CENTRAL LUZON COLLEGE OF SCIENCE AND TECHNOLOGY

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN RELATED LEARNING EXPERIENCE IN NCM 103

PARKINSONS DISEASE
(CASE STUDY)
SUBMITTED BY: Barabad, Apple Dimapilis, Rina Nina Felipe, Aileen Jennifer Imperial, Gayle Mamaril, Bruce Kelly Sakili, Smyrna Sardan, Apple Mhae

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INTRODUCTION Parkinsons disease (also known as Parkinsons, Parkinson Disease, or PD) is a degenerative disorder of the central nervous system that impairs motor skills, cognitive processes, and other functions. The most obvious symptoms are motor-related, including tremor, rigidity, slowness of movement and postural instability. Among non-motor symptoms are autonomic dysfunction, and sensory and sleep difficulties. Cognitive and neurobehavioral problems, including dementia, are common in the advance stages of the disease. PD usually appears around the age of 60, though there are young-onset cases. PD is also called Primary Parkinsonism or Idiopathic PD (meaning having no known cause), although some cases have a genetic origin. Many risk and protective factors have been investigated, showing an increased risk of PD in those exposed to pesticides; and a reduced risk in smokers. Symptoms result from insufficient midbrain (especially the substantia nigra). Pathologically, the disease is characterized by the accumulation of alphasynuclein protein forming inclusions called Lewy bodies. Such pathology can only be demonstrated at autopsy, so diagnosis is mainly clinical (based on symptoms). Some tests such as nueroimaging techniques can also aid in diagnosis. The disease is named after the English surgeon, James Parkinson, who gave the first detailed description of it, in An Essay on the Shaking Palsy (1817). PD is a costly disease to society. Several major organizations promote research and improvement of quality of life of those with the disease and their families. Research directions include a search of new animal models of the disease, and investigation of the agents.

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Advocacy actions includes April 11, birthday of James Parkinson as the World Parkinsons Day, and the use of red tulip as the symbol of the disease. People with PD who have greatly affected public awareness include Michael J. Fox and Muhammad Ali. Epidemiology Parkinsons disease occurs worldwide in equal incidence between men and women. Disease symptoms usually begin the ages of 40 and 70, peak age at onset occurring in the sixth decade. In North America, there are approximately one million patients with Parkinsons disease. It is estimated that 1 percent of the population over age 65 is afflicted. Etiology The etiology of Parkinsons disease is unknown. Several factors may play a part in causing the disease including hereditary predisposition, environmental toxins, and aging. Several studies have examined the possibility of a gene that can be linked to Parkinsons disease. There have been a few case reports of multiple cases within an extended family. The search for a specific gene responsible for Parkinsons disease continues. Environmental toxin exposure has been identified as a potential cause. Chemical such as carbon monoxide, carbon disulfide, cyanide, manganese, and

methylphenyltetrahydropyridine (MPTP) have been linked to the development of Parkinsons disease. MPTP is containment often bound in elicit strip drugs. Another environmental exposure connected to the development of Parkinsons disease is seen in welders, but the age of onset is earlier (30-40 years old).

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Two theories are being examined concerning aging as a cause of Parkinsons disease. The first theory states that the disease is an accelerated form of aging. The second theory attributes the cause to some acute insult to the substantia nigra, followed by a slow loss of neurons, and development of symptoms in the six decades of life. Research continues in hopes of eventually identifying a specific cause of Parkinsons disease.

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ANATOMY AND PHYSIOLOGY

Frontal Lobe The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms (Kolb & Wishaw, 1990). The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium, proximity to the sphenoid wing and their large size. MRI studies have shown that the frontal area is the most common region of injury following mild to moderate traumatic brain injury (Levin et al., 1987).

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Functions: How we know what we are doing within our environment. (Conciousness) How we initiate activity in response to our environment. Judgments we make about what occurs in our daily activities. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose. Involves word associations. Memory for habits and motor activities.

Observe Problems: Loss of simple movement of various body parts. (Paralysis) Inability to plan a sequence of complex movements needed to

complete multi-stepped tasks, such as making coffee. (Sequencing) Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought. (Perseveration) Inability to focus on task. (Attending) Mood changes. (Emotionally Labile) Changes in social behavior. Changes in personality.

