Midterm Study Guide
Multiple Sclerosis (MS) (Irreversible)
● Pathophysiology
○ Chronic, progressive, degenerative disorder of CNS characterized by demyelination of
nerve fibers of brain and spinal cord
○ Caused primarily by autoimmune R/T fatigue
○ Autoimmune process
■ Activated T cells migrate to CNS and disrupt blood brain barrier
■ Antigen-antibody reaction w/in CNS
■ Activates inflammatory response and unmyelinated axons
○ Three pathologic processes characterize MS
■ Chronic inflammation
■ Demyelination
■ Gliosis in the CNS
●Priority → respiratory
○ Assessment for aspiration
○ Teach coughing + deep breathing exercises
● Physical considerations for patient
○ ages= 20-50
○ Women are more common than men
○ Virus and infections
■ Exacerbations triggered by upper respiratory infection and UTI
● Ask about urinary tract infections
○ Physical injuries
○ Smoking
○ Emotional stress
○ Pregnancy
○ Fatigue
○ Overexertion
○ Temp extremes (not too hot or cold)
■ Can experience= Uhtoff sign after being exposed to heat
, ● Temporary worsening of vision
● Pregnancy considerations
○ During gestation period: S/S improve and experience remission
■ Hormone changes affect the immune system
○ Postpartum= risk of exacerbation increase and s/s get worse
○ Pt teaching= s/s can exacerbate after giving birth
● Manifestations
○ Motor S/S
■ weakness/ paralysis of limbs, trunk, head
● Fatigue in lower extremities
■ Diplopia- blurred or double vision
● Blurred or double vision, red-green distortion and blindness in one eye
can be the first s/s with MS.
■ Scanning speech- spoken words broken up in separate syllables
■ Muscle spasms
○ Sensory S/S
■ Numbing, tingling, paresthesia
■ Scotomas; patchy blindness
■ Blurred vision
■ Vertigo
■ Tinnitus
■ Decrease hearing
■ Chronic neuropathic pain
■ Lhermitte's sign- radicular (nerve root pain)
● Present in low thoracic and abdominal region
● Electric shock radiating down spine or into limbs with flexion of neck
○ Cerebellar
■ Nystagmus- repetitive uncontrolled movement of eye
■ Ataxia- loss of full control of body movement
■ Dysarthria- difficulty articulating words (slurred speech)
■ Dysphagia- difficulty swallowing
○ Bladder and bowel dysfunction
■ Bladder
● Spastic-more common
○ Small capacity for urine
○ Urgency and frequency to go
○ UTI’s can result and incontinence
● Flaccid - crede's maneuver → manually placing pressure on
abdomen over the bladder → helps expel urine
○ Large capacity for urine
○ No desire to void
○ Self-cath may be needed
○ Sex dysfunvction
■ Erectile dys
■ Decrease libido
■ Difficulty w/ orgasm
■ Painful sex
, ○ Cognitive dysfunction
■ Short term memory attention
■ Information processing
■ Planning
■ Visual perception
■ Word finding
● Nursing Care Interventions
○ Monitor for
■ Visual acuity
■ Speech patterns- fatigue when talking
■ Cognitive changes- place objects used in daily routines in the same places
■ Swallowing
■ Activity tolerance
■ Skin integrity-risk for pressure ulcers
○ Increase fluids to prevent UTIs
■Drink measured amount of fluid q2hrs → attempt to void 30 mins after
drinking
○ Small frequent meals
○ Assist with bladder elimination
■ Intermittent self cath
■ Crede's maneuver
■ Bladder pacemaker
○ Communications board for dysarthria
○ Eye patches for diplopia
■ Alternate every few hours
■ Exercise and stretch involved muscles
● Water aerobics is great for MS pts
○Rest periods → take frequent short rest periods → lay down
○ Safe home and hospital environment
■ Wide base support when walking
■ Assistive devices
■ Skin precautions
● Patient teaching
○ Good balance of exercise and rest
○ Minimize caffeine intake
○ Well-balanced meals
○ Follow treatment regimen
○ Self cath if needed
○ Emotional adjustments
○ Lifestyle changes to avoid or decrease triggers
● Realistic patient goals
○ The client will walk with a walker independently to and from the library
○ Goals can and should include the support partner/family
○Assessment for aspiration → work with speech therapist
● Activity and Rest schedule
