Multiple Sclerosis Flashcards
What is Multiple Sclerosis?
Chronic, progressive, degenerative disorder of the central nervous system (CNS)
Characterized by segmental demyelination of nerve fibers of the brain and spinal cord
The Three pathologic processes that characterize MS
Chronic inflammation
Demyelination
Gliosis in the CNS-surround neurons and support
Pathogenesis of MS
Etiology and Pathophysiology of MS
Initially, attacks cause damage to myelin sheaths of neurons in brain and spinal cord.
*Nerve fiber is not affected.
Patient may complain of noticeable impairment of function.
With ongoing inflammation, myelin loses ability to regenerate.
Nerve impulse transmission is disrupted without myelin
Clinical Manifestations
Common manifestations of MS include motor, sensory, cerebellar, and emotional problems.
*Vague symptoms occur intermittently over months and years.
*Disease may not be diagnosed until long after onset of the first symptom.
Clinical Manifestations are characterized by what?
Chronic, progressive deterioration in some
*Remissions and exacerbations in others
*Progressive deterioration in neurologic function with repeated exacerbations
Clinical Manifestations
òCommon manifestations of MS
òMotor problems
Scanning speech
Sensory problems
Numbing, tingling, tinnitus, neuropathic pain,
Cerebellar problems
Impaired balance, dysarthia, nystagmus, Ataxia
Emotional problems
Anger, euphoria-with severe cognitive impairment, FATIGUE, depression
Bowel and bladder functions-in assessment this is very important may be impaired.
Constipation
Spastic bladder
Small capacity for urine results in incontinence.
Flaccid bladder
Large capacity for urine and no sensation to urinate
Sexual dysfunction can occur in MS.
Cognitive manifestations
Diagnostic Studies
No definitive diagnostic test for MS
Based primarily on history, clinical manifestations, and results of certain diagnostic tests
*MRI of brain and spinal cord may show the presence of plaques, inflammation, atrophy, and tissue breakdown and destruction.
- Cerebral spinal fluid (CSF) analysis
- ↑ in immunoglobulin G- IgG
- Presence of oligoclonal banding-Proteins that if present are a sign of inflammation in the central nervous system
For a diagnosis of MS
Evidence of at least 2 inflammatory demyelinating lesions in at least 2 different locations within the CNS
Damage or an attack occurring at different times (usually >1 month apart)
All other possible diagnoses must have been ruled out.
Collaborative Care
Drug Therapy
Currently there is no cure for MS.
Drug therapy used to slow the progression of disease includes the use of immunosuppressants, immunomodulators, and adrenocorticotropic hormone.
Immunomodulator drugs are used initially to modify the disease progression and prevent relapses.
Interferon b -SQ(Betaseron, Extavia, Avonex (IM), Rebif)
Glatiramer acetate (Copaxone) (SQ)-type of medication
Teriflunomide (Aubagio) (PO)
Fingolimod (Gilenya) reduces disease activity by preventing lymphocytes from reaching the CNS and causing damage
Collaborative Care
Drug Therapy for more advanced/aggresive MS
IV natalizumab (Tysabri)-anti-body given monthly
IV mitoxantrone (Novantrone)-HASSERIOUS S/E-Cardio toxicity and leukemia
Dimethyl fumarate (Tecfidera)- for relapsing-intermitting
Corticosteroids (methylprednisolone, prednisone)
Helpful in treating acute exacerbations by reducing edema and acute inflammation at the site of demyelination
Collaborative Care
Other Drug Therapy
Muscle relaxants
CNS stimulants
Anticholinergics
Tricyclic antidepressants
Selective potassium channel blocker –dalfampridine (Ampyra) –shouldn’t be used in pt with seizure and severe kidney disease
Antiseizure drugs
Collaborative Care
Physical Therapy
Relieve spasticity.
Improve coordination.
Train patient to substitute unaffected muscles for impaired muscles.
Nursing Assessment
Subjective Data
Health history
Viral infections or vaccinations
Residence in cold or temperate climates
Physical and emotional stress
Medications
Elimination problems
Weight loss, dysphagia
Muscle weakness or fatigue, tingling or numbness, muscle spasms
Blurred or lost vision, diplopia, vertigo, tinnitus
Decreased libido, impotence
Anger, depression, euphoria, isolation
Nursing Assessment
Objective Data
Apathy, inattentiveness
Pressure ulcers
Scanning speech
Tremor
Nystagmus
Ataxia
Spasticity
Hyperreflexia
↓ hearing
Muscular weakness
Paresis
Paralysis
Foot dragging
Dysarthria
Planning
Maximize neuromuscular function.
Maintain independence in activities of daily living for as long as possible.
Manage disabling fatigue.
Optimize psychosocial well-being.
Adjust to the illness.
↓ factors that precipitate exacerbations- Such as childbirth, trauma, immunizations, ect
