Multiple Sclerosis
Multiple Sclerosis & Myelin Sheath. Both begin w/ "M"
Autoimmune
- Attacks the myelin sheath that covers nerve fibers (axons) leading to damaged communication from the brain to the rest of the body. Affects CENTRAL NERVOUS SYSTEM
Relapsing
- May improve at times, but will have exacerbations.Â
- It is a relapsing and remitting disease course.Â
- Mostly Women 20 to 40 years
Romberg
- Positive Romberg sign (when a client is able to stand with feet together and eyes open, but sways or falls with eyes closed).
Lhermitte
- Lhermitte’s sign: Sudden feeling of electric shocks down the back of the neck and spine and radiates to arms and legs.
Perception
- Tingling & Burning
- Numbness/crawling sensation (e.g. in legs)
- Pins and needles feeling
- ⇓ sensitivity to pain
- Electric shocks
- Overheating of body
Safety: Can’t feel so client can burn easily. Keep room cool
Muscles
- Spastic muscles/Cramps
- Overheating during exercise
- Weakness (loss of power in an arm or leg)
- Lack of coordination
- Poor balance (Cerebellar lesions)
- Dysmetria: over or under estimating range of movement
Mouth
- Difficulty Swallowing (Dysphagia)
- Slurred speech
- Stuttering in speech
- Scanning speech, speaking with pauses.
- Dysarthria (issues with word articulation)
Visual
- Blurred/Double Vision (First Symptom)
- Loss of vision in one/both eyes
- Nystagmus
- Optic Neuritis (pain w/eye movement, blurry vision, seeing dark spots)
- Scotomas: Blind spot in center of vision
Safety: Fall Precautions
Brain
- Fatigue
- Depression
- Cognitive ImpairmentÂ
- Tremors/Dizziness
- Unstable Mood
Safety: ⇓ Stress and overexertion
Urinary
- Frequent Urination
- Incontinence/Retention
- Urecholine & Bethanecol for urinary retention
- Credé maneuver: exert manual pressure on abdomen at the location of the bladder to stimulate voiding.
Safety: Prevent UTIs; Acid Ash diet; Treat urinary retention
Digestive
- Changes in Bowel Habits
- Diarrhea
- Constipation
Stool Softeners
Treatment
- Diazepam (Valium), Baclofen, Dantrium for muscle spasms
- ACTH & corticosteroids to decrease edema in demyelienation process
- Oclelizumab/Interferon beta to slow progression (an immunosuppressant)
- Glatiramer Acetate (Copaxone) an immunomodulator that ↓ relapses.
Keep Calm & Cool
Uhthoff’s Sign: Client gets too much heat (weather, exercise, emotional) and MS symptoms get worst. Keep client from overheating. Prevent over exercise, avoid hot temperatures, and avoid emotional stress. Â
Key words
- Myelin Sheath
- First symptom: Burred Vision
- Optic Neuritis
- Relapsing and Remitting
- Women 20 to 40 years of age
- Romberg
- Lhemitte
- Prevent overheating/overexertion. Avoid stress. Prevent infection.
- Muscle relaxants used for muscle rigidity and pain: Diazepam, Baclofen, Dantrium
- Urecholine and Bethanecol for urinary retention
- ACTH (stimulates adrenal gland to secrete corticosteroids), Corticosteroids, Interferon Beta, and Oclelizumab (immunosuppresant)
Results
#1. The nurse educates a client with multiple sclerosis about the medication Baclofen. Which of the following teaching points should the nurse include?
#2. The nurse is caring for a client with multiple sclerosis. Which of the following assessment findings requires follow up?
Coughing while eating? Think Aspiration. Clients with multiple sclerosis have dysphagia.
All the symptoms here are expected of multiple sclerosis. Dysphagia is expected, but not aspiration! This requires follow up.
#3. The client has been diagnosed with an acute relapse of multiple sclerosis. The client has been placed on intravenous corticosteroids. Which of the following physician’s order should the nurse anticipate?
Steroids= hyperglycemia. This is practical knowledge. Once you get your first job, if you have a client on steroids, expect elevated glucose levels and insulin scale.
#4. The nurse is caring for a client with multiple sclerosis. Which of the following assessment findings should the nurse anticipate. Select all that apply.
Select all that apply:
I hope that if you see “difficult to arouse” and “slow shallow breathing,” you know that these symptoms require follow up. Something is wrong. They are UNEXPECTED!
#5. The male client with multiple sclerosis complains of feeling an electric shock up and down the spine when moving his neck. The nurse interprets this complaint as which of the following?
For multiple Sclerosis: Positive Romberg sign (when a client is able to stand with feet together and eyes open, but sways or falls with eyes closed).
For Multiple Sclerosis: Lhermitte’s sign: Sudden feeling of electric shocks down the back of the neck and spine and radiates to arms and legs.
For multiple Sclerosis: Uhthoff’s Sign: Client gets too much heat (hot weather/excessive exercise) and MS symptoms get worst. Keep client from overheating. Prevent over exercise, avoid hot temperatures, and avoid emotional stress.
For Acute Cholecystitis:Â Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area.
#6. A nurse is caring for a client who is experiencing trouble with speech, blurry vision, has muscle spasticity and numbness and tingling to both of his lower extremities. The client is most likely experiencing which of the following conditions?
#7. The nurse is developing a nursing care plan for a client with multiple sclerosis who is experiencing urinary retention. Which of the following is an appropriate nursing intervention for this client?
Never restrict fluids on a client who is at high risk for UTI’s.
Foley catheters place clients at a high risk for infection
Going to the bathroom hourly is not a good choice because the problem is not urge incontinence, but inability to empty bladder.
If the client had urge incontinence then developing a bladder program/schedule would be appropriate.