Deborah Henderson Case Scenario Flashcards
(21 cards)
What is multiple sclerosis (Ouellette, 1523)
A chronic, progressive, degenerative autoimmune disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain, the spinal cord, and the optic nerves
Which sex is MS more prevalent among? (Ouellette, 1523)
Women
What is the usual age of onset of MS and when do symptoms often first appear? (Ouellette, 1523)
Onset age - 20 - 50
Symptoms first appear - 30 - 35
Which ethnic groups are less at risk of contracting MS? (Ouellette, 1524)
Hispanics
- Asians
- African descent
- Indigenous groups
What -likely- causes MS? (Ouellette, 1524)
MS develops in a genetically susceptible person after an environment exposure, such as an infection, usually involving multiple genes.
MS is passed on to future generations, meaning that having first-degree relatives with MS increases a person’s risk for developing the disease
What are 7 precipitating factors of MS? (Ouellette 1524)
Infection
-Smoking
-Physical injury
-Emotional stress
-Excessive fatigue
-Pregnancy
-Poor state of health
What are the three pathological processes involved with MS? (Ouellette 1524)
- Chronic inflammation
- demyelination
- Gliosis in the CNS
What are common symptoms of MS? (Ouellette 1524)
Motor system
-Weakness/Paralysis of limbs, the trunk or head
-Diplopia
-Scanning speech (words are unintentionally slowed or injected with pauses)
-Spasticity of muscles
Sensory abnormalities
-Numbness
-TIngling
-Paresthesias
-Patchy blindness
-Blurred vision
-Vertigo
-Tinnitus
-Decreased hearing
-chronic neuropathic pain
-Radicular (nerve root) pain
-Lhermitte sign (electric shock radiating down spine)
Cerebellar signs
-Nystagmus
-Ataxia
-Dysarthria
-Neck
-Severe fatigue
Elimination
-Constipation
-Spastic bladder (lesion to S2)
-Flaccid bladder (lesion to reflex arc)
Sexual Function
-Erectile dysfunction
-Decreased Libido (:( for sex)
-Difficulties with orgasm
-Painful intercourse
-Decreased vaginal lubrication
Cognitive function
-Short-term memory
-Attention
-Information processing
-Planning
-Visual perception
-Word finding
What 5 diagnostic procedures are conducted on patients with MS? (Ouellet 1526)
-Health history and physical examination
-CSF analysis (increased IgG, oligoclonal banding)
-CT scan
-MRI, MRS (plaques, inflammation, atrophy, tissue breakdown, destruction)
-Evoked response testing (delayed)
What types of medications are recommended for patients with MS? (Ouellet 1526)
Aimed at decreasing progression of disease and controlling symptoms
-Anticholinergics, Cholinergic, Corticosteroids (treats acute exacerbation of disease, reducing edema and inflammation at site of demyelination)
-Immunosuppressants (beneficial effects with progressive=relapsing, secondary + primary progressive MS)
-Immunomodulators (modifies disease progress, decrease # of MS relapses
What are recommended alternate therapies for treating MS? (Ouellet 1527)
- Surgical intervention (neurectomy, rhizotomy, cordotomy, dorsal column electrical stimulation)
-Physiotherapy and speech therapy (improve neurological dysfunction)
-Exercise (decreases spacity, increases coordination and muscles strength, improves mobilization, gait, fatigue, and quality of life)
-Water Exercise (buoyancy, pt is able to perform activities that would be normally too difficult)
-Stem cell therapy (can reduce brain inflammation)
What are recommended nutritional therapies for patients with MS? (Ouellet 1527)
Megavitamin therapy (Vitamin b12 + Vitamin C)
-Supplemental vitamin D
-Low fat + gluten-free food + raw vegetables
-Well-balanced diet (high protein, high roughage diet with supplement vitamins)
What subjective data should be gathered for patients with MS? (Ouellet 1528)
Past health history
-Recent or past viral infections or vaccinations
-Other recent infections
-Residence in cold or temperate climates
-Recent physical or emotional stress
-Pregnancy
-Exposure to extreme temperatures
-Positive MS in family history
Medications
-Use of MS medication
Symptoms
-Weight loss -> difficulty chewing, dysphagia
-Urinary freq, urgency, dribbling or incontinence, retention, constipation
-Generalized muscle weakness, muscle fatigue, tingling and numbness, ataxia, malaise
-Eye, back, leg, joint pain, painful muscle spasms, vertigo, blurred or lost vision, diplopia, tinnitus
-Erectile and sexual dysfunction, decreased libido
-Anger, depression, euphoria, social isolation, cognitive changes, memory loss
What objective data should be gathered for patients with MS? (Ouellet 1528)
General (apathy, inattentiveness)
-Neurological (Scanning speech, nystagmus, ataxia, tremor, spasticity, hyperreflexia, decreased healing)
-Musculoskeletal (Muscle weakness, paresis, paralysis, spasms, foot dragging, nysarthria)
