Multiple Sclerosis

MULTIPLE SCLEROSIS -A chronic, progressive disease of unknown etiology affecting the central nervous system. -Young adults 20-40 Years-old / Increase in women and men in northern climates

ETIOLOGY • •

Do not really know May be Viral infection or Autoimmune response

PATHOPHYSIOLOGY •

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Degeneration of myelin sheath with resulting nerve degeneration. Patchy areas involved become sclerosed, and the flow of nerve impulses is interrupted. Manifestations presented dependent upon nerves affected. The optic nerves, chiasm tracts, cerebrum, cerebellum and brain stem, and the spinal cord most often affected. Manifestations presented depend on nerves affected The optic nerve, chaism tracts, cerebrum, cerebellum and white matter of the brain stem, and the spinal cord are most often affected Impulse is proper or not at all – Short circuit

CLINICAL MANIFESTATIONS • • • • • • • • • • •

Fatigue Weakness Numbness Coordination difficulties, and loss of balance Diplopia – Blurred vision Scotoma - Spots before the eyes Cognitive and psychosocial problems Emotional Instability o Euphoria, depression – mood swings Bowel and Bladder Sexual problems Will also have exacerbations and remissions (give Corticosteroids) As The Disease Progresses They Will Have: o Nystagmus – constant movement of the eyeballs o Scanning speech disorder – slurred slow type speech o Urinary incontinence and frequency o Changes in muscular coordination and gait Late Manifestations o Urinary retention or incontinence o Pressure ulcers o Severe muscle spasms o Spastisity ataxic gait – unable to walk o Spastic paraplegia with slight speech disturbance o Pain not common (only with muscle spasms) Hazards of Immobility o UTI’s o Constipation o Pressure ulcers o Contracture deformities

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Pneumonia and Depression

PROGNOSIS • • • •

Can live 12-25 years after diagnosis, after 10 yr 1/3 won’t have any disabilities, 1/3 slight, 1/3 severe. No record of recovery Patient usually dies from some sort of respiratory infection or GI problem The more often the person had the symptoms the more they progress – get worse with exacerbations

MANAGEMENT • • • • • • • • • • • • • • • • •

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Prevent and treat muscle spastisity Prevent skin breakdown and any problems with immobility Presently, no cure. Assistance to overcome the effects of incoordination and ability to get around Keep active but nothing that requires quick reaction time Prevent complications and work with symptoms Provide support Frequent rest periods Treatment aimed at relieving patient symptoms and providing support May be on steroid therapy at time of exacerbation Corticosteroids and ACTH (adrenocorticotropic hormone) may improve nerve conduction due to anti-inflammatory properties Azathioprine, cyclophosphamide, and interferon are immunosuppressive drugs used to reduce progression of disease as well as decrease exacerbations. Baclofen – Treatment for spasticity Well balanced diet, appropriate foods with increase vitamins and fluids Assist family and patient with dealing with stress and dealing with disease Peaceful environment Bladder & Bowel management most difficult problems o Patient may not be able to:  Store urine – Hyperreflexic  Empty bladder – Hyporeflexic  Have a combination of both at times  May get antibiotics prophilactically to prevent UTI Antibiotics are administered as well as ascorbic acid to reduce bacterial growth They can have intellectual impairment

DIAGNOSIS • • •

MRI – the primary diagnostic aid for detecting small plaques and determining course and treatment of disease. CSF of 95% of patients reveals abnormal IgG antibodies Cognitive impairment assessed with neuropsychological testing

NURSING DIAGNOSIS • • • • •

Physical mobility impairment HRF Injury – due to gait problems Urinary and bowel elimination impairment Altered thought processes Ineffective coping

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Sexual dysfunction potential Home maintenance management impairment