Multiple Sclerosis Nursing | Multiple Sclerosis Treatment, Symptoms, NCLEX Review

Summary

In this NCLEX review video, Sarah Thresher discusses Multiple Sclerosis (MS), an autoimmune disease affecting the myelin sheath of neurons in the central nervous system. She covers symptoms, diagnosis, pathophysiology, and nursing interventions, emphasizing the importance of lifestyle changes, medication, and support for patients.

Takeaways

• 🧠 Multiple Sclerosis (MS) is an autoimmune disease that targets the myelin sheath of neurons in the central nervous system, leading to inflammation and scarring.
• 🔍 The diagnosis of MS involves a process of ruling out other conditions and may include MRI, lumbar puncture, and evoked potential studies to identify lesions and inflammation.
• 👩‍⚕️ Nursing care for MS patients focuses on managing a wide range of symptoms, including motor and sensory issues, cognitive problems, and bowel and bladder dysfunction.
• 💊 Medications for MS aim to reduce inflammation, manage relapses, and address specific symptoms like fatigue, spasms, and bladder issues.
• 🌡️ Uhthoff's phenomenon is a key symptom of MS where heat exacerbates the patient's symptoms, emphasizing the importance of keeping the patient cool.
• 🏃‍♀️ Exercise is crucial for MS patients to combat fatigue and improve mood, but it's important to avoid overexertion and maintain a cool environment.
• 🏠 A clutter-free environment and the use of assistive devices can help MS patients navigate their living spaces safely, especially when experiencing vision and coordination issues.
• 🗣️ Speech and language pathology may be involved in the care plan for MS patients to address speech and swallowing difficulties.
• 🤝 Support groups can provide emotional and practical support for MS patients, helping them connect with others facing similar challenges.
• 🧬 The exact cause of MS remains unknown, and while there is no cure, lifestyle changes and medications can help manage symptoms and improve quality of life.
• 📚 The video script serves as an educational resource for nursing students preparing for the NCLEX exam, highlighting the importance of understanding MS for patient care.

Q & A

What is Multiple Sclerosis (MS)?

Multiple Sclerosis, also known as MS, is an autoimmune disease that affects the myelin sheath of the neurons in the central nervous system, which includes the brain and spinal cord. This leads to inflammation and scarring, disrupting nerve signal transmission and causing various motor and sensory symptoms.

How does MS affect the central nervous system?

MS affects the central nervous system by causing the immune system to attack the myelin sheaths, leading to demyelination. This disrupts the normal functioning of neurons, impairing their ability to transmit signals effectively, which results in a range of symptoms.

What are some common symptoms of MS?

Symptoms of MS can vary widely between patients and may include fatigue, tremors, spasms, numbness, tingling, dizziness, vertigo, vision problems, emotional and cognitive issues, bowel and bladder dysfunction, and coordination problems.

What is the most common form of MS?

The most common form of MS is called relapsing-remitting MS, where patients experience periods of symptom flare-ups followed by periods of remission.

How is MS typically diagnosed?

Diagnosing MS is a process that involves assessing the patient's signs and symptoms, ruling out other conditions, and conducting tests such as MRI to look for lesions, a lumbar puncture to analyze cerebrospinal fluid for oligoclonal bands, and evoked potential studies to assess the response to electrical signals sent to the CNS.

What is the role of the myelin sheath in the context of MS?

The myelin sheath is crucial for insulating and protecting the axons of neurons, ensuring the efficient transmission of nerve signals. In MS, the myelin sheath is damaged, leading to demyelination, which impairs signal transmission and causes symptoms.

Why do symptoms of MS vary between patients?

Symptoms vary between patients because MS affects different areas of the central nervous system, depending on where the demyelination occurs. This can lead to lesions in various locations, resulting in a range of different symptoms.

How can lifestyle changes help patients with MS?

Lifestyle changes can help manage the symptoms of MS by reducing factors that may exacerbate symptoms, such as avoiding excessive heat, managing stress, maintaining a healthy diet, and engaging in appropriate exercise to improve energy levels and reduce fatigue.

What are some nursing interventions for patients with MS?

