Multiple Sclerosis
Presence of _____ on brain and spinal chord support diagnosis of MS
2 lesions
How much more prevalent is MS in women than it is in men?
2-3 times more prevalent
Onset of MS usually occurs between the ages of what?
20 to 50
Approx how old is a pt when the first symptoms of their MS appear?
30-35 years old
What does the plaque in the white matter of the CNS do?
It damages the myelin sheath and interferes with impulse transmission between the CNS and the body
What diagnostic test is used to help diagnosis MS?
MRI
______ is disrupted without the presence of myelin
Nerve impulse transmission
Is there a cure for MS?
No
Name six Sensory manifestations of MS
Numbness and tingling Pain (in low thoracic of ABD regions) Hearing loss Vertigo an tinnitus Chronic neuropathic pain Lhermitte's sign
What are four cerebellar manifestations of MS?
Nystagmus Ataxia Dysarthria Dysphagia
What type of drugs may be prescribed to a pt with MS to tx their depression?
Tricyclic antidepressants
The average life expectancy of MS is ______
greater than 25 years
What are two corticosteroids used to help tx acute exacerbations of MS?
methylprednisolone, prednisone
MS is characterized by the development of ______ in the white matter of the CNS
plaque
What is the overall trend of MS?
progressive deterioration in neurologic function
Inter professional care for MS is aimed at treating the disease process and _____
providing symptomatic relief
What may need to be taught to a pt with MS about urinary elimination?
How to self cath
What are two main side effects of steroids?
Hypervolemia and personality changes
What are the three pathological processes that characterize MS?
1. Chronic inflammation 2. Demylination 3. Closes (scarring) in the CNS
Explain Crede's maneuver...
A maneuver done by applying pressure to the lower ABD to help expel the bladder
Define Multiple Sclerosis
A neurological and autoimmune disease affecting nerve cells in the brain an spinal cord that typically results in impaired and worsening function of voluntary muscles
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? Select all that apply... 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
A, B, C, D, H If lesions are present on the optic nerves, optic neuritis can occurs which can lead to blurry vision, pain when moving the eyes, and dark spots in the vision. If cerebellar lesions are found, this can affect movement, speech, and some cognitive abilities. This would present as dysarthria (issues articulating words), and balance/coordination issues. "Pill rolling" of the fingers and hands is found in Parkinson's disease. Ptosis is common in myasthenia gravis, and heat intolerance in thyroid issues.
A student is assisting the healthcare provider with the care of a patient diagnosed with multiple sclerosis (MS). The student correctly identifies which of the following as part of the pathophysiological process of MS? Select all that apply... A. Scarring and plaque development B. Hypoxic damage to cerebral tissue C. Deficiency of acetylcholine at the neuromuscular junction D. Axonal loss in the central nervous system E. Myelin regeneration and remission of symptoms F. Autoimmune damage to myelin sheath
A, B, D, F MS is characterized by inflammation, formation of demyelinating plaques, and axonal loss in the CNS.
A patient is prescribed high-dose methylprednisolone for an acute exacerbation of multiple sclerosis (MS). Which of these findings, if identified in the patient, would indicate the patient is experiencing an adverse effect of the medication? Select all that apply.. A.Epigastric pain B. Angioedema C. Hypokalemia D. Candida Infection E. Paralytic ileus F. Hyperglycemia
A, C, D, F By suppressing the inflammatory response, methylprednisolone inhibits the actions of leukocytes, thereby increasing the risk of opportunistic infections (e.g. Candida). Suppressing the inflammatory response also involves inhibition of COX-1, thereby increasing the patient's risk of gastric ulcers (which may be manifested by epigastric pain). Glucocorticoids such as methylprednisolone increases blood glucose levels and decreases serum potassium levels.
Which cytokine is used to treat multiple sclerosis? A. B-interferon B. Interleukin-1 C. Erythropoetien D. Colony-stimulating factor
A. B-interferon β-Interferon is a cytokine used to treat multiple sclerosis. Interleukin-2 is used to treat metastatic melanoma. Erythropoietin is a cytokine used to treat anemia related to chemotherapy. Colony-stimulating factor is a cytokine used to treat chemotherapy-induced neutropenia.
What is the likely initial event in the development of MS?
Activated T cells migrate into the CNS disrupting blood-brain barrier
At what age does MS typically become more progressive?
After 50 years old
List three emotional manifestations of MS
Anger Depression Euphoria
What is some objective data that can be seen in MS pt?
Apathy, inattentiveness Pressure ulcers Scanning speech Tremor Nystagmus Ataxia Spasticity
What should be assessed r/t drug therapy for MS?
Assess HTN and renal labs
_____ is an immunomodulatory agent with anti-inflammatory properties
Aubagio/Teriflunomide
What two medications are used to tx relapsing forms of MS?
Aubagio/Teriflunomide Gilenya/Figolimod
____ is a commonly used muscle relaxant for MS
Baclofen
Anticholinergics are used with MS pts to tx...
