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T4: MS

Ch. 59: Multiple Sclerosis

This is a chronic, progressive, degenerative disorder of the CNS characterized by segmental demyelination of nerve fibers of the brain and spinal cord. Multiple Sclerosis
Onset of MS usually occurs b/t the ages of? 20 and 50 years but can occur in young teens and much older adults
What are common manifestations of MS? motor, sensory, cerebellar, and emotional problems
Characteristics of MS Chronic, progressive deterioration in some. Remissions and exacerbations in others. Progressive deterioration in neurologic function with repeated exacerbations.
Motor manifestations of MS Weakness or paralysis of limbs, trunk, and head; diplopia; scanning speech-words broken into syllables; spasticity of muscles
Sensory manifestations of MS Numbness and tingling; blurred vision or patchy blindness (scotomas); vertigo and tinnitus; decreased hearing; chronic neuropathic pain; Lhermitte's sign - electric shock in spine or limbs w/flexion of the neck.
Cerebellar manifestations of MS Nystagmus-rapid involuntary eye mvmt.; ataxia-lack of coordination muscles; dysarthria-poor articulation of words; dysphagia-difficulty swallowing; fatigue
The fatigue is usually associated with what? Increased energy needs, heat, humidity, deconditioning, depression, and medication SEs.
What urinary problems can occur with MS? Constipation, spastic bladder (small capacity for urine results in incontinence), and flaccid bladder (large capacity for urine & no sensation to urinate)
What sexual dysfunction can occur in MS? ED; decreased libido; difficulty w/orgasmic response; painful intercourse; decreased lubrication
Some women w/MS who become pregnant experience what? Remission or an improvement in their symptoms during the gestation period. The hormonal changes associated with pregnancy appear to affect the immune system.
Cognitive manifestations of MS Difficulty with short-term memory attention, attention, information processing, planning, visual perception, word finding
What cognitive functions remain unchanged and intact with MS? general intellect, including long-term memory, conversational skills, and reading comprehension
Emotional manifestations of MS anger, depression, euphoria; physical and emotional trauma, fatigue, and infection may aggravate or trigger signs and symptoms
What are some diagnostics done for MS? No definitve diagnostic test for MS. History, CM, MRI of brain and spinal cord may show the presence of plaques, inflammation, atrophy, & tissue breakdown and destruction.
What is needed for a diagnosis of MS? Evidence of at least 2 inflammatory demyelinating lesions in at least 2 different locations w/i the CNS. Damage or an attack occurring at different times (usually >= 1 mth apart). All other possible diagnoses must have been ruled out.
There is no cure for MS so collaborative care is aimed at? Treating the disease process and providing symptomatic relief. Therapy is tailored specifically to the disease pattern & manifestations that the patient is experiencing.
What drugs are used to slow the progression of MS? immunosuppressants, immunomodulators, and adrenocorticotropic hormone
Why is physical therapy important in MS? To relieve spasticity; improve coordination; and train patient to substitute unaffected muscles for impaired muscles.
Exacerbations of MS are triggered by what? Infection (esp. upper respiratory & UTIs), trauma, immunization, delivery after pregnancy, stress, & change in climate.
During an acute exacerbation, the patient may be immobile and confined to bed. The focus of nursing intervention at this phase is what? To prevent major complications of immobility, such as respiratory and urinary tract infections and pressure ulcers. This involves avoiding exposure to cold climates & to people who are sick, as well as vigorous & early tx of infection when it occurs.
What should patient teaching include? Good balance of exercise & rest. Minimize caffeine intake. Nutritious, well-balanced meals (increase roughage if constipated). Treatment regimen (mgmt. of meds), drug SEs, how to watch for & manage SEs, & drug interactions w/OTC meds.
What is a major problem for many patients with MS? bladder control
Why are anticholinergics beneficial for some MS patients? it decreases spasticity
If anticholinergics do not work for bladder control what should you teach the patient to do? self catheterization
Bowel problems, particularly constipation, occur frequently in patients with MS what should you advise them to do? Increase the dietary fiber intake to achieve regularity in bowel habits.
Created by: eblanc1
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