Parkinson’s Disease Research Paper
Definition of Disease Processpage 3
Signs and Symptomspages 4 -5
Diagnosis and Treatmentpages 5-6
Nursing Diagnosispages 6-7
Parkinson Disease (PD) is a neurologic disorder that affects the motor neurons of the brain and includes systemic nonmotor and neurologic symptoms (McCance, Huether, and Brashers 565). The disease is caused by the degeneration of the basal ganglia, affecting the dopaminergic nigrostriatal pathway. There are primary and secondary causes of Parkinsonism. The primary causes include idiopathic and genetic. Conversely, secondary causes include neurodegenerative disorders, such as different dementia conditions, certain genetically mediated disorders, such as Huntington disease, repeated head trauma, metabolic conditions, drugs, and toxins. The onset of PD is usually after 40 years of age and it is the most prevalent of the primary central nervous system disorders and leading cause of neurologic disability in individuals over the age of 60. Men are much more likely to develop PD than are women (McCance, Huether, and Brashers 565).
The degeneration of the dopaminergic pathway in the substantia nigra causes a decrease in secreted dopamine (McCance, Huether, and Brashers 565). The decrease in dopamine secrete causes underactivity of the direct motor pathway, the part of the brain that facilitates movement, and overactivity of the indirect motor loop, the part of the brain that inhibits movement. This imbalance of promoting and inhibiting parts of the brain causes the symptoms characteristic of PD. The decrease in motor cortex activity produces the symptoms of bradykinesia and rigidity. The increase in subthalamic nucleus activity affects the limbic system, producing emotional signs and symptoms of the disease (McCance, Huether, and Brashers 565).
The cause to the disease is still unknown. However, according to the Mayo Clinic, researchers have identified several factors that play a role in the development of the neurological impairment. Specialists have identified specific genetic mutations that increase one’s risk for the development of PD (“Parkinson’s disease”). Additionally, researchers have identified that environmental triggers such as certain toxins increase one’s risk for the development of Parkinson’s (“Parkinson’s disease).
The onset of symptoms typically occurs after 70-80% loss of pigmented nigral neurons and 60-90% loss of striatal dopamine (McCance, Huether, and Brashers 566). The classic symptoms of PD include a resting tremor, bradykinesia or akinesia (the loss of movement), rigidity (muscle stiffness), and postural abnormalities. Every case is different as one or many symptoms may occur. However, as the disease progresses to later stages, it is common to see all four symptoms. The manifestations are graded on the Hoehn and Yahr scale, a device used to assess the progression of the disease’s symptoms (McCance, Huether, and Brashers 566). The scale is as follows:
The tremor is the first sign to appear (McCance, Huether, and Brashers 566). It is seen at rest and disappears when the patient moves his or her limb for a purposeful movement. Intensity and amplitude of the tremor varies among patients and their disease process. The tremor more often affects the arms than the legs (McCance, Huether, and Brashers 566). The tremor is caused by the lack of inhibitory influences of dopamine (McCance, Huether, and Brashers 567). More simply, the rigidity is an increased resistance to the passive movement of a joint that impedes active and passive movement. The rigidity usually begins as painful cramps in the toes and hands. There are two subtypes of rigidity, plastic and cogwheel, which the patient may experience. Bradykinesia occurs when there is an absence of voluntary movement. This is the most prevalent and devastating symptom. The overactive subthalamic nucleus inhibits the motor thalamus and cortex, producing the absence of purposeful movements. Lastly, a patient’s posture may also be affected, caused by a loss of normal postural reflexes, muscular rigidity, axial dystonia, weakness caused by myopathy, and impaired proprioception. Furthermore, the postural abnormalities causes a decrease in a patient’s equilibrium, causing him to tilt or fall (McCance, Huether, and Brashers 567).
Eventually, as the disease progresses, the autonomic and neuroendocrine dysfunctions produce nonmotor symptoms that create increased discomfort to the patient (McCance, Huether, and Brashers 567). These other symptoms include inappropriate diaphoresis, gastric retention, constipation, and urinary retention (McCance, Huether, and Brashers 567). Additionally, mental status can be affected. In the early stages, mental status is usually normal (McCance, Huether, and Brashers 566). However, as the disease progresses, nonmotor symptoms may include hyposmia, fatigue, pain, autonomic dysfunction, sleep fragmentation, depression, and dementia with or without psychosis (McCance, Huether, and Brashers 566).
