Nursing Care Plan for Multiple sclerosis (MS): Nursing Priorities & Discharge Goals; Nursing Diagnosis and Nursing Intervention with Rationale.

Nursing Care Plan for Multiple sclerosis (MS): Overview

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Nursing Care Plan for Multiple sclerosis

Multiple Sclerosis

Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults. It is a chronic disorder in which irregular demyelination of the CNS (brain and spinal cord) results in emotional changes and varying degree of cognitive, motor, and sensory dysfunction at the central and peripheral level. It is a perivascular inflammatory response, possibly to chronic viral infection in genetically susceptible individuals, producing a limited disruption in the blood-brain barrier, allowing [beta]-lymphocyte clones to colonize the CNS.

Research suggests that in addition to destruction of myelin sheaths (which facilitate the movement of nerve impulses), some underlying nerve fibers are also damaged or severed, which may account for the permanent neurological impairment.

Multiple sclerosis MS is grouped into the following four types:

  1. Relapsing-remitting: Periods of neurological dysfunction followed by partial or full recovery.
  2. Primary-progressive: Steady decline with periods of minimal recovery (fairly uncommon).
  3. Secondary-progressive: Initial pattern of relapse and recovery, which becomes steadily progressive over time.
  4. Progressive-relapsing: Progressive from onset with clear exacerbations (rare).

Nursing Care Plan for Multiple sclerosis (MS)

Nursing Care Plan for Multiple sclerosis (MS): Nursing Priorities & Discharge Goals

NURSING PRIORITIES

  1. Maintain optimal functioning.
  2. Assist with/provide for maintenance of ADLs.
  3. Support acceptance of changes in body image/self-esteem and role performance.
  4. Provide information about disease process/prognosis, therapeutic needs, and available resources

DISCHARGE GOALS

  1. Remain active within limits of individual situation.
  2. ADLs are managed by patient/caregivers.
  3. Changes in self-concept as acknowledged and being dealt with.
  4. Disease process/prognosis, therapeutic regimen are understood and resources identified.
  5. Plan in place to meet needs after discharge.

Nursing Care Plan for Multiple sclerosis (MS): Nursing Diagnosis

Nursing Diagnosis of Multiple Sclerosis (Ms)

  • Fatigue May be related to Decreased energy production, increased energy requirements to perform activities; Psychological/emotional demands; Pain/discomfort; Medication side effects.

Nursing Care Plan for Multiple sclerosis (MS): Nursing Intervention & Rationale

Nursing Interventions of Multiple Sclerosis (MS) With Rationale

Energy Management (NIC)

Nursing Interventions of Multiple Sclerosis: Independent

  1. Note and accept presence of fatigue. Rationale: The most persistent and common symptom of MS. Studies indicate that the fatigue encountered by patients with MS occurs with 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/review factors affecting ability to be active, e.g., temperature extremes, inadequate food intake, insomnia, use of medications, time of day. Rationale: Provides opportunity to problem-solve to maintain/improve mobility.
  3. Accept when patient is unable to do activities. Rationale: Ability can vary from moment to moment. Nonjudgmental acceptance of patient’s evaluation of day-to-day variations in capabilities provides opportunity to promote independence while supporting fluctuations in level of required care.
  4. Determine need for walking aids, e.g., Canadian canes, braces, walker, wheelchair, scooter; review safety considerations. Rationale: Mobility aids can decrease fatigue, enhancing independence and comfort, as well as safety. However, individual may display poor judgment about ability to safely engage in activity.
  5. Schedule ADLs in the morning if appropriate. Investigate use of cooling vest. Rationale: Fatigue commonly worsens in late afternoon (when body temperature rises). Some patients report lessening of fatigue with stabilization of body temperature.
  6. Plan care consistent rest periods between activities. Encourage afternoon nap. Rationale: Reduces fatigue, aggravation of muscle weakness.
  7. Stress need for stopping exercise/activity just short of fatigue. Rationale: Pushing self beyond individual physical limits can result in excessive/prolonged fatigue and discouragement. In time, patient can become very adept at knowing limitations.
  8. Investigate appropriateness of obtaining a service dog. Rationale: Service dogs not only can increase patient’s level of independence (e.g., balance/mobility assistance), but can assist in energy conservation by carrying items in “saddle” bags, fetching/retrieving, and performing tasks (e.g., turning lights on/off).

Nursing Interventions of Multiple Sclerosis: Collaborative

  1. Recommend participation in groups involved in fitness/exercise and/or the Multiple Sclerosis Society. Rationale: Can help patient to stay motivated to remain active within the limits of the disability/condition. Group activities need to be selected carefully to meet patient’s need(s) and prevent discouragement or anxiety.
  2. Administer medications as indicated, e.g.:
  • Amantadine (Symmetrel); pemoline (Cylert); Rationale: Useful in treatment of fatigue. Positive antiviral drug effect in 30%–50% of patients. Use may be limited by side effects of increased spasticity, insomnia, paresthesias of  hands/feet
  • Methylphenidate (Ritalin), modafinil (Provigil); Rationale: CNS stimulants that may reduce fatigue but may also cause side effects of nervousness, restlessness, and insomnia.
  • Sertraline (Zoloft), fluoxetine (Prozac); Rationale: Antidepressants useful in lifting mood, and “energizing” patient (especially when depression is a factor) and when patient is free of anticholinergic side effects.
  • Tricyclic antidepressants, e.g., amitriptyline (Elavil), nortriptyline (Pamelor); Rationale: Useful in treating emotional lability, neurogenic pain, and associated sleep disorders to enhance willingness to be more active.
  • Anticonvulsants, e.g., carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal); Rationale: Used to treat neurogenic pain and sudden intermittent spasms related to spinal cord irritation
  • Steroids, e.g., prednisone (Deltason), dexamethasone(Decadron), methylprednisolone (Solu-Medrol). Rationale: May be used during acute exacerbations to reduce/prevent edema formation at the sclerotic plaques; however, long-term therapy seems to have little effect on progression of symptoms.
  • Vitamin B. Rationale: Supports nerve-cell replication, enhances metabolic functions, and may increase sense of well-being/energy level (although reports are more anecdotal than research based).
  • Prepare for plasma exchange treatment as indicated. Rationale: Research suggests that individuals experiencing severe exacerbations not responding to standard therapy may benefit from a course of plasma exchange.

Nursing Care Plan for Multiple Sclerosis: Overview; Nursing Care Plan for Multiple Sclerosis: Nursing Priorities & Discharge Goals; Nursing Care Plan for Multiple Sclerosis: Nursing Diagnosis; Nursing Care Plan for Multiple Sclerosis: Nursing Intervention with Rationale.

Nursing Care Plan for Multiple Sclerosis

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