1. Nursing management of Multiple sclerosis
Today’s topic is Nursing Management for clients with Multiple Sclerosis.

2. Pathophysiology – Multiple Sclerosis

3. Pathophysiology Three pathologic processes
Chronic inflammation
Demyelination
Gliosis in the CNS
A chronic CNS disorder in which myelin and nerve axons in brain and spinal cord are destroyed
Patterns of MS
1. Relapsing remitting
2. Primary progressive
3. Secondary progressive
4. Progressive relapsing

4. Demyelination plaque (P) at gray-white junction and adjacent partially remyelinated shadow plaque (V)

5. Etiology The cause of Multiple Sclerosis (MS) is unknown
Unlikely due to one cause
Genetically susceptible patients
Related to infection, immunologic, and genetic factors
Precipitating factors:
Exposure to an infection
Emotional stress
Excessive fatigue
Pregnancy

6. Etiology Onset between 20-50 years of age
Although can occur in young teens and much older adults
Women are affected 2-3 time more than men
More prevalent in colder climates

7. Clinical Manifestations
Motor, sensory, cerebellar, emotional disturbances
Weakness and/or paralysis of limbs, trunk, or the head
Visual disturbances (diplopia) or blindness
Paresthesias
Sudden, progressive weakness of one or more limbs
Spasticity of muscles
Nyastagmus
Tremors
Gait instability
Fatigue
Bladder dysfunction (UTIs, incontinence)
Depression

8. Assessment of Labs/Diagnostics
MRI of the brain and spinal cord
plaques, inflammation, atrophy, tissue breakdown and destruction
Lumbar Puncture
CSF analysis shows an increase in immunoglobulin G and oligoclonal banding
Evoked Potential responses
delayed-decreased nerve conduction from the eye and the ear to the brain

9. Problems with MS Impaired physical mobility Activity intolerance
Fatigue
Impaired urinary elimination
Ineffective self-health management
Grief and depression
Potential for infection

10. Interventions
No cure for MS so disease management is centered on symptoms and treating underlying disease process
medication management
Disease modifying
Immunomodulators (B-interferon)
Immunosuppressant
Sphingosine 1-Phosphate Receptor Modulator
Monoclonal antibody
Managing exacerbations
Corticosteroids
Symptom management
Cholinergic
Anticholinergic
Muscle Relaxants
Nerve conduction enhancer

11. Interventions Acute phase of exacerbation Fatigue Exercise
Immobility
prevention of complications of immobility
Fatigue
Exercise
Diet (high in roughage)
Rest periods
Minimize caffeine
Self catheterization
Support groups

12. Nursing education Balance of exercise and rest
Minimize caffeine intake
Medication management
Self-catheterization if necessary
Adequate intake of fiber to aid in regular bowel habits
Emotional adjustments
Lifestyle changes

13. Evaluation Expected outcomes:
Maintain or improve muscle strength and mobility
Use assistive devices appropriately for ambulation and mobility
Maintain urinary continence
Make decisions about lifestyle modifications to manage MS
Maintain independence and functionality

14. References
Rangel-Castillo, L, Gopinath, S., & Robertson, C.S. (2009). Management of intracranial hypertension. Neurologic Clinics, 26(2),
Ignatavicius, D. D. & Workman, M. L. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis, MO: Saunders Elsevier.
Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., & Bucher, L. (2014). Medical-surgical nursing: Assessment & management of client problems (9th ed.). St. Louis, MO: Mosby
Hogan, M., Dentlinger, N.C., & Ramdin, V. (2014). Medical- surgical: nursing pearson nursing reviews and rationales (3rd ed.). Boston, MA: Pearson.