Multiple Sclerosis

Question 1

multiple sclerosis

Answer 1

a progressive immune-related demyelination disease of the central nervous system (CNS)

Question 2

demyelination

Answer 2

destruction of the myelin sheath that surrounds the nerve fibers in the brain and spinal cord

Question 3

myelin

Answer 3

protein and fatty material that insulates the nerves

Question 4

risk factors of MS

Answer 4

Age (between 20-40 years old) – peak is 25-35 years old
Gender (females > males)
Family History
Geographic location (temperature)
Temperature (Distance from Equator) – farther from the equator
Low vitamin D levels and smoking

Question 5

Clinical manifestations of MS

Answer 5

Fatigue
Depression
Cognitive dysfunction
Weakness
Numbness
Difficulty w coordination
Ataxia
Loss of balance
Spasticity (muscle spasms) 
Pain
Visual Disturbances
Bowel/bladder dysfunction

Question 6

Relapsing-remitting

Answer 6

With each relapse there’s recovery (residual deficits)

Level of recovery will decline over time

Question 7

Primary progressive

Answer 7

Steady increase in signs and symptoms and rare plateaus

Temporary improvement but disability is steady

Question 8

Secondary progressive

Answer 8

Begins as relapsing-remitting and follows progression that is variable

Question 9

Progressive-relapsing

Answer 9

Begins with progressive and characterized by relapses with exacerbations

Question 10

Lumbar puncture

Answer 10

Bands of immunoglobulin stuck together

Question 11

Evoked potentials

Answer 11

Monitor disease progression and check extent of disease

Question 12

disease modifying treatment

Answer 12

reduce frequency of relapses and the length of the relapse

Question 13

mechanism of action for Methylprednisolone

Answer 13

decreased inflammatory response in acute exacerbation of MS, ↓ neutrophil migration, ↓ inflammatory mediators, ↓ capillary permeability; shortens duration of relapse and minimizes symptoms

Question 14

adverse effects of Methylprednisone

Answer 14

Hyperglycemia, Immune suppression, Leukocytosis, Emotional lability (pathological laughing and crying)

caution in elderly, diabetics

Question 15

mechanism of action for Interferon B 1b (Betaseron)

Answer 15

Relapsing MS: Improve MRI lesions, ↓ relapse rate/disease severity

Question 16

route of Interferon B 1b

Answer 16

SQ every other day

Question 17

adverse effects of Interferon B 1b

Answer 17

peripheral edema, headache, fever, chills, pain, nausea, suicidal ideation, lymphocytopenia

Question 18

contraindications of Interferon B 1b

Answer 18

hypersensitivity, pregnancy, liver disease, cardiac disease

Question 19

nursing considerations for interferon B 1b

Answer 19

analgesics with flu-like symptoms, injection site reactions usually occur in 1st 4 months, monitor thyroid function, & CBC- ↓ WBC count!!

Question 20

immunomodulators

Answer 20

teach patient and caregivers how to administer injection, side effects, etc

stress the need to avoid exposure to potential infectious agents which may further complicate MS

do not use during pregnancy (symptoms of MS are better)

older adults are already immunosuppressed so they have a higher risk when they’re on an immunomodulator

Question 21

Potential triggers that bring on a relapse

Answer 21

Temperature
Stress
Illness
Fatigue

Question 22

goals and outcomes for MS

Answer 22

Promotion of physical mobility 
Avoidance of injury
Achievement of bowel and bladder continence
Promotion of speech and swallowing mechanisms 
Improvement in cognitive function
Development of coping strengths 
Improved home maintenance 
Adaptation to sexual function