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MULTIPLE SCLEROSIS Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults. It is a chronic disorder in which irregular demyelination of the CNS (brain and spinal cord) results in emotional changes and varying degree of cognitive, motor, and sensory dysfunction at the central and peripheral level. It is a perivascular inflammatory response, possibly to chronic viral infection in genetically susceptible individuals, producing a limited disruption in the blood-brain barrier, allowing [beta]-lymphocyte clones to colonize the CNS. Research suggests that in addition to destruction of myelin sheaths (which facilitate the movement of nerve impulses), some underlying nerve fibers are also damaged or severed, which may account for the permanent neurological impairment. MS is grouped into the following four types: Relapsing-remitting: Periods of neurological dysfunction followed by partial or full recovery. Primary-progressive: Steady decline with periods of minimal recovery (fairly uncommon). Secondary-progressive: Initial pattern of relapse and recovery, which becomes steadily progressive over time. Progressive-relapsing: Progressive from onset with clear exacerbations (rare). MS is characterized by periods of exacerabations and remissions and is progressive in approximately 60% of patients. Individual prognosis is variable and unpredictable, presenting complex physical, psychosocial, and rehabilitative issues. CARE SETTING Community or long-term care with intermittent hospitalization for disease-related complications. RELATED CONCERNS Extended care Pneumonia: microbial Psychosocial aspects of care Sepsis/Septicemia Patient Assessment Database Degree of symptomatology depends on the stage and extent of disease, areas of neuronal involvement. ACTIVITY/REST May report: Extreme fatigue/weakness, exaggerated intolerance to activity, needing to rest after even simple activities such as shaving/showering; increased weakness/intolerance to temperature extremes, especially heat (e.g., summer weather, hot tubs) Limitation in usual activities, employment, hobbies Numbness, tingling in the extremities Sleep disturbances, may awaken early or frequently for multiple reasons (e.g., nocturia, nocturnal spasticity, pain, worry, depression) May exhibit: Absence of predictable pattern of symptoms Generalized weakness, decreased muscle tone/mass (disuse), spasticity, tremors Staggering, dragging of feet, ataxia Intention tremors, decreased fine motor skills CIRCULATION May report: Dependent edema (steroid therapy or inactivity) May exhibit: Blue/mottled, puffy extremities (inactivity) Capillary fragility (especially on face) EGO INTEGRITY May report: Statements of reflecting loss of self-esteem/body image Expressions of grief Anxiety/fear of exacerbations/progression of symptoms, pain, disability, rejection, pity
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Keeping illness confidential
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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