this is sarah thresher nurse rn.com and in this video i'm going to be going over multiple sclerosis and this video is part of an nclex review series over the neuro system and as always don't forget to check out the free quiz that will test you on this condition so let's get started what is multiple sclerosis also called ms it is an autoimmune disease that affects the myelin sheath of the neurons in the central nervous system and what's included in our central nervous system our brain and our spinal cord now whenever these myelin sheaths are being attacked by the body what happens is it affects the neuron and it causes it to become inflamed and scarred now what's the role of our neuron well a rollover neuron is the same nerve signals to either another nerve or a gland or a muscle well if it's inflamed and scarred it can't do this so there is a decrease in nerve signal transmission which is going to lead to a lot of motor and sensory symptoms that you're going to see a little bit later now in nursing we have to know a lot of different neuro diseases and how do you keep them straight how do you know what's going on in parkinson's how do you know what's going on in multiple sclerosis or myosinia gravis well to help me keep them straight and to remember this condition with multiple sclerosis i think of okay multiple sclerosis is also called ms we have the myelin sheath that is being affected so ms myelin sheath that is how i keep this straight compared to parkinson's where your dopaminergic neurons are being affected and things like that so hopefully that helps you now before we dive into the patho let's talk about some quick facts about ms okay this disease like we've already said is immune related so you actually have your immune system cells going to these neurons within the central nervous system and attacking these myelin sheaths and our myelin sheaths protect our axon and whenever they're gone that axon can't really take that signal and transfer it to wherever it needs to go so we have issues with that now let's talk about symptoms symptoms in patients vary this patient over here may have these symptoms while this patient over here has a little bit different symptoms now why is that well it affects our central nervous system those myelin sheaths and you have a lot of different neurons in a lot of different locations in the brain and the spinal cord and certain areas can be affected in certain patients so you're going to see lesions in different areas of the body for example let's say that a patient with ms has lesions where their myelin sheaths are inflamed and scarred in the cerebellar area well this patient just because the function of that area of the brain is going to suffer from tremors dysarthria where they have trouble articulating speech because those muscles that help you do that aren't working correctly ataxia where they're going to have some balance and coordination issues and some cognitive issues compared to if they had lesions where the myelin sheath were damaged going to the optic nerve and the optic nerve can become inflamed patients can experience pain whenever they just move their eyes and their sockets they can experience blurry visions see dark spots and things like that a little bit later we're going to really talk about those symptoms in depth but just be aware of that and another thing that is interesting about ms is that there's different forms of it and the most common form of ms is called relapsing re-emitting ms and this is where just like the name says the patient will have symptoms that appear they have them and then they'll disappear so they like go back into remission in a sense and this ms tends to affect women more than men and it tends to strike between the ages of 20 to 40 years of age so relatively young the cause of ms is unknown they're not sure as of now and there is currently no cure for ms however lifestyle changes can help with that because there's some things that patients with ms can do that they can do to prevent making their symptoms worse which we're going to talk a little bit more about in our nursing interventions and medications can be prescribed to improve their signs and symptoms now let's quickly talk about how ms is diagnosed because from the nursing standpoint you want to be able to educate your patient about potential tests they may go for and the prep for them and things like that so one thing with diagnosing ms is that it takes time the neurologist has to assess a lot of different things because there's not just one test that says hey this patient has multiple sclerosis so they're going to look at the patient's signs and symptoms because a lot of the signs and symptoms that present in this condition mimic other conditions so they may have to rule out other diseases and they can also order an mri which will take imaging of the brain and the spinal cord and it's looking for that inflammation and scarring on those neurons so it's looking for lesions in the brain or spinal cord that could represent that this patient might have ms another thing that can be ordered is a lumbar puncture and this is where they go in and they remove a sample of cerebral spinal fluid and they're looking for a high amount of proteins specifically oligoclonal bands and if these bands are present in there that shows that there's inflammation in the central nervous system which correlates with multiple sclerosis and another type of test that can be ordered is an invoke potential studies and this is where they're literally invoking