Transcript MultipleSclerosis

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
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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