Parkinson's Disease Symptoms, Treatment, Nursing Care, Pathophysiology NCLEX Review

Summary

This video provides a comprehensive overview of Parkinson's disease, a movement disorder affecting dopaminergic neurons. It discusses the disease's impact on movement, the role of dopamine, and the imbalance with acetylcholine. The video also covers symptoms, treatments including medications like carbidopa-levodopa, and nursing interventions focusing on safety, psychosocial support, and nutrition.

Takeaways

• 🧠 Parkinson's disease is a neurological condition that primarily affects movement, characterized by the degeneration of dopaminergic neurons in the substantia nigra.
• 💉 The reduction in dopamine, a neurotransmitter crucial for movement accuracy, leads to the characteristic symptoms of Parkinson's disease.
• 🔄 There is an imbalance in the nervous system between acetylcholine, an excitatory neurotransmitter, and dopamine, an inhibitory neurotransmitter, in Parkinson's disease.
• 💊 Medications for Parkinson's disease aim to restore the balance between acetylcholine and dopamine, with anticholinergic medications being a common treatment for younger patients experiencing tremors.
• 👴 Parkinson's disease typically affects older adults, but it can also occur in younger individuals, such as actor Michael J. Fox, who was diagnosed at age 29.
• 🚶‍♂️ Early signs of Parkinson's disease include subtle tremors, stiffness of extremities, and changes in gait, which can progress to affect the entire body over time.
• 🏠 Nursing interventions for Parkinson's disease focus on safety, psychosocial support, digestion and nutrition, and education about medication side effects and management.
• 🛠️ Assistive devices like canes, walkers, and handrails, as well as modifications to the home environment, can help improve safety and mobility for patients with Parkinson's disease.
• 🍽️ Dietary considerations for Parkinson's patients include a soft diet, high-fiber intake, and careful management of protein intake to optimize medication effectiveness.
• 💪 Encouraging physical activity and providing support for autonomy in daily living tasks can help maintain quality of life for individuals with Parkinson's disease.

Q & A

What is Parkinson's disease?

Parkinson's disease is a neurodegenerative disorder that primarily affects movement. It is characterized by the degeneration of dopaminergic neurons in the substantia nigra, leading to a decrease in the neurotransmitter dopamine, which is crucial for movement accuracy.

Why are movements affected in Parkinson's disease?

Movements are affected because the dopaminergic neurons in the substantia nigra start to die, resulting in less dopamine being produced. Since dopamine is essential for the accuracy of movements, its deficiency leads to various movement-related issues.

What is the role of the substantia nigra in Parkinson's disease?

The substantia nigra is a part of the basal ganglia in the midbrain that controls movement. In Parkinson's disease, the dopaminergic neurons in this area degenerate, leading to a reduction in dopamine and affecting movement control.

How does the balance between acetylcholine and dopamine relate to Parkinson's disease?

In Parkinson's disease, the reduction of dopamine leads to an imbalance with acetylcholine, an excitatory neurotransmitter. With less inhibitory dopamine, acetylcholine over-stimulates neurons, causing symptoms like tremors and rigidity.

What is the significance of dopamine agonists in treating Parkinson's disease?

Dopamine agonists, such as ropinirole, stimulate dopamine receptors and help improve the signs and symptoms of Parkinson's disease by mimicking the effects of dopamine.

Why are anticholinergic medications used in the treatment of Parkinson's disease?

Anticholinergic medications, like benztropine, are used to decrease the excessive cholinergic activity caused by the dopamine deficiency. They help reduce symptoms like tremors and rigidity but are typically prescribed to younger patients due to potential side effects.

Which group of patients is more likely to experience extreme tremors in Parkinson's disease?

Younger patients with Parkinson's disease are more likely to experience extreme tremors and may be prescribed anticholinergic medications to help manage these symptoms.

What are some common early signs and symptoms of Parkinson's disease?

Early signs and symptoms of Parkinson's disease can be subtle and may include tremors at rest, stiffness of extremities, and changes in walking posture. These symptoms often start in one extremity or side of the body and can progress to affect the entire body over time.

