SNo.

Time Specific Objectives Contents Teaching Evaluation

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Method
INTRODUCTION L
E
1. 3 min The students will Parkinson's disease (PD) is the second most common C
get a brief neurodegenerative disorder and the most common T
introduction of the movement disorder. U
topic. Parkinson's disease is a disorder of the brain that leads to R
E
shaking (tremors) and difficulty with walking, movement,
and coordination
As symptoms worsen, it may become difficult to walk, C
talk, and complete simple tasks. U
PD is named after James Parkinson, who, in 1817, wrote M
a classic essay on ‘shaking palsy’, a disease whose cause
is still unknown.
D
DEFINITION I
2. 2 min The students will It is a disease of the basal ganglia characterized by S What is the
know definition of slowness in the initiation and execution of movement C definition of PD?
PD U
(bradykinesia), increased muscle tone(rigidity), tremor at
S
rest, and impaired postural reflexes.
S
.
I
ETIOLOGY
3. 5 min The students will be O Enlist the etiological
The prevalence of PDis about 160 per 100,000 population. The
able to enlist the N factors for PD.
diagnosis of PD increases with age with the peak onset in the
etiology for PD
70’s. PD more common in men with a ratio of 3:2.
AVAIDS: LCD
presentation
Etiology includes:
 Lack of dopamine due to the loss of dopamine-
producing cells in the substantia nigra
 Intoxication with a variety of chemical including
Carbon monoxide and manganese can cause
parkinsonism
 Drug-induced parkinsonism can follow reserpine,
methyldopa, haloperidol, chlorpromazine
therapy.
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 Secondary causes of parkinsonism include L
hydrocephalus, hypoxia, infections, stroke, tumor and E
trauma. C
T
4. 7 min The students will be PATHOPHYSIOLOGY U What is the
able to explain the R pathophysiology of
pathophysiology of The pathologic process is as follows: E PD?
PD.
Degeneration of dopamine-producing neurons in the
substantia niagra, of the midbrain C
U
Disruption in the balance between dopamine and M
acetylcholine in the basal ganglia

DA is the neurotransmitter essential for the normal D

functioning of the extrapyramidal motor system, including the I
control of the posture, support and voluntary motion. S
C
Symptoms of PD do not occur until 80% of the neurons in the U
substantia niagra are lost. S
S
5. 5 min The students will be CLINICAL MANIFESTATIONS I Enumerate the
able to enlist the O clinical
clinical The onset of PD is gradual and insidious, with gradual N manifestations of PD.
manifestations of progression and prolonged course. The classical signs of PD
PD are: tremor, rigidity and bradykinesia. Other symptoms AVAIDS: LCD
include: presentation
 Slow blinking
 Constipation
 Difficulty swallowing
 Drooling
 Problems with balance and walking
 No expression in the face (like you are wearing a
mask)
 Muscle aches and pains
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 Movement problems, which include: L
 Difficulty starting movement, such as starting to E
walk or getting out of a chair C
 Difficulty continuing to move T
 Slowed movements U
 Loss of small or fine hand movements; R
 writing may become small and difficult to read; E
 eating becomes difficult
 Rigid or stiff muscles, often beginning in the legs
 Shaking, called tremors C
 Usually occurs in the limbs at rest, or when the arm U
or leg is held out M
 Goes away when you move
 Eventually may be seen in the head, lips, tongue,
and feet D
 May be worse when tired, excited, or stressed I
 Finger-thumb rubbing (pill-rolling tremor) may be S
present C
 Slowed, quieter speech and monotone voice U
 Stooped position S
 Low blood pressure when getting up, sweating, S
drooling, lack of body temperature control. These I
problems are due to something called autonomic O
dysfunction. N
Other symptoms may include:
AVAIDS: LCD
 Anxiety, stress, and tension
presentation
 Confusion
 Dementia
 Depression
 Fainting
 Hallucinations
 Memory loss

