MS Flashcards
how is MS caused
interferes with the myelin sheath. Characterized by randomly scattered patches of demyelination in the brain stem, cerebrum, cerebellum and spinal cord.
Periods of remission and exacerbation.
When myelin sheath is first damaged symptoms may be mild or barely noticeable. Myelin can regenerate in very early stages.
As disease progresses, loss of myelin permanently damages neurons.
is MS one type of disease
no there are many different forms of MS. some more severe than others
symptoms of MS
there are many different type of symptoms depending on where the myelin sheath is effected.
progression of MS
Recovery following each exacerbation is increasingly less complete over time and permanent loss of function eventually occurs.
Degree of disability varies. Some patients can maintain independence or assisted living throughout a normal life span. Others may be severely limited in activities or become bedridden in a few years.
how do you know if your MS is going to be good or bad
In most cases the onset of MS at a young age indicates a more severe form of the disease with increased disability.
statistics of MS
MS considered to affect young to middle-age adults. Onset 15 to 50 years of age.
Women affected more than men.
Higher rates in northern Europe, northern United States, southern Canada and southern Australia and New Zealand.
Low rates in southern Europe, Japan, China and South America.
Five times more prevalent in temperate climates ( between 45 and 65 degrees latitude ).
African Americans have prevalence rate that is 40% that of European Americans. Suggests genetic susceptibility related to ethnicity.
250,000 t0 350,000 people in US have MS
causes of MS
Many experts believe MS is caused by an inflammatory response caused by an individual’s immune system, perhaps triggered by a virus in a genetically susceptible individual.
Possible precipitating factors may include infection, emotional stress, excessive fatigue, pregnancy, and a poorer state of health.
Role of precipitating factors is controversial.
types of MS
Relapsing- remitting
Primary- Progressive
Secondary-Progressive
Progressive-Relapsing
relapsing - remitting MS
Clearly acute attacks with full recovery or with sequelae and residual deficit upon recovery. Periods between disease relapses are characterized by lack of disease progression.
primary-progressive MS
Disease progresses from onset with occasional plateaus and temporary minor improvements.
Characterized with no remissions.
secondary-progressive MS
Begins with an initial relapsing-remitting course, followed by progression at a variable rate, which may also include occasional relapses and minor remissions.
May have plateaus.
progressive-relapsing
Progressive disease from onset, with clear acute relapses, with or without full recovery.
Periods between relapses are characterized by continuing progression.
things that can cause an exacerbation of MS
include infection, emotional stress, excessive fatigue, pregnancy, and a poorer state of health.
prognosis of MS
Has improved with new immune modulating drugs that slow the progression of the disease and decrease the number of episodes of active disease.
Now life span is only slightly shorter than those without the disease.
clinical symptoms of MS
Often insidious and gradual, with vague symptoms occurring intermittently over months or years.
The disease may not be diagnosed until long after the onset of the first symptom.
The disease has a varied distribution in the CNS so signs and symptoms vary over time.
most common symptom of MS
eye problem
vision issues
they go to the eye doctor and find out there is problems with the optic nerve
Blurred vision, scotomas (blind spots), diplopia, optic neuritis
often resolved in later stages
how is MS diagnosed
spinal tap - through spinal fluid
MRI can sometimes see the myelin sheath deterioration
other common symptoms of MS
vague numbness weird parasthesia's, go around the trunk, or all the way around a limb. weird sensation altered sensations of pain, temperature, touch altered position sense vertigo ringing in ears loss of hearing neuropathic pain Lhermitte’s sign spasticity
Lhermitte’ssign
electrical shock all the way down your spine to your lower limbs
impaired motor function in MS
Weakness, paralysis, spasticity, tremors.
Scanning speech.
Cerebellar Symptoms
Nystagmus, ataxia, dysarthria, dysphagia, problems with balance, intention tremor.
MS impaired bowel and bladder function
Constipation.
Generally, there is urinary retention, but urgency and frequency may also occur. May have either a Uninhibited, spastic bladder or a flaccid bladder.
sexual dysfunction in MS
Erectile dysfunction from spinal involvement.
