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!
Speaker 1:
Hey and welcome to Nursing with Dr Hobbock Today. I thought we would go over Parkinson's disease, some of the classic features of this terrible disease and things that you'll need to know to be able to take care of these patients. The first thing that should come to mind when you think about Parkinson's disease are the classic symptoms that we see. Those include rigidity of the extremities. This is also called hypertonicity, so the muscles are rigid. We see a mask-like facial expression associated with difficulty in chewing, swallowing and speaking. That's because those muscles are hard to control. We might see some drooling. Those are going to be later on in the disease process. Stooped posture, a slow, shuffling gait. They often have trouble. They have braided kinesia so they have trouble getting that motion started. We'll also see tremors, specifically at rest. The tremors are at rest and they usually start unilaterally, so keep that in mind. They call it pill rolling. When we have a coarse tremor of the fingers and thumb on one hand, it usually disappears during sleep and purposeful activity because again, it's at rest.
Speaker 1:
We want to focus on safety for these patients because with the trouble with movement they are at risk for falls, at risk for injury. So safety is a big concern. I forgot to mention that. Of course they also have postural instability and later on in the disease we can see some lability of the blood pressure. So they have a labile blood pressure.
Speaker 1:
We want to make sure that we schedule their activities later in the day so that they can get their self-care activities completed without rushing. We may need to encourage exercise that's still going to help. A cane or a walker Might be something that they need an ambulatory aid. We want to keep the environment less noisy and just encourage them to speak slowly, clearly and pause at intervals. A soft diet is usually easy to swallow and remember. When we're helping somebody who's having trouble swallowing, we're going to ask them to tuck their chin when they swallow. Anybody out there who's an RD, go ahead and put your comments there someplace so that we can see some additional swallowing advice. And then we want to make sure that we give them their anti-Parkinsonian drugs as prescribed. Classic medication would be levodopa, which is the precursor to dopamine. We usually give levodopa-carbodopa and that medication can cause changes in blood pressure. So we want to make sure the patient gets up slowly, that they allow themselves a little bit of time before they start moving. So when they sit up on the bed. Let's dangle a little bit Once they stand, give their blood pressure just a few minutes to normalize and then go ahead and get started moving.
Speaker 1:
To contrast Parkinson's with Huntington's, huntington's is a rare hereditary disorder that is really characterized by progressive dementia and those choreoform movements, those uncontrolled, rapid jerky movements. So we might. If someone is young or middle-aged with those signs and symptoms, they could potentially be confused or misdiagnosed with Huntington's versus Parkinson's disease. Parkinson's can also cause changes in cognition, including dementia and psychosis in the later stages. We know that primary Parkinson's, which is when you have Parkinson's disease, that's not caused by something else, that it does have a familial tendency and it's associated with a variety of mitochondrial DNA variations. What we want to make sure that we know when we collect our data from the patient time of onset of symptoms, the progression of them that's been noticed by the family. We want to make sure that some people don't really think that these are associated with aging, that they're normal signs and symptoms. But it's that unilateral resting tremor that is usually noticed first and in one arm, unilateral. Of course, if you developed Parkinson's you could also have emotional changes like depression, irritability, apathy, insecurity. I can only imagine that I would feel any of those emotions.
Speaker 1:
There are a couple of surgical options stereotactic and paladotomy, which is an opening into the pallidum within the corpus striatum. That can be an effective treatment for controlling symptoms. And deep brain stimulation is the one I have the most experience with and that is a proof of treatment for Parkinson's disease. The electrodes are implanted into the brain and connected to a small electric device called a pulse generator and that delivers an electrical current. The generator is usually placed under the skin, kind of like a pacemaker is, and externally programmed, and this actually can help decrease those involuntary movements, that dyskinesia that's associated. It can also reduce the need for levodopa, the medication that I mentioned earlier, and it can help alleviate fluctuations in symptoms, help with that slowness of movement and gait problems.
Speaker 1:
So there's one final thing fetal tissue transplantation. That's experimental as far as I know and of course highly controversial ethical and politically, where the fetal substantia nigratissue is transplanted into the caudate nucleus of the brain. Preliminary reports suggest that they do have clinical improvement with this in their motor symptoms after receiving it, but we don't really know long-term what will happen. That's all I've got for Parkinson's disease. Thanks for joining me today and I'll see you next time on Nursing with Dr Havik.