Medical-surgical Nursing Demystified

(^244) Medical-Surgical Nursing Demystified
cell. The loss of neurons within the substantia nigra continues and results in dimin-
ished voluntary fine motor skills due to dopamine loss. There is also development
of sympathetic noradrenergic lesions, causing norepinephrine loss within the sym-
pathetic nervous system. There is excess effect of the excitatory neurotransmitter
acetylcholine on the neurons; this causes increased muscle tone, leading to rigid-
ity and tremors. There seems to be a genetic tendency towards development of
Parkinson’s disease. Environmental factors such as exposure to airborne contami-
nants, occupational chemicals, toxins, or a virus have been implicated in the devel-
opment of the disease. Typical age of onset is after the fifth decade of life.
PROGNOSIS
Parkinson’s disease is a progressive disorder and does not have a cure. The symp-
toms can be managed with medications, but will return as the medications wear off.
The dosages will need to be adjusted periodically, and additional medications may
be needed to address the side effects of the medications used. Some patients
develop mental status changes or dementia in conjunction with Parkinson’s disease.
HALLMARK SIGNS AND SYMPTOMS

• Mask-like facial expressions


• Slow, shuffling gait


• Pill-rolling movements of hands


• Stooping posture


• Tremor at rest


• Change in handwriting—gets progressively smaller over time


• Bradykinesia (slow movement)


• Trouble chewing or swallowing


• Drooling


• Inability to control voluntary movement (dyskinesia) and fine-skilled move-
  ment, or to initiate movement—due to loss of dopamine which has an
  inhibitory effect and helps refine movements while acetylcholine retains the
  excitatory effect on the neurons


• Rigidity of limbs:
  
  
  • Cogwheeling—there is a rhythmic stopping or interruption of the move-
    ment of the extremity
  
  
  • Lead pipe—no bending; resists movement completely