Multiple Sclerosis MS Nursing Care Plans Diagnosis and Interventions
Multiple Sclerosis MS NCLEX Review and Nursing Care Plans
Multiple sclerosis (MS) is a chronic condition involving the central nervous system. It is an autoimmune disease characterized by the demyelination or degeneration of myelin sheaths which are protective covering of nerve cells.
The damage causes problems in the communication between the brain and the rest of the body.
There are three types of multiple sclerosis, namely: relapsing MS, secondary progressive MS, and primary progressive MS.
- Relapsing MS – the most common type, accounting for about 85% of all the MS cases. Relapsing MS is characterized by a relapsing and remitting cycle.
- Secondary progressive MS – starts off as relapsing MS but symptoms get steadily worse.
- Primary progressive MS – described as the gradual worsening of MS symptoms over time.
Signs and Symptoms of Multiple Sclerosis MS
Multiple sclerosis involves a range of different signs and symptoms.
These symptoms may vary depending on the location of affected nerve fibers, and may include:
- Numbness or weakness on one or both sides of the body
- Lhermitte sign – sensations of electric shocks when moving the neck
- Tremors and unsteady gait
- Partial/complete vision loss – typically occurs one eye at a time
- Prolonged double vision
- Blurred vision
- Slurring of speech
- Tingling sensation
- Issues with sexual, bowel, and bladder function
Causes of Multiple Sclerosis MS
Multiple sclerosis is considered an autoimmune condition although the exact etiology of the disease is still unknown.
In the case of MS, the body attacks the protective covering of nerve fibers of the brain and spinal cord called myelin sheaths.
The risk factors for developing the condition are as follows:
- Age – the onset of MS commonly occurs between 20-40 years of age. However, all ages can develop the condition
- Sex – women are reported to be more susceptible to the disease
- Family history – having immediate family members diagnosed with MS increases the risk of developing the condition
- Some infections – there are infections associated with the development of MS such as Epstein-Barr infection
- Race – those with Northern European descent are at higher risk of developing MS
- Climate – MS is more common in countries with a temperate climate such as the US, New Zealand, and Europe
- Vitamin D – low level of vitamin D is linked with the development of MS
- Autoimmune diseases – those with pre-existing autoimmune diseases are slightly at risk of developing MS
Complications of Multiple Sclerosis MS
- Muscle spasms
- Problems related to bladder, bowel, and sexual functions
- Mental changes
Diagnosis of Multiple Sclerosis MS
A neurologist typically makes the diagnosis of multiple sclerosis. The diagnosis for this condition may not be straightforward and may require a series of tests, which may include:
- Neurological exam – questions about health problems at present and in the past may be asked as part of the assessment. The medical history may help explain the symptoms and rule out other possible diagnoses. A neurological exam may include physical tests to assess for changes and weaknesses in movement, vision, balance, sensation, speech, and reflexes.
- Magnetic resonance imaging (MRI) – an MRI of the brain and spinal cord is performed to identify the exact location of damage to the nerve tissues. MRI has been successful in providing a definite diagnosis in 90% of cases.
- Evoked potential test – this procedure involves the attachment of electrodes on the head to record brain patterns while stimuli are presented.
- Spinal tap – also known as lumbar puncture, this test involves the insertion of a needle into the space surrounding the spinal cord to take a small sample of the spinal fluid. In people with MS, the fluid will show the presence of antibodies.
- Blood tests – blood tests are performed to help rule out other conditions that are similar to MS.
Treatment for Multiple Sclerosis MS
Multiple sclerosis has no cure; however, several therapies and treatment options are available to help manage the disease.
- Disease-Modifying Therapies (DMTs). DMTs are known to be effective in relapsing MS. They work by slowing down the progression of symptoms and damage caused by the condition. There are a variety of DMTs available in the market in the form of tablets, injections, and infusions.
- Hematopoietic Stem Cell Transplantation (HSCT). HSCT is an intensive treatment involving the use of chemotherapy to wipe out and regrow the immune system with the use of stem cells. It is most effective in the early stages of the disease.
- Physiotherapy. Physiotherapists can help deal with physical difficulties associated with the disease. They can advise on movements and exercises to deal with the problematic area of the body.
- Complementary and Alternative Therapies. Also known as complementary and alternative medicine (CAMs), this therapy option involves the use of a variety of “natural” medicine such as acupuncture, yoga, and aromatherapy.
