NURS 4385 MS,ACL AND GB 2023 GUIDE 2023 A+
SUCCESS ASSUARED
Multiple Sclerosis (Mylin Sheets)
• Affects everything in the brain AND spinal cord
• Autoimmune disease, problem in the CNS (brain and spinal cord). Neuron inflammation
forms scaring causing a decrease of transmission of nerve signals.
• Affect mostly skeletal muscles.
• Priority= Respiratory depression
• Usually on women 20-40ys, unknown cause, common in families.
• Mimic signs of stroke.
Nurse Intervention:
• Prolong life, make them comfortable, but they will not survive because they cannot breathe
on their own.
• Triggers: Suppress immune system we can prolong life.
Diagnosis:
• Takes time, and it is a rule out process until it can be proven that is MS
• Neurologist= MRI and CT show plaque on brain and spine
• Lumbar puncture high levels of antibodies (high protein=inflammation)
Signs and Symptoms:
• Main problem: stiffening. Stiffness of tissue (muscles in this case)
• Motor problems, and some point sensory problems (issues w sensation), and coordination
• Late stages: cognitive problems (at some point)
• LOC will be affected and die as a vegetable.
• Triggers could speed up/exacerbation that provoke immobility.
• Priority: RESPIRATORY DEPRESSION!
• Excessive temperatures (too hot/cold)
• Pregnancy (most women get diagnosed)
• Infection
Areas
• Cerebellar areas
o Coordination (unsteady gait, balance, Lose ADLs)
o affect eyes and move to other parts of body.
Early signs
• Cognitive: Fatigue, speech issues, DISPHESIA,
, NURS 4385 MS,ACL AND GB 2023 GUIDE 2023 A+
SUCCESS ASSUARED
• Sensory: spasms, dizziness, tingling, coordination problems, Lhermitte’s sign (assess- ask pt
to move head in different directions, Passive/active neck flexion they report electric shock
that goes from head, to back, to legs)
• Vision: optic neurotic, double vision, blurred, Pain in the eye (move side to side), dark spots
• Elimination: nocturia overactive bladder, lose control of bladder and then retention, could
have constipation or diarrhea in the beginning.
Late signs (PROGRESSIVE)
• Cognitive: Depression, mood swings, forget who they are…, trouble thinking.
• Sensory: Tinnitus, hearing problems, Romberg’s sign (balance test- Cerebellar function
is completely messed up). We must talk about SAFETY-RISK FALL
• Vision: Nystagmus (eyes make uncontrolled movements)
• Elimination: Completely lost their bowel. Incontinence. Think about diapers, in-out
catheters. Male- sexual dysfunction
If they encounter a trigger, they get an exacerbation and they get worst. They will never go back to
baseline, and they will die.
Complications
• Focus on pt, things you can do to slow down the progression.
o Safety, prevention, stage
o PT/OT (beginning)
o Bladder regulation
o Help with memory (still cognitive).
• Clots
o DVT prevent.
▪ Prevent DVT: Heparin, Levonox,
• PE will be the most developed
• Constant UTI
• Risk for osteoporosis and contractures
o If you have a contracture, you cannot straight it anymore.
• Prevent Pressure injures
o Q2turns
o Off boney prominences
o Keep skin moisturized (reduce friction)
• Prevent pneumonia:
o VACCINATIONS (PNEUMOCCOCAL)
o Reposition, turn, high fowlers,
o Physiotherapy
o Prophylactic antibiotics.
• Prevent Contracture:
o Passive ROM
o Assistive devices
o Reposition.
, NURS 4385 MS,ACL AND GB 2023 GUIDE 2023 A+
SUCCESS ASSUARED
• Prevent Osteoporosis
o Passive ROM
• Always allow the patient to work independently as much as they can in the
beginning. Questions:
• How sleep at night? Turn on AC (heat is very bad for MS patients)
• Immunosuppress patient, to slow down the progression (steroids)
o Priority- Risk for infection
Medications
• Bladder issues: Bethanechol, oxybutynin
• Fatigue: Amantadine, modafinil
• Spasms: Baclofen (pump), dantrolene, diazepam
• Tremors: propranolol, isoniazid
ALS (Amyotrophic Lateral Sclerosis)
Is also called Lou Gehrig’s disease. Only affects the mobility part. It’s a progressive paralysis (only
movement) Sensation and cognitive are intact.
• They are there, they cannot talk, only move the eyes. They understand everything, but unable
to move.
ALS= Advance Life Support.
• Pt’s will likely have to go on a ventilator to be a life. (intubated) because t
o Won’t be able to breath on their own.
• It presents as a deterioration of motor neurons in the brain and spinal cord, resulting
in progressive TOTAL body paralysis.
• Expected life 3-5 years
o Usually die on Respiratory Failure (usually at 3 years)
• Mechanical ventilation can lead to pneumonia
• More in men
o 2 in 1 woman
• Onset
o After 55 y/o
• DOES NOT affect your senses or intelligence.
Signs and Symptoms
• Progressive paralysis
o Mayor muscles
▪ Legs: problems walking, start tripping
• Difficulty breathing, swallowing (NPO), speaking, constipation.
