Term Paper: Parkinson's Disease Is a Neurological

Pages: 4 (1430 words)  ·  Bibliography Sources: 1+  ·  Level: College Senior  ·  Topic: Disease  ·  Buy This Paper

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[. . .] There is a positive relation between depression and Parkinsonism and in at least 30% to 50% of patients depression is found to be a co-existing condition. Dysphagia is again a severe complication and the patient may even require a feeding tube. [Jeff Blackmer]

Medical treatment

Medical treatment of Parkinson's disease is broadly divided under two main categories namely surgical and non-surgical (pharmacological) treatments. Advancements in stereotactic surgical techniques such as thalamotomy, pallidotomy and deep brain stimulation have created new breakthroughs in the treatment of Parkinson's disease. Of these thalamotomy and pallidotomy are considered as destructive surgeries in that they involve creating lesions in the brain segments to limit the effect of anomalies and improve the motor functions. Thalamotomy is proven to be greatly effective in arresting or relieving tremor which has responded poorly to drugs. Similarly pallidotomy procedure is effective in controlling the anomalies in the 'globus pallidus' from affecting the motor functions. Deep brain stimulation on the other hand is a reversible procedure unlike the above mentioned destructive surgeries. Stimulation of the globus pallidus and the lateral thalamic nuclei have successfully controlled tremor in around 80% of the patients. Apart from these, clinical trials of transplantations such as Adrenal medulla, xenograft and Fetal mesencephalon grafts have received mixed success and much work needs to be done in this area. [Jeff Blackmer]

Pharmacological treatment involves the use of anticholenergic drugs to restore the balance in the acetylcholine - dopamine ratio and other forms of anti-parkinsonian drugs like dopamine agnostics, dopaminergic agents etc. Benzhexol is an example of anticholenergic drug which has been successful in controlling of tremor symptom. Similarly Selegiline is an example of MAO-B inhibitor which reduces the action of the enzyme monoamine oxidase which metabolizes dopamine. Benztropine and amantadine have strong dopaminergic effects. Levodopa (L-dopa) is another important drug which is used as a replacement for the dopamine. Recently COMT inhibitors (catechol-O-methyltransferase inhibitors) have become more widely used along with L-dopa to slow down the lateral metabolism and prolong the effect of the L-dopa. [David Nicholl]

Patient Education and Care (Nursing Intervention)

The debilitating effects of Parkinson's disease, requires efficient nursing care. Nurses play an important part in educating the patient about the long-term effects of the disease, the possible complications, and side effects of the continuous use of medicines and in assisting them to successfully manage the symptoms. The positive therapeutic effects of a loving and supportive nursing care cannot be understated. Especially for very old people who require long-term care, nurses play a vital role in overseeing the nutritional interventions, studying the functional status and the daily progress and in effectively managing other complications (like Orthostatic hypotension, Dysphagia) which are common in advanced stages. [Suzanne C, 1983]

Since constipation is a major problem and it may lead to other dangerous complications such as volvulus, and paralytic ileus nurses have to stress the importance of preventive bowel care. Mobility of the patients in the advanced stages is severely restricted with acute bradykinesia and there is also an increased risk of fractures. In such cases nurses and other caregivers can encourage the use of appropriate assistive devices. Above all, the intake of anti-parkinsonian drugs may have side effects such as confusion, hallucinations, and other forms of drug psychosis. Nurses are the first persons to notice any adverse reaction to drugs, worsening symptoms or other behavioral changes. Under these circumstances they can adjust the dosage of the drugs to restore normality in thinking though it may temporarily compromise on the mobility of the patient. [Susan M. Calne] Skilled nursing is essential for good symptomatic management and there is no question of doubt that nurses have an indispensable role in delivering quality care in a long-term patient care setting.

Bibliography

1) Dr. David Nicholl (2003, OCT 19), "Parkinson's Disease," MedWeb

Retrieved June 4th 2004, at http://medweb.bham.ac.uk/http/depts/clin_neuro/teaching/tutorials/parkinsons/parkinsons1.html

2) Jeff Blackmer, MD (2004, May 20), "Parkinson Disease," eMedicine

Retrieved June 4th 2004, at http://www.emedicine.com/pmr/topic99.htm

3) Suzanne C. O'Connell Smeltzer EdD, RN, FAAN Brenda G. Bare RN, MSN,

Medical-Surgical Nursing" Brunner & Suddarth, 10th Edition pg 1979-1983

4) Susan M. Calne, Ajit Kumar, "Nursing Care of Patients with Late-Stage

Parkinson's Disease" [Electronic Version]. Journal of Neuroscience Nursing,

October 2003, Volume 35, Number 5

Retrieved June 4th 2004, at http://www.aann.org/ce/pdf/jnn10_03a.pdf [END OF PREVIEW]

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