Nursing Diagnosis for Multiple Sclerosis MS
Nursing Care Plan for Multiple Sclerosis 1
Impaired physical mobility related to neurological impairment secondary to multiple sclerosis, as evidenced by numbness or weakness on one or both sides of the body, Lhermitte sign, tremors, and unsteady gait
Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.
|Multiple Sclerosis Nursing Interventions||Rationales|
|Assess the patient’s level of functional mobility and ability to perform ADLs.||To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy.|
|Assist the patient during exercises and when performing activities of daily living.||To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.|
|Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach.||To maintain patient safety and reduce the risk of falls.|
|Encourage the patient to perform range of motion (ROM) exercises in all extremities.||To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.|
|Refer to the physiotherapy and occupational therapy team.||To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.|
Nursing Care Plan for Multiple Sclerosis 2
Nursing Diagnosis: Fatigue related to body weakness secondary to multiple sclerosis as evidenced by numbness and weakness on one side of the body or both, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness
Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.
|Multiple Sclerosis Nursing Interventions||Rationales|
|Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.|
|Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep. Encourage enough rest and sleep, and provide comfort measures.||To help the patient balance his/her physical activity and rest periods. To reserve energy levels and provide optimal comfort and relaxation.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.|
Nursing Care Plan for Multiple Sclerosis 3
Nursing Diagnosis: Disturbed Sensory Perception (Visual) related to visual impairment secondary to multiple sclerosis as evidenced by verbal complaint of vision problems such as blurry vision, prolonged double vision, or partial/total loss of vision
Desired Outcome: The patient will regain optimal vision while being able to cope with and accept permanent vision changes.
|Multiple Sclerosis Nursing Interventions||Rationale|
|Assess the vision ability of the patient using an eye chart.||To establish a baseline assessment in terms of vision capacity.|
|Encourage the patient to have regular checkups with an ophthalmologist at least once a year.||To monitor worsening of vision loss and treat accordingly.|
|Encourage the patient to promote sufficient lighting at home.||The patient may not be able to perform activities of daily living as normal if he/she cannot see properly. Sufficient lighting also reduces the risk for injury.|
|Administer eye medications as prescribed.||Eye drops prescribed by the ophthalmologist can help the patient cope with vision problems.|
|Encourage the patient to use vision aides.||Lenses or devices that enlarge images are helpful in addressing difficulties such as blurry vision.|
|Assess the need for a carer for the patient.||To ensure patient’s safety considering that he/she is experiencing visual problems and other symptoms of multiple sclerosis such as unsteady gait and body weakness.|
|Encourage the patient to add foods containing vitamins C, E, beta-carotene, zinc, and copper in his/her diet in accordance to daily recommended intake.||Foods containing vitamins C, E, beta-carotene, zinc, and copper are beneficial to eyesight when introduced to the patient’s diet.|
|Encourage the patient to inform the ophthalmologist if there is any worsening of symptoms.||To monitor if vision is worsening and if there is a need for further investigation and treatment.|
Nursing Care Plan for Multiple Sclerosis 4
Nursing Diagnosis: Impaired Urinary Elimination related to neuromuscular impairment (i.e., spinal cord lesions, neurogenic bladder) secondary to multiple sclerosis as evidenced by nocturia, frequency, incontinence, urinary retention with overflow, and recurrent urinary tract infections (UTIs)
- The patient will express their knowledge of the situation.
- The patient will exhibit infection-prevention/minimization habits and procedures.
- The patient will routinely and fully empty his bladder (voluntarily or by catheter as appropriate).
- The patient will demonstrate the absence of urine leakage.
|Multiple Sclerosis Nursing Interventions||Rationale|
|Keep track of reports of urine frequency, urgency, burning, incontinence, nocturia, and urinary stream size or force. After voiding, palpate the bladder.||It tells the extent of interference with excretion or the presence of bladder infection in the patient. After voiding, fullness over the bladder indicates insufficient emptying or retention and needs attention.|
|Examine the patient’s drug regimen, including prescription, OTC, and street medications.||Pharmaceuticals including antispasmodics, antidepressants, and narcotic analgesics, as well as over-the-counter (OTC) medications with anticholinergic or alpha agonist characteristics and recreational substances like cannabis, can all cause bladder emptying problems.|
|As needed, implement a bladder training program or timed voiding.||Reduces the risk of incontinence and bladder infection by restoring proper bladder function. Bladder training seeks to help the patient go longer between bathroom visits. To begin, make a schedule for when the patient will pee. Then you teach the patient to resist the first urge to go and wait until the designated time. The duration between restroom visits eventually stretches to several hours. Timed voiding aids those who have a condition that makes it impossible for them to get to a bathroom in time, such as a physical impairment. The patient visits the restroom according to a regular timetable. This strategy does not attempt to teach the individual how to resist the temptation to leave.|
|Encourage proper hydration, avoid caffeine and aspartame, and limit consumption in the late evening and before bedtime. Cranberry juice and vitamin C are recommended.||Hydration encourages urine output and helps to prevent infection. Note: When a patient is taking sulfa medications, appropriate fluid intake is required to ensure proper drug elimination and reduce the danger of cumulative effects. Note: The sugar substitute aspartame (e.g., NutraSweet) can cause bladder discomfort and malfunction.|
|Maintain the patient’s mobility.||Reduces the chances of getting a UTI. Many MS symptoms, such as fatigue, stiffness, dizziness and vertigo, pain, numbness, and issues with walking, coordination, and vision, can limit mobility. Even depression, which is frequent with MS, can make it difficult for a person to remain mobile and active.|
|Advise hand cleansing and regular perineal care.||Reduces skin irritation as well as the danger of infection spreading.|
