Drug: Antiviral Agents: Amantadine (Symmetrel)
Indication: Decrease rigidity and akinesia
Side effects: Confusion, lightheadedness, anxiety, blurred vision, dry mouth, urinary retention, constipation
Drug: Anticholinergic Agents:
• Benztropine (Cogentin)
• Biperidan (Akineton)
• Orphenadrine (Disipal)
• Trihexphenidyl (Artane)
Indication: Decrease tremors and rigidity
Side effects: Dry mouth, blurred vision, urinary retention, photophobia, constipation, tachycardia, confusion, depression, hallucinations
Drug: Monoamine Oxidase B (MAO-B) Inhibitor: Selegiline (Eldepryl)
Indication: Decrease tremors and rigidity
Side effects: Dry mouth, blurred vision, urinary retention, photophobia, constipation, tachycardia, confusion, depression, hallucinations
Drug: COMT inhibitors:
-Tolcapone (Tasmar)
Indication: Improves motor function
Side effects: Hepatic failure, dyskinesia, nausea, orthostatic hypotension, sleep disturbances, hallucinations
-Entacapone(Comtan)
Indication: improves motor function
Side effects: Vomiting, diarrhea, constipation, dyskinesia, orthostatic hypotension, hallucinations, sleep disturbances
• The limitations of levodopa therapy, improvements in stereotactic surgery, and new approaches in transplantation have renewed interest in surgical treatment of Parkinson’s disease.
SURGICAL MANAGEMENT OF PARKINSON’S DISEASE
Surgery:
-Thalamotomy
Procedure: Lesion placed in the thalamus
Outcome: Relief of tremors
-Pallidotomy
Procedure: Destruction of globus pallidus using electrical stimulation
Outcome: Improved control of symptoms
-Deep-brain stimulation:
Procedure: Placement of electrode(s) in the thalamus, then attaching to a pulse generator implanted in the infraclavicular region
Outcome: Relief of tremors
VI. Nursing Diagnosis
• Impaired physical mobility related to muscle rigidity and motor weakness
• Self-care deficits (feeding, dressing, hygiene and toileting) related to tremor and motor disturbance
• Constipation related to medication and reduced activity
• Imbalanced nutrition: less than body requirements related to tremor, slowness in eating, difficulty in chewing and swallowing
• Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles
• Ineffective coping related to depression and dysfunction due to disease progression
• Disturbed thought processes related to hallucinations and decreased cognitive abilities
• Sleep deprivation related to rigidity and weakness
• Risk for injury related to postural disturbances
VII. Nursing Management
• Provide client and family teaching
• Promote measures to enhance body image
• Prepare the client for stereotaxic surgery to reduce tremors and rigidity if indicated.
• Administer prescribed medications, which may include antiparkinson medication, anticholinergics, antihistamines, amantadine hydrochloride, antiviral agent, and monoamine oxidase-inhibitors.
• Promote measures to maintain an adequate airway.
• Promote methods to ease difficulty with swallowing if indicated. Encourage semi-solid diet.
Maximize functional abilities.
• Improve mobility and prevent complications of immobility.
• Encourage daily exercise, stretching exercises and special walking techniques to offset the shuffling gait.
• Instruct the client in ways to prevent constipation (e.g. increase fluids, maintain high-fiber diet, follow regular bowel routine.
• Promote self-care
• Maximize effective communication