How can patients with Parkinson's disease manage 'freeze ups' during walking?

Patients can manage 'freeze ups' by changing the direction of movement, using a cane or walker with a laser pointer to guide their steps, or consciously making an effort to raise their legs high as if marching or stepping over an object.

What are some nursing interventions for patients with Parkinson's disease?

Nursing interventions include ensuring safety through the use of assistive devices and education on preventing falls, addressing psychosocial needs to reduce isolation and depression, and managing digestion and nutrition issues such as constipation and difficulties with swallowing.

Why is it important for patients with Parkinson's disease to be cautious with their diet, especially protein intake?

It is important because protein can compete with Parkinson's medications, such as carbidopa-levodopa, in the small intestine, potentially reducing the absorption of the medication and affecting its effectiveness.

What are some side effects of carbidopa-levodopa, and how can they be managed?

Side effects of carbidopa-levodopa include nausea and involuntary movements. To manage these, patients may be prescribed COMT inhibitors, such as entacapone, to extend the effect of levodopa and reduce the 'wearing off' phenomenon.

How do monoamine oxidase type B inhibitors help in the treatment of Parkinson's disease?

Monoamine oxidase type B inhibitors, such as selegiline, increase dopamine levels by inhibiting the enzyme that breaks down dopamine, leading to an improvement in motor symptoms.

Outlines

00:00

🧠 Parkinson's Disease Overview

This paragraph introduces Parkinson's disease as a neurological condition affecting movement, characterized by the degeneration of dopaminergic neurons in the substantia nigra. The significance of dopamine in movement accuracy is highlighted, and the imbalance between acetylcholine and dopamine is discussed. The paragraph also touches on the treatment approach, including anticholinergic medications, and the importance of dopamine in maintaining normal movement.

05:02

👵 Signs and Symptoms of Parkinson's

The second paragraph delves into the signs and symptoms of Parkinson's disease, which initially may be subtle but worsen over time, affecting mobility. Tremors, stiffness, and bradykinesia (slow movement) are common, with tremors often improving with purposeful movement. The paragraph also covers other symptoms such as difficulty in swallowing, facial expression changes, and the progression of symptoms from one side of the body to the whole body.

10:04

🏃‍♂️ Nursing Interventions for Parkinson's

This section focuses on nursing interventions for Parkinson's patients, emphasizing safety due to balance and coordination issues. It discusses the use of assistive devices, environmental modifications, and strategies to manage 'freeze ups' during walking. The importance of psychosocial support, addressing depression, and maintaining autonomy through adaptive clothing and utensils is also highlighted.

15:04

🍽️ Digestion and Nutrition in Parkinson's

The fourth paragraph addresses the challenges Parkinson's patients face with digestion and nutrition, including constipation and difficulties with swallowing and chewing. Recommendations for a soft diet, high-fiber intake, and adequate fluid consumption are provided. The role of speech-language pathologists in assessing and managing these issues is mentioned, along with the importance of timing medication intake with meals to optimize absorption.

20:05

💊 Medications for Parkinson's Disease

This paragraph discusses various medications used to treat Parkinson's disease, including carbidopa with levodopa (Sinemet), dopamine agonists like ropinirole (Requip), antivirals like amantadine, anticholinergics like benztropine (Cogentin), and monoamine oxidase inhibitors like selegiline (Zelapar). The paragraph also covers the importance of diet considerations when taking these medications, such as avoiding high protein meals and foods high in tyramine.

25:06

🏁 Conclusion and Further Resources

The final paragraph wraps up the discussion on Parkinson's disease, summarizing the key points and encouraging viewers to take a free quiz and subscribe for more educational content. It emphasizes the importance of understanding the disease and its management, highlighting the role of medication and lifestyle adjustments in improving the quality of life for patients.

