Multiple sclerosis NCLEX review for nursing students. This review is part of a neuro review, so be sure to check out those other NCLEX reviews.
Don’t forget to take the multiple sclerosis NCLEX quiz.
Lecture on Multiple Sclerosis
Multiple Sclerosis NCLEX Review
What is multiple sclerosis (MS)? It’s an autoimmune disease that affects the myelin sheath of the central nervous system (CNS). This leads to inflammation and scarring of the nerve, which causes a decrease in nerve transmission. This is why many patients experience sensory and motor problems.
Quick Facts about Multiple Sclerosis:
- It’s an autoimmune condition, which means the immune system is actually attacking the myelin sheath found on the nerve.
- It affects the nerve cells in the brain and spinal cord, and this leads to many sensory and motor type problems.
- Symptoms vary among patients because different areas of the central nervous system are affected.
- For example, if the patient has lesions (damage to the myelin sheath)in the cerebellar area, the patient may experience tremors, dysarthria (issues with articulating words…muscles for speech aren’t working well), ataxia (trouble controlling body movements), and cognitive issues.
- Furthermore, if the nerve to the eyes (optic nerve) is being affected the patient will have vision issues like blurry vision or blindness in one eye etc.
- Women tend to be affected more than men, and MS seems to show up in the age category of 20-40s.
- Symptoms can appear and then disappear. This is the most common form of MS where signs and symptoms come and go called: relapsing-remitting multiple sclerosis (RRMS)
- Exact cause is not totally known
- There is currently no cure, but there are lifestyle changes and medications that can improve signs and symptoms.
How is Multiple Sclerosis Diagnosed?
Diagnosing (takes time): the neurologist has to assess several things because there is not one test that can diagnose it:
- Assessing patient’s symptoms…may need to rule out other diseases
- MRI to assess for lesions in the brain and spinal cord
- Lumbar puncture: assesses spinal fluid for specific proteins called oligoclonal bands (which are immunoglobulins). If these are present it shows there is inflammation in the CNS.
- Evoked potential studies (sends electrical signals to the CNS and sees the response).
Pathophysiology of Multiple Sclerosis
You have to understand the anatomy and physiology of the nerve cell (neuron) in the central nervous system.
Dendrites: receive the signal needed to create some type of action. This signal goes down to the:
Soma: (which 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 axon connect at the axon hillock.
Then the signal goes down this long area known as the axon. For the axon to be able to deliver this signal properly to either another neuron, muscle, or gland, it must be nicely be insulated and protected by the myelin sheath, which is made up of Schwann cells. These cells consist of fats and proteins.
****This is our problem with MS (the myelin sheath has experienced demyelination)…..so guess what?! The signal is NOT being transmitted properly to the area that the nerve supplies!!
After the signal leaves the axon in a healthy neuron it goes to the axon terminal (the end of the axon) where it synapses (where a nerve signal passes) with another neuron, muscle or glands to cause an action of some type.
So, in MS we’re talking about the nerve cells in the CNS, which is our BRAIN and SPINAL CORD…..because of this we can expect to finding sensory type problems (touch, vision), coordination, emotional, cognitive, and bowel/bladder issues
For sign and symptoms let’s divide them by category. Remember signs and symptoms vary in patients depending on where the lesions have occurred due to demyelination.
Signs and Symptoms of Multiple Sclerosis
Emotionally and cognitive: drained (feel weak), fatigued, depressed, trouble articulating speech (issues swallowing), mood swings, trouble thinking (focusing, solving, keeping thoughts etc.)
- involuntary tremors, spasms (painful and strong), clumsiness (leads to unintentional injury), numbness/tingling (face and extremities)
- electric shock sensation that travels down the body when moving head or neck in various position called “Lhermitte’s sign”
- dizzy, muscles hard to move (stiff)….affects coordination (cerebellum area)
- unable to be aware of body positon (proprioception) when eyes are closed….Romberg’s Sign…patient puts feet together and closes eye…this causes them to sway
Vision: nystagmus (issues with controlling eye movement), optic neuritis (early) double vision…blurry vision or vision is gray (dull colors), blindness in one eye, and seeing dark spots in vision, painful when moving eyes
Elimination (nerves are affected that control the bladder/bowel and their sphincters):
- can’t hold urine….overactive bladder (incontinence) leads to nocturia
- problems urinating…hesitancy leads to retaining urine (at risk for UTI’s and renal stones)
- bowel: constipation/diarrhea or incontinence
Early signs and symptoms of MS include: vision issues, tingling numbness, weakness, dizziness, balance issues, bladder problems, cognitive issue…issues speaking, weakness, spasms
****Symptoms can get worse due to heat called Uhthoff’s sign. Heat can be from the weather, physical exercise etc.
Nursing Interventions for Multiple Sclerosis
Nursing considerations: safety (vision, coordination, decrease perception with pain), RRMS (most common form of MS)….preventing symptoms from worsening, bladder and bowel issues, medications
Preventing symptoms from getting worse:
- Watch the heat (keep room cool, avoid heating blankets, pads etc.), avoid infection, stressful events, and getting too tired…overexertion (pace out activities and take time to have many rest periods)
Very important to maintain regular exercise as tolerated…not too much because it can exacerbate symptoms (swimming…water aerobics, …keeps energy and mood level up)
Use assistive devices to help with walking and preventing injury (toileting and showering) when symptoms are presenting, clutter free environment, especially when vision affected or experiencing vertigo, scan environment if experiencing blindness in one eye or dark spots
Consult SLP (helps with speech if speech is slurred or hard to understand, difficult swallowing), PT (exercises, assistive devices), support groups with others who have MS
Bladder and bowel: make accessibility to bathroom easy due to overactive bladder, may need to learn how to self-cath if retaining urine, plenty of fluids to prevent stasis of urine and to keep it from becoming too concentrated 1-2 L, high fiber to prevent constipation…stool softeners
Medications for Multiple Sclerosis
**Medications vary depending on what symptoms the patient is having…medications treat symptoms…. don’t cure disease
- Beta interferon: decreases the number of relapses of symptoms by decreasing inflammation and the immune system response ….risk of infection because decreases WBC
Drug Names: Avonex (interferon beta 1a), Rebif, Betaferon
- Corticosteroids: for relapses of symptoms…methylprednisolone (solu-medrol), prednisone
- Bladder issues:
Oxybutynin: anticholinergic that helps with an overactive bladder…relaxes bladder to prevent contractions
Bethanechol: cholinergic that helps with completely emptying the bladder by helping bladder contract fully.
- Fatigue: Amantadine (antiviral and antiparkinson but has CNS effects. This helps improve fatigue in MS patients….another drug Modafinil (CNS stimulant)
- Spasms: baclofen (skeletal muscle relaxants that act centrally), diazepam
- Tremors: propranolol (beta blocker), isoniazid (antibiotic used to treat infection, especially TB…helps with certain tremors in MS)
Multiple sclerosis Diagnosis. Genetics Home Reference. Retrieved 9 April 2018, from https://ghr.nlm.nih.gov/condition/multiple-sclerosis#diagnosisMultiple Sclerosis Fact Sheet. (2010) (p. 1).
Multiple Sclerosis. NCCIH. Retrieved 9 April 2018, from https://nccih.nih.gov/health/multiple-sclerosis