Bladder symptoms
The first three symptoms of MS may include....
Blurred of double vision Red-green color distortion Blindness in one eye
What part of the body is scanned in an MRI for a pt suspected with MS?
Brain and spinal chord
An MRI with a suspected MS pt will show...
Brain and spinal chord with the presence of plaques, inflammation, atrophy, and tissues breakdown and distraction.
Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply.. A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil
C, D
Anti seizure drugs are given to pts with MS to tx...
Chronic pain
Explain relapsing-remitting MS....
Clearly defined attacks of worsening neurologic function (relapse) with partial or complete recovery (remitting)
What bowel and bladder functions may be impaired in a pt with MS?
Constipation Spastic bladder Flaccid bladder
The healthcare provider is planning care for a patient diagnosed with multiple sclerosis (MS). Which of the following is the priority intervention? A. Encourage bed rest in order to conserve strength B. Teach the patient's family how to meet the patient's needs C. Monitor the patient's temperature to avoid overheating D. Advise the patient to drink liquids through a straw
D. Advise the patient to drink liquids through a straw Problems related to dysphagia (such as aspiration) can be minimized if the patient drinks liquids through a straw. Sensitivity to heat is a concern with MS, but monitoring the patient's temperature is not necessary.
What are some findings r/t sexual activity in pt with MS?
ED Decreased libido Difficulty with orgasmic response Painful intercourse Decreased lubrication
What should the nurse encourage fluid intake with MS pt?
Encourage fluid intake to decrease risk of UTIs
Researchers suspect that exposure to _____ before puberty may predispose a person to develop MS later in life
Environmental agents
True or False: Corticosteroids are safe to use continuously in a patient with MS
FALSE
Cns stimulants are used to tx _____ for pt with MS
Fatigue
What is the Lhermitte's sign?
Feeling of being zapped or electrocuted r/t flexing the neck
A diet for a pt with MS should consist of high ____
Fiber
____ is an immunomodulatory agent that prevents lymphocytes from reaching the CNS and causing damage
Gilenya/Fingolimod
______ drugs are used initially to modify the disease progression and prevent relapse of MS
Immunomodulator drugs
What three types of drugs are used in MS to slow the progression of the disease?
Immunosuppressants Immunomodulators Adrenocorticotropic hormones
What at three popular nursing diagnosis for a pt with MS?
Impaired physical mobility Impaired urinary elimination Ineffective health management
Selective potassium channel blockers are used with MS pts to....
Increase nerve conduction
CSF analysis will depict _______ in pts with MS
Increased Immunoglobulin G and presence of oligoclonal banding
Use of interferon B-1a and B-1b and Glatiramer acetate increase pt's risk for....
Infection
What are some possible factors for the etiology of MS?
Infection Smoking Physical injury Emotional stress Pregnancy Poor state of health
What are the three Immunomodulator drugs used to modify disease progression in MS?
Interferon B-1a Interferon B-1b Glatiramer acetate
Nursing actions when MS pt is taking Baclofen....
Monitor liver function DONE STOP ABRUPTLY
What are the four main clinical manifestations of MS?
Motor problems Sensory problems Cerebellar problems Emotional problems
What happens to the myelin in MS when ongoing inflammation occurs?
Myelin loses the ability to regenerate
What happens if there is not myelin?
Permanent loss of nerve function
How long might it take before a patient with MS notices symptoms?
Possibly years
Does exacerbation of MS occur during pregnancy or post partum?
Post partum
_____ is the most common form of MS
Relapse-remitting
What effect does exercise have on MS?
Relieves spasticity Improves coordination Trains pt to substitute unaffected muscles for impaired muscles
What test is performed to confirm ataxia in pt with MS?
Romberg sign
How are the immunomodulator drugs administered to pt with MS?
Self administration subcu
Cognitive manifestations of MS create difficulties with....
Short-term memory Attention Information processing Planning Visual perception Word finding
Urinary leakage in a pt with MS puts them at greater risk for....
Skin breakdown
If muscle relaxants are deffective in tx spasticity in pt with MS, what three medical interventions may be required?
Surgery Dorsal column electrical stimulation Intrathecal baclofen pump
MS is more prevalent in ____ climates
Temperature changing climates
What is the action of corticosteroids in tx acute exacerbations of MS?
They reduce edema and acute inflammation at the site of demyelination
What is the cause of MS?
UNKNOWN
What are some triggers that can exacerbate MS?
Viruses and infectious agents Physical injury Emotional stress PREGNANCY Fatigue Overexertion Temperature extremes
What to monitor in pt with MS...
Visual acuity Speech patterns, fatigue with talking Swallowing Activity intolerance Skin integrity
Name five Motor manifestations of MS
Weakness or paralysis of limbs, trunk, and head Spasticity of muscles Scanning speech Hearing loss Tremors
Does MS affect men or women more?
Women
Is there a genetic component to MS?
Yes
