Multiple Sclerosis

Describe Progressing relapsing type of multiple sclerosis.

Least common. Frequent relaspes with some partial recovery but not a return to baseline.

Which diagnostic tool is considered diagnostic for multiple sclerosis?

MRI demonstrates the presence of plaques and is considered diagnostic for MS.

Describe Relapsing Remitting type of multiple sclerosis.

Majority of cases. Defined periods of exacerbation and remission, may be mild or moderate and resolve in a few weeks to months after which the patient returns to baseline.

What would a CT scan show?

May show an increased density in the white matter and multiple sclerosis plaques.

When the white fiber (axons) that connect the neurons in the brain and spinal cord are impaired, What areas are impaired?

The areas affected include optic nerves, pyramidal tracts, posterior columns, brainstem nuclei, and the periventricular region of the brain.

What are the purposes of managing multiple sclerosis.

To modify the disease's effects on the immune system, prevent exacerbations, manage symptoms and improve function.

The McDonald criteria may be used to diagnose multiple sclerosis. Criteria include... (4)

Two events or "attacks" separated in time and space, MRI evidence consistent with MS, cerebral spinal fluid findings, and analysis of evoked potentials as a means of identifying a second attack.

MS: Bowel and bladder disturbances (3)

frequency, incontinence, retention

MS: Cognitive disturbances (4)

mild to moderate problems with memory, conceptual thinking, and abstract reasoning; behavior disturbances

MS: Sensory Disturbance (4)

Hypalgesia (deminished sensitivity to pain), paresthesia, facial pain, and decreased temperature perception.

Multiple sclerosis is characterized by an inflammatory response that results in what?

Diffuse random or patchy areas of plaque in the white matter of the CNS.

What would an EEG reveal r/t multiple sclerosis?

An abnormally slow electrical signal when compared with normal.

What does an abnormal cerebrospinal fluid finding include?

An elevated protein and slight increase in the white blood cell count.

What medication would be used to treat muscle spasticity r/t multiple sclerosis?

Antispasmodics such as baclofen (Lioresal) and Valium (benzodiazepine)

What are some late psychosocial assessment findings for multiple sclerosis?

Apathy, emotional lability and depression.

Describe Secondary progressive type of multiple sclerosis.

Begins with relapses and remissions but later becomes steadily progressive. Functioning continues to decline with no clear times of remission.

MS: Visual Disturbances (5)

Blurred vision, diplopia, decreased visual acuity, scotomas (changes in peripheral vision and, nystagmus (involuntary, rapid movement.

What medication would be used to treat paresthesia r/t MS.

Carbamazepine (Tegretol) or tricyclic antidepressants.

What is the definition of multiple sclerosis?

Chronic autoimmune disease characterized by develop- ment of plaque in the white matter of the central nervous system. This plaque damages the myelin sheath and interferes with impulse transmission between CNS & body

Continue listing some nursing diagnosis for multiple sclerosis.

Chronic pain r/t chronic physical disability, self-care deficit r/t neuro- muscular impairment, disturbed thought processes r/t disease state, imbalanced nutrition r/t difficulty swallowing, sexual dysfunction.

List some concerns concerning the bowel.

Constipation, impaction, incontinence, adequate fluids, dietary fiber and bowel training.

Define demyelination.

Destruction of myelin between the nodes of Ranvier; myelin sheath is damaged and its thickness is reduced.

MS: communication disturbances (2)

Dysarthria (slurred speech),and dysphagia.

List some nursing diagnosis for multiple sclerosis.

Fatigue related to disease state, activity intolerance r/t generalized weakness, disturbed sensory perception (visual) r/t altered sensory reception, impaired physical mobility r/t neuromuscular impairment,

What medication would be used to treat or prevent relapses r/t multiple sclerosis?

Immunomodulators such as Interferon beta (Betaseron). This is an antiviral protein that suppress the replication of virus cells. If patient doesn't respond use Tysabri (natalizumab).

List some concerns concerning the bladder.

Inability to store urine (hyperreflexic bladder), inability to empty the bladder (hyporeflexic), keep urinal close, voiding schedule, intermittent self catheterization, may require urinary diversion or condom catheter.

What are some side effects of Tysabri (natalizumab)?

Infusion reactions, hives, chest pain, headache, and joint pain.

MS: Cerebellum Findings(4)

Intention tremors (tremor when performing an activity), dysmetria (inability to direct or limit movement), dysdiadochokinesia (inability to stop one motor impulse and substitute another), ataxia.

What medication would be used for edema and the inflammatory response in acute exacerbations r/t MS.

Methylprednisolone (Solu-Medrol).

List the signs and symptoms of multiple sclerosis.

Muscle weakness alternating with spasticity, fatigue (most disabling), depression, numbness, coordination difficulties, loss of balance, pain, dysmetria, bowel and bladder dysfunction, cognitive and sexual changes

List some factors that may exacerbate multiple sclerosis symptoms.

Overexcertion, stress, extremes of temperature (fevers, hot baths, over heating, and excessive chilling), humidity, recent insomnia, influenza and people with upper respiratory tract infections.

List some interventions for multiple sclerosis.

Prevent infection, prevention of exacerbations, promote mobility, minimize spasticity, maintain bladder and bowel control, maintain or improve speech and swallowing, drugs, support and self care .

What medication would be used to treat cerebellar ataxia (uncoordinated movement) and tremors r/t MS.

Propranolol hydrochloride (Inderal), Neurontin (anti seizure) and Klonopin (benzodiazepine).

List the major types of multiple sclerosis.

Relapsing-remitting, Primary Progressive, Secondary Progressive and Progressive Relapsing

What medication would be used to combat disabling fatigue and lassitude (weariness) r/t multiple sclerosis?

Symmetrel (amantadine)

List some complications of multiple sclerosis.

UTI, constipation, pressure ulcers, contractures, deformaties, dependent pedal edema, pneumonia, reactive depression, osteoporosis and stress.

What is the etiology of multiple sclerosis?

Unknown, possibly viral, immunologic, genetic or environmental.

MS: Cranial Nerves and Brainstem (3)

Vertigo, tinnitus, facial weakness, and hearing loss.

MS: Neurologic Findings (3)

Weakness, Spasticity, ataxia.

What happens when the random or patchy areas of plaque appear in the white matter of the CNS?

When this happens the myelin sheath is damaged and its thickness is reduced or demyelinated.

Describe Primary progressive type of multiple sclerosis.

Worst type. Relentless progression with no remissions, steady deterioration with no acute attacks.