multiple sclerosis

Question 1

multiple sclerosis

Answer 1

• A chronic demyelinating disease that affects the myelin sheath of neurons in the CNS

Question 2

incidence of MS

Answer 2

Onset: between 20-40 years
Affects women 2x more than men
Affects more Whites
Prevalent in the northern latitudes

Question 3

etiology of MS

Answer 3

Exact cause unknown

? Viral etiology which triggers immune-mediated demyelination (Epstein-Barr virus)

Question 4

pathophysiology of MS

Answer 4

• The myelin sheath is essential for normal conduction of nerve impulses
• Plaques form along myelin sheath causing inflammation, edema, scarring and destruction
• Plaques may occur anywhere in white matter of CNS, but most commonly affects: optic nerves, cerebrum, cervical spinal cord

Question 5

MS clinical patterns

Answer 5

Relapsing-remitting most common initial pattern

Question 6

MS clinical manifestations

Answer 6

Weakness or paresthesias of one or more extremities (cerebrum)
Vision loss from optic neuritis
Incoordination (cerebellum)
Bladder dysfunction: frequency, loss of sensation, incontinence, retention, hyperreflexia
Constipation
Sexual dysfunction
Fatigue: common, often disabling
Spasticity
Emotional responses: depression, apathy, emotional instability

Question 7

MS diagnostics

Answer 7

NO definitive test
Based on clinical presentations
MRI: to determine presence of MS plaques
CSF: cerebrospinal fluid for presence of oligoclonal banding (Oligodendrocytes are responsible for making myelin)
Evoked potentials of the optic pathways and auditory system to assess for slowed nerve conduction

Question 8

MS management focuses on

Answer 8

Treatment of acute relapses
Treatment of disease management
Symptomatic Treatment

Question 9

for an acute MS relapse

Answer 9

IV or Oral corticosteroids (Methylprednisolone)

Question 10

MS symptomatic treatment

Answer 10

Bladder dysfunction: oxybutynin
Constipation: Metamucil, Dulcolax suppositories (Repeated stimulant use for constipation can cause dependence)
Spasticity: Baclofen (muscle relaxant)
Tremor: phenoorbital, propranolol
Fatigue: Amantadine (Symmetrel), Modafinil (Provigil)
Trigeminal Neuralgia: Dilantin (phenytoin), Amitriptyline

Question 11

MS nursing diagnoses

Answer 11

Deficient Knowledge r/t new diagnosis of MS
Impaired Urinary Elimination r/t bladder dysfunction
Constipation r/t immobility and demyelination
Activity Intolerance r/t fatigue and muscle weakness
Impaired Physical Mobility r/t weakness, contracture, spasticity, and ataxia
Risk for Self-Care Deficit r/t muscle weakness
Situational Low Self Esteem r/t loss of independence and fear of disability
Altered Sensory Function r/t visual changes

Question 12

MS impaired urinary elimination r/t blader dysfunction

Answer 12

Neurogenic bladder most common bladder dysfunction
Maintain fluids
Void q3hrs
For retention: Intermittent self-cath using clean technique

Question 13

MS constipation r/t immobility and demyelination

Answer 13

High fiber diet
Stool softeners
Adequate fluids
Avoid laxative, enema dependence
Glycerin or digital stimulation to initiate evacuation

Question 14

MS activity intolerance r/t fatigue and muscle weakness

Answer 14

Fatigue exacerbated by warm temperatures
Plan activities for peak energy level, usually in morning
Plan rest periods

Question 15

MS impaired physical r/t weakness, contractors, spasticity, and ataxia

Answer 15

ROM bid to stretch spastic muscles water therapy (Flexor muscles are stronger than extensors)
Antispasmodics (Baclofen (Lioresal): provides synaptic inhibition of spinal reflexes)
Splints to help maintain position (Foot drop: severe plantar flexion, may need surgical intervention for Achilles)