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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000425749.73429.51
Feature Articles

CE Test 2.5 Hours: Perioperative Medication Withholding in Patients with Parkinson's Disease: A Retrospective Electronic Health Records Review

Contrada, Emily

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Continued Education
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To present the details of a study done to measure the perioperative duration of carbidopa-levodopa withholding, to record the time of day that surgeries were performed on patients with Parkinson's disease, and to record perioperative exacerbations of Parkinson's disease symptoms.

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After reading this article and taking this test, you will be able to

* review the background information helpful in understanding the need for the authors’ study of the impact of perioperative medication withdrawal on patients with Parkinson's disease.

* summarize the characteristics of the authors’ sample population, the results of their study, and the implications for practice.

1. A mood disorder commonly associated with Parkinson's disease is

a. mania.

b. confusion.

c. catatonia

d. irritability.

2. A motor symptom commonly seen in Parkinson's disease is

a. bradykinesia.

b. hyperreflexia.

c. limb flaccidity.

d. hemiparesis.

3. The National Parkinson Foundation reports that, in the United States, the number of people with Parkinson's disease is about

a. 0.5 to 1 million.

b. 1 to 1.5 million.

c. 1.5 to 2 million.

d. 2 to 2.5 million.

4. About how many new cases are diagnosed each year in this country?

a. 20,000 to 30,000

b. 30,000 to 40,000

c. 40,000 to 50,000

d. 50,000 to 60,000

5. What is the average age (in years) at diagnosis?

a. 50

b. 55

c. 60

d. 65

6. Adding carbidopa to levodopa reduces the peripheral conversion of levodopa to dopamine, thus also reducing peripheral dopamine adverse effects, which include

a. nausea.

b. joint pain.

c. candidiasis.

d. pupil constriction.

7. A concern with perioperative withholding of carbidopa-levodopa in patients with Parkinson's disease is that the drug

a. interferes with blood glucose testing results.

b. tends to worsen depression.

c. has an especially short half-life.

d. must be taken with high-protein meals.

8. In the study sample, the type of surgery most commonly performed was

a. ophthalmic.

b. genitourinary.

c. orthopedic.

d. gastrointestinal.

9. In the study sample, the most common comorbidity category was

a. neurologic–non-Parkinson's disease.

b. endocrine.

c. respiratory.

d. cardiovascular.

10. In the study sample, the most common individual comorbidity was

a. hypertension.

b. diabetes mellitus.

c. coronary artery disease.

d. gastroesophageal reflux disease.

11. The median time of medication withholding for the 89 surgical events included in the study sample was

a. 11.38 hours.

b. 12.35 hours.

c. 16.75 hours.

d. 20.59 hours.

12. The mean surgical start times for the entire sample and for only the outpatient procedures were similar, occurring

a. in the early morning.

b. just before noon.

c. in the early afternoon.

d. just before evening.

13. What percentage of the 32 inpatient records analyzed contained a nursing or progress note referencing Parkinson's disease symptoms or symptom management?

a. 28%

b. 37%

c. 45%

d. 56%

14. Of the following broad categories into which such notes fell, which had the most notations?

a. increased tremors, shakiness, or both

b. symptom management complicated by pain, pain medications, or both

c. increased agitation, confusion, or both

d. antiparkinson medications received inconsistently or not at all

15. What percentage of the 32 inpatient procedures had medication withholding times of more than 30 hours?

a. 18%

b. 28%

c. 38%

d. 48%

16. Preoperatively, patients with Parkinson's disease can take carbidopa-levodopa and other antiparkinson medications with a sip of water until

a. the early evening before surgery.

b. the midnight before surgery.

c. 2 to 3 hours before surgery.

d. shortly before the initiation of anesthesia.

17. Many surgical patients with Parkinson's disease can safely resume taking carbidopa-levodopa and other antiparkinson medications

a. in the postanesthesia recovery unit.

b. 12 hours after surgery.

c. 24 hours after surgery.

d. 36 hours after surgery.

18. One recommendation for improving symptom management in surgical patients who have Parkinson's disease is to

a. administer antiparkinson medications intravenously.

b. shorten the duration of their NPO status.

c. schedule the surgery as early in the day as possible.

d. make sure their medications are available at home.

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