Multiple Sclerosis - is an immune-mediated, progressive demyelinating disease of the CNS.

Predisposing Factors:
• Age (20-35 y.o) Precipitating Factors:
• Gender (Female) • Exposure to:
• Geographic Location o Epstein-Barr Virus (most common)
• Genetic Susceptibility o Measles Virus
• Smoking o Human Herpes Virus-6
• Low levels of Vit. D

Sensitized T & B lymphocyte passes blood brain barrier

Sensitized T cell remain in CNS and promote infiltration

Interferon gamma T-cells attach to T cells attach to myelin sheath receptor

activates macrophages macrophages

T cells release cytokines

Macrophage release of tissue necrosis factor

Inflammatory response is started

Myelin sheath is attacked

 Destruction of Myelin Sheath

Oligodendrocytes attempts to repair damaged

myeline

T cells, macrophages and interferon gamma

attack the myelin sheath, oligodendrocytes,
axon as they were identified as foreign

Axon becomes demyelinated Primary S&S

Degeneration of axons • Fatigue
• Depression
Plaques of sclerotic tissue appear to • Loss of Balance
demyelinated sheath • Difficulty in
coordination
Permanent irreversible
• Pain
damage Interruption if impulse transmission

Manifestation depending on involves neurons

Urinary Tract Infection

Sensorimotor Optic nerves:

Bladder Nerve:
nerves: • Blurring of vision
• Incontinence
• Weakness • Diplopia
• Urgency
Impaired physical • Difficulty in • Scotoma
coordination • Frequency of
mobility r/t weakness • Blindness urination
and spasticity • Numbness
• Pain
• Spasticity Impaired urinary
elimination r/t nervous
Risk for injury r/t visual system dysfunction
impairments
• Assist patient in for muscles
exercises as able or allowed out
of bed
• Present a safe environment: bed
rails up, bed in a down position,
important items close by.
• Provide analgesics as prescribed
• Evaluate need for assistive
devices
• Teach patient or family in
maintaining home atmosphere
hazard-free and safe
• Let the patient accomplish tasks
at his or her own pace
• Recommend to make use of an
eye patch if experiencing double
vision.
• Orient to the surroundings; keep
personal belongings and furniture
on fixed arrangement.
• Advise making use of other
senses to compensate for
reduced sensation.
• Provide a clutter-free and safe
environment.
• Assess voiding pattern
• Ensure adequate hydration to
prevent urinary tract infection and
stones.
• Use a catheter to expel retained
urine.
• Set up on a bladder training
program to lessen incontinence
episodes
• Encourage proper hand hygiene
and perineal care
• Administer medications as
prescribed
• Obtain periodic urinalysis, urine
culture and sensitivity as indicated

• Electrophoresis – the cerebrospinal fluid is

being studied to check for the presence of
IgG antibodies.
• Magnetic Resonance Imaging – helpful in
visualization of the lesions on the white
matter of the central nervous system
• Visual, auditory and somatosensory
evoked potentials – can help define the
extent of the disease process and monitor
changes.
• Neuropsychological testing - may be
indicated to assess cognitive impairment.
• Urodynamic Studies – for underlying
bladder dysfunctions
 Disease-Modifying Medications:
• Interferon beta-1a (Rebif) and interferon beta-1b
(Betaseron)
• Glatiramer acetate (Copaxone)
• IV methylprednisolone
• Novantrone

Symptoms Management Medications:

• Baclofen (Lioresal)
• Benzodiazepines (Valium), tizanidine (Zanaflex), and
dantrolene (Dantrium)
• amantadine (Symmetrel), pemoline (Cylert), or
fluoxetine (Prozac
• beta-adrenergic blockers (Inderal), antiseizure agents
(Neurontin), and benzodiazepines (Klonopin)
• anticholinergic agents, alpha-adrenergic blockers,
antispasmodic agents
• Ascorbic Acid & Antibiotics

Legend:

Predisposing Factors Complication Nursing Diagnosis

Precipitating Factors Disease Process Nursing Management Diagnostics

Disease Signs & Symptoms Medical Management