CH 43
Multiple Sclerosis (MS)
chronic disease caused by immune, genetic, and/or infectious factors that affects the myelin and nerve fibers of the brain and spinal cord.
What are the leading causes of SCI's?
#1 Trauma (+1/3 MVA) -falls -acts of violence -sport related
Emergency care for Autonomic Dysreflexia:
- Place client in sitting position (1st priority) or return to a previous safe position -notify Dr and Rapid -assess and treat cause -determine if UTI or stones are causing GU irritation -check for fecal impaction -examine skin for pressure injuries -monitor BP q10-15min -give nifedipine or nitrate as prescribe to lower BP
Drug therapy to treat the symptoms of MS?
-Baclofen for muscle spasticity -carbamazepine for paresthesia -marijuana has helped relive muscle spasm pain
Secondary Progressive MS (SPMS)
-Begins with relapse-remitting course that later becomes steadily progressive (half of all people with RRMS develop SPMS within 10 yrs)
What are the typical causes of Autonomic dysreflexia?
-GI -GU -vascular stimulation
Specific risk factors for Autonomic dysreflexia:
-bladder distention -UTI -epididymitis or scrotal compression -bowel distention or impaction or hemorrhoids -pain -circumferential constriction of thorax, abdomen, or an extremity -contact with hard or sharp objects -temperature fluctuation
Relapsing-remitting MS (RRMS)
-course may be mild or moderate depending of degree of disability -symptoms develop and resolve in a few weeks-months and pt returns to baseline -during relapse the pt reports loss of function and continued development of symptoms
Progressive-relapsing MS (PRMS)
-frequent relapses with partial recovery but not a return to baseline (seen only in a small % of pts) (progressive, cumulative symptoms and deterioration occur over several years)
What are secondary injuries to Spinal Cord Injury?
-hemorrhage -ischemia -hypovolemia -impaired tissue perfusion -local edema
Key features of MS:
-muscle weakness and spasticity -fatigue (associated with sensitivity to temo) -intention tremors -dysmetria -parasthesia -ataxia -dysarthria and dysphagia -diplopia, nystagmus, scotomas -tinnitus -bowel and bladder dysfunction -depression
A nurse promotes the prevention of lower back pain by teaching clients at a community center. Which instruction should the nurse include in this education? a. Participate in an exercise program to strengthen muscles. b. Purchase a mattress that allows you to adjust the firmness. c. Wear flat instead of high-heeled shoes to work each day. d. Keep your weight within 20% of your ideal body weight.
A
What is the priority for a patient with a cervical SCI?
AIRWAY MANAGEMENT
Spinal Shock
occurs immediately after spinal injury -lasts less than 48 hrs but may continue for weeks
Autonomic Dysreflexoa
potentially life-threatening condition in which noxious visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge in people with high-level SCI
When is atropine sulfate used?
to treat bradycardia if HR falls below 50-60 bpm
Nursing interventions for MS:
-collab with PT/OT -teach avoidance of anything that increases temp -teach to plan activities and allow time to do them -make daily items easily accessible -alternate eye patch every few hours for pt with cognitive decline: -single date calendar, use written lists or verbal messages
Lab tests for MS?
-no single specific lab test diagnosis -CSF (elevated protein) -MRI shows plaques
Primary Progressive MS (PPMS)
-steady and gradual neurologic deterioration w/o remission of symptoms -progressive disability with no acute attacks (pts tend to be 40-60 yrs at onset)
key features of autonomic dysreflexia
-sudden, significant rise in systolic and diastolic BP with bradycardia -profuse sweating -flushing -blurred vision -nasal congestion -throbbing headache -feeling of apprehension
MS affects which populations?
-woman twice as often as men -20-30 years -whites of northern European ancestry
A nurse plans care for a client with a halo fixator. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Tape a halo wrench to the clients vest. b. Assess the pin sites for signs of infection. c. Loosen the pins when sleeping. d. Decrease the clients oral fluid intake. e. Assess the chest and back for skin breakdown.
A,B,E
A nurse assesses a client who experienced a spinal cord injury at the T5 level 12 hours ago. Which manifestations should the nurse correlate with neurogenic shock? (Select all that apply.) a. Heart rate of 34 beats/min b. Blood pressure of 185/65 mm Hg c. Urine output less than 30 mL/hr d. Decreased level of consciousness e. Increased oxygen saturation
A,C,D
An emergency department nurse cares for a client who experienced a spinal cord injury 1 hour ago. Which prescribed medication should the nurse prepare to administer? a. Intrathecal baclofen (Lioresal) b. Methylprednisolone (Medrol) c. Atropine sulfate d. Epinephrine (Adrenalin)
B
Why is it important for those on immunomodulators to keep routine follow-ups for lab tests?
because these drugs can cause decreased WBC and can make them more at risk for infection
A nurse assesses a client with a spinal cord injury at level T5. The clients blood pressure is 184/95 mm Hg, and the client presents with a flushed face and blurred vision. Which action should the nurse take first? a. Initiate oxygen via a nasal cannula. b. Place the client in a supine position. c. Palpate the bladder for distention. d. Administer a prescribed beta blocker.
C
A nurse assesses a client with early-onset multiple sclerosis (MS). Which clinical manifestation should the nurse expect to find? a. Hyperresponsive reflexes b. Excessive somnolence c. Nystagmus d. Heat intolerance
C
A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod (Gilenya). For which adverse effect should the nurse monitor? a. Peripheral edema b. Black tarry stools c. Bradycardia d. Nausea and vomiting
C
A nurse assesses clients at a community center. Which client is at greatest risk for lower back pain? a. A 24-year-old female who is 25 weeks pregnant b. A 36-year-old male who uses ergonomic techniques c. A 45-year-old male with osteoarthritis d. A 53-year-old female who uses a walker
C
A nurse plans care for a client with lower back pain from a work-related injury. Which intervention should the nurse include in this clients plan of care? a. Encourage the client to stretch the back by reaching toward the toes. b. Massage the affected area with ice twice a day. c. Apply a heating pad for 20 minutes at least four times daily. d. Advise the client to avoid warm baths or showers.
C
A nurse cares for a client who presents with an acute exacerbation of multiple sclerosis (MS). Which prescribed medication should the nurse prepare to administer? a. Baclofen (Lioresal) b. Interferon beta-1b (Betaseron) c. Dantrolene sodium (Dantrium) d. Methylprednisolone (Medrol)
D
What was the first oral immunomodulator approved for management of MS?
Fingolimod (Gilneya) -with or without food -monitor pulse because it can cause bradycardia especially within the first 6 hrs
What is the one test considered as diagnostic for MS?
MRI with contrast
What new class drug is given for severe chronic back pain?
Ziconotide (Prialt) a N-type calcium channel blocker
