Multiple Sclerosis

MULTIPLE SCLEROSIS - abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminate - usually diagnosed between ages of 20 and 40, and in 2–3 times as many women as men. - is an autoimmune condition in which the immune system attacks the central nervous system (CNS), leading to demyelination demyelination- damages the myelin sheath and neurons - this damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS MAIN PROBLEM: damage to the myelin sheath affects the areas of the brain and spinal cord known as the white matter COMMON MANIFESTATIONS: • Visual disturbances, which may include eye pain, distortion or loss of vision in one eye, or impairment of color perception • Difficulty walking or performing tasks that require coordination • Loss of sensation • Fatigue and/or weakness • Loss of bowel or bladder control NURSING DIAGNOSIS: Primary: Impaired Physical Mobility related to neuromuscular impairment, decreased strength and fatigue Nursing Interventions: >Encourage and facilitate early ambulation and other ADLs when possible. >Facilitate transfer training by using appropriate assistance of persons or devices when transferring patients to bed, chair, or stretcher. >Encourage appropriate use of assistive devices in the home setting. >Provide positive reinforcement during activity. >Allow patient to perform tasks at his or her own rate. >Keep side rails up and bed in low position. This promotes a safe environment. >Turn and position every 2 hours or as needed. >Maintain limbs in functional alignment (e.g., with pillows, sandbags, wedges, or prefabricated splints). >Perform passive or active assistive ROM exercises to all extremities. >Encourage coughing and deep-breathing exercises. >Encourage liquid intake of 2000 to 3000 ml/day unless contraindicated. >Initiate supplemental high-protein feedings as appropriate. >Set up a bowel program (e.g., adequate fluid, foods high in bulk, physical activity, stool softeners, laxatives) as needed. >Administer medications as appropriate. Antispasmodic medications may reduce muscle spasms or spasticity that interfere with mobility.

Secondary: Impaired Bowel and Bladder Elimination related to neuromuscular impairment Nursing Interventions: Constipation: >Encourage daily fluid intake of 2000 to 3000 ml/day, if not contraindicated medically. >Encourage increased fiber in diet (e.g., raw fruits, fresh vegetables); a minimum of 20 g of dietary fiber per day is recommended. >Encourage patient to consume prunes, prune juice, cold cereal, and bean products. >Encourage a regular time for elimination. >Encourage isometric abdominal and gluteal exercises. Incontinence: >Note frequency, urgency, burning, incontinence, nocturia, size of/force of urinary stream. Palpate bladder after voiding >Institute bladder training program >Encourage adequate fluid intake, limiting intake during late evening and at bedtime. Recommended use of cranberry juice/vitamin C. >Promote continued mobility >Recommend good handwashing/perineal care. MEDICAL MANAGEMENT Medications for relapsing MS: >Beta interferons >Glatiramer (Copaxone) >Natalizumab (Tysabri) Medications for progressive MS: >Corticosteroids >Muscle relaxants - Baclofen (Lioresal) and tizanidine (Zanaflex) >Medications to reduce fatigue - amantadine (Symmetrel) and modafinil (Provigil)