To provide effective nursing care for patients with multiple sclerosis, it is crucial to understand the nursing diagnosis and nursing interventions. In this article, we will explore the nursing diagnosis for multiple sclerosis, the development of nursing care plans, and provide tips for managing symptoms.
What is Multiple Sclerosis?
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 planning goals for patients with multiple sclerosis include managing symptoms such as fatigue, pain, and spasticity, promoting physical mobility and independence, preventing complications such as falls and infections, and providing emotional support and education on self-care and disease management. The main goal is to improve the patient’s quality of life and maintain their functional abilities as much as possible.
Here are nine (9) nursing care plans and nursing diagnosis for multiple sclerosis:
- Self-care Deficit
- Low Self-Esteem
- Risk for Ineffective Coping
- Ineffective Family Coping
- Impaired Urinary Elimination
- Deficient Knowledge
- Risk for Caregiver Role Strain
Fatigue is a common symptom in patients with multiple sclerosis due to the disease’s impact on the central nervous system, which can lead to disruptions in nerve signals and cause the body to use more energy to complete simple tasks. Additionally, the immune system’s constant attack on myelin, the protective coating around nerve fibers, may also contribute to the development of fatigue.
May be related to
- Decreased energy production, increased energy requirements to perform activities
- Psychological/emotional demands
- Medication side effects
Possibly evidenced by
- Verbalization of overwhelming lack of energy
- Inability to maintain usual routines; decreased performance
- Impaired ability to concentrate; disinterest in surroundings
- Increase in physical complaints
- The patient will identify risk factors and individual actions affecting fatigue.
- The patient will identify alternatives to help maintain desired activity level.
- The patient will participate in the recommended treatment program.
- The patient will report an improved sense of energy.
Nursing Assessment and Rationales
1. Note and accept the presence of fatigue.
Fatigue is the most persistent and common symptom of MS. Studies indicate that the fatigue encountered by patients with MS occurs with the expenditure of minimal energy, is more frequent and severe than “normal” fatigue, has a disproportionate impact on ADLs, has a slower recovery time, and may show no direct relationship between fatigue severity and patient’s clinical neurological status.
2. Identify and review factors affecting the ability to be active: temperature extremes, inadequate food intake, insomnia, use of medications, and time of day.
Provides an opportunity to problem-solve to maintain or improve mobility.
3. Investigate the appropriateness of obtaining a service dog.
Service dogs can increase a patient’s level of independence. They can also assist in energy conservation by carrying items in “saddle” bags and retrieving or performing tasks.
Nursing Interventions and Rationales
1. Accept when the patient is unable to do activities.
Ability can vary from moment to moment. Nonjudgmental acceptance of patients’ evaluation of day-to-day variations in capabilities provides the opportunity to promote independence while supporting fluctuations in the level of required care.
2. Determine the need for walking aids. Provide braces, walkers, or wheelchairs. Review safety considerations.
Mobility aids can decrease fatigue, enhancing independence and comfort, as well as safety. However, individuals may display poor judgment about the ability to safely engage in an activity.
3. Schedule ADLs in the morning if appropriate. Investigate the use of a cooling vest.
Fatigue commonly worsens in the late afternoon (when body temperature rises). Some patients report a lessening of fatigue with stabilization of body temperature.
4. Plan care consistent rest periods between activities. Encourage afternoon naps.
Reduces fatigue, and aggravation of muscle weakness.
5. Assist with physical therapy. Increase patient comfort with massages and relaxing baths.
Reduces fatigue and promotes a sense of wellness.
6. Stress the need for stopping exercise or activity just short of fatigue.
Pushing self beyond individual physical limits can result in excessive or prolonged fatigue and discouragement. In time, the patient can become very adept at knowing limitations.
7. Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis Society.
Can help the patient to stay motivated to remain active within the limits of the disability or condition. Group activities need to be selected carefully to meet the patient’s needs and prevent discouragement or anxiety.
8. Administer medications as indicated:
- 8.1. Amantadine (Symmetrel); pemoline (Cylert)
Useful in the treatment of fatigue. Positive antiviral drug effect in 30%–50% of patients. Use may be limited by side effects of increased spasticity, insomnia, and paresthesias of hands and feet.
- 8.2. Methylphenidate (Ritalin), modafinil (Provigil)
CNS stimulants may reduce fatigue but may also cause side effects of nervousness, restlessness, and insomnia.
- 8.3. Sertraline (Zoloft), fluoxetine (Prozac)
Antidepressants useful in lifting the mood, and “energizing” a patient (especially when depression is a factor) and when the patient is free of anticholinergic side effects.
- 8.4. Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor)
Useful in treating emotional lability, neurogenic pain, and associated sleep disorders to enhance willingness to be more active.
- 8.5. Anticonvulsants: carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal)
Used to treat neurogenic pain and sudden intermittent spasms related to spinal cord irritation.
- 8.6. Steroids: prednisone (Deltasone), dexamethasone (Decadron), methylprednisolone (Solu-Medrol)
May be used during acute exacerbations to reduce and prevent edema formation at the sclerotic plaques. Note: Long-term therapy seems to have little effect on the progression of symptoms.
- 8.7. Vitamin B
Supports nerve-cell replication, enhances metabolic functions and may increase a sense of well-being and energy level.
- 8.8. Immuno-modulating agents: cyclophosphamide (Cytoxan), azathioprine (Imuran), methotrexate (Mexate), interferon [beta]-1B (Betaseron); interferon [beta]-1A (Avonex, Rebif), glatiramer (Copaxone); mitoxantrone (Novantrone)
May be used to treat acute relapses, reduce the frequency of relapses, and promote remission. Interferon [beta]-1B (Betaseron) has been approved for use by ambulatory patients with remitting relapsing MS and is the first drug found to alter the course of the disease. Current research indicates early treatment with drugs that reduce inflammation and lesion formation may limit permanent damage. Therapy of choice is “A, B, C” drugs: Avonex, Betaseron, and Copaxone. Therapeutic benefits have been reported in patients at all stages of disability with a reduction in both steroid use and hospital days. (Copaxone chemically resembles a component of myelin and may act as a decoy, diverting immune cells away from myelin target.) Note: Novantrone may be used if other medications are not effective but are contraindicated in patients with primary progressive MS.
9. Prepare for plasma exchange treatment as indicated.
Research suggests that individuals experiencing severe exacerbations not responding to standard therapy may benefit from a course of plasma exchange
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to neurological disorders:
- Alzheimer’s Disease | 15 Care Plans
- Brain Tumor | 3 Care Plans
- Cerebral Palsy | 7 Care Plans
- Cerebrovascular Accident | 12 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