MULTIPLE SCLEROSIS Flashcards
multiple sclerosis occurs in what age?
ages 20 and 40 years
Define multiple sclerosis
-a chronic, unpredictable progressive, degenerative disorder of the CNS
-disseminated demyelination of nerve fibers of the brain and spinal cord
Etiology of Multiple Sclerosis
-idiopathic
-autoimmune
- viral exposure
the result of autoimmune in the etiology of multiple sclerosis is because of _____
-driven by activated T cells
T cells can cause_____
T cells can cause inflammation and demyelination and destruction
What is the Pathophysiology of Multiple Sclerosis?
-immune system attacks on the myelin protein
-slowed transmission of nerve impulses
- 3 process (chronic inflammation, demyelination and gliosis)
-recurrence destroys oligodendrocytes
- further damage to underlying axon
- disruption of nerve impulse transmission
- loss of nerve function
- hard, rigid plaque formation
- atrophy of cerebral cortex
Gliosis is a
-scar formation
- a fibrous proliferation of glial cells
a fibrous proliferation of glial cells
Gliosis
Clinical Manifestations of Multiple Sclerosis
-First sign of MS
- coordination and balance problems
- extremity muscle weakness
-partial or complete paralysis
- numbness and tingling
- LHERMITTE’S SIGN
- MS HUG
- Cerebellar Signs
What is the first sign of MS (Multiple Sclerosis)?
-blurred or double vision
- red-green color distortion
-blindness in 1 eye
What is Lhermitte’s sign?
a temporary sensory symptoms described as an electric shock going to the spine or into the limbs with neck flexion
What is MS HUG?
-pain around the low thoracic and abdominal regions
- muscle spasm in intercostal and abdominal muscles
What are the cerebellar signs?
-nystagmus
- ataxia
- dysarthria
- dysphagia
what is nystagmus?
involuntary eye movement
what is ataxia?
loss of muscle control
what is dysarthria?
difficulty in speaking
what is dysphagia?
difficulty swallowing
other clinical manifestations of multiple sclerosis
-hearing loss
-tremors
-dizziness
-constipation
-spastic bladder
- flaccid (hypertonic) bladder
- erectile dysfunction
- decreased libido
- anger & depression
Diagnostic Studies of Multiple Sclerosis
-MRI with contrast of the brain and spinal cord
-CSF analysis
Show plaques, inflammation, atrophy and tissue
MRI with contrast of the brain and spinal cord
The diagnostic criteria for MS
- evidence of at least 2 inflammatory demyelinating lesions in at least 2 different locations within the CNS.
- two or more attacks occurring at different times (usually 1 month or more apart)
- all other diagnosis ruled out
Medical Management of MS
-Immunomodulator Drugs
- Disease- modifying drugs
-Corticosteroids
What is the mechanism of action of the immunomodulator drugs?
modify the response of the immune system by increasing or decreasing the production of serum antibodies
What are the immunomodulator drugs?
-interferon B-1 a (renif, plegridy)
- interferon B-1b (betaseron)
- glatiramer acetate (copaxone)
Drug alert of B-interferon
-assess for depression and suicidal thoughts
- teach patient to wear sunscreen and protective clothing when exposed to sun
- tell the patient that flu-like symptoms are common after starting therapy.
What is the mechanism of action of the disease-modifying drugs (DMOs)?
-immunosuppressant
-modify disease progression and prevent relapses
- more effective if started early
- given after immunomodulators
what are the disease-modifying drugs?
-interferons
- monoclonal antibodies
- synthetic agents
mechanism of action of the corticosteroids
-reduce edema and acute inflammation at the site of demyelination and speed recovery
Examples of corticosteroids in MS
prednisone
Nursing Management of Multiple Sclerosis
-Maximize neuromuscular function
- Maintain independence in activities of daily living
- Watch out for complications of immobility like respiratory complications, UTIs, and pressure injuries
- High fiber diet for constipation is common.
- Promotion of exercise for spasticity (rigidity of muscles)
