NRSG 3200 Unit 10 Multiple Sclerosis(answered)2022

Multiple Sclerosis An immune-mediated, progressive demyelinating disease of the CNS. Risk Factors Age - most commonly people who are age 20-40 Gender - Women are twice as likely as men Family History - 1 in 3 chance if parent or sibling has MS Certain Infections - Epstein-Barr virus linked to MS Ethnicity - European Other Autoimmune Diseases - Thyroid Disease, Type 1 DM, Inflammatory Bowel Disease Environmental- smoking, lack of vitamin D exposure 00:06 01:14 Cells that make the myelin sheath in the CNS oligodendrocytes Demyelination interrupts the flow of nerve impulses and results in a variety of manifestation, depending on the nerves affected. The areas most frequently affected are: the optic nerves, chiasm, and tracts; the cerebrum; the brainstem and cerebellum; and the spinal cord. Relapsing-remitting MS Approximately 85% of patients have this type of MS. Characterized by clearly acute attacks with full recovery or with sequelae and residual deficit upon recovery. Periods between disease relapses are characterized by lack of disease progression. With each relapse, recovery is usually complete; however, residual deficits may occur and accumulate over time, contributing to functional decline. Over time, most patients with this type of MS progress to a secondary progressive course, in which disease progression occurs with or without relapses. Primary Progressive MS Approximately 15% of patients have this type of MS. Disabling symptoms steadily increase, with rare plateaus and temporary minor improvement. It may result in quadriparesis, cognitive dysfunction, visual loss, and brainstem syndromes. S/S of MS Varied based on the location of the lesions. Bladder dysfunction Bowel dysfunction Cognitive impairment Depression Fatigue Gait impairment Heat intolerance Pain Paroxysmal symptoms Seizures Sexual dysfunction Sleep disturbances Spasticity Speech, swallow , and respiratory dysfunction Tremors Vertigo Visual disturbances ____ affects most people with MS and is often the most disabling symptom. Fatigue Avoiding hot temperatures, effective treatment of depression and anemia, a change in medication as well as occupational and physical therapies may... help manage fatigue Many people with MS need daily analgesic medications. In some cases, pain is managed with ____, ___, or ____ opioids; anticonvulsant medications; antidepressants Among women who are perimenopausal, those with MS are more likely to have pain related to ____ osteoporosis In addition to estrogen loss, immobility and corticosteroid therapy play a role in the development of ____ among women with MS. ____ testing is recommended for this high-risk group. osteoporosis; Bone mineral density ____ occurs in 90% of MS patients, most often in the lower extremities, and can include loss of abdominal reflexes. Spasticity Researchers reported that patients with MS have higher rates of... depression, arthritis, diabetes, coronary artery disease, migraine headaches, and cancer. Complications of MS UTIs Constipation Pressure ulcers Contracture deformities Dependent pedal edema Pneumonia Osteoporosis Emotional, social, marital, economic, and vocational problems During exacerbations, new symptoms ____ and existing ones ____. appear; worsen During remissions, symptoms ____ or ____. decrease; disappear Relapses may be associated with ___ and ____ ____ emotional; physical stress Gerontologic Considerations for MS Life expectancy is 5-7 years shorter than those without MS. They may have chronic health problems, for which they may be taking additional medications that could interact with their MS meds. They must be monitored for adverse and toxic effects of MS meds and for osteoporosis (especially if corticosteroids are used frequently to treat exacerbations). The cost of medications may lead to poor adherence. They may be concerned about increasing disability, family burden, marital concern, and possible future need for nursing home care. Immobility contributes to loneliness and depression. They tend to have an increased need for assistance with self-care. A diagnosis of MS is based on the presence of multiple plaques in the CNS observed with ____ MRI Medical Management of MS No cure Stem cell treatment is newly approved by the FDA Disease-modifying therapies [DMT] - Decreases relapse rates, and slows accumulation of brain lesions on MRI Interferon B-1a and interferon B-1b Symptom management Promote independence for as long as possible PT, OT, ST, bowel and bladder training Complementary and Alternative Medicine Exercise, meditation, yoga, relaxation, acupuncture, massage, vitamins & mineral, herb supplements The goals of treatment are to ___, ____, and ____ delay the progression of the disease; manage chronic symptoms; treat acute exacerbations Interferon beta-1a and 1b Disease-modifying medications. May be given subcutaneously every other day or IM once a week. Side effects: flulike symptoms in half of patients taking them. For optimal control, they should be started early in the course of the disease. _______, the key agent in treating acute relapse in the relapsing-remitting course, shortens the duration of relapse but has not been found to have long-term benefit. IV methylprednisolone _____ is the medication of choice for treating spasticity Baclofen Nursing Assessment of Patient with MS Address neurologic deficits, secondary complications, and impact of the disease on the patient and family. Observe the patient's mobility and balance- determine fall risk. Assess function when the patient is well rested as well as when they are fatigued. Assess for weakness, spasticity, visual impairment, incontinence, and disorders of swallowing and speech. Assess how MS has affected the patient's lifestyle Assess the patient's coping Assess patient adherence to prescribed medication regimen Inquire what the patient would like to improve Nursing Diagnoses Impaired bed and physical mobility Risk for injury Impaired urinary elimination (urgency, frequency, incontinence) Constipation Bowel incontinence Impaired verbal communication Risk for aspiration Chronic confusion Ineffective coping Impaired home maintenance management Ineffective sexuality pattern Patient Goals/Outcomes Promotion of physical mobility Avoidance of injury Achievement of bladder and bowel continence Promotion of speech and swallowing mechanisms Improvement of cognitive function Development of coping strengths Improved home maintenance management Adaptation to sexual dysfunction Nursing Interventions to Promote Physical Mobility Teach relaxation and coordination exercises to promote muscle efficiency. Teach progressive resistive exercises to strengthen weak muscles. Encourage patients to walk. Instruct about how to use an assistive device. Warm packs