Multiple Sclerosis<br />
Learning objectives<br />
Describe multiple sclerosis in terms of:<br />Pathophysiology<br />Clinical manifestations<br />Medical management <br />N...
Overview<br />
Multiple Sclerosis<br />A chronic, frequently progressive neurologic disease of the CNS<br />Caused by progressive demyeli...
Characterized by exacerbations and remissions of symptoms over the course of the illness<br />May progress rapidly, causin...
Incidence:<br />Highest in females <br />High among people in northern urban areas and higher socioeconomic groups<br />Lo...
Pathophysiology and etiology<br />
Demyelination<br />Destruction of the myelin (fatty and protein material that covers certain nerve fibers in the brain and...
Other possible factors: (may help destroy axons and the myelin sheath)<br />Trauma<br />Anoxia<br />Toxins<br />Nutritiona...
classification<br />
Four Clinical Forms of MS (National Multiple Sclerosis Advisory Committee)<br />Relapsing remitting (RR)<br />Clearly defi...
Secondary progressive (SP)<br />Always begins as RR but clinical course changes with declining attack rate, with a steady ...
More prevalent among males and older individuals<br />Worst prognosis for neurologic disability<br />Ten percent of cases ...
Clinical manifestations<br />
Lesions can occur anywhere within the white matter of the CNS<br />Symptoms reflect the location of the area of demyelinat...
Sensory disturbances: paresthesias, impaired deep sensation, impaired vibratory and position sense<br />Impaired speech: s...
Diagnostic evaluation<br />
Establishing a definitive diagnosis is often difficult, with much uncertainty concerning prognosis once the diagnosis is m...
Electrophoresis study of CSF<br />shows abnormal IgG antibody<br />Visual, auditory, and somatosensory evoked potentials<b...
complications<br />
Respiratory dysfunction<br />Infections<br />Bladder<br />Respiratory<br />Sepsis<br />Complications from immobility<br />...
management<br />
MS treatment is dynamic and rapidly evolving, covering two main areas<br />Direct treatment of MS<br />Treatment of the ef...
Current Disease-Modifying Drugs<br />Corticosteroids or adrenocorticotropic hormone<br />To decrease inflammationshorten d...
Copolymer-1<br />A mixture of synthetic polypeptides composed of four amino acids<br />Effective in reducing relapse rates...
Treating Exacerbations<br />A true exacerbation of MS is caused by an area of inflammation in the CNS<br />The treatment m...
Chronic Symptom Management<br />Treatment of spasticity with<br />Agents: baclofen (Lioresal), dantrolene (Dantrium), diaz...
Counselling<br />Bladder management:<br />Anticholinergics<br />Intermittent catheterization for drainage<br />Prophylacti...
to restore or maintain functions essential to daily living in individuals who have lost these capacities through the disea...
Nursing assessment<br />
Observe motor strength, coordination, and gait<br />Perform cranial nerve assessment<br />Evaluate elimination function<br...
Nursing diagnoses<br />
Activity intolerance<br />Acute pain<br />Chronic low self-esteem<br />Constipation<br />Disabled family coping<br />Distu...
Key outcomes<br />
The patient will:<br />Perform activities of daily living within the confines of the disease<br />Verbalize feelings of co...
The patient will:<br />Show no signs of malnutrition<br />Maintain joint mobility and range of motion<br />Develop regular...
Nursing interventions<br />
Provide emotional and psychological support for the patient and his family, and answer their questions honestly<br />Stay ...
Assist with active, resistive, and stretching exercises to maintain muscle tone and joint mobility, decrease spasticity, i...
Keep the bedpan or urinal readily accessible because the need to void is immediate<br />Evaluate the need for bowel and bl...
Patient teaching<br />
Review the disease process, emphasizing the need for optimizing the patient's potential and avoiding exacerbations as poss...
Encourage adequate fluid intake and regular urination<br />Promote emotional stability<br />Help the patient establish a d...
