Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations for MNDs, Alzheimer disease, amyotrophic lateral sclerosis (ALS), and Parkinson disease
- Describe the diagnostics and laboratory values in MNDs, Alzheimer disease, ALS, and Parkinson disease
- Apply nursing concepts and plan associated nursing care for the patient with MND, Alzheimer disease, ALS, and Parkinson disease
- Evaluate the efficacy of nursing care for the patient with MND, Alzheimer disease, ALS, and Parkinson disease
- Describe the medical therapies that apply to the care of MND, ALS, Alzheimer disease, and Parkinson disease
The decline in cognitive abilities, such as memory and reasoning, in a manner that disrupts patients’ daily lives is known as major neurocognitive disorder (MND). MND refers to a group of disorders characterized by neurological changes that make it more challenging for patients to continue routine activities.
Link to Learning
It is important to note that in DSM-5 criteria, the definition of dementia has been updated. The term major neurocognitive disorder is now the correct terminology for dementia.
MND varies in severity and may worsen over time. For some patients, MND is mild enough that they can still function reasonably well, whereas other patients experience MND so severely that they are unable to care for themselves. MND is a general term that refers to several neurological disorders. The most common form of MND is Alzheimer disease, which is also a neurodegenerative disease, a chronic condition that damages the brain and central nervous system, causing problems with cognitive abilities as well as physical movement. In addition to Alzheimer disease, amyotrophic lateral sclerosis (ALS) and Parkinson disease are other neurodegenerative diseases. Neurodegenerative diseases are incurable, but they can be treated and managed. This section will provide an overview of MND, Alzheimer disease, ALS, and Parkinson disease, including symptoms and how nurses can assess, plan, and care for patients with these diseases.
MND Pathophysiology
MND occurs when the brain’s neurons, or nerve cells, die after they become inactive and lose their connections to other brain cells. This is a normal process that every person experiences, particularly as individuals age. But for patients who develop MND, this process is more active, and they lose a larger number of neurons. Although MND is associated with aging, not everyone develops MND as they get older. The National Institute on Aging estimates that about one-third of people over age 85 may have some type of MND (Figure 17.8). In addition to Alzheimer disease, other common forms of MND include the following (National Institute on Aging [NIA], 2022b):
- Abnormal deposits of protein in the brain lead to Lewy body dementia. The condition progresses slowly and changes patients’ ability to think and concentrate.
- Damage to the brain’s frontal and temporal lobe neurons leads to a frontotemporal disorder. The condition progressively gets worse and causes personality and behavior changes.
- Insufficient blood and oxygen to the brain leading to damage to the brain’s blood vessels causes vascular dementia. The condition may affect all aspects of a patient’s cognitive abilities, including behavior, memory, and reasoning.
Clinical Manifestations
The symptoms of MND include cognitive problems such as memory loss, disorientation, and confusion; difficulty reasoning and using abstract thinking, logic, and judgment to think and solve problems; decreased ability to organize and plan; communication difficulties, including forgetting simple words; spatial awareness issues, which may include getting lost; and needing more time than usual to complete routine tasks. Patients may lose things or put them in the wrong place for safekeeping. MND symptoms may also include psychological issues, such as changes in personality, which may include losing interest in favorite activities and/or no longer caring about others; feelings of paranoia; being irrational and/or impulsive; hallucinations; anxiety; and depression.
Assessment and Diagnostics
Health-care professionals assess and diagnose MND with a physical examination that includes a review of the patient’s symptoms, as well as diagnostic tests. Patients should be asked about their medical background and history, including whether their family has a history of MND and whether they are taking any medications, such as anticholinergic drugs and opioids, which can cause symptoms of MND. The patient’s general health needs to be assessed, because patients with MND may have other health problems, such as traumatic brain injury, cardiovascular disease, Parkinson disease, and immune disorders. Patients with MND may also lead unhealthy lifestyles, which may include poor nutrition and lack of exercise, particularly if they are forgetful and don’t remember to eat or get exercise.
Diagnostics and Laboratory Values
The diagnostic tests that can help diagnose MND include brain scans, such as a CT or MRI, lumbar puncture, positron emission tomography (PET) scans, and cognitive and neurological tests. Brain scans may show tumors and stroke, and lumbar punctures may show a high level of protein in CSF. PET scans may show abnormal brain activity and may also reveal deposits of protein in the brain. Cognitive and neurological tests will show decline and problems in the patient’s mental abilities. Each of these problems can contribute to MND.
