Nursing Diagnoses

Nursing diagnosis for Multiple Sclerosis

• Risk for self care deficit 
• Risk for cognitive impairment 
• Impaired mobility 
• Risk for fatigue 
• Risk for impaired urinary output 
• Risk for pain
• Risk for Depression

Nursing Diagnosis	Risk for self care deficit relating to neuromuscular impairment, intolerance to activity and motor impairment.
Nursing Intervention	Determine level of current activity. Encourage the patient to perform self care tasks Note the presence of fatigue Provide assistive devices and aids Find ways to encourage nutritional and fluid needs
Desired Outcome	Identify individual areas of needs Demonstrate ways to meet self care needs Preform activities to their own ability Identify resources that may provide assistance

http://nurseslabs.com/9-multiple-sclerosis-nursing-care-plans/

http://www.nationalmssociety.org/What-is-MS

Helpful Resources

This week I wanted to list some various websites that may help with your understanding of the disease MS. Here are my top picks...

For a brief overview and easy to understand information:

http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/

mayoclinic can be used as a platform to begin understanding what multiple sclerosis is, the signs & symptoms of the disease and many possible and current treatments. Once you get your toes wet with this information you can move on to gain a more in-depth understanding which leads me to...

http://www.nationalmssociety.org/What-is-MS

The national MS society is probably the most extensive, accurate, up-to-date and helpful resource there is on MS. The website also has information on MS support and how one can live well with the disease.

MS connection allows one to make a profile and may be a helpful support group for some

https://www.msconnection.org/

I've also listed some nursing care for individuals living with the disease

Risk for Activity Intolerance May be related to fatigue, medications, emotional demands and pain/discomfort	§  Identify and review factors affecting ability to be active: temperature extremes, inadequate food intake, insomnia, use of medications, time of day §  Determine need for walking aids. Provide braces, walkers, or wheelchairs. Review safety considerations §  Assist with physical therapy. Increase patient comfort with massages and relaxing baths §  Administer medications as ordered
Risk for Self-Care Deficit   May be related to neuromuscular impairment, decreased strength and endurance, motor impairment, memory loss, pain/discomfort, fatigue and depression	§  Encourage patient to perform self-care to the maximum of ability as defined by patient. Do not rush patient §  Assist according to degree of disability; allow as much autonomy as possible §  Provide assistive devices and aids as indicated: shower chair, elevated toilet seat with arm supports §  Reposition frequently when patient is immobile (bed or chair bound). Provide skin care to pressure points, such as sacrum, ankles, and elbows. Position properly and encourage to sleep prone as tolerated
Impaired Urinary Elimination May be related to neuromuscular impairment	§  Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of urinary stream. Palpate bladder after voiding §  Review drug regimen, including prescribed, over-the-counter (OTC), and street as a side effect may be due to use §  Encourage adequate fluid intake, avoiding caffeine and use of aspartame, and limiting intake during late evening and at bedtime §  Promote continued mobility

Until next week!

A Complex Disease Calls for a Complex Approach

A complex disease calls for a complex approach to treatment. There is currently no cure for MS, so treatment includes management of symptoms, slowing progression of the disease, treating exacerbation's and addressing emotional health.

There are currently 10 medications that help slow the progression of MS. These are used to treat relapse and reduce the accumulation of lesions in the brain and spinal cord (remember, it is these lesions that cause slowing of nerve transmission that we talked about in our first post!).

MS exacerbations are caused my inflammation (swelling), particularly in the central nervous system. Remember, it is damage to the myelin that slows nerve transmission. When this inflammation is particularly increased, MS "flare-ups" are able to occur. Exacerbations decrease daily functioning and make the individual with MS particularly miserable. These are commonly treated with high-dose corticosteroids. These are medications that reduce inflammation!

Managing symptoms of MS include may include medications as well as rehabilitation.  Rehabilitation focuses on increasing the function of the individual. Problems with mobility, speech, memory and cognitive function needs to be addressed and treated. All members of the health-care team can be included in this portion of treatment. Physical therapy (therapists that focus on rehabilitating movement and activities of individuals and speech therapy (professionals which provide therapy to increase speech function and swallowing function).

Depression, anxiety and general mood disorders are often associated with MS. Therefore, providing emotional support is an important part of treatment. Mental health professionals can help provide support as well as other health care professionals.

