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Discussion on Parkinson's disease (PD) (Essay Sample)


Topic: Parkinson’s Disease.
When developing your teaching resources, please be sure to include the following elements:
• Pathophysiology
• Incidence/Occurrence
• Diagnostic testing
• Signs and symptoms
• Complications
• Medical management/treatment
• Relevant pharmacology
• RN role and responsibilities
• Client and family teaching/education


Parkinson's disease (PD)
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Parkinson's disease (PD)
PD is the second most widespread neurodegenerative sickness. According to Copas et al. (2021), motor signs of bradykinesia, resting tremor and rigidity, non-motor signs of sleep, depression, and constipation characterise the disorder. PD is a chronic, progressive neurological condition with four cardinal motor manifestations, including tremors at rest, rigidity, bradykinesia, and postural instability. Primarily, PD is associated with the gradual cell loss in the substantia nigra of the brain, an area that produces dopamine. Dopamine deficiency in the striatum causes loss of control of the nerve cells in the region, limiting an individual's capacity to control movement. Consequently, it causes the first PD symptoms. As the condition progresses, other brain and nervous system areas degenerate, causing more intense movement disorder (Copas et al., 2021). The precise cause for the cells' loss is unknown, with genetic and environmental factors predicted to be possible causes.
Recent studies indicate that genetic factors can increase PD risk. Around 15-20% of PD patients have a close relative with parkinsonian symptoms. In some families, the alpha-synuclein gene (present on chromosome 4) is linked with PD. However, this gene accounts for only a small percentage of the total PD cases, but it is linked with a significant percentage of familial PD with an onset before the age of 60 (Copas et al., 2021). On the other hand, multiple toxins, including drugs contaminated with MPTP, can cause severe PD symptoms. Once the MPTP chemical crosses into the brain, it kills brain cells. Potential toxins include herbicides and pesticides, toxins released by industrial plants, and air contaminants linked to road traffic. Others include manganese dust, carbon disulfide, and severe carbon monoxide poisoning.
According to Tysnes and Storstein (2017); Brakedal et al. (2022), PD affects 1 to 2 per 1000 of the population. Its prevalence increases, and Tysnes and Storstein (2017) further illustrate that the condition affects 1 per cent of people aged over 60 years. Its onset is usually at the age of 65 to 70 years. Recent empirical findings indicate that onset before 40 years of age is less than 5% of the cases in population-based cohorts. Tysnes and Storstein (2017) underline earlier onset as genetic variations. Generally, genetic factors are involved in 5-10% of cases or more, while the condition is slightly more frequent in men than women (Park et al., 2019). PD prevalence ranges from 100 to 200 per 100,000 individuals and has an annual incidence rate of 15 per 100,000.
Diagnostic Testing
Presently, there is no specific test for diagnosing PD. Physicians trained in nervous system conditions can diagnose PD based on their medical history, studying indicators and symptoms, and neural and physical examinations. According to Esmail (2018), the disease remains a clinical prognosis. Its treatment and management is presently limited to symptom control instead of modification of the fundamental pathophysiological process.
Signs and Symptoms
PD diagnosis is the first motor symptom based on defined criteria from the UK PD Brain bank. According to Sveinbjornsdottir (2016), main motor signs include tremor, slowness, rigidity, and postural instability. Besides, most individuals suffering from the condition experience non-motor symptoms likely to precede motor symptoms. Early symptoms may be mild and go unnoticed, while signs often start on one bodyside and remain worse on that side. One of PD's main symptoms is tremor or shaking that often starts in a limb, usually on the hand or fingers. The second sign is slowed movement (bradykinesia). The disease may slow the victim's movement, making simple tasks challenging and time-consuming as the disease progresses. The other symptom is rigid muscles that can occur in any body part. Muscle stiffness is painful and limits movement range. PD patients also suffer from weakened posture and stability, automatic movements’ limitation, speech and writing changes.
