Multiple Sclerosis
Introduction
Multiple sclerosis is a chronic and disabling disease that usually starts in young adults and is 2.3 times more common in women than men. It is caused by damage to nerve cells in the CNS. Myelin is produced by oligodendrocytes, which are a group of cells that support neurons.
In multiple sclerosis, demyelination occurs when the immune system inappropriately attacks and destroys the myelin, which makes communication between neurons break down, ultimately leading to sensory, motor and cognitive problems.
Definition
Multiple sclerosis is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of the nervous system to communicate, resulting in a range of signs and symptoms.
Causes
- Unknown
- Autoimmune dysfunction
- Infectious process
Risk Factors
- Dysarthria
- Nystagmus
- Intention tremor
Pathophysiology
Clinical Manifestations
Diagnostic Evaluations
- History collection (infection, genetic factors)
- Neurological examination
- CT Scan
- CSF Examination
- Electrophoresis study
- Visual evoked potential
Management
Medical Management
- Corticosteroids therapy.
- MRI.
- Alkylating agents, e.g., cyclophosphamide.
- Use of interferon beta-1a (Avonex) and interferon beta-1b (Betaseron), for reducing rate and size of multiple sclerosis plaques in CNS also decreases severity.
Nursing Management
- Provide psychological support to the patient and family.
- Increase comfort with massages and relaxing baths.
- Administer medications as prescribed.
- Promote emotional stability. Help the patient establish a daily routine to maintain optimal functioning.
- Keep bedpan or urinal readily accessible because the need to void is immediate.
- Encourage the patient to take adequate fluid and regular urination.
- Assess adverse reactions to administered medications.
- Monitor bowel and bladder function during hospitalization.
- Assess patient's neurologic status for deficits.
- Nurse should encourage patient and family to develop and strengthen problem-solving skills to deal with situation.
- We should encourage the patient/family for expression of feelings, including frustration, anger, hopelessness etc.
- Identify community resources, e.g., support groups, home care agencies, to provide information and opportunities to share with other similar patients/family.
- Emphasize the importance of exercise.
- Nurse should teach the patient about bowel and bladder training if necessary.
- Encourage patient input in planning schedule.
- Encourage/instruct scheduling activities early in the day or during the time when energy level is high.
- We should anticipate hygiene needs and assist as necessary with care of nails, skin, hair, mouth and shaving.
Nursing Diagnosis
- Fatigue related to decreased energy/weakness.
- Self-care deficit related to neuromuscular and motor impairment, tremors, fatigue.
- Low self-esteem related to dependence on others, body changes.
- Impaired urinary pattern related to incontinence, retention, frequency of urine due to neuromuscular impairment.
- Risk for ineffective coping/disabled family coping related to physiological changes, psychological changes, anxiety, situational crisis, role changes.
- Deficient knowledge related to disease process, prognosis, treatment and needs.
- Impaired verbal communication related to impaired speech.