NORCET 2 -2021 (Shift…: A Patient with Parkinson's syndrome receives continuous levodopa to prevent what complication?

NORCET 2 -2021 (Shift-2)

Medical & Surgical Nursing

Hard

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

Continuous levodopa therapy aims to provide stable and consistent plasma levels of the drug, mimicking the brain's natural, steady release of dopamine.
Standard intermittent oral dosing leads to fluctuating drug levels, causing pulsatile stimulation of dopamine receptors, which is linked to both motor and non-motor complications.
Psychosis is a serious neuropsychiatric complication of dopamine therapy, often triggered by the high peak concentrations of the drug seen with oral dosing.
By maintaining stable dopamine levels and avoiding these peaks, continuous infusion helps reduce the risk of developing or worsening levodopa-induced psychosis.

Option B: Agnosia is a cognitive deficit involving the failure to recognize sensory stimuli. It is not a characteristic complication of Parkinson's disease or a known side effect of levodopa therapy.
Option C: Ataxia is a lack of voluntary coordination of muscle movements, which is a primary symptom of cerebellar dysfunction. Parkinson's disease is a disorder of the basal ganglia, and its motor symptoms are rigidity, tremor, and bradykinesia, not ataxia.
Option D: While anxiety is a common non-motor symptom in Parkinson's disease, continuous levodopa therapy is an advanced treatment specifically indicated for managing severe motor fluctuations that are inadequately controlled by oral medications, not primarily for anxiety.

Clinical Relevance

Nursing practice connection: Use the key finding related to Complications of Levodopa Therapy in Parkinson's Disease to guide bedside assessment, documentation, and the next nursing action.
Nurses play a vital role in managing patients on continuous levodopa infusions (e.g., levodopa-carbidopa intestinal gel), which involves monitoring the infusion pump, providing care for the percutaneous endoscopic gastrostomy with jejunal tube (PEG-J) site, and assessing for both therapeutic effects and adverse events.
Key nursing assessments include monitoring for improvements in 'on' time, reduction in dyskinesias, and observing for non-motor side effects like psychosis, confusion, or orthostatic hypotension.
What if? If a patient on continuous levodopa develops new or worsening hallucinations, the nurse's priority is to ensure patient safety, reorient the patient, check the pump settings for any errors, and immediately notify the neurologist or prescriber, as a dose adjustment is likely required.

How to Approach the Question

First, identify the core concepts in the question: 'continuous levodopa' and 'prevent complication' in the context of 'Parkinson's syndrome'.
Recognize that 'continuous' therapy implies a solution to a problem caused by 'intermittent' therapy.
Recall that standard oral levodopa causes fluctuating drug levels, leading to complications. The main complications are motor-related ('on-off' phenomenon, dyskinesias).
Scan the options. Notice that the primary motor complications are not listed. This requires you to consider other complications related to fluctuating dopamine levels.
Evaluate each option: Eliminate Agnosia and Ataxia as they are not characteristic of Parkinson's disease or levodopa side effects.
Compare the remaining options, Psychosis and Anxiety. Psychosis is a well-known, severe side effect directly linked to dopamine overstimulation. Continuous therapy, by avoiding high dopamine peaks, is a logical strategy to mitigate this risk. Therefore, it is the best answer among the choices.

Concept Tested & Keywords

Qg9CZfagQP-0QaCK1ff5ay

E6 Medicine Harrison 22e Part 2 pp. 1405-1407, 1410-1412

E6 Pharmacology Nursing Lilley 11e Part 1 p. 253-255