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SCHOOL OF HEALTH SCIENCE BACHELOR IN NURSING
YEAR 1 SEMESTER 1
ACADEMIC SESSION 2018/2019
GTJ 104/9 NURSING FOUNDATION II
Name : Nurshazwani binti Jasni
Matric number : 141860
Lecturer name : Madam Duangta
Title of assignment : Parkinsonism
Introduction
Parkinsonism is the condition which named after Dr James Parkinson who described it in a paper in 1817 under the title ‘ An essay on the shaking palsy,’ is the most frequent neurological disorder of the elderly other than stroke.

Parkinson ( 1755-1824 ) was a doctor in London.He observed about this disease which he studies about the symptoms.He observed this disease through his 3 patients and 3 people that he saw on the streets of the city.From the observation he theorized that the disease developed because of a problem in the brain’s medulla region.In his essay he conclude that some of the main symptoms that may shown from the parkinson’s disease patient are tremors,rigidity and postural instability.

It usually occurs in the late fifties or sixties,and if not treated progresses slowly throughout the rest of the patient’s life.The age at which it starts does seem to have increased recently and a number of cases have been recognized for the first time in the mid-seventies,perhaps as a result of the use of phenothiazine drugs in this age group.

For many decades,doctor couldn’t treat Parkinson’s disease effectively,and classify it as a terminal illness.The drugs such as arsenic,morphine,hemlock and cannabis used to treat the symptoms of tremor in the late 1800s.By the 1940s and 1950s,neurosurgeons began to perform surgery on the basal gangila of the brain,which resulted in improvements in Parkinson’s disease symptoms.But somestimes this surgery cannot be performed effectively which may also be risky which death may occur.

Parkinson’s Disease
Parkinson’s disease is a brain disorder that common attack most among elderly.

Parkinson’s disease are defined as a disease that the brain cells are not anymore function well which occur deficiency chemical substances called dopamin.

This phenomenon will be faced by the elderly when their age keep increases.

Parkinson’s disease can be categorized to 4 symptoms which are tremor,rigidity,hypokinesia and festination.

Tremor : This is the most usual presenting symptom and signs that can be shown clearly by the parkinson’s disease patient.About two thirds of sufferers make this their complaint and the so-called ‘pill-rolling’ tremor of the hands is quite characteristic of the condition.The tremor affects the hand,forearm or foot and ankle and is often confined to one side at first.Progression of the disease affects the other limbs in due course,and it is often the leg on the same side as the tremulous hand that is affected the head and neck,but tremor of the jaw and tongue are not unusual.

Rigidity : This is generalized increase in the stifness of the limbs giving rise to a combined spasm of flexors and extensors giving the limb the feel of lead pipe,resisting the movement in either direction.Where there is severe tremor the shake makes the limb feel as if it were being moved over a cog,as with the brake of a car if it is put on without releasing the ratchet,and this description is the most frequent given to describe the tremor and rigidity together.Neck rigidity produces flexion deformity and cervical spine changes are frequent if flexion has been maintained for a long time.

Hypokinesia : This is the term used for the slowing down of movement,especially of the automatic movements such as facial expression,blinking or swinging of the arms.The dysarthria,which can sometimes rob the patient of speech almost completely also arises from this neuromuscular problem,as aslo may the peculiar small writing micrographia which these patients demonstrate.The reason for this particular feature is quite obscure and the physiology of hypokinesia is unexplained.The hypokinesia is probably also responsible for the salivary drooling which can make the Parkinsonian patient appear so pathetic,since poor swallowing allow saliva to accumulate in the mouth rather than being swallowed,and dribbling is the only means by which it may be got rid of.Similarly the weight loss which accompanies the severer forms of the illness is the result of poor food intake.The wasting may well be so great as to raise the suspicion of neoplastic disease.

Festination : The gait of the Parkinsonian patient arises from the combination of the flexed rigidity of the trunk muscles and the impairment of postural sensitivity which is also part of the condition.Normal postural reflexes do not compensate for the shift of centre of gravity occuring when the person moves,and a shortened rapid step is necessary to bring the feet under the body as it moves forward.The progression of this process makes it necessary for these steps to be taken a little faster each time and the patients seems to break into a little run to catch up.In practice the use of a pulit walking aid may help this until the effects of medication are developed.