Link to Learning
The Alzheimer’s Association (AA) provides a guide to help patients understand the medical tests available to determine if someone has Alzheimer disease or another form of MND. AA’s website also includes a link to an interactive tour that helps patients understand what to expect when they are evaluated for cognitive issues.
Nursing Care of the Patient with MND
MND cannot be cured. Patients who have mild MND may be able to continue functioning reasonably well with minimal assistance, but as MND progresses, patients may need more in-depth and routine care. Patients with MND should be in a safe, secure environment that provides the resources they need to function as well as possible, such as health-care facilities that provide memory care or assistance with ADLs.
Recognizing Cues and Analyzing Cues
To recognize and analyze the cues of MND, nurses should review the findings of the patient’s physical examination. This includes noting whether the patient seems confused, struggles to communicate, or has paranoid tendencies. Patients with MND may do things such as repeat questions, have trouble writing, or lack interest in a conversation. To gather additional cues, nurses can talk with the patient’s family members and ask them about problems they have noticed in the patient. Other cues will come from diagnostic test results. If the results of brain scans, lumbar punctures, PET scans, and/or cognitive and neurological tests show abnormal results, these may be cues that indicate the patient has MND.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
The symptoms of patients with MND should be prioritized based on their severity. For example, if a patient’s symptoms are so severe that they do not remember others and do things such as wander from home and get lost, this is more urgent than symptoms that cause a patient to do things such as misplace their keys. Keeping patients safe is paramount, and symptoms that put patients in danger must be prioritized. Solutions should focus on ensuring patients’ safety while helping them live as independently as possible. The nursing interventions appropriate for patients with MND may include those in Table 17.12.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | The patient’s cognitive status, including confusion, memory issues, communication difficulties, and problem-solving skills may indicate MND. This includes whether the patient acts impulsively, wanders away and gets lost, seems disinterested in others, and repeats questions. |
| Monitor vital signs. | Changes in the patient’s vital signs, such as heart rate and blood pressure, as well as balance issues may indicate health problems. |
| Administer medications. | Patients with MND may need medications, such as cholinesterase inhibitors and memantine, to help with MND symptoms. |
| Coordinate with occupational therapist. | Some patients with MND may benefit from occupational therapy, which can teach coping behaviors, particularly how to keep patients with MND safe from threats such as losing their balance and falling. Nurses may refer patients to occupational therapy. |
| Help with exercise. | Patients with MND may benefit from exercise and should be encouraged to develop an exercise regimen. Although results are not definitive, research suggests that exercise such as walking and swimming may improve brain functioning. Nurses can help patients identify exercise opportunities and formulate a plan to make exercise part of their daily routine. |
| Coordinate mental health support. | Patients with MND and their families may need consultation with a mental health professional to help them cope with the challenges of living with MND. Some patients may need prescription medications to help with issues such as anxiety and depression. |
Link to Learning
Read this article to learn more about how exercise can decrease the risk for cognitive decline from the Alzheimer's Association.
Evaluation of Nursing Care for the Patient with MND
The desired outcome for patients with MND is alleviation of symptoms if possible. If a patient’s symptoms of MND cannot be alleviated, or at least improved, the desired outcome is to help patients and their families learn how to cope with MND. Patients with MND should be kept safe and provided the support needed to enhance their quality of life as much as possible. Goals for patients with MND include helping them live at home if possible, maintaining a routine of physical activity, engaging in activities that provide mental stimulation, and avoiding hospitalization.
Medical Therapies and Related Care
The medical therapies used for patients with MND may include medications, such as cholinesterase inhibitors, which can decrease acetylcholine breakdown, enabling nerve cells to communicate; and memantine, which can decrease neurotoxicity (damage to nerve cells) and protect nerve cells from damage. Other treatments include occupational therapy and regular exercise. Some patients may also need mental health support.
Amyotrophic Lateral Sclerosis (ALS)
A disease of the central nervous system, amyotrophic lateral sclerosis (ALS) affects the motor neurons of the brain and spinal cord, causing patients to lose control of their muscles. The disease, which is incurable and ultimately fatal, is sometimes called Lou Gehrig disease for the baseball player who had the disease. The cause of ALS is unknown, but a small percentage of cases, perhaps 5 to 10 percent, are inherited. In all cases of ALS, as motor neurons die and the disease progresses, patients may lose the ability to walk, eat, speak, and breathe (ALS Association, n.d.).
