MULTIPLE SCLEROSIS: A REVIEW OF NURSING ASSISTANCE
Multiple Sclerosis, known as Sclerosis on plaques in French literature, is a disease that affects the Nervous System, destroying the myelin – basic protein in nerves impulse1. In MS, axons and myelin sheaths are damaged, disrupting the electric impulse causing paralysis and body function loss. That is why Multiple Sclerosis carriers have serious neurological after-effects with great deficit of the Sensorial, Motor, Autonomic and Neurocognitive functions5. These temporary and/or cumulative dysfunctions may be a result of a combination between inflammation and edema, demyelination and remyelination cycle, axonal loss, cytokines acute effect in axonal conduction, cytotoxic cytokines effect, chemokine and proteolytic enzymes, oligodendrocytes loss and neuronal death15. The disease manifests with a series of alternate outbreaks4,8. The outbreaks are typically a symptom and/or a combination of sensorial symptoms, optical neuritis, gait disorders, brainstem symptoms (diplopia, ataxia), Uhthoff Symptom (body temperature can worsen signs) and Sphincter dysfunction3. The concern over MS carriers increases among Health professionals, particularly Specialized Nurses5, owing to the fact that this is a neurologic, demyelinating, chronic, progressive, with unknown cause, inflammatory that presents itself, in general, with outbrakes4 and serious clinical manifestation that may include either Sensorial, Motor, Brain and Visual dysfunction, unstable mood or others6.
It is possible that, in this millennium, researches based on evident fundamental practices advance and more nurses, independently or as a participant of research teams7, may be prepared to develop MS focused researches9.
MATERIAL AND METHODS
To develop the present article, studies that investigate the Assistance of MS carriers Nurses were analyzed. Based on a key word and a research strategy, the scientific articles were found at PubMed data, where a relation among Nursing, Multiple Sclerosis and MS patients were stablished.
32 review articles and 10 original articles were selected, all published in English. They included the key/initial articles about Multiple Sclerosis, current articles, published between the years of 2001 and 2011.
DISCUSSION AND CONCLUSION
Epidemiologically, MS geographical distribution is unequal, that is, countries were qualified according to rates of incidence. Central and North Europe, Italy, North of United States of America, Canada, South Australia, part of Soviet Union and New Zealand population are considered high level risk (>30 cases/ 100.000 inhabitants)11,20,23. In Brazil, there are few publications about epidemiology. Epidemiologic survey data between the years of 1990 and 2001, in São Paulo, shows a prevalence of 5 and 15 cases per 100.000 inhabitants, respectively17. In Campo Grande, data survey between January of 1987 and March of 2002, verified a prevalence of 1, 36 cases/ 100.000 inhabitants. Multiple Sclerosis constitute a clinical syndrome that follows the pattern outbreak-remission, which affects several white substances pathways of the Central Nervous System, starting mostly in Young adults18.
However, the disease has some clinical heterogeneity aspects. The most frequent manifestation are the lack of attention and recent memory, difficulty in solving problems, perform cognitive tasks, and slow information processing. Several studies show high rates of depression in MS carriers with a 50% of life prevalence and 20% of annual prevalence. Depression is, many times, secondary to the fact of the18 heavy burden of living with a chronic incurable disease4,12,13,24. The sensorial signs are frequent in almost all MS patients at any time of the disease and this may be a result of either a spinothalamic pathway or a superior spine lesions. It may occur subjective changes such as paresthesia or decreasing of deep and superficial sensitivity20,21,27.
The delivery of sensitive manifestations depends on the topography injuries. It is also very common an increasing pattern of weakness those onsets in the lower limbs and keeps moving on to the upper limbs. The cerebellar dysfunction generally onsets as an action tremor and it may involve members, head, stem and voice (dysarthria)23,25,27. In advanced stage, it may be difficult to determine the degree of cerebellar involvement in affecting the motor and sensorial system. The degree of sexual and sphincter dysfunction follows the motor deficit in lower limbs. One of the most common signs of vesical dysfunction is the urgency in urinate which is a result of hyperreflexia. The symptoms become worse until urinary incontinence. Fecal constipation (>30%) is more frequent than fecal incontinence (>15%) since the general mobility of the10,11,20 patient decreases. Sexual dysfunction is common: 50% of the ills ended up in a sexual idle state and 20% reduces sexual activity. The Lhermitte phenomenon is a temporary sensorial sign described as an electrical discharge that goes down the spine in response to active or passive neck movements; it may2,4,7 be a very rare symptom. Uhthoff phenomenon is the name given to a sensibility added to the rise of the body temperature that reinforces temporarily the previous existent symptoms. The Nurse, as a member of a multidisciplinary team, attends the patient (person, family, community) in his basic human needs, devises actions to promote the Nursing Assistance, benefitting more and more the patient, client recovering, and giving, wherever possible, tools to self-care12,13,19,22.
The Nursing Assistance towards the MS carrier cannot be widespread. Although the needs, difficulties and complications are common to all, one’s particularities, values, beliefs and conflicts must
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be respected1,8,15, even if other people and the environment influence it. In this sense, the attention, care and services must be individualized. The Multiple Sclerosis Nurse is centered in the needs of this particular customer, especially about the clinical and remedial aspects, considering as a basic pillar of your work the agreement between16,18 professionals and clients, mostly with regard to self-care orientation.
Self-care as an educative support already exists since the Modern Nursing was stablished. It represents a manner of being more participative and independent from the Conventional Health Services. Once one has the Nurse orientations after the consultation, one rapidly gets more familiar with the dilution method, preparation and using of the Immunomodulators. Therefore, Nursing must hold, wherever possible, homecare as an alternative that benefits people with chronic disability. That way, nurses will be interacting with the family17,19, knowing the physical space, planning with the person and family the possibilities and needed adjustments to take care of the person with no risks, as well as identifying and interfering in the family overcharged situations20,21,22.
This assistance during the treatment, added to emotional support, we give to MS people, the concern we have with their survival, self-sufficiency, social, familiar work interaction and self-care orientation can be summarized in just one word: Rehabilitation18,19,21.
All these interferences predict the nurse co-participation with patients and family, working together, to identify, plan, program and measure12,13,19 each way of caring to achieve nursing attention based on the person’s world vision. In this process, the nurse plays a management function that would be the nurse team coordination in the educational process and assistance in diagnosing, treating and nursing care. The literature remembers that clinical changes may vary according to the disease clinical path, so the nurse must hold specific capacitation to attend the MS carrier22,23,27. The Nurse behavior as an educative aspect in terms of training proceedings according to the Literature was also considered2,11,17,25.
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