Caring for patients with Parkinson disease
Bridget R. Roberts MSN, RN

July 2010 
Volume 40  Number 7
Pages 58 - 64
  PDF Version Available!

A COMPLEX NEUROGENERATIVE disorder, Parkinson disease (PD) affects millions worldwide. An estimated 500,000 Americans have PD, which strikes about 50% more men than women. The true incidence of PD is probably underestimated because it's often misdiagnosed in the early stages, when signs and symptoms may be mild and mistaken for normal age-related changes.1Considered a type of movement disorder, primary or idiopathic PD is a chronic and progressive condition characterized by tremor, rigidity, bradykinesia, and postural instability. It's caused by impairment or loss of neurons producing dopamine, a monoamine neurotransmitter necessary for normal movement. Parkinsonism is the name for disorders with a different etiology that produce signs and symptoms similar to PD.In most cases, the cause of PD is unknown, but factors such as genetics, vascular damage, infection, and environmental exposures may be implicated. Signs and symptoms typically begin during the fifth decade of life, but PD sometimes strikes much younger people. Although not a terminal illness, PD can lead to life-threatening complications such as choking, pneumonia and other infections, and falls.As the population ages, you'll see more patients with PD. This article discusses the pathophysiology, assessment points, and nursing care for patients with this common disorder.PD symptoms result from the impairment or destruction of 60% to 80% of dopamine-producing neurons in the substantia nigra, a section of the basal ganglia. This creates deficits in the inhibitory neurotransmitter dopamine and excesses of the excitatory neurotransmitter acetylcholine at the synapse. (See Dopamine deficits disrupt motor function.) These neurotransmitters must be balanced to maintain muscle tone and allow normal movement. Research indicates that patients with PD may also fail to produce enough norepinephrine, which may be responsible for some nonmotor movement symptoms of PD such as fatigue.1–3Diagnosis

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