Avoiding exacerbation of MS<br />
Educate the patient and her family about multiple sclerosis (MS)<br />Emphasize the need to avoid stress, infections, and ...
If the patient has trouble with position sense, tell her to watch her feet while walking<br />If she's still in danger of ...
Provide bowel and bladder training if necessary<br />Teach the patient how to use suppositories to establish a regular bow...
Learning activity<br />
A 28-year-old woman raised in Minnesota complains of weakness and tingling in the right arm and leg for 2 days. She report...
What is MS (multiple sclerosis)?<br />MS is a progressive neurologic disease that is not infectious, and is caused by dest...
What purpose would the drug baclofen (Lioresal) serve when administered to a patient with multiple sclerosis?<br />It is a...
http://nurseRD.blogspot.com<br />www.authorstream.com/reynel89/Nursing<br />www.slideshare.net/reynel89/slideshows<br />TH...
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Multiple sclerosis: Medical and Nursing Managements

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A comprehensive presentation on multiple sclerosis

Published in: Health & Medicine

Multiple sclerosis: Medical and Nursing Managements

  1. 1. Multiple Sclerosis<br />
  2. 2. Learning objectives<br />
  3. 3. Describe multiple sclerosis in terms of:<br />Pathophysiology<br />Clinical manifestations<br />Medical management <br />Nursing management .<br />Use the nursing process as a framework for care of patients with multiple sclerosis.<br />
  4. 4. Overview<br />
  5. 5. Multiple Sclerosis<br />A chronic, frequently progressive neurologic disease of the CNS<br />Caused by progressive demyelination of the white matter of the brain and spinal cord<br />Unknown etiology<br />Characterized by the occurrence of small patches of demyelination of the white matter of the optic nerve, brain, and spinal cord<br />Causes disruption of electrical messages from the brain to the peripheral nervous system<br />
  6. 6.
  7. 7. Characterized by exacerbations and remissions of symptoms over the course of the illness<br />May progress rapidly, causing death within months or disability by early adulthood<br />Most common CNS disease among young adults <br />A major cause of chronic disability in young adults (20-40 y.o.)<br />Prognosis varies<br />About 70% of patients lead active, productive lives with prolonged remissions<br />
  8. 8. Incidence:<br />Highest in females <br />High among people in northern urban areas and higher socioeconomic groups<br />Low Incidence in Japan<br />Increased risk:<br />Family history of MS <br />Living in a cold, damp climate<br />
  9. 9. Pathophysiology and etiology<br />
  10. 10. Demyelination<br />Destruction of the myelin (fatty and protein material that covers certain nerve fibers in the brain and spinal cord)<br />Results in disordered transmission of nerve impulses<br />Inflammatory changes lead to scarring of the affected nerve fibers<br />Cause: Unknown<br />Possibly related to:<br />autoimmune dysfunction<br />allergic response<br />genetic susceptibility<br />infectious process<br />
  11. 11.
  12. 12. Other possible factors: (may help destroy axons and the myelin sheath)<br />Trauma<br />Anoxia<br />Toxins<br />Nutritional deficiencies<br />Vascular lesions<br />Anorexia nervosa<br />Emotional stress, overwork, fatigue, pregnancy, or acute respiratory tract infections may precede the onset of this illness<br />More prevalent in the northern latitudes and among Caucasians<br />
  13. 13. classification<br />
  14. 14. Four Clinical Forms of MS (National Multiple Sclerosis Advisory Committee)<br />Relapsing remitting (RR)<br />Clearly defined acute attacks evolve over days to weeks<br />Partial recovery of function occurs over weeks to months<br />Average frequency of attacks is once every 2 years and neurologic stability remains between attacks without disease progression<br />At the time of onset, 90% of cases of MS are diagnosed as RR<br />
  15. 15. Secondary progressive (SP)<br />Always begins as RR but clinical course changes with declining attack rate, with a steady deterioration in neurologic function unrelated to the original attack<br />Fifty percent of those with RR will progress to SP within 10 years<br />90% will progress within 25 years<br />Primary progressive (PP)<br />characterized by steady progression of disability from onset without exacerbations and remissions<br />
  16. 16. More prevalent among males and older individuals<br />Worst prognosis for neurologic disability<br />Ten percent of cases of MS are diagnosed as PP<br />Progressive relapsing (PR)<br />the same as PP except that patients experience acute exacerbations along with a steadily progressive course<br />Rarest form<br />
  17. 17.
