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Multiple Sclerosis (MS) NCLEX Review

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.)

Sensation issues:

 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)
References:
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

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