electrical signals they're trying to invoke a response where they're sending electrical signals to the cns and they're assessing that response after those signals are sent now let's talk about patho because in order to understand why you're seeing these certain signs and symptoms in patients with multiple sclerosis you have to understand the anatomy and physiology of the neuron how it works so let's look at the neuron first we're going to talk about the dendrites and this is really where it all starts because the dendrites receive the signal needed to create some type of action and then that signal that they receive goes down to the soma which soma means body and this structure helps pass on the signal it just received from the dendrites to the rest of the neuron then the signal goes down and passes where the soma of the neuron and the axon connect which is called the axon hillock then it goes down this long area known as the axon and remember axon away takes away from the neuron and for this axon to be able to deliver this signal correctly and strongly to either like another neuron or muscle or gland it must be insulated and protected by the myelin sheath so this is the problem with multiple sclerosis our myelin sheath has experienced damage which is called demyelination so guess what when a signal is going to be transferred down through this neuron it's not going to happen correctly or even strong enough in a patient who's having demolization of their myelin sheaths so that signal is not going to go and be able to stimulate that area that that nerve supplies however in a healthy neuron where your myelin sheath isn't damaged it's nice and insulated once that signal leaves the axon it's going to go down through the axon terminal which is like the end of the axon hence terminal and it's going to snap and where it snaps is this is where a nerve signal passes with either another neuron or muscle or gland to cause some type of action but that's not really happening here in our patients who have ms so the concept in multiple sclerosis is that we're talking about the nerve cells where in the central nervous system which is our brain and our spinal cord so before we jump here into our signs and symptoms we need to remember that because of this we can expect to find sensory problems and some motor problems like sensory being like their touch their vision even it can go into emotional and cognitive issues also coordination and bowel and bladder issues now we're going to signs and symptoms and remember again patients vary on their signs and symptoms depending on where that demyelination has occurred within that central nervous system now whenever you see these little asterisks these are usually the signs and symptoms that are present early on that patients are going to have so what i've done is i've divided the signs and symptoms up by category because as we just learned the patient can have emotional cognitive sensory and motor issues along with bowel and bladder so we're going to look at it from those standpoint okay first let's look at emotional and cognitive a lot of patients early on they're going to report that they feel just very fatigued they haven't even really done anything to make themselves feel this tired but they are extremely drained and petite they can also experience depression have speech issues which gets back to that dysarthria that we talked about when there's cerebellar lesions present also later on they can have dysphagia where they have difficulty swallowing because those muscles just aren't working like they should also mood swings they can easily be happy and then switch to side depress things like that they can also have trouble thinking and this goes back to the cognitive issues and that's where they can have lesions on that cerebellum area and they can have trouble focusing problem solving planning thinking of those right words to say and things like that now sensation issues this is another big thing that people report they can have tremors and spasms and the spasms can be just very painful and which can lead to a lot of clumsiness a lot of patients report that they just feel drunk and this can lead to injury so be thinking about that whenever we're thinking about our nursing interventions and our plan of care also numbness tingling this can be on the face the extremities dizziness vertigo and this can cause coordination issues along with having a positive romberg sign now what is that now and sometimes whenever you do your nursing head to toe assessment you can assess for romberg sign and that's where you have the patients stand with their eyes closed and their feet together and if they have a positive rum bird sign that means that they have lesions on that cerebellum area that's responsible for knowing where your body is in space with your eyes closed and whenever they close their eyes they'll actually start to lose their balance and sway so that's what that is and another thing is i want you to remember anytime you see a fancy name with the word sign and nursing always remember that for exams it's called learn meets sign and this is where the patient if they move their head in various motions they can experience an electric shock sensation down their body a lot of patients with multiple sclerosis have experienced this now how can you remember this for tests remember the l in lermates and lightning it's like an electric shock that's how i keep those straight now let's look at vision issues in a patient with multiple sclerosis okay they