MULTIPLE SCLEROSIS abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminate usually diagnosed between ages of 20 and

nd 40, and in 2 3 times as many women as men. is an autoimmune condition in which the immune system attacks the central nervoussystem (CNS), leading to demyelination. It is non-contagious however very damaging for the individual demyelination damages the myelin sheath and neurons this damage slows down or blocks messages between your brain and your body, leadingto the symptoms of MS

RISK FACTOR and CAUSES HEREDITY AGE between the ages of 20 and 40 GENDER Being female Having a family history Having certain infections RACE and Ethnicity Being white Living in countries with temperate climes

 Having certain other autoimmune diseases Vitamin D Smoking SIGNS and SYMPTOMS The most common early symptoms of MS include: Tingling Numbness Loss of balance Weakness in one or more limbs Blurred or double vision Less common symptoms of MS may include: Slurred speech Sudden onset of paralysis Lack of coordination Cognitive difficulties

Other symptoms: Fatigue Cognitive impairment Depression Unstable mood Nystagmus is a condition of involuntary eye movement Optic neuritis Diplopia Dysarthria (difficult to understand) Dysphagia (difficult to swallow) Weakness Spasms Ataxia Pain Hypoesthesias refers to a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli. Paraesthesias is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins

and needles" or of a limb "falling asleep". The manifestation of paresthesia may be transient or chronic. Diarrhea or constipation Frequency or retention Trigeminal neuralgia (or "tic douloureux") is a disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw, affecting 12% of MS patients. Lhermitte's sign Lhermitte's sign is an electrical sensation that runs down the back and into the limbs and is produced by bending the neck forwards.

MEDICAL INTERVENTIONS Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri) Fingolimod (Gilenya ) Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well Steroids may be used to decrease the severity of attacks.

Medications to control symptoms may include: Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine Cholinergic medications to reduce urinary problems Antidepressants for mood or behavior symptoms Amantadine (Symmetrel) and modafinil (Provigil) for fatigue. NURSING INTERVENTIONS: Primary: Impaired Physical Mobility related to neuromuscular impairment, decreased strength and fatigue. Encourage and facilitate early ambulation and other ADLs when possible. Facilitate transfer training by using appropriate assistance of persons or d e v i c e s w h e n transferring patients to bed, chair, or stretcher. Encourage appropriate use of assistive devices in the home setting Provide positive reinforcement during activity Allow patient to perform tasks at his or her own rate. Keep side rails up and bed in low position. This promotes a safe environment. Turn and position every 2 hours or as needed. Maintain limbs in functional alignment (e.g., with pillows, sandbags, wedges, or prefabricatedsplints). Perform passive or active assistive ROM exercises to all extremities. Encourage coughing and deep-breathing exercises Encourage liquid intake of 2000 to 3000 ml/day unless contraindicated. Initiate supplemental high-protein feedings as appropriate. Set up a bowel program (e.g., adequate fluid, foods high in bulk, physical activity, stoolsofteners, laxatives) as needed. Administer medications as appropriate. Antispasmodic medications may reduce m usclespasms or spasticity that interfere with mobility. Secondary: Impaired Bowel and Bladder Elimination related to neuromuscular impairment. Nursing interventions: Constipation: Encourage daily fluid intake of 2000 to 3000 ml/day, if not contraindicated medically. Encourage increased fiber in diet (e.g., raw fruits, fresh vegetables); a minimum of 20 g of dietary fiber per day is recommended. Encourage patient to consume prunes, prune juice, cold cereal, and bean products. Encourage a regular time for elimination

 Encourage isometric abdominal and gluteal exercises. Incontinence: Note frequency, urgency, burning, incontinence, nocturia, size of/force of urinary stream. Palpate bladder after voiding Institute bladder training program Encourage adequate fluid intake, limiting intake during late evening and at bedtime. Recommended use of cranberry juice/vitamin C. Promote continued mobility. Recommend good handwashing/perineal care.