Keywords

💡Parkinson's Disease

Parkinson's Disease is a neurodegenerative disorder that primarily affects movement. It is characterized by the degeneration of dopaminergic neurons in the substantia nigra, a part of the basal ganglia. This leads to a decrease in the neurotransmitter dopamine, which is crucial for movement control. The video emphasizes that Parkinson's is a movement disorder, with symptoms such as tremors, rigidity, and bradykinesia. The disease typically affects older adults but can also occur in younger individuals, as exemplified by actor Michael J. Fox.

💡Dopaminergic Neurons

Dopaminergic neurons are neurons that produce and release the neurotransmitter dopamine. In the context of Parkinson's Disease, these neurons are found in the substantia nigra and are responsible for movement control. The death of these neurons leads to a reduction in dopamine, causing the characteristic motor symptoms of Parkinson's. The video script mentions that the loss of dopamine results in decreased accuracy in movement, highlighting the importance of dopamine in the disease.

💡Acetylcholine

Acetylcholine is an excitatory neurotransmitter that plays a crucial role in the nervous system, including muscle movement. In Parkinson's Disease, there is an imbalance between acetylcholine and dopamine. The video explains that the reduced dopamine leads to an over-stimulation of neurons by acetylcholine, causing symptoms like tremors and rigidity. Medications that block acetylcholine, such as anticholinergics, are used to treat these symptoms.

💡Bradykinesia

Bradykinesia refers to the slowness of movement, a common symptom in Parkinson's Disease. The term is derived from 'brady-' meaning slow and '-kinesia' relating to movement. The video script describes how patients with Parkinson's may have difficulty swallowing, speaking, and performing other movements due to bradykinesia. This symptom is a direct result of the reduced dopamine affecting movement control.

💡Tremors

Tremors are involuntary, rhythmic muscle contractions that cause shaking movements. In the context of Parkinson's Disease, tremors often occur at rest and can affect the hands, arms, legs, and even the lips and tongue. The video script specifically mentions 'pill rolling' as a type of tremor in the fingers and hand, which is characteristic of Parkinson's. Tremors are one of the earliest and most noticeable symptoms of the disease.

💡Rigidity

Rigidity, or increased muscle stiffness, is another key symptom of Parkinson's Disease. The video script describes how this can lead to an abnormal gait, where the patient's arms do not swing naturally at their sides and the patient may develop a shuffling walk. Rigidity can also cause a condition called 'cogwheel rigidity,' where the limbs jerk back when passively moved.

💡Anticholinergic Medications

Anticholinergic medications are a class of drugs that block the action of acetylcholine, thereby reducing the overstimulation of neurons. The video script discusses these medications as a treatment for Parkinson's Disease, particularly in younger patients who experience extreme tremors. These medications can help alleviate symptoms like tremors and rigidity but are typically prescribed with caution due to potential side effects.

💡Levodopa

Levodopa, often in combination with carbidopa as 'Sinemet,' is a medication used to treat Parkinson's Disease. It works by increasing the levels of dopamine in the brain. The video script explains that levodopa crosses the blood-brain barrier and is converted into dopamine, which helps improve motor symptoms. However, it also mentions potential side effects like nausea and involuntary movements.

💡Nursing Interventions

Nursing interventions in the context of Parkinson's Disease involve strategies to manage the symptoms and improve the patient's quality of life. The video script outlines several areas of focus, including safety, psychosocial support, digestion and nutrition, and medication education. These interventions aim to address issues like balance and coordination problems, depression, constipation, and difficulties with medication management.

💡Constipation

Constipation is a common issue for patients with Parkinson's Disease, often related to the disease's effect on gastrointestinal motility. The video script discusses the importance of a high-fiber diet, adequate fluid intake, and sometimes the use of stool softeners to manage constipation. This symptom is particularly relevant in the context of the disease's impact on digestion and nutrition.

💡Dopamine Agonists

Dopamine agonists are a class of medications that mimic the action of dopamine by stimulating dopamine receptors. The video script mentions Ropinirole (Requip) as an example of a dopamine agonist used to treat Parkinson's Disease. These drugs can help improve motor symptoms and are also used to treat conditions like restless leg syndrome. However, they can cause side effects such as severe drowsiness.

