Presented by Group 3-B

Evangelista, Joe Ana Marie

Fonte, Chelsey Kate
Frane, Liezl
Honrada, Gleadhies
Macaraig, Bernadette
 INTRODUCTION
• Multiple sclerosis (MS) is a potentially disabling disease of the brain
and spinal cord (central nervous system).
• In MS, the immune system attacks the protective sheath (myelin)
that covers nerve fibers and causes communication problems
between your brain and the rest of your body. Eventually, the disease
can cause permanent damage or deterioration of the nerves.
• Signs and symptoms of MS vary widely and depend on the amount
of nerve damage and which nerves are affected. Some people with
severe MS may lose the ability to walk independently or at all, while
others may experience long periods of remission without any new
symptoms.
• There's no cure for multiple sclerosis. However, treatments can help
speed recovery from attacks, modify the course of the disease and
manage symptoms.
 CASE SCENARIO
Patient X is a 28-year-old Caucasian female who has been living here in the Philippines since a
month ago. She is an online English tutor as well as a part-time waitress in a beach resort in
Calatagan, Batangas. On the 20th day of June, while working as a waitress, she suddenly experienced
blurry vision but she ignored it because she thought that it was because of her lack of sleep. A few
hours have passed, before she finishes her duty, she felt numbness and weakness in her right leg and
trunk. Her vision also got worse that her co-workers brought her to the nearest hospital.
At the emergency room, her vital signs were taken: BP – 130/90mmHg, T – 36.2°C, PR – 112
bpm, RR – 18 cpm, O2Sat – 95%. Several laboratory and diagnostic tests were done to her such as
the MRI specifically the McDonald criteria, and evoked potential tests. After a few hours, the MRI
showed one T2 bright lesion in the juxtacortical, perventricular and infratentorial areas of her brain.
The evoked potential tests, however, revealed that there is a delay in the P100 latency after full-field
stimulation of her single eye. Later she was diagnosed with multiple sclerosis and was immediately
admitted in the hospital on June 20, 2021 at 11 o’clock in the evening.
 CASE SCENARIO
Upon the admission, the patient was assessed and she said that she has type 1 diabetes, and
some of her family members from her mother’s side has a history of multiple sclerosis. She also
admitted that due to workload, she only goes out of her house on night time when she is going to her
part-time job. She does not get enough exposure to sunlight and she smokes at least two sticks of
cigarette a day. In contrast to that, the patient said that since she has type 1 diabetes, she makes sure
that her diet is healthy although that day before she got admitted to the hospital, she skipped two
meals.
 SYMPTOMS
• Multiple sclerosis signs and symptoms may differ greatly from person to person
and over the course of the disease depending on the location of affected nerve
fibers. Symptoms often affect movement, such as:
• Numbness or weakness in one or more limbs that typically occurs on one side
of your body at a time, or your legs and trunk
• Electric-shock sensations that occur with certain neck movements, especially
bending the neck forward (Lhermitte sign)
• Tremor, lack of coordination or unsteady gait
• Vision problems are also common, including:
• Partial or complete loss of vision, usually in one eye at a time, often with pain
during eye movement
• Prolonged double vision
• Blurry vision
• Multiple sclerosis symptoms may also include:
• Slurred speech
• Fatigue
• Dizziness
• Tingling or pain in parts of your body
• Problems with sexual, bowel and bladder function
CAUSES
• The cause of multiple sclerosis is unknown. It's considered
an autoimmune disease in which the body's immune
system attacks its own tissues. In the case of MS, this
immune system malfunction destroys the fatty substance
that coats and protects nerve fibers in the brain and spinal
cord (myelin).
• Myelin can be compared to the insulation coating on
electrical wires. When the protective myelin is damaged
and the nerve fiber is exposed, the messages that travel
along that nerve fiber may be slowed or blocked.
• It isn't clear why MS develops in some people and not
others. A combination of genetics and environmental
factors appears to be responsible.
 COMPLICATIONS

• Muscle stiffness or spasms

• Paralysis, typically in the legs
• Problems with bladder, bowel or sexual function
• Mental changes, such as forgetfulness or mood swings
• Depression
• Epilepsy
 RISK FACTORS
• Age (20-40 years old)
• Sex (women have more chance)
• Family history (genetic susceptibility)
• Certain infections (Epteinbarr virus)
• Race: White people, particularly those of northern European
descent
• Climate: Common in temperate climates
• Low levels of vitamin D and low exposure to sunlight
• Certain autoimmune diseases: Thyroid disorders, type 1
diabetes
• Smoking
ANATOMY & PHYSIOLOGY
 STRUCTURE OF NEURON

Dendrites
Dendrites are branch-like structures extending away
from the cell body, and their job is to receive messages
from other neurons and allow those messages to travel
to the cell body
 