|Encourage the patient to look for sediments or blood in the urine, a foul odor, a fever, or an increase in inexplicable MS symptoms.||Indicative of an infection that has to be evaluated or treated. Multiple sclerosis is thought to be an autoimmune illness caused by T cells. As a result, autoreactive T-cells are very likely to become activated in response to peripheral infection. This is one of the first events that lead to relapse.|
|As needed, ask the patient to consult a urinary continence specialist.||Helpful in building an individualized treatment plan to fulfill a patient’s specific needs using the most up-to-date procedures and continence supplies.|
|As directed, catheterize.||If the patient is unable to empty their bladder or holds urine, this test may be required as a treatment and for evaluation.|
|Teach the patient self-catheterization as well as how to use and care for the indwelling catheter.||Aids the patient’s autonomy and promotes self-care. Depending on the patient’s ability and the severity of the urine condition, an indwelling catheter may be required.|
|Obtain urinalysis, urine culture, and sensitivity tests on a regular basis as directed.||This allows the monitoring of renal status. Over 100,000 colonies suggest the existence of an infection that requires treatment. Urinalysis is helpful in ruling out a UTI; however, it is insufficient to confirm a UTI without a urine culture. Asymptomatic UTIs should not be treated unless there is an acute return, according to experts.|
|As needed, administer anti-infective medications.||Bacteriostatic chemicals suppress bacterial growth and kill microorganisms that are sensitive. To avoid major sepsis/shock consequences, the infection must be treated quickly.|
Nursing Care Plan for Multiple Sclerosis 5
Nursing Diagnosis: Low Self-Esteem related to structure/function modification, disturbance in the patient’s perception of his or her own body, reversal of roles, and dependence secondary to multiple sclerosis as evidenced by confusion over one’s identity, purpose and life path, denial, retreat, rage, self-destructive/negative behavior, using ineffective coping strategies, and changes in one’s/others’ perceptions of their role/physical ability to resume it.
- The patient will express a realistic view of the body and acceptance of it as it is.
- The patient will see himself/herself as a capable individual.
- The patient will take part in and be responsible for satisfying his or her own needs.
- The patient will notice and incorporate changes in self-concept/role without compromising self-esteem.
- The patient will make realistic preparations for adjusting to new roles.
|Multiple Sclerosis Nursing Interventions||Rationale|
|Establish a therapeutic nurse-patient relationship and openly talk about the patient’s fears and concerns.||Conveys a compassionate attitude and fosters trust between the patient and the caregiver, allowing the patient to communicate worries of rejection, loss of former functioning and/or appearance, emotions of helplessness, and powerlessness over potential changes. Promotes the patient’s sense of well-being.|
|Take note of withdrawn habits, denial, or excessive concern about the body and disease process.||Initially, this may be a normal protective response, but if it persists, it may prevent you from dealing with reality correctly and lead to inadequate coping.|
|Encourage the employment of protective mechanisms, allowing the patient to process information at his or her own pace and in his or her own way.||Confronting the patient with the truth of the situation may increase anxiety and reduce the patient’s ability to cope with the new self-concept and role.|
|Recognize the reality of the grieving process when it comes to actual or perceived changes. Assist the patient in dealing truthfully with anger and despair.||The disease’s nature causes continuing losses and changes in all facets of life, preventing the grieving process from reaching its conclusion.|
|Review facts regarding the disease’s progression, remissions, and prognosis.||When a patient learns about the disease and realizes that his or her own actions (such as feeling hopeful and keeping a good attitude) can enhance general well-being and everyday functioning, the patient may feel more in charge, boosting self-esteem. Some people may never experience remission.|
|Provide accurate verbal and written information about what’s going on, and talk to the patient/SO about it.||Helps the patient stay in the “here and now,” reducing the anxiety of the unknown and providing a future reference source.|
|Explain that shaky feelings are common. Consider how to deal with these emotions.||Reduces anxiety and aids in the management of unexpected emotional outbursts.|
|Note the existence of depression, slowed mental processes, and suicidal ideation (rate on a scale of 1–10).||It’s difficult to adjust emotionally to a long-term, progressive debilitating incurable sickness. Furthermore, cognitive disability might make it difficult to adjust to life changes. Suicide may seem like the greatest method for a depressed person to cope with their situation.|
|Examine the patient’s interaction with the SO. Changes in the relationship should be noted.||SO may unintentionally or actively support the patient’s negative attitudes and beliefs, or secondary gain difficulties may obstruct improvement and ability to manage a situation.|
|Provide a safe space for the patient and SO to talk about their sexual problems, such as exhaustion, spasticity, arousal, and changes in sensation.||Physical and psychological changes frequently cause stress in relationships, changing normal roles and expectations and lowering self-esteem.|
|To improve sexual function, discuss the use of medicines and adjuncts.||The patient and partner may choose to try prescribed medicine that may improve their sexual relationship.|
|Ask the patient to consult with a rehabilitation team or an occupational therapist.||Identifying assistive devices and/or equipment improves general function and involvement in activities, as well as one’s sense of well-being and self-perception as a capable individual.|
|As needed, refer the patient to a psychiatric clinical nurse specialist, a social worker, or a psychologist.||Thorough, supportive counseling may aid in the resolution of issues and the adjustment to life changes.|
Nursing Care Plan for Multiple Sclerosis 6
Nursing Diagnosis: Self-Care Deficit related to motor impairment, tremors, neuromuscular/perceptual impairment, intolerance to exertion, diminished strength and endurance, pain, discomfort and exhaustion, memory problems, and depression secondary to multiple sclerosis as evidenced by frustration, inability to execute self-care activities, and poor personal hygiene.
