MS

- Sensory (e.g. numbness) - Motor (e.g. spasticity) - Cerebellar (e.g. loss of balance) - Miscellaneous (e.g. vertigo)

4 categories of MS s/s

Standard walker Crutches Cane The best device is one that is stable and provides good support. Wheels are not recommended on the walker, because they are not as stable as a walker without wheels.

A client who suffers from multiple sclerosis (MS) struggles with spasticity of the leg muscles and requires assistance with ambulation. Which ambulatory assistive device would be most appropriate for a client with muscle spasticity? Select all that apply. Standard walker Rollator Front-wheeled walker Crutches Cane

Remission & exacerbations

MS is a disease of ___ & ___

- Demyelination - CNS (schwaan cells)

MS is chronic, progressive, characterized by ___ of cell fibers within the ___

- Incr. energy - Frequent rest periods - Mobility + fxnl ability - Comfort - Elimination

Nursing priorities

- Stress - Overexertion - Infection - Heat

Triggers

False

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years. True False

False Yes, patients with MS have different signs and symptoms because lesions can present at different locations in the CENTRAL NERVOUS SYSTEM....hence the brain and spinal cord (not the peripheral nervous system).

True or False: Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system. True False

B. oligoclonal bands These specific proteins, oligoclonal bands, which are immunoglobulins will be found in the CSF. This demonstrates there is inflammation in the CNS and is a common finding in multiple sclerosis.

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present. A. high amounts of IgM B. oligoclonal bands C. low amounts of WBC D. oblong red blood cells and glucose

C. Hand hygiene and avoiding infection Interferon Beta decreases the number of relapses of symptoms in MS patients by decreasing the immune system response, but it lowers the white blood cells count. Hence, there is a risk of infection. It is very important the nurse stresses the importance of hand hygiene and avoiding infection.

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of? A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues H. Dark spots in vision

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

Unknown- autoimmune - Fam hx

Cause of MS

B. Infection C. Overexertion F. Stress

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: A. Cold temperatures B. Infection C. Overexertion D. Salt F. Stress

Nothing specific: - H/Hx - MRI - CSF analysis - Evoked potential study

Dx

2 L (at least)

Fluid intake (daily)

- Remove tripping hazards - Temperature reg. (water heaters, heating pads, baths...)

Home safety

Secondary progressive

Form of MS: relapse-remitting transitions to this

- Relapse-remitting - Primary-progressive - Secondary progressive - Progressive-relapse

Forms of MS

Women

Gender at risk: 2-3x more common

Northern

Geographical component ___ latitudes

Relapse-remitting

Most common form of MS (85%)

- Fatigue - Nystagmus (involuntary eye mvmnts) - Vertigo - Gait disturbance - Sensory loss - Lower extrem. weakness - Spasticity - Bladder/bowel incontin.

Most common s/s

- Immunosuppressants - Interferons - Antispasmotics - Beta-blockers - Corticosteroids - Glucocorticoids - Anticholinergics - Stool softeners

Rx

B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system."

Select all the TRUE statements about the pathophysiology of multiple sclerosis: A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."

20-40

Typical age of dx

A) Fatigue B) Falls D) Skin breakdown E) Difficulty speaking

When assessing a client diagnosed with Multiple Sclerosis which of the following potential complications should be assessed by the nurse? Select all that apply. A) Fatigue B) Falls C) Dehydration D) Skin breakdown E) Difficulty speaking

B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis? A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.