Works:
http://www.pharmacytimes.com/publications/specialty-pt/2011/february-2011/SPT-NPP-0211
http://www.nationalmssociety.org/Treating-MS/Comprehensive-Care
http://www.spiraldream.org/tag/multiple-sclerosis-symptoms/

Signs & Symptoms of MS

Today we are going to talk about Signs & Symptoms of MS. Below is a short video explaining some MS symptoms from first-hand experience. 

Signs and symptoms of MS vary greatly, are unpredictable and affect each person with the disease in a unique way. MS symptoms can range from debilitating to mildly uncomfortable. MS symptoms may be managed with medication, rehabilitation and other strategies. Usually a combination is used for treatment.

Common Symptoms:
> Fatigue                                                  
> Numbness & Tingling                          
> Weakness
> Dizziness & Vertigo 
> Sexual Problems
> Walking & Gait Difficulties 

> Muscle Spasms

> Vision Problems

> Bladder & Bowel dysfunction

> Cognitive Change 

> Depression 

Less Common Symptoms: 

> Speech & Swallowing problems
> Tremor
> Seizures 
> Itching
> Hearing Loss
> Headache
> Breathing Problems 


Works:
http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms
http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/basics/symptoms/CON-20026689
http://driverlayer.com/img/ms%20symptoms/20/any
http://www.sclerosistreatment.com/2014/01/early-signs-of-multiple-sclerosis.html

MS diagnosis

This week we are going to discuss diagnosis of MS. It is extremely difficult to diagnose multiple sclerosis. An individual needs to meet many criteria and they may go years having the disease without the official diagnosis. Here are some tests that are used to diagnose the disease, when a patient tests positive for many of them, they might receive the diagnosis of MS.

MRI: Because an MRI is a particularly useful tool in detecting central nervous system damage and demyelenation, it is a powerful tool in helping to establish an MS diagnosis. However, approximately 5 percent of people with clinically definite MS (someone who tests (+) for enough tests to receive a diagnosis) do not initially show lesions on MRI at the time. If repeat MRIs continue to show no lesions, the diagnosis of MS should be questioned.

Spinal Tap: A small amount of cerebrospinal fluid (CSF) may be taken from the spinal column. The presence of oligoclonal bands (a certain type of antibody) is consistent with 90% of the population with MS. However, just because a personal has oligoclonal bands present does not necessarily mean they have MS!

Optical Coherence tomography: A relatively new diagnosis tool for MS is OCT. It is an imaging device that allows retinal structures (like the optic nerve) at the back of the eye to be viewed. OCT studies have shown that the retinal nerve fiber layer is different in people with MS than in people without MS.

 Blood Tests: There are still no blood test to diagnose MS, however blood tests are used in an MS patient to rule out other disorders. Lyme disease, HIV, rare genetic disorders, lupus, rheumatoid arthritis and scleroderma can all be ruled out using blood tests.

There basic rules that are applied when diagnosing MS are...

•  Rule out all other diagnosis AND
• Finding evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
• Find evidence that the damage occurred at two different points in time

Hence...MULTIPLE sclerosis

Diagnosis is essential for early treatment of MS. Permanent neurological damage can occur even in the early stages of the disease, so therefore early detection is crucial.

Diagnosis also gives people an answer to why they are feeling so much discomfort. Getting the diagnosis allows them to begin the adjustment process and relieves them of worries about other diseases such as cancer.

To get more information on MS read this article posted in the SAGE journal.
http://msj.sagepub.com/content/14/9/1157.full.pdf+html

Until next time!

Works:
http://msj.sagepub.com/content/14/9/1157.full.pdf+html
http://www.bbc.com/news/health-20836082
http://www.msfocus.org/diagnose-multiple-sclerosis.aspx
http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/basics/symptoms/CON-20026689
http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms

MS Etiology

I wanted to start this weeks blog with a video. While we can try to imagine what MS is like, I thought it might be helpful to hear a first hand account of what it is like from someone who lives with MS everyday.

 
Many of the debilitating side effects caused by MS (paralysis, blindness and numbness) is due to conduction block caused largely by demyelination and inflammation. Remember the analogy of the game, telephone? Conduction block is when the message can not be properly relayed down the line. You are probably wondering what causes this "demyelination" that we have been talking about for the last three weeks. This week we will discuss the etiology of MS.

