9 Multiple Sclerosis Nursing Care Plans

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Multiple sclerosis (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
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Self-care Deficit

Nursing Diagnosis

May be related to

  • Neuromuscular/perceptual impairment; intolerance to activity; decreased strength and endurance; motor impairment, tremors
  • Pain, discomfort, fatigue
  • Memory loss
  • Depression

Possibly evidenced by

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  • Frustration; inability to perform tasks of self-care, poor personal hygiene

Desired Outcomes

  • Patient will identify individual areas of weakness/needs.
  • Patient will demonstrate techniques/lifestyle changes to meet self-care needs.
  • Patient will perform self-care activities within the level of own ability.
  • Patient will identify personal/community resources that provide assistance.
Nursing Interventions Rationale
Determine the current activity level and physical condition. Assess degree of functional impairment using a 0–4 scale. Provides information to develop a plan of care for rehabilitation. Note: Motor symptoms are less likely to improve than sensory ones.
Encourage patient to perform self-care to the maximum of ability as defined by the patient. Do not rush the patient. Promotes independence and sense of control; may decrease feelings of helplessness.
Assist according to the degree of disability; allow as much autonomy as possible. Participation in own care can ease the frustration over the loss of independence.
Encourage patient input in the planning schedule. Patient’s quality of life is enhanced when desires and likes are considered in daily activities.
Note presence of fatigue. Fatigue experienced by patients with MS can be very debilitating and greatly impact the ability to participate in ADLs. The subjective nature of reports of fatigue can be misinterpreted by healthcare providers and family, leading to conflict and the belief that the patient is “manipulative” when, in fact, this may not be the case.
Encourage scheduling activities early in the day or during the time when the energy level is best. Patients with MS expend a great deal of energy to complete ADLs, increasing the risk of fatigue, which often progresses through the day.
Allot sufficient time to perform tasks, and display patience when movements are slow. Decreased motor skills and spasticity may interfere with the ability to manage even simple activities.
Anticipate hygienic needs and calmly assist as necessary with the care of nails, skin, and hair; mouth care; shaving. Caregiver’s example can set a matter-of-fact tone for acceptance of handling mundane needs that may be embarrassing to patient and repugnant to SO.
Provide assistive devices and aids as indicated: shower chair, elevated toilet seat with arm supports. Reduces fatigue, enhancing participation in self-care.
Reposition frequently when the patient is immobile (bed or chair bound). Provide skin care to pressure points, such as sacrum, ankles, and elbows. Position properly and encourage to sleep prone as tolerated. Reduces pressure on susceptible areas, prevents skin breakdown. Minimizes flexor spasms at knees and hips.
Provide massage and active or passive ROM exercises on a regular schedule. Encourage the use of splints or footboards as indicated. Prevents problems associated with muscle dysfunction and disuse. Helps maintain muscle tone and strength and joint mobility, and decreases the risk of loss of calcium from bones.
Encourage stretching and toning exercises and use of medications, cold packs, and splints and maintenance of proper body alignment, when indicated. Helps decrease spasticity and its effects.
Problem-solve ways to meet nutritional and fluid needs. Provides for adequate intake and enhances the patient’s feelings of independence or self-esteem.
Consult with a physical and/or occupational therapist. Useful in identifying devices and/or equipment to relieve spastic muscles, improve motor functioning, prevent and reduce muscular atrophy and contractures, promoting independence and an increasing sense of self-worth.
Administer medications as indicated: 
  • Tizanidine (Zanaflex), baclofen (Lioresal), carbamazepine (Tegretol);
Newer drugs used for reducing spasticity, promoting muscle relaxation, and inhibiting reflexes at the spinal nerve root level. Enhance mobility and maintenance of activity. Tizanidine (Zanaflex) may have an additive effect with baclofen (Lioresal) but use with caution because both drugs have similar side effects. A short duration of action requires careful individualizing of dosage to maximize therapeutic effect.
  • Diazepam (Valium), clonazepam (Klonopin), cyclobenzaprine (Flexeril), gabapentin (Neurontin, dantrolene (Dantrium);
A variety of medications are used to reduce spasticity. The mechanisms are not well understood, and responses vary in each person. Therefore, it may take a period of medication trials to discover what provides the most effective relief of muscle spasticity and associated pain. Note: Adverse effects may be increased muscle weakness, loss of muscle tone, and liver toxicity.
Reduces dizziness, allowing the patient to be more mobile.
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See Also

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Neurological Care Plans

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