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Patient Centered Care 3 > Inflammation: Multiple Sclerosis Exemplar > Flashcards

Inflammation: Multiple Sclerosis Exemplar Flashcards

1
Q

What is Myelin?

A

fatty substances on the outside of neurons that insulate the nerve to create better conduction of information

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2
Q

What is multiple sclerosis?

A

An immune-mediated disorder of the CNS in which immune cells attack the myelin sheath around nerve cells, causing decreased transmission of nervous signals

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3
Q

What is demyelination?

A

When the immune system attacks and destroys myelin sheaths.

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4
Q

What are the 4 classifications of multiple sclerosis?

A
  1. Relapsing-remitting MS
  2. Primary-progressive MS
  3. Secondary-progressive MS
  4. Progressive-relapsing MS
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5
Q

What are the characteristics of Relapsing-remitting MS?

A

Clearly defined flare-ups with worsening neurologic function followed by periods of partial or complete remission with few or no symptoms

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6
Q

What is remyelination?

A

Repair of the damaged myelin sheath by oligodendrocytes

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7
Q

What are the characteristics of primary-progressive MS?

A

Slow, but nearly continuous, worsening of the disease from the time of onset with no distinct remissions.

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8
Q

What are the characteristics of secondary-progressive MS?

A
  1. Develops within 10 years of diagnosis in about half of the patients with relapsing-remitting MS who are not receiving treatment
  2. An initial period of relapsing-remitting MS, followed by a progressive form of the disease with or without occasional flare-ups and minor remissions.
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9
Q

What are the characteristics of Progressive-relapsing MS?

A
  1. These individuals experience a steady worsening of disease with acute relapses.
  2. The periods between relapses are characterized by continued progression of the disease rather than remission of symptoms
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10
Q

What are the potential causes of Multiple Sclerosis?

A
  1. Environmental factors
  2. Infections
  3. Genetics
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11
Q

What environmental factors can cause MS?

A
  1. Geography
  2. Sunlight
  3. Environmental toxins
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12
Q

People from what area of the world are more likely to develop MS?

A

People who live farther away from the equator and are exposed to less sunlight are more likely to develop MS

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13
Q

Between what ages are people usually diagnosed with MS?

A

20-40

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14
Q

What are the risk factors for MS?

A
  1. people between the ages of 20-40
  2. People of European descent
  3. Smoking
  4. people who live farther away from the equator
  5. women are twice as likely as men to develop MS
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15
Q

What are some of the best ways to prevent MS?

A

Avoiding smoking and taking vitamin D supplements

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16
Q

What are the criteria for someone to be in an exacerbation?

A

The symptoms must last at least 24 hours and must be separated from the previous attack by at least 30 days

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17
Q

What are the common signs and symptoms of MS?

A
  1. Fatigue
  2. Paresthesia
  3. Lack of coordination and balance; unsteady gait
  4. tremor
  5. bladder and bowel dysfunction
  6. visual disturbances
  7. dizziness
  8. sexual dysfunction
  9. Pain
  10. cognitive dysfunction
  11. depression
  12. anxiety
  13. muscle spasticity or weakness in one or more limbs
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18
Q

What are the less common symptoms of MS?

A
  1. Speech disorders
  2. swallowing problems
  3. hearing loss
  4. seizures
  5. breathing problems
  6. itching
  7. MS hug (a sensation of a tight band around the abdomen
  8. partial or complete paralysis
19
Q

What are some things that could trigger a relapse?

A
  1. Stress
  2. Fatigue
  3. increased body temperature
  4. extreme hot or cold temperatures
20
Q

What are the primary symptoms of MS?

A
  1. Secondary disturbances
  2. motor disturbances (unsteady gait; bladder dysfunction, paresthesias)
  3. Cognitive dysfunction (concentration, memory, reasoning, judgment, and depression)
21
Q

What are the secondary symptoms of MS?

A
  1. Pressure injuries
  2. Osteoporosis
  3. Aspiration pneumonia
  4. UTIs
  5. Back or hip pain
  6. Muscle atrophy, poor postural alignment
  7. Bone fractures
22
Q

What are tertiary (psychosocial complications) symptoms of MS?

A
  1. Social problems (partner, family, friends, social isolation)
  2. Vocation problems (loss of job, loss of transportation)
  3. Emotional problems (Depression, irritability, hopelessness)
23
Q

What are the respiratory effects of MS?

A
  1. Diminished cough reflex

2. Respiratory infection

24
Q

What are the urinary system effects of MS?

A
  1. Hesitancy
  2. Frequency
  3. Retention
  4. Reflex bladder emptying
  5. Recurring UTIs
  6. Incontinence
25
Q

What are the GI/ Oral or esophageal effects of MS?

A
  1. Difficulty chewing
  2. Dysphagia
  3. Decreased or absent sphincter control
  4. Bowel incontinence
  5. Constipation
26
Q

What are the Musculoskeletal effects of MS?

