Parkinson’s Disease
Parkinson’s Disease: Caused by degeneration of the substantia nigra, results in too little
dopamine and too much acetylcholine so you have an imbalance
Symptoms:
oTremor
oSlow shufÒing of gait
oMuscle rigidity
oBradykinesia (slow movement)
oMask like face
oDrooling (sialorrhea)
oDifÏculty swallowing
Care:
-Monitor swallowing, food intake, thicken food, sit up right to eat, have suction
available, encourage ROM (range of motion) & exercise, help with ADLS as
needed..
Medications:
oLevodopa carvadopa (Sinemet) - Increases dopamine
oBenzdropine anticholinergic that decreases acetylcholine.
Communication board:
oSpeech difÏculties & voice problems are common in these people. This is
because it affects nerves & muscles that affect your speech like the larynx
(voice box), throat, resp muscles, roof of mouth, tongue & lips, facial muscle
movement,, areas of the brain that control hearing and affect voice & speech
processing .
oPT may experience softened voice or reduced volume in voice, speaking in
unchangeable pitch (monotoned). Having hoarse or strained voice,
breathiness in voice, run out of air while speaking, trouble clearly and easily
pronouncing speech, loss of facial expression.
, oCan use pen and paper if possible, or alphabet board to point to first letter of
word being said, spell word s with board or use gestures.
Increase calorie intake:
• Dyskinesia: extra movements which can be a side effect of Levodopa Carvadopa
(Sinemet) resulting in excessive energy consumption, you burn more calories leading to
weight loss,, so you need to increase intake of calories to maintain weight & for energy..
Drooling:
• Keep chin up & lips closed when not speaking or eating, swallow often, especially before
speaking, ask speech therapist about exercises to strengthen up muscles, avoid sugary
foods that can cause more saliva to develop,, ask about medications that help with
decreasing saliva such as anticholinergics like glycopyrrolate and scopolamine and
benzhexol hydrochloride..
Fall risk:
• Due to poor balance, freezing, stooped posture (causes forward falls).
, Epilepsy/Seizures
Seizure
• Uncontrolled electrical impulses of neurons.
Epilepsy
• Chronic seizures.
Care for pt experiencing a seizure:
• Prime objective when caring for a pt experiencing a seizure is to prevent injury, keep a
patent airway, and if possible, turn pt to their side to prevent aspiration if they vomit. DO
NOT force anything into mouth or airway once a seizure has begun. Airway takes priority.
Reducing stimuli will not help once a seizure has begun.
Medications (Seizure meds are taken lifelong):
oPhenytoin (10 - 20mcg//mml safe dose)) - an antiseizure hydantoin. Side
effects include drowsy & dizziness. Adverse reactions include steven Johnson's
syndrome. Do not take if pregnant. Do not take with herbals, or
anticoagulants, monitor serum blood levels and liver enzymes, take with foods
high in calcium.
oLorazepam – Sedative that is used to treat seizures, like epilepsy, can be
used before surgery and medical procedures to relieve anxiety. Can cause
paranoid or suicidal ideation, impair memory, judgement & coordination.
Combining with other substances like alcohol can lead to slow
breathing/death.
oGabapentin – Anticonvulsant prescribed to prevent recurrent seizures.
Sudden withdrawal can result in status epilepticus.
oDiazepam – 1st line for continuous seizures. Do not give with CNS
depressant, will make more tired.
EEG:
• Records brain waves between seizures called interictal brain waves. Electrodes are
attached to scalp with a paste like substance or cap. Does not always show past
, abnormalities. Can show abnormalities even if seizure does not occur during the test. Helps
diagnose seizure types.
Safety:
• Important to prevent injury. Make sure environment is safe as possible. Pad bed rails, have
suction in the room, never put anything in their mouths once they are seizing, DO NOT
restrain someone seizing.
Triggers:
• Stress, caffeine, fatigue, flashing lights.
Risk factors:
• Cerebral edema, fevers, infection, exposure to toxin, brain tumors, hypoxia,, alcohol//drug
withdrawal,, fluid & electrolyte imbalances .
Post Ictal:
• Period after seizure pt is confused, you need to reorientate them.
10 - 20mcg//mml is the therapeutic range of phenytoin.
Electrolyte imbalances that cause seizures:
oEspecially hyponatremia
oHypocalcemia
oHypomagnesemia
oAlbumin – 3.5 - 5
oIron – male 80 - 180 female 60 - 160
oMagnesium – 1.5 - 2.5
oPhosphorus – 2 - 4.5
oHemoglobin – male 14 – 18 female 12 - 16
oHematocrit – male 42 - 52 percent female 37 - 47 percent
oWBC – 5 - 10mm
oRBC – male 4.7 - 6.1 female 4.2 - 5.4
oBicarbonate – 22 - 28
oO2 sat – 95 - 100 percent
oBleeding time – 1 - 9 minutes
oD dimer – 500ng//mml
oCholesterol <200mg//ddl
Parkinson’s Disease: Caused by degeneration of the substantia nigra, results in too little
dopamine and too much acetylcholine so you have an imbalance
Symptoms:
oTremor
oSlow shufÒing of gait
oMuscle rigidity
oBradykinesia (slow movement)
oMask like face
oDrooling (sialorrhea)
oDifÏculty swallowing
Care:
-Monitor swallowing, food intake, thicken food, sit up right to eat, have suction
available, encourage ROM (range of motion) & exercise, help with ADLS as
needed..
