NEUROLOGICAL SYSTEM
S.Y. 2223 2ND SEMESTER
MEDICAL-SURGICAL NURSING
PROFESSOR CEDDIE LOMIBAO
17/02/2022
MULTIPLE SCLEROSIS
 Autoimmune disease that affects myelin sheath of neurons
in the CNS.
 It is also called MS = Myelin Sheath.
 CNS: consists of the brain and spinal cord.

When myelin sheaths are being attacked by the body, it
causes inflammation and scarring of the neuron 
decrease in nerve signal transmission which may cause
motor and sensory symptoms.
 Role of neuron is to transmit electric signals to another
neuron, gland or a muscle.
QUICK FACTS
 Immune related  immune system attacks the myelin
sheath that is protecting the axons, therefore damage to the
myelin sheath may cause ineffective transmission of signal
of the axon.
 Systems vary specifically where the lesions are in the CNS.
o Cerebellar: tremors, dysarthria, ataxia, cognitive
o Optic Nerve: pain when moving eyes, blurry vision, dark
spots
 Most common form of MS: relapsing-remitting MS
(patients will have symptoms that will appear and
disappear)
 Common in:
o Women
o 20-40 years old
 Cause: unknown
 No cure: however, lifestyle changes & medications may
help to improve signs and symptoms.
PATHOPHYSIOLOGY
 Myelin sheath has experienced damage called
demyelination. Signal will be transferred ineffectively
because the myelin sheath was damaged which was
responsible for insulating and protecting the axon for a
complete and effective transmission of signal.
 Normal: Dendrites  Soma (body)  Axon (insulated and
protected by myelin sheath)  Axon terminal 
neuron/muscle /gland to initiate a certain response/action.
 It is normally expected for patients with MS to have sensory
and some motor symptoms.
DIAGNOSTIC PROCEDURES
 It takes time to diagnose MS so the neurologist needs to
assess various things; there is no single test that is
indicative of MS.
 Assess signs and symptoms to rule out other diseases.
 MRI – to check for lesions on the neurons of the CNS
 Lumbar puncture – assess CSF for elevated proteins,
specifically oligoclonal bands showing inflammation is
present in the CNS which correlates to MS.
 Evoked potential studies: electrical signals are transmitted
to the CNS and response shall be assessed afterwards.
SIGNS AND SYMPTOMS
EMOTION & COGNITIVE
 Drained (fatigue)
 Depressed
 Speech issues – swallowing
 Mood swings
 Trouble thinking (focus, problem solving)
SENSATION
 Tremors
 Spasms
 Clumsy
 Numbness & tingling
 Dizzy
 Coordination
 Positive Romberg’s sign  lesions on cerebellar area
which is responsible in knowing where your body is in space
when you close your eyes. (they lose their balance when
they walk with eyes closed)
LHERMITTES SIGN
 If patient moves their head in various motions, they may
experience electric shock sensation.
VISION
 Nystagmus
 Optic neuritis
o Double vision
o Blurry vision
o Dull/gray vision
o Pain moving eyes
o Dark spots vision
ELIMINATION
 Urine
o Can’t hold urine: nocturia, overactive bladder
o Problems w/ contraction to void: retention
 Bowel: constipation/diarrhea, can’t hold stool
UHTHOFF’S SIGNS
 Heat makes signs and symptoms WORST!
NURSING INTERVENTIONS
 SAFETY (vision, coordination, decreased perception of
pain, bowel/bladder, RRMS prevention, medications)
 Prevent increase of signs and symptoms
o Heat can make it worst, so maintain temperature (nice
and cool)
o Stress can worsen the symptoms – perform stress relief
exercises or techniques
o Avoid infection and overexertion
 Exercise very important: increase energy, decrease
depression  DO NOT OVER DO IT!
o Swimming
o Water aerobics
 Use assistive devices: showering  standing is hard for
them so provide shower chair, handrails to hold on to,
clutter-free space and scan the environment due to vision
changes
 Consult SLP (speech and swallowing difficulties) and
PT (exercise, devices) and SUPPORT GROUPS.
 Bladder:
o If overactive bladder, client should have easy access
to bathroom that is clutter free so they could go back
and forth.
o Assess for skin breakdown and encourage skin care
especially if client is immobile.
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PREPARED BY: SOPHIA NICOLE UGTO
o
If retention problems, client may have to be taught on
how to self-catheterization, to remove urine in the
bladder. If urine stays in the bladder for too long, it is a
good medium for bacterial growth leading to UTI and
stone formation.
o Maintain 1-2L of fluids a day to keep urine not
concentrated.
 Bowel:
o Increase fiber intake – lots for fruits and vegetables to
keep stool soft and easy, bulky to pass
o Stool softeners if needed
o If patients are incontinent of stools – assess their skin
and make sure it’s not breaking down and use barrier
creams
MEDICATIONS
 Beta interferon: decreases the number of relapses of
symptoms by decreasing inflammation and the immune
system’s response.
o Risk for infection because it decreases WBCs
o Drug Names:
 Avonex (Interferon Beta 1a)
 Rebif
 Betaferon
 Corticosteroids: for relapses of MS symptoms; help
decrease inflammation and immune system response’
o Drug Names:
 Methylprednisolone, Prednisone
 Bladder Issues
o Oxybutynin: anticholinergic that helps with overactive
bladder by relaxing the bladder muscle to prevent
contractions.
o Bethanechol: cholinergic that helps with emptying the
bladder by helping with bladder contraction
 Fatigue
o Amantadine (antiviral & antiparkinsonian) – it has CNS
effects that helps improve fatigue in patients with MS
o Modafinil - CNS stimulant
 Spasms
o Baclofen – skeletal muscle relaxant that acts centrally
o Diazepam (Valium)
 Tremors
o Propanolol: beta blocker
 Warn the diabetic patient because it mask-out
symptoms of hypoglycemia such as tremors and
shakiness.
o Isoniazid: antibiotic used for infections, especially TB;
helps with certain tremors in MS
MYASTHENIA GRAVIS

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PREPARED BY: SOPHIA NICOLE UGTO