Nursing interventions for MS patients may include providing a safe environment to prevent injuries, managing bowel and bladder issues, educating patients on stress relief techniques, promoting appropriate exercise, and using assistive devices to aid in daily activities.

What medications are commonly used to treat MS symptoms?

Medications for MS can include beta interferons to decrease inflammation and immune system response, corticosteroids for symptom relapses, anticholinergic drugs for overactive bladder, cholinergic drugs for bladder emptying issues, and medications like amantadine or modafinil for fatigue. Other drugs may target specific symptoms like spasms or tremors.

Outlines

00:00

🧠 Introduction to Multiple Sclerosis

Sarah Thresher, a registered nurse, introduces a video on Multiple Sclerosis (MS) as part of an NCLEX review series focusing on the neuro system. She emphasizes the importance of a free quiz for testing knowledge on the condition. MS is defined as an autoimmune disease that targets the myelin sheath of neurons in the central nervous system, leading to inflammation and scarring. This impairs nerve signal transmission, causing motor and sensory symptoms. To differentiate MS from other neurological conditions, Sarah suggests associating MS with the affected myelin sheath. The video promises an in-depth look at symptoms, diagnosis, and management strategies for MS.

05:02

🌐 Understanding Multiple Sclerosis Pathophysiology

This paragraph delves into the pathophysiology of MS, explaining how the immune system attacks myelin sheaths, leading to demyelination and affecting nerve signal transmission. Symptoms vary among patients due to the location of lesions in the central nervous system. The paragraph outlines different symptoms related to emotional and cognitive issues, sensory disturbances, and motor problems. It also introduces the concept of Uhthoff's sign, where heat exacerbates symptoms, and discusses the importance of recognizing early signs and symptoms for prompt diagnosis and treatment.

10:04

🔍 Diagnostic Approaches for Multiple Sclerosis

The script outlines the diagnostic process for MS, which includes a comprehensive assessment due to the condition's mimicry of other diseases. Diagnostic tools such as MRI for brain and spinal cord imaging, lumbar puncture to analyze cerebrospinal fluid for oligoclonal bands, and evoked potential studies to assess nerve signal responses are discussed. These methods help identify the presence of lesions and inflammation indicative of MS.

15:05

🏥 Nursing Interventions for Multiple Sclerosis Patients

The paragraph discusses nursing interventions for MS patients, focusing on safety due to sensory and motor issues, bowel and bladder management, and the prevention of symptom exacerbation. It highlights the importance of a cool environment to avoid Uhthoff's sign, stress management, and the promotion of适度 exercise to combat fatigue and depression. The use of assistive devices and maintaining a clutter-free environment is emphasized to prevent injuries. The paragraph also touches on the potential need for speech and swallowing therapy, physical therapy, and joining support groups for emotional well-being.

20:08

💊 Medications for Managing Multiple Sclerosis Symptoms

This section reviews various medications used to treat MS symptoms. Beta interferons are highlighted for reducing inflammation and relapses, with examples like Avonex, Rebif, and Betaseron. Corticosteroids are mentioned for managing relapses, with drug names such as Methylprednisolone and Prednisone. The paragraph also covers medications for bladder issues, fatigue, spasms, and tremors, including Oxybutinin, Bethanechol, Amantadine, Modafinil, Baclofen, Diazepam, Propranolol, and Isoniazid. The discussion underscores the multifaceted approach to symptom management in MS treatment.

Keywords

💡Multiple Sclerosis (MS)

Multiple Sclerosis, also known as MS, is an autoimmune disease that targets the myelin sheath of neurons in the central nervous system, leading to inflammation, scarring, and a decrease in nerve signal transmission. The video's theme revolves around understanding MS, its symptoms, and management. The script frequently refers to MS to explain its impact on patients, such as causing motor and sensory symptoms.

💡Myelin Sheath

The myelin sheath is a protective covering that insulates nerve fibers and aids in the efficient transmission of nerve signals. In the context of the video, the myelin sheath is compromised in MS, resulting in demyelination, which hampers nerve signal transmission and contributes to the disease's symptoms. The script uses the term to explain the pathophysiology of MS.

💡Neuron

A neuron is a nerve cell that transmits signals in the body. The video emphasizes the role of neurons in MS, particularly how the disease affects their function due to damage to the myelin sheath. The script explains that when neurons are inflamed and scarred, they cannot effectively transmit signals to other nerves, glands, or muscles.

