Wondering how to navigate the intricate journey of caring for Parkinson's patients? We've got your back. Join us on this episode of "Nursing with Dr Hobbock Today," as we unpack the nuances of the disease. From identifying the hallmark symptoms to exploring the potential risks and the importance of creating a safe environment, we've got you covered. The conversation gets even more interesting as we discuss strategies to manage the disease, such as scheduling activities later in the day and encouraging slow, clear speech.
Dive deeper with us into the world of neurodegenerative disorders as we compare Parkinson's with Huntington's disease. Witness the intricacies of cognitive changes that can occur with Parkinson's. Enlighten yourself with the treatment options, including the revolutionary deep brain stimulation and the contentious experimental fetal tissue transplantation. Hear insights from Dr Hobbock on the significance of patient data, such as time of onset of symptoms and their progression. This episode is a treasure trove of vital knowledge for those caring for Parkinson's patients, don't miss out!
Episode Transcript
Hey and welcome to Nursing with Dr Hobbock Today.
I thought we would go overParkinson's disease, some of the
classic features of thisterrible disease and things that
you'll need to know to be ableto take care of these patients.
The first thing that shouldcome to mind when you think
about Parkinson's disease arethe classic symptoms that we see
.
Those include rigidity of theextremities.
(01:03):
This is also calledhypertonicity, so the muscles
are rigid.
We see a mask-like facialexpression associated with
difficulty in chewing,swallowing and speaking.
That's because those musclesare hard to control.
We might see some drooling.
Those are going to be later onin the disease process.
Stooped posture, a slow,shuffling gait.
(01:26):
They often have trouble.
They have braided kinesia sothey have trouble getting that
motion started.
We'll also see tremors,specifically at rest.
The tremors are at rest andthey usually start unilaterally,
so keep that in mind.
They call it pill rolling.
When we have a coarse tremor ofthe fingers and thumb on one
(01:47):
hand, it usually disappearsduring sleep and purposeful
activity because again, it's atrest.
We want to focus on safety forthese patients because with the
trouble with movement they areat risk for falls, at risk for
injury.
So safety is a big concern.
I forgot to mention that.
(02:07):
Of course they also havepostural instability and later
on in the disease we can seesome lability of the blood
pressure.
So they have a labile bloodpressure.
We want to make sure that weschedule their activities later
in the day so that they can gettheir self-care activities
completed without rushing.
We may need to encourageexercise that's still going to
(02:31):
help.
A cane or a walker Might besomething that they need an
ambulatory aid.
We want to keep the environmentless noisy and just encourage
them to speak slowly, clearlyand pause at intervals.
A soft diet is usually easy toswallow and remember.
When we're helping somebodywho's having trouble swallowing,
(02:53):
we're going to ask them to tucktheir chin when they swallow.
Anybody out there who's an RD,go ahead and put your comments
there someplace so that we cansee some additional swallowing
advice.
And then we want to make surethat we give them their
anti-Parkinsonian drugs asprescribed.
Classic medication would belevodopa, which is the precursor
(03:19):
to dopamine.
We usually givelevodopa-carbodopa and that
medication can cause changes inblood pressure.
So we want to make sure thepatient gets up slowly, that
they allow themselves a littlebit of time before they start
moving.
So when they sit up on the bed.
Let's dangle a little bit Oncethey stand, give their blood
pressure just a few minutes tonormalize and then go ahead and
(03:41):
get started moving.
To contrast Parkinson's withHuntington's, huntington's is a
rare hereditary disorder that isreally characterized by
progressive dementia and thosechoreoform movements, those
uncontrolled, rapid jerkymovements.
So we might.
If someone is young ormiddle-aged with those signs and
(04:02):
symptoms, they couldpotentially be confused or
misdiagnosed with Huntington'sversus Parkinson's disease.
Parkinson's can also causechanges in cognition, including
dementia and psychosis in thelater stages.
We know that primaryParkinson's, which is when you
have Parkinson's disease, that'snot caused by something else,
(04:24):
that it does have a familialtendency and it's associated
with a variety of mitochondrialDNA variations.
What we want to make sure thatwe know when we collect our data
from the patient time of onsetof symptoms, the progression of
them that's been noticed by thefamily.
We want to make sure that somepeople don't really think that
(04:46):
these are associated with aging,that they're normal signs and
symptoms.
But it's that unilateralresting tremor that is usually
noticed first and in one arm,unilateral.
Of course, if you developedParkinson's you could also have
emotional changes likedepression, irritability, apathy
, insecurity.
(05:07):
I can only imagine that I wouldfeel any of those emotions.
There are a couple of surgicaloptions stereotactic and
paladotomy, which is an openinginto the pallidum within the
corpus striatum.
That can be an effectivetreatment for controlling
symptoms.
And deep brain stimulation isthe one I have the most
(05:29):
experience with and that is aproof of treatment for
Parkinson's disease.
The electrodes are implantedinto the brain and connected to
a small electric device called apulse generator and that
delivers an electrical current.
The generator is usually placedunder the skin, kind of like a
pacemaker is, and externallyprogrammed, and this actually
(05:49):
can help decrease thoseinvoluntary movements, that
dyskinesia that's associated.
It can also reduce the need forlevodopa, the medication that I
mentioned earlier, and it canhelp alleviate fluctuations in
symptoms, help with thatslowness of movement and gait
problems.
So there's one final thing fetaltissue transplantation.
(06:10):
That's experimental as far as Iknow and of course highly
controversial ethical andpolitically, where the fetal
substantia nigratissue istransplanted into the caudate
nucleus of the brain.
Preliminary reports suggestthat they do have clinical
improvement with this in theirmotor symptoms after receiving
(06:32):
it, but we don't really knowlong-term what will happen.
That's all I've got forParkinson's disease.
Thanks for joining me today andI'll see you next time on
Nursing with Dr Havik.
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