SUCCESS ASSUARED
Multiple Sclerosis (Mylin Sheets)
• Affects everything in the brain AND spinal cord
• Autoimmune disease, problem in the CNS (brain and spinal cord). Neuron inflammation
forms scaring causing a decrease of transmission of nerve signals.
• Affect mostly skeletal muscles.
• Priority= Respiratory depression
• Usually on women 20-40ys, unknown cause, common in families.
• Mimic signs of stroke.
Nurse Intervention:
• Prolong life, make them comfortable, but they will not survive because they cannot breathe
on their own.
• Triggers: Suppress immune system we can prolong life.
Diagnosis:
• Takes time, and it is a rule out process until it can be proven that is MS
• Neurologist= MRI and CT show plaque on brain and spine
• Lumbar puncture high levels of antibodies (high protein=inflammation)
Signs and Symptoms:
• Main problem: stiffening. Stiffness of tissue (muscles in this case)
• Motor problems, and some point sensory problems (issues w sensation), and coordination
• Late stages: cognitive problems (at some point)
• LOC will be affected and die as a vegetable.
• Triggers could speed up/exacerbation that provoke immobility.
• Priority: RESPIRATORY DEPRESSION!
• Excessive temperatures (too hot/cold)
• Pregnancy (most women get diagnosed)
• Infection
Areas
• Cerebellar areas
o Coordination (unsteady gait, balance, Lose ADLs)
o affect eyes and move to other parts of body.
Early signs
• Cognitive: Fatigue, speech issues, DISPHESIA,
, NURS 4385 MS,ACL AND GB 2023 GUIDE 2023 A+
SUCCESS ASSUARED
• Sensory: spasms, dizziness, tingling, coordination problems, Lhermitte’s sign (assess- ask pt
to move head in different directions, Passive/active neck flexion they report electric shock
that goes from head, to back, to legs)
• Vision: optic neurotic, double vision, blurred, Pain in the eye (move side to side), dark spots
• Elimination: nocturia overactive bladder, lose control of bladder and then retention, could
have constipation or diarrhea in the beginning.
Late signs (PROGRESSIVE)
• Cognitive: Depression, mood swings, forget who they are…, trouble thinking.
• Sensory: Tinnitus, hearing problems, Romberg’s sign (balance test- Cerebellar function
is completely messed up). We must talk about SAFETY-RISK FALL
• Vision: Nystagmus (eyes make uncontrolled movements)
• Elimination: Completely lost their bowel. Incontinence. Think about diapers, in-out
catheters. Male- sexual dysfunction
If they encounter a trigger, they get an exacerbation and they get worst. They will never go back to
baseline, and they will die.
Complications
• Focus on pt, things you can do to slow down the progression.
o Safety, prevention, stage
o PT/OT (beginning)
o Bladder regulation
o Help with memory (still cognitive).
• Clots
o DVT prevent.
▪ Prevent DVT: Heparin, Levonox,
• PE will be the most developed
• Constant UTI
• Risk for osteoporosis and contractures
o If you have a contracture, you cannot straight it anymore.
• Prevent Pressure injures
o Q2turns
o Off boney prominences
o Keep skin moisturized (reduce friction)
• Prevent pneumonia:
o VACCINATIONS (PNEUMOCCOCAL)
o Reposition, turn, high fowlers,
o Physiotherapy
o Prophylactic antibiotics.
• Prevent Contracture:
o Passive ROM
o Assistive devices
o Reposition.
, NURS 4385 MS,ACL AND GB 2023 GUIDE 2023 A+
SUCCESS ASSUARED
• Prevent Osteoporosis
o Passive ROM
• Always allow the patient to work independently as much as they can in the
beginning. Questions:
• How sleep at night? Turn on AC (heat is very bad for MS patients)
• Immunosuppress patient, to slow down the progression (steroids)
o Priority- Risk for infection
Medications
• Bladder issues: Bethanechol, oxybutynin
• Fatigue: Amantadine, modafinil
• Spasms: Baclofen (pump), dantrolene, diazepam
• Tremors: propranolol, isoniazid
ALS (Amyotrophic Lateral Sclerosis)
Is also called Lou Gehrig’s disease. Only affects the mobility part. It’s a progressive paralysis (only
movement) Sensation and cognitive are intact.
• They are there, they cannot talk, only move the eyes. They understand everything, but unable
to move.
ALS= Advance Life Support.
• Pt’s will likely have to go on a ventilator to be a life. (intubated) because t
o Won’t be able to breath on their own.
• It presents as a deterioration of motor neurons in the brain and spinal cord, resulting
in progressive TOTAL body paralysis.
• Expected life 3-5 years
o Usually die on Respiratory Failure (usually at 3 years)
• Mechanical ventilation can lead to pneumonia
• More in men
o 2 in 1 woman
• Onset
o After 55 y/o
• DOES NOT affect your senses or intelligence.
Signs and Symptoms
• Progressive paralysis
o Mayor muscles
▪ Legs: problems walking, start tripping
• Difficulty breathing, swallowing (NPO), speaking, constipation.
