Dan Crenshaw Case

The World Health Organization projects that, by 2040, neurodegenerative diseases will become more common than cancer (Cashell, 2014). Parkinson’s Disease (PD) is widely listed as the second most common neurodegenerative disease (Wuong, 2012; Gillies et al., 2014; Cashell, 2014; Walker, Davidson, & Gray, 2012). This disease, usually characterized by a tremor, but featuring systemic effects, has been diagnosed in one to two percent of people over age 65 (Casey, 2013). Parkinson’s disease is incurable; the goal of the healthcare team is to help the patient to maintain function, independence and quality of life (Miertová et al., 2014; Magennis, Lynch, & Corry, 2014). In the discussion that follows, current understanding of the causes and treatment of PD will be summarized, along with examples of nursing interventions.

Information from the nigra cells passes through the synapses with the aid of a specific hormone, dopamine, which is a significant chemical transmitter in the brain. Because the existence of dopamine is essential to the function of the substania nigra, it is also essential for the various muscular activities controlled by the striatum, such as walking, balance, etc. (16).

Some dopaminergic (i.e., dopamine-releasing) neurons run from the substantia nigra to the corpus striatum; their loss gives rise to the clinical manifestations of Parkinson's Disease (Korczyn 1994); others, involved in the rewarding effects of drugs and natural stimuli, run from the mesencephalon to the nucleunucleus accumbens.

Before his diagnosis, Fox was unsure of where his life was going. He enjoyed his job and the perks that came with it. He had everything he could want in his life and more, yet he still did not feel content with himself. Through his battle with Parkinson’s Disease he begins to understand himself better. He realizes that if he does not accept and embrace his new life with Parkinson’s, then he will never be able to move on. Therefore he says, “I lowered my guard at home, allowed myself to be open with my symptoms around my family. What a relief it was to relax for a change,” (Fox 191). This new self-awareness brings him to the realization that his new place in life is to promote awareness of Parkinson’s disease and use his fame to share his experience with the disease in hope that someday a cure can be found. His new sense of place allows him to find out who he wants to be and what he wants accomplish with his

History is taken from the patient, who is a good historian along with records from her inpatient stay at Portsmouth Regional Hospital and her outpatient visit for Dr. Tan. In short, she is a 64-year-old right-handed white female who on August 8, 2015 awoke with acute weakness on the right side of her body. She had difficulty getting out of bed. She was able to move around and walk, but she had noted coordination problems. She called family who was concerned about her slurred speech. After they arrived, they recommended that she go to the emergency room. The patient did not notice any visual field cut. She did not notice any language problems other than slurred speech. There was no dizziness. No significant sensory changes. She has no history of palpitations. Her risk factors are all poorly controlled diabetes, hypertension, hypercholesterolemia, and cigarette smoking. She was not on an aspirin a day at the time of her event. She presented to the emergency room, where she noted significant improvement. She was discharged with minimal findings on the right side for outpatient physical therapy. She has one more physical therapy visit on Thursday. Currently, she states that she has no problems with ambulation. As far as the stroke is concerned, because her hip pain will affect her before any fatiguing, she thinks she has only a 10 to 15% deficit as far as overall right-sided strength. She is able to do her ADLs. She is having

This is 51 year old AAM. Patient has a history of HTN and DM, his current medications are glipizide 5 mg QD and lisinopirl 5 mg QD, but hasn't been taking them for more than one week. Patient reports neuralgia, tingling and prickling sensation at his bottom of his feet. Patient is a current resident at a Group Home and unable to afford any of the medications and needs community resources. Patient also report blurred vision, denies chest pain, SOB, N/V/ D,or fever. Patient is a current tobacco user, denies use of alcohol or illicit drugs.

