Managing Epilepsy and Parkinson’s: Patient Care Strategies
Antiepileptic Drug Therapy: Goals and Management
The primary goal of antiepileptic drug (AED) therapy is to suppress neuronal activity sufficiently to prevent hyperactivity and seizures. These substances do not alter the course of the disease (they do not cure or stop its progression), but rather treat the symptoms by decreasing or inhibiting crises. This approach aims to improve the quality of life for patients and reduce the chances of brain damage secondary to seizures.
Potential Side Effects and Monitoring
Patients on antiepileptic drugs may experience various side effects, often requiring careful monitoring and dose adjustments. Key issues include:
- Ineffectiveness of Dose or Drug: Observe for changes that may indicate a need for dose adjustment, such as the emergence of unexpected seizures or absences.
- Intoxication: Monitor especially for neurotoxicity.
- Hepatotoxicity: Liver function should be regularly checked.
- Cutaneous Reactions: Skin rashes or other reactions.
- Hemorrhage: Monitor for signs like bruising or epistaxis (nosebleeds).
- Bone Marrow Suppression: Monitor for fever or unusual infections, which could indicate a compromised immune system.
Patient Interventions and Education
Effective management of antiepileptic therapy involves patient education and lifestyle adjustments:
- Activity Precautions: Patients should avoid activities that involve significant physical risk until they understand the effects of their medication on daily life activities.
- Factors Decreasing Drug Effectiveness: Certain factors can decrease drug effectiveness and precipitate seizures. Patients should avoid:
- Excessive sun exposure
- Alcohol consumption
- Exposure to light flashes
- Sleep deprivation
- Disruption of normal schedules
- Symptom Recognition: Instruct patients on recognizing symptoms indicating the presence of side effects, so they can communicate these to healthcare professionals promptly.
- Symptom Diary: Encourage patients to keep a diary of symptoms, especially during phases when medication is being adjusted.
- Medication Adherence: Patients must take the drug dose exactly as prescribed. If a dose is missed, take it as soon as possible. However, it is crucial not to double the next dose, as this could lead to toxicity.
Parkinson’s Disease: Pathophysiology and Management
Parkinson’s disease is a degenerative disorder affecting the substantia nigra pars compacta (nigrostriatal pathway) in the brain. Balance, posture, muscle tone, and involuntary muscle movement depend on the delicate balance between the production of two key neurotransmitters: dopamine (DA, an inhibitor) and acetylcholine (a stimulator). The absence or death of dopamine-secreting neurons leads to an imbalance, where acetylcholine’s stimulatory effect becomes unopposed.
Nursing Considerations and Potential Complications
Nursing interventions for Parkinson’s disease focus on managing symptoms and potential complications:
- Drug Toxicity: Monitor and instruct the person on the detection of early symptoms of intoxication related to Parkinson’s medications.
- High Blood Pressure: The person must have their blood pressure values checked regularly, ideally bi-monthly.
- Arrhythmias and Tachycardia: The person must inform healthcare professionals if they experience palpitations or dizziness accompanied by chest tightness.
- Inefficiency of Dose: This can occur when treatment is initiated or when medication dosages are adjusted.
- Cognitive Changes: Monitor for confusion and hallucinations.
Patient Care and Health Education
Comprehensive care for Parkinson’s patients includes promoting safety and providing essential health education:
- Safe Environment: Provide a safe environment to facilitate mobilization and prevent falls.
- Health Education: Instruct the person on various self-management strategies:
- Position Changes: Start position changes slowly and progressively to prevent orthostatic hypotension and dizziness.
- Fluid Intake: Increase fluid intake to help with common issues like constipation.
- Home Adaptation: Adapt the home environment to prevent falls (e.g., removing rugs, improving lighting).
- Mobility Aids: Assess the need for and encourage the use of canes or walkers.
- Physical Activity: Encourage the person to maintain physical activity to preserve muscle mass and mobility.
- Understanding the “On-Off” Phenomenon: This phenomenon occurs mainly in people taking levodopa. Patients may experience periods of improved physical fitness followed by a sudden worsening of symptoms. This is due to fluctuations in levodopa levels and significantly increases the risk of falls.