Week 7 - MS Flashcards
what is multiple sclerosis
- chronic, progressive, degenerative autoimmune disorder of the CNS
what is MS characterized by
- demylination of the nerve fibres of the brain, spinal cord, and optic nerve
- chronic inflammation, demyelination, and scarring in CNS
= electrical transmission not fully transmitted from A to B
what are causes/risk factors for MS of MS (6)
- unknown
- may be linked to vit D deficiency
- genetic factors
- poor access to sunlight, cold climates
- infectious (viral) factors
- immunological
describe the onset of MS
- insidious
- begins w vague symptoms that occur intermittently over months or years
- involves remissions & exacerbations
- S&S vary over time as the disease process has a spotty distribution in the CNS
- eventually leads to progressive deterioration d/t progressive scarring
what do the S&S of MS depend on
- varies according to the areas of the CNS involved
what are common symptoms of MS (6)
- motor
- sensory
- cerebellar
- emotional problems
- severe fatigue
- pain
- urinary problems –> retention, freq, urgency, incont.
- constipation
- sexual dysfunction
what motor symptoms are often involved w MS (4)
- weakness or paralysis of limbs, trunk, or the head
- diplopia (double vision)
- scanning speech
- spasticity of the muscles
what sensory symptoms are involved in MS (8)
- numbness
- tingling
- patchy blindness (scotomas)
- blurred vision
- vertigo
- tinnitus
- decreased hearing
- neuropathic pain
what cerebellar symptoms are involved in MS (4)
- nystagmus
- ataxia
- dysarthria
- dysphagia
what emotional problems are associated w MS (4)
- fatigue
- depression
- anger
- euphoria
what is used to diagnose MS (4)
- history
- S&S
- MRI (for lesions)
- evoked response testing
what is evoked response testing
- tests that measure the electrical activity in parts of the brain caused by light, sound, and touch
what are the goals of care for a pt with MS (7)
- functioning
- independence in daily living
- manage fatigue
- mental health
- help adjust
- reduce factors that lead to exacerbations
- treat the disease process and provide symptomatic relief
what are some triggers for exacerbations (7)
- infection (esp. upper resp & UTIs)
- trauma
- emotional stress
- excessive fatigue
- state of poor health
- pregnancy/child birth
- changes in climate
what is included in collaborative care for MS (3)
- meds
- nutritional therapy
- alternate therapies
what is the goal of drug therapy for a pt with MS (2)
- decrease the progression of the disease process
- control symptoms
what classes of meds are used for treatment of MS (6)
- corticosteroids
- immunomodulators
- immunosuppressants
- anticholinergics
- antispasmodic
- fatigue meds
what are 2 examples of corticosteroids for MS
- methylprednisolone
- prednisone
why/when are corticosteroids used for MS (2)
- reduce edema & inflammation
- treat acute exac
what are 2 examples of immunomodulators used for MS
interferons
- betaseron
- avonex
what are 3 types of immunosuppressants used for MS
- methotrexate
- imuran
- mitoxantrone
what should be noted w immunomodulators and immunosuppressants
- can have more serious s/e
- consider risk vs benefit
what is an example of an antispasmodic used for MS
- baclofen
what are antispasmodics used for in MS
- muscle spascitity
what is a type of anticholinergic used for MS
- ditropan
why are anticholinergics used for MS
- bladder symptoms
- decrease bladder spasms & increase tone
- more bladder control, can be fully emptied
- decreases risk of UTIs
what med is used to fight fatigue w MS
- ritalin
what nutritional measures can be used for mngmt of MS
- no standard prescribed diet
- nutritious well balanced diet essential
- high protein, supplemental vitamins (ex. D), good fibre (prevent constipation) is advocated
- adapt based on pts ability to swallow*
what are the benefits of exercise in a pt w MS (4)
- improves daily functioing
- decreases spascitity
- increases coordination
- retrains unaffected muscles to substitute for impaired ones
what should be noted w exercise for a pt with MS
- no excessive exercise in summer d/t the extreme heat = weak
- light to mod, interval training instead
what is a specifically beneficial type of exercise for pts with MS
- water exercise
what is the most common reasons for hospitalization for a pt with MS (2)
- diagnostic workup
- treatment of acute exac
describe care for a pt with MS during an acute exac (2)
- pt may be immobile
= prevent major complications of immobility - treat the symptoms or complications (pain, spasms, etc.)
describe pt teaching for a pt with MS (6)
- triggers & how to minimize or avoid them
- good balance of exercise & rest
- nutritious & well balanced diet
- avoid hazards of immobility
- med education
- consult w HCP before taking nonprescription meds
bladder control is a major problem for pts with MS. what can be used to decrease bladder spascitity and improve bladder control (2)
- anticholinergics
- self catheterization (straight cath)
bowel problems is an issue associated w MS. what can be done to help the pt achieve regularity in bowel habits
- increase in dietary fibre
a nursing diagnosis r/t MS is impaired physical activity d/t muscle spasms & weakness/paralysis. what nursing interventions can be done for this (5)
- use assistive devices
- ROM exercise 2x/day
- encourage and assist w ambulation
- turn q2h
- perform stretching exercises
a nursing diagnosis r/t MS is impaired urinary elimination. what nursing interventions can be done for this (6)
- anticholinergic meds
- intermittent cath
- reflex stimulation to help empty bladder
- maintain fluid intake of 3000mL/day to dilute urine and reduce risk of UTI
- teach pt S&S of UTI
- initiate bladder training
a nursing diagnosis r/t MS is sexual dysfunction. what nursing interventions can be done for this (2)
- initiate sexual counselling
- suggest alternative methods of achieving sexual gratification
a nursing diagnosis r/t MS is interrupted family processes. what nursing intervention can be done for this (4)
- facilitate open communication
- promote problem solving
- refer for family or financial counselling
- educate family regarding fluctuating nature of disease
