mr. mahesh kumar
TRANSCRIPT
![Page 1: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/1.jpg)
MULTIPLE SCLEROSIS
MODERATOR : MRS Sibi RijuLecture CON
PRESENTER :Mr. Mahesh Kumar SharmaM.Sc. nursing 1st year
![Page 2: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/2.jpg)
NEURON
![Page 3: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/3.jpg)
INTRODUCTION It is an Auto Immune Disease which is when the body
starts to destroy itself. It is a life-long disease with no cure. In MS, the body attacks and destroys the fatty tissue
called myelin that insulates an axon/nerve, and is called demyelination.
If damage is severe it can also destroy the nerve/axon itself.
![Page 4: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/4.jpg)
CONT .. MS affects the central nervous system and inflames
the white matter in the brain which creates plaques. White matter is below the top layer of our brain and spinal cord. Plaques block a signal from being passed from the body to the spinal cord and brain.
Currently in the US, 250,000-300,000 people have been diagnosed with MS and there are 200 new cases diagnosed every week.
![Page 5: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/5.jpg)
INCIDENCEWomen makes up 70-75 % cases of MS
Whites are commonly affected
Age of onset ranges from 10 to 50 yrs .the distribution is bimodal ,with one peak at in mid 20s and other at mid 40s.
![Page 6: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/6.jpg)
DEFINITION • Multiple sclerosis is a chronic demyelinating disease
that affect the myelin sheath of neurons of central nervous system.
![Page 7: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/7.jpg)
ETIOLOGY , RISK FACTORS
• ETIOLOGYExact etiology not knownEnvironmental agentGenetic susceptibility
• RISK FACTORSInfectionPhysical injuryEmotional stressPregnancyFatigue
![Page 8: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/8.jpg)
![Page 9: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/9.jpg)
![Page 10: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/10.jpg)
![Page 11: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/11.jpg)
CONT..
![Page 12: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/12.jpg)
PATHOPHYSIOLOGY
T lymphocytes
Recognizes parts of CNS as foreign and attack
Trigger inflammatory process
![Page 13: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/13.jpg)
Damaging effects
Demyelination
Demyelination also plays an important role with repeated attack less affective demyelination
Multiple lesions are produced in the CNS
Multiple lesions are produced in the CNS
![Page 14: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/14.jpg)
Clinical manifestationCranial nerve dysfunction
Blurred visionDiplopiaDysphagiaFacial, weakness ,numbness , pain
![Page 15: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/15.jpg)
CONTD..• Motor dysfunction
• Weakness• Paralysis• Spasticity• Abnormal gait
![Page 16: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/16.jpg)
CONTD..• Sensory dysfunction
ParesthesiaLhermitte’s signDecreased proprioceptionDecreased temperature perception
![Page 17: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/17.jpg)
CONTD..Cerebellar dysfunction
DysarthriaTremorIncoordinationAtaxiaVertigo
![Page 18: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/18.jpg)
CONTD..
• Bowel and bladder dysfunction
• Fecal urgency ,constipation ,incontinence
• Urinary frequency ,urgency ,hesitancy ,nocturia, retention,incontinence
![Page 19: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/19.jpg)
CONTD..Cognitive dysfunction
Decreased short term memoryDifficulty in learning Decreased concentrationMood alteration , short attention span
Sexual dysfunction
Fatigue
![Page 20: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/20.jpg)
TYPES OF MSI. Relapsing –remitting MSII. Primary – progressive MSIII. Secondary – progressive MSIV. Progressive – relapsing MSV. Benign MSVI. Malignant or fulminant MS
![Page 21: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/21.jpg)
TYPE OF MS..
![Page 22: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/22.jpg)
PROGRESSIVE RELAPSING MS
![Page 23: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/23.jpg)
RELAPSING-REMITTING
• Describes the initial course of 85 % to 90% of individual with MS
• Characterized by unpredictable relapses followed by periods of months to years of recovery
• Deficit suffered during the attacks may either resolve or may be permanent
• When deficits always resolve between attacks this is referred to as benign MS
![Page 24: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/24.jpg)
CONT.2 Primary progressive MS
• Gradual progression• Superimposed relapse• No remission
3 Secondary progressive MS• It is characterized by gradual deterioration with or with out
acute relapse• Initially remission and then gradually progress• Neurological symptoms• Cognitive functions worsens
![Page 25: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/25.jpg)
CONT..4 Progressive relapsing• From the onset, gradual progression of disability • Continuous disease progression• Significant recovery immediately following a relapse• Between relapses there is a gradual worsening of
symptoms
![Page 26: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/26.jpg)
CONTD..