can have nystagmus where there's involuntary movement of the eyes they can also have optic neuritis where the optic nerve that supplies the eyes is inflamed and scarred because demolization of that myelin sheath which can lead to double vision blurry vision they their vision can become dull or gray it's not as vivid as it used to be when they move their eyes it's very painful or they see dark spots in their vision and a lot of times patients will start having this maybe they don't have any other symptoms they go in they have this and this is really associated with multiple sclerosis now let's look at elimination issues and we're talking about the bowel and the bladder because the nerves that feed those organs that help us void and have bowel movements aren't working very well especially those sphincters and those muscles so the nerves can't stimulate them like they should so it can go really one of two ways like with urine some patients can't hold their urine their bladder is very over active so they can have incontinence they can pee a lot at night with not nocturia or they can have issues with actually starting a stream with pain because there's problems with contracting devoid so they can have retention issues which puts them at risk for urinary tract infections and renal stones which is why in our nursing interventions we need to educate how to prevent that with bowel they can either have constipation or diarrhea sometimes they can't even hold the stool because they can't control the sphincter that is connected to the bowels and another thing they can experience is called utop sign and this is where heat will actually make their signs and symptoms that we just went over worse so if they experience extreme heat outside or doing physical exercise they will actually start doing a lot worse with their signs and symptoms so it's important that a patient with multiple sclerosis does not overheat themselves now let's talk about nursing interventions what are we going to do for a patient with multiple sclerosis what's going to be included in our plan of care well we need to think back to what we've just learned what's going on with our patient well we know based on all those signs and symptoms that they're going to have safety issues because they have vision problems coordination issues and issues with their perception of pain because they have the numbness and tingling so they could easily injure themselves so we want to be having our thinking around that also we want to be thinking about the bowel and the bladder how we can educate them about that because they're at risk for urinary tract infections kidney stones skin breakdown and we learned that the most common type or form of multiple sclerosis was the relapsing remitting multiple sclerosis where they have symptoms and then they go away and we need to talk about how we can prevent when they do have their symptoms out of making them worse and of course medications so let's talk about preventing the increase in the signs and symptoms we learned just recently about udolph sign and we know that heat can make that worse so we don't want to make a patient with multiple sclerosis we don't want to increase their temperature with heating pads warming blankets keeping the room temperature hot we want to keep the environment nice and cool and stress can increase it so we want to have a calm environment as well and teach them some stress relief techniques because if they experience a lot of stress it can increase their symptoms also avoiding infection can do it as well and over exertion which brings me to the next point with exercise exercise is very important for a person who has ms it's going to help increase their energy level because they need as much energy as they can get because of the fatigue they have and it's going to help lessen that depression but they don't want to overdo it so teach them they need to pace themselves but they still need to work out but if they're just feeling horrible it's okay to skip a day some best types of exercising for them is swimming water aerobics type exercises because heat can cause worsening of signs and symptoms if they're in water they're staying nice and cool and if they pace themselves out it can be a great way to work out another thing is using assistive devices especially when those signs and those symptoms are really out and i've had patients with multiple sclerosis they say even taking a shower is very hard for them because standing in the shower is hard the coordination so getting them a shower chair having the railing just there to help them with that goes a long way importance of having a clutter clutter free room for them because a lot of patients may have the dark spots on their eyes where they can't see certain parts of their visual peripheral fields and teaching them to scan the environment before they get up because they can have the blurry vision as well so you want to teach them how to do that in preventing injury and another thing is usually what's going to be consulted depending on what's going on with your patient if they have where their speech is affected and their swallowing speech language pathology will be consulted to help the patient with their speech and swallowing and also you want to assess your patients swallowing are they coughing a lot when they eat are they drooling do their lungs sound like you can hear crackles or anything like that where they possibly aspirated they have usually the difficulty swallowing is in late stages of multiple sclerosis