Decrease in Dopamine Production

Dopamine/Acetylcholine Imbalance

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ACh is produced by the basal ganglia and is responsible for transmitting excitatory neurons. Dopamine inhibits these, making voluntary motor refinement possible.

Inability to Refine Voluntary Movement

Cognitive Changes

Dementia

Delayed Reaction Time

Memory Deficits

Diagnostics

No specific Diagnostic Tests

Clinical Findings based on symptoms after ruling out other neurological diseases

Analysis of CSF may show decrease in dopamine levels

Risk for Injury

References

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Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing: Patient-centered collaborative care (7th ed.). 941-946. St. Louis, MO: Saunders/Elsevier.

Risk Factors

Genetic Factors

Older than 40 years

Reduced Estrogen Levels

Familial Tendency

parkin 1 gene on chromosome 4

50% more males than females

Environmental Exposure

Pesticides

Herbacides

Industrial Chemicals

Drinking Well Water

Metals

Mini Stokes

Head Trauma

Brain Tumor

Antipsychotic Meds

Normal Pressure Hydrocephalus

Clinical Manifestations

Motor Changes

Stage 1

Unilateral Limb Involvement

Minimal Weakness

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Fatigue, difficulty getting out of bed

Hand and Arm Trembling

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Tremors at rest

Stage 2

Bilateral Limb Involvement

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Bradykinesia

Masklike Facies

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With wide, fixed, staring eyes

Facial Rigidity

Chewing/Swallowing Impairment

Inadequate Nutrition

Aspiration

Choking

Pneumonia

Uncontrollable Drooling

Changes in Speech Patterns

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Dysarthria, echololia, hypophonia

Slow, Shuffling, Gait

Stage 3

Postural Instability

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Stooped

Increased Gait Disturbances

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Short, hesitant, or propulsive gait with inability to stop quickly. Sensation of being frozen or glued to floor.

Stage 4

Akinesia

Rigidity

Stage 5

Complete ADL Dependence

DEATH

Autonomic Nervous System Changes

Orthostatic Hypotension

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Loss of sympathetic innervation in the heart and blood vessel response

Excessive Perspiration

Erectile Dysfunction

Bowel and Bladder Dysfunction

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Urinary incontinence or retention, due to ANS regulating smooth muscle activity, and constipation due to slow motility of GI tract and/or poor nutrition and fluid intake.

Skin Changes

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Flushing, seborrhea, oily skin, changes in texture

Emotional Changes

Depression

Fear

Pessimism

Rapid Mood swings

Irritability

Insecurity

Paranoia

Embarrassment

Secondary

Risk Factors