SETARA ’11

Rated by MQA

AUTOIMMUNE DISEASE
 Systemic Lupus
Erythematosus (SLE)
 Systemic Lupus
Erythematosus (SLE)
• Chronic multisystem inflammatory disease
• Associated with abnormalities of immune
system
• Results from interactions among genetic,
hormonal, environmental, and
immunologic factors
 Systemic Lupus Erythematosus

• Affects the
– Skin
– Joints
– Serous membranes
– Renal system
– Hematologic system
– Neurologic system
Systemic Lupus Erythematosus

• A variable disease
– Chronic
– Unpredictable
– Characterized by exacerbations &
remissions
 Incidence

• SLE affects 2 to 8 persons per 100,000 in

United States
• Most cases occur in women of
childbearing years
• African, Asian, Hispanic, and Native
Americans three times more likely to
develop than whites
 Etiology
• Etiology is unknown
• Most probable causes
– Genetic influence
– Hormones
– Environmental factors
– Certain medications
 Pathophysiology

• Autoimmune reactions directed against

constituents of cell nucleus, DNA
• Antibody response related to B and
T cell hyperactivity
 Clinical Manifestations

• Ranges from a relatively mild disorder to

rapidly progressing, affecting many body
systems
• Most commonly affects the
skin/muscles, lining of lungs, heart,
nervous tissue, and kidneys
Clinical Manifestations
 Clinical Manifestations

• Dermatologic
– Cutaneous vascular lesions
– Butterfly rash
– Oral/nasopharyngeal ulcers
– Alopecia
Dermatologic Manifestations
 Clinical Manifestations

• Musculoskeletal
– Polyarthralgia with morning stiffness
– Arthritis
• Swan neck fingers
• Ulnar deviation
• Subluxation with hyperlaxity of
joints
Swan Neck Deformity
 Clinical Manifestations

• Cardiopulmonary
– Tachypnea
– Pleurisy
– Dysrhythmias
– Accelerated CAD
– Pericarditis
 Clinical Manifestations

• Renal
– Lupus nephritis
• Ranging from mild proteinuria to
glomerulonephritis
• Primary goal in treatment is slowing the
progression
 Clinical Manifestations

• Nervous system
– Generalized/focal seizures
– Peripheral neuropathy
– Cognitive dysfunction
• Disorientation
• Memory deficits
• Psychiatric symptoms
 Clinical Manifestations

• Hematologic
– Formation of antibodies
against blood cells
– Anemia
– Leukopenia
 Clinical Manifestations

• Hematologic (cont’d)
– Thrombocytopenia
– Coagulopathy
– Anti-phospholipid antibody syndrome
 Clinical Manifestations

• Infection
– Increased susceptibility to infections
– Fever should be considered serious
– Infections such as pneumonia are a
common cause of death
 Diagnostic Studies

• No specific test
• SLE is diagnosed primarily on criteria
relating to patient history, physical
examination, and laboratory findings
Diagnostic Studies
 Diagnostic Studies

• Antinuclear antibodies
– ANA and other antibodies indicate
autoimmune disease
– Anti-DNA and anti-Smith antibody tests
most specific for SLE
– LE prep can be positive with other
rheumatoid diseases
– ESR & CRP are indicative of
inflammatory activity
 Diagnostic Tests

• CBC for hematologic problems

• UA for lupus nephritis
• X-rays of affected joints
• Chest x-ray for pulmonary problems
• ECG for cardiac problems
 Collaborative Care

• Prognosis is improved with

– Earlier diagnosis
– Earlier and better treatment
regimens
– Careful monitoring for organ
involvement
 Collaborative Care

• Drug therapy
– NSAIDs
– Antimalarial drugs
– Steroid-sparing drugs
– Corticosteroids
– Immunosuppressive drugs
 Nursing Management
Nursing Assessment

• Assess patient’s physical, psychologic, and

sociocultural problems with long-term
management of SLE
• Assess pain and fatigue daily
 Nursing Management
Nursing Assessment

