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9 Multiple Sclerosis Nursing Care Plans

Multiple Sclerosis Nursing Care Plans (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults. MS is a progressive disease caused by demyelination of the white matter of the brain and spinal cord. In this disease, sporadic patches of demyelination throughout the central nervous system induce widely disseminated and varied neurologic dysfunction. MS is characterized by exacerbations and remissions, MS is a major cause of chronic disability in young adults. The prognosis varies. multiple sclerosis may progress rapidly, disabling some patients by early adulthood or causing death within months of onset. However, 70% of patients lead active, productive lives with prolonged remissions. The exact cause of MS is unknown, but current theories suggest a slow-acting or latent viral infection and an autoimmune response. Other theories suggest that environmental and genetic factors may also be linked to MS. Stress, fatigue, overworking, pregnancy or acute respiratory tract infections have been known to precede the onset of this illness. MS usually begins between ages 20 and 40. It affects more women than men.

Nursing Care Plans

The nursing care plan goals for patients with multiple sclerosis is to shorten exacerbations and relieve neurologic deficits so that the patient can resume a normal lifestyle. Here are nine (9) nursing care plans (NCP) and nursing diagnosis for multiple sclerosis:
  1. Fatigue
  2. Self-care Deficit
  3. Low Self-Esteem
  4. Powerlessness/Hopelessness
  5. Risk for Ineffective Coping
  6. Ineffective Family Coping
  7. Impaired Urinary Elimination
  8. Deficient Knowledge
  9. Risk for Caregiver Role Strain
  10. Other Possible Nursing Care Plans

Fatigue

Nursing Diagnosis
  • Fatigue
May be related to
  • Decreased energy production, increased energy requirements to perform activities
  • Psychological/emotional demands
  • Pain/discomfort
  • Medication side effects
Possibly evidenced by
  • Verbalization of overwhelming lack of energy
  • Inability to maintain usual routines; decreased performance
  • Impaired ability to concentrate; disinterest in surroundings
  • Increase in physical complaints
Desired Outcomes
  • Patient will identify risk factors and individual actions affecting fatigue.
  • Patient will identify alternatives to help maintain desired activity level.
  • Patient will participate in recommended treatment program.
  • Patient will eport improved sense of energy.
Nursing Interventions Rationale
Note and accept the presence of fatigue. Fatigue is the most persistent and common symptom of MS. Studies indicate that the fatigue encountered by patients with MS occurs with expenditure of minimal energy, is more frequent and severe than “normal” fatigue, has a disproportionate impact on ADLs, has a slower recovery time, and may show no direct relationship between fatigue severity and patient’s clinical neurological status.
Identify and review factors affecting the ability to be active: temperature extremes, inadequate food intake, insomnia, use of medications, time of day. Provides an opportunity to problem-solve to maintain or improve mobility.
Accept when the patient is unable to do activities. Ability can vary from moment to moment. Nonjudgmental acceptance of patient’s evaluation of day-to-day variations in capabilities provides the opportunity to promote independence while supporting fluctuations in the level of required care.
Determine the need for walking aids. Provide braces, walkers, or wheelchairs. Review safety considerations. Mobility aids can decrease fatigue, enhancing independence and comfort, as well as safety. However, individual may display poor judgment about the ability to safely engage in an activity.
Schedule ADLs in the morning if appropriate. Investigate the use of cooling vest. Fatigue commonly worsens in the late afternoon (when body temperature rises). Some patients report lessening of fatigue with stabilization of body temperature.
Plan care consistent rest periods between activities. Encourage afternoon nap. Reduces fatigue, aggravation of muscle weakness.
Assist with physical therapy. Increase patient comfort with massages and relaxing baths. Reduces fatigue and promotes a sense of wellness.
Stress need for stopping exercise or activity just short of fatigue. Pushing self beyond individual physical limits can result in excessive or prolonged fatigue and discouragement. In time, the patient can become very adept at knowing limitations.
Investigate the appropriateness of obtaining a service dog. Service dogs can increase a patient’s level of independence. They can also assist in energy conservation by carrying items in “saddle” bags and retrieving or performing tasks.
Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis Society. Can help the patient to stay motivated to remain active within the limits of the disability or condition. Group activities need to be selected carefully to meet the patient’s needs and prevent discouragement or anxiety.

Administer medications as indicated: 

Useful in treatment of fatigue. Positive antiviral drug effect in 30%–50% of patients. Use may be limited by side effects of increased spasticity, insomnia, paresthesias of hands and feet.
  • Methylphenidate (Ritalin), modafinil (Provigil)
CNS stimulants that may reduce fatigue but may also cause side effects of nervousness, restlessness, and insomnia.
  • Sertraline (Zoloft), fluoxetine (Prozac)
Antidepressants useful in lifting mood, and “energizing” patient (especially when depression is a factor) and when the patient is free of anticholinergic side effects.
Useful in treating emotional lability, neurogenic pain, and associated sleep disorders to enhance willingness to be more active.
  • Anticonvulsants: carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal)
Used to treat neurogenic pain and sudden intermittent spasms related to spinal cord irritation.
May be used during acute exacerbations to reduce and prevent edema formation at the sclerotic plaques. Note: Long-term therapy seems to have little effect on the progression of symptoms.
  • Vitamin B
Supports nerve-cell replication, enhances metabolic functions and may increase a sense of well-being and energy level.
  • Immuno-modulating agents: cyclophosphamide (Cytoxan), azathioprine (Imuran), methotrexate (Mexate), interferon [beta]-1B (Betaseron); interferon [beta]-1A (Avonex, Rebif), glatiramer (Copaxone); mitoxantrone (Novantrone).
May be used to treat acute relapses, reduce the frequency of relapse, and promote remission. Interferon [beta]-1B (Betaseron) has been approved for use by ambulatory patients with remitting relapsing MS and is the first drug found to alter the course of the disease. Current research indicates early treatment with drugs that reduce inflammation and lesion formation may limit permanent damage. Therapy of choice is “A, B, C” drugs: Avonex, Betaseron, and Copaxone. Therapeutic benefits have been reported in patients at all stages of disability with a reduction in both steroid use and hospital days. (Copaxone chemically resembles a component of myelin and may act as a decoy, diverting immune cells away from myelin target.) Note: Novantrone may be used if other medications not effective but is contraindicated in patients with primary progressive MS.
Prepare for plasma exchange treatment as indicated. Research suggests that individuals experiencing severe exacerbations not responding to standard therapy may benefit from a course of plasma exchange
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