Exam 3 -- Multiple Sclerosis

Diplopia (Nursing)

* Apply and alternate patches * Teach scanning techniques

Dysarthria (Nursing)

- Facilitate Communication * Communication board

Antispasmodics

- Observe for increased weakness - Monitor for liver damage if on tizanidine or dantrolene - Report increased weakness and jaundice to provider - Avoid stopping baclofen abruptly

Collaboration

- Plan for disease progression - Referrals: * Occupational and physical therapy * Adaptive devices for daily living activities. * Speech for dysarthria and dysphagia

Ataxia/Muscle weakness/Spasticity (Nursing)

- Promote and maintain safe home/hospital environment * Walk with wide base of support * Assistive devices * Skin precautions

Cognitive Changes (Nursing)

- Monitor cognitive changes - Plan interventions to promote cognitive function * Reorient pt. * Objects in routine places.

Ataxia

lack of muscle coordination in the execution of voluntary movement

12. The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess? Select all that apply.

1. Muscle flaccidity is a hallmark symptom of MS. 3. Dysmetria is the inability to control muscular action characterized by overestimating or underestimating range of movement. 4. Fatigue is a symptom of MS. 5. Dysphagia, or difficulty swallowing, is associated with MS.

Medication management

* Immunosuppressive agents: - reduce frequency of relapse * Corticosteroids - reduce inflammation in acute exacerbations * Antispasmodics - treat muscle spasticity * Immunomodulators - prevent/treat relapse * Anticonvulsants - Paresthesia * Stool softner - constipation * Anticholinergics - bladder dysfunction * Beta-Blockers - Tremors

Interventions and Safety

** Monitoring of: ■Visual acuity ■ Speech patterns - fatigue with talking ■ Swallowing ■Activity tolerance ■ Skin integrity

Multiple Sclerosis Patho

- Autoimmune d/o --> Voluntary muscles are affected --> due to plaque in white matter of the central nervous system - White matter --> myelinated nerve cells give the matter its white color --> myelin sheath helps with conduction and transmission --> plaque damages myelin sheath and INTERFERES with nerve CONDUCTION between the CNS and the BODY

Bladder/Fluid Intake (Nursing)

- Decreases R/F developing UTI - Assist with bladder elimination * Bladder pacemaker * manual abdominal pressure (Crede maneuver) * Intermittent self-Cath.

Fatigue/Overheating (Nursing)

- Exercise and stretch involved muscles - Promote energy conservation by grouping care and plan resting periods.

Multiple Sclerosis S/Sx: Assessment findings

- Fatigue (esp. L/E) - Paresthesia - Pain - Diplopia - Changes in peripheral vision - Decreased visual acuity - Uhthoff's sign (heat exposure) - Tinnitus, vertigo, decrease hearing acuity - Dysphagia - Dysarthria (slurred/nasal speech) - Muscle spasticity - Ataxia/Muscle weakness - Nystagmus - Bowel/Bladder dysfunction - Cognitive changes (memory loss, impaired judgment) - Sexual dysfunction

The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by ...

- Hx. and clinical manifestations ** There is no specific diagnostic test for MS. A diagnosis is made primarily by history and clinical manifestations. ** Certain dx. tests may be used to help establish a diagnosis of MS. ** Positive findings on MRI include evidence of at least two inflammatory demyelinating lesions in at least 2 different locations within CNS. ** Cerebrospinal fluid may have increased immunoglobulin G and the presence of oligoclonal banding. Evoked potential responses are often delayed in persons with MS.

During assessment of a patient admitted to the hospital with an ACUTE exacerbation of MS, what should the nurse expect to find ?

- Motor impairment, visual disturbances and paresthesias. ** Specific neurologic dysfunction of MS is caused by destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system (white matter), Motor, sensory, cerebellar, and emotional dysfunctions , including paresthesias as well as patchy blindness, blurred vision, pain radiating along dermatome of the nerve, ataxia and severe fatigue are the most common manifestations of MS. ** Constipation and bladder dysfunctions, short-term memory loss, sexual dysfunction, anger, and depression or euphoria may also occur ** Excessive involuntary movements and tremors are not seen in MS.

A patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the nurse to do ?

- Promote the use of assistive devices so the patient can participate in self-care activities. ** The main goal in care of the patient with MS is to keep the patient active and maximally functional and promote self-care as much as possible to maintain independence. ** Assistive devices encourage INDEPENDENCE while preserving the patient's energy. ** No care activity that the patient can do for himself or herself should be performed by others. ** Involvement of the family in the patient's care and maintenance of social interactions are also important but are not the priority in care.

