UNIT 3 Chapter 40 NEUROLOGICAL: Concepts of Care MS

Question 1

What is Multiple Sclerosis?

Answer 1

MS is characterized by demyelination (loss of myelin sheaths)

• Chronic, progressive degenerative
  disease
• Autoimmune
• Inflammatory

Affects the myelin sheath anywhere
along the brain, optic nerve, and
spinal cord (sensory and motor)

Question 2

Pathophysiology of MS

Answer 2

Chronic neurologic disease that affects the brain and spinal cord due to immune- mediated demyelination and nerve injury; characterized by remissions and exacerbations

Myelin is responsible for the electrochemical transmission of impulses between the brain and spinal cord and the rest of the body; demyelination can result in slowed or stopped impulse transmission. The white fiber tracts that connect the neurons in the brain and spinal cord are also usually involved in MS.

Question 3

Does MS affect more women than men?

A. No
B. Yes

Answer 3

B. Yes

MS affects women two to three times more often than men, suggesting a possible hormonal role in disease development. Some studies show that the disease occurs up to four times more often in women than men. However, the exact reason for this difference is not known (National Multiple Sclerosis Society, 2020).

Question 4

Risk factor of Multiple Sclerosis

Answer 4

Modifiable
* Well water
* Low Estrogen
* Industrial and Chemical metals
* Exposure to pesticides and
herbicides

Nonmodifiable
* Familial link
* Over 40, especially over 60
* Affects men more than women

Question 5

A nurse is assessing a client with a suspected diagnosis of multiple sclerosis. Which assessment findings will the nurse expect? Select all the apply.
A. Resting tremors
B. Memory loss
C. Muscle spasticity
D. Fatigue
E. Diplopia
F. Dysarthria

Answer 5

B. Memory loss
C. Muscle spasticity
D. Fatigue
E. Diplopia
F. Dysarthria

Question 6

What is Dysarthria

Answer 6

difficulty speaking due to weakness in facial muscles.
- where you have difficulty speaking because the muscles you use for speech are weak

Question 7

What is Diplopia?

Answer 7

Blurred or double vision

Question 8

Signs and Symptoms of MS , name 5

Answer 8

Fatigue
Muscle spasticity
Blurred or double vision (diplopia)
Scotomas
Nystagmus
Paresthesias
Areflexic (flaccid) or spastic bladder
Decreased sexual function
Intention tremors
Gait changes

Question 9

What would you suspect to find in a a patient with Multiple Sclerosis?

A. hyperflexibility
B. muscle contractures
C. priapism
D. diarrhea

Answer 9

B. muscle contractures

Spasticity is abnormal muscle tightness due to prolonged muscle contraction. I

Question 10

Signs and Symptoms of Multiple Sclerosis, name 10

Answer 10

• Muscle weakness and spasticity
• Fatigue (usually with continuous sensitivity to temperature) * Intention tremors (tremor when performing an activity)
• Flexor muscle spasms
• Dysmetria (inability to direct or limit movement)
• Numbness or tingling sensations (paresthesia)
• Hypoalgesia (decreased sensitivity to pain)
• Ataxia (decreased motor coordination)
• Dysarthria (difficulty speaking due to slurred speech)
• Dysphagia (difficulty swallowing)
• Diplopia (double vision)
• Nystagmus (an involuntary condition in which the eyes make repetitive uncontrolled movements)
• Scotomas (changes in peripheral vision)
• Decreased visual and hearing acuity
• Tinnitus (ringing in the ears), vertigo (dizziness)
• Bowel and bladder dysfunction (flaccid or spastic)
• Alterations in sexual function, such as impotence
• Cognitive changes, such as memory loss, impaired judgment, and decreased ability to solve problems or perform calculations
• Depression

Question 11

What diagnostic test is mainly used to diagnose Multiple Sclerosis?

Answer 11

No single specific laboratory test is definitively diagnostic for MS. However, the collective results of a variety of tests are usually conclusive. Abnormal cerebrospinal fluid (CSF) findings include elevated proteins (oligoclonal bands) and an increase in the white blood cell (WBC) count.

