G MULTIPLE SCLEROSIS.pdf

IMMUNE-MEDIATED PROGRESSIVE DEMYELINATING DISEASE OF THE CNS ETIOLOGY  RISK FACTORS GENETICS Gender: >2-3x females Family hx of MS Race: > Caucasians ENVIRONMENTAL northern climates...

IMMUNE-MEDIATED PROGRESSIVE DEMYELINATING DISEASE OF THE CNS ETIOLOGY  RISK FACTORS GENETICS Gender: >2-3x females Family hx of MS Race: > Caucasians ENVIRONMENTAL northern climates Infections (Epstein Barr Virus) Socioeconomic status < rural areas, lower class Migration: < 15 years old – risk is with people place moved to > 15 years old – risk stays 3 properties of a neuron Excitability Conductivity Ability to influence other neurons  Sensitized T cells, B lymphocytes cross BBB Remains in CNS promote infiltration-inflammation Production of inflammatory cytokines Demyelination, destruction of oligodendrocytes Formation of plaques Scarring, destruction of sheath Scattered irregularity theoughout CNS Interruption of nerve impulses MULTIPLE SCLEROSIS  OPTIC CORTICO CORTICO BULBAR SPINAL AREAS AFFECTED POSTERIOR CEREBELLAR COLUMNS OF SC MEDIAL LONGITUDINAL SPINOCERE FASCICULUS BELLAR LHERMITTE’S SYMPTOM uses an electrical current on a CSF sample to separate out types of protein called immunoglobulins.  visual evoked potential (VEP) measures electrical response of the brain's primary visual cortex to a visual stimulus. To measure the electrical response place 3 electrodes on the scalp.  TREATMENT 1. DISEASE-MODIFYING Pharmacologic therapy A VONEX (Beta Interferon 1a, IM) B ETASERON (Beta Interferon1b) C OPAXONE (Glatiramer Acetate) R EBIF (Beta Interferon 1a) IMMUNE ENHANCERS 2. FOR ACUTE EXACERBATIONS: Corticosteroids (Methylprednisolo ne) ACTH Plasmapheresis  Plasmapheresis plasma, is separated from the blood cells plasma is replaced with another solution such as saline or albumin, or the plasma is treated and returned to body 3. FOR TREATMENT OF SYMPTOMS For spasticity: Baclofen (Lioresal), Benzodiazepine Valium) Dantrolene (Dantrium) Tizanidine ( Zanaflex) For fatigue: Amantadine ( Symmetryl) Fluoxetine (Prozac)  For ataxia: Beta adrenergic blockers – Inderal Antiseizure agents – Neurontin Benzodiazepines – Klonopin For bladder problems: Ascorbic acid (vit C) Anticholinergics 4. For secondary progressive: * Novantrone – reduces frequency of relapses NURSING INTERVENTION PROMOTE OPTIMUM MOBILITY A. MUSCLE-STRETCHING & STRENGTHENING EXERCISES B. WALKING EXERCISES TO IMPROVE GAIT USE WIDE –BASED GAIT  C. ASSISTIVE DEVICES: CANES, WALKER, RAILS, WHEELCHAIR AS NEEDED D. MINIMIZE SPASTICITY & CONTRACTURES Administer medication as ordered Exercises  E. ACTIVITY & REST Frequent rest periods Fatigue exacerbates symptoms F. ENCOURAGE INDEPENDENCE IN SELF CARE G. PREVENT COMPLICATIONS OF IMMOBILITY  PREVENT INJURY Test bath water with thermometer Avoid heating pads, hot water bottles Frequent position changes Inspect body parts for injury ENHANCE BLADDER & BOWEL CONTROL 1. Force fluids 3000 ml/day 2. use of acid-ash foods (cranberry, grape juice) 3. URINARY RETENTION: intermittent catheterization bethanecol chloride 4. URINARY INCONTINENCE: Establish voiding schedule Anticholinergic: propantheline bromide, tolterodine (Detrol)  BOWEL * ADEQUATE FLUIDS * DIETARY FIBER * BOWEL TRAINING PROGRAM  ENHANCE COMMUNICATION & MANAGING SWALLOWING DIFFICULTIES *REFER FOR SPEECH THERAPY /SWALLOWING PROBLEMS *PREVENT ASPIRATION  IMPROVE SENSORY & COGNITIVE FUNCTION 1. VISION: DIPLOPIA – use eye patch Prism glasses if in supine position Large prints or audio books  2. PROVIDE PSYCHOLOGICAL SUPPORT Refer to MS societies & encourage community positive agencies attitude, assist in setting realistic goals Provide compassion in adapting to Provide no changes in body false hope image & self concept  PROMOTING SEXUAL FUNCTIONING USE OF ALTERNATIVE METHODS FOR SEXUAL GRATIFICATION REFER FOR SEXUAL COUNSELLING  PROVIDE TEACHING & DISCHARGE Well-balance PLANNING Balance diet between activity & rest Fresh air & sunshine Use of energy conservation techniques Avoid fatigue, overheating, chilling, stress, Regular exercise – infection walking, swimming, biking  corticobulbar tract descending pathway medial longitudinal innervating CN, fasciculus - found in Innervates muscles of the brainstem is a set of crossed fibers with face, tongue, jaw, and ascending and descending pharynx, via CN3(5,7,1112] fibers. links the 3 CN which control EOM, & CN VIII spinocerebellar tracts carry unconscious proprioceptive information gleaned from muscle spindles, Corticospinal tract Golgi tendon organs, and joint pyramidal tract capsules to the cerebellum. carry movement-related information from the The cerebellum is for making cerebral cortex to the postural adjustments to maintain balance. spinal cord. Scanning speech is a type of ataxic dysarthria spoken words are broken up into separate syllables, often separated by a noticeable pause, & spoken with varying force. weakness and/or incoordination of the muscles of the tongue, lips, cheeks and mouth Nystagmus in MS r/t nerve damage to the cerebellum or brainstem, regions of the brain which co-ordinate balance, muscle movements and vision. may arise from damage to CN II so that visual information is not intepreted correctly.