Highlights

Parkinson's disease is a movement disorder affecting the dopaminergic neurons in the substantia nigra.

Dopaminergic neuron death leads to reduced dopamine production, impacting movement accuracy.

A balance between acetylcholine and dopamine is crucial, with Parkinson's causing an over-activity of acetylcholine.

Anticholinergic medications can be used to treat tremors in younger Parkinson's patients.

Parkinson's typically affects older adults but can also occur in younger individuals, like actor Michael J. Fox.

There is no cure for Parkinson's, but medications can alleviate symptoms.

Early signs of Parkinson's can be subtle and often start unilaterally before progressing.

Common symptoms include tremors at rest, which may appear as 'pill-rolling' in the hands.

Stiffness can cause a shuffling gait and difficulty with voluntary movements, known as 'freezing'.

Bradykinesia refers to the slowness of movement experienced by Parkinson's patients.

Coordination issues can result in problems with swallowing, facial expressions, and speech.

Non-motor symptoms such as loss of smell and constipation are also associated with Parkinson's.

Nursing interventions should focus on safety, psychosocial support, digestion, nutrition, and medication education.

Assistive devices and environmental modifications can improve patient safety and prevent falls.

Education on handling 'freeze ups' and the use of devices like laser-point canes can assist with mobility.

Support groups and maintaining autonomy in daily activities can help combat isolation and depression.

Dietary adjustments, like soft foods and high-fiber intake, are important for managing digestion and nutrition issues.

Medications like carbidopa/levodopa, dopamine agonists, and COMT inhibitors are used to manage symptoms.

Education on medication side effects and dietary restrictions, especially regarding protein intake, is crucial.

