Parkinson’s Disease - Medical Surgical Nursing Guide

Nursing students must understand the condition’s pathophysiology, risk factors, clinical signs, diagnostic approaches, management strategies, and patient education. This comprehensive guide aims to equip nursing students with essential knowledge about Parkinson’s Disease.

Definition

Parkinson’s disease is a progressive neurodegenerative disorder characterized by the loss of dopamine-producing neurons in the substantia nigra pars compacta, leading to disrupted basal ganglia circuitry and impaired initiation and scaling of movement. Clinically, PD is defined by its motor features—bradykinesia plus tremor and/or rigidity—and a wide spectrum of non-motor symptoms that often precede motor signs by years. It is not curable at present, but many symptoms can be managed effectively for long periods with medication, rehabilitation therapies, and advanced interventions. Authoritative summaries from the National Institute of Neurological Disorders and Stroke emphasize the dopamine deficit underpinning movement symptoms and the long trajectory of disease management. ninds.nih.gov+1

NCLEX frame: Remember that PD is a progressive disorder with dopamine deficiency. Link “dopamine down → movement slows” to bradykinesia, rigidity, and gait disturbances.

Contributing Factors

PD arises from an interplay of aging, genetics, and environmental factors. The precise cause remains multifactorial, but key contributors are consistently noted across major clinical sources:

Age: The strongest risk factor. Incidence rises after age 60 as neuronal resilience declines. National Institute on Aging

Genetics: Mutations or risk variants in genes such as LRRK2 and GBA can increase susceptibility, though most cases remain sporadic. ninds.nih.gov

Environmental Exposures: Long-term exposure to certain pesticides and solvents, and a history of head trauma, have been associated with increased risk in epidemiologic studies. National Institute on Aging

Pathophysiology Clues: Intraneuronal alpha-synuclein aggregates (Lewy bodies) are pathological hallmarks, contributing to neuronal dysfunction and death. ninds.nih.gov

Nursing takeaway: When taking a history, note age, family history of PD or dementia with Lewy bodies, occupational exposures, and any prior concussions or head injuries. These are not diagnostic on their own but can raise clinical suspicion.

Manifestations

Motor Symptoms

Bradykinesia: Slowness and decrement in movement amplitude; difficulty initiating tasks like buttoning clothes or rising from a chair.

Resting Tremor: Classically “pill-rolling,” typically asymmetric, most evident at rest and dimming with voluntary action.

Rigidity: “Lead-pipe” or “cogwheel” quality on passive movement; contributes to stiffness and musculoskeletal pain.

Postural Instability and Gait Changes: Stooped posture, shuffling steps, decreased arm swing, freezing episodes, and increased fall risk. National Institute on Aging

Non-Motor Symptoms

Non-motor symptoms are common, clinically significant, and often precede motor signs. These include:

Neuropsychiatric: Depression, anxiety, apathy, hallucinations (often visual), cognitive impairment that can progress to Parkinson’s disease dementia.

Autonomic: Orthostatic hypotension, constipation, urinary urgency or retention, sexual dysfunction, and temperature dysregulation.

Sleep: REM sleep behavior disorder, insomnia, excessive daytime sleepiness.

Sensory: Hyposmia (reduced smell), pain, paresthesias.Contemporary reviews and classic summaries emphasize that non-motor symptoms are integral to PD burden and quality of life. PubMed+1

NCLEX frame: PD is not just tremor. Expect questions about constipation, orthostatic hypotension, fall risk, depression, and sleep changes.

Diagnostic Procedures

Clinical Diagnosis

Diagnosis is primarily clinical, based on bradykinesia plus tremor and/or rigidity, asymmetry of signs, response to dopaminergic therapy, and exclusion of mimics. Neurologist evaluation includes a detailed history, medication review, and a focused neurologic exam. There is no single blood test for PD. Mayo Clinic

Imaging and Ancillary Tests

DaTscan (I-123 ioflupane SPECT): Demonstrates presynaptic dopaminergic deficit. Useful in distinguishing PD or atypical degenerative parkinsonism from essential tremor or drug-induced parkinsonism when the exam is ambiguous. It does not reliably differentiate PD from atypical parkinsonian syndromes such as MSA or PSP. Occasionally a patient meeting PD criteria can have a “SWEDD” (scan without evidence of dopamine deficit). practicalneurology.com

MRI: Often normal in PD, but valuable to rule out structural causes of parkinsonism.

