1
Concept Map: Selected Topics in Neurological Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
PATHOPHYSIOLOGY
PHARMACOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Huntington’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_P_I_E
--Decrease ICP
--Disease /
Condition
Specific Meds
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary

Progressive

Grossly affects motor function

Symptoms of Parkinson's disease may appear at any age, but the
average age of onset is 60

Rare in people younger than 30, but 5% - 10% of pts experience
symptoms before the age of 40
3



Normally Dopamine & Ach neurotransmitters work together to
enable motor neurons to refine voluntary movement
Parkinson's results from the degeneration of dopamineproducing nerve cells in the brain, specifically in the substantia
nigra and locus coeruleus
Clients have lost 80% or more of their dopamine-producing cells
by the time symptoms appear
4
5
6
7
1)
Tremors (at rest)
2)
Muscle Rigidity (may produce muscle pain, expressionless,
mask-like face, difficulty chewing)
3)
Bradykinesia (slow movement)
4)
Cognitive impairment (mood swings…dementia)
5)
Postural instability:
- Falls are common
- Poor balance
- Stooped posture
- Difficulty walking (slow, shuffling, propulsive gait)
8



Based on symptoms and ruling out other disorders that
produce similar symptoms
Must have two or more of the primary symptoms, one of which
is a resting tremor or bradykinesia
Often diagnosis is made after observing that symptoms have
developed and become established over a period of time
9

There is no cure for Parkinson's disease

Treatment centers on relieving symptoms
 meds
 surgery or surgically implanted device that lessens
tremors
10
Dopamine Replacement / Agonists

Levodopa (DOPAR)
- can become ineffective over time
- abnormal movements (dyskinesias)

Levodopa and carbidopa combined (Sinemet®) is the mainstay of Parkinson's
therapy

Side effects: gastrointestinal distress, especially early in treatment, hypotension, and
dyskinesias

Slow dosage adjustment and taking medication with food can reduce these effects
and using lowest effective dose may prevent or delay appearance of motor
dysfunction
11
Dopamine Agonists

Parlodel

Mirapex (pramipexole)

Side effects: hypotension and
hallucinations
12

Dopamine Agonists
Dopamine agonists mimic dopamine's function in the brain. They are used primarily as adjuncts to
levodopa/carbidopa therapy. They can be used as monotherapy but are generally less effective in
controlling symptoms with Side effects similar to those produced by levodopa
- Bromocriptine (Parlodel®)
- Pergolide (Permax®)
- Pramipexole (Mirapex®)
- Ropinirole (Requip®)


MAO-B Inhibitors
Dopamine is oxidized by monoamine oxidase B (MAO-B). Selegiline (Carbex®) inhibits MAO-B,
increasing the amount of available dopamine in the brain. MAO-B inhibitors boost the effects of
levodopa
Anticholinergics reduce the relative overactivity of the neurotransmitter acetylcholine to balance
the diminished dopamine activity. This class of drugs is most effective in the control of tremor, and
they are used as adjuncts to levodopa. Side effects associated with anticholinergic drugs include dry
mouth, blurred vision, constipation, and urinary retention
- Benztropine mesylate (Cogentine®)
- Biperiden (Akineton®)
- Diphenhydramine (Benadryl®)
- Trihyxyphenidyl (Artane®)

COMT (catechol-O-methyl transferase) Inhibitors
These new class of Parkinson's medications augment levodopa therapy by inhibiting the COMT
enzyme, which metabolizes levodopa before it reaches the brain. Inhibiting COMT increases the
amount of levodopa that enters the brain. These drugs are only effective when used with levodopa
- Entacapone (Comtan®)
- Tolcapone (Tasmar®)
13

It is imperative that patients inform their physician of
any over-the-counter medications, herbs, or other
supplements that they use on a regular basis, because
they may interact with medication and because drug
dosages may need to be adjusted
14


Surgery may control symptoms and improve quality of life
when medication ceases to be effective or when medication
side effects, such as jerking and dyskinesias, become
intolerable
Only about 10% of Parkinson's patients are estimated to be
suitable candidates
15
• Ablative Surgery
- This procedure locates, targets, and then destroys (ablates) a clearly
defined area of the brain affected by Parkinson's
- The object is to destroy tissue that produces abnormal chemical or
electrical impulses that produce tremors and dyskinesias
- This type of surgery involves either pallidotomy or thalamotomy
- A related procedure, cryothalamotomy, uses a supercooled probe
that is inserted into the thalamus to freeze and destroy areas that
produce tremors
• Deep Brain Stimulation (DBS)
- DBS targets the subthalamic nucleus, which is located below the
thalamus and is difficult to reach, the globus pallidus, or the thalamus
- Targeted region is inactivated, not destroyed, by an implanted
electrode
• Transplantation or Restorative Surgery
- In transplantation, or restorative, surgery dopamine-producing cells are
implanted into the striatum
- The cells used for transplantation may come from one of several
sources: the patient's body, human embryos, pig embryos
16


Goal = help relieve symptoms & improve quality of life
Physical therapy can help strengthen and tone underused muscles, and give rigid muscles a
better range of motion. The goal is to help build body strength, improve balance, overcome gait
problems, and improve speaking and swallowing

Simple physical activity such as walking, gardening, and swimming can improves one's sense
of well-being

Gentle, soothing massage techniques may provide relief from muscle rigidity and may have
some neuromuscular benefit as well

The slow flowing movements of Tai Chi help maintain flexibility, balance, and relaxation


Support groups provide a caring supportive environment in which patients and their loved
ones can ask questions about Parkinson's, expressing their frustrations, and obtain advice
about coping with and treating symptoms from people who share the same problem
Parkinson's appears to progress more slowly in those who remain involved in activities that
they enjoyed before the onset of symptoms and in those who engage in new interests
17