Transcripts

this is cereth registered nurse RN comm

and in this video i'm going to be going

over parkinson's disease in this video

is part of an in clicks review series

over the neuro system and as always at

the end of this youtube video you can

access the free quiz i will test you on

this condition so let's get started

first let's start out talking about what

is parkinson's disease it is a neuro

disease that affects movement so

whenever you're studying parkinson's

remember that it is a movement disorder

disease and a lot of your signs and

symptoms are going to deal with

movements now why is this happening why

is there movement being affected

well these dopaminergic neurons start to

die that are located in the substantia

Niagra now where is the substantia

located if you were to look at the side

of the brain here where the red square

is you would see where the substantia

would be located and this area is

part of the basal ganglia which is part

of the midbrain that controls our

movement so if you look deeper and you

took a section of the midbrain you could

find the substantia

and here where these arrows are pointing

you will see that it's black hence why

it's last part of its name is Niagara

which means black and here the

dopaminergic neurons are dying and what

do dopaminergic neurons release they

release the neurotransmitter dopamine so

if they are dying this leads to less

dopamine being produced now what is the

significance of this why is this an

issue

well because dopamine provides us with

accuracy with our movements so if we are

losing this not having a lot of it we're

gonna have problems

so over here we had a normal

dopaminergic neuron it's nice and

healthy

so it's releasing the neurotransmitter

dopamine and those receptors are gladly

accepting that and we're getting normal

movement however over here to contrast

it we have

a dopaminergic neuron that is dying it's

not very healthy so because of that it

can't release a lot of dopamine so those

receptors are fine they're there they're

wanting to take that dopamine which

makes it a little bit different than

these other neuro diseases that we've

talked about the receptors are fine it's

just the issue with the neurotransmitter

so we're getting abnormal movement now

let's talk about the relationship

between acetylcholine and dopamine in

the nervous system there's always this

balance between acetylcholine and Dubb

Amin now acetylcholine is an excitatory

neurotransmitter and it causes

cholinergic activity we talked a lot

about what cholinergic activity does and

our sympathetic versus parasympathetic

video so if you're not familiar with it

be sure to check out that video now

dopamine on the other hand has

inhibitory properties so it's an

inhibitory neurotransmitter so what's

happening in Parkinson's like we've just

talked about there's less dopamine the

neurotransmitter dopamine hanging out at

those receptor sites so that throws off

the balance between acetylcholine and

dopamine so because acetylcholine is an

excitatory neurotransmitter it's going

to cause over stimulation of those

neurons and so that's why you're gonna

see a lot of those signs and symptoms

like tremors rigidity etc which we're

gonna go in detail here in a second and

another thing I want to point out is one

of the treatments like medications for

Parkinson's is to administer

anticholinergic medications to slow down

this cholinergic activity that's going

on and typically it's prescribed for

patients who are younger who have

Parkinson's disease rather than the

older adults because of the side effects

of the anticholinergic and these younger

patients usually are experiencing

extreme tremors so we can give them

these medications and help with that now

let's talk about some key points of this

disease along with the signs and

symptoms it can cause okay Parkinson's

disease tends to usually affect the

older adult population like 60 plus

however it can of

young people for instance a well-known

actor his name is Michael J Fox was

diagnosed with Parkinson's disease at

the age of 29 so young people can get

this disease currently there is no cure

for Parkinson's however medications can

be prescribed which can decrease the

signs and symptoms and we're going to go

over them a little bit later and the

cause of Parkinson's is not fully

understood they think maybe it could be

genetic or an environmental issue now

let's talk about the signs in the

symptoms okay at first in the early

stages of Parkinson's disease the signs

of symptoms tend to be subtle so the

patient or people around them will not

notice the signs and symptoms however as

time goes on they the signs and symptoms

will become worse and the patient will

notice them because it'll affect their

mobility along with the people around

them will see them as well and the signs

and symptoms tend to vary every patient

will be different with what they

experience so remember that also with

Parkinson's a sign and symptom can start

out in one extremity or just one side of

the body and those early stages and then

as time goes on it will progress

throughout the whole body so what is a

common sign and symptom experienced in

Parkinson's disease it is tremors

tremors that will occur at rest and they

can occur in the hands the arms the legs

and even the lips and the tongue now

when the patient experiences tremors of

the fingers and the hand we call this

pill rolling and just as the name says

the hand in the fingers will tremor and

it looks just like the patient is

rolling a pill in between their fingers

so remember this term and Assefa nishan

and as I go throughout the lecture if

you see something that has a unique

nickname remember that because it's

probably gonna be on your exam and one

thing to remember about these tremors is

that they tend to improve with

purposeful movement