Medications:
oLevodopa carvadopa (Sinemet) - Increases dopamine
oBenzdropine anticholinergic that decreases acetylcholine.
Communication board:
oSpeech difÏculties & voice problems are common in these people. This is
because it affects nerves & muscles that affect your speech like the larynx
(voice box), throat, resp muscles, roof of mouth, tongue & lips, facial muscle
movement,, areas of the brain that control hearing and affect voice & speech
processing .
oPT may experience softened voice or reduced volume in voice, speaking in
unchangeable pitch (monotoned). Having hoarse or strained voice,
breathiness in voice, run out of air while speaking, trouble clearly and easily
pronouncing speech, loss of facial expression.
, oCan use pen and paper if possible, or alphabet board to point to first letter of
word being said, spell word s with board or use gestures.
Increase calorie intake:
• Dyskinesia: extra movements which can be a side effect of Levodopa Carvadopa
(Sinemet) resulting in excessive energy consumption, you burn more calories leading to
weight loss,, so you need to increase intake of calories to maintain weight & for energy..
Drooling:
• Keep chin up & lips closed when not speaking or eating, swallow often, especially before
speaking, ask speech therapist about exercises to strengthen up muscles, avoid sugary
foods that can cause more saliva to develop,, ask about medications that help with
decreasing saliva such as anticholinergics like glycopyrrolate and scopolamine and
benzhexol hydrochloride..
Fall risk:
• Due to poor balance, freezing, stooped posture (causes forward falls).
, Epilepsy/Seizures
Seizure
• Uncontrolled electrical impulses of neurons.
Epilepsy
• Chronic seizures.
Care for pt experiencing a seizure:
• Prime objective when caring for a pt experiencing a seizure is to prevent injury, keep a
patent airway, and if possible, turn pt to their side to prevent aspiration if they vomit. DO
NOT force anything into mouth or airway once a seizure has begun. Airway takes priority.
Reducing stimuli will not help once a seizure has begun.
Medications (Seizure meds are taken lifelong):
oPhenytoin (10 - 20mcg//mml safe dose)) - an antiseizure hydantoin. Side
effects include drowsy & dizziness. Adverse reactions include steven Johnson's
syndrome. Do not take if pregnant. Do not take with herbals, or
anticoagulants, monitor serum blood levels and liver enzymes, take with foods
high in calcium.
oLorazepam – Sedative that is used to treat seizures, like epilepsy, can be
used before surgery and medical procedures to relieve anxiety. Can cause
paranoid or suicidal ideation, impair memory, judgement & coordination.
Combining with other substances like alcohol can lead to slow
breathing/death.
oGabapentin – Anticonvulsant prescribed to prevent recurrent seizures.
Sudden withdrawal can result in status epilepticus.
oDiazepam – 1st line for continuous seizures. Do not give with CNS
depressant, will make more tired.
EEG:
• Records brain waves between seizures called interictal brain waves. Electrodes are
attached to scalp with a paste like substance or cap. Does not always show past
, abnormalities. Can show abnormalities even if seizure does not occur during the test. Helps
diagnose seizure types.
Safety:
• Important to prevent injury. Make sure environment is safe as possible. Pad bed rails, have
suction in the room, never put anything in their mouths once they are seizing, DO NOT
restrain someone seizing.
Triggers:
• Stress, caffeine, fatigue, flashing lights.
Risk factors:
• Cerebral edema, fevers, infection, exposure to toxin, brain tumors, hypoxia,, alcohol//drug
withdrawal,, fluid & electrolyte imbalances .
Post Ictal:
• Period after seizure pt is confused, you need to reorientate them.
10 - 20mcg//mml is the therapeutic range of phenytoin.
Electrolyte imbalances that cause seizures:
oEspecially hyponatremia
oHypocalcemia
oHypomagnesemia
oAlbumin – 3.5 - 5
oIron – male 80 - 180 female 60 - 160
oMagnesium – 1.5 - 2.5
oPhosphorus – 2 - 4.5
oHemoglobin – male 14 – 18 female 12 - 16
oHematocrit – male 42 - 52 percent female 37 - 47 percent
oWBC – 5 - 10mm
oRBC – male 4.7 - 6.1 female 4.2 - 5.4
oBicarbonate – 22 - 28
oO2 sat – 95 - 100 percent
oBleeding time – 1 - 9 minutes
oD dimer – 500ng//mml
oCholesterol <200mg//ddl
