All if the following are clinical manifestations of what?
Numbness/tingling or weakness
Partial or complete loss of vision
Optic neuritis
Double or blurred vision
Decreased pain/sensation/temp perception
Electric shock sensations with head movement
Tremor, spasticities
Lack of coordination
Unsteady gait, ataxia
Fatigue
Dizziness, vertigo
Depression/paranoia
Reduced bowel & Bladder control
MS
What phase of MS is this
Condition worsens past relapsing-remitting
Early phase still has relapses
General deterioration occurs
No real recovery even though some improvement may be seen
- Secondary progressive
What stage of MS is this?
- Most common form
- Exacerbations bring NEW clinical manifestations while older ones worsens or reappears
- Lasts days or months
- Partial or Total recovery which can be slow or almost instant
- Relapsing and remitting
What phase of MS is this?
Progressive course with gradual worsening of clinical manifestations from onset.
Relapses may or may not have recovery.
- Progressive relapsing
What phase of MS is this?
Gradual progression
No remissions, but may see temporary plateaus
Occurs in late 30s, early 40s
Initial disease activity in spinal cord
Less likely to develop cognitive problems
- Primary progressive
How to dx MS
2 separate symptomatic events
MRI changes in 2 locations
Ways to r/o other conditions
Laboratory Testing to r/o other inflammatory or infectious diseases
Lumbar puncture to r/o viral infections
MRI to ID brain lesions
How long should a patient lay flat after a lumbar puncture
4-6 hours
How To decrease headache intensity after a lumbar puncture?
encourage fluids
If headache persists for a couple weeks post-lumbar puncture what can be done?
blood patch
Medications to slow progression of MS
Beta interferons
Interferon beta-1b
Immunosuppressive agents
Medications to treat MS attacks
Corticosteroids
Plasmapheresis
Medications to treat clinical symptoms of MS
Muscle relaxants and anti-spasmotics
Anticholinergics
Pain medications
Antidepressants
Anticonvulsants
Antimuscarinics
Laxatives
Priority Nursing assessments for MS
Neuromuscular Function
Vision/Eye Movement
Skin Integrity
Ability to Perform ADLs
Bowel Function
Bladder Function
Priority Nursing Interventions for MS
- Encourage ROM
- Administer medications as prescribed
- Implement safety measures
- Alternate patching of the eyes daily, as needed
- Promote regular elimination through bladder and bowel training programs
- Balance activity with rest periods
- Assess need for assistive devices
- Initiate PT and OT
- Encourage independence
Complications of MS
- Muscle stiffness or spasms
- Paralysis, often in the legs
- Problems with bladder, bowel, sexual function
- Mental status changes - memory loss & problems concentrating
- Depression
- Seizures
- Pressure injuries r/t immobility
- Skin breakdown r/t bowel & bladder incontinence
- Ataxic gait r/r weakness and loss of position sense
- Speech defects r/t muscle weakness
Teaching for MS patients
- Instruct on proper use of assistive devices
- Instruct on increased fluid intake
- Instruct on low-fat, high-fiber diet
- Instruct on safety measures related to: Temperatures (water, heating pads) and Fall Precautions
- Instruct on medication administration
- Instruct on community resources (National MS Society)
How to correct diplopia
Patch each eye daily as needed in patients with visual deficits and/or diplopia — Alternating the patching of each eye several times per day improves balance and vision.
Diet for MS patients
- Low fat-diet
- High fiber
- Increase fluid intake
Safety measures for patients with MS
- Temperature of heating pads and water
- Fall precautions
Labs to test for when ruling out other conditions to confirm MS diagnosis
Blood Tests
- Vitamin B 12
- Vitamin E
- Lyme titer
- ANA
- Angiotenstion converting enzymes
- HIV/HTLV
- ESR
- RPR
List clinical manifestations of MS
- Numbness/tingling or weakness
- Partial or complete loss of vision
- Optic neuritis
- Double or blurred vision
- Decreased pain/sensation/temp perception
- Electric shock sensations with head movement
- Tremor, spasticities
- Lack of coordination
- Unsteady gait, ataxia
- Fatigue
- Dizziness, vertigo
- Depression/paranoia
- Reduced bowel & Bladder control