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Difficulty with problem solving. Inability to express language. (Brocas Aphasia)

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PATHOPHYSIOLOGY

Parkinsons disease is a slowly degenerative neurological disorder caused by the loss of nerve cell function in the basal ganglia. The basal ganglia includes several structures, the substantia nigra, striatum, globus palidus, subthalamic nucleus. and the red nucleus. Loss of nerve cells in the substantia nigra causes a reduction of dopamine production. Dopamine is the neurotransmitter essential for such functions as control of posture, supporting body in an upright position, and voluntary motions (Calne & Kumar, 2003).

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DIAGNOSTIC TEST A diagnosis of Parkinsons Disease is based on your medical history and a thorough neurological exam. Your doctor also may check your sense of smell. Sometimes, your doctor will have you try a medicine for Parkinsons disease. If that medicine helps your symptoms, it may help the doctor find out if you have Parkinsons disease. There are no lab tests that can diagnose Parkinsons disease. If your symptoms and the doctors findings during the examination are not entirely typical of Parkinsons disease, certain tests may be done to help diagnose other conditions with similar symptoms. For instance, blood tests may be done to check for abnormal thyroid hormone levels or liver damage. An imaging test (such as a CT scan or MRI) may be used to check for signs of a stroke or brain tumor. Another type of imaging test, called PET, sometimes may detect low levels of dopamine in the brain, a key feature of Parkinsons disease. But PET scanning is not commonly used to evaluate Parkinsons disease because it is very expensive, is not available in many hospitals, and is only experimentally. Early Detection For some diseases, doctors can do tests to look for problems or diseases before you have any symptoms. This is called screening. But there is no screening test for Parkinsons disease at this time.

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BIBLIOGRAPHY Nursing 2007 ( 27th Edition) DRUG HANDBOOK (Lippincott Williams and Wilkins) Thomson Asian Edition CONTEMPORARY MEDICAL-SURGICAL NURSING (Rick Daniels; Laura Nosek; Leslie Nicoll) Brunner and Suddarths (Eleventh and Tenth Edition) TESTBOOK OF MEDICAL AND SURGICAL NURSING (Suzanne C. Smeltzer; Brenda G. Bare; Janice L. Hinkle; Kerry H. Cheever) Nurses Pocket Guide ( Ninth and Eleventh Edition) DIAGNOSES, INTERVENTIONS, AND RATIONALES (Marilynn E. Doenges; Mary Frances moorhouse; Alice C. Geissler-Murr) Bates Pocket Guide To Physical Examination and History Taking (Ninth Edition) http://www.philippinenursingdirectory.com http://www.webmd.com http://www.nurselabs.com http://en.wikipedia.com http://www.nursingcrib.com http://www.pinoynurse.com

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SURGICAL MANAGEMENT Some patients with Parkinsons disease respond differently to the pharmacological methods of treatment. Other patients have the potential for less conservative treatments in the form of surgical interventions. Some of these types of surgical management are relatively recent and have varying levels of success.

SURGERY
Thalamotomy Pallidotomy

PROCEDURE
Lesion placed in the thalamus Destruction of globus plallidus using electrical stimulation

OUTCOME
Relief of tumors Improved control of symptoms

Deep-brain Stimulation

Placement of electrode(s) in the thalamus, then attaching to a Relief of tumors pulse generator implanted in the infraclavicular region.

Experimental Treatments Provide viable dopamine producing cells into the caudate nucleus. Provide viable dopamine producing cells into the caudate nucleus. Long-term results have not been promising

Adrenal Tissue Transplant

Stem Cell Transplant

Long-term results have not been promising

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PHYSICAL ASSESSMENT

SKIN HEAD AND NECK

Normal Facial Movements: not symmetry Visual Impairment: normal; wear glasses Hearing Impairment: normal; hard of

hearing (possible due to age) Neck: normal; stiffness (possible) THRORAX AND LUNGS Chest Appearance: symmetrical Lungs: normal Breath Pattern: Non-labored Breath Sound: Clear all lobes CARDIOVASCULAR Rhythm: regular Type: pounding Radial Pulses: palpable Dorsalis Pedis: palpable ABDOMEN Malnourished Oral Mucosa: moist; dry (possible because of medications side effects) Bowel Sound: present

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MUSCULOSKELETAL

Joint Stiffness; Tremors Muscle Strength: Grips: weak Pushes: weak

NERVOUS SYSTEM

Presence of motor disturbances Level of Consciousness: stuporous Speech Impairment: slurring Communication Barrier: yes