Question

1,What assessment findings would you anticipate for the client with multiple sclerosis regarding alterations in visual acuity?
2,If the demyelination from multiple sclerosis is affecting the brainstem, what physical assessment data is a priority for the nurse to gather related to sensory perception?
3,How will the administration of interferon beta-1a (Avonex) put the client at risk for alterations in mood and affect?
4,What mental health data is a priority for the nurse to assess before planning care for the client with MS?

Answer 1

1. Multiple sclerosis is often associated with involvement of the visual pathway that can lead to clinically evident manifestations such as optic neuritis, nystagmus and diplopia. In some cases patient reports blurred vision even if visual acuity is normal. Alteration of visual evoked potential latencies during pattern stimulation is considered one of the most characteristic electrophysiological signs in patients with MS. Such alterations are present almost invariably in subjects affected by optic neuritis.

2. Nerves send and recieve messages from every part of your body and process them in your brain. They allow you to speak, see, feel and think. Many nerves are coated in myelin. Myelin is an insulating material. When it is worn away or damaged, nerves can deteriorate, causing problems in the brain and throughout the body. Damage to myelin around nerves is called demyelination. Demyelination prevents nerves from being able to conduct messages to and from the brain. Signs of demyelination include loss of vision, bladder or bowel problems, unusual nerve pain and overall fatigue. Demyelination is detectable with MRI scans. MRI scans can show demyelination plaques in the brain and nerves caused by MS. Therefore, MRI scan report is the assessment data that is required.

3. Common side effects of Avonex include dizziness, stomach pain, fever, muscle aches etc. But some patients using interferon medications (Avonex) develop mood or behavioural changes like depression ( feeling of hopelessness and worthlessness), suicidal thoughts, irritability, nervousness, anxiety, aggressive behaviour, hallucinations ( hearing or seeing things that others do not hear or see).

4. Before planning care for the patient with multiple sclerosis, the healthcare provider should gather mental health data of the patient. They need to know whether the patient is being treated for a mental illness or had treatment in the past for any mental illness, including depression and suicidal behaviour. Interferon medications could not be given to clients with psychiatric problems or those who have history of psychiatric problems because IFNbeta 1 therapy exacerbate the symptoms or it make the MS patients vulnerable for a relapse.