• Obtain subjective and objective data

• Educate and counsel on expected issues
 Nursing Management
Nursing Diagnoses
• Fatigue
• Acute pain
• Impaired skin integrity
• Ineffective therapeutic regimen
management
• Body image disturbance
 Nursing Management
Planning
• Overall goals
– Have satisfactory pain relief
– Comply with therapeutic regimen to achieve
maximum symptom management
 Nursing Management
Planning
• Overall goals (cont’d)
– Demonstrate awareness of, and avoid
activities that cause disease exacerbation
(triggers)
– Maintain optimal role function and a positive
self-image
 Nursing Management
Nursing Implementation

• Health promotion
– Prevention of SLE is not possible
– Promote early diagnosis and treatment
 Nursing Management
Nursing Implementation
• Acute intervention
– During exacerbation, patient will become abruptly,
dramatically ill
– Record severity of symptoms and response to
therapy
 Nursing Management
Nursing Implementation
• Acute intervention (cont’d)
– Observe for
• Fever pattern
• Joint inflammation
• Limitation of motion
• Location and degree of discomfort
• Fatigability
 Nursing Management
Nursing Implementation
• Acute intervention (cont’d)
– Monitor weight and I&O
– Collect 24-hour urine sample
– Assess neurological status
– Explain nature of disease
– Provide support
 Nursing Management
Nursing Implementation
• Ambulatory and home care
– Reiterate that adherence to treatment does
not necessarily halt progression
– Minimize exposure to precipitating factors –
fatigue, sun, stress, infection, drugs
 Nursing Management
Nursing Implementation
• Ambulatory and home care
– Teach energy conservation and relaxation
exercises
– For joint problems, all the teaching for RA related
to joint protection, ROM, and positioning to
prevent contractures
 Nursing Management
Nursing Implementation
 Nursing Management
Nursing Implementation
• Lupus and pregnancy
– Infertility can result from SLE treatment regimen
– SLE is associated with complications of pregnancy
– Pregnancy & post partum can cause exacerbations
of SLE
– Women with serious SLE should be counseled
against pregnancy
 Nursing Management
Nursing Implementation
• Psychosocial issues
– Counsel patient and family that SLE has good
prognosis
– Physical effects can lead to isolation, self-esteem,
and body image disturbances
– Assist patient in developing goals
 Nursing Management
Evaluation
• Expected outcomes
– Completion of priority activities
– Verbalization of having more energy
– Expression of satisfaction with pain relief
measures
 Nursing Management
Evaluation
• Expected outcomes (cont’d)
– Performance of activities of daily living without
pain
– Limitation of direct exposure to sun and use of
sunscreen
– No open skin lesions
 Nursing Management
Evaluation
• Expected outcomes (cont’d)
– Expression of satisfaction with activity level
– Pacing of activities to match level of tolerance
– Expression of confidence in ability to manage SLE
over time and in home environment
Rheumatoid Arthritis
 Rheumatoid Arthritis (RA)

• Chronic, systemic autoimmune disease

• Inflammation of connective tissue in
diarthrodial (synovial) joints
• Periods of remission and exacerbation
• Frequently accompanied by extra-articular
manifestations
 Incidence

• Occurs globally, affecting all ethnic groups

• Occurs at any time of life
• Incidence increases with age
– Peaks between 30s and 50s
• Nearly 2.1 million Americans affected
• Women have incidences three times higher
than men
 Etiology

• Cause of RA is unknown
• No infectious agent found
• Two etiologies
– Autoimmune etiology
• Most widely accepted
– Genetic factor etiology
 Pathophysiology

• Chronic inflammation of the joints leads

to:
– Scar tissue (pannus) & joint cartilage
destruction
– Joint laxity, subluxation ( dislocation), &
contracture
Pathophysiology
Pathophysiology
 Pathophysiology

• Pathogenesis of RA is more clearly

understood than its etiology
• If unarrested, RA progresses in four
stages
– Stage 1: Early
• No destructive changes on x-ray,
possible x-ray evidence of
osteoporosis
 Etiology and Pathophysiology

