Multiple Sclerosis

NURSING CAREMed-Surg

Four Type• Relapse Remitting• Primary Progressive• Secondary

Progressive• Progressive Relapsing

Relapse Remitting• Unpredictable acute

attacks with worsening of symptoms followed by full, partial, or no recovery

• Then complete or partial absence of symptoms (Remission)

Primary Progressive • Steady gradual progression of

disability, without any obvious relapses and remissions

• Most common after age 40

Secondary Progressive• Starts with a relapse

remitting• Advance to

progressive disease

Progressive Relapsing• Steady progressive

disability • Acute Attacks• Possible recovery

Precipitating Factors• Infection• Cold climate• Physical injury• Emotional stress• Pregnancy• Fatigue• Overexertion• Hot shower/bath

Complications

• Spasticity• Neurogenic bladder• Aspiration• Paralysis

Diagnostic Procedures

MRI

CSF Analysis• Tell the patient that this test usually

takes at least 15 minutes• Headache is common adverse effect• VS• Pillow support• Place one arm around knee & neck• Remain calm and still• Label containers in which they were

filled• Allergy check initially• Remain flat • Encourage fluids• Check site for redness, swelling,

drainage hourly 4 1st 4 hours then Q4 for 1st 24hrs.

• Assess neurolgoic Q15 min for 4 hours; it stable assess Q2 then Q4

Electrophysiological Testing

Medications

Immunosuppressants

Immunomodulators

Antispasmodic

Anticonvulsant

Stool Softener

Nursing Diagnosis

• Fatigue• Activity intolerance• Disturbed sensory

perception (visual)• Impaired physical mobility• Impaired urinary

elimination• Chronic pain• Imbalanced nutrition:

Less than body requirements

Nursing Care• Encourage fluid intake • Assist with bladder elimination

o intermittent self-catheterization,o bladder pacemakero Credé

• Reorient• Place Routine Objects in Routine Places• Communication Board 4 (dysarthria) • Speech language therapist referral• Apply alternating eye patches to treat diplopia. Teach

scanning techniques.• Utilize energy conservation measures.• Reduce injury—call lights, ask 4 assistance, home

safety• Encourage independence

Thanks….