Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
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Study Tools For Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Multiple Sclerosis Symptoms (Mnemonic)
Multiple Sclerosis Pathochart (Cheatsheet)
Multiple Sclerosis Symptoms (Image)
Multiple Sclerosis Patho (Image)
Multiple Sclerosis Assessment (Picmonic)
Multiple Sclerosis Interventions (Picmonic)
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Outline
Pathophysiology: This occurs when there has been an insult to the nervous system caused by a previous virus in a person that is genetically at risk of an abnormal response by the immune system. Irreversible damage to the tissue occurs by the body. There is inflammation and demyelination throughout the central nervous system that progress. There are changes to the gray matter of the brain including loss. Brain atrophy occurs and progresses. And damage to the myelin.
Overview
- Chronic, progressive demyelination of the neurons in the CNS
- Memory Aid: Multiple Sclerosis → Myelin Sheath
Nursing Points
General
- Remission and exacerbation
- Primarily ages 20-40 years old
- Cause Unknown
Assessment
- Fatigue
- Tremors
- Weakness
- Spasticity of muscles
- Can be painful
- Bowel and Bladder dysfunction
- Incontinence
- Diarrhea or Constipation
- Decrease peripheral sensation (pain, temperature, touch)
- High risk for injury
- Visual disturbances
- Emotional instability
Therapeutic Management
- No cure – supportive therapy
- Analgesics
- Muscle relaxants
- Energy conservation
- Provide bowel and bladder training
- Maintain adequate fluid intake 2000 mL/day
- Encourage activity independence
- Regulate temperatures on water heaters, baths, and heating pads
- Risk for burns
- Ensure in home safety (rugs, cords, etc)
- Risk for falls
Nursing Concepts
- Safety
- Comfort
- Coping
Patient Education
- Coping strategies
- Cluster activities, provide periods for rest
- Importance of fluid intake
- Bowel and bladder training
- Check temperature of water
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Transcript
Let’s talk about Multiple Sclerosis. This is something you’ll definitely see in your time in nursing school and for sure when you’re working.
Multiple sclerosis or MS is a chronic, progressive disease that causes demyelination of the neurons. If you remember from the anatomy lesson, the axons of the neurons are surrounded by this myelin sheath. The purpose is to make the nerve impulses travel smoother and faster. With demyelination, the axon is exposed and we lose that myelin sheath – we’ll look closer at that in just a second. A key point about MS is that it is cyclical, it has periods of remission and exacerbation. Sometimes they’ll feel great and others they won’t be able to get out of bed. It primarily begins between the ages of 20 and 40 and the cause is entirely unknown at this point.
So again remember that the axons are covered with this myelin sheath that helps the impulse to travel smoother and faster down the length of the neuron. In demyelination, that myelin sheath degrades and the axon is exposed. So…logically speaking, since the myelin sheath makes impulses travel smoother and faster…if we lose that myelin sheath and the axon is exposed, we’re going to get impulse transmission that is neither smooth, nor fast. And MS affects both sensory (or afferent) and motor (or efferent) neurons. So you have jumpy or spastic nerve impulses and/or super slow or lost nerve impulses. Pause the video if you want to brainstorm what this looks like in a patient before we talk about it.
So let’s see practically what this looks like in a patient. Remember there’s sensorimotor spasticity and slowness. So they’re very weak and fatigued. We will see tremors and spastic muscle movements – again that’s the jumpy, spasticity of the nerve impulses. We’ll also see bowel and bladder dysfunction as a result of that loss of nerve impulses. They can have incontinence of both, but could also get constipation because the gut has slowed way down. They will also have a significant sensory loss peripherally. Their ability to sense pain or temperatures is dramatically decreased which can lead to a multitude of other problems. Because of the effects on the neurons in the brain and central nervous system, we could also see visual disturbances and emotional instability. So already you can imagine that this is not a pleasant disease to live with. Many people are able to live with it for years while others don’t last as long because their bodies can’t handle the stress of it.
There is no cure for MS, so most of what we do is supportive therapy. We can give analgesics and muscle relaxers as needed, but there are behaviors we can encourage in the patient that will help them cope with their condition. We encourage them to conserve energy by clustering their activities and providing time for rest. We will encourage independence as long as possible – many of these patients will lose their independence as the disease progresses. We will help them with bowel and bladder training where they plan to go to the bathroom at certain times to avoid accidents. Then, we want to encourage adequate fluid intake. Many of these patients will stop drinking so much because of their bladder incontinence – they think if they drink more they will have more accidents. But then they end up getting super constipated and dehydrated – so if we can encourage that bladder training, they can keep their fluid intake up as well. Now these last two are extremely important because they deal with safety. It’s important to regulate temperatures on water heaters in the home – you can actually set the max temperature to be lower. Remember these patients can’t really feel pain or temperature well, they could sustain severe burns from hot water because they couldn’t tell it was hot. So they should have someone check temps for them or turn their water heater down. Then because they have decreased sensation and slowed motor response, they’re at high risk for falls. So we make sure we secure rugs, move cords and cables, etc. to prevent falls.
The priority nursing concepts for a patient with MS are safety, comfort, and coping. Of course we can’t do much about what’s going on with the patient’s nerves, but we can keep them safe from injury, keep them comfortable and independent, and help them find coping strategies to manage their disease. Check out the care plan attached to this lesson for more details.
I loved this quote and I think it sums up life with MS so well. “MS can be an overwhelming challenge. One day you can feel strong and resilient, but the next day you can feel helpless and isolated.” This is very frustrating for the patient and we can play a huge role in making this even a little easier for them.
So remember that MS is progressive and cyclical with periods of remission and exacerbation. The nerves are demyelinated which causes spastic and slow nerve impulse transmission, both motor and sensory. So we wee sensorimotor loss – tremors, weakness, decreased pain sensation, bowel and bladder dysfunction, etc. We need to encourage independence and help patients learn how to cope with their disease. Many people live with MS for decades and have a great life. We can encourage our patients to do the same.
Now, go out and be your best selves today. And, as always, happy nursing!
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Lab Panels – The Basics and What YOU Need to Know 2 – Live Tutoring Archive
Fundamentals Course Introduction
Legal & Ethical Issues in ER
Nursing Care and Pathophysiology of Osteoporosis
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
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6 Rights of Medication Administration
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Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
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Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
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Nursing Care and Pathophysiology for Gout
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Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperparathyroidism
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Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Lyme Disease
Nursing Care and Pathophysiology for Male Infertility
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Pulmonary Embolism
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Scleroderma
Nursing Care and Pathophysiology for Seizure
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Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for Syphilis (STI)
Nursing Care and Pathophysiology for Testicular Torsion
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoporosis
Nursing Care and Pathophysiology of Renal Calculi (Kidney Stones)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care Delivery Models
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Anxiety
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Nursing Care Plan (NCP) for Decreased Cardiac Output
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Nursing Care Plan (NCP) for Glaucoma
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Nursing Care Plan (NCP) for Herpes Zoster – Shingles
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Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
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Nursing Care Plan for (NCP) Autism Spectrum Disorder
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Pertussis – Whooping Cough
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Postpartum Physiological Maternal Changes
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Rh Immune Globulin (Rhogam)
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Thrombocytopenia
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Types of Exercise
Types of Schizophrenia
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Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Varicella – Chickenpox
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Vent Alarms
Vitals (VS) and Assessment
Vomiting
What Guides Nurses Practice
What is CCMM?
White Blood Cell (WBC) Lab Values
Working night shift
Working with a Preceptor
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Selecting a Dressing
Wound Care – Wound Drains