MULTIPLE SCLEROSIS

- abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminate

- usually diagnosed between ages of 20 and 40, and in 2–3 times as many women as
men.
- is an autoimmune condition in which the immune system attacks the central nervous
system (CNS), leading to demyelination
demyelination- damages the myelin sheath and neurons
- this damage slows down or blocks messages between your brain and your body, leading
to the symptoms of MS

MAIN PROBLEM:
damage to the myelin sheath
affects the areas of the brain and spinal cord known as the white matter

COMMON MANIFESTATIONS:
• Visual disturbances, which may include eye pain, distortion or loss of vision in one eye, or
impairment of color perception
• Difficulty walking or performing tasks that require coordination
• Loss of sensation
• Fatigue and/or weakness
• Loss of bowel or bladder control

NURSING DIAGNOSIS:
Primary: Impaired Physical Mobility related to neuromuscular impairment, decreased strength
and fatigue

Nursing Interventions:

>Encourage and facilitate early ambulation and other ADLs when possible.
>Facilitate transfer training by using appropriate assistance of persons or devices when
transferring patients to bed, chair, or stretcher.
>Encourage appropriate use of assistive devices in the home setting.
>Provide positive reinforcement during activity.
>Allow patient to perform tasks at his or her own rate.
>Keep side rails up and bed in low position. This promotes a safe environment.
>Turn and position every 2 hours or as needed.
>Maintain limbs in functional alignment (e.g., with pillows, sandbags, wedges, or prefabricated
splints).
>Perform passive or active assistive ROM exercises to all extremities.
>Encourage coughing and deep-breathing exercises.
>Encourage liquid intake of 2000 to 3000 ml/day unless contraindicated.
>Initiate supplemental high-protein feedings as appropriate.
>Set up a bowel program (e.g., adequate fluid, foods high in bulk, physical activity, stool
softeners, laxatives) as needed.
>Administer medications as appropriate. Antispasmodic medications may reduce muscle
spasms or spasticity that interfere with mobility.
Secondary: Impaired Bowel and Bladder Elimination related to neuromuscular impairment

Nursing Interventions:

Constipation:
>Encourage daily fluid intake of 2000 to 3000 ml/day, if not contraindicated medically.
>Encourage increased fiber in diet (e.g., raw fruits, fresh vegetables); a minimum of 20 g of
dietary fiber per day is recommended.
>Encourage patient to consume prunes, prune juice, cold cereal, and bean products.
>Encourage a regular time for elimination.
>Encourage isometric abdominal and gluteal exercises.

Incontinence:
>Note frequency, urgency, burning, incontinence, nocturia, size of/force of urinary stream.
Palpate bladder after voiding
>Institute bladder training program
>Encourage adequate fluid intake, limiting intake during late evening and at bedtime.
Recommended use of cranberry juice/vitamin C.
>Promote continued mobility
>Recommend good handwashing/perineal care.

MEDICAL MANAGEMENT
Medications for relapsing MS:
>Beta interferons
>Glatiramer (Copaxone)
>Natalizumab (Tysabri)

Medications for progressive MS:

>Corticosteroids
>Muscle relaxants - Baclofen (Lioresal) and tizanidine (Zanaflex)
>Medications to reduce fatigue - amantadine (Symmetrel) and modafinil (Provigil)