![Page 27: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/27.jpg)
DIAGNOSTIC EVALUATION
• HISTORY• viral infection • precipitating factors • family history• signs and symptoms• Sexual history
• mental status examination• cranial nerve examination• motor deficit• sensory examination• Cerebellar functions• reflexes
![Page 28: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/28.jpg)
DIAGNOSISMRI brainMRI spineEvoked potentialsLumbar punctureEEGPET
![Page 29: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/29.jpg)
CT- SCAN
![Page 30: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/30.jpg)
CSF ANALYSIS• protein, IgG,oligoclonal
lgG bands ,Myelin basic protein
![Page 31: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/31.jpg)
EVOKED POTENTIAL TEST
• To assess nerve conduction• Response measured using EEG readingsThree main types• visually evoked potential (VEP) • Brain stem auditory evoked response (BAER)• Somatosensory evoked potential {SSEP)
![Page 32: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/32.jpg)
DIFFERENTIAL DIAGNOSIS
• Lyme disease• Neurosyphilis• Sarcoidosis• SLE• HIV associated myelopathy• Polyarteritis nodosa • tumors, cervical spondolysis • Vitamin B12 deficiency
![Page 33: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/33.jpg)
TREATMENT• Medical management
• Surgical management
• Nursing management
![Page 34: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/34.jpg)
CONT..Aim
• Delay the progression of disease• Manage chronic symptoms• Treat acute exacerbations
• Generally palliative• Immunotherapeutic drugs
• Methyl prednisolone• ACTH
• Nonsteroidal immunosuppressive agents• Azathioprine• Cyclophosphamide• Cyclosporine• interferon's
![Page 35: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/35.jpg)
MEDICAL MANAGEMENT
• Treat acute relapse• IV or oral corticosteroids
(prednisolone ,ACTH )• Immunosuppressants (azathioprine ,
cyclophoshomide )
• Treat exacerbations• Interferon β1b• Interferon β1a• Glatiramir acetate
![Page 36: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/36.jpg)
CONTD..• Symptomatic treatment
• Bladder dysfunction (oxybutin , propanthalene)
• Constipation ( psyllium hydrochloric mucilloid ,bisacosyl)
• Fatigue ( amantadine )• Tremor (propranalol ,clonazepam)
![Page 37: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/37.jpg)
SURGICAL MANAGEMENT• Intrathecal baclofen via surgically implantable pump• Adductor tenotomy• Dorsal rhizotomy• Surgical diversion for urinary incontinence , retention
etc.• Plastic surgery to cure decubitus ulcer• No surgical intervention to alter the disease course of
MS.
![Page 38: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/38.jpg)
NURSING MANAGEMENT
• Impaired urinary elimination R/T bladder dysfunction
• Fluid intake should be maintained at 2L/day• Avoid fluid intake after evening meals• Voiding to be attempted at every 3 hrs when
awake• If voiding not successful-intermittent
catheterization• Teach self catheterization
![Page 39: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/39.jpg)
CONTD..• Constipation R/T immobility and demyelination
high fiber diet ,bulk formers ,stool softnersFluid intake ,2L/dayLaxatives and enemas to be AVOIDED because it
cause dependenceA bowel program to be performedRectal evacuation by glcerin ,bisacodyl
suppositories ,digital stimulation
![Page 40: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/40.jpg)
CONTD..• Activity intolerance R/T fatigue and muscle weakness
Assist client in planning his activities at his peak energy level ,which is usually the morning
Periods of rest through out he day to be plannedCollaboration with physical and occupational
therapist helps a lot .Drug amantadine may help to reduce fatigue
![Page 41: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/41.jpg)
CONTD..• Impaired physical mobility R/T weakness, contractures ,spasticity ,
ataxia
Spastic muscles can be stretched at least twice a day through their full range of motion
Correct body alignment to prevent contracturesUse of splints is helpfulAtaxia and tremor lessened by small weights applied to distal
extremities
![Page 42: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/42.jpg)
CONTD..• Risk for self care deficit R/T muscle weakness
Client may require aids like wheel chairs ,or canes to perform ADL and to ambulate
Teach client to use ADL aidsTable tops are adjusted at comfortable heightsWork in combination with physical therapist ,occupational
therapist and social worker
![Page 43: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/43.jpg)
REFERENCES• Ellen barker ; neurosciences nursing ; 2nd edition ; pg 685 –
718• Joyce M Black ; medical surgical nursing ; 7th edition ; pg
2177-2189• burner medical surgical nursing ;5th edition p.g. 1765- 17• www . wikipedia .com
![Page 44: Mr. mahesh kumar](https://reader036.vdocuments.site/reader036/viewer/2022062316/586fcacd1a28aba24c8b6b15/html5/thumbnails/44.jpg)
• thank all students for attention