Question 12

When a patient is getting an MRI for suspected Multiple sclerosis, what would indicate that the patient has MS?

Answer 12

MRI of the brain and spinal cord demonstrates the presence of plaques in at least two areas, which is considered diagnostic for MS.

Question 13

Which populations is mainly affected by MS?

A, white women
B. Asian men
C. Black Women
D. Black men

Answer 13

A, white women

Commonly occurring disease that affects people (women twice as often as men) between the ages of 20 and 50 yr; most often affects whites of Northern European ancestry

Question 14

Are patients with an autoimmune disease at risk for infections?
A. No
B. Yes

Answer 14

B. Yes

Question 15

Nursing interventions/ Nursing teachings for patients with Multiple Sclerosis

Answer 15

As with any chronic disease, the client who has been diagnosed with MS is at an increased risk for infection. Teach the patient to avoid large crowds and children, who develop many infections from their classmates in school. Remind them to wash their hands frequently and use hand sanitizer when soap and water are not readily available.

Question 16

Is there a cure for Multiple Sclerosis?

A. Yes
B. No

Answer 16

B. No

The patient with MS is treated with a variety of drugs that are used to treat and control the disease progression.

Question 17

Drug therapy for Multiple Sclerosis

Answer 17

The patient with MS is treated with a variety of drugs that are used to treat and control the disease progression.

Many of these drugs are immunomodulators or anti-inflammatory medications that can alter immunity and place patients at risk for secondary infection.

Teach patients receiving drug therapy for MS to avoid crowds and anyone with an infection.

If signs and symptoms of an infection occur, remind them to contact their primary health care provider for prompt management and medical observation.
Examples of drugs used for treatment of relapsing types of MS include (Burcham & Rosenthal, 2019):

• Interferon-beta preparations (interferon beta-1a and beta-1b drugs), immunomodulators that modify the course of the disease and also have antiviral effects
• Glatiramer acetate, a synthetic protein that is similar to myelin-based protein
• Mitoxantrone, an IV antineoplastic anti-inflammatory agent used to resolve relapses but with risks for leukemia and cardiotoxicity
• Natalizumab, the first IV monoclonal antibody approved for MS that binds to white blood cells (WBCs) to prevent further damage to the myelin
• Fingolimod, teriflunomide, and dimethyl fumarate, newer oral immunomodulating drugs

Question 18

What should you monitor for if you patient with Multiple sclerosis is prescribed an immunodialtor?

Answer 18

INFECTION

Question 19

Patient Teaching Drug Administration Multiple Sclerosis

Answer 19

The interferons and glatiramer acetate are subcutaneous injections that patients can self-administer.

Teach patients how to give and rotate the site of interferon-beta and glatiramer acetate injections because local injection site (skin) reactions are common. The first dose of these drugs is given under medical supervision to monitor for allergic response, including anaphylactic shock. Teach patients receiving them to avoid crowds and people with infections because these drugs can cause bone marrow suppression. Remind them to report any sign or symptom associated with infection immediately to their primary health care provider.
Instruct patients about flulike reactions that are very common for patients receiving any of the interferons. These symptoms can be minimized by starting at a low drug dose and giving acetaminophen or ibuprofen. Adverse effects of glatiramer are not common (Burcham & Rosenthal, 2019).

Question 20

Patient Teaching Multiple Sclerosis

Answer 20

• Teach regarding treatments
• Medications
• Minimize risk factors
• Stress, avoid infections
• Eye patch
• Safety precautions
• Prevent skin breakdowns
• Risk factors for future problems
• Respiratory failure, deteriorate over years

Question 21

MS DRUG - Natalizumab

Answer 21

Natalizumab, a humanized monoclonal antibody, can cause many adverse events. It is usually given as an IV infusion in a specialty clinic under careful supervision. The patient is monitored carefully for allergic or anaphylactic reaction when each dose is given because the drug tends to build up in the body.

Patients receiving this drug are at risk for progressive multifocal leukoencephalopathy (PML). This opportunistic viral infection of the brain leads to death or severe disability.

