9 Multiple Sclerosis Nursing Care Plans

By
Matt Vera, BSN, R.N.
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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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Low Self-Esteem

Nursing Diagnosis

  • Risk for Situational Low Self-Esteem

May be related to

  • Change in structure/function
  • Disruption in how the patient perceives own body
  • Role reversal; dependence

Possibly evidenced by

  • Confusion about a sense of self, purpose, direction in life
  • Denial, withdrawal, anger
  • Negative/self-destructive behavior
  • Use of ineffective coping methods
  • Change in self/other’s perception of role/physical capacity to resume role

Desired Outcomes

  • Patient will verbalize a realistic view and acceptance of the body as it is.
  • Patient will view self as a capable person.
  • Patient will participate in and assume responsibility for meeting own needs.
  • Patient will recognize and incorporate changes in self-concept/role without negating self-esteem.
  • Patient will develop realistic plans for adapting to role changes.
Nursing Interventions Rationale
Establish and maintain a therapeutic nurse-patient relationship, discussing fears and concerns. Conveys an attitude of caring and develops a sense of trust between patient and caregiver in which patient is free to express fears of rejection, loss of the previous functioning and/or appearance, feelings of helplessness, powerlessness about changes that may occur. Promotes a sense of well-being for the patient.
Note withdrawn behaviors and use of denial or over concern with body and disease process. Initially may be a normal protective response, but if prolonged, may prevent dealing appropriately with reality and may lead to ineffective coping.
Support use of defense mechanisms, allowing the patient to deal with information in own time and way. Confronting patient with the reality of the situation may result in increased anxiety and lessened ability to cope with changed self-concept/role.
Acknowledge the reality of grieving process related to actual or perceived changes. Help patient deal realistically with feelings of anger and sadness. Nature of the disease leads to ongoing losses and changes in all aspects of life, blocking resolution of the grieving process.
Review information about the course of the disease, possibility of remissions, prognosis. When a patient learns about the disease and becomes aware that own behavior (including feeling hopeful/ maintaining a positive attitude) can significantly improve general well-being and daily functioning, patient may feel more in control, enhancing a sense of self-esteem. Note: Some patients may never have a remission.
Provide accurate verbal and written information about what is happening and discuss with patient/SO. Helps patient stay in the “here and now,” reduces the fear of the unknown; provides a reference source for future use.
Explain that labile emotions are not unusual. Problem-solve ways to deal with these feelings. Relieves anxiety and assists with efforts to manage unexpected emotional displays.
Note presence of depression and impaired thought processes, expressions of suicidal ideation (evaluate on a scale of 1–10). Adapting to a long-term, progressively debilitating incurable disease is a difficult emotional adjustment. In addition, cognitive impairment may affect adaptation to life changes. A depressed individual may believe that suicide is the best way to deal with what is happening.
Assess interaction between patient and SO. Note changes in the relationship. SO may unconsciously or consciously reinforce negative attitudes and beliefs of the patient, or issues of secondary gain may interfere with progress and ability to manage a situation.
Provide an open environment for patient and SO to discuss concerns about sexuality, including management of fatigue, spasticity, arousal, and changes in sensation. Physical and psychological changes often create stressors within the relationship, affecting usual roles and expectations, further impairing self-concept.
Discuss the use of medications and adjuncts to improve sexual function. Patient and partner may want to explore trial of medications (papaverine [Pavabid], dinoprostone [Prostin E2]) or other avenues of improving the sexual relationship.
Consult with an occupational therapist/ rehabilitation team. Identifying assistive devices and/or equipment enhances the level of overall function and participation in activities, enhancing a sense of well-being and viewing self as a capable individual.
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See Also

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Neurological Care Plans

Nursing care plans for related to nervous system disorders:

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