they're worse when they're resting

another thing they can experience is

stiffness of the extremities and this

can lead to the patient whenever they

walk instead of their arms swinging at

their side their arms will just be still

at their sides so they'll have an

abnormal looking gait also they can

experience what's called a kinesia and

this is where they lose the ability to

actually do movements voluntarily and

for instance they can be walking and all

of a sudden they frees up their legs

frees up and it feels like their feet

are just stuck to the ground and can't

move and this is term freeze ups in

Parkinson's disease and in our nursing

interventions we're gonna talk about

some education pieces you can provide to

the patient on how to deal with these

freeze ups because that is definitely a

safety issue for them also this

stiffness is going to lead to them

having a shuffling gait where they

really don't pick their feet up very

well as they walk and their posture is

going to be bent forward as they walk

and because of this stiffness they can

have what's called cogwheel rigidity one

of those fancy little nicknames I would

remember and this is where whenever you

passively move their arms for instance

toward their body that the arms will

just jerk back like this as you move

them and that's called cogwheel rigidity

another thing a patient can experience

is called brady kinesia and this is

where their movements are slow so just

look at the word if you were on exam and

you don't know what this word means just

try to dissect it brady means slow like

bradycardia no it's slow heart rate and

kinesia is dealing with movement so they

have slow movements and this can affect

a lot of things for instance they're

swallowing because whenever we are

swallowing we're doing a lot of movement

and we need dopamine to help us with

that so if we don't have a lot of

available they're gonna slow down be

sluggish so they can have difficulty

swallowing food and they can experience

drooling because all that slow Ava's

just staying in their mouth and it can

pull outward because another thing

they're gonna have

like this expressionless faith and it

can be masked like from again where

their movements in their face if they're

gonna smile make some type of

expressions really not going to happen

because those movements are so slow they

can have chewing issues and they can

have speech issues where their voice is

really soft or slurred another thing

they can have is problems with

coordination so they're from a nursing

standpoint they are definitely at risk

for safety issues like Falls and hurting

themselves and again we talked about

this little bit earlier to compensate

for that because they're afraid of

falling they'll stoop forward to

compensate for that to make them

themselves feel like they have better

control of standing now some Nollan

motor signs and symptoms they can

experience is like loss of smell they're

not for sure why that happens but many

times Parkinson's patients tend to say

I've lost my sense of smell they can

also have constipation and again that's

dealing with the GI tract the movement

of those intestines thats slowed down so

they can deal have issues with that and

depression so to help us understand what

a patient let's say with late stage

Parkinson's disease would look like

let's look at this illustration okay

right off the bat we can see as this

patient is standing it's illustrating

him with movement he is bent forward and

if you take a closer look at his face

his face is expressionless

he even has a little bit of drooping in

his face from where the movements are

very slow so it gives him that like

mask-like appearance his hand has a

tremor and then down at the bottom his

feet don't really raised off the ground

as he walks he has like a shuffled type

gait now let's switch gears and talk

about nursing interventions okay based

on all that material we just learned we

should be pulling from our nursing

knowledge and be thinking of some

certain areas that we want to be

intervening

in and these areas include safety

because these patients are gonna have

balance coordination problems because

again this is a movement and disorder so

we've got to watch them with that cuz we

don't want them to fall also they can

experience freeze ups where once the

freeze up is over they increase the risk

of injury so we want to be providing

education about that

another thing is psychosocial these

patients one of the signs and symptoms

is depression also they're going to be

losing the ability as a disease

progresses to take care of themselves so

they're gonna lose their autonomy and

this can make them feel very isolated so

we want to concentrate on that

another thing is digestion and nutrition

they're gonna have constipation issues

and due to the difficulty chewing and

swallowing there's some things we can

help them do with improving that so they

make sure that they're getting as many

calories as they need to maintain and

sustain life along with educating them

about medication side effects and the

education pieces that go with that

because as you're gonna see some of

these medications that they're

prescribed to treat their Parkinson's

has requirements of certain foods that

they need to limit or avoid so as I'm

going over that pay attention to those

points so first let's talk about safety

what can we do to keep our patients safe

well first we want to teach them how to

use assistive devices anywhere from

canes and walkers to handrails in the

bathroom

keeping rugs off the floor that can

cause them to slip along with making

sure if they have pets that those pets

don't get around their feet and cause

them to trip because these patients have

balance issues and to help them with

these balance issues you can tell them

that whenever they go to change

positions they need to do this slowly

