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
Impaired Urinary Elimination
May be related to
- Neuromuscular impairment (spinal cord lesions/neurogenic bladder)
Possibly evidenced by
- Incontinence; nocturia; frequency
- Retention with overflow
- Recurrent UTIs
- Patient will verbalize understanding of the condition.
- Patient will demonstrate behaviors/techniques to prevent/minimize infection.
- Patient will empty bladder completely and regularly (voluntarily or by catheter as appropriate).
- Patient will be free of urine leakage.
|Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of the urinary stream. Palpate bladder after voiding.||Provides information about the degree of interference with elimination or may indicate a bladder infection. Fullness over bladder following void is indicative of inadequate emptying or retention and requires intervention.|
|Review drug regimen, including prescribed, over-the-counter (OTC), and street.||A number of medications such as some antispasmodics, antidepressants, and narcotic analgesics; OTC medications with anticholinergic or alpha agonist properties; or recreational drugs such as cannabis may interfere with bladder emptying.|
|Institute bladder training program or timed voidings as appropriate.||Helps restore adequate bladder functioning; lessens the occurrence of incontinence and bladder infection.|
|Encourage adequate fluid intake, avoiding caffeine and use of aspartame, and limiting intake during the late evening and at bedtime. Recommend use of cranberry juice/ vitamin C.||Sufficient hydration promotes urinary output and aids in preventing infection. Note: When the patient is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of the drug, reducing the risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., Nutrasweet), may cause bladder irritation leading to bladder dysfunction.|
|Promote continued mobility.||Decreases risk of developing UTI.|
|Recommend good hand washing and proper perineal care.||Reduces skin irritation and the risk of ascending infection.|
|Encourage patient to observe for sediments or blood in urine, foul odor, fever, or unexplained increase in MS symptoms.||Indicative of infection requiring further evaluation or treatment.|
|Refer to urinary continence specialist as indicated.||Helpful for developing an individual plan of care to meet patient’s specific needs using the latest techniques, continence products.|
|Administer the following medications as ordered: Oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M), flavoxate hydrochloride (Urispas), tolterodine (Detrol).||Reduce bladder spasticity and associated symptoms of frequency, urgency, incontinence, nocturia.|
|Catheterize as indicated.||May be necessary as a treatment and for evaluation if the patient is unable to empty bladder or retains urine.|
|Teach self-catheterization and instruct in the use and care of the indwelling catheter.||Helps patient maintain autonomy and encourages self-care. An indwelling catheter may be required, depending on the patient’s abilities and degree of the urinary problem.|
|Obtain periodic urinalysis and urine culture and sensitivity as indicated.||Monitors renal status. Colony count over 100,000 indicates the presence of infection requiring treatment.|
|Administer anti-infective agents as necessary:|
|Nitrofurantoin macrocrystals. (Macrodantin); co-trimoxazole (Bactrim, Septra); ciprofloxacin (Cipro); norfloxacin (Noroxin).||Bacteriostatic agents that inhibit bacterial growth and destroy susceptible bacteria. Prompt treatment of infection is necessary to prevent serious complications of sepsis/shock|
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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