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.
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.
- Self-care Deficit
- Low Self-Esteem
- Risk for Ineffective Coping
- Ineffective Family Coping
- Impaired Urinary Elimination
- Deficient Knowledge
- Risk for Caregiver Role Strain
- Other Possible Nursing Care Plans
Risk for Ineffective Coping
- Risk for Ineffective Coping
Risk factors may include
- Physiological changes (cerebral and spinal lesions)
- Psychological conflicts; anxiety; fear
- Impaired judgment, short-term memory loss; confusion; unrealistic perceptions/ expectations, emotional lability
- Personal vulnerability; inadequate support systems
- Multiple life changes
- Inadequate coping methods
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- Patient will recognize the relationship between disease process (cerebral lesions) and emotional responses, changes in thinking/behavior.
- Patient will verbalize awareness of own capabilities/strengths.
- Patient will display effective problem-solving skills.
- Patient will demonstrate behaviors/lifestyle changes to prevent/minimize changes in mentation and maintain reality orientation.
|Assess current functional capacity and limitations; note the presence of distorted thinking processes, labile emotions, cognitive dissonance. Note how these affect the individual’s coping abilities.||Organic or psychological effects may cause the patient to be easily distracted, to display difficulties with concentration, problem-solving, dealing with what is happening, being responsible for own care.|
|Determine the patient’s understanding of the current situation and previous methods of dealing with life’s problems.||Provides a clue as to how a patient may deal with what is currently happening and helps identify individual resources and need for assistance.|
|Discuss the ability to make decisions, care for children or dependent adults, handle finances. Identify options available to individuals involved.||Impaired judgment, confusion, inadequate support systems may interfere with the ability to meet own needs and needs of others. Conservatorship, guardianship, or adult protective services may be required until (if ever) patient is able to manage own affairs.|
|Maintain an honest, reality-oriented relationship.||Reduces confusion and minimizes painful, frustrating struggles associated with adaptation to altered environment or lifestyle.|
|Encourage verbalization of feelings and/or fears, accepting what the patient says in a nonjudgmental manner. Note statements reflecting powerlessness, inability to cope.||May diminish patient’s fear, establish trust, and provide an opportunity to identify problems and begin the problem-solving process.|
|Observe nonverbal communication: posture, eye contact, movements, gestures, and use of touch. Compare with verbal content and verify meaning with the patient as appropriate.||May provide significant information about what the patient is feeling; however, verification is important to ensure the accuracy of communication. The discrepancy between feelings and what is being said can interfere with the ability to cope, problem-solve.|
|Provide clues for orientation: calendars, clocks, notecards, organizers.||These serve as tangible reminders to aid recognition and permeate memory gaps and enable patient to cope with the situation.|
|Encourage patient to tape-record important information and listen to the recording periodically.||Repetition puts information in long-term memory, where it is more easily retrieved and can support decision-making and problem-solving process.|
|Refer to cognitive retraining program.||Improving cognitive abilities can enhance basic thinking skills when attention span is short; ability to process information is impaired; patient is unable to learn new tasks; or insight, judgment, and problem-solving skills are impaired.|
|Refer to counseling, psychiatric clinical nurse specialist and/or psychiatrist, as indicated.||May need additional help to resolve issues of self-esteem and regain effective coping skills.|
|Administer medications as appropriate: amitriptyline (Elavil); bupropion (Wellbutrin); imipramine (Tofranil);||Medications to improve mood and restful sleep may be useful in combating depression and relieving a degree of fatigue interfering with function.|
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Neurological Care Plans
Nursing care plans for related to nervous system disorders:
- Alzheimer's Disease | 13 Care Plans
- Brain Tumor | 3 Care Plans
- Cerebral Palsy | 7 Care Plans
- Cerebrovascular Accident | 8+ Care Plans
- Guillain-Barre Syndrome | 6 Care Plans
- Meningitis | 7 Care Plans
- Multiple Sclerosis | 9 Care Plans
- Parkinson's Disease | 9 Care Plans
- Seizure Disorder | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans