MS Flashcards
MS
NO CURE -
Characterized by segmental demyelination of nerve fibers of brain and spinal cord
Periods of remission and exacerbation more progressive hen diagnosed at age >50 affects most women between 20-50
Enviromental factors (temperate climates)
Plaque formation on spinal cord and brain (seen on MRI)
Causes MS
No known causes but can be Infection smoking physical injury emotional stress excessive fatigue pregnancy poor state of health genetic component
Mostly occurs in women
With women who get diagnosed with MS after 50
No signs of remission and excerbations
But have progressive deterioration in some pt
Clinical manifestations
Chronic progressive deterioration in some pt (women older than 50)
Remissions and exacerbations in others
Overall trend progressive detestation in neuro function
Plaque build up on spinal cord and brain ( CNS) (on MRI)
Tremors in MS
Intestional tremors
Why does it take so long to get diagnosed with MS
Vague symptoms in the beginning,not enough to seek medical treatment
Will rule everything out before you get diagnosed with MS
Multiple sclerosis s/s common
Visual (blurred or double, blindness in one eye)
Motor problems- gait difficulties/assisted devices
Sensory problems(facial numbness ,
Inkling)
Cerebella’s problems
Bowel,bladder and sexual
Cognitive
Emotional problems
Death in MS pt
Not because of MS but from immobility , or pneumonia
Sensory manifestations
Numbness pain tremor
Decrease hearing
Chronic neuro pain
Llermitte’ssign
Motor manifestations
Weakness or paralysis
Spasticity of muscles
Scanning of speech
Impaired bowel and bladder functions
Spastic bladder
Constipation
Sexual dysfunction
Erectile dysfunction
Decrease libido
Painful intercourse
Cognitive manifestations
Short term memory attention
Info processing
Attention , planning
Visual perception word finding
MS diagnostic studies
No definitive test for MS
H&P , clinical manifestations and result of diagnostic test
MRI
CSF analysis
Evoked potential studies
Neuropsychological testing
Sexual history
For diagnosis of MS
Evidence of at least 2 inflammatory demyelination’s lesions in at least 2 different locations within the CNS
Damage or an attack occurring at different times (usually > 1 month apart)
All other diagnosis must be ruled out
MS medical management
No cure
Goal is to delay progression of disease manage chronic symptoms and treat acute exacerbations
Immunomodulaators (disease modifying drugs I)
Interferon beta-1a
Interferon bet-1b
Glatiramer acetate
Teriflunamide
Interferon beta
Is a naturally occurring glycoprotein with antiviral , antiproliferative , antimmunomodulatory actions
Reduced the frequency and severity of attacks
Reduces the number and size of lesions detectable with MRI
Delays progression of disability
Given subq or IM injections
Adverse effects and drug interactions INterferon beta
Flu like reactions
Hepatotoxicity (liver function test,CBC)
Myelosuppression
Injection - site reactions
Depression
Suicidal thoughts
Drug reactions
PREPERATION dosage and admin of interferon beta
Dispense as single use syringes and vials
Disease modifying drugs II
Immunosuppressant
Only one approved by the US food and drug admin
Mitoxantrone
Mitoxantrone
More toxic than immunommodulators
Produce greater suppression of immune function
Originally developed to treat cancer can delay time to relapse and time of disability progression
Therapeutic use of mitoxantrone
Decreases neuro disability and clinical relapses
Binds with DNA and inhibits topoisomerase
Adverse effects and drug interactions
Myelosuppression (monitor fever chills and cough inform physician immediately )
Cardio toxicity
Fetal harm
Reversible hair loss, injury to GI ucosa n&V
Amenorrhea , allergy symptoms and blue green tint to urine and Sclera
Drug therapy for MS
Corticosteroids
Prednisone and methylprednisolone
Medication to manage symptoms (bowel dysfunction , etc)
Medication for spastic muscles
Backlafin
Medication for neuropathic pain
Gabapentin
Medication to help with walking
Dalfampridine
Nursing interventions
Promote physical mobility
Prevent injury
Enhance bowel and bladder control
Enhance communication
Improve sensory and cognitive function
Teach about medications
Educate family
Gait training
Interproffesional care
Surgery
Dorsal column electrical stimulation
Intrathecal baclofen pump
Therapy for MS
Water therapy
Psychological
Anger anxiety depression acceptance
Social system
Family
Financially
Friends
Counseling
Individual
Family
support group