Monitor for neurologic changes, especially changes in mental state, such as disorientation or acute confusion. PML is confirmed by MRI and by examining the cerebrospinal fluid for the causative pathogen (Burcham & Rosenthal, 2019). Natalizumab also causes damage to hepatic cells. Carefully monitor liver enzymes and teach patients to have frequent laboratory tests to assess for changes.

Question 22

What are patients at risk for when taking Natalixumab?

A. hypotension
B. decreased liver enzymes
C. progressive multifocal leukoencephalopathy
D. hyperglycemia

Answer 22

Patients receiving this drug are at risk for progressive multifocal leukoencephalopathy (PML). This opportunistic viral infection of the brain leads to death or severe disability.
-Monitor for neurologic changes, especially changes in mental state, such as disorientation or acute confusion

LIVER TOXIC

Natalizumab also causes damage to hepatic cells. Carefully monitor liver enzymes and teach patients to have frequent laboratory tests to assess for changes.

Question 23

MS DRUG- Mitoxantrone

Answer 23

Mitoxantrone, a chemotherapy drug, has been shown to be effective in reducing neurologic disability. It also decreases the frequency of clinical relapses in patients with secondary progressive, progressive-relapsing, or worsening relapsing-remi ing MS.

Question 24

MS DRUG- Fingolimod

Answer 24

Fingolimod was the first oral immunomodulator approved for the management of MS. The capsules may be taken with or without food. Teach patients to monitor their pulse every day because the drug can cause bradycardia, especially within the first 6 hours after taking it. Two other immunomodulating drugs have been approved for MS: teriflunomide and dimethyl fumarate. Like fingolimod, these drugs inhibit immune cells and have antioxidant properties that protect brain and spinal cord cells. Teach the patient that the two most common side effects of all the oral drugs are facial flushing and GI disturbances (Burcham & Rosenthal, 2019). Remind the patient to keep follow-up appointments for laboratory monitoring of the WBC count because the oral drugs can cause a decrease in WBCs, which can predispose the patient to infection.

Question 25

You are observing a new graduate nurse about to administer Findolimod to a patient whose vital signs has been unstable. The recent heart rate was 56. What is the your next.

A. encourage that she follows the health care providers ask.
B. hold the medication and contact the health care provider.
C. administer the medication yourself and observe.
D.

Answer 25

B. hold the medication and contact the health care provider.

The capsules may be taken with or without food. Teach patients to monitor their pulse every day because the drug can cause bradycardia, especially within the first 6 hours after taking it.

Question 26

1. The nurse is assessing a 48-year-old client diagnosed with multiple sclerosis. Which clinical manifestation warrants immediate intervention?
2. The client has scanning speech and diplopia.
3. The client has dysarthria and scotomas.
4. The client has muscle weakness and spasticity.
5. The client has a congested cough and
   dysphagia.

Answer 26

4. The client has a congested cough and
   dysphagia.

Dysphagia is a common problem of clients diagnosed with multiple sclerosis, and this places the client at risk for aspiration pneu- monia. Some clients diagnosed with mul- tiple sclerosis eventually become immobile and are at risk for pneumonia.

Question 27

The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse
to make?
1. “Why are you crying? The medication will
help the disease.”
2. “You seem upset. I will sit down and we can
talk for awhile.”
3. “Multiple sclerosis is a disease that has good
times and bad times.”
4. “I will have the chaplain come and stay with
you for a while.”

Answer 27

2. “You seem upset. I will sit down and we can
   talk for awhile.”

Question 28

The nurse and a licensed practical nurse
(LPN) are caring for a group of clients. Which nursing task should not be assigned to the LPN?
1. Administer a skeletal muscle relaxant to a
client diagnosed with low back pain.
2. Discuss bowel regimen medications with the
HCP for the client on strict bedrest.
3. Draw morning blood work on the client
diagnosed with bacterial meningitis.
4. Teach self-catheterization to the client
diagnosed with multiple sclerosis.

Answer 28

4. Teach self-catheterization to the client
   diagnosed with multiple sclerosis.