  18. 18. Clinical manifestations<br />
  19. 19. Lesions can occur anywhere within the white matter of the CNS<br />Symptoms reflect the location of the area of demyelination<br />Fatigue and weakness<br />Abnormal reflexes: absent or exaggerated<br />Vision disturbances: impaired and double vision, nystagmus<br />Motor dysfunction: weakness, tremor, incoordination<br />
  20. 20. Sensory disturbances: paresthesias, impaired deep sensation, impaired vibratory and position sense<br />Impaired speech: slurring, scanning (dysarthria)<br />Urinary dysfunction: hesitancy, frequency, urgency, retention, incontinence; upper UTI<br />Urinary dysfunction affects about 90% of patients with MS and may exacerbate relapse of MS<br />Neurobehavioral syndromes: depression, cognitive impairment, emotional lability<br />Symptoms of MS are often unpredictable, varying from person to person and from time to time in the same person<br />
  21. 21.
  22. 22. Diagnostic evaluation<br />
  23. 23. Establishing a definitive diagnosis is often difficult, with much uncertainty concerning prognosis once the diagnosis is made<br />Serial brain MRI studies<br />Useful for diagnosing and monitoring patients with MS<br />Show small plaques scattered throughout white matter of CNS<br />Magnetic resonance spectroscopy <br />Monitor specific pathophysiology of evolving MS plaques<br />
  24. 24.
  25. 25. Electrophoresis study of CSF<br />shows abnormal IgG antibody<br />Visual, auditory, and somatosensory evoked potentials<br />slowed conduction is evidence of demyelination<br />
  26. 26. complications<br />
  27. 27. Respiratory dysfunction<br />Infections<br />Bladder<br />Respiratory<br />Sepsis<br />Complications from immobility<br />Speech, voice, and language disorders<br />dysarthria<br />
  28. 28. management<br />
  29. 29. MS treatment is dynamic and rapidly evolving, covering two main areas<br />Direct treatment of MS<br />Treatment of the effects or symptoms resulting from MS<br />Aim: relieving symptoms and helping the patient function<br />A therapeutic relationship between the patient and nurse creates a critical and strong bond that is essential across the long trajectory of the illness<br />
  30. 30.
  31. 31. Current Disease-Modifying Drugs<br />Corticosteroids or adrenocorticotropic hormone<br />To decrease inflammationshorten duration of relapse or exacerbation<br />Immunosuppressive agents<br />Stabilize the course<br />Interferon beta-1a (Rebif, Avonex) and interferon beta-1b (Betaseron) <br />Used for treatment of rapidly progressing symptoms in some patients<br />
  32. 32. Copolymer-1<br />A mixture of synthetic polypeptides composed of four amino acids<br />Effective in reducing relapse rates and disability in patients with relapsing-remitting MS<br />Glatiramer (Copaxone)<br />An immunomodulator,<br />Used in relapsing-remitting disease<br />Mitoxantrone (Novantrone)<br />Chemotherapeutic agent used for the treatment of secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting MS<br />To reduce neurologic disability and frequency of clinical relapses<br />
  33. 33. Treating Exacerbations<br />A true exacerbation of MS is caused by an area of inflammation in the CNS<br />The treatment most commonly used to control exacerbations is I.V., high-dose corticosteroids<br />Solu-Medrol (ethylprednisolone)<br />Plasmapheresis (plasma exchange)<br />considered for the 10% who do not respond well to standard corticosteroid treatment<br />
  34. 34. Chronic Symptom Management<br />Treatment of spasticity with<br />Agents: baclofen (Lioresal), dantrolene (Dantrium), diazepam (Valium)<br />Physical therapy<br />Nerve blocks<br />Ssurgical intervention<br />Control of fatigue:<br />Amantadine (Symmetrel)<br />Lifestyle changes<br />Treatment of depression:<br />Antidepressant drugs<br />
  35. 35.
