Transcript Adult Medical-Surgical Nursing 2

Adult Medical-Surgical
Nursing
Neurology Module:
Multiple Sclerosis
Multiple Sclerosis: Description
A chronic degenerative progressive
disease of the central nervous system
affecting persons of all ages
Involves small patches of demyelination in
the brain and spinal cord → impaired
transmission of impulses
Multiple Sclerosis:
Aetiology and Incidence
Unknown cause
Possible viral damage in early life → later
auto-immune response (defective immune
response)
Genetic component (chromosome 6)
Occurs in northern temperate zones more
than hot climates
Often occurs in young adults
Occurrence in female twice that in male
Multiple Sclerosis: Pathophysiology
Demyelination in patches irregularly
throughout central nervous system
Replaced with sclerosed patches
interrupting the flow of impulses
Areas most affected: Optic nerves/ tracts
Cerebrum
Brain stem and cerebellum
Spinal cord
Multiple Sclerosis:
Disease History
MS is a progressive neurological disease
but has periods of:
Remission (no symptoms, no progress)
Relapse: new symptoms and progression
(may be related to stressful times)
Remyelinisation may occur
Multiple Sclerosis:
Clinical Manifestations
Fatigue, weakness; dysphasia, dysphagia
Numbness and paraesthesia (pain)
Poor coordination (proprioception)
Loss of balance, ataxia
Blurred vision, diploplia → blindness
Spasticity of extremities
Depression, cognitive problems
Bladder, bowel, sexual dysfunction
Multiple Sclerosis: Complications
Urinary tract infection
Constipation
Pressure ulcers (paraesthesia/ spasticity)
Contractures, deformities, spasticity
Oedema of feet, legs
Pneumonia
Depression
Multiple Sclerosis: Diagnosis
Patient history and clinical picture
Neurological examination
MRI: shows small focal sclerotic plaques
(will also evaluate disease progression)
Lumbar puncture: CSF shows “oligoclonal
bonding” in 95% patients (bands of
abnormal IgG)
Bladder function tests (neurogenic
bladder)
Multiple Sclerosis:
Medical Management
Multiple Sclerosis is a progressive chronic
disease: no cure exists
An individualised care plan is required to:
Delay progression
Minimise complications
Maintain function
Relieve symptoms
Support the patient
Multiple Sclerosis: Medications
Corticosteroids: anti-inflammatory (may
improve nerve function)
Immunosuppressants (as abnormal
immune response):
Imuran, Cyclophosphamide, Cyclosporin
β-Interferon to reduce exacerbations
Anti-spasmodic for spasticity, Baclofen
Anticholinergics: improve bladder tone;
Antibiotics for UTI control
Multiple Sclerosis:
Nursing Considerations
Psychological/ emotional support
Assist self-care and patient education to
avoid complications:
Self-catheterisation, bowel care, use of
walking aids, wheelchair may be required
Prevent UTI: vitamin C, juices to acidify
urine
Advise on side-effects of steroids, regular
health screening, not to omit medication