A
  1. fatigue
  2. limb weakness
  3. Ataxic movements (shaky, irregular, uncoordinated)
  4. Intention tremors
  5. Spasticity
  6. Muscular atrophy
  7. Dragging of foot and foot drop
  8. Dysarthria with slurred speech
27
Q

What are the neurologic effects of MS?

A
  1. Emotional lability (euphoria or depression)
  2. Forgetfulness
  3. Apathy
  4. Scanning speech
  5. Impaired judgment
  6. irritability
  7. convulsive seizures
  8. dementia
28
Q

What are the sensory visual effects of MS?

A
  1. Blurred vision
  2. Diplopia
  3. Nystagmus
  4. Visual field Defects
  5. Eye pain
29
Q

What are the auditory effects of MS?

A

Vertigo and nausea

30
Q

What are the tactile effects of MS?

A
  1. numbness
  2. Paresthesias
  3. Diminished sense of temperature
  4. Pain with spasms
  5. Loss of proprioception
31
Q

What are the reproductive effects of MS?

A
  1. Impotence
  2. Loss of genital sensation
  3. Painfully heightened sensation
  4. Vaginal dryness
32
Q

What are the diagnostic tests used to diagnose MS?

A
  1. MRI
  2. Lumbar puncture
  3. Evoked potential
  4. Blood tests
33
Q

What are the most common medications used for MS?

A
  1. Beta interferons
  2. Glatiramer acetate
  3. Fingolimod
  4. Natalizumab
  5. Mitoxantrone
  6. Teriflunomide
  7. Dimethyl fumarate
  8. Baclofen
34
Q

What are the nonpharmacologic therapies for MS?

A
  1. Physical therapy
  2. Occupational therapy
  3. Speech-language therapy
  4. Cognitive therapy
  5. Vocational rehabilitation
35
Q

What are some complementary health approaches?

A
  1. acupuncture
  2. aromatherapy
  3. therapeutic horseback riding
  4. electromagnetic therapy
  5. massage
  6. prayer
  7. herbal remedies like valerian for insomnia or cranberry for preventing UTIs
36
Q

What kind of symptoms do children have with MS that adults may not usually have?

A
  1. seizures
  2. mental status changes
  3. reduced academic performance
  4. difficulty in family and peer relationships
  5. Distorted self-image
37
Q

Because of the increased risk for developing depression, what is important for nurses to assess in patients with MS?

A

Assess for depression and suicidal ideation

38
Q

What things should a nurse include in a physical examination for someone with MS?

A
  1. observe the patient’s ability to move and walk
  2. Affect
  3. Balance and coordination
  4. hygiene
  5. Speech
  6. The Expanded Disability Status Scale
  7. MS Functional Composite scale
  8. MS symptom Checklist
39
Q

In outpatient settings what are appropriate nursing interventions with someone who has MS?

A
  1. Facilitate a home safety assessment
  2. Facilitate arrangements for home healthcare
  3. provide safety teaching related to safe body mechanics and fall prevention
  4. Establish a patient baseline to help identify exacerbations and subsequent return to baseline
  5. Provide teaching or referral regarding a bladder training program to help the patient remain continent
40
Q

What interventions are important for nurses in the hospital setting working with someone who has MS?

A
  1. Encourage patient participation in decision making
  2. Teach intermittent urinary catheterization (self-catheterization promotes independence)
  3. Administer meds as ordered
  4. Administer antipyretics to control high body temperatures
  5. Teach the patient to use an incentive spirometer to promote respiratory function
41
Q

What patient teaching is important for someone with MS?

A
  1. Pathophysiology of the disease
  2. A projected disease course and disease classifications
  3. Symptoms commonly experienced by patients with MS
  4. MEds used to treat MS and its symptoms, including dosing, schedule, side effects, and drug-drug interactions
  5. Mechanisms to prevent exacerbations, such as managing fatigue and stress and avoiding cold and heat extremes, high humidity, physical overexertion, and infections
  6. Mechanisms to avoid complications, including pressure injuries, infections, and bone fractures
  7. Cautions for women who want to become pregnant or are pregnant or breastfeeding
  8. Safety modifications for the home
  9. Community resources
42
Q

If a patient needs an assistive device because of MS but does not want to use it, what should a nurse do?

A

Provide emotional support, explain the benefits, and explain how to use the device

43
Q

If a patient with MS needs a wheelchair, what could a nurse recommend to help promote independence?

A

Provide information about motorized wheelchairs, handicap-accessible transportation services, and home modifications

44
Q

How might a nurse promote self-care for a patient with MS?

A
  1. encourage the patient to wear an arm or wrist brace to provide stability with self-care activities
  2. teach the patient to perform self-care activities when energy levels are high
  3. Use assistive devices while eating
  4. modifying the consistency of foods to make eating easier
  5. receiving assistance from others for meal preparation
  6. adequate fluid intake
  7. Scheduling regular voiding
  8. Self-catheterization
  9. Bowel training
  10. Exercise to maintain muscle strength

Patient Centered Care 3 (19 decks)

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