NCP for Parkinson's Disease
Definition of Parkinson's Disease
Parkinson's Disease is a progressive neurological disease that affects the response mesensefalon and movement regulation. This is inherently slow disease that strikes middle age or old age, with onset at age 50 to 60 years. Not found a clear genetic cause and no treatment that can cure it.
Parkinson's Disease is a progressive neurodegenerative disease that is closely related to age. This disease has a characteristic degeneration of dopaminergic neurons of substantia nigra pars compacta, plus the presence of inclusions intraplasma consisting of a protein called Lewy Bodies. Neurodegenerative Parkinson's disease also occurs in other brain regions including the locus ceruleus, raphe nucleus, nucleus basalis of Meynert, hypothalamus, cortex cerebri, the motor nucleus.
Etiology of Parkinson's Disease
Parkinson's is caused by damage to brain cells, specifically in the substance nigra. A group of cells that regulate the movements that are not desired (involuntary). As a result, the patient can not control / restrain the movements unconsciously. Mechanisms of how the damage was unclear.
Parkinson disease is often associated with abnormalities of neurotransmitters in the brain of other factors such as:
- Deficiency of dopamine in the substantia nigra in the brain respond to the symptoms of Parkinson's disease,
- The underlying etiology may be associated with the virus, genetic toxicity, or other unknown causes.
Two hypotheses are referred to as a mechanism of neuronal degeneration in Parkinson's disease are: the free radical hypothesis and the hypothesis of neurotoxins.
1. Free Radical Hypothesis
Alleged that the enzymatic oxidation of dopamine can damage nigrostriatal neurons, because this process generates hydrogen peroxide and other oxygen radicals. Although there is a protective mechanism to prevent damage from oxidative stress, but at the advanced age of this mechanism may fail.
2. Neurotoxin Hypothesis
Presumably one or more kinds of neurotoxic substances play a role in the process of neurodegeneration in Parkinson's disease.
Current view emphasizes the importance of the basal ganglia, in neurophysiology plan required in movement, and the part played by the cerebellum is to evaluate the information received as feedback on the implementation of the motion. Basal ganglia is a primary task of collecting program for the movement, while the cerebellum monitor and rectification of errors that occur seaktu movement program is implemented. One picture of extrapyramidal disorders are involuntary movements.
Signs and Symptoms of Parkinson's Disease
Parkinson's disease had clinical symptoms as follows:
- Bradykinesia (slow movement), disappears spontaneously,
- Tremor is settled,
- Actions and movements are not controlled,
- The autonomic nervous disorders (insomnia, sweating, orthostatic hypotension,
- Depression, dementia,
- Face like a mask.
Parkinson's Disease Nanda Nursing Care Plan
- Assess cranial nerves, cerebral function (coordination) and motor function.
- Observation of gait and while performing the activity.
- Assess history of symptoms and their effects on body functions.
- Assess the clarity and speed of speech.
- Assess signs of depression.
Nanda Nursing Diagnosis of Parkinson's Disease
- Impaired physical mobility related to the stiffness and muscle weakness.
- Self-care deficit related to neuromuscular weakness, decline in strength, loss of muscle control / coordination.
- Impaired verbal communication related to the decline in speech and facial muscle stiffness.
Nursing Interventions of Parkinson's Disease
1. Impaired physical mobility related to the stiffness and muscle weakness.
Purpose: the client is able to perform physical activity according to ability.
Criteria: the client can participate in training programs, joint contractures did not occur, increased muscle strength and the client indicates an act to meninktkan mobility.
- Assess existing mobility and the observation of increased damage.
- Conduct training program increases muscle strength.
- Encourage warm bath and massage the muscle.
- Help clients to perform ROM exercises, self-care as tolerated.
- Collaboration physiotherapists for physical exercise.
Purpose: self-care are met.
Criteria: the client may indicate a change of life for the needs of self-care, client is able to perform self-care activities in accordance with the level of ability, and identify personal / community that can help.
- Assess the ability and the rate of decline and the scale of 0-4 to perform ADL.
- Avoid anything that can not be done and help the client if necessary.
- Collaboration of laxatives and consult a doctor of occupational therapy.
- Teach and support the client during the client's activities.
- Environmental modifications.
Purpose: to maximize the ability to communicate.
- Keep the complications of treatment.
- Refer to speech therapy.
- Teach clients to use facial exercises and breathing methods to correct the words, volume, and intonation.
- Deep breath before speaking to increase the volume and number of words in sentences of each breath.
- Practice your talk in short sentences, reading aloud in front of the glass or into a voice recorder (tape recorder) to monitor progress.