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Caring for Multiple Scerosis

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Multiple Sclerosis is an autoimmune disease that is characterized by the immune system attacking the myelin sheaths located around nerve cells in the brain and spinal cord . The damage to the myelin causes a disruption in the signals traveling through the nerves. The cause of multiple sclerosis is unknown MS can develop at any age , but commonly begins in ages 20 - 50 . MS is 3 times more likely to occur in women than men

What is Multiple Sclerosis ?

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MS progresses differently based on its type , with four main forms: Relapsing - remitting , secondary progressive , primary progressive and progressive relapsing.

The 4 forms of MS

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  • Relapsing - remitting MS - Is the most common form of this disease . It is characterized by episodes of attacks followed by periods of remission, during which individuals may experience no visible symptoms for months or years . RRMS can progress to Secondary Progressive Multiple Sclerosis.
  • Secondary progressive MS - can have moments of relapses however , overtime the immune attacks becomes constant and progressively worsens.
  • Primary progressive MS - Is a constant immune attack that gradually progresses as you age. There's no remission or relapses
  • Progressive relapsing - is the least
common and consists of relapses with ongoing progression of the disease

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B. FALSE

A. TRUE

True or False: Patients who have MS have different signs and symptoms becasuse this disease affects different areas of the central nervous system.

NCLEX question #1

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The signs of Multiple Sclerosis varies in every patient depending on the location of the damage to the central nervous system. However as the disease progresses the symptoms become more severe. Symptoms that occur in late stages of MS include;

  • Trouble with balance and coordination
  • Limited mobility or paralysis
  • Muscle spasms , stiffness and cramping
  • Bladder and bowel dysfunction
  • Cognitive changes
  • Vision loss
  • fatigue

MS over time

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Diet, exercise, and healthy behaviors are essential for overall well-being.

  • Consuming foods rich in antioxidants supports immunity and reduces inflammation. Examples include fruits, vegetables, and nuts.
  • Incorporating high-fiber foods promotes digestive health. Examples include whole grains, legumes, and vegetables.
  • It is advisable to avoid processed foods and those with added sugars.
  • Limit the intake of foods high in trans fats and sodium, such as fried foods and salty snacks.

Regular physical activity is recommended for patients with MS. Exercise helps with minimizing muscle spasticity and contractures Swimming , walking , stationary bicycling and progressive weight bearing exercise can relieve spasticity in the legs The patient should exercise regularly but avoid pushing themselves to the point of exhaustion , as intense workouts can worsen symptoms. Patient should take short frequent rest breaks

Physcial activity

C. Rest in an air-conditioned room whenever possible

B. Take an extra dose of muscle relaxers

A. Take a hot shower daily

A nurse is caring for a patient with Multiple Sclerosis (MS). The patient complains about the fatigue associated with the illness. What should the nurse include in the patient education on how to reduce fatigue?

D. Donโ€™t take daily naps

NCLEX question #2

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Assistive Devices:CanesCrutchesManual chairsMotorized scootersOrthoses (braces)Power wheelchairsPushrim-activated power-assist wheelchairsWalkers and wheeled walkers (rollators)

Mobility and Accomodations

Assistance Animals Automotive Adaptations Restrooms โ€” installing grab bars, lower the height of soap or paper towel dispensers Entrances โ€” ramps or mechanized door openers Location of workspace โ€” moving your office closer to the restroom Parking โ€” parking spot closer to the door

Patient experiencing MSEmotions play a big role with how the patient takes care of themselves and how they feel on a day to day basis.They may be under lots of stress during this time of their diagnosisFocus on viewing challenges as opportunities for problem solving, with this technique it allows the patient to gain self confidence and feeling of competence MS can cause a change in moods, it is important to address mood changes as it can affects cognitive function and relationships. Immobility results in fewer social outings can contribute to loneliness and depression .

