Hi, I'm Cathy with Level Up RN. In this video, I will be talking about Parkinson's disease,
Alzheimer's disease, and Huntington's disease. At the end of the video, I'm going to give you
guys a little quiz to test your knowledge of some of the key points I'll be covering in this video,
so definitely stay tuned for that. And if you have our Medical-Surgical Nursing Flashcards,
available from leveluprn.com, definitely pull those out so you can follow along with me.
Parkinson's disease is a progressive neurodegenerative disease that causes
muscle rigidity, akinesia, as well as involuntary tremor. So with this disorder,
we have degeneration of the dopamine-producing neurons in the substantia nigra in the brain. So
we have decreased dopamine and we have increased acetylcholine, which creates this imbalance.
So the cause of Parkinson's isn't really known, but it is believed to be caused by genetic and
possibly environmental factors as well. Because of this imbalance of dopamine and acetylcholine,
we end up with symptoms such as muscle rigidity, like I mentioned, tremor, slow shuffling gait,
postural instability, which means that the patient will be at risk for falls. It also causes
akinesia, which I mentioned, which means lack of movement. So the A part of that word means lack
of or no, and then kinesia means movement, so lack of movement as well as bradykinesia. So that means
slow movement. And then the patient may also have a mask-like expression and may exhibit drooling
as well as dysphagia, which means they're going to have difficulty swallowing, which places them at
risk for aspiration pneumonia. So our little cool chicken hint here on the card to help you remember
some of these signs and symptoms of Parkinson's disease is the word TRAP, and T stands for
tremor, R stands for rigidity, A stands for akinesia, and P stands for postural instability.
With Parkinson's disease, initial symptoms are primarily physical. So cognitive changes are
possible, but they usually occur much later on with disease progression. In terms of treatment,
we are trying to correct that imbalance of too little dopamine and too much acetylcholine.
So we can give the patient levodopa/carbidopa, which increases dopamine levels, as well as
benztropine, which is an anticholinergic agent that helps to decrease acetylcholine levels.
In terms of nursing care, because the patient will have dysphasia, we want to monitor their
swallowing and food intake. We want to thicken their liquids, sit the patient upright, which
makes it easier for them to swallow, advise them to tuck their chin right when they're swallowing
because that will help, and that we need to have suction equipment nearby. We should encourage
range of motion exercises and we should assist the patient with ADLs if necessary and then implement
fall precautions because they have that postural instability.
Next, let's talk about Alzheimer's disease. Alzheimer's disease is a gradual,
irreversible form of dementia that causes memory problems, judgment issues, as well as
changes in personality. The pathophysiology behind this condition includes the formation of
beta-amyloid deposits and neurofibrillary tangles in the brain, such that communication between the
neurons in the brain is impaired, and eventually this leads to neuron atrophy and death. So
risk factors include older age, family history, as well as cardiovascular disease.
In terms of signs and symptoms, we usually group those into stage 1, mild symptoms, stage 2,
moderate symptoms, and stage 3, severe symptoms. So during stage 1, the patient may exhibit
forgetfulness, short-term memory loss, as well as mild cognitive impairment. These changes may not
be obvious to everyone around the patient, but typically the family and close friends
will notice those changes. During stage 2, the patient may exhibit disorientation, agitation,
wandering, as well as incontinence, and assistance with their ADLs, or activities of daily living,
may become necessary during this stage. Then during stage 3, the patient may become bedridden
and they may lose their ability to talk or to control their movement or to swallow.
In terms of diagnosis of Alzheimer's, the provider will likely do a review of the patient's symptoms.
They will likely run some memory and thinking tests and kind of rule out other causes of the
symptoms. Definitive diagnosis of Alzheimer's is not possible until after death and upon
examination of the patient's brain tissue. In terms of treatment, there is no cure for
Alzheimer's. There are some pharmacological agents, such as donepezil, which can help
improve the patient's cognition. But again, it's not going to provide a cure.
We can also provide medications to help manage the patient's symptoms, such as antipsychotics,
antidepressants, and antianxiety medications. In terms of nursing care, we are going to want
to maintain a structured environment. We want to provide short directions, repetition as needed,
and frequent reorientation. We want to avoid overstimulation and use a single-day calendar
in the patient's room, and then maintain a routine toileting schedule as well.
We also want to provide for home safety because the patient's going to be at risk for falls and
at risk for wandering. So we want to implement some safety measures in the home. So we want
to remove scatter rugs because those are trip hazards. We also want to install door locks,
which are out of sight and out of patient reach, to prevent them from wandering down the street.
We also want to provide good lighting, particularly over the stairs, and then we
can mark the step edges with colored tape to make it really obvious where those edges are
to help prevent falls down the stairs. And then we absolutely want to remove clutter as well.
The last condition I'm going to cover in this video is Huntington's disease,
which is a progressive brain disorder that causes uncontrolled movement, emotional problems, as well
as dementia. Huntington's is an autosomal dominant genetic disorder. And it causes symptoms such as
chorea, which is spelled C-H-O-R-E-A. With chorea, we have abnormal or excessive
involuntary movements. Other signs and symptoms of Huntington's disease include cognitive issues
such as dementia, memory loss, and poor impulse control. It also causes psychiatric issues such
as depression, mania, and personality changes. In terms of diagnosis, we can do genetic testing
because, again, this is a genetic disorder. And then in terms of treatment, there is no cure.
However, we can help manage symptoms with psychotropic agents
for those psychiatric issues. There's also a medication called tetrabenazine, which is used
to help decrease those symptoms of chorea. All right. You guys ready for your quiz?
I have three questions for you. First question, levodopa/carbidopa is used to treat what disorder?
The answer is Parkinson's disease. Second question, this is a true-false question.
A mask-like expression and muscle rigidity are symptoms of Alzheimer's disease, true or false?
The answer is false. These are symptoms of
Parkinson's disease. Question number three,
with Alzheimer's disease, why do we install door locks that are out of sight and patient reach?
We do this because of the risk of wandering. So we're trying to provide for patient safety,
and we don't want them to walk out of the house in the middle of the night and wander down the
street. So that's why we do the door locks. All right. I hope this video has been
helpful. I will see you on another video soon. Thank you so much for watching.