Multiple Sclerosis

Question 1

what is MS?

Answer 1

a chronic, progressive, degenerative disease of the CNS

Question 2

what is MS characterized by?

Answer 2

segmental demyelination of nerve fibers of brain and spinal cord

Question 3

what is the cause?

Answer 3

unknown

Question 4

cause is related to?

Answer 4

genetics, infection, immunity

Question 5

affects mostly who?

Answer 5

women between 20-50

Question 6

MS is similar to cancer how?

Answer 6

periods of exacerbation and remission

Question 7

more progressive when?

Answer 7

diagnosed at age 50 +

Question 8

most prevalent in people of what ancestry

Answer 8

northern European

Question 9

primary problem with MS

Answer 9

autoimmune process

Question 10

possible factors include

Answer 10

-infection
-smoking
-physical injury
-emotional stress
-pregnancy
-poor state of health

Question 11

3 pathologic processes that characterize MS

Answer 11

-chronic inflammation
-demyelination
-gliosis (scarring) in the CNS

Question 12

immune system attacks the what?

Answer 12

myelin sheath

Question 13

4 patterns of MS

Answer 13

-relapsing-remitting
-primary-progressive
-secondary-progressive
-progressive-relapsing

Question 14

onset of disease is ?

Answer 14

gradual

Question 14

clinical manifestations overview

Answer 14

-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

Question 15

s/s

Answer 15

-visual
-motor
-sensory
-cerebellar
-bowel, bladder, sexual
-cognitive
-emotional

Question 16

sensory manifestations

Answer 16

-numbness and tingling
-pain
-tremor
-decreased hearing, vertigo, tinnitus
-chronic neuropathic pain
-lhermittes sign

Question 17

motor manifestations

Answer 17

-weakness/paralysis of limbs and trunk
-spasticity of muscles
-scanning of speech

Question 18

impaired bowel/bladder functions

Answer 18

-constipations
-variable urinary problems
-spastic bladder
-flaccid bladder

Question 19

sexual dysfunction

Answer 19

-ED
-decreased libido
-painful sex

Question 20

cognitive manifestations

Answer 20

-short term memory
-information processing
-attention, planning
-visual perception
-word finding

Question 21

is there a definitive test to diagnose?

Answer 21

NO

Question 22

what is diagnosis based on?

Answer 22

hx, clinical manifestations, and results of diagnostic tests

Question 23

what diagnostic tests can be done?

Answer 23

-MRI
-CSF analysis
-evoked potential studies
-neuropsychological testing
-sexual hx

Question 24

for diagnosis of MS, there must be

Answer 24

-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

Question 25

is there a cure for MS?

Answer 25

NO

Question 26

goal of treatment

Answer 26

delay progression of dz, manage symptoms, treat acute exacerbations

Question 27

what do dz modifying drugs do? (DMD)

Answer 27

-decrease frequency and severity of relapses -reduce development of brain lesions -decrease future disability

Question 28

DMD I

Answer 28

-drugs that suppress immune system to modify dz progression, prevent relapses

Question 29

immunomodulators

Answer 29

-treatment should begin as soon as diagnosed -modify dz progression and prevent relapses

Question 30

interferon beta

Answer 30

SQ -reduces frequency and severity of attacks -reduces # and sizes of lesions -delays progression of disability

Question 31

interferon beta adverse effects and drug interactions

Answer 31

-flu-like reactions -hepatotoxicity -myelosuppression -injection site reactions -depression -suicidal thoughts -drug interactions

Question 32

how is interferon beta dispenses

Answer 32

single use syringe/vials

Question 33

dz modifying drugs II

Answer 33

immunosuppressant mitoxantrone and cladribine

Question 34

mitoxantrone and cladribine

Answer 34

-more toxic than immunomodulators -produce greater suppression of immune function

Question 35

mitoxantrone therapeutic use

Answer 35

decreases neurologic disability and clinical relapses

Question 36

mitoxantrone adverse effects and drug interaction

Answer 36

-myelosuppression -cardiotoxicity -fetal harm -reversible hair loss, injury to GI mucosa, n/v, amenorrhea, allergy symptoms, blue/green tint to urine and sclera

Question 37

drugs used to manage exacerbations

Answer 37

corticosteroids - methylprednisone, prednisone

Question 38

corticosteroids -

Answer 38

-helpful in treating acute exacterbations -reduce edema and acute inflammation at site of demyelination

Question 39

other drug that can help with exacerbations

Answer 39

therapeutic plasma exchange and IV immunoglobulin G

Question 40

MS symptoms - drugs can be used to manage these

Answer 40

-bladder dysfunction -bowel dysfunction -depression -fatigue -spasticity -neuropathic pain -improved walking -dizziness and vertigo

Question 41

MS nursing interventions

Answer 41

-promote physical mobility -prevent injury -enhance bowel and bladder control -enhance communication -improve sensory and cognitive function -teach about meds -educate family

Question 42

want pt to -

Answer 42

-maximize neuromuscular function -maintain ADLs -manage fatigue -optimize psychosocial well-being -adjust to illness -decrease factors that precipitate exacerbations

Question 43

what kind of tremor?

Answer 43

intention tremor