Nursing Care Plan (NCP) for Multiple Sclerosis (MS)

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Outline

Pathophysiology

Chronic, progressive demyelination of the neurons in the CNS. This leads to spastic and slow nerve impulses. This impairs movement and sensation and can cause issues with bowels, bladder, and vision.  MS comes in cycles of remission and exacerbation.

Etiology

The cause of MS is unknown, though suspected to have a genetic component. It primarily is diagnosed between the ages of 20-40 years old.

Desired Outcome

Optimize patients’ level of functioning while managing symptoms such as pain, incontinence, and difficulty swallowing.

Multiple Sclerosis (MS) Nursing Care Plan

Subjective Data:

  • Fatigue
  • Weakness
  • Pain
  • Numbness
  • Visual Disturbances
  • Mood swings

Objective Data:

  • Tremors
    • Bowel dysfunction
    • Constipation
  • Diarrhea
  • Bladder incontinence
  • Decreased peripheral sensation

Nursing Interventions and Rationales

  • Administer medications as ordered:
    • Analgesics
    • Muscle Relaxants

 

Therapeutic management is mostly supportive. Analgesics can help with the aching joints, while muscle relaxants can calm some of the tremors and spastic muscles. Gabapentin is especially helpful.

 

  • Encourage activity independence

 

As the disease progresses, patients will lose their independence. Encourage them to stay active as long as possible to keep up their strength.

 

  • Educate patient on energy conservation techniques

 

Patients get fatigued easily, teach them to cluster their activities and provide frequent rest periods to conserve their energy for important tasks.

 

  • Educate patient on bowel and bladder training

 

Bowel and bladder training includes planning to go to the bathroom at specific intervals. This helps to minimize and avoid incontinence episodes.

 

  • Ensure patient maintains adequate fluid intake of at least 2000 mL/day.

 

Due to incontinence and weakness, patients often choose not to drink much to try to avoid accidents. It’s very important that they get adequate fluid intake.

 

  • Check temperature on water and heating pads, educate patient to adjust max temperature on water heater at home.

 

Decreased sensation for pain and temperatures means that MS patients are at risk for burns because they can’t feel how hot the water is. Turning the max temperature down can help to prevent this from happening.

 

  • Ensure safety from falls in the home (move rugs, cords, etc.)

 

Decreased sensation peripherally combined with weakness means that the patient’s response time will be diminished and their ability to catch themselves from falling is poor.

Writing a Nursing Care Plan (NCP) for Multiple Sclerosis (MS)

A Nursing Care Plan (NCP) for Multiple Sclerosis (MS) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for multiple sclerosis. Let’s take a look. Multiple sclerosis is a chronic progressive the demyelination of the neurons in the central nervous system. This leads to spastic and slow nerve impulses. This impairs movement and sensation and can cause issues with bowels, bladder and vision. MS comes in cycles of remission and exacerbation. Some nursing considerations we want to think of. The first thing we want to do with these patients is we want to optimize their energy levels. We want to provide frequent rest periods, optimize their mobility, and functional ability. We want to promote comfort and address elimination needs. Also there’s some pain management we want to do. The desired outcome for these patients is that these patients are going to optimize their level of functioning while managing symptoms such as pain and incontinence and difficulty swallowing. So, MS. Multiple sclerosis, the patient is going to come in to see you. They’re going to give us some subjective data that’s going to help us take care of them. Some things that they’re going to say, are they’re going to be tired. So, they’re going to say they are fatigued. Okay. They’re going to complain of some weakness, pain, numbness. Remember, this is a neurological disorder. So they’re also going to complain of some, uh, visual disturbances and some mood swings. 

Okay. Some of the things that we’re going to notice as nurses taking care of these patients, we’re going to be able to see it with our assessment. The objective data we’re going to collect is that we’re going to see tremors. They’re going to shake. They’re going to have some bowel and bladder dysfunction and incontinence. They’re going to have some constipation or diarrhea. And also, there’s going to be some decreased peripheral sensation. Remember, this is the neural that is being affected. So because of the, uh, the neurons that are being demyelinated, those impulses are going to be slower. So, what are some things that we can do when we’re taking care of this patient? Well, the first intervention I think we should do is let’s take care of that pain. So, we’re going to go ahead and do a good pain assessment. So, let’s do that. That’s assessing their pain. 

Um, this is a pain assessment. Let’s do a pain assessment and we are going to administer analgesics and we are going to administer muscle relaxants. Okay. The analgesic is going to help with the aching joints and muscle relaxants are going to calm some of those tremors and spastic muscle. Um, one of the medications that they tend to order, uh, for this is Gabapentin,  Okay? The next thing we want to educate the patient on is bowel and bladder training. Because these patients often experience times of incontinence, Uh, we want to make sure that they have bowel and bladder training, and that includes planning to go to the bathroom at specific times and at specific intervals. It also is going to help minimize and avoid any type incontinent episodes. So, that is bowel and bladder training. Very important. The next thing is we are going to check the temperature on the water and heating pads. 

We’re going to educate the patient to adjust max temperatures on water heaters at home. Okay? So, this is the thing these patients have. And let’s talk about this, these patients have decreased sensory, usually, um, peripheral, but they’re feeling, and their sense of touch is decreased because of that demyelination of those neurons. So, because the MS is affecting them that way, they are at risk for burns, and that water can get really hot at home. And oftentimes, they will not be able to know that the water is burning them. Turning the max temperature down can help prevent this from happening. So, let’s do that. They are a risk for burns. Decrease H2o. That’s very important. And another thing we want to do is we want to educate the patient on energy conservation techniques. You don’t have to remember. These patients are constantly in a state of fatigue and weakness. So, because they get fatigued so easily, because these patients are easy to tire and easy to fatigue, we want them to cluster their activities. We’ve got to teach them to cluster their activities and make sure that they give themselves plenty of rest periods, so that they conserve their energy for important tasks. So let’s say that, let’s say cluster activities, conserve strength, okay. Here’s the completed care plan. Now let’s take a look at the key points. With the pathophysiology, we’ve talked about this, uh, MS is a chronic progressive demyelination of the neurons in the central nervous system. This leads to spastic and slow nerve impulses. Some of the things that the patient is going to tell us when they are coming in to see us is they’re going to complain of fatigue, weakness, pain, numbness, and mood swings. 

Some things that we’ll be able to notice when we do our objective data is we are going to notice that they have some bowel dysfunction. They’re going to have some, um, bladder incontinence. They’re going to have some tremors, constipation, or diarrhea. What are we going to do for these patients? Where the first thing we’re going to do is we’re going to manage that pain. We’re going to make sure that we are taking care of that pain because they are in pain. We are going to give analgesics for those aching joints, muscle relaxants for those tremors and those spastic movements. Remember Gabapentin is the preferred for the spastic movement and tremors. We’re also going to do some blowout, bowel and bladder training. That is a tongue twister. We’re going to do bowel and bladder training, and we’re going to help minimize and avoid incontinent episodes. We love you guys. Go out and be your best self today. And as always, happy nursing.

 

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