Pathophysiology & Assessment
Which neurotransmitter is deficient in Parkinson’s disease, and what effect does this have on movement?
Dopamine — its loss leads to unbalanced acetylcholine activity and the hallmark motor symptoms of tremor, rigidity, and bradykinesia.
What combination medication is considered the “gold standard” for Parkinson’s disease?
Carbidopa/Levodopa (Sinemet).
Which anticholinergic drug reduces tremors and drooling in Parkinson’s?
Benztropine (Cogentin).
Why should patients with PD change position slowly?
To prevent orthostatic hypotension and falls.
Why do many PD patients experience depression?
Neurochemical dopamine loss and the chronic, progressive nature of the disease affect mood regulation.
What are the four cardinal symptoms of Parkinson’s disease remembered by the acronym “TRAP”?
Tremor, Rigidity, Akinesia/Bradykinesia, and Postural instability.
How does carbidopa improve the effectiveness of levodopa?
It prevents peripheral breakdown of levodopa, allowing more to reach the brain and reducing nausea.
Why is benztropine contraindicated for patients with glaucoma?
It increases intraocular pressure.
What kind of foods should be encouraged if the patient experiences constipation?
High-fiber diet with 2 L/day of fluids and prescribed stool softeners.
What community resource helps patients and families cope with Parkinson’s?
Parkinson’s support groups and the American Parkinson Disease Association.
Describe the characteristic gait seen in Parkinson’s disease.
Shuffling, short-stepped gait with a stooped posture and reduced arm swing.
What should patients avoid when taking carbidopa/levodopa?
High-protein meals and vitamin B6 supplements—they interfere with levodopa absorption and metabolism.
What education should nurses provide to minimize benztropine’s side effects?
Manage dry mouth with sugarless candy or gum, avoid alcohol, and never stop abruptly to prevent rebound symptoms.
What type of exercises are best to maintain mobility in PD?
Range-of-motion and balance exercises, walking, and swimming to improve coordination and strength.
What should nurses teach about medication timing for PD drugs?
Take exactly on schedule to maintain consistent dopamine levels and prevent “off” periods.
Why do Parkinson’s patients often drool or choke while eating?
Weakness of facial and throat muscles causes dysphagia and excessive salivation, increasing aspiration risk.
What is a common long-term complication of carbidopa/levodopa therapy?
Wearing-off effect or dyskinesias (involuntary movements) from fluctuating dopamine levels.
Which antiviral also helps treat Parkinson’s symptoms, and how?
Amantadine — increases dopamine release and reduces tremors and fatigue.
Why should a PD patient be referred to a speech-language pathologist (SLP)?
To evaluate and assist with swallowing and communication difficulties.
What safety measure reduces aspiration risk during meals?
Upright position, small bites, soft foods, and remain upright for 30 minutes after eating.
Name two non-motor symptoms of Parkinson’s that affect quality of life.
Depression, sleep disturbances, cognitive decline, orthostatic hypotension, or constipation (any two).
What color change in body fluids is expected with levodopa use?
Dark or reddish-brown discoloration of urine, sweat, or saliva — harmless but important to teach.
What should patients know about MAO-B inhibitors such as selegiline or rasagiline?
Avoid tyramine-rich foods (aged cheese, cured meats, beer) to prevent hypertensive crisis.
How can nurses promote independence with ADLs in PD patients?
Provide adaptive utensils, nonslip shoes, clothing with Velcro or zippers, and allow extra time for self-care.
What long-term goal reflects effective nursing care for a PD patient?
The patient maintains mobility, safety, adequate nutrition, and participates in self-care with minimal complications.