• RA progresses in four stages (cont'd)

– Stage 2: Moderate
• X-ray evidence of osteoporosis, with
or without slight bone or cartilage
destruction
• No joint deformities, adjacent muscle
atrophy, possibly presence of extra-
articular soft tissue lesions
 Etiology and Pathophysiology
• RA progresses in four stages (cont'd)
– Stage 3: Severe
• X-ray evidence of cartilage and bone
destruction in addition to osteoporosis;
joint deformity; extensive muscle atrophy;
possible presence of extra-articular soft
tissue lesions
– Stage 4: Terminal
• Fibrous or bony ankylosis, stage III criteria
 Clinical Manifestations
Onset
• Onset is typically insidious
• Nonspecific manifestations may precede
onset of arthritic complaints
– Fatigue, anorexia, weight loss,
generalized stiffness
• Some report a history of precipitating
events
 Clinical Manifestations
Joints
• Specific articular involvement
– Pain, stiffness, limitation of motion, and
signs of inflammation
• Symptoms occur symmetrically
• Frequently affect small joints of hands and
feet
• Larger peripheral joints may also be
involved
Typical Deformities of
Rheumatoid Arthritis
 Clinical Manifestations
Joints
• Patient experiences joint stiffness after
periods of inactivity
• Morning stiffness may last from 60 minutes
to several hours or more
• MCP and PIP joints typically swollen
• Fingers may become spindle shaped from
synovial hypertrophy and thickening of joint
capsule
 Clinical Manifestations
Joints
• Joints become tender, painful, and warm
• Joint pain
– Increases with motion
– Varies in intensity
– May not be proportional to degree of inflammation
• Tenosynovitis frequently affects extensor and
flexor tendons near wrists
 Clinical Manifestations
Joints
• Tenosynovitis
– Produces manifestations of carpal tunnel
syndrome
– Makes grasping objects difficult
• As RA progresses, inflammation and fibrosis
of joint capsule and supporting structures
may lead to deformity and disability
 Clinical Manifestations
Joints
• Atrophy of muscles and destruction of
tendons around joint cause one articular
surface to slip past other
• Typical distortion of hand
– Ulnar drift, swan neck, and boutonnière
deformities
• Metatarsal head subluxation and hallux
valgus (bunion) in feet may cause pain
Extraarticular Manifestations of
Rheumatoid Arthritis
 Clinical Manifestations
Extraarticular Manifestations
• Three most common
– Rheumatoid nodules
– Sjögren’s syndrome
– Felty syndrome
• Rheumatoid nodules develop in up
to 25% of all patients with RA
• Those affected usually have high
titers of RF
 Clinical Manifestations
Extraarticular Manifestations
• Sjögren’s syndrome
– Seen in 10% to 15% of patients with
RA
– Can occur as a disease by itself or in
conjunction with other arthritic
disorders
• RA and systemic lupus
erythematosus (SLE)
 Clinical Manifestations
Extraarticular Manifestations

• Sjögren’s syndrome (cont'd)

– Patients have diminished lacrimal and salivary
gland secretion
– Complaints of burning, gritty, itchy eyes
– Decreased tearing, photosensitivity
 Clinical Manifestations
Extraarticular Manifestations
• Felty’s syndrome
– Most commonly in patients with severe,
nodule-forming RA
– Characterized by
• Inflammatory eye disorder
• Splenomegaly
• Lymphadenopathy
• Pulmonary disease
• Blood dyscrasias
 Complications
• Joint destruction begins as early as first
year of disease without treatment
• Flexion contractures and hand
deformities
– Cause diminished grasp strength
– Affect patient’s ability to perform
self-care tasks
 Complications

• Cardiopulmonary effects may occur

later in RA
– Pleurisy, pleural effusion,
pericarditis, pericardial effusion,
cardiomyopathy
• Carpal tunnel syndrome can result
from swelling of synovial
membrane
 Diagnostic Studies

