Care and Management of the Patient with Multiple Sclerosis (3 CEUs)

 Written By: Kristi Hudson RN MSN CCRN

Written: 9/9/06

Updated: August 31, 2009

Course Description:

This course is designed to provide the student an overview of the care and management of the patient with Multiple Sclerosis (MS). Focus will be placed on pathophysiology, cause, onset, signs and symptoms and diagnosis of this disease process. Emphasis on medical and nursing treatment options will be the final focus of this course.

Course Objectives:

Upon completion of this course the student will be able to:

• Describe the pathophysiology that leads to MS
• List known causes of the MS
• Explain the process for diagnosing MS
• Discuss pharmacological treatment options for patients with MS
• Differentiate the four types of MS
• State the factors known to exacerbate MS
• List NANDA nursing diagnosis’ appropriate for the patient with MS
• Describe important patient/family teaching necessities

Pathophysiology:

• Multiple sclerosis (MS); which is thought to be a chronic disease in which the body’s immune system “attacks” the myelin sheath (a fatty substance that covers the axons of nerve cells). This in turns disrupts proper nerve conduction which causes debilitating affects to the central nervous system.
• The inflammation, scarring or injury to the myelin sheath causes slowing or blockage of nerve signals that control muscle coordination, strength, sensation and vision.
• In addition to myelin sheath deterioration; certain T cells (white blood cells that play a role in cell-mediated immunity) play a key role in the development of MS. Under normal circumstances, T cells can distinguish what is foreign in the body and what is not, but in cases of MS, these T cells view health body tissues as “foreign” and attack them as if they were an invading virus (this triggers the inflammatory process and causes leakage in the blood-brain barrier).

Cause:

The exact cause of MS is unknown but most researchers believe that the disease is an autoimmune disease. Although the actual triggers to the immune system have not been proven, most scientists agree that there are several factors involved. These factors include:

• Genetics
• Gender
• Environmental Triggers (viruses, trauma and heavy metals)

Onset:

Onset of MS most often occurs between the ages of 20 and 40. The initial symptoms of this disease process are blurred or double vision, red-green color distortion, or even blindness in one eye. These visual symptoms are often followed by complaints muscle weakness in the extremities and difficulty with coordination and balance. If these musculoskeletal symptoms are severe enough, partial or complete paralysis can occur. 

Signs and Symptoms:

Signs and symptoms of MS vary depending on the location or affected myelin sheath damage. Common presenting symptoms include:

• Numbness or weakness in one or more limbs (typically occurs on one side).
• Partial or complete loss of vision.
• Double or blurred vision.
• Tingling or pain in numb areas of the body.
• Electrical shock sensations that occur with certain head movements.
• Tremors.
• Lack of coordination/unsteady gait.
• Fatigue.
• Dizziness.

Less Common Symptoms:

• Muscle stiffness.
• Muscle spasms
• Slurred speech
• Paralysis
• Bladder/Bowel/Sexual dysfunction.
• Mental changes (forgetfulness, concentration difficulties).

Diagnosis:

Diagnosis of MS can be difficult in the early stages but evidence of symptoms characteristic of MS that involve two different anatomical locations occurring at least 30 days apart) is thought to be highly suggestive of the disease. Other diagnostic testing includes:

• MRI scan provides a detailed view of the brain and spine, including demyelinating lesions or plaque.
• Lumbar puncture checks cerebral spinal fluid for signs of the disease such as chronic inflammation or oligoclonal bands which are found in 85% to 95% of all patients with MS.
• Visual Evoked Potential (VEPs) or Somatosensory Evoked Potentials (SEPs) that show decreased activity of the optic nerve or sensory nerves can also assist in the diagnosis of MS.
• Myelin Oligondendrocyte Glycoprotein (MOG) is a test that measures glycoproteins that are thought to be important in the myelinization of nerves in the central nervous system (this test in not currently a mainstay for diagnosing MS but thought to a test of the future).   

Four categories of MS

Drug Treatment Options

Symptom Management for MS

Nursing Management:

Patient education regarding MS and factors that are related to relapse are important nursing interventions. The following are exacerbating factors and should be avoided:

• Undue fatigue or excessive exertion
• Overheating or excessive chilling (exposure to cold)
• Infections
• Hot baths
• Fever
• Emotional stress
• Pregnancy (should be discussed with physician to weigh the degree of expected problems prior to making decision to become pregnant)

Nursing Diagnosis:

• Knowledge deficit
• Impaired mobility
• Self care deficit
• High risk for injury
• Self concept disturbance
• Impaired home maintenance

Note: For patients with advanced disease, nursing education will include the use of braces, canes and if necessary confinement to a wheelchair, modifying lifestyles to maintain optimal independence.

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