Multiple Sclerosis

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  • Affects the brain and spinal cord
  • Autoimmunean inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged
  • Development of plaque in the white matter of the CNS--- demyelinatedThis plaque damages the myelin sheath and blocks impulse transmission between the CNS system and the body
  • Inherited--first-degree relative has the disease
  • Fatigue:especially of the lowerextremitiesAtaxiaDysarthria, dysphagiaUhthoff’s sign:a temporary worsening of vision after exertion or heat exposureTinnitus, vertigo, decreased hearing acuityBladder dysfunction (areflexia, urgency, nocturia)
  • MRI: most diagnosticMRI of brain and spine
  • CSF analysis:Elevated proteinIncreased WBCComplications: Reaction to anesthetic, meningitis, bleeding into the spinal canal, cerebellar tonsillar herniation, and medullary compression Signs of meningitis Signs of herniation Infection
  • Electrophysiological Testing
  • Reduce the frequency of relapses
  • Prevents or treats relapse
  • Treat muscle spasticity
  • Used for paresthesia, seizures
  • Constipation
  • Multiple Sclerosis

    1. 1. Multiple Sclerosis NURSING CARE Med-Surg
    2. 2. Four Type • Relapse Remitting • Primary Progressive • Secondary Progressive • Progressive Relapsing
    3. 3. Relapse Remitting • Unpredictable acute attacks with worsening of symptoms followed by full, partial, or no recovery • Then complete or partial absence of symptoms (Remission)
    4. 4. Primary Progressive • Steady gradual progression of disability, without any obvious relapses and remissions • Most common after age 40
    5. 5. Secondary Progressive • Starts with a relapse remitting • Advance to progressive disease
    6. 6. Progressive Relapsing • Steady progressive disability • Acute Attacks • Possible recovery
    7. 7. Precipitating Factors • Infection • Cold climate • Physical injury • Emotional stress • Pregnancy • Fatigue • Overexertion • Hot shower/bath
    8. 8. Complications • Spasticity • Neurogenic bladder • Aspiration • Paralysis
    9. 9. Diagnostic Procedures
    10. 10. MRI
    11. 11. CSF Analysis • Tell the patient that this test usually takes at least 15 minutes • Headache is common adverse effect • VS • Pillow support • Place one arm around knee & neck • Remain calm and still • Label containers in which they were filled • Allergy check initially • Remain flat • Encourage fluids • Check site for redness, swelling, drainage hourly 4 1st 4 hours then Q4 for 1st 24hrs. • Assess neurolgoic Q15 min for 4 hours; it stable assess Q2 then Q4
    12. 12. Electrophysiological Testing
    13. 13. Medications
    14. 14. Immunosuppressants
    15. 15. Immunomodulators
    16. 16. Antispasmodic
    17. 17. Anticonvulsant
    18. 18. Stool Softener
    19. 19. Nursing Diagnosis • Fatigue • Activity intolerance • Disturbed sensory perception (visual) • Impaired physical mobility • Impaired urinary elimination • Chronic pain • Imbalanced nutrition: Less than body requirements
    20. 20. Nursing Care • Encourage fluid intake • Assist with bladder elimination o intermittent self-catheterization, o bladder pacemaker o Credé • Reorient • Place Routine Objects in Routine Places • Communication Board 4 (dysarthria) • Speech language therapist referral • Apply alternating eye patches to treat diplopia. Teach scanning techniques. • Utilize energy conservation measures. • Reduce injury—call lights, ask 4 assistance, home safety • Encourage independence
    21. 21. Thanks….

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