multiple sclerosis Flashcards Preview

chronic > multiple sclerosis > Flashcards

Flashcards in multiple sclerosis Deck (15):
1

multiple sclerosis

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

2

incidence of MS

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

3

etiology of MS

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

4

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

5

MS clinical patterns

Relapsing-remitting most common initial pattern

6

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
Constipation
Sexual dysfunction
Fatigue: common, often disabling
Spasticity
Emotional responses: depression, apathy, emotional instability

7

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

8

MS management focuses on

Treatment of acute relapses
Treatment of disease management
Symptomatic Treatment

9

for an acute MS relapse

IV or Oral corticosteroids (Methylprednisolone)

10

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

11

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

12

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

13

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

14

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

15

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)