  36. 36. Counselling<br />Bladder management:<br />Anticholinergics<br />Intermittent catheterization for drainage<br />Prophylactic antibiotics<br />Bowel management:<br />stool softeners, bulk laxative, suppositories<br />Multidisciplinary rehabilitation management<br />physical therapy, occupational therapy, speech therapy, cognitive therapy, vocational rehabilitation, and complementary and alternative medicine<br />
  37. 37. to restore or maintain functions essential to daily living in individuals who have lost these capacities through the disease process<br />Control dystonia:<br />carbamazepine (Tegretol)<br />Management of pain syndromes<br />carbamazepine (Tegretol), phenytoin (Dilantin), perphenazine/amitriptyline (Triavil)<br />Nonpharmacologic modalities<br />
  38. 38. Nursing assessment<br />
  39. 39. Observe motor strength, coordination, and gait<br />Perform cranial nerve assessment<br />Evaluate elimination function<br />Explore coping, effect on activity and sexual function, emotional adjustment<br />Assess patient and family coping, support systems, available resources<br />
  40. 40. Nursing diagnoses<br />
  41. 41. Activity intolerance<br />Acute pain<br />Chronic low self-esteem<br />Constipation<br />Disabled family coping<br />Disturbed thought processes<br />Fatigue<br />Imbalanced nutrition: Less than body requirements <br />Impaired physical mobility <br />Impaired urinary elimination <br />Ineffective coping <br />Ineffective role performance <br />Interrupted family processes <br />Risk for infection <br />Risk for injury<br />
  42. 42. Key outcomes<br />
  43. 43. The patient will:<br />Perform activities of daily living within the confines of the disease<br />Verbalize feelings of comfort and reduced pain<br />Voice feelings relating to self-esteem<br />Maintain a normal bowel elimination pattern<br />(Family members will) use support systems and coping mechanisms<br />Remain oriented to person, place, time, and situation<br />Express feelings of increased energy and decreased fatigue<br />
  44. 44. The patient will:<br />Show no signs of malnutrition<br />Maintain joint mobility and range of motion<br />Develop regular bladder habits<br />Use support systems and coping mechanisms<br />Resume regular roles and responsibilities to the fullest extent possible<br />(Family members will) discuss the impact of the patient's condition on the family unit<br />Remain free from signs and symptoms of infection<br />Remain free from injury<br />
  45. 45. Nursing interventions<br />
  46. 46. Provide emotional and psychological support for the patient and his family, and answer their questions honestly<br />Stay with them during crisis periods<br />Encourage the patient by suggesting ways to help her cope with this disease<br />Assist with physical therapy<br />Increase patient comfort with massages and relaxing baths<br />Make sure the water isn't too hot because it may temporarily intensify otherwise subtle symptoms<br />
  47. 47. Assist with active, resistive, and stretching exercises to maintain muscle tone and joint mobility, decrease spasticity, improve coordination, and boost morale<br />Provide rest periods between exercises because fatigue may contribute to exacerbations<br />Promote emotional stability<br />Help the patient establish a daily routine to maintain optimal functioning<br />Her tolerance level regulates her activity level<br />Encourage regular rest periods to prevent fatigue and daily physical exercise<br />
  48. 48. Keep the bedpan or urinal readily accessible because the need to void is immediate<br />Evaluate the need for bowel and bladder training during hospitalization<br />Encourage adequate fluid intake and regular urination<br />Eventually, the patient may require urinary drainage by self-catheterization or, in men, condom catheter<br />Watch for adverse reactions to drug therapy<br />
  49. 49. Patient teaching<br />