- The patient will identify individual aspects of weakness/needs.
- The patient will exhibit self-care practices and lifestyle improvements.
- The patient will execute self-care activities to the best of his or her abilities.
- The patient will discover personal and community resources that can help.
|Multiple Sclerosis Nursing Interventions||Rationale|
|Determine the patient’s current level of activity and physical fitness. On a scale of 0–4, rate the patient’s degree of functional impairment.||Provides information for developing a recovery strategy. Motor symptoms have a lower chance of improving than sensory problems.|
|Encourage the patient to perform self-care to the best of his or her abilities. Be patient with the patient.||Reduces feelings of helplessness and promotes independence and control.|
|Allow as much autonomy as possible while assisting according to the degree of handicap.||Participating in self-care can help people cope with their loss of independence.|
|Encourage patients to participate in the planning process.||When desires and preferences are considered in daily activities, the patient’s quality of life improves.|
|Observe any presence of fatigue and weariness.||Fatigue in MS sufferers can be extremely debilitating, limiting their capacity to do daily activities. Because of the subjective nature of fatigue reports, healthcare providers and family members may misinterpret them, resulting in conflict and the assumption that the patient is “manipulative” when this is not the case.|
|Encourage the patient to schedule activities early in the day or when they have the most energy.||Patients with MS consume a lot of energy to execute ADLs, which increases the risk of fatigue, which can last all day.|
|Allow enough time to complete chores and be patient when things move slowly.||Reduced motor skills and spasticity can make it difficult to manage even simple tasks.|
|Anticipate sanitary needs and provide calm assistance as needed with nail, skin, and hair care; mouth care; shaving.||The caregiver’s example might develop a tone of acceptance for dealing with daily requirements that may be embarrassing to the patient and repulsive to the SO.|
|As needed, provide assistive gadgets and assistance, such as a shower chair and an elevated toilet seat with armrests.||Reduces weariness and increases self-care participation.|
|When the patient is motionless, reposition the patient frequently (bed or chair bound). Pressure points such as the sacrum, ankles, and elbows require special attention. As tolerated, position yourself properly and encourage you to sleep prone.||Prevents skin damage by reducing strain on vulnerable regions. Flexor spasms in the knees and hips are reduced.|
|On a regular basis, give massage and active or passive ROM exercises. As needed, encourage the use of splints or footboards.||Prevents difficulties caused by muscular dysfunction and inactivity. Maintains muscle tone, strength, and joint mobility while lowering the danger of calcium loss from bones.|
|Encourage stretching and toning exercises, as well as the use of medications, cold packs, and splints, when needed, and good body alignment.||Reduces spasticity and its symptoms.|
|Solve problems to meet nutritional and fluid requirements.||Increases the patient’s sentiments of independence or self-esteem by ensuring proper intake.|
|Seek the advice of a physical or occupational therapist.||Useful for discovering products and/or equipment that ease spastic muscles, improve motor performance, prevent and lessen muscular atrophy and contractures, and promote independence and self-worth.|
|Administer medications as indicated.||At the spinal nerve root level, newer medications are utilized to reduce stiffness, promote muscular relaxation, inhibit reflexes, improve mobility, and promote activity maintenance. Spasticity is treated with a variety of medications. The mechanisms are unknown, and reactions differ from person to person. As a result, finding the best effective treatment for muscle spasticity and related pain may need a period of pharmacological trials. Increased muscle weakness, loss of muscle tone, and liver toxicity are possible side effects.|
More Multiple Sclerosis Nursing Diagnosis
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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