can help with spasticity. Discourage against hot baths because of the burn potential. Encourage daily exercise and muscle stretching. Swimming is a good option for these patients. Encourage the patient to work and exercise to a point just short of fatigue. Very strenuous activity is not advised because it raises body temperature and may aggravate symptoms. Advise the patient to take frequent short rest periods, preferably lying down. Promote healthy eating and weight reduction. Avoid alcohol and cigarettes. Encourage the patient to perform coughing and deep breathing exercises. Nursing Interventions to Prevent Injury Instruct patient to walk with feet apart to widen the base of support and increase walking stability. If loss of position sense occurs, instruct the patient to watch their feet while walking. Gait training may require assistive devices and instruction about their use by a physical therapist. A wheelchair may be needed if gait remains inefficient. Include occupational therapist as a resource in suggesting aids that will promote independence. Weighted bracelets or wrist cuffs are helpful for tremors. Train patient in transfers and ADLs. Take precautionary measure to prevent pressure ulcers. Nursing Interventions to Enhance Bladder and Bowel Control Keep the bedpan or urinal readily available. Set up a voiding schedule Instruct the patient to drink a set amount of fluid every 2 hours and then attempt void 30 minutes after drinking. The use of a timer or wristwatch may be helpful for those who do not have enough sensation to signal the need to empty the bladder. Encourage the patient to take the prescribed medications to treat bladder spasticity, because this allows greater independence. Intermittent self-catheterization may be used in some cases. Female patients with permanent urinary incontinence may consider urinary diversion procedures. Male patients with permanent urinary incontinence may consider the use of a condom catheter. Promote adequate fluids, dietary fiber, and bowel training program. Nursing Interventions for Enhancing Communication and Managing Swallowing Difficulties Involve speech-language pathologist in evaluating speech and swallowing and teaching ways to compensate for problems identified. The nurse reinforces instruction and encourages the patient and family to adhere to the plan. Nursing Interventions to Improve Cognitive Function An eye patch may be used to help with double vision. Prism glasses may be helpful for patients who are confined to bed and have difficulty reading in the supine position. Encourage obtaining reading that is available in large-print or audio books Make sure the family is aware of the nature and degree of cognitive impairment. Encourage support of family and friends. Assist the patient to set meaningful and realistic goals. Encourage the patient to remain as active as possible. Encourage the patient to maintain interests and activities. Promote hobbies. Keep environment structured Reduce distractions Use lists and other memory aids to help the patient maintain a daily routine. Occupational therapist may be helpful in formulating a structured daily routine. Nursing Interventions for Strengthening Coping Mechanisms Assist patients and families to manage or reduce stress Make appropriate referrals for counseling and support to minimize the adverse effects of dealing with chronic illness. Initiate home care and coordinate a network of services such as social services, speech therapy, physical therapy, and home maker services. Provide as much information as possible. Provide a list of available assistive devices, services, and resources. Assist the patient with problem solving. Encourage the patient to plan carefully, maintain flexibility, and preserve a hopeful attitude. Nursing Interventions to Improve Home Management Encourage modifications that allow independence (assistive eating devices, raised toilet seat, bathing aids, telephone modifications, long-handed comb, tongs, modified clothing, etc) Recommend air conditioning in at least one room. Warn against extreme heat and cold. Nursing Interventions to Promote Sexual Functioning A sexual counselor can help bring up resources and suggest relevant information and supportive therapy. Encourage the patient to share and communicate their feelings. Suggest planning sexual activity to minimize the effects of fatigue. Suggest exploring alternative methods of sexual expression. Patient and Family Education Teach strategies to maintain optimal independence. Educate about self-care techniques Educate about the use of assistive devices, self-catheterization, and administration of medications. Educate about exercises that enable the patient to continue some form of activity or that maintain or improve swallowing, speech, or respiratory function. Encourage the patient to contact the local MS society for services, information, and contact with others with MS. Evaluation of Patient Goals/Outcomes- Improves Physical Mobility Participates in gait training and rehabilitation program. Establishes a balanced program of rest and exercise. Uses assistive devices correctly and safetly Evaluation of Patient Goals/Outcomes- Preventing Injury Uses visual cues to compensate for decreased sense of touch or position. Asks for assistance when necessary. Evaluation of Patient Goals/Outcomes- Bladder/Bowel Control Monitors self for urine retention and employs intermittent self-catheterization technique, if indicated. Identifies the signs and symptoms of UTIs. Maintains adequate fluid and fiber intake. Identifies the foods that are constipating versus food that increase gastric motility. Evaluation of Patient Goals/Outcomes- Improvement of Speech and Swallowing Practices exercises recommended by the speech therapist. Maintains adequate nutritional intake without aspiration. Evaluation of Patient Goals/Outcomes- Compensates for Chronic Confusion Uses lists and other aids to compensate for memory losses. Discusses problems with trusted advisor or friend. Substitutes new activities for those that are no longer possible. Evaluation of Patient Goals/Outcomes- Demonstrates Effective Coping Strategies Maintains sense of control. Modifies lifestyle to fit goals and limitations. Verbalizes desire to pursue goals and developmental tasks of adulthood. Demonstrates healthy social interactions. Participates in groups or community activities. Evaluation of Patient Goals/Outcomes- Adheres to Plan for Home Maintenance Uses appropriate techniques to maintain independence. Engages in health-promotion activities and health screenings as appropriate Evaluation of Patient Goals/Outcomes- Adapts to Changes in Sexual Function Is able to discuss problem with partner and appropriate health professional. Identifies alternative means of sexual expression.