💡Relapsing-Remitting MS

Relapsing-remitting MS is the most common form of the disease, characterized by periods of symptom occurrence followed by periods of remission. The script describes this form of MS to highlight the fluctuating nature of symptoms that patients may experience, which is a key aspect of the disease's presentation.

💡Demyelination

Demyelination refers to the damage to the myelin sheath, which disrupts the normal functioning of neurons. The script explains demyelination as the central pathological process in MS, leading to the various neurological symptoms experienced by patients.

💡Lhermitte's Sign

Lhermitte's sign is a symptom experienced by some MS patients, characterized by an electric shock-like sensation when moving the neck. The script mentions this sign as an example of the sensory issues that can arise due to demyelination in the spinal cord.

💡Nystagmus

Nystagmus is an involuntary eye movement that can be a symptom of MS. The script describes nystagmus as one of the vision issues that may affect patients, illustrating the wide range of symptoms that MS can cause.

💡Optic Neuritis

Optic neuritis is inflammation of the optic nerve, which can lead to vision problems such as pain with eye movement, blurry vision, or seeing dark spots. The video script uses optic neuritis as an example of how MS can affect vision and is often associated with the disease.

💡Corticosteroids

Corticosteroids are medications that can be prescribed to MS patients to reduce inflammation during a relapse. The script mentions corticosteroids as part of the treatment plan to manage the symptoms of MS when they worsen.

💡Beta Interferon

Beta interferon is a class of medications used to reduce the frequency of MS relapses by decreasing inflammation and immune system activity. The script discusses beta interferon as a treatment option that can help manage the disease's progression.

💡Nursing Interventions

Nursing interventions encompass a range of strategies and care practices aimed at improving patient outcomes. The script outlines various nursing interventions for MS, such as maintaining a cool environment to prevent symptom exacerbation, promoting exercise, and providing assistive devices, which are crucial for managing the complex needs of MS patients.

Highlights

Multiple sclerosis (MS) is an autoimmune disease affecting the myelin sheath of neurons in the central nervous system.

MS leads to inflammation and scarring of neurons, resulting in decreased nerve signal transmission and various motor and sensory symptoms.

Nurses can use the mnemonic 'MS Myelin Sheath' to differentiate MS from other neurological conditions like Parkinson's.

Symptoms of MS vary widely among patients due to the different locations of lesions in the brain and spinal cord.

Relapsing-remitting MS is the most common form, with symptoms appearing and disappearing in episodes.

MS is more prevalent in women and typically affects individuals between the ages of 20 to 40.

The cause of MS is currently unknown, and there is no cure, but lifestyle changes and medications can help manage symptoms.

Diagnosing MS involves a neurologist assessing signs and symptoms, ruling out other diseases, and conducting tests like MRI and lumbar puncture.

Demyelination in MS disrupts the proper transmission of nerve signals, affecting various bodily functions.

Early signs and symptoms of MS include fatigue, depression, speech issues, and sensory problems.

Uhthoff's sign is a phenomenon in MS where heat exacerbates symptoms, highlighting the importance of avoiding overheating.

Nursing interventions for MS include safety measures, bowel and bladder management, stress reduction, and appropriate exercise.

Assistive devices and environmental modifications can improve the quality of life for MS patients with mobility issues.

Speech and language pathology consultations may be necessary for MS patients with speech and swallowing difficulties.

Bowel and bladder management in MS includes dietary adjustments, fluid intake, and potential self-catheterization.

Medications for MS aim to reduce inflammation, manage relapses, and address specific symptoms like fatigue and spasms.

Beta interferons, corticosteroids, and various other medications are used to treat different aspects of MS symptoms.

Nurses play a crucial role in educating MS patients about potential tests, medications, and self-care strategies.

Support groups can provide emotional and practical support for MS patients as they navigate their condition.

