NCLEX Review: Multiple Sclerosis (MS)

Overview

• Multiple Sclerosis (MS): Autoimmune disease affecting the myelin sheath of neurons in the central nervous system (CNS).
• CNS Includes: Brain and spinal cord.
• Effect on Neurons: Inflammation and scarring lead to decreased nerve signal transmission causing motor and sensory symptoms.

Key Facts

• Autoimmune Attack: Immune system attacks myelin sheaths.
• Symptoms Vary: Different lesions in CNS lead to varied symptoms in patients.
• Common Form: Relapsing-remitting MS (symptoms appear and disappear).
• Demographics: More common in women, ages 20-40.
• Cause and Cure: Unknown; no cure but lifestyle changes and medication can help.

Diagnosis

• Time-Consuming: No single test for MS; requires assessment of symptoms.
• Tests Include:
  • MRI for brain and spinal cord lesions.
  • Lumbar puncture for oligoclonal bands.
  • Evoked potential studies for CNS response.

Pathophysiology

• Neuron Anatomy:
  • Dendrites: Receive signals.
  • Soma: Passes signal.
  • Axon Hillock: Junction of soma and axon.
  • Axon: Transmits signal, protected by myelin sheath.
  • Terminal: End of axon for signal transmission.
• MS Impact: Demyelination leads to poor signal transmission.

Signs and Symptoms

• Varied by Lesion Location:
  • Emotional/Cognitive: Fatigue, depression, speech issues, mood swings, cognitive difficulties.
  • Sensory: Tremors, spasms, numbness, dizziness, Romberg sign, Lhermitte's sign.
  • Vision: Nystagmus, optic neuritis, blurry vision, pain with eye movement.
  • Elimination: Bladder/bowel dysfunction leading to incontinence or retention.
  • Uthoff's Sign: Heat exacerbates symptoms.

Nursing Interventions

• Safety:
  • Address coordination, vision, and perception issues.
  • Clutter-free environment.
• Bowel/Bladder Management:
  • Easy bathroom access, skin care for incontinence, self-catheterization teaching.
• Exercise: Encourage without overheating; swimming is beneficial.
• Support Groups: Encourage participation.
• Consultations: Speech therapy for swallowing, physical therapy for exercises.

Medications

• Beta Interferons: Decrease relapses.
  • Examples: Avonex, Rebif.
• Corticosteroids: Manage relapses.
  • Examples: Methylprednisolone, Prednisone.
• Bladder Management:
  • Overactive: Oxybutynin.
  • Retention: Bethanechol.
• Fatigue Management: Amantadine, Modafinil.
• Spasms: Baclofen, Diazepam.
• Tremors: Propranolol, Isoniazid.

Conclusion

• Summary: Multiple Sclerosis is a complex autoimmune condition with varied symptoms and requires comprehensive management including lifestyle changes and medication.
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