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PATHOPHYSIOLOGY
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• Autoimmune process and
infectious agent

Activates T-Cells

Macrophages enter the brain

from peripheral circulation
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Initiates inflammation

Release of cytokines and

activated T-lymphocytes

Demylination and destruction

of oligodendrocytes
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Formation of plaque in
the myelin sheath

Scarring and destruction

of myelin sheath and
axon
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Impaired urinary elimination related

to bladder dysfunction
Interventions:
1. Assess skin for incontinence associated dermatitis with each
voiding.
2. Maintain fluid intake of 2000ml/24hr.
3. Toilet every 3 hr while awake.
4. Scan bladder to confirm postvoid residual (PVR) volume.
5. If PVR is >100ml, catheterize the bladder using sterile
technique in the hospital.
6. Instruct client on self-catheterization with a clean catheter.
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Constipation related to immobility and

demyelination
Interventions:
1. Assess normal bowel movement pattern.
2. Develop a bowel program with .suppositories or digital stimulation
45min after breakfast.
3. Avoid routine use of enemas and laxatives
4. Perform manual disimpaction if other methods do not work.
5. Teach client to consume a high-fiber diet and 2000ml of fluid.
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Fatigue related to fatigue and muscle weakness

Interventions:
1. Keep the environment cool.
2. Teach client to plan activities during peak energy periods.
3. Plan for rest periods during the day.
4. Facilitate sleep by reducing nighttime interruptions, noise and light.
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Impaired physical mobility related to weakness,

contractures, spasticity and ataxia
Interventions:
1. Assess degree of muscle spasticity.
2. Stretch muscles and perform ROM on joints.
3. Administer antipasmodics as ordered.
4. Position in neutral alignment.
5. Consult with physical therapists for mobility aids.
6. Consult with occupational therapists for utensils and splints.
7. Avoid intense aerobic exercise.
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Situational self-esteem related to loss of

independence and fear of disability
Interventions:
1. Assess for the presence of depression and any previous treatment for
depression.
2. Assess the client’s problem-solving strategies.
3. Evaluate the client’s support systems.
4. Provide experiences that increase the client’s autonomy
5. Assist client to accept dependence on others.