• RA is defined as having at least 4 of the

following seven criteria
– Following must be present for at least 6
weeks
1. Morning stiffness that lasts ≥1 hour
2. Swelling in three or more joints
 Diagnostic Studies
• Criteria for RA (cont'd)
• Must be present for at least 6 weeks
3. Swelling in hand joints
4. Symmetrical joint swelling
5. Erosions or decalcification seen on
hand
x-rays
6. Rheumatoid nodules
7. Presence of serum RF
 Diagnostic Studies

• Accurate diagnosis is essential to initiation

of appropriate treatment and prevention
of unnecessary disability
• Diagnosis is often made
– Based on history and physical findings
– Some laboratory tests are useful for
confirmation and to monitor disease
progression
 Diagnostic Studies

• Positive RF occurs in ~80% of patients

• Titers rise during active disease
– Antinuclear antibody (ANA) titers
• Indicators of active inflammation
– ESR
– C-reactive protein (CRP)
 Collaborative Care
• Care begins with a comprehensive program
of education and drug therapy
– Education of drug therapy
• Correct administration, reporting side
effects
• Frequent medical and laboratory
follow-up visits
• A caring, long-term relationship with an
arthritis health care team can increase
patient’s self-esteem and positive coping
 Collaborative Care

• Physical therapy helps maintain

joint motion and muscle strength
• Occupational therapy develops
extremity function and encourages
joint protection
 Collaborative Care

• Since irreversible joint changes can begin

within the first year of RA, aggressive
treatment with disease-modifying
antirheumatic drugs (DMARDs) is
initiated early
 Drug Therapy

• Drugs remain cornerstone of treatment

• DMARDs can lessen permanent effects of
RA
• Choice of drug is based on
– Disease activity
– Patient’s level of function
– Lifestyle considerations
 Drug Therapy

• Many of the drugs used to treat RA are

expensive
• Methotrexate (Rheumatrex) is drug of
choice
– Rapid antiinflammatory effect decreases
clinical symptoms in days to weeks
– Inexpensive
– Lower toxicity compared to other drugs
 Drug Therapy

• Effective DMARDs for mild to moderate

disease
– Sulfasalazine (Azulfidine)
– Antimalarial drug hydroxychloroquine
• Leflunomide (Arava) is a newer synthetic
DMARD that blocks immune cell
overproduction
 Drug Therapy

• Use of combination therapy can slow

symptoms and joint damage while
improving function
• Drug combinations are individualized and
often include
– A DMARD
– An NSAID
– A corticosteroid
 Drug Therapy

• Biologic/targeted drug therapies can

also slow disease progression in RA
• Can be used in patients with moderate
to severe disease who have not
responded to DMARDs or in
combination therapy with an
established DMARD
 Drug Therapy
• Corticosteroid therapy can aid in symptom
control
– Intraarticular injections may relieve pain and
inflammation associated with flare-ups
• Long-term use should not be a mainstay
–Risk osteoporosis, avascular necrosis
– Low-dose prednisone for a limited time to
decrease disease activity until DMARD effect
is seen
 Drug Therapy

• Various NSAIDs and salicylates to treat

arthritis pain and inflammation
• Aspirin is often used in high dosages of 4
to 6 g/day (10 to 18 tablets)
• NSAIDs have antiinflammatory, analgesic,
and antipyretic properties
 Drug Therapy

• NSAIDs
– Do not alter natural history of RA
– Full effectiveness may take 2 to 3 weeks
• Some relief may be noted within days
– May be used when patient cannot
tolerate high doses of aspirin
 Nursing Implementation
Acute Intervention
• Usually treated on an outpatient basis
• Hospitalization may be necessary for
patients with extraarticular complications
or advancing disease
– Reconstructive surgery for disabling
deformities
• Nursing intervention begins with a careful
physical assessment
 Nursing Management
Assessment