Pathophysiology
ALS occurs when motor neurons degenerate and die, causing the muscles they control to also weaken and degenerate. Except for the small percentage of ALS cases caused by an inherited gene, medical experts do not know why patients contract ALS. A few environmental factors, such as smoking and exposure to toxins, have been linked with an increased risk for ALS. Age is also a factor, because the disease usually affects patients over age 60 (Mayo Clinic, 2023c).
Clinical Manifestations
ALS typically begins with stiffness and weakness in the muscles that control the limbs, including the legs and arms. As the disease progresses, it typically spreads to muscles in the trunk and eventually to muscles that control vital functions, such as breathing. As the muscles get weaker, patients lose the ability to do things, such as walk, chew, swallow, speak, and breathe. The muscle weakness may be accompanied by muscle cramps, as well as twitching in the shoulders and arms. In some patients, the tongue may also twitch. The disease also affects cognitive abilities, changing a patient’s behavior and affecting their ability to think. Some patients with ALS also develop frontotemporal MND.
The progression of the disease varies by patient, and some patients even have periods when the disease stops progressing for a few months or longer. On average, patients who develop ALS live about three years once the disease is diagnosed. Some patients do live longer, with about 20 percent surviving at least five years, about 10 percent living for ten years, and 5 percent surviving for more than twenty years after they are diagnosed (ALS Association, n.d.).
Assessment and Diagnostics
Typically, ALS is diagnosed by ruling out other conditions and diseases with similar symptoms, such as multiple sclerosis and myasthenia gravis. The tests that can be useful to help identify whether the patient has a disease or condition other than ALS include blood and urine tests, lumbar punctures, nerve conduction studies, electromyogram (EMG), imaging such as MRI, nerve biopsy, and muscle biopsy. A physical examination can also determine if a patient has symptoms typical of ALS.
Diagnostics and Laboratory Values
The diagnostics and laboratory values that may help diagnose ALS may include the following:
- Blood and urine tests may show higher-than-normal levels of serum neurofilament light chain (NfL), a protein that increases when neurons are damaged.
- Nerve conduction studies may show that the patient has nerve damage, which is an indicator of ALS.
- EMGs document the muscles’ electrical activity at rest as well as when contracting. In patients with ALS, this test, which should be performed in tandem with a nerve conduction study, will show muscle and/or nerve damage.
- MRI imaging with high resolution will show changes in nerves and muscles, such as cortex iron deposition, which indicates ALS. MRIs may also show problems such as herniated disks and spinal cord tumors, which can be used to rule out ALS.
- A nerve biopsy will not show if a patient has ALS but may be used to rule out ALS by diagnosing another condition or disease. For example, a nerve biopsy may show inflammation of the nerves or a demyelinating disease, which is a condition that damages the protective covering of the brain’s nerve fibers.
- A muscle biopsy will not show if a patient has ALS but may be used to rule out ALS by diagnosing another condition or disease. For example, a muscle biopsy may show infections in the muscles or a disorder such as muscular dystrophy.
Nursing Care of the Patient with Amyotrophic Lateral Sclerosis (ALS)
Nursing care for patients with ALS should focus on controlling symptoms and helping patients and their families learn to manage the disease. Because ALS is a fatal disease, nursing care should include mental health support. As patients with ALS near the end of life, they may need palliative care.
