Multiple Sclerosis (MS)οΏΌ Flashcards
NORMAL NEURON
- THE AXON IS WRAPPED IN A SOFT, WHITE, FATTY MATERIAL CALLED THE NEURON SHEATH.
- THE MYELIN SHEATH INSULATES THE AXONS AND ENABLES SIGNALS TO BE CONDUCTED ALONG THEM AT A FASTER RATE.
- LOSS OF SHEATH MAKES CONDUCTION NEARLY IMPOSSIBLE
Multiple Sclerosis (MS) Patho
- an immune-mediated, Chronic, Progressive demyelinating disease of the Central Nervous System (CNS) that disrupts the communication within the brain. (Signals in the brain are slowed or disrupted entirely)
β Demyelination: the destruction of the myelin; impairs the transmission of nerve impulses.
β- Myelin: the fatty and protein material that surrounds certain nerve fibers in the brain and spinal cord - From video: In response to demyelination, Oligodendrocytes repair/ restore the myelin in a process called Remyelination which becomes increasingly less effective as time goes on (becomes overwhelmed by immune system)
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What happens to nervous tissue when you have multiple sclerosis?
- People with multiple sclerosis often have a leakage in the blood-brain barrier, which allows immune cells through enabling them to invade and attack the nerve tissue inside.
β Blood-brain barrier: a highly selective permeable membrane that prevents immune cells and other unwanted material from entering the central nervous system
β Like double agents your immune cells can turn and start causing damage to organs or tissues within your own system. - Causes inflammation and destruction of the myelin sheaths of the neurons, disrupting the flow of information along the nerve pathways.
β One of the tactics used by these delinquent cells is to cut communications between your brain (HQ) and your organs, muscles and tissues (operations) by destroying parts of your nerves that are essential for efficient and effective transfer of information.
MS Risk factors/ causes:
- Early Viral Infections (Epstein Barr common)
- Smoking
- Trauma
- Emotional stress
- Pregnancy
- Fatigue
- *onset between the 25- 35
- > in women
- Genetics; in families that have 2 or more people with the disease
- Geographic/ Climate change:
β- Caucasian
β- Northern European descent/ northern hemisphere
Types and courses of MS.
- Relapsing-remitting (RR) MS
- Primary progressive MS
- Secondary progressive MS
- Progressive-relapsing MS
Relapsing-remitting (RR) MS
is characterized by *clearly acute attacks with full recovery or with sequelae (a condition, which is the consequence of a previous disease or injury) and residual deficit upon recovery.
- Periods between disease relapses are characterized by lack of disease progression. (85%)
- The residual deficits may occur and accumulate over time.
- functional decline characterized by disease showing progression of disability from onset
- without plateau
- temporary minor improvements
- most common
- debilitating fatigue
- always fully recover, may have residual symptoms that persist after recovery
Primary progressive MS
- is characterized by disease showing progression of disability from onset
- without plateau
- temporary minor improvements.
- no recovery, only progression
Secondary progressive MS
- begins with an initial relapsing-remitting (RR) course, followed by progression of variable rate
- may also include occasional relapses and minor remissions.
Progressive-relapsing MS
- shows progression from onset
- with clear acute relapses with or without recovery.
MS Priority labs & diagnostics
CT and/or MRI of brain and spinal cord:
- shows the presence of *multiple plaques/ lesions (condition of having lesions in the brain known as sclerosis; hence the term multiple sclerosis; multiple lesions) in the CNS, tissue damage, inflammation
Lumbar puncture (CSF):
- Identifies the presence of elevated gamma globulin level / *oligoclonal banding
β several bands of immunoglobulin G bonded together, indicating an immune system abnormality
MS Priority Assessments
Because these lesions may develop in multiple parts of the brain, various systems may be effected at once (vision, cognition, movement, touch, emotion). No 2 cases are the same and may present with any combination of signs and symptoms depending on the part of the brain affected.
- Neuro assessment: Neurologic deficits
- Respiratory assessments to detect any early symptoms of - compromise
- Energy level
- Vision
- Speech
- Bowel and bladder assessment;
- Balance and coordination;
- Cognitive dysfunction; loss of words and memory
β keep things the same for the pt/ sticky notes/etc.
- Assess skin:β for burns/ bed sores
- Emotional/ social/ coping assessment
Multiple Sclerosis Signs & Symptoms
- Vary and have different patterns according to the location of the lesion and how many. Symptoms can be mild to severe.
- Disease is relapsing and remitting; has exacerbations and recurrences of symptoms
- ** Exacerbations and remissions are characteristic of MS. It is during the exacerbations that new symptoms appear and existing symptoms worsen. Relapses can bring on emotional and physical stress.
- *Fatigue:
β often the most disabling symptom.
β Heat, depression, anemia, deconditioning and medications can contribute.
β Avoid hot temperatures, OT & PT may help manage fatigue
β Provigil - *Pain
β may need daily analgesic medications - *Spasticity (muscle hypertonicity)
β most often in the lower extremities.
β Results from involvement of the main motor pathways of the spinal cord.
β Tense/stiff/ constantly contracted (causes pain)
β *Baclofen (Lioresal) - *Ataxia
β impaired coordination of movement.
β Caused by a loss of control connections between the cortex and the basal ganglia.
β Bladder, bowel, and sexual dysfunctions are common. - *weakness
- *numbness/ pins and needles/ paresthesia/ paralysis
β may get burns or sores from numbness - *loss of balance
β walking ability; *fall risk
β Install shower handles - *visual disturbances
β Damaged optic nerve
β double or blurred vision, or unilateral blindness
β (From Video) one of the first symptoms to appear
β Color vision washing
β Decreased eye movement (staggering eye motion/ vibration look when looking horizontally) - Difficulty speaking
β loss of words and memory (cognitive)
β (from video) Difficult speech/ swallowing (Cranial nerve IX- Glossopharyngeal nerve) - Incontinence or retention and constipation
β Constant muscle contraction (urinary frequency changes) - Pressure sores due to immobility
- Sexual dysfunction
- Cognition:
β Attention
β Memory
β Thinking
β Decision making (indecisive)
MS Nursing diagnosis:
- Impaired physical mobility
- Risk for injury (impaired senses)
- Impaired bowel and bladder function
- Impaired verbal communication
- Disturbed thought processes
- Ineffective coping
- Impaired home maintenance
- Potential sexual dysfunction
MS Nursing planning:
major goals may include:
- 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
MS Symptom management
- Continuity of care with an interdisciplinary team in both the rehabilitation and home setting is necessary to maintain maximum strength, function, and independence
- Spasticity - Baclofen (Lioresal) (muscle relaxant) for muscle spasms
- Fatigue - Provigil (may have to continually take)
