Multiple Sclerosis Flashcards
multiple sclerosis
a progressive immune-related demyelination disease of the central nervous system (CNS)
demyelination
destruction of the myelin sheath that surrounds the nerve fibers in the brain and spinal cord
myelin
protein and fatty material that insulates the nerves
risk factors of MS
Age (between 20-40 years old) – peak is 25-35 years old
Gender (females > males)
Family History
Geographic location (temperature)
Temperature (Distance from Equator) – farther from the equator
Low vitamin D levels and smoking
Clinical manifestations of MS
Fatigue Depression Cognitive dysfunction Weakness Numbness Difficulty w coordination Ataxia Loss of balance Spasticity (muscle spasms) Pain Visual Disturbances Bowel/bladder dysfunction
Relapsing-remitting
With each relapse there’s recovery (residual deficits)
Level of recovery will decline over time
Primary progressive
Steady increase in signs and symptoms and rare plateaus
Temporary improvement but disability is steady
Secondary progressive
Begins as relapsing-remitting and follows progression that is variable
Progressive-relapsing
Begins with progressive and characterized by relapses with exacerbations
Lumbar puncture
Bands of immunoglobulin stuck together
Evoked potentials
Monitor disease progression and check extent of disease
disease modifying treatment
reduce frequency of relapses and the length of the relapse
mechanism of action for Methylprednisolone
decreased inflammatory response in acute exacerbation of MS, ↓ neutrophil migration, ↓ inflammatory mediators, ↓ capillary permeability; shortens duration of relapse and minimizes symptoms
adverse effects of Methylprednisone
Hyperglycemia, Immune suppression, Leukocytosis, Emotional lability (pathological laughing and crying)
caution in elderly, diabetics
mechanism of action for Interferon B 1b (Betaseron)
Relapsing MS: Improve MRI lesions, ↓ relapse rate/disease severity
route of Interferon B 1b
SQ every other day
adverse effects of Interferon B 1b
peripheral edema, headache, fever, chills, pain, nausea, suicidal ideation, lymphocytopenia
contraindications of Interferon B 1b
hypersensitivity, pregnancy, liver disease, cardiac disease
nursing considerations for interferon B 1b
analgesics with flu-like symptoms, injection site reactions usually occur in 1st 4 months, monitor thyroid function, & CBC- ↓ WBC count!!
immunomodulators
teach patient and caregivers how to administer injection, side effects, etc
stress the need to avoid exposure to potential infectious agents which may further complicate MS
do not use during pregnancy (symptoms of MS are better)
older adults are already immunosuppressed so they have a higher risk when they’re on an immunomodulator
Potential triggers that bring on a relapse
Temperature
Stress
Illness
Fatigue
goals and outcomes for MS
Promotion of physical mobility Avoidance of injury Achievement of bowel and bladder continence Promotion of speech and swallowing mechanisms Improvement in cognitive function Development of coping strengths Improved home maintenance Adaptation to sexual function
