NURSING PRACTICE IN MULTIPLE SCLEROSIS A CORE CURRICULUM

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Nursing Practice in
Multiple Sclerosis:
A Core Curriculum
Kathleen Costello, RN, MS, CRNP, MSCN
Maryland Center for Multiple Sclerosis
University of Maryland
Baltimore, Maryland
June Halper, MSCN, ANP, FAAN
Gimbel Multiple Sclerosis Center,
Consortium of Multiple Sclerosis Centers (CMSC)
Teaneck, New Jersey
and
Colleen Harris, RN, MN, MSCN
Multiple Sclerosis Clinic
Foothills Hospital
Calgary, Alberta

Demos Medical Publishing, 386 Park Avenue South, New York, New York 10016
© 2003 by Demos Medical Publishing. All rights reserved. This book is protected by
copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted
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without the prior written permission of the publisher
Library of Congress Cataloging-in-Publication Data
Costello, Kathleen.
Nursing practice in multiple sclerosis : a core curriculum / Kathleen Costello,
June Halper, and Colleen Harris.
p. ; cm.
ISBN 1-888799-76-5 (pbk.)
1.  Multiple sclerosis—Nursing.
[DNLM: 1. Multiple Sclerosis—nursing. WL 360 C84 In 2003] I. Halper, June.
II. Harris, Colleen. III. Title.
RC377 .C66 2003
610.73'69—dc21
Printed in Canada
Visit the Demos Medical Publishing web site at www.demosmedpub.com
2002151624

Contents
Preface: Kathleen Costello, RN, MS, CRNP, MSCN v
Background Information for Nursing Practice
in Multiple Sclerosis
1. The History of Multiple Sclerosis Care 1
2. Domains of Multiple Sclerosis Nursing Practice 7
3. Change Theory and Its Application in
Multiple Sclerosis Nursing 11
4. Multiple Sclerosis Nurses’ Code of Ethics 13
The Diagnosis of Multiple Sclerosis
5. Epidemiology 17
6. The Complete Neurologic Examination 21
7. Magnetic Resonance Imaging (MRI) 27
8. Determining the Diagnosis and Prognosis
of Multiple Sclerosis 31
Management of the Disease Process
9. The Immune System and Its Role in Multiple Sclerosis 39
10. Disease-Altering Therapies 43
Functional Alterations: Physical Domains
11. The Symptom Chain in Multiple Sclerosis 51
12. The Multiple Sclerosis Care Team 65
13. Bladder Dysfunction 69
14. Bowel Elimination and Continence 75
15. The Nurse’s Role in Advanced Multiple Sclerosis 81
Functional Alterations: Personal Domain
16. Psychosocial Implications 85
17. Financial and Vocational Concerns 87
Shaping Multiple Sclerosis Nursing Practice
18. Primary Care Needs 91
19. The Nurse’s Role in Multiple Sclerosis Research 95
20. Study Guide in Multiple Sclerosis 99
21. Case Studies 101
22. Certification Study Questions 113