Multiple Sclerosis

Multiple many, more than oneSclerosis hardening of tissue, usually due to scaring after inflammation or due to agingMultiple SclerosisDefinitionbody's immune system eats away at the protective sheath (myelin) that covers your nervesDamage to myelin causes interference in the communication between your brain, spinal cord and other areas of your body affects CNSThis condition may result in deterioration of the nerves themselves, a process that's not reversible.

SymptomsNumbness or weakness in one or more limbTingling or pain in parts of your bodyParesthesias of the lower half of the bodyElectric-shock sensations that occur with certain head movementsTremor, lack of coordination or unsteady gaitSlurred speechFatigueDizzinessPartial or complete loss of central vision, usually in one eye, often with pain during eye movement (optic neuritis)Double vision or blurring of vision

Etiology/CausesUnknownAutoimmune diseaseWhen myelin is damaged, the messages that travel along that nerve may be slowed or blocked.Risk FactorsAge.most commonly affects people who are ages 20 to 40.Gender.Women are about twice as likely asFamily history.Certain infections.A variety of viruses, such as Epstein-Barr virus and othersEthnicity.White people, particularly those whose families originated in northern EuropeGeographic regions.Multiple sclerosis is far more common in areas such as Europe, southern Canada, northern United States, New Zealand and southeastern AustraliaComplicationsMuscle stiffness or spasmsParalysis, most typically in the legsProblems with bladder, bowel or sexual functionMental changes, such as forgetfulness or difficulties concentratingDepressionEpilepsy

Investigation / DiagnosticBlood tests Elevated WBCSpinal tap (lumbar puncture) abnormal levels of white blood cells or proteins. Increased immunoglobulin G (IgG)Magnetic resonance imaging(MRI)/CT Scanreveal lesions, which may appear due to myelin loss in your brain and spinal cord.EEG - Evoked potential test measures electrical signals sent by your brain in response to stimuli

Treatment And DrugsNo treatment for Multiple SclerosisTreat AttacksCorticosteroids e.g Prednisone Methylprednisolone, DexamethasonePlasma exchange (plasmapheresis) procedure removes some blood from your body and mechanically separates your blood cells from your plasma, the liquid part of your blood. Doctors then mix your blood cells with a replacement solution and return the blood to your body.Treatment and DrugsSlow Progress of DiseaseBeta interferons Avonex, Betaseron, Extavia and RebifGlatiramer acetate (Copaxone) glatiramer acetate works by blocking your immune system's attack on myelinFingolimod (Gilenya) trapping immune cells in lymph nodesNatalizumab (Tysabri) interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cordCyclophosphamide, Azathioprine immunosuppressant medicationTreatment and DrugsTreat symptomsPhysical therapy stretching and strengthening exercisesMuscle relaxants baclofen (Lioresal) and tizanidine (Zanaflex) may improve muscle spasticity.Reduce fatigue amantadine modafinilNursing DiagnosisDeficit knowledge related to disease processFatigue related to muscle weaknessIntolerable pain related to insufficient restIncreased attacks related to poor stress managementSelf care deficit related to muscle stiffness and pain during movementRisk for paralysis or the lower limbs related to disease process and non compliance to treatment.

Nursing InterventionAssess patients ability to do ADL ( assisted/ independent)Assess for S&S of acute exacerbation of progression of diseaseProvide catheter care and bowel care to improve comfort and reduce risk of secondary infectionPlace patient in a cool and stress free areaEncourage family participation in coping and understanding disease processProvide written and verbal information about treatment and drugs , stress importance of drug compliance and time drug should be takenHealth EducationMedication teach patient to take medication as prescribed. Do not discontinue medications abruptlyGet plenty of restExercise - improved strength, muscle tone, balance and coordinationCool down (temperature) - keep the body cool avoid extreme heat or hot environmentsEat a balanced diet - strong immune system and maintain bone health.Relieve stress relaxation techniques or spiritual meditation / prayer