Multiple Sclerosis

The flashcards below were created by user discomann1 on FreezingBlue Flashcards.

  1. Multiple Sclerosis
    • a chronic, degenerative disoder of the CNS.
    • Characterized by disseminated demyelination of nerve fibers in the brain and spinal cord
  2. Etiology
    • Cause is unknown
    • Viral
    • Immunologic
    • Genetic Factors
    • Intrinsic Factors
    • Susceptibility appears to be inheritedViralImmunologicGenetic FactorsIntrinsic Factors
  3. Precipitating Factors
    • Exposure to pathogens
    • Infection
    • Physical injury
    • Emotional stress
    • Excessive fatigue
    • Pregnancy
    • Poor state of health
  4. Pathophisology
    • Chronic inflammation
    • Demylination
    • Gliosis (scarring)
  5. Autoimmune disease
    • orchestrated by autoreactive T cells (lymphocytes)
    • - This process may be triggerred by a virus in gebetically
    • susceptible individuals.
  6. T cells
    • Migrate to the CNS
    • - causing blood-brain barrier disruption and the intial development of MS
  7. Antigen-antibody reaction with the CNS
    resulting in activation of the inflammatory response and leads to demyelantion of the axon
  8. Desease process
    • Loss of myelin
    • Disappearance of oligodendrocytes
    • Proliferation of astrocytes
    • Characteristic plaque formation (sclerosis)
  9. oligodendrocytes
    type of brain cell (insulation of the axon)
  10. astrocytes
    biochemical support that form the blood-brain barrier, provision of nutrients to the nervous tissue, maintainece of ion balance, and a role in the repair and scarring process of the brain and spinal cord following traumatic injuries.
  11. Early in the disease
    • Myelin sheath damaged (nerve fiber is not effected)
    • Patient may complain of noticeable impairment of function
    • Weakness
    • Myelin sheath can regenerate (symptoms disappear)
  12. Axon becomes involved
    • Myelin is replaced by glial scar tissue
    • Without myelin, nerve impulses slow
    • With destruction of nerve axons, impulses are totally blocked
    • Resulting in a permanent loss of function
  13. glial scar tissue
    forms a hard, sclrotic plaques in multiple areas of the CNS
  14. Symptoms
    • Onset of the disease is insidious and gradual
    • Vague symptoms over months or years
    • Spotty distribution in the CNS (not every nerve affected)
    • S&S vary over time
  15. Common areas affected
    • Motor
    • Sensory
    • Cerebellar (cognition)
    • Emotional
    • The S&S of MS are triggered by physical and emotional trauma, fatigue, and infection.
  16. Motor
    weakness or paralysis of the limbs, trunk head; and plogia; scanning speech; and spacicity of the muscles that are chemically affected.
  17. Sensory
    numness, tingling, patchy blindnes, blurred vision, virtigo, tinnitus, decreased hearing, and chronic neuropathic pain, parasthesia
  18. parasthesia
    burning, tingling, prickling, or numbness.
  19. Cerebellar (cognitive)
    nystagmus, ataxia, dysarthia, and dysphagia
  20. Emotional
    anger, depression, euphoria
  21. Characteristics
    • Chronic, progressive deterioration in some people
    • Remissions and exacerbations in others
    • Overall trend is progressive deterioration in neurologic function
  22. Central
    • fatigue
    • cognitive impairment
    • depression
    • unstable mood
  23. Visual
    • nystagmus
    • optic neuritis
    • diplopia
  24. Speech
  25. Throat
  26. Musculoskeletal
    • weakness
    • spasm
    • ataxia
  27. Sensation
    • Pain (chronic)
    • hypoesthesias
    • paraesthesias
  28. Bowel
    • Incontinence
    • dirrhea or constipation
  29. Urinary
    • Incontinence
    • frequency or retention
  30. Pregnancy
    • Can experience remission or an improvement in their symptoms during gestation
    • Postpartum will often exacerbate the disease
  31. Life Expectancy
    • Death usually occurs due to infectious complications
    • - pneumonia
  32. Diagnostic Studies
    • No definitive test
    • Diagnosis
    • History
    • Clinical manifestations
    • CSF fluid