Transcripts

this is sarah thresher nurse rn.com and

in this video i'm going to be going over

multiple sclerosis and this video is

part of an nclex review series over the

neuro system and as always don't forget

to check out the free quiz that will

test you on this condition so let's get

started what is multiple sclerosis also

called ms it is an autoimmune disease

that affects the myelin sheath of the

neurons in the central nervous system

and what's included in our central

nervous system our brain and our spinal

cord now whenever these myelin sheaths

are being attacked by the body what

happens is it affects the neuron and it

causes it to become inflamed and scarred

now what's the role of our neuron well a

rollover neuron is the same nerve

signals to either another nerve or a

gland or a muscle well if it's inflamed

and scarred it can't do this so there is

a decrease in nerve signal transmission

which is going to lead to a lot of motor

and sensory symptoms that you're going

to see a little bit later now in nursing

we have to know a lot of different neuro

diseases and how do you keep them

straight how do you know what's going on

in parkinson's how do you know what's

going on in multiple sclerosis or

myosinia gravis well to help me keep

them straight and to remember this

condition with multiple sclerosis i

think of okay multiple sclerosis is also

called ms we have the myelin sheath that

is being affected so ms myelin sheath

that is how i keep this straight

compared to parkinson's where your

dopaminergic neurons are being affected

and things like that so hopefully that

helps you now before we dive into the

patho let's talk about some quick facts

about ms okay this disease like we've

already said is immune related so you

actually have your immune system cells

going to

these neurons within the central nervous

system and attacking these myelin

sheaths and our myelin sheaths protect

our axon and whenever they're gone that

axon can't really take that signal and

transfer it to wherever it needs to go

so we have issues with that now let's

talk about symptoms symptoms in patients

vary this patient over here may have

these symptoms while this patient over

here has a little bit different symptoms

now why is that

well it affects our central nervous

system those myelin sheaths and you have

a lot of different neurons in a lot of

different locations in the brain and the

spinal cord and certain areas can be

affected in certain patients so you're

going to see lesions in different areas

of the body for example let's say that a

patient with ms has lesions where their

myelin sheaths are inflamed and scarred

in the cerebellar area well this patient

just because the function of that area

of the brain is going to suffer from

tremors dysarthria where they have

trouble articulating speech because

those muscles that help you do that

aren't working correctly ataxia where

they're going to have some balance and

coordination issues and some cognitive

issues compared to

if they had lesions

where the myelin sheath were damaged

going to the optic nerve and the optic

nerve can become inflamed patients can

experience pain whenever they just move

their eyes and their sockets they can

experience blurry visions see dark spots

and things like that a little bit later

we're going to really talk about those

symptoms in depth but just be aware of

that and another thing that is

interesting about ms is that there's

different forms of it and the most

common form of ms is called relapsing

re-emitting ms and this is where just

like the name says the patient will have

symptoms that appear they have them and

then they'll disappear so they like go

back into remission in a sense and this

ms tends to affect women more than men

and it tends to strike between the ages

of 20 to 40 years of age so relatively

young

the cause of ms is unknown they're not

sure as of now and there is currently no

cure for ms however lifestyle changes

can help with that because there's some

things that patients with ms can do that

they can do to prevent

making their symptoms worse which we're

going to talk a little bit more about in

our nursing interventions

and medications can be prescribed to

improve their signs and symptoms now

let's quickly talk about how ms is

diagnosed because from the nursing

standpoint you want to be able to

educate your patient about potential

tests they may go for and the prep for

them and things like that so one thing

with diagnosing ms is that it takes time

the neurologist has to assess a lot of

different things because there's not

just one test that says hey this patient

has multiple sclerosis so they're going

to look at the patient's signs and

symptoms because a lot of the signs and

symptoms that present in this condition

mimic other conditions so they may have

to rule out other diseases and they can

also order an mri which will take

imaging of the brain and the spinal cord

and it's looking for that inflammation

and scarring on those neurons so it's

looking for lesions in the brain or

spinal cord that could represent that

this patient might have ms another thing

that can be ordered is a lumbar puncture

and this is where they go in and they

remove a sample of cerebral spinal fluid

and they're looking for a high amount of

proteins specifically

oligoclonal bands and if these bands are

present in there that shows that there's

inflammation in the central nervous

system which correlates with multiple

sclerosis

and another type of test that can be

ordered is an invoke potential studies