but you want to be familiar with that physical therapy might be consulted to help them develop exercise regimen and using those assistive devices and it's important that you get with your patient and look up local support groups of other patients who have multiple sclerosis and if they're interested in that they can go there be with other patients who have this and just be a support to one another while they're battling this disease and of course bowel and bladder okay bladder remember they can have where they have an overactive bladder or their bladder is really not working so they're retaining the urine so if they have an overactive bladder you want to make sure that they have easy access to that bathroom that's clutter free so they can go back and forth because they're probably going to be up a lot and they may have incontinent episodes so you want to make sure if your patient's like immobile and they can't do that themselves that you're assessing them for skin breakdown that they have clean pads underneath them at all times to prevent the urine from breaking down the skin and if they're having issues with retaining urine they may need to be taught how to self cath to remove the urine from the bladder because when blood when urine stays in the bladder what happens it is a great reservoir for infection urinary tract infections and renal stones because when that urine just stays stagnant in the kidneys and the ure and the bladder stones can form so you want to educate that patient you want to make sure you're getting lots of fluids as long as it's not contraindicated at least one to two liters of fluids a day to keep that urine um not concentrated and for bowel issues again they can have constipation or diarrhea incontinence so for patients who are having constipation issues you want to teach them about maintaining high amounts of fiber in their diet lots of fruits and vegetables to keep that stool soft and easy and bulky to pass and stool softeners if needed and your patients who are incontinent of stool you need to be assessing their skin making sure it's not breaking down and using those barrier creams okay now let's talk about medications used to treat multiple sclerosis okay these medications we're going to talk about they really vary depending on what symptoms the patient is having but first what we're going to talk about is beta interferon and what these medications do is that they decrease the number of relapses of symptoms by decreasing the inflammation in the body and the immune system's response now because it's doing this what do you think the patient's at risk for the risk for infection because it's going to decrease the number of white blood cells and white blood cells helps us fight infections and some drug names of drugs that include the beta interferons are avenex which is interferon beta 1a rebif and then beta feron now let's look at if your patient is having a relapse of multiple sclerosis symptoms what are they going to be ordered to help decrease that inflammation and decrease that immune system's response corticosteroids so that helps with the relapses and some drug names include methylpregnisalone and prednisone now let's look at bladder issues what can a patient be prescribed who may have an overactive bladder well a good one is oxybutinin and this is an anticholinergic and what it does is it helps with an overactive bladder by relaxing the bladder muscle to prevent contractions now on the flip side let's say the patient has issues with emptying the bladder so they can be ordered a drug called bothanacol which is a cholinergic drug that helps with emptying and what it does is it helps with bladder contraction so they can get rid of that urine it won't stay stagnant in the bladder and for patients who are having fatigue they can be ordered amantadine which is actually an antiviral and an anti-parkinson medication that is used to treat some of those conditions but they have found that this drug has central nervous effects that actually helps improve fatigue in some patients with multiple sclerosis and another drug sometimes used is called modafinil which is also a central nervous stimulant so that would help with fatigue as well and for patients who are having spasms they can be ordered baclofen which is a skeletal muscle relaxant that acts centrally so helps with those spasms or diazepam which is also known as valium can help with that and for patients who have tremors they can take various medications one being propranolol which is a beta blocker and we talked about this drug law inner cardiac series and one of the things with beta blockers remember you have to warn the diabetic patient that if you know normally when you know your blood sugar's dropping you get tremors you get shakes well this drug will mask that and that's how this drug can work for a person when a person with multiple sclerosis will help decrease their tremors and another drug used to treat tremors in some patients with multiple sclerosis is ionized and this is actually an antibiotic used to treat infections especially in patients who have tuberculosis tb but they've also found that this drug helps with certain tremors and multiple sclerosis so you can see probably already from where we talk about drugs a lot that although these drugs are used to treat these certain conditions they can also treat signs and symptoms in other conditions as well okay so that wraps up this nclex review over multiple sclerosis thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos