QLexNursing

💎 In multiple sclerosis (MS) acute exacerbations, the priority is to reduce acute inflammation and demyelination in the central nervous system.

💎 High-dose IV corticosteroids (e.g., IV methylprednisolone) are the standard first-line treatment to shorten the duration and severity of the relapse.

💎 Steroids work by suppressing the immune response, stabilizing the blood–brain barrier, and decreasing edema around demyelinated nerves, which can improve motor function and mobility.

💎 Early administration during an acute exacerbation can help prevent permanent neurological deficits, especially when the patient is having difficulty walking.

💎 Other long-term strategies (like changing the disease-modifying therapy) may be important, but they are not the immediate priority during an acute relapse when functional decline is present.

Making an appointment with a psychiatrist:

💎 While stress can exacerbate MS symptoms, psychiatric referral is supportive care, not the first-line response to an acute neurological deterioration.

💎 The patient’s difficulty walking indicates a significant neurological flare that requires urgent anti-inflammatory treatment, not delayed outpatient mental health follow-up.

💎 A psychiatric consult may be beneficial later to help with coping, depression, or anxiety, which are common in chronic illness.

💎 However, relying on stress management alone would delay essential medical therapy and allow further demyelination to occur.

💎 Because of this, it does not address the acute pathophysiology of an MS relapse and is not the priority action.

Administering a different DMT (disease modifying therapy):

💎 Disease-modifying therapies (DMTs) such as interferons, glatiramer acetate, or newer agents are used for long-term relapse prevention, not for acute symptom management.

💎 Changing DMTs is usually based on overall relapse frequency, MRI activity, and tolerance, and is decided after careful evaluation by a neurologist.

💎 In an acute exacerbation, the immediate goal is to control the current flare with IV steroids, not alter the maintenance regimen.

💎 Starting a different DMT now would not produce rapid neurologic improvement, because DMTs take weeks to months to show benefit.

💎 Therefore, while DMT adjustment may be considered later, it is not the next immediate nursing action for this patient.

Notifying physical therapy of a consultation:

💎 Physical therapy (PT) is very helpful in MS for gait training, balance, and strength, especially after an exacerbation.

💎 However, PT is most effective once the acute inflammation is controlled, and the patient’s neurologic status has stabilized.

💎 Calling PT before addressing the underlying acute flare would focus on rehabilitation without first correcting the medical cause of the decline.

💎 The priority is to reverse or minimize neurologic injury with IV corticosteroids, then support recovery with PT interventions.

💎 PT referral is appropriate later, but it is not the first, most urgent action in an acute exacerbation.