MULTIPLE SCLEROSIS- abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminate- usually diagnosed between ages of 20 and 40, and in 2–3 times as many women as

men.- is an autoimmune condition in which the immune system attacks the central nervous

system (CNS), leading to demyelinationdemyelination- damages the myelin sheath and neurons- this damage slows down or blocks messages between your brain and your body, leading

to the symptoms of MS

MAIN PROBLEM: damage to the myelin sheath

affects the areas of the brain and spinal cord known as the white matter

COMMON MANIFESTATIONS:• Visual disturbances, which may include eye pain, distortion or loss of vision in one eye, or impairment of color perception• Difficulty walking or performing tasks that require coordination• Loss of sensation• Fatigue and/or weakness• Loss of bowel or bladder control

NURSING DIAGNOSIS:Primary: Impaired Physical Mobility related to neuromuscular impairment, decreased strength and fatigue

Nursing Interventions:

>Encourage and facilitate early ambulation and other ADLs when possible.>Facilitate transfer training by using appropriate assistance of persons or devices when 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 prefabricated splints). >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, stool softeners, laxatives) as needed. >Administer medications as appropriate. Antispasmodic medications may reduce muscle spasms 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.

MEDICAL MANAGEMENTMedications for relapsing MS:>Beta interferons>Glatiramer (Copaxone)>Natalizumab (Tysabri)

Medications for progressive MS:>Corticosteroids>Muscle relaxants - Baclofen (Lioresal) and tizanidine (Zanaflex)>Medications to reduce fatigue - amantadine (Symmetrel) and modafinil (Provigil)