Multiple sclerosis (MS) is a chronic, progressive, degenerative disease of the central nervous system. It is characterized by disseminated demyelination of the nerve fibers of the spinal cord and brain.
The age of onset is often between 20 to 40 years of age. This condition affects women more than men, and caucasian people more than any other race.
There are several types of Multiple Sclerosis:
Relapsing-remitting MS (RRMS): The most common form of MS is characterized by flares or relapses and periods of remission where symptoms may disappear.
Secondary progressive MS (SPMS): This often occurs after an initial diagnosis of RRMS, where the disease progressively worsens.
Primary progressive MS (PPMS): 15% of patients may receive this diagnosis which is a steady worsening of neurological function without any periods of remission.
The cause of MS is unknown. However, possible precipitating factors of this condition include a family history of MS, a history of viral infections like Epstein-Barr, smoking, other autoimmune diseases, and low levels of vitamin D.
Clinical manifestations of MS often exhibit slowly and gradually, with symptoms occurring periodically over several months or years. Since the symptoms are vague in most cases, patients with MS often do not seek treatment until later in the disease process. Other patients, however, experience MS with rapid and progressive deterioration in neurologic function. MS symptoms can vary with each patient and may include any of the following:
- Vision changes
- Extremity muscle weakness
- Poor balance and coordination
- Partial or complete paralysis of the extremities
- Speech impairments
- Hearing loss
- Dizziness
- Tremors
- Severe disabling fatigue
- Sexual, urinary, or bowel dysfunction
There is no definitive diagnostic test for MS, and testing is often used to rule out other possibilities. An MRI will help visualize the plaques, atrophy, inflammation, and tissue breakdown of the brain and spinal cord.
To confirm the diagnosis of MS, the patient must have at least 2 inflammatory demyelinating lesions in different parts of the CNS, an attack occurring at different times, and all other possible diagnoses ruled out.
Nursing Process
There is no established cure for MS at this time. Its treatment is aimed at managing the disease and providing symptomatic relief. Nurses play a vital role in the treatment regimen of patients with MS as they provide interventions that can shorten flares and relieve neurologic deficits. They encourage MS patients to stay active, avoid fatigue, and use stress reduction techniques to help boost their immune system and live a normal lifestyle.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for multiple sclerosis, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for multiple sclerosis.
Impaired Physical Mobility
Impaired mobility is one of the most common and disruptive effects of MS. It can affect the patient’s independence and quality of life. Other symptoms of MS that interfere with mobility include spasticity, dizziness, fatigue, vertigo, pain, and numbness.
Related to:
- Disease process
- Fatigue
- Neuromuscular impairment
- Pain
As evidenced by:
- Altered gait
- Decreased fine motor skills
- Decreased gross motor skills
- Decreased range of motion
- Difficulty turning
- Movement-induced tremor
- Postural instability
- Slowed movement
- Spastic movement
- Uncoordinated movement
Expected outcomes:
- The patient will verbalize increased strength and demonstrate an increased ability to move
- The patient will utilize mobility aids to improve physical mobility and ambulation
Assessment:
1. Assess the extent of physical mobility impairment.
Assessment of mobility impairment, functional difficulties, and self-care deficits can help ensure client safety and plan appropriate rehabilitation interventions.
2. Assess the causative factors of mobility impairment.
Mobility impairment may have a physiologic cause that psychological and motivational factors can also aggravate. Some patients are less active because of fear of falling or pain.
Interventions:
1. Encourage the use of mobility aids as needed.
Mobility aids like walkers and wheelchairs can help decrease fatigue and enhance comfort, safety, and independence. Overhead trapeze bars, slide boards, and braces can support mobility.
2. Perform passive range of motion exercises.
Range of motion exercises can help strengthen muscles and bones to improve mobility.
3. Encourage exercise.
Patients with MS often struggle with fatigue, but exercise is shown to improve symptoms. Patients should participate in moderate aerobic exercise while staying cool and hydrated.
4. Administer medications as ordered.
Baclofen can help relieve muscle spasms and rigidity in patients diagnosed with multiple sclerosis.