Recognizing Cues and Analyzing Cues
The cues of ALS will be found in the patient’s physical examination and test results and may include muscle weakness that affects the patient’s ability to speak, swallow, and walk. Some patients may struggle to concentrate and may exhibit unusual behavior, such as untimely laughing or crying. A discussion with the patient may reveal that the patient is struggling to carry out routine activities because of muscle weakness. Nerve conduction studies may show that the patient’s lumbar punctures will not reveal findings that indicate ALS, but they may indicate that the patient has a condition with similar symptoms, such as MS.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
ALS symptoms should be prioritized based on severity, with symptoms that affect patients’ ability to do life-sustaining activities, such as breathing and eating, given priority over symptoms that do not create life-threatening situations. Solutions should focus on sustaining lives of patients with ALS and enabling them to live as independently as possible. The nursing interventions appropriate for patients with ALS may include those in Table 17.13.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | Patients with ALS may have a limited ability to do things, such as speak, eat, and use their hands. They may also have twitching and/or exhibit unusual behavior, such as untimely laughing. |
| Monitor vital signs. | Changes in the vital signs of patients with ALS, such as heart rate, blood pressure, and ability to breathe, may indicate severity of ALS symptoms. This is particularly true for patients in more advanced stages of ALS. |
| Administer medications specifically for ALS. | ALS can be treated with riluzole, edaravone, and/or sodium phenylbutyrate-taurursodiol. Patients with ALS should receive prescribed drugs as appropriate and side effects should be monitored. For example, riluzole may cause gastrointestinal problems and dizziness, whereas edaravone may cause headaches and bruising. |
| Administer other medications. | Patients with ALS may need medications to control other problems that may occur as a result of ALS. For example, patients who experience constipation may need a laxative, patients who have trouble sleeping may benefit by taking a sedative, and patients in pain may get relief with acetaminophen. |
| Give breathing support. | Patients with ALS who struggle to breathe may need mechanical ventilation assistance. |
| Coordinate with speech therapist. | Patients with ALS who struggle to speak may benefit by working with a speech therapist to learn how to speak with weakened muscles. |
| Coordinate with physical therapist. | Physical therapy can help patients with ALS learn exercises and techniques to strengthen their muscles, maintain a greater range of motion, and improve their cardiovascular fitness. |
| Coordinate with occupational therapist. | Occupational therapy can help patients with ALS learn how to use assistive devices, such as an electric toothbrush, to overcome muscle weakness and continue doing routine activities, such as brushing their teeth. |
| Coordinate mental health support. | Patients with ALS and their families may need consultation with a mental health professional to help them cope with the challenges of living with ALS. Some patients may need prescription medications to help with issues such as anxiety and depression. |
Evaluation of Nursing Care for the Patient with Amyotrophic Lateral Sclerosis (ALS)
The desired outcome for patients with ALS is control and management of their symptoms to improve their quality of life and help them live longer. This may include enabling them to maintain their independence with activities such as feeding themselves.
Medical Therapies and Related Care
The medical therapies used for patients with ALS may include medications, such as riluzole, which blocks glutamatergic neurotransmission in a patient’s central nervous system; edaravone, which captures molecules that can damage cells and thereby protects neurons; and/or sodium phenylbutyrate-taurursodiol, which can help prevent nerve cells from breaking down and dying. Other medications needed to treat problems caused by ALS may include laxatives for constipation and sedatives for insomnia. In the early stages of ALS, some patients may benefit from speech, physical, and/or occupational therapy. Therapy may enable patients with ALS to retain mobility for a longer period. Therapy may also help patients with ALS avoid, or at least postpone, issues such as contractures, which can cause deformity and rigidity in joints if muscles, tendons, and tissues are shortened and/or hardened. As ALS progresses, some patients may need mechanical ventilators for breathing support. Mental health support should be provided as needed. As conditions deteriorate for a patient with ALS, nurses should also strive to help them and their families make end-of-life preparations.
Alzheimer Disease
Alzheimer disease is a disorder in the brain that gradually destroys patients’ memory and thinking abilities, eventually making it challenging for patients to handle basic tasks and live independently. As noted previously, Alzheimer disease is the most common form of MND, accounting for at least 60 percent of MND cases. Generally, Alzheimer disease affects people over age 65 and gradually worsens as patients age. The disease, which has no cure, affects memory and causes patients to be disoriented and confused. Patients with Alzheimer disease struggle to remain independent and continue their daily routines (Alzheimer’s Association, 2024).
Life-Stage Context
Early-Onset Alzheimer Disease
Whereas Alzheimer disease may be regarded as a disease that primarily affects individuals over age 65, early-onset Alzheimer disease affects people in their 40s and 50s. Cases for this age group may be overlooked because providers generally do not expect younger patients to have Alzheimer disease. But occasionally, younger patients with memory problems are experiencing Alzheimer disease, particularly if they have a family history of the disease.