• Nurse must also

– Evaluate psychosocial needs and
environmental concerns
– After problem identification, coordinate
a carefully planned program for
rehabilitation and education for
interdisciplinary health care team
 Nursing Management
Problems

• Chronic pain
• Impaired physical mobility
• Activity intolerance
• Self-care deficit
• Ineffective therapeutic regimen
management
• Disturbed body image
 Nursing Management
Planning
• Overall goals
– Satisfactory pain relief
– Minimal loss of functional ability of affected
joints
– Perform self-care
– Participate in planning and carrying out
therapeutic regimen
– Maintain a positive self-image
 Nursing Management
Planning

• Primary goals in managing RA

– Decrease inflammation
– Manage pain
– Maintain joint function
– Prevent or correct joint deformity
 Nursing Management
Interventions

• Goals may be met through a comprehensive

program
– Drug therapy – pain control, antiinflammatory
– Rest
– Joint protection
– Heat and cold applications – pain control
– Exercise
– Patient and family teaching
 Nursing Management
Interventions
• Suppression of inflammation
– NSAIDs
– DMARDs
– Biologic therapies
• Careful attention to timing is critical to
– Sustain a therapeutic drug level
– Decrease early morning stiffness
 Nursing Management
Interventions
• Discuss with patient
– Action and side effects of each prescribed drug
– Importance of laboratory monitoring
• Many RA patients take several different
drugs so the nurse must make the drug
regimen as understandable as possible
 Nursing Management
Interventions
• Nonpharmacologic relief of pain
– Therapeutic heat and cold
– Rest
– Relaxation techniques
– Joint protection
– Biofeedback
– Transcutaneous electrical stimulation
– Hypnosis
 Nursing Management
Interventions

• Lightweight splints may be prescribed to

rest an inflamed joint and prevent
deformity
– Should be removed regularly to perform skin
care and ROM exercises
– Should be reapplied as prescribed
– Occupational therapist may help identify
additional self-help devices to assist in
activities of daily living
 Nursing Management
Interventions

• Morning care and procedures should be

planned around morning stiffness
• To relieve joint stiffness and increase
comfort
– Sitting or standing in a warm shower
– Sitting a tub with warm towels around
shoulders
– Simply soaking hands in a basin of warm water
 Ambulatory and Home Care
Rest
• Alternate scheduled rest periods with
activity throughout day
– Helps relieve pain and fatigue
– Amount of rest varies
• Total bed rest
– Rarely necessary
– Should be avoided to prevent stiffness and
immobility
 Ambulatory and Home Care
Rest

• Even a patient with mild disease may

require daytime rest in addition to 8 to 10
hours of sleep at night
• Nurse should help patient
– Identify ways to modify daily activities to avoid
overexertion
– Pace activities and set priorities on basis of
realistic goals
 Ambulatory and Home Care
Rest
• Good body alignment while resting can be
maintained through use of a firm mattress
or bed board
• Encourage positions of extension
– Avoid flexion positions
• Splints and casts can help maintain proper
alignment and promote rest
 Ambulatory and Home Care
Rest
• Lying prone for half an hour twice daily is
recommended
• Pillows should never be placed under
knees
– Increases risk of joint contracture
• A small, flat pillow may be used under
head and shoulders
 Ambulatory and Home Care
Joint Protection

• Important to protect joints from stress

• Nurse can help identify ways to modify tasks
to put less stress on joints during routine
activities
• Energy conservation requires careful
planning
– Pacing: Work should be done in short periods
with scheduled breaks
 Ambulatory and Home Care
Joint Protection