COMPLICATIONS
Physical
*tend to falls
*dizziness/imbalanced when body posture changed suddenly
*constipation
*difficult of swallowing (dyphagia)
*difficult in speech (dysathria)
*weight loss
*excessive sweating (hyperhidrosis)
*excessive drooling
Physiological
Emotions problem:
*depression
*anxiety
Brain function ineffectively:
*thinking process
*memory
*insomnia
Sosial
*lost of independent
Treatment of Parkinson’s Disease
Parkinson’s disease can’t be cured,but medications can help to control the symptpms of this parkinson’s disease.But in some cases surgery may be needed by some patients.Other than that,the lifestyle changes may be advised by the doctor to their patients.Especially ongoing aerobic exercise.In some cases,physical therapy that focuses on balance and streching also is important and if the Parkinson’s patient have a problem with their speech so a speech-language pathologist may be needed in improving their speech problems.Medications such as drugs may help the Parkinson’s patients to manage problems such as walking,movement and tremor.Dopamine is an example of drug that had been used to treat this Parkinson’s disease which this function of Dopamine will increase or substitute in the brain.This is because of patients with Parkinson’s disease have low brain Dopamine concentrations.However,Dopamine can’t be given directly,as it can’t enter the patient’s brain.Eventhough this medication will may give have significant improvement of the symptoms however in over time the benefits of drugs become less consistent and frequently diminish.
Drugs
The treatment of Parkinson’s disease has been treat through levodopa therapy.L-dopa is among the first drugs to meet a specifically defined deficiency in brain tissue,the defiency having been determined by the examination of the brain tissues in deceased patients who had suffered from the disease.Dopamine also has been used as a treatment of this disease.But it could not be given to the patient anymore because of it is broken down readily in the intestine so L-dopa is the more stable drug to be used in Parkinson’s diseases treatment.L-dopa was found to be quite toxic in therapeutic doses.This will bring the patient under through physiological effect of the substances which they will felt in muscle,heart,intestine and blood pressure,as well as in brain,where the primary effect is desired.It was necessary because of it will block these peripheral actions and give a alternative way to L-Dopa to work in brain more effectively.This has been achieved the simultaneous use of carbaminodopa (carbidopa) or of benserazide,both of which inhibit extracranial activity of the L-Dopa.The simultaneous reactions from the carbaminodopa and of benserazide will make the L-Dopa drug in smaller doses to reaches the brain tissues and it is beneficial in just only giving the L-Dopa drug to the patients to avoid unwanted effects.However,the L-Dopa effects can be less long-lasting over the following years because of more nerve cells in the brain are lost so it will make the drugs are fewer to be absorbed.Long term use of L-Dopa also may contribute problems such as uncontrollable,jerky muscle movements (dyskinesia) and also “on-off ” effects may be occur which is sometimes patients with this disease are rapidly switches between being able to move (on) and being unable to move (off).

The L-Dopa drug dosage is more safer to be used by the elderly compared to the younger neurological patients,and often as little as 400-500mg only may suffice to control symptoms and signs.This L-Dopa also may reduce the side effects of feeling sick (nausea) or vomiting,tiredness and dizziness.

Suppotive therapies – Physiotherapy
A physiotherapy may help the Parkinson’s patients with relieve muscle stiffness and joint pain through movement (manipulation) and exercise.Purposes of this therapy is to make the patients to move more easier and want the improvement based on walking and the flexibility.They also try to help the patients to improve the fitness levels and ability to manage things by themselves.

Surgery
Most of the patients with this Parkinson’s disease can be treated by the medications or some helps from the physiotherapist.Some cases also may need a treatment by perform a surgery which called deep brain stimulation.Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into the patient’s chest wall.This required one or two fine wires to be connected which will be placed under the skin,and is inserted precisely into specific areas in the patient’s brain.From the deep brain stimulation,a tiny electric current is produced by the pulse generator,which runs through the wire and stimulates the part of the brain which affected by Parkinson’s disease.This surgery is not for curing this disease but it can helps inhibit the symptoms of Parkinson’s disease.
Conclusion
Parkinson’s disease mostly faced by the elderly.This Parkinson’s disease will make patients daily activity being disturbed.It is because of the patients cannot do something on their own.For an example it will affect the patient’s movement,flexibility and other symptoms that difficult for them to do something.The most worried condition of Parkinson’s patients are more easier tend to falls.So from this condition it will make the patients tend to receive more fractures and will make his condition tend to be more serious.The patients with this disease may have insomnia so it will make the situation more complicated whether difficult to the patients,nurses and the most one is their family.It needed full commitment from these people in providing care to them.

This disease will make the patients to faced some of the symptoms such as tremor,rigidity,festination and hypokinesia.From the symptoms that faced by the Parkinson’s patients will give difficult to them to be in a normal condition just like before.Parkinson’s disease cannot be cured but it can inhibit the symptoms of the disease.Eventhough the patients are having the treatment it is also cannot be as the long lasting in curing this disease.For an example of the famous treatment that the physician prescribe for the patients are through medications such as using the L-Dopa drug.Sometimes it also may need some supportive treatment such get helps from the physiotherapist and sometimes surgery may be performed on this Parkinson’s patients.

In conclusion,many of reseacher contributing their commitment in finding a cure to treat this disease.But they fails in finding the cure.So this disease cannot be cured and just can relieve the symptoms only.

References
Chalmers.G.L., (1980). Caring for the Elderly Sick, England : Pitman Medical Limited
McCoy, K. (2016, April 27). Parkinson’s Disease Then and Now. Retrieved from HYPERLINK "http://www.everydayhealth.com/parkinsons-disease/history-of-parkinson-disease.aspx" http://www.everydayhealth.com/parkinsons-disease/history-of-parkinson-disease.aspx
Ngeh, D. J. (2012, April 26). PENYAKIT PARKINSON. Retrieved November 16, 2018, from HYPERLINK "http://www.myhealth.gov.my/penyakit-parkinson/" www.myhealth.gov.my/penyakit-parkinson/
Staff, M. C. (2018, June 30). Parkinson’s Disease. Retrieved November 19, 2018, from HYPERLINK ;https://www.mayoclinic.org/disease-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062; https://www.mayoclinic.org/disease-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062