NURS 1730 Lecture Notes - Lecture 9: Rapid Eye Movement Sleep Behavior Disorder, Toilet Seat, Sexology
11-63-173
Week Nine: March 19 - 23, 2018
Introduction to Nursing II
Health Promotion and Protection: Movement Disorders
Learning Goals:
-Define Movement Disorders
-Identify the etiologies, sign & symptoms, diagnosis, prevention and management of movement disorders affecting the
aging population
-Parkinson’s disease
-Tremors
-Sleep disorders
-Impact on health and well-being
Signs and Symptoms
- Dyskinesia - impairment of voluntary movement
- Hyperkinesia - “alive and kicking” → excessive, involuntary movement
- Tremor, dystonia, tics, chorea athetosis
- Hypokinesia - “stuck in a movement” → slow or absent voluntary movement
- Akinesia and rigidity
Hyper- and hypo-kinesia arise from the basal ganglia; all about dopamine. ⇒
Movement Disorders
- Parkinson's disease
- Dystonia
- Tremor
- Restless legs syndrome (RLS) and reflex sympathetic dystrophy/periodic limb movement
disorder (RSD/PLMD)
- Ataxia
- Huntington's disease
- Myoclonus
- Progressive supranuclear palsy
- Wilson disease
- Tics
- Tourette's syndrome
Parkinson’s Disease: Incidence and Prevalence
- Risk increases with age.
- Men develop the disease slightly more than women.
Parkinson’s Disease: Etiology
- Unknown
- Theories include a combination of factors
- ie. free radicals that are damaging dopamine cells in the brain.
- ie. pesticides can result in parkinson’s
- ie. some genetic connection; not as common but about 1/5th (20% of parkinson’s
patients) can be genetic in nature.
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11-63-173
Week Nine: March 19 - 23, 2018
Parkinson’s Disease: Signs and Symptoms
- May develop several symptoms over time.
- Most patients do not develop all of the symptoms.
- Primary symptoms include:
- Bradykinesia → slow movement
- Pain/muscle cramps
- Tremor
- Rigidity
- “Parkinsonian gait”
- Pain and muscle cramps
- “ON and OFF” → medications
- Inability to have facial expression with development of
disease.
- Can have difficulty initiating movement, stopping
movement.
- Secondary symptoms include:
- Constipation
- Dysphagia → difficulty swallowing; therefore assess nutrition
- Scaling, dry skin on the face and scalp
- Soft, whispering voice
- Loss of intellectual capacity (dementia)
- Depression, psychosocial anxiety, isolation
Parkinson’s Disease: Diagnosis
- Based on signs and symptoms and ruling out other disorders that produce similar
symptoms.
- Tremor at rest
- Rigidity (stiff muscles)
- Akinesia (poverty of movement)
- Postural abnormalities
- Must have two or more of the primary symptoms of Parkinson’s one of which is a resting
tremor or bradykinesia (slow movement).
Parkinson’s Disease: Management
- Medication treatment → with dopamine
- Symptom management:
- Exercise/physio → ie. Tai Chi
- Support groups
- Complementary therapies
- Medication - replacement, mimicking or slowing down dopamine breakdown.
- Surgery - ablation, deep brain stimulation, transplantation of dopamine cells into brain.
Implications for Healthy Aging
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11-63-173
Week Nine: March 19 - 23, 2018
→ overall goals of care - What?
- Relieving symptoms with medications
- Increasing functional ability
- Preventing excess disability
- Decreasing risk of injury and preventing other complications
Implications for Healthy Aging
→ Four Pillars of Care - How?
1. Exercise → balance and flexibility exercises like tai-chi or yoga, ROM x2 daily.
2. Eating and Nutrition → Small, frequent meals, ample water, smaller food pieces,
exercise face, chew food and move around mouth before swallowing.
3. Continence and Constipation → routine toileting, increase vegetables and fruit in diet,
drink adequate water, used raised toilet seat and grab bars.
4. Sleep Difficulties (due to cramps and muscle pain) → Try meditation or music to relax,
avoid sleep medications, use satin sheets to aid turning, body pillows for comfort.
Assessment
→ Comprehensive functional assessments
- Self-care abilities in ADLs
- Nutritional assessment
- Fall assessment
Parkinson’s Disease Management
- Exercise
- Support groups
- Complementary therapies
- Symptom management:
- Medication – replacement, mimicking or slowing down dopamine breakdown
- Surgery – ablation, deep brain stimulation, transplantation
Essential Tremor (ET)
- Not a result of disease
- Caused by abnormalities in areas of the brain that control movement
- Occurs with purposeful movement
- Most often in the hands and head but it also can affect the arms, larynx, trunk, and legs.
ET: Etiology
- Family history of the disorder
- Age > 60 is a significant risk factor
- Having a parent with the disorder
ET: Signs and Symptoms
- Symptoms may remain mild or increase in severity over time
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Document Summary
Identify the etiologies, sign & symptoms, diagnosis, prevention and management of movement disorders affecting the aging population. Hyperkinesia - alive and kicking excessive, involuntary movement. Hypokinesia - stuck in a movement slow or absent voluntary movement. Hyper- and hypo-kinesia arise from the basal ganglia; all about dopamine. Restless legs syndrome (rls) and reflex sympathetic dystrophy/periodic limb movement disorder (rsd/plmd) Men develop the disease slightly more than women. Theories include a combination of factors ie. free radicals that are damaging dopamine cells in the brain. Theories include a combination of factors ie. free radicals that are damaging dopamine cells in the brain. ie. pesticides can result in parkinson"s. Most patients do not develop all of the symptoms. Inability to have facial expression with development of disease. Can have difficulty initiating movement, stopping movement. Dysphagia difficulty swallowing; therefore assess nutrition. Scaling, dry skin on the face and scalp. Based on signs and symptoms and ruling out other disorders that produce similar symptoms.