and say that they lose their balance a

lot while they're walking they can use a

rubber tip cane that a single point to

help with maintaining stability also

shoe wear is very important they want to

wear a low heel shoe

without that Rubber Soul because those

rubber soles tend to grip to the floor

and this can lead to them tripping so

something other than that that's smooth

but not slick so now let's look at some

education pieces about those freeze ups

that patients can experience and again

this is where for instance say that the

patient's walking and in their walk all

of a sudden their legs freeze up they

can't move or what a patient's described

it is feeling like their feet are stuck

to the ground and they can't move and

after that freeze up there's an

increased risk of injury or fall so what

can you educate the patient to do to

help prevent that from happening okay

one thing is that while they're walking

walking at the freeze up occurs they can

try to change direction of movement so

say they were walking forward freeze up

happens they could try to change their

direction by maybe stepping to the side

another thing is is that they can use a

cane or a walker that has a laser point

to it so if they're using this device as

they use it a laser line will appear on

the ground and as they walk and if

freeze up occurs they will know where to

move their leg after that freeze up is

over so it gives them some coordination

about where they should move their foot

another thing is is as they walk they

need to consciously make the effort to

raise their legs as they walk like they

were marching or stepping over something

instead of having that shuffling type

gait and it's important that the patient

doesn't try to push through those freeze

ups instead just try to bear with it but

don't push through it and use either the

laser point cane which can help them

know where to step or just try to stand

still until the freeze up is over now

let's look at the psychosocial part okay

with these patients we want to help them

feel as autonomous as possible so it's

important that they are able to feed

themselves and do those basic activities

of daily living so it feels like they

have a sense of control over their life

and what

way we can do that is educate them and

show them where they can get special

cookware and utensils to help them be

able to still cook and feed themselves

because forks and spoons and knives

they're made in a different way for

patients who have Parkinson's disease

where they can still feed themselves

also dressing it's best if they put on

shirts that don't have buttons or

zippers which are hard to maneuver when

you're experiencing the tremors and

instead that they velcro so it's easily

to put on or it's just like a sweatshirt

that you slide over the head also the

patient wants to have shoes that they

don't have to tie they're like velcro

and to help prevent isolation there are

local support groups with other people

who are experiencing Parkinson's disease

where these people get together share

their stories and help encourage one

another with this disease so provide

your patient with that it's important to

exercise as much as possible and another

thing that you want to educate the

patients family members and people who

are going to help provide care to these

patients it's not to stress them out

with trying to rush them through their

activities or with getting ready or

presenting something stressful to them

because it actually makes their signs

and symptoms worse and we don't want to

do that and another thing if the

patient's going to have a busy day they

have a lot of things going on it's best

for them to do these activities when

their medications which we're gonna talk

about here in a moment are in their peak

now moving on to digestion and nutrition

because remember these patients are

probably going to experience

constipation and they're gonna have

issues swallowing and chewing so one

thing is that they can have a soft diet

of soft foods that don't require a lot

of chewing that's really easy to swallow

so on an exam if you see which options

are best for a patient with Parkinson's

disease always pick the food that's

easiest to chew and swallow don't pick

some big steak or a taco or something

like that and a lot of these patients

are going to be evaluated by

speech-language pathologists which will

look at their swallowing and chewing

abilities may recommend the liquids

become thickened with nectar honey thick

liquids and it's important that you

educate them about a high-fiber diet

with lots of fresh fruits and vegetables

and to drink at least 2 liters of fluid

per day unless contraindicated that

helps prevent constipation and per MD

order they can take a stool softener to

keep those stools soft and that's the

nurse you want to be asking when was

your last bowel movement if it was a

week ago that's not good and you want to

look at that abdomen listen about belly

sounds palpate on it make sure you don't

feel any hard masses and an education

piece which were really going to go over

here in a second when we talk about meds

is that they want to watch their protein

intake like they need protein so they

need to incorporate that in their diet

but they don't want to eat a protein

rich meal when they take their

medication because they're anti

Parkinson medication because some of

these medications compete with protein

in the small intestine which will

decrease the absorption of that

Parkinson Parkinson medication now let's

talk about medications used to treat

Parkinson's disease now remember these

drugs do not cure the disease but will

help decrease those motor signs and

symptoms so the first thing I want to

talk about is called carbidopa with

levodopa so it's a combination drug and

its brand name is called cinnamon and