Cell Body
Like other cells, each neuron has a cell body (or soma)
that contains a nucleus, smooth and rough endoplasmic
reticulum, Golgi apparatus, mitochondria, and other
cellular components. The cell body carries genetic
information, maintains the neuron's structure, and
provides energy to drive activities.
Axon
An axon, at its most basic, is a tube-like structure that carries
an electrical impulse from the cell body (or from another
cell’s dendrites) to the structures at opposite end of the
neuron—axon terminals, which can then pass the impulse to
another neuron. The cell body contains a specialized
structure, the axon hillock, which serves as a junction
between the cell body and the axon.
Synapse
The synapse is the chemical junction between the axon
terminals of one neuron and the dendrites of the next. It is a
gap where specialized chemical interactions can occur, rather
than an actual structure
Myelin Sheath
Myelin sheaths are sleeves of fatty tissue that
protect your nerve cells. These cells are part of
your central nervous system, which carries
messages back and forth between your brain and
the rest of your body. The myelin sheath wraps
around the fibers that are the long threadlike part
of a nerve cell. The sheath protects these fibers,
known as axons, a lot like the insulation around
an electrical wire.
 
Glial Cells
The myelin sheath is not actually part of the
neuron. Myelin is produced by glial cells which
are non-neuronal cells that provide support for the
nervous system. Glia function to hold neurons in
place supply them with nutrients, provide
insulation, and remove pathogens and dead
neurons. In the central nervous system, the glial
cells that form the myelin sheath are called
oligodendrocytes; in the peripheral nervous
system, they are called Schwann cells.
 PATHOPHYSIOLOGY
• Sensitized T- and B lymphocytes cross the blood–brain barrier; their function is
to check the CNS for antigens and then leave. In MS, sensitized T cells remain in
the CNS and promote the infiltration of other agents that damage the immune
system.
• The immune system attack leads to Inflammation that destroys myelin (which
insulates the axon and speeds. The conduction of impulses along the axon) and
the oligodendroglial cells that produce myelin in the CNS.
• Demyelination interrupts the flow of nerve impulses and results in a variety of
manifestations, depending on the nerves affected.
• Plaques appear on demyelinated axons, further interrupting the transmission of
impulses.
• Demyelinated axons are scattered irregularly throughout the CNS. The areas
most frequently affected are the optic nerves, chiasm, and tracts; the cerebrum;
the brainstem and cerebellum; and the spinal cord.
• The axons themselves begin to degenerate, resulting in permanent and
Irreversible damage
DIAGNOSTIC FINDINGS
•Takes time!
•Neurologist assesses various things
•Patient signs and symptoms: related other
diseases
•MRI
•Lumbar Puncture: CSF
•Oligoclonal Bands – inflammation in CNS
•Evoked potential study: electrical signals to
CNS and assess response.
 PHARMACOLOGICAL MANAGEMENT

•There is no cure for multiple sclerosis.

•Treatment typically focuses on speeding recovery from
attacks, slowing the progression of the disease and
managing MS symptoms.
•Some people have such mild symptoms that no treatment is
necessary.
 Treatments for MS attacks
Corticosteroids (oral prednisone and intravenous methylprednisolone).
 To reduce nerve inflammation.
 Side effects: insomnia, increased blood pressure, increased blood glucose levels, mood
swings, fluid retention.

Plasma exchange (plasmapheresis)

