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Ignatavicius: Medical-Surgical Nursing, 7th Edition
Chapter 45: Care of Patients with Problems of the Central Nervous System: The Spinal
Key Points - Print
Spinal cord problems share a common characteristic of impaired mobility.
The patient’s ability to perform activities of daily living is often affected.
Sensory function may also be impaired, either temporarily or permanently.
Assess for the need for adaptive/assistive devices to become independent in ADLs.
Implement bowel and bladder retraining programs for patients with spinal diseases.
Refer patients to appropriate resources, such as a specialists for urological problems
Recognize progressive neurologic diseases, such as MS, require the patient to adjust to major
life changes.
 Encourage patients to share their feelings about life-altering neurodegenerative disease.
 Multiple sclerosis (MS) is a chronic autoimmune disease that affects the myelin sheath and
conduction pathway of the central nervous system and is a leading cause of neurologic
disability in young adults.
 This chronic disease is characterized by periods of remission and exacerbation of an
inflammatory response that results in demyelinization, but may become progressive without
 The four major types of MS include:
o Relapsing-remitting
o Primary progressive
o Secondary progressive
o Progressive-relapsing
 Since there is genetic predisposition, having a first-degree relative such as a parent or sibling
with MS increases a person’s risk of developing the disease.
 EMG may help make a differential diagnosis to rule out multiple sclerosis or amyotrophic
lateral sclerosis.
 Magnetic resonance imaging demonstrates the presence of plaques and is considered
diagnostic for MS.
 Current therapies for MS treat a dysfunctional immune system, using a variety of medications
to control the disease, decrease symptoms, and slow progression.
o Fingolimod (Gilenya) is the first oral immunomodulator approved for the
management of MS.
o Refer to pre-lecture work meds
 To maintain maximum strength, function, and independence, continuity of care with an
interdisciplinary team in both the rehabilitation and home setting is necessary.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.