Multiple Sclerosis Flashcards
what is MS?
a chronic, progressive, degenerative disease of the CNS
what is MS characterized by?
segmental demyelination of nerve fibers of brain and spinal cord
what is the cause?
unknown
cause is related to?
genetics, infection, immunity
affects mostly who?
women between 20-50
MS is similar to cancer how?
periods of exacerbation and remission
more progressive when?
diagnosed at age 50 +
most prevalent in people of what ancestry
northern European
primary problem with MS
autoimmune process
possible factors include
-infection
-smoking
-physical injury
-emotional stress
-pregnancy
-poor state of health
3 pathologic processes that characterize MS
-chronic inflammation
-demyelination
-gliosis (scarring) in the CNS
immune system attacks the what?
myelin sheath
4 patterns of MS
-relapsing-remitting
-primary-progressive
-secondary-progressive
-progressive-relapsing
onset of disease is ?
gradual
clinical manifestations overview
-vague symptoms intermittently over months - years
-dz diagnosed long after 1st onset
-chronic progressive deterioration in some pts
-remissions and exacerbations in others
-overall = progressive deterioration in neuro function
-symptoms vary
s/s
-visual
-motor
-sensory
-cerebellar
-bowel, bladder, sexual
-cognitive
-emotional
sensory manifestations
-numbness and tingling
-pain
-tremor
-decreased hearing, vertigo, tinnitus
-chronic neuropathic pain
-lhermittes sign
motor manifestations
-weakness/paralysis of limbs and trunk
-spasticity of muscles
-scanning of speech
impaired bowel/bladder functions
-constipations
-variable urinary problems
-spastic bladder
-flaccid bladder
sexual dysfunction
-ED
-decreased libido
-painful sex
cognitive manifestations
-short term memory
-information processing
-attention, planning
-visual perception
-word finding
is there a definitive test to diagnose?
NO
what is diagnosis based on?
hx, clinical manifestations, and results of diagnostic tests
what diagnostic tests can be done?
-MRI
-CSF analysis
-evoked potential studies
-neuropsychological testing
-sexual hx
for diagnosis of MS, there must be
-2 inflammatory demyelinating lesions in at least 2 different locations
-damage or an attack occurring at diff times (usually >1 mo. apart)
-all other diagnoses ruled out
is there a cure for MS?
NO
goal of treatment
delay progression of dz, manage symptoms, treat acute exacerbations
what do dz modifying drugs do? (DMD)
-decrease frequency and severity of relapses
-reduce development of brain lesions
-decrease future disability
DMD I
-drugs that suppress immune system to modify dz progression, prevent relapses
immunomodulators
-treatment should begin as soon as diagnosed
-modify dz progression and prevent relapses
interferon beta
SQ
-reduces frequency and severity of attacks
-reduces # and sizes of lesions
-delays progression of disability
interferon beta adverse effects and drug interactions
-flu-like reactions
-hepatotoxicity
-myelosuppression
-injection site reactions
-depression
-suicidal thoughts
-drug interactions
how is interferon beta dispenses
single use syringe/vials
dz modifying drugs II
immunosuppressant
mitoxantrone and cladribine
mitoxantrone and cladribine
-more toxic than immunomodulators
-produce greater suppression of immune function
mitoxantrone therapeutic use
decreases neurologic disability and clinical relapses
mitoxantrone adverse effects and drug interaction
-myelosuppression
-cardiotoxicity
-fetal harm
-reversible hair loss, injury to GI mucosa, n/v, amenorrhea, allergy symptoms, blue/green tint to urine and sclera
drugs used to manage exacerbations
corticosteroids - methylprednisone, prednisone
corticosteroids -
-helpful in treating acute exacterbations
-reduce edema and acute inflammation at site of demyelination
other drug that can help with exacerbations
therapeutic plasma exchange and IV immunoglobulin G
MS symptoms - drugs can be used to manage these
-bladder dysfunction
-bowel dysfunction
-depression
-fatigue
-spasticity
-neuropathic pain
-improved walking
-dizziness and vertigo
MS nursing interventions
-promote physical mobility
-prevent injury
-enhance bowel and bladder control
-enhance communication
-improve sensory and cognitive function
-teach about meds
-educate family
want pt to -
-maximize neuromuscular function
-maintain ADLs
-manage fatigue
-optimize psychosocial well-being
-adjust to illness
-decrease factors that precipitate exacerbations
what kind of tremor?
intention tremor