    • Evoked response testing
    • Presence of multiple lesions on an MRI (over time)
  33. CSF Fluid
    increased lymphocyted and macrophages
  34. Collaborative Care
    • Because there is currently no cure for MS
    • Care is aimed at treating the disease process and providing symptomatic relief
  35. Drug Therapy
    • Corticosteroids
    • Immunomodulators
    • Immunosuppressant's
    • Cholinergics
    • Anticholinergics
    • Muscle Relaxants
  36. Corticosteroids
    decrease inflammation on the nerve, decrease edem at the site of demyelination
  37. Immunosuppressant's
    • Imuran
    • Cytoxan
    • Novantrone - has a lifelong dose limit bc of the cardiac toxicity
  38. Anticholinergics
    bladder spasms
  39. Muscle Relaxants
    tremors and muscle spasicity
  40. Depressants
    • providual & ridlin
    • treat fatigue
  41. Aricep
    • cognitive agent
    • treat inflammation
    • helps with short term memory loss
  42. Treatments
    • Surgery
    • Neurectomy
    • Rhizotomy
    • Cordotomy
  43. Neurectomy
    removal of the nerve or section of the nerve (decrease spacicity and tremors)
  44. Rhizoctomy
    removes nerve roots in the spinal cord
  45. Cordotomy
    disables selective pain conduction tracts in the spinal cord
  46. Intrathecal baclofen
    antispacmotic - helps the pt to void nromally
  47. Thalamotomy or deep brain stimulation
    for the tremors that are unmanageable
  48. Physical therapy
    stregthen muscle function
  49. Excersice
    • decrease spacicity
    • increase coordination
    • retains unaffected muscles
  50. Subjective data
    • past health issue
    • - physical or emtional stress
    • - nutrition and exercise
    • - how they are coping
    • - issues with extreme heat or cold (especially the heat)
  51. Objective data
    • look at the skin (prone to skin breakdown)
    • VS
    • cognitive orientation
    • general appearence
  52. Nursing Diagnoses
    • Impaired Physical Mobility
    • Impaired Urinary Elimination
    • Interrupted Family Processes
    • Ineffective Self-Health Management
  53. Planning
    Overall goals
    • Maximize neuromuscular function
    • Maintain independence in activities of daily living for as long as possible
    • Manage disabilitating fatigue
    • Optimize psychosocial well-being
    • Adjust to the illness
    • Reduce factors that precipitate exacerbations
  54. Nursing Implementation
    • Patient with MS should be aware of the triggers thatmay cause or worsen the disease
    • Each person responds differently to these triggers
    • Assist the patient to help identify particular triggers and avoid ways to minimize their effects
  55. Exacerbation of MS
    triggered by infection (increased resp and unrinary tract), trauma, immunization, delivery after pregnancy, stress, and change in climate (heat and cold), smoking
  56. Patient Teaching
    • Avoid
    • Fatigue
    • Extremes of heat and cold
    • Exposure to infection
  57. Evaluation
    • 1. Mobility (keep moving) - excersice
    • 2. Safety - fall risk
    • 3. Flaccid bladder, spacicity (anticholinergetics) depends on where the plague is [may need to teach pt self-catheterizations]
    • 4. coping - everyone gets affected pt (20-50 yo)
    • 5. self -mamagement - treat symptoms and loss of function
  58. Other teaching
    • Achieve a good balance of exercise and rest
    • Eat nutritious and well balanced meals
    • Avoid hazards of immobility
    • Know their treatment regimes
    • Know side effects of drugs and their interactions with over the counter medications
    • Bladder control-may need to be taught; self catheterization
    • Bowel problems particularly constipation
  59. Pt and family
    • The patient with MS and the caregiver need to make many emotional adjustments
    • Unpredictability of the disease
    • Need to change lifestyles
    • Challenge of avoiding or decreasing precipitating factors

    The pt and the family must be taught
Card Set:
Multiple Sclerosis
2012-03-27 01:16:20
Multiple Sclerosis Santa Fe Nursing NPll

Multiple Sclerosis (test 5)
Show Answers: