-
MS
- chronic, progressive, degenerative disease of the CNS
- patches of demylination of brain/spinal cord called sclerotic plaques
- -myelin-insulates the nerve
- -no myelin-transmission of impulses slowed down or stopped
- 2 times more common in women , ages 20-40
-
cause
- autoimmune-body's immune cells attack
- viral? latent viral infection or slow acting one
- genetic?
-
course of illness
- exacerbations and remissions
- chronic, progressive-usuallymore deterioration each timne
-
diagnosis
- no definitive test
- may have for yrs b/f diagnosed
- based on hx, clinical signs, and lesions in brain
- -EEG=abnormal in 1/3 of pts
- -MRI=sclerotic plaque will show
- -CT=increased white matter density
- CSF=increase IgG and lymph/monocytes
- -IgG reflects hyperactivity of the immune system caused by chronic demyelination, if IgG CSF up, check this out
- -sometimes PRO and WBCs are increased
-
assessment
- early:
- vision-blurred, diplopia due to lesions on optic nerve
- motor sensation changes
- tremors, only pt notices, usually in upper extremities
- late:
- progression is not orderly
- fatigue-disabling
- pain-lesions of sensory pathway,may need daily analgesics
sxs can go away and come back
-
cognitive changes
- intellect may be ok for a long time
- memory loss, dec concentration
-
bowel and bladder changes
- contipation-loss of abdominal muscles
- -internal sphincter:blocked nerves, don't sense
- incontinence, UTI's
- -suprapubic catheter, blocked nerves, don't sense
-
muscular incoordination
unusual clumsiness
-
ataxia and tremors worsen
impaired coordination of movements
- spasticity
- nystagmus-eyes move back and forth rapidly, diplopia
dysphagia and chewing
-
dysarthria
- impairment of cranial nerves
- scanning-talking slowly, hesitantly, in syllables, slurring, low volume
-
emotional instability
- intellect intact but emotions not stable
- apathy, anger, depression, euphoria
sexual dysfunction
-
sxs aggravated or triggered by:
- physical and emotional stress
- fatigue
- infection and fever-inc metabolism
- overheat or too cold
- pregnancy
- death occurs b/c of infective complications such as pneumonia, sepsis
-
treatment
- no cure
- symptomatic and supportive
- will lead to paraplegia or complete paralysis
-
medications
- IV or SC
- corticosteroids-Solu-Medrol, ACTH
- -dec edema of myelin sheath
- given during exacerbations
- remember-with corticosteroids wastch wt gain, inc BS, don't stop abruptly, watch salt intake, can cause GI upset/GI bleed
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immunomodulators
- interferon beta 1a=Avonex
- interferon beta1b=betaseron
- glatiramer acetate=capaxone
- (ABC)
- Avonex-IM weekly, dec disability and number/severity relapses
- Betaserone-SC QOD, dec frequency and serverity fo relapses
- Copaxone=SC QD, dec relapse rate and disease progression
- s/e:
- flu-like sx, use Tyleno, Motrin, will resolve in a few months
- depression, suicidal ideation
- thrombocytopenia-dec platelets
- leukopenia-dec WBC's
- liver damage
-
immunosuppressants
- mitoxantrone-Novantrone-reduce relapses
- IV infusion Q3months
- urine may turn blue-green initially
- maintain adequate fluid intake
- monitor for cardiac problems
- -Imuran, Cytoxan
-
other meds
- bethanechol-Urecholine (cholinergic)
- for urinary retention
- oxybutynin-Ditropan (anticholinergic)
- for urinary frequency and urgency
stool softeners-Colace
- lioresal-Baclofen
- for spasticity, twitching
- Baclofen with food to dec irritation
- carbamazepine-Tegretol
- mostly used for seizures but in this case it is used for paresthesia pain, check lab level of carbamazepine
- clonazepam-Klonopin, propanolol and gabapentin-Neurotin
- for ataxia
- neurotin for pain
- amatadine-Symmetrol
- for fatigue
- Botox injections in bladder
- for bladder spasms, done with cystoscopy
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nsg dx
- impaired physical mobilityr/t weakness, spasticity or paresis
- rest
- -heat and humisity can bring it on, rest may help but not totally take fatigue away
- active/passive ROM
- transfer activities
- progressive resistive exercises
- bedridden
- -wt bearing exercises
- -turning, SCDs, ect
- water therapy
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high risk for injury r/t sensory and visual impairment
- gait training
- -wide base of support-walk with feet apart
- mobility aids
- -cane, walker, crutches, wheelchair
- avoid abrupt changes in position
- bed alarms
- visual-diplopia
- -eye patch
-
urinary and bowel elimination r/t spinal cord dysfunction
- may not be able to hold urine or may not be able to empty completely
- voiding schedule
- intermittent self-cath
- supra-pubis cath
- men can use condom cath
- bowel program
- meds as ordereds
- I/O
-
altered thought process (loss of memory, euphoria) r/t cerebral dysfunction
- allow to vent feelings
- encourage to stay active-use lists to remember daily routines
-
impaired verbal communication
- speech consult
- reduce environmental noise
- encourage conscious effort to slow speech down, speak louder
- ask questions that require short answers when tired
- use other forms of communication
- -boards, cards, paper/pen
- YOU SPEAK NORMAL-DON'T SHOUT
-
potential sexual dysfunction r/t neuromuscular deficits
- encourage pt/spouse to share concerns
- initiate activity when energy levels are high
- some positions require less energy and cause less muscle spasm
self-care deficit
-
altered nutrition
- needs:
- dec fats
- inc PRO, fiber
- adequate fluid intake
- may have swallowing difficulties
- -careful feeding, suction, proper positioning
-
impaired home maintenance mgmt r/t physical, psychological and social limits imposed by MS
- factors that may exacxerbate sx
- meds-time, route, dose, s/e
- ADL's
- exercise program
- -stretch-hold exercise are good for muscle spasticity-stationary bike, swimming
- rest periods, avoid undue stress
- coping with personality changes
-
complications
- PREVENT INFECTIONS
- UTI, PN, renal insufficiency
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