Med-Surg - Nervous System, part 9: Parkinson's, Alzheimer's, and Huntington's Disease

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.