and this is where they're literally

invoking

electrical signals they're trying to

invoke a response where they're sending

electrical signals to the cns and

they're assessing that response after

those signals are sent now let's talk

about patho because in order to

understand why you're seeing these

certain signs and symptoms in patients

with multiple sclerosis you have to

understand the anatomy and physiology of

the neuron how it works so let's look at

the neuron first we're going to talk

about the dendrites and this is really

where it all starts because the

dendrites receive the signal needed to

create some type of action and then that

signal that they receive goes down to

the soma which soma 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 the

axon connect which is called the axon

hillock then it goes down this long area

known as the axon and remember axon away

takes away from the neuron and for this

axon to be able to deliver this signal

correctly and strongly to either like

another neuron or muscle or gland it

must be

insulated and protected by the myelin

sheath so this is the problem with

multiple sclerosis our myelin sheath has

experienced damage which is called

demyelination

so guess what when a signal is going to

be transferred down through this neuron

it's not going to happen correctly or

even strong enough in a patient who's

having demolization of their myelin

sheaths so that

signal is not going to go and be able to

stimulate that area that that nerve

supplies however in a healthy neuron

where your myelin sheath isn't damaged

it's nice and insulated once that signal

leaves the axon it's going to go down

through the axon terminal which is like

the end of the axon hence terminal and

it's going to snap and where it snaps is

this is where a nerve signal passes with

either another neuron or muscle or gland

to cause some type of action but that's

not really happening here in our

patients who have ms so the concept in

multiple sclerosis is that we're talking

about the nerve cells where in the

central nervous system which is our

brain and our spinal cord so before we

jump here into our signs and symptoms we

need to remember that because of this we

can expect to find sensory problems and

some motor problems like sensory being

like their touch their vision

even it can go into emotional

and cognitive issues also coordination

and bowel and bladder issues now we're

going to signs and symptoms and remember

again patients vary on their signs and

symptoms depending on where that

demyelination has occurred within that

central nervous system now whenever you

see these little asterisks these are

usually the signs and symptoms that are

present early on that patients are going

to have so what i've done is i've

divided the signs and symptoms up by

category because as we just learned the

patient can have emotional cognitive

sensory and motor issues along with

bowel and bladder so we're going to look

at it from those standpoint okay first

let's look at emotional and cognitive a

lot of patients early on they're going

to report that they feel just very

fatigued they haven't even really done

anything to make themselves feel this

tired but they are extremely drained and

petite

they can also experience depression

have speech issues which gets back to

that dysarthria that we talked about

when there's cerebellar

lesions present also later on they can

have dysphagia where they have

difficulty swallowing because those

muscles just aren't working like they

should

also mood swings they can easily be

happy and then switch to side depress

things like that they can also have

trouble thinking and this goes back to

the cognitive issues and that's where

they can have lesions on that cerebellum

area and they can have trouble focusing

problem solving planning thinking of

those right words to say

and things like that now sensation

issues this is another big thing that

people report they can have tremors and

spasms and the spasms can be just very

painful

and which can lead to a lot of

clumsiness a lot of patients report that

they just feel drunk

and this can lead to injury so be

thinking about that whenever we're

thinking about our nursing interventions

and our plan of care

also numbness tingling this can be on

the face the extremities

dizziness vertigo and this can cause

coordination issues along with having a

positive romberg sign now what is that

now and sometimes whenever you do your

nursing head to toe assessment

you can assess for romberg sign and

that's where you have the patients stand

with their eyes closed and their feet

together and if they have a positive rum

bird sign that means that they have

lesions on that cerebellum area that's

responsible for

knowing where your body is in space with

your eyes closed and whenever they close

their eyes they'll actually start to

lose their balance and sway so that's

what that is and another thing is i want

you to remember anytime you see a fancy

name with the word sign and nursing

always remember that for exams it's

called learn meets sign and this is

where the patient if they move their

head in various

motions they can experience an electric

shock sensation down their body a lot of

patients with multiple sclerosis have

experienced this now how can you

remember this for tests remember the l

in lermates and lightning it's like an

electric shock that's how i keep those

straight now let's look at vision issues

in a patient with multiple sclerosis

okay they can have nystagmus where

there's involuntary movement of the eyes