5. Refer the patient to a PT/OT.
Patients with MS can have problems with functional abilities like vision, coordination, movement, and sensations. An occupational or physical therapist can help assess the patient’s functional abilities and formulate an appropriate plan of care.
Powerlessness
Multiple sclerosis steals from a person’s independence, and since there is currently no cure, a sense of powerlessness can develop.
Related to:
- Progressive nature of the disease
- Anxiety
- Depression
- Debility
- Inadequate motivation to improve one’s situation
- Inadequate social support
- Ineffective coping strategies
- Low self-esteem
- The perceived complexity of the treatment regimen
As evidenced by:
- Depressive symptoms
- Expresses doubt about role performance
- Expresses frustration about the inability to perform previous activities
- Expresses a lack of purpose in life
- Expresses shame
- Withdrawal
- Loss of independence
- Reports an inadequate sense of control
Expected outcomes:
- The patient will acknowledge feelings of powerlessness and actively participate in the planning and implementation of care
- The patient will verbalize areas in which they do/do not have control
Assessment:
1. Assess factors that contribute to feelings of powerlessness.
Identifying factors that make the patient feel powerless can help plan interventions to channel patient behavior effectively.
2. Assess the patient’s sense of control over their current situation.
Powerlessness is often associated with feelings of loss of control over the current medical situation. Note if there have been other changes in roles, their career, environment, social relationships, etc.
Interventions:
1. Encourage the patient to express feelings and thoughts about their condition.
The patient’s perceived barriers and susceptibility to the disease can affect the patient’s motivation to take action to participate in the treatment regimen, self-care management, and complication prevention.
2. Assist the patient in planning and identifying health goals.
Patients with MS often lose their sense of control over their health. Allowing them to plan their care can motivate them and promote a sense of control over their situation.
3. Acknowledge the reality of the patient’s health condition while expressing hope.
Even though the prognosis of MS can be discouraging, new treatments and technological advancements are occurring. Providing hope can help patients feel motivated.
4. Refer the patient to support groups.
Support and community groups can empathize with the patient in dealing with an uncommon and progressive disease.
Self-Care Deficit (Feeding)
Multiple sclerosis is a progressive condition and can cause self-care deficits as functional abilities deteriorate over time.
Related to:
- Neuromuscular impairment
- Decreased strength
- Impaired physical mobility
- Fatigue
- Depression
- Memory Loss
As evidenced by:
- Tremor
- Muscle spasms
- Difficulty feeding self
- Difficulty swallowing food
- Difficulty using assistive devices
- Difficulty preparing and handling food
Expected outcomes:
- The patient will be able to feed themselves safely and effectively
- The patient will demonstrate using assistive feeding devices
Assessment:
1. Assess the degree of functional impairment that is causing a self-care deficit.
Multiple sclerosis is a progressive condition and can cause varying degrees of impairment.
2. Observe the patient feeding self/swallowing.
Establishing a baseline of the patient’s current abilities can help develop an appropriate plan of care for rehabilitation.
Interventions:
1. Encourage the patient to perform self-care as capable.
This will help promote independence and a sense of control while promoting strength and endurance.
2. Assist the patient in feeding and other self-care needs.
If unsafe to perform tasks, the nurse or other staff can assist the patient in feeding.
3. Provide small frequent meals with plenty of time.
Multiple sclerosis may affect swallowing later in the disease, and fatigue can occur with chewing. Smaller meals may be easier, and allowing plenty of time without rushing will lessen the risk of choking or aspiration.
4. Implement weighted utensils.
Weighted utensils can help with hand tremors or muscle spasticity.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Multiple sclerosis. Mayo Clinic. Reviewed: January 7, 2022. From: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
- Overview: Multiple sclerosis. NHS. Reviewed: March 22. 2022. From: https://www.nhs.uk/conditions/multiple-sclerosis/
- What is MS? National Multiple Sclerosis Society. 2022. From: https://www.nationalmssociety.org/What-is-MS
