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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Deficient Knowledge

Nursing Diagnosis

May be related to

  • Lack of exposure; information misinterpretation
  • Unfamiliarity with information resources
  • Cognitive limitation, lack of recall

Possibly evidenced by

  • Statement of misconception
  • Request of information
  • Inaccurate follow-through of instruction; development of preventable complications
  • Inappropriate or exaggerated behaviors (e.g., hysterical, hostile, agitated, apathetic)

Desired Outcomes

  • Patient will participate in the learning process.
  • Patient will assume responsibility for own learning and begin to look for information and to ask questions.
  • Patient will verbalize understanding of condition/disease process and treatment.
  • Patient will initiate necessary lifestyle changes.
  • Patient will participate in the prescribed treatment regimen.
Nursing Interventions Rationale
Evaluate the desire and readiness of patient and SO and/or caregiver to learn. Determines amount or level of information to provide at any given moment.
Note signs of emotional lability or whether the patient is in a dissociative state (loss of affect, inappropriate emotional responses). Patient will not process or retain information and will have difficulty learning during this time.
Provide information in varied formats depending on the patient’s cognitive or perceptual abilities and considering the patient’s locus of control. Changes in cognitive, visual, auditory function impact the choice of teaching modalities: verbal instruction, books, pamphlets, audiovisuals, computer programs. Whether locus of control is internal or external affects a patient’s attitude toward helpfulness of learning.
Encourage active participation of patient or SO in the learning process, including the use of self-paced instruction as appropriate. Enhances a sense of independence and control and may strengthen commitment to the therapeutic regimen.
Review disease process or prognosis, effects of climate, emotional stress, overexertion, fatigue. Clarifies patient or SO understanding of the individual situation.
Identify signs and symptoms requiring further evaluation. Prompt intervention may help limit the severity of exacerbation or complications.
Discuss the importance of daily routine of rest, exercise, activity, and eating, focusing on current capabilities. Instruct in use of appropriate devices to assist with ADLs, e.g., eating utensils, walking aids. Helps patient maintain the current level of physical independence and may limit fatigue.
Stress necessity of weight control. Excess weight can interfere with balance and motor abilities and make care more difficult.
Review possible problems that may arise, such as decreased perception of heat and pain, susceptibility to skin breakdown and infections, especially UTI. These effects of demyelination and associated complications may compromise patient safety and/or precipitate an exacerbation of symptoms.
Identify actions that can be taken to avoid injury, e.g., avoid hot baths, inspect skin regularly, take care with transfers and wheelchair/ walker mobility, force fluids, and get adequate nutrition. Encourage avoidance of persons with upper respiratory infection. Review of risk factors can help the patient take measures to maintain physical state at optimal level/prevent complications.
Discuss increased risk of osteoporosis and review preventive measures, e.g., regular exercise, intake of calcium and vitamin D, reduced intake of caffeine, cessation of smoking, hormone replacement therapy (HRT) or alternatives (e.g., bisphosphonates—Fosamax), and fall prevention measures such as wearing low-heeled shoes with nonskid soles, use of handrails/ grab bars in bathroom and along stairwells, removal of small area rugs. Decreased mobility, vitamin D deficiency (possibly a result increased of decreased exposure to sunlight, which can exacerbate MS symptoms), and decreased the likelihood of engaging in preventive measures increase bone mass loss and the risk of fractures.
Identify bowel elimination concerns. Recommend adequate hydration and intake of fiber; use of stool softeners, bulking agents, suppositories, or possibly mild laxatives; bowel training program. Constipation is common, and bowel urgency and/or accidents may occur as a result of dietary deficiencies or impaction.
Review specifics of individual medications. Recommend avoidance of OTC drugs. Reduces the likelihood of drug interactions and/or adverse effects, and enhances cooperation with the treatment regimen.
Discuss concerns regarding sexual relationships, contraception, and reproduction, effects of pregnancy on an affected woman. Identify alternative ways to meet individual needs; counsel regarding the use of artificial lubrication (females), genitourinary (GU) referral for males regarding available medication and sexual aids. Pregnancy may be an issue for the young patient relative to issues of genetic predisposition and/or ability to manage pregnancy or parent-offspring. Increased libido is not uncommon and may require adjustments within the existing relationship or in the absence of an acceptable partner. Information about different positions and techniques and/or other options for sexual fulfillment (e.g., fondling, cuddling) may enhance personal relationship and feelings of self-worth.
Encourage patient to set goals for the future while focusing on the “here and now,” what can be done today. Having a plan for the future helps retain hope and provides an opportunity for the patient to see that although today is to be lived, one can plan for tomorrow even in the worst of circumstances.
Identify financial concerns. Loss or change of employment (for the patient and/or SO) impacts income, insurance benefits, and level of independence, requiring additional family and social support.
Refer for vocational rehabilitation as appropriate. May need assessment of capabilities and job retraining as indicated by individual limitations and disease progression.
Recommend contacting local and national MS organizations, relevant support groups. Ongoing contact (e.g., mailings) informs the patient of programs and services available and can update the patient’s knowledge base. Support groups can provide role modeling, sharing of information and enhance problem-solving ability.
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See Also

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