Ch. 59: Multiple Sclerosis
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| 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
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| Onset of MS usually occurs b/t the ages of? | 20 and 50 years but can occur in young teens and much older adults
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| What are common manifestations of MS? | motor, sensory, cerebellar, and emotional problems
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| Characteristics of MS | Chronic, progressive deterioration in some. Remissions and exacerbations in others. Progressive deterioration in neurologic function with repeated exacerbations.
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| Motor manifestations of MS | Weakness or paralysis of limbs, trunk, and head; diplopia; scanning speech-words broken into syllables; spasticity of muscles
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| 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.
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| Cerebellar manifestations of MS | Nystagmus-rapid involuntary eye mvmt.; ataxia-lack of coordination muscles; dysarthria-poor articulation of words; dysphagia-difficulty swallowing; fatigue
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| The fatigue is usually associated with what? | Increased energy needs, heat, humidity, deconditioning, depression, and medication SEs.
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| 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)
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| What sexual dysfunction can occur in MS? | ED; decreased libido; difficulty w/orgasmic response; painful intercourse; decreased lubrication
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| 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.
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| Cognitive manifestations of MS | Difficulty with short-term memory attention, attention, information processing, planning, visual perception, word finding
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| What cognitive functions remain unchanged and intact with MS? | general intellect, including long-term memory, conversational skills, and reading comprehension
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| Emotional manifestations of MS | anger, depression, euphoria; physical and emotional trauma, fatigue, and infection may aggravate or trigger signs and symptoms
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| 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.
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| 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.
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| 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.
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| What drugs are used to slow the progression of MS? | immunosuppressants, immunomodulators, and adrenocorticotropic hormone
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| Why is physical therapy important in MS? | To relieve spasticity; improve coordination; and train patient to substitute unaffected muscles for impaired muscles.
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| Exacerbations of MS are triggered by what? | Infection (esp. upper respiratory & UTIs), trauma, immunization, delivery after pregnancy, stress, & change in climate.
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| 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.
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| 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.
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| What is a major problem for many patients with MS? | bladder control
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| Why are anticholinergics beneficial for some MS patients? | it decreases spasticity
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| If anticholinergics do not work for bladder control what should you teach the patient to do? | self catheterization
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| 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.
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