MULTIPLE SCLEROSIS = MS MYELIN SHEATH
What is Multiple Sclerosis?
 an autoimmune disease that affects the
Myelin Sheath of the central nervous system
(CNS).
 This leads to inflammation and scarring of
the nerve that decreases nerve transmission.
 may experience sensory and motor problems.
Facts About Multiple Sclerosis
 an autoimmune condition where the immune
system attacks the myelin sheath found on
the nerve.
 It affects the nerve cells in the brain and
spinal cord that leads to sensory and motor
type problems
 Women tend to be affected more than men
 Age- 20-40s
Quick Facts about Multiple Sclerosis
 Symptoms can appear and then disappear.
Common in Relapsing-Remitting Multiple
sclerosis (RRMS)
 Exact cause is not totally known
 Currently no cure
How is Multiple Sclerosis Diagnosed?
 Assessing patient’s symptoms
 MRI -to assess for lesions in the brain and
spinal cord
 Lumbar puncture: assesses spinal fluid for
specific proteins called oligoclonal bands
(immunoglobulins)
Pathophysiology of Multiple Sclerosis
Pathophysiology in MS
 the Myelin Sheath is experienced
demyelination and the Signal is NOT being
transmitted to the area that the nerve
supplies
 expect sensory type problems such as touch,
vision, coordination, emotional, cognitive, and
bowel/bladder.
Clinical Manifestations
 Early signs and symptoms: vision issues,
tingling numbness, weakness, dizziness,
balance issues, bladder problems, cognitive
issues, speaking, muscle spasm.
 Uhthoff’s sign- Symptoms can get worse due
to Heat.
Clinical Manifestations
 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, clumsiness, numbness/tingling.
Clinical Manifestations
 Lhermitte’s sign-electric shock sensation
(travels down the body when moving head
or neck)
 Dizzy, muscles stiff which affects
coordination
 Proprioception- Unable to be aware of body
position
 Romberg’s Sign- patient puts feet together
and closes eye this causes them to sway
Clinical Manifestations
 Vision: nystagmus, 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-overactive bladder (incontinence)
leads to nocturia, hesitancy leads to retaining
urine (at risk for UTI’s and renal stones,
constipation/diarrhea or incontinence
 (antibiotic used to treat infection, especially
TB)
 helps with certain tremors in MS)
Nursing Interventions
SPINAL CORD INJURY (SCI)
 Safety (vision, coordination, decrease
 a traumatic injury to the spinal cord
perception)
resulting to partial or complete disruption
 Preventing symptoms from worsening- keep
of nerve tract and neurons leading
room cool, avoid heating blankets, pads etc.),
paralysis, loss of reflexes, loss of motor
avoid infection,stressful events, and getting
and sensory function, autonomic
too tired.
dysfunction
 maintain regular exercise as tolerated
(swimming, water aerobics)
 Use assistive devices
 Clutter free environment
 Scan environment

Nursing Interventions

 Consult SLP (helps with speech if speech is

slurred or hard to understand, difficult
swallowing), PT (exercises, assistive devices)
 Make accessibility to bathroom
 Catheterization if retaining urine
 Plenty of fluids 2 L,
 High fiber diet and stool softeners

MEDICATIONS

Beta interferon

 decreases the number of relapses of

symptoms by decreasing inflammation and
the immune system response
 Avonex (interferon beta 1a), Rebif, Betaferon

Corticosteroids

 for relapses of symptom

 methylprednisolone (solu-medrol),
prednisone
SPINAL CORD INJURY (SCI)
Bladder issues
 Most common site: Cervical areas: C5 C6
 Oxybutynin: anticholinergic that helps with an
C7 and junction of the thoracic and
overactive bladder, relaxes bladder
lumbar (T12 and L1).
 Bethanechol: cholinergic that helps with
 Most injuries results in tetraplegia and
completely emptying the bladder by helping
most are incomplete than complete.
bladder contract full

