MS Flashcards
Chronic neurological =
no cure
Multiple Sclerosis
A chronic, progressive, degenerative disorder of the central nervous system
MS characterized by
segmental demyelination of nerve fibers of brain and spinal cord
remission and exacerbation
Cause of MS
unknown
related to genetics, infection, and immunity (possible environment early in life)
mostly women btw 20-50
- pregnancy
excessive fatigue, poor health
injury, stress
More progressive MS when dx at age greater than 50 due to
comorbidities
What celebrities do you think of when you hear MS?
Selma Blair
Kristina Applegate
Why does MS take longer to dx
do not notice till worsen s/s by compensation
The onset of MS is
insidious and gradual
vague s/s intermittently over months or years
- not enough to seek medical help
The overall trend of MS
progressive deterioration in neurologic function
- remission and exacerbations
MS s/s
Intention tremors = trying to grab something it gets worse
Spastic Bladder = bladder retraining
speech impediment , tremors, dizzy, LOC, limb weak, attention deficit, vision loss, tingling and prickling pain
Relapsing-remitting:
patients tend to experience an attack or series of attacks (exacerbations) followed by complete or partial remission.
Primary progressive:
disease shows progression from onset with occasional plateaus and temporary minor improvements.
Secondary Progressive:
chronic, progressive form of the disease where, unlike the RRMS stage, there are no real periods of remission, only breaks in attack duration with no real recovery from symptoms although there may be minor relief
S/S 1st common of MS
visual loss (blindness, double vision, blind in one eye)
facial numbness
gait difficulties need assistive device
then motor, sensory, mind, and anger
As an MS pt gets older, the disease becomes more
progressive
The average life expectancy after the onset of MS symptoms is
25 years
Sensory Manifestations of MS
Numbness and tingling
Pain
Tremor intention
↓ Hearing, Vertigo and tinnitus
Chronic neuropathic pain
Lhermitte’s sign
Motor Manifestations of MS
weakness or paralysis of limbs and trunk
spastic and slow speak
Bladder issues related to MS
constipation
spastic and flaccid bladder
sexual dysfunction
Emotional state of MS
Angry
depressed
Dx of MS
no definitive
based primarily on history, clinical manifestations, & results of diagnostic tests
MRI= plagues, inflammation, damage
Increase in immuno G
For Dx of MS
at least 2 inflammatory demyelinating lesions in at least 2 different locations within the CNS (spine and brain)
= damage attack occurring at diff times (greater than 1 month)
- rule out
MS Tx
no cure
goal= delay progression of disease, manage chronic symptoms, & treat acute exacerbations**
early intervention is most effective
Disease-Modifying Drugs
tx as soon as dx
*Interferon beta-1a (Rebif, Plegridy, Avonex)
Decrease future of disability, mechanism of actions, lesions, and relapses
*Interferon bet-1b (Betaseron, Extavia)
*Glatiramer acetate
*Teriflunamide (Aubagio)
injections
Interferon Beta
naturally occurring glycoprotein with antiviral, antiproliferative, and immunomodulatory actions
Drug Therapy for MS is given to
Reduces the frequency and severity of attacks
Reduces the number and size of lesions detectable with MRI
reduce relapses
Delays progression of disability
Interferon Beta adverse effects and interactions
flu-like
hepatotoxicity
myelosuppression
injection reactions
depression
suicidal
All MS pts need to take
immunomodulators
Immunosuppressant
Mitoxantrone ( Novantrone)
Mitoxantrone ( Novantrone)
More toxic** than Immunomodulators
Produce greater suppression of immune function
HELPS WITH RELASPSES
Not primarily against progressive
Increase clinical attack rate
Most tx for MS are also used in
CA
Mitoxantrone
Myelosuppression*
Cardiotoxicity*
Fetal harm*
Reversible* hair loss, injury to GI mucosa, nausea & vomiting, amenorrhea, allergy symptoms, and blue-green tint to urine & sclera – not harmful
Myelosuppression s/s
fever
chills
cough
immediately call HCP
Corticosteroids for MS
Prednisone & methylprednisolone
Prednisone & methylprednisolone
Helpful in treating acute exacerbations
Reduce edema and acute inflammation at the site of demyelination
Therapeutic plasma exchange and IV immunoglobulin G
If stop working = IBIG given too
What other drugs would be given to MS pts besides for MS?
manage symptoms
bladder, bowel, depression, fatigue, spasticity
Meds for spasticity and neuropathic pain are
GABA
A pt with MS is prescribed with Interferon Beta, What is the priority for teaching at this time?
a) Provide information about myelosuppression
b) symptoms of hepatotoxicity
c) Educate about self-injection technique
d) blue tint of urine or skin
c) Educate about self-injection technique
The nurse cares for a pt who is receiving Mitxandrone it is most important for the nurse to assess the pt for what?
elevate temperature
due to myelosuppression infection
MS: Nursing Interventions
Promote physical mobility
Prevent injury
Enhance bowel & bladder control
Enhance communication
Improve sensory & cognitive function
Teach about medications
Educate family and support systems
MS can also use what activity therapy
water therapy
support groups so they are not alone
MS psychological interventions
anger anxiety depression
acceptance