• Time-saving joint protective devices

should be used whenever possible
• Tasks can also be delegated to other
family members
• Assistive devices that help with simple
tasks can increase patient independence
 Ambulatory and Home Care
Heat and Cold Therapy
• Help relieve pain, stiffness, and muscle
spasm
• Ice
– Especially beneficial during periods of disease
exacerbation
– Application should not exceed 10 to 15
minutes at one time
 Ambulatory and Home Care
Heat and Cold Therapy
• Superficial heat sources
– Can relieve stiffness to allow participation in
therapeutic exercises
• Moist heat
– Relief of chronic stiffness
– Application should not exceed 20 minutes
– Alert patient to not use a heat-producing
cream with another external heat device
 Ambulatory and Home Care
Exercise
• Individualized exercise is an integral part of
the treatment plan
• Usually developed by a physical therapist
• Nurse should reinforce program
participation and ensure that exercises are
being done correctly
 Ambulatory and Home Care
Exercise
• Inadequate joint movement can result in
progressive joint immobility and muscle
weakness
• Overaggressive exercise can result in
increased pain, inflammation, and joint
damage
• Gentle ROM exercises are usually done
daily to keep joints functional
 Ambulatory and Home Care
Psychologic Support
• Self-management and adherence to an
individualized home treatment program can
only be done if patient has a thorough
understanding of
– RA
– Nature and course of disease
– Goals of therapy
 Ambulatory and Home Care
Psychologic Support
• Patient’s value system and perception of
disease must be considered
• Patient is constantly challenged by
problems of
– Limited function and fatigue
– Loss of self-esteem
– Altered body image
– Fear of disability or deformity
 Ambulatory and Home Care
Psychologic Support
• Alterations in sexuality should be discussed
• Chronic pain or loss of function may make
patient vulnerable to unproven or even
dangerous remedies
• Nurse can help patient recognize fear and
concerns
 Ambulatory and Home Care
Psychologic Support
• Evaluation of family support system is
important
• Financial planning may be necessary
• Community resources may be considered
• Self-help groups are beneficial for some
patients
Multiple Sclerosis
 Multiple Sclerosis

• Chronic, progressive, degenerative

disorder of the CNS characterized by
disseminated demyelination of nerve
fibers of the brain and spinal cord
 Multiple Sclerosis

• Usually affects young to middle- aged

adults, with onset between 15 and 50 years
of age
• Women affected more than men
 Multiple Sclerosis
Etiology

• Unknown cause
• Related to infectious, immunologic, and
genetic factors
 Multiple Sclerosis
Etiology

• Possible precipitating factors include

Infection
Physical injury
Emotional stress
Excessive fatigue
Pregnancy
Poor state of health
 Multiple Sclerosis
Pathophysiology
• Mylelin sheath
– Segmented lamination that wraps axons of
many nerve cells
– Increases velocity of nerve impulse conduction
in the axons
– Composed of myelin, a substance with high
lipid content
 Multiple Sclerosis
Pathophysiology
• Characterized by chronic inflammation,
demyelination, and gliosis (scarring) in
the CNS
• Initially triggered by a virus in genetically
susceptible individuals
• Subsequent antigen-antibody reaction
leads to demyelination of axons
Pathogenesis of MS

Fig. 57-1
 Multiple Sclerosis
Pathophysiology

• Disease process consists of loss of myelin,

disappearance of oligodendrocytes, and
proliferation of astrocytes

• Changes result in plaque formation with

plaques scattered throughout the CNS
 Multiple Sclerosis
Pathophysiology
• Initially the myelin sheaths of the neurons in
the brain and spinal cord are attacked, but the
nerve fiber is not affected
• Patient may complain of noticeable
impairment of function
• Myelin can regenerate, and symptoms
disappear, resulting in a remission
 Multiple Sclerosis
Etiology and Pathophysiology

• Myelin can be replaced by glial scar tissue

• Without myelin, nerve impulses slow down
• With destruction of axons, impulses are
totally blocked
• Results in permanent loss of nerve function
 Multiple Sclerosis
Clinical Manifestations

• Vague symptoms occur intermittently over

months and years
• MS may not be diagnosed until long after
the onset of the first symptom
 Multiple Sclerosis
Clinical Manifestations

• Characterized by
– Chronic, progressive deterioration in
some
– Remissions and exacerbations in others
 Multiple Sclerosis
Clinical Manifestations