they can also have optic neuritis where

the optic nerve that supplies the eyes

is inflamed and scarred because

demolization of that myelin sheath which

can lead to double vision blurry vision

they their vision can become dull or

gray it's not as vivid as it used to be

when they move their eyes it's very

painful or they see dark spots in their

vision and a lot of times patients will

start having this maybe they don't have

any other symptoms they go in they have

this and this is really associated with

multiple sclerosis now let's look at

elimination issues and we're talking

about the bowel and the bladder because

the nerves that feed those organs that

help us

void and have bowel movements

aren't working very well especially

those sphincters and those muscles so

the nerves can't stimulate them like

they should

so it can go really one of two ways like

with urine some patients can't hold

their urine their bladder is very over

active so they can have incontinence

they can pee a lot at night with not

nocturia or they can have issues with

actually starting a stream with pain

because there's problems with

contracting devoid so they can have

retention issues which puts them at risk

for urinary tract infections and renal

stones which is why in our nursing

interventions we need to educate how to

prevent that

with bowel they can either have

constipation or diarrhea sometimes they

can't even hold the stool because they

can't control the sphincter that is

connected to the bowels and another

thing they can experience is called utop

sign and this is where heat will

actually make their signs and symptoms

that we just went over worse so if they

experience extreme heat outside or doing

physical exercise they will actually

start doing a lot worse with their signs

and symptoms so it's important that a

patient with multiple sclerosis does not

overheat themselves now let's talk about

nursing interventions what are we going

to do for a patient with multiple

sclerosis what's going to be included in

our plan of care well we need to think

back to what we've just learned what's

going on with our patient well we know

based on all those signs and symptoms

that they're going to have safety issues

because they have vision problems

coordination issues and issues with

their perception of pain because they

have the numbness and tingling so they

could easily injure themselves so we

want to be having our thinking around

that also we want to be thinking about

the bowel and the bladder how we can

educate them about that because they're

at risk for urinary tract infections

kidney stones skin breakdown

and

we learned that the most common type or

form of multiple sclerosis was the

relapsing remitting multiple sclerosis

where they have symptoms and then they

go away and we need to talk about how we

can prevent when they do have their

symptoms out of making them worse and of

course medications so let's talk about

preventing the increase in the signs and

symptoms we learned just recently about

udolph sign and we know that heat can

make that worse so we don't want to make

a patient with multiple sclerosis we

don't want to increase their temperature

with heating pads warming blankets

keeping the room temperature hot we want

to keep the environment nice and cool

and stress can increase it so we want to

have a calm environment as well and

teach them some stress relief techniques

because if they experience a lot of

stress it can increase their symptoms

also avoiding infection can do it as

well and over exertion which brings me

to the next point with exercise exercise

is very important for a person who has

ms it's going to help increase their

energy level because they need as much

energy as they can get because of the

fatigue they have and it's going to help

lessen that depression

but they don't want to overdo it so

teach them they need to pace themselves

but they still need to work out but if

they're just feeling horrible it's okay

to skip a day

some best types of exercising for them

is swimming water aerobics type

exercises because heat can cause

worsening of signs and symptoms if

they're in water they're staying nice

and cool and if they pace themselves out

it can be a great way to work out

another thing is using assistive devices

especially when those signs and those

symptoms are really out

and i've had patients with multiple

sclerosis they say even taking a shower

is very hard for them because standing

in the shower is hard the coordination

so getting them a shower chair having

the railing just there to help them with

that goes a long way

importance of having a clutter clutter

free room for them because a lot of

patients may have the dark spots on

their eyes where they can't see certain

parts of their visual peripheral fields

and teaching them to scan the

environment before they get up because

they can have the blurry vision as well

so you want to teach them how to do that

in preventing injury and another thing

is usually what's going to be consulted

depending on what's going on with your

patient if they have where their speech

is affected and their swallowing speech

language pathology will be

consulted to help the patient with their

speech and swallowing and also you want

to assess your patients swallowing are

they coughing a lot when they eat are

they drooling do their lungs sound like

you can hear crackles or anything like

that where they possibly aspirated they

have

usually the difficulty swallowing is in

late stages of multiple sclerosis but

you want to be familiar with that