 The liquid portion of part of your blood (plasma) is removed and separated from your blood
cells. The blood cells are then mixed with a protein solution (albumin) and put back into
your body.
 May be used if your symptoms are new, severe and haven't responded to steroids.
 TREATMENTS TO MODIFY
PROGRESSION
For relapsing-remitting MS, several disease-modifying therapies are available.
1. Injectable treatments
•Interferon beta medications.
 Among the most commonly prescribed medications to treat MS.
 Injected under the skin or into muscle and can reduce the frequency and severity of
relapses.
 Side effects: flu-like symptoms and injection-site reactions.
•Glatiramer acetate (Copaxone, Glatopa)
 May help block your immune system's attack on myelin and must be injected beneath the skin.
 Side effects: skin irritation at the injection site.
 TREATMENTS TO MODIFY
PROGRESSION
2. Oral treatments
 Fingolimod (Gilenya)
 Reduces relapse rate.
 You'll need to have your heart rate and blood pressure monitored for six hours after the
first dose because your heartbeat may be slowed.
 Other side effects: rare serious infections, headaches, high blood pressure and blurred
vision.
 Dimethyl fumarate (Tecfidera)
 Can reduce relapses.
 Side effects: flushing, diarrhea, nausea and lowered white blood cell count.
 Diroximel fumarate (Vumerity)
 Similar to dimethyl fumarate but typically causes fewer side effects.
 TREATMENTS TO MODIFY
PROGRESSION
•Teriflunomide (Aubagio)
 Can reduce relapse rate.
 Can cause liver damage, hair loss and other side effects.
 Associated with birth defects when taken by both men and women. Therefore, use
contraception when taking this medication and for up to two years afterward.
•Siponimod (Mayzent)
 Can reduce relapse rate and help slow progression of MS.
 Approved for secondary-progressive MS.
 Possible side effects: viral infections, liver problems, low white blood cell count, changes in
heart rate, headaches and vision problems.
 Siponimod is harmful to a developing fetus, so women who may become pregnant should use
contraception when taking this medication and for 10 days after stopping the medication.
 Some might need to have the heart rate and blood pressure monitored for six hours after the
first dose.
 TREATMENTS TO MODIFY
PROGRESSION
•Cladribine (Mavenclad)
 Generally prescribed as second line treatment for those with relapsing-remitting MS.
 Approved for secondary-progressive MS.
 Side effects: upper respiratory infections, headaches, tumors, serious infections and reduced
levels of white blood cells.
 MEDICAL MANAGEMENT
• Most medical treatment is designed to slow disease
progression and address the symptoms of the disease, such
as urinary retention, spasticity, and motor and speech
deficits. Currently, however, physicians generally prescribe
steroid therapy to reduce tissue edema during an acute
exacerbation.
• Consult with a physical therapist if the patient needs to
learn how to use assistive devices or needs to learn
exercises to maintain muscle tone and joint mobility.
• Muscle stretching for spastic muscles and selective
strengthening exercises for weakness are prescribed.
• A social service agency may be required to help the family
deal with the often expensive and long-term financial effect
of the disease. Vocational redirection may also be required.
• For a patient who is experiencing depression, consider a
referral to a psychiatric clinical nurse specialist. Family
 NURSING MANAGEMENT
A. Stimulating motor function
• Instruct to perform everyday exercises that are both helpful to strengthen and stretch
the muscles.
• Teach how to perform stretch-hold-relax activities to reduce muscle spasms and
contractures.
• Before muscle stretching, apply ice packs to minimize spasm.
• Advise to take frequent rest periods and avoid muscle fatigability as much as possible.
• Encourage to do activities and ambulate as tolerated.
• Instruct on the proper use of assistive devices such as braces, canes and walkers.
B. Reducing fatigue
• Inform about fatigue and how it is an integral symptom of multiple sclerosis.
• Make a plan of activities for each day. Make sure there are enough rest periods in
between activities.
• Encourage to use techniques that conserve energy such as sitting while doing some
activities and pushing or pulling objects instead of lifting them up.
 NURSING MANAGEMENT

C. Enhance sensory function

• 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.
D. Maintaining urinary elimination
• 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.
 NURSING DIAGNOSES

• Impaired physical mobility

• Fatigue
• Sensory-perceptual alteration
• Altered urinary elimination
• Altered family processes
• Sexual dysfunction
NURSING INTERVENTIONS

• Provide bed rest during exacerbation.

• Protect the client from injury by providing safety measures.
• Place an eye patch on the eye for diplopia.
• Monitor for potential complications such as urinary tract
infections, calculuses, decubitus ulcers, respiratory tract
infections, and contractures.
• Promote regular elimination by bladder and bowel training.
• Encourage independence.
• Assist the client to establish a regular exercise and rest program.
• Instruct the client to balance moderate activity with rest periods.
• Assess the need for and provide assistive devices.
• Initiate physical and speech therapy.
• Instruct the client to avoid fatigue, stress, infection,
overheating, and chilling.
• Instruct the client to increase fluid intake and eat a
balanced diet, including low-fat, high-fiber foods and
foods high in potassium.
• Instruct the client in safety measures related to sensory
loss, such as regulating the temperature of bath water
and avoiding heating pads.
• Instruct the client in safety measures related to motor
loss, such as avoiding the use of scatter rugs and using
assistive devices.
• Instruct the client in the self-administration of
prescribed medications.
• Provide information about the National Multiple
Sclerosis Society.
 HEALTH TEACHING
• Get plenty of rest. Look at your sleep habits to make sure you're getting the best
possible sleep. To make sure you're getting enough sleep, you may need to be
evaluated — and possibly treated — for sleep disorders such as obstructive sleep
apnea.
• Exercise. If you have mild to moderate MS, regular exercise can help improve
your strength, muscle tone, balance and coordination. Swimming or other water
exercises are good options if you're bothered by heat. Other types of mild to
moderate exercise recommended for people with MS include walking, stretching,
low-impact aerobics, stationary bicycling, yoga and tai chi.
• Cool down. MS symptoms often worsen when the body temperature rises in some
people with MS. Avoiding exposure to heat and using devices such as cooling
scarves or vests can be helpful.
• Eat a balanced diet. Since there's little evidence to support a particular diet,
experts recommend a generally healthy diet. Some research suggests that vitamin
D may have potential benefit for people with MS.
• Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai
chi, massage, meditation or deep breathing may help.