what it does is it adds more dopamine in

the brain which is what we need because

we're low on it and how it works is it's

pretty interesting is that the carbidopa

of the pay after the patient ingests it

will prevent the levodopa from breaking

down in the blood so more of it can

cross over into the brain and whenever

the levodopa crosses over it will turn

into dopamine and help decrease those

signs and symptoms some side effects of

this medication include nausea and

involuntary movements now let's talk

about the education pieces associated

with carpet diaper levodopa and I really

want you to pay attention to these diet

pieces down here because it

and in clucks love to ask about that

okay so this medication if your patient

is newly prescribed it let them know

that it can take up to three weeks for

them to notice a decrease in their signs

and symptoms so it's not that the

medication is not working it just takes

a while to take effect also their body

fluids like Slava sweat can turn a dark

color so not to be alarmed by that it

happens with this drug and this drug if

a patient takes it for long-term use

they can start experiencing signs and

symptoms that are really pronounced

before their next scheduled dose of

their carpet Oh beloved open because the

drug is wore off and what they can

prescribe with this which we're going to

talk about here in a second is a comt

inhibitor like int a capone also called

common tan which will help decrease this

is wearing off from happening and this

medication should not be taken with a

mono amine inhibitor it can lead to

hypertensive crisis and the patient

doesn't need to take or consume high

amounts of foods or supplements

containing vitamin b6 it can decrease

the effectiveness of this medication

along with not taking their scheduled

dose of carpet OPA levodopa with a high

protein rich meal like milk and meats

and being things that are super high in

protein because protein and carpet OPA

levodopa compete in the small intestines

and the body will pick protein and it'll

decrease the absorption of this drug

another type of drug used to treat

Parkinson's disease it's called rope pin

or also known as Requip and it is a

dopamine agonist so it stimulates those

dopamine receptors which will help

improve those signs and symptoms it's

also used to treat conditions like

restless leg syndrome and one thing I

want to point out to you is that you

really want to educate your patient that

this can cause severe drowsiness where

they'll become so drowsy where they'll

abruptly fall asleep so they don't mean

to take this

medication before operating machinery or

driving or cooking or something like

that

because they may fall asleep another

type of drug used to treat Parkinson's

is called a manta gene and it is a it's

actually used as well as an antiviral in

the treatment of influenza A but this

drug they have found stimulates the

dopaminergic activity in the CNS which

helps with those signs and symptoms

another category of drug is used to

treat Parkinson's and we talked a little

bit about this in the beginning when we

were talking about the path of

Parkinson's it's called anticholinergics

and one kind is called Vince tripping

and its brand name is ko jintan and what

it does is it blocks the acetylcholine

so you get decreased and that call

energic activity because remember

there's an imbalance between

acetylcholine and dopamine and

acetylcholine was that excitatory

neurotransmitter and the dopamine was

inhibitory neurotransmitter so these

neurons are becoming overstimulated

and you can get those signs and symptoms

so this will help decrease rigidity also

decrease the salivation which will help

with that drooling and decrease signs

and symptoms however this is not for

patients who have glaucoma

so assess your patients history their

eye health and make sure that they don't

have glaucoma and some other things is

that they never want to just quit taking

this abruptly it can cause worsening of

signs and symptoms they will experience

dry mouth with this just because of what

it's doing on the cholinergic side so

sugarless gum or candy can help with

that and absolutely no alcohol while

taking this medication some other drugs

used to treat Parkinson's disease

include monoamine oxidase inhibitors

type B and a popular one is called

recycling also known as a select and

what this does is it increases dopamine

by stopping monoamine oxidase activity

so you're going to get improvement of

those signs and symptoms but there's

some important teaching parts with this

and I would definitely remember this

okay so

whenever any type of monoamine oxidase

inhibitor you don't want the patient

ingesting foods high in tyramine and

this would include foods like aged

cheese smoked cured meats fermented

foods and beer so they would definitely

want to limit those in their diet and

then last but not least are those comt

inhibitors that I talked about earlier

in the lecture when we are talking about

carpet OPA levodopa and popular one is

called intok apone also known as compton

and the comt stands for catechol o

methyl transferase inhibitor and this is

used what with what drug the carpet OPA

levodopa so the cinnamon now how does

this drug work because remember it's

used to decrease that wearing off phase

that can happen with carpet OPA levodopa

and when patients have been using it for

a long term because their signs and

symptoms they notice they're starting to

become more pronounced before that next

dose of their medication so what it'll

do it will block that comt enzyme that

will break down that levodopa in the

blood which will make it last longer

hence not have those signs and symptoms

okay so that wraps up this NCLEX review

over Parkinson's disease thank you so

much for watching don't forget to take

the free quiz and to subscribe to our

channel for more videos