Women may experience decreased libido, difficulty with orgasmic response, painful intercourse, and decreased vaginal lubrication.
MS has no apparent effect on pregnancy, labor & delivery and lactation. Some experience remission when pregnant.
emotional effects of MS
Euphoria, mood swings.
May be some problems with cognition, changes in mental status, attention deficits.
Many people experience anger and/or depression.
diagnostics for MS
History and physical evaluation CSF Analysis-increased protein, leukocytes and Ig immunoglobulin MRI CT Scan Vision testing Evoked response testing
Medical management
Corticosteroids Immunomodulators Immunosuppressants Muscle Relaxants Cholinergics Anticholinergics
immunomodulators for MS
reduce the relapse by 30%
decreased the appearance of new lesions by 80%
causes flu like symptoms
these drugs have to be given parentally
A. INTERFERON 1A ( AVONEX) ** only drug that is not sub-Q - can cause CHF and Tachycardia
B. INTERFERON 1B ( BETASERON ) -can cause CHF and Tachycardia
C. GLATIRAMER ACETATE ( COPAXONE ) - can cause a lot of injection site reactions, also can cause palpitations and chest pain.
D. REBIF - do not give to a patient with a history of depression. **Do not give certain drugs every day. They need to have at least 48 hrs between them . all these drugs can effect blood cells and the liver enzymes
immunosuppressants for MS
II. ANTINEOPLASTIC AGENT—MITOXANTRONE ( NOVANTRONE )
decreases your immune response and periods of exacerbation.
side effect is cardiotonic. can develop cardiomyopathy, can cause liver toxicity. Can effect your bone marrow. monitor CBC and liver function tests.
corticosteroids for MS
reduce severity of exacerbation when you have them.
treated for 1-5 days
muscle relaxants for MS
baclovin
can be a pump or PO
dantriun is another one
used for spastic episodes
side effects : drowsy, dizzy, muscle weakness, tired, nausea
dantriun can cause an erratic blood pressure
Examples: Baclofen ( Lioresal ) , Dantrium ( Dantrolene ) & Valium ( Benzodiazepine )
Common side effects of Dantrium & Baclofen are dizziness, drowsiness, fatigue, nausea.
Baclofen is treatment of choice for spasticity. Will improve mobility. Can be given po, intrathecal injection and by a surgically implanted baclofen pump which is put in the abdomen and delivers the med directly into CSF.
cholinergics for MS
urecholine
increases tone of bladder
Side effects are hypotension, heart block, cardiac arrest, faintness, bronchospasm, headache, nausea, diarrhea, vomiting, urgency, flushing,sweating.
anticholinergics for MS
used for too much tone
Corticosteroids for MS
(acth, solumedrol, predisone)
IV corticosteroids have been effective in reducing severity of exacerbations in may patients.
Reduces inflammation and edema at site of demyelination in neuron.
IV steroids have less side effects than po steroids.
Patient teaching—restrict salt intake, do not abruptly stop, know drug interactions.
medications to treat Ataxia
Beta-blockers like Inderal
Antiseizure agents like Neurontin & Klonopin.
Amantadine ( Symmetrel), Ritalin, Prozac and SSRIs are used to treat aspects of fatigue, depression and apathy.
nursing interventions for MS
Assess for specific deficits r/t location of demyelination
Promote optimum mobility
Teach patient not to get overtired—can lead to exacerbation.
Administer medications
Maintain bowel & bladder elimination
Prevent complications of immobility
Prevent injury r/t sensory problems
Provide psychological support to patient, family members and significant others.
For sexual dysfunction
For pain control
Experimental Treatments
discharge teaching for MS
Balance between rest & activity
Regular exercise ie. Walking, swimming, biking in mild cases
Use energy conservation techniques
Well-balanced diet—High protein with supplements, vitamins
Fresh air and sunshine
Use of medications and side effects
Alternate methods of sexual gratification
Avoid fatigue, stress, overheating, chilling, infection
patients with MS
should not become overtired and overworked
it promotes an exacerbation.
what to watch with MS
watch laxatives, you do not want to create bulk because it will cause an obstruction