Multiple Sclerosis (MS) (Irreversible)
● Pathophysiology
○ Chronic, progressive, degenerative disorder of CNS characterized by demyelination of
nerve fibers of brain and spinal cord
○ Caused primarily by autoimmune R/T fatigue
○ Autoimmune process
■ Activated T cells migrate to CNS and disrupt blood brain barrier
■ Antigen-antibody reaction w/in CNS
■ Activates inflammatory response and unmyelinated axons
○ Three pathologic processes characterize MS
■ Chronic inflammation
■ Demyelination
■ Gliosis in the CNS
●Priority → respiratory
○ Assessment for aspiration
○ Teach coughing + deep breathing exercises
● Physical considerations for patient
○ ages= 20-50
○ Women are more common than men
○ Virus and infections
■ Exacerbations triggered by upper respiratory infection and UTI
● Ask about urinary tract infections
○ Physical injuries
○ Smoking
○ Emotional stress
○ Pregnancy
○ Fatigue
○ Overexertion
○ Temp extremes (not too hot or cold)
■ Can experience= Uhtoff sign after being exposed to heat
, ● Temporary worsening of vision
● Pregnancy considerations
○ During gestation period: S/S improve and experience remission
■ Hormone changes affect the immune system
○ Postpartum= risk of exacerbation increase and s/s get worse
○ Pt teaching= s/s can exacerbate after giving birth
● Manifestations
○ Motor S/S
■ weakness/ paralysis of limbs, trunk, head
● Fatigue in lower extremities
■ Diplopia- blurred or double vision
● Blurred or double vision, red-green distortion and blindness in one eye
can be the first s/s with MS.
■ Scanning speech- spoken words broken up in separate syllables
■ Muscle spasms
○ Sensory S/S
■ Numbing, tingling, paresthesia
■ Scotomas; patchy blindness
■ Blurred vision
■ Vertigo
■ Tinnitus
■ Decrease hearing
■ Chronic neuropathic pain
■ Lhermitte's sign- radicular (nerve root pain)
● Present in low thoracic and abdominal region
● Electric shock radiating down spine or into limbs with flexion of neck
○ Cerebellar
■ Nystagmus- repetitive uncontrolled movement of eye
■ Ataxia- loss of full control of body movement
■ Dysarthria- difficulty articulating words (slurred speech)
■ Dysphagia- difficulty swallowing
○ Bladder and bowel dysfunction
■ Bladder
● Spastic-more common
○ Small capacity for urine
○ Urgency and frequency to go
○ UTI’s can result and incontinence
● Flaccid - crede's maneuver → manually placing pressure on
abdomen over the bladder → helps expel urine
○ Large capacity for urine
○ No desire to void
○ Self-cath may be needed
○ Sex dysfunvction
■ Erectile dys
■ Decrease libido
■ Difficulty w/ orgasm
■ Painful sex
, ○ Cognitive dysfunction
■ Short term memory attention
■ Information processing
■ Planning
■ Visual perception
■ Word finding
● Nursing Care Interventions
○ Monitor for
■ Visual acuity
■ Speech patterns- fatigue when talking
■ Cognitive changes- place objects used in daily routines in the same places
■ Swallowing
■ Activity tolerance
■ Skin integrity-risk for pressure ulcers
○ Increase fluids to prevent UTIs
■Drink measured amount of fluid q2hrs → attempt to void 30 mins after
drinking
○ Small frequent meals
○ Assist with bladder elimination
■ Intermittent self cath
■ Crede's maneuver
■ Bladder pacemaker
○ Communications board for dysarthria
○ Eye patches for diplopia
■ Alternate every few hours
■ Exercise and stretch involved muscles
● Water aerobics is great for MS pts
○Rest periods → take frequent short rest periods → lay down
○ Safe home and hospital environment
■ Wide base support when walking
■ Assistive devices
■ Skin precautions
● Patient teaching
○ Good balance of exercise and rest
○ Minimize caffeine intake
○ Well-balanced meals
○ Follow treatment regimen
○ Self cath if needed
○ Emotional adjustments
○ Lifestyle changes to avoid or decrease triggers
● Realistic patient goals
○ The client will walk with a walker independently to and from the library
○ Goals can and should include the support partner/family
○Assessment for aspiration → work with speech therapist
● Activity and Rest schedule