Emerging and adjunctive imaging: Research continues into PET and other modalities; DaTscan remains the most widely used clinical tool in uncertain cases. American Parkinson Disease Association+2PMC+2

Nursing takeaway: Many patients will not need advanced imaging for a typical presentation. When DaTscan is ordered, prepare patients by explaining purpose and limitations.

Nursing Actions

Nursing care targets safety, symptom control, medication adherence, mental health, and caregiver support across settings.

Assessment Priorities

Motor: Document tremor, rigidity, bradykinesia, freezing episodes, dyskinesias, and fall history.

Autonomic: Screen for orthostatic hypotension (lying, sitting, standing BPs), bowel patterns, urinary symptoms.

Neuropsychiatric: Evaluate mood, anxiety, cognition, hallucinations, and sleep.

Functional: ADLs, IADLs, swallowing safety, weight trends, and nutrition.

Safety and Mobility

Implement fall precautions: Non-skid footwear, clear pathways, adequate lighting, grab bars, and bed/chair alarms as needed.

Coordinate PT/OT for gait training, cueing strategies for freezing, posture and balance exercises, and adaptive equipment.

Encourage assistive devices when appropriate, emphasizing correct height and use.

Teach movement cueing: Rhythmic auditory cues, counting steps, laser/light cues for freezing.

Medication Management

Administer carbidopa/levodopa on time and without abrupt interruptions to prevent “off” episodes.

Maintain consistent timing relative to protein intake if instructed by the provider, since high-protein meals can reduce levodopa absorption.

Monitor for side effects: Dyskinesias, nausea, hypotension, hallucinations, impulse control disorders with dopamine agonists, and sleep attacks. Keep vitals and orthostatics. Mayo Clinic

Nutrition and Swallowing

Collaborate with SLP and dietitian for dysphagia screening, texture modifications, small frequent meals, and adequate hydration and fiber to combat constipation.

Consider timing levodopa 30–60 minutes before meals if tremor or rigidity impairs eating, per provider guidance.

Bowel, Bladder, and Autonomic Care

Establish a bowel regimen: Fluids, fiber, activity, scheduled toileting, stool softeners or osmotic laxatives if needed.

Address orthostatic hypotension: Rise slowly, compressive stockings, liberalize fluids and salt if appropriate, and review medications that worsen hypotension.

Sleep and Mental Health

Promote sleep hygiene, daytime light exposure, and safety measures for REM sleep behavior disorder.

Screen for depression and anxiety; facilitate referrals and support groups.

Education and Caregiver Support

Provide medication calendars, alarm reminders, and written instructions.

Teach about on/off fluctuations, fall prevention, and when to contact the provider.

Encourage caregiver respite resources.

Treatment

Management is individualized and evolves with disease stage. The broad pillars are medications, rehabilitation therapies, device-aided and surgical options, and comprehensive self-management.

Pharmacologic Therapy

1. Levodopa/Carbidopa

• First-line for most motor symptoms due to robust efficacy. Carbidopa reduces peripheral conversion of levodopa to dopamine, improving tolerability. Over time, patients can develop motor fluctuations (wearing-off, on–off) and dyskinesias. ninds.nih.gov

2. Dopamine Agonists (pramipexole, ropinirole, rotigotine)

• Can smooth motor fluctuations and sometimes delay levodopa initiation in younger patients. Monitor for impulse control disorders, sleep attacks, and edema. Parkinson's Foundation

3. MAO-B Inhibitors (selegiline, rasagiline, safinamide)

• Mild symptomatic benefit; also used as add-on to reduce wearing-off. Be mindful of drug interactions and serotonergic cautions. Parkinson's Foundation

4. COMT Inhibitors (entacapone, opicapone, tolcapone)

• Extend levodopa effect by reducing peripheral breakdown. Tolcapone requires liver monitoring; opicaponeoffers once-daily convenience. American Parkinson Disease Association

5. Amantadine

• Helps dyskinesia and sometimes tremor; extended-release formulations target troublesome involuntary movements. Parkinson's Foundation

6. Anticholinergics (benztropine, trihexyphenidyl)

• Useful for tremor in younger patients but limited by cognitive and anticholinergic side effects in older adults. Parkinson's Foundation

7. Adenosine A2A Antagonist (istradefylline)

• Add-on for off episodes in patients using levodopa. Parkinson's Foundation

8. On-Demand Rescue Options

• Apomorphine injections or sublingual films and inhaled levodopa can rapidly abort “off” periods for selected patients. Mayo Clinic

Nursing pearls: Give meds on time, watch orthostatics and mental status, teach about protein interactions with levodopa, and document patterns of wearing-off to inform dose adjustments.