Pathophysiology
Medical experts have not identified the specific cause(s) of Alzheimer disease, but it appears to be linked to factors such as a family history of Alzheimer disease; poor lifestyle, such as lack of exercise and excessive alcohol consumption; head trauma; and environmental factors, such as excessive exposure to air pollution. Alzheimer disease may result when the brain’s neurons become damaged, losing their connections and eventually dying.
In addition, patients with Alzheimer disease tend to have issues with beta-amyloid and tau proteins, which provide support to the brain’s neurons. When the beta-amyloid proteins malfunction, they may clump together in amyloid plaque deposits, which disrupt cell functioning, and the tau proteins may transform into structures called neurofibrillary tangles, which occur when proteins inside neurons accumulate abnormally. These conditions contribute to Alzheimer disease by disrupting brain functioning.
Clinical Manifestations
Typically, Alzheimer disease affects memory first before spreading to affect other brain functioning. Initially, patients with Alzheimer disease may do things such as forget appointments, misplace items, and have trouble remembering the right words to describe things. As problems with memory progress, patients with Alzheimer disease may repeat themselves, sometimes over and over, and do other things such as get lost in familiar surroundings and even forget people they know well.
As the disease progresses, it affects other brain functioning, making it challenging for patients with Alzheimer disease to do things such as reason, make decisions, organize, and make plans. Patients with Alzheimer disease also typically experience personality changes, which may include disinterest in activities they once enjoyed, social withdrawal, moodiness, and aggressive behavior that may include anger. They may also have delusions, change their sleeping habits, and become depressed. As the disease progresses into late-stage Alzheimer disease, patients experience additional symptoms, including the inability to participate in a conversation and difficulty responding to their environment. Eventually, they tend to lose the ability to control their movements, and additional personality changes may occur. At this stage, patients typically need round-the-clock care, and they may become more susceptible to infections, such as pneumonia.
Assessment and Diagnostics
Alzheimer disease is diagnosed by conducting a physical examination that reviews the patient’s overall health to gather details about any recent changes in memory, personality, and daily habits. This examination should include a family member who can provide additional details about any recent changes in the patient’s behavior and thinking abilities. One goal of the physical examination is to rule out other conditions and diseases that may be causing symptoms similar to Alzheimer disease, such as brain tumors, stroke, and Parkinson disease. As part of this process, the physical examination should review the patient’s overall physical health, including eye movements, coordination, speaking patterns, and reflexes.
Diagnostics and Laboratory Values
Diagnostic tests of the patient’s memory and skills, such as cognitive/thinking, language, and mathematical abilities, can provide additional evidence of Alzheimer disease. Other tests that may provide helpful data include blood tests, lumbar puncture, and imaging with brain scans. For patients with Alzheimer disease, the diagnostics and laboratory values that indicate the patient has Alzheimer disease include the following:
- Blood tests cannot confirm an Alzheimer disease diagnosis but can be used to rule out other causes of memory loss, such as vitamin deficiencies and thyroid disorders.
- Lumbar punctures will show increased levels of beta-amyloid and tau proteins, which are indicative of Alzheimer disease and other forms of MND.
- MRI imaging may show shrinkage of areas of the brain that are associated with Alzheimer disease. In addition, MRIs provide evidence to rule out other conditions and diseases that have symptoms similar to Alzheimer disease, such as brain tumors and strokes.
- PET scans can show areas of the brain that have poor metabolism, which is an indicator of Alzheimer disease.
- CT scans will not help diagnose Alzheimer disease, but their findings can help rule out other conditions and diseases, such as head injuries, strokes, and brain tumors.
Nursing Care of the Patient with Alzheimer Disease
Nursing care for patients with Alzheimer disease should focus on controlling symptoms, as well as helping patients and their families learn to manage and live with the disease. This includes helping patients recognize when they are no longer able to care for themselves. Nurses should educate patients and their families about Alzheimer disease and help them establish routines that can help patients live more independently. For example, caregivers should be educated to gently remind patients with Alzheimer disease when it is time for meals and other tasks, such as taking medications. Nurses should also help patients and their caregivers create a safe environment that protects patients from risks, such as wandering away from home and forgetting where they are.
Link to Learning
Visit the Alzheimer’s Association for more information and resources about MND.
