result: dopamine hydrochloride depletion
usually occurs in older adults and males more than females
etiology unknown
Findings
a.resting tremors of the lips, jaw, tongue, and limbs, especially a resting pill-rolling tremor of one hand that is absent during sleep. This is different from an essential or intention tremor in which the tremor is action related.
b.bradykinesia
c.fatigue
d.stiffness and rigidity with movement
e.signs first unilateral, then bilateral
f.mask-like facial expression
g.slow, shuffling walk; gradually more difficult
h.difficulty rising from sitting position
i.ultimately confined to a wheelchair
j.mind stays intact unless other aggravating conditions
k.echolalia in most cases
Diagnostics
a.based on finding with history
b.EEG
c.MRI
d.computerized tomogram (CT scan)
Management
- outcomes: palliative; postpone dependence
- pharmacologic
anticholinergics - minimize extrapyramidal effects
• benzotropine mesylate (Cogentin)
• procyclidine (Kemadrin)
dopamine hydrochloridergics: Levodopa (L-Dopa)
antiparkinsonian agent: amantadine hcl (Symmetrel) reduces rigidity and tremor
MAO inhibitors: selegiline (Eldepryl)
3. therapies
i. physical
ii. occupational
iii. speech
4. surgery: stereotaxic thalamotomy to decrease tremor
Nursing interventions
a.maintain safety of client
b.prevent effects of immobility
c.foster independence in activities of daily living (ADL)
d.reinforce the use of assistive devices for ambulation as indicated
e.maintain good nutrition
- small, frequent meals
- soft foods
- roughage with sufficient fluids to decrease constipation
f.monitor effectiveness of administered medications
g.provide emotional support to client and family members
h.teach client
- when and what side effects of the drugs to report
- the benefits of daily exercise
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