MULTIPLE SCLEROSIS

MULTIPLE SCLEROSIS (MS)

Chronic intermittent disorder of CNS – white patches of demyelenation in brain & spinal cord.

- Remission & exacerbation

- Common – women, 15 – 35 yo cause – unknown

Predisposing factor:

1. Slow growing virus

2. Autoimmune – (supportive & palliative treatment only)

Normal Resident Antibodies:

Ig G – can pass placenta – passive immunity. Short acting.

Ig A – body secretions – saliva, tears, colostrums, sweat

Ig M – acute inflammation

Ig E – allergic reactions

IgD – chronic inflammation

Sign and Symptoms

1. Visual disturbances

a. Blurring of vision

b. Diplopia/ double vision

c. Scotomas (blind spots) – initial sx

2. Impaired sensation to touch, pain, pressure, heat, cold

a. Numbness

b. Tingling

c. Paresthesia

3. Mood swings – euphoria (sense of elation )

4. Impaired motor function:

a. Weakness

b. Spasiticity –“ tigas”

c. Paralysis –major problem

5. Impaired cerebellar function

Triad Sx of MS

I – intentional tremors

N – nystagmus – abnormal rotation of eyes Charcots triad

A – Ataxia

& Scanning speech

6. Urinary retention or incontinence

7. Constipation

8. Decrease sexual ability

Dx – Multiple Sclerosis

1. CSF analysis thru lumbar puncture

- Reveals increase CHON & IgG

2. MRI – reveals site & extent of demyelination

3. Lhermitte’s response is (+). Introduce electricity at the back. Theres spasm & paralysis at spinal cord.

Nursing Management Multiple Sclerosis

- Supportive mgt

1.) Meds

a. Acute exacerbation

ACTH – adenocorticotopic

Steroids – to reduce edema at the site of demyelination to prevent paralysis

Spinal Cord Injury

Administer drug to prevent paralysis due to edema

a. Give ACTH – steroids

b. Baclopen (Lioresol) or Dantrolene Na (Dantrene)

To decrease muscle spasticity

c. Interferone – to alter immune response

d. Immunosuppresants

2. Maintain siderails

3. Assist passive ROMexercises – promote proper body alignment

4. Prevent complications of immobility

5. Encourage fluid intake & increase fiber diet – to prevent constipation

6. Provide catheterization die urinary retention

7. Give diuretics

Urinary incontinence – give Prophantheline bromide (probanthene)

Antispasmodic anti cholinergic

8. Give stress reducing activity. Deep breathing exercises, biofeedback, yoga techniques.

9. Provide acid-ash diet – to acidify urine & prevent bacteria multiplication

Grape, Cranberry, Orange juice, Vit C