Nursing management of Multiple sclerosis Today’s topic is Nursing Management for clients with Multiple Sclerosis.

Pathophysiology – Multiple Sclerosis

Pathophysiology Three pathologic processes Chronic inflammation Demyelination Gliosis in the CNS A chronic CNS disorder in which myelin and nerve axons in brain and spinal cord are destroyed Patterns of MS 1. Relapsing remitting 2. Primary progressive 3. Secondary progressive 4. Progressive relapsing

Demyelination plaque (P) at gray-white junction and adjacent partially remyelinated shadow plaque (V)

Etiology The cause of Multiple Sclerosis (MS) is unknown Unlikely due to one cause Genetically susceptible patients Related to infection, immunologic, and genetic factors Precipitating factors: Exposure to an infection Emotional stress Excessive fatigue Pregnancy

Etiology Onset between 20-50 years of age Although can occur in young teens and much older adults Women are affected 2-3 time more than men More prevalent in colder climates

Clinical Manifestations Motor, sensory, cerebellar, emotional disturbances Weakness and/or paralysis of limbs, trunk, or the head Visual disturbances (diplopia) or blindness Paresthesias Sudden, progressive weakness of one or more limbs Spasticity of muscles Nyastagmus Tremors Gait instability Fatigue Bladder dysfunction (UTIs, incontinence) Depression

Assessment of Labs/Diagnostics MRI of the brain and spinal cord plaques, inflammation, atrophy, tissue breakdown and destruction Lumbar Puncture CSF analysis shows an increase in immunoglobulin G and oligoclonal banding Evoked Potential responses delayed-decreased nerve conduction from the eye and the ear to the brain

Problems with MS Impaired physical mobility Activity intolerance Fatigue Impaired urinary elimination Ineffective self-health management Grief and depression Potential for infection

Interventions No cure for MS so disease management is centered on symptoms and treating underlying disease process medication management Disease modifying Immunomodulators (B-interferon) Immunosuppressant Sphingosine 1-Phosphate Receptor Modulator Monoclonal antibody Managing exacerbations Corticosteroids Symptom management Cholinergic Anticholinergic Muscle Relaxants Nerve conduction enhancer

Interventions Acute phase of exacerbation Fatigue Exercise Immobility prevention of complications of immobility Fatigue Exercise Diet (high in roughage) Rest periods Minimize caffeine Self catheterization Support groups

Nursing education Balance of exercise and rest Minimize caffeine intake Medication management Self-catheterization if necessary Adequate intake of fiber to aid in regular bowel habits Emotional adjustments Lifestyle changes

Evaluation Expected outcomes: Maintain or improve muscle strength and mobility Use assistive devices appropriately for ambulation and mobility Maintain urinary continence Make decisions about lifestyle modifications to manage MS Maintain independence and functionality

References Rangel-Castillo, L, Gopinath, S., & Robertson, C.S. (2009). Management of intracranial hypertension. Neurologic Clinics, 26(2), 521-541. Ignatavicius, D. D. & Workman, M. L. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis, MO: Saunders Elsevier. Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., & Bucher, L. (2014). Medical-surgical nursing: Assessment & management of client problems (9th ed.). St. Louis, MO: Mosby Hogan, M., Dentlinger, N.C., & Ramdin, V. (2014). Medical- surgical: nursing pearson nursing reviews and rationales (3rd ed.). Boston, MA: Pearson.