• Common signs and symptoms include

motor, sensory, cerebellar, and
emotional problems
 Multiple Sclerosis
Clinical Manifestations

• Motor manifestations
– Weakness or paralysis of limbs,
trunk, and head
– Diplopia (double vision)
– Scanning speech
– Spasticity of muscles
 Multiple Sclerosis
Clinical Manifestations
• Sensory manifestations
– Numbness and tingling
– Blurred vision
– Vertigo and tinnitus
– Decreased hearing
– Chronic neuropathic pain
 Multiple Sclerosis
Clinical Manifestations
• Cerebellar manifestations
– Nystagmus
• Involuntary eye movements
– Ataxia
– Dysarthria
• Lack of coordination in articulating
speech
– Dysphagia
• Difficulty swallowing
 Multiple Sclerosis
Clinical Manifestations
• Emotional manifestations
– Anger
– Depression
– Euphoria
 Multiple Sclerosis
Other Clinical Manifestations
• Bowel and bladder functions
– Constipation
– Spastic bladder: small capacity for
urine results in incontinenceFlaccid
bladder: large capacity for urine and
no sensation to urinate
 Multiple Sclerosis
Other Clinical Manifestations
• Sexual dysfunction
Erectile dysfunction
Decreased libido
Difficulty with orgasmic response
Painful intercourse
Decreased lubrication
 Multiple Sclerosis
Diagnostic Studies
• Based primarily on history, clinical
manifestations, and presence of multiple
lesions over time measured by MRI
• Certain laboratory tests are used as
adjuncts to clinical exam
 Multiple Sclerosis
Diagnostic Studies

• Diagnosis based primarily on:

– history and clinical manifestations
– ruling out other causes of
symptoms
• No definitive diagnostic test
• MRI – demonstrates presence of
plaques
 Multiple Sclerosis
Collaborative Care

Drug Therapy
– Corticosteroids
• Treat acute exacerbations by reducing
edema and inflammation at the site of
demyelination
• Do not affect the ultimate outcome or
degree of residual neurologic
impairment from exacerbation
 Multiple Sclerosis
Collaborative Care
– Immunosuppressive Therapy
• Because MS is considered an
autoimmune disease
• Potential benefits
counterbalanced against
potentially serious side effects
 Multiple Sclerosis
Collaborative Care

• Antispasmotics (muscle relaxants)

• Physical therapy helps
 Relieve spasticity
 Increase coordination
 Train the patient to substitute unaffected muscles
for impaired ones
 Multiple Sclerosis
Collaborative Care
• Nutritional therapy includes megavitamins
and diets consisting of low- fat, gluten-free
food, and raw vegetables

• High-protein diet with supplementary

vitamins is often prescribed
 Multiple Sclerosis
Nursing Assessment

• Health History
Risk factors
Precipitation factors
Clinical manifestations
 Multiple Sclerosis
Nursing Diagnoses
• Impaired physical mobility
• Dressing/grooming self-care deficit
• Risk for impaired skin integrity
• Impaired urinary elimination pattern
• Sexual dysfunction
• Interrupted family processes
 Multiple Sclerosis
Nursing Planning

• Maximize neuromuscular function

• Maintain independence in activities of
daily living for as long as possible
• Optimize psychosocial well-being
• Adjust to the illness
• Reduce factors that precipitate
exacerbations
 Multiple Sclerosis
Nursing Implementation
• Help identify triggers and develop ways to
avoid them or minimize their effects
• Reassure patient during diagnostic phase
• Assist in dealing with anxiety caused by
diagnosis
• Prevent major complications of immobility
 Multiple Sclerosis
Nursing Implementation

• Focus teaching on building general

resistance to illness
Avoiding fatigue, extremes of hot
and cold, exposure to infection
• Teach good balance of exercise and
rest, nutrition, avoidance of hazards of
immobility
 Multiple Sclerosis
Nursing Implementation
• Teach self-catheterization if necessary
• Teach adequate intake of fiber to aid in
regular bowel habits