Assignment 1 Week 3

Shannon Dennison

Family Nurse Practitioner, Walden University

NURS-6501N-25: Advanced Pathophysiology

Dr. Mary Sizemore

April 10, 2024

 Primary Diagnosis: Parkinson's disease

1. Describe the pathophysiology of the primary diagnosis in your own words. What are the
patient's risk factors for this diagnosis?
Pathophysiology of Primary Diagnosis
Parkinson's disease is the result of the disrupted communication between the dopaminergic
neurons signaling pathways between the dopamine-producing substantia nigra and the
striatum. This disruption prevents the movement of dopamine from its origin in the substantia
nigra to the striatum, where it is unable to send signals to the thalamus and cortex, triggering
muscle movement in the direct pathway. The disruption is caused by the aggregation of Lewy
bodies made of alpha-synuclein proteins aggregating in the nigrostriatal pathway. This leads to
difficulty starting purposeful movements throughout the body, bradykinesia, and rigidity. Over
a period, the neurons in this signaling pathway then die, and the direct pathway for appropriate
movement is eliminated. This diagnosis can also lead to dementia.
Causes Risk Factors (genetic/ethnic/physical)
Parkinson's has a genetic link; however, this Five locations for point mutations to the
is a small percentage of patients as a point SNCA gene have been discovered to cause
mutation to the SNCA gene. Persistent head Parkinson's and can determine severity and
trauma has been linked to the disease, as well onset. Environmental exposure to chemicals
as repetitive exposure to chemicals and such as pesticides, petroleum products
mitochondrial toxins such as pesticides, heavy exhaust in the form of petroleum
metals, and cleaning agents. Evidence of hydrocarbons, trichloroethylene, and other
trichloroethylene, an industrial solvent used in industrial chemical exposure, and food
various ways, such as decaffeination of coffee additives such as monosodium glutamate,
to a degreaser, has been linked to the repetitive head trauma, and poor exercise
development of Parkinson's by 500 percent. habits; however, the direct cause is not fully
understood. It is markedly more prevalent in
men than women, leading to a gender
component, although no noted ethnic
component has been determined.

2. What are the patient's signs and symptoms for this diagnosis? How does the diagnosis impact
other body systems, and what are the possible complications?
Signs and Symptoms – Common presentation How does the diagnosis impact each body
system? Complications?
Signs and symptoms include motor function The decreasing and interruption of the
dysfunction such as difficulty initiating dopamine signaling system between the
movement, tremors at rest, rigidity, substantia nigra and striatum decreases the
downward gaze, balance issues, shuffling direct pathway to increase movement. This
gait, pill-rolling of the fingers, constipation, ultimately affects all of the somatic nervous
 sleep pattern irregularities, dysphonia, and system. This includes muscular motor
dysarthria. functions from walking to swallowing. It can
also affect the autonomic nervous system,
impairing cardiovascular, gastric,
genitourinary, and thermoregulation systems.

3. What are other potential diagnosis that present in a similar way to this diagnosis
(differentials)?
Dystonia disorders, epileptic disorders, drug-induced Parkinsonism, supranuclear palsy,
Wilson's Disease, essential tremors, and Lewy body dementia,

4. What diagnostic tests or labs would you order to rule out the differentials for this patient or
confirm the primary diagnosis?
Biomarker diagnostics for genetic mutation confirmation, Berg balance scale assessment,
forward and backward function reach assessment, and DaTscan; however, diagnosis is
primarily based on the patient's symptoms, longevity, and progression of motor function
decline. A definitive diagnostic test would be a biopsy post-expiration.

5. What treatment options would you consider? Include possible referrals and medications.
Levodopa medications, anti-depression medications, exercise as tolerated, physical therapy,
referral to speech therapy for functionality and swallowing ability, and referral to neurology.
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