229 Nursing Assessment, Management and Treatment of Autoimmune Diseases
● When myelin is damaged the myelin sheath becomes inflamed. ● Inflammation causes the membrane layers of the myelin sheath to break into smaller components. ● The smaller components become circumscribed plaques, which are filled with lymphocytes, microglial elements, and macroglia. This is referred to as demyelination. ● The damaged myelin sheath is unable to appropriately transport messages to the brain. Messages within the CNS are either altered or stopped completely. ● Damage to areas of the CNS produce various neurological symptoms that vary in type and severity. ● Damaged areas develop scar tissue. Areas are multiple, which leads to the name of the disease: multiple sclerosis. Assessment and diagnosis To date, there are no signs, symptoms, physical findings, or laboratory tests that can make a definitive diagnosis of MS. Diagnosis is made based on the findings of a careful physical and mental examina- tion/history, a neurologic exam, lab stud- ies, and imaging studies (National MS So - ciety, 2021). Before MS can be diagnosed, other causes must be excluded since there are many causes of neurological signs and symptoms. For some people, the diagnos- tic process may be fairly rapid. For others, it may take quite a bit longer. Waiting for a diagnosis is stressful and frightening. It is crucial that a diagnosis be made as ac- curately and as quickly as possible so that patients can begin to adjust to the reality of having the disease and treatment can begin as early as possible (National MS Society, 2021).
estimate from an earlier study (National MS Society, 2020b). The majority of people with MS have a relapsing-remitting disease course. These patients experience periods of new symp- toms or exacerbations of previous symp- toms that take place over days or weeks. Patients usually improve partially or com- pletely after each relapsing period. Re- lapses are typically followed by periods of disease remission. Remissions can last for months or even years. Other persons may be diagnosed with primary-progressive MS, which is characterized by a steady progression of signs and symptoms with- At least half of patients with relaps- ing-remitting MS eventually experience a steady progression of symptoms with- out periods of remission. This is referred to as secondary-progressive MS (Mayo Clinic, 2020b). Pathophysiology In MS the immune system destroys my - elin (the fatty substance that coats and protects nerve fibers in the spinal cord and brain). Myelin is critical to the trans - port of electrical impulses to the brain for interpretation. The myelin sheath is a lipoprotein complex that is formed by glial cells. It protects the nerve axon (the neuron’s long nerve fiber) similarly to the insulation on electrical wires. (Rebar et al., 2019). Myelin can be damaged by hypoxemia, toxic chemicals, vascular insufficiency, or autoimmune responses such as those with MS. A summary of the pathological process that occurs when myelin is dam- aged is as follows (National MS Society, 2020a; Rebar et al., 2019): out relapse (Mayo Clinic, 2020b). EVIDENCE-BASED PRACTICE
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