The diagnosis of PD is made by assessment of the patient’s signs and symptoms, biochemical markers, genetic tests, and imaging techniques that help to visualize the brain. Upon examination of the brain structure, one will find the brain to have Lewy bodies, fibrillary intracellular eosinophilic inclusions, and high concentrations of alpha-synuclein, ubiquitin, tau protein, tuberculin, and other proteins within the substantia nigra, locus ceruleus, and other areas of the brain. These deformities lead to an increase in the dysfunction of the brain structures. The degeneration of the locus ceruleus causes a decrease in noradrenergic neurons and the loss of norepinephrine may be associated with behavioral symptoms as norepinephrine is hypothesized to be a neuroprotective. Furthermore, molecular events, such as mitochondrial dysfunction, oxidative stress, abnormal folding of brain matter, abnormal phosphorylation and dysfunction of chemical systems add to the neurological degeneration (McCance, Huether, and Brashers 566).
After the diagnosis of PD is made, drug therapy is started and aims to restore dopamine levels in the brain (McCance, Huether, and Brashers 568). Such oral medications include levodopa, a precursor to dopamine, dopamine agonists, anticholinergic drugs, antihistamines, amantadine, and monoamine oxidase B inhibitors. All these drugs work to control the motor functions of the body. In addition, other therapies, such as physiotherapy, speech therapy, and occupational therapy to prevent the secondary symptoms of the disease and further complications (McCance, Huether, and Brashers 568).
Several nursing diagnoses exist as PD affects all of the body’s systems. First and foremost, the endocrine system is affected as there is a decreased dopamine secretion related to the degeneration of the substantia nigra (Ackley). This is the most important nursing diagnosis for PD as it is the causation of the disease and its symptoms. The second most important system affected is the respiratory system. There is decreased respiratory function (later in the disease) related to the degeneration of the autonomic nervous system and a risk for aspiration related to immobility. Although these effects may be seen later in the disease, they cause the most lethality to the individual affected with the disease. The next most important diagnosis is to the immune system. There is a risk for decreased immune function related to corticosteroid medication use. Corticosteroids may be prescribed to relieve that pain and joint stiffness associated with the disease. A decrease in immune function puts the patient at increased risk for infection. The fourth most important diagnosis is to the neurological system. The patient experiences decreased cognitive function related to the degeneration of the brain and impaired verbal communication related to the decline in speech and facial muscle stiffness. This is a very important consequence of the disease, however, I would not rate it above any of the others. Although the patient may not be able to tell us some things, we know that every patient requires nutrition, medication, and to maintain personal hygiene. The next nursing diagnosis is for the musculoskeletal system. The patient experiences impaired physical mobility related to stiffness and muscle weakness caused by the disease. These changes increase the patient’s risk for falls and causes many of the other problems experienced due to the decrease in mobility. The sixth nursing diagnosis is for the patient’s integumentary system. The patient is at risk for skin breakdown related to immobility and decreased continence. A decrease in mobility will cause pressure sores and skin breakdown that may become infected. The next nursing important diagnosis is for the gastrointestinal system. There is impaired bowel elimination related to medication use and decreased mobility and activity. Very closely related is the decline to the urinary system. The patient experiences decreased urinary continence related to immobility and neurological impairment. The next system to be affected is the cardiovascular system. PD does not have a very large impact on this system, as compared to the other systems of the body. However, it can lead to a risk for cardiovascular disease related to the inability of the blood vessels to supply oxygen to the tissues. Lastly, the reproductive system is affected. The patient will experience sexual dysfunction related to altered body function and neurological impairment. This is the least important diagnosis as it is not lethal to the patient. It will in fact have an impact on the patient’s relationship with his or her significant other, but this will be the least of their worries (Ackley).
Ackley, Betty J. Nursing Diagnosis Handbook: An Evidence-based Guide to Planning Care. 10th
ed. Maryland Heights: Mosby, 2014. Print.
McCance, K., Huether, S., Brashers, V., & Rote, N. (2014). Pathophysiology: The biologic basis
for disease in adults & children (7th ed., p. 668). St. Louis: Mosby.
"Parkinson's Disease." Mayo Clinic. Mayo Foundation for Medical Education and Research, 28
May 2014. Web. 2 Mar. 2015. <http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/causes/con-20028488>.
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