1. 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
  2. cause
    • autoimmune-body's immune cells attack
    • viral? latent viral infection or slow acting one
    • genetic?
  3. course of illness
    • exacerbations and remissions
    • chronic, progressive-usuallymore deterioration each timne
  4. 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
  5. 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
  6. cognitive changes
    • intellect may be ok for a long time
    • memory loss, dec concentration
  7. 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
  8. muscular incoordination
    unusual clumsiness
  9. ataxia and tremors worsen
    impaired coordination of movements

    • spasticity
    • nystagmus-eyes move back and forth rapidly, diplopia

    dysphagia and chewing
  10. dysarthria
    • impairment of cranial nerves
    • scanning-talking slowly, hesitantly, in syllables, slurring, low volume
  11. emotional instability
    • intellect intact but emotions not stable
    • apathy, anger, depression, euphoria

    sexual dysfunction
  12. 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
  13. treatment
    • no cure
    • symptomatic and supportive
    • will lead to paraplegia or complete paralysis
  14. 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
  15. 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
  16. immunosuppressants
    • mitoxantrone-Novantrone-reduce relapses
    • IV infusion Q3months
    • urine may turn blue-green initially
    • maintain adequate fluid intake
    • monitor for cardiac problems
    • -Imuran, Cytoxan
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. altered nutrition
    • needs:
    • dec fats
    • inc PRO, fiber
    • adequate fluid intake
    • may have swallowing difficulties
    • -careful feeding, suction, proper positioning
  25. 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
  26. complications
    • UTI, PN, renal insufficiency
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