Amantadine and Modafinil (CNS stimulant) CAUSES

 antiviral and antiparkinson but has CNS effects  MVA, Trauma, Violence, Falls
 It helps improve fatigue in MS  Infections, Tumor
patients….another drug Baclofen and
diazepam
 skeletal muscle relaxants due to muscle
spasm Propranolol (beta blocker), isoniazid
ASIA Impairment Scale
ASIA A = complete; absent sensory and motor
function
ASIA B = Incomplete, intact sensory but absent
motorfunction below the neurologic level of injury
ASIA C= incomplete, intact motor function distal to
neurologic LOI, and more than half of key muscles
distal to LOI have muscle grade less than 3
ASIA D= incomplete, intact motor function distal to
LOI, and more than half of key muscles distal to LOI
have muscle grade greater than or equal 3
ASIA E= normal, intact motor and sensory function
Clinical Manifestations
Cervical SCI
 C1 to C3=quadriplegia with total loss of
muscular and respiratory paralysis, complete
dependency of ADL
 C4-C5= quadriplegia with impairment, poor
pulmonary capacity, complete dependency of
ADL
 C6-C7= quadriplegia with/ without Some arm/
hand movement , bladder and bowel
retention
THORACIC SCI
 Paraplegia- paralysis involving the lower
extremities
 Poor control of upper trunk.
 bladder and bowel retention
 Autonomic dysreflexia- injury above T 6 and
in Cervical lesions
LUMBAR
❖ Paraplegia (flaccid paralysis) ❖ bowel and bladder
retention
SACRAL
❖ Above S2- allows erection but no ejaculation
❖ S2 and S4- no erection and ejaculation
❖ Paraplegia and bowel and bladder incontinence
 Cervical- Quadriplegia, bowel and bladder
retention
 Thoracic, Lumbar, Sacral-Paraplegia
 Thoracic, Lumbar- bowel and bladder
retention
 Sacral- bowel and bladder incontinence
Diagnostic Test
 X ray-
 Myelogram-
 MRI-
 CT scan-
NURSING ASSESSMENT
 assess cardio pulmonary status and VS
 Determine LOC
 Frequent motor and sensory assessment
 Note signs of spinal shock such as flaccid
paralysis, urine retention, absent reflexes
 Assess bowel and bladder function
ACUTE PHASE
 Intubation of mechanical ventilation
 Vasopressor
 Spinal cord immobilization- use of skeletal
tongs (Crutch field and Vinks tongs
 Surgical intervention- Decompression
laminectomy and Stabilization
 Insertion of IFC
Sub-Acute Phase (1 Week)
 Halo traction- cervical injuries
 H2 receptors blockers
 Early mobilization and passive exercise
Chronic Phase (Beyond 1 week)
 Compression boots
 Antibiotics
 Analgesics and anti-spasmodic to control
pain and spasticity
 Rehabilitation includes PT and occupational
therapy
NURSING INTERVENTIONS
 ABC
 Immobilization in a flat firm surface, (cervical
collar, rigid spine board,)
 Apply cervical collar brace
 Immediate transfer (tertiary hospital)
 Do NOT realign the body part
 Definitive management: Traction, Cast,
Surgery
 Maintain patent airway
 Teach effective coughing
 Adequate fluids and humidification
  Suction as needed
 CPT and ROM
 Logroll PRN
NURSING INTERVENTIONS
 Encourage PT and practicing exercise
 Inspect pressure ulcer
 Turn every 2 hours-
 Encourage fluid intake 2-3 l/day
 Monitor urinary retention
NURSING INTERVENTIONS
 Assess bowel sounds and abdominal
distention
 High Calorie, high fiber
 Check fecal impaction and remove fecal
matter PRN.
 Use suppository
 Bowel program as needed.
COMPLICATIONS
SPINAL SHOCK
 A period of flaccid paralysis and a complete
loss of all reflexes
 Bowel and Bladder retention, Absence of
sweating below the level of lesion,
Hypotension and Bradycardia
AUTONOMIC DYSREFLEXIA
 Occurs with SCI above T6; most often in
cervical areas
 is an exaggerated (excessive) reflex response
by the autonomic system (specifically the SNS
or hyperstimulation of the SNS.)
CM of Autonomic Dysreflexia
 Severe/throbbing headache
 Hypertension Flushing of skin ABOVE the
spinal injury site (vasodilation)
 Bradycardia
 Pale, cool, clammy BELOW the spinal injury
site (vasoconstriction)
 Goosebumps on the skin
 Sweating
 Dilated pupils/blurred vision
 Nasal stuffiness/congestion
 Anxiety
 Blurring of vision Sweating ABOVE the lesion
Nursing Interventions
 Bladder-assess urinary output, prevent
distention, bladder scans, catheterization
 Bowel- assess LBM, bowel sounds, and note
for distention. If impacted, use an anesthetic
jelly prior to manually removing the stool.
 Break down of skin- assess skin regularly,
remove any binding clothing or devices, turns
eq 2 hours, keep skin protected from injury
Nursing Interventions
 Catheterization
 Anti hypertensive- Hydralasine, Nitruprusside
(vasodilator), Nitropaste (topical application),
Calcium Channel blocker
 Relieve fecal impaction
 Turn to side
 Sitting position
DETECTION and ACTION
 Patients experience at T6 or higher spinal cord
injury are at HIGHEST risk.
 ALWAYS ASSESS BP and monitor for elevation
(20-40 mmHg higher from baseline - AD).
 If patient reports a headache, INVESTIGATE
by checking BP immediately
 Monitor for the signs and symptoms above.
What to do if this develops: It’s a medical
emergency!
 Call rapid response), get help, and stay with
the patient.
 High Fowler’s/ 90 degree angle with legs
lowered
 Check blood pressure every 2-5 minutes.
 Remove any binding clothing or devices.
 Investigate and correct the problem, any of
the three Big B’s ( Bladder, Bowel, Breakdown
of skin)