Rhys Carlo M.

De Sesto

Multiple
Sclerosis

Chronic, progressive, degenerative disorder of the CNS

characterized by disseminated demyelination of nerve fibers of
the brain and spinal cord

Usually affects young to middle- aged adults, with onset

between 15 and 50 years of age

Women affected more than men

Etiology

Unknown cause

Related to infectious, immunologic, and genetic factors

Possible precipitating factors include

Infection
Physical injury
Emotional stress
Excessive fatigue
Pregnancy
Poor state of health

Pathophysiology

Mylelin sheath

Segmented lamination that wraps axons of many nerve

cells

Increases velocity of nerve impulse conduction in the

axons

Composed of myelin, a substance with high lipid content

Characterized by chronic inflammation, demyelination,

and gliosis (scarring) in the CNS

Initially triggered by a virus in genetically susceptible

individuals

Subsequent antigen-antibody reaction leads to

demyelination of axons

Pathogenesis of MS

Disease process consists of loss of myelin, disappearance of

oligodendrocytes, and proliferation of astrocytes

Changes result in plaque formation with plaques scattered

throughout the CNS

Initially the myelin sheaths of the neurons in the brain and

spinal cord are attacked, but the nerve fiber is not affected

Patient may complain of noticeable impairment of function

Myelin can regenerate, and symptoms disappear, resulting in a

remission

Myelin can be replaced by glial scar tissue

Without myelin, nerve impulses slow down

With destruction of axons, impulses are totally blocked

Results in permanent loss of nerve function

Clinical Manifestations

Vague symptoms occur intermittently over months and years

MS may not be diagnosed until long after the onset of the first
symptom

Characterized by

Chronic, progressive deterioration in some

Remissions and exacerbations in others

Common signs and symptoms include motor, sensory,

cerebellar, and emotional problems

Motor manifestations

Weakness or paralysis of limbs, trunk, and head

Diplopia (double vision)

Scanning speech

Spasticity of muscles

Sensory manifestations

Numbness and tingling

Blurred vision

Vertigo and tinnitus

Decreased hearing

Chronic neuropathic pain

Cerebellar manifestations

Nystagmus

Involuntary eye movements

Ataxia

Dysarthria

Dysphagia

Lack of coordination in articulating speech

Difficulty swallowing

Emotional manifestations

Anger

Depression

Euphoria

Bowel and bladder functions

Constipation

Spastic bladder: small capacity for urine results in

incontinence Flaccid bladder: large capacity for urine and
no sensation to urinate

Sexual dysfunction
Erectile dysfunction
Decreased libido
Difficulty with orgasmic response
Painful intercourse
Decreased lubrication

Diagnostic Studies

Based primarily on history, clinical manifestations, and

presence of multiple lesions over time measured by MRI

Certain laboratory tests are used as adjuncts to clinical

exam

Diagnosis based primarily on:

history and clinical manifestations

ruling out other causes of symptoms

No definitive diagnostic test

MRI demonstrates presence of plaques

Collaborative Care
Drug Therapy

Corticosteroids

Treat acute exacerbations by reducing edema

and inflammation at the site of demyelination

Do not affect the ultimate outcome or degree of

residual neurologic impairment from
exacerbation

Immunosuppressive Therapy

Because MS is considered an autoimmune

disease

Potential benefits counterbalanced against

potentially serious side effects

Antispasmotics (muscle relaxants)

Physical therapy helps

Relieve spasticity

Increase coordination

Train the patient to substitute unaffected

muscles for impaired ones

Nutritional therapy includes megavitamins and

diets consisting of low- fat, gluten-free food, and
raw vegetables

High-protein diet with supplementary vitamins is

often prescribed

Health History

Risk factors

Precipitation factors

Clinical manifestations

Nursing Diagnoses

Impaired physical mobility

Dressing/grooming self-care deficit

Risk for impaired skin integrity

Impaired urinary elimination pattern

Sexual dysfunction

Nursing Planning

Maximize neuromuscular function

Maintain independence in activities of daily living for as

long as possible

Optimize psychosocial well-being

Adjust to the illness

Reduce factors that precipitate exacerbations

Nursing Implementation

Help identify triggers and develop ways to avoid them or

minimize their effects

Reassure patient during diagnostic phase

Assist in dealing with anxiety caused by diagnosis

Prevent major complications of immobility

Focus teaching on building general resistance to illness

Avoiding fatigue, extremes of hot and cold, exposure

to infection

Teach good balance of exercise and rest, nutrition,

avoidance of hazards of immobility

Teach self-catheterization if necessary

Teach adequate intake of fiber to aid in regular bowel

habits

REFERERENCE: MEDICAL SURGICAL NURSING BOOK BY LEMONE 2014TH

MEDICAL SURGICAL NURSING BOOK BY BRUNNER AND
SUDDARTH LATEST EDITION