II.

PATHOPHYSIOLOGY

Causative Agents:
 Unknown

SIGNS AND SYMPTOMS

 Fatigue  Intentional Tremor

Predisposing Factors Precipitating Factors
 Pain  Lhermitte’s sign
 Gender  Smoking
 Numbness and tingling  Dizziness and vertigo
 Age  Obesity
 Spasticity and muscle spasms  Gait and mobility changes
 Viral Infection  Vitamin D
 Muscle weakness  Speech disorders
(Epstein-Barr Virus) Deficiency
 Learning and memory problems  Swallowing problems
 Genetic
 Emotional changes and depression Impairment to sensitivity
predisposition
(Autoimmune)  Vision problems specially to touch
 Geographic  Bladder problems  Urinary tract infections
Prevalence  Bowel problems

T cell gain entry into the brain via disruption of the

blood brain barrier.

T cell recognize the myelin as a foreign object and

attack it.

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 DIAGNOSTIC/LABORATORY MANAGEMENT SPECIFIC TO THE S/S
CONFIRMATORY TEST
Medical Management
A. Physical Assessment of the Affected
System  Intravenous Therapy – for
Eyes rehydration
 Vision loss in one eye  Low fat and high fiber diet

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 T cell gets activated by the myelin.  Slowed conduction in optic nerves Pharmacological Management
Face  Combination of adrenal
 Facial weakness corticosteroid hormone (ACTH)
Blood brain barrier cells changes to express more
receptors, and this allows immune cells to more easily  Numbness and glucocorticoids - for anti-
bind. Neuromuscular inflammatory and
 difficulty with a speech that persisted immunosuppressive actions.
Myelin specific T cell release cytokines to dilate the for 24 hours  Interferon beta- 1a (Rebif) and
blood vessels. interferon beta- 1b (Betaseron)
Cytokines attract B-cells and macrophages as part of - these drugs are among the
the inflammatory reaction. B. Medical Diagnostics
most commonly prescribed
B-cells make antibodies that mark the myelin sheath  History Taking and Physical
medications to treat MS.
proteins. Macrophages use the antibody markers to Examination
 Glatiramer acetate (Copaxone)
engulf and destroy the oligodendrocytes.  Sexual history – to identify changes
(DEMYELINATION AND DESTRUCTION OF in sexual dysfunction - This medication may help
OLIGODENDROCYTES)  MRI or CT scan – to detect block the immune system's
Formation of plaques. presence of multiple plaques on the attack on myelin and must be
Regulatory T cell will inhibit or calm down the other CNS injected beneath the skin.
immune cells, leading to a reduction in the  CSF electrophoresis – identifies the  IV Methyl prednisone - it exerts
inflammation. presence of oligoclonal banding anti-inflammatory effects by
After that, some remyelination process occurs. (several bands of immunoglobulin acting on T cells and cytokines.
Remyelination stops and the damage becomes G bonded together, indicating an  Immunosuppressive agents –
irreversible with the loss of axons. immune system abnormality). Azathioprine (Imuran), and
Multiple Sclerosis  Neuropsychological testing – to Cyclophosphamide (Cytoxan) -
assess cognitive impairment. used for their ability to
 Cerebrospinal fluid (CSF) analysis suppress immune reactions
– reveals an increased number of T
 Mitoxantrone (Novantrone) -
lymphocytes that are reactive with
antigens, indicating the presence of treats MS by stopping certain
immune response in the patient. cells of the immune system
 Evoked potential tests - measures from reaching the brain and
the speed of nerve messages along spinal cord and causing
sensory nerves to the brain.

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  Positron emission tomography (PET) damage.
scan – measures brain activity, the  Baclofen (Lioresal) - used to treat
If Not Treated If Treated scan reveals areas with changes in muscle spasticity such as from a
glucose metabolism. spinal cord injury or multiple
sclerosis.
C. Nursing Diagnosis (NANDA)
 Impaired physical mobility  Benzodiazepines (Valium),
Multiple Sclerosis  Early detection or Tizanidine (Zanaflex),
 Activity intolerance
can lead to: diagnosis ofthe disease Dantrolene (Dantrium) -used for
Impaired urinary elimination
 More nerve  MRI or CT Scan memory
 Impaired treating anxiety, panic attacks,
damages  Electrophoresis
 Impairedof sleep pattern depression, insomnia, seizures,
 Increase in CSF  Sexual disfunction nausea, vomiting, muscle
symptoms  Evoked Potential
 Self-care deficit relaxation.
 Complications Studies  Fatigue  Amantadine (Symmetrel),
such as  Urodynamic Low-self
studiesesteem Pemoline (Cylert), Fluoxetine
infections or  Powerlessness/Hopelessness
 Neuropsychological (Prozac) - used to treat a
pneumonia that testing  Risk for ineffective coping variety of movement
 Ineffective family coping disorders.
may lead to  CSF Analysis
 Deficient knowledge
death.  Sexual History  Beta-Adrenergic Agents
 Risk for caregiver role strain
 History and Physical (Inderal) -used to treat high
 Impaired home maintenance
Examination blood pressure, irregular
 Disturbed visual, kinesthetic,
heartbeats, shaking
Bad Prognosis  Administrationtactile
of sensory perception
(tremors), and other
prescribed medications for
conditions.
disease modification and  Anti-Seizure Agent
for symptom management. (Neurontin) - used to treat
 Physical Therapy partial seizures.
 Dose of analgesic, some
are treated with opioids
Good Prognosis (Narcotic e.g.,Morphine
sulfate; PCA- patient-
controlled analgesia)

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 Nursing Management
 Encourage the patient to have a
consistent rest periods between
activities and after-noon nap to
reduce fatigue.
 Encourage the patient to do the
heat and cold applications to
relieve pain.
 Teach the patient some
exercises to help strengthen
the pelvic floor muscles.
 Encourage patient to eat
foods high in fiber and increase
oral fluid intake to avoid
constipation.
 Encourage patient to increase
water intake to help flush out
the urinary tract.
 Instruct patient to develop
skills need to self-care and
improve independence
with visual impairment.
 Advise the patient to ask
for speech therapy to help
improve speech and
swallowing safer.
 Encourage the patient to
do exercise recom-
mended by a physical
therapist to help
decrease depression,
to relax and may to

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 improve strength, muscle tone,
balance, and coordination.
 Execute passive or active assistive
ROM exercises to all extremities
because exercise enhances
increased venous return, prevents
stiffness, and maintains muscle
strength and stamina. It also
avoids contracture deformation,
which can build up quickly and
could hinder prosthesis usage.
 Use devise methods in assisting
patient with memory deficit;
these aids may assist client to
function more independently,
thereby increasing self-esteem.
 Instruct the patient to check
the numb areas on the body
often.

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