DIAGNOSIS
6. 3 min The students will be Diagnosis is based solely on the history and the features What is the
able to know the diagnostic criteria
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Method
Diagnostic criteria A firm diagnosis can be made when at least two of the L For PD?
for PD three characteristics signs of the classic triad are present: E
tremor, rigidity, and bradykinesia. C
The ultimate confirmation of PD is a positive response to T
U
anti-parkinsonism drugs.
R
E
7. 10min The students will MANAGEMENT What are the various
know about the approaches for the
know about the Because there is no cure for PD, collaborative C treatment of PD?
various management is aimed at relieving the symptoms. U
managements for M
PD and the MEDICAL MANAGEMENT / DRUG THERAPY: it is aimed at
collaborative care correcting the imbalance of neurotransmitters within the
CNS. Levodopa with Carbidopa is the first drug to be D
used. Levodopa crosses the blood brain barrier and gets I
S
converted to DA in the basal ganglia.
C
Other drugs used are DA antagonists include
U
bromocriptine, pergolide, pramipexole. S
The anti-viral drug amantadine is also an effective anti- S
parkinsonian agent. I
Selegiline is a type of MAO inhibitor that is used. MAO O
degrades DA and thus with MAOI’s the levels of DA are N
increased in the brain.
AVAIDS: LCD
SURGICAL THERAPY: presentation
Used for the patients unresponsive to drug therapy.
Surgical therapy falls into 3 categories: ablation
(destruction), deep brain stimulation (DBS) and
transplantation.
Ablation surgery involves the stereotactic ablation of the
areas in the thalamus (thalamotomy), globus pallidus
(pallidotomy), and sub-thalamic nucleus (sub thalamic
nucleotomy).
DBS involves placing an electrode in either the thalamus,
globus pallidus, or the subthalamic nucleus and
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Method
connecting it to a generator placed in the upper chest. L
The device is programmed to deliver specific currents to E
targeted brain location. C
Transplantation of fetal neural tissue into the basal T
U
ganglia is designed to provide DA-producing cells in the
R
brains of patients with PD.
E

8. 10min The students will NURSING MANAGEMENT: Briefly explain the

know about the Nursing care of the clients with PD include health C nursing measures for
various nursing assessment, medication instruction and monitoring, U the client with PD?
measures for the liaison with other members of the health care team, and M
client with PD client and family education.
Advice the client to maintain fluid intake of 2L every 24
hours and to increase the intake of dietary fibers, stool D
softeners and mild laxatives can be used. A regular time I
S
for bowel movements should be established.
C
Teach the client various techniques to enhance the
U
voluntary movement. S
Encourage daily range of motion exercise to avoid rigidity S
and contractures. I
The client should sleep on a firm mattress. Because self- O
care activities are performed more slowly by the client N
with PD, extra time should be allowed for the completion
of tasks such as dressing, bathing and eating. AVAIDS: LCD
Recommend rest periods during meals to avoid presentation
aspiration.
Teach the clients about home safety; loose carpeting
should be removed. Grab bars should be placed in the
bathrooms. An elevated toilet seat should be installed.
Walking aids such as cane or walker can provide added
stability.
The client and the family need emotional support. The
nurse can provide them the information about the
various support groups in the town.
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NUTRITIONAL THERAPY:
Patients with dysphagia and bradykinesia need
appetizing foods that are easily chewed and swallowed.
Foods high in roughage and fruit to avoid constipation.
In addition, absorption of levodopa can be impaired with
protein ingestion and vitamin B6. To decrease this
problem evening intake of proteins is decreased.

9. CONCLUSION
Parkinson's disease is a disorder of the brain that leads to
shaking (tremors) and difficulty with walking, movement,
and coordination
As symptoms worsen, it may become difficult to walk,
talk, and complete simple tasks.

SUMMARY
10.
This lesson plan on Parkinson’s disease covers various
topics like introduction, definition, etiology,
pathophysiology, clinical manifestation, diagnosis, and
collaborative care for PD.

11. BIBLIOGRAPHY
Black Joyce M. Medical-Surgical Nursing: Clinical
Management for Positive Outcomes – 8th Edition Single
Volume, published by Evolve international, pages-2170-
2176

Lewis, Heitkemper, Dirksen, Bucher, Medical Surgical

Nursing, Assessment and Management of clinical
problems, 7th edition, published by elsivier international,
pages 1549-1553