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
Ineffective Family Coping
- Ineffective Family Coping
May be related to
- Situational crisis; temporary family disorganization and role changes
- Highly ambivalent family relationship
- Prolonged disease/disability progression that exhausts the supportive capacity of SO
- Patient providing little support in turn for SO
- SO with chronically unexpressed feelings of guilt, anxiety, hostility, despair
Possibly evidenced by
- Patient expresses/confirms concern or complaint about SO response to patient’s illness
- SO withdraws or has limited personal communication with patient or displays protective behavior disproportionate to patient’s abilities or need for autonomy.
- SO preoccupied with own personal reactions
- Intolerance, abandonment
- Neglectful care of patient
- Distortion of reality regarding patient’s illness
- Patient will identify/verbalize resources within themselves to deal with the situation.
- Patient will express more realistic understanding and expectations of the patient.
- Patient will interact appropriately with patient/healthcare providers providing support and assistance as indicated.
- Patient will verbalize knowledge and understanding of disability/disease and community resources.
|Note length, severity of illness. Determine the patient’s role in the family and how illness has changed the family organization.||Chronic illness, accompanied by changes in role performance and responsibility, often exhausts supportive capacity and coping abilities of SO or family.|
|Determine SO’s understanding of disease process and expectations for the future.||Inadequate information and misconception regarding disease process and/or unrealistic expectations affect the ability to cope with the current situation. Note: A particular area of misconception is the fatigue experienced by patients with MS. Family members may view a patient’s inability to perform activities as manipulative behavior rather than an actual physiological deficit.|
|Discuss with SO/family members their willingness to be involved in care. Identify other responsibilities and factors impacting participation.||Individuals may not have the desire or time to assume responsibility for care. If several family members are available, they may be able to share tasks.|
|Assess other factors that are affecting the abilities of family members to provide needed support.||Individual members’ preoccupation with own needs and concerns can interfere with providing needed care and support for stresses of long-term illness. Additionally, caregiver(s) may incur decrease or loss of income or risk losing own health insurance if they alter their work hours.|
|Discuss underlying reasons for the patient’s behaviors.||Helps SO understand and accept and deal with behaviors that may be triggered by emotional or physical effects of MS.|
|Encourage patient and SO to develop and strengthen problem-solving skills to deal with the situation.||Family may or may not have handled conflict well before illness, and stress of long-term debilitating condition can create additional problems (including unresolved anger).|
|Encourage free expression of feelings, including frustration, anger, hostility, and hopelessness.||Individual members may be afraid to express “negative” feelings, believing it will discourage patient. Free expression promotes awareness and can help with resolution of feelings and problems (especially when done in a caring manner).|
|Identify community resources and local MS organization, support groups, home care agencies, respite programs.||Provides information, opportunities to share with others who are experiencing similar difficulties, and sources of assistance when needed.|
|Refer to a social worker, financial adviser, psychiatric clinical nurse specialist and psychiatrist as appropriate.||May need more in-depth assistance from professional sources.|
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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