Caregiver Being a caregiver for a patient with MS you may experience depression, denial, stress and anxiety. Different ways to deal with these emotions is talking to a provider or counselor. Attending a support group can be very beneficial because you can learn from others that are experiencing the same thing.

Emotional and Spiritual Well-being

C. Encourage the caregiver to spend more time with their spouse to strengthen their relationship.

D. Recommend the caregiver seek professional counseling and connect with a support group for caregivers.

A. Suggest the caregiver to put their feelings aside and focus on their spouse

4. A 46-year-old caregiver is providing care for a spouse with multiple sclerosis (MS). During a routine clinic visit, the caregiver expresses feelings of anxiety related to her spouses diagnoses and feelings of sadness. Which of the following actions should the nurse take to best support the caregiver's emotional well-being?

B. Advise the caregiver to focus on the positive aspects of caregiving and avoid discussing their feelings.

NCLEX question #3

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Cognitive and psychosocial problems may occur and reflect frontal and parietal lobe involvement, Some of the cognitive changes that may occur are memory loss and decreased concentration this occurs in about half of patients, whereas severe cognitive changes like dementia are rare

Cognitive health

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Ways to improve cognition: -Eat a more healthy diet such as the MIND diet -Exercise your brain by doing crossword puzzles, reading, and drawing -Cognitive remediation therapy (CRT) is a treatment designed to improve attention, memory, and executive function -Physical activity for better brain function โ€œregular aerobic exercise and weight training can help reduce fatigue and improve strength. They can also rebuild critical connections and generate nerve growth in the brain and nervous system (Empowering People Affected by MS to Live Their Best Lives, 2024)โ€

B. Increased muscle spasticity and tremors

A. Difficulty remembering recent events and conversations

A 55-year-old patient with multiple sclerosis (MS) is being assessed in the clinic for cognitive changes because his wife has noticed a change in his memory. The nurse is reviewing the patientโ€™s symptoms and history. Which of the following findings would be most indicative of cognitive impairment related to MS?

NCLEX question #4

C. Frequent episodes of blurred vision and double vision

D. Persistent feelings of happiness and joy

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A diagnosis of MS is distressing to the patient and family. MS affects people who are often in an early stage of life and concerned about career and family responsibilities. Family conflict, disintegration, separation, and divorce are not uncommon. As the disease progresses itโ€™s often young family members assume responsibility of caring for their parent which may cause a relationship strain with their partner.

Relationship Changes

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Relationship Changes

Ways to maintain a healthy relationship -Open communication -Set boundaries -Seek professional help -Maintain intimacy -Share task with other family members -Build a support network

-Support Groups-Online Communities-Financial Support-Educational Programs-Walk-Fundraising -Family & Friends-Meal train-Caregiving plan-End of life plan/ Important Documents

Resources

Caregiving is HARDPrioritize healthUse resources

Caring for You as a caregiver

D. Try to do every task on your own

C. Set boundries with your partner

B. Avoid your partner

A. Avoid your partner when they are trying to communicate how they feel

What are diffrent ways to maintain a healthy relationship with your partner who has been diagnoses with MS?

Knowledge check

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Resources

Multiple Sclerosis Caregivers: Youโ€™re Not Alone (article). (2024). Family Caregiver Alliance. https://www.caregiver.org/resource/multiple-sclerosis-caregivers-you-are-not-alone-article/ Empowering people affected by MS to live their best lives. (2024). National Multiple Sclerosis Society. https://www.nationalmssociety.org/managing-ms/living-with-ms/emotional-well-being Living with MS. (2024). National Multiple Sclerosis Society. https://www.nationalmssociety.org/managing-ms/living-with- msHinkle, J. L., Cheever, K.H., & Overbaugh, K.(2021). Lippincott CoursePoint Enhanced for Brunner & Suddarth's Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975186722Pietrangelo, A. (2021, September 28). What to know about the final stages of Multiple Sclerosis . Retrieved fromhttps://www.healthline.com/health/ms/multiple-sclerosis-final-stages