Etiology /eti·ol·o·gy/ (e″te-ol?ah-je)

1. the science dealing with causes of disease.

2. the cause of a disease.

Immunologic:
The etiology of MS is still currently not completely understood. What we do know is that in MS, and abnormal immune mediated response occurs. This basically means that in an auto-immune response, the body doesn't recognize itself, but rather sees it as something that shouldn't be there and attacks itself. In the case of MS, the body attacks the coating around the nerve fibers called myelin. In recent years, researchers have finally been able to identify which immune cells are causing the attack, why they may attack and some of the receptors on the attacking cells that seem to be attacked the the myelin.

Environmental:
MS has been found more frequently in areas that are father from the equator. Because of this, etiologists are studying geography, demographics, gender and ethnic background to shed light onto potential risk factors. Studies have even shown that people who are born in an area with a high risk of MS who move to an area of lower risk under the age of 15, assume the new risk of the area they moved to. There is also evidence of Vitamin D (or lack of it!) contributing to a higher incidence of MS. Smoking (as with many diseases) may also contribute to the disease as well as contribute to a more rapid disease progression.

Genetic:
While MS is not hereditary (meaning passed through genes from parents to their offspring) , having a first degree (mom, dad, sister, or brother) relative who has MS does increase a person's risk of developing it themselves.There are theories that suggest that while MS itself is not hereditary, some may have a genetic predisposition to react to environmental agents.

Why we may not completely understand why a person may develop MS, we have disproved many theories. Here is a list of things that we know does not cause MS...

Living with a dog or other small pet: Some years ago, canine distemper a virus carried by dogs was proposed as a cause of MS, but research has since ruled this out (thankfully!). Be at ease knowing that there is no evidence to support that playing with your pooch has any influence on MS!

Having allergies: There is no evidence that MS is triggered by a reaction to a specific environmental allergen. Allergies are common in the general population and can occur in people with MS.

Exposure to heavy metals: While it is true that heavy metals may damage the nervous system, the damage is completely different than that which occurs during MS. There is no evidence that heavy metal exposure causes MS.

Aspartame:  No scientific evidence supports the claims that aspartame, an artificial sweetener used in many diet soft drinks and other foods causes MS. Kick back and enjoy your diet coke

That is all for now... until next week!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692682/
http://www.nationalmssociety.org/What-is-MS/What-Causes-MS
https://www.youtube.com/watch?v=lpDhCOO1EII

The Whys & Wherefores of MS

Epidemiology: The incidence, distribution and possible control of diseases and other factors relating to health

MS is thought to affect more than 2.3 million people worldwide. While gender, genetics, age and geography have all been ruled contributing factors of MS, epidemiological studies have proven difficult. Because of the complexity of the disease, MS can be difficult to diagnose. The incidence (or the number of new cases in a given period in a given population) has been proved virtually impossible to estimate. Epidemiologists instead focus on prevalence (the number of people with MS at a particular point in time, in a particular place) of MS. Here are some of the main points regarding the prevalance...

http://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic

• Although more people today are currently being diagnosed with the disease, this may be because of an increase in testing, awareness and a greater access to medical care. There is not definitive evidence that proves the rate of MS increasing in the population. 
• MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is more common in Caucasians of northern European ancestry
• Most are diagnosed between the ages of 20-50 years of age
• MS is 2 to 3 times more prevalent in women than in men
• MS is the leading cause of non-traumatic disability in young adults
• In general, MS is more common in areas farthest from the equator

 

 http://www.medicine.ox.ac.uk/bandolier/booth/neurol/msgeog.html

As you can see in the above images that prevalence rates are higher in places closer to the poles compared to places closer to the equator. This may be due to lack of sunlight and vitamin D found in the regions furthest from the equator. While this fits the hypothesis that a higher exposure to sunlight decreases the incidence of MS, studies of not definitively found this to be true yet.

While we know some of the factors contributing to the prevalence of disease, MS is still widely misunderstood as to why, who and when people develop the disease. Possibly because of this, there is still no treatment for MS.

Works:
http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS
http://multiplesclerosis.net/what-is-ms/statistics/