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Multiple Sclerosis: Symptoms (Nursing)

by Rhonda Lawes

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    00:00 Okay, now I have a very long list for you because this disease can be life-altering.

    00:09 One of the most common symptoms is fatigue.

    00:11 The patients experience a fatigue on an incredible level.

    00:16 They might have some numbness or some tingling.

    00:18 Well, that should kind of makes sense because they've got problems with the nerves.

    00:22 They may have weakness because they can't control things like they used to be able to.

    00:26 They could be dizzy and have vertigo.

    00:28 They might have issues with their sex acts.

    00:31 They have pain, itching, emotional changes.

    00:34 They be very labile.

    00:35 They might have trouble walking with difficulties.

    00:38 Remember if you have weakness and fatigue and dizziness and vertigo.

    00:41 And then they have a hard time controlling their legs.

    00:44 It might get worse and turn to like spasticity where they really lose control in periods of exacerbation.

    00:50 It can also affect their eyes.

    00:52 They can have problems with their bladder.

    00:53 They may have problems with their bowel.

    00:55 They can have some cognitive changes.

    00:57 They just may not seem like themselves.

    00:59 It can also include depression.

    01:02 Now, depression may show up as a primary symptom or as a result of what they're dealing with.

    01:08 These are actually a pretty good list of the most common symptoms of MS.

    01:12 But different patients may have different.

    01:16 So, this is where you come in and can really make a difference.

    01:19 When you have a patient that we think might have MS or does have MS, you need to plan extra time in communicating with them.

    01:27 Make sure you appear unrushed.

    01:30 You listen to their symptoms, make sure you document them, and make sure you understand how important it is to them to feel heard and validated.

    01:40 See how vague some of these symptoms are? Sometimes people with MS feel like people are calling them whiners or they're not taking their symptoms seriously.

    01:48 You can quickly establish trust in a therapeutic relationship with a patient struggling with these issues.

    01:55 If you'll slow down, sit down, make eye contact, and ask them questions about what they're experiencing.

    02:03 You'll be amazed at what a difference it makes for that patient.

    02:06 Now, those were the primary symptoms.

    02:08 These are the secondary symptoms.

    02:10 These are complications that can come from the primary symptoms.

    02:14 So they can have bladder dysfunction.

    02:16 Well, they might have repeated UTIs.

    02:18 And those are miserable.

    02:21 If you've never had a UTI, take it from those of us who have.

    02:24 That is really uncomfortable and very inconvenient.

    02:28 Now, they might have complication with being inactive because they might have loss of muscle tone.

    02:32 They might have that weakness.

    02:34 They could have poor posture.

    02:36 Their bone density may go down, which no female needs, so they're gonna have an increased risk of fractures.

    02:42 Wow, stop and think about that for a minute.

    02:45 They have decreased bone density that could have increased risk of fractures.

    02:49 Well, you know due to the primary symptoms, they're at a really increased risk of falling if they're having spasticity or weakness.

    02:56 So, you can see why this is a really big deal.

    02:59 They also might have problems with shallow and inefficient breathing which is just going to add to their fatigue.

    03:06 They also get immobility.

    03:07 There's a difference between inactivity and immobility.

    03:11 Immobility is not able to move.

    03:14 They spend long periods of time sitting or laying, then the patient is at risk for pressure sores.

    03:19 So, secondary symptoms can be treated, but our goal as healthcare providers and the whole team is to help avoid the secondary symptoms by trying to help the patient deal and address with the primary symptoms.

    03:32 So, the more we can help the patient control and minimize the primary symptoms will reduce the value of the secondary symptoms.

    03:41 Okay, we looked at the primary symptoms.

    03:44 Remember that full slide of symptoms? We look at the secondary symptoms which we can treat, but remember our goal is to try to control the primary symptoms as much as possible, so we minimize the impact of the secondary symptoms.

    03:58 Now we're going to look at tertiary symptoms.

    04:01 Okay, these result from the impact of the disease on the patient's life.

    04:05 You know if you're working in a hospital setting, we get really focused on what we're doing in the hospital setting and we sometimes don't pay enough attention to what the patient is dealing with, all the other days of their life when they're not with us in the hospital.

    04:19 That's tertiary symptoms.

    04:22 So, they can include the impact on their social life, their vocational world, and psychological complications.

    04:28 So, think how this would be.

    04:31 We've talked about the primary symptoms and some of the secondary symptoms that we try to avoid.

    04:36 But think if the patient is no longer able to drive or walk, how would that affect your life if you could no longer go somewhere when you wanted to, or even walk when you got there.

    04:48 That may affect their ability to hold down a job and to feel like getting out and being independent.

    04:55 So, if MS has gotten to the place where the patient can no longer walk on their own or drive themselves where they need to go, this can really play a huge role in their psychological complications.

    05:07 If it impacts their job, think about the extra stress that would bring into their life.

    05:12 So, the stress and strain of dealing with MS often alter someone's social networks.

    05:17 It's not as easy for them to get to places.

    05:19 They don't feel like socializing.

    05:21 And so they end up sometimes losing relationships and support systems that they really need when they're going through something like this.

    05:29 So, patient could have problems with bladder control, tremor or swallowing.

    05:34 These are not things that would make me want to be out with people.

    05:37 It would be difficult to deal with.

    05:39 So they might want to withdraw from social interactions and become more and more isolated.

    05:45 So, you can make a difference as a nurse if you ask the patient some not harsh questions, but just some easy conversational questions about how often they're able to be with friends or to be with people outside their families.

    05:59 Just ask some questions that are open-ended and allow the patient to share what they feel like sharing.

    06:06 Over time as you build that relationship, they'll open up more and more to you.

    06:11 Now, depression is a very common sign in people that are dealing with MS.

    06:17 But, really, depression is a problem in any patient with a chronic disease.

    06:22 But let's talk specifically about MS.

    06:25 See, it might be both a primary or a tertiary symptom because it could be caused by the disease process itself of MS or it might have been triggered by the challenges that we've talked about in these previous slides.

    06:38 Either way, it's our role as healthcare providers to address this area of health with the patient.

    06:44 So, you'll have-- this might be awkward for you, but it is so important to practice.

    06:50 Practice having difficult conversations that could really make a difference for your patient.

    06:55 Be calm, sit down, make eye contact, be unhurried, and listen to what they have to say.

    07:04 You may be the one person that they'll feel comfortable to opening up to.


    About the Lecture

    The lecture Multiple Sclerosis: Symptoms (Nursing) by Rhonda Lawes is from the course Chronic Neurological Disorders (Nursing).


    Included Quiz Questions

    1. Listen closely to the client and validate their symptoms.
    2. Leave a lot of time because it always takes longer than anticipated.
    3. Teach the client all the symptoms of MS that could occur.
    4. Encourage the client to become better engaged because clients often complain about their condition.
    1. By treating the primary symptoms
    2. By treating with medications
    3. By treating with physical therapy
    4. By treating with comfort measures
    1. Altered social life
    2. Inability to continue working
    3. Depression or isolation
    4. Bladder infections
    5. Fatigue
    1. Fatigue
    2. Weakness
    3. Spasticity
    4. Depression
    5. Immobility

    Author of lecture Multiple Sclerosis: Symptoms (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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