Recognizing Cues and Analyzing Cues
The cues of Alzheimer disease may include memory loss, struggles to think clearly, language difficulties, personality changes, despondency, and aggression. The cues from the diagnostic tests may include increased levels of beta-amyloid and tau proteins and shrinkage of the areas of the brain that control memory and related functioning.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
Care for patients with Alzheimer disease should be prioritized based on the severity of their symptoms. Symptoms that threaten patient safety should be prioritized over less severe symptoms, such as mild forgetfulness. Solutions should be generated based on recommendations from the patient’s care team to address each patient’s needs. The nursing interventions appropriate for patients with Alzheimer disease may include assisting with daily routines and providing healthy meals.
Evaluation of Nursing Care for the Patient with Alzheimer Disease
The desired outcome for patients with Alzheimer disease is control and management of their symptoms to improve their quality of life and help them live as independently as possible. This includes enabling them to cope with the challenges of Alzheimer disease and maintaining a safe environment. For example, helping them develop a daily schedule that includes healthy meals and an exercise regimen can help them establish a routine that promotes independence and safety, while also helping them learn to live with Alzheimer disease.
Medical Therapies and Related Care
The medical therapies used to treat Alzheimer disease may include medications such as antiamyloid treatments, which remove beta-amyloid proteins from the brain, preventing the formation of plaques and promoting healthy brain cells. Some patients with Alzheimer disease may benefit from taking cholinesterase inhibitors, which increase the amount of acetylcholine in the nervous system, promoting healthy nerve cells that can sustain memory and learning processes. Some patients with Alzheimer disease may need other medications, such as sedatives and pain relievers to treat additional health problems such as insomnia and pain. If necessary, patients and their families struggling to cope with the challenges of Alzheimer disease should receive mental health support.
Parkinson Disease
Parkinson disease is an incurable brain disorder that affects the nervous system, causing body parts, such as the hands, to have movements that are unintended and uncontrollable. This includes stiffness and shakiness, as well as balance and coordination issues. Parkinson disease affects multiple parts of the body, including the face, arms, and legs.
Pathophysiology
Parkinson disease occurs when neurons in the brain’s basal ganglia are damaged and/or die. The basal ganglia are the areas of the brain where movement is controlled. The basal ganglia’s neurons produce dopamine, a chemical neurotransmitter involved in movement, as well as disposition and memory. When the basal ganglia’s neurons are damaged or die, the body does not have sufficient dopamine to control movement. In patients with Parkinson disease, the nerve endings that generate norepinephrine are also damaged and die. The primary chemical messenger for the sympathetic nervous system, norepinephrine, controls bodily functions such as blood pressure and heart rate.
Parkinson disease appears to be caused by genetics in a few cases and may be hereditary for some patients. But in most cases, Parkinson disease is not inherited and may be caused by other factors, such as exposure to toxic substances. The brains of patients with Parkinson disease also tend to have clumps of Lewy bodies, which are abnormal protein clumps, and these contain clumps of alpha-synuclein protein that cells cannot break down. This creates chemical changes in the brain, affecting patients’ moods and their abilities to think and remember (NIA, 2022a).
Clinical Manifestations
The symptoms of Parkinson disease typically begin subtly and progress gradually. The primary symptoms include the following:
- tremors in head, jaw, arms, hands, and legs
- stiffness and contractions in muscles
- slowed movement, called bradykinesia, as patients attempt to do things such as walk or write
- loss of balance and coordination
- difficulty speaking, chewing, and swallowing
- loss of automatic movements, such as blinking or swinging the arms while walking
- constipation and urination issues
- blood pressure irregularities, including orthostatic hypotension, a sudden drop in blood pressure when standing up or sitting down
- sleep disorders
- fatigue
- pain
- cognitive issues, such as thinking difficulties, dementia, and MND
- depression and other mental health issues
Assessment and Diagnostics
Parkinson disease is assessed and diagnosed through a physical examination and by conducting tests to rule out other conditions and diseases, such as a brain tumor, which may be causing symptoms similar to those experienced by patients with Parkinson disease. A physical examination may show symptoms of Parkinson disease such as tremors, stiff muscles, coordination and balance difficulties, loss of automatic movements, constipation and urination issues, and cognitive issues.
Diagnostics and Laboratory Values
Tests that can be helpful to confirm a Parkinson disease diagnosis include a dopamine transporter (DAT) scan and imaging tests, such as MRI and PET scans. A DAT scan may reveal that the patient has an unhealthy dopamine system. This does not provide a definitive diagnosis of Parkinson disease, but it is an indicator of Parkinson disease. MRI and PET scans will not diagnose Parkinson disease but may help rule out other disorders, such as a brain tumor, which may be causing the patient to have symptoms similar to those of patients with Parkinson disease.