Multiple Sclerosis (Triggers)

- Viruses - Infectious Agents - Cold Climate - Physical Injury - Emotional Stress - Pregnancy - Fatigue - Overexertion - Temperature Extremes - Hot shower/bath

A patient with newly dx. MS has been hospitalized for evaluation and initial tx. of the disease. Following d/c teaching, the nurse realizes that additional instruction is needed when the patient says what ?

- When I begin to feel better, I should stop taking prednisone to prevent side effects. ** Corticosteroids used in treating acute exacerbations of MS should not be abruptly stopped by the pt. b/c adrenal insufficiency may result and prescribed tapering doses should be followed ** Infections may exacerbate symptoms and should be avoided and high-protein diets with vitamin supplements are advocated. ** Long-Term planning for increasing disability is also important.

A 38 year old woman has newly diagnosed MS and asks the nurse what is going to happen to her. What is the best response by the nurse ?

- You will have either periods of attacks and remissions or progression of nerve damage over time. ** Most patients with MS have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions and plateaus that progressively cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but patients may experience anger, depression, or euphoria. A few people have chronic progressive deterioration and some may experience only occasional and mild symptoms for several years after onset.

2. The client newly diagnosed with multiple sclerosis (MS) states, "I don't understand how I got multiple sclerosis. Is it genetic?" On which statement should the nurse basethe response?

1. The exact cause of MS is not known, but there is a theory stating a slow virus is partially responsible. A failure of a part of the immune system may also be at fault. A genetic predisposition involving chromosomes 2, 3, 7, 11, 17, 19, and X may be involved.

9. The male client diagnosed with multiple sclerosis states he has been investigating alternative therapies to treat his disease. Which intervention is most appropriate by the nurse?

1. The nurse should listen without being judgmental about any alterative therapy the client is considering. Alternative therapies, such as massage and relaxation, are frequently beneficial and enhance the medical regimen.

11. The nurse writes the client problem of "altered sexual functioning" for a male client diagnosed with multiple sclerosis (MS). Which intervention should be implemented?

1. This will assist the client and significant other to maintain a close relationship without putting undue pressure on the client.

5. The client diagnosed with multiple sclerosis is scheduled for a magnetic resonance imaging (MRI) scan of the head. Which information should the nurse teach the client about the test?

2. MRI scans require the client to lie still and not move the body; the client should be warned about the loud noise.

4. The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make?

2. This is stating a fact and offering self. Both are therapeutic techniques for conversations.

7. The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance?

3. A potential suicide statement is priority for the nurse when caring for the client with MS.

10. The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented?

3. Steroids interfere with glucose metabolism by blocking the action of insulin; therefore, the blood glucose levels should be monitored.

3. The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client?

3. These are clinical manifestation of MS and can go undiagnosed for years because of the remitting-relapsing nature of the disease. Fatigue and difficulty swallowing are other symptoms of MS.

1.The nurse is assessing a 48-year-old client diagnosed with multiple sclerosis. Which clinical manifestation warrants immediate intervention?

4. Dysphagia is a common problem of clients diagnosed with multiple sclerosis, and this places the client at risk for aspiration pneumonia. Some clients diagnosed with multiple sclerosis eventually become immobile and are at risk for pneumonia.

6. The 45-year-old client is diagnosed with primary progressive multiple sclerosis and the nurse writes the nursing diagnosis "anticipatory grieving related to progressive loss." Which intervention should be implemented?

4. The client should make personal choices about end-of-life issues while it is possible to do so. This client is progressing toward immobility and all the complications related to it.

8. The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which nursing task should not be assigned to the LPN?

4. The nurse should not assign assessing,teaching, or evaluation to the LPN. Evaluating the client's ability to perform self catheterization should not be assigned to the LPN.

Dysphagia

Difficulty swallowing

Nystagmus

Involuntary rapid eye movements

Dysmetria

Lack of coordination of movement typified by the undershoot or overshoot of intended position with limb. Type of Ataxia.

CorticoSteroids (Nursing)

Monitor for: - increased risk of infection, - hypervolemia - hypernatremia, - hypokalemia - hyperglycemia - gastrointestinal bleeding - personality changes

Paresthesia

abnormal sensation of numbness and tingling without objective cause

Dysarthria

the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system