58 - Multiple Sclerosis Flashcards
multiple sclerosis
chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain + spinal cord
MS is characterized by…
disseminated demyelination of brain + spinal cord
MS age of onset
bw 20-35
___ yrs + older have a more progressive disease
50
MS sex as a risk factor
women>men
MS etiology
genetically susceptible + environmental exposure
(infection, smoking, phys injury, emo stress, excessive fatigue, pregnancy)
autoimmune process driven by activated T cells
the role is ___ as a cause is controversial
pathogens
MS is marked by 3 processes
1 chronic inflammatn
2 demyelinatn
3 gliosis in CNS
MS pathology
T cells in systmc circltn go to CNS> disrupt BBB> antigen-antibody rxn in CNS> inflammatory response> axon demyelinatn
when nerve fiber is unaffected, ____________. however, myelin sheath can _____
transmission of impulses still occurs;
still regenerate
when underlying axon is damaged, _____
- impulse is disrupted
- nerve functn is lost permanently
- glial scar tissue replaces damaged tissue
gliosis
glial scar tissue replaced damaged tissue> formation of hard rigid plaques> found throughout white matter of CNS
avg life expectancy after onset of symptoms is…
25 yrs
MS symptoms vary bc…
of the spotty distribution in the CNS
-it depends on the areas involved
the first symptom is often…
- blurred or double vision
- red/green color distortion
- blindness in one ye
MS symptoms
- ocular
- extremity weaknss
- problms w coordination/balance
- partial/cmplte paralysis
- numb/tingling
- Lhermitte’s sign
- cerebellar signs
- disabling fatigue
Lhermitte’s sign
temporary sensory symptom described as an electric shock going down the spine or into limbs w neck flexion
cerebellar signs
- nystagmus
- ataxia (no coordinatn)
- dysarthria (slurrd spch)
- dysphagia (diffct swallng)
diabling fatigue can be worsened by
- heat
- humidity
- deconditioning
- medication
bowel + bladder function
- constipation
- spastic bladder
- flaccid bladde
spastic bladder
bladder is too small + cntractn unchecked
-urgency + frequency + dribbling + INCONTINENCE
flaccid bladder
lesion w reflex arc of bladder center
- urinary RETENTION bc loss of sensation (no urge no pain)
- may have urgency + frequency
MS + sex dysfunction
- erectile dysfunctn
- decr libido
- difficulty w orgasm
- painful intercourse
- decr vaginal lubricatn
MS + cognitive dysfunction
- short term memry attntn
- info processng
- planning
- vsual perceptn
- word finding
- Intelect remains unchanged
In MS, intellect remains intact such as.
- long term memry
- converstnl skills
- reading comprhnsn
MS diagnostic tests
- CSF analysis
- CT scan
- MRI/MRS
an MRI of brain + spinal cord in MS may show…
- plaque
- inflammation
- atrophy
- tissue breakdwn
- tissue destrctn
CSF analysis in MS may show..
- incr igG
- oligoclonal banding
3 criterias to be diagnosed w MS
1 2 or more inflammatry demyelinating lesins at 2 diff locations
2 damage/attack occurring at 2 diff times
3 all other possible diagnoses ruled out
immnunomodulator drug therapy
B interferon to decr progressn + prevent relapse
B interferon
nursing actns
- rotate injections sites
- asses for depressn/suicidl
- flu like symptm are common in beginng
tremors that become unmanageable are often treated w….
thalamotomy or deep brain stimltn
nurologic symptm sometimes improves w…
phys + speech therapy
-exercise decr spasticity, incr coordinatn, retrains unaffected muscles to act for impaired ones
triggers that may cause worsening..
- infectn esp upper resp or UTI
- trauma
- immunization
- childbirth
- stress
- climate change
in an acute exacerbatn, client may be…
immobile + confined to bed
complications of immobility
- resp
- UTI
- pressure injuries
to prevent triggers, pt should avoid…
- fatigue
- extreme hot/cold
- exposure ot infectn
____ may help to decr spaticity
anticholinergics