Multiple problems and complications often accompany PD, including thinking challenges, hopelessness, expressive changes, swallowing difficulties, chewing and eating difficulties, sleep complaints, bladder complications, and constipation. Besides, persons suffering from PD may experience blood pressure changes, smell dysfunction, exhaustion, discomfort, and sexual dysfunction. Past studies indicate that an estimated 10% of patients after treatment initiation with levodopa develop movement instabilities, with 40 per cent developing these problems between 4-6 years of treatment (Aradi & Hauser, 2020). According to Armstrong and Okun (2020), persons experience complications, including deteriorating symptoms and functional deficiency when medicine doses wear off. Motor complications' strongest predictors include worse disease severity and higher levodopa dose.
Medical Management/Treatment
Conventional techniques for treating PD start with a pharmacologic dopamine replacement approach. According to Church (2021), the first line for such treatment includes everyday oral levodopa or a dopamine agonist. The author further illustrates that some drugs extend endogenous dopamine lifetime. Lifestyle changes can offer therapeutic benefits, as diverse forms of active aerobic are neuroprotective coupled with the quality of life benefits presented by consistent workout. Church (2021) underlines that corresponding and substitute medicine and integrative medicine techniques are employed by many to advance the brain and health of people with Parkinson's. Therefore, persons suffering from PD must communicate explicitly with their healthcare teams to handle such problems and manage PD's motor and non-motor signs.
Multiple empirical findings support the prompt introduction of anti-parkinsonian treatment immediately after confirmation of diagnosis. Pirtošek et al. (2020) illustrate that oral levodopa remains the most efficient and prevalently employed therapeutic alternative in treating PD. It is the initial gold-standard PD therapy. Nonetheless, its use ultimately develops motor variations and levodopa-induced dyskinesia. Almost 40 per cent of PD patients develop levodopa-induced dyskinesia after 4 to 6 years of levodopa treatment (Pirtošek et al., 2020). Among younger patients with motor complications occurring earlier and more severe, Pirtošek et al. (2020) recommend pharmacological treatment starting with MAO B inhibitors or dopamine agonists and adding levodopa later. When PD indicators cannot be optimally eased with traditional oral treatments, Pirtošek et al. (2020) recommend applying incessant dopaminergic administration techniques by presenting unconventional treatments or device-aided treatments. Nonetheless, before reaching this advanced phase, the suitable utilisation of accessible oral treatments can assist in optimising traditional pharmacotherapy in patients. Some non-pharmacological techniques should be employed in managing PD.
Pirtošek et al. (2020) key messages for treating PD during the initial stages include starting low and going slow until reaching effective clinical benefit. The researchers emphasise that individual strategy is necessary based on signs and preference when choosing the right medication. The preferred medication during the initial stages should be medications with a more incessant stimulation profile if suitable for the patient's clinical profile. Pirtošek et al. (2020) underline that levodopa should not be avoided at all costs, even during the early phases. In cases where alternative medications are ineffective or not indicated, considering levodopa is the recommended. Overall, PD's treatment and primary management goal should encompass maintaining acceptable levels of functioning and independence.
Relevant Pharmacology
Motor symptoms' medications should not start until symptoms impair function and quality of life. Mouchaileh and Hughes (2020) underline that mild, non-troubling signs in early disease do not demand therapy. The treatment goals differ between younger and older patients. For example, younger patients concentrate on sustaining employment and escaping long-term treatment complications. Contrary, older patients focus on maintaining everyday skills and maximising function (Mouchaileh & Hughes, 2020). The least medication amount should be employed to control symptoms but require many agents, particularly in later stages. Overall, optimal management demands an individualised technique usually encompassing a multidisciplinary team.
RN Role and Responsibilities
Recent empirical findings indicate increasing specialisation among nurses caring for PD patients. Therefore, knowledge regarding PD's pathophysiology is arguably a significant starting point for vocational training. Empowering nurses with specific knowledge domains permits behaviour standardisation, maximising interpersonal collaboration challenges. In this context, nursing care for PD patients should concentrate on the biopsychosocial factors. Besides, it should be based on principled, legal, functioning, and conceptual expectations of the occupation for health promotion, complications prevention, treatment, and recovery. According to Hellqvist and Berterö (2015), nurses should at least give information and education, support patient and caregivers in self-management, screening offering prevention, working in multidisc...

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