Multiple Sclerosis (MS)

  1. General information
    1. Chronic, intermittently progressive disease of the CNS, characterized by scattered patches of demyelination within the brain and spinal cord
    2. Incidence
      1. Affects women more than men
      2. Usually occurs from 20-40 years of age
      3. More frequent in cool or temperate climates
    3. Cause unknown; may be a slow-growing virus or possibly of autoimmune origin
    4. Signs and symptoms are varied and multiple, reflecting the location of demyelination within the CNS
    5. Characterized by remissions and exacerbations
  2. Assessment findings
    1. Visual disturbances: blurred vision, scotomas (blind spots), diplopia
    2. Impaired sensation: touch, pain, temperature, or position sense; paresthesias such as numbness, tingling
    3. Euphoria or mood swings
    4. Impaired motor function: weakness, paralysis, spasticity
    5. Impaired cerebellar function: scanning speech, ataxic gait, nystagmus, dysarthria, intention tremor
    6. Bladder: retention or incontinence
    7. Constipation
    8. Sexual impotence in the male
    9. Diagnostic tests:
      1. CSF studies: increased protein and IgG (immunoglobulin)
      2. Visual evoked response (VER) determined by EEG: may be delayed
      3. CT scan: increased density of white matter
      4. MRI: shows areas of demyelination
  3. Nursing interventions
    1. Assess the client for specific deficits related to location of demyelinization.
    2. Promote optimum mobility.
      1. Muscle-stretching and strengthening exercises
      2. Walking exercises to improve gait: use wide-based gait
      3. Assistive devices: canes, walker, rails, wheelchair as necessary
    3. Administer medications as ordered.
      1. For acute exacerbations: corticosteroids (ACTH [IV], prednisone) to reduce edema at sites of demyelinization
      2. For spasticity: baclofen (Lioresal), dantrolene (Dantrium), diazepam (Valium)
      3. Beta interferon (Betaseron) to alter immune response
    4. Encourage independence in self-care activities.
    5. Prevent complications of immobility.
    6. Institute bowel program.
    7. Maintain urinary elimination.
      1. Urinary retention
        1. administer bethanecol chloride (Urecholine) as ordered.
        2. perform intermittent catheterization as ordered.
      2. Urinary incontinence
        1. establish voiding schedule.
        2. administer propantheline bromide (Pro-Banthine) if ordered.
      3. Force fluids to 3000 ml/day.
      4. Promote use of acid-ash foods like cranberry or grape juice (see Bladder Surgery).
    8. Prevent injury related to sensory problems.
      1. Test bath water with thermometer.
      2. Avoid heating pads, hot-water bottles.
      3. Inspect body parts frequently for injury.
      4. Make frequent position changes.
    9. Prepare client for plasma exchange (to remove antibodies) if indicated.
    10. Provide psychologic support to client/significant others.
      1. Encourage positive attitude and assist client in setting realistic goals.
      2. Provide compassion in helping client adapt to changes in body image and self-concept.
      3. Do not encourage false hopes during remission.
      4. Refer to multiple sclerosis societies and community agencies.
    11. Provide client teaching and discharge planning concerning
      1. General measures to ensure optimum health
        1. balance between activity and rest
        2. regular exercise such as walking, swimming, biking in mild cases
        3. use of energy conservation techniques
        4. well-balanced diet
        5. fresh air and sunshine
        6. avoiding fatigue, overheating or chilling, stress, infection
      2. Use of medications and side effects
      3. Alternative methods for sexual gratification; refer for sexual counseling if indicated.