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(ASSESSMENT # (Obtain Patient history, inquire about changes in:…

- - - - Speech
      - Coordination
      - Ataxia ( gait and truncal)
      - Tremors
      - Weakness
      - Hyperreflexia
      - Extensor plantar response
      - Positive Romberg
      - Paralysis
    - - Pins and needles
      - Feeling of wetness
      - Numbness
      - Vision problems
      - Nystagmus
  - - - Genetics
        
        HLA(Human Leukocyte Antigen) DR2 - haplotype (inherited from a single parent)
        
        Codes for MHC( Major histocompatability complex)
        
        Regulates immune system
        
        Highly polymorphic ( high variable between individual -changing consistently
    - - Worsens existing symptoms
      - Shown to increase risk of MS ( mechanism unknown)
    - - Deficiency in vitamin D equates to higher risk of MS
      - Helps with remyelination
      - Vitamin D important for suppressing inflammation
  - - - Sagittal, coronal and horizontal view of the brain
      - Lesions and plaques present as white spots to myelinated neuronal damage
    - - Lumbar puncture for the extraction of cerebrospinal fluid (surrounds the brain and spine)
      - Fluid is analyzed to detect oligoclonal bands (antibodies) - indicates inflammation of the central nervous.
    - - In MS nerve impulses are slowed/delayed
      - Speed of nerve impulse conduction of visual, auditory, motor and sensory responses
- - - - CNS Stimulants (Pemoline)
      - SSRis (Fluoxetine)
    - - Anticholingerics (Oxybutynin)
      - Antimuscarinics (Tolterodine)
      - Alpha adrenergics blockers (Terazosin)
    - - Beta-interferons
        
        Increased risk of infection
      - Corticosteroids
    - - Stool softeners (sodium docusate)
      - Enemas
      - Bulk-forming agents (psyllium)
    - - Anticonvulsants (Phenytoin)
      - Tricyclic antidepressants (Amitriptyline)
    - - SSRIs
      - Tricyclic Antidepressants
    - - Alpha Agonists (Tizandine)
      - GABA antagonists (Baclofen)
      - Anticonvulsants (Diazepam)
    - - Heartburn
        
        Loss of Appetite
        
        Diahrrea
        
        Vomiting
        
        Nausea
        
        Trouble Sleeping
        
        Increased Sweating
        
        Acne
        
        Depression
        
        Weight Gain
        
        Abdominal pain
        
        Peptic ulcer
        
        Anxiety
        
        Insomnia
        
        Severe Joint Pain
        
        Hepatic Steatosis
  - - - Occupational
      - Cognitive
      - Physical Therapy
      - Auditory
    - - Moist Heat
      - Noxious stimuli
        
        Worsens symptoms
      - Restrictive clothing
    - - Dangers of smoking
      - Diet with Vitamin D
      - Switch from solid foods
  - - - Family
        
        Provide care, support and education across the spectrum of the disease
        
        Promote Health and Wellness
        
        Promote Independance
        
        Uphold Quality of Life
        
        Empowerment
        
        Maintain function
      - Healthcare providers
      - Client
- - - - COMPLICATIONS / SYMPTOMS
        
        Physical symptoms
        
        Sensory Neurons
        
        Sensation
        
        Itching sensation #
        
        Pain #
        
        Hypoethesias #
        
        Paraesthesias
        
        VIsion
        
        Optic Nerve damage
        
        Vision problems #
        
        Diplopia
        
        Nystagamus
        
        Dizziness and vertigo #
        
        Motor Neurons
        
        Bowel dysfunction
        
        Inconitence #
        
        Extreme fatigue #
        
        Sexual dysfunction
        
        Muscle spasticity
        
        Gait dysfunction #
        
        Postural problems #
        
        Bladder dysfunction
        
        urinary tract infections #
        
        Incontinence # #
        
        Dysphagia
        
        Aspiration #
        
        Poor nutirtion
        
        Respiratory problems
        
        Advanced MS patients
        
        Diminished control on breathing #
        
        Speech problems (Dysarthria) #
        
        Paralysis
        
        Decreased coordination #
        
        Tremors
        
        Muscle Weakness #
        
        Psychological symptoms
        
        Depression #
        
        Emotional instability #
        
        DECREASED QUALITY OF LIFE
        
        Inability to mainain friendships
        
        Inability to maintain career
        
        Being confined to home
        
        Inability to do things that were once enjoyable
        
        Dependence on medication and all their side effects
        
        inability to go outside in warm weather because of increase intensity of symptoms