Rehabilitation and Lifestyle

• Physical Therapy: Balance, gait, amplitude training, cueing, and fall-reduction strategies.

• Occupational Therapy: ADL optimization, home safety assessment, adaptive equipment.

• Speech-Language Pathology: Dysphagia evaluation, LSVT LOUD or similar voice therapy, communication strategies.

• Exercise: Regular aerobic activity, resistance training, tai chi, boxing-style programs, and dancing can improve function and quality of life.

Device-Aided and Surgical Therapies

1. Deep Brain Stimulation (DBS)

• Indicated for motor fluctuations, dyskinesias, or medication-refractory tremor in levodopa-responsive patients without prohibitive cognitive or psychiatric comorbidity. DBS reduces motor complications and can lower medication burden for years. Five-year cohort data show sustained improvements in UPDRS motor scores and reductions in dyskinesia and levodopa dose, although PD remains progressive. PubMed

• Adaptive DBS (aDBS): Newer systems adjust stimulation in real time to brain signals, with emerging reports of improved symptom control and fewer side effects compared with constant stimulation. Recent news coverage and clinical reports highlight FDA-cleared adaptive capabilities and continued innovation. The Washington Post+2Financial Times+2

• NINDS provides accessible overviews of DBS indications and safety for patient education. ninds.nih.gov

2. Intestinal Levodopa Gel (Duopa/Duodopa)

• Continuous jejunal infusion of carbidopa/levodopa via PEG-J can reduce off time in advanced PD with severe fluctuations. Parkinson's Foundation

3. Focused Ultrasound and Other Lesioning Approaches

• In selected cases, MR-guided focused ultrasound thalamotomy can reduce tremor; candidacy and laterality considerations apply.

Nursing role: Pre- and post-procedure teaching, device care, wound and infection surveillance, battery or pump troubleshooting, and symptom diaries.

Patient Education

Patient and caregiver teaching should be ongoing, practical, and tailored to the person’s stage and goals. Reinforce key points in writing, and link families to reputable organizations.

Understanding the Condition

PD is chronic and progressive, but many symptoms are manageable for years with a combination of medications, therapies, exercise, and support. Emphasize the value of regular neurologist follow-ups and honest reporting of fluctuations and side effects. ninds.nih.gov

Medications

• Take medications on time every time. Use phone alarms, pillboxes, and calendars.

• Report wearing-off features: Return of tremor, slowness, or stiffness before the next dose.

• Know side effects to watch for: Nausea, dizziness, hallucinations, sleep attacks, impulse control changes, dyskinesias.

• Discuss protein timing if applicable to levodopa absorption. Never stop dopaminergic meds abruptly without guidance. Mayo Clinic

Safety and Mobility

• Prevent falls: Remove loose rugs, improve lighting, install grab bars, and keep walkways clear.

• Learn freezing strategies: Rhythmic counting, stepping over lines or laser cues, and using metronomes or music.

• Use assistive devices correctly and keep footwear supportive.

Bowel, Bladder, and Autonomic Tips

• Constipation plan: Fluids, fiber, daily movement, and scheduled toileting; escalate to stool softeners or laxatives as guided.

• Orthostatic hypotension: Rise slowly, dangle legs before standing, hydrate adequately, and discuss compression garments with the clinician. Track home blood pressures if advised.

Swallowing, Nutrition, and Weight

• Watch for coughing while eating, prolonged meals, or weight loss. Involve SLP early.

• Favor small, frequent meals and adequate hydration. Consider texture modifications if recommended.

Sleep and Mental Health

• Maintain regular sleep routines, reduce evening stimulants, and ensure a safe sleep environment, especially if acting out dreams.

• Screen for and speak up about depression, anxiety, apathy, and hallucinations. Many treatments exist.

Cognitive and Communication Support

• Use LSVT LOUD or similar voice therapy, amplification devices, and communication strategies such as shorter sentences, extra time to respond, and minimizing background noise.

Exercise and Community

• Encourage consistent exercise programs and community classes designed for PD, which support mobility and mood.

• Connect with reputable organizations for resources, helplines, and local support groups.