NURS 201 Midterm Questions And Answers With Verified Study Solutions

NURS 201 Midterm Questions And Answers With Verified Study Solutions

Multiple Sclerosis
(MS) (Irreversible)
● Pathophysiology
â—‹ Chronic, progressive, degenerative disorder of CNS characterized by
demyelination of nerve fibers of brain and spinal cord
â—‹ Caused primarily by autoimmune R/T fatigue
â—‹ Autoimmune process
â–  Activated T cells migrate to CNS and disrupt blood brain barrier
â–  Antigen-antibody reaction w/in CNS
â–  Activates inflammatory response and unmyelinated axons
â—‹ Three pathologic processes characterize MS
â–  Chronic inflammation
â–  Demyelination
â–  Gliosis in the CNS
● Labs → elevated protein + slightly elevated WBCs
● Priority → respiratory
â—‹ Assessment for aspiration
â—‹ Teach coughing + deep breathing exercises
● Physical considerations for patient
â—‹ ages= 20-50
â—‹ Women are more common than men
â—‹ Virus and infections
â–  Exacerbations triggered by upper respiratory infection and UTI
● Ask about urinary tract infections
â—‹ Physical injuries
â—‹ Smoking
â—‹ Emotional stress
â—‹ Pregnancy
â—‹ Fatigue
â—‹ Overexertion
â—‹ Temp extremes (not too hot or cold)
â–  Can experience= Uhtoff sign after being exposed to heat
● Temporary worsening of vision
● Pregnancy considerations
â—‹ During gestation period: S/S improve and experience remission
â–  Hormone changes affect the immune system
â—‹ Postpartum= risk of exacerbation increase and s/s get worse
â—‹ Pt teaching= s/s can exacerbate after giving birth
● Manifestations
â—‹ Motor S/S
â–  weakness/ paralysis of limbs, trunk, head
● Fatigue in lower extremities
â–  Diplopia- blurred or double vision
● Blurred or double vision, red-green distortion and blindness
in one eye can be the first s/s with MS.
● **diplopia is unique to MS
â–  Scanning speech- spoken words broken up in separate syllables
â–  Muscle spasms
â—‹ Sensory S/S
â–  Numbing, tingling, paresthesia
â–  Scotomas; patchy blindness
â–  Blurred vision
â–  Vertigo
â–  Tinnitus
â–  Decrease hearing
â–  Chronic neuropathic pain
â–  Lhermitte's sign- radicular (nerve root pain)
● Present in low thoracic and abdominal region
● Electric shock radiating down spine or into limbs with flexion of
neck
â–  Uhthoff’s sign- temporary worsening of vision after exertion/heat
exposure
â—‹ Cerebellar
â–  Nystagmus- repetitive uncontrolled movement of eye
â–  Ataxia- loss of full control of body movement
â–  Dysarthria- difficulty articulating words (slurred speech)
â–  Dysphagia- difficulty swallowing
â—‹ Bladder and bowel dysfunction
â–  Bladder
● Spastic-more common
â—‹ Small capacity for urine
â—‹ Urgency and frequency to go
â—‹ UTI’s can result and incontinence
● Flaccid - crede's maneuver → manually placing pressure on
abdomen over the bladder → helps expel urine
â—‹ Large capacity for urine
â—‹ No desire to void
â—‹ Self-cath may be needed
â—‹ Sex dysfunvction
â–  Erectile dys
â–  Decrease libido
â–  Difficulty w/ orgasm
â–  Painful sex
â—‹ Cognitive dysfunction
â–  Short term memory attention
â–  Information processing
â–  Planning
â–  Visual perception
â–  Word finding
â–  Impaired judgment
● Nursing Care Interventions
â—‹ Monitor for
â–  Visual acuity
â–  Speech patterns- fatigue when talking
â–  Cognitive changes- place objects used in daily routines in the same
places
â–  Swallowing
â–  Activity tolerance
â–  Skin integrity-risk for pressure ulcers
â—‹ Increase fluids to prevent UTIs
â–  Drink measured amount of fluid q2hrs → attempt to void 30 mins after
drinking
â—‹ Small frequent meals
â—‹ Assist with bladder elimination
â–  Intermittent self cath
â–  Crede's maneuver
â–  Bladder pacemaker
â—‹ Communications board for dysarthria
â—‹ Eye patches for diplopia
â–  Alternate every few hours
â–  Exercise and stretch involved muscles
● Water aerobics is great for MS pts
â—‹ Rest periods → take frequent short rest periods → lay down
â—‹ Safe home and hospital environment
â–  Wide base support when walking
â–  Assistive devices
â–  Skin precautions
● Patient teaching
â—‹ Good balance of exercise and rest
â—‹ Minimize caffeine intake
â—‹ Well-balanced meals
â—‹ Follow treatment regimen
â—‹ Self cath if needed
â—‹ Emotional adjustments
â—‹ Lifestyle changes to avoid or decrease triggers

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