  50. 50. Review the disease process, emphasizing the need for optimizing the patient's potential and avoiding exacerbations as possible<br />Inform the patient about potential adverse effects of drug therapy and the medication regimen<br />Emphasize the need to avoid stress, infections, and fatigue and to maintain independence by developing new ways of performing daily activities<br />Be sure to tell the patient to avoid exposure to bacterial and viral infections<br />Stress the importance of eating a nutritious, well-balanced diet that contains sufficient fiber to prevent constipation<br />
  51. 51. Encourage adequate fluid intake and regular urination<br />Promote emotional stability<br />Help the patient establish a daily routine to maintain optimal functioning<br />Inform the patient that exacerbations are unpredictable, necessitating physical and emotional adjustments in his lifestyle<br />Refer the patient to the social service department when appropriate and to a local chapter of the National Multiple Sclerosis Society<br />
  52. 52. Avoiding exacerbation of MS<br />
  53. 53. Educate the patient and her family about multiple sclerosis (MS)<br />Emphasize the need to avoid stress, infections, and fatigue<br />Stress the need to maintain independence by developing new ways of performing daily activities<br />Be sure to tell the patient to avoid exposure to bacterial and viral infections<br />Emphasize the importance of exercise and inform the patient that walking may improve gait<br />If her motor dysfunction causes coordination or balance problems, teach walking with a wide base of support<br />
  54. 54. If the patient has trouble with position sense, tell her to watch her feet while walking<br />If she's still in danger of falling, a walker or a wheelchair may be required<br />Stress the importance of taking rest periods, preferably lying down<br />Teach the importance of eating a nutritious, well-balanced diet that contains sufficient roughage to prevent constipation<br />Encourage adequate fluid intake and regular urination<br />
  55. 55. Provide bowel and bladder training if necessary<br />Teach the patient how to use suppositories to establish a regular bowel elimination schedule<br />Inform the patient that exacerbations are unpredictable, necessitating physical and emotional adjustments in lifestyle<br />Help the patient and her family establish a routine to maintain optimal functions<br />
  56. 56. Learning activity<br />
  57. 57. A 28-year-old woman raised in Minnesota complains of weakness and tingling in the right arm and leg for 2 days. She reports an episode of right eye pain and blurred vision, which resolved over one mo that occurred 2 years ago. She also recalls a 2-week episode of intermittent blurred vision 1 year ago. What disease process could be present?<br />Multiple sclerosis (MS). She could be experiencing optic neuritis, a symptom of MS.<br />
  58. 58. What is MS (multiple sclerosis)?<br />MS is a progressive neurologic disease that is not infectious, and is caused by destruction, injury, or malformation of the myelin sheaths that cover nerves; these areas of demyelination are called plaques and are most common on the white matter of the brain and spinal cord; symptoms of MS may be transient, variable, and bizarre. <br />The first symptoms are usually sensory and visual problems. <br />Fatigue is usually the most debilitating symptom. <br />Diagnosis is by MRI and other techniques. <br />There is no cure, although medical treatment does help symptoms, including steroids, glatiramer acetate, and others.<br />
  59. 59. What purpose would the drug baclofen (Lioresal) serve when administered to a patient with multiple sclerosis?<br />It is a muscle relaxant used to help relieve muscle spasms common with MS.<br />
  60. 60.
  61. 61. http://nurseRD.blogspot.com<br />www.authorstream.com/reynel89/Nursing<br />www.slideshare.net/reynel89/slideshows<br />THANK YOU!Have a nice day : )<br />- RDG<br />

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