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Flashcards in multiple sclerosis Deck (15):

multiple sclerosis

• A chronic demyelinating disease that affects the myelin sheath of neurons in the CNS


incidence of MS

Onset: between 20-40 years
Affects women 2x more than men
Affects more Whites
Prevalent in the northern latitudes


etiology of MS

Exact cause unknown
? Viral etiology which triggers immune-mediated demyelination (Epstein-Barr virus)


pathophysiology of MS

-The myelin sheath is essential for normal conduction of nerve impulses
-Plaques form along myelin sheath causing inflammation, edema, scarring and destruction
-Plaques may occur anywhere in white matter of CNS, but most commonly affects: optic nerves, cerebrum, cervical spinal cord


MS clinical patterns

Relapsing-remitting most common initial pattern


MS clinical manifestations

Weakness or paresthesias of one or more extremities (cerebrum)
Vision loss from optic neuritis
Incoordination (cerebellum)
Bladder dysfunction: frequency, loss of sensation, incontinence, retention, hyperreflexia
Sexual dysfunction
Fatigue: common, often disabling
Emotional responses: depression, apathy, emotional instability


MS diagnostics

NO definitive test
Based on clinical presentations
MRI: to determine presence of MS plaques
CSF: cerebrospinal fluid for presence of oligoclonal banding (Oligodendrocytes are responsible for making myelin)
Evoked potentials of the optic pathways and auditory system to assess for slowed nerve conduction


MS management focuses on

Treatment of acute relapses
Treatment of disease management
Symptomatic Treatment


for an acute MS relapse

IV or Oral corticosteroids (Methylprednisolone)


MS symptomatic treatment

Bladder dysfunction: oxybutynin
Constipation: Metamucil, Dulcolax suppositories (Repeated stimulant use for constipation can cause dependence)
Spasticity: Baclofen (muscle relaxant)
Tremor: phenoorbital, propranolol
Fatigue: Amantadine (Symmetrel), Modafinil (Provigil)
Trigeminal Neuralgia: Dilantin (phenytoin), Amitriptyline


MS nursing diagnoses

Deficient Knowledge r/t new diagnosis of MS
Impaired Urinary Elimination r/t bladder dysfunction
Constipation r/t immobility and demyelination
Activity Intolerance r/t fatigue and muscle weakness
Impaired Physical Mobility r/t weakness, contracture, spasticity, and ataxia
Risk for Self-Care Deficit r/t muscle weakness
Situational Low Self Esteem r/t loss of independence and fear of disability
Altered Sensory Function r/t visual changes


MS impaired urinary elimination r/t blader dysfunction

Neurogenic bladder most common bladder dysfunction
Maintain fluids
Void q3hrs
For retention: Intermittent self-cath using clean technique


MS constipation r/t immobility and demyelination

High fiber diet
Stool softeners
Adequate fluids
Avoid laxative, enema dependence
Glycerin or digital stimulation to initiate evacuation


MS activity intolerance r/t fatigue and muscle weakness

Fatigue exacerbated by warm temperatures
Plan activities for peak energy level, usually in morning
Plan rest periods


MS impaired physical r/t weakness, contractors, spasticity, and ataxia

ROM bid to stretch spastic muscles water therapy (Flexor muscles are stronger than extensors)
Antispasmodics (Baclofen (Lioresal): provides synaptic inhibition of spinal reflexes)
Splints to help maintain position (Foot drop: severe plantar flexion, may need surgical intervention for Achilles)