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Lesson 33. Multiple Sclerosis


a. Definition. Multiple Sclerosis (MS) is a chronic, progressive disease of the central nervous system characterized by the destruction of myelin. Myelin is the fatty and protein material that covers certain nerve fibers in the brain and spinal cord.

(1) The cause of MS is unknown. Research is investigating the possibilities of infection by slow virus, alteration in the immune system, and genetic factors.
(2) Multiple Sclerosis primarily affects adults between 20 and 40 years of age.

b. Signs and Symptoms.

(1) Weakness.
(2) Visual disturbances (nystagmus, blurred vision, blindness).
(3) Slurred, hesitating speech.
(4) Intention tremor.
(5) Abnormal reflexes (absent or hyperactive).
(6) Ataxia.
(7) Paraplegia.
(8) Urinary and bowel incontinence/retention.
(9) Emotional lability; (depressed, euphoric).

c.      Medical and Nursing Management.

(1) Objectives of care.

(a) To keep the patient as active and functional as possible in order to lead a purposeful life.
(b) To relieve the patient's symptoms and provide him/her with continued support.

(2) Instruct patient to perform muscle stretching exercises to minimize join contractu res.

(a) Particular emphasis on hamstrings, gastrocnemius, hip adductors, biceps, wrist and finger flexors.
(b) Instruct family about passive range of motion exercises for patients with severe spasticity.
(c) Advise patient to prevent muscle fatigue with frequent rest periods.
(d) Instruct patient to participate in walking exercises to improve gait affected by loss of position sense in legs.
(e) Administer muscle relaxants as ordered.
(f)   Utilize braces, canes, crutches, walkers when necessary to keep patient ambulatory.

(3) Avoid skin pressure and immobility.

(a) Pressure sores will accompany severe spasticity in an immobile patient due to sensory loss.
(b) Change patient's position every 2 hours even if patient is in wheelchair.
(c) Give careful attention to sacral and perineal hygiene.

(4) Support the patient with bladder disturbances.

(a) Observe patient closely for retention and catheterize, as ordered.
(b) Patient may need to be taught self-catheterization.
(c) Administer urinary antiseptics, as ordered.
(d) Support the patient with bladder incontinence by initiating a bladder training program.
(e) Meticulous skin care is required for the incontinent patient.
(5) Assist the patient to establish a routine of regular bowel evacuation.
(6) Administer corticosteroids, as ordered during periods of exacerbation.
(a) May reduce severity of exacerbation by reducing edema and inflammation.
(b) Encourage bedrest during the acute stage as activity seems to worsen attack.
(c) Keep in mind that the residual effects of the disease may increase with each exacerbation.

(7) Support the patient with optic and speech defects.

(a) Eye patch to block vision impulses for patient with diplopia.
(b) Obtain services of speech therapist.

(8) Discharge planning considerations.

(a) Instruct patient and family in activities of daily living using assistive and self-help aids.
(b) Assist the patient and family to cope with the stress of multiple sclerosis.
(c) The patient with MS will experience behavioral changes such as euphoria, depression, denial, and forgetfulness.
(d) Avoid physical and emotional stress as they may worsen symptoms.
(e) Assist patient to accept his new identity as a handicapped person.

David L. Heiserman, Editor

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Revised: June 06, 2015