physical therapy might be consulted to

help them develop exercise regimen and

using those assistive devices

and it's important that you get with

your patient and look up local support

groups of other patients who have

multiple sclerosis and if they're

interested in that they can go there be

with other patients who have this and

just be a support to one another while

they're battling this disease and of

course bowel and bladder okay bladder

remember they can have where they have

an overactive bladder or their bladder

is really not working so they're

retaining the urine so if they have an

overactive bladder you want to make sure

that they have easy access to that

bathroom that's clutter free so they can

go back and forth because they're

probably going to be up a lot and they

may have incontinent episodes so you

want to make sure if your patient's like

immobile and they can't do that

themselves that you're assessing them

for skin breakdown that they have clean

pads underneath them at all times to

prevent the urine from breaking down the

skin

and if they're having issues with

retaining urine they may need to be

taught how to self cath to remove the

urine from the bladder because when

blood when urine stays in the bladder

what happens it is a great reservoir for

infection urinary tract infections and

renal stones because when that urine

just stays

stagnant in the kidneys and the ure and

the bladder stones can form so you want

to educate that patient you want to make

sure you're getting lots of fluids as

long as it's not contraindicated at

least one to two liters of fluids a day

to keep that urine um not concentrated

and for bowel issues again they can have

constipation or diarrhea incontinence so

for

patients who are having constipation

issues you want to teach them about

maintaining high amounts of fiber in

their diet lots of fruits and vegetables

to keep that stool soft and easy and

bulky to pass

and stool softeners if needed and your

patients who are incontinent of stool

you need to be assessing their skin

making sure it's not breaking down and

using those barrier creams okay now

let's talk about medications used to

treat multiple sclerosis okay these

medications we're going to talk about

they really vary depending on what

symptoms the patient is having but first

what we're going to talk about is beta

interferon and what these medications do

is that they decrease the number of

relapses of symptoms by decreasing the

inflammation in the body and the immune

system's response now because it's doing

this what do you think the patient's at

risk for the risk for infection because

it's going to decrease the number of

white blood cells and white blood cells

helps us fight infections and some drug

names of drugs that include the beta

interferons are avenex which is

interferon beta 1a

rebif and then beta feron now let's look

at if your patient is having a relapse

of multiple sclerosis symptoms what are

they going to be ordered to help

decrease that inflammation and decrease

that immune system's response

corticosteroids so that helps with the

relapses and some drug names include

methylpregnisalone

and prednisone now let's look at bladder

issues what can a patient be prescribed

who may have an overactive bladder well

a good one is oxybutinin and this is an

anticholinergic and what it does is it

helps with an overactive bladder by

relaxing the bladder muscle to prevent

contractions now on the flip side let's

say the patient has issues with emptying

the bladder so they can be ordered a

drug called bothanacol which is a

cholinergic drug that helps with

emptying and what it does is it helps

with bladder contraction so they can get

rid of that urine it won't stay stagnant

in the bladder and for patients who are

having fatigue they can be ordered

amantadine which is actually an

antiviral and an anti-parkinson

medication that is used to treat some of

those conditions

but they have found that this drug has

central nervous effects that actually

helps improve fatigue in some patients

with multiple sclerosis and another drug

sometimes used is called modafinil which

is also a central nervous stimulant so

that would help with fatigue as well and

for patients who are having spasms they

can be ordered baclofen which is a

skeletal muscle relaxant that acts

centrally so helps with those spasms or

diazepam which is also known as valium

can help with that and for patients who

have tremors they can take various

medications one being propranolol which

is a beta blocker and we talked about

this drug law inner cardiac series and

one of the things with beta blockers

remember you have to warn the diabetic

patient that if you know normally when

you know your blood sugar's dropping you

get tremors you get shakes

well this drug will mask that and that's

how this drug can work for a person when

a person with multiple sclerosis will

help decrease their tremors and another

drug used to treat tremors in some

patients with multiple sclerosis is

ionized and this is actually an

antibiotic used to treat infections

especially in patients who have

tuberculosis tb but they've also found

that this drug helps with certain

tremors and multiple sclerosis so you

can see

probably already from where we talk

about drugs a lot that although

these drugs are used to treat these

certain conditions they can also treat

signs and symptoms in other conditions

as well okay so that wraps up this nclex

review over multiple sclerosis thank you

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