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Multiple Sclerosis (MS). Adult Health II Neurological Diseases. Jerry Carley RN, MSN, MA, CNE Summer 2010. Concept Map: Selected Topics in Neurological Nursing. PATHOPHYSIOLOGY Traumatic Brain Injury Spinal Cord Injury Specific Disease Entities : Amyotropic Lateral Sclerosis - PowerPoint PPT Presentation
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Adult Health IINeurological Diseases
Jerry Carley RN, MSN, MA, CNESummer 2010
Multiple Sclerosis (MS)
Concept Map: Selected Topics in Neurological Nursing
PATHOPHYSIOLOGY
Traumatic Brain InjurySpinal Cord Injury
Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Huntington’s Disease Myasthenia Gravis Guillian-Barre’ Syndrome Meningitis Parkinson’s Disease
PHARMACOLOGY
--Decrease ICP--Disease / Condition Specific Meds
ASSESSMENTPhysical Assessment Inspection Palpation Percussion Auscultation
ICP Monitoring“Neuro Checks” Lab Monitoring
Care PlanningPlan for client adl’s, Monitoring, med admin.,Patient education, more…basedOn Nursing Process: A_D_P_I_E
Nursing Interventions & EvaluationExecute the care plan, evaluate for Efficacy, revise as necessary
Progressive
Degenerative
No Cure
Affects nerve fibers in the brain and spinal cord
Most common neurological cause of debilitation in young people (ages20 - 40)
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Multiple Sclerosis
Probably autoimmune disease
Antibodies and white blood cells attack the proteins in the neuron’s myelin sheath
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Pathology
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Inflammation in the nervous system destroys myelin, Schwann cells, and the oligodendrocytes. After tissue destruction a scar or hardening forms, the MS plaque. This can be visualized on MRI to aid in diagnosis of multiple sclerosis..
MyelinSheathAround nerve
“demyelinization” “demyelinating” “demyelinizing”
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Inflammation and injury to the sheath and ultimately to the nerves that it surrounds
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SchwannCell
Myelin Sheath
Dendrite
Axonterminal
Multiple areas of scarring…+
Hardening (Sclerosis) of nerve fibers...usually in spinal cord, brain stem and optic nerves
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What’s in a Name?
More women than men
More common in Caucasians
Children of parents with MS have a higher rate of incidence (15 – 50% depending on data source)
Geographic location --- Cold climate…?
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Risk Factors…
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Northern Europe and the northern United States have the highest prevalence, with more than 30 cases per 100,000 people
Based on the presence of CNS lesions that are disseminated in time and space (neurologic dysfunction in more than 2 sites at least one month apart), with no better explanation for the disease process
Because no single test is totally reliable in identifying MS, and a variety of conditions can mimic the disease, diagnosis depends on clinical features supplemented by the findings of certain studies such as:
- MRI (visualize plaques)- CSF analysis (increases protein and slight increase
WBCs)- Evoked potentials (define extent of disease and
monitors)
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Diagnosis
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"Turbo FLAIR" MRI
Because different nerves are affected at different times, MS symptoms often worsen (exacerbate), improve, and develop in different areas of the body
This disease is unpredictable and varies in severity
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Disease Progression – Erratic !
Intermittent damage to myelin…intermittent severity
Scarring and sclerosis of nerve fibers usually in the spinal cord, brain stem, and optic nerves…
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Hallmark Characteristics…
Fatigue - Muscle Weakness
Muscle Spasticity - Dyarthria
Ataxia = Balance + Coordination difficulty (dizziness / vertigo / spasticity of extremities)
Lhermitte's sign (Electrical sensation down the spine on neck flexion)
Dysphagia - Tinnitis
Uhthoff’s Sign (Exertion or Heat causes sudden exacerbation of S&S)
Numbness, tingling (Paresthesia) - Pain
Bowel, bladder and sexual dysfunction
Vision Disturbances (Blurring, blindness, diplopia, patchy blindness)
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Common S & Ss
Emotional labile
Depression (suicide increased 7.5%, usually in first 5 years)
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Common S & Ss
MS can progress steadily… or cause acute attacks (exacerbation) followed by partial or complete reduction in symptoms (remission)
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Course of Disease
Returns to baseline + recovery Increasing severity … maybe minor plateaus or remissions
85% 10-20%
Control symptoms
Prevent complications
Provide adaptive devices to increase mobility and self-care
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Collaborative Tx Goals
Avonex IM Weekly (interferon beta – 1a)
Betaseron SQ Daily (interferon beta 1b)
Copaxone SQ Daily
Rebif SQ given 3 x week
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Meds specific for MS disease
Baclofen / Dantrium (for spasms)
NSAIDS (for flu-like side effects and pain)
Analgesics
Corticosteroids (limit severity by modulating immune response which decreases inflammation)
Antidepressants (like Prozac)
Beta blockers for tremors (like Inderal)
Anticonvulsants for parethesia (like Tegretol)
Anticholinergics for bladder dysfunction (Pro-Banthine)
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Symptom Management Meds
Bacterial infections (lung, bladder)
Disturbed thought processes Impaired bladder & bowel function
Contractures
Seizures
Impaired mobility / speech / swallowing
Sensory & visual impairment
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Complications
In some people, MS is a mild illness, but, for others, it results in permanent
disability
Most patients have a normal lifespan
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Prognosis