This study guide is about multiple sclerosis (MS), diagnosis of multiple sclerosis (MS), treatment for multiple sclerosis MS, and 4 nursing care plan examples for multiple sclerosis (MS). Use it to create educational nursing care plans for multiple sclerosis.
Multiple Sclerosis (MS)
What is multiple sclerosis (MS)?
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 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.
What are the 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
What are the 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
What will happen if Multiple Sclerosis (MS) is left untreated?
- Muscle spasms
- Problems related to bladder, bowel, and sexual functions
- Mental changes
Diagnosis of Multiple Sclerosis (MS)
How do you diagnose Multiple Sclerosis?
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
What treatment options are available for a patient suffering from Multiple Sclerosis?
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.
4 Nursing Care Plan Examples for Multiple Sclerosis (MS)
What are some of the available nursing care plans for multiple sclerosis?
Nursing Care Plan 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.
|Assess the patient’s level of functional mobility and ability to perform ADLs.||To assist in creating an accurate diagnosis and monitor the 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 phones and eyeglasses are easy to reach.||To maintain patient safety and reduce the risk of falls.|
|Encourage the patient to perform a 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 specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.|
Nursing Care Plan 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 an increase in activity levels.
|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 the physiotherapy/occupational therapy team as required.||To provide 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 3
Nursing Diagnosis: Disturbed Sensory Perception (Visual) related to visual impairment secondary to multiple sclerosis as evidenced by the 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.
|Assess the vision ability of the patient using an eye chart.||To establish a baseline assessment in terms of visual 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 aids.||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 with 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 4
May be related to
- Illness-related regimen, the unpredictability of the disease
- Lifestyle of helplessness
Possibly evidenced by
- Verbal expressions of having no control or influence over a situation
- Depression over physical deterioration that occurs despite patient compliance with regimen
- Nonparticipation in care or decision making when opportunities are provided
- Passivity, decreased verbalization/effect
- Verbal cues
- Lack of involvement in care/passively allowing care
- Isolating behaviors/social withdrawal
- Patient will identify and verbalize feelings.
- Patient will make use of coping mechanisms to counteract feelings of hopelessness.
- Patient will identify areas over which the individual has control.
- Patient will participate/monitor and control own self-care and ADLs within limits of the individual situation.
|Note behaviors indicative of powerlessness or hopelessness. The patient may say statements of despair.||The degree to which the patient believes their own situation is hopeless, that he or she is powerless to change what is happening, affects how the patient handles life situations.|
|Acknowledge the reality of the situation, at the same time expressing hope for the patient.||Although the prognosis may be discouraging, remissions may occur, and because the future cannot be predicted, hope for some quality of life should be encouraged. Additionally, research is ongoing and new treatment options are being initiated.|
|Encourage and assist the patient to identify activities he or she would like to be involved in within the limits of his or her abilities.||Staying active and interacting with others counteract feelings of helplessness.|
|Discuss plans for the future. Suggest visiting alternative care facilities, taking a look at the possibilities for care as condition changes.||When options are considered and plans are made for any eventuality, the patient has a sense of control over own circumstances.|
|Determine the degree of mastery the patient has exhibited in life to the present. Note locus of control.||A patient who has assumed responsibility in life previously tends to do the same during difficult times of exacerbation of illness. However, if the locus of control has been focused outward, the patient may blame others and not take control over their own circumstances.|
|Assist patients to identify factors that are under their own control. List things that can or cannot be controlled.||Knowing and accepting what is beyond individual control can reduce helpless or acting out behaviors, promote focusing on areas individuals can control.|
|Encourage the patient to assume control over as much of their own care as possible.||Even when unable to do much physical care, an individual can help plan care, having a voice in what is desired or not.|
|Discuss needs openly with patient/SO, setting up agreed-on routines for meeting identified needs.||Helps deal with manipulative behavior, when the patient feels powerless and not listened to.|
|Incorporate patient’s daily routine into home care schedule or hospital stay, as possible.||Maintains a sense of control and self-determination and independence.|
|Refer to vocational rehabilitation as indicated.||Can assist the patient to develop and implement a vocational plan incorporating specific interests and/or abilities.|
|Identify community resources.||Participation in structured activities can reduce a sense of isolation and may enhance the feeling of self-worth.|
Other possible nursing diagnoses:
- Impaired Verbal Communication
- Impaired Elimination
- Risk for Self-care Deficit
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.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.