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Multiple Sclerosis Multiple Sclerosis • Chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord Multiple Sclerosis • Usually affects young to middle- aged adults, with onset between 15 and 50 years of age • Women affected more than men Multiple Sclerosis Etiology • Unknown cause • Related to infectious, immunologic, and genetic factors Multiple Sclerosis Etiology • Possible precipitating factors include Infection Physical injury Emotional stress Excessive fatigue Pregnancy Poor state of health Multiple Sclerosis Pathophysiology • Mylelin sheath • Segmented lamination that wraps axons of many nerve cells • Increases velocity of nerve impulse conduction in the axons • Composed of myelin, a substance with high lipid content Multiple Sclerosis Pathophysiology • Characterized by chronic inflammation, demyelination, and gliosis (scarring) in the CNS • Initially triggered by a virus in genetically susceptible individuals • Subsequent antigen-antibody reaction leads to demyelination of axons Pathogenesis of MS Fig. 57-1 Multiple Sclerosis Pathophysiology • Disease process consists of loss of myelin, disappearance of oligodendrocytes, and proliferation of astrocytes • Changes result in plaque formation with plaques scattered throughout the CNS Multiple Sclerosis Pathophysiology • Initially the myelin sheaths of the neurons in the brain and spinal cord are attacked, but the nerve fiber is not affected • Patient may complain of noticeable impairment of function • Myelin can regenerate, and symptoms disappear, resulting in a remission Multiple Sclerosis Etiology and Pathophysiology • Myelin can be replaced by glial scar tissue • Without myelin, nerve impulses slow down • With destruction of axons, impulses are totally blocked • Results in permanent loss of nerve function Multiple Sclerosis Clinical Manifestations • Vague symptoms occur intermittently over months and years • MS may not be diagnosed until long after the onset of the first symptom Multiple Sclerosis Clinical Manifestations • Characterized by • Chronic, progressive deterioration in some • Remissions and exacerbations in others Multiple Sclerosis Clinical Manifestations • Common signs and symptoms include motor, sensory, cerebellar, and emotional problems Multiple Sclerosis Clinical Manifestations • Motor manifestations • Weakness or paralysis of limbs, trunk, and head • Diplopia (double vision) • Scanning speech • Spasticity of muscles Multiple Sclerosis Clinical Manifestations • Sensory manifestations • Numbness and tingling • Blurred vision • Vertigo and tinnitus • Decreased hearing • Chronic neuropathic pain Multiple Sclerosis Clinical Manifestations • Cerebellar manifestations • Nystagmus • Involuntary eye movements • Ataxia • Dysarthria • Lack of coordination in articulating speech • Dysphagia • Difficulty swallowing Multiple Sclerosis Clinical Manifestations • Emotional manifestations • Anger • Depression • Euphoria Multiple Sclerosis Other Clinical Manifestations • Bowel and bladder functions • Constipation • Spastic bladder: small capacity for urine results in incontinenceFlaccid bladder: large capacity for urine and no sensation to urinate Multiple Sclerosis Other Clinical Manifestations • Sexual dysfunction Erectile dysfunction Decreased libido Difficulty with orgasmic response Painful intercourse Decreased lubrication Multiple Sclerosis Diagnostic Studies • Based primarily on history, clinical manifestations, and presence of multiple lesions over time measured by MRI • Certain laboratory tests are used as adjuncts to clinical exam Multiple Sclerosis Diagnostic Studies • Diagnosis based primarily on: • history and clinical manifestations • ruling out other causes of symptoms • No definitive diagnostic test • MRI – demonstrates presence of plaques Multiple Sclerosis Collaborative Care Drug Therapy • Corticosteroids • Treat acute exacerbations by reducing edema and inflammation at the site of demyelination • Do not affect the ultimate outcome or degree of residual neurologic impairment from exacerbation Multiple Sclerosis Collaborative Care • Immunosuppressive Therapy • Because MS is considered an autoimmune disease • Potential benefits counterbalanced against potentially serious side effects Multiple Sclerosis Collaborative Care • Antispasmotics (muscle relaxants) Multiple Sclerosis Collaborative Care • Physical therapy helps Relieve spasticity Increase coordination Train the patient to substitute unaffected muscles for impaired ones Multiple Sclerosis Collaborative Care • Nutritional therapy includes megavitamins and diets consisting of lowfat, gluten-free food, and raw vegetables • High-protein diet with supplementary vitamins is often prescribed Multiple Sclerosis Nursing Assessment • Health History Risk factors Precipitation factors Clinical manifestations Multiple Sclerosis Nursing Diagnoses • • • • • • Impaired physical mobility Dressing/grooming self-care deficit Risk for impaired skin integrity Impaired urinary elimination pattern Sexual dysfunction Interrupted family processes Multiple Sclerosis Nursing Planning • Maximize neuromuscular function • Maintain independence in activities of daily living for as long as possible • Optimize psychosocial well-being • Adjust to the illness • Reduce factors that precipitate exacerbations Multiple Sclerosis Nursing Implementation • Help identify triggers and develop ways to avoid them or minimize their effects • Reassure patient during diagnostic phase • Assist in dealing with anxiety caused by diagnosis • Prevent major complications of immobility Multiple Sclerosis Nursing Implementation • Focus teaching on building general resistance to illness Avoiding fatigue, extremes of hot and cold, exposure to infection • Teach good balance of exercise and rest, nutrition, avoidance of hazards of immobility Multiple Sclerosis Nursing Implementation • Teach self-catheterization if necessary • Teach adequate intake of fiber to aid in regular bowel habits