The next part the dopamine reward system jumps to is the basal ganglia, which within the basal ganglia is the dorsal striatum. The dorsal striatum’s job is to receive

Parkinson’s disease is a progressive chronic incurable neurological disorder that affects 0.3% of the populations in the United States. The incidence of Parkinson’s disease increases with age and it is estimated to affect 5% of the population over the age of 85 (Nolden 2014). Historians have found evidence of the disease as far back as 5000 B.C. It was first described as “The shaking Palsy” by British Doctor James Parkinson. Because of his early work in identifying the symptoms, the disease came to bear his name. (Parkinsons foundation, n.d.) (Parkinsons foundation, n.d.)

About one million Americans and four million people worldwide suffer from Parkinson’s disease. The number of individual’s with Parkinson’s increases by at least sixty thousand per year in America. Although the Parkinson’s disease has been around for thousand of years, it was not officially recognized until 1817 by a Dr. James Parkinson. Dr. James Parkinson clearly stated in his paper An Essay on the Shaking Palsy symptoms of Parkinson’s that are still recognized today as markers for the disease. Even though he wrote that paper in 1817, it was not until 1861 that the medical community began to collectively look into this debilitating disease.

Inside brain ,dopamine plays important roles in motor cortex , motivation , conditioning and reward .Dopamine is produced in the limbic system particularly in ventral tegmental area and substantial nigra .Dopamine itself is also found in some food but since it can not penetrate to blood brain barrier we can not use it in regulatory function .

Charcot examined a large group of patients within Salpetriere Hospital in Paris, he had developed a way to observe tremors in action and at rest. “He noted that the patients with action tremor had accompanying features of weakness, spasticity, and visual disturbance. In contrast, those with rest tremor differed in having rigidity, slowed movements, a typical hunched posture, and very soft spoken.” (Goetz 2011) Charcot early tremor studies helped to establish Parkinson’s Disease through his very high publicized findings that neurological entity could be confidently be diagnosed. In 1957 a Swedish scientist Arvid Carlsson found out that dopamine in the brain region that is important for movement control. He showed that the levels of dopamine can be reduced in animals to cause symptoms of Parkinson’s Disease and also by giving the animals levodopa (L-dopa) to reverse the symptoms of PD. PD is second most common neurodegenerative after Alzheimer’s Disease and the most common movement disorder. Over 60,000 people here in the United States are diagnosed every year but they say the numbers can be much higher with undiagnosed people out there but over one million people live with Parkinson daily.10 million people worldwide live with Parkinson’s Disease and April 11th is World Parkinson’s Day. On April 11th, 2017 marked 200 years since James Parkinson publicized his essay.

The patient is a 72-year-old gentleman that has significant cervical spine arthritis he has been having extreme dizziness, numbness and pain in the left arm for the the past few months. He was a same-day surgical admission on the third for an elective vasectomy. He underwent a C3-4, C4-5, 8D, ACDF. The patient is also noted in the history to have a myopathy with great gait difficulty. The day after the surgery he is evaluated by physical therapy. He has great difficulty walking, Aspen collar is in place. His upper extremity strength is detail as 3+ over 5 both upper extremities,lower extremities are 4/5. His sitting balance was good. Standing was fair. This was all with a rolling walker. He also reported having some difficulty swallowing.

Parkinson’s Disease (PD) is a chronic neurological disease that effects about 329 per 100,000 people in the US. The average onset of this disease usually is for people over the age of 50, with the baby boomers getting older there may be an increase in this disease, as much as 9 million people worldwide. (Pawha 2010)

Dopamine is mostly referred to as the “pleasure chemical.” Although this is true, there are many other functions and effects dopamine has on the brain. “Dopamine is produced in the dopaminergic neurons in the ventral tegmental area (VTA) of the midbrain, the substantia nigra pars compacta, and the arcuate nucleus of the hypothalamus” (Mandal). It is released to activate and assist the following: movement, memory, pleasure, social functions, attention, and milk production.

The brain is the site for the production of dopamine. The brain uses the dopaminergic neurons that are present in the midbrain to manufacture dopamine. It