Nursing Care of the Patient with Parkinson Disease
Because Parkinson disease is incurable, nursing care for patients with Parkinson disease should focus on controlling symptoms, which can be done with medication as well as techniques such as exercise. Nursing care should also strive to teach patients and their families how to live with the disease.
Recognizing Cues and Analyzing Cues
The cues of Parkinson disease will primarily be found in the physical examination. Nurses should analyze these cues, which may include tremors, stiff muscles, coordination and balance difficulties, loss of automatic movements, constipation and urination issues, and cognitive issues. In addition, if the DAT scan finds that the patient has an unhealthy dopamine system, this is a cue that the patient has Parkinson disease.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
Parkinson disease should be prioritized based on the severity of symptoms, with more severe symptoms a higher priority than less severe symptoms. Symptoms that affect a patient’s ability to function and live independently, such as severe tremors and pain, are more urgent than milder symptoms, such as muscle tension. Solutions should be generated with input from the patient’s care team. The nursing interventions appropriate for patients with Parkinson disease may be those in Table 17.14.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | Patients may struggle to do things such as speak, eat, and use their hands. |
| Monitor vital signs. | The vital signs of the patient with Parkinson disease, particularly blood pressure, can be adversely affected by Parkinson disease. |
| Administer medications as ordered specifically for Parkinson disease. | The medications that may be ordered for Parkinson disease include the following, which should be administered as prescribed:
|
| Prepare for surgery and provide aftercare. | Some patients with Parkinson disease may benefit from deep brain stimulation, which is the process of implanting electrodes into the brain that are connected to a generator implanted in the patient’s chest. Electrical pulses from the generator to the brain may help with symptoms. For surgery patients, nurses should help them prepare for surgery and then provide surgery aftercare, such as dressing their surgical wounds. |
| Coordinate with speech therapist. | Speech therapy can help patients with Parkinson disease learn how to control their voices and speak despite muscle difficulties. |
| Coordinate with physical therapist. | Physical therapy can help patients with Parkinson disease learn exercises and techniques to strengthen their muscles, improve balance and coordination, and gain greater flexibility. |
| Coordinate with massage therapist. | Massage therapy can help patients with Parkinson disease reduce tension in their muscles. |
| Coordinate with occupational therapist. | Occupational therapy can help patients with Parkinson disease learn how to use assistive devices, such as electric toothbrushes, which can help them maintain more independence. |
| Assist with mental health support. | Patients with Parkinson disease and their families may need consultation with a mental health professional to help them cope with the challenges of living with Parkinson disease. Some patients may need prescription medications to help with issues such as anxiety and depression. |
Evaluation of Nursing Care for the Patient with Parkinson Disease
The desired outcome for patients with Parkinson disease is control and management of their symptoms to improve their quality of life. This includes educating patients and their families about Parkinson disease and helping them cope with their symptoms to function as normally as possible. If a patient’s Parkinson disease is well-managed, they should be reasonably independent, with the ability to feed and dress themselves. They should also have the ability to manage their medications. Their home and other environments where they spend a lot of time should promote safety and provide surroundings that help them avoid falls and other hazards.
Medical Therapies and Related Care
The medical therapies used to treat Parkinson disease may include medications such as dopamine agonists, which activate dopamine receptors to make the brain think that it is receiving dopamine, the neurotransmitter needed for learning and motivation. Some patients with Parkinson disease benefit by taking anticholinergics, which treat tremors by blocking dopamine uptake. In addition to medications, some patients may benefit from speech, physical, massage, and/or occupational therapy.
Surgery may be an option for some patients. The surgical procedures that benefit some patients with Parkinson disease include deep brain stimulation, which implants a device in the brain to produce electrical impulses and disrupt the brain signals causing Parkinson disease. Another surgical procedure, ablative surgery destroys the brain tissues that produce abnormal chemical or electrical impulses responsible for a Parkinson disease patient’s tremors. With transplantation, the brains of patients with Parkinson disease are implanted with cells that produce dopamine.
Link to Learning
To learn more about Parkinson disease, visit the Parkinson’s Foundation for information on research and resources to help patients.