-Possible findings (decrease T cells, demyelinating lesions, increased IgG or oligoclonal banding in CSF, delayed evoked potential)
What are 6 overall nursing goals for patients with MS? (Ouellet 1528)
- Maximize neuromuscular function
- Maintain independence in ADLS as long as possible
- Manage fatigue
- Optimize psychosocial well-being
- Adjust to illness
- Reduce factors that precipitate exacerbations
What are nursing implementation strategies that should be implemented on patients with MS? (Ouellet 1528)
-Nurse should help pt identify triggers that may cause exacerbations or worsen disease (infection, trauma, immunization, child birth, change in climate) and develop methods for avoiding or minimizing their effects
-Nurse should reassure pt that certain diagnostic studies must be done to rule out other neurological disorders, even if tentative diagnosis of MS is made
-Nurses should prevent complications of immobility of pt is confined to bed due to acute exacerbations of MS
-Nurses should conduct pt teaching related to general measures to avoid illness, good exercise + rest + diet, treatment plan and medication side effects, how to manage side effects, and OTC medication interactions
-Teaching pt with self catheterization if needed
-Teaching pt high fibre diet for constipation
-Teaching emotional adjustments because of disease unpredictability, lifestyle changes, and challenge of avoiding or decreasing precipitating factors
What patient teaching should be conducted for various medications that treat MS? (Ouellet 1526)
Corticosteriods
-No salt
-No stopping
-Medication interactions
Immunomodulators
-Self injection
-Report adverse effects
Cholinergics
-Consult before using other medications
Anticholinergics
-Consult before using other medication (sleeping aids + antihistamines)
Muscle Relaxants
-No driving
-No stopping
-No tranquilizers and alcohol
Acetylcholinesterase Inhibitor
-Hydration of 2-3L
-Rise slowly when getting up from lying or sitting position
-Report abdominal discomfort, increased salivation, unresolved diarrhea, increased muscle pain, visual changes, or shortness of breath
Sphinogosine-1-phosphate receptor modulator (wtf)
-Increase risk for infections
-Reduce effectiveness of influenza and tetanus boosters
What are burdens to caregivers for pts with MS? (Maguire 2)
-Reported pathologic anxiety
-Reported pathological depression
-Elevated levels of fatigue, depression, and anger
-Objective burden - caregivers take time and cost to carry out care-related tasks for MS pt (avg 6.5 hrs per day) -> resulting in missing work, juggling other responsibilites, some caregivers may be more happy with more objective burden
-Subjective burden - caregiver own perception of the impact that caring has on daily life, more strongly related to caregiver well-being -> emotional strain, mental health like depression, less quality care to MS pt
What are risk factors that influence the amount of burden that MS caregivers experience? (Maguire 4)
MS pt chracteristics
-Type of MS (primary + secondary progressive MS)
-Level of Disability (higher cognitive/neuropsychiatric problems)
-Experience of symptoms
-Psychological distress
-Extent of disease progression
Caregiver characteristics
-Relationship to pt (different needs if young or parental caregiver)
-Gender (male -> physical concerns for caregiving, females -> need for emotional support)
-Physical health
-Income/education (lower financial status)
-Psychological appraisals
Social or Contextual factors
-Time spent caring (objective burden)
-Social support
-Provision of information
-Healthcare services support
What are psychosocial factors that can influence MS caregiver burden? (Maguire 4)
Unpredictable nature -> higher prevalence of psychological problems with MS caregivers
-MS relapse/progression -> caregiver fear, anticipatory grief
What are nursing interventions that can alleviate MS caregiver burden? (Maguire 4-5)
Developing supports for helping MS pt and MS caregiver to deal with cognitive consequences of MS
-Consider gender identity to develop tailored caregiver supports
-Working to alleviate psychological distress (help MS pt and MS caregivers to cope with uncertainty of disease)
-Offer psychological appraisals and illness perceptions in explaining how MS caregivers respond to care situation when informing provision of supports (fostering resilience, optimism, and self efficacy)
-Psycho-education
-Providing MS caregivers with information of disease
-Assisting MS caregivers in tasks, such as provision of respite care
-Provision of community and social supports
-Use of connective technologies (internet support groups, online peer interactions)
-Coping strategies (supportive engagement + positive reframing)@
